According to the Academy of Sleep Medicine (AASM), the Sleep Research Society (SRS), and the National Sleep Foundation (NSF), adults should regularly sleep at least 7 hours a night to promote optimal health. However, over one-quarter of adults do not meet this recommendation. (Oops, me included!) AASM states that about 30% of adults have insomnia symptoms, and about 10% of adults have insomnia that is severe enough to cause daytime repercussions. What is it about sleep that it’s so important to have? What is the parameter of good and quality sleep? What are the health risks of not sleeping enough? In this episode, we tackle it all: sleep, dreams, the sleep cycle, sleeping pills, sleep disorders, and so much more!
We are joined today by Dr. Meredith Broderick, a triple-board certified sleep neurologist and the Founder of Sound Sleep Guru, a boutique sleep telehealth service focused on discovering the root of individualized sleep problems. She received her BA in Chemistry from The Ohio State University as Summa Cum Laude, MD from The Ohio State University College of Medicine, Neurology Residency at the University Hospitals of Cleveland, and Sleep Disorders and Behavioral Sleep Medicine Fellowship at Stanford University. Dr. Broderick is on the Medical Advisory Board of Ozlo Sleepbuds®, wireless biometric sensors to help optimize the sleeping experience. She has been the Assistant Professor of Neurology at Case Western Reserve School of Medicine, the Sleep Lab Director at Alaska Neurology Center, and the Medical Director at several sleep centers in Seattle, Washington.
Livestream Air Date: June 28, 2023
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hello, hi friends!
(00:07):
Happy Friday!
Happy Friends of Franz Friday!
I hope you all had a great sleep last night if you're listening to this early in the
morning or in the afternoon.
If you're listening right before bedtime, I hope you have a great sleep ahead.
Ugh, sleeping.
It's such a dream.
Literally.
I love to sleep.
Especially when I have to be awake at 4.30am or 5am for work.
(00:30):
I wish I could just have the luxury of just going back to sleep and not worry about not
getting paid because the dollars will just fall from a tree.
Okay Christian Franz, wake up.
Literally and figuratively.
Sorry for all the sleeping puns, but it's the center of our podcast topic today so I
cannot help myself.
Please don't snooze me.
(00:52):
Joking aside, sleep.
I love to do it, but I must admit it's not my best friend.
For as long as I can remember, ever since I was probably 5 years old from some of my
earliest memories, I have always had a hard time falling asleep.
Sometimes just rolling around the bed for an hour or two or even the whole night.
My mind racing, thoughts endless, and then I just find myself waking up somehow that
(01:17):
morning.
Tired.
Exhausted of course.
But how long should one actually sleep to live life to the fullest by feeling great
or even at the bare minimum just feeling okay to function?
According to the American Academy of Sleep Medicine or AASM, the Sleep Research Society
or SRS, and the National Sleep Foundation, NSF, adults should sleep at least 7 hours
(01:40):
a night to promote optimal health.
But over one quarter of adults actually do not meet this recommendation.
Oops, I'm raising my hand right now.
Me included.
AASM states that about 30% of adults have symptoms of insomnia and about 10% of adults
have insomnia severe enough to cause daytime consequences.
(02:00):
But why?
Why is it that when we don't have enough sleep, it's so hard to function?
What is it about sleep that it's so necessary for us to have the human experience of living?
Why do we sleep?
Is there a right way to fall asleep or be asleep?
Do I really have insomnia or is it simply because I have wifi and I'm too caught
up on my Netflix dramas right before bedtime?
(02:23):
In today's episode, we talk about it all.
Sleeping, dreams, nightmares, the sleep cycle, sleep aids, sleep disorders like insomnia,
sleep apnea, narcolepsy, restless leg syndrome, you name it, and so much more.
It's just rightful to have a sleep expert with us, and so I am beyond honored to have
(02:44):
Dr. Meredith Broderick, a triple board-certified sleep neurologist, fellowship trained in sleep
disorders and behavioral sleep medicine, founder of boutique practice Sound Sleep Guru, assistant
professor of neurology, sleep lab director, and medical advisory board of Ozlo Sleepbuds
to keep us awake tonight discussing these topics.
You're in for a dream, so try not to snore.
(03:06):
Have a good day.
Hello!
Hello!
Hi, doc!
How are you doing?
Hey, yeah, I'm really happy.
It's been a year now.
It's so exciting for us.
We met at Dr. Sugai's celebratory party, and I was like, wow, this is the perfect time
because since I started the podcast series almost three years ago, I need a sleep medicine
(03:27):
physician.
I was like, I don't know anybody, and then it just so happens that we met.
So thank you so much for joining me today, doc.
If you could first please introduce yourself to everyone.
Thank you.
Sure.
Hi, I'm Dr. Broderick.
I'm a sleep therapist.
I'm a sleep therapist.
I'm a sleep therapist.
Everyone, thank you.
My name is Meredith Broderick, and I am a sleep medicine physician out in the Seattle,
(03:50):
Washington area.
And yes, it was so great to meet you.
There's so many good colleagues that were at that party for Dr. Sugai, which is a thing
for his one million TikTok followers.
Yeah, so I am a neurologist by training, and I have my own little boutique practice out
here in the Northwest.
And sleep medicine is what I do.
(04:11):
I mean, it's amazing.
I feel like sleep medicine is such a niche specialty as well, right?
A subspecialty.
I think the first time I've ever heard of it was when I was still working bedside.
And I think one of the discharge papers said, refer to a sleep medicine specialist.
I was like, oh, there's such thing as sleep medicine.
There's like, yeah, there's also lifestyle medicine and obesity medicine.
(04:32):
It's just so interesting, I guess, throughout the years and decades, how subspecialized
medicine is becoming, which is great.
I guess we're targeting so many issues that people need help with, right?
I guess before people were like, who do I go to for sleep problems?
Is it a psychiatrist, a neurologist?
I guess we have our own subset now.
(04:54):
I wanted to ask first your journey into medicine.
What made you enter this field that's so long until so many sacrifices, like family, friends,
or personal experience?
Yeah, I think part of it was family and that my mother was a professor at a medical school
in town.
And so grew up going into the anatomy lab.
(05:15):
And I think the first time I held a human brain in my hands, I was probably like seven
or eight years old, pretty young.
And also my grandfather had wanted to become a physician.
And we, our family, have physicians going all the way back to the Civil War times.
I'm actually adopted by a family that part of our roots are in Missouri.
(05:36):
And my mom's dad actually really wanted to be a physician, but ended up going off to
fight in World War II and then sort of never followed through on his dream.
And so it was interesting because my mom named me after a physician in our family.
And so I felt like it was meant to be.
I mean, I feel people outside of medicine or health care in general are really not aware
(05:59):
regarding the road it takes to become a doctor, right?
Such a long road is four years of undergrad, X amount years of presidency, going anywhere
from three to seven years.
And then if you'd be fellowship and sub-specialized and so much sacrifices involved, right?
It can be financial and missing family and friends' birthdays and so much studying.
(06:21):
At the end of it all, now that you have been practicing as an attendant, having your own
practice, do you have any regrets in pursuing this long, long field of medicine?
Right now, I feel pretty happy about it.
But I'll tell you, I didn't always feel that way.
And I questioned it a lot at times because I think the main thing for me has been, you
know, as a woman delaying kids, you know, can result in some challenges in terms of
(06:45):
having to be able to have babies at an older age and things.
I think I'm aware of that.
And you know, since I live in Seattle and there's a lot of tech here, you see a lot
of people having success at a very young age and you're like, wow, I was like just going
into debt more and more at that age, right?
(07:07):
Or you know, even people who go into like financial like investment making and stuff,
you realize like it might not be the best way to become financially independent at a
younger age.
So I think there are some drawbacks.
But right now, I feel pretty happy and satisfied.
Yeah, speaking of love what you're doing, I guess, like I was saying, that sleep medicine
is something that's so niche and sub specialized.
(07:28):
So I know you did neurology residency and then you did like sleep medicine fellowship,
right?
Why neurology and then why sleep medicine?
For me, part of the reason I chose neurology is I loved neuroscience and I love the neurological
exam and I loved how the diagnostic thinking part of being a neurologist that really appealed
(07:52):
to me.
So mainly it was just the material.
I really liked that area of medicine and I really liked the thinking, the very cerebral
nature of it.
And then sleep medicine.
So once I finally got into neurology, a lot of the residency training in neurology is
inpatient.
It's like stroke, neurology, neuro ICU, so people who have infections in their nervous
(08:15):
system like meningitis or even people with brain tumors and things like that.
And so it's very acute.
It's very like high pressure life or death.
People are really sick.
And when I was doing that, I realized that was really taking an emotional toll on me.
I was really having a hard time with it.
And so one of the faculty members at where I trained mentioned sleep medicine and she
(08:37):
said you should do a visiting rotation at Stanford.
That's like the place to go for sleep medicine fellowship.
So I went there for two weeks and it gave me so much hope about what I was seeing because
the sleep doctors were talking about preventing stroke, about preventing cardiovascular disease,
fixing up a sleep disorder with a mental health disorder and that being a misdiagnosis.
(08:59):
But if you treat the sleep disorder, the person's mental health condition gets better.
And so that whole preventative nature of it really appealed to me after seeing sort of
the other side.
And you can go into sleep medicine by many ways.
You can be a psychiatrist, as you mentioned, you can be a psychiatrist, you can be an ENT
doc, you can be an internal medicine doc, you can be a lung doctor.
So it also is a very multidisciplinary field.
(09:21):
Dentists, orthodontists, surgeons, you know, we all work together.
And so that really appealed to me about sleep medicine as well.
Yeah, and I think that's something that the whole interdisciplinary role is.
But we'll talk a little bit more.
I mean, speaking of sleep now, now that we're veering into it and I'm actually sitting in
my bed, how timely is this?
Well, I guess as a physician, I feel like sleep is something that should be deprived
(09:43):
of for quite a few years of your life, right?
In med school, especially residency in the hours.
I guess just the act of sleeping in itself.
Why is it so important?
Like what is the function of sleep?
Why do we have to, you know, take a rest for these amount of hours at night?
(10:03):
Like where did this come from?
Yeah, it's interesting because there are a lot of theories about why we sleep.
And I think some of it we're still figuring out.
But the main one that we do know is if you know a little bit of physiology, you'll know
that there's what's called the blood brain barrier.
So there's no actual like around the brain.
There's not blood around the brain.
There's something called cerebrospinal fluid.
(10:26):
And we think that during sleep is when our brain clears itself of metabolic waste.
So as our cells metabolize energy, they produce waste just like anything that's happening,
any chemical reaction.
And that's the time that our brain removes it and removes those like byproducts of those
cellular reactions.
(10:47):
So that's one thing the brain is cleaning itself.
And the other thing is that we're learning, we're consolidating memories, we're figuring
out what do we need to hold on to?
What can we get rid of?
You know, we don't remember every single detail from every day.
We, you know, remember what's important.
And then we also create connections with our experience from the past so we can make new
(11:07):
connections and build.
And so learning is a big one, cleaning the brain from metabolic waste.
And so it has this restorative process to it.
Those are some of the big things that some people think there's a temperature regulation
that might be playing a role because we do have this change in our temperature when we
sleep.
Some people think that energy conservation is part of it, it's a way to conserve energy
(11:31):
by resting this, you know, third of our lives at night when the sun goes down and it might
be dangerous to be out in the world, which it is before electricity.
So interesting.
I mean, I've read a book, I forgot what it was called before.
I think it's called The Why We Sleep or something like that.
And I know there's like so many, I guess, explanations and theories about why we sleep
(11:52):
and all of the nuances about it.
Now when we're talking about sleep, I think most things, I guess, in healthcare and medicine
or about the body, we think of something like the optimal state, right?
As a sleep specialist, is there an optimal hours that I should be sleeping or is it like
dependent if we're talking to a child or someone in their seventies or what not?
(12:14):
Yes.
You know, the average is going to be somewhere between seven to nine for most adults.
Children definitely need more sleep and probably into your early twenties, you probably need
a little bit more than that.
But for adults, it's going to be in the range of seven to nine and it does vary.
Yeah, I mean, outside of optimal, I think, regarding to the hours, I think the question
(12:35):
that came a lot in my DMs when I started promoting our livestream is the idea of, you know, quality
sleep.
I guess for some people too, they could be sleeping maybe seven hours, but they wake
up still so tired and so groggy or what not.
Such thing as a definition for like a parameter of what classifies as quality sleep.
(12:56):
Yeah.
So, I mean, I think there are some subjective measures, like just things that people report,
like whether they feel rested during the day, whether they had a lot of fragmentation, maybe
like did they wake up a lot during the night.
But there are more objective measures we use, you know, so sleep efficiency is one data
point we use.
(13:17):
It's the percentage of time that someone's asleep, that they're in bed, a ratio of the
total sleep time over the time in bed.
There are also other measures, like sometimes people look at the sleep architecture.
That's where we look at the four stages of sleep and look at the percentages of those
four stages and then how the pattern of how someone cycles throughout them through the
(13:39):
night.
So there's kind of an ideal pattern that we consider.
Yeah.
Can you briefly talk about those four stages of sleep that you mentioned?
Sure.
Yeah.
So the four stages of sleep are divided into two types.
There's non REM sleep and REM sleep.
And then non REM sleep has three stages, one, two, and three.
(13:59):
And as you go from one to two to three, it gets deeper, deeper, meaning it's harder to
wake that person up.
And then stage REM is the rapid eye movement sleep.
That's when most of our dreaming occurs and they have different characteristics based
on when we record in sleep studies, we can distinguish them mainly through brainwaves.
Yeah, so interesting.
(14:19):
I mean, I think I saw a video before of, I was like, why is it called the rapid eye movement?
And I guess our eyes are literally rapidly moving, right?
And underneath that, I was like, this is so interesting and so scary as well.
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You also mentioned that when you get enough sleep, it's kind of like set for the day,
right?
You always have a good day if you have a good number of hours of sleep.
And I want to focus on that aspect of the day, right?
Like, oh, I sleep throughout the night and then I'm good for the day.
But there are people who are what they call night owls and they sleep in the day and they're
(18:06):
like all up at night.
And I guess people who also work night shift as well outside of people who are just like,
oh, I'm a night owl.
Do we have data on sleep in the night versus the day?
Are bodies made to sleep for the night?
So we in sleep medicine, they're called chronotypes.
So we have what are called owl chronotypes and then we have lark chronotypes.
(18:28):
So larks are the early morning people.
The owl chronotype is going to be more of a night owl.
Most people are going to be kind of in the middle where they fit into the culturally
normal day.
But we do have these outlying people that their preferential time or the time they're
most alert is more morning, like an extreme morning and then people who have more of a
(18:50):
night owl tendency.
And it has to do with the genetic traits.
It can be influenced by environment, mainly light.
And also it varies throughout our lifespan.
So we all tend to have more of an owl tendency as we're in our teenage years.
We usually shift more towards being a lark as we get older, which makes a lot of sense
(19:11):
if you think about young people like to go out, they like to stay up late and sleep in
and then your citizens are going for the early work special.
So there are reasons for that.
Do we know of any possibly health impacts though?
Let's say I sleep on the day versus the night.
Do you prefer if your patients sleep throughout the night as opposed to like the day?
(19:32):
So it really depends.
So the main health risk is if one, you're very irregular.
So some days you're this way and some days you're not.
So that's when it really becomes a health issue is when you're sleeping, we call it
out of phase with your circadian rhythm.
So if you are a night owl, but you're always a night owl and you're still really regular,
(19:54):
you go to bed at four in the morning and you get up at noon every day, you go to bed at
four in the morning.
We don't necessarily think that that by itself could that population of people who have that
genetic risk be at a higher risk for certain conditions.
People are very interested in studying that and there may be some research and I don't
know how definitive it is where there might be risks associated with that.
(20:17):
But the real one is where there's that circadian misalignment where someone really their body
wants to sleep at four in the morning, but they're getting up at four in the morning
to go into nursing is a huge occupational risk for like shift work, right?
Because there's so many nurses that work night shift.
So that's when it does become health risk and we know that for instance, like nurses
(20:41):
have a higher risk of fertility issues, maybe even some kinds of cancer because of that.
I must say though that I used to work night shift and most of the, I guess, older nurses
that were on night shift with me, it's so interesting to see that we're taking hypertensive
medications as opposed to those who were working in the day shift.
(21:02):
I was like, we can do an actual research study on this in our unit.
So yeah, it's so, so interesting.
And you also mentioned about dreams earlier.
I guess this can go into a spectrum of like very physiologic and scientific to something
psychological like Freud, right?
Do we know what's the purpose of dreaming?
Why do we have dreams at night and why do some maybe don't have or they just don't
(21:25):
remember it, I guess?
Yeah.
So we think that everybody dreams and that, you know, one of the functions of dreaming
is to sort through like the daytime experiences, put them into our memory or make associations
between other things that have happened in the past.
We think the reason why some people don't remember their dreams is because they don't
(21:47):
have any awakenings during the dream.
But if we were to like watch someone and wait for them to go into REM sleep and then wake
them up and go, what were you dreaming about or were you dreaming that people would remember
better?
Like the way REM sleep was discovered, this is actually what they did is they would like
(22:07):
hook up the electrodes so then they would see the rapid eye movements and then they
would wake people up and they might see someone's eyes going like this and the person would
wake up and say they were, you know, watching a tennis match, you know?
Sometimes people just don't remember, but it is happening.
Dreams are just so weird and it's just so interesting.
(22:28):
Like you can have the craziest dreams ever and then there's dreams that make you hopeful
and there's dreams that make you wake up, like you run and then there's dreams where
you feel like you fell and then you like suddenly jumped up, right?
Dreams are just so interesting.
Well, outside of dreams and outside of nightmares as well, I feel like sleep, as with any physiologic
behavior that we have, I mean, the body's not perfect.
(22:50):
There's disorders that come with it too and you are the expert in this.
In your office or I guess just in sleep medicine as a whole, when it comes to bread and butter,
would you say that there's like top three reasons why someone would see a sleep physician?
Yeah, snoring and sleep apnea is probably number one, directly or indirectly.
(23:10):
So either the person's bed partner or family has a concern about the person's snoring
or breathing during sleep or, you know, they were diagnosed with high blood pressure and
their cardiologist told them like you need to go see a sleep doctor because of that other
health issue.
I would say number two would probably be insomnia, so difficulty falling asleep or staying asleep.
(23:34):
And then probably number three would be daytime sleepiness.
So feeling sleepy.
Got it.
And I guess let's go through each like very briefly.
Sleep apnea, when the snoring become kind of like, oh, I should see a doctor for this.
You know, some people are like, oh, I snore when I'm tired.
(23:56):
When would be the barometer of like, oh, the snoring is no longer just, I guess, a tired
night, it's actually obstructed sleep apnea.
Yeah.
So I think if you ask different sleep doctors or different doctors, you would get different
opinions on this.
But for me, anytime the snoring is an issue, they should come in.
So if it's loud enough to bother a bed partner, you know, that raises my concern because then
(24:21):
it's affecting your partner's sleep too.
If the person is waking up a lot or not feeling really rested and alert through the day, that's
another reason to come in to see someone.
We also think about like associated conditions like high blood pressure, migraines, depression.
There are these other things where we just raises our suspicion a little bit.
(24:42):
We want to screen for sleep apnea because all those things get better with, you know,
identifying.
I must say though that sleep apnea can be quite scary.
I mean, I've had a patient when I used to work in, I think I quoted to the CT ICU one
day, one of my patients was on telemetry and, you know, it has the respirations on it.
And like every few minutes or so, I would get the apnea alert on the telemetry monitor.
(25:05):
I was like, oh my gosh, why is my patient's respiration zero like every few minutes?
And I was like, do you have sleep apnea?
And they're like, no, I don't know, but I've been having this house as a kid.
So we actually got a sleep medicine physician to actually diagnose the patient.
So it can actually be quite scary, right?
I mean, going next to insomnia, I was going to send you a meme that I saw on my timeline
(25:28):
the other day.
He said, do I actually have insomnia or is it just a wifi?
So I think we've reached a point where people are just up on their phones at night and I
guess with the light as well, or I guess people's minds become busier with what they consume
on their phones or on their computers.
People don't get to sleep or watching the okay dramas like me, I guess.
(25:51):
When is it that, I guess as with the previous question, when is it a concern when, oh, I'm
tossing and turning.
It's just a bad night or is it actually insomnia?
I guess, how do you diagnose someone as an insomnia?
Yeah.
Well, there's different types of insomnia, but the one that is kind of the bread and
butter of sleep medicine practice is called chronic insomnia.
(26:13):
And we think that you have to experience it more than three days a week for over three
months.
So there's this kind of like normal difficulty sleeping that happens with life transitions,
with stressors that we think will pass if you just wait, the person will kind of solve
whatever's on their mind and it will pass.
(26:34):
If it's very long standing and very frequent of that nature, that's when we definitely
want someone to see a specialist.
There's also a questionnaire that I use sometimes to get more an objective measure of how severe
insomnia is called the insomnia severity index.
And it's just a bunch of questions and you score it and it can kind of tell you like
(26:55):
if it's in the category.
It's so difficult.
If you can't sleep, it's like you're doomed for the rest of the day.
It's like can't focus, your brain is cloudy and all of that.
And I guess for the third one is daytime sleepiness.
Is that the same thing as narcolepsy or is narcolepsy some more severe thing compared
to daytime sleepiness?
Yeah.
(27:16):
So daytime sleepiness is the most prominent symptom in narcolepsy and then in a category
of sleep disorders called primary hypersomnia.
And that is like in what I would call the differential diagnosis of day-to-dayness is
a primary hypersomnia like narcolepsy.
But of course there are also other sleep disorders like what are called circadian rhythm sleep
(27:40):
wake disorders.
There's also the sleep disorder breathing category.
So that's really my job is to take that symptom of daytime sleepiness and say what is it?
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(31:28):
Now that we've talked about sleep, and we've also talked about disorders of sleep, I guess
the answer that people really want is how do we fix these things?
Yes, someone comes up to you in your office, gets a consult, and is like, Doc, I'm having
these problems with sleeping.
What is your approach to that?
What modalities do you offer this patient?
(31:48):
Is it medications right away?
No, definitely not medications right away, just because medications are not always the
best option.
But when my patients see me, I usually first do a 60 to 75 minute consultation with them,
and a lot of it is just talking, and really getting to know and understand, one, the problem,
(32:09):
the nature of the problem, two, their lifestyle, three, their medical history.
And then, as a physician, I kind of think of myself as a pattern recognizer.
We recognize patterns, right?
And so I'm sort of able to start understanding, okay, these are the patterns that I see that
kind of fits with this, like either it's a sleep apnea, or it's a combination.
(32:30):
It's very common to see people with more than one to have sleep apnea.
And so I might order a sleep study to confirm and to see what their breathing is like.
I might have them wear a sleep tracker called Actigraphy to look at their sleep wake patterns
over more of like a seven day period.
I might have them keep a sleep diary.
So I usually want to collect more data.
(32:53):
And then that experience that I have from working with people for a really long time
can help me understand like, oh, this person's daytime sleepiness fits with this pattern.
Like some people come with a story, and you're like, that story sounds an awful lot like
narcolepsy.
He could test you for narcolepsy.
(33:13):
So that's my job is to really communicate with people in a way that I can see what's
wrong by talking to them and by collecting the additional data.
And I guess sleep problems have become kind of like an epidemic now, right?
It's a consternation, I guess, across the world, and people are desperate to sleep,
right?
They're tired.
They have things to do.
They have work the next morning.
(33:34):
They obviously can't function without sleep.
And so I guess outside of sleep disorder becoming an epidemic in itself, I feel like people
trying so many things to get to sleep has also become such a big practice, right?
And I think a big part of that is melatonin, right?
We see it as gummy bears, we see it as pills and tablets.
(33:56):
I guess as a sleep doctor too.
So many of your patients have, I guess, tried melatonin of its varying dosages.
What do we know about melatonin?
How safe is it to consume?
Is it nightly or just for like a get over a jet lag?
Yeah.
So melatonin is a hormone that's naturally made within our body by a little structure
in our brain called the pineal gland.
(34:17):
And what we're seeing in the sleep medicine community is, well, melatonin is actually
generated in darkness.
So when the light stops getting a signal that there's light, the pineal gland starts making
it.
So because of all this light, artificial light in our environment, like from screens and
even electricity, like overhead lights, street lights, city lights, we're not making as much
(34:40):
of it.
And so we know, for instance, that we sleep about an hour less than our ancestors did,
you know, two years ago.
And we think that's because one of the reasons because of light.
So I think that's one of the reasons why people are reaching for melatonin is like, I think
from how people know that, like, they're not making as much of it, right?
So the problem in the US is that melatonin is not a pharmaceutical grade product in the
(35:05):
sense that there have been studies showing there's variable amounts in like, you know,
if you buy a brand, like, and it says three milligrams, there's not actually three milligrams
in there.
And there are other things in there.
So that's one problem.
I heard this year at the sleep meeting that there is also concern about that it can delay
(35:25):
puberty if kids are part of it now.
I don't know by how long and I don't know that, like, you know, so if it's delaying
puberty by a year, and I don't know what the statistics shows, but I don't know that that
necessarily has any long lasting consequence.
On the other hand, melatonin is a potent antioxidants.
(35:46):
It probably maybe the reason it's delaying puberty is because it has an anti aging property.
I don't know.
But in my mind, the real concern that I have about melatonin is that most people don't
use it correctly.
They put it in the way that could be really effective.
And sometimes they're using it, and they really need a different treatment.
(36:06):
And so it's kind of like, yeah, and I guess outside of melatonin, the hormone, I think
one more thing that I wanted to touch was, I guess, an electrolyte that I didn't really
know actually supposedly helps for sleep, which is magnesium.
I know you created a post on this too.
I mean, what have you seen with magnesium and sleep?
Like do you think it's better to get it like in supplement form or should we rely on like
(36:29):
our dietary sources for magnesium?
And does it help with sleep at all?
Yes, it does help with sleep.
So the post that you're talking about, when I researched that, what I found was that in
the nutritional literature, that magnesium deficiency is becoming more common just because
of our processed diet.
Because most of the magnesium we get, like in terms of food consumption, is from green
(36:52):
leafy vegetables, you know, and also they have to be raw to really absorb it.
And so just aren't really eating that as much anymore.
But I also read that the best way to absorb magnesium is actually from tap water.
But if you think about how people are not, they're drinking all these like soft drinks
and stuff and fancy drinks instead of tap water, like they're probably not getting
(37:14):
the minerals they need from the water.
It probably depends where you live if you have magnesium in your water.
So I think that's a real thing.
As far as for sleep, I mean, the research doesn't really support taking it for like
insomnia, let's say.
But we do think magnesium deficiency can cause like these generalized sleep complaints.
Like when you measure the serum level of magnesium, it doesn't really represent what's going on
(37:36):
in the body, because it's mostly stored in our bones and tissue.
But like leg cramps, restless legs, those are the sorts of things where we might try
it and just see if it's helping.
And of course, I think taking it to answer your question, like taking it as a supplement
or food is good.
The supplements can cause like magnesium citrate can cause diarrhea.
(37:57):
So you have to think about that.
I know for myself, like when I looked into it, there are also some certain brands of
water that do fortify the water with magnesium.
So that's an option too, is to if you can't get your tap water tested, you could drink
bottled water.
This is also helpful.
I mean, I might just bone with some of the information that you're spitting right now,
(38:20):
Doc, especially when it comes to melatonin.
Well, I guess to end it all, I mean, I guess sleep is becoming such an epidemic and sleep
is such an important thing, right?
And even I myself, and I don't have enough sleep.
I mean, I guess when I was way younger, I was so proud of, oh, I can only, I can function
with three hours of sleep every night.
(38:41):
And I guess now it's just kind of, I was like, wow, I need like six or seven hours of sleep.
And as a sleep medicine physician, you see people who are struggling with so many sleep
disorders have all types of things.
And I guess to end it all, what would be your message to someone out there in the world
who's just struggling so much with sleep and, you know, just their life is in shambles because
(39:07):
they cannot sleep?
What would be your message to that person as a sleep medicine expert?
I think my message would be that we can fix these things and we can correct them and you
can feel better.
Yeah, I mean, I'm so surprised by all of this information.
It's just such an interesting and such a niche field.
And I feel so honored to be able to talk to you today and get all of this negative information.
(39:31):
So Dr. Meredith, thank you so much for joining me tonight.
Oh, thank you for having me.
I really appreciate it.
You have a great rest of the day that you get to rest finally and have a good sleep
tonight.
Thank you.
Thank you, you too.
Hello, hi friends!
(00:07):
Happy Friday!
Happy Friends of Franz Friday!
I hope you all had a great sleep last night if you're listening to this early in the
morning or in the afternoon.
If you're listening right before bedtime, I hope you have a great sleep ahead.
Ugh, sleeping.
It's such a dream.
Literally.
I love to sleep.
Especially when I have to be awake at 4.30am or 5am for work.
(00:30):
I wish I could just have the luxury of just going back to sleep and not worry about not
getting paid because the dollars will just fall from a tree.
Okay Christian Franz, wake up.
Literally and figuratively.
Sorry for all the sleeping puns, but it's the center of our podcast topic today so I
cannot help myself.
Please don't snooze me.
(00:52):
Joking aside, sleep.
I love to do it, but I must admit it's not my best friend.
For as long as I can remember, ever since I was probably 5 years old from some of my
earliest memories, I have always had a hard time falling asleep.
Sometimes just rolling around the bed for an hour or two or even the whole night.
My mind racing, thoughts endless, and then I just find myself waking up somehow that
(01:17):
morning.
Tired.
Exhausted of course.
But how long should one actually sleep to live life to the fullest by feeling great
or even at the bare minimum just feeling okay to function?
According to the American Academy of Sleep Medicine or AASM, the Sleep Research Society
or SRS, and the National Sleep Foundation, NSF, adults should sleep at least 7 hours
(01:40):
a night to promote optimal health.
But over one quarter of adults actually do not meet this recommendation.
Oops, I'm raising my hand right now.
Me included.
AASM states that about 30% of adults have symptoms of insomnia and about 10% of adults
have insomnia severe enough to cause daytime consequences.
(02:00):
But why?
Why is it that when we don't have enough sleep, it's so hard to function?
What is it about sleep that it's so necessary for us to have the human experience of living?
Why do we sleep?
Is there a right way to fall asleep or be asleep?
Do I really have insomnia or is it simply because I have wifi and I'm too caught
up on my Netflix dramas right before bedtime?
(02:23):
In today's episode, we talk about it all.
Sleeping, dreams, nightmares, the sleep cycle, sleep aids, sleep disorders like insomnia,
sleep apnea, narcolepsy, restless leg syndrome, you name it, and so much more.
It's just rightful to have a sleep expert with us, and so I am beyond honored to have
(02:44):
Dr. Meredith Broderick, a triple board-certified sleep neurologist, fellowship trained in sleep
disorders and behavioral sleep medicine, founder of boutique practice Sound Sleep Guru, assistant
professor of neurology, sleep lab director, and medical advisory board of Ozlo Sleepbuds
to keep us awake tonight discussing these topics.
You're in for a dream, so try not to snore.
(03:06):
Have a good day.
Hello!
Hello!
Hi, doc!
How are you doing?
Hey, yeah, I'm really happy.
It's been a year now.
It's so exciting for us.
We met at Dr. Sugai's celebratory party, and I was like, wow, this is the perfect time
because since I started the podcast series almost three years ago, I need a sleep medicine
(03:27):
physician.
I was like, I don't know anybody, and then it just so happens that we met.
So thank you so much for joining me today, doc.
If you could first please introduce yourself to everyone.
Thank you.
Sure.
Hi, I'm Dr. Broderick.
I'm a sleep therapist.
I'm a sleep therapist.
I'm a sleep therapist.
Everyone, thank you.
My name is Meredith Broderick, and I am a sleep medicine physician out in the Seattle,
(03:50):
Washington area.
And yes, it was so great to meet you.
There's so many good colleagues that were at that party for Dr. Sugai, which is a thing
for his one million TikTok followers.
Yeah, so I am a neurologist by training, and I have my own little boutique practice out
here in the Northwest.
And sleep medicine is what I do.
(04:11):
I mean, it's amazing.
I feel like sleep medicine is such a niche specialty as well, right?
A subspecialty.
I think the first time I've ever heard of it was when I was still working bedside.
And I think one of the discharge papers said, refer to a sleep medicine specialist.
I was like, oh, there's such thing as sleep medicine.
There's like, yeah, there's also lifestyle medicine and obesity medicine.
(04:32):
It's just so interesting, I guess, throughout the years and decades, how subspecialized
medicine is becoming, which is great.
I guess we're targeting so many issues that people need help with, right?
I guess before people were like, who do I go to for sleep problems?
Is it a psychiatrist, a neurologist?
I guess we have our own subset now.
(04:54):
I wanted to ask first your journey into medicine.
What made you enter this field that's so long until so many sacrifices, like family, friends,
or personal experience?
Yeah, I think part of it was family and that my mother was a professor at a medical school
in town.
And so grew up going into the anatomy lab.
(05:15):
And I think the first time I held a human brain in my hands, I was probably like seven
or eight years old, pretty young.
And also my grandfather had wanted to become a physician.
And we, our family, have physicians going all the way back to the Civil War times.
I'm actually adopted by a family that part of our roots are in Missouri.
(05:36):
And my mom's dad actually really wanted to be a physician, but ended up going off to
fight in World War II and then sort of never followed through on his dream.
And so it was interesting because my mom named me after a physician in our family.
And so I felt like it was meant to be.
I mean, I feel people outside of medicine or health care in general are really not aware
(05:59):
regarding the road it takes to become a doctor, right?
Such a long road is four years of undergrad, X amount years of presidency, going anywhere
from three to seven years.
And then if you'd be fellowship and sub-specialized and so much sacrifices involved, right?
It can be financial and missing family and friends' birthdays and so much studying.
(06:21):
At the end of it all, now that you have been practicing as an attendant, having your own
practice, do you have any regrets in pursuing this long, long field of medicine?
Right now, I feel pretty happy about it.
But I'll tell you, I didn't always feel that way.
And I questioned it a lot at times because I think the main thing for me has been, you
know, as a woman delaying kids, you know, can result in some challenges in terms of
(06:45):
having to be able to have babies at an older age and things.
I think I'm aware of that.
And you know, since I live in Seattle and there's a lot of tech here, you see a lot
of people having success at a very young age and you're like, wow, I was like just going
into debt more and more at that age, right?
(07:07):
Or you know, even people who go into like financial like investment making and stuff,
you realize like it might not be the best way to become financially independent at a
younger age.
So I think there are some drawbacks.
But right now, I feel pretty happy and satisfied.
Yeah, speaking of love what you're doing, I guess, like I was saying, that sleep medicine
is something that's so niche and sub specialized.
(07:28):
So I know you did neurology residency and then you did like sleep medicine fellowship,
right?
Why neurology and then why sleep medicine?
For me, part of the reason I chose neurology is I loved neuroscience and I love the neurological
exam and I loved how the diagnostic thinking part of being a neurologist that really appealed
(07:52):
to me.
So mainly it was just the material.
I really liked that area of medicine and I really liked the thinking, the very cerebral
nature of it.
And then sleep medicine.
So once I finally got into neurology, a lot of the residency training in neurology is
inpatient.
It's like stroke, neurology, neuro ICU, so people who have infections in their nervous
(08:15):
system like meningitis or even people with brain tumors and things like that.
And so it's very acute.
It's very like high pressure life or death.
People are really sick.
And when I was doing that, I realized that was really taking an emotional toll on me.
I was really having a hard time with it.
And so one of the faculty members at where I trained mentioned sleep medicine and she
(08:37):
said you should do a visiting rotation at Stanford.
That's like the place to go for sleep medicine fellowship.
So I went there for two weeks and it gave me so much hope about what I was seeing because
the sleep doctors were talking about preventing stroke, about preventing cardiovascular disease,
fixing up a sleep disorder with a mental health disorder and that being a misdiagnosis.
(08:59):
But if you treat the sleep disorder, the person's mental health condition gets better.
And so that whole preventative nature of it really appealed to me after seeing sort of
the other side.
And you can go into sleep medicine by many ways.
You can be a psychiatrist, as you mentioned, you can be a psychiatrist, you can be an ENT
doc, you can be an internal medicine doc, you can be a lung doctor.
So it also is a very multidisciplinary field.
(09:21):
Dentists, orthodontists, surgeons, you know, we all work together.
And so that really appealed to me about sleep medicine as well.
Yeah, and I think that's something that the whole interdisciplinary role is.
But we'll talk a little bit more.
I mean, speaking of sleep now, now that we're veering into it and I'm actually sitting in
my bed, how timely is this?
Well, I guess as a physician, I feel like sleep is something that should be deprived
(09:43):
of for quite a few years of your life, right?
In med school, especially residency in the hours.
I guess just the act of sleeping in itself.
Why is it so important?
Like what is the function of sleep?
Why do we have to, you know, take a rest for these amount of hours at night?
(10:03):
Like where did this come from?
Yeah, it's interesting because there are a lot of theories about why we sleep.
And I think some of it we're still figuring out.
But the main one that we do know is if you know a little bit of physiology, you'll know
that there's what's called the blood brain barrier.
So there's no actual like around the brain.
There's not blood around the brain.
There's something called cerebrospinal fluid.
(10:26):
And we think that during sleep is when our brain clears itself of metabolic waste.
So as our cells metabolize energy, they produce waste just like anything that's happening,
any chemical reaction.
And that's the time that our brain removes it and removes those like byproducts of those
cellular reactions.
(10:47):
So that's one thing the brain is cleaning itself.
And the other thing is that we're learning, we're consolidating memories, we're figuring
out what do we need to hold on to?
What can we get rid of?
You know, we don't remember every single detail from every day.
We, you know, remember what's important.
And then we also create connections with our experience from the past so we can make new
(11:07):
connections and build.
And so learning is a big one, cleaning the brain from metabolic waste.
And so it has this restorative process to it.
Those are some of the big things that some people think there's a temperature regulation
that might be playing a role because we do have this change in our temperature when we
sleep.
Some people think that energy conservation is part of it, it's a way to conserve energy
(11:31):
by resting this, you know, third of our lives at night when the sun goes down and it might
be dangerous to be out in the world, which it is before electricity.
So interesting.
I mean, I've read a book, I forgot what it was called before.
I think it's called The Why We Sleep or something like that.
And I know there's like so many, I guess, explanations and theories about why we sleep
(11:52):
and all of the nuances about it.
Now when we're talking about sleep, I think most things, I guess, in healthcare and medicine
or about the body, we think of something like the optimal state, right?
As a sleep specialist, is there an optimal hours that I should be sleeping or is it like
dependent if we're talking to a child or someone in their seventies or what not?
(12:14):
Yes.
You know, the average is going to be somewhere between seven to nine for most adults.
Children definitely need more sleep and probably into your early twenties, you probably need
a little bit more than that.
But for adults, it's going to be in the range of seven to nine and it does vary.
Yeah, I mean, outside of optimal, I think, regarding to the hours, I think the question
(12:35):
that came a lot in my DMs when I started promoting our livestream is the idea of, you know, quality
sleep.
I guess for some people too, they could be sleeping maybe seven hours, but they wake
up still so tired and so groggy or what not.
Such thing as a definition for like a parameter of what classifies as quality sleep.
(12:56):
Yeah.
So, I mean, I think there are some subjective measures, like just things that people report,
like whether they feel rested during the day, whether they had a lot of fragmentation, maybe
like did they wake up a lot during the night.
But there are more objective measures we use, you know, so sleep efficiency is one data
point we use.
(13:17):
It's the percentage of time that someone's asleep, that they're in bed, a ratio of the
total sleep time over the time in bed.
There are also other measures, like sometimes people look at the sleep architecture.
That's where we look at the four stages of sleep and look at the percentages of those
four stages and then how the pattern of how someone cycles throughout them through the
(13:39):
night.
So there's kind of an ideal pattern that we consider.
Yeah.
Can you briefly talk about those four stages of sleep that you mentioned?
Sure.
Yeah.
So the four stages of sleep are divided into two types.
There's non REM sleep and REM sleep.
And then non REM sleep has three stages, one, two, and three.
(13:59):
And as you go from one to two to three, it gets deeper, deeper, meaning it's harder to
wake that person up.
And then stage REM is the rapid eye movement sleep.
That's when most of our dreaming occurs and they have different characteristics based
on when we record in sleep studies, we can distinguish them mainly through brainwaves.
Yeah, so interesting.
(14:19):
I mean, I think I saw a video before of, I was like, why is it called the rapid eye movement?
And I guess our eyes are literally rapidly moving, right?
And underneath that, I was like, this is so interesting and so scary as well.
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You also mentioned that when you get enough sleep, it's kind of like set for the day,
right?
You always have a good day if you have a good number of hours of sleep.
And I want to focus on that aspect of the day, right?
Like, oh, I sleep throughout the night and then I'm good for the day.
But there are people who are what they call night owls and they sleep in the day and they're
(18:06):
like all up at night.
And I guess people who also work night shift as well outside of people who are just like,
oh, I'm a night owl.
Do we have data on sleep in the night versus the day?
Are bodies made to sleep for the night?
So we in sleep medicine, they're called chronotypes.
So we have what are called owl chronotypes and then we have lark chronotypes.
(18:28):
So larks are the early morning people.
The owl chronotype is going to be more of a night owl.
Most people are going to be kind of in the middle where they fit into the culturally
normal day.
But we do have these outlying people that their preferential time or the time they're
most alert is more morning, like an extreme morning and then people who have more of a
(18:50):
night owl tendency.
And it has to do with the genetic traits.
It can be influenced by environment, mainly light.
And also it varies throughout our lifespan.
So we all tend to have more of an owl tendency as we're in our teenage years.
We usually shift more towards being a lark as we get older, which makes a lot of sense
(19:11):
if you think about young people like to go out, they like to stay up late and sleep in
and then your citizens are going for the early work special.
So there are reasons for that.
Do we know of any possibly health impacts though?
Let's say I sleep on the day versus the night.
Do you prefer if your patients sleep throughout the night as opposed to like the day?
(19:32):
So it really depends.
So the main health risk is if one, you're very irregular.
So some days you're this way and some days you're not.
So that's when it really becomes a health issue is when you're sleeping, we call it
out of phase with your circadian rhythm.
So if you are a night owl, but you're always a night owl and you're still really regular,
(19:54):
you go to bed at four in the morning and you get up at noon every day, you go to bed at
four in the morning.
We don't necessarily think that that by itself could that population of people who have that
genetic risk be at a higher risk for certain conditions.
People are very interested in studying that and there may be some research and I don't
know how definitive it is where there might be risks associated with that.
(20:17):
But the real one is where there's that circadian misalignment where someone really their body
wants to sleep at four in the morning, but they're getting up at four in the morning
to go into nursing is a huge occupational risk for like shift work, right?
Because there's so many nurses that work night shift.
So that's when it does become health risk and we know that for instance, like nurses
(20:41):
have a higher risk of fertility issues, maybe even some kinds of cancer because of that.
I must say though that I used to work night shift and most of the, I guess, older nurses
that were on night shift with me, it's so interesting to see that we're taking hypertensive
medications as opposed to those who were working in the day shift.
(21:02):
I was like, we can do an actual research study on this in our unit.
So yeah, it's so, so interesting.
And you also mentioned about dreams earlier.
I guess this can go into a spectrum of like very physiologic and scientific to something
psychological like Freud, right?
Do we know what's the purpose of dreaming?
Why do we have dreams at night and why do some maybe don't have or they just don't
(21:25):
remember it, I guess?
Yeah.
So we think that everybody dreams and that, you know, one of the functions of dreaming
is to sort through like the daytime experiences, put them into our memory or make associations
between other things that have happened in the past.
We think the reason why some people don't remember their dreams is because they don't
(21:47):
have any awakenings during the dream.
But if we were to like watch someone and wait for them to go into REM sleep and then wake
them up and go, what were you dreaming about or were you dreaming that people would remember
better?
Like the way REM sleep was discovered, this is actually what they did is they would like
(22:07):
hook up the electrodes so then they would see the rapid eye movements and then they
would wake people up and they might see someone's eyes going like this and the person would
wake up and say they were, you know, watching a tennis match, you know?
Sometimes people just don't remember, but it is happening.
Dreams are just so weird and it's just so interesting.
(22:28):
Like you can have the craziest dreams ever and then there's dreams that make you hopeful
and there's dreams that make you wake up, like you run and then there's dreams where
you feel like you fell and then you like suddenly jumped up, right?
Dreams are just so interesting.
Well, outside of dreams and outside of nightmares as well, I feel like sleep, as with any physiologic
behavior that we have, I mean, the body's not perfect.
(22:50):
There's disorders that come with it too and you are the expert in this.
In your office or I guess just in sleep medicine as a whole, when it comes to bread and butter,
would you say that there's like top three reasons why someone would see a sleep physician?
Yeah, snoring and sleep apnea is probably number one, directly or indirectly.
(23:10):
So either the person's bed partner or family has a concern about the person's snoring
or breathing during sleep or, you know, they were diagnosed with high blood pressure and
their cardiologist told them like you need to go see a sleep doctor because of that other
health issue.
I would say number two would probably be insomnia, so difficulty falling asleep or staying asleep.
(23:34):
And then probably number three would be daytime sleepiness.
So feeling sleepy.
Got it.
And I guess let's go through each like very briefly.
Sleep apnea, when the snoring become kind of like, oh, I should see a doctor for this.
You know, some people are like, oh, I snore when I'm tired.
(23:56):
When would be the barometer of like, oh, the snoring is no longer just, I guess, a tired
night, it's actually obstructed sleep apnea.
Yeah.
So I think if you ask different sleep doctors or different doctors, you would get different
opinions on this.
But for me, anytime the snoring is an issue, they should come in.
So if it's loud enough to bother a bed partner, you know, that raises my concern because then
(24:21):
it's affecting your partner's sleep too.
If the person is waking up a lot or not feeling really rested and alert through the day, that's
another reason to come in to see someone.
We also think about like associated conditions like high blood pressure, migraines, depression.
There are these other things where we just raises our suspicion a little bit.
(24:42):
We want to screen for sleep apnea because all those things get better with, you know,
identifying.
I must say though that sleep apnea can be quite scary.
I mean, I've had a patient when I used to work in, I think I quoted to the CT ICU one
day, one of my patients was on telemetry and, you know, it has the respirations on it.
And like every few minutes or so, I would get the apnea alert on the telemetry monitor.
(25:05):
I was like, oh my gosh, why is my patient's respiration zero like every few minutes?
And I was like, do you have sleep apnea?
And they're like, no, I don't know, but I've been having this house as a kid.
So we actually got a sleep medicine physician to actually diagnose the patient.
So it can actually be quite scary, right?
I mean, going next to insomnia, I was going to send you a meme that I saw on my timeline
(25:28):
the other day.
He said, do I actually have insomnia or is it just a wifi?
So I think we've reached a point where people are just up on their phones at night and I
guess with the light as well, or I guess people's minds become busier with what they consume
on their phones or on their computers.
People don't get to sleep or watching the okay dramas like me, I guess.
(25:51):
When is it that, I guess as with the previous question, when is it a concern when, oh, I'm
tossing and turning.
It's just a bad night or is it actually insomnia?
I guess, how do you diagnose someone as an insomnia?
Yeah.
Well, there's different types of insomnia, but the one that is kind of the bread and
butter of sleep medicine practice is called chronic insomnia.
(26:13):
And we think that you have to experience it more than three days a week for over three
months.
So there's this kind of like normal difficulty sleeping that happens with life transitions,
with stressors that we think will pass if you just wait, the person will kind of solve
whatever's on their mind and it will pass.
(26:34):
If it's very long standing and very frequent of that nature, that's when we definitely
want someone to see a specialist.
There's also a questionnaire that I use sometimes to get more an objective measure of how severe
insomnia is called the insomnia severity index.
And it's just a bunch of questions and you score it and it can kind of tell you like
(26:55):
if it's in the category.
It's so difficult.
If you can't sleep, it's like you're doomed for the rest of the day.
It's like can't focus, your brain is cloudy and all of that.
And I guess for the third one is daytime sleepiness.
Is that the same thing as narcolepsy or is narcolepsy some more severe thing compared
to daytime sleepiness?
Yeah.
(27:16):
So daytime sleepiness is the most prominent symptom in narcolepsy and then in a category
of sleep disorders called primary hypersomnia.
And that is like in what I would call the differential diagnosis of day-to-dayness is
a primary hypersomnia like narcolepsy.
But of course there are also other sleep disorders like what are called circadian rhythm sleep
(27:40):
wake disorders.
There's also the sleep disorder breathing category.
So that's really my job is to take that symptom of daytime sleepiness and say what is it?
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(31:28):
Now that we've talked about sleep, and we've also talked about disorders of sleep, I guess
the answer that people really want is how do we fix these things?
Yes, someone comes up to you in your office, gets a consult, and is like, Doc, I'm having
these problems with sleeping.
What is your approach to that?
What modalities do you offer this patient?
(31:48):
Is it medications right away?
No, definitely not medications right away, just because medications are not always the
best option.
But when my patients see me, I usually first do a 60 to 75 minute consultation with them,
and a lot of it is just talking, and really getting to know and understand, one, the problem,
(32:09):
the nature of the problem, two, their lifestyle, three, their medical history.
And then, as a physician, I kind of think of myself as a pattern recognizer.
We recognize patterns, right?
And so I'm sort of able to start understanding, okay, these are the patterns that I see that
kind of fits with this, like either it's a sleep apnea, or it's a combination.
(32:30):
It's very common to see people with more than one to have sleep apnea.
And so I might order a sleep study to confirm and to see what their breathing is like.
I might have them wear a sleep tracker called Actigraphy to look at their sleep wake patterns
over more of like a seven day period.
I might have them keep a sleep diary.
So I usually want to collect more data.
(32:53):
And then that experience that I have from working with people for a really long time
can help me understand like, oh, this person's daytime sleepiness fits with this pattern.
Like some people come with a story, and you're like, that story sounds an awful lot like
narcolepsy.
He could test you for narcolepsy.
(33:13):
So that's my job is to really communicate with people in a way that I can see what's
wrong by talking to them and by collecting the additional data.
And I guess sleep problems have become kind of like an epidemic now, right?
It's a consternation, I guess, across the world, and people are desperate to sleep,
right?
They're tired.
They have things to do.
They have work the next morning.
(33:34):
They obviously can't function without sleep.
And so I guess outside of sleep disorder becoming an epidemic in itself, I feel like people
trying so many things to get to sleep has also become such a big practice, right?
And I think a big part of that is melatonin, right?
We see it as gummy bears, we see it as pills and tablets.
(33:56):
I guess as a sleep doctor too.
So many of your patients have, I guess, tried melatonin of its varying dosages.
What do we know about melatonin?
How safe is it to consume?
Is it nightly or just for like a get over a jet lag?
Yeah.
So melatonin is a hormone that's naturally made within our body by a little structure
in our brain called the pineal gland.
(34:17):
And what we're seeing in the sleep medicine community is, well, melatonin is actually
generated in darkness.
So when the light stops getting a signal that there's light, the pineal gland starts making
it.
So because of all this light, artificial light in our environment, like from screens and
even electricity, like overhead lights, street lights, city lights, we're not making as much
(34:40):
of it.
And so we know, for instance, that we sleep about an hour less than our ancestors did,
you know, two years ago.
And we think that's because one of the reasons because of light.
So I think that's one of the reasons why people are reaching for melatonin is like, I think
from how people know that, like, they're not making as much of it, right?
So the problem in the US is that melatonin is not a pharmaceutical grade product in the
(35:05):
sense that there have been studies showing there's variable amounts in like, you know,
if you buy a brand, like, and it says three milligrams, there's not actually three milligrams
in there.
And there are other things in there.
So that's one problem.
I heard this year at the sleep meeting that there is also concern about that it can delay
(35:25):
puberty if kids are part of it now.
I don't know by how long and I don't know that, like, you know, so if it's delaying
puberty by a year, and I don't know what the statistics shows, but I don't know that that
necessarily has any long lasting consequence.
On the other hand, melatonin is a potent antioxidants.
(35:46):
It probably maybe the reason it's delaying puberty is because it has an anti aging property.
I don't know.
But in my mind, the real concern that I have about melatonin is that most people don't
use it correctly.
They put it in the way that could be really effective.
And sometimes they're using it, and they really need a different treatment.
(36:06):
And so it's kind of like, yeah, and I guess outside of melatonin, the hormone, I think
one more thing that I wanted to touch was, I guess, an electrolyte that I didn't really
know actually supposedly helps for sleep, which is magnesium.
I know you created a post on this too.
I mean, what have you seen with magnesium and sleep?
Like do you think it's better to get it like in supplement form or should we rely on like
(36:29):
our dietary sources for magnesium?
And does it help with sleep at all?
Yes, it does help with sleep.
So the post that you're talking about, when I researched that, what I found was that in
the nutritional literature, that magnesium deficiency is becoming more common just because
of our processed diet.
Because most of the magnesium we get, like in terms of food consumption, is from green
(36:52):
leafy vegetables, you know, and also they have to be raw to really absorb it.
And so just aren't really eating that as much anymore.
But I also read that the best way to absorb magnesium is actually from tap water.
But if you think about how people are not, they're drinking all these like soft drinks
and stuff and fancy drinks instead of tap water, like they're probably not getting
(37:14):
the minerals they need from the water.
It probably depends where you live if you have magnesium in your water.
So I think that's a real thing.
As far as for sleep, I mean, the research doesn't really support taking it for like
insomnia, let's say.
But we do think magnesium deficiency can cause like these generalized sleep complaints.
Like when you measure the serum level of magnesium, it doesn't really represent what's going on
(37:36):
in the body, because it's mostly stored in our bones and tissue.
But like leg cramps, restless legs, those are the sorts of things where we might try
it and just see if it's helping.
And of course, I think taking it to answer your question, like taking it as a supplement
or food is good.
The supplements can cause like magnesium citrate can cause diarrhea.
(37:57):
So you have to think about that.
I know for myself, like when I looked into it, there are also some certain brands of
water that do fortify the water with magnesium.
So that's an option too, is to if you can't get your tap water tested, you could drink
bottled water.
This is also helpful.
I mean, I might just bone with some of the information that you're spitting right now,
(38:20):
Doc, especially when it comes to melatonin.
Well, I guess to end it all, I mean, I guess sleep is becoming such an epidemic and sleep
is such an important thing, right?
And even I myself, and I don't have enough sleep.
I mean, I guess when I was way younger, I was so proud of, oh, I can only, I can function
with three hours of sleep every night.
(38:41):
And I guess now it's just kind of, I was like, wow, I need like six or seven hours of sleep.
And as a sleep medicine physician, you see people who are struggling with so many sleep
disorders have all types of things.
And I guess to end it all, what would be your message to someone out there in the world
who's just struggling so much with sleep and, you know, just their life is in shambles because
(39:07):
they cannot sleep?
What would be your message to that person as a sleep medicine expert?
I think my message would be that we can fix these things and we can correct them and you
can feel better.
Yeah, I mean, I'm so surprised by all of this information.
It's just such an interesting and such a niche field.
And I feel so honored to be able to talk to you today and get all of this negative information.
(39:31):
So Dr. Meredith, thank you so much for joining me tonight.
Oh, thank you for having me.
I really appreciate it.
You have a great rest of the day that you get to rest finally and have a good sleep
tonight.
Thank you.
Thank you, you too.
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