Recognizing Sleep Awareness Month with Dr. Joanna Fong-Isariyawongse

Episode Transcript

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katy Peters, and this is the Brain and Life Podcast.
I am sure that all of our wonderful Brain and Life podcast listeners know that in spring that we have to spring forward. Now, Daniel, do you struggle with springing forward with daylight savings time?

Dr. Correa:
I love the spring so much that it's nice that just to notice and feel like, oh, okay, things are moving along. But the actual time change can really be a challenge. I find it's worst around the time when I end up having to do an overnight call around a fall or the spring, daylight savings hour change. It throws me off, I'm already off because I didn't sleep as well that night before. And the next day, just that transition to whatever my next day is, seems a lot more difficult.
I usually find it helpful even if I'm tired from not sleeping well the night before, still just getting up and doing a little bit of exercise with some sunlight exposure. Ideally, if it's outside or even just inside with the windows open, that really helps that beginning and transition of the day. And if I have time for nothing else, my dog needs to walk each day at least. So I just get her outside, breathe in some of that fresh air, get some of that sunlight to really stimulate the start of my day, and I find that helps.

Dr. Peters:
Well, I'm glad that Cookie is a partner in your sleep hygiene journey. I think improving your sleep and practicing good sleep hygiene, it really is accessible. And hey, if you've got a Cookie, it's even easier, right? You get the exercise in before you go to sleep.
But when we moved into our new house, I was very purposeful to not have a TV hookup in our bedroom. I'm also a big fan of just keeping the gadgets out of the bedroom unless I'm on call. And I also like the light awakening clock that goes down with a warm yellow light in the evening, to dark, and then a white bright light when you wake up. And still, I really am trying to get up at the same time even on the weekends. I know you were traveling recently. How do you get the best sleep? I guess, I can't even imagine while at home in NYC, but also traveling?

Dr. Correa:
Well at home, I like the idea of the natural light or a light awakening clock, but my household is probably similar to many others. Just the practicality of that doesn't work. My wife and I have different sleep schedules in some ways. I get up really early for work or sometimes for a run, and she works from home and enjoys a later morning. So yeah, we keep it really dark in the bedroom because that helps us fall asleep at night, but it could be really dark in the morning and that transition for me. So I get out of the bedroom, open the shades in the living room to let in sunlight or get ready and go out for some exercise or just to take a Cookie for a walk. And that helps when I'm at home, but as you said, traveling outside of the city or traveling away from home is a whole different challenge. I have a deep appreciation for my own bed.
I kind of grew up and had this mentality when I was younger of this like, you sleep when you get older, you maximize the time to party and do activities, and I didn't see sleep as an activity. And over time, I just have realized how much and how important it is to me, but now I really value it as its own activity for my body and brain. And literally, there's a moment of relaxation and almost even achievement I try to appreciate each night when I'm getting into my bed and it just feel so good. Oh, yeah.
But yeah, I mean, that's a key thing for me. And I also have, when I'm at home, there's that pleasant reassurance of being there alongside your partner, my wife. And so when I travel over time now, I've had to develop this thing that I set up the extra pillows that are there in the hotel bed on her side of the bed because just visually you start to wake up at night and you're not really sure where you're at. And it's more comforting to see that shadow and that space or to feel that presence next to you.

Dr. Peters:
Yeah, I agree with all those tips, and I always, when I travel, I'm always sleeping on the same side of the bed that I do when I'm at home. And so it's, I am a creature of habit, I love my own bed. And a lot of times when I'm talking to my patients about sleep hygiene and how much they travel, I'm always like, "Don't you like your own bed?" It's like, I love mine. So, yes, I do feel it's an achievement every time I can get into bed and then also get up and see a beautiful sunrise. And because March is Sleep Awareness Month, we had a great conversation with a sleep expert, Dr. Joanna Fong-Isariyawongse. I think you're going to enjoy the conversation.

Dr. Correa:
I'm really looking forward to Joanna's insights. I've been working on the quality of my sleep and improving my numbers of sleep hours, since it was disruptive, after years of night shifts and call nights in medical school and residency and all the training that we do. And now really seeing it as such an important, valuable part of my day.

Dr. Peters:
Hello, Brain and Life podcast audience, and thank you for joining us today. We are going into the end of Sleep Awareness Month. Yes, March is Sleep Awareness Month. Again, I'm your co-host Dr. Katy Peters, and I'm so excited today because we really have a special guest today to really talk about sleep awareness, sleep hygiene, sleep health, and how sleep can help our brain. And it's Dr. Joanna Fong-Isariyawongse.
So, Dr. Fong-Isariyawongse is an associate professor of neurology at the University of Pittsburgh Medical Center. Her expertise lies in the medical management of patients with epilepsy, but is very interested also in sleep and sleep apnea, insomnia, and also circadian rhythm sleep disorders. She is dedicated to sleep health advocacy and has extensive experience in sleep medicine and neurology. She understands the significant impact of sleep on physical well-being, cognitive function, emotional resilience, and overall quality of life. She's deeply committed to raising awareness and advocating for the importance of sleep health across a variety of populations, and I know that you're going to enjoy listening to her today. Dr. Fong-Isariyawongse, welcome to our podcast.

Dr. Fong-Isariyawongse:
Thanks for having me, Katy. I'm really excited to be here, especially as you mentioned, March is Sleep Awareness Month, so I think it's perfect. And obviously I'm biased, but sleep is super fascinating. Can't wait to talk about it.

Dr. Peters:
I agree, and I can't wait to learn more. And I'm sure our listeners are going to have so many questions. I know I have so many questions. But let's start off, tell us a little more about yourself.

Dr. Fong-Isariyawongse:
Yeah, so I'm a neurologist, but I practice a couple of things. I'm an epilepsy and sleep medicine specialist. I see patients with general neurology issues. So I'm kind of a little bit of a Swiss Army knife, you can say, but sleep is really my passion. As you know, sleep is fundamental to our health, but let's be honest, it's usually the first thing we sacrifice. So we don't really look at sleep in a way that we do nutrition and exercise, and I think it's catching up to us. We're a very sleep-deprived nation. 35% of adults not sleeping enough, and teens are really getting hit the hardest. In fact, four out of five or 80% aren't getting enough sleep, which is a huge problem. It's affecting their mental health, physical health, safety, their academic success, athletic success. And I think that's why the conversation about sleep and school start times really matters.

Dr. Peters:
I agree. And can you tell us really the basics? Why is sleep so important for us?

Dr. Fong-Isariyawongse:
Yeah, yeah. So sleep, when we think about sleep, we always kind of think of sleep as a time for just a chore, a break from the day, but it's really essential. It's the time for our body to restore cells for our brain to recalibrate. As I mentioned before, it is the foundation of our health. And when we push through the late night cutting sleep for work or scrolling on our phone or Netflix, we're really not getting the sleep that we needed.
So, let's talk about sleep. Sleep, the recommended sleep duration according to the National Sleep Foundation and the CDC, for adults, we need seven to nine hours. For adolescent, 8 to 10. For school-aged children, 9 to 11 hours. As I mentioned before, we're one sleep-deprived nation. A lot of us are sleep-deprived, but sleep is a very important event. It's not an on and off event, it's actually nicely structured. As we fall asleep, we go through different sleep stages, we go through the light sleep stage first, stage one and two, and then we go to deep sleep or delta sleep, slow-wave sleep, and then we dream, our REM sleep. And that kind of cycles through four to six times a night.
And sleep has important functions. So when we dream, it is the time for our brain to consolidate memory. So it's really important for learning, and also it is the time for our brain to process emotion. So, that's the reason why sleep deprivation always linked to mental health. In fact, if you look at teens, they're having a huge crisis in mental health, as you know. If teens not sleeping enough and if we're talking about like less than six hours, three to four times more likely to develop depression, anxiety, even higher risk for suicidality. So, that's REM sleep.
Deep sleep or stage three is a time for us to kind of restore our body in a way. And a lot of important things happen during deep sleep. For example, our body release a human growth hormone that helps our body to heal its cells. And then certainly for a growing body is very important. Also, it is the time when our immune system really gets to work. It survey our body for, for example, infection, even cancer cells, and that's why sleep deprivation associate with more illnesses. There's one study looking at high school students. When they don't sleep enough, they have three times more likely to have a cold and they have more absences.

Dr. Peters:
Oh, wow.

Dr. Fong-Isariyawongse:
Yeah. So it's not a minor thing. In the time when truancy is a big problem in our K to 12 system, I think this is one thing to really look at.
And then glymphatic system, this is a big, big term, but it's in a way when you think about glymphatic system, it's like lymphatic system in our body. So it's really a mechanism for our brain to clear out waste product, including toxins that have been implicated in neurodegenerative disease such as Alzheimer's, Parkinson's. So, it's really important. There are a lot of studies showing that even just one night of sleep loss, you see more of these waste product and toxins in the brain in healthy individuals.
So yeah, we cannot see sleep as chores or punishment or just a time for a break. It is really essential for our health.

Dr. Peters:
Thank you so much for telling all of that. You mentioned the high school students and teenagers and middle school students. You were talking about how there is the American Academy of Sleep Medicine position statement about delaying middle school and high school start times to really promote student health and performance. Can you tell us a little bit more about that and why it's so important?

Dr. Fong-Isariyawongse:
Yeah, so the American Academy of Pediatrics, they made a recommendation back in 2014, so that's more than a decade ago now, for secondary school. So middle school and high school to start no earlier than 8:30. And that was later backed by many other health organizations, including the American Medical Association, our own American Academy of Neurology, and American Academy of Sleep Medicine, and so forth. And also including CDC, the US Surgeon General. So we all agree that our school start time currently is really too early.
So, here's the statistics, 13% of high school start after 8:30, that's the recommended sleep duration. And when you look at the spread, 10% start even before 7:30, and half of the time is even earlier than that. My son's high school actually starts at 7:20, he's in sixth grade, so I have a couple of years to help advocate the issues, but start time is not the only issues. Think about the bus. A lot of the time, bus come around at 6:00 in the morning. And in Florida, one county, the first flight of bus come around before 5:00 AM. That is just insane. We are treating teens as shift worker and it's not healthy. And how can they learn? And maybe that's the reason why we see the rising mental health crisis as well. Certainly, I think there are other factors, but sleep is a big one.
And there's really not much teens can do. You can try to get them to practice good sleep habits, but ultimately, they are stuck. The reason why I said that is, when they go through puberty, the natural bedtime actually shifts two hours later. So instead of my nine-year-old fall asleep at 9:00 religiously every night, they really cannot fall asleep no matter how hard they try, until about 11:00 or even midnight. And by asking them to wake up so early, we're limiting the sleep opportunity, and that's why most of them can't get that 8 to 10 hours of sleep. So, and it has major consequences. It affects their mental health as I mentioned before, academics, and safety. Drowsy driving, reckless driving. There are a lot of data also showing that sleep deprivation actually increase their risk-taking behaviors, and that's including substance use, aggressive behavior, like engaging in physical fights, risk of carrying a weapon. So, when you think about the top three causes of death among this age group, which are accidents, suicide, homicide, they all linked to sleep.

Dr. Peters:
So have you seen any successful interventions other than this position statement and sort of making our audience aware and making people aware, where has there been success to sort of change these start times and you see I guess better performance out of the students or even better mental health?

Dr. Fong-Isariyawongse:
Yeah, so it really has come a long way. So far, we're not doing enough. We only have California and Florida that passed the law to delay school start time to 8:30 for their high school students, and I believe their middle schoolers is 8:00. And California enacted the law in 2022, and Florida will be in 2026.
When you look at individual states, there are really persistent efforts, but it's not enough. I'll give you my own state statistic. We have about 500 school districts in our states. We only have so far 44 school districts that shift to later start time, not exactly 8:30, just a little bit later. So yes, a little bit later is better than nothing but as you can see, state-wise legislative efficacy, yes it's important, but I feel like it's really not enough. It's not efficient enough. So that's why I'm trying to find ways to see if there's a way to do it through federal legislation. It's going to be harder, but I want school start time to benefit all students, not just certain school districts.
And here's, you asked about if we've seen actual improvement with later start time, so we do have a lot of data on that. So for schools that shift to later start time, they see increased improvement in their students' GPA, SAT scores, attendance rate and graduation rate. And also, I mentioned before the mental health aspect and safety aspect. And when you look at economic data, so RAND actually did a study back in 2017, basically just looking at what happened if all school across our states changed to 8:30 start time. And they only factor in two things, because they said that otherwise they would blow up their model. So they look at better graduation rate and less car crashes. And what they found was $8.6 billion saved in our US economy, just two years. So this not only is the right thing to do, but it's also smart economics.

Dr. Peters:
I think that's just, we need to do this now. Let's just start a little later and give those great teenage brains a chance to relax and recover and then thrive. I mean, that's what it's all about.

Dr. Fong-Isariyawongse:
Yeah, there's really no time to waste. Is their health, safety, and their academic success, their future, in line here?

Dr. Peters:
Absolutely. So another hot button issue that's also about our sleep hygiene is also daylight savings time, and it just started in March. What are the health concerns about daylight savings time?

Dr. Fong-Isariyawongse:
Yeah, daylight saving is bad for our health, plain and simple. It really forces us to wake up in the dark more often and it really messes us in a way that really kind of give us jet lag almost. It misalign our circadian rhythm, and that makes us feel groggy. And if in the month of March you may feel a little bit groggy in the morning, just not quite sharp, and that's the reason why. But there's actually real consequences. Right after the switch, just the first week or so, we see a spike in car crashes, heart attacks, strokes, workplace injuries, and suicide related to depression. And this is the immediate effect, but long-term effect, you see more chronic diseases, more mental health struggles. And then same idea as the later school start time, actually billion dollars can be saved if you get rid of daylight saving, and that's just in loss of productivity and better health for our public.
And I just want to mention, daylight saving and school start time. I mean, there's a really tight relationship because teens and actually also essential workers, get hit the hardest during daylight saving because they already have such early start time. So, that's why there's a growing push to stop changing the clocks, even from President Trump himself. He mentioned that he wants to stop the clock change, but here's the catch. We don't want permanent daylight saving time. That's what Sunshine Protection Act is, it's a misnomer. The sunshine, we're not protecting the sunshine, we're just taking it away from our morning and put it in the evening. So makes it not safe, not healthy in the morning, I mean, for our body. And then to be brighter at night makes it harder for us to fall asleep.
And by the way, we tried it once in the '70s, we actually had permanent daylight saving time. At that time, people hated it so much that the Congress actually reversed it within nine months. So, let's learn from history and push for permanent standard time because our health really depends on it.

Dr. Peters:
Particularly for the brain. What happens to the brain when you're sort of forced that shift from standard time to daylight savings time? Is there anything specific that happens to our brain?

Dr. Fong-Isariyawongse:
Yeah, so when it comes to the brain or actually our patients with neurological conditions, that social jet lag, that forced misalignment in the circadian rhythm, can really sometimes trigger migraine. And I'm an epileptologist, so patients with seizures, they usually see a little bit worse in seizure control during that time. And that's mainly from the misalignment of circadian rhythm making it really hard for them to wake up, hard to fall asleep, worse sleep quality.
And then not just migraine and epilepsy, but also patients with neurodegenerative conditions, so Parkinson's, Alzheimer's. We know that when these patients don't sleep well, whether it's daylight saving or other issues, they have more symptoms. And for all of us, the rest of us, I guess, cognitively, daylight saving really creates a disconnect between our internal clock and the external world, leaving us really groggy like this month in March with the daylight saving. Hard to focus and even just a little bit more irritable. We feel off, reaction time slower, memory, decision making, suffer, more workplace errors. When you read, you have to read the question twice, that's me yesterday, and car accidents. So, it has real life consequences. And then the health aspect that we mentioned, more heart attack, stroke. So, we really do need to end daylight saving.

Dr. Peters:
I agree with you. I think whenever we have that shift, I was actually in another time zone and took advantage of the daylights, the change. I was in central time, but I'm usually on eastern, so I just pretended that I was still on eastern, so I didn't feel the shift. And you sort of play these little mind games of like, what time zone am I in? A lot like jet lag. So, I appreciate the advocacy and I hope that we can make a permanent switch.
Now, you work with a really interesting population. You work with the Pittsburgh Steelers.

Dr. Fong-Isariyawongse:
Yeah, so I'm their consultant. So basically, I'm their neurologist. Anything neurological related, I'm there to help. But when we talk about sleep, sleep is very important for athletic performance. It is the, how to say it, the ultimate legal performance enhancer. So, I think pro athletes are finally catching on. You see these commercials about mattresses and Patrick Mahomes is their spokesperson for WHOOPs, which is sleep wearable. So, I think they're really catching on, they see sleep as the ultimate weapons to achieve peak performance.
So, here's the study. What do we know about sleep and sports performance? When athletes get enough sleep, they have faster reaction time, they can run quicker, they have higher endurance strength. So, what does it translate to? Actually in sports, the sprinters shave off time of their runs. Basketball players shoot more accurately. Football players process and make decisions much quicker, play better under pressure.
So yeah, I think sleep is important for athletes, but it's also for us too, right? We don't have to be a pro athletes to gain the benefit from better sleep. So, you may be training for a marathon or just hitting the gym after work. Good sleep really helps to improve reaction time, stamina, and recovery. So yeah, I think we should all do it and we should see sleep as important as nutrition and exercise.

Dr. Peters:
I like how you lump it in with, sleep is just one of these critical components. It's exercise, it's your diet, and your sleep. Sort of putting all those three things together because it doesn't seem overwhelming for patients.
Now, you're our expert today, we need tips. I want you to give us your top five tips on how we can all improve our sleep practice and our sleep hygiene.

Dr. Fong-Isariyawongse:
Oh, I have many tips, but I will try to restrict to five.

Dr. Peters:
No, no, no, [inaudible 00:26:27].

Dr. Fong-Isariyawongse:
I may be giving you six or seven. So I think first thing is that we need to have better awareness of how many hours we sleep per night, because if I ask you, Katy, how many hours you slept last night, you'd really have to think about it, right?

Dr. Peters:
Yeah, yeah.

Dr. Fong-Isariyawongse:
Yeah, yeah. So again, for adults we need seven to nine hours, for teens, 8 to 10, school-aged children, 9 to 11. So, how do we gain more awareness? Well, we can just simply get a piece of paper, write down the bedtime and wake time and track your sleep duration that way. Or you can use sleep wearables. I think the statistic now is 35, 40% of American adults have some kind of wearables and some do track sleep and I think that's really great, because not only you get an instant feedback to really know not only sleep duration, now sleep quality, but it gives you a trend so you can really have better look of your overall sleep. And again, I think awareness is the first step towards change, so this generation of sleep wearables is fantastic.
The second thing is, it is kind of mundane type of recommendation, but we need a bedtime routine that is relaxing and calming. So, I personally like to read, but you can do other things like meditation, yoga, listening to music that calming, that can really help to wind down before bed. A warm bath is really fantastic. So the idea behind warm bath is not only it relaxes our muscles, but as you step out of the warm bath, that instant cooling actually help you to wind down and get you sleepy.
So, and here's actually the third recommendation. Cool temperature for bedtime is actually what we prefer. So the best temperature for sleep is actually 68 degrees. So that's why that warm bath, the cooling, the cool bedroom is so important. We also want our bedroom to be quiet. So if you live in the city, sometimes quiet is not achievable. So what you can do is get earplugs or use white noise machine, that usually can be quite helpful. And then you want your bedroom to be dark, so you can use blackout curtains or these simple eye masks that you can get anywhere now. They're really effective, it really does block out the bright light from outside your bedroom, perhaps.
And the fourth tips is caffeine. Sometimes when we think of caffeine, we actually forget the half-life of caffeine is actually at least six hours, if not eight.

Dr. Peters:
Oh, wow.

Dr. Fong-Isariyawongse:
Yeah. So if you can't fall asleep at night, think about when was the last dose of caffeine. So the FDA recommend no more than 400 milligrams of caffeine per day, and that's for health reason, but the American Academy of Sleep Medicine, the recommendation is no more than 300 milligrams, and that's just better for sleep onset. But not all caffeine is bad, I think we can use caffeine strategically. Caffeine does help to boost cognitive function and alertness, obviously. In fact, a fun fact, NCAA, you can't have caffeine in your blood-

Dr. Peters:
Really?

Dr. Fong-Isariyawongse:
... at the [inaudible 00:29:55], is considered as illegal because it's a sports enhancer, athletic performance enhancer. So, we can use caffeine strategically when we're sleepy, when we do night shift, things like that. It's best to do small doses rather than that big fancy cup of coffee, because large dose of caffeine all at once can give you a crash and sometimes even withdrawal symptoms like headache and that grogginess after. I think I'm hitting like five tips now, so one more.

Dr. Peters:
You're doing great. As many tips as you can give.

Dr. Fong-Isariyawongse:
So screen, screen is actually not good for bedtime because that brightness from our electronics can suppress the release of melatonin from our brain. So, it's not just your phone or your computer, but also the ambient lighting. So our bedroom lighting, our living room lighting, we should dim the intensity down one hour, two hours before bed. And also, the color of lighting is also important. So if you can switch out these white light to these amber yellow light, it's actually better because they contain less blue light within it.
Just like caffeine, not all lighting is bad. So we mentioned a little bit earlier with the daylight saving, natural sunlight in the morning is fantastic. It really helps to reset your body's internal clock, making it easier to wake up in the morning, to fall asleep at night. If you can't have natural lighting in the morning, like during daylight saving, you can use a light box. So, the best light box is ones with intensity of 10,000 lux. So you can use it when you wake up in the morning for at least 20 minutes, 20 inches from your face, don't look directly at it. It really can help to kind of give you a boost of alertness and a boost in mood also. It's like a nature's best version of a morning coffee. And you can use the light box if you're a night shift worker. I think that's actually really, really helpful. And then also, seasonal depression.
And then I have one more, Katy.

Dr. Peters:
Oh, no, yes, you can have... Yes, please.

Dr. Fong-Isariyawongse:
Regular sleep-wake schedule, so, meaning that regular bedtime, regular wake time, even on the weekend. I know we all want to sleep in on the weekend, but it's actually a sign that we're not sleeping enough during the weekdays. But here's the tricky part of things. Regular sleep-wake schedule may not be possible for our teens, because remember they're very sleep-deprived during the school week, right? So I think for teens they can actually make up some of the sleep on the weekend. Maybe don't go sleep until 1:00, but maybe just two hours more on the weekend. I think that can really help to replenish those sleep lost during the week.
But I just want to kind of mention one thing. There was one study looking at the NASA healthy recruit. So these are like high functioning individuals. So what they did was actually the study was done at Pitt, they actually asked these healthy recruit to sleep deprive Monday through Friday. So, sleep only five hours and on the weekend eight hours, and do that for I think like seven weeks or something like that. And they put them through a whole battery of cognitive testing. Not surprisingly, the cognitive scores drop in all domains during that Monday through Friday, five hours of sleep, and it's sequential. But what is the light bulb moment is on the weekend, it's not that eight hours of sleep is not enough to bring the cognitive performance back to baseline. So, I think the message is really clear. We need to have good quality enough duration sleep every day, not just on the weekend.

Dr. Peters:
I agree, it has to be every day. I will say something about these tips. First of all, thank you for the tips, and these are accessible. A lot of it is really subtracting something, a distraction that is in the bedroom or at the time that you need to sleep, or adding or just changing up the lighting, or really thinking about, when am I going to sleep, when am I waking up and making your schedule regular. I think these are accessible tips to everyone across every age group and across every situation.
And I'm going to vouch for something. I moved to a new house and my husband and I were very thoughtful about our bedroom. It had to be certain lighting and we were very... We said, I remember the builder said, "Do you want a TV in your bedroom?" We were like, "No, we're not going to have a TV in the bedroom, we're not going to have gadgets in the bedroom." And we both agreed that we're sleeping better and it's just wonderful when I can wake up and see our sunrise. That makes me really, really, really happy. So, these are expert tips, accessible tips, and I think it's something that everyone can do.
I do have a few more questions, I hope that's okay.

Dr. Fong-Isariyawongse:
Oh, go for it.

Dr. Peters:
Yes. So, one of my big problems for me when I sleep and something I hear from some of my patients is when they travel, it's like all the good habits that we had at home, if we do have good habits, disappear. And I'm not in my normal bed, I'm not in my normal space, the TV is there now. What do I do when I travel and how can I avoid or how can I sleep in the context of jet lag in different time zones?

Dr. Fong-Isariyawongse:
Yeah, travel related sleep issue is really real and really common, especially if you travel across time zones. So, the more time zones changes, the worse it gets. So when it comes to the travel sleep environment, I think it's just important to try to do your best. I do always bring my earplugs and eye mask, because then you really have control of the bedroom environment. Most hotels, they actually do have blackout curtains, so that's great. And then you can take advantage of the endless hot water, do a warm bath before bed, that can really be helpful.
Now, with jet lag or if you travel without time zone changes but struggle to fall asleep, I think it's probably safe to take melatonin, especially jet lag, for sure. So here's kind of the tricky part in United States, melatonin is over the counter, but it is actually not a supplement, it's not a vitamin, it is a hypnotic. So, and that's actually the reason why some country, like Japan, Australia, UK, you actually can't get melatonin unless it's prescribed by physician.

Dr. Peters:
Oh wow.

Dr. Fong-Isariyawongse:
Yeah.

Dr. Peters:
I did not know that.

Dr. Fong-Isariyawongse:
Yeah, so the downside of it being not FDA regulated is that what you get from these gummies really do have a wide variety of quality. So, there was one study looking at all the over-the-counter melatonin and what they found was that you get from minus 80% to 400% of melatonin ingredient in your vitamins, I mean, melatonin. So, I mean the minus 80%, well that sucks, I waste my money. But the 400% can have consequences. It's not very common, but people can get overdose on melatonin, especially for children. If you give your kid five milligram, it may actually ending up to be 20 milligrams. So, the recommendation is that if you need to use melatonin, get the USP certified label one. So it's a little bit more regulated, is better.
And so going back to the jet lag, if you know that you're going to travel ahead of time, you can actually start shifting your bedtime-wake time to the travel time zone, by like maybe 30 minutes, an hour a day, so that you can kind of prep yourself to that time zone. That can be really helpful. I know it requires more planning. There's actually a lot of apps out there that help you to shift your time, especially if you travel across time zones, so you can use those gadgets to help you plan ahead. But for athletes, travel fatigue and jet lag is important to look at, because that's going to affect whether they're going to win or lose, right? So the strategy is really important to make sure they perform at their peak, even when they travel to out of country locations.

Dr. Peters:
So, I think the tip on melatonin, that's fascinating to me because so many of my patients either take it or want to take it, so I'm going to make sure that they check that label because maybe when they tell me it isn't effective, they're just not taking the correct level that they need to have.
And on that note, for our medical providers and for our patients that think they need to see a sleep specialist, when do they need to see you? When do they need to be evaluated for a sleep disorder? When is that important for them?

Dr. Fong-Isariyawongse:
Yeah, so I think we all should practice these sleep hygiene tips. So if you still after practicing these tips and still can't fall asleep or can't stay asleep, I think that's a time to bring that up to your family doctor, because you may be having sleep conditions like sleep apnea, insomnia, restless leg syndrome.
So, sleep apnea is quite common. It affects at least a quarter of adult male. For women after menopause, it's the same as male, about 25%. So the symptoms of sleep apnea is as you expect, snoring, but also waking up not feeling refreshed. Your sleep is very light, you wake up a lot in your sleep. When you wake up, you may feel elephants on your chest, gasping for air. Those are symptoms of sleep apnea. And sleep apnea is really important to get quick diagnosis and get treated for, because it associate with many health conditions, including cardiovascular disease, stroke, and many other health concerns. So definitely if you have these symptoms, talk to your doctor and ask for a sleep study.
Insomnia is incredibly common as well, but a lot of the time I would say insomnia is 90% behavioral, and that's the reason why it's important to practice these sleep hygienes. If that does not work, then I would say talk to your doctor and you may need to see an insomnia specialist. So it may be a psychologist or a therapist, because in those situations, a cognitive behavioral therapy for insomnia, CBTI, may be very helpful. And that's the philosophy behind CBTI, is to really adjust the behavior, the thinking, so that's the cognitive part and completely change your way to see sleep and that's why it's so effective.
And then restless leg syndrome is completely based on symptoms. So the diagnosis is symptom based. So if you have uncomfortable feelings in your legs usually, but sometimes can be hands in the evening, and it can be a variety of symptoms. Can be skin crawling, can be tightness, can be pain or achiness, numbness, tingling. And when you move your legs, you have an urge to move your legs and when you do move your legs, the symptoms go away. So, those are classic restless leg syndrome symptoms and it has a correlation with, sometimes, correlation with iron deficiency. So we do recommend iron supplements in those situations. The treatment for restless leg syndrome, I would recommend seeking advice from the sleep specialist in those cases.

Dr. Peters:
Well, I would call you our sleep champion. Okay? Of course our sleep expert. But I think we all need to be really advocates for our sleep, because it's really about our health with that same thing that you mentioned before, it's diet, it is exercise, it's sleep, we need to integrate it all. So, how can our listeners be advocates for their sleep and for I guess their sleep health?

Dr. Fong-Isariyawongse:
Yeah, I think we all can be advocates. You don't have to be a physician, you don't have to be a politician. So, you can start by just talking to your family. I think as parents it's important to set a good example. So maybe practice good sleep hygiene together, turn off our phone together before bedtime, do something together as a family. I think that actually can be a game changer. As parents, sometimes it's really challenging to tell your teens to sleep better because again, it's not without them trying, right? It's the school start time that actually makes it hard for them to get that sleep. So rather than telling them to go to bed early, kind of help them to connect the dots, why sleep is important. Connect it to what matters to them, whether it is better grades, better sports performance, better skin, better mood. When you tie sleep to their goals, I think that can make it more meaningful and more impactful.
And then for parents out there, if your teen's school start time is super early, talk to the teachers, the school board, the superintendents, your neighbors. I think it's important to have that conversation and maybe ask school to start teaching about sleep. Actually, this is one thing that I'm trying to work on. School don't teach it, sleep enough. There's an ongoing study looking at the school curriculum across the state. The word sleep that's mentioned in curriculum is like a fraction 1/12, as nutrition exercise. So really I think we're not putting sleep in the same footing as nutrition exercise. So we need to build that awareness, that foundation for our kids.
And then as adults, I think talk to the employer about the importance of sleep. I think nowadays companies are more aware of sleep as a really important factor for performance, a way to reduce workplace injuries and errors and boost productivity. And that's why you see these fancy nap pods sometimes in companies like Google and Facebook. But I think we all need to prioritize sleep. As physicians, we have this mentality that, oh, not enough sleep is a badge of honor, but we really need to change our mentality, and that sometimes start from top down. So, find ways to educate the leaders, the importance of sleep as well. Keep the conversation going.

Dr. Peters:
Absolutely, and thank you for educating us. Again, Dr. Fong-Isariyawongse, I'm going to call you our sleep champion, our sleep expert. It's March, we're ending March with Sleep Awareness Month. I just want to thank you so much for chatting with us today, and I can't wait to go to bed tonight and get up in the morning.

Dr. Fong-Isariyawongse:
Thank you for having me, Katy.

Dr. Correa:
Thank you again for joining us today on the Brain and Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain and Life Magazine for free at brainandlife.org.

Dr. Peters:
Also, for each episode, you can find out how to connect with our team and our guests, along with great resources in our show notes. We love it when we hear your ideas or questions. You can send these in an email to blpodcast@brainandlife.org and leave us a message at (612) 928-6206.

Dr. Correa:
You can also find that information in our show notes, and you can follow Katy and me and the Brain and Life Magazine on any of your preferred social media channels. We are your hosts, Dr. Daniel Correa, connecting with you from New York City and online at Neuro Dr. Correa.

Dr. Peters:
And Dr. Katy Peters, joining you from Durham, North Carolina and online at Katy Peters MD-PhD.

Dr. Correa:
Most importantly, thank you and all of our community members that trust us with their health, and everyone living with neurologic conditions.

Dr. Peters:
We hope together we can take steps to better brain health and each thrive with our own abilities every day.

Dr. Correa:
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Recognizing Sleep Awareness Month with Dr. Joanna Fong-Isariyawongse

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