Sleep: Dr. Wendy Troxel of the RAND Corporation On Why You Should Make Getting A Good Night’s Sleep A Major Priority In Your Life, And How You Can Make That Happen

Set a consistent wakeup time. This is the single most important cue to set our internal biological clocks, which in turn is critical for setting us up for sleep success that night. Inconsistent wakeup times, including sleeping in on the weekends, while delicious, has been shown to disrupt sleep patterns and is associated with health consequences.

Getting a good night’s sleep has so many physical, emotional, and mental benefits. Yet with all of the distractions that demand our attention, going to sleep on time and getting enough rest has become extremely elusive to many of us. Why is sleep so important and how can we make it a priority?

In this interview series called “Sleep: Why You Should Make Getting A Good Night’s Sleep A Major Priority In Your Life, And How You Can Make That Happen” we are talking to medical and wellness professionals, sleep specialists, and business leaders who sell sleep accessories to share insights from their knowledge and experience about how to make getting a good night’s sleep a priority in your life.

As part of this interview series, we had the pleasure to interview Wendy Troxel.

Wendy M. Troxel, PhD is a senior behavioral and social scientist at the RAND Corporation and holds adjunct faculty positions at the University of Pittsburgh and University of Utah. She is a licensed clinical psychologist and certified behavioral sleep medicine specialist. Dr. Troxel is internationally recognized for her work on sleep in couples, how sleep affects health and the global economy, and how social environments, including public policy affects sleep.

Thank you so much for doing this with us! Before we dig in, our readers would like to ‘get to know you’. Can you tell us a bit about your background and your backstory?

I am a clinical psychologist and researcher who specializes in sleep medicine. That means, I spend most of my waking hours thinking about and studying how humans spend the roughly third of our lives we spend asleep. My research focuses on how sleep affects and is affected by social environments, from our closest connections, to the communities in which we live, and the implications for public policy. Now, you may wonder what sleep has to do with public policy. It turns out quite a lot. In fact, all you have to do is think of a population that is at high-risk for experiencing sleep problems, and there is likely a policy that goes along with that. Take for example, teenagers — only about 1 in 10 teenagers regularly achieves the optimal 9.25 hours of sleep per night that their developing brains and bodies need to function at their best. There are of course, lots of factors contributing to teen sleep loss, some within their control, like spending too much time on their phones, or consuming too much caffeine. But, there’s one big factor that is out of their control — and that’s early school start times. I am particularly passionate about this topic as I have two teenagers myself, and so I can see first-hand, the consequences of sleep-deprived teens. It’s also a perfect example of a public policy that is in direct conflict with the science. The scientific community has known for years that adolescents have a biologically driven phase delay — meaning that they are predisposed to stay awake later, and sleep in later. And yet, just when this developmental shift occurs, we start sending teens to school earlier and earlier. I have written extensively on this topic, provided testimony for state legislatures, and have a TEDx talk on adolescent sleep and school start times with over 2 million views. Importantly, as a result of many fierce advocates and the scientific community who has contributed to this work (including myself) many school districts across the country and the state of California, are making the change towards healthier start times for teens. Doing research that has an impact on policy, and the lives of so many children is by far, one of the most rewarding aspects of my work.

Beyond teenagers, my work also focuses on other groups that face disproportionate risk for sleep problems, including socioeconomically disadvantaged individuals and marginalized racial/ ethnic groups, including Black Americans and American Indian/ Alaska Natives. Policy factors, including systemic racism, play a significant role in contributing to sleep health disparities. My research in this area focuses on understanding the factors that underlie such disparities and identifying policy-level interventions that could mitigate them.

In terms of professional accomplishments, my research has been funded by the National Institutes of Health, the Department of Defense, private foundations, and corporations, and is published in top-tier medical journals. I am Associate Editor for the highly respected research journals Sleep Health and Behavioral Sleep Medicine and have served on the National Institutes of Health Sleep Disorders Research Advisory Board. and the American Academy of Sleep Medicine Task Force on Behavioral Treatments for Insomnia. I am also thrilled to announce that I recently released my first book, entitled “Sharing the Covers: Every Couple’s Guide to Better Sleep”. This book brings together both the research and stories of couples with whom I’ve worked clinically, to provide the definitive guide on sleep for couples, with proven strategies to improve both sleep and relationship health.

Can you share a story with us about what brought you to this particular career path?

I have always been fascinated by how and why relationships are so important for our health, and indeed our survival. Science shows us that married or partnered people live happier, healthier, and longer lives than their unpartnered counterparts, but we lack a thorough understanding of how relationships get under the skin to impact health. Sleep is a critical health behavior, strongly linked with physical and mental health. Sleep also happens to be the one health behavior that couples regularly engage in together — as about two-thirds of U.S. adults regularly share a bed with a partner. And yet, when I began this work, few scientists were studying sleep in the context in which it actually occurs — within couples. So, sleep became this obvious and important behavior to study that could affect and be affected by our closest relationships, and also help to explain why some relationships may be health-protective, whereas others may confer health risks. I find this work endlessly fascinating, because our need for connection with others and our need to sleep are intricately tied, and both provide a window of understanding into our deepest vulnerabilities as human beings.

Can you share with our readers a bit about why you are an authority in the sleep and wellness fields? In your opinion, what is your unique contribution to the world of wellness?

In general, what sets me apart from many of my sleep research and clinical peers is that I have always studied sleep through a social or interpersonal lens. Historically, sleep research has focused on sleep as an individual behavior. Just think about the typical sleep laboratory set-up. An individual is brought into a lab, under tightly controlled conditions, and is isolated as much as possible. But that’s not how sleep in the real-world actually looks. Sleep in the real-world is highly influenced by the social environments in which we live, and with whom we sleep. For example, about two-thirds of adults regularly sleep with a bedpartner, but the historic neglect of considering the social nature of sleep, has led to a number of tired myths, misconceptions, and paralyzing stigmas about the meaning of the marital or otherwise shared bed. In fact, there’s probably no question I’m asked more frequently, than “Is it bad if my partner and I sleep apart?” The answer is “no”. There is no one-size fits all sleeping strategy that will work for all couples. In my work and in my book, I try to help couples first recognize the value of a good night’s sleep for their own personal health and well-being, and for the health of their relationship. Then, I help couples learn to openly and honestly discuss what’s working and what’s not working in the bedroom (when it comes to sleep), and find the sleeping arrangement that will optimize both of their sleep quality, while at the same time maintaining intimacy and closeness, even if choosing to sleep apart.

Do you have a favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life or your work?

“Be where you are, otherwise you will miss your life.” (Buddha).

I am someone who believes strongly in living life to its fullest and always trying to stay mindful of what really matters. It’s easy to get caught up in thoughts about the future, regrets about the past, or just the day-to-day stresses of life, but if you stay focused on the present and remind yourself that at the end of the day (or at the end of life), what really matters is your connection to others, then it helps to put things in perspective. My father died at the age of 45 when I was 16 years old. He was an amazing human being, loved deeply by his family and friends, and just about anyone who had the privilege of coming into contact with him. Because his life was so tragically cut short by cancer, I think it really shaped how I view life and death. I don’t fear death, because I know it is inevitable. Therefore, all I can do, and what I strive to do every day, is to live each day to its fullest, and never take the blessing of a new day for granted.

Ok, thank you for all that. Now let’s move to the main focus of our interview. Let’s start with the basics. How much sleep should an adult get? Is there a difference between people who are young, middle-aged, or elderly?

Our sleep needs change across the lifespan, with younger people needing more sleep, which attests to the critical role of sleep in healthy brains and development. It’s also to important to recognize that there are individual differences in needs for sleep duration, and other aspects of sleep, including the quality, timing, and regularity also remember. But the general guidelines based on scientific consensus recommend the following:

• Infants up to 12 months should sleep around 12 to 16 hours per day
• Children 1 to 2 years of age should sleep 11 to 14 hours per day
• Children 3 to 5 years of age should sleep 10 to 13 hours per day
• Children 6 to 12 years of age should sleep 9 to 12 hours per day
• Teenagers (13 to 18 years of age) should sleep 8 to 10 hours per day
• Adults (>18 years) should sleep at least 7 hours per day.

Is the amount of hours the main criteria, or the time that you go to bed? For example, if there was a hypothetical choice between getting to bed at 10PM and getting up at 4AM, for a total of 6 hours, or going to bed at 2AM and getting up at 10AM for a total of 8 hours, is one a better choice for your health? Can you explain?

The thing about sleep health, like health in general, is that you can’t distill it down to a single number, like how many hours of sleep you are getting. Getting adequate sleep duration is of course important (for most adults, 7–9 hours per night is the recommendation), but sleep duration is not the only metric that matters for sleep. Other dimensions of sleep, like the quality (do you feel refreshed in the morning?), the timing, the regularity, the efficiency (is your sleep fragmented?), and your alertness during the day all matter for health. While there are individual differences in sleep needs and preferred timing of sleep, 6 hours is simply not enough sleep for most people. On the other hand, the 8- hour scenario suggests this person may be getting enough sleep at least on that particular night, and may be a natural “night-owl”, but the question is — is that schedule sustainable or is that the weekend schedule, but the person has to revert back to an earlier schedule during the week? This is a classic pattern for teenagers, who are natural “night owls”, meaning biologically they are programmed to stay awake later and sleep in later. The problem is, most middle and high schools start around 8 am, forcing teenagers to wake-up hours before their biological clocks tell them they are ready to wake-up. So on the weekends, most teenagers will revert back to their natural, later rhythms, of going to bed later and sleeping in later. The problem is this erratic sleep schedule is also associated with health problems. The key is to strive for a sleep routine that allows you to consistently get sleep that feels deep and refreshing, that is of adequate duration, and follows a regular routine in terms of bedtimes and wake-times.

As an expert, this might be obvious to you, but I think it would be instructive to articulate this for our readers. Let’s imagine a hypothetical 35 year old adult who was not getting enough sleep. After working diligently at it for 6 months he or she began to sleep well and got the requisite hours of sleep. How will this person’s life improve? Can you help articulate some of the benefits this person will see after starting to get enough sleep? Can you explain?

The transformations I have seen with my clients who come to me for behavioral treatment for insomnia are often quite profound. As one client told me, when he started sleeping better on a regular basis, he felt like he could “conquer the world”. Although that may sound like hyperbole, the truth is, improving sleep has benefits for virtually every aspect of health, functioning, and productivity. For starters, healthy sleep is a major mood enhancer. Sleep helps to smooth out our emotional edges, so we become less emotionally reactive when negative experiences happens. When sleep-deprived, our emotions can feel raw, we are more irritable, more prone to conflict, and even more likely to develop mental health problems, like depression. These mental health effects not only exact a toll on one’s own well-being but can also compromise relationships. Then, there are the cognitive effects. Science clearly shows that healthy sleep is critical for memory, concentration, attention, and even may protect against the development of certain dementias. From a physical health perspective, healthy sleep is essentially a panacea, for just about everything that ails you. Healthy sleep supports immune functioning, growth and recovery, inflammatory responses, and may protect against the risk of developing chronic health problems, including obesity, diabetes, heart disease, and certain cancers. There are also huge societal benefits of getting enough sleep. My colleagues and I at the RAND Corporation published a study demonstrating that a lack of sleep among the U.S. working population costs the economy up to $411 billion a year. On the other hand, our economic projections showed that increasing nightly sleep from under six hours to between six and seven hours could add $226.4 billion to the U.S. economy. It’s time we recognize that the benefits of sleep that extend far beyond the individual, affecting society as a whole.

Many things provide benefits but they aren’t necessarily a priority. Should we make getting a good night’s sleep a major priority in our life? Can you explain what you mean?

We need to have a paradigmatic shift in how we think about sleep, because it is so vitally important for health, well-being, relationships, productivity, and even survival. For many people, sleep is the thing you do when everything else is done. As a result, sleep often gets the short shrift. But we need to start viewing sleep as the pillar of health that it is, along with healthy diet and physical activity. But honestly, sleep is the foundation that supports those other healthy behaviors. Just think about how hard it can be to make healthy food choices or engage in regular physical activity if you are chronically sleep-deprived. By prioritizing sleep, we build a solid foundation that sets the stage for healthy living.

The truth is that most of us know that it’s important to get better sleep. But while we know it intellectually, it’s often difficult to put it into practice and make it a part of our daily habits. In your opinion what are the 3 main blockages that prevent us from taking the information that we all know, and integrating it into our lives? How should we remove those obstacles?

It’s true — behavior change is hard, and it is especially hard in a culture where, until recently, the importance of sleep has been undermined. But simple steps can make a big difference. The first strategy for reducing or removing obstacles to getting healthy sleep is to make getting adequate sleep a non-negotiable priority — that means for most adults, allowing for roughly 8 hours per night for sleep. If this seems unreasonable or unrealistic given your current schedule, consider simply adding 15 minutes on to your current sleep schedule a building up slowly, as you see the benefits. The second strategy is to make the “healthy option” (i.e., getting adequate sleep), easier and more of an automatic behavior that relies less on willpower. Even with the best intentions, it is far too easy to let the night slip away from you, and instead of going to bed at the desired, e.g., 10 p.m., you find yourself barely racing off to bed before midnight. To avoid this common pitfall, set an alarm about an hour before your desired bedtime, to set a runway reminding yourself that it is time to start winding down and preparing for sleep. Third, focus on setting a consistent wake-up time. Wake-up time is the single-most important cue for setting our internal biological clock. So, by making wake-up time consistent (and by allowing for an adequate opportunity for sleep), you send a powerful signal to your brain that will support getting adequate, refreshing, and consistent sleep.

I should mention that these tips are for people whose primary sleep issue is not allowing adequate opportunity for sleep. This is very different from people who suffer from insomnia. Among individuals with insomnia, the challenge is that the ability to sleep is compromised, whereas the opportunity for sleep is adequate. There are a whole different set of strategies to cope with insomnia, but perhaps we can discuss that at a later date!

Do you think getting “good sleep” is more difficult today than it was in the past?

Certainly, the COVID-19 pandemic has caused many challenges for healthy sleep, due to the increased stress and profound disruptions to daily rhythms and routines. Even as we emerge from COVID-19, sleep problems are likely to spike because there are the new stressors and adjustments we have to make as we make the return to “normal”.

Ok. Here is the main question of our discussion. Can you please share “5 things you need to know to get the sleep you need and wake up refreshed and energized”? If you can, kindly share a story or example for each.

So the last thing I want to do is leave you only with the bad news about the consequences of poor sleep. Frankly, none of us needs another worry to keep us up at night. So, I’d like to leave you with some good news. As I discuss in my book, small changes can make a big difference, for your own health and the health of your relationship. Here are 5 strategies to support healthy sleep and healthy relationships.

First, set a consistent wakeup time. This is the single most important cue to set our internal biological clocks, which in turn is critical for setting us up for sleep success that night. Inconsistent wakeup times, including sleeping in on the weekends, while delicious, has been shown to disrupt sleep patterns and is associated with health consequences.

Second, make bedrooms media-free zones. Social media, work, and video games are far too stimulating, and exposure to light from electronic devices can directly suppress the hormone melatonin, which signals sleep onset. For couples, whether choosing to sleep together or not, the time before bed is often the most important time for connecting and bonding with your partner. So instead of scrolling through social media or independently binge-watching shows on your devices, use the time before bed to connect, unwind, and digest the day with your partner. It’s a win-win for your sleep and relationship.

Third, keep it cool. As we sleep, our body temperatures’ naturally decline. In fact, a dip in core body temperature is a key signal to our brains that it’s time to fall asleep. It’s generally recommended to keep your bedroom between about 60 to 67 degrees, which is honestly, much colder than many of us would naturally feel comfortable in during the daytime. Make sure you have enough blankets that can come on or off as needed to regulate your temperature throughout the night, but by gently nudging your body temperature a bit lower by setting your thermostat lower, this can facilitate sleep onset and deeper, more restful sleep. Taking a warm bath before bedtime is good for sleep, for this very reason. While in the bath your temperature rises, but quickly falls when you get out. Try a bath about 90 minutes before bedtime. Better yet — do it with your partner and make it a part of your shared bedtime ritual! It’s a great way to relax and unwind with each other, and reduce your body temperature (provided that things don’t get too steamy in the bath).

Fourth, it’s better in the dark. While some may argue whether sex is better in the light of day or in total darkness, there is no question, that sleep is better when the lights are down. Sometimes this is more than simply turning off the light switch. Make sure if light creeps in through the window, that you use blinds or drapes or even hang up a dark sheet over the window if necessary. If some light cannot be avoided or perhaps, if you and your partner are on different schedules, with one coming to bed later, consider wearing an eye mask. And it goes without saying but must be repeated, if the light is coming from a phone or other electronic device in the hands of your partner or yourself, get that sleep-stealer out of the bedroom. Light in general, but particularly, the blue light that comes from electronic devices directly suppresses the hormone melatonin that signals the brain that it is time for sleep. And before you go excusing your device because you have a blue-light filter, let me just say that it is the stimulating content that we consume from our devices, not just the light that can keep us up at night. Set the mood (for sleep and maybe even a little romance) by turning the lights down in the evening, a couple hours before bedtime, as dim lights can also stimulate the release of melatonin, and set you up for sleep success that night.

Fifth, make yourself a tidy and inviting nest. I am a scientist, not an interior designer, so while I am no expert in the trendiest or most stylish room decor. I can tell you that there are some science-backed, basic do’s and don’ts when it comes to turning your bedroom into a haven for sleep. In terms of colors, neutrals, silvers, and greys have been shown to be relaxing and can even lower your blood pressure and heart rate. Splashes of color, particularly if they make you happy or feel warm and inviting are also acceptable, but just don’t make it too bright as that can be alerting. Beyond the color palette, what’s even more important is what you keep in your room and what you keep out. You want your haven to be free from clutter and the distractions of the day — that includes dirty laundry scattered on the floor or your phone by your bedside. All that detritus sends the wrong signal to the brain and can increase anxiety. The bedroom should be for sleep and sex — keep it simple and inviting. And when you wake up in the morning, set yourself up for sleep that subsequent night by making your bed first thing. Each night that you return to bed should be like an invitation to your warm, inviting, and tidy haven.

What would you advise someone who wakes up in the middle of the night and can’t fall back to sleep?

If you wake up in the middle of the night and can’t fall back to sleep, the best technique is to get out of bed and go do something that is distracting (so you get your mind off the fact that you are not sleeping), but relaxing, and in a relatively low-light conditions (like with a lamp). The goal is to train your brain that the bed is for sleep, not for lying there staring at the ceiling, or stressing about the fact that you are not sleeping. Getting out of bed helps to break this negative habit and can reduce frustration. You may find that if you become engaged in another quiet, relaxing activity, like reading a book or magazine, you might start feeling sleepy again. At that point, you can return to bed and try to fall asleep. If you’re someone who struggles most nights with difficulty falling asleep or staying asleep, you may have the clinical disorder known as insomnia, and seeking professional help might be warranted. And here’s another tip — the most evidenced-based treatment for insomnia does not come in a pill. It is actually a behavioral treatment, called cognitive-behavioral therapy for insomnia or CBT-I. This type of treatment has been proven to be as effective, longer lasting, and without the side effects of sleep medications.

What are your thoughts about taking a nap during the day? Is that a good idea, or can it affect the ability to sleep well at night?

The key with naps is the timing, duration, and why you are doing it. Generally speaking, naps that are shorter (around 30 minutes or less), and earlier in the day can be beneficial for many people, provided that they don’t interfere with sleep at night. Generally speaking, individuals struggling with insomnia should avoid naps. In terms of “why” you are napping, if a short, pick-me-up nap feels refreshing and your schedule allows, then that can be a great way to recharge. However, if you are napping to compensate for chronic sleep loss or because your sleep quality at night is compromised, perhaps due to a sleep disorder, then napping could be masking the real problem, and it’s important to get to the root of why the night-time sleep is inadequate or of poor quality.

Wonderful. We are nearly done. Is there a person in the world, or in the US, with whom you would like to have a private breakfast or lunch, and why? He or she might just see this, especially if we tag them. :-)

Ina Garten. I am a huge fan of hers, I own every one of her cookbooks, and love her cooking shows. Her style of cooking and entertaining has always resonated with me because it is all about preparing simple food beautifully, and keeping the focus of cooking and entertaining on what really matters — connecting with others.

How can our readers further follow your work online?

First, I’d invite your readers to check out my book “Sharing the Covers: Every Couple’s Guide to Better Sleep”. It is a science-backed book to help couples recognize the importance of sleep for their own health and the health of their relationship and it provides practical tips to help couples optimize their sleep and relationship quality. My work can also be found at wendytroxel.com or https://www.rand.org/about/people/t/troxel_wendy_m.html or via social media — twitter: @wendytroxel; instagram: sharingthecovers

This was very meaningful, thank you so much. We wish you only continued success on your great work!