All right. Well, so we have one major question that came in. And what I'm going to do is answer that question or maybe open discussion depending on how those and then if there are other pressing questions, we'll go right into the questions since this is mainly about that. But I have some stuff I can talk about, you know, Andrew, any of you who are taking the sleep Yoga Book, book study, know that we just covered the you know, the science of sleep, the basics of sleep, the stages and all that. And I can riff on that for a little bit and show you some slides with stuff looks like and maybe just talk about some of the basics for a bit or just do all of your just just do a question and answer. So let me start with the first question, which is, someone wrote in I'm interested in Sleep Medicine. Can you tell me what the difference between an MD and a PhD is in this field? And if not too personal, why you chose the PhD route? So at the risk of getting too personal, and at the risk of offending any MDS out there? You know, there's a, it used to be and I think things have changed, but certainly when I entered about 30 years ago, there was a real first there was no difference in sleep clinicians 30 years ago, I become board certified in sleep medicine, I had to take the same exam that will the physicians had to take and same grading the whole thing and when we passed, we became specialists. And then about, I don't know about 10 years in or so things began to diverge somewhat. And what happened was because of you know, variety of outside changes, Medicare rules, locking down the licensing licensing for the various areas. The MDS and PhDs decided to split. Now, interestingly enough, the field was started by PhDs in general who were doing research. So back in the day, you did PhD work if you wanted to mainly focus on research, and you did MD work if you mainly want to focus on treating patients. And back in the day there weren't there wasn't even a field of sleep. Medicine to speak of. So dogs didn't have anything different than what the PhDs did. In fact, they had a lot less. And so as PhDs really started the field of Sleep Medicine, and we score sleep and we came up with all the criteria to know what the different stages were and what they meant. And then now that slowly became sort of CO opted by the physicians in terms of some of the medical components of sleep disorders. So sleep disorders became clear, pretty early on that sleep apnea, for instance, was a major medical disorder with medical consequences that required more knowledge than let's say the PhDs had to deal with, you know, comorbid disorders, medication effects be able to prescribe medications and all that. So the fields diverge, and now there's a behavioral sleep medicine that sort of certifies to PhDs and sleep and the there's a board of Sleep Medicine that had started certifying all of us together, but now only certifies the MDS. So, in terms of practice right now,
you know, there's still a bit of a bit of a difference in terms of more research is done by PhDs than is done by MDs. So when you do a PhD, you are trained in research methods, you are trained in how to evaluate data, how to set up studies, how to do statistics, and all of that, to really determine what you're looking at. Whereas MDS kind of come to it after they've had clinical training, if they so desire to look at research, and so they have to kind of add that on after the fact. So, actually, I don't know who asked that question. And whether you're here or not, but so So that's if you hear want to come on and talk about it, we can do that. So the reason I went into it, obviously, was to do research. I was more interested in doing research back when I started. In fact, I did a research in neuro my PhD in neurobiology because I was interested in studying the brain. There wasn't even neuroscience back then it was only called neurobiology and then it slowly morphed into what what does that look like for humans only and became neuroscience how do we actually apply what we find out about the brain and the nervous system to realize walking talking human beings, which is what had my interest? Once I got through my research, I realized I wanted to know more about what's going on in human brains and how it impacts them. And then the whole business with insomnia became really important because while sleep apnea affects a lot of people, insomnia affects more. Insomnia is the most common sleep disorder or I should really say sleep complaint, until we rule out all the other potential causes and then we're left with just pure insomnia. And that most of the PhDs can still work with pretty directly, although they don't prescribe. Their goal isn't to prescribe. It's to help people get to sleep by learning how to sleep and not necessarily needing aids. So therein lies my history and my understanding of how the field developed and where we are today. So if anyone has any further questions, happy to to discuss
it. See what just came in through the chat too. From Quilly
okay, I can see that now. Okay. That's what you suggested I move my sleeping awake time with the light and with melatonin I have been using the lightbox at about three to 4pm about four to five times per week. I have not used melatonin because I think he said that I should take it at the time I want to go to sleep. And that is after when I have already gone to sleep. Well, first of all, if you've already gone to sleep, that's a good thing. If you're getting to sleep, so tell me more quickly. Yeah, the melatonin is to help you start the sleep process. And if you already are falling asleep, that's equally here. Yeah, you're here. Come on, on. Let's talk. So others can get in on the discussion. So you wanted to go to bed later, right? If I Yeah, want
to go to bed later. I'm waiting. You know, I'm still going. It's moved a little bit with the lightbox, but I can still I have to force myself to make it to nine. Okay,
and then what was it before was it nine before
I fallen asleep even by 730? A couple of times. And I just you know, don't want that.
Yeah. Okay. All right. So it's moving. So what that's telling us is that you need to get like later now, even later,
before five
okay. It's so intense. I think it's keeping me awake. Okay, all right. So moving on
to Part of the problem. It's trying to tell you a system it's still daytime in no uncertain terms. That's why it's so intense or it feels like it's waking you up. Okay, so yeah, yeah. And so yeah, you don't need to take the melatonin if you're falling asleep. Melatonin would help your brain sort of know it's bedtime, but what you're trying to do and it would be necessary if the light therapy were using became too intense. So if it started pushing you back, all of a sudden you're finding you, you can't fall asleep before 11 or 12. You would then take the melatonin at let's say 10 o'clock or something like that. And you'd be asleep by 11. Does that make sense?
Yes. And I'm not sure if you'll know the answer to this question. But on and off in my life. I've been a sun gazer, where either the hour after the sun rises or the hour before the sun goes down. I gaze into the sun or no, that's not everybody's thing, but it has been going on 1000s of years and and I find that when I am not doing it right now. I don't have access to sun at those times. But when I started doing that light I was I've been getting kicked back like it's almost the same experience in a way. And so then I started thinking it's not natural, like is there any danger in looking at this artificial light?
No. As long as you know it's by a well made company because some of the, you know, again, any kind of cheap knockoffs we know right? You could have a little bit of UV
I don't know what, like companies are good. This is something by light therapy lamb by our OHS.
I don't know either, but I would just look them up online, make sure they're a better business bureau. The only thing you worry about is UV exposure to intense light. So for your eyes. Most of the light boxes out there and light devices light alarm clocks and such are are shielded for that reason. So most likely not to worry. But no, that's a great actually, you know, that leads that's gonna lead into another whole discussion. What is natural for sleep? So for 1000s of years, yes, people were up with the sun and went to bed soon after the sun in fact, there was just a great article came out. Somebody sent it to me when I fax you a couple people send it to me it's great. I have people out there in the world who if I miss anything they send it to me make sure I don't miss it. A great article on you know the by phasic sleep in which people back in the day before electric light before artificial light would be up in the morning with Sunrise would be and this is key. And current research is really underscoring how important this is. And they'd be out in the light all day. And then they would get laid at sunset and then go to you know come home eat and go to sleep or some people would go to sleep a couple hours wake up any you know and be up for a couple hours and then have their second sleep. And then again sleep till morning right and get up with with the sun so that is a strong Zeit giver or circadian and trainer or light signal to tell the brain when is day. Morning evening. So now the rest is night, you know so that was strong signals. But what people haven't looked at until recently is the effect of all daylight exposure on how we sleep. And it turns out just just as an aside, that people who are out in the light like farmers and such and people work outdoors are much more likely to have a regular schedule to go to bed a little bit earlier and to sleep longer than the rest of the population. And in part that speaks to us getting less than like less and less like indoors, like Office lights and I have a couple actually have a couple of slides was gonna show maybe oh, maybe I'll do that. Yeah, maybe I'll do that to support to support this and then we'll go on to the next question. Let's see if I could pull this up. Yay. I think this is the one. Everybody see that kind of in my screen. Yeah. Okay. So so this is so they these guys did this experiment. Pretty interesting. This is 20 years ago. Now in 2002. They published this, but people have been sort of now adding it adding on more and more data to this. So they took people and they had them wear goggles, like you know, sunglass goggles, deep shade goggles all week long. Okay, no matter what they were doing all week they would wear these gym goggles so they were really getting exposed to very little light. And then they had people were you know, have been forced to have our light they brought him into the lab, and they gave him something like this light box all day long, simulating being out in the sun, from sunrise to sunset. Okay. And then what they did was, they then gave them they gave them two conditions they gave them dim light or bright light and what they found was when they gave these people who are out who are in dim light or weak and they gave them a bright light stimulus and bedtime, they were wide awake, they became wide awake, okay? When they gave them dim light at bedtime, their whole rhythm stayed the same. They had very little melatonin turning on. When they get when they get the reverse to the people who had bright light all week. The bright light they were given a bedtime did not change their rhythm. Makes sense?
Yeah. Yeah. And that's, you know, and so one of the you know, there's been a little discrepancy now about this blue light, you know, that you're reading from your devices really delay your sleep onset, and there's been some mixed data coming out. And that has more to do with this kind of idea where people aren't getting enough light during the day, on a regular basis. And without getting enough light on a regular day, during the day. Then we're going to be much more sensitive to any light we have in the evening. And so bright light and evening for that. So not to speak to your particular issue necessarily. But you know, I would suggest I start with what has nature provided us with? That's what I always start with when I try to help people figure out what they need to get to sleep. So and that was always my thing I you know, like there's always been data about when you get up in the morning that light turns on your clock, so when it's ready to fall asleep, but it doesn't always work because of these other issues. Okay, and some of these other issues are not having enough light during the day or we're having mixed light during the day and so on and so forth. So, so clearly, you're going to turn that light box on later, maybe starting five to six. Okay, no, do it incrementally though. Don't like put it on at seven and then stay up till three okay. Okay. All right. And we'll check in with you next month and we'll see how it's going. Thank you. Thank you.
I see birdie. And up here. Okay.
So on birdie, I see your hand raised.
Yes. What about how did these rhythms get established in the far far north, where it's like for six months and then dark for six months? Because they do get established? Yeah,
well, that easily, not easily at all. And that's one of the major complaints is during the dark and during the light. So what happens during the dark is they have to have like these light boxes that Willie has, they have to have them and they have to have them exposed on a regular basis. So so they get light.
Yeah, but those are travelers like us or scientists that go in I'm talking about the population who's lived there for 1000s of years. They don't have any light boxes and they established I don't mean us.
Yeah, I hear what you're saying. Yeah, no, what they do is they basically sleep much longer in the winter. They sleep much longer in the winter, and they sleep a lot less in the summer times. And they have adapted to that. Yes.
But just population when you're studying sleep. Yeah.
Well, it isn't it isn't because it's it's so when I say natural, right, depending on where you live natural can be dramatically different. And so in those cases, diet is dramatically different to so for instance, they don't you know how many plants they don't even see green plant till the summer and so, you know, they live on and yeah, yeah. And they can be just as healthy and live just as long in fact, sometimes longer than our current diet. So good question birdie. Yeah, sure. There was something else going Oh, and there are also indigenous populations, hunter gatherers in our latitudes, who they studied as well, and they act a lot more like us, before we had exposure to artificial light. So there you go. All right. Any more questions on the layout and whatnot. Otherwise we'll move to the next chair question. I think there's another one that came out a couple more. Two more, I think. Okay. Tim? Yeah. My wife and I have been dealing with the virus symptoms this week. And on the men Good, I'm glad you're on the mend. One thing we both noticed was that our dream stopped for a number of days. Do you think this virus somehow disrupts or blocks our REM sleep cycle? I almost always remember regular dreams, that during that period, none. It is now getting a little better. I don't know. That's really interesting. That's an interesting question. If anyone else here has had COVID and seen a change in your dream recall. That would be really interesting. Let's see, the way I would. The way I would think about it, is that a lot of things go a lot of ways like for instance, so REM sleep is really important for stress reduction, emotional processing, and that kind of thing, right and if our daytimes aren't loaded with emotional issues, or a lot of stress, and when we're ill with kind of like damped down, we might not have as much need for the REM sleep processing that it usually does. And probably more non REM sleep, which more supports immune function and restoration and physiologic improvement. So I can make a case. But like most scientists, I could probably argue the other side too, so we won't go there. But I can seem to make a case more for having less RAM while you're sick and we can you know, if we think back to when we're sick that we have less swim people have less dreams. birdies right on this one too. Okay, Bertie, can you we need to unmute Bertie, hold on.
I'm just thinking since COVID is a vascular disease. And we know that some people with COVID have very disturbed thinking and you know, they can't think clearly, et cetera, et cetera. And that seems to go along with it also,
could be that it could be directly suppressing remedy. Uh huh. Yes.
It's a bash. It's a vascular disease. Yeah.
Yeah. Well, yes. And no, I mean, it is but then these variants are seems to be creating different symptomology too. Yeah. Yeah. About the
first one. Yeah.
I mean, half the world still doesn't believe that the Coronavirus causes COVID We still have a crazy world we're dealing with but the science Yeah, mainly as a vascular disease only gets into the lungs, but some there are some variants that there are different Yeah. So that's interesting. So if anyone else comes down with COVID I don't wish it on anyone. And I haven't experienced that myself. So can't speak to that. But yeah, certainly, certainly kick in and tell us what you think or what your experience is. And Kim, when when when the gyms do come back online, like they're starting to see if you notice any difference in quality, or frequency. Okay. Another question from Candida. What do you think about vowel key devices? Do not know vowel key devices. Tell me more or send us a link? You want to okay your parents raise. Can we unmute Candida?
Okay. Let me see.
Think you have to do it Candida. Can you do the unmute? Lower left of your screen? The microphone in the lower left?
Oh, this it's Karen. I was looking for the wrong name. Here we go.
Let's try that. No, no, it's Candida. Okay, sorry. Yeah, no pro Candida more.
It should be asking you to unmute now
yeah, um, yeah,
I got it. Okay. Yay.
Okay, go for it. So
the vowel key are sort of interesting. They were developed. I can go get one and you can see it. They were developed in Scandinavia. I think Denmark, I'm not sure. But they're basically intense light earbuds and you wear them for 12 minutes. And they're kind of awesome. Actually. I much prefer them to the light box. But I'm not sure what I'm noticing from it.
Well, there you go. Yeah, I actually they sent me a device data probably gosh, probably 5678 years ago. And right. That the name was a little familiar. I think it's the finished made. And they were Yeah, there were these little like earbuds that have light and they sign right into your through your drum. And apparently that has some because the perfusion is so great. They're talking about blood flow, and it apparently activates substances in the blood that then turn on your brain and keep you more alert and keep you more awake. And you know, I wore them for a while too and I just couldn't decide if they were doing anything. Yeah. Now,
I've had a number of psychology patients. I'm a psychologist, and I've recommended them for depression. And they've helped a number of people so something is happening something is happening. I'm more interested in Can I sleep better? And and I haven't noticed they're helping me with that.
How long have you worn them for no they don't let the power you need to recharge and pretty often
right? Oh I I tried them easily for and I only do it kind of in the winter months, but I did it for good six months. And this year. I did it for three months and I didn't feel like the sleep was any better than it had been an iPod.
How did you use it? What time of day and how long
morning soon as I get up, plug him into my ears.
Well, and so for sad, for instance, to affective disorder. It's the light throughout the day more so than it is in the morning or evening. Right. Right. It's so it's time of exposure. And that may be the case for improving sleep as well. Yeah Ah interesting. And wanting is for making you know getting the rhythm Correct. Maybe make allowing you to be sleepier at bedtime but then at depends on whatever else happens during the day on which exposure you're getting with you get late at night and all that stuff so yeah, try it well you know mean if you can keep keeping in for half an hour every other half an hour or something during the day. See if that makes a difference. Oh,
I'll try it. I'll try it or just
get outside. Well,
today is great, but two days ago it was like 10 below so
kinda Yeah. Were you up north? The Northeast? Yeah, I'm
in Iowa.
Oh, yeah, it
got really cold here for a while. Yeah.
Alyssa was telling me about her kids, you know, walking in shorts today and I said it was minus one on my thermometer here in the Berkshires.
Exactly. Well, thank you. I'll try that and see what happens. It has worked for depression for a number of people though. So you know, there's something happening.
And is that how they're using it? Just putting it on the morning? Yes,
yes. One woman who had actually was profoundly depressed for years, and it has changed her life. So I'm like, okay, yeah, keep doing it. Oh,
wow. Okay. Yeah. It's kind of amazing. Yeah. I have to like take it out, brush off the mothballs and try it out again. Thank you, everybody. And clearly if the Blight thing doesn't work, you maybe get some of those ear, your ear plugs with light. All right. Karen, can you tell something about the so called Golden REM phase? The second REM phase of the night is there such a thing and if and if can you recommend to try web TB in all caps. I don't know what that is. Can you recommend to try web TB at this early time in the night, the BTB I heard that this room is a constant room for younger and older people. Well, no, Andrew the coming on, you know something about that. WT B WB TB
There we go. Finally, get awakened back to bed. Ah, okay.
See, my big steel bears
his term for that primetime drain time sleeping lucidity technique. Okay,
got it. Thank you. Okay, good. He's listening. Still awake, though. Unfortunately. I've been talking to importantly about stuff. Alright. Golden No, I don't know. I haven't heard it. term the golden REM phase. The second REM phase of the night. I'm not sure why that is. But what we do know. And this will give me an opportunity to great segue to bring up some of the some of what I was trying to present where is that? Now? Let me see if I can do that.
Okay, you guys just seeing seeing this thing, right? Okay, so let's just look for a minute. So this is in other presentations too. But this is that general sleep hitting the ground Okay, across a night of sleep an eight hour opportunity to sleep. And people usually go from the Wake state which would be mocked up here and it's like how many minutes you're in Wake. And then how many minutes you're in non REM stage one and stage two and now three four has been combined into one. So this is the general sleep cycle okay. And when you come out of that sleep cycle from deep non REM, you go through lighter non rem and then to REM sleep and they improve or increase in duration across the night. And they're conversely increasing as the deep non REM decreases across tonight. Okay, so that's, that's just standard fare. That's just the way it works. So, you know, the second REM phase at night and you know, that can be disturbed that can be shorter, longer. It can only be 10 minutes, five minutes, 15 minutes, 20 minutes. I don't know if there's anything special about that. And I'm not sure why people would say that is I would think and one of the processes that we use in lucid dreaming is setting an alarm for this part of the night. And that's when you would take like if you get up around here and you take some Galantamine or you just wake yourself up a couple of times in the latter third of the night, you're much more likely to catch the dream state or to when you fall back asleep. Awake Induced Lucid Dream you would drift back into I know that one and two wild, you would drift back into DRAM more like more into REM sleep more likely with your awareness, thereby creating lucid dreams. So I don't know about that second phase. I do know that the best time to go in and out of Rome would be in the last third of the night. And clearly that last hour before awakening would be the longest room period of the night. Okay. And if you want to come on and talk more about that we can I'm going to go on just to give you a little more data while we're here, just to show how things change. I found this one. I was looking for one I was like, you know, maybe I should draw on my own. And then I found this one and I said I'll just use this. So you could tell somebody just drew this and took a picture of it and but it's the same general idea. Okay, so it's showing you know what happens you go through your non REM lighter to deeper stages in the beginning part of the night, and REM is very brief and then room gets longer as the night progresses. And that's more or less disturbed when you're young. And the older we get, the more period there is for disturbance. And these dark red bars here aren't REM they awakenings. Okay, so as we get older, we have less deep sleep overall. And we have a lot more light sleep, and our sleep can be more fragmented. And a fragmentation can be due to a number of things anything, anywhere from other medical disorders to medications we're taking to having our sleep be lighter overall. And less deep. So it's more easily disturbed by things that didn't disturb us in the past, and so on and so forth. So yeah, so this is a good, a good
sort of demonstration of what it looks like as we get older. But on the other hand, that means our REM is going to be a little more broken up and we may be able to have more opportunities to drift back into REM as well. And, you know, in healthy aging, this doesn't have to look quite as fragmented. Even though we may have less sleep we could have more sustained sleep, if we understand that because our sleep is more easily disturbed. We take measures to prevent those disturbances or to explore and find out what those disturbances are or potential disturbances are. So we mitigate them and and we don't have those disturbing sleep. Okay, so, you know, moving to eyeshades, or, again, blackout curtains, earplugs or sound machines. Or whatever you need to do to protect your sleep as much as you can. You want to do it as we get older. Again, only if you find your sleep isn't as good as it was then you better ways of sleeping. Then explore what's in your environment that might need to change or be to be managed.
Alright, question that came into the chat that you may want to answer now or you may want to wait it says this may seem like a silly question, but can I wake up without knowing it? I don't think I wake up wake at night until early morning like three or four.
Yes and yes. So absolutely. Many of us do wake up in fact, I guarantee everyone on this call and that would mean all the adult humans in the country and in the world do wake up at night and aren't aware of it. Their brief arouses and so those can be arousals from three to four 510 seconds, and you wouldn't be aware of it necessarily. And I usually use that distinction between people with insomnia and people without insomnia the people with without insomnia wake up, turn over go back to sleep and erase it never happened because there was nothing charged about it. So the brain just puts you back to sleep. And there wasn't anything to really denote there was an awakening. And so when people get up in the morning, especially in the sleep lab, but then we we do these studies at home now and this the numbers change. But at home, people wake up about five times per hour of sleep. So not just once or twice five times per hour asleep. Now most of those are brief awakenings and then maybe five times all night for a little bit longer than a brief awakening, maybe 30 seconds a minute and fall back asleep. So there are multiple times you can do that without being aware of it. The insomnia person the person who has you know, is really focused on the insomnia. They wake up and they go oh my god, I'm awake again, you know, and they jot it down on the internal board. The mental board, you know, it's like okay, another awakening. Another way I can see I have insomnia. I'm having trouble what's going on? brain gets activated all kinds of things are happening. So So clearly, you're better off not noticing if you are waking up at night, as long as your daytime function is reasonable. You know, when people you know that they're general generally two reasons why the sleep isn't good. Either. We're not getting enough or it's fragmented. There are a lot of wakeups and you may not be aware of some of those multiple wakeups that may be causing issues. And the best way to know that is how you're feeling in the daytime. If you notice a decrease in your energy levels, and everything else being equal. Then there's a good chance your sleep is probably being fragmented and you want to go check it out what's happening. If you're sleeping less hours, well then it's a it's a different approach you need to take you need to figure out why sleeping less hours, maybe there's more stress in your life. Maybe there's more anxiety, let's reduce the stress, reduce the anxiety, increase the sleep and see if that improves the function during the day. Okay, but but how you feeling during the day is really the best barometer of how you're sleeping at night. Oh, Andrew has his hand up. There he is. Still there. Okay,
well yeah, you have to get a muted Yeah, so yeah, um, actually one quick question for Alyssa and then one for you ad. We did have that one question. There was email then Alyssa, I think I just forwarded to you so make sure it gets that one. But I'm wondering what if any traction or experience do you have with acupuncture or oriental approaches to your OMD type approaches to sleep disorders, is now being researched a little bit more rigorously and have you actually employed this in your own practice?
Um, you know, it's not really being researched anymore than it was in the past. But from my personal experience, it certainly helps. And it really helps when there's pain involved. Acupuncture is great for pain reduction. And, you know, there are some really good protocols they have to improve sleep. I usually see the people who have been through acupuncture and it hasn't worked. I don't see the people who acupuncture has worked for, but I talked to the acupuncturist when I help people with pain, and they say, you know, we work with a lot of people with insomnia, and our protocols seem to work. So it's not a far cry to think that your energy blockages are somehow creating sleep disturbance, you know, I mean, I think that's going to follow but you know, there's not a lot of hard research. But then again, I don't need a lot of hard research. I need to hear people telling me what's working, what isn't and that's what I use. So other Asian approaches or Eastern approaches I should say, I definitely if it's working for you do it. In fact, I recommend a lot of these practices to be done during the day. When people come in with anxiety around insomnia or insomnia caused by anxiety. They gotta find ways to offload the daily stressors. And when they do that, with Tai Chi movements, Qi Gong movements, or they lessen pain through acupuncture. Whoa, helpful.
Well, so I'm also curious in your extensive practice, what are some of the more bizarre curious remedies that you've come across? That either people are brought to you that obviously it's anecdotal or most of it I would suspect is anecdotal. But I'm always very interested in like you know, the Oliver Sacks type fringe approaches to these sorts of things. So it for both entertainment purposes and clinical purposes, are there some humorous sight insightful little ways you've discovered from your clientele about working in particular, let's just take the most famous of the sleep disorders in insomnia.
Well, yeah, you know, we used to have a disorder that was called sleep state misperception and I may have mentioned this in the past, we call a sleep state misperception is that, you know, we record your sleep and it looks like you're sleeping and you come in and you tell me, you know, I'm not sleeping. And I had that experience when I was running in the lab in in Norwalk hospital a number of years ago. And we had, you know, it's not common, but it's certainly I've seen a couple of cases over the years. And this one gentleman comes in and like, he's the kind of guy he's like the truck driver kind of guy. He's not gonna complain, unless something isn't working, right and he's you know, and he's not going to take any guff. He wants to know what's going wrong. How do I fix it? And he came in and complaining that he was not sleeping at night. And he hadn't been sleeping at night for months. And it wasn't clear whether it just started when he changed jobs or whatever. And we didn't really get a good handle on what any particular potential trigger was. But he clearly said I haven't been sleeping for months. And so first of all, we know that no one can go for months without getting sleep of some sort. Some physiologic sleep must be happening and so we try to figure out why is the person not experiencing it? So in that case, of course, you know, and somebody has a complaint like that we bring them in the sleep lab, hook them up, and we record every you know, orifice of your body and activity during the night which is what we did with this gentleman and I was really, you know, curious. I wanted to know what was going on in his sleep. And so I was one of the one I came in that morning when before he got up I watched the last bit of the recording. We pulled up the recording, we looked at the whole thing and I did a brief run through the whole thing. Wow. Okay. Yeah, he slept all night. So I go in and their text taken off the electrodes and stuff and I go, so how was your night? He goes, Well, I hope you got that because I did not sleep a wink. And I'm like, and now being reasonably decent. I'm not gonna say good, but reasonably decent clinician, I know not to challenge him directly face to face and say, but you did sleep. And I said, Well, you know, from our recordings, it looked like there were periods when you did get pretty restful. No, I didn't sleep but damn wink. Oh, okay. He goes, I said, but the equipment that recorded was showing us that He said your equipment must be broken. And so I had to really, really finesse the situation so well. I tell you, what, you go back home, we have a follow up appointment scheduled. Why don't you come in during that follow up and we'll look at what we saw and we'll talk about it set. off he went, and he came back into follow up. And he you know, I showed him the data and I showed him I said look, here's where I'm going to show you guys in a second. What the EEG looks like as we go into sleep. asleep and this is what we call asleep. Now. He'd never believed that. But I did say and I was able to convince him that at least the physiologic process of sleep was happening. And his body was getting restored, but his mind wasn't. And so we needed to find ways to quiet his mind somewhat more than what's happening now so that he felt more like he was sleeping. Because to me the best clinician is someone who addresses the complaint they came in with because if I don't fix that I haven't fixed anything right I you know, he just go off and go to another sleep lab but and, and get increasingly frustrated. So that was one of the better ones. That was I was like wow, shocked you know? Any other really odd unusual ones? I mean, that you know that probably tops to the the tops, the scale for the complaints that people have that they don't sleep. I hear that more often than I would like. Most of the time we can work with it and find ways
there are a couple of cases where, you know, people are notoriously poor historians, you know, they'll, I mean, that's one reason why we invented the sleep log with a sleep diary because people will say the same thing is happening every single night. You know, it's not different. And then you give them a sleep log and you find out they go into bed at this time and then that time and they're napping at this time and having three cups of coffee at that time, none of it which came across in the history. And so that's happened a couple of times where each week I would get a little more of the story, you know, like Oh, I'm not sleeping well, I don't know why I'm not sleeping. And then next week I found out well yeah, you know, my dog needs to sleep in the bed with me and he's getting a little on in the years and he needs to get up and pee several times during the night. And so I have to get up with him. Otherwise he goes in the bed. Oh, that might be one of the reasons why you're not sleeping at night or I was working with someone who had a cat right and the cat was in the bedroom viewing and and you know cats right? When they want to get up. They're gonna stare at you. They're gonna like just walk up the chest put their face in your eyes and go it's time to get out now right and so, so I said okay, I you know, I get that but look if you want to improve your sleep, you're gonna have to do something about your cat. You know, your cat's not gonna so fine. Okay, I'll put the cat outside next week they come in and Well, that didn't work well, because the cat was scratching at the door. Meow, meow meow. And I said, Okay, how about some earplugs? Let's try some new plugs. No, I couldn't do that because I won't be able to hear my cat. Okay, so let's see a sandwich. She's not going to work. I got it. Why don't you put the cat food outside the door with the cat so the cat won't wake you up to feed them. And that eventually did work. So those are the best cases I can come up with right now but for next month I'll pick on a few I'm sure a couple more will come in. Alright, that question elicit did I have seen it?
Yeah, the the one that Andrew sent me is the one that you address at the very beginning.
Oh, yeah. I talked about that the MD PhD route. Yeah. You talked about that. Andrew?
I thought another one maybe I missed it. I thought I thought there was one there was formally submitted that I just got from Alyssa.
I emailed Bob earlier because when they get sent to me, it doesn't show me the question anymore.
Okay,
so a clear but it did show me that there were two that were sent and I just couldn't see them.
Alright, I'm gonna see if I can find the other one real quick. So, because I thought there was one that may not have been addressed. So let me look for that real quick and paying into the Okay.
All right. And I'm gonna look at I'm gonna pull up the showing you guys before everybody can see that again, the slide. Okay. So, so I found this one. This is a good one. Okay. So this is, you know, it's really interesting. And this is what, you know, this is what I was trying to show that gentleman who swore equipment was broken. That and you've seen this in other places, and I'm going to show it to you again another way but when we're awake and alert, there's a lot of and beta brain waves of fast brainwaves. Okay, they're there. The brain, multiple areas of the brain are operating at the same time and they're talking to one another or they're talking to somebody else. So there's a lot of brain activity going on. And it's desynchronized okay, it means there's not a lot of synchrony to it, like we see in slow waves where a lot of cells are doing the same thing. So they all they all turn off and on together, off and on together off and on together. But beta is very desynchronized and low amplitude fast activity. Because different cells are doing different things at different times. And that's cognition. That's what's happening, hopefully in everybody's brain right now. And then as we start getting drowsy, or we do some meditation, maybe or we're getting closer to that sleep stage, sleep state, we start having alpha, which starts becoming it looks like it's more synchronized. They're very regular waves, they fall into a different frequency. They're much slower than a fast activity. Beta is anything above 1314 hertz all the way up. To 5060. We're getting all kinds of stuff at the higher frequencies. But this is down in the eight to 13 range. Okay, so it's much slower than any of the beta activity. So we're awake, but what kind of drowsy or if we're kind of like, going offline, and we close our eyes and we can get these kinds of waves like the brain is kind of ready for action. But unless something happens, nothing changes. But then once we drift into sleep, this is when we're actually pulling away from the outside world. There's usually a mixture of waveforms that are here like we still may see a little bit of this alpha mixed in here. We're getting some much slower waves. These are the beta waves, they're like, four to eight cycles per second. So they're much slower than alpha and much slower than beta activity. Okay, and so that's what characterizes stage one. And there's some really real particular signs of that as as we look at sleep across the night. And then stage two is unequivocal sleep. And even though it's unequivocal sleep, and it's unequivocal because we can look at the sleep spindles, which are really these brief, they have criteria they're half a second up until two seconds maximum, they have a certain shape, and the frequency is always between 12 and 14. Hertz, very clear, very obvious, very clear to see. But there is that little bit of overlap with theta, right? So theta goes eight, I'm sorry, with alpha alpha goes eight to 13. So that 12 to 13 and alpha can overlap with a 12 to 13. Goes 12 to 14 and spindles. But spindles are always discrete. There's always a little burst of them. Whereas Alford's pretty continuous, okay, except that sleep onset where you can have a little bit of Alpha a little bit of this, so, but we don't ever see spindles. In stage one. Once we see a spindle, we know we're in stage two. And there's also this really striking waveform. That's called the K complex. And these two are generated in the thalamus. And it's kind of like the thalamus is in the middle of the brain and it's the way station for all sensory information. Okay, so everything that's coming into you, my voice, the images from your screen, the sounds in the background, the feeling on your skin, the temperature, all of that information goes through the thalamus in the center of the brain. During sleep during unequivocal sleep, the thalamus shuts down all the inputs from the outside world blocks it off, shut down and act with these spindles and K complexes do their self generated, they're internally generated. So they shut down the outside world and then anything that happens internally at that point, for example, during the dream state is internally generated. Okay, so this is unequivocal sleep.
But even in stage to sweep there are examples of people's names being called out while in the sleep lab while being recorded and they immediately wake up or you can wake them up a little bit after it and they will recall they will say Oh, you will just call my name that's why I got up. Okay. So really salient information can still break through. You can say over a microphone, nonsensical words or just common everyday non emotional declarative words, and they will wake up but in the same tone, the same volume you say their name and boom, they wake up. Okay, so so there's some of that happening somewhere in that thalamus. It kind of like knows, hey, this is really important of information. We got to let it to the alarm clock goes off in the room. Right before we were waking up at during this intense dream. You hear the phone ringing in the dream. Okay. It's the alarm clock going off in the dream. So there are various ways information does get through, which was really important when they first when Steven the burst did those early experiments to demonstrate being aware during the dreamstate, which I have a slide on to. Okay, and then we go to stage three, which this is a terrible example of it. It's just really a terrible example I thought I can say, but stage three for which they've combined them because it looks completely like this. Only the 32nd epoch epoch that we're using to score the stage of sleep is 123 or awake. That stage is either greater than 50% of these waves for less than 50% of these ways, and more than 20%. So if it's between 20 and 50%. It's stage three sleep, and it's not an arbitrary amount, even though it may sound that way. But what happens is when your brain is shifting into this deeper synchronized state where billions of neurons are firing in synchrony together, okay? And the brain is mostly offline and there's really no cognition happening. When the brain is doing that. It's a process so it's dropping deeper and deeper and so it creates more and more deep waves. And unless something disturbs it, it goes into that really deep sleep. Okay. So now here's that EEG again a little more clearly. And what's interesting about showing this is that you can see the D synchrony that's happening here with the D synchrony in the wake state. Right? That's I'm talking about that first activity, the beta activity. It's low amplitude very, very small. We're talking 1020 micro volts of activity. And if you jump down here, I don't know somebody has to tell me if my newer maybe I can hide this thing is in the way
I can see your mouse is not mature.
Can you see this last way from way down here that okay? Yeah, good. Okay. So if you look at the first saw to the very indicative of REM sleep, but if you look at this other piece of REM sleep there's less sawtooth and it looks a lot like pieces of wig. And that's because we're cognate eating during dream sleep, right? We're having dreams are our brains our courses are going back online and we're processing information back and forth. We're creating hopefully, lucidity. Alright, so Oh, I lost you guys. No time.
Oh, gosh. Okay. I found you and lost everything else. Okay, quick question real quickly, and then I'll check on the question from Melissa. Yeah, does it sound we shut down incoming data in deep meditation states. Well, it shuts down the outside world to a certain extent, but not to the extent it does for deep sleep. So that's what's really interesting about now. Looking for, like the studies that Andrews involved in looking at awareness during deep sleep. So there's that still there's that level of awareness in the deep meditative state. Your thalamus is going to be less responsive to the outside world, but loud enough or sharp enough stimulus will still get through. So your brains not in that physiologic state of sleep so that it would shut it down automatically. But it is interesting, most of the activity has reduced. Alright, let's see if I can find
Are you looking for the one that Andrew sent? Yeah, it's actually my email. I can read it to you. Good. I'm Eileen Aileen. Sorry, I mispronounce that. But it says my husband text tells me that I sometimes hum or talk in my sleep. I'm 72 are humming and talking in sleep concerning.
I know what you're saying. You don't give you don't give away any secrets. You're probably okay. Sleep talking sleepwalking, sleep humming sleep singing sleep laughing and as Andrew noted on the last book, study, sleep yoga book study. Session. Weird stuff like sleep driving, sleep, murder, sleep, sex, sleep, all kinds of things happen during non REM sleep. Okay, and that's when people are those slow waves. Like I said, we're not cognitive during really deep sleep. Okay, so moving towards deep sleep or being in deep sleep. Actually, I might have a picture there he will do most of the brain is offline.
So most of the brain is offline. So here's here's a confusional arousal now sorry, it's different than the other slides. This is. These are all EEG channels, okay, across the scalp. There's like one in every location. There are 20 of them and they're all named and labeled and they're connected to each other. And this is what a neurologist do when they're looking for seizure activity. For instance, that kind of thing. But when they're also looking for non REM sleep abnormalities, they will look they will do this full headset. And what happens here is right here at this point, this person was in deep sleep. So this is what deep sleep looks like when you have electrodes referred to each other and we'll get into the details of why it looks that way. But imagine amplifying this and you can see the same kinds of waves. They're pretty synchrony in synchrony. I carry a good example of them here. And actually, as a quick aside, because they only have like another 10 minutes and I gotta go. A quick aside here is that Andrew was mentioned a couple of times that part you know, the latest research shows parts of the brain can be awake, and parts of the brain can be asleep at the same time, right. So look at this, this series of electrodes right here, or waves right here. These are deep, slow waves. This part of the brain is deeply asleep here. And this is nearly awake, in the same area of the brain. And here it is deeply asleep again, for this whole period. Okay? And then there's an arousal and this is clearly awake. But here you can see a lot of these alpha waves remember the alpha waves I showed you? They're synchronized in a different way. So the brain is awake and ready for action, but nothing is happening. Okay, and then there's some movement, and then there's some beta activity. And then look at this. There are slow waves again, and this is all on the orders of this is about 30 seconds here. So this is a brain that's half awake and half asleep fully in the conscious state consciously have a way consciously half asleep, and the brain in different parts is asleep. Or awake, or in light or awake here, light sleep here, deep sleep here, same moment in time. Okay, so that's the long answer. The short answer is no, it's not a problem, generally speaking, but people do. It depends on whether or not your daytime function is handling whatever's happening for you and your daytime. And your daytime, let's just say. So people who have a lot of stress in their lives, and tend towards sleepwalking you're talking we'll talk more. We'll do more have more episodes during stressful times. So it's kind of like where it's not fully processed in the day. It can be processed in non REM sleep, by having that sleep talking sleep, homing sleep movement, sleep activities, and what they really mean by that is you're in a non REM sleep and there's some breakthroughs. Okay, hopefully that answers it. And if not, and you're here, you want to come on and talk more about it. And for the final time, I'm going to go back to
there was another question that was sent in in advance, too. I just got it it's from Peter says Dear Dr. O'Malley for a considerable number here. I'm going to copy and paste this to you so you can see it.
Okay. Though I'm having fun here with my slides. I was going to show you another something or that. Oh, yeah. Okay, I'm gonna go into the chat all night
and decided that wanted to be slow.
Okay, do you want to just read it out? Yeah. I can. Okay, go ahead. Stop this contract with a minute. Okay.
It says for a considerable number of years now. Approximately 10 I have been taking sleep medication for my nighttime repose including. Oh, goodness. mirazur pin. Okay, my dog's gonna work here. So book club. Does that sound right? Yep. Yeah. Melatonin and occasionally. Clonazepam? Yep, okay. Also for a considerable number of years, I have been aspiring to achieve lucid dreaming. This as I understand it, being the gateway to eventually accomplishing the nocturnal practice of Dream Yoga. I can report that my overall capacity for regular, regular and ordinary dreams has over the years been adequate but as far as lucid dreaming is concerned, I am making no headway. My question to you is are you to aforementioned sleep related objectives? reconcilable or error? irreconcilable sorry, I can't say that. That's something in between.
Well, you know, in general medications can reduce the amount of dream sleep. Medications can affect the amount of non REM sleep we have and so thereby affect the balance of REM sleep. But if you're having dreams, then there's no reason why you can't move that dream state into lucidity. It's a longer answer than I'm willing to, to entertain right now because there's I need a lot more information. But in general, if you are already dreaming and you are having dreams and you're recording your dreams, what is your experience with trying to improve or increase the number of dreams and or try to get lucid? Have you tried all the different things techniques? Have you tried some and some have failed Have you not been able to try them because of waking up too much when you try them? You're not on the call if you want to call be great to come on and talk a little bit more about that. Yes, yes. Oh, Peter. Yes, it is. Okay. Can you unmute Peter Peter? It should be okay, let me try. Yeah. Can you hear me? Okay, there we go. Okay, thank
you. Sure. Yeah. Um, so So my question has to do with the fact that I think medications have on on Dream specifically the capacity to to have lucid dreaming. And I I'm sort of inclined to think that it's, it's sort of disqualifies you, if you're taking medication because you're asleep then is not going to like follow the the regular dynamics that you would find in someone who's who's having who's lucid dreaming without medication. So I just wanted to ask that. I can also mention I have a friend who thinks that I have an ulterior motive with my question, which is that I want to go I want to go off all my meds, including the ones that I take in the day. And I'm trying to get like, you know, what an expert to say. Yeah, it's true. If you can get off as much of those meds as possible. You'll be a better practitioner. You'll be you'll be a better sleep, lucid dreamer and so on. So could you respond to that?
When to the latter part? No, because I cannot give medical advice. Okay. If you want to email me offline, we can have a conversation about that. Okay, but that part about whether or not you should get off medications, you always need to do that with your physician, whoever's prescribing the medications, you could do that in concert. I can assist in that and make suggestions, okay. And I people come to me all the time to get off their medication. So that's possible, but it's always in conjunction with their primary care physicians or who's ever prescribing the meds. Okay. So that's, that's part two first, part one. No, I would not assume that because you're on these medications that they necessarily prevent you from having lucid dreams. Yes, your sleep may be different than if you weren't taking those medications. But if you're having dreams, if you're recalling dreams, I should say, You're recalling dreams. It's saying you're having REM sleep you're having recallable a wearable REM sleep. So some of these some of these techniques should still work for you. Yes. So like setting the alarm like are you having the dreams towards morning and if that's the case, you set the alarm to wake up before your typical time and see if you can then drift back into sleep and you know, become lucid, that kind of thing. So I would work with I would work with the assumption that you have REM sleep, get a sense of when that's happening for you and work with those kinds of techniques that will target when you're having REM sleep. Now maybe if you weren't on the medications, you would be having more REM sleep or you'd be having more this and more of that. But, you know, it's not an a priori conclusion to having lucid dreams. In my mind.
I understand. But there was just one last little part to the question. The same question, but with with reference to CPAP that the seat can CPAP in some way interfere with one's capacity for lucid dreaming or not at all?
Not necessarily again. It's the same reasoning Okay, actually before CPAP then more likely the apnea can prevent you from having lucid dreams because your sleep is very disturbed on CPAP. Now you should have regular cycles of sleep like everybody else. So if anything, you should have your REM sleep, there should be no reason why you can't use that same techniques to become lucid during REM
sleep. Perfect. Thank you very much. You're quite welcome. In my able to did you say offline I could send you another question or
you can email me Yeah, email me directly if you want to talk about the meds and getting awesome and help. Perfect.
Well, thank you very much. I guess your email address is somewhere. I'll find it. Yeah.
I communicate with you through
Yeah, that's fine. You can use my add on seven at Gmail.
Yeah. Put that in the chat for you.
Thank you very much.
You're welcome. Okay. Good luck, Peter. Thanks. Sure. Um, I do have to leave right now as a matter of fact, unless there's another quick question or anything else I didn't see anymore. Okay. So next time somebody remind me I'm going to try to remember myself to talk more about bring back to civil liberties data why sleep is still disturb rubble in some ways that are positive. In fact, even for you, Peter that probably supports what you're asking is that he was able to break through and have some motor activity in REM sleep when you're completely paralyzed with enough intent. So that's an interesting thing. We'll talk about it next time. All right. Great questions. Very interesting. Andrew, glad to have you back in the saddle and hopefully you'll do better and yes,
thank you. Yeah, burning through the verse said I need some reverse ed.
I like it. Good one. You're still you still got that bit. of humor. I like
going to sleep I probably should. But thank thank you so much, my friend.