Sleep Part 1 was on shift-work sleeper issues. This episode deals with optimizing sleep in general. This is incredibly important for health, mental functioning and cognition.
How Sleep Works – Sleep Pressure/Circadian
3 Major Systems
- Circadian – Melatonin from the pineal gland. Master clock in the Supra-Chiasmatic Nucleus
- Sleep Drive – Adenosine build-up
- Cortisol – Parasympathetic system for sleep, sympathetic wakes you up
Presleep/Wind-down
Controversy over blue light
Level of light and location
Anxiety
Sympathetic Activation
Worry Journal
Take 5 minutes to write down every anxiety that is on the top of your mind before bedtime–this let’s your brain know that you are regarding them as important and that persistent brain may then let you off the hook to worry about them instead of falling asleep.
Exercise
is ok [34805080]
Mobility
Meditation
Orgasm
Temperature before Bed
- Warm up to cool down-sauna, warm bath. Socks or foot warming
- Stay Cool to Stay Asleep
- Warm up to wake up
Put your Subconscious to Work
From Josh Waitzkin’s recommendations: harness the power of your subconscious by asking your brain to provide an answer to a problem or brainstorm ideas while you sleep.
If public, use the below and change member area from both to none
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You Scott: Love this content! Nothing particularly different than what I’ve heard in the past, but a great reminder segment and nice to have it all together in one place. A question: I’m 47 and starting to wonder how much longer I am going to work nights for. I’d love to hear a little more about the impact of nights on the aging clinician. I started as an EMT 29 years ago so it’s years of missed sleep at this point. Any thoughts about how this changes over time besides just being worse in every way? Two sleep hacks that… Read more »
fantastic additions, Lon!!!!!
Great reminders of basic sleep hygiene as well as some more nuanced tricks. My Finnish wife says the Finns and Russians have known about the sauna trick for generations. While you are usually exceptionally logical about your approach to medicine (and it would seem life), I don’t understand the comments about trazodone for sleep. Doses that help with sleep left you hung over the next day, and doses that you could tolerate didn’t help with sleep. That doesn’t sound like a good choice. I know it is commonly used because it is cheap and on formularies, but we could make… Read more »
Michael,
thanks for writing!
Trazodone is effective for many folks, added some meta-analyses from my database to the shownotes above. The problem with me is if you only sleep 5 hours a night then morning somnolence is def. going to be an issue. I think people who are closer to 7 or 8 hours will have a much better experience with the medication. There are not too many other options that are safe for long-term use as opposed to occasional use.
Wonderful review. I do worry about brilliant people offering suggestions in fields outside their expertise. When you present critical care information you refer back to original research and point out the problems with the studies. Here you are not doing that. Despite this, I agree with almost everything you said. However, you presented rules that may not be appropriate for all. For example you said keep your bedtime the same. This is great for the average person but for an insomniac it can be deleterious. Going to bed when you are not sleepy can exacerbate insomnia. Another example was not… Read more »
Dominic, Absolutely agree and thank you for these comments. So much of the standard guidelines are suspended for the treatment of insomnia, just as you state. I was specifically targeting people without insomnia–for those insomnia folks, I recommended CBT-I which would encompass those differing rules, e.g. minimizing time in bed to increase efficiency, pushing back bedtime to maximize ease of sleep initiation and maintenance, etc. And of course anyone with sleep issues, should clearly seek out a professional. As to the waking up later occasionally, I have heard differing opinions from the various sleep professionals I have interacted with. I… Read more »
Scott thank you so much for the two sleep episodes. I find them so important and would love if you did more wellness talks sprinkled in between the critical care. All your tips are great and agree with most. I am a shift worker and have figured out how to optimize almost every shift with lots of trial and error that involved changes to diet, caffeine, and exercise. The only shift however that I can’t figure out are my overnights. I am lucky, I only have to do one or two a month. My question for you though. 1) How… Read more »
Great ?s!!!
In the course of your reading, did you come across any research on propranolol or other beta-blockers to aid in sleep? I’ve wondered if propranolol could aid in sleep by buffering the sympathetic response similarly to how it helps for performance anxiety. I searched a bit in the past and didn’t find any research addressing the idea.
Paradoxically to what you might think, insomnia is a well known potential side effect of beta blockers. Potentially more so for a lipophilic drug like propranolol.
Great podcast. I’ll be starting many of your recommendations! I’m looking forward to reading your protocol that you referenced would be in written form. I’m a new member so let me know how to find this! Thanks!
Hey Scott, enjoyed the podcast, you touched on it in Part 1 but it didn’t come up at all in Part 2… ADHD medications and their impact on sleep?
if dosed correctly, they should be worn off before they affect sleep. Changing the admin time for night shifts is definitely something to talk to your prescriber about b/c I personally would push them way later in the day, perhaps with some short acting upon wake-up for bridge.
Dear Scott,
I’m a resident emergency medicine from Belgium. For 5 years a devoted listener.
Love this podcast. I really like your variation in topics (pure medical + lifestyle + enhancing performance).
Please keep up your amazing work!
Scott- Excellent episode with lots of practical advice. If I can emphasize one small section that could really change people’s lives it’s where you briefly mentioned that if you think you have sleep apnea or other sleep disorders to get a sleep study. I did and it changed my life. I was diagnosed with severe sleep apnea with an AHI of 43. For those that aren’t familiar with AHI, that’s 43 apneas or hypopneas per hour! That’s an event every 84 seconds on average! I started on CPAP and got the best sleep of my life one night number 1… Read more »
amazing–thanks for sharing that, buddy!
Nice episode, thanks for sharing. If we all got great sleep, used mindfulness techniques, ate real food, went outside, and mitigated our stress most of our jobs would probably be obsolete.
I want to be clear, I do brush my teeth and floss, but I also want to push back slightly on the oral hygiene segment haha. You should read the book dental diet by Steven Lin and follow up by looking into the work of Weston Price. Fascinating stuff.
Thanks again.
– Justin
You asked for feedback, so here it comes… I love this kind of episodes and don’t mind if they make up a significant amount of content on emcrit. Even if you are not a trained expert on a specific topic, I trust you more than any other “self-made” expert, since I know and love your content for years and I am sure that you have read an excessive number of studies on it and talked to more “real” experts than I even know of. Additionally, you bring all those recommendations to practice, e.g., not only saying “you should keep your… Read more »
I have a very similar issue with the next night after ambien feeling awake all night but my sleep tracker says I’m rested. I thought it was a flaw in the sleep tracker but hearing you say that made me relieved to know I’m not the only one with that issue.
Where/how did you do genetic testing to see if you’re a short sleeper? I’m guessing it was an ADRB1 single gene panel
Alyssa, I am a patient in a concierge performance medicine group so they did all the genetic testing and interp.
I just wanted to take a moment to thank you for your recent blog post. Your insights and ideas were precious and thought-provoking. I appreciate your time and effort in creating such a well-written and informative piece.
Source –
https://www.tharwaniinfrastructures.com/millenia/
Tharwani Infrastructures
Marvelous!
I just wanted to take a moment to thank you for your recent blog post. Your insights and ideas were precious and thought-provoking. I appreciate your time and effort in creating such a well-written and informative piece.
Once again, thank you for sharing your knowledge and expertise with your readers. Your dedication to providing high-quality content is evident, and I look forward to reading more of your posts in the future.
Source –https://www.tharwaniinfrastructures.com/palacia/
Regarding the sleep cave—when I graduated critical Care fellowship I landed a dream job—but the first 3 years are 100% nights. I took my sign on bonus and built a room above my walk in closet that holds just a single bed. I take a ladder from my closet up through a trap door into the room, which is not even full standing height, fully finished and painted (and houses my old high school band posters and all the art my kids make for me ha). I have a window AC unit that keeps it cold and drowns out any… Read more »
I love this!! I have often thought that bedrooms would be improved by making the walk-in closet the sleeping chamber and the bedroom the closet/sitting area.