Lessons from the Sleep Doc
Is an undetected sleep disorder wrecking your health?
With an estimated 50 million to 70 million Americans suffering from some kind of sleep disorder, we’re clearly a country in trouble. Researchers have found that chronic sleep deprivation can be as bad for our health as smoking, and that driving while sleep-deprived is as dangerous as driving drunk. Yes, an occasional sleepless night might just render you tired the next day, but chronic sleep deprivation and insomnia can cause long-term health problems such as type 2 diabetes, hypertension, heart attack, stroke and depression, and make it nearly impossible to maintain a healthy weight.
New guidelines from the National Sleep Foundation suggest adults need a minimum of seven hours of sleep.
“Sleep problems are very common and very prominent,” says Torrance Memorial Physician Network internist Khalid Eltawil, MD, who is board-certified in pulmonary critical care and sleep disorders. “So many people don’t realize they have a sleep issue and/or are embarrassed to mention sleepiness to their doctors. They think it’s just laziness or age-related. But without good sleep their overall health is being impacted.”
Many who have sleep issues might be surprised to find they are referred to a pulmonary specialist. So we asked Dr. Eltawil the following questions:
Why is someone suffering from sleep deprivation sent to a pulmonary doctor?
“There are many specialties that deal with sleep—neurologists, psychiatrists, even dentists, but the most common cause of sleep deprivation is sleep apnea, which is a pulmonary issue. Men are especially vulnerable. About 50% of men over 50 have some degree of sleep apnea.”
What is sleep apnea? And how do I know I might have it?
“Sleep apnea involves an episode during sleep when the air flow stops or decreases, and you wake up because you can’t breathe—often due to a throat airway obstruction. It happens repeatedly over the night, and therefore your sleep is constantly disrupted. You aren’t aware of it, but often a partner will hear a pause in your breathing, then a snort, and you’re back to sleep. So even though you have been asleep for eight hours, you wake up feeling tired and not rested. If you live alone, you might not even realize it’s happening, although you feel tired. Some might think it’s normal, and it’s just what happens as you get into your 60s, for instance. But sleep apnea has a very negative effect and can raise blood pressure and lead to atherosclerotic tract problems such as heart attack. The warning signs are simple: If you are getting a full night’s sleep and still need a nap, or doze off reading or watching TV, you should see a specialist.”
What is the treatment for sleep apnea?
“A lot depends on what the problems are. There might be other reasons a patient can’t sleep. They might have insomnia or abnormal leg or body movements that keep them awake. We go over medical history and medications and look for red flags. We examine them and see if we can get a diagnosis. They might get set up for a sleep study.”
What happens in a sleep study?
“There are two different kinds of sleep studies. Nowadays we do the majority at home. The patient brings home a small recording device and wears it for one night, then brings it back and we see what’s on it. It will show us patterns of sleep apnea, if they are occurring.
“For the second type of sleep study, we bring them into the sleep lab to spend the night. It’s not bad—it’s a simulated bedroom or hotel room, made as comfortable as we can make it feel. The patient is hooked up to wires that monitor different systems. The majority of people have no trouble with it.
“If we determine that it is sleep apnea, we often prescribe a feedback machine, which is a small device—a mask worn over the face that provides a puff of air down the throat, just enough pressure that when the patient breathes, they breathe more comfortably without the airways collapsing. It really is the easiest and most effective treatment. The mask is worn during sleep and only until there has been a change. People often get better.
“The big change people can make on their own is weight loss. Mild to moderate sleep apnea often subsides with just a few pounds of weight loss. If these measures are not successful, we discuss surgery, which will depend on the facial anatomy.”
What about those nasal strips?
“The Breathe Right® strips can be helpful when you have nasal congestion or something obstructing your nasal passages. Unfortunately, the bulk of sleep apnea occurs in the back of the throat, so they don’t help with sleep apnea.”
What if the diagnosis is insomnia?
“That can be much more challenging. There are so many things that can lead to insomnia, so you have to look at all the lifestyle issues, such as watching TV or using your iPad in bed. Medications or chemicals can disrupt sleep—the most common being caffeine in coffee and soda. Next we look at alcohol. People end up becoming dependent on it to fall asleep and, in turn, alcohol can hinder sleep.
“Anxiety, stress and depression are factors in about 35% of insomnia cases. And many seniors have chronic pain issues, too, so you have to address all of those possibilities. We start with lifestyle, sleep hygiene, and medical and chemical issues, and start to manipulate sleep times and habits. Sometimes we might have to use sleep aids, but I prefer to start with good hygiene and avoiding caffeine and alcohol first.” (See “Good Night,” Dr. Eltawil’s sleep tips, at right.)
What about melatonin and valerian?
“Melatonin is an interesting chemical. Its main goal is to tell your body what time it is. When melatonin levels are high, it’s time to go to bed. Not being a drug or medicine, it’s not very well regulated, so doses can vary from 1 mg to 10 mg, and there’s no exact absorption from one person to another. You just have to go with trial and error. It does have a sedating effect, so that is a positive. But some of it might be a placebo effect so taking more is not necessarily better.
“Another natural agent is valerian root, which seems to help people sleep. The root is made up of so many components, we are unsure which is working … but it can be sleep-promoting.”
Khalid Eltawil, MD is a member of Torrance Memorial Physician Network. He can be reached at 310-517-8950.