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MedicalIamA board certified sleep physician and neurologist, here to answer all your questions about sleep. AMA!

Aug 30th 2017 by SleepDocWatson • 39 Questions • 118 Points

Dr. Nate Watson here. I am a sleep specialist, past president of the American Academy of Sleep Medicine (AASM), professor of neurology at the University of Washington and co-director of the University of Washington Medicine Sleep Center. Recently, the AASM launched an online calculator to help you find your customized ideal bedtime and improve sleep habits. I am here to help you sleep better to improve your life! (This is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.)

Proof: https://ibb.co/kL1smk, http://bit.ly/2wlnwPt, http://www.aasmnet.org/articles.aspx?id=4339

Link to online sleep calculator: http://www.sleepeducation.org/healthysleep/Make-Time-2-Sleep-Bedtime-Calculator

EDIT: Hi everyone - I have to sign off now, but thanks so much for all your excellent questions. I will do my best to answer some of them later. In the meantime, make sure you check out www.sleepeducation.org for numerous helpful resources.

Q:

Why is that when I'm home I have to be laying down & comfortable to fall asleep & sometimes it still takes a while, but at work I can fall asleep sitting up in a chair with background noise all around? Lack of sleep at night isn't an issue

A:

Sleeping better outside of your typical home environment may indicate a problem with your home sleep environment. Check out this page for a lot of info that may help: http://www.sleepeducation.org/healthysleep/Make-Time-2-Sleep-Bedtime-Calculator


Q:

Hello Dr. Nate Watson, my wife and I feel like we needed something like this and I woke up early on Australia's east coast to participate, thank you.
Our two year old has always had difficulty sleeping, and has not once slept the whole night. We were able to have intensive sleep training through Tresillian at 1 year, and reduce his wake ups to twice or once per night. Since his sibling was born 10 weeks ago, however, the situation has deteriorated and he is waking five or six times a night, bellowing for his mother and he will not self-soothe or settle on his own. Between breast-feeding our infant and tending to our toddler, we are both having to get up at least four to five times a night each.
Possibly relevant: I am a rotating shift worker (4 on, 4 off) and my wife takes the children to her parent's house when I am working my shifts. My mother-in-law has always coddled my toddler to sleep. He also receives constant stimulation (large Italian family with other babies, television always on, very long dinner periods, etc).
My wife is insistent on sleep training, but we don't have enough consistency in our own lives to create a daily routine.
Our infant also shows signs of needing significantly less sleep than would be typical, and we're concerned that we may go slightly mad during these formative years. Would you have any cursory advice for us please?

A:

Talk to your doctor about any lingering sleep problems, but also try developing a relaxing, consistent bedtime routine for everyone. Allow at least 30 minutes to wind down after a busy day or stimulation. A bedtime routine also helps get your family ready to fall asleep. Here are some options to consider: Tips for Parents of Infants -Give your baby a warm bath. -Follow the bath with a gentle massage. -Briefly cuddle or sing a lullaby. -Turn the lights out at bedtime. Tips for young children -Shut off all electronic devices 1 hour before bedtime. -Take a warm bath and brush teeth. -Read a book or sing a song. -Turn the lights out at bedtime http://sleepeducation.org/news/2017/08/14/make-time-2-sleep-with-online-bedtime-calculator


Q:

I have had issues falling asleep since i was 6. My brain wont quiet down. I am constantly thinking about something. Any tips?

A:

I suggest that you start a worry journal in the evening, set aside 15 minutes before you go to bed - write down your negative thoughts and then close the book, allowing you to go to bed with those thoughts on the page, not in your head.


Q:

Why do we sleep?

A:

Much of that is yet to be determined. We do know that the spaces in the brain expand to allow clearing out of the days thoughts - like a garbage man for the brain.


Q:

Why are some humans more nocturnal and others more diurnal?

A:

Chronotype is the notion that some people are "morning larks" while others are "night owls". Much of this is genetically determined.


Q:

What can you do help an overtired 3 yr old that still needs to nap, but won't? "I'm not tired" When we finally get her to sleep at night she wakes up multiple times kicking and screaming angry. We've done all of the suggested routines, and trying quiet time.nothing seems to work. Any new suggestions would be GREATLY appreciated! Thank you! 

A:

Consistency is key - if you continue to do what you are doing, it should eventually pay dividends. You can slowly reduce the number of times you respond to the kicking and screaming until she eventually self-soothes and goes back to sleep. More tips to try here: http://www.sleepeducation.org/healthysleep/Make-Time-2-Sleep-Bedtime-Calculator


Q:

Do you think in the future we'll be able to sleep less hours but our brains will get the same amount of rest as they do now when we're told we should get at least 8 hours of sleep?

A:

We don't know what the future holds - at this point there is no substitute for sleep, though. As tech gets more advanced, there may be opportunities for implantable electronics to amplify the benefits of sleep - but that is purely speculative.


Q:

I can fall asleep alright but I have trouble staying asleep for more than an hour. I've tried sleeping on both sides, my back, and stomach but nothing held. Any advice?

A:

Everyone wakes up a handful of times each night - but it's a problem when you can't fall back asleep. Definitely do not look at the clock if you wake up during the night - leads to unproductive thinking.

Talk to your doctor about this sleep problem. He or she may refer you to a board-certified sleep medicine physician at an accredited sleep center for help. Effective treatment of sleep disease, like sleep apnea, improves quality of life by restoring healthy sleep, improving daytime alertness and concentration, increasing physical energy and reducing feelings of depression. Treatment may also decrease the risk for other serious medical problems such as high blood pressure and heart attack.


Q:

Why do so many people have similar experiences during sleep paralysis? I've personally dealt with it and there seems to be a trend of a "visitor" in the room with them or on top of them throughout those that have been affected by it. I'm not saying it's real or anything, I'm just interested in why our brain comes up with similar situations.

A:

Paralysis and dreamlike imagery are likely REM sleep-related phenomenon occurring during wakefulness.


Q:

Is it possible to mentally rest while still awake?

A:

Yes, but the regenerative aspects of sleep require the EEG of the brain to show characteristics of sleep. Naps can be very helpful, best if brier (around 10-15 min).


Q:

Hi Dr. Watson,

Oh So many questions but I will try and keep it to one (and thank you for doing this).

I have had issues with feeling rested as long as I can remember. I live PST but work CST so I am up every day by 5/530 am. I have tried going to be anywhere between 7 and 930 PM but it does not help. I switched to a light alarm clock, blackout curtains, bed upgrade all of which have helped a bit but I just cant seem to feel rested.

I recently got tested and diagnosed with moderate Sleep Apnea 18.5 (came here from /r/SleepApnea actually) and I have been doing CPAP therapy for a couple months now but still no improvement (other than sleeping through the night). My Fitbit does a ruff tracking and I never seem to get into deep sleep.

No matter what I try 530 just has me a zombie all day. If I sleep just a couple hours later I feel so much better (even if I goto bed that much later so it is the same hours of sleep). I am hoping you might have some tips to finally get me over this last threshold of poor sleep so I am waking up refreshed!

Do you have any tips or suggestions to help me get quality sleep that I havent already tried?

Thank you so much for your time!

A:

5:30 simply just might be too early for your personal circadian rhythm. It would benefit you to try to get additional sleep in one way or another. This might be a good start: http://www.sleepeducation.org/healthysleep/Make-Time-2-Sleep-Bedtime-Calculator


Q:

Are there any long term negative effects for people that work 24h shifts?

A:

That kind of work could impair your driving performance similar to being legally drunk. Insufficient sleep overall – due to inadequate or mistimed sleep – contributes to several health epidemics, including cardiovascular disease, diabetes and obesity. Simply missing one night of sleep can lead to decreased cognitive function, trouble concentrating, headaches and general moodiness. Sleep deficiency can lead to trouble making decisions, solving problems, controlling emotions and behavior, and coping with change – as well as distractions and mistakes.


Q:

Can sleep apnea really be improved with exercises to increase tone of throat muscles or is that hokum?

A:

There are studies that show that throat exercises - even playing the didgeridoo - can lead to modest improvements.


Q:

For me, when I sleep for 6 hours I feel refreshed and more energized than when I sleep 10 hours+. Any reasoning that, that could happen?

A:

Daytime alertness is a combination of adequate sleep and circadian factors. It's likely that circadian alerting factors are at play when you're feeling good on 6 hours, you still may be sleep deprived. While most adults need 7 or more hours of sleep each night, a small percentage of people function well on less sleep. If you feel refreshed when you wake up and remain alert throughout the day without needing to take a nap, then you may be getting enough sleep. But the problem is that we tend to be poor judges of our alertness level, and we underestimate how we are affected by insufficient sleep. In addition, there is a ton of data to support that not getting enough sleep puts you at greater risk for heart disease, high blood pressure, diabetes and more. Try sleeping 7+ hours for a week, and I think you’ll notice a more energetic, productive version of yourself that you didn’t know existed.


Q:

Any advice for someone who has trouble STAYING asleep? I'm a super light sleeper and feel like I wake up multiple times every sleep cycle. Earplugs have not helped.

A:

If you sleep in a noisy environment (earplugs), a white noise machine may be helpful. I'd also recommend talking to your doctor about any sleep problems.


Q:

Some of his responses have been saying that it's more important that you fall back asleep and how much you get overall.

A:

There is also some thought that white noise might replicate the sounds you heard in the womb - making it soothing for children and adults.


Q:

Hey doc, why is it that even when I sleep for a good 7 hours (non-disturbed, non-disruptive) sleep, I feel yawn-y in the morning?

A:

Adults need 7 or more hours, but each person is unique. You may need 9 hours a night to feel rested. Take 3 weeks and get 9 hours a night and see if you wake refreshed.


Q:

[deleted]

A:

Talk to the current residents, if they seem happy and rested you are good, if not, avoid.


Q:

Why is it easier to fall asleep in a chair like a recliner rather than lying down flat? And is it safe to have a normal sleep cycle of 4 hours every 2 days? I don't feel tired or sick, merely I just only sleep once every 2 days.

A:

When you are flat, gravity pulls your tongue base into your airway - sitting in a recliner doesn't encourage that much. You may be prone to sleep apnea due to this preference and you might want to see a doctor.

The bottom line is that very few people are able to succeed and be healthy on less than 7 hours of sleep per night. Insufficient sleep – due to inadequate or mistimed sleep – contributes to the risk for several of today’s public health epidemics, including cardiovascular disease, diabetes and obesity. Simply missing one night of sleep can lead to decreased cognitive function, trouble concentrating, headaches and general moodiness. Sleep deficiency can lead to trouble making decisions, solving problems, controlling emotions and behavior, and coping with change – as well as distractions and mistakes. Sleep loss increases the risk of accidents caused by human error.Sleep deprivation impairment is comparable to being legally drunk. Those in relationships who consistently experience poor sleep are more likely to engage in conflict with their partners. Sleep loss decreases levels of empathy.


Q:

Thank you for this AmA. What is the current consensus regarding treatment of Restless Leg Syndrome? Probable causes, effective medication, lifestyle changes?

A:

There is a lot going on in this question! It is a good one, though - check this out http://sleepeducation.org/essentials-in-sleep/restless-legs-syndrome


Q:

Why is it that after im tired and I don't go to sleep, I finally try to sleep but im no longer tired?

A:

In order to stay awake at the end of the day, your circadian alerting signal is active. This is why some people feel more "awake" at night.


Q:

Hello, thanks for your time ! Is there really such thing as an ideal number of hours to sleep at night ?

Also, is that true that hours slept before midnight tend to provide a better rest than hours after midnight ? If so, why is that ?

A:

Yes, there is and it varies for each person. To find out how much you need, try to go to bed when you are tired and wake up spontaneously when refreshed for a while - that will help determine your needs. This could also serve as a guide: http://www.sleepeducation.org/healthysleep/Make-Time-2-Sleep-Bedtime-Calculator


Q:

Every night when I fall asleep I get cold so I bundle up, but even though I feel that I'm still freezing I sweat, which only makes me colder. I get no restful sleep and wake up exhausted, freezing, and shaking. Help!

I've recently had a physical and labs, all normal. I will be having a sleep study in February, but until then do you have any thoughts?

EDIT: Just thought to add, I've been exhausted all my life. It takes me no time at all to fall asleep, no matter what is going on. This is the first time ever anything has stopped me from sleeping deeply.

A:

Sweating can indicate sleep apnea. Sounds like you are on the right track to get this taken care of.


Q:

How do you feel about taking melatonin before sleep? Sometimes when I take melatonin I will wake up at 5 or 6 in the morning no matter what time I go to sleep why is this?

A:

Melatonin is not a "sleeping pill" per se and has never been FDA approved. If you take it, then take it at least 3 hours before your intended bedtime, if not sooner, to notice any effect.


Q:

I seem to sleep fine but hell am I tired constantly, what's that all about?

I can nap then need a nap to fix how tired I am after my nap.

A:

There are medical causes for fatigue that you should have checked out by your doctor. This could also be an indication of a sleep disorder. Sleep and sleep disease, such as obstructive sleep apnea and insomnia, are increasingly recognized as vital to a wide variety of public health and chronic disease concerns, including obesity, hypertension and cancer.

Definitely make sure you getting at least 7 hours, too. http://www.sleepeducation.org/healthysleep/Make-Time-2-Sleep-Bedtime-Calculator


Q:

I was recently diagnosed with severe obstructive sleep apnea , I was told severe is stopping breathing 30 times an hour and my tests show I stopped breathing 74 times within an hour, I can in no way afford the machine but I'm always dreadfully tired, I'm used to it tho, however can this cause any serious issues in the future ? Or is tiredness the extent of it?

Thanks Doc !

A:

Yes there are cardiovascular consequences of obstructive sleep apnea and I would do everything you can to get this treated.


Q:

How come when I drink 2 cups of coffee in the morning I have trouble sleeping that night but when I drink 5-6 throughout the day I fall asleep fine? Seems counter intuitive

A:

You might want to look into the caffeine content of the types of coffee you are drinking.


Q:

Did it ever happen to you that you were dreaming and you suddenly fall out of nowhere in your dream then wake up in panic thinking you just fell? What that all about?

A:

That's called a "hypnic jerk" and it is normal.


Q:

Hello, I've had a real bad cold for the last few days and my sleep has gotten super weird. Instead of just falling asleep I keep waking up every few hours with really weird dreams. Why does that happen?

A:

Probably infection related immune mediators influencing your sleep.


Q:

Whenever I am dreaming and I realize it, which I believe is termed lucid dreaming, as I "do what I want to" I feel myself waking up, every time, and have to actively focus on staying asleep. I also wake up due to sounds that aren't really there. My SO will be awake reading and I will jolt up asking if she heard the loud bang or door slam and she looks at me like I'm crazy. Is there possibly something wrong with me I should be concerned about?

A:

Sounds like you have an occasional "hypnagogic hallucination." This alone is not reason for concern.


Q:

Are there any ethical restrictions against conducting studies to see how long people can go without sleep beyond a certain point, and what is the cutoff, if there is one?

A:

Rats die after about 3 weeks of total sleep deprivation. This is how we know sleep is essential to life. I have seen studies of 24-36 hours of sleep deprivation, but not much longer than that.


Q:

Sorry for not asking this in my earlier post.

There are odd occassion where I am not fully asleep but I make noises. I am not fully awake either to make out the words I am trying to say. Why could that be?


Q:

Hi Dr. Watson! First, thank you for taking time out of you're extremely busy schedule to answer some questions! I work 3p-3a in a busy Emergency Room. Neurology put me on 10mg Ambien because I wasn't falling asleep till 7-8am in the morning and only getting 5-6 hours of sleep wasn't cutting it. I really don't like the Ambien "hangover" and Melatonin is just to help me try and stay regular...is there a better research basef alternative for 3rd shift workers?

A:

Melatonin is not a "sleeping pill" per se and has never been FDA approved. If you take it, then take it at least 3 hours before your intended bedtime, if not sooner, to notice any effect.


Q:

I can't seem to sleep more 6 or 7 hours a night. If I go to bed early before 9pm I'm up at 4am. If I stay up till 11 I am still up at 4 or 5. How does one deal with early rise insomnia?

A:

If you think you may have insomnia, ask yourself the following questions: 1)Does it take you more than 30 minutes to fall asleep, or do you wake up during the night and have trouble returning to sleep, or do you wake up earlier than desired? 2)Do you have daytime symptoms such as fatigue, moodiness, sleepiness or reduced energy? 3) Do you give yourself enough time in bed to get at least 7 hours of sleep each night? 4) Do you go to bed in a safe, dark and quiet environment that should allow you to sleep well?

If you answered “yes” to all of these questions, then you may have insomnia. http://www.sleepeducation.org/essentials-in-sleep/insomnia/diagnosis-self-tests

Also, are you using a good bedtime routine?http://www.sleepeducation.org/news/2017/08/14/make-time-2-sleep-with-online-bedtime-calculator


Q:

I take ZzzQuil usually 5 to 6 times a week so I can fall asleep faster and stay asleep without waking up a bunch of times. Will this have any long term negative side effects?

A:

While most adults need 7 or more hours of sleep each night, a small percentage of people function well on less sleep. If you feel refreshed when you wake up and remain alert throughout the day without needing to take a nap, then you may be getting enough sleep. But the problem is that we tend to be poor judges of our alertness level, and we underestimate how we are affected by insufficient sleep. In addition, there is a ton of data to support that not getting enough sleep puts you at greater risk for heart disease, high blood pressure, diabetes and more. Try sleeping 7+ hours for a week, and I think you’ll notice a more energetic, productive version of yourself that you didn’t know existed.


Q:

hello doctor and thank you for this AMA!

i'm curious about the length of sleep and why it can have differing results in people, such as, when a person gets relatively little sleep (say 4-6hrs) and feel okay, but that same person getting too much sleep (say 10-12hrs) can make them feel awful. does length of sleep have more of an affect on a person than the actual quality of it? at what point does quality and length even out? and lastly, does this length of sleep needed to feel rested differ from person to person or do we all collectively need exactly 8hrs as many are told from youth?

A:

The bottom line is that very few people are able to succeed and be healthy on less than 7 hours of sleep per night. Many who claim to get little sleep are probably exaggerating – and if they’re not, I suspect that they would be even more successful, and much healthier in the long term, if their brains and bodies were fully charged with sleep. We tend to be poor judges of our alertness level, and we underestimate how we are affected by insufficient sleep. In addition, there is a ton of data to support that not getting enough sleep puts you at greater risk for heart disease, high blood pressure, diabetes and more.


Q:

I was diagnosed with narcolepsy about two years ago and I struggle with it daily. Is there any advice you can give to fight it? The medications that I take for it are not my favorite and I wish there was something I could do naturally. I have tried melatonin and I have a "healthy sleep regime" where I try to go to bed at the same time, not eat too late, etc. I also have nightmares every single night. This has been the case since I was young. Do you believe the two are related in any way? Thank you for your time!

A:

If possible, schedule short 20-minute naps throughout the day, and try to exercise regularly.


Q:

A lot of the time as I'm falling asleep my body jerks. Its pretty pronounced and obvious to my partner. Typically I don't wake up, but every now and then I've experienced this as a dream of falling and I've jerked awake. When this happens this very shortly after falling asleep. Why does this happen? Is it anything significant or does it happen to lots of people?

A:

That's called a "hypnic jerk" and it is normal.


Q:

Do you have any tips for napping? I don't know how long it will take me to get to sleep, so how do I know when to set an alarm?

A:

Just set your alarm for 10-15 min. from when you lay down so you don't wake from a deeper stage of sleep and be groggy.