I am a sleep expert – a board-certified clinical sleep psychologist, here to answer all your questions about insomnia. AMA!

In your experience, how accurate are sleep trackers like Fitbit and Apple Watch? I track my sleep every night but curious how much attention I should really give them

Consumer products can be helpful in tracking your sleep habits and behaviors, and giving you a good estimate about how much you sleep at night. These devices are not very accurate when it comes to determining what stage of sleep you are in (e.g., whether you are in REM sleep, deep sleep or light sleep). These devices generally rely on movement and/or heart rate, so anything that can impact heart rate might make the devices less accurate too.

Generally, what are the long terms effects of a lack of sleep? I'm only getting 5-6 hours of sleep instead of 7-8 hours, as an adult.

People who sleep less than 7 hours a night seem to have more health issues over all. If you are sleepy during the day (or can’t function without staying active or stimulated with caffeine), you probably need more sleep. In general, regularly getting less than 7 hours of sleep per night can lead to decreased cognitive function, trouble concentrating, headaches and general moodiness. Sleep deficiency can alter activity in some parts of the brain, so people may have trouble making decisions, solving problems, controlling emotions and behavior, and coping with change, and they may be more easily distracted and less likely to catch and correct mistakes. Sleep loss adversely affects neurobehavioral function leading to excessive daytime fatigue and sleepiness, which increase the risk of accidents caused by human error. Cognitive and motor performance impairments from sleep deprivation are comparable to those induced by alcohol consumption at or above the legal limit. Studies have shown that those in relationships who consistently experience poor sleep are more likely to engage in conflict with their partners. Sleep loss also decreases levels of empathetic accuracy – meaning study participants were less able to understand or interpret their partners’ feelings. Virtually all forms of sleep deprivation result in increased negative mood states, especially feelings of fatigue, loss of vigor, sleepiness and confusion. Bottom line: for many people, insufficient sleep has negative effects on our mood, behavior, alertness and performance.

What tips do you have to help someone fall asleep fast and stay asleep?

Also, thoughts on OTC meds/suppliments that help promote sleep like melatonin or unisom?

I either have trouble falling asleep or if I do fall asleep I have trouble staying asleep and getting a good night's rest. I'd love to solve that problem because I'm just exhausted all day.

If this is an occasional problem, the best thing to do is let it go, and avoid the cycle of one bad night leading to stress the following night. If your sleep problem is chronic - meaning it goes on for more than three months and occurs more than 3 nights a week, it might be best to reach out to a healthcare provider for help. The best treatment for chronic insomnia is a treatment called cognitive-behavioral therapy for insomnia or “CBT-I”. You can learn more about CBT-I at: https://sleepeducation.org/patients/cognitive-behavioral-therapy/. There are also tips about healthy sleep in general on this website.

If you are struggling to fall asleep or stay asleep more than 3 times per week for longer than 3 months, you should reach out to a sleep specialist for help. You may have chronic insomnia disorder.

I had undiagnosed sleep apnea for (I believe) a number of years. Could this have caused permanent psychological or physiological damage?

(Eventually I got a sleep study and a CPAP thankfully)

The bottom line is that it’s never too late to get sleep apnea treated. While it is possible that there are some lingering effects of untreated sleep apnea, the good news is that studies show the damaging effects of sleep apnea can be stopped, and even reversed, through treatment with a CPAP. Make sure to keep using your CPAP device!

I have a bipolar 2 & ADHD (and take stimulants). Is it unhealthy to use sleeping pills indefinitely? I take trazodone for sleep - not benzos - I know benzos are addictive and not good long term.

The most important step is to work with your prescribing physician regarding the timing of stimulant medications so you can limit the impact on sleep. In general, trying to get stimulants out of your system before bedtime is better than taking sleeping pills to counteract their effects. If that isn’t an option, work on finding the lowest dose medication to help with your sleep. Trazodone is a sedating antidepressant, which may be a reasonable option for people with mood disorders. People with comorbid conditions like bipolar disorder and ADHD can still benefit from non-medication treatments for insomnia. The recommended first-line treatment for insomnia (including sleep maintenance insomnia as you describe) is cognitive-behavioral therapy for insomnia (CBT-I). You can read more about that treatment HERE: https://sleepeducation.org/patients/cognitive-behavioral-therapy/

I usually sleep 5-6 hours at night and then a 1-2 hour nap in the afternoon. I get around 7 hours total sleep. Is this OK, better or worse for my health?

digitulgurl · 20 min. ago

I always wake up at pretty much the same time every night and can usually fall back asleep. My dad does the same thing. Is there anything to do to make it stop?

There are some parts of the world where napping is the cultural norm. In fact, having a “siesta” is not a problem unless you are struggling with your sleep at night. If this schedule works for you, you should stick to it (as long as you can protect your afternoon nap and don’t get tempted by other activities). If you struggle with sleep, skipping the nap can help increase your internal sleepiness and lead to longer sleep at night.

Is it really okay for people to change their sleep schedule on a whim? (ex. going from day to night shift at work)

How bad is that for the body in general?

In general, we can change our schedule by an hour (or so) without much trouble, but big changes can result in feelings of constant jet lag. If you do have to work nights on occasion, try to make the changes as infrequently as possible. Changing your sleep schedule can be very hard on your body, so you should do it as gradually as possible if it can’t be avoided. Many of those who work the night shift suffer from chronic sleep loss caused by a disruption in the body’s circadian rhythm. Chronic sleep deprivation is associated with an increased risk of depression, obesity, cardiovascular disease and other illnesses that negatively impact a worker’s well-being and long-term health.

Does sleeping during the day and staying up at night (with around 7-8 hour sleep) bring about any health issues?

I find my sleep schedule keeps pushing later and later till I'm sleeping at 5am (or later) plus I'm always waay more energetic at night as opposed to daylight hours where I feel fatigued. Pretty much forces me to work night shifts. I have noticed my mood drops though. (I am planning to have a sleep apnea check).

What you describe could be a sign of a circadian rhythm sleep wake phase disorder. Some people who find it hard to fall asleep and get up at “standard” times suffer from circadian rhythm sleep/wake disorders. People with these conditions often feel like they are living in the wrong time zone. Some people are able to get themselves back on track, but others need more comprehensive treatment, and should find an accredited sleep center where they can get specialty care.

Thank you for all of the great questions about sleep and insomnia!! I’m sorry I ran out of time before getting to all of them. I will do my best to reply over the next few days. Hopefully some of this information has been helpful, and I encourage any of you who are struggling with sleep to get help from a sleep specialist. You can find one near you here: www.sleepeducation.org.

Sweet dreams!

How do I wean myself off of melatonin? I’m trying everything….magnesium, CBD, all of the things…sleep alludes me.

This can be a challenge. When we get into the routine of “taking something” every night, it’s hard to interrupt that habit. The best available treatment for chronic insomnia is a brief treatment called cognitive-behavioral therapy for insomnia or “CBT-I”. You can find more information here: https://sleepeducation.org/patients/cognitive-behavioral-therapy/, and to find a provider in your area who is skilled at CBT-I you can go to https://behavioralsleep.org/, and use the “providers” menu.

Which is more disruptive to sleep: light or noise? I've recently been waking up at 5am, and I'm not sure if it's the birds chirping or the sunlight waking me up!

It might not be the same thing every night. Both light and noise can impact sleep negatively. You might consider a simple strategy like earplugs or white noise to block out sound, and an eye mask or black out shades to reduce light impact. If you don’t want to use these all night, you can keep them near your bed and try as needed.

Sleep paralysis- are there effective ways of preventing it? I have it chronically and it’s not very restful!

For some people, sleep paralysis occurs once in a while and is not problematic. For others, it is worse when they are sleep deprived. A simple thing to try is to get enough sleep for a week (or two), and see if it goes away. Sleep paralysis can also be a sign of a sleep disorder called “narcolepsy”, and it would be best to consult with a board certified sleep medicine specialist who can ask you a series of questions and decide if you need a sleep study. You can find one at sleepeducation.org.

Thanks for sharing your wisdom.

I experience ‘dreams’ that are more like hallucinations in that I have trouble distinguishing the dream from reality and continue to ‘see’ elements from the dream, even after waking.

This might be a stranger in my bedroom, or animals crawling on the walls. In the harsh light of day I know these things aren’t really happening, but at night they seem so real and often threatening.

Is there a term for this? I sometimes physically respond (i.e. crawl out of bed to escape the threat) but it doesn’t seem to be classic sleepwalking or night terrors.

Nightmares can occur any time day or night when we sleep. For most people, nightmares happen in the early morning hours because that is when we have the most REM sleep, and most nightmares happen during REM. You could be experiencing Hypnagogic hallucinations which are visual, auditory, or sensory hallucinations that occur as you’re falling asleep or waking up. This can be a sign of a sleep disorder called narcolepsy. It would be best to see a sleep specialist in an accredited sleep disorders center who can complete a clinical history and recommend appropriate diagnostic testing for sleep disorders. YOu can find a center at sleepeducation.org.

What’s more important: the total hours of sleep or what time you sleep? For example, if you were a night owl, is it still possible to be healthy going to sleep at 2 am as long as you got 7-8 hours of sleep?

This is an interesting question. In general, it is more important that you are sleeping 7-8 hours a night rather than what time you are falling asleep. Consistent sleep schedules are associated with good health, so try keeping a consistent bedtime and wake up time every day. If you are a night owl and you can adjust your daytime schedule to accommodate a late bedtime and wake up time, you are better off sleeping in sync with your internal clock. If you struggle with this issue because you can’t get up at the time you need to during the day, there are treatments to shift the timing of your internal clock including carefully timed exposure to light or carefully timed use of melatonin supplements. You can work with a board certified sleep medicine provider on one of these treatments if needed.

I always wake up at pretty much the same time every night and can usually fall back asleep. My dad does the same thing. Is there anything to do to make it stop?

It’s not unusual to wake up multiple times each night. If you are able to quickly fall back asleep then it is not something we would consider a sleep disorder in itself. However if this bothers you, make sure you are getting into bed in a relaxed state, and avoid looking at the clock during the night. Simply knowing what time it is can be disruptive to sleep!. You start thinking about the fact that you keep waking up every night at the same time, and that can create concern in itself. Turn around the clock, put your phone out of reach, and allow yourself to drift back to sleep without worry…

Two questions. Do you have any suggestions on how to get “good” sleep with an infant? (~6 Mo) and do you have any tips on getting the tiny human to sleep easier/longer through the night?

First, sleeping when you have an infant to care for is difficult. In infants don’t have the same sleep needs as adults, and they wake up more frequently at night. Babies do eventually sleep soundly, and it’s best to establish some good family sleep habits, even with a baby. For example, if the baby falls asleep early and wakes up early, do your best to shift your own schedule to align with the baby. Just like adults, noise and light can disrupt a baby’s sleep, so keeping their room quiet and dark is important. Lastly, even a baby can benefit from a bedtime routine. When putting your baby to bed at night, make this a quiet and peaceful time. Keep the room dark and quiet during nighttime feedings and diaper changes. Again - the most important thing to remember is that the baby’s sleep will improve over time. Hang in there.

How do you think marijuana use contributes positively or negatively to sleep?

There isn’t a lot of research on marijuana as a sleep aid, in particular, we have very little information about its safety. There also is some research showing that, over the long term, marijuana use can make sleep worse. This study shows that a history of cannabis use was associated with an increased likelihood of reporting difficulty falling asleep, struggling to maintain sleep, experiencing non-restorative sleep, and feeling daytime sleepiness. https://aasm.org/marijuana-use-is-associated-with-impaired-sleep-quality/

Hey Jennifer, thanks very much for doing this AMA! I've recently been tracking my sleep by writing in a notebook when I wake up during the night. Are there any other metrics that someone could record at home before visiting a doctor to help them make a diagnosis? I looked into the various sleep recording apps, but reviews from specialists seemed mostly critical.

Hi, I am glad to be here! Keep tracking your sleep patterns in your notebook is a great idea; however, I generally suggest people DON”T do this during the night (because it can prolong awakenings). You can simply use a log in the morning and document the number and timing of awakenings or you can use a wearable device to give you an idea about your sleep without tracking. Be aware that these devices are just estimates and might not be completely precise. If you are not feeling well during the day, it’s best to see a sleep specialist who can take a complete history and recommend any diagnostic tests that might inform how to approach your sleep issue.

I have struggled with insomnia since taking medication for my depression and anxiety. When I’m not taking them and weaned off, my sleep is fine. But since my medications help so much I’d prefer not to be off of them. Is there anything that can be done besides taking seeping pills like I’ve been doing for the past 7 years? Thanks so much.

It can be a challenge to balance taking important medications for mental health conditions with the possible side effects, sometimes insomnia does need it’s own treatment. The good news is that non-medication treatments are actually more effective, and don’t have the same negative side effects as sleeping pills, and these treatments work very well for people with depression and anxiety. The best treatment for insomnia is a treatment called cognitive-behavioral therapy for insomnia or “CBT-I”. You can learn more about CBT-I at: https://sleepeducation.org/patients/cognitive-behavioral-therapy/. There are also tips about healthy sleep in general on this website.

How much rem sleep to we need to feel rested? Is there anyway to get more rem sleep?

Sleep has been traditionally divided into two distinct phases: Non-rapid eye movement (NREM) and rapid eye movement (REM). Both are what they sound like: your eyes remain still during NREM and move rapidly during REM. We shift through NREM and REM sleep stages throughout the night, in a cycle of about 90 minutes. A single cycle usually progresses sequentially through each stage of sleep: wake, light sleep, deep sleep, REM, and repeat.

There is no “perfect” amount of REM sleep. Most people spend about 90 minutes of time in REM sleep during a full night, but there is a lot of variation across healthy sleepers. The best way to increase the amount of REM sleep you get is to limit things that wake you up during the night like noise, light, pets, or other environmental factors.

If you are not feeling rested during the day, it could be because you have a sleep disorder or simply because you are not getting enough sleep overall.

What, if any, damage can severe cases of insomnia do to the brain/body over time?

While it’s true that chronic insomnia can be a detriment to physical, mental, and emotional health by negatively impacting daytime alertness, mood, memory and cognitive function, once insomnia is treated, these impacts can be reversed. Research suggests chronic insomnia can lead to increased risks of depression, anxiety, substance abuse and motor vehicle accidents. Impaired sleep can also be a risk factor for Alzheimer’s disease, and a recent study found that people who have insomnia are 28% more likely to develop Type 2 diabetes than those without. Chronic insomnia also has a negative impact on work and school performance, impairing concentration and increasing the risk of errors and accidents.

If you are struggling with insomnia, the best thing to do is to reach out to a healthcare professional and ask about cognitive-behavioral therapy for insomnia (CBT-I), or contact an accredited sleep center, which you can find at sleepeducation.org.

I have a tough time sleeping at night. I also deal with sleep paralysis and have recently taken melatonin to help me sleep. Can I continue being dependent on melatonin to help me get a good nights rest or is there something else I could be doing?

Sleep paralysis can be a sign of a sleep disorder, and it would be best to consult with a board certified sleep medicine specialist who can ask you a series of questions and decide if you need a sleep study. You can find one at sleepeducation.org.

In general, melatonin supplements appear to be safe, but the evidence that it is effective for some sleep disorders is limited.