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Scot: The Core Four and some basic strategies around nutrition, activity, sleep, and mental health can go a long way to help us be healthy and feel good today and in the future. But sometimes those basics aren't enough. And today on "Who Cares About Men's Health," the topic is "Sleep, It's Complicated."

Sleep, of course, is one of the Core Four and it's critical for good health, and it can be really frustrating when you're not getting the sleep you need. And today on the show, Mitch is going to talk about how he had to go beyond the Core Four to address some of his sleep struggles, on his journey to getting more quality Zs.

This is "Who Cares About Men's Health," providing information, inspiration, and a different interpretation of men's health. I'm Scot Singpiel. I bring the BS. He brings the M.D., Dr. Troy Madsen.

Troy: That's right, Scot. I had no idea sleep was so complex, but we're going to see how complex it is.

Scot: Just trying to stay awake, it's Producer Mitch.

Mitch: Every day, just trying to stay awake. And hopefully, we can talk a little bit about that today.

Scot: And our expert today, Dr. Kelly Baron. She's a behavioral sleep medicine expert at the University of Utah Sleep Wake Center. And her response to . . . Well, we'll save her response to Mitch's sleep study that he took for a little bit later on the podcast.

Did you know, Troy, that Mitch . . . Doing a podcast like this, you learn a lot about somebody. Did you know that Mitch likes running a true crime podcast? Did you know that?

Troy: I actually did know that, yeah.

Scot: And he's trying to build up his vinyl collection. We've learned that about him. And when he sleeps, he starts out on his left side. Then he's on his right side for a short time. Then he's prone for a bit, and then supine for a bit, and then he ends up back on his right side. That's according to his sleep study. He also has a sleep efficiency of 75%. Is that good? I don't know.

Mitch: I don't know either. It doesn't feel good.

Dr. Baron: Yeah, how does it feel?

Troy:It's a passing grade.

Scot: Dr. Baron, you're trying to get in among the three guys. We're going to be quiet and let you say what you wanted to say.

Dr. Baron: So in a sleep study, you're coming to a lab and it's just one night. So I would caution you to over-interpret something like sleep efficiency. Sleep efficiency is the amount of sleep divided by the time in bed. And so on a sleep study, they might be like, "Hey, it's 8 p.m. Get into bed. Let's start this recording." And you're like, "Okay, I guess so," and you might spend two hours trying to get to sleep because you normally sleep at 10 or something like that. So that number can be a little bit influenced by the characteristics of how the study is done.

Now, in this case, your sleep period started or your recording period started about almost 10, like 9:40 or so. And so I think the sleep efficiency number also reflects how much you're awake during the night.

So it is one measure of how consolidated or consistent your sleep is through the night. But it can go up or down depending on how they run this study. Yours is not good, and it's consistent with your experience in your sleep.

Troy: Regardless, it's not good.

Mitch: It's just not good. All right.

Troy: It's not good.

Mitch: Here we go.

Scot: It's going to be a fun ride today, isn't it, Mitch?

Mitch: I know. I'm so excited.

Scot: On "Who Cares About Men's Health," of course, sleep is part of the Core Four, and we've done a couple of episodes talking about sleep and if you're not waking up refreshed, or you're having a hard time going to sleep, or if you're waking up during the night, some of the basics.

Now, Mitch, tell us about your experience with sleep.

Mitch: When I first started getting involved in this podcast, and we were talking about the Core Four and stuff like that, sleep was always one of the ones that I had trouble with, right? I've had a long history of insomnia, of not being able to fall asleep, not being able to stay asleep, etc.

And so after we did the first couple of episodes, I'm like, "You know what I'm going to do? I'm going to do it. I'm going to focus on my sleep hygiene. I'm going to get into a rhythm and everything." And for the last year or two, it's been go to bed at 10 or 10:30, make sure I'm not playing on my devices after a certain time. I got a fancy-schmancy sleep mask because that's what Troy told me I should do.

I did everything I possibly could. I'm waking up at the same time. If I can't sleep, I get up for a little bit and go back. I was doing everything I possibly could. I even got a little app about cognitive behavioral therapy and sleep to make sure I'm not having sleep anxiety.

I was doing everything and I still woke up feeling miserable every day, right? I was still tired. I was still trying to pound coffee just to get through the middle of the day or whatever, right? And I recognize that could also be a problem and I cut that back, but it just was all the time tired, tired, tired.

And so over the last year with dealing with my fatigue problems and everything like that, while I was looking at testosterone, while I was looking at mental health stuff, I was also looking at what is going on with my sleep, because it is so important.

What the "It's Complicated" series is all about is sometimes it's a little more complicated than just "Do better."

Scot: Yeah, or you do the things you're supposed to do and it doesn't feel like you're really making any progress.

Dr. Baron, what you're hearing from Mitch, is that common? What's your take on what you just heard right there?

Dr. Baron: I mean, first of all, you did all the obvious things, and it can really leave you feeling just kind of helpless or even feel kind of like, "Well, maybe this is just all in my head." And so I think your experience is really common.

And this feeling of unrefreshing sleep or afternoon fatigue, it really is . . . A question is "What could this really be from?" It could be from a lot of different disorders, and that's really the difficult thing, is where to turn. And we do see a lot of patients who have that sort of fatigue or sleepiness.

So a question I really would have is did you feel like it was sleepiness, that you felt drowsy and couldn't stay awake? Or did you feel that it was fatigue or mental or physical tiredness, or both of those things?

Mitch: Yeah. So they were pretty mixed together until recently. We had an episode where I worked with a men's health specialist who diagnosed me with low testosterone/hypogonadism. And once that got fixed, a lot of the physical fatigue had disappeared and it was like, "Oh, okay, so my hormones were all off. That makes sense." But it didn't solve the tiredness.

I was feeling sleepy. I was dragging. I was feeling like I needed a nap in the middle of the day. And it wasn't the same kind of physical tiredness like I had before. It's a lot in the head, and just feeling like I needed to go back to bed all day long.

Dr. Baron: That's really interesting. In my clinic, in the Behavioral Sleep Medicine Clinic, I tend to see mostly people with insomnia. And so it's the difficulty falling asleep, staying asleep, waking up too early.

But sometimes we get through the whole cognitive behavioral therapy, and they don't see sufficient improvement. That's when we would say, "Let's do a sleep study." If they don't have any obviously apnea symptoms, we'll say, "Let's treat the insomnia, and then if needed, we'll do a sleep study later." We don't need a sleep study to say you're not sleeping. Insurance is like, "We believe you. We don't need a study."

But for those patients, we will do a sleep study to look exactly at what you did. You're like, "I did everything I thought I should do and I still don't have good sleep. What is going on here?"

Troy: In hearing this, too now, Mitch, you recognize the problem. How did you actually end up in a sleep lab? Did your primary care provider refer you, or did you just call a sleep expert? How did you get to that point?

Mitch: I had been working with my PCP. And after we had figured out some of the testosterone and the mental health stuff, it was now down to, "Hey, man. I'm still feeling tired all day." And he's like, "Well, let's do a basic at-home apnea test. Let's try that out and see how your sleep is doing." And the results came back medium, right?

But it was enough of a negative result that he's like, "Hey, we should get you in. Let's at least clear the decks. Let's just at least make sure that you don't have apnea, all these other things are going on before we continue troubleshooting."

That's basically what it sounds like these days. It's like, "Hi. Things aren't working. Have you turned me on and off again?" It's just so frustrating.

Finally, what happened was the first test was done. It came back with middle-of-the-road results. And he's like, "All right. Let's go ahead and try out the full thing. Let's get you all hooked up and just make sure that there isn't anything super serious happening with your sleep schedule."

Troy: Yeah. So it just sounds like it at least raised a little concern in your primary care provider's mind that they wanted to get the full study.

Mitch: Yeah. So they send you home with this little armband and finger thing or whatever. And basically, the results said, "Could be apnea." I don't know. I can't read it. I don't know what the . . . But it was just like, "There is . . ."

Scot: It sounds like it was a Magic 8 Ball they gave you. "Could be apnea."

Mitch: "Maybe."

Dr. Baron: Was it just oxygen levels or did it have a chest belt as well?

Mitch: It had a chest belt as well.

Dr. Baron: So you did a home sleep test, which is really the first step for most patients. That's what insurances want people to do first these days. And I think a lot of patients prefer it. I think a lot of patients are kind of relieved when you say, "Oh, you can take this and just strap this around your chest and put this on your finger and wear it at home," versus spending the night in the lab.

And the research really shows that for someone with moderate to severe apnea, they're very good at picking that up. And it reduces barriers that someone with kids, for example, doesn't need to find childcare. It's a little bit less burden to the participant. It's lower healthcare cost as well. And they do just as well on CPAP treatment if they have sleep apnea and they did the home test. It's not like they missed having that experience in the lab.

And so I think that lowers a barrier for patients. But as you're pointing out here, it didn't show that you had apnea, but perhaps it showed a little bit of desaturation or a couple apneas that maybe they thought they wanted to have a more in-depth study in the overnight test in the lab.

Troy: It is really good to hear about that home test too. I'll say personally that's a big barrier for me. The thought of going to a lab, an unfamiliar environment, and being hooked up to all these different probes and everything and feel like you're being watched all night. That just seems weird. I'm going to be curious to hear what you experienced, Mitch.

Mitch:Oh, it was weird.

Troy:The home test sounds good. That sounds doable.

Scot: So after the home test, then it was recommended that you go and do a sleep study. What was that like? Now, that's where you actually have to go somewhere else and they hook you up to a few more things, don't they?

Mitch: Yeah. I think I sent you a picture I had the nice technician take a picture of me after I was all hooked up. But it is a bit intimidating. You go to this lab and the person . . . It takes like 20 minutes to get everything on. There are chest straps and back straps, and they have all these wires that they're running on. They put all this stuff through my hair and on my scalp. They're taking these little bits of sandpaper-y type thing and making a spot on my head and sticking all these probes on.

And then the next thing is like, "Well, we'll watch you and we'll be able to talk to you."

Scot: "Good night."

Mitch: "Crawl into bed with all this stuff. Give me a holler if you need me to disconnect you to use the restroom, but good night."

Scot: Wow.

Troy: That sounds so awkward.

Mitch: I don't know who picks the decor up at The U stuff. No shade, it's a wonderful center, love them, but it was an obviously haunted photo in my room as well. Three ghostly Victorian women with their heads on their shoulders. I'm like, "Not okay."

Dr. Baron: I did my training there in the early 2000s and that place has not changed one bit.

Troy:Oh, wow.

Dr. Baron:And it probably hasn't changed since they put those photos in, in the Victorian era. I mean, it's meant to look like a sort of hotel room sort of place.

And I do like to tell my patients that we're not expecting the best night of sleep of your life. We're really expecting to just get a couple hours of sleep to know how your breathing is going. And so it kind of takes the pressure off, but it's uncomfortable. You're hooked up, you're in an unfamiliar place, and it can be a little bit unnerving.

Troy: I will say, too, hearing this I have stayed in a hotel that is in the top 10 list of the most haunted hotels in the U.S. Your decor sounds a lot like that hotel.

Mitch:But it was really a great center. I don't want to disparage it at all. It's just it was a weird painting to try to sleep with.

Troy: These Victorian women looking at you.

Dr. Baron: There's a whole genre of sleep art and a lot of these paintings depicting these Victorian women with demons or that sort of thing. It's thought that a lot of these sleep disorders were interpreted as hauntings or demons or things like that. There are things like sleep paralysis they're depicting where you wake up, you know you're awake, you can't move, or hypnagogic or hypnopompic hallucinations, that you kind of see things as you're drifting off to sleep or as you're waking up.

So there are some really famous paintings, like one called The Nightmare where there's a demon is sitting on someone's chest. Sleep people love that stuff.

Mitch: So, yeah, you just curl up with all your wires and fall asleep eventually. And then next thing I know, I'm being woken up, very kind voice being like, "Hi, I'm here to unhook you." And then you go about your day and wait to hear from the doctor to read the results.

Scot: Yep. And then you get three or four pages of information here, it looks like.

Mitch: Yes.

Scot: Mitch sent Troy, myself, and Dr. Baron the results of the sleep study. And we're all playing pretend sleep experts.

Troy: Well, two of us are playing pretend sleep experts. One of us is an actual sleep expert. Two of us are like, "Yeah, I'm just picking out this stuff. Oh, wow, look at your oxygen levels. Oh, wow," which probably is completely meaningless. I have no experience interpreting this, but I found it fascinating.

Scot: I don't know where to go from here. I don't know if I should just ask Mitch what were you told? I don't know if we should ask Dr. Baron what she's seeing. What do you think we should do next?

Mitch: So I guess the main takeaway was that . . . I do have a family history of sleep apnea, right? There are CPAPs in my family. And so it was like, "Okay, maybe I have apnea. Maybe I need to figure that out." I was preparing myself for that.

Scot: Yeah. Hold on. Let's jump in here. Dr. Baron, what is sleep apnea in the 30-second version? What does that even mean?

Dr. Baron: So sleep apnea is a diagnosis made by showing that you have repeated pauses or blockage in your breathing at night. And so they're 10 to 30 seconds long usually, and then you wake up and you start breathing again. So it's a partial or complete closure of the airway.

Scot: So it's a breathing thing that not only doesn't sound great, but it's . . .

Dr. Baron: I should clarify there are two types of sleep apnea. There's obstructive sleep apnea, which is pauses in breathing due to the closure of the airway, and then there's central sleep apnea, and that's when the brain has pauses. And that happens, for example, in heart failure, with opiates, and that sort of thing. So there are two different kinds, but obstructive is the most common kind.

Mitch: Got you.

Scot: So is that what you ended up being diagnosed with, Mitch?

Mitch: No, surprisingly not.

Scot:Even though it's in the family? All right.

Mitch: As terrible as it sounds, there was a part of me that was like, "All right. My family's dealt with this before. I just get a CPAP machine. It's not the most exciting thing in the world, but I'll just do it and I'll sleep better and everything will be great." But no, that's not what the results said.

Scot: Not only that, but it doesn't even look like you snore.

Mitch: Nope, not a snorer.

Scot: Go ahead and put that on your dating profile.

Dr. Baron: The main signs of sleep apnea are snoring, as you pointed out. Snoring, daytime sleepiness, unrefreshing sleep. But there are also people who can have sleep apnea and not snore, and they can just kind of have some gasping or pauses in their breathing. And so we often ask them to ask their bed partner, if they have one, if they've heard them pause in their sleep. That's a big sign of it.

But otherwise, you also can just have sleep apnea and be unrefreshed from your sleep or be depressed or irritable. It can really come out in a lot of different ways in how it affects you. And even sexual dysfunction. There can be erectile dysfunction, low libido. It can affect testosterone.

So there are a lot of different ways that sleep apnea can affect somebody. Not everybody with sleep apnea snores, but it is obviously the most outward symptom of it.

Scot: Yeah. On this study, though, it doesn't even show that you snore. So what was it?

Mitch: Apparently, my leg moves a lot. Dr. Baron, how did you respond to the email I sent you showing you my results?

Dr. Baron: Well, there's a little graph at the bottom. I said, "Holy moly," because there's a little graph. There's a picture of it at the bottom, the events throughout the night. It's blue when you have an event, and literally your entire night is pretty much all blue.

Scot: It's like a solid blue bar. It should be little lines here and there.

Mitch: Little lines, yeah.

Dr. Baron: Your legs are twitching all night long. And not only are they twitching, but it's waking you up. So each time you have a twitch, they've also scored an arousal in your EEG of your sleep recording.

It's quite substantial. You had total limb movements 524 over the night, which is a lot. But you look at it per hour, and so number of limb movements per hour, that's 83.6. And the number causing arousal is 27.3.

Scot: And I take it by your "holy moly" that's not usual. That's not something you normally see me.

Dr. Baron: We would consider it elevated if it's above 10.

Mitch: Oh, my.

Troy:Ten per hour?

Dr. Baron: Yeah. But keep in mind, limb movements themselves, or if somebody is kicking their legs at night and it's not bothering them . . . It's kind of this weird thing. We're unsure of the clinical significance of limb movements unless it's causing a daytime impairment.

Most people who have limb movements also have a subjective feeling of restless legs. And so I was going to ask you that as a follow-up. Do you have a creepy crawly urge to move your legs in the evening?

Mitch: I've had it on occasion. It's never been something super serious. It just comes up occasionally. But we can talk a little bit more about what could potentially cause it, I guess, is what I'm kind of curious about. Everything is complicated and connected.

Dr. Baron: Yeah. Actually, I don't even know what causes periodic limb movements. I mean, there's something in the dopamine pathway related to it. But most people who have this level of movements will have a subjective experience of restless legs.

But the point of treating the legs is really only worth treating if somebody feels like their sleep is bad quality, in your case. Otherwise, it's not clearly related necessarily to a health risk, having your legs kick at night.

There are some studies showing an increased risk of cardiovascular disease, but it's not really consistent at this point. It's really to understand whether the limb movements themselves are problematic. Unless you feel bad, and then that's clearly a target to address.

Troy: Sounds like in Mitch's case there was clear evidence it's affecting his sleep. You said 27 movements per hour that were disrupting sleep? Is that what the report said?

Dr. Baron: Yes.

Troy: It's like every two minutes you're waking up because your legs are moving. That's impressive.

Mitch: Yeah, you got it.

Troy: Wow.

Scot:Just to clarify, while you're trying to fall asleep, you don't have necessarily restless legs. You don't have this need to move your legs.

Mitch: I would have it maybe once or twice a month. It was never a big thing. There is a genetic side to it or whatever.

But one of the things that was interesting is my sleep doctor brought up . . . Speaking of the dopamine pathway, guess what is a potential side effect of some of the anti-anxiety meds I'm on? It's maybe an increased rate of restless leg syndrome or occurrence of restless leg syndrome.

It's like a whack-a-mole problem with my health sometimes where it's like, "Great. So we figured out mental health stuff, but is it making my sleep worse?" So we're trying to figure out one thing or another.

Man, oh, man, I was just shocked. Like I was saying before, I almost wish it was apnea because then there's a clear path forward, but it's just more complication. And it's just like, "Okay, what else do I have to do to get a decent night's sleep?"

Dr. Baron: That's true. Now, I think all of the SSRIs are related to restless legs or limb movements, but Wellbutrin is one that's not. So not all of them are. Some more than others.

Mitch: Right. And so now we're like, "Now we're playing with the brain chili," as our wonderful mental health people talked about. We've got to go back to the drawing board on this thing. So anyway, it's very interesting.

Dr. Baron: The most interesting thing to me about the drugs that treat restless legs or periodic limb movements is that you kind of get to choose one or the other. The drugs either quiet down the brain arousal . . . So either it's a benzo that makes your brain more stable at night and you're kicking, but you're not waking yourself up, or they're the more dopamine-type drugs. Those keep your legs from kicking, but then you still have the brain arousal. Isn't that interesting?

Mitch: Yeah, it is. Interesting and fun.

Dr. Baron: They both improve the symptom, but they do it in a different way. No drug does both of them. I think the most common drug used, the most recommended drug used is Gabapentin.

Mitch: And that's what they've got me on. So the treatment moving forward is, one, work with my mental health person to maybe look at my mental health meds, and is there something we could try differently that might minimize having just that many "holy moly" amounts of leg wiggling? So we're messing around with that. I'm on Gabapentin. And then I do some little yoga stretches before bed just to try to calm the legs and make sure that everything is relaxed before I go to bed.

Troy: And have you noticed a difference yet?

Mitch: We've been doing it for about a week. It hasn't been too long. These results are relatively recent. But it's been a week. I haven't noticed a big shift yet, but I'm told that it can take a while for the drugs to build up in your system. It can take a while for your body to get used to the stretching. So I'm trying it out, working with my doctors, seeing what's next.

Scot: So then you're trying out some stretches, some medications. What's the next step, then, to see if this works? Is it just simply are you waking up more refreshed and bing, bang, boom, we've got it? Or are you going to go back in and they're going to check your leg movement again during a sleepover study?

Mitch: Well, we're going to first try some stuff for the next couple months, is what I've been told as it can take some time, to see if we can improve my general sleep quality.

But because of just how much movement I was experiencing, my doctor has suggested within the next year going back in, getting hooked up, sleeping underneath the spooky pictures, and going back to just one more time make sure that things are actually getting better physically, just because of how much leg movement there was in this situation.

Scot: Dr. Baron, I have restless legs, where sometimes it prevents me from falling asleep. And then eventually I do. My wife then will comment, sometimes even while I'm sleeping, she'll go, "Oh, you were kind of twitchy last night."

Am I understanding correctly that restless legs like that wouldn't necessarily always impact your sleep quality? Because after hearing Mitch's story, I'm like . . .

There's something you've got to know about me, Dr. Baron. I'm always looking for what's my thing. Why am I tired all the time? Why am I lacking energy? I'm doing all these things. "Nope. Normal, normal, normal." So now here's my new one thing. Would my restless legs potentially be causing me not sleeping well, too?

Dr. Baron: So do you remember that . . . There used to be a commercial that said, "The most common disorder you've never heard about." Remember that one?

Scot: Yeah.

Dr. Baron: So that's restless leg. And restless leg now is going by the more complicated title of Willis-Ekbom disease. We feel like a lot of people don't take it seriously, and they say, "Oh, you just kick your legs at night." But obviously, you guys both know the impact on your quality of life.

So just to go over the criteria for restless legs, it's an uncomfortable, creepy-crawly sensation in the legs that is relieved by movement. And it also has come on in the evening, so it's specific to the time of day.

Troy: Does it have to be every day you experience it, or once in a while in terms of timeframe?

Dr. Baron: I mean, a lot of people experience it occasionally. I even experienced it like when I'm really overly tired or have jetlag. The worst is a very late-night flight. I'm so restless. And it's also worse when you have to stay still.

They used to have a test for restless legs, an objective test, where they used to record people and say, "Stay still," and then count how many times they moved. It sounds like torture, but it is a really torturous feeling.

I mean, the severity is related to how much it disrupts your sleep, how many times a week you have it, how much you feel like it impacts your daytime, that sort of thing.

So somebody experiencing it once or twice a week, or once or twice a month, that's on the more mild side. But somebody who is saying every night it impacts their sleep, that's on the more severe side.

Scot: I guess my question ultimately is, let's say, out of a week, maybe it bothers me falling asleep three nights out of the week. But I always just assumed after that then, "All right. I've fallen asleep. Restless legs aren't an issue anymore." But clearly, what we're seeing here with Mitch is that's not the case, right? They can wake you up in the night and you might not even know that that's what's happening.

Dr. Baron: So just to separate, though, there's the subjective experience of your legs, and then there's the objective kicking. And they don't always go together. As a clinician, I'm most interested in the subjective. So I'm most interested in how much is it bothering you when you fell asleep, or if you're unrefreshed during the day.

Scot: Got it.

Dr. Baron: I guess if you're having trouble falling asleep three times a week because your legs are uncomfortable, I would say that crosses a threshold of going to talk to somebody. So maybe this is your thing too.

Mitch: Hey.

Troy:We got something for you, Scot.

Scot: Yeah, maybe. I'm always disappointed, though, so I plan on being disappointed here too.

Dr. Baron: Restless legs, though, doesn't require a sleep study.

Scot: Oh, okay.

Dr. Baron: Because if your legs are uncomfortable, then that . . . Unless you have signs of sleep apnea or other indications, do a sleep study. If your legs are restless, that's a sign that you could have a treatable condition. Then just treat it. You don't have to treat it and then follow the impact objectively. It's more about how you feel during the day or how much your legs bother you at night.

Scot: Yeah. Well, for what I'm looking for here is, like I said, I tend to feel like I'm tired a lot, right? So I'm looking at what could possibly be causing that. And I hear that restless legs or leg movement in the middle of the night could be the problem.

Up until this point, maybe on a night where I have restless legs it puts me going off to sleep for 15 minutes extra. But after I fall asleep, I assume that they're not impacting me anymore. Is that a safe assumption? Or could they be still going and I don't realize it, causing these little micro-wakeups like Mitch was experiencing?

Dr. Baron: Yes. It's highly likely that you're having that because about 80% of people who have restless legs also have these limb movements at night. I mean, it's so common when people have restless legs that they don't even necessarily need to do the sleep study to document them.

Mitch: Wow.

Troy: And if someone's listening or maybe Scot wants to try something before trying medication, what would you recommend?

Dr. Baron: Interestingly, for restless legs, it has really the most folk treatments of any disorder. I don't know if you've heard about the bar of Ivory soap under the bed.

Troy: No.

Scot: I was really kind of hoping for something tastier.

Troy: Ivory soap.

Dr. Baron: I mean, there are some people who have tried magnesium, for example. And then iron can improve restless legs as well. And that's really the first line if it's indicated, because it is more safe, less side effects than going on to medications.

Scot: As with these episodes and talking about health, a lot of times one man's experience then kind of morphs into another man's experience and then it starts asking questions like here. But let's get back to Mitch briefly. Is there anything else looking at this sleep study that you noticed, Dr. Baron, that you'd like to bring up?

Dr. Baron: Well, we were talking about the sleep stages earlier as we are going through this together and . . .

Scot: Yeah, and actually, I wanted to jump in because we had a talk with you about these sleep trackers that you can get that allegedly tells you how many minutes of REM sleep you get. And we discussed whether that's the gold standard or not, which it's not.

But what was Mitch getting for REM sleep? Thirty-nine minutes? Thirty-three minutes, yeah.

Dr. Baron: Thirty-three, 8.8% the night. Again, you have to take the sleep study stages with a grain of salt, because, again, it's not your normal environment. You're going to sleep a little bit earlier. How different is the timing of the sleep, from 9:40 to 6? Is that pretty consistent with when you sleep at home?

Mitch: I usually do 10 to 7, so it wasn't that big of a difference.

Dr. Baron: Okay. So it's similar, but the thing with REM sleep is you get the most and the early morning hours. And if you have a 20-year-old in the sleep lab and you wake them up at 6, well, that's the middle of the night for them. They're getting their REM usually later, like 8, 9, or 10 in the morning, for example, if they're a later sleeper. But in your case, this was aligned with your normal sleep.

It showed that only 10% of the night was in deep sleep and 8% was in REM sleep. And the REM sleep number was really lower. That should really be about 20% or 20% to 30%.

And as I look at your hypnogram, which is the picture of your sleep, to me, it really suggests that the leg movements are interrupting your sleep stages. And so you can see how even sometimes you get into REM and then it just wakes you up.

Mitch: I see that, yeah. The line goes from what? It's deep sleep, REM whatever, and then at the top is awake, and I keep bouncing right back up to awake.

Scot: How does this compare with your fitness tracker?

Mitch: The fitness tracker made it seem like I was sleeping better.

Scot: Oh, okay.

Mitch: The numbers that they gave me are much lower from the actual sleep study than the Fitbit that I wear.

Scot: Got it. Well, Mitch, I guess as with other aspects of health, you've proven our hypothesis of just focus on the Core Four. Sometimes it's a little bit more complicated. When can we get an update, did you say?

Mitch: They said a couple of months to try the Gabapentin and the stretching and everything. So yeah, we will bring Dr. Baron back on and we can chitchat about how it's improved.

I hate to blow up the Core Four, but man, oh, man, if you are someone out there that you're hitting your head against the wall being like, "I'm doing it. I'm doing the sleep journaling. I'm doing all of this stuff and it's still not working," maybe you have shaky legs. Maybe you have some chemical imbalance. Maybe you've got who knows, right? Maybe there's something else going on.

Scot: Dr. Baron, to wrap this up, how long should somebody try to do the things that are generally recommended before they kind of take the next step that Mitch took?

Dr. Baron: That's a good question. I think if you've done it for a couple months, you've done all the things you should do, get the electronics out of the room, have a regular schedule, sleep diary, at that point, that's the time you should come in and talk to somebody. And it sounds like he was working with his primary doctor as well the whole time to try to just kind of rule out the different possibilities that could be causing this. I mean, this process has probably taken a couple of years is my guess.

Mitch: We're about to enter Year 2, so here we are.

Troy: Yeah, but it's nice though hearing this, Mitch. You're right, it is frustrating on the one hand, but it's nice hearing it. You tried everything, but there are other options. And I think that's a good thing, too, to know that you can try all these things and it may just not work for you and there may be something else going on you need to address. You're doing that.

Mitch: You're not a failure. I mean, that's the thing that I kept getting in my head, where it's just like, "Am I not doing this right? This is sleep. How is this so hard? Babies can do it."

Troy:Some babies can do it.

Mitch: Some babies can do it, right?

Dr. Baron: That's funny. My patients are always like, "I bet you sleep well." And I'm like, "I struggle just like everybody else." Just the stress and bad habits. I don't always take my own advice. So it's not easy for anybody, except maybe babies.

Mitch: Sure.

Scot: Troy's a new dad, so I think he's going to argue with us on that one.

Troy:I would tend to disagree. But anyway, that's another discussion.

Scot:That's another podcast. Well, Mitch, thank you very much as always for sharing your experience. Your health journey has been interesting and it's been great to talk about. As we've talked about on this podcast, talking about it is how we help each other maybe find a path to better health, especially when something like the Core Four isn't working, and you've been honest about it, and you've given it the true shot that it deserves. Sometimes health is complicated.

Dr. Baron, thank you very much for being part of the podcast. And listeners, thank you very much for listening, and thank you for caring about men's health.
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Scot: Getting up at 5:00 in the morning and then grinding into the night to get things done, that's a badge of honor. "I'm not lazy. I'm getting it done. I'll just get a couple energy drinks and do it again tomorrow." Probably heard the saying, "I'll sleep when I'm dead." That feels pretty manly to say, by the way.

Regardless, if it makes you feel good to tell people how little you sleep, or there are other reasons you're not getting sleep, sleep has proven health benefits and not getting enough can have similar downsides as not getting enough activity or good food.

You could have the other three core four dialed in and if you're not getting enough sleep, it could sabotage at all. That's how important sleep is.

So today, on the "Core Four: Back to Basics" series, we're going to talk about sleep, how good sleep improves your life and how to get better sleep.

My name is Scot Singpiel. I bring the BS to the proceedings here, and the MD to my BS is Dr. Troy Madsen. And before you say hi, I want you to say, "I'm Dr. Troy Madsen, and I'll sleep when I'm dead," in your manliest voice.

Troy: I'm Dr. Troy Madsen, and I'll sleep when I'm dead.

Scot: Also we've got Mitch Sears in the mix. Same thing.

Mitch: I'm Mitch Sears, and I'll sleep when I'm dead.

Troy: Sounded like you were thinking about it. You're like, "I'll sleep tonight."

Scot: We have one opportunity for our manliness to be saved here, and that's Thunder Jalili.

Thunder: I'm Thunder Jalili, and I will sleep when I'm dead.

Scot: There you go. All right. So, today, we are going to talk about the benefits of good sleep. And for some reason, I think society kind of undervalues sleep. What do you guys think of that? When we think about being healthy, it's pretty common to come to nutrition or exercise, but sleep is just as crucial as we're going to learn in a couple of seconds. Is it just me, or does society kind of devalue it? And why do you think that is?

Thunder: I think actually American society maybe does devalue sleep. I think it's part of our work hard work ethic, get it all in and don't be a wimp, and get your stuff done, because other cultures around the world aren't like ours. The Spanish, they value sleep. They have a nap built into the day. We're not like that.

Troy: Yeah, I agree. I think we definitely undervalue it and it certainly is a badge of honor for a lot of people. And as someone who works in the healthcare profession, I can say it is absolutely a badge of honor. If you can talk about how little you sleep or let's say you say, "I just came off a night shift and I didn't go home and sleep, and now I'm here in the office working all day," that's a badge of honor. It's not like, "Wow. That's stupid." Yeah, no question about it.

Mitch: I remember when I was working in broadcast, you would come in and the night shift would be coming off and they would have their pile of energy drinks and they would just be very proud of how much caffeine they were functioning off of and "still getting a good job done." That was always very like, "What are we doing?"

Scot: Dr. Madsen or anybody, do you think that people just don't realize the benefit of sleep? Because a lot of times it's the first thing to get jettisoned, right? When things get tight in your life, that's where you'll cheat, either getting up early or staying up late to get things done. Do you think it's just because people don't realize what that tradeoff is actually costing them?

Troy: Yeah, it may just be that we don't quite realize the magnitude of the effect. I think we recognize, "Yeah, there's some detrimental effect, but those effects are more immediate. I'm tired, but I can use caffeine. I can drink some caffeine or whatever, and that will eliminate that short-term effect." But I do think we definitely undervalue the long-term effects.

Thunder: Yeah, I agree with that. I think cutting sleep is an easy thing to do in the short-term to get things done, and there are ways to get around it, like Troy said, with caffeine. So I agree with him completely.

Scot: All right. I think that's a good segue into talking about the benefits of getting enough sleep and how it can impact your health. Thunder, go ahead and kick us off on that.

Thunder: So there are many benefits to getting good sleep. I'll just share a couple with you. One is sleep is actually tied into maintaining healthy body weight. And I know that's a big focus of what we've talked about on this show in the past. We talk a lot about the exercise and the nutrition component, but getting enough sleep is also a valuable contributor to healthy body weight.

The other thing that's great about sleep is it helps you keep your stress levels low and it helps improve your mood. If you think about it, think about the nights that you haven't gotten a good night's sleep and you wake up the next day and you're just kind of a little grumpy or a little off and things are bothering you. That's something everyone has experienced, and that's really that function of not getting enough sleep.

So having that regular sleep schedule can definitely improve with that. It gives your mind a chance to reset at night and reduce your stress level.

Troy: Yeah. Thanks, Thunder. And the other thing too that I've definitely seen plenty of studies that have shown that sleep lowers your risk for diseases like diabetes and heart disease and cancer as well, like long-term studies.

It's a little scary because I've often seen these studies done with shift workers like myself, which is kind of depressing, but it is one of those things. They do find those who don't sleep well do have higher risk of diabetes, heart disease.

I think the obvious thing we've talked about already is it does help you to think more clearly. But this is something that's been quantified in multiple studies. They've kept people awake for 18 to 24 hours and just noted their ability to perform tasks just declines over time to the point where . . . At 18 to 24 hours, you're at a point where your technical skills, and your focus, and your attention are on par with if you were legally intoxicated. So definitely effects there.

I think we all know we've had those experiences when we don't sleep well, we get sick. Sleeping well helps us to stay healthier, get sick left less often, and helps us look better too. We look better. We look healthier. Our appearance is improved when we sleep well, when we're well-rested. So that's a big thing as well.

Thunder: Don't have those bags under your eyes.

Troy: Exactly. Get rid of the bags.

Scot: I'm noticing the last two episodes that that's been Troy's thing, appearance. So do you want to talk about something?

Troy: I'm feeling self-conscious about my appearance and I need to sleep more. Maybe that's it.

Scot: You look wonderful.

Troy: Thanks, Scot.

Scot: We're going to hit up here some of our sleep struggles and then what we've done to try to work through those or not work through those.

But first, Mitch, let's talk about, like we have in past episodes, the basics. These are kind of the rules that you want to try to incorporate when you're talking about sleep.

Mitch: Yeah. And these are the ones that have been kind of tried and proven from research and studies, etc. So these are kind of the things that have the most evidence behind them.

The first thing that you want to do with your sleep is to prioritize it. And it's important to realize that when you prioritize sleep, it also means that it's not just quality of sleep. It's also quantity of sleep.

So what they're saying is that you need to get at least a minimum of seven hours and that you can't really just make it up. You can't sleep four hours one night and nine the next and expect it to be as healthy as if you were to get seven hours each night.

The other thing is that in order to get a better quality sleep, try to go to bed at about the same time every night and wake up at the same time every morning, which is something that we've kind of talked about before with Kelly Baron on a previous episode about everything from your sleep hygiene to making sure that you're going to bed and waking up at the same time every morning.

Now, the other thing you want to make sure to do is to not underestimate how things you do during the day can impact your sleep. A lot of things you do throughout the day can really impact not only the quality, but the quantity of sleep that you're actually getting. So make sure that exercise, nutrition, and mental health are all big factors that go into your sleep.

Stress, anxiety, depression can all impact how well you sleep every night. Activity, exercise during the day is good, but not less than two hours before bedtime. They've shown that that can kind of interrupt your sleep cycle, if you work out too close to going to bed. And finally, caffeine, alcohol, and nicotine four to six hours before bedtime and big meals before bed can impact your quality of sleep.

So you just want to make sure that you're not working out too close to bed, but you should be working out through the day, and to kind of avoid some of these different chemicals that can really impact the quality of your sleep.

The other thing is that sleep environment needs to be dark, quiet, and a comfortable to temperature. By making sure all of those things are kind of in place, it will really improve the quality of your sleep.

And make sure that you are not doing things that engage your brain like screens, TVs, games, radio, talking on the phone. If you do those things too close to sleep, it can also impact the quality of sleep that you get.

And finally, if you've tried everything else and you are still having trouble with sleep, go talk to a doctor and rule out that you don't have a sleeping disorder.

Scot: Some good basics there. So let's hit the sleep struggles. I want to start with Troy because you work in the ER, you work crazy shifts, you might be working during the day for a few days and then you do an overnight shift. What is one of your sleep struggles?

Troy: My sleep struggles are so plentiful, it's difficult to choose from them. But like you said, Scot, I do shift work, so I end up working nights, evenings. And for me, evening means I get to bed at like 2:00 or 3:00 in the morning. Night means I get to bed at like maybe 9:00 or 10:00 in the morning.

Scot: Wow.

Troy: Yeah. And so I'm trying to do that and then turn around double back and do a 7:00 a.m. shift the next day and do a 10-hour day on that.

So I have no doubt, and I think talking to Kelly Baron, it was very clear I do suffer from shift work sleep disorder. It's not something I really had prior to doing shifts when I started my residency training.

I have plenty of times where I think I don't struggle so much to get to sleep. I generally fall asleep once I get back into my regular routine, but then I will often find that I'm awake four hours later and just lying there and not sleeping. So that's probably the biggest for me.

I feel like I can get to sleep, I can fall asleep, but then I'm often awake a few hours later and not sleeping at that point. So that's definitely a struggle and I think not an uncommon struggle, definitely for people who do shift work, but I think a lot of people I've talked to have that issue as well.

Scot: Yeah. I look forward to hearing if you have some things that you've figured out of work around that. I mean, you can't totally fix it, right? The best you can do is kind of make the best out of a worse situation.

Troy: Yeah.

Scot: Thunder, how about you? Do you have any sleep struggles or you do all right?

Thunder: In general, I do all right. But my sleep struggle that does come up from time to time, believe it or not, is temperature. If it's too warm, I have trouble sleeping. So I have to be aware of that. Most of the time it's fine, especially in my own house, but when I travel, sometimes you're out of your comfort zone and you're someplace where the temperature may not be right.

So I try to do what I can, make sure I'm not putting too many covers on the bed because if it's too warm, it's tough. Hopefully I can adjust the temperature in a room, things like that. But that's my main challenge.

Scot: I'm pretty fortunate that I haven't had a lot of struggles. I have a job that allows me to have a pretty regimented sleep schedule. And for the most part, I fall asleep. For the most part, I sleep through the night. And then for the most part, I'm able to wake up in the morning when I need to. So I am pretty fortunate.

I think my biggest challenge, though, is I'm always thinking. My brain is always going, and sometimes I'll just lay in bed and I can't quite shut it all off. And part of it might be my fault. Maybe I was doing something too close to bedtime, but that's kind of mainly the struggle that I have.

How about you, Mitch?

Mitch: So I guess I have a slightly different story here. I have always struggled with waking up feeling refreshed. Every single night, it just feels like I haven't gotten any sleep the night prior and it's day after day after day, month after month.

I've been working with my doctor for the last year to try to figure out what I should be doing. And from stuff that we've talked about on the show, I've made sure that I go to bed at the same time every night. I'm waking up at the same time in the morning. I've played around with using a little bit of melatonin sometimes before bed. I've tried making sure not to look at screens or anything beforehand, and it doesn't seem to help.

And it was just recently after trying all of these things, my doctor had me do an at-home sleep study and they think they have found that I have sleep apnea. So I am waiting to go to do a formal sleep study in the next month or so and kind of figure out what's going on.

The struggle I've been having is I try everything and I still feel so tired. And when it comes to the Core Four, I'm working on my nutrition, I'm working out, I'm doing all the mental health things I can, but sleep has been one that's been really troublesome. And it eventually led me to talk to the doctor and we might be able to actually fix it now that we can find what's going on.

Troy: That's great you did that, though, Mitch. You talked to them and you went and looked for help. Yeah, that's a common story I hear from people where they say exactly that. They feel like they're getting plenty of hours of sleep, but they are just awake and they are not refreshed.

And I'm guessing they talked to you about in your sleep study, or in the sleep study you'll do, if they do see that, you wake up so many times at night due the sleep apnea that you're really not sleeping a whole lot, or at least good, deep REM sleep.

Mitch: Yeah. And that's kind of what they've explained. It's like, "Hey, if you have a sleep disorder, whether it be apnea or . . ." They talked about some restless leg syndrome. They talked about all these different kinds of things that can keep you up through the night. It doesn't matter what you're doing. It doesn't matter how often you're going to bed. It doesn't matter how healthy you are with your sleep hygiene and your hours and everything. If your body has something a little messed up that is waking you up all night, it doesn't matter. So that's where I'm at.

Troy: You're going the right direction. That's good. That's good to hear.

Scot: Mitch, do you find that impacts you, any of your other Core Four, like your nutrition, your . . .

Mitch: Oh, yeah.

Scot: How so?

Mitch: So I find that on days where I have not had any restful sleep and it's been day, after day, after day, when your energy level is so low, the idea of cooking a meal goes right out the window, right? In my sleep deprived state, all I want is a Big Mac. You go straight to the fast food whenever you can.

When I'm tired, I find that I can't work out the way I'm supposed to. When I go out for a jog or something like that, I can't go nearly as far as I think I need to. The whole process is really kind of frustrating and your heart rate gets up higher than it's supposed to, etc.

And mental health-wise, things . . . We're living in a very stressful time right now and I find that on the days where I don't get enough sleep or I'm not able to sneak off and take a nap in the middle of the day, I get really stressed and my anxiety gets high and I'm quicker to be frustrated and all sorts of things.

And it's been really surprising, ever since starting working on this podcast, that I'm focusing so much on all aspects of my health, but sleep was the last one. Sleep was the one that was like, "Eh, that one will figure itself out." But here I am learning that maybe I have something else going on. And hopefully, by working with my doctor and finding out a treatment plan, maybe in the next little while I can start seeing better results elsewhere.

Scot: That's a great point about how "maybe it'll just work itself out," right? This notion of "something might fix itself," I think that can be kind of dangerous, and I think a lot of us guys have that.

Mitch: And that was kind of the thing that was interesting when I first started speaking with my doctor. He was like, "Well, yeah, if you're having trouble sleeping, you might be having mental health stuff. Why don't you go talk to someone about that?" and, "Oh, when you start getting more activity, I'm sure you'll feel tired by the end of the day," and, "Oh, if you improve your nutrition and drink less caffeine, I'm sure your sleep will kind of fall into place."

And so, for the last year, I've really been working under that assumption that sleep is easy, sleep is going to just happen if I do all these right things. But if you're out there and you've been trying everything, maybe it's time to talk to a doctor.

Scot: All right. Let's go ahead and talk about maybe three struggles or three things that we've learned and what we've done to overcome those. And again, the hope is that if somebody else is struggling with something similar, this might be a new, fresh idea for them.

So I'm going to kick things off with this notion of a dedicated bedtime, being sure that you get to bed at the time that you've decided to get to bed. For me, it was 10:00. And it was challenging because if it was 9:15 or 9:30 and my wife and I were up and we were hanging out and she wanted to start a show, I'm like, "Well, it's going to be 52 minutes. I can't do that. That's going to put me past my bedtime."

Or sometimes I feel like I don't have enough time in the day to get things done. And I'm sure that's something that a lot of men deal with. And so, as a result, you push into the night, or what I've learned is you kind of have to prioritize what's important or ask for help to get all the things done that you need to get done. You can let go of some of those things.

So a dedicated bedtime has really, really helped me, and it helps me wake up a lot more refreshed, but it is challenging for those reasons and other reasons as well.

Troy: Scot, I'm going to jump right on that, and I'm going to say also a dedicated wake-up time. That's been big for me. We talked about that also with Kelly and just saying, "I'm going to get up every day." For me, it's, "I'm going to get up every day by 7:00 a.m. regardless."

And certainly, I have shifts where I have to get up early. I don't care if it's the weekend, whatever. Granted, I did mention there those times I'm getting to bed at like 3:00 or 4:00 in the morning, so I might sleep in a little after that. But once I'm in my regular routine, I'm up at 7:00, and I know I'm going to get up at 7:00.

Just knowing that, it kind of helps mentally, because before, I would kind of give myself this nebulous wake-up time. If I didn't have a shift or if I didn't have something going on early, I'd be like, "Well, I'll just get up when I wake up, because I have to make up for my missed sleep."

And then during my night sleeping, I would just lie there and I wouldn't really fall back asleep and I would just be like, "Well, I don't really have to get up. Okay. Maybe 9:00. Maybe it'll be 10:00." Kind of this mental thing where I just kept putting it off in my mind.

But I think knowing, "Hey, I'm going to be up at 7:00," something about that mentally just lets me know, "This is my sleep time, and I'm going to take advantage of it and I'm not going to sleep past that, so don't think I'm going to be able to make up what I'm missing now by sleeping in until 9:00."

Thunder: So I'm going to jump on the regular schedule bandwagon as well. I'm also all about that, going to bed about the same time and waking up about the same time.

I will add one thing about the waking. I usually wake up around 6:30, give or take a little bit, and I never have to set an alarm because I'm used to waking up at 6:30. So all the things that you have to do in life that you have to wake up early for and you need to set an alarm for, I never do that, and I find it cuts down on my stress level the night before. You're not thinking, "Oh, I've got to wake up extra early," or, "My alarm is going to go off," or something. You just wake up at your normal time.

The new thing I'll add to that is I have a bit of a relaxation routine that I engage in almost every night, and that is I read a little bit before bed. And for me, that works. I'm talking reading out of an actual book, or a magazine, or sometimes I'll read on my Kindle with a black screen.

So that kind of helps my mind disconnect from whatever was going on during the day and get lost in something else for a little bit. And I don't last too long reading. Maybe I can do like 10 minutes to 30 minutes, depending on what it is. So that's part of my routine, that little relaxation moment.

Scot: All right. Mitch, you're up.

Mitch: So the thing that it really helped me out is I'm the worst millennial. I am on my phone up until . . . I used to be, at least. I was on my phone up until the moment of my bedtime. What I have found is that regardless of your phone, most modern phones, whether it be an iPhone or an Android, they have digital wellbeing settings. And if you can go into there and turn them on and respect them, it has really helped me make sure that I'm not doing too much screen time before bed.

On my phone, at least, I set in my bedtime. I'm like, "Hey, I want to start winding down. I want to stop using my screen for an hour before bed. Here's when I want it." And when the phone hits that time period, it turns off all my notifications, it turns super-duper dim, and black and white.

And it seems kind of dumb because it's like, "Well, I can still use the phone." But for some reason, the lack of color, the fact it's super dim, the fact that you can't hear anything, it really helps just kind of disconnect and set it aside before I go to bed.

Scot: That was a big thing for me too. Up until recently, I would go to bed and I'd get out my iPad and I'd scroll social media, and then I'd find something that enraged me and then I couldn't stop thinking. Somebody would make some comment and then I would spend the next hour coming up with what my comment would be back to them, right? So, for me, getting rid of that social media has been absolutely crucial.

And the other thing that I struggled with too, and, Mitch, tell me if you did this, are the Instagram Reels, which are like TikTok videos, right?

Mitch: Oh, yeah.

Scot: I'd watch those. And even if I'd quit an hour before bedtime, then I'd have one of those stupid songs playing in my head and I couldn't get it out and fall asleep.

Mitch: Well, it's so easy to just get sucked into that hole too. You're just scrolling, and swiping, and swiping, and swiping and the next thing you know, it's like, "Oh, man, I've been doing this for two hours."

Troy: And how much of our life do we waste just thinking about snarky replies to other people's snarky replies?

Scot: Right?

Troy: I totally hear you on that. It's like, "What am I going to say to this?"

Scot: That I would never ever actually enter in, but I'll spend a lot of time thinking about what it's going to be.

Troy: Yep. I'm going to think about it, and it's going to be good. It's going to keep me up all night.

Scot: All right. Number two for me. Now, I don't know if this is a type of meditation or what, but it's a little exercise I do. It could be considered maybe a form accounting sheep or whatever. But if I'm struggling falling asleep, I will pick a color. That kind of tends to be my go-to. So I'll pick the color green, for example, and then I'll just let my mind go and think about things in my life that are green or in my past that have been green.

Troy: Oh, wow.

Scot: It takes me down this kind of memory lane. My parents' first car that I remember was this big green Plymouth from the 1970s. And then I'll think, "Oh, I had a toy box. It was a frog, and it was green." I just kind of let my mind go where it wants to with whatever color I've picked, and I find that after a few minutes of that, I feel kind of tired or I might just fall right asleep. So it's a little weird, but it's worked for me.

Thunder: So it's so boring that it puts you to sleep?

Troy: I guess so. I just feel like that would be too engaging. You would really be thinking way back into your childhood and trying to come up with all different things. I don't know. That's interesting. You just kind of let your mind wander and somehow that puts you to . . . I've never heard of people doing that, but whatever works.

Scot: Yeah. I mean, I get the engaging part because I have caught myself in the trap where I'm engaging and thinking about it too much. I think, for me, the trick really is just to let your mind wander through your past and just those things that were green. So anyway, that's mine.

Thunder: It almost sounds like a type of meditation. You pick one thing and you just kind of reflect on it and just let your mind go on it.

Scot: I don't know why it works, but it works. Who's next?

Thunder: Another thing that works to me for me is related to . . . We talked a little bit about temperature of the room is important. So we have this Nest thermostat in our home and it's programmed to start reducing temperature around 9:00. And it's great in a winter because by the time I want to go to bed around 10-ish, the temperature of the bedroom is probably like around 65 degrees, which for me is a good temperature.

So it's kind of good. It's automated, so I don't have to do it. It just happens every evening, and that is part of what helps with my sleep schedule.

Troy: Well, kind of along the lines of making sure you're addressing external factors, for me, it's about white noise and sleep mask.

Six years ago, I reached a point where I said, "I'm going to do everything I can to try and optimize my sleep and do what I can to optimize it and control what I can in terms of environment." For me, that meant white noise.

And for me, white noise means I actually have earbuds I sleep with that are made for sleeping. They're comfortable. They're soft. And then I just have a white noise thing I play that I listen to there, just kind of a sound of a fan or something. And I wear a sleep mask.

For me, that's made a big difference just being able to have that, control what I can, trying to eliminate the light, and noise, and all those sorts of things.

Mitch: And even for people who aren't doing shift work where you might be trying to sleep during the daytime, there are a lot of little itty bitty lights that are turned on in every room, in my house at least, whether it be a little power indicator light, or whether it be the light on a fan, whatever. And it has been night and day since I've gotten my sleep mask how quickly I'm able to fall asleep and stay asleep.

Scot: Tell me more about these earbuds that you have in because I've seen Bose advertise these sleep-only earbuds, but they're super expensive, right?

Troy: Yeah, crazy expensive.

Scot: Yeah. So did you find a cheaper alternative, and how do they work?

Scot: Mine are super, super cheap. It's like $10. They're designed to be ergonomic flat. They're noise-blocking. So they're just earbuds. They're soft. It did take about a couple weeks to get really used to them and comfortable with them.

Thunder: Hey, Troy, have you ever tried just foam earplugs?

Troy: Yes, I have.

Thunder: I've done that on occasion when I'm somewhere where there's a lot of ambient noise.

Troy: Trust me, Thunder, I've tried everything. And once again, I'm probably going to admit things here that are very embarrassing, but I not only have tried foam earplugs, I've tried foam earplugs with construction-type . . . like those noise blockers, those big headphone things that construction workers wear.

Mitch: Oh, my.

Troy: I'm a side sleeper, so I actually took an old pillow and I actually hollowed out a little spot in the pillow.

Scot: Oh, my.

Mitch: Oh, wow.

Troy: I was that desperate to try and block noise that I tried it. And I actually used that for a couple months. I took a lot of heat from Laura, from my wife, making fun of me, that I was that desperate that I tried that.

Finally, just these ergonomic things, these earbuds with just white noise going through it, that's what worked for me. So trust me, I've tried it.

Scot: Mitch, what do you have?

Mitch: So one of the things that is a constant struggle for me is I'm a list maker, like, "What is my to-do list? What am I doing next?" And when I try to fall asleep, for the longest time, it would just be, "Okay. What do I have to do tomorrow? I'm waking up, I'm doing this, I'm doing this, I'm doing this."

And what I found is that I keep my day planner . . . When I'm going to bed, as part of my ritual, I take the day planner, I climb into bed, I take my little pen out, and I write everything down that I'm going to be doing the next day. And for me, at least, that has really helped cut down the anxious thinking about the next day that typically happens when I try to fall asleep.

Troy: Yeah. I've heard of people doing that. And just doing a notepad, not typing it on your phone because you don't want the blue eye to mess you up. You just have a notepad, something is on your mind, write it down, deal with it later. That's a great idea.

Scot: My last one is another weird one. It works for me. I don't know if it'd work for anybody else. But sometimes when I have a hard time falling asleep . . . I'm a side sleeper, but I will lay on my back with my knees bent. Can you kind of picture what that looks like? What? Why are you laughing?

Mitch: You're just curled up and thinking about colors, and that's . . .

Troy: That's called a fetal position, Scot. You're doing it on your back.

Scot: No, I'm not on my side in the fetal position. I'm on my back and I've bent my knees, right? So if you were to come in the room, you would see this big bump of where my knees are in the comforter, right?

Troy: Yeah.

Scot: So I will lay on my back with my knees up. I mean, 99% of the time, if I can't fall asleep within five minutes, if I do that, I will fall asleep.

Troy: Wow.

Scot: I don't necessarily fall asleep on my back, but I get so tired from that position that I will turn over to my side and I can fall asleep. I don't know why it works. I don't know how I discovered it, but there it is.

Troy: I just want to be a fly on the wall in your house, Scot, and just see this, just see you lying there and sleeping with your knees brought up to your chest.

Mitch: And then talking about snakes and cars.

Scot: No, it's not all way up to my chest. I'm not that flexible. It's just like a 45 . . . Yeah, it's like a 45- or 90-degree of your knees.

Troy: I'm trying to think of the physiology of this, how this might work. I will tell you there are certain things called vagal maneuvers that basically increase the blood flow to the head and slow the heart down.

If someone comes in with a very rapid heart rate in the ER and something called super ventricular tachycardia, we will do a procedure where we lay the head of their bed down and lift their legs up at the same time to increase that blood flow. And that sort of has a calming effect on the heart rate.

So I'm trying to think of this physiologically, Scot. I don't know if there's anything to that, but it's interesting you do that and you found that works. Maybe there's something to it.

Scot: Thunder, you're up next.

Thunder: Well, this last one may be kind of old fashioned, and it doesn't actually pertain to me exactly. But I think having a television in the bedroom, a lot of people have that. I think that could actually interfere with sleep. I've never done that, but similar to being on the phone, being on a tablet, laptop, whatever, I think having a TV on when you're in bed trying to go to sleep . . . Again, it's something to engage your mind and keep you active. So that's something I think we should consider.

Scot: And Kelly Baron, when she was on the show, talked about the bedroom is for two things. It's not to watch TV. It's to sleep and to . . . I guess we're going to go to Troy next.

Troy: And to make sweet love. Is that what you want me to say, Scot? Anyway, Scot, moving on from that, this third thing I'm going to say is something I am going to try. And I will tell you I recently celebrated a birthday. For this birthday, I received a gift, and my sister was so excited to send me this gift. She said, "This is something I heard about on the podcast." The gift I received was a toilet light. So Mitch suggested this. This is one of the gifts Mitch suggested getting.

Mitch: Yes.

Troy: And I have now been using it for about a week. It's awesome. It's got a motion sensor, Mitch. It's everything you described. You come in . . .

Mitch: I told you.

Troy: Yeah, it's so cool. It's like a joke kind of gift, but I've used it and I'm like, "I love it." You come in and it just . . . I've got it on this very dim, purple light. It just hangs over into the toilet. It just lights up the bowl like this little beacon in the night, like, "Oh, there it is." I don't have to flip on lights. I'm not struggling to find the toilet. It's great.

I think it definitely helps you to avoid those interruptions in your REM sleep where you're flipping on lights and you're too focused on the task at hand, so to speak. Instead, you've got the toilet light, great, in and out, go back to sleep.

Mitch: I love that. A couple of my friends also purchased. So I don't know how much reach we have in this podcast, but some toilet lights were bought this Christmas season because of what we were saying. And I cannot be more delighted because everyone has been saying, "This is ridiculous. I can't believe I spent $10 on this." And then the next day they're like, "It's wonderful. This is the best thing. I don't have to wake up. I don't have to turn on the lights."

Thunder: Yeah. Add me to the list. I also have a toilet light.

Scot: What?

Mitch: Yes!

Thunder: Yeah. And it is, it's awesome. The only thing that I don't like about the toilet light is it . . . or maybe it's just the one we have. When the batteries start to go low, it flashes red like a police siren.

Troy: Oh, no.

Mitch: Yeah.

Thunder: So that's the one thing. You walk in there and batteries are always like, "Flash, flash, flash." It's like, "Oh, my gosh." It's very bright red. But love it.

Mitch: It's interesting you thought police siren. I thought poltergeist the first time I woke up in the middle of the night and there was a flashing light in my bathroom. I was like, "My house is haunted. I've got to go figure this out."

Troy: Your toilet. Something is going to emerge from the toilet.

Mitch: Yeah.

Thunder: But all in all, it is really a great invention.

Troy: Well, we've got three believers here, Scot. I think you're next.

Scot: Yeah, I guess.

Troy: Now I know what I'm going to get you for your graduation.

Scot: Oh. Yeah.

Troy: Because we know that's coming up soon.

Scot: Oh. Mitch, you're taking us out with number three.

Mitch: So the last one is actually a tip for my partner, Jonathan, and it's kind of this same thing. If you have difficulty sleeping and it has something to do with not being able to turn your brain off or not being able to just let go of the anxieties of the day, the thing that he does every night as part of his sleeper team that he's come up with is he has a series of positive affirmations and mantras that he tells himself.

At the start, again, I think there's a touch of toxic masculinity where I'm just like, "You're doing what? You're positive self-talking before bed?" I don't know. I need to be better about that. But he has seen a significant . . .

Scot: Go ahead and incorporate that into your self-talking.

Mitch: Right. I've got to bring that in to me, right? But he's found a lot of real benefit from it. And I've been trying it out recently where it's just . . . If you are someone who's struggling with any sort of negative self-talk or any sort of . . . if you go to bed and you replay the bad moments that happened through the day, if that's you, this has been really helpful.

And it sounds cheesy and it feels ridiculous. You're looking in the mirror telling yourself something, but it works for him. And since I've been doing it, I've been finding myself able to go to sleep faster.

Thunder: Mitch, I think that's awesome because I think we're good at being hard on ourselves about different things and replaying those in our mind, but we're not good at the opposite, patting ourselves on the back when we need to.

Scot: This turned out to be a far more entertaining show than I could have expected.

Mitch: Not the snooze fest?

Scot: Yeah, not the snooze fest I thought it was going to be. I was like, "What are we going to talk about?" But I think we've learned a lot about each other.

Troy: And I'm so glad you shared, Scot. I'm so intrigued by your sleep techniques. Anyway, it's definitely been entertaining.

Scot: Yes. It's been a good show. So I think the takeaway is that the Core Four . . . Sleep is one of them. And a lot of times, if you get your activity, and your nutrition, and your mental health right, the sleep will take care of itself. But sometimes it doesn't. Sometimes maybe the sleep is the first thing that you need to tackle.

The Core Four don't live in isolation. They all impact each other. And like Mitch explained to us, how sleep impacts those other three for him is absolutely huge.

So hopefully you got some good tips here. Hopefully you have a better understanding of the importance of sleep, and thanks for listening.

We are going to talk about next week, in our "Back to Basics: Core Four" series, mental health. So that'll be next.

If you have a technique that you would like to share, you can get a hold of us. It's so easy.

Troy: Yeah. You can reach out to us, hello@thescoperadio.com. We're on Facebook, facebook.com/whocaresmenshealth. Call our listener line, 601-55SCOPE. I would love to hear who is going to try Scot's elevation of the knee technique tonight when they can't sleep and tell us if it worked. I'm going to try it, Scot. If I can't sleep, I'm trying it, and I'm going to give feedback.

Scot: All right. I look forward to that.

Thunder: I'm going to try the color technique.

Mitch: Oh, yeah.

Troy: The color technique. I'm going to start with color and then I'm going to move on to knees. That's my strategy.

Scot: I'm glad I had an influence on you guys today.

Troy: You did.

Scot: As always, it's awesome. Thanks for listening and thanks for caring about men's health.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Welcome to the "Sideshow" on "Who Cares About Men's Health." We're going to talk about an article that I found about sleep. This is kind of interesting. But the first question I have for you guys, Troy and Mitch, is would you like a sleep consultant? Would you like to have somebody in your life that would help you make sure that you're getting the optimal amount of sleep?

Mitch: Are they sitting and watching me sleep or . . . Because that's the first thing I thought of. I don't know if that's accurate, but just what do you mean?

Troy: Yes. There are people who do that.

Mitch: I know. But it just sounds . . .

Troy: They're also called stalkers, but yeah.

Mitch: Just pull up a chair and watch me toss and turn.

Scot: That's right. Maybe you should lay on your left side, Mitch, for a little bit. I notice you seem uncomfortable on your right side.

Mitch: Right.

Scot: "Thanks, sleep consultant."

Troy: I'm going to say no, I would not want that just, because it would just make me more frustrated than I already am. I know my sleep is not good.

Scot: So this is kind of interesting. In the Olympics, Olympic teams, a lot of times they have coaches and trainers and physical therapists and massage therapists and all that so they can perform at the height of their abilities. In Tokyo, the U.S. weightlifting team had another person on the team to help athletes perform at the top of their game. It was a sleep performance director. They're the only Olympic team to have such a thing on their staff. And this person's job essentially . . . He said, "I'm a sleep doper, is what I am. I just try to manipulate using people's natural rhythms and sleep to make sure that they get the maximum amount of sleep and recovery."

Troy: Sorry, which team was this?

Scot: The U.S. weightlifting team.

Troy: Oh, wow. And only the weightlifting team. It wasn't like the soccer team or anyone else?

Scot: Yeah. This year, it was just the weightlifting team. So Jeffrey Durmer, Dr. Jeffrey Durmer, he's a neuroscientist who specializes in sleep, and he's been doing this since 2013. He's been a sleep consultant that helps optimize athletes' performance through sleep programs and just using natural physiology and science to improve the sleep.

I thought this was an interesting thing. He said, "What we found is the concept of overtraining syndrome really is not about overtraining. It's about under-recovery." And when we talk about the core four, we talk about activity, nutrition, emotional health, and sleep as important components to your health. And I think that really underlines how important sleep is, first of all, that Olympic team had a sleep consultant, and then this notion of under-recovery.

Something else that the doctor said that I really, really liked was this notion of, "Don't think of going to sleep as ending your day. Think about it as getting ready for tomorrow." You guys like that?

Troy: I like it. Here's my thought on sleep. And it's funny, I was just thinking about this today. Sleep is the new smoking. I feel like we're going to look back . . . honestly, I think we're going to look back in 30 years and be like, "What were we thinking?" in terms of our approach to sleep, in terms of often disregarding it. Obviously, we're seeing changes there, but we feel like, "Oh, anyone who sleeps eight hours a night is weak. I admire people who sleep five hours a night and look how productive they are."

And I think in 30 years, we're going to look back and be . . . kind of how we look at smoking in the 1950s and '60s now. You look back at the doctors who would smoke and appear in ads and be like, "Smoking is healthy." It's funny. Maybe I thought about that because I'm actually listening to a book on the history of tobacco right now.

Yeah, I feel like sleep is the new smoking. And in 30 years, we're going to be like, "Wow, we were stupid."

Scot: The doctor said that the most important part of his job as a sleep performance director is first educating the athletes about the benefits and necessity of sleep. So there's this mentality, like you referenced, Troy, "I'll sleep when I'm dead," or when you're an athlete, you've got to use all those waking hours to train.

Troy: Yeah.

Scot: So that's the first thing. And then the second thing is to actually help the athletes and the individuals sleep better. And we've talked about some of this stuff before, but I think it's worth repeating. I would like to have a sleep expert on and talk about this notion of, out of the three of us, maybe one of us does better going to sleep at 3:00 in the morning and sleeping their eight hours until whenever they get up. This notion of you have to get up at 6:00 in the morning or 5:00 in the morning, that doesn't necessarily work because everybody has their own kind of natural sleep rhythms, if you will.

Troy: Yeah. But it's fascinating to me too, and I think we talked to Kelly Baron about that, the idea that there are short sleepers out there. People who function just fine on three, maybe four hours a night. And her response was that, "No, they don't. These people don't exist. They just have learned to be tired." They've learned to be tired, and that's how they function.

We all need sleep. We're not superhuman. And it's so prevalent in the medical profession. That's what's so hard for me. It's just this idea that it's crazy how . . . As medical professionals, sure, I'm going to tell patients who need sleep, but among our profession, how we disregard that. And we even look at people who prioritize that as weak or unfit.

I think in our society, larger society, it's in so many areas people disregard it. And certainly in the tech industry, I think there's a lot of that there where it's like, "Yeah, you can work all day and party all night, or work all night too and get by on four hours of sleep," and that's the definition of success. So, hopefully, that'll change.

Scot: Yeah, the short sleeper notion that Dr. Baron talked about, I think about that a lot. The notion that they've done research. There are still these people in the world that say, "I only need four hours of sleep, and I work great. I actually do better than if I sleep too much."

But what their research found that I wanted to also throw out there is they do things to really keep themselves awake. They drink a lot of caffeine beverages, or a lot of sugar beverages, or they really amp up their excitement level and their intensity to try to push through it.

So it's not necessarily they don't need fewer hours of sleep. It's just they found strategies to get around that and cheat sleep a little bit, which, as you said, cheating sleep, not a good idea.

Troy: Yeah. And I think as they studied those people, too, they found that they engage in multiple what they referred to as microsleeps during the day, where essentially, their brain is turned off. Their eyes are open, but their brain is off, which is a little scary if you're driving. That happens and they may try napping or just . . . essentially, involuntarily napping, just doze off for 10, 15 minutes just to try and . . . Their body is trying to compensate.

Mitch: Well, for me, when I'm hearing Troy talk about the social impact of how it's cool not to sleep, etc., I think the one that I get tripped up on a lot is, "Am I sleeping right?" And for sleep to be such a standard biological process, there's a part of me that's like, "Oh, I have to have the most perfect sleep hygiene. Am I sleeping right? How do I optimize whatever?"

And so I guess what I wonder is, does the consultant help you figure out how to do that? Because that would be great, especially if you're trying to personalize and figure out what works best for you, rather than just what works for everyone.

Scot: This consultant in this article did give some suggestions, so I'll go ahead and go through those. We have heard some of them. There's a couple of them that I hadn't heard before.

So wind down before bed. Slow down 30 to 45 minutes before you go to sleep. This individual suggested setting an alarm even to remind yourself to do that. How many times have you been like, "Oh, geez. I've got to go to bed now"? You don't get that 30 to 45 minutes to wind down. So meditation, reading, stretching, anything that helps you settle.

The second suggestion is to cool your core. So take a warm shower or a bath and then rapidly cool your body in the air.

Troy: Oh, interesting.

Scot: And that helps you fall asleep faster. Also, belly breathing will help with that as well.

Troy: Haven't heard those before.

Scot: Treat the bedroom as a recovery sanctuary. So the technology stays out. We've heard that, right?

Troy: No TV.

Scot: You can't be reading that stuff. Yeah, not only the light of the technology, but sometimes the content when you're scrolling and looking through the comments of Facebook or social media

Troy: Yeah, it gets your blood pressure up.

Scot: Don't add anything until you've eliminated stuff. So light, noise, heat, bed discomfort, or objects that stimulate wakefulness.

Include sleep as part of your training. This was the notion that sleep is your basis for your performance the next day. So think of your sleep as the beginning of tomorrow, instead of the end of today.

And then be mindful of your own sleep habits and patterns. Are you giving yourself enough time to sleep with a regular routine?

And if you still are doing all these things, you're winding down, you're trying to get the eight hours, and you're getting to bed on a consistent time, you're getting up at a consistent time, and you still don't feel rested, then they suggest you get professional advice from a sleep physician.

So there are a couple extra tips for how to make your sleep a little bit better. Any final thoughts on that?

Troy: Yeah, it's got some interesting points in there. Again, I hadn't heard that about the shower and then cooling your body core down after that. That's an interesting concept.

The other stuff, like you said, Scot, the screen time, that makes great sense, and having that 30- to 45-minute wind-down time, definitely essential just to slow the brain down, decrease all the external stimuli, and then be ready to go to sleep.

Scot: Hey, this is Scot. Thanks for checking out the "Sideshow" episode. By the way, I've got a couple of extra little sleep tips. So these are some thoughts and concepts that have come up over the course of the podcast tying back into the core four, and just remembering how your activity, your nutrition, your stress, your sleep, and your genetics can impact your health. They all interrelate. They're not separate things.

So, over the course of the podcast, we've learned nutrition can also have an impact on your sleep. So take a look at how late you're eating, how close to bedtime you're eating, how much you're eating.

We've talked to Thunder Jalili about intermittent fasting. And if you stop eating before bedtime a few hours, sometimes that can help you sleep. I know it definitely changed the way that I sleep when I stopped eating, say, at 6:00 p.m. versus having a snack at 9:00 p.m. or 10:00 p.m.

Another one of the core four is activity. So getting some activity can help you with your sleep. Again, I know from personal experience if I get the activity that I need to get during the day, but not too much because if you overtrain, that can actually limit your sleep, but getting some activity, making sure that you get out and being active will help you with your sleep as well over time.

Of course, stress can really impact your sleep. So we have some old episodes on some better tools to deal with stress you might want to check out. Or you might want to get some sort of help and find somebody you can talk to to get those tools to deal with stress.

Alcohol and other substances can impact your sleep as well. Alcohol is notorious because a lot of people think it actually helps them fall asleep, but research has shown that you do not sleep as well after you've had alcohol. You don't get into that deep sleep. So that could be another cause. And other substances you might want to check out for smoking or drugs.

And then there could be some medical conditions that some of the symptoms might be sleep-related. They impact your sleep. Obviously, the obvious one is you have to get up and go to the bathroom. It could be something going on with your bladder, your kidneys, or it could be a health condition that you're not aware of.

So if you're not sleeping, those are some other things you can check out. A good first step is to go to your primary care physician and just let them know that you're not sleeping very well, and you can start working through some of those things.

You can also check out some of our past episodes where we talked about sleep. Episode 6, we talked about if sleep trackers work or not. Episode 11, how to beat your insomnia. So some tips there from our sleep expert, Kelly Baron.

And then Episode 44, tips for better sleep. And those are some of the sleep hygiene things that we briefly talked about here, but we have a little bit more of an expanded conversation with sleep expert, Kelly Baron.

And then Episode 45, that's your mental health toolbox episode. Just such a great fallback episode with some exercises, some breathing exercises that might help you as well.

All right. Thanks for checking out the show. Next week, we're really super stoked because we're going to have a migraine update. We had a show about men and migraines and we learned . . . Well, we knew Troy had migraines, but we learned that Mitch also suffered from migraines, even though he wasn't admitting it to himself. And they both went to a doctor to find out more to see if they can get help, and we'll find out about that next week on "Who Cares About Men's Health."

One last thing, if you know somebody that would get use out of this podcast, please do us a favor and share it with them whether it's on social media or in person just by saying, "Hey, I've got a really cool podcast you might enjoy," if there's a specific episode that might help somebody. It's the best way to help us get into the ears of more men and help more men care about their health.

Other ways you can reach out to the show if you want to contact us include hello@thescoperadio.com. You can go to our Facebook page facebook.com/whocaresmenshealth. And then we also have our listener line. You can leave a message at 601-55SCOPE. That's 601-55SCOPE.

Thanks for listening. Thanks for caring about men's health.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

There are times when you know it's right to sleep and you know that there are times of the day that your mood's a little better than others. And you know that there's a time of day when you're hungry and there's a time when you're not. And there's a time when you emotionally go up and down, and it turns out that your body, our bodies, have a circadian rhythm.

That means throughout the day, some things are more or less on and some things are more or less off. And this is called the circadian rhythm, and it turns out there are controls of our circadian rhythm that don't have anything to do with necessarily when the last time was you ate or what the lights are outside although there are social cues to how you decide when you're going to eat and sleep and be happy and take your tests. But in general, your circadian rhythm is set by cues inside your body.

Now, with us in the studio today is Dr. Chris Jones. Dr. Jones is an MD and a PhD, and he studies when creatures do stuff. He's a chronobiologist. He studies when creatures do stuff and why they might do those things when they do.

Dr. K. Jones: Can I call you, Chris?

Dr. C. Jones: Oh, all right.

Dr. K. Jones: I can call you Chris, as long as they don't call you late for dinner, right? And in the interest of full disclosure, Dr. Chris Jones has lived with my chronotype for over 45 years. So he has a lot to say about chronotypes, and he can speak up about mine if he ever wanted to. So welcome to the studio. Now, we're going to ask Dr. Jones or Chris, Chris, how would you define chronotype?

Dr. C. Jones: Basically, there are two obvious chronotypes. One is the so-called morning lark, people who wake up very early and they're very happy when they wake up early. And then there are night people who don't fall asleep until sometimes well after midnight, 2:00 or 3:00 in the morning, and we call those people night owls.

Dr. K. Jones: So how is your chronotype determined, and are you born with it?

Dr. C. Jones: Yes, definitely. We think this is a genetic predilection to be either a very morning or very night person.

Dr. K. Jones: So, certainly, there are mutations that make people morning people or evening people, but in fact, all of our genes work together to fine tune our chronotype. So if you were to look at people, there are some very few really morning people, and there are some very few really late people, but then there are sort of morning people and there are sort of evening people, and there are a bunch of people in the middle. There's a bell-shaped curve of times that people like to go to sleep. So does your chronotype change as you go through life?

Dr. C. Jones: Yes, absolutely. The adolescent period is a time when we become later and later and later sleep onset people. In other words, sleep phase delay, and every parent of an adolescent knows that their kid is wide awake at midnight, who knows what they're doing out on the town. And even in very rural circumstances, like the jungles of Central America, sociologists know that the moms and dads in the jungle have no idea where their children are in the dark at night and what they're up to.

Dr. K. Jones: But they do know that they kind of stay up late when everybody else is sleeping and then they wake up late. And we know from researchers in the Kalahari Bush that the word for teenagers means owners of the shade, meaning they keep sleeping in the shade all day because they've been up all night. And this is part and parcel with being an adolescent is you get to be more of a night person. And then what about later in life?

Dr. C. Jones: Well, some people actually use 20 years old as the end of adolescence because that is the age at which people stop getting more and more of a night person or sleep phase delayed sleep schedule. Later in life, things get more variable, whatever your sleep schedule was in your teens, 20s, and maybe your 30s, you know, we're pretty healthy and our genes are working well, but you get to be my age and you don't sleep quite as deeply and sleep schedule could be a little more variable. So it's like everything else, the older you get, things start to fall apart.

Dr. K. Jones: Don't say that. Well, so older people tend to be a little bit more morning people, but whether it's their biology or just because their joints hurt or it's time to get up because they can't sleep that much more.

Dr. C. Jones: Well, the bladder and the joints are the two biggest complaints that elderly people have about their disruptive sleep. They attribute it to bone and joint pain and the bathroom calling and things like that.

Dr. K. Jones: Oh, the bathroom calls me.

The planet has its own chronotype, and it changes where you are in the planet. And particularly, in the very upper and lower latitudes, when the days are very, very long in the summer and the nights are very, very long in the winter, there are some serious problems when the planet doesn't want to work with your own chronotype. What happens to people who are living in very northern climes when it's bright all the time, what happens to their mood or their sleep?

Dr. C. Jones: First of all, it's thought that the sleep-wake cycle and a lot of the way our brain works evolved in the deserts of Africa, Equatorial Africa. And then we migrated north into the Scandinavian countries. So the folks who live in the Scandinavian countries may or may not have evolved as much as they would have liked to those northern climes. But basically, it's as you said, there are months in the year where it's dark for most of the 24-hour day-night cycle.

Dr. K. Jones: And during the time that it's light people get a little manic when it's light all the time. There's a famous movie called "Insomnia" with Robin Williams and Robert De Niro, and a detective moving up to Alaska to solve a mystery gets a little crazier and a little crazier because he can't go to sleep. It's easier to kind of huddle in when it's cold and dark, so you tend to sleep a little bit longer in that winter months. People get a little more depressed in the winter months. So the planet has its very own chronotype, but it changes through the year.

Your circadian rhythm isn't only just about your sleep. It's about your emotional highs and lows. People tend to get a little bit more depressed at night and are sometimes a little bit more activated and positive in the morning. And there's also some evidence that the evening time is time for people who have a tendency toward depression. It's a time when people tend to involute. They tend to look inward a little bit more. In the evening time, they're tired. They have a tendency toward depression.

And so, when you're thinking about having conversations with people that might be important, it's important to know where they are. In the morning, people are often a little bit more activated. Not everyone. Certainly morning people are, they got the get up and go. They're feeling pretty optimistic. I think of all the farmers on the planet who have to get up early and get going and they have to feel like they can get stuff done, and there's some biological cues for this.

But in the evening, before we go to sleep, we tend to be more involuting or turning inward and shutting down a little bit all our activities in the brain. And some people get a little bit more depressed at that time and having conversations that might be important, you have to spend some time understanding where somebody might be in their daytime schedule.

Dr. K. Jones: So you have a certain chronotype, you would like to get up at a certain time, but life isn't always like that.

Dr. C. Jones: Usually, that means the person is sleep-deprived. If you don't have the option of falling asleep when your brain really wants to fall asleep, you probably will not fall asleep. And therefore, you'll be sleep-deprived the next day, and that has profound implications for relationships with other people because you're irritable. It also does not impress the employer because you've been late to work. Whatever your work schedule is, it may or may not work with your circadian rhythm.

Dr. K. Jones: Well, and there's some data that says shift workers or night workers who haven't flipped over completely to working nights have a higher rate of cancer. And this has to do with an important hormone made by the brain and now we know it's made throughout the body called melatonin.

And melatonin seems to have some anti-cancer activity in our own bodies, maybe because it's such a powerful antioxidant melatonin is. And people, particularly women, and we've studied this in nurses is that nurses who spent most of their career working night shifts have significantly higher rates of breast cancer. Melatonin may be acting, perhaps there's an antioxidant effect. It's important not to suppress your melatonin because it's there for a number of reasons, and people who work in bright lights all night long and are trying to sleep during the day may be suppressing their melatonin. And that might be some of the activity that might make women more likely to get certain cancers.

Adolescents who are often taking tests, so when I think about my test taking years, although as a physician, I took tests right up until my 60s, but you take tests and when you take your tests, your intellectual health, so what is the chronotype of your brain? When I think about adolescents who might have to take SAT tests at 8:00 in the morning or they have to go to school at 8:00 in the morning and their brain says they should still be asleep, so your intellectual health, there are times of your day when your brain is really on and you've sat across the table from me, looking at me at 9:30 at night and looked at me and said your computer is shutting down, I can watch it. So there are times when your brain isn't working. What do you do about that?

Dr. C. Jones: Oh, it's really hard to argue with your genetic morningness, eveningness sleeper type. There are some things you can do to nudge it one way or the other, and the most powerful is to fix morning wake-up time with lots of light and fix the evening as very dark, as dark as you can, but that doesn't always work for everybody with a very morning or very evening biological genetic sleep schedule.

There are times when you're feeling really sharp and there are times when you're not so sharp, and actually in some of the web-based chronotype questionnaires, they would ask you as they're trying to figure out whether you're a morning person or a night person, when you feel like your work is most productive, or when you feel like you do best on a test. And people often know this, they know when their brain is the sharpest, and that plays into their chronotype, their intellectual wellness.

Dr. K. Jones: Clearly, if you're doing finances, it's important for you to know when your brain is the sharpest, when does it like doing arithmetic. Now, I love arithmetic and I'm a morning person. So I like to do my finances and think about finances certainly before 2:00 in afternoon. But for couples who might have different chronotypes, our sleep psychologist has a really important quote about when couples should talk about money.

Dr. C. Jones: Absolutely. This is from the experience of Dr. Laura Czajkowski, a psychologist at University of Health Sleep Center for quite some time. And her recommendation, very strong recommendation for people who have insomnia or difficulty getting to sleep, one major factor is to schedule the money discussions before noon. Do not wait until the afternoon. It's too close to the evening bedtime. What you want is to get the real sort of irritating discussions that can arise long before you have to go to sleep.

Dr. K. Jones: And when you're actually interested in solving problems and not interested in going to bed or not going to bed angry with someone, so always do your financial discussions before noon, according to the sleep psychologist. Just that you know, you do your finances when you're cognitively most alert and you don't do your financial discussions with your bed partner after noon.

Culturally, around the world, there are some cultures whose religious practice is focused on the rising of the sun and certainly Eastern Indian practices in terms of morning yoga. Yoga is not usually done at 10:00 at night. It's something you do in the morning. And some spiritual practices are morning-based.

In Western culture, we go to church in the mornings, but we tend to pray at night. And everyone has a different way of expressing their spiritual life. But it often is based either on morning or evening. It's not usual that we are expressing our spiritual practice throughout the day, except in some quite observant religious cultures. And I think specifically about many monasteries, which might actually pray seven times a day and their prayer is based on the first thing in the morning, the midday, noontime, afternoon and evening prayers, and then there is a bedtime prayer. And, of course, in Islam, they pray multiple times a day.

However, for many cultures, their spiritual practice may be morning based or evening based. And for people who don't have a particular culture, they may find their own time, which is best for them. And it may be based on their chronotype. It may be based on their social time. It may not be so busy in the morning that moms don't have a minute to think about their spiritual life. And it's something that's done later in the day.

But people who tend to work on their spiritual life tend to do it at about the same time of day. And knowing when that time of day is, recognizing how it's important to you, being able to express it to the members of your family, so that you have a little bit of quiet time to indulge, or it's not an indulgence, it's actually important practice of your spiritual life is going to be important in terms of being able to make sure you have the time to do your own spiritual awareness and connections.

What happens in a household with 2-year-olds and 17-year-olds and 40-year-olds and 75-year-olds? How do you work a house when you've got so many people with different chronotypes either because of their age or because of their biology? How do you get along and do so without disrupting each other's hard-wired biological sleep-wake schedule?

Dr. C. Jones: It's really an exercise in relationships between people. And I hate to say that because I'm a guy, but that's really what has to happen. People have to realize, you know, mom's been up early because she's breastfeeding or she's up late because she's feeding somebody or somebody's screaming. And we know from a brainwave recordings that even a whimpering noise can bring a sleeping mother up very close to wakefulness and sometimes full wakefulness. So now you've got a sleep-deprived mom, and sleep-deprivation is really good at causing irritability.

Dr. K. Jones: Well, that's not personal. You're not talking about this personally, given that I spent so many years as an OB, was chronically sleep deprived for about 35 years. But so your brain works . . . when you're sleeping, your brain actually is working, it's sorting out what's important, it's remembering things that are really critical. So you may wake up at 2:00 and if you're really awake, it's like, oh, I forgot to send someone . . . I need to send someone something. And in the olden days, you wrote it down and when you woke up in the morning, you gave someone a call. But now, we can actually post something at 2:00, even knowing that someone won't get it until they wake up.

It's not uncommon for people to remember something that's important when they wake up at 2:00. And that's a time when your brain has been sorting out what you need to remember and what you don't need to remember. That's when you'll say, "Oh, I'll just send her a text." Now, I don't recommend doing that in the middle of . . . because then you really wake up and then you get very fragmented sleep. So it's better just to roll over, not turn on a bright light screen. Just roll over, write down the note. Just tell yourself to remember it in the morning, because things that you tell yourself before you go to sleep tend to be things that you remember.

We've been talking for about a half an hour about sleep, wake, your chronotype, circadian rhythms, when you wake up, when you're sad, when you eat, are you a night person or a morning person, and all parts of your life which are affected by your circadian rhythms. And tomorrow is another day. So not living your chronotype has some biological effects. People who do shift work are more likely to gain weight. So people who aren't sleeping well. So increased rates of obesity, increased rates of cancer, increased irritability, difficulties at home, all those can happen when you're not able to live your chronotype.

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Interviewer: You know, sleep is so critically important for both physical and mental health, and during times of stress and uncertainty, you might find that you're not able to sleep, which then starts the cycle of worrying about not sleeping which then leads to more sleepless nights which then can impact your physical and mental health.

It's a big circle, and Dr. Kelly Baron is a sleep expert at University of Utah Health, and she's here to help us to start sleeping better again. So Kelly, what can a person do when they're experiencing stress to the point that it's impacting their sleep?

Dr. Baron: So stress and sleep are really known to have a bidirectional or a two-way relationship. So if you're under stress, it affects your sleep. I would really describe the state that we're in right now as a state of hypervigilance or hyperawareness to what's going on, to the threats in our environment. You know, if you just think about it, at any moment we're going to get a text or a notification that our job has changed or that we're forced to work from home, that schools are canceled, ski resorts are closed. It seems like any moment of the day we're going to get an update of how our life is going to significantly change, and I don't know about you, but that has me totally on edge.

And so that sort of feeling of being under threat impacts how deeply you sleep, because if you think about it, we're really not supposed to sleep deeply when we're under stress. That's a basic survival mechanism that organisms have. You know, you would be someone's lunch if you're a little mouse in your hole and you're sleeping deeply and there's a fox outside. That's what I explain to my patients. It's just not normal to sleep under stress.

The problem is that we've been under this stress for weeks. You know, it was the anticipation and the planning and that sort of thing, and now that things are changing they change so rapidly. I know my clinic, for example, between 8:00 and 10:00 a.m. last Monday, went from optional, "Do you want to do a phone visit?" to, "We're canceling everyone. Everybody is over the phone. We've got to figure this out as we go." You know, it changes just hour by hour, which really, really leaves you feeling frazzled.

Interviewer: Yeah. Are you finding it's affecting your sleep as well?

Dr. Baron: I think in two ways. First of all, it's affecting my sleep that I'm home more and I'm actually . . . I think I'm sleeping a little more because I'm making an effort to wind things down. I've got more time to do the little things at home that I normally don't have time to do, like just put everything away, to get my laundry done. So I have a little bit more time to sleep because I'm not commuting, and my work day is kind of chopped up in a weird way that it just leaves me a little more time to unwind and go to sleep.

The other thing though is . . .

Interviewer: I hadn't considered that. Yeah.

Dr. Baron: . . . these like notifications and constant vigilance that I think we're all experiencing right now, I find that that's impacting my sleep because I wake up in the night and I think, "What's going on in Italy?" Or I think, you know, "What's going on, what's going to change today or, you know, what do I need to cancel or reschedule?" So there's certainly a sense of anxiety.

Now the other direction, though, is that if you're not sleeping, that affects how you perceive stress. There's actually a lot more data showing that if you sleep poorly or if you don't sleep enough, you interpret stress differently. You're affected by it differently. It makes you more emotional. You handle it worse. I don't know if you've felt like that before, but even in a normal day, if I sleep poorly, I'm more easily irritated by things that don't normally get under my skin, or I might get more emotional when something happens during the day. On the other hand, if you sleep better, you can more go with the flow. And so, you know, at a time like this is that we're kind of getting wound down. You know, over time, we're getting more and more sleepless and stressed. That can lead to just a cascade really of effects.

Interviewer: So are there two kinds of concerns when it comes to sleep when you're stressed, one not being able to fall asleep at all, and two, you might fall asleep, but you're just not getting that deep sleep?

Dr. Baron: Stress can affect your sleep by either trouble getting to sleep, because you're thinking, you're ruminating, or maybe you're doing things to prepare, you're working later or trying to get things done, like behaviorally. It can cause awakenings during the night. It can also cause people to feel like their sleep is less restful. So even if you aren't up for large periods of time, perhaps you're not sleeping as deeply as you normally would, or you're more restless in your sleep. Also people do have early morning awakenings. So that means you're waking up an hour or two before you intend to wake up and you're struggling to get back to sleep.

Interviewer: So what is the solution if somebody is having difficulty sleeping or feeling like perhaps they're not getting the sleep that they need?

Dr. Baron: The first thing that I talk about with my patients is that when you're under times of stress like this, it's normal to have some disruption to your sleep. That's a normal human thing. So being stressed about being stressed is never going to help anyone. So just accepting that some people are more vulnerable to having stress-induced sleep disruption. That's just a characteristic of who you are. I tend to be one of those people that was, you know, having trouble sleeping before my first day of school or those sorts of things. I mean, that's just a feature that some individuals are more sensitive to that than others.

But then on top of it, you know, if you can't sleep, we say don't force yourself to sleep. You know, wind down, turn off the news, give yourself a good hour to relax before you go to sleep. If you're not ready to fall asleep, then do some reading, do some other things, but don't get stressed about not sleeping.

The other thing to think about too is that we're all off of our schedules, our schedules for eating, for exercise, for sleeping. You know, our routines are totally shooken up right now, and that can have a big implication for sleep. And so I recommend that people stay on a routine and kids as well to have a consistent bedtime, rise time, to make sure that you're having a regular eating pattern, and then also getting physical activity during the day. Now that I'm working from home, especially I'm trying to intersperse that throughout my day. So I'm getting up and working out as I normally would in the morning before work, and then also trying to get a little lunchtime walk and get a walk in the evening with the kids so we're all getting some activity, some sunlight, some stress relief, that sort of thing.

Interviewer: Yeah. I like that because keeping that routine can be so important, and I never considered that exercise and eating could also contribute to an inability to get the kind of sleep that you need. And during stressful times, a lot of times we don't have an appetite, or we decide, oh, I don't have time to work out. And I guess it's in times like that that really you should almost double down on those things and just really commit to them.

Dr. Baron: Or the appetite can go the other way. You know, being home I have more availability of snack foods and things like that. You know, and some people might have a tendency to graze. So I made sure to position my office on the far other side of the house from the kitchen so I'm not tempted to go in there for the Fruit Roll-Ups or other things we got for the kids so they could help themselves while we're working. But on the other hand, you know, when you're under stress, you do have more of a craving sometimes for these comfort foods. You know, if your sleep is off, your eating is off, you know, it can just lead to generally feeling worn down and stressed out. And so trying to pay attention to these routines, healthy eating . . . you know, an interesting thing I noticed was that in the grocery store they're not out of lettuce. You know, there's no run on carrots.

Interviewer: No. Right.

Dr. Baron: You know? I mean, so I'm actually having plenty of fresh fruits and vegetables in my diet right now. You know, they're not out of that stuff, apples and that sort of thing. So, you know, people should take this as an opportunity. I don't know if you've seen the blogs from Korea, how people who have never cooked in their life, these sort of young adults who are mostly focused on take-out, they're learning how to cook and they're sharing this, and this is how they're bonding over Instagram and different recipes. I think that's great. I mean, people should really focus on getting a healthful diet. Again, you have a little bit more time if you're not commuting, so focusing on these routines of having regular meal times, healthy foods, getting adequate time in bed, it's actually an opportunity for some people.

You know, but I don't want to be insensitive to the fact that there are some people who are being extremely disrupted right now, that they've lost their jobs, their hours have been cut way back. You know, that's an enormous stressor, and it can really contribute to insomnia, especially if they don't know how long this is going to go. In those situations, we really talk about trying to, you know, make sure that you're getting through the day, kind of stay in the moment. You know, you can only deal with the information that you have.

Interviewer: So managing stress, those types of skills, mindfulness during the day, trying as much as possible to not, you know, I guess not let it affect you is not the right word, and then just accepting that maybe you might not sleep as well as you should, and that's okay. Don't get stressed. Don't add that to the stress, because then that just is that vicious circle.

Dr. Baron: Absolutely.

Interviewer: Is that a fair summary?

Dr. Baron: That is a fair summary.

Interviewer: All right.

Dr. Baron: It's an extremely stressful time for a lot of people right now, and it's going to understandably affect your sleep.

Dr. Gellner: It's 3 a.m. and you hear that cry from your infant or toddler's room that you dread every night. Why do they do that and what can you do? I've got tips on little ones sleep issues for you today on The Scope.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone" with Dr. Gellner on The Scope.

Dr. Gellner: I'd like to start by calling this Scope piece the "Don't do what I did with my own kids." podcast. I was that mom who felt so bad that I wasn't home for my kids because I had to work that I used any excuse I could to have extra snuggle time. Boy, was that a mistake. I try to let my patients' parents know about my experiences so they can hopefully get more sleep than I did during those years.

Recent data shows that one in five infants who have trouble sleeping may continue to have challenges during the toddler years. And, yes, some of this can be blamed on the behavior of parents. You hear your little one crying. You wait to see if they go back to sleep, and then if they don't, you go rush in there to pick them up or give them a bottle.

Well, guess what? Your child is training you very well to do what they want. It's not on purpose really. Babies learn to be comforted when they wake up from newborn on. Then as they get older they should start sleeping through the night. But some babies become trained night criers or trained night feeders. These are called sleep associations. They really don't know how to go back to sleep on their own unless they're rocked or cuddled or fed.

Parents often will tell me that they will go into their baby's room and the baby only feeds for a few minutes and then is sound asleep again. That's because they aren't waking up for nutrition. They're waking up to go back to sleep in the manner that they were put to bed in the first place.

This is learned hunger. This occurs in children who are drinking a bottle or two of milk or nursing for prolonged periods at night. They have learned to expect food at night to go to sleep. So when they wake up, they're looking for it.

If your child is over seven months, healthy, and feeding multiple times a night, then this is your problem. Most babies are able to sleep through the night by six months old. Now, of course, kids are going to wake up more if they're sick or something is off with their routine. But, in general, they should be able to get back into good sleep patterns easily if you are consistent. If kids are waking up several times a night, both you the parents and the child are going to be cranky the next day.

So how do you fix this? First thing is to get your child to go to sleep on their own by putting them to bed when they're still sleepy but awake, no bottle, no pacifier, no cuddling. Have a good bedtime routine and do the same thing every night. For our kids, it was PJs, brush teeth, story time, usually the same three books every single night to the point I didn't even need to look at the book anymore and then say the good nights.

Sometimes you have to move bedtime 15 to 30 minutes later to make sure they're really ready to conk out. Yes, they may fuss for a few nights, but they should learn, if you are consistent with this, that when it's time for bed, it's time for bed, not an extra drink of water, not just one more story, or being rocked for 15 more minutes.

Bedtime routine done, then lights out. Dark, quiet, maybe a night light if needed, or soothing music. We have an ocean sound CD that our kids have listened to since birth, and they're double digits now.

Trust me, I know how hard this sleep training thing is. My older son decided that 11 p.m. was a good bedtime. I would hold him as he fell asleep, again, mom guilt, and then when he woke up, he'd need me to hold him until he fell back asleep again.

Funny thing is that if his dad put him to bed and he woke up, he'd be like, "Oh, it's just you, dad," and go back to sleep, because my husband made my son self-sooth from early on, and so our son learned that Dad wasn't going to pick him up or cuddle him.

Now if I put him to bed and he woke up, you'd think that me closing the door was because I was putting him in a torture chamber and he'd scream and cry until I went back and held him or stayed by him and then he went back to sleep. Our younger son was just a sleep nightmare for a variety of reasons, including night terrors, but that's a whole different subject.

Bottom line is this is a very common issue and one that most pediatricians have experience with either as parents or having worked with other parents facing the same problem. If you're having a hard time with getting your little one to fall asleep and stay asleep without waking to eat or be comforted and your child is over six months old, talk to your child's pediatrician, we can help.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com

Announcer: Need reliable health and wellness information? Don't listen to the guy in the cube next to you. Get it from a trusted source, straight from the doctor's mouth. Here's this week's listener question, on The Scope.

Interviewer: Today's patient question is about sleep. This particular individual's having a hard time falling asleep at night. So they'll go to bed, they lay down, but you know, they can't get to sleep. Dr. Tom Miller, what do you recommend to your patients in that situation?

Dr. Miller: Well, first thing I ask is, what's changed? Is there more stress in their life? Is there something going on at work? Is there a family problem? Is it related to depression, perhaps? I'll look at those issues.

The next thing is, are they following a sleep schedule? Are they getting to bed at the right time, same time? And are they getting up at the same time each day? Because of our busy lifestyle we're sometimes all over the place. Monday through Friday, we may have some variable times in which we go to bed because of when we're going to work and we have morning meetings. And then on the weekends maybe we stay up late and go out and then get up late.

These kinds of disruptions in sleep patterns make it difficult, even more difficult to get a normal night sleep. The first thing I'd say is let's try to get you back into a regimented sleep pattern, so that you go to bed at the same time each night. After that try to mitigate the stress. You know, what are you doing at work or what can you do with work or family that would help you. Sometimes this may result in counseling or maybe even in the most extreme case, a change in job, you know, so that they . . . if it's bad enough, that they can get sleep.

And then ultimately if folks are still having trouble falling asleep, a short course of medication designed to help people fall asleep can be helpful. But I don't like the idea of using those long term because they have some problems associated with them. So there are number of medications on the market as prescription medications that do help people fall asleep, and they're pretty effective in small doses, for, say, up to two weeks. The other thing that I will talk to folks about is alcohol. If they're using alcohol to get to sleep, that's not a good idea.

Interviewer: All right, so you're not a big fan of the medications generally because they can actually cause more problems down the road when you stop taking them. Is that correct?

Dr. Miller: I think the problem with meditation is we jump to that as a solution before we look at sort of lifestyle issues. Whether you're, you know, increasingly stressed at work, whether you have frustrations, whether there might be depression, those are the issues that I like to tackle first before moving on to medications. You can do them simultaneously, but not assessing the lifestyle aspect of insomnia would not be the right way to approach this problem.

Interviewer: So take a look at the lifestyle, try to get that consistent sleep pattern. If you go to your physician at that point, if those other things aren't working, they might put you on a short course of some sleeping medication. If you come off . . .

Dr. Miller: As you're working on your lifestyle changes.

Interviewer: Yeah, yeah.

Dr. Miller: Getting to bed at the same time, tackling those frustrations at work, trying to regiment your lifestyle in a way that allows you to reduce the amount of stress and frustration that you might have in your life.

Interviewer: Yeah, those are underlying causes.

Dr. Miller: Underlying causes.

Interviewer: And if they get to the point where they've tried those things and they feel that they've put in a good effort towards those things, still not working, where do you go from there?

Dr. Miller: We start looking at sleep patterns and thinking about things like obstructive sleep apnea. We think about depression. Has the physician done the right evaluation to sort out whether the person has anxiety state or is depressed? There are different treatments for those problems. So, as we go down, you say an algorithm for insomnia, we will get to those sorts of things where we are digging in a little deeper to try to find a solution and treatments.

Interviewer: So it sounds like the first step for a lot of people is something they can do on their own. It's just take a look at their life and see are there causes of stress and what can I do to perhaps reduce that, maybe finding professional help.

Dr. Miller: Yeah, the majority of folks with insomnia usually have this for a short period of time. It doesn't go on for a long periods of time. So, for instance, in grief response if someone in the family has died and you're not sleeping, you know, treating that short term likely will result in a return to normal sleep patterns, as would be the case with stress at work. These things usually disappear as soon as the stress is resolved.

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Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com.

Interviewer: We all know someone that sleeps six hours or less each night and then they claim that doesn't bother them. Actually, they say they thrive on little sleep. Is that really the case, or is it really not good for their health? Paula Williams is an associate professor of clinical psychology at University of Utah. And Brian Curtis is a clinical psychology PhD student. And they are part of a research team that is researching a phenomenon called "short sleepers," and these are people that sleep six hours or less a night and report no ill effects.

So the first thing I think we need to do, and Paula, would you please define what a short sleeper is? I kind of summarized, but did I miss anything there?

Dr. Williams: Well, at the broadest level, it is someone who sleeps six hours or less a night on average. The recommendation is seven to nine hours. The people we're interested in, though, are also habitual short sleepers. That is, regardless of the work schedule or vacation schedule, these are people who tend to sleep six hours or less.

Interviewer: Yeah. And we all know, maybe, you know, you are one. Are you a short sleeper?

Dr. Williams: I am not.

Interviewer: How about you? Are you a short sleeper, Brian?

Brian: I'm an insomniac, but that's a whole different . . .

Interviewer: Oh really?

Brian: Yeah. I've had insomnia. My mother has insomnia. My three older brothers have insomnia. So it's in the family.

Interviewer: Sounds like it, yeah. I'm definitely not a short sleeper. But about 30% of the United States are short sleepers the way you define them. But then there's a 10% subset. Explain what that group is like.

Dr. Williams: Right. So about a third of the population report they don't sleep more than six hours. And within that group, however, there is a small percentage, maybe 10% we think, that feel fine on six hours or less. They don't feel the usual negative effects that most of us would. That would include fatigue and irritability, etc.

Interviewer: And they claim they're different almost. It seems like.

Dr. Williams: Yes. For some it's a badge of honor that, "I can, I feel fine. I don't need much sleep. I feel good." And so they're a fascinating subgroup of people that we want to understand better.

Interviewer: And it can be concerning because the question is, is that really the case? Or are they just as susceptible to the detriments of lack of sleep that the rest of us are?

Dr. Williams: Right. At a minimum, we can say that they feel better. And so that's something in and of itself. But there are lots of other questions about whether cognitively, objectively they are functioning as well as they perceive themselves to be. There is a whole area of psychology that is looking at the discrepancy between self-assessments and objective assessments. And that's something that's of interest to us.

Interviewer: And, Brian, short sleepers think that they function just as good as somebody who's gotten the seven to nine hours if not better. Why do they think that way?

Dr. Williams: That's the million dollar question.

Dr. Brian. That's why it took me aback. I mean, that's just how they feel. I mean, they are reporting that in fact they feel just as good and in my experience, talking to these individuals, often better. I mean, these people they tend to be almost the flipside of what you would expect, at least what they're reporting, of somebody who has been sleep deprived or who's sleeping six hours or less. In other words, instead of having less energy, they report having more energy. Right? So this concept of behavioral drive, these people are always on the go it seems.

A couple of these participants have told me that their idea of hell is just nothing to do. Like what if we put you in a room, you don't have your phone, you have nothing to read, right, that to them is very, very off putting.

So this high degree of stimulation, behavioral drive and they just feel fine. They've been told by many, many people that something is either wrong with them or, you know, there are a bunch of negative health consequences, but they just feel fine.

Interviewer: So I would love to be able to get two extra hours a day, right? So is there a way I can become a short sleeper? Are there strategies that they're using to actually survive on less sleep, or are they just genetically different than you and me?

Dr. Williams: Right. We don't know, and that's why we're researching this question. It's a question that we get a lot because everybody wants to do more in less time, to have more time, etc.

But, you know, there's too much research out there on short sleep duration and health consequences that we need to look at this subgroup more specifically.

Interviewer: To see if that applies to them.

Dr. Williams: Exactly. So it's possible that someone is feeling fine, but they're not fine. So we just need to know more. And we need to know how their partner perceives them as well. So part of what the research would look at is, what do other people report in terms of their behavior and their functionality.

Interviewer: How could a person determine if they or a loved one are a true short sleeper? I mean, is it just simply cut and dry as they're not getting the seven and nine hours of sleep that they should?

Brian: I think the most important thing there is, if you take away societal obligation, you take away needing to wake up early for work or to stay up late to study, whatever it is in your environment that's dictating your sleep schedule. If on the weekends with a lot of opportunity, right, you're still getting six hours or less a night, if you're on vacation, that's still the case, often with these individuals this isn't something that started in college or when they got a high pressure job. A lot of these people report that they've kind of always been this way, reaching far back, even into childhood.

And it's also not uncommon to hear that they may not be the only person in their family that tends to have this sleep pattern as well. So there seems to be a familial pattern of short sleep. And that's been borne out at least in one study that our research colleagues, Chris Jones and his geneticist collaborators, they found a mutation in a mother and a daughter. And when you put that human mutation into mice, you now have short sleeping mice. And not only short sleeping mice, but these mice run more on their running wheels during the day. So you have a behaviorally driven mouse.

So this was back in 2009. That's almost a decade old. And since that time, we haven't found a similar slam dunk mutation in families. So it does appear that these genetic short sleepers may be very, very rare. But assessing them objectively into the lab and getting more of these people is the goal now.

Interviewer: I would be a little scared if I was a short sleeper right now, because of all of the evidence that's out there that says, "If you're not getting seven to nine hours, you know, it could be detrimental to your health." And we don't know a lot about whether or not it is. So if I am a short sleeper, do I worry? What should I do? Should I try to get more sleep?

Dr. Williams: No. These are important questions. But the reason we don't know is that the vast amount of medical research is epidemiological. It looks across the population and looks at associations. What we're trying to get at now are individual differences. That is, are there differences between people in the effects? And we know that at least in perception there are.

Interviewer: But as far as behavior changing, if I'm a short sleep or have a loved one, really, at this point, nothing you should do. I mean, if it's true short sleeping, that you're not, you know, getting up because you have responsibilities, you're not sleeping because of stress, but you just naturally do that, just get up after six hours.

Dr. Williams: You know, a question I would ask somebody is, what are they doing to stay awake, for example, because one of the things we think about some of these short sleepers, given what Brian just said about behavioral drive is that they are seeking out stimulating activity in the night. And what I would recommend is pulling all environmental stimulation. You know, what we should be sleeping in is the equivalent of a cool, dark cave. If you put yourselves in that kind of situation, do you still not sleep? Right?

Interviewer: Yeah. So that might be a good thing to check.

Dr. Williams: Yeah.

Interviewer: A good experiment to do.

Dr. Williams: I would do that. And all kinds of things we know, like having a routine, trying to sleep at the same time, not having in a hot environment, noisy environment, all of these things, light blocking shades. Try all of those things. And then see how your sleep is.

Interviewer: And you might discover, it turns out, you're a regular sleeper.

Dr. Williams: Right. Or, I mean, part of what I study is personality and so that's part of what we see is that people are behaviorally different around sleep. In fact, sleep might really be part of personality.

Interviewer: So if somebody is concerned that maybe they should take a look at some of their sleep hygiene things or some lifestyle things. Ultimately it might end up that they're just sleeping six hours, because that's just how they're wired, and at that point, I mean, at this point, what do you do then?

Brian: They get in touch with us.

Interviewer: And become part of your research study.

Dr. Williams: Part of the research.

Interviewer: Okay. And how would they do that?

Brian: So our laboratory has a website. It's restlab.psych.utah.edu. And on that website there there's a section for the short sleepers study. They can go there, read up a little bit about the background. And if they're still interested, there's a quick questionnaire that they can complete online about eligibility criteria. And then a member of a research team will get back into and go forward from there.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Announcer: Need reliable health and wellness information? Don't listen to the guy in the cube next to you. Get it from a trusted source, straight from the doctor's mouth. Here's this week's listener question on The Scope.

Interviewer: So Tracy has sent us an email. She says she's been having trouble sleeping lately and she says that one of her girlfriends gave her a sleeping pill for the same problem. She says that so far, so good. But Dr. Jones, what's your take on this? She's wondering if this is actually okay by a doctor's point of view.

Dr. Jones: Okay, well, let's talk about sharing your prescription drugs. First of all, it's not a good idea to share your prescription drugs. Although it's not uncommon for women who often share their medical problems, meaning they'll discuss it with a girlfriend, and they may have medications that they feel like they've got extras. And that could include Valium-like drugs for anxiety, or it could include sleeping pills.

Usually birth control pills, I don't recommend that because then you're missing some so someone's missing out. And the person who's getting them isn't getting enough to make a difference, so that's not such a great idea. So in general, taking other people's medications is a bad idea. Also, dispensing drugs without a license is a felony.

Interviewer: Oh, that's illegal?

Dr. Jones: That's illegal. So your girlfriend, she's got a little problem with the law. It's a good thing you didn't give us your girlfriend's name, Tracy.

So what about sleepers? It turns out that 30% to 50 % of Americans have difficulty sleeping on occasion, and it's not uncommon to have an acute episode, maybe it's a divorce or it's an upcoming test or it's financial trouble. They keep you from sleeping. You say, "God, if I could just get a good night, one good night's sleep, I could solve this problem."

There are medications that are available over the counter that work a little bit for sleep. They are sedating antihistamines and you can get them. Benadryl and doxylamine under Benadryl you can get over the counter, and it's used as a sleeper. Unisom is a brand name you can get over the counter. These antihistamines, antihistamines are drugs people use for allergies and things like that, are mildly sedating so they can work for some people. I'm not the only one who's taken a hit of NyQuil when I didn't really have the worst cold in the world because I just couldn't get to sleep. And NyQuil has Unisom in it or doxylamine.

Now, taking somebody else's drug for that one time makes you kind of think that another time would be okay and then another time. And first of all, you don't know how that medication is going to affect you. That medication was given to that specific person for a specific reason in a dose that at least someone thought was appropriate for them. Just because you're like your girlfriend and the same age, maybe you even wear the same clothes, that doesn't mean your biology is the same and it may not be the right drug for you.

So taking another person's sleeper can have some unexpected consequences. Most sleeping pills actually don't give you that much extra sleep. They do make you close your eyes, but your sleep quality is not that great, and you can have difficulty with sleepwalking, sleep talking, or sleepy driving. You may have difficulty waking up in the morning. So if you're worried about something and you need a really careful brain, sometimes taking a sleeping pill may not be so great for you.

So in sum, most sleeping pills are not all that great, although the placebo effect is big. So you took the pill, you fell asleep, now you know it's good for you and you want some more. Mostly in general studies, sleeping pills aren't that great for sleep. Taking somebody's medications that aren't yours may actually harm you. My guess is you've already taken it and you feel okay and now you think, "Wow, maybe I'll ask her if she's got some more." That kind of diversion of drugs is illegal, so I don't think that's such a good idea.

I think that if you're having difficulty sleeping you should see your health professional, or there are actually some free online techniques for helping you sleep, cognitive behavioral in therapy for insomnia, CBTI. There's some online tricks for helping yourself sleep better. Don't share your birth control pills. Definitely don't share your narcotics. Don't swap out your antibiotics because the person who was given them should have taken all of them, the full dose.

I think taking somebody else's sleepers, it didn't kill you, that's good news. You think it's great, you want some more. I think that usually there's some other medications that might be better for you, and I don't recommend taking somebody else's pills. You can share your peanut M&Ms but don't share your drugs.

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Announcer: Five things for better sleep that you're probably not doing. That's coming up next on The Scope. Medical news and research from University Utah specialists and physicians you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: We're in the studio today with Dr. Kyle Bradford Jones, family physician at the University of Utah. First of all, let's explain to the audience how important sleep is. We know that sleep is important because we all need it, but exactly how important is the amount of sleep that we get?

Dr. Jones: It's huge both from an issue of quantity as well as quality. Making sure that you're sleeping long enough but also making sure that you're doing the things that you get good quality sleep. So getting adequate sleep improves your thinking, it allows us to better handle stress. Getting too little or too much actually can cause us to die prematurely. It can cause heart disease, it can cause obesity, and if we're trying to lose weight, it keeps us from losing weight. It just kind of affects everything and when you think about little kids in school, if they get adequate sleep they're going to do much better. They're going to do better in school, they're going to be better behaved and they're going to be smarter overall.

Interviewer: So in a nutshell it's pretty important.

Dr. Jones: Exactly. And especially as a nation, we're basically all sleep deprived and so this becomes a huge issue to make sure we're doing the best we can to kind of optimize our body.

Interviewer: So five things to better sleep then, to increase that amount of people getting the right amount of sleep and the quality of it as well. So number one?

Dr. Jones: Avoid caffeine, nicotine and alcohol four to six hours before sleep. So some people think that some of these things kind of calm them down and help them get to sleep, but it actually decreases the quality of your sleep. And so you're not getting as much rest and it actually can be detrimental for you.

Interviewer: So no coffee before bed?

Dr. Jones: Exactly.

Interviewer: All right. Number two?

Dr. Jones: Next one, set a comfortable environment. You want it to be dark; you want it to have a comfortable temperature and things like turning off the TV, turning off the radio. Those types of things can actually keep your mind working a little bit more then actually decreases the quality of your sleep.

Interviewer: But turn off the radio is a little bit surprising to me personally because I always sleep with my iPod on with music kind of low. Is that not good then?

Dr. Jones: Some people do better with a small amount of noise, whether it's typically . . . white noise can actually help a lot of people. Having the music or something that's constantly changing, your mind wants to focus on that and so it can actually kind of detract your mind from getting the quality of sleep you need.

Interviewer: That's probably why I'm not falling asleep as fast as I could be. All right. It makes sense.

Dr. Jones: Maybe.

Interviewer: Number three?

Dr. Jones: Turn off your screens. So cell phone, TV, computers, try to avoid using them for an hour before you go to bed. Now, I realize that's very difficult and this may be the most difficult thing for all of us.

Interviewer: I'm thinking in my head too. I'm failing at all of these but especially this one.

Dr. Jones: Exactly, most of us do. But again, it disrupts sleep quality. It makes it harder to fall asleep. It actually increases depression, decreases your attention span, lots of things that are attached with using these too much, especially right before bedtime.

Interviewer: Okay. Well, number four?

Dr. Jones: Number four is getting exercise during the day. So especially cardiovascular exercise.

Interviewer: Like walking and jogging?

Dr. Jones: Exactly.

Interviewer: Okay.

Dr. Jones: Making sure your body is moving, making sure you're increasing the blood flow, especially to your brain. That then helps your body to be able to get a better rest and fall asleep quicker, but also try to avoid exercise a couple of hours before bedtime because that can actually ramp up your body and make your sleep a little worse.

Interviewer: All right. Five things for better sleep. The last one, number five?

Dr. Jones: The last one is consistency. So making sure you're going to bed the same time each night, making sure you're waking up the same time each morning, and making sure you're having the same rituals before you go to bed, kind of doing things in the same order because that helps structure your mind and your body and prepare you to go to sleep.

Interviewer: Seems like I'm just failing at all five of these and they're so simple. I feel like a lot of Americans or people in the world in general, I want to say, don't really do these. And they're so simple and they're so easy and they lead to better health, but we're not doing them.

Dr. Jones: And that seems to be a lot of things that optimize our health. But you're right, we're all sleep deprived and doing some of these things with them being fairly simple can really improve our sleep. So again, focusing on these things even though they seem very simple, they're kind of hard for a lot of us to do. So make sure we're doing those to improve our sleep, which actually makes us happier as well as can make us more productive and improve our wellbeing.

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