It's Sleep Awareness Week.

So, what happens when we sleep?

Well, our heart rate drops and our breathing slows down, the mind and body can relax and recuperation from the stress of the day can begin.

Sleeping is one way that your body repairs itself.

But what about people who can't sleep, those of us who miss out on a good night's rest due to one thing or another?

A poll from the National Sleep Foundation found that on average, Americans don't get enough sleep at least three nights out of the week.

In addition, that same research found that people of color experience more trouble with sleep.

On this episode, we'll examine sleep disorders, talk with sleep experts and also a sleep study patient.

He not only underwent surgery to correct his sleeping abnormalities but now faces a new set of sleep apnea issues.

Welcome to A Su Salud, Cheers to Good Health.

I'm your host, Genesis Ortega.

We're broadcasting from inside the PPL Public Media Center in Bethlehem, Pennsylvania.

My first guest is Dr. Giuseppe Guglielmello from the St. Luke's University Health Network.

Thanks for joining us today, Doctor.

- Thank you.

It's a pleasure to talk to you.

Let's get started.

Let me ask you this.

How much sleep do we really need?

So typically about anywhere between six to eight hours is an appropriate amount of sleep.

We know that below six is too little and above ten is too much.

So everybody varies a little bit.

But generally that six to eight hours is what we're aiming for.

- Six to eight hours.

why is that?

What are some of the benefits of sleeping?

- So the benefits of sleeping have a lot to do with, as you mentioned yourself, repairing the body in general.

So it has a lot to do with the body's immune system and allowing that to recuperate.

It has a lot to do with neurologic function and how our memory consolidates itself along with our vigilance and how quickly we are able to process certain situations.

But that's only part of it.

I mean, obviously there's a lot of other benefits having to do pretty much with every organ system, especially the heart.

The heart has a lot to do with recuperation in that period.

So, you know, it's very important for that specific organ as well.

- I'm just curious.

I have a one-year-old at home and he sleeps a whole lot more than I do.

So what happens when a child sleeps?

- So that's a good question.

As children growing up, they definitely require a different amount of sleep as well.

Typically, children have extended periods from infancy up to 16, 18 hours.

And then as we get older and older, the amount of sleep that is required decreases.

But the truth of the matter is, is that it's just as important in their development and their brain health as well as it is with adults, too.

So it's a very important process for them as well.

- Now, I want to talk about the types of sleep.

And, you know, one of the reasons why I know this is because I have a Fitbit and on my Fitbit, if I wear it at night, it'll tell me how many hours I slept in REM sleep.

So what's that?

- So this is a very important part of sleep.

It's probably the most deep level of sleep.

It's also where we dream and really it becomes imperative to our neurologic health and our health overall to make sure that we get as much of that as possible.

And typically, it's about a quarter of the night that we sleep in REM sleep in various cycles.

So it's very important that you try and get that to be as efficient and beneficial as it can be.

- Are there any ways to get yourself to have more REM sleep at night versus lighter sleep or deeper sleep?

- Well, so making sure that there are things that are not interrupting your sleep are very important and making sure that you're getting adequate amounts, you know, so getting the length of time that you need is very important, but also making sure there's nothing interrupting it, like sleep apnea, restless legs, other things that can prevent you from getting as deep a sleep as you possibly can.

- Now, there's a whole host of common sleep disorders that affect people.

Can you go through some of those?

- Sure.

So probably the most common still is insomnia.

Many people, unfortunately, suffer with insomnia, and that comes from a multitude of things, from just a simple stress to other disorders.

But other common disorders that you'll typically see, again, are obstructive sleep apnea.

It still forms a very big portion of sleep disorders, restless legs or limb movements in sleep also, and then other things also that are there are things like narcolepsy or transitioning into sleep too quickly and also parasomnias or abnormal behaviors in sleep.

So there's a lot there to unfold and diagnose.

- When it comes to not getting enough sleep, what are some of the repercussions for someone who's moderately or severely sleep deprived, I mean in the short term and then also in the long term?

- That's a very great and very important question.

I mean, so there's like I said, the quickest and most abrupt changes sometimes affect mood.

Specifically, it can make people either more depressed or anxious.

But of course, there's other things that also contribute neurologically, like, again, memory changes, concentration issues.

Those are some of the more... And vigilance, you know, so some things like accidents tend to happen, you know, errors at work.

Those are very common in sleep deprivation.

And then over time, other things fit in like cardiovascular issues such as high blood pressure arrhythmias.

And then that could also lead to other unfortunate things like heart attacks and strokes and heart failure.

So there's a lot there.

And it can also affect weight and weight loss, amongst many other things as well.

- Now one of the things that you do in your profession are sleep studies.

So tell us about sleep studies and what you as a doctor look for during that.

- So sleep studies come in a couple of different flavors, one of which, fortunately, we can now do at home and the other one we do in lab.

Now, the in-lab is a little bit more involved, where we're watching brain activity and how you fall asleep and what stage of sleep you're in.

We also watch the heart and how it's functioning along with the respiratory system.

We watch how your breathing flows through the night and what your oxygen levels do.

Also, we can look at whether or not restless legs are moving.

We look at leg activity as well to kind of get an idea of what kind of abnormalities.

And in lab, too, we also have a video which also sometimes, if people do abnormal behaviors in sleep, sometimes we can catch as well.

The second flavor of the sleep study, which is the home study, that one is a little bit more straightforward.

Now, the benefit there is you obviously get to be able to do it at home.

And really the only pickup there is that sometimes it's not as efficient of a study, but it can give us really the question of is sleep apnea present, yes or no.

That's really what it's intended for.

- Now, can a patient come to you as a doctor and say, I want to sleep study?

Or what's the process of recommending a sleep study for someone?

- So typically usually people will describe sleep issues to their primary care physician.

And with the primary care physician, they will typically try and sort out if it's something that they can handle on their own.

But a lot of times they will refer to us as sleep specialists to kind of tease out what the major issues are.

So typically it comes from a referral from a primary care physician, but people have been able to seek out our help separate of that and can certainly, you know, go online and find your local physician.

- Now, Covid-19 has affected a wide sort of issues.

So I'm curious to know, has Covid-19 affected sleep studies in the way that you conduct them?

- Yes, Covid does seem to influence our entire world.

It also influenced sleep as well, and not just in the studies, but also in manifestations of disease.

Unfortunately, people are suffering more with insomnia than ever before.

Lots of stress obviously contributes to that.

But as far as the sleep studies specifically, you know, we did defer for a good period to more home studies to prevent additional exposures and not necessarily bring people into the lab at all times.

As things got to be a little bit better, we tried to see whatever safety precautions we could to appropriately get people tested in lab when we felt it required.

So, you know, it's become a big strategy for us as to how to attack this because we want to make sure everybody's as safe as they possibly can be.

And not just them, but our techs and everybody who works in those environments.

But fortunately, we've come up with an excellent plan between us and our infectious disease doctors to kind of make sure that we conduct it as safe as we possibly can.

- Now, you bring up a great point, which is pandemic insomnia.

What are you hearing as a doctor?

- Well, you know, it's been a challenge for multiple people.

You know, fortunately, my wife's a psychiatrist.

She's had to struggle through a lot of mental health issues specifically for her patients during this pandemic.

And for me, I'm a kind of an extension of that.

As you may assume, insomnia and sleep has a lot to do with mental health as well.

So, unfortunately, through the stressors of whatever has been going through here with Covid, whether financial or just generally having to figure out how to rearrange their lives, people have not been sleeping as well.

Even patients I've seen that had been doing well and treated for, say, sleep apnea, restless legs, are now losing some of the consistency that they had before.

And we've been working to kind of get that back for some patients.

So it's become a different challenge, though happy to confront it, of course.

But, you know, it certainly rearranges how we think about things.

- I remember at the start of the pandemic.

For me as a newborn mom, I also was experiencing some sleep issues at night, just thinking about how the way the world was changing and all of the repercussions of that.

So I want to ask you, too, somebody is going through those types of issues, are there any tips that they can, you know, anything that they can do to get through that?

- So, yeah, I mean, you know, one of the things that here at St. Luke's we're trying to do in general, mostly docs try to do, is try and identify what kind of things interrupt sleep, and insomnia becomes a bit of a challenge in general, specifically because trying to find what deep-rooted problems or patterns are causing that interruption in sleep become a challenge, too.

But to kind of help with that, I mean, just finding different ways with relaxation, how to quiet one's mind becomes different for everybody.

But, you know, it's certainly understanding some basic things about sleep that you need to know, which again, is keeping cell phones and TVs off around sleep, keeping rooms relatively quiet and cool.

Some people will utilize lavender scents or weighted blankets.

These kind of things can sometimes help in calming people and getting them comfortable and really focusing in.

Another thing that is very important is if you're laying in bed for an extended period of time that's any longer than 30 minutes, sometimes getting out of bed, doing something quiet, sometimes reading a book until you get to the point where you really can't stay awake anymore and then getting back into sleep, because unfortunately, people learn to develop a pattern that their bed is not where necessarily they sleep.

And that's something you have to kind of fight against.

- Now, Doctor, the National Sleep Foundation also found that people of color, Hispanics and black Americans, have a harder time sleeping.

Can that be attributed to certain health disparities, like higher rates of cardiovascular issues, for example?

- Yeah, I think that that's a very excellent point.

You know, the Latino population specifically, unfortunately, is underdiagnosed, as we all are to some degree, with some of these sleep conditions, because a lot of times we don't bring up the issues that we have associated with sleep.

But interestingly enough, looking at some of the studies that have been out there, the Latino population tends to underreport even more.

Now, is it a cultural thing or is it just an environmental thing, a socioeconomic issue?

There's a lot of factors that factor in, but it even adds more of a challenge.

When the symptoms sort of tend to be mild, they often tend to be ignored and then diagnoses come too late, you know, or significantly later than they could.

And that's a challenge that we see in these populations, which then unfortunately then leads to other conditions, blood pressure issues, other health issues that pop up before we could have maybe done something earlier.

So, you know, being extra vigilant about snoring, being extra vigilant about getting enough sleep, these kind of things become imperative to health and could be a very huge benefit specifically in these populations that might not be as symptomatic.

- Now, from a societal perspective, how important is it, for example, to have a Spanish speaking sleep apnea doctor?

You, for example, speak Spanish, so I'm sure that you hear from patients how helpful it is to have somebody that has the skill set in the language that you do.

- Yeah, I mean, for me, it became such an important thing, honestly.

I mean, I'm Italian myself, and I got to high school and they offered me the possibility of taking Spanish, French or German.

And man, am I so happy that I went to the pathway of Spanish because again, it's so imperative.

I mean, bonding with somebody is hard enough when you're first meeting them as a physician to patient.

But when you don't have that connection, at least through language, which is something so basic, it really makes it even more challenging.

And, you know, some people come in so incredibly grateful just for the fact that I can converse with them back and forth in Spanish.

And it really brightens my visit and makes my day that much better, but also allows that trust relationship to really build much easier because of that.

- A really great sleep discussion.

I hope it didn't put any of our viewers to sleep, but you are awesome.

Thanks so much, Doctor.

Muchas gracias.

- Muchas gracias.

- My next guest is Dr Michael Breus, a board certified psychologist and world renowned sleep expert.

He has lectured, consulted and even writes an insomnia blog.

Thanks for joining us today, Dr Breus.

- Thanks for having me.

I'm excited to be here.

- Let's jump right in and get started with a discussion on insomnia.

What is it?

- So there's a lot of different types of insomnia.

There's the I can't fall asleep, I can't stay asleep or I wake up and feel even unrefreshed, or maybe I didn't get the amount of sleep that I'm looking for.

And if this occurs more than three days a week for longer than three months, this could be considered a serious medical condition.

- So what happens with the body or the brain that causes people not to sleep?

- You know, it's an interesting question.

Up to 48% of older adults are experiencing these symptoms and we believe there's a physiological mechanism going on.

The research shows that when your brain is awake, it's sending a signal to keep you awake.

When it's time for sleep, then it sends a sleep signal.

Well, sometimes the wake signal and the sleep signal don't really work well together, or what's called a miscue.

That can be pretty devastating for sleep.

Also, the behaviors that people have at night, like maybe drinking coffee too late or having an inconsistent sleep schedule, all of these things can be causes of insomnia.

This is why I'm working with Merck and we're going forward with the Why So Awake campaign.

That way, people can learn a tremendous amount of information about insomnia.

- So what are the symptoms of insomnia?

How do you diagnose yourself and know that you're suffering from it?

- Well, you know, if you're having a difficult time falling asleep, staying asleep or waking up too early, those can definitely be some of the signs or symptoms.

And again, even if you get unrefreshing sleep, that can be something.

But I've got some great behavioral tips that I'd love to be able to present if I can.

- Go ahead.

Yes.

What are some of those tips?

- Absolutely.

So one of the things I tell people all the time is, hey, keep your sleep rhythm really tight.

What do I mean by that?

Go to bed at the same time and wake up at the same time daily if you can.

Other things to do.

Maybe adjust the lighting a little bit in your bedroom in the evenings, maybe 90 minutes before bed set the mood.

But also, you know, all those digital devices that you've got, go ahead and put those away, because those are pretty detrimental to sleep as well.

Now, I do have some patients who say to me, well, Dr. Breus, I wake up in the middle of the night, what am I supposed to do?

It's OK to leave your bedroom, go into a separate part of the house or apartment, wherever you are, be relaxed and calm and quiet for a little while.

Then once that sleepy feeling hits you again, go back to bed.

We do this so that way we don't have an association with the bedroom and insomnia.

And then finally, it's good to have exercise during the day.

A great way to improve your sleep, but don't do it too close to bed and try to avoid large meals before bed as well.

- How does alcohol consumption fit into this?

Should you not drink right before bed?

- So alcohol definitely has effects on sleep, and it's certainly something that you would want to avoid too close to bedtime as well.

You know, a lot of times people turn to me and they say, well, Dr. Breus, there's a lot of information here, when should I talk to my doctor?

What should I be doing here?

Please don't hesitate to talk with your doctor.

I tell people all the time, go to whysoawake.com and you can download a discussion guide.

This helps people have that discussion with their physician where they may or may not know exactly what to say.

It's also got a sleep diary and a sleep quiz in it.

So a lot of really important, good information.

But I guess the one thing I really want to get out today that people should understand is that insomnia is not a normal part of aging.

There are a whole host of behavioral and medicine treatments available.

Just ask your health care provider.

- Let me ask you this.

With the pandemic, I've read about another type of sleep disorder, which is coronasomnia.

What is it and how can we combat it?

- So, long before we had the situation that we're going in now, we actually had lots of problems with sleeplessness and I would argue that a lot of people are having significantly even more sleeplessness during these stressful times.

So I think it's pretty similar.

Just a little bit more stress going on.

- Any thoughts that you can suggest on how to just relieve some of that anxiety before bed?

- Absolutely.

One of the things I tell people all the time is, believe it or not, if you go over to whysoawake.com, we've got a whole host of resources there that people can utilize that can be extremely helpful for them right away.

- Wonderful.

Is there anything else you'd like to tell our viewers today?

- Well, one thing I think that's important for viewers to really understand is that sleep is critical to overall health.

And so what being able to understand what's going on with your sleep and address some of those issues, if you do have them, is only going to make you overall a healthier person.

So I highly recommend, again, speaking with your physician if you're not sleeping particularly well and following some of these guidelines and tips.

I think you'll find them quite useful.

- Thank you so much, Dr. Breus, for being with us today.

- Thank you.

- My next guest is Michael Nugent.

Michael was originally diagnosed with severe sleep apnea some years ago and underwent surgery to correct the problem.

Now, years later, he's suffering once again from sleep apnea.

Michael, thanks for joining us today.

- Hi, Genesis.

Thanks for having me.

- Let's start by talking about 1997.

What was that like for you?

- It was a very scary time when it originally started.

It started with a shortness of breath one night when I went to fall asleep and I woke up and it felt like somebody was strangling me, and it was a little scary.

So I went to try to go back to sleep again and it kept happening repeatedly.

And finally I said, I can't get to sleep.

What's going on?

I went to the emergency room and they did a couple of tests.

And finally they said, we're going to sit you in a room with a pulse oximeter on your finger, which checks the saturation of oxygen in your bloodstream.

And they sat a nurse next to me and an alarm kept going off every time I went to go to sleep because I started dropping so low.

That's what the alarm was set for.

And they finally determined that I had sleep apnea or they thought I had sleep apnea and they wanted me to do a sleep study.

- Before the surgery, what was it like living with severe apnea during the day?

- I would go to meetings and, try as hard as I may, just really painful trying to keep your eyes open.

You're nodding off and you've got to get up and go to the bathroom or something, splash water in your face.

And I realized at the time that that's what was happening, that I was just not getting sleep at night.

So that kind of stuff.

- Before you underwent the surgery, I understand you were fitted for a CPAP machine.

How long were you on the machine before you decided to have surgery?

- I'd say I was on the machine probably from the end of September to April of the next year when I had the surgery, and even the machine itself back then was not what it is today.

Back then, it was like one constant air flow.

It was uncomfortable.

Your nose got dried out.

It was cold there sometimes.

Now they have a machine that's so much better.

I've tried it out and it's day and night.

- Talk to me about surgery.

What was surgery like for you once you had it done?

- The surgery wasn't too bad because I had my tonsils still and they were enlarged.

I had really large tonsils.

That was contributing to it.

And part of the surgery they do, it's a long name, uvulopalatsty or something like that.

And they take out your uvula.

They took a little bit of the neck fat out and then they took my tonsils out.

So after the fact, it was just like having your tonsils out, your throat was sore.

You got to eat ice cream.

But the result of the surgery was your throat didn't fully close.

So if you were drinking something, it would sometimes go down your windpipe and they told you that was going to happen until everything kind of moved back to where it's supposed to be.

- How long did the effects of the surgery last?

I mean, were you able to get years of uninhibited sleep after that?

- Yeah, it worked well for many years.

It wasn't until recently that I fell asleep on my back one day and I woke up short of breath.

And I knew what the symptom was.

But it wasn't as bad as it was back then.

It was just noticeable that I'm a little short of breath.

I wonder what's going on here.

And I had a recent incident where I had to go to the hospital and stay overnight and they were monitoring me and they noticed that I had low oxygen saturation, a slow heart rate.

And they said, we want you to go get a sleep study.

- What was the sleep study - like?

- Well, I wanted to go for an in-lab because they can do a more detailed study in lab, but my insurance company wouldn't approve it.

They only approved an in-home sleep study.

So you have to go to the doctor's office and pick up the hardware and take it home, and they give you a set of instructions.

You put a thing on your head.

It's not too intrusive, but sleeping with anything on your head is uncomfortable sometimes.

So I did that.

And the result was I have mild sleep apnea, whereas the first time I had severe.

So I think weight contributes to it as well.

My weight fluctuates.

So when I'm a little heavier, I think that's when it's more prevalent.

- Where are you today with your sleep issues, Michael?

- As a matter of fact, today I went to the company that provides the CPAP machine to get fitted up and tonight would be the first night I'm going to use it.

So we're going to see if maybe it'll help me with any remaining sleep issues that may have come up recently, because I am a little tired during the day.

So I have a feeling it came back a little bit and the CPAP now may take care of that and I'll be full of energy tomorrow.

- Well, I wish you luck.

I hope you get a good night's sleep.

And before we let you go, I want to ask you, for viewers who might be experiencing sleep issues, was there any sort of piece of advice that you were given that has helped you through this process?

- Not really.

I mean, losing the weight and exercising is always the best option.

I know if I was in good shape and my muscles were tight, maybe even my throat muscles, I would probably not have that, but I'd let it get a little out of control.

And I think that's probably why it came back.

So time to diet.

- Well, thank you so much, Michael, for sharing your experience and your story.

Again, I wish you a great night's sleep tonight.

- You're welcome.

Thank you, Genesis.

- I want to thank our St. Luke's University Health Network expert and our other guests, Dr. Michael Breus and Michael Nugent, for joining us today.

And thank you for tuning in.

We look forward to seeing you again soon.

If there is a medical subject you'd like for us to cover, send me a message on social media.

You can find me on Facebook and on Instagram.

Plus, you can tune in to hear more of our reporting on 91.3 FM, WLVR News, your local NPR News source all day every day.

I'm Genesis Ortega, and from all of us here at Lehigh Valley Public Media, stay safe, be healthy and cheers to your health.