Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half hour, Dosc in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Rajay Seudath and former television broadcaster Gina Galviz will share information to improve your health and well-being. 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. I'm so pleased to have you with us today. Our program is available on podcast 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 Docs in a Pod co-host Dr. Rajay Seudath. Welcome, welcome. Before you start talking, I want to toot your horn that you're a board certified family medicine physician in Tampa. You're a Tampa native. You're currently a physician for Optum, and you're at the university location in Tampa. So, stop by and say hi to him. Dr. Seudath received his medical degree from the University of South FloridaÊMorsaniÊCollege of Medicine. You've had a passion for primary care and guiding patients to meet their health care goals while maintaining their values. Dr. Seudath enjoys educating patients and their caregivers, very important, on a variety of health and wellness topics. The interesting thing about you, and I think this is why you're such a wonderful doctor, is that you've worked as an English teacher. I mean, you have actually worked out there with the folks and, you know what patients need. Welcome, Dr. Seudath.

DR. RAJAY SEUDATH
Thank you so much for having me again.

GINA GALAVIZ EISENBERG
The cool thing about you is you're also our expert. We are talking about sleep and its role in mental and physical recovery. How many times do patients come in saying, I just I'm not sleeping well. And what do you say to them?

DR. RAJAY SEUDATH
Well, first and foremost, people, when they're having issues with sleep, you want to kind of get to the underlying cause of that. That's one of the things. Oh, doc, I'm just stressed. That's why I'm not sleeping well. And it's easy to say, well, okay, go to sleep earlier. Let's see what happens. But really, truly, you should be getting to the core of the problem. Finding out, teasing out what's going on. Are you having difficulty falling asleep or are you having difficulty staying asleep? Just differentiating between those two is part of uncovering what's going on.

GINA GALAVIZ EISENBERG
I mean, because you say go to bed early. What does that mean? Because you could be in bed by 9:00 and you're not going to sleep till midnight.

DR. RAJAY SEUDATH
Absolutely. That's correct. How much sleep should I be getting? Well, it's different for different age groups. When you're in your newborn and infant years, it's anywhere from, you know, 12 to 14 hours as a toddler. As a toddler, as a preschooler, you get into your school ages, you're looking at 10 to 9 hours. As a teen and a young adult, anywhere from 7 to 8 hours. As we're in our adult years, we typically want at least seven hours on a regular basis each night. Now, can you do more? Can you do less? Yes, it can be appropriate to have only six hours, but that kind of sweet spot is at least 7 to 9 hours. Now, once we get to our senior year, as we get over the 64-year-old threshold into our senior years, that can become a little bit less, you know, 7 to 8 can be considered normal. Some people can get by on 4 to 6, but, that 7 is very consistent across many different age groups and populations. If you can get seven, that's a pretty good amount.

GINA GALAVIZ EISENBERG
So, if you get 6 or 6 1/2, so is a nap during the day okay? Can you supplement what you're missing? Does that count?

DR. RAJAY SEUDATH
So, we typically recommend against napping. Napping can affect your circadian rhythm. The rhythm that is the sleep wake cycle. We typically try to tell people not to nap. But, if you are tired, you had a long night, your sleep schedule is messed up because you're traveling. Sure. Is it okay to nap. Typically, we want people to nap for less than 30 minutes. More than 30 minutes is going to continue to offset your sleep cycle. When I was in residency, they they taught us that if you're on a 36-hour day, basically, 15 minutes is better than no sleep. Even if you can't fully fall asleep for 15 minutes. So, trying to do that 15 to 30 minutes at a time, that's going to get more restorative for you.

GINA GALAVIZ EISENBERG
I'm going to ask you a question. I usually like to remind folks what they're listening to. This is the award winning Docs in a Pod with our co-host Dr. Rajay Seudath. I'm Gina Galvez Eisenberg. Just a reminder that our podcast is available wherever you get your podcasts. Our expert today, and he's our expert every time he's on the radio is Dr. Rajay Seudath. Today weÕre talking about sleep and its role in our mental and physical recovery. Here's also a question. Say I slept six, seven, eight hours a night, but right after lunch, I'm just I just hit a wall. Some seniors were still working. We're not all retirees. We're still working. What does that mean?

DR. RAJAY SEUDATH
So, that reflex after you eat something, particularly if it's delicious, particularly if it's a nice, warm, fatty, protein rich meal, your body's going to go into that rest and relaxation mode. We have two different models in our bodies. We have fight or flight. So, a bear jumps out, you've got to fight that bear or youÕve got to run away from that bear. Now you are going to rest and relax. You have a meal, so you eat that meal. Now your body wants to cool you down, slow you down, rest and relax. YouÕre not working a 9 to 5 when you're out in the wild. You're kind of listening to your body. So, one of the things that we can do to offset that is have more of a lighter meal. Have a little more vegetables, have a little less fat, maybe a little leaner on the protein. Those are the kind of things. For people who it's very, very, profound the amount of Òfood comaÓ is the vernacular that we use, right? Oh, IÕm in a food coma. Certain foods are notorious for that. Ribs, barbecue, those kinds of things. It's because they're so fatty. They're so protein rich. Your body has to take the blood away from other parts of your body to absorb all those nutrients.

GINA GALAVIZ EISENBERG
So, is that a sign that, hey, you know, you're really not eating healthy if that's happening to you?

DR. RAJAY SEUDATH
It could be. It could be that you're not eating healthy. It could also be that your sleep quality may not be good. When you're getting your large block of sleep for the night, you may not be getting good quality of sleep or like we talked about, you may not be getting that full seven. You might be getting four or it might be interrupted.

GINA GALAVIZ EISENBERG
I also found that maybe I was getting good sleep and then would get behind a wheel and then I started driving after I started getting sleepy. That doesn't happen anymore because I lost, like, maybe over 60 pounds. So, I'm wondering if that kind of compounds the whole sleep problem and wanting to fall asleep in the middle of the day.

DR. RAJAY SEUDATH
Absolutely. That leads us to the idea of sleep disorders. The number one thing that people have heard about is obstructive sleep apnea. Apnea is when you are sleeping and you're breathing, and all of a sudden, you're not breathing. For most people, their partners or your parents or your siblings, somebody is seeing you and youÕre snoring, and then nothing for a minute, for a minute and a half and they're like, is this guy still living? You're hearing somebody waking up and their body is not getting oxygen. So, they have to wake up, but they're breaking their sleep cycle. They're not fully waking up, they just take a breath and they go back to sleep. That can be central, or it can be obstructive. So, like you said, losing weight typically affects obstructive sleep apnea because of the extra cushion, the extra weight on your face and the soft tissues of your mouth, of your palate, that is obstructing the airflow into your lungs, and that could stop you from breathing. So, there's many ways to treat that. Weight loss, lifestyle changes. Those are the number one things. We can send people for sleep studies. The sleep studies are great now, by the way, because you can do an in-office sleep study where they're watching you. If a person has diseases or they have a body type that's out of the ordinary, they may want to do it inside the sleep suite. But nowadays, most of my patients, I'm doing it right in their homes. I'm sending them a kit. There's one that goes on your finger that's doing your blood oxygen.

GINA GALAVIZ EISENBERG
Wow.

DR. RAJAY SEUDATH
There's one you tape to your nose that's doing your carbon dioxide, the old air that's coming out of your body. Then there's a band that goes around your chest and that's measuring how often are you breathing. So, I can say you breathed 30 times, and one minute your oxygen level was nice and high, your CO2 levels nice and low. You're sleeping like a champ.

GINA GALAVIZ EISENBERG
Does that go straight to your office?

DR. RAJAY SEUDATH
No. That goes to a recorder. Typically, we want people to have at least two days on the recorder. Then that goes back to usually a durable medical equipment company or the company that's going to process that.

GINA GALAVIZ EISENBERG
Then you take the information and what happens next?

DR. RAJAY SEUDATH
Once we get that information, it can have mild, medium or severe. Based on that, we come up with what's your plan. A person with mild sleep apnea, they didn't have a lot of desaturation, or they didn't have a lot of loss of oxygen in their bloodstream, their carbon dioxide levels didnÕt go too high, maybe we put you on an exercise regimen. We really control your caloric intake, and we try to get some of that weight off and see does it get better? Do you feel better? Then we work on sleep hygiene. For someone who's moderate to severe, we may start them on a CPAP, which, some people are very vehemently, oh, my God, I don't want to do that. I'm claustrophobic. I could never use that. I couldn't do that. I'll tell you, it is a challenge to try convince people to do that. But for the people who are able to stick with it, who are able to start using it consistently, almost to a person, they've said, this is the best sleep I've ever had in my life.

GINA GALAVIZ EISENBERG
Ron is on one.

DR. RAJAY SEUDATH
Oh, okay.

GINA GALAVIZ EISENBERG
Yeah, he is on one. I tell you, as a caregiver, I guess you could say a wife, it really saved his life.

DR. RAJAY SEUDATH
Yes.

GINA GALAVIZ EISENBERG
He looks younger again. His voice is strong and he's not snoring like he used to.

DR. RAJAY SEUDATH
Absolutely.

GINA GALAVIZ EISENBERG
Which I think it is a sign or a symptom.

DR. RAJAY SEUDATH
Could be. Like you said, I like the word that you said as a wife, as a caregiver, it is absolutely true. Men who are married live longer than unmarried men. So, that's an important thing to realize. Yes, your partner is a caregiver. Absolutely.

GINA GALAVIZ EISENBERG
Well, you remind him next time he's co-hosting with you, I'm saving his life every day.

DR. RAJAY SEUDATH
I definitely will.

GINA GALAVIZ EISENBERG
I that we're going to take a short break, and we'll continue our discussion in just a moment. I'm Gina Eisenberg, along with Dr. Rajay Seudath. We'll be right back.

AD
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GINA GALAVIZ EISENBERG
Thanks so much for staying with us on the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. I'm Gina Eisenberg, and let's continue our discussion on sleep. We were last talking about how I saved Ron's life because he's on the CPAP. What are some other things that can help us with sleep? Sometimes I will even take a small dosage of melatonin. What are your thoughts on that?

DR. RAJAY SEUDATH
Let's talk about sleep aids. What can we do to improve sleep in general? I think that's quite important. When we talk about what are the things we can do to improve sleep, that's called sleep hygiene. Sleep hygiene is important because those are the things that we're doing to ensure that we're having good sleep. I often ask patients who tell me, oh, doc, I'm not sleeping well. I say, what are some of the things that you're doing to ensure that you're having good sleep? And they kind of give me this blank look and say, I donÕt know. I close my eyes. That's okay. Sleep hygiene, like oral hygiene, like your personal hygiene, there are things that we do to keep from smelling. There are things that we do to keep from getting cavities. There are things that we should be doing to ensure we're having good sleep. So, starting off with that, the whole reason for sleep hygiene, the overarching theme behind sleep hygiene, is to reinforce the natural cycle. Humans have a natural cycle of sleep. It's bright outside. We wake up. It gets dark, we go to sleep. So, we can reinforce that even in modern time. First, let's have a dark room. Let's have a dark room so that it's mimicking nighttime. Even if you have to have a nightlight, you have to have this, you have to have that. Try to mimic the darkness of the night. So, that's one. Is your room? Two. Another thing is, as we're children, you snuggle up to your mom. Cats, dogs, they'll snuggle up into their sides or into their haunches. Cats will sometimes put their tail over their eyes. That feeling, that tactile feeling of something over your face can help to induce sleep. So, an eye mask, a sleep mask can also help you to fall asleep and stay asleep. Second thing, if you're sleeping outside, it's going to be cooler in the nighttime than in the daytime. So, one of the things I'll ask my patients is, what's the temperature you keep your house? And they say, oh, it's 78 degrees, rain or shine, 24 hours a day. That could be part of the issue. When it's light, it should be a little bit warmer, and when it's cold at night time, it should be a little bit cooler. I can tell patients to start setting a timer to shift the temperature of your house. Even if it's only 3 to 4 degrees, that can help to maintain that day and night routine. The second thing would be sunlight. So, if it's bright in the daytime, you want to have some natural light hitting your eyes. Even if it's only for a short period of time. When I was in residency, and again, we're talking about 36-hour shifts, and you've got to be on and you're dealing with people's lives, we're talking about what are the things you can do to make sure you're sharp. Any time we were by a window, we would say, look out into the sky. Don't look directly at the sun, youÕll burn out your retina but look at the sky. See it as your sunlight being bounced off of those atmosphere particles and that goes to your eyes. Which brings me to melatonin. Melatonin is released by your brain. When it's time to sleep, it gets dark, your brain releases melatonin, it kind of gets you into that time to go to sleep. There are other neurotransmitters like adenosine. All of those things get you ready to fall asleep. When you wake up and that sunlight hits your eyes, that is waking you up. That turns off the melatonin. So, lack of melatonin should be waking you up now.

GINA GALAVIZ EISENBERG
Right.

DR. RAJAY SEUDATH
It's okay to take melatonin. It is a supplement. It's not going to harm you. But I want my patients to know what I'd like everybody who's listening to know that there are things that can offset that. So, for instance, if you're watching a lot of TV before you go to sleep, it's going to mimic the sunlight. That can decrease the amount of melatonin production. And the screen times. Those are the kind of things that you have to worry about. But that's the major thing about sleep hygiene, which is the most important thing.

GINA GALAVIZ EISENBERG
So, do patients actually ask you, well, what should I do? Is there a sleep position like your back side stomach? When I used to sleep on my stomach, I thought I was going to, like, die in my sleep because I couldn't breathe, and I had to find a space or a place.

DR. RAJAY SEUDATH
It's kind of case by case. Typically for people who have sleep apnea, on their back may be better. On their side can also be okay. It really is case by case. For people with a lot of heart failure, lung disease, sleeping on their stomach can make them feel more uncomfortable. And then it also has to do with your back muscles, your spine, if you've got arthritis. Sometimes people are tossing and turning just because they can't find a comfortable position.

GINA GALAVIZ EISENBERG
Once we're doing everything, we have our routine just like we do with babies, right? They get ready for bed and then we like to have maybe, a cup of tea or maybe even some coffee. Coffee doesn't really affect me at night, but right into my good sleep, I have to go to the bathroom. Is there something wrong with me, or is this normal? How do we stop that?

DR. RAJAY SEUDATH
Yes. Coffee can interrupt your sleep cycle. It can keep you awake. It could shorten the amount of time you're asleep. It can make it longer for you to fall asleep. The caffeine can do that, but the caffeine can also cause you to go to the bathroom. It is a diuretic. It can cause you to go to the bathroom. With caffeine, we usually say six hours before. No caffeine six hours before if you're having sleep problems. Now, you asked me about sleeping and waking up to go to the bathroom. If you're over 65 and you are getting up more than four times a night, that's abnormal. Up to three could be considered normal depending on your disease. You could always talk to your doctor about that if it's causing problems. Because I have patients who they'll have 2 to 3 nighttime awakenings for urination, and they're perfectly fine when they go to sleep. So, thatÕs not an issue for that. Then there's medicines. You got to talk to your doctor before you start taking medicines, even over-the-counter ones.

GINA GALAVIZ EISENBERG
Even Tylenol or anything like that?

DR. RAJAY SEUDATH
Yes. Anything over the counter that says PM is going to have Benadryl in it. So, Tylenol PM, something. Sleep-ease, NyQuil. The main ingredient is Benadryl. Benadryl can affect your bladder. Benadryl can affect your memory. It can affect a lot of different things. So, for people over 65, we typically don't want patients to be taking those as an everyday thing.

GINA GALAVIZ EISENBERG
Oh, what about a nightcap? I'm talking not just water or coffee or sparkling juice. Can that affect our sleep?

DR. RAJAY SEUDATH
Yes, it can. Alcohol in any way. Some sleep medicines that are called benzos, Xanax, those kinds of things. They act on the same place that alcohol does. While that can make you fall asleep quicker, it does not improve sleep quality. That can actually keep you out of restful sleep, which is the REM dream sleep. So, if you want to have a glass of wine with dinner, fine. But if you're like, I can't fall asleep, I've got to have me two cocktails, there are much better ways of improving that. Absolutely.

GINA GALAVIZ EISENBERG
On Docs in a Pod, I want to ask the doc, what is your sleep hygiene?

DR. RAJAY SEUDATH
For me, I have a routine where all the kids, all the wife, all the family, they go to sleep. I do some more work on the computer for about two hours, and then I have about 30 to 45 minutes of no screen time. That could be a book, that could be washing dishes, that could be anything but at least 30 to 40 minutes of no screen time. I have four cats, so usually the four cats will somehow invade my sleep area. For me, just hearing my cats purr, that's what just lulls me to sleep. They have this kind of magical effect where IÕm just out.

GINA GALAVIZ EISENBERG
How many hours of sleep would you say you generally get?

DR. RAJAY SEUDATH
I usually get at least 6 to 7 on a good day. On a bad day, I might get 4 to 5, but again, I'm doing all of those things to help wake up. If you have to be on a reduced sleep schedule, what are the things to do to make sure you're staying awake? Looking at the sky, having natural light, using lubricating eye drops. That feeling of that waking you up and lubricating your eyes could help. If you have to use caffeine, try not to use more than two cups per day of coffee. Energy drinks, things like that, try to keep it comparable, because some energy drinks can equal 4 to 5 cups of coffee. So, you want to kind of be cognizant of how much of the caffeine you're having, and be careful on the crashes.
GINA GALAVIZ EISENBERG
What's the red flag that your patients should recognize that they really need to say, doc, I need help?

DR. RAJAY SEUDATH
Falling asleep while you're driving. Having difficulty in two realms of function. So, you're having difficulty at work because you're falling asleep on the job. You can't get your things done. Or you're having problems with your spouse or your family. You're not able to stay awake, to spend time with them, to cook a meal, to do laundry. Your house is in a shambles. Or you're very irritable. Sleep helps with immunity, but it also helps with psychological health. Those are some of the things. It's very interesting how lack of sleep as well as depression symptoms, what we used to diagnose depression, a lot of the symptoms of sleep deprivation are mirrors to depression. They could also be mirrors to dementia. Those are the things that we kind of do as health care providers, as caregivers, as patients, if we're noticing these things, we're trying to connect the dots. That's what I always tell patients. You don't come to me to be a pill pusher. You come to me for guidance so we can help connect the dots in your life.

GINA GALAVIZ EISENBERG
If your doctor doesn't ask, how are you sleeping? Is that something you should bring up?

DR. RAJAY SEUDATH
Absolutely. Especially if you're having an issue. If everything's fine and you say, oh, doc, I sleep like a log. I'm in for seven hours at a time. I wake up with the birds and I'm ready to go, great. That's good. But if you're having issues, particularly at home, on the job, you're feeling like I wish I could do more, that can also prompt other things, because it might not just be sleep. It could be other diseases. Other disease states can worsen your sleep. Chronic pain, diabetes, heart failure, metabolic disorders, thyroid disorders. All of those things can play into this.

GINA GALAVIZ EISENBERG
The bottom line is talk to your doc. And guess what? We're out of time. I stayed awake for this talk. Thanks for joining us today on the award winning Docs in a Pod. 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.

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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