Dr. Tracy Kuo

on Living Healthier

Staff psychologist and clinical researcher at Stanford Sleep Disorders Clinic

Dr. Tracy Kuo on Living Healthier

Tracy Kuo, Ph.D., is a staff psychologist and clinical researcher at Stanford Sleep Disorders Clinic with expertise in managing the emotional effects of sleep loss and treating the symptoms of insomnia and disturbed sleep complicated by medical or psychiatric conditions. She is a diplomate of the American Board of Sleep Medicine and a certified behavioral sleep medicine specialist by the American Academy of Sleep Medicine. In this interview, Kuo addresses why sleep is so important to a healthy lifestyle.

What role does sleep play in a healthy lifestyle?

Sleep—in addition to nutrition, physical fitness and emotional health—is a basic condition for well-being and health. However, the benefits of sleep are not generally known. People know about a healthy diet and the importance of exercise, but sleep is rarely mentioned, other than the fact that one should get eight hours a day. The result is that many people don’t know the importance of sleep or how to regulate their sleep. Just as with nutrition and exercise, unless a person makes sleep a priority and invests the time for sleep, it’s not going to happen. So sleep is really a discipline and a lifestyle choice.

Are Americans sleep-deprived?

The National Sleep Foundation reports that 63% of American adults do not get the recommended eight hours of sleep needed for good health. It also notes that at least 15% of people in this country report chronic sleeping troubles.

A big problem comes from how many things people try to cram into their lives. Americans place a lot of emphasis on activity, but the body is not made to be on that level of intense activity all the time. Modern life makes everything very difficult and stressful.

How can people stop getting caught up in their to-do lists and activities in order to improve their sleep?

At bedtime, I encourage people to write down any unfinished business they have to do, with some notes about how they plan to finish the tasks. Or they can acknowledge that it’s the end of the day; whatever wasn’t done can be done tomorrow. Bedtime is not the time to continue to dwell on activities. These techniques are about having closure to the day so this person can go to bed with a sense of calm and tranquility.

What happens when we sleep?

The brain is not like a light switch that one can turn on or shut off. We don’t yet know about all the functions going on during sleep, but the brain is very active during this time. The general function of sleep is for the body to repair and take care of cells. It gets rid of old, irrelevant “information” and updates new information learned during the day. So sleep is important for learning and memory, as well as emotional and physical regulation. When a person does not get enough sleep, or if sleep is very disrupted or disordered, mood, cognition and physical functioning starts to disintegrate.

What roles do nutrition and exercise play in relation to sleep?

Sleep is a barometer of well-being and health, so whatever affects well-being and health will also affect sleep. Imagine a triangle: One angle or corner is your mental/thinking area, another corner is sleep and the top is your physical conditioning or fitness. If any of these three angles is disordered or disturbed, then sleep is going to be affected.

When I treat my patients, I look at all three angles. I teach them some tools to manage their stress or quiet the mind or examine their life to see if they’re taking on more than they can handle. I try to raise their awareness about how they live so they can make better choices.

Lifestyle choices, such as nutrition and exercise, are part of this. A person who suffers from poor or malnutrition probably doesn’t sleep very well. Obesity, for example, is highly correlated with poor sleep and certain sleep disorders, such as sleep apnea. Also, stimulants—such as caffeinated beverages, cigarettes, and chocolate—interfere with sleep.

I see a lot of people who are very sedentary. Many people who don’t exercise tell me that they don’t have time. If they don’t have time to exercise, they probably don’t have time to eat well, either. Time can be made: We all have 24 hours.

What’s your view of sleeping pills and other drugs taken in the pursuit of sleep?

Sleep medicine has its own appropriate time and situation. One of my concerns is that because people live such a jam-packed lives, they’re looking for quick fixes. So, when they can’t sleep, taking a pill seems like the quickest way to accomplish the task. I don’t think sleep medication is bad overall, especially for the short-term. But once someone’s sleep problem is chronic, I don’t think medication is the way to go. It’s better to get an evaluation because sleep disorders are very common and very treatable.

What about alternative approaches to better sleep?

Any activity that helps a person feel relaxed, de-stressed and provides a sense of tranquility and well-being in their spirit or mind is helpful for sleep. The necessary condition to go to sleep is when a person is relaxed and calm, not threatened, nervous and upset or in pain or discomfort. Alternative techniques, such as acupuncture, yoga and meditation, can relax people so that sleep follows.

What types of sleep issues affect older people?

Older folks need just as much sleep as other adults. The reason they don’t sleep as much is because their ability to sleep is reduced, partly because of physiological changes and also because an older person faces more frequent health conditions, such as breathing problems, high blood pressure, diabetes and chronic pain. All these can interfere with sleep. Chronic health problems usually require ongoing medications, some of which disrupt sleep.

Lifestyle changes make a difference, too. A more sedentary lifestyle exacerbates sleep dysfunctions: Older people are retired and may no longer have a structure to the day that designates active time and rest at night. Healthy older folks who are very active and maintain their emotional and physical well-being sleep fine.

When’s the best time to sleep? Are certain hours better than others?

Nighttime is still the time for human beings to be sleeping. However, each person may have a different body clock, which dictates the proper time to sleep. There are night people, people whose natural body clock likes to go to bed a little later and sleep a little later. There are morning people, who behave just the opposite.

Ideally, a person wants to schedule sleep that matches his or her own body clock, and be consistent with that schedule. That means generally keeping the same time to go to bed and the same time to get up. Also, it’s important to sleep in a way that provides very few interruptions. A consolidated piece of sleep, even a short amount, is more restorative than a long, very fragmented and light sleep. Try to sleep the amount of time that matches your sleep needs for the day. This is very individual: For some people, five hours are plenty, some people need nine and most people center around seven and a half hours.

For more information about Tracy Kuo, visit www.drtracykuo.com.