Are you getting good quality sleep?

Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. How is sleep tied to our mental health? What can improve our ability to focus during the day? How can fatigue weigh a person down physically, mentally, and emotionally? I'll talk about all of this with Dr. Dragos Manta. He's a doctor who specializes in sleep medicine at Upstate. Welcome to The Informed Patient, Dr. Manta.

Dragos Manta, MD: Thank you for having me, Amber.

Host Amber Smith: I'd like to start by asking you about the impact the pandemic has had on sleep disorders, overall. Have you seen more people with trouble sleeping over the past couple years?

Dragos Manta, MD: Yes. Unfortunately, the pandemic has been a major problem for the sleep community. At the beginning was definitely very disrupting for the care of our sleep patients. So I remember we had to go through a lot of changes, and we could not see patients. We had to switch to telemedicine. The sleep lab had to be closed. And then, although initially it sounded like with close downs, we had more time to sleep, you know, that was just a transient issue. And over time, we've had been seeing a lot of insomnia, a lot of people having trouble sleeping because of the stressors that were associated with this pandemic, having to do with health stressors and economic stressors. So it has been a definitely a high increase of insomnia cases during the pandemic and has definitely worsened the sleep of our general population.

Host Amber Smith: So if the sleep disturbances are tied to stressors -- economic, or the fears of COVID and that sort of thing -- is there a risk that those disorders would become chronic or will they resolve when the stress resolves?

Dragos Manta, MD: In some patients definitely a stressor can cause long-term consequences. A significant stressor can be a precursor or a risk factor for chronic insomnia. Not in everybody. A lot of people can recover from a stressor, but some people will develop chronic insomnia after a significant stressor. Or we see a lot in patients that undergo a major accidents for example, or major health issues that chronically can have problems. So yes, it could be a problem in a certain subset of patients.

Host Amber Smith: Well, let's talk about how the quality of sleep helps maintain mental health. What happens in our bodies while we sleep? And what physical impact does that have on our mental state?

Dragos Manta, MD: Well, a lot happens during sleep. I think we know a lot about it, but there's a lot that we don't know. But in general, we know that sleep is essential. There is no way we can survive without sleep. Sleep is restorative, for your brain and your body. So, it's imperative to have a certain amount of sleep every night. And people that are sleep deprived have significant long-term consequences, both medical and then psychological.

Host Amber Smith: So definitely I think people feel a difference if they've had a good night's sleep, you know, they tend to wake up feeling better than if they've had a bad night's sleep. What happens physically and mentally and emotionally when we're fatigued? Are we more likely to make mistakes?

Dragos Manta, MD: Yeah. Definitely there are numerous health consequences of poor sleep quality or sleep deprivation. Definitely your performance will be decreased. Definitely. You are going to be at higher risk of accidents, for example. The one that comes to mind right away is increased risk of motor vehicle accidents. There are long-term medical consequences. You know, sleep deprivation and insomnia are associated with increased cardiovascular risk on the long term. There is an increased risk of dementia with sleep deprivation. There's also an increased risk of cancer. Non-restorative sleep or sleep deprivation have a lot of short term and long term consequences.

Host Amber Smith: I'd like to ask you as a sleep expert, what you think of Daylight Saving Time and how the body reacts to dark mornings versus dark nights?

Dragos Manta, MD: The sleep community for a while has been advocating against the Daylight Saving Time, because the forced change in the sleep habits, twice a year, have a lot of consequences, especially during the spring time. There is an increased risk of sleep deprivation, increased risk of motor vehicle accidents. And you have an increased cardiovascular risk, including risk of heart attacks in the week following the fall-back time. The sleep community has been advocating for permanent universal time, rather than switching to the Daylight Saving Time every year.

Host Amber Smith: So our body will just adapt to the natural fluctuations in sunrise and sunset times, without noticing?

Dragos Manta, MD: That's correct. Because the light is the biggest contributor to your circadian rhythm or your sleep rhythm. So your body will just follow the natural light cycle.

Host Amber Smith: Well, I'd like to ask you about the advice you give patients to get quality sleep. What can a person do if they have trouble falling asleep? When they get into bed and lay down, they just can't go to sleep.

Dragos Manta, MD: So there are a lot of factors involved in maintaining a good sleep habit. Probably the most important is to maintain regular sleep hours, , so keeping the same bedtime and waking up time every day. There are two processes that tend to, maintain our sleep cycle. One of them is the homeostatic process. You are sleepier and sleepier, the more you awake. But also there is a innate circadian rhythm. So we all have a certain higher propensity of falling asleep during the night and less chance of falling asleep during the day. So aligning those two processes generates the best sleep. So, keeping the same hours is probably the most, most important. The second one is probably getting enough light exposure during the day, especially during the morning. The light is the one that maintains that circadian rhythm, and getting enough exposure to light during the day is very important -- and not getting too much exposure to light during the night, which is a common thing that happens, you know, with too much light exposure at night, watching TV, staying on the computer all night.

So, those are probably the most important things. There are a lot of other things, like making sure you get, exercise everyday. Caffeine is also a big, big problem. So not having caffeine late in the afternoon is important.

Host Amber Smith: Is there anything special someone should do if they go to sleep okay, but then they have a tendency to wake up in the middle of the night and then they can't get back to sleep?

Dragos Manta, MD: We see this in patients with insomnia, and what we recommend is if you wake up and you really can't fall back asleep within reasonable amount of time, which for most patients is probably 15, 20 minutes, we recommend getting out of bed and ideally, even, going out of the bedroom and doing something in low light until you become sleepy again and return to your bed in your bedroom only when you are sleepy and ready to go back to sleep.

Host Amber Smith: This is Upstate's The Informed Patient podcast. I'm your host, Amber Smith talking with Dr. Dragos Manta. He's an assistant professor of medicine at Upstate, and one of his specialty areas is sleep medicine.

If someone has disturbed dreams or nightmares, does that disrupt the quality of their sleep overall?

Dragos Manta, MD: Yes, it can. Definitely it's something that, if it's more frequent than an occasional nightmare might require further intervention. Most of the time, it's related to some type of anxiety disorder, or it's a stressor that might go away as the stressor goes away. If it's something more chronic I would recommend to speak with a provider and see what's driving the nightmares.

Host Amber Smith: Do you ever recommend any sleep medications?

Dragos Manta, MD: We've been looking a lot into this because over the years there have been a lot of medications that have been approved and tried for sleep. And just the fact that you've had so many different medications tells you that they don't really work very good. The American Academy of Sleep Medicine and also the American College of Physicians, they really recommend that medication should be a second line treatment. And the first line treatment, it's a combination of what we call cognitive and behavioral therapy where you work with your provider to identify the problems that cause your sleep problems in the long-term and then develop better sleep habits in the first place. And sometimes patients need to see a psychologist to help with that before resorting to medication. So medications are really a second-line treatment. And the current recommendation is to be used just short term because there are a lot of long-term consequences associated with, especially with hypnotics.

Host Amber Smith: How can we determine how much sleep we really need? Because I know some people who exist on few hours and some people who really require a lot of hours.

Dragos Manta, MD: So there is a certain variability in the sleep duration of a population. Most of the people need anywhere between seven and eight hours of sleep. There are people that need, that can get away with six hours. And there are individuals that need eight, nine hours of sleep. So, between six and nine hours is probably normal as long as otherwise you're doing okay. Most of the people should know how much, it's genetically determined. So most of the people know how much time you need to sleep by your early adult years. You know, teenagers do need a little bit more sleep. So, I wouldn't go on based on how much sleep you need as a teenager. But I usually ask my patients by your mid twenties, what is your total hours of sleep that you need? That's kind of my guiding principle. OK, is this patient needing less than that? If they sleep less than that, then there might be a problem, if that's how much they need. There are people that are short sleepers. There are people that are long sleepers. And as long as they function OK, then that's not necessarily abnormal.

Host Amber Smith: Does it matter when those hours take place within a 24-hour period? Can you sleep anytime and get good quality sleep?

Dragos Manta, MD: Well, you can sleep anytime if you are very, very tired, but generally you should try to align those hours to that circadian rhythm. And most of the people, they are sleepier during the night, but there are people that work the night shift and they train their circadian rhythm to be more sleepy during the day by constant exposure to light at night and then sleeping during the day. So, as long as you maintain your sleep during your determined circadian rhythm, those are the best hours to sleep. And some people do get a little benefit from a nap in the afternoon because there is a certain dip in the circadian, in the alertness during the afternoon. That's also natural. Some patients in some cultures that observe the siesta, they get a benefit from a nap in the mid-afternoon hours.

Host Amber Smith: Do those naps sort of count toward your sleep hours. In other words, do you need to have eight hours all together sequentially? Or can you do six hours with a two hour nap?

Dragos Manta, MD: So in general, I would say probably the best is not to nap. You know, it is also cultural. And, in our culture, at least in North American culture, it's not. So I would say the best is not to nap, but if you do have to nap, then I would recommend a shorter nap. The longer naps, more than half an hour, they are associated to a certain degree of what we call sleep inertia, where you are groggy, basically when you wake up. So if you do have to take a nap, I would recommend the shorter one up to half an hour, what we call a power nap, in the afternoon.

Host Amber Smith: Now, what about someone who's really, really busy during the week? Can they plan to catch up on their sleep on the weekends?

Dragos Manta, MD: It's better than not to catch up. The ideal is you should have the same type of, the same sleep hours every day. But if you are sleep deprived, it's okay to catch up. I would say, make sure you catch up during the same time period that usually sleep during the weekdays. Maybe add, maybe go to sleep a little earlier or add another hour. I would not add a lot of sleep time because that can change your circadian rhythm.

Host Amber Smith: Well, I imagine everyone may have trouble sleeping on occasion, but I wonder how much of the population has a real disorder like insomnia, or sleep apnea, or restless leg syndrome. Do you have an idea how common sleep disorders are?

Dragos Manta, MD: They're very common. So insomnia and sleep apnea are probably the most common sleep disorders. The estimations vary, but depending on the population that you look at, they vary anywhere between 5% and 15, 20%of the population might have what is called chronic insomnia. And also, there's a high incidence of sleep apnea, again with incidences between five and 20%, depending on what patient population you look at. But yeah, unfortunately, sleep problems are very common.

Host Amber Smith: So how long should a person struggle with sleep issues before they consult a specialist?

Dragos Manta, MD: In general short-term insomnia, it's related to a stressor and tend s to get better after the stressor disappears. But if patients have problems falling asleep at least three times a week for three months, then we call that a chronic insomnia disorder. And for that, I always recommend to see somebody because it can become a long-term condition.

Host Amber Smith: So if someone comes to see a sleep specialist like yourself you may recommend a sleep study. Can you walk us through what that is and what a person should expect?

Dragos Manta, MD: Not everybody needs a sleep study, but a lot of patients do. I would say insomnia by itself, most of the time, it's a clinical diagnosis and did not need the sleep study. We would recommend the sleep study for somebody that we worry about sleep apnea, which is a condition where the breathing is impaired during sleep or other abnormal behaviors during sleep like sleep walking, sleep talking, or acting out your dreams. So in situations like that, we would recommend a sleep study, which basically it's a recording of your sleep, looking at several parameters, looking at your brainwaves, looking at your breathing, your muscle tone and other, EKG, oxygen saturation. Most of the patients come to the sleep lab, and they get pretty much a room, almost like a hotel room, where technologists will apply all these leads and sensors. Believe it or not patients do fall asleep despite of all that, and then we record what happens during sleep and then we will send the patients home in the morning, we review the data and then, we try to make a diagnosis of what is causing the patient's sleep problem.

Host Amber Smith: Do you think if someone's partner is snoring at night, that they need to see a sleep specialist?

Dragos Manta, MD: Snoring is very, very common. Not everybody who snores needs to see a sleep doctor. I would say if a bed partner were to observe breathing problem during sleep, like what we call apnea or an episode of stopping breathing during sleep or choking during sleep, if that happens more than occasionally, that would be a reason to maybe consider seeing a sleep doctor. If somebody who snores very loudly is also very sleepy that's also an indication that somebody might be at risk of having sleep apnea. So I would say not everybody that snores. I'd say snoring with some other signs that there might be something going on more than just snoring.

Host Amber Smith: I know that there's a lot of people that rely on sleep apnea machines when they're sleeping. I wonder if, are there alternatives to sleep apnea machines? Because I think a lot of people look at the contraption and the tubes, and they're just like, "there's no way I can sleep with that."

Dragos Manta, MD: I would say that yes, there are alternatives, but the C-PAP machine, despite all the contraptions, is still the best treatment for sleep apnea. And I have to tell you that I've been thinking of so many patients that came to me and they said, "no, I don't think I can use that." You'd be surprised how many patients that initially wouldn't even consider it, they feel so much better and they swear by it. So it's definitely something that initially sounds like and looks a little bit more difficult, but, it is the gold standard treatment. And I would be very reluctant to go to a second line because all the other lines of treatment are really, I wouldn't even call them second line. I would say maybe third or fourth line of treatment. But yes, you're right. Some patients, after that trial, a lot of patients feel better, but some patients cannot tolerate. And in that situation, we do have other options. The most popular one would be an on oral appliance, which is a device that a dentist will make that the patients will have to sleep with at night. It's effective, although a little less effective and mostly effective in maybe mild to moderate cases of sleep apnea.

Host Amber Smith: You called it a C-PAP machine. What does that stand for?

Dragos Manta, MD: It stands for continuous positive airway pressure. So it's a device that maintains a certain pressure into the airway to prevent the airway collapse that is the main problem that happens with sleep apnea.

Host Amber Smith: Well, before we wrap up, I wanted to ask your advice for purchasing a mattress and pillow. If someone is having sleep trouble, do you have any advice for the type of mattress or pillow they should look for?

Dragos Manta, MD: In general, I would say the comfort is probably the most important thing. So you have to be comfortable in your mattress. I would say the other thing that's probably important -- in general, you don't want a mattress that overheats. So you want to have a mattress that has a fair amount of ventilation because heat does not help with sleep. In general, we recommend a cooler environment to promote sleep. Those are the two things that I would recommend.

Host Amber Smith: Well, I really appreciate you making time for this interview, Dr. Manta.

Dragos Manta, MD: You're welcome. I hope this helps.

Host Amber Smith: My guest has been Dr. Dragos Manta. He's an assistant professor of medicine at Upstate who specializes in sleep medicine. The Informed Patient is a podcast covering health, science and medicine brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/Informed I'm your host, Amber Smith, thanking you for listening.