Did you know that according to a major study, people who don’t get enough sleep are twice as likely to get heart disease? Sleep disorders are a big problem. About 70 million Americans suffer from them, and 60 percent have a chronic sleep disorder.
Through proper testing, diagnosis and care, sleep disorders can be managed and overcome. Listen to an interview with Claire Barker, clinical sleep educator at the UVM Medical Center Sleep Program. She is a registered sleep technologist and certified in sleep health. A transcript of the interview is available below.
UVM Medical Center: We all know that getting too little sleep can affect moods, job performance and even cause car accidents, but did you know that according to a major study, people who don’t get enough sleep are twice as likely to get heart disease? I can’t resist saying that’s a wakeup call. Sleep disorders are a big problem. About 70 million Americans suffer from them, 60% of those folks have a chronic disorder. Luckily, through proper testing, diagnosis and care, sleep disorders can be managed and overcome. Here to help us understand a lot more about this today is Claire Barker. She’s a clinical sleep educator at the UVM Medical Center Sleep Program, also a registered sleep technologist and certified in sleep health. Thanks for coming.
Claire Barker: Thank you for having me.
UVM Medical Center: Let’s start by saying how much sleep do you need and does it change at different stages of life?
Claire Barker: It certainly changes during different stages of life. Children, babies in particular, need much more sleep than we do as adults obviously. When you’re really young, it’s anywhere from 16 to 14 hours of sleep. Then as we grow into adulthood, it’s closer to eight hours. Some people can go with the six hours and whatever’s normal for them, so there is a bit of wiggle room there, but it’s generally recommended between seven to eight hours. As we age, that tapers off a little bit, but not quite as much as we think as we get older. We may need more like seven hours of sleep.
UVM Medical Center: With older people, you do hear that they have trouble sleeping, and it can really drop down. That causes lots of problems.
Claire Barker: Yes it does. There’s a few things that happen there where when we lie down to go to sleep when we’re older, it takes us a little longer to get to sleep. That sleep is maybe not as deep of a sleep. The amount of sleep is near the same, but the time that we spend in bed is actually, when we’re older, we need longer time in bed to actually get that much sleep because there are periods of wakefulness in that.
UVM Medical Center: In addition to the things I mentioned, this is bad, not getting enough sleep. I think actually you should tick off some of the ones that are most worrisome from a clinical standpoint or just lifestyle.
Claire Barker: Sleep deprivation is detrimental to a lot of aspects of your life that you wouldn’t necessarily associate with just a good night’s sleep. It can affect anything from your mood and your disposition, how grumpy you are during the day to your amount of energy and how fatigued you feel during the day. It can also affect you health-wise, and it really plays a role in your metabolism, so how we store calories and use calories. Some of the sleep disorders that are out there can put you at higher risk for heart disease, stroke, obesity, and that kind of thing.
UVM Medical Center: The connection to weight is really very clearly established, right?
Claire Barker: Yeah. If a lot of your metabolism functions happen during sleep and you’re not sleeping properly, then it can attribute to weight gain. It actually plays tricks with our minds because there are certain hormones that make us crave fatty, high-caloric food, and those will actually kick in if we don’t get enough sleep because we want quick, fast energy. We didn’t get it from sleep, so now we want some carbs that can really give us some energy quickly. It’ll actually override the part of your brain that says, “You know, I should have a bowl of carrots right now, but I’m going to go for the donut.”
UVM Medical Center: This is why I want spaghetti for breakfast.
Claire Barker: Yes, exactly.
UVM Medical Center: The other thing that’s, I think, relatively recent or you hear more about it anyway is that when you sleep, there’s this washing of the brain going on and the fact that doesn’t happen can contribute to, I think they suggest Alzheimer’s and other problems.
Claire Barker: Yes, absolutely. It’s a fairly new discovery that during sleep our brain is washed with the cerebral fluid. The idea is that is our brain’s waste management system. That’s the period where we clean out the dead skin cells and things that our brain uses so those synapses are nice and clean so that we can make quicker connections during the day. There’s a lot of speculation if you’re not getting enough sleep and you’re foggy and slow on the uptake the next day, is it because you didn’t get that washing of your brain and you still have some waste in there, floating around.
UVM Medical Center: Pay attention folks. This is very serious. What are the most common two, three sleep disorders that you deal with?
Claire Barker: The most common sleep disorder that we see here at the sleep clinic and in the sleep lab tends to be obstructive sleep apnea. Essentially, muscles somewhere in your airway, usually in your throat, relax when you go to sleep, and they relax to the point where they collapse your airway. Your body’s still trying to breathe, but it is just not quite getting through. That can really cause your oxygen levels to drop during the night. It puts a lot of stress on your heart in particular because when you lose oxygenation to your blood, your heart has to work double time to get all of that oxygen that is there everywhere that it needs to go.
It does increase your heart rate. It really disrupts your sleep. You may stay in bed for eight hours and think you got a whole eight hours night’s sleep. If you’re having these periods where you’re not breathing, your body is going to say, “Hey, stop that,” and actually kick you into lighter stages of sleep, disrupt your sleep, and keep you from getting that nice, deep, restorative sleep. For sleep apnea folks, it really is that stage of sleep that gets disrupted the most and is actually not a nice, restful time for their bodies. It’s a time when they’re really struggling to breathe.
UVM Medical Center: The treatment I think that a lot of people are aware of is these air machines, CPAP machines that push air down your airway. Is that the last step? Are there other things that can be done before that?
Claire Barker: Actually, it’s the first step. Because it’s noninvasive, it is just regular room air. I talked about when your airway relaxes and collapses on you, it ends up a lot like a deflated balloon. It’s real hard to push air in and out through your airway if it’s like a deflated balloon. Really all CPAP does, it stands for continual positive airway pressure, and essentially what it’s doing is inflating your airway for you, keeping it nice and stable so that it’s easier for you to breathe. Because it’s a noninvasive measure, it’s fairly well-tolerated because it is just regular room air. It’s got some pressure behind it, so it’s some air blowing up your nose. Because it is easy to try and it is quite effective, that’s generally the first line of treatment.
UVM Medical Center: It can get to surgery, right, for some people?
Claire Barker: It can indeed. Depending on the severity of the sleep apnea, depending on physiologically what’s causing the sleep apnea, surgery can be an option. There’s also a mandibular advancement device, so it’s an oral appliance that you wear when you go to sleep. It looks like a bite guard, kind of like what the football players wear when they’re on the field. The goal there is to pull your lower jaw forward to open up the back of your airway and open you up that way.
UVM Medical Center: What’s one other really common thing you run into?
Claire Barker: Well, insomnia tends to be talked about a lot. We get a lot of questions of how do I get my brain to turn off when I want it to and things like that.
UVM Medical Center: For insomnia, what are some typical first steps you take?
Claire Barker: To really set out a routine for your body and your brain. Make cues for yourself to cue your brain to know that it’s time to sleep. There are a few things that we can do. Dim the lights, do something relaxing like reading a book, taking a nice, warm bath, writing thoughts down in a journal – get them out of your head, get them on paper – listening to soft, soothing music, practicing breathing or meditation. That’s the first thing is really to start preparing your body to wind down.
Next, we want to set the stage for sleep. You want your bedroom to be a nice sleep cohesive environment, dark. I’m not a big fan of nightlights. Cool and quiet, but not too quiet. A little bit of a white noise actually helpful to drown out some of those noises that can happen with cars driving by and whatnot. Also, you want to use your bed and your bedroom for sleep. When you walk into that room, when you’re in that space, you don’t want to be telling your body, “This is where I sit and watch TV. This is where I get my stimulation.” You want that space to be this is where my body goes to relax.
UVM Medical Center: Speaking of TV, one big no-no and really it’s become a huge problem is technology. People bring their smartphones and other video devices in there. That just signals to the brain, right, even the light from it can signal to the brain that it’s not time to sleep.
Claire Barker: Absolutely. Blue light emitting devices in particular, so cell phone screens, tablet screens, television, computer screens. Blue light actually halts the production of melatonin, which is the hormone that triggers sleep. If you’re staring at a screen, you’re telling your body to not sleep. It’s time to be awake right now. I need to be focused. You actually need to start producing melatonin a couple hours before you plan on being asleep. It’s good to turn off that computer, turn off the cell phone before bed.
UVM Medical Center: Boy, that’s just like an epidemic though. Everybody sits in bed with their laptop and watches their favorite show, right?
Claire Barker: That’s true. There are applications being developed now that you can actually put on your phone and put on your computer that will over the course of the day start eliminating the blue light. It’s actually an interesting thing to see because come 10 o’clock at night, if you’re looking at a white screen with one of those apps turned on, it actually looks bright orange because it’s taken all the blues out of your screen. You can still read it and you can still see it and everything, but it’s not telling your body to be awake. It’s not turning off that melatonin, which is nice.
UVM Medical Center: Speaking of melatonin, you see a lot of over-the-counter medications that include that. Do those work? Do you recommend them?
Claire Barker: Our doctors do sometimes. Yup. I always say to speak with a doctor because they can interact with other medications and things like that. If you are taking anything, a supplement like that, certainly talk to your doctor about it and let them know. Just because they’re over-the-counter doesn’t mean that they’re innocuous. They do have reactions and things like that.
UVM Medical Center: We’re almost out of time, but I wanted to ask about the, you made reference to the lab a couple of times. What happens there? The sleep apnea testing mostly?
Claire Barker: We test for all sleep disorders. When you go into the lab, we wire you from head to toe. You get about 26 sensors put on you. Mostly we’re looking to see how your body functions during sleep. We have a technician in a separate room that is monitoring your brain waves and respirations and heart rates and things like over the computer.
UVM Medical Center: One other thing, in terms of apps I’ve seen often recently, these apps that have meditative cues, even bedtime stories for grownups and music and soothing sounds. What do you think about those?
Claire Barker: I think any routine that helps you relax is good. Routine is paramount. If it’s something that you like, keep at it. If it’s something that doesn’t work for you, try something else. Everybody’s a little bit different, so it could be a different routine that you need to develop.
UVM Medical Center: It sounds like in life, health depends on routines. You’ve got good sleep routine, good eating routine, exercise routine.
Claire Barker: Absolutely, and I’m actually happy that you touched on the exercise and eating because that too can play a role in your sleep. Caffeine for instance is a stimulant that can actually stay in your system for eight plus hours. You think about that, and you think, “Well, I got to stop drinking coffee by two in the afternoon if I plan on actually being in bed by 10 o’clock and being ready to sleep.” I think paying attention to what you’re putting in your body and how you’re stimulating your body can really play a role in how well you can sleep. If you sleep better, you have more energy to exercise. If you exercise, you have a reason to sleep better. They are correlated.
UVM Medical Center: A lot of things people can do on their own, but if they do need professional help and guidance, you folks are here at the sleep program. If you want to learn more about the sleep program, you can go to our website, which is uvmhealth.org/medcenter. In the upper right of the home page, you’ll see a search box. If you just put in sleep, it’ll bring you to a page with a lot more information. Well Claire Barker, I want to thank you very much. She’s a clinical sleep educator at the University of Vermont Center sleep program, a registered sleep technologist, certified in sleep health. Nice to talk to you.
Claire Barker: Thank you so much for having me.