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Brian Lehrer: Brian Lehrer on WNYC, and all this week we're taking a closer look at some of the tricky new health challenges that have come up during COVID living, and offering some solutions. We picked five different pandemic self-care topics to end the show with, one each day this week, based on what we've been hearing from you and seeing around the internet. Yesterday, we talked about your pandemic skin and haircare, many of you heard that, and now we'll tackle sleep. If you've been waking up in the middle of the night with feelings of anxiety, and why getting enough sunlight during the day, even if you're living a mostly stay-at-home lifestyle, might be a key to falling asleep faster.
Joining me now to break this down and more is Dr. Charlene Gamaldo, M.D., medical director of the Johns Hopkins Center For Sleep at Howard County General Hospital. Dr. Gamaldo, thanks for some time today. Welcome to WNYC.
Dr. Charlene Gamaldo: Thank you for having me.
Brian: I saw that the word insomnia was googled more in 2020 than it had ever been before, according to a recent article on the BBC website. How do feelings like stress, anxiety and isolation actually impact our sleep?
Dr. Gamaldo: That's a great question, and yes, so all of us will have what we call our insomnia symptoms every now and then, where you have a difficult time falling asleep or staying asleep, due to just the typical woes of life. We've reached a whole new level that with, of course, the pandemic. We really consider insomnia to be an official condition once it becomes a problem at least three times a week, and for at least three months straight, and causes problems with daytime functioning. Once you hit that level, it becomes an issue to be addressed.
Brian: We've talked on this show before about how alcohol sales have been high during the pandemic, is it a fact or is it a myth that drinking in the evening might interrupt your sleep in the middle of the night?
Dr. Gamaldo: It's an absolute fact, and where it becomes a bit of a trumor is that, we know the word nightcap, and that's the idea that people will drink some alcohol and that'll help them to fall asleep. The issue is that, yes, it may do that, but it also, quickly during the night, breaks down, and then forces people to wake up, and what we call a rebound insomnia. That's the reason why, if you're having problems falling asleep, alcohol is not really the way to achieve it.
Brian: Do sunlight or exercise, two things that may be people are getting less of if they're in the staying at home mode, affect sleep?
Dr. Gamaldo: Sunlight and exercise are wonderful things to bring into your armamentarium to be a better sleeper, and unlike alcohol, they really provide only good things. The differences though, and I guess similar to alcohol, it's about the timing of it. Sunlight is great to be exposed to in the morning, to set your wake clock so that ideally, this clock will then, 13 to 14 hours later, know it's time to go to sleep. It helps to schedule things.
Exercise is a great promoter in terms of waking you up, and also helping to inboost your sleep drive later at night. The problem becomes you don't want to get either one of those things too close to bedtime because it gives the brain a mixed signal, "Should I be asleep or should I be awake right now?" You really want to do it earlier during the day.
Brian: How about stretching, things like that, that aren't really active cardio, get your metabolism going exercise, but I actually stretch before bed sometimes, and I think it helps me go to sleep.
Dr. Gamaldo: Sure, that's a great question. Stretching is actually a very good thing to do and it really brings in the whole idea of also relaxation. If your muscles are tense, being able to stretch and hopefully iron out those kinks, it's really going to put you in a physical and mental mode to transition to sleep. One thing you may want to add to that regimen is if you do some vigorous stretching, you may want to drink a little bit of water to go with it so that you can flush out any of the lactic acid or some of the things that may have built up in those previously tense muscles.
Brian: Is there a different set of techniques that you advise people on, if they have trouble falling asleep at first, compared to if they wake up in the middle of the night, and then they start thinking about things?
Dr. Gamaldo: There are some similar techniques and things that are a tad different. If you, in terms of priming yourself for your best capability of transitioning into sleep, and it really should be within 30 minutes, so anything within 30 minutes is considered normal. You want to again, do everything during the day, that's going to make you primed with exercise, sunlight exposure, healthy diet during the day to hopefully initiate sleep at bedtime. Then surrounding bedtime, you should have a routine of again, relaxing, if you want to do stretching, those sorts of things. Then limiting light exposure, and certainly any sort of content, whether it's on the radio or the TV that may be emotionally charged.
If you wake up in the middle of the night, you give yourself about a 30-minute buffer to see if you can fall back to sleep, and if not, then you should go to another room and do engage in relaxing things until you feel you're ready to go to sleep again, try again and then you go back to the bedroom and start over. Then basically it's just a wash, rinse, repeat, as the way to hopefully get you ideally in a mode to initiate and maintain sleep within a 30-minute time period.
Brian: All right, 30 seconds left, under what circumstances, if ever, do you recommend sleep aids, be it the more natural melatonin type things or prescription ones?
Dr. Gamaldo: The sleep aids available? I would recommend melatonin first. Keep in mind that in most cases over the counter, it's considered an unregulated supplement, so know that there could be quite a bit of variability from brand to brand or even till to till. At that point, if that has not worked, I really would consult your doctor regarding any of the other over-the-counter medications, much less any of the prescription medications, because any of them can have side effects and you really need to individualize it for the patient.
Brian: Dr. Charlene Gamaldo, medical director of the Johns Hopkins Center for Sleep at Howard County General Hospital, thank you so much, this has really been very informative.
Dr. Gamaldo: Thank you for having me and sweet dreams.
Brian: Sweet dreams to you, and our Pandemic Self-Care series continues tomorrow with a group stretching session on the air. Don't miss it.
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