People generally cycle through Four Sleep phases 4 to 6 times Per Night
Broadcast Retirement Network’s Jeffrey Snyder discusses the impact of poor sleep on your daily mental health and cognition with Brienne Miner, MD, MHS, Yale School of Medicine.
Jeffrey Snyder, Broadcast Retirement Network
This morning on BRN, spending less time in two deep sleep phases can contribute to Alzheimer’s risk. Joining me now to discuss this is Dr. Brianne Miner of Yale Medical School. Dr. Miner, great to see you. Thanks for joining us on the program this morning.
Brienne Miner, MD, MHS, Yale School of Medicine
Thank you for having me.
Jeffrey Snyder, Broadcast Retirement Network
It’s absolutely a pleasure. And just so you know, just for the audience’s edification, we’ve talked about sleep in the past and we’ve also talked about Alzheimer’s, but you and the team actually have discovered a kind of a connection potentially between the different stages of sleep and Alzheimer’s. Is that correct, doctor?
Brienne Miner, MD, MHS, Yale School of Medicine
That’s correct. Yeah.
Jeffrey Snyder, Broadcast Retirement Network
And so what is the connection? Because maybe we start with the different stages of sleep and then what stages might be associated with greater risk for Alzheimer’s?
Brienne Miner, MD, MHS, Yale School of Medicine
Sure. Okay. So I do like to start off by saying, and I will say, so my passion is taking care of older people and also thinking about sleep problems.
These are both things that I focus on with my clinical time and my research. And so what I love to remind people of is that sleep is not an eight hour coma. So we cycle through lighter stages and deeper stages of sleep all throughout the night.
Arousals from sleep are normal. Sometimes we remember them, sometimes we don’t. But as we start to think about the stages of sleep, we start in lighter stages and then we move into deeper stages.
So the lighter stages, we call those N1, N2, and then deeper sleep is N3. And then about 90 minutes into our sleep, we have our first REM period. So REM is rapid eye movement or dream sleep.
And then that might end with an arousal. And then we do it all again. We cycle through.
And so we got very interested in looking at, well, I guess, let me back up and say, we know that sleep and Alzheimer’s disease are related. We know that impairments in sleep are a risk factor for Alzheimer’s disease. So that is not something new that I’m finding with my research.
What we wanted to do with our team, and as you know, this study was led by Dr. Cho. She’s a postdoctoral fellow working with me. We are trying to figure out more about why and how.
How is it that sleep might increase your risk of Alzheimer’s disease? And so Dr. Cho led the study to look at specific stages of sleep, like you were talking about. And we were interested in your deepest sleep, which is called slow-wave sleep.
It’s also called N3. And we were also interested in looking at REM sleep, your rapid eye movement sleep. So we think about those as being very important stages of sleep.
And what Dr. Cho was able to show is that people who spent less time in those stages of sleep were more likely years later to have these impairments in different parts of their brain that we think are affected very early in the Alzheimer’s process. So basically what she showed in these areas is that these areas were smaller if you had less time in deep sleep or REM sleep. I know that’s a lot of information, but that’s an overarching explanation of the study results.
Jeffrey Snyder, Broadcast Retirement Network
Absolutely. And I didn’t mean to jump in and cut you off. I was just saying that I think it’s great information.
So let me ask as a follow up to that. As we age, I noticed that as I’ve aged, I’ve had trouble having longer periods of sleep. I think typically, doctor, I get about six hours of sleep.
I know you said it’s not a coma, but I would say I have a very disruptive sleep. So is that typical as we get older that our sleep, you know, there’s a lot of things going on in the brain, but is that typical for our sleep to be less pronounced?
Brienne Miner, MD, MHS, Yale School of Medicine
Yeah. So that’s a great question. And I do think that it is important at this point to talk about how does our sleep change as we get older and what is considered as normal.
So a couple of things that I would point out here. Number one, we do know that it is normal as we get older, sort of as a part of healthy aging, that we will have less sleep time overall, overnight. So the sleep duration does get shorter and that we do as we age, spend less time in slow wave sleep and less time in REM sleep, our dream sleep.
And then the other thing we know is part of healthy aging and just part of what happens to all of us with our sleep is that we have more arousals from sleep. And so, you know, again, most of the time, hopefully those are brief and you’re able to get back to sleep, but that is definitely something that we will all experience regardless of what medical problems we have and what medications we are on. We will all have more arousals from sleep.
So when I, I guess when you’re reflecting on your pattern, I would say you probably are spending, as you get older, you are spending less time in deep sleep. You’re having more arousals. When I hear the six hours, I say, um, I wonder about whether you’re getting enough sleep.
Okay. And so if I were your sleep doctor, I would probably start there. So we know that the, the recommendations are for people, really there’s not a big difference between middle age and older age, that the sleep duration should be, the sweet spot is really about seven hours.
Okay. And so when I hear six, I, I will say that may be appropriate, but I would start to want to know more. You know, if I heard that as your, as your doctor, I would want to know more about what’s going on with sleep.
What’s, you know, what are those things that maybe are making it hard for you to sleep or the things that are waking you up in the middle of the night? I would do, I would, you know, I would do more of an evaluation of your sleep and try to figure out, is there something, a sleep disorder, medication, something like that, that may be preventing you from getting a normal amount of sleep.
Jeffrey Snyder, Broadcast Retirement Network
And, and doctor, just to, as another follow-up, what about napping? So let’s, let’s just take the six hours hypothetically. I’m sure it fluctuates, but what if someone gets a short amount of time sleeping, shorter amount of time sleeping, doesn’t get all the REM sleep they need, but naps during the day, say they take a nap after lunch, could that help make up that deficit of not getting enough sleep?
Brienne Miner, MD, MHS, Yale School of Medicine
Yeah. So they, you know, and this was certainly not a, not a focus of the work we did, but the, there’s really interesting literature about napping because there’s a lot out there that says that napping might be associated with adverse outcomes. But there’s also literature out there that says that napping may have health benefits.
And so it, in your case, actually, where we find that napping can have benefit is for people who maybe aren’t getting as much sleep overnight. So if you, if your sleep is on the shorter side, maybe around six hours, but then you have the nap during the day, that is where we find that that can be good for cognitive performance and good for cardiovascular health. But if you need to nap every day, if your nap is long, so an hour or longer, and if you are napping in spite of getting a normal amount of overnight sleep, then we start to worry that that’s the kind of napping that’s a signal to us that there might be something going on.
Oftentimes it’s an underlying sleep disorder that we need to evaluate and treat.
Jeffrey Snyder, Broadcast Retirement Network
So let’s talk about getting tested. I’m going to call it getting tested, but what do you do if someone’s watching this program and they, forget it’s me, they’re having challenges sleeping? Can they, where do they go to their, do they go to their internist, their primary care physician to begin the process, or do they just reach out directly to a specialist like yourself in their local area?
Brienne Miner, MD, MHS, Yale School of Medicine
I think it makes the most sense to start with the primary care provider to see if there are things that are a signal that maybe there’s a problem or, and to see if it’s, if it seems appropriate to have an evaluation by a sleep medicine physician. So I definitely encourage people to talk to the primary care provider. I think one of the things that I notice is that people don’t talk enough about sleep.
They sort of don’t think of sleep as a medical problem, or they think of their sleep as something that they have to fix on their own. So I think definitely a good place to start is a primary care provider. And usually by the time somebody gets to a sleep medicine provider, then there’s almost always a sleep disorder that has to be treated.
Jeffrey Snyder, Broadcast Retirement Network
And doctor, is there good, are there good practices or best practices for good sleep hygiene? Do I need to go out and buy a Tempur-Pedic or sleep number bed? But are there other in seriousness, are there good, best practices that we should all follow to maybe reset and get?
Brienne Miner, MD, MHS, Yale School of Medicine
You don’t have to buy any expensive gadgets, or fancy mattresses, or spa treatments. I’ve been asked about this. There’s no evidence that those have any more benefit than the things that we can all do very simply.
Well, I don’t want to say simple. It’s not always simple, but things we can all do that are not expensive. So you don’t need a fancy mattress.
You don’t need an Apple watch. What do you need to do? You need, as you mentioned, good sleep hygiene.
So that means going to bed at the same time every night, waking up at the same time every morning. And it means not sort of sleeping in on those days where you didn’t sleep well the night before. You want to be very strict about your sleep schedule.
It means avoiding things like alcohol. It means caffeine. Maybe you cut that off early.
Me personally, I can’t drink any caffeine afternoon. It means physical activity. So that’s where maybe it’s not so simple, but it’s cheap, right?
We can all go outside and exercise. You don’t have to have a gym membership. You don’t have to have fancy equipment.
So I would say the best things, better than any sort of spa treatment or fancy gadget, are keeping a regular schedule, avoiding alcohol, getting physical activity, getting social activity. So those are things that we can all do that don’t cost a lot of money.
Jeffrey Snyder, Broadcast Retirement Network
And I would imagine, doctor, that having a one-year-old kitten who wants to sleep in the bed next to you may not be the best rule of thumb.
Brienne Miner, MD, MHS, Yale School of Medicine
Well, listen, I think that I often hear about pets when I’m talking to people about their sleep. But of course, pets can have a lot of benefits, right? They can make you physically active and they can make you feel sort of socially connected and give you a purpose.
So the literature on pets is not super straightforward, but I imagine that after your kitten grows up a little bit, perhaps your sleep will be better.
Jeffrey Snyder, Broadcast Retirement Network
I hope so. I’m looking down at her and she’s looking up at me. Dr. Minor, thank you so much for joining us. Great conversation and we look forward to having you back on the program again very soon.
Brienne Miner, MD, MHS, Yale School of Medicine
Okay, thank you very much.
Jeffrey Snyder, Broadcast Retirement Network
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