Sleep is My Waking Passion with Dr. Alison Kole

We are back talking to our good friend, Dr. Alison Kole,  Board Certified Sleep Medicine specialist and chronic insomniac turned sleep biohacker, who is on a mission to empower her listeners to improve their sleep naturally. We discuss her journey into Sleep Medicine, the importance of sleep in optimizing overall health and her Podcast, "Sleep Is My Waking Passion."

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Episode Transcript

Speaker 1 (00:00):
I want people to be able to be their own advocates,
because for me it took likechanging a job, really focusing
on work-life balance, getting aregular schedule, really
Decreasing that sympatheticoverdrive I was in.
I mean, I was like infight-or-flight, if you will
like, 24-7.
I could not calm down.
I was like an insane person andI really needed to be away for

(00:22):
it, for it to work for me.
Not everybody needs that, butthis is 100 percent the right
journey for me.
You know, things evolve asthey're meant to evolve is kind
of my philosophy.
So I learned a lot.
I feel incredibly blessed tohave had the career I had, the.
I'm incredibly blessed to havehad the opportunities that I
have and I'm just going forwardbeing like listen, at the end of

(00:44):
this life I want to feel like Imade an impact and for me I
really.
I still enjoy one-on-onepatient care, but if I can
impact Thousands or hundreds ofthousands or millions of people
by educating them, dude, that'sa win.
That's a win, isn't it likerefreshing?

(01:15):
And it really the conversationsthat you have.
Sometimes you actually end uplearning Things about yourself
sometimes, things like, at leastin my neck of the woods, with
doing sleep, like I alwaysprided myself and feeling like I
was a really good sleep doc.
I was like I really do abang-up job, like I'm proud of
myself, like I I put out qualitywork and I feel confident about
that.
And then I started talking toso many different people who are

(01:39):
either in academics or justpeople who are in private
practice but are academicallyminded, like myself in sleep,
and I'm like boom, my world hasjust expanded.
The amount of reading I'm doing, going to conferences, getting
different insights into howpeople practice, what's the
newest and greatest, and feelingconfident with the newest and
greatest things, like inmedications, particularly in

(02:01):
rare disease, like narcolepsyand i-h, where I really had.
I've always enjoyed taking careof those patients.
But you, because it's rare, youkind of have limited exposure.
It's sort of that, that unicornthat you find that you can
really but you know, evolvetreatment for them.
But at the same time it's likeI can treat you but there's so
many new things coming down thepike and you want to feel
confident and comfortable aboutwhat you're doing and really

(02:23):
kind of know what are people'sexperience with all this stuff
and getting that opportunity.
You know I can honestly say itwas, it's been the best thing
for me to transition out of whatI was doing.
You know I I do miss bedsideclinical care quite a bit, um,
but really in the sleep arena,you know.
So I'm sure you I mean, ifyou're Doing hd and all that, I

(02:46):
don't know how you guys had itduring cove but I mean we, the
whole first round, we kept ondoing that thing that you do,
where you're like, oh, we needto restrict fluids, and I never
really agreed with that.
I was like, no, these peopleare like sweating and febrile,
they probably need more fluids,but because of their hypoxemia
we're trying to do that likeminimize fluids thing and

(03:07):
inevitably with like a row ofpeople with renal failure, I'm
like, uh yeah, could havepredicted that happening.
Then we got smarter a bit, youknow.

Speaker 2 (03:16):
Having a bit.
You know, we we're like theepisode on northeast and we were
giving people Psythromycin.
We're getting vitamin c, we'regiving a magnesium black one oh
we were getting black for ashort period of time Ivermectin,
uh, calitra, which is an oldhiv drug, um you know.
So we definitely learned a lotthrough that.
But, by the way, that was anexcellent intro, I think, to the

(03:37):
start of our podcast.

Speaker 3 (03:38):
So we are gonna start the show by uh clit and once
again you have to fix yourcollar, fix it, it's crooked.

Speaker 2 (03:44):
Come on, why you put, why you bring it.

Speaker 1 (03:47):
And look at you nerds with your set the scopes around
your neck.

Speaker 3 (03:51):
Actually.

Speaker 1 (03:52):
Medicine doctors, right, the surgeons never have
that and the medical the jibberguys ever joke about that.

Speaker 3 (03:57):
And trading it was always like they never use it.

Speaker 2 (04:01):
I might even sure clinton knows how to use it
anymore, do you?
I took a fish or fries To theyellow one.

Speaker 1 (04:07):
That's the one in s2.
You don't hear that s4.

Speaker 2 (04:12):
I do a lot of great time maneuvers and all my
patients Thank you.

Speaker 3 (04:14):
Are you done, doctor Suraj?

Speaker 2 (04:17):
I'm done.
I'm done, go, go for infectiousdisease extraordinary.

Speaker 3 (04:20):
I'm dr Clinton Coleman.
Welcome back to recommend adaily dose.
We have an amazing guest today,dr Allison Cole.
She's board certified sleeppulmonary and critical care
physician.
She says she is a chronicinsomniac turned sleep bio
hacker.

Speaker 2 (04:37):
That sounds cool, I like that.

Speaker 3 (04:39):
She's also the host of a podcast.
Sleep is my waking passion.
Welcome to the show, so welcome.

Speaker 1 (04:46):
Thank you so much for having me.
I was Blissfully honored thatyou guys remembered who the heck
I was and invited me to come on.
I think it's super cool to chatabout all things medicine and
and it's so refreshing to seeother people kind of venturing
out and do another stuff besideswhat we do during the day.
Very cool stuff.

Speaker 2 (05:06):
No, you're right, and uh, you know we want to know
about your story, but you knowyou hit the nail on the head
there with doing other things.
I think this idea of side, whenwe talk about all time Side
gigs, entrepreneurship, you knowwe do consulting, we do some
media stuff, and so tell us alittle bit about your journey.
You, you have us.
I think you went to Columbiaright Then and then from there
you ended up.

(05:27):
We actually all were fortunateto work together for a short
period of time, a very long ago,when I had more hair had hair
in cladding.
Didn't have to color his, butthose days.

Speaker 3 (05:40):
I'll tell you a funny story.

Speaker 1 (05:42):
It's our guest.
No, no, no, I don't hear thestory.
Go ahead, all right.

Speaker 3 (05:46):
So when I first started getting gray hair, I had
my hair in my beard, so Ithought it was cool to try and
dye my hair.
You ever dyed your hair andlook out, see how ridiculous you
look I look like everyone cantell yeah, everyone knows.

Speaker 1 (05:59):
Did you get that hair club?
Not hair club for men, what'sthat one?

Speaker 2 (06:04):
The oh, you're talking just for men, that's
what it was.
Yeah, I answer that question alittle too fast, but yeah.

Speaker 1 (06:15):
Oh man, I think you both look fabulous.
We're aging gracefully, as theysay, right.

Speaker 2 (06:22):
Allison, tell us what you've been up to since you
know.
We saw you initially when youwere um an angle.
Angle would oh yeah, yeah, yeah.

Speaker 1 (06:29):
So, um, just for clarification, I went to
undergrad.
I was a barnard grad and then Itook off and I went to Tufts in
Boston and then I ended up outon the west coast and did all my
training at cedar sign.
I actually and it was reallythanks to Perry young she was a
ruby to mine and we becamereally tight in med school and
she was from SoCal.

(06:49):
So it was a completelyspontaneous Conversation with
her she encouraged me to go outthere and interview.
I interviewed and I was like,oh my goodness, it's sunny all
the time and I'm across thestreet from a mall and I just,
you know, I saw a celebrity kindof yelling at a paparazzi and I
was like this is magical, Ineed to come here and they let

(07:10):
they just buy.
Complete happenstance, I happento get in.
And so I was this Jerseytransplant in Los Angeles and I
was there all through internalmedicine poem crit, yeah and
then I worked.
I came back.
My dad had some health issuesat that time, so I came back,
took a job with someone I reallywanted.
I don't know if you guys everexperienced this, but like when
I first finished poem critfellowship at least I kind of

(07:34):
felt like that imposter, alittle bit like I'm okay, I'm
passing things I've.
You know I'm in this point thatI'm like yeah or different I
felt that probably the firstfive I wanted, almost 10 years
like.
You have to put in a time tofeel validated right, so I

(07:55):
really felt insecure, like I waslike, can I really do this as
an attending, you know?
And so I was like, alright, I'mgonna.
They had offered me an actualsleep position In the fellowship
program because I, you know,they were saying, listen, if
you're interested, come stay.
That that time it was stillveryo Santiago.
He he retired used to call himPapa Santiago.
So Papa Santiago had encouragedme to do it and, like my dad, I

(08:17):
just was like you know what,let me.
I need to be around my familyright now and I need to feel
like I could actually do this asan attending.
So I found a job in theMarstown area and I work with
the gentlemen who had split offfrom his group.
And you know, first andforemost, that's kind of a hint
like why did this personsuddenly break off from their
group?
And what I came to realize isthat just the model of medicine

(08:39):
was a little bit moreprogressive in California.
They had like Kaiser models andthey were more organized and
things were like sort of Groupswere starting to form and it was
less of the individual privatepractitioner.

Speaker 2 (08:51):
I'm sure is kind of a lot and that's changing to now,
but for a long time was one ofthe last bastions of small
independent practices, right?

Speaker 1 (08:58):
Exactly exactly.
So at that time this was beforeeverything started getting
organized, so he had gone out onhis own, he had hired someone,
he needed someone else.
So I interviewed with him.
He seemed like a nice personand I was like I was new.
I was like, alright, you know,let me try this out.
So I had a two-year contract,which I honored, and this person
, you know, really was apulmonologist.

(09:21):
But what I realized was that myrole really was to allow him to
do a lot more sleep medicineand we were gonna take over the
poem crit responsibilities andat that time they didn't have
closed ICU's or anything.
So you know, it was again avery traditional old-school way
things used to run.
Yeah how Jersey ran for a longtime.
After a lot of parts of thecountry weren't running that way
anymore, and you know it.

(09:42):
It I was on call like 50% of amonth and it was not a situation
that was sustainable.

Speaker 2 (09:50):
Yeah, exactly.

Speaker 1 (09:51):
Yeah, and I just was like this is really not what I
want to do forever and LiterallyI made a phone call and I
called a Papa S.
I said you know, papa Santiago?
Of course they didn't call himthat, but I was like so, very
like, you know, talk to me aboutsleep.
I really the one thing I haveto say is as challenging a role

(10:11):
as that first job was.
I I learned a lot and I alsocame to appreciate sleep
medicine on a level I didn'treally understand before and and
it was almost like that that,okay, now I can be.
I figured out I could be apulmonologist, I figured out you
could do critical care, but thesleep piece was like this
nebulous, like oh, I just don'tknow enough about it.
And we did it in our fellowship.
We, we had a sleep clinic andeverything.

(10:32):
But you know how it is like.
Until you get that in-depthknowledge or you can really
spend time on it, you just don'tknow.

Speaker 2 (10:38):
What the public awareness wasn't there, right
like?
Sleep is like all the ragethese days, and I mean that in a
very positive way, but Tenyears ago people didn't really
understand how important so true.

Speaker 1 (10:48):
And it was like all sleep, with sleep apnea too, and
you're kind of like it's notreally, but I didn't know what
to look for, you know.
So it's literally a phone callchanged my life.
He's like can you be here inJune?
And I was like, yes, and I wasjust like I'm piece and out, I'm
going to do a sleep fellowship.
And it was glorious and I'll,for multiple reasons.
Yes, I was learning sleep and Iwas really into it, and I

(11:11):
literally just came back thisweekend from the sleep American
American Academy of SleepMedicine sleep disruptors
meeting and it was really aReunion.
I was there with VicenteSantiago and Valcocho, hey guys,
and those are two of my sleepco-fellows and I've not stopped
talking to them since we were insleep fellowship.
So over a decade we've had thislike tech stream where we're
sharing ideas, going back andforth, just being in each

(11:33):
other's lives.
So I met some really coolpeople.
But for me, yes, aside from thesleep you have to understand,
think about this for the firsttime for an entire Year, the
only call I really took wasself-imposed because I wanted to
keep up my critical care skills, so I did some moonlighting at

(11:53):
another hospital just so I could, you know, be teaching and
spending time with residents andfellows and still keeping that
skill set.
That's it.
I did nothing for a year otherthan sleep fellowship I it was
like a nine to five gigbasically.

Speaker 3 (12:06):
You find it weird that critical care and sleep are
like their hand-in-hand.
I mean, I understand whypulmonologists going to sleep
medicine, but it seems likepolar opposites right?
Critical care You're dealingwith a whole different level of
acuity and then you have to likeslow it down to treat someone
with a sleep disorder.

Speaker 2 (12:23):
Yeah, the feedback on that, can you do sleep
fellowship like in primary care,or you have to do neurologists.
I know some neurologists who dosleep right.

Speaker 1 (12:31):
Clinton, you're absolutely right.
So internal medicine, sleep now.
Family practice sleep,neurology sleep.
There's psych sleep.
I even met a gentleman who iscardiology sleep.
So now there's a lot.
It's like a subspecialty withinspecialty or you don't even have
to do a specialty to do it.
I think I think you knowthere's certain things that

(12:51):
certain specialties, if yousubspecialize and sleep you
bring to the table.
Like psych is very strong inthe Cognitive therapy.
They understand the intimaterelationship between your mood
and that I think thatneurologists bring to the table
that expertise in EEG reading.
They often because a lot ofcentral disorders of
hypersomalins I alluded to them,narcolepsy and adiopathic

(13:13):
hypersomnia are things that maycome to a neurologist attention
sooner before.
And pulmonologists there isutility to that when you're
talking about Advanced modes ofventilation, being really
comfortable with anything fromCPAP, a pap by pap, asv, you
know non-invasive ventilators,these are things that
pulmonologists deal with all thetime so that you know

(13:36):
neuromuscular disease withrespiratory muscle weakness.
So so I think we all lendourselves to a certain skill set
and that's one of the things Ireally love about sleep is that
it kind of there's thisintersection amongst specialties
even, and we all sleep.
Plus, clinton, you had alludedto it.
It's very different thancritical care, right?
So the time I did in sleepfellowship actually just gave me

(13:59):
this break from the.
I mean, like I said, I was oncall 50% of a month.
Yeah, like you're incrediblybusy, there's no time to breathe
, and sometimes you need thatspace where you actually have
time to like, breathe, reflect,figure out what you Want to do
in the next stages of your life.
And Some people are not intothat slowness.
Sleep may not be interesting tothem.
I found it fascinating and Ialso, honestly, was really

(14:22):
rewarding to help someone with asleep disorder and you're like
I don't have to talk to youabout, like cancer or you know,
in stage of life Issues thatoccur and like the ICU.
You know that it's all relevantis what I'm saying, but some of
it's a little bit morechallenging and I just kind of

(14:42):
liked the pad on the back, ifyou will.

Speaker 2 (14:45):
Remind me after you did sleep, is that when you came
back?

Speaker 1 (14:48):
That is when I came back and that is when I my very
first job coming out of sleepfellowship Now is a seasoned,
seasoned, quote-unquotepulmonary critical care doc and
sleep doctor was to Englewood,and that's where I met you,
gentlemen, did you drive like a?

Speaker 2 (15:03):
white car.

Speaker 1 (15:04):
I'm just all coming back to me.
Oh my goodness, I have no ideawhy I.

Speaker 3 (15:12):
Wait, I can see him in the parking lot.

Speaker 2 (15:14):
We had this question about something, probably, and I
remember you had this white car, I, I could, you and my maybe I
make this up.
Is that my correct?

Speaker 1 (15:21):
I have, I still have a Ford Mustang convertible.
I knew it, I'm convenient carto have a New Jersey in the
winter.

Speaker 3 (15:31):
That was my baby.

Speaker 1 (15:37):
Still have it.
You know when I first drove itin wood.

Speaker 2 (15:41):
I saw the same car I had from like Red and Seen
fellowship and there they were,like this is for attending's
only.
I'm like no, I honestly, thisis actually my car Attending
today.
They almost didn't let me inUpgraded.
So you did pulmonary criticalcare and you know, we always saw
by people Because we're allprobably the same stage of our
careers, but what was it that,well, tells what you did there.

(16:04):
I think you've doneentrepreneurial things, you know
, and that's what we love Reallytalking to physicians.
I think anyone out there reallyjust becomes inspiring to hear
about people doing so manydifferent things.
In the old days, which was notlong ago, it was kind of like
you know, you come out offellowship, you hang up a
shingle and you do the samething for 40 years, you know,
and then right and then maybeyou have a little time to
yourself.
I think a lot of docs Don't findthat Professionally or

(16:28):
personally, you're worth right,and so a lot of people are doing
and getting into a lot ofdifferent things for a lot of
Different reasons.
So tell us some of yours.

Speaker 1 (16:35):
Yeah, I mean I Transition out of the part with
Englewood, which I shared withyou a little bit, because, you
know, I really, you know, hadthis opportunity, as a person
who is young and female, to havean opportunity to build a sleep
program and and so I took offto do that.
I was like this is the coolestthing ever.
And in my mind when I left forthat job, I was like this is my

(16:57):
dream job, this is what I wantto do, I want to run a program,
I want to build it, I want to doall these cool, cool things and
and it was that way for a longtime.
And Then you just start throughyour experiences and I'm sure
you guys, I'm, I'm no, I'm notpreaching to the choir when I
say this there's been a hugeshift in just how medicine works

(17:18):
in In 10 years, 15 year, likesince we started it's it's it's
it's been a monumental change ina very quick, short, you know,
a short amount of time, and thisis even pre COVID and Just how
things, what the focus was, howmany time, how much time you
have for a patient visit, theresponsibilities of do you

(17:38):
really have that Infrastructureof that staff You're not cherry
picking these staff.
When you grow largeorganization, they sign you
people.
Some people are better thanothers.
That means some of the worklife balance kind of goes out
the window and and I foundmyself spending more time just
seeing the patient and feelingas though I was overextending
myself and less time on programbuilding and Really figuring out

(18:02):
interesting ways to manage anentire patient population, which
is ultimately why I started outdoing what I was doing.
I thought I'd have thatopportunity and I didn't feel
like there was really room builtin to make that happen.
And Then COVID happened,obviously, and I call you know
it.
Was it all?
Covid did, truth be told, andat least for me it was an

(18:22):
accelerated process that hadalready been brewing.
It's not like I wasn't feelinga certain way, it's just that
then all of a sudden it's theNortheast.
You guys know just as well as Idid.
I mean you know my hospital.
We had a hundred people onventilators.
I mean we're using ventilatorslike that are like used for MRI.
Machines are never geared to anARDS patient.

(18:43):
I mean we were going old schoolbecause we had no equipment you
know they were using.

Speaker 2 (18:47):
The PB is like the whole drama of it all right one
mask that we would have to wearIf we keep a brown paper bag we
walk around with the mask andyeah, totally, you know.

Speaker 1 (18:59):
We found creative ways to sort of survive that
experience.
Really snarky sense of humor,as we know.
You know you got a laugh whenyou're crying inside, you know
and a lot of really, reallysolid relationships were forged
during that time, just amongstyou know, being in the ICU and
Really getting close with my IDpeers and the nurses and another

(19:23):
colleagues and everything.
So there was good that came outof it.
But it also, you know when,when you're thrust into the
situation where, at least for me, my reflection was these are
people that never thought amillion years that this was how
it was gonna go down.
You know, and yet you neverknow when your time is gonna
come, and I really started tofeel For lack of a better term a

(19:43):
little bit selfish.
I was like I'm I give so much ofmy.
I was giving like a hundred andfifty percent Everybody else.
There was nothing left for meand maybe a fraction left even
for my family, and at this timeI had toddlers, so I literally
had my mom being like when areyou coming home?
And I'm like when I get doneand to have little kids that
want to like hug mommy and I'mlike don't touch mommy.

(20:05):
Mommy Touched cove it, mommyneeds to shower now and just
that whole, you know psychology.

Speaker 2 (20:10):
I stay in the basement.
I'm sure it's the same thingyou know, or I should.
Did you work in covered, or youactually took a little break?

Speaker 3 (20:16):
I work, we actually in our house.
We have a different wing.

Speaker 1 (20:22):
You.

Speaker 2 (20:26):
Walk the door so.

Speaker 3 (20:27):
I can't know my son's older.
So I can imagine havingtoddlers and explain to them
that you know but now we justwalk around with COVID all over
our clothes and we now we'relike whatever, I'm just gonna
pick my booger and I'm fine.

Speaker 1 (20:40):
But you know, it was just a reflection period for me
and I, I really truly like, cameout of that going okay, now I'm
gonna start advocating formyself.
Now I'm noticing that thatwhole idea that we are taught
throughout our training, right,post bono, it don't do that,
it's okay, finish this and thenyou can do that.
You'll be happy when you knowall of that like it's the next

(21:03):
step.
It's the next step.
Well, now we're attending likewhat's the next step?
Right?
So I started to advocate formyself and I started to say
listen, I, I think I'd like tocut my hours down.
Can I focus more on things thatI enjoy, like the
administrative part of the sleepprogram?
Can I build that out?
And it just was.
My goals were not aligned withmy organization at least that
was my perception and I triedfor about a year or so to try to

(21:25):
make some of those changes.
Once the kind of the dustsettled and I no longer needed
to do like as deep a COVID callsituation and I just found my
personality changing.
Like I felt like I didn'treally enjoy patient care
anymore.
I felt like I was too snippywith folks.
I was like this is not me.
I'm like a happy person, likewhere am I?

(21:46):
What's happening?
This is not any person that Irecognize.

Speaker 2 (21:49):
I'm so glad you mentioned that because that is,
I think, exceedingly importantand and A delayed graphic as
things are whole eyes weretaught like just keep studying
and keep Working, you know, andso and have fun later.
And then I think all of us atsome stage, you know, became
impatient and then you startviewing patients instead of like
a privilege to work with them,instead of they're looking as a

(22:10):
burden, you know, and then yourealize this is really affecting
your personality and yourmental well-being.
So we appreciate you talkingabout that, you know, I mean
yeah, I mean, I think it'sreally important.

Speaker 1 (22:19):
Yeah, I mean I and, and for me, like, literally, I'm
not, I'm not even this.
For me, this is like I got tothe point where I'd be on rounds
.
I go to the hospital Dr Cole'shere to save the day, march in,
take care of my ICU patients, dothis.
Round up a have a break.
I would find the quietest place.

(22:41):
They had two little tiny rooms.
They, I mean I mean they weresmaller than my bathroom, like
that's how small they were.
They had a little desk with acomputer.
Right, it's in there, shut thedoor, because it's the only way
to have privacy.
Sometimes I would just likespontaneously find myself crying
.
Other times I would just starein a space and I'd be like, what
do I want to do?
Is this it like?
Is this, is this it like I like?
Every time I try to do, make achange or advocate for myself,

(23:04):
nobody seems to be appreciativethat this is like for me.
It's a big deal to extendmyself this way.
I'm not a person who admitsdefeat.
I'm trying to admit defeat here, like I can't do this anymore
and nobody seems to really takeme seriously.
And there's something about,there's something to resilience.
There's something to saying toyourself I refuse to accept that

(23:27):
this is the way it's gonna beforever.
I'm not happy with thesituation, but I also know that
there's some part of me thatwon't give up.
I just I refuse to give up.
But that not giving up to mewas like feeling like I use the
analogy of like Hang on the sideof a cliff by your fingernails,
like I'm like what, what am I?
How am I gonna hold on here?

(23:47):
And it was a podcast.
It was the sleep is my wakingpassion podcast.
I spoke to about it with myhusband.
I'm like I don't know what Ineed.
I don't know how to make thishappen.
I don't know anybody else who'sreally doing this, or at least
I, you know.
It felt so overwhelming that,you know, I just didn't have
time to process at all and Ijust decided that that was what
I was going to pursue.
I didn't have a backup plan.

(24:08):
I mean, you got a podcast,aren't free, right?
You got to start thinking abouthow you're gonna, you know,
monetize or how you're going tomake a living and everything.
And I and I thought to myselfgee, this telemedicine thing is
really a thing, and I've neverbuilt a program that's purely
telemedicine.
Do I think I could do it?
Well, I don't know, but maybeI'll try.

(24:29):
And so it was one of thosethings where I just decided it
was time for a break and I justneeded some time to think about
it and I finished out my callcycle.
I was given the opportunity tosort of really spend some
quality time with the family,take a little time off, really
process.
I take care of myself and, forthose listening that, there's no

(24:49):
shame in admitting thatsometimes you talk to a
therapist, sometimes you takeanti-depressants.
These are things that reallyhelped me and I'm not shying
away from that.
We shouldn't be ashamed to talkabout it in the healthcare
field.
So I'm gonna bring it up.
Um, and you know, I really sortof got my headscarf on straight
and then, through thatexperience, I was able to have
time.
So now I'm like searchingsocial media.
My friend Matt has a podcast.

(25:10):
Let me talk to him, let mereach out here, let me do this,
let me see what's on youtube.
And you start doing researchand then the idea was born, the.
I put very specific parametersaround goals I wanted to
accomplish.
So that was something that Ilearned early on.
Like you can't just like gointo the ether and not have a
plan, but sometimes, when youdon't know what the plan is,

(25:31):
it's helpful to brainstorm andsay what am I hoping to
accomplish in the next month, orin the next three months, or in
the next six months, or in thenext year?

Speaker 2 (25:39):
Did you do this on your own?
I hear a lot about like careercoaches, even physicians Hiring
or utilizing career coaches.
It doesn't normally in ourpsyche and how we think about
looking.
You know I made it to the tophere.

Speaker 1 (25:53):
I'm triple board certified you know, but now
there's actually.

Speaker 2 (25:55):
There could be more I don't have to be stuck where I
am now.
But how did I feel like whatyou did takes a lot of courage
and a lot of physicians.
I feel like you know, okay,well, I have a job now and I
have a family, and so how didyou make?
I mean, did you utilize anyhelp or was this all self self?
You know here's retrospective,inward thinking and inward

(26:16):
looking or did you utilize Anykind?
Of external forces.

Speaker 1 (26:21):
I would say the external forces.
Believe me, when you startdoing things like this or you
start trolling around, you knowLike the internet knows things,
so they start like populatingyou with messages.
I did go through a program runby a woman called Julie Santiago
and it was really about.
What struck me was it wasbasically like are you a career
woman who's burning out?
Like, have you burnt out?
What does that look like?

(26:41):
How do you address it?
So I really went through aburnout program, but it wasn't
geared toward physicians oranything, it was just general.
It was very expensive, but Ifelt like it was an investment
within myself and and that'swhat I chose to do, and it does
help that I, you know, have ahusband.
So I'm like, hey, guess whatGirlfriend's taking a break?
You can be paying the bailsmore, thank you.

(27:02):
So it did help to have someoneto that I felt like I had a
safety net, like there wassomebody else bringing income
and I didn't have to do it allon my own.
But that program is where Ilearned to really think about
first of all, just to heal first, to give myself that time to
heal and not just jump intosomething because I wanted to
escape my feelings, which Ithink sometimes, if you're have

(27:22):
a tendency to be a go-getter andyou feel like you got to
accomplish things, and thenthere's Sometimes you just don't
get a chance to process youremotions all that well and I
think I've been going heavypretty much my entire life and
it was just time to be like, ohRight, a little growing up to do
you know, just in terms ofhealing how I felt and how I got
to my plate and actually, to behonest with you, also, taking

(27:42):
ownership like how did Icontribute?
Like I didn't have goodboundaries, um, I kept saying
yes to everything but I shouldhave said no, like just little
things that we don't think about.
But taking ownership of where Ifit into the paradigm.
And you know, I tell people allthe time I'm like listen,
create the boundaries now,because it's really hard when
you don't have any, to startputting guardrails around

(28:02):
yourself, because people don'tlike it.
They want the old version ofyou.
That's what they're used topeople don't like.

Speaker 2 (28:08):
Yeah, there's someone who's saying I'll take that,
I'll be on that committee, I'lltake this responsibility, I'll
teach students, I'll teach theresident Right, I hear you.
So that that that's, that's um.

Speaker 3 (28:18):
Yeah, there's a, there's an art form to saying no
, so I'm glad that you found it.
It looks like you found yourpassion.
I want to get into the podcast.

Speaker 1 (28:24):
Yeah, please.

Speaker 3 (28:25):
I think for you it probably serves more than one
purpose, as far as you know anoutlet for you and creative
outlet, but also Uh service aslike an education form, because
I know, as a primary care doctor, I'm pretty bad at sleeping,
discussing sleep, you know likeif someone says I have trouble
sleeping, like if you triedmelatonin and that's what stops,
right.
So I we really don't Learn itvery well in our in medical

(28:50):
school.
Um but it is really importantfor you know, optimizing health
and stuff.

Speaker 2 (28:55):
So let's, let's get into that like what do you say
middle-aged man, who you mayhave just met?

Speaker 3 (29:01):
middle-aged.

Speaker 2 (29:01):
Yeah, comes to you and tells you he snores a little
bit at night.
He's been told by his wife and,um, he wakes up cranky a little
bit, and when he wakes up atnight, you know this is a common
issue, right?
So I mean, I mean so a how doyou get the word out there?
And then be you know what, giveus some sleep tips and and
pearls, if you will, because, um, as I've gotten, you know, past

(29:22):
the 40 and 45 year oldthreshold, man, I am really
realizing I don't sleep like Iused to, and I'm realizing it
more and more, and like anyoneelse out there, uh, how
important sleep is foreverything, right?

Speaker 1 (29:34):
Yeah, I mean whatever it is.

Speaker 2 (29:35):
So I'm telling there are.

Speaker 1 (29:37):
So there's so much to unpack here.
So I'll do my best.
But you know, clinton, youcommented that we don't get a
lot of this education.
We totally don't, and it almostseems like, in a way, it's like
they don't want you to know.
Important sleep is because whenyou're going through med school
, Stuff.

Speaker 3 (29:51):
It kind of feels like you know they don't want you to
know that.

Speaker 1 (29:55):
What's that?

Speaker 3 (29:56):
I said maybe we just don't know how important it is.
You know, it seems like there'sbeen a I think uh sarasha
alluded to this of a revolutionin and sleep and sleep education
.

Speaker 1 (30:05):
Correct.
So I think you know it's.
First of all, it needs to beemphasized more in medical
schools, which it was not, andagain, I think part of it was
that our sleep was neverprioritized when we were in
training.
You know, it was like if you'releft in the dark you can't
focus on it.

Speaker 2 (30:21):
It was a bad day of honor.
I worked all night and you knowI was before the 80 hour work
week so we didn't have nightfloat, it was you work all day,
you work all night, you work thenext day and maybe you leave
whenever you're done.
You know, and it was a bad dayof honor that I had half an hour
of sleep.
I had an hour of sleep.

Speaker 1 (30:35):
Right, exactly.
So what we're coming to find,just in terms of, like the
literature on even sleepdeprivation, is that it really
affects multiple, multiple organsystems, right, and we're also
learning from circadian sciencethat all of our organ systems
actually have somewhat of acircadian approach.
So, even like our digestion,you know, when you're asleep

(30:57):
it's supposed to be restorative.
So we see, this is why, when wewake up and we're not sleeping
well, we may have cognitiveimpairment or immune system
doesn't function as well, andthen there's a ton of a slew of
cardiovascular risk associatedRight, we have high blood
pressure, stroke, myocardialinfarction, congestive heart
failure, atrial fibrillation, socardiac arrhythmias.

(31:20):
So there's a lot of things thatare not good if we're really
not getting, you knowconsistently Ask your friend how
about the effects on thebladder?
So that's very interesting,because how?

Speaker 2 (31:29):
many times do you wake up in the morning?
I know Dr Urie is a real thing,right, so that's a real thing.
Yeah, I wake up twice.

Speaker 1 (31:36):
Yeah.
How I've experienced how I teachit and I you know forgive me if
it's not perfect science, buthow I understand it.
Basically is that you know ifyou are having, particularly if
it's associated with sleepdisorder, breathing sleep apnea,
which I'm about to talk to youabout in a second, 20, about a
quarter of men at all come orall lifetime are going to be at

(31:57):
increased risk.
Women it's about 9%premenopausal.
It goes up to the same risk asmen as their postmenopausal.
So right out the gate you got a25% chance roughly of
developing sleep apnea at thecourse of your lifetime.

Speaker 2 (32:11):
But for peeing, for example, what we see is that if
you that across all people, sobecause I'm learning more and
more we always thought thatsomeone with a bull neck and
very thick or wide necks orconference.
But I feel like more and moreagain asking for a friend some
of us that are of normal BMI andhave normal necks or
conferences that BMI is notnormal.

Speaker 3 (32:33):
Come on, have you seen data?

Speaker 1 (32:35):
So I'm just saying generally speaking across the
population.
So if you were looking, it's asthe most recent study that was
looking at the just generalglobal worldwide assessment of
sleep apnea, and this is mildall the way to severe.
So we're talking about evenmore mild cases.
It's estimated that a billionpeople in the world have sleep
apnea and what we know is thatphenotypes right, you're talking

(32:58):
about a phenotype Obese, noneck, looks like snowman, if you
will, a bowling ball on top ofa bigger bowling ball kind of
situation thick neck, as youdescribed, some of those very
sleepy sleeping all the time,snoring, stopping breathing,
gasping, all those typical sortof things that we look at for

(33:20):
sleep apnea.
That is just but one phenotype,that's just one type of patient
.
But, especially if you'regetting into South Asian, asian,
african American, hispanic,when you're talking about the
underserved, the minoritypopulation, there is a actually
there's significant sleep apneapopulations.
In fact, it's higher thanCaucasians when compared, and

(33:44):
what we know is that and I'lltell you this from personal
experience.
Plus, we know people may notthe next circumference issue
that we always talk about withlike stop being, and that's like
one of the common ways that wescreen for sleep apnea, and I'm
sure you probably have to dothis for all your people that
are going in surgeries and stuff.
But like the stop beingquestionnaire, the next size may

(34:06):
not be maybe completelyinaccurate.
If you're female, premenopausalversus postmenopausal makes a
difference.
You can be thin.
Females don't even have tosnore.
They may still have sleepdisorder.
Breathing Women are morecommonly going to say, hey, I
have insomnia, difficultysleeping, than men are.
Doesn't mean that men won'tcomplain of insomnia, but it's
more common in the ladies.

(34:26):
Sometimes it has to do withyour jaw.
Sometimes it's really a familyhistory thing.
I've caught a ton of people whoare sort of a normal body mass
index, may not have a big neck,may not obviously have it, but
you know, mom has it, dad,grandpa they didn't check back
then but grandpa snored.
They may have had some of theother issues hypertension, high

(34:46):
cholesterol, diabetes.
Those are some really commonthings that we associate with
sleep apnea and I'll test themand we will find significant
sleep apnea.
I mean I've had people thatsoaking wet.
They've got to be barely 100pounds and be a thin Asian male,
not a super small jaw.
They look okay from the outside, boom, terrible sleep apnea.
So you just never know.

(35:08):
It's one of those things like ifyou're going to go back to that
patient that you mentioned,that middle-aged patient just
asking who may get up a coupleof times to pee at night, for
example, if you were havingobstructive events at night.
If you have untreated sleepapnea right, what's happening?
Well, it's a relaxation of theair.
This is the most common type ofsleep apnea.
So I'm kind of generalizingthis.
Speak of obstructive sleep apneaand just call it sleep apnea.

(35:30):
But if you're having upperairway relaxation right, and
that obstruction can be multipleplaces, anywhere from nasal all
the way back, commonly it'sgoing to be the tongue rolling
back, closing off the airway.
But that's not the whole pieceof the puzzle.
Okay, so if you have an upperairway relaxation muscle issue,
right, and you're, even if itdoesn't close off completely, if
you're having at least a 3%drop in your oxygen levels, that

(35:54):
your body may and again, Iwould imagine that you might see
it more profoundly in someonewho's more severe drops in
oxygen levels right, not whatwe're coming to learn is that
your airway could close off 30times an hour, that severe sleep
apnea.
Maybe your O2 satinator, yourlowest oxygen saturation, points
90%.
Well, is that the same as aperson who drops to 60% and has

(36:16):
an AHI of 30?
I would argue no.
I think those are twophenotypes that we're dealing
with.
Somebody is getting much morehypoxemic, you know, and I think
that might have, you know,worse implications potentially.
That's what we're looking at.
I mean, there may be data.
I can't tell you that I knowfor sure, but I know these are
things that are actively beingstudied.
Like you know, there's otherparameters.

Speaker 3 (36:33):
But when most of us think of sleep apnea, as far as
severity, we think of apneaepisodes we don't think of as a
late, not a late, but not as anexpert.
We think of how many times juststop breathing.
You don't think of the hypoxiaassociated with it.

Speaker 1 (36:47):
So and that's these are the things that we're
actively studying in the sleepmedicine world and I'm
fascinated by because I'vealways suspected I'm like it
seems like that person with thereal low oxygen levels is
there's something more severeabout that person than the other
person and that may haveclinical significance.
And they're going to look intothat because I do think drops in
oxygen levels and also, likeyou know, what's your heart rate

(37:09):
response to that Some peoplehave a bigger heart rate
response, other people not itimplies that there's a little
bit more, you know, autonomicsympathetic nervous system
activation, which might be worsefor you in the long run.

Speaker 3 (37:19):
And I think we downplay the, the car, the
long-term cardiac effects, right, I tend to see a lot of sleep
apnea.
I wouldn't say see a lot ofsleep apnea, but part of the
secondary work of hypertensionis, you know, really I'll sleep
apnea.
So that's where I run into allof these patients who have who
look like normal people haveunderlying sleep apnea, so I
think it's worth an exploration.

Speaker 1 (37:39):
I really do.
I'm like because it's lowhanging fruit, like you know.
It's like okay, you've got aproblem with your breathing,
let's fix it, as opposed toadding multiple.
You know, because and sometimesthat's where I catch them is
they're on three medications fortheir blood pressure already.
And I'm like, okay, and they'relike coming to me because, oh,
it's not really working.
And you know, I don't think thearenal aureus stenosis or
whatever workups happen in theback story to figure that out.
You know, you're just sittingthere going okay, well, what

(38:02):
else is it?
You know?
But it wouldn't be nice if Isee them from the get go, or
even, ideally, if we couldfigure out are they having these
subtle symptoms.
If there was a way and this iswhat they're actively studying
if there was a way to predictsomeone's going to be at a
higher risk for high bloodpressure based on something they
haven't developed it yet, butcertain parameters that might

(38:23):
suggest sleep apnea, I thinkthat's really fascinating
research.

Speaker 2 (38:26):
Can you talk us through like, for instance, now
like diagnosis and then let'sput a hypothetical middle-aged
male who wears nice shirts, likeyou know and then possible
treatment options?
But first and foremost, are youreferring patients that you
would suspect to an inpatientsleep lab or at the at home
monitoring?

Speaker 1 (38:46):
is as that adequate for diagnosis of OSA.
That is a great question so I dowant to answer.
You asked about nocturia.
We didn't quite get to it, so Iwant to answer that first.
But the nocturia, the frequencyof urination, if you're having
big drops in your oxygen levels,if what happens is that's a
stress on the heart, right, theheart's going to sense that it's
.
You know, there's hypoxemiathere, so it will.

(39:08):
It's almost like it sort ofreleases hormones that make you
have to pee.
So that's just where I wantedthat's my cursory understanding
is it basically has to.
It's almost like a transientheart failure piece.
It's like, hey, you need to.
It's almost like it's it's yourbody telling you like to have a
diuretic effect, basically, andthat wakes you up when you have
to pee.
Yeah, so it's.
It's crazy when you think aboutstuff like that.

(39:29):
But getting back to your pointin terms of how we would
diagnose it, so you know, in thethere is the doctor answer and
then there is what really rulesthe world, which is insurance
answer.
So I'm we're getting a bit intothe weeds here, in my opinion,
because which I don't mind doing, but it is, and again, this is

(39:50):
just a dr Cole opinion but I'mvery concerned that insurance
does a bit too much dictating ofhow we Actually do our jobs.
I do understand from the flipside, from a utilization
management perspective, that ifa physician is incentivized to
have their own lab and fill thatlab with tons of patients and
the testing that they'reOffering the in lab sleep study

(40:12):
is very expensive and they'rejust milling people through the
sleep lab, there is a profit tobe made, and so you do need
people who say is this anappropriate use of Limited
resources?
So there is an argument to bemade on that side and I'm sure
that's where the insurance planswould come in.
But basically, if I had to wavea magic wand, what I'm looking
at is if I really think your lowprobability of having sleep

(40:34):
apnea theoretically I should beallowed to put you in the sleep
lab and Based on that becausethe sleep lab is going to really
eliminate Some of the downfallsof home sleep testing, which is
an accuracy, particularly forpeople may have mild disease
it's really the gold standard.
Okay, so I'd rather have an inlab, but many insurance plans
may say, listen, if you suspectsleep apnea, they have to have a

(40:57):
home test.
And so you know the home testsreally vary in accuracy.
But the limit the accuracy goesdown when you're talking about
very mild sleep apnea and therecan be slight night-to-night
Variability.
For example, if I gave you abeer and told you go to sleep
and you fell asleep on your back, I may have a certain number.
If you are sober and sleepingon your side, I may get a
different result.

(41:17):
So there are some dependencieshere and you can tease some of
that information out.
If you're not doing a home test,like if you're actually in the
lab the flip side of the lab isthen I hook you up to like 30
electrodes.
You know there's all sorts ofbands and wires all over you and
I'm telling you to go to sleepwith someone staring at you that
you've never met before, thatmy that's called the first night
effect and that's real.

(41:37):
So some people might not do alot with that.
So there's a little bit ofgive-and-take here about what we
need to do.
But generally speaking, if Iwas suspicious I would start off
with a home test, because mostinsurance pens will let me pass,
go and do a home sleep study.
That may change in the future,but that's where we're at right
now.
And then if it was negative andI really was concerned, I would
pursue further testing.

(41:57):
Ideally, ideally everyone get asecond test.
But you know, I really havethat discussion with the patient
because, for example, forinsomnia, difficulty sleeping,
either difficulty falling asleepor difficulty maintaining sleep
, when, when I'm looking at that, it really kind of depends on
what description you're giving.
But again, like I said, somepeople they're just gonna say,

(42:18):
well, I have trouble sleeping,doc, but they're gonna look thin
, they're gonna have a goodairway, they're gonna have a
Malin potty one airway.
They're gonna.
That's their only complaint.
Oh, my husband never says Isnore, I don't know what you're
talking about.
I feel okay, I don't know why.
I'm just, you know, I'm justgenerally not able to sleep at
night.
This is a classic thin Womangoing through menopause.
I can't tell you many people,these folks of these I've seen

(42:39):
and I learned my lesson becauseI actually had a thin woman and
I was like I really don't thinkthis lady needs a sleep study.
And I am telling you, herdentist did a sleep study.
I've found that she had sleepapnea gave her.

Speaker 3 (42:50):
Because what?
How does someone whospecializes in sleep medicine as
a pulmonary feel about dentistsand as.

Speaker 1 (42:59):
You know, well, that's another, yeah treating
with jaw devices and.
I actually am very, verysupportive of it because there's
like over 10 years worth ofliterature that really supports
that it could be helpful.
Is it gonna work in everypatient?
No, and it depends on theseverity of the patient.
You know, if I don't reallythink I'm gonna get a good
response, let's say they have anAHR of 100.
I mean, if I reduce you by 50%,which is the average, right, if

(43:23):
I give you an AHR 50, I guessthat's better, but it's still
pretty bad.
Like what am I doing?
You're still severe, right.
Or I may have that patientwho's like docalism, I really
want to get an oral applianceand I'm like, yes, but your neck
is like 24 inches and likemoving your jaw forward, is that
really gonna take care of theproblem?
But you'd be surprised.
There are some people, even inthe severe category, who may get

(43:44):
a decent response from it interms of, like dentists Just
ordering test willy-nilly.
I Believe it's really importantfor us to collaborate.
There is a role forcollaboration between dentists
and sleep physicians.
In fact, I'd like to see moreof that because, especially for
your more mild patients, you mayreally have a shot at getting

(44:05):
some pretty good control oftheir disease and they may not
want to wear a mask.
You know masks.
It really depends on who youlook at, which institution In
terms of efficacy, because itcan be all over the board and
it's generally pretty bad.
I'd say it probably works inabout 60% of patients.
And again, it also depends onare you looking at one year out
or five years out, because thatthat compliance may fall

(44:26):
Considerably and we're lookingat ways to predict who's gonna
be more compliant with CPAP thanothers.

Speaker 2 (44:31):
You know, and then she's are getting smaller and
supposedly more comfortable,right unless that is that is
true.

Speaker 1 (44:37):
I mean they have portable units.
Now those are generally notcovered by insurance but if you
have a deeper pockets than some,you can spend, like I don't
know, 900 ish dollars and youcan get, you know, a travel unit
and the masks are.
They have a lot of innovationin terms of masks.

Speaker 2 (44:53):
So what about different styles and everything
comment?
What about this pacemaker?

Speaker 1 (44:57):
that they can insert.
You're talking about theinspire, yeah so right now
there's inspire therapy forobstructive sleep apnea.
There is a different devicecalled remedy for central sleep
apnea.
We're not gonna get into theweeds with that.
It's very new but the inspiretherapy has been out now.
It's probably been around adecade or so.
I remember back in Englewood Iwas speaking to a thoracic
surgeon who asked me about itand at that time they were very,

(45:19):
very strict with who theyrolled out inspire therapy to,
meaning now you can get trained,you can become an inspire
center.
It's a lot easier than it was adecade ago but that's viable
for patients with severe sleepapnea.
It used to be that there wasvery specific criteria.
Like you couldn't really be too, too obese, like I think you
had a body mass index of like 32or below.

(45:40):
Sometimes it was 35 or below,based on some European data.
Your AHI had a range I thinkthe cap was around 65 in terms
of severity and they would dosomething called a drug-induced
sleep endoscopy.
That's a procedure where theyput you to sleep with anesthesia
.
They're giving you some MichaelJackson juice, a little
propofol, lights adhesion, soyou're not stopping breathe,

(46:00):
they're just Lights adhesion,but they're mimicking what you
might do with sleep.
Right, you're relaxing themuscles and you're watching how
the airway closes and if it wasfelt that your airway really
showed Demonstrates that thetongue is really rolling back
and kind of closing off yourairway, then you'd be an
appropriate candidate.
The rules are looser now.
You can have a higher BMI, Ithink.
The AHI and I was like to ahundred.

(46:20):
I'd like to see some outcomestate.
I'm sure they have them becausethe FDA approved them changing
this protocol.
I'd like to see if it still iseffective for patients who have
some of those who are really onthe edges of being very, very
severe.
But at the same time it's justkind of like you use something
if you can.
The battery life is around 11years.

(46:42):
It's.
You know, it's a smaller device.
I actually Show in telltime.
I'm telling you a huge nerd.
Here you go.
This is what it looks like.
I'm holding it in my hand, okay, but that goes in a pacemaker
pocket and it for the rightpatient it can be very
Efficacious.
Like we see, the goal here isto get them in the mild range.

(47:03):
Really that's where they gotpositive data.
But if you get them to it's,it's possible to resolve sleep
apnea in the right patient too.
So it's definitely something.
I was one of the folks thathelped to start the Inspire
program at my previousorganization.
I felt so strongly it wasnecessary, and people are gonna
go and get it anyway, so you mayas well jump on the train and
and see if we can keep thosepatients in house was and what
about like Less invasivemeasures or over the counter

(47:26):
stuff like nasal strips?

Speaker 2 (47:28):
I always hear this catchy thing on the radio, a
ZIPA or something you know.
Oh okay, All right.

Speaker 1 (47:33):
So I would say, okay, says the ZIPA.
God, I hope these companiesdon't start hating on me.

Speaker 2 (47:41):
Um, let me or blame clean, no problem but the ZIPA.

Speaker 1 (47:43):
I just have personally not had any patients
really be happy about thatparticular Product, so I would
say it wouldn't be something I'dhighly recommend.
That is feedback from patientsZIPA people.

Speaker 2 (47:56):
For the marketing purposes.
They have a great jingle.
So I mean you know yeah, theydo, I agree.

Speaker 1 (48:00):
And then there's something called the snore Rx.
My friend, dr Val, turned me onto that and I've used that for
some patients, the key with someof the over-the-counter Devices
.
They basically just move yourjaw forward a little bit right.
But a lot of them, like thesnore Rx to use for an example,
it literally just it's like adevice.
You, it's a boiling bite device.
You make your own mold,essentially, and then you adjust

(48:21):
it, so you kind of click itforward and then it keeps your
bottom jaw forward Just in alittle bit.
It's not going to be as severe,let's say, is what you get with
a dentist.
It's not, as you know, moldedto your teeth or as small, it's
a little bit bulkier a device,yeah, but they can be okay in a
certain patient.
But if you grind your teeth, Isay be very careful and talk to

(48:41):
your dentist because remember,that's a lateral movement, right
, brux's, if you're grindingyour teeth, a lot of these
over-the-counter devices don'tallow for that movement.
So if you're moving your jawforward, but it's fixed, you're
kind of like grinding.
Anyway, you could actually kindof some people felt that their
teeth got loose and stuff, so itcould be doing some damage.
So you just got to be careful.
But in the right patient itcould be helpful and helping

(49:02):
with snoring, just keeping yourjaw in a more optimal position.
The breathe right strips myhusband uses them.
I don't know if I'm allowed totalk about that.

Speaker 2 (49:10):
No, go fine, Don't talk about him.
I was considering buying someother day on Amazon.

Speaker 1 (49:16):
Yeah, so he, he has a little nasal valve incompetence
, meaning that if you sniffSometimes your nostrils kind of
collapse in.
That's an indicator the littlevalve in your nose may not be
working properly.
Oh, you have it.

Speaker 2 (49:28):
I have it I just saw it yeah oh my god your nose
clock.

Speaker 1 (49:31):
Yeah, totally.
If you think about stentingopen the nose right, you're just
flailing.
You're just trying to keep thepassage open.
If you could breathe betterthrough your nose, that tends to
reduce upper airway resistancea little bit it's like a.
It's like a built-in humidifier,if you will right.
You got the little hairs andthe cilia and all that, so that
helps you breathe a little bitbetter if you can breathe your

(49:51):
nose.
It's just less upper airwayresistance.
It tends to be beneficial toyou to breathe through your nose
.
So in that case it could behelpful and I know if he could
breathe through his nose and hesleeps on his side.

Speaker 2 (50:01):
We're good to go, so you mentioned sleeping your side
, so that's part of the.
I think the last part we wantto talk about was sleep hygiene.
But do you recommend thatpeople, uh, sleep on the side?
Do you recommend like pillowsso they're staying on their side
?
No fall backs.

Speaker 1 (50:16):
I think ultimately, a lot of people kind of know like
, hey, my, my significant othersays that if I'm on my side I
seem to be okay.
I always like to check.
I want to know because be keepin mind, it's very difficult to
stay in one position for eighthours, like I start off on my
right side.
My husband tells me all thetime I end up on my back.
I have no clue, I'm sleepingright, but I do end up on my
back.
It's very difficult.

(50:36):
Plus, the people who stay onone side.
They often complain of shoulderdiscomfort.
So they make these differentgadgets so that, like, if you
roll onto your back, some ofthem will jiggle.
There's one called the nightbalance from respironics, where
it kind of vibrate to remind youto move over to your side
without bothering you.
They make belts to keep you inone position.
Can you imagine strappingsomething your back?
I have recommended it.
I had a patient who was blindlegally blind, and that was he

(50:59):
couldn't really use any of theother gadgets, so he used a belt
to keep him on his side.
It worked really well for him.
He used that in addition to ac-pap.
Um, so it I would really.
If somebody's reallycomplaining.
I want to test them and reallysee what's my hypothesis.
Are they better on their side?
And sometimes I've proved.
I had a patient who really wedid side therapy and oral

(51:20):
appliance Boom, sleep apnea wentaway and that's, he couldn't
tolerate a mask because that'swhat we did and it worked, so we
stuck with it.
So it's different strokes fordifferent folks.
Basically it's it's, and that'swhat I really like about sleep
too is we're moving in adirection to try to get as
personalized as we can, and thatis, and remember, everybody
cares about their sleep.
Now, right, you said it in thebeginning, so we're doing all
these like commercial devices.

(51:41):
Right, you have your aura ringand your what you know, your
fitbit and your apple watch andall these parameters, and when
you think about it, theseDevices are really collecting a
lot of data.
So people are going in, it'sbeing Depersonalized, and then
they're actually trying toanalyze data from millions of
people to Establish any patternsthat we see that might be
helpful in managing people andmaybe preventing disease in the

(52:03):
future.
So, very exciting.

Speaker 3 (52:04):
Well, how do you approach as a insomniac and
biohacker, how do you approachinsomnia?
I mean, I, I have the wholesleep hygiene and you know.

Speaker 1 (52:14):
Yeah, I need you know that's a loaded question,
because in two minutes hygienealone is not going to work.
Ok, but in two minutes, what Iwould tell you is not going to
work.
Focus on your behaviors.
A regular wake up time is huge.
Seven days a week, regular wakeup time.
Go to bed when you're sevendays a week.

Speaker 3 (52:33):
I can't sleep A week.

Speaker 1 (52:35):
Keep your basically establish a routine.
It is so, so helpful.

Speaker 2 (52:41):
I got into my routine with my kids, so I should your
routine, you're looking at yourphone in the middle of the night
and I'm guessing.

Speaker 3 (52:47):
No, right, I started reading a miracle morning.
Have you heard about that book?

Speaker 1 (52:51):
I have not.
Should I be checking that out?

Speaker 3 (52:53):
Yeah, it's good, it's a I'm reading the audio version
obviously OK.

Speaker 1 (53:00):
Me, because I always had trouble waking up.

Speaker 3 (53:02):
I mean I could not wake up, but I wake up tired and
stuff like that.
So it's more about you knowbeing productive in the morning,
you know how to wake upproperly and just just being
productive and act like beingthankful for your friends and if
you're a co host, your podcast,co host.

Speaker 1 (53:16):
Right and just really thankfulness goes a long way.

Speaker 2 (53:20):
Yeah, I tell them every day to thank you.
You should be thankful.
He knows me every day.

Speaker 3 (53:23):
Well, part of it is you know, journaling and you're
waking up being grateful forsomething and planning out your
day and it's done.
I did it for a good week.
I'm trying to get back onto it,but it's really helpful to wake
to, to get good sleep and wakeup.
We feel like what about person?

Speaker 2 (53:38):
What is see?
We're hitting you up with thoserandom questions, but that's
great.
What's the optimum temperaturea bedroom should be for sleep,
oh shoot.

Speaker 1 (53:45):
There is some data on this.
I want to say that it's 68degrees, but we have it at 71 in
my house.

Speaker 2 (53:53):
68 is nice.
I like it cooler.
Yeah, cold.

Speaker 1 (53:57):
Yeah, and they also.
If you have a bed partner whodisagrees, you can actually get
a heated, or you can get acooling or heated like mattress
cover and they'll change thetemperature so that a person who
needs cooler can just kind ofcool themselves and someone who
needs it warmer, like you could.
Compromise is what I'm sayingit's funny.

Speaker 3 (54:13):
This is less about our audience and more about us
now.

Speaker 1 (54:16):
We're talking about waking up to pee.
Well, I would like to think ofthe temperature there you go.

Speaker 2 (54:21):
I would like to think our audience has the same
questions, and so I think wecould talk to you forever.
We're going to have to have youback on, but how about one last
question, which is what about aweighted blanket?
I didn't say a teddy bear, buta weighted blanket.
I've heard that these thingsare now being and my wife and I
have to tell you I find it veryUseful I was almost like
cocooning yourself for havingthis way to blankets in the

(54:41):
winter, and there's real datathat supports it.

Speaker 1 (54:43):
Because when you think about it, we have these
receptors on our skin and theykind of sense pressure and that
can have a calming effect.
I actually researched thisbecause I was a gentleman from
Quiet Mind.
Reach out to me.
That's a weighted pillow thathe designed and he's like, hey,
I want you to check this out.
I'm like, oh, this is kind ofquirky.
Okay, cool, I'm into newgadgets, let me check it out.

(55:04):
Let me check it out.
And he made it, he designed it.
He wanted to see about sleepbecause he found that he was
sleeping better at ADHD.
I use it to kind of calm mykids down and when I meditate I
put it on my lap and I do findit somehow that connection helps
, like it's almost like aphysical sensation that helps
keep me in the present, asopposed to my mind going around

(55:24):
in different places so.
I found it helpful for that.
The weighted blanket, though,for people of difficulty
sleeping, as long as you're nottoo hot underneath, that, it can
be very helpful.
Yeah, it can.
There's actual data thatsupports it.

Speaker 3 (55:36):
I appreciate that we could talk to you forever.
This is fine.
We're going to have like aweekly episode.

Speaker 2 (55:41):
No, this hypothetical , this hypothetical middle aged
guy really has gotten a lot ofquestions answered.

Speaker 1 (55:45):
So there you go.
I think there's a.
I think there's a homesleepapnea test in the future for
this hypothetical middle agedguy.
That's what I would do.

Speaker 3 (55:52):
I would be calling your office tomorrow.

Speaker 1 (55:57):
Yeah, I'm, I just to finish up, just so you are aware
of what I'm doing now.
So I did start a sleeptelemedicine program and because
I'm not part of a large groupanymore and I'm just on my own,
I partnered with a mental healthcompany called Oak Health
Center and it was just throughmy relationships with folks that
I still know out in California.
So they're based in California,but I always kept my California
medical license all these years.

(56:19):
So California, new Jersey andnow I have one in Georgia, new
York.
What I will tell you in fulltransparency is that I'm a
direct specialty care so peoplecan submit to get reimbursed
from their insurance.
But I don't take insurancebecause you know what we try
negotiating with Etna.
They wanted to pay me tendollars.
Ten dollars.

Speaker 3 (56:39):
No sure, Not gas money.
Dude and California.

Speaker 1 (56:44):
It's crazy, well, I mean it's a negotiating power.
Yeah, I mean it's, it's, butthat's.
That's the situation that we'rein in medicine.

Speaker 2 (56:51):
It's kind of messed up and a lot of talented people
are going this route and youknow, you explain the beginning
of why you know and this ideaand this is for another podcast
but moral injury in medicine andreally you know the old way of
thinking that we have toeverything for our patients at
the expense of our own mentalwell-being and that's just not
conducive for a long term career.
So we really appreciate yousharing your journey.

(57:14):
Can you tell us a little bitabout where people might find
you?
Are listeners on social media,linkedin websites, et cetera.

Speaker 1 (57:20):
As of today, I actually launched a website.
They're going to be more blogposts and it's going to be built
out over time, but it's sort ofmy, my website person felt that
we were ready to go go live andI'm really proud of it and you
can.
So you can get more informationon ask the sleep mdcom, because
my middle name is Sunkee, soask the sleep mdcom.

(57:40):
And you can also go to oak dotcare, slash sleep.
I do offer free 15 minuteconsultations, really just to
triage, where I think you know Ioffer a lot of different
services because different folksfor you know different.
You know what's what's that?
Different strokes for differentfolks.
Yes, I love that show.

Speaker 3 (57:58):
Great TV show.
The world don't move to be likejust one drum.

Speaker 1 (58:02):
So, in other words, like, if you're kind of curious
about where you fit in, do youneed a shorter console, a longer
console?
I will help you out with that,because I really try to practice
holistic medicine and being agood steward, I don't want to
just be pushing pills and stuffon people.
So if I can fix you withoutmedications, that's what I'm
going to do and that's reallywhat my services are geared
toward.
But yes, I'm happy to chat withyou and, you know, make a.

(58:23):
You can feel free to make anappointment with me if you want
to see me in real time and seeme with my services and I
promise you I will.
I will bring my A game and helpyou out.

Speaker 2 (58:33):
And so where can people find your podcast Like
where are you?
Apple.

Speaker 1 (58:36):
Spotify, youtube.
Sleep is my waking passion.

Speaker 2 (58:41):
We love it, you know I feel like we had our own
personal more than 50 minuteevaluation by you, so we really
there you go.

Speaker 3 (58:48):
Check us in the mail.
Ten dollars is in the mail.

Speaker 2 (58:52):
No, but you know it was just so nice to reconnect
after all this time and we'veall gone different journeys but
you know it's kind of like youcome back together.
So we're very happy to see youdoing so well and doing such
important work, because we tryto always give our podcast light
and joke around.
But you know, clearly sleep andsleep disorders is a major
issue, you know, for so manypeople, as you alluded to.

(59:13):
You know talking over apotentially a billion people
with some form of sleep apnea.
So obviously it's inherentlyimportant to hear about more and
more in the news and media andother health care providers.
But I still think it's probablyunder studied and under, you
know, publicized, not even justfor the general public but even

(59:33):
for health care providers.
So you're doing an extremelyvaluable service and we
appreciate it so much.

Speaker 1 (59:37):
That's the plan.
I want people to be able to betheir own advocates, because for
me it took like changing a job,really focusing on work, life
balance, getting a regularschedule, really decreasing that
sympathetic overdrive I was in.
I mean, I was like in fight orflight, if you will like 24
seven.
I could not calm down.
I was like an insane person andI really needed to be a way for

(01:00:01):
it to work for me.
Not everybody needs that, butthis is 100 percent the right
journey for me.
And but things had to.
You know, things evolve asthey're meant to evolve.
It's kind of my philosophy.
So I learned a lot.
I feel incredibly blessed tohave had the career I had, the.
I'm incredibly blessed to havehad the opportunities that I
have and I'm just going forwardbeing like listen, at the end of

(01:00:25):
this life I want to feel like Imade an impact and for me I
really.
I still enjoy one on onepatient care, but if I can
impact thousands or hundreds ofthousands or millions of people
by educating them, dude, that'sa win, that's a win.
So you know that's what we'rehere to do and plus it's like

(01:00:46):
fun.
I'm really, really enjoyingthis.
I had such a good chat with youguys.

Speaker 2 (01:00:50):
Oh well, your joy and what you're doing comes out in
this podcast.
We appreciate it so much.
Dr Allison Cole thanks so muchfor coming on.
Recommend daily dose withmyself and my illustrious
sidekick, dr Clinton Coleman.
Please don't forget to rate,subscribe, listen, check out all
of Dr Cole's.
Her check out her podcast willinclude the social media handles

(01:01:11):
when this comes out.
Until next time, be well.