How to Get Better Sleep with Dr. Jaime Hughes

Ask Dr. Mia: Conversations on Aging Well

Transcript Ep. 8

Intro 00:03

Welcome to ask. Dr. Mia Podcast conversations on Aging Well. This podcast is for educational and informational purposes only and solely as an educational tool for your own use. Dr. Mia is not providing medical, psychological, or nutritional advice. You should not use this information to diagnose or treat any health problems or illnesses without consulting your own medical practitioner. For more information, including transcription, please go to miamd.com. That's miayangmd.com. And now our host, Dr. Mia. 

Dr. Mia 00:36

Welcome to Ask Dr. Mia Podcast Conversations on Aging Well. Today I'm talking with Dr. Jamie Hughes about sleep and implementation science. You might wonder what those two have to do with each other. I'm going to let Jamie introduce herself. 

Dr. Jaime Hughes 00:53

Great. Thanks, Dr. Mia. I'm so pleased to have the chance to talk with you today. So, again, my name is Jamie Hughes. I'm a faculty member at Wake Forest University School of Medicine, where I work both with the Department of Implementation Science as well as the section of Gerontology and Geriatric Medicine. So as a researcher, I focus mainly on developing and spreading effective programs to help keep older adults healthy and active and aging in place. And I have a particular interest on sleep and activity programs. 

Dr. Mia 01:28:

Absolutely. It's so important. I think there's the data out there that it takes 17 years from the time when research is published to the time that it's actually incorporated into real world clinical practice. And everybody wants to have good sleep, but not everyone gets it. What do you think are some of the barriers for older adults in particular to get good sleep? 

Dr. Jaime Hughes 01:52

That's a great question. Sleep naturally changes as we all age and then actually starts changing even as early as our 30’s and 40’s. So in later life, sleep becomes lighter, it becomes more fragmented. So this can mean it's harder to fall asleep, it's harder to stay asleep during the night. It might be harder to go back to sleep if something wakes you up during the night. And as we age, we also spend less time in deep sleep each night. And then another thing that happens is our internal clocks and rhythms change. So as we get older again, beginning in midlife, but maybe a little bit more pronounced in the later decades of life, that means falling asleep earlier in the evening, maybe in the afternoon. 

Dr. Jaime Hughes 02:39

So it might mean kind of wanting to go to bed a little bit earlier, wanting to wake up a little bit earlier, and that may or may not be in line with the schedules that we've all followed for years. So in general, again, kind of sleep changes as we age, and there are normal changes. And those normal changes kind of in our sleep architecture, as we think can make it harder to get the deep, restful sleep that we're all hoping to get. 

Dr. Mia 03:06

Absolutely. And I think a lot of times people also have perhaps what we call poor sleep hygiene, which my own family, and maybe myself as well, included in the sense that we're on our phones or watching TV kind of right until the time of bedtime and don't necessarily have a good winding down routine. I think of my mother in particular. She tends to fall asleep on the couch watching TV around seven or 08:00, and then by 11:00 she'll wake up and transition to go to sleep in her bedroom and then wonder why she can't fall asleep. So I think we have a lot of conversations about turning off screens, making the sleep environment comfortable, maybe a little colder, doing something relaxing, not on your phone, not on a computer. 

Dr. Mia 03:57

And all of those things, I think, is really important, not to mention the medical complexity in most of our patients and older adults. And sometimes their medications make it harder for them to sleep, or they're getting up in the middle of the night and going to the bathroom five times overnight and then having a hard time going back to sleep. So sleep is certainly related to so many other things. How has your research been sleep and helping people get good sleep? 

Dr. Jaime Hughes 04:27

Sure, I'm happy to share a little bit more. I just want to go back a little bit. I think you brought up a great point. There are some things so we talked a little bit about sleep changes as we age. So there's some things a little bit out of our control. We always think sort of within our own team of these age related changes are part of normal aging. But age-related changes resulting in poor sleep do not necessarily have to be part of aging. So there are some things in our control, like our sleep hygiene. So all of the things that we do or don't do throughout the day, so this could be what we eat, what we drink, the amount of exercise we get or don't get, the type and intensity of light that we get and when. 

Dr. Jaime Hughes 5:12

So that use of, “Oh, let me just watch TV to wind down,”  “I'll read on a tablet or look at my phone,” no matter our age, that type of light maybe makes it harder to fall asleep, or again to stay asleep. What we do, we know that many of our older adults may not be as active during the day, they might not have a lot of social interaction, may not get out of the house everyday. And so thinking about how can we maintain connections with other people throughout the day, all of those kinds of things are in our control. Again, our sort of sleep hygiene. But I also want to just touch on before we talk a little bit about the sleep research you brought up, some other good points of maybe medications make it harder to fall asleep. 

Dr. Jaime Hughes 5:56

So we know that there's some medications that are more alerting. Maybe they wake us up. And this could be at any age. There are also maybe other medications that are a little bit more sedating. They make us fall asleep. So a kind of initial first step of any of us are having a bad night of sleep for an extended period of time, no matter our age, talking to a doctor or a healthcare provider about what's the best time to take different medications are. There some that are better suited to be taken in the morning, and then maybe others that are better suited to be taken at night. So in our particular research, we really think about what things are in someone's control when it comes to both nighttime sleep. But again, all of those daytime activities that we engage in. 

Dr. Jaime Hughes 6:45

So we know that sleep depends on daytime and nighttime to kind of have a healthy, restful night of sleep. So we focus mainly on chronic insomnia interventions. And you'd be happy to talk a little bit more about what we mean by insomnia and what we can do to help alleviate insomnia. 

Dr. Mia 07:05

Yeah, that would be great. I would love to hear your definition of insomnia. I think that word gets thrown around a lot, but in particular in research, I think it's probably a very specific thing. 

Dr. Jaime Hughes 7:15

Yeah, that's great I think we all, again, no matter our age, like, “oh, if I don't sleep, this is going to happen.” Or “oh, I had really bad insomnia last night.” And it's normal, we're human, we're all, again, no matter our age or health status, we're all going to have a bad night of sleep from any point in time. That's normal. Chronic insomnia, sort of in terms of thinking about a clinical definition, is three months or more of difficulty falling or staying asleep and or poor nighttime sleep that causes impairment or disruption or dysfunction in someone's day. So this can be disruptions in our social relationships, how we're thinking, how we're feeling, feeling sharp, being able to work, volunteer, manage one's health, and this is sort of chronic. 

Dr. Jaime Hughes 8:09

And three months or more when we think about those symptoms, having a hard time falling or staying asleep, those symptoms are happening three nights or more a week. And really a lot of the older adult patients that we see by the time sleep is brought up in any sort of clinical setting, or even in a community health or activity program, sleep problems have often been present for much longer, maybe a year or more. Sometimes in some of our more complex older adults with more chronic conditions, we even see sleep problems lasting a decade or more. 

Dr. Mia 8:45

Yeah, usually these are very long-standing issues. And what type of population of folks with sleep issues have you been focused on? 

Dr. Jaime Hughes 8:54

So I focused on a range of folks. I've spent almost 12 years working for the VA hospital, so I have worked with a lot of older veterans. So we've had folks, we have a few remaining kind of World War II era, a lot of Vietnam and Korea era veterans who are maybe faced with multiple chronic conditions, maybe faced with some challenges in their mobility or function, maybe some cognitive changes for some of our Vietnam era veterans, maybe even some remaining sort of PTSD or trauma-related challenges, and tend to focus on similar groups of patients, even in a non-veteran population. So again, thinking about older adults who have one or more chronic conditions. So it could be as simple as hypertension, COPD, maybe depression, anxiety. 

Dr. Jaime Hughes 9:48

For the longest time, insomnia was thought to be comorbid with some of these conditions or sort of running alongside or kind of in parallel to maybe a more chronic medical condition. Thinking has really shifted in the past few years. We all know we can turn on the TV, we can read an article, how important it is to get enough good quality sleep every night. And so this shift towards more focus on sleep health and just the role of sleep and overall health and function and kind of parallel to that movement, we now see sort of insomnia as its sort of standalone condition. In the sleep field, we joke that insomnia is insomnia, as insomnia is important to treat insomnia, no matter if there's one other chronic medical condition or there are ten. 

Dr. Jaime Hughes 10:38

And I think the sort of important thing to think about insomnia is we think of it developing in kind of this series of factors. So there's a leading model of insomnia used within sleep medicine called the 3P model. So we all have these kinds of predisposing factors that can increase our risk for insomnia. And again, I'm using language to kind of remind us all that poor sleep or insomnia is not a normal part of aging. It can happen at any point in one's life. So these predisposing factors are maybe a genetic risk, kind of being more susceptible to stress. What really sort of happens with insomnia is there's a precipitating event. So for many older adults, this can be a stressful life or health event. 

Dr. Jaime Hughes 11:28

So this might be a new diagnosis, it could be a fall, it could be an illness, it could be a change in financial or health status, new caregiving duties, loss of a friend or family member. I think we can all think about when we have any type of stressful event. Even if we have a cold, we don't sleep well. Our minds are racing, we can't get comfortable. And what happens to make up for that kind of poor sleep? We start to do things to compensate for that poor sleep. Maybe we watch TV, so we fall asleep on the couch. Some folks turn to kind of self-soothing with different food or drink. Maybe it's staying in bed longer in the morning because we got such a lousy night of sleep. 

Dr. Jaime Hughes 12:15

Over time, these behaviors that we want put in place to help kind of relieve the stress of having poor sleep around that stressful life event, they become a little bit chronic. And it's these chronic, unhealthy, poor sleep behaviors that over time, actually really kind of contribute to insomnia being a little bit of an acute setting to more chronic. So the work that I focus on is really thinking about working with individuals, older adults specifically, who have chronic insomnia and helping to identify what are the unhealthy behaviors that might be contributing to this chronic insomnia. So for a lot of folks, especially, it's common for folks maybe who are retired and not dictated by a regular, “oh, my alarm is going to go off at 06:00 a.m. I need to be at work by 08:00 a.m.“ who don't have a regular sleep wake schedule that can really contribute to sleep problems. 

Dr. Jaime Hughes 13:15

We've also talked with older adults who maybe the bed is a place of relaxation. There might be chronic pain. There might be a lot of resting, maybe reading. I've talked to patients who eat in the bed, who pay their bills in bed, who do all sorts of things other than sleeping in the bed. What happens is our brains and our bodies get confused. So when we try and go to bed at night, if there have been ten or more other activities that happen in the bed, our brain and our body no longer know, should I be sleeping or should I be paying bills or reading or watching TV or on the phone? 

Dr. Jaime Hughes 13:51

So some of what we do is really working on these modifiable behaviors using a program called Cognitive Behavioral Therapy for Insomnia, or more commonly referred to as CBT-I. 

Dr. Mia 14:06

Thank you. Yeah, that's really fascinating. And I think you mentioned earlier the 3P model is one of the PS, like a precipitating event?

Dr. Jaime Hughes 14:15

Predisposing, precipitating that stressful health or life event and then perpetuating. So the perpetuating are those unhealthy sleep behaviors kind of going to bed at different times each night, spending extra time in bed. For a lot of individuals challenged with insomnia, we know that it's, “oh, if I stay in bed a little bit longer, maybe I'll fall asleep.” “Maybe I'll stay asleep.” And so we start to see this really wide discrepancy between maybe only getting, let's say, 6 hours of sleep a night, but actually being in bed for about 8 hours. So trying to identify strategies to reduce that time awake in the bed and replace it with time of sleep. 

Dr. Mia 14:58

Got you. And can you tell the audience who may not understand what CBT-I or Cognitive Behavioral Therapy means as maybe an example of behavioral change related to sleep? 

Dr. Jaime Hughes 15:10

Sure. Absolutely. CBT-I is what we call within medicine and within sleep medicine the kind of gold standard recommendation for chronic insomnia. So we've had a number of different professional organizations really recommend, based on the evidence, based on our research studies, to say this behavioral treatment, or CBT-I, is safer, longer lasting, and in many times more effective than sleep medications. So CBT-I is typically delivered in anywhere from four to eight sessions most often delivered by someone with some sort of training or expertise in sleep medicine. For the most part this tends to be a clinical psychologist. We also know that there are a number of other different providers who can learn to offer CBT-I maybe social workers, nurse practitioners, physicians’ assistants kind of a range of different providers with different training and expertise. And CBT-I really focuses on a number of core components. 

Dr. Jaime Hughes 16:16

So one I had focused or I had mentioned the kind of trying to regulate an individual sleep-wake schedule. So this is the first thing that is done within CBT-I is finding a regular time to go to bed each night and a regular time to get up each morning and trying to maintain that within about 15 to 30 minutes every day of the week. The next thing is really thinking about is an individual spending more time in bed than they are actually asleep and kind of trying to get back to that ideal. If I'm in bed for 8 hours a night ideally I want to be sleeping about seven and a half hours. We know that even the best sleepers it takes a few minutes to fall asleep, everyone's going to wake up and maybe toss and turn a few times. 

Dr. Jaime Hughes 17:04

Again, that's natural but really trying to kind of optimize the time in bed so that is as close as possible total sleep time. CBT-I also focuses on, for older adults particularly the importance of those daytime routines so a little bit of this sort of more traditional sleep hygiene. So when are medications being taken? When might be the best time to get natural light? What is someone's day look like? Are there regular meal times? Are there opportunities for physical activity? Are there opportunities for social engagement and not trying to necessarily focus on changing all of those things at once, but again, starting small and thinking about one or two changes that can promote some kind of regularity individuals day. And then the other two pieces that we focus on are one sometimes we know that our thoughts can be really powerful. 

Dr. Jaime Hughes 17:57

So kind of reframing. It's not the end of the world to get a bad night's sleep from every few weeks or every few months. Life will happen, stress will happen, events will happen. So kind of reframing unhelpful or unhealthy thoughts about sleep to be a little bit more helpful and we do that kind of also in a little bit of a focus on relapse prevention. So again, we're all human beings, things will happen, there will be a change in life or kind of health events, a change in our social circle. All of these things are a little bit more common with aid. So when those stressful events happen again, we think about the 3P model those precipitating events. 

Dr. Jaime Hughes 18:42

What are some strategies to kind of cope with an acute bout of insomnia or a few nights or maybe a week or more of poor sleep and really kind of empowering older adults with the strategies to get back on track when those episodes of poor sleep might come up from time to time? 

Dr. Mia 19:02

Got it. And I think the modality of CBT-I, as you said, it's really the gold standard. It's not a medication that could have other side effects. It's not a medication at all. It's a behavioral intervention. And that is such a great example of things that I wish was more widespread than it currently is, because it's so hard to figure out where to send people for CBT-I for sleep. And sometimes there are some patients, not everyone, but some people really just kind of want a short fix, or they don't really believe that changing their behavior will necessarily help with their sleep. Can you tell us a little bit more about how do you actually get people to make some of these behavioral changes, like getting more physical activity during the day? 

Dr. Jaime Hughes 19:52

That's a great question. My own sort of professional background in education and training is in behavior change. And it's probably one of the most challenging things to get someone to make changes and then to sustain those changes over time. For sleep. One. We kind of found that a lot of the older adults, by the time they find their way to us, they are so ready to make a change because poor sleep has really impacted how they feel during the day. Maybe how they get along or don't get along with their friends or family members, their ability to engage in the activities that they want to do. 

Dr. Jaime Hughes 20:29

So we really start and this is also, I think, really helpful for folks who might be a little bit more resistant to making changes in their kind of day-to-day behaviors or schedules, is thinking about what matters to you, what's important from day to day? What is it that gets you out of bed? What do you look forward to? And then backtracking a little bit and taking time to really think and explore. Well, how is your sleep impacting your ability to visit with your friends, to go for a walk, to manage your health, to visit your grandchildren, and really sort of helping facilitate and understanding your connection between our nighttime sleep and kind of those daytime activities. 

Dr. Jaime Hughes 21:13

So I think one just really sort of starting with what matters most and treating each individual patient that we see as an individual, knowing those goals and kind of what matters might be different for different individuals. And then I think in regards to sort of this specific question around activity, starting small, so we know that sometimes for individuals, maybe they have a favorite TV show, that's fine. Certainly relaxing at night is okay. That's not a bad thing. We're not asking anyone to go lift weights or run a marathon kind of day in and day out, simply getting movement throughout the day, standing up during commercial breaks. What we know is most detrimental to sleep is we think of it as we have this kind of sleep bank. We all need one amount of sleep every 24 hours period. 

Dr. Jaime Hughes 22:05

For the most part, that's between seven and nine hours. But even that hourly amount differs from one individual to the next. Well, anytime any one of us fall asleep during the day, we're essentially robbing ourselves of our own sleep bank. So a 30-minute nap here and a 30-minute nap there, suddenly the 8 hours of sleep that we need in that 24-hour period has decreased to seven. If we nap unintentionally or intentionally after dinner and take off another 15 minutes, well, when we get into bed at night, it's that much harder to fall asleep. So all of that to say for older adults, a big piece of increasing activity is not necessarily the physical activity it is. Again, going back to what matters most. Is it finding opportunities to stay engaged? 

Dr. Jaime Hughes 22:53

Is it finding opportunities to do something meaningful to connect even through the telephone, the neighbor or friend, or family? Is it thinking about having a safe place to walk? Is it thinking about helping older adults? Again, sleep is just not about what we do at night, but maybe finding some community programs or resources to find that engagement during the day. 

Dr.Mia 23:16

Yeah, I also think that if you're not getting much stimulation, whether it's social or intellectual or physical, during the day, you don't feel as tired or at night, just like the days when you're inside the house might feel different from a day that you're out and about. So coming back to CBT-I for a little bit, I know implementation science is a discipline of science that really is about implementing evidence-based interventions such as CBT-I, Cognitive Behavioral Therapy, into the real-world practice. And I think sleep and therapies that are targeted for sleep is such a need for everyone to be able to access CBT-I. Can you give us an example of how implementation science is being used to disseminate non-pharmacologic or non-medication-based interventions for sleep? 

Dr. Jaime Hughes 24:15

Absolutely. I think you brought up a good point a few minutes ago about just how do we get these programs to different individuals? And we can think of I like to think of implementation science as two broad areas. One, like you said, how do we get the things or the programs that work into practice and to the people and the individuals who need them or could benefit them the most? The second piece is once we identify those particular patient populations or those programs and settings in which we might want to offer a program like CBT-I, how do we build the environment and the tools and the resources within that setting so that the program can be delivered and sustained over time. So our team has a couple of different projects that we're focusing on right now. 

Dr. Jaime Hughes 25:05

One, we know that we can't really offer CBT-I programs unless we first identify individuals who have poor sleep. So the first thing we're doing is taking a step back and thinking about can, through brief surveys, either sent through the mail to patients or through an electronic patient portal, can we send out brief sleep surveys that can help our providers within our healthcare system better identify who might have clinically significant poor sleep or insomnia specifically. The second project that we're working on is really working with primary care clinics to sort of refine our process, to work side by side with patients, with staff, with all different healthcare providers of different disciplines, to really sort of come together in our team as a group of researchers and clinical researchers, to say we have this sleep program that we built about ten years ago. 

Dr. Jaime Hughes 26:09

We have plenty of data to show that it works, it's effective, patients like it. They feel better during the day, and we think it would be really beneficial to start offering it in your primary care clinic. But at the same time, we know that we're researchers. We don't understand what's your workflow day to day, who's on your team? What are other challenges? What other new initiatives are you trying to implement or integrate into your clinic? What do you think of sleep? Is it important? How might it fit into initial visit with an older adult, a return visit? What information do you as a clinic need or want to screen for sleep or to treat sleep? And really using all of that information, recognizing that our providers and our clinic staff are the experts, we as researchers, maybe have a tool with CBT-I. 

Dr. Jaime Hughes 27:05

Our program is Swell or sleep well. We know that it works, but again, we know that we're not the ones in the clinic day to day. And really, again, kind of working with these providers and these primary care clinics to think about how a program might be offered in routine settings. And a piece of that is also to recognize that we know after several years of shifting to telehealth and kind of the ongoing effects of the pandemic, there may benefit in offering more virtual programs. We also know that sometimes just telephone or things through the mail can really help get a program like CBT-I to patients who may not be able to come to the clinic on a weekly basis or maybe every other week for a particular program. 

So again, kind of thinking about screening and then how can we identify the kind of barriers and facilitators and help give clinics the tools to start offering a program like Swell within their own clinic practice.

Dr. Mia 28:04

Got it. And I think one other aspect. I know your research is really within healthcare systems and kind of implementing CBT-I or sleep interventions within the domains of primary care clinics. But in your comment about the pandemic and moving things to telehealth, I know a lot of mental health therapies are also moving into internet-based modalities. And in thinking about the main domains of CBT-I that you mentioned for sleep, none of those necessarily need to have a physician or even an advanced practice provider. A lot of it is about identifying with patient or the person who has chronic insomnia and sorting out their sleep schedule, narrowing down the amount of time they stay in bed, talk about their daytime routines, changing their behaviors in a way that maybe doesn't need to be housed within a clinical encounter. 

Dr. Mia 29:05

Are there programs that are offering CBTi to people who are interested in doing this, but maybe don't have a primary care clinic or a health system that could connect them to something like this? 

Dr. Jaime Hughes 29:18

That's a great question, and I love the sort of attention to this idea of you've hinted at it, but it's how can we offer CB-I to more patients? And within sleep medicine and behavioral sleep medicine, this has been a challenge for probably more than a decade. We just know there are too few CBT-I providers for the number of individuals who would benefit from insomnia treatment. And I think you've also brought up a good point of some of the activities that are a part of CBT-I or these kinds of core components may not need to be housed within a clinical encounter. So another sort of piece of our team's underlying program of research is really thinking about are there other settings that could be ripe for offering CBT-I? So could we take a sort of stepped-care approach? 

Dr. Jaime Hughes 30:10

Could a group CBT-I program be delivered, let's say, at a senior center or a library or any sort of community organization if someone needs or wants a little bit more support? Or maybe there is a clinical challenge or consideration that could benefit from more clinic or face-to-face interaction, maybe that individual steps up to more individual treatment. I think to your sort of question around who could deliver these programs. Traditionally, CBT-I has been delivered or sort of limited to individuals with specific sleep training. I think there's a need and a push to sort of expand our thinking of who could deliver it. And generally CBT-I even offers through some of our digital programs or modalities does require prescription or a kind of provider's recommendation. 

Dr. Jaime Hughes 31:01

And I think as we talk about insomnia, the really critical piece to remember is there are other more serious sleep disorders, one of which is obstructive sleep apnea. For folks listening, sleep apnea is breathe cessation and breathing during one sleep. And this can be something that changes with age, weight, medication. It can have a number of different risk factors. There's also central sleep apnea where your brain essentially doesn't quite send enough signal to your body to keep breathing. And these kind of brief cessations or pauses in breathing repeated times overnight can be very dangerous and it can have a number of consequences, sort of cardiac, cognitive, you name it. 

Dr. Jaime Hughes 31:48

So that's really one reason that if there is a concern around insomnia so again, prolonged difficulty falling or staying asleep, it's really important to talk to a healthcare provider to rule out any other more serious sleep disorder like sleep apnea. And that's really a little bit kind of the history or the motivation of why there are plenty of sleep health programs out there within the world. Self-help books or phone apps or internet-based programs, but really to engage in kind of more intensive behavior change or CBT-I, really important to rule out any other kind of more serious sleep disorders. 

Dr. Jaime Hughes 32:29

Got you. Yeah. And thank you for bringing in obstructive sleep apnea and other apnea episodes which are definitely very common and also underdiagnosed. I think we can talk about sleep all day, but just to be aware of time, what do you think? Some things that older adults can do if they have sleep problems and they certainly are encouraged to talk to their own doctors about their sleep issues. But what else can they do on their own to help them sleep better? 

Dr. Jaime Hughes 33:00

So there are things that we can all do. Some really simple tips from day to day. Or one, getting natural light and getting that as soon after we wake up in the morning. So this doesn't have to mean getting out and putting your shoes on and walking down the block every morning, even when it's raining or cold. This could be as simple as sitting next to a window, opening the blinds, opening the curtains, trying to get natural light. For folks that maybe don't have as much control over their environment, we can think about light therapy and ways to kind of mimic some of those natural light even within portable lamps. And whatnot the other thing goes back to kind of these principles of sleep hygiene. So we think routines, routines. 

Dr. Jaime Hughes 33:45

Our bodies, we have little tiny clock genes all over our bodies and our bodies love routines. So the more that we can eat meals at the same time every day, take medications at the same time, and most importantly, go to bed at the same time and get up at the same time every morning on a day-to-day basis. All those routines help regulate what's called our circadian rhythm or our internal clock. And the other piece is kind of just stay active and engaged in a way that means something and is fulfilling to you as an individual. We know that there are recommendations for kind of minimum amounts of daily activity, but I think it kind of comes down back to what matters most, social engagement can help individuals feel fulfilled. So kind of your point. 

Dr. Jaime Hughes 34:34

It might be easier to fall asleep in mind if we feel fulfilled if we've been engaged physically or socially. Those are some kind of simple tips that can sometimes really make a big difference for improving how we sleep at night. 

Dr. Mia 34:48

Thank you so much, Jaime. I love the conversation today. I think it could really help a lot of folks who are dealing with sleep issues, which is so common. I'm going to put some of these information into the show notes and ways to potentially contact to get involved in one of the sleep studies for people who might be interested in looking at that. And thank you again. 

Dr. Jaime Hughes 35:12

Well, thank you for having me. It's been such a pleasure to talk a little bit about sleep and to share about our team's work. And we are always happy to hear from anyone and everyone who might be interested in how we, as a field and kind of as a community, can improve sleep health for older adults. So thanks for the conversation. 

Dr. Mia 35:32

Thank you. 

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