National Emergency Medicine Assoc. (NEMA)



a special program of the National Emergency Medicine Association (NEMA)

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Week: 603.7

Guest: Dr. John Herman, Assoc. Prof. Psychiatry, Sleep Specialist, University of Texas Southwestern Medical School, Dallas

Topic: Getting some sleep

Host/Producer: Steve Girard

NEMA: Many of us are on very hectic, family, recreation...all keep us really busy. Up early, late to are you sleeping? Sleep seems to be the thing we feel we can do without...and sometimes, our sleep patterns and habits get all messed up. Today, we’re going to talk about sleep - without putting you to sleep - with Dr. John Herman, a sleep specialist at the University of Texas Southwestern Medical School in Dallas. Dr. Herman, you’ve told me there are lots of different problems associated with our sleep habits or patterns...

HERMAN: There are lots of different problems with sleep, right? One is people just cannot fall asleep at night for a long period of time, and then once they do, they sleep soundly. Okay, another type of sleep problem is people who fall asleep okay, but then wake up too early. And then there’s some people who can’t fall asleep and still wake up very early. So, there’s kind of three constellations. And there are people who have very light sleep, in addition to not being able to fall asleep.

NEMA: What about the first group...those who can’t fall asleep, but then sleep soundly?

HERMAN: ....those typically are individuals who have trouble waking up in the morning. And what’s going on with them is there clock is set too late. And these are people who will just toss and turn, males and females, typically starts in adolescence, and they need to get to bed around 11 o’clock or something like that, and they can’t fall asleep until one, two in the morning and when the alarm goes off at seven or eight, they can’t get up. And this goes on all week. And then weekends, they’ll sleep late - go to bed late, sleep late, and they’ll be fine. And then the whole thing starts over again the next week.

A lot of people like that think they have insomnia, and doctors actually treat them sometimes with sleeping pills. And giving someone a sleeping pill, who is not falling asleep until one, two in the morning and then sleeps soundly, is kind of like you or I taking a sleeping pill at 8 o’clock in the evening to fall asleep earlier. It just doesn’t work, and it’s not a good idea. It’s a very bad idea, in fact.

So...the other thing is that the time that it’s most difficult to fall asleep...and this is just about an hour to an hour and a half before when you normally fall asleep. So, that is...most people nap sometime during the day, they can nap in the mid-morning or a little bit after lunch in the afternoon, or early in the evening. But virtually nobody naps an hour and a half before they go to sleep. And that’s because we have a zone that does not get penetrated by sleep at all - just before we fall asleep.

And suddenly sleep is permitted, and we go from being mandatorily awake to being deep asleep. The point I’m getting at is that that makes it virtually impossible for someone who is falling asleep late, to fall asleep earlier. Follow me?

NEMA: Absolutely, it’s like a ‘catch 22’ what’s happening?

HERMAN: Your biological clock is telling you this is when you need to be awake. So, then if you suddenly try to go to bed earlier, you naturally can’t fall asleep. So, the way to fix that is to get up earlier, get out in the bright light in the morning. Exercise in the morning in bright light, and that will reset your clock earlier, and then you will naturally fall asleep earlier.

Same with kids. If a parent has a child that won’t fall asleep at night, don’t make them go to bed earlier, get them up earlier. Get them out in bright light, get them outdoors playing, riding his bike, whatever....or get her out. And that will shift them. And the opposite can be done with children who are waking up too early in the morning, or adults who get sleepy too early, and wake up too early. They need bright light at night, and maybe even a little more activity at night, to kind of shift their clock in the opposite direction. These people don’t really have insomnia, they just think they do.

NEMA: What about the second group you mentioned...those who wake up too early in the morning...or in the middle of the night?

HERMAN: The second group of people, let’s say people who wake up too early in the morning...I just want to go into them for a second. These people will get to sleep at a normal time, and then wake up. Typically, what’s going on with them is that something is on their mind, and waking them up...and they’re going right from sleep to wake. And typically, they’re coming out of rapid eye movement sleep, in fact...your dreaming sleep...or very light sleeping into being wide awake. And their mind is on something. Well. it’s an important dictum to remember, at this point in time...when one wakes up at 3, 4, 5, 6 o’clock in the morning. Number one is there should not be a clock to see, one should not look at the time. One is best off is one does not have a clock. So turn the clock around.

Number two is that, if we’re up for more than a minute typically, we have an arousal response...where we have a little bit of cortisol secreted, our heart rate goes up a little bit, our metabolism goes up a bit, so it’s difficult to get back to sleep. The main thing is to try to fall back to sleep rapidly. And to do that, one needs to remember the following dictum: That when one is at work during the day, sleep is an intrusion, and not permitted. Right? Likewise, when one wakes up at night, any type of waking thought, any type of worry or concern is an’s not permitted. So, if any thoughts start to creep into mind; about what needs to be done the next day, or what one did wrong the preceding day, or not getting enough sleep or something like that...needs to be banished almost instantly. And the individual needs to focus on breathing or something peaceful. Whatever that person finds peaceful, and stay focused on that - it should be peaceful and boring. That might help get the sleep process started again.

NEMA: Sometimes trying to hard fall asleep can cause a self fulfilling prophecy, true?

HERMAN: One of the worst causes of sleeplessness is lying in bed worrying that one can’t sleep. Worrying is just like waiting for a pot to boil. Waiting to fall asleep will keep you from falling asleep.

NEMA: What about those people who always do things in bed before they fall asleep...does that help or hinder the process of falling to sleep?

HERMAN: Let’s take these people and divide them into two groups. Some people have no problems whatsoever with sleep, even though they read magazines, they work on the computer, they read a book...whatever, in bed. But for the rest of the world, the bed is to be used for only two things: Sleep & Sex. And that rule should be remembered: that the bed become sacrosanct as a spot that is associated only with sleep and sex...and nothing else can happen there.

A lot of people can condition themselves to think about the bed and work, or concentration or even studying...even students. So they get into bed and their mind is in the study mode. So, for the people who have trouble falling asleep, they need to remove everything possible from the bedroom that doesn’t have to do with sleep. And the second thing is to make the bedroom as conducive as possible for sleep to occur. Which means it need to be quiet.

NEMA: You told me earlier that can be important for sound sleep is temperature...

HERMAN: (Another thing that’s very important for everybody is that) we all sleep better when our temperature is dropping. That’s why everybody says they get the best sleep ever when it’s a cold night. And they’re under some warm blankets. Have you experienced that?

NEMA: Yes, I’ve always made it a bit cooler at night for sleeping, but I’ve never known why....

HERMAN: Okay, what’s going on there is that we have two thermostats, one in our body and one in our head. And the one in your body has the warm blankets over it, so temperature’s being maintained. But your head is exposed to the cold air, and it’s the chilling of your brain that causes you to have more deep sleep. This has been experimentally verified and demonstrated, without going into the research that backs this up, but it’s just known that the more your head cools, the better you sleep. So, that means to turn the thermometer down, keep the bedroom cool...never sleep with too many blankets. You’re much better off being too cool than too warm during sleep, because typically when people wake up and they feel cold, they’ll just throw on another blanket, and be back asleep within seconds. But waking up sweating has someone up for a long time. So, getting back to what one does in bed...if one has trouble sleeping, one keeps it as a place only for sleep, and one sets up the bedroom as a place conducive to sleep. Keeping sound out of it, other activities out of it...and making it comfortable and dark, are all important.

NEMA: When does someone know that they really have a sleep problem that needs medical treatment?

HERMAN: The main thing to look for is excessive daytime sleeping. When a person finds himself unable to concentrate, unable to get the job done...there’s something wrong in their mind that isn’t functioning properly during the day. They feel very tired, sleepy, washed out...they are falling asleep during the day...anything like that - they need help. Sleep should be restorative, people should wake up feeling refreshed. And wakefulness should be with an alert feeling, and if wakefulness is compromised, then sleep isn’t good enough. On the other hand, if somebody is sleeping two hours a night, and feels fine all day long, that’s okay. There is no required amount of sleep...only enough sleep to make you feel rested and refreshed.

NEMA: And what about people who nap during the afternoon...I know some people who take a little siesta even at work?

HERMAN: Well, you mention something interesting, because typically, when one naps in the middle of the afternoon, it’s at 12 hours out of phase...or 12 hours away from when one’s minimum body temperature is. So, that person taking a two, three o’clock nap, might well...2, 3 in the morning...have a minimum body temperature. And 2, 3 in the afternoon, when they’re taking a nap, their body temperature is dipping, right then. And as we know, the siesta occurs at that time in Latin American countries, people nap at that time around the world, and most primates are napping at that time, so it’s perfectly, evolutionarily natural to be sleeping at that time.

NEMA: Our thanks to Dr. John Herman of the University of Texas Southwestern Medical Center in Dallas. Sleep is necessary, but the amount each of us needs is different. Could be 4 hours, or 10 hours a night. If you find yourself in a strange or inconvenient sleep pattern...maybe you can’t get to sleep and then you have a hard time getting can change it by getting up earlier and getting out and active earlier...which will help you fall asleep earlier the next night.

Or if you’re falling asleep too early and getting up too early, get into the light and be active later in the day...which will help you fall asleep later and get up later. Dr. Herman says it works on kids, too...don’t send them to sleep earlier if they can’t get up in the morning...get them up earlier, and they will fall asleep earlier the next night.

You may need a doctor’s help if you feel sleepy too often in the daytime...can’t concentrate, and if you’re not waking up rested and recharged...because if your waking time isn’t alert and active, then your sleep time will be less effective, too.

SPOT: 15 years in the prevention of heart disease, stroke and trauma - The National Emergency Medicine Association. This show is just part of what NEMA does. We send out millions of pieces of prevention information to people around the country, give grants to organizations in research, public information and emergency services, and have been instrumental in the creation and expansion of the Chest Pain Emergency Room movement. To play a role, call 800-332-6362.

NEMA: Thanks for joining us for today’s program. If you have any comments or suggestions, contact this station. Or visit our home page at:

...for a look at transcripts of this or past programs, or to find out more about the National Emergency Medicine Association. I’m Steve Girard at The Heart of the Matter.



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Last modified: December 16, 2021