Episode Transcript
[00:00:00] Speaker A: Foreign.
[00:00:10] Speaker B: Welcome back to part two of our series on sleep. Sarah, are you awake?
[00:00:17] Speaker A: I'm awake and ready to go. Caffeinated and everything.
[00:00:20] Speaker B: Awesome. Let's dive in.
But maybe you could talk about, you know, up until about 20 years ago, not everybody had these cell phones, right? And smartphones, and now they're an integral part of our lives. And it seems like it's a. They're a big problem when it comes to a lot of things, including sleeping well. And it's a new thing that's been introduced to civilization that, you know, we never had before that becomes a huge impediment to winding down and going to sleep.
Maybe talk about what are some strategies, because we all have them, we all look at them and we know we probably shouldn't be when we want to get ready to go to sleep at night.
[00:01:13] Speaker A: Yeah, yeah, absolutely. Great point. Sleep hygienists for years have been telling us to turn off the television. And then we turn off the television and we roll over and grab our cell phone. So now it's a new problem. And honestly, it' another glowing rectangle, right? Any kind of light wakes us up and it can interrupt with our circadian rhythm. And your circadian rhythm is essentially your body's pattern of when it releases melatonin and when you get sleepy. And I commonly compare ourselves to birds. If you ever put a blanket over a bird in a cage, right, like a parakeet, they'll. They'll go to sleep. They think it's nighttime and they'll go to sleep. We're kind of the same, except we're not going to walk around with blankets over our heads. And so I hope not.
And so what happens instead is we need to help set ourselves up. I know that summer can be really hard for a lot of people when the sun is still up at 8pm and so some of the important things is you need to get away from this light. And unfortunately, our devices are, you know, just so handy. And a lot of times it's good intentions. Individuals will tell me, I picked up my phone to set my alarm and then I noticed I got a text and. And then I needed to respond to this. And then right next thing you know, they end up on social media doom scrolling for an hour and they lose track of time. And the truth of the matter is a lot of these apps are designed to activate the reward pathway so that you don't put your phone down. They're designed to essentially be a little addictive. And the truth of the matter is, is you need to be very mindful of that. So I like to use technology in a way that it can be helpful because I don't think it's completely harmful. And I also think it's unrealistic for me to tell you to lock in a box three rooms over and don't touch it, because even I don't do that. And I'm not a complete hypocrite. And so a couple of things that I recommend. One is be mindful of the time and start unplugging mentally. And by doing so, that also means you plug in things into chargers and putting them kind of away. Try to at least be away From a device 30 minutes before bedtime so that you're not being exposed to light. Some hygienists for sleep will tell you even two hours before.
I find that really hard for a lot of my patients. So a lot of times I'll tell them, you know, it's okay for you to, whatever it is, maybe they're watching cat videos, maybe they're watching baking videos, whatever it is that makes them happy. But to be mindful of the time and go ahead and use the timer. There are now phones and devices that have things like a sleep timer, sleep mode. It activates at a certain time, it stops turning, it stops giving you certain alerts. So I encourage people to play with their settings. Let's go ahead and use this technology to our advantage. That was the reason we bought it in the first place, wasn't it? And so using that can be really helpful. The other thing that I really encourage is keeping it face down. Because even in the middle of the night, you'll get certain things being pushed to you, certain ads, and I'll have a lot of patients tell me, you know, I woke up in middle of the night for just a couple minutes. I adjusted my pillow, my back kind of hurts, but then I saw a text and then that wakes me up.
And so I encourage you don't have it right next to your. Right next to your head. Try to get a little arm's reach or even further if you can.
[00:04:21] Speaker B: Some people say keep it in a different room when you're sleeping.
[00:04:24] Speaker A: Ideally you would, but I know so many individuals who have, you know, college age kids or elderly parents, and they'll tell me, I can't in the event of emergency. That's the phone they're calling and I don't want to miss it. So I understand that if you can. I do encourage that if you can't, at least not within arm's Reach, make it a little bit of an effort. I even say that of alarm clocks. I don't want your alarm clock on your nightstand staring at you. Because what you do is you wake up and you look at your alarm clock and then you start doing that backwards sleep math of if I hurry up and fall asleep right now, maybe I can still get three more hours of sleep and then total, I'll have five hours of sleep and then I won't be right. And you start doing that. Don't do that. Oh yeah, yeah, right, the backwards sleep math, we're not doing that. So I do encourage people to turn their alarm clock away so it's not staring at them like, like a ticking time bump. I want cell phones face down. I want them at the very, you know, arm's distance. At least, you know, I understand again, emergencies, but do that and turn off as many alerts as you possibly can, putting it into sleep mode and for yourself as part of your sleep bedtime routine, don't have that be one of the last items you do. Right? And so because I do get a lot of patients who tell me, well, the evening is when I watch the news and sometimes the news can be really upsetting as we mentioned. And so I'll encourage them, you know, can you, I'm like, I'll encourage them, like can you record the 5 o' clock news and watch it at 7? You know, if you, if there isn't a 7 o' clock news that you like, I'll encourage them to watch it because I don't want that to be the 10 o' clock news or the 11 o' clock news and then they try to go to sleep that sometimes can be really, you know, aggravating and upsetting, not to mention another glowing light. And so being mindful of your bedtime routine for, for 30 minutes before bed, not to include any glowing screens. And you can still use technology and perhaps instead it's a white noise machine, perhaps you're using sleep meditation.
There are so many other ways. I have patients who might, you know, read scripture or certain self help books, things that are really positive and, and enjoyable for them before they go to sleep. They might read it on a Kindle or an iPad or whatever the case may be. And so just being mindful of that because that still is a glowing screen.
[00:06:32] Speaker B: And I think consistency is really important, right?
Having find your routine, find your optimal bedtime, your optimum wake up time and stick to it as much as you can. Obviously you can't do it every night, but Being consistent with your patterns keeps your sleep cycle consistently good in most cases and becomes, you know, a really important part of getting that under control.
[00:07:03] Speaker A: Oh, absolutely. And in regards to your sleep pattern, I usually encourage my patients not to sleep in on the weekends. And if they absolutely must sleep in because they'll tell me, I'm going to a family wedding, we're going to, you know, it's a different coast, my sleep time is going to be thrown off. I encourage them not more than an hour, because otherwise I'm like, what kind of internal jet lag are you creating in your body? It is just going to completely throw you off because maybe you're going only for a day and then you come back and now your sleep's totally thrown off, or you do that for a weekend and then what happens? Sunday night is, well, Sunday morning you slept in, it's throwing you off. And Sunday night, now you're stressed out because you're not as tired because your sleep pattern got thrown off, but now you're worried about the work week ahead. So Sunday night is, like, notorious for individuals having lousy sleep. But one of the things is, you know, even if you have weird work schedules, to try to keep that even on the weekends is so important. And then the other thing too is, you know, go ahead and set up your, your bedroom in your home for success.
That's the other thing too. If your household is loud and you're trying to go to bed early, you know, have a conversation with your loved ones, see what you can do for your bedroom. You know, sleep hygiene and the, the things that you do to your, to your setting is so critical and so important and makes a lot of difference as well.
So I'm curious.
Go ahead, Go ahead.
[00:08:31] Speaker B: I was going to say, what are a couple tips for setting up the bedroom?
[00:08:36] Speaker A: So, a few things. I always recommend taking a look at how much light your bedroom gets, and not just during the day, but at night, because oftentimes our eyes adjust.
And so all the little glowing lights, and I'm talking about as little as the little light on the surge protector that's behind the dresser. You can see that when you're, when you're, when you get up at night, we want it as dark as possible.
And so we do have a lot of patients who get up in the middle of the night to use the restroom or, you know, maybe they need to do some stretches or whatever it is. So I usually encourage to have some kind of, like, soft night light accessible that they can turn on if they need to. But. But otherwise the light disrupts your sleep pattern. And so you want your room as dark as possible. That includes things like blackout curtains. And I do like black electrical tape on the things that have, you know, sensors and lights, you know, air purifiers. Maybe you have a humidifier that has a light sensor on, blocking all of those.
Some of them now even have night mode where you can turn off the screen so you don't see that on your air purifier, which I appreciate, or turn them away.
I encourage patients to put a dark cloth, like a dark sock over their alarm clock so they can't see the light at night. I am not a fan of the alarm clocks that project onto your ceiling. I think those are horrible.
[00:09:56] Speaker B: Right.
[00:09:56] Speaker A: Why would you just stare out? You know, it's 2:00am I can't sleep. Thanks for reminding me. It's the last thing I want.
[00:10:03] Speaker B: Oh, my goodness.
[00:10:04] Speaker A: Yeah. So definitely dark, dark room as much as you possibly can. The other item is a cool room.
And I know as we're going into summer, that can be kind of tough. Some homes don't have air conditioners, things like that. I do encourage looking into a window unit if you can afford it. You know, lots of fans. You want your room to be cool. And what they have found is 68 degrees is ideal. And I do get a lot of patients, especially with chronic pain, will tell me that's too cold for them. And one of the reasons we want it to be colder is that if your body warms up later, you won't wake up in sweat. And we have found that to be true even for infants. They sleep better in a cold room.
And I do encourage a lot of blankets and layers. So that way, if you do get cold or you do get hot, you have the layers accessible. I don't want you to get up and have to go find them. So that's another thing that has been very helpful as well as I want air circulating.
So if you're able to have an air purifier or a. I know a lot of individuals with allergies will sleep with air purifiers or humidifiers or a fan because you don't want your room to get stale because that also makes it right warm and stuffy. And some individuals will wake up from that. Not everybody lives in a place where they feel safe that they can open a window. But if you can, you know, on the nicer evenings, go ahead and open the window a little bit, that's another option as well. However, we also want to make sure there's no outside light coming in through that window or noise. And then noise is the other setting that I always, you know, encourage individuals to think about. You know, you might have other individuals in the household that have lead feet, right? And you're like, what are they doing? And so what you can do, as much as, you know, we want to snap at them to be quiet, is also control what you can. And that includes things like a white noise machine. And there's all sorts of research about white noise. And honestly, whether it be white noise, brown noise, I. I don't care. Anything that muffles the sound has been really, really helpful. And there are a lot of apps that you can download that just do a white noise. So you don't even have to buy a machine if you want to try this out tonight. And it will just play throughout the night. And it helps muffle the noise so that you don't hear anything else. I've had some individuals love nature sounds, which is great. I caution about anything that has water sounds, right? Waterfalls, in case you have to go to the bathroom a lot. That's not fun. But you want to try to buffer that noise. And then also, I do have some patients who will sleep with some earplugs. I'm not A fan of AirPods in your ears overnight just because of the damage it can do to your eardrums all night long. Not to mention it structurally can get uncomfortable if you're sleeping on your side. But I do like soft earplugs if you need that. And then, last but not least, another inexpensive way to kind of like manage all this is an eye mask. And they do have eye masks that have extra cushion around the orbit of the eye so it doesn't put pressure on the eye. Because I do get some patients who don't like that pressure directly on their eyes. And that's another way to kind of like create a blackout room even when you're traveling, because you may not have blackout curtains at, you know, wherever you're staying. But an easy way is to set yourself up for success regardless of where you are to your environment.
Making it cool, making it quiet, making it dark. And then have your sleep hygiene tools with you, right? Your bedtime routine, your soothing book, maybe it's a podcast, whatever it might be with you and ready to go is so important.
And so I'm curious, Peter, are there things that you do during the day that helps your sleep?
[00:13:30] Speaker B: Well, I was also gonna say sometimes in the summer, you know, we like to sleep with the window open, and then a skunk will walk outside and all of a sudden you'll start to smell it and then we all jump up and shut all the windows. But I, I would, you know, kind of to your point, I think our sleep hygiene and preparing for a good night's sleep actually can start when you first wake up in the morning. And it seems like it's really important to start training your circadian rhythms right away.
A lot of people advocate for getting some movement in, you know, whether it's exercise or some sort of movement activities as a way of getting the body and the mind to be alert and awake. And, you know, the, to get, you know, that's the time when the cortisol levels go up, the body temperature starts to go up.
And also this is a hard one for a lot of us, you know, who, you know, we get up, we get ready for work, we go to work, we work indoors. If we work indoors, not getting enough sunlight, you know, in the morning and in the middle of the day to kind of train your brain, you know, in the way it's processing things, that this is daytime, this is the time to be awake. And that kind of sets you up for the cycle of, you know, later in the evening when things start to get dark, but that's the time to go to sleep.
So ways that we can get ourselves as much sunlight as we can, you know, during the early part of the day, it seems like it's important, but it seems like it can be hard to do depending on where we live, what climates we live in, where we work, you know, those types of things. So I always try to make a point of trying to catch a little bit of sunshine whenever possible.
So that, that seems to be, you know, another thing that we can do during the day to help us sleep better at night.
I think the other thing, you know, that we, we maybe didn't mention that I'm sure you talk to patients a lot about too, is our caffeine use. Right. And whether it's coffee, tea, soda, energy drinks. There's a long half life to caffeine and we probably shouldn't be drinking it after about noontime. Right.
[00:15:47] Speaker A: Would you say there's actually some research that says 10am Which.
Yes. Which I even, I'm not good about that one. So, yeah, it has a very long half life. And a lot of individuals will be like, but it doesn't faze me. I don't feel it. Well, it doesn't necessarily give you energy.
It blocks your melatonin of being produced at night. And so being aware of that, I think, is so important. And I'm. And I think it's important to what you just pointed out, which is caffeine isn't a lot of things. A lot of times individuals just think coffee, but it's the teas, the sodas, so many energy drinks, even some migraine medication. And so being mindful of that. Now, of course, if you need it for a migraine, that's a whole different story. I'd rather you treat that migraine. Right.
But just being mindful of that. Right.
[00:16:36] Speaker B: Chocolate's a hard one.
[00:16:38] Speaker A: Yes, chocolate is. Absolutely. And you think about, right. What we want to eat at night, we want sweets. And oftentimes that's a combination of. Right. Caffeine and sugar. So less than ideal. Another thing to avoid is alcohol. Alcohol breaks down into sugars. And so if you have a lot of sleep issues, being mindful of your alcohol consumption, not only does it. Right. Break down into sugar and give you energy when you're sleeping, it can wake you up, but it also dehydrates you. And for a lot of our patients with chronic pain, they might be struggling with dehydration as well. So that definitely something else to avoid. And another stimulant that I encourage a lot of individuals to avoid is nicotine. And now with all the vaping and the flavored ones and everything like that, be mindful of that. It's going to impact your sleep.
And, you know, again, a lot of times I get patients who are like, well, it didn't impact my. My sleep for years. And I'm like, yeah, but you're not bulletproof.
Right. And as we age, our sensitivity to sleep, and maybe now your body's also trying to manage sleep with chronic pain, be a little kinder to it, set it up for success. And so making replacements is the easiest way to change a behavior. So instead of, you know, cutting out, you know, the. The chocolate at bedtime. Right. Maybe you replace it with, right. Some. Some fruit where that sugar does not get broken down the same way. Right. And some chamomile tea. Right. There are ways that we can make substitutions without feeling deprived. Um, and I think that's so important. So I'm curious about, you know, some of the things that you do during the day that helps you, Peter, what helps you to set yourself up for success for sleep?
[00:18:13] Speaker B: Well, definitely getting some exercise seems to be really important.
And interestingly, I think I like to exercise early in the morning usually.
And I think that sets me up for feeling tired at the end of the day. And you know, there's different types of exercise and certainly I've noticed that anytime I do more high intensity workouts, you know, early in the day, I usually feel more sleepy at nighttime. You know, I, I've, I've noticed that. But I think any type of exercise seems to help.
Also for me I, I've definitely noticed that how much I eat and when I eat dinner really matters and you know, anytime like I have more than probably I should eat at dinner time and I feel like maybe too full afterwards, that seems to really interfere with my sleep. And I think the body's trying to metabolize and digest all that food which just revs up your metabolism, revs up your temperature and, and it's definitely not good. So I think downsizing the meals as best you can at dinner time, giving yourself at least a few hours between dinner and bedtime, I think really important for me.
And I, you know, I try not to drink caffeinated anything you know, after, in my case after lunchtime. But those are some things that I find helpful. And I also thought maybe we should say a few things about supplements like melatonin and medications that people might take or thinking about asking their doctors about. Any thoughts there?
[00:19:57] Speaker A: That's a great question.
I think that it your path back to wellness with a good sleep is not going to be.
I can't even get my words out today. All right, let me try that again. I think the journey to good sleep looks unique for everybody. For some individuals that may include medication that's okay. Have that conversation with your provider. I think that's so important to have. There's a lot of over the counter items, right. We see the Tylenol PMs, the Advil PMs which essentially is diphenhydramine or Benadryl added to it. We also see melatonin. Research is actually showing that melatonin less is more.
There's also some concern about using too much of it in the older population. So these are conversations to have their providers do. I think that sometimes using it for a short term to help an individual build up their pattern can be helpful. Absolutely. And I do have some patients who need to follow up with, with a physician or even a psychiatrist because sometimes they've already exhausted some of those lower levels and the sleep is just so stubborn. But there's a lot of also safe non habit forming sleep aids available and you need to talk to your doctor about that and see if one is appropriate for you. And Many of them have been around for like 70 years.
Some of them even used to be antidepressants. And we found they were mediocre antidepressants, but they were really good at making patients sleepy. And so those became off label sleep aids that a lot of people tolerate well. But again, it's a unique journey and so I think it can be helpful. I also want to point out to be mindful of some of the bedtime teas, you know, the, the, the, the sleep teams or the sleep teas that sometimes have added not just herbs, but sometimes they also add. I've seen some that have added things like melatonin to it. So just be mindful of it because I think sometimes if you're not reading the back or the fine print, you may not be aware of it. I've seen valerian root be added to some of these teas as well. And so they can be helpful. But if you're taking a supplement as well as the tea, be mindful of the dosage, of course, and oftentimes, you know, individuals, individuals might even be struggling with, you know, horrible nightmares and night terrors. And there are actually some sleep medications that can even help with that. And so it's worth talking to with a physician or more specifically if you need to, to a psychiatrist. It can be helpful. But I also encourage you to take the power of changing your environment, changing your thought pattern and changing what you do on a daily basis. I love that you talked about the importance of exercise. And it's true. The more active you are during the day, you're going to be more tired and more likely to sleep better at night. So you want to get a little bit of activity even if you can't get a full workout. And ideally to do it earlier in the day because if you do it, if you do a major workout after dinner, what we find is it actively activates you, which is a shame because I know a lot of people work out at night. They're like, that's when my schedule allows. And so try to see what you can do to kind of flip flop some things in your schedule to get a workout earlier in the day if you, you can. But I am curious what your thoughts are about medications as well. Peter, is that a conversation that you often have with patients?
[00:23:12] Speaker B: Yes, it is a common conversation. I have, you know, some, you know, general opinions. Of course, everybody's situation, you know, is different and unique. But I think in general, you know, sleeping pills are not a good choice in most cases.
Typically they're FDA Approved only for short term use. They're not really meant to be used long term. So using them that way falls kind of outside of how they were invented to be used.
We see that there's a lot of long term potential risk that you can get with using them. You know, lower life expectancy, higher cancer rate, greater chance of sleepwalking, you name it, all kinds of weird things.
[00:24:00] Speaker A: Yes.
[00:24:00] Speaker B: Yeah, dementia.
So there can be some problematic things that come up with long term use.
But you know, there are times where maybe that's what's what's needed for that particular person's situation.
I should point out, I thought it was interesting. I was at a conference recently and one of the presentations was looking at sleep and talking about medications.
And one medication that we use a lot in treating chronic pain, particularly chronic nerve pain, is gabapentin.
And interestingly, gabapentin did well in some studies that were presented in, you know, with nighttime use in improving sleep cycles and, you know, sleep patterns, which, you know, since a lot of patients do try gabapentin, it might be something to think about, you know, if you're having a hard time, you know, sleeping at night. Of course, anything that we talk about, it's always good to ask your doctor who knows you and your particular needs and, and, and medical condition.
And these are just some, some ideas that were we're throwing out there. But that's, you know, I always try to encourage patients to try to avoid medicating for sleep as much as possible, but recognize that, you know, there are times where, you know, we'll, we'll try things to see if overall quality of life gets better. And you know, it's, it's not black and white, you know, so.
[00:25:27] Speaker A: Yeah, and oftentimes I find the patients may need the sleep medication short term while they're working through their stress or developing a good sleep pattern, sleep hygiene, everything like that. And then they taper off the medication too. So that's something else to kind of keep in mind. And I agree with you the, there's more and more research coming out and a lot of these medications are meant to be short term use, not, not chronic. And so it's just an additional tool in your toolbox. Hopefully you won't need it as much as some of these other tools that you can do behaviorally on a daily basis.
Anything else to add before we wrap up today, Peter?
[00:26:01] Speaker B: I think I'm going to have a good night's sleep tonight.
[00:26:04] Speaker A: I really do.
[00:26:06] Speaker B: How about you, Sarah?
[00:26:07] Speaker A: Because this conversation was exhausting. No I agree with you. I think also whenever we bring it up to the forefront of our minds, right. It is important that even as healthcare providers that everybody takes of care care of their sleep. Even if you don't have a sleep issue, let's keep it that way. Let's make sure you're getting a good quality rest so that we can show up our best and give our body the chance that it needs to heal and recover every day. So a hundred percent. Yeah. Lots of good stuff today. Thank you for everyone who has tuned in and listened on the Comeback with Boomerang Healthcare. We're grateful to have you here. If you've enjoyed today's episode, be sure to subscribe so you never miss an update. You can follow us on social media for more tips, information and inspiration.
Until next time, keep moving forward. Your Comeback is just getting started.
