Best practices for achieving refreshing sleep, from an expert

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

A trend that has spread on social media lately is the goal of rising at 5 a.m. to get a jump on the day. But is that a good idea? I'm talking with a sleep expert from Upstate to find out. Dr. Ryan Butzko is also an assistant professor of medicine at Upstate.

Welcome back to "The Informed Patient," Dr. Butzko.

Ryan Butzko, DO: Hi, good morning. Thanks for having me again.

Host Amber Smith: The social media influencers are doing this to be more productive because they feel like they can be more focused at 5 a.m., but is there any evidence that people are more productive before sunrise or the first part of the day?

Ryan Butzko, DO: No. No. There's no specific evidence for that. But this process is called a circadian rhythm, and it's a biologically determined process, which we're all born with. So some people are biologically driven to go to bed early and wake up early, and some people are more biologically driven to go to sleep late and wake up late.

The people driven to wake up early in the morning are probably going to be more productive at 5 a.m. But the people that are biologically driven to go to sleep at, like, 1 to 2 a.m. -- you probably notice anyone with teenagers out there have this issue. You try to wake them up at 5 a.m.: What happens? They can't wake up. They are not productive, and they can't do anything until around 10 a.m., when they're naturally designed to wake up.

Host Amber Smith: So if someone is naturally designed to be a night owl type of person, if they're trying to force it and get up at 5, are they going to be ragged all day? Will they fall asleep at night? Will they need naps during the day before they realize that it's just not working?

Ryan Butzko, DO: Yeah, and actually this is one of the more common reasons that people come to see me in the office, especially younger people, in their early 20s or mid-20s, that are just getting out of college and starting a job.

They've been used to their own schedule of choosing what time they want to wake up, choosing their classes, going to sleep late and waking up late, and all of a sudden they're thrust into the workforce, and they have to be up at 6 a.m. to get to a job at 7 a.m.

What happens is they struggle to wake up. Most of the time they're sleeping through their alarms, or when they wake up, they tell me they feel exhausted, and they just can't get through the day, or at least the morning, as productively as they would want. So it's almost like they're waking up in a fog or in, like, a sleep/drunk state, and it takes several cups of coffee for them to finally get into the day.

So usually, what'll happen is they'll wake up, and they won't be productive for about three hours, until they're naturally designed to wake up.

They would only necessarily need naps if they're waking up before they had enough sleep the night before. So if they're still going to bed at about 1 a.m. and trying to wake up at 5 a.m., it's not enough sleep for them, and they'd probably need a one- to two-hour nap during the day just to maintain, in hours of sleep, during the day.

Host Amber Smith: So there's a lot of jobs that start later or that are overnight shifts, but a good portion of office work is still done 8 to 5 or whatever, so people may still have to learn how to get up early, even if they're not a night owl.

Do you have advice for a safe way to do that?

Ryan Butzko, DO: It is. So the circadian rhythm that I talked about, which, again, is our biologically driven rhythm that tells us, it basically gives us, the opportunity to go to bed.

There's two competing forces that allow us to sleep.

One of them is this circadian rhythm, and all that does is give us the opportunity to go to sleep, and usually around nighttime because we are diurnal animals, meaning we are awake during the day and asleep during the night. It allows our body, or gives us the opportunity, to sleep.

The second drive we have is the homeostatic sleep drive, which in a nutshell is the buildup of our sleep drive throughout the day as we're working and doing things.

Once those two things meet at a head, it allows us to fall asleep. This process is, again, inherently biologically driven, so you're genetically predetermined as to what your sleep hours are going to be, but it can be manipulated by behaviors or other external factors.

One of the best external factors to use is sunlight. Sunlight is something that tells our brains that we should be awake because again, we're animals that are normally designed to be up during the day. But it can be manipulated with other behaviors, most commonly eating and exercise.

So when I get people that come to me, I tell them that this can be manipulated by changing your behaviors a little bit, but it has to be done very, very slowly. It's not like one day you're going to sleep at 1 a.m. and waking up at 9 a.m., and then all of a sudden you can just fall asleep at 9 p.m. and wake up at 5 a.m. You have to do tactics that slowly bring your bedtime back, and it has to be done over a period of weeks, otherwise it's just going to get worse.

Host Amber Smith: Well, let me ask you this:

If somebody is suddenly put on an overnight shift, does all of what you said apply to them as well? Can they shift and adjust and become used to being a night owl?

Ryan Butzko, DO: It's really, really hard. We actually have a disorder known as shift-work disorder, that we treat, especially because most people are not designed to be up at night. And shift work is usually three to four days a week, so what most people do is, they go in, they do their shifts, and then the other three days that they have, they're on their normal schedule, and it actually wreaks havoc with their body. The best thing that I tell people is that they try to shift it over a couple days before they start to go to work, and they try to stack their shifts consecutively so that they're not shifting back and forth on a daily basis.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking with Dr. Ryan Butzko. He's an assistant professor of medicine at Upstate, specializing in sleep medicine.

Now, as long as we get our eight hours, does it matter too much if it's from 11 p.m. to 7 a.m. or 9 p.m. to 5 a.m.? Does that matter, or does it just need to be any eight hours?

Ryan Butzko, DO: It doesn't necessarily matter, but I'm glad you brought up the eight-hour problem because everyone thinks to have a good night's sleep, you have to have eight hours, and it's just not true, actually.

It's true that most people need about seven to eight hours to feel as refreshed and as capable during the day, but some people feel just fine with six hours. And some people feel that they need nine to 10 hours to be able to function at their best. It works as a bell curve, but most people need about seven to eight hours. What we recommend, or what I recommend, is that you need at least six hours of sleep per night, but as long as you're feeling refreshed and OK, the actual amount of time doesn't matter as much.

And does it matter if it's broken up throughout the night or during the day? It's certainly better to get it all done at once because when we sleep at night, we sleep in cycles, and as the night goes on, the cycles get longer, and we have more dream sleep.

And if you're breaking your eight hours of sleep up into, say, four two-hour fragments, the opportunity for you to have dream sleep is a lot less than if you had an uninterrupted night of sleep. So it's definitely better to get it done all during the night, but it's not awful to, say, if you have some shift work, and you have to come back from your shift at, like, 7 a.m., go to bed from 8 to 1, just because you're not able to sleep any more than that, and then try to take a two-hour nap before your shift is something that I usually recommend so it's not as bad. It can be broken up, but it's certainly better to get uninterrupted sleep throughout one period during the night. Plus, I think most peopleare more comfortable with that type of behavioral pattern.

Host Amber Smith: Do our sleep needs change as we age, where maybe we could get by on six hours, but as we get older, we need more or less?

Ryan Butzko, DO: Yes, actually. As we age, we do have less of a need for sleep, and the effects of sleep deprivation are less pronounced in us as we age. Unfortunately, we also sleep worse as we age. We become lighter sleepers. And that biologically driven clock that I talked about, the circadian rhythm usually advances, meaning that as we age, we start to feel the need to go to bed earlier and wake up earlier, which is why you start to see those early-bird specials at diners usually populated by our senior citizens.

Host Amber Smith: What about somebody who has a physically demanding job, where they're maybe a construction worker, and they come home physically exhausted, not just tired and sleepy, but physically exhausted. Do they need more sleep, or do they have less trouble falling asleep?

Ryan Butzko, DO: They probably have less trouble falling asleep because of that second process that I talked about building up our sleep drive. If they've been physically demanding the entire day, when the opportunity arises for them to go to sleep, it's going to be much easier for them to go to sleep.

So with people that are struggling with falling asleep at night, especially falling asleep and not necessarily staying asleep, what I tell them is to be active. Don't be sedentary, because the more active that you are and the more that you stimulate both your mind and body during the day, it's going to give you an easier opportunity to fall asleep at night.

Do they necessarily need more sleep? No. They don't necessarily need more sleep.

Host Amber Smith: What about someone who has a habit of watching television or scrolling on their phone before they go to bed? Do you see that as an issue very often?

Ryan Butzko, DO: Almost always. (laughs) That's one of the core components of sleep hygiene. So when I did talk about the effects on our drive to fall asleep: Light keeps us up. So the light from the TV screen and the light from the phone, especially blue light, is something that tells our brain that, no, I'm not quite ready to fall asleep. It's not time yet. This is kind of a small process.

What I see is more of an issue is people are scrolling through their social media or watching an engaging television program, and they're not allowing their brain the opportunity to shut down. And while they're still engaged and active, it becomes very, very hard to fall asleep. So usually what I recommend: not watch tv, not use your phone, especially in the bedroom. If you want to do it outside the bedroom and try a less engaging television program, or maybe a game that helps put you in a relaxed state, that's fine, but once you get to the bedroom, it's just for sleep.

Host Amber Smith: If someone came to you with a complaint of having trouble focusing and also struggling to get a good night's sleep, what are the things that you, as a provider, would be potentially concerned about?

Ryan Butzko, DO: Well, almost always, one of the first things we think about is sleep apnea. So if you have the typical characteristics of sleep apnea, I'll usually send you for a sleep study. But if you don't, then I'll start asking about your behavioral patterns and your family's behavioral patterns, because, like I said, the circadian rhythm is a biological process, but it's genetically driven.

So what I tend to see is families that are night owls are just that: families that are night owls, and most of their family also likes to stay up late and wake up late the next morning. If I can nail down their sleep habits and what they would like, I can use some medications and actually timely light therapy to help to manipulate the circadian rhythm, to try to get it to what they desire their sleep hours to be.

Most importantly, this is not an easy process. Like I said, it takes weeks to do, and once you have your desired sleep hours, you have to be consistent because you're kind of fighting your own biology. And while you can make it work while you are consistent with the sleep hours, it is incredibly easy to fall back into the old habits if you're not consistent with it.

Host Amber Smith: So an early bird that is born into a family of night owls is up for kind of a rough run.

Ryan Butzko, DO: Yeah, usually they are.

Host Amber Smith: Now, in terms of focusing, do you ever recommend caffeine products? There's a lot of beverages that have caffeine and products that you can eat that have caffeine. Do those really help someone focus if they haven't been able to sleep well?

Ryan Butzko, DO: Caffeine's an interesting drug, and as a coffee drinker myself, it's hard for me to speak against caffeine. The drug works as a blocker to one of the receptors in our brain that is one of our sleep receptors, essentially. So by drinking coffee, you're blocking the body's perception of sleep.

I don't usually recommend commercial caffeine products, mostly because a lot of the energy drinks that we see are not just caffeine. There are a lot of other chemicals in those products that aren't necessarily just caffeine. And they're not all tested, and we don't know how safe they are. And I have had, very rarely, some patients have some heart issues associated with that.

But a timely cup of coffee can really work to your advantage, especially if you're working on shift work, as long as you don't overdo it. Everything in moderation.

Host Amber Smith: Dr. Butzko, I really appreciate you making time for this interview. Thank you.

Ryan Butzko, DO: Of course. Thank you for having me.

Host Amber Smith: My guest has been Dr. Ryan Butzko, a sleep specialist who's also an assistant professor of medicine at Upstate.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

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