Are you getting enough sleep?

Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half hour, docs in a pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Rajay Seudath and former television broadcaster Gina Galaviz, we'll share information to improve your health and wellbeing. And now here are Gina Galaviz and Dr. Rajay Seudath.

GINA GALAVIZ EISENBERG
Welcome to the award-winning Docs in a Pod presented by WellMed. I'm your host, Gina Galaviz Eisenberg. Ron Aaron is on special assignment today. I'm so pleased to have you with us on Docs in a Pod. Our program is available wherever you get your podcasts. We're also on the radio in several cities in Texas and Florida. Each week, we talk about a variety of health and wellness issues that impact Medicare-eligible seniors and others. We welcome our new Docs in a Pod co-host, Dr. Rajay Seudath. Welcome, Dr. Seudath.

DR. RAJAY SEUDATH
Thank you so much.

GINA GALAVIZ EISENBERG
How is it so far? Our second show here.

DR. RAJAY SEUDATH
It's doing great. I love it.

GINA GALAVIZ EISENBERG
Well, just so I can brag on you a little bit, you're board-certified family practice physician. You're a Tampa native and you're currently a physician for Optum and you're at the university's location in Tampa. Now, before your medical career, you had many jobs, but you worked as an English teacher abroad and that was the inspiration that led you to a field in family medicine. That's quite fascinating.

DR. RAJAY SEUDATH
That is correct.

GINA GALAVIZ EISENBERG
Is it turning out the way you thought it would be?

DR. RAJAY SEUDATH
Absolutely. When you're doing your dream job, you don't work a daily life.

GINA GALAVIZ EISENBERG
Oh, that's good. That's good advice. For all of us, right? Well, today we're going to talk about sleep. Dr. Ricardo Pedraza in San Antonio is going to talk about sleep and the importance of it. We're so pleased that you're here today. So, I'm not sure how much sleep I had last night, but what should I have had for a 61-year-old woman?

DR. RICARDO PEDRAZA
I would recommend for anybody really to have seven hours of sleep. That's the target for pretty much anybody. It is hard to accomplish. We do get distracted easily with different tasks around home and stress, but that's really the best amount of sleep that I would recommend is seven hours. Easier said than done, but I do recommend it.

GINA GALAVIZ EISENBERG
I know, because if you have kids or grandkids running around, everybody has to have lights out because if you're not, somebody stays up. You're an internal medicine specialist, so sleep is probably at the core of everything that you talk about with your patients, correct?

DR. RICARDO PEDRAZA
Absolutely. It is a very common concern that my patients have is a lack of sleep and insomnia. It is something that at some point it will affect everybody, but as we get older, it gets harder to get into a routine schedule. So, it is something that I educate my patients on about having an appropriate schedule, sleep hygiene, help them feel better overall.

GINA GALAVIZ EISENBERG
Dr. Seudath, with your patients, when does the topic of sleep come into the conversation?

DR. RAJAY SEUDATH
Often. It's one of the major complaints that we get. Someone's coming in just for their routine follow-up. Oh, your diabetes, you're doing good. Your joint pain is doing fine, but by the way, doc, I'm not sleeping. That kind of opens that conversation to the myriad of reasons a person can have disturbed sleep, lack of sleep, bad quality of sleep, lots of different things in that umbrella of sleep issues.

GINA GALAVIZ EISENBERG
What causes that when maybe you've slept well and then you're not, or you're starting to take a lot of naps during the day? I mean, what does that point to? What does that mean that's happening to us?

DR. RICARDO PEDRAZA
There could be different things that could be affecting our quality of sleep. For instance, anxiety and stress can really affect us. Even if it doesn't seem like we may be so stressed, but it might be internal. When we go to sleep, we wake up, we get anxious, and then it's harder to fall asleep. And then as we get older, we have more medical conditions, you know, heart conditions, lung conditions, all of that plays into a role into how we sleep.

GINA GALAVIZ EISENBERG
So, if we're taking medicine for other ailments, I guess some of the side effect could be, it'll interrupt your sleep.

DR. RICARDO PEDRAZA
Yes. So, it's always important to talk about that with your primary care doctor. Some of the medications that are necessary for different conditions may cause, let's say, increased heart rate, which will make it harder to sleep.

GINA GALAVIZ EISENBERG
What do you do then? We need that medication. I mean, can we ask our doctors to maybe prescribe something differently? What's the solution or what options do we have?

DR. RICARDO PEDRAZA
Yeah, so it'd be a good conversation to have with the primary care doctor about alternatives that may not cause problems with sleep. We have to weigh the risks and the benefits of every medication. We can always try to adjust the dose as well or maybe schedule it at a different time. For instance, patients will take diuretics for heart conditions or kidney conditions, and if they take that close to bedtime, they're going to end up waking up all night to go to use the restroom and then there goes their sleep. So, a lot of it is going over each single medication, figuring out the right time to take it so that sleep is not disturbed as much.

GINA GALAVIZ EISENBERG
If you just joined us, you're listening to the award winning Docs in a Pod with our new co-host, Dr. Rajay Seudath. I'm Gina Galaviz Eisenberg. Our podcast is available wherever you get your podcasts. Our expert today is Dr. Ricardo Pedraza talking about sleep. Now you're here based in San Antonio, Dr. Petrazza, and I know it's hot in Florida also, but it just seems really hot in Texas. Does heat affect the way we sleep?

DR. RICARDO PEDRAZA
Absolutely. I mean, if it's too hot in our home, we don't have a proper AC, we're not going to get that quality of sleep that we want. Most of us will prefer a cooler environment to sleep or the sheets to be cooler, the pillows. So, we don't have that because of the heat. That makes it so much harder to sleep and to stay asleep.

GINA GALAVIZ EISENBERG
I found on Amazon cooling pillows and a blanket that is like a waffle type blanket that I use with a sheet to keep me cool or to keep me warm depending on the season. What are some other options? A cold bath before you go to sleep or lowering the thermostat? What do you think?

DR. RICARDO PEDRAZA
You can try adjusting the thermostat, getting a pillow that's comfortable and cool or a sheet. Some of the mattresses now have that option too, to change temperatures. The other thing I would recommend and just in general, it depends, everybody's different. Some people prefer a cold shower. Some people prefer a warm shower before they sleep. Most of my patients will say they prefer a hot bath before sleeping that kind of helps them relax and they can go to sleep. It just depends. Everybody's different. You can try different things to see what works best for you.

GINA GALAVIZ EISENBERG
A lot of seniors do not have AC in the summer. How do we help seniors who are in these conditions and don't have access to lowering our temperature or thermostat?

DR. RICARDO PEDRAZA
A fan will work for sure. You can try that. A lot of times, for instance, with our clinics and with WellMed, we do have resources to try to help out our patients with anything that's going on at home. We do like to evaluate at home to help patients in different aspects.

GINA GALAVIZ EISENBERG
So, I guess don't be afraid to ask if you're a patient. If one of you guys are their doctors and they ask you, you'll give them the information?

DR. RICARDO PEDRAZA
Yes, exactly.

DR. RAJAY SEUDATH
Yes. For WellMed and Optum, we have resources available. We have social workers and things like that in different townships, in different counties. Sometimes they have those kinds of things available. So, for instance, San Antonio is very hot. Florida is very hot. So, depending on the county that you're in, there may also be resources available to help people to make sure they have central heating or ACs or some sort of thing like that so they're not having heat stroke or dehydration or things like that.

GINA GALAVIZ EISENBERG
How does social media affect our sleep? You take your phone to bed and you're like, I'm going to read a book and then you start scrolling. You could be up for hours.

DR. RICARDO PEDRAZA
That is a common problem we all experience. If we are on our phones, browsing the internet, on our social media sites, we get so focused on that, that bright light makes it harder. It tricks our brain into thinking it's daytime. So, when we try to sleep, it gets so much harder to sleep. I always tell my patients, cut off all electronics about an hour before you plan to sleep. That'd be phones, televisions, laptops, computers, just cut off all that. If you have to read something, read a book in a dim light and then go to sleep, but nothing too bright because that will make it so much harder to sleep.

GINA GALAVIZ EISENBERG What about white noise? You could buy a white noise machine. Is that good for us or can that cause other problems?

DR. RICARDO PEDRAZA
No, that's a good option too. I use white noise. Most people do well with the white noise. You can try different types of noise. But that is one way to help sleep. It kind of helps calm us down. When we’re much calmer, it's so much easier to sleep.

GINA GALAVIZ EISENBERG
What do you use? Which white noise? I'm just curious.

DR. RICARDO PEDRAZA
Oh, it's a little machine that my wife got on Amazon, but I was able to just put it in right next to me so that I could sleep so I don't have to keep waking up. So, I would recommend that to my patients. I do bring it up. There are different types of little machines that you can use and they're very relaxing.

DR. RAJAY SEUDATH
Those machines are good for people who also have tinnitus. If you have the ringing in your ears when there's no sound at all, that can really be very annoying for a patient who's trying to sleep and they're getting this almost like a hallucination, an auditory hallucination where they're hearing this ringing or a whooshing or something. Having the white noise machine kind of drowns that out and it allows them to relax and go to sleep.

GINA GALAVIZ EISENBERG
It's amazing what our brain does to us. It's powerful. Sometimes when I am up scrolling, not too late at night, I mean 10 o'clock is late for me with but I see some of my friends and then in the morning I'll look to see what happened overnight and they're like, it's 4 AM. I'm still up and I'm watching Law and Order or what have you. I don't know what to tell them. I wish I could say, hey, here's what you need to do. What do you tell folks who talk to you about this. I just cannot sleep, and I don't want to take any more medication. Or maybe that's all that the other option that there is. I don't know. What do you suggest?

DR. RICARDO PEDRAZA
That's when I go over sleep hygiene and scheduling. I recommend to my patients to try to sleep at the same time, aim for the same time every day. That makes it so much easier to get adjusted to a regular sleep schedule. It's hard for a lot of people to give up on electronics or TV or cell phones when they've been doing it for such a long time. I do that one hour cut off, so an hour before they plan to sleep to eliminate all of that. Also limit caffeine intake. I would say by 12 not to have any more caffeine because even an extra cup of coffee after 12 can make it so much harder to sleep and to stay asleep. Meditation also helps. So, if someone gets anxious before they sleep, try to do some meditation. There are so many different techniques you can find resources to help you meditate. That'll help a lot. We go over a lot of those techniques in my clinic. I try to figure out what's the best way to help them sleep.

DR. RAJAY SEUDATH
For the example you used about your friend not being able to sleep, one of the first things I'll ask my patients is, what are the steps you're taking to ensure you're having very good sleep? And that opens the conversation for sleep hygiene, because they’ll say, well, I close my eyes. Well, okay. You brush your teeth; you have oral hygiene. You wash yourself; you have personal hygiene. What are you doing for your sleep hygiene? And then that can kind of get you to where are the mismatches with their lifestyle. And again, as Dr. Pedraza said, there's so many different ways that we can influence that.

GINA GALAVIZ EISENBERG
We do it for babies. Get on a sleep schedule. We'll continue our discussion in just a moment. I'm Gina Galaviz Eisenberg, along with Dr. Rajay Seudath and our guest, Dr. Ricardo Pedraza. We will be back in just a moment.

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GINA GALAVIZ EISENBERG
Thanks so much for staying with us on the award winning Docs in a Pod. I'm Gina Galaviz Eisenberg. Let's continue our discussion on sleep or no sleep. Here's one that everyone wants to know more about. My husband snores. My wife snores a lot, and then they have these weird dreams. Are they just having weird dreams or is that a big sign that they have sleep apnea, and they really need to go see your doctor right away? Cause that could lead to other things, couldn't it?

DR. RAJAY SEUDATH
Absolutely. So, sleep apnea is one of those diseases that can worsen all of the other diseases. If you think about it, you can't go for food for about a week. You can't go for water for three days at most. Most people can't go for a minute to a few minutes without air.

GINA GALAVIZ EISENBERG
So, sleep apnea is when you stop breathing while you're sleeping?

DR. RAJAY SEUDATH
You literally stop breathing. That's why you hear this kind of choking, snoring sound often. That's called an apneic attack. That's why I like to have patients come into the room with their families if there's an issue of, do I have sleep apnea? Well, let me talk to the people who see you sleep and let me ask them the questions. Are you snoring and it sounds like you're in there sawing through some logs? Those are the kind of conversations that can lead us to the questions that can kind of be the screening questions for, is this a person who needs to have a sleep study?

GINA GALAVIZ EISENBERG
Because that can put you in the hospital and you're not hallucinating, you're almost dying. That almost happened to Ron. Sorry, I didn't want to throw you under the bus there, but that's when I realized, even with myself, because during COVID, we gained all this weight. And that's when I said, oh my gosh, I'm going to die. I'm afraid of going to sleep because I won't breathe. What can we do? We get a sleep study, how long before we get results?

DR. RICARDO PEDRAZA
Most of the sleep clinics will give you results within a week or so. They'll try to try to find the right treatment for that. Most of the time you do a sleep study and if they diagnose sleep apnea, they will recommend a CPAP machine. A lot of times when I bring that up to patients, there's a lot of patients that fear about the machine itself because of the mask. There are different types of masks, and the sleep clinic will always try to find the most comfortable one for you. It is extremely beneficial to use that machine. It helps you improve your sleep, your energy levels the next day, and it helps with blood pressure. It has so many benefits to be able to treat sleep apnea appropriately.

GINA GALAVIZ EISENBERG
One of my neighbors was like, I just got a smaller machine. Some people don't want it because they feel it's going to restrict them from traveling or they can only go somewhere where they can drive. It's not that case anymore. It seems like with technology, things are getting smaller that have big impacts on our lives. Is that a hindrance in being able to do whatever you want to do?

DR. RICARDO PEDRAZA
Yeah. There are different machines that you can get. Definitely ask your primary care doc or your sleep clinic to get you the right machine. I recommend patients ask all these questions so we can find the right comfort for you.

DR. RAJAY SEUDATH
Right. For most people, if they have a CPAP machine, I tell them, this is part of your luggage. You're packing your stuff. You're packing your toothbrush. You're packing your deodorant. You pack your CPAP. Because again, as we were talking earlier, we talked about sleep hygiene. This is what are the things that you are doing to ensure you have good sleep? This is part of that sleep hygiene.

GINA GALAVIZ EISENBERG
As we age, will most people eventually use a machine like this?

DR. RAJAY SEUDATH
Not necessarily, no. Again, some of the risk factors for it are again, other diseases, smoking, COPD, but also overweight, obesity. For some people who may have been diagnosed with sleep apnea, losing weight, having more tone in their upper body, in their necks by doing exercise. Sometimes that can decrease the apnea expels and they may not have as bad of a sleep apnea.

GINA GALAVIZ EISENBERG
Is sleep apnea a silent killer also with people who don't know that they have it? They just think they snore.

DR. RICARDO PEDRAZA
It is definitely underdiagnosed and undertreated. A lot of times, we primary care doctors, we focus on other things and then we forget to ask those important questions about sleep apnea. Then sleep apnea can lead to heart disease, it can lead to lung disease. As I mentioned before, elevated blood pressure and we know for sure that hypertension can lead to so many other complications. So definitely it can be a silent killer.

GINA GALAVIZ EISENBERG
Dr. Pedraza, in San Antonio, do you find that the Hispanic community to be very hesitant to even like bring certain things up? They don't want to be a burden. I don't want to bother the doctor with that. That's not important. Do you find that trying to break through some cultural barriers in them following treatment?

DR. RICARDO PEDRAZA
Absolutely. There are culture barriers, there are socioeconomic barriers. When I get to know patients, I try to get them comfortable with me. We may not address everything but maybe in the 2nd, 3rd or 4th visit, more and more concerns start to be brought up by the patient or the family. So, I always try to make them comfortable with me so we can address everything. And over time, we do manage to address all of that.

GINA GALAVIZ EISENBERG
Do you suggest they bring their advocate, bring their spouse, bring their daughter, because four ears are better than two. Even with just two ears, I'm like, I don't know what the doctor told me. And I'm educated. It's not that easy.

DR. RICARDO PEDRAZA
Yes, I do recommend that. As patients' conditions become more complicated or over time and over age, I do recommend bring someone in. Bring your spouse, bring your daughter, your son. Even if you are able to understand everything, having someone else know what's going on with your health is very important. Sometimes, I might give them a lot of information and they may not catch everything, but that's where the family member is there to catch the things that they may not remember and then write them down and then they can come with the next visit with more questions. I do try to encourage my patients to bring someone to their appointments. I love meeting family members because we can all work as a team to address these health concerns.

GINA GALAVIZ EISENBERG
That's why you got into family medicine, right, Dr. Seudath?

DR. RAJAY SEUDATH
That’s right.

GINA GALAVIZ EISENBERG
Who's more stubborn, Floridians or Texans?

DR. RAJAY SEUDATH
Oh, I mean, I would have to say the Texans on that one. I mean, it is the Lone Star State for a reason, you know.

DR. RICARDO PEDRAZA
I agree.

GINA GALAVIZ EISENBERG
How do you break through the cultural barriers with patients?

DR. RAJAY SEUDATH
I think a lot of times you have to kind of bring it back to the things that are important to the patient. If you can tie this sleep apnea into their life and say, look, you said you're falling asleep at the wheel, right? When you go to pick up your granddaughter, do you want to fall asleep at the wheel and possibly cause an accident that hurts her? You bring it back to the things that are important for each person. That's a case by case. That's one of the things that again, if you can do that, if you can bring this disease back to the here and now, what's important to this person. Because again, almost all of these diseases will impact their life in so many different ways. And I think that's the way that we can do that. Also, I love it when patients bring their families. The unit of medicine is the family, so having two brains, absolutely. But sometimes you get people to tattle. That's the best part. Doc, he was staying up until 3am eating cookies and he skipped his blood pressure medicine for three days. You get all the juice, so now sometimes whenever they walk in, I greet the patient, and then I turn to the wife and say, all right, spill the tea.

GINA GALAVIZ EISENBERG
That's true though. I would think for the family it makes it more of a fun. We're all in this together. Because whatever's happening to us, our husband or the mother or the father, it's affecting everybody.

DR. RAJAY SEUDATH
Oh, yes. One of the other ones with sleep apnea is quite often we see it with people who have COPD. So, people who are smokers, people who have had exposures, people who have had asthma for a very long time, any type of obstructive disease in the lungs can put you at a higher risk for sleep apnea. Again, if they're smokers, it's usually a husband and wife. Sometimes both of them are smoking. Sometimes one. It's good to get them both on board if we're going to try to do that smoking cessation type of thing.

GINA GALAVIZ EISENBERG
Oh, that's true. How about secondhand smoking that affects the spouse?

DR. RAJAY SEUDATH
Yes.

GINA GALAVIZ EISENBERG
That's something that can contribute to the whole to their disease or to sleep apnea. If you had to like rank it as far as diet, exercise, sleep, how would they rank it in your viewpoints?

DR. RICARDO PEDRAZA
I like to put them all on the same level. When I talk to patients, I want them to address every single one of them. Having a healthy, balanced diet is important to reduce a lot of different medical conditions. Also to help with sleep. Exercise has been shown to help with sleep. But you want to exercise earlier in the day, not closer to bedtime. Because then it makes it much harder to sleep. So, diet, exercise, all of that, having techniques to help calm us down, that's for focus on our mental health. All of that helps with sleep.

GINA GALAVIZ EISENBERG
Is that something that we should start early in life in our fifties, or by the time we're at 60, should we start thinking in those terms even more?

DR. RICARDO PEDRAZA
Absolutely. The earlier the better. As we get older, it gets harder to make new changes and to change our habits. When I talk to patients about having a sleep schedule, if they're used to sleeping so late and waking up so late, it is difficult to get them to adjust to that. So, the earlier the better. Have good habits for sleep, good habits for diet, for exercise. It makes it easier as we get older.

GINA GALAVIZ EISENBERG
Is it okay to nap? What if we take a nap during the day? Is that going to mess up our sleep later?

DR. RICARDO PEDRAZA
That's a great question. Napping is very common with my patients and with a lot of people in general. I would recommend not napping close to bedtime. If you have to nap, I would say maybe after lunch and maybe limited to 45 minutes to 50 minutes. Once it gets to more than an hour, it gets so much harder to wake up. And then when we wake up after a long nap, we're just groggy, and then our whole rhythm for sleeping gets thrown off. So, I recommend if you're going to do it earlier in the day and for a shorter interval.

GINA GALAVIZ EISENBERG
That's good advice. Dr. Seudath, you were going to say something.

DR. RAJAY SEUDATH
I was just going to say, when we're talking about sleep and we're talking about all of those things, we're talking about diet exercise, medications, all of those things, those are all important that we're looking at the persons different diagnoses, different diseases, and educating the patient. So, for instance, GERD. If you have bad acid reflux and you eat a chili dog for dinner, that's probably going to keep you up. We talked about sleep hygiene in general. The goal of sleep hygiene is to mimic the natural sleep cycle. Oftentimes when you tell patients, we're trying to get you to have a natural sleep cycle, so, if you were out in the jungle, when the sun goes down, it's lights out. If you were in the jungle, it would be warm during the day and cooler during the night. Those are the kind of things that we're trying to reinforce because on a primal level, humans are still animals. So, we can use some of those things. If you see when dogs and cats usually wind down for sleep, sometimes they'll put their hands over their eyes. That's great. You can get an eye mask. An eye mask simulates that texture, that feeling, that tactile sensation over your eyes. And that can help you fall asleep. So, there's a lot of different things when you explain it. We're not doing anything different than what your body is already naturally used to. We're just trying to reinforce that natural order to get you to sleep.

GINA GALAVIZ EISENBERG
All right, and with that, I will say good night. Thanks for joining us today on the award winning Docs in a Pod. Thank you to Dr. Ricardo Pedraza. I'm Gina Galaviz Eisenberg along with Dr. Rajay Seudath. In the words of the late Charles Osgood, I'll see you on the radio. Thank you both for being here today.

DR. RICARDO PEDRAZA
Thank you.

DR. RAJAY SEUDATH
Thank you so much.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod, presented by WellMed. Be sure and listen next week to Docs in a Pod, presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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