Frankye Myers: From Riverside Health, this is the Healthy you podcast, where we talk about a range of health-related topics focused on improving your physical and mental health. We chat with our providers, team members, patients, and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
All right. I am really excited to have with me in the Healthy you podcast studio with me today, Doctor Givens, we're going to be talking about pulmonary and sleep specialists. This episode is going to dive into the science of sleep and unlocking better sleep. Doctor Givens, thank you for joining us.
Dr. Delp Givens: My pleasure.
Frankye Myers: Great, great. Sleep is so such a critical pillar for overall health and well being, yet we often overlook it. Today, we'll explore why sleep is so critical to your health. Share five actionable tips to enhance your sleep hygiene and discuss what steps you can take in your struggles with sleep. Whether you're looking to revamp your nighttime routine or just curious about how sleep affects your daily life, I invite you to listen to this discussion in more detail. Thank you, doctor Givens, again, for joining us. Tell me a little bit about how you ended up in this line of medicine.
Dr. Delp Givens: Well, when I finished my internal medicine residency and started in pulmonary at Vanderbilt, that was in 1984, and that was only ten years after Doctor William Dement and Christian Guillaumeau Stanford had announced that sleep medicine was a new field. So it was brand new. And I saw it as an opportunity to have a front seat on a new aspect of medicine that was going to be exciting in the decades to come. And that's exactly what it has turned out to be.
Frankye Myers: Okay, so you were a trailblazer?
Dr. Delp Givens: Sounds like I was certificate number 217 in the country. Yeah.
Frankye Myers: Wow, wow, wow. All right, so as it relates to this specialty, how does. Oh, gosh, I'm off track. Okay. What does your day to day routine look like, doctor Givens, as it relates to sleep specialty?
Dr. Delp Givens: So, if you are a patient that has a sleep symptom complaint, you'll be evaluated just like anyone else. Come to the office, you'll get a history and physical examination, and what people are most interested likely is what happens after that.
Frankye Myers: Okay.
Dr. Delp Givens: And so most people remember that in the very beginning, we have nocturnal polystynography, or the overnight sleep study, where patients come into the sleep center to the sleep lab. They get monitored with their brain waves, their breathing pattern, their oxygen levels, their muscle movements, and that lasts all night long. Most people are also aware now that we have alternative portable systems that, well, that we can monitor them at home.
And sometimes it's as simple as having a pencil and paper sleep diary that gives us the information that we need to know as well. So there are multiple tools we have in our toolbox now to help take care of patients who have sleep complaints, to try to figure out what they are, and then to help take care of them.
Frankye Myers: So are your patients coming from a certain source? Is it through primary care?
Dr. Delp Givens: Typically through primary care.
Frankye Myers: Typically through primary care. So that just reinforces that relationship of keeping up with your primary care, having your physicals. I know that there are people that probably need to have a sleep study. So is snoring an indicator that someone may need to have that evaluated? Can you talk a little bit about that? So as I think about our viewers and individuals who may not know some of the signs and symptoms that, hey, I need to go get an evaluation or have someone explore this a little bit further. Can you give some insight into that? And as it relates to nocturnal, you're talking about the nighttime evaluation and monitoring that your office would provide.
Dr. Delp Givens: So sleep apnea is clearly the 800 pound gorilla of sleep disorders. Right now, it's estimated that probably 7% of adult women and 12% of adult men have the disorder and most have not been diagnosed. So the cardinal symptoms are, number one, disruptive snoring, just like you mentioned, and then usually associated. Not always, but usually associated with excess of daytime sleepiness. And one way that patients can judge how sleepy they are, if they're not sure or their spouse is not sure or partner's not sure, you can search on the Internet in your search bar Epworth sleepiness scale score. And if you go down about in the first top ten, there's going to be one from Harvard University, and it will actually give you the quiz, give you your score. And if your score typically is over ten, that usually is an indication that you're pretty sleepy and deserve to have an evaluation.
Frankye Myers: Okay. Okay. That's great feedback. All right. Another thing that comes up. So, you know, I'm thinking about myself and family members. You know, if you reposition a person and it goes away, it's not an issue as it relates to snoring. Is that fact or fiction?
Dr. Delp Givens: Fiction.
Frankye Myers: Okay. Okay. So the repositioning, just because sometimes it'll stop the snoring.
Dr. Delp Givens: It will stop the snoring, but what you don't know is what else is going on in terms of their brain activity, their oxygen levels. And there are a lot of people who do have positional apnea, but that does not negate the fact that they may need more evaluation or treatment than just moving them on their side.
Frankye Myers: I'm glad you cleared that up. That's really good stuff there. All right. Why is. You talked a little bit about that, but let's talk a little bit more high level overall, why is sleep so important, and how much sleep do you need? I've heard people say four, six, eight. What is it?
Dr. Delp Givens: Good question.
Frankye Myers: What's the real number?
Dr. Delp Givens: Good question. So it's a trick question.
Frankye Myers: Okay.
Dr. Delp Givens: So if you're a school age child, you need probably ten or 11 hours a night. If you're a teenager, you need around nine to 10 hours a night. If you're an adult, then the number that is now recommended by the NIH is between seven and eight. And there appears to be a hard floor about six and a half.
Frankye Myers: Wow.
Dr. Delp Givens: And if you go below six and a half, that's when you're going to start to have all kinds of medical problems that are going to occur.
Frankye Myers: Wow. You heard it here. So that's something I need to work on.
Dr. Delp Givens: Well, we all need to work on it, but particularly the children. The children. It affects, obviously, their school performance, their behavior. And it's a real issue in our schools these days, the way the school schedule works.
Frankye Myers: Wow. Okay. Great information. Talk about, you know, sleep as it relates to diet, exercise and weight.
Dr. Delp Givens: Okay.
Frankye Myers: And stress.
Dr. Delp Givens: And stress. So a couple of years ago, the American Heart association actually, for the first time, incorporated sleep into their life's essential eight. So it brings up exactly what you're talking about. So diet, exercise, weight control, sleep, avoiding nicotine products, and then control of your blood pressure, cholesterol and blood sugars. So that's part of life's essential aid. And sleep is right in there with those. And what we probably ought to talk about is what happens if you don't get enough sleep?
Frankye Myers: Yes, yes, absolutely.
Dr. Delp Givens: So there are short term consequences and then there are longer term consequences. It's interesting that we're doing this vodcast in 2024. It's the 60th anniversary of the Randy Gardner sleep deprivation science experiment. You remember that? So Randy Gardner was a high school student in San Diego, and he wanted to win the science fair, so he and two of his buddies decided they would try to break the Guinness World Records of staying awake.
And so the reason this is so recorded, it's in Wikipedia and you can google it. Randy Gardner Sleep is doctor William Dement, who was the same William dement at Stanford came from Palo Alto to San Diego to monitor him while he did this. And he ended up staying awake for eleven days, 24 minutes.
And doctor Dement was able to document what happened during the first two or three days. He started to have gastrointestinal effects, nausea, muscle aches and pains. And as the days went on, he started to hallucinate, get paranoid, and then his short term memory completely was eliminated. He couldn't remember from hour to hour what he had just done. And doctor dement was able to document by doing a brainwave examination, that toward the end, he was having involuntary micro sleeps. So he didn't have his eyes open, but his brain was struggling to try to go to sleep while he was doing this science fair experiment.
So it's sort of ironic that we're doing a 60th anniversary of this, so there are short term effects like that, but then the long term effects are probably what the audience is interested in, and there are multiple, most of them having to do with cardio metabolic effects. So if you violate that floor of six and a half, 7 hours, and you're not getting at least six and a half or 7 hours of sleep per night, then over time, you're going to double your risk of developing hypertension. Your risk of having a stroke is going to go up by one and a half times. You're going to run the risk of having problems with diabetes develop over time So there are multiple cardiometabolic and in our society, problems that now have been pretty closely linked in other factors as well, but particularly the lack of enough sleep per night over time.
Frankye Myers: Yeah, that's great stuff. That's great information. How much sleep do you get?
Dr. Delp Givens: Between six and 7 hours. Six and seven, typically.
Frankye Myers: Do you have a nighttime routine? Because I know, for me, you know, after getting off work and you get home and you do dinner and everything, I like to turn on the tv and I find that sometimes I'll end up falling asleep with the tv on. And I do know that sometimes I don't feel rested, even if I lay down and get six or 7 hours. Is it true that that can impact your quality of sleep? Lights on, tv on, you know, your brain is still working because it's hearing those things?
Dr. Delp Givens: Yes, absolutely. That's one of the worst things we have right now in our society are screens, whether it's our phone, our tablet, our computer, whatever it is. Exactly, yes. So let's talk a little bit about some sleep hygiene tips to help you sleep better at night.
So your example of falling asleep before bedtime and from the tv is very common and very bad. And so I think one of the most important rules of sleep hygiene is having a consistent bedtime and wake time. That's really the most important. And having it consistent so that you're getting that seven to 8 hours if you're an adult or nine to eleven if you're younger. But the consistent wake time is very important.
The one thing that will help the quality of your sleep is regular exercise. So again, going back to the life's essential aid, it's clear that with exercise done on a consistent basis, that you increase the amount of deep sleep that you're able to get. And it's in deep sleep where we get a lot of consolidation of memory. And so it's super important. So consistent bedtime, exercise. And then you talked about, I think about diet.
Frankye Myers: Yes.
Dr. Delp Givens: So caffeine is probably the most ubiquitous thing in our society that may interfere in terms of food products. We're going to talk about another in a minute. But caffeine, most people probably ought to stop their caffeine ingestion sometime around noon because caffeine's half life, how long it's lasting in your body may be 6,8,10 hours depending on the individuals.
Frankye Myers: You stepping on some toes?
Dr. Delp Givens: Yes, I realize that, but that's the fact of the matter. Now you can do your own individual test and see when the cutoff should be for you. But for the average person, right around noontime, lunchtime ought to be the last time you have caffeine.
Now, alcohol is the evil one in terms of your sleep. Alcohol wrecks your sleep, even though people will say and experience some drowsiness after they've had alcohol or beverage. The alcohol then once you fall asleep is metabolized into an aldehyde, which is a stimulant within which then wakes you up during the night. Okay, so if you're going to have an alcoholic beverage, you should allow at least four to 6 hours between the last time you consume one and when you go to sleep.
Frankye Myers: Okay. And that would be the same for any fluids or liquids because somebody, you consume a lot of water, then you're getting up during the night.
Dr. Delp Givens: So probably should structure that as well. From person to person is a little bit different. But alcohol, definitely you need to cut off there. Yeah, that's the diet portion you were asking about. And then you ask about the wind down time and the wind down time again, I do have a wind down time and I try to cut off all screens about 90 minutes before I'm ready to go to bed. And I think everybody else ought to think about doing that. Is put your phone in the recharger, turn it off, turn on airplane mode.
Frankye Myers: Or do not disturb. Now is a popular thing with some of these phones. That's an hour and a half. That's a huge gap.
Dr. Delp Givens: Well, it's because it allows you to wind down.
Frankye Myers: Okay.
Dr. Delp Givens: The other tip for wind down routine is a lot of times patients will say, when I get in bed, my mind starts racing and I have all these thoughts coming in. And so one technique to use during the wind down time is to write down, literally write down on a piece of paper the things that are on your mind. And then when you finish the list, fold it up and put it aside and just say to yourself, well, I'll deal with that tomorrow.
Frankye Myers: Okay.
Dr. Delp Givens: And by physically writing it down, it does something psychologically.
Frankye Myers: You're not trying to process it. I feel like you kind of resolved it.
Dr. Delp Givens: You let it go for the night. Exactly.
Frankye Myers: Okay. Exactly.
Dr. Delp Givens: So that's a good little trick. And then in terms of your bedroom environment, most people are going to sleep better if it's cooler. So my advice always is to find the temperature in your bedroom that's comfortable for you, but a little on the cool side because you're gonna sleep more soundly. Usually. It should always be dark, of course.
Frankye Myers: Okay.
Dr. Delp Givens: And then the sound is gonna be, you do not want to have your television on. Some people say, well, I like to have a background noise going, yeah.
Frankye Myers: Waves or.
Dr. Delp Givens: I don't have a problem with white noise or pink noise. But what I do have a problem is the television, because our televisions these days have such bright light that even with your eyes closed, the light is going to interfere with your sleep structure while you sleep. So tv is in the bedroom is one of the no nos that we don't want to see. We don't want to see at all. So those are sort of some hygiene tips that will help people.
Frankye Myers: And I don't know how you feel about this or whether you want to comment on it at all, but I know dealing with some of my family, they use supplements. There's a lot of over the counter things that you can buy to help you rest. What is your thought around those things to help you sleep?
Dr. Delp Givens: Well, most of the supplements I think you're talking about are herbal sort
of things.
Frankye Myers: Yes. Yes.
Dr. Delp Givens: So the herbal supplements have weak data associated with them. They won't hurt you. So things like chamomile, they won't hurt you. And if you believe that they're helping you, then that's. Then do it.
The one over the counter, that is probably overused is melatonin. Melatonin.
The bad thing about melatonin is because it's non prescription, people will use escalating doses, and particularly in children. Parents think that because it's non prescription, I can give it to my child and it's not going to be a problem. And there have been some reports of parents giving their children ten times the recommended adult dose. So that is not a good thing. So I would say talk to your primary care clinician about it. If you feel like you're having that much of an issue with your sleep, rather than taking melatonin, ask about other things that might be interfering with your sleep instead. Small doses of melatonin won't necessarily hurt you, but it may not get you to the solution that you need.
Frankye Myers: That's great, great information, great feedback. These are all great tips and some of which I have to incorporate into my own sleep hygiene. And I'm a healthcare professional and so I know better, but I still have.
Dr. Delp Givens: Opportunities, so we all do.
Frankye Myers: Thank you. Thank you. And now that we know more, we're equipped with, you know, each day just trying to do better to get there. Talk a little bit about recognizing some of the formal disorders that occur in the sleep area.
Dr. Delp Givens: Sure, sure. Each one of these problems could deserve its own podcast time.
Frankye Myers: Well, you always can come back.
Dr. Delp Givens: So I'll mention these interesting couple, but really they each require a lot more time. So we talked already a little bit about sleep apnea.
Frankye Myers: Yes.
Dr. Delp Givens: Which is the very prevalent in society and recognizing snoring and daytime sleepiness. The daytime sleepiness. Using the Epworth sleepiness scale score that you can find on your search bar, the other big problem that patients have, of course, is insomnia, either falling asleep or staying asleep.
What I would offer up is that medication for insomnia is really a short term issue. So if you are asking for medicine from your doctor, it's really for short term issues like you've had a death in the family or some other thing that's short term disturbing your sleep and you really shouldn't take medication hypnotics more than about a week at a time. The most effective therapy for insomnia really is cognitive behavioral therapy. And that's been shown there on multiple studies to have long term lasting benefits, whereas medications like hypnotics are in the long run not as effective as the cognitive behavioral therapy.
Frankye Myers: Do you do those therapies within your practice?
Dr. Delp Givens: I do those therapies in our practice, but the problem is there are not enough trained clinicians that do cognitive behavioral therapy. Now, fortunately, the group at the University of Pittsburgh and several others have actually, in the VA medical center system has also devised apps that you can actually use in conjunction with seeing your clinician to help you through cognitive behavior. There's a free one that's put out by the VA system called CBT coach. So cognitive behavior, CBT coach, and it's free, and it's really great information if people want to look at that. The other cause of insomnia that's very common is restless legs. Restless legs is, again, a very common problem. It's estimated 7% of us have it, and there's great medication to take care of that, but it's also may be an indicator of iron deficiency. So you want to make sure that you do not have iron deficiency, because about half the time, if you replete the iron stores, the legs get better and you don't need any medication.
Frankye Myers: Okay.
Dr. Delp Givens: So that's something you want to be sure about.
Frankye Myers: Absolutely.
Dr. Delp Givens: The other main type of sleep disorder that we see are parasomnias, sleep talking, sleep walking. But the one I want to mention is REM behavior disorder. REM sleep behavior disorder is the parasomnia, where patients act out their dreams, literally.
So patients may appear to be fighting in their sleep, or they may be arguing in their sleep. The most extreme example of when people jump out of bed or jump off their bed and break a bone or jump out the window, that is a very serious disorder. That may be an early indicator for alpha synucleinopathies, like Parkinson's disease, and it may be the first indication of a neurological problem. So that needs to be paid attention to and evaluated closely.
Frankye Myers: Yes. And then I couldn't do this without asking you about dreams.
Dr. Delp Givens: So, dreams? Yes. Dreams are manifest from REM sleep behaves. Rem rapid eye movement sleep. Go back to doctor dement again. Stanford. So it's an indication of how young our field is. It was only in 1953 that Doctor Demin, as a graduate student, was working with doctor Nathaniel Kleitman in Azerinski at the University of Chicago, and they discovered these rapid eye movements. It was first in one of Doctor Azarinsky's child. And when he woke the child up and said, what were you thinking just there? He said, I was having a dream. And that was how they ended up studying more patients and figuring out it was actually our rapid eye movement stage of sleep. This is, again, a fascinating whole science topic in and of itself. But the current thinking about REM sleep is that it is a time that humans use to incorporate emotionally what has happened to them during the day and then resolve it in some way psychologically and process it. So the big issue in PTSD, post traumatic stress disorder, is one theory is that patients have not processed their experience properly during REM sleep. And so scientists are working on a way to try to expedite that processing in REM sleep for those soldiers that may have been exposed to something that would take them there.
Frankye Myers: Wow. That's fantastic. Fantastic. Great stuff. This has been a great conversation. I've learned a lot today. Thank you so much for taking time out of your busy schedule to talk with us. You have an open invitation to come back.
Dr. Delp Givens: I hope you'll ask some of my colleagues as well.
Frankye Myers: Yes, yes, definitely, definitely, definitely. So I encourage our listeners, please reach out if they want to contact you or the practice. Can you walk them through how they can make that connection?
Dr. Delp Givens: Sure. Sure. Our practice is a specialty practice and other practices within our sleep center organization within Riverside, we typically ask patients to contact their primary care doctors and clinicians and make sure that the referral is appropriate. And they will expedite the, the referral to see us in our office. Absolutely, yes.
Frankye Myers: And I think it's so important. Would you just reiterate the emphasis on sleep and early identification of sleep issues?
Dr. Delp Givens: Yes. Again, the need. So sleep's part of that life's essential aid, and it's just as important as diet, exercise, controlling your weight, controlling blood pressure, your blood sugars, cholesterol, equally as important. And in order to live a full, healthy life, you need to have enough sleep and enough quality sleep.
Frankye Myers: Yes. Thank you again. Thank you so much for joining us.
Dr. Delp Givens: Can I do a little book plug?
Frankye Myers: Yes, absolutely.
Dr. Delp Givens: So this is a book by Doctor Matthew Walker. He is a scientist at UC Berkeley, and this was published about 2017 while we sleep. It's an excellent book, and it's written for the lay public to understand sleep better. And it's really jam packed full of information for patients that have trouble with their insomnia. This is a book, goodnight, mind, by doctor Rachel Manber and Colleen Carney, that's written for the public as well. It has great tips in terms of helping people work through their symptoms of falling asleep or staying asleep.
Frankye Myers: Yes.
Dr. Delp Givens: And the last book I have here is called Sleepy Head. This is a more entertaining book by Henry Nichols. He's a british writer and he goes over a lot of fundamental sleep things, but he intertwines anecdotes about patients experiences with the topic, and it's very entertaining as well.
Frankye Myers: Yeah, thank you.
Dr. Delp Givens: I recommend those for people who want to read more.
Frankye Myers: Yes, thank you. Knowledge is power. Thank you for those additional resources. Thank you so much. And to our listeners, thank you for listening in. If there's a health topic you're interested in or learning more about, please email your idea to Riverside strong.
Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
