Bill Klaproth (Host): There are different types of sleep disturbances including snoring, sleep apnea, narcolepsy, insomnia, sleep deprivation, and restless legs syndrome, among others. Getting a good night’s sleep is necessary for optimal health and living a quality life. Here to talk with us about sleep disturbances is Neal Lilly, a Physician’s Assistant at Tidelands Health. Neal, thanks for your time. What are the most common types of sleep disturbances you treat?

Neal Lilly (Guest): I see a great range of them, but probably one of the most common ones is obstructive sleep apnea.

Bill: And tell us, what exactly is that?

Neal: That is when you have an issue that may be causing you to stop breathing during the night, and if you’re not breathing during the night, it definitely does make it difficult for having a good night’s sleep.

Bill: And how do you know if that’s happening to you? Obviously, you’re sleeping. Is it totally up to your partner or will you notice this? Will you wake up? Will you wake up gasping for air feeling like you’re choking? What are the symptoms? How do you know?

Neal: Generally, what I do when I talk with the person that tells me that they’re usually tired throughout the day and that they also snore throughout the night. I have an acronym called STOP-BANG that I go by. The S stands for snoring, so if they individual is snoring, they get a point. The T will stand for being tired throughout the day. O is observed, meaning that someone has observed them to stop breathing while they’re sleeping. P will stand for blood pressure. Are you being treated for blood pressure? B is for BMI. Is your BMI greater than 35? Age is for the A, and that means that if you’re over the age of 50, you get a point for that. Is your neck circumference greater than 16 inches? And then the G stands for gender. Males tend to have more problems with this than females.

If you have 0 to 2 points, you’re at a low risk for obstructive sleep apnea, a 3 to 4, you’re at an intermediate risk, and at a 5 to 8 you’re at a high risk. At that point, I would recommend that someone has a sleep study done to see if they do have obstructive sleep apnea.

Bill: Okay, STOP-BANG, thank you for explaining that to us. How common is sleep apnea?

Neal: I see it a few times a month with individuals. Generally, it’s with folks that are obese, but there are others that tend to have the problem. Weight loss is an important factor to help out with sleep apnea.

Bill: And when you say, “Stop breathing,” you mean they will just take a breath in and no exhale for a matter of time, and then eventually it comes out?

Neal: Exactly, exactly. I’ve heard of people going in for the sleep study, and within the first three minutes, they stop breathing several times. That is, they will take a breath in and then just sit there. No exhale, no other breathing in – or maybe it’s after the exhale, but they do not take a deep breath in. And then they startle and then will take that deep breath in.

Bill: But they don’t know it, right? They’re not cognizant of this?

Neal: Not necessarily. Some folks have told me, “I’ve woke myself up not breathing before.” Some folks do recognize it, and some folks do not.

Bill: Wow. And what is the general treatment for this?

Neal: Generally, you may have heard of a CPAP machine – Continuous Positive Air Pressure machine. That is a mask that people wear during the night that provides a constant amount of air pressure to keep their airway opened up.

Bill: Okay. Is that the main way to treat this? Are there other ways being developed now because I know those machines are kind of clunky--

Neal: They have gotten better over time. My father-in-law has had a couple of different machines for his sleep apnea. They have also changed the devices. Sometimes they go over the full face; sometimes it’s just over the nose. They have done some really good work on improving the comfort level of that. There are other ways. Sometimes all you would need is a mouth brace that will hold your mouth open enough for you to be able to breathe properly.

Bill: And how effective is the CPAP machine?

Neal: Very effective. I had an individual, a young gentleman with two young kids, and he was telling me he was tired all the time. He’d just get done with work, come home, and just rest because he didn’t have the energy to do anything else. I went through the STOP-BANG questionnaire with him and determined that he needed to have a sleep study done. I saw him about three months later, and you wouldn’t recognize the guy. It was great. He had very bright eyes, and you could tell there was something different about him. The thing that made me feel best was he looked at me and said, “Now, I can play with my kids.”

Bill: Wow. That’s a great story. You were talking about the sleep study. Can you tell us more about how that works?

Neal: Well, there are a couple of different sleep studies, and that is something that the sleep medicine folks will determine which would probably be the best for you to do. There is the over night sleep study where you come to the office, and they hook you up to machines to check your blood pressure, to check your heart rate, to check your O2 or oxygen saturation during the night as you sleep. There are some that you can take home and do at home, but sometimes, depending on the study itself, that may end up going into where you spend over night at the clinic.

Bill: And preparing for that, you just go there with your pajamas and your toothbrush and things, and you spend the night?

Neal: [LAUGHS] Right.

Bill: They hook you up with all kinds of electrodes and things, and they just monitor your sleep?

Neal: Yes, they do.

Bill: Now, who is a good candidate for a sleep study?

Neal: They need to check with their primary care physician and see if they are meeting criteria that would call for a sleep study. As I discussed earlier on my STOP-BANG, if you are in the intermediate range or high range, I do recommend you have a sleep study.

Bill: Okay, and what are some of the other sleep disturbances you see fairly regularly?

Neal: Well, there are sleep-wake phase disturbances. There are three different types of that. There’s delayed, advance, and irregular. Delayed sleep-wake phase is that it takes you longer to fall asleep. You may still get the right amount of hours – we’re looking at seven to eight hours of sleep – but instead of going to bed at 10 O’clock at night, you may not go to bed until 2 O’clock in the morning, but then you sleep the same seven to eight hours.

Advance is you go to sleep early and wake up early. You may go to bed at 8 O’clock, but you’re up at 3 in the morning. And then irregular just means you have different sleep periods throughout the day. Basically, your circadian rhythm, which is your body clock, is not in sync and so you don’t have a steady sleep-wake cycle.

Bill: And how do you diagnose and treat that?

Neal: If people are getting enough sleep and it’s not interrupting their daily activities, I don’t usually treat for that. It is recognized that that is a bit on the abnormal side, but if they’re having where it does affect their daily activities, or work, or something like that, we can treat that through medicine.

Bill: Okay, and let me ask you this question. We hear of these high performing people that are proud of the fact that they get four hours of sleep a night – “I only need four hours of sleep a night. That’s all I need.” In reality, that’s going to catch up with them, right? That’s not a good thing to be proud of?

Neal: I agree. We need to have all phases of sleep. There’s REM sleep and non-REM sleep. You may have heard of REM sleep being Rapid Eye Movement. That is the time frame when you’re dreaming. Well, there’s three other stages of non-REM sleep, which we have. The first stage lasts about ten minutes. That’s when you’re first trying to fall asleep. That’s when you decide – you lay in bed, you close your eyes to fall asleep.

About ten minutes later, you should be what we call -- into your second stage of non-REM sleep. This is a little bit deeper sleep. You’re still not into a full sleep. You’re easily awakened. And then you get into your third stage of non-REM sleep – this is your deep sleep. This is actually when the repairing function of your body when you’re sleeping is occurring. This happens – these cycles happen three to four times a night. That’s why we need seven to eight hours of sleep a night so that we can get all of those stages in throughout the night.

Bill: Right, and we need that restorative sleep. Can you share with us some tips on how to get a good night’s sleep?

Neal: Yes, I’ll be glad to. Some things to do is get some exercise each day. Get some movement going on in your body. Get that blood flowing. It also helps wear you down a little bit so that you have a good night’s sleep. Another suggestion is to take a warm bath about 45 minutes before bed. This is a relaxation time frame to get you ready to go to sleep. If you’re having trouble falling sleep, you can learn some relaxation or tension release exercises. Lay down in bed, start with your toes, and curl them up and then release the tension in your toes and in your ankles. And then continue moving that up through your legs, and into your torso, and into your shoulders. That relaxation tension exercises will help relax your body.

If you have trouble falling asleep, do not continue to lay in bed tossing and turning wishing you could go to sleep. Get up, go to another room, but don’t do anything that may excite you. Read a book, but don’t read one that will cause you to be excited – maybe the phone book, something that will help bore you back to sleep, but it will not cause you to be too interested – don’t go play a video game or watch TV because that’s not going to help you fall back to sleep.

Establish a good routine. Go to be at the same time every night and wake up the same time every morning. This will help you establish a good cycle and help get you a good sleep pattern started.

Bill: And even on the weekend?

Neal: Correct.

Bill: Neal, thank you, so much, for your time today. We really appreciate it. For more information about Tidelands Health physicians, services, and facilities, visit TidelandsHealth.org, that’s TidelandsHealth.org. This is Better Health Radio. I’m Bill Klaproth. Thanks for listening.