We know sleep is an essential function for our body and mind, but how much sleep do we really need? What happens if you don’t get enough sleep? Episode 68 of the Hope4Med podcast features Dr. Olufunke Afolabi-Brown, a board-certified pediatric pulmonologist and sleep medicine physician. Dr. Brown talks to us about the importance of sleep, in both quantity and quality. She discusses the detrimental effects of sleep deprivation and how we can create habits to get a restful sleep. She also shares sleep “hacks” to help shift workers optimize their sleep.

Connect with our guest:
Website: https://www.restfulsleepmd.com/

Transcript:
[00:00:00] Dr. JB: Welcome to Hope4Med.

[00:00:04] Hi, welcome back to the Hope4Med podcast. I am your host, Dr. JB, and today’s featured guest is Dr. Olufunke Afolabi-Brown. Dr. Brown is a board-certified pediatric pulmonologist and sleep medicine physician. Welcome to the show.

[00:00:21] Dr. Afolabi-Brown: Thank you so much for having me. I’m so excited to be here.

[00:00:25] Dr. JB: Yes, me too. And I am very excited to learn about your origin story, so let’s start there.

[00:00:32] Dr. Afolabi-Brown: Yeah, absolutely. So, as you mentioned, I am a board-certified pediatric pulmonologist and sleep medicine physician, and the reason or how I came about this, I would say started off from when I was in medical school, right? It was a very stressful time, needless to say. I struggled a lot with sleep, lack of sleep, right? It was kind of like a narrative or a badge of honor to say that you slept only six hours and all that, and I followed the crowd. So, my friends would go to the study hall at 10:00 PM. I’m not really understanding my, kind of, like what we call our sleep chronotype, meaning our sleep tendencies, would just go with them and just kind of sleep the entire time that they’re there. Then they wake me up to come back to the room afterwards and so I would be exhausted. My neck hurts. I’ve been reading one line over for like four hours, the next day I would not be able to remember that one line I read. And so, I did that for a while, extremely exhausted and anxious and just really, really struggling, working like three times as hard for the same results. And at that time I did not know the, I did not understand the consequences of sleep deprivation. I just thought this was what it was.

[00:01:54] It’s now like, as a sleep medicine physician understanding the science and realizing that everything I experienced was all like, it’s been supported by research in terms of the consequences of sleep deprivation.

[00:02:08] And so, eventually I kind of realized I needed my sleep. I needed to go to bed in time. And even if I needed to wake up early to study, that was just how I function. And so that was kind of like my introduction to sleep. That’s interesting, right? And then, fast forward to training and residency and then came the kids. My son had reflux and that really impacted his sleep a lot, and of course automatically, affected mine.

[00:02:36] And again, I was on this, I was really struggling because of that, but, I went into my pulmonary fellowship really to help kids who had sleep disorders and then they come in and one of the things their parents are saying is they’re not sleeping. They’re up all night coughing or they’re snoring and I’m not sleeping. And so, theme again, comes back and prompted me to go forward and pursue a fellowship in sleep medicine. And then, once I did sleep medicine, just really realizing that it’s not just about the breathing, the sleep-related breathing disorder, there’s so much more that goes on when we sleep and when we don’t sleep. I really decided I wanted to take this on as just my career moving forward and I, and that really prompted me to create the company, my company, Restful Sleep MD.

[00:03:30] As the families were coming in and mom’s like, what? I don’t even know how I got here. I just know I drove here somehow because I haven’t slept in days And my son hasn’t slept in days. I realized this sleep deprivation in children is not only affecting them and their growth and development but affecting the parent as well. And this really resonated with my story as well. And so, I’ve really been on a mission to help moms sleep better by helping their kids sleep.

[00:03:59] Dr. JB: So, tell me a little bit more about the science behind the sleep, the importance of sleep.

[00:04:06] Dr. Afolabi-Brown: Yeah, yeah, absolutely. So, one of the things I say is sleep is not just a cure for sleepiness. We don’t just Sleep because the days ended. And really looking from top to bottom, every organ system pretty much is impacted by sleep. And we, starting from up top, we talk about even just the cleansing function of sleep. So, there is a system in our brains called the glymphatic system, So G- lymphatic system, so similar to our lymphatic system, and what this really does is it helps with cleansing deposits that kind of accumulate on in our brains over the course of prolonged wakefulness over the course of the day. So, think of it as a, kind of like the brain’s plumbing system. And actually, some of these deposits include things like amyloid beta which have been associated with diseases like Alzheimer’s. So over time, those deposits have to go, they need, we need to get rid of them.

[00:05:10] Not just– so, so when we talk about sleep, it’s not– most people feel that sleep, during sleep, there’s just period of quiet and rest and quiet sense. It turns out your brain is quite active when you sleep, really doing that. I mean, addition to that, sleep is important for our memory. And so, a lot of studies have shown that as well. Our executive function, our creativity, and really the way this is, is that we go through different cycles of sleep, and while the absolute functions are not well-known, there have clearly been studies that I’ve looked at, if you deprive someone of slow wave sleep, what happens.

[00:05:49] So really in slow wave sleep, that’s when we get rest and restoration and recovery and regulation of our immune system, you get hormone regulation, and so, things like growth hormone, for example, in children it’s really produced during slow wave sleep. And then in REM sleep, we talk about creativity and emotional regulation and things like that. So, they, all of it all works together. And so that’s why when people ask things like, oh, what’s the best time if you’re going to shortchange yourself of sleep, which one should it be like earlier or later on? The answer is no, both, both play a role in really helping us to be our healthier selves.

[00:06:27] And then of course the consequences even on our heart health. So, sleep deprivation has been associated with increased risk of hypertension and cardiac arrests, and strokes, and things like that. So really, really spanning the entire system. I would say sleep is beneficial and has deleterious consequences when we don’t get enough of it.

[00:06:50] Dr. JB: So, is there a definition for sleep deprivation?

[00:06:55] Dr. Afolabi-Brown: So really when we talk about sleep deprivation, there things like sleep deprivation, insufficient sleep, and really it’s when you have– I mean you might have periods of like actually sleep deprivation, which even right away, you start to tell, even if you miss one night of sleep of good sleep, you can already tell that something is a little unwell, so you already have that, but over time, when you talk about sleep deprivation, you’re talking about the impact or decrease in either sleep quality or sleep quantity. So not just focusing on quantity because a lot of times we do try to get those ideal seven to nine hours of sleep and all, but beyond that, there are other facets to sleep that can actually deprive us. So, you may be getting the seven or nine hours of sleep, but if it’s not continuos sleep, because there’s some kind of underlying disorder, you can actually be sleep deprived.

[00:07:55] Dr. JB: So, does the clock start over every time you get awake or waken up? Does that make sense? So, if you get one hour here and then you’re up for thirty minutes and then two hours there and you add them all up, does that give you seven hours or does that really just start all over each time?

[00:08:14] Dr. Afolabi-Brown: That’s, that’s a really great question. The way it is, we actually go through different cycles of sleep. And we all wake up, It turns out we all wake up at night. Everyone wakes up in the middle of the night, anywhere from two to four, or two to six times actually, we all do. And the reason why is we cycle through different stages of sleep. So, you go through, you know, usually it’s slow wave sleep, that deep sleep you get, what we call non-REM sleep, occurs on the earlier part of the night, but we kind of cycle through and then you start to get more predominant REM sleep at the latter part of the night. So, for example, a typical sleep cycle would be you go through that non-REM sleep, which is then further broken down into three. You go through light sleep, which is kind of that drowsy feeling you start to get, and then you get to N2 sleep, which is sort of a slightly deeper level, and then N3 sleep, or the third stage is that really deep sleep. And then you then go into REM sleep, which is your dream sleep.

[00:09:14] So your REM sleep at the beginning of the night in proportion, relation to your, to your non-REM sleep, your REM sleep is more shorter overall. Though REM sleep is still shorter, but as you go through the night, as you have more continuous sleep, you’re cycling through normally, And then you start to get longer and longer REM sleep. So, if you fragment your sleep, well, it may not necessarily mean that you’re starting from N1 or the first stage again, you’re going to probably be depriving yourself of the ability to get into that REM sleep appropriately overtime, if that makes sense.

[00:09:48] Dr. JB: And so, you mentioned that quantity and quality of sleep is important. And so, I can understand how somebody could try to control the quantity of sleep they get, but how do they improve the quality of sleep they get?

[00:10:01] Dr. Afolabi-Brown: Yeah. Yeah. So, with quality of sleep, there are various things that can be affected. So, some of those things are, sort of external factors that can affect the quality of our sleep. And then there are more like intrinsic factors as well as disorders, medical disorders, and things like that can affect our sleep. So, I usually try to break it down that way.

[00:10:26] So those sort of more extrinsic factors are things like caffeine intake, things like technology use right before bed and the use of blue light. The factors that can affect our sleep environment. So if you’re too hot, it’s hard for you to get good quality sleep even though you’re in bed. If your mattress is uncomfortable, those are things that can affect our sleep quality. The type of food we take, if you eat a really heavy meal just before bed, that’s going to make you really uncomfortable because then your body’s sort of focusing on digestion.

[00:10:57] And then intrinsic factors, things that I like to talk about are things like, anxiety or underlying stress, emotion dysregulation, all those things can affect our sleep quality, because then your brain is really just still constantly in that fight-flight-response mode.

[00:11:17] And then thirdly, would be sleep disorders. So, obstructive sleep apnea, periodic limb movement where you just have this restless leg, restlessness in your sleep and those jerking movements kind of takes you out of deep sleep to lighter stages of sleep. So really fragmenting your sleep and then you’re waking up just really exhausted. And so those really are things. So, there are some things that are modifiable with our sleep in terms of the quantity And there are some that definitely will need the help of an expert to really tease those factors out.

[00:11:51] Dr. JB: Well, could we take some time to explore the topic of stress? Our work as a physicians is pretty stressful, no?

[00:12:00] Dr. Afolabi-Brown: Exactly, absolutely. And I think, especially during this time, who knew we would still be in a pandemic, right? So, things have really escalated mental stress, mental health, as anxiety, depression, suicidality, it’s at an all-time high. And well, usually the way we see this is it’s almost, it’s a bi-directional relation. So not necessarily that sleep deprivation is what’s causing stress. It does impact your ability to handle, it impacts your ability to be, to show empathy, your ability to be resilient, when you’re sleep deprived. And then on the other end, if you are stressed just the coping mechanism and the ability to separate sleep or your bed, um, associate your bed with sleep is harder.

[00:12:49] So one of the things that I usually would talk about is when we’re sleeping, one of the framework that I share is it’s really important to assign your sleep for bed and your bed for sleep. So, you think you’re in bed, then your brain should think sleep. But when we’re extremely stressed, when we’re going through a very hard time, your brain makes all kinds of random associations, so sleep and worry, sleep and overwhelm, sleep and, oh my goodness, that endless to-do list, sleep and all the obligations that I’m bringing into bed with me. So, then that really makes it harder for us to fall asleep. And then on the, you know, it becomes this vicious cycle that you wake up because you have just kind of slept with all that worry on you. If you had a hard time with sleeping, then your threshold to handle the stress the next day is much lower. And so, then you’re really in this cycle. So, it definitely does impact our sleep significantly and vice versa.

[00:13:50] Dr. JB: So, what did you notice when you were going through training and you were, you explained how you are spending these– well you didn’t say all-nighters, because actually it’s like, oh, I didn’t sleep at all last night and I’m going to go take this test in six hours, it’s a lot of time to actually get…

[00:14:07] Dr. Afolabi-Brown: I was being, I was being generous. You’re right, if you got 6 hours, you were lazy. Like, yeah.

[00:14:15] Dr. JB: Yeah. So, no, but yeah, yeah, six hours you were, what were you doing? You got six hours of sleep. So, what did you experience if we go back through those sleep deprivation periods of your life, through training and things like that, that made you say, ” I want to specialize in sleep medicine.”

[00:14:34] Dr. Afolabi-Brown: I think it was the living in a constant fog. It was, it was just exhausting and just really my anxiety level. I didn’t even know it was anxiety, it was just constantly feeling like your heart rate was high and your heart was in your mouth. And without any clear, I mean, of course being in medical school in and of itself is anxiety-provoking but living that way constantly even when it wasn’t like the shoe was about to drop, was something that I felt. And just the fatigue. So that was, so it was, I felt very anxious, I felt constantly rolled, and I was just tired. Those three main things, and I would say my decision-making skills were not necessarily the most ideal. So, I think, you know, I feel like it affected all those areas definitely when I was in, when I was in training and I wasn’t getting enough sleep.

[00:15:33] Dr. JB: And were you able to make up for it? So, one night you, you stayed up all night and then the next day you slept, did that cancel each other out?

[00:15:42] Dr. Afolabi-Brown: I know, right? That’s the, that’s always the conversation I have a lot with teenagers or even parents, even moms, the idea that, let’s just go through this period and maybe we’ll try to catch up. The thing is, we never can catch up because if you think about it, using adults as examples, seven to nine hours of sleep is what’s recommended and that has not necessarily changed. The society has changed that, and caffeine and all these other energy boosting tools have definitely changed that, but that physiologic need has not changed. And so, if you think about it, even if you didn’t sleep enough all week, let’s say even if you were, you should be able to get seven hours and you were only sleeping five or four hours, that’s a lot of debt. That’s like 10 hours worth of sleep that you owe. So even if you try to split it up on Sunday and Saturday, the likelihood that your body will be able to add on an extra five hours on top of the seven hours, it’s possible but not continuously in the long run. So, you are not likely to be able to catch up on sleep.

[00:16:56] The idea is to try to prioritize it now and get as much of it as you can. Sometimes taking a nap sometimes will help, especially when I think more of like our teenagers who have early school start times and they have a whole change in, in the kind of like delayed circadian rhythm, and so their bodies are preferring a later time and things like that. Like taking a little bit of a nap can help with taking the edge off, but overall, the amount of sleep you get when you chronically sleep deprive yourself, it’s going to be really hard to make up for.

[00:17:30] Dr. JB: So, if we talk a little bit more about like healthcare workers and shift work and settings where you are expected to work different times, so it’s not like a set schedule that several healthcare professionals find themselves working in. How do you incorporate that in terms of good sleep?

[00:17:51] Dr. Afolabi-Brown: So, that’s one, it’s actually, the international classification of sleep disorders actually classifies shift work as a significant health risk because of that, because it’s really hard to make up that sleep. And actually, there’s an actual diagnosis of shift work sleep disorders, we’re really seeing in people who have, who do work shifts and such that even when they are now back to regular work time, are just unable to cope. They’re unable to sleep. They’re really having a hard time functioning. And so that’s like a true disorder.

[00:18:30] And so, but for shift work, I have, I make different recommendations. One of the things that I have asked people to consider is just getting as much sleep as they can, because what are we going to do? We can’t shut down shift work because we do need the ED, we do need the hospital, we need nocturnists and things, so the idea is getting as much sleep as we can. So, there are strategies that can be put in place before you go into your shift, there are strategies you can put in place while you’re on your shift, and there are things that you can do after to optimize sleep.

[00:19:08] So before your shift, the idea is to try to take a nap as much as possible. It’s going to be hard because our bodies sleep, our bodies or our sleep is regulated by two processes. One is our circadian rhythm, which really operates on a night and day. And so, you’re asking someone to sleep when it’s against their circadian rhythm, their bodies are supposed to be awake. So, there are ways you can do it, you can make your room as dark as possible, make it cool, avoid interruptions and all that to try and get as much of a nap as possible before your shift.

[00:19:43] When you’re on your shift, now I’m talking about maybe people who are night shift, you want to either take some caffeine, so in this case, you can see, I mean, usually I would say avoid caffeine after 12, but if you’re going into a shift, you can take caffeine at the earlier part of your shift and you expose yourself to as much bright light as possible. So, the reason why is your body’s melatonin production really kicks up at night, right? Because it responds to the dark, we call it the dark hormone. So, when you expose yourself to light, you’re really suppressing that. And when we’re using some caffeine on a background or at least a nap before, you’re driving down that adenosine which really contributes to your sleepiness. So, when you do that and you go through your shift, about, I would say, maybe like four hours or so to the end of your shift, you really want to start getting, avoiding very bright light as much as possible.

[00:20:40] So you can see that we’re sort of almost like trying to mimic what you would do if you were on a regular schedule. So, you’re, you start to try to avoid that And then at the end of your shift, I want you to wear the darkest, ugliest sunglasses ever to avoid any type of light. Because again, now we’re trying to get that melatonin, you know? And then you don’t, don’t go to the grocery store, don’t run any errands, go straight home. If you’re sleepy, Uber, catch a cab, whatever, because you’re not, you shouldn’t drive sleepy. So dark glasses, headed straight home, a “do not disturb” sign at the door. You have, you know, family that can understand that this is time to sleep, this is my night. Blackout curtains may be an investment, but it’s definitely worth it for shift workers. And then you get into a routine. So, you have the same routine you would have had at night, which is you take a warm shower, you get into comfortable clothes, you take, you know, noise cancelling headphones if you need to. Try to minimize any form of distraction and you sleep for as long as possible to prepare yourself for the next night. So that I feel really helps people cope, especially when they’re working shifts.

[00:22:03] Dr. JB: And so, what about when you transition from nights to days and then back and forth?

[00:22:10] Dr. Afolabi-Brown: Yeah. So, it’s, it then starts to be, it gets very complicated with that too, but I think– oh, the other piece I would say is you can also take melatonin. So exogenous melatonin, which is, it’s marketed as a dietary supplement, that can help as well. So, when you’re shifting, if you have sort of more of a rotating shifts, it’s really, again, looking at when your shift is and kind of using that system, same system to prepare yourself for the shift. And then there will be overlaps, which what I would recommend is just to try to either push through as much as possible so that you can get at least a decent amount of sleep at night.

[00:22:51] Dr. JB: Okay. You brought up melatonin, lately, I don’t know if you’ve seen in the news, there’s a lot of talk about melatonin and it not necessarily being healthy. That there’s some discrepancies in terms of like the over-the-counter melatonin products, how much melatonin truly is in the product, and there was no standardization. Have you seen any of those things?

[00:23:12] Dr. Afolabi-Brown: Yeah, absolutely. So, I think that’s the issue, melatonin is not FDA regulated. So, it’s a dietary supplement and you might have one that’s marketed as having 5 milligrams, in that same bottle, You may have 0.5 milligrams and you may have 20 milligrams in there. And there are studies that actually looked at just the content in terms of the dosage, and I think it ranged from anywhere from like minus 83% to like plus 470-something percent, just the variability in one formulation. So again, it’s not FDA regulated, some countries have it regulated and so there’s like, I think in some European countries and things like that, so you’ll just have to be cautious about the use.

[00:24:00] And also, even when it says “all natural” and “certified,” you just have to be careful because some of them also have pollutants in there. So really reading the instructions as much as possible. Some may have things like additional serotonin and things, which can affect the dosing of the melatonin as well. So, if you’re going to get that, make sure you’re getting it from like a brand that’s well-trusted, well-known, as things like that, because yes, we do run into those issues. And another thing I tell people, if you use melatonin, you really want to use it with the guidance of your doctor, because there’s some medications that melatonin actually can interact with. And so again, if you’re on like things like anticonvulsants, if you’re on anticoagulants, I think some anti-hypertensives as well may potentially interact with melatonin. So that’s definitely something I always recommend if you’re going to use it, even if it’s just for short time, definitely just checking with your physician.

[00:25:04] Dr. JB: So, share with us a little bit more about your schedule and your sleep habits.

[00:25:10] Dr. Afolabi-Brown: Yeah, that’s a great question. So, I, it’s so interesting and that was part of why I really went into this work, and even in terms of the moms and the professional women that I really focus my energy on, a lot of them are healthcare professionals, because we’re not the greatest role models. And while we tell our patients you need to sleep, we ourselves are not sleeping enough. And the fact that you, or for me personally, the fact that I’m a sleep physician doesn’t mean, oh, it just came perfectly. It was work that I had to do on myself because I know what the science shows, right? It’s like, you, can’t unsee what you have seen. And so, I have to constantly be very intentional about prioritizing my sleep.

[00:25:58] So the way I go about it is I just have a set time when I have to stop work. And so, I set a reminder on my phone to say it’s time to wind down so that way I can finish up whatever I’m doing because I look at sleep as an appointment. And the same way I would not miss my physician’s appointment, sleep is a healing process, I have an appointment with sleep because my brain is going to now get to work and consolidate everything I’ve done, everything I’ve learned and things like that. And so, once I do that, then I have a routine, a bedtime routine, because otherwise I’m taking all that work and all that energy and stimulation into bed with me, and that’s not a good place to be.

[00:26:42] So I have a routine that I practice, just to kind of cue my body for sleep. And that is, things like, what I will do is I always take a bath. One, it helps drop my core body temperature, which is something that happens when you sleep. And then I’ll get into my PJ’s, and around then, we would have put the kids to bed anyway, and then I either will read a book or just reflect and do some journaling. Gratitude habits is something that I try to work on, so what are things that went well today and just write it. If there’s anything in my mind that’s causing my mind to race, usually I’ll note that down as well, so that kind of like offload it from my mind so I’m not sleeping with it. So that’s been what I’ve done and it’s worked really well. Of course, there are times when boundaries become a struggle and so that’s always something we have to work on. And so that’s, that’s been, that’s been my own personal sleep journey.

[00:27:37] Dr. JB: Yeah. I like what you mentioned about how you’re not perfect, right? Because none of us are perfect and putting down like structured, I guess, pathways and things like that to allow us to be able to achieve our goals. So, if our goal is to go to sleep at a certain time, inputting those reminders like you mentioned. Whatever you’re doing, you have 30 more minutes to wrap it up and then now it’s time to start your bedtime routine. I think that’s really important and that’s very practical that allows anyone to really be able to replicate.

[00:28:17] Dr. Afolabi-Brown: Yeah. Yeah. I mean, it took doing that because even though if you have a hard time, especially if you’re someone that gets in the flow, which I tend to do, it’s just like– I feel like I’m like my son again, it’s like five more minutes! Five more minutes! So, I think that’s been really a game changer for me and just helps me to maintain consistency.

[00:28:44] Dr. JB: So, could you tell my audience if they wanted to find out more about you and how they could get in touch with you, how can they do so?

[00:28:51] Dr. Afolabi-Brown: Yes. So, I am on social media. I’m on Instagram as well as Facebook as a Restful Sleep MD. I’m on LinkedIn as a Dr. Olufunke Brown. And then I have a website, resftulsleepmd.com, and I actually, I have a framework that I use to help people to create restful sleep habits, and so you can actually get that and start sleeping better tonight. Start being intentional about your sleep tonight. So, it’s restfulsleepmd.com.

[00:29:20] And I do a lot of work with parents of teenagers, and one of the things that I’ve also done is I’ve created a course for teenagers sleep because the preaching, the talking, the yelling, the arguing, the trying to get the phone out of their hands, just doesn’t seem to work. So, I created a course that’s specific for teenagers just to help them learn about sleep and why sleep is important and how they can sleep better. And that’s also on my website under the courses section. So those are a few places to find me.

[00:29:52] Dr. JB: Awesome. So, in closing, do you have any pearls of wisdom for my listener?

[00:29:59] Dr. Afolabi-Brown: Yes, I’m biased, and so I feel like sleep is just the foundation for everything. I believe that we all have an inner brilliance that we can radiate. And when we prioritize sleep, we can radiate that brilliance. And it’s something that’s free and it’s something that we can start tonight.

[00:30:18] Dr. JB: Yeah. Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or prerecorded. Come learn some. Each one, teach one. I’m done.