HEALTH Magazine recently spoke with Gary Alexander, MD, a pulmonary and sleep medicine specialist at Tanner Clinic in Layton, Utah, and a member of the Davis County Board of Health.
HEALTH Magazine: How did you become involved in sleep medicine? Dr. Alexander: When I first came to Tanner Clinic almost 29 years ago, I expected to practice just pulmonary medicine. However, shortly after arriving, the CEO at Davis Hospital asked me if I would be willing to make sleep medicine a part of my practice, as there were no other sleep specialists in the area. That led me to pursue board certification in sleep medicine. Over the years, about half of the patients I’ve treated have had complaints related to sleep issues.
HEALTH Magazine: What are the most common sleep disorders you see? Dr. Alexander: Obstructive sleep apnea syndrome is the most common sleep disorder we see in our clinic. Insomnia, both acute and chronic, is probably the second most common sleep problem that we encounter. We also see patients with restless legs syndrome and narcolepsy symptoms. Sleep problems such as night terrors, sleepwalking, circadian rhythm disorders, shift work sleep disorder, or REM sleep behavior disorder are much less common.
HEALTH Magazine: How is sleep apnea treated? Dr. Alexander: The “gold standard” for treating moderate to severe obstructive sleep apnea is continuous positive airway pressure (CPAP) therapy. Sometimes patients require bi-level positive airway pressure (BiPAP). Depending on the severity of the sleep apnea, some patients may use oral dental devices to manage it. There are now surgical interventions available to treat sleep apnea, including implantable devices that create upper airway stimulation during sleep that helps to move the tongue forward. This procedure can be used in patients who can’t tolerate positive airway pressure therapy. And, of course, there are lifestyle changes that can improve sleep apnea, such as weight loss, avoiding alcohol and sedatives, smoking cessation, and regular exercise.
HEALTH Magazine: What do you recommend for people with insomnia? Dr. Alexander: Cognitive behavioral therapy for insomnia (CBT-I) is considered a first-line treatment for management of chronic insomnia. It focuses on behavioral and cognitive strategies to help people fall asleep more easily and sleep better throughout the night. There are a number of medications that are available as well that are used to treat insomnia, but are best used for short-term therapy. Good sleep hygiene is also important. This includes maintaining a consistent sleep schedule, keeping the bedroom cool, quiet, and dark, limiting screen exposure to 30-60 minutes before bedtime, and avoiding heavy meals, caffeine, or alcohol late in the evening.
HEALTH Magazine: Are there specific recommendations for children and sleep? Dr. Alexander: Pediatric sleep specialists recommend establishing a predictable bedtime routine. In addition to a consistent schedule, having at least 60 minutes of screen-free time before bed with relaxing activities such as reading, taking a warm bath, or listening to quiet music are helpful. Getting enough physical activity during the day and other good sleep hygiene habits are just as important for kids as they are for adults.
HEALTH Magazine: What are the greatest challenges to personal sleep health? Dr. Alexander: I think it’s just prioritizing the time to sleep an adequate number of hours each night. As a result of busy lifestyles we often shortchange the amount of time we need for good, high-quality sleep. Nightly use of smartphones, tablets, and TV can also reduce our ability to fall asleep and stay asleep. Inconsistent bedtimes and wake times can interfere with our internal circadian clock.
Improved public awareness of the importance of sleep can have a positive impact on the overall physical and mental health of the population. When people understand how essential sleep is, they’re more likely to prioritize it and seek professional care when needed.
“We should be thinking of sleep as an investment in our performance the next day.” — Michael Grandner, PhD, MTR
“There’s lots of data that shows an increase in health problems and mortality if we don’t give ourselves enough sleep. Making sleep a priority has to become a habit.” — Robert Pearson, MD
“There are many potential treatment options for sleep issues, so ask your doctor and if needed, ask for a referral to see a sleep medicine physician.” — Charlene Gamaldo, MD