Scott Webb (Host): Many of us are tired, and if you're tired of being tired and want to know why you have trouble falling or staying asleep, or what else might be affecting your quality and length of sleep, my guest today can definitely help. I'm joined today by Dr. Callum Dupre. He's the Medical Director of Capital Health's Center for Sleep Medicine.

 This is the Health Headlines podcast series from Capital Health. I'm Scott Webb. Doctor it's nice to have you here today. We're going to talk about sleep disorders and how you diagnose, how you treat, and I know lots of folks don't get the sleep they want. Don't get the sleep they desire, and maybe they have legitimate sleep disorders. So it's great to have you here. Great to have your expertise.

Let's just start there, like what is considered a sleep disorder and how common are they?

Callum Dupre, DO: Sleep deprivation, whether we're talking deprivation of quantity, just not getting enough sleep or quality, sleep disorders that throw off and make the sleep not as restful as it should. It's an epidemic. It's incredibly common, affects more than 50 million Americans. So yeah, I'd it's common.

Host: Yeah, it's very common. There's a lot of sleepy folks in the world, uh, you know, and some maybe they do it to themselves. I like to fall asleep with the TV on, which I blame my mom for because she said I wouldn't go to sleep without some sort of noise on as a baby. But others may have legitimate, you know, sleep disorders. So let's dive into that, like what are the most common sleep disorders that you see in your practice?

Callum Dupre, DO: Well, so the most common that people think of when they think of sleep disorders are sleep apnea and insomnia. Sleep apnea is a condition where people repetitively pause in their breathing during their sleep, and they generally do start again, but that pause in breathing, as you would expect, is not without health consequences and certainly results in substantial sleep disruption. Insomnia is incredibly common, whether it's difficulty falling asleep, difficulty staying asleep, waking up, and just not getting back to sleep. So those two are the stereotypical sleep disorders and some of the most common we see. Along for the ride, we get restless leg syndrome. And all the fun stuff like narcolepsy and all the abnormal behaviors, these complex motor behaviors that people can do in their sleep, like driving, cooking, eating, walking, talking.

Host: Yeah, I, I see what you mean. Yeah. There's a whole litany there. And some may be more serious to someone's health than others, and some may be easier to fix, so to speak, than others. What are the common symptoms? Is it just, we wake up in the morning and we just don't feel rested? We feel tired? Like, how does someone know, Hey, you know what? I'm probably not sleeping well. I should probably go see somebody about this.

Callum Dupre, DO: Absolutely. Yeah. So daytime sleepiness, just waking up and not feeling like you benefited from the sleep that you received, is an incredibly common sign that, yeah, I, I should probably get this checked out. On top of that, anybody who's regularly experiencing difficulty falling asleep, staying asleep, struggling and waking, feeling less rested than they should, should get checked out.

Interestingly enough, there are gender discrepancies in the way that sleepiness presents. Men tend to be more classically sleepy, you know, falling asleep in the chair and all that in the afternoon, whereas women tend to be more fatigued like in their sleepiness, and so much so that there are fairly impressive statistics about how much later in life and at worse severities women tend to be diagnosed with sleep disorders than men just because of the difference in the way they present.

Host: Interesting. Yeah. So you're saying there's some gender differences and we went through a whole list of things that may be affecting folks getting to sleep, staying asleep, all of that. So then how do you diagnose a sleep disorder? Is it just like always a sleep study? Is that the, the gold standard?

Callum Dupre, DO: Sometimes. It really depends on what we're looking for. So if we're talking about, you know, more run of the mill insomnia, so that would be your difficulty falling asleep, staying asleep, et cetera. Sometimes sleep logs, sleep diaries that we ask the people to keep, can be very helpful. There are conditions where sleep testing is warranted.

It's not necessarily a full in-lab sleep study at this point. Home testing has had some pretty major advancements over the last decade or so, and so, you know, often first if someone is concerned about, you know, if I go in and see somebody, am I going to have to go and sleep in an unfamiliar environment in a facility. These days, that's often not the case.

Host: Yeah. And in terms of treatment, uh, as you say, things have come so far, lots of advancements. So are we talking lifestyle based, medical, a combination? You know, how do you treat sleep disorders?

Callum Dupre, DO: So similarly, it really depends on what we're treating. Not every person is the same. Most people are different in some way. And so, you know, if we're treating someone for run-of-the-mill sleep apnea, CPAP, a machine that gives additional air, that they take in while they breathe in their sleep is often still the gold standard, but not everybody can tolerate that.

And for people who struggle with CPAP, there are a fair number of non CPAP alternatives now ranging from mouth pieces to positional devices, to implanted devices, electrical stimulators. Technology has really advanced pretty substantially. If we're treating insomnia on the other hand where those things wouldn't be so warranted there, it really depends on what the person's individual difficulties are.

Sometimes that requires medications, sometimes it requires sleep habits, changing the way we look at or think about sleep. So, you know, there's a wide range of options depending on what we're treating.

Host: Sure. Yeah. And you said that this is very much a sort of an epidemic, if you will, affecting millions and millions of men and women. So what about the untreated sleep disorders? I feel like a lot of people are out there just sleepy, always sleepy, always tired, kind of miserable, and probably don't do enough to help themselves.

How can that impact our health if we just sort of just plow on through, you know, and, just try to deal with this on our own?

Callum Dupre, DO: Sure. So there's a famous quote out there from a, a sleep research by the name of Dr. Rechtschaffen. " If sleep doesn't serve a major function, then it's the greatest mistake that evolution ever made." We spend about 30%, or we should spend about 30% of our life in sleep, if we're getting eight hours a night, which frankly, most of us don't.

And that's very true and sleep does serve fairly substantial functions depending on whether we're talking about just pure, insufficient quantity of sleep or disrupted sleep, stopping breathing during sleep. Some sleep apnea for instance, if untreated can substantially increase the risk of high blood pressure, can make it more likely someone can have a heart attack or stroke. Even just all cause sleep disruption, not getting enough sleep or poor quality of sleep, has been shown to impair immune function, it can change our sense of emotional wellbeing. I think we all would attest that when we're sleep deprived, our emotional armor is just nowhere near as thick.

Host: Emotional armor. I love that. I've never heard that term, but that's just so true. When we're tired, we tend to be irritable and cranky and our armor is down, so to speak.

Callum Dupre, DO: We're just not our best selves.

Host: Yeah, absolutely. You know, I was reading through and, and preparing for this and I came across sleep hygiene and I was like, I think I know what that is. But let me ask an expert, what does that mean and what are some tips you have for improving it?

Callum Dupre, DO: Sure. So sleep hygiene, encompasses all of the things, whether we're talking about habits, strategies, schedules, et cetera, that we can do to put ourselves in the best position to be able to fall asleep and stay asleep. So, you know, that's things like establishing a consistent routine, going to bed at a consistent time, waking up at a consistent time, allowing sufficient hours to actually sleep enough, eliminating bad habits.

So things like limiting two of the most common drugs in the world out there. Caffeine and alcohol. It's incredibly common that people come in and say, oh, I can have a cup of coffee and go to sleep just fine. Answer is maybe, but that sleep is not going to be as, as restful.

It's going to be more disrupted. Things like eliminating napping during the day, cutting out clock watching, laying in bed, just saying, ah, you know, it's, if I could get to bed now, I'll at least get four hours of sleep. But the idea of putting that timer just puts that additional stress of, oh, I need to fall asleep at that time, which ends up being self-defeating.

So sleep hygiene is just that, the whole range of things that we can do to set ourselves up to be in a good position, to be able to fall asleep and stay asleep.

Host: Yeah, I feel like our phones should be on that list. You know, caffeine, alcohol, phones, you know, so many times I fall asleep with my phone in my hand, and then I end up dropping it on the floor next to the bed. I feel like, you know, we're engaging our brains, when we're staring at those phones and then we try to close our eyes and just go to sleep. I feel like our phones are one of the culprits as well.

Callum Dupre, DO: Incredibly sleep disruptive. A hundred percent.

Host: Yeah, I like to bust myths, if you will, when I host a podcast, Doctor. So are there any misconceptions about sleep or sleep disorders that you often encounter?

Callum Dupre, DO: Yeah, so one of my favorites, or I suppose my least favorite, if you will, is that six hours is enough. You know, often I ask patients how much sleep do you get on a regular nightly basis? And you know, people understand that, hey, I should probably be aiming for seven to eight hours, but, you know, sometimes they say it's six, approaching seven or seven meaning actually six and change. But there's this conception out there that six hours is enough. And while many of us truly do function on six hours of sleep, the emphasis there is on function. And you know, in order to function well and to be operating at our best, six hours just isn't enough.

Host: I want to talk about technology. We talked earlier about how things have come so far and whether it's, you know, in the sleep center or at home devices, trackers, you know, how has all this changed the way you, we understand and manage sleep health?

Callum Dupre, DO: So technology has absolutely overhauled the way people interact with their health and their sleep in general. I find that as wearable technologies, whether Fitbits or phone linked devices, become more common, that patients are more in touch with their health, and I find that it is making people more likely to investigate some of the things that they otherwise might have just assumed was normal or might just be something that they have to live with. Maybe they don't have to live with it. From a testing standpoint, technology has definitely changed the way that we evaluate patients. Home testing becomes much more common, and has done so over the past decade or so.

In terms of the way patients address insomnia, one of the most common interventions for insomnia is something called cognitive behavioral therapy, which aims to just reframe the way the person approaches the problem of not sleeping. And the way we look at sleep and computer-based online cognitive behavioral therapy has become incredibly common and is, is a great way for patients who are just too busy to go to sleep Psychologists that are the more conventional ways of addressing this.

Host: Sure. Yeah, it really does feel that like some sleep issues are related to sleep and how we sleep and getting to sleep and staying asleep and other things, as you say, there are things below the surface. Things may be in our brains, and more investigation, more time. And I just feel Doctor like there's a lot of folks suffering out there. We've identified, so many millions of Americans, men and women suffering and just not feeling good. And our armor's down and all this stuff we've talked about. So how do we get connected for diagnosis and treatment? Like how do we get to the diagnosis and treatment center, in other words?

Callum Dupre, DO: Absolutely. So if patients have decided that I'm done with being tired. I am tired of, I'm tired of muddling through. They should absolutely give us a call. The number at the office is 609-584-5150. Or even if they want to just talk to their primary care doctor and let them know, Hey, this is going on. Ring that bell. I'm sure they would be happy to help get them in touch.

Host: Yeah, that's exactly what I was thinking when you said that. If we get tired of being tired, right. There is help out there, there is help available. We just, uh, as you say, ring the bell. Just want to give you a chance here at the end, any practical advice or key takeaways for those of us looking to improve our sleep?

Callum Dupre, DO: The biggest takeaway I would have people leave this conversation with is that while many of us live our lives being tired or have been not sleeping well for decades; that doesn't necessarily need to be the norm. That doesn't have to be how life is.

Host: Yeah, that's perfect. I appreciate your time today, your expertise, just trying to understand this a little bit better. You got me thinking about my sleep hygiene and my habits, so appreciate that. Thanks so much.

Callum Dupre, DO: Yep. Thank you. Thank you for having me.

Scott Webb (Host): Visit sleep at capitalhealth.com for more information or call 609-584-5150 to schedule an appointment at Capital Health Center for Sleep Medicine.

And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for additional topics. This is The Health Headlines Podcast from Capital Health. I'm Scott Webb. Stay well.