The Crackin' Backs Podcast

Unveiling Sleep's Secrets for Optimal Performance: Dr. Amy Athey Breaks down insomnia, napping, and the future of sleep studies

• Dr. Terry Weyman and Dr. Spencer Baron

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Welcome to a very practical episode of the Crackin Backs Podcast with Dr. Amy Athey, where we're pulling back the covers on a subject near and dear to everyone: SLEEP.

We spend roughly a third of our lives doing it, yet for many, a good night's sleep remains a mystery. Dr. Athey takes a "real-world approach," shedding light on everything from the significance of 8-hour sleep cycles to strategies for when this isn't feasible.

Remember when napping was a joyous part of the day? We're bringing it back with a discussion on the benefits and optimal timing for a healthy midday nap.

Explore the positives and negatives of sleep-tracking technology, and gain insights into common sleep concerns like insomnia, sleep apnea, social jet lag, and the role of sleep in pain management and injury rehab.

We'll also look into the future of sleep studies and the habits you can adopt today for a more rested tomorrow.

Whether you're looking to enhance performance or simply catch better Z's, this episode will provide you with the tools to transform your sleep. It's time to wake up to the realities of sleep with Dr. Amy Athey!

We are two sports chiropractors, seeking knowledge from some of the best resources in the world of health. From our perspective, health is more than just “Crackin Backs” but a deep dive into physical, mental, and nutritional well-being philosophies.

Join us as we talk to some of the greatest minds and discover some of the most incredible gems you can use to maintain a higher level of health. Crackin Backs Podcast

Dr. Spencer Baron:

Welcome back to the cracking backs Podcast. Today we brought back one of our favorite guests, Dr. Amy Athey. In today's essential episode, we're diving into a topic that resonates with all of us sleep from the importance of those elusive eight hours to enjoy. We're taking a real world approach to help you understand and master this vital aspect of life. Are you struggling with insomnia are triggered by the latest sleep tech? Dr. S? Yes, your cover will discuss strategies for when a full night's rest just options, explore the positives and negatives of sleep monitoring technology and even troubleshoot common sleep concerns. Whether you're a restless dreamer, or season this episode is insights to help you rest better and perform at your don't sleep on this one.

Dr. Terry Weyman:

Alright, so Dr. Amy, welcome back. Yeah, it's so nice to see your beautiful face. And for round two.

Unknown:

Round two. Here we go. Every

Dr. Terry Weyman:

today's podcast, we're going to talk about something everybody can relate to, except Dr. Spencer who does asleep. So sleep is one of my favorite things to do. And yeah, there have been a lot of podcasts, you and I have actually talked off air a little bit about it, there's been a ton of podcasts talking about sleep, there's been businesses that are based around sleep, there's apps that are based around sleep, and we is a publicly multi million dollar industry based around sleep. Yet today, we want to take a real world approach, you know, knock off some of the science so people can understand. And I want the average person after listening to this for 45 minutes to walk away with some real knowledge about sleep. So I want you to set the stage of and tell people what the importance of sleep is for wellness and performance.

Unknown:

Yeah, and first, thank you guys for the opportunity to be back. I had so much fun last time and just really appreciate also the opportunity to share, hopefully some takeaways that people can immediately start using to help their own lives, their wellness, their performance and optimizing sleep. So thank you. So yeah, so sleep. You know, just like oxygen, water fueling, this is a fundamental physiological requirement that our body and brain needs. And I think you're seeing the boom in the industry because finally, like we are recognizing that this isn't a cost anymore is rather investment. And so this basic biological need, I break it down oftentimes to understanding how we can optimize both the quality and the quantity that we know can impact our wellness and performance, we know that there's significant health benefits for those who are not having that quantity and quality. We see it impacting all of our bodily functions and systems, anything from difficulty regulating our blood sugar, or our body weight. Anything from the emotional regulation side. So you know, you might be aware, I don't know if Dr. Spencer ever gets irritable on his Rockstar evenings. But if you're not getting that sleep, certainly, you probably may see those who care about being a little grumpy or irritable or just perhaps more reactive and situations. And then other things like attention, memory, the concept, the consolidation of learning, and decision making, right? None of which really, we have seen. We haven't really seen something that can rescue those documents if if somebody is not having that quantity and quality. So whether it's kind of in the moment for performance or even overall wellness and longevity, it's an it's critical. It's a critical process that allows our brain and bodies to restore, recharge, and be able to meet the demands in our lives.

Dr. Spencer Baron:

You know, I always felt that sleep was overrated. And it's actually underrated. You know, I remember as a kid wanting to go to bed and get up right away. So in defense of my sleeping habits, it um, I may be up at 330 in the morning, every morning without an alarm clock, but I'm worthless by 830 at night just to be clear, so people know not to give me a call.

Unknown:

Yeah, and you know, and there are, you know, in general we, in general, the population kind of has oriented to the sleep schedule more on our circadian rhythms, which is this natural biological clock we all have. It actually regulates a lot of processes in the brain in the body, not just sleep. And that is largely attuned to the light. So when the sun at dusk, when the sun is going down, our body starts through the penal grant gland releasing natural melatonin, and we start with our hormonal processes, having that build of our sleep drive, that then 234 hours later, we find if the conditions are right, this natural rhythm and falling asleep for some Spence, Dr. Spencer, like, there are few who who may be like this night owls, or those those early morning risers? I do, I am hesitant as a practitioner and and jumping in too much those are very small percentage of the population. I think for a long time, people would say, Oh, well, you know, I just get up early. That's just my natural clock. And I think it was a little bit of a cover for the fact that actually you're you're, you're really meeting other needs, the need to be productive, the need to execute, you know, whatever's on the list for the day. Versus if you removed those contextual demands, what would really happen? Like what would your natural rhythm kind of be, and general, people tend to find that like, nine to 11 window somewhere, if all of those demands were removed, and then wake, you know, anywhere from that, like, five 738 window. So there are very much individual differences. And I think understanding that is a key component when we look at sleep needs sleep ability, and sleep opportunity. And those are three very important aspects. When we think about how we optimize our sleep, you first off to understand what is your need, and like you said, Dr. Spencer, your need, you tend to kind of go to bed early, get up early, and that's more of your natural rhythm, I would argue probably your need is still in that seven to nine hour window of sleep, that, you know, if you go to bed too late, and you're still getting up at that time, or you know, even trying to extend it, it's probably harder for you. But then, you know, we we also talk a lot about and this is where I am grateful for this opportunity to get into more around the specific strategies to optimize our sleep ability, and what can we do in terms of our behaviors that can optimize our sleep. And then of course, we have to have the opportunity. And that goes back Dr. Terry to the real life demands, whether they are a shift worker, whether you're an athlete who doesn't get to decide what time game time is in your flight, coming back to your to your home, or just our personal lives of travel, and manage juggling kids and work, that sleep opportunity, we do have real life constraints. And so how do we navigate those real life constraints to be able to have those opportunities to sleep?

Dr. Spencer Baron:

So let me let me understand that now. You I had to giggle while you were saying that there are you know, getting up at that hour is because you default to the demands that you place on yourself for getting things done being productive, because that's like a big obsession for me. What and when I remove those elements, I can actually sleep till 435 o'clock, I don't have to walk the dog or I'm on vacation or what have you. And it's funny because it you're so right now but the age old conversation about how many hours to sleep and you know, what, what, what would that be for the average person? I've read so many different. Yeah, you know, ranges with that.

Unknown:

It does differ on age and like when we talk about athletes or high performers, the the load and which one the allostatic load, whether that's cognitive load, physical load, emotional relational stressors. In general for adult age, people are going to probably fall in the lines of seven to nine hours. In general. We do have a extensive body of research supporting that under seven hours consistently. We see significant deficits and when you talking about cognitive emotional deficits, some of that oftentimes we are even unaware of. And there's some great studies out there that said objectively, someone may not acknowledge the impairments. But if the objective data on the neuro psychological tests are very clear, we do just kind of adapt. I mean, I remember frankly, my first child had colic. And I was also studying for my national exam for psychology. And I remember it wasn't until after I recovered that sleep loss, like and got out of that chronic state of deprivation for six, eight months, I looked back and I was like, holy cow, like, the fact that I was driving a child around like, was absurd, like, it's so you, when you are sleep deprived, in the midst of it, people will deny the fact that they may be impaired. And yet the reality is, if you look at objective measures, the impairment is incredibly clear for that sleep deprived state the overall long term. So that's why you see in industries now, a lot of protective policies and processes, whether it's in the trucking industry, the airline industry, where there are dedicated rest periods to be protected, to to hopefully mitigate, or hopefully avoid chronic deprivation. But ya

Dr. Terry Weyman:

know, you talked about sleep deprivation, can people sleep too much?

Unknown:

Yeah, you know, the literature, it's kind of a little bit over the all over the place. Because a lot of times when people say that they're sleeping a lot. If you dig into that, oftentimes what they may be more referencing is that they're in bed a lot, but they may not actually be sleeping all of that time. So you an example of that is when I'm working with clients who may be dealing with depression, and just a neuro vegetative state where they will report sleeping a lot. But if you kind of dive in and ask them, What time did you fall asleep versus what time you went to bed, you'll probably get some some data that would be more characteristic of really low sleep efficiency, which is a significant data point that we use and understanding someone sleep ideally, the amount of time that you're in bed, we want over 90% of that to be sleep sleeping. So that the data is kind of all over. I mean, I will look at Dr. Matt Walker, I'm a leading sleep researcher Hill Hill Hill suggests that actually there could be those who are sleeping and having negative health effects from 1011 12 hours of sleep at night. We don't have certainly the the national crisis with sleeping too much as we do the the the deprivation or low, low number of hours. So it doesn't get talked about as much and I think we still have a lot to learn in the science around what what is really happening when people report sleeping too much for them.

Dr. Terry Weyman:

I just know sometimes you go on vacation, and if you sleep too much, don't feel good. And there's been times when I wake up it's been like 12 hours and the whole day I feel like I'm just in a lethargic fog. I just don't see anything go as well.

Unknown:

Yeah, absolutely. I think there's also like, I'm also really curious about the relationship then the sleeping too much but also then the physical inactivity that you know, obviously something has to give if you're taking those hours up and for me, I similarly I know when I am stressed sometimes I just want to go to sleep. But sleeping like the that nine hours what I'm taking away is honestly getting up and getting a workout in right so is it the extra hours sleep that's kind of making me lethargic is the absence of physical activity. But the also the other piece you mentioned on vacation, something that's very real, and often I am dealing with this when I'm working with elite performers is the concept of social jetlag. And just like when we travel time zones, and we are our body clocks are just incongruent, given the fast paced travel with a new time when you know, oftentimes elite athletes for example, their their day is very programmed, right? Like they may have their morning lift or the morning workout, they're up by 530. And they're stocked, whether that's meetings, classes, video, treatment, practice, etc. And then they get an off day. And they and oftentimes it may be Sunday, it may be Saturday, but it's often correlated sometimes with a weekend, right. So when they get that off day, it's like well, what are you going to do? I don't have practice tomorrow. I don't have a game tomorrow. So we're gonna go out and we're going to actually like, kick it up a little. And you extend then your night. 2345 hours, right, and then you still want to get some sleep because it's an off day I can sleep in. So now I'm going to sleep in till 1112, one, two, it really is no different than shifting time zones that many time zones. And so the regularity of sleep schedules really is critical. Now, I'm not saying I'm you know, I'm not saying don't live a little, but just be aware that like you mentioned Dr. Terry on vacation, if you're drastically changing, shifting off of a regular schedule, you may experience some negative kind of just not feeling not feeling so great. Because it does, it's really hard to shift more than an hour honestly, like when we work with scheduling issues with people sleep schedules, we tried to kind of do that in 15 minute increments a day. But but really big shifts like that can can leave you feeling kind of foggy and groggy.

Dr. Spencer Baron:

I read last year, a fascinating fact. And it was it's driving with sleep having experienced sleep deprivation is more dangerous than driving under intoxication. And we had, right.

Unknown:

Yeah, yeah, we have the impact of drowsy driving is much more pervasive. And we actually want to Dr. Michael grandeur, and I've put together rest recovery enhancements, sleep training, a sleep bonus program for performance for we started with athletes. Now we've kind of iterated it for many high performing occupations. That was a noticeable difference was not only that when people receive the information, so they know more of what to do to troubleshoot their sleep and optimize their sleep. They had the support, perhaps they had data coming from a wearable device. But not only did that we see benefits in their increased reported energy. More sleep, they were getting more sleep, better quality sleep, improved mental health, anxiety, depression, decreased in stress, but direct drowsy driving was also one of them that we asked about, and it was significant, you know, improved in terms of like that overall alertness, and it is a significant issue. We have a lot of people driving around, windows down air conditioning going, music blasting, and you're starting to see, you start to see some more comprehensive strategies. Like for example, I bought, my car is relatively new. And I was just on a road trip this past weekend. And after about three or four hours, the computer asked if I needed a break. Or should I pause? Yeah, take a break, which is interesting. But it was it was it was pretty cool as someone who values that, that recovery, it was cool to see. Yeah, I

Dr. Spencer Baron:

I unfortunately learned the hard way. I almost crashed, just nodding off. And my ex wife used to scream in my ear. What if she was driving with me and I thought, wow, I should probably make a recording of that. And consider using that every day. And now. Now if I get tired, I will pull off the road anywhere, any place anytime. And it could be in a terrible neighborhood. But I'd rather get robbed than the crash and burn. So anyway, yeah. With that said, I am curious of certain about five different aspects that you may want to enlighten us with in regards to what they would people can do to have a better sleep right now, whether it be a routine or cold versus dark or quiet or maybe, you know, you know, maybe white noise or you know, wind down routines or wake up routines. Any can you make comments on all those possible issues?

Unknown:

Sure. So I alluded to the first one. The first thing is a regular schedule, which I understand. For some people, the real life constraints make that challenging if their occupational schedules or shift work are varied. But we know that if we can get into that regular schedule, people tend to deal with those real life constraints. I guess they're more able to kind of bounce back. So I really encourage and we do this pretty deliberately with our kids. I mean, many people talk about my kids naptime is that this time if they're a little little they have to nap times, and then at this time we do dinner at this time we do bath, then we read a book, and then we rock and then there's bedtime. Right? And we know kids who get off that Beth that time. Schedule, like when you travel. I mean, I referenced it as DEF CON to DEF CON three, like things go off the rails Right? Very quickly. So why is it I mean, we're doing this with little humans and we see the value of schedules for our sleep. And yet, then we're we kind of forget, forget the value of that. So I start with scheduling. Like I said, I know that's hard. Sometimes you have a weekend, you're like, Oh, I'm gonna extend my hours, that's great. But really kind of staying as close to that as possible is really helpful. The second thing I talk a lot about is those those environments. And you also just mentioned cool, dark and quiet. Some people we have found do like the white noise, and certainly dealing with those environmental changes or challenges. Like when you're traveling and hotel rooms. I was just in a hotel room. I don't know what what the Knuth deal is with a blue strobe in the smoke detector, I don't know what that's going on in hotels. Now. I'm like, that's gotta go. But dark out as much as you can at night for the getting rid of that blue green light. Cold. Usually, you need to see our body temperatures gonna drop about one degree Celsius two to three degrees Fahrenheit at night, so many of us do better if we can drop that temperature. There's even products out there on your mattress cooling pad kind of mattress is temperature controlled. For those who run hot and need assistance dropping that temperature. I'll talk about in the the need for wind down routines in a minute. But with regards to temperature, hot showers or baths, saunas can also help because when we're exposed to that heat, then our internal kind of body temperature regulator will kind of overcorrected through and help facilitate the dropping of that body temperature. And yeah, so cool, dark, quiet, the dark piece light is huge. And I'll talk about it and wake up routines in the morning. But at night, we really want to be mindful of the exposure to blue green spectrum light. So you know, the best example I can give to you of this is if you've ever been to a casino, in Vegas, you walk in, they have down all that will keep you energized, engaged, alert. And what happens when you're in Casino all of a sudden you look up and it's 230 in the morning, and you're like holy shit, it's 230 in the morning. Why? Because this is the exact opposite of everything you need, right to facilitate a restful, relaxed kind of sleep state. So why is it that you're surprised when you've been working under fluorescent lights for eight 910 hours and you get home and it's taking you a minute, you know, when you're Go, go go? So it's there are blue blocking glasses, avoiding the like our screens now on phones are pretty good with that night shift blue, orange Amber setting. But being mindful of your exposure sitting in front of a screen exposing yourself to all that light is really inhibiting that melatonin. So cool, dark. So that's kind of like the environment winding down. I'll just take a quick minute and talk about winding down. Again, I'll go back to we've done this, we help our kids wind down right but then there's always like that great uncle who comes over like at 730 and start wrestling, roughhousing running around playing ball chasing and they're like, Oh, I gotta go and it's now 750 The kids are spawn up, they're out the door and you're like, Okay, this is not going to be an eight o'clock bedtime. Why? Because it takes a while to relax the mind and the body. And oftentimes maybe as adults we may not have that physical that same physical amp up I mean certainly be mindful of your workouts. Working out late at night can be pretty energizing. You may not want to do that. But what are you doing to quiet the mind and quiet the body and it takes time. So you know I recommend at least an hour getting into some type of routine. Most people brush their teeth can you add on one more thing to that habit tonight? Is when you before you brush your teeth You're going to maybe take 510 minutes and just kind of sit quietly and do some deep breathing or an active like relaxation routine. Can you just listen to some music with the beats per minute 115 or less is important. So I don't really care of the genre, I don't care if it's spa music or classical music, but you do want the beats per minute 115 or less, it keeps kind of your heart rate from pumping up, and just kind of unwind and write for those people who have a lot just kind of carrying a lot from the day things to do on motions. Grab a journal, or a voice memo and get some of that out. Sometimes people refer referenced that as like a worry journal, but you're kind of putting it out there. It's not going where you've got it for tomorrow. And you can kind of like, let that go. It's concrete, let that let that go. A wind down routine is critical. But so is waking up. So what are you doing to get going wake up routines I mentioned avoiding light at the night, the more you can expose yourself. So light within the first hour of waking, ideally, direct sunlight, take the dog for the walk to have your coffee on a patio. Actually, that helps to regulate your sleep. So it's not just about warding off that sleep inertia that sometimes you might feel just kind of like slow roll in the morning. But it also helps improve your sleep and at night. So get your feet on the floor, get off the phone, get some sunlight get moving. And then the last thing I know I've been really long winded right now, but these are kind of like the core toolbox. The last piece I would be remiss not to talk about is stimulus control. stimulus control refers to it's based on basic behavioral theory, where we want a stimulus to result in a specific, conditioned response. And so what this means is when we see a bed, when we lay in the bed, we feel the bed. Ideally, we want that bed paired with the habit of relaxation, and then sleep. To do that it's best if that stimulus is only linked, like maybe only one or two things are linked. So if you have a bed, and he only sleep in the bed, then when you see a bed, that's the only thing you know. But if you have a bed where you see a bed and it's sleep, Netflix, sending emails, having that tough conversation with a partner, paying your bills, sending out the tweet FaceTiming then all of a sudden the power of that stimulus is diminished because it spread across all these other activities, not just sleep. So for stimulus control, I am a huge proponent of get the screens out of the room. Reserve the bed for sleep and sex only. If you have to send that last email before Yeah, I helped you out Dr. Spencer helped me out. Keeping the keep the emails like standing up like send the last text standing, then put the phone down then get into bed. So just protect the bed for sleep as much as you can and get the screens and all of the other things that could disrupt that being a powerful stimulus for sleep out out of the room. So it's a long toolbox I know.

Dr. Terry Weyman:

I'm glad you brought that up because I was afraid Spencer was gonna have to ship the sex to the couch so he could just go to sleep

Dr. Spencer Baron:

well, I was actually

Unknown:

gonna digress.

Dr. Spencer Baron:

Boy, did you spark some fire here. Speaking of fire, I have an issue. I've always thought that having a TV in the bedroom in when you're in a relationship is the worst thing you could do and have that TV on because I've had friends of mine say Well, that's how I fall asleep I go well how's your sex life? But anyway, that's another story. But yeah, TV that some people say they sleep with the TV on and I don't understand that.

Unknown:

I would prefer if I well nowadays TV stream music right. So if it's a dark screen and it has white noise, you might be able to sell me on that. But if it's your traditional like movie lights, all of all of that stimulus, it really is, in general going to disrupt sleep now they may report they're still able to sleep I guess I'd be really curious about kind of their sleep archetype texture and how Often they're waking in the middle of night, we haven't talked about as much of that like, light sleep, deep sleep, REM sleep. And then certainly the normal pattern of that those sleep cycles. But all of those environmental pieces can be disruptive and subjectively, someone may not may not be noting it or as aware,

Dr. Spencer Baron:

what that how it brings up an interesting point, how about the fact that there are some people that go on vacation, they live in New York in the city, and then they go on vacation in the country where there's no light, no sound, and they can't, they can't sleep, they can't sleep,

Unknown:

they have adapted a little bit, but sometimes, you know, I've lived in this city, and I've come to like, appreciate some of so I usually like the white noise, I like something. And many people who are in high stress occupations, who may be like chronically sympathetically driven, also may want some of that, like the complete quiet actually may be kind of triggering, like more of like a hyper vigilance, right? Like, what's what's going on, you know, that if you're always used to sign up some of the activity or noise in the background.

Dr. Terry Weyman:

Alright, so I like a good nap. And you know, and it's so funny when we met our kids nap. In fact, if our kids don't nap, we get grumpy as adults, you know, and then we go through this period where naps aren't cool, or I don't have time for a nap. And then we get to our age, and we're like, have a good nap. And, and I remember I felt like I had to give myself permission after like, 55 in order to take a nap. And, and so, it if and I don't know which uncle you were referring to the riles up the kids, if that's on your side sounds like that's on your side of the family. Because I know your side of family went through that. But you talk to us about napping and why napping is such a good thing and should ever be nap or is that a beginning your life and the layer on your life? Time?

Unknown:

Yeah, so I mentioned love first go back to the the need, like sleep need the quantity when I mentioned that, on average, seven to nine hours is kind of like a target. I am refering. to adults, there is differing sleep needs younger children, adolescents, right? So for naps for children, where there's just significant greater sleep need 1012 hours a night depending on an age, right. And when I was referencing sleep need seven to nine for some who are under a tremendous allostatic load high performance, their need is going to be greater to facilitate the rest and recovery that's needed for all this systems, given the load that they're taking. Naps can help, you know, add to that sleep quantity. But even for the rest of us, right. Naps can be beneficial. I would say there are some people who will tell you they really need a nap. And there's some that can kind of like no, I'm good. Like I might have that after lunch kind of normal kind of law, but I don't really need a nap. If they're having 79 hours of quality sleep at night. They may not. So there are two different types of naps that I'm most commonly referenced. There are those kind of boosted naps. And we have seen from the literature as little as 17 minutes 20 minutes can really have wellness and performance benefit. So it doesn't have to be that long. And in general, I do if you're getting seven to nine hours at night of quality sleep, you really aren't looking for sleep restoring, you really are looking for that kind of boost. So I do recommend keeping that under an hour and keeping that mid day. Where you see the the risk of naps is when people start napping too late in the day and certainly if it's getting close to dusk. The reason for that is when you nap you are relieving some of that sleep pressure that naturally builds in our circadian rhythm across the day. So when you relieve some of that it's just kind of like literally a pressure cooker like letting out some of the steam. Then when you go to bed, you don't have a strong pressure built up and a mate people might report having difficulty falling asleep. So we try to keep it midday assuming that bedtime is that nine to 11 window and we keep it under an hour. If you wake from a nap and you feel like you just got hit from a Mac Trump like just disoriented feeling like crap. Odds are you woke during a deep sleep cycle and I know we haven't talked about the stages of sleep and But certainly if you wake in a deep stage of sleep, it can be very disorienting just can feel like crap. So if that's the case, you need to, when you try again, set your alarm for about, you know, 1520 minutes a little earlier get up. But definitely, you know, that 2030 minute mark, there can be tremendous benefits. The second type of nap is more of like a sleep restoring nap. And it's for those people who may not have gotten all that that they needed a night and they can sleep. And I typically say more than 90 minutes, which gives them enough time to go through light stage deep sleep back up to light to that REM, that full cycle can also be restoring. But in general, I if if you find a 20 minute nap mid day is great. And you are still having enough and good quality sleep at night. Go for it. Dr. Terry.

Dr. Spencer Baron:

What are your thoughts on on all the ways to gauge or all the apps and all the gadgets out there that measure? You know, I hear different points of view? Your thoughts?

Unknown:

Yeah. So great question. And I'm so grateful for the opportunity to speak on this part. I so certainly in my career, I was an early adopter for many of the wearable technologies sleep included, and have learned a lot around what can we really use it for. And then what are also some of the risks of just using the technology. And I think it's more in the research is starting to come out about that. And first off, I will remind everyone that wearing XYZ device, whichever one and there's tons of them out there measuring sleep and other biometrics that in and of itself is not an intervention. A a scale, in and of itself does not help you lose weight. It measures your weight. It's helpful information informing you perhaps on maybe the the impact of some of the choices you are making. But honestly, when we look at weight management, and especially for those who are trying to optimize their weight, there is not a dietician out there that says it's a good idea to weigh yourself every day. Right or to look at it multiple times a day. If anything, I've had performance dieticians tell me to freakin chuck the scale out the window, right? They don't even want you looking at it. They want to they want to know more about other subjective ratings of how you feel. Where's your energy, how's your emotionality, your ability to regulate emotions bounce back from stress or bounce back from physical demand. So wearing a device that tells you about your sleep is not the same as behavior change is an element of information that can be valuable if used in an improper way. We are seeing recent research come out that actually for some people, it is creating such rumination and anxiety that is actually negatively impacting their sleep. So they had a night. They thought they slept pretty well. They wake up the next morning, they look at this app, the app tells them whatever our score, and all of them have different names for them. And you know, oh, well, I'm only at 65% and shit. I thought I did pretty well. Right? And so now I'm all spun up wondering like I've had shitty sleep now what am I going to do? So how do you use this data in a way that's actually going to help optimize you not spin you up? Not get you ruminating? Right? I encourage people to look at the patterns. So data is helpful. Look at the pattern, maybe check it. If you're wearing it, maybe check it once a week, certainly maybe once a month, kind of like what is the overall pattern? What is your overall sleep schedule? Is it really erratic is that because of your own choices or outside demands? What can you mitigate there? For the current commercial products, typically most of them are stronger on measuring whether or not you're awake or you're asleep. The gold standard of measuring sleep is something called polysomnography. It's when you go to a lab there. There are some at home kits now that through medical facilities, you can doctor's orders, you can get those tests too but they are measuring our brainwaves. That is how they are measuring light sleep, deep sleep, REM there's nothing that you're going to wear on your wrist or your finger that is going to measure your brainwaves, what they are measuring or other biometrics and trying to correlate and guess what that sleep stages. In general what I found is many of the commercial products are very what we call reliable, valid and measuring whether or not you're asleep or awake. Pretty good close to that gold standard. Um, but telling you if you're in XYZ, or you're in deep sleep for four hours or two hours or light sleep, that's where in my opinion, they are falling short, we just don't have it yet. I have technology advances could happen, and we might get there. That's, in my opinion, a weakness, but don't get so caught up with that stage asleep. But if it's telling you your sleep efficiency score is 70%. Meaning when you're in bed, you're only sleeping 70% of that time. That's important data. So what can you do to increase that first thing is, if you're not sleeping, get out of bed, within 30 minutes, again, goes back to stimulus control, we want the bed for sleep. So if you're not sleeping within 30 minutes, get out of bed, if that's to aim, get out of bed, do some of that wind down routine that that can kind of help relax you and then try again. That's huge. So I use wearables understand where they can give you patterns, understand if they can tell you if you're awake or asleep, and be a little bit hesitant around the sleep stage data.

Dr. Spencer Baron:

I think it's funny of somebody who wears that aura ring said that they registered it at the same level that they did before they caught COVID. And I said, Well, how do you feel? And they go, Well, I feel good. And I go, Well, alright, there's a disconnect there somewhere. So that's why that's one of the compelling reasons why ask, I want to ask you about the you know, there's, you know, we didn't mention anything about nutrition. And, you know, I see a lot of people get on these CPAP machines to help them obviously, oxygenate their systems so they could sleep better because they snore, they choke, they choke themselves awake again. And I mean, I shared some thoughts about changing their diet less, less wheat before they go to bed, or bread or pasta, or less dairy and it works magic. Talk to me about what you find with these people opting for CPAP machines.

Unknown:

So CPAP machines are a primary intervention for a sleep disorder called sleep apnea. And sleep apnea is when when we are sleeping, we actually have events where honestly they we are not breathing. There's two main types of apnea Central and obstructive. Obstructive is really common in males over 30 athletic build. And it's often not treated. So when someone is loud, snoring, gasping for air waking choking for air, there, actually, their oxygen levels are dropping. And this is a very significant disorder that needs treatment CPAP machines, what they do is there's 100 Different kinds of masks out there, but its essence and wearing a nose mouth mask, there's air that's kind of keeping their airway open, and it allows their breath. And many people, once they have found the right mask, and they are using this machine, they will report their energy levels have been better than they have been in years. They're a better better able to manage their weight, respond to the stressor. So all this physical and mental impacts from poor quality sleep do improve. So CPAP machines for apnea. There's also new dental guards coming out. So there's some different treatments. But the first thing I do when I'm working with individuals is do a screening, because no amount of sleep hygiene is going to treat a disorder. It's like going to a doctor with strep throat and he tells you Oh, you just need to wash your hands. No, I that's like we've missed that vote, right? Like yes, I need to wash my hands and I need treatment for my illness. So cool, dark, quiet is not going to help wind down routines, it's not going to help sleep apnea. So it's really a critical for people to be screened to talk to their medical provider when people are reporting decrease in energy levels. sleepiness is an also a risk factor are kind of a sign of apnea. So not just feeling tired in the afternoon, but literally like nodding off. You get in the car and the passenger seat you nod off. So they do have screeners to kind of ask questions about sleepiness, or if you're sleeping that seven to nine hours a night but you still aren't feeling rested. It's an indicator that there's something with a sleep quality that's going on. And apnea is incredibly common and needs to be kind of rolled out. So as far as other common sleep, kind of the supplementation, the nutrition is a great, great question. Oftentimes I'm just Trying to recommend things avoiding things that may be disruptive. So if you're a spicy food, that's probably not the best at night, a large large meal, probably not the best at night. Supplementation industry is a wild wild west. literature on supplements such as melatonin, which is the most widely used and also misused supplement for sleep besides alcohol is when you look at the literature, the purity ratings on any of the over the counter supplements, they don't match what they're reporting in the bottle anywhere from like, like 20% of what they're really saying all the way up to like 400%. So it's all over the bottle. So really be careful there. And reality is melatonin is not an effective sleep aid for insomnia. And it's commonly commonly misused. It's really around helping with sleep timing, and that circadian so it can be helpful for adjusting and time zones, and if you're needing to shift your schedule, but if you're trying to fall asleep with it, it's not it's not really gonna, it's not gonna be effective. And it's just often miss dosed and misuse. So I lean a lot on our, our performance, dieticians and experts there for the nutrition, but those are some general guidelines that I share.

Dr. Spencer Baron:

Yeah, I mean, traditionally, people have dessert, a high carbohydrate or, you know, simple carbohydrate approach to their last to dinnertime. And then you know, I understand that really affects you know, hormone balances your blood sugar rises and drops or even some people that drink red wine before bed, you know, that has a that has an effect on stimulating your system. Or you could fall asleep, but then you wake up with your heart pounding from what I understand.

Unknown:

Right. So alcohol is the most widely used sleep aid around the globe. It can help you fall asleep, it is going to ultimately disrupt your sleep disrupt your RAM and the metabolites from alcohol. So when our body breaks down alcohol, the metabolites are stimulants. So if you've ever rockstart, from seven to 11, you go to sleep, and then you wake up at like, three, four in the morning and you're like, awake? That could be some of what's going on for you. So absolutely. It may help you fall asleep, but it's incredibly disruptive. Even even as little as one glass of wine. If you're wearing any of those wearable devices, you'll see certainly your heart rate variability take a tank, as well as impacting your sleep.

Dr. Spencer Baron:

Yeah, I think nutrition is often offended, you know, by people don't realize it and how it affects their sleep, whether they eat too much or, or not. But, you know, I we, I would like to ask before we wrap up, if there's anything that you would like to share that we haven't asked you about. That would be something the audience can, can entertain tonight, even to get a great night's sleep. Anything? Yeah,

Unknown:

I would. I would say some of the most common questions I get when people walk in my office is especially so you mentioned the wearables, they're going to highlight to people that they're waking up, I'm waking up a lot. Well, how many? How many times you're waking up five, six times a night, when you wake up five, six times a night? How long does it take you to fall back to sleep? Oh, I don't know, a minute. Two minutes are normal sleep. If we go through our sleep style cycles I get I didn't dive into that. But we start with light sleep we go too deep, we come back up to light we have REM we wake up in those cycles at the at the that light sleep 10 to 15 times a night is normal, we just don't remember them. So the issue isn't that you're waking up. The issue is if you wake up and you can't fall back to sleep, again, I go back to that sleep efficiency score. That's the total time in bed what percentage of the time are you sleeping? So if you take 10 minutes to fall asleep, and you may have two awakenings that are five minutes you make take 10 minutes to get out of bed. Your sleep efficiency score over an eight hour night is pretty high. Right? So if you have multiple awakenings, however and and or you're up for five hours combined, then your sleep efficiency score is going down. So I just remind people when they hear they're waking up multiple times. My question is how long does it take you to go back to sleep? Where's your sleep efficiency score? Do you feel rested? And then the other piece you know I mentioned Dr. Michael granular he also worked with Dr. Michael Perlis at UPenn. who's done a credible work around insomnia and on also understand poor sleep with related to suicidal ideations and mental health issues. We are seeing sleep disruption as one of the most powerful indicators of onset of depressive episodes as well as suicidal ideations. And so it, I've mentioned it at a very high level the impact on mental health. But this is a key thing for providers of all allied professions to be tuned into and understanding the disruption that it can take and impacting their significant mental health concerns and suicidal ideation. So for insomnia, the biggest thing is prevention. If you're not sleeping within 30 minutes, get out of bed. If you have if you typically are solid sleeper, and you have that one night, for whatever reason, you may not even know why. Just bad night you couldn't fall asleep, maybe it was kind of the biggest thing is Dr. Perlis will say is do nothing. Do not sleep in because you didn't fall asleep early, get up at your normal time, don't take a two hour nap because you only got five hours of sleep, power through, don't jack up the caffeine trying to get through and then disrupting your ability to fall asleep at night, go to sleep at your regular bedtime. And it's amazing how our bodies do come back to that homeostasis and that regular rhythm. So if you have a one off a bad night, the little i insomnia is just like the little d of depressed. If my boyfriend and I break up, I might feel depressed. That's not the same as having major depression. If I have a rough night's sleep, I may have the little i insomnia, it actually doesn't meet criteria for insomnia disorder. So we can troubleshoot and cope when we have disruptions in our lives and our mood are asleep. And if we have if things do shifts to major depression, we have treatment if things do Shift to insomnia disorder, cognitive behavioral therapy for insomnia is incredibly effective, far more effective than medications. And we can help right the ship there too. So those are the two kind of main pieces that I get asked about a good bet.

Dr. Spencer Baron:

I was great. I actually, I feel like I have so many more questions. We you know what? We love you we love your

Unknown:

fun, I love nerding out I love sharing this and more importantly, I I think I shared with you guys this offline. Like there are some remarkable scientists in this field that I draw upon. I learned from I love kind of just absorbing and taking in my passion is hopefully being able to help people with the changes they're looking to make in their lives and whether it's troubleshooting, feeling more confident and more in control of the choices they're making, and kind of instead of just responding to oh my oh my gosh, I gotta get a 4am flight. How am I going to do this? I've got a game plan, right? So I love the opportunity kicking around nerding out but also I love the practical side of let's let's help people with some tangible to do's Awesome.

Dr. Terry Weyman:

Awesome. Thank you so much, Doc. And you have a great day and we'll be in Yeah, you're always welcome back in the show. And when you so when you find something that's really cool, nerdy, you know, bring it on. Yeah, well,

Unknown:

here's the here's the first really cool or nerdy I'm not sure I'll let Dr. Spencer but I have not seen the ski video and I'm kind of I'm a little hurt. I'm a little hard, but I've not seen the video because

Dr. Terry Weyman:

it hasn't happened yet. It's not until July 28. So I won't be on the slope until July 28.

Unknown:

So I'm holding on to it. This is ability Yes, I countability yeah,

Dr. Terry Weyman:

I've got Mary how low lamb on cue ready to go and we will be doing

Unknown:

I will be asking you I will be

Dr. Spencer Baron:

bye. Thank you for listening to today's episode of The cracking backs podcast. We hope you enjoyed it. Make sure you close Instagrams cracking backs podcast. catch new episodes every Monday. See you next time.