Teresa Valerio is an assistant professor in the Mennonite College of Nursing, a family nurse practitioner, and a sleep specialist. She has a clinical practice in sleep disorders at Illinois State University’s Student Health Services, and in 2012, she became the first nurse practitioner to be board certified in behavioral sleep medicine by the American Board of Sleep Medicine.

“A regular schedule will keep you on track with your sleep pattern, but the wakeup time is really the anchor.”—Teresa Valerio

Valerio’s writings on sleep have been widely published in scholarly journals. The American Journal of Nursing’s 2011 Book of the Year Award went to the book Sleep Disorders and Sleep Promotion in Nursing Practice, for which Valerio was a contributing author. Earlier this year, Valerio co-authored a study, “Association of Sleep Quality to Health Behaviors, Functioning, and Information Among U.S. College Students,” published in the American Journal of Health Education with Illinois State Nursing Professor MyoungJin Kim and Elmhurst College Psychology Professor Kathy Sexton-Radek. The research team examined the sleep problems of 27,750 college students from 57 U.S. institutions of higher learning.

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In the following Q&A, Valerio talks about her latest sleep research and offers lessons on how to
sleep well.

Can you describe your most recent research? What kinds of things are you finding out?

After looking at the health survey data from ISU students for several years, it was clear that sleep problems were consistently in the top three health problems they reported. So I reviewed the literature and found that this has been a problem across U.S. and international university students and that sleep problems were getting worse.

There had not been an evaluation of the sleep problem across multiple U.S. colleges and universities for a few years, so I assembled a research team to do this. Our major findings were that sleep quality decreased with increasing levels of stress or alcohol/cigarette use and with decreasing levels of general health. We recommended that college interventions should include efforts to address sleep quality to improve students’ academic performance and long-term quality of life, especially for students experiencing substantial stress or poor general health.

There are few interventions that have been tested. Because of this gap in the science and our findings in the aforementioned study, I am conducting a study to test an intervention to improve college students’ knowledge of sleep health, use of sleep health information, and quality of sleep. The study includes a pre- and post-survey of sleep health knowledge, sleep-related experiences, and associated health and academic performance. The intervention is an enhanced Web page with various types and forms of sleep health information. Our research team includes leaders in Illinois State’s Health Promotion and Wellness and University Assessment, and myself. We have collected data from over 100 ISU students and are in the analysis phase.

Why is sleep so important?

Sleep gives the body and brain time to rest, of course, but also time to heal. Blood pressure goes down during sleep, which allows your arteries to relax a little. Heart rate goes down. Respiratory rate goes down. There are over 20 hormonal changes that occur during sleep. One of those changes involves growth hormone, which is released during sleep, and which we need for healing.

Teresa Valerio
Nursing Professor Teresa Valerio

How are sleep and memory connected?

Memory consolidation happens in sleep. Whatever occurred during your day—in the classroom or at work—becomes consolidated into your memory from short-term to long-term during REM sleep. REM, or rapid eye movement, is a stage of sleep that occurs approximately every two hours in an adult sleep cycle. So if you sleep eight hours as opposed to six hours, you get an extra REM cycle, which gives you a better chance at having a better memory and being more alert and able to access that memory. The alternative is being tired, being in a fog, and not feeling mentally sharp. This can lead to lower job performance or lower academic performance.

What is a normal amount of sleep?

Research shows that six hours or less of sleep will cause a person to live a shorter life and have more disease; some studies now show those same results for people getting between six and seven hours of sleep. The normal amount of sleep for an adult is seven to nine hours. Increased disease and earlier death are associated with getting less than six hours of sleep per night; however, sleeping more than nine hours each night may be an indication of underlying health issues.

Should bedtime be at the same time every night?

A regular schedule will keep you on track with your sleep pattern, but the wakeup time is really the anchor. On weekends, keep the same wakeup time or keep within an hour of your regular wakeup time. Bedtime is based on when you’re sleepy, and getting up at the same time every day will help regulate that part of your schedule. Ideally, an adult is sleepy by 10 or 11 in the evening and wakeful by 6 or 7 a.m.

Are bedtime snacks OK, or are they harmful to sleep?

Bedtime snacks are fine, but you don’t want to eat a big meal so that you feel full. Conversely, it’s not good to go to bed hungry, because hunger will distract you and make it difficult to relax.

What are the most common sleep problems?

There are over 90 varying sleep disorders, affecting all ages from infants to older adults. Sleep deprivation, simply not getting enough sleep, is the No. 1 sleep disorder in America. Insomnia is No. 2 and affects 30 percent of the adult population in the U.S.

Restless leg syndrome (RLS) is No. 3, affecting about 15 percent of the population. With RLS, you get a feeling of discomfort in your legs causing the urge to move. It’s neurological. It occurs in the evenings when you’re at rest and not in the mornings.

Sleep apnea is No. 4 and affects about 10 percent to 20 percent of adults. Apnea is caused by a blockage in the airway where soft tissue in the back of the throat collapses during sleep. That blockage causes snoring as air tries to make it through the blocked airway. Any snoring at all is not normal. Apnea contributes to high blood pressure. It’s more common in overweight or obese people but can affect people with a normal weight.

What treatments are available for sleep disorders?

First you should see your primary provider to see if the problem can be resolved quickly. If not, your provider should refer you to a sleep specialist, which could be a physician, nurse practitioner, physician’s assistant, or psychologist.

What are the causes of sleep disorders?

The causes of sleep disorders fall under two categories: behavioral versus biological. The majority of sleep problems are the result of behavioral problems like, for example, falling into bad habits of staying up too late and waking up too late. That’s why sleep specialists focus on a person’s schedule and habits based around their sleep.

Sleep tips

  1. Schedule time to sleep. Put it on your schedule like other parts of your day.
  2. Incorporate a relaxing period before sleep for about 30 minutes to an hour where all electronics are turned off, and the lights are dimmed so as to induce sleep. Reading is a great thing to do before sleep, but if you read with a Kindle, use the black screen with white letters to decrease light exposure.
  3. Don’t try to sleep with the TV or radio on. Give yourself the best opportunity for good sleep by controlling your environment by having low light, low noise levels, and no electronics.
  4. Keep a consistent schedule. Most people think a consistent schedule involves going to bed at the same time every night, which is helpful, but more important is making a habit of waking up at the same time every day.
  5. If you have a night where you’re having trouble sleeping, don’t fight it. Get out of bed and keep the lights low and computer off. Try to relax to invite sleep. Get to a comfortable chair, read or listen to soothing, quiet music. You want just enough distraction so that you’re not thinking about sleep. Don’t go back to bed until you’re feeling sleepy.
  6. Finally, if you’re doing everything right and still not getting the proper sleep, then it’s time to see your health care professional.