 Joining us to talk about your health and to answer your sleep related questions is Dr. Emerson Wickwire, a sleep specialist at the University of Maryland Medical Center and professor of psychiatry and medicine at the University of Maryland School of Medicine. Doctor, thank you so much for joining us again. It's a pleasure to be back. Let's reintroduce you to the audience. Tell us about what you focus on. What are the chief complaints of the people you see? At the University of Maryland Medical Center, Midtown Campus and at the School of Medicine, we have a large and comprehensive sleep medicine program. We do all the sorts of things that one would expect in an academic medical center. We have a busy outpatient clinical practice. We feature an accredited sleep medicine fellowship and we do a great deal of extramirally funded sleep research. So next weekend we're going to spring forward and I don't think I'm bothered by that. Maybe I'm forgetting something but it definitely bothers some people. It does bother some people. There are a few different ways to think about the issue. From a health perspective, even though it's only an hour, quote-unquote only an hour, when we consider that subtle change and the very precise fine tuning of what's called our circadian clock, multiply that by 330 million individuals in the United States and there are actually significant health risks associated with that one-hour time change. I mean it's shocking. I mean people have heart attacks. They have car crashes, strokes, things that I wouldn't have thought could be related to what I feel like is a little shift. It's not flying to Australia, put it that way. It's not but also when you fly to Australia you are one individual who can employ a number of mitigation strategies from getting extra sleep before you go to sleeping on the plane and avoiding alcohol and all those other things that were advised to do with international travel. From a public health perspective, a third of Americans are sleep deprived to begin with and so when we take away that extra hour of sleep, it increases risk significantly. 6% increased risk for motor vehicle crash, for example, in the several days following the time change and of course currently we change times twice per year. It's really the springing forward that is associated with the increased risks because in the fall, by contrast, we gain an additional hour of sleep. What's your perspective on the idea of just doing away with this? There are two ways to proceed. The first would be to adopt a permanent daylight savings time approach that was proposed in Congress even within the past several years or to adopt a permanent standard time approach. The coalition for standard time advocates adopting a permanent standard approach and there are a number of reasons. Let me remind our viewers if you have a question, you talk about daylight savings time, but if you have a question about sleep insomnia related problems, give us a call at the number on the screen or send us an email to livequestionsatmpt.org. You said a third of people are sleep deprived. The average U.S. adult is significantly at risk for insufficient sleep or what we call chronic sleep disorders. You asked earlier about the University of Maryland. The two most common sleep disorders that we see in our outpatient clinical practice as well as throughout the entire UMMS system are what's called obstructive sleep apnea, which is a disorder of breathing during sleep. One way to think about that is that it's severe snoring or chronic insomnia, which by contrast is difficulty falling asleep or staying asleep. And both of these sleep disorders are of course associated with a number of daytime symptoms as well as long-term health risks. We'll come back to that. Let's go to the phones to Calvert County. This is Sue. Thank you for calling. Go ahead. Oh, hi. This is Sue from Calvert County. Yes. I'm calling because I'm 70 years old and sort of starting to have geriatric type sleep problems. It sounded like something Biden discussed recently, the sleep apnea and waking at different times. And I know they can be associated with aging and various sleep problems. So I'm curious about the insomnia type problems that geriatric patients might have. Thanks for the call. Good luck with that. And is that a thing as you get older? There are changes in sleep as we age. The caller and our other audience members will be interested to know that insufficient and disturbed sleep increase risk for a number of age-related consequences, not only better known consequences like diabetes and cardiovascular risk, but also present an increased risk for dementia and cognitive decline. There are a number of studies that very strongly suggest that clinical sleep disorders as well as sleep duration increase risk for Alzheimer's disease. Some people because of work or shift workers, they're going to have problems. It's tough. I've been there to adjust to a different shift and then adjust back. But if you're not in that boat, give us some good advice. Well, I'd be happy to, but I want to build on something, Jeff, that you just mentioned. Because for one week, everyone in the United States is a shift worker or for at least a few days. By having this very subtle one hour shift, again, at a population level, this is how we end up sleep deprived and where those risks really come from. Deep inside our brain, equidistant between our third eye and our temple, there's a very specific and well known bundle of cells that regulates in part what's called our circadian rhythm. We've all heard of the Latin Carpe DMC is the day, circadium about a day. Our internal body clocks function on about a 24.2 hour cycle. And this is very precisely and finely tuned. We have evolved to be diurnal creatures. In other words, we're awake during the day and we are asleep at night. You'll notice things like learning ability, sex drive, when we even feel the need to go to the bathroom or when we feel hungry, these all follow a specific biological rhythm. And a one hour shift at a population level leads to a significant increased risk. Now, earlier, you asked about what do we do in terms of getting rid of the back and forth. And I was thinking, of course, about our conversation on the drive over this evening. There are three options. One is stay where we are with a daylight saving shift twice a year. Two would be to adopt a permanent daylight approach. And three would be to adopt a permanent standard approach. And by far from a scientific and health perspective, adopting a permanent daylight approach is the worst of those options. Again, from a scientific and health perspective. The reason is that although many of us enjoy the extra hour outdoors on the back porch in the summertime, in the wintertime, that comes at a one hour cost. And history doesn't repeat itself, but it rhymes. And we've been down this road before. In fact, in 1973, Congress enacted a two year trial period of permanent daylight savings time. And it only lasted eight months. It was such a such a failure. For people who know they're going to have a problem with with the shift, what are some strategies to to make it make it go more smoothly? I read one idea is you start adjusting your meal time by like 10 or 15 minutes in the prior week. Would that make a difference? Absolutely. The exact same kinds of strategies that we would use in flying to Australia, as you mentioned earlier. So really three things. First, get more sleep. We know that sleep banking or oversleeping in the several days before the transition can help mitigate the effects of sleep loss. So number one, make sure that you're well slept. Number two, begin to focus on those circadian factors over the three nights prior to Sunday. Go to bed 20 minutes earlier, for example, so that you are going to sleep a total of an hour earlier over the past few days to help soften the blow of that hour. And the third thing is be very careful on Monday. We tell all our patients at the University of Maryland, I'm sure that physicians do this everywhere and health providers do this everywhere, alive, safe, healthy, happy. And there is an increased risk for motor vehicle crash. There will be drowsy drivers on the road. Be very, very safe on Monday. And that's a great way to tell the work if you have the option. Let's go back to the phones. Baltimore County, this is Tony. Tony, thank you for calling. Go ahead. Yeah, most of the data you're talking about regards people in the temperate zone, the certain latitude where we are, but as you go further and further north, you know, the days get longer in the summer and much, much shorter in the winter. So has there been any data on circadian rhythms, you know, way, way north and way, way south? Great question. Thank you. It is. It's a very astute question. Tony in Baltimore County, thanks so much. I appreciate that. As we move farther north, the effects are worse. So for example, in New York City, if we were to adopt permanent daylight savings time, which was recently proposed at the congressional level and has been combated or is actively being combated by over 20 professional societies and health associations, the American Academy of Sleep Medicine and others. In Montana, for example, sunrise would happen at 9.30 in the morning. So for all you parents and grandparents, do you want your children waiting at the bus stop in the pitch dark until it's 9.30 in the morning? Many of us, so I understand, have been a few minutes behind on the way to work in the morning, and maybe you are driving trying to make up that time. And we really, from a public health perspective, probably don't want tens of thousands of children standing outside at the bus stop in the pitch dark. Yeah, I'd be interested to know if people, natives of Alaska, say, you know, Fairbanks, where you're going to have, what, three or four hours of daylight in the winter? Are their sleep habits different? Have they evolved differently? And in the summer, conversely, you're going to have 20-some hours of daylight. Do they stay awake? Do they sleep very little? That's a great question. And I would love to look up. In fact, I'll look up tonight if there are data on Alaska-specific sleep habits, having been to Alaska once and gone for a run at 2 o'clock in the morning, because it was still perfectly sort of dusk-like outside. It's a fascinating question. You were telling me there are no creatures that don't sleep. And you would think it would be an evolutionary advantage if you're the creature, the predator that's working 24-7. So sleep is critical. It's hardwired for all of us. That's right. Well, we still don't know definitively the answer to that question. But within the past 10 years, scientific data has emerged, first in animals and more recently in humans, that slow wave sleep, the earliest, most restorative stages of sleep in particular, are when the cells in our brain cleanse themselves. And this is very important from a cognitive decline perspective. So you mentioned connection to dementia before? Absolutely. So the hypothesis that's being examined in multiple studies in many populations currently is that what we call glimphatic clearance or the ability of cells to release their toxins, the same way that the plaque accumulates and increases cardiovascular risk, there are toxins that accumulate in the brain and increase dementia risk. And those toxins are actually cleared during slow wave sleep. All right, another reason to help everybody watching get a good night's sleep. That's right. So how do we do that? If somebody's having a problem, you know, if you go to a mattress store, they're going to tell you you need a new mattress. Do you need a new mattress? Not necessarily, but it can't hurt. So you want to be comfortable, certainly. Embedding is an easy place to start. The four take-home messages, Jeff, that I'd offer to our readers is that your bedroom environment should be cool. It should be dark. It should be quiet. And it should be uncluttered, almost a sacred space for sleep. And just the same way that regardless of your faith background, everyone knows that when you enter a sacred space, there's a ritual, whether that's a mosque or a synagogue or a church for that matter. We want to create a ritual through which we enter our sleep environment. And if you wouldn't be glued to your iPad or cell phone when you are at mass or synagogue and so forth, you shouldn't be glued to your electronic device when you're in your own bed. Viewer wants to know, are naps good or bad? It depends why we nap. There is some evidence that in older adults, increased napping increases risk for dementia, for example. However, in healthy sleepers, naps are wonderful, plus they're enjoyable. They improve cognitive performance. All of us who are working would have a more productive afternoon if we took a brief siesta. Viewer question, I'm not sure I get it, but you may. What impact will AI, artificial intelligence have on sleep scoring? Will it broaden the availability of sleep medicine screening, specialist treatments, impact on inequity and so forth? Is your profession looking at artificial intelligence? We are, as are other health professions of course, and that's a, we could have a chat only about artificial intelligence in sleep medicine. One of the promises of AI in sleep is that we can make evidence-based treatments available to all. What about medications? Either taking a sleep aid that you get at the drug store, I'm sure there's prescription stuff that we could talk about. Taking a pill that might have a little drowsiness as a side effect or other things people do, like having a glass of wine or now that cannabis is pretty legal, doing that. Good or bad? Let's talk about the alcohol example first. It's bad. And the reason is alcohol decreases sleep latency. It helps you fall asleep faster. There's no question. But after you fall asleep, everything else that alcohol does is very bad. For example, alcohol increases the relaxation or decreases the patency of the muscles in the upper airway. Earlier we were talking about snoring and obstructive sleep apnea. Alcohol alone will cause obstructive sleep apnea even in patients that don't have it. Now, the other thing that alcohol does, and this is partially why we might feel hung over or tired the next day, is it changes our sleep architecture. We were talking earlier about climatic clearance during slow wave sleep. And alcohol changes the way our brain oscillates in and out of different stages of sleep. You talked before about having a mental or having a ritual, as if you were going into a church when you go into the bedroom to sleep. How about a mental ritual? When you actually you put your head on the pillow, what should be going through your mind? Probably not whatever annoyances happen during the day, right? Jeff, what you've described is so common in all the patients that we see. The idea is I'm going to get in bed and then get ready to go to sleep. And this is very important. I'm going to get in bed and then I'm going to get ready to go to sleep. What I want to encourage our viewers to do is to swap that order. First, I'm going to get ready to sleep and then only when I'm highly confident that I'm ready to sleep do I actually get in bed. What should be going through your mind when your head is on the pillow is absolutely zero. Our brains aren't wired that way. I only have a couple of seconds, but you need you need to relax, right? Before you get in bed, the idea is I want to gain repetitions. Practice makes permanent. I want to practice getting in bed, falling asleep quickly, getting in bed, falling asleep quickly. So step number one, get ready for sleep. Step number two, only get in bed when you're highly confident that you're ready to sleep. Very good. Dr. Emerson, Wickwire Sleep Specialist at the University of Maryland Medical Center. Dr. We appreciate your time. Thank you. A pleasure to be with you. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.