Dr. Meredith Broderick is triple board-certified sleep expert and clinician. She attended medical school at The Ohio State University, completed a neurology residency at Case Western Reserve University, and a sleep medicine and behavioral sleep medicine fellowship at Stanford Medical Center. After training, she served as an assistant professor of neurology at Case Western Reserve University before transitioning to private practice in Seattle, WA and Anchorage, AK where she has worked most of her career. She is board certified in neurology, sleep medicine, and behavioral sleep medicine. She is one of the only physicians in the country to hold this combination of board certifications.
Dr. Meredith Broderick is triple board-certified sleep expert and clinician. She attended medical school at The Ohio State University, completed a neurology residency at Case Western Reserve University, and a sleep medicine and behavioral sleep medicine fellowship at Stanford Medical Center.
After training, she served as an assistant professor of neurology at Case Western Reserve University before transitioning to private practice in Seattle, WA and Anchorage, AK where she has worked most of her career. She is board certified in neurology, sleep medicine, and behavioral sleep medicine. She is one of the only physicians in the country to hold this combination of board certifications.
SHOWNOTES:
😴 Could sleep apnea look different in women?
😴 Why might fatigue signal more than poor sleep?
😴 Are sleeping pills masking the real sleep problem?
😴 Why is insomnia sometimes only a symptom?
😴 Could a sleep diary reveal patterns trackers miss?
😴 What does your regular 3 AM wakeup really mean?
😴 Could worrying about wakeups actually make them worse?
😴 Is your bed partner quietly disrupting your sleep?
😴 Could snoring raise your risk of chronic insomnia?
😴 Why might a negative home test miss problems?
😴 Could airway resistance exist without obvious sleep apnea?
😴 What if feeling tired became your normal?
😴 Discover Ozlo Sleep Earbuds, as recommended by Dr. Broderick—visit ozlosleep.com/sleepisaskill.
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The information contained in this podcast, our website, newsletter, and the resources available for download are not intended to be medical or health advice and shall not be understood or construed as such. The information contained on these platforms is not a substitute for medical or health advice from a professional who is aware of the facts and circumstances of your individual situation.
Welcome to the Sleep Is a Skill podcast. My name is Mollie Eastman, and I am the founder of Sleep Is a Skill, a company that optimizes sleep through technology, accountability, and behavioral change. As an ex-sleep sufferer turned sleep course creator, I am on a mission to transform the way the world thinks about sleep.
Each week, I'll be interviewing world-class experts ranging from researchers, doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper. Ultimately, I believe that living a circadian-aligned lifestyle is going to be one of the biggest trends in wellness, and I'm committed to keeping you up to date on all the things that you can do today to transform your circadian health and, by extension, allowing you to sleep and live better than ever before
And welcome to the Sleep Is a Skill podcast. You can be productive, successful, checking all the boxes, and still not realize how much better you could feel. Today I'm joined by Dr. Meredith Broderick, a triple board-certified sleep expert, whose own experience with an overlooked sleep disorder completely changed the way she thinks about what it means to truly thrive.
In this episode, we explore the sleep problems that can quietly hide behind fatigue, insomnia, afternoon crashes, and even a negative sleep test. Dr. Broderick shares why waking up at the same time every night may not be the problem you think it is, why a simple sleep diary can reveal things your wearable misses, and why treating sleep should begin with understanding the cause, not automatically reaching for a prescription.
We also look at where personalized sleep technology is headed and how it could change the way we approach our sleep in real time. So if you are getting through your days but have a feeling you could be feeling a whole lot better, listen in. You may discover that what you have learned to call normal is worth looking at a little more closely.
Share this with someone who is still searching for answers, and remember, sleep is a skill you can train. And for those of you interested in checking out Ozlo Sleep earbuds that Dr. Broderick mentions, go to Ozlo, spelled O-Z-L-O, ozlosleep.com/sleepisaskill. And welcome to the Sleep Is a Skill podcast. I was just laughing with our guest because it feels like we know each other thanks to social media, and yet this is like really one of our first opportunities to go in deeper together, so I'm really excited, and really grateful for...
Meredith, thank you so much for taking the time to be here. Oh, thank you for having me. Yes, yes. You are just a rock star in the world of sleep, providing so much value for so many individuals, and so it's just an honor to have you here. And so maybe just a little bit about how in the world you found yourself in this fascinating domain of sleep.
Yes. I started my career in neurology. I'm a neurologist by training. And when you are in your neurology training, it's very, your training is very based in the hospital versus like in the outpatient clinic. And so by nature, a lot of what you're doing is taking care of people who have had strokes, who are having a stroke, and seeing people with devastating neurological disease.
And I sort of had this existential crisis in my training that, wow, I, I wish I could have helped these people sometime previous to now, like there could've been more prevention, and I think that's when I realized that I wanted my career to really take a preventative- Path Mm. Uh, and even though I love neurology uh, it just felt like it's too late at some, you know, at some point when someone has a stroke, you can't, you can't really...
There's no cure for that And so sleep medicine offered that to me. It's a subspecialty of neurology. I mean, it's a multidisciplinary field, but it's neurology is one of the s- uh, one of the specialties that feeds into sleep medicine. And so, a, a mentor of mine, Amani Ra- Ramahi, who is w- a neurology attending at Case Western, where I trained, said, "If you're interested in sleep medicine, you have to go to Stanford.
That is, like, the mecca of sleep medicine." And so when I was in neurology training, I went there for a visiting rotation. And when I got to experience what, what we do in sleep medicine, I just knew this is it because I saw how something that's preventative, something that's non-invasive, and something that is almost like surgery in its results, meaning you get these really dramatic outcomes just...
And was preventing strokes, preventing these horrible things that were happening to people. I thought, "This is, this is, this is what I wanna do with my life." Amazing. Did you ever read Mapping the Darkness? Have you seen that book come out at all? No. Mm-mm. I feel like you will love it. Okay. It's kind of just looking at, uh...
It's fairly new, and it's award-winning journalist and mapping the domain of sleep and certainly highlighting, of course, the ground zero of sleep, Stanford. And just looking at over time as a domain. And just really some fascinating work. And I love that you found yourself at Stanford and this throughline of prevention.
So when you think about sleep now, how are you working with people or what does your day-to-day look like as far as getting this information out for people to understand that sleep could be this preventative, you know, bedrock for them? Yeah, I, I see a really wide spectrum. So there is everything in my clinic from, you know, someone who did have a stroke or had new onset cardiovascular disease, and it's now a part of their secondary prevention to get screened for sleep apnea or address whatever sleep issues they have.
There are... I mean, the interesting thing is, as you know, there's been this explosion of interest in sleep, even more of a sleep health or a sleep optim- optimization mindset. So there are those folks as well- Yeah ... that come to see me. And then the other huge thing in terms of prevention is I see a lot of children- Mm
where we're getting to intervene very early and to shape the craniofacial growth and their airway development, and then also work on, you know, things like behavioral training that kind of lay the foundation of, you know, learning sleep as a skill, which you, like you just- Yeah ... you know? I know, you know, I love that.
But- Yeah, I think you know my backstory maybe 'cause it came from me having very little skill in the area of sleep and getting myself into trouble with insomnia and all that. And so then discovering some of these cornerstones of the things that you speak to made a life-changing difference for my experience of the world around me.
And then the difference that it can make as- We start to see more and more people having interest in this, to your point, from even just an optimization perspective, but also to facilitate and support really severe problems that we might see down the road, stroke, et cetera. So right now, what would you say are some of the areas of sleep that are just really lighting you up that you are really excited about that you love to kinda share about?
Well, for people like me that are traditional medical doctors in- Yeah ... sleep medicine, I mean, sleep-disordered breathing is, I call it the emperor of all sleep disorders. Uh, because if you think about it, it's true in our daytime life as well that your breathing is number one, right? It's necessary for life, and it just is very underappreciated in sleep.
Yeah. And, you know, being a medical doctor, the very medical side of things is sort of like what, you know, what's the most exciting. And so seeing all these new surgical options come out, seeing that there's a pill on the market, seeing there's a new type of CPAP technology called KPAP or Kairos PAP, those things are all extremely exciting to me, and also just the explosion in awareness and seeing, like, women getting tested, seeing kids getting tested.
I mean, we still have a long way to go. Yeah. But... And then tirzepatide also coming onto the market, which is, you know, it's a life-changing event for someone to go on that. So to be able to have, like, another option, like, you know- Yes ... not just the CPAP, but then... And also, for so long we would treat people for sleep apnea with CPAP, but we would untouch the metabolic part.
And so to be able to sort of address both, it's, it's amazing. It's, it's extremely gratifying and very exciting. I love that you're hitting on this, and I still think we have not done enough on this podcast to really share more and more information, and just really underscore the excitement, to your point, around the fact that it's no longer just a one-track treatment plan that I think a lot of people still might imagine and hinder them from maybe even testing or exploring that they might benefit from some of the things that you're speaking to.
So maybe breaking down a bit more of that in case people are newly getting diagnosis back of whether it's sleep apnea, et cetera, or just even exploring, "Could this be me?" What might some of those things look like a little more in detail? Yeah. There's this idea that we... There are different endotypes of sleep apnea.
And so I tell people think of it like the word cancer. You know, lung cancer is very different than colon cancer or breast cancer. And sleep apnea is kind of a general word as well, where there's different types of sleep apnea. You know, there's central, there's obstructive, there's upper airway resistance.
But even within obstructive sleep apnea, there are different types. And so for instance, in women, we're gonna not see as much oxygen desaturation per se. We're not gonna see maybe the same symptoms like very loud snoring and witnessed apneas. We're gonna see more like fatigue, insomnia, morning headaches.
And so just being able to have greater awareness around that and know that, um, depending on what the symptoms are, depending what that endotype is, that will lend itself better to different treatment options. And g- gaining a better understanding, too, of- Um, different aspects of sleep apnea, like there's a term called hypoxic burden, which is, you know, helping us understand, like, how much of the time the person's asleep is the oxygen low.
Those can help us really customize the treatment, and obviously the person's, you know, preference matters as well. Those are some of the things that are exciting and, you know, other things go hand-in-hand with sleep apnea, like being overweight or, uh, trying to control cardiovascular risk, and so that's where something like tirzepatide can be really helpful 'cause you can see, you know, this incredible improvement in blood biomarkers with using that medication.
So that's where, you know, that's where it's going. And then also the other really exciting thing is, like, the sleep tech that's coming into the space where I think, you know, being able to sort of alert people that they should get tested, that's incredible as well. Yes. I love that. And so day to day, are you starting to see more of kind of this multi-layered approach where you're having people kinda experiment with bringing in the GLP-1s, bringing in CPAP, bringing in oral appliances?
Is it multi-layered for people in the case they think, well, it's just you have one treatment? What are you seeing? Yeah, I mean, it's interesting because for me, I ask people where they are psychologically coming into it. There, there are people that will just come into it and say right away, "I don't want tirzepatide.
I don't want an oral appliance." Right "I don't want CPAP." So, you know, I need to work around that, but- I have my own solo practice here in Seattle. Okay. And one of the reasons why I decided to leave kind of corporate medicine is i- it's very, it's not as easy to work multidisciplinary with people like dentists and myofunctional therapists and orthodontists and oral surgeons outside of corporate medicine j- just because, like, your bandwidth for that type of collaboration- Mm-hmm
and your bandwidth to spend longer visits is not as, you don't have as much autonomy around that. Yes. So, um, that's also really exciting to me is to be able to, like, have my own boutique practice and to be able to, you know... It goes both ways because those people refer to me and then I refer to them. Um, just helping u- to understand is this person a candidate for this, and having them get some education about what that would entail so they can make the best decision instead of just, you know, going down the, like, CPAP or not CPAP- Yes
route. Yeah, absolutely. Yeah. That was a big part of my journey, too, was when I was dealing with insomnia, finding... I was traveling at the time, this was years ago, and found myself with different doctors that were stretched very thin, and so you maybe had a few minutes, and would leave with sleeping pills to address something that was more layered than that.
And so to have seeing that there's people like yourself that are looking to really dive in and explore what's really at the root of what's not working for this person, whether, uh, be it insomnia, sleep disorders of sleep apnea or, or beyond, and really getting in there and having the time to do that. So is that what you're seeing, too, just, uh, having more time with each patient that's coming your way and to be able to kind of reverse engineer what would make the biggest difference for them?
Yeah, for sure. It's interesting you bring that up because, about the sleeping pills, because- Yeah ... I've actually just got a publishing deal to write a book about that. What? Because that is one of the biggest, I think, problems in our healthcare system is that... And, you know, as I'm sure you know, sleeping pills are not evidence-based.
There's no, there's no guideline that says, and it's so, and this is, this shows the under-education about sleep disorders in our healthcare system- Yeah ... is that you go tell your doctor that you have a sleep problem, and that's what you leave with. You leave with a prescription for something that there's no investigation, there's no diag- you know, no, no diagnostic testing in a lot of cases.
And then the plan is, there's no plan to take you off of it. The plan is when that stops working, I'll give you a prescription for something else. And so, you know, my background is unique in that I also trained in behavioral sleep medicine. Yeah. So I wear that hat very strongly- Yes ... in terms of like not wanting to get people
Now, there are some times I will prescribe, but- Sure ... in general I like to avoid that. But that's my whole thing is like we need to stop having this knee-jerk reaction to get out a prescription pad because we're pressed for time and, you know, no, no, you know- I don't wanna, you know, criticize my colleagues- Yeah, of course
but because I understand what the situation they're in is like your patients are asking you for help. In some ways they want you to give them the prescription. Totally. Yeah. And everybody wants to have agency over getting better. Yeah. And that's pretty much the best thing you can offer when you only have, like, 10 minutes, right?
Totally. Congratulations on the book, Possibilities. That's amazing. And so will the book be that opportunity to kind of go in deeper to really make this case that while, of course, there's bio-individuality, there's case-by-case basis, certain people maybe can benefit from certain types of medications. But by and large, that we've got this whole area of study that has quite impressive results.
I'm assuming for you, uh, potentially CBT-I. Are there other pieces that you lean into for people dealing with things like that with insomnia? Yeah, I mean, that's the whole thesis of the book is that taking that step is the wrong step. You have to stop and examine your sleep problems, and this is how you examine them.
And then he- here's, like, some, some of the most common solutions. So it won't just be focused on CBT-I. Obviously, that's an important- Yeah ... piece. Um, but, you know, there ... I, I want it to be more, like, comprehensive around sleep disorders, not just with insomnia. Totally. Great. 'Cause insomnia is a symptom. I mean- Mm
when people say insomnia, it means something different than it means to a sleep doctor. Yeah. Insomnia just means, you know, I have a stomach ache, but it doesn't tell you w- what is the stomach ache, right? When we say it, we mean you've been having trouble falling asleep or staying asleep more than three times a week for over three months.
It means something very specific. Yeah. Well said. Beautiful. Okay, that's amazing. So then on this topic of sleep, if someone's, you know, kind of tuning in and they're either struggling with sleep in an acute sense or a chronic sense, are there certain steps that you would have them take? I know that's a huge, giant giant, broad scope.
But often we see that people are just tuning in 'cause they're like, "Help. I don't know what to do. I'm not sleeping." And so whether it's, it's not sleeping or not sleeping well, what are just some of the ways that they can think about this? Is it kind of connecting with someone like yourself? What are some of the first steps for someone that, uh, you know, is listening right now and struggling with their sleep and they don't know where to begin?
Yeah. The one advice I would give is I think one mistake that people make is they wait until it's, like, a 10 out of 10 to get help. Yeah. Yeah. Then it's like two problems, you know? Mm-hmm. Because you're trying to get out of a crisis, and there's this other kind of long-standing problem, right? It's acute and chronic problem.
Um, so if you are having trouble, I just think it's, it's something you really wanna be preventative about. I always tell people keep a sleep diary. Yeah. Um, and I wanna distinguish that from using a tracker- Yeah ... because a tracker is a completely passive pr- uh, process. And I'm not against trackers. I like trackers for the right reasons.
Sure. But I just want, if you're really trying to understand more about your sleep, I would like you to write things down. Because when you write things down, you pay, like, just enough attention but not too much attention to very specific things. And if you keep a sleep diary, you can use any kind of standard- standardized sleep diary.
I like, there's CBT-i Coach is a free app that was developed- Mm ... for the VA by one of the insomnia researchers that trained me. And when you enter those things and you start- What I notice is people will say, "Oh, just in doing that, I kind of realized some things that I could work on. I realized I was sleeping not enough.
I, you know, so that's why I'm tired. I realize that whenever I, you know, work out late, it's harder for me to fall asleep." People will notice different patterns, so I think just keeping that diary as a baseline just for yourself is something you can do right now, is extremely dynamic. Um, but for whatever reason, some people I think have a little resistance.
Like maybe they don't believe how helpful it could be- Yes ... and they just wanna like... 'Cause people tell me all the time when I ask them to do a diary, they'll say, "Oh, well, I just wear my, you know, ring or I wear my watch and-" Totally. I'm like, "I don't want you to do that. I want you to have a little bit more a-awa-awareness of what's going on on a daily basis, and I want it to be less around like what your score is or your HRV is.
I want it to be more around things like how much time you're in bed, you know, which you're g- ... I think we'll get a little bit more accurate from that on a diary versus a tracker." So those are, those are some things, and then I might have them add on like a caffeine entry, an alcohol entry, whether they ate late, like a couple of those things.
Mm. And I think a lot of times from that, people can make some small gains just on their own. Mm-hmm. Oh, absolutely. And then this is where the education piece can come in, 'cause it's sometimes such these small tweaks of the realization that often people that might come my way, they're really perfectionists and they're trying to get it right, and that becomes the problem, right?
And then often they're giving so much time in bed, so they're, "I'm gonna go to bed so early and it's gonna be great," and they're spending inordinate amounts of time in bed. And just so to your point, the something about the writing it out can help illuminate where things are not working to help p-provide, to your point, that agency to make a difference.
Great. Okay. So for most people that you're working with, is that a starting place for people, and even for someone listening, just begin with writing it down and start getting clear on that. If they're resistant, it's not like they have to do it forever. It's for a stretch of time. Is that kind of how you language it?
Yeah, I mean, I don't have everyone do it. Mm-hmm. I think people sometimes underestimate- How much having a conversation with someone can help. Because my job is I'm trained to see patterns, so when I talk to people, um, people say very specific things that indicate what their diagnosis is. And in having, you know, a- an interview with someone, a consultation with someone, it often helps me understand what these root causes are.
Um, for instance, you know, someone who says, "I'm very sleepy in the afternoon. I'm sort of fine, but when the afternoon comes, it's very hard for me to stay awake. I fall asleep watching TV, and then I have trouble falling asleep," you know, that is gonna tell us more of, like, a sleep apnea issue, where- Mm ... you know, your sleep's just not restorative enough to get you through the day.
Yes. And then you develop insomnia because of your nap, right? Like, there's certain patterns where it helps us know, okay, that person needs to have a home sleep apnea test, whereas there's a diff- you know, there are different patterns for people who have insomnia, where we might have them do a sleep diary.
Now, a sleep diary's gonna be more helpful to me if I'm interviewing you and I say, "What time do you go to bed?" And you go, "It depends." Mm-hmm. "What time do you... How many times do you wake up per night?" "It depends." "How many ti- what time do you get up in the morning?" "It depends." Now, if I ask you, "What time do you go to bed?"
"At 10:00." "What time do you get up?" "At 5:00." "What, how many times do you wake up at, per night?" "Once." I don't need a diary for that as much as I need a diary for someone who it's like, "I can't really give you an answer." Yeah, it's all over the place. Right? This helps me- Yeah ... tells me it's variable, and I need to know how variable it is in what way.
You mentioned the wake-ups, and that's probably one of the biggest things that people will respond back to a lot of these conversations about, is, "What do I do with these wake-ups?" I know that's probably something that you hear all the time, and I don't know about you, but oftentimes it feels like there's so many things that play into that, so it's a big question.
But for the person listening that's struggling with wake-ups, how do you think about wake-ups and to help support the kind of psychology around wake-ups? Yeah. The very first thing to try to understand about wake-ups is how severe they are. Yeah. Right? So if someone just tells me, like, "I wake up and I go to the bathroom and I go back to sleep," um, but they just have this kind of sleep optimization mindset that they feel like they should or they used to- Yes
I'm not as worried about that. Now, if I have someone that, you know, there's times they nev- they wake up at 3:00 and they never go back to sleep, I'm a little more concerned about that, especially if it's a long-standing pattern. I worry about, like, conditioned arousal and chronic insomnia, right? But what I always tell people at the very beginning is- You know, l- like I see this every day on Facebook, and even in physician groups that I'm in, is- Sure
I wake up on the dot every night at 3:00 AM. It's right on the dot. I look at the clock, and it's 3:00 AM. Yes. And, uh, you know, what I always tell patients is if it's like that, like it's so predictable on the dot, what's happening is you just ended a sleep cycle, right? Mm-hmm. Because we know, like sleep cycles are, they're circadian trained, right?
Your, your brain is keeping a time, and most likely what happened is you're, you just ended a sleep cycle, and you're aware that you're awake. And, you know, this sort of happens, like, as we get older where our sleep maybe is a little bit lighter or just we have more stress, right? So what I always tell people is, like, there's nothing pathological about that at all.
We watch people sleep in the sleep lab, and they wake up every s- sleep cycle, but- Mm ... you don't always remember it. But you might remember it more towards the end of the night when your sleep drive is not as high. But how you, how you respond to that and how, what kind of meaning you assign to it and how you react to that can develop a life of its own.
Mm. Right? Yes. And for some people it may be, like, no big deal. That's not even anything I need to talk about. For other people, it's almost like it, there's an anticipatory anxiety around it- Yeah ... where, you know, your brain is aware of what time it is even when you're unconscious, right? Mm-hmm. So, so sometimes I just explain that to people, and even if your mind is racing, it's like, yeah, your brain was working.
It was doing a lot of, like, creative, you know, bizarre things that might, you know, if you're actually aware of the thoughts that are going on. It's, there's nothing pathological about that at all if it doesn't bother you, right? Mm. So I think just sometimes, like, not focusing on it. Yes. Yeah. You know? There are, there are some folks where, um- If they're having four servings of caffeine a day, I'm like- Mm-hmm
okay, that's the first thing we need to do is we need to get your caffeine consumption down, 'cause that's just making you have to go to the bathroom. Yes. Those are, like, my top two things. Mm-hmm. Is to just say right away, let's, uh, let's talk about that. And then the third one would be if there is the conditioned arousal pattern.
I'm like, "This is a chronic insomnia problem," and, like, CBT-i is where we're gonna go with that. So good. Yes. So, yeah. Okay. Yeah. Okay. So for the people listening, it's very possible that one, they're making a problem that isn't necessarily there. Like, to normalize wake-ups to a certain extent, is there a kind of a line that you draw when you start to see, okay, I'm waking up five, six, seven, eight times or what have you?
So in case people are listening, it's like, oh, I'm waking up once or twice. You know, I fall back asleep. But starting to make themselves wrong about it. It's more the often that psychological piece for those smaller number of wake-ups? Yeah. I, I think if they're prolonged, like if the, uh, if the, if, if a person's awake, let's say, longer than, like, 15 or 20 minutes- Yeah
and then they, they don't feel rested in the morning, like, we think it's affecting the daytime. Yeah, I mean, and you know, one of the things we might do is, like you mentioned earlier, we might compress the time in bed a little bit just to see- Sure ... if we increase the sleep inertia, if we can get rid of it.
But sometimes it is sort of this Pavlovian thing, this behavioral pattern- Yes ... where it does need to be extinguished through a stimulus control technique from CBT-i where, you know, we have people get out of the bed and- Not laying there tossing and turning, going- Sure ... "Oh, it's happening again," you know? Yes.
The anger and frustration, all that activation. Sure. Okay, that's really helpful. And you've been in this space for an extended period of time. You're out there, you're hearing these conversations. What are some of the things that you think people are missing in this conversation around sleep, or that you'd like to highlight more or see get more kinda air time that's really just not getting discussed?
Yeah, I think something that's becoming more and more is our environment, not only during the day, but at night. Yeah. So getting bright light during the day I think is becoming more and more of a problem, especially with people working inside, people working all day long, sedentary. The bright light during the day, not getting it is why we think the light we're getting in the evening from artificial light is more harmful.
Mm-hmm. Yes. So you can kind of counterbalance that. And then also things like noise, things like it global war- you know, you know, um, getting, uh, climate change- Yes ... and air pollution. Like, those are all things, uh, even as a neurologist, like for brain health, we're starting to see, like these are a really big problem for people.
So, um, anything you can control in your environment as far as like keeping your bedroom cool, you know, making sure that the air is clean. Um, I think having a snoring bed partner is a really big thing. Yes. There's this really interesting statistic that if your bed partner snores, you're 50% more likely to be diagnosed with chronic insomnia.
I did not know that stat, but that tracks. That feels accurate. Wow. Geez. Yeah. It's like this belittling or just kind of well, you know, my husband snores or whatever, and just the bed partner, and just kind of resignation around it, or it's just how it is, but you're really highlighting that we need to address this in some way, shape, or form.
Yeah, and it's a really difficult problem. Actually, there's a company that I'm a medical advisor for called Oslo Sleep. Yes. And- I have some of those, yeah ... you have the sleep buds? Yes. Yeah. I have 'em here. But, um- Very nice ... one of the, one of the- One of the best, I think, kind of feedback w- um, that Ozlo has gotten is for a bed partner who has a bed partner who snores and is kind of resistant.
I mean, this is the problem, is like sometimes we know there's a sleep apnea problem, or we're like almost sure, right? Yes. And they don't wanna go get, they don't wanna go get tested or treated, but the problem is that your bed partner is also affected by that. Um, so these earbuds, which are very comfortable, very slim, you can side sleep in them.
Uh, I mean, I don't know about you, I get approached by so many companies- Yes ... for little things. Yeah. And when I met the founder, Charlie Taylor, and he showed me these, I mean, I, I was... It's the most exciting product I think I've seen- Uh-huh ... um, as far as tech. Because they have the potential to track as well, and to deliver, you know, sound masking so that you're not listening to this bed partner snore.
Um, and also there's a huge trend, I don't know if you've seen this as well, where people are listening to audio as they- Yes ... fall asleep. Whether it's a podcast, whether it's like a soundscape, whether it's a noise-masking tool. Totally. Uh, which I love because- Yeah ... if you're not scrolling on your phone, that's like the, a big hurdle, right?
Huge. I'm sure you've encountered that too. Well, one, we had so far over the years, you know, we're almost at 300 or so episodes, and Dr. Wendy Trexel's episode is one of the tops because it's about sharing the cover. You know, her book Sharing the Covers. Yeah. And so bed partners, so your partners, your kids, your pets, anybody that be sharing the bed.
So the snoring aspect of things or just this extra noise that we may or may not have control over, so addressing that. But I don't know that we got into things like this that could be innovative throughout dealing with that. But then to your point, in addition with the activation of how activating a lot of the things that we might be taking in at night, especially when we're engaging with them, whether it's on smartphones or what have you.
So to even just cut out some of that, and then just be listening to something, I've found a lot of people to find kind of relief and down-regulation by taking those steps. So that's great. I love that you're bringing that in. 'Cause it's so interesting. I, I find that a lot of people immediately are almost like apologizing for some of their habits, and they'll be, "I know I shouldn't be doing X, Y, and Z."
But to your point, it's we're looking for effectiveness, and we're looking for things that can support what's gonna calm the mind. And if that can do that, that's great. Yeah. And there are tons of people in urban settings where there's traffic, there's- Yes ... a neighbor, there's the garbage truck. And we're, you know, we're trying to- Mask that so the bra-- it's not awakening the person.
It's not one of the reasons why they're waking up in the middle of the night. Um, but then also it has, you know, I like to always tell people who are trying to extinguish that condition arousal that this Pavlovian or behavioral approach to sleep, it works both ways, right? So you can also use something like the Ozlo Sleep Buds to condition yourself so that, you know, it's a cue, now it's time to sleep, and then you can use the sleep sensing option where they actually go off if you don't need the masking.
But it can just kind of be like I'm going into my nature place. I, I mean- Yes ... I love the one that's like a campfire, and there's one that's like, um, uh, just like waterfalls and, um, there's one that's called Under the Canopy I really like. I don't know if you have any favorites, but I know. I, I think it depends on your personal experience, 'cause some people have like childhood memories where like that reminds them of like whatever happy place.
Yes. Yes, totally. Yeah, I'm pretty boring I feel, 'cause I'm often just kind of like the any of the kind of standard almost like the white noises, brown noise, you know, the just very background. Almost like you're on an airplane, and it's kind of just that airplane noise. So just nah. But I love that concept too of, 'cause it's so true.
It can have such a calming effect to, you know, bring about those memories. That's amazing. My husband will often travel with them too when he finds himself into, you know, some noisy hotel room. I'll do the same. So they're, they really can come in handy, especially when there's unexpected noise or there's...
What else would you do? The average person would just be struggling and suffering all night, and then when you have something like that, like I have like almost a little sleep kit that I travel with. It's great to have those things on hand so that you're not having to deal with that. Ironically, I just had to deal with that at, um, the last sleep meeting in Baltimore.
It was, uh, the, for whatever reason my room was loud as could be. It was whole thing. And so thankfully I had my little sleep kit and was able to pop those in, and it made such a difference. That's so funny. I saw- do you know Kathy Goldstein? She's like- Yes. Okay. So I saw on Instagram she was using like the pant hangers to clip up something over th- whatever- Yes
something in her hotel room. Right. I just thought, oh gosh. Do what we gotta do on these things. Yeah, totally. I know. And then you're in like a windowless room all day in the conference. It's like everywhere. Exactly. That whole daylight piece is just not happening for that stretch. That's so funny. Yes, I love that.
So that's great. And what I was sharing about Dr. Wendy Troxel's podcast, I think part of the reason that one was just well received was a lot of people, whether searching for like sleep divorce, sleep bed partner, whatever, and certainly not knowing what to do, she was speaking to this concept of a sleep alliance.
So kind of having communication and sometimes separating in the bedroom for stretches of time or what have you. But while we're figuring all these things out, or for certain times when we can't, we got the kids, we got the dog, whatever, to have something like that in your back pocket I do think can make a lot of sense to potentially invest in so that we get night after night of uninterrupted sleep.
So that's really great. Okay. Well, actually, this is a great kind of segue I think. As far as every person that comes on the podcast, we ask them a few questions around how they're managing their own sleep. Before we do that, was there anything that we left out? I know this is a huge topic of sleep. You've got tons of information.
I know we only just scratched the surface, and you got books coming out and all kinds of things. But was there anything that we left out before we get into your own kind of personal sleep habits? No, I mean- Okay. We did- Okay. We hit on a lot of things. Great. Okay, good. Okay, so the first question that we ask everyone is what is your nightly sleep routine looking like right now?
Yes. I have two young children. They're three and seven, so that kind of kicks off my... is I do their routine. So they're- Yes. ... taking their bath, they're reading their books, and they're getting in bed. And then after that, I kinda do the same thing. For me, it's like a shower, and then I read for a little bit, and then I go to bed.
I like to read in really dim lights. Like, I usually- Mm-hmm ... I have this, like, clip-on red light that's my favorite thing. Me too. Yes. I love that. So I like to get it really dark, and then... But it's, that's my time of day where I can, you know, read for personal pleasure, so it feels very relaxing to me. And I- That's great
I, I'm not perfect about being off my phone, like- Yes, sure ... an hour before something, but I try my best. Me either. Yeah, I hear you. That's g- I know. I feel like it's important to normalize that, right? Like, just to know that it's not, like, automatical, the shame spiral, you know? There's, we can work with that, and I love that you're also introducing other alternatives as well.
The one thing I am very religious about, though, is I do not... I, I have caffeine. I have one, uh, I have one coffee in the morning, and that's it. Yeah. I'm very religious about that and, and no more. And then also, I'm very religious about not eating within three hours of bedtime. Mm. Huge, yeah. Yeah. Makes such a difference.
I ac- Yes. Ugh. I just had a late dinner last night, and I was like, why? Why? I, if I could just get out, like, a loud speaker. C- can we have, like, the early bird special dinner? Like, let's meet 5:00 please, 6:00 maybe. Yes. But this was a 6:30 every... By the time everyone sat down, ordered, it's, like, 7:30. It's like, ah.
Yeah, it's not it. Yeah. So I love the attention to that. That's great. Okay, and then your morning sleep routine with the idea that how we start our day could impact our sleep. Yes. I do like to work out in the morning, so I'm usually like, I, I get up, I have my coffee, and then I, I... Morning is my best time of day in terms of, like, mental bandwidth as well.
Sure. So I try to... I do kind of hit the ground running. Um, right now I'm nursing an ACL surgery repair, so I'm always- Ouch ... I, I, my first thing I do in the morning is I ice and do my PT. Yes. Um, so I actually get up before my kids, and I just get that, get, get that done. It would be working out or doing my PT.
But that's pretty much how I start my day, and if I can step outside for a few minutes, I will. But I usually do go outside, like, pretty early, like, to start my day, 'cause I take my kids to school and all that. Okay. Yeah. Yeah. The kids topic. I do not have kids at the moment, so great, uh, nod to you and all that that can bring in from the sleep side of things and the, the balancing all that.
I actually did want to ask you about that too, 'cause you were sharing about you... It sounds like you're conscious of really carving out some you time in the evening to be able to kind of wind down apart from the kids and what have you. I'm wondering if you've seen mu- had many thoughts on the revenge bedtime procrastination topic, and just that kind of throughline or some of the results that come out from conversations about that, of needing to have some of our own time that's distinct from stealing it from our bedtime.
Any thoughts on that one? Yeah, it's kind of estra- interesting. I, I think there's different types of bedtime procrastination. Yeah. I mean, thinking about this concept of conditioned arousal- Mm-hmm ... which I'm assuming you know what I mean- Yes, yes ... where people sort of expect to have insomnia 'cause they've had it before.
Exactly. I do think the same thing can happen with- People knowing they're gonna feel horrible when they wake up, so they don't wanna go to bed. Yeah. And then there's also the people who are like you were saying, that's their only time to themselves. Mm-hmm. I mean, I personally did not experience that because especially when both my kids were younger, I was so incapata- pa- incapa- in- Yeah
incapacitated- Yes ... by the end of the day. I just, I, I, I would feel so horrible if I didn't get enough sleep. I was just like, it's, life is too miserable. Yes. But I mean- Okay ... what I try to do is there's a nice concept called bedtime fading, where if you do have someone sort of staying up too late where their sleep period is too restricted- Mm-hmm
is trying to make a more gradual step. I mean, we use- Yes ... that with kids who have insomnia, is we kind of s- fade their bedtime. Mm. Yeah. So that's a technique I like to use with that. But I think sometimes just getting people to say, "Well, like, can you do an experiment for a week where you, let's rearrange your me time somehow?"
And then if people can just notice, "Gosh, I feel so much better. I feel so much productive. My whole day sort of operates better without the survival mode tactic I'm employing of- Mm-hmm ... you know, basically, you know, w- usually on your phone or watching your screen somehow." I think people can be more mind over matter about changing it.
I don't know. What's your experience? I'm curious too, 'cause I know you do a lot of coaching. Yeah, yeah. It is interesting how so often I'll find this kinda time management piece throughout the course of the day being such a factor for the ability to be your word in getting to bed at around the same time, being your word to be able to get out of bed at around the same time, even if the night looked not the way we might have wanted it to look.
'Cause it's certainly a lot of perfectionism is often linked in with insomnia and what have you. And so allowing kind of the loosening of that, but the awareness of how we're managing our day. But carving out some of that time, exactly like it sounds like you're been able to do, and to have the sense that we're not gonna need to take that from our sleep opportunity time.
Even if it can look a little small, or it's different points of life with kids or what have you, does seem to make that difference. We've had a few experts on the podcast speaking about that revenge bedtime procrastination 'cause it seemed to be trending during COVID and what have you. And so that seemed...
And also people talk about kinda creating a personal contract, and how kind of giving your word to creating some of that time for yourself wherever it might be. But I also appreciate what you shared too, of that kind of conditioned response to the anxiety around how they're gonna wake up and just feel worse.
Almost like resignation that it's hopeless for them or something. And so I think s- often this can kinda get healed in looking at this whole conversation around sleep in a more broader, kind of expanding the aperture, 'cause a lot of this kind of falls into place regardless. Yeah, some of the folks too, I think you have to know when there's a circadian component to it.
There are some folks that are either they're, you know, an owl chronotype, or they're not getting bright light during the day. So those are the other two things- Mm-hmm ... that can help that without having to like mind over matter it, is like if you give people more light exposure during the day and they are naturally sleepier, they're more going to sleep in alignment You know, they're, they're sort of ca- get- catching the wave.
Um, you can usually, like, that... I th- I will recommend, like I tell people who do CBTI with me- Mm-hmm ... and then they have a little social jet lag because they're- Yes ... like still in their, the phase of their life where they're going out to dinner on the weekends or going to concerts. I'll just tell them like, "Just take .5 of melatonin when you get home because you're just like very stimulated."
Yeah. You've probably phase shifted yourself by being in the bright lights. Um, so there's that too that I- 100% ... always like to think about. Yeah. Yeah. And I find that too for so many people when, I found that for myself last night when I came back a little bit later than my normal time, eating later than my normal time, knowing that it is going to, that normal sleep wave is just gonna be a little pushed out, and so, but still maintaining to still get up at around the same time.
And so everything kinda just falls back into place. But yeah, so to your point, so much of this can often get handled when we have some of the awareness so that we're not then, to your point, pushing it into social jet lag or just creating a whole monster from one incident, you know? Yeah. And I appreciate what you said too about the fading, and I was wondering if you can just kinda define that for anyone listening because I don't think we've done enough in languaging it in that way, just in case that would be helpful for anyone.
Yeah. So let's say that- We often use this technique with kids, but it applies to adults as well. So let's say that you are g- let's say you are one of these people that has social jet lag, and you, maybe your natural time that you fall asleep is around midnight, and then on the weekends you get up at 8:00 or 9:00.
But on the weekdays, let's say you have to get up at 6:00 for work, or 6:15, and that is just causing a problem. Yeah. So what we might do is just say, "Can you make your bedtime... I don't want you to try to go to bed at 10:00 because you're having trouble because that's not in sync with you." So what we might do is say, "Well, you're able to fall asleep okay on the weekend at midnight."
So what we might do is say, "Why don't, let's have you go to bed at 11:45, and then have you get up at 7:45." And then, you know, you can do that every day, shift it 15 minutes- Yeah ... or you can do like two or three days, or you can do... You know, you don't really wanna do like a week or two 'cause it just makes it really prolonged.
Yeah. But what you're trying to do is you're trying to slowly adjust the circadian rhythm very gradually. And I tell people it's like having a ladder where the rungs are really far apart versus like having like little baby steps. Yes. And that, that sort of makes it easier. But we do it, we use that technique in children that, you know, sort of don't wanna go to bed on time, and then they're hard to wake up in the morning or, you know, they're just not getting enough sleep.
Yeah, that's great. Awesome. Thank you for that. Well, the third question about your own sleep would be what's on your nightstand right now, but not restricted to that. So if it's anything in your environment, anything to share that could be helpful for people. Yeah. So my Ozlo Sleepbuds, for sure. Yes, yes. I have those.
I have a Manta sleep mask. I always have a book. I always have, I always have probably a couple good books, and then I have my red light reading lamp. Yeah. Um, and that's pretty much it. Yeah. I say this probably many episodes, noticing this through line that naturally, especially the sleep experts as compared to maybe someone that's coming on with from a product vantage point or what have you, it's so funny how there's just this minimalism of not needing to rely on all these things.
Whereas we might have certain people that are like, "Truth be told, I'm still kind of struggling with my sleep to a certain extent," or whatever, and then they've got 27 things on their nightstand, you know, to try to, like, have that external reliance. And often that's the beauty of doing this work, is that you don't have to think about sleep that much.
It's kind of, you know, you got systems in place, and it kind of just works. So love that. Yeah. And then the last question would be, so far to date, what would you say has made the biggest change to how you're kind of relating to your sleep, or said another way, biggest aha moment in managing your own sleep?
For me, going back to sleep-disordered breathing, when I actually went to Stanford for my fellowship training, I... They make you have a sleep study as part of your curriculum. Great. And that's when I discovered that I had upper airway resistance syndrome, which is a type of sleep-disordered breathing. And I've had gone through many different treatments for that.
So I started with CPAP. I got my tonsils taken out. Hmm. I've had nasal surgery. I've had the MARBIE, the palate expansion. Yes. I've had tongue tie release. Um, I've tried an oral appliance and, you know, pretty much everything that's available, other than maybe the Inspire device, I've tried. But I would say treating my sleep ap- my sleep-disordered breathing- Has made the biggest difference in not only just my sleep, like how I feel, but my whole health.
Because I mean, I, when, as I approach it for a neurologist, I'm thinking about this person's total health and their whole life. Yes. Not just, like, what, how they feel right now. That's important too, but for me, like, my heart rate is lower, my blood pressure is lower. Mentally, I'm sharper, more attentive. I have better memory.
You know, all the things. So yeah. So great. Real quick on the upper airway resistance syndrome, any thoughts on that? Just, you know, if the average person just got, like, a... They ordered online an at-home sleep test, and they said, "Ugh, I guess I'm fine. I guess I don't have sleep apnea." Are there certain things that you would suggest for people to be able to dive in more to understand could upper airway resistance syndrome be missed in some of the standard at-home sleep tests, or ways to think about that differently?
Yeah, so the first thing is is that most of the home testing is what's called a type three test. So it's a flow-based test. As you know, it's a nasal cannula, chest belt- Yeah ... and then there's an ox- you know, an oxygen s- sensor. Those tests are not gonna detect upper airway re- resistance syndrome. Yeah. And they also miss a lot of sleep apnea, milder sleep apnea.
Yeah. So if you're gonna do a home test, you know, I like the PAT, the peripheral arterial tone based- Mm-hmm ... uh, watch PAT studies because- Sure ... they do give us, you know, a better idea if there is, um, respiratory dis- they give a respiratory disturbance index, which is the indication for upper airway resistance.
Yeah. Now, it's not the gold standard. Mm-hmm. But it's gonna be more sensitive as far as getting a home test. The other thing you have to know is, you know, what I always tell people is, "If it walks like a duck, it quacks like a duck, it's a duck." So you can have a negative study- Mm-hmm ... or a non-diagnostic study, and you can still have it.
If you have all the symptoms, I tell my patients, like, "Well, let's just try a CPAP. It's harmless. If it doesn't work, it doesn't work," but sometimes that's the only way to know if that's what it is. Back when I did my training at Stanford, we would actually put an electrode in the esophagus so we could measure the intrathoracic ch- Mm
uh, pressure changes, and that's really the on- that's the gold standard way- Mm-hmm ... of diagnosing UARS. But I don't know of any lab that does it. I don't even think Stanford does it anymore, just because, you know, it's basically you're putting a nasogastric tube in people and then telling them to sleep.
Right. Um, which they did. I mean, we did it- Yeah ... all the time. Yeah. We always gave people Ambien when we did it. But, you know. Yes. Who are- See, these, I feel like, are some of the opportunities in the area of sleep where so many of these things might get missed, and so it's so amazing that you were able to discern that this is what you were dealing with, and to help get some of this information out and read between the lines for many that might just have no clue and lived their entire life not knowing that they're dealing with these things.
No, for sure. I think that if I had not gone to Stanford for my training, I wouldn't have gotten diagnosed. And- Right ... I, the thing that I always like to point out is with sleep disorders, you can sort of be doing fine in life, right? I mean, I had gone to medical school. I completed my neurology residency, no problem.
But I wasn't thriving the way that I could. You sort of don't know what you're missing out on. Yeah. Um, you don't feel great, but, you know, you might get told you're just depressed. You might get told you have ADHD. You might just feel like, you know, you're s- you're an outlier. You know, there's lots of stories I think people will tell.
But, um, and that's the tricky thing, is that, um, it doesn't, it's not like chest pain where you're like, "I'm having chest pain. I know this is wrong." It's so, like, ingrained in our society that, you know, if you work hard, that you're gonna be tired, and, like, not sleeping is kind of sort of like this badge of honor, right?
100%. Yeah, exactly. And I'm sure it's gotta be frustrating for you. I'd imagine it's like this mix of misinformation out there and trying to sort through what's, you know, tend to provide reliable, evidence-based results for people, and tools that they can use. But at the same time, you know, how not to, yeah, lose the forest for the trees, and to be able to help support people to really get some of this innovation.
I'm hoping that the tech keeps evolving to a point where we're able to provide, like you were saying, some of the wearables that could be exciting, where they're just at least providing a bit of a red flag to say, "Okay, let's get you tested. Let's investigate this more." And then to have more people like yourself that have the time, not have the time, but have setting up your system so that you're having more time with the individual to really get to the heart of what's going on, versus, you know, a five-minute meeting and hoping for the best, you know?
So I really appreciate that. Yeah, for sure. No. That's great. Yeah. I mean, I am already starting to see that, where people come in and they are, they're, um, you k- Their tracker is flagging, you know, you need to be, get tested. Right. Yeah. And so it's, we're in this weird time where it's, there's a lot of fine lines it feels with sleep, where these wearables can make such a difference and provide awareness, and suddenly people are in the conversation, but we don't wanna go too far 'cause we don't wanna be obsessive and, you know, orthosomnia, et cetera.
And then this, the tech, I think there's, I hope, excitement down the road where it'll be able to better distinguish some of these many sleep disorders that many people have no idea that they're running around with. So really appreciate the work that you're doing in many aspects of sleep to make a difference for people.
So if people are wanting to then follow you, your work, the products that you mentioned, any ways for people to take action, how can they do that? Yes. I'm on Instagram. My handle is @thesleepneurologist. I also have a Substack newsletter where I give little tutorials about different, uh, cases or educational things about sleep.
Um- Great And, um, yeah, check out Oslo Sleep, the SleepBuds. You know, the technology, and I think this is the thing that's so promising about the SleepBuds, is the trackers take something but they don't necessarily give you as much back as I want them to. Yeah. And I think that's really the mission of, you know, NB Patil and Charlie Taylor and Brian Mulcahy, the founders of the, of Oslo, is they wanna be able to give something back.
They wanna be able to treat in real time. So one of the interesting things I've heard Cathy Goldstein talk about is right now everything is like randomized controlled trials. Everything is like evidence-based medicine based on randomized controlled trial- trials. But that way of thinking when we have technology like a sleep tracker- Yeah
will become obsolete because it's too slow. It takes too much time. Yeah. We're gonna be able to look at an individual data and make an intervention in the moment for that person. Like, we're gonna be able to tell, "Guess what? Your bed partner's waking you up snoring," and we're gonna be able to say, "Did deep brown noise help?
Did, was it this one that masked?" What, you know, and then you slept better when it was this intervention, and that's what you need. That to me is the most exciting thing because- Hmm ... the human experience is so diverse and so- Yes ... varied that to be able to customize it that way is just really exciting. I love that.
Yes, that innovation and being able to evolve with what is coming out there 'cause it is just, I mean, in the day and age of AI and what is coming out faster than we can even keep track of - I know. I know ... yeah, it's wild times, you know? Well, yes, I, I appreciate, again, you taking the time, sharing your information.
Exciting news about this book. I can't wait to read that. And yeah, and thanks for sharing some practical things too. That's really part of the mission with Sleep Is a Skill, is just some practical actions that people can take and to get back in the driver's seat of their sleep, 'cause when you've been feeling helpless, resigned, powerless in this area, it can just be maddening.
And so to have people like yourself that can, whether, you know, they reach out and work with you directly, which of course we'll have that information in the show notes, or follow some of your work, et cetera, can just make such a difference. So thanks so much, Meredith. I appreciate it. Yeah. Thank you for having me.
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