WEBVTT - 25 - Dr. Christopher Earley: The Science of Sleep (Or Lack Thereof) 0:00:00.090 --> 0:00:04.080 From Kerkow media coming up on the show, you can't 0:00:04.080 --> 0:00:06.000 not move, you have to move the legs. 0:00:06.150 --> 0:00:10.140 I can't convey in simple words the experience is beyond 0:00:10.140 --> 0:00:12.549 anything any of us can imagine unless you actually have 0:00:12.550 --> 0:00:16.800 had the disease. And I can tell you, you become so, 0:00:16.800 --> 0:00:21.050 so desperate to get rid of the sensation that. 0:00:23.780 --> 0:00:27.530 Do you have any of these issues, daytime drowsiness can't 0:00:27.530 --> 0:00:30.560 fall asleep, can't stay asleep, you don't wake up refreshed 0:00:30.560 --> 0:00:34.220 in the morning snoring, she says you stop breathing. You 0:00:34.220 --> 0:00:36.199 may even be one of those people who joke around 0:00:36.200 --> 0:00:38.500 about how you haven't had a good night's sleep in years. 0:00:38.810 --> 0:00:41.110 So if you were anyone, you know, one of the 0:00:41.120 --> 0:00:43.790 hundred million people who don't get a proper night's sleep. 0:00:43.790 --> 0:00:48.260 This is your episode of Medicine. We're still practicing. I'm 0:00:48.260 --> 0:00:48.919 Bill Kurtis. 0:00:50.180 --> 0:00:52.670 Johns Hopkins is one of the highest regarded health care 0:00:52.670 --> 0:00:55.580 institutions in the country. There seems to be no end 0:00:55.580 --> 0:00:58.100 to the roster of specialists who bring us the edge 0:00:58.100 --> 0:01:02.180 of the art in research, medicine and patient care. Today, 0:01:02.180 --> 0:01:04.850 we continue our Johns Hopkins series with the issues that 0:01:04.850 --> 0:01:07.730 keep you up at night or have us yawning our 0:01:07.730 --> 0:01:11.120 way through the day. First, of course, my co-host, Doctor 0:01:11.120 --> 0:01:15.620 Stephen Tayback. He's the quadruple board certified doctor of internal medicine, 0:01:15.800 --> 0:01:19.759 pulmonary disease, critical care and neuro critical care. And he's 0:01:19.760 --> 0:01:22.580 also my very best friend, Dr. Tayback. How are you 0:01:22.580 --> 0:01:23.630 holding up these days? 0:01:23.870 --> 0:01:27.020 Hayesville actually doing a lot better. Things are looking up. 0:01:27.440 --> 0:01:29.450 Oh, that's good to hear. I look forward to getting 0:01:29.450 --> 0:01:32.720 into that a little bit. Dr. Christopher Lee joined Johns 0:01:32.720 --> 0:01:36.950 Hopkins almost three decades ago. He's board certified in internal 0:01:36.950 --> 0:01:40.700 medicine and psychiatry and neurology. He's also a professor of 0:01:40.700 --> 0:01:45.260 neurology at Johns Hopkins and he specializes in sleep or 0:01:45.260 --> 0:01:46.110 the lack thereof. 0:01:46.550 --> 0:01:49.520 Welcome. Nice to have you, Doctor early. Thank you for 0:01:49.520 --> 0:01:52.190 having me. I wonder, Chris, can you just help us 0:01:52.190 --> 0:01:55.010 define the phases of sleep? What are those? 0:01:55.430 --> 0:01:58.010 The sleep studies are published on the grounds that we 0:01:58.020 --> 0:02:01.670 have more or less broken step up into two big bits, 0:02:01.670 --> 0:02:05.480 which is what's called non REM sleep and REM sleep. 0:02:05.480 --> 0:02:08.570 And REM stands for Rapid Eye Movement. And in about 0:02:08.570 --> 0:02:11.660 a quarter of your sleep is involved in this REM state, 0:02:11.870 --> 0:02:14.930 which is the dreaming state. The non REM state can 0:02:14.930 --> 0:02:18.260 be partitioned into what's called stage one, stage two, three 0:02:18.260 --> 0:02:21.110 and four with stage three and four is really called 0:02:21.110 --> 0:02:25.160 slow wave sleep. Stage one would be drowsiness. We spend 0:02:25.160 --> 0:02:28.489 most of our time in stage two sleep the deeper 0:02:28.490 --> 0:02:32.150 sleep so-called stage three four tends to be of a 0:02:32.150 --> 0:02:35.570 larger proportion of sleep when you're younger. And so when 0:02:35.570 --> 0:02:37.970 you're in your teens and twenties, that's about 20 percent 0:02:37.970 --> 0:02:40.220 of your sleep. If you're in the 50s and 60s, 0:02:40.220 --> 0:02:41.750 that's about three or four percent, obviously. 0:02:42.260 --> 0:02:44.930 Did you say that the really quality sleep goes down 0:02:44.930 --> 0:02:46.640 to like three percent when you're old? 0:02:47.310 --> 0:02:51.320 Well, well, the deeper sleep our ability to maintain sleep 0:02:51.320 --> 0:02:53.030 in general from an age point of view is a 0:02:53.030 --> 0:02:56.120 little complex. But essentially the elements of sleep when we 0:02:56.120 --> 0:02:59.580 talk about stage three for sleep, that is much higher 0:02:59.580 --> 0:03:01.670 in the younger and gets less and less as we 0:03:01.669 --> 0:03:04.070 get older, fertility gets down to a few percentage, as 0:03:04.070 --> 0:03:05.720 I mentioned, after the age of 50. 0:03:06.410 --> 0:03:09.140 So for the lay public, what's the significance of those 0:03:09.139 --> 0:03:12.050 stages and and what should they be targeting and what 0:03:12.050 --> 0:03:14.330 do we do on a day to day basis that 0:03:14.330 --> 0:03:16.940 is either helpful or harmful to the stages that we 0:03:16.940 --> 0:03:17.750 actually require? 0:03:18.260 --> 0:03:22.880 The biggest element of sleep is consolidation of sleep, whether 0:03:22.880 --> 0:03:25.730 you're in stage two, stage three, stage four, it's how 0:03:25.730 --> 0:03:29.170 consolidate your sleep is. What is what does that mean? Consolidated. 0:03:29.210 --> 0:03:33.230 So humans, unlike cats and dogs, really need a continuous 0:03:33.230 --> 0:03:35.870 period of sleep. Now, we might be able to break 0:03:35.870 --> 0:03:38.210 that up into two sections, a four hour and a 0:03:38.210 --> 0:03:41.030 four hours. But generally most people need between seven and 0:03:41.030 --> 0:03:43.070 eight hours of sleep. And it needs to be fairly 0:03:43.070 --> 0:03:47.630 consistent from start to finish if you're awakening frequently at night, 0:03:47.630 --> 0:03:51.410 that sleep fragmentation. So the first and foremost thing is 0:03:51.410 --> 0:03:54.590 trying to get a consolidated amount of sleep. That is 0:03:54.620 --> 0:03:56.540 from the time your head hits the pillow to the 0:03:56.540 --> 0:03:58.850 time you wake up in the morning. That period of 0:03:58.850 --> 0:04:01.280 time should be seven to eight hours and basically you 0:04:01.280 --> 0:04:03.890 should be able to have slept through that full duration 0:04:03.890 --> 0:04:06.830 of the night. The second issue is that it's not 0:04:06.830 --> 0:04:09.860 clear if the different stages of sleep are relevant to 0:04:09.890 --> 0:04:13.340 you experiencing a certain good quality of sleep as much 0:04:13.340 --> 0:04:17.289 as it may be involved in memory and memory consolidation. 0:04:17.300 --> 0:04:20.539 So the deeper sleep is in stage three four might 0:04:20.540 --> 0:04:23.960 be relevant to how you hold on to certain memory. Generally, 0:04:23.960 --> 0:04:26.409 if you're spending most of your time in stage two, 0:04:26.420 --> 0:04:29.299 three or four sleep, that's good. If you're spending too 0:04:29.300 --> 0:04:32.300 much time in what's called stage one sleep, that's bad 0:04:32.300 --> 0:04:35.390 because stage one sleep would be drowsy. You're sort of 0:04:35.390 --> 0:04:38.719 in sleep, but you're never really you're not quite into 0:04:38.720 --> 0:04:42.320 sleep yet. And so if you have a disproportionate amount 0:04:42.320 --> 0:04:46.790 of stage one sleep, then you're more likely to experience 0:04:46.790 --> 0:04:50.630 a sense of not feeling rested, tired, memory problems, things 0:04:50.630 --> 0:04:51.109 like that. 0:04:51.890 --> 0:04:53.780 Now, is this in our control at all? Can the 0:04:53.779 --> 0:04:56.750 layperson do something so that they make sure that they 0:04:56.750 --> 0:05:00.140 don't linger in stage one and can optimise their stage 0:05:00.140 --> 0:05:01.280 three and stage four sleep? 0:05:02.029 --> 0:05:04.489 We talk about the brain resting and the importance of 0:05:04.520 --> 0:05:08.150 the brain and sleep. The truth is, sleep is really 0:05:08.150 --> 0:05:12.950 a total biological rest and your sleep is looking to 0:05:12.950 --> 0:05:15.919 the metabolic demands you put on your body during the day. 0:05:15.920 --> 0:05:18.140 As much as it's looking at the metabolic demands you 0:05:18.140 --> 0:05:20.960 put on its brain each day, a significant amount of 0:05:20.960 --> 0:05:24.719 physical activity during the day, we're. Well, to improve the 0:05:24.720 --> 0:05:28.880 quality of sleep, the timing of sleep is equally important, 0:05:29.160 --> 0:05:32.130 not all of us are designed to be going to 0:05:32.130 --> 0:05:34.830 bed at 10:00, getting up at 6:00. Some of us 0:05:34.830 --> 0:05:38.580 are called night owls. So our biological clock doesn't make 0:05:38.580 --> 0:05:40.650 us ready for sleep until 1:00 in the morning or 0:05:40.650 --> 0:05:42.150 two in the morning or three in the morning. 0:05:42.660 --> 0:05:46.530 Have you helped people to adjust that? Yes. How do 0:05:46.529 --> 0:05:46.919 you do that? 0:05:47.460 --> 0:05:50.820 There are two basic ways. The use of lights in 0:05:50.820 --> 0:05:53.160 the morning, particularly if you're getting up early. So you 0:05:53.160 --> 0:05:56.820 have a large urban society which gets up at whatever time, 0:05:56.910 --> 0:05:58.529 four or five, six in the morning in order to 0:05:58.529 --> 0:06:00.930 get to work. You spend an hour or two driving, 0:06:01.080 --> 0:06:02.430 so you've got to get up work. You have to 0:06:02.430 --> 0:06:03.900 be in work by 8:00, then you've got to be 0:06:03.900 --> 0:06:07.020 up at six, five or six. So using artificial lights, 0:06:07.020 --> 0:06:10.860 high intensity looks, lights to mimic the sunlight can help 0:06:10.860 --> 0:06:13.950 what's called phase advance. Move your clock back to something 0:06:13.950 --> 0:06:15.470 that's more socially acceptable. 0:06:15.930 --> 0:06:19.469 That's one thing. Melatonin appears to have some value. I 0:06:19.470 --> 0:06:22.650 know people use melatonin at high doses to try to 0:06:22.650 --> 0:06:23.909 get them to sleep. 0:06:24.240 --> 0:06:27.540 But the purpose of melatonin really is a biological marker 0:06:27.540 --> 0:06:30.930 to sort of indicate that sleep is about to happen 0:06:30.930 --> 0:06:33.180 in three or four hours. And you take it one 0:06:33.180 --> 0:06:35.910 to three milligrams, three or four hours before bedtime. That 0:06:35.910 --> 0:06:37.150 also might help the brain. 0:06:37.170 --> 0:06:41.580 Your phase delayed biological clock back to something that's a 0:06:41.580 --> 0:06:44.730 little bit more in line with your early bird tendency 0:06:44.750 --> 0:06:47.610 to get what is melatonin do and don't we make 0:06:47.610 --> 0:06:52.170 that naturally into the melatonin is tied to what you're 0:06:52.230 --> 0:06:55.530 called your circadian rhythm based on your circadian rhythm is 0:06:55.529 --> 0:06:58.950 your internal biological clock, which is ticking away over a 0:06:58.950 --> 0:07:02.070 twenty four hour period. That's sort of in the beginning 0:07:02.070 --> 0:07:05.099 decides to activate everything so you can be busy, inactive, 0:07:05.100 --> 0:07:07.500 ready to go and then start slowing things down as 0:07:07.500 --> 0:07:10.890 you approach sleep within that curve. There was a period 0:07:10.890 --> 0:07:13.260 of time in which it triggers this melatonin to be 0:07:13.260 --> 0:07:16.410 produced and have a peak. And that peak basically should 0:07:16.410 --> 0:07:19.470 appear three to four hours before you're actually ready for 0:07:19.470 --> 0:07:21.050 your brain to hit the go to sleep. 0:07:21.060 --> 0:07:23.880 So the purpose of the melatonin is to let the 0:07:23.880 --> 0:07:25.950 rest of the body. So when the melatonin goes up, 0:07:25.950 --> 0:07:29.520 your your heart rate starts going down, your metabolism, your liver, 0:07:29.520 --> 0:07:32.820 your muscle, those all start going down in terms of 0:07:32.820 --> 0:07:35.910 their metabolic need long before your head hits the pillow. 0:07:36.300 --> 0:07:38.880 The brain's the last organ on board about three or 0:07:38.880 --> 0:07:41.550 four hours later to get the sleep. So the purpose 0:07:41.550 --> 0:07:44.700 of that melatonin really is a biological signal to set 0:07:44.700 --> 0:07:47.120 that into motion for that given period of time. 0:07:47.580 --> 0:07:51.180 What about people who chronically have trouble falling asleep? Is 0:07:51.180 --> 0:07:54.540 it helpful to use sleep AIDS? Is it counterproductive? Is 0:07:54.540 --> 0:07:58.470 it better to only use natural means or no sleep aids? 0:07:58.620 --> 0:08:02.150 What's your perspective on sleeping pills and other sleeping AIDS? 0:08:02.430 --> 0:08:05.970 I'm not completely anti sleeping pill. I just think there 0:08:06.000 --> 0:08:09.150 are a lot of really good alternatives that will work 0:08:09.150 --> 0:08:12.120 for like 90 percent of people. I just think that 0:08:12.120 --> 0:08:14.580 the sleeping pill is a quick answer. You walk into 0:08:14.580 --> 0:08:17.000 a doctor's office, I can't fall asleep. I can enhance 0:08:17.010 --> 0:08:20.190 a prescription for a pill. There are a couple fairly 0:08:20.190 --> 0:08:24.900 straightforward approaches. Again, some really good data demonstrating the value 0:08:24.900 --> 0:08:26.610 of what's called sleep hygiene. 0:08:27.210 --> 0:08:28.200 What sleep hygiene. 0:08:28.710 --> 0:08:31.200 Sleep hygiene is trying to get the person to think 0:08:31.200 --> 0:08:35.250 in terms of what they need to do behaviorally in 0:08:35.250 --> 0:08:38.940 efforts to prepare for sleep. The simple things are about caffeine. 0:08:39.090 --> 0:08:41.640 There are some people that are very, very sensitive to caffeine. 0:08:41.970 --> 0:08:43.829 If they take a cup of coffee at 1:00 in 0:08:43.830 --> 0:08:45.809 the afternoon, it still affects them at night. So I 0:08:45.809 --> 0:08:48.900 understand how sensitive you are, but basically you shouldn't be 0:08:48.900 --> 0:08:52.410 drinking caffeine four or five hours before sleep onset time. 0:08:52.440 --> 0:08:55.980 That straightforward exercise exercise is something that you should be 0:08:55.980 --> 0:08:59.640 doing as a product of your arousal state, your awake state. 0:09:00.030 --> 0:09:01.470 What do you want to do in the morning or 0:09:01.470 --> 0:09:05.790 the afternoon? But you shouldn't be doing significant aerobic exercise 0:09:05.790 --> 0:09:09.120 for hours before bedtime or otherwise. You're just activating your system. 0:09:09.750 --> 0:09:13.440 The other issues and the most common problem and it 0:09:13.440 --> 0:09:22.110 has been very successful is what I call blue screen habits, iPhones, iPads, computers. 0:09:22.290 --> 0:09:25.920 People live in their bedrooms with these devices and they 0:09:25.920 --> 0:09:29.250 don't know how to disconnect. My general is no blue 0:09:29.250 --> 0:09:33.809 screens three hours before bedtime, no TV. The last hour 0:09:33.809 --> 0:09:36.690 before bedtime, people said, what do I do? I said, 0:09:36.690 --> 0:09:38.939 I'll read, listen to music. If you have a bit 0:09:38.940 --> 0:09:42.000 of a hobby, do something that relaxes. And they said, well, 0:09:42.150 --> 0:09:44.910 I'm going to get bored. So that's perfect. That's exactly 0:09:44.910 --> 0:09:46.740 what you you want to get bored and tired and 0:09:46.740 --> 0:09:49.950 ready to go to sleep. So sleep hygiene is really 0:09:49.950 --> 0:09:52.740 effective for the majority of people because I think many 0:09:52.740 --> 0:09:56.340 people have difficulty getting to sleep because they've developed bad 0:09:56.370 --> 0:10:00.000 habits around using their iPhones up until the last minute 0:10:00.000 --> 0:10:00.780 and things like that. 0:10:01.679 --> 0:10:05.150 What are the long term ramifications, then, of sleep fragmentation? 0:10:05.520 --> 0:10:07.500 Is it going to shorten your life expectancy or is 0:10:07.500 --> 0:10:08.429 it just a nuisance? 0:10:08.910 --> 0:10:12.600 There are three major consequences that come as a consequence 0:10:12.600 --> 0:10:16.290 of any sleep loss. The first and foremost is attention 0:10:16.290 --> 0:10:20.760 and concentration, and most of us attention. Concentration might not 0:10:20.760 --> 0:10:22.650 be a big deal. If you're in a job that's 0:10:22.650 --> 0:10:26.730 fairly routine, it's reflexive. It will impact learning significantly in 0:10:26.730 --> 0:10:29.520 the younger age groups because that's what kids are trying 0:10:29.520 --> 0:10:32.939 to do, is learn multitasking is probably the biggest consequence 0:10:32.940 --> 0:10:36.750 for the more working individual. The second element is moved 0:10:36.960 --> 0:10:41.190 off the state and increased problems with decreased interest, decreased drive, 0:10:41.370 --> 0:10:45.750 lack of motivation. It can aggravate or cause an anxiety 0:10:45.750 --> 0:10:49.470 or depression. And both those elements are pretty early in 0:10:49.470 --> 0:10:52.830 the process within weeks, if not months, of you having 0:10:52.830 --> 0:10:57.360 chronic sleep loss. The third element is sleepiness, which, interestingly enough, 0:10:57.360 --> 0:11:01.849 is really poor as a measure of one's sleep quality. 0:11:02.190 --> 0:11:04.679 It is the least reliable. There are plenty of people 0:11:04.679 --> 0:11:06.840 out there who are not getting quality sleep, who don't 0:11:06.840 --> 0:11:07.560 feel tired. 0:11:08.210 --> 0:11:11.610 Let's talk about sleep aids like Restoril and Ambien and 0:11:11.730 --> 0:11:14.790 challenges that people have had with that. And just to 0:11:14.790 --> 0:11:18.240 be straightforward, many years ago I pulverized my ankle on 0:11:18.240 --> 0:11:22.170 a ski slope and had trouble sleeping, was prescribed sleeping pills. 0:11:22.350 --> 0:11:24.300 I was told that you don't really get the same 0:11:24.300 --> 0:11:27.750 quality of sleep on something like Ambien, a Restoril. Is 0:11:27.750 --> 0:11:28.410 that so? 0:11:29.160 --> 0:11:32.610 Yes and no. There really there to suppress arousal. They 0:11:32.610 --> 0:11:35.580 don't necessarily induce sleep. We go back to my original 0:11:35.580 --> 0:11:39.120 discussion about the difference between sleep is not just the 0:11:39.120 --> 0:11:43.440 absence of arousal sleep. It's its own biological state. It 0:11:43.440 --> 0:11:44.580 has to exist. 0:11:44.820 --> 0:11:47.910 That biological phenomena has to exist for you to enter 0:11:47.910 --> 0:11:50.069 it just by knocking yourself out. I mean, I could 0:11:50.190 --> 0:11:52.110 I could knock myself out with a fifth of whiskey. 0:11:52.110 --> 0:11:53.490 Does that mean I'm sleepy? 0:11:53.910 --> 0:11:57.240 So the issue is the sleeping pills in general with 0:11:57.240 --> 0:11:59.640 respect to which one you choose, are there to suppress 0:11:59.640 --> 0:12:03.330 arousal such that if sleep is sitting there waiting, you 0:12:03.330 --> 0:12:06.480 can enter sleep. So I think the sleeping pills work 0:12:06.480 --> 0:12:09.570 well if you have a certain type of person, just 0:12:09.570 --> 0:12:12.870 can't turn it off, you know, sleep is there. Their 0:12:12.910 --> 0:12:15.929 the biology sitting there waiting for them. They're just waiting 0:12:15.929 --> 0:12:18.720 for them to finally turn off that arousal mechanism. 0:12:18.870 --> 0:12:22.199 Sleeping pills may be a value in that situation, but 0:12:22.200 --> 0:12:25.740 believe me, that's a very, very small number of people 0:12:25.740 --> 0:12:27.360 for which it has some value. 0:12:27.660 --> 0:12:31.050 Do you actually convince yourself, is it a psychological thing? 0:12:31.050 --> 0:12:34.199 You convince yourself that you're going to sleep well or 0:12:34.200 --> 0:12:36.690 you convince yourself, well, I'm not going to sleep well, 0:12:36.690 --> 0:12:39.420 and then you wake up at whatever time you think 0:12:39.420 --> 0:12:40.109 you're going to wake up? 0:12:40.860 --> 0:12:44.400 Yes, I think that there's a lot of cognitive machinations 0:12:44.400 --> 0:12:47.550 that go on to create an environment. I mean, the 0:12:47.550 --> 0:12:49.740 very nature that you go to your doctor for an 0:12:49.740 --> 0:12:53.040 answer and they give you an answer, you'll come to 0:12:53.040 --> 0:12:56.090 believe that that's the right answer. And therefore, you believe 0:12:56.090 --> 0:12:57.840 if I stop this, I won't be able to sleep. 0:12:57.850 --> 0:13:01.140 And unfortunately, what happens is if you try to stop, 0:13:01.140 --> 0:13:04.160 you'll get a rebound that is coming off the medications. 0:13:04.170 --> 0:13:06.060 There'll be a period of time which you will go 0:13:06.059 --> 0:13:08.400 back to some degree of insomnia. Thus it's sort of 0:13:08.400 --> 0:13:12.120 fulfilling your belief that I can't get off this medication. 0:13:12.640 --> 0:13:16.110 I wonder, could you talk to us a little bit about, well, 0:13:16.110 --> 0:13:19.380 that noise that you hear from your partner, that snoring 0:13:19.380 --> 0:13:23.730 kind of. So I understand that that falls into two categories. 0:13:23.730 --> 0:13:27.960 There's the snoring and there's sleep apnea. Can you explain 0:13:27.960 --> 0:13:30.000 the difference dynamically? 0:13:30.000 --> 0:13:33.390 The snoring really comes from the upper part, the soft palate. 0:13:33.630 --> 0:13:37.410 It's basically air rushing through your nasal passages versus your 0:13:37.410 --> 0:13:41.040 mouth at different pressure differences. So you get this flap, 0:13:41.260 --> 0:13:44.640 that's the the snore. Any time you have to pull 0:13:44.640 --> 0:13:47.850 the air fast across the soft palate, you're likely to 0:13:47.850 --> 0:13:50.190 get the snoring. So if you have a little bit 0:13:50.190 --> 0:13:52.709 of nasal congestion, you open your mouth a little bit 0:13:52.710 --> 0:13:55.319 to breathe and you're going to snore. If you have 0:13:55.320 --> 0:13:59.790 obstruction farther down in the upper part of the airway. Again, 0:13:59.790 --> 0:14:02.640 if there some resistance, you can breathe harder. And again, 0:14:02.940 --> 0:14:04.920 the air is going to rush across the soft power 0:14:04.920 --> 0:14:09.630 and cause you to snore. Sleep apnea, persay really involved 0:14:09.630 --> 0:14:12.420 in that upper part of our weight, sort of below 0:14:12.420 --> 0:14:15.719 the tonsils for want of a better word. That's basically 0:14:15.720 --> 0:14:20.300 a muscular tube. And essentially, when you have sleep apnea, 0:14:20.310 --> 0:14:23.850 that muscular tube is very collapsible. There's nothing to support it. 0:14:24.420 --> 0:14:27.960 So when you breathe in, that tube starts to collapse. 0:14:27.960 --> 0:14:30.420 The example I give is when we were kids, we 0:14:30.420 --> 0:14:33.240 used to have paper straws. And if you left the 0:14:33.240 --> 0:14:35.100 paper straw in the soda long enough, you want to 0:14:35.100 --> 0:14:37.320 suck it. What would happen? The straw would collapse in 0:14:37.320 --> 0:14:39.780 the middle. The same, too. If you have a tube 0:14:39.780 --> 0:14:42.510 going down to your lungs and that tube is relatively 0:14:42.510 --> 0:14:44.760 flabby and you take a breath in, it's going to 0:14:44.760 --> 0:14:48.900 collapse and cause obstruction. Thus the term obstructive sleep apnea. 0:14:49.200 --> 0:14:51.420 And so sleep apnea really has to deal with that 0:14:51.420 --> 0:14:54.990 lower part for want of a better anatomical term. Blow 0:14:54.990 --> 0:14:57.750 your where your tonsils are. The snoring is more or 0:14:57.750 --> 0:15:00.240 less above where the tonsils are into that soft part 0:15:00.240 --> 0:15:00.810 of your tissue. 0:15:01.430 --> 0:15:04.910 So other than divorce court, what are the other ramifications 0:15:04.910 --> 0:15:05.720 of snoring? 0:15:06.350 --> 0:15:09.290 There's a lot of associations and I will point out 0:15:09.290 --> 0:15:13.480 to people listening in an association doesn't mean it's causally related. 0:15:13.490 --> 0:15:16.010 That means there's some relationship. We just don't know what 0:15:16.010 --> 0:15:19.610 that relationship is. So there's an association between snoring and 0:15:19.610 --> 0:15:22.250 risk of high blood pressure, snoring and risk of stroke. 0:15:22.500 --> 0:15:26.930 But in general, most studies don't tie any specific health 0:15:26.930 --> 0:15:31.850 concerns to snoring persay. If it is not associated with 0:15:31.850 --> 0:15:34.210 sleep apnea, what if it wakes you up? 0:15:34.550 --> 0:15:37.220 You are not aware of your own snoring. If it 0:15:37.220 --> 0:15:38.530 wakes you up, it's because you have. 0:15:38.960 --> 0:15:41.460 Yeah, I keep telling her I don't snore. That's right. 0:15:42.350 --> 0:15:44.540 It is a problem to degree that you're awake in 0:15:44.540 --> 0:15:47.870 your bed partner up. So that's the critical Mexia. When 0:15:47.990 --> 0:15:50.900 people come to me from the snoring point of view, 0:15:50.900 --> 0:15:53.750 it's usually he comes to me, he's snoring and the 0:15:53.750 --> 0:15:56.030 answer is, I can't wake my wife. I, I keep 0:15:56.030 --> 0:15:58.400 getting nudged in the middle of the night. If you 0:15:58.400 --> 0:15:59.570 share a bed with someone, someone's going to have a 0:15:59.570 --> 0:16:02.210 consequence on the other bed partner unless the other bed 0:16:02.210 --> 0:16:03.530 partners are really good sleep as well. 0:16:03.610 --> 0:16:06.470 So, OK, so let's go to the more difficult one. 0:16:06.480 --> 0:16:11.810 Sleep apnea, the act of actually stopping breathing often many 0:16:11.810 --> 0:16:13.880 times a minute is that destructive. 0:16:14.330 --> 0:16:17.000 So when we talk about sleep apnea, even though the 0:16:17.000 --> 0:16:20.330 term apnea means to stop breathing, most of the events 0:16:20.330 --> 0:16:24.650 are partial obstructions and not always complete obstructions. So what 0:16:24.650 --> 0:16:28.610 we refer to as Hypponen is so the airway partially collapsed, 0:16:28.610 --> 0:16:32.480 doesn't completely collapse. So it's a range between the partial 0:16:32.480 --> 0:16:34.280 all the way up to 100 percent collapse. So when 0:16:34.280 --> 0:16:37.250 you talk about obstructive sleep apnea, we talk about some 0:16:37.250 --> 0:16:40.100 degree of collapse, maybe 40, 50 percent collapse, up to 0:16:40.100 --> 0:16:41.450 100 percent collapse. 0:16:41.900 --> 0:16:45.170 And so sleep apnea by the numbers. So we can 0:16:45.170 --> 0:16:48.950 talk about having 20 events per hour, 30 events per 0:16:48.950 --> 0:16:52.400 our normal is considered less than five events per hour. 0:16:52.400 --> 0:16:54.200 So we all have a little bit during the night. 0:16:54.440 --> 0:17:00.140 The data is fairly strong for suggesting that untreated obstructive 0:17:00.140 --> 0:17:03.320 sleep apnea, if your rate is above 30 per hour, 0:17:03.590 --> 0:17:07.550 probably has risk of at least hypertension, stroke. And it's 0:17:07.550 --> 0:17:11.420 also about the heart disease at rates less than 15 0:17:11.420 --> 0:17:14.780 per hour. It's probably not a long term health risk 0:17:14.780 --> 0:17:16.640 between 15 and 30. It's unclear. 0:17:17.450 --> 0:17:20.660 What about position in sleep? Are there things that that 0:17:20.660 --> 0:17:24.740 an individual can do without using mechanical devices that might 0:17:24.740 --> 0:17:27.409 improve their sleep apnea and their quality of sleep? 0:17:27.650 --> 0:17:30.350 So obstructive sleep apnea tends to be worse on your 0:17:30.350 --> 0:17:33.139 back versus side versus your stomach. If you have a 0:17:33.140 --> 0:17:37.220 tendency to be a backslapper trying to recondition yourself to 0:17:37.220 --> 0:17:39.830 your side, there are wedge pillows and things like that 0:17:39.890 --> 0:17:43.430 that people can buy online. There are these special shirts 0:17:43.430 --> 0:17:45.740 that have a sort of rubber ball in the back 0:17:45.740 --> 0:17:47.899 of it that makes it very uncomfortable for you to 0:17:47.900 --> 0:17:50.900 roll over on your back. So those are positional things 0:17:50.900 --> 0:17:53.600 that you can do. A few people for whom they've 0:17:53.600 --> 0:17:56.600 never been able to tolerate PAP and I think their 0:17:56.600 --> 0:17:58.850 apnea is bad. I tell them to get a lounge 0:17:58.850 --> 0:18:02.030 chair and to start sleeping. So the more upright you sleep, 0:18:02.030 --> 0:18:04.700 the more the jaw and the tongue comes forward, basically 0:18:04.700 --> 0:18:06.919 reduces the degree of obstruction. So. 0:18:10.950 --> 0:18:13.470 We're going to take about a 30 second break. I'm 0:18:13.470 --> 0:18:15.780 going to go grab a coffee. We'll be right back 0:18:15.780 --> 0:18:18.240 with Dr. Christopher Lee from Johns Hopkins. 0:18:24.350 --> 0:18:28.160 A moment of your time, a new podcast from Kerkow Media. 0:18:28.850 --> 0:18:32.930 Currently 21 years old and today, like magic, extended from 0:18:32.930 --> 0:18:35.419 her fingertips down to the blood to take care of 0:18:35.420 --> 0:18:38.420 yourself because the world needs you and me. Every do 0:18:38.420 --> 0:18:40.159 gooder that asked about me was ready to spit on 0:18:40.160 --> 0:18:42.890 my dream. Fingers who are facing you can feel like 0:18:43.040 --> 0:18:45.770 your purpose in your worth is really being done to 0:18:45.770 --> 0:18:48.980 stop me from playing the piano. She buys walkie talkies, 0:18:49.160 --> 0:18:51.379 wonders to whom she should give the second. I don't 0:18:51.380 --> 0:18:52.300 love humans. 0:18:52.310 --> 0:18:53.510 We never did. We never. 0:18:53.510 --> 0:18:56.210 Well, we just find the beauty of rock climbing is 0:18:56.210 --> 0:18:58.850 that you can only focus on what's right in life 0:18:59.090 --> 0:19:01.429 and so are American life begins. 0:19:02.460 --> 0:19:05.780 We may need to stay apart, but let's create together 0:19:06.140 --> 0:19:10.760 available on all podcast platforms. Submit your piece at Kerkow Dotcom, 0:19:10.760 --> 0:19:12.050 slash a moment of your time. 0:19:17.900 --> 0:19:21.500 OK, we're back, Dr. Christopher, let's talk about kind of 0:19:21.500 --> 0:19:23.179 the opposite side of the coin, I'm going to tell 0:19:23.180 --> 0:19:24.080 you a quick story. 0:19:24.380 --> 0:19:28.100 I once sold advertising for a career, and I was 0:19:28.100 --> 0:19:31.850 in a very important meeting for probably the largest advertising 0:19:31.850 --> 0:19:35.810 contract that I had ever even imagined. And the CEO 0:19:35.810 --> 0:19:39.230 of the company was all excited and actually took out 0:19:39.230 --> 0:19:43.130 the contract, took out a pen, was prepared to sign 0:19:43.130 --> 0:19:46.450 that contract. The salesperson and I were all excited. 0:19:46.670 --> 0:19:50.030 He put the pen to the paper and fell asleep. 0:19:50.210 --> 0:19:54.980 And he was he was gone. What happened, Chris? 0:19:55.609 --> 0:19:58.190 Given the acute nature of it, I sort of does 0:19:58.190 --> 0:20:00.170 raise the question of whether or not he had narcolepsy. 0:20:00.590 --> 0:20:03.680 He did have that narcolepsy. He later talked about that. 0:20:03.680 --> 0:20:04.670 But what is that? 0:20:05.119 --> 0:20:09.229 Narcolepsy actually has some really nice, good understanding of the pathophysiology. 0:20:09.600 --> 0:20:13.870 It is now within the category of what's called autoimmune diseases, 0:20:14.090 --> 0:20:18.909 type one diabetes, narcolepsy. Basically, you develop antibodies for whatever reason. 0:20:18.920 --> 0:20:22.580 There are a couple concerns that certain viruses may trigger this, 0:20:22.580 --> 0:20:27.230 but basically develop an antibody to a very, very specific 0:20:27.230 --> 0:20:30.440 set of cells in your brain. The cells produce a 0:20:30.440 --> 0:20:35.330 peptide called Eareckson. What happens is this destroys those cells 0:20:35.330 --> 0:20:40.129 either completely or to a significant degree diminishes them. And therefore, 0:20:40.130 --> 0:20:44.820 you don't have enough of this peptide Orexigen to maintain alertness. 0:20:44.840 --> 0:20:47.389 And as I mentioned earlier, one of the parts of 0:20:47.390 --> 0:20:51.740 the brain that's relevant to wakefulness is this posterior hypothalamus 0:20:51.740 --> 0:20:54.890 and these cells sit in that posterior part and that 0:20:54.890 --> 0:20:58.400 erection is an important factor in maintaining alertness. 0:20:58.710 --> 0:21:05.020 So it wasn't contract avoidance, it was actually something more specific. 0:21:05.420 --> 0:21:07.639 So let's move from there and talk about some of 0:21:07.640 --> 0:21:10.550 your other specialties. One of the things I understand you've 0:21:10.580 --> 0:21:15.140 been researching and working on for some time is RLC know. 0:21:15.170 --> 0:21:17.390 Some of us didn't know anything about our last till 0:21:17.390 --> 0:21:21.619 we saw a commercial, the Restless Leg Syndrome. What exactly 0:21:21.619 --> 0:21:24.950 is that? And is it prevalent or just we see 0:21:24.950 --> 0:21:26.560 a lot of commercials for it on CNN. 0:21:27.050 --> 0:21:30.440 So the the estimated prevalence for the US is about 0:21:30.440 --> 0:21:33.800 five percent of the population, with about half of them having, 0:21:33.800 --> 0:21:38.510 I think, clinically relevant symptoms requiring some treatment. Basically, it 0:21:38.510 --> 0:21:43.130 is a motor sensory disorder. It's associated with this often 0:21:43.130 --> 0:21:48.350 hard to describe, very irritating, uncomfortable sensation in your legs 0:21:48.440 --> 0:21:51.680 that almost compulsives you. You can't not move. You have 0:21:51.680 --> 0:21:53.689 to move the legs. The reward is as soon as 0:21:53.690 --> 0:21:56.870 you move the legs, the sensation drops off and disappears, 0:21:56.869 --> 0:22:01.010 but may crescendo and Amanor start to increase again. So people, 0:22:01.130 --> 0:22:03.650 after moving the legs a couple times, often get out 0:22:03.650 --> 0:22:05.780 of bed and actually just walk for a while to 0:22:05.869 --> 0:22:08.290 get enough relief to get back in bed again. So. 0:22:09.109 --> 0:22:10.970 So you've been studying it quite a bit. What are 0:22:10.970 --> 0:22:12.790 some of the things that you found out about it? 0:22:12.830 --> 0:22:15.680 What causes it, who has it, who doesn't have it? 0:22:15.680 --> 0:22:17.240 And what are you guys doing about it? 0:22:17.810 --> 0:22:20.750 Well, essentially, it's about three to four times more common 0:22:20.750 --> 0:22:22.010 in women than men. 0:22:22.940 --> 0:22:27.020 It basically increases in prevalence over the age group, probably 0:22:27.020 --> 0:22:29.750 coming to a plateau at about 50 to 60 years 0:22:29.750 --> 0:22:32.419 of age. But there is a progressive increase through childhood, 0:22:32.420 --> 0:22:36.139 adolescence and up through the younger adult ages. Most of 0:22:36.140 --> 0:22:38.630 our research for the last 30 years has been trying 0:22:38.630 --> 0:22:41.720 to understand the pathophysiology of this disease. And what we 0:22:41.720 --> 0:22:45.830 know is that there is a association and what we 0:22:45.830 --> 0:22:49.100 believe is part of the primary pathology is that the 0:22:49.130 --> 0:22:52.369 brains of patients with restless syndrome have lower levels of 0:22:52.369 --> 0:22:55.430 iron in certain regions of the brain. So it's an 0:22:55.430 --> 0:22:59.330 insufficient state of brain and insufficient state, despite the fact 0:22:59.330 --> 0:23:02.450 that their blood levels of iron are normal. So it's 0:23:02.630 --> 0:23:08.120 very organ specific phenomena. And this iron insufficiency leads to 0:23:08.119 --> 0:23:10.670 a couple of changes in your brain, one of which 0:23:10.670 --> 0:23:14.780 is an alteration in this chemical called dopamine. By altering, 0:23:14.780 --> 0:23:18.889 it doesn't specifically decrease the overall amount of dopamine. It 0:23:18.890 --> 0:23:24.020 basically changes its circadian change in dopamine. So don't levels 0:23:24.020 --> 0:23:26.900 are right in the morning and low at night. And 0:23:26.900 --> 0:23:29.720 it seems to make that nater the lower point at night, 0:23:29.720 --> 0:23:33.439 lower or decreased, so that you start having symptoms of 0:23:33.530 --> 0:23:37.250 that lower level of dopamine at night that triggers the symptoms. 0:23:37.460 --> 0:23:39.620 And therefore, some of the first treatments that we had 0:23:39.619 --> 0:23:43.310 available back 30 years ago was the use of some 0:23:43.310 --> 0:23:48.050 of the agents commonly used in Parkinson's disease, generate RAPEX, 0:23:48.260 --> 0:23:52.970 reequip the agonists. The symptoms are somewhat different in the 0:23:52.970 --> 0:23:56.209 younger age group, particularly men whose symptoms start before the 0:23:56.210 --> 0:23:59.990 age of thirty five have a very vicious form of disease. 0:23:59.990 --> 0:24:02.840 I mean, it will come on basically affect the whole 0:24:02.840 --> 0:24:05.540 life within a year or two. I mean, I mean, 0:24:05.540 --> 0:24:08.030 it was not just happen at night or during the 0:24:08.030 --> 0:24:11.090 evening and eventually they'll have it 24/7. It is. It's 0:24:11.869 --> 0:24:15.200 in women at a younger age under 40. It starts 0:24:15.200 --> 0:24:17.910 to be an intermittent. So the symptoms come and go 0:24:17.910 --> 0:24:20.670 in coming and going, but becoming a nightly problem by 0:24:20.670 --> 0:24:22.890 the time they reach somewhere between 40 and 50. 0:24:23.890 --> 0:24:28.240 So early on, you alluded to the earliest reported sleep 0:24:28.240 --> 0:24:30.730 aid and I'd like to know where that fits in 0:24:30.730 --> 0:24:33.910 to all of these syndromes, that being alcohol, how does 0:24:33.910 --> 0:24:39.430 that impact our sleep, our restless legs, our sleep apnea, good, bad, indifferent, 0:24:39.820 --> 0:24:42.679 chronic use of alcohol will actually make your sleep worse. 0:24:43.150 --> 0:24:46.060 The usual scenario is you're using to get the sleep 0:24:46.270 --> 0:24:49.720 and it may work months, years, but then you start 0:24:49.720 --> 0:24:52.840 having problems with awakening from having a difficult time getting 0:24:52.840 --> 0:24:56.379 back sleep as regards to restless leg syndrome. About a 0:24:56.380 --> 0:24:59.650 third of patients, even a few sips of alcohol, would 0:24:59.850 --> 0:25:03.100 drive their legs nuts. In fact, seven is one that 0:25:03.100 --> 0:25:06.909 came out with the value of the Parkinson drug Sinemet 0:25:06.910 --> 0:25:09.609 being a significant value in treating Arless patients. Part of 0:25:09.609 --> 0:25:12.910 that time there were people who were suffering with our 0:25:12.910 --> 0:25:15.610 loss for 20, 30, 40 years who were getting no 0:25:15.609 --> 0:25:17.620 more than two or three hours sleep a night, and 0:25:17.619 --> 0:25:20.510 some of them used alcohol and the way they did. 0:25:20.530 --> 0:25:22.990 So if you take alcohol and it makes it worse, 0:25:23.320 --> 0:25:25.630 what you have to do is drink it fast enough 0:25:25.630 --> 0:25:28.910 and get enough down you to learn to become an anesthetic. 0:25:28.920 --> 0:25:32.290 But to clarify, you're not advising that? No, I'm not advising, no. 0:25:32.609 --> 0:25:34.300 It's a very unfortunate situation. 0:25:34.369 --> 0:25:37.600 That's how desperate I mean, I can't convey in simple 0:25:37.630 --> 0:25:40.929 words the experience is beyond anything any of us can 0:25:40.930 --> 0:25:43.720 imagine unless you actually have had the disease. And I 0:25:43.720 --> 0:25:48.040 can tell you, you become so, so desperate to get 0:25:48.040 --> 0:25:51.010 rid of the sensation. And obviously during the day you 0:25:51.010 --> 0:25:53.380 can walk. That's fine, but you can't walk and sleep 0:25:53.380 --> 0:25:56.290 at the same time. And so when you've missed night 0:25:56.290 --> 0:25:59.050 after night for years on end, you will do what 0:25:59.050 --> 0:26:01.630 you need to do. And some people have resorted to 0:26:01.630 --> 0:26:04.330 the use of figured out, if I drink this half 0:26:04.330 --> 0:26:06.560 this year, the whiskey straight down, I can get some sleep. 0:26:07.150 --> 0:26:08.830 How are you affecting treatment here? 0:26:09.250 --> 0:26:11.619 So one of the outcomes of that research I talked 0:26:11.619 --> 0:26:16.270 about was to see if I raised your body iron stores, 0:26:16.600 --> 0:26:19.720 whether a certain percentage of that could get over into 0:26:19.720 --> 0:26:23.379 the brain or your brain probably only constitutes about five 0:26:23.380 --> 0:26:26.890 percent of your total body in stores. But if I increase, 0:26:26.890 --> 0:26:29.590 the total amount, even of that fraction may not change 0:26:29.590 --> 0:26:33.850 the amount obviously would. We started with some simple studies, 0:26:33.850 --> 0:26:39.040 mostly Open-Ended designs, demonstrating the value of iron, initially oral iron. 0:26:39.050 --> 0:26:42.400 Then we went to intravenous iron and there's been several, 0:26:42.400 --> 0:26:46.750 essentially three randomized placebo controlled trials of intravenous iron in 0:26:46.750 --> 0:26:49.630 patients who were not anemic, who did not necessarily have 0:26:49.630 --> 0:26:53.230 an iron deficiency, and demonstrated that you can get about 0:26:53.230 --> 0:26:55.780 45 percent of patients who are going to demonstrate a 0:26:55.780 --> 0:26:59.980 much greater improvement in symptoms with intravenous iron. And so 0:26:59.980 --> 0:27:02.290 that's one of the things I think, as was an 0:27:02.290 --> 0:27:04.840 outcome of all of our basic research, that we can 0:27:04.840 --> 0:27:05.770 improve symptoms. 0:27:06.070 --> 0:27:08.139 But that sounds kind of temporary because you're not going 0:27:08.140 --> 0:27:09.790 to have intravenous iron permanently. 0:27:10.420 --> 0:27:13.420 It's a one off experience. And then I usually evaluate 0:27:13.420 --> 0:27:16.000 the patient at eight weeks after the infusion. If they've 0:27:16.000 --> 0:27:19.960 had improvement in symptoms, I will check their current iron 0:27:19.960 --> 0:27:22.870 status and then I will follow. And it may be 0:27:22.869 --> 0:27:25.570 six months, it may be two years before they contact 0:27:25.570 --> 0:27:28.540 me and say my symptoms have worsened. I will repeat 0:27:28.540 --> 0:27:30.730 a set of iron labs and if it has dropped 0:27:30.730 --> 0:27:33.550 in a reasonable degree, I will give them another iron infusion. 0:27:33.730 --> 0:27:37.180 I have a patient who developed a bad gastritis and 0:27:37.180 --> 0:27:41.050 for whatever reason developed severe inefficiency, developed our and he 0:27:41.050 --> 0:27:44.229 calls me every 22 to 24 months, say they are 0:27:44.230 --> 0:27:47.500 less back time for our infusion. Check his blood guarantee. 0:27:47.500 --> 0:27:49.359 I know where it's going to be is iron is 0:27:49.359 --> 0:27:51.490 going to be a certain level given the iron infusion 0:27:51.700 --> 0:27:53.830 four or five weeks later, it's gone. And I don't 0:27:53.830 --> 0:27:54.940 hear from another two years. 0:27:55.570 --> 0:27:57.840 So I'm not trying to lead the witness here, Chris. 0:27:57.850 --> 0:27:59.800 But one of the things that we try to do 0:27:59.800 --> 0:28:03.790 on this show is debunk and misinformation that is often 0:28:03.790 --> 0:28:07.480 presented to our listeners. So these commercials that you're seeing 0:28:07.480 --> 0:28:11.050 all over the place for some prescribed pill for RLC, 0:28:11.320 --> 0:28:15.130 what is that? How does it work and does it work? 0:28:15.130 --> 0:28:17.830 And is that something that our listeners should be paying 0:28:17.830 --> 0:28:18.430 attention to? 0:28:18.970 --> 0:28:22.570 There are pills or creams there, devices out there. There's 0:28:22.570 --> 0:28:26.379 no shortage of information about our less about things that 0:28:26.410 --> 0:28:29.619 will work at the current time. I am not comfortable 0:28:29.619 --> 0:28:34.080 with any device. Is there are PADDs vibrators, there's leg sleeves. 0:28:34.090 --> 0:28:36.820 So far, none of my patients have ever found any 0:28:36.820 --> 0:28:40.390 success with any of them. There are numerous different creams 0:28:40.390 --> 0:28:42.820 out there which again, in general I don't see any 0:28:42.820 --> 0:28:45.100 harm in use them, but I don't have anyone for 0:28:45.100 --> 0:28:48.370 whom it's worked. There's a whole thing about magnesium pills. 0:28:48.400 --> 0:28:52.120 There's one clinical trial demonstrates the value of magnesium. I 0:28:52.120 --> 0:28:55.480 generally have no problems with my patients trying standard magnesium 0:28:55.480 --> 0:28:59.050 Oxlade or something like that, four 800 milligrams. Again, I 0:28:59.050 --> 0:29:01.630 have one person out of my experience for whom she 0:29:01.630 --> 0:29:04.930 swears by it. That's why the treatments that are out 0:29:04.930 --> 0:29:09.370 there that are value include those medications that are used 0:29:09.370 --> 0:29:12.910 for the Parkinson's disease, which are called dopamine agonist. They 0:29:12.910 --> 0:29:16.660 they mimic or they are both mean, they are valuable 0:29:16.780 --> 0:29:19.030 and some of them have been approved. Actually, all three 0:29:19.030 --> 0:29:21.250 have been approved by the FDA for us. Like, so 0:29:21.250 --> 0:29:24.350 do you have what's called the Alpha to. Delta agents, 0:29:24.590 --> 0:29:28.790 these are medications which bind to the protein called Alpha 0:29:28.790 --> 0:29:32.960 to Delta, which is calcium channel and modifies calcium and 0:29:32.960 --> 0:29:36.560 thus the intensity or discharge of the sensory nerves. And 0:29:36.560 --> 0:29:41.050 they fall into the categories of what's called gabapentin pregabalin. 0:29:41.240 --> 0:29:43.550 Many people have heard about them from they're used often 0:29:43.550 --> 0:29:46.730 used for pain, are often used for neuropathy, nerve pain. 0:29:47.180 --> 0:29:48.350 So those are value. 0:29:48.800 --> 0:29:51.620 There are so many patients who are awakened by troubling 0:29:51.620 --> 0:29:55.100 leg cramps, foot cramps, and the folklore is all your 0:29:55.100 --> 0:29:58.820 low in potassium. And yet when you checked people's potassium level, 0:29:59.000 --> 0:30:02.240 it turns out to be normal. What are these cramps 0:30:02.240 --> 0:30:03.620 and how do you avoid them? 0:30:03.830 --> 0:30:07.100 So leg cramps. Some people refer to them as Charlie Horace's. 0:30:07.280 --> 0:30:10.580 They are not exclusively but almost consistently in the lower 0:30:10.580 --> 0:30:12.680 extremities of a few of my patients. Get them in 0:30:12.680 --> 0:30:13.610 their upper extremities. 0:30:14.120 --> 0:30:17.600 Things like overly exercising, particularly if you're not really used 0:30:17.600 --> 0:30:21.680 to exercising, may cause some dehydration and dehydration may be 0:30:21.680 --> 0:30:25.660 relevant to the salt question about potassium, sodium, potassium, maybe low. 0:30:26.030 --> 0:30:29.000 There's a big family history. Family history plays into it 0:30:29.000 --> 0:30:31.490 in a big way. You know, I used to be 0:30:31.490 --> 0:30:34.400 for years used as the treatment option, but you can't 0:30:34.400 --> 0:30:37.400 get quinine over the counter anymore. So you can get tonic, 0:30:37.430 --> 0:30:39.830 you know, the sorts of stuff, the tonic that has 0:30:39.830 --> 0:30:42.980 quinine in it. Some people will take that. It's interesting 0:30:42.980 --> 0:30:46.400 because actually when you look at the data for treatment options, 0:30:46.550 --> 0:30:49.970 there's been a couple good, though not perfectly great studies 0:30:49.970 --> 0:30:53.150 that looked at the various treatments. And the only one 0:30:53.150 --> 0:30:58.100 that has consistently demonstrated some value in reducing the cramps 0:30:58.520 --> 0:31:03.020 is doing about five, six minutes of stretching exercises before 0:31:03.020 --> 0:31:04.820 you go to bed at night of that muscle group 0:31:04.820 --> 0:31:05.650 that's involved. 0:31:05.810 --> 0:31:08.810 So across a couple of different, smaller studies, that's the 0:31:08.810 --> 0:31:13.580 one that has been at least the most consistent and interesting. So, Chris, 0:31:13.580 --> 0:31:15.740 are you online? How can people follow you? 0:31:16.250 --> 0:31:19.520 We have a website, AAPA Less at Hopkins's, our primary website. 0:31:19.730 --> 0:31:22.670 Great. And how do they contact you for care? If 0:31:22.670 --> 0:31:26.420 you go through the Hopkins Sleep Disorder Clinic, they have 0:31:26.420 --> 0:31:29.870 a website for Hopkins' Sleep Disorders Medicine, which has the 0:31:29.870 --> 0:31:31.180 appointment number of things like that. 0:31:31.820 --> 0:31:34.250 Dr. Christopher, earlier, we want to thank you for joining 0:31:34.250 --> 0:31:37.700 us today. And Dr. Tayback, thank you for joining us 0:31:37.700 --> 0:31:40.430 as well. And we're still practicing is produced and edited 0:31:40.430 --> 0:31:44.420 by A.J. Mosley, mastering his by Steve Rickey Bird Music 0:31:44.420 --> 0:31:48.500 for We're Still Practicing is composed and performed by Celeste Anorectic. 0:31:49.040 --> 0:31:51.440 Don't forget to hit the subscribe button so you don't 0:31:51.440 --> 0:31:54.350 have to wait around for our next episode. We'll catch 0:31:54.350 --> 0:31:58.130 you next time, everyone. And OK, tonight, shut off the TV, 0:31:58.250 --> 0:31:59.180 get a good night's sleep. 0:31:59.900 --> 0:32:14.000 Bye bye from Kerkow Media Media for your mind.