[28] Navigating Sleep Challenges: From Grief to Circadian Rhythms

11:04PM Aug 8, 2023

Speakers:

Andrew Holecek

Ed O'Malley

Myra

Keywords:

sleep

insomnia

grief

melatonin

people

hours

morning

asleep

issues

light

sleep disorder

bed

day

complicated grief

night

hypnagogic

brain

started

questions

rhythm

We're waiting for Dr. Ed to show up. It's a little bit like him not to be on time. Wait, here he is dada. I was all set. I was all set to sing and dance. So you're You're lucky that he showed up.

He's always great. Oh, there he is because he prepares his slides and everything. Hey, Dr. Ed.

Yeah, somebody threw a couple of curveballs. At the very last minute turn to questions.

You are busy preparing. Oh, that's great. We appreciate that. So I was just telling everybody that you you saved them from I was gonna sing and dance for them. So you came

in. I can get off real quick.

Oh, you can you can still sing and dance if you like very quickly

so I'm just the background person here but I always really love attending these events with with Dr. Ed because I learned so much. But if you're new to this, what we do is once a month wonderful Duquette. O'Malley comes on board. people submit questions. He addresses the questions. He does want a beautiful way with PowerPoint stuff. And then obviously those of you who are here you can you know what to do if you have an additional question. Or comment or an offering. If there is a particular set of experiences you want to share this in conjunction with what Dr. Wright is sharing. Feel free to do that you know how to do that go to the reactions column, raise your hand or just type something in the chat. But in the meantime, I disappear into the background. My favorite thing is I love this is my favorite event because I get to just step into this audio audience role. And I turn it over to my dear friend, Dr. Ed O'Malley. Thanks, Ed.

All right. You're welcome, Andrew. Good to see you all. Listen in the background somewhere. Where you're bigger. Okay, great. So as per usual, I will share my screen and jump right in. I would comment though, that if you do want me to have a little more in depth response to your question, you know, I like to look up the latest evidence and all that. Get it in before, like five minutes before this group starts so that I can spend a little time with it. But anyway, there were a few really good questions coming in. You guys are really giving me some pithy questions to work with some that we've gone through a couple of times. So I'll refer you back there but still mentioned. Just so we know and a couple would be great if you would come on. So Andrew is prepared doing a preparing to die program. Can you talk about grief effects on sleep? Also, the book we do in the book study, preparing to die so that's yeah, it's up in the air. And just so before I get into that, before we get into these little details here, let me just also say that, you know, in my other role as an inter spiritual counselor, facilitator for the program, certificate program, we just did grief. And, you know, when we think of grief, we usually think of losing someone someone close to us a friend or someone passes but grief is something that we experience when there's some type of loss. Okay, any kind of loss can create the feeling of grief and someone and so these are more generic responses to any type of grief not just losing someone. And also I'll add that what I did during our program we teach usually we give everything online first, like it's a reverse classroom. And then so people look through all of what's out there and they so they have a good sense of what we're going to talk about it and then we they come in and we sort of discussed any of the sticky points, but I switched it up and I talked about because of the craziness happening as a result of climate change that we had just experienced. I did this two weeks ago, and it was you know, the wild fires. It was flooding, intense storms tornadoes touching down in places they pretty much never happened. What else was going on? It was just lots of craziness. Oh, the temperatures to heat you know, hottest month ever in the world. July right and temperatures where we haven't seen breaking records everywhere. So this was something we were all experienced. So I talked about eco grief. And that's the same general idea that it's a grief and it was something live and happening to us. So we're losing the way we the losses, the way things used to be more I guess normal in the sense that we kind of knew what to expect and now that's been pretty much disrupted, and we're not sure where we're going you know, we're talking about losing the current golf current. We're talking about Greenland losing pretty much most of its ice so there are lots of things going on. So grief is loss of something that's really important to you or really personally important. And generally we think of people and so when we're in a grief period sleep can be significantly disturbed. And it's common and bi directional. And by what I mean by bi directional is that the grief causes sleep disturbance and then the sleep disturbance makes it more difficult to deal with the grief. Okay, and so in general it takes people longer to fall asleep. They wake up for periods of time after falling asleep and maybe not just one period during the night but multiple ones and each time they wake up, it's more difficult to fall back asleep. They're waking too early, resulting in short sleep periods and not being able to get back to sleep and just getting up for the day. And so all of these difficulties, generally track with how intense or how close to the heart, the grief is and generally how close if it was the loss of a person or something very close to you. So and then for some, the sleep issues actually persist beyond the grieving period, and they really do need to be addressed. Okay. And, and this is you're going to find this as a common refrain about sleep issues. Okay, lots of different causes for sleep issues, but the response to them almost always is the same. Okay, ma'am. I'll talk about what that is and why that is. So, in general, and again, there is nothing normal predictable. There are stages but they don't occur in a certain order. Some do happen, some don't happen. So grief is intensely personal, personal. And so however you experience it, you experience it. There's never a time when grief is over. So that's not the way to look at it. It's that how do we learn to integrate it into our lives? How do we learn to live with what with a loss in some way? And so again, for most, the grief intensity lessons with time and maybe after about six months, but again, there is no cut and dried period for grief. But let's just say if it lasts longer than six months or so. Then we begin getting concerned about complicated grief or turning into a grief that doesn't resolve readily or within a reasonable amount of time. And complicated grief occurs in about 10 to 15% of people with this loss. And so it's been defined as complicated give grief because now they actually have an official diagnosis, you know, in the DSM 10 or whatever we're up to now. And, you know, it really does seem that oh, now we're medicalizing grief what that's not normal to be grief stricken when someone passes something close to us, but now I really feel like it has at least support for people who need to seek therapy, and it gets reimbursed. Okay. So, you know, in some respect, maybe you know, the way our society particularly in the West, particularly here in the states, if it's not in one of the diagnostic manuals, you don't get reimbursed for it. So this is a way you can actually go seek out therapy makes it easier to seek therapy when you need it and to get it treated and reimbursed. And that's really important because if that's not managed, then depression or anxiety can can set in even PTSD can develop as secondary to complicated grief. So you want to make sure if someone is completely non functional after a period of time, and they you know, they just can't get out of bed in the morning after six or eight or 10 months or a year. Something else may be going on and you don't want it to really spiral out of control. And certainly the closer the loss is to someone, it's more likely to progress into something else and not just go away will be integrated. And so there are therapies because now that it's in the book, you can get cognitive behavioral therapy or interpersonal psychotherapy, very effective for treating complicated grief. And really the goal of the treatment is just to bring it into your life and be able to live with the loss integrated somehow in your life going forward. But in some and not a small number, like about half of the people who have their grief, their complicated grief under control, the sleep complaints can persist. And so for that reason alone, but also because independent management of sleep issues should always be considered because they don't always, like I said earlier, even in standard everyday grief, it's bi directional. So if you don't deal with the sleep issues, it will prolong the grief. It'll make it more difficult to learn to live with the grief. Keep an eye on the chatbox

okay, just leave that question for me to get through a few of these. Bring it back up if I forget to lucid dreaming, and either case, independent management is important and there is cognitive behavioral therapy for insomnia. It's a real thing. It's been designed the cognitive behavioral therapy the focus of it is is to treat insomnia complaints, okay? And that should be introduced at any time along the period of the sleep complaints whether it's early in grief, middle grief, complicated grief any other time. And we know this is true for other mental disorders, depression, if we don't independently treat the sleep issue, treating the depression may not resolve the sleep issue. So you always want to consider independent treatment to make it easier to treat whatever else is primary. Okay, any other questions about grief or if you ask the question when it come on really quickly, and maybe have some something else to add? I'd be happy to take that right now. See any hands are people coming on? So we'll move to the next question, which was supposedly a simple question. What is the most common sleep issues I see in my practice? What can one do to prevent these? And if this is too much of a question, what is the most common issue? So by far the most common issue is sleep. Insomnia is an insomnia complaint. And I put it that way because, as a complaint, it's not considered an independent sleep disorder, until other potential causes of the complaint are ruled out. Maybe they feel like they're maybe they've just started a new medication and now they have insomnia. Maybe they are experiencing grief and now having some you know, maybe they have depression and insomnia. Maybe they have a medical disorder. That is gaudy. has both created sleep issues, as well as created concern worry and anxiety about that medical disorder that's creating a sleep issue. So and I am just getting through a little bit of a cold so I may take a couple of pauses to sip something. The actual diagnose the actual diagnosable disorder is chronic insomnia. But that's their specific criteria. So first of all, you rule out any other potential cause like medical issues, other mental disorder issues and so on. And you have to have, you know, an opportunity to have a block of sleep on a regular basis and only things shift work for instance, isn't chronic insomnia, it may be shift work sleep disorder. So you really want to get the criteria right, and understand that everything else has been ruled out. And now we're dealing with someone who just can't sleep for no major or apparent reason. Okay. And then treatments in general consist of again, cognitive behavioral therapy for insomnia CBTI. Okay. It's been shown to be better than any medication, treatment of insomnia because it's longer lasting. People learn how to, in a sense, like everything else, integrate the issues in their lives. And find ways to get their sleep despite whatever the issues are. And so they learn a better way of sleeping, they learn how to sleep better, and so that's going to give them long term impact long term effect. But it's also very possible that short term medication use will be needed, because if they haven't been sleeping for quite a bit, then just getting some sleep may be indicated. So that then they can really hear some of the other strategies that they're going to be asked to implement in order to have long term treatment effects of their insomnia. Okay. Now, we're going to we're going to continue in this insomnia thread in a moment because some of the other questions kind of related as to but and, you know, the more I do this work, and it's now been over 30 years the more I do this work, the more I feel like most of not the organic sleep disorders like apnea. We'll talk about those in a minute. But most of insomnia is not a sleep disorder. It's a wake disorder. We're not figuring out how to deal with our lives well enough to allow sleep to occur at night. And then of course, what we try to do it becomes bi directional. What we try to do to get more sleep usually makes it worse. And so we need to really do deal with that as well. My Iris hand is raised. Hey, Mara, do you want to come on and comment?

Yes, talking about insomnia and RAM disorders. My husband was prescribed doxepin he has Parkinson's and I never heard about it. Have you heard about

Dr. Pain? Yes. Yeah. For Insomnia. Yeah, low, low dose. No,

it's not so much. It's something that we also has the REM disorder because of Parkinson's.

So he has REM sleep. behavior disorder as well. Yes, use at night. I haven't heard of doxepin for REM sleep behavior disorder, per se. Has he started it and has it been effective?

It's been like two weeks so far. It is a little tired during the day, actually. He was sleeping only two and a half to three hours at the most and now he's five to five and a half which with a nap during the day we're talking about. I mean, it's it's much better. And he seems to have calmed him down too. So I do not know I just was wondering what have you heard? Is it been used? For a long time and

well, yeah, long term actually. Any depressant? And recently recently, by recently, I mean about the last decade or so they started using it in insomnia and lower doses in like quarter the dose that it was used for depression, and found that was very effective to get people to sleep, at least in a certain subpopulation, not everyone. The reason why, you know a lot of anti depressants will suppress REM sleep. And so that is probably why they're prescribing it more so than something for Parkinson's per se, that would be more like dopaminergic, something dopamine wise, something like doxepin or an antidepressant will suppress REM sleep and so make it less likely to have a REM sleep period during the night. So

he has had it for over 12 years and actually he's doing very well he has DBS in both sides and and is helping a little bit of quality of life. But I was curious in the last appointment because they also on he has made an appointment they have a neurologist, who is now as specialized in sleep disorders at Northwestern for Parkinson patients. And I didn't know I mean, I think that if I want him to do it because I think from him maybe he gets a little bit of the hints of behavioral during the day in the daytime and all that kind of thing. That may help them too. But I was very curious of having that specialty within the neurologist department at Northwestern.

Yeah, most. You know, most disorders these days are bi directional. If they're disturbing sleep, they're going to make it more difficult to control or manage the disorder because you're not getting any of the repair work at night. You're not getting that time to maybe, you know, do something that would make it better in the day and then so it kind of just keeps becoming a vicious cycle. The fact that the neurologist is is included for at least now a major part of the team is really important because the only worst sleep in Parkinson's is dementia, Alzheimer's, and it really is a deterioration of the sleep wake system. And there's you know,

I see I see it coming.

Yeah, the best we can do is prolonging you know make life a little better along the way. I will say though, that Neurofeedback you know and depending on a neurologist, they may think oh yeah, you know why not? Nothing can hurt. Or they may say I that's placebo crap. You know. I have seen it work. I've seen it really be a good use for

a midwife though. You know, I may know her a lot, but I'm just his wife. So but I did ask permission to ask about tonight before I address it with you. So I think he's receptive. Thank you. Any side effects that you have heard about using doxepin? That is not good. No. Thank you.

You're welcome. Yes. Ah, okay. So, okay, so, and again, you know, all of these things that Myra by the way, well, the things I'm saying to do for insomnia, you know, you want to see see what you can do for your husband. You know, any thing that disturbs sleep, you need to address the insomnia complaints by changing at least you're doing whatever you can to support it. So we'll, we'll get there. All right. Sleep apnea is the second most common sleep disorder, but it's seen more commonly in a sleep disorder center. So I have a private practice right now. And although I do see it, I get people who come in either because they have insomnia and sleep apnea, both independently diagnoseable. But I also see some sleep apnea patients who they're failing CPAP or they just, you know, like so much of this is secondary to how well what's a nice way I can say, our medical system sucks. Can I say? So, you know, they a lot of times primary care is making this diagnosis. They get the thing from the sleep center says a guy's got and you give them a CPAP machine and send them on his way. And they just put it in the closet and never use it because they don't know. They have trouble. They feel like they're choking on the air. Nobody works with them. The mask doesn't fit right. They're having leaks. It's all kinds of issues that you need to address if you want to be successful. And because we don't have a great system in place these days, a lot of people fall by the wayside and don't get it well treated. Or at least in my area. People know I have my expertise in the area. And I can even do Neurofeedback with some of these sleep apnea people while they've got the mask on while they're having trouble adapting to it. And that helps calm them down. And so they can better go home and use the device. So, you know, there are a lot of things we can do to get people comfortable. But I see usually the exceptions in my office. There are definitely several presentations if not, you know a number of them in which app needs addressed. Go back and take a look at them. I show all the different masks and different treatments but different types of masks, the mandibular advancement device that pulls the jaw forward a little bit made by a sleep savvy dentist who does a lot of follow up to make sure it's working for you. Other potential management options depending on the severity, so you need to know a lot of information about what to be recommended. CPAP is not the only thing but when you do fail it there are other options. So it's worthwhile continuing to find a way to treat it, particularly if it's severe. Okay. Any quick questions about your bad? No? More yet? Good. Okay. Moving on. So I have a teenager who sleeps at least 10 hours a night at what point is too much sleep an issue in my book almost never. It's almost never an issue. There are some studies that show people who tend to sleep longer and longer have some other neurologic issue that may be contributing more or it may be a sign of something. And yes, certainly depression it could be a sign of depression, but you need to look at the whole picture. So was this teenager as a child someone who slept longer than other kids who are needed more sleep than other kids may just be along along sleeper? Was this teenager someone who slept well as a kid and just slept longer? As a teenager we'll talk about how that changes you know I puberty a lot of things happen. As we all know, anyone who's raised a teenager knows there are a lot of changes of puberty, but also the hormonal changes shift the internal clock. I'll show you that in a moment. And so what happens a lot with teens is that their brains turn off later. At night and turn on later in the morning. And with schools starting early. They're not meeting their asleep need during the weekend. So they pound out sleep on the weekend. They can sleep 1011 12 hours on the weekend, trying to make up for lost sleep during the week. So again is this teenager sleeping 10 hours a night during the week or just on weekends. on vacations. When time is often they don't have to work. So I need to know more information but generally, adolescents need on average nine to nine and a half hours of sleep a night. Okay, how many of you know teenagers who are getting that much sleep? 10 hours is certainly in standard deviations of nine, nine and a half hours. So that's not that far off the normal walk in the sense, so I wouldn't be as worried about that. Unless this is something de novo just started when you know last week all of a sudden or two months ago we started sleeping 10 hours and used to sleep aid. Okay? If you're if you're here and asked the question want to come on, raise your hand here the circadian rhythm of melatonin in general. And the dotted dashed lines are what our brains do as adults okay. We generally in the morning, this is 7am in the morning, our melatonin shuts down. It basically is non existent during the day and it begins turning on about an hour before brains turn off at night. So prepares us to go to sleep somewhere between 910 11 o'clock. Okay, so comes on at that time, but the adolescence rhythm and only during the adolescent years from pretty much the puberty pubertal onset until early adulthood or late adolescence or early adulthood. Somewhere in it can last as long as the mid 20s. Okay, in which their melatonin turns are turned off much later in the morning here we're saying it's turning off at 9am and it doesn't turn on to 1112 Sometimes one o'clock at night, right that's the range so their melatonin rhythm has shifted later. And school start times. Do not not only do they go earlier than they were in middle school, but they're ungodly early. They can be on the bus stop at 630 for 730 Start Time some schools start at 7am There's a whole movement in certain states have now because of this movement and because of all the sleep Doc's I don't know of one sleep doc who does not advocate for later school start times in adolescence in high school and sometimes even in the middle schools because this process puberty start it starting earlier and earlier and it's starting in middle school. So somewhere between sixth seventh and eighth grade and eighth grade this starts usually late sixth grade early seventh grade. And in girls before boys and biological females before males, they'll start a little bit earlier. And that's when their brains shift and they need more sleep and they need to go to bed later and get up later. And so they're they're kind of handicapped during school women. Okay, before I go into our next one, any questions about the adolescent sleep or that person who was worried about their teenager if you're here, you want to raise your hand. Let me know I don't see any hands raised Okay. Okay.

This question, quite a long question, but, but let's just say so, what the reason I put the whole question up here is because these are a lot of the questions I would be asking someone who comes in and says to me, I have trouble falling asleep, right. I have a delayed sleep onset. I can't fall asleep when I want to fall asleep. So how long has this been going on while since I was very young since I was a kid. So going back to that teenager, you know, that teenager may have a delayed sleep phase syndrome, which is what we're going to talk about here, and may have always needed to go to bed later and gotten up later, in addition to maybe needing more sleep than the next person. So we want to know what's the history of this. So this is since he was very young. It's taken him a few hours divorcing, and why could that be? Well, most kids are told they need to be in bed by let's say seven o'clock at a certain age and then eight o'clock, the next stage and then nine o'clock, and then 10 o'clock, you know, so we have a sense of what normal bedtimes are for our kids. And since he was very young, he's had trouble to fall asleep. When they probably tried to put him to bed at those hours. Okay, and if he had delayed sleep phase syndrome, or he may have had it his whole life, and so he always had trouble falling asleep, no matter what time they tried to put him as a kid to bed, and then high school. It probably got even worse, because the pubertal shift still happens. And so if he already has a delayed phase syndrome, he would now even be not really being ready for sleep until even later at night and having a much harder time to get up in the morning. So I want to know what you know, what was it like during his elementary school years, let's say and then I'd want to know what it was like during high school. Okay. And then college if he went to college and what happened there, and most likely, in this case, I would bet my career on it that he didn't take any eight o'clock classes because he couldn't get up for him. And he finally had the opportunity to choose classes. And so he would take classes that start at 1011, maybe noon, you know, and his whole career may be built around something that starts later. Not early. Okay. Maybe even sleep shift work working night. Okay. But so and now what did he do to deal with that? Well, I learned to tell myself detailed stories in my head. I still have sleep onset issues and still Daydream to get to sleep. Okay, you know, so he figured out sort of a workaround. He's going to be in bed for two hours, way before he needs to fall asleep, but he's figured a workaround. He's figured a way to entertain himself, almost like taking guided meditations and giving him something give him something for his brain to do to keep him occupied. For that time that his brain is not ready for sleep, he needs to do something else. And if this was an insomnia patient, I would say, Well, what you need to do is have a later bedtime and go out and do something else to keep you occupied. You know, make your day longer. Because your brains not ready for sleep. And if you try to get it, it's not going to work. And so he figured out a way around that by telling themselves stories. And he does some pretty good you know, good sleep hygiene, right? That's to make sure you're not having late caffeine you're exercising during the day. Not too close in the evening. Oh, he and then when I get to menopause, sorry about that. That's my patriarchal bias here coming through. Usually it's because the women are bringing the men in by the year saying you got to get your snoring taken care of now, or I'm divorcing you but it goes the other way to menopause. Oh, boy, that's like, I don't wish that on my worst enemy and much. Sometimes glad I'm a male, even though we've we've messed up the world pretty well won't go into that way now. Okay. So since menopause now are asleep is really disturbed in addition to having a delayed sleep onset or delayed sleep phase syndrome, only getting five hours of sleep, being in bed for eight to nine hours. So that's one of the issues I would start with right away. You can't lie in bed for three or four hours and expect that to be good. Although, intuitively it seems to make sense, right? If I lay in bed a long enough time, some of that time I'll finally fall asleep or at least I'm resting right that's as good as sleep right now, not only is it not as good asleep not only is it not helpful to lay in bed, but you're actually training your brain to be more anxious and awake in bed, instead of sleepy and falling asleep. Like the storytelling was great, but now she has to tell stories for four hours. That ain't going to work right but it's just gonna get create more anxiety and so forth. Okay, I wake frequently I'm not stressed or upset I just can't sleep. Oh god if mattresses sleep into hypnosis, melatonin over the counter sleep medicine prescribed medicine diphenhydramine, which is Benadryl works well, but, and that's already giving me some information because if that works, it's telling me something about her sleep system and what's responsive to it. But it wears off after four hours. And I have forgetfulness and inattention during the day right? It has a tremendous hangover. It has a long half life. It's a real dirty drug. So it's not it's not really going to be useful if you can't really function in the morning. I have chronic gastritis and nearly everything upsets my stomach except Dramamine, which is a variant of diphenhydramine I think half a tablet. And another commonality among insomnia patients or insomnia clients is that they have not developed tolerance for whatever they found works because they try to use it sparingly because they need to get some sleep and they know if they use it every single night it's going to stop working and they're going to be right back to where they started. So there are no danger of becoming drug addicts on drugs that put them to sleep. They really need them to work for sleep, so we never really have to worry about that. I noticed that my biological clock doesn't run on 24 hours. So there we go. This is a delayed sleep phase syndrome. It runs on 26 to 27 hour cycles instead. The one time during my life I slept well was when I lived alone. No pets. No job, go to sleep when I wanted and wake up when I wanted and what happens. She addressed her biological need, what is her biological need? It's to go to bed, go to sleep. Go to bed later and later each night and sleep later, and then sleep later. In the morning. And then it becomes problematic because what happens is you begin sleeping around the clock sleep around the clock Okay, so I was at times happily awake all night and asleep most of the day until it cycled back around. Okay, so that's a very clear description of what her circadian rhythm is doing. I would want to know how many hours she was sleeping during that time. Probably eight or so. Maybe a little bit more, maybe a little less, but that would be the target number I'd be looking for. Because that's what her system wants to do. I'm not able to do this now due to family and work any advice for me at all? I really feel like I've tried everything and I'm simply on the wrong planet. There might be something to that, but we haven't found another one yet. So we're gonna have to deal with it. But thought I'd ask just in case there's something I haven't thought of. And if you're on, it'd be great to have a couple of questions answered. Come on and and raise your hand and we'll see if we can sort this out a little more. But so really what I would diagnosis delayed sleep phase syndrome, okay. That means your internal clock is shifted later than the next person. And in general we have we have larks and we have owls. Okay, so everyone is shifted towards one side or the other. Some of us very little like, ah, you know, I'm more of a morning person. You know, although I can sleep in a little bit, not a big deal. Some of us are. Yeah, I'd rather be doing my work at night but I go to bed earlier. So those are slight shifts, right. But then there are people who must get up early because they're sharp. In the morning and they don't you know, by eight o'clock they're ready to start winding down in bed by nine sound asleep. And there are people who are opposite. They only come alive in the afternoon and they love working late into the evening and don't go to bed till 12 Or one. Okay, so larks on the one hand, I was on the other and that's just a variation of our circadian clocks. It's within the normal range, but some people it goes a little bit longer. Okay. So she can't manage this schedule.

But in general, all of our clocks are longer than 24 hours. Okay. The circadian rhythm. You know, I've said this in other talks when I've done circadian rhythm sleep disorders. And you can go back and look at some of those presentations, which I really did focus on it did a lot of work on it. But it comes from circuit which means near and DN is a day. So it's near a day rhythm, right? It's near 24 hours, but it's slightly longer, which then allows us to adapt to the changing seasonal day legs. Okay. So, you know, in the winter, we would sleep a little bit less in the summer we sleep a little bit more. I'm sorry, the other way around. In the winter we sleep a little bit more because their day lengths are shorter and the summer our day lengths are longer so we can sleep a little bit less. And so those are really responsive. Our rhythm is responsive to daylight we evolved in daylight not with electric lights, not indoors, not in buildings with no windows. We evolved out in nature and so our rhythm was designed to respond to the natural shifts in daylight. Okay, so in your case, person with delayed sleep phase syndrome, you need to go to get yourself a light box and I don't know if anyone's ever proposed that to you or not. But here's what here's that whole light system. Okay. So in our eyes, the back of the eye is where the retina is. That's the business end of the eye. That's where the cells respond to all of visual cues that allow us to have color, movement, shapes, size, all that stuff that comprise vision, but there's also a subset of cells that their only function is to respond to the presence or absence of light. Okay, so they code they encode light presents, and they send that information to the super charismatic nucleus in the hypothalamus. That's the home of the biological clock. That's what governs the biological by the circadian clock. That information in the hypothalamus is gifted later into the brain deeper into the brain to the pineal gland, home of melatonin production. Okay. Now there are two components to this. One is the responsiveness to light. Okay, that's why we make the recommendations. You know, don't have your devices on after a certain hour. You know, try to get down to get blue blocker sunglasses and all that kind of thing to prevent light after hours so your brains not being told. It's daytime shut down melatonin production, okay, at night. Excuse me. At night or in the absence of daylight, then our rhythm is going to come on and melatonin production is going to start okay. Now, that's one component. So we're designed to respond to the presence and absence of light, but there's also an endogenous rhythm and the endogenous endogenous means internal rhythm, or melatonin. And that internal rhythm is what makes us either larks. Or owls. Okay, that internal wisdom. So we've already genetically we're genetically predisposed to be a night owl, or morning lark and then we adapt to that, to some extent the majority of us buy light exposure from the outside that allows us to wait let's say we're now it would allow us to wake up earlier in the morning because we'd get light exposure and that would shut down our melatonin production and activate us. wake us up. So there are light alarm clocks that you know if you want to email me offline, I can give you some recommendations. There are light alarm clocks that you set for a certain time and about 20 minutes or half an hour before it's all settable the light starts coming up and gets brighter and brighter and brighter. And that information goes through closed eyelids into your eyes and it hits the cells and it tells the cells Hey, it's morning. Let's start shutting down melatonin production. Okay, so that's one half of it. The second half of it is to take a light box independent of the light alarm clock, and it's gotta be at least 10,000 Lux and you want to sit in front of that in. You want to sit in front of that during the morning once you get up. Because that will help tell your brain strongly. You're getting sunlight like that's the closest thing to sunlight we can have or better yet, get your butt outside in the sunlight when you first get up. Okay because your eye is is genetically biologically geared towards seeing sunlight and telling you it's morning and it will help your brain strongly turn off the endogenous rhythm to melatonin. And so it brings your your rhythm your later rhythm earlier. Okay, so light exposure in the morning will help your brain know what's really morning and then set its clock from that point. So let's say you need eight hours a night and you're getting exposed to light in the morning at eight o'clock. Now 16 hours later, is when your internal melatonin rhythm will come on. Okay, and that'll be at a reasonable time. 16 hours later it would be midnight 11 o'clock, okay, depending on when you get it in the morning instead of two or three in the morning. Another way of working with this is as you noted when you slept around the clock, if you're on vacation, and you get to be able to do that again and probably if the kids are young, you're not going to have a vacation for another 20 years. So that's not going to work but if you happen to be at the latter end and the kids are now going off to college, then you could start sleeping a little more ad lib if you can try to do it on a two week vacation if you can sleep around the clock and then lock it in with light exposure in the morning with a light alarm clock and with that strong 10,000 Lux light or sunlight where you basically are going to sit in front of the light and let it really 20 minutes half an hour. Let it really tell your brain it's morning. So you can help shift your internal rhythm. You probably can't change it completely and you're going to have to stick to it. Like Lou because if you allow yourself to shift in one way a little you stay up a little late on New Year's Eve or is it late on a Saturday night, you're gonna blow it out of the water and have to start all over again. Because that's what your brain wants to do. You can convince it to do something else but you have to really stick with it. Okay, um, I don't see anyone coming on about that. Last two questions that came in. Let's see if we can get to them and then I'll take the ones in the chat. Oh, wait, wait, let's see. Heidi says What if you are typically an owl, but quickly become the opposite lock mode as you say if camping or backpacking? Can't you know they did that study? They took a bunch of people and they sent them out camping where there were no artificial lights. And what happened? They went to bed a little bit after sunset and they got up with the sun in the morning and they never felt better. Okay. insomniacs, they started sleeping really well. Okay if camping or backpacking and also then James get better to reflect organic relationship holistic in lots of color and daylight etc. In our Mo James become darker literally and metaphorically. Also taking more on more of the constructed landscape. Don't know if there's a question in there, but it's something to think about. Well, yeah, I mean, I don't know if you're commenting that that is what happens to you. But I don't know if I go as far as saying literally, your dreams are darker. If you're an owl. Okay, I don't know that that's true or anyone's really shown that. I just think that you are more adapted to schedules in which the days are longer. Like maybe you're Norwegian or Scandinavian right. Yeah, so it's hard to say that but interesting observation were interesting, at least idea to explore and play with. Thank you. Okay. Okay, good. I'll try a light box. Yeah, get the Okay good. So get the light box but also get a sleep alarm clock. Okay, email me offline, because that's going to be helpful. Helpful you to get started with it. Okay. But yeah, I would start with a light box whenever you get up if it's a reasonable time in the morning, where somebody drags you out of bed at a certain time. Sit you in front of the box, get outside in the sunlight, and then start setting your light alarm clock to that time, whatever that is. Okay. All right. I'm

hitting the terrco article. Barrier, I think synthesis in basically it's about Hypnic jerks. myoclonus where you're trying to, you're just drifting off to sleep and your body does one of these things you know, like you're falling into sleep and boom, you recognize you're falling and you your body goes into spasm and like says I'm not falling off this cliff just yet. I'm gonna wake myself up. That's kind of what's happening. It's basically affected by all the sleep hygiene do's and don'ts. So essentially don't do the don'ts, okay, which mainly come down to late caffeine including chocolate late intense exercise, anything that's muscular that you activate later in the evening is going to keep your muscle muscle system more sensitive, let's say more easily activated. So anything that activates your muscles will be more likely to activate myoclonus as you're falling asleep late worrying you know reviewing the difficult days anxieties lying in bed you know anything that's going to increase your stress level. Sleep deprivation, okay, will will increase it variable sleep wake schedules because the brain doesn't know what to do. And so you're trying to fall asleep but then it wakes you up because it's not fully ready for sleep. But the last line in the article I really love it's absolutely having a best attitude, especially for anyone with insomnia, right trouble falling asleep. So whenever he wakes up with a hypnic jerk he sometimes registers or wackadoodle hallucination along with it, whatever. It's assigned to him that he's doing everything right. His body's headed in the right direction, and sleep is near. Okay, so he's turning it around instead of it becoming a problem and becoming an issue preventing sleep onset. Oh, no, it's just a sign that my body's heading into sleep and I'll relax into it. Okay, and that's basically what happens. Questions buried you have questions about you experiencing that and that's not how it works for you. That's the case Come on.

Okay, great. Like that one. Good. And finally, this one came in right before I came on. What triggers in regards to Cluse imagery is increased melatonin a prerequisite so I'm just going to add to the so it occurs that sleep onset as you're drifting off to sleep, right. hypnopompic imagery occurs when you're coming out of sleep in the morning, you may just consider that more a little dreamless as you're coming out of sleep, but hypnagogic is what we most remember because we're moving from a awake state into a sleep state. So there's a lot of more brain activation happening. Increase melatonin is not directly related to hypnagogic hallucinations. Remember what I was showing you about melatonin production comes on in the evening in the lack of light exposure, and roughly 16 hours after you've awakened in the morning. So that's already set. And it's not because it's going up. It just happens to be coming on. And depending on when you fall asleep, you may hit it you may not happens at night more often as sleep drive is more intense, right? So your brain is trying to get you to sleep and if you start Are you still have a lot of stuff running around up there a lot of anxieties, a lot of stress, a lot of activation from caffeine or all the other things I mentioned for Hypnic jerks, same kind of stuff will push you back awake. So the sleep system, the sleep switch is not an all or none. It may start your thing off to sit and then come back. And if you're asleep drive is strong. It's really trying to push you to sleep and you may have the imagery kicking in before you're fully asleep so you can stay more aware of it as it's happening. And there's less sleep drive during the day during a nap. So having a nap will be more like that to happen more conducive, and conducive to it. And then he caught I also find it easier to experience wake Induced Lucid dreaming when I can focus my attention on hypnagogic imagery. Very cool. Okay, keep doing that. That's great wake Induced Lucid Dreaming we liked that we want to do that we want to have to all doing here on nightclub right we want more lucid dreams. We want more wild dreams. We want to do this stuff. So for you, it's a real benefit. Just like in the guy with the article on Hypnic jerks. He figured out hey, this is a sign I'm falling asleep for you. It's a sign you're drifting you're drifting into awake Induced Lucid dreaming. That's great. I get less hypnagogic imagery myself. And I do more of that in the morning when my brain is coming out of the dream state you know I can more easily go back into dreams but for people who have a lot of hypnagogic hallucinations go for it. That's a great way to keep you aware enough as you're drifting into sleep. Excellent. And I didn't have time to look up this reference. I'll put it in the stuff I sent to Alyssa which attaches to each week's or each month's presentation. A researcher Horry at all they describe 13 stages of sleep onset by the EEG in their studies

so that's really cool stuff you want to look at that you you know we see it sleep onset we see the Theta Waves not kicking in, but there are certain percentages in which hypnagogic imagery is more likely when there's enough data waves and still some alpha and a little bit of beta, you're more likely to have it and then so he's really codified a lot of these different stages as you drift into it. So pretty interesting work there. For it's why You are quite welcome. And acknowledging it was the last minute question. Thank you. Okay, let me go back to the beginning. Okay, so can you make the change? Yeah. So I talked about that with light exposure. Also for people with melatonin. You know, when people tell me they've tried everything too. I want to know well, how did you try melatonin? What was the dosage? When did you take it? Was it pill form? Was it slow acting? Was it liquid was it under the tongue? Was it so mental, you know? So there are different ways but melatonin is another way you can shift your circadian rhythm. Use me

all right. And let's see there was something that came in early. This is this first question. Yeah, Tim. Okay, doctor, that wasn't there was an interesting topic by one of our other groups regarding how aging might affect lucid dreaming. I know that aging does affect sleep to some degree Could you say a bit about how aging may affect our general sleep process? And particularly lucid dreaming? I would you know, just off the top of my head I would say it will actually benefit our lucid dreaming because sleep becomes less deep at age. Our amount of deep non REM sleep begins to decrease. But the amount of non REM sleep we get across the night stays about the same which means our REM sleep periods stay about the same until really 70s 80s 90s And it only drops by a few percent maybe 5% or so. So we're much more likely as we get older to have REM sleep than we are non REM sleep if you want to look at it that way. And coupled with the fact that we're more our sleep is lighter. It means we can have more awareness as we're in our sleep stage, our sleep states or non REM sleep states moving into our REM states, so we can be more likely to become aware during our REM states. Now. Andrew may come on for this. I don't recall research that looked at frequency of lucid dreaming and age. But that would be an interesting study. I don't know if anything has been done with that. But I can actually look look to that and see what the evidence is. If anyone's done those studies, you know, I haven't met up on all the books I've driven but probably I'll start with Stephen burrows first. And see what what he would have to say about that. All right, um, I am going to stop the share and see if there are any other questions hand raised. We're kind of at the limit here. And we're at my voice number two, I think it's it's fading fast, Andrew.

No, I really don't have anything to add I'm very interested in the Horia tall study to see if there's actually I'm very curious to see what they say about if I'm understanding what you're saying. The study seems to suggest granularity of 13 spaces stages of actually going through wow

yeah yeah, based on the EEG, which is really like a tour de force to study but he and it's an older study, which is why I didn't have it really readily available. It's probably done in the 70s. And then he wrote there's a book he wrote, I think following it, you know, talking about these different stages, and, you know, nobody was interested in dreams back then, except for Freud, so he wasn't too interested in EG at the time. So no one really followed it up, as far as I know. But he gave some really compelling examples and good data and you know, so, but I'll find that and put it along and maybe we can raise it again next week and see if there's anything interesting that comes out.

I'd be super interesting because that's a little handholds on on articulate stages, even though it's still at the level of a map or the study. I think the more we can inform our ability to track what's actually happening as we go from the waking state into the dream and in dreamless sleep state. So that kind of stuff I think is really cool. Yeah, yeah.

Yeah, Indeed, indeed. All right.

Well, thanks. Thanks. For coming out. And despite struggling with a cold, we really appreciate it. Every time I attend one of these things. I take our little notes and it's like, awesome stuff. So a big big round of applause from all of us here. Really appreciate it. See you around the block, so to speak and out. We'll do it again next month. appreciate it so

much. All right. Very good. Sounds great. Always a pleasure, joy.

Okay, thanks. Yeah. Really great. Thanks, everybody. recording stopped