Joey Wahler (Host): Do you get enough sleep at night? If not, how might that affect your health? How can it be assessed and what can be done to get you resting more productively?

This is Be Well with Skagit Regional Health, the podcast brought to you by Skagit Regional Health. Thanks for listening. I am Joey Wahler. Our guest, Dr. Nikhil Samtani, Sleep Medicine provider and Medical Director at the Skagit Valley Hospital Center for Sleep Disorders. Dr. Samtani, thanks for joining us.

Dr. Nikhil Samtani: Thanks for having me.

Joey Wahler (Host): So first, generally speaking, how exactly does sleep or lack thereof impact one's health?

Dr. Nikhil Samtani: Oh, in multiple ways, I would say because, if you just think about it from a big picture perspective, we spend about eight hours sleeping generally. So that's almost a third of our lives. If you have issues with that third of your life, it's going to spill out to so many different facets of what we do. Compared to a lot of other specialties that have had decades and decades of research, sleep is still a relatively new field. So every single year, we learn more about kind of the importance of sleep and how it impacts certain organ systems.

But just to understand what lack of sleep does to us, it's important to understand what is normally happening when we sleep. So when we think about what happens when we sleep a little bit, we go into these lighter stages of sleep. We go into a deep sleep. We go into REM sleep. Anyone with a sort of a Fitbit or a sleep tracker will have these familiar terms. But what our body generally does is it slows down, you know? So in our light stages of sleep, our heart rate slows and our breathing slows. In the deeper stages of sleep is when we have a lot of tissue repair and growth and sort of cell regeneration or immune system strengthens. REM sleep is kind of essential to memory, learning and creativity. So these are core functions that happen almost during a third of our life and not having enough time or poor sleep quality can spill out on so many different things, not just your overall health, but your mental health, your focus, and a bunch of other stuff as well.

Joey Wahler (Host): And health-wise, what would be a couple of examples of things that people might suffer from if they're not sleeping enough?

Dr. Nikhil Samtani: When we look at what we do in the sleep medicine world, we do sleep deprivation studies. So, once we understand the importance of sleep, let's just take it away and kind of see what happens. So most studies, what they find when we have sleep deprivation, which is defined as five or under hours of sleep, healthiest person on planet earth, no problems whatsoever, fit as a fiddle, just simply getting insufficient sleep is an independent risk factor for cardiovascular disease, for example. And again, going back to what our body does when we sleep, so it just kind of gives our body term to heal and recover. So cardiac health is a big one.

For me, I think the other two that I like to focus on are memory and focus as well. Sleep plays such a critical role in memory. And so there are these immensely complex processes that happen in our brain when we sleep that are still being studied. And it's thought that it takes almost 30 minutes of sleep to process for every hour that we're awake. It's easy to understand the idea that, if we don't sleep well on Monday night, for example, Tuesday is going to be bad. We've all been there. But what I find fascinating is if you don't get sleep on Monday night, it's not just Tuesday, but stuff that you learned on Sunday or the week before, that's also going to be affected because there are these memory processes like consolidation and recall that occur when we sleep. And not getting enough, certainly plays a role in that as well.

Joey Wahler (Host): Well, you mentioned REM sleep. And if I recall correctly from school, doc, that's rapid eye movement. What in a nutshell is REM sleep exactly?

Dr. Nikhil Samtani: I think REM gets the most press for that's where we dream, right? So this is when we all dream. So the reason why that does happen is because the activity in random eye movement sleep or REM sleep is just a little higher than when it is in deep sleep. So what essentially is happening at that time is a lot of important cognitive functions, such as memory consolidation, learning and creativity as well. So to prevent ourselves generally from acting out what we dream, it's also normal to have a drop in muscle tone so that we don't act out what we dream. So REM is a critical part of what we do when we're sleeping and it seems to happen every 90 minutes or so as part of the sleep cycle.

Joey Wahler (Host): So if someone has trouble sleeping, what are a few of the symptoms they should notice that would typically bring them to you for help?

Dr. Nikhil Samtani: That brings to a good point of when you're not getting enough sleep, how it can affect your judgment during the day. So I like to share this one study where you just have one sleepless night and it induces impairments in performance that is equivalent to those induced by a blood alcohol level of 0.10, which is beyond the legal limit. So like alcohol, sleep deprivation also affects your judgment. So it's hard to assess, but a lot of things can happen when you don't get enough sleep in terms of mental focus also during the next day,

Joey Wahler (Host): So one measure taken with those, having trouble sleeping is a sleep study. What exactly does that entail?

Dr. Nikhil Samtani: So there are different kinds of sleep studies. There are simple at-home sleep studies where you take a little device, you go home, sleep with it and return it the next day. You have these in-the-facility sleep studies where you come to your sleep lab, you spend the night over there. And it depends on what question we're asking, because the sleep studies at home mainly look at breathing. So if you're having snoring, sleep apnea type disorders, it's a good set of snippets into what's happening during that one night of sleep. But if you're looking at a little bit more, you know, where we look at sleep stages, we want to look at movements at night, we want to look at a little bit of the heart function, we get a lot more signals when we do it in the lab compared to when we do it at home. So depending on the question that your doctor is asking, an appropriate test might be recommended.

Joey Wahler (Host): Well, you mentioned sleep apnea. That's something that one might be suffering from causing that lack of sleep. Tell us for those unfamiliar, what exactly is sleep apnea?

Dr. Nikhil Samtani: So sleep apnea, at least in my mind, the way I like to think about it or explain it is sort of like a spectrum. There's this benign or harmless snoring where, you know, when the muscles relax when you're sleeping, it can cause some vibrations which result in the noise of snoring. But as long as you're still getting air and you're getting your oxygen, that's okay. We call that benign or harmless snoring. Maybe annoying people around you, but not necessarily harming yourself.

But now, if this snoring is causing these collapses of your airway, and as a result, you're having these dips and oxygen or your body is responding by releasing adrenaline, they're trying to wake you up, then it's not a benign thing anymore. And that's when you fall under this whole sleep apnea side of the spectrum. So short-term, it causes issues with sleep quality. You know, you don't get those sleep cycles that kind of we were talking about earlier, but long-term, you know, because of those dips and oxygen, it puts a strain on the heart, puts a strain on the brain and so many different organ systems. So it's not just a short-term set of hazards, but it's also a long-term health consequence. And hence, it's important to address.

Joey Wahler (Host): So typically doctor, when someone comes to you reporting a lack of sleep, what's the first step in assessing their situation?

Dr. Nikhil Samtani: Lack of sleep by definition is insomnia, right? So that's not getting enough sleep or having difficulty falling asleep or staying asleep. So mostly doctors, they kind of like to think of it as its primary problem? Insomnia can be a disorder by itself. Or is it something secondary that's causing it? You know, like an underlying sleep disorder, like restless legs or sleep apnea or mental health problems. So many different things can be contributing to your poor sleep quality.

So generally speaking, a good history is the first step. Just trying to evaluate what's causing the difficulties in sleep. And once we get to a little differential, then we can do appropriate testing to help narrow that down and pick the right problem. So it's kind of figuring out what's causing the difficulties in sleep in an individual patient, it's generally a good starting point.

Joey Wahler (Host): And speaking of what might be causing this, how much does diet impact sleep? Not just what we eat, but perhaps what we drink as well, like caffeine, right?

Dr. Nikhil Samtani: Caffeine plays such an enormous role in sleep quality. Most studies that have evaluated this, state that caffeine stays in your system for between 9 to 14 hours, so it's interesting. And so, the general consensus in the field is just to cut off the caffeine around noon, so it doesn't affect your ability to fall asleep at night. But I'll always get that patient, that tells me, "Doc, I'm immune to caffeine. I can have a soda or a cup of coffee and go to sleep. It doesn't affect my ability to fall asleep." And I always found that fascinating. And there are actually a few studies that have looked at that as well. And it's interesting that there are some patients, yes, that can fall asleep even with the caffeine. But with the caffeine in the system, it affects a lot of sleep fragmentation. And it inhibits those sleep cycles from occurring the way they should. So even though it might not affect the ability to fall asleep, it affects their ability to kind of stay asleep and have those critical functions occurring at night the way they're supposed to.

Joey Wahler (Host): A couple of other things, you mentioned that sleep medicine comparatively is relatively new in the medical world. What are one or two things that are happening now or that are sort of on the drawing board, so to speak, that you're most excited about that people such as yourself may know a lot more about to help people in the not too distant future?

Dr. Nikhil Samtani: I personally think that there's so much technological incorporation with sleep medicine, which I find fascinating. When you think about the common ways to treat disorders such as sleep apnea, it involves c-PAP therapy, which is sort of this breathing machine that blows air into you, but there are so many technological advancements that occur on a yearly basis. And we have these nerve stimulators now that are out in the market where you get a surgically implanted pacemaker that stimulates your airway muscles while you're sleeping to keep the airway open and prevent those sleep apnea disturbances from occurring.

So there's technological input in the field of sleep medicine, not just in terms of treatment, but also in terms of tracking. Every person I know has some sort of sleep tracker or some sort of fitness tracker that gives them information about sleep. So just understanding the data that we get and how that can help an individual patient. I think that's an amazing thing to be a part of.

Joey Wahler (Host): So in summation here for those struggling to get good sleep, what's your main message or main takeaway that you want them to have?

Dr. Nikhil Samtani: With access to information so easily available, if you just do a simple Google search on good sleep habits, you'll find the most common ones like a regular bedtime or regular wake time and have a good sleeping environment, have a cool temperature, those kinds of things. But there are certain more nuances to these sorts of sleep hygiene as we refer to that I'd like to elaborate on, at least the ones that I see have the biggest bang for the buck in clinical practice. It sounds simple, but you know, using your bed only for sleep or sex is super important. Because like most things, we are creatures of habit and so is our brain. And the more time we spend in bed awake, not sleeping, your brain starts associating with the act of being awake with the act of being in bed. So breaking that habit is very important and seems to have big impact in someone's ability to fall asleep.

We alluded to the caffeine bit earlier as well, which plays such a big role. And electronics, we all hear press about not using electronics before bedtime. So just elaborating on that a little might help too, because most electronic devices, they have lights. And light corresponds to different wavelengths and corresponds to different colors. And we see that the one corresponding to the color blue seems to suppress melatonin, which is a naturally present sleep hormone in our body. And that's why you get a lot of these devices with blue light filters to kind of decrease that suppression. So just staying away from electronics, using your bed mainly for sleep and sex and just following good sleep practices like we alluded to earlier are just good starting points.

Joey Wahler (Host): So limit what you're doing in bed, particularly the use of the phone, and perhaps you'll get more quality sleep, right?

Dr. Nikhil Samtani: That's the goal.

Joey Wahler (Host): Excellent. I had never thought of a few of those final thoughts. I appreciate that. So, folks, we hope you now know more about sleep issues and how they're addressed. Dr. Nikhil Samtani, thanks so much again.

Dr. Nikhil Samtani: Of course. Happy to be here.

Joey Wahler (Host): And for more information, please visit SkagitRegionalHealth.org. That's SkagitRegionalHealth.org. if you found this podcast helpful, please do share it on your social media. And thanks again for listening to Be Well with Skagit Regional Health. Hoping your health is good health, I'm Joey Wahler.