Sleep Disorders: Insomnia, Restless Leg Syndrome, Central & Obstructive Sleep Apnea, and Sleep Hygiene

January 9, 2020

In 2018, a research study found that at least 36% of Americans were sleeping less than seven hours each night. Inadequate sleep can lead to a number of physical and/or emotional conditions. Some common sleep disorders include insomnia, restless leg syndrome, central or obstructive sleep apnea, and sleepwalking.

Have you perfected your sleep hygiene behaviors to achieve optimal rest and sleep each night? If not, perhaps you’ll want to hear what sleep specialist, Dr. Catherine Darley, has to say.

In addition to Dr. Darley’s advice, as well as the sleep hygiene tips I offer at the end of this podcast episode, check out this blog post on Brain & Life‘s website.


welcome to glass half full with leslie krongold she shares her stories experiences and knowledge of living and coping with a chronic health condition learn about tools and resources and hear inspirational interviews that help you to live a life filled with quality and dignity with two decades of support group leadership leslie’s ready to help you make lemonade out of life’s lemons are you ready are you ready hello and happy new year to you happy new decade i was going to close out 2019 with this episode on sleep hoping you could use some of the tips during the frenzied holidays but i got to frenzied so now you can add this to your new year resolutions heck i’m always looking for new advice or research to help my sleep and rest routines i’ve been scrutinizing my sleep for a while now i’ve made changes to my daily rituals all with the intention of improving my night’s sleep i know sleep issues are common amongst my patient community amongst my friends pretty much across the western world there are many books about improving your sleep i’ve read many of them in the glass half full facebook group i did an informal poll asking people about their sleep there were four options do you have trouble falling asleep staying asleep waking up or is your sleep perfect the way it is well no one responded to the last option the majority of the respondents had trouble staying asleep and that’s usually my problem though here and there i have nights where i just can’t fall asleep at the end of this episode i’ll share some of my sleep hygiene tips with you everyone’s different so i don’t know if they’ll help you but i think i found a great guest for this episode her name is catherine darley dr darley is a naturopathic doctor and these types of doctors are guided by principles that include the healing power of nature they first try treatments that are of a lower force and have fewer side effects like behavioral or dietary treatments this happens before prescribing any pharmaceuticals and that philosophy certainly appeals to me i met dr darley at a day-long class she taught about sleep and mental health it was geared toward therapists counselors and nurses i was incognito she travels around the country teaching people about sleep research you can check out her website the link is in the podcast notes on the glass full website what is a sleep specialist so a sleep specialist is a physician who has not only the training of primary care but has also gotten specialized training in sweden as a student and there is actually an academy of sleep medicine which is part of the american academy of medicine and is it is it like a subset of neurology or is it just completely its own special it’s entirely recognized in its own right sleep medicine is actually a relatively new discipline of medicine compared to some others like cardiology or respiratory medicine the sleep annual sleep meeting has only been happening for about 27 years so it’s a relatively new discipline in light of some of the longer history of other disciplines yeah okay yeah it’s interesting i wonder if it’s a comment on society or where is our sleep has it just become progressively worse yeah i don’t know i think that you know it sleeps interesting to me in um you know in our social standing because even though we all sleep and we all must sleep it seems like it’s been an area that really hasn’t gotten much focus until the last 30 years or so and uh and that’s kind of surprising considering how essential and how basic it is but did we know how important it was you know more than 30 years ago did we just take it for granted i think it is taken for granted although there was certainly research being done since the 1940s if not earlier looking at sleep and one of the first when i first started getting interested in sleep was about 1991 in college and so i was doing literature reviews and reading research papers and at that point we knew that at least animals would die without sufficient sleep so i think that’s a pretty good indication of how essential it is and uh you know early 90s that’s a long time ago and the research i was reading at that point had been you know conducted in the 10 or 15 years prior to that so we’ve certainly known for a long time how essential it is so what did bring you into this field of expertise was it those you know that original that research that sort of lit a fire for you i have always found sleep very just personally interesting to me i’ve always been a pretty good sleeper and i’ve really my parents my household that i grew up in prioritized getting sleep and i’ve prioritized getting enough sleep and so i’m really very aware of what happens to my experience personally when i don’t get enough sleep and so that’s part probably of what motivated me i also when i was a kid i slept walked uh into the neighbor’s house when i was 12 which was a pretty um wow noteworthy experience and i think speak to my interest yeah so oh wait so did that run in your family or was that an anomaly or did you have an issue with sleepwalking my i don’t believe that sleepwalking ran in my family but i was a little bit of a sleepwalker that was the most extreme case or example of my sleepwalking but there were a few other times that i would sleepwalk and the last time was when i was in college about age 21. so how it ended abruptly i mean did you cause it to end abruptly by no i didn’t do any treatment it’s sleepwalking is something that people often outgrow it kind of peaks when people are around seven to twelve years old although certainly adults there can be adults who sleepwalk regularly but i’m not one of them okay that’s good because you you you spend time in a lot of hotels with the work you’re doing i’m sure that would be a little scary yes and for people who are regular sleepwalkers adults it can be distressing but it seems every magazine i pick up it doesn’t matter what kind of magazine there’s something about sleep and i’ve read you know a lot of books on sleep i attended your workshop i mean i’m just so intrigued about it but it seems like perhaps a lot of america is intrigued about it so i was wondering if you could tell me you know some of the statistics about sleep or or lack of sleep that contribute to poor physical sure i can and i want to comment on your your observation about many magazines now will have articles about sleep and that it’s something that’s really captured the interest a huge uptick in the amount of media interest and attention and public interest years ago so i think that’s a really positive sign for us improving our sleep on the other hand there’s some new research that evaluated americans sleep up to 2018 and found that 36 of americans are sleeping seven hours or is not enough sleep for adults most adults seven hours or less so that’s a increase in the percentage percentage of americans not getting adequate sleep and i think about it impacting five domains leslie i think i talked about this briefly in the course that you’ve got your physical health and and our quality of life and our kind of non-diagnosable symptoms to full-blown diagnosable anxiety depression as i think of our physical performance and mental performance so many people in america operate cars right which is a form of is absolutely impaired when you’re sleep deprived then there’s this cognitive performance things from simple memory all the way up to complex problem solving are going to be worse your performance will be worse in those areas if you’re not getting adequate sleep and then the fifth dome appropriately to them which can cause disharmony in your relationships and your social functioning basically i asked dr darley to tell me about other common sleep disorders especially insomnia we definitely want to be treating obstructive sleep apnea and there are other sleep breathing disorders is insomnia and we think this person’s uh insomnia is chronic if they’ve had it for more than three months which you know three months can speed by right and someone’s acute insomnia due to maybe a life event a good insomnia continues after that other categories would be movement disorders things like restless leg syndrome other categories are circadian rhythm disorders and this is a category that’s getting a lot more attention now as we learn how pervasive our circadian systems are throughout our bodies one population that really struggles with circadian issues is shift workers about 20 of americans do shift work where they’re commuting to work or working at times they would naturally be sleeping that can cause a big problem and actually increase cancer risk other two categories of sleep disorders are hypersomnias like narcolepsy and then the last category is parasol it’s where we see those more abnormal sleep features such as the sleep walking sleep eating those types of conditions one is you know roughly how common is sleep apnea and i recently read just a short little blurb that there are different types of sleep apnea can you you know elaborate a little on that so we think it’s somewhere between five and ten percent of men have sleep apnea and slightly lower percentage in women but i’d like to make sure that your listeners know that when women get through menopause and their post-menopausal at that point the rates of um be equivalent to the rates in men and it’s because estrogen has a protective function keeping the airway toned and as women go through menopause and no longer have such high estrogen levels their airway is more easily obstructed like men of their age so that’s something to keep in mind for women as they get older and yes there are another type of apnea is called central sleep apnea and the physiology of obstructive versus central sleep apnea is quite quite different what happens with obstruction of sleep apnea the brain is still telling the body to breathe so you’ll still see the diaphragm the chest rising and falling as the person tries to breathe but they’ve got an obstruction in their upper airway kind of right at the back of the throat usually but in central sleep apnea there’s a problem with the brain respiratory drive and the brain is not giving a signal to breathe and so the diaphragm actually will be still during these apnic pauses and they’re not even trying to bend again it may panel even attempt at respiratory effort the obstruction of sleep apnea is more common in people who have high bmi high body mass index but it’s not exclusively true and i think that we generally think that women tend to be more missed diagnosis of obstructive sleep apnea because they tend to be slimmer or smaller people and so we don’t want to just assume that someone who isn’t overweight doesn’t have obstructive sleep apnea because thin young women could have obstructed sleep apnea also it’s really not only is it the entire body habitus but it’s the shape of the airway so for people who have maybe a small or recessed jaw they’re going to be at increased risk people who may have a deviated septum and can’t breathe through their nose and so therefore they’re breathing through their mouth that increases their risk of obstructive sleep apnea or you know if they have a large tongue or enlarged tonsils making the airway more crowded it’s easier to obstruct you know we did you know year decades ago think of it more as a overweight person’s disease but now we know it’s really mostly impacted by the shape of the airway i asked for a bit of an elaboration on the circadian rhythm and how it impacts us so our circadian rhythm is several many systems in our body that help us stay entrained to the 24 hour a day that we’re seeing on our earth and it’s signaled mostly and it’s uh we’re entrained to the day uh environmental day by the time that we get bright light in the morning so you know sometimes people really focus on getting to bed at the same time and that that is the most important for sleep but i would suggest that actually getting up at the same time each morning and getting bright light as soon as you can helps in train your circadian rhythm and your sleep we want our circadian rhythm to be robust so that we are widely awake during the day and deeply asleep at night one of the things that is really confusing our bodies now in modern lifestyle is the amount of artificial bright light that we have available to us at night both on our electronics on the evening cell phones tablets computers tvs etc and then also just with the ambient lighting that we have in our homes and that is that actually causes a delay in our sleep hormone melatonin and it causes a shorter time of that root melatonin is being released each night so that can impact our sleep so in these uh winter months where you know we have less light and i often wake up here in northern california and i don’t have a clock in in the bedroom but i look and it you know i think oh my god it’s like 5 a.m but it turns out to be 8 a.m and there’s just you know like minimal sun and even you in seattle you know how do you how do you get that hit if it doesn’t exist naturally for some people they may choose to use a light box other people may choose to just get up you know even though it’s dark and maybe cold outside get up at the same time turn the lights on really actively start their day and then as soon as it’s light out a great practice is to go out for a walk 20 minutes of a walk with the bright outside light and for those of your listeners who are in seattle or other places that are known for being overcast and cloudy even on an overcast morning it’s going to be brighter outside than almost any indoor setting is going to be and that amount of light will really help clue to your body its day and switch into daytime physiology awake physiology and then i think the other corollary is to purposely be turning down the lights in your home and not only turning down the brightness of them but also switch to more historical types of light waveforms that people would historically be exposed to at in the evening which would be your yellow and think uh sunset or fire light or candlelight those kinds of hues of lighting so what i recommend is people set an alarm on their phone or something for an hour hour and a half before their bedtime and at that time they turn off all the lights in their home except for maybe one light which they’ve put kind of a yellowish hued relatively dim bulb in so they can still do their recreational wind down activities you know snuggling and talking with the family or reading a book or doing some gentle yoga or listening to a podcast or something but they’re not getting bright light they’re not getting blue light i was curious if jack and darling could give us more suggestions on how to improve our sleep hygiene nutrition and exercise have gotten a lot more media attention over the last 60 years than sleep has well if you just had the exercise and nutrition piece that’s not very stable is it you’ve got to have the sleep piece and then i think of some other some other pieces of a healthy foundation being positive social relationships loved ones that we can count on and that we and who have esteem for us and we have esteem for them another one would be joy having joy in our lives and then the sixth connection to nature and there’s lots of research coming out now about how nature improves our health and i know when i’ve been out nature or i exercise on a day my sleep my ability to sleep that evening is easier is enhanced so sleep hygiene is basically creating a lifestyle that promotes healthy sleep and a strong circadian rhythm uh and so there’s many many components of this if i was just going to choose out the top five components of sleep hygiene i would say i mentioned bright light in the morning for 20 minutes ideally in the first hour or two of getting up sooner the better after getting up the second one would be like i said earlier avoiding the blue light and the artificial light at night and replicating as best you can naturalistic historical lighting conditions which would be dim yellowish reddish spectrum of light would be deciding to give yourself enough hours of sleep because insufficient sleep syndrome is definitely the most common sleep problem that i see people having and it contributes to so many domains that can be negatively impacted the physical health the physical performance measures so the way that i think about this which i’m not sure that other people do is that if you are an eight hour sleeper and that’s the ideal amount of sleep for you that means you can have a 16-hour day and if you’re trying to have 17 or 18 hours of activity each day you’re not going to be getting the sleep you need and therefore you’re going to be having some domain and i encourage people to think about the question would you rather have a long day or would you like to have a good healthy day that’s shorter because you’re getting enough sleep and i’m not sure that people are thinking about it quite as explicitly or quite in those terms so that would be the third thing get enough sleep the fifth thing is your sleep hours to rest and sleep and don’t take your daytime rolls and responsibilities to bed with you i think that idea that we’ve probably all heard of leave a bet pad of paper and pencil at your bedside so if you have a good idea in the night you can jot it down i think actually that’s a horrible idea because it trains you to be on all the time instead of practicing some limit setting that it’s okay and it’s valid for me to stop taking care of my responsibilities and just rest and sleep and recover and be recharged for the next day when i can pick those up again so those are my recommendations and then the fifth one would be about probably exercise and just giving yourself enough wind down time between your active day or eating or exercise and turning lights out some people transition more quickly others need a little bit more time but you know kind of evaluating that for yourself and determining how much time you need to wind down so that you’re ready to sleep once you’re in bed regarding insomnia does this refer to something more than having difficulty falling asleep i asked dr darley about waking up in the middle of the night and not being able to fall back to sleep depending on what their problem is if they are aware of waking up gas with a gasp in the middle of the night or if a bed partner or someone sharing the room says that they’re snoring loudly or pausing in their breathing at night they definitely should be evaluated for a sleep breathing disorder if they’re having difficulty with intimates at the beginning of the night to fall asleep being awake in the middle of the night or waking up too early not refreshed not ready for their days insomnia can manifest at all those different points in the night that is something that should be addressed we know that the more episodes of acute insomnia that somebody has the greater their chances of having insomnia in the future so that would be important and then if they have restless leg syndrome where they’re feeling like they just have to move their legs in the evening and that movement uh or that sensation subsides when they move that would be an indication to go see a sleep specialist such high percentage of americans are not getting adequate sleep i would really encourage people to do an optimal sleep plan for two weeks where they’re really prioritizing getting the amount of sleep that they need and just then noticing how does it impact their health and their sense of well-being is it worth it to get more sleep does it really make a difference and how can you do that that’s what i would recommend and i think i ended with that leslie in our sleep class i’m wondering if you had the chance to do it and if so how did that work for you oh i know yeah the more i sleep the better i feel years ago i did my silver presentation i was doing for my patient in my disease community and i had you know impairment like maslow’s hierarchy of needs but it was based on my self-care routine and the foundation is sleep and getting a good night’s sleep is critical for my next day and a lot of what i do during the day is to lead to that optimal sleep experience so it’s based on exercise and winding down stimuli like lights and sounds i take a hot bath every night the only thing i do which is probably contrary to uh what sleep experts suggest is i i watch a little tv in bed i mean there’s you know there’s these recommendations that we make that are based on physiology but every person is an individual and has different success abilities i mean as we know we we’ve all got probably friends who can drink more and and handle it fine you know there’s you know we can give examples in any area of health where we see individual variability and so i encourage people to follow the rules and then if they find that they can break them in one area more power to you dr darley has certainly provided us with food for thought one thing i’ll definitely start doing is getting outside in the morning even if it’s overcast not mentioned in this podcast but we did talk about it during our conversation is starting a sleep journal or diary there are also online versions or apps to help with this dr darley believes it’s good to document and look for trends rather than relying on your subjectivity and another way to track sleep and include relevant data is to use a wearable device to sleep this wouldn’t be comfortable for me but my partner does it and can check to see how much sleep she got the previous night and at what time she may have awakened during the night i remember from my time receiving regular acupuncture treatments that when you wake up in the middle of the night i can point to issues related to different body organs this is all part of traditional chinese medicine so you might if you find that you’re waking up at a particular time every night you might want to consult an acupuncturist anyhow as i mentioned in my conversation with dr darley i am intentional during my day to create a fertile ground for restful sleep i exercise earlier in the day i eat frequent small meals with my last meal several hours before i’m gonna go to bed i do wind down and i limit stimuli such as lights and noise and i take a hot bath using essential oils like lavender which is known to have a relaxing effect and i also take a one to one thc a cbd tincture sublingually under my tongue about an hour before i anticipate falling asleep and this routine usually works but nothing is foolproof anxiety can still rear its ugly head and keep me awake or arouse me from asleep it’s all a work in progress so rest peacefully my friends and when you wake up well rested the next day turn one of your friends onto this podcast thanks for listening

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