Transcription:
Breathe Better/Sleep Better Month (March)

Intro: Another informational resource from UK Healthcare. This is UK HealthCast, featuring conversations with our physicians and other healthcare providers.

Caitlin Whyte: Welcome to UK HealthCast from the University of Kentucky Healthcare. I'm your host, Caitlin Whyte. Today, we are talking all about sleep. I know I struggle a lot with getting enough good sleep. And I'm sure some of you do too. So joining us to talk about sleeping better and breathing better are Dr. Rajan Joshi and Martha Rosenthal, both pulmonary critical care and sleep medicine specialists with UK Sleep Disorder Center. Dr. Joshi, I'll start our conversation with you today. Tell us just how prevalent sleep disorders really are.

Rajan Joshi, MD: In the United States, at least 50 to 70 million adults have some form of sleep disorder. And to make it more detailed, insomnia is in 30% of the US population, which means sleep deprivation leading to daytime sleepiness, 4% of total males and 2% of females have obstructive sleep apnea. In this day and age, shift work circadian rhythm disorder where they don't have good sleep-wake cycle. And also some of the college students, as well as other people who tend to have sleep-wake schedule disorder also. And overall, if you look at all the sleep-related disorders or breathing disorders, 9% of total population would have that.

Caitlin Whyte: Okay. Well, that leads me into my next question. What are some of the most common sleep-related issues that you treat at the UK Sleep Disorder Center?

Rajan Joshi, MD: There are many of them. We are a total sleep center provider, and we do see all different kinds of sleep apnea, which includes obstructive sleep apnea, central sleep apnea, hypoventilation, upper airway resistance, nighttime low oxygen disorders, insomnia shift work, circadian rhythm disorder, sleep-wake schedule disorder in general; also, restless leg syndrome and periodic limb movement disorder, which also causes insomnia in some patients; hypersomnia or excessive sleepiness during the daytime or narcolepsy. Also, we see patients who have nightmares, night terrors, REM behavior disorder, and sleepwalking and sleeptalking disorders. So many of those conditions will present in different forms and we try to analyze those patients in our sleep center.

Caitlin Whyte: So what are some signs that maybe we could look out for in ourselves that tell us we might have a sleep disorder?

Rajan Joshi, MD: First of all would be, if you find yourself your sleep is not satisfying enough to make you feel better next day, that would be a very simple thing that you can look for. Difficulty with sleep initiation, like taking long time; difficulty in going to sleep or people who have maintenance insomnia, meaning they cannot maintain their sleep and they have lot of broken sleep all night, which in turn will lead to not feeling rested when they wake up in the morning, more sleepiness and fatigue, like mid-morning and afternoon hours; poor concentration and difficulty in focus at work or at studies; loss of interest in work, as well as hobbies. You know, some of those symptoms will guide you to see whether you have any form of sleep disorder, which can be discussed with your primary care doctor and sleep evaluation after that.

Caitlin Whyte: Now, I'm sure this is a common question, but stress and anxiety I know wreak havoc on our sleep and wake cycle. Can you tell us more about that?

Rajan Joshi, MD: Typically, anxiety and stress, you know, which we do see in recent months and the last two years with COVID-19, and you can see that they would have difficulty with sleep initiation, meaning they cannot go to sleep because their mind starts working at full speed and they are unable to get relaxation before they can go to sleep. They would also have very fragmented sleep, meaning broken sleep, and they would wake up frequently throughout the night, which then leads poor consolidation, meaning they don't have continuous sleep, which in turn during the daytime, they will again have concentration difficulties, sleepiness and fatigue and foggy brain when they wake up in the morning.

Caitlin Whyte: How about COVID? What impact has COVID had on our sleep patterns? And are you seeing more patients with sleep impairments because of, you know, pandemic stress, or a result of having COVID, just everything that's happened in the last two years?

Rajan Joshi, MD: Yes. We do see that. Anxiety, stress, depression, and posttraumatic stress disorder, those are some of the things that happen related to either having COVID themselves or one of their family members who went through COVID and very serious illness. They all can develop all these disorders, which in turn leads to a variety of difficulty in initiation, or maybe getting to sleep, maintaining sleep, waking up early in the morning and cannot go back to sleep. Working from home can also lead to poorer sleep. Martha would give you some example of some of the patients that she has seen related to that.

Caitlin Whyte: Yeah. Martha, please share with us what you've been seeing in your practice.

Martha Rosenthal, DNP, ARPN: Yes. So I have seen one like major trend that's kind of changed in the sleep hygiene is like a lot of people will tell me, you know, "Now I have my office actually in my bedroom" or, you know, they'll take a nap on their lunch break because they say, "Oh, it's just so much easier because I'm here at home." But I just encourage the patients to really separate the sleep environment. We really want to reserve our bed only for sleep. It really messes with our circadian rhythm when we have that lack of separation, you know, between sleep and daytime work and that type of thing.

Caitlin Whyte: I have to admit, I did some bed work in the early days of the pandemic and it just felt way too comfortable. I was like, you know, I got to sit up at least.

Martha Rosenthal, DNP, ARPN: Yes. And even if, you know, you don't have an office in your bedroom, but some people will even, you know, get into their bed to read or work on something, and I encourage people just not to do that during the daytime.

Caitlin Whyte: Absolutely. Absolutely. Understandable. Now, Dr. Joshi, are insomnia and sleep apnea related? Tell us more about these conditions and how we can tell the difference.

Rajan Joshi, MD: Actually, we have seen patients who have sleep apnea or obstructive sleep apnea, and they present mainly as symptoms of insomnia, meaning they have difficulty going to sleep and maintaining sleep. And going to sleep would be, they would fall asleep immediately after dinner while they're watching TV. And as soon as they get up and try to go to bed, you know, they have difficulty going to sleep after that. And then they have broken sleep all night long because of obstructed sleep apnea, which is a physical condition with obstructed airway, struggling to breathe keeps them frequently awake throughout the night. So, yes, patients will present with excessive daytime sleepiness, but some patients will present totally with insomnia at night related to sleep apnea.

Caitlin Whyte: What about the overall impact of sleep disorders on someone's health? How can that kind of impact our general health?

Rajan Joshi, MD: It does make you very foggy when you wake up in the morning when you don't sleep good. Also, you have difficulty making decisions, which is very important, you know, for school bus drivers, truck drivers, pilots. Many a times, you know, those patients would have poor daytime performance due to daytime sleepiness and fatigue. They also have medical risk, you know, of dementia, memory problems, increased incidence of strokes, cardiovascular events, sudden deaths in sleep, heart attacks, cardiac arrythmias meaning irregular heart rhythm, developing at night, heart block. A variety of such things can happen, but more so, we don't realize that we can have sleep drunkenness, you know, which is almost similar or worse than alcohol drunkenness, you know, where you could have near miss accidents, motor vehicle accidents too.

Caitlin Whyte: So in layman's terms, doctor, what is happening in the brain when we're experiencing insomnia?

Rajan Joshi, MD: Actually, insomnia itself has not been shown to cause changes within the brain itself. But degenerative changes within the brain has been shown to cause variety of sleep disorders, which can be excessive daytime sleepiness, insomnia, broken sleep, sleep walking, sleep talking, variety of other things, you know, can be noted. Some post COVID or after COVID long haulers, you know, where they're still having symptoms of sleep, they have also shown some MRI changes on the brain in few patients. So they do think that the virus can affect brain in a way that can also lead to some sleep disorder, but not very commonly.

Caitlin Whyte: Now, Martha, I'd like to move to you for the last couple questions. When do we know that it's time to seek out treatment like this?

Martha Rosenthal, DNP, ARPN: So I think that there's definitely a variety of reasons to think about. Main one would be people who are experiencing excessive sleepiness. And I describe this to patients as like you're falling asleep inappropriately. So maybe at your work desk, you're fighting that sensation, you're sitting at a traffic light. Or I mostly see people who witness this or family or friends, you know, you're falling asleep very quickly, or you get home from work on the couch and you dozed off in the early evening. And then also loud snoring, if there are any pauses in breathing or we call this a witnessed apnea. But if someone, you know, who sleeps with you, a bed partner, they're really more of a reliable person to ask. Waking up with morning headaches. The other thing to think about is your daytime effects. So, you know, if there's an impact on your quality of life or ability to function well, nonrestorative sleep, you know, those are reasons to seek treatment. We do see a lot of patients present with fatigue as well rather than actual sleepiness, that's just kind of the way that they describe it. So always worth investigating that further with your primary care to see if there's any relevance to the sleep. And then, one thing is when you're looking at actually younger children, sometimes sleep disorder in children can present as restlessness at night versus insomnia or maybe having any like hyperactivity disorder or changes in their pattern of how they perform on schoolwork.

Caitlin Whyte: So let's talk about sleep kind of culturally now, is sleep truly one of the pillars of a healthy lifestyle? And if so, how do we derail this idea that like sleep is a sign of weakness somehow?

Martha Rosenthal, DNP, ARPN: Yes, absolutely. I think that there's a misperception. You know, people think they don't need sleep. We have such busy lifestyles now, they should push through. But we remind people that, you know, sleep is very important. It affects so many things, our ability to learn new information, our memory, decision making. It also affects our immune system, you know, our muscle regeneration at night, and most importantly, our mood.

So essentially, if we're losing hours of sleep, we're actually losing the ability to be productive during the hours that we are awake. And another thing that Dr. Joshi and I have talked about is, you know, one night of sleep deprivation can actually add up over the whole week. So we encourage people not to even miss, you know, one night of sleep and really remembering that sleep is a necessity and definitely not a sign of weakness.

Caitlin Whyte: As we wrap up our conversation here, is there anything else you'd like to add that we didn't touch on?

Martha Rosenthal, DNP, ARPN: Yes. Number one is what I go to is our sleep environment. So we really want to have a great sleep environment. We want it to be somewhere that we enjoy going to. Cool is better. Keeping the room temperature actually around 65 degrees Fahrenheit. A dark room, a quiet room, you know, something cozy. I also encourage people to keep this only for sleep. So not doing anything else in the actual bedroom. Blocking out any light that could leak from the windows or maybe those little LED lights that are on our alarm clock. And then during the daytime, you know, whatever our schedule is during the day, we want to keep that consistent, because that can actually help simulate the brain to know, you know, when the proper time is to be awake or go to sleep at night. Making your sleep environment something of enjoyment, having strategies at night where you have a really relaxing bedtime routine. So you do activity at night to relax, you know, light meditation or stretching, and then it comes back to something we call sleep hygiene. So avoiding caffeine six hours before bedtime, you know, avoiding alcohol before bedtime, no tobacco use that type of thing.

Caitlin Whyte: Well, Martha, as we wrap up our conversation here, is there anything else you'd like to add that we didn't touch on?

Martha Rosenthal, DNP, ARPN: One thing that we've mentioned is, you know, people need to remember that sleep is really not an on and off switch. It definitely is actually a learned type of skill. It takes a training process and our body responds best to, you know, what our environmental cues are and our habits to have the proper alignment with our sleep at night.

Caitlin Whyte: And of course, Dr. Joshi, same question to you. Any last thoughts?

Rajan Joshi, MD: I would like to add, you know, I think daylight exposure is so critically important. We all forget when working in an office environment, the lights we get in office is not adequate enough as like daylight. So always make sure that you have daylight exposure off and on throughout the day. You know, when there are break times and walking outside in daylight, you know, when weather permits. So I think day and night, you know, is meant to help of our body in terms of enzymes, the hormones. You know, they all work according to circadian rhythm and our biologic clock should be matching with the outside clock if possible.

The other thing we also see that if sleep disorders are not adequately treated, then they have increased mortality, increased medical disorders, accidents risk, errors performed at work, or while they are working. Absentism you know, has been quite commonly noted with patients who have sleep problems; decreased in productivity and deterioration in personal and professional relationships too. So it affect the overall life cycle as well as medical disorders.

Caitlin Whyte: Well, thank you both so, so much for sharing this information today. I hope our listeners can get some good sleep tonight. For more information, call UK Healthcare Sleep Disorder center at 859-226-7006. That's 859-226-7006.

And that wraps up another episode of UK HealthCast with the University of Kentucky Healthcare. Please remember to subscribe, rate and review this podcast and all of the other University of Kentucky Healthcare podcasts. I'm Caitlin Whyte. Sleep well.