Mercy Clinic Pulmonology and Sleep Medicine

Dr. Adeel Iqbal Kahn, left, critical care medicine, pulmonology and sleep medicine, and Dr. Umer Hafeez Siddiqui, sleep medicine and pulmonology, see patients at the Mercy Clinic Pulmonology and Sleep Medicine office in the Mercy South Medical Building.

How much sleep did you get last night? Did it feel like enough?

Odds are it wasn’t.

According to the 2018 Sleep in America poll conducted by the National Sleep Foundation, a majority of Americans (65 percent) says that getting enough sleep makes them a more effective person, yet 41 percent admit to rarely taking into account how much sleep they need in planning for the next day.

The amount of sleep we need changes as we get older, but the reality is that everyone needs a good amount of sleep each night in order to be their best and to be healthy, said Dr. Adeel Kahn, who specializes in pulmonary, critical care and sleep medicine at Mercy in Washington.

The minimum recommended amount for adults over age 26 is seven hours. While that may not surprise you, how about the recommended amount for teenagers: 8-10 hours. School-aged children (6 to 13) should be getting between nine and 11 hours of sleep a night.

With the start of a new year, people everywhere are setting goals for themselves to be healthier. If those goals don’t include getting the recommended amount of sleep, people may be unknowlingly sabotaging themselves.

“The tripod to healthy living is good food, good exercise and good sleep,” said Dr. Kahn.

He pointed to a study involving Schneider trucking company to illustrate that point. The company gave CPAP machines (used to treat sleep apnea) to employees with and without the medical condition. All were required to use the machines, which kept track of how much sleep they had each night, said Dr. Kahn.

In the end, the company saw its medical claims go down, not just for people with sleep apnea, but the others too.

They realized it wasn’t so much that the people without sleep apnea benefited from the machine itself, “but that they were forced to log eight hours of sleep a night,” Dr. Kahn remarked.

That is not an isolated incident. Companies that allow employees to take naps during the day have seen increased productivity, and at schools where the daily start time is later than usual, students grades have improved.

“They attribute all of that to people getting enough sleep,” said Dr. Kahn, noting that the natural rhythm of when a person is inclined to sleep changes more from when they are young to when they are older than the amount of sleep that’s needed.

“The elderly tend to be morning larks,” he said. “They tend to wake up early . . . but they also tend to go to bed early.

“As opposed to when we are younger and teenagers, we tend to be more night owls. We like to go to bed late and sleep in late.”

Both age groups need close to the same amount of sleep, but they benefit from starting and ending their days in opposite ways.

Sleep Apnea, Insomnia and ‘Retirement Syndrome’

The first thing anyone has to do to set themselves on the path to better sleep is believe that sleep is important.

“Some people mistakenly believe they are superhuman and need less sleep than everyone else, so you have to break those barriers first,” said Dr. Kahn.

About 30 percent of his patients come to see him regarding the quality of their sleep, whether that is a result of something like sleep apnea (a sleep disorder where a person repeatedly stops and starts breathing) or insomnia.

“Usually it’s when someone is snoring too loudly at night and their significant other has had enough,” said Dr. Kahn. “Then I find out they sleep while watching TV because they sleep better — sure you do, because you fall asleep sitting upright. Sleep apnea gets better when you sleep upright, same as when someone has a cold.”

In other cases, people have fallen asleep while driving, had a car accident as a result of drowsiness (from lack of good sleep at night) or they were given a sobriety test because a police officer found them napping in their car on the side of the road, said Dr. Kahn.

For patients who come to see him as a result of insomnia, he asks a lot of questions about their daytime routine.

“Before Edison invented the lightbulb, before there was TV 24-7, before we had iPads, iPhones, Kindles and all of that, people did not have that much trouble falling asleep,” Dr. Kahn remarked. “So what are they doing before they try to sleep? Are they taking naps? Are they drinking any caffeinated beverages after noon? Because that caffeine will still be in your body when you try to go to bed that night.”

Some people who find their sleep has been disrupted suffer from what Dr. Kahn calls “retirement syndrome.”

“They retired from their jobs, and now they have lost all the structure that was in their lives,” he said. “They don’t have to wake up at a certain time, so they don’t have to go to bed at a certain time either. Now they sleep whenever they want and wake up whenever they want.”

As a result, people can end up getting too much sleep, or just not at the right time.

“You can get fragmented sleep that adds up to eight hours, and that is better than not getting eight hours. But that being said, there is no substitute for nighttime sleep,” stressed Dr. Kahn. “When we sleep during the night, our hormones are in sync . . . and is conducive to how we should be sleeping.”

People who don’t get nighttime sleep because they can’t — night shift workers or people in professions that disrupt their night sleep — typically have more health problems and a shorter life span.

Health Issues From Lack of Sleep

One of the reasons sleep deprivation can lead to increased health problems is that it decreases your immunity, said Dr. Kahn.

“So people who are sleep deprived tend to get the sniffles more often than people who are not sleep deprived. They tend to put on more weight,” he said. “We have seen medical outcomes after surgery and such get better or worse depending on how sleep deprived they are.”

Also, people who are sleep deprived are generally less inhibited. He found that out himself one day back when he was working a lot of night shifts in his training to becoming a doctor. He acted very out of character toward his boss, but then took a nap, woke up and was shocked at how he had responded in an email to his boss.

“We know that our cognitive abilities are sharper when we have the right amount of sleep,” said Dr. Kahn. “They are worse when we are sleep deprived. That is why aviators and truck drivers have to log their sleep hours. There’s a reason why we have rules for that. Far too many lives have been lost because of sleep deprivation.”

Students: Studying Doesn’t Help Unless You Sleep

Dr. Kahn uses the analogy of a computer shutting down to illustrate how sleep helps people feel refreshed.

“Even computers need to be shut down once in a while just so they can reset, so their reference value can come down to zero,” he said. “Otherwise you lose that baseline where you operate from. Sleep does the same thing for us.

“There are a multitude of physical and mental benefits from sleep. Almost every life form, from a single cell to a multicell being has this biological urge to sleep,” he said. “Sleeping is just as important as eating and drinking . . . it’s one of those things we need to sustain life. It is imperative that we get our hours of sleep.”

Dr. Kahn also was quick to point out that students who like to stay up late studying and “cramming” for a test the next day should realize that it is all for naught if they don’t get some sleep.

Memory consolidation is one of the things that happens during sleep, and if you cut the amount of sleep you get short, your body may not have the time it needs to complete all of the sleep phases needed to remember.

“Then we wake up less prepared to concentrate, make decisions or engage fully in school and social activities,” according to the National Sleep Foundation.

Tips for Getting a Good Night’s Sleep

People who struggle to get a good night’s sleep have usually tried lots of tricks to aid them before they finally make it to a doctor for help. One of those things is sleeping in front of the television.

It may work, in that people do fall asleep in a recliner or leaning back on the sofa, said Dr. Kahn, but that doesn’t mean they are getting quality sleep.

“You would think that watching TV numbs your mind, so you can fall asleep with it on in the background, but there’s nothing peaceful about watching television,” he said. “Even something dull and boring can keep you awake. And if you do fall asleep with the TV on in the background, your brain is still responding to the changes in brightness of the screen and the brightness of the room . . . and the changes in the sound.”

Listening to music is a better choice, and white noise machines are also good, said Dr. Kahn.

“Some people use guided imagery, which is like an audio recording that takes you through sleep. It tells you to relax your toes and works its way up to your legs, your breathing, everything . . . that actually helps,” he said.

Clean Up Your Sleep Hygiene

If you are wanting to improve your sleep quality, cleaning up your sleep hygiene is a good place to start, said Dr. Kahn. This includes things like limiting caffeine intake to the morning, exercising during the daytime rather than at night too close to when you want to fall asleep, not having a glass of wine to help you fall asleep and keeping your bedroom as dark as possible while you are trying to sleep.

People who think drinking alcohol before bed will help them fall asleep are correct, said Dr. Kahn, but they don’t realize that once that alcohol is out of their system, which will happen a couple of hours after they have fallen asleep, they will wake up. At that point, they often have to use the bathroom and then they are unable to fall back to sleep.

“So you’ve traded one problem — not being able to fall asleep — for another — not being able to get back to sleep,” said Dr. Kahn.

His advice is to be active as much as possible during the daytime. Exhausting as much of your energy as possible during the day will make it that much easier to fall asleep at night, he said.

And rather than watching TV or staring at your smartphone or tablet, read. If you are really doing it to try to fall asleep, he recommends it be something boring where you won’t care if you finish the next page or find that you are thinking about the story once you set the book down.

“Sensory overload is a big contributor to insomnia,” said Dr. Kahn. “Being disciplined and limiting your exposure to TV and devices can be helpful.”

The ideal room temperature of a bedroom is different for everyone, said Dr. Kahn, but he noted that a person’s core body temperature drops by around two degrees when sleeping, hitting the lowest point around 4 a.m.

While he doesn’t recommend any certain kinds of pillows, Dr. Kahn said sleeping with your head a little elevated is never a bad idea.

“Six inches is a good measure,” he said. “But don’t stuff pillows under your neck. It’s better to place a book or brick or something underneath the mattress to elevate it . . . or take a wedge pillow, like what babies use to sleep on.”

Sleep Clinic at South Medical Building

People who don’t have any trouble sleeping are likely not bothered by issues like the sound of the TV while they sleep, exercising right before bedtime or from the room being too bright, just as not every person who drinks alcohol is an alcoholic, Dr. Kahn noted.

Insomnia, he said, is often as result of the three Ps — predisposing factors, precipitating factors and perpetuating factors. Some people are more likely to develop insomnia for whatever reason, something triggered the insomnia and something is causing it to continue or even making it worse, Dr. Kahn explained.

To help people suffering from poor sleep figure out what is going on, Mercy in Washington has a Sleep Disorders Center located on the second floor of Mercy Medical Building South, where diagnostic sleep testing can be performed and interpreted.

For more information on the sleep clinic, people can contact Mercy Clinic Pulmonology and Sleep Medicine at 636-231-6245. Hours are Monday through Thursday, 8:30 a.m. to 4:30 p.m. and Friday, 8:30 a.m. to noon.