Who tends to wake up earlier? Who is more prone to sleep apnea? What role do hormones play? And how can you keep your partner's sleep issues from keeping you awake?
Those questions and more are explored in this episode as host, Jonathan Fialkow, M.D. welcomes Harneet Walia, M.D., medical director of sleep medicine and continuous improvement at Baptist Health's Miami Cardiac & Vascular Institute.
Who tends to wake up earlier? Who is more prone to sleep apnea? What role do hormones play? And how can you keep your partner's sleep issues from keeping you awake?
Those questions and more are explored in this episode as host, Jonathan Fialkow, M.D. welcomes Harneet Walia, M.D., medical director of sleep medicine and continuous improvement at Baptist Health's Miami Cardiac & Vascular Institute.
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At Baptist Health, South Florida, it's our mission to care for you when you're injured or sick, and help you stay healthy and fit. Welcome to the Baptist HealthTalk podcast, where our respected experts bring you timely practical health and wellness information to improve your family's quality of life.
Dr. Jonathan Fialkow:
Welcome back HealthTalk podcast listeners. I'm your host, Dr. Jonathan Fialkow. I am a preventative cardiologist and lipidologist at Baptist Health's Miami Cardiac and Vascular Institute, where I'm also Chief of Cardiology at Baptist Hospital and the Chief Population Health Officer at Baptist Health. We've talked before in this podcast about the importance of sleep to our health. We've looked at some medical issues like sleep apnea and insomnia that can negatively affect our sleep. Americans log about the same amount of sleep as we did 50 years ago, but that doesn't mean it's enough. According to a 2020 poll by the National Sleep Foundation, only one in three adults are getting the recommended seven hours of shut eye. And among those who said they do get good rest, one quarter say drowsiness interferes with their daily life. Are you one of them? We've previously discussed healthy sleep habits, the effects of alcohol, caffeine, bright phones and TV screens, and stress and more. And the consequences of poor sleep, the risk of accidents, cardiovascular disease, and diabetes, but for today's podcast we're going to hone in on one potential sleep issue, your partner.
Dr. Jonathan Fialkow:
Does your partner snore? Does your partner steal the blankets? Is one of you a night owl while the other rises at dawn? Do men and women sleep differently, and what can be done to make sure both partners get enough shut eye? Those are questions I'll explore with my guest today, Dr. Harneet Walia, Medical Director of Sleep Medicine and Continuous Improvement at Miami Cardiac and Vascular Institute. It's great to have you back on the podcast, Harneet.
Dr. Harneet Walia:
It's a pleasure to be here.
Dr. Jonathan Fialkow:
I really appreciate it, again, you coming back. You've already given us great wisdom and shared your expertise on the medical consequences of sleep and various sleep disorders. But let's talk about this real important one, which it probably is more affecting everyone's sleep than all the other things, which is the sleep habits of their partner. First let's start with basic sleep needs. Do men and women have differences physiologically, or in any other way, that would cause them to have different kinds of sleep or different sleep needs?
Dr. Harneet Walia:
Yeah. In general both men and women have similar sleep needs. We recommend seven to nine hours of sleep on a regular basis. There are some data to suggest that women get more sleep than men when we count the night and daytime naps. However, a woman sleeps maybe more fragmented and there are some differences in how they sleep. Women may spend more time in deep sleep, less time in lighter sleep. These are some of the things that are just related to biology, and some of the other psychosocial construct that also interplay in why these differences occur.
Dr. Jonathan Fialkow:
When you see a patient in your clinical practice who might have a sleep disorder, or sleep related issues, do you approach it differently if you're speaking with a woman versus a man?
Dr. Harneet Walia:
Yes. When I am evaluating men or women with sleep disorders, I know, especially for sleep disordered breathing or obstructive sleep apnea, that woman may have a different presentation than men. Women may not necessarily have that loud snoring, she may present with difficulty maintaining sleep, or depression, tension, nightmares, and those sort of things. Whereas, men may have loud snoring. They may have witnessed apneas, which means having pauses in breathing and excessive daytime sleepiness. There is some difference in the presentation of the symptoms.
Dr. Jonathan Fialkow:
With that said, do you find more often women are affected by their partner's sleep versus men be affected by their partners sleep? Or, again, is it pretty much even based on the different kinds of problems?
Dr. Harneet Walia:
It's pretty much even based on different kinds of problems. There are some sleep disorders that are more prevalent in men. For example, obstructive sleep apnea is very prevalent in men compared to women. Whereas, insomnia or restless leg syndrome is more prevalent in women compared to men.
Dr. Jonathan Fialkow:
A man may be snoring at night and the partner is awakened and gets a bad sleep and sleeps poorly with the consequences of that. But a woman may be kicking the legs or have restless checking the clock, not able to fall asleep, and that might affect the male partner. More commonly, though, as you're saying, both can be in both populations. Is that fair to say?
Dr. Harneet Walia:
Absolutely.
Dr. Jonathan Fialkow:
Yeah. I mean, I can tell you in my practice and I talk to people about that, I do ask a woman, "Does your spouse snore? How do you sleep?" And vice versa. But it's good information to think about the terms that, I usually couch [inaudible 00:04:31] it in snoring, but as you said, insomnia, restless leg, there might be other things that we don't think about that might be affecting one's sleep that would be addressed. Do you find when patients get referred to you for sleep disorders, the patient themselves more commonly says, "I think I have a sleep disturbance," or, "I'm not sleeping well." Or is it the spouse saying, "You better go get this checked out if you want me to sleep in the bed with you."
Dr. Harneet Walia:
Well, if it's the nocturnal symptoms, it's mainly coming from the bed partner or the spouse, but if they have excessive daytime sleepiness, or impaired concentration, or difficulty working in the workplace environment, that generally comes from the patient. It's both ways, patient and the bed partners are affected by the sleep.
Dr. Jonathan Fialkow:
Are there benefits to someone, to a couple, sleeping separately? Or would it be more, obviously their preference, but you can actually work with them to find out what's causing that impact on each other and correct that? I mean, or is it just sometimes it's just say, [inaudible 00:05:26] "Hey, sleep in a different room." How do we handle that?
Dr. Harneet Walia:
Yeah. Again, I go to the root cause of every issue.
Dr. Jonathan Fialkow:
Right.
Dr. Harneet Walia:
I would ask, "What is it that is preventing your partner to have a good night's sleep?" If it is loud snoring or having pauses in breathing that needs to be further evaluated and managed, because that could be a sign of a very dangerous sleep disorder such as obstructive sleep apnea-
Dr. Jonathan Fialkow:
Sure.
Dr. Harneet Walia:
Likewise, if it is restless leg syndrome, which causes leg movements during sleep and can also cause insomnia, which is sleep maintenance issues that could also be treated. The good part about these sleep disorders are they can be easily treated and managed, and can improve the sleep of the patient and the bed partner.
Dr. Jonathan Fialkow:
I want to continue the conversation regarding the differences between men and women and how spouses can affect sleep. Just a quick point I want to clarify, or for you to clarify, when someone has restless leg syndrome does it occur every night or is it something that can come and come and go?
Dr. Harneet Walia:
Yeah, great question. Restless leg syndrome could be intermittent. It could occur once in a while, or it could be more persistent, which means it can happen on a daily basis, and can really have effect on the sleep and the quality of life.
Dr. Jonathan Fialkow:
That's good to know. I see certainly, and again, my practice patients sometimes say, "Oh, I'm taking a stat [inaudible 00:06:44], and then my legs are always bothering me and I can't sleep." When you really question it, they actually have restless leg syndrome and probably even had it before, before the stat [inaudible 00:06:51] in therapy [inaudible 00:06:52] it had nothing to do with it. All right. Let's talk about a couple of other things that are more common, at least that we see in our practices. What about sleep with women with hormonal disruptions, menopause, does that change at all or is it part of a transition of women through menopause?
Dr. Harneet Walia:
Sure. Hormonal influences impact sleep significantly. Menopause is a big one. Sleep problems are very common during perimenopause and menopause. That can happen because of the hormonally induced changes in circadian rhythm and the hot flashes, and the night sweats are also very common. It can affect up to 80% of the women. Similarly, these hormonal influences could occur in pregnancy, right? Sleep disturbances are common in pregnancy. About half the women experience that. Also, these hormonal influences occur during the menstrual cycle, and women may experience disrupted sleep during the menstrual cycle.
Dr. Jonathan Fialkow:
If a woman is having a disrupted sleep because of hormonal issues, which is certainly real and very common, and we've already said that can affect the partner, do you find the partner basically tells the woman, "Hey, get checked out." Or is the woman just so uncomfortable they get checked out themselves?
Dr. Harneet Walia:
Women are so uncomfortable themselves with the hot flashes that they want to get it checked out themselves. There are treatment options for these women who are undergoing menopause or postmenopausal. Certainly hormone replacement therapy could make a huge difference only if it is appropriate. One has to, being that they are a appropriate candidate for it, but certainly these things could make a difference. However, I would want to say the prevalence of obstructive sleep apnea increases tremendously after menopause. If the menopausal woman is having snoring or insomnia, they should certainly seek evaluation for sleep disorder breathing or sleep apnea.
Dr. Jonathan Fialkow:
I think the common theme is that we want the individual to recognize that their sleep patterns are addressable, treatable, so they can have a better night's sleep. Obviously, with your expertise and that of others, as well as think of its impact on their partner. That can be addressed as well, both from the partner and for the individual [inaudible 00:08:55] standpoint. That's the common theme as we go through these questions.
Dr. Harneet Walia:
Absolutely.
Dr. Jonathan Fialkow:
A couple of other questions, are women or men more likely to have insomnia? You kind of mentioned women are more likely to have insomnia to some degree. Do they seek help for it? I think sometimes people are so afraid they won't go to sleep hours before they fall asleep then it becomes a self fulfilling prophecy. How do you address a woman who might have insomnia?
Dr. Harneet Walia:
Yeah. Women are more likely to have insomnia. There could be, again, various factors that play into role, including the social factors, the psychological factors. Women are more likely to have mental disorders such as depression and anxiety, and that could play into insomnia as well. In terms of what we could do to promote sleep, many times women tend to ruminate a lot while trying to sleep. They engage into some non-healthy sleeping habits, such as spending a lot of time in bed trying to fall asleep, or taking naps to compensate for the lack of the sleep. These are the things that we exactly don't want them to do. We don't want them to watch the clock, we just want people to associate that bed and bedroom is just to sleep. It's not there to lay down, think about stuff, or do any other thing besides sleep.
Dr. Jonathan Fialkow:
Again, with some self recognition, there are ways to get help or have a better night's sleep, which is important.
Dr. Harneet Walia:
Absolutely.
Dr. Jonathan Fialkow:
How about, I tend to get up very early without an alarm clock. I can't think of the last time I slept past 6:30 in the morning. I actually like it. I find I'm very active in the morning, though, 9:30 at night might not be my best time to be thinking clearly. Is that genetic? Is that just lifestyle? More importantly, is there a difference between men and women in terms of their, or the time they wake up and the time they, or if they may sleep later?
Dr. Harneet Walia:
Yeah. We all have our internal circadian rhythm, which really governs what time we go to bed and what time we wake up. It is also, it's generally in sync with the external rhythm. As we grow older, we are more likely to have what we call, "Advanced sleep phase rhythm," that is we tend to go to bed early and wake up early. Women are also more likely to have advanced sleep phase syndrome, which is they're more likely to go to bed early and wake up early compared to men. There could be some subtle differences in the circadian rhythm that could play in a role in sleeping patterns.
Dr. Jonathan Fialkow:
Some people, that's just their normal lifestyle. One may get up early and the other one sleeps a little later, but for those that find it somewhat disruptive in their daily activities, or even relationship, can that be adjusted? Can one adjust their circadian rhythm sleep patterns?
Dr. Harneet Walia:
One could adjust. It's not easy to adjust. There is a very fine balance between the external light and the melatonin. It has to be given at a certain time point, but if one wants to adjust, we can certainly help people adjust to those.
Dr. Jonathan Fialkow:
Two more quick questions just regarding general things that come on. First thing I would ask is regarding shift workers. If someone works overnight, or evenings, and the other doesn't, again, have you found that that can cause particular sleep disturbances in the partner?
Dr. Harneet Walia:
Yeah, of course. Shift work disorder is very common. When you're working shift you are naturally going to sleep at a different time than the conventional times that your other bed partner may be sleeping. Shift work itself could pose some sleeping issues. They may experience more insomnia or daytime sleepiness, and we can help in those situations as well.
Dr. Jonathan Fialkow:
Are there things to offer shift workers? Are there recommendations or things they can do to get into a normal sleep habit? Or, again, we can recognize as an issue, but are there resources for shift workers to at least minimize the impacts of these, of the different hours that they work?
Dr. Harneet Walia:
Yes. There are non-pharmacological or norm [inaudible 00:12:50] medications, the treatment that we can offer, and there are medications that we can offer. We often tell these patients to make sure that the sleeping environment is as conducive as possible when they're trying to sleep. Making sure they have the dark black curtains when they are sleeping. The light exposure during certain times is also a very sensitive marker. We could also give some melatonin, we could supplement some of these wake promoting things with caffeine. There are medications that could also be given for difficulty sleeping or for excessive daytime sleepiness.
Dr. Jonathan Fialkow:
Last question, Harneet, a little bit out there, a little bit compared to partner sleeping, what about that of children? What, is there any medical evidence or any kind of recommendations regarding, "Should children sleep in a bed with the adult?" How, again, that can affect adult sleep patterns and potentially lead to some medical consequences.
Dr. Harneet Walia:
We don't recommend co-sleeping with children because that could cause some behaviorally induced insomnia in kids. We really recommend that children should be sleeping in separate bedroom in their own beds.
Dr. Jonathan Fialkow:
I appreciate that. There's certainly cultural consequences, and sometimes a parent is just so fatigued it's just, "Just come in the bed," but we do want to recognize that optimally that would not be recommended, let's put it that way. Great. Just before we wrap up, any other insights or advice regarding this topic? We've hammered home the point a couple times about partners effect of sleep on the other partner, and what those consequences and resources are to recognize it. Any other points you'd like to make?
Dr. Harneet Walia:
Yeah. I would just like to say that all couples, all men, all women, everybody should make sleep a priority. When we talk about diet and exercise, we should always talk about sleep in the same token.
Dr. Jonathan Fialkow:
I welcome that, and I welcome your expertise and I welcome what you bring to Baptist Health. Both in terms of, again, your knowledge and your passion towards educating and identifying sleep disturbances, and improving obviously those conditions in our community. Thanks again. I'm sure we'll have you back for other sleep related topics, and maybe even some other things we can talk about. I'd love to talk about the continuous improvement at some point as well. Again, listeners, before we sign off, we could really use your help in feedback. Please take a moment and give this podcast a five star review on whichever platform you listen to us on. Have a comment or a suggestion for a future topic? Email us at baptisthealthtalkatbaptisthealth.net. That's baptisthealthtalkatbaptisthealth.net. We'd love to hear from you. Thanks for listening. Stay safe.
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