The Art of Manliness - #661： Get Better Sleep by Stressing About It Less

00:00:00.000 Brett McKay here and welcome to another edition of the Art of Manliness podcast.

00:00:11.100 So over the past decade, there's been an emerging focus on the importance of sleep.

00:00:14.440 Thousands of books and articles have been put out which drive home just how important

00:00:17.920 sleep is to our mental and physical health.

00:00:20.180 This emphasis on sleep has had the positive effect of motivating people to better prioritize

00:00:24.360 it.

00:00:24.820 But there's been a downside to all the sleep talk as well.

00:00:27.080 People are getting more stressed out if they're not getting the kind of sleep they think

00:00:30.380 they're supposed to.

00:00:31.520 My guest day says that ironically, stressing about sleep may be exactly what's hurting your

00:00:35.520 sleep.

00:00:35.940 His name is Dr. Chris Winter.

00:00:37.040 He's a neurologist, sleep specialist, and the author of The Sleep Solution, Why Your Sleep

00:00:40.700 is Broken and How to Fix It.

00:00:42.240 Chris and I begin our conversation with why we get sleepy and how sometimes people confuse

00:00:46.080 fatigue with sleepiness.

00:00:47.600 We then get into the real dangers of sleep deprivation, but how you probably shouldn't worry about them

00:00:51.520 if you have common problems with falling and staying asleep.

00:00:53.680 We then talk about how many hours of sleep you actually need and how you may be stressing

00:00:57.340 yourself out trying to get more than is necessary and why it's best to compare your varying hunger

00:01:01.500 for sleep for your varying hunger for food.

00:01:03.860 Chris unpacks what insomnia is, how it's not just an inability to sleep, but your response

00:01:07.580 to that inability and the extent to which insomnia is rooted in fear.

00:01:10.620 From there, we turn to the disparity that often exists between the perception, the reality

00:01:14.160 of how much sleep you're getting, and the fact there's a good chance you're actually

00:01:17.020 getting more sleep than you think.

00:01:18.440 We then discuss creating a plan for what to do when you can't sleep, which may involve spending

00:01:21.860 less time in bed, or in fact, relishing the time you spend lying away in your bed at night.

00:01:26.720 And we end our conversation with when you should and shouldn't take a nap, and when you should

00:01:29.920 see a sleep doctor about your sleep problems.

00:01:32.200 After the show's over, check out our show notes at aom.is slash sleep.

00:01:44.240 Alrighty, so you are a neurologist and a sleep specialist.

00:01:46.860 You have helped thousands of people from regular Joes to professional athletes improve the

00:01:51.560 quality of their sleep.

00:01:52.940 And I'm hoping in today's conversation, you can provide some insight, some advice to our

00:01:57.440 listeners who are having a hard time sleeping, so they can have a more restful night of sleep.

00:02:01.440 But before we get to the advice, I think it'd be useful to understand a little bit about

00:02:06.120 how sleep works.

00:02:07.900 Specifically, let's talk about what is going on in our body that makes us want to sleep

00:02:13.720 or makes us feel sleepy.

00:02:15.060 So there's a bunch of things.

00:02:17.480 The two things we think about most are the longer we're awake, the more we start to accumulate

00:02:23.440 a chemical called adenosine in our brain.

00:02:25.660 If you remember back from your biology days when you're studying the different parts of

00:02:30.660 the cell, one of them was the mitochondria.

00:02:33.520 The mitochondria is really sort of the energy furnace of the cell.

00:02:37.200 It's where we take, you know, theoretically food energy and transform it to energy.

00:02:42.300 We can actually do things like mow a lawn or, you know, run a race or something like that.

00:02:47.220 So when we talk about ATP, you know, capital ATP, going into that mitochondria, it explodes

00:02:53.300 with this, you know, fantastic chemical reaction.

00:02:56.100 And now we have energy.

00:02:57.660 What we don't talk about is that there's a byproduct of that response called adenosine.

00:03:02.600 And it's adenosine that accumulates in your brain that makes us want to seek sleep.

00:03:07.380 Therefore, the longer we're awake, the more we accumulate this chemical, the more we want

00:03:12.920 to sleep.

00:03:13.460 So that's really the homeostatic chemical for sleep, you know, which is why eventually everybody

00:03:19.340 sleeps.

00:03:20.020 You know, it's impossible just to make a decision.

00:03:22.140 I'm going to stay up forever because, you know, accumulate so much of this chemical that

00:03:25.820 eventually your brain will take the decision out of your hands and you'll just fall asleep

00:03:28.720 in whatever you do.

00:03:30.060 So that's one part of it.

00:03:32.040 Another part is melatonin, which is a chemical that really has to do with our relationship

00:03:37.400 with sleep and our environment.

00:03:39.820 So if we sit out on our back porch all day and read a book or do our Zoom meetings, eventually

00:03:45.100 as the sun starts to go down, we'll probably start to get a little sleepy.

00:03:48.920 And it's because as we lose light in our environment and our eyes see that loss of light, we start

00:03:54.980 to produce a chemical called melatonin.

00:03:56.800 So melatonin's job is to take the sleepiness we're all going to develop and try to regulate

00:04:02.740 it in terms of timing.

00:04:04.100 So theoretically, most humans are going to be more awake during the day and more sleepy

00:04:09.720 during the night.

00:04:11.160 You know, raccoons have the complete opposite response to melatonin.

00:04:13.760 They want to be awake in your garbage can at night and sleep during the day.

00:04:16.780 So those are sort of the biological underpinnings of sleep.

00:04:21.460 It's a primary drive.

00:04:22.960 It's something that we can't escape.

00:04:24.460 So even the worst sleeper out there is going to sleep.

00:04:28.900 I mean, humans are going to sleep about five to six hours of, you know, every 24 they're

00:04:32.960 alive and there's not a thing we can do about it.

00:04:35.600 So it's important to understand that, you know, for an individual who comes to tell me,

00:04:39.800 I had a guy tell me he'd been in Germany for nine and a half months and never slept the

00:04:43.560 time he was there.

00:04:44.980 That's not a true statement.

00:04:46.460 It may be true from his perception, but the idea that there are people out there going

00:04:50.780 nine and a half months without any sleep just doesn't happen.

00:04:53.440 Why is it, I think everyone's experienced this, like they feel really sleepy.

00:04:56.640 This happened to me this week.

00:04:58.580 I feel really sleepy.

00:05:00.040 I'm like, all right, time for bed.

00:05:01.380 And as soon as I get into bed, I feel wide awake and I can't go to sleep.

00:05:05.040 Like what, what happened, what's going on there with our sleep drive that causes that?

00:05:10.000 Yeah, it's probably a bunch of things.

00:05:11.640 I mean, I think number one, people poorly define the feeling of sleepy.

00:05:15.880 So to me, sleepiness is drive to sleep.

00:05:20.280 So if somebody says to me, I am so sleepy when I go to bed at nine o'clock every night

00:05:25.100 and I ask them, how long does it take you to fall asleep?

00:05:27.620 And they say two hours minimum.

00:05:29.620 I'm going to argue that at nine o'clock, they're not particularly sleepy.

00:05:33.160 So humans often use the feeling of fatigue as a surrogate for sleepy, meaning that you're

00:05:40.320 sitting there at night and you're exhausted.

00:05:42.220 You've got no energy.

00:05:44.040 If somebody came up to you and said, hey, let's go run a few miles or a few laps around

00:05:47.320 the track, you would say to them, look, I don't have any energy.

00:05:50.920 I don't have the energy to fold a load of laundry, let alone go for a run.

00:05:55.740 That's not the same thing as sleepiness.

00:05:58.580 In other words, when you're running in the marathon and you get to mile marker 19, you

00:06:03.760 might quit, but generally you're going to quit because of fatigue, not because of sleepiness.

00:06:09.300 I got to mile marker 19, doc, and I could barely keep my eyes open.

00:06:13.220 So I lay down in the middle of the road and took a nap.

00:06:15.040 Like that said, nobody ever, right?

00:06:17.340 So that could be part of it.

00:06:19.440 The second is sleep is a skill.

00:06:23.300 And like any other skill, there's a performance that goes along with it.

00:06:27.920 So maybe you are sleepy when you decide to go to bed at night.

00:06:31.640 And once you get into bed, you've got some sort of performance anxiety that's going to keep

00:06:37.200 you awake a little bit longer.

00:06:38.700 Meaning we've all come across an empty gymnasium with a basketball sitting there and started

00:06:44.060 shooting some hoops and maybe, oh my gosh, you just made 10 straight free throws.

00:06:48.360 Nobody's in the gym.

00:06:49.460 Nobody's watching you.

00:06:50.380 Nothing's on the line.

00:06:51.860 You just made 10 free throws.

00:06:53.720 Now put that same individual on the free throw line for the NBA championship.

00:06:59.600 You know, so the entire team and the entire community is looking to you to make these two

00:07:04.140 free throws.

00:07:04.660 If you do, you're the champion, you're going to get a massive bonus.

00:07:08.580 You're going to be a hero in that city for the rest of your life.

00:07:11.480 Miss it.

00:07:12.380 And everybody will remember you as the person who couldn't make the free throws to win the

00:07:15.800 championship.

00:07:16.620 So it's still no different than the activity that you were engaged in in that empty gym.

00:07:21.940 It's putting a rubber ball through an iron hoop.

00:07:24.440 But now you've engaged in a completely different psychological action than you were when nothing

00:07:31.340 was on the line.

00:07:32.280 And so for people who really struggle with their sleep, they put a tremendous amount on

00:07:38.960 the line when they get into bed.

00:07:41.040 And that's part of the problem that we have with our dialogues and discussions about sleep.

00:07:46.720 Yes, we know a lot more about sleep than we did even 10 years ago.

00:07:49.700 Yes, it's incredibly important for your health.

00:07:51.980 But when you start going to bed at night with this feeling of, I've got to go to bed now,

00:07:56.380 get my eight hours of sleep because some doctor said I needed to, and if I don't, I'm going

00:08:00.340 to develop dementia.

00:08:02.340 That's a really terrible way to initiate sleep at night.

00:08:05.980 So I always tell people, look, get into bed.

00:08:08.440 One of two things will happen.

00:08:09.760 You're going to fall asleep or you're not.

00:08:11.420 But you need to be equally comfortable and happy with either of those outcomes.

00:08:17.120 And if you're not, we need to get you to a place where you are because that's where sleep

00:08:22.060 problems really can dig their teeth into people when you start fearing that activity of going

00:08:28.260 to sleep at night and maybe not falling asleep immediately.

00:08:32.140 And we'll talk about some things that people can do to do that here in a bit.

00:08:34.540 But I want to go with this idea between the difference between sleepiness and fatigue because

00:08:36.920 I thought that was really interesting.

00:08:37.860 I think I've struggled with that distinction for a long time.

00:08:41.480 Sometimes I just, I think I'm sleepy when I'm actually fatigued.

00:08:44.400 Like, how do you tell the difference between the two?

00:08:47.020 I mean, I think it's really about behaviors.

00:08:49.700 If somebody says, I'm really sleepy, typically when I go to that five o'clock meeting on Friday

00:08:56.400 and they're saying, I've got to walk around or I have to eat goldfish crackers or M&Ms and

00:09:03.040 drink something.

00:09:03.920 Otherwise, I fall asleep and my principal makes fun of me.

00:09:08.580 I would say that you're exhibiting some signs of pretty excessive sleepiness at that time.

00:09:13.660 Somebody says that when they drive, they will often wake up at a stoplight to the sound of the

00:09:17.940 person behind them honking because the lights turn green.

00:09:21.540 Or they love to read, but it's a very frustrating procedure for them because every time they sit

00:09:26.680 down to read this book that they're really interested in, they get halfway through the first page and

00:09:30.640 they fall asleep. So they've been trying to read this book for the last six weeks. All they do is

00:09:34.840 read the same three pages over and over because every time they sit down to start to read,

00:09:38.800 they fall asleep. I had a young woman who built a desk on a treadmill because if she sat to do work, 1.00

00:09:44.040 she'd fall asleep. And she discovered that one trick was to be walking when she did work and

00:09:48.900 that would help her stay awake. I would say those are great signs of somebody who's excessively

00:09:53.200 sleepy. And if you're excessively sleepy, it's happening through one of two mechanisms only.

00:09:58.440 You are not getting enough sleep. You're not spending enough time in bed to get to sleep.

00:10:03.120 You like to stay up and watch Stephen Colbert. Then you watch Seth Meyers. So now it's 1.30 when you go

00:10:08.100 to bed. You have to be up at six o'clock the next morning to go to work or get on your Zoom meeting or

00:10:12.120 start your commute. So that individual is probably not giving himself or herself an adequate amount of

00:10:17.620 time to get sleep at night. Or you're somebody who's sleeping nine, 10 hours a night and feels

00:10:22.820 sleepy. Well, that's not an inadequate amount of sleep. That's probably coming because your sleep

00:10:28.040 is dysfunctional or there's something wrong with the quality of it. So you can kind of make up for

00:10:33.620 a lack of sleep quality with more sleep quantity to a point. But then it gets to a place where somebody

00:10:39.620 sleeping 12 hours and still can't control their drive to sleep during the day. And that's how some

00:10:46.200 people with severe sleep apnea and narcolepsy will get. They can't sleep enough. And even other

00:10:52.120 people will start to notice that family members, partners, like, gosh, honey, you slept 10 hours last

00:10:56.700 night, woke up, had breakfast, and you sat down to read the paper and you fell asleep again?

00:11:01.480 Like, what's going on? How are you able to sleep 10 hours and still be sleepy enough that you don't

00:11:06.660 want to go out and go on the hike with the rest of the family? You want to stay home and sleep.

00:11:10.800 Why? That doesn't make any sense. And it can really, these types of things can really drive a wedge

00:11:14.980 in relationships. So sleepiness is always going to be defined as your drive to sleep.

00:11:21.320 Again, somebody says to me, I am so sleepy and it takes me four hours to fall asleep every night. No,

00:11:25.680 you're not. That's the same thing as saying, I am so hungry and I offer you a sandwich and an apple

00:11:30.560 and you don't want it. No, you're not that hungry. Because if you were hungry, you'd eat the food I was

00:11:34.680 offering you. In fact, if you were really hungry, you might eat this food out of a trash can.

00:11:38.800 You know, so drive to sleep is really easy to figure out. Fatigue is different. Fatigue is more

00:11:44.460 of a body energy, motivation during the day. You know, kind of the way you might feel if you were

00:11:51.140 getting sick. You know, sure, you might want to go to bed because you don't feel well. But sometimes

00:11:55.620 you go to bed, you don't fall asleep. It just feels good just to be in the dark, quiet, lying there,

00:12:00.140 not having to do anything. So I always think about fatigue as the way you would feel

00:12:04.460 after you ran 10 miles or, you know, mowed a big lawn or engaged in a Spartan race or something

00:12:12.320 like that. You know, at the end of the Spartan race, yeah, you're done. You want your t-shirt

00:12:15.820 and want to get on social media and start bragging. But you're not necessarily thinking, oh, I've got to

00:12:21.160 lay down here in this field and take a nap before I can do anything. You know, it's not a sleepiness

00:12:25.960 that you're describing. All right. So a lot of people, they're confusing sleepiness with fatigue,

00:12:30.680 including me. And I can see how this can cause a lot of anxiety because you're tired at night.

00:12:35.520 You feel like, oh, it's time to go to bed. You go to bed. But because you're not sleepy,

00:12:39.160 you're just tired. You just lay there and you can't fall asleep. And then the anxiety compounds

00:12:43.780 because you start thinking like, oh my gosh, I've read these articles of all these bad things that

00:12:47.320 happen if you don't get enough sleep. Dementia, I could get in a car wreck. My working memory is going

00:12:52.320 to be bad. And then it just perpetuates and it makes it harder and harder to fall asleep.

00:12:56.640 Sleep. So two questions here. The first one is, what are the downsides of not sleeping? Like what

00:13:01.760 happens when you don't get enough sleep? You're sleep deprived. And the second part is, do most

00:13:05.560 people who can't fall asleep at night or have trouble every now and then, do they really need

00:13:08.980 to worry about this stuff?

00:13:10.540 Sure. So I think it's important to kind of understand that when we're talking about the

00:13:15.240 negatives of sleep deprivation, that we're truly talking about sleep deprivation, meaning that an

00:13:21.360 individual has the opportunity to get seven hours of sleep, but has decided or it's been decided for

00:13:27.200 them by their boss that they're only going to get two or three hours of sleep. I think it's important

00:13:32.100 to differentiate that from what we consider to be insomnia, where a person says, I'm going to bed at

00:13:37.560 11 o'clock every night and it takes me four hours to fall asleep. They're really two very different

00:13:42.640 things. But if somebody is truly sleep deprived, either on purpose, and we meet people like that all the

00:13:48.300 time who say, look, I go to bed at midnight, I get up at three o'clock to work out or something

00:13:53.100 ridiculous like that. And they'll tell you, well, I'm fine. I know it doesn't seem like a lot of

00:13:57.300 sleep. As long as I get my three hours of sleep, I'm really good to go. You're really not. You're

00:14:01.900 really harming yourself over time. So one of our little secret sayings, and we've got about 10 of

00:14:07.840 them in our clinic, is just because you can do it doesn't mean you should. And I think that sleep

00:14:13.120 deprivation kind of falls into that category because these are the people who are getting up at three

00:14:16.800 o'clock in the morning to train for triathlons and they die at age 51 and nobody can figure out why.

00:14:22.820 I mean, the effects of long-term sleep deprivation are absolutely profound. I mean, in addition to

00:14:28.780 just being sleepy all the time, such that every time you sit down to watch a TV show or read a book,

00:14:35.440 you fall asleep, you know, and obviously driving a car and being that sleepy aren't terribly compatible.

00:14:40.860 It just erodes at our cardiovascular health, makes us much more likely to develop high blood

00:14:47.160 pressure, heart attack, stroke. We tend to create issues with metabolism and gain weight. There's a

00:14:53.400 lot of cognitive issues that go along with sleep deprivation, including perhaps the development

00:14:58.920 and the acceleration of dementing illnesses like Alzheimer's disease. There's great evidence to

00:15:05.400 suggest that chronic sleep deprivation or chronic changing of schedules, kind of sleeping all over

00:15:12.040 the place could lead to cancer. So it's really difficult to find an organ system that's not

00:15:19.500 affected by sleep loss and sleep deprivation. Even the way we look has been shown that, you know,

00:15:26.480 our skin sags more, we wrinkle more, bags under our eyes, we look older, we age faster when we're not

00:15:33.340 sleeping the way we should. Again, I'm just going to stress one more time, just because I think it's

00:15:38.020 often lost when there are discussions about sleep. If you're listening to this and thinking,

00:15:43.000 oh my gosh, I go to bed at 10 o'clock every night and it never takes me any less than an hour or two

00:15:47.680 to fall asleep, we are not talking about you. This is nothing to do with the individual who's giving

00:15:53.400 themselves the opportunity to sleep, but they're not taking it. And that's important because when you

00:15:59.100 think of sleep deprivation, true sleep deprivation causes one thing above all else, it causes

00:16:06.400 sleepiness. It's like food deprivation causing hunger or fluid deprivation causing thirst.

00:16:13.960 So if somebody says to me that they go to bed every night at 10 o'clock and it takes them two hours to

00:16:18.740 fall asleep on a good night, it's hard to make a case that that individual is sleep deprived. They've

00:16:25.200 got a sleep problem. They've got difficulty initiating sleep or they wake up in the middle

00:16:29.380 of the night, they're up for a couple hours. But that sort of behavior is inconsistent with the

00:16:34.480 pattern that we see with sleep deprivation, which is my father who every time he sits down,

00:16:39.300 he goes right to sleep. That's what sleep deprivation looks like. And the problem is the

00:16:43.720 media message is all about insomnia. How long does it take you to fall asleep? Do you struggle to fall

00:16:48.780 asleep? Do you need a little moth to fly into your bedroom at night and kiss you on the cheek to make

00:16:52.900 you fall asleep as the drug ad would tell you? So when my father sees those ads, he thinks,

00:16:57.720 I don't know who those people are with sleep problems. I'm the best sleeper in the world

00:17:00.920 because every time I sit down, I fall asleep. Sleep science is actually more worried about the

00:17:05.800 person who falls asleep every time they sit down versus the individual who might take them a little

00:17:10.580 while to fall asleep. They're really two separate entities. We're going to take a quick break for your

00:17:14.280 word from our sponsors. And now back to the show. All right. So the downsides of not sleeping,

00:17:20.460 this comes from actual sleep deprivation. These are people who are sleeping two, three hours a

00:17:25.240 night for extended periods. It's not the people who are having a hard time falling asleep or they

00:17:29.960 wake up occasionally throughout the night. They don't have to worry about it too much about it because

00:17:33.760 what's going to happen, it sounds like, is that their body is just going to get sleepier and they're

00:17:38.920 going to sleep more and they're going to get the sleep they need. But I can still see this is going

00:17:42.500 to be nerve wracking for people even when they hear this because, as you said, we have this culture

00:17:47.540 around sleep that we've developed where we obsess about and try to optimize it. And one number,

00:17:52.820 one thing that people hone in on a lot when they're thinking about optimizing their sleep

00:17:56.100 is what's the number of hours of sleep I should get minimum? So sleep doctor, how much sleep do most

00:18:03.280 people need to get? So how much sleep most people need? I want you to think about that question and I

00:18:09.540 want your listeners to think about that question as a similar question to how much food do we need or how

00:18:15.880 many calories should I be consuming? The answer to that question depends incredibly on the eye.

00:18:21.540 Who are we talking to? Are you a 80-year-old retired accountant who's basically inside your home

00:18:27.540 because you're nervous to go out and get the coronavirus? Or are you a 18-year-old gymnast

00:18:34.180 in training for the Olympics? Or a 300-pound football player for the Baltimore Ravens? I mean,

00:18:41.820 so those questions have a context to them that we often don't dive into when we talk about sleep.

00:18:47.380 Oh, you need eight hours. Well, okay. Does the average person need eight hours? Maybe. I think

00:18:53.040 seven and a half is a better average for a general mid-range adult population, but there's nothing wrong

00:18:59.980 with eight. As long as people understand that eight is an average. It's like the average person

00:19:05.860 at a picnic eats two hot dogs and a hamburger. Okay. That doesn't mean everybody's buying or eating

00:19:11.540 two hot dogs and a hamburger. It's a nice number to have if you're planning a huge picnic. It might be

00:19:17.060 a nice number to have if you're seeing patients who have sleep problems. But one of the biggest causes

00:19:22.000 of, quote, insomnia in this country is an individual who needs six hours and 50 minutes of sleep

00:19:28.140 every night getting in bed and trying to get eight. You are genetically not programmed to get eight

00:19:33.680 hours of sleep. So you've got as much of a sleep problem as a person eating an extra large pizza

00:19:39.520 every night and not being able to finish it has an appetite problem. Sure, that person could go to

00:19:44.360 their doctor and say, I got something wrong with my appetite. I can never finish my dinner.

00:19:49.400 I think a bad doctor gives that patient an appetite stimulant and doesn't ask any more questions.

00:19:53.960 A good doctor would say, oh, I'm sorry to hear you're struggling. Tell me more about your dinner.

00:19:57.820 Well, it's an extra large pizza, thick crust, deep dish, tons of meat.

00:20:02.140 Well, listen, you're a five foot, 740 pound guy. I don't know that it's necessarily appropriate

00:20:11.380 for you to be eating that much food at dinner at night. So I'm not sure your struggles to finish

00:20:16.760 that pizza rise to the level of a medical problem that we need to treat. Even if the patient says,

00:20:23.100 well, my friend eats a whole extra large pizza and he's super healthy, I want to be like him.

00:20:28.680 Yeah, well, he's a linebacker for the Baltimore Ravens. That's a completely different situation.

00:20:34.780 But when it comes to sleep, we often lose those pieces of dialogue. In fact, I have people all

00:20:40.840 the time, oh, I'm writing for this magazine and we want some great tips for our readers to help them

00:20:46.980 if they wake up in the middle of the night, what are some tips they can use to get back to sleep?

00:20:50.500 And I asked one writer one time, I'll give you a tip, but I need a tip too. And she said,

00:20:55.100 what do you need a tip about? I said, well, sometimes I get halfway through my sandwich.

00:20:58.900 I get this sandwich every day from this restaurant for lunch and occasionally I get halfway through

00:21:03.260 it. I don't want to eat the rest of it. So what's a good tip for me to help finish that sandwich so

00:21:08.560 I don't starve to death? And she laughed and said, I don't think you need to finish the sandwich.

00:21:13.420 I don't think that's a problem if sometimes every now and then you don't finish that sandwich.

00:21:17.700 I said, well, I don't think the question you've brought to me is a problem either.

00:21:22.780 And I think we have to think about that as a society and a culture when we think about sleep,

00:21:27.520 that if somebody wakes up at four o'clock in the morning and can't get back to sleep,

00:21:31.960 why do we have to treat that? What are we treating? What are we concerned about?

00:21:37.460 Because to me, it might just be a brain that says it's got enough sleep and doesn't really want

00:21:41.820 to sleep right now. So I don't think that's a big issue. I think we make some problems into much

00:21:47.780 bigger issues than they are. And when you start fearing waking up at four o'clock in the morning

00:21:53.480 and wondering if your pill that your doctor's giving you or pills is going to do the trick,

00:21:59.200 I think we start to create more problems than we solve.

00:22:02.480 Well, is that fear of sleep and being able to fall asleep or stay asleep, is that what insomnia is?

00:22:07.860 Like, what is insomnia? If you were to ask me what my definition of insomnia would be,

00:22:14.100 I think for a lot of people, if you had to whittle it down to one word, it is that. It is a fear.

00:22:20.740 Insomnia, if you define it with medical professionals, is not an individual who can't

00:22:25.440 sleep. So if you go out to an outdoor mall and there's people walk by on a pretty day,

00:22:29.960 ask them, hey, can I ask you a real quick question for a survey? And they say, sure. If you ask them,

00:22:34.260 what's insomnia? They'll say, I don't know. It's when somebody can't sleep. That's the definition,

00:22:37.640 can't sleep. It's not really the definition of insomnia because can't sleep doesn't exist in

00:22:43.080 nature, really. It's an individual who's not sleeping in a way or a time in which they've

00:22:49.880 decided they want to. So they've decided 11 o'clock is their bedtime. They're going to bed 11. It takes

00:22:54.680 an hour or two to fall asleep. So that's part A. Part B is you have to have a negative response to

00:23:01.440 part A. So when somebody says to me, hey, Chris, I've heard you're a sleep doctor. So I go to bed

00:23:05.980 every night at 10 o'clock, takes me two hours to fall asleep. My first question is, how do you feel

00:23:10.220 about that? And if somebody says, oh, I don't mind, then I don't really think they have insomnia. I

00:23:15.620 don't think anything really needs to be done about that. In fact, I would say, yeah, sometimes it takes

00:23:20.040 me a while to fall asleep too. And I don't mind either. In fact, I like being in bed awake. I don't

00:23:24.960 have a problem with it at all. If you start having a problem with being in bed awake,

00:23:30.880 that's really the origin of insomnia. We talk about insomnia is sort of runs kind of in people

00:23:38.840 who are more predisposed to be a little bit anxious, a little bit more type A. These are

00:23:42.860 successful people. They're entrepreneurial in spirit. If there's a problem, they're going to

00:23:48.000 figure out a solution right away. I mean, these are traits that you want in a partner or a spouse

00:23:53.000 or an employee. They're not great traits to have when somebody goes to bed at night and then they

00:23:59.500 are struggling to fall asleep. Now, all of a sudden, the wheels start churning and they are

00:24:03.240 trying to solve the problem, which is unfortunate versus just, oh, well, I'm awake. I'm going to sit

00:24:09.680 here and use this time to think about what to buy for my husband for his birthday coming up.

00:24:14.780 Or I'm going to use this to think about a way that I could deal with an employee who has very unusual

00:24:20.480 political beliefs, but I've got to work with them. And I think that the way I've been kind of making

00:24:25.220 fun of them is not a great way to move forward. I'm going to really try to get inside

00:24:29.480 his head and come to some understanding about thinking about the way he thinks. I mean,

00:24:33.120 you can use that time. I mean, I embrace time in bed awake. I love it. And that's why I always,

00:24:39.420 when I lecture about insomnia, I always tell people, look, I'm never going to have insomnia

00:24:43.340 in my life. And there's always murmuring in the crowd. And I say, well, wait a minute.

00:24:47.520 I didn't say I wouldn't have sleepless nights. A sleepless night is part of the human condition.

00:24:53.020 We're all going to get in bed and struggle to fall asleep from time to time.

00:24:55.740 Insomnia is when we really care about it, when it's upsetting and frustrating. If you want to

00:25:01.340 really see a tour de force of insomnia or insomnia thinking, go on Amazon, find my book. It's called

00:25:08.940 The Sleep Solution. Go down where the ratings are and just look at the one-star reviews of the book.

00:25:15.600 And you really start to get a sense of the word that you use, Brett, which is a good word. It's fear.

00:25:20.780 There are people out there who are traumatized by the condition. So when I say that inability to

00:25:28.100 sleep or not being able to sleep doesn't exist, that doesn't mean insomnia doesn't exist. Insomnia

00:25:33.000 is a very real thing. We just often define it incorrectly, which leads to incorrect treatments.

00:25:40.220 Michael Jackson went to his doctors and said, I can't sleep. And instead of probing that and

00:25:46.120 redefining the problem, they said, okay, here's some drugs. And he came back and said, these drugs

00:25:51.700 don't work or don't work anymore. I need better drugs. And eventually they got to a point where

00:25:56.540 a surgeon was going to his house and anesthetizing him with a drug called propofol, which is completely

00:26:02.440 problematic and just a terrible way to deal with somebody who's got sleep problems. 0.64

00:26:08.480 And we killed him. The sleep community or the medical community, not the sleep community,

00:26:13.760 the medical community killed Michael Jackson, not on purpose, but they thought they were doing the

00:26:18.500 right thing. And that's where we've got to get out from under these things and understand that,

00:26:24.520 listen, I hear you when you are frustrated and fearful and dread going to sleep at night.

00:26:30.760 You've created almost a PTSD situation. And when you read those one-star reviews, you can feel that

00:26:37.220 PTSD. And one person whose Amazon name was tired69 said, it's hell on earth, which is a really

00:26:47.360 interesting thing to think about. If somebody said to me, Chris, what is your hell on earth situation?

00:26:52.980 I can give you a bunch of them, being captive in a hole or having a kid kidnapped or a kid going

00:27:01.020 through cancer or something. There's a lot of hell on earth scenarios I can give you.

00:27:05.020 One of mine is not, you're in a climate controlled bedroom at 68 degrees, the love of your life

00:27:11.500 sleeping next to you and you're awake and it's two o'clock in the morning. Like, okay, like that

00:27:17.500 might not be the scenario I really want to be in the most, but I don't care about that. It's not

00:27:24.160 really a hell on earth to me. And part of that comes with the belief that I know that just because

00:27:29.300 I'm awake at two o'clock in the morning, I'm going to sleep. So there's nothing to really be that

00:27:33.880 worried about. So that's where we've got to get people. So if you flip over and read the five-star

00:27:39.080 reviews of the book, you can see that change in thinking. I've had people say, like clinic patients

00:27:45.540 say, just by talking to you, I feel like my insomnia is better already because of the fears and

00:27:53.280 misunderstandings that people take to bed with them. So I think fear is a great way to describe

00:27:58.500 a lot of insomnia. Yeah. So it sounds like it's more of a psychological issue. It's not like there's

00:28:02.700 nothing medical you need to do for insomnia. It's more about changing cognitive behavioral therapy.

00:28:07.880 I mean, for a lot of people, there can be medical reasons for it. I mean, for a lot of people who have

00:28:12.520 restless leg syndrome, they don't come to me and say, hey, I got restless leg syndrome. They say,

00:28:17.360 I have trouble sleeping. So there is a psychological component to some of it, a lot of it,

00:28:23.880 but not all of it, which is why if you're like, look, Chris, I go to bed and I don't care if I

00:28:28.140 fall asleep or not, but these things are happening and I am super sleepy during the day. We always talk

00:28:34.720 about if you have knee pain, you might buy a little brace at Walgreens or you might ice your knee or take

00:28:40.540 some Advil or Motrin or something. But eventually, if you're feeling like, gosh, my knee is really

00:28:47.320 hurting more than it did a few weeks ago and none of the things I've bought at Walgreens or these

00:28:52.020 remedies I've tried are helping, you're probably going to go see your doctor and orthopedic

00:28:56.280 specialist. So to me, yeah, I mean, if you're feeling like, look, I've struggled with these

00:29:00.220 things for a long time, even if they're sort of fear-based kinds of situations, talk to a sleep

00:29:06.180 doctor. There is a much better solution than some sort of pill to knock you out at night.

00:29:11.380 You know, sedation and sleep are two very different things.

00:29:14.320 Well, related to insomnia, it is kind of like insomnia. It's not people are afraid of

00:29:17.020 sleep, but people who sleep or like people who think they're not sleeping or they're having bad

00:29:21.580 sleep, but then they come to you and say, doc, I'm not sleeping. My sleep's terrible.

00:29:25.580 And they do a sleep study and like their sleep's fine. Like what's going on there where the

00:29:29.460 perception is off between the quality and the quantity of sleep they're getting, but like what

00:29:33.840 they think they're getting. Sure. So a sleep study, particularly in these days when we've got home

00:29:39.040 sleep studies, it's not necessarily a guarantee that your sleep is normal. So, but your point is a good

00:29:46.560 one that another one of our secret sayings in the clinic is perception of sleep and reality are two

00:29:52.300 very different things. So when the patient comes to me and says, I've been in Germany for the last

00:29:56.880 nine and a half months and I haven't slept, he wasn't sitting at home the night before saying,

00:30:02.260 I've got this great idea, honey. I'm going to go to see this sleep doctor. I'm going to wait several

00:30:06.640 months for my visit. And when I finally get in to see him, I'm going to lie about my sleep and tell

00:30:10.980 him I'm not sleeping when in fact I really am. It'll be so much fun. Like nobody ever does that.

00:30:15.020 So when that individual comes or I had a circuit court judge, you know, right below Supreme Court,

00:30:21.080 she came in at one point and said, I'm not sleeping. You know, I said, when you say you're

00:30:25.400 not sleeping, what do you mean? She said, do I stutter? I don't sleep. You know, the husband had

00:30:31.020 a kind of a funny look on his face and the funny look was, I don't think that's necessarily true,

00:30:35.560 but I don't want to say anything because I'm living with her, et cetera. So, but that's her

00:30:39.200 perception. So we actually put her in a sleep center and she did a sleep study and she came back and

00:30:43.900 said, see, I told you I don't sleep. And I'm like, ma'am, you slept for six and a half hours.

00:30:48.540 I showed her the video. And she said, Chris, that is absolutely not my perception of what

00:30:53.640 happened that night. In fact, if I didn't know any better, I would think that you superimposed

00:30:58.040 my face digitally onto the body of somebody else who was actually sleeping because my experience was

00:31:04.000 I was awake all night. Now it starts to make sense when you understand that she's awake all night,

00:31:10.060 yet she's hearing court cases all day long, doesn't feel sleepy. In fact, when she tries to nap,

00:31:15.820 she can't. So that behavior makes sense now. And so it's important that we understand that how we

00:31:22.720 feel about our sleep doesn't always match up with the reality. In fact, that's one of the wonderful

00:31:28.260 things about some of the technology we have. Sure, it may not be great at determining REM sleep and deep

00:31:34.180 sleep. But if you're wearing an Apple watch or a Fitbit or a Withings band, trying to figure out

00:31:40.300 how much sleep you're getting, and you're waking up every morning and writing in your sleep diary,

00:31:44.660 I slept 28 minutes last night. But your Fitbit is saying you slept six hours and 17 minutes.

00:31:51.480 No offense to you. And I understand that a Fitbit can be off, but I actually believe the Fitbit more

00:31:57.140 than I do you. And I bet your bed partner does as well too. So it's sometimes nice to have an

00:32:03.360 objective measure because now that fear of, oh my gosh, I am sleeping 30 minutes a night and I have

00:32:11.400 so for the past eight days. I'm going to develop dementia by the end of the month. My sleep is so

00:32:16.160 bad. Now you have this objective voice saying, hey, don't worry. Maybe you didn't sleep great last

00:32:22.140 night, but you got six hours and 17 minutes sleep, which is a whole lot better than 28 minutes.

00:32:26.060 So these things have started to play a real positive role in people's lives that

00:32:31.140 they're actually sort of a referee. I can tell you, look, you're not in danger of sleeping 28

00:32:36.840 minutes a night. I had a parent who said their kid slept two hours a night. I'm like, no, he doesn't.

00:32:41.940 Not on average. I mean, maybe last night he did, but there's no way over a month's time

00:32:46.360 your 11-year-old son's averaging an hour or two of sleep. It just doesn't happen in nature.

00:32:52.140 And if you don't believe me, buy him a Fitbit, stick on his wrist, and we'll talk in a month.

00:32:56.380 Nobody ever brings me that Fitbit back that says, oh, wow, you're right. One hour.

00:33:01.420 You know, if that ever is the case, the medical sleep community is going to be up in arms because

00:33:08.180 we've been looking for that person for years, but have never been able to validate that somebody

00:33:12.580 like that could even exist.

00:33:14.640 Yeah. That was one of the biggest takeaways from this book that helped me really right away.

00:33:18.500 Like I've had those where you wake up in the morning and you don't feel great. You don't feel

00:33:21.420 refreshed and you think, ah, I didn't sleep last night. My sleep is horrible. And I was

00:33:25.180 like, well, I probably did sleep. And if I asked my wife, she'd be like, no, you were snoring

00:33:28.860 when I came into the bedroom to get into bed. So yeah, okay. I did sleep. I did get to sleep

00:33:33.120 by my body need. I might not feel like it, but I did.

00:33:36.360 Right. Or you might even say that sleep quality wasn't that great. So again, when a person comes

00:33:42.660 to my clinic, for a lot of people, you know, the first thing we have to agree on is you sleep. And

00:33:50.180 for 90% of people, that's not a problem. Like scientifically, sure. We have to eat, we have to

00:33:56.540 drink, we have to sleep. So when you say to your wife, oh, I slept terribly last night. And she said,

00:34:01.880 well, I think you slept better than you thought you did because that time you thought you were awake,

00:34:06.000 you were actually snoring. Sure, you did sleep. So if the question is, does Brett sleep or not?

00:34:11.820 I'm sure he does. Your wife agrees. There we go. Does that mean your sleep that night was

00:34:16.340 as good as it could be? Absolutely not. So when I'm telling a patient who has insomnia,

00:34:22.260 look, you sleep. I am not saying you sleep well, but we do have to get to a place in our relationship

00:34:29.920 where we can believe that you actually sleep. And like I said, if you go back to those one-star

00:34:35.620 reviews of the book, these are people who've read the book and are like, I don't care what this

00:34:41.680 smart-ass sleep doctor has to say. I haven't slept more than two hours a night. And I guess I'm the

00:34:49.180 exception. And his book really didn't help me figure out a way where I can get more than two

00:34:54.360 hours of sleep at night. No, it's not going to do that. In fact, I've always had a great idea for

00:34:59.440 a television show. I want to contact those one-hour sleepers and I'm going to move into their home for

00:35:05.780 the next 14 days. And now I'm in complete control of their schedule. We're going to hook some cameras

00:35:11.340 up in their bedroom and we're going to get down to figuring out the problems these individuals have.

00:35:16.800 But now we've got eyes on the situation. So if you're truly not sleeping at night,

00:35:21.440 we're going to see it. And I'm going to make sure you're up at six o'clock in the morning and eating

00:35:25.280 right and exercising and getting sunlight and doing all the secondary things we need to do for our

00:35:32.080 sleep versus just hiding behind. Well, I only sleep an hour and you're frustrating me by this

00:35:37.400 conversation. So goodbye, I'm going to find another sleep doctor. It'll just give me more ambient,

00:35:41.420 which is something that I wish I could control, but sometimes I can't because that perception can

00:35:45.540 be incredibly strong in people. Well, let's talk about things that people can do to one,

00:35:50.920 if they have insomnia, sort of mitigate that and sort of training themselves to sleep. Like you said,

00:35:55.860 sleep is a skill, what they can do, but also for people who are sleeping, they know they're

00:36:00.380 sleeping, they're not sleeping great. Some things they can do to improve their sleep.

00:36:04.940 And I think this goes under the rubric of, it's called sleep hygiene. So what does good sleep

00:36:09.900 hygiene look like? Yeah. I mean, I didn't put a lot of effort into talking about sleep hygiene in

00:36:16.740 my book just because I feel like, man, if you don't know a dark room is better than a bright room in

00:36:21.720 2020 for your sleep, you've been living under a rock. This is the stuff that everybody seems to focus on.

00:36:27.440 A dark bedroom, a cool bedroom, get a good comfortable mattress, make sure you're exercising

00:36:32.600 and make sure you don't have a computer screen in front of your face at night and make sure you're

00:36:37.160 not smoking and drinking a bunch of coffee right before you go to bed. I mean, the number of people

00:36:41.920 who come to my clinic who I am solving their sleep problems by giving them sleep hygiene tips

00:36:47.640 rounded to a whole number of zero, they've come in doing all those things. So to me, A,

00:36:54.540 do all those things. Exercise. Don't smoke when you go to bed at night. Don't have a computer screen

00:36:58.800 playing an episode of Friends right in front of your face as you're trying to fall asleep. Don't

00:37:02.340 watch any political television in the hour before going to bed because either side of the aisle you

00:37:07.120 sit on, you're going to be frustrated by the situation. So to me, once you've gotten past those

00:37:12.720 things, bedroom's dark, it's cool. Wife doesn't snore. We've kicked the dog out of the bedroom.

00:37:17.780 The kids sleep great, whatever. That's probably the time to come talk to somebody before you

00:37:23.280 plucked down another $3,000 on a state-of-the-art mattress because you've already bought two of

00:37:28.740 them in the last year. That's the time where you say, look, this might be a problem that's intrinsic

00:37:35.100 and medical that you can't fix. You can wear the knee brace. You can ice your knee. You can take

00:37:39.500 the aspirin. But if you've got a torn ligament, I'm not aware of a CVS fix-it-yourself torn MCL

00:37:46.380 ligament kit that's available where you just walk yourself through it on a YouTube video. You need

00:37:51.480 professional intervention at that time. And in that case, you might need a sleep study because

00:37:56.820 there is something intrinsically wrong with your sleep. Again, do you sleep? Everybody's listening

00:38:02.580 to this right now. I can tell you that you do. Do you sleep well? Is there something wrong with

00:38:07.580 your sleep? There very well could be. And the best way to figure that out is through some sort of sleep

00:38:11.920 study. All right. So let's do a quick recap here. Some people are going to need more or less sleep than

00:38:17.280 other people. It's different for everybody. And even the amount of sleep you need personally,

00:38:21.160 that's going to change or fluctuate throughout your life. Like some days you're going to need more

00:38:24.820 sleep. Other days you need less sleep. You're not sleepy. And I like the analogy made with food

00:38:29.000 because that really hit it home with me. Like some days you're hungrier. So you need more food.

00:38:33.660 Other days you're not as hungry. You need less food. Same thing with sleep. But regardless of the

00:38:38.000 fluctuations in your sleep, everyone is going to sleep. So the people with insomnia, and these are the

00:38:43.000 people who are afraid to fall asleep because they're afraid they can't fall asleep, or they're afraid

00:38:47.260 they're going to wake up in the middle of night. What they need to do is sort of manage their

00:38:51.240 expectations about sleep. Don't stress out about it. They can't fall asleep. Don't put pressure on

00:38:55.620 themselves that they need to fall asleep. And I mean, really just adjust their expectations for

00:39:00.080 these natural fluctuations that happen with our sleep throughout our life.

00:39:04.540 Absolutely. Or maybe you don't have as much time in bed. I mean, it's amazing. I mean,

00:39:08.940 people tell me that, you know, what time do you go to bed? Nine o'clock. How long does it take you to

00:39:11.980 fall asleep? Two hours. When do you wake up? Six o'clock. Okay. Well, you're seeking

00:39:17.120 nine hours of sleep. You don't go to bed until 11 o'clock. You know, most nights, why not make

00:39:22.360 11 o'clock your bedtime and keep six o'clock your wake up time? That's still seven hours. That's

00:39:27.380 plenty. So if somebody says they need nine hours, then by all means, get it. But if you're trying

00:39:33.960 to get nine, but you only need seven, those extra two hours, that difference is insomnia. So if

00:39:41.180 somebody, again, somebody says, well, I don't mind lying in bed for two hours before I fall asleep at 11,

00:39:44.880 then don't. If somebody says, yeah, it drives me crazy, then, hey, let me gift you the gift of two

00:39:51.620 more hours in the evening to get some things done or watch some more TV or finish up the Queen's

00:39:56.160 Gambit, whatever you're interested in doing. Like, don't go to the restaurant at five o'clock for

00:40:01.480 dinner when you're not hungry until seven. Sitting in the restaurant, annoying the waitresses,

00:40:05.860 everything that come out, what do you want to eat? I'm not hungry. And you go there every day at

00:40:09.360 five o'clock. Why do you go at five o'clock? Well, five o'clock is my dinner time. No, it's not.

00:40:12.640 You've determined it's your dinner time, but there's nothing about your behavior

00:40:16.480 that would say it's your dinner time. So if somebody says out there that they go to bed at

00:40:21.280 nine, go to bed at 11. Now keep your wake up time where it is, but that's perfectly fine.

00:40:26.560 So having those expectations and freeing yourself up from some schedule can be extremely liberating

00:40:34.800 for a lot of people.

00:40:36.200 And also, at one point you make in the book is if you're having trouble falling asleep,

00:40:39.040 don't immediately go through, well, I'm just going to pop an Advil PM or NyQuil. Because

00:40:44.080 one, they don't really do all that much. And you can also disrupt your sleep. And two,

00:40:49.700 there's also long-term consequences of taking sleep aids.

00:40:52.820 There can be. Absolutely. I mean, some of those, anything that has PM in the end of it,

00:40:57.220 it's probably just an antihistamine. And there's some evidence that chronic use of antihistamines

00:41:01.800 could lead to early dementia. Because a lot of antihistamines have an anticholinergic effect,

00:41:06.480 which means they block the chemical acetylcholine, which is integral in Alzheimer's dementia.

00:41:11.740 So to me, tonight, we're all going to go to bed at some point. Let's have a plan.

00:41:17.200 And the plan can't be, I'm going to have great sleep or else terrible things are going to happen.

00:41:21.060 The plan's either going to get in bed and fall right to sleep, or I'm not. And if I don't,

00:41:25.760 what's the plan? The plan could be a Sudoku puzzle. The plan could be, read my book. I always tell

00:41:30.320 people it's either the best book in the world in sleep and it'll help you figure out your problem,

00:41:33.740 or it's the worst book on sleep and it'll put you right to sleep. So have a good book next to

00:41:38.840 your bed when you're interested in reading. Like a Dan Brown, he's running around the Vatican trying

00:41:43.280 to figure out the killer's motives for all these little clues or whatever. There's all kinds of

00:41:48.440 good books out there to read. Something fun and light. It's not tax theory or something divisive or

00:41:56.500 upsetting. Something relaxing. Or the advice that always drives me crazy is if you're in bed and you

00:42:02.600 can't fall asleep, give yourself 15 minutes. And if you're still not asleep in 15 minutes,

00:42:06.940 get up and go do something else. Sure. I hate the 15 minutes or the 20 minute part because now it's

00:42:12.820 like a clock. Tick tock, tick tock, tick tock. You have 15 minutes to get yourself to sleep or else,

00:42:18.200 which never works. To me, it's just be in bed. And if you like being in bed, it's relaxing and your

00:42:24.980 eyes are closed and you're thinking pleasant thoughts and planning out your next trip once we can get out

00:42:29.600 from under this virus and travel again. Great. You sitting there resting, meditating is doing

00:42:35.700 something positive for your body. If it starts to frustrate you or bother you or you don't like

00:42:41.960 sitting there in bed awake with your eyes closed in the dark, yeah, then go up and go do something.

00:42:47.300 And don't worry about it. I mean, okay, it's midnight and you can't sleep. So you get out and

00:42:51.020 go out in the living room and check some emails or paint some little figurines or models that you like

00:42:58.440 to build or clean out your workroom or whatever you like to do. And if finally at three o'clock in

00:43:03.500 the morning, you're starting to feel sleepy, then go to bed. It's three o'clock, go to bed. Now,

00:43:07.340 you got to keep your wake up time set. That's the key. That just because you went to bed at three

00:43:12.380 doesn't allow you now to sleep until 11 and skip your first Zoom meeting of the day. Nope.

00:43:19.260 You got to wake up on time. And that's the thing that keeps our brains honest. I tell people all the

00:43:24.180 time. If I can't fix you, go join the military. There is a wonderful drill sergeant out there

00:43:29.140 and she will fix your sleep problem in about a week. It will not take her very long because she's

00:43:34.580 going to put you in your barracks at midnight. She'll wake you up with a beautiful horn at five 1.00

00:43:38.780 o'clock in the morning and she will not let you out from under her sight from five o'clock in the

00:43:42.880 morning till midnight. You will run and do pushups and eat these exact times every day. And there'll be

00:43:47.700 no opportunity for napping. There'll be no opportunity to say, hey, Sarge, I'm a little tired.

00:43:51.760 Mind if I go take a nap while you all go do this obstacle course and I'll meet up with you all

00:43:55.520 later? No, that's not going to happen. So you may have very different problems in a week,

00:43:59.540 but one of them will not be an inability to fall asleep because she's going to take care of that

00:44:03.460 very quickly. Well, speaking of naps, can naps get in the way of sleep? And if so, how do you nap

00:44:08.940 without it messing up your nightly sleep? I think naps are for efficient sleepers who are still tired

00:44:14.100 despite a decent night of sleep. So if somebody says to me, hey, I got my eight hours, my seven hours,

00:44:19.020 my six hours last night as normal, but I'm feeling a little tired today. For whatever reason,

00:44:24.000 I've been sleeping very well lately. I felt really tired yesterday. I'm not exactly sure why and

00:44:28.600 fell asleep like at eight o'clock watching TV, which is very unusual for me.

00:44:33.220 So if somebody is a good sleeper and for whatever reason on this Tuesday feels a little tired and

00:44:39.440 wants to take a nap, go for it. Keep it short. Try to keep it earlier in the day rather than later,

00:44:43.860 but there's nothing wrong with that. It's like a snack. I had breakfast and it was pretty good

00:44:47.620 breakfast, but I'm really hungry and don't think I can make it till lunch without having a few

00:44:51.600 crackers or a bite of an apple. Okay, great. Go ahead and have it. What napping is not for is the

00:44:56.520 person who says, I go to bed every night at nine o'clock, takes me until five o'clock in the morning

00:45:00.100 to fall asleep. And so I'm tired when I wake up because I go to bed at five o'clock, have to get up

00:45:05.220 at nine for work at four hours and I can barely keep my eyes open. Napping is not a great idea for

00:45:09.940 that individual. Your brain had ample opportunity to sleep at night and it chose not to, which is

00:45:15.660 perfectly fine. We told our kids when they were little, you need to be in your room at nine

00:45:19.820 o'clock, eight o'clock, 10 o'clock, whatever. But I don't care when you go to bed. You're eight years

00:45:24.500 old. You're practically an adult. You decide when you're going to go to bed at night. Now,

00:45:27.820 what I didn't tell them was stay up all night or go to bed on time. I'm still going to wake you up

00:45:32.040 every day at seven o'clock. It's not going to change. And I'm not going to be the parent that when you

00:45:37.040 say, oh, dad, I struggled last night to sleep. I was up till four o'clock. I couldn't sleep because I'm so

00:45:42.640 worried about my AP US history exam. Can you take me to school at lunchtime and let me sleep in? No,

00:45:48.940 I can't. I'm nice about it. It's okay. Listen, you're 15 years old. You can handle a night of

00:45:54.840 four hours sleep. It's no big deal. And you'll probably sleep great the next night. So we

00:46:00.320 acknowledge it. We don't minimize it, but we don't maximize it either. And we keep the schedule,

00:46:05.880 just like that drill sergeant. We're nice about it though. But this idea that because you were up till

00:46:11.100 four o'clock worried about an exam is going to give you some sort of Starbucks gift card,

00:46:15.440 allow you to sleep until noon and miss half your school day, it's not going to happen. It's not

00:46:19.380 going to happen on the weekend either. And so now he's going to go to bed the next night at nine or

00:46:24.540 10 o'clock. Having only slept a few hours a night before, suddenly that problem becomes a one night

00:46:30.440 situation versus, oh, we let him sleep until noon. We took him to school at one o'clock. Now it's 11

00:46:37.460 o'clock. He's not that tired to go to sleep because he just woke up at noon and the situation

00:46:42.140 perpetuates itself. My biggest record in my clinic is 58 tardies. One child in a half a year had 58 1.00

00:46:50.580 tardies because his parents were so concerned about his sleep, they'd let him sleep until he woke up in

00:46:56.160 the morning. Sometimes that was two in the afternoon. So that napping can really make a

00:47:04.200 little temporary hiccup in your sleep into a much bigger problem if you're not careful with that.

00:47:11.260 So if you're doing all this stuff, the sleep hygiene, you've taken care of the cognitive

00:47:15.220 aspect of sleeping and the insomnia, but you're still having trouble sleeping, that's when you'd

00:47:19.380 probably go visit someone like you, a sleep doctor, to see if there's some other issue like maybe sleep

00:47:23.840 apnea, restless leg syndrome, et cetera. And in those cases, those are medical conditions where

00:47:28.800 you might treat with some sort of drug or CPAP, right? Absolutely. Yeah. So if you're really

00:47:34.120 struggling with your sleep, the first visit to a sleep doctor is we're just going to talk. In fact,

00:47:41.260 if you're coming to my clinic, we're going to talk over your computer because we're completely

00:47:45.480 virtual right now. So nobody's going to hook up any wires to you. Nobody's going to probe you during

00:47:50.260 your sleep. It's just a conversation. That's how we really diagnose sleep disturbances. What time do

00:47:55.740 you go to bed? I want to take you to fall asleep. How long has this been going on? What medications

00:47:59.480 do you take? What does your partner notice about your sleep? How do you feel during the day? What

00:48:03.720 other medications do you take? To me, there's a lot of information gathering that happens to start to

00:48:09.820 understand where this problem is coming from and what of the 88 diagnosable sleep disorders might you

00:48:15.840 have. So there's really no risk for that first evaluation. Could you need a sleep study? A lot

00:48:22.840 of patients who come to see us do, but we work really hard to keep people out of the sleep lab.

00:48:27.420 Or we have home sleep studies that we can do now where you take this little device home and hook it

00:48:33.240 up to you and you sleep in your own bed. And we can get a wealth of information that way. So

00:48:38.340 don't let this thing be a chronic problem. I mean, if you're somebody who's not happy with the

00:48:45.460 way you sleep, somebody out there can deal with it and fix it. I mean, it's pretty rare

00:48:54.760 to be given something as a sleep specialist who's been in the field for what, almost 30 years that

00:49:00.100 I'm like, oh my gosh, I've never heard of that before. It just doesn't happen. And the nice thing

00:49:06.480 about sleep too is a lot of people kind of feel embarrassed about sleep and talking about what

00:49:10.340 they do. And I get up, I'm naked and I run around the house and scream things that embarrass me or

00:49:15.280 whatever. But like I said, we've heard it a million times before. We've heard about the adult wetting

00:49:21.040 the bed. We've heard about the weird sexual encounter you had with your partner that you

00:49:25.340 don't remember and the weird things you said during that time. I mean, it's okay. We are not here to

00:49:31.920 judge. We're here to fix. And we generally do a pretty good job of it. Sleep disorders are usually

00:49:36.980 pretty easy to fix if you're coming with a pretty educated, open mind. And that's really why I wrote

00:49:41.540 the book. So I feel like if you educated yourself about sleep, you could fix a lot of your own sleep

00:49:47.640 problems. It's the fear and the not understanding what's going on that usually lends itself to more

00:49:54.220 anxiety, which more anxiety never helps with sleep problems, which is why in this current political

00:49:59.780 landscape we're in right now, we're just exploding because anxiety amongst COVID and elections and all

00:50:05.440 this stuff is pretty prevalent. Well, Chris, this has been a great conversation. Where can people

00:50:09.120 go to learn more about the book and your work? Sure. I mean, if you can follow me on

00:50:13.020 at sportsleepdoc, S-B-O-R-T-S-L-E-E-P-D-O-C on Twitter. I work with a lot of professional sports

00:50:19.260 teams. That's why I picked that handle, even though the majority of what I do is to see average

00:50:23.700 patients. I'm not even that huge of a sports fan. I just think it's interesting when you fix an

00:50:28.680 athlete's sleep problem, we can measure their performance a lot easier than we can a lawyer,

00:50:33.500 for instance. So I find them to be a wonderful laboratory for does better sleep actually make

00:50:39.420 us perform better? So I'm at sportsleepdoc on Twitter. You can go on Amazon, Kindle, Audible,

00:50:45.160 and find my book. It's called The Sleep Solution, Why Your Sleep is Broken and How to Fix It.

00:50:50.140 I've got an upcoming book coming up about kids' sleeps called The Rested Child. So I'd be looking

00:50:55.280 for information about that. We've got a webpage that kind of some links to various things. But

00:51:00.500 I would just say, talk to your primary care doctor and say, look, I heard some sleep doctor

00:51:04.680 talk on a podcast. And I think that that's something that I could use. And if we can help

00:51:09.080 you, that's great. If not, I can almost guarantee you there's a smarter, more professional sleep

00:51:14.960 doctor in your vicinity that's ready to help you out and really change your life.

00:51:21.220 Fantastic. Well, Chris Winter, thanks for your time. It's been a pleasure.

00:51:23.520 Hey, my pleasure, Brett. Thanks for having me.

00:51:25.000 My guest today was Dr. Chris Winter. He is a sleep specialist and the author of the book,

00:51:29.680 The Sleep Solution. It's available on amazon.com and bookstores everywhere. You can check out our

00:51:33.180 show notes at aom.is slash sleep, where you can find links to resources where you can delve deeper

00:51:36.980 into this topic. Well, that wraps up another edition of the AOM Podcast. Check out our website

00:51:48.240 at artofmanliness.com, where you find our podcast archives, as well as thousands of articles written over

00:51:52.220 the years. And if you'd like to enjoy ad-free episodes of the AOM Podcast, you can do so on

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00:52:18.900 reminding you not only to listen to the AOM Podcast, but put what you've heard into action.

The Art of Manliness - November 16, 2020

#661： Get Better Sleep by Stressing About It Less

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