Human beings spend between one-quarter to one-third of their lives asleep — and that might seem like a huge waste of time. But sleep is the time for the body to rejuvenate in many complex ways.
“If we think about it, when you’re sleeping, you’re not feeding, you’re not procreating, and you could be exposed to attack by predators,” observes Jonathan Fialkow, M.D., deputy medical director, chief of cardiology and a certified lipid specialist at Miami Cardiac & Vascular Institute. “So why would sleep be important? It must confer some kind of essential benefits in order to outweigh these serious disadvantages.”
The importance of sleep is the subject of the latest episode of the Baptist HealthTalk podcast, hosted by Dr. Fialkow with guest Jeremy Tabak, M.D., a Baptist Health sleep medicine physician and medical director for the Galloway Sleep Center. You can access Baptist HealthTalk on your computer or smartphone, or via Apple Podcasts and Google Podcasts.
Check out some Q&As from their wide-ranging discussion on everything from sleep hygiene to sleep disorders to a cautionary note on sleep medications.
Dr. Fialkow: “A lot of people think of sleep as just the absence of wakefulness. It’s not really a passive state where the brain shuts off. So, what is sleep?”
“Well, I mean the bottom line is we still don’t know one reason why we sleep, but there appear to be at least several different reasons that we’re sleeping. There are several processes going on. The brain metabolism is changed and we’re able to consolidate memories during sleep, so it’s important for learning, brain function. Sleep has an important cleansing function for the brain where metabolic materials that are built up during the day are cleaned out. In addition, in terms of our overall body, it’s important to obtain rest during that period of time so the body can rejuvenate.”
Dr. Fialkow: “A question we get asked all the time is ‘how much sleep does one need?’”
“Well, we’ve always felt that it’s a range. Some people need more; some people need less. But this question has been looked at a lot in recent years and now the American Academy of Sleep Medicine, our professional organization, has put out a position paper based on research that recommends that people get at least seven hours of sleep during the night.”
Dr. Fialkow: “Do we feel as adults in the United States of America, we are getting enough sleep?”
“Well, clearly as a society we’re not getting enough sleep. There was a recent National Sleep Foundation survey which showed that a third of adults get less than seven hours routinely on weeknights. We know that has a significant impact because sleep deprivation affects us in many different ways.”
Dr. Fialkow: “What would be some of the reasons, though, we’re not getting the sleep?”
“Well, I mean for a lot of people there’s the demands of work. Many people have to work two jobs. People come home from work and have to do household chores and help the children with their homework and so forth. As a society, we have this idea that sleep is not important, not necessary, and that it’s the one thing that we can give up within impunity. But it’s not with impunity. There’s consequences that result from that.”
Dr. Fialkow: “That leads us into the concept of good sleep habits.”
“When we talk about good sleep habits and sleep hygiene, we want to first focus on the bedroom. Is the bedroom dark? Is the bedroom cool enough? Is the bedroom quiet? Are the children coming in and out? Are the dogs coming in and out of the bedroom? Is the animal sleeping in the bed with the person? Is the mattress comfortable? All of these things are important. The sleep environment is very important.”
Dr. Fialkow: “What about light? Do you recommend that patients kind of dim the lights or don’t look at bright screens right before bed?”
“Well, that’s very important. Nowadays many people have a screen. They’re going to bed with their phone or their iPad and that light from the screen is alerting to the brain and naturally shuts off our melatonin. Melatonin is a natural hormone that signals to the brain that it’s nighttime and time to go to sleep. But once the brain is exposed to bright light through the eye, that shuts off our melatonin production. So the use of screens and bright light, including TV or having bright lights in the room, it can be very detrimental to sleep.”
Dr. Fialkow: “Let’s talk a little bit about obstructive sleep apnea. It’s very prevalent. That was when I first became involved as a preventive cardiologist in sleep medicine, seeing the confluence of cardiovascular disorders with obstructive sleep apnea.”
“Snoring is very common as a symptom. It can be loud. It can be disruptive to the partner’s sleep. So, one common reason people come into the office is because their bed partner can’t sleep because the patient is snoring … and very often the partner can hear apnea, so periods where the breathing stops. Someone who has sleep apnea may have a very restless sleep, so they’re all over the bed. They may wake up in the morning with a headache. They may feel tired in the morning when they wake up at night.”
Dr. Fialkow: “When you have that increased pressure to open up your airway, it puts pressure on the bladder and pressure on your stomach to push acid up. So reflux and going to the bathroom at night can be sleep apnea. When someone may have sleep apnea, what’s the usual medical evaluation?”
“We examine them. We want to know what their weight is because the majority, 80% or so, patients with sleep apnea are overweight. We look at their neck circumference because there’s a strong correlation between the neck circumference in inches and whether or not they have sleep apnea. We look in the mouth to see whether there’s crowding in the mouth, which is a sign of sleep apnea.
… Then in order to confirm our impression or get an idea of how severe the apnea is, we have to do a sleep test either in the lab or sometimes at home, in appropriate situations, to confirm the diagnosis and, again, to get us a measure of the severity and indicate what the proper treatment might be.”
Dr. Fialkow: “And what would some of those treatments be?”
“We usually will talk about C-PAP or continuous positive airway pressure, which is a small mask that fits over the nose that puts a little pressure on the throat to keep your tissues open during the night. So the person has a normal breathing pattern and more restful sleep. A lot of people get started on it, feel much better, but also have improvement in some of the cardiovascular risks that are associated with untreated severe sleep apnea.”
Dr. Fialkow: “If you’re listening to your spouse snore and you hear them stop breathing for eight, 10 seconds, should you wake them up or should you just let them get through it and then make sure they see a doctor for follow-up on sleep apnea?”
“Well, I mean I know people get worried and they want to shake the person, sort of rouse them out of it. But this is something that in people with severe sleep apnea is going on throughout the night many, many times. We see people who stop breathing 20, 30, 40, 50 times per hour. So the spouse isn’t really going to be able to treat that by just watching them and shaking them. But if there is a concern, they should definitely discuss it with their doctor so that it can be evaluated.”
Dr. Fialkow: “Let’s talk a little bit about medications. You mentioned melatonin, a natural-occurring substance in the brain that prepares the brain for sleep. Does taking melatonin help people fall asleep if they have any kind of sleep disorders?”
“Well, it’s not going to compensate for a sleep disorder, like sleep apnea or restless leg syndrome. But if someone has simple problems falling asleep, it can help them sleep. … I would certainly rather have someone try melatonin than to try a prescription sleeping pill. Because with prescription sleeping pills, there’s a concern about what kind of side effects they have, how they affect people during the day. We know that people, especially older people who take prescription sleeping pills, have a greater incidence of falling during the day and all the consequences from that. They begin to develop memory problems over the years. So for insomnia, we focus on other treatments other than taking medications to sleep.”
Dr. Fialkow: “Any points you’d like to make that that we didn’t get to?”
“I’d just like to bring up in this time when we’re all fighting the COVID epidemic, that the importance of sleep is especially there. Getting a good night’s rest is very important to our immune function and how we’re able to fight off an infection. Of course, it’s during a stressful time and may be difficult to get to sleep well. So, it’s important to address that and do some of the things that we can do to sleep better during the night. It has important health benefits for us.”
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