Sleep and Its Centrality to Brain Health (Podcast)

Evidence linking sleep quality to overall health seems to grow on a weekly basis. One physician-researcher at the forefront of that evidence, particularly as it relates to brain health, is Nancy Foldvary-Schaefer, DO, MS, Director of the Sleep Disorders Center in Cleveland Clinic’s Neurological Institute.

In a new episode of Cleveland Clinic’s Neuro Pathways podcast for healthcare professionals, Dr. Foldvary-Schaefer sits down with podcast host Alex Rae-Grant, MD, to explore how sleep impacts neurological health and vice versa. Among the topics touched upon:

• The multiple ways in which sleep and epilepsy interact, with Dr. Foldvary-Schaefer drawing on her additional expertise as a neurologist in Cleveland Clinic’s Epilepsy Center
• Research on how sleep-disordered physiology impacts cognition in populations at risk for Alzheimer’s disease
• Why neurologists should screen for sleep disorders in their practice, and advice for doing so

Click the player below to listen to the 13-minute podcast now, or read on beneath the player for an edited excerpt of the larger discussion, focusing on advice for providers who want to improve their own sleep health. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

Excerpt from the podcast

Dr. Rae-Grant: Many physicians are not great sleepers, and we don’t always take good care of ourselves. What advice do you have for getting a good, restorative sleep so we can do a better job of caring for our patients with neurological disease?

Dr. Foldvary-Schaefer: In the general population, at least 40% of adults are not getting enough sleep and at least 30% of people have some degree of insomnia or sleep apnea. The most important thing may be to recognize that sleep is not a passive function. Centuries ago, sleep was likened to being in a coma. But sleep is actually a very active function. When we sleep, we’re restoring every cell in our body, every cell in our brain. We’re reversing proinflammatory processes and enhancing clearance of neurotoxins from the brain. So just getting enough sleep — seven to nine hours is what’s recommended for most adults — is critically important.

People who have trouble sleeping at night typically benefit from having a standard wake-up time more than from trying to start with a standard bedtime. If you give yourself the same wake-up time every day and you don’t let yourself sleep in on weekends, over time things will tend to backfill a bit and you’ll likely establish a more reliable go-to-sleep time. The result will be more — and more consistent — sleep overall.

Then, of course, there are things in the environment and things we ingest that wreak havoc with sleep. Alcohol is the most common substance that adults use to self-sedate at night, and while it helps hasten sleep onset, it is very destructive to sleep continuity. Alcohol reduces REM sleep and causes a lot of sleep fragmentation, which contributes to cognitive impairment, irritability, fatigue and daytime sleepiness. So we certainly recommend against use of alcohol for self-sedation or routine use of over-the-counter agents like antihistamines.

Instead, we recommend cognitive behavioral therapies like learning how to clear the mind at night, perhaps even creating a “worry journal” or a list of next-day to-do’s. Doing this during the day or early in the evening can help clear your mind of worries, and then it makes sense to give yourself a little time to wind down without electronics — without looking at light from your electronics — for an hour or so before bedtime.

All of these things together are probably the best strategies for ensuring a good night’s sleep. Of course, if you struggle with sleep problems for more than three months, talk with your doctor.