Well Wisconsin Radio

Host: Hello, and welcome to Well Wisconsin Radio, a podcast discussing health and wellbeing topics with experts from around the state of Wisconsin. I’m your host Renee Fox, and my guest today is Dr. Daniel Dixon.

Dr. Dickson is a licensed clinical psychologist in the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health. He completed his Ph.D. at Loyola (loy-ow-luh) University Chicago and pre-doctoral clinical internship in the Department of Psychiatry at the University of Wisconsin-Madison. Dr. Dickson has specialty training in cognitive-behavioral therapy for insomnia, evidence-based interventions for circadian rhythm disorders and other sleep disorders, as well as cognitive-behavioral and acceptance-based interventions for depression and anxiety with adults.

Dr. Dickson, thank you for joining us today to talk about sleep and how we can get a better night’s rest.

Guest: Yeah. Thank you for having me.

So can you start by explaining how much sleep we need and why it’s important to get enough sleep? Yeah, well that’s a question I get quite a bit is everyone asks like, how much sleep do I need?

And a lot of people have heard the recommendation everyone needs, you know, I think says seven to nine hours is what people recommend. Um, however, like everyone’s sleep needs a little bit different. Uh, I kind of equate it to. Not too different from like calorie intake. Um, I use the example of my son, I have a four year old.

He sleeps well. He should sleep more, but he sleeps about 13 hours a day within a 24 hour day. And so he needs that amount, amount of sleep, which is different than me at my age now of almost 40. I have a different need, but the calories where if I eat 2000 calories, I will probably maintain my weight.

If my four year old who weighs about 40 pounds ate 2000 calories he would be pretty plump pretty quickly. So the idea with sleep is figuring out how much sleep your body needs and everyone’s needs might be a little bit different. Um, so I can actually share with you, I’ve tracked my sleep for many years now.

My sleep is around just a hair under seven hours a night. Well, some, like my partner, she sleeps about eight and a half to nine is her norm. And I tell people it’s not about getting more sleep, it’s about getting a quality sleep, getting it consistently around the same time, the consistent amount will be effective.

Um, so when I think about it, it’s like everyone, the lowest sleep I’ve ever seen has been about five to five and a half hours, and I’ve seen sleep needs as biggest as 10. So realizing everyone’s needs are a little bit different, it’s figuring out, well, how much sleep does your body need in particular?

Host: I love that customized approach. That is really a great way of looking at things. love the examples too. What are some behaviors that we can do or either avoid doing to improve our quality of sleep and making sure we’re getting that amount that we specifically need?

Guest: The biggest one I recommend is, people have probably have heard the recommendation. Everyone go to bed at the same time every night. However, like I often ask people I work with, are you sleepy or going to bed the same time every night? Most people say no. Uh, the biggest habit I recommend people having is having consistent wake up time. Every, every day within about a half hour or so.

That’s one of the biggest things you can do for your sleep, regardless of how much you sleep. We find a lot where people sleep in on the weekends. I, I tell patients it’s kind of like taking a payday loan on your sleep for the following night. You’re going to not only take some sleep from that night, you’re going to short yourself eventually because you’re going be delaying your sleep that following night.

People say, oh, if I sleep in too long, I know I won’t fall asleep at night. That’s a principle of like basically your body needs to not, let’s use the example of everyone needs. Say for example, I need seven hours of sleep. Think it conversely, as my body needs 17 hours of wake time before it’s ready for sleep again.

So if I start my clock much later, it’s pushing my bedtime the following night a little bit later. And so the key thing is I sort recommend keep your consistent wake up time as best you can give or take. And for new parents, they usually say, throw that out the window. Uh, also just having consistency with your routine.

More of, not necessarily the same thing every day, but thinking about eating around the same time. Social contacts around the same time. Uh, exercise is always great for sleep. Any kind of physical activity, mental activity can go a long way. Uh, regular light exposure is big. Um, also having a having room that’s cool is really important.

Uh, actually your body gets really warm at the start of the night of sleep, so you need somewhere for the heat to go, so you can be under a warm blanket, but having a cool room can help where you might get too warm if your bedroom’s too warm, might heat you up and you’ll have difficulty kind of staying asleep.

Other things I would recommend is having some time to wind down before sleep. If you think about yourself, like a, think about arousal being wakefulness. If you’re awake, think if you’re like an airplane. It’s like at 35,000 feet . We want our planes to take their time to come on down, right? Mm-hmm, they need to descend.

It needs to take some time to. gets the ground where sleep will happen. Think of your brain the same way. If you’re working until you try to go to bed, your brain’s going to be at 35,000 feet and if you want to go to go down the ground, it’s still going to take some time for it to descend. So its recommended that about a half hour to an hour before bed, just kind of giving yourself some space for your plane to descend down to the ground again.

You don’t want it to crash, we don’t want it to go that direction. Uh, so it’s really important to make sure you give yourself just that little bit of space for your mind to come down.

Host: I like the plane analogy. That’s a good one. Can you talk a little bit about how our sleep needs change over our lifecycle and, and also not even just our lifecycle, but maybe thinking of a parent who has a newborn, and they especially may find it difficult to get quality sleep.

Guest: Yeah. Yeah. I think we, one of the big, uh, issues I see in work is people will say, well, my sleep has changed or my, I can’t sleep like I normally did, you know, a few years ago. And we have the assumption that sleep is really static. Um, but it actually fluctuates quite a bit. You know, from how you slept when you’re a baby.

Even adolescence, like, you know 13 and 19, they actually have a delayed sleep phase, they go to bed later, they prefer later periods of time. They might sleep a little bit more. Our sleep kind of like, does this accordion like thing over the course of our lifespan. Not only that, not only how much sleep, but when we sleep shifts over time.

Um, as I think about it, my grandmother, she goes to bed much earlier than she did when she was a teenager. And so we see sleep just being very dynamic and we actually start seeing decreases in total sleep need. We’re pretty much, once we hit like our early thirties, we think it’s only when you’re older, like when I’m fifties, sixties, seventies, eighties, we actually see you start losing even 10 minute increments over the course of life after in your thirties.

So sleep isn’t always the same. Um, so I usually try to figure out for people is seeing how much sleep your body needs. And so I can talk about, if you like, I can put this in the notes after the meeting here is how to track your sleep, to know how much sleep your body needs to then know, here’s how much time I should be spending in bed, how much time I should be devoting to sleep.

Because if we spend too much time in bed kind of chasing after sleep, uh, the metaphor I give is, um, if you’ve ever chased a dog before? What happens to the dog if, if you have any experience with this, ReXnee, what happens when we chase after a dog?

Host: Well, he runs faster.

Guest: He runs faster, right? The same thing happens with our sleep. Like the more we try to get sleep, the more it runs away. And so we figure out, well, how do we get sleep to you not chase after sleep? We get sleep to come get you. And so as we get older, given our sleep need might change or figure out, well, how much sleep do I need so I can consistently get it?

Not always get the same amount of sleep as we got when we’re younger. Figure out how to optimize the sleep that I do get. Um, so again, sleep will change over the lifespan. Also, again, in terms of phases, uh, in terms of for, uh, new parents, difficulty getting sleep, I say nap as much as get it when you can.

Uh, that’s the one thing I would say like I tell a lot of patients, like the, the sleep rules I give you all go out the window when you have a newborn because you’re kind of in survival mode for the first three months. It’s like sleep when you can sleep in the baby cans can, once you get out of that phase, great.

Go back to a sleep schedule. Nap when you can, again, you’re not really going hurt your sleep because you’re going be sleep deprived anyway, and you’re going have someone waking you up every few hours. So, uh, definitely sleep just as you can get it. Once you get out of that phase, just as you’re adjusting to the baby getting their own sleep schedule, that’s when you can start the process of returning back to yours.

Um, however, I do recommend getting naps, uh, when you’re a new even tell kids are, I think I’ve read that your sleep deprived of child’s, the youngest child’s six years old . So I do recommend getting naps when you can.

Host: Wonderful. Great recommendations. So, you know, you mentioned, older adults and that even kind of starts happening in our thirties, but especially as we age a little more, um, it does seem like, you know, the older adults that I’ve spoken with aren’t getting as much of adequate of the sleep that they did when they were younger. Do hormones play a role in that at all? In our ability to fall and stay asleep? And is there anything that we can do?

Guest: Yeah. Well it goes, I actually, we see a hormone hormonal changes mostly actually occur in women. Actually, the biggest difference primarily around like the menstrual cycle, we see actually the, I think women are more twice as likely to experience insomnia on around their hormone cycle.

So that’s one thing. I think hormones are linked to it, but in regards to the older adults, what we actually see is you have less need for sleep. Think of as your brain. Um, you know, we do about 90 minute sleep cycles of where we go through different, different depths of sleep and you have rem sleep periods. We see actually that the, the brain doesn’t need as much sleep.

I don’t know if it’s more efficient or doesn’t do as much work either way. We see we don’t need as much sleep. Because even if you spent, uh, the metaphor I use for patients is pizza. Actually, I’m going to have to ask you, do you like pizza? This is going to sound completely unrelated to everything.

Host: Absolutely.

Guest: Okay. Thank goodness. I’m glad you like pizza. Like, imagine like you were inviting me over to your house and I’d bring over a medium size ball of pizza dough. Uh, I love pizza by the way. And if you saw me with a medium size ball of pizza dough, you’d say, Daniel, you could eat a whole medium pizza by yourself probably. No problem.

Well, the issue is we’ll say, well, let’s just spread it out over an extra large pizza pan. What happens if you spread a medium size ball of pizza dough over an extra large pizza?.

Host: You’re likely to get the hole in the crust.

Guest: Instead, the hole in the crust gets thin, and I’ve learned in my, like almost 10 years of being in Wisconsin, Wisconsinites love cheese and love their toppings. Yes. We don’t want to lose those things. Well, the same thing can happen with our sleep when people like try to extend more time in bed, you might feel like you’re getting more pizza, but you’re actually just getting thinner crust. And so the idea is again, going back to is how much dough do you have and getting the right size pan to your pizza dough.

So if you extend it, you might get holes, which we think of as like wakefulness periods or really shallow sleep, which is like really thin crust pizza. I’m not saying deep dish, but we need something like the right kind of pan pizza thickness. And that goes back to how much sleep does my body need in fitting my pan or my time in bed to my dough?

Host: Great comparison and great analogy there. Um, so you mentioned naps can be really helpful for new parents out there. So what about the rest of us? Do you encourage nap taking as a good solution just to help people feel more rested?

Guest: Absolutely. Um, oftentimes when I, when I meet with patients the first time, they’ll look very sheepish if they mention naps. And I was like, no, actually I’m not here against to take out naps. It’s more how do we nap where it doesn’t hurt us. Um, so if you, if you think about your sleep, like, um, there’s a principle called a homeostatic sleep drive. Um, why tell people imagine like a sleepiness snowball. Say in the morning, you wake up, you have a very small, sleepy snowball, and the more you’re awake, the more active you are.

Think of it kind of like the cartoons, like the snowball rolls downhill, gets bigger and bigger and bigger and bigger because you want to be as sleepy as possible when you go to bed because when you fall asleep, your body eventually basically starts melting your sleepiness snowball, and you want it to be big.

So that means a harder and faster you’ll fall asleep with a big sleepiness snowball, go to bed too early. You’re not sleepy enough, you’re stuck kind of waiting for sleep to happen. What naps can do. If you nap for too long, you can melt your sleep snowball. Where then you try to go to bed and people say, oh, if I nap, I know I’m not going to sleep at night.

I say, oh, that means your sleep snowball is melting too much. You have to wait too long for it to get big again. It may takes more rolling for it to get large. So I typically recommend is napping for shorter periods of time. About six, eight hours before bed your desired bedtime. Usually say I set a timer for 45 minutes.

It could be half hour. The idea is with shorter naps, you’re actually knocking about your snowball as much. And what happens if we nap longer is our body basically goes in a nighttime sleep mode. It like kind of like gets momentum or gets inertia. And so you might wake up feeling more sleepy than when you went to sleep for your nap.

And you also won’t be tired enough at, at bedtime if you sleep nap for longer. So I typically recommend the shorter naps. Uh, we see in a lot of cultures, people will nap for maybe 20, 30 minute periods like siestas just to get their rest in, which doesn’t hurt their nighttime sleep and actually helps them feel more refreshed when they wake.

Host: Wonderful. That’s really helpful to understand that a little bit better. When I have trouble sleeping, um, it’s usually because my mind is just continuously thinking about things and I know I’m not alone. I’ve heard people talk about that same experience, so do you have recommendations for when people just have those active minds and you’re just really having a hard time winding down and falling asleep?

Guest: Yes. Well, yeah, we’ve all been there, right? There’s like some loose end or something stressful, something that has happened with the course today. There are a few different things I recommend. Um, one of them I go to for individuals is, um, constructive worry time. It’s actually time, maybe an hour before, but I want to end it before an hour before bed, but essentially, How I think of it as our brain doesn’t like loose ends.

You ever notice, so you’re not worried about things already done with, you’re worried about things that might happen or things that are incomplete. And there are some research that shows there basically our brains of the world’s greatest problem solvers. The problem is they’ll keep bringing us to problems to solve, even though we don’t want to solve them.

We’re trying to go to bed, right? And so I think of it was our brain seeks completeness at once and like, what are we going to do about this? What are we going to do? Let’s figure it out. And so what I often do is I’ll have them write individual individuals, write out, take maybe take a half. And say, I want you to write out the problems you see are forthcoming coming ahead, or a problem you think can occur in your mind.

Write out in some detail, and then write out what the next step you’re going to do is the following day. So for example, it’s maybe I’m worried about my finances. It’s okay, well tomorrow I’m going to reach out to a consultant, it’s giving your brain the next step.

So it goes, oh, you got this handled great. I don’t have to worry about this. I won’t bring it to you at 11 o’clock at night when you’re trying to sleep. I think you have it handled. Um, I do also recommend keeping it by your bed. So in case something comes up, writing it out again and again by hand, actually we see there’s something special about writing it out by hand.

It’s different than typing different, just thinking about it. So keep a pen and paper handy and there’s something about writing out the next step and what you see. The problem is that helps your brain kind of let it go.

Host: That’s very, very helpful.

Guest: Yeah. And the only thing I’d float out for that would be is if you’re noticing your brain really active is, you know, take another 20 minutes, go do something relaxing in a different room.

If you lie in bed chasing after your sleep, just go back to that dog metaphor. You spend a lot of time chasing sleep. And what can happen is the more time we spend thinking and analyzing a bed, our brain starts to think that’s a place to think and analyze. And so every time you go back to bed, your brain goes, oh, great, you’re back.

Welcome back. Let’s go back and think and analyze and problem solve. And so one way we kind of get your brain out of that mode is to make sure your bed is only for sleep. And so hop out of bed, go to a different room, do some light reading or even watch some television. I think sitcoms, friends, everybody loves Raymond, things like that are great.

Host: That’s wonderful. So, I’ve heard people talk about taking melatonin to help them get more sleep. Um, can you tell us more about your thoughts on this as or other dietary supplements as a sleep strategy?

Guest: Yeah. Uh, that’s a question I get, uh, quite a bit. Going back to sleep, uh, how sleep processes, and I mentioned like the sleep snowball.

That’s like one part of sleep. And a lot of people have heard about the circadian rhythm. I think that the homeostatic sleep drive and circadian rhythm work together. Um, if anyone’s ever seen those movies, like the nuclear launches from the submarines, you turn to two keys at the same time. Think of these two pieces of sleep working kind of like that.

We need both of them to work in conjunction for like the take offer for the launch to happen. The launch, in this case being your sleep. And so what melatonin is, we naturally secrete melatonin. Think of what, if you take melatonin as a supplement, essentially it’s setting the stage for sleep to happen.

If you’ve ever been to any performance, uh, you’ve ever been to a play or a musical, there’s two things that go to the play. There’s the stage, and there’s the performers. And you’re going be pretty bored if you get to a venue, and you’re just looking at the stage. That’s what melatonin, does.

It helps you set the stage for sleep, but doesn’t make sleep happen. And so people might say, oh, melatonin does nothing for me. It’s basically setting your sleep stage. However you need both the performers and, and the stage to be right at the same time. Of course, I do reckon melatonin, if you’re traveling across time zones because your sleep drive might be ready for sleep and you just need to get your stage ready a little bit earlier, definitely take melatonin.

But melatonin alone won’t make sleep happen altogether. It doesn’t make the performers show up any earlier.

Host: Hmm. Great information. So what about other medications that are on the market and designed to help you sleep better? Um, can you talk a little bit about more of those as a solution for improved sleep and how are they similar or, or different from melatonin?

Guest: Yeah. Well, I, it is, reminds me of a quote I had when I was a postdoc. The director of Wisconsin sleep, Ruth Bank gave this to me. She said, medications sedate you, but they don’t make you sleep, and I thought that was the most helpful tips I ever had. Because I came to the assumption, oh, if you take ZPA or ambient, you’ll fall asleep and stay asleep. And she says, well, no. Actually what it does, it brings your body’s arousal down for sleep to happen. Sleep is a very active process. Your brain’s doing a lot of work. If you actually look at your brain waves while you’re sleeping, it’s doing a lot of different things. It’s constantly moving. It’s not actually totally shut off.

And what these sleep aids can do. There’s a lot of other medications you we’ll see in our work that, um, that basically helps sedate you, but they don’t make sleep actually occur. And people will say, well, I need more and more of it over time. And they eventually get some tolerance to it and they’ll rely on it, basically help their body get sedated for sleep to happen.

Um, so in general, like I say, the for acute periods of time, absolutely helpful, like maybe going through stressful periods or periods of grief or role transitions or. Absolutely. Medications can be helpful, but actually the number one, uh, treatment for insomnia for long-term, long-term insomnia is actually behavioral treatment, which is the, the cognitive behavioral therapy for insomnia, which I do hear at UW because we do see the longer lasting effects. It’s more sustainable. And again, we see with the sleep aids, a lot of times actually we get tolerance to it and it loses effect pretty quickly.

Host: Nice. Are there resources that you would recommend for our listeners today just to, um, explore more, learn more about sleep and getting some more tips or, um, just any recommendations and things that you think would be helpful for them?

Guest: Yeah, absolutely. One I go to quite a bit is actually made by the US Department of Veterans Affairs. Uh, there’s actually a thing called the CBT-i coach. It’s available on, I think it’s an apple and both. For Google Devices, it’s a free app that actually offers a lot of insights on sleep. Has a sleep tracker, and again, thankfully it’s free.

Uh, it has a lot of great resource on tips, well, why this doesn’t work for sleep. How to maybe consider like how to deal with an active mind at night. What does sleep hygiene really mean? How do we make sure you see your bed just for sleep or for sex? That’s probably the best resource again because it’s free.

You’ll see a lot of of apps out there like Headspace meditation apps, but you know, those things are not too different. When I think of sleep aids, maybe they help you feel more, less amped up, but again, they might not always make you sleep. If you’re going through periods of insomnia or have lots of stress, those things can help. Maybe meditate, but that may not always help you get back to sleep.

Host: Yeah. Really good. That’s really helpful. And so, our listeners can check out our show notes for more information on that resource. And any, um, anything else that you would just love to add to wrap up our conversation today to share anything else with our listeners?

Yeah, I’m trying to think what else. I think the big thing is, is watching out for, the, a metaphor I use quite a bit in my work is—think of sleep like a date you have every night. And for a lot of people who deal with insomnia, it’s some nights. The date just shows up late or it shows up on time but then like leaves you halfway through the night with a really big, big bill or it comes in and out or it’s hard to like trust your sleep.

And I think a lot of times in my work I help try to help people do is how to make sure you can like trust that sleep will happen, but trust has to be earned. And so it’s a live as experience and practice. And so thinking about how do I regain my, my trust in my sleep and watching out, when you’re noticing those nights where you come in going to bed and you’re already on edge or stressed about sleep, you say, oh, maybe this isn’t time to go to sleep yet.

Because I don’t know about you. If I go on a date with someone who’s already on edge and very tense, it can be a really tough date. And so I try to think about sleep as having that date every night, being really mindful about how I approach in the way that can without having too much stress restraint, but also we have to earn our trust in our sleep.

Host: Um, yeah. That’s great. That’s a great analogy. And then, also if anyone of our listeners are, you know, really like trying to determine are they, you know, is, are they having some issues that they can overcome with some of the guidance that you’ve provided today? Or is it really insomnia that they need to seek some professional, um, you know, counsel on that. Could you give some guidance around recommendations around that and when someone might need to reach out for a medical care.

Guest: Yeah. The way I get most of my referrals, they come from primary care from like the Wisconsin Sleep Center, but I recommend most people, if you have concerns about your sleep, talk to your primary care physician saying, is this insomnia?

What do I think is going on? The good news is if you don’t want to even go that route, you can always. Directly to, actually, if you want to call UW Health, you can call directly and ask for psychotherapy services and ask, I’m looking for someone to treat sleep, and we have a few providers here that offer those services.

So you actually don’t need a formal referral of any kind. You can basically self-refer, if you’re just curious about the evaluation. The problem is we only a few mental health providers actually trained in this approach. So it might be a bit of a wait, but definitely worth it if I have trouble staying asleep.

Just even to get reassurance, oh, this is totally normal or not, or is this something problematic? I would recommend reaching out to schedule something just to take a look and have an expert weigh in on that.

Host: Excellent, wonderful advice. Thank you so much Dr. Dixon. I really appreciate your time today. This was, um, really great information and I think our listeners are going to really enjoy this.

Guest: Great. Thank you very much for having me.

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Explore the importance of sleep and changes that take place over the lifecycle, while learning things you can do to get a better night’s rest. Join me, your host, Renee Fox as I talk with Licensed Clinical Psychologist, Daniel Dickson, Ph.D. With specialty training in cognitive-behavioral therapy for insomnia and evidence-based interventions for sleep disorders, Dickson shares insight in how to improve your quality and quantity of sleep. You don’t want to miss this episode.

Learn more about the CBT-i Coach app that Dr. Dickson talked about in this interview.

Visit webmdhealth.com/wellwisconsin to get started with the Sleep Well Daily Habits Plan and schedule an appointment with a WebMD Health Coach.