[41] Navigating Sleep Challenges: Insights from the Sleep Doctor

11:21PM Nov 26, 2024

Speakers:

Ed O'Malley

Keywords:

circadian rhythms

sleep tracking

deep sleep

sleep hygiene

insomnia therapy

sleep maintenance

sleep devices

sleep disorders

sleep medication

sleep improvement

sleep hygiene protocols

sleep disruption

sleep quality

sleep techniques

sleep science

Oh, welcome. That's let's see. Get gallery up. There we go. Hi, Denise, how come your smiling face always pops up right in the middle of my screen. You must have something with the zoom. People, okay, lot of smiling faces. Let's see Karen. Susan, I have a question from you. It's in there somewhere. Great. Dennis is on Francois. A lot of new names, good. Okay, I'm gonna jump right in. We have a hard stop at seven. Right. Alyssa, there's a class we

can go a little bit over, but I'll need to start the waiting room for the next one about 745

oh, okay, so we had no problem. Okay, all right. Well, as per usual, I will share my screen, which means I will have my ask the sleep doc up for today. Let's see. I'm going to put you folks over here, yeah, so I, I answered the questions in reverse order. So what I'm going to do is I'm going to go to the last question first. The last shall be first. Here we go. And there were quite a few questions. Think this is the first one that came in after the last talk. So and as usual, if you put your questions in the chat as they come up, I'll keep an eye on it, hopefully, if it'll be relevant to these as answering questions, or raise your hand if there's a question I'm answering and it has to do with you. Want to talk more about that too. Okay, we'll try to keep everybody, everybody we're on top. Okay, excuse me. So this first question I have is tell us more about circadian rhythms. Why staying on standard time would be better than staying on daylight savings time, as long as we stay on one for the whole year and don't change twice a year, which is disruptive. So first of all, yes, it is very, very disruptive to change twice a year. It's not only practically disruptive, but it actually is physically biologically disruptive. Our systems do not like to shift rapidly like that. That's why we have trouble when we fly across time zones. It takes us a while to adjust, and if we're doing that, as powerfully as we do it with the change in time in the spring and the fall, when the light changes as well, we get thrown off our rhythms in general. And the reason we want to keep it to standard time is because this aligns mainly with our circadian biology, which is relevant to our sleep health and safety. So advocates for the adoption of permanent standard time as the appropriate option for public health. There's just no question about it, as far as all the research goes, and one of the most telling bits of research, and I didn't have a chance to get that data up to show you, but they actually looked at people within a time zone, and they compared the people on the east end of the time zone with the people on the West End of the same time zone, and the differences were dramatic. The further you away, or let's say, the closest you are to daylight savings time as opposed to Standard Time, the more disruption there was, the more accidents, the more illness, the more difficulty people had okay, even within the same time zone, because their clocks, our clocks, all align with the sun. And when the sun is overhead at three o'clock in the afternoon, things are really weird for our biology. And so if it's overhead at three o'clock in the afternoon, and then. Goes up to nine o'clock, and this is in the summertime daylight savings time. We're getting way more daylight and dark and activity time beyond what our circadian rhythms can adapt to. And so if we continually do that, then we create more, let's say disequilibrium in our circadian clocks, which run all of our physiological systems. So the further we are from Standard Time, the more likely we are going to have difficulty. Okay, so that's, that's the basic answer. There is more. There's a lot of data to support a lot of different ways of looking at it, but I think the most profound data is when they look within time zones and they show you those who are further from the sun, fair worse, no matter how you measure it. Okay, all right. Well, I was carrying Was that your question is just Yeah, great. Okay, glad to have answered. You're quite welcome.

Well, thank you. That was that was really helpful, because i This time when it switched, I really it took me some days to get over it.

Yeah, and that's even in the right direction this fall. You know, the Equinox we in the fall is better for us, because we're moving towards, we're getting out of the daylight savings time, but it's still that shift disconcerting and funny, yeah, yeah, we're out of sorts. Okay, good, alrighty, oops, it's going the wrong way. Okay, the next to last question,

so which sleep tracking device would you recommend? Are the results reliable? I remember you some year ago, you had said that the current devices were not reliable. Okay, so really there hasn't been a look. There has been some change. Most of the devices that are out there now are reasonably accurate as far as sleep timing, when you're falling asleep and when you're getting up, where they're still pretty inaccurate is in sleep staging, light sleep, deep sleep, REM sleep, middle sleep. You know all of these different connotations they have. They're still not medical grade devices, so they will give you good information in terms of like the total amount of sleep you're getting and or how fragmented your sleep might be okay, so if you know, you had a couple of drinks close to bedtime, it was Saturday night, went out late, had dinner late, maybe no alcoholic, but whatever you did differently on that night and the next day, you looked at your data. Not only did you feel lousy, but your data reflected that, and it showed you more disturbance than whatever you did the night before did not go well for your sleep ability, and so you want to change that. So using the devices to reflect when you're getting less total sleep or less quality sleep is a great use of that. But, and we have a question coming up about deep sleep that we'll get to. The problem becomes when you know you're looking at your data, oh, it's telling me I only got 2% deep sleep, and I know deep sleep is really important for restoration. I'm not getting enough. I better go to my doctor and figure out what's going on. Why am I not meeting my sleep need or using it as a perfection device? I need 20% RAM I need 18% deep sleep, but I didn't get that last night. My sleep must not be good. I guess I'm going to feel lousy today, or I'm not going to be on my game, or I'm not going to be as sharp. So the devices are again, there's still, there's still some question as to which ones are better. I still feel like the ring is pretty good. In case, I know there was a question last week, Myra asked me about the new Uber ring. Four is out, you know, is it any different? Is it any better? And they claim it's a little more accurate than it was. Okay, great. Maybe it is. Maybe it isn't. Hey, Myra, yeah, I looked at it and, you know, they're prettier, they're more expensive, and they're maybe marginally more accurate. So I'd let the dust settle for a while before I get another one, and we'll see how they look out. I just attended a huge webinar from the American Academy of Sleep Medicine on the devices. And I'm going to probably do a presentation on that at some point, solely on that, because, I mean, there were more devices than I had even heard of that they were covering, and the only way they could cover them, or the only things they can say about most of them, were, yeah, they can tell you when you fall asleep pretty well when you get up or beyond that, we ain't saying anything. And it's everything from the devices they put in the bed, on the bed, under the covers, next to the bed, above the bed, over here, over there, plus all the different ones we wear. And you know, 99% of them have not been validated against a sleep study in the lab, some of them have and then you know they're not bad. But in general, I would use them like I've always been using them. They can tell you, were you relatively good sleep or poor sleep? How does that correlate with how you feel and what you did the night before you got the lousy sleep? Okay? Because that probably wasn't good for you. And when you get great sleep, whatever you've been doing that's probably is good for you. So it's a good sort of reflection, but it's not something you're going to diagnose from or completely change your behavior because of what one night's data showed. Okay, all right. Myra, any other comments on that? Okay, save you 400 bucks. Alright? And another question that we have coming up, you know, I'm wearing this. This the whoop device, because one of my teachers attends in one year, Rinpoche, another big sleep yoga guy. He loves these devices. And he really likes this one because it has some black box algorithm which adds up everything. And it says you need this much sleep tonight, and then the next night, based on your activity levels, you know, how much whatever you did and how you did it, and what your strain was in terms of your activity and how much you made up and how much sleep you got or didn't get. It says how much sleep you need tonight, and about when you should be going to sleep and getting up, you know? And I'm like, no, sorry, yeah, I'm not buying it just yet. So, so the joy is still out on all those kinds of recommendations. All right, let's see if I can. No, I can't get it to go up. I There we go.

All right, here's an extended question that came in. I've already had overnight lab tests to check for sleep disorders, I follow sleep hygiene protocols, getting outside, sunrise and sunset and exercising. All good, all good, no caffeine after 10am all good, no food at least three hours before bedtime. Okay, right on target. There doing meditation, breath work and still having sleep maintenance, insomnia or early morning rising. I've been getting four to six hours of sleep a night for 10 years, constantly sleepy and tired. Physical checkups don't reveal anything except low thyroid, okay, and some gut issues. Tried hormone and other therapies, nothing has worked. Sometimes I see a small improvement, but I revert right back to old patterns. Now this is obviously the kind of question I cannot give you a short, succinct answer to and say, You know what, if you do this, you're going to be fine, because you've done a lot of what you're supposed to be doing. Whatever.

Here it goes, and I I say, Here, have you seen a CBTI cognitive behavioral therapy for insomnia specialist or an insomnia therapist, because what they would do, and if you were coming to me, you know, if we were working on you clinically, outside of this webinar, I would ask you a whole host of questions about all of the things you've done. Have you done them all at the same time. Are you? How sleepy Are you? Are you falling asleep inadvertently? Are you watching TV and then falling asleep for half an hour? Lots of different questions that might be contributing when you add it all up, as to why at one time or another. Something is continuing you in this pattern? Maybe it is, maybe it isn't, but I really would need a lot more information to be able to answer this directly. What I would say is check to find out how sleepy you really are. Are you falling asleep or are you just feeling fatigued? Do you need to take a nap and you can't? You need to take a nap and you won't? You need to take a nap, and you're allowing that to happen at different times during the day, maybe on different days, maybe for different reasons. Are you you're you exercise? But Are you active? Do you have social activity? What kind of foods are you eating? What kind of foods aren't you eating? So there are lots of different variables that may be contributing to why this is an ongoing issue. It may seem like it's the same issue over time, but I would really want to parse out, how has it changed? When it has changed. You say, sometimes something helps for a little bit, but then you go right back. Well, maybe because you return to the behaviors you were doing before. What is it that does make a difference when it makes a difference? Maybe we should do more of that and figure out a way in which you can do so. So, okay, just a way to say that there's too much that would need to be answered before I could give you straight answers. But that's what a specialist would do. That's what certainly I would do. And if you've been to a specialist and they haven't done that, find another one because they haven't done a good job. Okay, you can certainly email me outside of this if you're not getting or finding someone who can support you in your journey and trying to improve your total sleep. Okay, all right, let's see if I can go up to the next one for about six weeks, I've been waking up every two hours. Any idea what could cause this? I'm only taking Tylenol now. I had hip replacement surgery eight weeks ago, and then six weeks ago, I started waking up every two hours. Okay, so there's definitely a relationship there, right? None unexpected after significant surgical procedure to have a disruption in your sleep. Okay, oops, move typo there. My first question would be, how able are you to return to sleep? So you're waking up every two hours, but are you awake for five minutes? 10 minutes, 15 half an hour? Two hours, okay, if you're able to return to sleep rather quickly after those awakenings, not really to worry. Okay, your system will resettle, and you probably will be just fine. But I would also make suggestions for even if you're waking up for a while and being unable to return to sleep, the first one would be, do the wake back to sleep and do some Dream Yoga. Get some lucid dreaming going on. Since you awake anyway, you do some of that practice, and you'll see how I'm going to change my tune when I answer somebody else's question, who has something similar and can't get back to sleep after trying to do their way back to sleep process. But essentially, excuse me, you need you need to know what. I need to know what you're doing. If it's taking you a while to fall back asleep, what are you doing to try to get back to sleep? Are you just lying in bed for an hour or two. Are you getting up and doing something else? Are you reading, listening to music, watching TV, pulling out your device, checking getting up on Facebook? Patty, do you have something to say about this? Are you the questionnaire? Questionnaire,

so it's interesting. When it happens early in the evening, like midnight and 2am I fall back asleep pretty quick, but at when it happens at four o'clock, nah, can't get back to sleep, so I listen to an audible book that tends to put me to sleep, but really mixed success.

Okay, so what's happening earlier in the evening is because your sleep pressure is still high, right? You haven't met all your sleep need, you're going to be able to fall back asleep pretty readily, and you're also not going to be worried about it not happening, because you know that in the early parts of the night, when you wake up, you're going to be able to fall back asleep. But one of the reasons you know that is because you have a clock that's telling you it's the early part of the night. Correct, correct. Okay, so let's. Get rid of the clock.

Oh, wow. Okay, okay,

because the first thing you want to do is not have to figure out where you are in the process. That activates your brain, activates your arousal system, especially if you realize at 4am and now you're going to have to fight to get back to sleep if you wake up in the middle of the night, it's always the middle of the night if you don't have a time clock to remind you that it's some particular time. So that's what you want your brain to be trained to do, is to just go, oh, you know, another one of those wake ups. My sleep is still reorganizing from the surgery. I'm just going to turn over and try to go back to sleep. And that will probably help at least some of these awakenings that seem to last longer the later it is in the night, because once you don't know, you won't activate your brain as much. Okay, so I would do that, and then the second thing I would do is have your audible, if it's, is it, is it, does it routinely get you back to sleep, whatever you're listening to? Or does it depend on the topic or where you are in the book, or whatever?

No, there's, there's like three books that routinely put me back to sleep just the tone of the voice of the reader. Okay.

Oh, perfect. So, yeah, I get that from my voice a lot too. That's why I work great with insomnia people, you know, you know, like, just keep talking and keep talking. So you already have them queued up.

No. I have to open them up and hit play. Yeah.

Okay. And is it on the your phone or a device that has the time as well? Yeah,

it's on my phone.

Okay, So therein lies one of the issues. If you could have it on something else, like a tablet or something that all you have to do is like, you know, you can leave it on all night and just turn it on, hit the button. Can you figure out a way to do something like that, or put your figure out how you can leave it like, loaded in audible, or if that's what you're listening to, Audible, have it right there so that you just reach over you hit the button you know, like, and hopefully it doesn't need your pin number or your face ID, but if it does, just pull it up eyes closed, let it see if it'll recognize and open up and then just hit that try to do it as seamlessly without seeing the time as possible. You might even have to, excuse me, forget where the time is on the iPhone, but you might have to have a little barrier across the iPhone, you know, so you can't see the time, but you can see the audible buttons and just start the thing playing and put it right back down. Okay? So you really don't want to know what time it is, and you don't want to have to fumble around and try to find something and queue it up and then get going. Okay, that's all arousing activity. Okay, okay, give that a shot. Let us know it goes. Shoot me an email if it's a total failure, and maybe I can make another suggestion between now and next class. Okay, thank you. All right, you're welcome. All right, let's okay so this is a really interesting question. I don't have the name or family answers, but if you're here, be great to have you come on. So I've seen a demonstration video of hypnosis where two participants were given a signal to go into a very deep sleep like trance. And the asterisk was to that link which I did go to, and I did play it. The signal was closing a book. When the book was closed, the two participants fell into a deep sleep like trance. And by the way, that's a code word, right there, trance is not sleep. Trance is trance. Sleep is different. But anyway, while they weren't technically asleep, they look like it. I'm wondering if it would be possible for hypnotist to give a person a signal like that so they could use it later, blah, blah, blah to be able to fall asleep. Okay, and so do I know of any hypnotist who can do this, and perhaps any techniques like this? Personally, I don't know of any hypnotists like this, but there are hypnotists who can do that and who can make these post hypnotic suggestions. But it doesn't help everyone. It roughly helps half the people have to. Time, okay? And in the first place, you need to be at least moderately hypnotizable in order for it to work for you. So you have to go to a hypnotist and find out if you are very hypnotizable or not. And even better, if they can teach you auto or self hypnosis. That's something that you can rely on to do for yourself whenever you need to do it at home, like you really asking for the particular video that you showed that was really old, and basically what what the hypnotist was doing was implanting a an emotionally traumatic memory in these two participants hypnotized him, and he said, Okay, I'm going to give you the story. You know, when you were a kid, you stole some money and you wouldn't spend it, you didn't give it back, and you lied to your your mother about this, and you never told her, and now that's why you're having trouble today as an adult. And so these two people were kind of like, you know, freaking out. They were like, Oh, something doesn't feel right. I don't I don't know what it is, but I feel uneasy, this, this anxiety, you know, like he was basically implanting a false memory of a traumatic experience. And so, you know, these practices would not be allowed today. You wouldn't be able to do it with any review board or that kind of thing. You couldn't publish anything like that today. But the idea is that they were being put into trance. And again, trance is not sleep, but you can have a post hypnotic suggestion that suggests either you're very relaxed, and when you close your eyes, you're going to fall asleep, or you know when you're when you do it for yourself, you hypnotize yourself that you're deeply relaxing and you're deeply relaxing and deeply relaxing, and at the end of this process, I'm going to be asleep. And so you can do a self hypnosis like that, if, again, you are relatively hypnotizable, okay? And that's a trait that not everybody has, so worth a shot for you. But I would also explore,

oh, you know what it is? I'm sorry, this is the same gentleman who was having difficulty with the wake back to sleep. This is sorry. This is part two of his question. And since I did everything backwards, part two came before part one. And the reason I did that was because, long story short, all the questions that come in from the website, they get ordered differently if they all come in on the same day. And so they get ordered in a reverse order. And I just started realizing that after I was answering them, long story short, anyway, let me see if I can get to the first part of his question. There it is, okay. So the reason he was asking about hypnosis is the reason I temporarily stopped doing lucid dreaming is that when doing the weight back to sleep, technique, wake back to bed, I had significant difficulty getting back to sleep. Some stay, say, to stay up for 15 minutes, some 30, some an hour, then just go back to sleep. This the biggest problem for me. Often I'm unable to go back to sleep for hours, if not the rest of the night, then the next day is completely compromised. Okay, so that's, that's where this question comes from, and I believe that is the last one right here. No, okay, okay, so I'll go back down. Okay? So if you're here, if you're on and want to come on, raise your hand or type in the chat that you're here. So in the first place, it sounds like this started with the wake back to sleep, right? And I'd want to know, if you're not doing wake back to sleep, are you able to return to sleep? Are you still waking up, or now? Are you regularly waking up? It's a habit, and you can't fall back asleep no matter what's going on every single night. You know, we will always say, Andrew will say, I will say Tenzin Wangyal Rinpoche will say, you first need to sleep well before you can do lucid dreaming, Dream Yoga, or any of the nocturnal practices, okay, even the liminal dreaming, okay, if you have difficulty sleeping, then, first of all, you don't want to be doing these practices. Second of all, you want. To explore and examine. What is it about your sleep that's that's difficult once you determine that and either fix it or accommodate to that, then look at the practices and figure out which practice is going to work better for you. So maybe you could continue lucid dreaming if you do some of the other practices. Okay, so maybe go right from waking into lucid dream or from dream into lucid dream. Maybe you could just use intention. Maybe you could do more the illusory form practices during the daytime and focus on your lucid dreaming. Spontaneously occurring. Christy, are you questioning? Are you the questioner? Or you have a question about this? Question about this? Okay, so come on in. We'll keep the discussion going.

Hi there. I i also have, in a long history of insomnia, and since I've been listening to you, and since I kind of got into Andrew's community and the nightclub and all of that, I have ascertained that that my problem is anxiety, that I'm just not I'm very tense when I go to sleep, and I tend to wake up every couple of hours, almost, and quite abruptly, I'm wide awake, and then I have trouble getting back to sleep. So what's what's making me smile is that since I've learned about lucid dreaming and and found a book called wake, wake up to sleep, or wake, yeah, wake up to sleep, or something like that. By Charlie Morley, who is a losing finger. I am, I am more hopeful that I will recover healthy sleep, that I found those things. I mean, it's better, but I am doing a lot of the coherent breathing and yoga nidra during the day, and I'm making a conscious effort to knock down my anxiety through emotional processing. So so all together and all the other obvious things, like fresh air and moderate exercise and all of that stuff. Like I say I'm more optimistic that I never have than I ever have been in a very long time. But I did not know that I shouldn't be trying to do lucid dreaming if I have trouble sleeping well.

So, you know, I wouldn't say directly, you know, it's, it's the practice to arrive in a lucid dream that you should or should not be doing so in this particular case, for this particular person who wrote this in, they should not be doing the wake to back to sleep, back to bed. Approach, because, yeah, that approach is about waking yourself up. That's why you stay awake for 15 minutes, half an hour, an hour, you're reading, you're doing something that's activating your brain so that when you go back to sleep, you're carrying some of that activation with you to carry into the dream state so you become lucid. But if you're not falling back asleep, Well that ain't going to work, too.

Yeah. Have had a lucid dream like three times, and I get so excited that then I wake up I can't get back to sleep. When

I first started having lucid dreams, same thing, you know, now I'm awake. Oh, now

watch this, right? So I'd

also say that, you know, 80 to 90% of the people I see for insomnia have anxiety. Insomnia is primarily an anxiety disorder that manifests at night. Okay, that's the way I hold it, and it's, you know, and most people who are Insomniac, even if they're not anxious in the daytime, have hyper arousal in general, more sensitive, more right, more arousable, easily. So, yes, find ways. And that's what you're doing. You're finding ways to reduce that hyper arousality, hyper arousability in you so that you're less tense. Going to bed. You know, Myra, have you done my rooms yoga? Nidra, there's myRA. You can see a smiley face up there, over whatever you are. She's got the palm trees behind her.

No,

I can't scream. You okay?

My Wave. Wave. Say, Hi. Can you see my okay? Now,

hi, hi.

My check out, check the site for it. But she leads yoga nidra, and it's a great voice, and she'll carry. Right into sleep, if you just even are on on that night. But yeah, yoga nidra is very helpful. All these practices that reduce that arousal you probably want to and this may sound funny at first, but you may want to start preparing for sleep right after dinner. And I don't mean putting on your pajamas and doing brushing your teeth, but rather, all that activity you do between dinner and bedtime is all quieting activities like no exciting movies, no dramas, no murder mysteries. You know. You know. Maybe no TV at all, maybe some light reading, some light music. But do that for a while, till you're you're trained to not be hyper arousable After dinner. And then you could probably do a couple of things and be able to come right back down. But right now, you're too sensitive to be able to take in anything that's just too disturbing, you know, not, not even disturbing, but arousing. Put it that rousing,

yeah, okay, great. Thank you very much.

Got a hand up. She might have a couple more suggestions again. Myra,

yes, that even some yoga. Nidra, for some people, will make him a little bit more active later. So you just have to make sure that you incorporate a lot of breathing that comes down into the body. But if they have too many images, and not only relaxation, and you stay too long in that liminal state, you can also there are some people that react, so do not think that it fails or not fail. Sometimes we are just in different states when we do it. So just go with it with an open mind. If you feel like you're just too active, then just shut it down too because that doesn't mean that it's, you know, the knee dress sometimes make people a lot more active afterward that, because they that's when they call the yogi sleeve, that maybe an hour yoga nidra will be a lot of more restful in terms of the body. So just, I don't want to sell it like a good solution, because it's sometimes it works the opposite, right?

Okay, thank you for that. I'll see you the first Tuesday of every month, thank you. Okay, bye, and thank you, and

thanks, you're welcome. Christy, good, good discussion. Let's see if I Okay, and this might be the last question, another one. Nope, no one. Okay. Oh yeah, so this is another two parter. Okay, so my doctor put me on doxopin to help me sleep, and then put me on a 24 hour release methylphenidate to help clearer thinking. It seems like the stimulant would interfere with sleep, yes, if it was a 24 hour but most likely, they don't make 24 hour Ritalin, okay, or methylphenidate. They make sustained release methylphenidate. And what that does is it's being released slowly, but across the daytime only now, if you're a bit sensitive, or if you're a bit sensitive, or if you're taking it later, you may need to adjust the dose so you need to talk to your prescriber about the fact that it seems to be keeping you up at night, if that indeed is the case, okay, now you really Just want its impact and its effects during the daytime. So your second part of the question is, I don't want to be alternating overlapping drugs just to get up and down every day. I used to take melatonin until I was told it was problematic. It could increase the chance of Alzheimer's. Is this true, or what would you recommend? So first of all, if you work with the methylphenidate the way it's being the way it's supposed to be prescribed, that should not be impacting your ability to fall asleep at night, so you need to get that Joe's dose adjusted, or the timing of the dosage. Okay, the second part of this is, I'm not sure where you heard that melatonin was a problem creating Alzheimer's. In fact, it's the opposite. Melatonin can be helpful to prevent Alzheimer's. It may not make Alzheimer's much better. It may not improve cognition with Alzheimer's once you already have it, but it's a free radical Scavenger. It also eats up and breaks down the amyloid that gets in these tangles and causes brain cells to die in Alzheimer's, and it's really positive support for aging brains and all these typos and potentially a preventative agent in Alzheimer's. It's an anti inflammatory agent. A fair amount of the thinking today about Alzheimer's is that it's an inflammation issue. It's brain inflammation that's causing cells to die. It's an overactive inflammatory system being fueled by a lot of the other things we do that aren't doing well. But we know that sleep clears amyloid protein and tau proteins, the two big culprits in Alzheimer's. And if you're not getting enough sleep, you're not fully clearing out these things. And if melatonin helps you to sleep, and melatonin decreases with age, supplemental melatonin can be hugely helpful, both in preventing dementia and in at least keeping it from getting worse. So I would go back to talk to your doctor, or talk to a sleep doctor, or talk to someone who knows a little bit more about melatonin, but I would certainly talk to your doctor about the methylphenidate, because that's, you know, for attention deficit disorder in the daytime, and that can be helpful. Myra,

I have heard conflicted about melatonin, not in terms of Alzheimer's, but when can you really take it because it is used more to keep this cycle going and not to trigger rest and sleep? So if it is recommended for people that are sleeping less, when do you recommend it to be used?

Yeah, always in the evening, always as an inducer of bedtime. I mean, it usually starts to rise about so we have a basal level of melatonin, which it seems to be constant even throughout life, even as we age. But as we age, the melatonin rise and the level it rises to diminishes or decreases with age. And so first, first of all, first of all, we can boost that somewhat by taking exogenous melatonin. That's when it's that's when, when it could be most helpful. I mean, jet lag and all that. But you want it where the circadian timing is present, and that is about two hours before bedtime. Melatonin starts coming up. Now, if you're going to take the liquid, like I usually recommend, the liquid, or the supplemental tablets that go under the tongue and dissolve and go right into the circulatory system, then you would you need to take that except for within half an hour of the bedtime you're preparing for, because your melatonin is coming up. It's probably not come up that far, and then about 1520 minutes, half hour before bedtime, you take a boost, and you boost it up. It's going to help your brain be sleepy on its circadian clock the right time and go to sleep. So you don't want to really take it during the daytime at all, because it can have sedative effects. Okay, so if

somebody's taking, like the person that doxa, I forgot the name, but if they're taking, is that a contract indication to take both? You have to check with the doctor.

Well, you know, we check with the doctor. You know, I would be trying melatonin before we try the doxyp. Doxyp is a prescribed antidepressant, actually, it's a sedating antidepressant, so it can have pretty strong side effects, way more than melatonin, although melatonin can have some, you know, nightmares and things like that might pop up. So there's that possibility. But you know, anytime you're taking a supplement versus a prescribed medication, the side effect potential is much greater for the prescribed medication. Yeah, and if you're going to take the two together, yeah, they could be synergistic. Be like having alcohol with the sleeping pill. So you don't, you don't really want to do that. So if you, if you, it sounded to me like this person didn't or was benefiting from taking melatonin for sleep. But then got some misinformation and went to the doctor and say, I need something to help me get to sleep because I can't take melatonin. And so he was prescribed doxopin, which is a lower dose for sleep than it is usually for any depression uses. But it's still sedating, and it would still be synergistic with the melatonin.

Thank you. Thank you so much.

You're welcome. Okay, all right. Okay, that's the second part of that. Okay? And I think this, I keep thinking it's the last Oh, okay. There are two more questions, okay, um, dear doctor, my 90, my dear 93 year old husband is having nightmares more and more often. Okay, so right, there is something in. Is increasing, and it wasn't there before then you need to go to your doctor. Now she does. He wakes up terrible, terribly agitated and disoriented. His internist, Doctor advised to see a psychiatrist, but my husband won't go in the in that older generation, you know, seeing a psychiatrist meant you were probably crazy. And you know, people didn't do that back then. Of course, we all do it today. It's part of being in Western society 21st century, right? But what I would suggest is that he should see probably a geriatrician who is more comfortable with what's normal as we get to these advancing years than the internist would be, particularly if the internist is a bit younger, and they didn't teach a lot about geriatric medicine when they were going through med school, Right? So I'd want to see a geriatrician, and preferably one who had some some sleep knowledge as well. Most of them do, because that's a big question as we age, is, you know, sleep gets worse. How do I deal with that? So you want to sleep informed geriatrician? That would be ideal. There may be, you know, you want to explore why these nightmares suddenly started and why they're getting worse, right? They don't that's not part of normal aging. Contrary to, I think there's a myth in there somewhere. It's not part of normal aging. So something is creating this, not just because we're getting closer to death. People may have fear about impending death, and that's another issue, and that's worth talking about with someone. If that's the case, generally, there'll be some waking indication that that's the case. You know someone is, is really afraid to die. Now, in our society, we're afraid to talk about being afraid to die. We're afraid to talk about death. In this program, we're not we talk about Bardo and death. And, you know, like we, we would rather be prepared. Okay, I'd like to have a little facility in the unknown world, because I'm going to be going there too. You know, like we're all going to be going there, so why not figure out what we can to at least make the ride a little more comfortable as we approach it? And so within normal aging, though, you know, nightmares should not be just considered normal. So I'd want to know what was going on. One of the things that I would also consider is light exposure. Alright, you know, there's a concept of sundowning in both Alzheimer's and aging patients, and part of it is because the brain loses its ability to circadian rhythm to light. You know, have light be the signal? Because either there isn't a lot of light, or the system has now become dulled to light and doesn't respond as well, and so you want to make sure this person is getting reasonably good light in the morning, read some reasonable light during the day, and then that light diminishes in the evening. There also may be medications that, while effective for something earlier as this person is aging, those medications may now be doing more than they should. They may be contributing to to the nightmares, or there may be some other disorder that's developing so 93 or not, I would not consider anything that's changing and worsening as normal for even the the elderly, elderly. Okay, so I would if you're listening to this, you know, explore your health plan, ask your neighbors, friends, even your internist. Is there a geriatrician he knows or she knows that you might be able to see? Okay, something popped up in the chat. Let's just say, Could I do? What can I eat or do to increase glymphatic, glymphatic flow significantly? Anything that helps you sleep? That's the simple answer. I'm sorry, didn't notice who asked that question. Oh, Steve. Okay, so Steve, anything that increases deep sleep, you know, one of the lines of evidence that we're finding as to why sleep medications in general seem to put everyone at greater risk for dementia later in life. Is because most benzodiazepines and benzo like the benzodiazepine like medications. They decrease the amount of deep sleep we get. They lighten. Sleep, although they keep you asleep, the sleep you get is lighter, and that lighter sleep is not when we use our lymphatic system to clear the junk, the beta amyloid protein and the tau protein out of our brain cells. Okay, so the brain opens up during deep sleep, the cerebral spinal fluid is allowed to push through and clear out all the garbage that's been building up all day long. And so any, any, any food that increases your ability to deeply sleep, there are some herbals out there, but you know, foods, like we did a whole thing on foods in one of the earlier presentations, bananas, dairy products, cherries, pistachios. There's a variety of foods and substances that have either melatonin or serotonin precursors that help the brain sleep better. And so any of those kinds of foods in the evening would be supportive of sleep, okay, and then anything that supports sleep is going to support deep sleep is going to clear your brain even better. Okay, if you have more question or greater question about that, go ahead and pop it in. Steve Susan, thank you for your advice. You're quite welcome. I have one more that I said it was one more, right? Let's see. Oh, yeah. Okay, so this is a graphic, so someone came on. Let me see what it good. Got it, okay, how much deep sleep is considered restorative for someone in their 60s. So as we age, the percentage of deep sleep definitely drops. It definitely decreases after 860 though it remains fairly constant through the end of life, and that is into the 90s and hundreds. Okay, so again, you know, dementia itself is not part of normal, healthy aging. It's just not unfortunately, you know what? We're learning a lot of this stuff late, and what we've done earlier in our lives may not have been very supportive of not developing dementia or of healthy aging, and so we're kind of doing a lot of remediation these days. I'm going to show you that graphic about how everything changes across the lifespan in just a second. But does LDN inhibitor facilitate deep sleep? I do not know what you mean by LDN. If you're on the call, come on in and tell us what you mean by LDN. Or does anyone else know that acronym offhand, Terry, Terry's motioning, maybe, let's Terry speak. Let's say, Can we open up? There you go, Terry, hi,

so LDN is low dose Naltrexone.

Ah, okay, thank you. So does inhibit or facilitate deep sleep block the opioid receptors? You know, I don't know the answer offhand, but my guess would be it would probably support deep sleep, because I have a strong feeling that opiates decrease deep sleep. They give you sleep and not to get Okay, okay. And then,

and then, how much deep sleep? What would be a target for

numbers, percentage? What are you asking?

Like, how many minutes an hour?

So, so roughly, somewhere around 15% of an eight hour night. So it's probably, you know, an hour, more than an hour in minutes, okay? And, and here's the general I can get to it, yeah, the general areas. So here's a nice graphic that relatively came from 2004 paper, but it pretty well been supported by data. This was taken from EEG studies, so we know for sure. And so you can see slow wave sleep across the lifespan, that roughly around age 60, it's going to stay roughly the same amount. It drops off maybe a little bit towards the very end, you know, in the 80s and 90s of. Um, but that's still about, you know, somewhere around 60 minutes, 80 minutes, somewhere in that range. Okay,

great. Thank you. You're welcome.

Okay, um, yeah, great, yeah. Rachel came in with low dose, you know, checks on too. Yeah, that's a good one. I'm going to look that up to be be sure. Write it down, though I won't.

Okay real quick. I'm going to let me find my and I meant to plug myself in the beginning of this, and forgot to so I'm going to do that now. Find my link. I'm

Where is my special link? Here is my special link to so my, my it's an elective for my spiritual companioning class that I teach. And it starts next Tuesday, which is why our next meeting is going to have to shift in time. At some point, I'm going to put this in good it went in in the chat. It's for my class to My Sacred states of being, sleeping, dreaming, waking, and so it's going to be a really good class. I'm going to talk a lot about I'm actually using chapter eight from Andrew's new book, I'm mindful now, what it's great. He really, it's like, it's like, it's like, sleep for Dummies or something like that. You know, sleep yoga for Dummies kind of and it's not really for dummies. It's just that it's very concise, well spoken, well articulated. And chapter eight is on the nocturnal meditations. And so, yeah, it's a great discourse on all the nocturnal meditations. And so I'm going to be teaching that as part of, what are we doing for good sleep, for good waking, for meditation, and then from liminal dreaming all the way to the Bardo state, really focusing on everything but the Bardo state. We're not going to it's a four week, two hour a night consecutive Tuesdays, beginning next Tuesday. But it talks about, you know, how we you know a lot about how Andrew approaches this, and how I approach it with the spiritual or the sacred overtones. Really addressing that, finding meaning in life is really important for all of us, and to me, that's the common denominator for what spirituality is across every tradition you want to know you're okay. You want to know you're doing the right thing. You want to know you're in the right place because death is creeping up. And so you want to hit the right buttons before you you know you want to. You want to cross all your T's and dot your i's before the final bell comes down, right? And so these practices are a way in which you are staying aware 24/7, and that's that's the goal of the presentation. So anyway, if anyone is interested that's in the chat. All right. Well, anyone have any questions while we still have a couple minutes.

Good. All right, so thanks for your questions and your attention. We will see you all. We can unmute everybody and just say our goodbyes, our sweet dreams for tonight, we're sweet, lucid dreams, hopefully for some of us, some Dream Yoga for some others of us, and maybe just some good sleep for the rest. All right, good night. All see everybody, thank you. Dr Ed, you're quite welcome.