The Facts About Sleep

How can you get more zzz’s? What are the consequences of inadequate rest or too much sleep? Learn the facts and myths about sleep and sleep disorders from Charlene Gamaldo, medical director of Johns Hopkins Center for Sleep at Howard County General Hospital. Submit a question below and check throughout the day for Dr. Gamaldo's responses.

How much sleep should I get each night?

Most individuals require roughly to 7.5 to 8.5 hours, which is much less than most adults in America are actually getting.

What lifestyle changes can I make If I have a problem getting to sleep?

Before you look into problems with sleep, think about simple and modifiable behaviors or activities that may be inhibiting your ability to get a good nights sleep.. This might be activities such as watching TV too late and close to your bedtime, new eating patterns or looking at your Nook or iPad too close to bedtime. Any recent changes, e.g. in medication, also might be an issue.

Once you’ve ruled those types of patterns out, then it is worth discussing with your doctor the possibility of an underlying sleep disorder.

What are the most common sleep disorders?

We’re becoming a more sleep deprived society. In last 10 years we have shaved off 30 minutes from our routine sleep schedule. Chronic insufficient sleep, which is not getting enough sleep, is the most common.

Next most common is insomnia, which is any difficulty in initiating or maintaining sleep or waking up feeling unrested that is also associated with problems functioning during the day.

Another disorder covers issues with breathing during sleep, e.g. sleep apnea or discomfort that results in difficulty initiating sleep such as Restless Legs Syndrome also known as Willis Ekbom Disease.

Finally disorders associated with your internal sleep clock being out of sync with your personal or occupational schedule are circadian rhythm disorders. Examples are e.g. jet lag, shift work disorder, night owl tendencies, early bird tendencies.

It’s never too soon to talk to your primary care physician first. Then if the problem is more urgent you can see a sleep specialist for more specialized care.

What are the health consequences of too much or too little sleep?

Changes associated with similar total sleep loss include decreased short-term memory, poor performance on newly learned or complex tasks, and difficulty maintaining attention. It is important to note that an individual's perception or subjective assessment of his or her sleepiness starts to level off after a few days. Thus, individuals may develop some tolerance to feelings of sleepiness over a few days, and this may make it more likely that sleep restricted people will be unaware of their continuing deterioration in alertness and performance.

Sleep and mood are closely connected; poor or inadequate sleep can cause irritability and stress, while healthy sleep can enhance well-being.

How do you treat sleep problems?

It has only been since the 1970s that sleep medicine was first recognized as its own specialty. Since that time, there are many options available to address sleep disorders. Treatments available include light therapy, medications and behavioral therapy, which have been proven in an evidence-based way. There are also medical devices that have been improved over the years, as well as new experimental techniques that are being investigated in terms of ways we can cure or better manage conditions such as sleep apnea.

There was a news report recently on successful people who routinely get by with four hours of sleep because of a certain gene? Can you train yourself to do that?

You cannot train yourself to get less sleep. You can train yourself to get better quality sleep by adopting sleep healthy behaviors by making sure you limit activities that impinge upon your natural sleep biorhythms ( circadian clock) to initiate sleep and maintain sleep. Examples are excessive exposure to light that impact the circadian rhythm or substances like alcohol or certain medications that can do this as well. All new medications should be discussed with your doctor to appropriately time when it is taken so it does not compete with sleep. There seems to be mounting evidence that the amount of sleep required by each individual is genetically determined and in some, but rare cases, it maybe as little as four hours of sleep. Most individuals require closer to 7.5 to 8.5 hours.

 What’s the latest research?

The most recent research publication, hot off the press, featured in our premier journal “Sleep," is entitled: Increased Use-Dependent Plasticity in Chronic Insomnia.

Dr. Rachel Salas was the lead investigator on this study. I was a contributing author and member of the team. Dr. Salas is the assistant medical director of the JH Center for Sleep and through her direction of a multidisciplinary research sleep team reported in the March 1, 2014 issue of the journal Sleep, set out to try and further our understanding of the differences in the brain activity of those with chronic insomnia compared to normal sleepers utilizing a magnetic tool/technique  called transcranial magnetic stimulation. They found that the tested brain area of for the insomnia individuals to had more “excitable” and energized neurons than "good sleepers." This finding added evidence to the notion that insomniacs are in a constant state of heightened information processing that may interfere with sleep.

The authors are: The authors are: Rachel E. Salas, MD; Joseph M. Galea, PhD; Alyssa A. Gamaldo, PhD; Charlene E. Gamaldo, MD; Richard P. Allen, PhD; Michael T. Smith, PhD, CBSM; Gabriela Cantarero, PhD; Barbara D. Lam; Pablo A. Celnik, MD


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{ 12 comments… read them below or add one }


Paula David March 5, 2014 at 4:41 pm

If you would like to schedule an appointment with Dr. Charlene Gamaldo, please call the
Johns Hopkins Center for Sleep at Howard County General Hospital

410 715 1060

Medical Arts Building
11085 Little Patuxent Parkway, Suite 201
Columbia, Maryland 21044


Kathryn Hunt March 5, 2014 at 12:22 pm

This gives me more good ideas. I am printing it to file at home.
I appreciate all the care you gave me when you were my doctor, Dr. Gamaldo!


Holly March 5, 2014 at 11:47 am

After trying behavioral therapy along with all of the sleep hygiene improvements , and not drinking alcohol anymore , I still have much trouble falling asleep and staying asleep. What could be the next step to improve my sleep ? What about the findings of the magnetic stimulation you cited above? With those results, any solutions? Thanks


Charlene Gamaldo March 5, 2014 at 12:40 pm

At this point it would certaily be time to consult a sleep expert to do a thorough clinical assessment for any sleep or medical disorders that may be causing these problems so a treatment geared toward the underlying problem can be implemented. Transcranial magnetic stimulation (TMS) remains a promising potential option but is still very much in the experimental arena and therefore could not be recommended as a standard path to care.


Crystal March 5, 2014 at 10:26 am

Hi, get up at 5 am Monday-Friday, I go to bed around 12 am, go to sleep maybe 12:30-12:45
i start waking up about 4-4:30 lay until 5 am. than i get out of bed. when i get up i am so tired..
i won't even lay down until 12 am. i have been doing this for years.. What can i do to get more sleep at least? 6 hrs would be so helpful.


Charlene Gamaldo March 5, 2014 at 12:44 pm

Good sleep habits, also called sleep hygiene, can help you get a good night's sleep. Here are some tips:

Try to go to sleep at the same time each night and get up at the same time each morning. Try not to take naps during the day especially after 4pm, because naps may make you less sleepy at night.
Avoid caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can cause waking in the night and interferes with sleep quality.
Get regular exercise. Try not to exercise close to bedtime, because it may stimulate you and make it hard to fall asleep. Experts suggest not exercising for at least three to four hours before the time you go to sleep.

Don't eat a heavy meal late in the day. A light snack before bedtime, however, may help you sleep.
Make your bedroom comfortable. Be sure that it is dark, quiet, and not too warm or too cold. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs, a fan, or a "white noise" machine to cover up the sounds.

Follow a routine to help you relax before sleep. Read a book, listen to music, or take a bath.
Avoid using your bed for anything other than sleep or sex.

If you can't fall asleep and don't feel drowsy, get up and read or do something that is not overly stimulating until you feel sleepy.If you find yourself lying awake worrying about things, try making a to-do list before you go to bed. This may help you to not focus on those worries overnight.


Carole Collins March 5, 2014 at 9:50 am

Is there any recent evidence for the effectiveness of the use of white noise and other sound machines out now? (Seen some use with tinnitus...)


Charlene Gamaldo March 5, 2014 at 10:43 am

Yes, white noise, quiet music, the use of a fan in your sleep quarters can help lull you to sleep. In fact, a recent study by suggests that listening to music while sleeping may improve memory consolidation. Slow wave sleep has been associated with memory consolidation. They hypothesize that playing music synchronized to the rhythm of the slow brain oscillations of people who are asleep enhances these oscillations by increasing the amplitude of the oscillations and by increasing the length of slow-wave sleep. The slow oscillations in brain activity that occur during slow-wave sleep are critical for retaining memories so boosting them in turn boosts memory.


Deborah Malone March 5, 2014 at 7:52 am

What is the best way to deal with restless leg syndrome? My legs some nights keeps me awake or even wakes me when I first go to sleep.


Charlene Gamaldo March 5, 2014 at 9:13 am

A "counter stimulus" that distracts from the RLS symptoms can often be helpful. For instance leg massage, compression socks or stockings or wrapping your legs in bandages (not too tight) may help. Sleeping with a pillow between the legs can help some patients. Try stretching before you lie down to sleep.

Of course if symptoms are severe and sleep quality and quantity is reduced consider speaking to a sleep specialist for evaluation and treatment.


Janet Anderson March 4, 2014 at 9:30 am

How does daylight savings time affect our sleep?


Charlene Gamaldo March 5, 2014 at 10:27 am

Depending on how sensitive your internal sleep clock is to schedule alterations, daylight savings time can result in a sense of grogginess and feeling of being off schedule for as long as a week. Spring forward is usually the more disruptive of the 2 changes since you have to adjust to losing an hour of sleep in addition to the disruption to your internal sleep rhythm.


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