Alright. So I am going to just start presenting since people do watch them offline. Maybe more people will jump in maybe not, we'll say. But there were some questions that came in. So I'm going to address those first and we will go through each of these and kinda actually prepared something for them. So we'd have some good hard data to talk about. So I'll talk about this answer the first question first, which is, can you talk about how and why sleep cycles and patterns change as we age? So I found this slide in my older collections. As you can see, this one's from 1990 but it still holds today. So these are histograms at various ages. And so you know when you see the ideal histogram, histogram, by the way is the collection of how sleep is scored across the night, and it's a histogram because they add up all of the different stages. And they get these different curves so so right now, this person's fully awake, and then they spend about five minutes in stage one and then a little bit in to a little more than three and a long bat and for now three and four have since been combined in the standards of practice. So three and four considered slow wave sleep and the deepest level of sleep. So I might talk about N three, which is the current jargon for describing slow wave sleep. But you could see mainly you know, in youngsters, they have a nice long bout of deep sleep upfront. And then they go right to that same process coming out of it. And they may instead of going directly to wake up, go into a short, Rem period here rapid eye movement sleep, and that's in these dark bands. Okay, so their first cycle is primarily made up of this deep slow wave sleep, and then they'll maybe awaken a little bit and then drop back into the same non REM stages of 1234. Let's say, and they'll have some more this sleep, which is not quite as long as that first bout, but still pretty deep, and then they'll go back out of it and this time into a longer REM sleep period. And then when it reverses this time now there's very much less lower asleep. And this can vary a little bit across tonight. But what's happening in the youngsters is that they're having long, uninterrupted blocks of sleep in their cycles as they move through the night. And as everyone does, they have the deeper sleep period longer periods early in the night and towards morning have longer REM periods. Okay. Now, in young adults, this begins to change and you can start to see that first off, these deep sleep periods are much shorter, and they're much more reduced and they basically go away and they only occur in the first third or so of the night. And then when periods get longer and there may be more awakenings. As we get older into our elder years, then there are many more awakenings, number one number two there is a market diminishment of deep sleep. So sleep becomes lighter overall, the REM periods they kind of norm sort of even out a little bit but there's still this general tendency to have more towards morning. This doesn't reflect that very well, but that's the latest evidence on on REM sleep.
But you can see the cycles are much less defined. There's a lot more wait time. And so if we compare our sleep across the ages, as we get older, it's harder to maintain sleep and there's much less deep sleep. Now over here on the right. They're showing what deep sleep waves look like in the youngsters. And that amplitude begins to diminish as we get older. So these are young adults, and this is their slow wave sleep or deep slow waves that comprise these deep levels of sleep. But you can see the amplitude goes down. And that's generally reflecting. When we see big waves in the EEG it's generally because many many many cells are firing together. So they fire together, they get positive together, they get negative together, they get positive together, they get negative together. And since they're in sync, it's when there are a lot more cells, they'll fire and there'll be a lot more activity that shows up when we record the activity as we get older that diminishes. And then there's a little controversy over what actually is happening in in the elderly. But it used to be the controversy was well is it because there's less brain activity that we're recording at the scalp? Or is it because the scalp becomes more calcified calcifications? They're more buildup of minerals and salts in the actual structure of the skull. And so that might impede the recording of these waves. And it's not that the waves have smaller, it's just that the scope is thicker. You know, some people might tell you get a little more hard headed as you get older. I think I've heard that now and again, and so there might be something to that. But even when they drop in electrodes like past, you know for surgeries for brain surgeries, when they drop electrodes in, the amplitude is pretty much diminished. So this is more likely not due to a thicker head or thicker skull, but rather we have less brain cells overall and so less brain cells firing in synchrony. And a lot more brain cells kind of doing whatever they want to do and, and not listen to the boss anymore. And that's why even cognitive activity can diminish as we get older. Okay. So that kind of answering that question. So the structure, the number of brain cells, all this changes, we get older. By the way, it's also why we have more wakeups because now we have less deep sleep. And so our sleep is now more easily disturbed Okay. Things that used to we didn't hear when we were kids and young adults now will break through and can wake us up among other multiple reasons why we wake up more as we get older. So I love this question. Is it true that my grandfather needs less sleep than my grandchild? That would be your great grandchild, wouldn't it be? Well, let's get that get that and we are getting on board here. If it's my grandfather, then my grandchild means that would be the grandfather's great grandchild I imagined but we won't have to we don't have to go there. Okay. So in general, as those histograms kind of reflect newborns and infants, they have not only that deep sleep, but they have much more of the 24 hour period of sleep. And as we move through the ages and kids start going to school, the amount of sleep diminishes. And then at puberty, things changed.
I thought I'd throw this in there because we're going to talk a little bit about melatonin that's another one of the questions. In adolescence what happens there's a couple things that happened. So as we move through development, we have overall less than less total amounts of sleep per 24 hours, but in adolescence, something else happens. So here in the dark curves would be the adolescent brain, and this is melatonin release. Okay, actually measured in the plasma. And what happens is, when they hit adolescence, this level of melatonin shifts to a much later time in the 24 hour cycle, so their brains begin turning off much later in the evening and turn off I'm sorry, turn on much later in the morning and turn off lights later in the morning. So this is a 9am for the adolescent brains level of melatonin. So that drops off between eight and nine in the morning, and their melatonin rhythm doesn't come on until now instead of like, you know, nine o'clock or 10 o'clock, it's 11 o'clock or later. And so their whole rhythm shifts later than it will be when they become adults. That drops back to the adult level. Where it now turns, turns off at seven in the morning and maybe turned on at about nine at night. So that whole shift occurs in adolescents, which makes it harder for them to go to school in the morning because schools start way too early. They're starting at this time. And although first period teachers will tell you, their students are mainly asleep when they get to school, and it's not until third or fourth period that they begin waking up and participating. So that actually contributes to making up sleep on the weekends, which is not all that different from the adults who chronically sleep deprived themselves during the week they get less than they actually need and then they make it up on the weekends because they're not getting enough so they look similar, but for different reasons. And then as I mentioned, sleep tends to become lighter with age so sleep disturbance is more common. Plus we have less, more medical issues, more medications, maybe so lots of reasons why things become more discoverable as we get older. And then once retirement kicks in there's a less demanding schedule. So sleep drifts and now becomes later in the morning since there's no work alarm, and there may be some napping during the day. But despite all of that, the amounts change dramatically. Okay, so no your grandchild sleeps much more than your grandfather. Your grandfather still needs a fair amount of sleep, but they needed roughly about the same as all adults. It just gets much more difficult to maintain. It. You know, maybe there's a tad less, okay. So your grandfather does need less and your grandchild does get more, but that's a developmental change. But once they hit the adult ages, that is pretty constant. Right through the end of life. So your grandfather doesn't need less than the adults just less than earlier in development of life. Okay, hopefully that tension questions and if any of you are on now who had those questions? I'm certainly willing to go a little further into it, if you would like.
Now, this is the other aspect of sleep. This is the circadian rhythm. People are asking about jetlag, how do we deal with jetlag? And why is it worse when I travel east and when I travel west? And does melatonin help? So that that we're going to keep the melatonin question till the very end. We'll talk about that separately. But this jetlag issue requires an understanding again, of how the circadian rhythm works. So, first of all, in our brains, we have a direct line to the pineal gland, or to place where melatonin is produced, and that direct line is carried by light cells, light detecting cells in the retina. So in our eyes, the back of our eyes in the retina is aware all the business is done and we're all the neurons are and they're our vision cells, of course, the ones that transduce movement, color, shape, size, all that kind of stuff. And allow us to see but they're also a subset of cells that respond only to the presence or absence of light. And so in the presence of light, the cells are turned on, and they take that information back to the s, SCN or super charismatic nucleus, and the hypothalamus, the location of where the source of the biological clock, this is the master clock of the brain and the body. So basically all our other rhythms are regulated by this one. Master rhythm. And that master rhythm makes sense because it allows us to respond to our environment. As the seasons change, we want to be able to move with the seasonal changes. So when there's more light, we actually are open about and more active. Then when there's less light in, in the wintertime, like we're moving into on the East Coast now. We already get less light and now we're getting a lot less light. But essentially, the way the earth is shaped and its path around the sun, we get less light in the northern hemisphere. During the winter months. And so that's recorded by this whole system. But there's also an endogenous rhythm. That's a daily melatonin rhythm. And these these studies were done back in. Oh, gosh, now back in the late 60s. And they were done in caves. Mammoth Cave in Kentucky was one place where the researchers would be put down into these caves and they'd stay in the cage for weeks on end. And their sleep and circadian rhythms were being recorded body temperature and such. And what was found was that there was this internal wisdom, even though there was no exposure to light. They were deep in this cave, and they only they only had the little red lights which don't really change the rhythm of brain doesn't respond to that's why we use infrared for instance, sorry, the red light in photographic back in the day of, of developing your own film, the dark rooms would have red light in red light would allow you to see something at least but not change the negatives and expose not given any photons of light that would act with the photographic process. And the same idea for the brain. The cells do not respond to red light per se. So in these caves, they found that their rhythm would advance and they would be going to sleep or feeling like being or feeling sleepy and then going to sleep a little bit later each day. So if they were in the cave for several weeks they would begin to shift their entire schedule relative to the outside day in day night schedule, the sunlight schedule, and that's because this system was designed to be able to shift when the light was changing. And interestingly, it only moves in one direction so it's always advancing biologically it would be really hard to pull it back. And we'll get into that just yet. But I will want to talk about the jetlag. So at any rate, there's this indiginous rhythm, where once this system is turned on in the morning or turned on by exposure to daylight, it then has a timer running that will then turn melatonin back on 16 hours later in an eight hour night sleeper.
And that's in general where you know, in general, we only need about eight hours. That's a population average. There are people need less people need a little bit more. But on average, I would say it's an eight hour night person, so eight hours of sleep, and then 16 hours of wakefulness and that's how the system was designed. So if you are getting up at various times in the morning, and by getting up I mean getting exposed to light, or you're lollygagging in bed, you know for a couple hours before getting out and getting strong light signals. Your brain just gets a mixed signal as to when to turn back on its melatonin The following night. Okay, so that's an endogenous rhythm, and that will be directed by exposure to light. Okay. Now of course in darkness, it's going to come back on in hours later, but if you have you know your blue light devices or your tablets or you're watching a webinar at a certain hour, you might be delaying because of the blue light after sunset. You may now be telling the cells that it's still daytime, and so it will send that information back to the SCN. Which will tell that by the pineal gland No, no, not yet. Don't turn on yet. And that's why people get exposed to blue light at night. Have difficulty falling asleep. Okay. And that's why the recommendation is shut your devices off a couple hours before bedtime. Give this melatonin a chance to come on like it should and will if not delayed by light exposure all right. And certainly you know you guys get away wildly if you have questions and if I'm not seeing any while we up there's a question by Quilly. A wild and wooly hand there. Go for it. Oh, you're still muted. Can you unmute? Yes. Did
it work quickly?
Yeah, back on the first slide, where you had the histograms Yeah, left, there's the 1234 so that the things are at different heights, and I don't quite get what that is I sorry to be so far behind. I just raised my hand politely.
Yeah, no, no. Yeah, definitely. Sorry. Then I can see your hands. Okay, so Oh, yeah, there's up there now. But you're small because I have a big presente screen so I can see it. Okay. So um, know what I'm Yeah. So you mean the height of dt
Yeah, there we go. Yeah, and so like, the with the baby, the two it's at four and then one time it's even up higher than one I don't know what what
Oh, okay. Okay, sure. That's my may explain it. Yes.
i I'm so I sort of get it now.
Yeah. So this is the Wake state. So anytime someone's awake, they would return to this line. Well, how do I know I'm awake? Well, that's regardless of whether you know you're awake. If I'm recording you're asleep, your brain will be awake. Generally, you will be aware of it but not always. But these are the longer the awakening, the more likely you'll be aware of it. Okay. What you're talking about, what if you're asking that question? Those are transient arousals. And in the parlance of sleep, scoring, every epic of sleep, a 32nd epic of sleep is determined to be what stage you know whether awake or asleep, and if asleep, what stage of sleep. So there are brief arousals that are briefer than that. 30 seconds so your brain can wake up with three seconds that's usually the minimum we consider and and then drift right back into sleep. Those you wouldn't be aware of at the time. However, they will cause you to be sleepy the next day or to feel like you had a lousy night's sleep, even if you had no long periods of wakefulness during the night, if there were a lot of disturbances during the night there. Were only three seconds you're asleep, continuity would be disturbed and you'd feel it.
I don't think I ever wake up at night. Except now that I'm older, I'd have to get up about three o'clock and use the bathroom. And then I just have to sleep. And I've been you know from my point perspective, I've been pretty much the same all my life.
And it's very, it's great. Yeah, I guarantee you though, if I recorded your sleep there would be arousal during the night. Yeah.
Well, I did send in a different question. I I don't I hope you've got it. I sent it from the website. Oh, you didn't print it?
Well, I had all the ones that we had. Yeah, that's the ones we had when I started so I'm not sure if we take a look.
Well, I can tell you what it is. Okay. All right. Um, you know, the one shift I have will say, is that awake or or not? I'm tired, more tired in the afternoon as I'm older, and I would and when the time changed back to standard time. I mean, I'm still struggling with staying awake until I should go to sleep because otherwise I wake up and I'm I'm I'm waking up way too early. And then it seems like that would feed on itself. I'm still getting a good night's sleep. I'm I could just assume get up at three o'clock in the morning and a half. But I just wonder if there's a way to manipulate that.
So so I'm sorry I missed the first part of that because I was scrolling let's see. So you're since the timezone everything is time change, everything shifted later you allowed to sleep an extra hour, which you didn't is you saying that you got up at the regular time, or you did get up with their time?
So I wake up too early now, and it's been more than a month now and I'm a little bit better.
Are you waking up about an hour earlier? Because of the hour shift. Okay, so you're waking up an hour earlier,
and I'm also tired and an hour earlier so I already am tired in the afternoon. Okay, so now I could I could go to sleep so you know 730 or eight o'clock. At night and happily, and sometimes I even will fall asleep and then wake up dawn at 11 or something.
The problem now is we're not getting exposed to light in the morning when you're getting up because it's dark stone and that's one of the issues you're getting much less light exposure now then you were before the time change. Okay, that's one thing. And have you ever considered a light box? Have you ever had that?
I've never had that. I thought that was about move, but maybe it's about other things.
Well, yeah. I mean, it's about exhaustion, too, because if your brain isn't being activated enough that in that's that's what priests that sort of precipitates the depressed mood is because there's not enough activation in the brain going on because there's so much more darkness now. Generally the reason we had that, you know the guys in the caves for instance, when it got darker, when we had more dark than we had light we would sleep longer. Okay, but right now you know you're taught you're not getting exposed to light to feel fully awakened. So your brain really wants to go back to the toll schedule and get up at I guess, let's say you were getting up at 630 before the time change. Now your brain still wants to get up at 630 but that's now 730 So it's getting up at 630 but not by the clock anymore because the clock is shifted. Yeah, but
it's more extreme than that. Is it really more extreme than that? I mean, I'm waking up at three and I got plenty of energy and I just do projects and do all the stuff I'm doing
Oh, you're dealing with three. You're not just waking up and going back to sleep. You're getting up.
There's no going back to sleep. I usually crawl back in bed but I don't really fall asleep. I might as well get up. It's my good time. Yeah,
you're right. No, no, you may you're better off not getting up then. So the way to do this the way to shift that. So you've what you've done is advanced your clock and let me well, you know what kind of since it's a live question, let me do this. Let me
Let's go here. So it's going to get to melatonin at the end but we'll get to it now because so you can sort of view this in the same way you would view light exposure. Okay, bright light exposure. So, what's happened to you and what you're doing is you're advancing your whole rhythm. Let's say here's your normal rhythm before the time change. And now what's happening is it's moving back okay. You're feeling sleepy earlier in the evening? Yes, then you're waking up earlier. Although this is ideal here. You're waking up about here, and you're getting sleepy about here. Okay. So you can help shift that later in one of two ways. And generally I advise people to do both. One is with melatonin addition. Okay? Because what you want to do is, you want to give yourself melatonin at a time in which it will help delay your sleep. Okay, so you want to be up later. You need to stay up later. Like you want to get back to this normal phase. So you probably want to take melatonin roughly an hour before when you would have gone to sleep before the time change. Okay, okay. And and you wouldn't even need it to be an hour before. If you're you are if you use the liquid or the under the tongue versions to segmental sublingual melatonin, okay, you can get that basically in health food stores and such better. Three Max, three milligrams Max. Okay, so let's start lower. Yeah, if you start with one milligram it depends some some formulations are half a milligram, summer milligram you can buy. I have this liquid stuff that's 10 milligrams per ml per milliliter per dropper. So you can take you know, pretty much down to like point five, you know, point seven 5.1. So find something that you can start at a lower dose just to see what works for you. Okay. Are you sensitive to caffeine by the way?
I don't use caffeine.
Are you sensitive to it? Have you ever had some in the past? Oh, sure. And
on rare occasions, if I need to go somewhere at night, I'll take
a little a little bit goes a long way. Yeah, all right. Well, because if you're sensitive to caffeine, you'll be sensitive to melatonin, that's, that means you'll hang around longer so and then you'll feel groggy in the morning, the next morning, even if you sleep in late, okay, so that's one thing. The second is the light exposure. What you can do is you want to give yourself light around this time, so that you're not getting sleep or you're going to be sleepy anyway, but so that you're not falling asleep at seven or eight o'clock. You want to go back to what time it used to be and maybe even a little bit later till it shifts. Okay, so that means you're allowed to take your tablet, your phone, your blue light, and have it blast away at you and keep you keep your brain going as if it is daylight longer into the evening. Okay, I lightbox goes a long way towards making that happen because that's really strong 10,000 Lux and that will definitely shift you but the devices probably will work too. And then if not then they're lightbox options that you might consider. Okay, great. Thanks. Sure. Well, let me let's go back and this is all these questions about jetlag or or or about the circadian system are all pretty, pretty useful because they all kind of go together. And so this is the circadian system, it responds to light and responds to melatonin. And it only moves in one direction. You can pull it back, but if left to its own devices, it'll keep moving later. But when we have daylight savings time, we pull it back. Okay. So I put this back up so that we get a sense of how these two interact. So we were just talking about this circadian rhythm, right. That's the process that turns on in the morning. And again, what's turning in on in the morning is light exposure. And if you get light at this time, 16 hours later, it's going to turn off and make a sleepy, hopefully bedtime. Okay, and there's a dip in the afternoon we all feel that this is not what you're talking about. Clearly but there's still this tip in the afternoon because that circadian drive drops off. Okay. The sleep pressure is something that builds up because it's a byproduct of being awake. So a byproduct of being awake. certain substances are created like adenosine. Adenosine makes us sleepy, but it's offset by the circadian rhythm. So these two factors interact, to allow us to be awake, alert, have a dip, and be even more alert for the rest of the day. Okay, so these two factors interact. We spent a lot of time and circadian. We're going to go back to that because the questions are about jetlag and that kind of thing. But you know, we need to be getting our sleep to Okay, and the more sleep we get, the more this system works well, the less sleep we get the more we run into other problems. Okay.
So jetlag now we're going to look at that question about jetlag and why is West better than east? Okay, West is best here. And what happens is when we fly west, okay, were allowing our circadian clock to do what it normally does. It's going to turn on New York time in the morning over here somewhere, and then we fly to the West Coast. Our clock is already turned on and that internal rhythm, the endogenous rhythm has already been set. When to turn off that first night we arrived in California, okay, and so it's going to turn off and make us sleepy. And it's going to make Cooley sleepy like after daylight savings time at seven or eight o'clock at night. But because we're in California now that seven or eight o'clock we can't go to sleep. We're on their time we're visiting friends or family or colleagues in a meeting, and so we can force ourselves to stay awake longer. Even though our clock our clock isn't putting us to sleep. It's allowing us to fall asleep. But we can say now No thanks. I'm going to go ahead and stay up and most adults chronically sleep deprived ourselves selves by doing the same thing. Even when our melatonin comes on. We can say you know what, I'm going to go eat later. I'm going to have some I'm going to go to the gym. I'm going to work out I'm going to become active. I'm going to have social interaction, lots of ways we can keep ourselves awake. Okay, way more than our typical falling asleep would be on the east coast. So that's what we do when we go west. Okay, and go in California. That's only three, three time zones. Not terrible, not too hard to manage. We can stay up a couple hours later. And then eventually, after three or four days in California with that nice intense sun. We're going to be shifting to their time. Okay, then our circadian rhythm is going to shift to California time and begin turning off at bedtime in California. And this is why East is least because then we fly back to the East Coast. Or worse. We flown to Europe, which is six timezones Okay, and when we go in that direction, now we're fighting against our circadian clock. So it has shifted and it's telling our melatonin to turn on you know, somewhere around two in the morning. And when our circadian when our melatonin doesn't turn on until two in the morning, that arousal mechanism of the circadian drive is keeping us awake. Now that we're back in New York. So when we fly east, our rhythm is stuck back here somewhere. And it's going to now keep us awake during those times that we want to get to sleep when we're we've gone east. Okay, so whoever asked that question I hope that explains why East is least and West is better. I get all messed up your army
I don't know what's going on. I can see so anyway, East is reduced and West is best. This thing is really weird things. Anyway, such is life. Okay. Now I don't see any more hands. Wildly shaking out there. So I'm going to continue
Okay, so does melatonin help? I just might be a little difficult to see. But these are all the factors that influence our melatonin. Okay. Oh, you know, actually there have been some questions in the chat box. Let me just see.
I had one come in to me through the chat. Who have you ready for it?
Oh, I thought we wait a second. Okay, hold on a second here. You know, let me I thought I thought you know, Andrew's email to me said four o'clock on the East Coast, because you are now able to make that time Alyssa and he said it had shifted the time and I thought that's what we saw. He told me that that time was the new time.
I looked at that too, because I noticed a bunch of people start getting on about 430 and the email he sent us to say to for some reason, the email that went out said
okay, sorry, everybody who got on late. Luckily, it's been recorded. So, but I can go back to a little bit in the beginning of the beginning stuff. People want to redress that. Yeah, okay. Let's see steady times. Okay, that's completely okay. Now you can too. I mean, you know, tears. Anyone have any questions about you know, okay. All right. So, I'm happy to go back to the beginning of people need to cover those. I basically talked about the questions that people had asked and the first questions were about, why is it more difficult to sleep as we get older, and do people as we get older girls into elderhood? Do we need less sleep than when we were younger? And so we talked a lot about that. But I can get back to that too. We need to
determine about REM sleep to I can send it over to you in the chat column so you can read it when you get a second.
Okay, great. Great. So let's finish with the circadian clock and its its role in sleep. So these are all the things that affect melatonin one way or another. Okay, so, light in the blue range, which is what this these know, this wavelength is is the most powerful shifter on the circadian rhythm, okay, or the melatonin endogenous rhythm. Okay, and it doesn't take much. That's why at night our devices can be really negatively impacting our ability to get to sleep and keeping us awake. So we want to make sure our devices are off. Everybody, except for cruelly will hopefully get into that more when I go back to the beginning. Let's see if I can get everybody up here. Okay, good. I can see everybody now great. Okay, so short wavelengths are the most effective so we can take that light. So as I was saying, the Quilly who has been having trouble with the time change time Daylight Savings Time Shift, that she's now getting up so too early, and getting really sleepy too early. And so you can end up shifting that phase with melatonin or with flight or with both as I usually recommend, and so she can use these devices and get that blue light exposure, even at low intensity and that will help her brain know it's still daytime and not be so sleepy and turn off its melatonin until later in the night so that she can go back to her old schedule. Begin sleeping later, going to bed later and getting up later and feeling more in sync with the the light rhythm out in wintertime too. So there are lots of little things we can do to help ourselves keep ourselves awake so exercise can again, keep us awake but exercise during the day allows us to produce more melatonin these Bayto beta adrenoceptor agonists like anti hypertensive medications, you know the beta blockers these are what would be called a beta blockers. They knock down melatonin, and they typically cause disturbances in sleep. Now there's a certain range of those and at one end of that range, they're the most disturbing at the other end do the least disturbing and that has to do with how well they cross the blood brain barrier. Some are more likeable Phillip lipophilic, which means they crossed the cell barriers easier. And those that are mostly like Fulfiller will cross in and disturb sleep. Certain medications so these are like your anti depressant, your SSRIs okay, they can increase melatonin. There's a lot more REM after you using this for a while. noradrenergic antidepressants can then also change the timing of it. And many, in fact, the way most antidepressants work on depression is by first suppressing REM sleep and then allowing you to reset so that it then comes back and does a much better job of what REM sleep is supposed to do, which is help us process our emotions, among other things, learning and memory and all that. But certainly it's a very strong emotion processor. And if it's not working well, we begin not getting rid of the stuff we're supposed to get rid of and kind of hangs around and because it causes us all kinds of issues. All right. Benzodiazepines have different effects. Most of them do knock down melatonin no and that's why we don't have our typical sleep stages. Most benzodiazepines knock down deep sleep and REM sleep unfortunately so we have a lot of stage two sleep and it's why may not feel like good sleep even though it is some sleep.
So I just want to mention that there were a few things. What's really important here is that alcohol decreases melatonin and hence the mechanism by which it destroys sleep later in the night. Caffeine remember I mentioned if you are sensitive to caffeine, you're going to be sensitive to melatonin. Okay, so that can increase melatonin
and whatever medicine, aspirins and NSAIDs decrease it, okay. Now, so I'd call this up before I'm bringing it back up again. In a moment, see if I can move you guys over to the side here. So here's the melatonin rhythm. And if you measure melatonin in the plasmids, how much melatonin is being released, and so generally melatonin will come on about 16 hours after being turned off in the morning. Okay. And it continues throughout the night, it peaks somewhere about our circadian, or our circadian rhythm needier somewhere around four in the morning and that's when we're most likely to have difficulty staying awake. And then we can shift that rhythm. If we delay our our sleep phase. That means we're going to get our melatonin rhythm coming on later. And turning off later. This is clock time. Down here. Okay, here would be 11pm You know, here's 11am. Here's 9am. So, these things are rhythms. These are idealized rhythms. But essentially, a delayed sleep phase rhythm is one that later it means you have a harder time falling asleep. It takes you longer to fall asleep, and you have a hard time getting up in the morning. And then advanced phase means it's one that's advanced, it's come earlier than it's supposed to be. It's coming on sooner than we wanted to. And so we're going to be sleepy or in the evening, earlier in the evening than we would like. And this is something that also seems to occur with age. Our rhythm seems to shift earlier and it's a chicken or egg kind of thing and it's not clear from the research certainly are the amplitude of our melatonin rhythm decreases with age until the amount of melatonin we have decreases with age. But there also isn't advancement and generally that's because people nap a little bit during the day. Or find another way you know fall asleep inadvertently watching TV or becoming less active or less exposed to light outdoors. And so there are less strong signals. There's a little more sleep happening. dispersed throughout the 24 hour rhythm and so begins to shift earlier. And so dinners earlier bedtime is earlier and waking up is earlier. And that's obviously a problem when you're up at three or four in the morning and the rest of the world is still asleep and you're trying to figure out what am I going to do for the next couple hours. All right. So that's what I had prepared based on the questions that were that had come in. Now there were some more questions or less he said you put one in the chat box. Yes. Okay. long question. I know that we need both RAM and deep sleep to be healthy. Make us be healthy and rested. Help healthy interested. I also know that more RAM tends to come later in the sleep cycles and increase in length as the night progresses. Okay, very good. So we tend to remember more dreams closer to our morning awakening. Yes, yes. Are there more components or categories of sleep besides the deep sleep and REM categories that are essentially essential to healthy sleep? Also, is there an ideal proportion of REM to deep sleep or other categories to be healthy? Is it 5050? Ideally, or different? Proportionally, can we be sufficient in one category and deficient in another? And if so, how do we adjust that? Thanks for your insight. Okay. It was more than one question but we'll take them all together. So I'm going to put this back up since we had
this ideal idealized set of histograms across a night for youngsters, you know, toddlers, young adults and the elderly. We were talking about that as how sleep changes. But here's a good example of what you know. Let's just look at the young adults and say, okay, yeah, there's and this isn't really showing the more room towards morning actually, it's not a good one for that. But essentially, the REM bouts do get longer as we approach morning so the other stages of sleep are one and two. And all they really are these are non REM stages of you know.
I'm gonna do something else. I'm just gonna go back to let's see. See, I'm going to go back to our I think one of these I think this one has the Yeah, okay. So here's a better histogram to look at and you everybody can see that I don't have to blow it up anymore. You can see okay, so so this one shows nicely more RAM towards morning Okay, Rem is here in red. And so anything arises to this lie is marked as REM sleep and so when they score nights worth of sleep, they're looking at 32nd epics of brain activity and they're saying, Is it awake or is it asleep and if it's asleep, what stage of sleep? Okay, so REM sleep is then scored when they see REM sleep, and you can see this little bits in the first couple of cycles and the cycles get longer, and REM periods get longer and that's why you're more likely to wake up during when you wake up during morning hours to come up from the REM state and therefore remember your dream. Okay? But the other stages of sleep are non REM stage one and two. And currently deep sleep was formally labeled three and four. It's just really a nomenclature for the depth of sleep and the depth of sleep. The reason why that other the other slide here is good. Are you guys seeing the slides when they change? We're back to the old one now. Oh, no. Can you see slow waves here? Yes, yes. Okay. So so what's good about this is it shows that the amplitudes of the amplitudes of the EEG during sleep and a three year old, and here's a young adult, and so the amplitude decreases as we get older. Okay? And that decrease and amplitude gives us less low wave overall. So as we get older, we have less slow wave. But essentially, when we have slow waves, we're in deep sleep and when we don't, we're in these other stages of non dream or non REM sleep. Now the amplitudes are different the
I'm really jumping around here a lot. Now just to see if I could show you I have one other slide that will show you
so I can file here it is yeah, good. Okay, now you're seeing him to go Oh, that's not the one I want. No, sorry.
That's fun with DJ and hold on. Let's see if we can get it here. Nope.
I think this one has Yes. It does. Okay. So this is what differs. Now. Are you seeing the EEG in red here? Is everybody seeing that?
No, it's still in the depth of slow wave slide.
Why No, it goes down, but just the way things work, so we'll have to deal with that way. Okay. Now you can see the ready EEG. Yes, everybody. Okay, great. Thanks. So here's your slow wave sleep again. Okay, deep sleep. And the reason it's slow waves is that in cycles per second, these are going from a half a cycle to two cycles per second and a cycle is from you know, from the trough to the next one. So this would be one cycle, this would be two cycles. And if you measure this out is roughly one second. So this would be two cycles per second. And that's what a slow wave would be. And the other defining characteristic is the amplitude. And as I was saying, in the beginning of the presentation, which everybody missed, to for a few of us, the amplitude of the of the EEG reflects how many neurons are firing and sync coherently together. They're all firing so there's a positive release, and then there's a negative return there's a positive release and a negative return. Okay, that's just what neurons do. And when they fire in synchrony, that means they're piling up. So the EEG we see is from billions of neurons firing together, as opposed to a few million but safe. Okay, so the more they fire together, and the slower they are, this constitutes deep sleep. Now, stage two sleep has a few big waves in it, but some other defining characteristics like these sleep spindles, okay? And what the sleep spindles are doing, they're occurring in the thalamus of the brain in the center of the brain if this was a brain, okay, in the center of the brain right in here, right in there would be the thalamus. And that cuts off all the outside stimulation. So we're not hearing what's going on in the room. We're not we're cut off from outside stimulation. So we can generate our own internal stimulation eventually in a dream. Okay. So these things blocked the outside world. And so to these k complexes here kind of looks like okay, if you really stretch your imagination, which people who are recording sleep and staying up way past their bedtime could easily see a k here. So this is stage two sleep. And then stage one sleep essentially is different than awake because even though your eyes can be closed and these really rapid alpha waves that are occurring here you can see how regular these are. If you count them out, they're eight to 12 cycles per second. You can see this looks very different than this. And that means the alpha is dropping away. That means you're still awake, you're kind of drowsy but you're ready to go, you know in a heartbeat. If somebody calls your name or there's something that pops into your mind. Stage one sweep or what's official sweep, fader waves begin to creep in. And so these are much slower frequencies than these frequencies. And that means the brain has really cut off from the outside world to some extent. You may still hear things and you may still incorporate those into the hypnagogia that we have as we fall asleep those little dream let's move images and and visions that happen during that first stage of sleep. Now. Are these important or as important as dream sleep by the way I saw it imagine dream sleep down here looks a lot like a combination, but it looks a lot like stage one sleep with the faster activity pulled out. And it's maybe hard to tell that but it has data waves in it. It's very distinctive as well and there are other things I'm not going to get into but it looks a lot more like wake than anything else in here does. Because you are conjugating you are creating dreams. You are creating activity and that's why you would see this. Now
the this stage of sleep, you might consider the least important but it's important in the sense that it creates the transition from wakefulness to sleep. So it serves an important purpose. Okay, and we can't say exactly what that is, except that when we don't, if we're sleep deprived, we will really exclude this stage and go directly into deep sleep. So we'll exclude both of these. But that's not because they're not important. That's because we're sleep deprived. And our body's not going to you know, owes the brain so much restoration that we have to get on with that restoration or things begin to break down in our bodies and our minds. So there are a certain amount of importance between dream and RAM between REM sleep and slow wave sleep, that the other stages don't seem to contribute to. But while this is the transitory phase between wake and sleep, stage two is the transition between an ascent dream and slow wave sleep. And without stage to sleep, there's not a lot of recording of memories. It seems to be very important for setting the stage so that our memories can get laid down in deep sleep, and our emotional regulation can be attached to our the material we've learned during the day in dream sleep. So when state but it's just really hard to selectively eliminate stage two sleep, it's much easier to eliminate either deep sleep, for instance, by taking benzos or eliminating REM sleep by waking people up when the brain goes into rapid eye movements very, very easy to see. And we can wake people up and keep them from having rem and see what impact it has. But you know, in our more holistic way of doing science and sleep, we're realizing all of the stages are important. Okay? And so I would get away from the reductionist, whether one's more important than the other and say they're all more important. They're all important. And in terms of in terms of proportions, let's go back to even though the numbers aren't here, if you look at the amount of how much each stage each stage comprises the proportion of the night. In general, slow wave sleep is about 20 to 25%. And so is REM sleep. Now, as we age, there's a diminishment of the slow wave sleep. Okay. Now people might argue, well, you know, we, we have more cognitive deficits as we get older and so maybe we needed more of that deep, slow wave sleep for cognition and functioning brains. But that's not directly related per se. So that doesn't correlate as well with cognitive function. Maybe overall the number of neurons can contribute to that but the percentage of slow way sleep drops pretty significantly down to about 5% in our 70s, maybe 10%. But that's more because we have less cells. Than it is because we have less of that stage. So there are still deep parts of sleep. They just don't meet the criteria for this deep sleep because they don't quite get to that level of amplitude that we need to score. Deep sleep. Okay. So there's a bit of there's a bit of procedural issue rather than an internal endogenous issue with how important this is and how much we should be getting later in life. And again, REM sleep diminishes for maybe 25 to 20%, maybe dropping down to as low as 15%. But that continues throughout the rest of life. So we're always having a bunch of room and so you know, that seven to eight hours instead of a full average of eight hours, that little bit of a loss as we get older. In total sleep time, is mainly made up for a loss of slow wave and
REM sleep. And so if they're the two most important levels of sleep, why do we still function pretty well and healthy, elderly and healthy aging 75 and 82, just as sharp as 35 and 40 year olds. In fact, I think they have more wisdom in some ways. So So you know, the the percentages that change with age, maybe more function of absolute changes, and you know, just like our joints don't work as well because we have less collagen we have less fluid we have less brain cells overall. That's what we're seeing as we get older, not necessarily lost in the importance of certain levels of sleep. Okay. So I hope that answers that question. We've got probably less than 10 minutes Okay, so let's get into this a few more questions here. So people are sensitive to light in the evenings my wife uses a phone up until she goes to bed despite my bleeding and seems by all I can tell the sleep Great. Yeah, people are less sensitive to all of these things. You know, everything is a biological has a biological determination to it. We have different genetic phenotypes, you know, how things get expressed. So some people are more sensitive to exercising late in the evening than others. So that answer would be yes. There is some recent data that to suggest that be interesting or that she get exposed to light at sunset. Because getting good light exposure good sunset light exposure seems to steal the brain against having an effect of light exposure late in an evening that blue light exposure. So to change is sort of how the brain processes light in the evening. So that would be an interesting observation if possible, but yeah, people some people are sensitive to caffeine, others aren't. They're not as sensitive. Okay? And they can have that cup of coffee right before bed. Okay, see you in a month. Quilly questions about earlier I thought I heard you say that if you need to stay awake longer at night. You can use a lightbox when this possibly cause you to stay awake too long. Yeah, absolutely would. But it depends on if you want to stay awake longer for what reason? So we were talking about Cooley's adaptation to the light change, you know, with daylight savings time we just went through for the fall. And she's had a difficulty so her clock is still way back before we made the change. So she was falling asleep earlier and waking up at three in the morning. So for her we to shift her clock later, like those three melatonin rhythms I showed you. So we want right now her schedule has been advanced. It's coming on too early. And so we want hers to be delayed relative to where it is now. So light exposure early in the evening will tell her brain it's still daylight, which for other people who are trying to go to bed at their regular time would be a problem. Because instead of them being sleepy at their regular time, we'd be telling them that day is longer, and they'd stay up longer. But for people who are having advanced phase light exposure later in the day will help their brains realize oh it's still daytime I should stay awake longer. So she can now get back on a regular schedule. Okay. And would it be good for an older adult to strive to increase their time in deep sleep and if so how? Well, like I said, that's not necessarily something you can do because it's a reflection of the fact that you know, we've lost some brain cells as we've gotten older. Anything you can do to get the amount of sleep your brain needs, which as I've said before, is measured by how awake and alert you are throughout your day. How pleasant and engaged you are in your day and your activities. If all that's really good, then you're getting enough deep sleep do not worry about it. Okay, there are some devices coming out that purport to increase your deep sleep by giving you certain stimulations during the sleep during your sleep itself.
And it's not so clear what that actually does and whether you can do that in someone who's had less sleep because they just may not be enough cells to engage with or to be stimulated. So I think in being an older adult, it's getting your asleep getting your regular sleep, getting your activity, doing your exercise, eating well and healthy and getting your greens and doing all those other things that support good health would be more important than anything else. Okay, that's my take on all that. So, questions. More questions about some of the questions that came in if I didn't answer in detail and you want to come in and talk or physically ask a question.
There was one more that I just sent you over to I accidentally sent you a double one but somebody was asking about Klonopin.
Okay. Ah. Okay, what is that this was three to 4am Wake up in trouble getting back to sleep till seven quarter tab of okay, so I take a quantitative Klonopin most nights would rather not be taking it at all. And I take content if I'm awake at three or four for more than 15 minutes. You know, there's a couple of whole presentations on what the best sleep practices are. And I would do all of those in addition to taking your Klonopin until you're not waking up and needing to take it or you're not staying awake that long. So that has to do with getting up at the same time. Every day, getting strong light exposure in the morning when you get up. So don't just stay indoors unless you have a 10,000 Lux light box. Instead get outdoors within the first 1520 minutes of being awake. And that will help set your clock to come on and beyond during the night to have your melatonin stay on. You might try some melatonin at bedtime. It doesn't say here what your bedtime is that you want to say what? Come on and tell me what your bedtime is right now. You may need to go to bed a little bit later. Are you napping during the day? Are you stealing some of that sleep pressure during the day and inadvertently or planned? So these would be things to check you want to get all your sleep at night. You want to make sure you're getting up roughly the same time every day and getting out and getting exposed. To light. Getting a little light exposure at sunset as mentioned for Eric's wife, Eric, that was the last what I was saying about that
not eating too late you know of course the caffeine and all that. And recognizing that waking up in the middle of the night is not a typical most of us do but people with insomnia. Notice they're awake and have trouble falling back asleep those that don't turn over and go back to sleep and just erase it. So being prepared for knowing you're going to be awake at that hour having something to read that's good and distracting you from whatever's going on in your head, which most likely is worrying about not getting back to sleep. So at least you're talking about Okay, so tell me more or
you know, it's been going on a long time and it's most nights and I can't really figure out any you know, pattern to it. If I you know, don't drink alcohol after six or, you know, whatever it might be, but it's chronic. And so, yeah, adjust. I have a I feel kind of obsessive about my my sleep. So, I do exercise and I eat pretty well and so on. I mean, I'm not an angel,
but when you go to bed what time you go to bed.
I try not to about 930 Yeah, okay. Early. Yeah, it is a little bitter like yes, I do get sleepy. Um, but I also find it seems my REM cycle kicks in really better, really late. I mean, if I'm up to about 7am, like five to seven. So I realized that would be what 10 hours but I wake up a lot too. So
if you want to sleep if you want to sleep more deeply, you can go to bed later to increase your sleep pressure. And I would just try that number one number two. I would get rid of the clock. Okay, because not is not just oh yeah but you don't have to say it. Okay. And that will definitely reinforce you being awake, not reinforcing how much sleep you've had. Okay? And if you want if you really want to be like really picky, because like I've said before, your frontal lobes are offline when you wake up at night, right? So the first thing you do is go oh, what time is it? Or right? And so get a little great tape. Here's another function for that good old duct tape and put it across the watch before going to cover the watch. Yeah, and then take it off in the morning. Yeah. Just during this trial period and see what changes.
Yeah, that would be a good idea. I mean, all I have to do is not press the button. That's all I have to do. So yeah,
but you're not good enough to do that. That's the problem. You know, you go then you go Oh, right. I wasn't supposed it's too late. So you have to make it inaccessible. That's one of the key. Okay. And then the other is plan for being awake in the middle of the night. If it happens to you. It's always the middle of the night. If there's no clock reinforcement, it could be two it could be four right? But then 130 Okay, the more you we enforce three o'clock every night, then you know it's gonna be three o'clock but then you start breaking that habit. Okay by not seeing the time and then having some reading materials or I don't know if you watch or you read.
But you meditate when I'm Yeah, follow my breath. Yeah,
okay. And do you fall but you don't always fall right back to sleep. Right? Correct. So when that stops working, you need something else. So you stop fretting about what you get back to sleep tonight. Okay, I think
I have a thought in the past that if I got up and read that would stimulate my brain more to not go back to sleep. Sure. And
would if you get up and you turn on big lights and all that. But what my suggestion is you stay in bed, and on the bedside stand you already have the magazine level one. You have People Magazine level one, you know the fluff. Level two is no, you don't want to try cycles level one. Sorry. That's too damn good. Right? So you're like, Okay, I'm awake. I got a good article here. I'm gonna read this article. Now you are aware. Alright, so that's level three. That's level three have a Nature magazine, National Geographic level two, and level one. Really? I know no one on the in our group has People Magazine, but go ahead and buy one because it is now not People magazine. It is a sleep aid. Okay, and if any of your friends see it on, you know, the coffee table, it's asleep at my talks that I needed.
Okay. Okay, thank you very much. You're
welcome. All right, guys. I do have to run this week right now. Sorry. That's why I just started for you get off at 430 or 530 My time. So let's see. One of the best ways is to try to go to bed later you know like it's just it's counterintuitive, but it does help our brains both break the bad habits we've had. And, and mouth taping, you know, like, to me that's like barbaric, especially with me. That would be very barbaric. Eric that would be very barbaric for you. If you're finding your mouth is really dry in the morning, you need to explore further because it may be that you have some acne or something going on, but try to stay off your back first. Never pill there have something to keep you off your back. Raise their head in the bedroom or bed have another pillow. But mouth taping isn't great unless you do have sleep apnea and and that's another whole story. Okay, all right guys. Got to cola See ya. Bye. Thank you. You're welcome.