Sleep: Dr. Mark Sullivan On Why You Should Make Getting A Good Night’s Sleep A Major Priority In Your Life, And How You Can Make That Happen

Originally posted on Authority Magazine (June 28, 2024)

Modify your sleeping environment to minimize disturbances. This includes a comfortably cool, dark room, with minimal exposure to external noise.

Getting a good night’s sleep has so many physical, emotional, and mental benefits. Yet with all of the distractions that demand our attention, going to sleep on time and getting enough rest has become extremely elusive to many of us. Why is sleep so important and how can we make it a priority?

In this interview series called “Sleep: Why You Should Make Getting A Good Night’s Sleep A Major Priority In Your Life, And How You Can Make That Happen” we are talking to medical and wellness professionals, sleep specialists, and business leaders who sell sleep accessories to share insights from their knowledge and experience about how to make getting a good night’s sleep a priority in your life.

As part of this interview series, we had the pleasure to interview Mark Sullivan, MD. Dr. Sullivan is a board-certified Internal Medicine physician dedicated to holistic patient care, currently practicing at North Virginia Family Practice in Arlington, Virginia. He emphasizes building trusting relationships to empower patients towards optimal health, focusing on preventive medicine and managing acute and chronic illnesses. Dr. Sullivan earned his BA from the University of Notre Dame and his MD from the University of Rochester, with additional training in clinical ethics and Latino health. He completed his residency at Stony Brook University Hospital and holds a Master’s in Medical Humanities, Compassionate Care, and Bioethics.

Thank you so much for doing this with us! Before we dig in, our readers would like to ‘get to know you’. Can you tell us a bit about your background and your backstory?

Thank you for the opportunity to share with you my background as a person and medical professional and important practical advice regarding good sleep habits.

I am a husband, father, and physician. I view these as interrelated vocations that inform my care of others and my well-being.

Regarding health advice, I try to “practice what I preach” recognizing that many of my views on what constitutes health, and the good life are based on the writing, research, and personal advice that was shared by close mentors, teachers, and medical professionals who came before me.

I received my Bachelor of Arts degree in Political Science and Pre-professional studies from the University of Notre Dame. I spent a semester in London and worked in the British Parliament. I also learned about healthcare systems in Latin America through work at the Pan American Health Organization in D.C. and Andean Health & Development in Ecuador (more on this below).

I earned my medical degree at the University of Rochester School of Medicine and Dentistry where I also completed pathway programs in clinical ethics and Latino health. I pursued my Internal Medicine residency at Stony Brook University Hospital where I served on the faculty and was involved in the education of residents and students. I have a Master of Arts degree in Medical Humanities, Compassionate Care, and Bioethics from Stony Brook University. I also have additional training in cardiovascular medicine.

Can you share a story with us about what brought you to this particular career path?

Three experiences solidified my “calling” to pursue a profession in medicine:

1. As a young child, I would round with my father, a thoracic surgeon, on the weekends. As I peered from the hospital room doors, I witnessed the special relationship that was formed between my father and his patients after surgery and his approach to motivating their recovery, often with his characteristic dry sense of humor.
2. My senior year of high school, I had the opportunity to attend a White Coat Ceremony. This special event marks the beginning of medical school when students take their oath to their profession. Headlining this special event was Dr. Edmund Pellegrino, a revered figure recognized internationally as one of the most prolific and passionate spokespersons on clinical ethics and the medical profession who later became an influential mentor and friend in my professional development while working with him in medical school during a fellowship.
3. With a deep interest in health policy and comparative politics, I worked with Dr. David Gaus, the founder of Andean Health and Development in rural Ecuador. An alumnus of my University, Dr. Gaus found his unique calling to the medical profession after working in finance when he decided to volunteer in an orphanage in rural Ecuador. He returned to Notre Dame to pursue his premedical studies and, with the help of former University president Rev. Theodore Hesburgh, founded Andean Health and Development that has provided a proven, sustainable model to deliver quality health care services to those most in need for over two decades. During my experience, we had the opportunity to conduct “home visits” in rural villages, and witnessing the relationship forged between patients and doctors was inspirational.

Can you share with our readers a bit about why you are an authority in the sleep and wellness fields? In your opinion, what is your unique contribution to the world of wellness?

My expertise in counseling patients regarding sleep stems from my experience and approach.

I focus on understanding my patients’ ideas of health and happiness. This understanding is gained through a trusting relationship that allows the patient to feel comfortable sharing with me their unique joys, hopes, fears, and anxieties, which often lead to interruptions in sleep.

I often give my patients ‘homework assignments’ that I believe are foundational to achieving one’s goals as they relate to health and happiness. The homework assignments become an instrument to empower one to participate in one’s care. These assignments usually begin with a focus on the following four areas: good sleep, good nutrition, good exercise or physical activity, and good work-life balance.

I use concepts validated by medical science and my personal experience of helping patients with the aforementioned foundational aspects of well-being. In time, these homework assignments turn into personal habits, and these habits turn into the basis of health and happiness, all suspended by a trusting relationship of care and empowerment.

Is there a particular book that made a significant impact on you? Can you share a story or explain why it resonated with you so much?

I am an avid reader and enjoy reading print and online media on various topics, including medical history, philosophy, health policy, and global affairs.

The book that most influenced my approach to medical care is For the Patient’s Good: The Restoration of Beneficence in Health Care by Edmund D. Pellegrino and David C. Thomasma.

The authors maintain that to be guided by beneficence, a healthcare professional must perform a right and good healing action that is consistent with the individual patient’s values. To act in the patient’s best interests or the patient’s good, the patient and physician must discern what that good is. This is gained only through a dialogue between patient and physician that respects and honors the patient’s self-understanding of what constitutes health and fulfillment.

Do you have a favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life or your work?

I think quotations and mantras serve as powerful tools to guide our habits and understanding of the good life.

Yesterday, I attended a virtual Grand Rounds from a current resident from my former internal medicine residency program who was presenting on “Cultivating Compassion in Medicine: A Toolkit for Medical Students to Improve Self-Kindness and Enhance Clinical Care.” Her presentation reminded me of a quotation by President George Washington often shared by my residency program director and was a guiding mantra in our work within a complex medical system:

“Labor to keep alive in your breast that little spark of celestial fire called conscience.”

A quotation by C.S. Lewis that will be important for our ensuing discussion of sleep is as follows:

“Many things — such as loving, going to sleep, or behaving unaffectedly — are done worst when we try hardest to do them.”

Ok, thank you for all that. Now let’s move to the main focus of our interview. Let’s start with the basics. How much sleep should an adult get? Is there a difference between people who are young, middle-aged, or elderly?

Sleep requirements rely on both time and quality of sleep. Consensus recommendations of the American Academy of Sleep Medicine and Sleep Research Society specify that adults aged 18–60 years should sleep seven or more hours per night regularly. The National Sleep Foundation recommends seven to nine hours for adults aged 18–64 and seven to eight hours for those 65 years of age and older.

Is the amount of hours the main criteria, or the time that you go to bed? For example, if there was a hypothetical choice between getting to bed at 10PM and getting up at 4AM, for a total of 6 hours, or going to bed at 2AM and getting up at 10AM for a total of 8 hours, is one a better choice for your health? Can you explain?

It is important to understand that while the amount of time is most important, certain scenarios may require a patient to achieve longer amounts of sleep. Quality sleep should be refreshing with minimal awakenings during the sleep period and minimize inadequate sleep-induced fatigue, tiredness, irritability, and cognitive difficulties. A thoughtful patient history and evaluation can reveal clues to different sleep disorders (e.g., chronic insomnia, sleep apnea, restless leg syndrome).

As an expert, this might be obvious to you, but I think it would be instructive to articulate this for our readers. Let’s imagine a hypothetical 35-year-old adult who was not getting enough sleep. After working diligently at it for 6 months he or she began to sleep well and got the requisite hours of sleep. How will this person’s life improve? Can you help articulate some of the benefits this person will see after starting to get enough sleep? Can you explain?

In the short term, adequate and quality sleep informs good mental health, cognition, memory, physical health, and even immune function. In the long term, this good sleep can lower the risk of several adverse health outcomes, including cardiovascular disease, immunosuppression, diabetes, dementia, obesity, and even all-cause mortality.

Many things provide benefits but they aren’t necessarily a priority. Should we make getting a good night’s sleep a major priority in our life? Can you explain what you mean?

I introduced above some of the ‘homework assignments’ that I prescribe to patients as I support their journey to health and happiness. These assignments usually begin with a focus on the following four areas: good sleep, good nutrition, good exercise or physical activity, and good work-life balance. If asked which of these pillars of health is most fundamental, I will respond with good sleep without reservation. Adequate, quality sleep helps inform good nutrition that fuels regular physical activity and gives us the energy to create professional boundaries that help create balance in life.

The truth is that most of us know that it’s important to get better sleep. But while we know it intellectually, it’s often difficult to put it into practice and make it a part of our daily habits. In your opinion what are the 3 main blockages that prevent us from taking the information that we all know, and integrating it into our lives? How should we remove those obstacles?

I think what prevents us from achieving our desire to sleep well can be whittled down to one obstacle, best exemplified by the C.S. Lewis quote above. Namely, sleep should not be a chore or something we fixate on achieving, but rather a natural process derived from creating a subconscious routine and an environment that fosters this essential bodily function.

Do you think getting “good sleep” is more difficult today than it was in the past?

Some dependence on electronics leads to the inhibition of good sleep when used late in the evenings. To counter this, we should create a bedtime routine that begins a couple of hours before it is time to sleep and includes winding down, like dimming the light and avoiding the blue light of electronics to promote natural melatonin rise.

Ok. Here is the main question of our discussion. Can you please share “5 things you need to know to get the sleep you need and wake up refreshed and energized”? If you can, kindly share a story or example for each.

1. Set a regular sleep schedule with consistent bedtime and waking time, even on weekends.
2. Avoid the use of stimulants such as caffeine after noon.
3. Modify your sleeping environment to minimize disturbances. This includes a comfortably cool, dark room, with minimal exposure to external noise.
4. Form a relaxing image that helps prevent intrusive thoughts. The image should be positive, oriented towards gratitude, and can be related to a pleasant previous or future desired experience. This form of meditation allows us to quiet the mind and be satisfied with the good we have accomplished in our day so we may welcome the next day refreshed and rejuvenated.
5. Practice progressive relaxation of muscle groups from head to toe if needed to relieve muscle tension. While this relaxation technique can be guided through a recording, I recommend taking a few gentle inhalations and exhalations while tensing muscle groups from the upper neck, down as you breathe. Hold the tension as you breathe in and release it as you breathe out while noticing how relaxed each muscle group feels.

What would you advise someone who wakes up in the middle of the night and can’t fall back to sleep?

Minimize the amount of time spent in bed not sleeping. If you cannot sleep do not look at the clock. Get up and go to another room to do something relaxing until you feel sleepy enough to return to sleep. This may include reading a book, drawing, listening to peaceful music, or practicing progressive muscle relaxation as above.

What are your thoughts about taking a nap during the day? Is that a good idea, or can it affect the ability to sleep well at night?

I believe in a concept called “sleep debt” that has been researched and elaborated by Dr. William Dement and Dr. Seigi Nishino at Stanford Sleep and Circadian Neurobiology Lab. In their work, these experts have found that individuals who are sleepy during the day or who easily fall asleep when lacking stimulation have accumulated “sleep debt,” and this occurs when we don’t receive the recommended seven to nine hours as mentioned above. According to these investigators, accumulated sleep debt should be paid back, and adding a small amount of sleep to your regular nightly schedule or even through short naps in the late morning or early afternoon can lead to more energy, focus, and a restored sense of well-being.

Wonderful. We are nearly done. Is there a person in the world, or in the US, with whom you would like to have a private breakfast or lunch, and why? He or she might just see this, especially if we tag them. 🙂

I would love to share time with many thought leaders in medicine and health policy. Today, however, what would be most meaningful is sharing a private breakfast or lunch with some of my elementary school and secondary school teachers who greatly impacted me from a young age. It would be a round table focused on gratitude and learning more about the people behind the teaching.

How can our readers further follow your work online?

You can read my blogs at https://nvafamilypractice.com/nvfp-media/.

This was very meaningful, thank you so much. We wish you only continued success on your great work!