Sleep deprivation is detrimental to physical health, mental health, and learning, but it’s harder to notice. It can affect your creativity and thinking skills. The best way to know if you are not getting enough sleep is to look at a time when you should have peak awareness.
If you feel like you are tired, yawning, or need a cup of coffee to function, that is a good indicator that you are not getting enough sleep. Becoming self-aware of what sleep deprivation looks likes for you can help you advocate and correct it. Everybody sleeps, and everyone needs sleep, and the more you are able to advocate for yourself, the more other people understand that they are not alone in their struggles.
Join the conversation with Dr. Audrey Wells as we discuss the importance of sleep and how we can take control of our sleep to feel more awake and improve our mental wellness and productivity.
During this episode, you will learn about;
[00:00] Introduction to the show
[02:07] A bit about our guest today, Dr. Audrey Wells
[02:40] Dr. well’s career background and her journey in medicine
[04:29] What inspired Dr. Well into sleep medicine
[06:50] When Dr. Well realized that he was sleep sensitive
[10:21] Signs that show you are sleep deprived and need to take action
[11:19] The difference between sleep deprivation and being drunk
[14:55] One way to know if you are getting enough sleep
[16:09] Steps to take when you realize you have sleep problems
[19:19] A practical tip on how to take control of your sleep
[19:47] How screens compete with our sleep
[24:12] Self-awareness and putting limits on technology to give your brain some space
[25:41] Net gain loss: The impact of sleep on creativity and productivity
[29:12] Dr, Wells’s message to her younger self and anyone starting out
[31:46] Ending the show and call to action
Notable Quotes
- One night of sleep loss is about the same as being drunk, having an alcohol level of 0.8 to 0.1
- The brain likes a consistent wake-up time over a consistent bedtime, so consider what time you wake up and work backward.
- If you have irregular sleep schedules because of work obligations, focus on light exposure to help you sleep and be awake when you want
- Even the dim light and the night-time settings you can engage on your screen are not significant when reducing the impact on sleep.
- The more we engage with screens, the less we sit down with our minds and are mindful of our thoughts.
- Compressing your sleep makes things that you have to do more difficult and takes longer to achieve
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Dr. Ryan Stegink
Website: https://www.medededwell.com
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Dr. Audrey Wells
Individual coaching re: sleep coaching, productivity: https://www.bossmythoughts.com/
CPAP/sleep apnea patients: https://www.supersleepmd.com/
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Above are the episode show notes and below is the transcript via www.temi.com. Some episode transcripts have been edited more than others, but they are up in the meantime to help those who would rather read and for searchability on the web. Extensive editing has not been prioritized as I seek to both produce regular content and maintain my own wellness. See the website disclaimer if you have questions, since this is all for your education and entertainment only. Enjoy!
Transcript
Dr. Ryan Stegink (00:01):
Does charting in medicine seem overwhelming the queue of messages, labs, patient calls that never seems to get smaller. The pile of preauthorizations awaiting your input, the tens or hundreds of charts that you still have to finish and sign it’s exhausting, right? And still all you want is to be able to go home with your work done, to be able to spend time with family, hang out with friends, practice self-care. I want to invite you to join me for a six week long coaching program, charting mastery, where you will get equipped with the skills and approach that you need to get home sooner and leave that work at work, to check out more info and to join the wait list, head over to charting mastery.net. You will be among the first to hear when the door is open so that you can join me on this journey.
Dr. Ryan Stegink (01:12):
There will be opportunities to reflect and earn CME after the different sessions as well. And now onto today’s show. Welcome to the MedEd well podcast, empowering physicians to get work done at work, and then be able to reflect and choose what is important for both their life and medical practice. I’m your host, Dr. Ryan Ste general pediatrician and life coach for physicians. Hello everyone. And welcome to another episode of the MedEd well podcast, where physicians come to be encouraged and equipped to take the next step in their own wellness journey. Thank you so much for subscribing and sharing these episodes and for engaging with these concepts today, I’m honored to have Dr. Audrey Wells as a guest, Dr. Wells is a sleep medicine physician and certified mindset coach on a mission to help people sleep better so they can feel more awake and alive all day long. She offers a group coaching program and private Facebook community for those struggling with sleep apnea and treatment, including C P a P. She also does individual coaching for those who want to up level their productivity and potential by taking too tired out of the equation. Dr. Wells, welcome to the show.
Dr. Audrey Wells (02:40):
Thanks, Ryan. It’s really nice to be here with you today.
Dr. Ryan Stegink (02:43):
So tell me a little bit about yourself and your journey to medicine.
Dr. Audrey Wells (02:47):
Sure. Well, I guess I’ll start by saying I was not one of those people that always knew they wanted to be a doctor. I actually dipped my toe in the field of research before I decided to go to medical school. And I guess , I didn’t like it so much. And so I decided to turn my attention to medicine. So I went to university of Michigan medical school, decided to do a pediatrics residency, uh, completed that did a pediatric pulmonary fellowship, then sleep medicine, fellowship, obesity, medicine, fellowship, and decided to stop at that point. So I’m a triple board certified. And as you mentioned, I’m also a life coach and it’s just been really great to include all of those skills in my interactions with people who struggle with sleep problems
Dr. Ryan Stegink (03:47):
Mm-hmm well, and just that continuous learning. And I’m sure some of those skills and curiosity from your research days have really translated well into how do I integrate all those things and caring for my patients.
Dr. Audrey Wells (04:06):
Yeah, it does. And I think one of the great things about being a sleep medicine doctor is that because everybody sleeps, it’s really starting from a place of common ground. Sometimes I say, I wish I had a dollar for everyone who wanted to talk to me once they found out what I do, because so many people have sleep problems it’s really pervasive in our society.
Dr. Ryan Stegink (04:32):
So how did you get interested in the, in the field of sleep medicine?
Dr. Audrey Wells (04:36):
You know, thinking back to medical school, I cannot remember any lectures or information about sleep, so I’m almost positive. It wasn’t there, but I do have a very clear memory of going to one of the ATS American thoracic society conferences at a, as a peds pulmonary fellow. And I was kind of bored in the one of the all day courses I was doing. I was ironically falling asleep in the course. It was still in the morning. And so I got up to walk around and I found another conference going on about sleep. And I read the board outside of the doors and just felt really connected to that material sleep is something that I’ve always kind of prioritized because I’m quite sensitive to sleep loss. And so I ended up going into that lecture hall that day and spent the rest of the day there kind of geeking out that this was something that I could actually pursue I as a medical field. And so that kind of planted the seed and later I was able to do the formal sleep medicine training and kind of solidify that as my career path.
Dr. Ryan Stegink (06:00):
That’s so cool. And just how some of those things that you think, oh, what are the odds? I mean, yeah, it’s just really cool. Those opportunities that come up and then just, just look back and see where it, where it took you.
Dr. Audrey Wells (06:14):
It felt like a revelation to me. I mean, it was very memorable experience. And so I think, you know, being able to just kind of make that happen has been fantastic path for me. And I really feel like I’m in my element, I’m very passionate about these things. And so talking about it and promoting sleep as a pillar of health is something that I really am enthusiastic about.
Dr. Ryan Stegink (06:41):
Hmm. Well, thanks for being here to share some of that. So when did you first notice that yeah, you were particularly sensitive to sleep loss or was that part of your time in training or some other experience you had?
Dr. Audrey Wells (06:57):
You know, I would say it probably started when I was a teenager and I remember in high school just getting up in the middle of the night, feeling anxious and I couldn’t sleep. And anxiety is often something that keeps people from sleeping. And I certainly experienced that firsthand. In fact, on some of the worst nights, I remember my dad getting up with me to kind of talk things through and help me relax enough to go back to sleep in medical school. I really struggled, and I want to kind of highlight this today because I think the culture of medicine sort of rewards taking sleep loss or productivity to extremes, and it’s really detrimental to not only physical health, but mental health and learning as well. So, you know, in med school and residency, when I was taking call and, you know, studying late at night and trying to do all the things, oftentimes I would compress my sleep and I’m sure you’ve had the same experience, right?
Dr. Audrey Wells (08:20):
So I, I’m not someone who has a high tolerance for that. It was quite clear to me that that would limit my career choices. For example, the emergency room is not for me and surgical practices, uh, where, you know, you’re on call and having to stay up. It was not for me. And, you know, I had to actively manage the rotations that I did with call involved so that I could catch up on my sleep and give myself enough time the next day, so that I could could function. And, and by function, I’m talking about just, you know, doing the very best I could. I don’t think that I was excelling during that time, to be honest, but on other rotations where I was able to have a normal or typical overnight sleep opportunity I was doing fine. And so it really highlighted for me, the fact that sleep is so critically important and you know, other people I’ve talked to in my training and all the way up until yesterday in fact have sort of echoed those experiences.
Dr. Ryan Stegink (09:35):
Yeah. I think that it’s so common. And even just looking back, I mean, some of those things, sometimes you have some wake up calls. I mean, I remember like having a microsleep while I was driving home from my sub internship in medical school, and thankfully I didn’t change lanes and it was just a momentary thing, but it really scared me enough where when I knew I was driving, I would be doing the congested part of the commute through Chicago doing a week of nights. I actually just stayed at the hospital. Mm-hmm my week of sub sub I nights. They had an extra call bed and I was like, this is not gonna work for me. so what signs do, should people be looking out for? It’s like how it affects their productivity, their mood to say, Hey, this is actually really limiting me in a way that I need to start addressing it.
Dr. Audrey Wells (10:30):
Yeah. I think that that experience you had while driving is a big red flag for me, that has happened too. I, and I remember one time sitting at a light in a turning lane and the light changed from red to green. And I didn’t know what that meant. I couldn’t remember what that change was. And I knew I was supposed to do something I was sitting in, you know, in my car. I think if anybody is having that kind of experience, of course, they are way past the point of being safe. And, you know, it’s kind of in the, in people’s awareness that one night of sleep loss is about the same as being drunk, having a blood alcohol level of 0.08 to 0.1. I do wanna say though that the difference between being sleep deprived and being drunk while you’re driving, is that when you’re drunk, all of your reactions are slowed.
Dr. Audrey Wells (11:37):
So you’re late to break or you’re late to turn, but when you have a microsleep behind the wheel, you don’t react at all. And so, especially if you’re driving at high speeds, then that accident that you have in your car could be catastrophic for you or for someone else. And that is a big difference between sleep loss and driving drunk. Now, I think there’s probably an extension of that analogy that, that I could make, which is even just modest sleep deprivation. So we’re talking, you know, pulling your sleep habitually down to six hours a night, sometimes four hours a night, even that probably has some, uh, equivalency with having a few drinks in you. And one thing about that is, you know, people tend to explain it away. Uh, they have some compensatory behaviors and such, but I think becoming aware of some slipups a little bit slower to make connections, becoming more aware of what sleep deprivation looks like for you is really the first step to help yourself to advocate and correct that I had an experience one time where I was charting at the end of a call shift.
Dr. Audrey Wells (13:05):
I remember trying to get done before rounds started and handoff. And this was, this was just before the 80 hour work week limitations. So I was the unlucky cohort that went through as, um, just before that was enacted. And I remember looking at the computer, the EMR, and there were, there was an octopus coming out of the computer at me. So I was having dream intrusion while I was sitting there. And yet I could hear people around me. I could like see people in my periphery walking by. So again, that is too late. And, you know, I, I think if you’re really wanting to kind of create a grade for yourself, you can assess your physical performance and kind of look at your creativity or your reasoning skills. And if you notice those are depressed, look at sleep deprivation as a potential cause
Dr. Ryan Stegink (14:10):
Yeah, those are great things to really dig into an evaluate because I mean, it’s so easy to think, oh, I’ve gotten by for these years of medical school or residency on six hours a night. And it’s like, okay, that just because it’s been a chronic thing, it’s harder to notice. I think sometimes
Dr. Audrey Wells (14:33):
Absolutely
Dr. Ryan Stegink (14:33):
Really does affect. Yeah. I mean your creativity, your analytical thinking skills. I mean, I remember I was post call and rounding and just trying to write orders for like the parental nutrition and I couldn’t do it. And the pharmacist was like, do you want me to do that for you? Yes, please. Before I mess something up, that’s really important. So those are really helpful tips.
Dr. Audrey Wells (15:02):
Yes. And you know, it, it’s not just overnight call that affects people. I know that to your point, a lot of folks will go to bed later and wake up earlier, getting six hours of sleep a night seems to be kind of a threshold there. But one way to know that you’re not getting enough sleep is to look at a time where when you should be having peak awareness for most people, that’s gonna be in the late morning. So around 10 to 11:00 AM. And if you are feeling like you’re still tired, you need a cup of coffee to function, or, you know, you’re having yawning or feeling like you could take a nap. That’s a really good indicator that you’re not getting enough sleep overnight.
Dr. Ryan Stegink (15:53):
So if people are saying, yeah, that’s me, what do you think that first step there’s certainly the awareness piece, which is huge, especially in coaching and just bringing some of those thoughts and feelings to awareness, say, you realize, okay, I have a, I have an issue here. What’s that first step that people should consider taking.
Dr. Audrey Wells (16:19):
I typically recommend that folks look at their sleep schedule and sleep opportunity. First, having a regular sleep schedule is not very sexy. I’m gonna say it’s kind of the equivalent of eat more vegetables when you’re trying to look at your nutritional health, but this is something where you really want to nail the basics and having a regular sleep schedule, meaning you have the same wake up time, seven days a week, and you have the same bedtime seven days a week, which allow for enough sleep opportunity is low hanging fruit when it comes to improving your alertness. And you know, for most adults enough sleep is going to be somewhere between seven and eight hours. So in order to achieve that, you want to allow for seven and a half, eight hours in bed because you know, it’s really hard to have a 100% sleep efficiency, which is the amount of time you’re sleeping over the amount of time you spend in bed.
Dr. Audrey Wells (17:32):
So you want to allow enough sleep opportunity. I usually suggest starting with the wake up time, the brain very much likes a consistent wake up time, even over a consistent bedtime. So consider what time would you have to wake up in order to start your day and, and get the things done and then work backward from that to identify your bedtime for those people who have irregular sleep schedules because of work obligations and such, I tend to focus more on light exposure as a way to help sleep when you want and be awake when you want. So light exposure upon awakening is really helpful for the brain to promote awareness and alertness, to have concentration and memory, and then dim light exposure. When you want to sleep on the other end of the spectrum really helps people to improve sleep quality and shorten the time it takes to get to sleep.
Dr. Ryan Stegink (18:38):
Yeah, that’s helpful. I remember rotating through my outpatient pulmonary rotation in peds residency and got to go to the sleep lab and watches the sleep medicine physicians were reading things and there were definitely lots of periods of wakefulness. And I think that kind of is really helpful just to say, okay, start with the wake up time and at least, and not everyone’s prefers to be, a morning person. I am one of them, others in my life are definitely not, but yeah, it’s about kind of setting some of those boundaries and, but like building it up so that you can say, okay, what, what do I need to get done? What are my obligations? And how do you take those steps forward?
Dr. Audrey Wells (19:25):
Yeah. I find that outlining things like with really specific action steps is the quickest way to kind of recruit someone to the idea that they can get in control of their sleep. So connecting those dots is really important.
Dr. Ryan Stegink (19:42):
How do you see, yeah, just what are some of the struggles with like that dim light, getting the wind down from the day and the use of screens, how has that changed things over the past 10, 15 years?
Dr. Audrey Wells (19:58):
Yeah. Screen time is really pervasive in our society. And I would kind of highlight two things about screens that compete with sleep. One is the light that screens admit particularly handheld screens. So, uh, smartphones, tablets, and laptop computers, and even the dim light or the nighttime settings that you can engage on your screens is not really terribly significant when it comes to reducing the impact on your sleep. So some people who experience that short wave length, blue light from their screens will actually delay their ability to get to sleep because the brain is quite in tune with light as a signal for wake. So some people delay getting to sleep, others can fall asleep and they perceive that they sleep. But if I were to magically have an E EEG montage on their heads, I would see micro arousals and sleep fragmentation. That would probably be connected to that screen exposure.
Dr. Audrey Wells (21:14):
So there’s a couple of ways that light can affect your brain. Sometimes it is just difficult or even not something you wanna do by taking out your screens at night, but you can manage the light exposure. So in addition to engaging the night settings on your device, I would suggest wearing some blue blocker glasses. You can look for different percentages of blue blocking, but suffice to say those that have orange lenses are gonna be the highest blue blocker capability. And hopefully you’re not in any fashion shows late at night because it is a little stark to see those orange glasses, but gamers use these. And I think they’re really something that I recommend for professionals and other people who do late night screen time and just can’t get around it. The other way that screens kind of affect sleep is there’s an emotional component to screen time.
Dr. Audrey Wells (22:18):
So with social media, for example, you’re kind of looking for a dopamine hit as you’re scrolling. And sometimes there’s some agitation emotionally, as you’re coming up on something that brings you down or lifts you up. You know, there’s, there’s this kind of emotional response that comes inherent with some screens. Stress is another one. And along with that, the more we engage in screens, the less we’re sort of sitting with our own minds and being mindful of our own thoughts. So when you put the screen down and close your eyes to sleep, oftentimes that’s the very first time in your whole day that your brain is getting a chance to sit there and be with itself and asking it to go to sleep in a snap is a bit too much. Our brains are just not designed that way. So, you know, screens are always available. In fact, I, I kind of joke sometimes I no longer wear clothes that don’t allow me to carry my phone with me. So I carry my phone in my clothes but I still try to take time away from my screen to be with myself. So that all of that time isn’t just as I’m trying to sleep,
Dr. Ryan Stegink (23:41):
I think that’s really helpful. And before I, I started my coach training, I was like, um, yeah, just those thoughts and experiencing the feelings and the sensations of like, oh, it’s like, this is what it feels like to be hungry or bored. It’s just so easy to be like, well, I have a spare moment. Let me pick this up. And then yeah, it’s like your emotions, your sleep, what you’re eating, like all these things. It’s like, we’re our whole human beings. So it’s, it kind of all affects each other.
Dr. Audrey Wells (24:19):
Absolutely. Right. And you know, unfortunately our brains are not evolving as fast as technology, but in a way that’s good because I, I think, you know, with that awareness, you can put limits on what you’re doing and I’ve had to do this for myself. You know, I notice that when I’m feeling bored, it’s a bit uncomfortable. So to distract, I pick up my phone and that uncomfortableness then is present at night as I’m trying to sleep. So if I can give my brain space earlier in the day to be bored and to become less uncomfortable with boredom or lack of stimulation, then at night, it’s much easier for my brain to soothe itself and invite sleep in a natural way.
Dr. Ryan Stegink (25:12):
Well, and I found when I’m able to put my phone down for a bit and either experience the boredom or just that opportunity for creativity. I think that has allowed me to be more productive, even as I’ve thought about topics for podcast episodes or things that I want to do say with my family, it’s just a different opportunity to engage. How have you seen the effects of sleep and productivity, particularly as you have walked people through just kind of the effects of, of sleep on that?
Dr. Audrey Wells (25:48):
Yeah. Productivity is something that I really enjoy. So I find it very easy to connect with like-minded people that really want to squeeze all the minutes out of their day, but a common sort of maladaptive coping mechanism is to shorten your sleep in order to get more things done. And it’s something I coach on a lot because I think it’s a bit subtle, but what ends up happening 99 times out of a hundred is that compressing your sleep and having mild sleep deprivation just makes the things that you have to do a bit more difficult and it takes longer. Anyway. So there is a net zero gain. in fact, when you’re compressing your sleep, you’re reducing your ability to learn. You’re also cutting back your creativity because your frontal lobes, the part of your brain, that is the new part, the executive functioner is most affected by sleep loss.
Dr. Audrey Wells (27:02):
And so those neuronal connections that the energy available for things like creativity, innovation, imagination, they are not functioning as well when you’re sleep deprived, even modestly. So if you’re giving your brain space away from the screens to just play, your thoughts are kind of flowing by that is really important for creativity. But also if you are doing that with a well slept brain, then you’re likely to see immediate gains in what your brain can produce. Now, there’s really interesting research over the past few years about sort of a sewage system of the brain whereby there’s sort of a lymphatic system in the brain it’s called the lymphatic system. And this is something that’s very active at night during sleep, to clean out all the metabolites produced by the neurons to allow the, the CSF to cleanse the brain effectively. And if your sleep is crimp or compressed, this lymphatic system cannot operate efficiently. And it effectively, constipates your brain from ideas and flow and creativity. So allowing that process to work is likely to give you a noticeable improvement in your productivity. If you’re able to keep a regular sleep schedule and get enough sleep,
Dr. Ryan Stegink (28:41):
That’s really helpful just to hear a little bit more of, okay, the anatomic mechanism, like why this works, but I mean, every part of your body, it’s like there’s actions that go on and processes and yeah. To have that opportunity for recharging and like for the body to take care of some of those things. But it just needs that time.
Dr. Audrey Wells (29:08):
Exactly.
Dr. Ryan Stegink (29:10):
Before we wrap up, what is one piece of advice that you’d have for somebody early in their earlier in their career that you wish you had known back then?
Dr. Audrey Wells (29:19):
Yeah, I have thought about this and I think what I would tell my younger self and anyone who’s in training, or just starting out is to advocate for your own sleep as part of your health and recognize when you’re limited. By that recognize when things are getting dangerous and speak up, it’s simply not worth it sleep deprivation. And its extreme has been associated with seizures, been associated with suicidality sleep deprivation. That’s even modest is affecting people’s mental health. It’s not worth it. You need to speak up, you need to take a break and make some changes. And I would really encourage people who struggle to be vocal and talk about it. I think that things are changing. The more that you’re able to advocate for yourself, the more other people understand that they’re not alone in these struggles, then we can all work together to improve this system, which is quite archaic in many ways.
Dr. Ryan Stegink (30:35):
Hmm. That’s really helpful. And yeah, even if that looks like for me, when I was post call, I would actually go and sleep in the call room from 10 or 11 until two or three. And then I just knew I’d call housekeeping and they’d turn over the room before the next resident needed it. But whatever that needs to look like to be an advocate to speak up and to say, okay, things need to change. And whether that’s scheduling, which like you said, some of these things have been around for a while and it may take time, but as we continue to speak up and to encourage people who have the ability to make those changes, I think that’ll be how we continue to move this forward.
Dr. Audrey Wells (31:23):
Yes. You know, everybody sleeps, everybody needs sleep. And so I guarantee that if someone realizes they’re struggling or they’re not safe, the person that they signal to will have some degree of understanding about that. And I would really encourage folks to just think about what tired feels like, know your warning signs and act on them accordingly.
Dr. Ryan Stegink (31:53):
Well, thank you so much Dr. Wells for joining me here on the MedEd well podcast and yeah, I think some really great tips and concepts to be aware of for yourself as you advocate for others, that you may get a chance to work with colleagues and trainees. Yeah. This sleep is part of life for everyone. And I want to encourage you to really realize how big of an impact this makes on your wellness and your ability to care for yourself and for others around you. So I wanna encourage you to subscribe to the podcast, to share this episode with anyone, with any other physician or just anyone who, you know, would really benefit from this and we all sleep. So like that’s everybody. So you can change the culture of medicine and promote wellness for your patients, your colleagues, and yourself. Thank you so much for all that you do and have a great day. And now for our important disclaimer, Dr. Ryan Stegen is a practicing general pediatrician, but the MedEd well podcast is not reflective views, opinions or belief of his employer nor his affiliated university. Additionally, the MedEd well podcast is for educational and entertainment purposes only, and should not be considered advice regarding financial legal student loan, medical, or any other specific topic. In such a case you should see consultation with certified professional in that particular area. Again, thanks for joining us on the MedEd well podcast and have a great day.