Episode 19: Sleep Health and Sleep Apnea

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Episode Summary:

Interesting things happen during sleep that impacts our health in a surprising number of body systems (sexual, cardiac, neurological, metabolic). Many careers, the modern world (devices), our health, and sleep apnea all interfere with good sleep. In this lively episode learn the scientific and medical reasons good sleep is critical, and how to make good sleep work in your life.

Episode Guest:

Scott Bonvallet M.D. Medical Director of the Overlake Sleep Disorders Center in Bellevue WA; Board Certified in Internal Medicine, Pulmonary Medicine, Critical Care, and Sleep Medicine.

During This Episode We Discuss:

  • The importance of good sleep for our well-being effect on other areas of our bodies.
  • Night time frequent urination, voiding (nocturia) related to sleep apnea. 
  • Weight gain related to sleep apnea.
  • Alzheimer’s Dementia related to obstructive sleep apnea.
  • Increased risk of stroke and heart attack with sleep apnea.
  • Sleep disruptors.
  • Sleep disorders.
  • Diagnosis.
  • Evaluation and treatment options for sleep disorders.
  • Tips for improved sleep health.

Quotes (Tweetables):

“Other myths are that you have to feel tired or sleepy to have sleep apnea, about ⅓ of people with sleep apnea will deny being tired or sleepy.”

“About 90% of men with sleep apnea snore. In women, about 50% of women with sleep apnea don’t snore at all.”

“People who have obstructive sleep apnea have decreased amounts of REM sleep, thereby it’s implied, and probably accurate to say having untreated sleep apnea increases the risk for Alzheimer’s dementia.”

Scott Bonvallet M.D.

Recommended Resources:

Episode Transcript: 

Intro (00:07):

Baseball game, day in a park with friends and family, fishing in a remote stream, work, travels, providing for loved ones, or heading out for adventures, whatever you do, whatever you enjoy, you need your health. The Original Guide to Men’s Health, as presented by the Washington State Urology Society, to help take you through the steps necessary to get the most out of life. If you have invested in a retirement plan for your future, why not invest in your body, after all it makes better sense to retire healthy and enjoy your future. These podcasts are a guide for how to take care of yourself. If you take care of your car and maintain it, why not do the same for your personal machine, your body, if you know you should, but haven’t yet, the information in these podcasts contains some easy recommendations for where, when, and how to get started. Follow the podcast, as we explore men’s health with renowned experts and embark on a journey towards better health!

Dr Pelman (01:26):

Are you feeling tired? Fatigued? Maybe you’re getting up and you think you have to empty your bladder, but it could be sleep apnea. Stay tuned for this episode of “The Original Guide to Men’s Health“. Where we interview Dr. Scott Bonvallet, a sleep expert. On this episode, of “The Original Guide to Men’s Health,” we’ll be looking at sleep, what interrupts sleep, and sleep apnea. We’re fortunate to be interviewing Dr. Scott Bonvallet.] Dr. Bonvallet completed his medical schooling at the Medical College of Wisconsin. And then he went to Oregon Health Science University for his residency in internal medicine. After that, he went to the University of Colorado for his fellowship in pulmonary disease, pulmonary medicine, and critical care where he was also exposed to sleep medicine. He became board certified in internal medicine, pulmonary medicine, critical care, and sleep medicine. He is an expert in sleep medicine, and we’re fortunate to be able to speak with him today about issues that interrupt our most vital asset, our ability to sleep. Dr. Bonvallet. Welcome. Thank you. So, a little background about sleep disorders. There’s many reasons why people have sleep disorders. Do you want to just give a general overview of what you do and what kind of things you look at? 

Dr Bonvallet (02:42):

So, I’m the medical director at Overlake Sleep Disorder Center based in Bellevue Washington. And we’ve had a sleep center here in Bellevue since 1999. And we see all types of sleep disorders to include disorders such as insomnia, sleep apnea, narcolepsy, and then other specific types of sleep disorders that are more common. For example, in adolescents, one of the more common sleep disorders quite frankly, is simply insufficient sleep, in that most adults are relatively sleep deprived, in that the average adult needs probably at least seven hours of sleep per night. And studies have shown that the average adult probably, at best, gets six hours of sleep per night on average, but we also see disorders as mentioned, like obstructive sleep apnea. And that’s a disorder where people will have episodes where they stop breathing during the night. And then that can interrupt their sleep. Not to mention it is associated with decreases in oxygen level in the bloodstream, which can have effects on the heart and brain long-term. And it’s probably one of the most under-recognized sleep disorders. There is in the United States.

Dr Pelman (04:03):

In general sleep disorders, there’s more than just sleep apnea, restless leg syndrome. Is that part of what could happen?

Dr Bonvallet (04:10):

That is correct. That’s a disorder where people will have uncomfortable sensations in their legs, particularly in the evening and at nighttime that can interfere with your ability to get to sleep. And it can also interrupt sleep once you’ve made it to that point of falling asleep and that people can continue to have twitching of their legs that prevents them from getting into a deeper sleep.

Dr Pelman (04:33):

And what about somebody who has a hard time falling asleep? They just say, “I can’t turn my mind off.”

Dr Bonvallet (04:38):

So that’s very common. A lot of that relates, often, to these days where people have bad sleep habits or sleep hygiene where they’ll commonly do work-related tasks right up until bedtime or use electronic media, whether it’s for work or for leisure that is stimulating and can interrupt our ability to get to sleep. Some of the light that’s emitted from electronic devices like iPads and iPhones is of a wavelength that stimulates a receptor in our retina that then sends a signal to the brain to wake up. And so that’s a phenomenon that’s evolved over the years where people are reliant on that kind of technology, whether it’s again, for work or just for their own personal entertainment.

*The wavelength of light most commonly scrutinized for this is “blue light.” Most electromagnetic waves are invisible. But a small band of waves, known as visible light, can be detected by the human eye. Visible light waves vary in length from 380 nanometers (violet light) to 700 nanometers (red light). The longer the wave, the less energy it transmits. Blue light has very short, high-energy waves. In fact, they’re only slightly longer and less powerful than ultraviolet (UV) waves (which are too short for people to see with the naked eye)

https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side

https://www.healthline.com/health/what-is-blue-light#is-blue-light-bad-for-your-eyes

Dr Pelman (05:26):

In, uh, advice to general public, how to get the best sleep to guys, how would you tell somebody to prepare for going to sleep?

Dr. Bonvallet (05:34):

Well? I think it’s first of all, very important to try to maintain a regular schedule, and that is we do not vary our sleep, or our bedtime, by more than an hour later/earlier with any sort of frequency. And the same holds true for our awakening times because otherwise our internal clock gets thrown off and doesn’t know whether we’re supposed be asleep at 11:00 PM or awake. That’s important. And I also think it’s very important to allow yourself to have time to wind down and so doing work-related tasks like answering emails and things like that, that can be stressful right up until bedtime is counterproductive. As it pertains to being able to get to sleep. Regular exercise helps, there’s data that shows that exercising 30 minutes per day increases your deep sleep, or what we call stage three sleep, by about 50%. So that is also important for sleep as well as other things. So those are some of the little things that we can do. And again, trying to get or achieve, you know, seven hours of sleep per night is important. It’s been shown that sleeping less than that can contribute to weight gain, increases risk for diabetes. And that’s independent of also having other sleep disorders like obstructive sleep apnea!

Dr Pelman (06:55):

Just being mad at exercise. You wouldn’t advise exercising just before going to bed. 

Dr Bonvallet (07:01):

Well, that was actually the older recommendations, but there really isn’t a lot of data that shows that exercising right before bed interferes with our ability to get to sleep. And often it’s hard. If you work all day, have dinner, and then it’s time to go exercise. It’s hard to be able to do that without it being right before bedtime. So, it really doesn’t make a big difference as far as when we time our exercise.

Dr Pelman (07:29):

Okay. So, it’s, if that’s the time that somebody can find to exercise, then do it. It’s better than not.

Dr. Bonvallet 

 Correct. 

Dr Pelman 

Okay. Now, if we’re looking at one last human need, which is to eat. Is there any information about meals and going to sleep?

Dr Bonvallet (07:44):

So, it’s recommended that we try not to have any significant meal, at least within three hours of bedtime. And that’s for a variety of reasons. One is simply things like acid reflux can be more pronounced if we have a meal right before bedtime, and then various hormones that participate in the digestive process can actually interfere with our ability to fall asleep. And so, it’s suggested that most people try to eat at least three hours before bedtime, if not longer. And alcohol, well, alcohol can affect our sleep. It has been shown that, for example, one to two glasses of wine or beers can help with our ability to get to sleep. But more than that, actually what occurs is it may help you get to sleep, but as the alcohol wears off, it can actually cause you to awaken in the middle of the night and interfere with depth of sleep. So, alcohol isn’t necessarily prohibited or recommended that we not consume alcohol before bedtime, but with moderation.

Dr Pelman (08:53):

And moderation is always the right. Any advice about stimulants, coffee, caffeine, even tea has some ability to keep people awake?

Dr Bonvallet (09:03):

So, its recommended that we refrain from drinking any sort of caffeine containing compound, whether it be tea or coffee or an energy drink, at least within six hours of when we try to go to sleep, otherwise it will interfere with our ability to get to sleep. 

Dr Pelman (09:21):

So, then you had spoken about obstructive sleep apnea. And as urologists, I see so many patients who come in because they’re up to empty their bladder at night, we call it nocturia. And while that’s multifactorial, I always tell them, go get a sleep study and they go, “why?” And I go, “well, you just told me daytime’s normal. Why does your bladder or prostate care whether it’s night or day? And you’re telling me you’re out five to seven times a night to empty your bladder. I think something else is driving your need to get up.” So, go a little bit through sleep apnea for us, a little bit of the physiology, what happens? 

Dr Bonvallet (09:56):

Sure, so sleep apnea is a disorder where people by definition will have this abnormal closure of the throat or upper airway while they’re sleeping. And the prevalence of sleep apnea has been shown in men to be about 10 to 12% of the population and in women about five to 6% of the population. And there are a lot of myths about sleep apnea. One of which is that you have to be overweight. It’s been shown that about 30% of people with obstructive sleep apnea have, as we say, a normal body mass index or BMI. And it isn’t all about weight. Although clearly people that are overweight or obese have a higher prevalence of sleep apnea. Also, by the way, obstructive sleep apnea can cause weight gain. And it does not have to do specifically with the fact that people are tired and don’t exercise, but more related to the fact that there’s an interference of our ability to get into the deeper sleep or REM rapid eye movement sleep.

Dr Pelman (11:01):

And we make a multitude of chemicals and hormones in REM sleep. Some of which are, as we described them, anti-obesity hormones, one of which is known as leptin. And so, it’s been shown that people with obstructive sleep apnea not only produce less leptin, but are also resistant to leptin interestingly, and are prone to weight gain. Other myths are that you have to feel tired or sleepy to have obstructive sleep apnea. And about a third of people with sleep apnea will deny being tired or sleepy. They are, they just don’t know it. And, and when you treat them, the majority will come back and state that they, you know, they feel that their energy level is improved as it pertains to nocturia or frequent urination. At nighttime, it’s been shown that about 25% of people with sleep male and female will complain of nocturia.

Dr Bonvallet (11:58):

And one of the theories behind it is that patients with obstructive sleep apnea, as a result of the apnea and strain that it puts on the heart, will release a chemical into the bloodstream known as atrial natriuretic peptide. That is like the body’s own diuretic. * And it makes us have to urinate at nighttime. And so that is one of the contributors to having to urinate excessively at night. The other is that people with sleep apnea are not in a deeper sleep in, so it takes less urine in the bladder to have that sensation of urgency to urinate. Whereas if they were sleeping deeper, they would have to have more urine in the bladder to have that sensation. So that’s the relationship between sleep apnea and having to urinate frequently at nighttime and as you know, as well or better than myself, a lot of men presume because all their buddies are talking about their issues with their prostate and having to urinate frequently at night.

*A diuretic is a compound found in food/drink/or medicine that increases your urination in either frequency, volume, or both. They make you produce more urine in essence.

(13:00):

And think that that is why they are having those symptoms and it turns out they have obstructive sleep apnea. I had a patient that in fact, I think you sent me that woke up probably hourly to urinate. And I remember him wondering why in the world was he seeing a sleep specialist and he snored loud and felt tired but presumed. It was because he had to urinate frequently at night, turned out to have sleep apnea. We treated him with the device known as C-PAP and now he hardly awakens at all to urinate. And he’s memorable because you could tell he was initially not happy having to be here and undergo a sleep study, but now he’s sleeping much better because we’ve treated his sleep apnea.

Dr Pelman (13:44):

So, if patient just skeptical, they usually go, “I don’t have that.” And I go, I tell patients, “You don’t know till you go for a sleep study,” is that true?

Dr Bonvallet (13:53):

Correct. I mean, there are some patients that, um, with sleep apnea, who’ll sleep very restlessly on occasion. Who’ll wake up gasping for air and complain about being tired and sleepy. But like I say about a third of people with sleep apnea, think that they’re fine. And part of it has to do with how we compensate for sleep apnea. One of the things that happens is our adrenal glands make extra amounts of adrenaline and cortisol, which are stress hormones that help alert us a little bit artificially. But the point is that you don’t have to be tired and sleepy to have sleep apnea.

Dr Pelman (14:28):

So, patient who snores, is that kind of a key or not necessarily? 

Dr Bonvallet (14:33):

Well, In men? It is in that I would say probably 90% of men with sleep apnea, snore. And if you look at snoring in general, about a third of people that snore will have sleep apnea, but in women about 50% of women that have sleep apnea, don’t snore. 

Dr Pelman (14:54):

It isn’t necessarily a key, but it’s something to look into.

Dr. Bonvallet

 Correct. 

Dr. Pelman

And, uh, if we took a guy who is looking towards a sleep study and goes, “I could never spend the night in one of those,” how do you do that?

Dr Bonvallet (15:09):

Well, so a lot has changed in sleep medicine in that the traditional testing used to be performed in a sleep center like we’re in here where you would spend the night where monitoring brainwaves like EEG and breathing and leg movements and things like that. But as you mentioned it’s a foreign environment. You’re hooked up to a lot of wires. It could be very uncomfortable. And there’s now technology to do portable sleep apnea testing, where there’s a device that patients can take home. So, they attach themselves or hook themselves up in the comfort of their own home. They’re more comfortable there and it’s a pretty decent way of screening or testing for sleep apnea. So, it’s a lot less invasive than it used to be. 

Dr. Pelman (15:55):

So that resolves one of the barriers, not having to spend the night in a sleep facility, but then patients sometimes are concerned about, “well, if I have it, I can never wear one of those devices.” So, we’re talking about C-PAP now that isn’t necessarily the only treatment, but why don’t you go through some of the treatments including C-PAP and what C-PAP is.

Dr. Bonvallet (16:15):

Right, so in the milder cases of sleep apnea, you can argue that it, it doesn’t need to be treated, as it typically does it disrupt sleep, nor does it cause issues with urination at night. In mild to moderate cases, some people are candidates for what’s called an oral appliance or mandibular advancement device, which fits into the mouth and is adjustable. And it pulls the lower jaw forward, widening the space between the tongue and the back of the throat. Um, the primary treatment though for sleep apnea is this device called C-PAP, which stands for continuous positive airway pressure. And what it is a device that applies a small amount of air pressure, typically delivered through the nasal passage, into the back of the throat to splint open and apart the soft tissues of the airway. So that as you are descending into the deeper sleep, where those structures are wanting to collapse down on top of themselves, you have enough air pressure that it prevents it from collapsing.

https://www.youtube.com/watch?v=Rsr8mPble4s

(17:18):

So, you continue to breathe and are allowed to go into a deeper sleep that you were not able to get into before. If you look at the average person that we put on C-PAP, they probably have, if you add up snores, apneas and near apnea, that interrupt their depth of sleep. The average patient that we put on CPAP probably has at least 150 to 200 interruptions per night in their sleep from those events on C-PAP, you’ll have maybe five or six events that truly interrupt your depth of sleep per night. So typically, the change in sleep quality is pretty dramatic, even though upfront, it seems daunting to put a mask like that on and wear it at nighttime. The devices have changed quite a bit in that they’re so quiet that you can’t hear it. I’ve not had a bed partner complain about the noise from a C-PAP device.

(18:19):

And at least five years nowadays, the devices have the ability to self-adjust to the degree of narrowing of the airway, such that if you’re on your back or you’re in REM sleep, you need more pressure than on your side or in a lighter sleep stage. They also now have the ability to upload data to the cloud so that we’re able to monitor patients remotely and intervene early on if needed. And so the devices have come a long ways, but definitely patients have trepidation upfront about wearing C-PAP. But once they experience deeper sleep, they feel significantly better. Other interventions, surgeries for obstructive sleep apnea overall have been pretty disappointing. There’s not a single surgical procedure out there that has, as we say, a curative success rate of better than 20%. And the reasoning behind that is that the collapse of the airway has been shown to be at multiple levels. It’s not as simple as we used to think, and that it’s not just from the tongue falling backwards and collapsing the airway, but the collapse has been shown to be above the tongue, below the tongue, and from the sides. And so, because of that, it’s not as simple of a disorder to address surgically. And I’m not sure that we’re ever going to have a surgical alternative That’s going to be better than C-PAP.

Dr. Pelman (19:42):

During your discussion, you reminded me of something I wanted to ask earlier back in diagnosis, but asleep partner, be somebody who could potentially, uh, tell somebody you got to go get checked. What would they be looking for? 

Dr. Bonvallet (19:58):

Well, typically it would be loud Snoring, just generalized restlessness. Unfortunately, only about 20% of people who have sleep apnea will have a bed partner that notices the apneas. So, it’s very helpful if they notice the apnea, but not helpful if they don’t. And part of it has to do with the fact that our apnea’s are more pronounced when we go into REM sleep and our propensity to go into REM sleep is later into the night where hopefully the bed partner is sleeping. That’s part of the reason we think that the bed partner doesn’t notice it and it could be very subtle. So again, helpful if they notice. It means nothing If they don’t.

Dr Pelman(20:38):

You actually carrying through on treatment. I always remind patients that it’s just not the benefit of feeling better the next day. I want them to understand that there was a really big study in neurology, not urology, but neurology about dementia and treated and untreated sleep apnea. You want to go into that?

Dr Bonvallet (20:59):

Sure. So, so there’s been recent data over the last few years, showing for example, that the brain just like any other organ system has metabolites or byproducts of its own metabolism that need to be excreted, and if they accumulate, they can be toxic. One of those toxins, so to speak, is what has been recently described as G amyloid protein and G amyloid protein has been shown to accumulate in brain tissue, been in higher-than-normal amounts in individuals with Alzheimer’s type dementia. And it’s been shown to delay the electrical transmission of current from one brain cell to the next. And that’s how brain cells communicate with one another. Unlike any other organ systems and studies have shown that these toxins to include G amyloid protein are predominantly eliminated only when we’re sleeping. And particularly when we’re in the deeper sleep like REM sleep. And so, people that have obstructive sleep apnea have decreased amounts of REM sleep and thereby it’s implied, and probably accurately, that that’s the mechanism by which having untreated sleep apnea increases risk for Alzheimer’s dementia. 

Dr. Pelman (22:23):

So, it’s not a small thing. It was actually a significant number of people. 

Dr Bonvallet 

That’s correct.

Dr. Pelman

 And besides dementia, we talk about diabetes, which you mentioned. 

Dr Bonvallet (22:33):

Absolutely, so if you look at patients with hype to diabetes, the prevalence of sleep apnea, depending on the study, is 60 to 70%. And one of the hormones that is felt to play a role, in how we respond to insulin is growth hormone. So, people, as you know, with type two diabetes, their pancreas works fine*. They just have relative resistance to insulin and growth hormone has been shown to help augment how we respond to insulin and growth hormone is predominantly made during stage three sleep. And so, patients with obstructive sleep apnea, once again, have relative reductions in REM and stage three sleep and thereby decreased production of growth hormone. And that is one of the things that we believe is the reason that untreated sleep apnea can contribute to insulin resistance. The other thing that I did forget to mention as it pertains to specifically men’s health is, is for example, testosterone production. So, it’s been clearly shown that untreated sleep apnea can be associated with decreased production of testosterone. All of the things that go with that as well as whether it’s related or not to erectile dysfunction. So obstructive sleep apnea has been shown to be associated with erectile dysfunction and treating it as you are aware as well, can improve that significantly.

*At early stages this can be true, however uncontrolled diabetes can lead to gradual exhaustion and degradation of certain pancreatic cells, known as beta cells, which are the pancreases insulin secreting cells.

Dr. Pelman (24:03):

And also for years, we’ve had an association of an increased risk for heart attack and stroke for untreated sleep apnea.

Dr Bonvallet (24:10):

That’s what sort of put sleep apnea on the map. It was starting about 15 years ago, studies came out showing that there may be a link between untreated sleep apnea and coronary artery disease, as well as stroke. And now it’s pretty well established and that if your sleep apnea is of a certain severity or worse, and it’s never treated that the prevalence or the probability of having a coronary event or stroke is two to three, fold that of, as we say, age matched controls at is people the same age who don’t have sleep apnea. So that’s the data that came out that really made people take obstructive sleep apnea seriously, to include myself as a critical care specialist. I deal with a lot of patients with stroke and coronary artery disease and 15 to 20 years ago, I wasn’t fully convinced. And then as the data came out, I’ve seen a lot of patients with coronary artery disease and untreated sleep apnea in treating their sleep apnea, improve their cardiovascular function.

Dr Pelman (25:16):

And going back to treatment with C-PAP that can reverse a lot of this correct. And absolutely, you know, patients again, reticent to wear a device, but once they get used to it, they won’t travel without it. 

Dr. Bonvallet (25:29):

Yes Correct. It’s funny. Most people will go without, as I would, C-PAP for a couple of nights after wearing it for a while, just because of the relative nuisance of having to take it with you. But if you at baseline had been stopping, breathing 65 times an hour and on your C-PAP it’s once an hour, and then you go away for a couple of days without your C-PAP you’re right back to stop and breathe in 65 times an hour. And, and that’s a that’s a hard shock after you’ve gone with better sleep for quite some time. So everybody goes without it, not that you have to take it with you everywhere you go. But most people after they do that little test once or twice, they’d take it with them. 

Dr Pelman (26:07):

Yeah, they adapt. They like it. They feel better and they protected their health. What about diagnostic new, you know, the new technology, a phone or watch, how good are these in helping?

Dr Bonvallet (26:18):

So the truth of the matter is none of them have been validated as it pertains to measurement of depth of sleep. And they will admit it up front. I think that they’re decent at many of them at differentiating wake from sleep, but not very good at differentiating whether you’re in REM sleep or stage one sleep. And it’s caused a bit of a problem, be honest, and that people will get a device that supposedly tracks their sleep. And they get this report that says that they’re not sleeping very well or not getting very much deep sleep. And then they start to ruminate about that issue. And then they end up developing a sleep problem because of the device. So I’m a fan of the activity monitoring devices. Most of them I think are decent. At least those that you were at differentiating, whether you’re awake or asleep, but they are not accurate nor have they been validated in measuring your depth. 

Dr Pelman (27:21):

And then are there medications as far as people say, well, I really need to take an Ambien every night. I mean, go into medications for sleep treatment. I’ve never been in favor of that patients. Post-surgery say, can you write some Ambien? I go, you’ll change your normal sleep pattern and become reliant. Was I off base, or no?

Dr Bonvallet (27:40):

No, no, not at all. I mean, that’s a scenario of consultation that we see a fair amount where we, as you know, we’ll automatically admit patients in the hospital, prescribe a sleeper, so to speak, sleeping medication, to help with sleep that night in, most of them help a bit. And then the patient is getting ready to be discharged and asphalt. Could you write a prescription for Ambien as well? And often doctors will do that. And then they get their primary care doctor to do it. And now we’re a year out and they then stopped the medication, and their sleep is significantly worse. They become reliant on the medications. There’s no magic sleeping medication out there. If you look at the process of how we sleep and the various neurotransmitters that help put us to sleep, you then understand why there’s not a medication that works perfectly for everyone.

(28:43):

There’s also now data showing that long-term use of, as we call them hypnotic agents, sleeping type medications may increase risk for dementia. And so, we’re getting even more conservative about prescribing medications like that. Also, lots of medications, to include Ambien, people develop tolerance to it where initially a certain dosage works fairly well, but after a few weeks, it’s not working as well. And they doubled their dosage and, and ultimately, it quits working. And then there’s other things, as you may be aware with some of the medications, Ambien’s been the one that’s been talked about the most, where people have some abnormal behaviors in their sleep where they’ll eat in the middle of the night, they’ll get up and send texts or emails with no recollection. One of the scariest scenarios that I had ever seen was a patient that lived in Issaquah and had taken Ambien before bedtime and at about three, four in the morning, he “quote unquote” wakes up and he’s driving his car down first avenue in downtown Seattle. And clearly wasn’t asleep, but pretty scary in that he had no recollection of getting into his car or driving to Seattle. And so, there’s consequences to taking these medications. So, we’re being much more conservative about prescribing them.

Dr Pelman (30:11):

A portion of the population may be listening, who work nights they sleep during the day. Do you have patients that you try to give advice and how to get better sleep in an abnormal sleep cycle?

Dr Bonvallet (30:23):

Yeah, that’s a great question because I do have a lot of patients. Obviously, I have a lot of patients that are nurses. I have physicians that work night shift, first responders, things like that. The problem is that hardly anyone stays on the same schedule when they’re not working. And so even if they’re getting, let’s say seven plus hours of sleep out of every 24 hours, it’s occurring at different times. And when that happens, your depth of sleep can be significantly less. And so, what we try to tell people to do, particularly people that work night shift is not for example, to go home, sleep three or four hours, and then, you know, do chores at home or things like that. And then try to get another three or four hours before they go to work that they need to try to get a block of sleep like they would at nighttime. Studies have suggested that you’re probably better off going home after, for example, night shift and sleeping, then rather than waiting till later in the day, it’s important to minimize light exposure.

(31:32):

So, in people that work night shift, they’re sleeping during the day. So, getting like room darkening, blinds, things like that are beneficial in making sure that there aren’t interruptions and that your sleeping room is quiet. Melatonin has been used, and I’ve found that it works hit or miss part of the problem is it’s a supplement. And so you don’t really know what you’re getting. It’s not regulated by the FDA, like pharmaceutical medication would be, but typically the dosages that we suggest are like three to six milligrams of melatonin before they try to go to sleep. So, things like that, but it’s, it’s a problem. It’s, because, you know, for example, firemen and paramedics, I mean, they’re on a very crazy schedule and it’s not like as they ascend the ranks from working night shift and get more seniority in their working day shift now in the first responders, I mean, that’s, that’s their job. And so, as time goes on, that takes a toll. I have a lot of patients with that are first responders that have been on those variable shifts. And one of the things that happens is that people gain weight too, from not getting good quality sleep, and now they’ve developed sleep apnea. And so trying to be on a schedule after your night shift, so to speak is helpful, not breaking it up, things like that help

Dr Pelman (33:01):

Any other naturopathic substances that you’ve heard about or would use besides melatonin?

Dr Bonvallet (33:07):

No, I mean, they’ve studied the various supplements out there, like valerian root things like that. There’s not any supplement out there that in clinical trials has been shown to be more effective than placebo, but melatonin in some people is effective.

Dr Pelman (33:22):

Yeah. And as we wrap up, I always like to ask, is there any online resource that you direct patients to? 

Speaker 3 (33:28):

As far as sleep apnea goes, there is, for example, the American Academy of Sleep Medicine, which has its own website and a link for the public and patients. The National Sleep Foundation is another good resource. The Sleep Apnea Foundation is another, so there’s a lot of good resources out there on the internet. There’s also a lot of stuff that’s not very helpful or accurate on the internet, but those are a couple of good ones.

Home Page – Sleep Education – American Academy of Sleep Medicine

National Sleep Foundation (thensf.org)

Sleep Apnea: Symptoms, Risks and Treatments – sleepapnea.org

Dr Pelman (34:01):

And anything that we didn’t cover that you think you’d like to talk about?

Dr Bonvallet (34:06):

Well, I think it’s important. One of the years that I have interest in a bit, partly because I’m a father is just the importance of good sleep habits in, in kids and teenagers. You know, one of the things that is, I’m sure you recall as well, is that teenagers have a propensity to want to go to bed later and awakened later. And there’s been a push towards delaying the start times of high schools. And there are few schools in King County that have done that, and it’s been shown to be associated with, improvement in SAT scores, less absences, things like that. And then also just simply electronic media with kids. I mean, it’s very common that kids will take their phones to bed and they’re texting friends or watching YouTube or getting on Facebook when we, as parents, think that they’re sleeping. But I think it’s important to try to establish good sleep habits, you know, at an early age in kids and try to restrict as best we can at least, you know, things that interfere with their sleep like electronic media in the middle of the night.

Dr Pelman (35:16):

I think we ran through a great summary of sleep issues. I think in the future, I’ll try to put a podcast together about reasons. Why guys get up to empty a bladder at night that have nothing to do with sleep apnea, which there are multiple other reasons, multifactorial problems that can affect somebody, but that’s a different subject, a different time. So I thank you for your expertise on sleep.

Dr Bonvallet (35:41):

Here. Thank you. Thanks for having me.

Dr Pelman:

This completes another podcast chapter of the Washington State Urology Societies: “The Original Guide to Men’s Health.” This is Dr. Richard Pelman reminding you to take care of yourself. The Washington State Urology Society wishes to thank all contributors, who volunteered their time and knowledge. The information presented is the opinion of the speakers. The Society also wishes to thank Sean Fox for his invaluable technical assistance, music theme “San Juan bells” written and performed by Dr. Dave Whiting, the podcast is the property of the Washington State Urology Society.  Reproduction and use without the express consent of the Society is strictly prohibited. For more information about men’s health visit wsus.org or visit your physician or care provider.

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