This week Drs. Daniel Correa and Audrey Nath hear from a podcast listener as a part of a reoccurring series that explores all things brain health. Lily from Minnesota asks hosts how sleep contributes to overall health and seeks advice about snoring. Our hosts walk you through essential sleep hygiene tips and explain why sleep is integral to brain health.

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Episode Transcript

Dr. Correa:
Bienvenidos and welcome back to the Brain & Life podcast from the American Academy of Neurology.

Dr. Nath:
Hello there, Daniel. I think it's really cool that today we're doing something different. We really wanted to hear from our listeners. And so for the first time, we're going to be opening our mail bag and listening to a question from a listener who called into our voicemail, Lily from Minnesota.

Dr. Correa:
Well, hello, Lily. Let's listen to her question.

Lily:
Hello, Dr. Correa and Dr. Nath. I've been married for 30 years and recently I've been disturbing my husband's sleep because I've suddenly started snoring. In addition to this being embarrassing, I've heard snoring can be a sign of an underlying health issue or can increase the risk of stroke. And so I'm wondering, should I be concerned? Can snoring, be cured? Thanks for answering.

Dr. Nath:
Oh, wow. That's a great question. We don't talk enough about sleep. Daniel, I can see you on video right now and you are looking a little rough. How's your sleep been?

Dr. Correa:
It's been a longer week. You know that sometimes when you're many days in the hospital, there's just a lot of stress that can build up, but I definitely sometimes need a little bit more sleep and I am definitely guilty of sometimes spending a little bit too much time with my phone late at night, trying to just wind down after a long day.

Dr. Nath:
I think so many of us do that.

Dr. Correa:
And Audrey, you have kids running around after a long day. Do you get a chance to wind down and have a nice mommy time and quiet evening? Or what does your typical sleep routine end up like?

Dr. Nath:
Ah, my three year old sleeps next to me. And then if I don't fall asleep at the same time as her, then I will read stuff on my phone.

Dr. Correa:
Oh wow.

Dr. Nath:
In the dark. Yeah, I know it's terrible. Neither of us are in any position to judge anybody. I think it's safe to say, it's a no judgment zone here at Brain & Life, but she brings up some really good questions.

Dr. Correa:
I think we're all working towards better sleep.

Dr. Nath:
Yeah, absolutely. This is something we are all working on. Seriously.

Dr. Correa:
Exactly.

Dr. Nath:
So Lily talked about snoring and sometimes, it's so interesting in our clinics. We hear from patients that it is oftentimes a spouse that brings up this issue. Like, hey, this didn't really used to happen so much before, but now there's this snoring. And maybe I even hear the other person stop breathing and little fits here and there at night. And sometimes the patient themselves might not even be completely aware. And that's how it comes to our attention. So why Daniel do we care about snoring?

Dr. Correa:
I've actually had this conversation very recently with my wife, because she's worried about my snoring, and has recorded me at night, and the big risk and the concern that we talk about with all of our patients and the people we care for, their family members, their spouses, the many people in the room, or in the house that are getting woken up by the snoring is the possibility of a condition called obstructive sleep apnea, condition that interrupts your sleep. And sleep is really important because a lot of what you've been doing for the day, those activities, a lot of that gets processed at night, and then more and more we're learning that aspects of the functions of your brain have to be solidified during your sleep, things have to be cleaned up. And there's many other important aspects that go on. Audrey, you've spent a little bit more time learning about sleep. Tell us some about what we know about what's going on or about studying about sleep.

Dr. Nath:
Oh gosh. Yeah. Back in grad school, a friend of mine, she studied this specifically, what happens during sleep and she studied a phenomenon specifically that they call replay. So they would have mice or rats do some sort of puzzle and they would record their brain activity using electrodes. And then they would have the mouse go to sleep and they would see some of those similar patterns happen right afterwards when the mouse was asleep, after working on a problem. So there's some evidence that if you're working on something and then you go to sleep, your brain, during the sleep, does work on some of the problems that you have been trying to figure out in the day and help... We use these hand wavy terms, like "taking out the trash" and consolidating. And I think we're learning a lot more about what that actually means at a molecular level, but suffice it to say, sleep is very important.

Dr. Correa:
So Audrey, what is obstructive sleep apnea or sleep apnea?

Dr. Nath:
The way that I think of it is you have your airways where you breathe in from your nose and it goes down your trachea and then to the lungs. And essentially there are some soft tissues back there that when you lie flat can be kind of pulled down with gravity essentially, and this can obstruct the airway. And that's what we call obstructive sleep apnea. And apnea is a pause in your breathing. And this is what happens in many, many American adults every single year. What's more rare is not obstructive sleep apnea, but central sleep apnea. That's something we'd see in pediatrics sometimes. And that's like a central hypoventilation syndrome. Sometimes it's called Ondine's curse. I don't know if you see this much Daniel, but apparently there was this old German legend where there was some nymph named Ondine I guess, and her boyfriend cheated on her. And then she put a curse on this guy. And the curse specifically was like, every time he went to sleep, he wouldn't be able to breathe.

Dr. Nath:
In any case. That's kind of like what happens with a central hypoventilation syndrome, which can be a genetic disorder that we sometimes see in children where they need to wear special devices in order to breathe safely while they're asleep. But obstructive sleep apnea is what affects far, far more people. And Daniel, I've got a question for you, how much sleep do we even need? What do you think?

Dr. Correa:
Generally, everybody should get at least seven to eight hours of sleep at night. And it's not just a total number. It's also important if you can to get sleep during key points in the evening. So trying to get to the point where you're falling asleep by around 11 o'clock at night, so that you get your first sleep cycle in before around two and three in the morning, and then you're also getting into another sleep cycle in the early hours. We've actually seen that in many neurologic conditions, that that time point between two and five or so in the morning, there can be higher numbers of stroke. There can be higher risk of many complications of medical conditions, including also heart attacks. So those are important times to be getting rest. And now some people think that, oh, they're short sleepers or they can sleep less. They're good on five hours or something like that. But in reality, actually many groups have tested people who think they're short sleepers, and very few of them are right.

Dr. Nath:
So when we talk about obstructive sleep apnea, I think the reason that we care, it's not just the snoring or there's a few problems, with these pauses and breathing overnight, this can then basically startle you awake over and over and over again overnight. And you might not even be aware of it. And so this can really decrease the amount of sleep that you're getting, and that startling awake over and over and over can really rev up your body in different ways and even increase blood pressure and cause hypertension in people, which has its own host of negative effects on the body. So that's why it's not just the snoring, it's the other downstream effects of obstruct sleep apnea that we get worried about. So what are you going to do to follow this up, Daniel?

Dr. Correa:
So yeah, I'm being pressured into the reality that I probably need to go ahead and have what's called a sleep study.

Dr. Nath:
Oh, are you putting it off? What is this?

Dr. Correa:
I have, yeah. I mean, we're all busy, but I do need to email a colleague or actually get on that patient line and call for an appointment with one of our sleep specialists. Sleep specialists can both be neurologists, but also lung doctors or pulmonologists, they're people who do extra training to learn how to help people with sleep conditions. And they do a test called a sleep study. Have you seen a sleep study, Audrey?

Dr. Nath:
Yeah. So basically you go to a room somewhere in a quiet dark place and you sleep there for the night with electrodes on your head and some other monitors to monitor your breathing and you go and you sleep the night there. And that's how we can collect data about if you're getting startled awake because of pause isn't breathing, or if there's other things happening during sleep that need to be addressed. You should totally go do it.

Dr. Correa:
And there are some places where you might be able to have the opportunity to do the sleep study at home or at another non-hospital-like setting. So there's lots of possibilities.

Dr. Nath:
That's true.

Dr. Correa:
If you're having sleep problems should definitely talk to your doctor and maybe consider seeing a sleep doctor that can help you get a sleep study to really figure out what is the reason you're having problems, either falling asleep, staying asleep, or having problems with snoring and breathing issues like sleep apnea, which is the most common sleep condition.

Dr. Nath:
Absolutely. And they also take a detailed history in physical and they will even look in your mouth and look at your neck and see if there's any other structural issues that could put a person at higher risk for obstructive sleep apnea too.

Dr. Correa:
So my hope is, for me, maybe I just need to adjust my activity schedule, lose a little weight, and then I won't have any issues with snoring or at least I don't have sleep apnea. But if you do Audrey, what are ways that we can treat the sleep apnea and achieve the sleep that people need?

Dr. Nath:
So it all comes down to opening up that airway. So what are the different ways we can do that? Some people will need to have on what's called a CPAP machine or continuous positive airway pressure. And this is a mask that's worn over the face that helps keep the airways open overnight. And there's different forms of this device. And many people use it and that can make a world of difference for some people.

Dr. Correa:
So it's important to work through if you do have sleep apnea with a fit and how things work for you with that CPAP machine, or there other alternatives with the settings, the type of mask, some of them only go over your nose. And for people who aren't able to wear the mask in certain cases, there may be surgeries that could help them out, but what's really essential is how long you wear it because just struggling through it and half sleeping a few hours a night and then taking it off to sleep the rest of the night, doesn't actually get you any benefit. Many studies have shown that if you're not wearing it for at least four to five hours, five days a week. So the easiest way to remember it is five hours, five days a week, then don't not actually getting that real benefit from keeping the airway open and achieving sleep. The more you wear, the more you're getting a chance to remove all the risk factors that sleep apnea can bring to you, because it is a major risk factor for many medical conditions and many neurologic or degenerative disorders.

Dr. Nath:
Five hours of sleep for at least five days a week at the absolute minimum.

Dr. Correa:
Now there's things that we can all do to get our sleep. Now in, we have a 2016 article on the Brain & Life website, 14 Ways to Sleep Better.

Dr. Nath:
This is a good one.

Dr. Correa:
I probably need all 14. I'll be honest, but I think there's really important things here and a few that we can touch on that we can each do. And please check out the article and we'll have more links to that in the show notes so you can see all 14. But first of all, you got to make sleep a priority. And really any things that you want to do for your health, whether it's activity or otherwise, you have to put it on your schedule, think about it and make it a priority. And sleep is probably one of the most important.

Dr. Nath:
Oh, absolutely. I think that it's something that affects all of us, but there's things like having screens on before bed. I know I do this. I know I'm checking my phone before bed, but there's something about the light from the screen that can trick your brain into thinking it's nighttime. So it can physiologically trick your brain into not wanting to sleep. So that is one of the first things that we talk about with patients is to really try to turn off the screens as much as possible, at least 30 minutes before bedtime, to help your brain do the best it can do.

Dr. Correa:
That light can actually change some of the chemical processes that help us all sleep. And really like you were suggesting Audrey, the light tricks our brain to thinking it's daytime and not nighttime. So then there's controlling noise.

Dr. Nath:
Oh yeah. So we have on a little noise machine because you know that three year old, that sleeps next to me, it helps her to kind of drown out any background noise and we've been using it since she's a baby. And by extension, I have been using it since she's been a baby, but it's something that could really help people out. Daniel, what about caffeine and alcohol? What about that? Are you ever having a little of that before sleep or-

Dr. Correa:
Yeah.

Dr. Nath:
Pretty good about avoiding it?

Dr. Correa:
No, I've done better over the years now that I've become more aware of it. For a long time, I used to think I was one of these people. I could have a cappuccino or a coffee at the end of a dinner and then go home and go to sleep. That doesn't work for me anymore. But ideally they recommend you try to avoid caffeine about six hours before bed. I try to just not have any in the afternoon. I'll switch to decaf, coffee or tea if I need to . Alcohol's the more challenging one. I like to have a little wine sometimes with dinner and I might have a late dinner, but ideally they suggest that you avoid alcohol about three or four hours before you're going to go to bed.

Dr. Correa:
So if you're going to bed at 11, got to do the math for when you are going to bed and getting up to try to get those seven hours, because there are some things in the alcohol that can disrupt the way you sleep, disrupt your sleep cycle. And at some point you metabolize that alcohol actually into being a stimulant. So those are all things that can disrupt the way you would sleep in the quality of your sleep.

Dr. Nath:
So it's good to know that sleep is something where there are things we can do. There's so much in our life, that's out of our control and there are people with sleep disorders, which may be difficult to treat, but there are some factors that we can try our best to maximize.

Dr. Correa:
Yeah, I think we all need to do it to stay healthy, have better days. And I hope now we're all ready for a little nap time.

Dr. Nath:
Sounds amazing.

Dr. Correa:
Well, thank you for joining us in the Brain & Life podcast. We'll look forward to more mail bags, answering your questions and getting back to our episodes, where we interview our guests and our medical experts about various topics related to brain health and many different neurologic conditions to live better together. Thank you for joining us today on the Brain & Life podcast, follow and subscribe to this podcast so you don't miss our weekly episode. You can also sign up to receive the Brain & Life Magazine for free at brainandlife.org.

Dr. Nath:
Also for each episode, you can find out how to connect with us and our guests along with great resources in the show notes, you can also reach out by email at BL podcast, at brainandlife.org.

Dr. Correa:
Follow me and Audrey and the Brain & Life Magazine at your preferred social media channels.

Dr. Nath:
Special thanks to the Brain & Life team, including...

Dr. Correa:
Nicole Lussier, our Public Engagement Program Manager, and Andrea Weiss, our Executive Editor for Education and News Publications.

Dr. Nath:
We are your hosts.

Dr. Correa:
Daniel Correa joining you from New York City and online at Neuro Dr. Correa.

Dr. Nath:
And Audrey Nath, beaming in from Texas and on Twitter at Audrey Nath, MD, PhD.

Dr. Correa:
Thank you to our community members that trust us with their health and everyone living with neurologic conditions. We hope together we can take steps to better brain health in each thrive with our own abilities every day.

Dr. Nath:
Follow and subscribe wherever you get your podcasts.

Dr. Correa:
We really appreciate it if you can give us five stars and leave a review.

Dr. Nath:
Thank you.

Dr. Correa:
This helps others find the Brain & Life podcast.

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