Mar 30, 2020

Interview Transcript

Interviewer: You know, sleep is so critically important for both physical and mental health, and during times of stress and uncertainty, you might find that you're not able to sleep, which then starts the cycle of worrying about not sleeping which then leads to more sleepless nights which then can impact your physical and mental health.

It's a big circle, and Dr. Kelly Baron is a sleep expert at University of Utah Health, and she's here to help us to start sleeping better again. So Kelly, what can a person do when they're experiencing stress to the point that it's impacting their sleep?

Dr. Baron: So stress and sleep are really known to have a bidirectional or a two-way relationship. So if you're under stress, it affects your sleep. I would really describe the state that we're in right now as a state of hypervigilance or hyperawareness to what's going on, to the threats in our environment. You know, if you just think about it, at any moment we're going to get a text or a notification that our job has changed or that we're forced to work from home, that schools are canceled, ski resorts are closed. It seems like any moment of the day we're going to get an update of how our life is going to significantly change, and I don't know about you, but that has me totally on edge.

And so that sort of feeling of being under threat impacts how deeply you sleep, because if you think about it, we're really not supposed to sleep deeply when we're under stress. That's a basic survival mechanism that organisms have. You know, you would be someone's lunch if you're a little mouse in your hole and you're sleeping deeply and there's a fox outside. That's what I explain to my patients. It's just not normal to sleep under stress.

The problem is that we've been under this stress for weeks. You know, it was the anticipation and the planning and that sort of thing, and now that things are changing they change so rapidly. I know my clinic, for example, between 8:00 and 10:00 a.m. last Monday, went from optional, "Do you want to do a phone visit?" to, "We're canceling everyone. Everybody is over the phone. We've got to figure this out as we go." You know, it changes just hour by hour, which really, really leaves you feeling frazzled.

Interviewer: Yeah. Are you finding it's affecting your sleep as well?

Dr. Baron: I think in two ways. First of all, it's affecting my sleep that I'm home more and I'm actually . . . I think I'm sleeping a little more because I'm making an effort to wind things down. I've got more time to do the little things at home that I normally don't have time to do, like just put everything away, to get my laundry done. So I have a little bit more time to sleep because I'm not commuting, and my work day is kind of chopped up in a weird way that it just leaves me a little more time to unwind and go to sleep.

The other thing though is . . .

Interviewer: I hadn't considered that. Yeah.

Dr. Baron: . . . these like notifications and constant vigilance that I think we're all experiencing right now, I find that that's impacting my sleep because I wake up in the night and I think, "What's going on in Italy?" Or I think, you know, "What's going on, what's going to change today or, you know, what do I need to cancel or reschedule?" So there's certainly a sense of anxiety.

Now the other direction, though, is that if you're not sleeping, that affects how you perceive stress. There's actually a lot more data showing that if you sleep poorly or if you don't sleep enough, you interpret stress differently. You're affected by it differently. It makes you more emotional. You handle it worse. I don't know if you've felt like that before, but even in a normal day, if I sleep poorly, I'm more easily irritated by things that don't normally get under my skin, or I might get more emotional when something happens during the day. On the other hand, if you sleep better, you can more go with the flow. And so, you know, at a time like this is that we're kind of getting wound down. You know, over time, we're getting more and more sleepless and stressed. That can lead to just a cascade really of effects.

Interviewer: So are there two kinds of concerns when it comes to sleep when you're stressed, one not being able to fall asleep at all, and two, you might fall asleep, but you're just not getting that deep sleep?

Dr. Baron: Stress can affect your sleep by either trouble getting to sleep, because you're thinking, you're ruminating, or maybe you're doing things to prepare, you're working later or trying to get things done, like behaviorally. It can cause awakenings during the night. It can also cause people to feel like their sleep is less restful. So even if you aren't up for large periods of time, perhaps you're not sleeping as deeply as you normally would, or you're more restless in your sleep. Also people do have early morning awakenings. So that means you're waking up an hour or two before you intend to wake up and you're struggling to get back to sleep.

Interviewer: So what is the solution if somebody is having difficulty sleeping or feeling like perhaps they're not getting the sleep that they need?

Dr. Baron: The first thing that I talk about with my patients is that when you're under times of stress like this, it's normal to have some disruption to your sleep. That's a normal human thing. So being stressed about being stressed is never going to help anyone. So just accepting that some people are more vulnerable to having stress-induced sleep disruption. That's just a characteristic of who you are. I tend to be one of those people that was, you know, having trouble sleeping before my first day of school or those sorts of things. I mean, that's just a feature that some individuals are more sensitive to that than others.

But then on top of it, you know, if you can't sleep, we say don't force yourself to sleep. You know, wind down, turn off the news, give yourself a good hour to relax before you go to sleep. If you're not ready to fall asleep, then do some reading, do some other things, but don't get stressed about not sleeping.

The other thing to think about too is that we're all off of our schedules, our schedules for eating, for exercise, for sleeping. You know, our routines are totally shooken up right now, and that can have a big implication for sleep. And so I recommend that people stay on a routine and kids as well to have a consistent bedtime, rise time, to make sure that you're having a regular eating pattern, and then also getting physical activity during the day. Now that I'm working from home, especially I'm trying to intersperse that throughout my day. So I'm getting up and working out as I normally would in the morning before work, and then also trying to get a little lunchtime walk and get a walk in the evening with the kids so we're all getting some activity, some sunlight, some stress relief, that sort of thing.

Interviewer: Yeah. I like that because keeping that routine can be so important, and I never considered that exercise and eating could also contribute to an inability to get the kind of sleep that you need. And during stressful times, a lot of times we don't have an appetite, or we decide, oh, I don't have time to work out. And I guess it's in times like that that really you should almost double down on those things and just really commit to them.

Dr. Baron: Or the appetite can go the other way. You know, being home I have more availability of snack foods and things like that. You know, and some people might have a tendency to graze. So I made sure to position my office on the far other side of the house from the kitchen so I'm not tempted to go in there for the Fruit Roll-Ups or other things we got for the kids so they could help themselves while we're working. But on the other hand, you know, when you're under stress, you do have more of a craving sometimes for these comfort foods. You know, if your sleep is off, your eating is off, you know, it can just lead to generally feeling worn down and stressed out. And so trying to pay attention to these routines, healthy eating . . . you know, an interesting thing I noticed was that in the grocery store they're not out of lettuce. You know, there's no run on carrots.

Interviewer: No. Right.

Dr. Baron: You know? I mean, so I'm actually having plenty of fresh fruits and vegetables in my diet right now. You know, they're not out of that stuff, apples and that sort of thing. So, you know, people should take this as an opportunity. I don't know if you've seen the blogs from Korea, how people who have never cooked in their life, these sort of young adults who are mostly focused on take-out, they're learning how to cook and they're sharing this, and this is how they're bonding over Instagram and different recipes. I think that's great. I mean, people should really focus on getting a healthful diet. Again, you have a little bit more time if you're not commuting, so focusing on these routines of having regular meal times, healthy foods, getting adequate time in bed, it's actually an opportunity for some people.

You know, but I don't want to be insensitive to the fact that there are some people who are being extremely disrupted right now, that they've lost their jobs, their hours have been cut way back. You know, that's an enormous stressor, and it can really contribute to insomnia, especially if they don't know how long this is going to go. In those situations, we really talk about trying to, you know, make sure that you're getting through the day, kind of stay in the moment. You know, you can only deal with the information that you have.

Interviewer: So managing stress, those types of skills, mindfulness during the day, trying as much as possible to not, you know, I guess not let it affect you is not the right word, and then just accepting that maybe you might not sleep as well as you should, and that's okay. Don't get stressed. Don't add that to the stress, because then that just is that vicious circle.

Dr. Baron: Absolutely.

Interviewer: Is that a fair summary?

Dr. Baron: That is a fair summary.

Interviewer: All right.

Dr. Baron: It's an extremely stressful time for a lot of people right now, and it's going to understandably affect your sleep.

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