Sleep and 4 Key Questions
Well, this week, we explored sleep again, and I had the absolute pleasure of talking with a sleep physician, Dr Dave McCarty, whose website and book are called Empowered Sleep Apnoea.
Dave is a passionate, patient-centred practitioner, totally devoted to his patients and takes them on a very interesting journey. If you follow the podcast through the interview or visit his website, you’ll understand exactly what I’m talking about.
He happens to be a very passionate cartoonist as well, and he brings that work into his website and his book. He’s just the most wonderful guy. I really enjoyed meeting him, and I’m looking forward to working with him in the future.
It was highlighted again sleep. Sleep is such a big and important topic. It’s worth revisiting. It’s worth reminding ourselves of how important it is. One of the things about seeing patients on a regular six-monthly basis, as we do, is that it’s an opportunity to reconnect with people and ask them three or four very basic questions.
I’ll ask you these as well. Is it easy for you to fall asleep at night? Yes or no? Do you wake up through the night? Do you need to go to the bathroom? That’s all one question. The third question is, do you wake up with a headache? The fourth question, probably the most important question, is, do you wake up feeling refreshed?
Well, let’s come back to the first question. Is it easy for you to fall asleep at night? Ideally, you should be falling asleep within about 15 or 20 minutes. There are times in our lives when that just doesn’t happen. We’re talking about, in general, the majority of the time is the case. Because insomnia or the inability to fall asleep is a common diagnosis that people get when they present in a doctor’s surgery with poor sleep quality.
They’re tired, excessive tiredness, lack of energy, anxiety, irritability, difficulties with tasks, learning and remembering. It’s worth remembering that insomnia, chronic insomnia, is defined as occurring when at least three nights a week for three months on end, you have trouble getting to sleep.
Three Different Types of Sleep Apnoea
I should say there are three different types of sleep apnoea. One is difficulty falling asleep, the other is waking up and having difficulty returning to sleep, and the other one is just difficulty staying asleep, so you keep waking up.
It’s suggested that women and older adults are more susceptible, but insomnia affects, according to the statistics in America, 40 million Americans. Insomnia is an interesting one because it is really when one looks at that first question, is it easy for you to fall asleep? That’s a real question about sleep hygiene, about how you prepare yourself.
I’m often asked, “What are some of the things you do to stay healthy in a day?” I always say, “Well, the first thing is I go to bed at a reasonable time the night before because, in order to prepare for my day, I need to be in bed and get enough sleep because we need 7 to 9 hours sleep a night for over 90% of us.”
But getting to sleep is the issue here. Is it easy for you to fall asleep? There’s a really interesting… Not everybody is the same. I think that’s important as well. My ideal sleep time is probably around 9:30 pm or 10:00 pm.
There’s a wonderful online quiz you can do called Auto Morning Evening Quiz. You can do this online and answer a few questions, and it will give you what is probably your ideal or give you an idea of when you’re best suited to go to sleep.
For example, if my ideal time is 10:00, then I need to start looking at my sleep hygiene. Because remember, we’re focussing on is it easy for you to go to sleep at night and so my sleep hygiene means okay if I’m starting if I should be in bed by 10:00, I set a mental alarm for 9:00. Now before to start toning things down to dimming lights in the house, to stop watching TV, to not have technology around me are the at my bedside.
I don’t look at my laptop. All my iPad and all my phones are in bed. The light from these devices has a negative impact on the melatonin and the switching on of that, that which puts you to sleep. So that’s important. Starting to tone down.
But I go back even further in the day, which is when I eat, and I don’t want to eat just before I go to bed. I certainly don’t want to eat a heavy meal and drink alcohol. Alcohol might make it easier for you to go to sleep, but it most certainly does not ensure that you get a good night’s sleep. In fact, quite the opposite. You don’t get into deeper levels of sleep because of the alcohol.
Caffeine and Electric Devices
Caffeine is another one. I stopped drinking caffeine. I do have one or two coffees a day. I stop. I will not have a coffee after 1:00 in the afternoon. I try to also get out in the sun because while blue light from devices like computers, laptops and phones is bad for my health and bad for my melatonin levels, getting out in the sun, particularly early in the morning, without sunglasses on and allowing the light to get into my eyes and impossible to get onto my skin is also really important in preparing for that night’s sleep.
If I can include some exercise, particularly in the early part of the day, I think that improves sleep quality as well.
Environment, Temperature, and Lighting
There are many things that you can do to make it easier to go to sleep. Then we look at the environment in which you are sleeping. Is it the right temperature? The ideal temperature is cooler. It should be around 18 degrees centigrade, which I guess is I have to go back into the old currency somewhere like 70 degrees Fahrenheit or high sixties lows, 70 degrees Fahrenheit.
Around 18 degrees is a good temperature. Is it dark in the room? If there’s light coming into the room, if you’ve got a digital clock right by your bed shining light into you, that’s not a good thing either, so the room should be dark.
I think that is something to factor into decisions that we make in our lives. You know, I think that there are some serious implications about that. And having noisy a… A road near you that is noisy raises issues about your sleep, but there are also environmental stressors involved there as well. Is your partner the person sleeping next to you, keeping you awake?
We’ve spoken about this on many occasions, but a partner that snores. This is not a social problem. This is a serious physiological problem. If you are fortunate enough to share a bed with someone who you care about, dare I say love and you are concerned for their health, then you should take your snoring seriously, not just for their benefit but for yours as well.
If you are snoring, it means you have a restricted airway, and you are not getting as good a night’s sleep as you should be getting as the snorer. But the snoree, your partner, who has to listen to this snoring, is getting a bad night’s sleep as well.
Noise is another one. Electronic noise is another thing to think about. Checking in with the world, checking your Facebook and your emails and connecting with the world just before you go to bed is not the time to do that. This is no time to connect with the world. It’s time to connect with your pillow. You should be doing things that are conducive to making you tired.
Personally, I keep a lot of books that I read for professional interest on my Kindle because I love to highlight and share quotes and store them for later use. I have a problem with that for two reasons. It usually stimulates me too much and makes me think about work when I shouldn’t. The light from it. Yes, I’ve got filters.
I could use blue blocker lights, but that’s not a good thing either. I find personally that history is very soporific. I love reading history, and I love reading it just before I go to bed because firstly, I find it interesting, and secondly, I find it makes me tired, and after three or four pages, I’m usually ready for sleep if I’m reading things like that, so think about things like that.
The first question is whether it is easy for you to fall asleep is a really important one. The second question is, do you wake up through the night? Many people wake up, roll over and go back to sleep. If you recorded it, it probably wouldn’t last for more than five, ten, or 15 seconds. But if you are consistently getting up at night to go to the bathroom.
Sleeping and Breathing Issue
There are many reasons why that might be. Medications, prostate, diabetes, a whole range of issues. Commonly, what causes people to wake up at night to go to the bathroom is disordered breathing while they are asleep. To any regular listener of this podcast, you will know that I have recommended, and I have, in my own practise for many years, recommended the use of micropore tape on the mouth at night.
The way I suggest that should be done to my patients is when I pointed out how to do it, which means you take a thin piece of micropore tape with a little tab on it so that it’s easy to find on your face if you want to remove it. In the morning, you never rip it off. You always poke and peel gently.
When I put the tape on at night, I lie on my back initially. For four or five breaths, I breathe in slowly through my nose, gently I breathe out, slower through my nose, and my exhale is longer than my inhale. I might hold my breath for three or four or 5 seconds, and I repeat that four or five times.
That is a great way to switch on that part of your nervous system, which is called the parasympathetic nervous system and the rest and digest part of the nervous system. The fight or flight or the sympathetic nervous system is often active in our modern world.
But this breathing technique of slowly in, slower out and a breath hold for a few seconds, repeating that five, maybe ten times within one or 2 minutes you’ve switched on the parasympathetic. A great time to do that just before you go to bed. I’m doing that on my back. I roll over and go on my side with tape on my mouth.
I love multitasking, so I’m performing a meditative breathing exercise while I’m asleep. How cool is that? But what it also does, is it helps balance out body chemistry. It helps balance out, and as you balance out body chemistry, that has an effect on smooth muscle as you breathe through your nose.
You also produce nitric oxide, which is a very important body regulator, and that has an extremely positive effect on the smooth muscle throughout your body. Your bladder is a smooth muscle. When young children are wetting their beds, this is called enuresis, often that is a reflection of sleep-disordered breathing.
As adults, we don’t tend to wet our beds. We get up to go to the bathroom. The reason for both of those things is very similar. In many instances, is a reflection of sleep-disordered breathing.
That is about waking up at night to go to the bathroom as a reflection of disordered breathing, and difficulty in getting back to sleep is also perhaps a reflection of that. Looking at the environment, looking at what stimulated you before you go to bed, looking at your exposure to natural light during the day. These are all factors that can impact your ability, your sleep cycle, on your circadian rhythm.
Now, the fourth question do you wake up in the morning with a headache is an important one because if you do, that generally indicates one of two things to me either your sleeping posture, your sleeping on your stomach, and that puts a twist on the muscles around the neck and attaching to the shoulder.
It will cause headaches across the forehead and across the temples, and the back of the head. So sleeping position is one, but another common problem is that you clench or grind your teeth. Now, why is that important? Because if you add it up in a 24-hour period, how often teeth should touch? It would add up to 15 to 30 minutes a day.
When I clench my jaw, as I’m doing now, not only do the muscles in my face and jaw tighten, but my head doesn’t move when I clench and grind my teeth. Why? Because the muscles at the back of the neck and shoulder support the head to keep it steady while this tension in the jaw is going on.
Well, that’s what happens when we eat, and that’s why the head doesn’t bob around when our muscles were chewing with our neck and shoulder muscles stabilise our head when we’re chewing, and if we’re only doing that for 15 to 30 minutes a day, there’s no big deal about that.
But if you clench or grind your teeth, you could be doing that for an hour or two or three or four. That fatigues the muscles of the back of the neck, which then refers to pain in your forehead, temples or the back of your head, and that is often the cause of headaches.
That happens so often in our practise where people who have never had that explained to them. That is important, and there are lots of things we can do about that. Specifically, we can use micropore tape on the mouth because we know now that clenching or grinding is often a reflection of sleep-disordered breathing.
If you’d asked me that question 30 years ago, I would have said clenching or grinding is a reflection of stress, nutritional deficiency, say you’re not getting enough magnesium, or you know, whatever the stress, nutritional deficiency or pain. But now we know that in 70 or 80% of cases, clenching or grinding is associated with sleep-disordered breathing.
The use of micropore tape on the mouth may be a simple way of trialling that and seeing if that makes a difference. That could help. It could help you get a better night’s sleep. If you still have a headache, then you need to consult with a dentist who understands temporomandibular joint dysfunction. That is the jaw joint dysfunction and how to make an appropriately fitting orthotic to fit in the mouth.
Now, many people come in and say, “Oh yeah, I clench and grind my teeth, and my dentist made me a splint. Not all splints are the same, and a lot of dentists don’t understand this either. A lot of dentists think all I need to do is put a piece of plastic either on the top of the bottom jaw, and that’s it.
Well, any piece of plastic will protect the teeth from where? That is true. There is so much more you can do with a properly adjusted, appropriately designed and appropriately adjusted night guard.
To a layperson and to many health professionals, including dentists, they all look the same. In our own practise, I would use at least ten different designs of what to an ordinary person would look exactly the same. It’s not. Are you waking up in the morning with a headache? We’ve talked about that.
The last one, perhaps most important, is do you wake up feeling refreshed? Because ultimately, that’s what sleep is about: Rebooting, regenerating, and rebuilding mentally and physically important. We’ve talked about what defines a consistently good night’s sleep. That is a question of quantity. Getting for 84 over 90% of the population.
That means getting 7 to 9 hours of sleep. But putting your head on the pillow is not enough. That involves breathing well while you’re asleep. That was the subject of many of our podcasts and specifically in our discussion with Dr Dave McCarty this week, where we talked about Empowered Sleep Apnoea.
Dave took us on a journey it understands the complexities of this sleep-disordered breathing condition. And it’s so much more than just giving you a face mask called a CPAP or a splint called a mandibular advancement splint.
I thought this week’s episode was a great discussion. I so enjoyed talking to Dave. I thought it was worth reviewing some of those sleep-disordered breathing conditions.
If you haven’t visited, you know, obviously, I thought I would just share with you what I often share with my patients when they come in for their regular check-ups, and that is to do a check on their sleep, something that I think we need to be constantly reminded of the importance of what a good night’s sleep is and what breathing well is as well. I hope this finds you well. Until next time.
This podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences, and conclusions.