For our series "Mornings in Michigan," we visited a sleep clinic to see what happens in the wee hours when someone goes in for a sleep test.
To learn more about some of the most common sleep problems and what we can all do to improve our sleep, we sat down with Dr. Mehwish Sajid.
Sajid is a clinical instructor in the Departments of Neurology and Family Medicine in the University of Michigan Medical School. She spoke with Michigan Public's Morning Edition host Doug Tribou.
Doug Tribou: We visited the sleep clinic and followed one patient through the process. Her name is Julie. She has sleep apnea, one of the most common sleep disorders. For those who aren't familiar with it, could you describe what sleep apnea is and how it affects people?
Mehwish Sajid: Sleep apnea essentially is pausing of your breathing that occurs while you're asleep. So essentially what happens is the tissues in the back of your throat will kind of collapse on themselves, and that prevents air from flowing through. And then you end up having all of the consequences of not breathing at nighttime.
DT: And what are those effects for people who have it and have it untreated?
MS: Typically patients will come in, and they'll say that either they've woken themselves up from snoring or their partner is telling them that they're snoring. They typically will say that they're waking up feeling like they didn't really get rest at all. Daytime sleepiness, difficulty with focus, all of those make us think that there's something going on that we've got to look into.
DT: Because of sleep apnea, millions of Americans now sleep with a breathing mask attached to a hose that runs back to a continuous positive airway pressure machine, better known as CPAP machine. What do those machines do and how effective are they?
MS: CPAP machines are the gold standard treatment option for sleep apnea because they are over 99% effective at addressing the the symptoms and side effects of untreated sleep apnea. What the machine itself is doing is it's essentially giving pressure to the airway at nighttime. That pressure helps to move tissue out of the way so you can get constant oxygen at nighttime while you're sleeping.
DT: And I was surprised to learn that not everyone who snores is prone to it. And some people who don't snore can also have sleep apnea?
MS: Interestingly, women actually typically don't present with the signs of sleep apnea that we think of. For women, we typically see either fragmentation of sleep or insomnia, feeling fatigue in the mornings. Those are the things that we will usually hear from from women.
"The biggest convincing factor for using the CPAP [machine] is that patients usually feel much better pretty quickly."Dr. Mehwish Sajid on overcoming patients' resistance to wearing a mask while they sleep
DT: Even with her experience with CPAP machines, her husband has one, Julie was still sort of reluctant to get the one that she didn't want. She called one of them the "Mr. Snuffleupagus" machine from Sesame Street. It sort of looks like an elephant trunk coming out of her nose. She was hoping to get a different placement for the hose.
But regardless of the type, you're using a machine that's covering part of your face. You're wearing headgear. How much of a deterrent is that for patients?
MS: Patients really do have some hesitation when they see the CPAP machine. But I would say the biggest convincing factor for using the CPAP is that patients usually feel much better pretty quickly after starting the therapy. So they'll be sleeping better, they'll be having less daytime symptoms. And then we have made a lot of advancements in our CPAP supplies and mask types as well. So we've got many more comfort options that are available that we can address with patients and see what what would work for them and their sleep style.
DT: Beyond sleep apnea, what are some of the most common sleep disorders or problems that you see?
MS: I would say the most common would be insomnia, whether that be issues falling asleep or staying asleep, and then also daytime sleepiness.
DT: When should someone look into getting a sleep test or seek out a sleep expert?
MS: Any time that you are either being told that you're snoring and that's coupled with either stopping breathing at night time, you waking yourself up, choking, gasping, or if you're having daytime symptoms where you're waking up and you're really not feeling like you got a good night's rest.
DT: There's no shortage of sleep advice out in the public. Don't drink caffeine in the afternoon. Don't look at the blue light of your cell phone before bed. Try to get to bed at a consistent time. Why do we have so much trouble following all of that advice? And if you had to give a few of your top tips, what are the the best strategies for people?
MS: I think the biggest reason why we have a hard time following that is because it's hard to get away from the electronics, right? [you] having that one hour of wind-down time where you're not necessarily looking at a phone. And I'm guilty of these things, too.
DT: [Laughs] No!
MS: [Laughs] It's hard! We talk about this and I try to practice what I preach, but it is difficult. And I like to tell patients to have like a dedicated worry time. Write down the things that you want to address in the morning so you're not thinking about them.
Exercise or getting movement in the day is excellent, but try and do that well before bedtime because it can be activating.
Not using alcohol to fall asleep. Alcohol can definitely worsen your sleep quality.
"Over-the-counter agents typically end up affecting your sleep quality in a more negative way."Dr. Mehwish Sajid on the risks of self-treating sleep issues without consulting a doctor
DT: There's also a lot of bad advice and misinformation out there about how to get a good night's sleep. What are some of the myths that you've run into in your practice?
MS: One of the biggest ones is patients using high doses of melatonin right before bedtime. That's really not how melatonin is intended to be used. Before trying any over-the-counter supplements or any medications that aren't medications that you've discussed with your provider or a sleep physician, I would be hesitant to start any medications — especially over-the-counter agents. [Those] typically end up affecting your sleep quality in a more negative way.
DT: I work the morning shift. The show starts at 5 a.m. and so I'm up very early, obviously. I also have three kids and want to be able to see them in the evening. I've been here over nine years, I've slept two hours in the afternoon and then whatever I can get at night. What are your thoughts on that strategy, which is now very ingrained in my life, for better or worse?
MS: Yeah. So you have the typical shift work schedule. And for that we do recommend trying to consolidate as much sleep as you can. But having that scheduled nap or that shorter sleep period in your 24 hour day can be very beneficial. So you're actually doing what we would recommend.
DT: Is it a bad sign that when I'm on vacation after maybe one night where I readjust and I get seven or eight hours of sleep consecutively or on the weekends, I feel like Superman under the yellow sun? Like, is that a bad sign that I feel that much more energy?
MS: It indicates that you're likely in a state of some sleep deprivation during the workweek. So whatever you can do to get a little bit of extra sleep, especially with that longer stretch that you get prior to work, it would probably be beneficial.
DT: Okay, I think you're telling me what I already suspected.
[Both laugh]
DT: Dr. Sajid, thank you very much for your time.
MS: Yes, you're very welcome.
Editor's notes: Some quotes in this article have been lightly edited for length and clarity. You can hear the full interview near the top of this page.
Michigan Medicine is part of the University of Michigan. The university holds Michigan Public’s broadcast license, but we report on U of M as we would any other institution.
