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Melanie Cole (Host):  We all know that getting a good night’s sleep is important, but did you know that it’s important for your overall health. And not everybody gets the quality sleep that they should be getting. My guest today is Dr. Sam Kashani. He’s a Sleep Specialist and a physician with the UCLA Sleep Disorder Center. Dr. Kashani, I’m so glad to have you on with us. What a great topic. Let’s just start with some of the health conditions that you have seen that can result from poor sleep.

Sam Kashani, MD (Guest):  You really bring up a wonderful and a really important question which is what happens when we have poor sleep? What happens when we don’t sleep well? What happens when we sleep too little at night? What happens when we have a sleep disorder like sleep apnea over time that’s not treated? And the answer to all of these questions is really kind of similar in that there are various complications from untreated sleep problems or sleep hygiene or sleep quality that is not optimal.

Increased risk of cardiovascular disease is one of them with an increased risk of heart attacks and strokes. For example, people with sleep apnea have a much higher risk of having a stroke in their life if their sleep apnea is untreated. Actually, a few days ago, CNN put out an article where they basically referenced a Journal of the American Heart Association study that showed that the people who slept less than six hours a night and also had high blood pressure and diabetes; also had a significantly increased risk of stroke and heart attack. So, aside from stroke and heart attack, Alzheimer’s, dementia, cognitive decline, has also been linked significantly to poor sleep and untreated sleep disorders.

Things like mood, depression, anxiety, things like obviously daytime performance and the ability to carry out things during the day and just kind of performing your activities of daily living. All of these things are just some of the complications that come from untreated sleep disorders or basically sleep that is insufficient or sleep quality that is not optimal to answer your question.

Host:  So, before we talk about some of the sleep disorders and who notices them; what is the recommended amount of sleep? If you could break it down a little bit for us; teens and then as we get a little bit older and then even our older folks. What is the recommended amount of sleep?

Dr. Kashani:  So, you asked a really, really great question and it’s one of the questions that I get from my patients every single day. It’s really hard to give an exact number of the quantity of sleep without really emphasizing the importance of the quality of sleep and what I mean by that is that in order to be able to get enough sleep to wake up feeling refreshed in the morning like you are ready to start your day and actually have enough energy to carry you through the day, through your workday, get you home and still be able to sleep at night; that could be different for every person.

For some people, that might be six hours in order to be able to do that. Like I said, waking up feeling refreshed and being able to go through the whole day and do everything effectively. For other people, that number might be eight. The American Academy of Sleep Medicine over many years, has put out kind of some guidelines and recommendations in terms of sleep hygiene and sleep duration and seven hours has been kind of a number that a lot of people throw out there in the literature especially. But again, there’s not really a hard, fast number in terms of the quantity of hours of sleep but really the quality of sleep in terms of practicing good sleep hygiene, maintaining a consistent sleep wake schedule. It’s really kind of these recommendations that we really try to emphasize are important to implement into your daily or your nightly routine rather as opposed to trying to focus on a special magic number of hours of sleep.

So, just another example of where quality is much more important than quantity.

Host:  Well thank you for clarifying that and so as long as we are on quality, let’s talk about sleep hygiene, with electronics and especially with our teens; I see it with both of my kids and the blue lights and the white lights and the answering emails and you must answer a text and all of these things we’re doing at night before we go to bed. Is that affecting our quality of sleep and what would you like people to know about sleep hygiene, getting ready for that good night’s sleep and shutting the electronics off how long before we go to sleep?

Dr. Kashani:  Well to answer your question first. And the answer is absolutely yes. It has a tremendous affect on our sleep and subsequently our daytime functioning. And specifically what I mean is when you are not practicing good sleep hygiene. So let’s back up and talk about sleep hygiene for a moment. What are we talking about when we say sleep hygiene? It’s really just the term that we use to really kind of describe good behaviors or good practices surrounding the bedroom, the bedtime hour and your bed. And really kind of making sure that you are creating an environment that is conducive to sleep; a sleep promoting environment. And part of that is keeping the room dark, meaning that technological devices whether it’s a handheld device that you can take into your bed with you and look at before you fall asleep or if it’s your big screen TV on the wall that you doze off while watching that last 30 minutes of whatever show it is on Netflix.

Regardless, these are all kind of things that really, really have a detriment on your sleep quality and specifically, these devices that you are talking about, laptops, iPads, Kindles, this blue light, this strong powerful intense light that is being emitted from these devices is actually triggering some of the cellular structures in the back of your eye like in the retina and that connects to your brain in such a way that it tells your brain that heh, it’s not quite time to go to sleep yet. I want to watch 20 more minutes, or I want to see 30 more minutes. Or this book is really interesting, I’m going to finish this chapter before I go to sleep. Well, it’s thoughts like these and behaviors like these that perpetuate the cycle of insomnia or difficulty with falling asleep, difficulty with maintaining sleep and not having enough quality sleep despite adequate opportunity during the night.

So, what I do with my patients, I really try to emphasize keeping a good two hour window between the time that they look at their last email that they do online or whatever bill they needed to pay on their website on their phone, whatever the case may be; to try to keep that two hour window between when you are last finishing up those last few things on your phone and when you actually go into bed; to really make sure that you are not carrying any of those devices into the bed, you are not looking at them around the bedtime; thereby allowing your brain to relax and have your brain and you body kind of in harmony to know that right now, it’s time to sleep. Right now my brain and my body need rest from a full day of activities where both have burned tons of calories, they are tired as well and I’m going to create this environment such that all of us can be rested and recharged for the following day.

Host:  Great advice. Absolutely great advice. I’m going to make sure that my 19 year old son listens to this segment. Now we’re about to change from daylight savings to standard time in November. What would you like us to know about that change and to maintain those good sleep habits during the transition and even briefly; helping children to manage this change because it’s even harder with our toddlers.

Host:  The topic that you are kind of touching on which is great because it’s something that we deal with a lot in sleep medicine is circadian rhythm. Now what is circadian rhythm? So, the word circadian, if you look at it and kind of cut it in half; it turns out to be circa dia which translates roughly to about a day, meaning around 24 hours or so. So, this is our circadian rhythm. This is a rhythm with which our body’s physiology kind of adheres to especially with regards to the day and night, meaning the darkness of the night and the light of the day which kind of works with our circadian rhythm in synchrony.

So, when you have time changes, whether it is travelling across overseas to another country which is four time zones ahead or behind or if it’s daylight savings or some other kind of shift in time zones; you have circadian dysrhythmia, aka, you have an issue with your circadian rhythm which could develop into a problem and a sleep disorder that can be treated by a sleep specialist. However, what to do in these situations.

Now, in terms of your practice and your sleep hygiene, maintaining a consistent sleep wake schedule is of the utmost importance. And that is regardless of changes in the time zone, daylight savings; this for everybody. This is a part of our sleep hygiene recommendations. So, when it comes to daylight savings time; we really try to emphasize that that is a time where you really need to be on your best behavior for lack of a better term, in a sense of practicing that maintenance of a consistent sleep wake schedule. Because, any kind of deterrence from that schedule in the setting of something like daylight savings time could set you up for a disaster. You are talking not being able to fall asleep for several hours with subsequent affect on your daytime functioning, maybe even causing you to take a nap from being so tired thereby affecting your ability to fall asleep the following night and then again, it just becomes this perpetuating cycle of insomnia.

So, really sleep hygiene and maintenance of a consistent schedule are really of the utmost importance not only for general health but especially when it comes to time changes in the case of something like daylight savings time or even if you are travelling across time zones which depending on how far you are travelling, there’s also a few other things that we recommend like exposure to bright light therapy, use of melatonin to help adjust your circadian rhythm. But when it comes to these kinds of things; it’s one of those things where it really depends on the situation.

However, specifically in regards to daylight savings; again sleep hygiene, consistent sleep wake schedule, good sleep habits and you will be able to overcome those kinds of bumps in the road from time changes.

Host:  It’s great information. As we wrap up, Dr. Kashani, what would you like the listeners to know if they have trouble sleeping, if they do suffer from insomnia or their partner has told them that they stop breathing in the night or that they snore very loud. Give us your best advice about sleep disorders, who would notice them and sleep hygiene, you best advice for getting a good quality night’s sleep.

Dr. Kashani:  I think the first thing that it’s really important to know and I really want the general public to know this and many people do; is that a couple of things. Number one, sleep disorders are extremely underdiagnosed. Whether it’s sleep apnea, insomnia, or even something like narcolepsy; sleep disorders are very much underdiagnosed. And it kind of makes sense if you think about it because the pathology or the problem in the disease is occurring at a time in which your consciousness and your alertness is reduced to a minimum compared to your state of wakefulness. And therefore, it can be really hard for the person themselves to really assess what’s going on when they have for example, untreated sleep apnea. Or they have insomnia or whatever the case may be.

Bed partners can be very valuable and very useful in situations like this because as you mentioned, people often come in saying that my husband is snoring all night, my husband looks like he stops breathing for a few seconds; all of these being typical signs of sleep apnea that’s not treated. And then next thing you know, we have our diagnosis and we can get the patient treated. So, knowing that it’s very underdiagnosed and knowing that other people witnessing or observing the way that you sleep can be really helpful in reaching a diagnosis and starting treatment is of critical importance in my opinion.

Now, specifically about sleep hygiene. When it comes to sleep hygiene, a lot of sleep hygiene recommendations that you can see published through the American Academy of Sleep Medicine’s website and the ones that we emphasize with our patients every single day are things that we really know already. These are intuitive things. We know that when we go to sleep at nighttime, our light should be off because we will sleep better probably if the lights are off or if the lights are more dim compared to bright lights. We know that we shouldn’t be in a distracting environment or a noisy environment when we go to sleep because that won’t give us good sleep. It could cause us to wake up. It could cause us to have light or restless sleep.

So, really knowing that sleep hygiene is something that even though it’s so intuitive and the practices and routines and things that we emphasize patients implement into their sleep behaviors are so kind of almost obvious; implementing them and actually practicing them religiously on a nightly basis takes a motivated person. And that’s really something that I think is important to keep in mind is that sleeping well is not easy despite how intuitive our recommendations of sleep hygiene or practicing good sleep hygiene are. It’s really takes the patient, it takes the person to realize that they have this issue and in order to improve it, they need to practice these basic things. like I said, keeping the room cool, keeping the room dark, keeping the room quiet. If the cause of your insomnia is your Boston Terrier coming in the room every single night around 2 a.m. and rustling the bed and jumping all over you; well then you have an underlying problem in your insomnia and that problem is your cute little dog should probably not be able to come into your bed at 2 o’clock in the morning. And boom, there you go. Your insomnia has improved.

So, insomnia has many, many causes. Poor sleep quality, many, many causes. It’s a matter of finding out what they are, what those causes are, eliminating or addressing them and really making sure to practice optimal sleep hygiene to get your brain and body in harmony to know when to sleep, when to wake up and how much sleep you need.

Host:  What a great educator you are Dr. Kashani. That was excellent information. Thank you so much for coming on and sharing your expertise. Something that we really all need to learn about is sleep and thank you again. That wraps up this episode of It’s Your Health Radio with Henry Mayo Newhall Hospital. To learn more about sleep related topics, visit the Health Library on the Henry Mayo.com website. You can go there for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share. Share on your social media, share with your friends and family. We all know somebody who suffers from sleep disorders and maybe you do yourself or your children. So this is the way we can all learn from the experts together. And don’t miss all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.