We are picking up our cross-disciplinary conversation about the impact of sleep on physical and mental well-being. What would a psychiatrist with a background in sleep medicine have to say on the subject? We chat with practicing psychiatrist and sleep expert Dr. Alex Dimitriu, MD, to find out.
ESW: Hi Alex. We’ve been talking to a range of health and wellness providers—but you are the first mental health professional. How would you define psychiatry?
Alex: Neurology is the medical discipline that strives to understand the brain: the functions of neurons, the central and peripheral nervous system. Psychiatry, in most ways, works to achieve the same goal, but with a greater emphasis on the behavioral aspect of the central nervous system. Psychiatry looks into why certain neurotransmitters can make us happy or sad, which parts of the brain help us think and control our behaviors, and how different substances can affect the way we feel.
The human brain is without a doubt the most complex and poorly understood piece of living tissue. This field is still very nebulous and constantly evolving. It’s largely what attracts me to this field.
You have been a practicing psychiatrist since 2010, and I understand your training included a fellowship in sleep medicine at Stanford. What is sleep medicine?
Sleep medicine is the study of things that go bump in the night. Sleep used to be seen as a passive process where nothing occurs. The discovery of REM or dream sleep in the 1950s indicated it is much more. On a fundamental level, sleep medicine strives to understand a process that has persisted across every species for hundreds of thousands of years of evolution. It’s such an important activity that we spend 1/3 of our lives doing it.
What drew you to the focus on sleep?
Sleep is even more nebulous than psychiatry. In psychiatry, we can ask someone about their feelings, mood, or anxiety. Sleep medicine is more limited. Aside from waking during the night, most people cannot report much about what went right or wrong while they slept. We are limited to sleep studies, which give us an occasional peek into people’s sleep, but these are expensive, involved, and can rarely be done for numerous nights in a row. It offers a very small observation of a very complex, variable process (sleep can vary substantially night to night in the same individual). Lastly, we use EEG to monitor the brain during sleep. This observes only the top inch of the brain at best leaving many questions about deeper underlying processes.
Is it common or uncommon for psychiatrists to have an emphasis on sleep medicine as you do?
Unfortunately, very few psychiatrists have formal training or even brief exposure to sleep medicine. Most sleep doctors come from either pulmonary medicine or neurology. As a psychiatrist, I cannot think of anything more important than sleep on how people feel and function the next day. How can any medical field ignore something we do 1/3 of our time?
You hear the “1/3 of our life” statistic so often it is almost cliche. But if you stop and really consider how significant that is, it casts sleep medicine as a critical and long overdue discipline! What is the connection between psychiatry and sleep medicine?
Sleep plays a huge role in every brain process. It has been implicated in memory formation and consolidation. It has a reciprocal relationship with depression and anxiety. It affects our moods and motivation. Sleep also can play a huge role in ADHD and can bring on symptoms of hyperactivity, impaired attention, poor focus, and poor information retention.
How does your knowledge of sleep medicine influence your practice?
From my standpoint, sleep always has a huge impact on a person’s well-being. I focus on sleep with every patient I see. I will obtain a thorough history of sleep patterns and daytime functioning and review any prior sleep studies. Good sleep is a priority in the treatment of my patients, and I see it as a cause rather than effect of most psychological disturbances.
I often see people with anxiety and insomnia. Poor sleep at night often exacerbates daytime fatigue and anxiety, which in turn fuels worse insomnia. You can see how this quickly becomes a vicious cycle. I believe having an understanding of both sleep and psychiatry is instrumental and is an advantage that psychiatrists have in the field of sleep medicine.
How often is sleep a significant aspect of someone’s troubles?
Sleep is an issue for about 1/3 of the patients I see, which is typical in this field.
Are you seeing any trends in terms of complaints or problems as they relate to sleep and well-being?
I often joke with my wife that the most dangerous thing to admit at a dinner party is that I am a psychiatrist and a sleep doctor. Everyone has stories and is looking for a cure. And everyone knows someone who has been depressed, anxious, or had trouble sleeping.
We live in fast times. People are working longer hours with more messages, texts, and deadlines. The time we have for sleep and relaxation is rapidly dwindling. People used to walk to the train or car and look at trees. Now we text and talk on phones. For this reason, I have been seeing a lot of people that are just plain overworked and underslept. It is a dangerous trend in our society and may be contributing to the rise in ADHD diagnoses, depression, and anxiety—and Starbucks/Redbull.
As a parent, I think about kids experiencing this as normal. My son is 2. He won’t have a pre-digital experience. Is finding time for sleep today’s biggest challenge?
No one has enough. For that reason, it is important to recognize the difference between sleep quantity and quality. If you cannot increase quantity due to life constraints, quality becomes of paramount importance.
I believe the future of sleep medicine is understanding and improving sleep quality. There are medical, physical, and psychological methods that can be implemented to improve sleep quality and make the most of the time you spend in bed. Sleep optimization will be the future, and I think it is only a matter of time before we see boutique practices pop up that specialize in this.
Sleep optimization! That’s catchy. Surely there will be similar growth in retail “boutiques” dedicated to sleep quality. In many ways, that is central to European Sleep Works approach to product design. We have a saying: every little bit counts. Sleep duration, quality, breathing—we are always looking for ways to improve them. Any last pearls of wisdom?
Nothing your grandmother has not told you already. Everyone needs to sleep more. Studies show that even people who are not tired feel MUCH better after being forced to sleep an extra hour a day for a month.
This has been really fascinating. Thanks Alex!
Dr. Alex Dimitriu, MD, is a board certified psychiatrist practicing in Northern California.
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