More than 1 in 3 adults in the U.S. don’t get enough sleep, and 12% suffer from chronic insomnia. What’s driving more Americans toward chronically poor sleep, and what can be done about it?
Guests
Suzanne Bertisch, associate professor of medicine at Harvard Medical School. Clinical director of behavioral sleep medicine at Brigham and Women’s Hospital.
Also Featured
Lauren Hale, professor in the program in public health at Stony Brook University School of Medicine.
Dominique Decoster, a western Massachusetts resident struggling with chronic insomnia.
The version of our broadcast available at the top of this page and via podcast apps is a condensed version of the full show. You can listen to the full, unedited broadcast here:
Transcript
Part I
AMORY SIVERTSON: Okay, we all know what it’s like when you don’t get enough sleep. Maybe you wear the evidence of it under your eyes. Maybe you’re sneaking an afternoon coffee to get through the day. Maybe you’re a little more irritated and emotionally on edge.
For some people, these feelings are a consistent part of life.
DOMINIQUE DECOSTER: My name is Dominique Decoster, and I am a social worker and a psychotherapist. What happens to me most of the time is not so much that I don’t fall asleep easily, it’s more that I wake up in the middle of the night, maybe 2 o’clock, 3 o’clock out of the blue.
I’m ready to go. I’m ready to go for the day. Not sleepy at all. This has been going on for about 23 years. It started when I had a life event that was very upsetting. At that time I was feeling very anxious and so it was tied into to that, but it has never really gone away. And I took medication for about 15 years to sleep with.
And it turned out that I couldn’t sleep without the medication. If I went somewhere and I forgot it, then I would be awake the whole night. It really decreases my motivation to get my work done and I’m just thinking, I really need a nap right now. I’ll forget to put a detail, I’ll forget to put a date of birth, or I’ll put the wrong phone number, or I do little mistakes, like nothing very significant, but things that, you know.
So like that I’m not paying attention. I’m not really focused. And even at home, I forget things or I’ll put things in the wrong place. I have a long commute and I’m on the highway and I feel extremely drowsy.
You know how there’s signs on the highway that tells you don’t drink and drive and that. But the other day it just says, it said, don’t drive drowsy. And it was like, are they talking to me? Because that’s exactly how I felt. And I just keep going because I know that I only have 15 more minutes and I just force myself to keep going. My eyes really want to close and it’s scary.
I also read that when you sleep, your brain is processing things and it’s doing some cleanup and your whole immune system, and it’s not good for my health. I tend to worry more about that than about being tired the next day, even though that’s an issue. I just worry about the effects on my general health and on my brain health. To the people who sleep well every night that don’t take it for granted.
Don’t take it for granted. That was Dominique Decoster. She’s a psychotherapist and social worker from Amherst, Massachusetts. She struggled with insomnia several times a week for 23 years. Dominique is not alone. I too am often awake in that dreaded 3:00 a.m. hour wondering if I will ever fall back asleep.
And the Centers for Disease Control says that more than a third of us adults are not getting enough sleep on a regular basis. And about 12% of us have chronic insomnia, according to the American Academy of Sleep Medicine. Many experts say poor sleep is not just a nuisance for millions of Americans. It’s a public health crisis and it needs to be solved.
Well, joining us today to talk about why so many of us are struggling to get enough sleep, and what we and society as a whole can do to get those Zs is Suzanne Bertisch. She’s an associate professor of medicine at Harvard Medical School and she’s also a physician and the clinical Director of Behavioral Sleep Medicine at Brigham and Women’s Hospital in Boston, Massachusetts.
And she’s sitting across the table from me right now. Dr. Bertisch, welcome to On Point.
SUZANNE BERTISCH: Thank you so much for having me.
SIVERTSON: It’s great to have you. And you are among the medical professionals who considers the lack of sleep to be a public health crisis. So why? What makes this so serious?
BERTISCH: As we know from copious medical literature that different dimensions of sleep, so we know both not getting enough sleep at night, really defined as sleeping, not enough hours of sleep.
So usually either less than six or seven hours of night have been linked to multiple significant chronic health problems such as increased rates of obesity, diabetes, and premature mortality. We also know that several other sleep conditions, one of which you mentioned, insomnia, is also linked to future risk of depression as well as future risk of heart disease and other significant public health outcomes, and then as well as other sleep disorders.
SIVERTSON: Okay, so I want to get into some of these definitions, but I also want to address this idea of enough sleep because we cited the statistic that one in three U.S. adults are not getting enough. But what is enough? There’s this idea that enough looks different, feels different for different people. Is that true or is there an a enough across the board that we can look to?
BERTISCH: That’s a great question, and I think it’s one of the issues that whenever we create clinical guidelines or public health messaging, those are really based on what we think is needed on average across a population, which is what we really learn from our data. So yes, there are several clinical guidelines by the American Academy of Sleep Medicine, by the American Thoracic Society, that generally recommend either getting at least seven hours of sleep or seven to nine hours of sleep at night.
But we know that the need for sleep, so how much sleep an individual needs actually varies quite a bit. And you could probably tell from one of the guidelines recommends seven to nine hours of sleep. Some people only need seven and a half hours of sleep; other people may need eight and a half hours of sleep at night.
How much sleep an individual needs actually varies.
Suzanne Bertisch
There’s like many other things, a lot of individual variation and so I think it’s important to people to keep that in mind when they hear the sleep goal is I need eight hours of sleep. That’s just not gonna be true for more than half the people.
CHAKRABARTI: Yeah. So I’ve already outed myself as a bad sleeper here, and I’ve been hesitant to use what I just call the ‘I word,’ insomnia. Because I don’t know if that represents me.
So what is insomnia?
BERTISCH: So that’s a great question and I’m really glad we’re starting with definitions, because I think even from what we just talked about previously, in terms of getting enough sleep, in my mind as both a sleep physician and researcher, that can mean a lot of different things and a lot of different things which could have different impacts in terms of not just health outcomes, but how we approach patients.
So just to start even more basically talking about not sleeping well or feeling you have poor sleep is really either just a most general symptom, that can be caused by a lot of things. Or even more recently been termed even just a singular dimension of sleep. What is the patient’s experience of their sleep and what is the quality of their sleep?
But when we think about trying to further identify what exactly is causing the sleep problems. To get a little bit more specific, we might talk about insomnia symptoms, which are classically difficulty falling asleep, either at night or during the middle of the night, which we often call staying asleep or early morning awakenings.
And I think where some of the confusion comes, because I do see a lot of patients with insomnia and they’re struggling by themselves in the bedroom at night. So it’s a very lonely experience. And so a lot of people talk to their friends, they talk to their family and they’re seeking solutions.
But it’s important to keep in mind that there are many different things, health wise, behavioral wise, other sleep disorders, other medical disorders, psychiatric conditions, schedules, social demands that can cause insomnia symptoms. So difficulty waking up in the middle of the night, trouble falling asleep.
And we distinguish that from actually insomnia disorder, which is a clinical terminology. It’s a diagnostic term that we define with those symptoms of difficulty falling or staying asleep, or early morning awakenings that occur at least three nights a week for at least three months. That by definition cause significant daytime impairment.
Despite opportunity for sleep, you have to have the opportunity for healthy sleep, but it can also not be caused or due primarily to another condition or disorder. So it’s really insomnia is its own entity with, importantly saying, it often can occur with other comorbid conditions. So you can still have insomnia disorder despite having chronic pain or having hot flashes, anxiety or depression.
Which is also not quite, when I was in medical school, the teaching was if you treat the underlying medical condition, you will cure the insomnia. And we know not only is that not true. Because often the insomnia persists, but there’s copious data to show that we can target and treat the insomnia even in the context of these ongoing medical conditions.
So again, just to reiterate, there’s the general term of poor sleep, more specifically insomnia symptoms that can be caused by many different things, and then the actual on the spectrum from there, insomnia disorder where we decide that the symptoms are really due to really fundamental changes that are happening in the brain that cause this persistence of difficulty sleeping, that impacts daytime function.
CHAKRABARTI: Okay, so we were talking about some of these statistics. This 1 in 3 are not sleeping enough for myriad reasons, probably. 12% are experiencing this chronic insomnia of having these insomnia symptoms maybe multiple times a week. Is this a problem that is getting worse or do we know that we are sleeping less or more poorly in 2025 than, say, years or decades past?
BERTISCH: I think it —
SIVERTSON: Or do we have better data?
BERTISCH: I think it’s a little hard to say. I know more recently there’s some studies that show that we maybe have not been getting enough sleep or sleeping worse, but wearing my researcher hat, these things are very hard to know for sure.
Like I’m not totally sure where the truth is. Is it that we have more studies, more awareness, better tools, more reporting? I think regardless, when you say one in three Americans is not getting enough sleep. So that’s actually statistics on sleep deprivation, and that is a public health crisis in some ways.
Similarly, when we look at insomnia symptoms, which are different from not getting enough sleep, we know that about a third of Americans have insomnia symptoms, and about 10% have actually insomnia disorder. Any disease process or symptom where one in 10 or up to one in three individuals are suffering and then count into the related public health and financial consequences.
I think the sleeplessness, no matter how you measure what dimension, is a real problem in our society at this time.
Sleeplessness, no matter how you measure what dimension, is a real problem in our society.
Suzanne Bertisch
SIVERTSON: Whew. Okay. I imagine there are a lot of people out there listening, going, I don’t know if it’s insomnia or insomnia symptoms or chronic insomnia. I just can’t sleep. And I promise we will be talking a lot more about this.
We’re going to be talking about solutions.
Part II
BILL: My insomnia started 10 or 15 years ago, but it was only a night, maybe two. Occasionally every couple of months couldn’t sleep until two to three in the morning. But over the years, it’s expanded, then it became a week and then longer. And during these episodes, my mind just races.
RUTH: And then you wake up at about 3:14 a.m., wide awake and you can’t go back to sleep. And then you start to ruminate about everything in the government. And then you start to worry, is your roof going to leak? Is the wind going to blow it off? And then you might doze off a little, then you’re up for the day and crying and tired all day long.
CHASE: I eventually had to drop out of high school, due to a lot of reasons, but part of it, in my opinion, was just due to the lack of sleep. It was affecting my physical and mental health severely.
CAROLYN: I was waking up exhausted in the morning. I was napping once, maybe twice a day. It felt like I was just sleeping all the time and never feeling rested.
AARON: It affects me profoundly, and when I do get good sleep, quite often my wife tells me I’m a whole ‘nother person. And I become playful and fun to be around and when I don’t get it, I’m emotionally and cognitively crippled.
When I don’t get [sleep], I’m emotionally and cognitively crippled.
Aaron, On Point listener
SIVERTSON: Going in order there. That was On Point listener Bill in Massachusetts, we had Ruth in Utah, Chase in Georgia, Carolyn in Oregon, and Aaron in Texas. Thank you all for calling in and I’m sorry for all of your sleep woes. Very relatable. Here in the studio with me in Boston is Dr. Suzanne Bertisch of Harvard Medical School and Clinical Director of Behavioral Sleep Medicine at Brigham and Women’s Hospital.
Dr. Bertisch, a quick reaction to what we just heard from some of these sleepless On Point listeners.
BERTISCH: I think these listeners really capture some of the classic stories that are unfortunately very pervasive around the country of the experience people have, the rumination, the thought process, the suffering that really goes on for a very long time, for decades or multiple decades for some people.
So these sound similar to some of the voices that I hear in my clinical practice, as well.
SIVERTSON: So I want to dig into some of these anecdotes a little bit. The mind racing, which reminds me of this, a favorite post of mine on X from a while back of the caption ‘My brain at 3 a.m.’ And then there’s a little screenshot of the Duolingo owl saying, ‘Let’s review your mistakes.’
Why is it that we, is there something in our internal rhythms or brains, that is waking us up in the middle of the night to fret?
BERTISCH: So that’s a great question. And I think the answer, like most things are, it depends. Evolutionarily, what people often state is that the alerting system in our brain is actually advantageous, right?
If we go back to our ancestors, we want to be woken up at night and be alert, if there’s an animal hunting us or so. For some other people, you know, what I wonder, where my brain goes to hearing this as a clinician and really trying to always figure out what is causing the problem sleep, are some people just getting to their part of their circadian rhythm? Where their body’s waking up in the morning, like their brain, it’s time to get up. It’s my biological morning.
And then in other people, thinking about why, what the term that psychologist uses, rumination, the repetitive thinking and thoughts as night. I can’t think of a necessarily reason why the brain would think that’s a good idea in the morning, but usually it is linked to worry. And it can be a classic feature of insomnia in not a small number of patients. So that’s a very common symptom that people report.
SIVERTSON: Yeah. And these ruminations that are maybe not just grounded in our own lives and to-do lists, but also, we heard one of the listeners there saying, I’m thinking about the government.
I’m thinking about the roof caving in or getting blown off. Is there any reason why we might resort to thinking about things that are really beyond our control at a time in the middle of the night when we are the most vulnerable, the least set up to do anything about the government and the roof and so on.
BERTISCH: That’s a great question. Not a psychologist. So I can’t necessarily articulate why that may be or have a theory as to why that may be. But I think it is a time where, as I mentioned before, people are usually alone with their own thoughts and perhaps it’s a time of day where they’re actually allowed to consider these thoughts and to think about things.
And during your waking hours, in the usual time, in the morning or afternoon, the evening, life can just be busy and you’re not necessarily being as reflective or concerns or it’s a time to process the emotions that occur at night. I will also mention that another reason why it’s difficult to fall back asleep.
But really in the middle of the night, particularly in the early morning awakening, is because we can think of our need to sleep almost similar to the mechanism that we have when we’re eating, right?
So when we get up in the morning, if we had a good night’s sleep, we’re not that sleepy because we sleep down sort of our body’s sleep hunger, might be a terminology to call it. And as we go throughout our day our sleep hunger slowly goes up.
And so what happens when we wake up at, 3, 4, 5 in the morning, if you’ve gone to bed, 9, 10, 11 o’clock at night, your sleep hunger starts going down.
So again, it’s another, it is harder to go back to sleep because it’s like almost you’ve had a snack, you’ve had a big dinner. Now you’re trying to eat more. So it is hard to escape that, but again I think it’s just the environment of context of when we actually have time to think about things that might scare us or be anxious or what I usually hear patients talk more about is worrying about their day, worrying about their work, worrying about their to-do list tasks, are often some of the common features that I hear about people try to solve in the middle of the night.
SIVERTSON: That makes so much sense that the body would almost have a sort of intermission in the middle of the night, and yet, is there something that people who can sleep through the night, who can power through those eight hours without waking up, is there something that those people are fundamentally doing differently? Or that their body is doing differently to allow them to carry on eight hours straight as opposed to, oh, my sleep hunger is diminished and now I’m up and now I’m really up.
BERTISCH: So I’ll first by starting comments. So there is historically some evidence that as humans, like we actually didn’t sleep in one eight hour shot of sleep. And there’s a wonderful book by a historian where it talks about the segmented sleep, where we slept in these sections of a first sleep and a second sleep, that is described again before the advent of electricity.
So, and we don’t know which sleep is necessarily better or not. But the problem is in our modern-day society, it’s very hard to have that long of a sleep opportunity with segments in between. The other thing I wanna point out, as I’ve alluded to earlier, is that everybody’s brain is different and we do things.
That we know that there are genetic determinants of sleep and the circadian rhythm as well. And people are different, right? Some people even come out of the womb very good sleepers. Others are problematic sleepers, and some people are just not great sleepers their entire life. So we do think that there are individual differences.
It doesn’t mean that people are necessarily doing the wrong things or bad things. It’s just how they’re built biologically and neurobiologically for sleep. And then it’s really hard on an individual basis to comment why some people are sleeping poorly and others are sleeping better.
Is it their schedule? Is it the regularity of their sleep? So again, going to bed at the right time. And by that, I mean I talked a little bit about the sleep hunger, which is a big influence on when we sleep, but the other is our body’s internal circadian rhythm. So it’s our innate biological clock that’s about 24 hours long.
And in order to achieve healthy sleep, you really want to go to bed when your sleep hunger’s the highest and it’s the start of your biologic night. And that’s aligned. And I think a lot of people in modern society try to sleep at times that’s not aligned with their normal biology, which can really interfere with their ability to get sleep.
A lot of people in modern society try to sleep at times that’s not aligned with their normal biology, which can really interfere with their ability to get sleep.
Suzanne Bertisch
So all to say, to postulate that what you gave, I think the healthy sleepers probably have more regular sleep, can sleep through the night. It’s normal to wake up in the middle of the night. Our brain does arouse; some arouse more than others. Again, that’s another variation we have in our brains.
But there’s a lot of other behavioral and biological factors that can contribute to who can actually achieve the, again, I wouldn’t say eight hours of sleep at night. Because that’s actually an unrealistic target. Because a lot of us don’t need that, though we certainly need more than six hours a night for the most part.
But I think it’s hard to compare across people.
SIVERTSON: Okay. You’re getting at something that I think is important here because we’ve been mostly talking about people who, we can assume that they’re putting in their best effort. They’re really trying to get sleep and then they’re having trouble falling asleep or staying asleep.
But there are some of us, and this is, I relate to this sometimes, who are maybe not allocating the full eight hours or they’re not going to sleep when their sleep hunger might be biologically greatest. And Alyssa Kim from Austin, Texas left us this voice message about exactly that.
ALYSSA KIM: I have a full-time job and a part-time job, and I do also have a lot of different hobbies, including some that are semi-professional. But the main reason why I think I struggle with sleep is the phenomenon called revenge bedtime procrastination. It’s when you feel like you have so little control over your time during the day that you take effectively revenge on yourself in your own bedtime, because that’s the only time that you can effectively make in your schedule is by sleeping less.
Which of course degrades the rest of my time during the day. It’s really hard for me to get to sleep at a reasonable hour, but I always have to wake up early enough to complete my work responsibilities.
SIVERTSON: So that I think speaks to something that we will be talking more about, which is just the place that sleep occupies in our life and maybe why we’re not prioritizing it as much as we should be. I do wanna hear from one more listener here, though. This is Andrew Pond from Burlington, Vermont who also left us a VoxPop message.
He’s 74 years old. He says he doesn’t get a lot of sleep, but he’s also not sure if that’s a problem.
ANDREW POND: I rarely have trouble falling asleep. It’s lights out at nine and I typically wake up between one and 2:00 a.m. When I wake up, I am usually wide awake and feel like I don’t need any more sleep. If it weren’t for the association between less than six hours of sleep and poor long-term brain health, I probably wouldn’t care about the short nights.
And I guess I really don’t think of myself as having insomnia. I’m not sure what the definition is of that. But then again, given how I wake up early, after four to five hours, it seems like my brain is doing what it needs to do. And I guess if I end up developing dementia someday, it’s what was meant to happen.
SIVERTSON: Dr. Bertisch, why is it that some of us can get four to five hours and feel like, nope. I’m good. I’m ready for the day. And others of us, as we heard from listeners earlier, it’s crippling when they don’t get enough sleep. What explains that, if we all need, as you say, more than six?
BERTISCH: So most people who say they do fine on four to five hours of sleep when they are actually brought into the laboratory and we do pretty basic tests of attention, they’re usually, in about 98% of the population, it’s estimated, would actually do poorly in some of those tasks of attention. And it could be some types of tests and not others. Usually, multitasking is what people struggle with. And over time our ability, it’s thought that our ability to detect those problems actually diminish.
And these really come from some studies done at the University of Pennsylvania in an experimental setting where they bring people in and sleep deprive them and have them do tasks of attention over time. With that said, when patients do have insomnia, we also know that in general that the data on how they perform cognitively is actually quite mixed.
If anything, we haven’t seen a lot of cognitive decrement in patients with insomnia disorder. So again, it’s taking what we know about the general population versus what we know about insomnia disorder, but usually when people are not getting enough sleep, there’s other types of, again, if not cognitive decrements, emotionally how they perform during the day.
If the last listener, what made me think about was we didn’t hear anything about, are they napping during the day? What are they doing around the 24-hour sleep schedule? Are they getting more sleep? Are they getting tired during the day? And for this patient I was curious.
You know, about when they start to get tired and could it actually be a circadian rhythm disorder issue? Because as we get older, we know that our clock moves earlier and earlier. And these are the couple things I’m thinking in my head. What else could be going on? But for the most part, most people who are sleeping four to five hours a night, other than some people with some just amazing genetics who do well, there are people who do not get sleepy on four to five hours a night, who perform really well, but the vast majority of people do.
So most people who say, I do fine on five hours of sleep. We usually really try to probe that and identify where the decrements may be coming up. Ways we can try to get them more sleep, if so. But we do know some people, again, but only about, it’s thought only about 2% of the population do fine on less than six hours of sleep.
SIVERTSON: I guess he also doesn’t know how much more fine he could be doing if he got, he knows what four to five hours feels like, but what would seven or eight hours feel like?
BERTISCH: It’s possible.
Part III
SIVERTSON: I do want to zoom out a bit now and hear about certain groups of people are affected by a lack of sleep. So if you look at the CDC’s map of where poor sleep is more common, often it matches areas where there are higher rates of poverty, low employment, and chronic health conditions. So for Professor Lauren Hale at Stony Brook University School of Medicine, this isn’t surprising.
LAUREN HALE: Time is valuable, and if you have insecurity about how you’re going to pay your rent or feed your children, you might have to substitute your sleep to either make money or take care of your kids, or do the everyday activities of life that you aren’t able to squeeze in other periods because you’re so busy.
If you have insecurity about how you’re going to pay your rent or feed your children, you might have to substitute your sleep to either make money or take care of your kids.
Lauren Hale
SIVERTSON: Hale says, similar to social determinants of health, there are social determinants of sleep. Things like how safe your neighborhood is, how loud your neighborhood is, how economically stressed your community is. These all factor into the likelihood that you’ll get poor sleep. And Hale says if you’re not getting good sleep, there are ongoing consequences.
HALE: It’s a vicious cycle of sleep and social disadvantage, it extends across employment characteristics, education, lifestyle behaviors, mental health, even relationship quality falls into this cycle of poor sleep, might exacerbate poor interpersonal relationships. So all of these things are social factors that affect sleep, health, and ultimately affect overall health.
SIVERTSON: Black, Native American and non-white Hispanic Americans are also more likely to experience sleep quality issues. Hale says policies that address systemic inequality and poverty overall would improve sleep, just as with other social determinants of health. But she also advocates for policies specifically around sleep.
HALE: Those include making all high school start times after 8:30 a.m. right now. Fewer than 20% of schools start after 8:30 a.m. Restricting age at which kids can be on social media. And finally getting rid of or eliminating the biannual clock change and moving to a permanent standard time. So all of those policies remove people’s agency over the quality of sleep they can get.
So if we are committed to promoting an environment of sleep health as a human right, we need to engage and embrace policies that move us in that direction and reduce disparities around sleep.
SIVERTSON: That was Lauren Hale, professor in the program in public health at Stony Brook University School of Medicine.
Dr. Bertisch, what are some of your thoughts hearing these larger societal inequities and issues around sleep?
BERTISCH: I agree with Dr. Hale in her comments. A lot of what has emerged from the literature, which she cited, was that there are multiple factors that influence our opportunity for sleep and how well we sleep.
So she mentioned various aspects of her life, economical, childcare, all different factors that influence sort of our ability to have, to enact these fundamental behaviors to control our sleep. The instance, and I think that we heard from an earlier listener, was just the sleep opportunity, right?
If you’re working multiple jobs, or as Dr. Hale mentioned, the time opportunity lost, right? Do I take care of my family by doing these chores at night or working extra jobs to raise money versus actually having the opportunity to sleep. Do I need the extra time to take away from my sleep just to be able to feed my children?
So these are real structural and social determinants that influence our ability to sleep, so that the opportunity, as well as how well we sleep as well. Because you imagine when you live in neighborhoods where there’s light pollution, noise pollution, higher crime those are also more stressful environments, as we alluded to earlier, right?
That’s gonna arouse our brain. And make us more concerned about the safety while we’re asleep. And we see this not uncommonly in the clinic. In terms of people often needing to work multiple shifts, rotating shift work, which provide people of limited, really limited opportunity to sleep as well, but also the same, unfortunately, determinants also tend to limit access to sleep treatments as well.
So it’s multiple reasons. Not just the cause, but the impact and limited access to treatments.
SIVERTSON: I’ve heard you use this phrase sleep opportunity several times and there was a piece in The Atlantic earlier this year. The writer Jennifer Senior poses the question in 2025, exactly how much of our sleep opportunity is under our control.
I wonder how you answer that, how much of good sleep is in our control when there are these societal factors that we’re talking about that we can’t control? What’s the lighting like on the street that we live? What’s the noise? What’s the students getting up at 7 a.m., 8 a.m. or being in school rather by 7 a.m. or 8 a.m. It does feel like we have set ourselves up to be a not very well rested society.
BERTISCH: Right. And as Dr. Hale pointed out, really depends on your circumstance. How much is under, what proportion is under control. Because as you mentioned, there are a lot of things we can’t necessarily control in terms of the light pollution coming into the room. Our job shift schedule, the time our kids have to get up for school.
There’s a lot of pressures put on our time, but again, those who are more advantage have more control, usually more of an opportunity to work from home or not have to have the financial stresses that could increase sleep, or having to work multiple shifts, including overnight night shifts, and then other shifts during the day.
So versus people who have better footing and are able to live in quieter neighborhoods. Are going to inherently have more control over the enacting sort of sleep behavior. So one example, often you’ll hear people talk about the temperature in your room, right? But to be able to cool your room, especially if you live in a hot environment, fundamentally requires you have air conditioning or access to something where you can lower the temperature which is a privilege for many people.
So I think it’s important when we think about how much control people have to realize that does vary quite substantially and can impact our sleep and how we actually approach helping those people.
SIVERTSON: Okay, so let’s talk about some solutions now, because we did put this question to our listeners as well.
What are they doing to try to get a better night’s sleep? And here’s what some of them had to say.
BARB: What do I do to help myself fall asleep and then stay asleep? There’s basically three things. The first one is a great mattress, the second is a cool room. The third is a very structured sleep routine, which I start about one hour before I go to sleep.
PETER: Things like keeping bedroom cold at 62 degrees, taking magnesium supplements, trying to avoid screens an hour or two before bedtime.
ANNE: I find that a melatonin that is a delayed release works really well.
ELIZABETH: Cannabis is now legal and I take a hybrid edible that helps me sleep.
DAVID: If you do this, these movements with your eyes closed, you move your eyeballs all the way up. All the way down, then all the way to the left, all the way to the right, and then you do a circle. 90% of the time I’ll fall back to sleep within five minutes.
BARB: And then if I wake up in the middle of the night, I get outta bed, I go out on my balcony with a sweater, sit outside, breathe the air, look out at the night sky, and eventually I then say, enough is enough. And then I go back to bed and I fall asleep.
SIVERTSON: Those were On Point listeners Barb and Peter from Massachusetts and from New Mexico. Elizabeth also from Massachusetts, and David from Connecticut. Dr. Bertisch, what did you hear in that kind of laundry list of things that people are out there trying to help them sleep better?
BERTISCH: So what I hear are very common techniques that we know multiple people use.
SIVERTSON: The first, the eye one was new to me. I have to say the closed eye movements —
BERTISCH: That was one I hadn’t heard before. But I always hear things that I never think about. But we did hear a lot of the more common ones in terms of supplements that people take of various formats, melatonin, over the counter sleep medications, dietary supplements such as magnesium.
There’s always a hot thing.
SIVERTSON: And do these hot things work? Are these things that you might recommend to people to try like melatonin and magnesium?
BERTISCH: In my clinical practice, I rarely recommend those things. Again, it depends on the circumstance. Because most patients who actually make it to the Brigham Sleep Clinic have tried all these things.
So we see the patients that fail all of these treatments. So when I hear all these different listeners from around the country, it really shows the extent and pervasiveness of sleep difficulties have, right? Because the vast majority of people suffering from sleep problems are going out there and buying stuff, putting things in their body, using different techniques, talking to their friends, trying to figure out what works.
And it’s hard to think about any other problems in medicine where people are turning so much to each other to try to get the answers and information. And when I think it’s problem. And I think one issue is that there’s also almost, we all sleep as humans. We have a biological imperative to sleep.
And I think most of us are experts when it comes to our own sleep. But don’t realize that may not, what works for you may not help for your friend and neighbor. And I think it’s fine for people to give each other advice on that. But I have issues where some of these things are perhaps not safe for people.
SIVERTSON: Yeah. And you’ve also studied prescription sleep medications, which with all of these kind of self-medicating solutions that we just heard about, I don’t feel like I’ve heard as much about lately. And I wonder if we know if these prescription sleep medications actually work and are safe, do we know enough about them?
BERTISCH: Interestingly, we know more about some prescription sleep medications than others. And we certainly probably know more about them than how dietary supplements work. So again, something like magnesium, we hear a lot about, there’s very little evidence supporting that works for sleep.
But as people are using that safely, then it’s okay. As far as prescription medications for sleep. That’s actually interesting, because we think about medications that actually have been studied in clinical trials to answer questions. Do these medications work for sleep and are they also safe?
So there’s groups of medications that fall into that category. And then there’s many other medications that are prescription medications, though they came to market for other indications. The most common one being Trazodone. Trazodone has very limited data. There’s some studies going on now where we’re going to have more information as to whether or not Trazodone is helpful for people to sleep, but we do also worry about safety.
It’s just easier to prescribe than some of the other sleep medications. As far as the prescription sleep medications, we heard a lot about that over recent years. Because the most commonly used prescription medication for insomnia is a medication called zolpidem is the generic name.
The brand name is Ambien, and that recently, in that class of medications had a black box warning because people, when they take it, it can produce the adverse event of effect of people doing things in their sleep, driving, sleep walking. And people died from using the sleep medications. So they got this black box warning. So we know that zolpidem use from some of the work that we’ve done and I’ve done along with Dr. Jenna Wong is to show that Ambien prescriptions have gone down over the past several years.
SIVERTSON: I’m also thinking back to Dominique, we heard from at the top of the hour, who it sounds like she’s had 23 years of bad sleep and has not even made it to the phase of maybe trying one of these, or she tried one of these medications and doesn’t use it anymore. And so it leads me to think about this as the public health crisis that we started out talking about.
And I wonder if we just don’t consider sleep to be this third pillar of health in the way that we think of diet and exercise. Are doctors not having the right conversation with their patients or enough of the conversation with their patients to make us all to take this more seriously?
BERTISCH: I think it’s well known that sleep is often left out of the conversations. And I don’t think that’s the doctor’s fault, per se. I think there’s limited training and education for any clinician on sleep in general.
I also think the way we were forced to practice medicine now in terms of 10, 15 minute appointments, competing with lots of other chronic medical illnesses, hypertension, diabetes, obesity. There’s honestly, frankly, not enough time to address all of the relevant health issues. So sleep is a pillar of health. It’s recommended by, good sleep by the American Heart Association now as one of the AHA 8 lifestyle measures.
But again, we’re far from having it embedded within our routine clinical practices.
The first draft of this transcript was created by Descript, an AI transcription tool. An On Point producer then thoroughly reviewed, corrected, and reformatted the transcript before publication. The use of this AI tool creates the capacity to provide these transcripts.
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