Agent of Wealth Episode 69 – Health is Wealth: Tools for Solving Common Sleep Issues with Dr. Michael Gradisar

Adults between the ages of 18-64 need seven to nine hours of sleep per night. However, 35.2% of all adults in the U.S. report sleeping on average for less than seven hours per night. In this episode of The Agent of Wealth podcast, Marc Bautis speaks with Dr. Michael Gradisar, a sleep scientist, sleep practitioner, sleep teacher and leader of WINK Sleep, a group of sleep scientists and therapists who have treated 1000’s of people and conducted over 100 studies about sleep. The two of them discuss the integral role sleep plays in health.

In this episode, you will learn:

National and worldwide trends related to sleeping.
How to measure changes in sleep.
Common causes of sleep issues.
How exercise before bed, CBD, melatonin and blue light do and don’t affect sleep — which may surprise you!
And so much more!

This is the fourth installment in a six-part Agent of Wealth series, called “Health is Wealth.” Listen to the other episodes:

Resources:

WINK Sleep | Bautis Financial: (862) 205-5000

Welcome back to the Agent of Wealth Podcast. On today’s episode, we have a special guest — Dr. Michael Gradisar. Gradisar is a sleep scientist, researcher and psychologist. Mike, welcome to the show.

Thanks for having me, Marc.

Is sleep really a problem? Are people not getting enough sleep, or getting the wrong type of sleep?

It appears so. If you look at the data and compare it to previous decades, there is incrementally less sleep over time — although it is a small amount. But if we keep going at this rate, we’re really going to push it. But when I say that, I’m talking about Western societies. The data elsewhere, like in Singapore and Hong Kong, is absolutely shocking. Australia and the United States are not there quite yet, but that’s where we’re headed.

I was at a virtual conference over the weekend where we took a look at some data that showed teenagers in Singapore are going to bed, on average, at 2:00 AM. That’s the sort of stuff that seems to be happening over there. When you’re getting to those low levels of sleep five to seven times a week, you’re pushing the limits and getting incredibly unhealthy.

Are you able to pinpoint the reason why it’s like that in Singapore and Hong Kong, for example?

The mentality and the culture there seems to be the big thing.

Is the United States trending the same way?

Yes, gradually — which is a real shame. In the United States, one of the biggest issues is the early school start times. Older adolescents are getting up earlier to attend school, which is restricting their sleep time. The good news is that there are changes that can be made — for example, California passed a recent bill that has allowed later school start times.

The Connection Between Sleep Issues and Biology

Do sleep issues seem to be related to the family structure or family habits?

Somewhat, yes. At our sleep clinic, we work with families — although we are primarily focused on pediatrics. One thing that I see in children with sleep issues is that one of the parents also had sleep issues. So it’s not necessarily social modeling only. There are also genetics behind it.

And it’s not just the amount of sleep… It’s also about sleep timing and whether you’re a night owl or morning person. Personally, I am a night owl and I have passed that down to one of my sons. So it really is a combination of genetics and social modeling.

Does the time that someone goes to sleep matter, if they are still getting eight hours of rest?

No. As long as they are getting the same amount of rest, the time that they go to bed does not matter.

How do you know how much sleep you need? And is the amount of sleep that one person needs different than what someone else needs?

Yeah. It’s like height, for example. We’re all different heights and we all differ in the amount of sleep that we need. When people come to us for their sleep issues, we certainly do help them measure sleep. We track that as we do some interventions and teach them some techniques, but really it’s about how you feel the next day. We ask them questions like:

Are you sensing that you can cope better?
Are you dragging your heels less, or shutting your eyes less?
Are you not making rash decisions?
Are you not feeling anxious or depressed?

Because as soon as you start to chip away at sleep, especially on a chronic basis, you start to get a lot of those issues. The body mentally and physically becomes unable to cope.

How to Measure Changes in Sleep

Is that how you treat sleep conditions? Through how people report feeling?

We look at what’s called “contributing factors” that affect a person’s sleep. Usually, when someone comes to see us, we’ll get them to fill in what’s called a sleep diary. They track their sleep — just standard pen and paper sort of thing. Then we do a one-hour session composed of Q&A. If someone’s waking up during the night, we usually ask if there is something internally that’s waking them up. Are they too hot? Are they experiencing sleep apnea? Are they snoring? Or, is it something external that’s affecting them? Is there a noise? Is their pet waking them up?

As soon as someone moves in their bed, there’s a 33% chance that they will wake up.

Sleep issues can be attributed to a lot of things: Having too much evening caffeine, for example. Stress, body clock changes, etc.

Solving Sleep Issues

Once you figure it out, is the next step to remove whatever is causing the issue?

Yes. First, we try to educate the client so they have the knowledge, in case the issue returns after our intervention. For example, if the issue is coffee-related, we’ll educate them about the effects of coffee and how much caffeine is in different food/drinks.

For teenagers — as another example — when they’re falling asleep because of their body clock, we have to match it with opposing techniques. Techniques include bright light therapy, melatonin implementation, and so on. It’s really a case of trying to identify the contributing factors and then matching that with a technique that we know works.

Is it more about changing the habit slowly, rather than cutting the stimulus cold turkey?

Yes, because this stuff takes practice.

I’ve been doing sleep science since 1998 so I know the research side of it. The really unfortunate thing is that although research has found that certain things don’t work, people are still advocating for these principles that are not supported by facts.

I was a part of the first research group to test whether or not looking at a bright screen affects the time it takes to fall asleep. We found, through our research, that there was no difference in the time taken to fall asleep between a group of teenagers who looked at a bright screen for an hour before bed and those who did not. The team and I didn’t think we’d get the research published, because there was so much fiction out there that opposed what we found. Once we did get it published, a whole bunch of other people started testing it and found the same thing. Yet, we’re trying to get that message out there.

Sleep and CBD Oil

You mentioned melatonin earlier. I’ve been reading more and more about CBD oil. Is there research being done on whether that can help sleep as well?

Absolutely. The research on CBD at the moment finds it can help people fall asleep quicker and sleep better, but it seems to be a bit of a temporary effect in that over time, you build up a tolerance to it. Chronic use seems to mean that the effect starts to slightly wear off.

Another effect of CBD is it seems to decrease a component of our sleep called REM sleep — which is super important for learning, memory and emotion regulation. If anyone is using CBD, it’s best to do it in short term bouts, if anything.

You mentioned limited caffeine before going to sleep. What about exercise? Are there studies that show exercising before you go to bed can cause trouble sleeping?

This is really fascinating. About 15, 20 years ago, we were always told not to exercise within three hours before bed. The whole idea behind it was that when you exercise, you’re increasing your metabolism and body temperature — which is like burning your engine. Certainly, the hotter you are on the inside, the more alert you are. It theoretically makes sense that if you’re exercising before bed, you’re going to increase your body temperature, increase alertness and that’s going to mean that you have difficulty falling asleep.

However, I looked at a meta analysis this year that focused on exercise three hours before bed time. It was concluded that, after various individual studies, exercise before bed does not affect the time taken to fall asleep. Furthermore, if you have a tendency to wake up during the night, exercising before bed helps you stay asleep. The data is showing that what we were originally taught is incorrect.

Infant Sleep Training: What the Science Says

Yeah, that’s interesting because like you said, it’s exercise… which gets your heart amped up. You would think that it would take longer to wind down. To shift a bit, what about sleeping babies? Babies and young children have plenty of issues sleeping. Are there actual strategies that someone can take to have their child sleep better?

This is the only area of my work that I’ve received death threats from. For any parents out there, you know there is a massive controversy around the cry-it-out method. If you go to Google Scholar and search my surname with the term “infant sleep”, you’ll find that I conducted research on this type of sleep training. Basically, the training includes a schedule that parents follow when their infant is crying in bed. The first time the infant cries, the parent responds immediately. Following the first bout of crying, the parent then respondes a bit longer each time. It is very gradual.

The thought behind this sleep training method is you are giving the infant the opportunity to learn to fall back to sleep on their own. If done on a consistent basis, night after night after night, what we see happening is not only does the child learn to fall asleep, but like any adults, they start to get slightly sleep deprived and the biology kicks in. That pressure to sleep takes over.

We had to be very careful when we came out with this particular research. But when we looked into the scientific literature, the only sleep training tactic that could actually harm an infant was parents sleeping with them in their beds.

Parents are the best person to know if a child has a sleep problem. Most children will go through sleeplessness for the first six months of life. Then by about six months of age, they develop the biology — the sleep pressure — and their body clock. Now, if there continues to be a sleep problem from six months onwards, that’s when intervention should happen. There are resources out there for intervention.

How to Determine if Your Child Has a Sleeping Problem

For an adult, it is quite obvious if you’re feeling tired. But how does an adult tell if a child has an issue? Especially if they aren’t forthcoming in saying they’re tired? Are there things to look for?

It’s almost the complete opposite for children as compared to adults. For adults, we’ll feel sleepy, lethargic and lack motivation. But young children can be the opposite: They get hyperactive.

I have three kids. One of the approaches we take is to tire our kids out before. Is that something that’s worthwhile doing?

The Two-Process Model of Sleep

Well, one thing I’d like to leave your listeners is a bit of education on the two-process model of sleep. If we look at the contributing factors for sleep across the lifespan, there’s two biological factors: Body clock and sleep pressure. We already talked about body clock, so let’s focus on sleep pressure.

The longer you stay awake, you’re building up the pressure to sleep. For example, with adults with insomnia, they have a tendency to get to bed as much as possible so they can capture as much sleep as possible. But the thing that ends up happening is they are awake in bed a lot. It’s a counter-intuitive approach. When we get them to stay up longer on a consistent basis, they fall asleep quicker. This happens after only a few nights.

You can apply the same process to school-aged kids and preschoolers. Although you should be careful with preschoolers because they are still developing. Some of them can get overly sleepy and start to have what we call parasomnias. Almost half an hour after they’ve fallen asleep, they’ll do some sleep walking or have a night terror.

But, staying up a bit later and experimenting incrementally with bedtimes — whether you’re an adult, child or teenager — is a good approach. As long as you are getting up at the same time each morning, even on weekends, and you’re just manipulating the other variable, which is your bedtime, you can see if you’re sleeping better.

Great. Okay, so we’re just about out of time. Thank you for being on the show. I know you have a sleep clinic. How best can someone find out more about what you and your company do?

You can visit WinkSleep.online, which is our website. It really has two purposes: One, as a resource for people who have issues relating to sleep. And two, for creating a network of sleep experts around the world. If you are a health professional and would like to learn more about sleep, we host online courses, for example, and ongoing supervision. Have a visit!

Great. Thanks again for joining us.

Thanks Marc. Appreciate it.

All right. Thanks to everyone who tuned into today’s episode.