For #sleepawarenessweek (March 12-18, 2023), Sleep Review is joined by sleep psychologist Jade Wu, PhD, DBSM. She is the author of Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications. She is also a Mattress Firm Sleep Advisor. Sleep Review’s Sree Roy and Dr. Wu discuss common #sleep myths including:
-What is the most damaging sleep myth you have heard?
-What is one sleep myth that you previously believed, but was disproven over your career?
-Have you seen other sleep physicians perpetuate certain sleep myths?
-Do those who move around in their sleep get worse rest?
-Does the brain truly “shut off” when we go to sleep?
-Do dreams only occur during REM sleep?
-Do scents, such as lavender essential oil in a diffuser, benefit sleep in any way?
-Do eye masks and/or earplugs benefit sleep?
-Is over-the-counter melatonin a good place to start if you’re having sleep problems?
Dr. Wu recommends the following resources for further information:
American Academy of Sleep Medicine:
Society of Behavioral Sleep Medicine:
Pediatric Sleep Council
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Hello and welcome. I’m Sree Roy with Sleep Review and I’m thrilled to be here with sleep Psychologist Jade Wu, PhD, DBSM. She is the author of Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications. She is also a Mattress Firm sleep advisor. We are celebrating Sleep Awareness Week from March 12th to 18th, and chatting about sleep myths.
Dr. Wu, what is the most damaging sleep myth you have heard?
Dr. Jade Wu:
Well, first of all, thanks for having me. And I would say the most damaging sleep myth I’ve heard it’s damaging because it’s half true and half not, and that’s the eight-hour myth. So the idea that everybody should get eight hours of sleep per night every night. And the reason it’s damaging is, like I said, it is actually partially true because there are some people who need eight hours or even more per night.
But it’s also damaging because many people do not need that much sleep. And so many of my insomnia patients are trying really hard to aim for these eight hours and then when they don’t get there, they feel very defeated, they feel frustrated, and then this performance anxiety that they feel ends up backfiring, and making it even harder for them to sleep well.
What is one sleep myth that you previously believed, but has been disproven over your career?
Dr. Jade Wu:
Hmm, that’s a great question. So maybe I’ll give you two, one little one and one maybe more involved one. One is that we’ve often heard before that we should not exercise close to bedtime because this will overstimulate us and make it hard to sleep. But actually recently in the last year or two, that has been debunked. There was a meta-analysis looking at these data, data about exercising close to bedtime, and we found that even moderately vigorous exercise close to bedtime does not negatively impact sleep.
And if anything that helps sleep on average a tiny bit. So I would say unless you’re literally in an MMA fight right before bedtime, other exercises that you’re doing at home like the elliptical, or stationary bike, or yoga, or stretching, all of these are perfectly fine. And in fact, I always say to my patients, “It’s hard enough to find time to exercise just in general. If the only time you can find is the end of the day, by all means I would much rather you exercise at bedtime that to not exercise at all.”
And then the other kind of fun one for myself is I used to think that when couples sleep apart, it’s a bad thing for their relationship. And now I know that that’s not a bad thing and it can actually be a very sleep-promoting and relationship-promoting thing to sleep separately if one partner is snoring, or movements, or body heat disturbs the other person’s sleep. So highly recommend people consider these options.
Great. Have you seen other sleep physicians perpetuate certain sleep myths?
Dr. Jade Wu:
Hmm, that is a really good question. Okay, so not so much sleep myths, but perhaps lack of awareness of possible treatment options. So I think this is not really the physician’s fault because the availability of evidence-based treatments, for example, insomnia are difficult to come by. I specialize in behavioral sleep medicine so I work with many people with insomnia and I use non-medication methods. And for insomnia, the non-medication methods like cognitive behavioral therapy for insomnia are the first line gold standard, most evidence-based treatments.
But many physicians either don’t know that we exist or know that we exist, but they don’t have someone in their vicinity to refer to, or they know that even if they have someone to refer to, their wait list is like four months long, six months long. That’s true of many of my colleagues. So then in that case they feel like their patient is really desperate for sleep help right now, tonight. So then, of course, the other option is to prescribe medications or try to double down on sleep hygiene, which can sometimes be helpful, but sleep hygiene can also backfire.
It is not the cure for insomnia, it doesn’t treat insomnia, and trying too hard to perfect sleep hygiene may actually increase sleep effort, and performance anxiety, and make insomnia worse. So in this sense, it’s certainly not the physician’s fault. They just don’t have the resources at their disposal, but I think this lack of resource and lack of maybe options for where to send patients can turn into counterproductive prescriptions.
Now, I have quite a few questions about some specific sleep myths. So it’s kind of like a, I guess a lightning round if you want to say if these are true, false, yes, no, any little details you can provide about the actual science behind them would be fantastic.
Question one in this section. Do those who move around in their sleep get worse rest?
Dr. Jade Wu:
Great question. So we all move around in our sleep, but some people move too much. So, for example, there’s periodic limb movement disorder, which is when our legs, or sometimes our arms, or even other body parts will sort of move not within our conscious control. And if this is happening a lot, then that can cause arousals, which means brief awakening during sleep.
And if that happens too frequently, that can certainly interrupt sleep and prevent us from having good quality sleep. And if it’s a type of movement where we’re acting out our dreams like punching, kicking, jumping out of bed, running, that may be a sign of REM behavior sleep disorder, and that also is associated with poor sleep quality.
Does the brain truly shut off when we go to sleep?
Dr. Jade Wu:
The brain does not shut off when we go to sleep. Actually, sleep is a very dynamic and very active state for the brain. And there are different stages of sleep where the brain does different things, have different patterns. But for example, during slow wave sleep, our brain is literally cleaning out the brain, and doing lots of releasing of growth hormones, sex hormones, helping us grow and heal.
And during REM sleep, rapid eye movement sleep, the brain is doing a lot of emotion regulation, memory consolidation, dreaming is happening during REM. So lots of things are actually happening when we sleep.
Speaking of REM sleep, do dreams only occur during REM sleep?
Dr. Jade Wu:
Dreams mostly occur during REM. There are times when we might have a dream dream non-REM sleep, but usually not.
Do scents, smells like lavender essential oil in a diffuser benefit sleep in any way?
Dr. Jade Wu:
There is not a lot of evidence showing that there’s any meaningful impact. There could be positive impact if you’ve always slept with some lavender scent, and you love lavender, it makes you feel calm and relaxed. In that sense, yeah, sure. If you travel to a hotel room and you bring some lavender with you, you have that conditioned response. When you smell lavender and you turn out the lights, then your brain knows it’s time to sleep, in that sense it could benefit.
What about eye masks and/or earplugs? Do they benefit sleep?
Dr. Jade Wu:
Yeah, they sure can, especially if you live in a noisy neighborhood or you don’t have blackout shades that blackout the light, or if you have a partner that snores, or likes to keep their light on, or use the phone, then using eye mask, earplugs can really help to drown out those stimuli because those stimuli really could impact your sleep even if you don’t notice it.
Last question in the lightning round. Is over-the-counter melatonin a good place to start for someone who is having sleep problems who’s trying to find a solution?
Dr. Jade Wu:
So for most sleep problems, over-the-counter melatonin is not the solution. Melatonin is something that’s naturally produced in your body that helps you to keep time, helps your brain to keep a time to say when is nighttime, when it should be sleepy time, when is daytime should not be sleepy time. And we use melatonin for people with circadian rhythm sleep disorders. So people whose sleep timing is really shifted. Like someone who’s an extreme night owl, for example, we might use melatonin to shift the timing of their natural melatonin release to help them become more of a standard kind of morning person.
But melatonin does not help the average adult with insomnia, for example, or other sleep disorders. But for some special circumstances like children with autism, for example, for some older adults with heart problems who are on beta blockers, melatonin might be needed to help them in general sleep better.
What is a good step then for somebody who hears this and is having a sleep problem?
Dr. Jade Wu:
Well, it depends on what type of sleep problem they have. So couple of major categories I can think of is one, they are not sleepy, and they have trouble falling asleep they wake up a lot during the night or they wake up and they can’t get back to sleep, they wake up too early in the morning, that we will call insomnia. So for someone with insomnia, a good place to start is to listen to your body for how much sleep you actually need. Because if you’re expecting that you must have eight hours per night, then you might be going to bed too early for what your body really needs or you’re not building up enough sleep drive, which is like your body’s hunger for sleep that you need to build during the day by being upright, and awake and active.
So just being open-minded to the idea that possibly you need to be awake longer or more active during the day. Or that you might be going to bed too early, or that you may be trying too hard to sleep, may be working too hard on your sleep hygiene and trying to force sleep when it’s not time for that to happen. But there’s a lot more to insomnia, it’s probably beyond the scope of this podcast, but I would say there are some good resources.
So, for example, I wrote a book called Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications. I tried to lay out the foundations of how sleep works, how insomnia works, and kind of busting myths about sleep hygiene topics, and how to kind of reset your relationship with sleep. Whereas another bucket of sleep problems might be you’re too sleepy so you can’t stay awake during the day, you’re accidentally falling asleep during meetings, or during meals, or even behind the wheel.
So too sleepy might be an indication of a different type of sleep disorder such as sleep apnea or hypersomnia disorder. And that requires more testing, more assessment. So then I would see someone who is a sleep specialist, sleep doctor. It might be a neurologist, it might be a pulmonologist. I think a sleep neurologist would be a good place to start. And I should backtrack and say too that you can also see a behavioral sleep medicine specialist, someone like myself who can do a thorough assessment, and point you in the right direction whether you have insomnia or hypersomnia or another type of sleep problem.
So the very last bucket of sleep problems, I would say are parasomnias, which are kind of bizarre experiences at night like sleepwalking, or acting out your dreams, night terrors, things like this might indicate some other disorder or might be happening due to some sleep behaviors that are unhelpful. So those are worth being assessed for as well.
Fantastic. Are there any social media handles, or websites, or anything like that that you’d like to share?
Dr. Jade Wu:
Yeah, I would say behavioralsleep.org. That is the website for the Society for Behavioral Sleep Medicine of which I’m a part. And this website provides lots of articles and resources, including a directory for finding a provider who specializes in behavioral sleep medicine, and can help a patient assess their sleep problem, and give them next steps.
So that’s one good resource. And in addition to the website I just mentioned, I will also send you some links for resources for people with hypersomnia and other types of sleep problems including sleep apnea. And I’m sure you’ll include those in the show notes for people too peruse.
Absolutely. And audience, you can get our show notes as well as a transcript of this episode at sleepreviewmag.com. Dr. Wu, thank you so much for chatting with us about sleep myths for Sleep Awareness Week.
You can find Sleep Review at sleepreviewmag.com and on LinkedIn, Facebook, Twitter, and YouTube. Thank you so much for tuning in to this episode.
Dr. Jade Wu:
Thanks so much for having me.