S01_E06 - Sleeping. Dreaming. Sleepsnacking? A conversation with a Sleep Medicine Doctor

Speaker 1: 0:03

Welcome to the healthy matters podcast with Dr. David Hilton, primary care physician and acute care hospitalist at Hennepin healthcare in downtown Minneapolis, where we cover the latest in health healthcare, and what matters to you. And now here's your host, Dr. David Hilton.

Speaker 2: 0:20

Hey everybody. It's Dr. David Hilton and we're onto episode six of the healthy matters podcast. And today we're talking about a subject that everybody cares about and that's getting good sleep to help me out with that. I have Dr. Ren vagi, a sleep doctor at Hennepin healthcare Ren. Thanks for being here and welcome to the show. Thank

Speaker 3: 0:39

You, Dave. It's a pleasure.

Speaker 2: 0:40

So what's a sleep doctor, you know, I don't even know if many people even realize there is such a thing. How did you get, what, what kind of training do you need to be a sleep doctor?

Speaker 3: 0:49

Dave? I didn't know that sleep medicine existed until I was a resident at Mayo clinic and psychiatry. I'm a general psychiatrist. And in my second year I had a lecture by one of our sleep physicians. I was like, what is this thing called sleep medicine? I was fascinated. So I did a rotation in Mayo. And then I did a, an additional year of sleep fellowship medicine at Mayo and the rest of this history. I've been doing sleep medicine ever since fellowship and you know, some psychiatry as well. And what's really interesting about sleep medicine. I, in my opinion, is that I'm a general psychiatrist, but pulmonologists can be sleep. Medicine, doctors and neurologists can be sleep. Medicine, doctors and pediatricians can be sleep medicine doctors. And that's, what's really wonderful about it. It's a multidisciplinary field. I,

Speaker 2: 1:32

If I write in saying that darn near everybody, so many people don't, uh, get the sleep that they need or they want, we all wanna get better sleep, but most of us don't realize that there are things we can do to improve it. So when you see people, uh, what, what kind of things are you seeing them for? They just come in here and say DACA, I can't sleep well. Or is it mostly thing? Medical things like sleep apnea.

Speaker 3: 1:56

I, I think it's all of the above. You're right. Everyone. I mean, sleep is such a fundamental part of our exp experience, right? A third of our life is spent sleeping eight out of a 24 hour cycle is devoted to sleeping, or at least we wanna get those eight hours, but rarely people achieve that, especially now in our society. That's so tuned in and wired and so much stress. So I see a combination of different patients. I see people that have so sleep apnea or restless legs or medications that might affect their sleep. But then I also see people that are struggling with stress in general, and that stress is amping them up and it doesn't allow them to relax their brain and they just can't get the sleep they need.

Speaker 2: 2:38

Is it true that there is an objective amount of sleep that people need to get, I mean, is a number or is it different for all people?

Speaker 3: 2:46

Yes, absolutely. Especially for kids. Kids need a lot of sleep. Infants children, you know, children about nine hours of sleep teenagers, same thing about eight or nine hours adults. If you just let us go without having to do anything, no obligations, our brains sort of why are wired to get about eight hours of sleep on an, uh, in average?

Speaker 2: 3:07

So I would, I don't know if I ever get eight hours of sleep, maybe I do occasionally, but I do know that if I don't have something going on that day, which isn't very common, but let's say a Saturday morning, I would probably sleep a couple hours longer than I do. I'll bet I'm not alone in that. I, I think probably a lot of people. What is the effect? That's my question to you. What is the effect on chronically? Like I don't ever get eight to nine hours of sleep. What is the effect on, on health and wellbeing? Yeah,

Speaker 3: 3:34

It it's, there's so many different things that we're starting to seize, right? So there's no unifying theory. There's no really one reason why we sleep. We haven't figured that out yet. There's a lot of different theories, but if we sleep the deprive view, if we just give you say five or six hours of sleep on a nightly basis, a lot of things go haywire. Let's say your immune system. So things like natural killer cell activities. So your immune system is a little bit diminished to, if you don't get an adequate number of hours of sleep, your brain will not function as optimally or efficiently. If you do not get the sleep that your brain requires, bone repair, muscle repairs. So a lot of different things go haywire. If we aren't getting an adequate number of hours of sleep. Now say that with a caveat, because I don't want to sort of alarm people because it is a common issue in the United States. I mean the average number of hours of people that are, that are getting sleepers about six hours. So I think what we need to do is just to be respectful about, yeah, the body needs and the brain needs about eight hours of sleep, but we don't want to be so alarmist and saying, if you don't do it, oh boy, things are bad. They're

Speaker 2: 4:39

Gonna drop dead tomorrow. If you only got six hours of

Speaker 3: 4:41

Sleep. Yeah. I think it's, we want to, we want the goal of being able to establish that if we can, and that most of these things that I'm talking about are long term issue. This is a long game, right? And so these things that we see can be seen on a day to day basis, like not thinking as clearly, your mood might be a little bit off if you don't sleep well. But the goal is to try and get you to that point where you're optimized.

Speaker 2: 5:07

Here's the deal. I bet you, I could fall asleep at almost any given time during the day if I tried to. And so, you know, for that's just me personally, like I, I think I could in between patients in a clinic, I'll bet you that if I went and sat at my desk and put my head down, I'd I'd crack. And I think it's because I'm maybe not getting quite enough sleep, but nonetheless, I seem to be able to function, uh, during the day it strikes me as just the most weird thing about the human. Well, maybe about any Mamal organism that we every single day become unconscious, that we like intentionally go lie down, turn off the lights and try to become unconscious. And something must be physiologically happening there. I mean, it's obviously required for, for the organism to survive, but do we know what is happening when we sleep? I mean, seriously, what's going on? Um,

Speaker 3: 5:55

It's so fascinating. It's that when I think about sleep, I don't think about us sort of being online right now. We're sort of communicating and getting information and then we go to sleep and we're completely offline. The brain doesn't do that. We're not completely offline. In fact, I mean, when we look at sleep, there are two stages of sleep, non REM sleep and REM sleep in REM sleep. We tend dream the most, right? We have vivid memory or vivid dreams. It's colorful, it's emotional. What does that suggest? It means that the brain is actually processing information during this period when we're sort of offline, if you will, or temporarily offline. So I look at it as not complete unconscious, but maybe just an altered state of consciousness, where there is some information and processing of information to make us again more optimized. The next day, we're consolidating memories when we're sleeping. Um, something that I think people should start to become aware of is that in the past few years, we've discovered something called the lymphatic system. And basically what lymphatic The lymphatic system,

Speaker 2: 6:57

I must have been asleep during that lecture in med school.

Speaker 3: 7:00

It's so new.

Speaker 2: 7:01

I don't have a clue what

Speaker 3: 7:02

You're talking, not a lot of people know, but the

Speaker 2: 7:05

Fat

Speaker 3: 7:05

It's basically our sewer system for the brain. So right now you and I are talking and our brain is working and there are toxins that are building up that need to be flushed out. Well, when is that gonna be done? It happens during sleep actually during our slow stages of sleep. And why is that important? Because if we don't do it, we are not as optimized perhaps the next day. And we're starting to figure out that these toxins include proteins, that if they build up over time can lead to things like Alzheimer dementia, memory problems and things like that. So we're really starting to understand that sleep may serve a role in cleaning out the toxin so they don't build up. So that later in life, those cells sort of cause these memory problems.

Speaker 2: 7:52

After we take a short break, I want to talk to you more about something you've alluded to that being dreams and like what the heck is going on there. And do we really know what those mean? But before we do that talk briefly about the sleep center, where you work, you work at Hennepin healthcare where I do. Uh, and, um, thank you for being here by the way. I, I, I often go to my colleagues at the, at the hospital when I have a topic I want to talk about, but you work in a sleep center. That's been around for decades who has on research on this. Tell me about specifically about the sleep center that you work at because you know, people, they see sleep places all over in strip malls here, there, and the other place you have been at a place that has been present for decades. That was actually pioneering in sleep research. Yeah.

Speaker 3: 8:36

Tell

Speaker 2: 8:36

Us about

Speaker 3: 8:36

It. Yeah. Thanks Dave. I mean, I'm really privileged to be at the, at Minnesota regional sleep disorder center at Hennepin healthcare. It was established in 1978 and it has just been a powerhouse of just wonderful clinical service education. We have a dedicated sleep fellowship, uh, education program, but also research. And in fact, in 1982, mark Maal and Carlos shank discovered something called REM sleep behavior disorder, which is a dream disorder where when we dream, normally we don't act out our dreams because our muscles are temporarily paralyzed in this condition. We, but that switch that turns the muscles off when we're dreaming is broken in these conditions, in this particular condition. And these patients tend to act out their dreams. Well, why, why do we care about that? Because some people injure themselves or their bed partners by acting out their

Speaker 2: 9:30

Dreams, is that common where people act out their

Speaker 3: 9:33

Dreams. Yeah. So it's not that common, but what what's really interesting about this is if you have it and it's real, and it's not caused by medications or other conditions, well, we, something, something called idiopathic REM sleep behavior disorder. That condition may be the earliest sign for the onset of what we call cyle these or like Parkinson's disorder or multiple system atrophy or dementia with Luie bodies, even 30 to 50 years before the onset of those conditions, this dream behavior dream sleep behavior can predict this.

Speaker 2: 10:07

It could be predictive. That's fascinating. So we're gonna take a quick break. When we come back, I wanna talk about two things in particular. Once I see it all the, a time in my practice and that's insomnia, people can't fall asleep, they can't stay asleep. I wanna talk a little bit about insomnia and then I wanna talk a little bit about dreams and what they might mean. But before we do that, uh, I'm gonna catch a quick

Speaker 4: 10:27

Nap.

Speaker 1: 10:29

You're listening to the healthy matters podcast with Dr. David Hilton, have a question or a comment for the doctor become a part of our show by reaching out to us@healthymattersathcmed.org. Or give us a call at six one two eight seven three talk that's 6 1 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 2: 10:57

Hey, we're back. We're talking to Dr. Ren vagi, who is a sleep doctor, a specialist in sleep medicine who practices with me at Hennepin healthcare at the Minnesota regional sleep disorder center in downtown Minneapolis insomnia. Okay. I'm a primary care doctor, uh, Ren, and just as sweet. I mean, well, it was all of yesterday. I had a patient say, I'm no trouble falling asleep. It's going fine. I go to bed. Same time every night, I go to bed at 10 30. I'm asleep instantly. And I'm up at four o'clock every single day or every single middle of the night. And that is causing such anxiety and she can't fall back asleep. That's one type of insomnia. Other people tell me I just can't fall asleep no matter what I do. So I think it might be one of the more common things I see in a primary care practice. Could you talk a little bit about insomnia, the effects of people, how common it is and what can people do about

Speaker 3: 11:48

It? Boy, it's probably the number one apart from sleep apnea, insomnia is probably the number, biggest thing that we see in our sleep clinic. It's hugely prevalent. So how common is it? It really depends. It could be up to 15 to 20%, uh, prevalence data in the United States. So really, really common. And it has these different variations, like you said, now, being able to stay asleep, but we think about it as not being to get to sleep, stay asleep, waking up early, or even if you've had sleep, just sort of non like, oh gosh, I really didn't get a good quality sleep. It's so common that people are like, you said, get distressed by it. And then it becomes its own beast, right? Is that you have a problem. And then you start worrying about the problem. Then you start to worry about the problem and the, then you're not what relaxed, if you're not relaxed, you can't get back to sleep. And then the behavior or that problem just sort of perpetuates on itself. Can

Speaker 2: 12:41

We blame it mostly on our behaviors or are some people more prone to it regardless of what they do?

Speaker 3: 12:47

So I, I, I would say there are four things that we look at. There's somebody called the four P model people that are predisposed people that I perhaps be a little bit more anxious when things go awry in their life, maybe a change in their career or stress in general or medical change. Then there's some sort of a precipitant in their life. Like I said, maybe someone has had a death in the family or a lot of stress, which makes that individual think more. And we tend to think about things in our life when things calm down when, uh, when the lights go off, when there's nothing else going on, there's no

Speaker 2: 13:18

Distractors.

Speaker 3: 13:19

The things in our minds start to reverberate. And then that tends to make people feel a little bit not relaxed. Um, then there's the perpetuating behaviors. Well, I'm thinking about these things, I'm in bed and I can't get back to sleep. What do I do? I just think about it some more. What, what people tend do is they lay in bed. They don't,

Speaker 2: 13:38

They stare at the ceiling, they look at the digital clock on their nightstand and

Speaker 3: 13:41

What are they? What are they? They're looking at the clock and what is the clock telling them you're awake. And then you're not relaxed. And then you're not relaxed enough to be able to get to sleep. And so that behavior tends to perpetuate this problem. And then it becomes Pavlovian conditioned, meaning once

Speaker 2: 13:56

That's the fourth P

Speaker 3: 13:56

That's the fourth P so you, all of the stuff goes away. Let's say the stress goes away, but then you you're like, why, why can't it get to sleep? Because it's been conditioned. The brain is now mixed up. I go to bed. But in the past, I've had to think about these things. And the brain starts getting confused about, well, should I sleep or should I be thinking? And it's an automatic behavior. So what we do to fix that is just try and rewind and rehabilitate the individual to reassociate the bed as a place only for sleep. And not those other things.

Speaker 2: 14:28

When people have that, when they're having struggles sleeping, what do you tell'em to do?

Speaker 3: 14:32

Well, if we rule out all these other things that might cause everybody

Speaker 2: 14:35

Wants, everybody wants a medication. So, and I, you know, that's not probably the way to go,

Speaker 3: 14:40

Is it well? So for acute insomnia, you know, like I've got these stressors and it's time limited, sure. Maybe a medication may be useful, but for these long term, insomnia's medications are not the way to go. The gold standard for long term or what we call condition. Insomnia is something called cognitive behavioral therapy for insomnia. And it's a rehabilitative approach. It's a talk therapy, and it's very focused on both sort of addressing maybe negative thoughts about your sleep, like what will happen. But if I don't get eight hours of sleep and then you start worry about, oh, he's trying to address those negative cognitions. But mostly it's the behaviors. It's like, well, if you can't get to sleep, don't lay in bed. Start to reassociate the bed with a place for sleep. There are other components too, where we might actually restrict the patient to their bed. Like, no, maybe you only need to be in bed for five hours only. And, uh, we try and do that to retrain the brain that, you know, the bed is a place for sleep. And once we achieve that, we sort of lengthened the time of sleep. So

Speaker 2: 15:39

C, B T, or cognitive behavioral therapy for insomnia. I have learned about over the last few years, partially due to you and your colleagues that have taught me about this, cuz I don't remember learning about it in med school 20 some years ago. Yeah. But it's the thing that C to work the best, but it requires a little bit of, of uh, commitment. Doesn't

Speaker 3: 15:56

It? It does. You need someone who's motivated that wants to do it. That kind of goes through it and, and is engaged in the process. And it's super effective. It's very effective. Even for those folks that said that isn't gonna work for me, I've had this for like 30 years, but really what we do this appropriately, we start to look for improvement on the sleep. We don't expect a perfection as the end goal because that's an expectation we can't meet. We look for better. And once we get a little bit better, it builds a little bit of confidence in the patient that they will continue to, you know, be, you know, get better on their own. What about

Speaker 2: 16:32

Screens? Mm. Blue screens.

Speaker 3: 16:36

Yeah.

Speaker 2: 16:36

I'm scrolling my Instagram on my phone in bed. Is it can't be good or I'm watching TV. What do you tell people in our screen filled

Speaker 3: 16:44

Life? There are two parts of that. It's it's not just that light. That's coming out of the screens physiologically. The light is so pressing a, a hormone in the brain called melatonin. It prevents that hormone to signal the brain to say, Hey, it's time to get to sleep. Now if melatonin isn't really sedating, it just says the signaling molecule to the brain that says, aha, this is the time that we normally go to sleep. Okay. Brain let's start the sleep machinery. It's not just that the light is doing that to rise. It's our engagement with these things. We're thinking about other things we're not allowing ourselves to sort of detune and detach to be able to provide a space for sleep, to arrive.

Speaker 2: 17:25

You said melatonin. Yeah. That's everywhere. Nowadays you can get eight zillion tablets of melatonin. Does it work for the general popul?

Speaker 3: 17:34

Yeah, yeah. Yeah. Well for, for some people, but it isn't acting as sort of a sedative. It doesn't make people feel sleepy. What it is is it's telling the brain at a certain dose, if taken at a certain time to that, the brain that tells the brain, Hey, this is the time to go to sleep. Just like our, our brains would normally do. What I should say about melatonin is that it's not approved or regulated by the FDA. So what you're getting in that bottle, you don't know whether it's actually melatonin or how much melatonin. And sometimes people over overdo it on the melatonin and there's a spill over effect during the daytime. And so I so kind of say, use it wisely. And um, we have mixed feelings in the sleep community about this, that it can be helpful, but it has to be done at the right dose at the right time for the right people.

Speaker 2: 18:20

So I'm talking to Dr. Ji vagi sleep specialist in Hennepin healthcare in Minneapolis. I'm gonna pivot from insomnia to dreams if I could, Randy. Yeah. Why do we dream?

Speaker 3: 18:33

We don't really know, but I think it serves some sort an advantage.

Speaker 2: 18:37

And does everybody dream?

Speaker 3: 18:39

I, everyone dreams, they may not remember their dreams, but they are going through a stage of sleep called re most people, if you just let them, we'll go into REM sleep, rapid eye movement, sleep where dreams tend to be the most vivid and technical and emotionally Laden. Um, and sometimes we remember them, sometimes we don't remember them. And we think the dreams may be this playground for our brains to practice out the things we learned in the previous day, so that we could consolidate them and be really good at them. The following day. In fact, when we sleep deprive people and they don't dream, they're not as good as what they practiced the previous day. So some Harvard researchers looked at people and they had them practice a certain technique, deprived them the sleep of sleep. And the other group was not, not deprived of sleep. The folks that had the most REM sleep did better on these procedural skills than others. So we think that it may have some role in sort of laying down memories and making you do things better the next day, if you

Speaker 2: 19:42

Will. But some dreams are awfully scary. You know, you know, I get it. Some people might be having this wonderful dream and you wake up feeling great. And other times it's a nightmare, literally a nightmare. How bet you've seen all kinds of people come in with scary stuff and good stuff you think, is there a role for the nightmares or, you know, is that just maladaptive?

Speaker 3: 20:01

We think that it may, well, if it it's maladaptive, if people are really disrupted by'em and I think it really speaks to what's going on during our date time, that might be intruding into our nighttime, you know, consciousness. And I think that's what's happening is that the stuff that may be that what we might be putting back in the back of our brain, we're not really thinking about, or maybe actively avoiding thinking about, cause we don't want to, might be traumatic, then tends to sort of flood, you know, float, float up to the top. And we think about it at that time. And it can be really distressing to a lot of people. What the role of that may be. It might just be what we call an epiphenomenon just as a natural thing that happens to happen when we go into the stages of REM sleep. But we're starting to work on why that may be the case.

Speaker 2: 20:49

I don't really remember most of my dreams or I can only remember like one in my whole life. So I'm not one of those that remembers them, but I've done some weird stuff when I'm asleep. When I was a kid back in the day in, in the good city of Minneapolis, they sent 12 year old kids out to deliver newspapers. So I would get up at 5:00 AM, 12 year old kid it's 20 below zero. And I would go to some neighbor's house, pick up the newspapers and uh, go throw'em on people's doors. And so I did that at four or five in the morning, but I remember my parents tell me that one time I got up to go do my newspaper route. And I got down to the kids' house who had the newspapers. And I went up there and they were still awake. And, and they said, David, what are you, what are you doing here? Your paper route, doesn't start for five hours. It turns out it was about midnight. I had awakened my 12 year old body. Yeah. Put on my jeans and my hat. And I walked down in the winter day, in the middle of the night, middle of the night. I think I was sleepwalk. Yeah. And, and, and, and I was, you know, that's a little scary, you know, but people do weird things in the middle of the night.

Speaker 3: 21:49

Absolutely. What you're describing as it sounds, sounds like a sleepwalking incident and the fancy name for that is parasomnias. And our center is actually one of the leading institutions on understanding these things called parasomnia, which is a fancy way of saying that the body is awake, but the brain is still asleep and it really common. It's so common in children, children usually sort of grow out

Speaker 2: 22:12

Of, oh yeah. I was gonna say, do you grow out? Cuz I don't do it so much. Well, I hope I don't do it now. Maybe. I don't know. Maybe I'm maybe I'm sleep walking through my day. I don't know. I hope not.

Speaker 3: 22:21

Um, yeah. Some people do grow out of it. Some people don't and if you don't grow out of it, it can be really just who cares if you sleepwalk, but sometimes it could be absolutely dangerous. Dave. And so as, as you describe it, this was in winter that you had a sleep walking incident, right? What if you didn't find someone that was going to redirect you back home? And in fact, that's the sort of stuff that we see. I had a patient that had awake. Wasn't awake actually about two hours into their sleep and their deep sleep. When these sleepwalk incidents usually occur, went out in the middle of winter, in their pajamas about a block away from their home and was found disoriented in the parking garage and

Speaker 2: 23:05

Their body was moving. Their brain

Speaker 3: 23:07

Wasn't brain was part or fully asleep. And that's really fascinating. We don't really know how that works, but it is a, it's not uncommon. It can be triggered by certain things like sleep deprivation. You know, there are certain sedative hypnotics or medications that can do this to people as well. Other conditions can worsen it with adults as well, but it's not uncommon. It's one of those things where if you have it probably, you know, see someone about

Speaker 2: 23:35

It and, and maybe not, everybody's getting up and sleep walking around the neighborhood, but people are doing things in their own bedroom. Are they eating, eating,

Speaker 3: 23:41

Eating, sleep, related, eating. So in addition to say like sleep walking or, you know, just kind of wandering the bedroom, there's a condition called sleep related, eating disorder, which I wrote a paper with Dr. Shank about people go to their kitchen or wherever they can find it they're fully asleep or they may have some semblance of a it's going on, but they're usually fully asleep go to their kitchens and eat, eat what, eat anything, usually calorie, rich food, the good stuff. And they may return to their bedroom and there's food all over the place, either the kitchen or in their bedroom or their bed, the following morning, they wake up, they've got all this food and kind of go, why, what,

Speaker 2: 24:24

Why is this here?

Speaker 3: 24:25

Remember it. They don't remember it. They have no recall of it. And they feel sick to their stomach because they've eaten so much and people gain like 20, 30, 40 pounds before they actually see someone and say, I think I'm doing this during sleep. People can, I've had a patient who locked their cupboard doors for their food, or

Speaker 2: 24:43

They prevent themselves from

Speaker 3: 24:44

Doing it. And guess what happens? They unlock it. They unlock it.

Speaker 2: 24:47

They unlock the door while

Speaker 3: 24:48

Asleep. They unlock the door while

Speaker 2: 24:50

They're asleep. So you just have the, the muscle memory or the, you you've done it so much. You know how to do it.

Speaker 3: 24:55

Exactly the,

Speaker 2: 24:56

Is there anything to be done about that at other short short of like, you know, pad locking on your cupboards, but any of those behaviors or you're hitting your bed partner or night terrors are sleepwalk in our sleep eating. Is there anything to be

Speaker 3: 25:09

Done about them? Yep, absolutely. So we, there is absolutely. So we assess'em to see if they're sleep deprived. If they have sleep apnea, which might be triggering these events, because really what's happening is something is triggering these events from deep sleep where the brain is really in deep, deep, deep, deep sleep, and not a able to remember anything in the morning, but the body's awake. So we assess them with a sleep study or we might say, get more sleep. Sometimes we do need to use certain medications to keep them asleep so that they don't injure themselves or their bed partners.

Speaker 2: 25:40

There are about 20 zillion other topics around sleep. I want to talk to you about, uh, and, uh, but that's all the time we're gonna have for today. So I'm hopeful that she'll come back on a future episode of the podcast rang and we can do a recurring segment about sleep because we've just touched the very surface. Now on last episode, I previewed that we were gonna be doing a sleep episode and we've got listeners that have actually asked questions sleep. And would, do you have time to take a question or two?

Speaker 3: 26:09

Yeah, absolutely. Sure.

Speaker 1: 26:11

Okay. So Dan from Sioux city is wondering, is there an actual benefit we get from dreaming and why do we sometimes dream of the deceased?

Speaker 2: 26:20

So is this a thing dreaming about people who are no longer with us?

Speaker 3: 26:23

Absolutely. We do this during the daytime as well. We think about people that might have left us if there's any sort of emotion that goes along with that. And if we're not actively thinking about it now, or if maybe there's some, you know, uh, leftover business that we weren't able to do, and we can't engage and talk with those people, like I mentioned before, the brain is really fascinating. And during REM sleep, those things that we might push away during the daytime either actively or passively might just sort of flow to the top. And then we entertain that in a sort of a different way than we would if we were able to process it during the daytime. So I think we think about everything and anything, and it's bizarre, or it can't, or it could be normal, but the brain is working. And I think that's the point. And it's what we do with those thoughts and what, how we, how we think about those thoughts and what our relationship to what we're dreaming about, I think is the more important thing, whether they have some sort of meaning the meaning making happens now when we're awake and fully conscious to be able to interpret what we think may have happened in our dreams.

Speaker 1: 27:34

Thanks, Reggie. And thanks Dan, for your question. This one came in on our phone line.

Speaker 5: 27:39

Hi, my name is Suzanne and I'm calling from lake Elmo, Minnesota. There are times when I cannot fall asleep at night, or I wake up in the middle of the night because I have AAW stuck in my head. Why is that happening to me? And also I heard about a breathing technique called the 5, 2 7 technique. Can you tell me, will that help me fall back when I'm awake in the middle of the night? Thank you.

Speaker 2: 28:07

Ooh, Reggie, that's a great question from Suzanne. So I hope it's a good song at least, you know, maybe it's like funky town or something. Have you heard about that? You know, what does someone do?

Speaker 3: 28:19

I've heard a lot and I, and this is not, um, this is not abnormal. I mean, I think that this is something that happens when Suzanne is falling asleep and maybe this song might be triggered by what's happening in the room. Or this is a song that she likes. I, I don't know whether it's triggered by any one particular thing, but she's attached to this.

Speaker 2: 28:42

It's intrusive,

Speaker 3: 28:43

That's it's intrusive, but I, I get the, a sense that the fact that it's intrusive might create some emotional attachment to it. I mean, if she's emotionally attached to something, it sort of says to the brain, Hey, this is something I should pay attention to because it's creating some sort of emotion. And so what I would say is anything that might seem that it's creating some sort of emotional valance, just try and take a step back detach from it, acknowledge that it's there and then kind of go, okay, I'll just let it play out as it is. And then it might diffuse the attachment to that particular song. Should

Speaker 2: 29:18

She play in different song?

Speaker 3: 29:20

Well, then she might get attached to that as well. I don't,

Speaker 2: 29:22

Especially if it's good Springsteen song, I mean, right.

Speaker 3: 29:25

I mean, I love, um, now, and, and if it's happening in bed, the, what I would say is get out of the bedroom if it's going on for more than 10 to 15 minutes. So at least the song is attached to let's say another room and less so with the bed. Um, but that would be my recommendation.

Speaker 2: 29:43

That makes sense. Yeah. Maybe go into the bathroom, shut the door and have a dance party.

Speaker 3: 29:46

Yeah, yeah. Sing in the shower. What

Speaker 2: 29:47

About her second half of her question? What is, do you know about 5, 2, 7 breathing?

Speaker 3: 29:52

I am, it's a sort of specific breathing where you, you breathe in, you hold the breath and you breathe out in a long ex explanation. And I don't know if there's really strong data that says this is going to enhance your sleep or get you to sleep. But what you're doing is you're just taking a nice, long, deep breath and breathing out in a certain way. What that does is it triggers what we call the parasympathetic nervous system. When that happens, that tends to relax the, the body in general. That's one way I think that it can be helpful. If you are able to relax your body, you're able to fall asleep a little bit easier. At least you support the environment to do that. The other thing is, if you are engaged in something as normal as breathing, you are not thinking about those other things that might be intruding yourself. So that, that's why I think the second way that I think it might be

Speaker 2: 30:43

Helpful. It's sort of like meditating and focusing on your breath, a deep breath in hold it in a long ex till it makes some sense. You know, there is some probably benefits in other aspects of your life on relaxation, your blood pressure and all that, but maybe it, maybe it is a technique worth trying. Yeah. Uh, in the nighttime. Thanks for your call, Suzanne. Another great question from our listeners. That's all we have time for today. I want to thank my guest, Dr. Ren vagi sleep specialist at Hennepin healthcare. Ren, thank you so much for being here and I hope you'll come back and be in a future episode with me. Absolutely.

Speaker 3: 31:13

Dave, thank you so much. It was my pleasure. It's

Speaker 2: 31:15

Been a great conversation about sleep. I'm hoping that you will join us for the next episode of the podcast. When I will have a station with twin cities, media personality, Jordan Green, she's gonna tell us about her career in broadcasting and her experience with her own medical diagnosis. That promises to be a great show. I hope you'll join us. And in the meantime, be healthy and be well.

Speaker 4: 31:40

Thanks

Speaker 1: 31:40

For listening to the healthy matters podcast with Dr. David Hilton. For more information on healthy matters or to browse the archive, visit our website@healthymatters.org. And if you have a question or comment for the doctor, you can email us at healthy matters. H C M E d.org. Or give us a call at six one two eight seven three. Talk. Finally, if you enjoyed this podcast and would like to support us, please leave us a review and share the healthy matters podcast with your friends and family. The healthy matters podcast is made possible by Hennepin healthcare in Minneapolis, Minnesota, and engineered by John Lucas at highball executive producers are Jonathan Comito and Christine Hill. Please remember we can only give general medical advice during this program. And every case is unique. We urge you to consult with your personal physician. If you have more serious or pressing health concerns until next time, be healthy and be well.