“The Mystery of Sleep: Patterns, Habits, & Tools” by Pamela Swift, Ph.D.

I’m Jim hood Jack I’m the chief of child
listen psychiatry at the Lerner College of Medicine and at the University of
Vermont Medical Center I also have a hobby called the UVM wellness
environment that I spend a fair amount of time on I’m just giving you some
context because I run the Center that Dr. Swift works in and I’ll make
references both to that Center and to the Wellness environment while I
introduced this incredible person first and foremost apart from being blessed
that she works in our Center and teaches in our program Dr. Swift is a Vermonter.
She came up in Barry and no, no end of humor for me when I’m working with that
with Pam when she gives me that Barry glare I know right where it came from the Barry glares well-known Spalding
high school then she went to University of Vermont and distinguished herself in
her undergrad work in psychology then went to West Virginia and Morgantown to
pursue the study of young children whose lives go sideways and then a PhD and a
fine dissertation looking at kids who whose lives and crew include law
breaking and criminal behavior she has told me privately after doing that
important work she knew that she wanted to do something else and we were blessed
to have her come back and do an internship in our Center shared with the
connecting cultures program run by moshav aanava’ and Karen Fonda Caro and
then I was lucky enough to get her to do a postdoctoral program with us where she
is an incredible clinician takes care of some of the most needy children and
adolescents in our Center and is an extraordinary teacher as you will see on
your own today in the wellness environment she has teaches courses on
sleep and on concussion and on the impact of substance use on children’s
brains but more than anything I value her as a colleague who has taught me
that the four hours I was getting is probably not enough so I’m
gonna ask you to welcome my colleague Pam Swift thank you can everybody hear
this okay okay excellent thank you for that welcome Jim I appreciate it um just
to kind of give you all a little bit of background and thank you all for being
here tonight too I know there’s overflow seating upstairs
and people are watching on streaming so I appreciate your interest in this topic
sleep is what I would call my soapbox topic during grad school when we would
interview students to join our graduate program we would always ask them like
what is the thing you get up on your soapbox about and I after undergraduate
and not taking good care of my sleep I realized that this is very much my thing
that I care a lot about and that I’ve put a lot of resources and time into
changing for myself and then researching um in a variety of different manners I’m
within my graduate program I worked for a period of time in our sleep research
laboratory with Dr. Holly Montgomery Downs primarily doing research on
pediatric sleep disordered breathing and postpartum sleep as well and I’m also
about to go back into that realm of postpartum sleep so I apologize for my
Footwear it is what is comfortable right now I’m sorry would usually wear heels
but we’re just we’re getting through the other thing that really you know I feel
really privileged to do um within my work right now is focusing on these
domains of wellness that we talk about within our clinic
um sleep is one of those domains that we talk about a lot and it was an area that
you know there wasn’t too too much um you know faculty interest in at the time
or there wasn’t too much research in so I was really happy to come into this
spot within the VCCYF and take over that area of expertise I’m so briefly
he’ll see you have like letters in front of you um so the learner College of
Medicine has really taken a focus on active learning in the past year or so
and this is kind of their definition of active learning right so active learning
methods rely on engagement to construct knowledge as opposed to me just standing
here being at you I’m so you know rather than
passively absorbing it hopefully you’re kind of participating in it too on so
you know the way that we’re going to work this in through our talk is we’ll
do pre and post questions as we go through some of these topics so we’ll
have some true and false questions will have some multiple-choice questions when
I have a true and false for you I’ll just ask you to raise your hand if you
think it’s true and then the multiple-choice you can see
the cards in front of you so you can spend a minute kind of heard like 30
seconds or so probably I’m talking to your neighbor talking to those around
you formulating some kind of answer and then we’ll check in at the end of the
topic too so to test this out true or false
my name is Pamela Swift good I like it good good participation and then your
understanding what are we gonna be learning about tonight are we gonna be
talking about what sleep is why we sleep how much sleep we need or hopefully all
of the above I’ll be above which I’m gonna warn you is a lot so I’m sorry if
I speak really quickly but I want to make sure we have the chance to like get
questions in at the end um so it’s a fine balancing act all right so let’s
get into that first one so what is sleep um so I asked my students this a lot I
asked my patients this a lot when we’re starting out with sleep treatment I’m so
these are the kinds of answers that I typically get in response so lack of
consciousness so we go unconscious when we’re sleeping lack of wakefulness so
we’re resting we’re relaxing dreaming is associated with sleep of course and it’s
typically associated with one portion or one stage of our sleep cycle muscle
paralysis so you lose muscle tone during certain parts of sleep we describe rat
or every sleep as being these two different categories so REM and non-rem
which will go into extensively in a couple slides we know there’s a
circadian rhythm or some kind of cycle associated with sleep and with
wakefulness I also have my students tell me about yeah it’s probably super
important that’s why I’m up here talking about it and then regularly my students
and patients are telling me that they’re not getting enough sleep and that is
typically true of American populations something like fifty to fifty three
percent of Americans are not getting as much sleep as they think they need in
the UK it’s even higher I think it’s like 68 percent so we’re not the worst
but we’re definitely struggling as adults especially with sleep so we know
that sleep accounts are about a third of our existence so if our you know you’ve
probably heard the adage you need sleep to sleep eight hours a night if you
divide that across your 24 hours of the day then about a third of your life is
spent sleeping it’s incredibly important and vital because it plays a role in
nearly every physiologic every psychological process that you can think
of I’m so and it’s subsequently affected by those processes too
so you’re thinking about immune system functioning cardiac functioning those
things are influenced by how much you’re sleeping and vice versa and then when
we’re thinking about like psychological disorders there’s a number of
psychological disorders that have some issue of sleep in their criteria so
depression for instance you could be sleeping too much or too little PTSD is
associated with nightmares and troubles with sleep if you want to put it really
succinctly then sleep is this biological state that consists of REM and non-rem
again we’ll talk about those in a second but it’s also defined by these
behavioral phenomenon – so there has to be minimal movement there has to be a
typical sleep position so for humans were typically laying down while we
sleep you can be supine on your back you can be on your side you can be on your
belly but we’re typically laying down it has to involve some reduced
responsiveness to stimuli so if I came up and whispered you might not wake up
all of those things could also be indicative of coma you know they could
also be indicative if none of those things are happening that could be death
so we need to have this last one here it has to be reversible you have to be able
to get somebody out of that state with some kind of intense stimuli you know
depending on how deep in sleep you are it might be something less intense like
just saying somebody’s name or you know shutting a door if it’s more of a deep
sleep of deep stage of sleep you might have to do like sternal rugs even or
something depending on how deep they’re sleeping but you can reverse it we know
that all and/or mammals have REM and non-rem sleep to some degree so
otters do sleep like this is adorable they hold hands they you know they make
sure they’re not losing their buddy elephants and my daughter sleep like
this so they like to kind of like you know put their butts up they’re sleeping
on their faces um the one exception to this rule because there’s always one are
echidnas echidnas are like those really weird kind of mammals they’re small they
have really long noses they lay eggs they’re like not like a mammals for a
lot of reasons but they’re classified as mammals they do not have REM sleep so
there are one exception to that rule but every other mammal has REM and non-rem
sleep and most a lot of other animals do as well
um so jellyfish there’s some evidence that jellyfish may be sleeping um which
yeah go figure one thing that’s really important to think about is that if
sleep does not serve some sort of vital absolute function then this is a huge
mistake because evolutionarily you’re putting yourself at a lot of risk while
you’re sleeping if you think about like how you’ve grown you know how we as
humans have grown and developed you were at a lot of risk by putting yourself to
bed same with some of these animals these mammals here um you know elephants
have a number prey that could attack them during sleep elephants have very
strange sleeps they sleep for maybe two hours total over the course of 24 hours
and they’re only sleeping in very small spurts so maybe like 30 minutes at a
time but all animals have adapted some kind of way to get through this rest an
active state and to get some kind of function from sleep what that is is not
clear so there’s a lot of different theories for why we might sleep one of
them is restoration or recovery so we could be clearing out some toxins we
could be clearing out some things that our brain is building up over the course
of the day and just kind of restoring us to baseline so some you know evidence
for this that came out a little more recently is that there is this protein
that’s encoded by this gene called Homer and what that does is it kind of scales
back some of these excitatory connections that have been made over the
course of the day so you know as you’re going through the day
the neurons are communicating they’re connecting with one another and you
don’t need all of that so the idea is that it’s clearing out some of that it’s
restoring homeostasis of the brain we don’t know exactly if that’s explaining
everything though because there’s a lot of other stuff going on during sleep
that’s job not just related to cellular homeostasis and if you want to get down
to it jellyfish sleep and jellyfish don’t have
a brain so there’s something else going on here it could be related to energy
conservation right so it could just be that we need rest we need to restore the
rest of our muscle groups the rest of our bodies the issue there is that
engaging in mindfulness engaging in meditation some of those like quiet rest
sorts of activities they might actually conserve a similar amount of energy to
sleep because there are active stages of sleep – it could be that it’s memory
consolidation so we do have a lot of information a lot of research that
suggests that if you learn new information just before going to sleep
then you can actually retain that information a little bit better so this
applies a lot of times in research to learning a new language or learning
nonsense words that kind of stuff if you do it immediately prior to bed you’ll
remember those things better in the morning
so there’s a lot of support for that one but it again doesn’t explain everything
these various other functions you know that have like minimal to some level of
support you know is physical growth especially during adolescence we see
that the pituitary gland does release more growth hormone over the course of
the night for adolescents so this could be important at least for them they have
a lot of other issues with their sleep though that we’ll talk about this last
one discharging emotions you know this is a little bit more maybe cycle
psychoanalytic in nature but you know if we’re thinking about how we go through
the day and we’re following social norms and we’re experiencing a lot of
different sorts of complex emotional situations then we can only get so much
of that out during the day without being judged without you know upsetting our
boss without things like that so potentially during dreams are over the
course of the night this could be a time that we’re getting the rest of that out
and kind of clearing out those emotional situations again kind of hard to
research this but ultimately what we know is that we don’t
know we just don’t know exactly why we’re sleeping it’s probably a
combination of all of these things we do know that at some point your body will
start to crave sleep you will physically start to crave it
I’m similar to the way you might crave chocolate or something like that
if you don’t get any sleep there is a point at which we kind of reach our
limit and you can die so one example of this is this incredibly rare genetic
disease that’s called fatal familial insomnia it’s in a single bloodline from
a family in Italy so if you have it you already know you have it otherwise you
probably don’t have it um but what happens is that these individuals can
only go into very light stages of sleep they don’t drop into any of the deeper
stages of sleep or into REM sleep and typically within 7 to 36 months of being
diagnosed we end up seeing that these people pass away so something is going
on where you need some of those more restorative stages of sleep there’s also
animal studies of course we’ve you know put rats we put my through total sleep
deprivation and seeing how long they can last you know depending on the animal it
could be as little as like two weeks or so but you know with humans
there was this one example that is incredibly confounded but you might find
this on the internet where a gentleman in China was watching the Euro
tournament which is a soccer tournament that occurs in Europe every four years
and they wanted to watch all of the games the time change made it so that he
was working during the day and then watching the games at night and he
stayed up for 11 days straight and he ended up passing away um the issue
related to this is like he was also doing a lot of drugs to try to stay
awake so it’s not entirely clear that it was just the sleep deprivation or if
there were some other causal factors there um the thing that I like to say to
my patients probably to the point where they get annoyed by me is that when
sleep goes everything goes because you start to see everything else kind of
trickle and get worse you start to see your mood get worse your cognition slows
it’s harder to pay attention it’s harder to focus you become more irritable it’s
harder for you to do basic functioning like driving or
getting to class or that kind of stuff so it’s really a vital function that
people don’t pay too too much attention to unfortunately so moving into the next
topic what is sleep physically how do we measure it so we’ll do a little pretest
here um true or false so you can raise your hand
if you think it’s true um if you want a good night of restorative sleep you need
to spend most of that time in REM sleep or rapid eye movement sleep raise your
hand if you think that’s true okay and then number two in order to stage sleep
it’s best to have what information so we want electro electroencephalogram data
so EEG data from electrical data from your brain
respiratory data heart rate data or all of the above you can hold up your little
I see a lot of do some eggs yeah see if any of you are students in my class then
you would know the answer to this cuz I I make a joke with them about certain
answers on multiple-choice alright so we’ll come back to this though and we’ll
talk about these so when we’re talking about sleep we talk about it in stages
um so we have stage 1 stage 2 we have stage 3 now is typically all we call it
it’s sometimes called stage 3 or stage 4 um they used to divide them into two
different stages but now we typically cluster them together because the
differences are not that huge for research purposes it’s probably
important to split them apart though those are all considered non REM sleep
and then we have REM sleep or rapid eye movement sleep this is like a really
weird way that we categorize this like there’s not many other things that we
say oh I’m eating or I’m not eating like there’s nothing that’s particularly
special about REM except for that’s not entirely true but there’s there’s
nothing like a more important about REM than any of these other stages of sleep
but for whatever reason we like to categorize them separately you need all
of them it’s kind of the summary there we get this data primarily using EEG
data that’s found through a poly sonography so polysomnography is an
overnight sleep study I’m here typically I think they do them mostly at one of
the hotels nearby sometimes in the sleep center as well but you’re hooked up to a
lot of different data or a lot of different data sources um so you’ll have
sensors on your head to measure your electrical activity so that’s our EEG
data you’ll have respiratory monitors you’ll have heartrate monitors you will
have oxygen saturation you’ll have snoring monitors you will have movement
monitors all sorts of things hooked up to you and then the wires will go out
into a computer that is analyzed by somebody who’s called a registered
polysomnography technician whose job it is is to watch you sleep and then read
the data from and the data are complex so these are people who know what
they’re doing Stage one of sleep this is the
electroencephalogram data or EEG data look something like this so there’s a
lot of activity going on in the brain we start to see these things that are
called SATA waves so as the waves kind of break up a little bit their frequency
gets a little bit less the amplitudes about the same so the height of the
waves is about the same but they just start to become a little less frequent
so that’s how we can guess that you’ve fallen into stage one sleep this is like
very light sleep drowsiness it could literally feel like you were falling has
anybody had that sensation before yeah it feels weird but that’s that’s going
into stage one essentially and this takes up typically about 10% of your
sleep over the course of the night stage 2 sleep takes up about 60% of your sleep
so stage 2 sleep is actually incredibly important we spend the largest portion
of our time here and we can tell that we’re in stage 2 because these two
different things start to happen in our eg data we get these things called sleep
spindles which are these like rapid bursts of activity that happen
electrically in the brain and then we get these K complexes which are these
pretty big amplitude waves that kind of look like the letter K um sleep spindles
are actually really heavily associated with memory consolidation so people who
have more of these during stage 2 might be remembering things better body
temperature starts to drop heart rate starts to slow during this stage we get
into more of like a light stage of sleep stage 3 again stage 3 and stage
4 look something like this so totally different we got these delta waves is
what they’re called so these really high amplitude low frequency waves and this
takes up about 10% of sleep we also call this stage slow wave sleep cuz I’ve you
know the waves are slow this is a really obvious name for it or deep sleep
sometimes – so this is a harder stage to wake people out of it might take a
little bit more effort REM sleep looks very very different from other stages of
sleep it actually looks like you’re awake in some senses so your brain is
pretty active during REM sleep um it takes up about 15 to 20 percent of your
night of sleep this is typically where dreaming is thought to occur the most
again your brains really active in some areas um so you might be like replaying
memories you might be you know going through something that happened to you
when you were in third grade and it just popped into your head while you were
sleeping um but you can dream in other stages – it’s just most commonly
associated with REM and it’s called REM because it’s rapid eye movement sleep so
if you have a bed partner and you look at them and they’re in REM sleep they
will probably be pretty quiet they’ll have no muscle tone through the rest of
their body except for their eyes will be darting back and forth and that’s a
little alarming to see but it’s totally normal that’s just what REM looks like
the muscle tone goes away because if you do have dreams during REM or this is one
of the reasons you don’t want to be acting out your dreams right so you want
to be quiet you want your body to be relaxed so we have this this period of
time where we might be engaging in more activity activity at least neuronal II
but we’re not really engaging in any activity in the body we also have a
little bit more like heart rate variability that goes on here a little
respiratory variability you can have some little like kind of muscle twitches
that happen during REM but otherwise your body is pretty quiet so this is
what it looks like when you’re hooked up we do this with kids – they’re adorable
it’s really hard to get all the monitors on them you give them a lot of stickers
a lot of a lot of chocolate all that kind of stuff just to really
rough them up before bed but you can see you know next both the this little guy
in this gentleman there’s kind of like a little computer that everything goes
into and then that kind of runs to the computer that the are PSG tech he’s
looking at and this is what they see I’m so they’re getting a huge stream of data
this person actually those they really only have a couple of EEG sensors on so
those top two would be our EEG sensors the next two are your ocular sensors so
again to measure if you’re in REM we need to see if your eyes are moving so
I’m pretty sure it’s above the right eye and below the left eye where those
sensors go then we have one on your chin to see if your chin is moving if we’re
having any twitches you have your EKG we have leg movements if people are having
I’m like restless leg syndrome or periodic live movement disorder we want
to look for that we have a monitor for snoring for airflow for thoracic and
abdominal effort and then for your oxygen saturation as well so there’s a
few different things that I again I’m not in our PSG so I would want somebody
else to read this or you know give me more information but there’s a few
things that kind of pop out there’s some eye movements that are going on there’s
some chin movements that are going on so typically we’re seeing some of those
twitches we have some heart rate variability and then we have the snore
that happens too so there’s a little bit of activity in the snore sensor so
either this person maybe woke up after that snoring or maybe they’re in REM I’m
the biggest way to tell the difference between REM and actually being awake in
terms of EEG data are these little things called sawtooth waves and unless
you’re a professional that can read these it’s really hard to see them
there’s some indication that those might exist but I don’t want to assume that
there is so either this person is in rem or they might be waking up at that point
with this data I’m the other thing to point out is this is only like about 30
seconds of data so if you’re sleeping for 8 hours you get a lot of data to
read but what you can do after that is kind of consolidate it into this thing
that we call a hypno Graham so a hypno Graham
gonna show how you went through these stages of sleep over the course of the
night and typically what we see is that the average person will excite goal
through from stage one to REM sleep in about 90 to 120 minutes again this is an
average perfect night of sleep I’ve never seen anybody who has a hypno gram
that looks like this this is just not what actually happens um
the thing that we do often see though is that the time that we spend in rem might
increase over the course of the night so you know your first REM cycle might be
something like half an hour but then the next the next time you go through REM it
might be a few minutes longer by the end of the night it might be closer to like
45 minutes or so there’s a lot of other ways that you can measure sleep P SGS
are expensive they also have to be clinically indicated you can’t just let
go and get one I also wouldn’t recommend it because it’s not gonna tell you
anything unless you have a sleep disorder that you’re really worried
about um a lot of times what people will do is they will use like wristwatches
they’ll use apps and things like that so I wanted to make sure we touched on
those I’m one of these watches is called actigraphy or acti-watches these are
more typically used in like research or clinical labs they’re similar to any
other watch that you might wear they just don’t have any of the other bells
and whistles there are exclusively accelerometers so they’re monitoring
movement essentially in the body so if you’re quiet it’s assumed that you’re in
a sleep state if you’re moving then it’s assumed that you’re awake the
accelerometers are a little more sensitive than the ones that you might
have in your watch or your Fitbit or something like that and they’re really
expensive some pieces they’re costing like one thousand two thousand dollars
and you don’t really get anything else from them so there’s no benefit for any
of you to go out and buy one unless you run a sleep lab um but the other thing
that it might have in some of the models is these like light sensors so it can
again kind of tell if I’m you know it’s daytime versus nighttime or if you have
a lot of lights on but you’ll get a readout that looks something like that
so having these like black bars would indicate if somebody was awake or having
an awakening versus when there’s fewer of those when they’re spread out that’s
a person who’s sleeping you’ll see you know even on a person who had like a
decent night of sleep this was a five year old sleep from a study on like
typical sleep patterns for kiddos um there’s gonna be a number of awakenings
through the night and that’s totally normal
you know you can have up to like 15 to 20 awakenings over the course of the
night and have that be a reasonable amount you’re just typically amnestic
you don’t remember any of those happening this kid will probably
remember those last two there’s a number like an amount of activity that’s going
on that would suggest that maybe they woke up and got out of bed or they had a
drink of water or they were moving around enough that that kid will
probably remembers those awakenings it also sleep gadgets there’s a lot of them
I’m sure you’ve seen ads for them I’m sure you’ve seen different kinds of you
know apps on phones for them some of them just require your cell phone others
require that you have some kind of fitness tracker and then it links to an
app um typically if you have one of these finished trackers then it’s
monitoring your movement again with an accelerometer some of them have
heartrate monitors in them and then sometimes they’re doing audio recordings
too so if you’re worried about snoring that kind of stuff then you can record
your sleep in that manner as well the accuracy for them is super debatable
so the depending on what models you have depending on how you’re using them what
features you’re using of them they can be off by as much as two hours when you
compare them to something like a polysomnography and there’s a lot of
data that’s that’s comparing these different kinds of gadgets this one
specifically was comparing a PSG to a Fitbit Ultra which I don’t know that
these are really around anymore this is a couple years old at this point um but
the Fitbit ultra and then the Fitbit ultra when it’s on sensitive mode so you
can see so the PSG is our our gold standard we get so much information from
this that this seems to be our best way of measuring sleep when we compare it to
that Fitbit ultra we’re seeing that the Fitbit ultra is overestimating the
amount of minutes that we’re spending sleeping it’s also under estimating the
amount of time that we’re awake after we sleep so TST is total sleep time wha so
is wake after sleep onset so if you’ve fallen asleep and then you wake up over the course of the night we would say that
that’s a period of WASO and then sleep efficiency is a mathematical calculation
it’s your time that you spend asleep so your total sleep time divided by the
amount of time they are actually in bed because those are different things you
don’t immediately fall asleep the moment you get into bed it’s normal to take a
few minutes so we’re aiming to have as close to 100 as we can but that’s not
typical for most people if you’re gonna have 85 or above that’s pretty good um
so again using the PSG we’re seeing that it’s about 83 percent but the Fitbit
ultra is saying it’s closer to 90 92 percent the really concerning thing here
is the sensitive portion the sensitive setting that Fitbit kind of markets is
like hey if you’re worried about a sleep disorder set this sensitive and see what
happens you know monitor your sleep that way this is vastly under estimating the
amount of time that people are spending sleeping upwards of you know a hundred
and five minutes so closer to two hours that it’s under estimating your sleep
time it’s really over estimating the amount
of time that you’re spending awake after you actually fall asleep and then as a
result your sleep efficiency is way way lower than what it was when you had a
psg so this might lead people to think that I have a lot of trouble sleeping
I’m like really struggling with sleep when that might not actually be the case
and then you’re seeking care that you don’t necessarily need okay regroup true
or false if you want a good night of restorative sleep need to spend most of
it in REM mouths yeah you got to get all of them they’re all important and
actually you’re probably gonna spend most of your time in stage 2 sleep
instead and then in order to stage sleep it is best to have what information All of the above if you’re gonna try to stage it and figure out was I on stage 1 was I on
stage 2 you need to have all of that information again that might not be that
important for you to know you might just be trying to figure out how good is my
sleep quality in you know in that case you definitely don’t need a PSG this is
very specific to figuring out what stages are you going through how is your
breathing overnight how is your movement overnight okay so moving to the biological basis
of sleep again let’s do a little pretest so true or false our bodies run on
basically a 24-hour schedule or rhythm give or take like 20 to 30 minutes lots
of truth the area of the brain that is our clock setter is called the
suprachiasmatic nucleus the retina the thalamus or the Timex you can hold up I
know it’s it’s so tempting C, A so I’m seeing a good mix of C’s and A’s okay
I’ll come back to these um so your brain is synchronized to a or your sleep is
synchronized to a solar clock so we follow the Sun so it runs on about a
24-hour cycle or 24-hour phase we call this entrainment so we use that solar
clock to decide whether it’s day or night and then we run on that and you
know circadian so our circadian rhythm comes from Latin so circa about diam a day
I’m so again that’s where we kind of get this like this name and then the 24-hour
focus we talked about these three different components when we’re talking
about the biological basis of sleep so we have these chemical components or
these central components that are really driving drowsiness versus wakefulness
we have these input pathways that are these environmental or exogenous cues
that are telling us you know whether we should be awake or whether we should be
sleeping and then we have these output pathways so our clock setter
our brain talks to all of these different areas of the body and kind of
sets our signals to change our behavior to change different physiological
functioning um you know to change heart rate to change all sorts of different
things the question is is it entirely exogenously, so does this entirely run from outside of our body or is there some kind of thing internally that’s deciding these things
that’s kind of setting this clock and there is if their narrowed Terrier
hypothalamus it’s called the suprachiasmatic nucleus so oh you said
A that’s our word of the day ah it’s really fun to say so if there is
endogenous clock so lives within our hypothalamus your
hypothalamus is really important for a lot of different functioning behaviors
from day to day um you know it’s associated with the for F so fighting
fleeing feeding and fornicating it’s involved in temperature regulation it’s
involved in sleep and wake it’s involved in all sorts of like growth all sorts of
things hunger safety a’ti all these kind of basic functions go through the
hypothalamus so that’s where our sleep clock is located as well um other thing
that’s important kind of from like a structural standpoint is that you’re
super cosmetic nucleus is located right above your optic chiasm so this is how
we get entrained to light this is why the light piece is so important so your
retina receives light information from the Sun even on not so sunny day it
receives light information and your retina hypothalamic tract sends that
back under through the eye eye man underneath the suprachiasmatic nucleus
and then that kind of sets your clock it decides as a daytime is at nighttime and
it tells your pineal gland whether it should be releasing melatonin or not
we’ll talk about melatonin much much more but when there’s light out we
typically see melatonin is suppressed we don’t have as much of that being
released once it gets darker then we see that melatonin is increased in the brain if for some reason this area of the
brain is destroyed as Lygia and is in in you know not functioning correctly we’ll
see that the amount of sleep and wake time does not change so we still will
sleep about the same amount of time we’ll still be awake about the same
amount of time the 24-hour clock that it runs on does so this is a case you know
where they had some rats some of them had their suprachiasmatic nucleus
removed so those would be the ones that have no diurnal rhythm and then some had
their normal kind of structures so all of those like black bars are times when
the rat is running on a wheel and being really active and you know rats are
nocturnal so they’re running more at night they’re engaging a more behavior
at night when they’re Sen is working functioning normally when they don’t
have it then it just looks like their free reign they’re doing whatever they
want whenever they want however if you kind of push those times together then
it would be about the same as those rats that did happen or
a functioning SEN it’s just the way that it runs is a little different there’s a
lot more evidence for the hypothalamus just broadly and how it functions with
sleep I’m so one area of the ventral lateral preoptic area so this is kind of
in the middle there the V LPO in blue that area is associated with gaba
release GABA czar inhibitory neurotransmitter kind of calms the body
slows the body down and it talks to other areas of the brain that are
typically more activating so the TMN for instance that releases histamine so
histamine is a pretty Wake inducing substance so the the LPO kind of says
hey let’s calm down this process let’s not release as much histamine let’s calm
the body if that area isn’t functioning very well then we tend to see people
experience insomnia so they’re not able to fall asleep as regularly or as
readily um you know they might be waking up multiple times overnight that kind of
stuff the lateral hypothalamus um so it’s not actually labeled on here
but in the red where it says hypocretin that is an area that releases hyper
Crean or orexin is sometimes called and this is a really
wake promoting area of the brain our substance in the brain and so this talks
to other areas of the brain that would typically maybe be a little bit more
inhibitory um and if it’s working well then it keeps you awake if it’s not
working so well then you might be experiencing things like narcolepsy
so you might fall into sleep stages a little more readily than you’re supposed
or when you’re not willing to actually be falling into those stages there’s
other areas of the brain that are important to these areas communicate
broadly with other areas of the brain um so you know our brainstem contains what
we have or contains what we call our reticular activating system and it sends
these really nonspecific kind of signals to the rest of the brain that hey it’s
time to wake up time to be active time to be engaged if it passes through our
SCN when it’s nighttime and when we’re supposed to be sleeping then the SDN
will say nope not going to send these signals not going to communicate this
similarly the thalamus will do the same thing it’ll kind of slow those things
down alternatively if it is time to wake up then it’ll send those
signals to the rest of the brain and say we need to be activated we need to be
engaged the thalamus has also been
associated with kind of synchronizing EEG behavior across different areas of
the brain and with sleep spindles as well so that area our that that period
of time in on stage two where you start to experience those rapid bursts of
electrical activity so our brain plays a really important role of course in sleep
wake but there’s a lot of these external cues for sleep as well we call these
psych gaber’s that’s another fun word of the day you know where this is regulated
by your feeding schedule you know a lot of times the typical kind of feeding
behavior would be three meals a day breakfast lunch dinner that’s not what
everybody does but that’s kind of the typical things that kind of set those
clocks again light is really important in this scenario um you know people who
are experiencing total blindness they don’t have a similar rhythm they have a
different kind of circadian rhythm they have non twenty-four is what it’s called
you’ve probably seen medications for that on TV so you know this is a really
big one that we experience and that tells us what time it is similarly
activity too so I’m you know the amount of activity that you’re engaging in when
you’re engaging in activities if you’re following like a work schedule or a
school schedule or something like that those things help to indicate what time
it is and whether we should be awake or asleep what happens if we take those
away so what happens if we just put you in a dark room mm-hmm
see what happens you know so they’ve done this with plants because plants
also have a circadian rhythm um we see that if you keep plants and darkness
that they’re still gonna kind of follow the light so the leaves will kind of
move to where the Sun would be even if they don’t actually see it we also see
similar kinds of things for not children or rodents if they’re kept in continuous
darkness they’ll still kind of follow the same sort of patterns with people um
so this study was looking at if you gave people the opportunity to kind of get a
typical sleep schedule over those first 10 days and then we took away all the
zite gaber, so we left you in total darkness, we took away all clocks we took away anything that would give
you an indication for what time it was um we’d see that the sleep and like wake
period kind of extends a little bit so we still see a similar pattern of you’re
gonna sleep for a consolidated period of time and then you’re gonna be awake and
active but we see it actually looks a little bit more like twenty five hours
or so um so everything just kind of shifts an
hour every single day and this is what we call like freerunning so if given the
opportunity to have nothing to tell us what time it is this is what it’ll kind
of start to look like and then if we go back to having those like guy burrs you
see you pretty quickly in train to that 24-hour period again you get back to the
same kind of same kind of schedule so this is regulated by some of these
competing processes I’m so sleep is regulated by our circadian rhythm and
then by sleep homeostasis so we call these process C and process S process C
is the thing that’s sending these alerting signals over the course of the
day so from the moment you wake up you start to see those increase over the
course of the day there is this period of time in the afternoon where they do
actually dip and so that’s why you feel kind of sleepy after lunch you’re
alerting signals have gone down during that time and then process s
alternatively is also building over the course of the day from the moment that
you wake up but these are kind of more of our drowsiness signals that are
building and these can be slowed by things I’m so like adenosine is one of
those one of these these substances that makes us feel drowsy adenosine is
blocked by caffeine so I can’t do its job anymore if you’re drinking enough
caffeine um so you have ways to kind of slow this process down if you need to
the other piece um is you do have an override switch
it’s called process W so that’s like if suddenly the fire alarm goes off then
you’re gonna wake up um you do have this response to danger that will get you out
of your sleep stage which is again evolutionarily really really important
so this is kind of what it looks like um so you have these sleep drives this
sleep homeostasis drive that’s building up over the course of the day and it’s
kind of working against this circadian rhythm or this alertness signal that’s
building you see around 2:00 p.m. or so that’s where we see that alertness
signal drop a little bit and you might feel kind of
drowsy and then we see it build up again if we want to kind of match this as best
as we can and this is really individual so this is the person who’s pretty well
entrained to sleeping from 10:30 to 6:30 matching your bed time to about an hour
and a half or so after your alertness signal starts to go down is the best
thing that you can do so in this case this person’s alertness signal is going
down around 9:00 p.m. and they’re sleeping around 10:30 this is really
hard to figure out it takes a lot of a lot of time and a lot of effort to
figure out where you fall in this rhythm and in this pattern but if you are able
to figure out those processes and you can match your sleep to these processes
pretty well okay so true or false now that we know our bodies run on a
basically 24-hour cycle you know again give or take twenty or thirty minutes
true the area of the brain that’s our clocks that are is that yeah good on you
it’s fun to say all right yeah so how much sleep do you actually need this is
kind of like it’s talked about a lot so true or false first of all so it got our
pretest older adults require less sleep than young adults or middle aged adults
okay I’m actually shocked that there was so much like gumption about that one
good on you all right and then adolescent sleep is characterized by a
advancement of sleep phase so going to bed earlier B delay of sleep phase so
going to bed later decreased time asleep and increase sleepiness or both B and C
and just Tahoe you don’t you throw up your little your little card CD B all
right I see some good variety I like that okay we’ll talk about that
adolescents I’m sorry but adolescents are a little bit doomed so just be aware
um so this is what the National Sleep Foundation so one of kind of our
governing bodies that puts out sleep recommendations this is what they
recommend for different age groups um so you see newborns of course they’re
sleeping a lot it doesn’t feel that way but they actually do sleep
by the time you’re getting to infancy and toddlerhood we’re seeing those sleep
needs decreased some and by the time you’re out of the preschool age we’re
seeing that naps kind of go away and sleep really consolidates more um and
then basically from like late teen years young adulthood on the average need is
about eight hours so there is actually this common belief that by the time
you’re in like the later stages of life if you’re 65 or older or something then
you might not need as much sleep but that’s really not the case we do see
that sleep needs are about the same once you get to older adulthood what are the
actual people doing with their sleep um so right like these are recommendations
what are people actually sleeping we kind of have this bell curve this normal
curve that most people are following um so you know again yeah on average people
are sleeping somewhere in that like six and a half to like eight and a half hour
range in adulthood um but we do have people who are short sleepers so people
who are sleeping less than six hours we have people who are long sleepers or
sleeping more than nine hours I’m the number of those people is much smaller
but we do know that there is actually potentially some like genetic component
to that there was a study that just came out that pointed to one particular gene
that a family had passed down in their in their generations and everybody in
their family just could not sleep more than six hours and it was potentially
due to this gene um they’re trying to find other candidate genes that could be
related to this but they found a couple so far that might make people more prone
to be these short sleepers so let’s go through these age groups really quickly
um so infants and toddlers they have really high sleep needs right like they
get cranky they need to be sleeping um it does become more consolidated after
the newborn stage and then it continues to consolidate through early childhood
circadian rhythm typically arises around two to three months in kiddos you know
that’s why you might see if you’re interested in doing sleep training with
infants that’s typically the time that you can start doing that kind of stuff
their cycles are a little shorter so they’re not like ours that are like 90
to 120 minutes theirs are closer to 50 minutes until
about nine months and then we also see that they split REM
and non-rem a little bit more evenly but this is kind of just graphically
representing the different periods of sleep time versus wakefulness across
these early age groups and then compared to adults so we see newborns they’re
sporadic right they’re gonna sleep for one hour chunks two-hour chunks here and
there it’s really hard to predict because they don’t have any sort of like
cycle or rhythm that they’re following yet by the time they’re one we’re seeing
you may be getting a couple of naps during the day and then more
consolidated sleep overnight by the time they’re three we’re seeing it’s really
just the one nap that we’re shooting for and then more consolidated sleep again
overnight by the time they’re nine we should definitely not see kids napping
regularly anymore naps should typically go there typically gone by the time kids
are 6 ideally they’re going away by like 4 or 5 and we’re really consolidating
sleep overnight adolescents poor adolescents they have so much going on
that so in addition to puberty they also have this developmental phenomenon
that’s going on where melatonin is actually released later for them so for
us you know we might have melatonin that’s released around like 8 o’clock
something like that adolescents are not gonna have their melatonin be released
in some cases until like 10:00 or 11:00 and melatonin is what we call like a
chrono biotic so it’s one of the things that sets our clock and tells like the
rest of our body whether we should be sleeping or not so if we don’t have that
then we don’t necessarily start the Cascade of cues that are telling us if
we need to go to bed I interestingly the over-the-counter kind of clock setting
dose that’s recommended for this group for melatonin is like 0.3 to 0.5
milligrams if you’ve ever looked at melatonin at the store you probably see
it’s like a 3 milligram dose or maybe sometimes 1 milligrams for 3 milligrams
um so it’s really a lot lower than what people might think um but this process
makes it really really hard for kids to get to bed on time adolescents to get to
bed on time and then to wake up when they need to wake up and you know we had
this kind of backwards issue where we were sending middle schoolers to school
later than our high school which is not what it should be it should
be the high schooler’s according to school later because they need that
extra time to sleep and there have been some school systems that have really
tested this and we see that there’s some pretty huge benefits to letting your
adolescents sleep in a little bit more I do want to talk about melatonin briefly
for a second because melatonin always comes up so again melatonin is a chrono
biotic so it’s a thing that defines whether it is night or day and what
activities our body should be redoing as a result of that so it’s kind of that
thing that’s telling you are you a morning lark are you a night owl you
know do you benefit from doing things in the morning versus that night and it’s
really significantly tied to our circadian rhythm if the levels of
melatonin are low or not being released at the right time then we’re gonna see
changes in the timing of sleep I mean so this is where this delayed sleep phase
syndrome comes into play for adolescence I mean you’ll see in older adults we can
sometimes have advanced sleep phase syndrome because of melatonin as well so
this is kind of the typical pattern again you know around 8 o’clock seeing
the melatonin levels are starting to rise and then overnight they kind of
peak and then they drop by the time we’re awake but the important thing to
kind of stress here is that melatonin is not necessarily a thing that makes you
drowsy it’s not a sedative it’s not a hypnotic it’s not the thing that’s going
to put you to sleep so this is kind of a thing that adolescents are dealing with
this whole like cascade of stuff that is just ruining their morning so they have
this circadian phase delay they have the slow rise of sleep pressure in part due
to melatonin and then that delays your sleep time we also are trying to make
independent adults out of our adolescence so we’re trying to give them
a little more autonomy trying to let them figure things out on their own they
have a lot of academic pressure they have significant amounts of social
pressure you know through social media and networking and then this all
combines with having this really early rise time that they have to get up for
school so this leads to kids that are early or late to bed and early to rise
and it ultimately end up being short sleepers and then you have this
irritable adolescent that you have to like physically shake or like pour ice
water on or something to get up out of bed and this is the reason for it
they’re experiencing later sleep needs than what you know you
where I are young children might mean there’s a lot of really significant
consequences to this um you know adolescents are learning how to drive
and that’s really scary in and of itself so you know we’re seeing that these
kiddos they tend to have longer response times they’re not as quick to hit the
brakes they’re not as quick to respond to things and so we’re seeing more motor
vehicle accidents as a result in this age group there’s also just poor impulse
control these kids become more irritable their academic and learning performances
are decreased they have a lot more stress and anger so these things all
combine to kind of make this unfortunate situation where I have parents and
adolescents have a really hard time during this age group young adults and
college students they’re kind of getting out of that phase they’re developing
these melatonin levels that are a little bit more reasonable and a little bit
more reasonably timed but they aren’t experiencing a lot of other things
they’re experiencing a lot more independence they can define their
schedules this college students especially specifically they’re in dorm
rooms potentially sir some other kind of shared living environment when they’ve
never been in one before so they don’t have the ability to necessarily control
all of those things I could be important for sleep they’re experiencing a lot of
social stressors experiencing a lot of academic stressors and again don’t
necessarily have parents to kind of help guide them through that there’s some
similar concerns we see for young adults who go directly into the work life or
who go directly into the military but we see those schedules be a little bit more
defined by you know whatever body they’re working for so there’s not as
many necessarily that pop up for that age or for those that population this is
some data from our students so these are a combination of 1,200 students within
UVM their first years and sophomores and some of them are in the wellness
environment some are in the general student population
I think it’s split pretty evenly and what they did was they track their sleep
for a good chunk of time I think they have something like a hundred and
sixty-five thousand data points on these kids and what they did was kind of
mapped out how sleep looked across the school year essentially and we can see
on the side so that’s the prevalence or the percentage of
students that are getting at least eight hours of sleep and then how that kind of
maps out over the school year so you see that those kids once they get home for
breaks once they’re at home for Thanksgiving winter break Spring Break
you see these big spikes in the amount of time that they’re sleeping you know
when they’re at school we see that kind of drop a little bit fewer students are
able to get that necessary or potentially necessary eight hours of
sleep if we break it down a little differently and look at their week you
see on Monday they start out okay and then it kind of
goes down very subtly the percentage of kids that are able to get that amount of
sleep that eight hours or more and then on the weekends they really try to
overcompensate they’re trying to sleep more during that
time and we’ll talk about why that’s problematic adults um so again as adults
age sleep needs don’t really change all that much we do see a lot of changes in
sleep timing and in sleep architecture so sleep architecture is how we’re going
through those different stages of sleep um so this kind of maps out from birth
until you know later in life how are we kind of hitting those different stages
and how much time are we spending in those stages of sleep so you see by the
time you’re 65 and older slow-wave sleep is really starting to decline so that
middle one on the SWS there we see some changes in the amount of time that
you’re spending awake after you’ve fallen asleep um so that WASO time again
by the time you’re an older adulthood that time is expanding so you might be
waking up more during the course of the night there’s a lot of you know things
that go on in adulthood that really affects sleep that unfortunately don’t
have a lot of time to get into but if you have questions I’m happy at the end
shift work is a really big one um so if you are working late at night or if
you’re working an overnight shift or something like that and you know those
schedules can vary too so some days you’re during the day and some days
you’re at night that can be really detrimental for your sleep and for your
circadian rhythm pregnancy and postpartum there’s a lot of changes
gonna happen with sleep I mean a lot of changes that happen in response to
having a new human in your home um again if you have more questions I’m talking
about that later and then jet lag I mean jet lag occurs across age groups
but again depending on your job depending on what kind of things you’re
required to do to see family to see friends to travel whatever jet lag might
be impacting you know adults a little bit more if we look at these like hypno
grams and see how sleep is kind of spread out again so those black bars
would be REM sleep and then kind of dropping into these later stages of
sleep at the bottom you know one thing you notice is that REM sleep is like
it’s usually like higher on these graphs and that’s primarily because we think of
it as being more active sleep again so it looks more like wakefulness that’s
why it’s kind of higher um you’ll see that like it looks a little different so
by the time that you get to young adulthood there’s a couple more
awakenings typically but it’s not that much by the time you’re into the 65 plus
range then we’re getting a lot more awakenings over the course of the night
you see that REM is kind of spread out a little bit differently it’s not
necessarily that you’re getting more REM over the course of the night um like you
would be getting in adulthood yes yeah we will talk about that when we
talk about sleep hygiene but yes is the short answer you do want to be like that
you do want to have consistency um you know again to kind of compare to
adolescence to we’re seeing the opposite that happens in older adulthood we see
that we have an advancement in our sleep stages you know melatonin production
kind of declines as as you age and so we just might not be getting the same kind
of cues or we might be getting those cues at different times when we reach
older adulthood that makes us more likely to fall asleep earlier and then
wake up earlier as well if we relate some of these sleep variables to things
like survival to morbidity and mortality we do see that there’s a number of
different things that pop up as being important um so we see that if you are a
short sleeper um if you’re taking too long to fall asleep so that top one is
your sleep latency yeah that’s the amount of time that it takes from when
you hit the pillow to when you actually fall asleep if it’s more than 30 minutes
then we’re seeing that your likelihood of survival actually dips a lot faster
than if you’re somebody who can get to sleep a little bit faster we’re also
seeing that REM if you’re spending too much time or too little time then your
survival likelihood is lower or it’s dropping faster than those individuals
who are getting a more reasonable amount of REM and I’m having trouble seeing
this one sleep efficiency too so if you are somebody who has lower sleep
efficiency again maybe spending more time in bed but not actually sleeping
then we see that the survival analysis kind of dips a little bit faster than
people who have higher sleep efficiency that’s not meant to be depressing just
things to think about um so again true or false you guys
already knew this one so I don’t even need to test you on it older adults
require less sleep than young adults or middle-aged adults well yeah basically
it’s eight hours at that point and adolescent sleep is characterized by
which of these D yeah it’s both B and C so they have this delay in their sleep
phase which is related to melatonin and then they have this decreased sleep time
overall and this increased sleepiness as a result so now what can I do
how do I help this that’s what everybody wants to know how do I make this better
so true faults if you have pretty significant sleep issues like insomnia
or something then cognitive behavioral therapy for insomnia is the treatment of
choice for a number of those kinds of sleep disorders like insomnia um you
know like even a restless leg syndrome this can be helpful for that kind of
stuff I kind of gave it away there and then to a characteristic of good sleep
hygiene maybe a drinking a large amount of water to stay hydrated before bed
drinking three to four glasses of wine to help fall asleep going to bed and
waking up at the same time every day which is fitting to your question sir or
sleeping in a very warm room see maybe we’ll talk about it so sleep hygiene
just kind of broadly I always ask my students this and I always get that one
person that’s like washing your sheets or like brushing your teeth which is not
wrong like that’s fine you can count that as hygiene if you want that’s
probably a good bedtime routine so this is the set of behavioral or
environmental recommendations that are meant to promote healthy sleep to make
it as best as we possibly can we derived a lot of these from people with insomnia
specifically and then we said geez this should be helpful for everybody like
this can’t hurt why don’t we try this for the general population so we’ll go
through each of these in a little bit more detail but these are kind of the
big things that we think about when we’re thinking about sleep hygiene so
your caffeine and nicotine other stimulant use alcohol use or other
depressants your exercise and when you’re getting it on the meals that
you’re eating the liquids that you’re drinking your stress level the bedroom
environment itself so you know what does your bedroom look like is there clutter
we’ll have the temperature all that kind of stuff
naps I get on my students about naps a lot and then timing of sleep so caffeine
does lower our sleep drive we talked about this a little bit so adenosine is
typically something that’s making us feel drowsy over the course of the day
so caffeine is gonna block the process of adenosine it actually blocks the
receptors that it would bind to so in that case it’s gonna make it so
adenosine can’t do its job appropriately um so if you are drinking caffeine so
whether that’s coffee sodas even you know
if you’re really worried about your sleep even think about chocolate before
bed that kind of stuff you do have to consider the half-life so like a half or
the half-life of like a afternoon cup of coffee potentially that’s like about
five hours so you want to time it so that you’re you’re not experiencing that
caffeine experience that late at night when it’s close to bedtime if you’re
pregnant then you can’t do any caffeine between
like nine hours before bed so I struggled after noon I’m doing good
right now though nicotine is a stimulant of course so it’s gonna alter your sleep
drive it’s gonna stimulate the body make it hard to go to bed alcohol is a
depressant it’s going to make you sleepy it could put you to sleep potentially
but it’s gonna really throw off your sleep architecture you’re probably gonna
be waking up a lot more times over the course of the night if you’re drinking a
lot it’s gonna lead to I think it’s lower amounts of time that
you’re spending in slow-wave sleep so good deep restorative sleep um so it’s
gonna change how you go through those sleep cycles and it’s gonna make it so
you don’t feel as rested in the morning you don’t feel like your sleep was very
high-quality as a result exercise is really helpful for sleep so we want to
kind of get rid of some of those activating signals we don’t want to wear
our bodies down a little bit um so typically we think about doing
that earlier in the day we don’t want to do really high vigorous exercise right
before bed because again that might like stimulate you a little bit too much and
get those endorphins going there is some evidence though that doing light
exercise before bed whether it’s like yoga or even going on like a brisk walk
or something like that could actually improve sleep onset this might be
related to you know similarly having like a hot shower or a hot bath before
bed can be really helpful you kind of want to separate as much that really
high temperature to the temperature drop that occurs when you’re about to go to
sleep so this could be helpful and kind of mimicking that or making it more
extreme or more obvious for the body if you’re engaging in some kind of exercise
meals and liquids again you want to avoid an excess before bed you don’t
want to drink a ton of water you could sip some water you don’t want to
dehydrate yourself while you’re sleeping but you don’t want to have too much
because then you’re gonna be getting up and using the restroom overnight and
interrupting your sleep having some kind of like light
carb-heavy sort of meal before bed could benefit sleep it’s gonna diminish any
chance of there being any overnight hunger your feelings like you need to go
get a snack or something like that I’m seeing like toast and peanut butter or
something could be really helpful as long as it’s something light you don’t
want to eat too much because then that gets digestion going and those processes
are gonna slow down to some extent during sleep then again you want to
avoid the frequent bathroom trips stress don’t bring your problems to bed the
bedroom is not a place for problems it’s a really bad thing to be awake when your
reasoning is sleeping because there gets to be a point where like cognitively
you’re just not working through these things as well you’re tired your brain
is tired and so you need to give it that rest and kind of give it that chance to
recover again we talk about this a lot when we’re talking about CBT I and we’re
talking about stimulus control you want to give your brain the best chance at
thinking that it’s going to be sleeping so you know with adults I say the the
best thing that you can do is use your bed exclusively for sleep and sex then
there’s a 50/50 shot right students love when I say that like really uh-huh but
if you’re adding all these other things like you see you’re working in bed
you’re eating in bed you’re watching TV in bed you’re doing
all these other things in bed then you might start to think like when I get
into bed what am I actually doing like what is my purpose in this space you
want to give yourself the best chance of that as possible so we’re moving all
those other things and just making it your place for sleep and sex is the best
way to do that the better man fireman you know you want to keep it cool
typically the temperature recommendations range from like 60 to 68
degrees for the bedroom you know we’re getting in the time right now we’re
having the windows open overnight can be really nice but then it can also be like
30 degrees in the morning so it’s a little tricky to balance um you want to
keep it quiet you want to keep it dark again having like light that’s coming in
your the eyelids on your eyes are not entirely opaque so you’re gonna read
some of that even if you are sleeping and it could kind of heightened those
cues that it’s time to get up before it really is time to get up so having
things like blackout curtains that kind of stuff there are some places in Europe
that use I can’t think of the name of the word but they literally use like
steel sheets that they pull down that they’ll keep so they keep light out and
they work really well but again this is where I like College can get kind of
tricky you’re not in control of a lot of these things so you’re not in control of
how quiet it is you’re not in control of how dark it is necessarily depending on
your roommate um so some of those things become a little bit more tricky naps you
want to try to avoid them if you can you know it’s really hard I know I love
napping too I tell pregnant women you nap as much as you want oh that’s fine
really it’s primarily because you want to build up that sleep drive so the
moment that you nap then you’re dropping some of that sleep drive you’re getting
rid of it and then by the end of the day you’re not going to feel as strongly
that you need to sleep at that point power naps caffeine NAB’s sometimes
those can be really helpful for people I’m it just you know it used them
sparingly um my husband was kind enough to send me an article today that was
like hey napping is actually good um so you know I I get this a lot too in terms
of you know there’s mixed research out there there’s mixed support for it um it
could in this case be beneficial for cardiac health but it’s again limiting
those naps and making them you know more no more than once a week or something
like that timing of sleep consistency is really key so that clock in the brain
the suprachiasmatic nucleus does not care what day of the week it is it
doesn’t care if it’s a holiday it doesn’t care about any of that
it wants you to be consistent and following that rhythm the same time all
the time the concern that comes about is that you if you are depriving yourself
from sleep if you’re not sleeping enough and you’re trying to play with that
clock a little bit then you can start to accrue sleep debt and sleep debt is a
little bit different from credit card debt paying it back is really difficult
to do I’m the best way to do it is to just get back on a consistent schedule
um I’ll show you an example so if you’re an eight hour sleeper typically you’re
sleeping from 11:00 p.m. to 7 a.m. you go to bed late on Friday night you got a
party to go to you’re spending time with friends you lose track of time you go to
bed at 1:00 a.m. but you know that oh gosh I got to get up at 7 for some
commitment so you wake up at your usual time you only slept 6 hours
similarly on Saturday night you stay up late again because it’s the weekend you
choose to sleep in on Sunday to make for that lost sleep time thinking about
like hey I can get it back I’ll get back on track I’ll a ver Ajay to eight hours
by getting ten hours tonight that means you woke up at 11 a.m. so do
you think that by Sunday night at 11:00 p.m. you’re gonna be ready to sleep no
so you’ve lost four hours to build up that sleep drive that’s a huge chunk of
time so it’s gonna take a little bit more to get you back into that rhythm
you know the best thing that we can suggest is while yourself be tired get
over it you know feel tired for that one day and just get back into that same
kind of schedule as soon as you can and then your body will thank you for it
later rather than trying to play this back and forth of paying back sleep debt
or not so if you do actually need treatment for sleep disorders for things
like insomnia things like circadian rhythm disorders you know we can talk
about a couple of different kinds of treatments obstructive sleep apnea –
that’s a big one when we’re talking about insomnia specifically I’m in again
CBT I for in some era CBT I can be used for other sleep disorders too but the
most research is in insomnia this is kind of a framework that we’re following
so we assume that you have some kind of predisposing you know genetic variables
even sleep hygiene actually gets categorized in these predisposing
variables so like how you relate to your sleep your basic sleep routine those
just kind of put you at some kind of risk at baseline then maybe we have
these acute events so some kind of stressor comes up it lowers your sleep
you know you have an exam coming up or you have some family emergency that came
up and it put you at a point where you just weren’t able to sleep very much
early kind of insomnia might be where those precipitating factors so those
acute stressors have gone away a little bit like they’re not as present anymore
but we’ve kind of developed these perpetuating unhealthy habits that
yellow that put us over the edge and make it so that we’re not getting very
good sleep and by the time it gets to chronic insomnia we’re seeing that those
precipitating factors those acute stressors are a lot smaller but we still
have these unhealthy habits that we’ve built up so we need to kind of address
those that’s primarily what CBT I addresses so we do do a lot of sleep
hygiene and education we do sleep restriction which is a terrible name for
what it we just figure out how much you’re
sleeping on average and then you’re only allowed to be in bed that amount of time
so it’s not that we’re making you sleep less it’s that we’re just kind of
finding your average and then we’re gonna build it up from there we’ll use
stimulus control so you can only be in your bed when you’re sleeping you can
only be in your bed when you’re tired and then we use cognitive therapy to to
kind of like work on the relaxation skills as needed that kind of stuff and
any thoughts that might be throwing off your sleep anxiety plays a huge role in
sleep so we kind of have to address that for obstructive sleep sleep apnea
you know we have CPAP so we have by PAP’s so CPAP is continuous positive
airway pressure a BiPAP is bi-level positive airway pressure so these are
going to treat obstructive sleep apnea where you’re having trouble with
breathing over the course of the night and there’s a lot of different styles of
machine the biggest thing that comes up is adherence it’s really hard to keep
people using these products sometimes they can be uncomfortable sometimes they
can be loud but they work they do their job so if you’re thinking about how this
works it literally pushes air into your lungs and then helps you pull it out so
it is doing the process that your body would be doing mechanically so there’s a
great amount of evidence for how beneficial these can be for obstructive
sleep apnea but we do deal with a lot of adherence issues there’s a lot of
medications right so there’s over-the-counter stuff that you can get
I’m not gonna go through the exhaustive list with melatonin you can purchase
that at any pharmacy of course I’m you know again it really only benefits some
sleep disorders so if you have jetlag if you have a circadian rhythm disorder
there is some evidence for with insomnia and the elderly because melatonin levels
are so low at baseline there’s really negligible support for this use of
melatonin in kids and in adolescence unless again that adolescent is
experiencing delayed sleep phase if you just have insomnia as an adolescent if
you have insomnia even as an early adult or something like that melatonin is
usually that first go to but it doesn’t typically help that much the other you
know side of that is there’s very low side effects so if you’re taking it it’s
not the end of the world or anything like that it’s just probably not going
to be all that helpful for certain sleep disorders and the timing
is really crucial so you have to time it to when melatonin would usually be
rising that’s hard to figure out for individuals you have your
benzodiazepines so your Pam’s and your Lambs I’m so these how I remember them
I’m see you buy these binds your GABA receptors they have some sedative
qualities so they’re going to inhibit processes in the body they also suppress
slow-wave sleep and REM sleep and they increase your amount of time that you
spend in stage 2 sleep so these act pretty quickly so these are a great way
to get to sleep but they have a really short half-life so if you wake up you
might have trouble getting back to sleep as a result they can be really
habit-forming so these can be super addictive you can build up tolerance to
them you can experience withdrawal symptoms from them I mean you need to be
really careful about how they’re combined with other substances too so
since this is so sedating you don’t want to be drinking alcohol um for instance
when you’re taking a benzo we have our non benzodiazepines these are zi drugs
typically zopiclone as so Picone ambien um you know those kinds of things
um clonidine and trazadone are sometimes prescribed in kids so
clonidine is actually a hypertension medication it’s given to kids with ADHD
sometimes when they have sleep issues I mean it’s it has some sedative qualities
to it and trazadone is actually an antidepressant again a given to kids in
adolescents sometimes it’s not entirely clear that they’re very helpful for kids
in adolescence again but sometimes it’ll be an option that doctors go to so these
are in hypnotics are unrelated to benzodiazepines unrelated to other
tranquilizers or hypnotics but they do interact with GABA
to some extent so again our inhibitory the side effects can be a little
concerning so some people can have sleep state confusion they can be unaware of
if they’re asleep or if they’re awake they can engage in sleep behavior so
sleepwalking sleep talking sleep eating sleep shopping sleep driving and you may
have heard of these things like ambien blackouts so where people can engage in
behaviors that are potentially really dangerous and then not remember them at
all in the morning this isn’t necessarily something that happens for
everybody or anything but it’s a side effect to think about there’s some other
medications are a little bit newer so modafinil is actually a wake promoting
agent so they will ride this some I won’t because I’m not a
prescriber but doctors will prescribe this sometimes for a shift work disorder
or narcolepsy sometimes for obstructive sleep apnea if you’re having a lot of
sleepiness throughout the day it’s really not entirely clear how it’s
working it works on a lot of different neurotransmitters so it increases
histamine so which is an activating agent and increases norepinephrine or
noradrenaline it’s increasing glutamate which is again one of our excitatory
neurotransmitters this decrease in gaba our inhibitory neurotransmitter so it’s
meant to kind of keep people awake keep them going if they’re having a lot of
issues with their sleep over night there’s other alternatives like light
therapies so these are typically used in folks that have like seasonal affective
disorder for instance but they can be really useful in individuals who have
advanced sleep phase syndrome too so if you’re having trouble like staying awake
until you really want to go to bed I’m like having some sort of bright light
our bright lumens can be really helpful to kind of you know engage the brain and
thinking that is daytime and keeping you up a little bit later um you know it’s
really helpful also just wake up in the morning if you’re having trouble getting
up and just open your shades even if it’s a cloudy day the level of light
that comes in can be really wake promoting at that point there’s a lot of
herbal supplements that you’ll see out there like valerian root chamomile um
it’s not entirely clear how beneficial these are this may be more of like a
placebo effect we need a lot more research to really tell that’s helpful
there can be some individuals who shouldn’t take some of these supplements
so it’s worth talking to your doctor about you know so I can’t have someone
negative interactions with some other medications um so it’s definitely
something you’d want to talk to your pcp about before starting on a CBD CBD is
huge you know I think it’s an again not entirely clear how beneficial CBD might
be for people it can be really relaxing for individuals it can you know
potentially make you feel more drowsy people have these perceived increases in
their sleep quality so they think they’re sleeping better and that might
be important enough but we do need more research again here to really be able to
know what the benefits are and you know I think it’s worth asking yourself at
that point when you’re thinking about these kinds of things is do I really
need medication or supplements or are there
some like lifestyle changes that I could make using these sleep hygiene variables
that could better your sleep like I would always suggest trying those first
if it’s possible okay true or false before we get into
question time um cognitive behavioral therapy for insomnia is the treatment of
choice for sleep disorders true yeah and you know I didn’t explicitly state this
but this is the one win that psychology gets over medication therapy works and
it works really well so this is actually the thing that your your internal
medicine your family medicine your pediatrician should be recommending for
insomnia for some of those related disorders and a characteristic of good
sleep hygiene maybe which of the following see yeah going to bed and
waking up at the same time every day keeping it consistent so that is all I
have I want to keep time for questions I know I ran over so thank you test could
you speak to blue spectrum lighting as a nightlight you know for waking up using
the restroom at night yeah so blue light during the day or at night can you say
that part again yes using a blue spectrum light is a nightlight in a
bathroom for you know getting up and going to the baby don’t have to turn
like a full overhead lighting on there using some other kind of like slower
lighting but blue spectrum kind of like so the issue with blue spectrum
lighting that you’ve probably read to some extent when you if you’ve read
anything about sleep hygiene variables is that it is known to potentially
affect melatonin levels so it can suppress the release of melatonin so in
that case what I typically recommend to my patients is use red light instead
yeah yeah so red light doesn’t have the same kinds of effects um so if you’re
using like a red light you plug in there’s red light bulbs that you can
pick up it’s not gonna have the same effect on melatonin levels and your eyes
adjust to it more easily so you’re actually gonna get better benefits if
you use something like that yeah what do you think about maintaining
sleep schedules for people who live at high latitudes what they don’t have
those endogenous or exogenous stimuli don’t have good consistency with
lighting and even like so like you know changes in like time zones even that
kind of stuff so even like the Arctic versus um you know where we live versus
like the equator is that what you’re talking about too is yes yeah
I’m so changes in latitude across you know across the globe like how can that
affect some of these sleep timing things it’s interesting cuz animals that live
in the Arctic they don’t necessarily have a great circadian rhythm so we know
they are pretty deeply affected by you know when they’re in a period of time
where it’s like 24 hours of darkness that kind of thing um you know in that
case then melatonin could potentially be more helpful because it’s again kind of
setting that clock and becoming you know setting you up to have that similar
sleep time over the course of the day I’m I don’t know to to much research
comparing those things though I’d have to look into it a little bit more what
the recommendations are it’s a really good question because yeah I mean even
here think about it like you know at five o’clock it becomes dark all of a
sudden and that’s very different from what it is in the summer or even a few
days before a good question we have a question from upstairs and the overflow
room did you say that restless leg syndrome is a disorder yes so restless
leg syndrome is unfortunate and it can be really debilitating for sleep onset
typically um so we do we can diagnose it um it’s typically related to like low
iron levels so you might be able to supplement it with like supplemental
iron it would be something you’d have to talk to your your providers about um but
it there there is a diagnosis for it and it can really implore really detriment
sleep onset typically it slows down your ability to get to sleep because
it’s so debilitating the the feeling that you have to get up and move is
essentially what it is in your legs typically um so there are treatments
word you could you speak to alternatives to CPAP such as oral appliances for
treatment of snoring and sleep apnea so there are yeah there are other
alternatives to CPAP um so you know in some cases they’ll do surgeries
for instance to remove the adenoids or tonsils like if there’s a really obvious
structural kind of issue thats related to your snoring or to your inability to
breathe regularly during sleep I don’t know – too much outs about the
orthodontics because I don’t really treat like a sleep apnea specifically
I’ll deal with the adherence issues with CPAP especially with kids but I’m not
too familiar with the other like orthodontic kind of kinds of features
that you can get to help with that when you say um that maintaining a consistent
sleep schedule means going to sleep at the same time every night how much of a
window is there like do you really – hour an hour yeah it’s a really good
question so how much of a window is there for that consistent sleep schedule
um you know I would recommend sticking within like 30 to 45 minutes it is
variable per person right so there’s a lot of different components that alter
your sleep schedule and alter your circadian rhythm um so it is gonna
depend person-to-person but I would start out with trying to keep it as
regimented as you can and then you can always give yourself some wiggle room
and see how it goes so say I’m gonna go to bed 15 minutes later tonight or I’m
gonna sleep in a little bit and see how your body reacts to it if your body has
a pretty negative reaction then that would tell me you need to stick to that
sleep schedule but you can kind of fiddle with it a little bit and
experiment so regarding circadian rhythm if you find that your circadian
rhythm is off your your 3:00 p.m. you’re getting tired 3:00 a.m. you’re waking up
for example is there something that can be done to shift it back to a more
normal rhythm yeah so if you’re like getting up I so so say that like
scenario again I just want 3:00 in the afternoon that’s when you’re sort of
plummeting you know all the things that should be happening at 8 or 9 yeah at
3:00 and then 3:00 in the morning is is mimicking what should be happening at 7
in the role so you’re kind of off is there something that can be done to get
the circadian rhythm back to where it should be yeah so what you’re describing
is more like that advanced sort of phase sort of things so if you’re feeling
tired around like 3 p.m. and then you’re waking up as a result like much much
earlier in the morning maybe even like 1 or 2 in the morning or something like
that life therapy can be really helpful for that so exposing yourself to blue
light or you know Sonlight that kind of stuff later in the
day so every round the time you feel drowsy I’m because again like around
3:00 p.m. you actually might be feeling that way just at baseline because you’re
alerting signals have gone down a little bit so doing something activating doing
something that’s gonna be added to your schedule that’s gonna make you more
active and alert can be really helpful but then the light piece can be really
helpful too because it again kind of mimics and tells the body that hey you
should be awake great now this should be what you’re dealing with and then it can
push it back some high yes um do you know if the main ingredient in a typical
sleep aid such as something from CVS or Tylenol PM interrupts the sleep cycle
that flushes away apparently I read this in Matthew Walters why we sleep book
interferes with the flushing away of plaque and therefore could be affecting
you and getting early Alzheimer’s I think I read that book a few years ago
so now I can’t remember totally that’s okay so yeah are some of
these sleep aids are they actually like affecting how we can flush away plaque
and tangles and the kinds of things that are related to dementia and Alzheimer’s
and those kinds of things there is some evidence for that I’m not entirely up to
speed on it either but there is some evidence that suggests that using some
of those sleep aids can actually be detrimental it does at higher doses and
it would extended use change sometimes how you go through sleep so if you’re
not getting the stages of sleep that you’re supposed to be getting or
spending as much time in them as you should be getting and that architecture
changes enough then yeah I could see how that could you know change how we’re
flushing out toxins change how we’re changing the brain and recovering the
brain through the night so I’m sure there is evidence
I can’t off the top my head remember exactly what it is either I have seen
those associations before I have a sense that it’s a fairly common problem that
people that some people will go to sleep pretty easily but then like in the
middle of the night they’ll wake up and then there’s a feeling of anxiety about
being being able to go back to sleep and I read an article someplace where in
pre-industrial times that it was common for people to
have actually two periods of sleep one in which they went to bed and they slept
for a while and they got up and they actually engaged in some activities and
then took another period of sleep and that was considered normal and I wonder
if you could comment upon that idea and also whether it’s wise to when you’re in
that situation where you wake up in the middle of the night you’re feeling
anxious should you get up and start doing stuff or should you kind of try to
meditate yourself back to sleep well I mean what’s the best approach so to
repeat the first one so like in pre-industrial times there was more of
this like biphasic sleep is what we called it so yeah you would have one
consolidated chunk kind of get up and do things then you have another
consolidated chunk of sleep um you know there’s some people that operate in that
manner again there’s some variability here in terms of what your circadian
rhythm looks like so what I’m talking about is very much the typical average
kind of adult or I’m you know kid or older adult whatever age group um so
there are some people that are perfectly functional running on a biphasic
schedule like that um if it works whether your work schedule or if it
works what you’re doing on a daily basis then hey I mean I think it’s probably
possible to engage in that I think it’s just hard to probably find those
scenarios potentially nowadays where that is gonna work out necessarily um
the other piece about what do you do if you wake up and you’re feeling really
anxious um and you know what should you get out of bed should you kind of like
reset basically um if you wake up overnight yes you should get out of bed
so that’s actually a part of stimulus control when we’re doing cognitive
behavioral therapy I’m for insomnia is that will actually tell you if you can’t
get back to sleep within like 10 or 15 minutes or so get up out of bed do
something that’s like lightly activating that’s just gonna keep you awake for a
period of time until you feel drowsy again so that could mean that you know
you go and like sit very straight you know we’ll tell people to sit in a chair
and kind of like lean forward basically because that reduces drive to
sleep for a period of time and you know maybe like do some reading for a little
bit um do some other like light low light
kind of activity until you start to feel drowsy again and then you can try again
and if you don’t fall asleep in like ten or fifteen minutes then you know you can
get back out again if it’s anxiety then I often recommend that people have like
a worry journal or something that they can like quickly write down like what
are the things that I’m thinking about let me get them out of my head and then
I can promise to revisit that in the morning like I will deal with those
worries I will have my worry time at some other time that does not you know
impact my sleep or in the middle of my sleep schedule mhm
you mentioned reading again just now I was saddened to see it in the list of
sleep hygiene is something not not favorable to do to get you to sleep but
I’m I’m a reader and all my life I’ve read before oh yeah so could you just
expand some more on reading on why it was even yeah you shouldn’t have reading
shouldn’t be in there reading is fine before bed especially if you’re not
using a tablet or something I give you a reading at actual book like a physical
book that’s a great like bedtime routine kind of activity do not read in bed
that’s what it is yes so you shouldn’t be reading in bed
that’s a good point thank you for for revisiting now try to figure out why
that would have been on there that’s weird I loved reading before bed that’s
great yeah it’s a quiet activity it’s just doing it outside of bed is the more
important thing and in part because depending on what you’re reading like if
you’re somebody who’s reading like some just like general novels or maybe
historical fiction or something like that like maybe that’s not that big a
video it doesn’t stress you out or something if you’re reading like a
thriller then you might be stressing yourself out in bed or like a crime
drama you know that kind of stuff so again these are like these they may or
may not apply right so if you’re reading something that relaxes you that soothes
you go for it that’s totally fine thank you for clarifying that that’s important
yeah hi um so when we were going over the EEG waves and like different some
stages of sleep I was wondering which stage correlates to the lowest brain
activity and then furthermore I’m sure we’ve all experienced like when you come
out of sleep you’re more alert and aware versus when you like wake up
groggily any you know ways whether the delta theta correspond to that different
stages obviously yeah um so the stage of sleep that has like the lowest brain
activity would be deep sleep or stage 3 sleep that’s when we see those big delta
waves there’s still definitely activity going on but the wave amplitude is much
higher the frequency of them is much much lower um when you’re talking about
like optimal time to get out of sleep is basically what that other question is so
yeah you know when you wake up out of deep sleep you can sometimes feel like
sleep inertia so you feel like that grogginess you feel like you’re just
really struggling to transition there are some apps that claim that they can
like wake you at the appropriate time there’s one called sleep on cue there’s
a couple other ones that’ll say like hey I can wake you up out of Stage one sleep
you know when you’re the the most close to being awake anyways it’s really
unlikely that they can do that because you need eeg sensors to be able to
accurately estimate that um but you know again once you get into a consistent
sleep schedule we do see that people tend to wake up maybe a couple minutes
before their alarm and they feel okay um so it’s really about hitting that
consistency more than anything else yeah I have two questions
does menopause affect sleep or is it just your aging
oh it’s both menopause and aging yeah just to answer that quickly um you know
you experience a lot of like complexities that come along with aging
that really interfere with sleep and you know menopause can be really
uncomfortable it can make your temperature rise it can new you know how
you have a lot of things that you experience that really throw off your
natural sleep cycle so yeah it can definitely have some of that it just
seems like I never recovered and went back to being able to sleep as well as I
did before menopause yeah yeah and my other question is frequency of having to
get up and use the bathroom you know not too frequently but when you’re not know
yeah yeah and I mean it happens for a lot of people regardless of like age or
regardless of pregnancy status or menopause or whatever
um you know it does it’s not a big deal as long as you’re able to get back to
sleep more quickly like quickly afterwards if it’s really starting to
interrupt it then we might work on like a high G or a hydration schedule that
will make you less likely to be getting up at night um but it’s definitely a
problem for a lot of people and can be interfering in sleep and you want to
avoid those big wake up’s as much as you can um anything that’s gonna keep you
awake for more than like 10 minutes something like that yeah that’s gonna
cause you to be awake overnight in like a meaningful way yeah frequency – yeah mm-hmm yeah yeah and that additively can
add up to potentially like an hour or two hours of your night of sleep that
you’re losing as a result and so if it’s for like restroom use then we would work
on a now it’s true you know when we’re doing
like cbt-i again the big thing is that we do have you get up out of them we
don’t want you in bed and trying to sleep because trying to sleep is
antithetical to sleep you’re not gonna fall asleep if you’re trying on so you
have to build up some of that drowsiness so doing some of those like low engaging
kinds of activities that might make you feel sleepy reading a boring book that
kind of stuff um then that can be really helpful and then you know if there’s
something that we can otherwise like you to those things like some other kinds of
behaviors that are related to it or some timing that might be related to it then
there might be some other things that can be done in treatment
um but it’s you know it’s totally dependent on that person’s sleep diary
and their scheduling okay okay yeah okay my question is about an eleven year old
who suddenly started sleepwalking yeah sleeping really are they really asleep
yeah yeah sleep walking sleep terrors can happen in really young kids to sleep
terrors are terrifying for the person who is witnessing them your kid will
never remember them um so you know it’s it’s more of a like management issue at
that point um it typically goes away towards the end of childhood and by
adolescence we’ll see they’re sleepwalking sleep talking a lot of
those things diminish those sleep behaviors um but in the meantime making
sure that your kid doesn’t have easy access of stairs you know doesn’t have
easy access to open windows you know anything that might make them trip make
them fall make them injure themselves you kind of have to try to minimize
those as best as you can I saw on the screen you had a reference to meadow
larks and night owls yeah and as long as I can remember I’ve been the latter I’ve
been a night owl when I was a kid I sleep walked I was my
mother was a nurse and really believed in good sleep hygiene I was in bed two
hours before my you know my my classmates were yeah I was I was always
a sleepyhead doesn’t matter you didn’t matter what I
did as a six-year-old I was falling asleep at the dinner table yes it might
be normal for a two year to fall asleep in their mashed potatoes
but a six or seven year old it’s not – probably doesn’t need to happen I have
been on CPAP therapy for about ten years now for sleep apnea and doing a little
with that but no matter how hard I have tried I can’t seem to break that
circadian rhythm and I’m at a point now where I’m just like okay I’m a night
owl I’m approaching retirement fine I’ll go to bed at 1:00 and get up at 10:00
what’s the problem yeah except that it is it it creates a problem in
functioning you know with the rest of the world who seems to be more awake in
the morning okay is this just a lifetime of bad habits is this an internal clock
that I’m fighting against and is there anything I should try or just accept I
mean I so the question is related to like if you are a night owl or if you
are a morning lark essentially can you change those things or can you alter
them or what is it related to um we primarily think of this as being related
to melatonin and so melatonin is driving this I’m like when you’re releasing
melatonin and when it’s at its highest levels those kinds of things are driving
that again because that’s really our timing switch so when we started to
start the other cascade of signals that makes us sleepy or not this is the thing
that kind of times that so you could potentially use melatonin to move your
sleep phase up a little earlier so that you could try to kind of match it either
what your family needs or you know – whatever the general society needs are
um but you know there’s also something great about just diving in and saying
this is what my life is and this is what my body wants to do because there is
there’s just people who classify like really deeply into that night owl kind
of classification or people that are like I gotta get up at 4:00 in the
morning or else it just drives my day in the wrong direction um so you know if
you are trying to just steer into that skin then I recommend trying it out but
there are potentially things that your doctor might recommend in terms of
melatonin use in terms of early light therapy that kind of thing so you know
if you have an advanced phase then we think about using light in the evening
but if your thing about delayed phase or night owl’ kind
of kind of behaviors and we say use light early in the morning yeah expose
yourself to like thirty minutes or so of light yeah
just literally sit in front of that light all right thank you

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