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Transcript
Introduction to 'Chocolate with a Side of Medicine'
00:00:16
Speaker
Ladies and gentlemen, welcome to another episode of Chocolate with a Side of Medicine. As you all know, I am Dr. Sunshine, and I am joined by my lovely co-host, Dr. No-No. Hey. Amy Jo MD. Hey, guys. And Dr. Chris. Hey, guys.
00:00:32
Speaker
And welcome to another episode. We have made it to a whole other week, you know, God willing, all that kind of stuff. You want to do it? Every time. Every time. Every time. You know, it's a whole another year, but it just feels like a continuation. So we're just thugging and bugging. That's cool. You're right.
Marvel Universe Excitement
00:00:50
Speaker
I will say this. Something that really has brightened my day was the fact that I finished WandaVision. And I think that we were talking about it before we started recording. I've gotten very deep into the Marvel universe.
00:01:01
Speaker
as of maybe the last two to three years, especially around Infinity War, in-game, re-watched a lot of movies. And I recently finished WandaVision, which I thought was wonderful and excellent. So if there's any Marvel fans out there, I see you. I am with you. What's interesting, though, which I actually forgot to talk to. So no-no is also a big Marvel fan. And I think Chris and Amy Jo, you guys probably watch casually too. I watch casually. Yes.
00:01:25
Speaker
But I did hear some rumors about the upcoming show coming out, the Falcon and the Winter Soldier. And apparently, it's supposed to really be featured around, you know, the fact that there's no more Captain America. I mean, if you didn't know that already, guys, spoilers, I guess. I mean, if you didn't watch anything, whatever. We gave you long enough. Two three year old spoilers in case you didn't know, whatever.
00:01:47
Speaker
But apparently there's supposed to be a rumor says that there's supposed to be a storyline about how America feels about the next Captain America being a black man. And since Captain America passed away and he gave the shield to Anthony Mackie's character, Falcon, that he's trying to step into the role of Captain America and how America is coping with a black man.
00:02:16
Speaker
That's supposed to be a race storyline, but that's a rumor. I don't know if it's true. It's not out yet. We'll see. But that's supposed to be a really big storyline. So I really want them to focus on, you know, because when Captain America went back with the blip.
00:02:29
Speaker
and came back like a super old man. I want them to cover kind of what he did in that blip. He lived his life. He lived his life, girl. I mean, but you want to see how he lived his life. Did he have the kids? Did he get the house? All that. That type of stuff is interesting to me.
00:02:47
Speaker
Um, but I'm really, I really enjoyed Mackie and, uh, uh, Bucky Barnes, like their chemistry and, um, an infinity war. Uh, so I'm, I'm excited to see how that's gonna pan out with the new season. So guys, I was going to share something with you that maybe I shouldn't share because y'all go to that. Cause I feel like I'm going to get judged.
00:03:08
Speaker
Go ahead and spit it out. All right, so no
Comic Influences and Discoveries
00:03:13
Speaker
judgment. So I watched Avengers Endgame like about, I want to say about a month ago, not even a month ago, like a few weeks ago, founded on Quable on TNT, of course, did not get the beginning. So I don't know what happened in the beginning, but I figured it out for the rest.
00:03:31
Speaker
Oh my gosh. Yes, I did. And then when I saw that Captain America got Thor's hammer, I was like, oh, crap. But then I wanted to call somebody and tell somebody that. But I was like, if I call somebody, I'm going to get super drunk about the fact that I'm so
00:03:54
Speaker
Oh, that's hilarious. That was a big deal, you know, because Captain America's worthy. I know, he can summon you. I realized that. That's why I was like, why is it that he was able to hold a hammer? And then I wanted to tell somebody that, right? But I was like, I can't. There's nobody I can call that won't judge me.
00:04:11
Speaker
But we knew it was coming, because remember when they were all at Tony Stark's house that time, and everybody was trying to lift the hammer. And when Captain America went to go lift it, it moved a little bit. And Thor was like, oh, yeah. So we knew it was coming. But that was a moment that you had to see in the theaters, because when Cap got that hammer, the entire theater I was in erupted in applause. It was so palpable.
00:04:39
Speaker
People could not stop clapping for one to two minutes after you got that hammer. And I remember that it was yesterday. That was probably the best moment in Endgame is when that happened. Yeah, I remember it like it was yesterday as well because it didn't happen. Because it was actually yesterday for Chris.
00:04:56
Speaker
See? There goes the judgment. I'm not judging you. I'm not judging you. I did see it the first one, not the end game. What was the one before that when everybody- Infinity War? What happened? It took me a while to see Infinity War. Armitra was definitely judging me because I knew what was going to happen and I was like, I just can't watch everybody disappear.
00:05:18
Speaker
I think she was like, really? You all had all seen it, and I was still like, I don't think I'm gonna be able to watch it to the end, but I did manage to go. But by the time I saw it, it was at the Five Dollar Theater in LaGrange, Illinois, and that's when I saw it. So there you go. I'll give you...
00:05:36
Speaker
I'll share your link viewing. But Amy Jo knows about all the comics and has read them and knows all the stuff. And then she'll get around to watching them whenever. She's like, oh, no, no, no. The way that that comic is supposed to go, they didn't do a really good job of explaining the background. I'm like, what? Let me give credit. I don't want to listen. I like comics, but I like them now. But shout out to my cousin, Cornell.
00:06:00
Speaker
because he is the reason why I know comics. Like he is really my source, right? Like, you know, you got a ghost writer, he is my like ghost source, right? Behind the scenes. So, you know, I call him and ask him questions because I know he's read every comic. Like he was a comic master when Ricky is like, you could not touch him. Like don't even eyeball the comic or else you're going to be kicked out of his room. So, um,
00:06:22
Speaker
He is the reason why I appear to be such a nerd, but I definitely am into it. So like, I'm asking a million questions. It's like Wikipedia, but it's like, he's like a real live person. So yeah, by the time the movie comes out, I have asked so many questions that I have the whole storyline. I'm like, wait a second. That's not who's supposed to do this. Or like, Dr. Sunshine was like, wait, why do you know so much? I'm like, because like, it's just so interesting. I'm waiting for Dr. to come back because I'm like, I don't believe that he gone.
00:06:51
Speaker
Tony is tired. Tony said he's tired. He was taking a rest. I don't think he's gone. But I like his character. I think Tony is tired or Robert Downey Jr. is tired. Robert is tired. Robert is tired. Robert is like somebody else. But because Robert Downey Jr. is the face of Iron Man, it's going to take some years before they can write him back in because people are not going to be able to let go of the character like you, Dr. Chris, that you grow into love.
00:07:18
Speaker
I do like him. And you know what, Chris? Chris, you would like Tony Stark. I mean, you two are basically the same people. That New Yorker vibe. Why are you coming to me with this? I can easily see that. And this is why I don't care for Captain America, his character.
00:07:35
Speaker
Because I just don't feel like it's believable. He's just too good. Like, that's not true. Like, when was that good? You are Tony Stark all day long. Nobody is that good. Like, I like a character that's, like, flawed. Maybe there are some Captain America's out there. They're not on this podcast. But Captain America does exist somewhere. You know, we got Tony Stark's slash Dr. Chris in the building right now. But, you know, listen.
00:08:04
Speaker
I mean, y'all should know Thor is my dude. I've been a Thor fan for a while. And of course, I love me some Black Panther, which came along a little bit later along. But I love me some Thor. Listen, the hammer, the family, the accent, everything about it, it's just so grandiose. It's so like, I have the hammer. I love it. Everything about it. He's extra. The family's extra. The hair is extra. The hammer's extra. I love it. It's great.
00:08:33
Speaker
I really love Tony Stark. And I think I like him too, just because he ends up being a hero, but you wouldn't expect him to be the hero. Because he's so kind of selfish, but not. It's so weird. He's a conflicted character. I know that I don't have the trending topics for this week. One of y'all does, and it's not me. I do. I do. And I'm going to keep it short, because I'm doing just this one, because I know we can get a little
00:08:58
Speaker
lengthy on them. But Dr.
Dr. Denar's Discrimination Lawsuit
00:09:02
Speaker
Princess Dinar, if I say her name right, Dinar, she's a black female physician that has a lawsuit against Tulane. So she has got this long story. So she became a co-director of the MedPeds, she became the program director, co-program director of the MedPeds program back in 2008.
00:09:23
Speaker
At the time she got the job, she's discussing that there was discrimination coming through the door. And so when she first was hired for the job by Dr. Lee Ham, he was the chair of internal medicine at that time. Dr. Lee Ham told Dr. Dinar that she could be co-director because he was afraid that white medical students wouldn't follow or rank favorably the program if it had a black program director. And at that time, they were not trying to change the face of two-lane medicine.
00:09:52
Speaker
Now, for people who do not know where Tulane is, it's in New Orleans and it's smack dab in the hood. And like most residency programs, it serves underserved patients, which means that a lot of patients look like her. And in hospitals where a lot of patients are underserved, to be quite honest, you find that a lot of black doctors kind of gravitate to this area. And so you kind of know that these programs
00:10:15
Speaker
are going to be attracting a diverse population. So in my residency program, we were very diverse, right? We had representation across all cultures, lots of women, Asian Americans, white Americans, black Americans, of all cultures. And so that's one benefit. And so this started in 2008. And so she goes on to talk about Dr. Weiss apparently was problematic coming through the door because
00:10:43
Speaker
He had introduced a program called Atlas. It's like this resident selection program, which ranked historically black medical colleges towards the bottom of his list. So for people who do not know about residency programs, there's a ranking system. So medical students go around, they interview a different residency programs, and then those programs rank all the people that they've seen. You rank them from your top people to your bottom. It's like a draft system.
00:11:11
Speaker
And so his program that she was forced to be this guy, Dr. Weiss, whom she was forced to be a co-program director with, had introduced this program. And it purposely ranked lower people who came from like HBCUs, black medical schools. So that was a problem. And apparently this guy had had
00:11:32
Speaker
formal complaints. And the GME in 2018, he'd had a complaint for some discriminatory actions by like seven black human residents. And so there was all this demand for fair and equitable treatment in their experience at Tulane. And so there's just been things that have been happening and brewing. So Dr. Dinar filed a complaint in 2018 against Dr. Wise for some discriminatory actions.
00:11:55
Speaker
He was forcing different residents to have more difficult rotations. He was refusing to allow some residents to complete their ACMG and ME rotations, which were necessary for graduation.
00:12:12
Speaker
Um, there was, he was threatening to reduce the number of, um, mad peas residents from like six down to four. And that doesn't sound like a lot, but that's a lot because most of the time residents are stretched thin on what they're covered in the hospital. You cannot afford to lose anyone, let alone two residents in a, and that's a small program. So all these things, you know, were coming up. And so, um,
00:12:37
Speaker
So she expressed these complaints and continued to express them. And then there were like issues with like when in 2020 when the pandemic hit, you know, there was like shortage of PPE supplies. And so her clinic, you know, she, you know, stating that her clinic was the only clinic that had to give up some of their PPE equipment where other residency clinics were not, you know, required to do so. And so she files this complaint and they essentially fire her.
00:13:05
Speaker
Of course they do. Yeah. So they fire her. And I don't know if you, I mean, I'm sure you all have seen, maybe you didn't like read the whole thing, but it has like taken off. So, you know, Facebook, Instagram, Twitter, like any, any, you know, black medical doctor group has been talking about it. And so they've been tweeting about it and they've been sending, you know, letters to the ACGME and all these things. So it's been a big deal over the past, I want to say six to eight months.
00:13:32
Speaker
to the point where Tulane is now said, okay, okay, okay, we were just playing, you can have your job back.
00:13:39
Speaker
Don't want it bad, man. Get out of here. Right. And of course, she's like, but what has changed? I mean, it became big news. It was on MSNBC. It's been on some of the major news outlets. It really gained some ground to the point where medical students were writing, both black and white alike, saying, we will be some residents. I mean, potential residents were pulling their applications from Tulane's Med-P program.
00:14:07
Speaker
This is not the place we want to be. We're not comfortable. They've got medical students in Tulane that were speaking out. There's like, you know, their black medical students were like speaking out, everything. So it became a lot of social pressure from them. And they were like, we're just playing. You can have your job back.
00:14:22
Speaker
I don't know what's worse, right? Like firing me because I filed a discrimination suit or when everybody hears about it, you're like, I'm just playing, you can come back. Like that makes no sense to me. That's cause that kitchen got too hot. The kitchen got too hot. They're like, oh man, we gotta, we gotta get it back, get it back, get it back.
00:14:38
Speaker
Right. And so, you know, uh, I had watched a news interview and she, you know, they were asking, of course, you know, why are you staying? Of course she was like, I'm staying for my residence. You know, like you stay because you think like you can hold out, you know, you just, you don't want to be run off. And I hear women say this all the time. Like I didn't want to be run off. Like I did want to appear to be weak.
00:14:56
Speaker
you know, I thought what I was doing was bigger than myself, and so I was willing to be the sacrificial lamb. But she's not taking the job back, you know, she's consulting her lawyer because she then put in like a, you know, I think a civil suit, I think, had been put in, you know, and so she's like, you know, the job they're offering me is not with any, um,
00:15:16
Speaker
They've not done anything to correct any of the actions in there. So there doesn't appear to be anything more than, hey, take this job back so people can stop talking about us. And so that's where they are. So it's ongoing. But it just kind of speaks to representation and the difficulties that black women, black doctors, but in this case of black women, black women are still having to work for. It's March. So we're talking about women this month and women in leadership.
00:15:44
Speaker
is always difficult like it always comes with something you still have got to fight against you know all of the social constructs so you know there's my there's my in the news but women are still fighting the fight and it's exhausting but
00:16:01
Speaker
It is good to know that there are some of them out there doing it very well. And there are some of them that are out there still fighting the good fight. So keep up the good work, ladies. Dr. Denar, I hope that there's some resolution. I hope that she gets everything that she deserves. And it'll be interesting to follow to see what happens to Tulane.
00:16:19
Speaker
I have questions because I'm also curious about because it sounds like she raised all these concerns and everything. I'm talking about Dr. Denard now. It sounds like she raised all these concerns and things, but what happened with her co-director, who she raised all these concerns about? Is he still at the program? Is she still supposed to take her position back and be co-director with this guy still? What is happening?
00:16:42
Speaker
So that's a good question. And I wish I knew. So I know that Dr. ... I think his name is Dr. Weiss or Dr. Weiss, W-I-E-S-E. I wouldn't want to work with him. I'm like, yo, nah, bro, we're not doing this. Right. We're not jumping back in the same thing. It sounds like since she took the job in 2008, there have been consistent
00:17:05
Speaker
Um, aggressions, macro or, uh, micro or macro, uh, against her. And so that's what I'm like you, Dr. Sunshine, like the answer isn't just, okay. Okay. We'll just plan. Listen, here's your key back to your office. Go ahead and, um, we'll see you on Monday. Like, absolutely not.
00:17:23
Speaker
Oh especially not because like because many of the listeners may not know but like when it comes to ranking you know all of the medical students that you guys have interviewed and if you have a co-program director the two of you are supposed to be working in tandem to make this list of of med students that you would possibly want to recruit
00:17:41
Speaker
So if I have to work with this man who I know is not, you know, treating all of these applicants equally and has this whole system to even more so marginalize certain groups, then no, I'm not going to do that. So I wouldn't want to be I wouldn't want to work at all. And then you said they she raised these concerns in 2008. So we're now in
00:18:01
Speaker
2021. That's about as well over a decade. It seems like 2008, that was when she first got the job. We started off on the wrong foot, right? When she got the job, she was hired as a co-director. For people in residence, that's really rare. I don't recall
00:18:20
Speaker
in my time in residency ever seen like a co-program director. So you're already splitting it. And so when she came into the job, the fact that they had said, which I think Dr. Lee Ham has denied saying this, but when they told her,
00:18:35
Speaker
We can't allow you to be the program director because you're black and we don't want to scare off white people. So you can't be the face of Mad Peds. Even coming into that, you're like, oh my God.
00:18:51
Speaker
So I'm sure she knew then that she was in trouble, but, you know, I mean, it's a big deal. Like, program directors are a big deal. You're responsible for the care and concern of, you know, residents, making sure they get everything. It's stressful, right? You know, the job as program director is stressful in itself.
00:19:09
Speaker
But to come into it knowing that somebody's like, you're black and you're black skin, we think is a problem regarding the people that we attract. So we're going to put this white man next to you so that it feels a little bit better for us so that they understand that we here at Too Late are white friendly and we're going to put a white face up.
00:19:30
Speaker
I don't know how you continue to work when that's that's that's that's day one that's like upon hiring like this is what we told you like the blackest of cities in the US like you think you know having a person who's like you know head of the program would be an asset to you
00:19:45
Speaker
in order to recruit more minorities to your program. But clearly, they're not seeing it that way. That's if you want minorities in your program. Exactly. And that's the problem. They're not seeing the value. And I'm like, that's horrible that they don't do that. I mean, I would think that you would capitalize on this. Like, hey, we have minorities and we have white person and we have black person. Everyone's welcome kind of a thing. But they don't see it that way.
00:20:15
Speaker
And that's unfortunate. Yes, you know, minorities are an asset in medicine. And I feel like, you know, Tulane just, you know, squandered that with this whole debacle with Dr. DeMar. So I honestly hope she gets her just due and that a program that she just decided not to go back to Tulane, that a program will see the asset that she can bring to their program and go from there.
00:20:41
Speaker
Because she deserves better at this. I wonder how they thought that would go over. Because you know, when they dismissed her, of course, they always dismiss you under performance concerns, right? Like, we don't think you're fit for the job. And so then here comes all this social media heat and the news
00:21:02
Speaker
Stations pick it up and you're feeling all this pressure and you're like you can come back to work So then which one it but I thought you said you let her go because of you know All these performance issues and now you're just like well she can have her job back. I'm petty I'm petty. No
00:21:19
Speaker
I would not say, oh, if it was me, I would not. She needs to go up and set up her little interview station, like how LeBron did, like, I'm going to take my talents to South Beach. She needs to go ahead and just kick back and just be like, you know, I'm just going to pivot. I'm just going to pivot. And I'm going to go somewhere that values me for everything I have to offer. But I do understand. And what's crazy is that I do understand her viewpoint, though, because I
00:21:48
Speaker
I'm a sucker. I mean, I'm emotional. I have feelings, all that good stuff. I try to keep it on the low, but I do have them. So when she says, I'm really here for the residents, because she is really dedicated to the education of other future doctors. That's really what she wants to do.
00:22:04
Speaker
And she wants to do it in this community and in this program. That's who she wants to serve. So she's like, all I want to do is this great deed towards the education of future doctors. And you are stopping me from doing that because of this heinous list of things I've created since 2008. So I get it. I get it. You got to go to the top. You got to make sure you get him out and you take the thing over.
00:22:30
Speaker
Cuz like I said, I'm petty. I'm gonna do it unless I am in charge and he's out of there. Chris wanna take over, Chris wanna take over. Cuz if I'm not taking over, no. And then what I'm gonna do, I'm gonna go to their rival, their real competition, make sure I take over. And then it'll be my mission. Cuz I'm petty, I'm petty.
00:22:49
Speaker
I'm a little petty. I'm a little petty. I mean, you're like a super villain. Yeah. You know, you want to be someplace where you appreciate it, you know? Yeah, you do. You do. Dr. Chris, Dr. Chris keeping it too real. Chris, talk to us about our featured topic today.
The Science of Sleep
00:23:05
Speaker
So what's the topic, Chris? Yes. So the topic is about sleep, guys. Chris is also all about the sleep, because Chris loves to sleep. What? And this is why it's so funny.
00:23:17
Speaker
Yes. It's important. It's important. And it happens to be the weekend that we're going to get less sleep because, you know, it's daylight savings time that's coming up tomorrow. So now we're going to get less sleep. I know guys, I know guys, but yes, but I think sleep, sleep is very important. Unfortunately, I don't even understand how I did this. I chose a profession that does not pay them to sleep, even though I love sleep, but
00:23:45
Speaker
It is what it is. This is going to be your eternal struggle. It is my eternal struggle. But yes, but we're going to talk about sleep. So what we're going to talk about is what happens when you sleep and also some good ways to help you with healthy sleep habits, sleep hygiene. We're going to talk about that. And then of course, you got to talk about, you know, about threes, about three different things. So like some disorders with sleep. So we're going to talk about
00:24:12
Speaker
insomnia, sleep apnea, and restless leg syndrome because it has to be three. Why would it be more than that? There are other sleep disorders, but we're not going to go into all of the type of sleep disorders. I was just going to hit on the most common ones that we end up seeing in the office. I chose sleep because I have to say
00:24:35
Speaker
That is one of the things that I have this complaint with a lot of patients, a lot of patients coming to me like, Oh doc, I can't sleep. You know, um, I need something for sleep. Help me. Cause I can't sleep. Right. So I think that is important that we talk about it. So, um, first thing I want to talk about is what happens when you sleep, right? So basically your brain cycles to two different types of sleep. You have your non REM.
00:25:02
Speaker
and your REM sleep. So REM stands for rapid eye movement. So during, so the first part of your sleep, you go to your non REM sleep. And so there's like three stages in sleep and your non REM. So the first stage, you're like kind of awake, falling asleep. Second stage is like, you get a little bit of light sleep. You can be aroused like your heart rate,
00:25:24
Speaker
and your breathing starts to regulate. And then in the third stage, that's when you're getting a deeper part of sleep, when your body temperature drops a little bit. And during that time, that's the time when your body kind of uses that time to repair itself.
00:25:43
Speaker
repair the tissues, build bones and muscles, strengthen your immune system. So that's important. And then after you cycle through, after you go through your non-REM, then you go to your REM sleep, right? And during that REM sleep, a lot of people know about the REM sleep because that's the part when you like start dreaming.
00:25:58
Speaker
And in that time that your eyes move rapidly behind your closed eyelids, your brain waves kind of are similar to when you're up. And that's probably part of the reason why you're dreaming around that time. During that time too, your breathing rate increases, your body temperature becomes more stable, and then you're paralyzed so you can't move because you're sleeping.
00:26:25
Speaker
And then during that time, then it stimulates your brain to help increase protein production and learning is increased during that time. So you cycle through this four to five times during the night. So this is what happens when you're sleeping. But there's also, of course, the whole sleep thing is more complicated, but I'm really breaking it down and simplifying it for people.
00:26:49
Speaker
Um, and you have two main regulars of sleep. Like you have two main processes that regulate your sleep. So you got your circadian rhythms and you got your sleep drive. So your circadian rhythms is controlled by your biological clock in your brain. Okay. So, um, which it responds to light cues. So that's why when there is light outside, you're up, right?
00:27:12
Speaker
And then when it gets darker, you get to be, you get more sleepy and you get more sleepy because your brain starts to produce melatonin. Right. So that's the hormone that it produces to try to get you saying, Hey, it's time to sleep. And as time goes on, it gets ramped up in production. Right. And then you also have this thing called your sleep drive. Okay. Which builds up as the day goes on, you get this drive to want to fall asleep. Right. So your sleep drive is unlike hunger. Cause when you're hungry, like you want to eat.
00:27:42
Speaker
You feel like you gotta eat, but you could not eat if you don't wanna eat. But when you need to sleep, you gonna end up sleeping. I feel like we have all gone through this at some point, cuz when you're tired, you can't do anything but go to sleep, right?
00:28:00
Speaker
And Amy Jo is the worst corporate for that. Amy Jo is the worst. I'm sorry, what? What y'all talking about? They're judging you. They're judging you. You are legendary for that. Like just fall asleep typing at your computer. Y'all listen, I'm tired, man. Like I've been up all night. You know, he has a problem. The sleep drive of Amy Jo is unrivaled by anyone else I've ever met.
00:28:28
Speaker
I can fall asleep. Like, listen, once once it is clear, once we are clear for sleep, I'm done. Like, I don't need a wind down time. But in the hospital, I'm so tired. Like, I swear to y'all. Listen, these people know, but to all the listeners.
00:28:44
Speaker
The hospital could be full of the happiest people, right? Everybody's getting better. Everybody's heart failure is improving. Cancers are being cured. You know, pains are going away. Like, everybody's breathing fine. Let me step into the hospital for a night shift, OK? There will be 10 codes, and nobody can breathe. Everybody's delirious. You know, alcohol withdrawal is happening right now. You know, people are peeing on walls. Like, that is the whole day.
00:29:13
Speaker
There's no time to be tired. So once I get the green light and it's time to go to sleep Listen, I'm out like on demand like I can do it
00:29:22
Speaker
You know, and I have to say, I feel like going through residency, I was never like this before. Like I can literally, if I sit still long enough and not doing anything, I could fall asleep. It just can't happen. It doesn't even matter. Like I'm sitting and I'm just sleeping. And everybody on this podcast knows like I have a bedtime and I'm very strict with my bedtime.
00:29:46
Speaker
And I go to sleep at my bedtime. And if you try to have a conversation with me past my bedtime, it's not going to work. I mean, I'm a night owl out of all y'all. I thrived on night shift. I was good. Just give me a pot of coffee, and I'm good to go. Ma'am, but listen, listen. No-No is also a white cloud. And Amy Jo is a black cloud. Thank you. So I felt like whenever No-No walks into the hospital, all of a sudden, everybody just feels great. They just giggling. It's tough.
00:30:15
Speaker
And then as soon as no-no goes to tag you out, like you switch your shifts, you know? No-no's like, oh, hey, tag your red. I'm clocking out. Have a good shift, girl. As soon as Amy Jo walked in there, everybody got, ooh, my chest hurt. Oh, my god. Right, lean on your chest, I heard. Right now. Nurses be like, doctor, doctor, doctor, they low on conscience. Like, I'm like, oh, my gosh. I'm like, it was all cool. It was all Amy Jo walking in. I'm like, why?
00:30:41
Speaker
Why does trouble surround Amy Jo? I'm like, this is so crazy. And we're talking about this, and we're joking about sleep, but sleep is really important, right? And people don't understand. That's why I take sleep seriously. Like, I'm like, if I do not sleep, I'm having a bad day the next day. Like, it's just
00:30:57
Speaker
I have to sleep. It's just not cool. And the reason why is because when you don't sleep, it significantly impacts your brain function. So a healthy amount of sleep is important for your brain to remember and process what you learn. Because if you don't sleep well enough, you're not going to remember what you learned. You could be studying something. As you know, I wish I could have learned through osmosis. And how many times I slept on a book and I wish I could have
00:31:27
Speaker
I remembered everything that I read before I slept. Or when you start writing and you fall asleep, and then you're just like, what happened? Exactly. Exactly. You don't remember. But here's the funny part. And I learned this in medical school. And I used to teach this when I was teaching. I used to teach board prep.
00:31:48
Speaker
It's hard to get students to get out of it because when you're a medical student, your first mind is like, if I can stay up as late as I can and I can read all this information, then I would have seen it and I would be ready. And it took somebody trying to convince me to say, look,
00:32:05
Speaker
go to bed. Like, there's a cutoff time where you just got to get to sleep. And ironically enough, when I started doing that, the stuff that I did get to read, your sleeping allows you to lay memory. And I understood it way better than if I'd stayed up all night trying to remember all that you're gonna, if you're gonna lose the whole information, like, yeah, maybe you saw everything you want to see, but you don't have enough, you don't have enough time to sleep that you lay the memory that you need. And so you're gonna wake up the next day,
00:32:33
Speaker
You're going to be fatigued, and you're not going to remember anything versus if you cut it off, the things that you did get to, you will know well. And the things that you did not get to, you went wrong anyway, so you might as well keep rolling. But you will still end up scoring better because you've got a group of information in your head. And so it took me a while to come to that. But I did learn even in medical school that if I slept, if I got quality sleep, my memory was better on what I retained from what I'd seen if I did it.
00:33:02
Speaker
But it was hard to convince me of that. But I did learn that. I learned that personally. Yeah. And it's so true. Because when you're trying to do that, you're trying to cram and get the answers to that test. And you're like, yeah, I'm going to stay up so I can get all the information I can. You wake up the next day to take the test, you fall asleep on the test. So you're going to get the stuff wrong anyway, right? Because you can't stay up to finish the test, right?
00:33:25
Speaker
So y'all know why they fall asleep in some tests. Oh, you're looking at the person who right slept through every I.T. exam. Look, all right. You go. She's like knocked out. OK, but yeah, that that advice for our use, any old and Gen Z folks, because all the millennials and Gen X we've graduated already. But yeah, I mean, all nighters are like they don't work. It's going to be like asleep midway through the night. I mean, fun fact, I worked as a barista for four years when I went to my undergrad.
00:33:55
Speaker
I didn't drink a drop of coffee, but when I got into med school, I was like, I mean, my blood is made out of it by now. So, I mean, so it's, it's all about, cause like what Dr. Chris said, like you retain all the info that you study when you actually go to sleep and you're actually processing that over in your head as you, as you're going through REM sleep. So that's why it's important for you to, you know, the all nighters, they don't, they're not,
00:34:24
Speaker
you want if you're trying to be the most efficient with how you're studying and trying to retain info you need you need to like at least go to sleep to make sure that like burns into your long-term memory so that you know it for the test the next day and on top of that y'all should not be studying cramming for any tests like the day before like that's just
00:34:41
Speaker
This is bad form. I don't do that. It is, but sometimes you gotta do what you gotta do. But then what I was also saying is too, like when you sleep, when you're sleeping better, you're actually healthier too, right? So when you don't sleep,
00:34:58
Speaker
very well. It increased your risk of depression, seizures. If you have a seizure disorder, if you're not sleeping, you can get more seizures. If you have migraine headaches, you don't sleep. That can precipitate more migraine headaches. Also, it helps with your immune system. Getting sleep is necessary and we need it. Your body needs to rest.
00:35:18
Speaker
And so a normal amount of sleep for a healthy adult is between like seven to nine hours. But there are some people that can like literally function on a little amount of sleep. And as we can all attest to, residency has definitely made you function on little to no sleep. Like you can make really big life changing decisions on like two hours of sleep.
00:35:43
Speaker
I don't even know how they even did that with us, but they really did. We can actually do that. But some people can literally function on four hours a week. After four hours, they don't need any more. They're good. And they feel well rested. Some people need that seven to nine hours. I'm one of those people.
00:36:06
Speaker
for I'm just not good. All right, so newborns, kids and teenagers require way more sleep than adults normally do. And mostly that is because like I said from before, that the sleep helps with repair and growth. So they require more sleep in order to have healthy growth development, right? And
00:36:28
Speaker
As you get older, you do still need sleep, but the whole thing is it might take a little bit longer for you to fall asleep if you're older. It also depends on your chronic medical conditions, or maybe you fall asleep a lot faster, and sometimes older people perceive that they don't sleep well, but mainly because they're sleeping mostly through the day and not sleeping at night and don't realize that, but we'll get into that.
00:36:55
Speaker
But can you cover that a little bit more because, you know, I find that I have to educate, I get a lot of like insomnia complaints, right? Yes. And it's often, and often if it's my older patients, I think that they are still wanting that, you know, Americans are overworked at baseline, so they're still wanting that I came home, I got home from work at five o'clock, by six o'clock I was exhausted,
00:37:23
Speaker
You know, nine o'clock I could barely keep my eyes open. I crashed and burned and I was dead to the world until the sun came up again.
00:37:31
Speaker
at 6 a.m. And because they're not getting that, they then say, oh, I have a sleep problem. You need to give me a medicine that will make me sleep. But I think people, and then you're trying to get them to under, when you're like asking like, do they sleep throughout the day? They say no, but that's not true. Sleep is cumulative. And so even if you nod off for five minutes and you were on the couch watching TV, you did that nod.
00:37:54
Speaker
And let's say you did that for your morning show. And then you did it again for your favorite noon show. And then you did it again. Oh, and then the grandkids came over. You were fine. And then somebody was cooking, and you nodded off. And so those nodding are adding up. So now here comes 9 o'clock. Before, you would have worked a full day and didn't get a chance to sleep at all. And you're ready to crash and burn at 9 o'clock. But you're not going to do that if you've been napping throughout the day. And because people don't go down for a nap, they were not like, well,
00:38:24
Speaker
I went and took a nap at one o'clock. And because they're nodding, they don't count it as a nap. And so in their minds, they should still be sleepy. But you will not be sleepy if you've been nodding off, even if you never fall asleep, if that head keeps falling forward for a whole movie.
00:38:42
Speaker
It counts. It's going to throw your sleep pattern off. And I'm glad that you said that because that is true. Because they do say that when you're napping for more than 30 minutes in a day, that decreases your sleep drive. Because remember, I was talking about the two main processes that regulate your sleep. So if you are napping a lot, and most people nap, they don't nap for like, they usually nap for more than 30 minutes. They go for a nap for like an hour or two and be like, I napped.
00:39:09
Speaker
That's not really a nap, like you fell asleep. So if you sleep earlier in the day, then it's going to decrease your sleep drive. So you're going to stay up later. And so then that throws everything off. So I'm also going to talk about some healthy sleep habits, because I think that is the main issue when I have people come in for insomnia. They're like, oh, doc, I can't sleep. But they have poor sleep hygiene.
00:39:37
Speaker
And it's like they want a medication, but it's kind of like if you just change some of your habits, maybe you'll be able to sleep. And then we don't have to give you medications. But we'll get into that. So I was going to talk a little bit about insomnia. So we have acute insomnia and chronic insomnia. So insomnia is when it's a sleep disorder when you have trouble falling asleep or staying asleep, right?
00:40:05
Speaker
So acute insomnia lasts for about from one night to a few weeks and chronic insomnia could happen at least three nights a week for at least three months or more, okay? So of course with most disorders you have primary and secondary, right? So primary insomnia is just that you can't sleep because maybe you're stressed out
00:40:27
Speaker
or your shift worker or your jet lag, that's a primary insomnia. And the secondary insomnia is you can't sleep because of a medical condition that's causing you to not be able to sleep. Like if you have a sleep apnea that we're going to talk about later on, depression or anxiety, all of those things can affect your sleep.
00:40:47
Speaker
Right. Um, so the number one treatment for insomnia is basically lifestyle changes. Right. Which would be exactly which will, which we're going to talk about healthy sleep habits. Right. So basically your bed is for sleep and for sex.
00:41:08
Speaker
That's it. Sleep and sex. But people do so many things in their bed. They read, they watch TV, and they wonder why they can't sleep. Because those are bad habits. So you have to give yourself time to sleep.
00:41:23
Speaker
keep a sleep schedule, going to bed at the same time every day, even when you don't work and waking up at the same time, even on the weekends, same time every day that helps keep you to have good sleep. And like I was saying, keeping like your sanctuary, like your bed, not reading, not watching TV, because it messes with what I was telling you from before with the circadian rhythms and the light,
00:41:51
Speaker
Because even though you're not really paying attention, your eyes are closed, but you can still, your brain is still processing, still seeing the light. So then it's not producing enough melatonin and it's not making you go to sleep, right?
00:42:04
Speaker
I tell people this all the time. It's in your cell phone and it's in these brand new TVs. Don't get me wrong, that LED screen is beautiful. When I'm watching ESPN, I'm like, man, this picture is so crisp. I can see the dimples on people, everything. That's great for daytime TV, but it's bad for, and it's particularly bad, it's bad for sleeping.
00:42:30
Speaker
If you got your cell phone out, you're still flipping through Instagram. I'm going to look at Twitter real quick. I'm going to check Facebook. I'm going to just look at stuff until I fall asleep. If you've ever noticed, if you are listening and you've ever noticed, like I was tired when I got to bed and I started flipping through my phone and we kind of get all into that danger. It's like, I'm going to flip through Instagram, see what these pictures are talking about. And then you look up and you're like,
00:42:50
Speaker
I'm not tired. It is because the LED screen on your phones, your tablet, your TV set, it is not, it's not two o'clock in the morning. It's two o'clock in the afternoon and you're not sleep, you're not sleepy, you're fine. You can get up and you can go do anything. So that will disrupt it. And that's hard for people who used to use a TV to go to sleep, but they use the old school TV that didn't have this LED screen. And so now they've got these brand new TVs that,
00:43:17
Speaker
you know, grandkids have bought for them and stuff like that. And these things are shining like pure sunshine into your brains. And they're like, I can't sleep. If you don't give me something, I don't know what I'm gonna do. And I'm like, I'm gonna give you the remote to turn your TV off. Because, you know, it's the LED screens. And I'm gonna tell my parents that who are like, my kid is hyped.
00:43:42
Speaker
at night. And I'm like, yeah, because I've recommended like charging stations, like let's have a charging station where at the end of the night, everybody, parents included, everybody brings their phones to the station. If you need an alarm, you got to go old school to set it up.
00:43:59
Speaker
and see if that helps, particularly for little kids who are like, I'm keeping my tablet. But if everybody's doing it, then they'll participate. From my teenagers and my adults, if your kids are old enough, they can follow some rules with some understanding. I'm sure Androids have it. I have an iPhone, so mine has it. But you can set up a sleep schedule in your phone. So at a certain time of the night, my phone automatically goes on to do not disturb, because I should be preparing for bed.
00:44:28
Speaker
If you are not saved in a particular phone list, then I'll holler at you in the morning. You're just not getting through. Now, I hope people don't start calling me and be like, I called you and I got to do not disturb. Am I not in your list? That's not what I mean. I mean, it is what I mean, but still. I mean, but yes, yeah, that is what you mean, though.
00:44:48
Speaker
It's just that, you know, just to prevent you from looking over at the phone, right? So if every text message or every, like, Instagram post or if every, you know, thing lights the phone up and you keep turning around and look at it really quickly, even for people that are like, I just want to, you know, pick the phone up, let me look real quick, and they turn it back over.
00:45:05
Speaker
that's still disturbing your sleep pattern. You're not winding down and you need about 30 minutes to wind down. And so you can set your phone up to help you practice better behavior. Yes, that's very true. But I mean, for me, anybody who called me after my bedtime, I'm not picking up. Cause I didn't hear you cause I'm asleep.
00:45:23
Speaker
Another thing that you mentioned, Chris, that's really important, especially as I do these remote visits with my patients and especially like, you know, not that I'm particularly paying attention to your background, you know, but you will notice sometimes that your patients are talking on their laptops and they're on their bed. And I'm like, are you on your bed? They're like, yeah.
00:45:40
Speaker
I work on my bed. And I'm like, why are you working on your bed? I'm like, what is happening here? But there's a bunch of people who like, they don't have, especially in the city, if you work in a major city, a lot of them are like, well, I don't have the space to have like, they're like, there's either my bed, there is the kitchen, there's the bathroom, and then maybe people have a dining room, you know, area that they can maybe turn into an office. But there's a bunch of people working from home and their bed is their office now.
00:46:02
Speaker
And their laptop is now what used to be their desktop. And that's just how they're living. But it's messing up their sleep because they don't have the whole the bed is my sanctuary anymore. Now the bed is everything. And I'm like, yeah, it confuses the body. They're always like kind of like it's it's not like random pet peeve of mine. Like when people eat in their bed and like when they're, you know, doing work in the bed, like your bed is solely for sleep. Like that's how you explain our brains to recognize the bed as only for sleep.
00:46:32
Speaker
if you were doing things. Chris, are you laughing? Are you laughing because no, no said no food. And then you were like, well, but during sex, if you have, is that what you're trying to say? What happened? I'm so confused. No, no, I'm laughing because she said it's only for sleep, but I'm like, but you also have to mention sex as well. Admit, admit it to Chris about gay and sex. Don't get me wrong, like gay and sex, all right? You can do both.
00:46:53
Speaker
I misspoke. Sleep and sex. That is what your bed is for. Anything else outside of that you need to do in other parts of your house. So because like your brain is trained to recognize the bed as that purpose. So if you're doing things outside of that, your unconscious self is going to get confused and that's going to also mess up your sleep pattern.
00:47:14
Speaker
which is what we do not want. So when we tell you to turn off your TV, tell you not to eat unless you're using the food for sex play or whatever, those are things that would come out of it.
00:47:28
Speaker
Yeah, those are things that we do not want you to do. Otherwise, you're not going to get a good night's sleep. And that is a problem. Yeah, so like avoiding large meals before going to sleep. Also, they said you shouldn't do that. Coffee, of course, caffeine, alcohol, you shouldn't be doing that right before bed because they can sleep.
00:47:49
Speaker
Um, and also another thing too, like, especially, um, just like with my menopausal ladies, a lot of times they get like hot flashes at night. And like, if you're hot, you're not going to fall asleep. If you're sweating, you're not going to sleep. So really making sure that the temperature is cool. Um, like at a good temperature for you to fall asleep. You can't be too cold, can't be too hot. You gotta have that right temperature, right? And making sure that the room is dark. Like it's important to have it dark.
00:48:19
Speaker
you know, pull your curtains so you can let your body know, hey, it's time for sleep.
00:48:25
Speaker
Set a timer for the TV so the timer goes off like if you're just like look I have to have the TV on okay fine but let's set a timer it does it does matter so like I track my sleep I you know I track a lot I love I'm a track fanatic so I track my sleep and when I look at the the cycles like the rim cycles because you people think that they go to bed and they have like this one long
00:48:50
Speaker
you know, elongated dream. I know in your dream, it sounds like you've been dreaming this same dream for hours, but you kind of fall, you go through multiple rounds of REM where you start to dream. So if you wake up, if you're in a healthy sleep pattern, I think is anywhere from like three to five REM minimum that you need to have. So you could have had
00:49:12
Speaker
tons of dreams in between that. But people will tell me like, oh, it's not the TV because I sleep fine. Like what you mean is you don't recall waking up, but you may not be getting those REM cycles. And when I fall asleep and I leave my TV on by accident, when I look at my sleep patterns, they're always different.
00:49:33
Speaker
They are always different. There are less cycles of REM. My heart rate doesn't drop down as low. It's always a little bit more elevated. I wish I need people to know that that's a thing.
00:49:49
Speaker
And also, like, if you find that you're laying in bed and you can't fall asleep, like, the recommendation is for you to get up, right? Do something quietly and then go to bed when you're sleepy. Because then you're just laying there and you're not falling asleep. Then you're just frustrated. And then it just takes longer.
00:50:07
Speaker
What you go do, though, should not involve your cell phone, your iPad, or an LED screen. Be careful with your dairies, be careful with your sugars. So if you want to drink some herbal tea, like, I got sleepy time tea in my, you know, cabinet, so I will get some. Now keep in mind that if you tend to run hot at bedtime and drink some warm tea,
00:50:30
Speaker
may increase your temperature too much. And ultimately, Dr. Chris was saying that a good temperature is what you're looking for, but your body tends to drop its temperature when you're sleeping. So whether you realize it or not, you prefer it a little bit on the cooler side.
00:50:46
Speaker
So sometimes tea is not a thing that helps everybody, but sometimes it is. Over hydrating when you get out the bed to in that window is going to be bad because it may work. But then if you get back to sleep and your bladder is a little sensitive, if you get triggered to get back up because you've got to use the bathroom, that's one thing. So I generally tell people, you know, journaling because, you know, most people pop up and they say, you know, I just had a really bad day at work.
00:51:12
Speaker
and I got these things on my mind. So sometimes getting a piece of paper, writing it all down and checking off things you can do about right now and things you can't do it. You answer those questions, you ball it up, throw it away and you keep going. Pull out a good old fashioned book, that book that you've been trying to read that you can't get through because it makes you sleepy. Well, let's do it tonight. So let's pull it out and let's read a few pages until you get sleepy and then go back to sleep.
00:51:35
Speaker
Um, stuff like that working out. Um, people sometimes will work out and they'll say, well, if I go to, if I work out, I'm always tired afterwards. And so I'll go to sleep. That's hit or miss. Some people can work out and be exhausted and then hop in the bed and crash and burn.
00:51:51
Speaker
but working out gets your endorphins going to get your adrenaline pumping. So you might be stimulated when it's time to go back to sleep. Sex is tricky. So for some people, the act of sex intercourse or masturbation ejaculation gives them a little bit of bounce of energy. So it may not let you sleep right away. So you really gotta play it by ear on what works for you when you're having this moment and you can't go back to sleep.
00:52:17
Speaker
Um, so like, let's say you tried all those things and it didn't work. Right. So now we move into what it'd be like, okay, doc, what can you get me to help me sleep? Right. So there are treatments out there to help with sleep. Right. First line, um, usually what we go to first.
00:52:34
Speaker
is if someone tells me, like, hey, doc, I can't sleep. My first thought, first thing I tell them, like, hey, did you try some melatonin, right? Because, like I told you with the sleep cycle, melatonin helps you fall asleep. So I'm like, did you try melatonin? Like, yeah, doc, I tried it. Or sometimes, like, it helps me. I'm like, does it help? Like, yeah, it helped a little bit. I'm like, OK, great.
00:52:53
Speaker
So keep doing it. And also with the sleep habits that we talked about. And then another medication, Doxapin, that's also first line that's safe that we normally give to people. And it helps you with falling asleep and also can help with maintaining sleep.
00:53:11
Speaker
So let's say you try that, that didn't work. So then we move into some other drugs that we normally get. I know for myself, I don't, I try my best. I try everything else before I give those drugs. Some that like a lot of people take
00:53:29
Speaker
um like uh drugs like benzodiazepines like like your valium right to to try to help them sleep and they use it for sleep but mostly it's a medication that's used for anxiety so like we're saying if you're anxious right it's gonna be really hard for you to sleep so how it's used to sleep is that it calms you down a little bit so you can fall asleep right
00:53:53
Speaker
So it is effective in that sense, but the problem with it is it controls substance and it has a high risk of abuse. And that's why we try not to prescribe those medications for sleep. And then it has long-term effects. It can, especially depending on what your chronic medical conditions are,
00:54:21
Speaker
It's not safe to mix with alcohol. It can increase your risk of sedation and other problems. So that's why we try not to prescribe those medications. And then you have all your other, your Z drugs, which are your Ambien, your Lunesta, your Sonata. Those are also control substances as well because of their potential for abuse.
00:54:45
Speaker
And those medications, they're great for sleep. Like I tell patients all the time, I'm like, yeah, it's going to help you go to sleep. But the problem is, is you become so dependent on it that you can't go to sleep without taking the medication. So then we're back to where we started, right? So now you're dependent on the medication that, so you got to take this medication and fall asleep. And we also know that when you're all these medications for long-term, it increases your risk of dementia. So.
00:55:11
Speaker
We try not to prescribe those medications. And it's really hard because I try to tell patients, like, if you just change your habits.
00:55:22
Speaker
then you might not have to put you on a medication. There's some people you have to put on medications, right? But there are a lot of people that come in with these complaints. Like, I mean, they just don't wanna do the work, right? And they want something like a quick fix, right? But then it causes a problem. And the irony is if you get dementia, you'll never sleep. Like you ain't seeing insomnia until you have taken care of
00:55:51
Speaker
a patient with dementia. I think that's the cruel irony and the whole thing is that some of the medicines that they, because everybody, almost all patients skip through all of the better options and they go straight to, I want the Ambient, I want the BZ2s.
00:56:13
Speaker
And they carry this risk of dementia, and you're thinking, OK, if you're your 50s and you're already like, we need to get on these medicines, and then you can't sleep without them. So for the next 20 years, you take this medicine every day, and then you develop dementia. Dementia patients don't have good sleeping patterns because just of how the brain starts to react.
00:56:40
Speaker
I always seems like a sad tale that the one thing that we were trying to do, which is develop better sleeping habits, and we skipped over all the natural ways and you eventually got on this medicine and you used to sleep, the side effect that it's going to give you is dementia, which is going to mean that you never sleep normally again. It's just such a sad ending.
00:57:01
Speaker
Yeah, it is. And it's because like, and then you're talking to the patient and you know that all of this stuff can happen, right? And you just don't want to perpetuate the habit. You don't want to start it, but sometimes- They are not trying to hear it. Unfortunately. Or I think because they're so focused, right? So patients, y'all do this a lot.
00:57:18
Speaker
you you've come to us with a goal like the medicine that you want right and we're offering all these other things and and you're and you're trying them and i got that in air quotes like yeah yeah i did that i did that i uh-huh child tv and when you really get into it they're like well i don't turn off the tv all the time but every now and then i turn off and that doesn't work either we're turning off the tv one day
00:57:42
Speaker
in a week does not count as developing good sleep hygiene, right? Yeah, yeah, I stopped drinking. So there's something like, first of all, your A1C is 10.5, so you're drinking something at night, right? And we do these, and we do these, you know, now we're doing this telehealth visits, like, I can't tell you how many times I've seen, like,
00:58:02
Speaker
ginger ale, Pepsi, Coke, juice, bottles, right? Leaders, you know, at the bedside. So you roll over in the middle of the night and you drink this down because, you know, well, I got to have something because my throat is dry. Well, not a pot, right? Like, or soda, because I'm in the south. But, um,
00:58:20
Speaker
You didn't have to have that. And so they kind of really are not taking a good inventory of all the things they can change for the natural remedies. And it's not that they wouldn't, but in their minds, they're convinced that the only thing that's gonna work is if you give me this ambient.
00:58:39
Speaker
Right, right. And I also think that it's the culture like even like for instance, even when people have some types of anxiety, sometimes you need to be on medication for your anxiety, right? But sometimes people don't want to do the work and find out, let's find the root cause of your anxiety or your depression, right? Like maybe if we find out what's going on,
00:58:58
Speaker
then maybe we can fix things right but that takes work right and it's just the same the same the same thing as when people want to lose weight right they're like doc give me this pill so i could lose weight yeah yeah it's gonna work for a while but you really have to do the work in order to lose the weight you have to eat right you gotta exercise that's
00:59:18
Speaker
The only way. One of the things that we haven't really talked about, I'm just going to touch on it really quickly, is that usually when patients tell me they have sleep problems, in addition to all the things we've already talked about, I usually talk to them about their alcohol habits too, because I'm like, all right, are you drinking? And sometimes you get to digging and you realize, all right, these people, they're drinking alcohol. How much alcohol are you drinking a night? Oh, you drink alcohol to help you fall asleep. But the sleep you get when you've been drinking alcohol is not the type of sleep that you need.
00:59:43
Speaker
because it messes with your ratio of your REM and your non-REM. And then sometimes you get to know these patients, you go through their med list, sometimes they're on a stimulant. So sometimes they're taking a medication that keeps you awake, it's a stimulant, and that's messing with their sleep. So there's a lot of different factors of what people are just doing in their day-to-day, stuff that they're taking on their day-to-day, and it's all just messing up their sleep. So if I see you for a sleep visit, we're going to dig into all these different aspects.
01:00:07
Speaker
you know, in addition to the fact that, you know, if you do have anxiety or depression, I agree with Dr. Chris, you probably should have at least a therapist on board at least to kind of help you through this. And then also let's also acknowledge that there's a whole like sleep medicine realm of specialists who do this all day, every day. So I also have a lot of patients who have ended up seeing sleep specialists, because you know, it's gotten to a point where
01:00:32
Speaker
you know, they are really finding it like difficult to navigate. And even with medication, you know, they aren't having a lot of energy. They're not being productive. They're not, you know, so people fall in different categories. But there's a whole realm of medicine dedicated just to this is called sleep medicine. Very true. Very true. Because you know, and I see a lot of people sleep medicine and you know, I think people think we only send you know, we only send our overweight patients when we think they have sleep apnea.
Improving Sleep Quality
01:00:55
Speaker
um to sleep medicine but that's not necessarily the case that's if you've just kind of failed you know all things and so we diagnose all kind of stuff you know some of you have restless leg syndrome and that may be an issue some of you are not having sleep apnea but for whatever reason you have like you know a nocturnal hypoxia and that you know becomes an issue
01:01:15
Speaker
You do not have to be obese to have sleep apnea or hypoxia issues. There are some people that are normal weight that just have bad anatomy. Maybe your jaw structure is set up in a certain way where you just don't breathe well at night.
01:01:32
Speaker
You know, some of that is the cause. But before I send you to the specialist, I really am trying to make sure we've been very thorough and making sure that there was not a way to naturally remedy what it is. I've even had to have some people sleep in separate rooms. So does your partner snore? You know, we're talking about your sleep and isolation, but does your partner snore? Are they a sweat box? You know, are they always a hot body? Do they sleep wild?
01:02:00
Speaker
Are you easily agitated? Or do you wake easily when people move around? And I've had to have a few couples sleep in separate rooms. They're like, let's just do a trial of it for a couple of weeks to see, does it make it better? And some people come back to say, yeah, it does. And we've had to make some decisions about what co-sleeping looks like.
01:02:29
Speaker
So maybe those old school movies where we were watching The Merry Couple and they both had their own twin bed in the room. Maybe they were onto something, right? Because if you can't feel your husband or your wife or your significant other, you know, tossing and turning and it doesn't disrupt your sleep, well, when you wake up in the morning, if you're not fatigued, a lot of things can happen when you're not tired in the morning. But if you're exhausted in the morning, you still can't interact with your partner.
01:02:58
Speaker
Yeah, and I definitely think you're onto something for real because like when you were looking at those old school comedies when they were in the separate bed, they seemed like they had happier marriages. You know, that's probably cause they were able to sleep. I mean, sleep is important. I'm trying to tell y'all.
01:03:14
Speaker
I'm just saying like if you're trying to have morning sex like nobody's getting up early to have some sex if you like been wrestling with your sleep right all morning you need some rest for that. But if you know if you wake up in the morning you're like who I ain't got a solid eight hours like what you know about this morning session we're about to get so you know I think it I think it matters because
01:03:36
Speaker
if you, you know, couples, especially with kids or with jobs, like gone are the days of traditional, okay, it's right before we go to bed, we're going to engage intercourse, and then we're going to fall asleep. Like sometimes it just ain't there. Like somebody's went to bed before somebody was on on kids, shower, bath duty, and I got to go to bed early, all kind of stuff happened. And so your ability to interact with everybody, including your partner that sleeps with you in the same room with you depends on how good your sleep is.
01:04:06
Speaker
You've been hearing this a lot about sleep apnea. So sleep apnea is a sleep disorder. It occurs when a person's breathing is interrupted during sleep. So it results in some periods while you're sleeping that you're not breathing, right? And that means that you're not getting enough oxygen to your brain and to the organs. So that can cause
01:04:28
Speaker
problems, right? It can increase your risk of hypertension, stroke. It can cause some arrhythmias, depression, headaches, worsening ADHD. So there are two types of sleep apnea. There's the obstructive sleep apnea, which is, and that's when you have blockage of the airway, usually with the soft tissue of the throat collapse during sleep. So that causes the periods of you're not getting enough oxygen.
01:04:57
Speaker
And then there's central sleep apnea, where the airway is not blocked, but the brain just fails to signal the muscles to breathe due to instability in your respiratory control center. So that's central sleep apnea. So basically, to diagnose this, we usually send you to get a sleep study, and they can diagnose sleep apnea. But some of your risk factors,
01:05:25
Speaker
are being male, overweight, over 40, large neck size, 17 inches in male and 16 inches in females, having large tonsils, snoring, loud snoring, family history of sleep apnea if you have some like nasal obstructions or like a deviated septum that can increase your risk.
01:05:49
Speaker
Some of their symptoms of sleep apnea are that you're having very sore, dry throat in the morning, really loud snoring, loud snoring with periods like your partner's telling you. If you're snoring so bad, it sounds like you're not breathing sometimes and it's scary. Waking up occasionally, like choking or gasping for air.
01:06:12
Speaker
having daytime sleepiness because you're snoring, waking up, you're not sleeping well enough. So then during the day, you're just falling asleep and you could just be falling asleep, like falling asleep while driving, which is like very dangerous. And also lack of energy in the day. And you can also have increased headaches, right? So forgetfulness,
01:06:37
Speaker
So all of these things are possible symptoms of sleep apnea. So we usually, if someone comes to my office and they're like, oh, I think I might have sleep apnea. So I ask them a couple of questions. We have these questionnaires. And if we think that you score kind of high on it, then we're like, OK, then maybe
01:07:01
Speaker
you probably do have sleep apnea. So you have to get a diagnosis of this by doing a sleep study. So basically what they do is they monitor your sleep. Monitor how long or what times that you're not breathing while you're sleeping. And then
01:07:22
Speaker
for the treatment, if they see that you are diagnosed with sleep apnea, they usually give you what's called a CPAP machine, right? So with this machine, what it does, it causes continuous airway pressure to open up and that they put
01:07:38
Speaker
open up the airways, especially your nasal airways, so you always are getting continuous amount of oxygen. So those periods where you wouldn't be breathing, you're getting oxygen, right? So you have more restful sleep. And some patients don't like it because it's annoying because you got to sleep with a mask, but it really is a game changer and changes your life. Like I try to tell patients, like you really, if
01:08:03
Speaker
If you've got this, like to do it because you really will change, you will feel much better and it's good if you can keep up with it. But let's say, you know, you don't want to do that. There are some ways that you can, without having to do the sleep, the CPAP if you just
01:08:21
Speaker
we always say you lose weight. Maybe if you're overweight, you lose a little weight. It can help, right? And if you have like this deviated symptom, maybe getting that fix that can help. So there are other things that you can do to help improve your sleep like we were talking like before.
01:08:38
Speaker
And can I say, because people like to skip out on using their CPAP machine. And the problem is, if you need a CPAP machine for sleep apnea, and you've got a respiratory problem, you probably have increased pulmonary, your lung pressures, and your lung system is supposed to be a low pressure system. But if it's turned into a high pressure system, and we are figuring that out through the fact that you have sleep apnea,
01:09:03
Speaker
then we know that if you do not treat your sleep apnea over the years, you will develop right-sided heart failure and right-sided heart failure ends up being left-side heart failure. But for you, regardless of whether it's right or left, you're going to get heart failure and you can get that from having uncontrolled sleep apnea for long periods of time. So your CPAP machine is doing more than just keeping your airway open. One, it's allowing you to sleep
01:09:31
Speaker
allowing you to get good REM sleep, which means that you can actually heal tissues, you know, rest, let your brain do its job, you know, wake up in the morning more refreshed, but it's also decreasing your lung pressures, which takes the pressure off your heart so you do not end up developing more problems. So, you know, it's always connected, you know, it's never just this one thing.
01:09:50
Speaker
The other sleep disorder I was going to talk about really quick guys is restless leg syndrome which a lot of people might not really know about that but basically this is when you have this overwhelming need to move your legs with
01:10:07
Speaker
and feeling these uncomfortable sensations or worsens during rest or inactivity. So it's like you just you just can't stop but move your legs a lot and it it it interrupts your sleep right because you are always moving so you can't like fall asleep. Simple blood work it could be that maybe you just have an iron deficiency or not taking enough magnesium stuff like that can help
01:10:30
Speaker
with that or if you have untreated sleep apnea that can also increase your risk of this rest of this leg. So and there's some medications can also precipitate this and make that worse like if you're taking lithium or any antihistamines that can increase your risk of having this rest of this leg. And there are medications that we kind of use for that. We use
01:10:56
Speaker
this medication called Requip and also some other medications that can help with that. But for the most part, sometimes it's just, we do some simple lab work and we turn out and it turns out, oh, your iron is a little low. We can just give you some iron or replace some vitamins and that can help. So guys, that's all I have for sleep unless anybody has anything else to add. That was good. You covered a lot of stuff. I'm impressed, Dr. Chris. I'm impressed.
01:11:26
Speaker
Well, you're not trusting times guys. So, uh, so we have some Q and A's. Um, I just want to remind you guys that, you know, I'll post some prompts onto our IG and our Facebook for if you guys need like submit questions. Cause again, you know, I check the inbox every day. If you have any questions about any previous episodes, doesn't have to be the one that we just covered. Um, feel free to send it to our inbox. Um, but these are some questions that we are going to get to today. So.
01:11:54
Speaker
First question here is, so with the new year here, I'm trying to get healthier and cook healthier meals.
Health Concerns with Cookware
01:12:01
Speaker
I've been wondering whether I should buy new cookware as my current set is made with mostly Teflon products. Is Teflon really unhealthy to use? Should I invest in Teflon free products? And I've also heard that storing food in plastic containers containing BPA is harmful. Is this true? And what is the consensus from the medical community regarding using Teflon in plastics containing BPA?
01:12:24
Speaker
So there are some articles out there that suggest that, you know, the no stick cookware has harmful products in it. And so, you know, depending on where you're reading at, they will recommend that you, you know, opt for, you know, non
01:12:40
Speaker
non-Teflon like I don't have any in my house but you know I had it in college and then once it went out and the part of the problem is is how people cook with them right so normally when you get Teflon pots and pans they come with you know plastic where that you're supposed to cook with them nobody ever does it right so everybody's always stuck a regular spoon in that pot in that pan to stir up something really quickly
01:13:02
Speaker
and it scratches the surface of the coating and they think that it's the chemicals underneath the coating that get exposed and start to seep into food as you cook and so they recommend that you not use it. Now if you are, now this is a budget thing and so if you are disciplined and you use woodware, you know bamboo wood, use plastic where when you're cooking with your dishes and you don't scratch them
01:13:23
Speaker
so you don't expose the surface and I think they're perfectly fine to use. If you can splurge and you can afford to, you know, buy some updated cookware, you know, I never tell anybody no to that. I've got cast iron skillets in my house. I love my cast iron skillets. They're seasoned. I use them all the time. And then I also have non-
01:13:43
Speaker
non-stick cookware, those are my primary things. So I get what the listener is asking for. If you can splurge on it, that's fine. What you have to know is that there is a, and this is not a physician thing, this is just from experience. We have been cooking on no-stick pots and pans for so long that I will warn you that there is a transition period on learning how to cook with old school, well, now new school non-stick cookware.
01:14:07
Speaker
to prevent from risking that, it's just going to be an adjustment. But, you know, if you can splurge on it, that's fine. If you've got to keep what you have, you can do that too. You just can't scratch the surface of the nonstickware, which means not putting those metal spoons, forks, knives in that dish as you are trying to stir your food or cook your food and you can still be safe.
01:14:31
Speaker
So I will add to this because I am in school, which I don't even know if I told the listeners that, so I'm also in school. I'm getting my master's. I'm pretty sure I mentioned that to y'all. Yeah, like you guys are my family now. You guys know that about me. Because I am getting my master's in public health, we actually talk about this a lot in my environmental health class. So basically,
01:14:52
Speaker
There is this whole huge movement that is getting a bunch of evidence around it. I'll make it really short for you guys. So there's a lot of new evidence and a lot of new research that's happening about something called nanoparticles, which basically just means small particles. So basically, as we have progressed in technology and things like that, as a people, there are some particles which are really, really small that are present in a lot of the things that we use on a day-to-day basis.
01:15:17
Speaker
But now we've come up with a way that, hey, we're identifying them, and now we're measuring them. And then now the new research is, OK, well, what is this causing inside of our bodies? So the more research we find, we're seeing that a lot of these particles that we thought weren't really a big deal are actually really a big deal. So in regards to his or her particular question about cookware, if you are really diligent about it, you can actually find non-stick, non-toxic cookware.
01:15:44
Speaker
that is basically absent of all of the nanoparticles that, you know, anybody uses in any type of cookware. Now, are they expensive? Yes. And usually you find them at like Surla table, maybe the top shelf of, you know, like a Bed Bath and Beyond type of thing, but they do exist. So if you don't want to think about, oh my gosh, is my son or daughter going to take that fork and use it on my nonstick pan? And if it's better for your anxiety to just get something that's non-toxic, nonstick, it does exist.
01:16:13
Speaker
But the research that is coming out is ever changing day to day. And it's on nonstick pans, even like water resistant clothing, like the ties and slacks and stuff. So there's certain particles that we're using more as a people that are causing lots of toxins to be in the world and in our bodies. So you're not wrong. This is something that's evolving and we're going to be on this journey together. That's all.
01:16:34
Speaker
I love a good cast iron skillet too though just you know heads up go old school my grandmother had them i think all of our grandparents had them growing up and so i will tell you that i don't i don't fry or cook things often so i and and lately because i am
01:16:50
Speaker
not eating meat. I've not pulled them out. But cast iron skillets are also good to go. You just have to learn how to season them. And please don't wash your cast iron skillet after you season it. But you can Google how to care for cast iron because that's also an option too. It's very old school, but they're versatile. You can use them on the top of the stove. You can throw them in the oven.
01:17:14
Speaker
You can throw them on your grill. So if you're like, you know, like you can take your cast iron skillet and put on your grill and you can fry up foods there. Like it's very versatile. And so I'm definitely a fan and it tends to be void of all the toxins that you're also looking for, but they require a little bit more care. Yep, they sure do. And they're heavy. They are very heavy. Definitely washed my cast iron skillet and I got rust all over it.
01:17:38
Speaker
Yeah, definitely look at those YouTube to learn how to- I cannot believe we are friends and you watched your cast iron skill. You know you can re-season it, right? Yeah, I did. I did. You brought it back. I brought it back, yeah. But I mean, I love my Dutch oven. I just bought a new Dutch oven from Macy's on sale and I absolutely love it. So I used it for Christmas and, you know, cook some cordish hens in there and it turned out really good. So pre all those Teflon products and BPAs.
01:18:09
Speaker
Um, just season it really well and just pop it in the oven and it tastes great.
Staying Active with Peloton
01:18:13
Speaker
So, um, so not a question, but I was, I was told to plug our little hashtag. So as you know, uh, myself and Dr. Amy Jo, uh, we have, uh, or you don't know. And they don't know. So we all, we're all about getting you active and healthy and, you know, with summertime shy coming up, I'm sure it's a big thought and everybody's minds here.
01:18:36
Speaker
So I want to plug our little Peloton hashtag. So it's the exact same as our handle, so the chocolate MDS. I usually ride at night. Amy Jo is a beast and likes to ride at the crack of dawn, which I do.
01:18:54
Speaker
If you're a night owl, follow me. If you're not, then do Amy Jo. But either way, we are on there most of the time. So we'd love for you guys to have us do a swarm with us, and hopefully we'll see you on the leaderboard pretty soon. Yes, join us. I told NoNo and Amy Jo that they have to make us look good then, because clearly me and Chris do not have a peloton, and we are not properly represented on this hashtag. We are not.
01:19:17
Speaker
I'm like, if you guys are on your Peloton representing us, y'all better be top notch. Y'all better be top of the class. Like, I heard you can give each other high fives. Like, oh, high five, friend. You're at the top of the class, queen. You can high five. I mean, you can video. It's so cool. But yeah, let Dr. Nodo break it down for you.
01:19:39
Speaker
No, I mean, I'm a I mean, I'm like an amateur cyclist. So I like do 20 miles on Lakeshore Drive just for fun. But I mean, I'm not a spokesperson for Peloton by any means. I just need something consistent with like a workout that I was, you know, the pandemic kind of took away from us because I wasn't trying to go down to the gym and like risking covid just like, you know, get a six pack. So
01:20:05
Speaker
It's very consistent. It's done in the comfort of your own home. The class playlists are like super good. I'm up doing like Megan Stallion and I hope they have released a Cardi B playlist pretty soon. I will be all over that. But playlists are decent and it's a really good workout and I highly recommend anyone if you need something consistent, that's the way to go.
01:20:35
Speaker
I am not planning on entering a gym for at least another two years, in my mind. I think it's going to take us that long to find some true normalcy. So when I invested in my gym, and the chocolate and peas have seen my gym, there's more than just a peloton in it, so it's quite extensive.
01:20:59
Speaker
I knew that this was where my money is and so I don't have a gym membership anymore. I gave it up and so the monthly fees that I'm spending really are all in my home gym. I think I like it because now when I'm negotiating with myself,
01:21:18
Speaker
The cool thing about the Peloton app is that there's always at least a 20-minute class you can get in. And no matter how much you slept over, you can convince yourself that you can get on this bike for 20 minutes. And you can find good classes. I love Tunde. You can get on 20 minutes with her, and you will be sweating by the end of your workout. So it has helped me.
01:21:41
Speaker
It has helped me have a class I can take versus me going in there just to do cardio in general. I'm just going to go get on this machine. I'm just going to do some cardio. Or I'm just going to do my own thing for the next 20 minutes. That's really hard to convince yourself to get out the bed to do. But if I know I can hit a class and say, for the next 20 minutes, I'm going to follow the instructions of this, I tend to like
01:22:03
Speaker
The older class is better than the live classes because I'm goal oriented, so I need to see my little bar fall into whatever they said, like resistance versus endurance. It's not a present in the live class that throws me off and I'm like, how do I know if I'm doing good? And I know I heard you, but I'm tired. I'm not always listening, so sometimes I need to see, I need to push to kind of keep myself within the goals. So whatever you can do to build your own community, to keep you eating and moving and healthy, do it.
01:22:32
Speaker
And apparently, if you happen to be in the Peloton community, then you can race against No-No and Amy Jo. Right. Yes. Come join us. Right. This is not an ad, by the way. This is not an ad. My output, but I can't do Tunde. I'll say that right now. I did her once and all the time. I love Tunde. But you know, I do have to say the commercials for the Peloton, they're very like, they get me motivated. I'll be like, oh, shoot. I should work out. Then I'm like, nah.
01:23:02
Speaker
Don't listen to Dr. Chris, y'all. She definitely works out. This woman has trainers, like, do not listen to Dr. Chris. She is out here in these streets working out. Don't let Chris fool you. Don't listen to Chris. I know, right? Yeah. I'm joking. I'm joking. She's working out.
Listener Engagement
01:23:20
Speaker
All right. So find us on the top three. So IG, Facebook, and Twitter. Our handle is TheChocolateMDS.
01:23:30
Speaker
Please be sure to send us questions so that we can feature them in our future episodes. So the email is the chocolatemds at gmail.com. Yeah, send us questions. I was surprised I didn't get any questions after the weed episode. So I know y'all are just itching to ask us stuff about it. So please send us those. And if you have any, if you listen to our old episodes and have questions about content that we covered there,
01:23:56
Speaker
You know, send us those questions by all means. No, no, you stay. You stay yelling at our audience. You stay yelling at them. Watch. Be careful. Be careful what you ask for. Watch this thing explode. Hey, I'm ready for it. Our inbox is dry. So please, you know, let's get some action going. Yeah.
01:24:15
Speaker
I will leave that right there, and I'm going to bid you guys farewell. Bye, guys. We'll see you in a couple weeks. Yes, it's past my bedtime. And it's gone. We gotta go. Bye. Bye, guys.