Sleepless in Boise

Derek Hiebert: Hey everyone, welcome to Bronco Health Talk here, and we’re just excited for this conversation today. This is Derek Hiebert here, the marketing manager for the College of Health Sciences, and I have our student media team employee, Sam Butler, who’s also obviously a student here at Boise State in Health Sciences.

And then we have our guest today, who is Amanda Leightner. She’s the Merrick Family Endowed Professor in Respiratory Care, and Amanda, thank you so much for being with us. 

Amanda Leightner: Yeah, thank you for having me. I’m excited to be here. 

Derek Hiebert: Good, good. You know, I’m excited for this conversation today on sleep and respiration, which I understand is something that you focus on in your research. As I think about sleep a little bit, you know, it’s like it just–it’s that thing in our lives that is a constant reality–it’s something that obviously our bodies need, that we need just for total health, right? And it’s like we’re always looking for that sort of prized and treasured eight hours of sleep on average every night. And we’re going to get into some of those things. But can you tell us a little bit more about your role in the department or the School of Respiratory Care, and just what you–maybe a little bit more of what you focus on in your research? 

Amanda Leightner: Yeah, sure. So that question alone makes me so happy because we are a school of respiratory care. We are the first in the world to be a school. And I am the first Endowed Merrick Family Professor. So that just makes me so excited to say those two together. So being an endowed professor allows me to really focus on two of my passions, one being teaching. And I’m going to call the second one–I’m going to call it discovery, just because that sort of–I’m, you know, I’m discovering things, my students are discovering things, the faculty and I together are discovering things.

My research dream is sleep, like you said, and I’m always game for a good conversation about sleep. Except if you talk to my kids, because they’re like, oh my god, my mom teaches sleep. But it is something that is so important in all of our lives, yet we forget about it. Until you don’t get enough of it, or you get too much of it, you get tired and sleep. So it’s just that the field of sleep medicine is so green compared to the rest of medicine in today’s society. We’re still gaining momentum with the population and health, and how it relates to just everyday activities. I’m super excited to–so sleep is very broad, you know, it’s very–there’s a lot of streams that we’re looking into.

A couple of streams that I have running right now is I have a student who is researching PAP compliance. So folks who have obstructive sleep apnea wear a machine, which is called either CPAP or BiPAP. We call it PAP, positive airway pressure. And she’s digging into research about compliance, because it’s hard. It’s tough to wear a mask; nobody wants to wear it, it’s not sexy, right? So she’s digging into barriers to it. And who’s educating these patients on wearing that PAP compliance, whether it be a respiratory therapist or–there’s a dearth of respiratory therapists in the world right now. So some places are substituting with, like, clinical assistance. And that’s who is providing the education. So she’s really looking into seeing if that makes a difference with PAP compliance? Who’s explaining the importance of wearing the device? So such great research that she’s working on.

And then to my colleagues, so Dr. Kristen McHenry, Dr. Lanny Inabnit, and I, we actually just presented at the Chest conference, we flew from Chicago to here. So we dug into big data, which is called H cup data, it’s inpatient data from hospitals around the world. And we really dug into overlap between inpatient trends with obstructive sleep apnea, sleep disorders, and the ALS population, because that’s kind of Dr. McHenry’s passion–hers is the ALS disease, as well as Lanny’s being great with this large data. So we went and presented at the Chest conference on that.

And then I have things coming up with Dr. Amy Spurlock, who’s the chair of nursing, and she is–her and I are going to do a round table discussion in March about chrononutrition, which is like–we always talk about what we eat, but we’re going to dig into the timing of when we’re eating to because it’s kind of like a newer thing. Like, we know it’s not the best to load up on a big meal before you go to bed. We know you’re going to have some interrupted sleep, right? So, those are just a couple of my streams that I have going. There are so many more that we can dig into, you know, mental health and sleep are huge too. So I hope to get into some of that too. 

Sam Butler: And Amanda, you’re a completely remote faculty, correct? 

Amanda Leightner: I am, but I love being here. I have to say that, and I’m enthralled by the mountains too. So I can’t get enough of those. I’m in South Carolina, I’m in Charleston, South Carolina, and I get to come visit. This is probably my fourth or fifth trip this year, so I am here. I’m learning–I got to the library today. So that’s fantastic. 

Sam Butler: Glad to have you here. Obviously, sleep is a major aspect of our general health, and our lungs are still breathing while we sleep, but how is our respiratory system connected with sleep specifically? 

Amanda Leightner: Yeah, so they’re married…no. So, no, I had a physician that would tell me–he was a pulmonologist that I work with, because I worked clinically back in the day, and he would say that they were dance partners, and they worked really well. Together, they’re really coordinated into one trip, and then something messes up that whole coordination. But this is why labs love to have respiratory therapists in their sleep labs as well, because we’re very familiar with what we monitor when we’re looking for sleep disorders, not just obstructive sleep apnea, but disorders in general. So, we’re very well married there. The brain…when we go to sleep without getting too complex, the brain kind of gives the body a chance to kind of take over for a little bit, and it kind of rests, too.

We can get into all types of sleep stages, right? We can talk about those, and we can talk about–I’d have to come back. But, so, it gives the brain a rest until something happens, right? And then folks who do have obstructive sleep apnea, which is the biggest disease that we researched today, or that we see in the labs. They stop breathing at night, right? So, then all of a sudden the brain’s like, oh, this is not right. You know, I need to wake up. I need to wake this person up. Or the heart starts reacting like, okay, now I need to work harder because this person’s not breathing. So, respiration, sleep, neurology, all that really is a big component of what we do when we are monitoring sleep. So, yeah. 

Sam Butler: And do you want to just briefly explain for anyone who doesn’t know what a PAP machine does? 

Amanda Leightner: Yeah, so it’s really simple. I wish we had designed it. We would have been millionaires. No, it’s literally just air, and that positive pressure keeps the airway open. And that’s it in a nutshell. See, there are different types of machines, and we’ve gotten really smart with these machines, too. So CPAP is just it just delivers one set pressure to the person that keeps that airway open. BiPAP is bi-level positive airway pressure. So, one pressure when you take a breath in, another pressure when you breathe out. Okay, so it works well with folks who need some help with ventilation as well.

And then there are really more elaborate devices that get into folks who maybe have had some sort of brain trauma, or like our ALS population. They work really well with a mode that kind of aids in breathing when they stop breathing, right? So it’ll breathe for them when they stop, and then all of a sudden they breathe on their own, and it takes a break, and then it kicks back in. It’s all algorithm-based. So it gets pretty complex, but in a nutshell, it’s simple. It’s just air being forced into the airway that keeps it open, and then you have to find the right pressure for each person that keeps their airway open. 

Derek Hiebert: That’s super fascinating. It’s amazing the technology, you know, because I…can imagine prior to when this technology was invented, I mean, we were–, but I’m like, my guess is people were close to dying or dying in their sleep because they maybe didn’t get enough air. They’re suffocating, or they just weren’t sleeping well because they, perhaps, wake up and they’re like, you know, they’re trying to gasp for air.

Amanda Leightner: So that’s even true, like we have–there’s like 30 million people, I think that’s the current statistic to have obstructive sleep apnea alone. And then there’s 60 million folks who have some sort of other sleep disorder, right? So it is, it’s a concern in today’s society. Then it’s sort of bi-directional with other diseases. And that’s why we were digging into that big data, because it overlaps where if you do have obstructive sleep apnea, you’re three times more likely to have a stroke or diabetes or sort of cardiac arrhythmias too. So it’s very bi-directional and so important for folks if they are diagnosed to wear this treatment.

You know, but like I said, no one really wants to wear the mask, right? But there are a lot of things out there now on the market that have really kind of changed our industry, like the GLP-1 meds are out there now, right? And that’s sort of changing the scope of how we’re treating patients, kind of unique. 

Derek Hiebert: Okay. What kind of meds are those? 

Amanda Leightner: So those are like your Ozempic meds too, and they’re working pretty well with this population. We’re going to say we don’t know a lot about it because it’s a new line of drugs, right? So we’re going to have to do some research for years to come on it. 

Derek Hiebert: Sure. 

Amanda Leightner: There are also surgical implants that are hypoglossal nerve stimulators. So that’s an option for folks who really don’t want to wear the mask, but you have to be the right candidate for it, too. So there are options out there. 

Derek Hiebert: Well, that’s great. You mentioned 30 million people in the world who struggle with some kind of sleep apnea, correct? 

Amanda Leightner: Yeah. 

Derek Hiebert: Are there any other stats, maybe important stats that are associated with, you know, Americans’ respiratory health, maybe particularly in America? 

Amanda Leightner: Yeah, we sleep really poorly. Yeah, we’re rough…we’re rough, right? Because we do things that we know we probably shouldn’t be doing. One of our biggest sleep limitations is that we take our devices to bed with us and we set them right next to us, or we watch TVs or shows. More often than not, it’s the telephones. But these devices emit this blue light, right? And then it triggers our brain to think it’s daylight, it’s time to be awake. Then we have poor sleep, or then we sit next to us and it does things through the night that we don’t even realize. Like, it buzzes, it beeps, it lights up. And maybe you don’t wake up totally, but it arouses you at night. That’s sort of a limitation to sleep and how much sleep we’re getting.

And then we work in a seven-day-a-week schedule world, too. That’s just constantly sort of awake and moving. So we tend to have poor sleep architecture on our own. But if we can manipulate that and you can kind of keep structure and go to bed at the same time and wake up at the same time, it really does help with allowing your brain to rest and your body to rest. Because…without getting too in-depth with sleep stages, there are really important sleep stages that we should get into and in a pattern, too.

And then sometimes–have you guys ever woken up and you’re like, my body feels good, I feel like I can go exercise, but my brain is so tired. Like, my brain is just not working. Like, I don’t want to take a test today, right? There’s probably a good chance you didn’t get into your REM sleep as we should. Now, then, there are other times where you’re probably like, wow, my brain feels good, but there is no way I’m going to exercise. I’m tired. My body’s tired. There’s probably a good chance that you didn’t get into your stages one, two, and three with that. So there’s a theory behind it. 

Derek Hiebert: Right, right. That’s really interesting, and we’ll get into some kind of practical tips and techniques for respiration when it comes to fostering healthy sleep here in a bit, but with the phone thing and the screen thing–you know it seems like to me, unless you’re using your phone as an alarm clock, probably the best thing to do is either turn it completely off, power down, or just put it in a different room or something before you go to bed. So it really just encourages you to get to sleep and fall asleep soon. 

Amanda Leightner: It’s fantastic advice, and if only we could do it. 

Sam Butler What do you do? 

Amanda Leightner: I try my best, you know, my phone is with me because I have kids, you know, so I’m always worried about what they’re doing. Are they okay? You know, do they need me too? But I know what I’m supposed to do, I know that that should be in another room, right? I should not eat a big meal before I go to bed, and I should really watch my caffeine intake like I am one–you know, today’s society loves coffee, right? I love some coffee, and then when it’s cold, I like coffee even more.

So that’s something that we really have to be cognitive to, even these energy drinks that are out there are really stimulants. And, you know–I don’t want to say younger population because it’s just the population in general likes them. They’ll drink them at dinnertime too. So then you got that fragmented sleep. You gotta love a good cup of coffee, but you gotta watch when you’re drinking it too.

Derek Hiebert: Oh, for sure, diet, beverage, all that stuff, I think matters. I’ve, yeah–that’s good.

Amanda Leightner: Yeah. And you guys probably know that about yourselves too–like I know it about myself, like when I can stop that caffeine intake, when do I feel best. You know, when do I feel best eating my last meal of the day or how do I feel–like I know I’m more–I lean more towards being a long sleeper than a short sleeper. And so Derek and I were talking about that, and you probably know what you are, too. You probably know whether you’re a short sleeper or a long sleeper, and there are both folks in the world. We don’t all need–it’s kind of a myth that we all need seven to eight hours of sleep at night, but that’s not necessarily true because some people can function on four.

Derek Hiebert: Wow, would you say on average it’s around maybe six to seven, is probably like if you can….

Amanda Leightner: Yeah, anywhere from that six to eight hours deal. Yeah, some of my worthless sleep trivia, I’ll throw it out there for you. So we always say, like, if an average 75-year-old sleeps that seven to eight hours a night, that’s 25 years of their life that they spent sleeping, right? So sleep is so important.

And I always laugh when I go to sleep conferences because if you guys ever get a chance to go to a conference, you’d really probably get some good giggles out of a sleep conference. There are people with beds, there are people with pillows and blankets, and there are things to put in your mouth. There are people drooling over there because they’re putting oral appliances in because they think that’s gonna work. So we’re a really unique dynamic field because even like–a big thing was the weighted blankets for a while there, and so it’s just a unique population of people coming together to try to figure out how to sleep best.

Sam Butler: I have a weighted blanket. 

Amanda Leightner: Yeah. 

Sam Butler: I think it helps me. 

Amanda Leightner: Yeah, there’s actually research that supports it with promotion of even getting into that REM sleep and everything. And they use it for stress, anxiety, too, and just falling asleep. But you have to have the right weight, too. So you’re supposed to do 10% of your body weight, and that’s the weight of the blanket you should buy. 

Sam Butler: I think that’s about right. 

Amanda Leightner: Because some people buy too heavy and they’re like, oh, that’s heavy, you know.

Sam Butler: Sometimes it like folds over on itself, and then it’s… 

Amanda Leightner: Then you got double the weight on you. 

Sam Butler: That’s a problem. I think it helps. 

Amanda Leightner: Yeah. There is research that supports it, too. Maybe we need to get everybody some weighted blankets around here. I did a podcast the other day, and the host was asking me about naps. You know, and I was like, well, maybe we need to implement naps at Boise. 

Derek Hiebert: Oh my goodness. 

Amanda Leightner: Other countries do it, and you know, maybe we could start something. 

Sam Butler: What are some specific issues that you’re tackling right now to help promote healthy sleep through respiration? 

Amanda Leightner: Like I mentioned earlier, some of the research is my students focusing on that PAP compliance and barriers to it, and who’s giving the education. So that’s interesting. We’re digging into that big data that I mentioned, the inpatient trends, and really looking at the overlap of sleep disorders and other disorders and what’s happening in our hospital patients. Chrononutrition, as I said, we’re going to do that roundtable there. And then essentially, I would like to get into some of the mental health and sleep issues, too, especially on college campuses. So those are all my streams all over the place that we’re looking forward to.

And at the end of the day, we want our research to be meaningful, and we want folks to read it. I don’t want it to go behind the desk of a library and just sit there. So we want it to be really beneficial to society and our patients and our population because that’s why I became a respiratory therapist. I wanted to help people. I come from a line of educators. And I was like, oh no, I’m going into health care. And so that’s really where I think all my colleagues and I–our train of thought sort of stems from really helping people. So that’s what we’re hoping for at the end of the day. 

Derek Hiebert: Yeah. That’s great. This is something I haven’t really thought of before, but specifically when it comes to breathing and respiration connected to sleep. And in order to foster healthy sleep, are there some tips or healthy techniques that a person can do? Maybe that doesn’t struggle with sleep apnea, but they can do prior to sleeping or throughout the day that would just encourage–that just foster maybe healthier breathing during sleep. What would that look like? 

Amanda Leightner: Yeah, that’s a great question. Even sleeping with the same sleep structure, where you go to bed at the same time and wake up, but something that you can do that’s really simple that we probably forget about is just nice, easy, deep breathing in and out through the nose. And that really helps even with relaxation and aids in that time to falling asleep. So if you do like five minutes of nice, easy breathing, taking it in and out through the nose, not through the mouth, you know, it will aid in relaxation too. So you can do that.

Something super simple, you know, a fantastic exercise is yoga, like yoga deals with that breathing, right? Opening up that chest and that heart. It’s a fantastic exercise that you could do before bed. Just some yoga moves can help with that, too, but it’s fantastic even if you just did it during the day. I’d love to do some more research with that and what, you know, long volumes look like when you’re doing yoga. Maybe not during hot yoga, but definitely yoga. That might be another area of research. 

Sam Butler: And kind of the opposite, what are some of the worst habits that you see? Not necessarily specifically for college students, but..

Amanda Leightner: …Society?

Sam Butler: Kind of both, yeah. 

Amanda Leightner: Definitely taking your device to bed, watching TV late at night, caffeine intake too late at night, big meals before you go to bed, because then that causes a lot of reflux and gastric kind of…disturbances that then awaken you through the night, and you have those arousals. So I think all of those are ones that society sort of forgets about, and then it’s too late, and you’re like, oh no, I can’t sleep now, yeah, I’m having a rough night.

We’ve all had those nights, too, where you’re like, oh, why did I eat that before I went to bed? And you could feel it in the morning too, you feel it the next day, and maybe you’re not getting into like I mentioned before that normal sleep architecture where you’re going from stage one to two to three to REM, or you’re missing it. Shift work is tough, too. If you’re a shift worker with sleep issues, and you’re trying to function on a different shift. But if you could keep with that shift, you do feel better, you have better longevity. Those are just some of the ones I think a lot of us struggle with. 

Derek Hiebert: Yeah, I thought of something. I’ve been married for a while, and I’ve got–I’m a parent of teen daughters. And at least for me, it’s hard to have a late night hard conversations, right? It always is just in general, but like having those and then trying to go to sleep. I’m like–I was like, can we pause this? Can we table this…

Amanda Leightner: …until tomorrow?

Derek Hiebert: Until tomorrow. 

Amanda Leightner: Yeah, give me some time to think about this. They probably know that about you, though. And they’re like, we’re going to hit up dad now, because we know he’s not thinking right. No, yeah, that’s really important, too. 

Derek Hiebert: And sometimes those things, I mean, I get it–life is just like no, we need to talk about this right now. I’m like okay, all right, let’s do it, but…

Amanda Leightner: Yes, understood, yeah. You know, also with that, there is research that supports, like for college students for studying, or just if you’re studying for anything. I mean, board exams those kind of things if you study and then you go to bed, they claim that you retain more information rather than keep studying and then you’re awake longer. But if you take that information and then go to bed at a decent time, you’re more likely to retain that information the next day. 

Sam Butler: That was actually one of the questions that we thought about talking about. 

Amanda Leightner: Study tip 101. Yeah.  

Sam Butler: So it’s worth it to go to bed and get a good night’s sleep?

Amanda Leightner: Yes. 

Sam Butler: As opposed to…

Amanda Leightner: Rather than burning the midnight oil. Yeah, 100%. We know cramming does not help with retention of material.  

Derek Hiebert: Yeah. What are some things as we kind of–you know, get to the sort of the end of this conversation, what are some things that we can do to aid our respiratory system, perhaps–maybe perhaps when sick or just you know–just I mean perhaps when we’re not sick. Is it like–is the use of a humidifier good, or maybe a fan to flow air a little bit, or…

Sam Butler: …window open…

Derek Hiebert: Yeah, door open, is our sleep positions maybe that help better, you know, both in sickness or health?

Amanda Leightner: Yeah, it’s so individual, too. It’s funny you should ask me that question, because I had the New York Times just recently send an editor my way, and they wanted me to say that dehumidifiers and humidifiers were amazing and everybody should have one. And I was like, well, that’s not necessarily true, you know, and first of all, if you–and it might be beneficial. If you’re not feeling good or you just want to, you need more humidity in the air. The thing with humidifiers and dehumidifiers is you want to keep them really clean, right, and sometimes we forget about that. But if you’re not feeling well, and maybe you just feel like you just need something to loosen up the secretions and stuff that could help, right? That could be something to do.

As far as sleeping positions, yeah, the worst sleeping position is on our backs. And everybody rolls over at some–every–you guys are all probably going to tell me no, I don’t sleep on my back. Everybody rolls over on their back at some point in time, like I’ve studied many, many patients, and we do–maybe not for long periods but short periods, people roll on their back. But that’s the worst position to sleep in because our airway is just naturally flattened right, and then god forbid you do have some obstruction in there or you got some secretions going on in there, right? It’s just going to make it that much worse. Now sleeping on your side or sleeping on your stomach if you can–best positions for sure. 

Derek Hiebert: Wow, okay.

Amanda Leightner: Yeah, holding up a pillow on your side is a great position–if you like to sleep on your stomach fantastic position even for oxygenation. That was a big thing during the world of Covid we learned that putting patients on their stomachs really aided in that population, which was fantastic. So it just depends on, you know, each person. Yeah, and maybe you feel comfortable with a window open. You know your body will naturally transition to that ambient temperature of the room, and you probably feel comfortable there–having a fan on, some folks can’t sleep without a fan. Some people need a white–you know that white noise machine in their room that aids in sleep. 

There are so many–one thing we didn’t even talk about yet is technology today, and there are so many devices out there. Like apps on your phone to listen to, like sleep music, white noise music, and then now we are kind of catching on as a society that sleep is important, so wearables are such a big topic today. And so I’d love to do some research with the wearables like the iWatch or…the Fitbit is in there, the Garmin is in there, and the Oura rings.

Now that we monitor sleep–you know, because society wants to know a little bit, like how am I sleeping, what’s it telling me. But then what are we going to do with it, and is it reliable information? So I’d love to dig into some of the undergraduate students, maybe testing these devices out–because then there are apps on your phone too that you can use. And, I just know those aren’t super reliable, but we’re gonna test out that theory and see. Society is getting more interested in sleep, and then what are we gonna do with it? 

Derek Hiebert: Yeah, for sure. I–it seems like in the last five years, I’ve seen a lot of marketing and advertising around mattresses. 

Amanda Leightner: Oh yeah. 

Derek Hiebert: And certain bed technology to help people–you know, to help encourage better sleep. It’s like, yeah, it’s really important. 

Amanda Leightner: It’s important, but it’s so individual, too. You see, like the big sleep–I don’t have any affiliation with any of them. But I’d love to dig into some other claims, because they do claim, like, better REM sleep. I’m like, did they study that? I don’t know. I would think that they did. They’re claiming it. But the Sleep Number, Purple, and Tempur-Pedic all these beds are out there claiming. But it’s so individual, too. You might like a really soft bed, or you might like a firm bed. You know, and that’s going to tell us how we sleep through the night, but definitely important.  

Derek Hiebert: That’s really interesting to know about the sleep on your back thing because I’m a side sleeper usually. But every so often, I’ll have a night where my arm falls asleep on one side, or I’m just feeling sore or something. So I’ll try to switch to the other side, and then eventually I’m on my back, and I’m like, I don’t ever sleep well on my back. I can still sleep in chunks, but I’m like always waking up, you know? And I’m just like, ugh. 

Amanda Leightner: I thought you were going to say your family’s like, oh, you snore so bad. Because you do, you know, naturally, if you roll on your back and our airways naturally collapse some, you’re going to snore, right? You know, and then there are folks who just will do quirky things with people. I’ve done some quirky things for folks who just cannot tolerate–like they have their vents when they roll on their back, right? But they cannot tolerate a mask. They’re just claustrophobic. They can’t tolerate it.

You know, so we–I’ve recommended weird, quirky things like, hey, we’re going to put a tennis ball on your back. And every time you roll over, it’s really uncomfortable, right? So you just flip back over, or if you have a bed partner and they’re like, hey, roll over, roll over. You know, so we do what we can to help people sleep. So even if it means sticking a tennis ball on someone’s back, I’m going to do it.  

Derek Hiebert: That’s great. Well, thank you so much for being with us Amanda really appreciate it. This is such a good conversation and maybe we will be able to have you back at some point. 

Amanda Leightner: Yeah.

Derek Hiebert: You know, we can dive a little bit more deeply into this. And so once again, this is Derek and Sam, we have Amanda Leightner, the Merrick Family Endowed Professor joining us. 

Amanda Leightner: Yeah, thank you for having me. 

Derek Hiebert: We also have Danya Lusk here as part of our sound and video engineer here today. She’s the communications specialist in the college. 

Amanda Leightner: A fantastic team.

Derek Hiebert: Yep. All right. Thank you so much.

Amanda Leightner: Thank you.