Ten Percent Happier with Dan Harris - 268: How to Get Sleep in Anxious Times | Dr. Donn Posner

Episode Date: July 27, 2020

I don’t know about you guys, but my sleep has suffered quite badly during the last few months. Today’s guest really got me thinking about this issue in a whole new way. First, he normalizes the sleep problems many of us are having. If you’re sleeping poorly right now, he says, don’t freak out; it is natural and normal. Second, he has a bunch of tips for how to deal with insomnia, some of which I had never heard before and am already starting to operationalize in my own life. His name is Donn Posner. He’s one of the leaders in the field of Cognitive Behavioral Therapy for Insomnia. His titles are: Founder and President, Sleepwell Consultants, and Adjunct Clinical Associate Professor, Department of Psychiatry & Behavioral Sciences at Stanford University School of Medicine. Not only did he answer all of my questions, but we also played him some listener voicemails. One last thing to say before we dive in: our episodes this week have a theme: primordial needs. Today we’re doing sleep; Wednesday it’s sex. So it’s a fun week here on the show.   Where to find Donn Posner online: Website: https://www.sleepwellconsultants.com/ Books: https://www.sleepwellconsultants.com/publications   Today is the first day of the Summer Sanity Challenge: a free 21 day meditation challenge. The goal here is to help you build resilience so that you are less buffeted by circumstances you can’t control -- and are therefore calmer, happier, and better prepared to show up the way you want to for your family and your communities. To join the challenge, you can visit tenpercent.com/challenge.   Other Resources Mentioned: Society of Behavioral Sleep Medicine: https://www.behavioralsleep.org/ American Academy of Sleep Medicine sponsored site to search for local accredited sleep centers: http://sleepeducation.org/find-a-facility   Additional Resources: Ten Percent Happier Live: https://tenpercent.com/live Coronavirus Sanity Guide: https://www.tenpercent.com/coronavirussanityguide Free App access for Frontline Workers: https://tenpercent.com/care   Full Shownotes: https://www.tenpercent.com/podcast-episode/donn-posner-268 See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Before we jump into today's show, many of us want to live healthier lives, but keep bumping our heads up against the same obstacles over and over again. But what if there was a different way to relate to this gap between what you want to do and what you actually do? What if you could find intrinsic motivation for habit change that will make you happier instead of sending you into a shame spiral? Learn how to form healthy habits without kicking your own ass unnecessarily by taking our healthy habits course over on the 10% happier app. It's taught by the Stanford psychologist Kelly McGonical and the Great Meditation Teacher Alexis

Santos to access the course. Just download the 10% happier app wherever you get your apps or by visiting 10% calm. All one word spelled out. Okay on with the show. Hey y'all is your's your girl, Kiki Palmer. I'm an actress, singer, and entrepreneur. I'm a new podcast, Baby This is Kiki Palmer. I'm asking friends, family, and experts, the questions that are in my head. Like, it's only fans only bad,

where the memes come from. And where's Tom from MySpace? Listen to Baby, this is Kiki Palmer on Amazon Music, or wherever you get your podcast. I'm from the Bronx by the way. I'm not shy. You're not going to scare me. I can tell I got that vibe from you right away. You're not a sleepy sleep expert. No, no, this should be fun. From ABC, this is the 10% happier podcast. I'm Dan Harris.

Our guest today is quite a character in a good way. We'll get to our sleep expert, Don Posner, and a second first one item of business today is the first day of the Summer Sanity Challenge. It's a free 21 day meditation challenge. If you sign up every day of the first day of the Summer Sanity Challenge. It's a free 21 day meditation challenge. If you sign up every day of the challenge, you'll get a short video followed by a free guided meditation. The goal here is to help you establish or reinvigorate your meditation habit.

You can do this solo or you can invite friends and family and track one another's progress to join. Visit 10%.com slash challenge. That's 10% one word all spelled out.com slash challenge. Of course, the link will be in the show notes. All right, let's get to our guest. I don't know about you guys, but my sleep has suffered at times quite badly during the last few months. Today's guest really got me thinking about this issue in a whole new way. First, he normalizes the sleep problems many of us are having. If you're sleeping poorly right now, he says, don't freak out.

It's natural and normal. Second, he has a whole bunch of tips for how to deal with insomnia, some of which I had never heard before, and I'm already starting to operationalize in my own life. His name is Don Posner. He's one of the leaders in the field of cognitive behavioral therapy for insomnia. His titles are founder and president of Sleepwell Consultants and adjunct clinical associate

professor, department of psychiatry and behavioral sciences at Stanford University School of Medicine. Not only did Don patiently answer all of my questions, but we also played him some listener voicemails from you guys. One last thing to say before we dive in here, you'll notice over the course of this week that our episodes this week have a theme,

which we're calling primordial needs. Today we're doing sleep Wednesday, it's sex. So it's a fun week here on the show. Stay tuned for all of that. First, it's sleep and Don Posner. Here we go. Great to meet you and thanks for doing this. I appreciate it. Sure thing. Good to be here. You gave a talk recently that got some attention deservedly. Hopefully you'll get now more attention now that we're putting you on the show about a cute insomnia. Yeah. Can you tell us what that means and why you're worried about it right now, especially? Let me clarify a couple of things.

Let me maybe work backward. The best way to define acute insomnia is to define chronic or long-term insomnia, which we in the field called insomnia disorder. And the way we define that is that a person is having trouble initiating sleep to begin with. Or they wake up in the middle of the night and can't get back to sleep. Or they wake up sort of at the end of their night and never get back to sleep. And so those are really three flavors of insomnia, if you will, beginning middle and end. We like to say chocolate vanilla strawberry and then there's neapolitan, which is a mixed bag, right?

So that's in Somnia. If that is happening and we say, what's a problem with getting to sleep or staying asleep? If you take longer than 30 minutes to get to sleep on average, if you are awake for some combination of 30 minutes in the middle of the night or you wake more than 30 minutes earlier than your desired time, if that's happening three or more nights a week for longer than three months and you have associated daytime symptoms, that's insomnia disorder. And I want to underscore that last piece, which is it's really a 24 hour disorder. It has to have impact on your day for us to say that this is really an insomnia disorder

problem. You have to have something like fatigue, sleepiness, concentration problems, performance problems, and so forth. So chronic insomnia is those symptoms more than three months. So now going back to your question about acute insomnia, acute insomnia is all of that less than three months. When I give talks and when I ask the audience how many people here have ever had a bad night's sleep. I know I'm going to get a laugh and 100% of the hands go up.

We've all had that experience and all of that is normal and nothing to concern ourselves about. And we don't even talk about anything as diagnostic as acute insomnia until we get to at least three days. But then anywhere between three days and three months is considered acute insomnia. And that means that you're having those problems either initiating or maintaining sleep. And you may or may not have daytime symptoms yet. And it's usually due to some stressor. And we say anything from the biopsychosocial spectrum.

I now say to my trainees, you could probably open the dictionary, put your finger down on a word, and find something that causes insomnia. Whether it's an illness, a physical pain, a change in your environment, a psychological stress like stress at work, tax time, those sorts of things. And I also hastened to add that the valence of that does not have to be negative, right? Change is stressful. So getting married and getting a new bed partner in your bed can change your sleep patterns. Having a child is a good recipient for an acute insomnia until you can get that kind

of straightened away. The thought process is absolutely very much that that's a normal reaction to stress, maybe even a good one because if we go back evolutionarily speaking, sleep is a dangerous activity, right? If you're asleep, you're vulnerable. It must be important for that reason, because every species does it. And so it must provide a very important function, but it's dangerous. So we always say that sleep is deferred when the lion walks into the mouth of the cave, right? And therefore we could say that acute insomnia is adaptive, if you understand.

So even now in our culture, it's adaptive in the sense that you're making changes, you're trying to deal with whatever is coming down the pike. But we always expect that if you then adapt appropriately or the problem itself goes away or you get on some medication or the stressor itself remits, then we expect the acute insomnia to remit. And so all of that we consider to be normal. And it is for a smaller subset, but yet epidemic numbers that sort of gravitate

into this chronic insomnia realm, which is where people like myself and my colleagues come in in terms of helping people to treat that. If I've heard you correctly, chronic insomnia is a big issue. You've dedicated your life's work to addressing it. Acute insomnia makes sense given what we're all living through right now. In some people, it will escalate to chronic, and that's the source of your big concern right now.

A hundred percent correct. So what could be causing a, you know, more acute insomnia now than in normal times? Well, we're all more under stress. We're under stress for a lot of reasons. We're under stress because of the disease and everything that goes along with that. What goes along with that?

Worries about our own health. Worries about our children's health. Worries about our elders health. Worries about ourselves getting the disease. But we're also concerned about the mitigation attempts we're making, at least some places, we're doing it well. We're concerned with loss of job, loss of revenue,

loss of our business. I can't imagine the person who's sleeping well through that. So again, I say, and we'll come back to this later, but the first thing with regard to acute insomnia is don't panic. It's normal, okay? There are lions in the cave, so to speak. There are lions in the cave is exactly right, so we should not be surprised. That said, in addition, not only do we have, are we faced with a tremendous increase in

the amount of stress to a vast swath of the population? We can really say this is now worldwide. It's also the case that the mitigation attempts threaten, potentially threaten our sleep. And let me come back to potentially at some point, but potentially threaten our sleep because of the changes we make in our day. As we go more into this and talk more about this today, Dan, I hope people will learn that one of the major things that keeps your sleep healthy is structure. And we are sort of most of us forced into a structure by our work and school day lives. And now that's gone for many people. So if you get to work from home, that's terrific.

But it also gives you the possible opportunity to throw structure out the window. One of the places we often see what we call a precipitant of acute insomnia and eventually chronic insomnia is retirement. And it's sort of the same thing. We've all been forced into this, well, you know, no need for that clock in the morning anymore. That in and of itself can potentiate acute insomnia. So we have all of these reasons for that. And again, none of that is of concern because especially the stress itself, I think we're kind of seeing it happen where we're adapting as best as we can.

It's a little bit of a moving target, but people who have now been working from home. I know at one point I tried to get a monitor from my computer at the store and I couldn't find any because they were all gone. Everybody's got monitors now at home. Everybody's learned to kind of create their home office. They're adapting better and better and better. It might be for those that kind of say, gee, this is kind of working okay. It's not what I prefer, but it's working okay.

We could imagine where they automatically, just on their own, start to sleep better. But there is this possibility that those that have thrown away a lot of what we would call good sleep health inadvertently are at more risk for chronic insomnia. And those that for anybody who gets an acute insomnia, those that begin to make a shift. And while I say acute insomnia is up to three months, myself and my colleagues would start to say that even one month or so to three months starts to get into what we

might call a sub chronic condition where we're starting to see this transition or this shift, where not only is the stressor, the problem, the stressor du jour is what you are concerned with, but you also are now starting to shift your attention to the sleep problem itself, if you understand what I'm saying. And that creates the potential for a vicious cycle and changes in behavior that serve only to make sleep worse and more chronic. And so that was sort of the line that when I was giving that talk, I was kind of saying, let's at least think about acute insomnia and what we might do in that phase of acute insomnia

to prevent the epidemic of chronic insomnia that might follow the pandemic. So what could we do to prevent this epidemic? What's on the list? Without getting too sciencey about it, let's understand that, as I said, there's an importance to structure. And if I was going to start that conversation, the place I always start is the single most point of important

structure there is and that's wake time. And so we all understand, most of us know that we have this internal biological circadian rhythm. And there are a number of bodily functions that fluctuate in a 24 hour basis, like hormone secretions and body temperature and so forth. But for the sake of our conversation, what we're looking at for a circadian point of view is sleep wake rhythms. And that rhythm is held in check is what we call entrained. The way to think about it is how do I get that clock to be well set, to chime when I want

it to chime and not to chime when I don't want it to chime. The single most important point of data of input into that clock is wake time, which is also a proxy for my first exposure to daylight and light exposure. And so getting up at the same time, at least most days a week is important. Okay? If you are someone who has now thrown the clock out, and some days you are getting up at six, and some days you are getting up at seven,

and some days you're getting up at eight, and nine, that is what we call social jet lag. So imagine if you will, just anybody listening has to just think, what would happen? And I'm based in the East Coast right now, so I'll take an East Coast reference. But what would happen if you flew from the East Coast to the Midwest, to say from New York to Chicago, and stayed overnight for one night and flew back to New York, and then stayed one night, but the very next day flew to Denver. And then stayed there one night and then flew back to New York, and then the very next night, but the very next day flew to Denver, okay? And then stayed there one night and then flew back to New York.

And then the very next night flew to Los Angeles and stayed there for a night and flew back to New York. How would you feel, Dan? I'd feel like a working journalist because that's what I used to do all the time, but it feels crappy. It feels crappy is the perfect word. It feels crappy. And that crappy is the perfect word. It feels crappy. And that's of course jet lag.

But what I want people to understand is that you can feel that same what we'll call social jet lag by varying your times in the morning just as much. So if you're not already having trouble sleeping, you don't have to be heavy-handed about it. When I'm working with patients and trying to write their sleep, I talk about getting up at the same time seven days a week to fix the clock.

But I will always tell them is a well-oiled clock, if you will, doesn't require quite the same amount of consistency as a broken clock to fix it. So the well-oiled clock, we will usually say requires what we've seen in most people, which is five days a week. Most of us get up around the same time every day, five days a week. And a couple of days, usually on weekends, we do it a little differently, and that doesn't throw anybody into a tizzy.

And so if you're already not having problems sleeping, all I can recommend is get up at the same time, five a week and largely go to bed at the same time or after if you're not sleepy five days a week because that will help maintain good circadian entrainment and good circadian rhythm. Now add to that any other regularity in our lives can add to that circadian entrainment. So regular meal times as opposed to grazing on a, you know, random schedule, regular exercise times, going back to some structure in your life, take a walk at the same time every day, do things like that at the same time every day, maintain your activities during the day, try to get out and be active.

Activity helps sleep. And nothing begets lethargy like lethargy. So sitting around and doing nothing is not a great idea either. We are diurnal animals, which means we're not raccoons. We don't forage for food at night. We do our foraging and our work during the day. So most of us should be on a daytime schedule. We should be eating our work during the day. So most of us should be on a daytime schedule. We should be eating our meals during the day. Our activity and work should be during the day. And as we transition at a night, we should make that transition into lower levels of light.

We don't have to be sitting in the dark, but lower levels of night and also transition our activities. We probably should not be working right up until bedtime. We should not be letting our difficult child, who lives on the other side of the country, call us at 11 o'clock at night with their problems. We should set a limit for that and transition into quieter, more relaxing times, at least an hour or two before bedtime. Those are just some good health tips for people who are already sleeping well. I'm staying away from the typical sleep hygiene, bed room environment.

Those are always in place and should be in place. We can talk about those later, but in terms of right now, what do you really need to focus on if you're home and not working and don't have that structure imposed upon you? I can say that, you know, we probably, for most of us, that now you might be able to nap a little bit. And napping is not bad. The problem with napping is there's a right way

to nap and a wrong way to nap. If you feel like you wanna build napping in, you can, and we can do it the right way. If however, you foresee that soon you're going to be going back to work, keep in mind that when you napping, when you take a see-esta during the day, as many cultures do, that you are reinforcing your internal clock for wanting that nap at that time of the day. So if you think in like even a month you're going back to work and can't nap, you're probably best off trying to avoid that nap during the day if you can at all help it.

If you do nap, whether because you want to now just build that into your life. As many, for instance, retired people might do, or you just can't help it because you're having a problem with sleep at night, you're trying to compensate as little as possible. So if you are going to an app, the ideal time to an app, we all know we have this little dip after lunch, this post-prandial circadian dip in rhythm. And that's a normal function. That's as it is expected to be. It's biological, it's programmed in. It's a time when our drive to sleep

has already been built up somewhat by half of our days activities. And yet our circadian rhythm is going into a little bit of a low. So that's the best time. And that is something like seven to nine hours after you wake up in the morning or habitual wake time. And a short nap, 20 minutes, and set an alarm to wake yourself up is much more preferable, so-called power nap, to sleeping for an hour or two. That's going to rob you again of more sleep the next night. And it is going to leave you feeling a lot of sleep inertia when you wake up. That's going to rob you again of more sleep the next night. And it is going to leave you feeling a lot of sleep and inertia when you wake up. You're going

to feel worse when you waken from that nap than you did going to sleep. A good short nap will carve off just enough sleepiness. And then you're circadian rhythms, alerting signals are kicking back in anyway, that it's going to give you a nice stepping stone for the day. I think I got all of those notions that you just listed. There was one thing though that you said, it was what you led with that I'm still a little curious about, which is you said, wake time is the sort of Apex predator of Leverage you can pull that mixing my metaphor horribly here, but anyway, okay, wake time is super important Let's just put it more colloquially. I'm having a hard time disentangling that from

Bedtime wouldn't that be the more important input? No, it really is wake time with regard to what with that daylight exposure and bedtime and when you feel ready for bed is determined by when you first get that light exposure in the morning. So you should set an alarm, figure out what time your body normally wants to wake up and then ensure that you are waking up at that time regularly with an alarm if need be, and then back timing your bedtime to that. Yeah, when you say back timing, that's an interesting story because the question is, how many hours does sleep do you need? Okay.

And I don't think most of us in this country know how much we need. That is each individual. But if you think you're good at knowing what you need and you are going to do that, yes, exactly what you said is what I would do. What time do either need to wake up in the morning or now want to wake up in the morning and then backtrack from that for the amount of hours you think you need? So, if I'm having trouble sleeping and by the way, I've definitely fallen in the chronic insomnia category. So just to say that, and I know you can't

and shouldn't be giving clinical advice here. So if I'm either chronic or acute insomnia, and I wanna work this first piece of advice that you gave about wake time, to operationalize that, I would think about what is the wisest wake time and then set an alarm to get myself up. Yes.

And then impose some discipline on the front end around bedtime so that I'm getting enough sleep. Yes. To hit that, okay. Yes, and the bedtime is also then not a curfew. I'm not saying you must then go to bed at that hour or else. What we're really saying about bedtime is if in a 24 hour day, you think you need seven hours and you're waking up at seven, then bedtime is roughly around midnight and you shouldn't

go to bed before that. And again, you started to make a transition I hadn't yet made, but is reasonable to do at this point, which is first, we have people who are already sleeping well. Should they maintain some of this structure to maintain that wellness? Yes. If you are starting to have a problem, now you should absolutely be doing those things to kind of get yourself back on track. And the second rule I would put on, wake time being structured and bedtime being structured

is don't compensate for a bad night. And that goes along with rule number one. If wake time is wake time, if it's seven o'clock, it should be seven o'clock, the fact that I was awake for two hours in the middle and I doesn't mean I should now sleep till nine, it will just make it more likely that I'm gonna have more trouble down the road.

Okay, so the rule is always, whatever your sleep need is, It will just make it more likely that I'm going to have more trouble down the road. Okay? The rule is always, whatever your sleep need is, get that amount of sleep most days or less. Never go for more. Certainly, don't go for more when you are trying to compensate for a bad night of sleep. It's that person who should neither get up any later, should not go to bed any earlier, and should not nap during the day to compensate for that

law sleep. We have an internal mechanism of sleep regulation between what we call sleep drive and circadian rhythm that will write itself if we allow it by not doing those things I just mentioned. How do we know how much sleep we need? How do I know how much sleep I need? Well, so that's why I say most people I think don't know because unfortunately my tribe, my brethren, the sleep people in the world have somehow gotten this message out there that we all need eight hours. And nothing could be further from the truth. Now the truth is, I do see more and more over the

last, say, five years or 10 years, that the message is now you need to get between seven and nine or else. And even that, the data is not so clear on that. That the range of what people need within maybe a standard deviation or so of the normal mean is somewhere between about six and nine hours. So that's about where I would put it. That said, understand, the average is actually not eight in this country. The average in the mode is closer to seven and a half. There's at least going to be a standard deviation on either side of that, meaning,

yeah, some people are going to need seven and some people are going to need six and a half. And some people are going to need eight and some people are going to need eight and a half. And the question is, how do you know you're getting the right amount of sleep? Because when you get that amount of sleep, you feel fine during the day. the right amount of sleep because when you get that amount of sleep, you feel fine during the day. Now, again, I caution what I mean by that is when you're getting that amount every day, the fact that you don't get, you know, that you get two hours tonight and three the next and four the next and then get your right sleep need for one night, you may not feel perfect. And by the way, if you compensate and then all of a sudden crash

in the weekend and get eight and a half hours or nine hours and say, gee, I feel great. That doesn't mean that's what you need. That's just you compensating for the bounce and judder of going up and down and up and down and up and down. But if you're a seven hour or seven and a half hour sleeper and you get that every day, if you're getting something every day and you say, yeah, I don't feel tired for most of the day. All of us have a little bit of sleep and inertia when we wake up in the morning, a little bit of transition to wipe the cobwebs out of our eyes and transition to wakefulness. So don't use that as your gauge. We all have that little bit of dip in the afternoon.

And we all, it stands to reason, should be starting to feel more tired and sleepy as we approach bedtime. So I ask people to gauge how they're functioning at all other times of the day. That's when I want to know how you're doing. Are you tired to sleepy? No? Are you concentrating? Well, yes. Are you active and creative and feel good? Yes, you're probably getting what you need. So this issue of what the message your brethren are putting out is interesting because coming into this conversation, I wanted to get to this.

We had a sleep expert on the show six months ago. So pre-pandemic, pre-racial justice protests, pre-economic deep freeze, all of the things that are providing us so much stress right now. And it was one of the most popular episodes we've ever done. This, and I expect this one to rival if not exceed that, because sleep is such a universal and resonant issue. This expert said all the data he had looked at suggested if you're falling below seven hours a night, you are in danger. I was just reading something about that and I am telling you that the data is not clear on that. It's probably a little bit more likely that if you fall below five hours a night,

that's a little bit more true. Okay. But you understand that a lot of these epidemiological studies do this by doing cut points and the cut points when they look at seven and below seven is they'll say something is below seven and include in below seven everybody who's below seven. So understand, there are people who are sleeping four hours and five hours and four and a half hours and five and a half hours. They're included in that number. And when you do a finer grain analysis of the data, it looks like going below five makes a difference.

But people who are at six, six and a half, if you just separate out them from everybody else that's below six, not so much danger. Okay, so I got quite exercised when I heard this injunction, this exhortation to make sure you're getting seven plus a night and started to get quite fixated on my sleep. I got one of those aura rings that tells you how much you're sleeping and

that turned into a mess for me. And we got some quite passionate people loved the episode by and large, but we got a few really gloriously negative reviews from people who said, I've never had a sleep problem until I listened to this interview. And they went down the same rabbit hole that I went down, which is they got fixated on sleep and then started to second guess themselves, et cetera, et cetera. So any thoughts on the foregoing? Yeah, you're singing my song. So this is why, I mean, I love my field.

And look, I mean, you know, I understand the data that this person, whoever they were, said they looked at, it's out there. I can show it to you. But what I'm telling you is when you do this finer grain analysis, there are a number of papers that are now saying, whoa, whoa, whoa, whoa. And in some ways, it doesn't matter.

So let me say a few things about that. So I will stick with this idea that under six is more the cut point. So give me six to nine. That even between five and six is maybe an issue, but not egregious. And again, it's about this way in which we do this fine grin. You have to think about how the questions have been asked. And the questions sometimes have been asked, and the cut points have been made with regard to these on the hour cut points. So what eventually some people did was to look at data below seven hours.

When you start to look at between seven and eight, that's a slice. And when you look at between eight and nine, that's a slice. When you look between seven and nine, that's a slice that's smaller than below seven. Okay? Below seven is everything that's below seven. That's a much wider margin. And so I tell you there are people in that margin that they looked at who are sleeping five hours and four hours. And therefore they're being included and they're swaying the numbers. So if you look under seven, yes, there's an indication that some of them are more prone to certain kinds of morbidity and mortality, we say,

but that may be because that number is overwhelmingly being swayed by the people who are getting much less sleep than that. Going back to your comment, which I love, the other thing they're not doing when they do these studies is they're never looking at the people I just talked about, which is they're just saying how much sleep do you get and not how do you feel? So, suppose you took a cohort of people who are getting six hours a night and felt great

and you found 10,000 of those people. That's not what they're doing. They're just lumping everybody in. So some people get six hours a night because they're not sleeping well, and they could get more, or they should get more. And some people are being forced into that by work schedules. But some people get six hours because that's what they need. And if you get six hours and you feel great

and you get that every day, if you try to sleep for seven or eight hours, you're going to get insomnia. Okay. You're going to expand your sleep opportunity, but on what your body can give you, you will occasionally sleep for seven or eight hours and put yourself into deficit so that you now no longer need as much sleep the next night and have a night of insomnia.

And this is what starts to happen. And then people get freaked out. And so I've been saying this for a long time, my brethren are well-meaning. We should definitely take, they're out there also saying we should take sleep much more seriously. Yes. We should be attentive to what our sleep needs are and fight like the dickens to get that? Yes. But to start saying, everybody needs between these numbers and you should get it is absolutely

makes business for me. I get people within Somnia all the time who are coming and saying, but so and so said, or they said, and I go, oh, they again, okay, let's debunk that. So if you're getting overly fixated on your sleep because somebody's told you that sleep is important, you're gonna undermine the whole machine. If you're getting overly fixated on sleep for any reason, you're gonna undermine the whole machine.

Sleep, that's one of the big issues here. And one of the advice pieces of advice I give to everybody, but also especially those people who are having trouble sleeping. You cannot make yourself sleep. You cannot. Sleep is such an autonomic, automatic process. It is, think of it like heart rate, digestion,

perspiration, respiration. And I say to my patients, you don't ever find yourself after you last meal thinking, let me see if I can digest a little bit faster here. Okay. And they'll say, oh, no, I never do that. And I'll say, why don't you do that? And I'll say, because I don't have any ability to do that. And I'll say exactly the same with sleep. If you get into bed and you start trying to make yourself sleep, you are done for. I ask these questions in my audiences. I always ask for somebody when I'm usually training other therapists how to do this work.

And I always ask for somebody who is a good sleeper in the audience. And I ask them to raise their hand and I say, okay, forget any other behaviors you have in terms of reading in bed or not reading in bed, watching TV in bed, whatever your habits are. At some point, most of us close the book, do all of that sort of stuff and put our heads down on the pillow. And I ask that person who's a good sleeper, tell me what it is that you do with that point to get to sleep. And 100% of the time, I get either a shrug of the shoulders, a quizzical look, the answer, I don't know the answer. I'm not sure what your question is because that's exactly the right answer.

Good sleepers do nothing. When you ask them, what happened last night when you got into bed, they say, I got in a bed and then I don't remember. That's what it should feel like, Dan. When you start getting into bed and saying, I don't know, am I close? Am I getting there? Am I not your way beyond already where you should be in terms of trying too hard? And of course, everybody in their brother has a remedy.

And when you start becoming fixated on your sleep, it is one of the worst what we call perpetuating factors that keeps insomnia chronic. Okay, well, you just described my life. Sounds like I need to come see somebody like you. And so that actually is because we're going to start taking some questions now from the audience, but before we do that, I wanna give you a chance to say something that you said to me before we started recording, which is, you're gonna give general, I, sorry, my son is opening the door to this closet.

Okay, hi buddy, he has his pajamas on. Oh, that's awesome. Alexander, I'm recording a podcast, so can you, go away? Okay, but I'll be here, definitely? Okay, be quiet. Okay. All of my meetings are like this not going. So he is five and has made a million appearances on this podcast during the pandemic. That's awesome. That's just awesome. Yes, he's coming in here to pet our cat. Okay. So That's just awesome. Yeah, he's coming in here to pet our cat.

Okay. So, your point is you'll give general, I hesitate to use this term, but advice, but it is not the same as going in to see a doctor and having the doctor or the sleep expert diagnose what your particular issues are. Right, exactly. So let me go back again. How do we transition from acute insomnia to chronic insomnia?

And we talk about what we call perpetuating factors. And those perpetuating factors by and large have to do with the things we've talked about here today. I start to alter my sleep schedule as a way to compensate for my poor sleep and therefore I throw myself further off. I will begin to work harder at something that I never had to work at before in my life and by doing so exert more energy and tense up, okay, which you can imagine is not conducive

to a good night's sleep. And this is one we haven't mentioned yet and it's a tip I can give. do a good night's sleep. And this is one we haven't mentioned yet. And it's a tip I can give if you are in the middle of the night awake. And I don't care whether you're just thinking random thoughts or all the way up to worry. It's not a good idea to stay there. And the people who are staying there are engaged in what I just talked about, which is sleep effort for one thing, right? They're holding onto that mattress for dear life, hoping that sleep will come back. But the other thing they're doing night after night, week after week, month after month, is associating their bed with a place of worry and thinking and ruminating about stuff. So imagine that you can start to get sleepy while you're on your sofa, watching television, and then go into bed and like Pavlov's dogs, boing your white awake because your bed is now a trigger

for being awake. So my recommendation to people who are not sleeping well is that if they're awake, never be in bed when you're awake. Go somewhere else, do something fun, wait until you're sleepy again and try again. And if it doesn't happen tonight, it doesn't happen tonight. Again, acute insomnia is normal. Don't panic. And if you don't compensate, if you don't stay in bed, if you don't overthink it, if you don't work too hard at it, it's going to rectify itself, as I said, and usually within a few nights. So yeah, you might lose two or three nights and then write the ship

and you'll be fine. But people got to get at it right away and they cause themselves more problems. The other thing, of course, people do is they start to worry about their stuff. Oh my God, I'm not getting enough sleep. What is this going to do to me? Imagine what that thought does to your sleep. So going back to your question, there are a number of different perpetuating factors and any given individual who's not sleeping well might be exhibiting some or all or others of those factors. And what it requires to get well

is a really good assessment, a good evaluation of that process by somebody who knows what they're doing and then knows how to fix those things. Because fixing up, right now I can tell somebody, look, don't stay in bed and you won't develop a problem. Once you've done that for six years, you ought to see a professional to help you get beyond that because just getting out of bed for one night isn't going to do it.

I want to prevent people from getting there, but if you're there, you should go seek professional help. As I always say, for other disorders, we understand that the doctor wants an x-ray before they cast your leg, they want blood work before they give you a medication. And likewise here, I'm not going to give anybody specific ideas about what to do other than what we've already talked about and what I would advise anybody who has tried a couple of these things and it's not working to do is go get it properly assessed by a professional who is a behavioral sleep medicine specialist like myself. So just to put a fine point on this,

the tips or advice that you're gonna, general guidelines that you're gonna share in the course of this and you've already shared in the course of this interview are basic sleep hygiene that we should all be sort of endeavoring to operationalize in our lives. But if we're finding ourselves with chronic or sub chronic insomnia, that's the time to actually go get an individual assessment. Yeah, look, even sub chronic, if you do some of these things, it might work.

But if you've gone beyond three months and more often than not, by the time somebody comes to see me, they've had their insomnia for three years and 30 years. So once you cross that three month mark, you tend not to get better without some targeted treatment. And I'm talking about non-pharmacological treatment, not medication. The number one, I should get this out there, the second largest medical organization in the country, the American College of Physicians, has now done a guideline paper on insomnia and has basically made the statement that the treatment of choice for insomnia disorder is cognitive behavioral therapy for insomnia, which is a non-medication therapy for insomnia, which goes after all these things we've talked about. And that, you know, if it were possible, unfortunately, there's not enough of me out there. But if it were possible, that somebody ought to

almost fail this before they go on to a medication. Because medications are great for short-term insomnia, but they were never really intended for the long-term problem. Is it safe to go see a sleep doctor right now? I mean, I had been under the impression that in order to really get the most out of a sleep doctor or sleep expert, you need a sleep study, but I don't really feel like going into a hospital in the era of COVID. Is it fine just to do a series of consults over Zoom and get going that way? I'm so glad you asked that question. First of all, when I say I practice behavioral sleep medicine, that encompasses a lot of

different sleep disorders, and insomnia is only one of those. And beyond what I do, behaviorally, there are medical sleep disorders and medical things that we do. The most common of those would be obstructive sleep apnea. And many of your listeners may know about that. And the most common, the treatment of choice for that is CPAP, or continuous positive airway pressure. In order to get diagnosed with sleep apnea,

appropriately, you have to have a sleep study, as you have noted. And yes, often that entails going into a sleep lab and sleeping there. But more and more frequently, even those labs are now doing home studies. And certainly in the era of COVID, I'm sure they're almost entirely doing home studies and diagnosing you for those kinds of disorders there. Coming back to insomnia, insomnia is a disorder that does not, unless you suspect other occult sleep disorders, does not require a sleep study whatsoever for the diagnosis. And so somebody like myself could diagnose you online like this, and we are right now

in an age when telehealth is flourishing, and state laws are allowing people to do more telehealth rather than bringing people in the office. So for the particular type of work we're talking about with regard to treating insomnia with cognitive behavioral therapy for insomnia, it can be done exclusively online through telehealth. How's that? I love it.

Figuring this out is now number one on my to-do list. Yeah. More of my conversation with Don Posner right after this. Hey, I'm Aresha and I'm Brooke and we're the hosts of Wunderys podcast, even the rich, where we bring you absolutely true and absolutely shocking stories about the most famous families and biggest celebrities the world has ever seen. Our newest series is all about drag icon RuPaul Charles. After childhood of being ignored by his absentee father, Ru goes out searching for love

and acceptance, but the road to success is a rocky one. Substance abuse and mental health struggles threaten to veer Ru off course. In our series RuPaul Bornnaked, we'll show you how RuPaul overcame his demons and carved out a place for himself as one of the world's top entertainers. Opening the doors for aspiring queens everywhere. Follow even the rich wherever you get your podcasts. You can listen ad-free on Amazon Music or the Wondery app. Before we dive into some of these questions that we got from listeners who called in and left us voice mails. Is there anything else, any other points you want to macro points,

micro points, anything you want to say before we start getting into these kind of specific issues? Yeah, there's one that we haven't touched on, which is one of the interesting things, and look, there's no question that everything we've talked about, I think, is true. And by the way, there's people all over the world right now doing research studies and getting grants on COVID and sleep and looking at all of those issues. So we don't have all the data right now, but we will eventually. But anecdotally, no question, some people are becoming more stressed and therefore at risk

for acute insomnia and at risk, therefore, for chronic insomnia. And some people may be altering their schedules in ways that are making them at risk for acute and chronic insomnia. That said, one of the things that I'm definitely hearing within my field is that at least some subset of people are sleeping better now than they ever did. And I wanted to get that out there because I can only speculate as to why that is. But I think it has to do with things that we've been talking about. But I did talk about this idea that we all have sort of a proper sleep number, if you will, a sleep need, having nothing to do with a sleep number mattress.

We all have a sleep number. I'm gonna use the number seven, because I hate using number eight, everybody's somehow thinks, all of my patients come in to me and they're locked into an eight hour timeframe. I'm gonna use the number seven. Suppose you're a seven hour sleeper. The other thing that we all genetically have is a preferred sleep phase, meaning when

in the 24-hour day am I best able to get my seven hours? And we all have an intuitive sense of this. This is the effect that we have when we think about somebody as being a night owl or somebody being a morning person. So when I say that somebody needs seven hours, they can probably get seven in a fair range of sleep, but it may be that they can get their best sleep between 10 to 5 and not between one to eight. And somebody else is going to get their best seven hours between one to eight and so on and so forth. What I think may be happening during COVID for people who are working home is that if in fact they are getting up with some structure in their lives,

they're doing so, but at a different set of phases than they did when they were forced to work. When you have to get up in the morning at 5.30, you know, to get showered and dressed and shaved or makeuped and then into the car and commute for an hour and then get to work on time. You don't have to do any of that anymore. And now maybe you can afford to get up at seven o'clock instead of five o'clock or 5.30. And it may be the just that slight shift of an hour and hour and a half allowed you to sleep a little bit better Because it's closer to your preferred phase It also may be that people are feeling better because they're not being shorted again

I'm not saying anybody can sleep any number of hours I'm saying if you're sleep need is seven you should try to get seven And if you're getting six you're gonna feel a little short. And it may be that our work schedules for many people are forcing them to burn the candle at both ends and not getting enough sleep. That's a message my brethren have out there that they're right about. We should try to get what we need is the way I'd like to frame the message. And COVID may be allowing some people to get what they need in the proper phase. And so if you're finding yourself sleeping better, I think that may be the reason.

That's so interesting. I know I said I wanted to get to the voicemail, but there's one other point I want to let you make because you kind of made a nod in this direction. But when we were talking about the importance of wake-up time, you then talked about exposure to daylight or sunlight. And I actually think, and I know in your talk, you expand on this, what does that look like?

Should we be, if we can, getting outside first thing in the morning, why is that important? And if we can't get outside, should be sitting by a window, why is this an emphasis for you? Again, light is what entranges the circadian rhythm. It is essential to that pacemaker in the brain. And so the timing of that light is essential to keep us entrained into a 24 hour schedule.

A controlling when you're exposed to that light is a good idea, which means two things. It means that when you get up in the morning, you should open up the curtains and get as much light exposure as you can. If you're not having a particular problem with sleep, sure sitting by an open window is good enough. Try not to sit in the basement if you get it all helped to do it. If you have a very dark place, if you can get out for a

little while, that's a good idea. That will help to strengthen. Again, if you're already sleeping well, I'm not telling people, boy, you better do this or else. But if you're not sleeping well, definitely you want to get light at the same time every day and try to get either by a window or get outside if you're not getting exposure to that light. And frankly, the other thing that people should be doing is controlling the light in their bedroom before that. We don't want to get too much light exposure before our destined time to wake up or that can predispose you to waking up earlier, or resetting circadian patterns and waking you early.

So a sleep mask is a good thing. If you can afford it, room darkening shades and putting shades on tracks, I always like to say that the rest of the world has gotten the memo and we missed it. We seem to have missed it in a lot of things now. The rest of the world got this memo, and the memo is we were born in caves and we should have stayed there. If you go to Latin America, they have what we call, they call Perseana. They have metal sheets on tracks that come down, and I feel fairly certain you could survive

a nuclear blast behind that thing, but for sure, you're not getting any light exposure. If you go to Europe, you're going to see the shutters that they close, and you kind of have a slat that comes down and closes them off. And there's no light coming in in the morning. We have window treatments. We have blinds and drapes that let a lot of light in in the morning, relatively speaking. And so I always tell people, it's much better to keep your bedroom as close to really dark as possible.

That what I'd like is to be able to develop film in your bedroom in the morning before you wake up. Okay, this is all been incredibly helpful. So let's, somebody other than me ask some questions here. We've got a lot of questions along the same lines. There is one really big theme that I want to hit first. You've already kind of hit it. It's going to require some repetition, but I think it's worth it because I think this is a big issue that a lot of people are dealing with, which is the middle of the night wake-up. So Samuel, our producer, is just going to play. We got three messages along these lines.

He's just going to play them for you and then you can hold forth. Okay. Thank you for taking these sleep questions. Mind deals with how to break the cycle of waking up in the middle of the night and not being able to get back to sleep. If there's anything that can be done to break that cycle, I would be interested to hear what the tips or suggestions might be. Thank you. What can I do if my anxiety is waking me up in the middle of the night? This is the question regarding sleep. It's Kathy calling from Palm Springs, California. And no trouble getting to sleep. I'm usually tired and sleepy before I'd like to be,

but inevitably anywhere between 0, 2, 30 and 4 I wake up and start ruminating and once I've started ruminating forget it and you know no matter what I do I can't pull my mind out of that constant trying to figure out this thing or that thing or whatever. Anyway, any help on that would be appreciated. Thank you. Okay. So I suspect you're hearing a lot of this during the pandemic. Yes.

I've heard a lot of this for 30 years. I mean, you don't require a pandemic to wake up in the middle of the night, ruminating. So yes, I mean, look, a couple of things. Let's go back and reiterate some things. I said one is that if you're having trouble sleeping in the middle of the night, the first thing to do is not lay there in bed and ruminate. If you're going to ruminate, ruminate somewhere else. At the very least, take it somewhere else.

But a better idea for ruminating is do something fun. If you occupy your mind, it's less prone to rumination than an idol mind is the devil's playground, as they say. And it's very hard to flip a switch on our minds and just turn them off. And frankly, the more we try to turn our minds off, that's like that sleep effort we talked about. The more we try to turn our minds off, the more energy we're expecting to do that. So it's a vicious do loop.

We can't get out of that as people are sort of noticing. So give that up, get out of bed, and do something fun and wait for sleepiness to return. If this has been a long-term problem, though, my sense is that that alone is not going to do the trick, that there's other issues going on here with regard to why somebody's awake in the middle of the night, and they really ought to get it properly assessed. And I know I gave you links to that people can kind of find somebody to help them with this. Another thing that I wanted to say is we have now talked a lot about how people get this

message when they're looking for problems, when they're looking for answers to their sleep problems, where they start to hear they need to sleep a certain number of hours. One of the things that can wake you up in the middle of the night is being in bed for too many hours. If you're a six hour sleeper or a seven hour sleeper and you start being in bed for eight hours because somebody on a podcast told you you need to be in bed for eight hours, you're going to open a hole somewhere and eventually reify that. And so you're just going to open this hole somewhere and eventually reify that. And so you're just gonna open this hole

in the middle of the night. It might be that you're getting the proper amount of sleep but you're just got a hole in the middle of the night because you don't need all that sleep. But I can't say to any particular person who just asked us a question whether that's their particular problem. I can just say that these are ways in which

those holes can open up. The holes will also open up. Remember, as we get older, there's lots of things that cause us to wake up in the middle of the night. First of all, waking in the middle of the night is not unusual. The average sleeper wakes 15, 20 times a night, if we were to study them in the lab, it's just that each of those wakening are so short that you're not you're amnestic for them. You don't remember them. Now, as we get older, we start to remember a couple of those awakenings because they get a little bit longer, maybe once or twice or even three times a night.

And if you can roll over and go right back to sleep, that's really not of concern. That waking up as we get older, I can't make it through the night now without waking up and needing to use the restroom. It's not happening. So the question is not, did I wake? The question is, can I re-initiate sleep? And that's what people with a chronic and so many a problem need to learn to do. And again, there's many things that they need to do to do that. But many people will hesitate to go get the kind of help I'm talking about because they will attribute the reason they're awake in the middle of the night is to some medical problem.

Is it true that a hot flash from menopause will wake you in the middle of the night? Yes. Is it true that a full bladder or a urinary retention problem will wake you in the middle of the night? Yes. Is it true that a prostate problem will wake you in the middle of the night? Yes. Is it true that chronic pain will wake you in the middle of the night? Yes, is it true that chronic pain will wake you in the middle of the night? Yes.

But most people who have those problems will tell you whether they're voiding in the bathroom and then coming back to bed, they're now done. Their bladder's not keeping them awake for 40 minutes at that point or an hour, something else is and they can get help with that. So you have a hot flash, if it doesn't last all night long and you get cooler, but then you still can't go back to sleep, that's something else and you can get help with that. And it may be the difference between waking three times a night for 20 minutes total or waking three nights, three times a night for 90 minutes total.

And that's the way to think about that. One last thing about waking in the middle of the night or early morning, the thing we haven't touched on at all is what I'd call general sleep hygiene. This is the kind of stuff where people are told, oh, drink less caffeine. What does Shai do about exercise? What should I do about alcohol? Perhaps the biggest one on that list is alcohol. Alcohol is an interesting substance because it will first cause you to be more drowsy and

sleepy and in some ways therefore it might help you to get to sleep, but it is a bismill sleep aid because it lasts very short and wears off in the middle of the night and can produce fragmentation and cause you to wake. I'm not talking about substance abuse issues now. I'm not talking about alcoholism or any of that. For some people, and I don't know who they are, for some people just having a glass of wine or an alcoholic beverage near bedtime

might make you both, first of all, sleepier than you want to be before bedtime. So you're falling asleep inadvertently on the couch earlier than you should, which will wake you up in the middle of the night. And the alcohol wearing off itself in the middle of the night will wake you up in the middle of the night. And so if anybody out there has a doctor that says, oh, maybe a glass of wine before bed

would be a good idea. Don't listen to that. It's a really a bad idea to use alcohol to help you to sleep right now. And I now said that. Do any of the people that called in, is it alcohol that's causing their problem? Almost certainly not, but it's a good jumping off point for worth talking about that issue. Let me ask a question on this waking up in the middle of the night thing. This plays off the very first thing you said, which is if it's going on for a while, you get out of bed, do something fun.

One thing that might be fun for some people that I would imagine you would say we shouldn't do is play video games on your phone or do anything on your phone because then you're bombarding yourself with the kind of blue light that might make it harder to fall back to sleep. Is that correct? So yes and no. I mean, remember, yeah, we don't want to get a lot of light exposure in the middle of the night, but please, for those of you out there who are taking this to heart, put out night lights and things like that. Don't bump into walls. Don't fall and break your hip. Don't do any of those things. It's okay to get low-level light. It's okay to watch television. If you're watching television, that's all about the light you need, right?

If you're reading a book, you want a book clip light or you want, you know, a source of light from behind you to light the book, that's fine. So then we come to devices like iPads and phones and things like that. And what I will say there is you touched on the idea that it's not light, per se, but the spectrum of blue light that has the most effect on the circadian rhythm. And most of us now, almost all of our devices have a blue light filter. So download the blue light filter. You can set it to say, I want no blue light between 10 pm and 8 am.

And your screen will take on a little bit more of an orange tint and that should do better. There are blue light filters that you can download off the internet if you don't have it built into your machine. So that would make it better. It depends on the person. There are people who have what I would call real circadian rhythm disorders. That's different from insomnia. You can have people who have significant circadian rhythm disorders, which is beyond the scope of today's talk. For those people, they need to be much more careful and sensitive about light. And I would be advising those folks to stay away from handheld devices with light sources close to the eye. But for the average person who does not have a significant circadian rhythm disorder, they

can probably get away with it. But if they're concerned again, do something fun, but do it at a distance from your eyes. Do the television, plug the computer with some device into your monitor screen so you can sit farther away from it, and download a blue light filter. And you should be fine. Great. So the next batch of questions actually only two in this category that we're going to play for you,

but I think this is quite a common question. It has to do with sleep aids. How do I end up with all my questions is related to sleep, not sleeping pills, but does non-addictive sleep things that get sold, which I had used in the early days of the pandemic pretty religiously. And it has to mean, really. And physics is equal.

And I didn't know how safe those actually were. I'm not using them as often now because I'm gyms are back open, I'm able to exercise, and that kind of tires me out and helps me sleep better. But I still do use them on occasion. And I know they're supposed to be non-addictive, but I suspect using them kind of as a crutch that I did for a while was less unhealthy. I just want to know what your expert had to say about these non-addictive sleep solutions. Thank you.

Hello. This is Erin calling from Portland, Oregon. I have a question for the sleep experts. I'm wondering what their thoughts are on using marijuana to help you sleep, especially if you're in the position of trying to avoid taking pharmaceutical drugs to try and help your sleep. Thank you very much. I love that the weed question came from Portland. This is amazing. Love Portland so much.

Isn't it perfect? Is it all right for me to take drugs to avoid taking pharmaceutical drugs? Question. Okay, so there's the weed question and then the anti-histamine or sort of what that caller was calling sort of non-addictive sleep aids. So take it in whatever order you would like. Yeah, I'll start with the order you had it in. Let's start with anti-histamines and over-the-counter sleep aids. Most of them are anti-histamine medications, which have as a side effect, drowsiness, not necessarily sleep.

And there's no good data, although there's not a lot of data whatsoever. I mean, they haven't been studied, is the basic answer. But what little there has been done suggests that they are not, as a class of medications, all that useful or helpful.

That doesn't mean that any individual might not derive benefit not as a class of medications, all that useful or helpful. That doesn't mean that any individual might not derive benefit from taking an over-the-counter sleep aid. But again, I would argue that all sleep aids are designed to be for short-term problems. And especially if you can define the problem. So as I said, a night or two of bad sleep

is not anything to think about. But you might think, well, yeah, but I always get my night or two of bad sleep before I have a big test. Or I always have a night or two of bad sleep before the big papers, whatever it is. There's a place for medications for sleep. Whatever we're talking about,

I would prefer if you're gonna use medications for sleep that you do use prescription medications. They were designed for this. And that you have a cutoff point. You're saying, yeah, I will use this for the next two nights. I will use this when I go to Europe and I have a little jet lagged and I wanna get myself to sleep at the proper time

for a few days. And then I'm done. But when you have a chronic insomnia, the idea of having to use those things for years and years and years is really not what was intended. And ultimately can provoke more problems than otherwise. Now, over the count of medications

is not my big, would not be my big thrust. Again, if somebody's having a severe problem even right now, really anxious, really troubled and they just need to get some sleep for a few days. Again, under an advisor or physicians guidance, maybe taking some medication under those circumstances to get themselves back on track would be a good idea. But that's in the acute phase. In the chronic phase, when you take those medications, they can work. They can work very well.

But they don't tend to fix those underlying perpetuating factors that I've now talked about so much today. And so the problem is when you try to come off those medications, those problems are still there, the worries are still there, the conditioning is still there. And so the insomnia often comes back, which is why we say, look, the better way to do this is to start the right way and not get on medications for chronic insomnia. For short term insomnia, they were made for this. Also, there's this sense of dependency.

There are certain classes of medications that are physiologically habit forming, and certainly some of them are sleep medications. But understand, I had said to you that there's a system for our sleep, which I call sleep regulation between sleep drive and circadian rhythm. And that will, if you let it and not compensate for poor sleep, we'll regulate your sleep and get you back on track eventually. And we've done some research and there is a bit of a rhythm of insomnia. And the rhythm of insomnia goes something like this.

Nobody has insomnia every night. Almost no insomnia, I will ever say to you, seven nights a week. That's why we define it as three or more nights a week. But the rhythm of insomnia is bad, bad, bad, good, bad, bad, bad, good, bad, bad, bad, good, which means after every third or fourth night, you're bound to pop off a reasonable night of sleep. Okay?

It's just going to happen. Now, it won't stay that way if you're doing everything wrong, which is why I don't want people to develop chronic insomnia. But if you're just in an acute phase and you just wait it out, you're bound to have a good night eventually. Now, if you start taking things on an intermittent basis, like, I wanna take this medication, but I don't wanna get addicted, so I'm only gonna take it every three or four nights,

you can see what happens. It's much more easy at that point to become at least psychologically dependent on those medications. And it may be that they didn't do much for you to begin with. A lot of my patients come back to me, I'll say, well, did that over-the-counter medication work? Did that thing that you tried work?

Did the doing whatever you do in bed work? And what I will hear inevitably is, well, yeah, sometimes, and I can say that about everything. You know what works for insomnia? Sometimes, everything, including magic pajamas. Okay? If on your third or fourth night, you wear the magic pajamas, you're gonna sleep.

You know why? Not because of the magic pajamas. So do you understand what I'm saying? I do understand. And I wanna get to the weed for a second, but let me just ask a question about sleep medications, the sleep expert that we had on previously, strenuously argued that there is a big difference

between sleep and sedation, so that if you're using something like a benzodiazepine or some of these sleep meds are in that family, I understand. And so like, what's the famous one? Ambien. Ambien is a benzo, I believe. It is not. Oh, I thought it was related to valium or clonopin and all.

No, the newer class of medications, like zulpium, which is Ambien, sonata, lunesta, those medications are what we call benzodiazepine receptor agonists. And they are much more specifically targeted to sleep and non-sedation. And they are, while again, anybody can develop a dependency on these medications psychologically.

Imagine you take it every night, and it works for you. And then you stop taking it tonight. What do you think's gonna happen? You're gonna get into bed and start thinking, oh my God, I wonder if I'm gonna be able to sleep without XY and Z. What do you think that does to your sleep? So basically anything can do that. But those newer class of medications are not benzodiazepines. I would hasten to say that. I would definitely agree with the idea though that there's a difference between sedation and sleep. And so again,

I'm not, I don't know whether he was advocating medications for sleep. I do advocate them as a short term, but not a long term solution. I don't think they're a good long term solution. And I think people should work to get off of them. Where are you on weed? What we know about marijuana is that it works a lot like ambient, okay? That is, it will, in the initial phases, it will work to put you to sleep a little faster. It may wake you more in the middle of the night, but if you wake, you'll get back to sleep faster. And so like ambient, it will do both of those things. But there is a tendency, a possibility, like with Ambien and Lumez, and any of those medications to become more

tolerance to the medication, which means that over time, it's having less effect. If that happens, you then may find that it's taking longer to get to sleep and you're longer awake in the middle of the night. If you use weed for, you know, a long time and then decide, I don't want to do this anymore, you again might have some significant problem trying to get to sleep and get back to sleep. Now, I'm not saying at that point that cannot be fixed. Just like everybody else's insomnia, I just talked about, it can be fixed. If you're using marijuana, again, I would think of it like any other sleeping pill. I wouldn't use it for long term fix. I would use it if you wanted for a short term fix. Now, the other thing to kind of hasten is, some people are using it for other things.

We need to remember that some people are on various kinds of medications that might not be great for their sleep, but they need it for other reasons. Then that is a struggle to then get to a person like me to say, how can we make you the best sleeper you need to be on marijuana because you're using it for glaucoma or on marijuana because you're using it for pain or on marijuana because you're using it for cancer. And we do that all the time. So what I don't want people to run away from here is saying, that's it, I better stop my marijuana that I'm using for other things. But as a soul sleep aid, I would think of it like any of the other sleeping pills. It wouldn't be my first choice for long-term management of insomnia.

Okay, so I think we have time for one more little set of questions here. These both have to do with something that a psychology that I see at play in my own mind about bedtimes. This is Amy from Connecticut and my question is about just staying up super late. In my normal life, I'm a night owl and I make myself go to bed around 11. But now that I have no reason to like get up early anymore, I find myself being up to till about 2, sometimes 2, 30, and even then I don't even want to fall asleep. I'm just wide awake.

So how can I bring it back to 11? How can I get sleepy again? How can I retrain my body to not want to party all night? Thanks, bye. I'm a subject subject to sleep. I'm just thinking that I struggle with not so much with the act of falling asleep or staying asleep, but I find myself every night, whether it be dooms rolling on Twitter or watching TV, too late at night, I kind of just want to keep it going and just won't

allow myself to go to sleep at a reasonable hour. And even though I always wake up in the morning feeling very exhausted and not well-refered I want to keep it going and just won't allow myself to go to sleep at reasonable hour. And even though I always wake up in the morning feeling very exhausted and not well-rested, and knowing that I should go to the sleep earlier and have a more calm nighttime routine, I forget that by the time night comes around and I just want to watch Netflix and scroll on Twitter. So I'm wondering if you were the expert's have any advice on how to kind of switch that knowledge to wisdom and just because I know that that is free,

but have a big impact on my life. Thank you. Yeah, these are my people. It's 10 o'clock at night and my wife or like, will we watch another episode of whatever show we're watching? And you know, it's like rebellion time. So what do you say?

Yeah, that's another thing that you should keep in mind is that I said marriage is a time when insomnia starts because people of different preferred sleep phases, you know, the people of the same sleep phase tend not to marry each other. And so there's always this argument over, you know, I want to go to bed earlier and I want to go to bed later. And somebody's going to lose that argument and that can precipitate insomnia. Going back to the caller, there's a general question here. So I want to address it in a general way, again, not necessarily to her problem, but there's a whole class of people.

What we're talking about here is preferred phase. She used the term night owl. Well, a lot of people are night owls and all that's saying is my preferred internal phase. The best time for me to get my good sleep number, is later than the average bear. There's a whole class of people that tend to fall on that category. They're always exceptions, but tend to fall on that category.

And we call them teenagers. Okay. All of us go from childhood into adolescence and into young adulthood. And children sleep long, they need more hours than adults, and they sleep early. An eight year old, a seven year old, is tending to wake at five or six in the morning and waking their parents to their utter consternation. And then like my son turned into an adolescent and it took dynamite to wake him up in the morning.

Okay, that's a natural change in preferred phase. Your sleep number doesn't change that much once you get to adulthood, but your preferred phase changes a lot during the course of the lifespan. And in younger age, the tendency is for what we call a delayed sleep phase, for later. And that has nothing to do with all the activities that kids are doing. If they had none of those, if they were living in a men and a night colony

and they, how all, we're living a highest life with no parties and no late night, you know, keggers and any of that stuff, they would still wanna go to bed later. It's just a natural shift that takes place genetically. I had already mentioned to you that some people are sleeping better because they're being allowed to sleep in their natural phase, and I think that's nowhere going to be more true than with our teenagers and young adults, that they are going to be finding that they're

going to bed later, and they're sleeping in later because they can, and because they're doing it, they're getting more sleep. We are doing a terrible disservice to our teenagers by making them get up earlier than the young kids to go to school. Crazy, okay? Absolutely crazy for the human animal. So with regard to the question that I get a lot, which is, well, should I allow my person to do that? Should I allow my team to do that? Again, if they're sleeping well and waking up in the morning and they feel like they're doing great, the answer is, I don't see why not. It's more their preferred phase.

And if they right now have an opportunity to get that, they're gonna function better and more efficiently in the hours that they have awake when they do that. What we still wanna stay away from in that class is irregular hours. I still don't want that teen getting up some days at nine, some days at 10, some days at 11, some days at 12, and so forth. If their natural phase is like from, you know, two in the morning to nine in the morning or 10 in the morning, then do that five days a week.

Now, the question was also about transitioning back. The question is how soon do you have to transition back? As you start approaching a time when you're going to have to get up earlier in the morning again, yeah, you may want to start transitioning. How do I learn to fall asleep earlier was the question. Again, I go back to you, set that with wake time. If you keep getting up at 10 o'clock, you're not going to be ready to fall asleep at 11. But if you start getting up earlier and earlier and earlier, you'll start to become more and more prone to be ready to sleep at 11. Unless again, you're so delayed, your clock is so off-kilter that that becomes a problem. And all of that can be fixed with a specialist.

Speaking of specialists, you referenced this earlier, but it bears repeating. We have links that you provided to us that we will put in the show notes that will allow people to find specialists should they need one. Right. So, one of them is a site, a sleep education site that's sponsored by the American Academy of Sleep Medicine. And it has a little bar in there where you can put in your zip code, and it will give you your nearest accredited sleep medicine. And it has a little bar in there where you can put in your zip code and it will give you your nearest accredited sleep centers.

But that's for other kinds of sleep problems. If things are going strange and bump in the night like you're sleepwalking and you got night terrors and you think you have sleep apnea or other kinds of problems like that, that's what you really want the sleep center for. If there's nobody else close to you, a sleep center might also be able to direct you to a behavioral sleep medicine specialist like myself. But if you haven't saw me and you want to get first to a behavioral sleep medicine specialist, the side I would go to is the other one, which is the Society of Behavioral Sleep Medicine.

And when you go there, there's a place that says Provider Search and it will give you a map of the United States. And you can click on your state and it'll give you a listing of all the providers in your state that either do this regularly or are frankly certified or have diplomate status to do this kind of work. Don, this has been a real pleasure. Really, I love a salty guy from the Bronx.

It's been really fun. We didn't get to your other question guy. I didn't know if you wanted to go back to that one, but we don't have to. The doom scrolling on Twitter and the Netflix thing. Yeah, and actually the answer is, I'm a little bit more flip about that. I mean, you know, this is a guy who's basically saying,

I know I should be going to bed earlier, but I don't. To which I have the answer is that, you know, there's an old joke that says, a guy goes into the doctor and says, doctor, it hurts when I go like this. And the answer is, don't do that anymore. You know, more seriously, there are some people

with various kinds of problems like attention deficit disorders and obsessive compulsive disorders that really do struggle in a way that it makes it difficult for them to just choose to do it. And again, I'd say they need to get professional help and get that assessed. If it's not that, then a simple trick you can try if you kind of blow past

the time you wanted to go to bed is set an alarm on your phone and have it go off at the time you want to get ready for bed and then do so and see if that works. But the same advice you gave to the female caller of setting alarm in the morning and you'll be paying the price for that Twitter late night doom scrolling on Twitter that might strongly disincentivize you from doing it the next night. Absolutely. That's absolutely right. So I must have done a good job here because I taught you the right stuff.

You definitely did a good job here. I'll tell you some bad advice. When I was a little kid, I would go to my father who was a joke-ster and I'd say, Daddy, I can't fall asleep and you would say, bend over and run as fast as you can into the wall. Yeah. Yeah. I know those treatments. Listen, I've seen it all. I've really seen it all, including Magic Pajamas. Yes. Well, I'm going to buy. I'm going to invest in some Magic Pajamas. Well, just remember they work sometimes. There you go. Don, thank you again, really appreciate it.

Yeah, my pleasure. Thanks for having me. This was a blast. Big thanks to Donna. I really enjoyed that. Also want to thank the folks who work so hard to make this show a reality. Samuel Johns is our senior producer,

Marissa Schneidermann is our producer. Our sound designers are Matt Blinken and Anya Sheshek of Ultraviolet Audio. Maria Wertel is our production coordinator. We get a ton of wisdom and input and guidance and oversight from TPH colleagues such as Jan Poent, Nate Toby, Ben Rubin, Liz Levin. Also a big thank you to Ryan Kessler and Josh Cohen from ABC News. We'll see you on Wednesday for the sex episode. Don't wanna miss that one.

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