Hey everyone, welcome. Let's see. Let's see. We go to gallery view here. Okay, we got a page full great. And they're still sneaking in. A Tim Russ berries picture. That picture works again buried because we definitely still in fall. Colors a nice up here. Bear is about hour hour and a half from where I am. Same latitude. Lots of color. Oh, I gotta show you guys something really cool. Hold on.
We have right across the street from my office is a beautiful, walking Nature Preserve area. It's like a mile round trip. It goes along the Housatonic River and it's really pretty, especially this time of the year. And along the way there are these huge sycamore trees and I just can't resist even though I have no I'm going to put them up on the wall. I decided I've already put one up. Look at the size of these leaves. You're like they are huge. And yeah, you know like you're walking along and you know there's a lot of leaves down the ground all sudden you see like these gigantic tours there on the ground. So I had to take some bring them back to the office. Put them up on the wall or something. Anyway, it's that time of year. So in the US, and I'm actually working with someone. I'm working with someone in Puerto Rico, who I just found out they don't change their time. They don't have daylight savings time in Puerto Rico. I found out by getting on Zoom an hour late. So we had to synchronize our watches. But you know this was the good one right? Everybody get a little extra sleep this past weekend, Sunday morning and I still sleeping in going Oh wow. This was Yeah, yeah, it's nice. The spring is what hurts. Right spring forward when they steal in our back. Yeah, so hopefully, you know, there's a lot of talk about just doing away with it. And we will eventually I just can't wait until we do. Hopefully they'll do it before we get we get challenged in the spring. So today, we had a couple of questions come in. And certainly we'll have time to take some questions from you guys in the chat box or unmuting. Folks if you have questions, but I'm going to talk a little bit about medicines for sleep. So to the questions that came in. The one asked about medicinals for sleep than I recommend or not. And the other was about cannabis and all its various hundreds of different forms. So we'll talk I have a little presentation on that I thought it might be nice to to put up so that we can look at some of the data that exists on this. So I'm going to do this now. Everybody see that? Okay. We're seeing it just give me a good thumbs up. Thanks. So um, so this is the medicinal slide. People want to know about medicinals and you're not going to be able to read all this. But the reason I put it up is because there are so many different medications out there and they all have differential effects on the different complaints people have about sleep. Okay. So so these are the medicines that are out there. Okay, and these are the fairly the most common ones that are being prescribed right now. And they have different effects on different so here's the here's the deal. So this first box is on total sleep time. Okay. And you can see in the top one seem to have the best effect on total sleep time. This is on sleep onset latency. So the more to the left, the more the less time it takes you to fall asleep. So it looks like guys our plan wins in this one. So Pons Lunesta. And then there's the effect on Wake after sleep onset so you fall asleep okay, but then you wake up during the night you have a lot of time awake during the night. And again, you want to reduce that. So you want negative effects. So I'm going to make this presentation available so you guys can like dig in and really look at it. And you could Google any of these names if you want to know what the common name is. or common drug name is. Zolpidem is, is Ambien, by the way.
So again, there are a variety but they all seem to have a pretty good effect on reducing wake after sleep onset. Except for this cause a PAM which actually I don't even know what that one is. So you don't want that one anyway. Sleep efficiency. So the time that you have to sleep the time from when you turn out the light and you're trying to sleep till the time you get up in the morning, the more efficient you are, that means the more of that time you're spending asleep. You know kids have efficiencies on the orders of 95% 98% Right. The older we get though, that efficiency drops to where if you're getting sleep efficiency better than 85% As an elder, you're doing good. Okay, so And this just shows that they all seem to have again some some significant improvement on sleep efficiency. So you have to think about what are the issues you're asking about medicinals for what do i What's my issue with sleep? Am I having trouble falling asleep? My having trouble staying asleep wake after sleep onset? Am I having multiple wake up stone tonight? A lot of that time isn't sleep can I improve my sleep efficiency? And then so these are all from studies done in the sleep lab, but they also have some subjective reports. And so you kind of want to know or so here's on total sleep time object subjective, like what drugs seem to make me feel like I slept longer. And then the actual data from the sleep lab, which drugs actually did increase the amount of time in the sleep bed that I was asleep, and there's some overlap between for instance, doxepin and an ester here. So I'm going to you know, make this available. You can look at it and make your own decisions. I'm going to say a few more words about this since this was a question. And again, subjective sleep onset. So how long you think it's taken to fall asleep versus what the computer says? And you're awake? Yep. To sleep onset. So it's it's it's occurred. It's 2120 21 study just done recently. So it's got the best data available. It's from the journal sleep, the one that is put out by the American Academy of Sleep Medicine, which both Andrew and I are members. So it's kind of like the Bible of sleep studies. So this is the latest data on sleep meds. Okay. Now, having said that, there are you know, I get a lot of reports because I deal with a lot of insomnia so there are they're not always good reports for some of these medications. So for instance, we know with Ambien, in fact, we know in general, long term use of any sleep medicine, there's there's there's increasing data to suggest that there's there's an increase in mortality, the longer we use these medications. So now, that's in large datasets looking at total populations, and not looking at why people are necessarily using these medications. And so I think a lot of sleep disorders like sleep apnea, get included in these numbers. And if you have sleep apnea, and it's untreated, and you're using medications that depress respiration, you're probably going to die sooner. So, but, you know, the evidence continues to accumulate. So, you know, in general, if you don't need to take a sleep medication, you're probably better off not taking it. If you have some acute issue you're dealing with, you know, like a major emotional hit that you take you lose someone lose a family member, there is an accident there's some PTSD from some emotional trauma. And you have difficulty sleeping that is perfectly normal, and that's a great normal response to trauma is to not sleep. In fact, if you go to sleep right after getting trauma, it's more likely to remain in your brain and become hardwired almost like a memory.
So when you don't sleep because of trauma data, okay? At some point though, you do need to sleep. And so you know if you've gone through a few nights of sleep disturbance or reduced sleep, and you know you still have to function maybe you have children you have to get to school, maybe you have an elder you're taken care of maybe you're have a partner you need to be present for and plus, you know, we all we all have our commitments during the day. In that case, then take the sleep net, get the sweep, and then at some point, once things settle down, then you can start weaning yourself off it and that's something you do want to do. Okay, take it while you need to take it while the emotional disturbance is high. But as soon as things begin to settle back, you want to make sure you start tapering off and seek help if you needed to get off the medicine and get back to your natural ability to sleep. Now if any questions pop up regarding that good to live meeting notes. Okay, live, raise your hand or make a lot of noise. But so having said that, these are the drugs that are probably doing more than just helping you get to sleep you know, they're messing with your brain in ways we don't fully understand yet. So that's why they may contribute to long term issues. But we have these other medications that are out there that aren't really medications. So this is the second question which asked a lot about what's the story with cannabis in sweep? Okay, anybody else have that question? No one else have that question. Can I see any? Yeah, there's a few. Okay, okay. I couldn't see everybody in the moment. So so that's why I want to get some of the latest data and put it out just so you guys whoever asked the question has a chance to to get some of the latest data and you can come back and look at these this presentation. So I just, you know, a quick and dirty way of getting this data was just do a lot of searches, do some reviews, look in my journals and just copy the title of some of these latest these latest presentation so this is a two 920 19 review. And the bottom line and I'll say that even about the 2021 studies and the 2021 reviews is that there is not a lot of hard evidence. There's not a lot of you know strong scientific support. For the effect of any of the cannabinoids for sleep. Okay. And that's why they mentioned this as a critical review. Okay, so the studies that have been done and if you look at you, you go through a bunch of websites, you'll find a saying, oh yeah, this is good. It's been shown to improve sleep. Those studies that they're citing, have eight people as their study number 10 people 15 people. A lot of the studies looking at pod and sleep have looked at the use of pot for something else like fibromyalgia or some other chronic, you know, irritable bowel syndrome or something. And then secondarily, oh look, it had some effects on sleep, so there aren't any orange aren't very many. Anyway, well done, you know, double blind placebo controlled studies on cannabis and sleep, but from what there are, okay, there's this general indication that the CBDs can be very helpful. Now. The younger you are, the more likely there's actually a positive effects. So this is a 20 to 2020 study that looked at cannabis use and sleep. Now this is cannabis use versus cannabinoid or CBD. Okay, so cannabinoids CBD cannabis is the plant family. Cannabis has the THC. CBD has the THC removed. Okay, but within those two major brands of natural medicinal there are multiple psychoactive
causes compounds in the cannabis plant. Okay, multiple multiple. So different ones have different effects. And it's, it's interesting because there are a lot of different factors that are going to play into what works and what works. When, and I've said this before, and I'm going to say it again. It hasn't changed much. A colleague said to me probably now going on two years ago, that the more he reads about, the more he reads the research on cannabis use, the less he knows. And I can't say that I know a lot more since then. Because we just haven't you know, it's still legal. At the federal level. It's still illegal. So it's really hard to do research. And so until that research is done we're going to have a lot of these anecdotal reports we're going to have have a lot of, well, my friend says, you know, and it works for him. And so the overall sense is, try something and see what it does for you. So with that caveat in mind, cannabis use is generally with an increased expectation that it improves sleep. So this is why people use it for sleep because there's a lot of reports a lot of anecdotal reports that it does improve sleep, but what I just showed you in the medicinal slide is, well what aspect of sleep does it improve, falling asleep, staying asleep, sleep efficiency, waking up during the night and falling back to sleep? Or waking up too early? So there's lots of different ways until then none of that will be clear. But certainly it seems to support fall asleep more quickly. It certainly seems to decrease subjective sleep quality now, the more meaning the more let's say you complain about your sleep, the more likely cannabis use is going to help it but that doesn't really tell us an awful lot. The longer you use it, just sort of like the other sleep meds, the actual pharmacologic sleep meds the more you're going to have some effects on sleep and a lot of it's going to show up when you go off it. So the more regular use you have, whether you're smoking pot or consuming edibles, the more likely you're asleep becomes dependent on its use cycle whether it's psychological or not. It does become physically dependent on it. Because you're asleep stages will change and they'll rebound when you go off, suggesting that they're suppressing some aspects of sleep. Okay. Now which aspects of sleep are they suppressing? It depends on which type you're using. So THC or the cannabis plant comes in two major strains. Indica, which is considered more soothing and relaxing and sativa, which is generally more exciting, exciting, happy and energized you know, for works for you. But another way to look at it, to look at it is indica is what makes your body feel relaxed. So that's where a lot of the CBDs are extracted from the indica version, the indica strain because that works on the body reduces pain, arthritic complaints, and a lot of the chronic body complaints, irritable bowel, those kinds of things could chronic fibromyalgia, you know, joint pains, so a lot of the pain syndrome seem to respond well to the indica strain. And the high strain getting that mind going is really where the sativa comes from. So if you're interested in some effects for relaxing the body relaxing the mind sudio reducing inflammation reducing pain to get to sleep, then you want to rely on the indica excuse me, you'll get a lot of reports from people in the pod stores now. I don't know where everybody lives here and I've got you all off to my side. That's why I keep looking over here so I can see my slides. But
certainly in Massachusetts, we've got I mean in this little town of 7000 people we have nine pot stores and counting. There are still a couple of more applications on the table. So you know if you want to come visit me there are lots of different things you can try if you want to try it for sure asleep. New York has just approved it made it legal in a number of states now are making legal but again at the federal level, it is still illegal. So in all of our pot stores, you have to come with cash, no credit cards. Some of them might accept a debit card, but they can't have any federal records available. The bank records can show transactions for anything marijuana. Okay, so it's really interesting, the state that we're in right now in in literal terms as well. But it is legal here and people buy it all the time. And there are lots of different varieties. Okay. Finally, there are these hybrids, okay. which seem to have a little bit of both, depending on what percentage of each and you know, it's like how do we study this stuff? I mean, we can, you know, you can have 10% to 20% sativa 30% You know, and then you can have all different kinds of like I've I've gone in for research purposes, to check out some of these stores. Okay. I have all my patients are asking about have the same questions. You know, what can I use for sleep? My friend says, this works with sleep and I say, Well, you try it out and you tell me what works. Now again, having said that, in general, this is what I'm hearing that the indicas have better, better for the body stuff. You want to feel the body you want to go to sleep. You don't want to be too excited. So even a low percentage of sativa is probably okay but you want to lean towards indica. Now when you
when you ingest this, there are different ways of ingesting Okay, so there are edibles and there are edibles that go through the digestive system just like melatonin for instance, and take longer to get to the circulatory system that then finally gets to the brain. Or there are some that are like under their tongue. There are lozenges there are there are these two E's that you can then put under your tongue and let dissolve slowly over time. And so those would be much more active and much more, much more quick, quickly active and go right to the circulatory system and therefore to your brain so you can get more of it and it'll work to work sooner. Smoking any of it is not highly recommended, but just because of the respiratory impacts, and you know, vaping and all that stuff like that's, that's not even in my generation. We don't we don't know anything about that to speak of, except that it's probably not good for your lungs. And so there are a lot of caveats on vaping now that are that basically say they're unhelpful, they're not really good for your respiratory system. So if you're gonna try some of these out, go ahead and get some of the the edibles and just be very aware. Always start you know, whatever dose it comes in, cut it in quarters, and try a little bit first. And there's one little tip that won't cost you anything that I found out from someone who's prescribing up here, and that is that if you take it, whatever variety you take, and you're still having the you know the brain stuff happening and you start getting a little wigged out then have peppercorns available. Two or three peppercorns will knock out the brain effects of the THC. Two or three pepper, whole peppercorns. Okay, get a fresh batch of peppercorns keep in your class, if you're going to try these out and if you start getting like all weirded out in your head, you know like woozy and all that. You take a couple of peppercorns chew them right up in your mouth while with some water. And that will immediately begin reducing that. That sort of head trip is what we used to call it. I don't know what they call it anymore. That's what I call it from the old days. Alright, so a couple more things and then we'll open up the floor this was a great review again, done it's 2021 it's a very recent review. It's done. What I look for are there any sweet people in the in the authors? Okay, and this Philip z is a long term sleep researcher. I don't know the other two but I know she's really good. And so they look at this stuff. And they look at it for sleep disorders in general. Well, of course, insomnia is one but then their sleep apnea is restless legs, and there are a lot of places it can play a role. And again, the studies just haven't been done. They're small. But the one thing I will say and I'll repeat it again, is that at least in the studies that are done, they seem to have positive effects, at least in the short term. Okay, so they seem to be doing what people are taking them for in the short term, but heavy users long term users have ultimately negative impacts. US recent study, this one had 27 I mean that was this was done in 2018. It's one of the ones that it's included in a couple of the reviews some good sleep people here too. They look just in healthy, normal everyday adults. And they looked at the sleep wake cycle and they didn't see any particular changes in any of the amounts. In fact, I took some of their like, I don't have the findings here. They they didn't see major changes in stages of sleep. And one reason why we be interested in that in this group is because what effects does it have on REM sleep? Now certainly in heavy users, REM sleep declines there is less dream sleep, okay? Conversely, there's an increase in deep sleep. But that's at least what's happening initially. And certainly if the long term user stops over whatever period of time, there'll be rebound, REM sleep so very clear, long term. Use suppresses REM sleep, okay, in the short term, it's just not so clear. It seems like it doesn't affect it. Now
one of the reasons people are looking at the mechanism by which this can have an effect on sleep and I found this really interesting that and I had never heard of this until all the you know, we started looking at the effects of THC you know, these cannabinoids on sleep that this was proposed back in 2001, I think was the first time in the literature that there are people with a clinical endo Cananda cannabinoid Deficiency Syndrome. And they propose this to underscore a variety of chronic disorders that seem to have some commonalities. So again, your double bow, fibromyalgia, chronic fatigue, couple others, other treatment resistant syndromes or you know, like you're trying all kinds of things and nothing seems to work for these different migraine, you know, chronic disorders. And what they propose is that there's an effect of both CB one and CB two these are receptors for the actual cannabinoid CBD in the body in the brain CB one, mainly found in the brain in the CNS, central nervous system. And then the CB twos are mostly in the peripheral organs, but these are throughout the body. We have receptors and domains they're internal to us. We have receptors for pot. That's part of our nervous system part of our physiology, why are they there? What are the substances that actually act internally to do this and there are endocannabinoids Okay, so these are there are proteins in the body that are produced by the body. But if you start looking at these you begin to see this stuff is all over the place. It's in fat, tissue, bone, cardiovascular, CNS, eyes, gut, immune system, kidneys, liver, pancreas, I mean, everywhere. So we have these receptors throughout our body. So it's really interesting and then you know, how you get you know, you go down the rabbit hole when you start doing all these searches, you know, and I, I thought this was a great way to to get towards the the end of this recent review is saying, hey, you know what, if you look at diet and neurodegenerative diseases, you begin to see this relationship. And then if you add on the endocannabinoid system, you begin to see some of these connections. And why there are these receptors throughout the nervous system, and how they're supposed to interact with keeping us healthy in our diet. And if we don't get these things that activate the system in our diet, we begin suffering from some of these chronic disorders. So I thought that was really really interesting and you know, make if it what you will. I think I'm going to end there. I think I already talked about the room. So let me stop this share. So, are there any questions about this before we go on and open the floor to whatever else we want to talk about anybody have any burning questions about THC? Oh, I should say one more thing about THC and the CBD that's in general finding and I'm hearing this from a lot of people. I'll say a couple more things. I'm gonna get I'm getting like Andrew more and more every day, you know, I think I'm done and then I, I start riffing on a bunch more things. So one is that
CBD anytime you're getting CBD for anything that you want to try it out, you want to test it out for your arthritic joints. Or for your sleep. You want full spectrum. And I to me, that's just the rule of thumb for any plant material you're using. That's why teas can be really helpful because they have most of the flower and a stem. There are so many substances in nature in a single plant that pulling apart all of the party associated factors that are in the plant to find the one active ingredient is really fooling ourselves. As to what we think we're getting. I think whatever active ingredients are in the plants, in part are active because of all the associated substances, all the other agents that are in that plant as well. And you know, the indigenous folks, our ancestors, they all knew this, they all you take the whole plant, or maybe you know, you take the flowers or the leaves or the stem or the root, but you don't I try to get one little thing in there, because that will almost always cause side effects and all we have to do is look at our pharmacologic performances of pharmaceutical industry. To understand that there are more if you look at any of their little sheets that come with any drug, including aspirin, there are like you know, 20 to 30 to 40 to 50 different potential side effects. And they're very few, although there can still be with whole plants. Okay, so that's one of the issues so if you want to use CBD, get the full spectrum at using the whole plant. And the second thing I'll say about that is most of the CBD for sleep, at least seems to require some THC. Okay, the stuff that gives you the high the stuff that we used to get when we smoked out behind the gym during high school pokes now I'm really outing myself. So Oh, Alyssa, ARE YOU ARE THEY asleep yet? I shouldn't Okay, thank you hear me okay. Okay. This is this is kids are in the backseat, you know, and we just want to make sure they weren't exactly hearing some of these stories. So yeah, so a little bit of THC seems to be necessary to really provide all the health benefits will at least asleep benefits of CBD. Okay, so just keep that in the back of your mind, and that's why they're having a few peppercorns available in case it's a little too much THC. THC can go a long way to making that unpleasant effect and get you to sleep or whatever that is that you need it for. And that made me think of the two two. Well, there's a lot about CBN coming out now. Can you remember what that refers to? But CBN is the to another version of it's like not CBD but it's CBN it's it's like a THC. But it's a non act non psychoactive version of THC and it's called CBN and that seems to be the sleep component of THC. They seem to be isolated but again, you know this one fact that one portion I don't know. I don't know about that. But anyway, that's out there. But the one thing that I will mention is something called bedtime. Betty's anybody heard of that. Anybody heard of bedtime bellies?
He was actually just talking about that in the chat. Oh, great. Okay. It didn't work for him. But his daughter, but it
worked for his daughter. So that's how these things work. You know, they may or may not work for you. Okay, but bedtime Betty's is it's a combination melatonin and THC. It in fact doesn't have CBD in it. But it has five milligrams of THC and two milligrams of melatonin. And they come as low edibles. And you know again, I suggest to people in fact, you know you can free you can cut them into quarters and try a quarter first to see to see potential effect for you. It can make you a little woozy. So it's the kind of thing where you want to start low. You can put it in the fridge till they get cold. Take him out, cut him into your quarters. And then if the quarter works for you fine, you freeze the quarters so you use him as lozenges. So that's one little side I've had a few people here in town who use them and love them. Great stores in Massachusetts, but the play with lots to choose from. But again, I would notice and especially any of you have any other devices you know anything you know I talked about the ring, I've got the whoop now I've got the Fitbit any of you who use devices, really pay attention to a few nights of regular sleep, and then whatever substance you take, see what it does to your sleep. Remember the relative differences are what we look for. And even though it's not entirely accurate, saying you're getting this much REM sleep every night, if you're getting this much REM sleep every night you take an edible and you get that much REM sleep. Well, I would suggest that it's probably reducing REM sleep. And then again, what's your subjective sense? Did you notice your dream the amount of dreams you had were reduced or maybe the quality of the dreams or the lucidity of the dreams okay. But most likely there will be some effect on your dream state. So you know take them with caution. But you know if you have a good reason to try them and do that alright I think I'm done talking about that. Let's see what else we have.
Barry, I think if you have any experience with Rick Simpson oil
I'm sorry what kind of oil?
Rick Simpson oil RSO
No, don't know what that is. Very, you want to say more? Are so
yeah, it's something that was brought up in our dream yoga group. And it's supposed to be really good from it's from Canada. It's made from synthesizing cannabis and some other products. And if you go if you search for it online, and I'm sure you will add because you want to know about these things. Yeah. I mean, it's really expensive. But if you go to the our medical marijuana stores in Massachusetts, they all have it. They have pills is also like syringes of it. And you don't need a lot of it to really work. And the people I've spoken to at the dispensaries tomorrow's Veterans Day so I get like all like 50% off some going. But is that they all speak about it as being like the absolute best for pain. And for sleeping for waxing. I just got some today. I'm going to try it tonight. And there's like I said Tomorrow I'm gonna get some more, but it's supposed to be really good. So might be something for you to check out as well.
Yeah, yeah. Yeah. Thanks, Barry. Yeah, definitely. I will. I will check the storage here. I'll pick up some and give it the old college experimental try for research purposes, of course. And we'll see maybe we'll report back next next month and we'll talk about it. Great. Thank you, Horace. Oh, okay. What else we have Alyssa.
Let's see.
You tried Rick Simpson oil.
John Beck said I used to make medicinal Rick Simpson oil. It is an alcohol extraction in its purest form. And then Tim actually asked How about calcium magnesium as a natural sleep aid?
Um, yeah, well, certainly calcium magnesium are really important minerals for sleep. So, you know, backing up, you know, to to to answer his question that he wanted to talk about last time you know, what, uh, what are the food items that are good for sleep? You know, starting at the top, a good diet in general you know, like what their Mediterranean diets you know, heavy and green leafy is heavy and organics heavy and oils, like olive oil. Maybe some fish very little weird me. If it is red meat, it's not grain fed. It's grass fed and that kind of thing. And so really good diets, you will most likely get all the calcium magnesium you need. But if you are having some sleep issues despite a good diet and you want to try supplementing with calcium, magnesium, that's they usually do come together certainly worthwhile. Excuse me if you have nocturnal cramps. Magnesium is is really good for that. And so you might get the calcium magnesium, either magnesium alone or calcium magnesium in which you have twice as much magnesium if you have nocturnal cramps, but yeah, you want to make sure you have enough calcium, magnesium.
There was another question What about over the counter sleep meds?
Well, you know, we've talked a lot about melatonin. You know, you can go back to some of the earlier of these presentations. We have talked a lot about melatonin. Just briefly, you know, sub mental tablets under the tongue, or liquids that go under the tongue. So you go directly into circulation and get to your brain sooner, faster, more effectively, and more completely than anything you can swallow. Keep the dose low, and you will have to see how you respond to it. A little aside, there are people who are sensitive to caffeine will most likely also be sensitive to melatonin, meaning you will need to take much less. Otherwise you'll probably have hangover and that's because it's metabolized by the same enzyme in the liver in the liver. And people who are sensitive to caffeine. Yeah, whatever. So those two go together. Other over the counters, you know all of the herbals all of the herbal teas, Valerian chamomile hops, they all do serve to relax. Depends on how intense your sleep issue is. A lot of people who come to me have already tried everything and that's what they'll say I've tried all this stuff. It doesn't work for me. I need more help than that. Okay. But if you have the occasional insomnia night, you know, you have the occasional you've watched the news that can happen almost any night these days. You know, you might need to relax a little more than usual. And so yeah, a nice relaxing herbal tea really helpful. Any of the ones sleepy time any of the, you know, again, clean teas like the herbal teas. Yoga teas can also be beneficial for relaxing and poor sleep over the counters, what are the over the counters are there there are there's Doxo succinate which is trying to remember the over the counter name. Somebody remember that for me? What was it called? Doxil succinate. It most of the over the counters are Benadryl. Everybody knows Benadryl? Right, Benadryl is like an anti histamine. Most of the ones like all the Tylenol PM Advil PM, all the pm drugs have pretty much Benadryl in them. And the anti histamine works in the through the histamine system to put you to sleep. The downside to the antihistamines like Benadryl are that they they have a 40 hour half life they left in your system forever. They can cause other issues they can leave you with hangover, but if it works for you, fine, you can use it. There's one called Doxil succinate and it's it's a different over the counter UNISOM you UNISOM yes, you're Assam Thank you. You disarm is the one that's not Benadryl, it's doctrinal. succinate and for some people who can't do Benadryl that seems to work really well for them. But otherwise, they're mostly all the same. Drug. Okay? And Benadryl is kind of what we would call a dirty drug for sweep effects so many other systems that it can cause for instance, restless legs and restless legs is an issue with you or too late twitches during sleep. You know your bed partner says your your legs are kicking overnight. You don't want Benadryl that would definitely make it worse. And while we're on that subject of leg twitches and restless legs, chocolate makes that worse than enjoy makes it worse. Caffeine makes it worse.
Okay, other over the counters. Let's see. I'm seeing all kinds of ones in you know, you go and CVS or Walgreens or Rite Aid these days. And there's like this explosion of and I think maybe since COVID. Maybe since some of the political situations which we won't get into. But, and I won't even say what my bent is, but I'm with Andrew. So that gives you a strong hint. So people have had trouble sleeping in the past, you know, four to six years, let's say first with the political system and then with COVID and now maybe even a combination, just trying to suss out the world these days. So, you know, my advice always is to not get the news at night. Do not watch the news after dinner even I mean, maybe watch you know, PBS news hour, but even that I stopped watching PBS news hour I just, you know, I get it at four o'clock now get well things considered or something, but you can get it in the morning, you know, and don't worry if the world is ending at 11 o'clock at night. You won't be there. In the morning anywhere so you won't have to worry about it. And if it's still there, you'll know in the morning, okay, so. So you want to you want to dial back, social media, you want to dial back all that stuff at night, your nervous system, you know what we do during the day, especially what we're learning in this community, right? What we do in the day manifests at night. Our dreams are revelatory, they tell us how much news we're watching. Have you noticed? So you know for really good sleep. You want your brain to not only have it to meditation during the day, but to not be overwhelmed with all these, you know, crazy images and news stories. And now, that's not to say to not be aware of what's going on in the world. Just be judicious about it. You choose the time when you're most able to say okay, I'm in a good place. I understand you know, the the world's going to hell in a handbasket. So what can I do or I will do this and I will do that. And then you go about your day and you do those things. You can incorporate it you can incorporate that awareness, but you certainly don't want it at night when your defenses are down. You're a little more like worn from the day. And this stuff can just go right in. You know. I was watching this series on Netflix and it had to do with magic occur the name of it, somebody is probably watching it, but don't tell me the name again. And it has to do with this. You know, like, like there was really bad magic happening in here, you know, in and I'm like I just have to get through that because it's a really interesting stuff going on. Like what could they do? And you know, and my wife goes why would you watch a show that teaches you about bed magic and how we can destroy people's lives at night before going to bed. Anyway, you're at home. So now there's a new you know, they have a new a new category on Netflix. It's called feel good movies. That if you want to watch anything at night, go to the few good movies. You know don't watch this crazy stuff. And of course a lot of it was on for Halloween and all the horror shows and all that and you just you don't need those images going into your brain before you go to sleep at night. All right, what else do we have Alyssa?
Yeah, we should do um, John asked. I said curious about neck posture and pillows by sleeping.
Well, so neck posture is important. I mean, one thing you don't want to do when you're sleeping is to have your neck crushed like that by your big fluffy pillow that pulls your jaw down and actually closes or compromises your airway more than if your head is back. You know, what do you do in CPR? What's the first thing you do when somebody is having trouble breathing? You pull their head back over their nose and by doing that you're opening the airway. So anyone who was happening knows that problematic you don't want to be having a crunched head so you don't want to fluff your pillow. And if you can get one that supports the neck and allows your head to go back a little bit. That would be the best neck posture. If you sleep on your back on your side, again, as long as you are crunching your throat with your chin to your chest. Most positions are fine on either side. You know, there's you know the Buddha position right the Buddhist sleep position right there and some of the more traditional Tibetan yoga is we'll talk about sleep yoga, as we'll talk about sleeping on the side. You know, I I've been doing a lot of tenza one job Rinpoche stuff and you know, there's that sleeping on your side you're holding, I think your one your right nostril close and you're in that one position. You know what if my nose is a little stuffy, I'm not going to sleep on my right side. If I am more comfortable on my left when I go to sleep, I go to sleep on my left you know so you know you want to be comfortable going to sleep you don't want to make that part of the problem. Okay, so we want to be as comfortable as possible, and I think you're asleep will be just fine. You'll have just as many lucid dreams on your right side as your left side. If you sleep in the position you're most comfortable just worrying about you know, crunching your throat or reducing your airway size. That's the only thing I would say about that.
Mary Rose said I typically only take sleep aids when traveling using either Benadryl or Ambien which would be better for occasional use.
Well, I you know, as much as I don't like Ambien, I would suggest Ambien, better overall than than Benadryl but at home, you know, trying them both out. Excuse me it's always better to try whatever you need on the road or when you're going to be in some special place for different plays. Always try it at home on the weekend when you don't have a lot of expectations for work the next day. Okay, and see what it does to you. Do you have hangover with Benadryl Do you have hangover with Ambien does Ambien that slow release in his ear being that acute release? Which type are we talking about? So you want to decide what works best for you at home. And in terms of your like the health impacts for short term use, whichever one works best for you is fine. Okay. Long term use is not advised for either one. So hopefully that answers it. If you have more questions certainly come on and we can talk about it.
Let's see there was up here we go. Ross said this is my first sleep doctor session and I'm wondering whether we could get into a brief recap of the best sleep hygiene practices.
Ross there's so much already done in that they're full presentations on that. There's a lot of talk on that and some of the earlier ones. You know, it's like, it's like anyone who's taking Andrews meditation class will say if you want to know the details of Shama tie, you would go back to the early sessions. So that's what I'm going to recommend. I will say very briefly. The best sleep hygiene is to get up at the same time every day. Get out as soon as you can get up to get sunlight to help set your internal clock so it's prepared to get you to sleep at the next the next night at the appropriate time. No undue noise arousal, stress in the evening and watch the food intake before bed. That would be a very briefly.
Let's see. Oh, and then I also said also wondering about best practices for someone like me who does a lot of international travel and deadlines that prevent a regular internal clock.
Well, it'll never be normal. And you probably already recognize that. But what you can do is you can use again, melatonin judiciously, knowing which direction you're flying in. How many time zones it's going to be right generally, one or two hours. It takes for every time zone that you're crossing in one direction or the other. It's going to take one or two days to get back to your regular schedule. Now having said that, flying West is easier than flying east. You've probably figured that out already. And the reason that is is because our clock advances with the sun, it doesn't go backwards. Okay, so when we're flying West, we can force ourselves to stay up later and go against our circadian clock in terms of making even though it's turned off, we can force ourselves to stay up by social interaction eating physical activity, and then get adjusted to for instance, California when we fly to California from the East Coast. Now when we fly back here, East is least East is the most difficult because now we're actually fighting our circadian clock, because our circadian clock now has been adjusted to an earlier time to turn off because we've been getting up earlier, you know, a few hours earlier on the west coast and east coast. And so when we want to go to sleep here now our clock wants us to be awake, it will turn off until later. And so you want to adjust. You want to take melatonin at a time when you are going to be flying east. You want to be taking it at a time that's earlier in the day. So your brain starts getting used to getting sleepy earlier. You want to start getting up earlier when you're on that in the you know you in the West timezone compared to the east time zone. So you can adjust but there's only so much you can adjust if you're going somewhere if you're flying six time zones, and you're going for for a weekend or two week, you know, a weekend or three or four days, then you're going to have just enough time there for which you start to shift and then you come back and that's going to be difficult to manage. If you're going somewhere for at least a week. Then you're definitely going to shift but you know how you're going to shift and you can prepare for that. And then several days before returning. You start taking your melatonin earlier. For instance, if you're going to be going back east, or you start taking it later if you're going to be going in the other direction or you start staying up later. But you want to set your clock by the Sun wherever you are, okay, the sooner you can get out in daylight in the new time zone the better off you will be. That's probably the bottom line. Okay, Ross. I see you're up there on the screen. Did you want to come on and say anything else or
let's see me.
There we go. Yeah, no, I would just say that that's, you know, entirely consistent. I travel a lot to Denmark. So that's you know, an eight hour shift from Colorado. And you know, East is really hard West is not so hard. Yeah. Yeah, but yeah, thank you for the for the daylight tip.
Go back and look at some of the earlier ones of these because I have some nice histograms, some nice graphics showing the interaction of the circadian system and our sleep pressure that builds up during the day and why we want to get those to align and what happens when they miss align. So there's a lot in there already, but those are the highlights. Those are really the highlights. Sunlight is an order orders of magnitude better for resetting your clock than anything any bright light we can get indoors. So that's why the outdoor exposure is the best. Thank you. Sure. Sure. Other questions, concerns I'm willing to stay on a little bit longer here. What do we got?
I think you've got up here, son. Oh, gosh, I cannot say this word. What about our show? Oh god.
Yeah, okay, good question. So Ashwagandha is one of those. What did they call? Who's got the word for that? Ashwagandha. It's one of the because a class of agents that well, it's I'll tell you how they work. They work to support wakefulness, when you are fatigued, and bring down bring you down when you're stressed. So they kind of work with the system and they work with whatever direction you need to move in versus where you are. There's a term for that class of agents and I just can't think of it offhand. Ashwagandha is one. Again,
what's the app? Apple kitchen?
Yeah. adaptogen Thank you. Thank you. Adaptogens. Okay, so they're there so they adapt to what your system needs, not unlike the endocannabinoid system, you know, in which the CBD seem to work. So they adapt what your system needs in the moment. So that's why they're pretty good. In there, there are there are numbers, there are a number of them Ashwagandha is one. Ginger can work like that. And that ginger ginseng, sorry ginseng was another one that begins Rhodiola is another one. So there are a number of them. But if you Google I like what Andrew was saying recently he calls it go to guru Google. And and you will learn an awful lot. So if you Google adaptogen you will see a number of these and that's kind of how they work. And again, you know, like any other substance, you should try some you should try to low dose and see what effect it has on your system. You know, the downside to the studies. There's a good side of the studies because they help us get a handle on what's the overall physiologic effect of certain things. But you have to realize that all of the studies done screen out people with everything under the sun except for what they want to look at. And there are very few humans on the planet who have nothing else going on. But what they want to look at in your study. And those few people go into the study. So they are totally atypical to the rest of the world, the rest of the population. So you take whatever you see the studies telling you with a grain of salt, but the more studies that fall in that direction, and the more the greater population seems to like like Ross was confirming that flying East is much more difficult than flying West. And all the data supports that too. So then you start believing that's true. That's what the studies tell us and you can go with them. So, but I feel like we are all unique beings, and you may be the one person who has an outlier effect to that particular medication, CBD, over the counter, under the counter, pharmaceutical, whatever it is, so test these things, even what your doctor prescribes testament home on the weekend, when you have less, less of a commitment to do anything and see what effect it has and note it
great. Got a hand up let me Kathy
okie dokie Hey.
Hi. I wanted to tell you that the chart the sleep chart, yesterday lesson that I use, I show you I was using, so I I had my console at the sleep clinic and you were right. They had never seen anything like that. And they loved it. And and looked at it and because I had a month month worth on there and I looked at it and said This tells me everything. Great. Where'd you get this? I said, Oh, you know somebody who knows what they're talking about? And he said I can tell you right now we're dealing, definitely dealing with insomnia. And then and then all these other things. He said you need to be here. We need to be dealing doing this. And then said, Okay, I'll take you about a month before I can actually get you in for a sleep study. Because you definitely need it and you need an overnight and so I talked to his his scheduler and she said Hey, I just got a cancellation. Can you come in tonight? So I went in that that night not really prepared anyhow, it took them two hours to hook me up. Yeah, I mean, I was everything hooked up. My legs hooked up the the straps to straps across the chest, my head all hooked up. And my eyes hooked up and the cannula across my nose, the cannula across my mouth, on your legs and on my temples and he said Well, hey, how's it going here? And I said what was like a keep hotel? I mean, the only difference is the bed is okay. And you know, it's really well insulated. You know, and I had a horrible, horrible night's sleep. And I asked him, you know, did you see how rough it was? He said yeah, he had a rough night but he said he got good information. So I meet with him next week to go over it but he said I think probably will be set up an appointment for me in January. See the sleep shrink? Okay. He said you're going to need it with stuff going on and he said, I just want to prepare you one of the things we're probably going to have to do is do a week of sleep deprivation, with you of four hours a night to get you back on schedule. It's like oh, okay, so I mean, is that is that
right? So a couple things. One is, you know, I'm glad you raised that, you know, in one of my earlier presentations, I absolutely have a slide of a guy who looks like he's he's strapped in and every single office there's a wire hanging off of that's what it is. But the second part of this is look, even if you have a horrible night as long as you sleep, some what they need is enough sleep to look at what happens physiologically when you do go into the sleep state
and that's what he said he got he got ferried information. But you know, the doctor told me that earlier in the day, maybe they'd have to do is sleep deprivation, a period of time. Well, so while by the time I got home, I was absolutely exhausted. And all I wanted to do all day was sleep and I thought well, I'm already sleep deprived. I'm going to try his idea. And I let myself go to bed until 11 o'clock that night, and I'll be damned if I didn't have a full seven hours sleep and it's the most rested. I have felt in years. Yeah.
It's called sleep restriction therapy. And it's, it's, you know, not a lot of people can do it because the Insomniac comes in and says I can't sleep and the doctor says, Okay, no problem. I'm going to keep you up. And you're like, No, you're not I'm coming. In here to get sleep. Well, it's called sleep restriction therapy because what they do is they look at your sleep logs, and what they see is, oh look, you're in bed this much time and you're only sleeping this much time. So what they do is they then restrict your time in bed to that amount of time with the minimum dose, generally about five hours is the minimum bill. Yeah. And so what and then what happens is people have a really hard time staying up to that late time to go sleep right. And that's because they're trying to figure out what to do with their to keep themselves awake. And so one trick and this is I work with my patients all the time with the same kind of therapy, although I don't do it right off the bat, because I sort of work up to it. And the reason is, it's a psychological turnaround. You want to view your days being longer. Okay, so now you have a day in which you have four more hours or three more hours or two more hours, whatever it is. And so what are you going to do with this found time and I want you to find something you really enjoy doing that you haven't had time to do lately? Usually I'm working with, you know, working mothers and that got 47 kids running around and you know, and the husband's not very much of a help or vice versa. And so I say what is it that you really enjoy doing you know, have time to do and Oh, I love to paint but I never you know, or I do my this or draw or write or whatever it is? I say okay, you now have time to do that. When the rest of the house is sleep. You have found time. So you go find yourself a quiet place and do that activity. Really enjoy it. You're not really staying up later, or you're not really trying to fight falling asleep. You're enjoying your time and that enjoyment usually keeps you awake. Okay. And so that's what you're doing. You're not staying up later to fix your sleep. You're doing something much more enjoyable or getting to something you usually don't have time
for. Oh, that was that that that will be quite a challenge. Because I I'd rather be outside hiking and it's dark.
Have you ever hiked in the dark?
I actually have I haven't done it for a while. Are you thinking that? Yeah, well. I headlamps and stuff. I do it on early mornings. I'll get up at four or five in the morning and yeah,
well now it's at least on the east coast. It's dark at like five 430 It's
just after 430 here. Yeah. So west coast so I'm I mean, that even influences even more like oh god is getting so dark so early. This is painful and I'm wanting to be really careful about I would like to be on the computer at night. I don't want to be on the computer at night.
Alright, so one thing is you want to be safe. So if you're going to walk I would say walk at night just you know just to check tested out with your headlamp and whatnot. If you're doing in your own backyard, turn off all the lights and watch your eyes adapt, see what you can see. But keep yourself safe in your Air and Air you know if you want to walk further use headlamps you know, explore play with the these things. And then in terms of so what you just mentioned something else you were going to do? Oh watch the computer. Right?
I got some of those blue light glasses. Yeah, the orange ones. Yeah, the ones that make everything orange.
Yeah, yeah. Ross you can use these when you need to block light so that you start adapting to where you're going. You could also use these just in the comfort and safety of your own room. Yeah, so if you have those, then the first couple hours you have to stay up. You can use those and use your computer. Okay. Okay. Okay. So I don't think yeah, because then do other things. Yeah, point
when I'm tired and I can't really I'm not I can't, I shouldn't go to sleep yet. Movement is what really helps.
Yes, you can't sit down in that hour before you're trying to now not fall asleep. So the other thing is to plan. Your day is this long now instead of this long. So what are you going to do in these hours? Okay, so I'm going to do this. I'm going to do that. I'm going to do this plan for all those activities. And yes, so maybe light yoga or light stretching Light Movement, tai chi, that kind of thing. As the last activity you do in the evening before bed,
as long as it's not too vigorous because then
light accent down light. Okay, some light stretching. slow movements. Okay, you know, nothing, nothing to activating.
Okay, so and being outside to with my head lap means not a bunch of up and down hills.
Exactly, exactly. Neck ground, right. Slow moving. Do you know I'll have to teach you the fox walk that'll be next time. Oh, yeah. Okay, good. We'll talk about the fox
one. Okay, great. Thank you. Thank you.
Give you a hint at what it does. We begin with the turtle walk. Oh, okay. All right. How are we good, everybody.
Good. One more that came.
Okay. Thanks Kathy. For being a case study for us. By the way. What else we got Alyssa
is Have you heard of Sarah light or que si light therapy lamp from carrots.
From carrots, care X glasses that have light for light intensity. Some glasses.
Oh let's see if we get the clarifies Richard if you're on there and you want to hop on you're more than welcome to
Yeah, I think I think you know what you're talking about. And I haven't
somebody forward me the word
no, this is a lamp
it's a lamb bear or
q i find it on Amazon.
Okay.
They're like or like to do.
Okay, um,
oh, it looks like it is like a sunlamp. So it
Yeah. So what I typically recommend are the Phillips 3520 Dawn simulator lights for a light alarm clock. So they're really good for setting your time in the mornings. Okay, setting your brain because the light goes through your closed eyelids helps your brain wake up and help set that clock. Any other light that you want to use for light exposure during the day like 20 minutes for you know, seasonal affective disorder, that kind of thing. You want it to be 10,000 Lux and you want it to be you know approved for buy optometrists, ophthalmologists for light for UV protection. So I like to use the Philips version of things because I know they've they're really good company and they've tested for protection of your eyes from and there's no UV in their products.
Yet it looks like this one is 10,000 Lux it does say UV free.
Yeah, they're like yeah, they're okay Karolina she now and Tasha. Pull that up. Yeah, but what did you use for what do you want to use it for? Richard?
Hi there. Okay. So yeah, I want to be able to help establish a better sleep pattern. And I just saw this this morning. I could post in the chat box here. Maybe a link from the yoga teacher who did a nine minute review of this that she uses. And it's a if you go on to Amazon and easy way to look for it and you can find it the screen that you look at the white, the white the light that comes into it. You don't look directly at the light. You're looking at it or you're drinking coffee, whatever you're doing, but the idea is to be able to open up the aura field so that it gives you then the proper exposure that you want to have to be able to both be be awake as well as sleep because you've exposed yourself to light.
So I don't know about the horror field but what it's doing is it's resetting your melatonin rhythm. Your circadian clock. That's the source of your circadian clock. And so that's why light exposure in the morning first thing in the morning is critically important for setting your melatonin rhythm. So your melatonin will come on 16 hours later from its first light exposure in the morning. But that light exposure needs to be intense enough in order for it to be told it's morning and to shut down melatonin production. Okay, so 10,000 Lux is great. Or something like a light alarm clock, which gets you up. wakes your brain up enough so that you can then either get more 10,000 Lux light exposure or get right outside. If you get right outside first thing in the morning, even on a cloudy day you will at least get as much as 10,000 Lux on any lamp you can get indoors, okay. So it's it's not so much that these lamps provide what the sun does. It's getting outside so that you're getting light exposure. It's trying to mimic what the sun does for free.
So I just posted in the chat here, this is Melissa West who's in Vancouver. It's like therapy for depression and insomnia. And a review she's done a review here takes about nine minutes YouTube to watch of the Thera light or key
Yeah. Yeah, I know. I know. I know of that device. Now that I see what it is. And again, what I'm saying to you is, if you want it for regulating sleep, okay, it's first thing in the morning, and if you can't get outside, then 20 minutes or so of that light exposure. You know, sitting on top of your computer while you're doing your computer work or sitting on your kitchen table while you're eating breakfast and reading your newspaper. And as long as the light gets to your eyes, it will help set your melatonin rhythm that's what it's doing. Now, further light exposure or light exposure at different times during the day will help keep your mood higher to other mechanisms through other mechanisms, then your circadian rhythm. Okay, so there are two effects of light on the physiology. One is to set that circadian clock so the melatonin turns off and turns on 16 hours later. The other is to work with your dopamine is generally the system in the brain that will respond to light exposure so that you have more of that around during the day and you feel better. Okay, that offsets seasonal affective depression, which is the effect on depression it has. But those are two separate things have its effect on depression and its effect on insomnia. Okay, so you can get the effect on depression by having that light exposure anytime during the day. Okay, anytime during the day. It'll work on said it'll work on depression in general. But for insomnia for that particular rhythm setting your circadian rhythm. You want that light exposure first thing in the morning and you don't want it at night. Unless you're like Ross and you're flying across, you know, like the time zones and having to get back. Okay. All right. Hopefully that's helpful and if you have more questions about it, certainly shoot me an email we'll talk to you offline about that. But you want to be clear there are two major effects of light and that she's talking about in that article and one is for depression, and that's different than what you do for sleep. Okay.
Looks like Kathy's got her hand up one. More time and then we'll
Okay. Okay. I was I lived in Alaska for 35 years. And we used those lights. All of us used to in the winter. Yeah, light boxes. Yeah. We specifically use them in the morning. The first thing in the morning and we used him specifically for depression. Because Alaska has got one of the highest rates of suicide. Yeah, related to light.
Well, your rhythms are just totally shot because you have no you have no signal. You're right on all the time. There's no signal or no light at all. Right.
Right. It's like mostly not a whole lot of light once once we get into this time of year. Yeah, yeah,
actually, that's a good that's a good I think good point because in Alaska or in places of really low light like that, in the winter. You can't have both effects for you because you're using it to tell you it's morning. So that helps your melatonin to have any kind of rhythm whatsoever, and extended amounts of light so that it Ward's off to depression because you need to be out in sunlight. You know, we grew up in sunlight.
There's not a lot of it. The further north you go in Alaska, there is none. I mean, I could go up to the top and on the coast of Maine. I live about about maybe 30 minutes of orange along the horizon.
You know, it'd be interesting to me is to is to look at that in terms of the natives, you know, the Inuit and such, those who have it in their genes. Do they do better? You know, are the high suicide rates more related to others? Who don't who haven't been raised there? You know, having grown.
It's so hard now because, you know, everything's so disrupted. Oh, yeah. Yeah. Oh, and so now we don't know because there's such a high alcoholism rate. Because everything's so disruptive. What I know because I was in schools. All the time is that once we started getting into changes in daylight, we had to start shooting in the villages. We had to change the hours of school time, because the kids would come in early in the morning and fall asleep underneath the tables. And another hole at like 11 o'clock in the morning, because nobody was away.
That's another whole talk. Yeah, we're doing that. You know, California just passed the state law starting schools later, because in general, for that same basic reason only it's on steroids in Alaska, but the same general idea, you know, these kids, their melatonin rhythms have shifted later, and you're forced to get up at six in the morning. It's like four in the morning for us, you know, and it's just, it's just not good. All right, we should let everybody go. We've been on a while. I know this is gonna go and thank you all. For a great you know, for hanging in there. It's always fun to talk sleep as far as I'm concerned. So thank you, everybody. Hi, everybody, if you can wave and come on. Otherwise, we'll see you guys. So thank you for being here and talking sleep. Hey, Ernie. I see the earnings driving. Keep your eye on the road. Ernie. Louisa. Great. Hi, you guys. Thank you. See you all next time. Bye. Bye. Bye bye. Listen, thanks.