All About Insomnia with Dr. Meredith Broderick
Sleep is something that I’ve personally struggled with for most of my life. If you’ve been there, you know just how frustrating it can be to feel like you just can’t get the quality rest you know that you need.
When I discovered Dr. Meredith Broderick, I knew I had to have her on the podcast. She is a triple board-certified sleep physician, and the founder of Sound Sleep Guru, a telehealth sleep clinic that serves Washington, California, and Alaska. She attended medical school at Ohio State University, completed a neurology residency at Case Western Reserve University, and a sleep and medicine and behavioral sleep medicine fellowship at Stanford Medical Center.
Dr. Broderick is board certified in neurology, sleep medicine, and behavioral sleep medicine, and is one of the only physicians in the country to hold this combination of board certifications. She practices the full scope of sleep medicine and treats conditions like insomnia, narcolepsy, circadian rhythm sleep-wake disorders, restless leg syndrome, and sleep-disordered breathing which includes all forms of sleep apnea. She originally became interested in the science behind sleep because her brother is a sleepwalker.
Although I’ve never been officially diagnosed with insomnia, I’m fascinated when it comes to sleep disorders as I myself have a hard time getting to sleep. Dr. Broderick and I discuss the different types of sleep disorders, treating insomnia, what's the deal with snoring, and whether or not we actually need eight hours of sleep per night.
Different types of sleep disorders
There are over 100 medical-grade sleep disorders. The most common include:
Obstructive sleep apnea
Restless leg syndrome
Circadian rhythm disorder
There is a very specific criterion for each one, and some — like chronic insomnia — need to be going on for several months for it to be considered a medical-grade disorder. That said, Dr. Broderick says that you should consider going to a doctor if you find that your lack of sleep impairs your daytime functioning. This could mean difficulties at work, in relationships, or if you’re not able to do the things you ordinarily would be doing.
There is no one size fits all reason for insomnia, but there are frameworks that can help sleep specialists like Dr. Broderick determine things that may prevent patients from sleeping. She relies on the Spielman model of insomnia in particular, which is sometimes called the 3 P Model of Insomnia:
Predisposing factors: Dependant on personality. Some people are innate light sleepers and others are deeper sleepers.
Precipitating factors: An event that could trigger insomnia. A breakup, sudden illness, or stress at work are just a few examples.
Perpetuating factors: Anxiety around sleeping. Once you’ve struggled to sleep for an extended amount of time, every time you get into bed you have it in your mind that you won’t be able to sleep. Essentially, you’re subconsciously preventing yourself from falling asleep.
Dr. Broderick relies on cognitive behavioral therapy for insomnia (CBT-I) to treat chronic insomnia. It targets those perpetuating factors to treat any anxiety or fear around going to sleep. When asked about her success rate, she says that it’s very high. Over 90% of people who complete her program feel better.
She says that that doesn’t mean that they have zero issues with sleeping. But, they do say that they’re sleeping better and don’t have to rely as much on sleeping medication. It’s important to note that because it’s a behavioral program, patients are required to put in a lot of work on their end. If they don’t follow the directions, Dr. Broderick says that she won’t be able to help them. It makes sense!
What about snoring?
While snoring itself isn’t considered a sleep disorder, it could be a sign that you have obstructive sleep apnea.
Obstructive sleep apnea happens when your breathing gets interrupted as you sleep. That’s why it’s called “obstructive” — your airway becomes too narrow to breathe comfortably. There are a lot of treatment options out there for sleep apnea, and step one is to speak with a sleep physician like Dr. Broderick.
However, it’s important to note that when people get to the most severe stages of sleep apnea, they actually don’t snore at all. Dr. Broderick says that sleep apnea tends to be more common in men, due to hormones and neck size. But, menopausal women can also experience it.
When a patient comes in complaining of snoring (or with their sleepy-by-default partner who just can’t take it anymore), Dr. Broderick doesn’t immediately assume that they have sleep apnea. She says that in order to characterize the snoring, she considers a myriad of other factors:
How severe is it?
Does it cause a decrease in oxygen?
Is the patient overweight?
Do they have a deviated septum?
Are their teeth normal?
If she is able to determine that the snoring is a symptom of sleep apnea, there are a lot of different options for how to deal with it. The good news? There are lots of treatments out there. Nasal sprays, mouth guards, surgery, tongue-stimulating devices, and CPAP machines are just a few.
Do we really need eight hours?
We’ve all heard the old adage that we need eight hours of sleep a night to feel rested. I personally find that if I sleep a full eight hours, I end up waking up drowsy. So, I had to ask: do we all really need eight hours of sleep per night?
Dr. Broderick affirms that on average people need eight hours. That means that some people get by perfectly fine on 5-6, while others may need closer to 8-10. She’s able to determine how many hours a given patient needs by working on CBTI with them. So many factors can go into figuring out how much rest you need, such as activity levels, gender, and age.
There are different stages of sleep as well. They range from awake to N1, N2, N3, and rapid eye movement (REM). Many people believe that REM is the deepest stage, but that’s actually a misconception. N3 is in fact the deepest stage of sleep.
These different stages beg another question: do we still get a good night’s sleep if we dream? Dr. Broderick says yes. Dreams can feel so realistic sometimes, but it’s comforting to know that dream-filled nights are still considered restful and restorative.
At the end of the day, Dr. Broderick wants folks to know that sleep medicine is a field and that it isn’t normal to walk around feeling horrible, sleepy, or have difficulty sleeping at night. There is help for it — and it works.
If you live in Seattle, you can visit Dr. Broderick’s office for treatment. And if you live in Alaska, California, or Washington, you can also go to her for telehealth visits. Go to her website to learn more. And, if you’re interested in listening to our full conversation make sure to head to the podcast!