Deborah Heart and Lung Center Health Report
Dealing With Sleep Disorders - Pt.2
Welcome to another episode of the Dibora Health Report, where we dive into current health and medical topics to keep the Delaware Valley informed and updated. The conversation continues with pulmonologist Dr. Zishan Khan about sleep disorders and how sleep specialists are helping each patient develop an ideal sleep strategy. Here's Rasa Kay. Hi, I'm Rasa Kay. Dibora pulmonologist Dr. Zishan Khan wants to put you to sleep, not during the next 15 minutes, but at night when you should be sleeping and maybe are not, or not enough, or not well. We'll talk now about what happens if a sleep study turns up a treatable medical condition that's interfering with your nightly reset and if it doesn't, how your behavior might be robbing your rest, starting with what we consume. Caffeine, you know, is considered a stimulant. The half-life of it can last anywhere between 8 to 12 hours. So, you know, there are definitely people who have more sensitive to it as opposed to other people who are not. So, sometimes people say if they have, you know, cup of coffee or tea after 12 o'clock, they can't fall asleep until later. So, usually we recommend not having caffeine, like after, you know, afternoon typically. Alcohol, a lot of times people can use alcohol to help them fall asleep, but we know long-term use, even short use of it, can affect their sleep so they don't go into deep quality sleep and it can also sometimes make your, if you have breathing issues while you're sleeping, worse too. So, obviously, we tell people to reduce or minimize that. And are there foods you eat that can mess with your sleep or timing the meal? Yeah. So, the timing, we refocus on the quantity of the meal and the timing. So, we recommend that patients don't consume large meals, especially prior to bedtime, you know, a couple hours before bed is probably because you don't, if you eat a meal right before bed, digesting and processing, it can be disruptive to your sleep. The lighting question, you know, staring at a screen, a light in the corner or a crack through the door or just how sensitive are we to light, to incandescent light, to ultraviolet light, to all of these light sources and energy sources around us? Our natural clock, which we call the circadian rhythm, is can be triggered by different cues. So, light is one of the most powerful cues for that to kind of set it. So, in the age of technology, a lot of people are using phones, computers, whatever it may be before bed. And we know that the blue light from these things can stimulate your brain. So, again, we recommend people not to use having trouble falling asleep to not use at least an hour or two before bedtime. I think they've done surveys and like over 70% of adults have some kind of electronic device in their room and they use it at bedtime. So, it's very common. And again, we recommend people not to do it prior to bedtime because it can stimulate that part of the brain to think that it's not time for bed. It's actually time to stay awake, right? You know, we always want people to have a nice dark room for that reason. You're right. You can't obviously get over all the light, but try to minimize as much as you can. Weighted blankets. That was a big thing. I don't see them advertise much anymore. Is it your opinion that really, if it helps you sleep, go with it? Pretty much. Yeah. You know, things like that, like people swear by a mattress or a pillow. It can. Weighted blankets still have been shown to help, you know, especially kids with autism, things like that to help them fall asleep. But, you know, I think in adults, there's not such great data. Exercise. How do you balance that out? I mean, if you're sitting around and staring in a computer all day because that's your job, then it might be harder to sleep at night because you haven't been very active. But if your workout time is then in the evening, how do you time that so that you're not mistiming your cycles? Yeah. So, there's a variation. So, some patients, again, they feel like they can exercise right before bed and they actually become more relaxed, they can help them fall asleep. But many people get them wired and more excited. So, usually we recommend for people not to do exercise a couple hours before bedtime. Usually, like afternoon or, you know, early mornings, probably the best time to do it. So, the lighting thing, the daylight thing, the time changes. Why do they mess us up so badly? I mean, it's like jet lag. Turning back the clock, turning it forward, the seasonal time changes. How do we adjust to that? And why do we need to adjust to that? What does it do to our bodies? Why do we need to is more of a political answer, but our society actually recommends against doing daylight savings, right? So, the society recommends doing standard time and not changing between daylight savings, right? And the reason why is because, as I mentioned earlier, light is one of the most powerful cues for our brain. So, by changing that, all of a sudden, one hour, it's been linked to a lot of medical issues. So, car accidents, horror attacks, ER visits, all these things have an increase on that time switch. And it's because that, again, you're used to a certain time and all of a sudden, you're throwing it off, right? So, a lot of times, people are either not used to waking up early or they're waking up later. And that's what can cause this trouble for a lot of people. Okay. So, if we're traveling across a time zone, you know, even going to Chicago for a couple of days and come back, I mean, does that raise the risk of all those things you just said? I mean, car accidents, hardest results? Yeah. Well, jet lag is different. So jet lag is different than daylight savings time to changes, right? So jet lag is because you are traveling such long distances. And now, obviously, with planes, we can get places a lot faster than usual. But the treatment for jet lag is actually a little different. Usually, melatonin can actually help adjusting your schedule. And there's also other medications that can help, too. But you can try to adjust to your destination. There's actually different formulas to come up with how to figure out how to adjust to where you're going to end up being. So the jet lag is not as bad. Okay. But like it or not, we have a time change coming up. Help us cope. Try to start the process about a week early. For example, if the time is going back, you want to start pushing your bedtime about 15 minutes before every night, if you can. So it's not a big jump up by an hour, right? So, if you can try to start that process a couple of days earlier, that can make the adjustment a little easier. Using light, obviously, can help, too. You know, again, if it's for the spring, as you move the clock forward, if you want to expose yourself to bright light to kind of get your clock resetting is also helpful, too. Yeah. In the fall, when we get that extra hour, why is that so disruptive? I think it comes down to the same, same problem, right? It's the cues we're using and we're messing with our circadian rhythm by this kind of arbitrary time and day. So it can definitely cause that disruption and again, lead to all those things we mentioned before. So let's talk about the meds, the melatonin, which you can find in almost anything at this point in all of the fragrances and everything from from a lotion to a pillow to a spray. Let's talk about all that stuff because there's lots of products out there and some of it is effective and some of it is. Yeah. Yeah. So melatonin, it's been used in the past to help people fall asleep, right? People have assumed that it's a natural hormone that's created by the body to help you fall asleep, but people have always assumed that by taking a supplement, it may help them, but there's been extensive research on this topic and we actually don't recommend using melatonin to help you fall asleep anymore. It's actually used for certain conditions. So to try to reset your clock for different issues, for example, they've typically fall asleep around 2 a.m. You can use melatonin to try to shift your clock back or vice versa, or if they go for jet lag, you can use melatonin. But for kind of running the middle insomnia, difficulty falling asleep for people, we don't recommend it. Yeah, because it does doesn't work, which is interesting. So all the things that you see over the counter, most patients, if they tell me this and I take melatonin and it helps me fall asleep, I tell them, okay, that's fine. But usually we don't recommend, I wouldn't tell you, if you came to me to see me, I have trouble falling asleep, I wouldn't tell you to take melatonin. Yeah. And there's so many formulations that get 3 milligrams, 12 milligrams. There's different formulations. So the standardization has also changed too. So you're right, there's gummies, there's liquids, there's all kinds of stuff. So it makes it harder, but yeah, we don't recommend it unless it's something specific. Yeah. And what about all of these other sleep aids, whether it's type in hydromine or... Una sound or something. Exactly. Those medications were actually designed for something else, but their side effect is causing you to be sleepy, right? So that's why they've been used to help in the sleep aids. But again, we generally don't want to recommend people using medications to fall asleep because we want to try to treat the underlying issue. So if you have trouble falling asleep, for example, because you have a lot of stress in your life or something's happened, usually they're getting some kind of therapy, whereas that problem gets better, you won't need medication, right? But some of these medications can be addictive in sense too, that you may need to take it long term. And again, we want to avoid, if we can, you know, to minimize taking medications or anything, if it's possible. All right. And then the prescription medications. Yes. So what's the feeling on that? Same thing then. Same thing. Yeah. We really only recommend them if people are really struggling and they're having a lot of issues, especially if they can't go to work or whatever they may need to do and they're having trouble falling asleep at nighttime, then we may recommend it as a temporary measure. But long term using these medications is generally avoided because they have long term effects. You know, there's increased risk of falling and sometimes dementia with some of these medications too. Dementia. Yeah. You know, that would have to be, again, chronic use for many, many years, right? And some people argue or insomnia, chronic sleep deprivation can also do that. Exactly. So what? What do you do? Yeah. Okay. Does the position you sleep have anything to do with anything? Yeah. Sleep position, again, it is for something specific, it may be helpful. So for example, like pregnant women, we obviously recommend to sleep on their side more for a comfort issue, obviously, but people who may suffer from sleep apnea generally want to avoid their back because gravity kind of pushes their airway to collapse more. So sleeping on their side could sometimes help that, even snoring. If people have back or neck issues or shoulder issues, some certain positions may be able to come from. But in general, there's no magic position. Yeah. All right. So sleep apnea and the main things that you guys treat, why is it so important? Sleep, we assume that it's a restful period. So your body is recovering, right? So your brain, your heart, all your vital organs are recovering when you're sleeping. It's supposed to be restorative in nature. But if you're suffering from a sleep disorder, especially sleep apnea, it's putting extra stress on your body because you're having typically low drops in your oxygen level. And that extra stress repetitively can cause long-term damage, heart attacks, strokes, arrhythmias, heart failure, all these different things. It restores actually many different functions. So and a good analogy is like a battery, you have to recharge your battery at night time, right? So the same idea is sleep is supposed to do that. So there are studies showing that we sometimes clear toxins, so brain toxins. So there's been studies on people who are sleep deprived. There's something called beta amyloid, which is a toxin your brain produces. And if you have poor quality sleep, it builds up and it doesn't get cleared and it's linked to dementia and all these Alzheimer's, things like that. Different hormones are released during sleep, which are very important for growth, appetite, all these different things that can be affected. And obviously your cardiovascular system and everything rests during that time. So if you're having disruption or any issue with sleep, that can kind of obviously lead to significant issues. So we've got somebody who's finally knuckled under and came and did the sleep study and you have found that, you know, you're stopping breathing every few seconds or whatever, you need to address this. What are the options for sleep apnea today? There's definitely different treatments for sleep apnea. You're right. The most common treatment is CPAP, which is the mass that everybody fears that blows an air that helps the air wakes stay open. But for some patients, it's a weight issue. So if they have, if they're overweight, a lot of times losing weight can either help or eliminate the issue. There's also a dental appliance that can sometimes be used from mild to moderate sleep apnea, which kind of advances their airway and their jaw. There's also surgeries that we can do for the mouth, the jaw, the airway to help, which we again would recommend for certain situations. And then the newest thing that came out is something called the Inspire, which is a pacemaker that they implant and they run up a wire to your tongue and that can sometimes help treat the sleep apnea. So those are kind of the different levels and grades of what could be option. Sometimes we also use oxygen by itself, that can be an option too. For sometimes people who have central sleep apnea, things like that, it can be used as well. Medications are still not there yet, but there's a lot of research being done currently about certain medications that can be used for sleep apnea that may be in the pipeline in the next couple of years. Obstructive sleep apnea and a medication that might take care of the obstruction. Yeah, yeah, interesting stuff. Yeah. So the medications that have been used for diabetes and obesity, everybody's heard about these injections that everybody's on. So there actually, there's been studies now that they've can help treat sleep apnea. And again, it comes down to probably the weight for most people, but that's probably going to change a lot of the treatment too for people. And they also have now external devices that are like the Inspire. So they still stimulate your tongue, muscle and nerve to build up the strength and that can help some people to sleep apnea as well. So instead of getting an implantation, you either put something in your mouth or there's something that you put on your neck. Yeah. The surgery, what kind of surgery is that? What are you doing in there? The surgery that has been shown to do the best is something called a maxo mandibular advancement. So what they do is they readjust your facial structure and your jaw. So they actually move your jaw forward because in these people, their anatomy, their jaw and the natural structure of their face, it's more, we would say, pushback, right? So if you advance it, it opens up the airway and can actually cure the sleep apnea. But that's obviously a big surgery can only be done on certain people who have that issue. I thought you were going to tell me about like tonsillectomy or something. So tonsillectomy has been used in kids, right? So tonsillectomy and adenoids removal in kids has been shown to treat sleep apnea. But with adults, obviously the neck gets longer and it's a little different. So that's not something that would be done for adults to go in there and like move fatty tissue. It depends on the situation. It would be unusual, but sometimes if the tonsils are extremely large and nothing else, we can see is a problem and it's relatively mild. Sometimes we might say it's worth doing taking out the tonsils, but the tonsils removal as an adult is quite painful. Yeah, and it's not so fun. We're team CPAP around here though. All right, so CPAPs though. Are we too afraid of the mask and the hose and the system? Right, so a lot of times it's trial and error, but I always recommend people either seek out going to their doctor or there's these companies that supply the equipment. So a lot of times they can actually go through a lot of the different masks with you and spend a lot of time with you, but it can take two, three, four, five, six masks before you figure out what works for you. And you know, I joke around, there's almost a mask for everybody because there's so many different types of styles, sizes that may work. I think being intimidated by the apparatus up front, I think I would tell people just go in with an open mind and kind of see how it goes, right? So overall though, your recommendation for everybody for good sleep hygiene, I think the most important thing is a routine. So keeping the routine consistent is very important. So a lot of times we see that shifting the routine over time becomes this vicious cycle. And then sometimes I see people who are retired, right? They lose that motivation to wake up in the morning to go to work. Their clock keeps running, running, running, and it kind of ends up being there sleeping at 4 a.m. Their spouse is yelling at them and they're they're joking. But keeping a routine is very important because our sleep/wake cycle is kind of regulated. We talked about different cues. So waking up in the morning, getting bright light, all that helps, right? Second thing is keeping a healthy lifestyle, right? So you kind of mentioned exercise and what we eat. I think we underestimate how much that affects the way we feel and how much we sleep from that. So we try to push to maintain a good balance between exercise, diet in terms of improving your sleep quality and routine. And then I think the third thing which we also mentioned was the electronics. I think nowadays, unfortunately, it's very common and it's very disruptive to our sleep. Some sleep physicians actually recommend people not even to bring a phone or a TV into the room, right? So they say put it into another room, which is hard for a lot of people, but I think it's important because it can really just be disruptive for all of us. How do you keep people on their regimen? We mentioned that not treating, especially sleep after any of the sleep doors or sleep disorder can have long-term consequences. So we always worry about, obviously, heart issues. And there's been studies linking heart attacks early, cardiac arrest, early morning cardiac arrest has been linked to sleep apnea that's not treated. Many arrhythmias are linked to sleep apnea not being treated. So it's very important to, if you're unable to tolerate CPAP or whatever treatment you're getting, to go back to your doctor and discuss that and find what works for you because there's several options. Then at the end of the day, if it's significant, the sleep disorder, it needs to be addressed. Tell me about the Deborah Institute for Sleep Medicine. Who do you see? How do they get here? They either go on the website or they can call the phone number. They can come to our sleep clinic, which we have here. It's been here for several years, one of the oldest sleep clinics in the state and actually the lab. Our mission is to kind of address any sleep problem, right? So it may not just be a sleep apnea, it may not be insomnia, it could be any sleep disorder, we try to provide a comprehensive sleep center where we can address almost any issue, whether we can help it here or may be referred for some specific therapy somewhere else, but we're always willing to evaluate the patient and help them in that way. That's Deborah pulmonologist Dr. Zishan Khan. Our next health topic might not be as restful as sleep, but our conversations with the experts at Deborah can certainly give you some peace of mind. We have another one on tap and it will be available the first Wednesday of the month. I'm Rasa Kay. You can always listen to all of the informative Deborah Doctor interviews at doborahealthreport.com. Schedule an appointment at demandobora.org. [BLANK_AUDIO]
KYW Newsradio's Rasa Kaye continues her conversation with Deborah Heart and Lung Center pulmonologist Dr. Zeeshan Khan. They discuss how sleep specialists are helping sleep disorder patients develop an ideal sleep strategy.