Carl Maronich (Host): Welcome to the Arbor Health and Life Podcast. I'm Carl Maronich. And joining me today is Dr. Victoria Acosta, a Family and Sleep Medicine physician from Arbor Health. And we'll be talking today about understanding sleep disorders. Dr. Acosta, welcome to the podcast.

Dr. Victoria Acosta: Thank you so much for having me.

Host: And I hope nobody naps during this, because it's going to be some very helpful information, I know. And maybe we should start by talking about what are the most common sleep disorders and how that might impact somebody's overall health.

Dr. Victoria Acosta: Absolutely. There are a lot of things that can go wrong with sleep, starting with simple insomnia, just not being able to sleep. There's sleep apnea. Both obstructive and central sleep apnea are common issues that I deal with in the sleep clinic. There's also restless leg syndrome or periodic limb movement disorder, which is another name for that. Or there's other types of parasomnias like talking in sleep or walking in sleep. Those are probably the most common ones I deal with. There are lots more. But if you want to talk about those, we can have an appointment at the sleep clinic.

Host: Sure. Yeah. Well, sleep apnea, that's probably, like you said, maybe the most common thing. And what are the symptoms that somebody might have that might alert them that they could have apnea as an issue?

Dr. Victoria Acosta: Sure. Snoring is probably the number one thing that people tell me that they have. That is a big risk factor or red flag symptom for sleep apnea. Snoring, feeling sleepy during the day, feeling like you sleep all night long, but then you're tired and you just don't feel like you're rested at night. Morning headaches can be a red flag symptom of obstructive sleep apnea. Those are kind of the most common symptoms that I see are associated with obstructive sleep apnea.

Host: Yeah. And we'll talk a little bit about of the options folks might have. But let's start with perhaps lifestyle changes. Are there effective lifestyle changes that folks can make that might help them with apnea or other sleep issues?

Dr. Victoria Acosta: Absolutely. Weight is a big factor in sleep apnea. So, losing weight if you're overweight. The neck, the size of your neck is a factor, and so that's not necessarily something that you can change on purpose, but weight contributes to that. The things that you do in your life day to day, so exercise is a factor that can decrease your risk for sleep apnea. The things that you eat and drink. So, alcohol use, other sedating medications can sometimes contribute to obstructive sleep apnea. There are some risk factors that you can't really change, things like age and being a man. So, those are unfortunately not things that you can change, but they are risk factors. And so, knowing about them can be helpful when you're deciding whether or not to pursue that.

Host: Talk a little, if you would, about screen time and pre-bed screen time. You hear a lot about that and how that can have an impact on sleep.

Dr. Victoria Acosta: Yeah. So, screen time can affect your sleep mostly, because the light that is emitted from screens, whether that's your laptop, your phone, your TV, that actually sends a signal to your brain that it's not time to sleep. Your brain releases hormones that tell your body it's time to sleep, it's time to wind down. And those hormones are released based on a lot of different factors. But one of them is whether or not your body is sensing light, because that typically indicates daytime. And so if you're telling your body that it's daytime and you're stimulating your brain with screens, it doesn't release the hormones that tell your body it's time to wind down, time to get ready for sleep. And so, screen time can have a big effect. And so, that's why I'd recommend against TVs in the bedroom. Not having your phone in your bed. Trying to do something else that's relaxing before bed, like reading a book or doing some other hobby like knitting or having a cup of tea to kind of wind down, those are all things that might help your body prepare itself for sleep a little bit better.

Host: So really, it's not as much the activity, it's really that screen itself that's causing signal to the brain that's impacting. Oh, that's interesting. I hadn't heard it put that way before. A little bit about technology and how that can help serve folks with apnea. CPAP machines are something you hear pretty commonly about. Talk a little bit about that technology and how that can impact and help folks.

Dr. Victoria Acosta: Yeah. CPAPs are a huge deal, and they've been around for a long time. They've changed a lot in the years since they became an invention. And so, some people say, you know, "I never want to do a CPAP machine. They're loud and obnoxious and big and bulky." While they can make some noise, they've changed a lot and improved a lot over time. And most of my patients that kind of come to tolerate them won't go anywhere without them anymore. It can affect your life in a big way. Because if you think about sleep apnea, during sleep apnea, you're not really reaching deep levels of sleep because your brain is constantly waking up just enough to breathe. Your body is not able to breathe with obstructive sleep apnea. And so, your brain is constantly waking up just enough to tell your body to breathe. But with the CPAP machine, your body is able to continue to do the work of breathing uninterrupted throughout sleep. And so, you're able to reach those deep levels of sleep, and your brain is able to maintain normal oxygenation. And so, you're not constantly depriving your brain of oxygen so you're feeling more awake and alert and reaching deep levels of sleep that you wouldn't otherwise. While the CPAP can sometimes be a little bit of a challenge for some people to get used to, it's a big deal. And it's a huge game-changer for most people with sleep apnea. They don't want to go anywhere without it anymore.

Host: Yeah. You may run into on the internet other devices. I've seen, I've even tried some and some-- nothing usually effective. But are there other, besides CPAP devices, that can be helpful when it comes to sleep apnea?

Dr. Victoria Acosta: There are. And so, not even devices, sometimes simply not sleeping on your back. Some people with mild sleep apnea can avoid treatment with devices or other things just by simply not sleeping on your back. When you sleep on your back, the weight of gravity, the weight of your neck can cause your airway to kind of collapse. And so, if you're not sleeping on your back, that changes a little bit and doesn't make it as easy for that to happen. So, an inclined base of your bed or sleeping on your side, having a body pillow to help you maintain that position throughout the night.

There are some specialized mouth guards that can sometimes be helpful for sleep apnea, usually only mild sleep apnea. And they're usually not covered by insurance, and so that's sometimes a barrier for people. There are nose strips, those things that you can buy over-the-counter or mouth guards. I don't see those usually being effective for sleep apnea, but they're worth a try and sometimes they can help with snoring.

There's also the new implants that probably people have seen either on the internet or on TV, the implants that actually connect to the nerves that support your breathing during the night. And those, I don't personally oversee the treatment with those, but they are becoming more common. Usually, you just have to fail sleep apnea treatment with CPAP before your insurance would consider paying for those. And so, I usually see folks saying, "I want to try one of these implants." And, so, the first step is to try CPAP. And usually, people tolerate that pretty well, but there are other options. You just got to kind of figure out if your symptoms will tolerate that or not.

Host: Yeah. Is CPAP generally covered by insurance?

Dr. Victoria Acosta: Yes. Every insurance is different in terms of how much you might owe in a copay. But every insurance, I haven't come across an insurance yet that doesn't cover CPAP.

Host: No. Very good. You mentioned a little earlier weight and those issues. Maybe you could talk about diet and exercise and how they may be able to be used to help with apnea.

Dr. Victoria Acosta: Absolutely. Exercise is a big deal or activity in general. It kind of helps your body regulate the schedule that your brain knows when to sleep. So, you might've heard of something called a circadian rhythm. That's your body's internal clock, and it helps your brain know when to release the hormones that control sleep.

So, exercise plays a role in that, partly because it also produces hormones when you exercise. So, you probably heard that exercise creates endorphins. It also releases serotonin and it reduces cortisol, which is probably a well-known stress hormone. So, all of those hormone shifts that happen when you exercise kind of help prepare your body for sleep or tell your body that there is a cycle happening and so that they know that your body knows to produce that hormone or those hormones that produce sleep as well. So, exercise is a big deal. Also, if you're tired from exercising, you'll probably feel tired to go to sleep.

Diet is also a big deal. Eating healthy food can make you just feel better in general. Eating really heavy meals can sometimes make you feel like you can't sleep. And kind of back to the sedating medications or alcohol, marijuana, they can all make you feel like you want to fall asleep, but they actually interfere with the brain's chemistry of getting to deeper levels of sleep. So, that's why sometimes like if you've drank too much, and you go to sleep, you feel still really tired in the morning or that hangover, you know, the alcohol makes you feel tired, but it doesn't let you reach those deep levels of sleep.

And then, sedating medications, like if you take anything that makes you kind of drowsy, sometimes it can be helpful to get you to sleep, like medications that we use for sleep. But other medications can make you drowsy and they can still interfere with sleep. And so, trying to limit any medications that you don't need that would make you sleepy in that way.

Host: So, all sleep is not created equal, is kind of a takeaway there, right?

Dr. Victoria Acosta: That's very true.

Host: A little bit about over-the-counter sleep aids. Some folks particularly, I would guess, with insomnia may be prompted to try to use those. Are they helpful? Can they be helpful or what's the story with over-the-counter sleep aids?

Dr. Victoria Acosta: Yeah. There are a lot of over-the-counter sleep aids that can be helpful. I usually recommend over-the-counter sleep aids before a prescription sleep aid, mostly because the over-the-counter ones tend to be less habit-forming, meaning you don't get like addicted to them or need to have them in order to continue getting a good night of sleep.

Benadryl is a good example. It makes you kind of sleepy, but it's not one that you're going to get hooked on, in other words, one that you can take every night if you wish. There's melatonin, which is actually just the hormone that the brain releases when it's getting ready for sleep. And so, taking melatonin as a pill can be sort of a more natural way to help you get ready for sleep. That one typically you'll want to take about an hour before you want to go to bed, just because that's sort of the timeframe of those hormones that get released in the body. Other things like ZzzQuil or NyQuil or Tylenol PM, they all typically have sort of a Benadryl component or a Benadryl cousin component. And so, again, nothing really wrong with those if you're having a hard time sleeping or want to try something over-the-counter, I think those are usually my first go-to options.

Host: Yeah. Now, aside from medication, maybe we could talk a little about relaxation techniques or mindfulness practices that can potentially help with sleep. Is that an option?

Dr. Victoria Acosta: Absolutely. And I usually recommend that before medication, even over-the-counter medications. Sleep hygiene is what we call kind of the practices that we use around sleep, the things that we do to wind down and get ready for sleep. So, the first thing that I tell people is to have a sleep schedule. If you don't have a sleep schedule, I've said this a few times now, your body doesn't know when to release those hormones that tell your brain it's time to sleep. So, having a sleep schedule is going to help you most of all.

Relaxation techniques are a really great way to help your body wind down, without the use of screens or other things that might feel relaxing, but actually end up stimulating you. So, things like square breathing, you might have heard of that. So, taking a deep breath in, holding it, and then letting your breath out slowly and then holding it. So, usually, three or four seconds for each step, kind of a square breathing.

Other things are progressive muscle relaxation. So when you're laying in bed and you're worried about things or you're having trouble falling asleep and relaxing, starting at the top of your head and going all the way down to the bottom of your toes and thinking about each thing. Relaxing your forehead, relaxing your jaw, relaxing your neck, and then just keep going down your body. And then, hopefully, by the time you get to your toes, you're asleep.

Host: I won't try any of those now, because I might doze off while we're talking. And I don't want to do that.

Dr. Victoria Acosta: Exactly.

Host: So, it's kind of a not counting sheep, but there are other techniques.

Dr. Victoria Acosta: Yeah. There are a lot of ways to kind of get your body relaxed so that you're ready for sleep.

Host: Anything else you want to mention or make sure folks take away from the conversation about getting better sleep?

Dr. Victoria Acosta: Yeah. I think just trying to maintain healthy activity during the day and having a schedule. that's just the biggest thing. If you don't have a schedule, your body doesn't know what to do when. And having healthy activity throughout the day, whether that's 30 minutes of walking around the block with your dog or getting on the treadmill or going to the gym, having that activity really helps set up your body for sleep later on.

But if you have issues with sleep, there's probably a sleep doctor nearby that's willing to talk to you about those things more in more detail or figure out if there's something else more going on that requires treatment of some sort, whether that's CPAP or something else.

Host: Yeah. And to that point, if somebody is having some of these issues, should they start with their primary care provider and talk to them and then get referred on?

Dr. Victoria Acosta: Yep. Usually, that's the best place to start. Usually, it takes a referral to get seen at a specialty clinic, like a sleep clinic. So, their sleep doctor can talk to them about what symptoms maybe they're experiencing, and if those fit the diagnostic criteria of sleep apnea or maybe there's something else going on. But they can certainly suss out a few details and send a referral if it's appropriate.

Host: Very good, Dr. Victoria Acosta. A lot of great information, helpful information. Thank you for joining us today.

Dr. Victoria Acosta: Thank you for having me.

Host: You can find even more information at myarborhealth.org/sleep. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest. I'm Carl Maronich, and this is Arbor Health and Life. Thanks for listening.