When you visit your doctor, chances are that lifestyle factors like diet and exercise are part of the conversation. Increasingly, so is sleep. Sleep deprivation not only has short-term effects on alertness and cognitive function, over time it can lead to a host of other significant health issues, discussed in this episode hosted by Jonathan Fialkow, M.D., preventative cardiologist and lipidologist at Miami Cardiac & Vascular Institute.
Guests:
Rachel Rohaidy, M.D., psychiatrist and medical director with the Recovery Village at Baptist Health South Florida
Harneet Walia, M.D., director of sleep medicine and continuous improvement at Miami Cardiac & Vascular Institute
When you visit your doctor, chances are that lifestyle factors like diet and exercise are part of the conversation. Increasingly, so is sleep. Sleep deprivation not only has short-term effects on alertness and cognitive function, over time it can lead to a host of other significant health issues, discussed in this episode hosted by Jonathan Fialkow, M.D., preventative cardiologist and lipidologist at Miami Cardiac & Vascular Institute.
Guests:
Rachel Rohaidy, M.D., psychiatrist and medical director with the Recovery Village at Baptist Health South Florida
Harneet Walia, M.D., director of sleep medicine and continuous improvement at Miami Cardiac & Vascular Institute
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Dr. Fialkow:
Welcome Baptist Health Talk podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a preventative cardiologist and lipidologist at Miami Cardiac and Vascular Institute. Where I'm mostly Chief of Cardiology at Baptist Hospital and the Chief Population Health Officer at Baptist Health. When you visit your doctor, chances are that lifestyle factors like diet and exercise are part of the conversation. Increasingly, so is sleep. We've talked before in this podcast about the important role that sleep plays in our overall health.
Dr. Fialkow:
On a recent episode of Baptist Health resource live program, my guests and I looked into the negative effects a lack of sleep can have on our physical and mental health. My guests were Dr. Rachel Rohaidy, Psychiatrist and Medical Director with the Recovery Village at Baptist Health South Florida. And Dr. Harneet Walia, Director of Sleep Medicine and Continuous Improvement at Miami Cardiac and Vascular Institute. Let's kick it off Harneet, by asking you a question. We're in a very fast-paced world. People stay up late. They seem to be sleeping less. Is there a real number for the average number of hours someone should be sleeping? What's the recommended sleep amount that we would tell people?
Dr. Walia:
Sleep need vary significantly among individuals and across the lifespan. On an average an adult requires seven to nine hours of sleep for optimal daytime functioning. And like you said, in this fast-paced world, many of us are sleep deprived. About 30% of us are obtaining less than six hours of sleep, which is a real crisis.
Dr. Fialkow:
I mean, I certainly find myself sometimes you work, you eat, you have a little bit to yourself and I find myself trying to stay up just to feel like I had time. Is that something you encounter and you coach people to recognize that it's okay to go to sleep a little earlier, and there might be benefits, which again, will allude to further. Do you have those conversations with your patients?
Dr. Walia:
Absolutely. Oftentimes people put sleep on the back burner and then we have to constantly educate and coach them that sleep is wider for optimal well being. Once you coach them and tell them the consequences of less sleep, I think they put sleep as a priority.
Dr. Fialkow:
So part of it's a recognition and education.
Dr. Walia:
Absolutely.
Dr. Fialkow:
Rachel, it, you know, again, it's a challenging world. It's hard to unplug, de stress. I find in talking to my patients and myself, sometimes the middle of the night, you know, things, thoughts just keep circulating in your head. Can you tell a little bit about, can you tell us a little bit about the link between stress and sleep?
Dr. Rohaidy:
We do know that increased stress, increased worry, can cause sleep deprivation, right? So, and it's difficult for us nowadays to unplug ourselves from the world and say, we're going to get sleep now. So it's really important to have those conversations with everyone. You need to pencil in sleep. We've got everything else regulated. We've got our phones hooked up to everything. Why not just put a little alarm and say, okay, time to start winding down and go to sleep and unplug from that busy world. We do know that there is definitely a direct link between the amount of stress and stimulation that you get and sleep deprivation.
Dr. Fialkow:
That goes both ways. The more stress, the more disrupted your sleep is. The less sleep does that impact your stress?
Dr. Rohaidy:
Absolutely. If you're not rested enough, if you don't have that restorative sleep, everything else the next morning is going to be impacted, right? So we're not forming those concrete, long-term memories. We're not learning. That's when our brain begins to kind of put things together and heal from the day, right? So when we're sleep deprived the next morning, we're not able to do those cognitive functions and figure things out. And we're a little slower. And so that causes more stress through our day.
Dr. Fialkow:
It's interesting when you have dialogues with people and I know we all deal in our practices with heavily stressed people, because it's so prevalent. That there are things you can't control your stress, right? You can't, I say to people, well, you can't just move to an island and sip margaritas. But there are things you can control. So as we go through this, let's start elaborating on the consequences of poor sleep. And then of course, speaking towards techniques to get a better sleep. So following up on that Harneet specifically, how can... When people don't get enough sleep, they wake up not feeling their best. How does it affect people physically? What are the physical manifestations of not getting the sleep your body needs?
Dr. Walia:
Yeah. Folks feel tired. They feel fatigued. They feel sleepy. There is this malaise, lack of well being. You know, alongside, like Rachel mentioned, they cannot concentrate. They're inattentive. It can really affect their performance and at their work and even at the personal level. So it can have far reaching consequences.
Dr. Fialkow:
Do you find when you're talking to a patient who has those symptoms, that the individual says, "Hey, I need a better night's sleep." Or do you find people around them, a spouse or a coworker say, "Hey, you need to get this checked out." In other words, are most of the people coming to you, self recognizing that their physical complaints are sleep-related or it's something pointed out to them by others? Maybe a primary care doctor as well.
Dr. Walia:
Both ways. So it's either the patient. They may have symptoms such as excessive daytime sleepiness, fatigue, not feeling good, or their caregiver or their bed partner who may bring the patient up to us. And sometimes it's recognized by the healthcare professionals. So there are many ways patients can enter our door.
Dr. Fialkow:
And you mentioned fatigue and various other lack of concentration, irritability. I mean these are common things that can be not just in the personal life, but in the work environment as well. Would that be fair to say?
Dr. Walia:
Absolutely.
Dr. Fialkow:
Yeah. So Rachel, we know, again, sleep can have, a lack of sleep, can have effects on mental and physical health. What about too much sleep? Is there something to be alerted to as a concern for an individual or someone whose loved one or coworker is sleeping too much?
Dr. Rohaidy:
Absolutely. So they, so even as little sleep as we get, or the more sleep that we get when we start sleeping 12 hours, 14 hours, things like that. We start looking at other things as well. You want to make sure that the person... That there's nothing organic going on, right? We want to get blood levels checked, make sure diabetes is not on board, that we're not kind of taking care of. The more we sleep, we're putting ourselves more at risk for cardiovascular illness and diseases, stroke. So too little sleep and too much sleep are both not good for our health. And so we want to find that balance, what works for you best. Because like you said, like Harneet said, absolutely it affects, every affects concentration it affects body. It affects mind. It affects everything.
Dr. Fialkow:
I think that the theme that we are continuously promoting in our conversations and we will to the viewers is think of sleep as part of your life. As part of your lifestyle. And it's, you know, if your stomach is bothering you, you'll say, Oh, I got to get that checked out." If you have a pain somewhere, but we don't think of our sleep habits and our sleep patterns as a major components, and obviously as you guys are elaborating and explaining with expertise. It is. So now let's talk about some things that sleep can affect and what we can do about it. Harneet, people come to you with sleep disturbances. Are referred by themselves, by others, et cetera. Talk about some of the things that you discuss with them. Let's start with nutrition and exercise. How are those things that one can address to improve their sleep habits?
Dr. Walia:
Yeah. First thing we talk about is having a good sleep hygiene. Maintaining a very good sleep hygiene. And a big part of it is diet and exercise. So we often tell folks not to have a heavy meal too close to the bedtime, avoid alcohol close to the bedtime. Because it can disrupt your sleep at the later part of the night. Avoiding caffeine after lunch hours because it has long half life and can disrupt the sleep. And also exercise is helpful in promoting good sleep. There are studies to show that folks who exercise and particularly do aerobic exercise are able to fall asleep quickly, have a better sleep quality. We do discourage them to not exercise close to the bedtime because that can disrupt sleep. But diet and exercise can play a good role.
Dr. Fialkow:
So avoiding caffeine would be a more common one that you see. Alcohol, follow up and alcohol. You said it quite well, which is alcoholic and disrupt the latest sleep. But people think I need some alcohol, unwind it'll help me sleep. Elaborate on that a little bit why that's not necessarily true.
Dr. Walia:
Alcohol initially can promote sleep. It does have those sedative properties, but as we go later in the night later in the sleep, it does tend to disrupt the sleep. It causes sleep fragmentation, you get these bad dreams and so forth.
Dr. Fialkow:
So the quality of your sleep is just as important as the quantity and the number of hours and alcohol can promote a poor quality sleep, as well as wake you up. And again, I think that's important for the viewers, because it's kind of contrary to what perception is, which is it makes you sleepy and you crash. Back to a mental health, on Rachel. Again, let's talk about some of the more common mental health disturbances that you're seeing. Some of which may be exacerbated with the whole COVID pandemic. And again, where you bring sleep in both as a cause, poor sleep as a cause and perhaps good sleep as a mitigator of certain mental health conditions.
Dr. Rohaidy:
Absolutely. So, you know, I mean, by the time a patient comes to see me, they've already been dealing with these issues for quite a while. Right? So as being a psychiatrist, I'm not really the physician people want to see. Unfortunately, what I have been seeing, especially with the pandemic, are alcohol use disorders are increasing. And they were increasing because there's too much stress and I can't sleep. And so a lot of my patients that I've been seeing are getting into this, well I'm trying to self-medicate because I'm not sleeping. And so there were kind of putting things in our body that are quite toxic and we shouldn't be doing. Right? And so it's really asking those important questions, right?
Dr. Rohaidy:
What are you doing? Why are you doing it? How often are you doing it? Right? So it's important to find out why they're sleeping so much, why they're not sleeping. Right? So we have patients that have a lot of trauma that are having nightmares and that's why they're not sleeping, right? Or we have patients who just don't want to deal with their family, or you don't want to deal with the day, they're too stressed. So they spend all day in bed, all day sleeping. And so you really want to make sure you're asking those important mental health questions. What'd causing what.
Dr. Fialkow:
So let me follow up on that and I'm going to ask the same question to Harneet. You mentioned people kind of self-medicating and looking to alcohol or sometimes other potentially dangerous substances to help either their stress and or their sleep. Is there a role for over the counter preparations to help people sleep? Are there prescription medications? I think it's fair to say. We don't want them first-line we want the proper sleep hygiene first, but in your experiences, your practice, what do you tell people who say, "Can't you just give me a pill to fall asleep?" Rachel, I'm asking you first. I'm sorry.
Dr. Rohaidy:
Okay. You know we live in a world where we need that gratification right away. Right? We've got these amazing computers in our hands all day, which are kind of work like phones, but we can kind of press a button and have things delivered and things happen right away. So we want that quick fix. We want that pill first. What I try to do in my clinic and from what I've heard of Harneet and what she's saying, really try to teach that sleep hygiene. The good restorative, helpful sleep, having a schedule. And so having this very healthy lifestyle of trying to get in a little bit of exercise, eating right, and making sure that we're practicing sleep hygiene is really important for patients.
Dr. Fialkow:
Is that something you would echo Harneet or again, I'm coming to you. I don't need, I just want, just give me a pill. I just want to sleep. How would you respond to that if a patient would have started the conversation with way?
Dr. Walia:
No, I would go to the root cause of the issue. Why are they not able to sleep? So there are many times there are reasons why folks are not able to sleep. It's either the stress or they may have underlying sleep disorders such as sleep apnea, restless leg syndrome. Even if they have pure insomnia, which is difficulty sleeping, difficulty, falling asleep, maintaining sleep, waking up early in the morning, despite getting right opportunity to sleep. The first-line treatment is often not medications. It's often what we call it, cognitive behavioral therapy for insomnia. Which is focused on restructuring those negative emotions or cognitive emotions that are linked with sleep. So that's a first line treatment. We generally do not recommend taking over the counter medications. They may have long half-life. They may stay in the body for a long time. They may promote grogginess and in turn, maybe actually perpetuating trouble sleeping.
Dr. Fialkow:
So some of our lifestyle might just prohibit people from getting enough sleep because they're going to sleep late, waking up. The increased stress environment might make it difficult to fall asleep, or stay asleep. Certain things that someone may do in their lifestyle, caffeine late in the day, alcohol may disrupt their sleep. Then again, for those that just can't fall asleep, you would work with them on the causes of that rather than just throw pills at the problem right away, which is exactly the point. Okay. Harneet, there are warning signs of sleep deprivation. Are there things that we would want people to say, maybe they don't get up in the morning and say, "Wow, I'm sleep deprived," but little things that might, we want to promote them to say, wait a minute, maybe you're developing a sleep disturbance.
Dr. Walia:
Yeah. I mean sleep deprivation is two kinds. One is acute sleep deprivation where folks may or may not recognize that they are either sleepy during the day. They are tired during the day. And that is because they were not able to sleep well in the night. Either because of the short sleep duration or a bad sleep quality. Then there is this cumulative sleep deprivation that many times often get under recognized and undertreated. Many times you have to really hone in the history of asking what time they're going to bed during the weekdays, during the weekends. How much sleep they're getting and questions about their quality of sleep. So essentially it's the symptoms such as daytime sleepiness, fatigue, impaired concentration, not able to work well and so forth.
Dr. Fialkow:
Now it's probably fair for someone or anyone to have a few days or a short period with that may occur for whatever circumstances. Is there, again, just idea as to when someone should seek help for it and where should they seek the help?
Dr. Walia:
Well if they have persistent difficulty sleeping and they're feeling tired and sleepy, despite obtaining seven to eight hours of sleep in the night. Or they are snoring and they're bothering their bed partner. Or they're constantly feeling tired and sleepy. That is the time to seek medical attention.
Dr. Fialkow:
And again, primary care doctor for an example would be a great first person.
Dr. Walia:
Absolutely.
Dr. Fialkow:
We've mentioned a couple of times proper sleep hygiene. Rachel, can you get into that with a a little more detail? What are the kinds of specific things that a person could do to ensure a better quality and quantity of sleep?
Dr. Rohaidy:
Absolutely. So, you know, sleep hygiene can include... You can go online and find 20 different things that you can do to improve sleep hygiene. But what it actually means is just having a better sleep routine, right? So just cleaning up that sleep. About half an hour before bed, an hour before bed kind of shut things down. Put your phone away, relax. And you're kind of telling your body, All right, it's time to time to rest. Keeping a schedule of sleep. So doing, you know, life happens, right? And so a lot of us can't necessarily always go to bed at 9:02 at night or whatever, right? So keeping a schedule as close as possible. And making sure that you're going to bed around the same time, even on weekends. You're getting up around the same time as well.
Dr. Rohaidy:
Having a nice routine. You can do a little meditation, take a shower, a bath, do a facial, whatever it is that you do to prepare and get your body ready to relax and sleep. And remember, bed is sanctuary. So really the only two things that should be happening in bed are the two S's right sleep and sex. We should not be on our phone in bed. We should not be writing a book in bed. We should not really be watching TV in bed, even though I know that it's kind of hard, everyone wants a TV in their room. But really, if you focus on cleaning up that sleep and knowing that good restorative sleep is really going to take you a long way. And it's going improve your mood, improve your processing, improve memory. We really got to put a little more focus into our state because it does have long-term benefits for us.
Dr. Fialkow:
I mean, how pervasive is that? How pervasive is that phone? I mean I actually started now keeping my cell phone in a different room, so I can't keep looking to it. I noticed my wife does it all night, keeps looking at the phone, picks something up, whatever, and started making her do it as well. And it's an adjustment. It's actually a positive one for those who can actually try it. But how big a disruptor are screens?
Dr. Rohaidy:
Huge. Nowadays, especially through the pandemic, everything was on Zoom. So we were on all the time. From the moment we woke up on a Zoom call meeting, you seeing patients via Zoom. Answering emails at night because now a lot of us are working from home and of course we've got these great little computers in our hands. So it is really difficult to unplug from the day. And if you just keep things, you know, put a time limit, do yourself a favor and disconnect for a moment. That's really part of a lot of self-care. What we're noticing is increase in stress, increase in anxiety, increase in substance use disorders because we're not unplugging. We're not doing that self- care. That's so necessary and sleep is self-care.
Dr. Fialkow:
That's, that's [crosstalk 00:19:19]. Go ahead Harneet, please.
Dr. Walia:
One additional thing I would like to add is that the blue lights emitted from these electronics can suppress the melatonin. Which is supposed to be the dark hormone, the sleep hormone, the night hormone. So more exposure to these electronics is going to suppress that good night's sleep because of the melatonin.
Dr. Fialkow:
Actually there's some great questions coming in. So I want to get to them to make sure that the viewers questions being answered. But let's jump to one of them right now, which is melatonin. And the question is, is taking it okay? Is it addictive? So maybe, Harneet, and if you could elaborate a little bit more about the role of melatonin and what melatonin supplements can and cannot do.
Dr. Walia:
Yeah, like you mentioned John, melatonin as a supplement, it's not really a sleep aid. So there are lots of formulations of melatonin. It comes at different dosages. It comes at different formulations. So one has to be really cognizant of what formulation you're taking. I mean, overall melatonin has not been shown to improve sleep. It's generally safe, but it really doesn't improve sleep. It is more to shift your sleep timings. For instance, if you are somebody who is a night owl. So that's when the melatonin is more handy to shift your time from the later sleep periods to an earlier time period. And similarly, if you're a morning lark, that's when the melatonin will come in to shift your time from the earlier time to the later times. That's where melatonin is most effective.
Dr. Fialkow:
So it's used for people who have to travel across time zones to maybe adjust as you're saying. I use this analogy and I'll ask the two sleep experts if I should stop using it. But I would say that we evolved where Twilight was when the sun started going down, our brain started getting ready for sleep. The sun went down, we went to sleep. And melatonin was kind of being released to kind of prepare the brain for sleep, but light burns it off. So if you could have taken a melatonin supplement, as you said, you look at a screen, you just burned off whatever it's going to do anyway. So it's the contrary of light versus the melatonin. Is it kind of, is that kind of right?
Dr. Walia:
Well, you said it right. Beautiful, actually. So light is the strongest cue that helps us with our circadian rhythm and with our internal body clock. And both light and melatonin playing a role in getting to that dark and the day cycle. So yeah.
Dr. Fialkow:
This has been great guys. I mean I on my own... Just ask you a bunch of questions for my own education, but in the interest of time, I'll just ask if each of you, anything you want to add that we didn't address or anything you want to emphasize that we did address. Rachel, any final comments or thoughts?
Dr. Rohaidy:
So absolutely. People ask, how am I supposed to change, you know, 20 things in order to go to sleep. And that doesn't make any sense to me either. But taking one or two things and making small changes at a time can help you improve your sleep over time. I know that everyone wants to try to do things naturally. Some people don't want to take medication for sleep. But you know, these are behavioral modifications that are really going to take you through a lifetime. And so making one or two small changes a month and you'll see over time. This is not a quick fix. These are lifestyle modifications that are very beneficial in the end.
Dr. Fialkow:
Harneet, similarly, any final comments or anything where you want to add?
Dr. Walia:
Yeah, I agree. When we say lifestyle modification, we always talk about diet and exercise. I just want our new viewers to know that sleep should be a priority. And when we're talking about diet and exercise, we should be talking about sleep in the same token.
Dr. Fialkow:
To our listeners. Remember that you can send us your comments and suggestions for future topics at Baptist Health Talk at baptisthealth.net. That's Baptist Health Talk at baptisthealth.net. On behalf of everyone at Baptist Health, thanks for listening and stay safe.
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