I think sleep has certainly come a long way, particularly as very many luminaries in the field have gone from the basic mechanisms of what's going on in the brain, what circuits and what neurotransmitters are being released and at what times all the way up to well, how is sleep actually affecting us? How does it affect our mood or decisions to what we eat during the day, How does it affect our metabolism.
Logan Schneider is a medical doctor and board certified clinician who specializes in the treatment of sleep disorders that includes things like sleep apnea, narcolepsy, insomnia, restless leg syndrome, sleepwalking, and ramsleep behavior disorder. He's earned awards and honors from the American Academies of Sleep Medicine and Neurology. I sat down with Logan to get a better idea of exactly how sleep research is done and its real impact on patients who struggle with sleep.
The nice part about being a sleep specialist is that you get to benefit from a community of all these different types of clinicians that are interested in sleep. I went by path of the neurology residency training, but you can come through internal medicine, pediatrics, family medicine, and a sociology.
Then once you've done your primary training in residency, you then typically do a year or maybe two year sleep in research or just sleep clinical sleep fellowship that specializes you by learning everything there is to know really about sleep in that one year, and then go and take your examinations and get certified, and then you start practicing sleep hopefully.
I also reached out to Chris Winter. He's a medical doctor with years of experience in the field. He's a neurologist and a sleep specialist who authored two books, The Sleep Solution and The Rested Child. He gave us some additional insight into this field and how it continues to evolve.
One of the nice things about the changes in technology is that has taken different shape as time has passed. So the original sleep studies we did, I mean, if you talk to all the people who were sort of the first generation sleep doctors, and we're not that far removed from them, those sleep studies were very primitive. I mean they were sort of experimenting with this. They were trying to figure out where there are ways to capture
information about sleep. And that's changed to the point where a lot of the sleep assessments that we do in individuals happens in a person's own bed.
We've had an interesting journey so far talking extensively about the science of sleep and showcasing examples of people with very unique sleeping patterns and challenges. Today, we're going right to the source, to the sleep researcher. We'll find out what it's like being at the forefront of one of the newest and most interesting fields in healthcare.
Hi.
I'm Anahad O'Connor, and this is Chasing Sleep and iHeartRadio production and partnership with Mattress Firm.
About a year ago, I decided I was going to visit a Mattress firm in every state of the Union. I'm really interested in the perspective on the ground. Mattress Firm sleep experts. They see it all and you never know what new nuggets of sleep you'll learn about. In fact, that a great conversation with the manager from one of their locations in Texas.
My name is Raoul Davila. I'm a senior store manager for Mattress Firm out of Houston, Texas. It's interesting because throughout the years, right you start to see all walks of life and all the different issues that are out there. So actually seeing guests come in with those issues saying that they're not sleeping at night, that they're not getting the recommended amount of hours of sleep, that they're being impacted at their jobs firsthand. Hearing those stories from my
guests really puts it in perspective. People are not sleeping well, and it all starts with what you're sleeping on. I mean that has a huge advantage on getting the sleep that we all need.
So I find it really interesting to talk to the sleep experts about and what do they see, What kinds of problems have they been confronted with. These individuals are using their pretty profound expertise. I mean, they get hundreds of hours of sleep training to do more than just sell a mattress. They're really trying to help people solve sleep problems.
Whether your sleeping habits are common or uncommon. We have the curious researchers to thank for blowing this relatively new science completely open. When I sat down with Logan, he was enthusiastic about his work and eager to tell me all about it. So put us in your clinic, I'd love to know what it's like.
Yeah, well it's a mostly outpatient clinical practice, which is really nice about sleep medicine, Like, there are virtually no sleep emergencies that I can think of and certainly don't get called in. The nice part about sleep is you get to I feel that you get to spend a lot of time talking to people about their history because that's a significant portion of the evaluation of sleep disorders. Right. There isn't much of an examination that you can do for sleep other than the actual in lab or home
sleep study or some other diary or other measures. So it's really gathering a story getting to understand people's experiences. And the things that we do in our sleep are really astounding, eating tubes of toothpaste or driving cars, all sorts of crazy stuff. So it's really interesting to hear people's experiences with sleep that we never thought possible. We all experience sleep a lot of it, and so we think we're quite expert at it, but every day I get a surprise.
Very interesting to think about how important the story behind each sleeping problem is, which makes sense considering how specific and unique each person sleeping circumstances are. Chris found the same thing to be true in his own practice.
Getting the patients side of the story is one of the most important techniques for finding out what's going on with their sleep. It won't give us the whole picture, of course, but if it just rules things out, it's useful. We do this from a medical standpoint. But Roll told me how sleep experts at mattress firm use the same methods with customers as we do with patients.
When I have a guess that comes in and they're looking for me to solve a problem, I mean it almost comes down to the support or lack thereof. For some reason, they are not happy with the current sleeping situation. So it's my job to really ask those questions to make sure that we're going to find the right mattress. If I'm not asking the right questions, I'm really not solving the right problem. When you go see a doctor, they're asking questions to try to diagnose something the just
randomly throwing darts out aboard. They're going to ask the right questions to make sure that they can make the right recommendation. It's just listening to the guests and really hearing them out.
When you are studying patients, in their sleep. What are you typically looking for? What tools are you using?
Yeah, there are all sorts of tools that we have at our disposal. Some of them are pretty rudimentary. The classic sleep diary where people print out the sheet of paper and fill out their sleep diary. Maybe that could be supplanted by some helpful objective monitoring through various technologies, things like an actigraph which is a watch almost like a standard sports or sleep fitness tracker, where it tracks movement and light. Sometimes that helps us understand patterns over
time that can complement a sleep diary. But then the major diagnostic tools we have are those things like a sleep study, and the sleep study in lab requires a specialized technician. Those are the people who are there overnight to help make sure that things are going well because there are a lot of wires, a lot of tubes, a lot of things to monitor various body signals, from brain wave activity to eye movements, to muscle activity in the face and muscles of the legs, to looking at
heartbeat and oxygenation and pulse and breathing effort. So that we're really gathering a very rich data set to understand all of the different things that could be going on in sleep.
These sophisticated ways to measure our bodies and our brains while we sleep clearly require equally sophisticated training, but it seems like there are also multiple ways to dive into this field. I mean, I personally have learned a whole lot about the science of sleep just by doing research as a journalist and by interviewing experts like yourself.
Absolutely, they're obviously doctors like Logan and myself who specialize in the medical realm of sleep. But the beautiful thing about this science is there are multiple avenues to approach it from a journalistic approach, as you mentioned in a number of other ways. In my conversation with Roll, he told me how he and other in store sleep experts complete over two hundred hours of training. Can you tell us more about your training as a mattress firm sleep expert and what it involves.
Yeah. Absolutely, so. When we use the term sleep expert, we don't use it lightly at all. There's hundreds of hours of hands on training that we do here in the store, and we talk about the quality of sleep, we talk about the type of mattresses we have, how we can connect the two, how a mattress can help increase the quality of sleep. We're the only ones that are really diving in to learn about sleep, and you know how that can benefit you and what can happen
if you don't get the right amount of sleep. There's so much out there on sleep that we still don't know about. But if we can pair what's happening with my guests to a certain mattress and a cert and feature, I think that's when we get that aha moment where you know, that's exactly what's happening to me and this is exactly what I need.
We'll be right back after a brief message from our partners at Mattress Firm, and now back to chasing sleep. Doctor Logan Schnyder broke down the different types of sleeping disorders.
We have a set of about six disorder categorizations that we can then subdivide into. You have a breathing disorder. Is it a breathing disorder because of a blockage like obstructive seatp apnea? Is it central meaning that your brain is not triggered to breathe, maybe because of a medication you're taking. We have all of these different signals that different chunks of them can tell us different things about
your sleep. If we don't need all of that, we're not looking for a more complicated disorder, but something more run of the mill. Sometimes we can farm that out to like a home based diagnostic study where we just look for breathing effort problems and oxygen problems where the blood is not getting enough oxygen because the breathing is impaired, to something like for just substructive sleep apnea, a little
bit easier to descend to the home. But if you need a more in depth diagnosis looking for more complicated sleep disorders, then we want all of those signals, and we have video to accompany it to make sure we know what's going on. Like when people sleepwalk, you can actually see their behaviors and try and differentiate was that actual sleepwalking from non dreaming sleep or was this guy of a dream based sleep disorder. It's important to know what stage of sleep you're in to know what's going on.
So there are different types of sleepwalking based on the stage of sleep that they're in.
Exactly, and it could even not be standard run of the mill sleepwalking, which is a relatively benign disorder unless it causes problems like somebody driving a car. We all sleep, but then we are trying to differentiate what's going on in your sleep. Right, people come to us and say, hey, I'm doing this weird thing, and we don't know. We can't know unless we're actually looking at what your brain
is doing. And that's really worth capturing it on a video and also looking at all these bios all at once can help us differentiate that.
And with insomnia, for example, what are some of the sort of common things that you see causing that. Is it going to be a person's you know, their sleep environment, or is it typically stress or anxiety or their job, or do you see common sort of themes underlying people's insomnia.
Yeah, there are a lot of commonalities in general and sleep, and particularly for insomnia. There are various constructs, various groups described to different ways of thinking about this, but one common model is called a three P model, where somebody might be predisposed. It might be your genetics that predisposes you to having sleepwalking similar type of thing here, So that's the predisposition, and then you have a precipitating factor. Often one big precipitating factor for a lot of people
actually happen to be the pandemic. Was it the stress of the pandemic? Was it the change in your schedule, even the opportunity to sleep more that actually cause you to develop an insomnia. So then there's that precipitating event that causes the insomnia happen. And then after that, when we see insomnia eventually come to us in the sleep clinic, often because that's an acute in Zombia, something triggered it.
You had a bad night. Everybody has a bad night here and there, but when it becomes chronic, it lasts for a long period of time, and that's where we have to worry about these factors that perpetuate it. That's the third p Things that people are doing in response to their insomnia that then keep it going on. So some people will stay in bed a lot longer hoping that sleep will come, and unfortunately that inherently induces in insomnia.
If you need six hours of sleep and you're in bed for eight hours, we'll guess how much insomnia you have two hours. So people will do different behaviors or even have thought patterns. Even the bed alone will make them anxious about going to bed, and so they're terrified. Oh, oh man, am I going to be able to sleep tonight? So it's these thought patterns and behaviors that keep it kind of rolling on.
That sounds like Pavlovian conditioning.
I was just want to say that, I was gonna say one of the most common things that's referencing poun Love's dog is people create this association with bed that is actually both physically activating as well as cognitive emotionally activating, so they actually just even being in bed. Stimulus control is one of the things that we use is to separate the stimulus of the bed from the sense of wakefulness.
And if we can effectively do that, people then start to get used to, oh, the bed is for sleep again. So yeah, it's exactly Pavlovas dog. You got it.
So you have to retrain their brains to view their bed as not a place of stress and anxiety and insomnia, but a sanctuary of sleep. A sanctuary of sleep is definitely my new favorite term for my bedroom, and it really highlights just how important being physically and mentally comfortable is to our health. Throughout this series, one of the most fascinating aspects of sleep science that we've looked at is the amount of power that our brains have to
perform certain functions completely on their own. And one of the best examples of how overwhelmingly strong our mental capacities can be, even on autopilot is the disorder that many people suffer from known as sleepwalking. You know, what are some of the common things that you see when people are sleepwalking? And what is the cause of sleepwalking? Generally speaking?
Yeah, well, we don't know what the underlying cause of sleepwalking is. It just is that some people have a tendency to do it and others don't, which would suggest that maybe there's a underlying genetic predisposition. It might be that their body doesn't do a good job of suppressing motor activity or doesn't do a good job of waking
up fully when it starts to do motor activity, for example. Right, So it could be something in that kind of pathway, because to sleep, you have to maintain sleep while you might actually have brain activity that would suggest wake for example. But what can trigger sleepwalking typically or the things that you might see like I had in residency, So excessive amounts of deep slow wave sleep that can come from chronic sleep deprivation, sometimes drinking alcohol can be a trigger
for it. Another thing that makes it more likely to have a sleepwalking event, for example, is being a kid. They have an awful lot of slow wave sleep, and so probability would be if you have more of the slow wave sleep and your brain hasn't matured enough to have all of these systems working together to promote stages of sleep or states of sleep, then there's a higher
chance that they might actually have an event where they sleepwalk. Right, Like, the trigger could be in them a bladder feeling full and they have to go to the bathroom, but it happens to be right in the middle of the deepest part of sleep where they're the most inactive. Well, that triggers them enough to become awake but not conscious. You have to be in the right state. So if you have more of that state, the deep sleep, then you're
more likely to have an event. And if you have a trigger in that state, well, then it's more likely that you're going to precipitate an event. About ten percent of people that will have a sleepwalking event about once a year or so.
Oh wow, and does it usually the person themselves who's becomes aware of it or is it sort of like sleep happneing like with myself, where it's a partner or you know, bed mate who brings it to the person's attention.
Yeah, it's about a mix. If somebody has something very clearly out of place or out of order, that might be a good indication. For example, with the sleep eating, some people come into their kitchen they're like, who cooked this meal in my house last night? Or they wake up and unusual contents like crumbs are in their bed and they're like, hey, I don't know how these got here. I think that's a good indication to people that something happened at night and it doesn't make sense. They'll check
their locks and think that they're going crazy. It's a great build up for a sci fi thriller, right, and then we now get this bed partner who is somebody who can finally observe our sleep for us again, And that's when typically these things come to people's awareness, is that they have somebody who's like, hey, you did this crazy thing last night, or hey you punched me in your sleep as everything okay, it sounded like you were
fighting off like a wolf or something. So it oftentimes most of our sleep disorders are recognized when people are sleeping in context. That's when you know, even if you're sleeping alone, you might catch it on these intermittent cases. But oftentimes it's things that are reported that are completely out of whack and people think is something wrong with them, but they're not likely to report it, like I don't
know what's going on. Normally it's a bad partner who's like, hey, that's weird, go check that out.
The more we learn about sleep science, the more interesting it becomes. Now, Chris, I'm curious as a medical doctor, what do you look for and what are your goals when it comes to getting good quality sleep?
Yeah, I love the idea of sleep metrics. I think the best way for people to really assess their sleep is are you still awake listening to this podcast? Meaning that do you struggle with excessive sleepiness during the day? So to me, looking at fatigue and sleepiness levels during the day, I think is probably the best way to determine whether or not somebody's a good sleeper. Somebody says to me, I'm so unsleepy that I can't nap. I've never taken a nap in my life. It's hard to
paint them as a bad sleeper. It's kind of like want a sandwich, Nope, want a strawberry nope? I want a cookie nope. Well, you're probably not hungry, so hard to paint that person to somebody who's starving to death. So, you know, to me, I think it's really about exploring.
Sleep studies are awesome, but it all starts with communicating with doctor Schneider and sitting down and having questions for him and exploring the things that are concerning you about your sleep and how sleep interconnects to other parts of your health. And you know, sleep studies are often very appropriate, but not always, so I don't think everybody should have
a sleep study. I think the secret to good sleep and my secret is I don't worry about it because I've learned enough about sleep to know that it's impossible not to. It won't be perfect all the time. We will have sleepless nights, but sleepless nights are a normal variant. That's what happens to people. It only becomes insomnia when you're scared of it. So understanding that I'm going to set aside a proper amount of time to sleep, I'm going to use it tonight or I won't. But that's
not something that I can really control. And you know, always tell people the secret to grade sleep is feeling as happy in bed awake as you are asleep. So I think that when you release fear from the process of sleep, it's incredibly empowering. So after you've done that, you create a schedule that gives you an ample opportunity to sleep. Start your time off every day at the same time you gotta exercise, you got to eat, write.
Mindfulness is not something the younger sleep doctor Winter would have told you was that important, but the older sleep doctor thinks it's everything.
So between sleep studies, communication and sleep metrics, it sounds like you have a lot of different techniques at your disposal, a.
Lot of tools, and the techniques are constantly evolving. The take of sleep study has become very popular versus strictly in lab studies, and the culture of sleep has changed a lot too, and I get a first row seat to that when I talk to sleep experts in my work with Mattress Firm.
I think throughout the years, the only thing that's really changed that we're now what we used to joke about. We're no longer joking about it, right. So we used to joke about and almost brag about how little sleep we need to function right, And now I feel like instead of joking about that, we're taking it more seriously
than we have in the past. It's still there, we're still saying the same thing, but instead of being proud that only got three hours of sleep, now it's I only got three hours of sleep, and it's not like you can make that up. It's lost, right. So I think making it more of a focus taking it serious. I think that's the big difference.
Besides the tools we talked about, both doctors had interesting ways to bring that extra bit of care to their practices. Logan explain that when doctors undergo sleep studies themselves, it helps them empathize with their patients.
Anytime you have a chance to walk in your patients shoes, I think is helpful, and doing a sleep study gives you a real understanding of what we're asking people to go through to help us understand what's going on in sleep and help them improve their lives.
And Chris shared how traveling the country and talking to people like Raoul helps him working with his own patients.
I think visiting mattress firms. Talking to sleep experts helps a lot with what I do. So I see patients every day, and I'm getting a certain group or collection of complaints. Either a patient had a complaint and they came to see me, or they saw a doctor who referred their patient to me. I don't know that I get to see the full array of problems that people have. In order for somebody to see me, it has to boil up to a point where somebody has arrived at
the decision to go see a doctor. So I feel like you're getting a much more organic swath of complaints and problems when you talk to somebody at a mattress for a meaning that somebody's not satisfied with their sleep, the sleeps. It's an interesting dynamic, and it's private. It's
a very personal topic. You know, if I'm buying, you know, a new frying pan because my old ones is kind of gross, that's not necessarily a personal communication I'm having with that store, you know, that manager or that clerk or that that sales representative. But when you're talking about sleep, it gets personal very quickly. So I find that the purchase of the bed product is the entry point. So I just find the stories that these sleep experts tell
me endlessly fascinating. So wherever I go, always try.
To stop it. We've learned a lot about sleep from experts and from people with very unique sleeping habits, and as this journey was coming to a close, I wanted to know what Logan and Chris considered to be a major component and find and keeping good sleep.
So the most important thing is keep a consistent routine. As long as you budget it enough time, your body will take what it needs. And then sometimes that might actually be less than you think. Right if you budget seven hours and your brain is only getting six hours, and then it wakes up and it's good to go, you might be lucky and get an extra half hour if you're finding that that extra hour of opportunity is not necessary, And then really set that routine, at least
in the time before bed. If you can't like structure your entire day, which is very difficult, but at least in that time before bed, say what are some things that can help me wind down? And always adhere to those. Make sure that the things that you enjoy so that you're wanting to do it, add things that help you sleep and pull away things that don't help you sleep, but make sure that the things that you add are enjoyable and budget that routine in because that's again just
like kids, we all rely upon routines. It's what structures our lives and makes our bodies and brains ready for the next step. And so make sure that you start at wake time, build backward, and then build a routine that promotes sleep.
With all the issues being studied, one thing is key. What you sleep on makes a difference. Roll you mentioned having a strong focus on quality sleep. Why do you think that's important? I mean, how does that affect performance?
I mean, we're all working hard. We all have to think, we all have to perform on our toes. Sometimes we have to make very important decisions, sometimes at the drop of a dime, so to be able to maximize that potential right go to work and really perform at that elite level. I think that's the difference waking up and not getting the quality of sleep and going to work and having to make these decisions when you're not at
one hundred percent or at your true potential. That can have devastating consequences, right, especially if you're in a position where you know you have a big responsibility. People think about health when you eat, health when you work out, But if you're not sleeping, right, I see it more as a triangle. If you're not sleeping, well, then it's it's It doesn't matter what you're doing in the gym or what you're eating.
That's all for this episode. Thanks for joining us this season.
If this was your first time tuning in, make sure to check out our earlier adventures, where we looked into the sleeping patterns of a marathon runner, a journalist working around the clock, a form an er doctor whose normal workday is someone else's emergency, a streamer who spends his nights reaching a global audience, a video game enthusiasts, a wildlife documentarian, and we even spoke to an astronaut and someone who lives in the Arctic Circle, where it's day's
day for months at a time. We want to hear from you. Leave a rating or review for our show on your podcast player of choice. You can find me on Twitter at Anahad O'Connor. We'll be back with more episodes of Chasing Sleep in the new year, but until next time, hoping you're living your best while sleeping your best. Chasing Sleep is a production of iHeartRadio in partnership with Mattress Firm. Our executive producer is Molly Sosha. Our EP
of Post is James Foster. Our supervising producer is Keia Swinton. Our producer is Sierra Kaiser. Our researcher and writer is Eric Leijia. This show is hosted by me annahad O'Connor