We’re repeatedly told getting a good night’s sleep is important. Scott Brocato recently spoke with Dr. Ikrita Klair, a sleep medicine specialist with MountainView Regional Medical Center, to explain the reasons why. In this first of their two-part conversation, Dr. Klair talks about sleep apnea, hypoxia, what’s causing us not to get a good night’s sleep, and what activities are going on in our brains and bodies while we’re sleeping.
Scott Brocato:
What are some of the ways that sleep is important for your overall health and well-being?
Dr. Ikrita Klair:
Multiple ways. Most important we know is cardiovascular, which is your heart, your brain, your cognition, blood pressure, memory, mood, multitude, even your weight. So a multitude of things and health issues that it relates to.
Scott Brocato:
What are some of the things that are causing a lot of us not to get a good night's sleep?
Dr. Ikrita Klair:
I think in today's world, if I have to pinpoint one of the very important reasons, would be a lot of psychological stress, personal stressors. And then on top of it are medical issues, which could be sleep disorders or non-sleep disorders. And at the end of the day, winding down, relaxation, those things are really important. But you know, we do what we can.
Scott Brocato:
You've been quoted as saying that while sleep is seemingly passive, your brain and body are engaged in activities that are necessary to live and link to quality of life, both mentally and physically. What sort of activities are your brain and bodies engaged in while you sleep?
Dr. Ikrita Klair:
So let's say, you know we have different sleep cycles. And a lot of our health parameters will be changing with our sleep cycles. For instance REM sleep, which is dream sleep: very, very important. But if someone is having significant sleep disruption, they may not get an adequate amount of REM, which is so important for your memory consolidation, your cognition, brain health, and feeling that you got a good restful restorative sleep.
And then our blood pressure or heart rate or cardiovascular health is totally related to sleep. I get a lot of referrals where people have uncontrolled high blood pressure despite optimal medical therapy, and then they want to know are they getting good sleep in terms of sleep quality and quantity?
A very common sleep disorder that we treat as sleep clinicians is sleep apnea, where we are not breathing right. We're not getting enough oxygen and sleep. That can also lead to exactly the same effects. So it is both in terms of quality of sleep and quantity of sleep.
Scott Brocato:
What about hypoxia? Is that related to sleep apnea?
Dr. Ikrita Klair:
So hypoxia is a very generic term. All it means is low oxygen, and it could be from sleep apnea. It could be from lung disorder, it could be from, you know, bleeding, anything; heart disorder. So it is a generic term, and we have to find out is it daytime hypoxia and night time? Or just night time? For a sleep apnea person, it would be only night time hypoxia when they sleep.
Scott Brocato:
What are some tips to getting a better night's sleep?
Dr. Ikrita Klair:
Generally...so for instance, caffeine, we should try to hold it at least six hours before bed time. Alcohol: a few hours, I would say roughly, let's say, 3 to 4 hours before bedtime.
So, alcohol. A lot of people think, well, it sedates me, makes me sleepy; shouldn't it be good for my sleep? It is bad in a number of ways. First, it is a sedative in the beginning of the night. But as the night progresses, it actually causes lot of sleep disruption. That is one. Second, alcohol is going to make your muscle tone decrease. You have more sleep apnea, the obstructive sleep apnea. So those are a few things.
And then we wanna make sure when we go to bed, that we are sleepy. We're not just laying awake, forcing ourselves. Same bed time, same wake up time, all seven days of the week should be a goal. Not taking long naps in the day, not taking hot showers right before bed time. Heavy exercise. So those are the few things which should be what we call good sleep hygiene practices. But if you have poor sleep because of a medical disorder like sleep apnea, lot of pain, anxiety, then just sleep hygiene is not going to completely help. Then you have to get proper help from the doctor.
Scott Brocato:
What are some things not to do if you're having trouble falling asleep? Some people, they reach for their cell phones and start scrolling.
Dr. Ikrita Klair:
So yeah, that is a really good point. Like anything which is giving us light, stimulatory light, it can really activate our brain pathways in such a way that we are not going to be able to get good sleep. There are some people who would who would use some screen protectors: “Well, I'm protecting myself from this wavelength and that.” And it can help. But towards the end of the day, we want to have darkness. The reason for that is we have natural secretion of melatonin, and the way those pathways work is when it's dark, our body secretes melatonin to help us fall asleep. And then it starts going down in the early morning hours because we have to wake up. So that is why we don't want that extra light. We want dim lights towards the end of the day.
Also cooling room: same. So they always say “cool down to sleep sound.” So a lot of us, the cooler the temperature is, we don't wanna be in a hot room unless it is a situational thing. So dark, dim lights would be really important towards the end of the day.
Scott Brocato:
MountainView has a sleep lab where patients can stay the night while a tech monitors or sleep. How does that work? And for whom do you recommend something like that?
Dr. Ikrita Klair:
So there are a lot of different reasons why we would do sleep studies, and there are different types of sleep studies. And we've been blessed with a lot of good work, good trust. We have right now four running rooms, all seven nights of the week, and we are going to be expanding to eight soon; we're working on that. But sometimes we are doing sleep studies to basically record someone's breathing and oxygen and sleep. A standard night’s study involves brain wave monitors, more for sleep cycles. Then heart monitor for the heart rhythm. Breathing, oxygen, restlessness, that kind of data.
But then there are people who need daytime studies. Those are people who are extremely sleepy, and it is not related to a lack of sleep or poor quality of sleep or another identifiable reason. So they need different kind of studies where they actually stay in our sleep centers during the day. So a lot of monitoring, and most of the time we're doing overnight studies.
Scott Brocato:
And where can listeners get more information about sleep medicine?
Dr. Ikrita Klair:
So for me it is, you know, our sleep academy, actually anybody can access that. But generally for sleep, there is also a website and an online app. It is called CBT-I Cognitive Behavioral Therapy for insomnia. And I encourage a lot of my patients to actually download that app. It is a very researched information and data, where in the country we have clinics, which actually provide cognitive behavioral therapy to improve insomnia. But places like where we are, we don't have a dedicated personnel or a clinic. So this app was actually made by VA, but now it's a free app, talks about everything outside of medications, how to improve sleep, how to track your progress. And that includes sleep hygiene. It has videos, imagery and I encourage people with sleep issues to really download this app and review information.
