Zzzzzzzzzzzz…Busting The Myths About Sleep And Sleep Disorders

By Mia Zaharna, M.D. and Henry I. Miller, M.D. Nov. 30, 2106, at 5:00am

A certain amount of sound sleep is necessary for optimal health and can affect hormone levels, mood and weight. However, sleep problems, including snoring, sleep apnea, insomnia, sleep deprivation, and restless legs syndrome are common.

In spite of being common, sleep and the problems associated with it are widely misunderstood. Here we address some of the myths.

• If you can’t recall your dreams, you’re not sleeping deeply. Not true. It’s normal not to remember your dreams, but most likely you are still having dream sleep otherwise known as REM (“rapid eye movement”) sleep every night. In fact, most people remember their dreams only because they may be waking up frequently in the middle of the night (from disorders such as sleep apnea) or because they were in the last stage of sleep when the alarm went off.

• Waking up in the middle of the night means you don’t sleep well. Not true. Most people wake up several times a night, but then roll over and fall back to sleep. As long as you feel well-rested during the day and are not awake for long periods of time in the middle of the night, it’s normal to wake up on occasion. Of course, if other symptoms are present such as snoring or fatigue, further evaluation for sleep apnea may be needed.
• You can’t have sleep apnea if you’re not fat. Not true. Sleep apnea may be related to being obese, but it can also be found in children and thin adults. Facial bone structure related to a small upper airway also contributes to sleep apnea. Physicians who diagnose and treat sleep disorders look for signs such as a small jaw, a recessed chin, teeth crowding, small nasal passages or a deviated septum (which means the thin wall between the nasal passages is displaced to one side).
• Some people have such bad insomnia that they just don’t sleep. Not true. We’ve all heard people say that they don’t sleep well. Some believe they never sleep. However, most people underestimate the true amount of sleep they are getting. When you’re sleeping, estimating time becomes more difficult. There is actually a disorder, “sleep state misperception,” in which people think they are awake when they have actually been sleeping. If you truly didn’t sleep at all every night, it could severely harm you. Studies in rats have shown deaths from sleep deprivation related to hypothermia, metabolic disruption, hormonal changes, infection and possible brain damage.
• Old people need less sleep. Not true. All adults need somewhere between seven and nine hours of sleep per night. (There are exceptions: Some people are genetically disposed to be “short sleepers” or “long sleepers.”) Although as we age our circadian clock shifts earlier, the total number of hours of sleep needed doesn’t change. So your grandmother may be waking up to start the day at 4 am, but she’s probably also getting into bed at 8 pm.
• Alcohol helps you sleep better. Not true. A nightcap before bed may calm you down and make it easier to fall asleep, but it tends to disrupt the quality of sleep. The depressant effects of alcohol may wear off in the middle of the night, increasing nighttime awakenings. Alcohol also reduces REM (Rapid Eye Movement) sleep and increases sleep-disordered breathing, which may lead to even more nighttime awakenings. And for some people, it can induce gastroesophageal reflux, which can cause discomfort and awakening.
• Everyone needs eight hours of sleep per night. Not true. Everyone has an individual “sleep need,” the amount of sleep needed in order to feel well rested. Some people are short sleepers, requiring only five or six hours of sleep per night while some are long sleepers and require 10 hours of sleep per night. The important thing is that you feel rested during the day. If you sleep six hours a night but are productive and well rested, you are fine.
• You can make up for lost weeknight sleep on the weekend. Not true. While you may be able to work off some sleep debt by sleeping more on the weekends, such sleep deprivation during the work week and binge sleeping on the weekends can contribute to insomnia. It disrupts circadian rhythms and makes it hard to fall and stay asleep. It’s best to set the same wake time seven days a week and get into bed when you’re feeling sleepy.
• If you get drowsy while driving, turn up the music and roll down the windows. Not true. Over half of Americans report they have driven while feeling drowsy. The National Highway Traffic Safety Administration estimates that 100,000 police-reported accidents are related to driver fatigue annually. The best remedy to tackle driver fatigue (other than actually getting enough sleep) includes napping, caffeine, or nicotine (although we don’t promote tobacco use).
• Getting into bed earlier means you’ll get more sleep. Not necessarily. Some people try to “cast a wide net” for their sleep. They might feel that because they suffer from insomnia, spending more time in bed will allow them to get more sleep. However, this may lead to inefficient sleep and actually worsen insomnia. If you spend 10 hours in bed, you may end up tossing and turning for two hours. It’s best to set the same wake time daily, get into bed when you’re sleepy, and, for most people, stay in bed no longer than eight hours per night.
• Fitness trackers can tell you how deep your sleep is. Not true. Most fitness trackers measure sleep by use of an accelerometer which detects motion, speed, and direction of motion. In theory, the absence of or minimal motion suggests sleep, while movement suggests being awake, but these trackers may be prone to mistakes. And although they might claim to, trackers that use accelerometers and cannot detect light versus deep versus REM sleep. Stages of sleep can only be determined by monitoring eye movements and brain waves using an electroencephalogram (EEG).
  Never watch TV before bed time. Not necessarily. If you are prone to insomnia or difficulty falling asleep, you should avoid performing “wake” activities such as watching TV, reading, or surfing the Internet in bed. However, if you never have trouble falling asleep and watching TV in bed is relaxing and enjoyable, it may not be a problem. While it is best not to have extensive exposure to light emitting devices like TV or computer screens right before bed, doing any activity that you find relaxing for an hour before bedtime can be helpful.
• Sleeping pills are fine if I don’t use them every day. Not necessarily. You’re better off avoiding sleeping pills for chronic insomnia. Among other undesirable complications, many sleeping pills have addictive potential, and you may build tolerance to them leading to a less potent effect, and the need for higher doses, over time. It’s best to focus on behavioral measures, such as improving your sleep environment and sleep habits, which may have longer lasting benefits and fewer side effects.
• Mia Zaharna is a psychiatrist specializing in sleep disorders. Henry I. Miller, a physician and molecular biologist, is the Robert Wesson Fellow in Scientific Philosophy and Public Policy at Stanford University’s Hoover Institution. He was the founding director of the FDA’s Office of Biotechnology.