Amanda Dinsmore (00:00.75)
Hey guys, welcome back to the podcast. I am Amanda.
Laura Cazier (00:04.686)
I'm Laura.
Kendra Morrison (00:06.011)
And I'm Kendra.
Amanda Dinsmore (00:07.63)
And we started with the Blue Zones series a couple of episodes back. We're going into a phase where we've talked a lot about stress and mental health issues and coming to terms with thought disorders and thought errors, that sort of stuff. But some of you want to know practical things that you can do right now without any assistance and things that you should focus on once you're feeling good enough to actually get to that stage—things you can do to make your life better. One of them, hands down, is going to be improving your sleep. So, Kendra is going to give us a little introduction here. Take it away.
Kendra Morrison (00:55.323)
So this really has become a passion of mine because I realized how much actually I thought it was, you know, we talked about the chicken or the egg. So we're like so stressed out because we work in a high-stress environment, which causes us not to sleep very well. But then also, lack of sleep or poor sleep increases our stress. So it's a vicious cycle. And so I've become pretty passionate about just learning everything I can about sleep, also because I'm married to a physician. He's on a pretty regular schedule, but there are still some things. And then for my kids, too, because I think some of what we see in the ED with this mental health crisis among kids—Ellie, you can speak to this too—but just that we're seeing in the ER this uptick in, you know, feelings of anxiety, depression. I mean, these kids are under all this pressure. And I don't think, or I haven't seen, or maybe I'm just naive, but just the real tangible evidence for sleep. I mean, these kiddos are on their phones or they're gaming until all hours of the night. And this disordered sleep is a big deal when we're talking about mental health. So we revamped our course, I think you guys have heard, and our module. I was fortunate to be able to do our module in the optimization called sleep. And a lot of what I got is from some of these sleep experts that I follow on the socials, but also Dr. Peter Attia. We've talked about his book Outlive. He has a great chapter on sleep. And just the fact that he dedicated a whole chapter to sleep just kind of tells you how important it is for his work, which is in longevity.
So we talk about chronic sleep deprivation, and it's a slow killer. It's really insidious because, like we said, if you work in a high-stress environment and then you can't unwind, you're not getting good sleep, and then that lack of good sleep is increasing your cortisol and your stress hormones throughout the night, and you just never can dial it down. You just never recover. Over time, that is what we're talking about. The acute sleep deprivation, sort of like us as docs or shift workers experience on a daily to weekly basis, does have a little bit less impact on those chronic conditions or health adverse health outcomes. But in Peter Attia's book, he works with a physician who takes care of the Navy SEALs, and he's done some work with even like a 24-hour training session where they're required to do their tactical things for 24 hours straight and not sleep. He has done some really powerful work on even going one night of wakefulness or not getting your right sleep has shown to be scientifically significant, like stress hormone levels are prolonged. Well, he calls it like old man blood because he says it's similar to when he measured it in the men in the Navy SEALs after one night of wakefulness. Their levels of inflammatory markers and cortisol levels were similar to men two and three decades older. So that's why it's called old man's blood. But anyways, we know what chronic sleep deprivation does, and the acute sleep deprivation usually is not as much to recover from, but over time, this is where we're seeing the significant effect.
So when we talk about sleep deprivation, it's less than seven hours per night. I mean, that's pretty big because that's going to encompass a lot of people. If you travel regularly for work, this impacts you too, especially if you're like international business and you're flip-flopping all time zones and jet lag and all the things. Even with less than seven hours of sleep per night, you see a decrease in the function of the immune system, and already they can measure markers for an increased propensity. So it's just like suggesting you're heading in the direction of that metabolic dysfunction. And when we talk about metabolic dysfunction, we're talking about that syndrome of type 2 diabetes, obesity, hypertension, and hyperlipidemia. So...
Sleep, why it's so important is because our brain needs it. Our brain absolutely needs it. It is crucial for optimizing our cognitive function. It is where memories are situated and sorted, and we keep the ones that we need to keep and toss the ones we don't. It also is important for emotional equilibrium, which is what we talk about a lot. During sleep, the brain is able to actually take that memory and separate out the emotion with that memory. So if something happened during the day that really created a lot of stress, your brain is actually able to keep the memory but separate or dissociate your emotional response to it in your wakefulness or in your consciousness, which I think is fascinating. And so your brain needs that time to really do this. It's also processing thoughts. So we talk a lot about thought work and recognizing and being aware of thoughts that work for you or don't work for you. In that sleep, when you're in that non-conscious state, this is the time when the limbic system goes to rest, and then all the other systems, especially the prefrontal cortex, use that time to really sort out everything and process some of those thoughts.
What I also found fascinating was in that non-conscious state of sleep, your brain actually has its own street sweeper system called the glymphatic system. It is aligned with the brain in the cortex, all these channels and tributaries that go all in the sulci and follow all the cerebral cortex. It's like a little tributary, and these street sweepers come sweep the junk off into the tributary and take it away. So it's tidy. It's like a self-cleaning organ, kind of like what our liver does. It's just fascinating. But if you do not drop down or enter into that non-conscious state of sleep, this does not happen. Hence why more and more studies, most recently in the last year or two, are being published for disordered sleep or poor sleep being an actual causation of things like Alzheimer's disease. Some of these neurogenic diseases are actually caused by the brain.
Interestingly enough, the first sign of them is poor sleep, but if you go back, you recognize that the sleep routine or your disordered sleep has gone on for a long time. So that's strong when we're relating things as causation, that's pretty strong. And then what also I found interesting in Peter's chapter on sleep was that he, when he was speaking, he worked a lot with this physician who works with the Navy SEALs. And he's like, don't you think maybe that bragging about not getting enough sleep is like a thing because if you were to, and he just challenged him, he said, I believe that it's actually hardwired in us to sleep. Like every species sleeps. And he went on to talk to Peter at dinner and said, I challenge you to get out your phone and Google something right now. Every single species does some sort of sleep, you know, not the sophisticated sleep cycle maybe that we humans have, but they all do something or they enter into kind of a non-conscious realm. And, you know, considering that, it's actually probably hardwired. Even as much or as specific as the time we need to sleep, there's evidence for that. It's hardwired.
So, like we said, we talk about how important sleep is and the effect of why it is so important. And so we know poor sleep affects metabolism. We know when you're tired, like anybody ever, we think Amanda talks about this sometime, and so does Laura with their Halloween candy. But when you come home tired from a shift, you're making poor decisions. When you are wanting to reach into the pantry, you are not thinking like, maybe I could whip up a kale salad with a little bit of cranberry and some lime vinaigrette. No, you are like, where's the Halloween candy? Where's the bag of M&Ms? Where is the Taco Bell? Right? And so that is, that's kind of multifactorial. You're not making good decisions. You're reaching for whatever's quick. Plus, we know that those comfort foods actually give us dopamine, and that does actually help us initially feel drowsy and want to sleep. But however, when it's being metabolized, we'll talk about how it's actually not too helpful. Same with alcohol.
But when we look at the actual effect, it increases your insulin resistance. There's a 50% reduction in glucose disposal. Obviously, if you're stressed and you're not getting into your deep non-REM sleep, you're going to have high cortisol levels, which lead to high blood pressure and cardiovascular disease. And then we can talk about obesity. And it's just this constant feedback loop. You know, he goes really in the weeds talking about leptin and ghrelin, all these hunger hormones. And like I said, it does have an effect on our brain. What we grab for at, you know, midnight or 1 am when we're coming home from it, we're not only stressed from our shift, but we're starving. We haven't eaten our whole shift.
And so we're definitely trying to self-medicate, I think, at that point. And so, yeah, so when he talked about that, when we looked at studies with, and they differentiated people with short sleep—so this is less than six hours per night—they were actually able to measure an increased risk of anywhere from 6 to 26% of cardiovascular disease. So on the low side, with people not having a bunch of risk factors for CVD, you were probably more in that 6 to 8%. But on the high side, if you're a smoker and you had poor sleep and you had high blood pressure, you're going to be on that 25 to 26%. That's significant. I mean, if sleep can increase your risk by almost a quarter, if you have other risk factors, that's really significant. And then short sleep—so like I said, less than six hours per night—also had a 20% higher risk of heart attack. And you wonder how many of these patients we get in the middle of the night or the wee hours of the morning that had the heart attack when they were in their sleep. You kind of wonder how much of that plays into that.
And then we talked about this poor sleep and the brain, which is the most important and most fascinating to me was that increased risk of anywhere from mild cognitive impairment all the way to full-blown Alzheimer's disease. So where we thought, I think, this is just a genetic component—people just have the genes to predispose them to these neurogenic diseases—it's not so much just this unilateral theory anymore, not just this one cause. So I'm fascinated by the studies that are coming out this monthly with this association of poor sleep and the brain and how significant it is for that mild, anywhere from MCI, mild cognitive impairment, to Alzheimer's. So just super cool stuff.
Laura Cazier (12:32.75)
Yeah, I mean, it's fascinating because you've just kind of gone through the list of all the diseases that affect westernized or industrialized nations in the world. And it does just kind of make you wonder. We've always kind of attributed it to our diets and activity levels. But if you're living in an agrarian society somewhere in Africa, you're not just getting five hours of sleep. You're probably going to bed pretty close to when the sun goes down and you're getting up with the sun. And so I wonder if some of, I can't imagine that it wouldn't be the case that some of the protective effect of living in a different country that is not highly industrialized is coming from the fact that they're probably getting better sleep because they're not staring at their iPhone all night.
Kendra Morrison (13:28.027)
I would probably agree with you on that one for sure.
Laura Cazier (13:31.886)
I will definitely attest that with the mental health crisis in kids—and I say kids because we've personally had to admit kids as young as five with suicidal or homicidal ideation—that the phones are a huge part of it. Amanda and I, you know, like, I don't know if you remember, but when we were rotating through the Peds emergency department and residency, I actually remember being shocked to see a kid sign in for suicidal ideation. Like it was maybe it happened once a month or so. It was not, it was an unusual thing. And we're like, what does a kid have to feel suicidal about? That's so sad. But now, I mean, there are definitely times I come into the department and half the beds are filled with kids waiting for psych admission beds. And this all started with the advent of the iPhone. And universally, actually, no, I can't say universally because I have had one. When I asked parents of these kids who are meeting psychiatric admission because of suicidal ideation, I've had one parent who's told me that their kid checks their phone into the parent's room at night. The rest of them, the kids have their phones with them all night long. And so is it any wonder that they're not well? They can't be getting good deep sleep because they're getting notifications from social media and texts from their buddies. And who knows what else they're getting into on the internet all night long. They are not ever getting into that deep non-REM sleep or the REM sleep that they really need for their brains to function properly and for them to grow, by the way. That's when they get their good growth hormone release is in that deep sleep. So it's not just a nice-to-have thing. And if you're trying to lose weight, anybody who's trying to lose weight and who is sleep deprived, that is an uphill battle right there because your brain is generating so much ghrelin, you're going to be super hungry. And just work against that when you're trying to lose weight. So it's really worth our while to make sure that we have good sleep and good sleep hygiene.
Kendra Morrison (16:12.507)
Yeah, I agree. I mean, we just came back from a conference, a bunch of coaches starting their own business, and several of the weight loss coaches address sleep right away. And I mean, it's a big part of it. It is a huge part of it. You know, increasing the risk of that metabolic syndrome and obesity is a huge thing. And especially moms and they talk about the perimenopausal, you know, aging mom or whatever. You know, if you're running, if you feel like you're running an uphill battle, getting weight off, you know, one of the first things is to look at what is your sleep pattern like? How many kids are you running in every different direction at all hours of the day and night? And so, yeah, it is not a maybe I'll address it at some point. It's actually pretty priority, something to prioritize.
Laura Cazier (16:57.485)
Mm-hmm.
No, and a couple of other thoughts there. One, if you do get good sleep and you have your sleep hygiene optimized, and you're in bed in the complete dark, and you're not messing with your phone, and it's a nice, cool room and all that, and you're sleeping, you're in bed an adequate amount of time and you're getting enough sleep, but you're waking up not feeling rested, that is also a red flag and suggests maybe go get a sleep study because you may be dealing with sleep apnea. This happened to me actually for years. And, you know, obviously for a long time I had kids and I was up at night dealing with that. But it kept, it never went away afterward. And I woke up tired, like exhausted, so tired. I was like, I don't know how I'm going to make it through this day until I shook the sleep off for an hour or so. And then about once or twice a year, I would wake up and feel rested. And I thought, huh, that is weird. I think that's how it's supposed to feel all the time.
And so if that sounds familiar, go get a sleep study because you may be struggling with sleep apnea. You may be struggling with even narcolepsy. If you have autoimmune conditions, especially narcolepsy now is being understood as an autoimmune condition where there's a small number of cells in your brain that produce a chemical called orexin or it's also called hypocretin. And that helps promote wakefulness. And sometimes in people with autoimmune conditions, those cells get destroyed or some of them get destroyed. So it makes it more difficult to regulate sleep. And that might look like they have a hard time staying awake, or they may not get into as deep of sleep at night. And so they never feel rested. So just, if you're not feeling rested and you're in bed enough, just talk to your primary doctor or go see a sleep doctor about getting a sleep study just to make sure that you know what is going on. Because as Kendra mentioned, it affects so many things. We seem to care the most about our brains, especially we physicians, we definitely want to stay sharp. And if we want our memory to be good, if we want to avoid that MCI or Alzheimer's, we need to allow ourselves to get into that deep sleep so that we can, it's like your brain gets flushed, that glymphatic system. And they really have just discovered that not all that long ago is my understanding, like within the last decade or so, that they have seen the brain kind of flush itself out during this deep sleep. That is definitely a benefit we want to access as we get into deep sleep to get rid of those amyloid-beta and tau proteins. And who knows what else is in there that we don't know causes problems. We want to get all that nastiness out and have a fresh, clean brain. And our REM sleep really helps us with our brain growth and development. It helps us form new connections and process things that we've experienced during the day. It helps expand our neural network. It helps our procedural memory. So we definitely need that as we're continuing to practice medicine. And even as we move on past our medical practice, it helps us to process emotions and emotional memories and helps us to maintain our emotional equilibrium. And I think anyone who has had a bad night's sleep and then had some emotional upset the next day happen, you know how quick you are to either go to tears or go to an anger reaction. If we want to be our best, even-keeled, non-reactive selves, we're going to do our best to get good sleep, to help our brains take care of themselves. Adding to that, I highly suspect that the increased rate of suicide amongst physicians, you know, and if you think about physicians in training too, sleep deprivation has got to play a role in this because our impulse control is just, or we aren't always thinking straight, we are more emotionally reactive. And that all is kind of like laying down tinder for an explosion to happen should the wrong stressor come along. So we, in fact, we'll link
a podcast that we did previously about physician suicide and an amazing, amazing mom physician who this is exactly what happened. It's just, she went too long, not taking care of herself. Nobody knew what was happening, but she didn't get enough sleep and then had an episode where she felt publicly called out and that was it. And so we don't want to do that. We want to take care of our brains so we feel good every day, but can prevent catastrophe or, heaven forbid, a car accident or who knows what else could happen if we are not completely on our mental game.
Kendra Morrison (23:26.107)
I would say too, one of the things that Laura mentioned about, you know, maybe seeing if you're waking up and feeling tired too, there's also this thing called long sleep. We talked about the short sleep, less than six or seven hours, but long sleep, like if you're going to bed and it's like 10 or 11 hours and you're waking up fatigued, there's also something, that's an early red flag that even if you are getting in there and having long sleep, I think Dr. Peter Attia talks about that in his chapter too, about kind of noticing that if you are sleeping longer, requiring that 10 to 11 hours of sleep, that that would also be something worth investigating as well.
Laura Cazier (24:06.254)
Yeah, and even using the snooze button apparently is not good. It's going to make you more tired because you may have entered a new phase of sleep, and so you're going to feel tired all day long while your body is like, wait, where's my deep sleep? Where's my REM sleep? So I mean, it's wild. Snooze button is not our friend that we thought it was.
Amanda Dinsmore (24:11.502)
Yeah.
Amanda Dinsmore (24:29.006)
Yeah, don't play on the snooze button. I argue with my kids all the time. They set it for much earlier than they plan on getting out because they say they love hitting the snooze button, but you're never dropping into that deep or REM sleep. So you've probably just disrupted you. You know, you get more REM sleep in the early morning, and so what they've probably done is like set their alarm to disrupt when they were in REM sleep to then just be in light sleep for 10 more minutes. Like, that's defeating the purpose. So that was, yeah, we can link to Dr. Brown's episode with us too, the sleep specialist that we had on.
Laura Cazier (25:05.734)
That's a waste!
Kendra Morrison (25:07.451)
Right. Yeah. Yeah, it's.
Amanda Dinsmore (25:18.926)
Yeah, so just that was something like, ooh, yeah, I definitely have considered, I have enough time to hit the snooze button three times. So I just went into light sleep three times at the expense of deeper REM sleep. That doesn't make any sense.
Kendra Morrison (25:27.099)
Yeah. Yeah. All right.
Laura Cazier (25:29.71)
Right. Yeah.
Kendra Morrison (25:32.251)
Yeah, and for all of you that don't know, a sleep cycle is 90 minutes. Just to put that out there, like when we talk about these cycles, a full sleep cycle is 90 minutes. And so even if you're night shifters and you're thinking about like how much or how much should I sleep, you know, some, you know, I used to get frustrated thinking if I need to sleep eight hours at night, I need to sleep eight hours during the day while my night shifts. And that was like near impossible. But once I figured out a sleep cycle is 90 minutes, and I'm like, okay, if I get six hours or whatever, like I felt good. And some people do, you know, 90 minutes at a time. Some night shifters I know that will even do 90 minutes at a time, but just the awareness of that sometimes can help take that stress off of how much you feel like you need to sleep during the day when you're working against your normal circadian rhythm.
Amanda Dinsmore (26:20.584)
Yeah, so we can talk about some practicalities here. One of the things is to just, you probably have a general sense of your sleep chronotype, meaning like if you are a lark or a morning person versus a night owl. The good news is if that works for your lifestyle, you don't necessarily have to change that if you're getting adequate sleep with it. The problem is, at least my problem was being a night shift worker but then also being a mom with a husband who wakes up early. Like that didn't work to stay on my night owl routine when I still had to get up to take the kids to school and all that sort of stuff. So if it's working for you, we're saying you don't necessarily have to change it. So that's good to know. Kendra, you had recently read something. Is there anything more about that?
Kendra Morrison (27:13.179)
Just that sleep chronotype is what they talk about. And really you should lean into it more than try to be something you're not. So, you know, really working with it. Like if you, it's okay, like, you know, right. I identify as a night owl. And so I lean into those hours in the night and maybe it's just cause, you know, after the kids go to bed, like free, you know, and I can do whatever I need to. But I think even when I was in college and med school, I would tend to go to class, come home, take a nap and then study late afternoon into the wee hours. That was just my prime time. And so maybe, you know, I...
I feel like then when I met my husband and he's a type A surgeon and that one was a morning person and he's like, hey, you want to get up at 5:30? And I was like, no. And just the constant feeling like, I have to get up at 5:30. Well, no, I don't have to. But also just leaning into it instead of trying to change it or alter it or just be something you're not.
Amanda Dinsmore (28:15.438)
Yeah, and I would also mention too, like it's normal to wake up during the night. Like that is something like if you're stressing yourself out about that, the thing that wakes you up is not what's keeping you awake. I mean, in the medieval times, like there was a whole, like that was just kind of factored in. People would get up in the middle of the night, spend 30 minutes, I don't know what they were doing, and then go back to sleep. Like that's...
Laura Cazier (28:33.902)
Yeah.
Amanda Dinsmore (28:41.358)
That's also, it's not unusual to wake up, so don't freak yourself out if you wake up frequently during. Yeah. Yeah. Yeah. Yeah, exactly. Yeah, so just like doing some more investigation on what actually is normal, you'd be surprised that maybe you're doing it pretty well.
Kendra Morrison (28:45.979)
Yeah, they had to attend to the fire. You know, the fire kept them warm. So they had to wake up in the night and move those coals around and put a new log on the fire just so you didn't freeze to death.
Laura Cazier (28:49.582)
Yeah.
Amanda Dinsmore (29:07.598)
And you don't have to. Then if you think you're doing it badly, then that adds anxiety and I'm not gonna get enough sleep tonight and all that sort of stuff. How many times does that help you go back to sleep? Hardly ever. So I will just mention there is an app, CBT-I Coach app, which is cognitive behavioral therapy for insomnia, is well researched and very helpful. There's a coach app for it on your phone or whatever, and it talks about things like that. So that can be helpful to just be like, yeah, I can still, to not freak out that, I mean, we've just told you all these horrible things that are gonna happen to you if you don't get enough sleep. But if you have a night or two, you're gonna be okay, all right? It's more detrimental to sit there and think, well, here comes Alzheimer's, you know. I don't fall back asleep very well whenever I'm stressed out about that. Another thing,
Laura Cazier (29:55.886)
You're gonna be fine.
Kendra Morrison (30:02.875)
Go ahead and put me on the Aricept now.
Amanda Dinsmore (30:04.942)
I know. Yeah. The next thing is your sleep environment. So really important, especially if you're a night shifter, to get blackout shades. It's just really hard when there is bright sunshine flooding in your room. Your retina picks up on that. Like even if your eyelids are closed, you see the orange glow. Blackout shades are a godsend for night shift workers. Be careful if you have a clock that has bright LED lights blasting in your face. Those blue lights are the devil. They just shoot right in. It's noticed by your pineal gland, and it really does affect your melatonin production. So if, especially the hours before you go to bed, if you can limit your exposure to blue lights, like phones, screens, whatever. TV for whatever reason is not quite as bad, but it's still a light.
A thing that is so fascinating is a good practice is when the sun goes down outside, you can start dimming your lights inside too. To just kind of
the number one cure or the sleep medicine doctors that are integrated medicine thing was like, if you have insomnia, go camping. You don't have electricity. You don't have and like this happened to me one time. We had an ice storm back in the day and I consider myself a night owl. But when there was no electricity and nothing to do and it was pitch black outside, I could not keep my eyes open. I was like, my God, this is fascinating. I might not be a night owl. It might be that I am on my screens all night long. And I really like my screens, I don't know. But just something interesting like, yeah, exactly. So really do notice trying to limit your blue light exposure to mimic what's going on outside in your homes too. I mean, because for millennia, we did not have lights that you could just flip a switch. And so our brains probably have not evolutionarily caught up with that. Notice your sleep environment. Try not to have lights blasting in your face. And then the temperature of your room, there really are suggestions that colder, like somewhere between the 65 to 68-degree range is probably ideal for sleep. I mean, whatever works for you. Like if you tell me you can't sleep unless it's 75 degrees, well, then I'm not going to argue with you. But if you're looking for something for most people, 65 to 68 degrees. Also, there is some, you know, there's something about dropping your body temperature that helps keeping the room clean. I mean, keeping the room clean. Well, that does help too, because then you don't have the mental clutter. But that's not what I'm talking about. Keeping the room cold helps. But if you took a hot bath or did a sauna or something like that, do not exercise right before bed. That keeps you hot too long. But if you did something like that and then dropped your body temperature, that's helpful. Here's, no one's going to like this. I personally, how many of us have a nightcap? Like you get the kids to bed, you pour yourself a glass of wine, watch Real Housewives, just me? Okay, whatever. Well, turns out that was the worst thing that I could do because alcohol and caffeine right before bed, the metabolites, like it prevent, unconscious is not the same as sleeping. Okay? Unfortunately. You can be unconscious, but your sleep is not that restorative kind of sleep that you want.
And then for people who really struggle with insomnia, you may not want to take a nap because you do need, there's a sweet balance between, it's called sleep pressure. How sleepy you are, you want to be sleepy when you get in bed. So don't get in bed before you're sleepy. That's step one. If you're sitting there tossing and turning and fretting and ruminating, a lot of people will have you get up out of bed and go do something that you don't get dopamine from. So like sit in a corner with nothing to do with the lights off. That sort of thing they're talking about when you get out of bed so that your brain doesn't learn that you get a nice reward. We get to go watch more TV whenever we don't sleep well at night. Our brains are sneaky like that. So it just gets a boring, not very exciting reward. It will eventually learn like I don't get a big dopamine payout when I keep us awake at night. And then, so,
So if you're having trouble falling asleep at night, maybe a nap isn't the most ideal for you. If you can take a nap and fall asleep, great. Well, then fantastic. But that'd be something to talk with your sleep specialist or your doctor about. I guess I should say that we are doctors, but not your doctor. And so all of these sorts of things are just educational purposes. Always talk with your doctor and the people that know you better. Number the next one. You cannot beat exercise for so many things that have to do with our well-being and our longevity and our health. Moving 30 minutes a day, if you are not, can make a tremendous difference in your sleep hygiene. So consider that. If you can move outside during the day, even better. If you can move outside early morning, getting that first light, there's something about the light spilling in from the horizon going into your retina that helps you regulate your circadian rhythm. And my understanding is they even do that, you know, getting that light, they even do that with stuff like narcolepsy. Yes, Laura? Okay.
Laura Cazier (36:07.758)
Yeah, yeah, they recommend blue light therapy for narcolepsy. But not at bedtime. That would be when you're trying to be wakeful. Yeah.
Amanda Dinsmore (36:13.87)
So if you need to stay awake, blue light, yeah, but bedtime blue light's not good. Yeah, and that's getting out in the early morning for a walk gets you that blue light regulation. It teaches your brain like this is when we should be awake and there are different set times. Set times for going to sleep that your brain has and set times for waking up. And they're two separate things. So it doesn't matter sometimes how sleepy you are. You might tend to wake up at the same time. So that's why you can't be like, well, I'll just catch up the next day. It's two separate things. So that's something to keep in mind. So that's kind of some tips. I can't think of any more right now. If somebody else has some.
Kendra Morrison (37:00.475)
Yeah, so that's what we talk about. Amanda was saying, think of it as two separate things, but also when you're going to bed, we talk about a sleep routine. And one of the first things that we kind of ask when we're in a coaching session or we're teaching is, what are you doing to promote wakefulness? So what are you actually kind of doing to sabotage your bedtime? And then what are you doing right before bed to promote sleepiness or to promote sleep? And so that's something that is kind of eye-opening for a lot of our clients because some of these things that you're doing right before bed actually promote wakefulness. And so we've talked about a few of these during this podcast, but I don't know, Laura and Amanda, if you have examples. I know one of the things I recognized was, you know, getting into a conversation that might be, you know, emotionally charged or emotionally involved, triggering, whatever. You know, either with my spouse and we'd hold it till the end of the evening because kids were in bed, but it was also right before bedtime sometimes or maybe, you know, my 18-year-old daughter, she had some drama and I would talk to her in her room right before bed.
Amanda Dinsmore (37:58.606)
Triggering. Yeah.
Kendra Morrison (38:14.907)
And then I wouldn't sleep for two or three days. I'm like, what is happening? You know, just that even acute situational stressor was promoting wakefulness or was promoting anxiety and stress and not allowing me to get into that deep sleep. And so that was a real awakening. I'm like, okay, I can't really engage, you know, the Jerry Springer show right before bed. Like I need to, I need to do a little something else to like actually chill. And so that might be something for having a conversation or you choose to speak with a family member, sometimes your spouse, you know, right before bed, that's probably going to promote wakefulness and not promote sleep.
Laura Cazier (38:53.422)
The Headspace app, if you like, I love that app. They have a lot of good sleep meditations on there and some really lovely ones where you're at the beach or you're in the woods. There are some really nice ones to help you go to sleep. And then they actually have some for if you wake up in the middle of the night or if you wake up in pain, those are great tools to kind of add to your sleep arsenal of what you're doing to try and get yourself the best sleep.
Amanda Dinsmore (39:28.526)
People also, I haven't checked it out, but people also rave about Matthew McConaughey reading you a bedtime story on Calm, on the Calm app. So that's also, I can imagine that that would be a nice soothing bedtime story. Yeah, there's help out there, that's all I'm saying. Find something that works for you, it's out there.
Kendra Morrison (39:35.067)
I don't know. Yeah. Yeah, exactly.
Laura Cazier (39:35.982)
Ha ha.
Laura Cazier (39:47.694)
Yes.
Kendra Morrison (39:49.499)
Well, thank you so much for joining us today. If anything, we've inspired you to just even look at your bedtime or sleep routine. And if you can even make one change tonight or tomorrow night or whenever you get back on days versus nights for all your shift workers and just kind of examine what you are doing and maybe if there isn't anything you can immediately do to promote sleep, maybe not do something that's promoting wakefulness. Maybe that's the easier step is to take something away that you recognize is actually promoting wakefulness. So think about it. And we are excited because we are having a webinar come up. It is back by popular demand. So join us on June 20th for "What's the ICD-10 Code for Injuries Sustained in a Dumpster Fire?" It's a very good time. We have a lot of fun with it and we call out your normal. So we're all in this together and we are going to show you how you can feel better stat. So join us on June 20th for that exciting free class.
Laura Cazier (40:58.574)
So those of you listening, if this podcast has helped you at all—and we know from talking to so many of you that it has—we ask you, please just take a couple of minutes. Might even just take you one minute and scroll down. Give us a five-star rating. Give us a review so that other doctors can find us. We just want to be able to reach as many doctors as we can to help them with the things that we're teaching and help them not feel so alone. And we need your help to be able to do that. And obviously share it with your friends. If you have friends who are looking for something good to help lift them up, you know, we're here and we would really appreciate that. Thank you so much for being willing to do that for us.
Kendra Morrison (41:57.915)
And always until next time, you are whole, you are a gift to medicine, and the work you do matters.
