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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Speaker 1 (00:05):
I think sleep has certainly come a long way, particularly
as 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.
Speaker 2 (00:28):
Logan Schneider is a medical doctor and board certified clinician
who specializes in the treatment of sleep disorders that includes
things like sleep apnea, narcolepsy, insomnia, restless leg syndrome, sleepwalking,
and ramsleep 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
(00:51):
how sleep research is done and its real impact on
patients who struggle with sleep.
Speaker 1 (00:57):
The nice part about being a sleep specialist is that
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 a sociology.
Then once you've done your primary training in residency, you
then typically do a year or maybe two year sleep
(01:19):
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.
Speaker 2 (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.
Speaker 3 (01:49):
One of the nice things about the changes in technology
is that has taken different shape as time has passed.
So the original sleep studies we did, I 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
(02:10):
mean they were sort of experimenting with this. They were
trying to figure out where there are ways to capture
information 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.
Speaker 2 (02:27):
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 the sleep researcher. We'll find out
what it's like being at the forefront of one of
the newest and most interesting fields in healthcare.
Speaker 1 (02:54):
Hi.
Speaker 2 (02:54):
I'm Anahad O'Connor, and this is Chasing Sleep and iHeartRadio
production and partnership with Mattress Firm.
Speaker 3 (03:08):
About a year ago, I 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
(03:29):
their locations in Texas.
Speaker 4 (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 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 not getting
(03:54):
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.
Speaker 3 (04:15):
So I find 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
(04:36):
sell a mattress. They're really trying to help people solve
sleep problems.
Speaker 2 (04:42):
Whether your 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 about it. So put us in your clinic, I'd
love to know what it's like.
Speaker 1 (05:05):
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 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
(05:26):
for sleep other than the actual in lab or home
sleep study or some other diary or other measures. So
it's really gathering a story getting to understand people's experiences.
And the things that we do in our sleep are
really astounding, eating tubes of toothpaste or driving cars, all
sorts of crazy stuff. So it's really interesting to hear
people's experiences with sleep that we never thought possible. We
(05:47):
all experience sleep a lot of it, and so we
think we're quite expert at it, but every day I
get a surprise.
Speaker 2 (05:53):
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 thing to be true in his own practice.
Speaker 3 (06:09):
Getting the patients 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 Roll told
me how sleep experts at mattress firm use the same
methods with customers as we do with patients.
Speaker 4 (06:31):
When I have a guess that comes in and they're
looking for me to solve a problem, I mean 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 not asking the right questions, I'm really not
(06:53):
solving the right problem. When you go see a doctor,
they're asking questions to try to diagnose something the just
randomly throwing darts out aboard. They're going to ask the
right questions to make sure that they can make the
right recommendation. It's just listening to the guests and really
hearing them out.
Speaker 2 (07:12):
When you are studying patients, in their sleep. What are
you typically looking for? What tools are you using?
Speaker 1 (07:19):
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 could
be supplanted by some helpful objective monitoring through various technologies,
things like an actigraph which is a watch almost like
a standard sports or sleep fitness tracker, where it tracks
(07:41):
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 are there overnight
to help make sure that things are going well because
there are a lot of wires, a lot of tubes,
(08:02):
a lot of things to monitor various body signals, from
brain wave 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 things that could be going on
in sleep.
Speaker 2 (08:24):
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 journalist and by interviewing experts like yourself.
Speaker 3 (08:45):
Absolutely, they're obviously doctors like Logan and myself who specialize
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 Roll, he
told me how he and other in store sleep experts
complete over two hundred hours of training. Can you tell
(09:11):
us more about your training as a mattress firm sleep
expert and what it involves.
Speaker 4 (09:16):
Yeah. Absolutely, so. 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
the store, and we talk about the quality of sleep,
we talk about the type of mattresses we have, how
we can connect the two, how a mattress can help
increase the quality of sleep. We're the only ones that
(09:39):
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
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 and a cert and feature,
(10:00):
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.
Speaker 2 (10:11):
We'll be right back after a brief message from our
partners at Mattress Firm, and now back to chasing sleep.
Doctor Logan Schnyder broke down the different types of sleeping disorders.
Speaker 1 (10:32):
We have a set 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 seatp apnea? 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
(10:53):
not looking for a more complicated disorder, but something more
run of the mill. Sometimes we can farm 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 enough oxygen because the breathing is impaired,
to something like for just substructive sleep apnea, a little
bit easier to descend to the home. But if you
need a more in depth diagnosis looking for more complicated
(11:15):
sleep disorders, then we 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 sleepwalking from non dreaming sleep or was this guy
of a dream based sleep disorder. It's important to know
what stage of sleep you're in to know what's going on.
Speaker 2 (11:33):
So there are different types of sleepwalking based on the
stage of sleep that they're in.
Speaker 1 (11:38):
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. We all 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 don't know. We
can't know unless we're actually looking at what your brain
is doing. And that's really worth capturing it on a
video and also looking at all these bios all at
(12:00):
once can help us differentiate that.
Speaker 2 (12:02):
And with insomnia, for example, what are some of the
sort of common things that you see causing that. Is
it going to 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.
Speaker 1 (12:20):
Yeah, 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 a 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 an 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 in Zombia, something triggered it.
You had a bad night. Everybody has a bad night
here and there, but when it becomes chronic, it 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 in 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. Even the bed alone will make
them anxious about going to bed, and so they're terrified. Oh,
oh man, am I going to be able to sleep tonight?
So it's these thought patterns and behaviors that keep it
kind of rolling on.
Speaker 2 (13:46):
That sounds like Pavlovian conditioning.
Speaker 1 (13:49):
I was just want to say that, I was gonna
say one of the most common things that's referencing poun
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 do that, people then start
(14:10):
to get used to, oh, the bed is for sleep again.
So yeah, it's exactly Pavlovas dog. You got it.
Speaker 2 (14:15):
So you have to retrain their brains to view 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 for my bedroom, and it
really highlights just how important being physically and mentally comfortable
is to our health. Throughout this series, one of the
(14:36):
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, even on autopilot is the disorder that many
people suffer from known as sleepwalking. You know, what are
(15:00):
some of the common things that you see when people
are sleepwalking? And what is the cause of sleepwalking? Generally speaking?
Speaker 1 (15:07):
Yeah, well, we don't know what the underlying cause of
sleepwalking is. It just is that some people have a
tendency to 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
(15:27):
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
might actually have brain activity that would suggest wake for example.
But what can trigger sleepwalking typically or the things that
you might see like I had in residency, So excessive
amounts of deep slow wave sleep that can come from
(15:51):
chronic sleep deprivation, sometimes drinking alcohol can be a trigger
for it. Another thing that makes it more likely to
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 sleep and your brain hasn't matured enough to
have all of these systems working together to promote stages
(16:11):
of sleep or states of sleep, then there's a higher
chance that they might actually have an event where they sleepwalk. Right, Like,
the trigger could be in 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
(16:32):
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, 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.
Speaker 2 (16:45):
Oh wow, and does it usually the person themselves who's
becomes aware of it or is it sort of like
sleep happneing like with myself, where it's a partner or
you know, bed mate who brings it to the person's attention.
Speaker 1 (17:00):
Yeah, 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 the sleep eating,
some people come into their kitchen they're like, who cooked
this meal in my house last night? Or they wake
up and 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 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 in
(17:43):
your sleep as 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 oftentimes it's things that are reported that are completely
out of whack and people think is something wrong with them,
but they're not likely to report it, like I don't
(18:05):
know what's going on. Normally it's a bad partner who's like, hey,
that's weird, go check that out.
Speaker 2 (18:10):
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?
Speaker 3 (18:22):
Yeah, I love the idea of sleep metrics. I think
the best 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 is probably the best way to
determine whether or not somebody's a good sleeper. Somebody says
(18:44):
to me, I'm so unsleepy that I can't nap. I've
never taken a nap in my life. It's hard to
paint them as a bad sleeper. It's kind of like
want a sandwich, Nope, want a strawberry nope? I want
a cookie nope. Well, you're probably not hungry, so hard
to paint that person to somebody who's starving to death. So,
you know, to me, I think it's really about exploring.
(19:05):
Sleep studies are awesome, but it all starts with communicating
with doctor Schneider and 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
(19:26):
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 sleep to know that it's impossible
not to. It won't be perfect all the time. We
will have sleepless nights, but sleepless nights are a normal variant.
That's what happens to people. It only becomes insomnia when
you're scared of it. So understanding that I'm going to
(19:50):
set aside a proper amount of time to sleep, I'm
going to use 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 grade sleep is feeling
as happy in 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,
(20:10):
you create a schedule that gives you an ample opportunity
to sleep. Start your time off every day at the
same time you gotta exercise, you got to eat, write.
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.
Speaker 2 (20:27):
So between sleep studies, communication and sleep metrics, it sounds
like you have a lot of different techniques at your disposal, a.
Speaker 3 (20:35):
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.
Speaker 4 (20:55):
I think throughout the years, the only thing that's really
changed that we're now what we used to joke about.
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
(21:15):
instead of joking about that, we're taking it more seriously
than we have in the past. 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 lost, right. So I
think making it more of a focus taking it serious.
(21:35):
I think that's the big difference.
Speaker 2 (21:40):
Besides the tools we talked about, both doctors had interesting
ways to bring that extra bit of care to their practices.
Logan explain that when doctors undergo sleep studies themselves, it
helps them empathize with their patients.
Speaker 1 (21:52):
Anytime you have a chance to walk in your patients 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 help us understand what's going on in
sleep and help them improve their lives.
Speaker 2 (22:05):
And Chris shared how traveling the country and talking to
people like Raoul helps him working with his own patients.
Speaker 3 (22:12):
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 certain group or collection
of complaints. Either a patient had a complaint and they
came to see me, or they saw a doctor who
(22:34):
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 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
(22:57):
and problems when you talk to somebody at a mattress
for a meaning that somebody's not satisfied with their sleep,
the sleeps. It's an interesting dynamic, and it's private. It's
a very personal topic. You know, 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
(23:21):
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 is the entry point. So
I just find the stories that these sleep experts tell
me endlessly fascinating. So wherever I go, always try.
Speaker 2 (23:43):
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 a close, I wanted
to know what Logan and Chris considered to be a
major component and find and keeping good sleep.
Speaker 1 (24:02):
So the most important thing is keep a consistent routine.
As long as you budget it 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 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 opportunity is
not necessary, And then really set that routine, at least
(24:25):
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 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 the things that you add are
enjoyable and budget that routine in because that's again just
(24:46):
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 start
at wake time, build backward, and then build a routine
that promotes sleep.
Speaker 3 (24:58):
With all the issues being studied, 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?
Speaker 4 (25:17):
I mean, we're all working hard. 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's the difference waking up and
(25:40):
not getting the quality of sleep and going to work
and having to make these decisions when you're not at
one hundred percent or at your true potential. That can
have devastating consequences, right, especially if you're in a position
where you know you have a big responsibility. People think
(26:01):
about health when you eat, health when 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.
Speaker 2 (26:20):
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 earlier adventures, where we looked into
the sleeping patterns of a marathon runner, a journalist working
around the clock, a form an er doctor whose normal
workday is someone else's emergency, a streamer who spends his
(26:43):
nights reaching a global audience, a video game enthusiasts, a
wildlife documentarian, and we even spoke to an astronaut and
someone who lives in the Arctic Circle, where it's day's
day for months at a time. We want to hear
(27:03):
from you. Leave a rating or review for our show
on your podcast player of choice. You can find me
on Twitter at Anahad O'Connor. We'll be back 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 iHeartRadio in partnership with
(27:24):
Mattress Firm. Our executive producer is Molly Sosha. Our EP
of Post is James Foster. Our supervising producer is Keia Swinton.
Our producer is Sierra Kaiser. Our researcher and writer is
Eric Leijia. This show is hosted by me annahad O'Connor
I think sleep has certainly come a long way, particularly
as 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.
Speaker 2 (00:28):
Logan Schneider is a medical doctor and board certified clinician
who specializes in the treatment of sleep disorders that includes
things like sleep apnea, narcolepsy, insomnia, restless leg syndrome, sleepwalking,
and ramsleep 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
(00:51):
how sleep research is done and its real impact on
patients who struggle with sleep.
Speaker 1 (00:57):
The nice part about being a sleep specialist is that
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 a sociology.
Then once you've done your primary training in residency, you
then typically do a year or maybe two year sleep
(01:19):
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.
Speaker 2 (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.
Speaker 3 (01:49):
One of the nice things about the changes in technology
is that has taken different shape as time has passed.
So the original sleep studies we did, I 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
(02:10):
mean they were sort of experimenting with this. They were
trying to figure out where there are ways to capture
information 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.
Speaker 2 (02:27):
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 the sleep researcher. We'll find out
what it's like being at the forefront of one of
the newest and most interesting fields in healthcare.
Speaker 1 (02:54):
Hi.
Speaker 2 (02:54):
I'm Anahad O'Connor, and this is Chasing Sleep and iHeartRadio
production and partnership with Mattress Firm.
Speaker 3 (03:08):
About a year ago, I 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
(03:29):
their locations in Texas.
Speaker 4 (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 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 not getting
(03:54):
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.
Speaker 3 (04:15):
So I find 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
(04:36):
sell a mattress. They're really trying to help people solve
sleep problems.
Speaker 2 (04:42):
Whether your 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 about it. So put us in your clinic, I'd
love to know what it's like.
Speaker 1 (05:05):
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 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
(05:26):
for sleep other than the actual in lab or home
sleep study or some other diary or other measures. So
it's really gathering a story getting to understand people's experiences.
And the things that we do in our sleep are
really astounding, eating tubes of toothpaste or driving cars, all
sorts of crazy stuff. So it's really interesting to hear
people's experiences with sleep that we never thought possible. We
(05:47):
all experience sleep a lot of it, and so we
think we're quite expert at it, but every day I
get a surprise.
Speaker 2 (05:53):
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 thing to be true in his own practice.
Speaker 3 (06:09):
Getting the patients 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 Roll told
me how sleep experts at mattress firm use the same
methods with customers as we do with patients.
Speaker 4 (06:31):
When I have a guess that comes in and they're
looking for me to solve a problem, I mean 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 not asking the right questions, I'm really not
(06:53):
solving the right problem. When you go see a doctor,
they're asking questions to try to diagnose something the just
randomly throwing darts out aboard. They're going to ask the
right questions to make sure that they can make the
right recommendation. It's just listening to the guests and really
hearing them out.
Speaker 2 (07:12):
When you are studying patients, in their sleep. What are
you typically looking for? What tools are you using?
Speaker 1 (07:19):
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 could
be supplanted by some helpful objective monitoring through various technologies,
things like an actigraph which is a watch almost like
a standard sports or sleep fitness tracker, where it tracks
(07:41):
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 are there overnight
to help make sure that things are going well because
there are a lot of wires, a lot of tubes,
(08:02):
a lot of things to monitor various body signals, from
brain wave 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 things that could be going on
in sleep.
Speaker 2 (08:24):
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 journalist and by interviewing experts like yourself.
Speaker 3 (08:45):
Absolutely, they're obviously doctors like Logan and myself who specialize
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 Roll, he
told me how he and other in store sleep experts
complete over two hundred hours of training. Can you tell
(09:11):
us more about your training as a mattress firm sleep
expert and what it involves.
Speaker 4 (09:16):
Yeah. Absolutely, so. 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
the store, and we talk about the quality of sleep,
we talk about the type of mattresses we have, how
we can connect the two, how a mattress can help
increase the quality of sleep. We're the only ones that
(09:39):
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
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 and a cert and feature,
(10:00):
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.
Speaker 2 (10:11):
We'll be right back after a brief message from our
partners at Mattress Firm, and now back to chasing sleep.
Doctor Logan Schnyder broke down the different types of sleeping disorders.
Speaker 1 (10:32):
We have a set 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 seatp apnea? 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
(10:53):
not looking for a more complicated disorder, but something more
run of the mill. Sometimes we can farm 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 enough oxygen because the breathing is impaired,
to something like for just substructive sleep apnea, a little
bit easier to descend to the home. But if you
need a more in depth diagnosis looking for more complicated
(11:15):
sleep disorders, then we 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 sleepwalking from non dreaming sleep or was this guy
of a dream based sleep disorder. It's important to know
what stage of sleep you're in to know what's going on.
Speaker 2 (11:33):
So there are different types of sleepwalking based on the
stage of sleep that they're in.
Speaker 1 (11:38):
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. We all 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 don't know. We
can't know unless we're actually looking at what your brain
is doing. And that's really worth capturing it on a
video and also looking at all these bios all at
(12:00):
once can help us differentiate that.
Speaker 2 (12:02):
And with insomnia, for example, what are some of the
sort of common things that you see causing that. Is
it going to 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.
Speaker 1 (12:20):
Yeah, 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 a 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 an 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 in Zombia, something triggered it.
You had a bad night. Everybody has a bad night
here and there, but when it becomes chronic, it 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 in 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. Even the bed alone will make
them anxious about going to bed, and so they're terrified. Oh,
oh man, am I going to be able to sleep tonight?
So it's these thought patterns and behaviors that keep it
kind of rolling on.
Speaker 2 (13:46):
That sounds like Pavlovian conditioning.
Speaker 1 (13:49):
I was just want to say that, I was gonna
say one of the most common things that's referencing poun
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 do that, people then start
(14:10):
to get used to, oh, the bed is for sleep again.
So yeah, it's exactly Pavlovas dog. You got it.
Speaker 2 (14:15):
So you have to retrain their brains to view 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 for my bedroom, and it
really highlights just how important being physically and mentally comfortable
is to our health. Throughout this series, one of the
(14:36):
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, even on autopilot is the disorder that many
people suffer from known as sleepwalking. You know, what are
(15:00):
some of the common things that you see when people
are sleepwalking? And what is the cause of sleepwalking? Generally speaking?
Speaker 1 (15:07):
Yeah, well, we don't know what the underlying cause of
sleepwalking is. It just is that some people have a
tendency to 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
(15:27):
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
might actually have brain activity that would suggest wake for example.
But what can trigger sleepwalking typically or the things that
you might see like I had in residency, So excessive
amounts of deep slow wave sleep that can come from
(15:51):
chronic sleep deprivation, sometimes drinking alcohol can be a trigger
for it. Another thing that makes it more likely to
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 sleep and your brain hasn't matured enough to
have all of these systems working together to promote stages
(16:11):
of sleep or states of sleep, then there's a higher
chance that they might actually have an event where they sleepwalk. Right, Like,
the trigger could be in 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
(16:32):
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, 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.
Speaker 2 (16:45):
Oh wow, and does it usually the person themselves who's
becomes aware of it or is it sort of like
sleep happneing like with myself, where it's a partner or
you know, bed mate who brings it to the person's attention.
Speaker 1 (17:00):
Yeah, 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 the sleep eating,
some people come into their kitchen they're like, who cooked
this meal in my house last night? Or they wake
up and 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 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 in
(17:43):
your sleep as 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 oftentimes it's things that are reported that are completely
out of whack and people think is something wrong with them,
but they're not likely to report it, like I don't
(18:05):
know what's going on. Normally it's a bad partner who's like, hey,
that's weird, go check that out.
Speaker 2 (18:10):
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?
Speaker 3 (18:22):
Yeah, I love the idea of sleep metrics. I think
the best 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 is probably the best way to
determine whether or not somebody's a good sleeper. Somebody says
(18:44):
to me, I'm so unsleepy that I can't nap. I've
never taken a nap in my life. It's hard to
paint them as a bad sleeper. It's kind of like
want a sandwich, Nope, want a strawberry nope? I want
a cookie nope. Well, you're probably not hungry, so hard
to paint that person to somebody who's starving to death. So,
you know, to me, I think it's really about exploring.
(19:05):
Sleep studies are awesome, but it all starts with communicating
with doctor Schneider and 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
(19:26):
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 sleep to know that it's impossible
not to. It won't be perfect all the time. We
will have sleepless nights, but sleepless nights are a normal variant.
That's what happens to people. It only becomes insomnia when
you're scared of it. So understanding that I'm going to
(19:50):
set aside a proper amount of time to sleep, I'm
going to use 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 grade sleep is feeling
as happy in 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,
(20:10):
you create a schedule that gives you an ample opportunity
to sleep. Start your time off every day at the
same time you gotta exercise, you got to eat, write.
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.
Speaker 2 (20:27):
So between sleep studies, communication and sleep metrics, it sounds
like you have a lot of different techniques at your disposal, a.
Speaker 3 (20:35):
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.
Speaker 4 (20:55):
I think throughout the years, the only thing that's really
changed that we're now what we used to joke about.
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
(21:15):
instead of joking about that, we're taking it more seriously
than we have in the past. 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 lost, right. So I
think making it more of a focus taking it serious.
(21:35):
I think that's the big difference.
Speaker 2 (21:40):
Besides the tools we talked about, both doctors had interesting
ways to bring that extra bit of care to their practices.
Logan explain that when doctors undergo sleep studies themselves, it
helps them empathize with their patients.
Speaker 1 (21:52):
Anytime you have a chance to walk in your patients 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 help us understand what's going on in
sleep and help them improve their lives.
Speaker 2 (22:05):
And Chris shared how traveling the country and talking to
people like Raoul helps him working with his own patients.
Speaker 3 (22:12):
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 certain group or collection
of complaints. Either a patient had a complaint and they
came to see me, or they saw a doctor who
(22:34):
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 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
(22:57):
and problems when you talk to somebody at a mattress
for a meaning that somebody's not satisfied with their sleep,
the sleeps. It's an interesting dynamic, and it's private. It's
a very personal topic. You know, 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
(23:21):
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 is the entry point. So
I just find the stories that these sleep experts tell
me endlessly fascinating. So wherever I go, always try.
Speaker 2 (23:43):
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 a close, I wanted
to know what Logan and Chris considered to be a
major component and find and keeping good sleep.
Speaker 1 (24:02):
So the most important thing is keep a consistent routine.
As long as you budget it 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 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 opportunity is
not necessary, And then really set that routine, at least
(24:25):
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 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 the things that you add are
enjoyable and budget that routine in because that's again just
(24:46):
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 start
at wake time, build backward, and then build a routine
that promotes sleep.
Speaker 3 (24:58):
With all the issues being studied, 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?
Speaker 4 (25:17):
I mean, we're all working hard. 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's the difference waking up and
(25:40):
not getting the quality of sleep and going to work
and having to make these decisions when you're not at
one hundred percent or at your true potential. That can
have devastating consequences, right, especially if you're in a position
where you know you have a big responsibility. People think
(26:01):
about health when you eat, health when 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.
Speaker 2 (26:20):
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 earlier adventures, where we looked into
the sleeping patterns of a marathon runner, a journalist working
around the clock, a form an er doctor whose normal
workday is someone else's emergency, a streamer who spends his
(26:43):
nights reaching a global audience, a video game enthusiasts, a
wildlife documentarian, and we even spoke to an astronaut and
someone who lives in the Arctic Circle, where it's day's
day for months at a time. We want to hear
(27:03):
from you. Leave a rating or review for our show
on your podcast player of choice. You can find me
on Twitter at Anahad O'Connor. We'll be back 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 iHeartRadio in partnership with
(27:24):
Mattress Firm. Our executive producer is Molly Sosha. Our EP
of Post is James Foster. Our supervising producer is Keia Swinton.
Our producer is Sierra Kaiser. Our researcher and writer is
Eric Leijia. This show is hosted by me annahad O'Connor
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