Caitlin Whyte (Host): What's keeping you up at night? Well, we're about to find out. This is Check-Up Chat with EvergreenHealth. And today, we're joined by Dr. Yoon Hee Chang, physician at EvergreenHealth Sleep Disorders Care, to help discuss what kind of sleep disorders can keep you awake. Well, first off, thank you so much for joining us today, Dr. Chang.

Dr. Yoon Hee Chang: Thank you so much for having me.

Host: Now, before we jump in, can you define what a healthy night's sleep really consists of?

Dr. Yoon Hee Chang: Yes, absolutely. So, healthy sleep involves getting enough uninterrupted sleep on a regular basis. So, on average, sleep cycle lasts about 90 minutes and each cycle contains four individual stages, three that form non-REM sleep and one rapid eye movement, which is REM sleep. Ideally, you need four to six cycles of sleep every 24 hours to feel rested and fresh.

The recommended sleep duration varies by age and person. But generally, adults should get between seven and nine hours of sleep per night. For children between ages six and 12, nine hours of sleep is normal. As you get older, you need less sleep, so a healthy 80-year-old will usually sleep about 6 hours at night. And sleep continuity is also important so that you can cycle through all sleep stages. So when your sleep is constantly interrupted, you might have trouble waking up in the morning even if you spent enough hours in bed. And you can tell if you're getting good sleep by how you feel when you wake up and feel during the day. If you feel and look well-rested, feel clear-headed, and have enough energy to get you through the day, you probably got enough sleep.

Host: Gotcha. Now, without getting into sleep disorders, since we'll have plenty of time to discuss those later, what are some common reasons that someone may not be able to fall asleep?

Dr. Yoon Hee Chang: So, some of the common reasons that keep people awake include stress, obviously, worries about work, family, school, finances, it can be very hard to fall asleep when you're thinking about them. Irregular sleep schedule can disrupt your ability to sleep because it adversely affects your circadian rhythm. So, circadian rhythm is your body's internal clock that regulates your sleep-wake cycle, metabolism, and temperature, and it's programmed by environmental cues and light. So, going to bed and waking up at different times can confuse your internal clock and not getting enough natural sunlight during the day can lead to poor sleep.

Also, unhealthy habits and routines related to lifestyle can affect your ability to fall asleep. Like, keeping your brain stimulated until late in the evening, like looking at your computer, playing video games, being on electronic devices can disrupt sleep. Napping late in the afternoon can throw off your sleep timing as well, and using your bed for activities besides sleep can create mental association between your bed and wakefulness, not sleep. Substances like caffeine, like in coffee, green tea, black tea, or chocolate, or nicotine can affect your sleep. Alcohol is a sedative that can make you sleepy, but actually worsens your sleep by disrupting your sleep cycle. And it can cause sleep fragmentation. Certain food that's too spicy or fatty can disrupt your sleep quality. And most importantly, or not the least, the bedroom environment that's not conducive to sleep, so such as room that's hot or too cold or if it's too noisy or the bed is uncomfortable, then that can lead to poor sleep as well.

Host: Well, a lot to consider there. Thank you so much, doctor. Well, Now that we know some of the lifestyle reasons that someone may not be able to fall asleep, let's get into the medical reasons. What are some common sleep disorders that could cause lack of sleep?

Dr. Yoon Hee Chang: So, there are various sleep disorders, such as obstructive sleep apnea. This is a condition that causes repetitive lapses in your breathing during sleep. So, this in turn causes frequent sleep interruptions. It's been associated with various health conditions such as high blood pressure, coronary artery disease, poor memory and cognition, and daytime sleepiness, which could in turn increase your risk of having car accidents. And it's a very common condition that's affecting one in three middle-aged men and one in six middle-aged women, which means that you probably know somebody who has sleep apnea.

Chronic insomnia is another common condition. It's affecting about 30% of general population. When you have insomnia, you have trouble falling asleep and/or staying asleep and you feel the impact of poor sleep the following day.

Another common sleep disorder that affects sleep is restless leg syndrome. So, this is a condition that causes uncomfortable sensation and urge to move your legs when you try to fall asleep. And it's linked to pregnancy, iron deficiency, Parkinson's disease, to name a few conditions, but many times the cause is unknown.

Many people might not realize that circadian rhythm disorder also can disrupt your ability to sleep. So, if you're a night owl, then falling asleep at night might be difficult. And on the flip side, if you're a morning lark, then staying asleep in the morning can be very difficult. And there are conditions like parasomnia or abnormal sleep behaviors such as nightmare disorder or dream enactment, those can interrupt sleep as well.

Host: Are any of these disorders that you mentioned treatable?

Dr. Yoon Hee Chang: Yes, absolutely. There are ways to treat many of these conditions. So for example, sleep apnea can be treated with positive pressure devices such as CPAP, but many patients worry about using CPAP. So because of that, there are also non-CPAP treatment options, dental devices, tongue stimulators, surgery or implantable device. Also insomnia can be treated with cognitive behavioral therapy as well as medication in certain cases. And there are pharmacologic therapy or medications to treat restless legs. And also, there are ways to treat circadian rhythm disorders as well. So of course, it's important to follow a healthy lifestyle and good habits for these treatments to be effective. So, getting ample sunlight during the day, following healthy diet and exercising regularly really helps to improve sleep quality. And if you suspect that you have these conditions, you can always make an appointment to see your primary care doctor, and they will refer you to our sleep disorders clinics where we'll evaluate and diagnose and help treat your conditions.

Host: Beautiful. Well, that was my last question. If someone is concerned that they may have a sleep disorder, what should they do? Is there anything else besides contacting your office?

Dr. Yoon Hee Chang: Yes. So, there are websites that can they check out, such as Sleep Foundation. They have a excellent website outlining healthy sleep habits. But if they feel that they try following healthy lifestyle, regular sleep schedule, exercising regularly, but, they are still having disrupted quality of sleep, then come and see us and we'll get you back to sleeping soundly.

Host: Wonderful. Well, thank you so much for your time and for this important information doctor. I just know that we helped a lot of people today. EvergreenHealth Sleep Services handles all varieties of sleep disorders from common insomnia to the more complex, all with the goal of getting people rested and back to functioning at a normal level. To learn more and make your appointment, visit evergreenhealth.com/sleep. This has been checkup chat with EvergreenHealth. Thank you for listening.