Neurologist addresses disrupted sleep patterns

By Janette Neuwahl Tannen

Neurologist addresses disrupted sleep patterns

By Janette Neuwahl Tannen
University of Miami sleep expert Dr. Salim Dib explains the reasons behind our collective issues and offers tips on things we can do to improve our slumber.

Lately, if you find yourself tossing and turning more or waking up from some disturbing dreams, you are not alone.

A growing number of people are reporting worsening sleep difficulty in the wake of the coronavirus outbreak. And, the sleep medicine department at the University of Miami has been fielding calls from existing patients and new ones who are struggling to get some shut eye during the COVID-19 quarantine, said Dr. Salim Dib, a neurologist in the Sleep Center at the Miller School of Medicine.

Dr. Dib
Dr. Dib

“With the current crisis and its confinement, a lot of us are at risk of being sleep deprived because we lose a lot of the daily routines and structure we used to have,” Dib said. “Also, the added stress we are under—from the news, to possibly losing our jobs, as well as having to deal with home obligations, children, and school—is astronomical, and that alone can affect our sleep timing, duration, and quality.”

Stress is a major hindrance to sleep because it triggers humans’ fight or flight reaction, Dib said. This in turn increases our body’s levels of adrenaline to help us cope and to protect us, but it can also make sleep more elusive. 

“That’s what is affecting everyone right now,” he added. “Sleep is a lot worse than it used to be.”

Still, sleep is incredibly important to our health and well-being. It affects our blood pressure and organ systems, our mood, our cognitive function, and performance, as well as our physical performance and abilities, Dib said. In addition, it impacts  our immune system.

“Our ability to defend ourselves from a virus is impaired and our risk for infection can significantly increase if we are not getting enough sleep,” Dib pointed out.

There is plenty of research to support this. In a 2002 influenza study published in the Journal of the American Medical Association, Dib said sleep-deprived patients were unable to mount the same antibody response to the influenza vaccine when compared to patients who were able to get seven hours of sleep. Also, in a 2009 study, investigators quarantined 153 healthy adults and exposed them to a common cold. Those who had gotten less than seven hours of sleep were three times more likely to develop a cold compared to those with eight hours or more of sleep.

So how much sleep should we be getting? Dib said that on average, most adults should be getting from seven to nine hours of sleep. He recommended a minimum of 7 to 7.5 hours of sleep. For children, the average varies by age, so Dib suggested consulting the National Sleep Foundation standards.

It is also important to go to bed and wake up around the same time each day to maintain a regular sleep-wake schedule.

“Recent studies have showed that an irregular sleep schedule can increase your risk for heart disease,” Dib noted.

To get the most out of a night’s rest, people need to be able to cycle through the various stages of sleep. These include “slow wave sleep,” when brain activity slows down and metabolic function is reduced. During this stage, nervous system restoration and memory consolidation occur, and the brain essentially clears itself of waste products. According to Dib, slow wave sleep is also essential for regulating hormones, tissue repair, and re-priming the immune system. Whereas, the rapid eye movement stage of sleep, or “REM” sleep—which happens about every 90 to 120 minutes—is important for processing emotions, reducing stress, and learning. That’s when we have our most vivid dreams.

“We do a lot of emotional processing and we sort through information during REM, which can influence the content of our dreams,” Dib said. “In fact, any internal or external stressor can affect our dream content and contribute to unpleasant vivid dreams at times.”

Although several stressors are clearly affecting us now, there are many things that people can do to improve their own sleep, as well as their children’s, Dib added.

Dib suggested that first, we need to create a sleep-conducive bedtime routine. This should include unwinding in the evening and doing something relaxing in the hour or two before bedtime—such as meditating, reading, taking a walk, or doing a puzzle or artwork. Taking a warm bath is also a good idea to relax the body and help it transition into sleep. 

Next, Dib said, ensure that your bedroom is a haven for sleep. Make sure it is dark, quiet, cool (ideally 60 to 67 degrees) and comfortable. Also, try not to bring work into your bedroom, and try not to use your electronics in bed (including computer, phone, or tablet). Dedicate time in the early evening to do problem solving and planning, away from the bedroom, and write down anything you need to remember for the next day before going into your room for the night.

“Stress reduction is crucial before getting into bed,” he pointed out. “Avoid stressful activities like watching the news and avoid bright light exposure in bed.”

Other things to avoid before bedtime:

  • Don’t drink alcohol within four hours of bedtime or caffeine in the late afternoon (after 2 p.m.).

While people often drink alcohol to calm down, and some even have a nightcap, Dib said it can result in significant sleep disruption and may contribute to unpleasant dreams.

  • Avoid strenuous exercise.

Dib said that physical activity is of utmost importance; but ideally, high intensity exercise should be done in the first half of the day. Along with exposure to bright light in the morning, this can help reset our internal clocks. He recommended 30 minutes of moderate intensity exercise per day, or at least three times a week. This can include aerobic activity, including brisk walks and/or swimming and light weightlifting.

“When we overdo it at night, we become more alert and our core body temperature rises, which makes falling asleep more difficult. We need to be able to lower our core body temperature to fall asleep,” he said.

  • Stay away from eating heavy or spicy foods at night.

Try to eat healthfully and avoid heavy or spicy foods, as well as excessive fluids, in the evening, Dib said. It will help you avoid discomfort and reflux, as well as excessive trips to the toilet, which will disrupt your sleep.