A good night's sleep is important for maintaining your overall health and well-being.
Sleep disorders can affect men and women differently.
Although men apparently suffer more from sleep apnea, women are more likely to report spending their nights tossing and turning.
Without enough shut-eye, children are more likely to struggle with their school studies, do poorly on the playing field, and suffer depression.
The quantity and quality of your sleep, diet or poor sleep habits promote stress.
Carol Ash, D.O., the director of Sleep Medicine at Meridian Health in New Jersey, is here to address the importance of a good nights sleep.
Selected Podcast
The Importance of Getting a Good Night’s Sleep
Featured Speaker:
She is a featured speaker on many nationally syndicated television and radio shows as well as a featured expert in related articles for many national magazines. She has been interviewed on The TODAY Show, Good Morning America, MSNBC, CNN, The Dr. Oz Show, ABC's Katie with Katie Couric, Fox and Friends weekend show, Fox’s nationally-syndicated The Morning Show with Mike and Juliet, CBS Early Show, ABC’s Nightline with Cynthia McFadden. She has been a featured expert in many national magazines and print media including, The New York Times, The Philadelphia Inquirer, Women’s Day, Shape, Parenting, Parents, Prevention, Glamour, Reader’s Digest, Huffington Post, Self, Success, and more. She is also on the Advisory Board for Ladies Home Journal.
Learn more about Carol Ash, D.O
Carol Ash, DO
Carol Ash, D.O., is a board certified general internist and fellowship-trained pulmonary, critical care, and sleep medicine specialist with more than 15 years’ experience in clinical medicine. Currently, Dr. Ash is the director of Sleep Medicine at Meridian Health in New Jersey.She is a featured speaker on many nationally syndicated television and radio shows as well as a featured expert in related articles for many national magazines. She has been interviewed on The TODAY Show, Good Morning America, MSNBC, CNN, The Dr. Oz Show, ABC's Katie with Katie Couric, Fox and Friends weekend show, Fox’s nationally-syndicated The Morning Show with Mike and Juliet, CBS Early Show, ABC’s Nightline with Cynthia McFadden. She has been a featured expert in many national magazines and print media including, The New York Times, The Philadelphia Inquirer, Women’s Day, Shape, Parenting, Parents, Prevention, Glamour, Reader’s Digest, Huffington Post, Self, Success, and more. She is also on the Advisory Board for Ladies Home Journal.
Learn more about Carol Ash, D.O
Transcription:
The Importance of Getting a Good Night’s Sleep
Bill Klaproth (Host): A good night’s sleep is important for maintaining your overall health and well-being. There are many disorders and disorders can affect men and women differently. With us is Carol Ash, D.O. She is the Director of Sleep Medicine at Meridian Health in New Jersey. Dr. Ash, thank you so much for being on with us. So, let’s start with, what are the most common sleep disorders that you see?
Dr. Carol Ash (Guest): Most people, when they think about sleep disorders, they typically think of sleep apnea or obstructive sleep apnea. That is a condition where individuals can stop breathing in their sleep. Or, they think of insomnia. There are also some movement disorders. One common one is called “restless leg syndrome.” Some people will describe it as the “Jimmy legs” or that’s how people will typically think of it. Then, insufficient sleep because of our lifestyle or medications or other health problems is also something that people will commonly struggle with. But, there are more than 80 different sleep disorders and science is showing us so much about the mechanics of sleep. It’s just a fascinating time to be practicing sleep medicine.
Bill: Absolutely. Are these sleep disorders mainly caused by hereditary things or are they caused by lifestyle or depression or stress, or maybe all of the above?
Dr. Ash: All of the above. You can have a sleep disorder like obstructive sleep disorder that could be due to the fact that you have larger tonsils or the shape of your face. Or, you can have a sleep disorder because of lifestyle. If you’re somebody who is trying to burn the candle at both ends or you are very stressed, it can cause your sleep to be disrupted or you may not get enough sleep. Restless legs – that’s a condition where we can see people having difficulty with unusual or uncomfortable symptoms in their legs that is relieved by activity that can be present because of an iron deficiency. People with insomnia, they commonly travel with other disorders like depression. We used to think of insomnia as a symptom. We now know that insomnia itself is its own disorder and tends to travel with other disorders like depression and anxiety. When you treat the insomnia, it’s actually easier to treat the depression or the anxiety that might be occurring with the insomnia. All of the above is the answer.
Bill: So, when is the time to go see the doctor, then? Someone may think, “Oh, geeze. I’m just being stressed out; I’m working too hard; I’m not eating right. This will go away.” When should someone come see you?
Dr. Ash: What I typically tell my patients or folks in the community when I talk to them is the first thing is just recognizing that there may be an issue that your doctor or a sleep specialist could help you with. The first thing that people need to be mindful of is, if you’re finding that you are not able to get the right amount of sleep that you need or if you’re somebody that has what we would classically think of as insomnia: if you’re having difficulty falling asleep at night; you’re not able to maintain sleep at night; you’re waking up too early or you just feel exhausted and tired during the day, that’s certainly somebody who might want to consider reaching out to their provider. Sometimes it could be something really simple. I’ll ask patients when they come to see me, “Why do you think you have a problem?” Patients know. They just haven’t really thought about how they can solve the problem. If you have a test you’re trying to study for or a lot of demands, it may be that you just need to understand how important sleep is and have somebody give you some insight about things that you could be doing to help make your sleep better so you can get the rest that you need and you wake up in the morning feeling wide awake. I’ll give people some simple tips such as, I want you to make sure you get the right amount--and most of us need about eight hours, the range being seven to nine. There isn’t really anybody who can really function well with less than seven hours of sleep. You want to make sure that you’re getting the right amount of sleep and you want to stick to a routine regular schedule every day. Most important is getting up the same time every day because there is a master clock in your brain and when you open your eyes in the morning and expose yourself to light, one of the strongest setters of the master clock is that light. If you get up the same time every day, if you need eight hours of sleep, and to keep it simple, if you got up at 8 a.m. and exposed yourself to light in the morning at 8 a.m., that light will help set rhythms for wake and sleep so that you’d be able to get to bed at 12 midnight. You would easily drift off and then you would wake up again at 8 a.m., even without an alarm clock. So, every day you would wake up feeling well rested and able to stay awake and alert all day long. If you’re sticking to those basic principles – getting the right amount, getting up the same time every day, and keeping the environment dark, quiet and cool to help facilitate sleep – if, after a month, you’re still struggling, then you really do need to talk to your doctor.
Bill: Very good tips. Thank you for sharing those. I appreciate that because I was going to ask you about healthy sleep habits. When it comes to determining a diagnosis, what tests are given for you to find out if somebody does have a sleep disorder?
Dr. Ash: If you find your way to the doctor because you are still struggling, the first thing they’ll do is go through a list of symptoms that would help them to understand what tests would be best for you. If you’re somebody who is snoring and you’re finding that your sleep is restless and you’re tired during the day and if you have cardiovascular disease, then that would suggest that you probably are at risk for obstructive sleep apnea. If you have a disorder like that, you would need a study called a polysomnography which is an overnight sleep study. You would go into a sleep lab where they would hook you up to monitors. They would watch your breathing, watch your heart rhythms, watch your oxygen count and your sleep and determine if there is a problem with your breathing in your sleep. If you do, there are some simple interventions. There is an appliance called a C-pap, there are surgical interventions, there are dental appliances. For some people, simple weight loss or just alleviating nasal congestion can solve the problem. If you come in and you describe to the doctor symptoms that suggest you can’t fall asleep easily at night, you have racing thoughts, your sleep is restless, typically, for those people, there are some simple sleep habits they could work on. They could use cognitive behavioral therapy to help people with insomnia. There are also certainly some medications we could use. Usually, people with classic insomnia symptoms, they wouldn’t need a test. People with restless legs, which is a common Jimmy leg sensation, and with that, pretty much from a history you can get the information that you need and there wouldn’t be a technical test that you would need. You could get a lab test – like a ferritin count which would look for a low iron level. The word “ferritin” is the word we use for iron. If the iron level is low, you just need the iron replacement. In that sleep study, typically we can bring people in if the symptoms do not strongly suggest an answer and you need a study to look into your sleep no different that an MRI would look into your body if you had pain or you had a problem that the doctor needed to get more information on. The sleep study is a way of the doctor looking into your sleep to discover what the problem might be, if you have symptoms suggesting a sleep disorder.
Bill: We’ve heard about sleep apnea and you’ve talked about that; and the C-Pap machine and you’ve talked about, good healthy sleep habits. What about these over the counter medicines or pills you can take? It seems like I see a new commercial every night where “if you’ve having trouble sleeping, try the Z thing and it will make you sleep”. That seems like not a good thing for people to be taking medication at night and trying to get good sleep on their own by taking some kind of a Tylenol sleep aid all night.
Dr. Ash: I always try to encourage patients to stay away from medications when they can and if you stick to those simple tips: making sure you get up the same time every day, keeping the right amount of hours at night, making sure the environment is conducive to sleep – the quiet, dark and cool bedroom. When you find you can’t sleep, sometimes what people can simply do is just do some simple breathing exercises. If you just really slow your breathing down and take a few slow breaths in and exhaling and getting the breathing to slow down. For some people, that can be enough to help them to drift off into sleep. Or, just starting with your toes and working all the way up to your head and just relaxing your muscles may be all you need to do to help you drift off to sleep without any over the counter medications. Typically, what the over the counter medications are is they are antihistamines that can be very sedating. So, you are taking advantage of a side effect of a medication that is really used for something else. Part of the reason why it’s been so difficult to control insomnia with medications in the past is, we didn’t really understand the mechanisms of sleep and wake. What we now know is there’s two separate circuits – one for sleep and one for wake. What the problem has been is, we now know that people that are having trouble falling asleep at night, it’s as if they have a foot on an accelerator because it is really a problem with hyperarousal in the wake system not shutting off. It’s as if they have a foot on the accelerator and what most of these over the counter medications and even prescriptions sleeping meds were designed to do was to put the foot on the brake. But, if you think about that for a second, it doesn’t make sense that if the foot is on the accelerator that simultaneously putting the foot on the brake is really going to accomplish what you need. We’re now really realizing that what we do to solve insomnia has to take the foot off the accelerator. So, those breathing techniques, trying to relax the muscles and decrease the tension in your muscles. There are some newer prescription medications that are designed to take a foot off the accelerator, but not the over the counter meds. So, your first bet is just really trying to relax your mind. Again, simple breathing exercise and muscle relaxation can work really well for that.
Bill: Dr. Ash, thank you so much for your time today. You’ve given us a lot of useful information. For more information, please visit MeridianHealth.com. That’s MeridianHealth.com. This is Meridian Physician Podcast with Meridian Health. I’m Bill Klaproth. Thanks for listening.
The Importance of Getting a Good Night’s Sleep
Bill Klaproth (Host): A good night’s sleep is important for maintaining your overall health and well-being. There are many disorders and disorders can affect men and women differently. With us is Carol Ash, D.O. She is the Director of Sleep Medicine at Meridian Health in New Jersey. Dr. Ash, thank you so much for being on with us. So, let’s start with, what are the most common sleep disorders that you see?
Dr. Carol Ash (Guest): Most people, when they think about sleep disorders, they typically think of sleep apnea or obstructive sleep apnea. That is a condition where individuals can stop breathing in their sleep. Or, they think of insomnia. There are also some movement disorders. One common one is called “restless leg syndrome.” Some people will describe it as the “Jimmy legs” or that’s how people will typically think of it. Then, insufficient sleep because of our lifestyle or medications or other health problems is also something that people will commonly struggle with. But, there are more than 80 different sleep disorders and science is showing us so much about the mechanics of sleep. It’s just a fascinating time to be practicing sleep medicine.
Bill: Absolutely. Are these sleep disorders mainly caused by hereditary things or are they caused by lifestyle or depression or stress, or maybe all of the above?
Dr. Ash: All of the above. You can have a sleep disorder like obstructive sleep disorder that could be due to the fact that you have larger tonsils or the shape of your face. Or, you can have a sleep disorder because of lifestyle. If you’re somebody who is trying to burn the candle at both ends or you are very stressed, it can cause your sleep to be disrupted or you may not get enough sleep. Restless legs – that’s a condition where we can see people having difficulty with unusual or uncomfortable symptoms in their legs that is relieved by activity that can be present because of an iron deficiency. People with insomnia, they commonly travel with other disorders like depression. We used to think of insomnia as a symptom. We now know that insomnia itself is its own disorder and tends to travel with other disorders like depression and anxiety. When you treat the insomnia, it’s actually easier to treat the depression or the anxiety that might be occurring with the insomnia. All of the above is the answer.
Bill: So, when is the time to go see the doctor, then? Someone may think, “Oh, geeze. I’m just being stressed out; I’m working too hard; I’m not eating right. This will go away.” When should someone come see you?
Dr. Ash: What I typically tell my patients or folks in the community when I talk to them is the first thing is just recognizing that there may be an issue that your doctor or a sleep specialist could help you with. The first thing that people need to be mindful of is, if you’re finding that you are not able to get the right amount of sleep that you need or if you’re somebody that has what we would classically think of as insomnia: if you’re having difficulty falling asleep at night; you’re not able to maintain sleep at night; you’re waking up too early or you just feel exhausted and tired during the day, that’s certainly somebody who might want to consider reaching out to their provider. Sometimes it could be something really simple. I’ll ask patients when they come to see me, “Why do you think you have a problem?” Patients know. They just haven’t really thought about how they can solve the problem. If you have a test you’re trying to study for or a lot of demands, it may be that you just need to understand how important sleep is and have somebody give you some insight about things that you could be doing to help make your sleep better so you can get the rest that you need and you wake up in the morning feeling wide awake. I’ll give people some simple tips such as, I want you to make sure you get the right amount--and most of us need about eight hours, the range being seven to nine. There isn’t really anybody who can really function well with less than seven hours of sleep. You want to make sure that you’re getting the right amount of sleep and you want to stick to a routine regular schedule every day. Most important is getting up the same time every day because there is a master clock in your brain and when you open your eyes in the morning and expose yourself to light, one of the strongest setters of the master clock is that light. If you get up the same time every day, if you need eight hours of sleep, and to keep it simple, if you got up at 8 a.m. and exposed yourself to light in the morning at 8 a.m., that light will help set rhythms for wake and sleep so that you’d be able to get to bed at 12 midnight. You would easily drift off and then you would wake up again at 8 a.m., even without an alarm clock. So, every day you would wake up feeling well rested and able to stay awake and alert all day long. If you’re sticking to those basic principles – getting the right amount, getting up the same time every day, and keeping the environment dark, quiet and cool to help facilitate sleep – if, after a month, you’re still struggling, then you really do need to talk to your doctor.
Bill: Very good tips. Thank you for sharing those. I appreciate that because I was going to ask you about healthy sleep habits. When it comes to determining a diagnosis, what tests are given for you to find out if somebody does have a sleep disorder?
Dr. Ash: If you find your way to the doctor because you are still struggling, the first thing they’ll do is go through a list of symptoms that would help them to understand what tests would be best for you. If you’re somebody who is snoring and you’re finding that your sleep is restless and you’re tired during the day and if you have cardiovascular disease, then that would suggest that you probably are at risk for obstructive sleep apnea. If you have a disorder like that, you would need a study called a polysomnography which is an overnight sleep study. You would go into a sleep lab where they would hook you up to monitors. They would watch your breathing, watch your heart rhythms, watch your oxygen count and your sleep and determine if there is a problem with your breathing in your sleep. If you do, there are some simple interventions. There is an appliance called a C-pap, there are surgical interventions, there are dental appliances. For some people, simple weight loss or just alleviating nasal congestion can solve the problem. If you come in and you describe to the doctor symptoms that suggest you can’t fall asleep easily at night, you have racing thoughts, your sleep is restless, typically, for those people, there are some simple sleep habits they could work on. They could use cognitive behavioral therapy to help people with insomnia. There are also certainly some medications we could use. Usually, people with classic insomnia symptoms, they wouldn’t need a test. People with restless legs, which is a common Jimmy leg sensation, and with that, pretty much from a history you can get the information that you need and there wouldn’t be a technical test that you would need. You could get a lab test – like a ferritin count which would look for a low iron level. The word “ferritin” is the word we use for iron. If the iron level is low, you just need the iron replacement. In that sleep study, typically we can bring people in if the symptoms do not strongly suggest an answer and you need a study to look into your sleep no different that an MRI would look into your body if you had pain or you had a problem that the doctor needed to get more information on. The sleep study is a way of the doctor looking into your sleep to discover what the problem might be, if you have symptoms suggesting a sleep disorder.
Bill: We’ve heard about sleep apnea and you’ve talked about that; and the C-Pap machine and you’ve talked about, good healthy sleep habits. What about these over the counter medicines or pills you can take? It seems like I see a new commercial every night where “if you’ve having trouble sleeping, try the Z thing and it will make you sleep”. That seems like not a good thing for people to be taking medication at night and trying to get good sleep on their own by taking some kind of a Tylenol sleep aid all night.
Dr. Ash: I always try to encourage patients to stay away from medications when they can and if you stick to those simple tips: making sure you get up the same time every day, keeping the right amount of hours at night, making sure the environment is conducive to sleep – the quiet, dark and cool bedroom. When you find you can’t sleep, sometimes what people can simply do is just do some simple breathing exercises. If you just really slow your breathing down and take a few slow breaths in and exhaling and getting the breathing to slow down. For some people, that can be enough to help them to drift off into sleep. Or, just starting with your toes and working all the way up to your head and just relaxing your muscles may be all you need to do to help you drift off to sleep without any over the counter medications. Typically, what the over the counter medications are is they are antihistamines that can be very sedating. So, you are taking advantage of a side effect of a medication that is really used for something else. Part of the reason why it’s been so difficult to control insomnia with medications in the past is, we didn’t really understand the mechanisms of sleep and wake. What we now know is there’s two separate circuits – one for sleep and one for wake. What the problem has been is, we now know that people that are having trouble falling asleep at night, it’s as if they have a foot on an accelerator because it is really a problem with hyperarousal in the wake system not shutting off. It’s as if they have a foot on the accelerator and what most of these over the counter medications and even prescriptions sleeping meds were designed to do was to put the foot on the brake. But, if you think about that for a second, it doesn’t make sense that if the foot is on the accelerator that simultaneously putting the foot on the brake is really going to accomplish what you need. We’re now really realizing that what we do to solve insomnia has to take the foot off the accelerator. So, those breathing techniques, trying to relax the muscles and decrease the tension in your muscles. There are some newer prescription medications that are designed to take a foot off the accelerator, but not the over the counter meds. So, your first bet is just really trying to relax your mind. Again, simple breathing exercise and muscle relaxation can work really well for that.
Bill: Dr. Ash, thank you so much for your time today. You’ve given us a lot of useful information. For more information, please visit MeridianHealth.com. That’s MeridianHealth.com. This is Meridian Physician Podcast with Meridian Health. I’m Bill Klaproth. Thanks for listening.