Shelby Harris
So, sleep deprivation, and sometimes an insomnia, which is a little bit of a different form, but just getting a lack of sleep, can lead to a number of different decrements.Collection: Sleep
So there's a few different ways that we treat insomnia. The first thing that we always do is we look at the cause.Collection: Insomnia
So a lot of people who work rotating shifts and they work at night, their bodies are set to want to be awake during the day and sleep at night. So there are some people who have a lot of trouble adjusting their rhythms and they have trouble working the night shift, they're sleepy, they're drowsy driving home.Collection: Home
So someone who is a child usually goes to bed about 8:00 or 9:00 at night, but then when they have a circadian rhythm shift, it shifts later. And this is natural. And they start to go to bed at 11:00, 12:00, 1:00 and they want to sleep later. So we see this a lot in teens.Collection: Children
So the deeper stages of sleep are really those times of quiescence, you're really restoring your body and we have a few different stages of sleep.Collection: Sleep
I'll work on patient's thoughts about sleep, "So I must get eight hours of sleep tonight or I won't sleep tomorrow." That sometimes - or "I won't function tomorrow." That sometimes makes it very difficult for you to sleep at nightCollection: Sleep
When you are more awake at nights, they'll toss and turn, they'll think more, they get frustrated. And when that starts to happen, you really don't sleep even more because you're making your body tense and your mind is getting more and more active.Collection: Sleep
We've looked at sleep diaries of patients with insomnia, and they'll say that they don't sleep for one or two days. And the body actually has a natural function, after about the third day to start catching up and you get a little bit more sleep the third night. And that's usually what I tell my patients.Collection: Sleep
The other option we have are medication treatments. So you'll have the treatments such as Ambien, Lunesta, Sonata, and we'll also have Rozerem and for some patients we use Benzodiazopine/Clonazepam. Things like that to help with anxiety.Collection: Anxiety
We'll work on relaxation strategies and also changing the times you go to bed will actually make them sleep a little bit less for a few nights so their body's natural sleep drive starts to kick in. That is very effective in about 60% to 70% of patients who do it, four to eight sessions, not even every week; it works for 60% to 70% of patients.Collection: Sleep
We think is happening in the brain, the way I like to think about it is, it's almost like, you're brain is going through all these stages of sleep and it's developing in children so fast that it's almost like you're shifting gears in a car. And at some point, you actually stall out a little bit, and that's kind of what happens during a night terror.Collection: Children
We try not using medications initially, and we use something called behavioral therapy for insomnia. This changes behaviors people do in bed, none of the tossing and turning.Collection: Insomnia
So if somebody has chronic pain, we want to manage the pain, but we still want to treat the insomnia separately. So what we'll tend to do in our sleep lab is we'll do a thorough evaluation and we usually have myself, who is a Psychologist and a Sleep Behavioral Sleep Specialist, I treat the patients first.Collection: Pain
So when it comes to circadian rhythms, it's a clock that's basically programmed in our body. So if you think back to times when people lived on farms and we didn't have electricity.Collection: Thinking
People went to bed when the sun went down and they woke up when the sun came up. That's what our bodies are naturally programmed to do. However, with all the new stresses in life with electricity, with technology, we tend to override that system and we'll stay up later and we'll get up earlier or later, and we use alarm clocks, we use the light.Collection: Stress
Night terrors are in deep sleep, and they're more common in kids, as are nightmares, but what happens in a night terror is like a flash - we think a flash of some image or something happens in the brain. We don't really quite know what. And it usually ends up with the child screaming almost like screaming bloody murder. It's very scary for the parents or whoever else is around.Collection: Children
Night terrors are very different from nightmares. A lot of people will think they're the same, but they're really not. Night terrors - you want to look at the time of night when you're having the problem. Night Terrors happen in deep sleep. Nightmares tend to happen in a lighter REM sleep.Collection: Sleep
There are people who have repetitive nightmares. And what happens is their brain is trying to process the stress and help their brain actually deal with what happens if this stress happens again, so their brain's preparing them to deal with it in case the stress happens again, but it's so scary that they awaken from it.Collection: Stress
When it comes to the reason why we have nightmares, we're still debating that. It's a new area of research, nightmares. And the way I like to think about it is, our brain - we have stress during the day and our brain needs to learn to process this stress.Collection: Stress
There's some debate as to whether you need to awaken from them because there are some patients who are actually starting to say, "I had these horrible nightmares, but I never woke up from them." But they can still recall them when they get up in the morning. So there's still some debate in the field.Collection: Morning
So it's like your brain has a large filing cabinet and it's opening up each drawer and it's taking in various images and memories from the day, consolidating what it needs to and puts in whatever file. And then if there's something that doesn't fit in any of the files and doesn't really belong, you'll forget about it. So it's a way of really getting a succinct way of storing things in your brain.Collection: Memories
Now circadian rhythms become very interesting and problematic for patients because when you become a teenager, your rhythms actually tend to naturally shift.Collection: Teenager
We haven't really - it's harder for us to set those rhythms. So it's really important to keep a steady bedtime and wake time to really lock in those rhythms.Collection: Important
There are some patients who just have insomnia and they've had it since they were a kid and we don't quite know why. So when we look at the cause, we definitely want to treat whatever else is going on, but insomnia often because it becomes its own diagnosis and that requires its own treatment.Collection: Kids
So, more times than not, but not every time, it can be linked to a medical problem, such as menopause, cancer, chronic pain, it can be linked to anxiety and depression. Those are the more common causes.Collection: Pain
So you have Sleep Stage One, Two, and then Three/Four. One is a little bit lighter stage of the quiet, non-REM sleep and then Three/Four is really deep, deep sleep. And what you want is, you actually want a number of - you want to go through all of these stages throughout the night.Collection: Sleep
So people only focus on getting the really deep sleep, but in reality, we spend almost 60% of the night in the stage two sleep.Collection: Sleep
So we go through in the beginning of the night, we go into the really deep stages of sleep and we actually cycle through. So, when you go down to the deep stage, then you go back up and you actually come into something called REM sleep, which is after about 90 minutes.Collection: Sleep
Really if it's an hour or two after you've fallen asleep because you're in such a deep sleep at that point.Collection: Sleep
So when you're in REM sleep, your brain is very active, our body is quiet, but your brain is really processing a lot of things, a lot of emotions; we dream the most in REM sleep. And then you go back down in the deep stages, and so on and so forth.Collection: Dream
People tend to remember their dreams in the morning a little bit better and if earlier in the night, when you're in a lot of deep sleep, if someone wakes you, or the phone rings or something, you're really confused.Collection: Dream
And you cycle throughout so that you do about five to six cycles throughout the night. And we spend more time in REM later on in the night than we do earlier on.Collection: Night
We actually don't know the function of sleep all that well yet, but sleep is a time of quiescence in the brain.Collection: Sleep
When you're in the more deeper stages of sleep - REM sleep, your body is quiet, but your mind is actually very active. So it's a time when your body and your brain is restoring itself. It's repairing any cell damage that happened during the day, it's really repairing, like I said, repairing your body, but also helps with digestion, helps with memory.Collection: Memories
Decrements in attention and concentration, being able to learn more efficiently, that's just not as good. Also, there are motor vehicle accidents, workplace accidents, we see that a lot.Collection: Motor Vehicles
Workplace accidents with people who are sleep deprived or people who work shifts and they don't get the right amount of sleep during the day or at night.Collection: Sleep
There's a new line of research showing that people who don't get enough sleep, they're body doesn't metabolize as well. And so they actually - it leads to weight gain. So if you're not getting enough sleep, you might have difficulty losing weight.Collection: Sleep
Well, the actual function of the brain, not so sure yet. There's a lot of different theories about it, but when you talk about psychologically in your brain, a lot of people with insomnia, though not all, report that they can't turn their minds off.Collection: Insomnia
So, it's not every patient that I see, but I'd say a good 70% to 80% of the patients when they go to bed it's like a stereo is playing at an 11 or 12 and they can't turn it down, at all. So it makes it very hard for their body to down regulate to be able to go to bed at night.Collection: Night
In general, there are patients with insomnia who - many patients with insomnia will actually over report the lack of sleep that they are getting.Collection: Sleep
Some patients are still having insomnia, but it's seems worse to them than actually it is. So, if they say they're sleep deprived, they haven't slept at all in three days; if we actually take them into a lab, most of the time we actually do see they're sleeping on and off here and there.Collection: Sleep
When they [people with insomnia] start worrying about not sleeping, I'll say, "Say the mantra to myself; if I don't sleep tonight, I'll likely sleep tomorrow, and if not tomorrow then definitely the third" because our body has a way of naturally catching up.Collection: Sleep
So when you go to sleep at night, if you're someone who hasn't had any sleep deprivation, you have a very normal sleep pattern, what we tend to see is that, in adults, they go to bed and they start off by going into the deeper stages sleep.Collection: Sleep
Now there's some night terrors that happen in adults. And if it starts as an adult and you've never had them before, then there might be other things that are happening; it might be anxiety, depression, stress. And that's when you might have more of a thorough psychological evaluation.Collection: Stress
Sleep paralysis is something that is actually very common. Many people have it, I've had it myself. And what happens is, when you're in that REM stage of sleep, your brain is very active. You're dreaming your most during that stage, you're mind, your eyes are moving, there's a lot going on. It's like fireworks going on in your brain.Collection: Dream
Some patients will report that they have sleep paralysis. If we see sleep paralysis alone and nothing else, we don't really think all that much of it, but if we see other symptoms, then it might be a red flag for something else that's going on.Collection: Sleep
There are some that are - REM Behavior Disorder, we'll see some court documented cases. And they really need to have a thorough evaluation with a sleep specialist.Collection: Sleep
There's confusional arousals, there are states in deeper sleep that can happen where people will go and they'll disappear and they'll take on some other persona. They'll commit some crime, but it's all when they are in a very deep stage of sleep. So you really need to have a very thorough evaluation.Collection: Sleep
Narcolepsy is a disorder that affects many different areas of life. So in typical patients with narcolepsy, they have something called "excessive daytime sleepiness." So, they're very sleepy during the day. Yet, at night, they're still sleepy, but their sleep is very broken.Collection: Sleep
Now narcolepsy is really hard though because they're very tired during the day, they're sleepy during the day and it's managed mostly with medications. So we use medications to help them sleep better at night and to stay away during the day. But there are behavioral things you can do also by changing diet, exercise, having an actual nap schedule.Collection: Tired