How To Get A Good Night Sleep

Sleep: Dr Ronald Popper On Why You Should Make Getting A Good Night's Sleep A Major Priority In Your Life, And How You Can Make That Happen

An Interview With Tyler Gallagher

Go to bed only when you are sleepy, not at a predetermined time. It's more important that you wake up each day at a predetermined, consistent time, rather than you go to bed at a predetermined time. There is a difference between "tiredness" and "sleepiness;" the later is indicated by yawning, heavy eyelids, difficulty thinking or concentrating, head bobbing, or intermittently dozing. You cannot make yourself go to sleep, especially if you're only tired. When you are truly sleepy, sleep should be natural and effortless.

G etting a good night's sleep has so many physical, emotional, and mental benefits. Yet with all of the distractions that demand our attention, going to sleep on time and getting enough rest has become extremely elusive to many of us. Why is sleep so important and how can we make it a priority?

In this interview series called " Sleep: Why You Should Make Getting A Good Night's Sleep A Major Priority In Your Life, And How You Can Make That Happen " we are talking to medical and wellness professionals, sleep specialists, and business leaders who sell sleep accessories to share insights from their knowledge and experience about how to make getting a good night's sleep a priority in your life.

As part of this interview series, we had the pleasure to interview Dr. Ronald Popper, MD.

With a Board Certification in Sleep Disorders Medicine by both the American Board of Sleep Medicine and American Board of Internal Medicine, Dr. Ronald Popper is recognized as one of the pioneers in the field, championing the concept of the free-standing sleep center. In 1984, Dr. Popper founded The Southern California Pulmonary and Sleep Disorders Medical Center, where he continues to serve as Medical Director until today. Dr. Popper is also a speaker for the National Sleep Foundation and has written and lectured extensively on the subject of obstructive sleep apnea.

Thank you so much for doing this with us! Before we dig in, our readers would like to 'get to know you'. Can you tell us a bit about your background and your backstory?

My story begins in Oak Park, Michigan, a suburb of Detroit, where I grew up and first discovered my calling to medicine. While attending Michigan State University as an undergraduate student, I became one of the first Paramedics in the state of Michigan. As a result, I was recruited to teach advanced first aid and resuscitation techniques to first-year medical students at Michigan State University Medical School, which I later became a medical student at myself.

Upon graduating from medical school, an internship and residency at the Hospital of Good Samaritan in Los Angeles, California brought me to the west coast. I was later accepted into a Pulmonary Medicine fellowship at VA Wadsworth/UCLA Medical Center which launched my career into what at the time was considered a new field of "sleep disordered breathing" medicine. With a Board Certification in Sleep Disorders Medicine by both the American Board of Sleep Medicine and American Board of Internal Medicine, I championed the concept of the free-standing sleep center, founding The Southern California Pulmonary and Sleep Disorders Medical Center back in 1984, where I serve as Medical Director till this day.

Can you share a story with us about what brought you to this particular career path?

When I began my fellowship in pulmonary and critical care medicine at VA Wadsworth/UCLA, all fellows were required to meet with the chairman of the department and declare their research plans and interests. Me — I didn't have any. In fact, I wanted nothing to do with research. The chairman didn't know what to do with me and questioned how I made my way into the program in the first place. To provide me with some direction, they placed me in a 6x8 foot room and told me "Go start a sleep lab and do some research on sleep apnea."

I had never heard of sleep apnea at the time, and I couldn't figure out what a sleep disorder had to do with pulmonary and critical care. But quickly, I learned it had lots to do with pulmonary care, and in fact, it was a subject I took quite a strong interest in. At the time, sleep health, specialties and fellowships didn't exist. I had to make do with what was available to me, teaching myself everything I could about sleep disorders and disturbances by rotating through various specialties.

Can you share with our readers a bit about why you are an authority in the sleep and wellness fields? In your opinion, what is your unique contribution to the world of wellness?

As one of the first people to ever study sleep disordered breathing at the university level, I had to be innovative and lay the groundwork to help both patients and future experts in the field. Back then, the continuous positive airway pressure (CPAP) machine had yet to be invented. Today, the CPAP machine is the most common treatment for obstructive sleep apnea (OSA), a sleep disorder that occurs when your throat muscles relax, blocking the airway and causing breathing to repeatedly stop and start during sleep.

During my research I performed bronchoscopy (a procedure that inserts a thin tube through the mouth or nose allowing a physician to look directly into the airways and lungs) patients during sleep. This allowed me to video tape the lungs of sleep apnea patients and better understand what exactly was causing their airways to collapse. My research led me to coin the term "pneumatic splint" — a term that most textbooks use to reference the mechanism by which a CPAP machine operates to date.

Sleep-disordered breathing and sleep apnea has not only become my specialty, but my passion. Today 23.4% of women and 49.7% of men in the United States are affected by sleep-disordered breathing, with an estimated 90% of cases remaining unidentified. The field of sleep medicine has dramatically advanced since I got started and treatment options for sleep apnea patients continue to grow. Particularly, eXciteOSA, one of the newest FDA approved treatment options for primary snoring and mild OSA is the first-ever daytime oral stimulation device. The eXciteOSA device only needs to be used once a day for 20 minutes over a period of six weeks, and twice a week thereafter for maintenance. It's incredible to see how far technology has advanced since I began my research back in that 6x8 foot room. I take great pride in my contributions to the field, which have paved the way for future physicians to continue advancing treatment options for patients.

Is there a particular book that made a significant impact on you? Can you share a story or explain why it resonated with you so much?

There is no one, single book that comes to mind.

Do you have a favorite "Life Lesson Quote"? Do you have a story about how that was relevant in your life or your work?

Life is short, and sleep makes up 1/3rd of our lives. It's important to make the most of the time you have.

I recently phased out my pulmonary and critical care practice, transitioning to spending 100% of my time on sleep medicine. This gave me more time to spend with friends and family, and practice what I preach: getting a good night's sleep!

Ok, thank you for all that. Now let's move to the main focus of our interview. Let's start with the basics. How much sleep should an adult get? Is there a difference between people who are young, middle-aged, or elderly?

The recommended hours of sleep per age group go as follows:

Infants should sleep 14–17 hours per day
Pre-school aged children should sleep 10–13 hours per day
School aged kids should sleep 9–10 hours per day
Teenagers should sleep 8–10 hours per day
Adults should sleep 7–8 hours per day

Is the amount of hours the main criteria, or the time that you go to bed? For example, if there was a hypothetical choice between getting to bed at 10PM and getting up at 4AM, for a total of 6 hours, or going to bed at 2AM and getting up at 10AM for a total of 8 hours, is one a better choice for your health? Can you explain?

We know that the recommended amount of sleep for adults is 7–8 hours per day. The optimal time of day to sleep is based on our circadian rhythm, meaning it's best to wake up when the sun rises and go to sleep when the sun sets — ideally from 10pm to 6am.

Shift workers and people who sleep outside of those hours may experience ill effects overtime. Disrupting our circadian rhythm can increase risk of cardiovascular disorders, metabolic disorders (like diabetes), high blood pressure, heart attack, stroke and even cancer. It can also have psychological implications including depression or take a toll on family life.

As an expert, this might be obvious to you, but I think it would be instructive to articulate this for our readers. Let's imagine a hypothetical 35-year-old adult who was not getting enough sleep. After working diligently at it for 6 months he or she began to sleep well and got the requisite hours of sleep. How will this person's life improve? Can you help articulate some of the benefits this person will see after starting to get enough sleep? Can you explain?

The bottom line is when you're not sleeping well, you're not functioning well. A lack of sleep over time and/or not sleeping during optimal times can increase a person's risk of all the disorders I mentioned previously. I often see this with my sleep apnea patients; they come in with symptoms of excessive sleepiness, difficultly thinking or concentrating, they may be irritable or depressed. The brilliant thing about sleep is once you start to sleep for enough time and repair your sleep cycle, often the side effects and co-morbidities associated with poor quality sleep will repair themselves as well. And the same is true for all sleep disorders — insomnia, narcolepsy, or any other disorder that results in poor quality sleep — patients will improve overall with improved sleep quality.

Many things provide benefits but they aren't necessarily a priority. Should we make getting a good night's sleep a major priority in our life? Can you explain what you mean?

We need to prioritize our sleep in the same way we do eating, drinking and exercise. Sleep makes up 1/3rd of our lives and good sleep is essential to maximize our daytime functioning and reduce our incidence of the co-morbidities that I mentioned previously. It's essential to our overall health and wellbeing.

The truth is that most of us know that it's important to get better sleep. But while we know it intellectually, it's often difficult to put it into practice and make it a part of our daily habits. In your opinion what are the 3 main blockages that prevent us from taking the information that we all know, and integrating it into our lives? How should we remove those obstacles?

In my opinion, the biggest obstacle preventing us from getting a good night's sleep is the infamous "FOMO" — fear of missing out. Today, we're always busy, from the moment we wake up, to the moment we go to bed. Kids today are in soccer, drama practice, you name it. And us parents are doing the same. More than ever, we're seeing two working parents in a household; the busier we get the less likely we are to implement regimented routines and consistent sleep habits. On top of it all, we have technology constantly distracting us and keeping us awake. There are so many factors that are at play here preventing you from getting a good night's sleep.

Do you think getting "good sleep" is more difficult today than it was in the past?

As mentioned, the rise of technology — iPhones, tablets, laptops, and TVs at our ready disposal has certainly made it more difficult than it used to be to get a good night's sleep. The blue light reflecting from the screen increases alertness, making it difficult to fall asleep at a desired bedtime.

Ok. Here is the main question of our discussion. Can you please share "5 things you need to know to get the sleep you need and wake up refreshed and energized"? If you can, kindly share a story or example for each.

On my website, you can find my Rules for a Better Night's Sleep . These are the tips I give my patients to improve their quality of sleep and their overall sleep hygiene. I've detailed five tips I'd like to emphasize below:

Go to bed only when you are sleepy, not at a predetermined time. It's more important that you wake up each day at a predetermined, consistent time, rather than you go to bed at a predetermined time. There is a difference between "tiredness" and "sleepiness;" the later is indicated by yawning, heavy eyelids, difficulty thinking or concentrating, head bobbing, or intermittently dozing. You cannot make yourself go to sleep, especially if you're only tired. When you are truly sleepy, sleep should be natural and effortless.
Create a designated 30–60 minute "quiet time" ahead of your desired bedtime. Quiet time should include mindless activities, preferably without electronics, that help you to wind down and feel sleepy. If possible, have your quiet time take place in an environment with low levels of lighting. Bright lights can suppress your brain from secreting melatonin, which helps with sleepiness.
Don't stay in bed while awake for more to 10–20 minutes at any given time. Staying in bed while awake tends to create more anxiety, making it more difficult to fall asleep. Furthermore, it perpetuates the sub-conscious association of being awake in your bed, rather than being asleep, increasing the risk of recurrence. Try to only get into bed once you're feeling sleepy. This rule applies for people who either experience sleep onset insomnia or wake up in the middle of the night and have difficulty falling back asleep.
Avoid use of sleep-aids including sleeping pills or alcohol. Chronic use of sleeping pills (whether they be prescription or over the counter), are frequently ineffective in most cases of insomnia. Over the long term, patients will escalate their dosing, which increases the risk of experiencing side effects. Similarly, alcohol will make you sleepy initially upon consumption, but it may cause you to wake up in the middle of the night as it gets metabolized in your body.
If you're following these tips and practicing good sleep hygiene and you're still experiencing sleep-related issues (i.e., trouble falling asleep and staying asleep), seek out medical attention from a board-certified sleep specialist at an accredited sleep center to be evaluated and treated for a sleep disorder.

What would you advise someone who wakes up in the middle of the night and can't fall back to sleep?

My first piece of advice is to go back to the rules that guide good sleep hygiene and implement them into your life. The most important sleep hygiene tip that I give to patients who wake up in the middle of the night is to get out of bed. Make sure you're not staying in bed while awake for more than 10–20 minutes at any given time. Go to another room and do something relaxing until you become sleepy. Read a book, meditate, dim the lights, and try to avoid electronics if possible. Once you start to feel sleepy, then you should return to bed.

If you're practicing good sleep hygiene yet waking up in the middle of the night persists, I recommend you seek medical attention from a board certified sleep specialist at an accredited sleep center and be evaluated for a sleep disorder.

It's important to know the warning signs of sleep disorders, including sleep-disordered breathing. For example, anyone who snores is a potential candidate for sleep apnea. Up to 60% of adults will snore at some point, but if you snore and experience day-time sleepiness and/or the other co-morbidities of sleep apnea, I encourage you to be evaluated. Co-morbidities include: being overweight, hypertension, coronary artery disease, diabetes; depression, have experienced a stroke, or atrial fibrillation.

Day-time sleepiness is a cardinal symptom of sleep apnea. However, some patients who come see me for a sleep apnea evaluation rarely complain of being chronically sleepy or fatigued, but once we treat them, they come back and tell me "I can't believe how much better my life is now that I'm not always sleepy, and I didn't even realize it." Their entire world opens up; and that's why it's so important to be evaluated and seek treatment. With devices like eXciteOSA, we can now provide patients with better quality sleep and potentially reverse some of the co-morbidities they experience from their sleep-breathing disorder.

What are your thoughts about taking a nap during the day? Is that a good idea, or can it affect the ability to sleep well at night?

Sleeping for a long period during the daytime can certainly affect your sleep onset or cause awakenings in the middle of the night. If you must nap, I recommend a "power nap" — no longer than 10–20 minutes. Make sure you're not napping late in the day; if you're aiming for a traditional bedtime for 10 or 11 in the evening, the latest you should nap is 2 or 3 in the afternoon.

Wonderful. We are nearly done. Is there a person in the world, or in the US, with whom you would like to have a private breakfast or lunch, and why? He or she might just see this, especially if we tag them. :-)

I would love to have a sit down with Bill Dement, the "father of sleep medicine". I had the opportunity of meeting with him in the 1980s and 1990s. Unfortunately, he recently passed on.

How can our readers further follow your work online?

Website: https://sleepmd4u.com/

Facebook: https://www.facebook.com/SleepMD4U

Twitter: https://twitter.com/SleepMD4U

YouTube: https://www.youtube.com/channel/UCZkflIV0QfTDgOPWTw47THg?

This was very meaningful, thank you so much. We wish you only continued success on your great work!