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Scott Webb: Most of the time, fatigue can be traced to one or more of your habits or routines, particularly lack of exercise. It's also commonly related to depression. On occasion, fatigue is a symptom of an underlying condition that may require medical treatment. And joining me today to help us understand why many of us are so tired and what we could do about it is Dr. Ketan Deoris. He's a board-certified sleep medicine specialist at Summa Health.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So doctor, thanks so much for your time today. We were just kind of chatting a little bit and, you know, I don't know if it's COVID or what it is, but it just seems like people are generally tired and not just tired of COVID, but just tired. People seem to be tired. And I think it's because many of us are just not getting enough sleep. So I think it's a great time to have you on and maybe just get rolling here by telling listeners why don't we get enough sleep. Like what are the main reasons, the main causes why people just don't get enough restful sleep?

Dr. Ketan Deoras: You're right. That's the most frequent complaint that people will come in with is that "I'm tired." And there is actually such a thing in the sleep world that they call insufficient sleep syndrome. It's actually a diagnosis where basically it's exactly what you were talking about, people aren't getting enough sleep. So we see a lot of reasons right now with COVID going on. There's kind of a lot of comorbid psychiatric issues. So we're seeing like a lot more anxiety, depression, and that definitely spills over into sleep where it's making it more difficult for people to sleep. And then even simple things like the holidays. It's a happy time, but obviously it's a time where it can be more stressful for people too. And they're trying to jam in a lot more things, and they take that away from their sleep time. So they're trying to do everything they need to and not allotting enough time for sleep sometimes.

Scott Webb: Yeah. And you're a perfect guest to have on, because as you mentioned, there are physical and mental effects, right, that cause us to not get enough sleep and then also affect us afterwards when we haven't gotten enough sleep. So what happens to us when we don't get enough sleep mentally, physically, or otherwise?

Dr. Ketan Deoras: Yeah, both. You're right. We can see it manifest as physical things like headaches when people aren't getting enough sleep. Even it can start to accumulate over time and cause blood pressure issues. And mentally, we've definitely seen things like depression. It makes sense if we're not sleeping well, we're not going to have as great of an outlook the next day. And then it can kind of exacerbate existing psychiatric issues like anxiety as well. So it affects us sort of all around, just makes it very difficult to function. And even cognition-wise too, I think have all had the experience when we're going on little sleep and we just don't feel as sharp. So we'll see problems with focus, memory, just kind of our processing speed.

Scott Webb: Yeah, definitely. And I think these types of things just kind of snowball, right? So it could be something like depression that is maybe interfering with our sleep, but then of course, the more tired we are, the worse we're going to feel and it just seems like this snowball effect a lot of times. And I'm sure maybe that's what you've experienced with your patients.

Dr. Ketan Deoras: Yeah, exactly. It becomes this vicious circle and, you know, they just kind of feed off each other, that you've got a psychiatric issue that makes it more difficult to sleep and then sleep kind of exacerbates that. And so for us, we're trying to find a way to sort of break that cycle, where do we kind of disrupt it, so that we can hopefully help both things, sleep and our functioning.

Scott Webb: Yeah. And let's talk about sleep apnea. I know you and I have discussed this before. But I'm sure in the list of sleep disorders, the possible sleep disorders, sleep apnea is probably at the top of the list and many people may sort of be undiagnosed for sleep apnea. So maybe let's go through this. What is it, how is it diagnosed and how does sleep apnea affect our overall health?

Dr. Ketan Deoras: You're so right. The numbers that they have for sleep apnea, they say are really not very indicative of how much they think it's actually there. It's just very underdiagnosed. So sleep apnea is basically repetitive stoppages of breathing while we sleep. It's usually the airway is closing up typically and we stop breathing. I think one misconception sometimes people have is that they expect that if that's happening, they're going to wake up choking or gasping or feeling like they're suffocating. And it doesn't always present like that. It can just show up the next day, that because they've stopped breathing, they're not getting optimal oxygen, so that they're feeling very tired, lethargic, sleepy throughout the day. I think one thing we always talk with patients about is that it doesn't just have to be kind of that waking up choking, gasping. We will typically see snoring with it. And sometimes partners will see their someone sleeping and stopping breathing.

But, in terms of diagnosis, there's two main routes to diagnose it. So one is an at-home sleep study where patients will actually take home a unit with them, wear it for one night in their own bed, and then bring it back the next day. And we usually reserve the home sleep studies for patients who don't have a lot of medical issues, so if they're pretty healthy from like a heart and lung standpoint. And especially if we have a pretty strong suspicion that, just from talking with someone, that they've got sleep apnea, they come in and tell me, "I'm snoring. I'm so sleepy the next day. My partner says it looks like I'm stopping breathing," we're pretty sure they've got it, but we just need a formal diagnosis, a home sleep study is a really good option.

The other route that we'll have patients diagnosed is by an in-lab study and that means that they'll go spend the night in a sleep lab. So for example, Summa has four sleep labs in Barberton, Akron, Medina, and Green. And some are attached to a hospital, some are their own standalone facilities. But basically, they'll come in usually around 8:00, 8:30 at night. And it's sort of set up like their own hotel room. They've got their own bathroom, TV, Wi-Fi all that kind of stuff.

Scott Webb: Sure, nice little vacation, you know.

Dr. Ketan Deoras: Right. Some people do say that it's a good break, that if they're not getting good sleep at home...

Scott Webb: Just need to get away from their family and get some sleep, you know?

Dr. Ketan Deoras: Exactly. Yeah. We've had people excited about that. And then, they wake them up pretty early though, usually like 6:00, 6:30 in the morning. But the in-lab sleep study is more accurate. They put a lot more sensors, they're monitoring more parameters than they would for the home sleep study. But it can be a little bit harder for some patients to sleep in that environment too. It's not their own bed.

Scott Webb: Yeah. That's what I was thinking, that it seems like, you know, it would be easier for people to sleep in their own beds, but of course, if they've come to you because they're not sleeping, so they're clearly not sleeping at home. So maybe actually changing the environment and going to the lab maybe would actually help them because they wouldn't have all the typical distractions. Although you did say you have Wi-Fi, so they'll still be able to use their phones, right? They'll still be able to play on YouTube and TikTok.

Dr. Ketan Deoras: Oh, yeah, everyone still gets to do that. And they've got the TVs there too. So, yeah, everything's still available from that standpoint.

Scott Webb: So doctor, we've talked about sleep apnea and, as I mentioned, that's probably number one on the list for most people, but what are some of the other sleep disorders and sleep issues that people are dealing with and that you're seeing?

Dr. Ketan Deoras: So yeah, you're right. And sleep apnea is the kind of the top thing we see in the office. Right after that would be insomnia. So insomnia is just basically difficulties falling asleep, staying asleep, or waking up too early. And again, kind of going back to an earlier point, we have to make sure that people are actually giving themselves enough time to sleep. So they have to give a lot the time.

And then beyond insomnia, the things that we'll see less commonly are things like restless legs, which is an urge to move the legs that more often happens at night, but that can also disrupt sleep; narcolepsy, which is actually a disorder where it's more difficult to stay awake during the day; and then kind of unusual behaviors during sleep, which are termed parasomnia, so these can be things like sleep walking or acting out dreams even.

Scott Webb: And doctor, are other things that we do to ourselves? You know, we were just talking about smartphones and YouTube and TikTok and things like that, do many of us just play on our phones or stimulate our brains, you know, right up until bedtime and then we wonder why we can't sleep? Is that a thing?

Dr. Ketan Deoras: Oh, absolutely. Yeah. I mean, I can't tell you the number of people that come into the office and they're telling me they're just, you know, either playing games or like you said, TikTok, Snapchat, whatever it is, they're just spending kind of their nighttime hours in bed just doing that for lengthy periods of time. And then of course, that's giving them some blue light exposure, which can be more activating and alerting and making it more difficult to sleep. But also, it's just not kind of letting their brains wind down to get ready for sleep.

So we'll talk with patients about kind of keeping this buffer period, that when you're done with the day, doing something more relaxing, whether it's, you know, meditating or deep breathing, something just to kind of let your body settle down before you try to go to sleep, rather than just going full speed and then trying to hit an off switch when you go to bed.

Scott Webb: Right. Yeah. Kind of like with athletes, like it's just sort of like a mental cool-down period, right?

Dr. Ketan Deoras: Exactly. Yeah, that's totally right. And we tell patients, you know, in the morning when you get up, you don't just expect to shoot out of bed. And, you know, you go through your routine, brush your teeth, shower, all that stuff. You give your self some time to wake up. So we kind of want you to do the same thing at night, give yourself some time to wind down before going to sleep.

Scott Webb: You know, I wanted to ask you and I forgot to ask you last time we were on, do people ever wake up in the morning, like when they first wake up and feel great? I'm 53 and I never feel great when I wake up. Now, once they get up and get moving and, as you say, get into our routine, have some coffee, have a shower, yeah, then I'm fine. But does anyone ever really wake up first thing in the morning and go, "Yes, I'm awake. I'm alive," you know, "Let's hit the ground running"?

Dr. Ketan Deoras: Yeah, that would be nice, right? Well, I would say I'm probably biased because, you know, everyone who's coming to me pretty much has a sleep issue. So it's very rare that we'll get someone that comes and says, "I wake up and I'm just ready to go." It does happen. It's not common. But for me, I'm never really seen that because people have a sleep disorder typically when they're coming to see me. One thing we will see is when we sometimes treat sleep apnea, at least patients will notice a huge improvement when they wake up compared to when they were untreated.

Scott Webb: The lack of sleep just affects everything we do, right? It makes us grumpy and grouchy and oftentimes that fatigue just leads to sort of, as you say, cognitive issues, so it's just sort of confusion and slower amount of RAM. You know, our brains just aren't operating at full capacity. So taking all that into consideration, doctor, what would be your takeaways for listeners? Because I think we've talked about today and I think we all know that there are these things that many of us, these we'll call them chronic things, right? Whether it's chronic pain or chronic lack of sleep, there are things that we just sort of tolerate and we just put up with, and we just drink more coffee, you know, or whatever it is to try to wake up, right? And you're here to say as an expert that we don't have to live like this, we don't have to be tired all the time, that there are experts like yourself who can help, right? So what would be your takeaway?

Dr. Ketan Deoras: You're exactly right. You don't have to live like that. One thing in the sleep world, we'll often distinguish between fatigue versus sleepiness. So our most common complaints, someone comes in and says, "I'm tired." And so the point of our clinical interview is to kind of make the distinction between, is this tired that your fatigue, like low energy dragging, but you're sleepy, you're drowsy throughout the day, or is it a combination of both?

And so I think for anyone listening out there and if they're noticing either of those things, of course, you know, a lot of people start off with their primary care and that's a good route and they can always investigate, you know, other causes. So for example, getting blood work, making sure people aren't low on things like vitamin B12 or iron or even, you know, evaluating their thyroid through their blood. But if all that comes back looking good, then I think the next step is to say, "Okay, this isn't normal. I shouldn't just be feeling this tired or sleepy or needing to down all these energy drinks or pots of coffee throughout the day. Maybe I should go get this checked out and make sure it's nothing else going on during my sleep that's causing all this."

Scott Webb: Yeah, that's great advice. And it's good I think that you mentioned the distinction between the two, right? Because there's like sleepiness because we're tired because we know we didn't sleep. And then there's the, "I'm sleeping eight hours, but I feel fatigued," which again, could be many other health causes, which is why it's a great reason to reach out and speak with our primary care physician and then move on to a sleep study like we have at Summa, the sleep labs, or do it at home, whatever it is.

So it's great to catch up with you. Always great to talk about sleep. I'm not sure why, but I always just kind of feel good, always makes me feel like I'm going to have a good night's sleep that night. So, doctor, thanks so much for your time and you stay well.

Dr. Ketan Deoras: Oh, thank you. You too.

Scott Webb: Visit summahealth.org/sleep for more information or to make an appointment. If you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the entire podcast library for additional topics. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.

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