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Dr. Kline, DO is a specialist in internal, pulmonary, and sleep disorders medicine. He has focused his practice on sleep apnea and breathing as the Director of the Viterbi Family Sleep Center at Scripps Green Hospital in La Jolla, California. He spoke with Down Etc. on the issues of sleep, sleep apnea, and his recommendations for getting a great night’s sleep.

What is sleep apnea?

Sleep apnea is common. “Sleep apnea is a disturbance in breathing where there’s either a complete or partial decrease in airflow.” Snoring can result from the turbulence of decreased airflow. First identified in 1982, sleep apnea has received a growing amount of attention recently. It has been incorporated into a specialty of medicine called sleep disorders medicine, which is managed by sleep centers all over the world. Dr. Kline was drawn to the specialty early in his practice after witnessing patients in the ICU with breathing disturbances and cardiac arrhythmias caused by fluctuations in blood oxygen during the night.

Poor quality sleep is as detrimental as insufficient sleep

Insufficient quality sleep and the tiredness that results can negatively affect memory, attentiveness, and performance. It is not only the duration of sleep, but also the quality of sleep that is at issue. The goal is comfortable and restful sleep without disturbances in breathing or abnormal movement, which can be detrimental. Wearable watches measure movement in bed alone. In the sleep clinic, Dr. Kline measures brain waves to determine if arousals, breathing, and movement might be connected to good or bad quality sleep.

Sleeping pills are not the cure to sleeplessness

Dr. Kline investigates the causes of sleep issues so as to determine ways to address those issues without resorting to sleeping pills. In 2012, Dr. Kline, co-authored a sleep study published by the open-access online journal BMJ Open that “linked the most commonly prescribed sleeping pills to a 4.6 times higher risk of death and a significant increase in cancer cases among regular pill users.”

Dr. Kline worries that sleeping pills give people the false belief they can choose precisely when they want to fall asleep; however, if you are otherwise normal, your ability to fall asleep is controlled by two factors. The factors controlling when you fall asleep are the duration of wake and the brain’s biological clock, set by morning light. The morning light is why people in San Diego are going to sleep at the same time as people in Italy are waking.

How can I improve my sleep?

To improve your sleep based on these factors, Dr. Kline recommends two practices: going to bed only when sleepy and waking at the same time every day. The bed should be only for sleep and sex, not for working or watching television, so that you associate bed with sleep. If you go to bed before you are sleepy, you will be “practicing insomnia” by lying in bed and not sleeping. If you have not fallen asleep within 20 minutes, Dr. Kline recommends getting out of bed and going to another room. In dim light or with orange sunglasses, you can read until you feel sleepy. Dr. Kline also recommends waking to bright light at a fixed time every day. Get up at the same time every day. Get bright light with no sunglasses for 30-60 minutes every morning.

Is napping okay?

Dr. Kline notes that napping during the day from 12:00 to 2:00 P.M. for 40 minutes is okay.

How much sleep do I need?

There is no hard and fast rule that applies to everyone with respect to the number of hours of sleep needed each night. Duration of sleep that is beneficial varies by age. There exists such a thing as too much sleep. Dr. Kline notes that adults who live the longest sleep between 6½ and 7½ hours a night.

What is the best sleeping position?

For people with sleep apnea who often snore and pause in their breathing, sleeping on their backs may aggravate the problem. As there can be significant consequences to untreated sleep disturbance, it is a good idea to have at least some testing done if you notice the results of such disturbance. It is wise for partners to let sleepers know if they see some evidence of sleep disturbance so those sleepers can take some action.

Comfort is key to a great night’s sleep

Methods and systems for assisting breathing during sleep is an area of developing research. It is certain, however, that a comfortable, quiet, safe environment is essential to a good night’s sleep for everyone. “Sleep happens in the brain, and when … the brain is ready to sleep,” so “we want to create the circumstance for sleep to happen, and that’s where the … bedding is important so that you’re comfortable and can go to sleep and look forward to that.”

Stop worrying

More and more often, Dr. Kline is seeing people worrying about sleeping less than the “recommended amount.” However, unless you remain tired after following the recommendations that you only go to bed once you are sleepy and you wake to light at a fixed time, the amount you are sleeping is probably meeting your needs.

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