LMTF Podcast Episode 21: Sleep

sleep_graphicRecent discoveries in the science of sleep have introduced new techniques to help people feel more well-rested and have increased cognitive abilities. Dr. Brandon Peters, MD, author, and board-certified practitioner of sleep medicine summarizes the most recent developments and answers questions from our panel on matters such as sleep apnea and polyphasic sleep.

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Episode Machine Transcript (unedited and uncorrected)

When people sleep last five hours a night they have two to three times a rest or a heart attack I think the consolidation of point to a single prolonged period overnight that last eight hours perhaps last nowadays is something that probably occurred predominantly with that shift towards industrial kind of work the fun part of Sleep Medicine is that we’re still learning to Newport and.

Let’s make. This.

Discussion.

With.

Everybody ends Welcome to our show Let’s Make future guest Dr Brendan PETERS Yes or certified in both Raji and medicine and critic practices at Virginia Center in Seattle he’s also a.

Separate University of Medicine and the Department of Psychiatry and Behavioral Sciences. Medicine and since college the sense of Rico and research experiences in the yolk and wrote over a thousand articles that millions of people each year you just published.

About a month ago actually and he wants to get another judge will.

Be able.

To recruitment.

Or basically becoming the receivers of computers thanks for joining us today and it’s my pleasure to be with you so we all are with because it is a concept force upon us I guess you could say the very spirit. On the other hand Scientifically speaking you still there is. Or what it exactly what we’re up to be discrepant with this and some but if I’m not why do you think there are still so I will knowledge of what. Exactly yeah I think that’s a very important question is which we can see a translator they have to understand historically how we’ve come to recognize that the final summary of Manson’s we can have in science asleep at last. Hundred years certainly most of what we know about sleep is the mind and the last hundred years probably combining all prior millennia wouldn’t even come close to what we’ve learned in our hundred years certainly we can win back at ancient texts from the Greeks Aristotle briefly comment on sleep but their understanding was very simple and perhaps not particularly scientific and not consistent with how we view sleep today there are certainly references in literature Shakespeare and so on insomnia seems to describe how I say six leap and even in the seventeenth century at that to see references to conditions we would recognise today like restless legs syndrome was first Sir Thomas was in sixty seventy two so there are references historically in literature but the scientific advancement really has come over the last century and the circadian research understanding the timing of sleep and wakefulness and other processes that are linked to a biological need for light exposure and darkness started in one thousand nine hundred thirty as a research doctor that nothing of quite men really only first understood there were sleep stages of sleep including REM sleep rapid eye movement sleep that was in the one nine hundred fifty one hundred fifty three we came up with the term circadian which is Latin for near day in the late one nine hundred fifty S. a doctor from Tulsa and it was in the sixties and seventies that we started recognizing that as a condition and came up with treatment in the early one nine hundred eighty S. other conditions like REM sleep behavior disorder it was in the mid eighty’s everywhere so really a lot of the advancement in our understanding and some of the disorders of sleep and treatment for those disorders had only been in the last several decades and certainly everyone can recognize what is simply defined system reversible state of unresponsiveness with disengagement from perception of the environment but some of the hallmarks we associate with. Being. A recumbent position may not be necessary features in the fun part of Sleep Medicine is that we’re still learning some of the importance each as it were all that. They have in how we have basic series of why we sleep important repair and restoration of tissues and function of the brain and we can certainly think about in terms of evolutionary advantage of energy conservation and relating predators but we’re also starting understand the role of sleep in learning and memory processes and consolidation so there’s a lot more to be learned which is exciting and I think the next years and decades really give us a new glimpse of the importance of sleep to our health and well being are here in the U.S. we see a lot of progress Yeah I think probably one of the hot topics in sleep medicine earns a role a circadian rhythm So certainly we’ve understood circadian rhythms for more than fifty years but we’re starting to understand that impacts beyond just sleep and Armaan regulation certainly coarsely adequate sleep effects appetite regulation hormone wept and growing but we’re saying understand that there may be other implications to circadian patterns on health so as an example there may be an ideal timing for a surgery based on cicada patterns there may be ideal timing for the administration of medication based on circadian patterns and that’s something that we’re just starting to really investigate and mine about and I think that’s something that will be important in the next five to ten years is really starting to recognize kind of the ideal circadian patterns and then maybe some individual variation ten percent of the population has delayed sleep they syndrome which those are night owls folks who would naturally if you know we flip in falsely between typically late after midnight but often want to clock work two o’clock in the morning and then naturally don’t want to wake up at six or seven but rather sleep until nine or ten in the morning so those people typically need morning light exposure to help precept the timing of their sleep but there are probably other circadian and there are issues that if recognize would help to optimize not only wait and wait for months and function during the States but also perhaps other determines how. My mother had a name for people like that she called them lazy maybe a scientific analysis would be be a good thing I would have loved to have the research papers to show my mother that there is something wrong with me staying up until one in the morning and sleeping in until ten every day and if that condition usually develops in teenagers and it certainly can persist throughout why it’s so many patients who are retired because they no longer have to get up a specific time for work they go back to their natural and a genetic tendency to go back to being a night owl staying up later and sleeping in and there’s nothing wrong with it certainly can have social implications if there’s an understanding of what’s going on it certainly is not a negative way to sleep. Under fair to wait myself I’m curious you know mentioned you know how come we know so little about sleep and you talk about the evolution of what we know so far and I recently wrote an article talking about how different sleep aids like medications work in our brains and I think there was one researcher who was saying that some of the ways we look at sleep or define it guide our research in might limit us and the way he framed it was maybe we’re cheap used to seeing being awake as our default States and sleep as a sort of rest or of like side activity but maybe we have a flip to that our brains Morse natural state is to be asleep and that being a way to sort of a question I wondered if you had any comments on that like how we happened to define it if there’s other ways that would help us open up a Research Fellow little bit I think that’s an important perspective to have William the man to his at Stanford and work for Dr quiet moments on kind of his early studies looking at REM sleep and identifying sleep stages and really helped to found the field of sleep medicine which has worked in Stanford had one of the first sleep clinics initially looking for patients with narcolepsy but actually identifying of folks actually having sleep apnea but Dr Demento likes to say that all wakefulness of sleep deprivation so that perhaps there is a key role for sleep and lots of different functions and certainly restoration of the body repairing of two. Sheers it’s was kind of climbing out chemicals within the brain that accumulate with Lake laments and the organization of memory and establishing networks within the brain up to reinforce and consolidate learning but yeah the role of medications in sleep is kind of interesting in that as many things can develop over the last fifty years early medications were the benefit add to being the fifty’s and sixty’s but more recently probably one nine hundred ninety S. and onward we have the V. drugs which are low put on our Ambien which is perhaps the most widely prescribed sleep probably eighty five percent description and those medications certainly impact our memory certainly our memory of wakefulness but they don’t add a lot to ours if you look at the research studies many had ten fifteen twenty twenty five minutes total sleep time but they really mask wakefulness So certainly being asleep is more than just being unconscious there are processes that are meant to occur during sleep with cleansing of metabolic waste from brain tissue and other functions and I think using a medication that masks that wakefulness is probably not adequate not really restoring what is lost when we don’t get enough sleep I was the very funny of things and I know them but if you know we all want to solve a problem today we’re actually to you know he is also the creative problem.

Here’s one of the major impacts on our sleeve and.

There certainly have been major cultural differences social change as a impact that has freed then I think technology is the big part of that if you would back historically and to shift that happened was revolutions in your change from an agrarian society where a person’s work is tied very clearly to Bill Bell they have light work and he’s to be done during daylight to having kind of the artificial light the onset of development of electricity and my public Thomas Edison’s work and that’s part of that industrial revolution kind of shifting to working in factories having that period of. Hours or ten hours or twelve hours a person is working and limits I might place on a normal sleep timing and ideally of course we get most of our sleep overnight that everyone experiences a little afternoon sleepiness and if you’re on the factory floor you don’t have the opportunity to take a short nap during that time or you have to push through it with his caffeine or other substitute I think the consolidation of sleep to a single prolonged period over night that last a Glee eight hours perhaps less nowadays is something that probably occurred predominantly with that shift towards industrial kind of work there are other kind of cultural differences too and we have a Western idea and ideal of probably historically somewhat unusual to retire to a separate room within one’s house and to sleep perhaps even alone that’s not something that certainly would have done and I was in years ago forty thousand years ago would have been unsafe for us to really isolate ourselves in the natural environment and tend to sleep amount and be unconscious many society didn’t today there’s shared sleeping spaces families and others within the community share a space and sleep together in somewhat protective and perhaps we don’t need that same level of protection we’re not subject to the same predation that we would have been subject to previously but that’s a major cultural shift to retire to a bedroom and now we’re really experiencing the impacts of technology in other ways having electronics within our veterans having a another television set up in the bed and we’re having a smartphone that we can bring into our room and access course Internet to games and social media and other things and there may be a role for that artificial light kind of impacting our Sikkim rhythm and some people may be more sensitive to that there’s also the stimulation of that and psychological way that happens when we interact with social media when someone like something that race or a comment on something and they said in that engagement may stimulate us and make us even more awake so if we look at this survey population we see that we’re sleeping less than we did previously and perhaps in our last bed. One hundred years ago and I think part of that is limits that we place on our own choices we make things we enjoy doing in the evening hours and they keep us awake a lot longer and perhaps a little class and to some importance of sleep so there’s research studies suggest perhaps thirty five to forty percent of people are sleeping Westphalen even seven to eight hours which is kind of the low end of an average weight need and that has a real impact sleep deprivation affects our mood it can worsen depression and gas abates pain and and really impacts important functions of the brain’s frontal lobe is important for judgment and planning organization and we don’t sleep enough all of those functions are in fact undermines concentrate memory and work performance and they mentioned before that that sleep deprivation affects hormones that regulate weight and growth and may even impact the function of the immune system make us more susceptible to illness even common cold and probably contributes to information that pro-inflammatory state that affects our heart health when people sleep less than five hours a night that have two or three times the risk of heart attack or beyond that perhaps they guess risk is risk driving when you’re sleep deprived or more likely to make mistakes or to behave impulsively and at risk for fatal traffic accident and sleep deprivation is really high and perhaps as high as impacts alcohol consumption which I think it’s important for us to recognize the importance of sleep in the impacts when we don’t sleep well enough and unfortunately we don’t have a lot of good insight or we may not recognize our own limitations and not getting enough sleep so the insurance technology whether it be a smart phone it’s taken in a bedroom or a television and watched as we try to fall asleep at night I think will have really impacts on some people you mentioned multiple times.

Somebody like you were king and you view it you have your sleep.

But he sure is a part of you are you as an expert I would say it is chala. And that’s something that takes a commitment and I as a physician I’m on call not often but perhaps a week a month among call so I have to have my phone in my bedroom space that someone can call if there’s an emergency over night I don’t get called often but when I do it certainly disturbs my own sleep but for me I mean I keep my smartphone charging in the kitchen and I would recommend others the same just use a simple alarm clock that we would have used years ago rather than using our phone us and all our men it’s often the case of someone wakes from the night when they need to reach over to their phone and see time is and perhaps they’ll go back to sleep right away or may happen to their e-mail or it on Facebook or Twitter and that is stimulating and that certainly can prolong the episode it wakefulness and ideally we would be completely disengaged from technology at night and really reserve that as a space for sleep and keep the technology elsewhere in our. Lives one really evil will that be able the publisher and they will then will I be then those the equation certainly the most common sleep disorder insomnia and this difficulty getting to sleep difficulty had back to sleep after waking in the night that affects perhaps ten percent of people chronically and I would say the majority of people have experienced it at least trans and we know lives and chronic insomnia can be exacerbated by other conditions so there may be a predisposition towards that and it may have a genetic influence and they run in families and some people describe a lifelong difficulty sleeping but typically there’s some sort of trigger for insomnia so often stress you can think of a hundred things that would potentially cause stress or it would exacerbate and in that work related stress studying for a emanations social stresses from divorce or death in the family there’s a lot of different things that would be a potential trigger for insomnia and often what happens when someone is not sleeping well as they can to make some other changes that the. Tend to negatively affect their sleep quality some of not sleeping well gosh I really need a good night’s sleep tonight they may go to bed early or if they’re not sleeping well they spend too much time awake in the night they might turn off their alarm clock in the morning it’s news to try to get a little bit more sleep last hours at night or they might try to take a nap when we tired I’m going to lie down for well that’s I think a nap but all of those things begin to really undermine the ability to sleep at night it really sends out the sleep what happens often or the person begins to spend too much time if their sleep needed eight hours or seven hours very commonly people are spending nine or ten hours and that trying to sleep can perpetuate the insomnia and there are other changes as well that can occur and perhaps a very a little bit individual by individual but the idea was with insomnia therapy including that which outlined in the book and some is solved as you identify what might be shooting for you and you make some adjustments and changes to get your sleep back on track and it’s not only about building sleep Dr unhandsome you know that legislate prolonging wakefulness with a little bit of sleep consolidation but also in forcing circadian rhythms getting morning weight exposure Sarah but I think one thing that goes unrecognized often on a concern to me is that something that can perpetuate it makes awakenings more likely to light minutes sleep. And sleep apnea is a condition that is more widely prescribed now when it was in the last several decades and many people I see with chronic insomnia also have sleep apnea perhaps eighty eighty five percent of people with chronic insomnia complaints also have a.

Part of resolving their insomnia is treating their conditions. Of course can be associated with snoring excessive daytime sleepiness and naps but there may be other symptoms that would seem unrelated waking up frequently to pee at night is actually commonly a symptom of sleep that men especially older men might think that prostate enlargement sort people might think that we bladder drink too much fluid at night. It can be related to sleep that has to do with the airway collapsing collapsing base the time blocking as the oxygen levels drop the brain realizes the person is not getting enough oxygen knocks I level it coming up and there is a burst of cortisol the dose or the body wakes the person resets their breathing often moves in from deep to light sleeper causes a very brief awakening and as the airway opens up it creates a negative pressure within the chest and that can impact the function of the heart the heart feels that it is a volume expansion so it feels like a volume overload state and when it does it and the hormone signal down to the kidneys and activates the kidneys and so personal get up and pee a small amount and few hours later have to get up again when I get up to three times or more during the night if you improve their breathing and that frequent trips to the bathroom goes away and there are other things that could be related that may seem unrelated like teeth grinding and clinch and often that occurs by down in clench a little bit to tighten up the muscles of the airway lock. In place and the tongue in a more forward this can help improve our breathing during sleep that many folks who may be told they’re grinding their teeth from their dentist say to wear patterns on their teeth they say wow you must be stress you must have a lot of stress and almost everybody would say well I guess I have some stress I work at it and nobody would ever think that that could be related to breathing to sort of during sleep that we see it with our sleep study is that those muscles are being activated during these APNIC events and if you improve the breathing if you use a treatment Mike Heaton is probably their way pressure or in an oral appliance or national sleep apnea that clenching and running often results as well and the problem with sleep apnea is it goes on recognize you either don’t think about it don’t know about it would not associate it with symptoms that are occurring or we just think well that this person unlikely to have it they don’t fit the stereotype of perhaps a more vividly obese man with a sick Nachman snores sitting up. Right that man certainly has sleeper in everyone a diagnosis but we need to look and a broader group of people you know look at people who are sent younger people because they may have symptoms that can get me back to cigarette as well and if we don’t if we don’t identify the condition and treat it and just persists and many people who have seemingly unrelated conditions often have sleep apnea So for example if I were my Alger chronic pain condition half of those people.

And it worsens other medical conditions diabetes eighty percent of people with diabetes have sleep and bursts of cortisol lead in fun resistance and that we’re since cross control worsens or diabetes when people have uncontrolled high blood pressure they often have sleep apnea contributing to their blood pressure issues or example a man who is on three different blood pressure medications if his blood pressure is hard to control he has a ninety six percent chance of having sleep that almost always and if you treat the sleep that control the blood pressure proves So the problem is we don’t look for it and a person may be unaware that they’re asleep all they know is perhaps I’m a restless sleep I wake up a lot I have been told they snore a little bit but beyond that they may not be aware of gas being they’re choking at night and may not be a witness to pauses and breathing and important that that person has a test to kind of assess for that and if it’s identified even if it’s mild that it be treated and when we talk about levels of sleep apnea there’s a certain number of events per hour so somebody can have five greeting events per hour and would say that’s normal five to fifteen miles. Fifteen to thirty moderate and more than thirty would be there but it can be quite severe often it’s fifty sixty and sometimes even as high as one hundred or more events per hour and the person’s not aware of waking up sixty times an hour but it really undermines their sleep quality of sleep does not refreshing they wake up in the morning even after and half hours of sleep and don’t feel rested and course later today they’re likely to feel sleepy and are out either. Dozing their sedentary activities and meetings and watching movies and reading cetera so it’s important to kind of reckon on spec initial guidance extremely common and it gets more in common as we get older is there a difference between snoring and sleep apnea or is there basically a one to one incidence of the two and not everyone who snores has sleep apnea but I would say that is. Norrington to complete a struction of the airway so snoring is just the vibration of the tissues at the back of the airway typically the soft power at. The base of the tongue and has to do with turbulent air flows where really meant to breathe. And if there’s knees old struction from it he did it from swelling within the nose of an allergy or has a cold that will cause across mouth breathing to reach your mouth at night because right now but any time the mouth is open becomes possible her jaw lower jaw and the tongue to shift and often will shift back.

And edges narrow that space at the back there we are so snoring might lead to a little vibration there but if those tissues are partially or completely blocking suddenly the oxygen will also compromise your lungs will continue to extract as much oxygen is possible but the accessory option closed off and then say the levels will drop her also come up enough to trigger an awakening a receptor a greeting so most people with leave that need to snore but not all many people are snoring of sleep apnea but again not all and just because you don’t snore you know honestly just because someone’s not witnessing raining may not mean that you don’t have sleep apnea and I tend to err on the side of evaluations someone has symptoms that could potentially be linked to unrecognized sleep apnea and then we do a test and with testing either in my sleep study called a polysomnogram or home for that new test which is more commonly done there and we’re measuring effort to help or warrant measure. Effort to bring back the chest or abdomen we measure airflow through the nose mouth and then we’re measuring oxygen levels so that work our May you have to agree but the crease air for the nose or mouth and rock him of all start to drop we would like to sleep.

Or in a podcast where we often talk about startups that are trying to make the future and I am sure that there are many startups out there that are looking into simpler diagnostic tools or perhaps leveraging the data that you get out of a Fit Bit or other fitness trackers to try to diagnose sleep apnea and other sleep disorders perhaps more easily than you otherwise could I wonder if you know anything about those technologies or if you think there’s any promise to that of that’s true and I’m so mean consulting with some companies that are developing that technology but the idea is that there should not be a barrier to this testing going to the survive and that we that the more accessible and there are far more people who need the assistance of a sleep physician than could ever be managed by the current number of sleepers actions that you have so at the estimated that perhaps a thousand new patients and have violation per year for each sleep position that makes sense and most physicians manage a few thousand patients in their total practice so we would never be able to accommodate the number of people so we need to do as a professional leverage these technologies to make the diagnosis marks us a bill and really to make treatment Mark I’ve done some work in telemedicine to make some of these resources available whether it be through just education and writing that I’ve done or creating that in some it’s all book to make in some therapy months or so but we also need to have treatment available her sleep apnea that can be accessed remotely because there are not enough specialists who can assist the speaker and the demand is just growing as people recognize what’s going on thanks no no he talked about I WANT TO DAY TO DAY say oh God here. Also if you can use a day now let’s switch the focus inward I mean for me if I can be honest when he really is a pain it’s probably because I’m really bad at it not only that all because it always goes away from your practice each time we’re puns I’m Just because either of you are asleep and can’t do.

More because it’s up to the really doctor of yours the boss away from your joy for example or raw issue I have to actual levels so I guess that’s why for me always seems like a spotting thing and also looking into the future I would say I really hope to see some changes to see who help us with that so my question movie how do you see the roles the future you think will last do you think who’ll be able to not sleep at all and be highly productive by everything’s just as we would do with full sleep when you think are some more or less poles in areas of which roles will say computer I think there’s little reason to suspect that our collective sleep need be there have changed or will change the future they’re rooted in certain immutable physiological processes that I’m likely to vary I think part of understanding our way to the how to optimize our function during the day is something we’re still kind of sorting out as part of that we need to really recognize what it is what is happening with sleep whether the things we talked about before memory consolidation or a cleansing of the brain clearing out metabolic wastes we need to know what doing to us and doing for us and that’s something that we’re so learnings for example on phatic system as something that was identified just in the last years and it’s basically a parallel system within the blood vessels of the brain that helps to climb the tissues and that’s part of sleep that system seems to be active to clear out metabolic rate including And a scene that accumulates and chip it might be nice but we’re just learning rich. In our issue years of there’s a lot more learned about what happens and once we know what it is we can perhaps better understand how we might opt to mines and perhaps make it more efficient that system that can phatic system of flushing those tissues to the supercharger so that we can do that more quickly perhaps we could shorten our total sleep time and not compromise or play does for us idea of memory consolidation and processing and learning again if we have a sense of how that occurs why that occurs during sleep that could perhaps be optimal and then there is a trade off hours that seem when a wasted but the benefit that we get from our sleep improvement in our hunch and when we get enough sleep then trade off occurs when we get six hours instead of eight hours perhaps were a productivity is increased our mental acuity is increased and as described in many other impacts to that’s with that revision over the long term as well but I think for us to really look to is usually how can we sleep last and agree have to understand what Cletus for and that’s something that we’re still learning about but I think ultimately it once we do understand the processes that are occurring certainly is possible we could try to optimize we have medications even today that are stimulants that help to improve wakeful moments but even blocking adenosine blocking a signal has something wakeful or may not do everything that sleep is doing again blushing out these chemicals in consolidating memory and the other processes may not be fixed by taking a stimulant medication but I think there is hope that as we understand sleep better that we may be able to really optimize it and perhaps increase our productivity increase the hours that we’re able the way I just wanted to know about people would probably all know someone at least one person in your life there are.

Some reason they always four or six hours of sleep and they don’t seem to have the same issues that energy or way for us that you do like my dad for example for like thirty years were obviously more than I had and so I. Two questions about those kind of people one are they truly as rested as they feel and the second question if so if they do happen to have.

Their research labs were. Going out why it is. And trying apply that to the future of the hand you know there’s certainly is research on and caring sleep need short sleepers and also long there’s a fair bit of research in the people who need a longer sleep seem to have other impacts of their house that they are more likely to die from various causes and more likely to have financial and other problems and we might wonder why that occurs and if you look at sleep in the perhaps the average sleep need is just over eight hours some researchers suggest about eight hours and ten minutes to avoid the effects of so deprivation but that is a bell shaped curve and even though that is the average and the majority of people are adults he seven to nine hours perhaps older adults only need seven to eight hours to feel rested there are people on the street and perhaps more from two percent of people who need four hours of sleep and on the other shamen probably are two percent of people who need ten or eleven ounces so it would be an interesting kind of better specially shorts which is how they’re able to sleep as little as they do and still function well so you might imagine that they have a various fish and system perhaps it comes out excess that is cleansing out the brain tissue so they’re just really good at cleaning up after a full day and clearing out person tabloids and resetting the brain tissues to when they find normal state and perhaps the people who need more sleep or just less efficient perhaps their system does not work as well and as a result they need more time to current chemicals and I think beyond the total C timing apostle looking at sleep disorders and people with untreated sleep. A lot of fragmentation of their sleep certainly that can the impacting system as well and as a result they may not be as efficient clearing away those chemicals and some research recently would suggest that perhaps they’re more likely to kill. You know a waste products and towel and other things that repeat should be a long term development dimension also I mused I think that’s a piece of it that me not beautiful story but understanding kind of that system and perhaps how to optimize decisions that perhaps something that would be beneficial to everyone.

By a question about how we include both the qualities he. Made a very able solution and the way that you have a game quality over quantity that maybe I think wearable technology whether that be set in a strap or is activity trackers like that and others the use of kind of independent monitors at that side that help to kind of identify patterns sleep and wakefulness and movement I think those are nice features they perhaps give us a little bit of information guidance but really low tech solutions are perhaps the most helpful when they’re simple saying that they are outlined and extensively with some of the Santa they rationale in my book insomnia solved but I will give you kind of some of the highlights and what I feel is the most important ten I think the first is just to really prioritize sleep recognize the benefit that it has to our health and well being protect our sleep time on a daily basis seven million sure that you get an adequate number of hours of rest and that may vary by individual it may vary somewhat to our lifespan and there may be times in our life we face pressures that use our sleep until it a little bit but most people need seven to nine hours of sleep and older adults and maybe seven eight hours and you want to make sure you protect that amount of time best you can or they have a basis it’s nice to have easy transition to sleep so protecting the last hour of the day to change gears So putting aside our work we always have more work to do more projects that the our attention but in that last hour saying OK I’ve done as much as I can do today I’m going to put it aside and come back to tomorrow and I’m going to spend some time lax and really preparing body and mind for sleep so. That can be time spent reading or watching a movie or watching a T.V. show or otherwise kind of relaxing and preparing for sleep we should really reserve the bedroom as a space for sleep there should not be electronic We should not have our phone at our bets on the bed should be a place as you go when you’re feeling sleepy if you wake in the night and have difficulty getting back to sleep ideal to get up to something relaxing and come back to bed when you’re feeling more sleepy that helps to recondition us and helps us to really associate the bed as a space for sleep and that conditioning makes it easier for us to fall asleep but the getting of the night it helps us to get back to sleep more easily when we wake in the night ten a course in the morning we should get up right away as well don’t linger and try to keep a regular fix awake time get up at the same time every day and that helps to reinforce our cicada in a rhythm sense will make it easier to wake and I usually recommend that people consider getting some sunlight in the morning if you think of how it develops evolves light is really part of our pattern wakefulness when it played out we should be awake and it stimulates the pattern of circadian waking in fifteen to thirty minutes of some might ponder what they can maybe best if you live in the northern latitude in might have to think about waiting till sunrise or is perhaps an artificial light box to get that light but that light helps wake up also helps set the timing of our sleep so the heating system might get feeling sleepy at the same time and I always recommend that people go to bed feeling sleepy pay attention to your own sense of sleepiness drowsiness nice feeling that comes right before you fall asleep I was getting heavier warm sensation that’s your cue to go to bed don’t go to bed based on the specific clock time for what reason you’re up late and busy or out late to social function you may need to step a little bit later that night to get feeling sleepy but if we really pay attention to our own sense of sleep in that helps us to sleep better and so many other things can be household and physically active and moderating the use of alcohol caffeine and attention to those impacts conflict can be helpful as well. But if someone is struggling someone and having difficulty either getting to sleep or their sleep quality is undermined or they’re experiencing other sleep patients like mess a slight syndrome they should get help they should reach out to their primary physician perhaps get referred to a board certified sleep position but sleep is treatable I trained as a neurologist and I spent all of my time practicing sleep very satisfied to help someone to sleep better and it really changes someone’s life to have incurred quality sleep and really turned ten things around Thanks very much I may be a lot of question these artificial some bias that you mention basically exists and help so there are lights that are available some are full spectrum they may have ten thousand blocks of light intensity Some are more in the blue spectrum may be a little weaker but the blue seems to be a pattern of light impacts the circadian timing hole sun is back so that you can go outside and get direct sunlight that’s one hundred thousand lux of light intensity and even through a cloud layer or a rainy day you’re going to get more light than it would from indoor lighting but these light boxes can be set up next you on a stand they can be worn as classes there’s different technologies that are available so that delivery but most people are going to benefit from using a light mediately upon a way to get up and immediately get that light exposure that will help especially folks who are night owls who have that delayed sleep phase timing that light is very key for them to set their circadian alleging that no one really regulate the pattern of their sleep so it lay back to their available the acceptable some might is free to get out first thing in the morning that would probably be fast writes things I can access to the effectiveness of the backers I just want to throw in as a plan there really are for January in Michigan out of ten thousand lux lightbox and it really made a difference for you in the mornings.

Here there’s one actually where I give myself a few today citing were some things that you all city really are but it’s holy basics I have a high ages. And that’s all they can talk to friends with that in fact actually in our local living space here Munich I believe that other friends invest and leaving that we want to use to sorry experimenting with this crazy environment with Oasis the abyss basically the attempts to make sleep more efficient and this amazing if under suppress the rents the share or ration of your tolls the basically do this by snoozing him short bursts will the day set of sleeping all night one of the most popular holiday sixty’s get us involved longer course leave at night where ninety minutes to six hours and then you supplement that with twenty minute naps over the day the length of the course the number of naps can vary different schedules but overall they always amounts to something three and seven Hours which is always less obviously than what you would have if you set normally pays the rent so you are really safe hours of your days could somehow do is not to give.

However there’s very little off research about this and I’ve always wondered if we really know other Sampras and what it means to reduce the amount of you see things I did that’s get you as you get less so Dr because I would really like to know your scientific perspective on the subject yes it’s an interesting concept and something that certainly you have had knowledge of for many many years I mean Shakespeare describes characters who are up in the middle night that in a friends at midnight for several hours and then going back to bed and if you think of most people that experience a little sleep in a funny afternoon if they have the opportunity to take a nap they have to say to their overnight free period I’m have Greece nap period if you think about sleep in terms of appetite for food and caloric intake it makes sense that you could divide up your sleep period and still accomplish really what you need to as far as sleep is concerned so it cycles themselves typically run about ninety minutes two hours you go through lighter stages of sleep stage one in. To a little slow wave sleep especially early in the overnight days and then you’ll have a period of REM sleep that REM sleep very vivid dreaming my whole body or completely relax paralyze and then there’s often a brief awakening So it’s pretty normal for folks to wake up three four times during the night a conclusion was REM periods you know you could set up a Ses where you have that period of sixty ninety minutes and what happens is perhaps with a little sleep deprivation you start to cut out later stages if you’re a man stage one and stage two slates stage two makes up about fifty percent of our sleep generally but when you’re in a state of sleep deprivation you’ll get more flow of sleep and more RAM sleep as a percentage of the total sleep time so with fewer hours a week and with broken up days of the Slate You may have a higher percentage of REM sleep now you might wonder if you spent half of your night in stage two sleep and must have some function and that must have some importance for it to make up that much of our sleep we can certainly function on reduced proportion of that and many people can really do quite well with weight then if you think about in terms of food you can do well using long as you reach your caloric needs you don’t have to have three meals a day with larger Clark intake you could do ten small meals and the same is probably true with polyphase explained you don’t necessarily need an eight hour period of sleep over night and perhaps you can get by with six or seven hours and you know like you to me as well and that sleep can be broken not just the famous those meals can be broken up and I would say that there definitely needs to be more research than there are individual see is this quite effectively and industries including sailors who use it effectively they wouldn’t be able to sleep for a prolonged period without sailing by themselves getting off course of a weight and wake and shorter periods but it does not seem to be particularly harmful I think it’s important to recognise the effects of sleep deprivation and ensure that you’re still meeting your they find sleep needed even if it’s broken up into those periods thanks very much that’s really surprising Dutch beers I was really expecting you to go. Off at the idea laugh and say you know some corner of the Internet crazy guys are probably physics plates so that’s really an interesting thing to hear you say that it’s possibly a thing that might be effective for some people I suppose if they have the discipline to do it yeah I think that’s a key part of it and the same thing in terms of food intake like that a discipline to limit your meals and break up the meals I wanted but I think it is possible and there is some variation and perhaps there is an ideal schedule but something that I think it would be tolerated by most people for discipline about it who have years on the bar and also that they have to think about it yeah I had a really rich question in some soup feast muzzling that ation it’s really emphasized when speech will leaders they have the ability to not see many night and using night as more Dally he to get warm and that it would hire spirits is very emphasized I want to know if you have any comments on that kind of perspective to sleep or not sleeping away so that’s something I don’t know a lot of but I suspect that there may be ten Imperial meditation when brain waves are flying down that perhaps there would be some unresponsiveness perhaps even equivalent to very light sleep so some people experience it was something called paradox consommé where they feel like they’re awake for many days sometimes even prolonged periods weeks months that they do get into light sleep they mean I’m not totally experience at the deeper state of sleep or even asleep at all but that’s possible that they may be having some of that slowing within the brain waves that would be somewhat a quick very light sleep and there’s some technology that might actually help to trigger that sounds and other things that help a person into that state of very light kind of meditative sleep one last question here is how can people I know who are crazy when Also maybe you can say one or two words about your book so I am always happy to answer the questions people can contact me through my own personal website which is grand and. Hitter’s M.D. dot com The new book insomnia song is available through Amazon paperback and the additions and I do a lot of writing very well back home so there are currently more than a thousand articles on various topics so if there is a topic that provoked further interest certainly to find something I’ve already written about resources wow cool awesome things actually or already arrived yesterday and I want it with you as a part of a ration discussion I’ve been looking forward to.

Thanks everybody thanks very much the years we’re going us and your time the hour of the Sunday and I want to wish you a great day it’s already getting nice all going to sleep but as you folks in the US you will enjoy any day thank you so much. Thank you thank you very much Dr Peters and I’m a slave to its Bangkok so it’s midnight thank you I have a good night.

Bye I don’t deny good day to everybody.

Bye Bye bye.

Let’s make the future featuring the voices of Danielle’s swale MICHAEL CAREY posing on a Sarah. And Michael.

Music and edited Christian Pelton.

Is it.

Let’s make the future doc. Broad.

Dot.

Delivery get a. Feeling it.

Good night.

Keywords

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