There are over 88 known sleep disorders, almost all of which are manageable or treatable, yet sleep deprivation remains an epidemic in the United States, and as the body of research on the impact of sleep on physical and mental health continues to grow, so too should the urgency with which people seek help. The associations between sleep and overall health haven’t been on anyone’s radar until recently. In fact, during her time in nursing school, Terry Cralle, RN didn’t even learn about the impacts of sleep as part of the curriculum. Today, there’s a growing body of research indicating a relationship between sleep and diabetes, obesity, suicidal thoughts or tendencies, depression, substance abuse, and overall poor productivity and quality of life.
For over 22 years now, Cralle has worked in the world of sleep medicine, doing her best to educate everyone—from heads of corporations to kids in elementary schools—on the role that sleep plays in our lives. On today’s podcast, she offers a glimpse into what it’s like to be a part of sleep studies that aim to diagnose a range of sleep disorders, from REM behavior disorder which can cause people to become physically aggressive during sleep, to narcolepsy and sleep apnea. She discusses how she became involved in the world of sleep medicine, some of the misconceptions regarding sleep studies and why people are hesitant to seek help, societal influences on the perception of sleep, and more.
Tune in for the full conversation and visit http://www.terrycralle.com/ to learn more about the work she’s doing.
Richard Jacobs: Hello, this is Richard Jacobs with the Future Tech and Future Tech Health podcasts, and I have Terry Cralle, she’s Clinical Sleep Educator at RN and a nurse. Terry, thanks for coming on the podcast. How are you doing?
Terry Cralle: I’m doing well. Richard, how are you doing today?
Richard Jacobs: Good, Yeah so tell me about your work as a nurse and a clinical sleep educator. What do you see and what’s your daily work look like?
Terry Cralle: Oh, well it’s busy and there’s a lot of different things I do a lot of different hats I wear but it’s probably interesting to note that as a registered nurse it wasn’t in our curriculum, we didn’t learn much about sleep, but of course when you were expected right out of school to work a lot of crazy shifts and I don’t think sleep was on anyone’s radar back in the day it’s only been very recent until, but it has been on the radar of employers, employees and, and all of us in general. So anyway as a nurse I ended up doing a lot of work in clinical research and we were doing insomnia trials. I was working with sleep doctors on that and one of the sleep doctors said you know you want to come to my lab and see what it’s like to test people for sleep disorders and I said, absolutely and that was the beginning of a very, very abrupt career change into sleep medicine. Once I sort of saw what went on, when people come into the clinic, sleep overnight and are diagnosed and treated for sleep disorders, it was very life changing you know, I think that was the epiphany I had where I realized, oh my gosh, sleep, it’s so incredibly important to health and why didn’t we learn about this and I need to spread the word. So that was sort of the beginning of my work, you know, trying to go to corporations and talk to grownups and I go to elementary schools and talk to little kids about sleep. So I really try to get the message out to everyone.
Richard Jacobs: Okay, So what have you experienced about the overnight sleep studies in the lab.
Terry Cralle: It always sounds worse you know people say oh gosh, I don’t want to go in the lab and get that study and it’s you know, I think there are so many common misconceptions about that, but what I wrote, you know, and I try to tell people or I spend a lot of my time educating people on the test itself and saying, look it’s a really easy task. It just doesn’t look easy because we have to put some sensors on you, but it actually is completely painless. It’s very easy and you go to sleep you know we get a lot of good information and I think two of the most common issues that people bring up are how can I sleep with all those wires? And you’d be surprised how well people sleep.
They’re often surprised at how well they do because you know, we put them in a comfortable bed and pretty soon they’re fast asleep on their normal schedule, but also they worry about, you know, just oh my gosh, I’ve got all these wires and that if I need to use the restroom at night, what do I do? And obviously, that’s really easy. All those wires really converge into one sort of plugs, hookup thing. So it’s a quick thing to get unplugged and get up and walk around or use the restroom, whatever you need to. So I mean, our goal is to get people tested for sleep disorders if they haven’t been able to get a good night’s sleep because sleep is so important. If physical health and mental health and just overall functioning and you know, rich, one of the things we used to say is, you know, I’ve been in sleep per 20 sleep medicine for 22 years now and we used to say sleep with one of the three pillars of health and wellness along with diet and exercise.
And now we don’t say that because what we’ve learned is sleep is actually the foundation of health and wellness and exercise and nutrition and diet are completely contingent on sleep. Whether we get enough or we don’t so we really put sleep at square one and describe it as foundational to health and wellbeing. And then it goes off, it can really affect our quality of life, how successful we are, how motivated we are you know, how our relationships are. That’s, that’s what’s so interesting about sleep. It affects pretty much every aspect of our functioning. And so I think the bottom line is, it’s incredibly important.
Richard Jacobs: Tell me about some of the things you’ve seen, some of the issues people have had and what you observed in the lab?
Terry Cralle: Yeah we’ve seen a lot of different things of course people, for the most part, they’re trying to see if they have sleep apnea. People come to the lab, with problems you know, just daytime sleepiness. And now some of the people that come in, for instance, you know, wives sort of bringing their husbands kicking and screaming because the wives or bed partners have noticed that their bed partner stops breathing during the night, chokes gas snores and then stops for a while and obviously now the person doing it, it’s probably not even aware of it most of the time, but the bed partner will say, oh my gosh, you know, I had to shake him or her to get them breathing again kind of thing. So that’s, that’s probably the number one issue. They bring them in to get checked for sleep apnea.
But we also have people that are just constantly tired during the day and they can’t figure out the reason why so you know we test them for narcolepsy. We test them for things like restless leg syndrome, periodic limb movement disorder, Rem behavior disorder there have been instances where a person sleeping can be calm, very aggressive during REM sleep and either punch or kick a bed partner kind of thing and we make you know this that’s a sleep disorder. It’s nothing personal but you know we have to test, you know, check for these things because they’re over 88 known sleep disorders. But most everything is very treatable and manageable. And since sleep is so important to daytime functioning, it’s imperative that if anyone has signs of a sleep disorder or it’s just not functioning well during the day and constantly tired, they really need to get it checked out because what we don’t want our people just having chronic sleep deprivation issues because that’s what leads to the really serious health problems.
So we want to get in there and make sure nothing’s going on with sleep and if get it treated really quickly, like with sleep apnea the gold standard is CPAP, that continuous positive airway pressure. And you know, some people will tell me, Oh gosh, Terry, I didn’t want to be hooked up to a machine at night. And, and I say, well, you know, 99% of the patients in the, in the clinic setting, once they realize, you know how poorly they’ve been sleeping, they get it treated with sleep happen and, and a c-pap helps them breathe during the night. They feel a hundred percent better. So it’s a real, you know, quality of life issues. People feel so much better wearing the mask and the masks are smaller now than they used to be back in the day when I started to.
Machines are smaller and quieter and there are a lot of people that just say they’re the best things since sliced bread. And there’s even new treatments available, mild sleep apnea cases or sometimes easily treated with an oral appliance and there’s also a new pacemaker product out there it’s pacemaker, like in that there’s a small sensor that’s inserted and it sort of stimulate people to brave during the night when they stopped breeding with sleep apnea. So I think they’re still there. They’re options and there’s something for everyone. And I think right now there are too many people with undiagnosed and untreated sleep disorders out there. You know, trying to get through the day when life could be a lot easier if they got diagnosed and treated for sure.
Richard Jacobs: Right, yeah. What are the things people complain about that necessitates a sleep study? What are some of the things that you’ve heard?
Terry Cralle: Well, you know, that’s a great question and I’ll tell you why. Because I recently read an article where a bus driver was falling asleep at red lights and it stops signs now during the day and here’s the bus driver driving children around, of course, in a school bus and when she was being interviewed, she said, I had no idea that falling asleep during the day had anything to do with how I slept at night and you know, that struck me as funny because to me it’s just such an obvious cause and effect. But there are a lot of people out there who sorted, don’t make the connection, you know they think they’re sleeping okay. When in reality they’re not you know, for instance, say someone has severe sleep apnea and they don’t have a bed partner or they live alone and no one’s hearing them.
Snoring, gasping, and choking for breath, things like that. So they don’t always make the connection and then there are other signs and symptoms of sleep deprivation that people don’t associate with sleep. And here’s where the problem is sometimes people are so, you know, used to be sleepy all day, but then they don’t realize that wow I’m irritable, I don’t like my job anymore. People are starting to tick me off you know, I’m picking fights with my spouse you know, there are a whole lot of other aspects of our functioning that are affected by sleep. I mean even things like just being able to focus at work I’m organizing, making good decisions, making financial decisions, how are we making good ones? I mean how much we sleep, how well we sleep or how little we sleep really impacts a lot of our day to day life.
And I think that’s where the breakdown comes along. And you know, people aren’t getting the message that it can affect so many aspects of their lives, so they just don’t take sleep seriously and you know probably as well as I do that lot of people disregard sleep. I mean, you’ll never hear one Brag anyone, bragging about like not drinking much water or not needing to drink water during the day. You know, it’s a biological need, but so is sleep but oddly, you know, people I’ve gotten used to just getting a little bit of sleep
Richard Jacobs: Society tells people to wake up early or there get ahead and you sleep in your dad and all these stupid things. Unfortunately, society makes you feel bad and lazy too much.
Terry Cralle: Exactly, It’s just been seen as a weakness, a character flaw or lacking motivation or the work ethic and we never collectively or individually, most of us have never looked at it as what it is which is a biological need. And the real problem comes down to the fact that most everyone on the planet needs seven. Yeah, I mean, I’m talking to adults. Kids, of course, need more, but most adults need seven to nine hours a night. And I would say easily a third of adults aren’t getting that amount. And the problem is people will tell me when I go in and do seminars and workshops, so they’ll say, Terry, I’ve gotten used to getting by on five hours and I really need to just sleep five hours because I’ve got so many things to do during the day. I need more waking hours will statistically less than 5% of the population are true short sleepers.
And that’s a genetic variant that is very rare. Very few people have it. And yet those people that have it do well on say six hours, five hours, or even less of sleep per night they can maintain a healthy weight, they’re very productive, they’re healthy, happy and they have got that gene but I everyone else really needs that seven and nine hours, but they’re making a big mistake by swapping. Here’s where the math gets tricky. They think well I need more waking hours, but it’s not quantity that’s important, it’s actually the quality of waking hours. So when we’re well rested, yeah, we’ll have fewer waking hours. Say if I get that seven to nine hours every night, I’ll have fewer waking hours and the person that gets five, but I’ll be more efficient I’ll just do everything better, I’ll do it and it won’t take me three tries to get something done, I won’t make any errors.
I mean it’s hard to explain that because I think we’ve all had it drilled into our heads that, you know, the opposite is true. So it’s really interesting now that we’re flipping the script on it and we have to say no, you have to be very unapologetic for your need for sleep. I mean it’s your biology you really should look at it as a strength and take the benefits of sufficient sleep and use them to your advantage. And I think rather than looking at sleep as an obstacle to success, you know, it’s a means to success. It really is something that will really enhance the quality of life and enhance your performance in just about every category there is. So it’s interesting to say, hey, everything you’ve known, throw it out of the window and here are some real eye-openers about sleep. This is how it can help you.
Richard Jacobs: What are some of the things that measured when you do a sleep study, what do they indicate?
Terry Cralle: Yeah, I mean, the same thing with sleep apnea. What happens is people with sleep apnea will have really don’t oxygenate well, their airway gets blocked and it can even be completely blocked or partially blocked but people will have many of those episodes in an hour and every time those oxygen levels drop, your body goes into this fight or flight mode and you wake up you might not remember all these waking, awakenings, but you’re just startling very frequently. It’s really bad for your cardiovascular system.
So we look at every aspect of, of breathing and of how much oxygen you’re getting. We also look at things like your legs are your legs moving during the night we look at things like, are you grinding your teeth during the night? Are you having any? And we also, of course, check the brain waves. That’s something we can do in the lab that we can’t do outside of the lab. Now there are home sleep testing kits that you can do at home that will check your breathing while you’re sleeping. But that’s pretty much the only thing it’s looking at is the oxygen which would lead you toward a diagnosis of sleep apnea. But for the other sleep disorders, you know, whether its narcolepsy or anything else, probably an in lab study would be the best route.
But in this tons of good information we know when you’re having REM sleep, when you’re not, if you’re kicking your legs at night, grinding your teeth, we can look at a whole lot of different things. And of course, children go through sleep studies as well. My co-author works with children in Texas at a large hospital lab and children can get sleep disorders just like adults do and that’s another thing we have to look at if they’re having certain symptoms, daytime sleepiness or even some kids get hyper when they’re sleep deprived but we look for sleep apnea in children as well.
Yeah, I mean it’s probably more frequent than we’ve sort of thought in the past and with kids, sometimes it’s an issue where they need their consoles out, but we do look at certain behaviors and again, going back to what I said before, we look at, we sort of start with sleep, in fact, we do look at sleep now that people in sleep medicine as a vital sign, you know, and that’s something that really has to be addressed. Like a fundamental aspect of your functioning, that should be addressed at every healthcare provider. How are you sleeping? So the same goes with kids, you know, if kids are just really not sleeping well at night, are seeing very, either sleepy during the day, hyper or behavior problems at school, things like that. People are now are starting to say wait a minute let’s look at this sleep and how they’re doing.
But yeah, and so which is something that teachers can call, be aware of. There’s been a lot of issues, there’s been a lot of dialogue about ADHD. And then is it truly an ability, a problem concentrating or is the child just not getting enough quality sleep? I mean there’s, you got to look at sleep in terms of duration and the national sleep foundation posts recommended sleep times for all age groups on their website. But you have to look at the quality of sleep as well. So you say an adult can be in bed for nine hours every night, but that doesn’t, if they have an undiagnosed and untreated sleep disorder, they’re not really getting good quality sleep. They’re probably having a lot of fragmentations and its disrupted poor quality sleep. So that has to come into play as well.
Richard Jacobs: Supposed to judge the quality of their sleep, subjective to them until they go into a lab. People that have severe problems.
Terry Cralle: Yeah, I mean it’s a great point some of its more scuttle of course, but I think people again have to feel when you wake up in the morning? Are you refreshed? Are you restored? How are your energy levels during the day? You know, we have such a caffeine culture in this country that you, are you really reached, are you looking at caffeine? You’re looking to stay awake all day long by virtue of having a cup of coffee in your hand all the time? Or can you do it without? So some people just say, well, I’m not sleeping during the day, but then my question back is, well, how many cups of coffee do you have energy drinks during the day? Things like that or, you know, and then of course when people do that all day to stay awake, too many people self-medicate at night with alcohol and they reach for a nightcap to help them fall asleep.
Well, the problem with that is the alcohol starts metabolizing a couple of hours later, which is in the middle of the night and it will disrupt sleep. And again, so the person wakes up tired, more caffeine, alcohol. I mean, that’s sort of one example of one of the vicious cycles that can, they might not say, well I don’t feel sleepy per se but look at other, you know, how are you functioning overall? You know, are you irritable? Are you snapping at people? Do you have to do things three times before you get it right? Or, you know, does it take a long time to get your work done during the day? I mean, really look at sort of those other, you know, the more scuttle things and then saying, okay, you know, how am I sleeping or, you know, do I wake up a lot during the night or am I looking at my electronics right before bed and then I have a hard time falling asleep.
I just simply watching Benjie on my Netflix shows and not going to bed on time it hopes to get used to it or people, I know a lot of people who admit to under sleeping during the work week and then hoping to make up for it on the weekends. And we know that’s not a good formula at all because you know, there’s a lot of metabolic damage done from sleep deprivation. That’s very short term in nature its sort of an acute it can throw your bloodwork and disarray very quickly. Your metabolism doesn’t take much to hurt your metabolism and then if you hope to sort of do that on the weekends with extra sleep, the research now really points to the fact that we can’t undo that damage and the damage is very real and it can have short term and long term implications. So I think the message is getting sufficient sleep every single night of the week not just hoping to make up for it on the weekends. That’s a really bad formula. We call it YOYO sleeping and it can get you in a mess pretty quick.
Richard Jacobs: Okay, What’s the best way for folks to start to get educated on sleep? How they’re feeling to potential sleep issues?
Terry Cralle: Yeah, I mean I think there are a lot of good resources, available to people. I think I send a lot of people to the national sleep foundation website and to the American Academy of sleep medicine puts out some really good information as does the CDC. And they, all three of those will websites have information on sleep requirements by age. They have really good information on sleep hygiene, which is just a sort of a different term for good sleep habits. You know, things people can do every single day to help them sleep at night and get better sleep and I think just doing some, some work. We’re definitely trying to get sleep health in the curriculum into elementary school so kids can develop good sleep habits early and which really has the potential to change their Projector throughout their lifespan if they are getting good sleep as children all the way through adulthood. And of course, we ask parents and adults to be good role models when it comes to sleep. You know, don’t try to get by on less than you need. Get a sufficient amount of sleep. Talk to your employers. We have a real big problem in this country. You may have been reading about it lately the school start times, teenagers. Really?
Richard Jacobs: Yeah!
Terry Cralle: Huge problem, Rich and they’re starting the school as early as seven, between seven and seven 30 in the morning. And it’s really, really unhealthy for the kids. And you know, I read parents, even parent comments that, oh, we’re coddling these teenagers by having healthy school start times they’re going to have to figure it out later. Well, biologically they are predisposed to having just as you say, they, they fall asleep later and want to sleep later. It’s just the way their Melatonin’s produced in puberty. And we have to realize we have to go by the science and it’s telling us that if we keep them from getting that slate they’re more likely to get heart problems early. They’re more likely to develop diabetes. And we’ve seen parallel epidemics in this country of sleep deprivation and obesity and it’s affecting all age groups.
And a lot of people when they do gain that weight, they can’t lose it because they don’t realize how important is sleep component is to that effort. You’ve got to get sufficient sleep to lose the weight and obviously getting sufficient sleep will help you maintain a healthy weight. So we’re very worried about the teenagers and obviously besides the health problems, physical health problems, we’re worried about the mental health issues they have increased, you know, thoughts of suicide. They’re more predisposed to substance abuse when they’re sleep deprived, a risky behavior. And then there’s drowsy driving, which is incredibly dangerous, just as dangerous as drunk driving really. So we have to look at that pretty seriously and realize some of these instances it could be a life and death matter and we have to take sleep that seriously now that we know how important it is. So like I said, it affects people of all age groups and if we want to be on a healthiest and perform our best, we really have to get that sufficient sleep every day.
Richard Jacobs: We’re short of time and a lot more to go over here, but I really appreciate you being on the podcast. Yeah, everyone’s got sleep issues and not themselves and someone in their families so important to look at this side. I appreciate it. You’d be coming on the podcast.
Terry Cralle: Thanks to rich. I really appreciate it. It’s been great and I will tell you too, it’s important we make sleep a personal, classroom, workplace and family value. It’s that important.
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