Episode Transcript
[00:00:21] Welcome to 45 left or right podcast episode, episode seven, who needs sleep? I can tell you I do. So we're going to talk about how insomnia and chronic insomnia affect us as we get older. And hopefully I'll give you some tips on maybe how to get a little better sleep. But also, I've got a ton of research for you today. Now, I was going to open with that Bare Naked lady song, who Needs Sleep? But I don't want to get sued, so I'm going to sing you the chorus. I'm going to try.
[00:01:08] All right, here we go. Who needs sleep? Well, you're never going to get it. Who needs sleep? Tell me, what's that for? Who needs sleep? Be happy with what? You kidding? There's a guy who's been awake since the Second World War.
[00:01:22] Ha. Not too bad. I've never been able to sleep much. I didn't sleep well before I went to Iraq, and I definitely struggled more once I returned. I had regular nightmares from some of the things that I experienced and that set me off on a long time of insomnia. And I deployed or I got home in 2006, and I still struggle with sleep, though fortunately for me, the nightmares are mostly gone. I have been on a lot of different medications to try to help me sleep and also for some mental health issues.
[00:02:09] Let me tell you about a medication called Seroquel.
[00:02:15] It definitely helped me sleep, but also made me very confused at night.
[00:02:25] One time, I was in our very tiny bathroom, which has just enough room to sit down, and it's shaped like an octagon, sort of.
[00:02:38] I got lost in the bathroom. I felt all around, and I could not for the life of me find the doorknob.
[00:02:49] And I remember thinking, well, if I could find the light switch, I might be able to find the doorknob. The light switch was just to the right, the doorknob. That was my thinking.
[00:03:03] And I don't know how long I was in the bathroom, but I remember panicking, and I thought, oh, my gosh, I'm gonna be in here until Jeff wakes up where he can rescue me.
[00:03:21] Another time, I had gotten up to pee and I couldn't find my side of the bed. And that has been my side of the bed for at least 10 years.
[00:03:35] I was feeling my way around and I found a foot, but I didn't seem to understand that it was Jeff's foot. So I just kept feeling my way upside his body. And I was just about to touch his face when he woke up and said, Are you okay?
[00:03:58] And that sort of put me out of my trance.
[00:04:02] And sweet man that he is, he directed me to my side of the bed and got me settled. But once I told my psychiatrist about those two stories, they took me off that really quickly.
[00:04:17] But if I didn't have medication, I would not sleep. And I have tried everything.
[00:04:26] Medications like Seroquel, Trazodone, Gabapentin, Clonidine, Lamotrigine, Melatonin, magnesium sleeve patches, a CPAP machine. Actually a couple calming music, brown noise, white noise, meditation, breathing, special pillows, a weighted blanket and warm showers.
[00:04:53] I cannot remember how many sleep studies I've had, but no matter what the results are, they're going to give you a CPAP machine. Yes, let's add an uncomfortable, suffocating mask to the equation.
[00:05:08] Now, even with medication, the best I get is probably seven hours and only maybe three to four times a week.
[00:05:20] There's a strong genetic correlation with insomnia as well as having more insomnia as we age.
[00:05:30] My poor mom hasn't slept since my brother and I were teenagers.
[00:05:36] She's been through all the studies and usually is just told that she has sleep anxiety and she should do something about that. No kidding. She has sleep anxiety. She knows she can't sleep and the nights are torture.
[00:05:54] The only thing that works for her somewhat is Ambien, but doctors won't prescribe it long term for fear of dependence.
[00:06:05] And it is associated with dementia and other health problems. But do you know what also causes these problems? Not sleeping and whatever. But like whenever I get a good night's sleep, I still don't feel rested. I always feel feel tired.
[00:06:31] The most common thing is I wake up between 12 and 2 and my mind just starts racing with worries or thoughts. Did I put the chicken in to thaw? How am I going to fit my gym workout in today? What if Devin one day doesn't like us? I wonder what kind of person he'll marry. What if I hate them? What if they hate me?
[00:06:59] Remember that time we went snowboarding and I had a meltdown that was embarrassing? Why did I say you too to the cashier who said she liked my hair? I can't believe I did an RSVP to that birthday party 10 years ago. How rude of me. When I was in Jiu Jitsu a week ago, I should have tried an armbar instead of an oma plata. I wonder what color looks best on me. Green. Can I wear yellow? Yellow. I like that song by Coldplay.
[00:07:33] So let's talk about sleep. Why don't we get it? Is there anything that we can do to get it?
[00:07:58] Welcome back to 45 left or right podcast. We are going to talk about some research and gonna warn you, I geeked out on the research this week so hopefully it will be interesting to you because it was really interesting to me. So let's start with some basics. What is the definition of insomnia? And this is from the Journal of Family Medicine Primary Care 2016.
[00:08:33] The article is called or it's the study Prevalence of chronic insomnia in adult patients in its correlation with medical comorbidities.
[00:08:46] Here is the definition. Insomnia is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation or quality, which occurs despite adequate opportunity for sleep and results in some form of daytime impairment.
[00:09:10] Why does this sound like it's all in your head? Because it's all up to your perception and it's subjective. But I'll move on. And then there is chronic insomnia and these. So basically these criteria specify that symptoms must cause clinically significant functional distress or impairment, be present for at least three nights a week for at least three months, and not be linked to other sleep, medical or mental disorders. I think this disclaimer is interesting. It says, you know, it's not linked to other disorders, but isn't insomnia. Insomnia like, I'm not getting sleep that should be present no matter what I have. But again, I'm moving on.
[00:10:13] So this is an interesting study because it says that insomnia is very common but is often missed by primary care doctors. They, you know, the patient has to ask or say, I'm not sleeping. Well, the doctor is not necessarily. They don't ask. So that basically means if you have insomnia, you need to be the one to bring it up.
[00:10:46] I will say that whenever I go to a psychiatrist, whether it's at the VA or outside of the va, the first question that they ask is, how are you sleeping? Because if you aren't sleeping, your mental health really suffers. So if you are feeling down and depressed and like super tired, do not neglect the quality of sleep that you're getting, whether you have to get help for it or just need to change your habits.
[00:11:24] This is important. Sleep is very important for your health.
[00:11:30] This article also mentions that people with diabetes and who are middle aged should always be asked about their sleep quality by their primary care physician. Those are the only two criteria criteria that were listed, diabetes and middle age. That tells you how common it is. So here are some insomnia symptoms Having a hard time falling asleep at night, waking up during the night. That's me waking up too early. That's me feeling tired or sleepy during the day.
[00:12:15] Definitely me feeling cranky, depressed, or anxious. Jeff will say that is me having a hard time paying attention, focusing on tasks or remembering things, making more errors or having more accidents. I can tell you this is like the fourth time I have recorded this podcast because I keep making mistakes with my audio editing equipment. So I'm there and having ongoing worries about sleep.
[00:12:51] Definitely me. Also, let's talk about some numbers. All right, so this is from.
[00:13:01] Actually, this is the same study that I referenced before, and there's been various studies worldwide that have shown the prevalence of insomnia in, like, 10 to 30% of the population.
[00:13:18] But it also says 50 to 60% of the population, so seems like a big range.
[00:13:26] I don't know. I think this might be. We don't really know the numbers, but we have to put a number on it. I've read other research studies that basically say it's about 30% of the population.
[00:13:41] So the next study that I'm going to reference is from the CDC. It is sleep difficulties in adults, data brief, 2020. We all know 2020 was a challenging year.
[00:14:00] In 2020, 14.5% of adults had trouble falling asleep most days or every day in the past 30 days. So if my math is correct, that is 4.6 million Americans. That's a lot of people.
[00:14:21] Women were more likely to have trouble falling asleep than men. Women at 17.1%, men at 11.7%. Now, this is not necessarily chronic insomnia, but you know, insomnia all the same. And I do want to note, even though women seem to have more insomnia than men, men struggle with it, too. So I won't leave you out. I promise.
[00:14:57] So what side effects does insomnia cause? And this is from the Institute of Medicine Committee on Sleep Medicine and research from 2006.
[00:15:11] I know that is a long time ago, but these sort of things that they're stating haven't changed since that time. So I still think it's pretty valid. All right, you have an increased risk of hypertension, so high blood pressure, diabetes, obesity, depression, heart attack, and stroke.
[00:15:38] So, like, I'm going to say this like 15 times in this podcast. Your sleep is very important for all kinds of help that you have.
[00:15:49] And this same same article from the cdc, of course it says you're going to have memory and concentration problems. And then I can't believe that they. They put this in but it says that insomnia can even make you look older. So that explains a lot of wrinkles on my face.
[00:16:15] And I've also noticed I started getting gray hair when I was in Iraq. And my absolutely amazing hair stylist, Felicity, she noticed a couple of years ago. She said, wow, you have a lot of gray all over Durace.
[00:16:38] It's a good thing. I love her. I was like, no.
[00:17:04] Welcome back to 45 Left to Right podcast.
[00:17:09] This next part we're going to specifically talk about insomnia in middle age, our midlife. So the first report that I found is from October 2023, and it was from a health conference of sleep specialist. And this one doctor was talking specifically about women and the causes of insomnia for us. Her name is Janet N. Meyers, M.D. and she also holds several certifications in sleep medicine. She is the medical director of Kaiser Permanente Sleep center of Moanalua Medical center. And she's also an associate professor of clinical medicine at the John A. Burns School of Medicine. So I would say she's qualified.
[00:18:09] What she found is that 16% of women have insomnia during pre menopause and then it jumps up to 39 to 46% in perimenopause and 60% during post menopause.
[00:18:31] So a lot of that, she said, is attributed to hot flashes waking women up. But also another probable cause is those gosh darn hormones. You have lower progesterone and estrogen, and then you have higher cortisol, which is a stress hormone that results in less REM and deep sleep. So that is why we don't wake up feeling rested.
[00:19:03] Cortisol, like I said, is a stress hormone, and so it raises with prolonged and extra anxiety and stress.
[00:19:15] Do you perhaps feel more stressed during this time of life? I sure do.
[00:19:22] So what she said, this is a quote. As women age, they may be the most vulnerable group because they have prolonged sleep onset and lower melatonin secretion over time.
[00:19:38] When I think of melatonin, I think of the vitamin that I take or not a vitamin. What is a supplement that I take before bed every night. But your body actually creates melatonin and there's a whole lot to that. But it does change as we get older and definitely can be can be a problem if it's secreted at different times.
[00:20:07] Now, Min, I did not forget you. All right. Men also have insomnia and their sleep suffers as they age just like women do. But my anecdotal evidence says otherwise. The man who sleeps Next to me every night, Jeff, I timed him once and he fell asleep in three minutes.
[00:20:38] Three minutes.
[00:20:41] I am happy he sleeps well. But I also see on the other side of the bed I'm like really? Now I realize that this is a small sample size, so I acknowledge that other men I'm sure have sleeping problems.
[00:21:03] This is an article that was published by the National Institutes of Health and it's a study entitled Sleep disturbances in sexual function among men age 45 to 75 years in an urban area of Iran. Now, I recognize that there are some significant cultural differences as compared to the United States, but in this study the sample size is pretty large. What they found is that most of men's sleep troubles are associated with a decrease in testosterone, another hormone or really in. They said at least half of the healthy men in this study and what they did is they compared 50 to 70 year old men to 20 and 40 year old men and I bet you can guess what group didn't sleep as well those older fellows. Now of course, this study's focus is mostly on how chronic insomnia affects sexual function, of course, but those were interesting numbers and it basically said to One conclusion is men usually suffer from insomnia after they turn 60. Ladies, it's earlier, men, it's later.
[00:22:37] But other reasons men don't sleep is untreated depression and anxiety and untreated sleep apnea. Because men do not reach out for those things. They do not ask for help for these things.
[00:22:57] The sleep apnea. I have a few friends whose husbands snore like crazy, but they refuse to get a sleep study because if you're snoring you probably have sleep apnea. But they won't do it. They won't go in. But you're not sleeping well. So men, let's get it together. Okay?
[00:23:36] Welcome back to 45 left or right podcast.
[00:23:40] So I am not going to give you doom and gloom. Insomnia is bad without offering some hope for you or at least some tips. This is from the National Heart, Lung and Blood Institute and they have many tips on helping you to sleep better. Number one is make your bedroom sleep friendly. Cool, quiet, dark place, no TV or electronics. And if you have to have electronics, wear blue light glasses. Now I'm a side sleeper. Blue light glasses don't really work for me but I have started using a sleep mask and that really helps because that you can't see anything with those.
[00:24:34] Number two, go to sleep and wake up around the same time each day, even on the weekends. Now if you have Young children, this should not be a problem because they wake you up around 6am or earlier. Devin is almost 12 and he the latest he wakes up on the weekends is 7 which is still early but it's a little sleeping in. I have heard this advice in several places and recently I had a nutrition and physical fitness coach named Amy Ledeen and her husband Eric Ledeen. They're with Lean Bodies Consulting highly recommend them. They're awesome but they this is a big thing that they talk about the same time each day.
[00:25:31] I think you get like a 30 minute grace period on the weekends but no more than that. So I've adopted that recently.
[00:25:41] Number three, avoid caffeine, nicotine and alcohol close to your bedtime.
[00:25:48] I cannot have caffeine past 2:00. 201, I'm not sleeping. It stinks because around that time is about when I hit the wall and I need some caffeine.
[00:26:02] Number four, exercise regularly.
[00:26:06] And I've heard I saw two things. One says at least two hours before bedtime and one says or I'm sorry, no more than five to six hours before going to bed.
[00:26:21] You gotta see what works for you. I heard. So I had a sleep doctor way back when I was in the army and he said that you should exercise close to your bedtime because your body temperature rises and then falls and that is supposed to make you sleepy. Did not work, but it's worth a try if you're struggling.
[00:26:46] Number five, avoid naps, especially in the afternoon.
[00:26:53] But there are, there's other evidence that say that power naps are helpful, especially as you get older. I struggle with naps for one, just falling asleep. But also once I do fall asleep I want to sleep for know two hours and it's hard to get up.
[00:27:12] Number six, eat meals on a regular schedule. Avoid late night dinners. Now if your children play sports or are in other activities, it's really hard not to eat late. I mean Devin sometimes gets home at 8:39 and we still haven't eaten, so that's really hard. And then if you travel a lot or you know, some people have weird hours of working. I've worked night shifts before and that's a bear. It really messes with your sleep. But try to do it as much as you can.
[00:27:57] Number seven, limit liquids close to bedtime so you don't have to wake up to pee. I heard also I think this was also from Eric and Amy Ledeen that the reason we wake up to pee is because our cortisol is elevated. So we wake up and our body's like, I have to pee. So that is just stress management.
[00:28:23] That's another. Another topic for another podcast now. So you're not supposed to drink liquids close to your bedtime, but there's also advice that says, drink warm milk or chamomile tea right before bed. So which one is that?
[00:28:43] Number 8. Learn Ways to manage stress. Wind down and relax before bed. Read a book, maybe know Stephen King. Listen to soothing music. Take a hot bath. Massage therapy. I wish I had a masseuse before bed. That would be nice. Meditate or yoga for relaxation. Have you tried yoga? It is so hard. But I know there are different forms of yoga, so, you know, I think that's worth a shot.
[00:29:19] So the last one, I think it's. The last one is a. Is a big one.
[00:29:26] Cognitive behavioral therapy for insomnia, or cbt. I usually before you're, like, prescribed anything or, you know, something like that, they make you go through some sort of CBT to help you out. So usually it's six to eight weeks, and it helps you to learn how to fall asleep faster and then stay asleep longer.
[00:29:59] And like I said, they usually. That's kind of the first. The first thing they try, first line of defense.
[00:30:06] So the whole idea is that it's supposed to help you feel less nervous about not being able to sleep. I mean, I get really anxious when I can. I just. My. In my body, I can tell I am not going to fall asleep. It's going to be a restless sleep. And I'm like, oh, God, this is. This is going to be a long night, you know, oh, I wish I could sleep. You know, here I go again. Those sort of thoughts.
[00:30:36] So they also. Part of this CBTI is kind of more specific relaxation or meditation therapy.
[00:30:48] I have tried meditation, but I haven't really followed through with doing it regularly. So that is something that I need to start doing better.
[00:30:58] All right, so one part of this CBTI is sleep restriction therapy.
[00:31:08] This one, I don't. I don't know all the specifics. It's a little complicated. But the idea is it gives you. It wants to limit your time in bed. You know, they don't want you like tossing and turning for two hours before you fall asleep, because then you associate your bed with not sleeping. Now, how they get you to do this, I think is cruel and unusual punishment.
[00:31:37] So let's say you need to get up at 7, and your target is to sleep six hours. So you go to bed at 1am and you wake up at 7, and then you do that for several weeks, and I think you add time, but that's brutal.
[00:31:57] Another one is you remain what they call passively awake or paradoxical intention. You get in bed, and instead of thinking, I have to go to sleep, I want to go to sleep. You try to stay awake.
[00:32:18] And so you're like, thinking, okay, I'm going to stay kind of like a kid on Christmas Eve. I got to stay awake. I got to catch Santa. I got to stay awake. Right?
[00:32:28] So the whole idea is it reduces your, like, extreme focus on going to sleep. And then, you know, you have anxiety over not sleeping. It's supposed to make you make it easier to fall asleep. Now, I am super competitive, and Jeff would say I am ridiculously stubborn. So I have a feeling I'd be like, I am going to win this. I am going to stay awake all night.
[00:33:00] I can see me doing that.
[00:33:03] So people, you know, generally want to avoid taking medication if they can, but that is also a valid option.
[00:33:14] Now we watch Good Morning America, and that is a ripe time for drug ads. So here are some of the medications that are a possibility.
[00:33:29] Lunesta, Roserum, Restoril, Halcyon, Sonata, Ambien, and there's a few versions of Ambien, Selenor, Bellsomera. And I think that's it. That's a lot for different kinds of medications, and each of them targets a different thing you might be struggling with. Like, I fall asleep quickly, and then I wake up, and then other people have a hard time falling asleep. You know, there's lots of. It's. It's complicated.
[00:34:08] Now, this is a drug that has fallen out of favor because it does tend to give some people nightmares. But I was on Trazodone for a while, and I had a dream once that there was this big mansion guarded by angels of evil, and I was the only good angel, and I was responsible for defeating the evil angels.
[00:34:43] And it was like, big battle back and forth, and I don't remember winning. So I woke up like, oh, my gosh. Oh, my gosh. Like, the end of the world is my fault. They took me off that pretty quickly after that.
[00:34:59] Our pharmaceuticals for sleep is a really big market, 21 point billion worldwide, and it went up substantially after Covid.
[00:35:14] But. And that. That's not my way of criticizing it at all. If it works for you, if medication works for you, there is no shame in that. I have been on medications for years, and, you know, I joke about not sleeping, but I do get better sleep because of medication.
[00:35:54] Welcome back to 45 Left to Right podcast I have some parting thoughts to conclude on this discussion about insomnia.
[00:36:07] I have this thing called an Oura Ring O U R A and it does lots of things but one thing it does is it measures my quality of sleep, I think by measuring my heart rate, my body temperature and then my activity.
[00:36:27] And every morning I get a sleep score. Now usually I'm in the 70s.
[00:36:34] Today I was a 56 because I woke up at 4:30 for Jiu Jitsu and I am tired.
[00:36:45] The other night though I think it was over the weekend, I slept really well according to it and it actually said we had to do a double take. Therese.
[00:36:57] Me too Aura, me too. I think my score was like a 91.
[00:37:04] Oh. As a college student I remember bragging when I pulled an all nighter, like look at me, look how hard I work. Or look at me. I was so drunk I didn't go to sleep.
[00:37:22] Now I lament all of those all nighters. I don't want another all nighter in my entire life. That would be so nice.
[00:37:35] Now usually if you have been listening to my podcast, I do not like to tie things up in a little bow because I don't believe that is realistic and I don't have any life changing, earth shattering advice.
[00:37:54] Insomnia is something we're just going to have to deal with at this time of our lives as we get older.
[00:38:02] But as a full time poor sleeper I do have some tips that won't hurt.
[00:38:12] I am a believer in same to bedtime, same wake time. Maybe because this, this is I'm like at the time of my life where I want to be in bed by 9 o'clock and I and I really get grumpy if I'm not in bed by 9:00. That's easy for me.
[00:38:34] So that was the first one. If the number two if you have chronic insomnia, get yourself a sleep study.
[00:38:44] Especially if you have insurance and get this from a reputable sleep disorder doctor. And they're usually pulmonologists.
[00:38:55] Don't go anywhere that just says they're a CPAP clinic because I mean sleep apnea is really serious. There's also other sleep disorders that you might have and so you want to make sure you get a comprehensive view of that.
[00:39:15] Number three, find whatever relaxation technique works for you, whether it's meditation, some inya white, brown or pink noise or like me, even though the experts say that this isn't good, I like to have a show on in the background that I've heard thousands of times because my brain is not engaged. And in the background, it's a familiar sound.
[00:39:49] Right now for me, I've got Gilmore Girls in the background, but I've also used Bob's Burgers. I've used Downton Abbey and this is weird, but Band of Brothers because I watched it over and over and over again.
[00:40:07] Number four, if you need to take some medications, then that is what you need to do. A lot of people want to avoid it, and I totally understand that. But it's more important that you sleep.
[00:40:25] Not sleeping isn't just an annoying thing that you have. It can actually be detrimental to your health. So don't let anyone dismiss that or tell you, oh, it's because you're too uptight or overweight or something. You just have to figure out it is a physical health problem.
[00:40:51] So I started with Barenaked Ladies and I'm going to end on Bare Naked Ladies.
[00:40:59] Who needs sleep? Well, you really need to get it. Who needs sleep? Tell me, what's that for? It's for your health.
[00:41:09] Okay, that is it for me today. I need a nap.
[00:41:16] Thank you so much for watching my episode today on 45 left or right podcast. And if you've been listening from the beginning, I'm especially grateful. It's very encouraging to me and, you know, I think it's. I really can't tell you enough how much it encourages me. If you really, really like it, please share the links. Whether it's Spotify, Apple or any of them, to your friends or anyone you think would be interested in it. That helps me out a lot.
[00:41:52] Spotify and Apple, and I don't. I'm not as familiar with the others, but I'm on like all the podcast apps. If you can write a review or even just rate it, that helps me out a lot. Another new thing I'm doing is on Spotify, I can ask you questions and do polls. So that would help me if you answer my questions or, you know, rate. Because any sort of involvement or activity in any of my stuff helps me get discovered. I'm also on Instagram, under 45 left or right podcast. I'm on Twitter. Twitter. I'm not calling it X. No, it's Twitter. And I'm also on Facebook and I'm thinking about Tick Tock, but I'll let you know on that one. But I really appreciate it again and bye for now.
