Q: What should I do if I am still tired after sleeping the recommended hours of sleep?
Dr. DelRosso:
The recommended amount of sleep per age group is determined by taking the average of the sleep requirements of the general population. In this sense, some people may require a little longer sleep. You may try to go to bed a little earlier or try to sleep in and see how you feel. If you still feel tired and have a bed partner, ask if there are any symptoms that are disrupting the quality of your sleep, such as snoring, leg kicking, or grinding your teeth. A visit with a sleep specialist may be recommended.
Dr. Lipford:
Most adults need 7-8 hours of sleep nightly to feel rested. If you still feel tired despite getting the recommended number of hours of sleep, it could mean there is a problem with the quality of your sleep. Some steps that can improve sleep quality include avoiding alcohol and caffeine late in the day, avoiding digital devices before bedtime, and sticking to a regular sleep/wake schedule all days of the week. If you are still tired despite these suggestions, check in with your doctor. Your doctor can evaluate you for sleep disorders that can disrupt sleep and prevent you from getting deep, restful sleep. Your doctor can also screen you for other medical disorders that may result in daytime tiredness.
Dr. Zak:
As wonderful as it is to have a recommended number of hours of sleep, it does not apply universally and is only a guide. You need the amount of sleep you need to feel rested so if you are tired during the day, do try to increase your total sleep time–either at night or by adding planned naps. If you are going to nap, try to limit the nap to 20 to 30 minutes so that the nap can be refreshing. Sometimes taking a longer nap can paradoxically be less refreshing if you enter “deep sleep”, you can have a feeling of “sleep drunkenness” and feeling as if you have not slept. If after maximizing total sleep times you still do not feel refreshed, then discuss with a healthcare professional whether you might require further workup for causes of poor-quality sleep as evidenced by snoring or leg kicking which could suggest an underlying sleep disorder.
Dr. Thomas:
Persistent exhaustion despite an apparently adequate number of hours at night means one of three things: that the sleep duration is not sufficient (there is a range of natural requirements, and some individuals need 9 to 10 hours sleep); there is sleep pathology (sleep apnea, etc.), or a third condition which causes exhaustion regardless of the quality of sleep (e.g., multiple sclerosis, chronic fatigue syndrome, idiopathic hypersomnia). It may be hard to differentiate sleepiness from fatigue, but sleepiness is somewhat easier to diagnose and treat. Thus, a trip to a sleep specialist is likely called for.
Q: Can heavy exercise interfere with sleep?
Dr. Thomas:
Exercise in the evening can improve sleep quality but not when close to bedtime. Exercising late in the evening under bright light (a typical gym) is a recipe for trouble falling asleep.
Dr. DelRosso:
Studies have shown that exercise during the day helps sleep but exercise too close to bedtime can actually delay sleep. I usually recommend exercising earlier in the day to mid-afternoon.
Dr. Lipford:
Exercise is an important part of a healthy lifestyle. A regular exercise regimen can be very conducive to restful sleep. However, a strenuous workout close to bedtime may make it difficult to fall asleep. Consider scheduling high-intensity exercise in the morning or afternoon. Light to moderate-intensity activities such as walking, yoga, or stretching are generally ok closer to bedtime. Each individual may have a different response to exercise, so it may take some trial and error to figure out the best time for your exercise routine.
Dr. Zak:
Great question because it emphasizes, as above, the need to figure out what is best for your body and brain. Generally, it is felt that exercise in the evening can have a negative effect on sleep so we recommend exercising earlier in the day. There are individuals for whom the opposite is true, and you can see what works for you. Many people find that stretching prior to sleep can be a useful way of engaging the body in part of the wind-down routine without increasing wake-promoting chemicals, such as adrenaline.
Q: How is sleep impacted by health issues like depression and heart disease?
Dr. Zak:
People are complex, so, yes, health issues can definitely have a negative impact on sleep continuity and quality, and ironically so can the medications used to treat these conditions. Thus, as clinicians, we try to identify if the health issue or its treatment could be having a negative impact and to walk that difficult line of trying to keep people healthy and functioning in all domains.
Dr. Thomas:
Sleep is often severely impacted. Insomnia is more common than hypersomnia (sleeping too long) in depression. Heart failure usually causes insomnia, in part from sleep apnea, which is very common in those with heart failure.
Q: Is it normal to wake up but not be able to move?
Dr. DelRosso:
This is called sleep paralysis; it usually occurs when you wake up in the middle of a sleep stage called REM. During this sleep stage, your body is in a state of “paralysis.” This can occur in states of sleep deprivation so a first recommendation is to obtain an adequate amount of sleep. If it persists and occurs frequently or in association with other symptoms, we recommend being evaluated by a sleep physician.
Dr. Zak:
You may have sleep paralysis. To understand sleep paralysis, you need to understand the physiology of REM or “dreaming” sleep. During REM sleep, most of the body is paralyzed (although obviously not all of it since “REM” does stand for “rapid eye movement” so the eyes are moving and your diaphragm, the base of your lungs, is moving) –particularly the arms and legs.
Sleep paralysis occurs upon awakening from REM sleep while maintaining that REM-related paralysis for a short period of time. It can be very scary and some people feel as if they cannot breathe–as if there is “an old hag” sitting on their chest–because some of the muscles usually used to breathe are also paralyzed but luckily not all so you are breathing–it just feels different. As you have probably figured out, this feeling will spontaneously resolve and it often runs in families (ask your parents!) It is more likely to occur when you are getting recovery sleep from prior sleep deprivation and, for some reason, is also more common when sleeping on the back so try to get adequate sleep nightly and, if necessary, sleep on the side. There are medications that can prevent it, but for most people, it occurs rarely enough that it is not worth taking a daily medication.
Q: What can I do to get my child to wake up early to go to school?
Dr. DelRosso:
The best situation is to have a bedtime that allows for an adequate amount of sleep at night. For example, a ten-year-old requires on average 10 hours of sleep at night. If wake-up time is 7 am, the child must be asleep by 9 PM. Ensuring an adequate amount of sleep will ensure an energetic morning awakening. If your child snores or has any other potential disruptor of sleep quality such as frequent movements, kicks, or nocturnal awakenings, it may be beneficial to consult a sleep specialist.
Dr. Lipford:
Most families face at least a few struggles this time of year when transitioning to the fall school schedule. It is important for children to obtain enough sleep nightly so they can wake up feeling rested and can stay energized and focused throughout the day. While adults typically need 7-8 hours of sleep nightly, children need more sleep. You may need to move your child’s bedtime earlier to ensure they are getting enough sleep and to make it easier for them to awaken. Creating a pleasant, calming bedtime routine can help children relax and fall asleep more quickly. Similarly, an energetic morning routine, with some moments of fun built in will make it easier for kids to get up and moving in the morning. If your child still struggles with getting up in the morning or seems to be low on energy during the day, check-in with your doctor or consult with a sleep specialist.
