Scott Webb: Sleep is important for all of us,
especially our kids, but many of us don't get enough sleep or the right kind of
sleep. And joining me today is Dr. Vipin Garg. He's the director of the sleep
disorder center at Trinitas regional medical center. And he's here today to
help us understand sleep disorders, sleep studies, and share the latest
technologies in diagnosing and treating sleep disorders.

 This is Trinity boss
health chat, the official podcast of tinnitus regional medical center. I'm
Scott Webb. So doctor, thanks so much for your time today. We're talking about
sleep and I know that sleep is important. So want to hear it from you? Why is
sleep so important?

Dr. Vipin Garg: As we know, we really need sleep to
do anything, actually, essentially. I mean, sleep amount may vary from person
to person or depending on what age group you are in. But you can't function
literally in terms of how you think, how you solve problems, how you learn,
like even driving, for example, judgment and paying attention to the details.
So everything gets affected and we have a lot of studies showing that if you
don't sleep enough, you're tired, you're more likely to end up in an accidental
crash. And besides the mental abilities, it also helps physically as well.

Scott Webb: I know for me personally, I just feel
grouchy when I don't sleep enough. What are some of the other effects of not
getting enough sleep?

Dr. Vipin Garg: Even for learning, for example, it's
extremely important. I mean, it could be learning math. It could be just
learning to play an instrument or playing sports. Sleep really enhances your
ability to learn and to solve problems, which we face day-to-day, pay
attention. So for children, for example, sleep is extremely important because
you know, they are on this stage and they're growing, so this helps in their
proper growth and the behavior.

The other thing is how you control your emotions, behavior,
how you cope with the change. Many things happen not expected and sleep is sort
of the keystone thing that, you know, how we respond to these things. Even when
we sleep, it's not like the body shuts down, it's like there is an active thing
going on in sleep, which is trying to repair the mind and body and make us
ready for the next day.

Scott Webb: That's a great way to put that. And it's
so important that we get that repair time, that downtime. And you mentioned
earlier that, you know, maybe everybody doesn't need the same amount of sleep.
And I've noticed as I've gotten older, that I don't seem to need as much sleep
or I can't sleep as long as I used to. My kids can sleep 10, 12 hours, but I'm
pretty good if I can get about six or so, you know. So if it's true that people
as they age or their natural personalities might not need as much sleep, why is
that?

Dr. Vipin Garg: There are two things. Well, first of
all, just like on average adults need seven to eight hours of sleep, okay?
That's just in general and then an individual may need a specific amount of
sleep. Though the way we look at the amount of sleep, it's really dependent
like how you perform the next day. If somebody feels sleep-deprived, that
simply means they're not getting enough sleep. And sometimes people may not
realize, you know, and some circumstances they do realize.

And now, for example, in children, they need more sleep
because the growth is happening. And it's important for physical growth and as
well as for mental growth. And then they're learning lot of new things. So like
adolescents may need 8 to 10 hours of sleep. And six, seven year olds, they may
need 10 to 12 hours of sleep.

We can't really curtail the amount of sleep. And it's not
only just the amount of sleep, it's the quality of sleep also is important,
because you may maybe sleeping seven to eight hours, which you think is
adequate, but if the quality is not adequate, then you're still maybe impaired
the next day.

Scott Webb: Yeah, I think that's so right. That it's
not just the number of hours. It's the quality of the sleep during those hours.
And it does seem like there's so many things that can factor into how good that
sleep is, whether it's the temperature in the room, the quality of our bed, the
pillows, there's a lot of factors in making sure however many hours we need are
good hours.

Dr. Vipin Garg: Yeah. I mean, we try to put those
things under something we call sleep hygiene. For example, going to bed just at
regular times. We have believe it or not like clock, which keeps tab what time
you go to bed. And then it's always easier to fall asleep at the same time and
then wake up at the same time, then you get kind of deeper sleep. If you try to
mess up with your schedule, you may have noticed, you know, during travel, you
still get sleep, but it's not as refreshing as your regular sleep.

So that's one thing, like you mentioned, the temperature.
Body has to be comfortable. And it's not only the physical things like
comfortable bed and no noise, no stimulants in terms of the TV, video games,
all that, because the mind has to relax and drift into sleep. So it's the
stress as well. And then, you know, how long it takes to fall asleep, you know,
so all these factors play a role.

Scott Webb: Yeah, they do. And especially with kids,
but even adults, we all like to play on our phones, these little mini computers
that we walk around, holding in our hands all day. And a lot of us will be
using them right up until bedtime, like right before we, you know, shut our
eyes. It's the last thing we're doing, is looking at a screen and stimulating
ourselves. And you know, our kids are doing that too, whether they're on TikTok
or Snapchat, whatever it is. Can you talk just a little bit about the effects
of that sort of stimulation and then trying to go to bed right away?

Dr. Vipin Garg: So there are two two things, like you
mentioned, the stimulants is one thing. You may have wondered why everybody
kind of sleeps at night time right when it's dark and everybody wakes up in the
morning when it's bright. So there's a science behind it. So with the darkness,
the brain secretes something called melatonin, and that's how we kind of drift
into sleep. So you can imagine if you're using all these tablets or TV and the
light is constantly going and it's giving the wrong signal to the brain. And
the melatonin is being sort of inhibited, so that's making it difficult to
sleep.

And the other aspect is, like you mentioned, that depending
on what you are watching or what is the content in front of you, that may
stimulate your brain and then make it harder to go to sleep. So what we
recommend typically that in your bedroom, try to avoid having all these
devices, TV, you know. And if you want to have just mild soothing music, some
people want to read a book, we will say just read a boring book, you know,
something not stimulating.

Scott Webb: Not a great book, but just something that
puts us to sleep.

Dr. Vipin Garg: Yeah, exactly. Just because sometimes
say, you know, some people tell that I just need to take my mind off the
things, so just to wind down. So there is a balance. So it's very important we
keep these devices out of the bedroom.

Scott Webb: Yeah, it definitely is. And I wanted to
have you talk about snoring. Sometimes it seems like snoring is just snoring
and sometimes it can be an indication of something else, like sleep apnea or
something like that. So let's just talk about snoring in general and those
people who snore, who have bed partners who are, you know, awakened by their
snoring. There's a lot to unpack here. But generally speaking, why do people
snore and is it always bad?

Dr. Vipin Garg: So what happens is we are breathing
24/7, right? We breathe in daytime, we breathe in nighttime and we all know
it's the essence of life. So, if the airway is obstructed, obviously it could
be partially obstructed, that's when the air flows through the obstructed airway,
it leads to some sort of noise. So snoring is nothing but just a noise, which
is indicating that the airway is not a hundred percent open. It's partially
occluded.

Now, depending on the level of obstruction, it may be that
you can overcome that obstruction by putting little bit effort, which is not a
big deal which means it could be benign in some circumstances. But in many
circumstances, it could also mean that you are not getting enough airflow,
which is needed to keep the bodily functions. That's when we start calling it
sleep apnea, because then we start seeing the consequences of that decreased
flow, like your oxygen will drop because the air is not enough. Once the oxygen
drops, as you know, we need oxygen, oxygen like gas, you know, go on. And so
then it starts affecting the heart, it can lead to kidney disease, it can lead
to stroke, it can lead to high blood pressure. So it's just a cascade after
that.

Scott Webb: So it does seem like there's just sort of
normal snoring, maybe taking a cat nap in the afternoon. But as you say, there
can be some serious health consequences if it's something that happens at night
and repeatedly. And that's definitely some of the stuff we're going to talk
about in a bit about sleep studies and things like that.

But before we get there, I wanted to have you talk about REM
sleep. You know, I hear a lot about this and I don't know exactly what it
means. It's not something we can sort of do ourselves, but there's that level
of sleep that's really desirable, right? That REM sleep.

Dr. Vipin Garg: Absolutely, as the name of this, REM,
it's basically rapid eye movement. And that's how the name REM. And typically
REM sleep makes like 25% of your total sleep. And strangely enough, that
percentage of sleep sort of remains constant throughout the life. And it's very
important for proper functioning of the body as well as sleep to be refreshing
that we have adequate REM sleep.

In the REM sleep, all the muscles kind of relax and they're
paralyzed. And a person may have dreams, person may have nightmares it
depending on the content. So this is the sleep, since the muscles are relaxed,
that anybody who has a issue with the sleep apnea, they are more likely they're
going to manifest it more. So as a defense mechanism or as a protective
mechanism from the brain, sometimes people with the sleep apnea, they will have
less of REM sleep because their sleep apnea gets extremely worse in REM sleep.
So the brain tries to avoid REM sleep and they can't have effective REM sleep,
so that can lead to problems. You know, sometimes they can be depressed in the
daytime and besides the medical problems.

Scott Webb: Are there also people who are just light
sleepers? And if that's a thing, you know, if there are light sleepers and
heavy sleepers, do the light sleepers ever really get into REM sleep? And if
not, are they then probably likely to wake up and just never quite feel
refreshed?

Dr. Vipin Garg: That's true. The light sleeper, a
person's sleep can be light. Either they have we call it fragmented sleep, that
they're just having very frequent arousals at nighttime and that kind of makes
us sleep light. Or they're not getting adequate amount of REM sleep, so this is
the one sleep which we just discussed and the other is delta wave sleep. So
that's also a deep sleep.

And sometimes we also see that people just feel that they
didn't sleep well and that's like psychophysiological, but they're able to
function, they can do everything daytime. So that necessarily may not be a
problem. But yes, if we do a sleep study and we see that you don't have
adequate REM sleep, adequate delta wave sleep, or you have frequent arousals,
then that's the problem. And then obviously, we go to the next step to see what
is causing that.

Scott Webb: That's a good transition point. Let's
talk about the next steps. Let's talk about first what are the common sleep
disorders and how would someone know if they have one. And if they don't just
know sort of instinctively themselves, then take us through that process.

Dr. Vipin Garg: So as we were discussing, sleep apnea
is pretty common. And some of the symptoms of sleep apnea for the patient,
snoring could be one. And they could have awakenings with choking sensation,
like I have patients come to me and they say they were fast asleep and they
just kind of woke up. And sometimes during these awakening, they realize that
they were choking. Sometimes, they don't realize because by the time they wake
up, I mean, they already are breathing normally. And in many circumstances,
their partners are telling that, "Hey, you snore loud" or "I
repositioned you in the bed and the snoring kind of stopped."

Scott Webb: Our partners tend to let us know, don't
they?

Dr. Vipin Garg: Definitely, they make sure that we
know, yeah. And then, you know, many times like some astute partners, they have
recorded the snoring and they have recorded how long they stopped breathing.
Like, they'll tell me, you know, "He stopped breathing 28 seconds. He
stopped breathing 48 seconds." So this is what we do in sleep studies
essentially. We are measuring if they stop breathing and how long it is and
what are the consequences of that.

And also in daytime, you know, they can be tired, they can
be unrefreshed. They wake up in the morning, they feel like they didn't get a
good night's sleep. They tend to drift to naps, like especially after lunch,
that's like a stress test. I tell my patients, if after taking lunch, you know,
you just kind of feel the need to take a nap, then this would be indication
that you're not getting enough good night's sleep.

Scott Webb: Yeah. And so what are some of the stats
about sleep disorders? You know, what percentage of us actually have a sleep
disorder?

Dr. Vipin Garg: Overweight people, probably 5%, I'll
say overall. But in men, it may go up to like even 10%. So it's pretty high,
you know? And then, if you are a young male and you have high blood pressure,
the chances are 85% to 90% that you have underlying sleep disorder because it's
sort of the number one cause, which people don't realize leading to
hypertension in that group.

Scott Webb: So let's talk then about the actual sleep
studies, how are they done? Where are they done? Do people have to stay
overnight in the hospital? Can they sometimes be done at home? Take us through
that process.

Dr. Vipin Garg: So sleep studies can be done in the
sleep center. Our sleep center is in a hotel. So one of the things was that we
want the patient to be comfortable, so they can sort of don't feel it's the
hospital environment. We want to get as natural picture as possible. So we have
many rooms in the hotel, which are converted into sort of those rooms where we
can monitor their sleep. but it can be done at home as well. So with innovation
and technology, so now we have devices which we can handover to the patient and
they're simple to use and they can just sleep in their bedroom and it records
at nighttime. And next day, we download the data, we analyze it and we go over
these results.

Scott Webb: Yeah, because it seemed like maybe that
was one of the reasons why people didn't go for sleep studies in the past,
because they would have to stay in the hospital, which is just not a natural
place for most people to sleep, right? But as you say now, you're doing it at
the hotel. People can do it from home. And one of the things I know you can use
from home is the WatchPAT. Maybe tell us a little bit about that for sleep
apnea.

Dr. Vipin Garg: Yeah. So WatchPAT is a very
innovative technology and they have made it very easy to monitor sleep. It's
like a watch and basically you put on your wrist. And then you have one sensor
which goes into the index finger and and then you connect that watch through
the app, with your smart phone device, and then just basically you turn it on
and then go to sleep and it records. And since it's connected to the smart
device, the data kind of all automatically goes to that cloud. And, you know,
these things are disposable. So once you use it. you don't even have to like
worry about returning it or maintaining it. It has done its job. And then we
can access that data from the cloud. In many cases, we are able to make the
diagnosis. In some cases, if it's inconclusive, we may have to get a lab-based
study. But it's really helpful because, in many cases, that's all you need.

Scott Webb: Really amazing technology. It's so great.
And this has been a great conversation, doctor. As we wrap up here,

Tell us about the tinnitus sleep center and what makes it so
special.

Dr. Vipin Garg: we are in existence for 25 years. And
we take great pride. We test individuals of all ages, including the children,
elderly. We can accommodate patients in wheelchairs, disabled. With the
hospital, you know, we have respiratory therapists that are specially trained,
you know, with much sicker people. So like patient needs oxygen at night time,
we can take care of all those things and we are accredited by the American
Academy of Sleep Medicine. You know, we have that accreditation for those many
years. So I would say, we take a lot of pride in what we do, and we have a lot
of patients who are happy and they have referred us their family members and
they can trust us here.

Scott Webb: Well doctor, thanks so much for this
conversation today. My takeaways are sleep is important. And if we're not
getting enough, we should do something about it, whether that's a sleep study
or at least starting with speaking with our primary and then moving on from
there. So doctor, thanks so much for your time today and you stay well.

Dr. Vipin Garg: All right. Thank you.

Scott Webb: Call the Trinitas comprehensive sleep
disorders center at 9 0 8 9 9 4 8 6 9 4. To learn how to get better sleep
tonight. Tinnitus health chat is the official podcast of tinnitus regional
medical center. I'm Scott Webb. Thanks for listening. Stay well.