March-April 2021 | Health

Tossing and turning

Why sleep matters more than people think

Photo by Lisa Helfert

Sleep is often the missing link when people think about their health, says Dr. Asefa Mekonnen, but getting them to pay attention to it can be a tough sell.

“The public sees people who don’t sleep enough as heroes. When someone says, ‘I can function on short sleep,’ society thinks they are successful,” says the 52-year-old pulmonologist, who is the founder and director of the Premier Sleep Center at Rockville Internal Medicine Group (RIMG). “We always talk about good nutrition and exercise, but to me, normal sleep is the main pillar of health.”

Mekonnen grew up in Ethiopia, where his father was an educator and his mother was a pediatric nurse—she nicknamed her young son “doctor” and took him on rounds at the hospital. After medical school, he moved to Chicago, where he did an internship in internal medicine at the University of Illinois and specialized in pulmonary medicine and intensive care at Northwestern University. Drawn to the field of sleep and its ability to improve lives, he trained at the Stanford Sleep Medicine Center. In 2004, he settled in the D.C. area, where he says the large Ethiopian community made him feel at home. A father of four, Mekonnen works in the same office as his wife, Dr. Belen Tesfaye, a gastroenterologist at RIMG. The family lives in Potomac.

Mekonnen says people typically get far less sleep than what research shows is ideal: seven to eight hours for adults; nine for teens. Even a single night of sleep deprivation can reduce brain function and the ability to clear out toxins. As for catching up on sleep, that’s not a substitute for a routine, Mekonnen says. Lack of sleep contributes to accidents and is associated with high blood pressure, stroke, cardiovascular and metabolic disorders, memory issues and depression.

Since the arrival of the pandemic, Mekonnen is seeing more patients than usual who are unable to get to sleep or stay asleep, some complaining about bad COVID-related dreams. “There is anxiety, fear about catching COVID, about the economy and work situations,” he says. Instead of waking up early, moving around and interacting socially, many people are staying up late and struggling to get up in the morning.

About a third of Mekonnen’s patients are dealing with insomnia; another third have breathing-related issues such as snoring or sleep apnea; and the rest have other sleep disorders, including narcolepsy. Before COVID, patients usually would stay overnight in one of RIMG’s four private rooms with beds so they could be observed and analyzed. These days, they’re more often diagnosed through home-monitoring—a medical smartwatch and forehead device, Mekonnen says. Treatment can involve behavior therapy, medication, oral appliances, or a device to keep the airway open if the patient has sleep apnea.

Mekonnen says good sleep habits begin in the morning by waking at a fixed time and using bright lights and physical activity to get going. He advises people to avoid caffeine after midday, and suggests staying off screens for 30 minutes before bed and dimming lights to trigger melatonin, a natural hormone that aids sleep.

A woman once told Mekonnen that her husband wasn’t the man she married because of his moodiness in the morning after a poor night’s sleep. After treatment for sleep apnea, the patient thanked Mekonnen for saving his marriage.

In his own words…

Snore no more

“Snoring is one of the main reasons people see me. Loud snoring can disrupt the family and bed partners. About 80% of people who snore have habitual snoring with no airflow limitation, but about 20% of people end up having sleep apnea. The family might observe them struggling to breathe, having unrefreshing sleep…and there is also high blood pressure and diabetes—those are clues to possible apnea.”

The awakening

“Insomnia is difficulty initiating or maintaining sleep. Beyond that, it affects your daytime function. Some people toss and turn, wake up a few times at night, but are alert in daytime. But if given the opportunity to get to sleep and you can’t within a half hour, you are awakening two or three times, it’s disrupting your daytime function—and if it’s happening for two or three months—you should have your sleep assessed.”

Deep sleep

“In children, growth happens during sleep, so it’s critical. Kids who are sleep-deprived can have attention deficit disorders and learning disabilities and lower performance at school. It affects the brain function. For adolescents who are short on sleep or have distracted sleep, they have higher incidents of psychiatric diagnoses and higher rates of suicide. When it comes to adults, sleep is a basic physiological function that rejuvenates our whole body.”

Catnaps

“There is a big cultural difference with napping. In some countries, a siesta is normal. If someone has to nap, it should coincide with our natural circadian rhythm. During the day, right after lunch, our natural alertness goes down. Taking a nap at that time and keeping it to less than half an hour is fine, as long as it doesn’t interfere with nighttime sleep.”