November 25, 2022 • 27 mins
There’s more to sleep than being a good sleeper. So many factors—from overall health to our environments—impact our experience of sleep and how our brains and bodies behave while sleeping. From restless leg syndrome to sleepwalking to narcolepsy, researching and diagnosing sleep uncovers myriad solutions for getting the quality sleep that helps us live our best lives. In this episode, Anahad speaks with doctors whose passion and calling is sleep in all forms. Dr. Logan Schneider, a clinical assistant sleep professor of Sleep Medicine at the Stanford Sleep Center, the important role sleep analysis plays in managing our health. Sleep neurologist Dr. Chris Winter returns to the show to share his insights on the importance of evaluating our sleep and the future of sleep wellness and health.
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Episode Transcript
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Speaker 1 (00:05):
I think sleep has uh certainly come a long way.
Particularly is very many luminaries in the field have gone
from the basic mechanisms of what's going on in the brain,
what circuits and what neurotransmitters are being released and at
what times all the way up to well, how is
sleep actually affecting us? How does it affect our mood
or decisions to what we eat during the day, how
does it affect our metabolism. Logan Schneider is a medical
(00:29):
doctor and board certified clinician who specializes in the treatment
of sleep disorders that includes things like sleep apnea and ourcolepsy, insomnia,
restless leg syndrome, sleepwalking, and ram sleep behavior disorder. He's
earned awards and honors from the American Academies of Sleep
Medicine and Neurology. I sat down with Logan to get
a better idea of exactly how sleep research is done
(00:53):
and it's real impact on patients who struggle with sleep.
The nice part about being a sleep specialist is you
get to benefit from a community of all these different
types of clinicians that are interested in sleep. I went
by path of the neurology residency training, but you can
come through internal medicine, pediatrics, family medicine, and athesiology. Then
(01:13):
once you've done your primary training in residency, you then
typically do a year or maybe two years sleep in
research or just sleep clinical sleep fellowship that specializes you
by learning everything there is to know really about sleep
in that one year, and then go and take your
examinations and get certified, and then you start practicing sleep hopefully.
(01:33):
I also reached out to Chris Winter. He's a medical
doctor with years of experience in the field. He's a
neurologist and a sleep specialist who authored two books, The
Sleep Solution and The Rested Child. He gave us some
additional insight into this field and how it continues to evolve.
One of the nice things about the changes in technology
is that has taken different shape as time has passed.
(01:57):
So the original sleep studies we did. That mean, if
you talk to all the people who were sort of
the first generation sleep doctors, and we're not that far
removed from them, those sleep studies were very primitive. I
mean they were sort of experimenting with this. They were
trying to figure out where they're ways to capture information
(02:17):
about sleep. And that's changed to the point where a
lot of the sleep assessments that we do in individuals
happens in a person's own bed. We've had an interesting
journey so far talking extensively about the science of sleep
and showcasing examples of people with very unique sleeping patterns
and challenges. Today, we're going right to the source, to
(02:40):
the sleep researcher. We'll find out what it's like being
at the forefront of one of the newest and most
interesting fields and healthcare. Hi, I'm on a hut O'Connor
and this is Chasing Sleep and I heart radio production
and partnership with Mattress Firm. About a year ago, I
(03:10):
decided I was going to visit a Mattress firm in
every state of the Union. I'm really interested in the
perspective on the ground. Mattress Firm sleep experts. They see
it all and you never know what new nuggets of
sleep you'll learn about. In fact, that a great conversation
with the manager from one of their locations in Texas.
(03:33):
My name is Raoul Davila. I'm a senior store manager
for Mattress Firm out of Houston, Texas. It's interesting because
throughout the years right you you start to see all
walks of life and all the different issues that are
out there. So actually seeing guests come in with those
issues saying that they're not sleeping at night, that they're
(03:53):
not getting the recommended amount of hours of sleep, that
they're being impacted at their jobs firsthand, hearing those stories
from my guests really puts it in perspective. People are
not sleeping well, and it all starts with what you're
sleeping on. I mean that has a huge advantage on
getting the sleep that we all need. So I find
(04:16):
it really interesting to talk to the sleep experts about
and what do they see, What kinds of problems have
they been confronted with. These individuals are using their pretty
profound expertise. I mean, they get hundreds of hours of
sleep training to do more than just sell a mattress.
(04:36):
They're really trying to help people solve sleep problems, whether
you're sleeping habits are common or uncommon. We have the
curious researchers to thank for blowing this relatively new science
completely open. When I sat down with Logan, he was
enthusiastic about his work and eager to tell me all
(04:57):
about it. So put us in your clinic. I'd love
to know what it's like. Yeah, well it's a mostly
outpatient clinical practice, which is really nice about sleep medicine,
Like there are virtually no sleep emergencies that I can
think of and certainly don't get called in. The nice
part about sleep is you get to I feel that
you get to spend a lot of time talking to
(05:18):
people about their history because that's a significant portion of
the evaluation of sleep disorders. Right There isn't much of
an examination that you can do for sleep other than
the actual in lab or home sleep study or some
other diarrhy or other measures. So it's really gathering a story,
getting to understand people's experiences. And the things that we
do on our sleep are really astounding, eating two as
a toothpaste or driving cars, all sorts of crazy stuff.
(05:42):
So it's really interesting to hear people's experiences with sleep
that we never thought possible. We all experienced sleep a
lot of it, and so we think we're quite expert
at it, but every day I get a surprise. Very
interesting to think about how important the story behind each
sleeping problem is, which makes sense considering how specific and
unique each person sleeping circumstances are. Chris found the same
(06:06):
thing to be true in his own practice. Getting the
patient's side of the story is one of the most
important techniques for finding out what's going on with their sleep.
It won't give us the whole picture, of course, but
if it just rules things out, it's useful. We do
this from a medical standpoint, But Roold told me how
sleepexperts it. Mattress firm used the same methods with customers
(06:28):
as we do with patients. When I have a guess
that comes in and and they're looking for me to
solve a problem, I mean, it's it almost comes down
to the support or lack thereof. For some reason, they
are not happy with the current sleeping situation. So it's
my job to really ask those questions to make sure
that we're going to find the right mattress. If I'm
(06:50):
not asking the right questions, I'm really not solving the
right problem. When you go see a doctor, they're asking
questions to try to diagnose something. They're not just randomly
throwing darts out aboard. They're gonna ask the right questions
to make sure that they can make the right recommendation.
Is just listening to the guests and and really hearing
them out. When you are studying a patients in their sleep,
(07:15):
what are you typically looking for? What tools are you using? Yeah,
there are all sorts of tools that we have at
our disposal. Some of them are pretty rudimentary. The classic
sleep diary where people print out the sheet of paper
and fill out their sleep diary. Maybe that can be
supplanted by some helpful objective monitoring through various technologies, things
like an actograph, which is a watch almost like a
(07:37):
standard sports or sleep fitness tracker, where it tracks movement
and light. Sometimes that helps us understand patterns over time
that can complement a sleep diary. But then the major
diagnostic tools we have are those things like a sleep study,
and the sleep study in lab requires a specialized technician.
Those are the people who were there overnight to help
(07:59):
make sure that things going well because there are a
lot of wires, a lot of tubes, a lot of
things to monitor various body signals, from brainwave activity to
eye movements, to muscle activity in the face and muscles
of the legs, to looking at heartbeat and oxygenation and
pulse and breathing effort. So that we're really gathering a
very rich data set to understand all of the different
(08:20):
things that could be going on in sleep. These sophisticated
ways to measure our bodies and our brains while we
sleep clearly require equally sophisticated training, but it seems like
there are also multiple ways to dive into this field.
I mean, I personally have learned a whole lot about
the science of sleep just by doing research as a
(08:41):
journalist and by interviewing experts like yourself. Absolutely, they're obviously
doctors like Logan and myself who specialized in the medical
realm of sleep. But the beautiful thing about this science
is there are multiple avenues to approach it from a
journalistic approach, as you mentioned in a number of other ways.
In my conversation with Role, he told me how he
(09:03):
and other instore sleep experts complete over two hundred hours
of training. Can you tell us more about your training
as a mattress firm sleep expert and what it involves. Yeah,
absolutely so. When we when we use the term sleep expert,
we don't use it lightly at all. There's hundreds of
hours of hands on training that we do here in
(09:28):
the store, and we talk about the quality of sleep,
we talk about the type of mattresses we have, how
we can connect it to how a mattress can help
increase the quality of sleep. We're the only ones that
are really diving in to learn about sleep, and you
know how that can benefit you and what can happen
if you don't get the right amount of sleep. There's
(09:48):
so much out there on sleep that we still don't
know about. But if we can pair what's happening with
my guests to a certain mattress in a certain and feature,
I think that's when we get that aha moment where
you know, that's exactly what's happening to me, and this
is exactly what I need. We'll be right back after
(10:12):
a brief message from our partners at Mattress Firm, and
now back to chasing sleep. Dr Logan Schnyder broke down
the different types of sleeping disorders. We have a set
(10:33):
of about six disorder categorizations that we can then subdivide into.
You have a breathing disorder. Is it a breathing disorder
because of a blockage like obstructive sleep apnia? Is it
central meaning that your brain is not triggered to breathe,
Maybe because of a medication you're taking. We have all
of these different signals that different chunks of them can
tell us different things about your sleep. If we don't
need all of that, we're not looking for a more
(10:54):
complicated disorder, but something more run of the mill. Sometimes
we can form that out to like a home based
diagnostic study where we just look for breathing effort problems
and oxygen problems where the blood is not getting into
oxygen because the breathing is impaired, to something like for
just substructive sleep APNA a little bit easier to descend
to the home. But if you need a more in
depth diagnosis looking for more complicated sleep disorders, than we
(11:16):
want all of those signals and we have video to
accompany it to make sure we know what's going on.
Like when people sleepwalk, you can actually see their behaviors
and try and differentiate was that actual sleep walking from
non dreaming sleep? Was this guy and a dream based
sleep disorder. It's important to know what stage of sleep
you're in to know what's going on. So there are
different types of sleepwalking based on the stage of sleep
(11:37):
that they're in exactly, and it could even not be
standard run of the mill sleepwalking which is a relatively
benign disorder unless it causes problems like somebody driving a
car while sleep. But then we are trying to differentiate
what's going on in your sleep, right, people come to
us and say, hey, I'm doing this weird thing, and
we're we don't know. We can't know unless we're actually
looking at what your brain is doing, and that's really
we're capturing it on a video and also looking at
(11:59):
all these bios signals all at once can help us
differentiate that. And with insomnia, for example, what are some
of the sort of common things that you see causing that?
Is it could be a person's you know, their sleep environment,
or is it typically stress or anxiety or their job
or do you see common sort of themes underlying people's insomnia. Yeah,
(12:20):
there are a lot of commonalities in general and sleep
and particularly for insomnia. There are various constructs, various groups
described to different ways of thinking about this, but one
common model is called the three P model, where somebody
might be predisposed. It might be your genetics that predisposes
you to having sleepwalking similar type of thing here, So
that's the predisposition, and then you have a precipitating factor.
(12:43):
Often one big precipitating factor for a lot of people
actually happen to be the pandemic. Was it the stress
of the pandemic? Was it the change in your schedule,
even the opportunity to sleep more that actually cause you
to develop in insomnia. So then there's that precipitating event
that causes the insomnia happen. And then after that, when
we see insomnia eventually come to us in the sleep clinic,
(13:05):
often because that's an acute and zomnia, something triggered it.
You had a bad night. Everybody has a bad night
here and there. But when it becomes chronic and lasts
for a long period of time, and that's where we
have to worry about these factors that perpetuate it. That's
the third p Things that people are doing in response
to their insomnia that then keep it going on. So
some people will stay in bed a lot longer hoping
that sleep will come, and unfortunately that inherently induces it insomnia.
(13:28):
If you need six hours of sleep and you're in
bed for eight hours, we'll guess how much insomnia you
have two hours. So people will do different behaviors or
even have thought patterns. Right, even the bed alone will
make them anxious about going to bed, and so they're terrified,
I'll come, man, am I gonna be able to sleep tonight?
So it's these thought patterns behaviors that keep it kind
of rolling on. It sounds like Pavlovian conditioning. I was
(13:49):
just I was gonna say. One of the most common
things's referencing Pound Love's Dog is people create this association
with bed that is actually both physically activating as well
as cognitive emotionally activating, so they actually just even being
in bed. Stimulus control is one of the things that
we use is to separate the stimulus of the bed
from the sense of wakefulness. And if we can effectively
(14:09):
do that, people then start to get used to, oh,
the bed is for sleep again. So yeah, it's exactly
pow Love's Dog. You got it. So you have to
retrain their brains to view their their bed as not
a place of stress and anxiety and insomnia, but a
sanctuary of sleep. A sanctuary of sleep is definitely my
new favorite term from my bedroom, and it really highlights
(14:30):
just how important being physically and mentally comfortable is to
our health. Throughout this series, one of the most fascinating
aspects of sleep science that we've looked at is the
amount of power that our brains have to perform certain
functions completely on their own. And one of the best
examples of how overwhelmingly strong our mental capacities can be,
(14:51):
even on autopilot is the disorder that many people suffer from,
known as sleepwalking. You know, what are some of the
common things that you see when people are are sleepwalking
and what is the cause of sleepwalking? Generally speaking? Yeah, well,
we don't know what the underlying cause of sleepwalking is.
It just is that some people have a tendency to
(15:13):
do it and others don't, which would suggest that maybe
there's a underlying genetic predisposition. It might be that their
body doesn't do a good job of suppressing motor activity
or doesn't do a good job of waking up fully
when it starts to do motor activity, for example, Right,
So it could be something in that kind of pathway,
because to sleep, you have to maintain sleep while you
(15:37):
might actually have brain activity that would suggest wake for example.
But what can trigger sleepwalking typically are the things that
you might see like I had in residency, So excessive
amounts of deep, slow wave sleep that can come from
chronic sleep deprivation. Sometimes drinking alcohol can be a trigger
for it. Another thing that makes it more likely to
(15:57):
have a sleepwalking event, for example, is being a kid.
They have an awful lot of slow wave sleep, and
so probability would be if you have more of the
slow wave of sleep and your brain hasn't matured enough
to have all of these systems working together to promote
stages of sleep or states of sleep, then there's a
higher chance that they might actually have an event where
they sleep walk. Right, Like, the trigger could be in
(16:18):
them a bladder feeling full and they have to go
to the bathroom, but it happens to be right in
the middle of the deepest part of sleep where they're
the most inactive. Well, that triggers them enough to become
awake but not conscious. You have to be in the
right state. So if you have more of that state,
the deep sleep, then you're more likely to have an event.
And if you have a trigger in that state, well,
(16:38):
then it's more likely that you're going to precipitate an event.
About ten percent of people that will have a sleepwalking
event about once a year or so. Wow, and does
it usually the person themselves who's becomes aware of it,
or is it you know, sort of like sleep happening
like with myself, where it's a partner or you know,
bed mate who brings it to the person's attention. Yeah,
(17:00):
it's it's about a mix. If somebody has something very
clearly out of place or out of order, that might
be a good indication. For example, with a sleep eating
some people come to their kitchen they're like, who cooked
this meal in my house last night? Or they wake
up an unusual contents like crumbs are in their bed
and they're like, hey, I don't know how these got here.
(17:22):
I think that's a good indication to people that something
happened at night and it doesn't make sense. They'll check
their locks and think that they're going crazy. It's a
great build up for a sci fi thriller, right, and
then we now get this bed partner who is that
somebody who can finally observe our sleep for us again?
And that's when typically these things come to people's awareness,
is that they have somebody who's like, hey, you did
this crazy thing last night, or hey, you punched me
(17:43):
in your sleep? Is everything okay? It sounded like you
were fighting off like a wolf or something. So it
oftentimes most of our sleep disorders are recognized when people
are sleeping in context. That's when you know, even if
you're sleeping alone, you might catch it on these intermittent cases.
But um oftentimes it's things that are reported that are
completely out of whack and people think that there's something
wrong with them, but they're not likely to report it,
(18:04):
like I don't know what's going on. Normally it's a
bad partner who's like, hey, that's weird, go check that out.
The more we learn about sleep science, the more interesting
it becomes. Now, Chris, I'm curious as a medical doctor,
what do you look for and what are your goals
when it comes to getting good quality sleep. Yeah, I
love the idea of sleep metrics. I think the best
(18:26):
way for people to really assess their sleep is are
you still awake listening to this podcast, meaning that do
you struggle with excessive sleepiness during the day? So to me,
looking at fatigue and sleepiness levels during the day, I
think it's probably the best way to determine whether or
not somebody's a good sleeper. Somebody says to me, I'm
so unsleepy that I can't nap. I've never taken a
(18:48):
nap in my life. It's hard to paint them as
a bad sleeper. It's kind of like I want a sandwich, Nope,
want a strawberry, nope, I want a cookie, nope. Well,
you're probably not hungry, so hard to hate that person
to somebody who's starving to death. So you know, to me,
I think it's really about explaining sleep studies are awesome,
but it all starts with communicating with Dr Schneider and
(19:11):
sitting down and having questions for him and exploring the
things that are concerning you about your sleep and how
sleep interconnects to other parts of your health. And you know,
sleep studies are often very appropriate, but not always, so
I don't think everybody should have a sleep study. I
think the secret to good sleep, and my secret is
I don't worry about it because I've learned enough about
(19:34):
sleep to know that it's impossible not to. That won't
be perfect all the time. We will have sleepless nights,
but sleepless nights are a normal variant that that's what
happens to people. It only becomes insomnia when you're scared
of it. So understanding that I'm going to set aside
a proper amount of time to sleep. I'm gonna use
(19:54):
it tonight or I won't. But that's not something that
I can really control. And you know, always tell people
the secret to great sleep is feeling is happy and
bed awake as you are asleep. So I think that
when you release fear from the process of sleep, it's
incredibly empowering. So after you've done that, you create a
schedule that gives you an ample opportunity to sleep, start
(20:14):
your time off every day. At the same time, you've
got to exercise, you gotta eat right. Mindfulness is not
something the younger sleep doctor Winter would have told you
was that important, but the older sleep doctor thinks it's everything.
So between sleep studies, communication and sleep metrics, it sounds
like you have a lot of different techniques at your disposal,
(20:35):
a lot of tools, and the techniques are constantly evolving.
The take of sleep study has become very popular versus
strictly in lab studies, and the culture of sleep has
changed a lot too, And I get a first row
seat to that when I talk to sleep experts in
my work with Mattress Firm. I think throughout the years
(20:58):
the only thing that's really changed is that we are
We're now what we used to joke about, we're we're
no longer joking about it, right. So we used to
joke about and almost brag about how little sleep we
need to function right, And now I feel like, instead
of joking about that, we're taking it more seriously than
(21:19):
than we have in the past. It's it's still there,
We're still saying the same thing, but instead of being
proud that only got three hours of sleep, now it's
I only got three hours of sleep, and it's not
like you can make that up. It's it's lost, right.
So I think making it more of a focus taking
it serious. I think that's the big difference. Besides the
(21:40):
tools we talked about, both doctors had interesting ways to
bring that extra bit of care to their practices. Logan
explained that when doctors undergo sleep studies themselves, it helps
them empathize with their patients. Anytime you have a chance
to walk in your patient shoes, I think is helpful,
and doing a sleep study gives you a real understanding
of what we're asking people to go through to to
(22:01):
help us understand what's going on to sleep and help
them improve their lives, and Chris shared how traveling the
country and talking to people like Raoul helps him working
with his own patients. I think visiting mattress firms talking
to sleep experts helps a lot with what I do.
So I see patients every day, and I'm getting a
(22:24):
certain group or collection of complaints. Either a patient had
a complaint and they came to see me, or they
saw a doctor who referred their patient to me. I
don't know that I get to see the full array
of problems that people have. In order for somebody to
see me, it has to boil up to a point
(22:47):
where somebody has arrived at the decision to go see
a doctor. So I feel like you're getting a much
more organic swath of complaints and problems when you talk
to somebody in a mattress for a meaning that somebody's
not satisfied with their sleep, the sleeps a It's an
interesting dynamic, and it's it's private. It's a very personal topic.
(23:11):
If I'm buying, you know, a new frying pan because
my old ones is kind of gross, that's not necessarily
a personal communication I'm having with that store. You know,
that manager or that clerk or that that sales representative,
but when you're talking about sleep, it gets personal very quickly.
So I find that the purchase of the bed product
(23:34):
is the entry point. So I just find the stories
that these sleep experts tell me endlessly fascinating. So wherever
I go, always try to stop it. We've learned a
lot about sleep from experts and from people with very
unique sleeping habits, and as this journey was coming to
(23:54):
a close, I wanted to know what Logan and Chris
considered to be a major component and finding and keeping
good sleep. So the most important thing is keep a
consistent routine. But as long as you budgeted enough time,
your body will take what it needs. And then sometimes
that might actually be less than you think. Right if
you budget seven hours and your brain is only getting
(24:14):
six hours, and then it wakes up and it's good
to go, you might be lucky and get an extra
half hour if you're finding that that extra hour of
opportunities not necessary, And then really set that routine, at
least in the time before bed. If you can't like
structure your entire day, which is very difficult, but at
least in that time before bed, Say, what are some
things that can help me wind down and always adhere
(24:35):
to those Make sure that the things that you enjoy
so that you're wanting to do it, add things that
help you sleep, and pull away things that don't help
you sleep. But make sure that those things that you
add are enjoyable. And budget that routine in because that's
again just like kids, we all rely upon routines. It's
what structures our lives and makes our bodies and brains
ready for the next step. And so make sure that
you started awake time, build backward, and then build a
(24:56):
routine that promotes sleep. With all the issues being stud
one thing is key. What you sleep on makes a difference.
Roll you mentioned having a strong focus on quality sleep.
Why do you think that's important? I mean, how does
that affect performance? I mean, we're we're all working hard,
(25:19):
we all have to think, we all have to perform
on our toes. Sometimes we have to make very important decisions,
sometimes at the drop of a dime, so to be
able to maximize that potential right go to work and
really perform at that elite level. I think that that's
the difference waking up and not getting the quality of
(25:42):
sleep and going to work and having to make these
decisions when you're not at or at your true potential,
that can have devastating consequences, right, especially if if you're
in a position where you know you have a big responsibility.
Most people think about health when you eat, health when
(26:04):
you work out, But if you're not sleeping, right, I
see it more as a triangle. If you're not sleeping, well,
then it's it's It doesn't matter what you're doing in
the gym or what you're eating. That's all for this episode.
Thanks for joining us this season. If this was your
first time tuning in, make sure to check out our
(26:26):
earlier adventures, where we looked into the sleeping patterns of
a marathon runner, a journalist working around the clock, an
e R doctor whose normal work day is someone else's emergency,
a streamer who spends his nights reaching a global audience
of video game enthusiasts, a wildlife documentarian, and we even
(26:51):
spoke to an astronaut YEA, and someone who lives in
the Arctic Circle, where it's days, day or night for
months at a time. We want to hear from you.
Leave a rating or a review for our show on
your podcast player of choice, and you can find me
on Twitter at on a Hot O'Connor. We'll be back
(27:12):
with more episodes of Chasing Sleep in the new year,
but until next time, hoping you're living your best while
sleeping your best. Chasing Sleep is a production of I
Heart Radio in partnership with Mattress Firm. Our executive producer
is Molly Sosha. Our EP of Post is James Foster.
Our supervising producer is Kia Swinton. Our producer is Sierra Kaiser.
(27:35):
Our researcher and writer is Eric Lesia. This show is
hosted by me on a Hot O'Connor,
I think sleep has uh certainly come a long way.
Particularly is very many luminaries in the field have gone
from the basic mechanisms of what's going on in the brain,
what circuits and what neurotransmitters are being released and at
what times all the way up to well, how is
sleep actually affecting us? How does it affect our mood
or decisions to what we eat during the day, how
does it affect our metabolism. Logan Schneider is a medical
(00:29):
doctor and board certified clinician who specializes in the treatment
of sleep disorders that includes things like sleep apnea and ourcolepsy, insomnia,
restless leg syndrome, sleepwalking, and ram sleep behavior disorder. He's
earned awards and honors from the American Academies of Sleep
Medicine and Neurology. I sat down with Logan to get
a better idea of exactly how sleep research is done
(00:53):
and it's real impact on patients who struggle with sleep.
The nice part about being a sleep specialist is you
get to benefit from a community of all these different
types of clinicians that are interested in sleep. I went
by path of the neurology residency training, but you can
come through internal medicine, pediatrics, family medicine, and athesiology. Then
(01:13):
once you've done your primary training in residency, you then
typically do a year or maybe two years sleep in
research or just sleep clinical sleep fellowship that specializes you
by learning everything there is to know really about sleep
in that one year, and then go and take your
examinations and get certified, and then you start practicing sleep hopefully.
(01:33):
I also reached out to Chris Winter. He's a medical
doctor with years of experience in the field. He's a
neurologist and a sleep specialist who authored two books, The
Sleep Solution and The Rested Child. He gave us some
additional insight into this field and how it continues to evolve.
One of the nice things about the changes in technology
is that has taken different shape as time has passed.
(01:57):
So the original sleep studies we did. That mean, if
you talk to all the people who were sort of
the first generation sleep doctors, and we're not that far
removed from them, those sleep studies were very primitive. I
mean they were sort of experimenting with this. They were
trying to figure out where they're ways to capture information
(02:17):
about sleep. And that's changed to the point where a
lot of the sleep assessments that we do in individuals
happens in a person's own bed. We've had an interesting
journey so far talking extensively about the science of sleep
and showcasing examples of people with very unique sleeping patterns
and challenges. Today, we're going right to the source, to
(02:40):
the sleep researcher. We'll find out what it's like being
at the forefront of one of the newest and most
interesting fields and healthcare. Hi, I'm on a hut O'Connor
and this is Chasing Sleep and I heart radio production
and partnership with Mattress Firm. About a year ago, I
(03:10):
decided I was going to visit a Mattress firm in
every state of the Union. I'm really interested in the
perspective on the ground. Mattress Firm sleep experts. They see
it all and you never know what new nuggets of
sleep you'll learn about. In fact, that a great conversation
with the manager from one of their locations in Texas.
(03:33):
My name is Raoul Davila. I'm a senior store manager
for Mattress Firm out of Houston, Texas. It's interesting because
throughout the years right you you start to see all
walks of life and all the different issues that are
out there. So actually seeing guests come in with those
issues saying that they're not sleeping at night, that they're
(03:53):
not getting the recommended amount of hours of sleep, that
they're being impacted at their jobs firsthand, hearing those stories
from my guests really puts it in perspective. People are
not sleeping well, and it all starts with what you're
sleeping on. I mean that has a huge advantage on
getting the sleep that we all need. So I find
(04:16):
it really interesting to talk to the sleep experts about
and what do they see, What kinds of problems have
they been confronted with. These individuals are using their pretty
profound expertise. I mean, they get hundreds of hours of
sleep training to do more than just sell a mattress.
(04:36):
They're really trying to help people solve sleep problems, whether
you're sleeping habits are common or uncommon. We have the
curious researchers to thank for blowing this relatively new science
completely open. When I sat down with Logan, he was
enthusiastic about his work and eager to tell me all
(04:57):
about it. So put us in your clinic. I'd love
to know what it's like. Yeah, well it's a mostly
outpatient clinical practice, which is really nice about sleep medicine,
Like there are virtually no sleep emergencies that I can
think of and certainly don't get called in. The nice
part about sleep is you get to I feel that
you get to spend a lot of time talking to
(05:18):
people about their history because that's a significant portion of
the evaluation of sleep disorders. Right There isn't much of
an examination that you can do for sleep other than
the actual in lab or home sleep study or some
other diarrhy or other measures. So it's really gathering a story,
getting to understand people's experiences. And the things that we
do on our sleep are really astounding, eating two as
a toothpaste or driving cars, all sorts of crazy stuff.
(05:42):
So it's really interesting to hear people's experiences with sleep
that we never thought possible. We all experienced sleep a
lot of it, and so we think we're quite expert
at it, but every day I get a surprise. Very
interesting to think about how important the story behind each
sleeping problem is, which makes sense considering how specific and
unique each person sleeping circumstances are. Chris found the same
(06:06):
thing to be true in his own practice. Getting the
patient's side of the story is one of the most
important techniques for finding out what's going on with their sleep.
It won't give us the whole picture, of course, but
if it just rules things out, it's useful. We do
this from a medical standpoint, But Roold told me how
sleepexperts it. Mattress firm used the same methods with customers
(06:28):
as we do with patients. When I have a guess
that comes in and and they're looking for me to
solve a problem, I mean, it's it almost comes down
to the support or lack thereof. For some reason, they
are not happy with the current sleeping situation. So it's
my job to really ask those questions to make sure
that we're going to find the right mattress. If I'm
(06:50):
not asking the right questions, I'm really not solving the
right problem. When you go see a doctor, they're asking
questions to try to diagnose something. They're not just randomly
throwing darts out aboard. They're gonna ask the right questions
to make sure that they can make the right recommendation.
Is just listening to the guests and and really hearing
them out. When you are studying a patients in their sleep,
(07:15):
what are you typically looking for? What tools are you using? Yeah,
there are all sorts of tools that we have at
our disposal. Some of them are pretty rudimentary. The classic
sleep diary where people print out the sheet of paper
and fill out their sleep diary. Maybe that can be
supplanted by some helpful objective monitoring through various technologies, things
like an actograph, which is a watch almost like a
(07:37):
standard sports or sleep fitness tracker, where it tracks movement
and light. Sometimes that helps us understand patterns over time
that can complement a sleep diary. But then the major
diagnostic tools we have are those things like a sleep study,
and the sleep study in lab requires a specialized technician.
Those are the people who were there overnight to help
(07:59):
make sure that things going well because there are a
lot of wires, a lot of tubes, a lot of
things to monitor various body signals, from brainwave activity to
eye movements, to muscle activity in the face and muscles
of the legs, to looking at heartbeat and oxygenation and
pulse and breathing effort. So that we're really gathering a
very rich data set to understand all of the different
(08:20):
things that could be going on in sleep. These sophisticated
ways to measure our bodies and our brains while we
sleep clearly require equally sophisticated training, but it seems like
there are also multiple ways to dive into this field.
I mean, I personally have learned a whole lot about
the science of sleep just by doing research as a
(08:41):
journalist and by interviewing experts like yourself. Absolutely, they're obviously
doctors like Logan and myself who specialized in the medical
realm of sleep. But the beautiful thing about this science
is there are multiple avenues to approach it from a
journalistic approach, as you mentioned in a number of other ways.
In my conversation with Role, he told me how he
(09:03):
and other instore sleep experts complete over two hundred hours
of training. Can you tell us more about your training
as a mattress firm sleep expert and what it involves. Yeah,
absolutely so. When we when we use the term sleep expert,
we don't use it lightly at all. There's hundreds of
hours of hands on training that we do here in
(09:28):
the store, and we talk about the quality of sleep,
we talk about the type of mattresses we have, how
we can connect it to how a mattress can help
increase the quality of sleep. We're the only ones that
are really diving in to learn about sleep, and you
know how that can benefit you and what can happen
if you don't get the right amount of sleep. There's
(09:48):
so much out there on sleep that we still don't
know about. But if we can pair what's happening with
my guests to a certain mattress in a certain and feature,
I think that's when we get that aha moment where
you know, that's exactly what's happening to me, and this
is exactly what I need. We'll be right back after
(10:12):
a brief message from our partners at Mattress Firm, and
now back to chasing sleep. Dr Logan Schnyder broke down
the different types of sleeping disorders. We have a set
(10:33):
of about six disorder categorizations that we can then subdivide into.
You have a breathing disorder. Is it a breathing disorder
because of a blockage like obstructive sleep apnia? Is it
central meaning that your brain is not triggered to breathe,
Maybe because of a medication you're taking. We have all
of these different signals that different chunks of them can
tell us different things about your sleep. If we don't
need all of that, we're not looking for a more
(10:54):
complicated disorder, but something more run of the mill. Sometimes
we can form that out to like a home based
diagnostic study where we just look for breathing effort problems
and oxygen problems where the blood is not getting into
oxygen because the breathing is impaired, to something like for
just substructive sleep APNA a little bit easier to descend
to the home. But if you need a more in
depth diagnosis looking for more complicated sleep disorders, than we
(11:16):
want all of those signals and we have video to
accompany it to make sure we know what's going on.
Like when people sleepwalk, you can actually see their behaviors
and try and differentiate was that actual sleep walking from
non dreaming sleep? Was this guy and a dream based
sleep disorder. It's important to know what stage of sleep
you're in to know what's going on. So there are
different types of sleepwalking based on the stage of sleep
(11:37):
that they're in exactly, and it could even not be
standard run of the mill sleepwalking which is a relatively
benign disorder unless it causes problems like somebody driving a
car while sleep. But then we are trying to differentiate
what's going on in your sleep, right, people come to
us and say, hey, I'm doing this weird thing, and
we're we don't know. We can't know unless we're actually
looking at what your brain is doing, and that's really
we're capturing it on a video and also looking at
(11:59):
all these bios signals all at once can help us
differentiate that. And with insomnia, for example, what are some
of the sort of common things that you see causing that?
Is it could be a person's you know, their sleep environment,
or is it typically stress or anxiety or their job
or do you see common sort of themes underlying people's insomnia. Yeah,
(12:20):
there are a lot of commonalities in general and sleep
and particularly for insomnia. There are various constructs, various groups
described to different ways of thinking about this, but one
common model is called the three P model, where somebody
might be predisposed. It might be your genetics that predisposes
you to having sleepwalking similar type of thing here, So
that's the predisposition, and then you have a precipitating factor.
(12:43):
Often one big precipitating factor for a lot of people
actually happen to be the pandemic. Was it the stress
of the pandemic? Was it the change in your schedule,
even the opportunity to sleep more that actually cause you
to develop in insomnia. So then there's that precipitating event
that causes the insomnia happen. And then after that, when
we see insomnia eventually come to us in the sleep clinic,
(13:05):
often because that's an acute and zomnia, something triggered it.
You had a bad night. Everybody has a bad night
here and there. But when it becomes chronic and lasts
for a long period of time, and that's where we
have to worry about these factors that perpetuate it. That's
the third p Things that people are doing in response
to their insomnia that then keep it going on. So
some people will stay in bed a lot longer hoping
that sleep will come, and unfortunately that inherently induces it insomnia.
(13:28):
If you need six hours of sleep and you're in
bed for eight hours, we'll guess how much insomnia you
have two hours. So people will do different behaviors or
even have thought patterns. Right, even the bed alone will
make them anxious about going to bed, and so they're terrified,
I'll come, man, am I gonna be able to sleep tonight?
So it's these thought patterns behaviors that keep it kind
of rolling on. It sounds like Pavlovian conditioning. I was
(13:49):
just I was gonna say. One of the most common
things's referencing Pound Love's Dog is people create this association
with bed that is actually both physically activating as well
as cognitive emotionally activating, so they actually just even being
in bed. Stimulus control is one of the things that
we use is to separate the stimulus of the bed
from the sense of wakefulness. And if we can effectively
(14:09):
do that, people then start to get used to, oh,
the bed is for sleep again. So yeah, it's exactly
pow Love's Dog. You got it. So you have to
retrain their brains to view their their bed as not
a place of stress and anxiety and insomnia, but a
sanctuary of sleep. A sanctuary of sleep is definitely my
new favorite term from my bedroom, and it really highlights
(14:30):
just how important being physically and mentally comfortable is to
our health. Throughout this series, one of the most fascinating
aspects of sleep science that we've looked at is the
amount of power that our brains have to perform certain
functions completely on their own. And one of the best
examples of how overwhelmingly strong our mental capacities can be,
(14:51):
even on autopilot is the disorder that many people suffer from,
known as sleepwalking. You know, what are some of the
common things that you see when people are are sleepwalking
and what is the cause of sleepwalking? Generally speaking? Yeah, well,
we don't know what the underlying cause of sleepwalking is.
It just is that some people have a tendency to
(15:13):
do it and others don't, which would suggest that maybe
there's a underlying genetic predisposition. It might be that their
body doesn't do a good job of suppressing motor activity
or doesn't do a good job of waking up fully
when it starts to do motor activity, for example, Right,
So it could be something in that kind of pathway,
because to sleep, you have to maintain sleep while you
(15:37):
might actually have brain activity that would suggest wake for example.
But what can trigger sleepwalking typically are the things that
you might see like I had in residency, So excessive
amounts of deep, slow wave sleep that can come from
chronic sleep deprivation. Sometimes drinking alcohol can be a trigger
for it. Another thing that makes it more likely to
(15:57):
have a sleepwalking event, for example, is being a kid.
They have an awful lot of slow wave sleep, and
so probability would be if you have more of the
slow wave of sleep and your brain hasn't matured enough
to have all of these systems working together to promote
stages of sleep or states of sleep, then there's a
higher chance that they might actually have an event where
they sleep walk. Right, Like, the trigger could be in
(16:18):
them a bladder feeling full and they have to go
to the bathroom, but it happens to be right in
the middle of the deepest part of sleep where they're
the most inactive. Well, that triggers them enough to become
awake but not conscious. You have to be in the
right state. So if you have more of that state,
the deep sleep, then you're more likely to have an event.
And if you have a trigger in that state, well,
(16:38):
then it's more likely that you're going to precipitate an event.
About ten percent of people that will have a sleepwalking
event about once a year or so. Wow, and does
it usually the person themselves who's becomes aware of it,
or is it you know, sort of like sleep happening
like with myself, where it's a partner or you know,
bed mate who brings it to the person's attention. Yeah,
(17:00):
it's it's about a mix. If somebody has something very
clearly out of place or out of order, that might
be a good indication. For example, with a sleep eating
some people come to their kitchen they're like, who cooked
this meal in my house last night? Or they wake
up an unusual contents like crumbs are in their bed
and they're like, hey, I don't know how these got here.
(17:22):
I think that's a good indication to people that something
happened at night and it doesn't make sense. They'll check
their locks and think that they're going crazy. It's a
great build up for a sci fi thriller, right, and
then we now get this bed partner who is that
somebody who can finally observe our sleep for us again?
And that's when typically these things come to people's awareness,
is that they have somebody who's like, hey, you did
this crazy thing last night, or hey, you punched me
(17:43):
in your sleep? Is everything okay? It sounded like you
were fighting off like a wolf or something. So it
oftentimes most of our sleep disorders are recognized when people
are sleeping in context. That's when you know, even if
you're sleeping alone, you might catch it on these intermittent cases.
But um oftentimes it's things that are reported that are
completely out of whack and people think that there's something
wrong with them, but they're not likely to report it,
(18:04):
like I don't know what's going on. Normally it's a
bad partner who's like, hey, that's weird, go check that out.
The more we learn about sleep science, the more interesting
it becomes. Now, Chris, I'm curious as a medical doctor,
what do you look for and what are your goals
when it comes to getting good quality sleep. Yeah, I
love the idea of sleep metrics. I think the best
(18:26):
way for people to really assess their sleep is are
you still awake listening to this podcast, meaning that do
you struggle with excessive sleepiness during the day? So to me,
looking at fatigue and sleepiness levels during the day, I
think it's probably the best way to determine whether or
not somebody's a good sleeper. Somebody says to me, I'm
so unsleepy that I can't nap. I've never taken a
(18:48):
nap in my life. It's hard to paint them as
a bad sleeper. It's kind of like I want a sandwich, Nope,
want a strawberry, nope, I want a cookie, nope. Well,
you're probably not hungry, so hard to hate that person
to somebody who's starving to death. So you know, to me,
I think it's really about explaining sleep studies are awesome,
but it all starts with communicating with Dr Schneider and
(19:11):
sitting down and having questions for him and exploring the
things that are concerning you about your sleep and how
sleep interconnects to other parts of your health. And you know,
sleep studies are often very appropriate, but not always, so
I don't think everybody should have a sleep study. I
think the secret to good sleep, and my secret is
I don't worry about it because I've learned enough about
(19:34):
sleep to know that it's impossible not to. That won't
be perfect all the time. We will have sleepless nights,
but sleepless nights are a normal variant that that's what
happens to people. It only becomes insomnia when you're scared
of it. So understanding that I'm going to set aside
a proper amount of time to sleep. I'm gonna use
(19:54):
it tonight or I won't. But that's not something that
I can really control. And you know, always tell people
the secret to great sleep is feeling is happy and
bed awake as you are asleep. So I think that
when you release fear from the process of sleep, it's
incredibly empowering. So after you've done that, you create a
schedule that gives you an ample opportunity to sleep, start
(20:14):
your time off every day. At the same time, you've
got to exercise, you gotta eat right. Mindfulness is not
something the younger sleep doctor Winter would have told you
was that important, but the older sleep doctor thinks it's everything.
So between sleep studies, communication and sleep metrics, it sounds
like you have a lot of different techniques at your disposal,
(20:35):
a lot of tools, and the techniques are constantly evolving.
The take of sleep study has become very popular versus
strictly in lab studies, and the culture of sleep has
changed a lot too, And I get a first row
seat to that when I talk to sleep experts in
my work with Mattress Firm. I think throughout the years
(20:58):
the only thing that's really changed is that we are
We're now what we used to joke about, we're we're
no longer joking about it, right. So we used to
joke about and almost brag about how little sleep we
need to function right, And now I feel like, instead
of joking about that, we're taking it more seriously than
(21:19):
than we have in the past. It's it's still there,
We're still saying the same thing, but instead of being
proud that only got three hours of sleep, now it's
I only got three hours of sleep, and it's not
like you can make that up. It's it's lost, right.
So I think making it more of a focus taking
it serious. I think that's the big difference. Besides the
(21:40):
tools we talked about, both doctors had interesting ways to
bring that extra bit of care to their practices. Logan
explained that when doctors undergo sleep studies themselves, it helps
them empathize with their patients. Anytime you have a chance
to walk in your patient shoes, I think is helpful,
and doing a sleep study gives you a real understanding
of what we're asking people to go through to to
(22:01):
help us understand what's going on to sleep and help
them improve their lives, and Chris shared how traveling the
country and talking to people like Raoul helps him working
with his own patients. I think visiting mattress firms talking
to sleep experts helps a lot with what I do.
So I see patients every day, and I'm getting a
(22:24):
certain group or collection of complaints. Either a patient had
a complaint and they came to see me, or they
saw a doctor who referred their patient to me. I
don't know that I get to see the full array
of problems that people have. In order for somebody to
see me, it has to boil up to a point
(22:47):
where somebody has arrived at the decision to go see
a doctor. So I feel like you're getting a much
more organic swath of complaints and problems when you talk
to somebody in a mattress for a meaning that somebody's
not satisfied with their sleep, the sleeps a It's an
interesting dynamic, and it's it's private. It's a very personal topic.
(23:11):
If I'm buying, you know, a new frying pan because
my old ones is kind of gross, that's not necessarily
a personal communication I'm having with that store. You know,
that manager or that clerk or that that sales representative,
but when you're talking about sleep, it gets personal very quickly.
So I find that the purchase of the bed product
(23:34):
is the entry point. So I just find the stories
that these sleep experts tell me endlessly fascinating. So wherever
I go, always try to stop it. We've learned a
lot about sleep from experts and from people with very
unique sleeping habits, and as this journey was coming to
(23:54):
a close, I wanted to know what Logan and Chris
considered to be a major component and finding and keeping
good sleep. So the most important thing is keep a
consistent routine. But as long as you budgeted enough time,
your body will take what it needs. And then sometimes
that might actually be less than you think. Right if
you budget seven hours and your brain is only getting
(24:14):
six hours, and then it wakes up and it's good
to go, you might be lucky and get an extra
half hour if you're finding that that extra hour of
opportunities not necessary, And then really set that routine, at
least in the time before bed. If you can't like
structure your entire day, which is very difficult, but at
least in that time before bed, Say, what are some
things that can help me wind down and always adhere
(24:35):
to those Make sure that the things that you enjoy
so that you're wanting to do it, add things that
help you sleep, and pull away things that don't help
you sleep. But make sure that those things that you
add are enjoyable. And budget that routine in because that's
again just like kids, we all rely upon routines. It's
what structures our lives and makes our bodies and brains
ready for the next step. And so make sure that
you started awake time, build backward, and then build a
(24:56):
routine that promotes sleep. With all the issues being stud
one thing is key. What you sleep on makes a difference.
Roll you mentioned having a strong focus on quality sleep.
Why do you think that's important? I mean, how does
that affect performance? I mean, we're we're all working hard,
(25:19):
we all have to think, we all have to perform
on our toes. Sometimes we have to make very important decisions,
sometimes at the drop of a dime, so to be
able to maximize that potential right go to work and
really perform at that elite level. I think that that's
the difference waking up and not getting the quality of
(25:42):
sleep and going to work and having to make these
decisions when you're not at or at your true potential,
that can have devastating consequences, right, especially if if you're
in a position where you know you have a big responsibility.
Most people think about health when you eat, health when
(26:04):
you work out, But if you're not sleeping, right, I
see it more as a triangle. If you're not sleeping, well,
then it's it's It doesn't matter what you're doing in
the gym or what you're eating. That's all for this episode.
Thanks for joining us this season. If this was your
first time tuning in, make sure to check out our
(26:26):
earlier adventures, where we looked into the sleeping patterns of
a marathon runner, a journalist working around the clock, an
e R doctor whose normal work day is someone else's emergency,
a streamer who spends his nights reaching a global audience
of video game enthusiasts, a wildlife documentarian, and we even
(26:51):
spoke to an astronaut YEA, and someone who lives in
the Arctic Circle, where it's days, day or night for
months at a time. We want to hear from you.
Leave a rating or a review for our show on
your podcast player of choice, and you can find me
on Twitter at on a Hot O'Connor. We'll be back
(27:12):
with more episodes of Chasing Sleep in the new year,
but until next time, hoping you're living your best while
sleeping your best. Chasing Sleep is a production of I
Heart Radio in partnership with Mattress Firm. Our executive producer
is Molly Sosha. Our EP of Post is James Foster.
Our supervising producer is Kia Swinton. Our producer is Sierra Kaiser.
(27:35):
Our researcher and writer is Eric Lesia. This show is
hosted by me on a Hot O'Connor,
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