(gentle music) - Welcome to WSKG Science Pub, a monthly series exploring the dynamic and exciting scientific world around us.

I'm your host, Nancy Coddington.

Tonight's episode wraps up our third season.

That's right, third season.

And we are so grateful you have joined us on this journey.

And I wanted to share some very exciting news, that Science Pub is the recipient of a New York State Broadcasters Association Award for outstanding use of digital platforms.

We are so proud of this work.

So thank you for continuing to tune in and bring your curiosity.

Tonight, we're sitting down with sleep expert, Dr. Fiona Baker on optimizing sleep in women.

Sleep is essential for a healthy life.

How many of us have experienced a bad night's sleep and we're just dragging the next day?

I'm sure you know that feeling.

Well in women, a range of sleep problems can emerge within the context of reproductive aging.

In these years, women who experience severe PMS or painful cramps are likely to have transi-insomnia and daytime sleepiness.

Alleviating pain can lead to a better night's sleep.

During pregnancy and postpartum, some sleep disruption is to be expected.

However, when severe, or if a sleep disorder like sleep apnea emerges, it needs to be managed to ensure maintenance of physical and mental health.

Midlife and menopause can also bring fluctuations in sleep patterns.

But research shows some promising solutions.

Clinical trials of cognitive behavioral therapy for insomnia show consistent improvements in sleep and hot-flash related interference and is now the first line of treatment for insomnia.

Our guest is Dr. Fiona Baker, the director of the Center for Health Sciences at SRI International, where she focuses on the interplay between sleep psychology and human health across the lifespan.

Dr. Baker is a world expert on issues of sleep and women.

Her areas of research includes sleep, EEG, sex differences in sleep, sleep across the menstrual cycle, menopause, sleep and cardiovascular functioning, and interactions between brain development, sleep, and behavior, such as alcohol use across adolescence.

Dr. Baker has published over 100 scientific papers on sleep, advancing our understanding of sleep health issues in women.

Welcome, Dr. Baker.

- Thank you so much, Nancy.

It's really nice to talk with you.

- Well, we are really glad that you are here with us tonight.

And before we get started, I wanted to ask you what first attracted you towards studying sleep?

- Oh, I love that question because I think for me it's been something, sleep has interested me for a long time.

And it started when I was doing my studies, which was in South Africa at the University of the Witwatersrand.

And there was a project that I had an opportunity to participate in that was about sleep.

And from that moment, when I sort of looked and saw, wow, there's so little that we understand, and there's so much that's fascinating about sleep and the brain, that from that moment onwards, I guess I was hooked.

And I even developed an interest very early on about issues of sleep in women.

And that has continued to be one of the focuses of my research for my whole research career up till now.

So still trying to really focus on the issues of sleep that women experience and try and make them better.

- Well, we are really excited to hear what you have to say.

So why don't you go ahead and start your presentation?

- All right, so we... And I'm starting with also a catchy title of optimizing sleep because I think that's what we wanna get at, is we know that sleep health is so important.

It's really important for everything.

And I think because sleep is something that we all take for granted, sometimes we don't stop and think, what do we get from that night of sleep?

So when we're are talking about sleep, it means a variety of different things.

So it's important to have a regular sleep, it's important to get enough sleep, and it's important to feel, good quality sleep, and when you wake up in the morning to feel satisfied with your sleep and ready to go about the day, whatever you need to do.

And because sleep is so important for everything, so anything you think of, whether it's memory consolidation, if it's controlling your heart, blood pressure, it's important for your immune system, it's really important for everything.

And so that's why, if you do not get a good night's sleep, then you may not be sort of of optimal health or functioning at your best the next day.

And I wanna talk about sleep sort of going beyond just not having a sleep problem or a sleep disorder, it's really important for all of us to have a healthy, strong sleep.

And everybody always wants to know, well, how much sleep do we need?

Could we do with much less sleep than what we get?

And these recommendations by the National Sleep Foundation gives an idea, gives a range of what amount of sleep you might be looking at needing, depending on how old you are.

So it does differ, depending on if you're a teenager or an adult.

And sort of why we put there a range, so about seven to eight hours as an adult, it's because not everybody is the same.

So the amount of sleep you need can vary from person to person.

But if you're getting less than, say, around about six hours of sleep, then that often means that typically that'll be too little sleep, probably not getting enough sleep.

So it's good to think about for yourself.

Are you feeling good during the day?

Are you able to function and feel rested and alert?

That would mean you're getting enough sleep.

And when we we're thinking about sleep, I study sleep, so I'm a researcher and so we have people coming into our sleep lab, very wonderful participants in our studies who will spend the night.

And then we are putting electrodes on their heads, like you can see on the screen.

And then we are recording their brain activity.

So we sort of do a deep dive into what's happening during sleep.

But we can also ask questions.

So just asking somebody, how good was your sleep last night?

Thinking about the past month, how many nights of good sleep did you get?

It's all important sources of information.

So it sort of is depending on what we're studying and what we're trying to get at, as to how we study sleep.

And here, I wanted to put this in, 'cause it just shows how amazing our brains are when we're sleeping.

So what you're looking at here is a whole lot of electrical brain activity.

So the two top channels are showing your brain activity, literally.

And so you have these wonderful, deep, slow waves, and this is one type of sleep.

So your sleep doesn't look like this the whole time.

This is 30 seconds of sleep.

And this is where you've got these very slow, high amplitude waves, so that's a deep sleep.

And we put electrodes, little sensors around the eyes, this is the left eye and the right eye, and that's so that we can detect eye movements.

Here, it's not your eyes moving that you're seeing here, it's just that your electrical brain activity has got such powerful slow waves that you can even measure it from the sensors next to the eyes.

And then we always measure heart activity, as well.

So this is the heart rate going on during the night.

So we get a sort of a really wonderful view of what's happening in your brain when you're sleeping.

And that tells us a lot about what your sleep is like.

And once, if somebody spent the night in the sleep lab and we are recording continuously their sleep, what we'd end up with is this.

This is called a hypnogram.

And if you look at the top one, this would be looking at a good sleeper and how their sleep breaks down across the night.

So you have different stages of sleep.

Like I say, you don't have just one constant sort of the same old thing the whole night.

There's a lot going on when you're sleeping.

So you change from these stages, N1, N2, N3, which sound sort of meaningless.

It's a staging system that we as researchers and clinicians use for sleep.

And then you've got your REM or your Rapid Eye Movement sleep.

And so you go through sleep cycles from these sort of stepping down from when you're awake and then going to deeper, deeper sleep, N3 is the deepest stage.

And then after about 90 minutes, you have your first period of Rapid Eye Movement, or REM sleep.

So that's commonly known to have a lot of dreams happening in this stage.

And then you change again to go through the N1 N2, three, and have some REM sleep, and so on.

So you'll end up with a few cycles across the night.

Now, if you're a poor sleeper, doesn't look so good, does it?

If we've got a recording of a poor sleeper, what's happening here is all these lines up here, they're waking up a lot.

So instead of having this very nice stepping down into sleep, it's disturbed a lot by repeated awakenings.

So you just don't get a good, solid night of sleep.

And that's a problem and that's what we wanna try and find out more about sleep and try and see if we can find solutions.

- [Nancy] Dr. Baker?

- [Fiona] Yes.

- Can we go back to that slide for just a moment?

- Sure.

- So I have a question, when you are looking at this, this is a great graph with lots of good information.

So I've noticed on the top one, when we have a good sleeper, they're not waking up as much so we don't see those spikes that come up to the top.

But it looks like they are actually in that stage, N2, much more than the poor sleeper, is that correct?

- They are.

Well actually, all of us, if we think about your typical sleeper, a good sleeper, which would be the top, we spend most of our night, so like 45% of the night is in that stage N2.

And so that's what you expect.

And then you have about 20% or 15% to 20% in the deep stage N3, and that would be normal.

So when you're a poor sleeper, sort of everything gets a bit disturbed.

So you're gonna have less of all sleep, including that N2 sleep.

So it's because N1 is like a little transition, so when you're a poor sleeper, you have a lot of transitions.

So wake, N1, and then you just get into N2 and then you wake up again.

So it's just like you're never getting into a proper sleep pattern, if you're a poor sleeper.

- Thank you.

- So let me, I wanna turn right away to women because women are more likely to say that they have poor sleep.

They're more likely to have insomnia.

So when we talk about insomnia, we can either be meaning symptoms like having trouble falling asleep, maybe having trouble staying asleep during the night.

And when it gets severe, sort of happening, say three to four times a week for a couple of months, three months or more, then it's an insomnia disorder.

And women are just more likely to have insomnia than men.

And this prevalence, this increase in insomnia in women begins in the teenage years, when they become at increased risk for insomnia.

And it's just something that they are at increased risk for compared to men throughout their lives.

And we don't know all the reasons for why women are more likely to have insomnia than men.

There is some factors that may contribute to that.

For example, we know since it starts to increase in prevalence in women, around the teenage years, there's probably a role of hormones.

Women are also more likely to have insomnia maybe premenstrually or around menopause.

So there's something about those hormones that affect sleep.

We also know that women are more likely to have depression than men, and poor sleep is often linked with depression.

So that's another reason.

And then women, they could also be just more exposed to stresses in their lives.

And stress is such a big factor for triggering insomnia.

So a whole lot of reason that just lead to women being more likely to have insomnia than men.

And if we sort of look a little closer at these hormones and the changes that are happening, what's shown here on this slide is just this changes that you see in the estrogens.

So as women, right from the times of puberty, sort of through those reproductive years, you have these wonderful, nice cycles of estrogen and progesterone as part of the menstrual cycle.

And then as women start to approach sort of the age of around 50, that's when things start to change and the hormones, estrogens begin to decline and they start approaching menopause.

And with that approach to menopause means that lots of things change, lots of things happen.

Some of these are good things, and then some of them are challenges.

And that's where I've focused quite a bit of my research lately, is trying to understand sleep problems in the context of menopause.

And I did wanna put this here because, again, as researchers, it's important of how we study these hormone changes and study the life cycle of women.

And so very nicely, there's some standard criteria that we are all encouraged to follow.

So to make sure that we are actually focusing on the same period, so that studies are using the same definitions.

So here, like I say in the reproductive age, you've got women going through the natural, normal menstrual cycles.

But as they get closer and closer to that menopause, to the time of menopause, which is really when they stop their period, so it's defined as when there's a whole year without having a menstrual period.

So it doesn't just happen instantly.

Most of the time, it takes a couple of years to build up to that.

And that's what this menopause transition is.

So it's sort of this, as the hormones gradually change, where you've got this increase in follicle-stimulating hormone, this decline in estrogen, it's around this menopause transition.

Women are still having menstrual cycles, they can still be ovulating, it's just that it's becoming a little sort of irregular, little less predictable.

And they're approaching this time of around age 51, is the median age when women have their final menstrual period.

So then they have menopause.

And this is also the time, this menopause transitioned then into the first couple of years of postmenopause, that they have lots of symptoms like hot flashes, which is an important factor for disturbing sleep.

So when we look at sleep and what we now understand from studies that have tracked women across the menopause, there's a wonderful consortium study of the study of women across the nation, in America.

And from this study and others like it, it's been able to do longitudinal tracking of women and their sleep.

Which is so important because sleep is changing, might change differently for some women.

There might be different factors that are affecting their sleep.

And so the best way of tracking or looking at these changes is to do a longitudinal study.

And this study showed very nicely and very clearly, actually, that across the menopause transition, so across all these perimenopause or menopause transition phases, there is an increase in sleep difficulties.

So there's an increase in difficulty falling asleep, which is this slide.

There is an increase in waking up early in the morning and not being able to go back to sleep.

But big, big factor is that they have sleep maintenance difficulty.

And what that means is, when someone can fall asleep without trouble, but then they're waking up, say, 2:00 AM and then having trouble going back to sleep.

So it's sort of these middle-of-the-night awakenings.

And that seems more common around the time of menopause.

Now, there are really so many factors that could be influencing sleep, no matter who we're talking about, whether we're talking about women or teenagers, whoever we are talking about, lots of factors.

But if we focus on midlife women, not every woman is the same.

And there can be lots of physiological factors that could be affecting sleep.

There can be those hormone changes, can directly be changing sleep.

Hot flashes, big factor that can be waking women up.

And then there's also other things like depression, anxiety, and then stresses.

So just think about it, if you're around the age late 40s, early 50s, maybe you have kids going off to college, you might be taking care of an elderly parent, might be sort of have a lot of work-related stress.

There's a lot of things going on in midlife that can be just making it hard for sleep.

So it could be disturbing sleep.

So when you think of all these multiple factors, it's hard to study.

And that's probably one reason why we do not have all the answers yet, but we're making progress.

And I did wanna focus a little bit of attention on hot flashes, 'cause that's one aspect that my lab has been looking at, is trying to understand those hot flashes and how they can be disturbing sleep.

And so anybody who has hot flashes knows what they are, but for anyone who does not, this really describes sort of the sudden sensation of heat.

It can be, some people maybe say sometimes it's mild.

Sometimes it feels really intense, like really hot.

It lasts just a few minutes, although sometimes women have night sweats and those can last longer.

And what we know is that it is triggered by the decline in estrogen.

We understand that.

And we understand as well that there's sort of, what happens with the loss of or decline in estrogen is it affects the thermoregulatory control, the centers in the brain that control our temperature.

And that's what then leads the body to have this sort of sweating response, this hot flash, and this increase in heart rate, and sort of really noticed on the chest and on the sort of upper body.

And the majority of women will have hot flashes.

They can occur day and night, they vary in the number.

So some women maybe just have a couple of hot flashes a week.

Some women maybe have about 10 a day.

And of course, they happen in the daytime and they can also happen at night.

And when they happen at night, they can be disturbing sleep.

And there are one other thing about hot flashes is that it doesn't just happen for the one year that a woman might be around menopause.

They actually can persist for a number of years after menopause.

So they can be disruptive for a while.

And we know from a number of studies that there's a strong link with hot flashes and insomnia symptoms.

So in this study done in 2006, by Dr. Hayan, he showed that severe hot flashes was associated with a much greater incident of insomnia.

And that even having...

Sort of see this range of increase from mild to moderate to severe, just more likely to have insomnia symptoms.

And what we've done in our study, and what other people have also been doing is just to understand better, well, what exactly is happening when somebody has a hot flush, to sleep?

So going beyond asking women about the insomnia that they may be experiencing, we've really tried to measure the hot flashes and to measure that sleep disruption that may be occurring.

And so, shown here is a little hot flash being recorded.

It's about five minutes long.

And what we are actually recording is skin conductance, which is really measuring the sweat response on the chest.

And across this five-minute period, then we are also measuring sleep at the same time, with those waves, this polysomnography that I was showing earlier.

And because we are measuring everything at the same time, we can determine, well, when a hot flash happens, what happens to sleep?

And we actually found that almost 70% of the time, the hot flashes are associated with an awakening.

So, very tightly coupled with sleep disturbance and waking up, which makes sense and sort of matches with what women are saying.

I did wanna put this here because this shows the number, this is a sort of a group of women participating in our study.

And what this is showing is the amount of wakefulness associated with hot flashes.

And you can see that not everyone is the same.

So women over here, they maybe have a couple of hot flashes, but it's not really disturbing their sleep.

Whereas the women on this side of the graph, they're having hot flashes that are really waking them up.

So majority of their awake time is due to those hot flashes.

So again, some women may be having hot flashes that don't really disturb their sleep and other women are waking up every single time they have a hot flash.

And then they may have trouble going back to sleep afterwards.

- Dr. Baker?

- Yes.

- So before you move off of that slide, is there a correlation between the intensity of the hot flash and the ability to fall back into sleep or the length of time that a woman might be awake?

- Such a good question.

And I think there's a few things to think about it, when you look at the intensity of the hot flash.

So most of the time we wanna ask women, how intense was that hot flash?

How do you feel with the hot flash?

And then you can understand, well, how severe is it?

But of course, when people are sleeping, it's not so easy to measure.

How intense was it, how severe was it?

So we measure our signals and then that shows the sweating.

But the signal is not a good indicator of just how bad or how severe that hot flash is.

What we are seeing is that the likelihood of waking up from a hot flash does depend on what stage of sleep you're in.

So for example, if you're in the Rapid Eye Movement, the REM sleep, you're less likely to wake up from the hot flash.

What we are also seeing is that there is something that we don't yet fully understand, which is why some women are waking up every time they have a hot flash, whereas other women are not.

So it's not just about the sleep stages, it's also seeing some women are just more sensitive to the hot flashes.

One other piece of information that we do know is, when we measure these hot flashes, so we don't only measure sweating, we also measure heart rate, and we do see that when a woman is having the hot flash that you also see this heart rate going up.

And so we're using all these signals together to just see, well, what is the... How bad are these hot flashes?

And how are they influencing the physiology of a woman?

And what we ultimately want to understand, what we don't yet fully know is, answering your questions of why does one hot flash disturb one woman and not another?

And how exactly do we even measure the severity of the hot flashes?

- Yeah, there's a lot there to, to take apart.

(laughs) - Yes, that's what keeps me busy.

- Thank you.

- I did want to...

I've shown a couple of slides just to give people sort of an idea of what we're learning about, how sleep can be disturbed in some women as they're going through menopause.

And one factor, for example, is the hot flashes that can disturb their sleep.

The good news is that there's things you can do.

So I think until relatively recently, women just stayed quiet and just thought, well, this is part of life, part of menopause symptoms.

I just have to suffer through problems with my sleep.

But in recent years, there are a number of studies looking at, well what can we do?

What can we do to treat it?

And we are seeing more hot flashes can be one factor in some women, so it would make sense, well then, we wanna try and treat those hot flashes if they're that severe that they're disrupting sleep so much.

Then there's various options for treating hot flashes.

We also see that there's other important factors for insomnia problems and insomnia disorder.

And this is around our cognitions, our beliefs, our attitudes about sleep, sort of worrying about what am I gonna do the next day?

I didn't have a good night's sleep, now I'm gonna... Won't be able to perform in my meeting tomorrow, or I'm just gonna feel bad.

And so all those problem thoughts that people can have when they're falling asleep or if they wake up at night and can't go back to sleep, those become perpetuating factors.

They just make the insomnia problem worse.

And we know that something can be done about that.

So we can target those beliefs and just help somebody take control of their sleep again.

And here's a number of studies, and the number is growing of clinical trials where they've looked at cognitive behavioral therapy for insomnia as being...

They've shown that it is effective to treat menopausal insomnia.

So cognitive behavioral therapy for insomnia is our front line, our first preferred treatment for insomnia, because it just has more staying power.

It lasts for longer, has even six months later it's still shown to be effective, compared to some hypnotics.

So cognitive behavioral therapy does require you to work with a healthcare provider because it really is working on those cognitions, faulty thoughts that you might be having, and changing those thoughts, and also just controlling your environment and the way you're sleeping.

It also has components of relaxation in there.

So it's this nice sort of helping cognitions and sort of approach to improve sleep.

And some of those factors you need help for.

So, like I say, it could be best to speak to a healthcare provider to figure out how to improve sleep.

But some of the factors you can do yourself, from home.

So I've put these questions out there to start with.

It's good to know, well, what might be causing your sleep problem?

So like I showed a few slides back, not every woman is the same as they go through menopause.

And sometimes sort of the problems for their sleep are not the same.

So you have to see, well, do I have a significancy problem?

It's affecting my daytime function, my quality of life, my performance.

You've gotta consider if you might have a sleep disorder, like sleep apnea, 'cause that requires different treatment.

Also, I think about medical conditions.

So do you have something, a painful disorder that might be disturbing sleep?

Sort of some secondary condition, depression?

Those all require different treatments and different approaches.

Any medications you could be taking can be disturbing sleep.

And then the factor that I spoke about already is those hot flashes.

So in the context of midlife, the hot flashes can cause significant sleep disturbance.

And then these are sort of some tips, and happy to talk about them more, but it's really, there's some... What seems so simple, some strategies that everybody can use and everybody can do, and actually can make a difference.

And I'll leave the list up here.

There's a few couple of key ones, which is really... We have a clock inside our brains.

One important sleep is the clock.

Going to bed and waking up around the same time every day is important.

It's good for our bodies to know when to expect to get ready for sleep.

So getting out of bed at the same time every day is a great strategy, even if you haven't had the best night's sleep.

- Do have some questions for you.

And I'm gonna start with going back to when we talked about how much sleep everybody needs, especially during different parts of your life, right?

Adolescents, how much sleep do adolescents need, Dr. Baker?

- Yeah, if we talk about a different age range, another phase of transitions is adolescence, when sleep is also so sort of sensitive to change.

So adolescents need around nine to 11 hours of sleep.

And that's a important time when their brains are developing.

There's so much change going on.

Cognitions are changing, their independence is growing.

And with all these changes that are happening, it's not surprising that sleep changes.

So there's a lot of these biologically-driven changes where teenagers, anybody who has a teenager at home knows this, they will want to go to bed later.

They'll wanna sleep in longer.

But of course, with school starting at a set time during the week, every day, they have to get up.

So they're always fighting this sort of biological change to go to bed later and sleep longer.

And then they have to fight with the fact that they have to get up to go to school.

So what tends to happen, then, is kids will sort of not be getting enough sleep, typically, during the week.

They will not be getting more than nine hours.

And then on the weekends, they do this major catch-up where they might sleep till 11:00, 12:00, 1:00, go to bed later.

But you unfortunately get a bit of the see-saw effect where you're going from long sleep on the weekend, and then along comes Monday and suddenly they have to get up at 6:00, 6:30 in the morning.

So that's difficult for teenagers to deal with, and it can also become a problem, so important, again, for them, as well, not to let the sleep see-saw backwards and forward so much from the weekdays to the weekends.

- So it sounds like trying to catch up on the weekends is only good for so long.

(laughs) - Yeah, we can't... That's also a wish, I guess, for sleep, is that we could catch up and like we could be fine for maybe for several weeks on end with very little sleep, and then think that we'll catch up.

We'll catch up next month, we'll catch up sometime.

But the processes that are happening in the brain during sleep sort of need to happen all the time, every night.

So it's a much better strategy to have a good rhythm in your sleep.

You have good, regular, and enough sleep for at least most nights.

- So staying the same realm, looking at adults, adults are between seven and nine hours.

So what if somebody is getting about six, six and a half hours at night, but they're waking up without an alarm clock?

They're waking up naturally just because their body is in tune to being an early riser.

But that also, if they're going to bed late, they're only getting that six hours of sleep.

Can you comment on that?

- Yes, and I think we spent a lot of effort trying to understand how much, what is the right amount of sleep?

How much sleep do we need?

And then as I showed with some of those figures, with the hypnograms, those charts, where we can see, well, it's not just about how long you sleep in total, it's how much of those different sleep stages you're getting, 'cause each part of them, each sleep component is important.

And then there is a large...

There is a lot of variability between people, as to how much sleep they they need.

So while on average, people need seven to eight hours, there are some short sleepers out there who can have six hours of sleep and be functioning quite well with their six hours of sleep.

There's fewer people who can sort of be the short sleepers, like we call them.

Probably what's more common, actually, is that some people are sleep depriving themselves and having six hours of sleep.

And then they will be waking up with an alarm clock.

They will be drinking a lot of coffee during the day to stay alert and sort of, yeah, short-changing their sleep.

And sometimes we're not always so good at recognizing that either.

So when you don't get enough sleep, your judgements also change.

Sometimes you'll be thinking you're feeling okay, think you're getting enough sleep, and so it's sort of a tricky thing when our brains do not seem so well able to sort of send us a message of where you're really not getting enough sleep.

But that's why I like to say I think someone can tell if they're getting enough sleep, if they are waking up feeling alert, feeling good, and able to function during the day without feeling exhausted.

And some of the common, some of the things that people will notice if they're not getting enough sleep, I think we can all notice this in ourselves, is if you're not getting enough sleep, then you tend to be more irritable.

So mood is one of the first things to be affected and that becomes negative.

And then performance, sort of just not able to... Just feeling a little less efficient, a little slower in doing tasks.

- Yeah, unfortunately your body tells you you need sleep when it's, I think, too late.

(laughs) You're falling asleep doing really important things.

And so we started with, or we talked a little bit about adolescents and then kind of middle age, for adults, seven to nine hours.

How about as you age and get older?

In our senior populations, do they need less sleep or more sleep?

- As people tend, as people get older, then their sleep changes in terms of what types of sleep that they're having during the night and also how solid their sleep is.

So how deep the sleep is, I guess you'd say.

So they do tend to wake up a little bit more.

And also, there is a change in that clock, circadian clock.

So as people get older, they do tend to wake up earlier in the morning.

But then at the same time, tend to go to sleep a little bit earlier at night.

And it's... We didn't really talk about naps, but it is good to think about naps.

So if somebody does not have any problems with their sleep and likes an afternoon nap, and this is something that can, when people get older, then sometimes they may be having a little nap in the afternoon.

And that's all fine if you're sleeping well, without trouble.

If you are having trouble at night, like having trouble falling asleep or staying asleep, then it might mean, if you've had a long nap, like an hour, two hour nap in the afternoon, well, it's not surprising that you're having trouble falling asleep at night.

So with naps, you sort of have to think about it, is this something that could be disturbing or preventing the nighttime sleep?

In which case, you wanna push back on the naps.

Whereas if it's just a short, like a 20-minute nap in the afternoon, then it can be restorative.

So I think, again, it's something... Don't wanna dictate how everybody needs to get their sleep and run their...

Sort of get their sleep across the day, across the night.

It's more, if you have trouble sleeping and to start being aware of some of the factors that might be disturbing sleep.

- Thank you.

So you talked about cognitive behavior, what about medical marijuana?

Is that effective for staying asleep and so you're not waking up during the night?

- So I myself have not done any studies to see whether medical marijuana has a positive or a negative effect on sleep.

I think that there are a number of studies ongoing to look into that.

Because there are some factors we have to think about if we are taking any substance.

You sort of need to understand, well, is it something that can help sleep or sometimes may think it helps sleep, but that it could disturb sleep?

So even, there's a lot more known about alcohol.

And sometimes people think they could use alcohol to help them fall asleep at night because it's sort of a...

It sedates you and can help you just fall asleep.

But the problem is that it's actually really bad for sleep because once the alcohol gets metabolized later on in the night, it disrupts sleep and wakes you up.

So sometimes I think the same with medical marijuana.

I think we are still do not have all our answers as to whether that might be helpful or might even have a negative effect on sleep.

So more to be found out.

- So staying kind of right in that same vein, there is a bunch of research that talks about how diphenhydramine can cause dementia.

That is one of the sleep aids that will be in an Ibuprofen PM, for example.

Can you talk a little bit about that?

- So there's a lot of substances that, as a sort of as a side effect, or any antihistamine could, as a side effect, make you sleepy.

And that's where you do see a lot of over-the-counter medications call them, this is... Could be taken at night or should be, could be taken at during the day because it won't make you drowsy.

So there's many substances that can make you drowsy.

But if, when we are talking about someone who maybe has insomnia symptoms having trouble with sleep, then it's not a good strategy to take one of these sort of over-the-counter medications.

With sleep, probably as with any behavior, you talk about eating, exercise, sleep, in order to fix the problem, it does take a bit of work and it can't be easily fixed by taking any form of medication, really.

So that's with the strategies of the cognitive behavioral therapy that really helps sort of deal with the problems of anxiety or sort of having difficulty worrying about sleep and helps control those and sort of helps lead to just a more improved sleep over the long term, which is what we wanna get at, not just quick fixes.

- That kinda leads me right into my next question.

A lot of people who have insomnia feel kind of hopeless.

They've tried different things or they've tried taking medications and it's not working.

And then when they bring this up to doctors, they're not taken very seriously.

Do you have thoughts on that?

- Oh, yes.

(Nancy laughing) I take it seriously.

It is serious.

And I think the sleep community has done a lot of work for education, 'cause I think that's what sort of goes at what you're talking about.

Which is first, it's important for the individual to know if they're having sort of a chronic sleep problem, that is so important to bring it up with their healthcare provider.

So important to make them listen and to realize that this is not something you have to just make do with.

Sleep is really important.

And I think that sort of the medical community as a whole is very aware now of the importance of sleep for so many... For our health.

And so first thing is, it's important not to just accept it and just try everything you can under the sun, Google it and try and fix it yourself.

It is important to have a conversation.

And then on the other hand, it is important, like my part of my job would be, through our research is to provide more information to healthcare providers so that they will be then open to listening and open to also giving solutions that can help somebody see better.

- So talking about sleep and relaxation techniques, listening to either music was actually mentioned in the comments as something that helps.

What other relaxation techniques can people try to kind of calm their mind down and help put them to sleep?

- And that is exactly what we're trying to get at, is to calm our minds down and calm our bodies down so that you can fall asleep.

So really, when thinking about the falling asleep process, it's something that doesn't happen just in a flash.

It's something that you sort of need to lead yourself towards sleep.

You have to do a number of... You have to sort of relax your body to almost open the window into sleep.

It's not something you can go from, oh, I'm just gonna quickly answer some emails or I'm gonna check my social media and then put your phone down and instantly, okay, now I can go to sleep and expect sleep to happen just like that.

You need our brains and our bodies to unwind a little bit.

And so that's where those relaxation techniques come in.

And the listening to music is a beautiful option.

Anything that that really does calm you down.

And it's not just about calming you down.

It's, at SRI International, in our sleep lab, we've also done quite a bit of work on understanding this, what is needed to help somebody to relax, to go to sleep.

And we know that it's important to relax the body and relax the mind.

So in order to do that, you can do some deep breathing exercises as well.

So by doing the deep breathing, you're really relaxing the body.

And at the same time, you're listening to music or distracting your mind, those two factors together can help you go to sleep.

So if somebody does have insomnia, then they often talk about sort of this overactive mind.

They can't switch it off.

Their thoughts just keep coming.

And so you need to distract yourself, think about something relaxing at the same time, say it's the deep breathing, or there's also progressive muscle relaxation.

Something that relaxes both your body and your mind so that you can enter sleep.

- So then I'm gonna assume you're not a fan of having a TV on in the bedroom.

- I'm not a fan of having a TV on in the bedroom, that's right.

And then, of course, any electronic device.

And of course my kids say, "Why do we have a mom who's a sleep researcher?"

(laughs) Because I am aware of that, sometimes it's fine to... Again, it's not sort of this is something we have to be rigid about, but we just know that, again, we are, as humans, I guess, we are so tempted to, just another 30 minutes, or just let me just check one more message.

Let me just watch one more TV show.

And of course, the way it is now, it's just so easy to just keep on watching or keep on chatting, keep on checking.

And then we, very easily, time goes by.

And just before you know it, it's really late and you haven't even started going to sleep.

So I think it's, again, if somebody, especially we're talking about if somebody's having trouble sleeping, then I think paying some attention to sleep.

Go back to paying some attention to your sleep, it's important.

And get some help, get some strategies, 'cause you can't do it alone either.

So it's...

There's a lot of tools that can help sort of help people get control again of their sleep if they're having trouble.

- I'm sure nobody watching this has done any of those things that you just mentioned.

(laughs) One more email.

Then you start thinking about work, oh, forget it, you're done.

So we have a great question about using different kind of tracking devices for sleep.

So this one's specifically talking about the Apple Watch, just tracks sleep.

How accurate are these types of tracking tools?

- Yeah, that's also a really, really good question.

And now we do have so many options of, we can track everything, including sleep.

And that is another focus of the human sleep research program at SRI International.

So one of my colleagues, Dr. de Zambotti, is really a world leader in looking at these devices and seeing what is their performance like compared to our gold standards.

And when I talk about our gold standard, I'm really referring to our in-lab polysomnography, the measures of the electrical brain activity.

And so we've done a number of studies to look at some devices and see, well, how accurate are they?

And they have, I think, when you think about how it's relatively recently that these wearables became available and they've sort of exploded onto the market.

There's lots of different options.

And they've also advanced very quickly.

So they went from just relying on measuring activity and just knowing if you move, then you're awake.

If you're not moving, you're asleep.

Now they have multi sensors.

So some of them maybe are measuring temperature.

Some of them are measuring sort of a derived measure of heart rate along with activity.

And so that's why now you can see with the wearable, they can even give you measures of sleep stages.

So now, from our studies, we know that they're actually quite good at detecting sleep and awake.

They're not quite there yet for the sleep stages, so seeing if you're in the deep sleep or the light sleep.

They they've certainly come a long way and they've improved a lot and they're actually quite accurate for detecting your Rapid Eye Movement or REM sleep.

I will say one caveat is that, it does, it can vary depending on who we are talking about.

So if somebody is quite a good sleeper, healthy, then the devices can perform quite well.

If somebody's having a sleep problem, a sleep disorder, then the performance can go down.

And also, depending on what you do during the day.

So if you maybe have a cup of coffee right before you go to sleep, then that can affect the performance.

So anything that affects those signals that the wearable is measuring.

So for example, the heart rate.

Anything that's affecting those signals can affect the performance of the wearable.

And they can be useful for tracking sleep over a long time.

And we even use them in some of our research studies to get a better picture of how people are sleeping in different situations and different populations.

Sometimes people say they don't like to look at their watch and see their watches telling them what their sleep was like.

Maybe it doesn't always match with what they felt.

So I think there's a lot in there as to how helpful.

They can be helpful for some people.

But it's also good to keep in mind, well, how not to forget.

We're talking about how you feel as well in the morning.

How do you feel after a night of sleep, and do you feel restored?

That's a very important part of understanding sleep.

- That might actually be a good thing to make note of, right when you get up, just similar to if you're trying to track dreams, right?

Because you don't recall the dreams later.

- Right, that's right, that's right.

- So what is actually the ideal room temperature for sleeping?

- Ah, so temperature, room temperature.

So I've done a number of studies looking at temperature and sleep.

And so, it is an important factor to think about.

And it gets to the sort of the picture of our environment.

What's our environment that we are sleeping in?

So temperature is one of those important factors.

So you, just like Goldilocks' porridge, not too hot, not too cold.

We want it to be just right for sleep.

So it would be, of course, you've gotta remember that you've got sleeping with a comforter on, so pajamas.

So it does depend on sort of what you're sleeping with.

So we're talking about a comfortable room temperature of 70, 72 degrees Fahrenheit.

Also not too humid.

And this raises the question, then, of, well, what do people do if they're living in a place where there isn't air conditioning or in parts of the country, parts of the world where it's very humid and extremely hot?

And that's why there's, it definitely disturbs sleep.

So if it's too hot or, of course, extreme, if it's too cold, then our sleep is disturbed.

And if it's... What I mean by that is then everybody will know this.

If they're not comfortable, then they'll be waking up more.

So if they're feeling too cold or too hot, then that will disturb their sleeps.

And it's not just the temperature, it's also noise.

So if you have a noisy environment, then that really disturbs sleep.

If we extend that even to the time of day when you're sleeping.

So for shift workers, of which there's been a large number of people who are having to try and sleep during times during the daytime, when other people are out and about, and then they really need to make their bedroom close off from the light, 'cause light is a major awake stimulus.

So if somebody is a shift worker, then they need to just make sure that their environment during the day is conducive to sleep.

And that's a hard one.

- That is a hard one.

I know for me that the light comes in and I'm starting to wake up.

We have a question, again, about additional things that can help you fall asleep.

So what about ashwagandha or melatonin?

- So there's quite a lot of work looking at melatonin and sleep.

And melatonin is a natural hormone in our bodies.

It's really important with sleep.

It's our circadian time marker, so that 24-hour rhythm.

So during the night melatonin is high and during the day melatonin is low.

So melatonin is suppressed by light.

So just as we were talking, that's what melatonin sort of is the signal from the environment to our brains to say whether it's daytime or nighttime.

And that's what led to the question of, well, whether melatonin could be a helpful sleep aid.

And melatonin can help people fall asleep at night.

It sort of can work in the short term.

And just as with anything else, though, people should just be aware of what formulas, where they're getting their melatonin from, and also not to use it as a constant use.

I think it's always better, like I say, to fix the problems of sleep, which takes more time, but works in the longer term, is with those cognitive strategies, cognitive behavioral therapy, with help.

And to avoid sort of depending on anything in sort of a constant, persistent use.

That said, melatonin is helpful for falling asleep, and especially if we think about jet lag.

So if somebody is making time zone changes, then using melatonin along with morning light can be good strategies to help them deal with that jet lag.

- Yes, absolutely, I agree with that.

I'm gonna jump back to having menopausal hormone changes and how that is so disruptive to sleep.

It doesn't seem that there is a good way to just measure what hormones or often fix them.

Often I think doctors want to try to prescribe hormones as a blanket prescription for many, many women.

Can you talk about, is there just not research that's available, or why is it just prescription drugs versus trying to balance out hormones?

- So when we talk about the reproductive hormones that are the changes that are happening in the woman's body, around the time of menopause, of course, it's one of the most dramatic changes and that's the reduction, of course, that's happening in estrogen.

And there's some dietary supplements, ISO... Wrong one.

Sort of soy products that can sort of boost the hormones a little bit, but it's not gonna be the same as our natural hormones in the time of our natural sort of reproductive phase of life.

And so that's where, in order to... That's probably the reason why, when people, when physicians are looking at the symptom profiles that women may have, if there's a lot of issues directly due to that big drop in hormones that is happening in women around the time of menopause, then they will consider hormone therapy.

And it's...

I think what we wanna think about is that there's options for women.

So we don't only want one option.

And I think that's what we are trying to get at.

We're trying to get towards, with our research, and with the science is to find, well, it's not only hormone that replacement that you could look at.

There's combination therapy, so there's alternatives.

And some of them require prescription.

And then some of them can, when we're talking about sleep, a lot of it can be some strategies that women could do at home.

And even with those hot flashes, sometimes it really does depend on the severity.

So if some women have such severe hot flashes that they're having so many of them, day and night, and it's really disturbing their quality of life, then hormone therapy can be an effective way to reduce those hot flashes.

But it's not the only option.

And there's more treatments on the horizon, as well, for treating hot flashes and in turn sleep problems associated with hot flashes.

So I think we're learning more.

Some, if we just, again, look at behaviors, which I think can be a big factor in this, what can people do?

Something even as simple as changing that temperature, the environment, so lowering the thermostat, having a cooler bedroom, using, sort of having a cooling pillow, anything like that could help with the hot flashes at night and could reduce the impact of the hot flashes on sleep.

- That is a great suggestion, good advice.

We do have a question, talking about sleep patches.

I know that you've touched on this a little bit, but they're asking if sleep patches are dangerous, especially the ones with melatonin in it?

I think because you're not supposed to be taking that for a long period of time, right?

'Cause it can upset your own balance of melatonin.

- So because I'm not a clinician, so I am a researcher, I would not be the right person to even answer that question.

I think that, again, anything that someone is using, wanting to use to fix a sleep problem would be better done with consultation with their healthcare provider.

- Thank you.

So here's a question about actually breaking your sleep up.

So if we had...

Eight hours would be the ideal sleep.

If we only all got eight hours.

But what if we broke that up into four hours?

Four hours here, and four hours there.

Does it have the same effect on the body if it's in within that 24-hour time period?

- Good question.

And again, that's why I love sleep research as a field, just because there's so many questions and some of them are so basic, you think we should be able to answer them all and we don't, and that would be one of them.

I think that there's some evidence pro and con as to whether, could we break our sleep up, and was this something that our ancestors did thousands and thousands of years ago?

And I think we're beginning to get a better idea of what happens during sleep, because that's, of course, what's critical.

That's why sleep matters.

It's what's going on in the brain and the body and restoration is happening and memory consolidation.

And so many important things are happening during sleep.

And we're just not quite yet knowing, well, can we divide it up?

Can we break it down?

Could we do without some parts of sleep?

Which are the essential parts we need?

Is it all essential?

So lots of questions that I think we still need to understand better.

But certainly there's enough cultures in the world, when you look at a siesta period and then a nighttime sleep, which people would say that that's what they do and are quite...

They're functioning and doing it well.

- With a siesta, I mean, are they typically getting an eight-hour sleep at night and then still having a good chunk of sleep in the afternoon?

- I don't think that it's gonna be someone landing up with a total 10-hour sleep period during the day.

I think it's more that maybe a siesta and then would be the eating very late at night, staying awake much later, going to bed later.

And so, everything's sort of just a bit shifted, so different from going to bed then at 11:00 PM.

- Sure, thank you.

Thank you for that clarification.

So, Dr. Baker, what are you currently working on?

- I am working on a number of projects.

So I'm doing a couple of projects, looking more into women and their sleep and trying to understand better around the links between sleep and memory function in women, in association with the hormone changes.

And then I'm also doing a couple of studies focusing on adolescents, and not just their sleep, also their brains.

So one of those studies is the Adolescent Brain and Cognitive Development, or the ABCD study.

So that's a very large study sponsored by NIH.

So we are part of a consortium, studying more than 11,000 kids around the country.

So a huge number.

They're now teenagers.

And so we are tracking how their brains are developing, how their brains are changing within the social context.

We also look at sleep because that's always important.

I bring in sleep into everything that I do.

We know that sleep is important for brain development.

And as I mentioned earlier, just how much it changes in those teenage years.

But the whole point within this project is that we can just really focus attention on our children, on the teenagers, because we know that that time of development is so important.

It sets them up for adulthood.

It really establishes their behaviors.

And it's just an opportunity, a time when things should be good and strong and health behaviors should be strong.

And that's what we're wanting to sort of build and learn about in that project.

- Well, that sounds very exciting.

Well, I would like to thank you, Dr. Baker, for being here with us this evening, it has been delightful.

I've learned so many great new things, as well as our audience, so thank you.

- Oh, you're very welcome, that was fun.

- For more information on Dr. Baker's work, there are links in chat that you can follow, to follow up on that.

So this is a wrap for our third season of WSKG Science Pub.

We'll be taking the summer to recharge and seek out exciting science for the fall.

Mark your calendars for our next Science Pub, on Tuesday, September 13th, with special guests Grace and Corbett Lunsford.

They are hosts of the PBS show "Home Diagnosis."

Grace and Corbett show the science behind our homes and what we should be focused on.

And very exciting news, hopefully, that this will be an in-person event.

So very excited for that.

But don't worry, we will offer also have an online component.

We will be streaming the event live, as well, and archiving it on our WSKG Science Pub page.

More details can be found on the WSKG science page, coming in the next few months.

You can watch past WSKG Science Pubs through the PBS app, on demand on your smart device, and on WSKG's YouTube channel.

Be sure to like our Facebook page for future events and science updates.

All of those links are being put in the chat for your reference.

I wanna thank our WSKG team tonight.

Our director is Andrew Pioch.

Our chat moderator is Kristine Kieswer.

Support for Science Pub is provided by the Robert F. Schumann Foundation and from viewers like you.

I'm host Nancy Coddington, thank you for joining us.

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