City of Cupertino, CA Cupertino Library Wellness Series, 28 Jul 2019

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From YouTube: Wellness: Why Sleep?

Description

Rafael Pelayo, MD is a clinical professor at Stanford University School of Medicine in the division of Sleep Medicine. In this video, Dr. Pelayo presents an informative talk on the current knowledge about sleep, what can go wrong, and how to fix it.

This video presentation is part of the Cupertino Library's and Cupertino Library Foundation's on-going Wellness Series, and was recorded July 28, 2019 at the Cupertino Community Hall.

A

Good afternoon and welcome to today's wellness program, my name is Claire for SEO I'm. The community librarian at Cupertino library were very pleased to be able to bring this wellness series to you and I hope you enjoy. Today's talk, Cupertino Library Foundation is our partner for this series, and I would like to welcome up Gopal Coomer Robin, who would like to give a few words about Cupertino library foundation,.

B

Thank You, Claire and I know it's a two o'clock and we didn't know that you're in deep sleep already after a nice lunch, but we thought no, it's, okay. You will come back and because to hear from our speaker so again my name is Gopal I'm, one of the board members of the Cupertino library foundation, one of the key things the foundation does partnering with the library, is to bring this kind of a wellness series to make sure that we bring awareness, doesn't matter what level of our education of our age level.

B

But we simply take it. Many things for granted, including the sleep. So we wanted to make sure that we bring it and and even myself included, I don't get enough sleep, but we have our own excuses either it's work or what not. So how do we really take a take away from the excuses and still get back into a good sleep and as Claire mentioned and after that, you will follow the dreams I was looking into it may be at the end of this session.

B

The our speaker will make you all have a nice sleep, and then you will start dreaming as well. So again we have a Henry here, both president as well from CLF, so we all partner mainly to make sure that we bring awareness like education. The health is so important at the pressure-filled situation, especially in the bay area, especially here I know how busy we are all so I really want to make sure that you take advantage of this session and then I'll hand out back to you Claire, to introduce the speaker. Thank you.

A

Thank You Gopal: you can learn more about our library Foundation at their website. Cupertino Library, Foundation org. Today's speaker is dr. Rafael Pillai Oh, dr. Pillai. Oh, is a clinical professor at Stanford, University, School of Medicine and the division of sleep medicine. His focus is the treatment of sleep disorders in patients of all ages. He was recently elected president of the California sleep Society, and in 2019 was appointed to serve on the board of the National Sleep Foundation. He currently teaches the Stanford University sleep and dreams undergraduate course, alongside dr. William DeMint.

A

Please join me in welcoming dr. Palais. Oh.

C

Thank you very much guys. Thank you, Claire. Thank you to the foundation for colleges met. You appreciate it. It's really nice here, I've never been to this library. Really nice I, like libraries, just nice places to be, and we should be lucky. We have them. You guys have a nice one here. Can you hear me? Okay? Is it coming out to Soph I'm, not sure it's coming out in the back? You guys just sit in the back for a reason, though, plenty of seats out front, but it's okay.

C

You can talk it's a little bit different because the screens on the side here so I can kind of I. Guess then here I'll stand right here, then we'll do it this way it's Sunday afternoon! This is your time when they first of I me to speak. Those people show up at something afternoon two lectures here. It goes yeah they do well. There's a wireless mic. I could do that so before I start I want to respect your time. Can just shout out a little bit come.

C

What is it you guys want me to cover the first time was ever invited to speak somewhere. I spoke with two hours and 45 minutes, so I don't want to do that to you guys today. So anything particularly you guys, hoping that I discuss or not discuss wanted me to bring up yes, ma'am deep sleep, yes, sleep better, yes and the further back.

C

What what chocolate and sleep you mean sleeping in chocolate, bathe in chocolate sounds yummy. Is that what you meant? You know, I've done. Thousands of talks nobody's ever asked me to talk about chocolate and sleep you're. The first ones ever to ask me that so I'm gonna think about you. So I'll have to come up something on chocolate and sleep. Yes, sir and Sammy we're gonna talk about sign right over in the beginning, I like the topic up in Simon, just sewed off with sir, whether we sleep at all. That's that's actual.

C

What got me in the field? Yes, we'll go over! That too happening dementia, okay, we're gonna the way I set up my slides for you guys and we don't need two slides at all, but I was going to talk a little bit of insomnia and sleep. Apnea is two main topics, but we can switch around to whatever you guys feel comfortable with. Yes, sir I'll turn it on sleep. Okay, yes, sir, for who it depends how's, it feel to you feels good six hours as we get older. Maybe six hours is enough for some people.

C

Well, it wouldn't be okay. If you were 15 years old, there won't be enough if you're 10 years old. So it's not a relative yeah, yeah bookie. Ladies yes, you you know, parents often ask how many hours should my child sleep and what I think what you really want to know is how many hours can you be away from your child? That's what I think you're really after, because it's the only chance we get to buy lifestyles before we were adults right before we were parents. Only chance again is when the kids are sleeping.

C

So I've said that many times and if it's a group of adults with parents, they say haha if I say that to a group of teenagers, they stare me blankly. They can't comprehend that you as a parent, don't want to be with them at all times. That's hard for them to understand this, because that's how we do things yeah. You had raise your hand.

C

See partnership we've talked about that or not I'm, sorry, okay, just one or two. Yes, you.

C

Seven days, you're gonna sleep a lot on the eighth day. That's what's gonna happen. Yes,.

C

ah Albers doesn't send yo the man who coined that phrase just passed away by the way about three weeks ago, dr. Jim, you know my friend and colleague, yes, I, see you waving. I, see you. Yes, it depends what the choices are. Our scene feels bad for you, okay, then it depends all right. So, let's just get on with this a little bit nothing's to go over. Hopefully you're, not gonna get bored. So these are the sleep as soon as we deal with why we sleep the best answer that we have.

C

Why we sleep is that it's actually restorative, it's something the body has to do. It's like asking whether we would breathe oxygen, whether we eat food. Basically, we have to sleep. The world's record for lack of sleep by the way is at 11 days very hard to do in the Guinness Book of World. Records no longer publishes that record because they do not want people to discourage him from doing it. And since you asked me the question, what's your name, Ryan says after the question I was thinking. You can look this up on YouTube they'll.

C

Let you use YouTube, sometimes yeah, there's a magician called David Blaine and David Blaine tried to do a publicity stunt he's not all these things where he he put himself in a block of ice. He starved himself. He did all these things. He tried to break the world's record for sleep deprivation and they wouldn't let him do it cuz. They thought it was too dangerous, but as a video of David Blaine, you don't do this at home, where he actually has a stunt where he gets shot in the mouth.

C

When he can, he catches the bullet with his teeth. That's your real thing. You guys can see so getting shot in the face is considered less dangerous than staying. Awake, apparently misses really really is true, so the record is 11 days and it's not clear whether that person really was awake Levin. He may have been sleeping a little bit in between, but sleep is restorative.

C

One of the earliest sleep scientists said: if sleep has no function, is the biggest mistake evolution ever made because think about why we do it right if we were to get together now we're in Silicon Valley. If I were to let you know that a Stanford, we got some research going on and we now have a medication available. Those gonna make you feel like you've slept eight hours, but you only need to see four. How many of you like would give it a try? Few of you have side effects right.

C

No, if you have anything like that, it doesn't exist. We can't really do that. You have to sleep if we could, if we could create something to replace our sleep, what would be the market for that? How much money would you make off that here in Silicon, Valley there's nobody! You know all kinds, a meetings going on people trying to raise money for all kinds of projects. Nobody trying to raise money to make a sleeping, robot literally make any sense right, it'll be ridiculous. To do this! It's an interesting idea.

C

We treat sleep by getting convenience and that's want you to think a little bit about this. What's the value of sleep in your lives, the research is showing more and more. That sleeping will help you feel better and as a wellness topic, there's really nothing will ever make. You feel better than a good night's sleep you're, not feeling of getting you've been traveling, but on the road getting back to your own bed, how nice that feels it feels good. It feels so good to get back to your bed.

C

Insomnia, I'll, always think better away from home. That's one of the features of insomnia. They sleep better away from home. Most of us be better in our own in our own beds, in our own homes, these are the sleep problems that we deal with I'm a physician I've been a Stanford now 26 years, taking care of patients full-time with sleep problems and there's dozens of different sleep disorders, but break it down mostly to different forms of insomnia, something with an S because of different forms of insomnia. We can talk a little about that.

C

We talk about sleep apnea, which is when people stop breathing when they sleep, CPAP needs kind of an interesting situation, because what happens in obstructive sleep apnea syndrome as the brain has to decide, is it better to sleep or breathe in the brain? Decides I'd rather sleep than breathe, and for a little while you keep sleeping, but you stop breathing, that's one point sleeping is the brain actually prefers breathing over sleeping in sleep apnea and a lot of you have some degree of it? How many of you snore?

C

How many of you know somebody who snores all of you come on right? How many of you been told by somebody that you snore yeah? Do you believe them? Yeah I mean every day at work. Somebody will show up and say my wife claims, I snore, and to this day the wives are batting. A thousand I've not had a single wife be wrong on this there's always always a true there's all kinds of couples in a relationship, but it typically is the guy snoring, more all kinds of situations.

C

Parasomnias is a fun topic. Nobody really asked to be about parasomnia, so we won't spend time on it. But parasites are the things that go bump in the night, sleepwalking sleepwalking sleep, terrors people acting out their dreams, violence and sleep alone, some medical legal cases, an expert Court cases where people have been charged with crimes and I've done expert work for both the prosecution and for the defense on this, and this matter restless leg syndrome. Nobody asks about it, but there's too many of us in this room not to have somebody with it.

C

Yes, you have it cool yeah, it's just creepy crawly feeling that's hard to describe urge to move you have it all, so it runs strongly in families by the way you have it's two, sir, runs strong and families. If you have it it's um it's. It's unlikely that you don't have some other relatives who have it also and in kids it's often manifested as growing pains. My training was in child neurology, so I did neurology and pediatrics just as a formative process to get into sleep.

C

Well, my focus always going to sleep restless legs, sometimes confuse with growing pains. You've got kids, who are growing pain issues. There may be restless legs or it gets worse in pregnancy, I've met women who say that they know they're pregnant cause. It likes it to bother them. That's when it starts to flare, and it often makes attention deficit disorder pretty much any of these sleep disorders will mimic a DD, the first symptom of not getting enough. Sleep is being inattentive and grumpy bigger.

C

Well, you guys know anybody who wakes up kind of irritable and hard time focusing that's typical for any sleep disorder. That's why they'll mimic EDD I, see it I see.

C

If you guys what well sleep it's okay, I, don't mind, it'd, be bad if I fall asleep, but some of you look jazzy to me already the other condition that we won't get into them, because I mean it applied. Much to this audience is narcolepsy. Narcolepsy is kind of an interesting disorder because our entire lives it's either the entire life. Our entire lives. You can summarize in the time either been awake. The time you've been dreaming or the time you've been sleeping, but I dreaming.

C

That's all we ever do either awake, we're dreaming or sleeping but I dreaming, and that's all we were done, we've been sleeping long and then we've been eating because babies sleep in utero but didn't eat hell after they're born. That's how long you've been sleeping so Norcliffe see what happens is the boundary between these three states awake world dreaming, world and sleeping, but not dreaming world get blurry, so they get sleepy in the daytime and they also can't sleep at night and they sometimes start dreaming while they're awake.

C

That's what narcolepsy is so it's a nice entry into the concept of. Why do we bother sleeping current ideas about why we sleep it's probably different for different animal in humans? We think has a metabolic process to it. That somehow is a cleansing of the brain to some ideas.

C

Now that these metabolites accumulate in the brain, these waste products coming to brain and that the flush out of our brains, when we're sleeping that's kind of a new your idea, it's only been about five or six years, it's an appealing idea and that everybody believes it, but the thought of, if their brains, electrical organ, the brains, electric, that if it's running all the time that there's some waste products that get accumulated, has it be flushed out, but that's only about the deep sleep.

C

This lady asks over about deep sleep and deep sleeps only about 10% of the night. So if that would sleep was all about in just that, we can get rid of 90% of our sleep and it's not gonna. Be that way at all. It's not that way at all. So there's more to it than that, and when people ask about deep sleep, it's what I've always sometimes wonder what you're really asking is: how can I get better quality sleep and that's what you really are asking?

C

It may not initially be just deep sleep because light sleep is important. Also in fact yes, ma'am.

C

Yeah because we're recording, let me repeat the question because they may not catch it. You want to know whether you thought those more health benefits to deeper sleep, I'm thinking about any specific sleep type or stage as more important than any others like saying which part of your transmission of your car is more important, which gear third gear or fourth gear. We think that the overall continuity of the process is what's important. The way we enter sleep, we talk about deep sleep, maybe 10% of the night dreaming sleep, twenty twenty five percent of the night.

C

The bulk of sleep is intermediate stage two. They call it or in two fifty six percent of night, but the type of sleep that's often never discussed. When you read about sleep people just kind of pass over quickly, Stage one sleep light sleep. What's the importance of that? It sounds like not important, but light sleep is how we enter our sleep and all have you seen light sleep, countless countless times, Stage one sleep go to any meeting any event the speaker's droning on and on. You wish you hadn't shown up, but oh my god.

C

What time is it? You know the clocks not not ticking fast enough you'll see somebody they were head nodding highs rolling.

C

If you ask that person, if you know June, what's the first thing, I say to you: I'm awake, I'm resting my eyes when you're in stage one sleep when your stage one sleep, you think you're awake when in fact you're asleep, so don't argue with anybody. If it tells you, oh I, think you're asleep, don't tell us all the time people say: oh people tell me I ask them: do you take a nap? No I, don't take a nap.

C

What I do after lunch, I, rest and yeah, but you're sleeping or family no, like he claims he's not asleep, but I can hear him snoring in light sleep stage, one you're actually sleeping, but you think you're awake so because of these people with insomnia, which we're gonna talk about a little more in a moment and sleep more than they realize you probably sleeping more than you realize, but it's not satisfying. It's very light sleep.

C

So these are the sources that we deal with myself, wouldn't sign a little bit. Why? Because in some is the most common sleep to sort of fight, not getting enough hours of sleep, but if you think of sleep just in hours, you're kind of missing it, because any sleep problem you can think of has four components to it. The amount of sleep clearly is important, but the quality of the sleep is just as important: I took care of a three-year-old, let's call him Eric and I.

C

Remember Eric, because when you talk to children they give you very clean history, so very pure, well how they speak to you. If they'll talk to you at all, usually like any patient, come in the door and I say why are you here and I ask Eric why here and usually little kids kind of hide behind the parent? So they say till the parents emerge him to talk for them because they don't want to talk to strangers and I'm a stranger but Eric. Looked me right in the eye and said doctor.

C

They said doctor doctor sleeping, makes me tired. Sixteen I never forget that sleeping makes me tired. That's what the three-year-old said the mother said. I don't know. What's wrong, he sleeps more than his friends. Some of his friends have stopped napping. He sleeps more than near the kids and he's always tired for Eric. It was in a the prom with Eric. Was he had big tonsils? He couldn't breathe that night, the more he slept, the more he was choking. The more tired he would get so sleeping did make him tired.

C

He once they open up his throat, his airway. Let him breathe more comfortably. Tiredness went away and he felt better, but sleeping should not make you tired. You should not wake up feeling tired if you work I feeling tired. Something is wrong right. You don't leave a nice restaurant from feeling hungry. Why should you get out of bed feeling tired? That makes no sense.

C

So, let's talk about insomnia, how do we fit chronic? You saw. How do we fix it? So the second most common sleep disorder other than not getting enough, is probably insomnia about 50% of you have insomnia or more as we get older. Its more common women have more in summary than men. A lot of men have insomnia, but it's much more common. In women, especially when, after menopause, we get a lot of insomnia.

C

These are these sleep stages.

C

We enter our sleep through this light, sleep Stage one. Then we kind of dip into our deepest sleep state, which is our Delta sleep. A lot of curious, worried things about sleep, it's sleeping as a paradox. Logic would be first not to sleep at all. Logic is first all we stay awake. If you hunt and gatherer you know, if you want to go capture your prey by simply capture praise, while it's sleeping with a top predator there's, an inherited leaderless sleeping sleeping animals can be attacked at any point.

C

So you think that the top part will be the angle to slept the least right or no matter how you think about these, a god evolution, natural selection, somewhere long denying some animal would not shown up. That did not need to sleep, but we all sleep yeah when you're sleeping you're, vulnerable being attacked. It turns out that all animals have made ways of protecting themselves, while they're sleeping and we're no exception.

C

We talk about how our brains are set up to protect us, while we're sleeping as we go along so turns out that humans are most alert about two hours before we fall asleep.

C

If sleep was just like gasoline, let's say just energy: that's all it was if it was like your cart, you guessing in your car when there's a carve the most amount of gas in it. When leaves the gas station, you should have right if sleep was like that, we should be fully alert as soon as we wake up in the morning. We're not. We have alertness but we're not asked full alertness. We had a little more awareness mid morning, then, without doing anything, we have a drop in our afternoon, no alertness, our predators.

C

Think back to our hunt see humans in the prehistoric times. That's when they're not around these are as hot as lions and the big cats they're not attacking. When did they come up? When did they get active at dusk? So what are humans most alert at dusk? All of us have a surge of alertness in the evening. It's built into our brains, so Cillian doesn't do that in your car. They got. The fuel gauge, doesn't like have less gas, the more gas than less gas or on its own.

C

It's linear, but sleep is not like that. We have our surge of alertness in the evening and after we had that surge of alertness, we fall asleep. We get our deepest sleep we can get. So we kind of like is the coast clear. Now we go deep, so our deepest sleep, our Delta sleep. The call is slow-wave.

C

Sleep is in that first third of the night, so we go from peak alertness to our deepest sleep in a very short period of time, and if we keep oscillating about every 90 minutes, but our every hour two hours about 90 minutes, we perco wake and make sure everything's. Okay and we go back to sleep. Nobody in this room has ever slept through the night. You never have. You never will. Okay. If we really slept through the night, wouldn't the lions and tigers know to eat us.

C

You know get us out of the cave or 3 o'clock in the morning. All humans open their eyes at night, several times, look around everything's. Ok, we go back to sleep, just stay awake and watch your partner sleep, you do it too right! Yes, you do it. Ok, you make sure everything's. Ok, look around go back to sleep. You only wait for a few seconds, but all of us wake up throughout the night and in fact, they've actually looked at this and pre-industrial tribes.

C

They've actually gone into rain forests and look at these communities, and they know that these people they've definitely put like little watches on them to record when they're awake and when they're asleep. If you look at a tribal them, they go to bed around the same time and they'll wake up around the same time.

C

They start today, but throughout the night, they're all sleeping at different times and somebody's awake through all times, and it's been speculated to the fact that when we're older or older grandmother, popping awake at night actually was good for the tribe good for us to be up there. Yes, sir.

C

You have notes, sir, you have a piece of paper: ok, cool.

C

I've actually just wrote about that. I just wrote about that topic. Claire was very kind to say. If I want to have any books for to bring in to you guys, I wrote a textbook for the course the course I teach a Stanford to have a textbook. It's called demesne leaping dreams and it's not Amazon but I. Think spec. You guys to buy a college textbook that wouldn't be fair, but I do have a book coming out.

C

Hopefully in January called the new rules of sleep and a section I put in at least in the giraffe thumbs into the publisher. I was gonna talk about dogs, I, don't know if they'll accept it or not we'll see. But it's interesting question is there any particular reason you asked that question at this moment you're curious about the dog. They just kind of.

C

Yeah, so dogs are the oldest colonized animal, the oldest domesticated animal. What dogs dogs compared to was the main difference is they have is a different hormone in their brain called oxytocin oxytocin is our love hormone? If you've ever knows of your mother's, when you're nursing are just secreted, it's how you bond actually toast is very powerful hormone. So love hormone and dogs have a different oxytocin than wolves do and in fact they think the best known examples of pure love was a mother for her child and play. Second, is adore for their owner.

C

All the oldest animal that we ever domesticated seems have been dogs. It goes free for our back and dog. Sleep is perfect, complementary to human sleep, because they're up at night, they watch over you and there's. Actually you can look this up, but some I think was on CNN or something look at my last name. I was quoted on somebody's. Did the research, but somebody asked me a question about it. So you'll see Pelayo dogs and sleep it'll pop up.

C

If you do a search, the accommodate turns out that women sleep better with dogs in the bedroom than men do, but not in the actual bed. This is padam buddies, actually studied this, that women sleep better with dogs in their room, not with cats. By the way cats were a whole different type of animal, but the dogs do it and I think. The fact is that the dogs are symbiotic to humans in the way they sleep.

C

Basically, throughout the night they don't they don't see well in the dark, I mean that we don't see well the dark. The dogs sleep better than we do so. I've always thought that perhaps this antagonism classically between cats and dogs may go back to our prehistoric times. The dog need to protect us when those big cats could have attacked us anyway. Thank you for the question. So anyway, she answers and you won't come. It.

C

Sure there is um what the Germans asking about is. There's a French word for this, which I can never get correct, but it means between sleeps that most of us, deep in spurts and in medieval times, and at least in French they would write about people who would go to sleep. Imagine you peasant or something you're working the field. You sleep the days now the night is cooler, you get up, get some work done and then you go back to sleep and cause segmented sleep.

C

If you read what segments need to discuss this issue, but it's not practical for our society now I mean it's hard enough to get people to sleep in a single trunk now filled in to spurts. Wait people do that a lot. A segment is sleep, so the issue and get back to this issue of insomnia is waking up is one thing. Waking up is normal.

C

What's what's the issue is if you have trouble going back to sleep people, obviously, to me my child wakes up every hour, I'm like Oh, congratulations, they're supposed to wake up every hour. That's good! Have a healthy child. No! No! No! The the problem is when the my kid goes to sleep again: I'm gonna, wake afterwards. I can get back to sleep afterwards. So the problem, your child, woke up with a problem that you can't get back to sleep yourself, so where's the problem. So we go through these different stages of sleep.

C

The bulk of sleep was gonna, be the same to mediate sleep and at the tail end of the night. The very tail at night is down it by our dreaming sleep. We're gonna have us electron dreams, dreams, one other things that fascinated me that got me into this field. Why we sleep, and why do we dream kind of curiosity about the science behind this, because any any hypothesis any ideas about why we dream get thrown out when we talk what certainly any ideas about why we sleep seem to get thrown out?

C

When we talk about dreaming when we're in a deep sleep, we actually have conserving energy or her base at its lowest point, we're breathing very slow. But when we're dreaming we actually consume more energy when we're dreaming our heart rates acelerate. If you have a sedentary lifestyle, Mabus have 70 V lifestyles. Your peak heart rate is when you're dreaming the biggest workout your heart gets is probably when you're dreaming. That's when it hits the highest point of the night and dreams dominate the last third of the night.

C

So it's right, no coincidence that that's also an heart attack seems to cluster heart attacks and strokes cluster in the early morning hours. That's also when we have the book of our dreaming sleep. If you think about it. For you to see me right now, I'm reflecting light onto the retina I mean reflecting light to back your eyes. But if you would have your dream, you know, god forbid, have a dream about me right. You got to create that image. It requires more energy to do that. So it's not just that simple.

C

It's actually a very strange thing that we do now current thinking. If we're going to hypothesize a little bit about this or some of the ideas is one of the things that we know about dreaming is they're hard to remember and that's something that's completely impossible for real, completely surreal. We accept as being true at that moment if half the things happen to you in a dream, happened to you in real life: you'd, never forget it. Yet these strange things happen.

C

Eternal games have to work to remember them, so there's a whole idea that dreams are a way of the brain processing, memories.

C

The the term REM sleep you've heard that that's when we were started with REM sleep, the term was coined rapid I believe was actually coined by dr. Dement, dr. William tomb and my friend and he's alive he's 90 years old he'll be 91 this month and if you ever want to meet him just he's lives on campus. You can meet him and he called the REM sleep simply because he didn't want to type out who's a true thinker, typist, and he didn't want to keep writing so.

C

He said REM and that's what he cared about was dreaming, so he called it REM and he didn't care about so much about the rest of sleep. He called the rest very kind of disrespectful. He actually in retrospect, non-rem, so 80% of the night he called non REM. It's not dreaming. Let's not, let's not focus on it, and now we know that that non REM is probably worried.

C

The bulk of this idea of memory and our brain health is happening as a non REM sleep, but the REM sleep is something he described in humans and they look back on it and found evidence later of cats.

C

Doing it went further back when I was started at my training, we thought that all mammals did it, except for the duckbill platypus in the kid now and now we know that the Kidner, which is endangered species in Australia's, actually has the most RAM of all them the mammals 50% of the time and just this week the cover of a journal called Nature has his really fish on it, and I was thinking about when I walked it.

C

When I saw the fish tank here, I thought about this beautiful fish tank, the cover of nature or me, one of the main site. If a journalist has these fish on it, parrot fish because they report it for the first time that fish now have REM sleep, also REM sleep people, it's hard to study the fish, because the NIEM have eyelids how they know if they awake or not. If you look at the fish tank, you'll see that they're still at certain times so now they have actually figured out a way to measure them.

C

They know that fish now have RAM so pushes back the evolutionary development of our rapidly moving sleep 450 million years. So it's very possible that the reason that the fish have REM be very different. The reason that we have REM play not the same thing and a question that often comes up we talk about dreaming is: do we have to dream? Is it essential in the way I've come to think of it?

C

If you ask a biologist, is dreaming essential, oh say: no, because some people can live the lies without dreaming right people can live the hospital dreaming. It's like asking a biologist is singing essential for life. We don't have to lot of us, don't sing right, but in our society we value singers very much, and certainly we value our dreams and society very much. When we talk about a good leader, somebody who knows what doing saying you know what is your vision and for you, kids out here and your young people out here?

C

How many times is somebody going to tell you some platitude so until you're saying we want you to follow your dreams, follow your mouth, you tell people weren't your follow your dreams headed all the time, follow your dreams and dreams actually dominate the last third of the night. Is this arrow showing up here and the cursor showing up?

C

It is thank you if you notice dreams happen in the last third of the night, mostly so, when kids don't get enough sleep, what are we cutting off their dreams or all this talk about following your dreams and we're not letting them dream we're cutting it off? We really thought we doing to them. We talk later one of the things I've been doing as community outreach from is. You may have heard about this idea of changing school start times.

C

I, don't know how you guys feel about that, but you may have heard this in the news. California might make, might be the first state in the nation to delay school start times for high school and middle school students, Public Schools, there's a there's, a groundswell of volunteers. Doing this and I've been one of the people. That's been helping with this, so I've gotten to go to Sacramento a couple of times whose testify I was there just a few weeks ago, testifying on behalf of this bill.

C

So if you have time we'll talk about that, not to politicize to talk, but it's something that's relevant what's happening, and why do we want to give our kids a greater chance to sleep? Yes, sir,.

C

Did the bill right now, SB 328? If you want to guys won't look it up is for it only establishes the floor. Says: middle school cannot start earlier than eight it'll start later, but can't start any earlier than eight in high schools cannot start any earlier than 8:30. That's just the floor. The school can can decide one and once you change it to later, it also gives schools three years because of school translation is just to implement it and it does not just does not stop people doing optional activities. 0 .

C

somebody wants a swim team or something else to do something. You can still do that, but the school cannot obligate a child can be sleep deprived right. If kid wants to go, the parents want to go earlier. That's okay, but you can't force the kids to do this and the reason is kids fall asleep a lot in class. We don't see elementary school kids falling asleep in class right any high school kids. Here anybody in high school, nobody any high school teachers here. So have you seen a kid fall asleep in class?

C

Yes, you think it's fall asleep. In class right did you tell the parents? No? No, no! No, if you're a parent and you kid fall asleep in class. Would you like to know you would like to know if your kids wanna keep in class, but the kids don't want you to do it? The kids? Don't want the parents to know and I asked the kids. Why? Because they're gonna take away our phones, the most common answer: they're scared and take away their phones. So anyway, this is sleep stages. Yes, sir.

C

Yes, I'll get on with it now. Thank you. If you really think of it, though, how can we be these eight hours sleeping mammals if you have to feed babies every two to four hours, unless you're, biologically built to avoid sleeping and not just women men? Do it also right and I'm using general turns out men and women, there's all kinds of combinations and and what you think about this, just in general terms, people in combat have to still be able to sleep right. Your life could be in danger.

C

You still must be able to sleep a little circumstances and if I asked any of you, your sleep needs your sleep desires. You know, give me two numbers and all of you right now have two numbers in your head. How much sleep you like to get it you'll say something like well I like to get eight I can go by with six I think at nine, but I can get by with seven and testing. You start you get by as little as possible in your mind as you go along so anyway.

C

Just another thing about sleep. Don't equate sleep medicine to sleep studies?

C

If you see a doctor and you tell your doctor, I'm tired, your doctors replies I'm, tired too. You seem too wrong. Doctor, okay, you really are. You should not be waking up. Tired sleep, medicine now is progress. A lot and most other patients I see get better, it's kind of a fun job. As physicians go. It's unusual. My vision is not to improve.

C

So if you're, not, if you're not happy with how you're sleeping and you've talked, you talked about and I getting the right answer and see a different doctor I'm serious about this there's, no reason you should not be sleeping well, I kind of made. This point already talked about the amount, the quality of this sleep. What else we need to know about somebody sleep, the timing of their sleep, my weekends, on weekdays, kids, do very unattractive in a lot on weekends. Little kids! Don't do that seven, eight year olds on Orion.

C

Are you sleeping in a weekends? A lot? Probably not, but your parents wish you would, but you don't right right, the kids just kind of wake up. That's a very thing: they do it's and it's because they're surprised they really are Monday through Friday. They don't get enough sleep, so they try to catch up on the weekends. We think oh yeah, of course, catching up. Of course, that was really doesn't make. Any sense biologically makes doesn't make any sense.

C

We don't starve our kids Monday through Friday, say: hey you're, not gonna, get no food Monday through Friday Saturday send it. You know you like cuz, I'm, starving you again starting Monday, but that's what we're doing to the kids right doesn't make any sense, but it's not just kids and weekends. So if your shift worker wouldn't know that, so we think about the Amana ste quality to sleep timing of asleep, well, anything's. The fourth thing that I want to know. If I want to valuate your sleep, what I know your state of mind?

C

How the what is sleeping mean to you not just what sleeping means to you is. What does being awake mean to you? Do you live to sleep sleep to live? What are you getting up for? Waking up is one thing getting out of bed? Is something different right? We wake up biologically we get out a bit volitionally. If I ask you all of you, why did you get up this morning when you got up? You all have the same answer, because I had to write I had to something got you out of bed, your first.

C

Don't you wake up this morning. Is what day is it? Okay, I, oh I can say conceived a little longer. It's just I think a little. What does this mean to you? We may have people who don't enjoy their work, who are dreading their day? Well, should we be surprised, I, don't sleep well if they don't enjoy what they're waking up to all right. Some people do not enough hours. In a day, some people just excited and just happy to do what they're doing so. I really want to know your state of mind.

C

What does sleeping mean to you all right? What is what are you sleeping for they need, for sleep is biological, but the way you sleep is learned, we've all been taught how to sleep. Don't believe me, it's easy to prove it's a lot like food. By the way, do you need for food is biological. What we eat is cultural. When you travel anywhere, you go in the world. You want to know about the food at that place right.

C

What's the food like there, you always want to know that or newborn babies drink milk five-year-olds throughout the world of different diets. The need for food is biological. Eat is cultural. All of you have been taught how to sleep easy to prove all of you have regular bed partners right. All of you who have regular bed partners. The first night you shared a bed with that person that you took a side.

C

The other person took aside from their folders, never ever discussed again my side, your side, never ever discuss when you travel, you go to you put the bags on the side that it's supposed to be right. If your partner is out of town and you dare cross over to their side, they view there's an invasion of privacy. You use my pillow last night. I can tell right they viewed it as a thing.

C

It's a crazy thing and I've learned that couples will only change sides when they're much older and they have an agreement among them that somebody's got to sleep closer to the bathroom and then when they travel that's when he switched sides just that one night, because they want to be close, the bathroom there and if you sleep alone, not believe me that sleeping is learned, easy to prove simply tonight, rotate your body a bit put your feet where your pillow belong and see how you feel you may even fall out of bed.

C

If you do that same bedroom, same mattress him, everything sleeping is a learned behavior. We have two. We teach our kids, how to sleep. We learn how to sleep. Yes,.

C

Almost deep apnea, then that mean normal uh-huh I.

C

Don't know what they'll do for you and I really can't talk about any of your any of your individual sleep issues right, but in general, so we know what to do. I thought that 4.9 is accurate or not maybe's 5.1 if we measure it again, wise five, their magic number anyway. How this come up, because the real issue is. Why did you have to sleep us to begin with yeah yeah? So it's not that something else. You need a different doctor.

C

Hopefully it's not me who so told you this no right, somebody else you saw okay, you might need a different doctor. You might need a different physician, maybe there's not that way at all. It'll get I think it depends what they might be talking about. There was something called cognitive, behavioral therapy, which is a form of treatment for insomnia. Where we teach you do you think differently about you, sleep and I'm, going to talk about that more as we go on I'll correlate to this issue. Yes, sir,.

C

Students, performance and sleep.

C

Did their studies for all ages all ages, showing that sleep is good for the brain all ages, including school performance? Oh, oh, all of them athletes now higher sleep coaches, because sleep enhances to perform their athletic performance. If we didn't have to sleep guys, you wouldn't do it. It's just not getting around the fact that we have to sleep. Nothing will make you feel better. So, yes, there is data showing this as several studies on this.

C

In fact, if you snore, if you have a child who snores in preschool quadruples quadruples risk of them being put on stimulants in the first grade, just four, they snore in preschool.

C

Yes, there is data on this also because the kids, who sleep more, have better quality sleep, get better grades and the kids who sleep less I'm, more impulsive, higher suicide tendencies. We'll talk a little more about that. There's a serious stuff here guys. So let me first tip is different.

C

So what's it like living on Arkansas Mia, if you don't sleep well, what's it like to live your life, not knowing whether you'll sleep or not, I want you think about your life a little bit what your life would be like if food was unpredictable to you? What? If, when you woke up some days, there's lots of food. You woke up some days. There's no food! You just don't know some day, there's a lot something there isn't any all day long. You can think about the food you make right.

C

We learn to anticipate our meals right. You know, Thanksgiving is coming. You may eat a little bit less that day, you're gonna go to a big meal, so your favorite restaurant. You have a lighter meal, you're gonna visit somebody who you don't trust the food at their house. You make sure you eat before you get there. You don't want to go that house hungry right. We anticipate our meals because we we predict we're gonna get our meals. What a sleep was like that?

C

What if he did not know what am I gonna sleep well or not tonight some nights are horrible. Some nights aren't so bad. Do I, take a pill or not take a pill. Do I take half a pill. Do it take two pills? What if I run out of refills, maybe leave a pill here by the bits and casing it for later those pills are addicting that could be a problem but I need it.

C

I need my sleep every night, not after night week week in week out the typical chronic insomnia minimum is three months duration, the people that come to see us in the clinic 15 to 20 years of insomnia of suffering with their sleep, not of time who had decades and decades of poor sleep. One thing you know if they you have insomnia, is your bed partner, sleeps, pretty well insomniac, still asleep with other inside mix in their bed?

C

You can't put up with each other if you're, if your bed partner has insomnia, you actually don't want to sleep with that person, because you don't be the focus of their ire in the morning when they're upset that didn't sleep well last night, unless people, because if you you, don't want that so people often end up in separate bedrooms. Because of this insomnia can sleep another insomniac any couple you mean one of you, sleeps lighter than the other early on the relationship. You know that one of you sleeps, lighter than the other.

C

Well, it always seems a little bit deeper one of these, a little more sleep and over time, the difference being the couple gets, bigger and bigger and bigger and I think the change in women couples really happens when they become parents, because if you know you the deep sleeper, if you hear the baby cry, you open your eyes and you quickly slam them shut and pretend you're sleeping on weight. You do this. Yes, oh guilty. Yes, he did it. Okay, yeah. They pretend that I, don't think a lot of people do this.

C

They hear the kid cry and they slap and they wait and they pretend they're sleeping away. The other one knows that the one that's labeled designated a light sleeper and in the relation this guy's not getting up. I'm gonna go take care of the problem and they sleep even lighter and the lighter you sleep.

C

That means you gonna watch over this other person, because, if sleeping is dangerous, if you have somebody sleeps, like it's light next to you that lets you sleep even deeper somebody's gonna break into the house till I sleep, it's gonna here at first. If you have a light sleeper next. Next to you, it allows you to sleep even deeper in different, gets more marked over the years and I've seen couples where they've changed partners and they actually switch roles.

C

Well, I sleep when I becomes a deep sleeper, they switch roles because the other person changed the situation, but we sleep depending on how the other person sleeps so I like to think about how a family sleeps not just an individual but how the entire family sleeps, because the one person doesn't sleep alone, impacts entire family right, the thought of sleeping awake, you, a lot of famous people, have had poor sleep lots of them. You know if you've got a chronic insomnia pattern.

C

If you simply answer one question, if you find that you're drowsy, you sleepy when you in the living room with a kitchen with some other part of the house, you're falling asleep, watching the TV set- and you say no- no come to the bedroom. When you get to the bed wide awake, that's chronic insomnia, the thought of sleeping wakes.

C

You up, you become now conditioned to sleeping poorly there which, by the way, if you go to any nice hotels, you'll see that every night, if you guys go to a high-end hotel, you'll see they sell the mattresses right who buys matches in hotels insomniacs. That's us buying them, because inside makes me better away from home. Usually if you anywhere around here, mattresses anywhere you go matches are always on sale. What's on TV at 3 o'clock in the morning, mattress commercials pillow commercials, who are they for they're for insomniacs.

C

They be marketed directly to them and they sleep better away from home because they don't have that negative conditioning to them. So usually you buy your The Bachelor part of you have at your home right now. You probably bought on sale, they're, always on sale. The worst mattress he ever got garage sale, don't buy those. In fact, it's up lease against the law to buy used mattress as a reason, they're used right, mostly guest rooms, have the worst mattresses in some places they use mattress.

C

But if you finally get a good night's sleep, this having stress in the sleep lab, if you come through the sleep table, some of you've had sounds like sleep studies but wise in your head and sensors. Everywhere. Cameras are on you, you're strangers all around you're watching you, sleep, people say hey what kind of mattress that you have, because they seem so much better they're, because they're away from the environment.

C

So that's how people end up buying matches in hotels, I think it's because they've come conditioned to this and it's never on sale at the hotel. It's full price right, there's no deals there. A lot of famous people have insomnia, insomnia, thinkers condition, people who don't think don't really get insomnia. It's a thinkers condition this. How we explain insomnia if you understand how this develops then you'll understand how to fix it.

C

huh For thinking that everybody in this room at some point is, has the ability to push off sleep, you could be perfectly sleeping, just fine somebody, yells fire, you're gonna get up and you should be able to wake up sleeping if you think about it, is very different than being awake, but must also be an inherit rigueur, rapidly, reversible, very different biology sneaking than awake, but you must get out of sleep super fast, it's very fast. Yes, sir.

C

They'll be part of a lot of hormones involved in sleep, not just adrenaline lot of them. Cortisol is actually important to sleep, but hopefully not every time you wake up, you're shot out of a cannon. Sometimes you wake up Jillian and you know look over this beautiful person. Next to you and you're in love and you're happy. Not every awakening is a crisis right right does. That has to be that way, but the point being that sleep has to be reversible right. Has he rapidly reversible? So there's something called the arousal threshold.

C

At what point will you stay awake? What will get you out of sleep, the arousal threshold and some of us have more than others right I. Personally, don't sleep well, I, see very well in general, but I, don't sleep well, I have to catch an early morning, flight and I'm at a staying away from out of town and early and not catching the morning. Flight I want to miss my flight, I'm gonna trust at the wicket. The wake up call up my phone. You know that's when I, don't sleep.

C

I may pop awake before the alarm clock. So there's an insomnia, Tennessee state of mind, and some of us are more predisposed to than others.

C

Well, studies show that your biological, gender, being a woman, makes you more prone to insomnia than men about two to one little kids. Having sign me just as much as each of the boys and girls, no difference teenage girls more in summer than teenage boys. In fact, in society, teenage girls get a lot less deep in teenage boys thought to be more a problem, among them certain personality types.

C

If you're a perfectionist, they're more logical, you are guys and should a must be some of you here, the more analytical you are, the more perfectionist you are, the more like, you'd screw up your sleep. You got to be a thinker to get insomnia because you try to fix the problem. Gonna fix up by being awake. The right approach to mostly problems is counterintuitive. If you apply logic to a sleep problem, gonna get screwed, it doesn't work that way.

C

You cannot apply logic to a sleep problem, because logic, let's say, is: if I can sleep I should rest. The rest thing is sleeping on two very different things biologically. If we got up in two hundred, jumping jacks you're gonna feel tired, but you lacked in the feel sleepy so sleeping in tiredness may converge or diverge. Then wanna litical, you are the more likely to screw up your sleep. I. Have lots of my patients are here from Silicon Valley that a lot of them are I.

C

Have a ton of engineers I take care of we're analytical people very smart people, very sophisticated people, the more they screw it up. Logic is if I I'll wake up depending on the time I slept if I trouble sleeping, then one should I wake up whenever I wake up, but that's not how it works, because their brain is trying to predict dawn and dusk.

C

So if you have a variable wake-up time, you mess up you're following a sleep time again, you can't apply logic to sleep that way, so some people are more Clinton sunnier than others. Some of us some sugar comes along. It could be anything good news, bad news anything can trigger bottom insomnia. Most of us, the the bottom insomnia past I mean the the trigger passes and we sleep better again. For example, let me assume that all of you live in nice homes, nice neighborhoods and you like you know, and you like your neighbors.

C

Let's assume that you, like you, never see good people, you, like your neighbors, we ask it was they're, not nice people. They were power to me. They're good people, my neighbors one night, you're woken up, cuz neighbours to a party. You hear the laughter hear the noise. They woke. You up, put you guys down. You go back to sleep next morning. You see a neighbor, they say: hey, I'm! Sorry, we bothered you last night had some friends over here, but not soaked. A little white lie. No big deal, that's fine!

C

You know you're gonna, sleep better, the next night you'll catch up, but imagine your neighbors to our second party and a third party, the fourth the first time they wake you up. Now they go. How come these bastards? Never let me do the parties what's going on here. How come I can't go to their parties? Who do they think they are they disrespecting me? So it's no longer it's no longer. The noise is what the noise represents right. You see this lot of time.

C

People goes I, can't sleep, because my spouse, snores now I, know people I'm from New York people sleep next to all kinds of noise in New York, but it's not the noises that one's represents. If you really cared about me, you know it bothers me. You don't take care of your snoring. I told you before you don't know anything about it. It's not just a noise. What the noise represents. It's not just that! So what drives the insomnia? What makes it continue is not what triggered it is.

C

What drives it and usually drive it as a misconceptions about sleep. Let's imagine. You've had several nights of bad sleep, many nights that bad sleep and all of a sudden one morning you wake up and go gee I slept well last night. What was better about last night? What was different about last night, you go, you kill self, you know, last name is actually quieter than usual. That's nice, actually, really quite I. Just need a good pair of earplugs. You go to the store, get the most expensive set of earplugs.

C

You can find right, put on earplugs and eight to eight family members. Don't make any noise tonight I'm putting in my earplugs I'm checking out, and you sleep better that night excellent. Now you convince yourself that you need quiet is sleep, but when you put in your earplugs it's harder to hear and you never adjust your root cause even sauna. To begin with, the insomnia will come back. You know you like. Now you need a special device.

C

Now you need our machines better earplugs and you get more more conditioned and one of the sayings we have there's a long. We've had insomnia the weirder, it gets the more conditions you'll have. If you live with an insomniac, they have a list of things that they need to have in order to sleep in the stillness thinking that well and the bed partner says whatever I'll sleep on there any circumstances you want right. So what we try to do when we take care of our patients is not change the predisposition.

C

We can't change that and we can't change the trigger. We don't have a time machine. We figure out what's driving insomnia, what things the use. Where are true about your won't sleep that are actually wrong and that's called condom Evo therapy about teaching you how to sleep that may be and what they meant when they said that to you, we figure out what is the biological factors behind this, but also we can figure out. What do you swear? It's true about your sleep.

C

That may not actually be true, for example, if you can, if you having trouble sleeping it's logical to go to bed earlier, so you can fall asleep. People with insomnia talk a certain way. They're only insomniac talk a lot. Nobody else talks the way they do. They say things like I try to go to sleep. Nobody else says that everybody says I go to sleep.

C

If you're trying to go to sleep, you got to stay awake to do that, so you can't do it that way, you don't try to get hungry you're, not trying to breathe if you're trying to breathe. Something is wrong right. So you're not that you shouldn't be trying to sleep. You should be going to bed when you're, sleepy, right and think about when you spend. When you go to bed, you go to bed to sleep.

C

Are you waiting to bet you like for it to kick in and we may have something in the back of this and a lot of times you hear where younger people, they say things like extra, will falling asleep I'm, not staying asleep most people. Our age group have trouble staying asleep doc I'm in trouble. Staying asleep.

C

If you really talk for them about how they fall asleep, they have trouble falling asleep that their masking so the reading a book until falls out of the hand or they have a TV or something in the background or there's a podcast. They just kind of block out their thoughts, and then they pop awake. If you really believe the most dangerous thing you can do is sleep, then, if you think anything is wrong, the brain is going to avoid sleeping as much as it can. Sleep is seasonal people.

C

Your field got friends in Alaska, but totally they sleep more in the winter less in the summer right. So, let's just imagine at any given day you have 10 things to do and you get eight of them done. You had a fantastic day. You got eight out of ten things done, but the two that you forgot when you're gonna remember for most of us, how much I think a moment I think about your own life right now right when you, along with your thoughts when doing nothing, but thinking don't think about wellness.

C

What are you doing nothing by thinking when you alone your thoughts for most of us on time, where long with our thoughts is were in bed? Cocoa know people said I'm alone, when I'm driving I'm alone. My thoughts, no you're, not you're, driving when you're doing nothing. But thinking probably was not an atypical thing to do in the past now rarely to spend time just thinking. When are you alone to thoughts most people when they're in bed another giving the body mixed signals?

C

I want to sleep, but I also have things to think about, and that's when you start to lay in bed and you arm flinches on you thinks jerk on you and you're falling into the bed. You found that feeling it's because you're giving your body mixed signals, you're, saying I want to sleep I'm in bed, but I want to stay awake because I got things to think about. So if I've got ten things and I only got it done, that's pretty good. I forgot you gonna, be gonna. Remember during the night, I mean you're gonna.

C

Remember your fall asleep, but if you still go to sleep and just crash people use that term crouch right I stayed awake until I crashed little kids, don't do that. They don't crash right. You mention a little kid. Oh yeah I just crash. You think! That's that's not good right!

C

Think. Do they think this with me? Okay,.

C

The they need for sleep is, but is biological right, but the way sleep is a learned component right, your sleep and realities of reflection of your life and you like to reflect in the way you sleep. It goes in both directions. Your life is reflected in your sleep is sleep as a reflection of your life. It goes on Motorz. You have to think about the kind of life you have and what's going on with, you think why you sleep?

C

Who do you think that the best keepers in society, if you think about all age groups, who are best sleepers, think about all think about your whole life, guys from your time you're born to now babies? You don't really want to sleep like a baby or not being continent. I mean I sleep pretty well, but don't sleep that great to sleep only an hour an hour an hour or so at a time. Maybe sleep pretty good, but not that well, teenagers. Are we a real positive sleep?

C

Our best sleepers are actually eight a nine year old. You know if I asked a group of teenagers with the best deepers they'll, say the elderly all right. It's a very interesting. It's always somebody else. It's not me! Here's what you're saying I know it's not I'm, not doing it all right best, sleepers.

C

If you think that, if you think about this, this simple truth that your life you're in your sleep and you sleep, reflection in your life think about the tip of life of a typical, eight or nine yo person and I want you think about your own lives. How you doing this think about typical eight or nine your person coming off school? huh Maybe he has to do some homework, yeah, a right, good, perfect, you're, sleeping well, oh cool!

C

Are you sleeping? Well, you come home from school. Maybe have a snack have to do some homework. You think it's a lot, but it's not really that much, but you think it's a lot right right. So when you're 8 or 9 years old, you finish your homework.

C

You have dinner what time you finish. Homework have dinner. It's too late to go outside, not a bunch of little kids like Ryan running around the streets. At night, there hang in there inside the house to spending time with the family when you're, 8 or 9 years old. You have a set bedtime. Your parents still tuck you and you have to go to bed.

C

4 &, 5, girls, fight their bedtime, Eden annuals know they have to go to the room, parent, stop by the room, sink another I love you when you're, eight or nine years old. Somebody wakes you up in time to go to school clothes. They laid out for you when you're, eight or nine years old do not worry about the mortgage or the rent safety, the house, it's all taken care of for you, you pop awake.

C

When you're, eight or nine years old, you run around all day full of energy when you're, eight or nine years old you go to bed feeling safe, comfortable and loved. You have serenity. Do most of you go to bed feeling that your days done, you finish with all your work, you're, not right. Let's just imagine all of you right now. You're with your bed partner, it's a perfect night for sleeping everything is just right perfectly. Everything is just right: you're in bed. You bought that your thoughts of sleep and you turn to partner go honey.

C

Did you lock your front door? You turn off the stove and your partner says to you I. Think so. What's gonna happen, you gonna make your partner get up and go check. You're gonna get up and go check or, as you about to get up and check your partner says to you. You worry too much. You did this every night, I'm pretty sure it turned off the stove I'm, almost positive, a lot, the front door. If you lay the long enough, what's gonna happen, you will fall asleep.

C

You cannot deny the biological drive to sleep after. If you are, is you're, gonna fall, asleep, you'll always fall asleep, but after three or four hours you know pop awake and go check the front door and go check the stove right. There's a difference between being safe and feeling safe. You get up and see the stove was turned off and the door was locked. Everything was fine, but you couldn't sleep, you can't the complete opposite thing.

C

You can fall asleep sleep through the night, wake up, refresh the birds singing when you go and look in your friend, your house, the front door was left wide, open, wasn't even locked, not even forget, lock was just left open right, you weren't safe, but you thought you were so your state of mind dominates all these things, so we got think a little approach. You think about these things. That's why the current way of thinking of insomnia we no longer rely much a medication.

C

We now are using more arm behavior treatments, so sleeping pills can be used for the original medications. The oldest things you ever had were love, potions and sleeping pills. We think back to the history of early early herbs and things people prepared there for sleeping right. I thought there was the same stuff for both situations. I bet right, but it goes back and right. mmm The guidelines are from the Academy. This is the is a professional journal for us in the medicine journal of clinical sieve medicine and they found that as weak evidence.

C

For most leading pills to work and not saying they're bad we're not saying that, isn't that a black and white situation they're just tools, but the science to show that they were that they are effective, is weak melatonin. By the way, if you look over somebody else about melatonin, specifically, the American Academy of Sleep Medicine, specifically states that melatonin not been found to have evidence that it works. Last thing it doesn't.

C

Work is saying when we say evidence that means that you've done the proper research study well, you've taken a population of people, randomized control, trial and somebody's blinded, and you give them and see if it's has an effect when that has been done, has not been shown to work. But the evidence is weak is nothing doesn't work saying it evidence is weak. Everything you give somebody for sleeping will work to some degree, because part of sleeping is a psychological hyper-vigilance to it. So everything will work for a while.

C

In fact, if you actually look at any sleeping product that you have anything that's for sleep, they always compare the side effects to placebo you'll notice that every one of those tables the placebo has side effects. Always the people on placebo get hangovers.

C

So if you feel like hangover a sleeping pill yeah, maybe we all hang on for the pill but know that the placebo group or also gets a hangover, because if you not slept well for awhile, when you take anything for your sleep, you sleep, deeper, you're gonna feel a little fuzzy in the morning at first it takes a few days, so a lot of people say well I'm a little scared. This pillow I'm not going to take it and then I only take it for one day one morning, I felt bad I'm, stopping it.

C

I knew this was bad. Just you gotta give it a few days to really see when it's for real, what's happening. Even the placebo group has side effects for all these sleeping pills, all of them.

C

So knowing this, the push has now been to take a different direction. So, for the last three or four years, the the current thinking and now that we understand what in Siamese about this, this hyper vigilance is sleeping. Now, we've got to teach you how to sleep better and cognitive. Behavioral therapy is predicated on the concept that people behave a certain way because they think a certain way and that you're asleep, if you have insomnia in part in part, there's gonna, be a component of something you've, not yeah, something you think is true.

C

That's actually not true about your own sleep and we got to give you the right information, and if you give the right information, then you think differently, which will let you behave differently. You know gradually, over several weeks, we need about two months little snowball in your favor. We can't get you better in two or three days, if you even sleeping horribly for years- and you come see one of us and we say what to do and the next day you sleep great, that's good, but you're also surprised by this.

C

The next night you go well if it doesn't work this time. The novelty of sleeping well has to wear off before you're nearly there as long as your prize you're, getting a good night's sleep you're, not there. Yet people who sleep well are not surprised that they slept well. They just know they sleep well right, it's not a surprise to them. So take a little while to get rid of that.

C

So there's CBT available and it's available throughout the Bay Area, where whoever you are seeing for your primary care, your physicians, you can ask a lot CBT to somebody doing it in your community. There has to be pretty much every medical system in the Bay Area has this now I wasn't like this five years ago, but now it's established just a way to go. These are some of the ideas behind it. One of the ideas behind this in other ways to make you sleep better, is have you spend less time in bed?

C

Let's see you normally go to bed at 10 o'clock at night, you get up at 6 o'clock in the morning. That's 8 hours of sleep but you're only getting four or five hours of sleep, not you've, heard something similar in your lives. Ok, if you're spending 8 hours in bed to get 5 hours of sleep, that's actually inefficient.

C

So people say what can I take. What can I do? What we actually have you do is go to bed later, because what we try to do is say: ask somebody what's: what's what's legend, do you want to have? Well, you go to bed at 10 o'clock, you're getting up at 6 and they say doc, I like to be on a 10 to 6 schedule. Ok, great!

C

Let's keep the six o'clock fixed, you're good, at staying awake lock in the wake-up time and I see now you're gonna go to bed at midnight later bedtime people say the same thing every time they say can't stay up that late. But, yes, you can't have insomnia. You can stay up later. You can do it. Ok, you can do it stay up later. The idea behind this is, if you go, spend less time in bed. Initially, the body will reject it.

C

By later the body will sleep deeper, going to deeper sleep, it's like lifting weights, I, don't lift weights because I get sore, no no work it properly and your muscles will adapt to it same thing with sleep. We first thing we wanna do is somebody sleeping very choppy 2 hours here not only happened, two hours there. First, we crunch in the single block, and then we stretch it out.

C

People argue well. There's a natural I said this choppy sleep, everything that I talked to you about you're, always gonna, say, but it doesn't apply to me. That's ok, not all of you have insomnia right. If you don't have diabetes, have chocolate cake for breakfast. Enjoy it it's a question as do. If you have a problem with your sleep, how can we get you out of it into data? Is the good news folks is about two-thirds to 80% of people who learn to do this?

C

Stop taking medications, whether they're sleep and no longer think of this I'm having insomnia in about two months? So if somebody's been suffering for condition for 20 years- and we tell you in two months- we're gonna get you better. Maybe it's worthwhile, giving it a shot. The data is there to support this.

C

Okay how'd they get kisses fall asleep in our lab. We tell them to stay. Awake, stay awake, go ahead. Some of you know. You know this stay awake, just stay away from me, fall asleep! There's my sleep! Apnea athle is just a Greek word. That means without air we're reading a little bit of time, so I want to move along, and this is based somebody who this is a pause in somebody's breathing. These are brainwaves. This is REM sleep and then this line is the air coming out.

C

Oops air is not moving, but the chest is trying to make an effort to breathe, so they throat is blocked. Nobody here should ever snore. All snoring is abnormal right now, listen to yourself, who's snoring, thankfully nobody yet! Oh, no, sir! Thank you. Volunteering, no I meant at this moment right. Thank you, sir. No, at this moment, nobody's snoring right breathing is silent. If you believe that sleeping is inherently dangerous, would you snip off your presence to predators by making noise I've? Had patients? Tell me? Oh, no snoring chases away the wild animals? Really?

C

No, it's a dinner bell. That's what it is! Nothing in the wild snores snoring. What means is a turbulent airflow. It is not normal to snore, it is common, but it's not normal. You may have a cold occasional, something like that. You should not be snoring a regular basis, especially not normal for your kids to snore. It's a real problem.

C

The original description, sleep apnea by the way, wasn't children, Charles, Dickens and that I'm sure the books in the library here, The, Pickwick Papers mr. Pickwick, is for middle-aged overweight man chasing his hat and no dad this guy, probably snored a ton, but what Dickens was describing as somebody who was sleepy and overweight was a boy named Joe up here and on the box out of fat and red-faced boy. Instead of someone see despite this commotion, it was something that was a comedic figure in the book. The snoring kid I was not too bright.

C

It was a comedic figure, been like this for a long time. These are kids and orphanages and in schools. What is the stereotype of somebody who's? Not smart. We want to make fun of somebody who we don't think is bright. We go duh mouth-breather, yes, yes, ma'am. Yes, what we do duh turns out a long time ago. People noticed that mouth breathers weren't smart and what happens is if he knows this block, you can't get action to your brain and your brain doesn't develop properly and if he knows, is blocked.

C

Normally we can tell who snores in the room you just push. You all play along right now, the biggest thing in our throats, the throw being a space when you adam's apple' to the back your nose. The biggest thing in our throats is our tongue that takes up the most space.

C

Normally the tongue she fit into the roof or your mouth like the Hammond glove tongue is wet, move the mouth lose weight stays together. We on your back, it's just a in place because being held in place, but if, instead, when you were a child when you're little, because we've seen overweight, sleep, apnea people for in the beginning, but we see a whole bunch of skinny people asleep.

C

At me, too, a lot of women with with were thin, who don't have the magic cut off a five, and we come up with other terms like upper resistance syndrome to describe situation. Somebody who is having difficulty breathing but doesn't have quite have these apnea to the same degree, because somebody happening means you stop breathing. But there's some people who are gonna have fragmentation of their sleep choppy sleep before they start breathing. Just when the increased work of breathing is enough to make you tired for some people.

C

So the tongue is the biggest thing holding up space, taking up space in our throats and should stay in position, but if, instead as a child as a little kid 3, 4 5 years old, you step with the mouth open. Yet allergies didn't take out your tonsils for whatever reason something happened and now you've been sleeping as a little kid like this.

C

If use the growth hormone by the way that make sure bones get longer it secreted in our sleep, we're not growing all the time, we're actually growing in our sleep, that's when the linking of the bones occurs. So if you're sleeping like this, your facebook girl, like that you have more vertical growth. That's what they're showing you here. You can look us up online, the double on your phones, this idea of having a long face or long face in dramatic face- and this was described a long time ago by people who are just observing.

C

This saying think people who have faces in this shape are less smart than the other people, and it's kind of this whole idea being slack-jawed didn't do as well in school. This was actually been shown and just seeing all these kids who are mouth beating, kids don't do as well right. If you look at these photos, they don't look bright. Something to think about this, so your cells right now don't show a lot of smart people in the room.

C

But if they do very a few when your mouth is closed, is a very tip of your tongue, touches your teeth, but not the roof of your mouth. You probably are a tendency to snore when your mouth is closed. The tip of your tongue should hit the roof of your mouth. She'd, not be touching your teeth at all.

C

If you're sleeping with your tongue out of position, there's gonna be an issue and if you're this long elongation of your face, the jaw won't be lining up correctly, with with your upper jaw and you're gonna need braces needed teeth taken out. All kinds of things will happen because you have this facial elongation, that's what we're looking for. This was a death certificate 1977.

C

If somebody who died from sleep, apnea, I'm gonna, skip over this a little bit too morbid that was used to be the treatment putting on a sleep apnea you people can't breathe well, while they're sleeping and what happens is, if you're being choked your heart rates. Gonna go up. Your blood pressure is gonna, go up, sleep apnea is worse when you're dreaming, that's when the muscles are most relaxed, see bathroom is worse. When dreaming, if you've been you get some treatment for sleep, apnea its that tail in the night that matters the most.

C

So if you've been choked all night, hundreds of times who's having sleep apnea, we find out that when you're awake, your blood pressure's, not elevated, also so having hypertension that doesn't respond well on medication is not considered an independent factor for somebody get checked with their sleep and your cardiologist. If you have one or like you want your sleep checked out for sleep apnea, especially if you snore reflux heartburn, gets worse morning, headaches unrefreshing sleep, grumpy, trouble, focusing trouble and losing weight, bad wedding.

C

Any bed wetters in the room getting up to pee at night by the way, is a sign of sleep. Apnea, a lot of people get up and pee at night a lot of people a lot of us. Do it a lot of men? Typically, some it's my prostate and it may be prostate in serious condition. If you got prostate, don't ignore it, however. Snoring by itself will make you get up in pee, because I work to breathe to get air through the narrowing that diaphragm pushing down pushes down on your bladder and makes it squeeze.

C

It makes you get up and go pee at night and little kids with they snore and their bed wetters. When you help them stop snoring the bedwetting stops within a week about half the time fast, fast, real, fast, so bedwetting something look for sweating in your sleeping snoring. Those are all things that can happen. We're not getting enough sleep super common. If you know some, if you snore, if you fast asleep apnea and something your family has it to it, just runs in families. Shape of your face has a lot to do with this.

C

This will run in your family. It's not just genetics, also gonna be environmental. You you aljahmeir running your family's super calm and you can be very thin and half sleep apnea, especially women, so sleeping should be silent. I made that point earlier, there's a lot of different treatments for it now you're just making anything in the back of the throat wider. This just shows that we normally suppose to have our throats, alright sleeping with our mouths closed. If you keep your mouth open, the tongues out of position.

C

Normally, if you little kid right, you'll get the little kids tongue. It's a little tiny muscle foots in the roof of the mouth, that's face gross and make space for itself and the roof of the mouth. It fits like hand in glove. If, instead, you guys, when we're a little your mouth breathers now the Sun grew out of position and eventually the tonsil things get better and you things get better for yourself, you, ten twelve fourteen, but now you become a young adult or your nine-year 30s.

C

All of a sudden sleep apnea will rear its head women, especially after age, 50 start having sleep apnea and when you looked, it happened as they were set up for this. We think when there were little kids that set up that the anatomy and then, as they get older, put on some weight. I'm also tone decreases and it all comes together becomes an issue. We look for this higher arch high roof in the mouth. That's what we're looking for I want to show you this guys, there's probably a doorstop somewhere and your doctor's office.

C

Could the dsm-4 that's the way we we diagnose things in psychiatry, I'm, not psychiatry. This is the standard book, I'm sure there's one in the library DSM, for you can pull it up. Curly now there in dsm-5 it gets updated, but version four. So a lot of your young adults here when they were kids, it was version. Four that was in place specifically said that if you have a DD, you might have a higher arch palette, so psychiatrists and psychologists.

C

Behavioral people were specifically taught that if you roof of your mouth was high, that was a physical sign of having a DD. We know anybody who doesn't get enough sleep he's gonna, have trouble paying attention and if you give anybody he's not getting enough sleep, a stimulant like ritalin or a cup of coffee, they're gonna feel better for a while. But that's didn't get to the root issue.

C

We can measure with different sleep tests, different treatments for it now the breeding machines, by the way, these breeding machines that are round now the CPAP machines they've, never been better they're, actually quieter. Smaller now, they're pretty much pocket-sized some of the nicer ones, they're silent. They should not be making a lot of noise. We are now living in when we look back on our field golden era, sleep apnea I mean CPAP. It's just much better see this travel size little ones.

C

Now a lot of things were doing I'm not going to sell you on a product. Let you know that if you tried this before and didn't work, try it again, because it's just gotten so much better. The last couple of years, there's really good surgeries, they've been developed, and now the latest thing you may not have heard of now. They've come up a pacemaker, sleep apnea, the let's do the biggest thing in our throats is our tongue. They now have pacemakers for our tongue and it's an implantable device.

C

Just goes on this like a regular pacemaker, but instead of having the wire go to your heart, it goes to your tongue and a sense is when you're inhaling and normally when you inhale the tongue goes backward. This senses you're inhaling some signal to the tongue. Push away so now have pacemakers for our tongue, so that was the latest treatment for sleep apnea now implantable device, no machine other than this thing. That's you're, sleeping with you have this big remote control.

C

You turn it on when you go to bed turn it off when you wake up in the morning and it works covered by insurance. You know in five six years even Medicare pays for it now. So this is a stab see when you know, Medicare pays for something it's become established means that the science behind this is good oral appliances. Dentists will make things for you again trying to get the tongue out of the way the tongue is what takes up space in our throats.

C

So, if I were through my time back, if I can move my jaw forward, my tongue is going to my joy moves moves before it and they all work just got to pick the right treatment. I always tell my patients for doctor gives you choices. There's a problem. I didn't give you choices for some things: appendicitis. It depends coming out nothing to discuss, so the pros and cons for all these things. I would want to segue quickly.

C

This topic of kids, asleep, can sleepy kids learn anything cuz I was a question 2012 data from Korea, and if anybody here is from Korea or Koreans, Korean, teenagers, almost leap to private and the planet right now, when this has been measured, so culture not giving kids enough sleep in Korea in South, Korea, specifically.

C

And if I'm about 20% of the kids, 19 percent of kids, we're not getting enough sleep based on these criteria that were established, including sleeping in more than two hours on weekends and those kids, have higher suicidal tendencies, suicidal ideation, that's Korea, the United States. We always think all the kid is not happy or depressed. That's the problem. Yes, people with depression can be suicidal, but it turns out that sleep deprivation by itself makes you impulsive. Well, you know get enough sleep.

C

The brain is engineered or whatever developed or evolved, how you gonna think of it. If, if there's not enough food around, we go into a mode of taking chances, they brain. Does this really interesting thing when you're a sleep-deprived to the brain? It means something is wrong, so the brain starts to switch into a mode of taking chances. It starts to gamble in that's what happens. People go to casinos and you sleep deprived. You make more mistakes, you overvalue the reward on the value, the the risks.

C

This has actually been something: that's been measured consistently with simple among get enough sleep and it's been shown in all ages and all and all of us, but particularly teenage boys, are more likely to take a chance when they sleep deprived. Take that risk they Dennis with driving simulators. We use need to pry them. They actually think they're driving better, because when you don't get have sleep, your body surges these hormones like cortisol, so they make.

C

You feel good, it's actually feel-good, you have a new forea with it, but he actually are making more and more mistakes.

C

This is a little bit data showing that the girls aren't particularly prone about about. 25 percent of the girls are getting enough sleep, that's just 7 hours. If you guys deal with teenagers in any way and your jobs in your life personally and professionally. When you deal with teenagers, you should just assume that teens are dealing with likely is not getting enough sleep when you get on that Carnival Ride and you get that little coaster and the teenager operating that things, but not getting enough. Sleep just know that.

C

Okay, if you deal with teenagers, the odds are he's not gonna sleep to the point. This is this data from the Center for Disease Control. By the way, this is a CDC. This is our tax dollars at work. Center for Disease Control has described lack of sleep among young people, particularly as a epidemic, because it's growing in numbers and it has health consequences.

C

This was a study just 2018 when they looked at supervision across different countries, though they were doing a lot of work in Taiwan, but us in the US, and they looked at the combined over 600, almost 600,000 teenagers, and they found that not getting enough sleep was the independent risk factor and I think what did they said was for every one hours, sleep less. They got jumped the amount of suicidal thinking by 11 percent.

C

The Academy Pediatrics there's enough data than 2014 the American County Pediatrics said all kids should start school, no, no earlier than I 30 as the best bang for the buck, the RAND Corporation does. Actually you can look at this RAND Corporation did a study just last year and in California, I think or the one exaggerate. The numbers I think the state would save like five billion dollars in the within three years.

C

I think it was I, don't member the exact number, but it was in billions of dollars because they found that when they've changed the school start time, one of the things that decrease right away, it was less accidents around the school. Less school accidents happened.

C

So this is the bill. That's out there now to delay school start time. The all the medical societies are supporting this every single one, but interesting you know, is now supporting it that wasn't supporting it before law enforcement. It turns out the sheriffs Association California is not supporting delaying school start times, because that data is juvenile crime Peaks after school. So if the kids go to school a little later, they get a little later crime decreases.

C

So this is how I've been shown that this has been a good thing for for people and also when kids get more sleep, they're get less likely to get into physical accidents at school. They don't get injured in sports as much there's. Another reason we're doing in the opposition by the way has been local schools to think that this should be the side at the local level, but this should not be they say we don't we don't doubt the science, but you should not tell us what you do.

C

They view to Sacramento imposing their will local communities. That's the battle, we're dealing with right now and where this stands right now is this is moving through the assembly. We did this already last year, Governor Brown vetoed it now we're hoping that we get it through the legislative process. Again. Hopefully, the new governor will sign it we'll see what happens, but this is a minute of news lately. This call 328 talk about that. One second I want to finish up because we're out of time we do have time for questions.

C

There's any one said anybody ask how to question the beginning of the session that I didn't get to, because we have a hard stop in a few minutes. There's something I didn't go over. Yes, sir.

C

Back to that we're trying. So if you want to increase your time and sleep, there's actual experiments called the sleep extension you do it by either going to bed around 15 minutes later once a week. You can't do it all of a sudden, because we have this second win at night.

C

So if you just try to do it on once your body rejected and you get frustrated, you can go change your bed time, 15 minutes and just wait about a week or so and then, if you fill it in, go another 15 wait a week or so fill it in you can't do it all at once. Your body rejections. That's why we get jet lag. You can't make an abrupt change in your sleep and one or two day so it'll get rejected. um The clock is blocked there.

C

Is it 3:30 yet or how we doing for time, 10, 10 minutes. Okay! So, sir, you had a question yeah.

C

How will we prove it so there's a common question. This is two that are always waiting about this people say: there's people son say if you die in your sleep really die in real life. People say that how can we prove it?

C

But but there's this thing called lucid dreaming where people can control their dreams and lucid dreamers have talked to us about on purpose, allowing themselves to die and seeing what it be like so they've seen their own funerals and things, and the classic thing people ask about, is if it's really true that, if I'm falling off a cliff, if I don't wake up rate, the ground I'll die. You've heard this before so me nodding your head, so lucid dreamer allowed himself to hit the ground on purpose and guess what happened in his dream?

C

He bounced that's what happened so so you can flip it around that way. However, people do die in their sleep. This has consequences right now since say way, just a little bit into to the political side of this George Anthony Scalia died in his sleep and if you look at this is not a controversial. This section was in the news just Scalia: if you've read the story, Supreme Court Justice Scalia was traveling and was with his buddies. It was in some Lodge or something in Texas, and that is when he was found dead.

C

His he said his breeding machine was unplugged next to him, so you probably had sleep apnea just didn't uses a machine that night and he choked and died in his sleep. So we think it's enduring the nightmares that it happens. It's not the fear. The nightmare. Never itself is that when you are dreaming your heart's accelerating. So if you have sleep, apnea you're, choking your sleep, not getting enough oxygen and your heart raises seller rating.

C

It's a perfect storm for something bad to happen to you and that's by the way, sir, how sleep research became sleep. Medicine. There's Nietzsche explains precisely the question: how other people died in their sleep? What's so hard about sleeping that somebody would die and that's what we think is behind it.

C

Lady, in the back, didn't ask any questions. Yes, hi.

C

C

You should be able to get they sell seep out throughout the world, so you should be able to sender the cash in the Philippines and her by her own machine have been fitted by a doctor because it no because it the same machines that they're gonna sell. Look with the current current machines that we have here are the same ones. They sell there. They may be some off brands, but the main machines, if I, if I, did the brands, the main the United States is ResMed and Respironics.

C

If you get a res Med machine which Brian's machine go buy it there, it may cost more than the knockoff or something that might be selling. But it's not just a machine. It's not like going to Costco the machine has to be set and that's right, the right mask. So you, the kind of some heart you may want to send her a machine, but it may not be set correctly. There's a CPAP as a bi-level. It makes more sense to provided the funds for her to have a sleep doctor in the Philippines.

C

Philippines has excellent sleep, medicine. There's some really good people out there doing work. So yes, sir Oh.

C

Chocolate, lady I'm, sorry, I'm. Sorry, yes, I knew this. You won't know what the first of all there's not that much eat your chocolate. It's going to be fine! There's people worried about the caffeine effects of chocolate. It's not that strong, I, don't think it's as big a deal. The way you metabolize caffeine may be individually different coffee.

C

Some people are fast, metabolize I'm, a slow metabolizers of it. So if you having trouble with your sleep, it's not likely to chocolate is a culprit. It's probably something else so I don't think there would be as big a deal. There's no reason why you can have chocolate for breakfast. Those theater affects your sleep right.

C

Yes, no I! Don't think that chocolate is as big a deal as they make it to be. As far as the caffeine portion in the actual chocolate of itself, it may not be that unless you happen to be very sensitive to caffeine in general, then it would be not just talking about any caffeine. Even even a soft drink with caffeinated would would affect your sleep also, but so I don't think our chocolate is is as big a dose. They make it. Sir.

C

Napping is like snacking. Okay, so if you not getting enough sleep, then, as not as an that makes complete sense, it's a luxury. Why not take a nap? It's a nice thing to do. However, if you're somebody who has a hard time sleeping at night, then napping is a problem.

C

People with insomnia sleep, better away from their beds, so sometimes what they do is they fall asleep on the couch or in the living room on a recliner, and they call that a nap, but there are is really just sleeping when their guard is down when they're not trying to sleep.

C

So that's who wants to avoid the nap, but if you're somebody who's just not getting enough sleep during during your regular night, you can do your sleep in spurts if your shift worker, by the way napping, makes a lot of sense because most of us wake up and go to work. So if you're a shift worker, you may have a chunk of sleep when you get home from work, but then you make sense the ticket nap. Just before you get up and start your day start your shift.

C

Now the thing with the nap issues, the duration, the nap- should be less than an hour and a half, ideally around 40 minutes, if you're not so longer than that. You kind of feel sluggish throws you off so for pilots by the way, if you ever notice, you can do international flights now they have mandated napping sessions for the crew and they also have rules about the duration of that nap period has to be 40 minutes or so only that they give them you sleep longer than that it misses you are.

C

Do we have time for more where's Claire? Yes, yes did you ask, and you asked more than once twice plan good answer.

C

So the people are trying to first try to prove whether this is true or not. It's not really clear. If it's true- and that is not clear what point of this, what happens is the spinal fluid? You know if you ever look at spinal food, it's nice clear, liquid, the circulation of it in our brains jumps by a factor of ten when we're sleeping, so this really fast circulation, and the thought is that it's bathing the brain and cleansing out things.

C

So it's like kind of flushing out your brain during part of the night, not the entire night, and that maybe some people who have some type of problems like early dementia may have impaired system. These things are accumulating. That's the hypothesis to be proven. But if this is turns out to be true, then it'll be pushes to open up that space. There are medications that can enhance your slow-wave sleep that make you see very, very deeply, but it's still the hasn't got to. The point says that doing this can reverse the process of dimension.

C

Anything like that and somebody it would make sense that would work a lot of things that we think it makes sense since in medicine, have turned out to be very bad, so you got to give it some time to prove this still, but that's what we're headed and that general idea behind that, sir, you know what is it.

C

It's different. The gentleman asked about restless legs and neuropathy defeat. A neuropathy is a disease nerve. People diabetes will have it a lot of congenital forms. That's the actual nerve is damaged. Restless leg syndrome is not a damaged nerve. It's actually, oddly enough, a problem with the way the brain handles. Iron iron is a cofactor. The body uses iron in the brain. To make dopamine, which is a neurotransmitter dopamine, is absent and affecting people who have Parkinson's disease doesn't function well, so restless legs is not a neuropathy.

C

It's not a nerve damage, peripheral nerve, it's actually a movement disorder. It's a movement problem, so the thing with restless legs is not so much that the feet are numb. It were problem. Restless legs is that you have a urge to move your legs. So if I were to tap your reflexes with a hammer, you neuropathy, your reflexes will be slow or absent. If I tap your reflexes with restless legs, your wrists are completely normal. What's happening is that you have. The sensation is weird feeling to move your legs it's hard to describe.

C

So it's a very different thing. It runs in families, but the nervous self is not damaged. It's an actually. We think it was an iron-fisted disease.

C

Sure, yes, so yeah! Well anything that causes pain will disturb your sleep. Chronic pain, things arthritis as people get older, they bail, the ability of sleep doesn't decreases, the excuse mean they need for C. Doesn't change? Is the ability to sleep so you're right, any neuropathy? What will bother you, but it's a different sensation. So if I have a neuropathy, some of the medications by the way are the same. Somebody may you something like a dependent in both conditions, but for the most part, restless legs is thought to be a different situation.

C

It's this urge to move you get up and walk around a neuropathy can bother you throughout the night. It's very different, restless leg syndrome. Has this quirky thing that only bothers people in the evening goes away in the morning. Neuropathy? Is there all the time for the restless legs are the neuropathy?

C

Well, if you have a neuropathy, then you a neurologist to find out the cause of it. Is it on a metabolic basis? Is it congenital? It depends on the closet, neuropathy. So a neurologist does that would work on that, for you sometimes I give people things like lyrica and things like that to help with it for certain metabolic basis. They want to change what it is. Let's say, people who have bad kidneys will have neuropathies.

C

Also you got to get dialysis there's a range of things have to get to it, but some people are just born in the rap of these. It's really really really unpleasant. Sir.

C

So the ability remember your dreams does not reflect it's not a clear indication, one way or the other. If somebody has mild sleep apnea, which is this trouble breathing when it's mild it kicks in when you are dreaming, but doesn't the muscles most relaxed so Bua sleep apnea may have lots of dreaming a lot of choking dreams, drowning dreams being buried, alive dreams, very unpleasant dreams, because they're choking by the one the sleep apnea gets worse. It's like a bad transmission.

C

They can't even get to that stage of sleep and they don't even dream at all, so that go I used to dream a lot that I stopped KB the sleep apnea. Then, when you treat the sleep apnea all of a sudden, they have a flurry regions called REM rebound the idea of dreaming and color vs. black and white. Dr. Dement did this experiment long time ago and says people who report giving back on white actually when they that's only what they remember of the dream. We dream for about two hours every night about two hours.

C

If you woke up in the morning and told your significant other, hey honey, let me tell you about my two hours with the dreams I had last night, you talk to the person for two hours and after you finish telling her about your two hours of sleep. She goes it's my turn. You know my two hours of sleep in your kid goes: hey I got two hours to tell you about so seems that they were meant to be forgotten to actual extent.

C

The one thing on them may be an issue and there's actually some people think that they're supposed to get rid of the information, but the black and white 'no swen. They actually woke people up who said they didn't sleep, dream or didn't dream only black and white when they actually walk them up, experimentally, they try not to have color dreams and I. Think in part, you don't hear that question that much anymore about black and white versus color anymore in part I think is because they reflect what you see.

C

So we had lots of black and white TVs, so you'd have dreams. What the shows in black and white now you have more color I met me an issue in that. But I bet, there's colors in your dream, sir I bet they really are probably one more question. If we have time clear what you pick the last person, please pick color pick Claire, no okay, somebody hasn't asked any class. You has up. You have one out: what's you you haven't? What's your question? You're the youngest one I think asking.

C

So the optimum thing is to wake up feeling refreshed. So first question is: do you wake up alert or not? So don't don't think about your bedtime?

C

Think about your wake-up time once you know you wake up time to feel refreshed and you work your way backwards and if you're young person give us about eight and a half hours in bed, if you're a little younger a little older, maybe seven and a half people in my age group, maybe six and a half is about they'll, be okay for the most part, it'll fluctuate within ourselves, but don't think of it, as your bedtime first think about your wakeup time and work your way back from there. Thank you for listening guys.