In today’s episode, Dr. Donn Posner proposes a whole new way of thinking about sleep. First, he normalizes the sleep problems many of us experience. If you’re sleeping poorly right now, he says, don’t freak out; it’s natural and normal. Second, he has a bunch of tips for how to deal with insomnia, some of which you may have never heard before.
Dr. Donn Posner is one of the leaders in the field of Cognitive Behavioral Therapy for insomnia. Dr. Posner is the Founder and President of Sleepwell Consultants, and Adjunct Clinical Associate Professor in the Department of Psychiatry & Behavioral Sciences at Stanford University School of Medicine.
In this episode we talk about:
- The difference between chronic and acute insomnia
- How we can adapt to things that can mess up our sleep, like remote work
- Sub-chronic sleep conditions
- What to do if we're experiencing acute insomnia so that it doesn't become chronic insomnia
- The importance of structure when it comes to good sleep
- What social jet lag is
- Dr. Posner’s take on napping
- Why wake time is so important when it comes to good sleep
- Why we shouldn’t try to compensate for a bad night's sleep
Full Shownotes: https://www.tenpercent.com/tph/podcast-episode/donn-posner-268-rerun
See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
The ten percent happier. Podcast Dan harris
hello. My fellow.
Offering beings. We are talking sleep today with a dude who is anything but sleepy, doktor, don posner as a proud, bronx native and is quite correct.
in a good way. In my opinion, and in this interview he got me thinking about the issue of sleep in a whole new way. First thing:
that he normalizes the sleep problems that many of us have, if
in poorly right now he said, don't freak out about it. It's natural and normal and and fixable
and he has a whole bunch of tips for how to deal with insomnia, some of which I had
I never heard before
As I said, his name is don posner he's one of the leaders in the field of cognitive behind
you're a therapy for insomnia or c b t I his title
are founder and president of sleep well consultants and adjunct clinical associate professor in the deep
men of psychiatry and behavioral sciences at stanford, university, school of medicine, not
the dawn patiently answer my many many questions in this interview, but we also played him some listener voice, males to get some answers to your questions.
here, just a quick preview of what we talked about the difference between chronic and acute insomnia. How we adapt to
the commission up our sleep like roma work. What sub chronic sleep conditions are what to do it
experiencing acute insomnia, so that doesn't become chronic insomnia. The importance of structure when it comes to goods
then: how do we achieve some structure? What social
jet lag. Is he's taken
having why waked
it is so important when it comes to good sleep and why we should not try to compensate for a bad night's sleep. This support
You have a series were running this week on sleep if you missed my conversation with the journalist, Diane Maceda, who wrote a book about her own sleep travails filled with evidence based advice, go check out that episode also
to say this episode with on posner originally aired at the hall
The pandemic, but, of course, advice on sleep is very much evergreen.
Don't miss out on the enjoy everyday walking meditation pack over on the ten percent happier app it's available for free until august twenty
If you haven't tried walking meditation on the app before I highly recommend, you check it out here
is what one use your head to say: I'm quoting here, I'm in my six the year with ten percent. I start and end my day with it. I like their walking meditations to use when I'm out exercising or walking the dog the long
I use it. The more I learn the nuances and subtleties and refinements of the process is life. Changing that's awesome to hear
although the ten percent happier after day wherever you get your apps and get started for free this.
Oh a sponsored by better help someone
in life were faced. A tough choices in the path forward is not always clear what he guilty
era say when you come to a fork in the road taken, not very useful, although I guess kind of
funny, but yeah we don't always know what the right way to go is, and I find myself and many forks in the road or places in the road where it does more than fork, and it can be really helpful to have expert advice,
better decisions, whether you're dealing with decisions around your career, your relationships or anything else, therapy help you stay connected to what you actually want. While you do your life, so you can move forward some confidence and maybe even some excitement. Trusting
to make this
Is that a line with your values
like anything else and life, the more you practice it the easier it gets
in quite a bit of time, going over big decisions with my therapist ten? I found him to be massively massively helpful.
if you're thinking about starting therapy, give better help, try its entirely online, designed to be convenient, flexible and suited to your schedule. Let therapy be your map with better help visit better health.
Calm, slash happier today to get ten percent off your first month. That's better help, h e dot com, slash happier.
Maybe you stayed in an air b and be before and thought yourself. This actually
pretty doable. Maybe my place could be an air be envy the could be as simple as starting with a spare room or your old place when you're a way you could be sitting on an air b and be gold mine and not even know if I stay
air. Being these every once in a while, I really enjoyed taxpayer
terrific alternative to hotels,
especially when I go on beach vacations with my family. We love to be able to have a house more space cook for ourselves, so big fan
and it really is something that many of us
it would take advantage of as an economic opportunity, for example, if there's a big music festival or tournament come into your city. That's a perfect opportune
to get out of town and avoid the traffic you can air.
Can be your home and make a little extra money, whether you could use a little extra money to cover some bills or something a little bit more fun. Your home might be worth more than you think, find out much more at air being be dot com, slash host great to meet you in thanks for doing this. I appreciate a sure thing good to be here.
You gave a talk recently that got some attention deservedly hopefully or get now more attention. Another other were putting you on the show about acute insomnia. Now. Can you tell us what that
means and why you're worried about it right now, especially, let me clarify a couple of things. Let me maybe work backward. The best way to define a cute insomnia is to define chronic or long term insomnia, which we in the field called
sound the disorder and the way we define that is that a person is having trouble initiating sleep to begin with
or they wake up in the middle of the night and can get back to sleep or they wake up sort of.
end of their night and never get back to sleep, and so those are really three
labors of insomnia. If you will beginning middle and end what we like to say, chocolate, vanilla
strawberry and then there's neapolitan, which is a mixed bag right. So that's insomnia. If that is happening, and we say what's a problem with getting to sleep or staying asleep its if you take longer than thirty minutes to get to sleep on average, if you
who are awake for some combination of thirty minutes in the middle of the night or you wake more than thirty minutes earlier than your desired time. If that's happening three,
more nights a week for long,
and three months and you have associated daytime symptoms, that's in some
disorder- and I want to underscore that last piece, which is it really a twenty four hour disorder it it has to have impact on your day for us to say that this is really in some sort of problem. You have to have something like fatigue, sleepiness concentration, problems, performance problems and so forth, so chronic insomnia is those symptoms more than three months. So now, going back to your question about acute insomnia, acute insomnia is all of that
less than three months. When I give talks and when I asked the audience how many people here have ever had a bad night sleep. I know I'm gonna get a laugh and a hundred per cent of the hands go up. We ve all had that experience
and all of that is normal and nothing to concern ourselves about, and we don't even talk about. Anything is diagnostic as acute insomnia until we get to at least three days, but then anywhere between three days and three months is considered acute in salmon.
And that means that you're having those problems either initiating or maintaining sleep.
and you may or may not have daytime symptoms yet, and it's usually due to some stress her and we
anything from the bio psychosocial spectrum. I now say too:
I trainees, you could probably opened the dictionary. Put your
finger down in a word and find something that causes insomnia, whether it's an illness, a physical pain
a change in your environment, a psychological stress like stress it work, tax time, those sorts of things, and I also hasten to add that the violence of that does not have to be negative right.
Change is stressful, so getting married and getting a new bed partner in your bed can change your sleep patterns having a child is a good precipitous
cute insomnia until you can get that kind of straightened away. The thought process is absolutely very much
that's a normal reaction distress, maybe even a good one, because if we go back evolution narrowly speaking, sleep is a dangerous activity right if you're asleep your vulnerable. It must be important for that reason, because every species does it and so on
must provide a very important function, but it's dangerous. So we always say that sleep is deferred.
When the lion walks into the mouth of the cave, and therefore we could say that acute insomnia is adaptive
you understand so, even now in our culture, its adaptive in the sense that you're making changes you're trying to deal with whatever is coming down the pike. But we always expect that if you then adapt appropriately or the problem itself goes away or you can on some medication or the stress or itself remit, then we expect the acute insomnia to remit, and so all of that we consider to be normal and it is for a smaller subset, but yet epidemic numbers that sort of gravitate into this chronic insomnia realm, which is where
people like myself and my colleagues coming in terms of helping people to treat that if I've heard you correctly chronic insomnia is a big issue. You ve dedicated you're your life's work to addressing in acute in sound
Yeah makes sense, given what we're all living through right now and in some people it will escalate to chronic and that's the source of your big concern right now, and one hundred per cent correct yeah so
I could be causing a lot. You no more acute insomnia. Now then, in normal times, well, were more all more under stress. We're under stress for a lot of reasons were under stress because of the disease and everything it goes along with that. What goes along with that worries about our own
Health worry about our children's health. Worry about our elders. Health worry about ourselves getting that the disease, but we are also concerned about the mitigation attempts were making at least some places were doing it. Well, we are concerned with you no loss of job loss of revenue, loss of our business. I can imagine the person whose sleeping well through that so again, I say and will come back to this later, but
The first thing with regard to acute insomnia is don't panic, its normal came. There are lines in the cave so to speak there
and in the cave is exactly right. So we should not be surprised. That said, in addition, not only
we have. Are we faced with a tremendous increase in the amount of stress to a vast swathes of the population? We really say this is now worldwide is also the case that the mitigation attempts threaten potentially threaten our sleep, and let me come back to potentially at some point but potentially threatens our sleeping
As of the changes we make in our day, as we go more into this and talk more about this today, then I would hope people will learn that one of the major things that keeps your sleep healthiest structure, okay and we are sort of most of us.
First into a structure by our work in school day lives. I now that's gone for many people, so if you get to work from home, that's terrific, but it also gives you the possible opportunity to throw structure out the window. One of the places we often see what we call a recipient of acute insomnia and eventually chronic and semi is retirement,
sort of the same thing, we ve all been forced into this. Well, you know no need for that clock in the morning anymore. That in and of itself can potentially eight acute insomnia. So we have all of these
reasons. For that and again, none of that is of concern, because, especially the stress itself, I think we've kind of seeing it happen where we're adapting as best as we can it's a little bit of a moving target, but people who have now been-
working from home, I know at one point I tried to get a monitor from my computer at the store and I couldn't find any cause. They were all gone. Everybody's got manner is now everybody's learned to kind of create their home office there adapting better and better and better, and it might be for those that kind of say, gee. This is kind of working. Ok, it's not what I prefer, but it
working okay. We can imagine where they automatically are just on their own start to sleep better. But there is this possibility that those that
of thrown away a lot of what we would call good sleep. Health inadvertently are at more risk for chronic insomnia and those that are for anybody who get an acute insomnia, those that begin to make a shift and while I say acute and sammy as up to three months, my
one of my colleagues would start to say that even one a month or so to three months starts to get into what we might call a sub chronic condition where we're starting to see this transition
nor this shift, where not only is the stress her the problem, distress or do jure is what you are concerned with, but you also are now starting to shift your attention to the sleep problem itself. If you understand what I'm saying- and that creates
the potential for a vicious cycle and changes in behaviour that serve only to make sleep worse and more chronic,
and so that was
the line that when I was giving that talk, I was kind of saying let it least think about a key.
Insomnia and what we might do in that phase of acute insomnia to prevent the epidemic of chronic insomnia that might follow the pandemic. So what could we do to prevent this epidemic was on the list without getting to science about it. Lets understand that, as I said, there is an important to structure and if I was gonna start that conversation the place, I always start is the single most
point of important structure. There is an that wake time, and so we all understand most of us know that we have this internal biological, circadian rhythm,
and there are a number of bodily functions that fluctuate and a twenty four hour basis like hormones, secretions and body temperature and so forth. But for the sake of our conversation, what we're looking at four a muster circadian point of view is sleep. Wake rhythms and that rhythm is held in check is what we call in trained the waiter.
about it is. How do we get that clock to be well set to chime when I wanted to chime and not to chime when I dont want to china
The single most important point of data of input into that clock is wake time, which is also a proxy for my first exposure to day,
and light exposure and so getting up at the same time at least most days a week is important kay,
If you are someone who has now thrown the clock out and some day
you are getting up at six and some days you're getting up at seven in some days, you're getting up at eight and nine. That is what we call social jet lag. So imagine if you
I'll. Just anybody listening has to just think what would happen and I'm based in the east coast right now shall take an east coast reference. But what would happen if you flew from the east coast to the mid west to say from now
to chicago and state overnight for one night and flew back to new york and then stayed one night, but the very next day flew to denver,
and then stay there, one night and then flew back to new york and then the very next night flew to LOS angeles and stay there for a night and flew back to new york. How would you feel then I'd feel like a working journalists, because that's what I used to do all the time, but it feels crappy. It feels crappy as it is the perfect word. It feels crappy and that, of course, jet lag, but what I want people to
and is that you can feel that it's same what we'll call social jet lag by varying your times in the morning, just as much so, if your
I had already having trouble sleeping. You dont have to be heavy handed about it. When I'm working with patience and trying to write their sleep, I talk about getting up at the same time. Seven days a week,
fix the clock, but I will always tell them is a well oiled clock if you will doesn't require quite the same amount of consistency as a broken clock to fix it, so the well oiled clock
we will usually say requires what we ve seen in most people, which is five days a week. Most of us get up around the same time
I am every day five days a week and a couple of days, usually on weekends. We do it a little differently and that doesn't throw anybody into a tizzy
and so, if you're already not having problems sleeping, all I can recommend is get up at the same time, five days a week and largely go to bed at the same time or after, if you're not sleepy five days a week, because that will help maintain good, sir
eighty and entertainment and good circadian rhythm now add to that any other regularity and our lives can add to that circadian, entertainment, so regular meal times, as opposed to grazing on you know, random schedule, regular exercise times going back to some structure and your life take a walk at the same.
I'm every day, do things like that at the same time every day maintain your activities during the day tat?
to get out and be active activity, helps sleep and nothing begets lethargy, like lethargy
oh sitting around and doing. Nothing is not a great idea either. We are,
diurnal animals, which means we're not raccoons, we dont forged for food at night. We do our foraging in our work during the day, so most of us should be on a daytime schedule
We should be eating our meals during the day. Our activity and work should be during the day and as we transition into night, we should make that transition into lower levels of light. We don't have to be
in the dark but lower
those of night and also transition are activities, we probably should not be working right up until bedtime. We should not be
letting are difficult child who lives on the other
The country call us at eleven o clock at night with their problems. We should set a limit for that and true.
Position into quieter. More relaxing times at
stir an hour or two before bedtime. Those are just some good. Health tips
for people who are already sleeping well
staying away for the moment from the typical sleep, hygiene joint things, bedroom
environment. Those are always in place and should be in place, and we can talk about those later. But in terms of right now,
what do you really need to focus on if your home and not working and don't have that structure imposed upon you? I can say that you know we probably for most
of us. Now you might be able to nap a little bit and napping is not bad. The problem with now
Is this a right way to nap in a wrong waiting up? If you feel like you,
build napping in you can, and we can do it the right way. If, however, you foresee that soon you're gonna go be going back to work,
keep in mind that when you nap when you take a siesta during the day as many cultures do, that
you are reinforcing your internal clock for wanting that nap. At that time of the day,
if you think in, like even a month, you're going back to work and can't nap you're, probably best off trying to avoid that nap during the day. If you can at all help it. If you do nap whether because you want to now just build that into your life as many for instance, retired people might do or you just can't help it because you're having a problem with sleep at night,
trying to compensate as little as possible. So if you are going to nap the ideal time now, but we all know we have this little dip after lunch, this post prendick circadian dip in red
and that's a normal function? That's as it is expected to be it biological it programmed in
it's a time when our drive to sleep has already been built up somewhat by half of our days activities.
and yet our circadian rhythm is going into a little bit of a low, so that's the best time and that that is
something like seventy nine hours after the you wake up in the morning or habitual wake time and a short nap,
the minutes and set an alarm to wake yourself up is much more preferable to so called power nap to sleeping for an hour or two that's going to rob you again of more sleep. The next night
and it is going to leave you feeling a lot of sleep inertia when you wake up you're, going to feel worse when you awaken from that nap than you did going to sleep, a good short nap will carve off just enough.
penis, and then your circadian rhythms, alerting signals are kicking back in any way that it's gonna give you a nice stepping stone for the day. I think I got all of those notions that you just listed. There is one thing
Oh, that you set up there with what you lead with that. I'm still little curious about, which is you said, wake time is the sort of apex predator of the lever. Is you can pull them, mixing
metaphor horribly here, but anyway I wake up. I'm is super important. Let's just put more colloquially, I'm having a hard time disentangled net from bedtime. Wouldn't that
the more important input? No really is wake time with regard to what do without daylight exposure.
and bedtime and when you feel ready for bed is determined by when you first get that light exposure in the morning. So you should
sudden alarm figure out? What are you
body normally wants to wake up and then ensure that your waking up at that.
I am regularly with an alarm if need be, and then back timing, your bed time to that
yeah. When you say back timing, that's an interesting story, because the question is how many hours of sleep do you need? Okay, and I don't think most of us in this country know how much we need that is each individual.
But if you think you're good at knowing what you need- and you are going to do that- yes, exactly what you said is what I would do-
What time do either need to wake up in the morning or now want to wake up in the morning and then backtrack from that for the amount of ours you think you need. So if I'm having trouble sleeping and by the way, I definitely followed me chronic insomnia category so just to say that, and I know you can't and shouldn't be giving clinical
Vice here, some of them either chronic or acute insomnia, and I want to work this first piece of advice that you gave about wake time
the operational that I would think about what
the wisest waked time and then set an alarm to get myself up yes and then impose some day
the plan on the front end around dead time, so that of getting enough sleep. Yes to hit that. Ok, yes, and the bed time is also then not occur.
I'm not saying you must then go to bed at that our or else what were we
saying about bedtime, is if, in a twenty four hour day, you think you need seven hours and your waking up it
Evan then bedtimes roughly around midnight and you shouldn't go to bed before that and again you started to make.
Transition I hadn't yet made, but is reasonable to do at this point, which is first, we have
people who are already sleeping well. Should they maintain some of this structure to me,
contain that wellness. Yes, if you are starting to have a problem
now. You should absolutely be doing those things to kind of get yourself back on track and
the second rule I would put on wake time being structured and bedtime being structured is don't compensate for a bad night.
It goes along with rule number one. If waked time is wake time, if seven o clock, it should be seven o clock the fact that
I was awake for two hours in the middle and I doesn't mean I should now sleep till nine. It will just make it more likely that I'm gonna
more trouble down the road k, so
the rule is always whatever your sleep needed,
get that amount to sleep most days or less, never go for more, and certainly don't go
more when you are trying to compensate for a bad night of sleep. So it's that person whose
neither get up any later should not
go to bed any earlier and should not nap during the day to compensate for that law. Sleep
we have an internal mechanism of sleep regulation between what we call sleep drive and circadian rhythm,
that will right itself if we allow it by not doing those things. I just mentioned
me up. Doktor posner tackles the controversy around.
Much sleep. We actually need every night when you should go, see Asleep expert and when and how sleep medications should be used.
Tad blocking is on the rise and audiences are getting harder to reach so to cut through both brands, throw.
if you see out the window and ramp up online tracking, but rave
There's a new approach: one we're privacy and performance come together. Brave users choose when and where they see brave adds the result in
three leading add engaged with brave, you can drive,
traffic sales and product awareness. Without
lady use your privacy and
each new audiences while you're at it
to get started with a new way of advertising online. Go to brave dot com forward, slash ads
when you ve gotta, help thing going on. You just want to make that thing less of a thing, so you can feel like yourself again, but we have to weigh days for a doctor's employment or shift your whole day around to get into the dockers office. That health thing
can become even more of a thing and the longer you wait, the worse it gets so instead, maybe
try amazon clinic a virtual health care service that helps you quickly and discreetly get
meant for common health conditions such as scientists, infections, uti, eyes, acne and more
from your phone or desktop just open amazon clinic and choose
condition to get
acted with an online doctor or nurse practitioner who will give you a personalized treatment plant with any necessary prescription? Amazon clinic
virtual healthcare that fits into your life. So you can get back to being. You had to cleanse
dot amazon dot com slash happier to get started? How do we?
oh, how much sleep we need. How do I know how much sleep I need? Well, so that's why I say most people, I think dont know because unfortunately, my tribe, my brethren, the sleep people in the world have
now gotten this message out there that we all need eight hours and nothing could be further from the truth.
now the truth is. I do see more and more over the last say, five years or ten years that the message is now you need to get between,
seven and nine or else, and even that the data is, is not so clear on that that the range of what people need within
be a standard deviation or so of the normal mean is somewhere between about six and nine hours. So that's about where I would put it that said, understood
and the average is actually not eight in this country, the average in the mode is closer to seven and a half there's at least gonna be a stir
or deviation on either side of that meaning. Yes, some people are going to need seven, and some people are gonna need six and a half
simply brutal guaranteed eight and some people are gonna need eight and a half, and the question is how
You know you're getting the right amount of sleep, because when you get that amount asleep, you feel fine during the day now again,
I caution? What I mean by that is when you're getting that amount every day. The fact that you don't get you know: do you get two hours to nine three then,
for the next and then get your right sleet need for one night. You may not feel perfect and by the way, if you compensate and then all of a sudden crashing
we can get eight and a half hours or nine hours and say gee. I feel great. That doesn't mean that's what you need. That's just! U compensating for the bound
gender of going up and down and up and down and up and down, but if you're, a seven
or seven and a half hours sleeper, and you get that every day, if you're getting something every day and you say yeah, I don't feel tired for most of the day, all of us have
a little bit of sleep inertia when we wake up in the morning a little bit of transition to wipe the cobwebs
out of our eyes and transition to wakefulness so don't use. That is your gauge. We all have that little bit a dip in the afternoon and we all it stands to reason should be starting to feel more tired and sleepy as we approach bedtime. So I asked people to gauge how their function
at all other times of the day, that's when I want to know how you doing. Are you tired sleepy? No, are you concentrating? Well, yes,
Are you active in creative and feel good? Yes, you are
probably getting what you need. So this issue of what the message your brethren are putting out is
Can we get coming into the conversation I wanted to get to this? We had a sleep expert on the show, and this expert said
all the data he had looked at suggested if your falling below seven hours a night, you are in danger. I was just reading something about that and I am telling you that the data
not clear on that? It's probably a little bit more likely that if you fall below five hours a night, that's a little bit more true
But you understand that a lot of these epidemiological studies do this. By doing cut points and the cut points when they look at seven and below seven is they'll say something is below seven and including below
seven every body whose below seven so understand there are people who are sleeping for hours and five hours and
four and a half hours and five?
half hours there are included in that number and when you do a fight
grained analysis of the data it looks like going below. Five makes a difference, but people who are its six six and a half. If you just
separate out them from everybody else. That's below six, not so much danger. Okay, so I got quite exercised when I heard this
junction, this exhortation to make sure you're getting seven plus a night and started to get from quite fixated.
My sleep. I got one of those aura rings that tells you how much you're sleeping and that turned into a mess for me, and we got some white passionate people love the episode by and large, but we got a few really gloriously,
negative reviews from people who said I've never had a slight problem until I listen to this interview and they went down the same rabbit hole that I went down, which is a vague got fixated on sleep and then started to second guess themselves, etc, etc. Show any thoughts on the foregoing, yeah yours
my my song. So this is why I mean I mean I love my field and look. I mean you
I understand the data that this person, whoever they were said they looked at its out there. I can show it to you
but what I'm telling you is, when you do this finer grain analysis,
There are a number of papers that are now saying well well, well, well, and it in some ways it doesn't matter. So let me say a few things about that, so I will stick with this idea that under six is more the cut point, so give me six to nine that even between five and six is may be an issue, but not egregious, and again it's about this way in which we do this fine grin. You have to think about how the questions
and asked, and the question sometimes have been asked and cut points have been made with regard to these on the hour cut points. So what eventually some people did was to look at data below seven hours when you start to look at between seven and eight, that's a slice, and when you look at between eight and nine,
that's a slice. When you look between seven and nine, that's a slice that smaller
then below seven k below seven is everything: that's below seven, that's a much wider margin, and so I tell you
There are people in that margin that they looked at. Who are sleeping
five hours and four hours and therefore their being included and there
swaying the numbers. So if you look under seven, yes there's an indication that some of them are more prone to certain kinds.
Of morbidity and mortality. We say, but that may be because that now
is overwhelmingly being swayed by the people who are getting much less sleep than that. Going back to your comment, which I love
The other thing they're not doing when they do these studies is there never
looking at the people I just talked about, which is their just saying, how much sleep d get and not? How do you feel? Ok, so suppose you took a cohort of people who are getting six hours a night,
and felt great, and you found ten thousand of those people, that's not what they're doing came there just lump it, everybody in so some people get six hours a night, because
not sleeping well, and they could get more? They should get more and some people are getting. You know being forced into that by work schedules, but some people get six hours because that's what they need and if you get six hours- and you feel great- and you get that every day, if you try to sleep for seven or eight hours, you're going to get insomnia you're going to
expand your sleep opportunity beyond what your body can give you. You will occasionally sleep for sex,
for eight hours and put yourself into deficit
so that you now no longer need as much sleep the next night and have a night of insomnia, and this is what starts to happen, and then people get freaked out, and so I've been saying,
for a long time, my brethren or well- meaning we should definitely takes they're out. There also think we should take sleep much more seriously. Yes, we should be attentive to what our sleet needs are and fight like the dickens to get
yes, but to start seeing everybody needs between these numbers and you should get. It is absolutely makes business for me. I
people with insomnia all the time we're coming in saying, but so and so said,
they said and I go day again. Ok, let's debunk that, so you see, if you're getting overly fixated on your sleep, because somebody told you that
sleep is important. You're gonna undermine the whole machine if you're getting overly fixated on sleep for any reason, you're going to undermine the whole machine sleep. That's one of the big issues here and one of the advice pieces of advice I give to everybody, but also especially those people are having trouble sleeping. You cannot make yourselves sleep
You cannot sleep is such an autonomic automatic process. It is think of it like heart rate, digestion, perspiration respiration, and I say to my patients: you don't ever find yourself after your last meal thinking, let me see if I can digest
a little bit faster here. Okay and they'll say: oh no. I never do that and I'll say. Why? Don't you do that and I'll say, because I don't have any ability to do that now say exactly the same with sleep. If you get into bed- and you start trying to make yourself sleep, you are done
in. I asked these questions in my audiences. I always ask for somebody when I'm I'm usually training other therapists, how to do this work, and I always ask for somebody who has a good sleep
in the audience- and I asked them to raise their hands. I say: ok, forget any other behaviors you have in terms of rights,
in bed or not reading in bed watching tv in bed, whatever your habits are at some point. Most of us close the book do all of that sort of stuff and put our heads down on the pillow, and I ask that person who's. A good sleeper. Tell me what it is that you do at that point to get to sleep and one hundred percent of the time I get either a
one of the shoulders a quizzical look. The answer I dont know the answer. I'm not sure what your question is because exact, that's exactly the right answer. Good sleepers! Do nothing
when you ask them what happened last night, when you got into bed, they say I got into bed and then I don't remember, that's what it should feel like Dan. When
you start getting into bed. In saying I don't know I my close to my getting there
Not your way beyond already where you should be in terms of trying too hard, and, of course s
buddy and their brother has a remedy, and when you start becoming fixated on your sleep, it is one of the worst. We call perpetuating factors that keeps insomnia chronic, okay. Well, you just described my life
sounds like I need to come, see somebody like you, and so that actually is because we're going to start taking some questions now from the audience, but before we do that, I want to give you a chance to say something that you said to me before we started recording which is you're going to give general. I sorry, my son is opening the door to this closet. Okay, hi buddy. He has his pajamas on. That's awesome, alexander, I'm recording a podcast. So, can you go away.
Yeah, ok club be quietly. All of my meetings are like this, so he is five and and
made a million appearances on this by gas during the pandemic. Big, that's awesome! That's just yes! He's coming in here to pet our cap. Ok, so your point
is you'll give general. I hesitate to use this term but advice, but it is not the same as
going in to see a doctor and having the doctor or the sleep expert, diagnose what your particular issues are right exactly so let me go back again. How do we transition?
from acute insomnia, some chronic insomnia, and we talk about. We call perpetuating factors and those perpetuating factors by and large have to do with the things we ve talked about here today. I start to alter my sleep schedule as a way to compensate for my poor sleep and therefore I throw myself further off. I will
begin to work harder at something that I never had to work out before in my life and by doing so exert more energy and tense up. Would you can imagine is not conducive to a good night's sleep, and this is
we haven't mentioned yet, and it's a tip I can give if you are
in the middle of the night awake, and I don't care whether you're just
thinking random thoughts or all the way up to worry. It's not a good idea to stay there.
and the people who are staying there are engaged in what I just talked about, which is sleep effort for one thing right there hold not do that
just for dear life, hoping that sleep we'll come back, but the other thing they're doing night after night week after week, month after month, is associating their bed
with a place of worry and thinking and ruminating about stuff. So imagine that you can start to get so
be while you're on your sofa watching television
go into bed and like pavlov's dogs, boy,
your wide awake, because your bed is now a trigger for being awake. So my
commendation to people who are not sleeping well is that if their awake now
be in bed when you're awake go somewhere else. Do something fun, wait until your sleepy again and try again and if it doesn't happen,
night. It doesn't happen tonight again. Acute insomnia is normal, don't panic, and if you don't compensate, if you don't stay in bed, if you don't over, think it if you don't work too hard at it
it's going to rectify itself. As I said, and usually within a few nights,.
So yeah you might lose two or three nights and then right. The ship and you'll be fine, but people got
get at it right away and they cause themselves more problems of the other thing. Of course people do. Is they start to worry about this,
my god, I'm not getting enough sleep. What is this going to do to me? Imagine what that thought does to your sleep. So going back to your question
There are a number of different perpetuating factors and any given individual, whose not sleeping well might be exhibiting some or all or others of those factors, and what it requires to get well is a really good assessment, a good evaluation of that process by somebody who knows what they're doing and then knows how to fix those
things because fixing a bug right now I can tell somebody look, don't stay in bed and you won't develop a problem once you've done that for six years you ought to see a professional to help you get beyond that, because just getting out of bed for one night isn't going to do it.
I want to prevent people from getting there, but if you're there, you should go, seek professional help, as I always say, for other disorders. We understand that the doctor wants an x ray before they cast your leg. They want blood work before they give you a medication, and likewise here, I'm not gonna, give anybody specific ideas about what to do other than what we have already talked about, and what I would advise anybody who has tried a couple of these things and it's not working to do is go, get it properly, assessed by professional who is a behavioral sleep, medicine special.
I like myself so just to put a fine point on this: the tips or advice that you're a general guidelines that you are going to share in the course of this and you've already shared in the course of this interview are basic sleep hygiene that we should all be sort of endeavoring to,
who operationalize eyes and our lives, but for finding ourselves with chronic or sub chronic insomnia. That's the time to actually go get an individual assessment, yet look even sub chronic. If you do some of these things, it might
work. But if you ve gone beyond three months and more often than not by the time for somebody comes to see me, they have had their insomnia for three years and thirty years. So once you cross that three month mark, you tend not to get better without some targeted treatment and I'm talking about non farm
logical treatment, not medication, the number one I should get this out there, the second largest medical organization in the country, the american college of physicians.
Has now done a guideline paper on insomnia and is basically made the statement that the treatment of choice for insomnia disorder is cognitive, behavioral therapy for insomnia, which is a non married
patient therapy for insomnia, which goes after all these things we ve talked about and that you know if it were possible. Unfortunately, it is not enough of me out there, but if it were possible that somebody ought to almost fail this before they go onto a medication, because medications are
rate for short term insomnia, but they were never really intended for the long term problem. Is it safe to go, see us
doctor. I now I mean I I had been under the impression that, in order to really get the most out of us, sleep, doktor asleep expert, do you need a sleep study
I don't really feel like going into a hospital in the era of covert, is fine. Just as you know you a series of consult
over of resume and gecko in that way, I'm so glad you asked that question. First of all, when I say I practice behavioral sleep medicine that encompasses a lot of different sleep disorders and insomnia,
one of those and beyond what I do. Behaviorally there are medical sleep disorders and medical things that we do. The most common of those would be obstructive. Sleep app and many of you listeners may know about that and the most common they treatment of choice, for that is see, pap or continuous, positive airway pressure in order to get diagnosed with sleep acne appropriately. You have to have asleep study, as you have noted, and yes often that entails going into a
sleep, lab and sleeping there, but more and more frequently, even those labs are now doing. Homes, studies and
certainly in the era of covert, I'm sure they're, almost entirely doing home studies and diagnosing you for those kinds of disorders they're coming back
Two insomnia insomnia is disordered. That does not, unless you suspect, other occult sleep disorders does not require asleep study whatsoever for the diagnosis, and so somebody like myself,
could diagnose you online like this, and we
right now in an age when tell a health is flourishing and law,
State laws are allowing people to do more, tell a health rather than bringing people in the office so for the particular type of work we're talking about. With regard to treating insomnia with cognitive behavioral therapy for insomnia, it can be done exclusively on line through tell health.
How's that I love it figuring this out- is now number one on my to do list coming up done.
Talks about why the pandemic may have ushered in better sleep for a certain subset of people how to break the cycle of waking up in the middle of the night and his advice on using devices in bed. Audible.
do you enjoy all your audio entertainment in one arab will always find the best of what you love ford,
something new to discover you'll discovered thousands of protests from popular favorite
to exclusive new series guy
well wellness programmes, theatrical performances, comedy
Am exclusive audible, originals from top celebrities, renowned experts
and exciting new voices in audio. As an audible member, you can choose one title amounts to keep from the entire catalogue, including that later
best sellers and rhythm, sits. I've
decided to start listening to Stephen kings. Dark tower series based on my husband's recommendation, he's listen
you all wish me luck. New members
can try audible free for thirty days, visit audible that council
ten percent or text. Ten percent to five hundred five hundred, that's audible, thou come slept.
Ten percent or text, ten percent to five hundred five hundred to try audible, free for thirty days, audible, dot, com flesh, ten percent sign,
shows that quality sleep helps improve your mental emotional, physical and relationship house.
If you find yourself. Waking up tired here are some tips to help. You sleep your best. If one door come
and tough work out these sleep number smart bed can help you get the quality sleep, you need to recover faster
I'm talking to your neck shoulders back and hips. The sleek number smart bed provides support and even weak distribution for more comfortable sleep
and did you know that eight out of ten couples prefer a different mattress firmness than their barton, sleep number,
smart beds, let you choose your ideal firmness on each side and then automatically respond to your individual movements throughout the night to keep you both sleeping comfortable.
Leap next level unlock your unique potential with a smart beds that can perform as well as you and now
sleep numbers biggest sale of the year were all badge on sale, say fifty percent on the sleep numbered limited edition. Smart bed
special financing for a limited time, only add sleep number stores.
with number dot. Com see store for details before we dive into that. Some of these questions that we got from listeners who called him and left us voice males. Is there anything else? Any other points. You want a macro points. Micro points. Anything you want to say before we start getting into these kind of specific issues here this one that we haven't touched on, which he is one of the interesting things.
Look, there's no questions. Everything we ve talked about, I think, is true and by the way, there's people all over the world right now doing research studies and getting grants uncovered and sleep and looking at all of those issues,
So we don't have all the data right now, but we will eventually but anecdotally, no question. Some people are becoming more stressed and therefore at risk for acute insomnia and at risk. Therefore chronic insomnia
and some people may be altering their schedules in ways that are making them at risk for acute and chronic insomnia. That said, one of the things that I'm definitely hearing within my field is that at least some subset of people
our sleeping better now than they ever did interesting and
I wanted to get that out there, because I can only speculate as to why that is, but I think it has to do with things that we ve been talking about, but I did talk about this idea that we all have sort of a proper sleep. Number, if you.
sleep need having nothing to do with asleep number mattress. We all have asleep number. I'm gonna use the number seven
I hate using number. Eight. Everybody somehow thinks all my patients come into me and they're locked into an eight hour timeframe, I'm going to use the number seven suppose you're a seven hour sleeper
The other thing that we all genetically have is a preferred sleep phase, meaning when, in the twenty four hour day and my best able to get me
seven hours and we all have an intuitive sense of this. This is the effect that we have when we think
Somebody is being a night owl or somebody
being a morning person. So when I say,
if somebody needs seven hours, they can probably get seven
in a fair range of sleep, but it may be that they can get their best sleep between tend to five and not between one two, eight and somebody else is gonna, get their best, seven hours between one, two, eight and so on and so forth. What I think may be happening during covered for people who are working home is that if, in fact, they are getting up with some structure in their lives, their doing so but-
a different set of phases than they did when they were forced to work when you have to get up in the morning at five thirty in order to get showered and dressed, and
shaved or make up and then in
the car and commute for an hour and then get to work on time you
had to do any of that anymore and now maybe you can afford to get up at seven o clock instead of five o clock or five thirty, and it may be that just
that slight shift of an hour an hour and a half allowed you to sleep a little bit better because its closer to your preferred phase. It also may be the people of feeling better, because their not being shortly
again, I'm not saying anybody can sleep any number of hours. I'm saying if your sleep me to seven, you should try to get seven and if you're getting six you're going to feel a little shorted, and it may be that our work schedules for many people are forcing than the burn the candle at both ends and not getting enough sleep. That's
as such my brethren have out there that they are right about. We should try to get. What we need is the way I'd like to frame the message and covert may be allowing some people to get what they need in the proper phase, and so, if you're, finding yourself sleeping better. I think that may be the reason. That's so interesting. I know I said want to get to the voicemails, but there's one other point I want to let you make because you kind of made a nod in this direction, but when we were talking about the importance of wakeup time, you then talked about exposure to daylight or sunlight, and I actually think
and I know in your talk- you expand on this. What does that look like? Should we be if we can getting outside first thing in the morning? Why is that important if we can't get outside should be sitting by a window? Why is this an emphasis for you again light is what in trains the circadian rhythm, it is essential to that pacemaker in the brain, and so the timing of that light is essential to keep us in trained into a twenty four hour schedule a controlling when your exp.
to that light is a good idea, which means two things. It means that when you get up in the morning, you should open up the curtains and get as much light exposures you can, if you're not having a particular
problem with sleep shore sitting by an open window is good enough. Try not to sit in the basement. If you put it all help to do it. If you are a very dark place,
you can get out for a little while that's a good idea that will help to strengthen again if you're, already sleeping well, I'm not telling people boy you're better, do this or else, but if you're not sleep,
Well, definitely you want to get light at the same time every day and try to get either by a window or get outside if you're not getting exposure. That light and frankly, the other thing that
should be doing is controlling the light in their bedroom before that we don't want to get too much light exposure before our destined time to wake up or that can predispose
you two waking up earlier or resetting circadian patterns and waking you early so asleep mask is a good thing. If you can afford it room darkening shades and putting shades on tracks
I always like to say that the rest of the world has gotten a memo and we missed it. We seem to
MR, in a lot of things now with the rest of the world, got this memo, and
I'm always we were born in caves and we should have stayed there. If you go into latin
god they have what we called. They call percy ana. They have metal sheets on tracks that come down and I feel fairly certain. You could survive a nuclear
last behind that thing, but for sure you're, not
in any light exposure. If you go to europe you're going to see the shutters that they
clothes and you kind have a slightly comes down and close them off, and there is no
I coming in in the morning we have window treatments. We have blinds and drake
that led a lot a light in the morning, relatively speaking.
And so I always tell people it's much better to keep your bedroom as close to really dark as possible that what I'd like to be able to develop film in your bedroom in the morning before you wake up. Ok, this is all about
incredibly helpful. So let's somebody other than me ask some questions here. We got a lot of
along the same lines there is war
in a really big theme that I want to hit first you've already kind of hit it it's going to require some repetition, but I think it's worth it because I think this is a big issue that a lot of people are dealing with witches, the middle of the night. Wake up so samuel our producers just going to
we got through. He messages along these lines is just gonna play them for you in and then you can all our ok. Thank you for taking any sleep strength minding elsewhere, how to break the cycle of wake up in the middle of the night and not being able to get,
to sleep. If there's anything that can be done to break that cycle,
would be interested to hear what the tips or suggestions might be. Thank you,
I do if my anxiety is waking up in the middle of the night. This is the question regarding flee. Cathy calling from palm springs
a foreign, yes and no trouble getting the slave. I'm usually tired and sleepy before I'd like to be, but inevitably
where between
thirty. Four, I wake up
start ruminating and wonder
start ruminating, forget it and you know no matter what I do and I can't pull my mind out of that constant, I'm trying to figure out this thing or that thing or
whatever anyway any any help on that would be appreciated. Thank you, okay
suspect your hearing a lot of this during the pandemic. Guess I've heard
out do this. For thirty years I mean you know you, don't you dont require a pandemic to wake up in the middle of the night ruminating, so
I may look a couple of things. Let's go back and reiterate some things I said one is that if you are having trouble sleeping in the middle of the night, the first thing to do is not lay there in bed
and ruminate, if you're, gonna, ruminate, ruminate somewhere else at the very least, take it somewhere else, but a better. I!
four ruminating is do something fun if you occupy your mom
and it's less prone to rumination. Then it
You know an idle mind- is the devil's playground, as they say, and it's very hard to flip a switch on our minds and just turn them off and frankly, the more we try to turn our minds off. That's like that sleep effort. We talked about the more we try to turn our minds off.
The more energy we're expecting to do that. So it's a it's! A vicious do loop, where we can't get out of that, as people are sort of noticing so give that up get out of bed and do something fun and wait for sleepiness
return. If this has been a long term problem, though my senses that that alone is not going to do the trick. That there's other is
What's going on here with regard to why somebody's awake in the middle of the night- and they really ought to get it properly assessed- and I know I gave you links to that people can kind of find somebody to help them with
Another thing that I wanted to say is: we have now talked a lot about how people get this message when they're looking for problems when they're looking for answers to their sleep problems where they start to hear they need to sleep a certain number of hours.
One of the things that can wake you up in the middle of the night is being in bed for too many hours if you're a six hours, sleepers, seven hours, sleep or a new start being in bed.
were eight hours, because somebody on podcast told you, you know,
the in bed for eight hours, you're, gonna, open a whole
somewhere and eventually reaffirmed that and so you're just
open this hole in the middle of the night. It might be that your getting the proper amount asleep.
You're just got a hole in the middle of the night, because you don't need all that sleep, but I can't say to any particular person who just asked the question whether that their particular problem
can you say that you did? These are ways in which those holes can open up the holes. Will
open up, remember ass! We get older, there's lots of things that cause us to wake up in the middle of the night,
first of all, we can, in the middle of the night, is not unusual. The average sleeper weeks, fifteen twenty times a night if we were studied them in a lab, it's just that their each of those wake
These are so short that you're not you're amnesty for them. You don't remember them. Now, ass, we get older. We start to remember a couple of those awakenings because they get a little bit longer, maybe once or twice or even three,
a night and if you can roll over and go right back to sleep, that's really not of concern that waking up ass. We get older. I can't make it through the night now without waking up and needing to use the restroom. It's not happening. So the question is not did I wake? The question is: can I re initiate sleep and that's what people with a chronic insomnia problem need to learn to do and again there's many things that they need to do to do that, but many people
will hesitate to go, get the kind of help I'm talking about, because they will a tribute. The reason their awaken. The middle of the night is to some medical problem. Is it true that a hot flash from menopause
Will wake you in the middle of the night. Yes, is it true that a full blown
or a urinary retention problem will wake you in the middle of the night? Yes, is it true that a a prostate,
problem will wake you in the middle of the night? Yes, is it true, the chronic pain
wake you in the middle of the night, yes, but most people who have those problems. Will
you whether their voting in the bathroom and then coming back to bed there now done their bladders, not keeping them awake for forty minutes at that point or an hour? Something else is, and they can get help with that. So you have a hot flash
if it doesn't last all night long and you get cooler, but then you still can't go back to sleep, that's something else, and you can get help with that, and it may be the difference between waking three times a night for twenty minutes, total
or waking three nights at three times a night for ninety minutes total and that's the way to think about that. One less
thing about waking in the middle of the night or early morning. The thing we haven't touched on it all is what I'd call general sleep hygiene. This is the kind of stuff where people are told owed
link less caffeine. You know what is it I do about exercise. What should I do about alcohol? Perhaps the biggest one on that list is alcohol, alcohols and interesting substance, because it will first cause you to be more drowsy and sleepy and in some ways, therefore, might help you to get to sleep, but it is a bit
sleep aid, because it last very short and wears off in the middle of the night and can produce fragmentation and cause you to wake. I'm not talking about substance abuse issue.
Now, I'm not talking about alcoholism or any of that for some people, and I dont know who they are, for some people just having a glass of wine or an alcoholic beverage near bedtime,
might make you both first of all, sleepier than you wanna, be before bedtime. So you're fallen asleep inadvertently on the couch earlier than you should, which will wait,
you up in the middle of the night, and
alcohol wearing off itself in the middle of the night? We ll wake you.
in the middle of the night and
If anybody out there has a doctor that says- or maybe a glass of wine before bed would be a good idea, don't listen to that
it's really a bad idea to use alcohol to help you to sleep right now, and I now said that do any of the people they called in is it alcohol is causing their problem almost certainly not. But it's a good jumping off point four worth talking about that.
Let me ask you a question on this. Waking up in the middle and night thing, this place of the very first thing you said, which is it
going on for a while you get out of bed, do something fun, one thing that might be fun for some people that I would imagine you would say we shouldn't do,
is play video games on your phone or do anything on your phone, because then you're bombarding yourself with the kind of blue light that might make it harder to fall back to sleep. Is that correct?
So yes- and no I mean remember yeah, we don't want to get a lot of light exposure in the middle of the night, but please for those of you out there who are taking this to heart, put out night lights and things like that, don't bump into walls, don't fall and break your hip. Don't do any of those things
it's. Ok to get low level light. It's ok to watch television if you're watching television, that's all about the light! You need right. If you're reading a book, you want a booklet lighter you want. You know a source of light from behind you to light the book. That's fine! So then we come to devices like
pads and phones, and things like that and what I will say there is. You touched on the idea that it's not light per se, but the spectrum of blue light that has the most effect on the circadian rhythm and most
us now, almost all of our devices, have a blue light filter so download the blue light filter you can set
to say I want no blue light between ten p m and eight a m and your screen. What
take on a little bit more of an orange tint and that should do better. There are blue light filters that you can download off the internet if you don't have it built into your machine, so that would make it better
It depends on the person. There are people who have what I would call real circadian rhythm disorders. That's different from insomnia. You can have people who have significant circadian rhythm disorders, which is beyond the scope of of today's talk for those people. They need to be much more careful and sensitive about light, and I wouldn't be advising those folks to stay away from handheld devices with light sources close to the eye,
but for the average person who is does not have a significant circadian rhythm disorder. They can probably get away with it. But if their concerned again yeah do something fun, but do it at a distance from your eyes. Do the television in a plug the computer with some device into your mouth monitors
green. So you can sit farther away from it and download a blue light filter and you should be fine great. So the next batch of questions actually to in this case
agree that we're in a play for you. But I think this is quite a common question has to do with sleep aids
How do you know about my question is ready to sleep, not sleeping pills, but that does not mean that those three things the castle, which are you
then he early days, the pandemics pretty religiously
the means really an equal and I didn't know
safe. Those actually were. I I'm not using them as often now, because I'm Jim tobacco, but I'm able to exercise and that kinda tires me out and helps me sleep better.
But I still do use on one occasion and I know they're they're supposed an addictive, but I suspect using them.
canada is a cry tonight for wireless, less unhealthy
I just want to know what your ashworth had to say about these not addictive sweet solutions. Are you
hello? This is air in kind from portland Oregon. I have a question for these sleep experts
I'm wondering what's their thoughts are on using marijuana to help you sleep, especially if you're in,
the position of trying to avoid taking pharmaceutical drugs to try and help your sleep? Ah, thank you very much. I love that we'd question came from.
Lend the maize and in his personal much and it's it's the is it our eye from you to take drugs to avoid taking pharmaceutical drugs question
so. There is the weed question and then the anti his demeanor sort of without collar was calling sort of non addictive sleep aid, so
take it in whatever order you would like
with the order you had it in, let's start with anti histamines and over the counter sleep aids, most of them are anti histamine medications which have as a side effect. Drowsiness, not nessus,
early sleep and there's no good data, although
not. A lot of data whatsoever I mean they haven't been studied, is the basic answer, but what little
there has been done suggests that they are not as a class of medications. All that useful or helpful,
that doesn't mean that any individual might not derive benefit from taking over the counter sleep aid. But again I would argue that all sleep aids are designed to be for short term problems and especially if you can define the problem. So, as I said a night or two of bad sleep is now
anything to think about what you might think well yeah, but I always get my night or to a bad sleep before I have a big test per hour
always have by night or to a bad sleep before the big papers, whatever it is, there's a place for medications for sleep, whatever
we're talking about. I would prefer, if you're, going to use medications for sleep, that you do use prescription medications. They were designed for this and that you have a I cut off point. You say
guy will use this for the next two nights
I will use this when I go to europe and I ve a little jet lag, and I want to get myself to sleep at the proper time for a few days and then I'm done, but when you have a chronic insomnia, the idea of haven't you,
those things for years and years and years is really not what was intended and ultimately can provoke more problems than otherwise now over. The counter medications is not my big would not paid by big thrust.
Again, if somebody having severe problem even right now, really anxious really troubled and they need just need to get some sleep for a few days again under
an adviser rose or or physicians guidance may be. Taking some medication in those circumstances. To get themselves back on track would be a good idea, but that's in the acute phase in the chronic phase. When you take those medications, they can work, they can work very well, but they dont tend to fix those underlying perpetuating factors that I've now talked about so much today, and so the problem is when you try to come off those medications. Those problems are still there. The worries are still there. The conditioning is still there, and so the insomnia often comes back, which is why we say look the better way to do. This is to start the right way and and and knock it. I'm medications for chronic insomnia for short term insomnia. They were made for this. Also
there's this sense of dependency. There are certain classes of medications that our physiological lee habit forming, and certainly some of them are sleep medications but understand. I had said to you that there is a system for our sleep which why costly regulation between sleep drive
and circadian rhythm, and that will, if you let it and not compensate for poor sleep, will regulate your sleep and get you back on track eventually, and we done summary
and there is a bit of a rhythm of insomnia and the river
of insomnia goes something like this. Nobody has insomnia every night, almost no insomniac
we say to you seven nights a week: that's why we,
find it s three or more nights a week, but the really
of insomnia is bad, bad, bad, good, bad, bad, bad, good, bad, bad, bad good, which means after every third or fourth night,
bound a pop off a reasonable night of sleep. I'm just gonna happen. Now it won't stay. That way
if you're doing everything wrong, which is why I don't want people to develop chronic insomnia, but if you're, just in an acute phase- and you just wait, it out you're bound to have a good night eventually. Now, if you start taking things on an intermittent base,
psych. I want to take this medication, but I don't want to get addicted, so I'm only
take it every three or four nights,
You can see what happens it's much more easy at that point to become at least psychologically dependent on those medications, and it may be that they didn't do much for you to begin with. A lot of my patients come back to me. I'll, say well did that over the counter medication work did
thing that you tried work, did the doing whatever you do in bed work and what I
here inevitably is well yeah, sometimes.
and I can say that about everything you know it works for insomnia, sometimes everything-
including magic, pajamas. Ok, if on your third
fourth night you where the magic pajamas you're gonna sleep. You know why not because of the magic pajamas
so? Do you understand what I'm saying I do understand and I want to get to the weed for a second. But let me just ask a question about sleep medications, this sleep act
bert that we had on previously strenuously argue
that there is a big difference between sleep and sedation so that, if your using something
benzodiazepines or and some these sleep meds are
that family, I understand so like. What's the famous one ambient ambien
there have been so I believe it is not. However,
was related to valley emperor caught up in a no. No, the newer class of medications like self it in which his ambien sonata lou nesta. Those medications are what we call benda diet.
Bein, receptor agonists and they are much more specifically targeted to sleep and non sedation, and
They are, while again anybody can develop dependency on these medication, psychological,
Imagine you take it every night and it works for you and then you stop taking it tonight. What do you think's gonna happen
you're gonna get into bed and start thinking. Oh my god. I wonder if I'm gonna be able to sleep without x Y and see what do you think that does to your sleep? So, basically anything can do that, but those newark
The medications are not benzodiazepines. I would hasten to say that I would definitely agree with a better idea, though, that there is a difference between sedation and
sleep and so again, I'm not, I don't know whether is advocating medications for sleep. I do. I was not here this evening or to term not a long term solution. I don't think, there's a good, long term solution and I think people should work to get off of them
where are you and weed,
you got some
where am I on we'd? What we know
marijuana is that it works a lot like ambient. That is, it will in the initial phases. It will work to put you to sleep a little fast
sure it may wake you more in the middle of the night but yeah. But if you wake you'll, get back to sleep, faster and so like ambien. It will do both of those things, but there is a tendency, a possibility like with ambien and will mess than any of those medications to become more tolerant of the medication, which means that over time, it's having less effect
If that happens, you then may find that it taking longer to get to sleep in your longer awaken the middle of night. If you use we'd for.
You know a long time and then decide. I don't want to do this anymore. You again might have some significant problem trying to get to sleep and get back to sleep. Now. I'm not saying at that point that can
be fixed. Just like everybody else's insomnia just talked about it can be fixed.
If you're using marijuana again, I would think
Like any other sleeping pills, I wouldn't use it for a long term fix. I would use it if you wanted for short term fix now. The other thing to kind of
there is some people are using it for other things. We need to remember that some people on various kinds of medications that might not be great for their sleep, but they needed for other reasons. Then that is a struggle to then get to a person like me to say
Can we make you the best sleeper? You need to be on marijuana because you're using it for glaucoma or on marijuana, because you're using it for pain
or on marijuana because you're using it for cancer, and we do that all the time. So why
dont want people to run away from. Here is saying that. Did I better start, my rwanda, that I'm using for other things, but as a soul, sleep bade, I,
think of it like any of the other sleeping pills, it wouldn't be my first choice for long term management of its army. Okay, so I think we have time for one more little set of questions here. These both have to do,
something that I was psychology that I see at play in my own mind about bedtimes,
me from connecticut and my question is about the sting staying super late.
In my normal life, I'm an eight hour and I speak myself- go to bed around eleven
but now that I have no reason to like get up early anymore, I find myself being up till about two. Sometimes just
He and even then I don't even want to fall asleep, I'm just wide awake. So how can I bring it
back to eleven? How can I get sleepy again? How can I retrain my body to not want to party all night thanks bye on the subject of sleep on screaming? I struggle with not so much with the falling asleep or staying asleep, but I find myself every night.
whether it be dooms rolling on twitter or watching tv too late at night? I can. I just wanna, keep it going into small, allow myself to go
free at reasonable hour, and even though I always wake up in the morning feeling very exhausted and not well rested and point that I should go.
earlier and ever more com. My time routine, I forget, got those I'm like comes around and I just wanna watch networks.
well on twitter, so wondering if you are, the experts have any advice on outer cash kind. That
our wisdom and are now better freak, whatever a big impact on my life accident, he added
My people lists ten o clock at night in my way for local should we watch another episode of whatever shall watching, and you know it's like rebellion time. So how would you say yeah, that's another thing that do you should keep in mind is
As I said, marriage is a time when insomnia starts because people of different preferred sleep phases in the people of the same sleep phased tend not to marry each other
and so there's always this argument over. You know I wanna go to bed earlier and I want to go to bed later and so
he's gonna lose that argument and that can precipitate insomnia going back to the collar. There's a general
question here, as I want to address it in a general way again, not necessarily to her problem but there's a whole class of people. What we're talking about here is preferred
Is she used the term nite owl all
People are night hours, and all that saying is my preferred internal phase, the best time for me to get my good sleep number
is later than the average bear, there's a whole class of people that ten
the fall in that category. There are always exceptions but tend to fall in that category and we call them teenagers. Think all of us go from childhood into adolescence and into young adulthood,
and children sleep long. They need more hours than than adults and they sleep early an eight year old, a seven year old, is tending to awake at five or six in the morning.
and waking their parents to their utter consternation. And then, like my son,
turned into an adolescent and it took dynamite to wake him up in the morning. Ok, that's a natural change in in preferred face. Your sleep number doesn't change that much once you get to adulthood, but your preferred
phase changes a lot during the course of the lifespan and in younger age. The tendency is for it. What we called the laid sleep face for life.
and that has nothing to do with all the activities that kids are doing. If they had none of those. If they were live,
in a mennonite colony.
How all we're living of pious life with no parties and no late night. You know carriers and any of that stuff.
They would still want to go to bed later it just an adult natural shift that takes place genetically. I had already mentioned to you that some people are sleeping better because there are being allowed to sleep in their natural state.
and I think that's no we're going to be more true than with our teenagers and young adults that they are going to be finding that they're going to bed later and their sleeping in later, because they can and because they're doing it they're getting more sleep. We are doing a terrible disservice to our teenagers by making them got up earlier than the young kids to go to school. Crazy, ok, absolutely crazy,
for the human animal. So, with regard to the question that I get a lot which is well, should I allow my person to do that should allow my team to do that again
sleeping well and waking up in the morning and they feel like they're doing great. The answer is, I don't see why not it's more their preferred phase and if they right now have an opportunity to get that they're gonna.
Should better and more efficiently in the hours that they have awake when they do that. What we still want to see
away from in that class is irregular hours. I still don't want that teen getting up
some days at nine some days at ten
some days at eleven, some days at twelve and so forth. If their natural phases
like from you know two in the morning to nine in the morning or ten in the morning, then do that five days a week now the question was also about transitioning back. The question is: how soon do you have to transit,
back, as you start approaching a time when you're gonna have to get up earlier in the morning again
yeah, you may want to start transitioning. How do I look?
the fall asleep earlier was the question. Again I go back to you set that with wake time. If you keep getting
but ten o clock you're not going to be ready to fall asleep at eleven? But if you start
not early earlier and earlier you'll start to become more and more prone to be ready to sleep at eleven
unless again you're so delayed. Your clock is so off kilter that that becomes
problem in all of that can be fixed with a with a specialist speaking of specialists. You reference this earlier, but it bears repeating ye. We have links that you provided to us
we will put in the show notes that will allow people to find specialists should they need one rights are one of them is a site that science education, education cited
answered by the american academy of sleep medicine, and it has
a bar in there. You can put in your zip code and it will give you your nearest accredited sleep centres, but that's for other kinds of sleep problems. If things are good,
strange and bump in the night, like your your sleep walking and you got night terrors, and you got you think: I've have sleep, apnea or other kinds of problems like that. That's what you really want to sleep centre for, if there's nobody else close to you asleep centre, might also be able to direct you to a behavioral,
sleep, medicine specialist, like myself, but if you haven't zambia and you want to get first to a baby- sleep medicine specialists decide. I would
Who is the other one, which is the society of behavioral sleep, medicine and when you go
there there's a place that says provider search, and
give you a map of the united states and you can click on your state
give you a listing of all the providers in your state that either do this
actually or are frankly certified or have diplomates status to do this kind of work down. This been a real pleasure. Really. I love a salty guy from the bronx has been
really fun, we didn't get your other question guy. I dont know. If you wanted to go back to that one, but we don't have to the doom sky,
going on twitter and the netflix thing yeah I'd. Actually the answer is I'm a little bit more flip about that? I mean you know. This is a guy who's. Basically saying I know I should be going to bed earlier, but I don't and to which I have. The answer is that you know there's an old joke that says the guy goes into the doctrine says doctor it hurts when I go like this, and the answer is don't do that anymore? You know more seriously. There are some people with various kinds of problems like attention, deficit disorders and obsessive, compulsive disorders that really do struggle in a way that it makes-
it difficult for them to just choose to do it on again I'd say they need to get professional help and get that assessed. If it's not that, then I simple trick you can try. If you conduct
pass. The time you wanted to go to bed is.
Sudden alarm on your phone and have a go
for the time you want to get ready for bed and then do so and see if that works, but the same advice you gave to the female collar of
set an alarm in the morning and you'll be paying the price for that twitter
late night, dooms growing on twitter that might strongly disincentive eyes you from doing it the next night. Absolutely that actually right. So I must have done a good job here cause I taught you the right stuff. You definitely did a good job here. I'll tell you some bad advice. When I was a little kid, I would go to my father, who is a joke, stir and I'd, say daddy, I can fall asleep and I would say, bend over and run as fast as you can into the wall.
Yeah yeah, I know those treatments. Listen I've seen it all really seen it all, including magic pajamas. Yes,
gonna, buy em and invest in some magic pajamas. Just remember they work sometimes done
you again really appreciate it yeah my pleasure thanks for having me this was a blast thing,
and doktor posner. That was very helpful conversation for me personally, thanks to
for listening and thanks, most importantly to everybody who worked so hard on the show ten percent happier.
by Gabriel's ackerman, Justine, gavi, Lauren smith and terry Anderson dj
kashmir as our senior producer research lighterman? Is our
Your editor and can be regular. Is our executive producer scoring
mixing by Peter bonaventure of ultraviolet audio, and we get our theme music from nick thorburn of the great envy rock band islands was
back here on Monday for a brand new episode of talking to. I was actually quite nervous for this because I so admire this person talking to a legend you're, a hero of mine, Jennifer egan, the novelist great conversation, even though I was.
A prime members. You can listen to
ten percent happier early and ad free
on amazon, music,
download the amazon music tat today or
You can listen early and ad free with wondering, plus in apple pie cas before you go
solid, and tell us all about yourself by completing a short survey at wonder
dot com, slash servant, welcome to the bishop
ray academy, the countries most exclusive boarding school, a place where the best and brightest art fighting to be prom queen or captain of the football team they are on track to become the next supreme court
Justice academy is a new scripted. Podcast follows eva richard, a brilliant scholarship student who must quickly adapt
in a school where rules mean nothing and money means everything eva
for sites? On being the first scholarships student to make the list bishop graze
all, coveted academic, top ten curious
by the head master himself, but with no clear patsy
hop! She joins the knight of the wolf bishop
raise underground society with more secrets than the illuminati. If sheep
and to their demands in exchange for her own success, one of the ten coveted spy
we'll be hers, but at what cost
Roy academy, on the wondering apple or wherever you get your podcast spins, all ten epoch,
of academy early and ad free on one replace, join wondering plus.
Over on the wondering, app or on apple pie, cast
academy. Is a new scripted podcast, the fellows aver richards, a brilliant scholarships student attending bishop grey economy, the countries most exclusive boarding school academy
makes you into the world of a cut throat, private school, where power, money and sex collide in a game of life and death, binge alternatives
the academy early and ad free on wondering plus
Transcript generated on 2023-08-17.