(light music) - [Male Voiceover] The region's premier medical information program, Call The Doctor.

- [Female Voiceover] Good sleep is the backbone of good health.

Sleep does so much for our bodies and our minds.

We all get a bad night's sleep once in a while, but not getting enough sound sleep over a long period of time can affect everything from memory to mood, from high blood pressure to diabetes, weakened immunity, even weight gain.

And there are a number of sleep disorders that can rob us of that restorative time.

We've asked the experts to help us find ways to get more Zs in this episode of Call The Doctor.

- Hello and welcome to Call The Doctor.

I'm Julie Sidoni.

I'm the News Director here at WVIA and also the moderator for the show this season.

Now this final topic of the season, some say, might be the most important topic of the season, "Sleep".

We all need good sleep.

Entire industries have been built around getting people more quality rest, but few people truly understand sleep, what's happening in our bodies and our minds when we're sleeping.

And if there's a sleep disorder, what kind of stress that can put on our bodies and our minds?

We're excited to speak with two experts on this topic.

I have a lot of questions and I'm gonna ask you both first.

Welcome, I would love for you to introduce yourselves and let people know where we can find you.

We'll start with you, Dr. Morse.

- Thank you so much.

I'm very excited to be here as well.

My name is Anne Marie Morse.

I am a physician with Geisinger Medical Center.

I'm a Director of Child Neurology and Pediatric Sleep Medicine there.

- [Julie] Welcome, it's great to have you.

- Thank you.

- [Julie] And Dr. Khan.

- Yeah, thanks a lot.

I'm Shazad Khan.

I am a Neurologist with special interest in Sleep Medicine.

I work for Lehigh Valley Hospital.

I am available at Health and Wellness Center in Hazelton as well as in Lehighton.

- [Julie] Hazelton and Lehighton, so you travel a little bit in your system.

- Yes.

- And you do, too as well, right?

- Yes.

Yes, definitely.

We are in Danville.

We also have offices in the Poconos Regions, Wilkes Barre, Scranton, and Muncy.

- All right, great.

We'll dive right in here with, I mean, it's a silly question, but I think when people think about sleep, they think that we're conked out, right?

We're done and everything is sleeping and resting, but it sounds as though that is really the opposite of what's actually happening.

I'll let you both take this one.

We'll start with you, Dr. Morse.

What's going on when we're sleeping?

- Sure, so what you're describing is something that we very commonly hear is that I can get away with less sleep.

I'll sleep when I'm dead.

And the reality is, is that medicine has perpetuated that.

Why?

Because it wasn't until the 1950s where EEG was developed.

That's where we put the stickies on the head to be able to look at the electrical activity of the brain.

What we'd learned at that time was that sleep is not actually something that is just kind of nothing's going on.

It actually is a very active and dynamic state.

We recognize that there's different stages of sleep that we cycle through throughout the night, every 90 to 120 minutes.

Non-REM 1, Non-REM 2, Non-REM 3, REM sleep.

And what we've learned by studying these electrical activity and when people are sleeping or not getting the right duration, quality, or timing of sleep, is that just as you've described, there's a lot of adverse outcomes that can occur.

- What about you?

What do you tell your patients?

- Yes, I always tell them it's very important for the health of your body, including the brain and heart and other part.

It's very important that when we sleep, next day, we recharge ourself.

It restore different functions in our body.

It's very helpful that we make new memories, we learn and also helpful for immunity.

So it has so many vast functions to help to rebuild and recharge for next day.

- What about when it rises to the level of perhaps, needing medical intervention?

So someone has a couple of bad night's sleep, or it happens once in a while versus you're chronically not getting enough sleep.

Is there a time when you would prefer, again, I'll throw this to both of you, Is there a time when you would prefer your patients to come in and tell you at the very first sign?

Or is there something that you look for in a length or severity of someone not being able to sleep very well?

- So most typically when you look at how we diagnose sleep disorders, we generally are identifying people who have more chronic disposition.

And when we say chronic, we're saying that this is typically occurring most nights of the week for at least three months.

Now, the reality is, is that no one needs to be sitting here listening to this show and going, "Well, it's only been two-and-a-half months, (Julie laughs) I better not say anything just yet."

The reality is if you're experiencing chronic nocturnal dysfunction or you're experiencing daytime dysfunction, you're waking up not feeling well-rested, you're having more irritability and moodiness.

just as he's described with the cognition or the learning component, you're feeling like you have brain fog.

You can't recall things.

Those are all your calls to action that you do need to talk to your provider and see whether or not there's a role for you to see a sleep specialist and to have further investigations as to what can be done to improve this.

- So not sleeping is just not normal?

- It is not normal.

It's definitely something that we all need to address.

And the reality is that because the majority of the United States does not sleep well.

We've all adopted this mentality that this is normal because they're not sleeping, you're not sleeping, she's not sleeping.

So that just must be the norm.

The reality is in 2014, the CDC came out and stated sleep disorders in United States are an epidemic proportion.

This is a public health crisis.

As we have all gone through a pandemic, we know what epidemic looks like.

And so, we really need to recognize that if we're struggling, we do need to respond to that.

It's not normal.

Sleepy's not normal.

Sleep deprivation's not normal.

Abnormal timing of sleep is not normal.

Those are all reasons for you, definitely take it seriously.

- Yeah, I see the most of the time, patient don't recognize it.

Majority of the time, their bed partner is the one who was saying something about the snoring or sometime, leg movement.

Or they are the coworker are saying that they are sitting in the meetings and falling asleep, or they are driving the car and have had the accident.

And then suddenly, you know, that you are seeing the patient and majority of the time, patient don't recognize.

The only few patient who recognize that majority of the time are the patient who has poor sleep at nighttime, when they feel like they cannot fall asleep.

Or when they wake up in the morning, they don't feel like they are fully awake and alert.

Or they start, the majority of the time, they start buying some pills from the stores.

- Right.

- And if I see some patient with a stroke and with the headaches, and when I try to talk to them about symptoms, like sleep apnea that, "Do you snore, or do you have any gasping?"

So they don't appreciate it.

Even their spouses that, "No, he's not saying right.

He snore a lot.

And I saw him that he's gasping and he's breathe with the open mouth.

My dad used to do that.

Nothing is new for me.

- Yeah.

- Although it's have very bad health consequences.

So we try to ignore it.

I think more education about the sleep disorder is gonna be helpful.

- Yeah.

And when you talk about snoring and the bed-partner effect, it's interesting because snoring, and obstructive sleep apnea has now become the third leading cause for divorce.

And the reality is, is that we see this slowly evolving because what happens is that this one of the bedmates are snoring.

They're stopping breathing.

The other partner's elbowing them.

Now they start sleeping in different beds.

And it just becomes a deterioration because now it's not just a sleep thing.

Now that person, when they wake up, they're both irritated.

They're both moody.

No one got a good night's sleep.

And so, you become more reactionary.

And so, it does end up being this vicious cycle of that it doesn't just affect the person.

It generally affects the whole family unit.

And so I think that's a very perfect example because you're right.

When we are eliciting a history in the clinic, many times I'm asking the patient, but I'm also asking everyone else who is involved - Involved, that's true.

- and is a witness for sleeping.

- I have seen a patient.

The couple was not sleeping in the same room for 25 years because of the snoring.

- [Julie] Wow.

- They are sleeping in different floor.

So it's like, it's so amazing to hear those kind of story.

- But they shrug it off thinking, "Well, my dad did it, so and so does it, I guess this is just what everyone does.

- 100%.

And again, when you look at the historical perspectives in the early 1940s and 1950s, there's tons of medical description of that.

This is just a cause of laughter to be able to mock and laugh at someone who's snoring.

Even to this day, we do a lot of that with other sleep disorders.

- Uh-huh.

- You take someone who has something called a Non-REM Parasomnia that's examples of sleepwalking, sleeptalking, abnormal behaviors coming out of sleep.

You go on YouTube and Google that right now, you're gonna see tons of families who've posted videos of their kids or their family members doing bizarre things outta sleep.

And the reality is it that it very frequently, can be a sign of a sleep problem.

And there's potential safety hazards there.

- Sure.

- So they can fall down the stairs.

They can walk outta the house.

They can drive a motor vehicle while asleep.

So the reality is, is that we do de-emphasize the importance of sleep.

And that's a major challenge because when you think about what sleep is, we many times are taking it for granted.

And what it actually is, is something that should be considered no different than any of your other vital signs, because it's a homeostatic process that your body must go through every single night.

And when you talk about a homeostatic process, I generally would like to give a comparison to another one that we're all familiar with.

- Sure.

- Your body temperature.

- You should be a balmy 98.6.

If you woke up this morning and your temperature was 94 or 104, you wouldn't be sitting here with me.

You would be at your doctor, not because of what that absolute number is, but what it represents.

It represents that your body is in dysfunction.

- Something's wrong.

- And if you'd left unattended, you're gonna get sick.

You're gonna die.

And the reality is if you're a typical adult who should be sleeping seven to nine hours, and you're sleeping four or 14, that same knee-jerk reaction needs to occur.

You need to really engage your provider and say, "Hey, I'm waving a white flag.

Something's wrong here."

- Let's talk about that a little.

Because when we hear sleep issues, I think we often just assume we're talking about not enough sleep, but people can oversleep as well, that is also dangerous?

- 100%.

- Yes.

- Well, I'll ask you about that.

- Yeah, that's true, that's true.

Like sleepiness, again, the activity time, sleepiness is different for different population.

Like a child can sleep up to 14 hours, but it can be a normal in the young age.

But a person like adult, like 25 plus, sleeping more than 10 hours, it just can be abnormal.

They are not paying attention in their meeting.

So they're falling asleep while driving.

So this can be abnormal.

The causes can be a variety of the reason.

The one of the common cause is the depression.

- Mm.

- That can cause the daytime sleepiness.

And we need to work into that.

The other common thing's can be a sleep apnea, which is also, it's a common entity.

And then they are very uncommon cause for the daytime sleepiness, which can include the narcolepsy, which is a different variety of the sleep disorders, can be seen in young, quite a very young population.

So there are more than one variety of the sleep disorder, which can be due to the excessive daytime sleepiness.

And again, at that time, if you feel like you are sleeping more than normal, then you should seek an advice from your provider.

- Narcolepsy, insomnia, sleep apnea.

Those are some of the biggies that you see most commonly?

- So I would say that narcolepsy is when I think people should be aware of.

It's a rare disorder, however, affects about one in 2,000 people.

When you're talking about the more common conditions, you're talking about things, like obstructive sleep apnea, insomnia, Many times like to try to bucket it out for people to really think about what kind of sleep disorders can there be.

And if you look at the "International Classification of Sleep Disorders," Third Edition, there's over 70 different types of sleep conditions that we could talk about.

- Wow.

- The reality is is you wanna bucket it out into duration problems, timing problems, quality problems.

If you're getting too little, too much, that's your duration.

Timing is, are you sleeping at inappropriate times in a day, going to bed at 3:00 AM or going to bed at four o'clock in the afternoon?

Or a shift worker who doesn't have a consistent schedule?

And then the quality is a variety of reasons.

It could be restless leg syndrome, obstructive sleep apnea, something else that is disrupting your ability to maintain normal restorative sleep.

- So somebody who's watching right now, I guess one question could be for them, timing, duration, quality, then how quality or how good, since the word quality is already used there, how good are those three?

That would be an example of a question you would ask a patient if they come to you?

- 100%.

And so, I think that many times the patients who are coming to us have already predetermined that.

I'm concerned because my quality is poor.

I'm concerned because I'm needing more hours of sleep than what most people my age need.

Or it can be just as he's described where, "I just had a motor vehicle accident.

I fell asleep at the wheel."

- Hmm.

- So all of those are definitely possible.

- Yeah.

Usually again, the patient don't come by themselves.

Like they are someone else is pushing him, asking them to go to see a sleep doctor.

- [Julie] Please go.

- So this is, this is the common scenario that someone has told me, like say, the truck drivers.

So they come to see a sleep specialist only because their neck sizes is 17 or 18 or 19 inches.

So, and they are majority of the time they are male, majority of time, they are obese, but they don't accept it that they snore at nighttime.

And when they're diagnosed, "You have sleep apnea," they don't accept it.

They say that, "This is the doctor who's saying me that I have a sleep apnea just to make some money or make some bucks."

And then you have to, literally, you have to beg them and the CDC has strong guidelines for those patient who has some increased neck size or the obesity to go through the sleep, pursue for their diagnostic and treatment modalities.

- And I think it's important for people to hear that it's not about there's any incentive for us to diagnose it.

Why are those types of laws in place?

Because we recognize that excessive daytime sleepiness is not normal.

It causes you to have a compromised psychomotor vigilance, reaction time.

And so the reason why when someone is a commercial driver, there's so much attention to this, is because if they do have untreated sleep apnea, they are a driving risk for themselves and others on the road.

And so those who are not commercial drivers, carry that same risk.

And in fact, as a sleep professional, if I am seeing someone who I know drives and is successfully somnolent, one of the things that is a part of my obligation is to say, "Are they safe to drive?"

- [Julie] Mm-hmm.

- And I sometimes do have to take away licenses for that reason.

And so, I think it is really important for there to be that communication of why are we doing these?

Because many times people are resistant.

Because we're a society that accepts sleep as being an alternative rather than good quality sleep being something that's contributing to overall wellness and health.

- I wonder how that happened, where we all think of it as a luxury or isn't that nice that you got eight hours of sleep when that really should be the norm for some people?

- Yeah.

I think it's competing priorities.

I think as we've increased the number of things that we need to accomplish in a day, sleep has become secondary.

I think one of the things that we definitely had seen during COVID is a new attention to sleep because when everything was shut down and people were actually able to get the right number of hours of sleep and retrain their schedules, when they start having to go back to work or going back to school, there was this newfound attention to, "This is different than what I was getting before."

And so, I do think that we have so much that we wanna get done in a day.

And that seems like the place that we can cut corners on, - Mm-hmm.

- And that's where that mentality of, "We can get away with less sleep."

But unfortunately that's far from true.

- Dr. Khan, I would like to ask you about naps.

I think a lot of people, I personally am not a napper, but I know a lot of people who swear by them.

Where do you as a sleep professional fall on the naps scale, do they help or do they hurt?

- Again, this individualized question, like there are some sleep disorders which helpful during which we ask, I will say that, "You take a short nap, like half an hour naps."

Like narcolepsy, in those patient, we do recommend to take naps.

Although in those patient who has insomnia, we don't recommend to take a nap at all, not even during the daytime or in the evening time.

So naps does help in some patients, but as for other patient it's not that beneficial.

- So it really depends?

- It depend on the diagnosis of what the problem they have.

- What do you tell your patients about naps?

I'm sorry, I didn't mean to cut you off there.

- That's fine.

- Yeah.

So I think very similarly, I think you do have to always tailor a plan for every individual's journey.

And I think when we are identifying periods that may potentially be high risk, you feel sleepy, but you need to drive.

A strategy that has been shown to be effective is taking a nap right beforehand.

So using a 20 or 30-minute nap to kind of rejuvenate yourself, to allow yourself to improve that reaction time.

I think individuals who have shift work disorder, many times we may use napping in order for them to get through the day.

And so this is where we have to try and work with our patients to understand what plan makes sense for you.

It can't be one size fits all.

And so, we do just wanna be cautious of when we're making those recommendations.

And I a hundred percent agree, 20 or 30 minutes is really that maximum that you wanna offer.

Greater than that, many times, you're just gonna distort your next night's sleep.

- So someone with a sleep disorder doesn't get help.

Doesn't come to see you.

Let's do a quick rundown of how that might come out in their bodies, in their systems, in their minds.

What will this turn into if it's not fixed?

- So when you're looking at the consequence of inadequate or problematic sleep, we see it affect every single organ system in the body.

So if you go back to that analogy to your body temperature, if you have a dysregulated body temperature, it's gonna affect every organ system, same thing is true for sleep.

So when you think about just starting from the head down, cognition, you're going to have impaired cognition.

You're not gonna be able to pay attention.

You're not gonna be able to recall.

You're not going to be able to process as quickly.

Mood, you're gonna have increased risk-taking behavior.

You're gonna be more likely for depression, anxiety, there's even evidence to suggest that individuals who have preexisting depression are higher risk for things, like suicidal ideation and attempts, when there's comorbid sleep issues.

- [Julie] Mm.

- You can move on and go into your heart.

You can go to your hormone system, so you can change how your body processes, feeding behaviors.

So you can end up feeling more hungry and less full by eating things and choosing poorer quality foods, which then results in increased likelihood for obesity, diabetes, and all these others.

I think you could probably also add a variety of other.

- I like to add more of the heart because the people do pay attention on the heart activity, like, - The heart, rate, sure.

- So the heart likes, heart, myocardial infarction, like heart attacks can happen.

You can have irregular heart rates, or like atrial defibrillation, which is common cardiac arrhythmia which can cause lot of comorbid condition.

And then you can have a hypertension, like nowadays, one of the good treatment for the hypertension is the CPAP machine.

- [Julie] Mm-hmm.

- It's very common to have the sleep apnea in those patient who have hypertension.

So you can develop hypertension, you can develop congestive heart failure, and even you can have a stroke and death due to the sleep apnea.

I'm going to all the way up to the highest level, which can have a bad effect on the health.

Diabetes is the one thing which you can have.

Even the people who go to bathroom on multiple times during the night can be due to the sleep apnea.

And if they use the CPAP machine, they don't go that often to the bathroom.

- Oh.

So they think they have to get up and- - Yes, like three or four times they're getting up, so this is one of the signs for the sleep apnea.

- Yeah, and that actually has a very interesting pathophysiology behind it because most people think, "Oh, it's because I'm waking up, it's making me have to use the bathroom.

- [Julie] Right.

- But unfortunately, when someone's having sleep apnea, what happens is they get stuck in inhalation.

So their lungs are fully expanded.

What that does is it actually brings more blood back to the heart and decreased blood outta the heart.

So it temporarily gets overfilled.

And when our heart feels overfilled, it creates peeing factors that says you need to urinate.

And so that's what happens to people is they're waking up multiple times in a night.

For kiddos, what we're seeing is that they're wetting the bed.

So, many times parents go, "I don't understand.

He was potty trained.

He stopped wetting the bed.

He's now 10 years old.

He started wetting the bed again.

I don't understand what's going on."

And many times, sleep apnea can be a reason that we're seeing that.

In the adult population we frequently are seeing, they're complaining of waking up five, six times in a night to go use the bathroom.

- And they think, "I'm just getting older, I guess this just- - A hundred percent.

- this is just what happens.

- Exactly.

It's my prostate.

It's this.

It's that.

So there's again, we use circuitous reasoning to say, "Okay, this is the reason why I'm experiencing this."

But the reality is is that there may actually be a disorder at the heart of it that can be corrected and improve overall quality of life.

- I imagine medication is a little bit of a thorny question because, and I don't wanna talk about anyone in particular.

- Sure.

- But it seems as though medication can certainly be helpful, but something that you don't want in any way, someone to get addicted to.

What's your stance on whether you would use medication to treat sleep issues?

- I'm sorry.

- Yeah.

Again, the medication, depending on what kind of sleep disorder you are treating, like if you are trying to treat the insomnia.

So current recommendation is not to use the medicine, the guidelines of American Academy of Sleep Medicine favors the use of CBTI, Cognitive Behavior Therapy for Insomnia.

- [Julie] Okay.

- So, and then, but for, if you're dealing with some condition, like narcolepsy, then you have to treat with the medications.

So it depend, and then dyslexic syndrome, so one of the way to treat is also the medication.

So we do use medication off and on.

It's not that we don't use it, but again, depending on the situation, individualized approach is the best way to do it, deal with it.

- Yeah, 100%.

I couldn't agree with that more.

- And what about, you know, I almost didn't wanna ask tips on how to get a better night's sleep 'cause people have heard these over and over and over, but from a doctor's mouth, what can people do if they're not getting great sleep, other than maybe get some medical intervention?

But tonight, right now, after they watch the show, what are some things they can do to try to get a better night's sleep?

- So I think one of the things that I very commonly encounter as a reason why people have a difficult time sleeping is because they get into bed with the expectation that this is the time that I'm supposed to go to sleep and therefore, magic is gonna happen.

I'm going to fall asleep.

And then there's this frustration of "Why I can't sleep?"

And then that frustration generally turns into ruminating, thinking about all the things that, "I need to get done or I have to complete."

So typically, one of the things that I'll make a recommendation for is worry earlier in the day.

Make it remote from your bedtime.

So that this way, when your brain starts to go there and start thinking about all the things I need to do tomorrow, all the things I had to get done today, you've already done that.

Now, you can rest your mind, assured that you did that.

Instead, engage yourself into something that actually is gonna wind you down and make your mind and your body associate being in bed with sleep.

So whether that's reading a book, listening to lulling music, light stretching, meditation, do those things and don't get into bed until you actually feel sleepy.

And if you feel like you've been laying there for 20 minutes and you're not asleep, not because you're checking the clock, that's only gonna contribute to further frustration, get outta bed and do it again.

It takes about a month for you to change behaviors.

And so, you really do wanna make sure that you're being consistent with those change in behaviors.

- You could retrain your brain to try to sleep better.

- 100%.

- You've had a couple of suggestions earlier as well, Dr. Khan.

- Yes, like I think it's, she's definitely right about that.

This is the one thing that we have to follow that.

And then I usually ask the patient to go into the bedroom or go into the bed only when you are sleepy.

If you are not sleepy, just stay there for 30 minutes, not more than 30 minutes and leave the bedroom, use the bedroom only to stay sleep.

And don't even use your telephone because all the screen, they stimulate the hormone dopamine, which can cause more alertness.

So if you open the Facebook, you're gonna be keep scrolling down and down.

We tend to avoid watching television or doing any other activities while in the bedroom.

Try to keep the bedroom cold, dark, and quiet.

These are all the things which can be helpful.

And wake up on the same time every day.

This is the first thing to do that.

If you didn't sleep well, still you wake up at the same time.

And try to do more activity during the daytimes and don't take any naps.

So those kind of the patients, if they take a naps or if they watch the television, I see the patient, they say, "We don't take a nap, but we are watching television and recline for one hour."

So it's like, they're getting rested.

- [Julie] (chuckles) Yeah.

- So they won't be able to sleep at nighttime.

- Well, thank you to both of you.

This was really enlightening and I hope people learned how important sleep really is.

I hope that message at least, gone through, went through and that's gonna do it for this episode of Call The Doctor.

For all of us here at WVIA, thanks for joining us and we'll see again next time.

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