Sleep Unplugged with Dr. Chris Winter

While we discussed sleeping pills on episode 11 of the podcast, there is a lot of unfinished business here. A recent conversation with a distinguished and highly educated colleague about sleeping pills made me question my practice and the practices of many providers.  In this episode we will:Examine the role of cognitive behavioral therapy for insomnia patients who do not have the resources, time, or interest in participating in the therapyExplore the differences in sleep clinics in terms of the demand for these medications. Are these drugs mainly a tool for primary care doctors or do sleep medicine specialist rely on them as a part of their insomnia toolbox?Review the data on the newest family of hypnotics, the orexin receptor antagonists, in particular their effects on sleep latency and decreasing wake time after sleep onset (WASO)Discuss the absolute lack of evidence linking any changes seen in sleeping pill sleep use and improved health/performance in their usersTouch upon the proper/ethical ways in which hypnotic data should be shared with patients who are using these drugs. If a drug is helping someone who "cannot sleep" to sleep through the night, what does it mean to withhold this data?Accepting that these medications may change sleep in very small but statistically meaningful ways, how are we as providers supposed to square these changes with the very different problems our patients bring to our clinic.Produced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

The media loves to talk about sleeping naked. The topic carries just enough taboo to make it irresistible to readers. Given that up to a third of adults sleep in the buff, is there any real science to supports its sleep and health benefits? In this episode we will:Examine current research about the metabolic effects of sleeping in cooler temperatures and how being naked might support these theoriesPostulate how sleeping naked/in a cooler environment could increase brown fat composition leading to increased metabolism, weight loss, and better glycemic control/lower diabetes riskRevisit the sleep benefits of colder temperatures (from Episode 25)Push back on the direct relationship between sleeping naked and healthier skinDiscuss the role of oxytocin on sleep, stress, and sleeping skin to skinTouch on the role of sleeping naked on vaginal healthDive into the idea that sleeping naked improved sperm counts and fertilityExplore the ways in which sleeping naked could lead to heightened self-esteem and body acceptanceDetermine if there is in fact evidence that sleeping naked promotes intimacyBriefly review potential cons of sleeping nakedProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

Chronic pain is a disabling problem that could affect as many as 1 out of every 5 adult Americans. It is a costly and tragic collection of disorders that often has limited and disappointing treatment options. Could sleep be a central mediator of chronic pain?  Could it be a pathway for treatment? In this episode we will:Contrast the relationship between pain causing disturbed sleep with the condition of disturbed sleep itself causing painExamine study numbers showing the high incidence of disturbed sleep in patients with chronic painConsider that while many patients with disturbed sleep have concurrent depression, a much higher cohort complains of disturbed sleepRevisit a 2006 study I highlighted in my first book that shows increased pain indices following relatively trivial reductions in total sleep and REM sleepExtend this concept as it relates to high incidence of chronic pain in military veterans with sleep disorders/disturbancesView the relationship through the lens of a 2022 Harvard study confirming a relationship but stopping short of endorsing causationList ways in which sleep considerations could be utilized to improve pain conditionsProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

Now that lettuce water and melatonin spray has had their moments, mouth taping seems to be the latest sleep social media trend that everyone is talking about. What does the evidence say about the practice? Is it legitimately helpful? In this episode, we will:Examine the functions of the nose in the respiration process (filtering, humidification, etc.)Attempt to quantify the scope of nocturnal mouth breathing, both in the sleep apnea and non-sleep apnea populationRank to incidence of mouth breathing based upon sleep stageContextualize the role in increased nitric oxide via nasal breathingEvaluate the scope of sleep apnea and snoring improvement based upon mouth taping and how it relates to other treatmentsDiscuss the role of mouth taping and CPAP complianceTouch upon the role of mouth taping and oral healthBreak down the relationship between ADHD and mouth taping, and the influence of sleep-related breathing disturbances in this proposed relationshipGo through the list of considerations related to the practice of mouth tapingProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

It would be tough to argue that one of the most important factors that influence your sleep is right under your nose (literally, depending on what position in which you sleep). Our pillow plays a big role in our sleep comfort and quality. In this episode we will:Touch upon when kids should begin using pillows for their sleepLook at evidence suggesting that few people give deep consideration to their pillow and of those who do, the majority may still be making the wrong choiceList the various pillow fillings (feather, wool, latex, etc.) and their relative strengths and weaknessesDetermine which pillow types tend to create the most spinal supportLay out the factors that go into pillow fittingUnderstand the supportive and comfort goals of a well-fit pillowDive into the factors that tend to influence pillow purchasesDiscuss other uses of pillows besides head supportGo through some disorders that can be improved with proper pillow selection.Produced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

Our identity as either a good sleeper or a bad sleeper plays an outsized role in the development and persistence of insomnia in individuals. In this episode, we will:Explore the origins of our sleep identityList the common ways individuals decide whether or not they are "good sleepers"Introduce the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) Scale, and how its components offer insight into the dysfunctional thinking that often characterizes insomnia Contrast the use of the DBAS with the Epworth Sleepiness Scale (ESS)Consider how the ESS helps to identify drive to sleep and what that means to have a high, or a low drive. Strategize how to use elements of the DBAS and the ESS to begin to construct a new foundation for sleep identity, an identity that is one of a good sleeper.Produced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

Maybe the Rush lyric should have been, "I've got no time for sleepin'" because a huge population of people in this world participate in some form of shift work, and it takes a heavy toll on sleep, health, and the bottom line of their employers. In this episode we will:Examine the inherent sleep deficit that comes with shift workDetermine how much sleep the average shift worker is losingDebunk the idea that staying on night shift actually creates a true biological adjustmentExplore the work-related consequences of shift work sleepinessHighlight the unequal 'double burden' women engaged in shift work assumeList the medical consequences of shift workDefine the medical disorder Shift Work DisorderEvaluate the countermeasures and interventions that can lessen the impact of shift workProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

Everyone wants slow wave sleep, commonly referred to as deep sleep. It's the sleep of youthfulness. It's the sleep of performance. It's the sleep of recovery. It's the sleep through which growth hormone flows. Lots of things promise a deeper sleep, but what really delivers? In this episode we will:Revisit the reasons deep sleep is so important for optimal healthExamine the research behind exercise and deep sleepExplore the links between mindfulness and meditation and sleepDetermine if hydration plays a role in slow wave sleep enhancementLook at the surprising link between lavender and deep sleepUnderstand the role temperature plays in this process and why exercise my actually be utilizing body temperature as a pathway for its enhancement of deep sleepUntangle the complicated research looking at alcohol and its role as both an enhancement and degrader of deep sleepProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

In Episode 5 of the podcast, we explored the confusing entity of mild/borderline sleep apnea and the treatment confusion it causes. In this episode we look at the other end of the sleep apnea spectrum...severe sleep apnea where the only confusion is, "Why didn't your primary care doctor order a sleep study sooner?" In this episode we will:Define sleep apnea and learn how the Apnea Hypopnea Index (AHI) helps us classify an individual's sleep apnea severityBriefly touch upon other metrics being considered to grade the severity of sleep apneaLook at sleep apnea through the lens of a recent patient who averaged 155.8 significant breathing disturbances/hour and understand what that means in terms of health and medical risk factorsExamine the process by which one slowly develops sleep apnea and ask the question, "Why, in the midst of elevated weight, high blood pressure, and/or diabetes do more doctors not order home sleep studies to screen for sleep apnea when it is a modifiable risk factor with massive potential for health benefit?"Understand how the concept of CPAP therapy "working" or "not working" needs to be clearly defined as different therapy modalities are considered.Examine Inspire therapy, understand what it entails, who is eligible, and how there is much more to consider than their advertisements seem to indicateCompare sleep apnea therapies and their strengths/drawbacksNote: I let an f-bomb slip in this episode…sorry to those offended by this.Produced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

"I can't shut my mind off at night" is a very common refrain among insomnia patients. Is this a real phenomenon and if so, how does it relate to the disorder of insomnia.  In this episode we will:Review the cognitive role of mental hyperarousal in insomniaExplore how mental de-arousal is an integral part of managing insomnia Learn how insomnia patients raise their level of arousal as they approach bedtime and are often cued to do so by their sleep environment.Differentiate poor sleepers who often view their racing thoughts or inner monologue as an impediment to their sleep versus normal sleepers who do not. See mindfulness as the countermeasure to our culture's propensity to stress mental escalation while ignoring techniques for de-escalationList some methods, including the use of biofeedback devices, for practicing how to manage a racing mindTouch upon the idea that the "racing mind" is something to embrace, not fearProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

Sleep tips are everywhere and the more 'surprising' the advice is, the better. While the majority of what is out there is helpful at its core, over time, these tips can distort the actual goal individuals have to develop not only healthy sleep practices, but a deeper understanding and sturdier relationship with sleep. To that end, it's important to dissect these ubiquitous instructions and figure out what they are really telling us. In this episode, we will: dive into why we are constantly ordering people to never be in bed awake, and how it can erode the positive feelings and impact resting can have in our lives.push back against techniques that promise faster sleepdispel the myth of fluid restriction at night and why hydration restriction is not only unhealthy, but also largely ineffectiveevaluate the idea that delaying caffeine intake scientifically reduces a mid-afternoon 'crash' and overlay his theories on the two-process model of sleep/wakefulnesslearn how going to bed at the same time every night might be unhelpful over timeexplore the idea of not watching television 2 hours prior to bed and why that is an impractical notion for most peopleunderstand why sleep hygiene alone is not likely to fix a significant sleep problembriefly touch upon the current fad of mouth taping, it's like of rigorous scientific backing, its academic opposition, and how medical trends (sometimes dangerous ones) are perpetuatedProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

In episode 26 of the podcast, we began a discussion about narcolepsy...what it looks like, how it's diagnosed, and why it's so often overlooked. Diagnosis is just the first hurdle as many patients are unaware of or simply not offered the best therapies for the disorder. In this episode, we will: touch upon theories of treating narcolepsy include non-medication therapieslist the major pharmaceutical therapiesdifferentiate the mechanism of actions among these medicationsoutline the drug strategies for managing narcolepsy symptoms including excessive daytime sleepiness and cataplexylearn why so many patients are denied optimal therapy because of doctor's ignorance or insurance company denials/red tapebriefly touch upon the obstacles involved specifically in narcolepsy careProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

There is no chemical on the plant more tied to sleep disruption and wakefulness promotion than caffeine. As every research paper on the plant points out in the first sentence of the manuscript, caffeine is the most widely consumed psychoactive drug in the world. The consumption of caffeine as spawned its own culture and massive business machine. In this episode we will:discover the history of caffeine research in sleeplearn about caffeine and the related methylxanthine chemicals theophylline and paraxanthineanalyze the antagonistic effects that caffeine has on adenosine signalingtouch upon the differential effects of caffeine based upon ageexplore the negative effects of caffeine on sleep including new research on its effects on REM sleepdetail the research looking at the timing of caffeine ingestion related to bedtime and how its effects may be more prolonged than most thoughtuncover the reality about the wakefulness effects of caffeine and the facts that predict it.break down the caffeine and performance findings of the International Society of Sports NutritionProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

The explosion of both medicinal and recreational marijuana use (as well as its derivatives) has led to the obvious question: Does marijuana help an individual sleep better? If you pay attention to those who sell it, the answer seems to be a resounding yes...but is that true. In this episode we will:learn about marijuana and the chemical cannabinoids that are often proclaimed to be sleep-promotingunderstand that in many ways, using marijuana for insomnia is no different than other pills and its success leans heavily on how we measure sleep success...or how it "works"touch upon older research about marijuanalearn the differences between transient sleep effects and the sleep effects of long-term useexplore cultural conversations and myths about marijuana use, in particular that it's helpful in pregnancydiscover the misperceptions surrounding marijuana use in collegeuncover how the bottom line of some studies can be affected by pharmaceutical companies trying to develop novel sleep therapieslook ahead to potential therapies for conditions like REM behavior disorder and Restless Legs SyndromeProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

Anyone who has traveled a significant distance has felt the effects of jet lag...the fatigue, the altered appetite, the sleep irregularities. The science of jet lag and sleep is topic of tremendous interest both scientifically and in popular culture. In this episode we will:Define jet lag and how it relates to the circadian rhythmExamine how jet lag can influence our general and cognitive health as well as cancer riskContrast the biological difference between eastward and westward travel and how they relate to circadian advances and delaysExplore the various ways jet lag can be mitigatedUnderstand the use of light exposure to lessen the impact of jet lag and how the timing of light relates to our body temperature curveLearn about the use of melatonin as a toll for jet lag mitigationTouch upon how caffeine and napping can be jet lag strategiesCharacterize the merits of hypnotics for travelDiscover the surprising relationship between fasting and jet lagConclude with the folly of alcohol as a jet lag strategyProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

The link between cardiovascular health and sleep is beyond compelling and is probably the most researched topic related to sleep health. This has taken on greater meaning as studies show the cardiovascular health of all age groups is declining. Recently, the American Heart Association added Sleep Health to its 'Essential 8'--a collection of the meaningful steps individuals can take to improve their cardiovascular health and outcomes. But what constitutes the relationship between sleep health and cardiovascular health?  In this episode, we will:Introduce the American Heart Association's Essential 8, and how sleep health not only factors into the list, but directly affects the other seven items.Trace the long history of sleep being associated with coronary artery disease.Explore the relationship between sleep and stroke riskUnderstand the mechanisms of increased atherosclerotic plaque burden in people getting inadequate sleepLearn about the relationship between inadequate sleep and  elevated blood pressure/"non-dipping," and how sleep extension may improve those measurementsCharacterize the increased risk or arrhythmias in patients with sleep=related breathing disorders and their underlying mechanismsProbe the link between inadequate sleep and systemic inflammation and how these changes can be permanentTouch upon the topic of poor sleep and impaired glucose homeostasisConclude with looking at the confusing relationship between insomnia and cardiovascular diseaseProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

Back sleeper, side sleeper, stomach sleeper...which is the best position for quality sleep? Body position is a popular topic in the media, but how much evidence is behind the recommendations? In this episode we will: Explore sleeping positions and our ability to perceive and control themBriefly touch upon considerations like facial wrinkling and glaucoma for which there is inconclusive evidenceRevisit how back sleeping in infants is thought about currently in the relationship to SIDS and infant sleeping safety (listen to episode 32 on co-sleeping for more information)Explore body position options for pregnant womenLearn about body position and joint painExamine the role that body position plays in GERD and the mechanism behind the recommendationsEvaluate the evidence for improved cardiovascular functioning based upon sleep positionCritique the 2015 study linking Alzheimer's disease risk to sleeping position and its relevance to humansTouch upon ways adults can improve sleep apnea, snoring, and GERD via sleeping position technology.Produced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

Clickbait title comments aside, cognitive behavioral therapy for insomnia (CBTi) is the scientific gold standard when it comes to insomnia therapy. It's effective and medical governing bodies and consensus statements lauding its benefits are too many to count...but what exactly is it? In this episode, we will:Learn about the overwhelming support for the use of CBTi for the treatment of insomniaList the various medical boards and governing bodies that support it and its overall efficacy ratesUnderstand why there is often reluctance to engage in the treatment and why the work involved often makes fad treatments seem appealingEvaluate why sleep education is generally felt to be the foundation of CBTiDefine cognitive restructuring and how thinking about sleep can reinforce positive and negative thoughtsLayout the tenets of stimulus control therapy and how they affect individuals with insomniaContrast the various methods of relaxation techniquesHighlight physician and clinicians with special training in CBTiProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

There are many controversial topics in the world of sleep. Not many spark more conversation and controversy than various forms of co-sleeping. In this episode we will:Define co-sleepingLearn about the various forms of co-sleeping: babies/children, pets, siblings, and spousesExamine the research about co-sleeping and SIDS as well as accidental deathLook at the various risk factors surrounding co-sleeping with babies Weigh the pros and cons of co-sleeping with petsTouch upon sibling co-sleepingConclude with the science behind couples co-sleeping and ways to mitigate the negative effectsProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

Perhaps no topic in sleep is more filled with more wild claims and unsubstantiated research than polyphasic sleep. The division of sleep into several distinct periods is not new. The question is, does it hold the key to enhanced health and performance? In this episode, we will:Define polyphasic and monophasic sleepLearn about the sleep of other animals and contrast their typical polyphasic sleep to the monophasic sleep of most humansFollow the history of polyphasic sleep through medieval times up through the Industrial Revolution.Explore specific types of polyphasic sleep including the Uberman Sleep Schedule and that followed by Buckminster FullerUnderstand how sleep cycles work and how increasing fragmentation can interfere with the health benefits of sleepConclude with the scientific recommendation concerning the health risks of polyphasic sleep practicesProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @ drchriwinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!