Transcription:
Common Sleep Problems

Melanie Cole, MS (Host): I'm a sleeper, and I’ll admit it. I'm a napper. It’s my dirty little secret, but I am somebody who values every second of sleep that I get. Not everybody is as lucky as I am, and not everybody can sleep very well. Here to tell us about sleep disorders is my guest Dr. Sandford Auerbach. He’s the director of the sleep disorder center at Boston Medical Center, and an associate professor of neurology, psychiatry, and behavioral neurosciences at Boston University School of Medicine. Dr. Auerbach, let’s just jump right into the new sleep lab at BMC. Tell us all about it.

Sanford H. Auerbach, MD (Guest): Well, we’re actually all very excited about it. We just had the opportunity to move our lab into this beautiful new facility on [inaudible] building. It’s a comprehensive sleep lab. 12 beds. We operate seven nights a week. So we’re quite busy there. We do everything. We see people at night there. We do sleep studies on all sorts of patients. We do all sorts of sleep studies for all sorts of specific types of problems. We see pediatrics, we see adults. When it’s appropriate, we also do some home sleep testing. We also have a variety of other tests that we do according to the needs of the particular patient. We have a full staff of clinicians who are involved in the sleep program as well. Not just from neurology and medicine and pulmonary medicine and pediatrics. We have surgeons who are very intimately involved in our sleep disorder center as well. So it’s quite a busy place.

Host: What are some of the most common sleep disorders that you see? If it’s quite a busy place, there must be a lot of people in the country today that are suffering from some sort of sleep disorder. Doctor, what do you see most often?

Dr. Auerbach: Probably the two sorts of problems that we see the most of. One of them is patients who have insomnia. People who have difficulties falling asleep, staying asleep, waking up too early. Just having non-restorative sleep. So we certainly see lots of patients with that problem. The other kind of problem we see are patients who really do need sleep studies because they have sleep disordered breathing. That is when they go to sleep at night, very often these people are loud snorers, but not necessarily. When they go to sleep at night, their breathing is irregular. They pause in their breathing. At the end of the night, they may think they’ve slept well, but they're not as refreshed as they should be. They feel tired during the day often times. They're also at greater risk for all sorts of other medical problems. So it’s a very important disorder that we can treat. So it’s very important that we identify that. 

Host: There are so many reasons, as I was saying and as you just pointed out, that people suffer from sleep disorders. We’re learning more and more, doctor, about the link between a lack of sleep and obesity and diabetes and heart disease and all of these other things. If you could tell people one most important bit of information about the effects of good quality sleep on our overall health, what would you tell them?

Dr. Auerbach: Sleep deprivation is bad. I say that somewhat facetiously in that there have actually been many, many studies to really define that. You’ve already hinted at some of them. These things are, it’s all pervasive. People who don’t sleep well certainly don’t function as well during the day. They’re not as sharp. Their memory is not quite as good. They’re not as clear in their thinking. They become more irritable, and they have more difficulty with interactions with others. There’s even more difficulties than just that. We know that these people are at increased risk for developing all sorts of medical problems. Difficulties with high blood pressure. They have difficulties with other kinds of vascular difficulties. People come into the hospital for other reasons like stroke. You’d be shocked at least 50 to 70% of them have sleep apnea and disruptions in the quality of their sleep.

Host: Wow.

Dr. Auerbach: So we’re very actively trying to develop programs to address those needs. There’s more than just that. These people are at an increased risk of developing—There’s plenty of studies showing that later in life, elderly people are at greater risk of developing cognitive impairments. Perhaps an even greater risk of Alzheimer’s disease and similar types of disorders without proper sleep. So sleep is critical. Not just for day to day function, but long term health.

Again, we see all these sorts of problems in our clinic when patients come in. It’s not the sleep complaint, per se, that drives them into our sleep clinic, but rather the identification of these other medical issues. We’ve talked so far about insomnia, we’ve talked about sleep related breathing problems, but we see other sorts of problems. We see things like restless leg syndrome. We see where people have nightmare disorders.

We see people who actually have developed a very curious kind of problem, usually when they're older, where they actually will act out their dreams. Which is concerning because normally when people dream, we’re paralyzed. We really don’t move much. Yet, here’s a group of people who have developed this dream enactment and they start acting out their dreams. Which, by itself, one could see they may be curious or interesting. Certainly with some safety concerns for the patient and the bed partner. But it turns out that these people are at significant risk for developing other kinds of neurological problems over the years. So all of those are very, very important different reasons to identify these problems.

What’s interesting too is that most of the sleep patients that we see, we can often times see very affective in helping them. 

Host: Wow. That is really interesting information, especially the people that act out their dreams. I would be so curious to be able to record my dreams. Tell us a little bit—We don’t have a lot of time. Doctor, there’s so much information on sleep disorders that we could go over, but what is a sleep study like? Can people really even get a decent night sleep there? Are they nervous? What is it even like for somebody?

Dr. Auerbach: Well, part of the trick is making sure we select the right patients to have these studies done. So the type of patients—In fact, often times we’ll see many, many patients where we do not get a sleep study done because we can go ahead based on information from the patient and examination and other sorts of tests that we may get that it’s often times not necessary to get an overnight sleep study. Some people do. If there’s any suspicions, for instance, of a sleep disordered breathing problem, then indeed a sleep study’s important. We see people whose sleep quality is pretty good. Yet, they need excessive amounts of sleep to function. There are disorders, one of which is called narcolepsy and other similar types of disorders. We will also do sleep studies to examine their sleep. Again, the types of treatments are very different.

On the other hand, we will often times see people who, after we examine them and talk to them, they seem to have a pattern of what we would call insomnia. Those people, oftentimes, we may not necessarily need to get a standard overnight sleep study on. Sometimes we may do other kinds of testing, but not necessarily the typical study that will bring them into the lab at night. So, again, it’s a matter of looking through this information and also picking and choosing our patients. So if somebody comes to me and they have trouble falling asleep and staying asleep, and after going over with them I think it’s more of a typical sort of insomnia pattern, I may not be inclined to bring them in for a sleep study. I don’t really want to initially have them come to our sleep lab and watch them not sleep all night. So we do place some effort in trying to properly pick and chose the patients that come to the lab.

It’s rare that we’ll have somebody come to the sleep lab, spend the night, and we won't be able to get information from that study. We know it’s not exactly the same thing as sleeping at home, but we also know how to balance out those effects. So it’s rare we have to repeat a study just because we didn’t get enough information.

Host: So that’s so interesting. Sleep studies, to me, are so interesting. As we wrap up, Dr. Auerbach, tell us your best advice. There is a new field now we’re hearing about. It’s called sleep hygiene. People want to know what it is you would like us to do whether it’s melatonin or the white noise or the lights and our phones and the electronics and the stress. There’s so many things now that come in the way of a good quality night sleep. Give us your very best information. What you would like us to know about the fact that a good night’s sleep, it’s not a luxury, it’s a necessity. So give us your best advice.

Dr. Auerbach: Well, I think that it’s back to basics. I think that’s what sleep hygiene is all about. Back to basics. It’s important that each of us establish some sort of regular sleep cycle. You can cheat a little bit here or there from time to time, but pretty much have a regular pattern of sleep. When you're gonna go to bed, when you're gonna wake up each day. Make sure that you allow enough time to get enough sleep. Very often with everybody’s busy day and busy days now, people don’t even allow themselves enough time to sleep properly. Make sure that you have a proper sleep environment. Make sure that there are no excessive distractions. For most people, a slightly cool environment is best if you have access to it. It should be relatively quite and free of distractions. Free of distractions because we want you to be able to relax. It has to be a time of the night or time of the day when you can just separate yourself from the rest of the world.

Of course, there’s always these things that come up which are somewhat controversial. For instance, should a person read in bed? Now for some people, and I have to confess like me, if I read in bed, usually I get maybe a paragraph done and I'm out. Other people though may read in bed and then stay up all night until they finish the book. So it’s a matter of designing this environment for yourself. It has to be free of things that are going to be distracting to you. It has to be something that will allow you to relax. Same thing goes for television or any other distractions. It has to be a relaxing environment. It’s not place for your desktop computer. It’s not place even for your iPhone to be or your other smartphone to be. It should be free of those kinds of distractions. 

There are other things that you can do to prepare your body for this. Regular exercise is very helpful for maintaining good quality sleep. Be careful of the things that we eat and drink. The two factors that we find that were most difficult to deal with with our patients. One of which is caffeine. People develop these caffeine habits. Caffeine can vary a lot from individual to individual in terms how potent it may be and also how long the effects may last. So for some people, it may last a very long time. People as they get older lose sight of the fact that you metabolize these things differently. So you may have been able to have an espresso after dinner when you were young, but now you get older you have to be careful because it may have a much more stimulating effect. So caffeine is a big issue. For some people, they have to really limit their caffeine consumption. They also have to be careful of the fact that it will change as they get older.

Alcohol is the other culprit. Alcohol is somewhat misleading and deceptive in some ways because for most people, alcohol in the evening can be very relaxing and help you actually fall asleep. The problem is is that after a few hours, most people are susceptible to this rebound effect. So the second half of the night is not that great. It’s more disruptive. So at the end of it all, the matter of fact is it’s not necessarily a positive effect. So one has to be careful about caffeine and alcohol among other things. Those are the basic elements that go into what’s called sleep hygiene. Again, it’s being careful with the environment, the setting, the timing of sleep. Things we eat, drink, and exercise.

The final thing is, of course, which goes into this is taking stock of the other medical issues that are ongoing. Make sure that those are properly addressed. Back pain, other kinds of pain problems will interfere with your sleep and will need to be properly addressed. We want to make sure that the medications you're taking, some medications may actually be stimulating and make it difficult. Should be shifted from taking them in the evening and should be taken in the morning. So there are a variety of things that the patient can address with their primary care physician about how to manage those features. 

Host: Wow. It’s great information. What a great segment. So usable and important, this information that you’ve given us today doctor. Thank you for sharing your expertise on something that so many people suffer from. Whether they recognize it in themselves of their loved ones, push them and say, “Stop it already. Let’s get in and see someone.” It’s really great information. This is Boston Medtalks with Boston Medical Center. For more information on the new sleep lab at Boston Medical Center, you can go to bmc.org. That’s bmc.org. This is Melanie Cole. Thanks for tuning in.