Scott Webb (Host): March is National Sleep Awareness Month. And today, we're talking about the importance of sleep and how the folks at the Tri-State Health Sleep Lab can help with Angela Stein, Director of the Sleep Lab, and Beth Monsebroten, family nurse practitioner who works with pulmonology and sleep lab patients.

 This is Tri-State Health Talk from Tri-State Health. I'm Scott Webb. It is nice to have you both here today. We're going to talk about an important thing, right? We're going to talk about sleep, and I think most of us probably don't get enough sleep or the right sleep. I'm definitely sleepy right now, but I've had lots of caffeine. And in sort of honor, if you will, of Sleep Awareness Month, it's great to have you both on. I'm going to start with you, Angela. Just tell us about a sleep study. Maybe some folks have never heard of one, they don't know exactly what a sleep lab is, what goes on in a sleep study.

Angela Stein: A sleep lab is set up like a hotel room. In ours, we have four separate private rooms where we are monitoring brainwaves, breathing patterns, heart rate, leg movements, blood oxygen. There's about 24 different electrodes of monitors that we place on patients. And they are usually here for about 12 hours, maybe sleeping seven to eight hours.

Host: Sure. And I've spoken with other experts about this, and it sounds like some really good sleep. I don't know if people are able to allow themselves to really get into a good sleep, but I am like, yeah, you know, just peace and quiet and nevermind the fact that someone's maybe watching you while you're sleeping. But it sounds like good stuff and probably really helpful, Beth, for folks who are suffering. And let's talk about maybe why they would be suffering. Like, what are the most common sleep disorders that are done diagnosed?

Beth Monsebroten: The most common sleep disorders diagnosed truly is sleep apnea. And there are actually two types of sleep apnea. So, the most common kind of sleep apnea is obstructed sleep apnea. And that's basically your airway gets blocked off for some reason. Maybe your tongue is a little too big for your oral space or some people still have their tonsils and they're quite large. And when we lie back, that will kind of fall back and collapse on to the back of their throat, blocking off that airway.

The other type of sleep apnea is central sleep apnea. That's not quite as common, a little more serious perhaps because it's actually where your brain forgets to tell you to breathe while you're sleeping. We tend to see that most often in patients who maybe have had traumatic brain injuries, but sometimes it just shows up. People just have it.

And like I said, they're both treatable. The CPAP is the most common treatment option, but there are other options available. And so, that's why I think it's really important that you can get in and see a sleep specialist, because they can talk to you about the different types of therapy that's available.

There are some other kind of less common sleep issues. And so, we've probably all heard of narcolepsy or another one we hear about is idiopathic hypersomnia, which is basically you're sleepy and we don't know why. We've ruled out the types of sleep apnea and we've ruled out narcolepsy and you're sleepy. And so, then there are some things that we can do to help treat patients with that as well. So, those are the basic, I think.

Host: Those are the biggies. Yeah. And let's talk then about the symptoms or complaints. Like, maybe it's obvious, like people are just tired or they're sleepy, or maybe there's a difference between tiredness and sleepiness. It's good that we have experts like yourself. So, take us through this. Like, what are the primary or the main symptoms or complaints that you hear from patients?

Beth Monsebroten: Honestly, the most common complaint is the bed partner complains about somebody snoring.

Host: Yeah. It checks out.

Beth Monsebroten: Yeah, right. It's usually what brings patients in. Because most of the time, what I hear from patients is, "I don't think I have sleep apnea. I feel fine." But if they do come in under their kind of own accord to see us, fatigue probably really is the biggest complaint, and hypersomnia is what we call it. And that's just feeling extremely tired when you probably really shouldn't, you know? So, feeling tired during the day, even after you've gotten a, you know, good eight to, what, 10 hours of sleep; feeling sleepy when you're driving; taking what I call unintentional naps. So, you are sitting there watching TV or reading a book, maybe sitting at a meeting at work and you accidentally kind of fall asleep. And so, those can be the symptoms also next to snoring, I would say, that really bring people into the office.

Host: So then, when, Beth, should we reach out? Like, when do we know? Is it because our sleeping partner, our bed partner, won't stop complaining about the snoring? Like, what's the threshold? When do we reach out and speak with someone like yourself?

Beth Monsebroten: Yeah. I like to try and see people sooner rather than later. Because ,I think, one of the biggest misconceptions about sleep apnea is, "Well, I'm just not getting good rest." So, like, no biggie, right? The problem is that untreated sleep apnea is extremely hard on the heart. And honestly, most of our referrals come from cardiology, because they're seeing patients with some heart issues that is often caused or at least made worse by untreated sleep apnea. So obviously, if you're feeling more tired than you think you should, if you are snoring to the point where it's waking yourself up or bed partner is complaining.

But it's not always snoring either. Sometimes it could be waking up gasping for air, or sometimes just waking up and not knowing why. One of the questions I often ask patients is, "How many times do you wake up during the night?" And, you know, we all usually wake up maybe one to two times during the night. But if you are waking up more than that and you're either not sure why, or if you're waking up four or five times during the night needing to use the restroom—now, sleep apnea isn't the only thing that could cause that.

Host: Of course, right?

Beth Monsebroten: But it is sometimes an indicator for us to go, "Hmm, maybe we better check this out."

Host: Yeah. I tell my wife all the time, because she complains about my snoring, which I believe is because I still have my tonsils at my ripe old age, and I say, you know, "The cats aren't complaining. They seem fine. What's your problem?" You know? I know she's just trying to help me and also help herself get better sleep, because, you know, Angela, like not getting good sleep or the right sleep and all that is just bad for us. It puts us in a bad mood. We're foggy. We're just sort of dragging the whole day. I wanted to have you address that, like when we think about better sleep, however one would define that, how it really can change our daily life or just our long-term health.

Angela Stein: So, getting enough quality sleep is great for your mental and physical health. Some key benefits would be improved memory, focus, learning; better mood and emotional regulation, which is really important, especially if you're married; stronger immune response, balanced appetite, and metabolism; and leading into heart disease, like Beth was talking about, reduced risk of chronic conditions like heart disease and diabetes; faster muscle recovery and tissue repair, and then increased energy and daytime alertness.

Host: Yeah, just so many benefits, regardless of how old we are, you know, getting the right amount of sleep and the good kind of sleep and all of that just helps us mentally, physically, all that good stuff. And it makes me wonder, Angela, like we're talking here about sleep studies, like are there different ones or is it just kind of a one-size-fits-all, generally?

Angela Stein: There are different ones. The main one that we see are the in-lab overnight sleep studies that obviously are done in the sleep lab. That's the gold standard. But there are certain times when the provider will order a home sleep study. Both of those can get you a diagnosis of sleep apnea. That is the main thing we're looking for for any of these sleep studies. But those are the two big ones that we see: the in-lab overnight sleep studies and the home studies.

Host: Yeah. And I've never done a sleep study at home or anywhere else. It makes me wonder, Angela, you know, because, like in my mind, I'm picturing it like I want it to be like a spa, you know? But I'm sure—

Angela Stein: Well...

Host: i'm sure some folks maybe think, "Oh, it's going to be like being in a hospital room. It's going to be clinical or uncomfortable." Tell us what's the environment like? Is it kind of like a spa?

Angela Stein: Maybe not quite like a spa, but definitely better than a hospital. It is set up like a hotel room. I always joke and tell patients it is just a little more expensive than a hotel room.

Host: Yeah. Hopefully insurance helps out there, yeah?

Angela Stein: Yeah. But we do have a TV and Wi-Fi, but the only downside would be they're hooked up to a lot of different monitors. But most patients, it's not as bad as they thought it was going to be in the morning. So, that's always nice to here.

Host: Yeah. And I'm wondering, just a little followup here is, you know, most of us are so addicted to our devices and many of us fall asleep with our phones in our hands, and then we drop them on the floor when we roll over, maybe that's just me. Are folks allowed to use their devices for at least some of the time or, at a certain point, do they have to hand that over?

Angela Stein: They are allowed to use our devices. I would not want to be accused of disrupting anyone's nighttime routine. But we usually encourage lights out by 11:00 PM, just so we get enough, you know, recording time.

Host: Absolutely. Yeah. Beth, I want to find out from you, like how easy is it to do this, to have a sleep study? Do we need referrals and however this works, like what's the first step?

Beth Monsebroten: The first step is we need an order right to go to the sleep lab. And so, I really encourage people if they are thinking that they might have sleep apnea, they want to get it checked out, to either talk to their primary care provider and ask for a referral to come and see us over here in the sleep clinic, or we actually do self-referrals as well. And then, we'll get them into the clinic, talk to them. We do have kind of a list of questions that we ask them. Obviously, you know, are they snoring and things like that. But we also ask about the sleep hygiene, their sleep routine, because sleep is as much habit as it is the brain chemical reaction that happens that helps us sleep. And so, making sure that we've got good sleep hygiene is Important as well. And we can help some with that also.

Host: Of course. Yeah. It makes me wonder, Beth, if we have a complaining bed partner, you know, do folks usually come together? Do couples come together? Is it helpful to have the person who's the one who's laying there awake because the other one is snoring? Like, is that good information to have?

Beth Monsebroten: It is really nice to have, particularly, you know, the bed partner come with, because usually what patients will say is, "Well, I don't know if I snore" or "It doesn't bother me," right?

Host: That's why I tell my wife, I'm like, "I don't have any idea that I'm snoring. What you talking about?"

Beth Monsebroten: Exactly. So, it is nice to kind of have that other perspective in there to really kind of help us figure out what's going on.

Host: For sure. Well, this has been good stuff today, really helpful. As I sort of prefaced when we got started, just not being an expert, of course, but it just seems like many of us don't get enough sleep, the right sleep. We have bad sleep hygiene. We fall asleep with our phones, in our hands, all this stuff, you know, the greatest hits that deprive us of good sleep.

So, I just want to get a sense from you, Beth, as we finish up, like, are there some simple things that we can do, you know, before we get to the sleep study and all of that, to just improve our overall sleep quality maybe?

Beth Monsebroten: Yeah. There really are, you know, and I kind of already alluded to it, and that is the sleep hygiene. It really is important to try and have a consistent bedtime and a consistent wake time even on the weekends. And unfortunately, I think our society nowadays wants us to do, do, do, and not spend that time resting like we really need.

And so, really working on trying to have those consistent bedtimes and wake times is important. But along with that is also having kind of a bedtime ritual, right? So, maybe an hour before, you're kind of planning on getting into bed, try dimming the lights, turning off the television. And, you know, kind of looking at things that kind of help to signal your body that, "Okay, we're getting ready for bed now. Some people like to take a bath or a shower." Some people like to have some tea. I would just encourage them to stay away from caffeinated tea. But chamomile tea can be a relaxing tea to help.

The other thing that I really recommend, which when it was first suggested to me a hundred years ago, was the brain dump. So, you know, sitting down about an hour before bed with a notebook or your phone, and just kind of writing down things that you need to do tomorrow or the next day, or grocery lists or errands or even just things that you were thinking about, because that really kind of helps your mind to get ready and kind of put those things away so that when we then lay down, then our mind starts going and we're like, "Oh shoot, that's right. Tomorrow, I have to, you know, go to the grocery store." And so, kind of trying to clear out the cache, so to speak, like on the computer, that can really make a big difference.

So, those are kind of the main recommendations I make to people when they're looking at kind of trying to figure out a bedtime routine and what they need to do to hopefully try and get a better night's sleep.

Host: Yeah, that's perfect. Yeah, just some things that we can do to help ourselves. But beyond that, of course, we can speak with our providers, refer ourselves or get referrals, possibly deal with insurance, but eventually maybe get to a sleep study, be diagnosed. And then, of course, there's help available in the form of a CPAP and other things. So, I just want to thank you both for your time today, your expertise. This has been good stuff. Thank you.

Beth Monsebroten: Thank you.

Angela Stein: Thank you.

Host: And for more information, go to tsh.org/sleeplab. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest. I'm Scott Webb. And this has been Tri-State Health Talk from Tri-State Health. Thanks for listening.