Sleep benefits every aspect of our physical and mental health. When you sleep better, you don’t just feel better. You are better, all around.

Science continues to tell us that less sleep means a shorter lifespan. But, it’s not just the amount of sleep that’s important. It’s also the quality of sleep. Few things rival the natural health benefits of high-quality slumber.

We sat down to hear about the latest developments in sleep science with Dr. Amy Bender, Director of Clinical Sleep Science at Cerebra Health and developer of the only validated sleep screening tool for athletes. In fact, she has implemented sleep optimization strategies for numerous Canadian Olympic and professional teams.

Dr. Bender covers topics ranging from the benefits of naps to tips for those working the night shift to the importance of natural, outdoor light for optimal sleep.

Learn more about the science of sleep and how you can get closer to the sleep of your dreams.

Follow Dr. Bender on Twitter and Instagram.

Transcript

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Host: This is Life Without Limits, the One Drop Podcast that gives you the tools, inspiration and support to challenge your limits. We talk with experts across all areas of health to open up more possibilities for you. Lean on us, as you step outside your comfort zone, to work your way toward better overall health and a Life Without Limits.

Kim Constantinesco: Welcome back to Life Without Limits, the One Drop Podcast where we hear from health experts to help people transform their lives and re-imagine possible. I’m your host Kim Constantinesco, and on today’s show we have Dr. Amy Bender who is going to tell us everything we need to know about sleep. She is the Director of Clinical Sleep Science at Cerebra Health and adjunct Assistant Professor of Kinesiology at the University of Calgary. She received her PhD and Master of Science degrees in experimental psychology, specializing in sleep EEG.

She has helped develop the only validated sleep screening tool for athletes and has implemented sleep optimization strategies for numerous Canadian Olympic and professional teams. Dr. Bender, thanks for joining us today.

Dr. Amy Bender: Thank you so much for having me. It’s great to be here.

Kim Constantinesco: So the first question I have is, what got you interested in studying sleep in the first place?

Dr. Amy Bender: Well, I was kind of at a crossroads with my career, and my aunt was a sleep technologist. And she said, “Well, why don’t you come over and check out the lab. I’ll show you what we do here.” And so I went over there. She hooked up a patient with electrodes over the skull, the face, the legs and what you would do if you went into a sleep lab with all these wires hooked up, and showed me how those wires translated to signals on the screen. And it just absolutely drew me in to the study of sleep.

So I ended up going back home, calling all the sleep labs in my area, seeing where I could volunteer. Ended up volunteering at a sleep lab where I would – I worked overnight a few times. And then ended up landing a job as the lead technologist at the Sleep and Performance Research Center in Spokane, Washington and just luckily landed this job because the person I was volunteering for new the director of the lab, and worked as a sleep technologist where I was doing the same thing. I was hooking up participants with electrodes. We were measuring their sleep. I was scoring the different stages of sleep.

And then decided to stay at the lab but pursue my master’s and PhD in experimental psychology at Washington State University, focusing on sleep EEG. And from there I did a postdoc at University of Calgary where I worked with Canadian Olympic team athletes and tried to optimize their sleep. And then after my postdoc, I actually was working in the mental health space where I was using what I learned from athletes and the sleep optimization strategies to really help impact overall mental health at the counseling center that I was working at.

And then currently I am the Director of Clinical Sleep Science at Cerebra Health, and we are – it’s a sleep technology company. We are looking at different ways of measuring sleep depth and sleep quality. So it’s really exciting to be a part of this sleep technology company who has different medical devices to really improve the way that people sleep.

Kim Constantinesco: How interesting and sleep is something we all obviously need. It’s something we all do. But tell us, how important is sleep for our health, both physically and emotional health?

Dr. Amy Bender: Let me start by just saying that the number one thing you can do to improve your physical and mental health is to optimize sleep. Now I am a little bit biased here. I am a sleep scientist. Originally it wasn’t recognized as one of the pillars of health along with exercise and nutrition. But it’s currently definitely one of the pillars now. And I believe it’s the foundation of health. I think when we look at the research, those with poor sleep, whether it be quantity or quality, we start to see higher risk of obesity, diabetes, Alzheimer's disease, cardiac disease, even quicker mortality as well.

And then all of us have a personal experience with what happens when we don’t get enough sleep and we understand that our energy levels can be impacted. Our mood is impacted, our decision making, how even we respond to food choices has to do with how much sleep we’re getting. And if we looked at just one example, so looking at even just one hour of sleep loss and how that impacts our physical health, we have that experiment currently in most states and in most countries across the world, with Daylight Savings Time where we switch in the spring, and we lost an hour of sleep.

And what we see with that is there’s actually a 24% increase in heart attacks the Monday after Daylight Savings Time. And we also see increases in car accidents, workplace injuries, even serious issues such as suicide increases after the Daylight Savings Time switch. So it’s really important for people to prioritize this, everyone out there to help with overall physical and mental health.

Kim Constantinesco: Wow, so even just that one hour of maybe lost sleep really makes a tremendous impact in so many lives. So let’s talk about hours of sleep. So many experts recommend at least seven hours, from what I’ve read. And that’s seven hours each night. But some people based on their individual needs require more or maybe they’re able to get away with a little bit less each night. What’s your take on this, and how can someone properly assess how much sleep they really need each night?

Dr. Amy Bender: The recommendation for adults is between seven and nine hours, and that’s a pretty big range. And there’s a lot of individual variability in that as well. So some people may need seven. Some people may need nine. Some people may need even nine and a half, and that would still be considered healthy. But I think yeah, people need to try and strive for that seven hour minimum. And in some of the research that I’m doing looking at depression levels with different amounts of sleep, we see that actually about seven and a half hours is kind of that sweet spot associated with the lowest levels of depression.

So I would say at least a minimum of seven hours. And there are probably – we usually see about less than 1% of the population that can do really well on six hours or less. They have no memory impairment. They are doing great with decision making, reaction time. So there are a handful of individuals that can do well on little sleep. But I would say the majority of people need to really aim for that minimum of seven hours.

Now getting to your question on how do we gauge how much sleep we need, I think if a person is waking up naturally without an alarm clock, that’s a good sign, which probably not many of us out there are. Me personally, have a three-year-old who wakes me up at 6:00 in the morning every morning. But potentially if you are going without an alarm clock, that would be a good sign that you’re getting a good quantity of sleep. Potentially if you’re not needing a lot of caffeine during the day, for me personally I drink decaf, and that really helps me understand that if I’m tired during the day, that okay, I need to go to bed a little bit earlier tonight.

And a lot of us don’t have the luxury of actually going somewhere on a vacation. But that would be another way to kind of gauge, you take the first couple of days of the vacation. You get a good amount of sleep. And then take the averages from then on where you’re not having to get up early for work. You don’t have a lot of these obligations, and hopefully that will give you a good sense as to the amount of sleep that you need.

Kim Constantinesco: So let’s say someone is sleeping for maybe four to six hours a night, for whatever reason. What is your take on napping? Is that daytime nap recommended?

Dr. Amy Bender: I love napping. I think napping is – especially in athletes, it’s a very underutilized strategy. Yes, napping can be a way to – if for some reason you aren’t able to get that seven hours every night, it can be a way to make up for some of that lost sleep. And consistency of sleep is important as well. So for me, and especially waking up at the same time in the morning is really important. And so if I get a poor night’s sleep and I’m tempted to want to sleep in an hour later if possible, but it’s really important to try to keep that wake time consistent and then potentially add in a nap during the day to kind of make up for the poor night’s sleep that had just occurred that night.

Kim Constantinesco: Is there a sweet spot in terms of the timing of naps or the length of naps?

Dr. Amy Bender: Typically we say between noon and 4:00 p.m. would be an ideal timing of the nap. Because it’s not getting too close to bedtime, which could impact your ability to fall asleep. So if I’m taking a nap at 7:00 p.m., even a 30 minute nap, that’s probably going to impact my ability to fall asleep at night. So we want to keep it between noon and 4:00 p.m. And that also is in alignment with our natural drop in alertness due to our circadian rhythms. Even independent of what food you eat at lunchtime, we typically will see this drop in alertness. And so timing the nap within the drop really makes it a lot easier to fall asleep.

And then also being aware the length of the nap as well. So if you’re wanting just kind of a quick alerting nap, you would want to aim for less than 30 minutes because then you’re not getting into the deeper stages of sleep, which make you – when you wake up you feel very groggy. Or you could try, if you have a longer opportunity, you could try for about a 90 minute to 110 minute. And that would be incorporating all the different stages of sleep. So you would get your light sleep, your deep sleep and also the REM sleep by taking that longer nap. And then potentially try and wake up naturally without an alarm for those longer naps. For the shorter naps I would recommend an alarm because you don’t want to go too deep into sleep, wake up groggy. For those longer naps you may want to set kind of an emergency alarm and try and wake up naturally because that will help your levels of alertness if you’re waking up naturally after the nap.

Kim Constantinesco: Very helpful tips. So let’s say someone either has trouble getting to sleep or staying asleep. What are some of the lesser known strategies you can offer this person?

Dr. Amy Bender: I would say it kind of falls into three different categories. So there are breathing techniques, cognitive techniques and then stimulus control techniques. So the first one, breathing, is to have kind of a toolkit of different breathing exercises that you can go to. And these breathing exercises will help activate that parasympathetic nervous system, that relaxation system and really get you relaxed and help you get back into a state of sleep.

So for those breathing exercises my go to are the four, seven, eight breathing technique. So that’s where you breathe in for four seconds, you hold your breath for second seconds and then you breathe out for eight seconds. And you repeat that four times. And that’s, again, activating that parasympathetic nervous system. And any breathing technique where you’re actually breathing out longer than you’re breathing in, is going to help activate that parasympathetic nervous system.

So another one that my daughter actually learned at school, I was really impressed by this, was called snake breathing. So you breathe in and then you hiss out like a snake. And you’re breathing out longer than you’re breathing in. So that’s kind of the important factor for people to keep in mind with these breathing techniques. So you have – start with a breathing technique, then you can kind of go to a cognitive technique.

So the one that people may not know about is called the cognitive shuffle. So this is where you think of a word, such as bedtime. And you imagine all the objects that you can that start with that first letter. So if you take bedtime it would be the letter ‘b.’ So we think objects like ball, banana, bus, bag and when you can’t think of any more objects you move onto the next letter. So, e, eagle, egg, ear. And by the time you get to the end of the word, hopefully you’ll be sound asleep. And that technique really simulates what we do when we’re falling asleep. So when we fall asleep we kind of imagine different objects, different shapes. And so it really kind of gets us into that mind frame. And it also helps us take our mind off not being asleep.

So sometimes when we wake up in the middle of the night we get very angry. We get stressed out. So this technique can help kind of take your mind off of that. Kind of keeps your mind occupied enough, but not too much to where you’re having to concentrate a lot. So that would be a technique I would recommend. And for my kids I do a variation on that. I have an eight-year-old, a six-year-old and a three-year-old. I don’t actually do this with the three-year-old. But for the older kids we think of a color and we imagine all the objects that we can that are that color.

So if we do red, we can imagine a strawberry. You can even imagine a red shirt, a red sweater, a red chair. Anything that is the color red. And that is kind of similar to that cognitive shuffle technique. And then the final technique is called stimulus control. So we want to associate our bed with being asleep. We don’t want to be awake too much in bed. So if we’ve tried those first two techniques and we’re still wide awake, the best piece of advice would be to get up out of bed. Go to a different room in low light and do a relaxing activity, such as reading a book. And only return back to bed when sleepy. And that will help associate our bed with being asleep.

And I just want to mention, too, that if this is happening to you a lot where you’re waking up almost every night, you’ve tried different things. This has been occurring for a couple of months now. You probably want to get it checked out by a sleep professional. So don’t wait. Don’t try and solve it on your own if this is kind of a chronic problem. Really get help from a sleep professional who can help you with potential sleep disorders that you might have.

Kim Constantinesco: And at what point do you realize that maybe you should seek that outside expert and go in for testing or for ways to cope?

Dr. Amy Bender: I would say if it’s occurring three or more times per week, and it’s been occurring for three months. That’s kind of the point where we want to definitely get it checked out. And I mean, you can do it sooner. That’s not a bad thing either. But if it’s occurring three or more times per week and it’s been happening for three months, that would be definitely the time where you want to get it checked out.

Kim Constantinesco: And those techniques that you just described, I would assume they work really well with those who work night shifts as well. Is there any other tips or strategies that might work especially well for night shift workers?

Dr. Amy Bender: Yes, night shift workers, it’s so challenging. But our society needs those workers working at night. We’re meant to be sleeping at night. So it can be challenging for night shift workers to be sleeping during the day. But I would say yes, using those techniques, having a napping strategy for sure. If you’re able to nap during your shift, this is becoming more recognized as a strategy. Previously it was, no napping at all. But I think employers are starting to realize that alertness levels are going to improve if I allow my workers to be able to nap on the night shift.

But those are some good techniques. Having a good sleeping environment. So obviously if you’re sleeping during the day we want to have blackout blinds. We want to have a controlled temperature as well. So we want it to be cool, dark and quiet, like a cave. So having earplugs, having maybe a white noise machine, blackout blinds. Those are going to make it better, more conducive to sleep when you’re sleeping during the day.

And I would say in general the research has shown that shifting more towards being a night owl, even on your days off can be beneficial. And it doesn’t have to be – obviously the ideal scenario would be to have your same schedule all throughout the week. But most night shift workers, they want to be with their families. They want to be with their friends. So on their days off they revert back to a more normal sleeping at night type of schedule. But if you can kind of stretch that out a little bit and on your days off go to bed later, maybe midnight where you’d normally go to bed at 10:00 and then wake up later, is going to kind of put your circadian rhythms in a more easier condition for when you have to work those night shifts. So that would be some strategies. Potentially limiting eating during the night has been shown in the research to be helpful.

So instead of having large meals during the night, kind of break that up with snacks if you can. And those strategies have been shown to be helpful. But it is very challenging for night shift workers for sure.

Kim Constantinesco: And I would imagine that a lot of the people who are working those night shifts are ones who tend to lean more on sleep aids. Whether it’s supplements or light therapy. Is there any merit to any of those sleep aids that are out there?

Dr. Amy Bender: Sleep aids, yeah, they’re tricky. I mean, in certain instances I think they’re very useful. So, for example, I was working with an athlete who could not sleep on the plane. And they were flying overseas a bunch for different competitions. And it would be an overnight flight, and he wouldn’t get any sleep whatsoever. The doctor had prescribed a sleep aid for him to allow him to sleep on the plane, and that was just a game changer for him. Because instead of going in with a huge sleep debt on this overseas trip, he would be relatively well rested for the start of training and the start of competition.

So in certain instances I think sleep aides can be useful. What we see in the research is that sleep aids, if you can get away with not having them, the sleep aids can kind of stimulate sleep. But they can impact the overall sleep architecture. So it’s better if you could avoid using them. And there are techniques, especially for insomnia that are the gold standard treatment. So cognitive behavioral therapy for insomnia is just as effective if not even better than using a sleep aid.

Now when it comes to melatonin, melatonin can be useful for shifting circadian rhythms. So in a night shift worker this would be potentially useful. As a sleep aid for falling asleep it’s not as effective. But if we’re talking about shifting rhythms for jet lag or for night shift work or even for an adolescent who is a night owl, consuming that melatonin two hours before they would want to go to bed is going to help shift their rhythms earlier. But I would say with melatonin that there is an issue of what are you actually getting? Because it’s an unregulated substance. It’s a supplement. And one study found that only about 20% of the melatonin supplements sampled was within 20% of the label.

So 80% were not what they were saying it was. So if they said 10 milligrams, 80% were not within 20% of that 10 milligram range. So you have to really be careful about what you’re getting, and you want to get a good, high quality melatonin supplement if you’re going to use that.

Kim Constantinesco: Sure, that makes a lot of sense. Now Dr. Bender, given all your experience in working with athletes and seeing the impact of sleep on physical activity and performance, can you talk a little bit about how sleep affects our ability to be active in day-to-day life and maybe our desire, our energy levels when it comes to exercising?

Dr. Amy Bender: Yes, we do find that with more sleep, we have a tendency to go longer in the workout. And when we sleep deprive the same person, they just get tired much, much easier. So sleep deprivation can impact the length of your workout, and actually more about how you perceive the workout. So if you’re sleep deprived going into a workout, you’re going to perceive that workout to be much harder than if you were well rested. So yeah, that is something to keep in mind, that with good sleep I think we get better exercise results as well.

Kim Constantinesco: So let’s talk about your sleep a little bit. What is one trick that you use almost every day to ensure that you get a good night’s rest?

Dr. Amy Bender: Great question. I don’t know if I’ve ever been asked this before. I would say one thing that I really strive to do is to get lots of light throughout the day, but especially in the morning. So light helps set our circadian rhythms. It helps regulate our melatonin. It helps improve our sleep quality at night if we’re getting light during the day. And especially getting light outside is just so much brighter than the light that we have indoors.

And I recently actually checked my light levels in my office, which I’m down in a basement. I have a very, very small window. And I checked my light levels and I was below 100 lux. So lux is measuring how bright the light is. So I was below 100 lux. I go outside on a cloudy day and I was up to 14,000 lux. So we’re talking 140 times brighter outside than it is with my indoor office lighting where I’m stuck at my desk a lot during the day.

So I think that’s something really important for people to keep in mind. That getting lots of light, especially in the morning, has been shown to improve sleep quality at night. But even just overall exposure during the day. So if you miss a walk outside in the morning during daylight, trying to get that during the afternoon and limiting that light in the two hours before bedtime is also important. Because light sends a signal to our brain to wake up. It reduces our melatonin. So if we’re in lots of bright light right before bedtime, that’s going to potentially impact your ability to fall asleep. But could be waking you up during the middle of the night.

Kim Constantinesco: Ah, that makes a lot of sense. So all those people living in Alaska, are they calling you year round for sleep strategies?

Dr. Amy Bender: {Laughs} I have a sister-in-law who actually lives in Alaska and yeah, I was there once during the summer. And it is just crazy that the sun doesn’t set. And it’s continually above the horizon. And yeah, the opposite is true during the winter as well. And it is interesting that we do see on, let’s say the shortest day of the year or during the winter months, you would expect because it’s so dark that we may be sleeping longer. But in reality we’re actually getting less sleep during the winter. And that’s potentially related to the fact that we don’t get a lot of light during the day. The sun is rising later and later during those winter hours.

And so that makes it absolutely even more important to get light outside. And if that’s not possible, to potentially use a SAD light, so a Seasonal Affective Disorder light. There is also light glasses that you can use as well that are really convenient. You can walk around your house. You can wear them over your glasses. And you’re getting about 20 minutes of that bright light in the morning that can help maintain your sleep quality and really help regulate your mood as well.

Kim Constantinesco: Wow, who would have thought, the power of even just stepping one or two feet outside, what that can do for your health.

Dr. Amy Bender: Yes, I love that tip, and I think people just don’t realize how much brighter it is outside versus our indoor lighting.

Kim Constantinesco: Definitely. Well Dr. Bender, thank you so much for coming on the show today. It’s been a pleasure, and we look forward to learning more about you. Where can people follow you, either online or elsewhere if they want to learn more about your work?

Dr. Amy Bender: I am on Twitter and Instagram at sleepforce4, the number four. And then I’m also working on developing a website, Sleepwelltowin.com. It’s not quite ready yet, but that would be a place for people to go. But follow me on social media, and I’ll be able to update you on when that website goes live. And also I’m planning on doing different blog posts and such. So yeah, hopefully people can get in touch that way.

Kim Constantinesco: And we’ll be sure to put the links to your Twitter and Instagram pages in our show notes as well. So Dr. Bender, before we sign off, is there one last tip or trick that you can give people when it comes to their sleep health?

Dr. Amy Bender: We’ve covered a lot. Let’s see, I would say having a good pre-sleep routine. So we didn’t necessarily talk about that. So an hour before bed put away those electronic devices. Do relaxing activities. So taking a warm bath or shower has been shown to make you fall asleep quicker at night, about an hour or two before bedtime. So you could try that. Writing a to do list. So right before bedtime, this study found that those who wrote a to do list actually slept better than those who were just journaling about their day.

So it wasn’t necessarily about the writing. It was about actually offloading those thoughts that you have—what do I need to do tomorrow—onto paper and then those people fell asleep quicker. So having a good pre-sleep routine, maybe incorporating some stretching, some breathing techniques as well will be a way to help prepare your mind and your body for sleep. And then just remember that it’s also not just about what you’re doing right before bed. But it’s what you’re doing throughout the day. So getting good exercise, getting lots of light activity outside. Stress management as well, so potentially medication. All those things we hear about that are important will also help impact your overall sleep health.

Kim Constantinesco: Great. Well, Dr. Bender, thank you so much again for coming on today.

Dr. Amy Bender: Thanks so much for having me. It’s been great.

Kim Constantinesco: Stay tuned for more great episodes of Life Without Limits as we aim to help you be proactive about your health and change how you think and feel on your health journey. We’re in this together.

Host: Thank you for listening to Life Without Limits. If you liked this episode, tell a friend. We’re here to help you take back your time, power and life so you can live to your fullest potential.

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