Run Rolling Rolling Rolling Hey everybody, once a month sleep doctor session with my dear friend Dr. Ed I'm here basically just to say hi and introduce him you all know who him and his work and we get some my sweet good questions as we always do with these. And then obviously the opportunity to ask raised, you know, go to the reactions column raise your hand, the end of the chat room, whatever you want to do to bring the topic up the conversation more than welcome to the doctor as usual. I said here I take my notes I learned as much as I can. So take her away, man.
Okay, thanks, Andrew. There's like a small group. You know, I noticed the list didn't send out a notice. Or at least I didn't notice I noticed about this week's event so maybe people are forgetting it's gonna get into this summer.
everything. Everything schools in the summer. Alright, well, I'll share my screen and I'll go through a couple of other questions really are from last time and that's probably know the side somewhere people haven't. haven't joined. Or haven't added any new questions in. So there'll be recording people can follow and of course, you lucky folks who are on get to ask your questions directly as as much as you'd like. So from last time, how much time do we spend in the last REM sleep phase before we wake up? So generally, that's the longest REM period of the night. It could be an hour or more. You know, for some people, it could be hour and a half, two hours, just depends on how long the night is and your particular physiology. The the that's the easiest thing to remember, but feels like whatever remember is too short and amount. So I'm suggesting that maybe they should try to get up a little bit earlier to see if they can awaken in the middle of a dream maybe have something that's a little more, live a little more fresh or a little longer. And they go on to say the only once in a while that they get a longer story. They don't need to use an alarm clock. And can you show the chart again? which I'll do in a minute, but you using an alarm clock might be one of the ways of ensuring waking up during, you know, the longer part of the dream period. So whatever time they typically wake up, I wouldn't you know, it's kind of like the brain already has shut down dream events of the night and now is waking you up if you're getting up spontaneously. So I would go ahead and set an alarm for half an hour 20 minutes earlier than your typical wake time and see what happens when the alarm goes off being ready Of course with your notebook and your pen to record a little bit longer dream. Try not to move when you first wake up and really just see if you can drift into and out of what was just taking place. It may just take some more practice but generally the longer period of REM sleep is at the end of the night. So here's the famous slide they were asking for. state of consciousness on the y axis time of night on the X and REM is in red here and you can see the periods get longer. as the night progresses. The non REM sleep especially that deep, deep Stage Three Four generally occurs mostly in the beginning of the night. REM sleep occurs mostly at the end of the night. Okay. Any questions about that? Raise your hand or see anything else, see their p&l or type in a chat question and see anything popping up? Still we'll move on to question two.
This is do work with the subtle body in your sleep medicine practice and if so, how do you work with it in terms of managing sleep issues? And you know, generally the answer is no unless someone who really has you know this you know, unless it's people from the class somebody who's really deeply interested in sleep and drain. And then I'll talk about how they can deepen their meditation and or add Sleep and Dream Yoga. As a way to get a little deeper into sleep. Maybe even you know, deal with, like disturbed sleep issue. I know that person who has the REM sleep behavior disorder I think I mentioned a couple times when we've talked about it. You know, her, her teacher, her Tibetan teacher said to her well, let me back up a couple. I think I gave to Alyssa right the links to that in somewhere on nightclubs should be the links to Yeah, so that person I was talking about. She wrote an article for spirituality and health, sent the link to that to Alyssa she's put it up online. And it was also a follow up podcast where they did an interview with her. And so she talks about her guru, her teacher saying to her, Oh, what a blessing it is that you have REM sleep behavior disorder. And you know, she's like, well, the jury's still out on whether or not it's a blessing, but she has deep into a meditation practice. She has increased the amount of time she practices and at last, at last contact with her. She seemed to be having less events. She seemed to not be having as many events as she's had in the past that brought her to getting diagnosed. She's also in the Harvard study that's looking at, again, frequency and potential treatment for REM sleep behavior disorder. What she's really concerned about, of course, is that it seems to be a precursor to developing something like Parkinson's, or some other neurodegenerative movement disorder that she's concerned about. But at any rate, she seems to have at least stabilized by increasing our meditation. And she's even beginning a little bit of Sleep and Dream Yoga from my last talk with her so I'll keep you posted on that. So anyway, we don't definitely get into it. Most people come to see me are coming because they have practical sleep issues. And I kind of stay on one side of the line unless they give me an indication they want to get a little deeper. Acupuncture help with insomnia was part two of that question. And the short answer is absolutely you know, acupuncture can help by via a number of mechanisms. Most common ones are reducing pain and stress that's associated with disrupted sleep. So acupuncture can be very helpful for improving sleep quality. And he's got his hand up. Okay.
Yeah, two questions that so one is, oh, what is the standard acupuncture regimen? For something like insomnia? I mean, do you do you actually have a kind of a go to acupuncturist that you work with? Or what is what is the degree of variability when people are actually working with acupuncture?
Yeah, I, I have a couple who are referred to and I don't know their particular protocols. There are some sites they use but interestingly, one thing they do do is on the year, are a couple of places where they put and I forget what they call them, but they're like they're like mobile acupressure. acupoint stimulating. Dots, they put on the ear in several places. The only way I really knew that was one of the first people came to me after their achievements there for neurofeedback, when I went to put on this sensor was like, Hey, what are those little dots they're doing? And it turns out the acupuncture person uses those to stimulate the certain points on the year, both years. So that was interesting, but they'll work with them more holistically than just sleep. So they're going to hear all the complaints and if sleep is one of them in addition to whatever else they're doing, then they'll add those in particular, but I don't know what particular points on the body that would use or that kind of thing.
But like if someone's suffering from really acute insomnia, is it sometimes recommended that they somehow try to get acupuncture prior to going to sleep or is it more kind of
No, no, no, it's more of a generalized treatment over time. So Chinese medicine in general they have they have a sense of the night and the night's broken into different hours or hour, let's say a couple of hour blocks in which the organs of the body are associated with doing their work. So during for instance, it's like I think around 3am three to 4am read somewhere in that range. It's generally the liver doing the work. So you're going to work on your liver and or associated anger issues. If it's one to 2am could be kidney you know, that kind of thing. And I don't I don't know the association's I didn't initially put much stock in in that only because people go to sleep at all different times of the night to wise three o'clock only the time you work, you know everyone works on their liver, but it's it's sort of the range of time so if you take an average bedtime of 10pm then these would hold 10 to 6am in those different blocks. So if you went to bed later, most likely than 4am or 5am is when you're working on your liver, that kind of thing. So there seems to be something to that, you know, Chinese medicine, it's been around a long time. And I don't think Tibetan medicine would would argue much with that assessment because I think they have the same sense that the body works on different organ systems at different times of the sleep state.
Yeah, might be interesting. Dr. NIDA who's a Tibetan physician and MPJ He talks about was first time I've ever heard it, there actually was three years ago the first time I heard a three years ago, was a mantra we can be used for insomnia, I think I might have mentioned it ri ri ah home we are home we are home.
All metal and solid body stuff, acupuncture, barter, all these sorts of things they obviously haven't worked their way into into western science
and medicine but right, but you know, the other thing is the problem too is also the whole system, right? So that probably works really well for people who are adhering mostly to the other aspects of, let's say, a Tibetan Medicine system, right? So you take that out, you try to just take the monitor and give it to somebody from the west. And you're gonna say, right, well, no, it didn't work, and
go for it and be, you know, completely taken out of its cultural social. milieu, that context probably
is not as effective. Yeah. And you know, you've noted in your book too, you know, the no SIBO effect right of those Tibetans, I think was Tibetans or No, some culture locations the hamam Yeah, yeah, amazing. They all got heart attacks, right. So that cultural part, I mean, it's a major part of the body's healing ability, that placebo
effect right. They actually read that paper quite extensively they talk about the use of term local biology, how that these these cultural and social contracts can be so over whelming that they literally overpower traditional biological
response. So I thought it was an interesting yeah, yeah. Yeah. Well, we know it's all mine. So at some level, at some level, you know, it probably does control everything. And really, it's a deep seated belief. You know, Bruce Lipton will talk about that and, but but that's, you know, the part that got me I always wondered how could that work right. And it is really deeply seated beliefs. Once that we have a hard time getting access to that really run the story. And that's why we do the kind of work we do. That's why we do the spiritual work we do to get at those beliefs to get a little deeper, maybe to get underneath them. So we recognize that a lot of what's happening is due to belief, you know, we can move them around but if we don't go and do that deep work, you
know, we're at the beach. So I just think it's literally just this afternoon I was rereading part of taken out Hans, I think it's his best book called Understanding our mind. And there's a really compelling chapter. In fact, I think he originally was the title to the first edition of the entire book, where each chapter is called transformation at the base. And then he talks about exactly what you're saying here that that in the kind of the yoga Chara mapping, working with the eighth consciousness and transforming everything down there at that level, then changes everything above it, which
makes it a heck of a lot of sense to me. Yeah. And the shamans talk about it, too. They say, you know, why don't Let's heal it at the energetic level before it manifests in physical reality as the heart attack or the hypertension or the whatever, you know, but you know, we've got to get there. That's the easy part. Right. Okay, cool. All right. Thank you. Sounds good. And I see there was a question in the chat box, but I think it's just a separate question. We'll get to it once we get through these Restless Leg Syndrome. So I have mentioned this a couple of times, but we'll talk a little bit about it. So the whole the thing about restless leg syndrome, and I even see it you know, if you search on the web, you'll see restless leg syndrome and periodically mood disorder. They're not restless leg syndrome is not a sleep. Disorder, per se. Okay. It's a daytime complaint has nothing to do with an origination. In sleep. It's not because of sleep that it occurs. It doesn't have anything to have that disturb sleep. Restless Leg Syndrome can be totally a daytime disorder and that can be treated by a neurologist can certainly be diagnosed by a neurologist. In general there's this creepy crawly sensation in the limbs. People describe it as like ants under the skin. Or these this need to move to need you know they can't sit for a couple hours watching a movie without crossing and crossing the legs. Maybe getting up and taking a couple laps around the movie theater in order to be comfortable sit back down. So it's a circulatory issue. It's it's it's related to iron, low blood iron or low ferritin and I'm not going to get into all that. But essentially, it's associated with sleep because there is a circadian rhythm to it. It worsens at night. And because it worsens at night. The symptoms can disrupt sleep onset, you gotta lay down to fall asleep and you can't fall asleep because you gotta gotta get up and do laps. You got to move the legs, move the limbs get the circulation going, or you take that hot bath, and then you're able to go to sleep and so for some people if they don't know what to do, it prevents sleep onset and can be a real issue. The other association is that unfortunately many of the people who have restless leg syndrome also have periodic limb movement disorder, which is a sleep disorder. And that's because you can have periodically movement disorder without having any restless leg syndrome or any symptoms during the day. Okay, just at night. But those who have that Restless Leg stuff during the day, can frequently also have during sleep. Now. The the issue during sleep only becomes obvious usually through a bed partner. Or through some kind of daytime dysfunction. Okay. And what's happening here is there are these, there are episodes of repetitive limb movements, generally the legs but it can be the arms any part of the body, but the twitches are associated with micro arousals and I threw up this slide I pulled off the internet just to show you how disturbing it can be now and how regular and repetitive so let's see the these are happening about every five to 10 seconds or so. So this is a couple of minutes right? And you can see how regular these are. Sensors put on the legs. This is the left leg and the right leg and you can see both legs moving. In this particular case this particular person hears the breathing signal they're breathing just fine breath after breath after breath. But what's happening is they're having these twitches. And these twitches are strong enough that they're actually causing if you look at the EEG channels and these are back at the back of the head, central part of the head and the frontal part of the head these leads on the scalp. And this is a arousal activity associated with each one of these the brain wakes up it goes into alpha rhythm. brain goes into alpha rhythm and brain wakes up brain wakes up. So almost every one of these can cause arousals and it's that disturbance of sleep that leads to daytime dysfunction right? People complain about being sleepy or they complain about having poor quality sleep or it's not refreshing. And so a sleep study would be required. But if you have restless leg syndrome, and you don't have a sleep complaint, then you may even have these without them disturbing sleep that much or you may not be having them at all. And they only treat the restless leg syndrome because that's what the complaint is. Okay, but if there's an associated complaint of sleep disturbance or poor quality sleep, then you got to look a little bit deeper and typically you'll see these repetitive leg movements disturbing sleep. Alright, so that's the restless legs and periodic limb movement disorders. This is that personal question which is fine. I thought I had another one first. I did. Yeah. Let me ask this one at the end. Okay, yeah, so the next one I want to get to was jetlag so this one's what's the best way to recover from jetlag outside of just letting get one it's uncomfortable course. Anything I can do. I'm a New nightclub member. Sorry, I didn't get to this last month you new nightclub member. Hopefully you're still a member and you'll get this eventually. So jetlag reflects a misalignment of your internal biological clock right the way your melatonin rhythm is told to turn on and turn off and the outside rhythm because you've crossed some time zones, and so your brain is trying to now adjust to a new 24 hour light dark cycle than it was used to. And the way that works. I wanted to put up a little more information so that you know we get the whole clear connection here. So it's governed by light exposure, our circadian rhythms, our internal rhythms and that works through this way. Light comes in through the eye. And at the back of the eye is the retina where the business end is right. That's where all the neurons are, are that comprise our vision. They show us color, size, shape, movement, all that stuff, right but there's also a subset of cells that their only purpose is to transduce the presence or absence of light. And those cells take the information directly to the super charismatic nucleus or the home of the biological clock right? That's the master clock of the entire system. It's in the hypothalamus, which controls you know, hunger temperature, sleep, wake and a few other things. So it controls the major major rhythms of the body and this is where sleep is controlled as well. Now the Sen takes the information about light ships a deeper into the brain to the pineal gland. And why that's important is because pineal gland is the home of melatonin production. Right? So in the presence of light, the Sen tells the pineal gland to shut down melatonin production. In the absence of light, there's an internal rhythm in which melatonin will come on approximately 16 hours after it was turned off in the morning. Right? That's your 24 hour rhythm. So if you're awake for 16 hours, then melatonin comes on and you sleep for eight hours and that's the internal rhythm, which will run its course even in the absence of light. But in the absence of light, that circadian rhythm is like the actual term means circa dia near a day, so it's near 24 hours, but not precisely 24 hours, because nature left some wiggle room so we could adapt to the changing light day lengths during the seasons. So it's always a little bit longer than 24 hours. So if you're in a cave, right with no signals about light or dark day or night, then your internal rhythm will run a little bit later day in and day out. Okay, so you will sleep a little bit longer each day, but you'll sleep about the same amount overall because now your next day length will be would be a little shorter. Essentially, that's still going to be close to 24 hours, but it's just going to keep shifting later and later and later, unless you get some signal to lock in that melatonin rhythm and that signal of course would be daylight and that's why we are governed by light and that's why we don't want light after hours. Right? That's why you know, when we're up late when we're getting our zoom sessions, you know, we're telling our brains hey, let's it's still daytime. We're gonna go to bed a little bit. Later tonight because we're getting light exposure after sunset, although right now, the days are long, so it's not going to have an impact like it would in midwinter, for instance. Okay. So I use this graphic,
just to show the influence of all these various factors. But just to give you a sense of what happens with daylight. So in general, you know, we're awake all day into the night we sleep and then we're awake and then we're asleep and awake. So these are rhythms that run through our days and nights. When we're awake long enough, there's generally enough sleepiness, but there's also a second factor and that is our alertness, pressure or circadian rhythm. And this is what also turns on in the morning, right because our, our eyes get light, or melatonin is shut down and that internal clock is set to come back on 16 hours later, roughly right about here. Hopefully after we've been up 16 hours is enough sleepiness. And our circadian drive or alertness drive drops off so we can fall asleep. And this is what gets messed up when we change time zones. So when we fly to the west, we have a saying West is best, right? And that's because when we fly west so here we are from New York to California. When we fly to California, we usually get out in the daylight. Were hanging out with friends, colleagues, you know, we're meeting we're going to family members, whatever it is, and we immediately get on to their time because they're going to be eating later than we would normally eat on the east coast. So we have to stay up later. So we build up later sleepiness, but anybody who's pulled an all nighter knows we can force ourselves to stay awake, at least in the short term, right? You know, and certainly with physical activity, social activity, eating dinner later, all these activities will allow us to stay up later and override our circadian drive ready to put us to sleep. We can keep ourselves awake. All right, but then we fly back and we're crossing three time zones. And now the problem is in California, our rhythm has finally adapted to the California sunlight, right? So now it wants to turn off three hours later. than our New York time. And so we have a problem now we're in the West Coast. We're ready to go to bed at me sorry on the East Coast, ready to go to bed at our regular time. And instead our brains are saying no, no, no, it's still daytime we're staying up. Okay because it's shifted by being exposed to daylight for at least several days, generally more than a weekend or longer is enough to shift our clocks and make it difficult. And the rule of thumb is generally and now, a day or two per timezone to really adjust. So yeah, so if we fly from the East Coast, for instance, or from you know, Mountain Time to Europe, for instance, and Andrew has had the experience not too long ago, where, you know, it's much more difficult flying east and then trying to get on their timezone. Then it is flying West. I mean, you can fly to Hawaii and it's much easier to adapt, which is a great reason to go to Hawaii right? Much easier to adapt flying to Hawaii than it is coming back. Alright, so hopefully that answers your question about jetlag, and sleep direction, all that. So Stephanie is asked in the chat, does a blind person get jetlag in the same way as a sighted person? So that first part of the answer is no, but it depends on when they were blind. So if they're blind from birth, then they generally don't have much of a circadian rhythm. If they are, you know, they develop blindness later in life someone gets macular degeneration with age, then they still have a rhythm but they can and they can adapt to rhythms by being given melatonin at certain times to help them maintain that rhythm. But no, it's not the same as that because they don't generally get you know, they don't have cells and it depends though. I should correct myself because in some blind people, there are those cells that respond to light, even though they're their blindness can be cortical meaning they don't have the way to transduce the information into vision, or the cells in the retina that code for color, shape, size movement, are the ones that are damaged or haven't developed, and so they're not able to see that way but they may still have a subset of left cells that respond to light and so they may have a circadian rhythm so really depends on what kind of blindness they do have. Yeah, because that's the part that is stimulated by outside light function even if one doesn't see or does not function. Yeah. As long as the light can come in and those cells are active, then it will work for them, because it's designed to be connected to the circadian rhythm and melatonin and all of that. So you, you may not have the visual cells to see, but you probably had a few have the light detection cells. It should work just fine. And when to sell so yeah, okay, we answered that. Okay, so there's miss this question. Okay. Yeah, so actually, Andrew, I think we talked a little bit about that. But you see, you asked about prescribing medication, whether relaxation practices. I absolutely. Do you know, when I first started working with people, especially behaviorally people who complain of insomnia I absolutely started with these behavioral techniques you know, you stay up later you block the light you wear I shade earplugs and all those things, and Nerio worried about meditation relaxation. Although I did you know, I did teach some relaxation exercises, because a lot of people with sleep disturbance, really, really have a I don't know how to wind down disturbance more than a sleep disturbance. And over the years, I've recognized that it's what we do during the daytime probably 90% of the issue to what happens when we can't sleep at night. There certainly are organic reasons why we have insomnia and other sleep disorders. But a lot of why people have insomnia have to do with the fact that they haven't figured out how to quiet their minds how to deal with the stressors of the day. And in fact, in the I don't, I don't have that particular slide in this in this one here. But usually I have I add one in here called physiological arousal or stress by living in 21st century Western society is stressful. Living today is particularly stressful. With all that's going on. We were talking a little bit about climate and all the crazy stuff going on in in our different weather patterns and all that. So there's a lot to worry about. And it's not that maybe even now, even though there may be we may think there's more to worry about people, you know, back a couple of generations still had plenty to worry about. But we have to figure out a way to deal with those worries, the worries aren't going away. We have to find a way to manage them and I find no better way than meditation. And for the people who can't do meditation, sit on the cushion meditation will haven't ever been able to do that. And I suggest guided meditations, walking meditations moving meditations, Tai Chi Chi Gong, you know, something that will allow you to get out of your mind to find a way to give your system some downtime, whatever that takes for you. And that's hugely important in all my work these days. So people can sit on the cushion they find I offer other ways in which they can pick up those techniques and then try to go back to sitting on the cushion once they've learned to quiet their bodies in whatever way they need to do that. So good questions. All right. Um, and this is the last question that had come in and we hadn't gotten to and I'll throw it out there now and then we could open the floor so I think I mentioned this once before, I don't remember what, which one we recorded this on or whatever. But so the first part is I got interested in sleep medicine because when I finished my PhD work in neuroscience I've done a lot of that work with animals looking at brain models, actually a Parkinson's
looking for neuronal survival factors and that kind of thing. But I wanted to get back into looking at more holistic brains, you know, and humans doing human work. And so I call my old adviser who said, Oh, yeah, you know, they're looking for a brain mapper, and I called up my former colleague, who was actually graduating when I was just starting. And she said, Yeah, we just got this brain mapping equipment. We're looking for a brain mapper. She said, there's only one catch. And I said, Well, what's that? She said, Oh, well, it's, we're in a sleep disorder center, and you're gonna map sleeps, sleep brains. And I'm like, Yeah, asleep, wake. I don't care. I just want to map brains. I'll do it. And so I came to the NYU Sleep Disorder Center, ostensibly to look at brain activity and ultimately becoming a sleep specialist because the field was just burgeoning at that point, just opening really in early 90s. And, you know, just really, and you know, I was always interested in dreams. So like, that was a nice place to be. It was sort of a backdoor to look at consciousness stuff which you couldn't look at back in the 90s. It was a bad word in neuroscience research. Today, of course, you can do all this work. But back then you couldn't. So anyway, that's how I got interested in sleep medicine, training and education. So as a PhD, you can you would have to become a psychologist to have some kind of clinical degree this day, these days. And you would be trained as a behavioral sleep specialist. Or you then need to be an MD and if you're an MD you could take asleep Fellowship, which is postdoctoral training for doctors, which we used to do in my sleep lab. We used to train residents in sleep medicine. So those are the two main avenues other associated clinical areas like nurse practitioners are getting into to some extent. We just need a lot more sleep people at every different level, certainly in the behavioral medicine to behavioral sleep medicine area that there's a dearth of insomnia, behavioral specialists who can treat you know and teach all of these practices. So and they can work in a sleep lab right alongside the medical Doc's who do sleep medicine. So a lot of opportunities opening up sleep technicians, as well as respiratory therapists are really involved in sleep medicine, sleep apnea, a lot of sleep apnea training, and not to mention the dentist. Speaking of which Andrew has his hand raised like a good zoom participant gets
when you look at your crystal ball, in the future, in the world of sleep, medicine, what do you get the most excited about? I mean, what are some of the really kind of cutting edge frontier stuff that
gets you jazzed? Well, you know, the stuff that really gets me jazzed is mostly what you're doing. I mean, you know, we've learned to look at sleep grossly. And the more finely we parse out what we're looking at and sleep through you know, more finely analyzed eg using mag, you know, Magneto encephalography magnetics, to look at sleep, using all the different scans, functional MRIs, and so forth. We're beginning to learn, you know, as you've mentioned before, that different parts of the brain are doing different things at different times and it can be parts of the brain awake, and how does this all one restore function so that we function well during the day? How does that all happen? And to what is that world have to do with you know, nature of mind, sleep, medicine, sleep, yoga, Dream Yoga, to me, that avenue of consciousness research, and getting it to sleep? Yoga, is a way of probably going to be the best way we understand what the mind actually
is and what it does. That's fantastic. I mean, Tom Metzinger, you know, one of the world's leading philosophers, he's actually studying this. And he says, When the sleep lucid, lucid sleep is finally proven in the labs, there's going to be a revolution in the mind sciences. Yeah, yeah. I completely agree with that. It's a game changer. I mean, look how much lucid dreaming has done. Since it was proven in the 70s. This This takes that up to a whole new level. Yes. Changing studies. So how about the world of pharmacology and meds because a lot of these meds are less than ideal. Do you see things on the horizon that you think are really promising in terms of less side effects and less
addictive qualities and all that kind of thing? You know, I really thought the more we understood about sleep, the more you know what areas were involved and what the control of sleep was, we the medicines would get better. And they sort of did for a little bit in terms of looking at the getting away from the opiates and those kinds of heavy duty knockout drugs and moving into the benzodiazepines and then the benzo like non benzodiazepines. Which started with Ambien and and some of the other ones. And now they're looking at orexin or ones that actually work on that sleep wake switch in the hypothalamus, right near where these super charismatic nucleus is where that circadian control is. And it's the same area that goes south in narcolepsy that those medications seem to stabilize sleep even better with fewer side effects. But none of the medications are without side effects. Yeah. You know, and I just, I think it's we're barking up the wrong tree, because we really started out with thinking the brain was a system of neurotransmitter systems and if we just attack the right system, and then as we looked into the systems, we began to realize, oh, the cells that respond to for instance, you know, serotonin have 50 different receptors, you know, and then and so all of these, and then they have feedback mechanisms, and they have breakdown mechanisms and Colin esterase is that break? You know, so it's a holistic system. It's a nonlinear system. We can't just stick something in and expect it to have one singular effect. It just
isn't going to be that way. So do you think is the direction you're supposed to be go to? Is that the one you think that
that you recommend the most? Um, I think those would be the best I mean, right now with Nesta is still probably one of the best nons up non benzo benzodiazepines non benzo, benzo, like non benzodiazepines that's out there. The next Lunesta, but the erections are going to be for certain people who have a certain type of insomnia. And I can tell you what, and they can't tell you what kind of insomnia that is, but you can try it and see if it has less side effects than the investor does. And Lunesta mainly, will work for probably 50% of people with insomnia and will have the least amount of side effects from all that kind of drug class, but it will work for the other half. And the other half may have more of an issue that deals with a weak sleep system or a weak weak system. And that's where rexon would probably be better to stabilize one or the other, whichever is weaker. But you know, we're all we're all unique to some extent, including the disorders that we have. It's not just one blanket issue, or one blanket brain area
that's involved. Make sense? What do you come down on Tramadol I mean, there's the I know that's not specifically asleep mad
but as some people use it for that. I you know, I don't know that one very well. I'm not familiar with it.
What's the class
do you know of any I don't? I don't. Yeah,
I don't I don't know that. I think is the schedule three. But I don't know
that pharmacology on that one. Yeah, yeah. They're coming out fast and furious, but I haven't you know, nothing's been impressed. Nothing's impressed the sleep world. I haven't seen anything that's really said you should try this. Unfortunately, he's gonna say something else. Oh, and including, you know, the sleep world or the sleep apnea world. It's getting a little more complex. There's some evidence to suggest that even central sleep apnea has an obstructive component to it. Something to do with basal muscle tone is impaired impaired enough that you just have one little sort of obstructive type event and then you have a whole series of central events because it actually was caused by the airway being unable to be stay open long enough. But the then because that started the cascade, it goes into sexual events. And somehow if you can increase muscle tone, you can reduce the essential events as well, because you don't start the cascade. But how can you do that? Strengthen the upper airway muscles. So they're now looking more at some of the exercises for singers. You know, opera singers. Did you redo Yeah, so the, you know, and again, in the beginning, everything looked like we had a hammer and everything looks like a nail CPAP on everybody, open that airway. We're good to go. Right. Well, it's not working on everybody. Now. Although when it's clearly obstructive. That's the best course. Or again, you know, mandibular advancements, whatever opens that airway, but now we're getting more complex cases. And so people looking deeper into the upper airway, and that, again, it's not a linear a few muscles close, and that's it. It's the combination in the interaction of all these muscles that may need to be worked in order to strengthen the upper airway. And if you strengthen the upper airway, you may then prevent a lot of other issues that need stuff. All right. All right. Questions.
I don't see anything else on the chat. We're pretty good right there. I have finished the chat. Yeah. Okay. Hey, how is that AI assistant taking, doing? The otter? Anybody looked at that? Is it a good process?
Does it give you a good? Yeah, we, you know, we work with that all the time. I mean, with a big preparing today program that we launched, we had hours of transcripts. It's pretty good, until you get to Tibetan Sanskrit names, and so like Trungpa Rinpoche comes across this Trumpster literally comes it's translated as Trumpster. And so that that to me is terrible. Quicken perfect, right. So it's actually quite comical the way the way it translate Sanskrit and Tibetan. It's reasonably okay. It's the best one out there that we've come across.
So does it take snatches? I was just reading what it said it did. It took snatches of presentations and that kind of thing. Yeah. Mostly you're like, if you click on you know, part of this transcript, it'll show you what was on the screen though. Okay. Your slideshow? Yeah.
Okay. We use it all the time. You're getting better but still, you can find it right.
There. It's kind of amazing. It actually that's another whole you know, AI in sleep is going to be a whole there are a couple of really good papers. These guys have been writing. You know, one of the issues with AI is well, what's, what's the gold standard? Right? We think the gold standard has been the NPS G right. We've been doing it for years, we score it. And so this guy points out that blanking on his name at the moment but he's written a good paper and I can send you a link to it with with this summary. That, you know, for the 50 years since we've had actually it's almost been 70 years now we've had a lot of stuff and in cows which was the original stage sleep manual, the Bible of how to score sleep. We've never gotten above 80 85% agreement among human scores, like like never. And it's pretty interesting because there's so much variability built into there's so much you know, human assessment of whether that way big enough is that small, how many of them are there, you know that. So AI comes along and AI says, Well, what we're doing is we're taking the 1000 studies that have been scored, and we're giving all that information to the computer and computer saying okay, what's the probability if I look at something new these waveforms that it's going to be stage 1234, whatever it is, they don't really have a gold standard either. So it's interesting. They may end up doing better at sleep ultimately, then then we are and then again, since we did everything on 32nd epochs,
without using 10 Second epochs. Yeah, the
granularity. Yeah, absolutely. So which brings us to all the devices, you know, who are worrying just added another they had something in beta for a while. They've been using an AI type approach like that now, and they just switched over. So my sleep just got lousy because they changed the algorithm. My sleep efficiency dropped like 10 points because they changed the algorithm. So you know, what does that mean? I don't even know what to recommend anymore. You know, that's interesting. Yeah. Yeah. Cool. Cool. So hi, everybody, are we are
we like this like an auction going once going twice. So we're doing great. I love this. The sessions are so great. I they're very selfish. For me. I get so much out of every one of these things. Appreciate the data, the fact that you get this together and collect it like that. It's super great. Really, really helpful. So yeah, we'll be back second Tuesday. And
where are we I guess August, August. Yeah. Okay. Bye.
Yeah. All right, everybody. Thanks, everybody. Thanks to you Alyssa.
