Latest / Drama, Darling: A Real Housewives Comedy Podcast / REPLAY Dr. Kashani, SLEEP DOCTOR talks all things SLEEP!

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REPLAY Dr. Kashani, SLEEP DOCTOR talks all things SLEEP! · Drama, Darling: A Real Housewives Comedy Podcast

• 0:05
  Speaker 1: Drama, Darling Drama, Darling Drama, Darling.
• 0:19
  Speaker 2: Okay, welcome in Darlings. This is a very exciting, a
• 0:24
  Speaker 2: very special episode about sleep. Joining me is the incredible
• 0:28
  Speaker 2: doctor Sam Kashani. He is an MD and he is
• 0:32
  Speaker 2: a d ABSM. What do those words and those letters mean?
• 0:36
  Speaker 2: He's going to tell us all about it in a second. Hello,
• 0:39
  Speaker 2: doctor Kashani, how are you welcome?
• 0:41
  Speaker 3: Hi, good evening. Thank you so much for having me.
• 0:44
  Speaker 2: Okay, this is so exciting. So I know how busy
• 0:49
  Speaker 2: you are as a doctor, but doctor Kashani has allowed
• 0:53
  Speaker 2: me some time graciously to ask him a million questions,
• 0:56
  Speaker 2: not only to talk about my own sleep journey, but
• 1:00
  Speaker 2: but I've gotten so many questions from you guys, So
• 1:02
  Speaker 2: thank you so much for submitting them. And we're going
• 1:06
  Speaker 2: to talk all about sleep. So this is a great
• 1:09
  Speaker 2: episode to not be snoozing on. It's not about housewives, guys,
• 1:14
  Speaker 2: but this is going to be very interesting. And actually,
• 1:17
  Speaker 2: doctor Kashani, so many people were just like messaging me
• 1:20
  Speaker 2: when I was asking them for questions and they were like,
• 1:23
  Speaker 2: this is so cool. I cannot wait to hear about this.
• 1:26
  Speaker 2: So you're on my friend, So this is so cool.
• 1:31
  Speaker 2: So I met you up here in Santa Clarita, but
• 1:34
  Speaker 2: because of my own sleep issues. But can you tell
• 1:37
  Speaker 2: me a little bit about, like where you went to school,
• 1:39
  Speaker 2: what your background is, and what brought you to study
• 1:42
  Speaker 2: sleep medicine.
• 1:44
  Speaker 3: Yeah, definitely, so I, as I was saying a moment ago,
• 1:48
  Speaker 3: I actually am a film school graduate. My bachelor's degree
• 1:51
  Speaker 3: is in cinema on television Arts. My passion initially was
• 1:55
  Speaker 3: screenwriting and producing, so got my degree in that and
• 2:00
  Speaker 3: I started working in the industry, which was a lot
• 2:01
  Speaker 3: of fun. I got to work on some pretty big movies.
• 2:04
  Speaker 3: I got to work for Sony Picture Studios for a
• 2:06
  Speaker 3: little while, which was a lot of fun.
• 2:07
  Speaker 4: Rash, no kidding, Yeah, it.
• 2:10
  Speaker 3: Was pretty awesome. And then what.
• 2:12
  Speaker 4: Are some of the movies you worked on?
• 2:13
  Speaker 3: I have to ask, sure, Shutter Island.
• 2:17
  Speaker 2: Oh my gosh, that is such a phenomenal movie.
• 2:22
  Speaker 4: Okay, what else? What else?
• 2:25
  Speaker 3: Other movies that I was working on include Zodiac with
• 2:29
  Speaker 3: Jake Chillenhall that was about the Zodiac murders in San Francisco.
• 2:32
  Speaker 1: Wow.
• 2:34
  Speaker 3: Yeah, so a couple of cool movies like that. But
• 2:36
  Speaker 3: you know, after a while, I kind of got tired
• 2:37
  Speaker 3: of working for the big corporation or the big studio,
• 2:40
  Speaker 3: just because you know, it's a lot of fun and
• 2:42
  Speaker 3: it's a really exciting environment and watching sort of you
• 2:45
  Speaker 3: know how the industry works. But I realized that my
• 2:49
  Speaker 3: whole reason for doing this was I wanted to be
• 2:50
  Speaker 3: creative and make my own films. So once I quit
• 2:53
  Speaker 3: working for Sony, I started producing my own films and
• 2:55
  Speaker 3: I actually got to make a few documentary films that
• 2:58
  Speaker 3: had some pretty decent success. I got to show them
• 3:01
  Speaker 3: at film festivals internationally and show them the BBC, so
• 3:04
  Speaker 3: that was pretty cool.
• 3:05
  Speaker 1: Wow, you know.
• 3:07
  Speaker 2: Those films accessible for us to watch?
• 3:10
  Speaker 3: Definitely. Yeah, I have clips of them on YouTube, and
• 3:13
  Speaker 3: then I sell one of them on Amazon. Okay, of
• 3:16
  Speaker 3: course you get a free comfy obviously, but yeah, you know,
• 3:23
  Speaker 3: after all that, it was really nice kind of traveling
• 3:25
  Speaker 3: and showing the film in different festivals and speaking and whatnot.
• 3:28
  Speaker 3: But one day I woke up a broke filmmaker and
• 3:31
  Speaker 3: decided that was probably the sign to go back to school.
• 3:34
  Speaker 3: And initially I was thinking about it. Told me about it,
• 3:40
  Speaker 3: especially in that industry, but you know, initially in my
• 3:43
  Speaker 3: mind I was thinking, maybe I should go get a
• 3:44
  Speaker 3: master's in film and then you know, work as a
• 3:46
  Speaker 3: film professor as a nine to five and then still
• 3:48
  Speaker 3: do movies on the side. But that didn't really make
• 3:51
  Speaker 3: a whole lot of sense to me. So fast forward,
• 3:53
  Speaker 3: long story short, I just figured that the best thing
• 3:56
  Speaker 3: would be to go back to school to establish a
• 3:58
  Speaker 3: career that would provide me stability and that I can
• 4:00
  Speaker 3: always revisit film later on.
• 4:03
  Speaker 2: So you're like, oh, well, just be a doctor. I mean,
• 4:05
  Speaker 2: who does that, Like that's insane. Oh my gosh, okay, sorry,
• 4:11
  Speaker 2: go on, that's so cool.
• 4:13
  Speaker 4: But you're like, okay, I'm going to go do this.
• 4:15
  Speaker 3: That was pretty much it. And you know, I don't
• 4:17
  Speaker 3: recommend that as a rationale to choose medical school. It
• 4:20
  Speaker 3: should not be something that you do with the idea
• 4:22
  Speaker 3: of going back into film or something later on. It's
• 4:26
  Speaker 3: really medical school is obviously at medicine, and a career
• 4:29
  Speaker 3: in medicine is a tremendous commitment. So I kind of
• 4:32
  Speaker 3: went in thinking, all right, I'll just be a doctor
• 4:34
  Speaker 3: and then I can make movies later. And then once
• 4:37
  Speaker 3: I got into med school, I was like, okay, this
• 4:38
  Speaker 3: is a little bit more involved. I really have to
• 4:40
  Speaker 3: kind of sync myself in this in this information in
• 4:43
  Speaker 3: this study. So I just kind of really really dove
• 4:47
  Speaker 3: deep into med school. I studied really hard, never having
• 4:49
  Speaker 3: taken a science class before in undergrad or anything like that.
• 4:53
  Speaker 3: And then as far as picking sleep medicine, I just
• 4:56
  Speaker 3: wanted to try different specialties. I really liked a little
• 4:58
  Speaker 3: bit of everything, but I tried sleep medicine as a
• 5:01
  Speaker 3: resident in training. I realized that there was a lot
• 5:04
  Speaker 3: more to sleep medicine than just sleep apnea and seapath machines.
• 5:09
  Speaker 3: That's kind of where my interest in sleep medicine started.
• 5:11
  Speaker 3: And it's a really nice marriage of neurology and pulmonary
• 5:14
  Speaker 3: medicine and behavioral medicine all than one.
• 5:16
  Speaker 2: So yeah, it is Oh my gosh, that is just
• 5:19
  Speaker 2: so fascinating. And you went to school for medicine. Where
• 5:24
  Speaker 2: did you go?
• 5:25
  Speaker 3: I went to the University of Guadalajara in Mexico.
• 5:28
  Speaker 4: Wow.
• 5:29
  Speaker 3: It's an international school that's English speaking. It's mainly for
• 5:32
  Speaker 3: American students. And it's cool because you get to do
• 5:35
  Speaker 3: essentially half of medical school at the main campus in
• 5:38
  Speaker 3: Mexico and then your second half of med school because
• 5:41
  Speaker 3: usually the third and fourth years of med school are
• 5:43
  Speaker 3: clinical years, where you're in hospitals and clinic settings. So
• 5:46
  Speaker 3: the way that they have it set up is that
• 5:48
  Speaker 3: you do the entire third and fourth year in United
• 5:50
  Speaker 3: States hospitals. So it was pretty cool. I got to
• 5:53
  Speaker 3: be in Mexico for two years, and then I did
• 5:54
  Speaker 3: my years three and four in New York, and then
• 5:56
  Speaker 3: I graduated with my MD, and then I came back
• 5:59
  Speaker 3: to California for residency and then I did fellowship in
• 6:02
  Speaker 3: sleep medicine at UCLA.
• 6:04
  Speaker 4: Wow, that's amazing. What a story. Mine is so similar.
• 6:11
  Speaker 4: We had so much in common. Oh wow, that is
• 6:15
  Speaker 4: so cool.
• 6:15
  Speaker 2: Well, I'm so lucky that I got to meet you,
• 6:17
  Speaker 2: because you know, I've always had issues with my sleep
• 6:20
  Speaker 2: since I was younger, and I finally did something about it,
• 6:25
  Speaker 2: and I was like, I have got to talk to
• 6:27
  Speaker 2: someone about it, and it's really changed my life. And
• 6:31
  Speaker 2: it is just such a fascinating field, I believe, and
• 6:35
  Speaker 2: I feel like it's also what's the word I'm looking for?
• 6:40
  Speaker 2: Under appreciated, not utilized enough? Why is that? Why don't
• 6:46
  Speaker 2: we get more opportunities to study our sleep or have
• 6:50
  Speaker 2: insurance cover certain things?
• 6:52
  Speaker 4: Do you have answers for that?
• 6:54
  Speaker 3: What an important question? And this is something that we
• 6:57
  Speaker 3: talk about a lot in terms of just sort of
• 6:59
  Speaker 3: sort of where sleep medicine and sleep disorders fit within
• 7:02
  Speaker 3: the landscape of health care and medicine, just because, first
• 7:05
  Speaker 3: of all, it's very multifactorial, and it starts sometimes with
• 7:09
  Speaker 3: people themselves. A lot of people have sleep issues and
• 7:12
  Speaker 3: don't know that there's such thing as a sleep doctor
• 7:14
  Speaker 3: that they can see, or a sleep study or sleep
• 7:16
  Speaker 3: test that they can complete to diagnose or evaluate what
• 7:19
  Speaker 3: their problem is. Believe it or not, there are a
• 7:22
  Speaker 3: lot of doctors and clinicians out there that don't know
• 7:24
  Speaker 3: that sleep medicine is a specialty and that they are
• 7:27
  Speaker 3: sleep specific or sleep specializing physicians like myself. So I
• 7:31
  Speaker 3: think awareness is a big part of it, a lack
• 7:33
  Speaker 3: of awareness in the general population as well as a
• 7:35
  Speaker 3: lack of awareness even in the healthcare population in the
• 7:38
  Speaker 3: healthcare setting. So that's one part of it. And then
• 7:41
  Speaker 3: another thing is sleep disorders are felt differently by every
• 7:45
  Speaker 3: single person. I mean, when we're talking about symptoms like fatigue,
• 7:49
  Speaker 3: daytime sleepiness, difficulties with concentration, irritability, and all the number
• 7:54
  Speaker 3: of other daytime issues that we see associated with sleep disorders.
• 7:57
  Speaker 3: Number One, they're not terribly specific, because there's only one
• 8:00
  Speaker 3: million reasons to be tired during the daytime and number
• 8:04
  Speaker 3: two a lot of people. Because human beings are so
• 8:06
  Speaker 3: good at adapting, we often kind of on our own
• 8:08
  Speaker 3: determine our own sort of remedies, whether it's you know,
• 8:11
  Speaker 3: scheduling an app in the afternoon, or having a certain
• 8:13
  Speaker 3: amount of caffeine to get through the day, or making
• 8:16
  Speaker 3: sure we get you know, a certain amount of sleep
• 8:18
  Speaker 3: at night time. So we have our own kind of
• 8:20
  Speaker 3: ways to adapt to things like sleep issues, and sometimes
• 8:23
  Speaker 3: that will also kind of prevent people from being evaluated
• 8:26
  Speaker 3: for sleep issues. So all that to say that it
• 8:29
  Speaker 3: is very multi factorial, everything from perception of symptoms to
• 8:32
  Speaker 3: just overall awareness of sleep as a specialty.
• 8:35
  Speaker 2: Yeah, I was wondering, you know, did you have any
• 8:39
  Speaker 2: sleep issues as you were growing up or was any
• 8:43
  Speaker 2: of that part of your story at getting into this.
• 8:46
  Speaker 3: Not exactly, but I did have as far as sleep issues.
• 8:49
  Speaker 3: I mean, I guess everybody experiences insomnia from time to time,
• 8:53
  Speaker 3: which we define insomnia as any difficulty falling asleep, any
• 8:56
  Speaker 3: difficulty staying asleep, or both of those things. We all
• 8:59
  Speaker 3: experiperience it. Here and there transiently. Sometimes it can be chronic.
• 9:03
  Speaker 3: But I guess the only sleep disorder that I can
• 9:05
  Speaker 3: think of that I have in my history is when
• 9:07
  Speaker 3: I was a teenager, like many other teenagers, probably well
• 9:10
  Speaker 3: over fifty percent of teenagers globally, I experienced what's called
• 9:14
  Speaker 3: delayed sleep face syndrome, which is a mouthful to just
• 9:17
  Speaker 3: say that a person who is sleeping later and waking
• 9:20
  Speaker 3: up later, which is very typical for the teenage age group, right,
• 9:23
  Speaker 3: And you know, you have a teenager very often who
• 9:26
  Speaker 3: has fallen asleep at four in the morning and fallen
• 9:28
  Speaker 3: asleep in class because they have to wake up at seven.
• 9:30
  Speaker 3: But then on the weekends they're sleeping till two three pm.
• 9:32
  Speaker 3: So that was definitely me. But not that that's also
• 9:36
  Speaker 3: not like this concerning or like a scary sleep disorder,
• 9:39
  Speaker 3: because that usually works itself out with right person getting
• 9:42
  Speaker 3: older and having to work.
• 9:44
  Speaker 2: Yes, exactly, that makes so much sense. Well with my experience,
• 9:50
  Speaker 2: it's it's always, you know, you just sort of feel like, well,
• 9:52
  Speaker 2: everyone is tired, and I've always felt like that my
• 9:56
  Speaker 2: whole life. Everyone's tired. They're just hustling, and that's what
• 9:59
  Speaker 2: you do. So I, as you guys. Know, I've talked
• 10:04
  Speaker 2: a little bit about some of my sleep issues. I
• 10:07
  Speaker 2: brought it to the forefront because of this sleep study
• 10:10
  Speaker 2: that I got to take, which was wild. If you
• 10:14
  Speaker 2: saw the graphic that I posted for this episode, you
• 10:17
  Speaker 2: will have seen me in the corner, you know, hooked
• 10:19
  Speaker 2: up to all of this stuff. So when I first
• 10:23
  Speaker 2: went and saw doctor Kashani, you know, it was actually
• 10:26
  Speaker 2: so cool and it was sort of fun because you
• 10:29
  Speaker 2: ended up you talked to my husband for a little while.
• 10:31
  Speaker 2: We got him on the phone a couple times actually,
• 10:34
  Speaker 2: because as you had mentioned, you know, what's better than
• 10:37
  Speaker 2: having a great witness to your sleep than the person who's.
• 10:41
  Speaker 4: Right next to you.
• 10:42
  Speaker 2: And and sure Brett really had some things to say,
• 10:46
  Speaker 2: so he was able to clarify a few things for
• 10:48
  Speaker 2: doctor Kashani what was happening. And you had diagnosed me
• 10:53
  Speaker 2: originally what you thought was potentially idiopathic hypersomnia, and so
• 11:00
  Speaker 2: we sort of landed there. And then the idea was
• 11:03
  Speaker 2: that I would eventually get a sleep study to see
• 11:07
  Speaker 2: what that would tell us, which I ended up doing,
• 11:09
  Speaker 2: and essentially it landed right back where you had started,
• 11:13
  Speaker 2: which was it pretty much told us that based on
• 11:17
  Speaker 2: what had happened in the sleep study. So could you
• 11:20
  Speaker 2: explain a little bit about what happens in a sleep
• 11:23
  Speaker 2: study that isn't just for finding out if you have apnea,
• 11:27
  Speaker 2: because there are two kinds. I did the sleep apnea
• 11:29
  Speaker 2: test at home, so you need to talk a little
• 11:31
  Speaker 2: bit about that.
• 11:33
  Speaker 3: Absolutely. So the sleep study that you did is a
• 11:36
  Speaker 3: two part sleep study. There's a nighttime portion and then
• 11:39
  Speaker 3: the daytime portion. Now, the nighttime portion of the study
• 11:42
  Speaker 3: you did is a very typical overnight sleep study that
• 11:45
  Speaker 3: we do in the center. It's similar to a home
• 11:47
  Speaker 3: sleep test, and that we're looking for kind of the
• 11:49
  Speaker 3: simple things like sleep apnea. But we have to do
• 11:53
  Speaker 3: that nighttime test before we do a daytime test to
• 11:55
  Speaker 3: make sure that your nighttime sleep is normal and that
• 11:57
  Speaker 3: you got enough sleep before you did the daytime test,
• 12:00
  Speaker 3: because the daytime test is really where we're diagnosing things
• 12:03
  Speaker 3: like narcolepsy at idiopathic hypersomnia. So the way that the
• 12:06
  Speaker 3: daytime test works is so first of all, the nighttime
• 12:09
  Speaker 3: you check in at night, you get hooked up to
• 12:11
  Speaker 3: the wires. There's brain wave monitoring, there's muscle monitoring with
• 12:15
  Speaker 3: wires on your legs, there's heart monitoring with wires on
• 12:17
  Speaker 3: the chest. There's respiratory or breathing monitoring with an oxygen
• 12:21
  Speaker 3: monitor on your finger and a canula up here. So
• 12:23
  Speaker 3: you get all wired up and then you sleep until
• 12:26
  Speaker 3: about six o'clock in the morning, and that's that. When
• 12:29
  Speaker 3: you wake up in the morning, you have a little
• 12:31
  Speaker 3: bit of a break, and then the daytime Sleep Touch.
• 12:33
  Speaker 3: The daytime Sleep test works a little bit differently. You
• 12:35
  Speaker 3: get five opportunities to take a nap, and each of
• 12:38
  Speaker 3: these nap opportunities is about twenty minutes in duration and
• 12:42
  Speaker 3: they are about two hours apart from each other. So
• 12:44
  Speaker 3: for example, nap number one would start at seven am
• 12:47
  Speaker 3: and go to seven twenty. Then you're free to hang
• 12:49
  Speaker 3: out or DM your sleep doctor on Instagram for example.
• 12:52
  Speaker 2: Yeah, and I got to keep a jud you got
• 12:54
  Speaker 2: to keep you up to speed on what's going on
• 12:56
  Speaker 2: that sleeps.
• 12:56
  Speaker 3: I loved. That was definitely. And then each two hours,
• 13:01
  Speaker 3: as two hours goes by, nine am to nine twenty
• 13:04
  Speaker 3: would be the second nap, and then eleven am to
• 13:06
  Speaker 3: eleven twenty the third nap, and so on and so forth.
• 13:08
  Speaker 3: And the way that we did the reason that we
• 13:10
  Speaker 3: do the test this way, it's not a perfect test,
• 13:12
  Speaker 3: but essentially what we're looking at is how quickly did
• 13:16
  Speaker 3: you fall asleep on each of these five naps, And
• 13:19
  Speaker 3: given that the first one starts at seven and the
• 13:21
  Speaker 3: last one ends like pretty much in the mid afternoon,
• 13:24
  Speaker 3: it kind of gives you an idea of how sleepy
• 13:26
  Speaker 3: are you during the daytime and how quickly can you
• 13:28
  Speaker 3: lapse into a drowsy state or a sleep state at
• 13:30
  Speaker 3: any given time of day from seven am to the
• 13:32
  Speaker 3: mid afternoon. So what we do is we take the
• 13:35
  Speaker 3: time that it took you to fall asleep across the
• 13:37
  Speaker 3: five naps and we average it. And the criteria for
• 13:40
  Speaker 3: what's considered pathologic sleepiness is if you fell asleep across
• 13:44
  Speaker 3: the five naps in an average of eight minutes or less,
• 13:47
  Speaker 3: and then as far as if you did meet that criteria,
• 13:51
  Speaker 3: then the diagnosis either becomes narcolepsy or idiopathic hypersomnia. What
• 13:55
  Speaker 3: separates those two from each other is if on those naps,
• 13:58
  Speaker 3: if you hit rem sleep abnormally early, which is a
• 14:01
  Speaker 3: feature of narcilepsy, then that supports the narcilepsy diagnosis. But
• 14:05
  Speaker 3: if you don't hit rem sleep on any of those
• 14:07
  Speaker 3: five naps, and you just meant the first criteria of
• 14:10
  Speaker 3: eight minutes or less than the diagnosis is idiopathic hypersong.
• 14:14
  Speaker 2: Wow, spoken like a true a doctor. I mean, you
• 14:17
  Speaker 2: really encapsulated that perfectly. And when I found out when
• 14:21
  Speaker 2: they were like, you know, when you just explained you
• 14:23
  Speaker 2: get five sleep opportunities to take a nap, because I
• 14:27
  Speaker 2: think to myself, oh my god, five opportunities to take
• 14:31
  Speaker 2: a nap.
• 14:32
  Speaker 4: That sounds like a dream.
• 14:34
  Speaker 3: You know.
• 14:35
  Speaker 2: I kind of took this as a little bit of
• 14:37
  Speaker 2: a vacation. Yes, it's uncomfortable. The night was uncomfortable mostly,
• 14:43
  Speaker 2: but then when I got to the daytime, I was
• 14:46
  Speaker 2: you know, every single time I took those naps, you
• 14:48
  Speaker 2: know what happened. I fell asleep under eight minutes, I
• 14:51
  Speaker 2: think with everyone, which is why we ended up with
• 14:55
  Speaker 2: idiopathic hypersomnia. I did not hit the rem sleep within
• 15:00
  Speaker 2: that time, so that excluded me from the narcolepsy club,
• 15:06
  Speaker 2: and so I remain over with idiopathic hypersomnia. One of
• 15:11
  Speaker 2: the things that really blew my mind was when you
• 15:15
  Speaker 2: had asked me, when you take a nap because I'm
• 15:19
  Speaker 2: so exhausted during the day all my life and I
• 15:21
  Speaker 2: just pushed through, push through. But if I ever get
• 15:24
  Speaker 2: an opportunity to take a nap, I'll take it. But
• 15:27
  Speaker 2: I don't like taking it because I don't want to
• 15:30
  Speaker 2: wake up, and when I do wake up, I feel
• 15:35
  Speaker 2: worse like I don't feel relieved, I don't feel refreshed.
• 15:39
  Speaker 2: And you would ask me that specific question, you said,
• 15:42
  Speaker 2: when you wake up from a nap, do you feel refreshed?
• 15:45
  Speaker 2: And I said, you know what, I don't.
• 15:47
  Speaker 4: I don't know.
• 15:49
  Speaker 2: And so the difference between would you say, someone who
• 15:53
  Speaker 2: has narcolepsy and then the hypersomnia, that's part of it.
• 15:56
  Speaker 4: The difference between those.
• 15:57
  Speaker 3: Two definitely up a really good point. Now, with that said,
• 16:03
  Speaker 3: with IH and with narcolepsy, this is like a controversial
• 16:08
  Speaker 3: conversation in our field. When all of the sleep nerds
• 16:10
  Speaker 3: get together at the conferences that we go to, there's
• 16:14
  Speaker 3: always kind of a lot of talk about is IH
• 16:17
  Speaker 3: something separate from narcolepsy? Is it just another is it
• 16:20
  Speaker 3: just a type or a type two narcolepsy as we
• 16:22
  Speaker 3: would call it, and are we just giving it this
• 16:25
  Speaker 3: name for no reason when in fact, a lot of
• 16:27
  Speaker 3: these people who have IH, or who test positive for
• 16:30
  Speaker 3: IEH may have features of narcolepsy, while some people with
• 16:33
  Speaker 3: narcolepsy have you know, they may test positive for IH
• 16:35
  Speaker 3: and vice versa. So all that to say, there's a
• 16:38
  Speaker 3: lot of overlap between these two and many of us
• 16:40
  Speaker 3: in the sleep world actually don't necessarily separate these two.
• 16:43
  Speaker 3: They're seen as on one spectrum of hypersnolens. Bottom line,
• 16:48
  Speaker 3: these are all words. But if we're talking the classic
• 16:51
  Speaker 3: textbook kind of definition or picture of each one of
• 16:54
  Speaker 3: these two entities. So the classic narcolepsy picture is excessive
• 16:58
  Speaker 3: sleepiness that's always there. It's the prominent core feature, but
• 17:02
  Speaker 3: the secondary or ancillary symptoms they have might be different, Like,
• 17:05
  Speaker 3: for example, a lot of people with narcolepsy, and by
• 17:07
  Speaker 3: the way, before I say these ancillary symptoms, not even
• 17:09
  Speaker 3: everybody has these. What everybody always has is sleepiness that's
• 17:13
  Speaker 3: always present. But the secondary symptoms that are more narcolepsy
• 17:17
  Speaker 3: like are hallucinations in the moments that you're just falling asleep.
• 17:21
  Speaker 3: A lot of times people might feel like they started
• 17:23
  Speaker 3: dreaming already before they even fell asleep, or they might
• 17:26
  Speaker 3: see shadows or figures in their room, or hear voices
• 17:28
  Speaker 3: as they're just kind of drifting off similarly as they're
• 17:32
  Speaker 3: coming out of sleep, so like as they're just entering wakefulness,
• 17:35
  Speaker 3: similar they might have hallucinations there. So it's like kind
• 17:38
  Speaker 3: of at those transitions into and out of sleep that
• 17:40
  Speaker 3: they have these weird sort of phenomena. Similarly, also at
• 17:44
  Speaker 3: the sleep to wake and wake to sleep transition. A
• 17:47
  Speaker 3: lot of people with narcalypsy experience recurring sleep paralysis, which
• 17:51
  Speaker 3: sleep paralysis if anybody's ever had it, it's that scary
• 17:53
  Speaker 3: feeling where you feel like you just can't move, you're frozen.
• 17:56
  Speaker 3: You try to move or try to make a noise
• 17:58
  Speaker 3: and you can't. And sometimes people will have the two
• 18:00
  Speaker 3: of these things together where they'll have a hallucination and
• 18:03
  Speaker 3: be paralyzed at the same moment, which can be very scary.
• 18:06
  Speaker 3: Of course, now with that said, the healthy population of people,
• 18:11
  Speaker 3: we can all experience sleep paralysis and hallucinations falling asleep
• 18:15
  Speaker 3: or exiting sleep, but it just so happens that the
• 18:17
  Speaker 3: classic narcolepsy picture is the sleepiness plus these other things.
• 18:21
  Speaker 3: And then, as to what you were saying, the daytime
• 18:24
  Speaker 3: naps typically in narcolepsy are refreshing, and so that's pretty
• 18:29
  Speaker 3: much that's narcylepsy. Now, as far as IH, the classic
• 18:33
  Speaker 3: IEH picture is once again excessive sleepiness. That's always the
• 18:36
  Speaker 3: core feature, but as far as the daytime, another thing
• 18:40
  Speaker 3: that a lot of people with IH report is brain
• 18:42
  Speaker 3: fog as well as unrefreshing naps regardless of how sleepy
• 18:46
  Speaker 3: they feel. So they might feel really really sleepy and
• 18:48
  Speaker 3: the need to sleep, but they don't wake up feeling refreshed.
• 18:51
  Speaker 3: And similarly, a lot of people with IH when they
• 18:53
  Speaker 3: wake up in the morning from their nocturnal sleep, they
• 18:56
  Speaker 3: experience a lot of sleep inertia, which is like that feeling, yeah,
• 19:00
  Speaker 3: it's like really hard to wake the brain up kind
• 19:02
  Speaker 3: of feeling in the morning. And then one other thing
• 19:05
  Speaker 3: about IH classically is compared to narcolepsi, a lot of
• 19:08
  Speaker 3: people with IH will have very prolonged sleep times. When
• 19:11
  Speaker 3: they're left to sleep ad lib with no alarm clock,
• 19:14
  Speaker 3: they can sleep for like twelve fourteen, sometimes more hours
• 19:17
  Speaker 3: than that. So those are kind of like the textbook
• 19:20
  Speaker 3: descriptions of both, but again a lot of people fit
• 19:22
  Speaker 3: in between. A lot of people have features of one
• 19:24
  Speaker 3: and might actually test for the other, and not to
• 19:26
  Speaker 3: mention treatment is identical between the two so this is
• 19:30
  Speaker 3: all part of the reason why many of us feel
• 19:32
  Speaker 3: like this really just represents one spectrum.
• 19:34
  Speaker 4: Wow.
• 19:35
  Speaker 2: I mean, so when you go to like a sleep convention,
• 19:39
  Speaker 2: what side of the room are you on? And are
• 19:42
  Speaker 2: you ready to fight some other people?
• 19:44
  Speaker 4: I'm kidding?
• 19:46
  Speaker 2: So where do you stand with the with the difference
• 19:49
  Speaker 2: and the controversy with you know, having IH in its
• 19:53
  Speaker 2: own category, and you know, where are you with that
• 19:57
  Speaker 2: good question?
• 19:58
  Speaker 3: I'm kind of undecided, to be honest with you, And
• 20:01
  Speaker 3: I say undecided because even though I do believe that
• 20:04
  Speaker 3: these two different entities, I mean, their classic pictures present
• 20:07
  Speaker 3: very differently from one another, despite the overlap of sleepiness.
• 20:11
  Speaker 3: But at the same time, I've seen so many people
• 20:14
  Speaker 3: the whole testing having one and testing positive for the
• 20:17
  Speaker 3: other thing has happened to me so many times that
• 20:20
  Speaker 3: that's kind of what makes me think, Okay, are we
• 20:22
  Speaker 3: actually talking about the same thing? And maybe these people
• 20:24
  Speaker 3: just express the symptoms differently or the syndrome differently. But
• 20:28
  Speaker 3: I also try not to get too tied up into
• 20:30
  Speaker 3: these into these things, because at the end of the day,
• 20:33
  Speaker 3: all these things are just words.
• 20:34
  Speaker 2: You don't want the drama, darling, I want the dramas
• 20:37
  Speaker 2: that well, I'm gonna show up at one of those
• 20:41
  Speaker 2: conventions and just strow the pot and be like, guess
• 20:44
  Speaker 2: what I think. Let me just also clarify or ask
• 20:50
  Speaker 2: for some clarification. If you have sleep paralysis and hallucinations,
• 20:57
  Speaker 2: that doesn't necessarily mean that you have IH or narcolepsy
• 21:04
  Speaker 2: exactly correct.
• 21:05
  Speaker 3: In fact, the most common triggers are the most common
• 21:08
  Speaker 3: causes of sleep paralysis, episodes and hallucinations at the sleep
• 21:12
  Speaker 3: wake and wake sleep transitions is sleep deprivation and stress.
• 21:16
  Speaker 3: So I, for example, recently took a trip to overseas
• 21:20
  Speaker 3: and it was a really long flight. It took like
• 21:22
  Speaker 3: twenty something hours just to get back to LA and
• 21:25
  Speaker 3: not to mention, I'm super sleep deprived and adjusted to
• 21:27
  Speaker 3: the time zone in the other country. And then as
• 21:30
  Speaker 3: soon as I got back home, I took a nap
• 21:31
  Speaker 3: in the middle of the day because I was so sleepy,
• 21:33
  Speaker 3: and then I woke up with a really intense sleep
• 21:35
  Speaker 3: paralysis and a hallucination to go with it, no.
• 21:38
  Speaker 4: Way, Oh my gosh.
• 21:41
  Speaker 3: Yeah, so those things can happen to anybody, Oh my gosh.
• 21:44
  Speaker 2: So yes, I've experienced sleep paralysis since I was young,
• 21:49
  Speaker 2: I've experienced hallucinations since I was young, not as much
• 21:53
  Speaker 2: when I was young, but I have noticed now that
• 21:57
  Speaker 2: makes sense when you bring stress into it, because I've
• 22:01
  Speaker 2: noticed that they kind of ebb and flow. You know.
• 22:05
  Speaker 2: I haven't had a lot of hallucinations, the terrifying ones
• 22:10
  Speaker 2: in several years that are really bad. But there was
• 22:13
  Speaker 2: a time where I would just see like a like
• 22:17
  Speaker 2: a serpent in front of me, like coming at me.
• 22:20
  Speaker 2: I'm like, oh, great, a serpent, how fun? Large insects
• 22:26
  Speaker 2: crawling up the walls. Yes, snakes figures like you said.
• 22:35
  Speaker 2: And now what I normally do in terms of my
• 22:38
  Speaker 2: hallucinations happen. As you had mentioned, there's a difference between
• 22:42
  Speaker 2: you know, falling asleep and having them and then waking up.
• 22:45
  Speaker 2: Mine are usually waking up and I'm having them, and
• 22:47
  Speaker 2: then I'm in the middle of the night going why
• 22:49
  Speaker 2: am I sitting up and staring at my my beautiful
• 22:52
  Speaker 2: pictures on the wall that I thought were clowns, you know, dancing,
• 22:56
  Speaker 2: you know on a cruise ship. You know, they're not
• 22:59
  Speaker 2: as scary, They're weird. And I usually fixate on something
• 23:02
  Speaker 2: in the room and it turns into something else. So
• 23:06
  Speaker 2: that's you know I could list off a million things,
• 23:08
  Speaker 2: but I also want to ask you, if you what
• 23:14
  Speaker 2: is your opinion on ghosts, because now that we know
• 23:19
  Speaker 2: about sleep paralysis and hallucinations when you're dreaming, so many people. Oh,
• 23:27
  Speaker 2: I think I lost you. Okay, we got disconnected. Literally
• 23:31
  Speaker 2: he went his screen went completely black. So I think
• 23:34
  Speaker 2: I know his answer. He believes in ghosts, because that
• 23:37
  Speaker 2: was paranormal activity.
• 23:39
  Speaker 4: So getting back to my question, do.
• 23:42
  Speaker 2: You believe that most of the paranormal activity or people
• 23:47
  Speaker 2: seeing things are due to sleep hallucinations?
• 23:51
  Speaker 3: You know, it's interesting. I was asked a similar question
• 23:54
  Speaker 3: on another podcast recently.
• 23:56
  Speaker 4: And me personally, I made up a question. No, I'm kidding.
• 24:03
  Speaker 3: No, you know, I'm a very spiritual person honestly, but
• 24:07
  Speaker 3: this is what I do for a living, so it's
• 24:09
  Speaker 3: kind of hard for me to separate things like this
• 24:11
  Speaker 3: from just knowing that it's neurologic phenomena. Again, I don't
• 24:16
  Speaker 3: want to sound like a boring doctor and sound the
• 24:18
  Speaker 3: church and.
• 24:18
  Speaker 4: State, Church and state.
• 24:19
  Speaker 2: I get it, you know it's the right answer. Well,
• 24:23
  Speaker 2: I can say my opinion, and I think it's a
• 24:25
  Speaker 2: little bit of both. I mean, I think that there
• 24:28
  Speaker 2: most of the time when people see something, it's usually
• 24:32
  Speaker 2: in the middle of the night, you know what I mean, Like,
• 24:34
  Speaker 2: come on, it's probably a hallucination.
• 24:37
  Speaker 4: I mean, let's be real.
• 24:39
  Speaker 2: If it's during the day, different story. But if you're
• 24:42
  Speaker 2: napping and it's during the day and you see it
• 24:44
  Speaker 2: during the day.
• 24:45
  Speaker 4: It's probably a sleepy illucination.
• 24:47
  Speaker 2: But that doesn't mean that I don't believe in those
• 24:51
  Speaker 2: types of activities and things of that nature. I am
• 24:54
  Speaker 2: totally open to that. So that being said, I just
• 24:57
  Speaker 2: never thought about that until recently. You know, it explains
• 25:02
  Speaker 2: a lot. I could have said that every place I've
• 25:06
  Speaker 2: lived in has been haunted because I'm seeing the craziest things,
• 25:10
  Speaker 2: but I never did because you know, I guess I
• 25:13
  Speaker 2: just knew obvious sleeping. And Okay, so doctor Kashani, we're
• 25:18
  Speaker 2: going to take a quick break and then when we
• 25:20
  Speaker 2: come back, I'm going to ask you all the Darlings
• 25:22
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• 25:25
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  Speaker 4: Like there you.
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  Speaker 2: Are just minding your business when a terrible, unwanted thought
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  Speaker 2: sends you spiraling. Maybe it's my partner doesn't really love
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  Speaker 2: me in the middle of a romantic date they planned
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  Speaker 2: for you. Or maybe run into a friend you haven't
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  Speaker 2: talked to in a while and your mind immediately goes
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  Speaker 2: to They probably think I'm a terrible person.
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  Speaker 4: That's why we.
• 30:17
  Speaker 2: Haven't been in touch. These thoughts can feel so real
• 30:21
  Speaker 2: and scary that you'll do anything to make the anxiety
• 30:23
  Speaker 2: go away. So you spend the next hour analyzing old conversations,
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  Speaker 2: comparing your relationship to other peoples, or looking for evidence
• 30:31
  Speaker 2: that your friend really doesn't hate you, Or maybe you
• 30:34
  Speaker 2: constantly ask for reassurance. Are you still attracted to me?
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  Speaker 2: Did I do something to make you mad? It might
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  Speaker 2: surprise you to learn that these thoughts and behaviors can
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  Speaker 2: highly misunderstood condition that causes people to get stuck in
• 30:54
  Speaker 2: a cycle of unwanted, intrusive thoughts that cause intense anxiety
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  Speaker 2: and behaviors to try to manage that anxiety. I've seen
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• 31:06
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  Speaker 2: of your own life.
• 32:01
  Speaker 4: Okay, we are back.
• 32:02
  Speaker 2: I'm with doctor Kashani oh I forgot to ask you,
• 32:05
  Speaker 2: by the way, what do your letters mean?
• 32:08
  Speaker 4: Your MD?
• 32:09
  Speaker 2: Obviously, but what does the DABSM stand for?
• 32:13
  Speaker 3: So dabsim Actually it's technically a discontinued credential at this point.
• 32:17
  Speaker 3: It stands for diploma. It stands for diplomatic. American Board
• 32:21
  Speaker 3: of Sleep Medicine, But the American Board of Sleep Medicine
• 32:25
  Speaker 3: a few years back they dissolved unfortunately. So now you
• 32:28
  Speaker 3: get certified in sleep medicine based on your primary specialty.
• 32:32
  Speaker 3: So if you did internal medicine, family medicine, pediatrics, you
• 32:35
  Speaker 3: get certified and sleep through that accreditation body. It's just
• 32:39
  Speaker 3: medical politics.
• 32:41
  Speaker 2: They shut them down. I'm telling you give the sleep medicine.
• 32:45
  Speaker 3: A chance, right, my thoughts exactly.
• 32:49
  Speaker 2: Okay, all right, Well, we've got some really great questions.
• 32:53
  Speaker 2: Some are similar to others, so I'm going to try
• 32:56
  Speaker 2: to put them all in kind of some categories. But
• 33:00
  Speaker 2: first off, let's just talk about waking up in the
• 33:03
  Speaker 2: middle of the night staying asleep. Colleen wants to know.
• 33:07
  Speaker 2: She says, I fall asleep pretty easily in bed, dark,
• 33:10
  Speaker 2: cool room, but wake up a few hours later and
• 33:12
  Speaker 2: have difficulty falling back asleep. How can I stay asleep?
• 33:16
  Speaker 3: Very good question, very common scenario that we see in
• 33:18
  Speaker 3: sleep clinics. So the difficulty with maintaining sleep as opposed
• 33:22
  Speaker 3: to the difficulty with initiating sleep in the first part
• 33:24
  Speaker 3: of the night, it always brings up the question is
• 33:27
  Speaker 3: is something happening during sleep itself that is unstable that
• 33:31
  Speaker 3: is allowing for these awakenings or this fragmentation of the
• 33:34
  Speaker 3: nighttime sleep. The awakenings could very well just be totally spontaneous,
• 33:38
  Speaker 3: but by talking to a sleep doctor or to your
• 33:41
  Speaker 3: doctor a little bit more about kind of you know
• 33:43
  Speaker 3: whether there are other issues like snoring or anything else
• 33:46
  Speaker 3: that might suggest that there's something happening during sleep, like
• 33:49
  Speaker 3: sleep apnea, Because sleep apnea, I mean, that's just one example,
• 33:52
  Speaker 3: but one of the most common symptoms of sleep apnea
• 33:54
  Speaker 3: when it's untreated is difficulty staying asleep. So and that's
• 33:58
  Speaker 3: just one sleep disorder that can cause that. So all
• 34:00
  Speaker 3: that to say that it very well could be that
• 34:03
  Speaker 3: none of that is at play here and that we're
• 34:05
  Speaker 3: this person is just having a spontaneous awakening and then
• 34:07
  Speaker 3: having difficulty getting back to sleep, in which case that's
• 34:09
  Speaker 3: a pretty clear cut case of insomnia, and we've got
• 34:12
  Speaker 3: wonderful treatment options for that that extend beyond sleeping pills,
• 34:15
  Speaker 3: which are not the first line treatment for insomnia. But
• 34:19
  Speaker 3: in general, when somebody has a predominant or an exclusive
• 34:22
  Speaker 3: difficulty with maintaining sleep through the night, it brings up
• 34:26
  Speaker 3: a lot of other questions because again, it suggests that
• 34:29
  Speaker 3: there might be something happening during sleep that may need
• 34:32
  Speaker 3: to be tested on a sleep study. Compare that to
• 34:34
  Speaker 3: somebody who has exclusive difficulty with falling asleep in the
• 34:37
  Speaker 3: beginning of the night, and once they are asleep, sleep
• 34:39
  Speaker 3: is stable and uninterrupted until they wake up in the morning.
• 34:42
  Speaker 3: That is less suggestive of something happening during sleep, obviously
• 34:46
  Speaker 3: because a person hasn't fallen asleep yet, so that paints
• 34:50
  Speaker 3: more of the kind of clear insomnia picture. But when
• 34:52
  Speaker 3: it's the difficulty staying asleep and only staying asleep, it
• 34:55
  Speaker 3: could very well just be an insomnia picture. But again,
• 34:58
  Speaker 3: it does introduce the possibility that there's some during sleep
• 35:01
  Speaker 3: happening that could be causing the instability.
• 35:03
  Speaker 2: Would you put that in the same category of somebody
• 35:05
  Speaker 2: who someone like Leah, who will read a little bit
• 35:09
  Speaker 2: each night and she will fall asleep and then she
• 35:13
  Speaker 2: says she wakes up after thirty minutes, and then she
• 35:16
  Speaker 2: feels like she's been asleep for six hours, and then
• 35:19
  Speaker 2: she's tossing or turning for about an hour or two
• 35:22
  Speaker 2: before she can fall back asleep. Is that similar to
• 35:24
  Speaker 2: somebody who's been asleep for a few hours and then
• 35:26
  Speaker 2: wakes up. Is it the same thing?
• 35:28
  Speaker 4: Okay, very much?
• 35:30
  Speaker 2: Okay, Leah and Colleen. Looks like you two need to
• 35:33
  Speaker 2: get together and figure this out. Sounds like we got
• 35:36
  Speaker 2: the same little issue. But I also find it interesting
• 35:38
  Speaker 2: for you to that you touched on insomnia being right
• 35:42
  Speaker 2: at the you know, the top of top of the boards,
• 35:44
  Speaker 2: right when you hit the sack. So there are Like
• 35:48
  Speaker 2: you said, the first line of treatment may not be medicine.
• 35:52
  Speaker 2: Do you give people exercises to do before they go
• 35:56
  Speaker 2: to sleep or how do you typically try and treat
• 35:58
  Speaker 2: the insomnia?
• 36:00
  Speaker 3: Great questions. So when it comes to treating insomnia, sleeping
• 36:04
  Speaker 3: pills or hypnotics as we call them, they are an option,
• 36:07
  Speaker 3: and of course as a sleep physician, I do prescribe
• 36:09
  Speaker 3: them because every single person is different and every single
• 36:12
  Speaker 3: person's preference on how they want to treat their issue
• 36:14
  Speaker 3: is obviously different. So would that being the case, that
• 36:18
  Speaker 3: is an option. But the most effective treatment for insomnia,
• 36:21
  Speaker 3: based on all of insomnia literature that we have, and
• 36:23
  Speaker 3: you can look this up if you just google it,
• 36:25
  Speaker 3: you'll see tons and tons of data, is cognitive behavioral
• 36:28
  Speaker 3: therapy for insomnia, also known as CBTI. There is so
• 36:32
  Speaker 3: much data demonstrating how effective this treatment is. In fact,
• 36:35
  Speaker 3: there are even studies that have compared the effectiveness of
• 36:37
  Speaker 3: CBTI head to head versus sleeping pills like ambient and Lunesta,
• 36:42
  Speaker 3: and still CBTI shows superior effect both short term and
• 36:45
  Speaker 3: long term. So that's why we typically recommend CBTI as
• 36:48
  Speaker 3: first line therapy for adults with insomnia, and I myself,
• 36:52
  Speaker 3: I'll deliver the CBTI myself, or sometimes what can be
• 36:55
  Speaker 3: really effective in certain cases is just taking pieces of
• 36:58
  Speaker 3: CBTI or components of EBTi and then prescribing them by themselves,
• 37:02
  Speaker 3: because without getting too much into the detail of what's
• 37:05
  Speaker 3: involved in CBTI, it's kind of like a you can
• 37:07
  Speaker 3: think of it kind of like a little bit like
• 37:08
  Speaker 3: a sleep boot camp almost where essentially you're put on
• 37:12
  Speaker 3: these kind of protocols that are very well studied, behavioral
• 37:14
  Speaker 3: protocols that are very well studied. You're given a set
• 37:16
  Speaker 3: of instructions, You're given a sleep log or a sleep
• 37:19
  Speaker 3: diary to track your sleep and track your progress. And
• 37:22
  Speaker 3: it goes way beyond your typical basics of just having
• 37:25
  Speaker 3: good sleep habits and good sleep hygiene at nighttime, because
• 37:28
  Speaker 3: we all know that just having good sleep habits and
• 37:30
  Speaker 3: making your room cool, dark and quiet is not enough
• 37:32
  Speaker 3: to treat fifteen years of insomnia usually, so that being
• 37:35
  Speaker 3: the case, CBTI is a little bit more involved than that,
• 37:38
  Speaker 3: and as long as the person is adherent, it really works.
• 37:41
  Speaker 3: Better than anything else. And the best comparison that I
• 37:43
  Speaker 3: can make make with CBTI is like, if I struggle
• 37:48
  Speaker 3: with obesity and I want to get on an evidence
• 37:51
  Speaker 3: based diet that's been proven to help people in my
• 37:53
  Speaker 3: weight range and in my age range, because I'm starting
• 37:56
  Speaker 3: to get high blood pressure and fatty liver and all
• 37:58
  Speaker 3: that stuff, So what do I do. I sign up
• 38:01
  Speaker 3: with a nutritionist and I have weekly sessions or weekly
• 38:03
  Speaker 3: appointments with that nutritionist. The first session, they're probably just
• 38:07
  Speaker 3: going to give me my diet, right, They're going to
• 38:08
  Speaker 3: tell me what I can eat when I can't eat,
• 38:10
  Speaker 3: what my calorie count is for the day, what my macros, proteins, fats,
• 38:13
  Speaker 3: carbs for the day is give me a food log
• 38:16
  Speaker 3: so that I can log my meals and make sure
• 38:17
  Speaker 3: I'm tracking my weights in progress. And then every week
• 38:20
  Speaker 3: when I go back to that nutritionist, that those follow
• 38:22
  Speaker 3: up visits, it's just looking at my diary, tracking how
• 38:25
  Speaker 3: I'm doing, making sure I'm not having difficulty with implementing
• 38:28
  Speaker 3: the diet, because diets are difficult obviously, So that's kind
• 38:31
  Speaker 3: of how CBTI is. In the very beginning, You're kind
• 38:33
  Speaker 3: of given this set of protocols and instructions that I
• 38:35
  Speaker 3: have been very well studied, tons of evidence, and they
• 38:38
  Speaker 3: just send you on your way to practice those things
• 38:40
  Speaker 3: and implement those things, and you track it all in
• 38:42
  Speaker 3: your sleep log and have follow up visits to make
• 38:44
  Speaker 3: sure you're going in the right direction.
• 38:45
  Speaker 2: What an incredible use of CBT. I had no idea.
• 38:50
  Speaker 2: I had no idea that there was something specific to
• 38:52
  Speaker 2: help people like that. That's really incredible. So let's move
• 38:58
  Speaker 2: on to some some sleep episodes. I guess, for lack
• 39:01
  Speaker 2: of better words, what we touched on paralysis because Steven
• 39:06
  Speaker 2: from Creek Talk podcast shout out, he was asking, how
• 39:09
  Speaker 2: can I stop having sleep paralysis? It's been happening since
• 39:13
  Speaker 2: I was a kid, and I'm forty five and still
• 39:15
  Speaker 2: getting it. And we have a couple other people who
• 39:19
  Speaker 2: chimed in about wanting to know about sleep paralysis also.
• 39:22
  Speaker 2: So one of the things you had already touched on
• 39:24
  Speaker 2: is that you may not necessarily have IH or narcolepsy
• 39:31
  Speaker 2: if you do get the sleep paralysis. But if you
• 39:36
  Speaker 2: do have it and that's the only thing you have,
• 39:38
  Speaker 2: how can you help? Well, you said stress, So just
• 39:42
  Speaker 2: stop stressing out, Stephen. I mean, it's that simple. Yeah,
• 39:47
  Speaker 2: what do you have any suggestions on specifically sleep paralysis?
• 39:51
  Speaker 3: Yeah, definitely, So if we are indeed talking about sleep paralysis,
• 39:55
  Speaker 3: sleep paralysis in the absence of any other suspicion that
• 39:58
  Speaker 3: there might be something else going on, because a history
• 40:01
  Speaker 3: of sleep paralysis for the last twenty thirty years plus
• 40:04
  Speaker 3: feeling tired and sleepy, well, now that's suspicious for an arcalepsy.
• 40:08
  Speaker 3: But apart from that, if it is recurring and for
• 40:10
  Speaker 3: this long period of time, and we're not concerned for
• 40:13
  Speaker 3: sleepiness or any other sleep issue and it's just isolated
• 40:16
  Speaker 3: sleep paralysis, there is if it's really a problem. Because
• 40:19
  Speaker 3: of course sleep paralysis doesn't require treatment, but in some
• 40:22
  Speaker 3: cases the hallucinations and the paralysis can be frequent enough
• 40:25
  Speaker 3: to cause a lot of distress to the person, and
• 40:27
  Speaker 3: not to mention the hallucinations themselves sometimes can be very
• 40:29
  Speaker 3: terrifying for a lot of people, and very often that
• 40:31
  Speaker 3: will bring them to our clinic. As far as options
• 40:34
  Speaker 3: for treatment, low dose antidepressants actually have been shown to
• 40:38
  Speaker 3: be very beneficial in reducing the frequency of sleep paralysis
• 40:41
  Speaker 3: and hallucination episodes, and the reason for it.
• 40:44
  Speaker 2: Maybe that's why I don't have them that much anymore,
• 40:46
  Speaker 2: because I am on a load doses as a r
• 40:49
  Speaker 2: Oh my gosh, that.
• 40:51
  Speaker 3: Is very bad. That is very common. So any okay,
• 40:59
  Speaker 3: any medication that increases serotonin, or any medication that is serotonergic,
• 41:03
  Speaker 3: because serotonin has this effect that it can kind of
• 41:06
  Speaker 3: mask or reduce the phenomena of REM sleep. And I
• 41:10
  Speaker 3: say remsleep meaning rapid eye movement sleep, because all these
• 41:14
  Speaker 3: things are sleep paralysis, hallucinations, falling asleep or waking up,
• 41:19
  Speaker 3: these are all components of rapid eye movements sleep. What
• 41:22
  Speaker 3: happens when we're in rapid ie movement sleep, our muscles
• 41:24
  Speaker 3: get totally paralyzed. And it's for that reason that we
• 41:26
  Speaker 3: don't act our dreams out because and it's exclusively during
• 41:29
  Speaker 3: rapid movement sleep that our muscles is paralyzed. Because obviously
• 41:32
  Speaker 3: we move around all night when we're in other stages
• 41:34
  Speaker 3: of sleep, but when we're in that stage of sleep,
• 41:36
  Speaker 3: typically our muscles get paralyzed and we start dreaming. So
• 41:40
  Speaker 3: think about it like this sleep paralysis, hallucinations. It's kind
• 41:44
  Speaker 3: of like the muscle paralysis and the dreams and imagery
• 41:46
  Speaker 3: of REM sleep, except it's kind of spilling out a
• 41:48
  Speaker 3: little bit and leaking into that moment that you're just
• 41:50
  Speaker 3: waking up. For example, So when you take a serotonergic
• 41:54
  Speaker 3: medication like an SSRI or an SNRI, these medications because
• 41:58
  Speaker 3: they can reduce REM sleep phenomena, they secondarily people notice
• 42:02
  Speaker 3: that the sleep paralysis and hallucinations improve as well.
• 42:05
  Speaker 2: Well, here I am thinking I just must have outgrown them,
• 42:08
  Speaker 2: you know, I think for a second, I mean, oh
• 42:12
  Speaker 2: my gosh, see I continue to learn. Well, on that note,
• 42:16
  Speaker 2: I have another question about a sleep episode situation. Julie says,
• 42:22
  Speaker 2: So this is weird. I act out my dreams and
• 42:25
  Speaker 2: kick and punch in my sleep. I remember these dreams
• 42:28
  Speaker 2: and I'm usually fighting off an attacker, so it's very violent.
• 42:32
  Speaker 2: I scare my poor dog. I can't seem to track
• 42:35
  Speaker 2: if anything triggers it. Why am I doing this?
• 42:39
  Speaker 3: Julie is describing what we call REM sleep behavior disorder. Well,
• 42:44
  Speaker 3: she's specifically describing dream and actmin behavior. But when we
• 42:48
  Speaker 3: hear dream and actment behavior, especially the way that you're
• 42:50
  Speaker 3: describing it, with the nature of the dreams surrounding conflict
• 42:53
  Speaker 3: and violence and things like that, it is very suggestive
• 42:56
  Speaker 3: of something called REM sleep behavior disorder, also known as RBD. Now, Julia,
• 43:00
  Speaker 3: I am definitely not diagnosing you with RBD on this podcast. However,
• 43:05
  Speaker 3: dream and actment behavior in general, I can tell you
• 43:08
  Speaker 3: it has a few causes. Funny enough, probably the most
• 43:12
  Speaker 3: common cause of dream and actment behavior is SSRIs and
• 43:16
  Speaker 3: Sarah's mergic medications. Also because again there's such an effect
• 43:20
  Speaker 3: on REM sleep and the stability of REM sleep by
• 43:23
  Speaker 3: these meds that hallucinations, sleep paralysis, lack of paralysis during
• 43:28
  Speaker 3: dreams causing dream and actment behavior. These are all things
• 43:31
  Speaker 3: that kind of can become a little bit fuzzy in
• 43:33
  Speaker 3: the setting of serotinergic meds. So all that to say,
• 43:36
  Speaker 3: it sounds like she's describing that now. I don't know
• 43:38
  Speaker 3: if she takes antidepressants or it could be something else
• 43:41
  Speaker 3: causing it, because, believe it or not, even sleep apnea
• 43:44
  Speaker 3: in some cases can cause a person to physically act
• 43:46
  Speaker 3: their dreams out anything that causes instability to sleep, which
• 43:50
  Speaker 3: sleep apnea is a breathing disorder during sleep that causes
• 43:54
  Speaker 3: respiratory interruptions to your sleep all throughout the night without
• 43:57
  Speaker 3: you realizing it. So it just creates really broken and
• 44:00
  Speaker 3: poor quality sleep. And that's why people would sleep apnea
• 44:02
  Speaker 3: feel so tired during the day very often. But anything
• 44:06
  Speaker 3: that breaks your sleep all night, like sleep apnea, creates
• 44:09
  Speaker 3: such sleep state instability that complex phenomena like dream inactment
• 44:13
  Speaker 3: behaviors or even sleep walking can be precipitated bying sleep apnea,
• 44:18
  Speaker 3: and in that case it should resolve when the sleep
• 44:19
  Speaker 3: apnoms treated, meaning that you stopped acting your dreams out
• 44:22
  Speaker 3: once you treated your sleep apnea. But all that to say,
• 44:27
  Speaker 3: the real concern here is injury because a lot of
• 44:29
  Speaker 3: people who have dream and acted behavior, who have RBD,
• 44:32
  Speaker 3: they'll punch their partner in the face because they're having
• 44:34
  Speaker 3: a nightmare and that they're in a fight. They'll fall
• 44:36
  Speaker 3: out of bed. I've had people that went to the
• 44:38
  Speaker 3: emergency room after cracking their head and have to get stitched,
• 44:41
  Speaker 3: or people who will walk into the walls. More rarely
• 44:44
  Speaker 3: do they actually exit the bed, but usually lots of
• 44:47
  Speaker 3: flailing and thrashing around in bed, punching the nightstand, punching
• 44:50
  Speaker 3: the headboard, fracturing fingers, black eyes on girlfriends. I mean,
• 44:54
  Speaker 3: we see it all kinds of stuff in the setting
• 44:55
  Speaker 3: of dream and acted behavior. One other thing that I'll
• 44:58
  Speaker 3: say about that is melatonin is a question that comes
• 45:01
  Speaker 3: up a lot in sleep right, like is melatonin good?
• 45:04
  Speaker 3: Is it bad? What is it good for? What does
• 45:06
  Speaker 3: it help for? I take it and it does nothing.
• 45:07
  Speaker 3: I take it and it's amazing. Melatonin as far as
• 45:11
  Speaker 3: actual scientific use, because as a sleep aid as a
• 45:14
  Speaker 3: treatment for insomnia, there is no good evidence to show
• 45:17
  Speaker 3: that melatonin is an effective sleep aid, which is why
• 45:19
  Speaker 3: there's so much variability in people's experience when they take it.
• 45:23
  Speaker 4: There's no evidence.
• 45:24
  Speaker 3: Oh wow, not as a sleep aid. But the one thing,
• 45:28
  Speaker 3: the one very scientific and evidence based use of melatonin
• 45:32
  Speaker 3: is the way that your body is supposed to be
• 45:34
  Speaker 3: paralyzed during rapidie movement sleep when you're having dreams, so
• 45:37
  Speaker 3: that you don't act your dreams out. Melatonin actually helps
• 45:41
  Speaker 3: the brain function better in that sense of paralyzing the
• 45:44
  Speaker 3: muscles during sleep. It's kind of like our brain has
• 45:47
  Speaker 3: like a little bit of a light switch. As soon
• 45:49
  Speaker 3: as we go from whatever stage of sleep we're in
• 45:52
  Speaker 3: and we all of a sudden go into rem Literally,
• 45:54
  Speaker 3: our brain literally turns this light switch off and all
• 45:57
  Speaker 3: of our muscles just get shut down for that period
• 45:59
  Speaker 3: of time. Melatonin helps make that light switch work a
• 46:02
  Speaker 3: little bit better. So even some of the most violent
• 46:05
  Speaker 3: behaviors on gen kicking, screaming, yelling, hitting the partner, hitting
• 46:09
  Speaker 3: the headboard, the right dose of melatonin can actually keep
• 46:12
  Speaker 3: all of that under control.
• 46:14
  Speaker 4: That is unbelievable.
• 46:16
  Speaker 2: We are really getting some answer here today, you guys.
• 46:19
  Speaker 2: I am I feel like I'm changing the world on
• 46:21
  Speaker 2: drama Darling forget Housewives. I'm just going to interview sleep
• 46:25
  Speaker 2: doctors for the rest but not Okay, So speaking of
• 46:30
  Speaker 2: sleep aids, that will lead me to my next question,
• 46:33
  Speaker 2: which I have. You know, several people asked about the
• 46:36
  Speaker 2: THCHC situation. I'm going to read you two questions. Number
• 46:41
  Speaker 2: one from jewles what are the safest and most effective
• 46:44
  Speaker 2: sleep aids? Do certain sleep aids cause dementia? Ambient works
• 46:48
  Speaker 2: great for me, but I worry taking it regularly isn't
• 46:51
  Speaker 2: healthy long term? Are sleep gummies with THHC a good option?
• 46:54
  Speaker 2: And then Alex asks is THHC beneficial or harmful for sleep?
• 47:01
  Speaker 3: A lot of good questions there. So as far as
• 47:03
  Speaker 3: the sleeping pills and the ambient question. You know, it's
• 47:07
  Speaker 3: one of those things where we have about eight medications
• 47:12
  Speaker 3: that have specific indication for the treatment of insomnia. Technically
• 47:16
  Speaker 3: there's more than that, but in terms of clinical practice
• 47:19
  Speaker 3: and standard of care and the way that we prescribe
• 47:21
  Speaker 3: meds these days, as sleep doctors, we're really selecting mainly
• 47:24
  Speaker 3: from eight evidence based sleep aids now Ambient and medications
• 47:27
  Speaker 3: like it. That represents three of those eight medications, those
• 47:31
  Speaker 3: medications in particular being Ambient, Lunesta and Sonata, and those
• 47:35
  Speaker 3: are brand names, but those medications because they're so similar
• 47:40
  Speaker 3: to traditional benzodiazepines like xanax and atavan and klonopin and
• 47:45
  Speaker 3: valium and medications like that, and because those medications have
• 47:48
  Speaker 3: been studied a little bit better long term and demonstrated
• 47:51
  Speaker 3: cognitive and memory issues with prolonged or with consistent use
• 47:55
  Speaker 3: for long periods of time, it's fair to assume that
• 47:58
  Speaker 3: because ambient and those types of sleeping pills are so
• 48:01
  Speaker 3: chemically similar to those meds, that it is a potential
• 48:04
  Speaker 3: risk for developing a problem like that, a neurocognitive issue. However,
• 48:11
  Speaker 3: those meds, the sleeping pills we're talking about, they have
• 48:13
  Speaker 3: not been studied long term, and there are plenty of
• 48:16
  Speaker 3: people that take them for thirty forty years and have
• 48:18
  Speaker 3: no issues at all. So it's kind of one of
• 48:20
  Speaker 3: those things where it's not really well known, it's not
• 48:22
  Speaker 3: really well studied. We'll still prescribe these meds. Thankfully, we
• 48:26
  Speaker 3: have newer sleeping pills that work on a very different
• 48:28
  Speaker 3: part of the brain now and we're we're thinking that
• 48:31
  Speaker 3: it's probably safer compared to those. But the concerning thing
• 48:34
  Speaker 3: with sleeping pills with Ambient and medications like that is
• 48:39
  Speaker 3: the automatic behaviors. So sleep walking and sleep eating, those
• 48:42
  Speaker 3: are things that we see sometimes as a side effect
• 48:45
  Speaker 3: with medications like Ambient. So that's a separate issue. But
• 48:48
  Speaker 3: as far as the dementia, again it's not really well known.
• 48:51
  Speaker 3: These things haven't been studied longitudinally, but it is fair
• 48:53
  Speaker 3: to assume that the risk exists just because of how
• 48:55
  Speaker 3: similar these mets are to meds that have been better studied.
• 48:59
  Speaker 2: And before you answer of the THHC question, when you
• 49:01
  Speaker 2: say that it works on another medications, other medications work
• 49:05
  Speaker 2: on different parts of the brain, what part of the
• 49:07
  Speaker 2: brain do you focus on or is it the entire thing?
• 49:11
  Speaker 2: When you are dealing with sleep stuff, that's my scientific question.
• 49:16
  Speaker 2: I'm so intelligent when you're dealing with your sleep Steff,
• 49:19
  Speaker 2: what bird of the brain are you dealing with.
• 49:25
  Speaker 3: No areas these meds, So when it comes to these
• 49:29
  Speaker 3: are essentially our armamentary and the sleeping pills that we prescribe.
• 49:32
  Speaker 3: You know, it's really when it comes to choosing an agent,
• 49:36
  Speaker 3: it's really just targeting the sleep what the sleep disturbances. So,
• 49:39
  Speaker 3: for example, if the person has difficulty with falling asleep
• 49:42
  Speaker 3: in the beginning of the night, and then once they're
• 49:44
  Speaker 3: asleep sleep is totally stable and uninterrupted, then you could
• 49:47
  Speaker 3: technically you just give that person a short acting sleeping
• 49:50
  Speaker 3: pill to just nudge them over into sleep, and then
• 49:52
  Speaker 3: it's out of their system in a few hours and
• 49:54
  Speaker 3: they're sleeping all the way into the morning. But if
• 49:56
  Speaker 3: it's a problem with the person staying asleep or both
• 49:59
  Speaker 3: falling asleep staying asleep, then electing to use a more
• 50:02
  Speaker 3: medium to long acting medication that they can take in
• 50:04
  Speaker 3: the beginning of the night and cover them for the
• 50:07
  Speaker 3: full duration of the sleep period. That's really kind of
• 50:09
  Speaker 3: the only sort of thought process using a medication.
• 50:13
  Speaker 2: Okay, let's drill down on the THHC. What are your
• 50:16
  Speaker 2: thoughts on that.
• 50:18
  Speaker 3: You know, with the THCHC in general, with cannabis, there's
• 50:22
  Speaker 3: all kinds of medical uses, obviously, but probably the biggest
• 50:26
  Speaker 3: limitation is once again the lack of data. There's really
• 50:29
  Speaker 3: not a lot of good, solid, strong evidence studying the
• 50:32
  Speaker 3: effect of cannabis on sleep and improvements in sleep or
• 50:35
  Speaker 3: improvements in insomnia. A lot of people do experience a
• 50:39
  Speaker 3: reduced latency to sleep onset or just easier time falling
• 50:42
  Speaker 3: asleep when they take something like cannabis, but there is
• 50:45
  Speaker 3: also the possibility there's some suggestion that relatively similar to alcohol,
• 50:50
  Speaker 3: chronic cannabis use may suppress RABBITI movements sleep, which we
• 50:54
  Speaker 3: definitely know that about alcohol, which is part of the
• 50:56
  Speaker 3: reason we feel the way we do when we drink
• 50:58
  Speaker 3: a lot. Alcohol is a very potent suppressant of REM sleep,
• 51:02
  Speaker 3: which is a stage of sleep that your brain really
• 51:04
  Speaker 3: needs at nighttime. So when you drink a lot of alcohol,
• 51:07
  Speaker 3: you end up in the first four or five hours
• 51:09
  Speaker 3: of the night, while the alcohol is really active in
• 51:10
  Speaker 3: your system, you end up really not getting much REM sleep,
• 51:13
  Speaker 3: and then all of a sudden, towards the end you
• 51:15
  Speaker 3: get kind of a little bit of a rebound effect.
• 51:17
  Speaker 3: So it's just kind of very discontinuous and not restorative
• 51:20
  Speaker 3: sleep quality which contributes to the hangover and the alcohol feeling.
• 51:24
  Speaker 3: But cannabis may again poorly studied, but there is some
• 51:27
  Speaker 3: suggestion anecdotally that it may have a similar effect in
• 51:30
  Speaker 3: suppressing rabbit eye movements sleep with consistent chronic use.
• 51:34
  Speaker 2: Wow, so alcohol, it affects the rapid eye movement, so
• 51:39
  Speaker 2: you don't go into that stage of sleep, So you're
• 51:43
  Speaker 2: stuck in the first stage.
• 51:46
  Speaker 4: Yeah here essentially, Yeah, how does that?
• 51:48
  Speaker 2: Because the alcohol does what to your brain to make
• 51:51
  Speaker 2: you not go into a deeper sleep.
• 51:54
  Speaker 3: You know, alcohol is a is a neurotoxin in a
• 51:57
  Speaker 3: lot of ways. I mean, you know, you drink enough
• 51:59
  Speaker 3: alcohol can start having seizures. You drink enough alcohol, all
• 52:02
  Speaker 3: kinds of horrible things can happen. But definitely, as far
• 52:05
  Speaker 3: as just chemically, we know that alcohol has a very
• 52:08
  Speaker 3: potent effect on suppressing rem sleep. And interestingly, you might
• 52:12
  Speaker 3: hear from a lot of people who drink a lot
• 52:14
  Speaker 3: or who smoke a lot of weed, and then they
• 52:16
  Speaker 3: all of a sudden abruptly withdraw or abruptly stop those things,
• 52:20
  Speaker 3: and in the nights following that abrupt cessation of either
• 52:23
  Speaker 3: one of those things, they start to get just tons
• 52:25
  Speaker 3: and tons of intense dreams, and essentially what that represents
• 52:29
  Speaker 3: is what we call a rem rebound when somebody's had
• 52:32
  Speaker 3: so much suppression of remsleep long term from drinking or smoking,
• 52:36
  Speaker 3: and then all of a sudden, the brain kind of
• 52:37
  Speaker 3: has this rebound effect where all this rem starts to
• 52:40
  Speaker 3: rush into our brains, which end up resulting in the
• 52:43
  Speaker 3: person having really vivid and sometimes intense streams in those
• 52:46
  Speaker 3: especially in those first few nights after stopping the agent.
• 52:49
  Speaker 2: Wow, that is really interesting. You know, when I was
• 52:53
  Speaker 2: doing my sleep study and I was doing the daytime
• 52:56
  Speaker 2: naps because I was aware after it was over what
• 52:59
  Speaker 2: it happened with the naps, and thinking about all the
• 53:03
  Speaker 2: naps I've taken in my life. If I lay down,
• 53:07
  Speaker 2: I will immediately feel like I'm starting to dream pretty quickly.
• 53:12
  Speaker 4: So what is that?
• 53:13
  Speaker 2: Because if you're not really dreaming dreaming until you're an RAM,
• 53:17
  Speaker 2: and I'm not an RAM right away, why am I
• 53:20
  Speaker 2: starting to just have these dreams?
• 53:23
  Speaker 3: It's a great question. So in general, you'll hear a
• 53:26
  Speaker 3: lot of people who when they take naps during the
• 53:28
  Speaker 3: day that that's the time where they actually notice or
• 53:31
  Speaker 3: they're more able to recall dreaming. Really, it goes back
• 53:34
  Speaker 3: to when our brain is suppressed of REM sleep, whether
• 53:38
  Speaker 3: it's from alcohol, weed, or if it's just from being
• 53:40
  Speaker 3: really sleep deprived, and then therefore very REM deprived when
• 53:44
  Speaker 3: we try to recover the sleep, whether it's during a
• 53:47
  Speaker 3: daytime nap or a weekend after a week of sleeping
• 53:50
  Speaker 3: three or four hours nightly for the last few nights,
• 53:53
  Speaker 3: when you try to actually recover the sleep lost, usually
• 53:56
  Speaker 3: your brain is hungriest for REM, so it will try
• 53:59
  Speaker 3: to go into first, or it will try to go
• 54:01
  Speaker 3: into REM a lot earlier than normal, just because of
• 54:04
  Speaker 3: the deprivation and the rebound effect of the missing or
• 54:07
  Speaker 3: deprived REM sleep. So it's not actually uncommon at all
• 54:10
  Speaker 3: too during daytime naps experience dreams and even those same
• 54:14
  Speaker 3: hallucinations we were talking about a lot of times people
• 54:17
  Speaker 3: will notice those more so during daytime naps, just because
• 54:20
  Speaker 3: again the brain is hungry ast for REM and as
• 54:22
  Speaker 3: soon as you try to recover, it'll try to go
• 54:24
  Speaker 3: in there first.
• 54:25
  Speaker 2: Wow, But if I'm having the dreams right away, but
• 54:32
  Speaker 2: I wasn't detected having ari REM sleep when I was
• 54:36
  Speaker 2: during my sleep study, so I wasn't technically an RIM.
• 54:39
  Speaker 4: Correct.
• 54:41
  Speaker 3: You're asking such good questions right now. So the question
• 54:46
  Speaker 3: you just asked highlights the limitations and issues with that
• 54:50
  Speaker 3: test that you did. Because again, when all of us
• 54:53
  Speaker 3: sleep nerds get together at these conferences and we're talking
• 54:55
  Speaker 3: about kind of the limited tools that we have to
• 54:57
  Speaker 3: assess and diagnose a lot of sleep disorders, I mean
• 55:00
  Speaker 3: that sleep study, aside from being obnoxiously long in duration,
• 55:04
  Speaker 3: it's so imperfect in a sense that I'm trying to
• 55:08
  Speaker 3: look for Rapidie movements and I'm catching the person on
• 55:10
  Speaker 3: just one day, one day, hoping that I can see
• 55:14
  Speaker 3: this one finding of their eyes moving in a certain
• 55:16
  Speaker 3: way and their brain wave of superior a certain way. Now,
• 55:20
  Speaker 3: if a person is extremely sleepy, chances are I can
• 55:23
  Speaker 3: get them to meet that criteria of eight minutes or
• 55:25
  Speaker 3: less because they're a very sleepy person. But I have
• 55:27
  Speaker 3: no guarantee even if I'm super suspicious that they absolutely
• 55:31
  Speaker 3: have anarcilepsy because they're having paralysis and hallucinations every single
• 55:34
  Speaker 3: night for the last several years. But the chance that
• 55:37
  Speaker 3: I get Rapidie movements on that sleep study is never guaranteed.
• 55:40
  Speaker 3: So this is why once again, the testing and this
• 55:44
  Speaker 3: whole overall picture of separating these two conditions. It may
• 55:47
  Speaker 3: just all be arbitrary and we're all talking about one thing.
• 55:52
  Speaker 2: Wow, I'm coming to the next convention. I swear I'm there.
• 55:55
  Speaker 2: I'm setting up my Drama Darling podcast. Okay, this is
• 56:01
  Speaker 2: from Diane. I have been using my seapap for over
• 56:04
  Speaker 2: a year now for moderate sleep apnea and former insomnia.
• 56:08
  Speaker 2: I traveled up to your point. I traveled without it
• 56:11
  Speaker 2: recently and didn't sleep as well and felt groggy during
• 56:15
  Speaker 2: the day. My family will travel to Italy next year
• 56:18
  Speaker 2: and I dread the thought of lugging my seapap from
• 56:20
  Speaker 2: place to place plus through customs. Do you have tips
• 56:24
  Speaker 2: for better sleep without it on a temporary basis or
• 56:27
  Speaker 2: should I just suck it up and deal with the
• 56:29
  Speaker 2: extra hassle.
• 56:31
  Speaker 3: Well, a lot of people travel with seapaps these days.
• 56:33
  Speaker 3: In fact, most of the times when you get set
• 56:35
  Speaker 3: up on a seapap, it usually includes a travel bag
• 56:38
  Speaker 3: with it when you get it delivered, so that you
• 56:40
  Speaker 3: can kind of lug it around. And I go to
• 56:41
  Speaker 3: the airport all it. I travel a lot, and I
• 56:43
  Speaker 3: see the seapap bags at every single airport I go to.
• 56:46
  Speaker 3: But the easiest answer and solution I have to give
• 56:48
  Speaker 3: you is buy a travel seapap. Travel seapaps are like
• 56:50
  Speaker 3: literally this big. They're so tiny they can fit in
• 56:53
  Speaker 3: like your little handbag.
• 56:54
  Speaker 2: Oh there's like a separate device for that. Oh my gosh, cute.
• 57:00
  Speaker 2: That's cute, and you can like bling it out and
• 57:02
  Speaker 2: stuff and like get it a little carrying case. I'm
• 57:04
  Speaker 2: sure they have them. That's cool, all right.
• 57:09
  Speaker 3: And then one other travel option is a lot of
• 57:12
  Speaker 3: people will actually get because seapap is one treatment for
• 57:17
  Speaker 3: sleep apnea. But another alternative treatment apart from seapap is
• 57:21
  Speaker 3: the oral appliance for sleep apnea, and that's called a
• 57:23
  Speaker 3: mandibular Advancement device or an MAD. What it is is
• 57:27
  Speaker 3: a fancy looking mouthguard that it usually gets fitted by
• 57:30
  Speaker 3: bio dentist. It's custom fitted to your teeth. It's got
• 57:33
  Speaker 3: a top and a bottom piece, and when you put
• 57:35
  Speaker 3: it in your mouth, what it does is it moves
• 57:37
  Speaker 3: your lower jaw slightly forward. And by moving your jaw forward,
• 57:41
  Speaker 3: then your tongue moves forward and now your airway kind
• 57:44
  Speaker 3: of opens up a little bit. So a seapap fixes
• 57:47
  Speaker 3: sleep apnea because it blows his air through your nose
• 57:49
  Speaker 3: and it's the air pressure that keeps your pipe open,
• 57:52
  Speaker 3: whereas this mouthguard achieves that just by mechanically moving your
• 57:56
  Speaker 3: lower jaw forward and creating that opening. It doesn't always. Yeah,
• 58:00
  Speaker 3: it's a great alternative, and for many people it works
• 58:04
  Speaker 3: just as well as a SEATPAP and they don't need
• 58:05
  Speaker 3: a seapap and they can just use this and their
• 58:07
  Speaker 3: sleep appning is treated. In fact, mild and moderate cases
• 58:10
  Speaker 3: of sleep apney aren't more likely to have success with
• 58:12
  Speaker 3: that compared to like really bad or severe cases. But
• 58:15
  Speaker 3: a lot of people will do that too. They'll use
• 58:17
  Speaker 3: their seatpap at home and then get one of those
• 58:19
  Speaker 3: mouth guards and take that with them when they on trips.
• 58:21
  Speaker 3: So that's another option.
• 58:22
  Speaker 2: Wow, Okay, that's super interesting. I didn't know that that
• 58:26
  Speaker 2: was a thing. Some people mentioned that they've had sleep
• 58:31
  Speaker 2: studies done that nothing was detected, and then they have
• 58:36
  Speaker 2: to go back for multiple or and then they can't
• 58:40
  Speaker 2: because their insurance company won't cover a second one. Do
• 58:43
  Speaker 2: you have anything to speak on about regarding.
• 58:46
  Speaker 3: That, Yeah, definitely, So sleep studies in general and sleep services,
• 58:52
  Speaker 3: whether it's seatpaps, tests, these things. Oftentimes, insurance will try
• 58:58
  Speaker 3: to block these things from allitude of reasons, which is terrible.
• 59:02
  Speaker 3: But I think that if you go through a process
• 59:04
  Speaker 3: like because a lot of people will go through the
• 59:06
  Speaker 3: process of getting tested for sleep apnean and things like
• 59:08
  Speaker 3: that with their primary care doctor, which is totally reasonable
• 59:11
  Speaker 3: and good. But when it comes to more complicated stuff
• 59:14
  Speaker 3: or you know, you need to do further testing and
• 59:16
  Speaker 3: further evaluation, doing that kind of thing with a sleep
• 59:19
  Speaker 3: doctor can be helpful, just because we're used to all
• 59:21
  Speaker 3: of the insurance blocks and we kind of know how
• 59:23
  Speaker 3: to work around them and document things a certain.
• 59:25
  Speaker 4: Way that totally makes sense.
• 59:29
  Speaker 3: Definitely can help.
• 59:32
  Speaker 2: Here's a menopause question. Why in menopause do I wake
• 59:35
  Speaker 2: up through the night? I'm on hormones, but still have
• 59:38
  Speaker 2: yet to sleep well for a year. And then someone
• 59:41
  Speaker 2: else asked if HRT hormone replacement therapy can help for
• 59:48
  Speaker 2: sleeping during menopause.
• 59:51
  Speaker 3: You know, I have a lot of women that tell
• 59:53
  Speaker 3: me that once they started taking progesterone, that that was
• 59:56
  Speaker 3: just their ultimate game changer. A lot of people take it,
• 1:00:00
  Speaker 3: specifically take progester on and find it that has a
• 1:00:02
  Speaker 3: little bit of an axiolytic property to it, meaning that
• 1:00:04
  Speaker 3: it helps with anxiety. It makes them relax a little
• 1:00:06
  Speaker 3: bit can help them ease into sleep. So that is
• 1:00:09
  Speaker 3: definitely one thing that comes up in these conversations. But
• 1:00:12
  Speaker 3: in terms of just sleep disturbance and menopause, a couple
• 1:00:15
  Speaker 3: of things. Number One, there's a bit of a spike
• 1:00:18
  Speaker 3: in the development of sleep apnea above the age of
• 1:00:20
  Speaker 3: fifty four males or females, and given that menopause more
• 1:00:23
  Speaker 3: commonly occurs around that same time, menopause itself sometimes can
• 1:00:28
  Speaker 3: also increase the sort of conversion to sleep apnea or
• 1:00:32
  Speaker 3: the development of.
• 1:00:33
  Speaker 4: Sleep apinae wedding.
• 1:00:35
  Speaker 3: Wow, believe it or not? Those hormonal Oh sorry, go.
• 1:00:39
  Speaker 2: Yeah, no, I believe yeah, exactly what you're saying. I
• 1:00:42
  Speaker 2: was going to say something similar, which is that, boyd
• 1:00:45
  Speaker 2: you know, the change of life sure really just messes
• 1:00:48
  Speaker 2: you the age of you know, it's not fair.
• 1:00:53
  Speaker 3: Interestingly, there was a study that came out several years
• 1:00:55
  Speaker 3: ago where they took like one hundred and fifty five
• 1:00:58
  Speaker 3: postmenopausal female and basically put them through cognitive behavioral therapy
• 1:01:04
  Speaker 3: for insomnia and then also compared that to tai chi
• 1:01:09
  Speaker 3: And what they found on this study was that CBTI,
• 1:01:12
  Speaker 3: being the most effective treatment for insomnia, had very very
• 1:01:15
  Speaker 3: similar results as the study arm that patients just completed
• 1:01:19
  Speaker 3: tai chi, Now, does that mean that tai chi is
• 1:01:22
  Speaker 3: just as effective as CBTI? I don't know. Obviously, there's
• 1:01:25
  Speaker 3: a lot you can interpret from a study like that,
• 1:01:27
  Speaker 3: but bottom line is things that can increase the threshold
• 1:01:32
  Speaker 3: for arousal from sleep, like yoga, meditation, tai chi. We
• 1:01:36
  Speaker 3: don't understand a lot of the science to it, but
• 1:01:38
  Speaker 3: it works, and there's data to show that these things
• 1:01:41
  Speaker 3: can be really beneficial to a lot of people, including
• 1:01:43
  Speaker 3: that population. So that's just one.
• 1:01:44
  Speaker 4: Other thing that is so cool. I love that.
• 1:01:47
  Speaker 2: Do they have tai chi and yoga at the sleep
• 1:01:49
  Speaker 2: conventions that I'll be joining you on. How would somebody
• 1:01:53
  Speaker 2: see a sleep doctor like yourself? Would they could they
• 1:01:57
  Speaker 2: go directly to you if they've got like AO or
• 1:02:01
  Speaker 2: I mean, or would they go to their primary and
• 1:02:03
  Speaker 2: get a referral?
• 1:02:04
  Speaker 4: How would that work?
• 1:02:05
  Speaker 3: Yeah? Definitely, just like with any other doctor, as long
• 1:02:08
  Speaker 3: as your insurance doesn't require that you have a referral,
• 1:02:10
  Speaker 3: you can absolutely just schedule an appointment or a consultation
• 1:02:13
  Speaker 3: with a sleep physician at your local academic center. Sleep
• 1:02:16
  Speaker 3: is one of those things where you know, depending on
• 1:02:18
  Speaker 3: where you are in the world. If you're in a
• 1:02:20
  Speaker 3: very rural area, you may not necessarily have a sleep
• 1:02:22
  Speaker 3: dot down the street that you could go to. But
• 1:02:24
  Speaker 3: usually academic centers almost always have a sleep department or
• 1:02:28
  Speaker 3: a sleep division where you can see sleep physicians. And
• 1:02:31
  Speaker 3: not to mention, a lot of us in our specialty,
• 1:02:33
  Speaker 3: a lot of us do virtual or telemedicine as we
• 1:02:36
  Speaker 3: call it. So these days getting access or having access
• 1:02:40
  Speaker 3: to a sleep physician is actually a lot better compared
• 1:02:42
  Speaker 3: to the way it was before.
• 1:02:44
  Speaker 4: Oh truly. Yes.
• 1:02:45
  Speaker 2: I went to my primary and I was finally like,
• 1:02:48
  Speaker 2: I just something's wrong, and she just said, you know, here,
• 1:02:53
  Speaker 2: go to the pulmonary branch of this office and you
• 1:02:58
  Speaker 2: will find a sleep doctor over there.
• 1:03:00
  Speaker 4: And that was you.
• 1:03:01
  Speaker 2: So it was very easy for me to do that.
• 1:03:04
  Speaker 2: I'm very grateful that it was just such a simple
• 1:03:07
  Speaker 2: way and it really made me go, I wish I
• 1:03:10
  Speaker 2: would have just done this a long time ago.
• 1:03:12
  Speaker 4: It was so easy to do.
• 1:03:13
  Speaker 2: You know, I'm just going to ask you, is there
• 1:03:16
  Speaker 2: anything that you would like to share with the Drama
• 1:03:19
  Speaker 2: Darling audience as a sleep doctor.
• 1:03:22
  Speaker 4: Yeah.
• 1:03:22
  Speaker 3: You know, one thing that I always like to say
• 1:03:24
  Speaker 3: is that a lot of people ask Okay, what should
• 1:03:27
  Speaker 3: I do about this? And what should I do about that?
• 1:03:28
  Speaker 3: And what's the best sleep habit or what's the best
• 1:03:30
  Speaker 3: nighttime routine? And honestly, I always say the same thing,
• 1:03:33
  Speaker 3: which is the most important sleep habit that you need
• 1:03:36
  Speaker 3: to keep in mind is to just sleep. Sleep when
• 1:03:39
  Speaker 3: your body is asking for it. We live in a
• 1:03:41
  Speaker 3: society and we live in a time where we're sleep
• 1:03:43
  Speaker 3: depriving ourselves. So we're always trying to push ourselves to
• 1:03:46
  Speaker 3: the latest time that we can stay up and then
• 1:03:48
  Speaker 3: curtailing our mornings or you know, the end of our
• 1:03:51
  Speaker 3: sleep period by waking up early in the morning. We're
• 1:03:53
  Speaker 3: a chronically insufficient population. And not to mention, there's a
• 1:03:57
  Speaker 3: lot of mental and behavioral and cognitive factor that interfere
• 1:04:00
  Speaker 3: with sleep at nighttime, everything from stress, anxiety, depression, which
• 1:04:04
  Speaker 3: these days, in the crazy world we live in, definitely
• 1:04:07
  Speaker 3: a lot of things come up at nighttime that interfere
• 1:04:09
  Speaker 3: with people's ability to sleep. So I think the most
• 1:04:11
  Speaker 3: important thing is when your body is asking for sleep,
• 1:04:15
  Speaker 3: listen to it. If it's not asking for sleep, then
• 1:04:18
  Speaker 3: don't stress about it, because the last thing you want
• 1:04:20
  Speaker 3: to do is have your mind get in the way
• 1:04:22
  Speaker 3: of what your body is wanting to do naturally.
• 1:04:24
  Speaker 2: Would you say that somebody who gets maybe four to
• 1:04:28
  Speaker 2: six hours a night doesn't feel like they need any more.
• 1:04:31
  Speaker 2: Is that okay?
• 1:04:33
  Speaker 3: It's Is it okay? Yeah? I think it's okay as
• 1:04:36
  Speaker 3: long as the person is getting by and functioning. I mean,
• 1:04:39
  Speaker 3: I wouldn't encourage somebody to cut or curtail or cut
• 1:04:42
  Speaker 3: their sleep, you know, just because they feel okay when
• 1:04:45
  Speaker 3: they wake up, because we know that your brain and
• 1:04:47
  Speaker 3: body do require a certain amount of sleep, and of
• 1:04:50
  Speaker 3: course you're going to feel okay if you cut that
• 1:04:51
  Speaker 3: by an hour or two. But I would encourage that
• 1:04:54
  Speaker 3: person to just, once again, going back to what I said,
• 1:04:56
  Speaker 3: listen to their body and sleep the full amount that
• 1:04:58
  Speaker 3: their body is asking for, because anybody can wake up
• 1:05:00
  Speaker 3: early and say I'm good, But that's sleep deprivation, okay,
• 1:05:05
  Speaker 3: and really we're all guilty.
• 1:05:07
  Speaker 2: Of yeah, right, I mean eight hours is really what
• 1:05:11
  Speaker 2: we're aiming towards, right, is it?
• 1:05:13
  Speaker 1: Eight?
• 1:05:14
  Speaker 3: So I'm glad this came up. So there's really no
• 1:05:16
  Speaker 3: magic number in terms of hours, because everybody's sleep requirement
• 1:05:19
  Speaker 3: is unique and different. Some people require six and when
• 1:05:22
  Speaker 3: we say require that means that they're not able to
• 1:05:24
  Speaker 3: sleep more than that. There's a big, big, big thing
• 1:05:27
  Speaker 3: to differentiate is what is a person who just requires
• 1:05:30
  Speaker 3: less sleep, like they just need their six hours, and
• 1:05:32
  Speaker 3: as long as they get their six hours, they can't
• 1:05:34
  Speaker 3: sleep anymore and they feel totally arrested when they wake up,
• 1:05:37
  Speaker 3: and they're good during the daytime. That's very different from
• 1:05:40
  Speaker 3: a person who requires seven hours and sleeps six hours,
• 1:05:43
  Speaker 3: or requires eight hours and sleeps six hours. Six hours
• 1:05:46
  Speaker 3: still is a good amount of sleep, but that person's
• 1:05:48
  Speaker 3: brain is asking for seven or eight in which case
• 1:05:50
  Speaker 3: I would encourage that person to sleep the full duration
• 1:05:53
  Speaker 3: of their sleep. And the only way to really know
• 1:05:55
  Speaker 3: what your natural individual brain sleep requirement is is, first
• 1:06:00
  Speaker 3: of all, this is very unrealistic, but give yourself a
• 1:06:02
  Speaker 3: good like ten to fourteen nights of sleeping, totally ad
• 1:06:05
  Speaker 3: lib sleeping as much as you can until you can't
• 1:06:08
  Speaker 3: sleep anymore, and then get up, and then just do
• 1:06:11
  Speaker 3: that for a period of time and you'll get an
• 1:06:13
  Speaker 3: idea what your body's natural sleep requirement is in that setting, which,
• 1:06:17
  Speaker 3: of course, like this said, is not realistic.
• 1:06:19
  Speaker 2: That's very cool, Yeah, take a two week vacation, figure
• 1:06:23
  Speaker 2: it out.
• 1:06:23
  Speaker 4: So hard about that.
• 1:06:27
  Speaker 2: You know what I was just realizing is that Leonardo
• 1:06:30
  Speaker 2: DiCaprio was in one of the greatest dream movies of
• 1:06:34
  Speaker 2: all time, Inception. Oh that's right, and you worked on
• 1:06:38
  Speaker 2: the film Shutter Island.
• 1:06:40
  Speaker 4: I wonder if you.
• 1:06:41
  Speaker 2: Would have stayed in the game just a little bit longer,
• 1:06:43
  Speaker 2: I would have worked on Inception.
• 1:06:45
  Speaker 4: What do you think of that movie? I love it,
• 1:06:48
  Speaker 4: you know, I.
• 1:06:49
  Speaker 3: Haven't seen it in such a long time. I don't
• 1:06:51
  Speaker 3: even really remember that movie too. I remember loving that movie,
• 1:06:54
  Speaker 3: but I need to go back and watch it again
• 1:06:55
  Speaker 3: to remind myself about that hot.
• 1:06:57
  Speaker 2: Yeah, I hadn't either. And then I was on a
• 1:07:00
  Speaker 2: flight recently within the last couple of years, and I
• 1:07:03
  Speaker 2: was like, you know what, I'm going to watch this
• 1:07:06
  Speaker 2: movie again, and it really holds up.
• 1:07:08
  Speaker 4: It's so good.
• 1:07:10
  Speaker 2: Well, maybe you can marry the two things together, your
• 1:07:14
  Speaker 2: film career and your sleep medicine, and you can write
• 1:07:19
  Speaker 2: the next great sleep dream movie that will rival Inception,
• 1:07:26
  Speaker 2: or team up with Leo again and do Inception two.
• 1:07:30
  Speaker 2: Because it was so good. They should do it again.
• 1:07:34
  Speaker 3: You should help. We should do this, We should co
• 1:07:35
  Speaker 3: screen ride.
• 1:07:36
  Speaker 4: That sounds good. Sounds good.
• 1:07:39
  Speaker 2: Doctor Kashani. I am so grateful that you took time
• 1:07:41
  Speaker 2: to do this, and I just feel so enlightened. I
• 1:07:45
  Speaker 2: think the darlings will feel very enlightened. And I would
• 1:07:48
  Speaker 2: like to ask you to share where people can find
• 1:07:51
  Speaker 2: you social media or how they can reach you.
• 1:07:55
  Speaker 3: Definitely, so you can find me on Instagram, I'm at
• 1:07:57
  Speaker 3: sam Kashawani, MD, and I'm also on LinkedIn and I
• 1:08:02
  Speaker 3: practice here at UCLA in Los Angeles. I practice out
• 1:08:04
  Speaker 3: of the Santa Monica location in UCLA. But like I said,
• 1:08:07
  Speaker 3: I do see patients over video telemedicine. In person, I
• 1:08:11
  Speaker 3: see patients of all ages for all sleep related issues.
• 1:08:14
  Speaker 3: So those are some ways you can find me.
• 1:08:16
  Speaker 4: That's great. Do you see kids? Do you ever get
• 1:08:18
  Speaker 4: kids in there?
• 1:08:20
  Speaker 3: Quite frequently? Yes, absolutely, thankfully. Most of the time. In
• 1:08:24
  Speaker 3: kids it is a behavioral issue, like the parents have
• 1:08:27
  Speaker 3: a little bit of difficult time setting limits, or maybe
• 1:08:31
  Speaker 3: a baby who needed to be sleep trained a few
• 1:08:32
  Speaker 3: years ago just never got sleep trained and it's been
• 1:08:35
  Speaker 3: an ongoing problem. So more often pediatric sleep issues are
• 1:08:39
  Speaker 3: like that, but we still have a lot of pediatric
• 1:08:40
  Speaker 3: sleep apnea and not to mention narcolepsy very commonly develops
• 1:08:45
  Speaker 3: in the early teens or in the second decade of
• 1:08:46
  Speaker 3: life in many cases. So a lot of times we'll
• 1:08:49
  Speaker 3: see teenagers who may have been sleeping totally normally and
• 1:08:51
  Speaker 3: then all of a sudden, at fourteen, they started sleeping
• 1:08:54
  Speaker 3: for twelve hours and falling asleep in class all the time,
• 1:08:57
  Speaker 3: despite having ten hours sleep at night time. So that's
• 1:09:00
  Speaker 3: something that we'll see in pediatric sleep as well.
• 1:09:03
  Speaker 2: I might have to have you come back and talk
• 1:09:05
  Speaker 2: about pediatric sleep stuff.
• 1:09:07
  Speaker 4: Well, thank you so much. I really appreciate it, and
• 1:09:12
  Speaker 4: I know it's great. Right Well, thank you, talk.
• 1:09:14
  Speaker 1: To you soon.
• 1:09:16
  Speaker 3: Look forward to it. Thanks again.
• 1:09:17
  Speaker 1: Drama Darling, Drama Darling