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Sleep Q&A with Troy Payne, MD

Published in Sleep Medicine, For the Health of It Author: CentraCare

Editor's Note: St. Cloud Hospital Sleep Center Medical Director Troy Payne, MD, sat down to talk on Facebook Live about sleep-related issues on Dec. 14, 2018.

Here are some of the questions asked during the Facebook Live event. Dr. Payne’s full interview is available in the video below. Some of the text below has been edited for length and clarity.

Q: What is considered a good night sleep?

Dr. Payne: It depends how old you are. So a young child will get about 18 hours of sleep a night, but most adults need around seven to eight hours of sleep most nights. A good night's sleep would be the ability to go to sleep within 20 to 30 minutes of first going to bed. Maybe getting up once to go to the bathroom at night or get a drink, going back to sleep fairly quickly and getting up feeling refreshed the next morning. That's the key. Feeling good the next morning.

Q: Is it true that some people just require less sleep than others?

Dr. Payne: Yes, so there are people out there who really only need about five or six hours of sleep at night. It sounds remarkable that they do and those people will actually get insomnia if they stay in bed for eight hours. But there's just as many people who need nine or 10 hours of sleep, like my wife, and if they only get eight hours of sleep, they feel terrible the next morning because they didn't get enough sleep.

It's a bit of a bell-shaped curve. Most adults need around seven and a half hours and there's about an equal number of people who do great with five and about an equal number of people who need 10 hours.

Q: What can you do if you're waking up frequently at night?

Dr. Payne: This is common. So you are a new mom, you're expecting to wake up a lot at night, you have a baby, that baby is going to wake you up. Or you may have a sick child at home. Or you may have a medical illness that wakes you up with pain or reflux. So there's a lot of different things that wake you up. What we're hoping is that people can go back to sleep fairly quickly.

However, there's a lot of people who wake up and say “I have no idea why I woke up and now I'm awake again and I'm still awake an hour later.” They actually have insomnia in the middle of the night. We typically think of insomnia at the beginning of the night when you're first trying to go to sleep, but just as many people have insomnia in the middle of the night and they can't go back to sleep. They think about money. They think about kids. They think about their brother's birthday present. They think about everything and they don't want to think about it — but they do. So that person needs a little bit of help actually squishing their sleep back together again.

Q: What are some things that people who have that problem can do?

Dr. Payne: What you don't want to do is get on your cell phone. So what people often do is they get on their cell phone and then you have that lovely blue light on your cellphone staring you in the eyeballs at three in the morning. Well, that you might as well just be staring out of a window on a bright sunny day, so that will actually keep you up later.

So what we tell people is to try to not do a lot of things that require a lot of thought or bright light in the middle of the night. So get up and do something boring. I don't care if you crochet, or read or something like that. Do that for just a little bit, then go back, try to go back to bed after about half an hour. If it's happening a lot then we actually have people go to bed a little bit later or get up a little bit earlier. I'm forever seeing people go to bed at nine o'clock at night, get up at seven in the morning and say they only get five hours of sleep at night. And I'm going "Well, then you're going to bed too early or you're getting up too late." So we actually have people spend a little less time in bed, which sounds weird but it works. We call it bed restriction, where we actually have you stay in bed less at night to squish your sleep back together. We also have a sleep coach that can actually work with people on this to try to fix middle-of-the-night insomnia.

Q: Is it possible to actually catch up on sleep?

Dr. Payne: Only to a certain amount. So the longer you're awake during the daytime you actually accumulate something in your system called adenosine which makes you sleepy. Now you can block adenosine with caffeine but that only goes so far and remember caffeine lasts for six hours, so a Diet Pepsi at five in the evening, half of that's still in your system when you go to bed at 11. So that's not so good for you. So we recommend people that have insomnia issues not drink caffeine after breakfast time.

But those that are trying to go to sleep at night and they're having a lot of problems due to caffeine, they just have to get rid of the caffeine entirely sometimes. Or really, really limit it. But if you can get to sleep at a regular time and get up at a regular time and feel refreshed, that's still the best.

Q: Is there any advice for sleep around the holidays?

Dr. Payne: Yes, alcohol make sleep worse. You will go to sleep faster but the sleep is no good and you'll have to get up to go to the bathroom more, you have weird, crazy dreams. So alcohol and sleep just aren't good for each other. Also we have crazy schedules. You have to get to the in-laws. You have to get to your parents. I mean this travel that we have is sort of crazy. So make sure to take care of yourself, while you're trying to get presents and take care of everybody else during the holiday season. So watch the alcohol, make sure you're still in bed at a reasonable time and watch how much caffeine you're drinking. Never drive when you're tired. And make sure that you're taking care of yourself too.

View the Entire Interview with Dr. Payne