😴 Sleep Medicine: Dr. Sam Kashani Answers Your Questions

Get ready for a snooze-tastic episode, darlings! Join Amy Phillips as she delves into the fascinating world of sleep with the incredible Dr. Sam Kashani, an MD sleep medicine expert. Discover Dr. Kashani's unique journey from film school to sleep medicine, including his work on major films like 'Shutter Island'. Learn vital insights into common sleep disorders, the power of cognitive behavioral therapy for insomnia (CBTI), the mysteries of REM sleep, and the impact of cannabis and alcohol on sleep quality. Whether you're curious about sleep paralysis, idiopathic hypersomnia, or the best sleep aids, this episode has got you covered. Don't miss out on this enlightening conversation that's sure to make you rethink your bedtime routine!

DR. SAM KASHANI CONTACT:
https://www.linkedin.com/in/samkashanimd
https://www.instagram.com/samkashanimd?igsh=NTc4MTIwNjQ2YQ%3D%3D

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Episode Transcript

Speaker 1 (00:05):
Drama, Darling Drama, Darling Drama, Darling.

Speaker 2 (00:19):
Okay, welcome in Darlings. This is a very exciting, a
very special episode about sleep. Joining me is the incredible
doctor Sam Kashani. He is an MD and he is
a d ABSM. What do those words and those letters mean?
He's going to tell us all about it in a second. Hello,
doctor Kashani, how are you welcome?

Speaker 3 (00:41):
Hi, good evening. Thank you so much for having me.

Speaker 2 (00:44):
Okay, this is so exciting. So I know how busy
you are as a doctor, but doctor Kashani has allowed
me some time graciously to ask him a million questions,
not only to talk about my own sleep journey, but
but I've gotten so many questions from you guys, So
thank you so much for submitting them. And we're going

(01:06):
to talk all about sleep. So this is a great
episode to not be snoozing on. It's not about housewives, guys,
but this is going to be very interesting. And actually,
doctor Kashani, so many people were just like messaging me
when I was asking them for questions and they were like,
this is so cool. I cannot wait to hear about this.

(01:26):
So you're on my friend, So this is so cool.
So I met you up here in Santa Clarita, but
because of my own sleep issues. But can you tell
me a little bit about, like where you went to school,
what your background is, and what brought you to study
sleep medicine.

Speaker 3 (01:44):
Yeah, definitely, so I, as I was saying a moment ago,
I actually am a film school graduate. My bachelor's degree
is in cinema on television Arts. My passion initially was
screenwriting and producing, so got my degree in that and
I started working in the industry, which was a lot
of fun. I got to work on some pretty big movies.
I got to work for Sony Picture Studios for a

(02:06):
little while, which was a lot of fun.

Speaker 4 (02:07):
Rash, no kidding, Yeah, it.

Speaker 3 (02:10):
Was pretty awesome. And then what.

Speaker 4 (02:12):
Are some of the movies you worked on?

Speaker 3 (02:13):
I have to ask, sure, Shutter Island.

Speaker 2 (02:17):
Oh my gosh, that is such a phenomenal movie.

Speaker 4 (02:22):
Okay, what else? What else?

Speaker 3 (02:25):
Other movies that I was working on include Zodiac with
Jake Chillenhall that was about the Zodiac murders in San Francisco.

Speaker 4 (02:32):
Wow.

Speaker 3 (02:34):
Yeah, so a couple of cool movies like that. But
you know, after a while, I kind of got tired
of working for the big corporation or the big studio,
just because you know, it's a lot of fun and
it's a really exciting environment and watching sort of you
know how the industry works. But I realized that my
whole reason for doing this was I wanted to be
creative and make my own films. So once I quit
working for Sony, I started producing my own films and

(02:55):
I actually got to make a few documentary films that
had some pretty decent success. I got to show them
at film festivals internationally and show them the BBC, so
that was pretty cool.

Speaker 2 (03:05):
Wow, yeah, those films accessible for us to watch, definitely.

Speaker 3 (03:11):
Yeah, I have clips of them on YouTube, and then
I sell one of them on Amazon. Okay, of course
you get a free comfy obviously, but yeah, you know,
after all that, it was really nice kind of traveling
and showing the film in different festivals and speaking and whatnot.
But one day I woke up a broke filmmaker and

(03:31):
decided that was probably the sign to go back to school.
And initially I was thinking about it. All told me
about it, especially in that industry. But you know, initially
in my mind I was thinking, maybe I should go
get a master's in film and then you know, work
as a film professor as a nine to five and
then still do movies on the side. But that didn't
really make a whole lot of sense to me. So

(03:52):
fast forward, long story short, I just figured that the
best thing would be to go back to school to
establish a career that would provide me stability and that
I can always revisit film later on.

Speaker 2 (04:03):
So you're like, oh, well, just be a doctor. I mean,
who does that, Like that's insane. Oh my gosh, okay, sorry,
go on, that's so cool.

Speaker 4 (04:13):
But you're like, okay, I'm going to go do this.

Speaker 3 (04:15):
That was pretty much it. And you know, I don't
recommend that as a rationale to choose medical school. It
should not be something that you do with the idea
of going back into film or something later on. It's
really medical school is obviously at medicine, and a career
in medicine is a tremendous commitment. So I kind of
went in thinking, all right, I'll just be a doctor
and then I can make movies later. And then once

(04:37):
I got into med school, I was like, okay, this
is a little bit more involved. I really have to
kind of sync myself in this in this information in
this study. So I just kind of really really dove
deep into med school. I studied really hard, never having
taken a science class before in undergrad or anything like that.
And then as far as picking sleep medicine, I just
wanted to try different specialties. I really liked a little

(04:58):
bit of everything, but I tried sleep medicine as a
resident in training. I realized that there was a lot
more to sleep medicine than just sleep apnea and seapath machines.
That's kind of where my interest in sleep medicine started.
And it's a really nice marriage of neurology and pulmonary
medicine and behavioral medicine all than one.

Speaker 2 (05:16):
So yeah, it is Oh my gosh, that is just
so fascinating. And you went to school for medicine. Where
did you go?

Speaker 3 (05:25):
I went to the University of Guadalajara in Mexico.

Speaker 4 (05:28):
Wow.

Speaker 3 (05:29):
It's an international school that's English speaking. It's mainly for
American students. And it's cool because you get to do
essentially half of medical school at the main campus in
Mexico and then your second half of med school because
usually the third and fourth years of med school are
clinical years, where you're in hospitals and clinic settings. So
the way that they have it set up is that
you do the entire third and fourth year in United

(05:50):
States hospitals. So it was pretty cool. I got to
be in Mexico for two years, and then I did
my years three and four in New York, and then
I graduated with my MD, and then I came back
to California for residency and then I did fellowship in
sleep medicine at UCLA.

Speaker 2 (06:04):
Wow, that's amazing. What a story.

Speaker 4 (06:08):
Mine is so similar. We had so much in common.
Oh wow, that is so cool.

Speaker 2 (06:15):
Well, I'm so lucky that I got to meet you,
because you know, I've always had issues with my sleep
since I was younger, and I finally did something about it,
and I was like, I have got to talk to
someone about it, and it's really changed my life. And
it is just such a fascinating field, I believe, and

(06:35):
I feel like it's also what's the word I'm looking for?
Under appreciated, not utilized enough? Why is that? Why don't
we get more opportunities to study our sleep or have
insurance cover certain things?

Speaker 4 (06:52):
Do you have answers for that?

Speaker 3 (06:54):
What an important question? And this is something that we
talk about a lot in terms of just sort of
sort of where sleep medicine and sleep disorders fit within
the landscape of health care and medicine, just because, first
of all, it's very multifactorial, and it starts sometimes with
people themselves. A lot of people have sleep issues and
don't know that there's such thing as a sleep doctor
that they can see, or a sleep study or sleep

(07:16):
test that they can complete to diagnose or evaluate what
their problem is. Believe it or not, there are a
lot of doctors and clinicians out there that don't know
that sleep medicine is a specialty and that they are
sleep specific or sleep specializing physicians like myself. So I
think awareness is a big part of it, a lack
of awareness in the general population as well as a
lack of awareness even in the healthcare population in the

(07:38):
healthcare setting. So that's one part of it. And then
another thing is sleep disorders are felt differently by every
single person. I mean, when we're talking about symptoms like fatigue,
daytime sleepiness, difficulties with concentration, irritability, and all the number
of other daytime issues that we see associated with sleep disorders.
Number One, they're not terribly specific, because there's only one

(08:00):
million reasons to be tired during the daytime and number
two a lot of people. Because human beings are so
good at adapting, we often kind of on our own
determine our own sort of remedies, whether it's you know,
scheduling an app in the afternoon, or having a certain
amount of caffeine to get through the day, or making
sure we get you know, a certain amount of sleep
at night time. So we have our own kind of

(08:20):
ways to adapt to things like sleep issues, and sometimes
that will also kind of prevent people from being evaluated
for sleep issues. So all that to say that it
is very multi factorial, everything from perception of symptoms to
just overall awareness of sleep as a specialty.

Speaker 2 (08:35):
Yeah, I was wondering, you know, did you have any
sleep issues as you were growing up or was any
of that part of your story at getting into this.

Speaker 3 (08:46):
Not exactly, but I did have as far as sleep issues.
I mean, I guess everybody experiences insomnia from time to time,
which we define insomnia as any difficulty falling asleep, any
difficulty staying asleep, or both of those things. We all
experiperience it. Here and there transiently. Sometimes it can be chronic.
But I guess the only sleep disorder that I can
think of that I have in my history is when

(09:07):
I was a teenager, like many other teenagers, probably well
over fifty percent of teenagers globally, I experienced what's called
delayed sleep face syndrome, which is a mouthful to just
say that a person who is sleeping later and waking
up later, which is very typical for the teenage age group, right,
And you know, you have a teenager very often who
has fallen asleep at four in the morning and fallen

(09:28):
asleep in class because they have to wake up at seven.
But then on the weekends they're sleeping till two three pm.
So that was definitely me. But not that that's also
not like this concerning or like a scary sleep disorder,
because that usually works itself out with right person getting
older and having to work.

Speaker 2 (09:44):
Yes, exactly, that makes so much sense. Well with my experience,
it's it's always, you know, you just sort of feel like, well,
everyone is tired, and I've always felt like that my
whole life. Everyone's tired. They're just hustling, and that's what
you do. So I, as you guys. Know, I've talked
a little bit about some of my sleep issues. I

(10:07):
brought it to the forefront because of this sleep study
that I got to take, which was wild. If you
saw the graphic that I posted for this episode, you
will have seen me in the corner, you know, hooked
up to all of this stuff. So when I first
went and saw doctor Kashani, you know, it was actually
so cool and it was sort of fun because you

(10:29):
ended up you talked to my husband for a little while.
We got him on the phone a couple times actually,
because as you had mentioned, you know, what's better than
having a great witness to your sleep than the person who's.

Speaker 4 (10:41):
Right next to you.

Speaker 2 (10:42):
And and sure Brett really had some things to say,
so he was able to clarify a few things for
doctor Kashani what was happening. And you had diagnosed me
originally what you thought was potentially idiopathic hypersomnia, and so
we sort of landed there. And then the idea was

(11:03):
that I would eventually get a sleep study to see
what that would tell us, which I ended up doing,
and essentially it landed right back where you had started,
which was it pretty much told us that based on
what had happened in the sleep study. So could you
explain a little bit about what happens in a sleep

(11:23):
study that isn't just for finding out if you have apnea,
because there are two kinds. I did the sleep apnea
test at home, so you need to talk a little
bit about that.

Speaker 3 (11:33):
Absolutely. So the sleep study that you did is a
two part sleep study. There's a nighttime portion and then
the daytime portion. Now, the nighttime portion of the study
you did is a very typical overnight sleep study that
we do in the center. It's similar to a home
sleep test, and that we're looking for kind of the
simple things like sleep apnea. But we have to do

(11:53):
that nighttime test before we do a daytime test to
make sure that your nighttime sleep is normal and that
you got enough sleep before you did the daytime test,
because the daytime test is really where we're diagnosing things
like narcolepsy at idiopathic hypersomnia. So the way that the
daytime test works is so first of all, the nighttime
you check in at night, you get hooked up to
the wires. There's brain wave monitoring, there's muscle monitoring with

(12:15):
wires on your legs, there's heart monitoring with wires on
the chest. There's respiratory or breathing monitoring with an oxygen
monitor on your finger and a canula up here. So
you get all wired up and then you sleep until
about six o'clock in the morning, and that's that. When
you wake up in the morning, you have a little
bit of a break, and then the daytime Sleep Touch.
The daytime Sleep test works a little bit differently. You

(12:35):
get five opportunities to take a nap, and each of
these nap opportunities is about twenty minutes in duration and
they are about two hours apart from each other. So
for example, nap number one would start at seven am
and go to seven twenty. Then you're free to hang
out or DM your sleep doctor on Instagram for example.

Speaker 2 (12:52):
Yeah, and I got to keep a jud you got
to keep you up to speed on what's going on
that sleeps.

Speaker 3 (12:56):
I loved. That was definitely. And then each two hours,
as two hours goes by, nine am to nine twenty
would be the second nap, and then eleven am to
eleven twenty the third nap, and so on and so forth.
And the way that we did the reason that we
do the test this way, it's not a perfect test,
but essentially what we're looking at is how quickly did
you fall asleep on each of these five naps, And

(13:19):
given that the first one starts at seven and the
last one ends like pretty much in the mid afternoon,
it kind of gives you an idea of how sleepy
are you during the daytime and how quickly can you
lapse into a drowsy state or a sleep state at
any given time of day from seven am to the
mid afternoon. So what we do is we take the
time that it took you to fall asleep across the
five naps and we average it. And the criteria for

(13:40):
what's considered pathologic sleepiness is if you fell asleep across
the five naps in an average of eight minutes or less,
and then as far as if you did meet that criteria,
then the diagnosis either becomes narcolepsy or idiopathic hypersomnia. What
separates those two from each other is if on those naps,
if you hit rem sleep abnormally early, which is a

(14:01):
feature of narcilepsy, then that supports the narchilepsy diagnosis. But
if you don't hit rem sleep on any of those
five naps, and you just meant the first criteria of
eight minutes or less than the diagnosis is idiopathic hypersong.

Speaker 2 (14:14):
Wow, spoken like a true a doctor. I mean, you
really encapsulated that perfectly. And when I found out when
they were like, you know, when you just explained you
get five sleep opportunities to take a nap, because I
think to myself, oh my god, five opportunities to take
a nap.

Speaker 4 (14:32):
That sounds like a dream.

Speaker 1 (14:34):
You know.

Speaker 2 (14:35):
I kind of took this as a little bit of
a vacation. Yes, it's uncomfortable. The night was uncomfortable mostly,
but then when I got to the daytime, I was
you know, every single time I took those naps, you
know what happened. I fell asleep under eight minutes, I
think with everyone, which is why we ended up with

(14:55):
idiopathic hypersomnia. I did not hit the rem sleep within
that time, so that excluded me from the narcolepsy club,
and so I remain over with idiopathic hypersomnia. One of
the things that really blew my mind was when you
had asked me, when you take a nap because I'm

(15:19):
so exhausted during the day all my life and I
just pushed through, push through. But if I ever get
an opportunity to take a nap, I'll take it. But
I don't like taking it because I don't want to
wake up, and when I do wake up, I feel
worse like I don't feel relieved, I don't feel refreshed.

(15:39):
And you would ask me that specific question, you said,
when you wake up from a nap, do you feel refreshed?
And I said, you know what, I don't.

Speaker 4 (15:47):
I don't know.

Speaker 2 (15:49):
And so the difference between would you say, someone who
has narcolepsy and then the hypersomnia, that's part of it.
The difference between those.

Speaker 3 (15:57):
Two definitely up a really good point. Now, with that said,
with IH and with narcolepsy, this is like a controversial
conversation in our field. When all of the sleep nerds
get together at the conferences that we go to, there's
always kind of a lot of talk about is IH
something separate from narcolepsy? Is it just another is it

(16:20):
just a type or a type two narcolepsy as we
would call it, and are we just giving it this
name for no reason when in fact, a lot of
these people who have IH, or who test positive for
IEH may have features of narcolepsy, while some people with
narcolepsy have you know, they may test positive for IH
and vice versa. So all that to say, there's a
lot of overlap between these two and many of us
in the sleep world actually don't necessarily separate these two.

(16:43):
They're seen as on one spectrum of hypersnolens. Bottom line,
these are all words. But if we're talking the classic
textbook kind of definition or picture of each one of
these two entities. So the classic narcolepsy picture is excessive
sleepiness that's always there. It's the prominent core feature, but
the secondary or ancillary symptoms they have might be different, Like,

(17:05):
for example, a lot of people with narcolepsy, and by
the way, before I say these ancillary symptoms, not even
everybody has these. What everybody always has is sleepiness that's
always present. But the secondary symptoms that are more narcolepsy
like are hallucinations in the moments that you're just falling asleep.
A lot of times people might feel like they started
dreaming already before they even fell asleep, or they might

(17:26):
see shadows or figures in their room, or hear voices
as they're just kind of drifting off similarly as they're
coming out of sleep, so like as they're just entering wakefulness,
similar they might have hallucinations there. So it's like kind
of at those transitions into and out of sleep that
they have these weird sort of phenomena. Similarly, also at
the sleep to wake and wake to sleep transition. A

(17:47):
lot of people with narcalypsy experience recurring sleep paralysis, which
sleep paralysis if anybody's ever had it, it's that scary
feeling where you feel like you just can't move, you're frozen.
You try to move or try to make a noise
and you can't. And sometimes people will have the two
of these things together where they'll have a hallucination and
be paralyzed at the same moment, which can be very scary.
Of course, now with that said, the healthy population of people,

(18:11):
we can all experience sleep paralysis and hallucinations falling asleep
or exiting sleep, but it just so happens that the
classic narcolepsy picture is the sleepiness plus these other things.
And then, as to what you were saying, the daytime
naps typically in narcolepsy are refreshing, and so that's pretty
much that's narcylepsy. Now, as far as IH, the classic

(18:33):
IEH picture is once again excessive sleepiness. That's always the
core feature, but as far as the daytime, another thing
that a lot of people with IH report is brain
fog as well as unrefreshing naps regardless of how sleepy
they feel. So they might feel really really sleepy and
the need to sleep, but they don't wake up feeling refreshed.
And similarly, a lot of people with IH when they

(18:53):
wake up in the morning from their nocturnal sleep, they
experience a lot of sleep inertia, which is like that feeling, yeah,
it's like really hard to wake the brain up kind
of feeling in the morning. And then one other thing
about IH classically is compared to narcolepsi, a lot of
people with IH will have very prolonged sleep times. When
they're left to sleep ad lib with no alarm clock,

(19:14):
they can sleep for like twelve fourteen, sometimes more hours
than that. So those are kind of like the textbook
descriptions of both, but again a lot of people fit
in between. A lot of people have features of one
and might actually test for the other, and not to
mention treatment is identical between the two so this is
all part of the reason why many of us feel
like this really just represents one spectrum.

Speaker 4 (19:34):
Wow.

Speaker 2 (19:35):
I mean, so when you go to like a sleep convention,
what side of the room are you on? And are
you ready to fight some other people?

Speaker 4 (19:44):
I'm kidding?

Speaker 2 (19:46):
So where do you stand with the with the difference
and the controversy with you know, having IH in its
own category, and you know, where are you with that
good question?

Speaker 3 (19:58):
I'm kind of undecided, to be honest with you, And
I say undecided because even though I do believe that
these two different entities, I mean, their classic pictures present
very differently from one another, despite the overlap of sleepiness.
But at the same time, I've seen so many people
the whole testing having one and testing positive for the
other thing has happened to me so many times that

(20:20):
that's kind of what makes me think, Okay, are we
actually talking about the same thing? And maybe these people
just express the symptoms differently or the syndrome differently. But
I also try not to get too tied up into
these into these things, because at the end of the day,
all these things are just words.

Speaker 4 (20:34):
You don't want the drama, darling, I want the dramas that.

Speaker 2 (20:40):
Well, I'm gonna show up at one of those conventions
and just strow the pot and be like, guess what
I think.

Speaker 4 (20:47):
Let me just.

Speaker 2 (20:48):
Also clarify or ask for some clarification. If you have
sleep paralysis and hallucinations, that doesn't necessarily mean that you
have IH or narcolepsy exactly correct.

Speaker 3 (21:05):
In fact, the most common triggers are the most common
causes of sleep paralysis, episodes and hallucinations at the sleep
wake and wake sleep transitions is sleep deprivation and stress.
So I, for example, recently took a trip to overseas
and it was a really long flight. It took like
twenty something hours just to get back to LA and
not to mention, I'm super sleep deprived and adjusted to

(21:27):
the time zone in the other country. And then as
soon as I got back home, I took a nap
in the middle of the day because I was so sleepy,
and then I woke up with a really intense sleep
paralysis and a hallucination to go with it, no.

Speaker 4 (21:38):
Way, Oh my gosh.

Speaker 3 (21:41):
Yeah, so those things can happen.

Speaker 4 (21:42):
To anybody, Oh my gosh.

Speaker 2 (21:44):
So yes, I've experienced sleep paralysis since I was young,
I've experienced hallucinations since I was young, not as much
when I was young, but I have noticed now that
makes sense when you bring stress into it, because I've
noticed that they kind of ebb and flow. You know.

(22:05):
I haven't had a lot of hallucinations, the terrifying ones
in several years that are really bad. But there was
a time where I would just see like a like
a serpent in front of me, like coming at me.
I'm like, oh, great, a serpent, how fun? Large insects

(22:26):
crawling up the walls. Yes, snakes figures like you said.
And now what I normally do in terms of my
hallucinations happen. As you had mentioned, there's a difference between
you know, falling asleep and having them and then waking up.
Mine are usually waking up and I'm having them, and

(22:47):
then I'm in the middle of the night going why
am I sitting up and staring at my my beautiful
pictures on the wall that I thought were clowns, you know, dancing,
you know on a cruise ship. You know, they're not
as scary, They're weird. And I usually fixate on something
in the room and it turns into something else. So
that's you know I could list off a million things,

(23:08):
but I also want to ask you, if you what
is your opinion on ghosts, because now that we know
about sleep paralysis and hallucinations when you're dreaming, so many people. Oh,
I think I lost you. Okay, we got disconnected. Literally

(23:31):
he went his screen went completely black. So I think
I know his answer. He believes in ghosts, because that
was paranormal activity.

Speaker 4 (23:39):
So getting back to my question, do.

Speaker 2 (23:42):
You believe that most of the paranormal activity or people
seeing things are due to sleep hallucinations?

Speaker 3 (23:51):
You know, it's interesting. I was asked a similar question
on another podcast recently.

Speaker 4 (23:56):
And me personally, I made up a question. No, I'm kidding.

Speaker 3 (24:03):
No, you know, I'm a very spiritual person honestly, but
this is what I do for a living, so it's
kind of hard for me to separate things like this
from just knowing that it's neurologic phenomena. Again, I don't
want to sound like a boring doctor and.

Speaker 2 (24:17):
Sound the church and state, Church and state. I get it,
you know it's the right answer. Well, I can say
my opinion, and I think it's a little bit of both.
I mean, I think that there most of the time
when people see something, it's usually in the middle of
the night, you know what I mean, Like, come on,
it's probably a hallucination.

Speaker 4 (24:37):
I mean, let's be real.

Speaker 2 (24:39):
If it's during the day, different story. But if you're
napping and it's during the day and you see it
during the day.

Speaker 4 (24:45):
It's probably a sleepy illucination.

Speaker 2 (24:47):
But that doesn't mean that I don't believe in those
types of activities and things of that nature. I am
totally open to that. So that being said, I just
never thought about that until recently. You know, it explains
a lot. I could have said that every place I've
lived in has been haunted because I'm seeing the craziest things,

(25:10):
but I never did because you know, I guess I
just knew obvious sleeping. And Okay, so doctor Kashani, we're
going to take a quick break and then when we
come back, I'm going to ask you all the darlings
questions that they have for you, and I know you'll
have the answers, So stay right there. So you know
how in the reality TV world everyone is always arguing

(25:31):
about take ownership, own it, own it, own it. Well,
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Speaker 4 (26:32):
Am I right?

Speaker 2 (26:33):
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(27:39):
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The link is in my podcast notes. Darling's let me

(28:00):
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(30:35):
that I sent you experience the new standard in bras
with Honeylove. Okay, we are back. I'm with doctor Kashani.
Oh I forgot to ask you, by the way, what
do your letters mean?

Speaker 4 (30:47):
Your MD?

Speaker 2 (30:48):
Obviously, but what does the DABSM stand for?

Speaker 3 (30:52):
So dabsim Actually it's technically a discontinued credential at this point.
It stands for diplom It stands for diplomatic. American Board
of Sleep Medicine, but the American Board of Sleep Medicine
a few years back they dissolved unfortunately, So now you
get certified in sleep medicine based on your primary specialty.
So if you did internal medicine, family medicine, pediatrics. You

(31:14):
get certified in sleep through that accreditation body. It's just
medical politics.

Speaker 2 (31:19):
They shut them down. I'm telling you give the sleep medicine.

Speaker 3 (31:24):
A chance, right, my thoughts exactly.

Speaker 2 (31:28):
Okay, all right, Well, we've got some really great questions.
Some are similar to others, so I'm going to try
to put them all in kind of some categories. But
first off, let's just talk about waking up in the
middle of the night staying asleep. Colleen wants to know.
She says, I fall asleep pretty easily in bed, dark,

(31:48):
cool room, but wake up a few hours later and
have difficulty falling back asleep. How can I stay asleep?

Speaker 3 (31:55):
Very good question, very common scenario that we see in
sleep clinics. So the difficulty with maint haining sleep as
opposed to the difficulty with initiating sleep in the first
part of the night, it always brings up the question
is is something happening during sleep itself that is unstable,
that is allowing for these awakenings or this fragmentation of
the nighttime sleep. The awakenings could very well just be

(32:15):
totally spontaneous, but by talking to a sleep doctor or
to your doctor a little bit more about kind of
you know, whether there are other issues like snoring or
anything else that might suggest that there's something happening during sleep,
like sleep apnea, Because sleep apnea, I mean, that's just
one example, but one of the most common symptoms of
sleep apnea when it's untreated is difficulty staying asleep. So

(32:36):
and that's just one sleep disorder that can cause that.
So all that to say that it very well could
be that none of that is at play here and
that we're this person is just having a spontaneous awakening
and then having difficulty getting back to sleep, in which
case that's a pretty clear cut case of insomnia, and
we've got wonderful treatment options for that that extend beyond
sleeping pills, which are not the first line treatment for insomnia.

(32:57):
But in general, when somebody has a pretty dominant or
an exclusive difficulty with maintaining sleep through the night, it
brings up a lot of other questions because again, it
suggests that there might be something happening during sleep that
may need to be tested on a sleep study. Compare
that to somebody who has exclusive difficulty with falling asleep
in the beginning of the night and once they are asleep,

(33:18):
sleep is stable and uninterrupted until they wake up in
the morning. That is less suggestive of something happening during sleep, obviously,
because a person hasn't fallen asleep yet. So that's that
paints more of the kind of clear insomnia picture. But
when it's the difficulty staying asleep and only staying asleep,
it could very well just be an insomnia picture. But again,
it does introduce the possibility that there's something during sleep

(33:39):
happening that could be causing the instability.

Speaker 2 (33:42):
Would you put that in the same category of somebody
who someone like Leah, who will read a little bit
each night and she will fall asleep and then she
says she wakes up after thirty minutes, and then she
feels like she's been asleep for six hours, and then
she's tossing or turning for an hour or two before
she can fall back asleep. Is that similar to somebody

(34:03):
who's been asleep for a few hours and then wakes up.

Speaker 4 (34:05):
Is it the same thing? Okay, very much?

Speaker 2 (34:08):
So Okay, Leah and Colleen, looks like you two need
to get together and figure this out.

Speaker 4 (34:14):
Sounds like we've got the same little issue.

Speaker 2 (34:16):
But I also find it interesting for you to that
you touched on insomnia being right at the you know, the.

Speaker 4 (34:21):
Top of top of the boards, right when you hit
the sack.

Speaker 2 (34:25):
So there are Like you said, the first line of
treatment may not be medicine. Do you give people exercises
to do before they go to sleep or how do
you typically try and treat the insomnia?

Speaker 3 (34:39):
Great questions. So when it comes to treating insomnia, sleeping
pills or hypnotics as we call them, they are an option,
and of course as a sleep physician, I do prescribe
them because every single person is different and every single
person's preference on how they want to treat their issue
is obviously different. So would that being the case, that
is an option. But the most effective treatment for insomnia,

(35:00):
based on all of insomnia literature that we have, and
you can look this up if you just google it,
you'll see tons and tons of data, is cognitive behavioral
therapy for insomnia, also known as CBTI. There is so
much data demonstrating how effective this treatment is. In fact,
there are even studies that have compared the effectiveness of
CBTI head to head versus sleeping pills like Ambient and
Lunesta and still CBTI shows superior effect both short term

(35:24):
and long term. So that's why we typically recommend CBTI
as first line therapy for adults with insomnia, and I myself,
I'll deliver the CBTI myself, or sometimes what can be
really effective in certain cases is just taking pieces of
CBTI or components of CBTI and then prescribing them by themselves,
because without getting too much into the detail of what's
involved in CBTI, it's like you can think of it

(35:46):
kind of like a little bit like a sleep boot
camp almost where essentially you're put on these kind of
protocols that are very well studied, behavioral protocols that are
very well studied. You're given a set of instructions, You're
given a sleep log or a sleep diary to track
your sleep and track your progress. And it goes way
beyond your typical basics of just having good sleep habits
and good sleep hygiene at nighttime, because we all know

(36:07):
that just having good sleep habits and making your room cool, dark,
and quiet is not enough to treat fifteen years of
insomnia usually, so that being the case, CBTI is a
little bit more involved than that, and as long as
the person is adherent, it really works better than anything else.
And the best comparison that I can make make with
CBTI is like, if I struggle with obesity and I

(36:29):
want to get on an evidence based diet that's been
proven to help people in my weight range and in
my age range, because I'm starting to get high blood
pressure and fatty liver and all that stuff. So what
do I do. I sign up with a nutritionist and
I have weekly sessions or weekly appointments with that nutritionist.
The first session, they're probably just going to give me
my diet, right, They're going to tell me what I
can eat, what I can't eat, what my calorie count

(36:50):
is for the day, what my macros, proteins, fats, carbs
for the day. Is give me a food log so
that I can log my meals and make sure I'm
tracking my weights in progress. And then every week when
I go back to that attritionists that those follow ups,
it's just looking at my diary, tracking how I'm doing,
making sure I'm not having difficulty with implementing the diet,
because diets are difficult obviously, So that's kind of how
CBTI is. In the very beginning. You're kind of given

(37:12):
this set of protocols and instructions that have been very
well studying, tons of evidence, and they just send you
on your way to practice those things and implement those things,
and you track it all in your sleep log and
have follow up visits to make sure you're going in
the right direction.

Speaker 2 (37:24):
What an incredible use of CBT. I had no idea.
I had no idea that there was something specific to
help people like that. That's really incredible. So let's move
on to some sleep episodes. I guess, for lack of
better words, what we touched on paralysis because Steven from

(37:45):
Creek Talk podcast shout out. He was asking, how can
I stop having sleep paralysis? It's been happening since I
was a kid, and I'm forty five and still getting it.
And we have a couple other people who chimed in
about wanting to know about sleep paralysis also. So one
of the things you had already touched on is that
you may not necessarily have IH or narcolepsy if you

(38:10):
do get the sleep paralysis, but if you do have
it and that's the only thing you have, how can
you help, Well, you said, stress, So just stop stressing out, Stephen,
I mean it's that simple. Yeah, what do you have
any suggestions on specifically sleep paralysis.

Speaker 3 (38:30):
Yeah, definitely. So if we are indeed talking about sleep paralysis,
sleep paralysis in the absence of any other suspicion that
there might be something else going on, because a history
of sleep paralysis for the last twenty thirty years plus
feeling tired and sleepy, well, now that's suspicious for narcolepsy.
But apart from that, if it is recurring and for
this long period of time, and we're not concerned for

(38:52):
sleepiness or any other sleep issue and it's just isolated
sleep paralysis, there is if it's really a problem. Because
of course sleep paralysis doesn't re wire treatment, but in
some cases the hallucinations and the paralysis can be frequent
enough to cause a lot of distress to the person
and not to mention the hallucinations themselves sometimes can be
very terrifying for a lot of people, and very often
that will bring them to ar clinic. As far as

(39:12):
options for treatment, low dose antidepressants actually have been shown
to be very beneficial in reducing the frequency of sleep
paralysis and hallucination episodes, and the reason.

Speaker 2 (39:22):
For maybe that's why I don't have them that much anymore,
because I am on a load doses as a r
Oh my gosh.

Speaker 3 (39:30):
That is very bad. That is very common. So an okay,
any medication that increases serotonin, or any medication that is serotonergic,
because serotonin has this effect that it can kind of
mask or reduce the phenomena of REM sleep. And I
say REM sleep meaning rapid eye movement sleep, because all

(39:52):
these things are sleep paralysis, hallucinations, falling asleep or waking up,
these are all components of rapid eye movement and sleep.
What happens when we're in rapidi movement sleep, our muscles
get totally paralyzed. And it's for that reason that we
don't act our dreams out because and it's exclusively during
rapidi movement sleep that our muscles is paralyzed. Because obviously
we move around all night when we're in other stages

(40:13):
of sleep, but when we're in that stage of sleep,
typically our muscles get paralyzed and we start dreaming. So
think about it like this sleep paralysis, hallucinations. It's kind
of like the muscle paralysis and the dreams and imagery
of REM sleep, except it's kind of spilling out a
little bit and leaking into that moment that you're just
waking up. For example, So when you take a serotonergic

(40:33):
medication like an SSRI or an SNRI, these medications, because
they can reduce REM sleep phenomena, they secondarily people notice
that the sleep paralysis and hallucinations improve as well.

Speaker 2 (40:44):
Well, here I am thinking I just must have outgrown them,
you know, even for a second. I mean, oh my gosh,
see I continue to learn.

Speaker 1 (40:53):
Well.

Speaker 2 (40:53):
On that note, I have another question about a sleep
episode situation. Julie says, So this is weird. I act
out my dreams and kick and punch in my sleep.
I remember these dreams and I'm usually fighting off an attacker,
so it's very violent. I scare my poor dog. I
can't seem to track if anything triggers it. Why am

(41:16):
I doing this?

Speaker 3 (41:18):
Julie is describing what we call REM sleep behavior disorder. Well,
she's specifically describing dream and actment behavior. But when we
hear dream and actment behavior, especially the way that you're
describing it, with the nature of the dreams surrounding conflict
and violence and things like that, it is very suggestive
of something called REM sleep behavior disorder, also known as RBD. Now, Julie,

(41:39):
I am definitely not diagnosing you with RBD on this podcast. However,
dream and actment behavior in general, I can tell you
it has a few causes. Funny enough, probably the most
common cause of dream and actment behavior is SSRIs and
Sarah's emergic medications. Also because again there's such an effect
on REM's sleep and the stability of REM sleep by

(42:02):
these meds that hallucinations, sleep paralysis, lack of paralysis during
dreams causing dream and actment behavior. These are all things
that kind of can become a little bit fuzzy in
the setting of serotinergic meds. So all that to say,
it sounds like she's describing that now. I don't know
if she takes antidepressants or it could be something else
causing it, because believe it or not, even sleep apnea

(42:22):
in some cases can cause a person to physically act
their dreams out anything that causes instability to sleep, which
sleep apnea is a breathing disorder during sleep that causes
respiratory interruptions to your sleep all throughout the night without
you realizing it. So it just creates really broken sleep
and poor quality sleep, and that's why people would sleep
apnea feel so tired during the day very often. But

(42:44):
anything that breaks your sleep all night, like sleep apnea,
creates such sleep state instability that complex phenomena like dream
and actment behaviors or even sleep walking can be precipitated
by sleep apnea, and in that case it should resolve
when the sleep apnms treat it, meaning that you stopped
acting your dreams out once you treated your sleep apnea.
But all that to say, the real concern here is

(43:07):
injury because a lot of people who have dream and
act behavior, who have RBD, they'll punch their partner in
the face because they're having a nightmare and that they're
in a fight. They'll fall out of bed. I've had
people that went to the emergency room after cracking their
head and have to get stitched, or people who will
walk into the walls. More rarely do they actually exit
the bed, but usually lots of flailing and thrashing around

(43:27):
in bed, punching the nightstand, punching the headboard, fracturing fingers,
black eyes on girlfriends. I mean, we see all kinds
of stuff in the setting of dream and acted behavior.
One other thing that I'll say about that is melatonin
is a question that comes up a lot in sleep, right,
like is melotonin good? Is it bad? What is it
good for? What does it help for? I take it
and it does nothing. I take it and it's amazing.

(43:48):
Melatonin as far as actual scientific use, because as a
sleep aid as a treatment for insomnia, there is no
good evidence to show that melatonin is an effective sleep aid,
which is why there's so much variability people's experience when
they take it.

Speaker 4 (44:01):
There's no evidence.

Speaker 3 (44:03):
Oh wow, not as a sleep aait. But the one thing,
the one very scientific and evidence based use of melatonin
is the way that your body is supposed to be
paralyzed during rapidi movement sleep when you're having dreams, so
that you don't act your dreams out. Melatonin actually helps
the brain function better in that sense of paralyzing the

(44:23):
muscles during sleep. It's kind of like our brain has
like a little bit of a light switch. As soon
as we go from whatever stage of sleep we're in
and we all of a sudden go into rem Literally,
our brain literally turns this light switch off and all
of our muscles just get shut down for that period
of time. Melatonin helps make that light switch work a
little bit better. So even some of the most violent

(44:43):
behaviors punging, kicking, screaming, yelling, hitting the partner, hitting the headboard,
the right dose of melatonin can actually keep all of
that under control.

Speaker 4 (44:52):
That is unbelievable.

Speaker 2 (44:55):
We are really getting some answer here today, you guys.
I am I feel like I'm changing the world.

Speaker 4 (45:00):
World and Rama.

Speaker 2 (45:00):
Darling, forget housewives. I'm just going to interview sleep doctors
for the rest but not okay, So speaking of sleep aids,
that will lead me to my next question, which I have.
You know, several people asked about the THHC situation. I'm
going to read you two questions. Number one from jewles

(45:21):
What are the safest and most effective sleep aids? Do
certain sleep aids cause dementia? Ambient works great for me,
but I worry taking it regularly isn't healthy long term?
Are sleep gummies with THHC a good option? And then
Alex asks is THHC beneficial or harmful for quality of sleep?

Speaker 3 (45:40):
A lot of good questions there, so as far as
the sleeping pills and the ambient question, you know, it's
one of those things where we have about eight medications
that have specific indication for the treatment of insomnia. Technically
there's more than that, but in terms of clinical practice
and standard of care and the way that we prescribe
meds these days, as sleep doctors, we're really selecting mainly

(46:02):
from eight evidence based sleep aids now Ambient and medications
like it. That represents three of those eight medications, those
medications in particular being Ambient, Lunesta and Sonata, and those
are brand names, but those medications, because they're so similar
to traditional benzodiazepines like xanax and atavan and klonopin and

(46:24):
valium and medications like that, and because those medications have
been studied a little bit better long term and demonstrated
cognitive and memory issues with prolonged or with consistent use
for long periods of time, it's fair to assume that
because ambient and those types of sleeping pills are so
chemically similar to those meds, that it is a potential
risk for developing a problem like that, a neurocognitive issue. However,

(46:50):
those meds, the sleeping pills we're talking about, they have
not been studied long term, and there are plenty of
people that take them for thirty forty years and have
no issues at all. So it's kind of one of
those things. It's not really well known, it's not really
well studied. We'll still prescribe these meds. Thankfully, we have
newer sleeping pills that work on a very different part
of the brain now and we're thinking that it's probably

(47:10):
safer compared to those. But the concerning thing with sleeping
pills with Ambient and medications like that is the automatic behaviors.
So sleep walking and sleep eating, those are things that
we see sometimes as a side effect with medications like Ambient,
So that's a separate issue. But as far as the dementia,
again it's not really well known. These things haven't been

(47:30):
studied longitudinally, but it is fair to assume that the
risk exists just because of how similar these mens are
to meds that have been better studied.

Speaker 2 (47:38):
And before you answer the THHC question, when you say
that it works on another medications, other medications work on
different parts of the brain, what part of the brain
do you focus on or is it the entire thing?
When you are dealing with sleep stuff, that's my scientific question.

Speaker 4 (47:54):
I'm so intelligent.

Speaker 2 (47:56):
When you're dealing with your sleep stuff, what part of
the brain.

Speaker 4 (47:58):
Are you dealing with.

Speaker 3 (48:04):
Hills these meds, So when it comes to these are
essentially our armamentary and sleeping pills that we prescribed. You know,
it's really when it comes to choosing an agent, it's
really just targeting what the sleeper, what the sleep disturbances. So,
for example, if the person has difficulty with falling asleep
in the beginning of the night, and then once they're
asleep sleep is totally stable and uninterrupted, then you could

(48:26):
technically just give that person a short acting sleeping pill
to just nudge them over into sleep, and then it's
out of their system in a few hours and they're
sleeping all the way to the morning. But if it's
a problem with the person staying asleep, or both falling
asleep and staying asleep, then electing to use a more
medium to long acting medication that they can take in
the beginning of the night and cover them for the
full duration of the sleep period. That's really kind of

(48:48):
the only sort of thought process choosing a medication.

Speaker 2 (48:52):
Okay, let's drill down on the THCHC. What are your
thoughts on that.

Speaker 3 (48:57):
You know with the THHC in general, with cannabis, there's
all kinds of medical uses, obviously, but probably the biggest
limitation is once again the lack of data. There's really
not a lot of good, solid, strong evidence studying the
effect of cannabis on sleep and improvements in sleep or
improvements in insomnia. A lot of people do experience a

(49:17):
reduced latency to sleep onset or just easier time falling
asleep when they take something like cannabis, but there is
also the possibility there is some suggestion that relatively similar
to alcohol, chronic cannabis use may suppress rabidi movements sleep,
which we definitely know that about alcohol, which is part
of the reason we feel the way we do when
we drink a lot. Alcohol is a very potent suppressant

(49:40):
of REM sleep, which is a stage of sleep that
your brain really needs at nighttime. So when you drink
a lot of alcohol, you end up in the first
four or five hours of the night, while the alcohol
is really active in your system, you end up really
not getting much REM sleep, and then all of a sudden,
towards the end you get kind of a little bit
of a rebound effect. So it's just kind of very
discontinuous and not restorative sleep. Quality, which contributes to the

(50:01):
hangover and the alcohol feeling. But cannabis may again poorly studied,
but there is some suggestion anecdotally that it may have
a similar effect in suppressing rabbit eye movements sleep with
consistent chronic use.

Speaker 2 (50:13):
Wow, so alcohol it affects the rapid eye movement, so
you don't go into that stage of sleep, So you're
stuck in the first stage.

Speaker 4 (50:25):
Yeah here essentially, Yeah, how does that?

Speaker 2 (50:27):
Because the alcohol does what to your brain to make
you not go into a deeper sleep.

Speaker 3 (50:33):
You know, alcohol is a is a neurotoxin in a
lot of ways. I mean, you know, you drink enough alcohol,
you can start having seizures. You drink enough alcohol, all
kinds of horrible things can happen. But definitely, as far
as just chemically, we know that alcohol has a very
potent effect on suppressing rem sleep. And interestingly, Wow, you
might hear from a lot of people who drink a
lot or who smoke a lot of weed, and then

(50:55):
they all of a sudden abruptly withdraw or abruptly stop
those things, and in the night following that abrupt cessation
of either one of those things, they start to get
just tons and tons of intense dreams, and essentially what
that represents is what we call a rem rebound when
somebody's had so much suppression of remsleep long term from
drinking or smoking, and then all of a sudden, the

(51:15):
brain kind of has this rebound effect where all this
rem starts to rush into our brains, which end up
resulting in the person having really vivid and sometimes intense
streams in those especially in those first few nights after
stopping the agent.

Speaker 2 (51:28):
Wow, that is really interesting. You know, when I was
doing my sleep study and I was doing the daytime
naps because I was aware after it was over what
had happened with the naps and thinking about all the
naps I've taken in my life. If I lay down,
I will immediately feel like I'm starting to dream pretty quickly.

Speaker 4 (51:50):
So what is that?

Speaker 2 (51:52):
Because if you're not really dreaming dreaming until you're an RAM,
and I'm not a RAM right away, why am I
starting to just have these dreams?

Speaker 3 (52:02):
It's a great question. So in general, you'll hear a
lot of people who when they take naps during the
day that that's the time where they actually notice or
they're more able to recall dreaming really, it goes back
to when our brain is suppressed of REM sleep, whether
it's from alcohol we'd or if it's just from being
really sleep deprived and then therefore very REM deprived when

(52:23):
we try to recover the sleep, whether it's during a
daytime nap or a weekend after a week of sleeping
three four hours nightly for the last few nights, when
you try to actually recover the sleep lost, usually your
brain is hungriest for REM, so it will try to
go into REM first, or it will try to go
into REM a lot earlier than normal, just because of
the deprivation and the rebound effect of the missing or

(52:46):
deprived REM sleep. So it's not actually uncommon at all
to during daytime naps experience dreams and even those same
hallucinations we were talking about. A lot of times people
will notice those more so during daytime naps, just because
again the brain as hungry as for remen as soon
as you try to recover, it'll try to go in
there first.

Speaker 4 (53:04):
Wow.

Speaker 2 (53:05):
But if I'm having the dreams right away, But I
wasn't detected having ari REM sleep when I was during
my sleep study, so I wasn't technically an RIM correct.

Speaker 3 (53:19):
You're asking such good questions right now. So the question
you just asked highlights the limitations and issues with that
test that you did. Because again, when all of us
sleep nerds get together at these conferences and we're talking
about kind of the limited tools that we have to
assess and diagnose a lot of sleep disorders, I mean
that sleep study, aside from being obnoxiously long in duration,

(53:43):
it's so imperfect in a sense that I'm trying to
look for rapidi movements and I'm catching the person on
just one day, one day, hoping that I can see
this one finding of their eyes moving in a certain
way and their brain wave severe in a certain way. Now,
if a person is a extremely sleepy, chances are I
can get them to meet that criteria of eight minutes

(54:04):
or less because they're a very sleepy person. But I
have no guarantee even if I'm super suspicious that they
absolutely have an earcilepsy because they're having paralysis and hallucinations
every single night for the last several years. But the
chance that I get rapidie movements on that sleep study
is never guaranteed. So this is why once again, being
testing and this whole overall picture of separating these two conditions.

(54:26):
It may just all be arbitrary and we're all talking
about one thing.

Speaker 2 (54:30):
Wow, I'm coming to the next convention. I swear I'm there.
I'm setting up my drama Darling podcast. Okay, this is
from Diane. I have been using my seapath for over
a year now for moderate sleep apnea and former insomnia.
I traveled up to your point. I traveled without it
recently and didn't sleep as well and felt groggy during

(54:53):
the day. My family will travel to Italy next year,
and I dread the thought of lugging my seapap from
place to place plus through customs. Do you have tips
for better sleep without it on a temporary basis or
should I just suck it up and deal with the
extra hassle.

Speaker 3 (55:10):
Well, a lot of people travel with seapaps these days.
In fact, most of the times when you get set
up on a seapap, it usually includes a travel bag
with it when you get it delivered, so that you
can kind of lug it around. And I go to
the airport all I travel a lot, and I see
the seapap bags at every single airport I go to.
But the easiest answer and solution i'd give you is
buy a travel seedpap. Travel seapaps are like literally this big.

(55:30):
They're so tiny they can fit in like your little handbag.

Speaker 2 (55:33):
Oh there's there's like a separate device for that. Oh
my gosh, cute. That's cute, and you can like bling
it out and stuff and like get it in a
little carrying case. I'm sure they have them.

Speaker 4 (55:45):
That's cool, all right.

Speaker 3 (55:47):
And then one other travel option is a lot of
people will actually get because seapap is one treatment for
sleep apnea. But another alternative treatment apart from seedpap is
the oral appliance for sleep apnea, and that's called a
mandibular Advancement device or an MAD. What it is is
a fancy looking mouthguard that it usually gets fitted by

(56:09):
a bio dentist. It's custom fitted to your teeth. It's
got a top and a bottom piece, and when you
put it in your mouth, what it does is it
moves your lower jaw slightly forward, and by moving your
jaw forward, then your tongue moves forward, and now your
airway kind of opens up a little bit. So a
seapap fixes sleep apnea because it blows his air through
your nose and it's the air pressure that keeps your

(56:30):
pipe open, whereas this mouthguard achieves that just by mechanically
moving your lower jaw forward and creating that opening. It
doesn't always. Yeah, it's a great alternative, and for many
people it works just as well as a seapap and
they don't need a seapap and they can just use
this and their sleep apne is treated. In fact, mild
and moderate cases of sleep apne aren't more likely to

(56:50):
have success with that compared to like really bad or
severe cases. But a lot of people will do that too.
They'll use their seapap at home and then get one
of those mouthguards and take that with them when they
go on trips. So that's another option.

Speaker 2 (57:01):
Wow, Okay, that's super interesting. I didn't know that that
was a thing. Some people mentioned that they've had sleep
studies done then nothing was detected, and then they have
to go back for multiple or and then they can't
because their insurance company won't cover a second one. Do

(57:22):
you have anything to speak on about regarding that.

Speaker 3 (57:26):
Yeah, definitely, So sleep studies in general and sleep services,
whether it's seat paps, tests, these things. Oftentimes insurance will
try to block these things for a multitude of reasons,
which is terrible. But I think that if you go
through a process like because a lot of people will
go through the process of getting tested for sleep apne

(57:46):
and things like that with their primary care doctor, which
is totally reasonable and good. But when it comes to
more complicated stuff or you know, you need to do
further testing or further evaluation, doing that kind of thing
with a sleep doctor can be helpful, just because we're
used to all of the insurance blocks and we kind
of know how to work around them and document things
a certain.

Speaker 4 (58:04):
Way that totally makes sense.

Speaker 3 (58:08):
Definitely can help.

Speaker 2 (58:11):
Here's a menopause question. Why in menopause do I wake
up through the night? I'm on hormones but still have
yet to sleep well for a year, And then someone
else asked if HRT hormone replacement therapy can help for
sleeping during menopause.

Speaker 3 (58:29):
You know, I have a lot of women that tell
me that once they started taking progesterone that that was
just their ultimate game changer. A lot of people take it,
specifically take progesterone and find it that has a little
bit of an anxiolytic property to it, meaning that it
helps with anxiety, it makes them relax a little bit,
can help them ease into sleep. So that is definitely
one thing that comes up in these conversations. But in

(58:51):
terms of just sleep disturbance and menopause, a couple of things.
Number One, there's a bit of a spike in the
development of sleep apnea above the age of fifty four
were males or females, and given that menopause more commonly
occurs around that same time, menopause itself sometimes can also
increase the sort of conversion to sleep appening or the

(59:11):
development of sleep mappa.

Speaker 4 (59:13):
Dding Wow, yes, believe it or not?

Speaker 3 (59:16):
Those hormonal Oh sorry, gh.

Speaker 2 (59:18):
Yeah, no, I believe yeah, exactly what you're saying. I
was going to say something similar, which is that, boyd
you know, the change of life sure really just messes
you the age of you know, this is not fair.

Speaker 3 (59:31):
Interestingly, there was a study that came out several years
ago where they took like one hundred and fifty five
postmenopausal females and basically put them through cognitive behavioral therapy
for insomnia and then also compared that to tai chi
And what they found on this study was that CBTI
being the most effective treatment for insomnia had very very

(59:53):
similar results as the study arm that patients just completed
tai chi. Now does that mean that taichi is just
as effective as CBTI? I don't know. Obviously, there's a
lot you can interpret from a study like that, but
bottom line is things that can increase the threshold for
arousal from sleep, like yoga, meditation, taichi. We don't understand

(01:00:15):
a lot of the science to it, but it works,
and there's data to show that these things can be
really beneficial to a lot of people, including that population.

Speaker 4 (01:00:22):
So that's just one other thing that is so cool.
I love that.

Speaker 2 (01:00:26):
Do they have tai chi and yoga at the sleep
conventions that I'll be joining you on. How would somebody
see a sleep doctor like yourself? Would they could they
go directly to you if they've got like a PPO
or could I mean or would they go to their
primary and get a referral? How would that work?

Speaker 3 (01:00:44):
Yeah? Definitely, just like with any other doctor, as long
as your insurance doesn't require that you have a referral,
you can absolutely just schedule an appointment or consultation with
a sleep physician at your local academic center. Sleep is
one of those things where you know, depending on where
you are in the world, if you're in a very
rural area, you may not necessarily have a sleep dot
down the street that you could go to. But usually
academic centers almost always have a sleep department or a

(01:01:07):
sleep division where you can see sleep physicians. And not
to mention, a lot of us in our specialty, a
lot of us do virtual or telemedicine as we call it.
So these days getting access or having access to a
sleep physician is actually a lot better compared to the
way it was before.

Speaker 4 (01:01:22):
Oh truly, yes.

Speaker 2 (01:01:24):
I went to my primary and I was finally like,
I just something's wrong, and she just said, you know, here,
go to the pulmonary branch of this office and you
will find a sleep doctor over there.

Speaker 4 (01:01:39):
And that was you.

Speaker 2 (01:01:40):
So it was very easy for me to do that.
I'm very grateful that it was just such a simple way,
and it really made me go, I wish I would
have just done this a long time ago.

Speaker 4 (01:01:51):
It was so easy to do. You know, I'm just.

Speaker 2 (01:01:53):
Going to ask you, is there anything that you would
like to share with the drama Darling audience as a
sleep doctor.

Speaker 3 (01:02:00):
Yeah? You know, one thing that I always like to
say is that a lot of people ask, Okay, what
should I do about this? And what should I do
about that? And what's the best sleep habit or what's
the best nighttime routine? And honestly, I always say the
same thing, which is the most important sleep habit that
you need to keep in mind is to just sleep.
Sleep when your body is asking for it. We live
in a society and we live in a time where

(01:02:21):
we're sleep depriving ourselves. So we're always trying to push
ourselves to the latest time that we can stay up
and then curtailing our mornings, you know, the end of
our sleep period by waking up early in the morning.
We're a chronically insufficient population. And not to mention, there's
a lot of mental and behavioral and cognitive factors that
interfere with sleep at nighttime, everything from stress, anxiety, depression,

(01:02:43):
which these days, in the crazy world we live in,
definitely a lot of things come up at nighttime that
interfere with people's ability to sleep. So I think the
most important thing is when your body is asking for sleep,
listen to it. If it's not asking for sleep, then
don't stress about it, because the last thing you want
to do is have your mind get in the way
of what your body is wanting to do. Naturally.

Speaker 2 (01:03:03):
Would you say that somebody who gets maybe four to
six hours a night doesn't feel like they need any more.
Is that okay?

Speaker 3 (01:03:12):
It's is it okay? Yeah? I think it's okay as
long as the person is getting by and functioning. I mean,
I wouldn't encourage somebody to cut or curtail or cut
their sleep, you know, just because they feel okay when
they wake up, Because we know that your brain and
body do require a certain amount of sleep, and of
course you're going to feel okay if you cut that
by an hour or two. But I would encourage that

(01:03:32):
person to just, once again, going back to what I said,
listen to their body and sleep the full amount that
their body is asking for, because anybody can wake up
early and say I'm good, But that's sleep deprivation, okay,
And truly we're all guilty of.

Speaker 2 (01:03:46):
Yeah, right, I mean eight hours is really what we're
aiming towards, right, is it?

Speaker 3 (01:03:52):
Eight? So I'm glad this came up. So there's really
no magic number in terms of hours, because everybody's sleep
requirement is unique and different. Some people require six and
when we say require, that means that they're not able
to sleep more than that. There's a big, big, big
thing to differentiate is what is a person who just
requires less sleep, Like they just need their six hours,
and as long as they get their six hours, they

(01:04:13):
can't sleep anymore and they feel totally rested when they
wake up and they're good during the daytime. That's very
different from a person who requires seven hours and sleeps
six hours, or requires eight hours and sleep six hours.
Six hours still is a good amount of sleep, but
that person's brain is asking for seven or eight, in
which case I would encourage that person to sleep the
full duration of their sleep. And the only way to

(01:04:33):
really know what your natural individual brain sleep requirement is is,
first of all, this is very unrealistic, but give yourself
a good like ten to fourteen nights of sleeping, totally
ad lib sleeping as much as you can until you
can't sleep anymore, and then get up, and then just
do that for a period of time and you'll get
an idea what your body's natural sleep requirement is in

(01:04:54):
that setting, which, of course, like they said, it's not released.

Speaker 2 (01:04:57):
That's very cool. Yeah, take it too week vacation. Figure
it out so hard about that? You know what I
was just realizing is that Leonardo DiCaprio was in one
of the greatest dream movies of all time, Inception. Oh
that's right, and you worked on the film Shutter Island.

(01:05:19):
I wonder if you would have stayed in the game
just a little bit longer, if you would have worked
on Inception.

Speaker 4 (01:05:24):
What do you think of that movie?

Speaker 3 (01:05:25):
I love it, you know, I haven't seen it in
such a long time. I don't even really remember that
movie too. I remember loving that movie, but I need
to go back and watch it again to remind myself that.

Speaker 2 (01:05:36):
Yeah, I hadn't either. And then I was on a
flight recently within the last couple of years, and I
was like, you know what, I'm want to watch this
movie again.

Speaker 4 (01:05:45):
And it really holds up. It's so good.

Speaker 2 (01:05:49):
Well, maybe you can marry the two things together your
film career and you're sleep medicine and you can write
the next great sleep dream movie that will rival Inception,
or team up with Leo again and do Inception two.

(01:06:09):
Because it was so good. They should do it again.

Speaker 3 (01:06:12):
You should help, We should do this. We should co
screen ride.

Speaker 2 (01:06:15):
That sounds good sounds good, Doctor Kashani, I am so
grateful that you took time to do this, and I
just feel so enlightened. I think the darlings will feel
very enlightened. And I would like to ask you to
share where people can find you social media or how
they can reach you.

Speaker 3 (01:06:33):
Definitely, so you can find me on Instagram, I'm at
Sam Kashawi, MD, and I'm also on LinkedIn and I
practice here at UCLA in Los Angeles. I practice out
of the Santa Monica location in UCLA. But like I said,
I do see patients over video telemedicine. In person, I
see patients of all ages for all sleep related issues.
So those are some ways you can find me.

Speaker 4 (01:06:55):
That's great. Do you see kids? Do you ever get
kids in there?

Speaker 3 (01:06:59):
Quite frequently? Yes, absolutely, thankfully. Most of the time. In kids,
it is a behavioral issue, like the parents have a
little bit of difficult time setting limits, or maybe a
baby who needed to be sleep trained a few years
ago just never got sleep trained and it's been an
ongoing problem. So well. More often pediatric sleep issues are
like that, but we still have a lot of pediatric

(01:07:19):
sleep apnea, and not to mention narcolepsy very commonly develops
in the early teens or in the second decade of
life in many cases. So a lot of times we'll
see teenagers who may have been sleeping totally normally and
then all of a sudden, at fourteen, they started sleeping
for twelve hours and falling asleep in class all the time,
despite having ten hours sleep at night time. So that's
something that we'll see in pediatric sleep as well.

Speaker 2 (01:07:42):
I might have to have you come back and talk
about pediatric sleep stuff.

Speaker 4 (01:07:46):
Well, thank you so much. I really appreciate it, and
I know it's great drama right well, thank you, talk to.

Speaker 2 (01:07:53):
You soon forward.

Speaker 3 (01:07:55):
Thanks again.

Speaker 1 (01:07:56):
Drama Darling, Drama Darling.