How well do you sleep?
If you’ve seen a medical provider in the last year (I hope you have), then you may have answered this question. But how did you answer it? And, did your answer spark any action plan?
Sleep is essential to overall health and well-being, so it’s important we understand more about it and how we can support good sleep.
In today’s article, we have the privilege of interviewing sleep expert Dr. Catherine (Katie) Siengsukon, PT, PhD, DBSM, CHWC.
About Dr. Catherine (Katie) Siengsukon, PT, PhD, DBSM, CHWC
Dr. Siengsukon received her Masters in Physical Therapy from Rockhurst University in 2002 and a PhD in Rehabilitation Science from the University of Kansas Medical Center in 2008.
She is a certified Health and Wellness Coach and certified in Behavioral Sleep Medicine (the first and only PT thus far!).
She first became interested in sleep health as a new grad practicing full time. So many of the clients she treated reported having sleep issues, and she didn’t learn about sleep or sleep health in PT school.
She would discuss positioning for sleep but that was the extent of education she felt knowledgeable enough to provide.
In 2004, she went back to school for her PhD, which was when research was emerging about the role of sleep in learning new skills.
Her dissertation project was focused on the role of sleep in learning new skills in people who’ve had a stroke. This experience opened her eyes to the importance of sleep for other systems of the body, for health, and recovery.
1. I recently watched a webinar you did called “Is Sleep the Fountain of Youth?” Can you briefly describe why you believe sleep may be the fountain of youth?
That title is a bit tongue in cheek, but if there is a fountain of youth, it might just be sleep.
We know sleep is critical for the proper function of most, if not all systems of the body. Without adequate sleep, we are at increased risk of developing chronic health conditions, such as cardiovascular disease, diabetes, obesity, and Alzheimer’s disease.
Evidence shows that getting adequate quality sleep is associated with better health and lowers risk of all-cause mortality.
2. How many hours of sleep are recommended for older adults? Does this value change with age?
The American Academy of Sleep Medicine recommends 7 or more hours of sleep/night for optimal health.
This value does not change with age.
3. Some people will say that they “don’t need” that much sleep. Is this true for some people? Also, how can one tell if they truly don’t need the recommended 7-8 hours?
There is a small percentage of the population that genetically has a short sleep need (6-7 hours/night rather than 7+ hours/night).
Probably the best way to tell how much sleep you “need” is by seeing how much sleep you get when your sleep opportunity window is not restricted by work or other activities. (For example, on the weekend when you don’t have to get up for work or activities or during vacation when you are not needing to get up for various activities).
If you truly only need 6-7 hours of sleep/night, that duration will be the same regardless of day of the week (week vs weekend), vacation or not, etc.
4. Many people have been told they need more sleep, but is there such a thing as too much sleep?
Needing more sleep than typical could potentially indicate an underlying health issue or sleep disorder that is disrupting your sleep quality so it’s worthwhile to discuss with your physician.
5. When trying to improve one’s sleep, is quality or quantity more important?
Both sleep quantity and quality are important.
It’s obviously ideal to get the needed amount of quality sleep for our bodies to function optimally.
The strategies for improving sleep really depends on the individual’s particular sleep challenges and contributing factors.
6. What are things that can influence one’s circadian rhythm?
(Note: Circadian rhythm refers to a part of our body’s internal clock, which runs on a 24-hour cycle. Circadian rhythm contributes to sleep-wake cycles1)
Exposure to light and dark is one of the most potent environmental cues to our circadian rhythm.
Traveling across time zones impacts circadian rhythm in the sense that our circadian rhythm doesn’t match the light/dark cycle or clock of the place we’ve traveled to.
Our bodies generally take 1 day per hour time zone travel to adjust.
7. Many older adults seem to have a hard time sleeping through the night or sleeping for as long as they once did. How does the sleep cycle change with age?
Older adults generally spend less time in slow wave sleep (or the deep stage of sleep) and spend more time in light sleep (the stage that is easiest to be woken up from which is why older adults often experience an increase in nighttime awakenings).
Our circadian rhythm also tends to shift earlier with age (meaning older adults often go to bed earlier and then wake up earlier).
8. What is insomnia and how does someone know if they have it?
Chronic insomnia is generally defined as the difficulty falling asleep, staying asleep, or waking up early 3 or more nights a week for the past 3 months.
I recommend talking with your physician if you are concerned about sleep issues to rule out health issues or sleep disorders that may be contributing and to discuss a treatment that is appropriate for you.
9. What is sleep apnea and how does someone know if they have it?
Sleep apnea is when the person has apneas (pauses in breathing) or hypopneas (periods of shallow breathing) above a threshold for diagnosis.
Risk of sleep apnea can be assessed using a questionnaire but diagnosis is done by either a home polysomnography or in a lab polysomnography to determine how many apneas and hypopneas the person has while they are sleeping.
10. What is restless leg syndrome (RLS) and how does someone know if they have it?
RLS is the persistent overwhelming urge to move your limbs while resting which is relieved temporarily by movement.
A person typically is aware of this issue and I recommend talking with their physician to consider if there are contributing factors (such as low iron levels) and the most appropriate treatment.
Exercise can be helpful for some people.
11. Let’s talk about naps. Do you recommend people nap throughout the day to feel more rested?
If someone is so tired that they feel like they need to take a nap on a daily basis, that indicates something may be interfering with their nighttime sleep, which would be my focus at first.
That being said, if someone feels like they need to take a nap, I encourage them to do that as they know their bodies best.
I encourage the nap to be as early in the day as possible and to try to keep it around 30 minutes.
They may also need to delay their bedtime at night until they are adequately tired (the nap will reduce their sleep drive).
People with health conditions (example, fatigue from multiple sclerosis) may benefit from a scheduled daily nap.
I’ve had some clients who enjoy taking an afternoon nap and that is part of their daily routine and it does not impact their nighttime sleep. So I do not see a problem with a nap in those instances.
12. What is sleep hygiene?
Sleep hygiene generally means the environment (ie. quiet, comfortable bedroom) and behaviors (ie. consuming caffeine and alcohol) that influence sleep.
I’m not a fan of the term due to the negative connotation with the word “hygiene”. Also, the recommendations included in “sleep hygiene” can vary from one source to another.
13. What are some recommendations you have for improving sleep hygiene?
I use the term “sleep health promotion” and I focus on four areas: entraining circadian rhythm, increasing sleep drive, reducing pre-sleep arousal, and general sleep hygiene recommendations.
See below for the handout Dr. Siengsukon uses for sleep health promotion!
14. Is improving sleep promotion the most effective way to improve sleep?
It depends on the factors and underlying cause of the sleep issue.
It can also be a challenge for people to change behavior (or we’d all be exercising regularly and eating healthy foods too). So working with an expert in behavioral sleep medicine can be helpful.
15. With all the technology we utilize daily, research has shown the importance of decreasing our screen time before bed as blue light has been shown to have a negative effect on sleep. Are there effective ways to help reduce the blue light emission from our devices?
The best way to reduce blue light emission is to be off your device 1-2 hours before bedtime.
If you have to be on a device, setting the device controls to reduce blue light and/or wearing blue light blocking glasses can be helpful.
Older adults appear to be less sensitive to blue light so it may be less of an issue for older adults.
The other concern with screens/technology is the content.
It can be engrossing so people stay up too late or it can increase stress/worry which interferes with sleep. So the device concern is not limited to just blue light emission.
16. Having a wind-down routine is important for sleep hygiene. So, is reading in bed before falling asleep a good practice for sleep promotion?
For clients having difficulty asleep, I recommend using the bed for sleep and sex only so the brain associates the bed with sleeping.
A wind-down routine is recommended to prepare the body and mind for sleep, but I recommend that wind-down activity to happen outside of the bed (if the person has difficulty sleeping).
However, if the person doesn’t have sleep difficulty, then reading in bed is fine. I read for 10-30 minutes each night in bed myself.
17. Who do you recommend readers see if they are concerned about their sleep, or lack thereof?
My biggest recommendation is don’t assume that difficulty sleeping is a normal part of getting older.
Talk with your physician about your concerns and to see what strategies would be recommended for you.
Thank you so much to our guest, Dr. Katie Siengsukon, PT, PhD, DBSM, CHWC!
Have the Strength to Live Life to the Fullest!
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Sources:
- Suni, E. (2023) What is circadian rhythm?, Sleep Foundation. Available at: https://www.sleepfoundation.org/circadian-rhythm (Accessed: January 31, 2023).
- All photos made on Canva.com
