If you're among the 70 million Americans who suffer from a sleep disorder, it's important to know that an inability to get quality sleep not only impacts how you feel every day but also can seriously affect your overall health. Those who consistently have problems sleeping are at greater risk for heart attack, stroke, diabetes, obesity, driving accidents and other conditions.
In this very important podcast, Arun Agarwal, MD, Medical Director, SLCH Center for Sleep Medicine, Fishkill, discusses the importance of a good nights sleep and the steps you can take to assure that you get that restful, restorative sleep that you need.
The Importance of a Really Good Nights Sleep
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Learn more about Arun Agarwal, MD
Arun Agarwal, MD
Dr. Arun Agarwal is the Medical Director of the St. Luke’s Cornwall Center for Sleep Medicine location in Fishkill, NY, which opened in 2017. He specializes in sleep medicine, pulmonology, critical care medicine, and internal medicine. He is board certified in all four categories. Dr. Agarwal has been a member of the Hudson Valley community since 1990 after completing his fellowship in pulmonary and critical care at New York Medical College. He completed his residency at Lincoln Hospital in the Bronx, and received his medical training at All India Institute of Medical Science in New Delhi.Learn more about Arun Agarwal, MD
Transcription:
The Importance of a Really Good Nights Sleep
Melanie Cole: We've all been hearing more and more about how a good night’s sleep is even more important for our health than ever before. My guest today is Dr. Arun Agarwal. He’s the medical director of St. Luke’s Cornwall Hospital Center for sleep medicine, Fishkill. Welcome to the show. Have you been seeing that people are getting a lower quality of sleep or less sleep whether it’s because of electronics or work or white light, whatever it is, is that what you're seeing now?
Dr. Arun Agarwal, MD, fCcP, FAASM: Yes. Unfortunately, it’s rampant at this time.
Melanie: What do you think are some of the main reasons? I mentioned electronics and our minds are working 24/7 so it’s hard to relax and clear our minds so we can fall asleep. What do you see are the major problems causing this?
Dr. Agarwal: It’s all you mentioned. It’s their modern life. We have information being sent to us at all times 24/7 through our devices. We’re always connected and disconnecting ourselves is what is needed, but in addition to that, I think we also work very hard. We work too much for too many hours. We just don’t devote enough time to sleep.
Melanie: What other risk factors would contribute to sleep disorders? If someone maybe has sleep apnea or insomnia or any one of these other disorders that are out there, what are some of the causes of those?
Dr. Agarwal: Sleep apnea is really a dysfunction where we don't understand why it affects some people. The upper airway muscles just excessively collapse. What we do know is people who are overweight have it more, people who drink a lot have it more, people who smoke have it more, people who have structural abnormalities of the upper airway have it more, certain people with thyroid or parathyroid disorders have it more. There are many causes of sleep apnea, not just one.
Melanie: I'd like to actually start with sleep hygiene and then we can get into a few sleep studies and treatments for sleep apnea and such. If you were to recommend at the beginning of this podcast your best advice about good sleep hygiene, getting our room ready, clearing our minds and the devices, what do you recommend to everybody to get that good night's sleep to at least start to try and get that good night's sleep?
Dr. Agarwal: A few things. First of all, make up your mind to sleep at least seven or eight hours a night. Second, regular timing is important. One does not have to be very rigid about it, but there's a sleeping time in your head and a waking up time in your head, and for most people, it would be from nine to ten p.m. and count eight hours to five or six a.m. The sleep environment needs to be very conducive to sleep, so no stimulation and absence of devices. I would highly recommend you don’t have access to a clock. The room should be quite dark and people who have difficulty sleeping or have light sleep, they really need heavy shades to keep the lights out. It should be quiet, I would prefer no animals in bed to wake you up, and it also should be cool. The right temperature is about 58 to 70 degrees, not higher than that. Lower than that by a degree or two actually works for people, but not higher than that. In addition to that, one needs to avoid both mental and physical stimulation prior to sleep for three to four hours. That includes exercise, coffee, stimulating stuff, and of course, one has to lead one’s life. I'm not asking people to become a saint, but for the most part, the evening time is relaxation time. I think this would cover about 90% to 95% or even 98% of sleep hygiene requirements and would work for most people. For the remaining 1% or 2% who have really poor sleep, there are additional things that may be required, but that would be specific to that person’s problem.
Melanie: What an awesome description of what we should be doing at night and the temperature being so specific. That is so excellent and great information. If they do have trouble falling asleep and tuning out and shutting down a bit, they try some of the things that are over the counter like melatonin. What do you tell them about those kinds of products – chamomile, melatonin and such?
Dr. Agarwal: These have never really been scientifically evaluated. I would hasten to add though that pharmaceuticals have been evaluated and they are useful in certain people who have difficulty falling asleep due to an illness. It generally does not apply to healthy people. Chamomile really has absolutely no studies to suggest that there are sleep-inducing qualities. What I would suggest to tune one's self out is relaxation, whether one just does it mentally by themselves or using meditation or relaxation techniques is another matter, but they do work. By the way, these are now freely available and for free via apps on smartphones. I just ask people not to use a smartphone device in the bed, but if you're using it for relaxation, you can always plan it that way that you use this device for 10 minutes and then shut it off.
Melanie: Now onto some sleep disorders and diagnosis. Is somebody is noticing they're very tired all day or maybe their partner is the one noticing that they snore or that they have apnea, tell us about how you diagnose a sleep disorder?
Dr. Agarwal: The first thing is to sit down with the person and ask questions and examine them. One of the main questions is if the daytime quality of alertness affected by poor sleep at night. If the answer to that question is no, meaning the daytime is fine, I generally ask the folks not to consider themselves for the sleep disorder, but generally the answer is yes, in which one has to see if the nocturnal sleep is affected either by their poor habits of poor sleep hygiene or by illness. Some of the common ones are sleep apnea, restless leg syndrome, painful conditions, one needs to entertain the possibility of medical disorders affecting sleep like heart failure or asthma. Some people have neurological disorders like Parkinson’s or even dementia. Those are sometimes very hard to fix. Some people have just simple anxiety and depression affecting night sleep. Some people are actually on medications that they're taking for other illnesses that is destroying nighttime sleep. Sitting down with the person and asking questions is really a focused analysis of whether the daytime problem is being caused by poor sleep at night and then delving deeper into what may be the possible causes. If the answer is sleep disorders like sleep apnea or restless leg, there are some other non-rare disorders and therein you need to some diagnostic studies and that is where I send them to the sleep lab to sleep overnight to collect psychological data to see what exactly is affecting their night sleep.
Melanie: Wrap it up for us. Tell us a little bit about the St. Luke’s Cornwall Hospital Center for Sleep Medicine, what people can expect, who should come there and your best advice about getting that good quality night’s sleep.
Dr. Agarwal: The sleep center is a full-fledged and accredited sleep center. It provides services to anybody and everybody with any kind of sleep disorder. It usually starts with a consultation with your physician, and as I said, after the interview process, one decides if one needs a sleep study in which case the person is referred to the sleep center by the physician. The sleep center takes care of making sure the study is covered by insurance, they make sure the person who has to come in knows the instructions and such. Generally, people who come in at nine o'clock in the evening, they should expect one hour to get used to the sleep lab and more importantly to get the electrodes put on which will be the monitoring electrodes. There are no needles involved. All the person really needs to do is go to sleep. Believe me when I say this – everybody goes to sleep well. It's a single room, attached bathrooms, we generally wake up folks at about five or six in the morning, there's a light breakfast and most people usually go to work or they could, of course, go home. It takes about a week to get the study results back. They're sent to the physician who ordered the study and the patient is encouraged to discuss the results with the physician.
I’ll say it three times: number one is sleep hygiene, number two is sleep hygiene, and number three is sleep hygiene. If one still has poor sleep, I think one needs a sleep evaluation. It’s fairly easy to do as long as you go to a person who’s interested in these disorders and about 10% or 15% of the time you need to come to the sleep lab to get properly diagnosed.
Melanie: Thank you so much. It’s really great information and so important for listeners to hear. This is Doc Talk presented by St. Luke’s Cornwall Hospital. For more information, please visit stlukescornwallhospital.org. That’s stlukescornwallhospital.org. I'm Melanie Cole. Thanks for tuning in.
The Importance of a Really Good Nights Sleep
Melanie Cole: We've all been hearing more and more about how a good night’s sleep is even more important for our health than ever before. My guest today is Dr. Arun Agarwal. He’s the medical director of St. Luke’s Cornwall Hospital Center for sleep medicine, Fishkill. Welcome to the show. Have you been seeing that people are getting a lower quality of sleep or less sleep whether it’s because of electronics or work or white light, whatever it is, is that what you're seeing now?
Dr. Arun Agarwal, MD, fCcP, FAASM: Yes. Unfortunately, it’s rampant at this time.
Melanie: What do you think are some of the main reasons? I mentioned electronics and our minds are working 24/7 so it’s hard to relax and clear our minds so we can fall asleep. What do you see are the major problems causing this?
Dr. Agarwal: It’s all you mentioned. It’s their modern life. We have information being sent to us at all times 24/7 through our devices. We’re always connected and disconnecting ourselves is what is needed, but in addition to that, I think we also work very hard. We work too much for too many hours. We just don’t devote enough time to sleep.
Melanie: What other risk factors would contribute to sleep disorders? If someone maybe has sleep apnea or insomnia or any one of these other disorders that are out there, what are some of the causes of those?
Dr. Agarwal: Sleep apnea is really a dysfunction where we don't understand why it affects some people. The upper airway muscles just excessively collapse. What we do know is people who are overweight have it more, people who drink a lot have it more, people who smoke have it more, people who have structural abnormalities of the upper airway have it more, certain people with thyroid or parathyroid disorders have it more. There are many causes of sleep apnea, not just one.
Melanie: I'd like to actually start with sleep hygiene and then we can get into a few sleep studies and treatments for sleep apnea and such. If you were to recommend at the beginning of this podcast your best advice about good sleep hygiene, getting our room ready, clearing our minds and the devices, what do you recommend to everybody to get that good night's sleep to at least start to try and get that good night's sleep?
Dr. Agarwal: A few things. First of all, make up your mind to sleep at least seven or eight hours a night. Second, regular timing is important. One does not have to be very rigid about it, but there's a sleeping time in your head and a waking up time in your head, and for most people, it would be from nine to ten p.m. and count eight hours to five or six a.m. The sleep environment needs to be very conducive to sleep, so no stimulation and absence of devices. I would highly recommend you don’t have access to a clock. The room should be quite dark and people who have difficulty sleeping or have light sleep, they really need heavy shades to keep the lights out. It should be quiet, I would prefer no animals in bed to wake you up, and it also should be cool. The right temperature is about 58 to 70 degrees, not higher than that. Lower than that by a degree or two actually works for people, but not higher than that. In addition to that, one needs to avoid both mental and physical stimulation prior to sleep for three to four hours. That includes exercise, coffee, stimulating stuff, and of course, one has to lead one’s life. I'm not asking people to become a saint, but for the most part, the evening time is relaxation time. I think this would cover about 90% to 95% or even 98% of sleep hygiene requirements and would work for most people. For the remaining 1% or 2% who have really poor sleep, there are additional things that may be required, but that would be specific to that person’s problem.
Melanie: What an awesome description of what we should be doing at night and the temperature being so specific. That is so excellent and great information. If they do have trouble falling asleep and tuning out and shutting down a bit, they try some of the things that are over the counter like melatonin. What do you tell them about those kinds of products – chamomile, melatonin and such?
Dr. Agarwal: These have never really been scientifically evaluated. I would hasten to add though that pharmaceuticals have been evaluated and they are useful in certain people who have difficulty falling asleep due to an illness. It generally does not apply to healthy people. Chamomile really has absolutely no studies to suggest that there are sleep-inducing qualities. What I would suggest to tune one's self out is relaxation, whether one just does it mentally by themselves or using meditation or relaxation techniques is another matter, but they do work. By the way, these are now freely available and for free via apps on smartphones. I just ask people not to use a smartphone device in the bed, but if you're using it for relaxation, you can always plan it that way that you use this device for 10 minutes and then shut it off.
Melanie: Now onto some sleep disorders and diagnosis. Is somebody is noticing they're very tired all day or maybe their partner is the one noticing that they snore or that they have apnea, tell us about how you diagnose a sleep disorder?
Dr. Agarwal: The first thing is to sit down with the person and ask questions and examine them. One of the main questions is if the daytime quality of alertness affected by poor sleep at night. If the answer to that question is no, meaning the daytime is fine, I generally ask the folks not to consider themselves for the sleep disorder, but generally the answer is yes, in which one has to see if the nocturnal sleep is affected either by their poor habits of poor sleep hygiene or by illness. Some of the common ones are sleep apnea, restless leg syndrome, painful conditions, one needs to entertain the possibility of medical disorders affecting sleep like heart failure or asthma. Some people have neurological disorders like Parkinson’s or even dementia. Those are sometimes very hard to fix. Some people have just simple anxiety and depression affecting night sleep. Some people are actually on medications that they're taking for other illnesses that is destroying nighttime sleep. Sitting down with the person and asking questions is really a focused analysis of whether the daytime problem is being caused by poor sleep at night and then delving deeper into what may be the possible causes. If the answer is sleep disorders like sleep apnea or restless leg, there are some other non-rare disorders and therein you need to some diagnostic studies and that is where I send them to the sleep lab to sleep overnight to collect psychological data to see what exactly is affecting their night sleep.
Melanie: Wrap it up for us. Tell us a little bit about the St. Luke’s Cornwall Hospital Center for Sleep Medicine, what people can expect, who should come there and your best advice about getting that good quality night’s sleep.
Dr. Agarwal: The sleep center is a full-fledged and accredited sleep center. It provides services to anybody and everybody with any kind of sleep disorder. It usually starts with a consultation with your physician, and as I said, after the interview process, one decides if one needs a sleep study in which case the person is referred to the sleep center by the physician. The sleep center takes care of making sure the study is covered by insurance, they make sure the person who has to come in knows the instructions and such. Generally, people who come in at nine o'clock in the evening, they should expect one hour to get used to the sleep lab and more importantly to get the electrodes put on which will be the monitoring electrodes. There are no needles involved. All the person really needs to do is go to sleep. Believe me when I say this – everybody goes to sleep well. It's a single room, attached bathrooms, we generally wake up folks at about five or six in the morning, there's a light breakfast and most people usually go to work or they could, of course, go home. It takes about a week to get the study results back. They're sent to the physician who ordered the study and the patient is encouraged to discuss the results with the physician.
I’ll say it three times: number one is sleep hygiene, number two is sleep hygiene, and number three is sleep hygiene. If one still has poor sleep, I think one needs a sleep evaluation. It’s fairly easy to do as long as you go to a person who’s interested in these disorders and about 10% or 15% of the time you need to come to the sleep lab to get properly diagnosed.
Melanie: Thank you so much. It’s really great information and so important for listeners to hear. This is Doc Talk presented by St. Luke’s Cornwall Hospital. For more information, please visit stlukescornwallhospital.org. That’s stlukescornwallhospital.org. I'm Melanie Cole. Thanks for tuning in.