All About the 4 Most Common Sleep Disorders

Speaker 1:

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Kerri Miller:

Welcome back to another episode of HealthTalks Now. I’m your host Kerri Miller in the studio with cohost Kendra Barnes. We’re joined on the phone today with a special guest, Dr. John White, with Baptist Health Medical Group, pulmonary and critical care medicine for an important conversation that affects us all, sleep. Dr. White specializes in a variety of sleep and breathing disorders, including insomnia, narcolepsy, obstructive sleep apnea and parasomnia. Thank you for joining us, Dr. White.

Dr. John White:

Thank you for having me.

Kerri Miller:

Before we get into some common sleep disorders and their impacts on listeners, can you walk us through the patient journey into the Baptist Health Sleep Center? At what point do you typically see patients turn to professional help?

Dr. John White:

Well, most of the patients that we get it at the sleep center are referred from primary care. Although there are certain specialties that refer quite a few, particularly cardiology, because a lot of cardiology problems can be associated with sleep problems too. Patients often are brought to our attention though because of their spouse or bed partners noticing problems such as snoring or even stopping breathing and often demanding that the patient have something done and they’ll contact their primary care and be referred.

Kerri Miller:

Makes sense. Yeah. They’re like your snoring is bothering me. Go get this taken care of, please. Dr. White, you are taking virtual care appointments right now, how does that work? What can patients expect from a virtual care visit with you?

Dr. John White:

Well, right now, the Baptist patients we’re seeing are already in the system, they have a MyChart connection already, then they can download Zoom and then they are sort of assisted through the process by the office. They will have an appointment time. They sign in, connect to Zoom and we have an interaction with video and audio. There obviously there are some limitations in that, although with sleep can really I think deal fairly well with most of the sleep problems with a video visit.

Kerri Miller:

Are the sleep studies being affected right now or delayed?

Dr. John White:

Well, we had to delay quite awhile. We’ve been reopening. We’ve been doing some home studies throughout much of this. There are now relatively low cost devices for sleep study that you could send to the patient. They could do the test and then be discarded. Now some of the other devices though, have to come back. Those are thoroughly cleaned. And then they’re set aside for a waiting time as suggested by the CDC and by the American Academy of Sleep Medicine. Starting next week, we’re going to be resuming on a limited basis at least from in lab study with prescreening of patients. They’ll have to undergo COVID screening before they’re allowed to come in. And then of course do temperature checks, system review as they arrive. And then the techs will be doing everything with appropriate personal protective equipment. And we will not be doing any positive airway pressure studies in the lab for now. That has been identified as risk factor in spreading. It’ll only be diagnostic studies.

Kerri Miller:

The sleep center is really it’s designed to help people discover the cause of their sleeplessness and figure out what the most effective treatment options are. But their first trip to the sleep center is typically a consultation. What do those consultations entail? And what can they expect?

Dr. John White:

Well, they come in or as we were saying, if it’s a virtual visit, we connect the audio visual and go over their history. What their problem is, even on the virtual visit. You can do a limited physical exam, certainly of the oral pharynx, which is important in some sleep disorders. And then we decide if they need to have a study or if there’s something such as insomnia, what would be the best approach to treatment?

Kerri Miller:

What’s the source of sleep difficulties?

Dr. John White:

Well, most common thing we probably say is sleep apnea, which a lot of the people are overweight. Second, most common thing we see are insomnia where people have stress or sort of maladaptive response to stress and problem sleeping. Those would be the most common things in the general population. A lot of the sleep difficulties are just not getting enough sleep.

Kerri Miller:

Sure. And some stress too, especially with COVID and just worrying about how life is affected and finances and medical concerns.

Dr. John White:

Oh, absolutely. Lot of increasing stress in this time and stressed people don’t sleep well.

Kerri Miller:

We live in a busy culture and we’re constantly trying to fit more into the hours we allot and adequate sleep just becomes more of a luxury than a necessity. For the listener who tuned in today wondering if lack of sleep is disrupting their life, what advice can you give?

Dr. John White:

Well, they have to make sleep a priority. There are three main things that you can do non-medication related to help your sleep, or help your life, which is one, exercise on a regular basis, two, watch what you eat or eat appropriately and three, get plenty of sleep.

Kerri Miller:

You treat patients as young as 13, is that right?

Dr. John White:

Correct. If they’re less than 18, they would need to have a parent with them if they have a study. But we do see some younger patients.

Kerri Miller:

Are we seeing a prevalence in sleep concerns in those younger patients with the increased use of devices? I think we know sleep is crucial in the growth and development of their bodies, but can you tell us more specifically about the relationship between development and sleep?

Dr. John White:

Well, one of the things that we discovered in recent years that a lot of human growth hormone, which is obviously important in growth and development, is released during slow wave sleep so that young people need to get adequate sleep so they can grow properly. One of the things that I think we talked previously was there was a study at the meeting last year, that in Texas about in their study, almost 40% of the teenagers that they polled were on the internet continuously. They go to bed with their devices and they’re texting or Instagramming with their friends all night long.

Kerri Miller:

There’s four specific disorders that we’ll jump into, insomnia, restless leg syndrome, sleep apnea and narcolepsy. Insomnia is categorized by the inability to sleep, trouble falling asleep, staying asleep, or waking too early. As we prepared for the discussion, we understand that many people will experience this at one point in their life. When does it become a concern?

Dr. John White:

Well, basically it just can persist. A lot of people have situational insomnia, go through a very stressful period, maybe with a few weeks, 15 to 20% people may experience that at some time. But if if persists after that goes on as long as three months, then obviously it’s much more serious problem.

Kerri Miller:

At that point would you classify it as chronic?

Dr. John White:

Yes.

Kerri Miller:

Okay. And that could be, like you said, from a situational, maybe the death of a loved one, a divorce or some sort of stressful traumatic experience in their life?

Dr. John White:

Oh sure. People who specialize in insomnia talk about the predisposing precipitating and perpetuating factors, which predisposing and sometimes it’s just the personality traits that people just maybe a little more high strung. Precipitating is an acute event that’s causing you to have stress, causing you to have insomnia. And perpetuating is how you respond to that. And then if you have a sort of maladaptive response, it can persist for years. It’s not uncommon to see people come in claiming that they hadn’t slept well in the past 20 years or so.

Kerri Miller:

What determines what type of insomnia you would classify it? I understand there’s primary versus secondary and acute versus chronic.

Dr. John White:

It’s mostly the history and trying to find out is there a specific event that’s triggered it. As you said, a death of a loved one or a divorce or something on that order.

Kerri Miller:

Okay. And can we move now to restless leg syndrome. Who is at risk and most likely to be affected?

Dr. John White:

Well, the studies have shown that a lot of people have iron deficiency and of course, younger women have frequently iron deficiency and that can be a factor in their restless legs. If they can correct their iron deficiency often their restless legs get better. People have chronic kidney disease often have problems with restless legs. Those are some of the most at risk. Although there are a lot of males with restless legs and people who are older.

Kerri Miller:

Do you typically see this in pregnant women? I experienced it in both of my pregnancies, especially toward the end.

Dr. John White:

Absolutely. With the change in iron stores with pregnancy, that can be a precipitating factor.

Kerri Miller:

Given that, is this a temporary condition or one that’s corrected if the iron is restored via food or a supplement?

Dr. John White:

It can often be just temporary. And then it also seems that some people just get better with time, even if they require medications besides iron supplement to control it. But they’ll can sometimes go off of that later on.

Kerri Miller:

We’ll be right back.

Kerri Miller:

If you need specialized diagnostic testing and help with a sleep disorder, you can count on the compassionate and skilled team at the sleep centers at Baptist Health to be with you every step of the way. Our staff includes board certified sleep physicians who keep up to date on the most current treatment options in order to prescribe what is best for each individual patient. From helping you prepare for tests, listening carefully to your questions and working with you to provide a personalized treatment plan, you’ll appreciate our care, attention and support. Find a sleep medicine provider near you by visiting baptisthealth.com/provider.

Kerri Miller:

And we’re back with our discussion with Dr. John White regarding common sleep disorders. Sleep apnea is a serious concern for many. That’s where someone can experience a momentary lapse in breathing due to the throat relaxing too much during sleep, thereby blocking the airway. And the troubling thing is that many people don’t even know that they’re doing it. Isn’t that right?

Dr. John White:

Oh, that’s absolutely correct. Most people that come in who have a history of snoring and sleep apnea often say that they don’t really know that they snore. That their spouse has been telling them. And they aren’t really aware of that they’re awakening gasping for breath. Or should say arousing gasping for breath, but their spouse can tell them that too. But it can be a very serious problem. And they do have an apnea because it drops their oxygen level, puts a strain on their system, contributes to high blood pressure and can contribute to arrhythmias.

Kerri Miller:

What are the primary forms of sleep apnea? In addition to snoring, what are some of the other symptoms to be on the lookout for?

Dr. John White:

For the obstructive sleep apnea, they can have a lot of difficult to control high blood pressure, can present with atrial fibrillation. But they can have also just severe sleepiness, which can be a problem. That can be a problem with professional drivers. We do a lot of screening for truck drivers with sleep apnea, anybody else who operates machinery in a high risk environment can have problems with sleep apnea and sleepiness during their work time.

Kerri Miller:

What are some of the risk factors and causes of sleep apnea?

Dr. John White:

Well, I think I alluded to earlier, being overweight, that causes some narrowing of the airway in the neck, but trauma to the nose often with sports when people are playing they can break their nose and they don’t really get it fixed and then they’ll have a deviated septum. And that just increases the airway resistance, trying to breathe through the nose that have to generate a more negative pressure and increases the collapse in your throat so that you have worse problems with sleep disordered breathing. In kids, large tonsils, adenoids can cause increased problems too.

Kerri Miller:

Can sleep apnea show up later in life if there was an injury to the nose in their youth?

Dr. John White:

Oh sure. A lot of people that show up, we see as adults that said, “Oh yeah, I broke my nose when I was a kid.” And they’ll have problems breathing through your nose. It’s just never enough problem for them to have it addressed when they’re younger. But then as they get older and they possibly gain a little more weight, it becomes more significant and they can present with sleep apnea at that time.

Kerri Miller:

It’s kind of a compounding effect. Can sleep apnea be cured? Or what are the treatment options and prognosis look like?

Dr. John White:

Well, depends on the cause. In part, if you have nasal airway problems, surgery on their nasal airway may well correct that. If you have a weight issue contributing to it, if you can correct your weight, either by dieting or surgery, that can correct the problem. But the most common treatments we have, the standard treatment would be a positive airway pressure or C-PAP device to keep the area open, allow to continue breathing. Milder cases can be addressed with an oral appliance that fits over the teeth while you sleep and pushes your lower jaw forward. There are some newer devices, the hypoglossal nerve stimulator, which is a surgical procedure. They implant a generator on your collarbone with a wire to the muscles that control the airway there at the base of the tongue. And they can turn that on at night.

Kerri Miller:

Oh wow.

Dr. John White:

Keep everything open. For central sleep apnea, which is a little bit different problem, which can be seen with people that have had congestive heart failure or people who are on chronic narcotics and that central apnea is where the brain’s not really sending a signal to the respiratory muscles to take a breath. We generally tried in the past, again, the positive airway pressure device, but we’re now also doing what’s called a phrenic nerve stimulator, which is an implanted device to cause the diaphragm to move and take a breath. We’re starting development of that at Baptist Health Lexington. And we’re looking in to the hypoglossal nerve stimulator. We haven’t gotten quite as far along on that process.

Kerri Miller:

Well, lastly, let’s cover narcolepsy. For the listener who considered him or herself tired all the time and maybe even require naps to function or an afternoon coffee, what characteristics define narcolepsy?

Dr. John White:

Well, narcolepsy’s not just being sleepy. I think a lot of people think it’s actually how your brain handles the sleep wake state. And it allows sleep to intrude on the daytime functioning but it also allows wake to intrude on nighttime so you don’t sleep well either. You can have what are called hypnagogic hallucinations, which when you’re first going to sleep, you’re sort of in this state where you’re not really sure if you’re dreaming or if it’s reality. And then also sometimes you have sleep paralysis where when you’re first waking up or first going to sleep, you’re sort of awake or you can’t move. Brain’s not able to send a signal to the muscles. Some people with narcolepsy also have the condition cataplexy where they sort of lose control of their muscles and they become very emotional and can get severe enough, can cause them to fall down at times.

Kerri Miller:

Oh wow.

Kendra Barnes:

That’s rather serious.

Kerri Miller:

When and how does it present itself? And how is this diagnosed?

Dr. John White:

Most tend to be presenting within late teens, early twenties, maybe as much as thirties or so, because I think in part, because we sort of overlook when they’re teenagers and they’re sleeping excessively during the day. We don’t think much about it, but when it becomes a problem, when they’re starting to go out in the workforce or things like that, it becomes more of a problem and they’ll present at that time. For diagnosis you have an overnight sleep study and then you keep them around the next day, assuming that the overnight study is normal. And then see if they fall asleep more readily on a nap. You have five separate nap studies and see if they fall asleep on that. And particularly if they go into REM sleep on two of those, would be strong evidence for diagnosis of narcolepsy. There are also some tests now to measure some of the chemical levels in free spinal fluid, the fluid around the brain. Obviously would require a lumbar puncture to get that. And so it’s not really very clinically used at this point, but there are other confirmatory test.

Kerri Miller:

That’s interesting. Do we typically not inter REM sleep during a nap?

Dr. John White:

Most people don’t. It’s relatively short. Most people don’t go into REM sleep until about 90 minutes into their sleep time. At night, if you’re going to sleep, it’s not for 90 minutes. And if you’re on a 20-minute nap, you usually don’t go into REM sleep.

Kerri Miller:

What happens in REM sleep for those who aren’t maybe as familiar with that term?

Dr. John White:

Sleep experts talk about there being three stages of being, wake, non-REM sleep and REM sleep. But in REM sleep it’s actually, your brain can be fairly active, but there is a disconnect between the thinking, acting, dreaming parts of the brain and the motor part. And the brain can be fairly active at those times, but the REM is for rapid eye movements because that’s what seen on your sleep study on the tracings from the eyes to shows them darting back and forward.

Kendra Barnes:

Obviously, there’s a variety of disorders one could suffer from in these are just four of the most common or more common ones rather, but another extremely common sleep issue facing many Americans, one that most people don’t even recognize as an issue is sleep deprivation. We want to touch on that.

Kerri Miller:

Yeah. I think the image that immediately comes to mind is a young mom at night, up with their infant or a college student, who’s pulling an all-nighter to finish that research paper.

Kendra Barnes:

Been there.

Kerri Miller:

But in reality, most of us aren’t getting the recommended hours of sleep per night. How much sleep should we be getting? And what are the negative effects we see if we don’t?

Dr. John White:

Well, for most young adults, it should be seven to eight hours or something. But long-term increased stress, increasing cortisol and other stress mediators can contribute to things like high blood pressure, can cause changes in sort of cognitive function too, if you’re enough sleep deprived. And sleep’s important for us for the consolidation of memories and the consolidation of learning. And so, staying up all night in the hall to study for that big exam may or may not be the most helpful thing too.

Kerri Miller:

Interesting.

Dr. John White:

They may be better getting some sleep.

Kerri Miller:

Many people turn to self-medicating to get the sleep that they need. We’re seeing products like CBD oil, melatonin, and Ambien being utilized for sleep assistance. Are these safe alternatives?

Dr. John White:

I think melatonin is fairly safe, but I think the jury is still out on CBD. I’m not sure we have enough studies to confirm. Ambien was fairly effective in getting sleep but our adults should be sleeping well without medication, if we can, rather than with. And certainly, any of today’s teens, which are most of the typical sleep-promoting medications are, can have long-term dependency issues and side effects with withdrawal. It’s best to try to avoid those if you can.

Kerri Miller:

Is there anything else that you recommend? Any supplements, natural supplements like lavender oil or any like a chamomile tea that you’ve noticed that your patients benefit from?

Dr. John White:

Melatonin is probably the only supplement I recommend regularly. Now I think that there are certain things you might want to consider non-medication wise such as relaxation techniques. There I do prescribe sometimes a yoga, which yoga nidra, which is a meditative type yoga. And you can go on YouTube. There are multiple different ones that are freely available and sort of pick the teachers, the ways that you find most helpful and most soothing. In trying to get to sleep, probably better to get the regular rise time in the morning, the regular bedtime at night. Your brain really likes to be on a regular schedule. Light exposure early in the day is important. Setting the brain’s internal clock so it knows when it’s time to go to sleep at night. And exercise, or even just walking or activity in general is important so your body’s tired at night and then get off your screens at least an hour ahead of time.

Kerri Miller:

That’s a big one.

Dr. John White:

Ahead of the time that you want to fall asleep. That’s a problem for a lot of people now.

Kerri Miller:

It is. Staying off, we do recognize we’re both in the marketing department and see a lot of traffic to our website and social media overnight.

Kendra Barnes:

How could someone distinguish then between something that’s just a minor, temporary sleep disruption that they could use these coping techniques to treat at home versus a true sleep disorder for which they need to seek care?

Dr. John White:

I think it’s part how chronic it is. How long are they willing to try and work on their solution themselves? And I would encourage them to try to get the solution themselves, but if they’ve gone on weeks and weeks, then I would talk to your primary care doctor. Or if they think that they need further evaluation, we’d be happy to see them.

Kerri Miller:

I think it’s one of those things that it’s very easy to write off. As I have a little, a young baby, and this is just life now, or I’ll get through this one day, that kind of thing. Do you recommend that your patients keep a sleep diary or a journal of their sleep disruptions?

Dr. John White:

Well, it’s a technique that we frequently use with patients who are being seen, but I don’t think you want to become so vigilant of your sleep that you’re fixated on it. You want to relax. You don’t want to stress out over it.

Kerri Miller:

That makes sense.

Kendra Barnes:

Yeah. And I’ve noticed on your phone that there are a few apps that track your sleep too and provide you with a report of the quality of sleep. In addition to offering white noise and gentle soothing sounds that can assist as well.

Dr. John White:

Correct. There are lots of new apps out there to help people to sleep. Some of the consumer wearables, we don’t really know what they’re measuring when they say is it light sleep or deep sleep. I think they’re probably do have some validity as far as tracking. If this week, it shows you’re sleeping pretty well and next week you’re not then there’s probably something significant with their measuring, if that’s the way you’ve been feeling.

Kerri Miller:

Yeah. That makes sense. I think just the amount of saturation in the market right now on Fitbits and Apple watches and meditation apps and those types of things just speak to what a significant issue this is for a lot of people out there.

Kendra Barnes:

Absolutely.

Kerri Miller:

Dr. White, what kind of mattress do you recommend? And sleeping temperature, a sleeping environment?

Dr. John White:

I recommend the one that you find comfortable. There’s a lot of variability in that. We’ve had some in the sleep lab that we had Tempur-Pedics before and I sleep on a Tempur-Pedic. I hate to give name brands in this discussion, but I think it’s quite comfortable. We’ve had patients come in and they thought it was awful. We currently have a, so I won’t give another name out there, but it’s one, you can adjust the firmness in and they tend to like that. Although some patients don’t like that. I think that’s awfully individual preference determined and you just got to find the one you like.

Kerri Miller:

That makes sense. It’s highly subjective. Some people love down pillows and other people think they’re extremely uncomfortable. What would you say though, is an ideal sleeping environment? About sleep hygiene?

Dr. John White:

Well, you want it dark and quiet. That’s a lot of the problem with people. They want to coat to bed with their TV on. Just like that. But temperature, most people tend to like it a little bit cooler at night then the rest of the time. I find that too. But there’s some people like that. There are people who swear by their weighted blankets. I think the important thing is to find what’s comfortable for you and go with that. If you like it 60 degrees and with a weighted blanket then fine.

Kerri Miller:

Well, thank you for joining us, Dr. White. If folks listening today want to get in touch with you, how can they reach your office?

Dr. John White:

Just Baptist Health Lexington Sleep Clinic. It’s 260-4300.

Kerri Miller:

Perfect. We appreciate your time. Thanks again.

Dr. John White:

Thank you.

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