As another dark winter season in Southeast Alaska approaches, developing healthy sleep habits can improve overall well-being, from creating a calming bedtime routine to tackling sleep disorders like insomnia and sleep apnea.
Internal medicine physician Dr. Guillermo E. Espinoza, who has worked for SEARHC since 2017, specializes in sleep study at the Mount Edgecumbe Medical Center in Sitka. Starting about three years ago, he began focusing on developing a practice for weight management.
“(There’s) a lot of overlap between obesity and obstructive sleep apnea,” he said. “That led to working out a pathway to treating sleep apnea in the Southeast population and got me interested in the study of sleep medicine … led to me pursuing a fellowship in sleep medicine that I’m actually currently doing at Duke University in North Carolina.”
Sleep apnea is a disorder that causes people to stop breathing or breathe shallowly while they sleep.
He said it’s never too late to develop good sleep habits, starting one hour before bedtime. “Make sure you turn off the lights, make the place cool, avoid (cellphone, computer and television) screens.”
Espinoza also stressed the importance of maintaining a consistent sleep schedule, even during the weekends, as staying up late at night and sleeping later can disrupt overall sleep health. “That takes some recovery … and the next week, you may not start so refreshed.”
He also said it’s important to avoid eating or watching television in bed, and don’t sleep in other areas of the home like the couch.
For issues with insomnia, Espinoza suggested avoiding naps during the day, and engaging in exercise or other physical activities to exhaust any energy before bedtime.
One unique factor uncommon to people in the Lower 48 is the long days of summer and long nights of winter in Alaska. “The climate and the exposure to the sun, or lack thereof, can affect your circadian rhythm,” Espinoza said, advising the use, when needed, of things like blackout curtains for summer nights and blue light therapy lamps during winter days to create a fixed circadian rhythm.
Espinoza said bad sleep is “a big driver of stress on the body,” which in turn can lead to health issues.
As he has helped patients dealing with sleep apnea, he has witnessed the effects of leaving it untreated. “You see the consequences of intermittent low oxygen levels on the brain that would lead to issues with long-term cognition, increased risk of dementia, Parkinson’s disease. … Increased stress of low oxygen on the heart leads to issues with heart failure, heart arrhythmia, hypertension,” he said. “Basically, most of the organ systems you can think of are affected by that increased stress level.”
He has seen patients ranging in age from the teenage to the elderly who have other issues with sleep in addition to or apart from obstructive apnea.
For many dealing with sleep apnea, one recommendation is a continuous positive airway pressure (CPAP) machine, which delivers continuous air through the nose or mouth to keep the airways open while the person is asleep.
“A lot of folks do prefer using CPAP machines that just go to the nose,” he said, citing its comfort level. “Problem is that half the pressure that goes in through your nose can escape out your mouth when you’re sleeping if you sleep with your mouth open.”
In those instances, if the patient still prefers the nasal mask, they have the option of using a chin strap that’s usually attached to the CPAP machine or porous mouth tape that gently keeps the mouth closed.
He also pointed out that a healthy amount of sleep can vary from one person to the next, which can pose other challenges. “Sometimes, the folks who don’t need that long of a sleep, their issue is that they try to force themselves into the norm of seven to eight hours,” he said, adding that such people can start developing anxiety from trying to reach that goal.
Espinoza said sleep patterns and behaviors can also vary by age as well as gender. “Men and women can definitely have different amounts of sleep that they might need. “They also can have different types of pathologies that come up. Sleep apnea is classic; it’s just more common in men and postmenopausal women.”
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