Dr. Subaila Zia: “Both quality and quantity of sleep matter”

Both quality and quantity of sleep matter. Quantity of sleep you need depends upon your age group. For examples, recommended sleep in 24 hours for adults between 18–64 years of age is at least 7–9 hours of sleep while for teenagers between 14–17 years of age, it is between 8–10 hours. Getting a good night’s sleep […]

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Both quality and quantity of sleep matter. Quantity of sleep you need depends upon your age group. For examples, recommended sleep in 24 hours for adults between 18–64 years of age is at least 7–9 hours of sleep while for teenagers between 14–17 years of age, it is between 8–10 hours.

Getting a good night’s sleep has so many physical, emotional, and mental benefits. Yet with all of the distractions that demand our attention, going to sleep on time and getting enough rest has become extremely elusive to many of us. Why is sleep so important and how can we make it a priority?

In this interview series called “Sleep: Why You Should Make Getting A Good Night’s Sleep A Major Priority In Your Life, And How You Can Make That Happen” we are talking to medical and wellness professionals, sleep specialists, and business leaders who sell sleep accessories to share insights from their knowledge and experience about how to make getting a good night’s sleep a priority in your life.

As part of this interview series, we had the pleasure to interview Subaila Zia, MD, MBA, FCCP.

Dr. Subaila Zia is an experienced board-certified Sleep Specialist, Pulmonologist and Critical Care Physician. She is a founder and CEO of a telemedicine company called Telemedora– a Silicon Valley based telehealth company which aims to offer physician services including TeleSleep in multiples states. She has served as a medical director of two sleep centers in Midwest and has been invited to speak on healthcare related topics on TV, different media platforms and conferences.

Thank you so much for doing this with us! Before we dig in, our readers would like to ‘get to know you’. Can you tell us a bit about your background and your backstory?

Sure. I am a board-certified Pulmonary, Critical Care and Sleep physician and founder and CEO of a Silicon Valley based telehealth company called Telemedora. I have served as a Medical Director of Sleep Centers in Midwest. In order to gain deeper insight about business of medicine, I did MBA from Washington University in St. Louis. My interests include finding value adding ways to integrate Telemedicine, AI and healthcare innovation in patient care. I have also completed course in AI in Healthcare from MIT. I have been invited to speak on healthcare related topics on different media platforms and conference.

I earned my medical degree with honors from Dow Medical College, Pakistan. After passing all the required exams called United States Medical Licensing Exams, I got Internal Medical residency from St. Barnabas Hospital, New York. This was followed by a Pulmonary Fellowship at Bridgeport Hospital/Yale University, Connecticut and later by a Critical Care Fellowship at Memorial Sloan Kettering Cancer Center, NYC. My third fellowship was in Sleep Medicine from Emory University, Atlanta, GA. I have worked in both urban, sub-urban and rural settings.

I believe best quality care should be accessible to patients wherever and whenever they need it the most regardless of their location.

Can you share a story with us about what brought you to this particular career path?

If you would have told me during my medical school or even during my Internal Medicine residency that one day I would be a sleep specialist, I would have not believed you at all.

It wasn’t until my Pulmonary Fellowship at Bridgeport Hospital-Yale University that I had the opportunity to take care of so many patients who were struggling in their personal and professional lives due to sleep issues in addition of lung diseases. The more I studied about sleep, the more passionate I became to learn more about it.

Also, the chance to see the positive impact of diagnosis and treatment quickly in some patient with sleep disorders like Severe Obstructive Sleep Apnea was clearly rewarding for me. This was in contrast to many chronic lung diseases. After Pulmonary Fellowship, I pursued Critical Care Fellowship in NYC from Memorial Sloan-Kettering Cancer Center which is the usual path for most pulmonologists and then went to work in rural Pennsylvania. There I came across more patients with chronic lung diseases with co-existing sleep issues like fatigue, excessive daytime sleepiness, insomnia, etc. So, I decided to pursue a dedicated additional one-year training in Sleep medicine from Emory University, Atlanta, GA which turned out to be a great learning experience. Since we know that a sleepy driver is as dangerous as a drunk driver. Improving sleep health became my passion. By treating sleep disorders in a timely manner in a patient, I have a chance to improve not only patient’s health but also play a vital role in public safety.

Can you share with our readers a bit about why you are an authority in the sleep and wellness fields? In your opinion, what is your unique contribution to the world of wellness?

Let me share with you briefly, what have I done so far to improve awareness for sleep disorders and to improve access to sleep physician.

I did a dedicated 1-year Sleep Medicine fellowship at Emory University, Atlanta where I was fortunate to be trained by the giants in the world of Sleep Medicine. After fellowship, I studied and passed a rigorous board certification exam for Sleep Medicine. As a fellowship-trained and board-certified Sleep physician, I have taken care of hundreds of patients with sleep disorders. I have been the medical director of sleep centers in Midwest. In addition, I have been invited on TV to speak about sleep disorders and have published on sleep medicine.

My unique contribution to the world of wellness is to promote sleep health and to improve access to sleep physicians. Currently, for a population of 325 million people, there are only 7,500 board-certified sleep physicians. This equates to having only 1 board-certified sleep specialist for a population of more than 46 thousand people. Currently, I am building a telehealth company in Silicon Valley called Telemedora to help expand access to sleep specialists via telehealth in multiple states. The goal of this company is to make quality care accessible to people regardless of their location via telehealth.

Is there a particular book that made a significant impact on you? Can you share a story or explain why it resonated with you so much?

My favorite book is Simon Sinek’s “Start with Why”. The book talks about the importance of understanding the reason for doing things. The art of understanding and communicating the rationale behind your actions is crucial if you want people to buy-in. The book also shares insights on how to lead instead of being a leader. Those who are able to lead effectively know how to inspire people to follow them while leaders are the people who are thrust in the position of power and people are required to follow them. It resonated with me so much because like many professionals, I have had both kinds of leaders in my life and clearly, I thrived in environment with authority figures who inspired me to follow them not because I had to follow them.

Do you have a favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life or your work?

Although I wanted to pursue Master of Business Administration, however, I was questioning myself whether I would have time to drive to St. Louis for classes, complete assignments and pass exams for Master of Business Administration in addition to my clinical and administrative duties. So, I called my dad for advice. My dad told me, “Your plate is never too full to follow your dreams and make magic happen.” I have found this to be the most helpful advice and has helped me get a Master’s in Business Administration from Olin Business School, Washington University, St. Louis. When I look back and think about it, I still can’t believe that I did MBA while working crazy hours as a full time Pulmonary, Critical and Sleep physician in addition to being the medical director for two busy sleep centers.

Ok, thank you for all that. Now let’s move to the main focus of our interview. Let’s start with the basics. How much sleep should an adult get? Is there a difference between people who are young, middle-aged, or elderly?

The amount of sleep you should get depends mainly on your age.

For instance, newborns require more sleep than adults. As we grow older, our sleep requirement continues to decrease till adulthood and then it plateaus out. According to National Sleep Foundation, the recommended amount of sleep per 24 hours according to age group is as follows:

For newborns (0–3 months), 14–17 hours of sleep per 24 hours is recommended.

For infants (4–12 months), 12–15 hours of sleep per 24 hours is recommended.

For toddlers (1–2 years), 11–14 hours of sleep per 24 hours is recommended.

For pre-school (3–5 years), 10–13 hours of sleep per 24 hours is recommended.

For school age (6–13 years), 9–11 hours of sleep per 24 hours is recommended.

For teenager (14–17 years), 8–10 hours of sleep per 24 hours is recommended.

For adults (18–64 years), 7–9 hours or more of sleep per 24 hours is recommended.

For older adults (65 or above), 7–8 hours of sleep per 24 hours is recommended.

Is the amount of hours the main criteria, or the time that you go to bed? For example, if there was a hypothetical choice between getting to bed at 10PM and getting up at 4AM, for a total of 6 hours, or going to bed at 2AM and getting up at 10AM for a total of 8 hours, is one a better choice for your health? Can you explain?

Both the amount of sleep and the time you go to bed are important.

First of all, the hypothetical choice of going to bed at 10 PM and waking up at 4 AM allows only 6 hours of time in bed for sleep which is inadequate. Like I mentioned before, the recommended amount of sleep for adults every 24 hours is at least 7 hours.

Now coming to second part of your question, does bedtime matters. Yes, it does. A study done in Australian showed that adolescents with late bedtime and late wakeup time were twice more likely to be obese when compared to those who went to bed early and woke up early.

Another study done in undergraduates few years ago showed that those with short amount of sleep and late bedtime were more likely to have repetitive negative thoughts as compared to those with adequate sleep and early bedtime. So the age old saying, “Early to bed and early to rise, makes a man healthy, wealthy and wise” is still a very practical advice for majority of us.

As an expert, this might be obvious to you, but I think it would be instructive to articulate this for our readers. Let’s imagine a hypothetical 35 year old adult who was not getting enough sleep. After working diligently at it for 6 months he or she began to sleep well and got the requisite hours of sleep. How will this person’s life improve? Can you help articulate some of the benefits this person will see after starting to get enough sleep? Can you explain?

Great question. We need adequate and quality sleep to restore energy, rejuvenate, for memory consolidation and for growth. Studies have shown that when we sleep, brain repair and brain maintenance is going on. So, this 35-year-old adult with good sleep health will reap multiple benefits. Some of these include: Better cognition, attention, more energy, improved behavior, learning, mood, mental and physical health. This adult will also reduce his/her chances of weight gain, dementia, diabetes, etc. since chronic sleep deprivation plays a role in dementia, mood disorders, diabetes and obesity.

Many things provide benefits but they aren’t necessarily a priority. Should we make getting a good night’s sleep a major priority in our life? Can you explain what you mean?

Absolutely. It is important to practice good habits to help achieve a good night sleep. These habits are called Sleep Hygiene. Like personal hygiene, sleep hygiene is very important. A survey done by American Academy of Sleep Medicine in 2019 found that unfortunately, overall 88% US adults prioritized binge-watching shows on TV/streaming over sleep. Other things which took preference over sleep for US adults were playing video games, reading, etc. As I mentioned before, since sleep health is vital for our overall wellbeing, it is imperative to prioritize sleep.

The truth is that most of us know that it’s important to get better sleep. But while we know it intellectually, it’s often difficult to put it into practice and make it a part of our daily habits. In your opinion what are the 3 main blockages that prevent us from taking the information that we all know, and integrating it into our lives? How should we remove those obstacles?

You are right. Habits which are beneficial for our overall health are also beneficial for our sleep health. Be it sleep hygiene or exercising regularly, eating healthy diet or avoiding smoking, they all require discipline and commitment to wellness. Being a sleep physician, I can’t stress enough about the importance of sleep. In my opinion, some obstacles which prevent people from getting “good sleep” are:

1. Inconsistent sleep schedules. Some people follow one sleep schedule during workdays and other during their time off. It is not a good idea. Let me explain why. Humans have a built-in internal clock called circadian clock. The circadian clock is responsible for regulating our sleep-wake cycles. This clock resets these sleep-wake cycles roughly every 24 hours. Irregular sleep schedules cause disruption of circadian rhythm. Studies have shown that irregular sleep schedules are associated with obesity, high cholesterol, impaired fasting glucose and high blood pressure. It is recommended to follow same sleep schedule daily whether it is a weekday or a weekend or vacations.

2. Use blue-light emitting electronic devices like TV, phone, laptops, TV, tablets, etc. at bedtime. These devices emit blue light which sends signal to our brain and suppresses the release of a hormone called melatonin- which is released at bedtime and help us fall asleep. So blue light is disruptive because it suppresses release of melatonin and causes delayed sleep onset. It is recommended to stop using blue-light emitting electronic devices at least 30–60 minutes before bedtime.

3. Going to bed when they are not sleepy. Sometimes people go to bed when they are not sleepy and get frustrated when they can’t fall asleep. If they do it regularly, then they start getting worrying hours before bedtime whether they will be able to fall sleep soon or not. It helps to allow yourself at least 30 minutes to wind down before bedtime. Avoid going to bed unless you are sleepy.

Do you think getting “good sleep” is more difficult today than it was in the past?

Unfortunately, yes. Today, we have many more factors which prevent us from what we consider “good sleep”. Some of which are:

  1. Too many options of programs available for us on TV or streaming services.
  2. Never ending use of social media.
  3. Sedentary lifestyle impacts sleep health adversely
  4. Increased consumption of caffeine.
  5. Insomnia related to COVID-19 pandemic called Coronasomnia. It affected not only patients with COVID-19 infection but also people who were impacted due to COVID-19 pandemic either financially, psychologically, emotionally, etc. Sleep problems related to ongoing COVID-19 pandemic was reported by up to 36% adults in general population as well as those working in healthcare in some studies.

Ok. Here is the main question of our discussion. Can you please share “5 things you need to know to get the sleep you need and wake up refreshed and energized”? If you can, kindly share a story or example for each.

In order to improve your sleep health, remember it takes time and discipline. Here are top five things you need to know to get the sleep you need and to wake up refreshed and energized.

  1. Both quality and quantity of sleep matter. Quantity of sleep you need depends upon your age group. For examples, recommended sleep in 24 hours for adults between 18–64 years of age is at least 7–9 hours of sleep while for teenagers between 14–17 years of age, it is between 8–10 hours. It is important to remember that quality of sleep is also important. Remember, the less sleep fragmentation you have, the better-quality sleep you will get. For instance, you can’t have quality sleep for only 4 hours in 24 hours and expect to wake up feeling rejuvenated. On the other, fragmented sleep of 7–8 hours will also not make you feel energetic. So, your goal should be to get both adequate hours of sleep and good quality sleep not one or the other.
  2. Consistent Sleep Schedule. When it comes to sleep schedule, consistency matters. For example, some people have different sleep schedule for weekdays and weekends. People like to stay up late and sleep in late on weekends. This does no good to their sleep health. Everyday be it weekday or weekend, try to follow the same sleep schedule.
  3. Sleep friendly bedroom. For example, your bedroom should be not be too cold or too hot, keeping bedroom temperature around 68-degree Fahrenheit is recommended. It should be quiet to avoid sleep fragmentation. Don’t sleep with TV on. Bedroom should be dark, relaxing and have a comfortable mattress. If possible, make your bedroom blue-light emitting electronic free zone by removing TV, laptop, phone, tablet, etc. Stop using blue-light emitting electronic devices at least 30–60 minutes before bedtime. Bed should be reserved only for sleep and intimate activities.
  4. Things which improve general health help improve sleep health as well. These include stopping smoking, avoiding alcohol, limiting caffeine intake, regular exercise as long as it is 6 hours before bedtime, avoiding large fatty meal at bedtime, etc. will all improve sleep health.
  5. Pre-sleep routine is important: Another thing which is helpful is to have a bedtime routine. Allowing 30 minutes before bedtime to unwind improves chances of falling asleep quickly like warm shower, relaxation exercises, deep breathing, etc.

What would you advise someone who wakes up in the middle of the night and can’t fall back to sleep?

If you wake up in the middle of night and can’t fall back to sleep within 20 minutes, then get out of bed and don’t return until you are feeling sleepy. You could try some quiet activity like reading a book without pictures with light source from behind your head. Avoid thinking about stressful things in the middle of night. It is helpful to have a “worry time” built into your daily schedule. Remember this worry time should not be too close to bedtime. During “worry-time”, make your to-do list for next day, write down things that are the source of your worry and how you feel about them in a journal. If you continue to experience difficulty with maintaining sleep and waking up earlier than you want to on a regular basis, bring it to the attention of your doctor.

What are your thoughts about taking a nap during the day? Is that a good idea, or can it affect the ability to sleep well at night?

When you take naps, which are either too long or too close to your bedtime, then you are likely to run into the issue of delaying your sleep onset. Hence it is recommended to keep your naps short at 20–30 minutes and don’t take them within 6 hours of bedtime.

Wonderful. We are nearly done. Is there a person in the world, or in the US, with whom you would like to have a private breakfast or lunch, and why? He or she might just see this, especially if we tag them. 🙂

Elon Musk. He is a genius with innovative mind. He continues to work extremely hard despite having it all. His resilience and discipline is very inspirational. He is trying to improve lives.

How can our readers further follow your work online?

Readers can go to my company Telemedora’s website and sign up for newsletter.

This was very meaningful, thank you so much. We wish you only continued success on your great work!

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