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Caitlyn Whyte: Sleep has never come easy for me personally, but in this time of COVID, it's gotten even worse. Here to help us catch some Z's is Dr. Anita Naik, the Medical Director of University of Maryland's Harford Memorial Hospital Sleep Disorder Center.

This is the Healthy Hero podcast from UM Upper Chesapeake. I'm your host, Caitlin Whyte. All right, Dr. Naik, what sleep complaints have you been hearing about most since the pandemic? I'm sure there's been so many different kinds.

Anita Naik: Yes, definitely. Some surveys from our Academy of Sleep Medicine have recently estimated there's been almost a 30% rise in sleep complaints since the pandemic, you know, since early March. And I've certainly seen it in the clinic and I've seen just, you know, friends and family complaining more about sleep issues. I think probably the most prevalent sleep concern I've been hearing since the pandemic is that I'm having trouble getting to sleep. And as a result of that, you know, they're tired and fatigued during the day.

But I think one of the newest and biggest complaints is inability or difficulty falling asleep. And if I had to pinpoint that to what's going around globally, I mean, obviously this is unprecedented for the world is I think there's more anxiety. There's more issues with uncertainty. And I think, you know, anxiety does play a big role in insomnia in general. And now we have a global situation where there's definitely more, you know, anxiety and worry about people's health and infection, COVID, what's happening to their families and to their workplaces and their work environments. So in that respect, I think anxiety and worry is playing a role of people's inability to fall asleep.

But more tangibly, I think it's also the blurring of work and home. Now that more people are working from home, I believe I can assume that there's not that hard and fast border that, "I'm at work and I'm coming home and I can kind of turn off the switch." I think because people are working from home, there's probably some blurring of when that work day ends and they're on their computers longer.

There's a lot of people joke around Netflix. People also entertainment-wise are kind of maybe watching more TV because they're stuck at home and they can't do their usual activities and socialize as much. So people are using more media. And that light source that light from these media sources also plays a role in the inability to fall asleep. So I think there's a lot of different things at play, but certainly there's been a rise in complaints of insomnia.

Caitlyn Whyte: I know all of the things you just listed are reasons I haven't been getting to sleep lately. So what are some things that we can do to sleep better?

Anita Naik: It's a great question. This is something I address in general, even before the pandemic. There's lots of behavioral things that we can do as, you know, patients to help us improve our own sleep without the use of medication. So we kind of couch that term as sleep hygiene or good sleep behaviors. One of those things is try to regulate a sleep and wake time, try to keep it fairly regular because your body kind of winds down and your own body gets used to certain rhythms of winding down. So, you know, within reasonable margin, try to keep your sleep time and your wake time relatively consistent and try to avoid big, you know, sways in that time. So that helps regulate things.

Along with that, as I mentioned earlier, try to limit the bright light exposure you have. We know that, you know, there's glasses that filter out the blue light, which is supposedly the alerting light. So that might be helpful if you really have to work on your computer or phone late at night. But really, we really ideally want people to turn off light sources and media an hour or two before they want to go to bed, just so the body can wind down.

Light is a very potent stimulator for the brain. And so even if you're watching something boring or relaxing on TV, I mean, the light coming off of that device is still very stimulating. And so it'll trick the brain to stay alert and stay awake. And it'll take longer for you to wind down if you're watching TV in bed, which I'm a big proponent against doing that.

So those are things that we can do behaviorally. Not eat too close to bedtime. We really don't want you to eat or drink two or three hours before bedtime. You should really shouldn't have a glass of water on your at nightstand sipping it all night, because that'll make you go to the bathroom more. These are sort of practical things.

Caffeine, we typically tell people to limit caffeine after 4:00 PM, really try to get it out of your system. Some people are very caffeine sensitive. It does last in our system for hours, whether or not you're aware. You may be able to go to sleep or you may not be able to get into deeper stages of sleep because of caffeine.

Those are the kind of behaviors. Really keeping your sleep environment, cool, dark, uninterrupted, no distractions. These are things that we can all definitely impact on.

Caitlyn Whyte: Now, what if we've tried all of these lifestyle changes, what are the signs and symptoms that there may be something underlying like a sleep disorder?

Anita Naik: Yeah. So these are the things that, you know, obviously you want to discuss with your physician. A lot of primary care doctors are excellent at screening for some of these things. Some of the symptoms that are more concerning that there is something actually organic going on with your sleep, maybe the presence of snoring.

So obviously, one of the most prevalent sleep disorders is sleep apnea, obstructive sleep apnea, which you may have heard of. And some of the symptoms of that are snoring loudly or consistently, usually obviously it gets worse when you're on your back positionally. But snoring, sometimes the bed partner or spouse can notice that there's a pause in the breathing or it looks like they're holding their breath for several seconds. And then they suddenly gasp and have a big, you know, intake of air. So A weird breathing pattern where they're stoppage of breathing or shallow breathing accompanied by snoring is a very troublesome sign.

You know, weight gain also along with snoring, kind of getting worse, tells you that maybe there's sleep apnea at play. It's very much a weight-related issue for many patients. So if you're gaining weight and snoring more loudly and having more interrupted sleep, that's probably a recipe where this could be sleep apnea.

If there are lots of movements or very restlessly or you're kicking and moving a lot at night, that could be an indicator of a sleep disorder, waking up with headaches, dry mouth in the morning, and feeling exquisitely tired and sleepy, despite getting, you know, six, seven, eight hours of sleep, but you're just, you know, very, very sleepy during the day, that's also an indicator that there's potentially something else going on with the sleep.

Caitlyn Whyte: One of the biggest sleep disorders that maybe many of us know of is sleep apnea. Tell us more about that.

Anita Naik: Right. So sleep apnea is very much a mechanical disorder to a large extent where the airway, the upper airway, anywhere from the nose to the back of the throat, the tongue, the upper airway is blocked to some degree and it collapses down when we're asleep. Now, this is not an issue when you're awake and upright, but when you're asleep and all the muscles relax and the tongue sort of rolls back and the jaw relaxes, is that a structure that then blocks the air flow going, you know, into you when you're asleep. And if there's a blockage of that airflow that could result in your oxygen level dropping and that oxygen level dropping then is an alert system to the body that this is a stressor. "I don't like this. Wake up. Go to a lighter stage of sleep because I'm not breathing properly." and as a result, you get chased out of deeper, more restorative stages of sleep and you either wake up consciously or you go to very light stages of sleep and it's a very fragmented sleeping pattern as a result of that.

Again, obstructive sleep apnea, we see that the prevalence goes up as your body mass index goes up. So the heavier you get, the more weight around the neck, et cetera, you know, you have a higher risk of sleep apnea. We know men get it a little bit more than women. Post-menopausal women tend to have more sleep apnea than premenopausal women for hormonal changes. The other issue could be your neck size. So we know that men, especially with collar sizes over 17 inches, probably have a higher prevalence of sleep apnea.

It's important for me, as a lung doctor as well, and as well as the primary care doctors and cardiologists out there, sleep apnea is associated with high blood pressure. It's associated with cardiac rhythm issues. It's associated with poor metabolism and weight gain. And it has a whole host of sort of cardiovascular relationships. Early stroke risk and heart attacks, things like that. So it's not a direct one-to-one, but they run together. So we think it's a risk factor for cardiovascular diseases as well.

Caitlyn Whyte: And what is the treatment when it comes to sleep apnea?

Anita Naik: So there's good treatment right now. I know a lot of my patients will come in and say, "I have a neighbor, they have this horrible looking mask they have to wear, and I don't want to wear that." So they usually start the conversation that way, but then I usually spend some time and educate them that, you know, this is a very effective treatment.

The good news is compared to, you know, 10 years ago, the masks that we use-- So what we use to treat sleep apnea is a mask of some sort to either can cover the nose or the nose and the mouth if you're a mouth breather and it's humidified air pressure. And what that does is it literally acts like an air splint and push us through that, you know, obstruction in your upper airway to keep everything open and patent, and that allows for you to breathe normally at night and not have that interrupted sleep.

So that's sort of the gold standard or treatment now. Having said that there's a lot of new experimental things going on, a lot of my patients have heard of a new FDA approved device. It is an implantable device that can help with sleep apnea. And that is more invasive because it's almost like a pacemaker type of a device.

So that's an option for people who really can't tolerate CPAP, but C-PAP right now is still the gold standard of treatment. It's non-invasive. There's really no side effects at all. It does get ticking and you have to get used to wearing it, but I'll tell you the majority of our patients, if it's done right and if you have the right support system and a good physician taking care of you, they tolerate this extremely well. And I have many patients who will not sleep a day without it. I mean, they travel with it. They can't believe how much better they feel and they won't sleep without it.

Caitlyn Whyte: Great. Well, Dr. Naik, any last minute sleep tips for those of us, just having a hard time with this whole pandemic?

Anita Naik: I wish I had an answer to that, but I think the main thing is to be patient. I think, you know, things are getting better. The vaccines are out. I do urge everyone to strongly consider getting the vaccine. I think that'll be a way out of this pandemic and stay safe and do all the normal precautions that, you know, the CDC and scientists are telling us to do.

But I think the main thing is to realize that, you know, this will get better and, you know, to help manage your anxiety. Do things that give you relaxation, give you ways to, you know, eliminate or help manage your anxiety better. I think your sleep will get better if you're not stressed out, if you're not anxious about everything. Adhere to those good sleep habits the best you can. Try to create a border between work and home if you can. You know, turn off those lit devices at an appropriate time. And, you know, exercise, eat right. Do all the things that we normally would recommend to get us through this difficult time.

This is again an unprecedented time and these are steps that we can all take some ownership of our individual lives and our families to get through this. And I think it's something you have to be hopeful about, now we have reason to have more hope with the vaccine and the precautions that everyone is taking.

Caitlyn Whyte: Well, thank you so much for joining us today, Anita. I'll definitely be trying some of these tips out tonight. Visit you umuch.org/healthyhero for additional resources and help related to COVID.

And thank you for listening. This has been the Healthy Hero podcast from UM Upper Chesapeake. I'm Caitlyn Whyte. Stay well.