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Dr. Suzanne Bartlett Hackenmiller on Integrative Approaches to Sleep

Suzanne Bartlett Hackenmiller, MDSleep is a highly complex state that deserves more of our attention. Increasingly, research is emerging about just how important it is for nearly every bodily function and organ system. Sleep is critical for physical and cognitive functioning, in particular for emotional processing and solidifying memories, as well as for cardiovascular, respiratory, cellular, and immune functioning. Sleep also clears our brains of waste metabolites.

But sleep disorders are prevalent. A study in February 2020 at the start of the COVID-19 pandemic to investigate its effects on people’s well-being found that 20% of respondents were already reporting sleep problems like insomnia, with 15.8% reporting acute stress, 18.5% anxiety, and 24% depression. It’s likely that these effects worsened over the ensuing months.

Two-thirds of adults worldwide fail to get the recommended eight hours of sleep per night. While it’s true that people with a certain gene can survive on five hours of sleep or less without impairment, that gene is found in less than 1% of the population. As for the nature of our sleep issues, sleep onset problems are more likely in younger people and sleep maintenance issues are more likely in older individuals.

So, how can you tell if the quality of your sleep is inadequate? Drowsiness during the day is a sign, and unlike what many people think, so is falling asleep within five minutes of lying down. People often say they fall asleep as soon as their “head hits the pillow,” but that can be indicative of severe sleep deprivation or a possible sleep disorder.

Poor sleep increases your accident risk, impairs concentration and performance at school and work, and increases your risk of cardiovascular disease, cancers, metabolic disorders, and obesity, among other conditions. Interestingly, a study found that a flu shot is less effective for people who sleep less than eight hours per night.

Sleep deprivation, for even one night, has health consequences. According to a study, a single night of only four hours of sleep wiped out 70% of natural killer (NK) cells circulating in the immune system. These are the cells that work to control tumors, as well as viral and microbial infections. A larger study of 25,000 people found that sleeping less than six hours per night was associated with a 40% increased risk of developing cancer compared to sleeping seven hours or more.

Common causes of insomnia include gastroesophageal reflux, restless leg syndrome, chronic pain, prescription drugs, caffeine, and alcohol. According to a 2003 study, alcohol is the most common ingested substance used as a sleep aid, but it actually suppresses deep and REM sleep and increases awakenings.

Integrative treatment for sleep problems takes into account all the factors that can interfere with sleep— biological, such as acid reflux; psychological, such as anxiety; and environmental, such as an uncomfortable bed or excessive light at night. Sleep aids are best avoided. A study of 4,500 people revealed that there was no difference in time to fall asleep between newer forms of sedating sleeping pills, like Ambien, and a placebo. By contrast, lifestyle changes may deliver some of the best results for improving sleep.  Pre-sleep rest practices like meditation and yoga or personal bedtime rituals like warm baths and journaling are very helpful. In general, we should:

  • Avoid heavy meals within three hours of bedtime
  • Avoid dietary triggers of gastroesophageal reflux
  • Avoid physical exercise before bedtime as this can raise core body temperature and inhibit sleep
  • Keep our bedrooms cool, dark, quiet, and comfortable

Programming your thermostat for colder temperatures in the middle of the night can also be helpful. Studies have found that rooms kept at 68 degrees or colder allows for the decrease in body temperature necessary for proper sleep.

Cognitive Behavioral Therapy (CBT) has also proved helpful for many people. Essentially, CBT for sleep recommends that you go to bed only when feeling sleepy. If you can’t fall asleep, get out of bed and do something relaxing until drowsiness sets in again, then return to bed, and repeat these steps as often as necessary.

Dr. Suzanne Bartlett Hackenmiller is a Diplomate of the American Board of Integrative Medicine (ABOIM), a Member Board of the American Board of Physician Specialties® (ABPS).

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Medical organizations throughout North America understand that our rigorous certification standards prove that ABPS Diplomates are capable of delivering the best patient care possible.

Far too often, medicine is led by less than 5% of non-practicing physicians taking away and replacing the voice of the 95% of physicians practicing and placing patient safety and care first on the front lines every day. The American Board of Physician Specialties has raised the standards in physician board certification not only in the quality of their boards of certification, but in hearing and allowing for the voice of those active physicians caring directly for patients. Having been a part of the ABPS over the last 28 years has allowed me to grow as a woman leader in a field often wrought with challenges. It helped me and others raise the bar of the standards of care in my specialty, Emergency Medicine, through their Board Certification in Emergency Medicine (BCEM). ABPS also helped raise the standards of care for 21st century medicine through their certifications in other specialties, particularly in Integrative Medicine & Disaster Medicine. Having physician voices heard matters to medicine and is essential in the betterment of patient safety and care.

Sarah E. Gilbert, MD, FAAEP
Sarah E. Gilbert, MD, FAAEP
Emergency Medicine
On October 18, 2007, President George W. Bush released Homeland Security Presidential Directive 21 (HSPD-21), calling on our nation, among other initiatives, to “collectively support and facilitate the establishment of a discipline of disaster health”. It is a great testament to the wisdom and foresight of the American Board of Physician Specialties that it immediately set to work and created, within the short span of only one year, an educational blueprint and set of certification examinations, both written and oral, for a new subspecialty of disaster medicine—and it is why I chose to be part this vital initiative and this wonderful organization. This is but one of the many innovative programs initiated by the American Board of Physician Specialties over the years, and why I am proud to support its work on behalf of our nation’s public health.

Art Cooper, MD
Disaster Medicine
When the American Board of Physician Specialties offered to host the American Board of Integrative Medicine, ABPS became a landmark organization working to move medicine into the twenty first century. Certifying physicians who have completed rigorous academic training in Integrative Medicine ensures that the field of Integrative Medicine will continue to develop academically, clinically, and professionally. The leadership of ABPS continues to impress me - they are diligent in constantly innovating to provide certifications for physicians who want to advance their careers and their areas of expertise. I am honored to be a part of this organization.

Ann Marie Chiasson, MD
Integrative Medicine
There are many ways board certification advances a physician career. ABPS Board examination verifies your accuracy, precision, and reflects your mastery of your residency training verifying your expertise. ABPS Board certification demonstrates your level of expertise beyond your practice experience, primary education degrees, and training which are necessary for insurance reimbursement and practice privilege requirements. Attaining your ABPS Board Certification will clarify your purpose, secure your practice growth, and expand into leadership positions. Board certification can serve as an indication of a physician’s commitment to medicine, beyond the minimal standards and competency of training, their measurement to quality of care, and attaining an award for excellence.

Chris Kunis MD
Internal Medicine
When I think historically, advancement in medicine and patient safety and care has been driven by the diversity of people and scientific thought. That’s what I found at the ABPS and more. For over 60 years that is just who we are. I found a physician certifying body that provides a choice and voice to all physicians ensuring that patients are always placed first.

Jerry Allison, MD
Emergency Medicine
When I decided to pursue a full time role as a physician executive it was important to me to obtain additional professional training, education and work experience. Board certification through the ABPS in Administrative Medicine is validation of my efforts and a demonstration of dedication to professional development. We need more physicians to become full time health care executives, knowing there is a board certification option in Administrative Medicine encourages physicians to take the leap from full time clinical practice to healthcare organizational leadership.

Richard Paula, MD
Administrative Medicine
The American Board of Physician Specialties has provided me with the opportunity to demonstrate mastery of internal medicine through board certification. As a hospitalist, board certification is an expected credential, and hospitals recognize the American Board of Physician Specialties (ABPS) as one of the three standard credentialling bodies for Internal Medicine. Additionally, the ABPS has helped me develop leadership skills as a Board member and Committee Chairperson. ABPS has also helped me sharpen critical thinking skills as a test question developer and reviewer. The Allopathic (MD) and Osteopathic (DO) physicians in the ABPS are lifelong learners and frequently pursue multiple board certifications. I enjoy the camaraderie of my peers in ABPS.

Loren Jay Chassels, DO
Internal Medicine
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