Hello and welcome to Arkansas Talks Health.

I'm Cristina munoz.

Today we're talking about something all of us need.

But many of us struggle to get enough of sleep.

Sleep is essential to our physical and mental health, affecting everything from memory, mood and concentration to our immune system and overall health.

But getting healthy sleep isn't always as simple as going to bed earlier.

Our internal body clocks, work and school schedules, stress, and daily habits can all affect when and how well we sleep.

And for millions of people, conditions such as insomnia and sleep apnea can make getting a good night's rest even more difficult.

Today we'll look at what happens in the brain and body while we sleep.

Why we sometimes struggle to get the sleep we need, and how sleep problems are diagnosed and treated.

We'll also talk about sleep at different stages of life, from children and teenagers to changes that come with aging, women's sleep and some of the new treatments, technology and wearable devices changing the way we understand and manage sleep.

Joining me in the studio are Doctor David de La sleep, medicine physician with Central Arkansas Veterans Health Care System, doctor Aaron Creighton, otolaryngologist and fellowship trained sleep medicine specialist with Arkansas Otolaryngology Center, and Doctor Fitzgerald, sleep medicine physician with Central Arkansas Veterans Health Care System, whose clinical focus includes behavioral sleep medicine.

And later, Elsbeth Fast, a licensed clinical social worker trained in cognitive behavioral therapy for insomnia or CBT.

I will join us virtually to explain this highly effective treatment for chronic insomnia.

We'll also hear from Doctor John Baker, pediatric pulmonologist, pediatric sleep medicine specialist, and medical director of the Arkansas Children's Hospital Sleep Disorder Center.

About sleep in children and teenagers.

Thank you all so much for joining us today.

And we also want to remind viewers that today's discussion provides general information and does not replace talking with your health care professional about your individual health and medical care.

Doctor Fitzgerald, let's start with the basics.

What exactly is happening in our brains and bodies when we sleep, and why do we even need it?

Well, I love to talk about how sleep is the fountain of youth.

This is when you're going to repair your body.

You're going to clean your brain.

You're going to restructure memory, and you're going to regulate mood.

You're going to regulate your immune system, your microbiome.

There are vital components throughout the entire body.

In fact, almost no party part of the body is untouched by sleep.

And so it truly is one of the most important parts of one of the most important functions that we have.

It really is.

And I feel like when you don't get it, you really notice that.

And it's basically because of what you just said, right?

Yes, yes.

So it really is so, so very important.

Okay.

So why does sleep leave us feeling restored or recharge?

You can just really feel the difference when you're dragging and when you're not able to get the sleep you need.

But when you do sleep well, you really kind of have that burst of energy.

Yes, Doctor Fitzgerald was mentioning all of these things are happening when we sleep, and you have kind of different stages of sleep.

And so some people know of light sleep and deep sleep and REM sleep or dream sleep.

And each of these stages is vitally important.

And each kind of have their own processes that kind of do all of those things in our brains and in our body.

And when you don't get the right amount of sleep that lets you get each of those stages or those stages are interrupted, you start to you start to feel it.

And sometimes you feel that acutely.

If you go without sleep acutely, or sometimes you have more chronic issues.

And if that sleep is interrupted over time, absolutely.

So I'm going to come over here to you and talk a little bit about those stages, because I've heard of them.

We hear REM sleep a lot and different things like that.

But can you kind of help us understand in layman's terms these stages and why they're so important?

Right.

So the brain is kind of like a truck putting in the clutch and changing gears during sleep.

And we go through different gears, different stages and the whole cycle in about 90 minutes.

And we we know now that certain of those lighter stages are important.

And then one of the deeper stages looks like it helps rinse out part of our brains, some things that are building up during the day, and then the REM sleep, the rapid eye movement, which occurs at about every 90 minutes, is like our darkroom for photography.

We're saving important memories and things we've learned during the day and putting them on our hard drive.

So it's it's important to get all these different stages in addition to getting the right amount.

Let's talk about those toxins and wastes that you're saying we kind of in a rent cycle.

If that doesn't happen, what's happening to our brain then?

Well, it's probably not good.

They're starting to link it toward senility and dementia.

And, it's important that we have it.

The problem is that only occurs during certain stages of sleep.

So now you've got to think about can you get all the different stages of sleep and exercise probably helps promote slow wave sleep, which is some of the sleep where this cleansing occurs.

So, as mentioned earlier, there's a lot of things interact with sleep, diet, exercise.

And that helps us to attain all these different stages.

And it's so fascinating because my mother is in severe dementia, and this was just brought up to us about the sleep issues that she was having prior to diagnosis.

So we found it very interesting.

Talk to us carries a little bit about the science involved in this can be kind of overwhelming and confusing.

So how do you all make sure you keep it relatable and accessible to the general public?

Yeah, well, I think that breaking it down to and trying to promote education is one of the most important things we do as sleep positions.

And sometimes, you know, a lot of my visits are spent in education.

So patients know, for example, that when you cycle through stages that it's okay to be awake for a short periods every 90 to 120 minutes, and that that's a normal, natural and important part of sleep cycling.

To be able to use the bathroom or attend to the fire, or just check your environment for safety.

And sometimes just knowing those bits of information can actually help bring down anxiety about periods of a weakness at night that are normal and natural.

Very good.

Okay, so million dollar question.

Everybody wants to know how much sleep do we actually need.

I know it's changed over time and it changes with your age, especially when you have babies.

I remember the recommendations as they were growing up and how much they needed and how important it was and how often it was interrupted, as well as the parents sleep.

But I want to start with you guys a little bit about what is the actual recommendation now for how much sleep we need.

For most adults, we recommend that they get at least seven hours of sleep, but there is a range and there is a healthy range, right?

So that range that is recommended is 7 to 9.

Most people who think that they can get by on less really can't.

And yeah, lots of research studies have shown that even if people aren't subjectively sleepy, they may not say that they're sleepy, but their performance, looks like they're sleepy.

And so that that kind of minimum of seven hours is what's recommended.

And I think kind of back to your point earlier about sleep education, I think a lot of the visits that I have with patients are just kind of focused on behaviors that interact with sleep.

You mentioned that earlier, like your work, your stress, having babies, not having babies anymore, like all of that stuff interferes with your sleep.

And so, when we're kind of talking about sleep timing and sleep disorders, all of that plays into it.

And it can be hard to, to suss out, like what's what's actually going on here.

But it's really important to kind of really dig into into behaviors.

And you're still in the baby world.

So generally baby world.

Yes, yes.

I have a newborn at home who sleeps like a newborn.

Yeah, we all know what that actually the saying sleeps like a baby is such a funny saying once you have kids.

Yes.

But it's interesting to talk about the length of time and always concerning when not getting enough sleep.

But can too much sleep be an issue as well?

Yeah, so some people do need more than that seven hours.

And so if you get more than that and you feel good and you're able to make it through your day and you have plenty of energy to kind of do what you need and want to do, then you're probably okay.

When that sleeps or too much sleep starts interfering with how you feel during the day, how you function during the day, with your mood, with your concentration.

Then that's when it becomes a problem.

Okay, so I haven't really thought about this with regard to sleep, but let's talk about quality versus quantity.

So it's not just the how much it's got to be good sleep.

Yes, yes.

That's a great point.

And just to kind of mention some of the things that might cause longer sleep, you know, so one of the most common things that we deal with is sleep apnea.

So it's interrupting the quality.

And that's resulting at times in longer need for sleep.

And we see that more in males versus females.

They may have trouble breathing in sleep and then get more insomnia fatigue.

So so we have sleep apnea.

We have certain medications or substances that the patient may be taking that lowers the quality of sleep, and, or causes, you know, maybe they're taking something for insomnia, but it's still with them in the morning.

And that sleeps not as restful because sedation is not necessarily the same as sleep.

And that's one of the big things that we're learning more and more about these days.

And then, you know, sometimes you have a circadian problem.

Your body clock is, not optimized.

And so the sleep that you're getting is not high quality.

And so even if you get more of it or longer periods, the quality is not there.

And so quality ends up being probably superior to the quantity at times.

Wow.

That's so important to notice.

So David, I'm going to have you talk more about this Arcadian rhythms first.

What is that and why does that matter so much with regard to sleep.

Right.

So we have this 24 hour cycle of light dark.

And we are built to be awake during the day and to sleep at night as opposed to other mammals and animals.

So we need to go with the flow and like caveman, when dusk comes and we need to start thinking about going to sleep and, and when sunrise we get up and the sun promotes our wakefulness, various means.

So we need to respect that and not be up shopping in the middle of the night and up and out.

We need to be in our in our beds.

It's great for parents.

Get home, it's dark outside, go home and go to bed.

How do you respond to those that simply can't?

Their job, their situation?

Children, whatever it is, is interrupting that circadian rhythm.

Well, the ones I feel the worse for are the 20% of shift workers who, you know, that's their job to be awake at night and, asleep trying to sleep during the day, which is very difficult.

And then all the others you mentioned.

Intermittent stressors, you know, family and and social stresses.

But, the shift workers are, you know, have trouble resetting during a given week of their sleep.

And then in other age groups.

I'm sure we'll talk about, some of our teenagers just don't feel sleepy until later.

So they end up shifting their their circadian phase, going to bed later, sleeping in later.

Whereas Grandma and Grandpa will go to bed earlier and be up at 3 a.m., you know.

So yeah.

Let's talk a little bit about that shift.

It's so interesting that, you know, you call yourself a night owl maybe when you're younger, but then when you're older, you want to go to bed right after dinner.

Why is that a part of how we treat our sleep patterns?

Yeah, I love talking about circadian rhythms and phase advancement and phase delay.

So phase delay is what the teenager gets.

That's like the night owl.

They want to go to bed later.

They want to wake up later.

And then advancement is what we see in our older population where they're going to sleep earlier and waking up earlier.

And we think of that as a natural, normal, you know, part of, of, aging.

But, you know, some there are some interesting behavioral things that have been looked at with this, with this advancement in delay.

So if you put a teenager under very specific conditions that that support the circadian rhythm, you can actually get them going to bed two hours earlier than what they would do on their own.

If you put them under conditions where they can do what they want to do, then they will delay 2 to 4 hours so you can have up to a six hour range, depending on behaviors of how much delay or appropriateness you know, the appropriate phase would be kind of more like a 10 to 6 pattern.

And for teenagers, that would be more like an eight to 9 to 6 pattern, versus adults, you know, or older adults especially, they may start to fall asleep in front of the TV at eight.

And, and then they won't count that sleep though.

They'll then go to bed at ten and then they'll think, oh, well, since I went to bed at ten I'll wake up at six.

But now that window of sleep is not eight hours, it's ten hours.

And they just don't, you know, they're going to especially a male in the older age is going to need about seven.

And so they're going to be awake.

You know, ten minus seven is three, three hours somewhere.

And that's not necessarily insomnia.

That is the fact that they have this phase advancement.

They should be waking up around 3 or 4 in the morning.

But because they're staying in bed, they've got all this time awake.

And that's again another point where behaviors and educations can make a really big difference in what they consider normal and abnormal.

So very interesting.

And we're going to talk about this more in a later segment.

But talking about that advanced sleep phase as we age, talk a little bit about why that happens and that desire to just go to sleep earlier.

Yeah.

So I think, you know, there might be some kind of changes in our that circadian rhythm, that kind of internal body clock.

There might be some thought that teenagers have a longer circadian, maybe it's a little bit longer than 24 hours.

Or maybe as we age it shortens a little bit.

So that clock might change a little bit.

But I think light you can't really talk about circadian without talking about light and how important light is for setting their circadian rhythm and for and for sleep in general.

And I think that kind of exposure to light, whether that's artificial light or natural sunlight, really drives a lot of, a lot of those kind of phase shifts and whether weather delayed or advancements, so on that.

No.

And I almost hesitate to bring it up.

But daylight saving time can be a very controversial topic.

Of course, it's being debated in Congress right now with the Sunshine Protection Act, and people are very passionate on both sides of the aisle.

But talk a little bit about the effects of changing our clocks twice a year, like we most of us currently do.

Right?

So there's two issues.

One is the change twice a year.

That's that's a challenge to all of us.

It's like a mini version of shift work.

But it's it's just in the spring and the fall.

And then the, the daylight savings time with a later light.

Keeping us awake later and putting us to bed later.

So those are the two issues, and it looks like the, politicians are headed toward a single type of sleep.

In this case, the late, daylight savings time.

But at least it looks like, we're headed toward getting rid of the shifts in the spring and the fall.

Okay, so stay tuned.

The first time that we've gone to, Yeah.

Daylight savings.

So in 1974, we went to Daylight Savings, and everything goes great in the summer.

But then winter comes and it's like 9:00 in the morning and still dark out.

And unfortunately, there were there were accidents at bus stops and dangerous situations that ended up being that we didn't keep daylight savings time that entire 1974.

We actually reverted back because the approval for it went so low.

So I think that in theory, daylight Savings time year round sounds great because we get rid of the shift, but it's very possible that, you know, people might not quite understand sometimes that the day is going to get shorter regardless because of the Earth's tilt.

And so we need to best be in line with standard time, which in the winter is what really benefits our clock.

So it's the winter that matters the most.

And so you mentioned that danger element of it, because normally we're taking to school in the sun and the daylight.

And if it's dark till nine that's a huge difference.

And you know, that's not the case for every city because you can be on one side of your time zone or the other, the east side of the west side of the time zone.

So it kind of depends on what side you're on.

But a lot of people will be affected by this.

And I'm from South Dakota originally, where it's very different how late the sun is up and our light.

And so it's just and of course in Alaska you've got some white nights apparently so, so many different things.

So she talked about the driving concerns a little bit, but also talk about the effect on our bodies having our children go to school in the dark or, and continuous dark for the beginning and how that can affect the kids.

Yeah.

So, you know, I mentioned earlier that that light can be really crucial to your sleep and especially that kind of early morning light that you get.

And if you are in school or you go to work early and you drive there in the dark and you do your first patience of the day, in the dark, in your first class of the day, in the dark, and you don't get any light in the morning, then you really kind of messes up that circadian, and you start getting a lot of what we like to call circadian misalignment, where your internal clock is in line with the sun and not in line with the clock on the wall.

And so then you start looking sleep deprived because you just can't get those two things lined up.

And so for our kids, it can be really tough, particularly for those teenagers who are sensitive to light and who you want to wake an alert and paying attention in class.

Wow, such good information.

I so appreciate all of you guys.

And sometimes we're simply not giving ourselves enough opportunity to sleep or our schedules, our fighting, our biological clocks.

But sometimes something is actually preventing healthy sleep.

We'll talk about how to recognize those problems and what can be done about them when we return.

We've talked about what healthy sleep looks like and some of the reasons why we don't get enough.

Now we're turning to what happens when sleep goes wrong.

From insomnia and sleep apnea to other sleep disorders, how they're diagnosed, and the treatments that can help later in this segment.

Elsbeth fast, a licensed clinical social worker trained in cognitive behavioral therapy for insomnia or CBT.

I will join us virtually to explain how this treatment can help people with chronic insomnia.

Doctor de Villa, I want to start with you.

How do we know when poor sleep has become something that we should talk to a health care professional about?

Everybody complains sometimes about sleep from time to time, but when is at that level where it's okay, we need to go see an expert, right?

So we all have different thresholds for symptoms at night.

How irritated or anxious we are with getting to sleep in a certain amount of time or staying asleep.

But really, the bottom line to an extent is how we function during the day.

So that's been mentioned earlier.

And if you're struggling before noon or after lunch to stay awake and stay focused, especially with driving things like that, then it's it's time to to get checked.

That can be very concerning, I know that, I know I can fall asleep easily, so I don't drive when I'm tired.

I have to get a ride or I can feel it, I can sense it.

And so I'm very careful with it.

I'm curious with regards to insomnia, are there parameters, scientific parameters about what determines to actually be insomnia?

Yeah.

So we you know, insomnia is inability to fall asleep or stay asleep or waking up too early despite giving yourself plenty of opportunity to sleep.

So we talked a little bit about earlier about kind of limiting our sleep.

But if you've got plenty of opportunity to sleep and you can't fall asleep or stay asleep, and that's persistent and it starts to affect your daytime function, that's when it's time to go get checked out.

Okay.

So what happens then?

We know where's the problem.

We know it's affecting us.

But what what do we do about it?

Yeah.

Well we have a standard evaluation for things like insomnia, where we're going to ask a lot about what your habits look like.

In sleep medicine, we have a standard airway evaluation.

So we're judging what your job profile looks like and, and asking questions to kind of rule out sleep apnea because it is so common.

And then other, you know, issues that might occur in sleep as well to impact the quality of that sleep or why you might be awake too much or sleeping too much.

Oh, very major concerns and definitely need to seek help and treatment.

Let's talk about I here of CPAp more often, but CPAp and PAP, what are they.

Well PAP is positive airway pressure.

So it's the response to this overly floppy airway that people develop in sleep, which is normally pretty wide open when we're awake.

But that sleep induces this, this narrowing.

And so pap CPAp is a response to that.

It's just a smooth column of air to keep the air passage open while we're asleep.

And that rids noisy breathing, snoring and then keeps the airway from blocking and having drops in the oxygen, which is what sleep apnea is.

CPAp is a very new term, okay?

It has nothing to do with Korean pop pop.

I was thinking the same thing.

Just make that clear.

Right?

But, it, it comes as a result of some of the engineers relooking at how CPAp was designed 20 or 30 years ago, and so now they're changing some of the algorithms and the timing of the pressure delivery to make CPAp more tolerable.

And there are medical treatments, medications, machines that can help.

Well, the CPAp been around for quite a while now, CPAp on the way.

And we have not had medications really, up until this point.

And that is something new that will be changing.

Hopefully in the next year or two.

There'll be 1 or 2 pills and a nose spray that will actually improve the airway function and the size during sleep, which has been hard to do.

Right.

Very interesting.

So we've talked a little bit about insomnia, but there really is a next level I guess you could say when it becomes chronic.

We all have trouble sleeping from time to time, but we want to talk about some serious issues with chronic insomnia, and it can require a very different approach.

So we want to bring in Elspeth fast to talk a little bit about this for us, and learn a little bit more about what it is you do with insomnia and CBT.

I Elspeth, thank you so much for joining us.

Thank you for having me.

So let's start at the beginning.

What is cognitive behavioral therapy for insomnia?

It is a highly effective short term, really incredibly robust evidence based therapy for insomnia.

And it takes about 6 to 8 sessions approximately.

But, in many, patients that we see, we can get, you know, 80%, resolution and some of their insomnia symptoms as a result of the therapy.

It's it's highly effective because it targets the underlying cause of the insomnia, including psychological factors that might be contributing and behavioral and distorted thoughts related to sleep or even thoughts.

You're telling yourself about your your medication that you're taking, whether it's over-the-counter or prescription medication.

Well, I mean, for people that struggle with this, this could be a huge, life changing help for them.

So who do you consider a good candidate for this treatment?

That's a great question.

When I first got trained, many, many years ago through the VA, we really were looking for somebody that just had pure insomnia disorder, kind of somebody that was very anxious about sleeping.

But, but we now know the treatment is so effective, you can get measurable results even with people with a lot of co-occurring disorders.

So in my practice, I see a lot of people with co-occurring depression, anxiety, post-traumatic stress disorder, and physical ailments as well, like chronic pain.

The really the only people that we have to sort of modify the protocol for are in cases of bipolar disorder, we don't want to restrict sleep too much because it could trigger mania.

But those patients do benefit from CBT for insomnia.

But we do a slightly modified protocol using sleep compression instead of sleep restriction.

We do the same thing if if a client has epilepsy as well.

But linking back to the definition of insomnia disorder that I would say the person that's not a good candidate is the person who doesn't have sufficient time to sleep.

So sometimes I'll get referrals for, a new mother that's having difficulty sleeping.

That wouldn't be a real appropriate candidate for CBT for insomnia, because they can't necessarily devote a full, you know, eight hours to sleeping if they're breastfeeding through the night or being awakened by the baby, or somebody working a swing shift or a night shift are not great candidates.

But but barring that, there are a lot of of modifications you can make to the protocol to really improve the quality of someone's sleep.

In CBT, we first focus on quality and then we focus on increasing quantity if we're able to do that.

So back to the room of panelists.

And Aaron kind of chuckled on the unable to sleep with littles around, because that's just not the stage of life you're in right now if you're trying to get more sleep, because that's not possible a lot of times with babies.

But I'm curious to know, knowing that this is such an effective treatment, why is it not done more often?

I think lack of access, you know, as fast as obviously, you know, super highly trained.

It's a very highly effective therapy.

There are not a lot of her around.

I don't know of anybody in the central Arkansas area.

You know, she's having to virtually being here with us today.

And I think telemedicine has really expanded access to patients kind of in general for a lot of different therapies.

But it's still not something that everybody can do.

And it also it takes some time.

And so 6 to 8 sessions for some people is a lot of work to take off of.

And things like that can, can really, inhibit the access.

That makes sense.

So, Elspeth, I want to go back to you.

So what actually happens during the treatment?

We target three areas.

We first do, really, kind of elaborate evaluation looking at the £0.03 model for how insomnia develops.

And finding out about stressors, including any prior history of trauma.

I always mentioned to to clients with insomnia, you know, sleep is one of the most vulnerable things we do.

And many of us think of the bed and falling asleep and being unconscious is pretty appealing.

But for anyone who's had a history of trauma or anything unexpected happening in their in their life, that can be psychologically like, very difficult for them.

So it's important to know about, their sleep throughout their lifetime, trauma history and even down to, I'll ask clients about messages you got about sleep growing up.

If you had a mother or father that would say things to you like, make sure you get a good night's sleep, you have a big day tomorrow.

You know, that causes you to make that connection in your mind.

That how tomorrow goes is dependent on tonight's sleep.

And I'm in charge of how much sleep I get, so we can start to develop these really distorted beliefs about sleep quite early in life.

In the therapy itself, we get baseline, a baseline sleep diary, and then we look at what's this person's average latency to sleep.

How many middle of the night time awakenings are there have, are they having what is the duration of those awakenings?

What's their total sleep time and their sleep efficiency?

And then we offer them a sleep prescription based on that data.

And we pretty quickly start targeting their distorted thoughts about sleep.

In CBT for insomnia, we do a lot of measures.

The, a Smith's measure of morning this evening.

This a beliefs about questionnaire and insomnia severity index.

It's a because it's an evidence based therapy.

We want to make sure we are getting symptom reduction you know week by week as we move through the protocol.

So along with, improving sleep drive your hunger, your homeostatic hunger for sleep, we work on strengthening your circadian rhythm, which is your internal body clock.

And then we work on decreasing nighttime arousal, which is both physiological arousal, which is, you know, how how easy is it for me to elicit a relaxation response?

Or do I feel really tired but wired when I go to bed at night?

And cognitive arousal, which is how easy is it for me to surrender my thoughts at night?

And while we're doing all of that decreasing conditioned arousal to the bed.

So we kind of go out insomnia from a multitude of different angles.

And I think that that's what makes it so highly effective.

Very interesting.

And I'm officially paranoid about what I've said to my kids with regard to sleep.

I hope I just say sleep well or something like that.

I'm not sure.

I know I'm questioning everything.

Sweet dreams.

Yes, maybe that one won't damage them too much, but, I want to talk a little bit about sleep studies, lots of TV shows and movies.

We'll we'll joke about these.

But what really is it?

How does it work?

And who needs it?

Well, it's a big topic.

And, you know, we've defined sleep through the brainwaves when they change from the awake pattern into the sleep patterns.

And so that's what classic sleep studies have involved is measuring that.

And then we've tacked on various things over the years.

We've tacked on measures of breathing measures of the legs moving or twitching.

And so that's considered a full sleep study, polysomnography.

And that's done in a facility in a sleep lab.

But over time, we've realized that some people will have trouble sleeping in a foreign environment like that and might do better at home.

Might.

Right.

And so there are some, home versions of sleep tests that are briefer, fewer monitors that can be attempted.

It's really about assessment.

I mean, trying to assess what's going on.

We're looking at the, when we have the brainwave tracings, we're looking to see if they are getting into all the different stages of sleep that we define non-REM and REM by the, the brain waves and some of the other monitors, muscle tone and whatnot.

And so we're looking to see if they achieve different stages of sleep and how long it takes them to get there and whatnot.

But at the same time, we're looking at breathing and, the legs, leg movements.

Okay.

And something we have not touched on yet I want to talk about is insurance with regard to the studies and the formal, assessments that we're getting, is that is that a concern?

Is that a problem?

Where does insurance fall with all of this?

Well, I'm probably the worst person to ask because I get to practice at the VA and so everybody gets care.

But, but yeah, you know, Medicare I believe bundles their, their services.

So you have to go a specific, you know, one thing comes after the other, a sleep study visit and then the actual sleep study and then potential treatment study with a machine on if you have sleep apnea.

And then so, you know, insurance can be different from insurer to insure.

But this is because sleep apnea in particular is so important to health and causes so many negative health outcomes.

When it comes to sleep studies for sleep apnea and particular, you usually do get a pay or to pay.

And then sometimes you know you want to do a sleep study for another reason.

That's much, much less often.

And then you have to jump through the hoops of that particular insurer.

And so what really is kind of that first step, you know, something's wrong.

You're not quite sure if it's sleep apnea, insomnia.

What's the kind of first step for people to take?

The first step is talk to your health care professional.

Kind of describe to them what you're feeling and collateral history from a bed partner or a family member who has heard you sleep from somewhere else in the house, or from a shared vacation hotel room is always very helpful.

Yes, and I always like to ask my patients, like, who had you come in today or did you?

Are you feeling bad?

Or did someone else in your house tell you that you should get checked out?

The snoring is too much to handle.

Enough.

Exactly.

And then, you know, similar to Elspeth, we do a lot of, questionnaires to try to kind of tease out exactly what's happening.

And then particularly for sleep disorder, breathing or sleep apnea, we're looking at some sort of a sleep study.

And sometimes that depends on what what are the complaints, whether or not that can be done at home or whether that can be done in the lab.

And insurance does kind of dictate some of that sometimes.

Or if you have any severe medical problems, then that also can kind of direct us, whether we're doing things at home or doing things in the lab.

I mean, that all makes sense.

Well, I want to say a big thank you to Elsbeth for joining us and helping us better understand insomnia and CBT.

I you can tell you're passionate about what you do and very well informed.

So thank you for sharing your insight with us today.

We've talked about what can interfere with healthy sleep and the different ways sleep problems can be diagnosed and treated.

Next, we'll look at how sleep changes throughout our lives and at some of the new tools and treatments shaping the future of sleep.

Medicine.

Sleep is not the same at every age.

Our sleep needs, our body clocks, and even the kinds of sleep problems we experience can change throughout our lives.

We'll begin with children and teenagers.

We spoke earlier with Doctor Supriya Baker, pediatric sleep medicine specialist and medical director of the Arkansas Children's Hospital Sleep Disorders Center.

About what parents should know about healthy sleep for kids and teenagers.

Let's hear from Doctor John Major.

Now, newborn sleep for anywhere between 14 to 17 hours.

And as they grow, this requirement for sleep slowly drops.

So at each age, the requirement of sleep is different.

Coming down to teenagers or adolescents, we say they require at least 8 to 10 hours of sleep.

And we would all know that most of our teenagers don't get that amount of sleep.

But it it it constantly, gradually drops the amount of sleep over the time that we get or we require.

Now how much sleep does anybody require?

There is no standard number.

So if somebody would tell, ask me that.

How much do I need to sleep?

There is no fixed answer.

There's a range.

So usually in adults we say 6 to 8 hours of sleep is what you need.

In teenagers it's 8 to 10 hours of sleep.

But the exact amount of sleep only that particular person knows it is the amount of sleep which if I get on a consistent basis, I'm going to function the best the next day.

That is the amount of sleep that I require.

So in teenagers there is a distinct, phenomenon or change that happens, which is the delayed sleep phase, which means that our internal clock or the circadian clock shifts in that normally the younger kids are able to fall asleep between seven 8:00.

And now, slowly, that time when melatonin kicks into the body and we start to fall or feel sleepy progressively gets delayed.

And during the teenagers, this actually shifts significantly.

And most of our teenagers cannot fall asleep till, say, 11:00 in the nine.

And now we are saying they need at least 8 to 10 hours of sleep after that, which means they wake up.

Time natural would be anywhere between seven, 8 or 9:00 in the morning.

And most of our schools, middle schools, as well as high schools start earlier than they should now.

Arkansas is not terrible in that most of the average school start time is 8:00.

We prefer it to be a 30 or later.

And, you know, there's a big movement that is going on to push it a 30 or later would be a better time to start at least high school, preferably middle school also, because that would allow a teenager who can actually fall asleep only after, say, 11:00, to get at least eight hours of sleep and then wake up and get ready.

Also, having an extremely fixed sleep routine helps in this whole picture.

Most of our children are either watching TV or, no longer TV, but maybe on their iPads or phones watching something.

There is a lot of electronics use that occurs around bedtime in bed, so it's American Academy of Sleep, medicine and all sleep physicians preach this.

No electronics at least an hour before bedtime.

Certainly not in bed.

There should be no electronic use.

And then having a very strict and fixed bedtime routine helps.

You know, having dimming of the lights at bedtime, you know, reducing the or avoiding caffeine throughout the day, especially after noon.

Having some physical exercise earlier in the day.

All of this helps with good sleep and maintaining good sleep or, you know, translates into better mood and better academic performance by the sleep clinic.

We see a lot of, parents bring in their younger children with are troubles falling asleep, trouble sleeping, staying asleep, waking up multiple times in the night.

A large part of this is behavioral, or what we call behavioral insomnia of childhood or behavioral insomnia in children.

So, most of this is not a mistake or that the parent is necessarily doing something wrong.

It usually starts off because of something and then progresses.

One of the things that can poorly affect sleep is sleep apnea.

And sleep apnea is common in children to the exact numbers are not clear because it depends on which population we are we are looking at.

But it is thought that anywhere between 1 to 3% of children may have sleep apnea.

The most common cause of sleep apnea in children is tonsils and adenoids enlargement.

But, you know, there could be other reasons.

And recently with the, the degree of obesity that we see in children and, the higher percentage of children that are obese, we are seeing obesity as a major cause of sleep apnea in children, too.

So that's something which should take you to the doctors if your child is known or if the child is mouth breathing, they actually see seeing the child stopping to breathe, snorting in the middle of the night, sleeping in weird positions with neck hyperextended, being tired during the day.

Then certainly this should be brought to the attention of the doctor, because in these cases further investigation would be needed.

Sleep apnea, if present, has to be treated because sleep apnea one disturbs sleep.

So all the adverse effects of inadequate sleep.

I want to come in like in children, as against adults, it is more common to see hyperactivity, to see impulsivity, to see behavioral issues, bad behaviors, to see mood issues, to see poor school performance, in response to inadequate sleep in adults.

They become sleepy and they become tired.

When they don't sleep well, children become hyperactive.

They become inattentive.

If the child is excessively sleepy during the day, that is of concern.

Usually, in, in the younger in the toddler age group, other than their scheduled naps and in school age children, we're talking up to middle school now again.

Teenagers, they tend to be sleepy because they have had inadequate sleep, partly because of the delayed sleep phase.

So the message to parents is that sleep is extremely important in the development of a child.

Sleep is not time wasted.

There's sometimes a concern that somebody is wasting time sleeping, so that's not the case.

Sleep is important for multiple things, and in children it is extremely important that, they get enough sleep so that they can achieve their maximum potential.

You know, intellectual, psychological, like mood wise, academic wise, physical milestones wise.

We've had a very young child, was like 18 months old with delayed milestones.

And when the patient got the patient got admitted, actually, for failure to thrive.

And we diagnosed sleep apnea, and we treated the sleep apnea.

And interestingly, in the hospital, following treatment of the sleep apnea, the child developed milestones in front of us.

So it is very important that patients sleep well so that they, you know, attain their milestones.

They have good focus, good attention.

They learn better.

Their memory is good because inadequate sleep is going to affect memory is going to affect reflexes.

So children play better.

For we know football players are monitored for the amount of sleep.

You know, people who are, paid large amounts of money to be in different teams.

They make sure that they're sleeping enough.

That's because when you sleep better, you function better.

So they will play their games better.

They will have better grades.

So it's very important that we monitor how much our children are sleeping.

Make sure that they are getting to bed on time, that they're getting as much sleep as is possible.

You know, balancing social and other requirements with sleep requirements.

It's not a good idea to sacrifice sleep to achieve other things.

So finding what the best mix is to achieve, you know, all the other stuff while getting adequate sleep is very important.

Most parents don't know how much their children are sleeping.

Most parents don't know if their children are snoring when they're sleeping in another room.

So checking intermittently is very important, and making sure that they're sleeping enough is important.

Wow.

So much good information there from Doctor John McGriff.

I took away anything major.

I think it would be.

It is very important.

I know we talk about all ages, but especially for kids and teenagers.

You agree?

Yeah.

I mean, she really just hit it home with hit a home run with expressing how important it is and all the different issues that can come up.

And it could all be related to sleep.

So Doctor John Baker, thank you so much for sharing that.

So that was a big focus on kids and teenagers and a great information for all the parents out there.

I want to switch gears and talk about women, because this thing called hormones seems to completely interrupt sleep numerous times in a woman's life.

And so talk a little bit about how sleep is so different and so affected in women.

Yeah, I think for women, sleep issues tend to pop up, kind of with different life stages.

So, you know, you've, you've, you've hit on my, on my, my newborns and my, my young children.

So that tends to be a common age or sleep gets disrupted.

Particularly in pregnancy, you see a lot of sleep disorders kind of rare, their head and pregnancy, restless legs and sleep apnea, insomnia are common in pregnancy and often extend throughout throughout the life after that.

And then kind of perimenopause and menopause tend to disrupt sleep as well, both with insomnia and sleep disordered breathing, and particularly postmenopausal women have a higher rate of sleep apnea or sleep disordered breathing than premenopausal women.

And so you start to see the kind of discrepancies between men and women having sleep apnea kind of even out.

But it looks different in women sleep.

Just breathing tends to look a little different in women than it does in men.

And so they tend to show up not falling asleep in the waiting room.

But they have headaches and they have insomnia and they can't stay asleep.

And and they don't breathe quite as noisily or as loud as the men who complain about rattling the windows.

Their partners might just say that they breathe noisily.

But all of those things are cause for concern and should be addressed.

And so when we talk about menopause, perimenopause, when does a woman need to go in and seek help versus oh, my hormones are just messing with my sleep?

Yeah.

So, you know, for women, we, start to think about hot flashes and night sweats and the insomnia and the brain fog and and always, you know, tend to we tend to chalk that up to, oh, it's my hormones.

And I think probably one of the most important things that we really nailed down today is that because sleep apnea is so dangerous and can lead to things like arrhythmia and stroke and heart attack and heart failure, among many other bad negative outcomes?

We really hone in on the fact that, sleep apnea is a big cause of this insomnia that we see.

And there's a really great saying, ovaries are not just for making babies, they're also for protecting them because our female hormones help both stiffen the airway so it won't close on itself.

And then the other thing they do is if we're having that trouble breathing, if there's a little bit of narrowing, we're not going to drop our oxygen like the men do.

We are going to put out the flight or fight alerting signals.

And can you think about having to slam on your brakes and traffic?

What does that feel like?

You're more alert.

There's more insomnia.

You are.

You become sweaty, there's more sweating.

You become flushed with heat.

And so it turns out that a lot of times those symptoms end up being present because of the sleep apnea.

And we treat the sleep apnea, they really improve.

Of course, you have to treat it fully and not partially, which is one of the challenges, but knowing those kinds of things and helping patients and other physicians understand what to look for on, you know, on the outside, what is what should a jaw look like?

And, and, you know, the fact that women are not going to present as the sleepy, loud snores, oftentimes they have a normal weight and they don't snore and they have the insomnia and the fatigue instead.

So these are vital things that when we talk about perimenopause and menopause, we consider one step further.

And Aaron, you back me up here.

Is that the way we score a sleep study ends up being vital because in the past, we've used male physiology to determine whether or not a person has sleep apnea.

And when you use that kind of criteria, that's when you see the big jump in sleep apnea, when women lose their protective hormones.

But if you use recommend what's now considered recommended criteria for scoring a sleep study, you can actually catch that sleep apnea much earlier.

And it can present in lots of funny ways.

And not just insomnia.

It might present as headaches, dizziness, a lot of acne or rashes or skin issues or gut issues.

Almost every part of the body is affected by sleep, so almost every part of the body can sometimes be a presentation depending on the genetics at hand.

Wow, that is absolutely so fascinating.

A lot of things that never thought about that fight or flight is so similar.

Very interesting.

We've talked about kids.

We've talked about teenagers, talk about women.

Let's talk about aging.

We alluded to this a little bit earlier in this show.

But, how does it how does normal sleep, I guess, change as we age.

Right.

Well, the actual amounts don't change that much.

We think they do because we have maybe more trouble at night sleeping.

But a lot of older folks, of course, will have sleep pressure during the day and nap, so they'll achieve close to 7 to 8 hours in a 24 hour cycle.

It'll just be fragmented.

But, yeah, older folks, you know, depending on light exposure, as Aaron mentioned, and activity levels during the day, all of that helps to synchronize our clocks.

And if we lose that, we become more docile and we don't get exposed to light, then we're going to have lower sleep pressure going into the night and have trouble getting to sleep and staying asleep.

So that's the bad news about getting older.

You know, more bad news.

But you know, we we now starting to understand these things and, are starting to, you know, amplify good behaviors and try to minimize bad behaviors.

I might tack on one thing to what was talking about, and, and, and, about the women.

Not that I'm the expert, but, it's interesting that, you know, hormone replacement therapy has been off the board for women for decades now, and it's now being reintroduced, and will be available to some women preparing menopausal symptoms.

So it'll be interesting to see if we can find the right dose there to help with all these, just bothersome symptoms of night sweats and insomnia.

And there's also some medications that, affect the reactivity of the blood vessels, which can result in the, some of the sweats, we think.

So, what we call basal motor symptoms.

But these drugs have not been a panacea.

So it's definitely more going on there than just replacing the hormones and getting on one of these new meds.

So, echo, Kara said, in terms of just a good general sleep workup needs to be had in many of these cases.

It's such a multifaceted conversation that we're having.

But with for we wrap up, I want to touch on wearables.

So many people are tracking a ring or a watch or a bracelet tracking their sleep.

How should we really be using these things?

I think the trend is what we should be paying attention to.

And so, you know, a lot of these will track different sleep stages.

Sometimes they don't call them what we call them in the scientific literature.

They kind of give them their own names and they use different algorithms.

But the trend can be helpful as opposed to paying attention to just one single sleep score, whatever that might be.

I've seen or heard people say that all my sleep was this, and it affects their day and their whole body.

And it could be wrong.

It could be misleading.

I would say, though, if you're if your device tells you that you should be checked out by a doctor, you probably should, because a lot of these devices do have pretty sophisticated algorithms to try to detect things like sleep apnea.

So if it's alerting you to something like that, don't just ignore it.

Don't dismiss it.

Well, you heard it here.

So that's some great advice for everybody out there.

So sleep is something that we all do.

But as we've heard today, healthy sleep is much more than simply getting a certain number of hours each night.

It changes throughout our lives.

It can be affected by everything from our daily schedules and habits to underlying medical conditions.

And there are more ways than ever to identify and treat problems when they occur.

Thank you so much to Doctor David, Doctor Aaron Crichton and Doctor Fitzgerald for joining us in the studio to Elizabeth Fast for joining us virtually, and to Doctor Supriya, John Brooker for sharing her expertise on sleep and children and teenagers.

Thank you all so very much for joining us today.

I love your expertise and I love the way you shared it so easily for us to understand.

So thank you, thank you, thank you.

For more information and resources from today's program, visit the Arkansas TV blog at Arkansas TV Slash blog.

And a reminder that today's discussion provides general information and does not replace talking with your health care professional about your individual health and medical care.

I'm Christina munoz.

Thank you for watching.

Arkansas talks health on Arkansas TV.