Transcription:
A Good Night's Sleep

Melanie Cole (Host): If you sleep poorly or snore or are excessively sleepy during the day, you might have a sleep disorder. My guest today is Dr. Brijesh Malkani. He’s the Associate Director of Sleep Services at St. John’s Riverside Hospital. Dr. Malkani, how does somebody know, if they have a problem sleeping, what are some of the symptoms that they might be looking for? And is it usually their partner who spots some of these sleep disorders?

Dr. Brijesh Malkani (Guest): Absolutely, first of all thank you Melanie for having me on the show and it’s a pleasure to speak with you today. In terms of your question, we usually find that the bed partner is a very helpful historian, often times the patient themselves is trying to sleep at night or they should be, and it usually helps to have collateral history, as we call it, from the bed partner. Now what symptoms should we be looking for is a great question. There’s quite a few of them. There’s someone reporting that they’re having difficulty falling asleep or staying asleep. Oftentimes patients will tell us they’re not feeling well rested when they wake up or they feel tired when they wake up. One key sign to look for is if there is very loud snoring or breathing difficulty, sometimes the bed partner will indicate that they noticed that the person had some pauses in their breathing at nighttime. If someone describes being excessively drowsy and feeling that they need sleep during the daytime, that may be a surefire indicator that there may be something going on. Other things to look for include slow reaction time, difficulty concentrating, a desire to take naps during the day, so if someone has those types of symptoms, it may be helpful to get them evaluated.

Melanie: How many hours of sleep should we be getting, the average person, each night?

Dr. Malkani: Sleep is a very individual experience and there isn’t an exact number for everyone. The recommended range actually varies depending on age, and for pediatric population it can be upwards of 16, 18, 20 hours in a day, and often times for the geriatric population, that becomes much less. Some elderly patients sleep less than 6 hours a night. The Academy recommends typically around 8 hours a night but everybody is different. There are people that are short sleepers that sleep only 5 or 6 hours and are functional and then there’s those of us that are long sleepers and they need to sleep 9 or 10 hours in order to feel refreshed the next day.

Melanie: Why do so many people have a hard time sleeping at night in this day and age of white noise or white light or electronics and stress, and ever evolving we need to check our emails all the time – is that contributing to a lack of good quality sleep for people?

Dr. Malkani: You’re absolutely right. I think as a society certainly we have significant stimulation that happens, not just throughout the day, but at night, particularly devices that you eluded to, all your Blackberries and Apple products and any other kind of fruit you want to think about, they definitely add this stimulation and blue wave length light that is emitted from these devices in the iPads and iPhones nowadays, they actually have a night mode that can reduce that blue wave length and help you go to sleep easier. And as I mentioned, it is an individual experience and insomnia, which is what you’re alluding to, which is a difficulty falling asleep and staying asleep, can have a multitude of reasons. It can be from sleep hygiene, whether someone’s sticking to a good sleep schedule, if they’re avoiding caffeine late in the evening, avoiding TV screens, phones. One of the things that I like to tell my patients is if they do wake up in the middle of the night is to actually avoid looking at the clock. If they set their alarm for the morning, if they do wake up prior to that, don’t look at the clock because it’s just going to make them think more and more about it, so I would recommend not looking at the clock in the middle of the night if you wake up. Another thing is if you can’t shut down, if someone feels that they’re having difficulty winding down and worry about things at nighttime, then they may benefit from scheduling some worry time earlier in the day. So basically figure out a time early on where they can tackle some of the stressors that they’re thinking out, and that way later on at nighttime, it doesn’t creep up on them and they’ve already addressed it and it’s already been tucked away. So that’s a significant stressor that can cause someone to be having difficulty sleeping at night, but you also have to consider some of the more significant pathologies such as sleep apnea and sleep disorder breathing, which is very common. Often times it is undiagnosed and it’s untreated, and that may be what is keeping patients awake at night. So that typically will require a sleep study, and if someone has very loud snoring that might be an indicator, although snoring on its own does not mean you have sleep apnea. Another thing I would say is just to avoid alcohol. Although it can help people feel that it puts them to sleep, it can also wake them up in the middle of the night. Now I don’t mean one glass of wine, but I mean several glasses or drinking excessively can certainly wake you up in the middle of the night.

Melanie: What a great bit of advice about planning your worry time and stressors and such because it is such a problem for so many people, and now Dr. Malkani, the most important question I’m going to ask you today, are naps good or bad for your sleep? So many people, myself included, love naps. Are they good or bad for our good night’s sleep?

Dr. Malkani: Now that’s a great question and I would say my recommendation is to typically have sleep consolidated at nighttime to maintain a full 8 hours as much as you can. Now if someone takes a brief nap, 20 minutes, a “power nap” that can help and that can help recharge someone. I advise not doing it every day because what happens is then it becomes set within our system and that can become difficult on days when we can’t find that naptime or if we have other social obligations or occupational commitments. Now one thing I definitely recommend is avoiding napping more than an hour because more than one hour can impair your ability to sleep at nighttime.

Melanie: Okay, so we have to calm down our naps and not nap for too long. Now if somebody does come to see you, they’re having trouble sleeping, they’re sleepy in the day, maybe somebody says that they’re a loud snorer and they come to you, what do you expect if you go to a sleep specialist and tell us a little bit about a sleep study. Does anyone get a good night’s sleep there?

Dr. Malkani: Absolutely. A sleep study is a study that you would do overnight. We do them at St. John’s Riverside Hospital. There’s a series of wires that get connected and they can look at everything from your oxygen levels to your heart to your rhythm to your leg movements, breathing, and so it’s a fairly comprehensive evaluation and it can certainly tell us the diagnosis of sleep apnea and help us differentiate with what’s going on. If they see a sleep specialist, they should bring in a good history of what their problems are an if they have a bed partner or someone who has witnessed either choking or gasping and things like that, to mention that to the physician so they know what to look for. Things to be aware of are if they’re kicking at nighttime and periodic limb movements that may be causing them to be restless and stay awake as well. Having evaluation from a sleep physician and the consultation will then start that pathway to getting that sleep study, hopefully getting a diagnosis, and then getting the right treatment on board.

Melanie: So then tell us a little bit more about sleep apnea. Really, what is it and how does a sleep study diagnosis this and what are some of the treatment options?

Dr. Malkani: So sleep apnea is a condition that occurs when you sleep. So typically when we’re awake our airway is open, it’s what we call patent, but at nighttime, as your muscles relax and as your brain winds down, those muscles in your airway, they relax. They lose the pressure that they have and so they collapse on themselves. Now for some of us, that’s not an issue. It happens to everyone. It can be normal in many of us, but in some of us when that causes a blockage, we refer to it as an obstruction and obstructive sleep apnea is that blockage of air flowing through and it causing either dips in the oxygen at nighttime, which causes the heart to then work harder in order to deliver oxygen throughout the body or it can cause arousals in the brain, and when that occurs then that can lead to symptoms. For example, someone might wake up with a headache in the morning, or they might have congestion or dry mouth, and so when they get this sleep study if they find that this blockage is occurring throughout the night, they can diagnose that someone has sleep apnea and they can actually stratify it between mild, moderate, severe, and then there’s a treatment plan depending on that severity. If they’re mild to moderate often times they’ll refer to them for either an oral appliance or evaluation from a dental sleep specialist. If they’re in more moderate/severe range, then we may consider using CPAP which is a treatment device that I can tell you more about, and based on that, hopefully they find that not only do they sleep better, not only do they feel more energized and refreshed the next day, but they feel like they have a better quality of life overall.

Melanie: Tell us a little bit about CPAP. We don’t have a lot of time, but tell us what it is. We hear about it in the media, Dr. Malkani, and some people find it uncomfortable and adherence might be a problem. Tell us a little bit about CPAP and why you use it as one of the options for sleep apnea.

Dr. Malkani: So CPAP is – it stands for continuous positive airway pressure, and that’s just a lot of words to mean you’re getting an air supply going through your oropharynx, going through your throat, and that is meant to keep the airway open. As I mentioned before the airway collapses when we’re sleeping, particularly when we get into those deep stages of REM sleep when our muscles are the most relaxed. That’s when our sleep apnea can be at it’s worst, and so this device puts pressure and it puts air through that airway and it keeps it open so that you’re not having drops in your oxygen and those drops then aren’t causing your brain to wake up to try to open up the airway to try to get more oxygen, your heart’s not trying to work harder. Now you’re right, compliance is challenging and getting used to a mask and machine can be difficult, but I have found that a lot of patients actually find it very helpful, and many times, they find that their best sleep was actually with the CPAP when they came into he lab and had it treated that night for the first time with the machine. Everyone’s a little different but I do encourage patients to give it a try because it certainly is very effective and is found to have cardiovascular benefits of reducing stroke, diabetes, blood pressure, heart attack, so it’s well worth the effort.

Melanie: As you mention all those comorbidities as it would be for sleep apnea and sleep disorders we’re learning more and more, doctor, about the effects that a lack of good quality sleep can have on our bodies, wrap it up for us with a good summary and your best advice of sleep hygiene. What you really want people to know about getting a good night’s sleep and using good sleep habits before they go to bed every night.

Dr. Malkani: Sure, sleep hygiene in terms of setting a good sleep schedule, going to bed the same time every night, waking up the same time every day including on weekends, trying to get as close to that recommended 8 hours of sleep a night, avoiding caffeine, getting exercise during the day. I would avoid doing exercise late at night because that could be stimulatory, but getting moderate exercise 3 to 4 days a week has cardiovascular benefits. So if you can exercise early in the day, don’t drink any caffeine late at night, put away your electronic devices, have some wind down time. You know sleep isn’t always a switch that you just turn on and turn off; sometimes it’s like a dimmer and you need to dim it down slowly over the course of an hour, turn down the lights, get the room at a comfortable temperature, make sure that there’s nothing there that’s going to cause stress and anxiety, and sleep is certainly an experience that can be anxiety provoking to those of us that have insomnia, but if we think of sleep almost like a clock and try to have it the same every day and try to have it regimented, certainly it can become more streamlined and it can become less erratic and that can be very helpful. If that doesn’t work, then certainly see a sleep specialist, do have a sleep study done, have it fully evaluated, and then you can go from there.

Melanie: Thank you so much Dr. Malkani for joining us today, sharing your expertise on this topic that is so important for our overall health but also that so many people suffer from sleep disorders and they may not even realize it, so thank you for explaining it all so well for us today. You’re listening to Riverside Radio Healthcast. For more information, please visit riversidehealth.org, that’s riversidehealth.org. This is Melanie Cole, thanks so much for listening.