Ologies with Alie Ward - Somnology (SLEEP) Part One Encore with Dr. W. Chris Winter

Episode Date: May 26, 2022

Birds do it. Bees do it. Why the hell can't we do it? Called "The Sleep Whisperer," neurologist and sleep specialist Dr. W. Chris Winter joins for an updated encore of the thrilling 2-parter about why we need sleep, the ideal amount of it, what sleep does to the brain, insomnia, sleep stages, ideal bedtime conditions, and even the historical lore around sleep paralysis. Next week, we'll answer listener questions about everything from sleeping pills to brain performance to insomnia cures to apnea to sleepwalking to parenthood and shift work. Think of it as a free seminar to fix your life. Maybe. And I am currently spending time with my family after my dad’s emergency brain surgery a few weeks back, but put a few extra notes and updates on how we’re doing. Thanks for all the thoughts, friends. Dr. W. Chris Winter's sleep clinicDr. W. Chris Winter's book, The Sleep Solution plus his 2021 release The Rested ChildFollow twitter.com/sportsleepdocYou may also enjoy the Hematology (BLOOD) and Chronobiology (CIRCADIAN RHYTHMS) episodesA donation went to Myeloma.orgSponsors of OlogiesTranscripts and bleeped episodesSmologies (short, classroom-safe) episodesBecome a patron of Ologies for as little as a buck a monthOlogiesMerch.com has hats, shirts, masks, totes!Follow @Ologies on Twitter and InstagramFollow @AlieWard on Twitter and InstagramSound editing by Steven Ray Morris and Jarrett Sleeper of MindJam MediaTranscripts by Emily White of The WordaryWebsite by Kelly R. DwyerTheme song by Nick Thorburn

Hi, hi, it's 2022 me up top letting you know that this is an encore of a pair of episodes Everyone needs and I really needed some time to be with my family after my dad's brain surgery I'm back up north and I'm recording this at my sister's dining room table with Jarrett nearby and There is a fresh update on how we are doing at the end of the episode for anyone who's been following along with our word family Stuff so thank you so much for all the love and support Thank you for just keeping us in your big brains in your hearts. Okay sleep. Oh, hey It's your little stepbrother who tries to trade you their calcified banana flavor now and later is for your mini Reese's peanut butter cups And you're like little dude step all the way off. That's not how life works

Alleyboard back for another episode of oligies. So this is coming out in October So let's get deep into something that happens usually in the dead of night if you're lucky sleep You do it every day or night Probably and it should be an exercise in comfort and restoration and flirting with deaths hotter Friendlier twin, but just looking at the word sleep probably made your bells drop with dread because you know you're screwing it up a little bit We kind of all are so in the next two episodes. That's right part two with your questions comes out next week We are gonna go head-to-head with the Sandman, but first let's get ready for bed a little business First things first happy happy birthday to my amazing mom Nancy Ward

Who's so funny and so smart and inspiring and accepts me even though I swear Like filth on this podcast. She also gave me the best cure for insomnia It has never failed me. We don't talk about it in part one of this sleep episode So you're gonna have to wait until part two next week, but it is an actual lifesaver I can't wait to tell you happy birthday mom me and my sisters and pop love you a bunch So thank you also to the patrons at patreon.com for donating as little as one shiny American quarter an episode to help fund the show and thank you to all who are sporting oligies wares from oligiesmerch.com and Thanks to the people who post on Instagram and tweet about it. You can tell a friend. You can tell a foe

I don't care. You can scream into the night about it and rate and subscribe and review that all helps get the show in others ears and Very often you make my day with your nice words in the reviews So like a succubus I pluck one every week to read from the bunch and this week T-Paf says ten out of ten would look like a complete nut job scream crying in laughter about sharks in my car again So thank you, please continue T-Paf to do that and thanks to everyone who left reviews that I savored Individually over a cup of herbal tea this week. I just appreciate them so much Okay, some analogy very much a thing It's the study of how we sleep and I looked up the etymology of it

Just after I wrote that intro and holy smokes you guys Somnus is the Roman god of sleep and yes the brother of death I had no idea when I wrote that a few minutes ago. So there you go Also, Somnos probably a remake of the Greek myth of Hypnos who was the Greek god of sleep Also the half-brother of Thanatos death. So Hypnos lived in a dark grotto in the underworld What a bachelor but was kind of a helper of humans He was a good dude. His dad was darkness and his mother was nicks or night and even Zeus was afraid of her Zeus was like damn lady. You're kind of a bitch

But I respect that and so somnology is the study of the god that comes in darkness to Incapacitate and recharge us and it seems to vex us more and more. So yes We have cars and antibiotics, but when it comes to sleep We're kind of boning ourselves fam. So in this two-parter episode I'm determined to help fix your sleep and by your I mean are I appalled my own friends Physicians I appalled my own Fitbit with my poor sleep habits and as a result I sometimes forget which month it is and I have eaten more stickers on produce than you need to know about So you're gonna learn the difference between deep sleep light sleep REM sleep

What aspects of sleep hygiene are important the root of insomnia? How much sleep you really need if you should go somewhere to get wires taped to your head while a stranger watches you and How to help the molecular janitors that live in your skull this guest has been called the sleep whisperer and works with Professional athletes and normies alike to perform better and to remedy their sleep issues. He has literally written the book on sleep It's called the sleep solution why your sleep is broken and how to fix it. He's based in Virginia He's the owner of the Charlottesville neurology and sleep medicine clinic So we scheduled this interview months in advance for a time He was gonna be in Southern California to give a talk

We met up at a hotel and I barraged him with so many questions that he was held Physically captive Answering them for me for close to two hours and I was like yes double episode. So get cozy Zip up your onesies and get ready for part one with the gently southern-voiced Dulsamer wisdom of neurologist and Somnologist dr. William Chris winter You are a neurologist, but you're also a Somnologist correct cuz you study sleep correct. Why sleep for you cuz I read your book, which is great

Your book is by the way, so funny. I was like, oh my god. This is keeping me up because it's so funny Why and you mentioned the book that you like sleep and you're a good sleeper So what drew you to this field if you have no problems in it? So what drew me to the field is just because I have a problem with it doesn't mean I don't love it number one Okay, number two. I Came into the field completely accidentally. I decided Around third grade that I would become a doctor and I'm pretty certain That there was a phenomenon going on my parents were both the first people in their families

I believe to go to college on both sides So dr. Winter says that he didn't grow up in a family of academics But that his appellation me ma and papa Supported big dreams for little whippersnappers. We go out and visit grew Mamma and grandpa and the Remote reaches of West Virginia if you told them that you would be a doctor They would give you you know a quarter and some candy So I think very from a very young age I realized if I tell a papal that I'm gonna be a doctor he gets really excited

He calls mamma and I get some candy and some money and this is awesome So I think that that probably had a big role in shaping so I went to be a doctor I didn't really want to be a sleep doctor or neurologist But I started doing research and sleep just to get beer money and biology credit hours as an undergraduate So quick question. How much does this pay according to one USA Today article? I read about 150 bucks a day is the going rate for research studies But there are accounts of folks making over three grand for a nine-day sleep study But based on the fact that the article was titled quote how to get paid to sleep

I'm guessing that the job competition might be stiff Like grueling farting and unconscious, but stiff a guy said here They'll pay you to do some research and you can get some cool things for your med school resume So it was just completely accidental, but the field is fun the the people within it are inviting It was a new field. So anything you sort of dreamt up Had never really been looked at before at what point did you get to start just doing research on humans? And what was your end goal to do want people to sleep better and thus be happier? Like what did you want to do as a neurologist? Sure

So that was my undergraduate experience from there I went to medical school down at Emory and was introduced to Don Blah wise and David Rye who are sort of they run the sleep center down there now When I was an undergraduate, I was working at a sleep lab was mainly pulmonary looked at breathing These gentlemen were more neurology oriented. So that was my first taste of neurology I really thought that you know, the brain was really cool. So I would go to medical school during the day and then at night I would run these studies One of them was and so this is when I first started interacting with real human subjects One was the idea of if you pull an all-nighter and stay up all night or if you have a night where your sleep is fragmented

Yes, like being on call or something of that nature. How was that? No, no, it's good. No. Yeah, I'm sure it is. I've heard all about you. You've got a lot going on. I'm worried about you, Alex So when you so the question was how is that affecting our brain's blood flow in the morning? So we would bring my a lot of these were my friends They were medical students who were looking for a little bit of money and I was hey You should come do this sleep study. So the sleep stay consisted of three nights the first night You would sleep normally the second night you would Not sleep at all the third night. We would fragment your sleep and the way we did that was we had these little C3PO

alarms that made this Believeably grating sound My god, that is the worst. I'm so glad I looked this up And we had them bolted underneath the subjects bed And so my job was on the on the fragment on the on the sleep deprivation night I just had to make sure they were doing whatever they wanted to do these couldn't sleep on the fragmented night I had to watch them and every time they would fall asleep I would give them five, you know, five minutes and then we would start sounding the alarms

So they would get little five minute chunks of sleep throughout the entire night and the funny thing was all my friends would make these big Arrangements for the sleep deprivation night But for the fragmented night, they're like so I get to sleep right like yes, you do But as soon as you fall asleep you'll sleep for a little while then we're gonna wake you up But you can go right back to sleep after that. They would make arrangements for that They were a mess after those studies One guy actually woke up and walked out of the sleep center with all the wires hooked to him and it was trying to get into his Car he had no idea what he was doing another person actually got up and went to the bathroom

Hooked up with everything. It was just they were absolutely hysterical and what we found was It was much more dangerous from a blood flow perspective To have fragmented sleep than it was to actually just stay up In fact, when you stood when you stayed up all night and never slept for the first few hours of the morning Your brain blood flow was really happening. It was really So I think that's that sort of the background you pull an all nighter for a test The next day you feel kind of euphoric for a while and then you crash So real quick as if being a walking skeleton

Covered in raw hamburger isn't chilling enough Just please take a moment to remember that the thought sponge Nested in your skull is soaked in blood. So during some stages of sleep the blood volume goes down But in rem it can be engorged with more blood than when you're awake So yes, you're snoozing and your brain has a dream boner Unless some factor screws it up like a creep in a lab coat with a c3po alarm clock But that fragmented night and when you think about that in relation to people who are on call or a new mother with a baby That's crying out throughout the night. It's a real risk factor potentially for things like stroke

Um, so just not a healthy situation to be in oof. Now. Do you have kids? I have three. Yes How did you did this affect you because it's not just new mothers? I imagine like you got to get like papa's got to get up To right papa does and papa was this pop. I was always I always felt so Not helpful and somewhat inadequate during the whole situation that I would always get up Even our first child my daughter was born when I was a third year medical student I would get up and just sit with my wife while she nursed because I felt like Okay, well you go take care of this creation I put inside of you and I'll be getting some sleep over here So I felt really guilty by that even though I would often kind of you know, not off as we were talking and the guilt really started from

The birth of my daughter at one point I fell asleep during labor And my wife said did you just fall asleep? I said And this is what I said. I was so sleep deprived from being a medical student I said something like I just didn't know it was going to take this long So those are those words that leave your mouth and you're trying to grab them as they leave to shove back in your face And so I think that part of the guilt stemmed from that comment. So Oh, and I imagine also as a med student I feel like there's no one who is more sleep deprived than a medical student

Like you have these insane long shifts and hours and then it's like, okay, you haven't slept in 36 hours Fix this person so they don't die. Correct. So yes, we were very sleep deprived Um, it's not an accident that a lot of mistakes are making made because of sleep deprivation in hospitals At one point I was at a computer entering medications for a patient And I got a call at the on the phone right next to me and I picked it up and this woman said, who is this? I said, this is dr. Winter. Who's this? She's this is Phyllis in the cafeteria. Why are you sending us medications through the cafeteria pathway? So I had somehow in my sleep deprived haze Gotten into the completely wrong system on the computer

And instead of sending dietary orders to the cafeteria was putting all their medications through there, which is fortunately Didn't hurt anybody, but I had no idea what I was doing. It was really bizarre Scone scone with sialis in it. It's just like a exactly right poppy seed clonopin. That's right. Good for you These are great. It's a really I'm sure they sell really well actually. I think Now Tell me a little bit about what is sleep? I mean, that's like the golden question because it does seem crazy that for eight hours of the day We just kind of semi die. It seems we're so vulnerable to predation

We just clock out like what what is sleep exactly? Yeah, I don't think people really know. I mean, there's all kinds of theories in terms of sleep being something important for energy balance There's a metabolic sort of pathway that sleep is very important for You know, we get some insight into the answer that question if we look at sleep deprivation models where you take something You know, they used to put these little mice on these rotating platforms over water and if they fell asleep The the platform would rotate and push them into the water which he really didn't like and so you found that after a very short period of time There's a lot of brain dysregulation that starts to happen Particularly with the brain it's regulation of our cardiovascular system. Our body temperature gets really screwed up

We have difficulty fighting infection and generally organisms die fairly quickly with sleep deprivation So I don't know that we necessarily know exactly what it is, but it's a very important thing for sort of reestablishing balance within our body Throughout organ systems and you know, every organism does it They do it differently, you know some fish that have to continue to always swim They'll sleep one half their brain and then the other at other times and really fascinating things like that But it's this very preserved process That you know kind of allows us to sort of reset and go forward about our day but to answer that Definitively, I don't think anybody really can which is shocking is something like you said so basic that we don't really know why we do it

Oof, we don't know. Is this true? I fact checked it. And yes, pretty much all legit scientific papers start with Even though how and why we sleep is a fucking mystery For real, but we do know that there are different stages of sleep So what happens in the different sleep stages? I just got a fitbit Yeah, I track my sleep because I'm there. I see you're wearing it. Yeah It's like you've made 200 steps this week. But um I so the different stages of sleep were kind of elusive to me Can you go through the different stages of sleep really quick and when they happen to you in night or the day?

So it's easy to think about sleep and sort of in terms of three stages There's light sleep deep sleep and dream sleep So a lot of people think dream sleep and deep sleep are kind of the same thing. They're not so very distinct So we spend about half of our night in light sleep Half in light sleep is normal. That just blew me away Light sleep is like the shoe that you wear most days like versatile Essential not the fanciest, but you need it And that's sort of the sleep that sort of moves us through all the different stages

So we're awake and we fall into light sleep and from there we might dream and then we'll go back to light sleep And then we might have deep sleep back to light sleep. Maybe wake up and go to the bathroom So light sleep is not only the the sort of the foundation of our sleep, but it's also The portal through which we we move to the different stages Um about 90 minutes after we fall asleep if we're tip if we're on a schedule and relatively well rested We'll have dream or REM sleep. So REM sleep rapid eye movement sleep and dream sleep are the same thing So generally that nine minutes after you fall asleep, you'll have your first dream. It's a very short dream typically very fragile So if you're in an uncomfortable situation a lot of anxiety in your life

If you're sleeping in a bad hotel, you may drop that first cycle quite a bit And then every hour to hour and a half we'll have another cycle of dreaming usually last somewhere between 25 to 45 minutes and those get longer and longer as the night goes on So light sleep starts as a stage called n1 as you're starting to drift off And you might have like a quick funky dream that kind of like oh shit. Yay. I'm falling asleep. Nothing is real feeling And then your brain waves slow down and then a little deeper light sleep is called n2 When your breath and your heart rate slow down Almost half of your night is spent in n2, but it's not terribly restorative

Now what is with this n1 and 2s? What are the ends? They're short for non REM sleep So all stages of sleep that aren't REM are called non REM Which is like if you had four kids and you just named the best most interesting one jeremy And then all the rest were just like non jeremy 1 non jeremy 2 That one's non jeremy 3 like sure they all have their place in this family Your life wouldn't be the same without them, you know, but they're not as interesting as jeremy So think of light sleep as your day-to-day shoe nothing fancy, but it works now another kind of shoe In your sleep closet, let's say the ugg of the shoes is deep sleep now also called

Slow wave sleep or delta sleep or if we're being an asshole n3 not REM 3 This stage of deep sleep happens more at the beginning of the night And during this deep sleep stage our bodies repair and they heal themselves We release human growth hormone, which is dope for free no shady prescription necessary And the more of this deep sleep we get those first few hours in bed Usually around 25 of the night the more chipper and refreshed and not sleepy or groggy Or crawling toward a triple espresso we feel In the first three hours of our night is predominantly when we have deep sleep

So if you sort of track somebody through a typical night Hop into bed should take you about 10 to 15 minutes to fall asleep You go into sort of transitional or light sleep into deep sleep about nine minutes later You'll have your first little cycle of dreaming back to light sleep some more deep sleep Maybe a little bit less this time a bit longer cycle of dreaming So as the night goes on we're having bigger bigger cycles of dreaming Smaller cycles of deep sleep So if you cut the night in half and I often ask this question to patients

If you're having difficulty with your sleep, do you feel like the first half of your night's better or the second half? And depending on their answer the first half is predominantly deep sleep the second half is predominantly REM sleep So you can get a little bit of a sense of what might be going on with somebody's sleep And in terms of the function of a deep sleep is what makes us feel rested So if somebody's nodding off listening to your podcast or falling asleep at a stop light Or in church or wherever you like to fall asleep, you can you know very quickly that person did not get enough deep sleep Either because they didn't get enough sleep or there's something inhibiting their deep sleep And then REM sleep has a lot more to do with focus concentration mood

Even pain perception. So it's a little bit more of a finesse sort of situation Which is probably why it's second in the night Your brain really needs the deep sleep to make the motor go to find the food to get through your day The second half the night is a little bit more detail-oriented So if light sleep is like an everyday sneaker and deep sleep is a comfortable hug REM sleep is like the shimmering dress shoe just full of dreams Increased breathing and heart rates more blood in your brain and our eyes are just like darting around like kittens under our eyelids Now REM sleep was discovered by a scientist only in the 1950s pretty recently. He was just

Watching children sleep. So that's a job. Just go to the office to watch baby's dream And he's like, hey, look at that. Maybe there's like a rapid eye movement stage of sleep and they're like, well, boy Howdy hot dang there is So in this state our brain is as active as when we're awake and REM sleep They think is supposed to help with memory and concentration and also mood Now if you're like What's up with REM the band if that's confused you you're not alone because up until about five minutes ago I wasn't sure if it was called REM or REM sleep. I had no idea and I would just never say it out loud

Michael's type just flipped to the dictionary Added periods between the letters and confused us all for decades. So the band is REM. The sleep is REM This would not have happened if REM had stuck to their original name, which was jars of piss That's a true story So the dress shoes takes care of memory and mood and it happens for about 25 percent of the night Now the cushy comfy ugg deep sleep or n3 also 25 percent of the night Repairs your bod And keeps you from feeling sleepy. So yes that light sleep is the majority of the night at 50 percent

But like what does it do? And then what is happening during light sleep? So light sleep is important. Again, like I said, it was it's sort of the foundation of sleep There are a lot of processes going on Not you know, it's I don't use the word filler But but it's a lot of sort of just the the general rest of our body our body is being inactive for a period of time And interesting about light sleep is for a lot of individuals who struggle with their sleep They will misperceive light sleep as being wakefulness

And we all do that. I mean my wife would sit down the couch and put on property brothers got that show It's the same episode every time. It's there's no shocker here You know, they're gonna get thousands of dollars of worth of renovation for like 600 bucks And I don't know what place they're living. I'm kidding. I love probably good good for you guys. I mean, this is just jealousy talking Come out here. Have a look at your pool. She sits down to watch, you know property brother. She'll fall asleep I'll grab the remote I'll flip it over to the Dodgers game and after 20 minutes she'll wake up and say Why did you do that? I was watching that show and like no, you weren't you were sound asleep?

She says I was not asleep. I'd know everything that's going on Then she'll flip it back over to property. Now it's new property brothers new couple and she's so proud She will not admit the fact that that is not the couple you were looking at before I thought the little rancher that they're renovating. We're all like the coastal, you know, whatever So yeah, so we all have that percept but some people In particular, they have a lot of anxiety Can really misperceive that 50% of our night is being wakefulness. So these are the people that often tell you Oh, gosh, you know if last six weeks I've not been able to sleep and I can sleep an hour or two

But when you look at them, they don't look particularly impaired and that's a that's a problem We often refer to it as paradoxical insomnia. It's just not the problem that often they think they have So with paradoxical insomnia, you're like, yo, I am up all night thinking about my props doc But it turns out you're actually asleep. You're just in light sleep that you think is wakefulness So it's a small percentage of insomnia patients But it does happen and insomnia itself is something that plagues a lot of people most of whom don't fully understand it And I know that you care about insomnia We all do and there's going to be more after the break

But each episode we donate to a cause and this week it's going to myloma.org The international myloma foundation is dedicated to improving the quality of life of myloma patients While working toward prevention and a cure and my dad was diagnosed with multiple myloma in 2013 My uncle passed away from it as well and the IMF has been just a Lighthouse beacon of hope and research and info and support So if someone you know has myloma, which is a blood cancer you can listen to the hematology episode with dr. Brian Dury And there's also an uncut version on my website that has more patient specific info

So thank you sponsors for making that donation possible and thanks to everyone at the IMF for everything they do Okay Insomnia, let's tackle it And so when people come to you, are they usually having trouble sleeping? Or is it mostly insomnia that you have to deal with like what's the big thing that brings people to you? So you're I think you're about to say it. It's it's really 50 50 people who walks through our door It's one of two things insomnia or I can't sleep is a huge problem Um, and then the the flip side is the individual who sleeps too much

They're nodding off at work and getting in trouble. They can't stay awake during their college classes They nodded off during an eras with concert. I mean name the situation as a promise. We've heard it I'm out. I just told you I fell asleep during childbirth My first you know my first daughter Um, you know intercourse during your own wedding like there's really some interesting things that people fall asleep doing There are entire reddit threads devoted to this topic if you need some tales about Drowsy pilots or people waking up in halloween coffins and bathtubs Now your all uncle ali has fallen asleep in her car in the driveway after pulling in on multiple occasions

I've fallen asleep on the bathroom floor with a toothbrush in my hand Somehow I have fallen asleep face first in the laundry pile More than once I once snoozed at a gothic industrial club while skinny puppy was blasting I All while sober now patron saint of podcasts Allergies editor Stephen Ray Morris Texted me while I was writing this to tell me that he fell asleep standing up once at disneyland As an employee, which is the most Stephen Ray Morris story I have ever heard now

It's all cute and fun until you get the bill sleep deprivation Bumps up the risk of us screwing up and it has an economic wallop. You ready for this? 50 billion dollars yearly in the united states just from like Sleepy sleepy. Whoopsie daisies now as for our accidents. It's estimated that 6 000 people could die annually just because of drowsy driving so Staying on your couch when you're not up to party is literally saving lives because trust me Even a skinny puppy soundtrack might not be enough to keep you alert All good people are sleeping dreaming

So those are the sort of the flips it too much sleep And it were the perception of not enough sleep or the two main things that people are coming to see us about and When did our sleep start? Really getting screwed up like has it been in the last century since we've had lights since we've had jobs in factories like When when did things start getting dysregulated? Because everyone always hears that study of like farmers used to wake up in the middle of the night for three hours And then they piece out like what are we how are we supposed to be sleeping?

So that's a great question. I think our sleep has always been screwed up Yeah, I think the farmer that you're describing. Yeah, I mean he's got so much on his plate you know Tuberculosis everywhere and crop, you know Blight and you know and money's bad and you know, so I think that they just never really thought about Their sleep. I think that as we've moved forward two things have happened one We've put a lot of barriers in front of our sleep including Podcasts that you're like gosh I should stop now, but I'm gonna listen to one more episode

This awesome podcast Allie's put together and then I'll go to bed, you know Thanks, but y'all get that sleep on dad's orders So then we have this much more technology at our fingertips I mean if I could have communicated with my girlfriend in middle school on a computer While we were both in bed and I could have watched the movie star wars anytime I wanted to I would not be talking to you today. There's no way I could have been It just would be too much for me So I think that people are trying to deal with a lot more distraction

And then also so the 24 hour culture really sort of gets in the way of us prioritizing our sleep I think a lot of people want to do the right thing They're just incapable of doing it because of all these barriers in front of us So there was a study published just last year that had tracked the sleep of 94 people in Bolivia and Tanzania Who were living hunter-gatherer lifestyles? They wanted to get a sense of pre industrialization sleep habits and it turned out Their average sleep was only 6.4 hours a night, but they were all in good health So they went to sleep about three hours after sunset and then they got up before dawn and they slept pretty well through the night

And as for insomnia Incredibly rare so much so that they didn't even have a word for it in any of their languages So how can this change your life? Now the researchers think that the sleep patterns have less to do with sunlight and more to do with temperature Which is tightly controlled in our houses. It does not match outdoor temperatures by design One article I read recommended sleeping in a room that was 60 to 73 degrees Fahrenheit, which Could help you get more restorative sleep. It's more natural. So this is I guess just another reason to bundle up Turn the heater down a skosh. Maybe keep a window open

I mean as a person who sleeps like shit and also turns hotel room thermostats up to 80 degrees. I feel personally called out I feel attacked by myself and I know this is still I feel like this is still such a basic question but what is the big difference like in brainwaves or Or whatever when we are awake and talking and functioning and like dodging things coming at our heads But then the difference between that when we're stone cold out Why does that sometimes happen in a the literally the blink of an eye? Sure. So, you know, it can happen in the blink of an eye generally because you've developed

A drive for sleep. So, you know, I always kind of compare sleep and hunger Um, if somebody says I'm hungry and I offer them well here. I've got a sandwich. I don't want you want it No, yeah, I don't want your sandwich It'd be hard to sort of argue that they're that hungry Yeah, if you're looking and notice somebody kind of looking at a trash can for something to eat They must be very driven to eat. So sleep is kind of like that. We can really enhance our drive to sleep And one of the things I always tell people is that sleep always wins. I mean If you push yourself hard enough and get yourself sleepy enough

It's not something that you really have a lot of control over and you're right It can happen in the blink of an eye when you're driving down the road Which is why a lot of people come to our clinic after there's been some sort of car accident I was driving back from the concert. I felt okay And the next thing I know I was in a median or I was in the oncoming lane of traffic Um, so sleep can sleep sleep happens. We're not in danger of not sleeping Um, I think that for a lot of when you look at sleep in terms of the wavelengths like you're talking about what's interesting is When you look at somebody's brain activity when they're awake

It looks very different from somebody who's in deep sleep deep sleep You can see the sort of the consciousness part of your brain taking a backseat to the more primitive parts of the brain We share like with an earthworm. So we have these big slow waves Which is why some people call deep sleep slow wave sleep, you know, consciousness is really suspended You know, your brain is really taking care of much more primitive aspects of itself But when you look at REM sleep, it's almost impossible to discern The brain activity of somebody dreaming versus the brain activity of somebody who's awake Really?

Yes, which is why it's really interesting people say you know, REM sleep or deep sleep They could not be more different In fact, one of the only ways you can tell that somebody's dreaming if you're just looking at their brain Is to look at their muscle tone because when we dream we're paralyzed So it's obvious from looking at a videotape. Oh, she's dreaming and she's awake. That's that's pretty obvious But to purely look at the brain's activity It's very difficult to discern and not to mention there's eye movements So these very unusual bold eye movements that happen when we're dreaming that we don't see when we're awake

But really that muscle tone is the biggest way we differentiate somebody Electrographically as to whether or not they're sleeping or they're awake, which is fascinating So when you dream you're taking the test naked and it was a test you didn't know you were going to have And your friends like we're gonna take our test and and you're enrolled in the class And my god, and even I was wondering this is my recurring dream, you know And you're sitting there taking a test or whatever you're being chased by wolves or whatever you like to dream about You actually can't move when those things are happening nor can we really regulate our body temperature, which is kind of interesting too Why can't we move like what and what is sleep paralysis?

So sleep paralysis has to do with that. So technically all of us are experiencing A quote-unquote sleep paralysis when we dream So what's happening is as we dream our brain is sending this signal down our spine That paralyzes voluntary muscles, which is really interesting. Yeah, so you're talking about creepy sleep studies a minute ago I love I use the word creepy all the time such a good word So a bemused glance from your beloved fine, but as an extended occupation It's really only fitting for stalker vampire hearthrobs or someone in a lab coat with a clipboard

I like watching you sleep it's um It's kind of fascinating to me The studies they used to sort of discern dreaming in the past were that you come in Fall asleep and we will walk around while you sleep and look at you And if we see your eyes Moving quickly underneath your eyelids and you can do like find a friend say close your eyes move your eyelids Eyeballs back and forth you can see them moving under eyelids at that point

They would wake somebody up and say what's going on and the person would wake up and say Oh my god, I was taking the test naked, you know, whatever their thing was So that's how they determined that oh wow looks like when these eyes are moving Your people are dreaming but they realized very quickly that every other muscle pretty much was not Except for a tiny little muscle in the ear There's a tiny little muscle in the voice box our diaphragms work so we can breathe and then our sphincters work So we don't have to much to clean up the next day, but outside of that everything voluntary is completely shut down So sleep paralysis what you're referring to is when people experience this they experience a

Uh recovery of consciousness before that paralysis has a chance to go away So what happens is you're sitting you go to bed and usually it's happening during stressful times in your life And when you wake up you hear the alarm clock going off But you're powerless to move to turn it off and can often feel like something's like on your chest like sitting on you It can be a terrifying experience. It usually only lasts about you know, 30 seconds a minute maybe And then it passes But for a lot of people who have those kind of fluctuating lifestyles and difficult schedules They can feel it a lot

It is a classic sign of narcolepsies if you get it a lot and you're excessively sleepy It could be a sign of that and interestingly Predominantly like in the southern african-american community They often talk about something called the witch riding you which is awesome I was just gonna say what if it's an invisible witch, but I didn't even know that was a thing So if you look at if you look at antiquity and one of the cool things about sleep is this awesome intersection between Science and mythology if you look at sleep, there's this idea of the witch riding You see they would think that a witch was literally sitting on your chest when he slept at night riding you

So I looked into this and nearly every culture has a name for this nocturnal perpetrator of sleep paralysis In scandinavian culture. It's a mare or a damned woman and in fiji. It's a demon in thailand It's a ghost in britain. It's an old hag and in eastern asia. It's a little breath stealing mouse Spain blames it on a cat, but officially the wikipedia for this is just titled casually Night hag which honestly sounds like the kind of down-to-earth self-aware lady who'd be fun to drink margues with and go to the disco Just a side note So this next aside was written and recorded in 2018 before I had read some great 2020 discourse on language and favoring the word black

capitalized Please instead of african-american and also before I learned that the term caucasian is rooted in some deep racism And now we just say white. So this next aside again from 2018 I was directly quoting stats from a 2005 study before these language updates I'm leaving it in so that we can all learn this. Okay carry on 2018 episode Now as an italian from northern california I'd never heard of this very common southern united states colloquialism about a witch riding her back But I did do a little further research

Now according to one 2005 study recurrent sleep paralysis was reported by 23 percent of african-american volunteers in the study But only six percent of caucasian volunteers and it can be linked to panic disorder So what causes panic disorder? The study states that significantly more early life stressors were reported by african-americans than caucasians And it went on to say that higher levels of psychosocial stressors including racism and acculturation May contribute to the higher rates of sleep paralysis Experienced by african-americans So just another reminder that privilege is sneaky and scientists are wonderful for turning over rocks and looking at the stuff

Because the solutions might not be right under our literal noses And a couple people have told me that the way you would keep the witch away is to keep a knife A fork and a spoon under your pillow, which is so cool I love that kind of stuff But even like you know incubus and succubus when you read about these demons that would kind of visit people During during the night They're you know feelings of paralysis or there's some really great You know renaissance paintings of these demons sitting on top of people's chests. There's one called the nightmare

And that was the thought that this thing was sitting on you, which is why You felt the weight, but it was actually the paralysis of the muscles in between your ribs Making your rib cage less easy to expand when you breathe. So it felt like weight on you. Which is really interesting Is that ever happened to you? I I don't know. I don't think so if it did it never really inspired any kind of fear now I've certainly woken up and felt kind of Incapacitated, but I don't know that I've ever had sleep paralysis. Yeah, it happened to me once and it was Horrifying it was like, oh, I'm going to happen when it happened. It happened oddly

I was on vacation, but I was on vacation with a boyfriend I broke up with shortly thereafter. So maybe it was stress, but um, yeah, he's on your chest in a weird way Oh god, he was a ghost boyfriend I was but I remember just being like, oh, this is the thing that people talk about But it just is so crazy because you feel like you're dead, but alive you feel like a ghost Absolutely. So when we talk about sleep, one thing that's fun to think about is sleep is not a light switch So we're not awake and then the light switch goes off and now we're asleep like it's a state on off It's really sleep is a mechanism in our brain

But then vigilance or wakefulness is too. So it's really two switches. So when you're awake and we're sitting here talking Our wake switch is turned on our sweet sleep switch is turned off And when we sleep vice versa now sleep paralysis is The wake and the sleep switch being turned on at the same time. Oh my god. Isn't that cool? Is are these switches kind of like instead of binary switches, they're more like levers that go Up and down like absolutely and they're affecting each other So as the sleep switch gets turned on and we start to accumulate chemicals like adenosine That is feeding back to make to make the the other switch

It's like the I don't know if you've ever been like a like a water park like an indoor water park often has this massive bucket in the middle Of it that's constantly getting filled with water And every you know seven minutes it just dumps it on everybody So that's kind of how sleep you know sleeping wakefulness as we are awake and talking we're accumulating chemicals That are making that sleep bucket wanting to tip over more and more Which is why we are a lot sleepier at 11 p.m. Then maybe 11 a.m And so what happens in sleep that is kind of like a janitorial system like I've read something about how With Alzheimer's and and other brain diseases that your brain kind of like rinses off plaques perhaps

I don't know absolutely what kind of things are we cleaning and I'm also asking you this As a way to get myself to sleep more to scare myself because I know I've got like a grimy ass brain And I'm like how can I clean this thing? That's great. Um so much to unpack there. Sorry. So yes when I was in medical school Back in the late 90s I remember the lecture on the lymphatic system with an L lymphatic was is the the the cleaning janitor. That's a great word Janitorial a system of our body. It's getting rid of waste products kind of flushing it out And I remember our lecture saying but interestingly the brain doesn't have one

And then we went on to the next topic and I remember sitting there thinking Wait a minute the most important organ of our brain or our body does not have this janitorial system So it turns out that that he in science was wrong This fantastic researcher in maryland. She discovered it. Um, and I'm blanking on her name right now Nettergaard, I believe was her name Danish neuroscientist dr. Makin Nettergaard in 2013 for anyone who just Wants to get a tattoo of a new science hero and she discovered it

She said it's hard to find because the way we we would prepare cadavers. You wouldn't see it So she not only discovered it. She named it the glimphatic system with a g um And realized very quickly that not only is it pumping out waste products But it's 10 times more active when we sleep at night than when we're awake So we've always known science is really good about knowing stuff. We just don't know why So we've always known that people who didn't sleep particularly well Often lent themselves to developing things like to mention Alzheimer's disease

So now we've got this really interesting theory that if you are the shift worker You're staying up late playing video games at night kind of abusing yourself You're not allowing your body to engage this waste removal system Effectively so the question becomes what waste product are we removing? We are removing a product called beta amyloid, which is exactly what you said the constituent of plaque In Alzheimer's disease. So if you have a busy schedule, you don't Value sleep and it's interesting because I'm getting the sense from you Reading about you and learning more about you is that you know, you kind of look at people on two different on a scale of

The horrible insomnia patient can't sleep tries like crazy desperate for sleep dreads going to bed at night And then you've got sort of you the alley the neurosurgeon, which is the person who's like, you know If I can get two hours of sleep, I'm pretty good We want you to be in the middle But we want you to find as you start getting into your 30s and 40s that middle ground of just because I can do it Probably doesn't mean I should so one major thing you can do to ease insomnia You're ready for this stop being afraid of it Dr. Winter says that the main cause of insomnia is anxiety and fear

You can see the Fiorology episode with Mary Poff and Roth for a one-two punch on dealing with that She's incredible. I mean also on the same token if you think you can get away with four hours of sleep Go ahead and try getting more let your brains clean up crew get to work. Now. What exactly what other things are we cleaning out? Other than the plaques like what how does that affect our memory and our motor coordination and like our ability to think quickly By having a like a cleaner brain. Yeah, so all those things you you mentioned are true So and you can look at science in one of two ways you look at the science that either deprived or restricted sleep Or you can look at sort of newer science where you force people to sleep longer and even just rest longer But even within sleep medicine my specialty is sleep and performance

So I work with a lot of professional sports teams not that I really care that much about athletes I don't care about them. I care about everybody. Um, I'm not sort of rabid athletic fan But what I like about athletes when you study it and you improve their sleep. We can immediately measure How well they're doing so I've never seen the the alley baseball card, you know, how's she doing? 2014 was a good year for her. She you know, she batted this she ran this she scored this many runs You know, so we're all doing things that require performance athletes We just tend to measure it more, right? So when you actually get an individual to restrict their sleep so we don't do a lot of sleep deprivation experiments anymore because they're kind of

Difficult and inhumane and frankly somewhat dangerous But even if you just restrict sleep those things to me are much more meaningful I think most people believe that if you stay up all night, you don't work that well the next day But what if you got four or five hours of sleep for several days in a row? So I use a fitbit and this was actually me All last week averaged four hours a night for an entire week I was so foggy that I confused my itinerary I missed my first flight in 10 years and then I cried in an airport bathroom out of frustration at myself

Like a big weepy cranky baby. So does lack of sleep make me a weak person though? well Physically, yes, it's been shown that you know bench press drops by 30, you know 20 to 30 pounds We make three times more attention Attention errors We have a much more impaired ability to read the emotions and cues of others Usually do these experiments where you would hear You know the person would say something like that's a great idea or that's a great idea, you know

Wow, this info is really helpful Our ability to kind of read cues to emotionally attach to other people becomes very impaired when we don't sleep Now the flip side is what if you do sleep? What if you do spend more time in bed? What if you're forced to spend 10 hours in bed no matter what sleeping or resting and it shows that people run faster They swim faster. They react to things quicker They're accuracy in terms of aspects of their life improve. They're happier They have better ideas. It's just amazing. They even lose weight. I mean, so The idea that difficulties in sleep is not affecting some part of your body is probably not true

Do you think that? depression or anxiety are related to a lack of sleep like I know that depression anxieties Are problems a lot of people face it seems like more and more so many people are on antidepressants anti anxiety medications And also our sleep is kind of kind of crappy side note asking for myself Is there any correlation with that or is what does one cause the other? I think it works both ways I I think it's not and most people who are struggling with depression mood disturbance anxiety will tell you things like If I could just sleep

I would feel better and now you set up this very vicious cycle of You know, you you're depressed. You're anxious. You're not sleeping well And that's going to feed back into making those You know depression anxiety worse and it makes you really not sleep well So there is a downward spiral that can be set up there, too But I also think the the the relationship works Oppositely, I think that individuals who are depressed And who have difficulty with mood disturbance their their disorder is creating a lot of sleep disturbances

As well as the sleep disturbances helping to facilitate the disorder I mean, it's very unusual to find somebody who has significant insomnia Who doesn't have some degree of anxiety and insomnia theory would tell you That step one in terms of developing insomnia is you have a predisposition to it. You're a type A You've got a lot on your plate and you know type A is a good thing I mean, I want my surgeon who's got to take the tumor out of my brain to be very type A. I don't want the Oh, well, you know, we'll get to it when we get to it You know, I'm gonna follow the dead this summer and you know, hacky sack flip flop jack johnson

I don't want that person I want you know the Really, you know kind of you know focus hyper focus type a attention to detail person managing my finances doing my surgeries What not so that type A tendency makes the world around be successful people have it when they start to apply that That type A to the insomnia becomes a real problem. So I think that you know individuals who are struggling with mood disturbance I think it's important to understand and have an open mind to it working in both ways Some people over is oh, I don't have depression doctor winner. I'm not anxious It's just my sleep is really messed up and they may be right

But I think it's also okay to sort of open yourself up to the idea that maybe This is also playing a causative role in it too. So there's a huge connection between those two things So lack of sleep can make you anxious and depressed according to one study Just skimping on your sleep excites your amygdala and your insular cortex Those are the parts of the brain that fire up your fighter flight response But anxiety and depression can also cause insomnia. So the primary cause of just Blinking awake in bed according to dr. Winter is anxiety Now there are secondary causes like pain that doesn't allow you to fall asleep

And those have to be addressed as a pain issue rather than a sleep issue But primarily insomnia is an anxiety issue Now my personal issue with sleep if we're going to get confessional is I learned this recently It's called sleep avoidance or sleep procrastination This is when you're tired and you need to sleep But you just keep delaying it either watching movies or scrolling or working or reading Now there are a few causes of this one might be workaholism and not being able to admit that the day is done Hem or it could be loneliness and scrolling helps you feel connected to others

Also, I do that or even a busy day tending to a lot of people can leave you needing alone time and staying up Well past what is prudent is the only way for some people to get it. So hypnosis like yo This is why I hang out in a cave in Hades. Nobody bugs me So what are better sleep habits? The cdc has some hot tips centers for disease control Who apparently considers not sleeping enough kind of a disease says be consistent go to bed at the same time each night Including weekends if you can make sure that your bedroom is quiet dark and relaxing and at a comfortable temperature We've learned colder is better. Who knew remove TVs computer smartphones from the bedroom the cdc says to throw them into the simmering caldera of a volcano

If you have one also avoid big meals and caffeine and booze before bedtime We all kind of know that we're supposed to do those things I'm trying to shift the way i'm thinking about sleep to thinking of it as a free thing You can do to make your brain sharper and your skin glowier and your future less addled with disease So if sleep hygiene were a thing you could buy And just not do we would all be so pumped for it We would amazon prime this shit out of it, but really it's just a behavior. So we have to see value in the behavior How much does sleep hygiene affect how much you actually sleep like when you have to prescribe sleep hygiene

What do you tell people to do? Yeah So what I would say about sleep hygiene is this the media focuses a lot of attention on sleep hygiene Because it's sort of a digestible little bite-sized nugget Hey having trouble sleeping make sure your room is this temperature and here's a study that shows that great moving on to the next topic or You know, whatever so sleep hygiene is great. I would say that in terms of its ability to solve a problem 20% so I would say of the people out there who is struggling with their sleep That 20% of people if they did something related to sleep hygiene could make their problem, you know much better or solve it

And what I mean by that too is also the idea that It's sort of like knee pain if you're a runner, you know, my knees starting to hurt So what are you going to do? You'll take some ibuprofen. Maybe you'll buy a brace at cvs You'll ice it. You'll take a couple days off. You're running. Well, you know If you're doing all those things and still hearing this clicking sound and having this excruciating Pain in your knee eventually you're going to say I don't know that this is within my Ability to solve you go see a specialist. They do an MRI. You've got a big piece of carlet sticking into your joint So to me that's sort of the sleep hygiene is we sort of have this message out there

That every one of your sleep problems is solvable if you just get the right mattress and the right pajamas and the right noise machine and the your Earplugs and and those are all fine. I just think that for the other 80 percent of people It's very anxiety provoking that you've invested in the $5,000 mattress You've got tom brady's, you know special pajamas that he wears and my god He's a quarterback married to a model. So it's got to work without the sleep Where I don't really feel like I would be able to achieve the things that I have done it You know, and you got all this stuff going on and it's not working. I think that creates a lot of anxiety

Sort of like where I'm hopeless like nothing worked. I've read 20 different books Which is why I didn't put a lot of sleep hygiene in my book just because I thought I think we all know these things now. It's kind of getting to the point of common knowledge You know, oh what not having the tv on really loud all night long. That's not good. Okay, you know, if you if you If you're surprised by that Where have you been? Um, so anyway, um, so I think sleep hygiene is important We want to set the stage for good sleep. We want to have positive thoughts about sleep like sleep's great I mean, we shouldn't be dreading it or fearing it. I think it's even strange to be kind of neutral about sleep

I mean I mean neutral about brushing your teeth, but sleep. Ah, it's the best thing in the world to get in bed And you know what not and um, so I think that we need to cultivate that attitude But understand that it has its limitations And now how dark and quiet should your room be though? You know, again, I I think that if you're struggling with your sleep Really dark and really quiet. Um, you know people ask about noise machines or things like that I mean, we're always going to sleep better in a quiet environment. So Um, and our brains pay attention to sound so if somebody says well, I really like listening to a podcast when I go to bed at night

That's fine. But maybe you could set it. So after 15 minutes, it turns itself off Um, dark rooms are really important. My parents. I think I talked about this in the book my parents Like redid their basement when I was growing up. We had this like unfinished basement They they finished it themselves and kind of did it, you know outside the you know the the law I think, you know, so one of the bedrooms the bedroom down there has no way to get out So it's like surrounded by earth on two sides and there's a door, but there's zero window. It is incredibly dark Incredibly quiet incredibly cool And I remember going there like when I would come home for like college breaks and falling asleep in there

And waking up at noon, you know and being like, well, what time is it? No, like where have you been? Yeah, I you know so even the smallest little bit of light coming in through a door or underneath a blind Can can really impair our sleep So side note We're going to get all into blue light and how it affects sleep in next week's part two Also stick around to this episode after the credits and I'm going to tell you And only a little bit gross secret about my eye mask. Anyway sleeping with the lights on very confusing to your brain So if you're a shift worker, you know, especially and you're sleeping a lot during the day

You want that room to be so dark that you cannot see your hand in front of your face And quiet maybe with earplugs and quiet and if you can't do that then you know, like I said earplugs or a mask over your eyes Is probably this is good and in your book you mentioned it's okay to not sleep in the same room as a spouse or a partner It is I mean I always I'm a doctor who practices in virginia So I consider that the south and you got to be very careful about the way you Speak to people They always give you that look like you're trying to steal my wife. Like, you know, it's got It says look like no, and it's you know, I

So I have I think sleeping with somebody is fantastic. I do find it sort of strange that we have evolved to do that like I you know, I don't Necessarily feel the urge to do other things like let's sit in the same chair honey and eat this from the same plate You know, it's okay to be like you sit over there and eat your thing. I'll eat over here There's a lot of things we do separately. Oh, you do it over there. I'll do my thing over here Even our bathrooms have two different sinks sometimes, you know, you You know, uh, so I do think it's funny that we've evolved to kind of create this thing that we need to

Sleep in the same bed and maybe it was evolutionary that you know houses were small You were conserving heat there are things of that nature like that, but you know, I think that you can love somebody intensely And not be in the same bed with them Or you know what I always tell people is some things that's a little bit more palatable for some couples is Let's pick thursday Thursday will be the day we watch handmaid's tale But then we sleep separately so we can consider what that means in terms of society

Independent of one another and over breakfast we'll talk about the episode and how we feel about it I was asleep before that's how we let it happen You know or whatever. So so that way there's no guilt. It's like, oh, it's thursday night We're gonna sleep separately and that's kind of fun to get back together on friday night, you know kind of thing Um, so when I was on call as a doctor, I would always sleep in the basement in a guest bedroom that had a window by the way Um, and I know my wife was secretly thrilled when I would not be there You know, she can stretch out and somebody's either not moaning or pagers going off and whatnot. So I think it's okay. I mean somebody says look, I really like sleeping with my partner

I don't want to sleep away from him or her. That's perfectly fine. But I think it's also it's you are We are capable of loving somebody and not be in the same mattress. I think Do you maybe just save some marriages right there? Yeah, we've got a sleep-cation. I think my wife came with that word It called a sleep-cation. It's kind of exotic like oh when what they're up to tonight And you know and I always tell people you know, you can get in bed and read and maybe fool around And then when it's time to sleep, you know kind of do the thing like well I'm going to leave now and and it doesn't mean you don't love them or want to be with them And my wife hates me being anywhere near her at night

And I for some reason kind of gravitate over to her side of the bed and she's like get away You know, you know, I just don't want that and just I don't mean I don't think I don't think it means she doesn't love me Um, but you know, I think that the people just need to sleep and do what's right for their sleep And not necessarily have some you know guy Breathing and hanging over top. You know, I think it's probably a good thing And if you do this side note, you're not alone I read one study that said almost 14 percent of couples who live together sleep apart Mostly because it's snoring and I read this one tip that said

Sleeping on your back can cause snoring and you can wear a t-shirt with a pocket backwards And put a tennis ball in the pocket to train you not to sleep in shivas in a corpse pose Now if it works or if you have wimbledon nightmares, please let me know Now what about naps good or bad I so my definition of so I think a nap is good If you're an efficient sleeper what I mean by that is If you're somebody who gets in bed falls asleep in a time that's that's that's pleasing to you You sleep relatively well and then you still feel like you need sleep on top of that

I think a nap is a great thing, you know If you can build it into your day at a designated time and have a little place where you can do it That's kind of special and I think that's great. I think it's a bad idea when somebody says I went to bed last night I was really upset about a decision on the voice And I can't believe they sent her home because she's so much better than that guy Who's saying doc of the bay for god's sakes and he got through seeing doc of the bay. I don't believe it And she completely reworked that christina or anyway i'm digressing so you're really upset about that thing and and um You go to bed and it takes you three hours to fall asleep

You know you were up all night because of that you can't believe the decision And then you take a nap the next day Because you couldn't sleep last night now you had the opportunity to sleep But for whatever reason your brain decided it didn't want to I think that's a dangerous path to go down You see that a lot with retired people and there's no kids in the house anymore I love old people they can get up at three o'clock and more if they want to they can go to bed six o'clock after mcneil lair If they want to they can do whatever the hell they want to they've earned it for god's sakes But the problem is when they have no sort of constraints on their sleep

If they have a bad night But they just sleep in or take a massive four hour nap right before you know at five o'clock in the afternoon And now it's 11 o'clock they want to go to bed. They can't Now they're frustrated and so the cycle sort of begins So I think napping is great try to keep it relatively short 20 25 30 minutes closer to the beginning of the day So we're adding on to last night not subtracting from the upcoming night And I think naps are great. I mean there's such a such a wonderful thing to You know kind of sleep at a time when you're not supposed to

I think it's also interesting to pay attention to how you fall asleep when you nap meaning I've got a lot of people who it takes them four hours to fall asleep at night And they feel completely dependent on sleeping pills But they'll say things like I was you know sitting the other day It's hard for me to you know, I come up from church. I'm so exhausted. I take a nap and I always ask him Well, what what pill do you take to take your nap after church and look at you like oh, I don't take a pill then Well, why do you think it's you're able to fall asleep after church? But you're not able to fall asleep 11 o'clock when you want to go to bed and it's always interesting the answers

They give you you know because we think of nap as being this sort of extra credit You know teacher gives you some problems and the last two problems on the test are extra credit Well, I've got some time. I'll do it no pressure and you to get those right Because it's like if you get them great if you don't it's not that big a deal It's extra credit naps sort of like our sleep extra credit, you know, it's bonus sleep But boy, you know the final exam is our sleep at night We got to sleep now like we want to kind of get out of that place That's not a good place. So the anxiety of sleeping doesn't let you sleep doesn't let you sleep

And so we don't want to we don't want nap to facilitate the process So to recap naps are fine, but not if they mess up your bedtime So do it earlier or just save that sleepiness for sweet sweet night slumber Now if sleep is an issue for you or for someone in your life Maybe take like a nerdy approach first and just gather some data And so what is the best way to track it because knowledge of your sleep will probably Motivate you to get better sleep our Fitbit trackers good. Should you wear like a headband with electronics on it? Should you just try to keep a journal next to your bed like what's the best way to figure out if you're getting enough?

So all those things are good. I think the personally the best way to figure out if you're getting enough sleep is to Look up either in my book or online something called the epworth sleeping scale So I was hoping that this quick test was named for like a lord epworth The duke of naps who fell asleep playing croquet But it was actually coined by an australian dr. Murray johns for the hospital that he works at Okay, a little bit of a snooze bust on that backstory. Anyway, you can take it at epworth sleepiness scale dot com I myself scored an 11 mild excessive daytime sleepiness now dr. Winter explains what this scale is

And which is a series of scenarios that you might find yourself in and the question is how likely would you fall asleep if you were in that situation How likely would it be for you to fall asleep reading a book watching television? Passing you in a car for an hour If you're answering the question all the time always fall asleep can't read because I fall asleep as soon as I start reading I really can't sit down the evening or I'll fall asleep That's a probably a good indication that you're not getting enough sleep or there's something wrong with it So I think all those modalities that you mentioned sleep diaries Fitbit tracker i'm wearing one that's made by nokia, which I think is outstanding because it uses movement and some

heart rate variability all those things are great You just need to understand sort of what they're built to do and what they're not built to do But they're they're a great way all these things do such a good job of keeping us honest about our sleep I mean I would go around tell people I get seven hours sleep at night Go better on 11 o'clock get up around six Which is such a lie like when I started wearing these I wore several trackers on my arm for a month to see which ones were good and not so good And then I did a sleep study of myself on the last night

Wearing all of them to see how they compared to the actual sleep study And the thing I learned the most about that process was what a liar I was about my own sleep, you know And not even knowing that I'm I'm not deceiving people intentionally. It's just that Yes, ideally I would like to go about 11 to get up at six, but my son swims so he's got to get driven to the pool early or Stephen Colbert looks really funny So I'm watching some of his monologue and by the time you get the dog put away And I you know get some water and kind of get things turned lights off for my wife

She's falling asleep on the couch check on the kids. Oh god. Check one more email and see what's going on here It's closer to midnight or even later sometimes So I think those things do a very nice job of kind of keeping us honest about How much sleep are we really getting? And I think that can be a very invaluable first step in terms of solving a problem But I do think that there's a lot of questions You can you know, do you sleep well at home versus at your girlfriend's place? Do you sleep better after a bunch of beers because you feel like you do versus when you don't drink?

And I think you know posing a question to something like a Fitbit can be really interesting Um, I'm really on an exercise kick. Let me look how my sleep looks now Versus a few weeks ago before I started. Oh, wow. It looks a lot more efficient Or I seem to have more deep sleep or I fall asleep a lot faster Generally they work best when you're comparing data to itself like your own data Pre this guy. I'm dating post this guy. I'm dating pre this supplement. I'm taking post. That's where it tends to work its best. I think and If in general of someone saying I'm having trouble sleeping. I'm having trouble falling asleep

I'm having trouble getting the right amount of sleep Is there like a one basic piece of advice that you're like start here and see if that helps Yeah, it's interesting. I think if somebody says to me, I'm having trouble sleeping They've already sort of moved past the biggest barrier Which is the person who comes to me and says I can't sleep Dr. Winter says that a lot of times we're getting a little more sleep than we think we are because if you literally did not sleep You would not be alive. Wait. What's the record? I mean the world record is something like 11 days and even that was a sham

The investigator said we couldn't keep him awake. He kept having these little micro sleeps Even when he was standing on his feet So provided that we're not seeking the world's attention by not sleeping How much should we sleep a lot of people are seeking 10 hours of sleep at night But they're only capable of getting six hours and 45 minutes So that difference of three hours and 15 minutes. I think is insomnia Um, it's also important to make sure that there aren't things that are happening within your body That are impairing your ability to sleep as well, too

Uh, that can be something from this insomnia to restless leg syndrome to sleep at me There's a lot of things that happen at night that can't impair our ability to sleep And how necessary is a sleep study usually? Is it like go figure out what it is? I mean, I really work hard to keep people out of a sleep center. I think most You know, we learn as doctors most of the Diagnosing and treatment of problems has to do with the clinical interview So that's why we spend a lot of time talking to our patients because we need to understand what the problem is You know, the sleep study

Is often Confirmatory like I already think this is what's going on So we'll do sleep study to confirm it or sadly in 2018 a lot of times the study is done Because that's the only way you can get insurance to pay for something. They won't take the expert's word for it They want proof that this person has narcolepsy. They want proof this person has restless leg syndrome Even though clearly from their story, that's exactly what's going on so not everybody who has a sleep problem needs a sleep study and Of the people who need sleep studies many of them can be done in your own home with these little simple devices so

Don't let that be a stopper in terms of getting help But you know when they're necessary they can be incredibly helpful So sleep studies can be a great ally in terms of convincing doctors that you do indeed have a serious issue They can also be a little bit like mr. Snuffle up against and if insomnia is caused by anxiety in your life Taking a break and sleeping in a hotel room like environment can be just the vacation You need from your usual mental anguish even if you have a bouquet of wires taped to your face So if you want to start small you can jot down the hours you sleep, of course Or you can try a sleep tracker

I bought my Fitbit at bed bath beyond with one of those 20% off coupons that my neighbor left near the mail boxes for a week And it's been a nice gaze into the underworld of my sleep issues Now tune in next week for part two which features more remedies to your sleep issues patrons wrote in with over 200 questions We got to as many as we could we covered sleeping pills supplements genetic factors in sleep blue light

making good habits stick alcohol to get you drowsy sleepwalking sleep talking the best positions for snoozing and of course my mom birthday girl nancy wards Magic cure for insomnia that I use all the time when I've had too much caffeine or at 7 p.m But I have to go to sleep to get out for the airport. So all of that is next week So make sure to come back the extra hour or so for part two could add years Back on to your life now. Meanwhile. Dr. Chris winter is at sports sleep doc on twitter And his book is called the sleep solution

Why your sleep is broken and how to fix it and he also has a kid's sleep book that came out in 2021 called the rested child why you're tired wired or irritable child may have a sleep disorder and how to help So just fyi. That's another book. He's got now. You can follow oligies at oligies on twitter and instagram I'm ali ward with one l on twitter and instagram too Um, you can get a comfy oligies t-shirt to sleep in at oligies merch.com Thank you shannon feltas and bonnie judge for so many great designs that are up You can join the oligies podcast facebook group, which is just a haven for benevolent and curious nerds on facebook I love each and every one of you in there. Thank you erin talbert for admitting

Thank you to editor steven ray morris for losing sleep piecing this all together each week A nick thore burn of the band islands wrote and performed the theme music And now at the end of each episode. I tell you a secret and this is part life hack and part you but Okay, so sleep masks always annoy me. They fall off the velcro gets stuck in my buffalo hair And so a few years ago I started using a sock You take a knee-high sock mine have all been worn on my feet before I just don't care I wash them anyway take a knee-high and you pin it in a big loop like a snake eating its butt Put a safety pin in it and then you pop that thing on your head and it stays all night

It is weird if you begin dating someone and you're like good night I'm putting this old sock on my face now So if you're crafty you could probably artfully sew it together If you don't have knee socks invest in a pair wear them on your face Bonus if you lose one you have a spare and they're very machine washable So if you do this, please take a photo for me and tag it Hashtag ology sock face. I promise to post one also Also, hi, it's 2022 Ali Ward again. Just saying thank you for bearing with these encore episodes

The last couple weeks of my life have been maybe the hardest On friday if you've been following along with what's been on with my family. My dad had emergency brain surgery for a brain tumor Um, he also has some lung tumors and some other things that are not great Um, and on on friday, my dad's oncologist made the call that it is time for treatment to stop and so we're just starting hospice and um, which is why i'm whispering at my sister's dining room table So while you listen to these on core episodes, just know that you're just letting me have some of the most uh

The most precious time of our lives. So we are spending time as a family and just hanging out and Thank you for that. Thanks for being um, so Patient and supportive and all that and thank you for everyone who's been sending me sweet messages Okay Go get some sleep. Okay. Just go get some sleep. Just You have earned it for bye

Meteorology Sleep yes, I sleep