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How Do You Know if You Have A Sleeping Problem? with Dr. Shane Creado

Dr Daniel Amen and Tana Amen BSN RN On The Brain Warrior's Way Podcast

Self-diagnosing issues with your sleep can be tricky. Observing your sleep patterns can be difficult because, well, you’re asleep! In this episode of the podcast, Dr. Daniel and Tana Amen are again joined by “Peak Sleep Performance for Athletes” author Dr. Shane Creado for a discussion on how to track your sleep patterns and make adjustments to get a better night’s sleep.

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Dr. Daniel Amen:
Welcome to the Brain warrior's Way podcast. I'm Dr. Daniel Amen.
Tana Amen, BSN RN:
And I'm Tana amen. In our podcast, we provide you with the tools you need to become a warrior for the health of your brain and body.
Dr. Daniel Amen:
The Brain Warrior's way podcast is brought to you by Amen clinics, where we have been transforming lives for 30 years, using tools like brain SPECT imaging to personalize treatment to your brain. For more information visit amenclinics.com.
Tana Amen, BSN RN:
The brain Warrior's way. Podcast is also brought to you by Brain MD, where we produce the highest quality nutraceuticals to support the health of your brain and body. To learn more, go to brainmd.com.
Welcome back. We are still here with Dr. Shane Creado, psychiatrist, sleep expert, and also sports medicine expert, which I did not realize. That's so awesome. And he works in our Chicago clinic. And I just have to say Dr. Creado, you're one of my favorites, because I love this topic and I love your new book.
So peak sleep performance, the cutting edge, sleep science that will guarantee a competitive advantage. And that's your new book, and I'm super excited about it, because this is such a major topic for so many people, I know for women, because I get bombarded by questions about this constantly, and I direct them to things we've done with you. But I think probably for a lot of people, it's just a major problem. And especially right now during a pandemic. So I love this, so I'm happy we're talking about this.
Dr. Daniel Amen:
How do people know if they're having trouble sleeping? People can't go to sleep, or they wake up in the middle of night, they know. I wear a Fitbit, what about sleep trackers and sleep testing?
Dr. Shane Creado:
So people may not think they have a sleep problem. They say, "I go to sleep okay. I wake up okay. And maybe I'll sleep a little longer on the weekends." But if I had to tell them that your work performance can improve 50%, your concentration can be boosted by 10 to 30%, that your speed, your power output if you're working out of the gym, could improve. You can slash your risk of relapse from inflammation by half. If you could do all those things with more sleep, then that's the way to go. So how do you know?
Well, you need to track your sleep. As you said, there's various sleep trackers. I always trust the good old fashioned sleep diary. They're free to download paper versions on the American Academy of Sleep Medicine website. There are several apps that have good sleep diaries you could fill out.
The sleep diary simply means that you fill it out in the morning, not in the middle of the night to be accurate, but fill out what time you went to sleep or you think you went to sleep, versus what time you actually got into bed. How many times you woke up, how long you think you woke up for, what time you woke up, what time you take your meds and supplements, and if you nap during the day. And that'll give us a really good leisure in terms of how much sleep you're getting, whether you're having trouble falling asleep or staying asleep or waking up too early.
Now, if you do have a fitness tracker, like the Apple watch or Fitbit or WHOOP, then sure, you can combine that data with your sleep diaries, because it really depends on how those devices are calibrated, how sensitive they are and the manufacturer determines how sensitive each device is. So they're not the most sensitive, and I would go with a combination of sleep diaries and a fitness tracker, if you want to use it.
But if you're the kind of person to lie in bed with very light sleep, like the Twilight zone, some people experience, the device may say you're asleep, but you feel miserable when you wake up and say, "I only got two hours of sleep, but it says I got six hours." Or if you have restless legs, or you act out your dreams occasionally, the device might think you're awake. So it might underestimate or overestimate the amount of sleep you get.
And of course, during the day you can use something like the Stanford sleepiness scale. It's downloaded, basically write out how sleepy you are, every two or three hours or so during the day. Maybe at 9:00 AM, 12:00 PM, 3:00 PM, 6:00 PM and 9:00 PM. So during the nighttime, you have a good sense of how you slept. In the daytime you know how sleepy you've been. And if you are sleepy during the day, you might want to extend your sleep, maybe 30 minutes more at the beginning of the night. So getting to bed maybe 30 minutes earlier and keeping your wake up time fixed. So again, really synchronize the circadian rhythms, and then monitor your sleepiness.
That's the quantity of sleep, but also there are qualitative issues. If your legs bounce around at night, if you act out your dreams, if your partner wants to suffocate you with their pillow. Why are you laughing?
Tana Amen, BSN RN:
I was just trying to protect you from COVID. I wasn't trying to smother you.
Dr. Daniel Amen:
You were trying to kill me.
Dr. Shane Creado:
Those are qualitative things. The sleep disorders, medications, chronic pain, PTSD, and mental health issues affect the quality of your sleep as well. So if you have a good quantity of sleep, if you've extended your sleep, and you're still feeling sleepy or tired during the day, then you probably need an evaluation [inaudible 00:05:50] to screen you for other disorders that damage your sleep.
Dr. Daniel Amen:
But you know what happened Shane, is, especially now, you're doing telemedicine with your family doc, and you're like, "I'm anxious. I'm worried. I can't sleep." And the first thing is you get a prescription for Ambien, or Lunesta, or Restoril or whatever, or marijuana. And no one's done a proper assessment, and they put you on something you cannot stop. So when my mom had trouble sleeping, I don't know, 20 years ago, one of her family doctors gave her Ambien, and she became attached to it, which just horrifies me. From Ambien to hemp gummies.
Tana Amen, BSN RN:
Some people don't realize it's medication doing it to them. They become extremely depressed. They behave very differently during the day. Tearful. It did it that to me. I couldn't figure out what was wrong. I'm like, "Oh my God, I just started taking Ambien." This was many years ago, and so I was like, "I can't take it."
Dr. Daniel Amen:
But what's your take on it? You're a sleep doctor and a psychiatrist, so good thing, not so good?
Dr. Shane Creado:
I don't like medications for sleep unless it's the right medicine for the right duration for the right person in the right context. So, the gold standard for insomnia is figuring out the underlying factors, which is what we do at Amen clinics every single day. Figure out what sabotages your sleep, and then correct it. So, medicines like Ambien and other sleep medicines have a black box warning, because you can do things. You can sleep walk, sleep talk, can get yourself in a lot of trouble. There's medical legal issues in some cases when people do things that they were unaware of when they were asleep.
Medications for anxiety like clonazepam, the benzodiazepines, can worsen sleep apnea. So if you have sleep apnea, it's going to worsen the quality of your sleep and your brain basically suffocates every time you're asleep. If you're on an SSRI like Zoloft or Prozac, it can cause you to act out your dreams more, and it can also worsen restless leg syndrome, medicines like Seroquel and other psychotic meds that are used to improve your sleep can cause weight gain and worsen sleep apnea.
So unless it's a very specific medicine for specific duration, I'm not a fan of medications for sleep, and they can be addictive, and they can have really bad side effects, which is why we collaborated on designing a really quality sleep supplement, even melatonin in very high doses can have an opposite effect and wake you up.
Tana Amen, BSN RN:
Yeah, I've heard people say that.
Dr. Shane Creado:
Which is why we use a low dose, because it's more physiologically appropriate. What about things like Tylenol PM, Benadryl, and now we know people who are taking medications like Benadryl have a higher incidence of dementia.
Tana Amen, BSN RN:
I want to just throw this in there. You scanned me after I had surgery, which number one, the anesthesia, but I was having trouble sleeping after the surgery, because of pain and other things. I didn't want to take painkillers. So I'm thinking, Advil PM is fine. And then I also take it when we would travel. And when I got my scan, I was like, "Whoa, what just happened to my scan?" It was not good. So it freaked me out.
Dr. Shane Creado:
So again, Advil PM, Tylenol PM, they basically are used for their side effect of sedation because it acts on histamine, but blocking your histamine receptors, also, they end up blocking up [inaudible 00:09:43] which results in increased risk of dementia. Blocking histamine can again worsen restless leg syndrome.
Again, I'm not a fan of those medicines because there are such good supplements available. There are such easy strategies to implement, to calm your brain down. Meditation, a nice winding down routine, a fixed wake up time. Those things can help you go a long way in improving your sleep without using medicines that can have really bad effects on your brain in the longterm.
Tana Amen, BSN RN:
I love that. One question I have is how does dreaming, not so much in nightmares, but like vivid, weird dreams. Does that affect your sleep? I've heard so many people say that during this time, even in our own home, the kids, everybody, they're having these weird wacky vivid dreams during this time. And I'm just curious, does dreaming help your sleep because you're processing or does it hurt it somehow?
Dr. Shane Creado:
That's a really great question. Dream sleep is really important to consolidate your memories, because dreams are generated in the hippocampus, the same area of the brain we know inspect imaging and neurobiology that helps you with new learning, memory consolidation, emotional stability. Dream sleep is vital in terms of the normal sleep cycle. Nightmares occasionally are okay. It depends on how you interpret them.
If you act out your dreams regularly, it's a problem called REM behavior disorder when your muscles are supposed to be paralyzed. But if you're waking up out of your dreams often, it might indicate an underlying anxiety disorder or PTSD disorder that needs to be handled adequately if you're to get better sleep, because then your brain is in danger mode, you're not going to be able to fall asleep better.
Dr. Daniel Amen:
We're going to talk about tips for you to have better sleep. We should also talk a little bit for our first responders about people who have shift work and how to optimize sleep for that, and then our last one, we're going to talk about what your dreams mean. Stay with us.
Tana Amen, BSN RN:
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Dr. Daniel Amen:
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