Transcription:

Bill Klaproth (Host):  According to the American Sleep Association, between 50 and 70 million people in the United States have a sleep disorder. Yeah, I said it. Fifty to seventy million people. And studies have shown how the impact of sleep or should I say lack thereof can negatively effect your body including heart health and cognitive function. But there is help. It’s called a sleep study and a sleep study can help you diagnose your sleep problem. So, let’s learn more about that and how to get good quality refreshing sleep with Dr. Talene Churukian. She is a Medical Director at Eisenhower Sleep Center and knows very well how people are impacted by disrupted sleep and lack of sleep. Dr. Churukian, thank you for your time. So, first off, how much does an adult need when it comes to sleep?

Talene Churukian, DO, MPH (Guest):  So, the quick answer to that question is seven to eight hours but there’s more to it than just telling someone to sleep seven hours a night and they really need to understand why that’s important and the risks of not getting enough sleep as sleep deprivation can have a ripple effect in many ways. So, the CDC had recognized sleep deprivation as a public health epidemic back in 2012. There was some data that had spanned over about three decades through census information where they identified that Americans were reporting sleeping less than six hours and that that number had doubled over those years from 38 million to 70 million individuals.

Host:  So, what do those stats mean for us?

Dr. Churukian:  So, why does this matter? Some statistics that may get the point across are for example, 250,000 drivers fall asleep at the wheel each day. And that driving drowsy can cause a crash every 25 seconds, an injury every minute, and a fatality every 70 minutes. So, with that information, the CDC had put together a national Healthy Sleep Awareness Project and had put a task force together with some experts from notable organizations such as the American Academy of Sleep Medicine and the Sleep research Society to come up with a consensus as to how many hours adults should be sleeping.

Host:  Okay. And you said seven to eight hours is what we are looking for.

Dr. Churukian:  Correct.

Host:  So, we need to pay attention to our sleep. So, I hear about sleep hygiene a lot which is supposed to help us get more quality, more refreshing, better sleep. So, what is sleep hygiene?

Dr. Churukian:  So, we like to use the term sleep hygiene as a way to educate individuals on what behaviors or habits they have that may be interfering with their ability to get enough sleep or good quality sleep. So, some examples could be, especially nowadays with the advancement in technology, people tend to spend a lot of time on their electronic devices. They may be sitting in bed with their Smart phone and essentially, that bright light mimics the sunlight and then that has ramifications on your ability to feel drowsy, to fall asleep and to stay in the deep sleep.

Host:  Right. So, sleep hygiene is kind of best practices to get the best night’s sleep you can.

Dr. Churukian:  Right. And there’s some other examples may be keeping a regular schedule in terms of your bedtime, wake up time, exercising regularly, eating a balanced diet, not eating close to bedtime, refraining from stimulants like nicotine and caffeine close to bedtime, alcohol as well even though not a stimulant can affect your quality of sleep. So, things of that sort are considered as sleep hygiene habits.

Host:  Right. So, that makes sense. So, get into those good habits like you just said. Go to bed kind of at a set time everyday and wake up as well. So get on a regular schedule. Make sure you are exercising. Make sure you are not eating close to bedtime. Avoid stimulants. Avoid alcohol again close to bedtime. So, those are all really good points to make. So, are some people at more of a risk to having a sleep disorder than others then?

Dr. Churukian:  Really anyone can experience a sleep complaint or sleep disorder at some point in their life and sleep disorders in general, can span anywhere across the lifespan from neonates all the way to someone who is 80 years or older.

Host:  Yeah, that’s really interesting. So, it can happen to younger individuals as well as older individuals. So, then what are some of the symptoms we should be watching out for? We hear a lot about sleep apnea, so I’m going to ask you about the symptoms of sleep apnea. But are there general symptoms of sleep deprivation or symptoms that show that we are not getting quality sleep that we should know about?

Dr. Churukian:  So, with sleep apnea, it is quite a prevalent disorder. They think that one in five adults easily has mild sleep apnea and one in 15 has moderate to severe. But many times, individuals may be completely asymptomatic and not aware or that they may be somewhat resilient to the symptoms. But basically, some of the typical symptoms that some people may be aware of or hear about are loud snoring, a bed partner noticing that the person may appear to stop breathing or gasping in their sleep.

Host:  So, Dr. Churukian, let me ask you this. If someone does have sleep apnea, what treatments are available?

Dr. Churukian:  Well Bill, the answer to that question is a bit complicated. Treatments really depend on the severity of the sleep apnea and possibly coexisting medical conditions that may sway your provider to recommend one treatment over another. But in general, most people are familiar with hearing about CPAP which is continuous positive airway pressure and we typically recommend that in patients who have at least moderate sleep apnea or possibly mild if they have other concerning medical conditions.

So, CPAP is essentially where positive pressure is helping to keep the airway open so that when you have effort to breathe that you are getting a good breath in and out and adequate oxygen. But not everyone can tolerate the CPAP whether it has to do with the mask or just the therapy itself. So, if someone is a candidate for an alternative treatment; the next most recommended nonsurgical approach would be an oral appliance and that is where you typically go to a dentist and you have a custom fit appliance that essentially is bringing the bottom jaw forward to open up the airspace in the back of your throat.

Host:  Okay, so that’s CPAP and the oral appliance. What about surgery? Is that generally for severe cases?

Dr. Churukian:   Usually more so with mild cases where they can do some procedures to kind of similar to the oral appliance in a sense to open up the airspace in the back of the throat. The surgeries may essentially minimize the uvula or the soft palate. Sometimes they even do procedures to decrease the thickness of the tongue in the back of the throat. But these surgeries sometimes eventually the sleep apnea can creep back in. So, it may not be a cure all for the rest of the person’s life.

Host:  And what about some newer procedures that we may not know about?

Dr. Churukian:  If someone is not able to tolerate CPAP, they could see about a device that’s almost like a pacemaker for the heart, but this is basically a pacemaker for breathing. The general description for it is what’s called a hypoglossal nerve stimulator. And this device is implanted under the chest wall similar to like a pacemaker and it has two wires. One wire that senses when you’re breathing in and breathing out and another wire that goes to the nerves in your neck that controls the tongue. And the interesting part is that you have an external remote that you can turn the device on and off. So, when you are going to go to sleep at night; you hold it up to your chest wall where the implant is and you basically turn it on and then as you are sleeping and as it senses each time that you are breathing in; it sends that impulse to the nerves that causes your tongue to move forward so that you basically have a nice open airway to get a good breath.

Host:  So, good to know there are other options besides the CPAP when it comes to treating your sleep apnea. Now when it comes to diagnosing a sleep disorder, there is something called a sleep study where you stay overnight, and they hook you up with electrodes on your scalp and over your body where they study your sleep while you are sleeping overnight. Can you tell us more about a sleep study?

Dr. Churukian:  So, you come in and most sleep labs likely would have you fill out some paperwork in the beginning. They typically want to know information about your sleep habits and what medications you are taking and other possible medical conditions that you have. So, that may take a little time there and then essentially, again in most labs, you typically have your own private room where you will be taken back by the technician. And so, as you mentioned, yes, you will usually be hooked up to electrodes on your scalp which monitor your brain waves so that we can see if the person is awake, asleep, what stage of sleep they go into. We monitor the heartrate and rhythm. We monitor the breathing, oxygen level, eye movements, body position. We look for limb movements and obviously with the breathing, we are also looking at the oxygen.

Host:  So, the test is very thorough. How do I know this? Because I’ve had one done and it goes a long way to diagnosing a sleep disorder and then helping with the subsequent treatment plan. So, somebody may be wondering well how do I get this done. How can I have a sleep test? So, do you have to have a referral from your primary physician first?

Dr. Churukian:  Yes, Bill. So, someone cannot just request to do a sleep study and go in and schedule themselves. They do require that their provider put the order in and that most insurances do require an authorization to get approval for doing the test. But in terms of possibly seeing a sleep specialist for a consultation for evaluation and whether or not they may need a sleep study; most insurances don’t necessarily require a referral for that.

Host:  Okay, good distinction. I’m glad you explained that to us and then does the patient’s primary care physician help the patient take action on the results of the sleep study? Sine I have experience in this, I would just tell you I kept meeting with my sleep specialist before the test and after the test. Is that normally the case?

Dr. Churukian:  There are different scenarios. It really depends on the comfort level of the provider who has put the order in for the sleep study. Sometimes they may place the order and then also put in a consultation at the same time for the patient to then establish care and follow up on the results and discuss what’s going on. Some providers, primary care doctors feel very comfortable in dealing with sleep disorders and interpreting the results and what to do and they can manage for example, sleep apnea and manage someone’s care with CPAP whereas some other physicians may not be as comfortable and so then they may refer to a specialist.

Host:  Well this has been a really good discussion about sleep and getting good quality sleep and what you can do if you are not getting good quality sleep. Dr. Churukian, thank you for your time. That’s Talene Churukian, the Medical Director at the Eisenhower Sleep Center and for more information about the Eisenhower Sleep Center please call 760-773-1411, that’s 760-773-1411. Get the good quality, refreshing sleep you need, call that number. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Living Well with Eisenhower Health. I’m Bill Klaproth. Thanks for listening.