Transcript:

Ben Smith (00:26):

Welcome everybody to the Retirement Success Main podcast. My name is Ben Smith. I'm one of your co-hosts here on the show today. Listeners, I hope you're all doing well. If you'd like to be a part of the show, please feel free to email us at bensmith@guidancepointrs.com, or you can connect with us on YouTube, Facebook, or LinkedIn. Just search for Retirement Success in Maine podcast so you can find more of our show. And now I'd like to welcome the calm to my chaos, Curtis Worcester. How are you doing today, Curtis?

Curtis Worcester (00:54):

I'm doing well, Ben. I'm doing well. I don't know. I think we might both be chaos today, but that's okay. We'll get through it.

Ben Smith (01:01):

I get you. Yeah. Well, I know obviously in our episodes of our show we touch on a lot of topics, but obviously we want to talk on something that talk that really impacts every single one of us, but often doesn't get the attention it deserves. And that's sleep.

(01:17):

And as someone that I have a child in fifth grade who has been sick a lot, I've not gotten a lot of sleep lately, so I can feel like this is going to be a pretty helpful topic. But as retirees seek to live healthier, more fulfilling lives, getting good quality sleep is often overlooked as a critical key to success in aging. Well, and we've all heard the phrase, I don't sleep as well as I used to, or I just don't need as much sleep anymore. But is this really a normal part of aging or are there deeper issues that can, it should be addressed? So in this episode, we're going to explore why improving sleep quality is one of the most powerful ways to boost physical, emotional, and cognitive health. In retirement. We'll uncover how better sleep helps prevent memory decline, manage stress, and even reduce risk for chronic illnesses like heart disease, from identifying common but overlooked sleep disorders like sleep apnea to practical strategies for achieving restorative high quality sleep.

(02:17):

This episode will provide actionable insights for our listeners. So we'll also discuss some of the myths about sleeping that might be holding retirees back from addressing their sleep struggles, like relying on sleeping pills or believing they simply need less sleep as they age. Whether you're struggling to fall asleep, stay asleep, or wake up feeling refreshed, today's conversation will help you take steps towards reclaiming better sleep and as a result, living a better life. So if you're ready to learn how prioritizing sleep can unlock more energy, clearer thinking, and greater vitality in retirement, stay tuned. We've got a fantastic expert to guide us through why sleep truly is the key to aging better. So let's dive in.

Curtis Worcester (02:55):

That's exactly right, Ben. And again, you teed me up perfectly here. So our guest today is a board certified sleep medicine specialist based in Savannah, Georgia. With over three decades of experience, our guest transitioned from a distinguished research career focusing on sleep disorders in psychiatric patients to a pioneering clinical practice. His expertise began in 1988 at the University of New Mexico School of Medicine where he co-authored the first randomized controlled trial on imagery rehearsal therapy or IRT for nightmares. His subsequent research at the Sleep and Human Health Institute resulted in extensive publications on IRT and the Landmark Manual Turning Nightmares into Dreams. Fast forward in 2001, our guest groundbreaking work on nightmare treatment in PTSD patients was published in JAMA, establishing him as a leader in the field. His research illuminated the significant comradery of sleep disorders in mental health patients, particularly PTSD sufferers, highlighting the prevalence of sleep apnea in this population.

(04:07):

His clinical practice and research have been featured in prestigious medical journals, including the American Journal of Psychiatry, chest Sleep and the Journal of Traumatic Stress. His contributions to sleep medicine extend beyond research as evidenced by his comprehensive guide, sound, sleep, sound Mind, which introduced Sleep Dynamic Therapy. He has conducted extensive training workshops worldwide, including military bases, veterans medical centers, and civilian mental health institutions emphasizing innovative approaches to sleep disorders in mental health patients. Since relocating to Savannah, Georgia in 2020, he has continued his pioneering work of offering innovative sleep coaching services and collaborating with Gateway Behavioral Health Community Service Board to integrate sleep medicine into psychiatry residents training his ongoing research and publications, his commitment to advancing sleep medicine and mental health treatment. His current academic appointment is professor in the Department of Psychiatry and Behavioral Health at the Mercer University School of Medicine. So after that very in-depth background, please join me in welcoming Dr. Barry Krakow to the Retirement Success in Maine podcast. Thank you so much for coming on our show today,

Dr. Barry Krakow (05:27):

Ben and Curtis. Thank you so much. I do have to say though, that introduction was so long. I got a little sleepy. Delighted to be here. Delighted to be here. Thank you, gentlemen.

Ben Smith (05:38):

Yeah, well our pleasure to have you on. And Dr. Krakow, we want to also be mentioning too, you have a book out lifesaving sleep, so we'll be talking about that a little bit throughout the show. But just want to point folks right now, if you're listening, you can go to Amazon and Dr. Krakow is showing this on screen. For those that are watching this on YouTube, you can go on the Amazon, you can look at that book. So just want to point out now, we will point it out again at the end of the show. It is also going to be in our show notes as well that you can get a link to that. So want to mention that right up front, Dr. Krakow, but also for us, we also wanted to get to our know our guests a little bit and hear a little about you. So love to hear a little bit about your upbringing and how your experience at the University of New Mexico School of Medicine led you down a path of sleep study and expertise.

Dr. Barry Krakow (06:27):

Well, like most if not all things in life, divine providence has a lot to do with where things start and end. I was trained as an internist, I'm not a psychiatrist, trained as an internist and spent about a decade doing internal medicine, emergency medicine, addiction medicine. And then I was actually in a situation where I started working with a bunch of psychiatrists at the University of New Mexico on this treatment for chronic nightmares. And that work was so interesting. I realized that the unexplored field of sleep medicine was going to be my home. And from that point forward, I was diligently involved in sleep medicine, both the psychological and the physiological aspects. And the part about this that was so surprising to me was that when we started the Nightmare Treatment Program in 1988, we looked at that as a obviously psychological phenomenon. We're treating trauma survivors, people with PTSD, post-traumatic Stress disorder.

(07:31):

And yet over those next few years, we were stunned to discover that most of these trauma patients with these very intense psychological disorders were also suffering physiological disorders, namely sleep apnea, and in some cases a condition called restless legs and leg jerks. And so our career pathway with our research group and our colleagues went for the next three decades looking at this and regularly finding the same thing that people with insomnia had sleep apnea, people with PTSD had sleep apnea, those with anxiety and depression had sleep apnea. And so we had to find ways to join these treatments because normally people just will go over to that place and get that psychological treatment or go over to that place and get that physiological treatment. But at our sleep center, we wanted to work on both. And so we ultimately developed techniques so that we could help people in all aspects.

(08:32):

And let me just say to wrap that point up, the beauty of this and the part that's the most amazing thing for those suffering from mental health conditions to hear is that when you treat a sleep disorder, you actually are treating the mental disorder as well. You actually will get benefits. In the JAMA paper published in 2001, the reason it was was because not only did we treat the nightmares with this non-drug treatment, but the PTSD actually got better, markedly better just by treating the sleep disorder that we all understand is nightmares, which many people have disturbing dreams, but people with chronic nightmares have them all the time.

Curtis Worcester (09:16):

I appreciate that. And so I know that you just went through your path, your group's study. Can we just zoom out a little bit and maybe talk about the history in general of medical professionals understanding sleep better? How has sleep science evolved over time?

Dr. Barry Krakow (09:34):

So if we use the umbrella term medical professionals, that's very easy. That would be zero zero. So most people in medicine know almost nothing about sleep. They may ask a few questions here and there, and of course some doctors are more curious and more interested and even more knowledgeable because they've recognized that sleep is a big deal. So in the general field of sleep medicine, only some primary care doctors, some cardiologists are paying attention in the field of sleep medicine itself. Unfortunately, you do have a bit of a silo effect where there are those very interested in sleep medicines approach to sleep apnea, like lung doctors, pulmonologists.

(10:19):

But then you have the neuroscientists and they're very interested in insomnia. And as I'm trying to bring about here, that's a problem because those two disorders are connected. And so those two groups of doctors should be talking to each other all the time and they're not. And so that's, my books have been about frequently describing how a person must recognize that most sleep disorders are pretty complex. I'm not saying they're complex, so difficult to treat. I'm saying they're so complex because the doctors working with you don't get the complexity. They think it's this one thing, but it's really three more things, or they think it's two things, but it's five other things. And that's an unfortunate thing that's happening in the field of sleep medicine is suffering for it because as you probably have heard the rumors from so many people that a lot of people can't stand C pap to treatment for sleep apnea. And so lots of doctors throw up their hands and go, what am I supposed to do? And so that's an area that's created more of this confusion.

Ben Smith (11:20):

Gotcha. Well, Dr. Krakow, so we are going to talk a little bit about obviously why getting better sleep is a key to aging better here. So that's the general theme we want to get into. I think there's, from a foundational perspective, I think it's going to be really helpful where obviously you upsize that poor sleep quality is not just an inconvenience, but a major contributor to health problems. So can you start by explaining what happens to our bodies when we experience bad and broken sleep over time?

Dr. Barry Krakow (11:46):

Absolutely. A great starting point because where people have for centuries disrespected sleep includes not just medical doctors, it's also society tends to disrespect. Sleep is largely because you can't see your sleep. You can't know your sleep other than of course you could wake up a lot or you could feel lousy when you wake up. But even then, the largest majority of people who would say that, they go, well, if I woke up and I didn't feel good, I've got about two options. I can drink a lot of coffee and I'll be just fine. Or I can say, well, this is who I am. This is just the way I sleep, nothing I can do about it. You know what? I think I'll go back to bed and pull up the covers and go back to sleep and see if I feel any better. I mean, you don't have a lot of options if you've never thought about it and your doctors aren't asking you questions.

(12:38):

So where this is going to change going forward is when people realize that when we talk about sleep, we're only talking about one thing. And if you grasp this and you digest it and absorb it, you'll go, oh, maybe this is a really big deal. And that one thing, of course is your brain. So your brain is what is the problem when you don't sleep well? When you don't sleep well, you are actually, and this is crystal clear, this is not an exaggeration. When you do not sleep well, you are suffering brain damage. Now, as soon as you say that term, you'd like to think, anybody who heard what we're talking about, it's going to go, well. Wait a second. Well, what are you talking about? Well, as you said at the outset, if you're talking about people that are middle-aged or older, they're thinking about what's going to go on in their later years. What's one of the things they're always talking about? My memory, my attention and my

(13:35):

Concentration.

(13:36):

Well, guess what? If you have brain damage, you're not going to have as good a memory, attention and concentration. It's that simple. So why is that the case though? Why is it? Well, it really should again be logical. Why are you even going to sleep? You're going to sleep because your brain says, I need rest.

(13:55):

I

(13:56):

Need restoration. I need removal of waste products. I need to get a cleaning in here, as we love to call it, my brain needs to be washed. So there is such a thing called healthy brainwashing, and there's a system inside the brain called the glymphatic system, and we know that it operates mostly while you're sleeping. And we know it operates best when you do what, when you get high quality sleep. So in a nutshell there, you see where we're going with this. You've got this very big deal that you can actually evaluate yourself and you can say, well, wait a second. You know what? I am starting to not remember name. I'm not remembering phone numbers. Of course my phone's remembering my phone numbers now. But certain things about your memory, your concentration, your attention, you go, wait a second, am I getting older? Well, that's what's unfortunate because in the medical profession, you go to a doctor with those where you're getting older, you're aging. Why are you worried about that? What the doctor should be saying is, let's investigate your sleep.

Curtis Worcester (14:59):

I love that. And I can say, you just got my attention because I probably don't sleep enough. And the words brain damage. You're exactly right. Stick out to people. I want to ask a question that you just led right into actually with your answer. So something that Ben and I hear quite a bit just in our conversations with clients or older family members, it feels common, which is what you just said, it feels common to hear people say that they're sleeping less or maybe waking up more frequently in the night. And like you said, I think people think that's a natural part of aging. I think the answer to my question of is that natural part of aging, it sounds like no, but are there underlying, I guess, kind of walk through the underlying sleep disorders that maybe do go unrecognized there?

Dr. Barry Krakow (15:41):

Absolutely. Before we get to the actual disorders though, let's just point out what normal sleep really is. In other words, when somebody ages, there is some truth to the fact that you might sleep a bit less. That could happen. You could also sleep more. But the bottom line is you've got to ask yourself, well, what is my sleep compared to the normal sleeper? Dr. Krakow is now going to describe because most people kind of go crazy when I say all this and they think that's not possible. It's not possible that that's normal sleep, but it is normal. Sleepers do really funny things. They get into bed at night and they go to sleep

(16:20):

And then they sleep through the night. They may wake up a couple of times, but it's for a slight arousal. They roll over, they go back to sleep. It's no big deal, big one, they don't get up at night to use the bathroom to pee. They do not get up at night to urinate. When they wake up in the morning, they have so much energy, they jump out of bed, they jump into the shower and they start singing. And if they're not singing, their mind is racing with all kinds of creative thoughts about how they're going to carpe diem and seize the day. They just got all this energy and then they're going to go about their day with high energy. They're going to have good memory, concentration, attention pretty much all day long. They're going to be active. They're probably not going to drink any caffeine.

(17:07):

They might have a very small dip in the afternoon of energy. What do they do about it? They get up and they walk around for a minute and the next thing you know that dip is gone. But here's the big one. Here's the real tell about somebody who's a normal sleeper. Rarely in the evening hours are they sitting watching a screen. They're not watching a movie, they're not watching a show, they're not looking at their phone, they're doing something, they've got a hobby, they're helping their kids with their homework. They're working on a repair in the house, they're exercising, they're involved in a community project, they're very, very active. And then finally they have their wind down period and do that really funny thing again where they get into bed and they go to sleep and they repeat this all the time, ad nauseum. And other people when they hear about it are super sick of it.

(18:01):

They don't want to hear about this. This person is an absolutely normal sleeper. And they're going, how do you do that? And the funny thing is, a lot of the people who do that, they're just genetically programmed like that and they don't get sleep disorders and they are so blessed to have that sleep. The rest of us, which by the way is more than 50% of the population, and it may be even higher according to some recent data, don't get that normal sleep. We get broken sleep, which means in a nutshell that the sleep patterns that we want are not there. Instead of being consolidated and rhythmical, they're fragmented, they're broken up. And so the brainwaves literally, instead of looking like, let's call it a peaceful rolling landscape, beautiful green meadows, some figurative picture of that, this is more like a jagged dense jungle where everything is chaotic and that's what sleep fragmentation is.

(18:57):

Instead of the brainwaves being rhythmical, the brainwaves are just a pile of junk and the person is constantly waking up. Sometimes the person can wake up 500 times in the night each time for like five seconds, 10 seconds, 15 seconds, maybe even 30 seconds, but they never know it. They think, well, I woke up a couple of times, but no, they're arousing is the sleep medical term hundreds of times, and therefore, of course their sleep is fragmented and therefore, of course sleep fragmentation leads to brain damage because the brain didn't get the rest it was supposed to get.

Ben Smith (19:34):

So yeah, Dr. Krakow. So that's really interesting to hear because obviously from what you're describing where you're going, here's the Rolling Meadows, and obviously that sounds like the sleeping quality part, which I know is a lot of your work is around sleep quality. So obviously if I have these fragmented sleep patterns that's happening, I'm having arousals all the time. And so it sounds like simply is that just since I said, well, I'm tired, I should get more of that sleep, perhaps that isn't the answer because I'm not really improving the quality of the sleep. I'm just getting more of these kind of broken waves.

Dr. Barry Krakow (20:13):

Well done, well done, Ben. I'm ready to, I'll put you on staff here and be the next sleep coach.

Ben Smith (20:20):

So just kind of logic one plus two equals three, so can talk about that a little bit. So we said we now identified quality is an issue, so can you explain on how do we improve then the quality of the sleep I think with me is like, I am tired. I'm just going to go to bed early tonight and hopefully that's the thing that gets me back to being rested. So if that's not the case, then how do I get the quality back,

Dr. Barry Krakow (20:44):

Right? So Ben, you've hit the jackpot because here's where it's so hard for people to think about this because they're so used to hearing what the media and doctors, well, you got to get eight hours of sleep or you got to get seven hours. It's all about quantity, which is a complete red flag. Your goal isn't how long you sleep. Now obviously there's exceptions. People have different schedules, night shift workers, babies crying in the middle of the night. I mean, there's all kinds of reasons why sleep can be shortened and you have to deal with that. And yes, you might have to get a nap during the day to get more sleep, but over the long haul, if you're focusing on the number of hours, it's what you just said like, oh, so you want to get some more hours of your bed and broken sleep?

(21:33):

No, you want to be able to figure out if your sleep is bad and broken. Because if you figure that out, then you're going to say, well, okay, then maybe I will be motivated. Because even though you asked the question, Ben, very nicely, most of your listeners and most people who hear about sleep, they're not going to go there. They're still going to say, well, that couldn't be me. I don't have that. I'll just try to get some more sleep. That sounds like the easiest fix. So I'll do that. So let me give you something we use in sleep medicine all the time that we call one of the most important, and it sounds like a funny concept, but one of the most important selling points, and I'm going to compare it to what's not. So for example, if I saw a patient and they came to me and they go, I don't know, there might be something wrong with my sleep.

(22:19):

And I say, okay, well do you snore? And I go, yeah, I snore. So what I say, well, would you like your snoring to go away? He said, well, no, my wife would, but it doesn't bother me. So I go, we learn over almost 25 years ago that we don't even talk to our patients about snoring anymore. So waste of time snoring is something that's actually, if you think about it, a deeply emotional issue because if you snore and you interfere with somebody else, you're actually injuring their sleep and you're giving them brain damage. So when you reflect on that, you're going to go, wait a second, I'm embarrassed. I'm ashamed, and I'm guilty of doing that to somebody else. Why would I ever want to talk about snoring? So snoring is not a good topic. Snoring makes people feel really uncomfortable, and people lie about their snoring, they won't even tell you about it.

(23:12):

So we learned over 25 years ago, when you want to talk about certain sleep issues, you don't go there. So here's the one we talked about because it's so remarkable why I'm going to ask you guys first and then I'll come back to it really quickly. Why do people wake up in the middle of the night to pee? And just so you're clear, primary care, doctors, urologists, even some sleep doctors, even some gynecologists and obstetricians will say they're waking up at night to pee once or twice a night is normal. Okay, so why do people wake up at night to pee as far as whatever you've heard?

Ben Smith (23:46):

Just they drank too much before.

Dr. Barry Krakow (23:48):

Yeah, I was going to say

(23:49):

Fluid. They drank too much fluid. That's the number one reason people give. Okay. Can you think of anything else about the human body having to do with the genital urinary system that might cause a person to wake up at night to pee?

Curtis Worcester (24:02):

I don't know if it's a, I guess where I think your question that is making me go is I think once you're awake, you then your body thinks you're awake and you have to go to the bathroom

Dr. Barry Krakow (24:12):

Sort of. I mean, after all, you do have a prostate. If you're a man, you do have a bladder if you're a man or a woman. And if these things are activated in some way, whether you have a problem like benign prosthetic hypertrophy and large prostate, everybody's told by their doctors, well, you've got BPH H. So that's why you wake up at night to pee. And with women they say, oh, well, you're getting older. You've got an overactive bladder. Okay, so that's on the table

(24:42):

And we all think that's the answer. So here's the selling point, which is just unbelievable, and I've got a five minute video on this, my website, barry Krakow md.com. And what it explains is that when you're having all these arousals and awakenings greater than 90% of the time, it's because you're having a breathing event. You're having some struggle with your breath, and we'll get into more details about that later. But that struggle with breathing puts a tremendous amount of pressure on your chest because your chest is saying, wait, I can't get air in. My airway is collapsing a little bit. I want to pull more air in. And when you do that, all that chest pressure forces all the blood or a certain amount of blood in your chest cavity to move towards your heart at a much faster rate, and it actually pushes into what's called the right atrium of your heart.

(25:39):

Now, fast forward through the whole process. The right atrium thinks, wait a second, I've got too much fluid in the heart. This is a danger. I better do something about it. What does the right atrium of the heart do? It releases its own manmade diuretic in your heart, it releases a diuretic, goes to your kidneys, says Make more water. Now, release that water because that will be safer. With all this extra fluid floating around, which really isn't extra, it just got pushed into the heart. The heart gets confused, it senses the fluid buildup and it thinks I'm overloaded. The diuretic gets released, the kidneys pass more water. You wake up and start peeing. That means if you take a sleep apnea patient, you treat their sleep apnea, guess how many times they wake up at night to use the bathroom to pee?

(26:31):

None.

(26:32):

Zero. Zero.

(26:33):

Yeah.

(26:33):

So we've seen patients who come to us with 3, 4, 5, 6 trips to the bathroom at night, and let's say they have a prostate problem, they get down to one trip a night and they go, this is amazing. I used to get up five times a night. I'm getting up once a night. Now we've seen people come in with one or two trips to the bathroom and they go down to zero and they're going, how is this possible? So you see, this is now a selling point because who wants to wake up at night to pee? Almost nobody. There are some people who don't care, by the way. They just wake up, they pee to go back to sleep, who cares? But you should care if you're elderly. Why? Because it's one of the leading causes of hospitalizations and death that you wake up at night to go pee and you fall and you break a hip leading cause. And yet all of these doctors don't know what I just told you about this pathophysiology.

(27:25):

So

(27:25):

You can see if you're talking to somebody about sleep quality and you say, well, by the way, in addition to your sleep quality, we're actually going to change something in your whole genital urinary system so you don't have to get up at night to pee. Now you get people saying, well, I'm kind of interested. Tell me more. What can I do about this? And the beauty of this is it's just the beginning. I mean, sleep apnea, sleep disorder, breathing has so much to do with the brain, with the heart, with the kidneys, with high blood pressure, diabetes with pain management. I mean, the list goes on and on and on because it has to do with sleep quality allows your brain to be restored properly, and sleep apnea is the number one destroyer of sleep quality by causing all of this fragmentation. So that helps people get to that place where they go, alright, I'm ready for the buy-in now what do I do about it?

Curtis Worcester (28:24):

Yeah, yeah. No, I love that. And this is just fantastic. Again, for a lot of reasons. I feel like I'm learning. Well, you just said it. We're learning things that some doctors don't learn. So here we are. So I have a question here. So I guess going towards that, trying to fix our sleep, right? I think a natural self fix that we hear and see many retirees do is using sleeping pills to address their insomnia. Again, you point out that these medications don't necessarily improve our sleep quality. So what are the risks that we can relate to people on relying on sleeping pills and maybe what alternatives would you recommend for people?

Dr. Barry Krakow (29:06):

It's a great question because they just had a research study come out this week, just came out this week showing that the drug Ambien actually may inhibit your brainwashing system at night while you're sleeping and therefore increase your risk for dementia. So that brainwashing system that I was talking about, which has only been discovered just a decade ago, and they're now understanding its importance, that same research group just released the data this past week

(29:39):

Showing that ambient inhibits the way the glymphatic system operates, and the glymphatic system is supposed to work to clear out the toxins from your brain. So sleep doctors in the know, and this includes many by the way, many sleep doctors have known for a long time that sleeping pills are not the answer. Sleeping pills are a short term fix that absolutely can help certain people in more urgent or crisis type settings, and that's just fine. Why wouldn't we help somebody in that setting? But to get somebody hooked on sleeping pills or to get somebody thinking that a chronic use of sleeping pills is the approach, it doesn't make any sense because when you're a sleep doctor, you get to look at these sleep studies that show all these different brainwave patterns. And most of the time when people are using sleeping pills, you're going, well wait, that person isn't getting the REM sleep they're supposed to, or that person isn't getting the deep sleep. I wonder if they realize that the pills they're taking, and by the way, this isn't just the sleeping pills. Sometimes this is the psychotropic medications like the antidepressants or the anti-anxiety pills that are also causing the same difficulties, not letting the person go into the best stages of sleep.

(30:55):

So number one, when you're thinking about your sleep, sleeping pills are at the bottom of the list, not at the top, they're at the bottom. They're a last resort treatment that can be used and must be used sometimes because some people are so deeply psychologically wound up that a sleeping pill might be the only answer. So we're not going to withhold that from them, but we don't want it to be the primary treatment pathway to begin with. We want to look at and say, well, what's actually going on with your sleep? And if the answer is it's a breathing disorder, the first thing we're going to do, and this is I go through this extensively in my newest book, life Saving Sleep, is to realize that if you say the word CPAP, you immediately are going to get people running in the other direction.

(31:42):

So we've learned to not do that anymore, even though CAP can be very good for people, and I'll explain the pros and cons of that later if you want me to, but we explain to people if your breathing is part of the problem, then let's start with an evaluation of your breathing. Don't talk to me about sleep tests yet. You don't even have to do a sleep test. Do an evaluation of your breathing. So I say to people, go in the shower, clean out your nose as best you can, do some steam in the shower, if that helps. When you come out of the shower, take a deep breath through your nose and ask yourself what you hear, because what you hear should be nothing. It should just be breathing air in and out, right?

(32:25):

The next question would be, what do you hear all day long? It should again, be nothing. So we call this zero tolerance policy that people can breathe through their nose pretty much all the time. Of course when they're talking, you have to breathe through your mouth some, but you breathe through your nose and you're not constantly having a dry mouth when you wake up in the morning or constantly having a dry mouth during the day because of mouth breathing. And when you evaluate all of that, many people discover there are mild elements or greater of congestion. They may have hay fever, they may have a stuffy nose, they may have a runny nose. And what do they do with that? They normalize it. They go, oh, well, that's just me again. Well, no, it's not just you. It's something wrong with your nose. Some people have to see an ear, nose and throat doctor and look at a deviated septum or swollen terminates or look at their tonsils. All of these things can be done in the early phases. And you get to the point where we say to them, now that you're doing this evaluation of your nose, let's maximize your nasal breathing. Let's look at some nasal sprays, some nasal strips, some nasal dilators, some techniques like neti pots, some techniques like navage. Do everything you can to maximize your nasal breathing. And guess what happens? They start sleeping better.

(33:46):

So this is why it's so beautiful. We learned this over 20 years ago. You can give people nasal saline sprays just a bottle of nasal saline, and you go squirt that in your nose five times a day throughout the day and clean out all the junk out of your nose. Within one to two weeks, that person will come back and say, doctor, this sounds crazy, but I'm already sleeping better. I say, of course you are. Your nose is clearer now. So that of course adds to the buy-in because the person goes, you mean just with those little steps? I'm already sleeping better and you're saying you can actually make me sleep even more better by doing more things for my breathing. And we say, yes, we can. Now each person is different. We've had many, many people get on the nasal strip routine and they'll use it for a year.

(34:38):

They'll use it for three years because they don't want CPA, and they will say, I'm just fine. I've done great with my nasal strip. So that's it. I don't want anything else. But eventually people want more because they realize they can get more. One of the next entry level places is called dental devices. These are specialized pieces that fit into your dental arches and hold your jaw forward, and it makes for a larger airway in the back of your throat. And then of course, ultimately there's CAP, and lemme just finish on CPAP to say we stop prescribing CPAP in 2005.

(35:10):

And the reason we stopped it is because it's too difficult to use, it's uncomfortable, and it really doesn't work that well. The more advanced devices in sleep medicine are called bilevel devices, and it sounds really obvious and common sense bilevel gives you high pressure when you breathe in, which is what you want and what's needed. And then it drops the pressure to lower so that when you breathe out, it's still breathing out against pressure, but now it's a lower pressure. So bilevel works much better for most people. That's what we switched to. And people in particular who suffer from anxiety almost never can tolerate CPAP. And so we get them on these advanced bilevel devices.

Ben Smith (35:49):

Gotcha. So Dr. Krakow, so you've talked a few things about the role of deep sleep here and things that are disrupting, right? So you talked about interacting medications, you've talked breathing here, and obviously it's really important deep sleep with REM and Delta sleep and repairing that mind and body as you said, that kind of the brainwashing mechanism here. Just be interested in hearing some of the other lists here of some common disruptions that prevent especially older adults from achieving these critical sleep stages. What other things are on your checklist that you would look

Dr. Barry Krakow (36:19):

At? So as you age, one of the most important ones you have to be evaluated for is the condition called restless legs and periodic limb movement disorder. So we just call it leg movement problems. You can have them while you're awake. It's that antsy feeling you can get in your legs and you want to move them, and it makes you so antsy. You may not even be able to go to sleep. The leg jerks is the unusual phenomena where your legs are moving even just a little bit while you're sleeping. They did a study in a nursing home, this is over 10, 15 years ago, maybe 20. And in this nursing home, the people were, I think over the age of 70. Every single person who was studied had movements in their legs, every single person.

(37:03):

Now, of course, a nursing home cohort is not going to be as healthy, so that may have added to it. But as you get older, it's very important not to miss that diagnosis because leg movements can interfere with trying to fall asleep and can interfere with staying asleep. So that's a big one. Another couple of areas to think about that are very important in terms of simple behaviors are that the temperature in the bedroom may have a critical role in someone's sleep, whether they're a normal sleeper or somebody who has a breathing disorder. It just seems to be that cooler bedroom temperatures are better for most people. But here's an ironic finding in that regard that's hard to make sense out of. If you're an insomniac, you'll often end up with very cold hands and feet when you go to sleep. Why? Because insomnia patients have more anxiety, and the anxiety does something to clamp down circulation a little bit as you get towards bedtime. So many insomniacs would never want to get into a bedroom or a bed that's cold, how's that going to work?

(38:13):

But then what happens is through the night, they actually do start to relax. And so now if they're all bundled up, what's going to happen? They're going to wake up and go, oh my God, I got all of these covers on me. And so they have a dilemma there. But if they understand how it operates, they might try something as simple as, let me do a really, really high temperature, but high temperature bath or shower so that my body is actually warm by the time I get into bed. This has actually been proven in a scientific study at Harvard 25 years ago. And then when I get into bed because my body temperature starts out high, it actually starts to drop faster, which is good because that actually helps you go to sleep. So in normal sleepers, whenever they get into bed, they release their melatonin just before bed usually, and the melatonin leads to your body temperature dropping, and that dropping in the temperature is absolutely associated with your feeling sleepy in your head, and now you go to sleep. And that's another big distinction to help people, especially in the retirement years, because so many people in retirement report early new insomnia. And why did that happen? Well, because they were used to this whole active lifestyle

(39:34):

And this whole specific routine, and now they think, well, I'll keep the same routine. Well, that's not going to work because you're going to get into bed and what are you not going to have when you get into bed? You're not going to have that sleepy feeling. You've not been anywhere near as active as you'd been before. You've not worn yourself out. You've not gone through all kinds of different encounters and experiences that help you gain satisfaction on the day where you go, all right, well, my day is closed now I'm emotionally regulated. I'm ready to have a great night of sleep and have some dreams and wake up tomorrow and have a great day. No, in retirement, you're going, oh, it's 11. I think I'm supposed to be in bed now. Okay, I'll get into bed here. Hey, I'm still here. Oh, wait, wait, I haven't gone to sleep yet. Oh, when am I going to go to sleep? And it is crazy. Happens to many, many people in retirement. We say, well, you're not sleepy. You can't get into bed yet. You've got to figure out a different routine to get sleepy. And for some of those people in the early phases of retirement, they might end up sleeping less.

Curtis Worcester (40:37):

Interesting. It is. And so Dr. Krakow, I want to bring up your book again. So again, lifesaving sleep. You mentioned in that book the breathing disorders like sleep apnea are often missed, right? Especially in people who may not display the typical symptoms like snoring. I know we were just talking about this. What are some surprising signs that again, for our audience retirees should look for to identify potential sleep disorders?

Dr. Barry Krakow (41:06):

So the most important symptom of all is a person wants to be able to evaluate how they feel when they wake up.

(41:13):

So sleep is supposed to be restorative. So if you wake up in the morning and you're tired or you're sleepy or you're low energy, you should immediately say, there must be something wrong with my sleep. But in addition to that, there's some other sort of peripheral markers. Getting up at night to urinate is clearly a sign of sleep apnea. Waking up in the morning with a headache is a sign of sleep disorder breathing. Because what happens is your body is not releasing as much carbon dioxide as it should, and the carbon dioxide is festering in your brain, causing your blood vessels to dilate inside your brain, and that gives you the sense of a headache. You can also wake up in the morning with a dry mouth, poorly controlled blood pressure is a huge indicator of likely sleep. Ap all cardiovascular diseases and strokes often have an association with sleep apnea.

(42:10):

Cardiologists are the only other group in all of medicine, even more than psychiatrists and psychologists who are routinely ordering sleep tests on their patients because so many cardiac arrhythmias are linked to sleep apnea. So you can see there's all kinds of interconnections between sleep and other disease processes that the individual would like their doctor to know this. But if they don't, they can do their own homework and ask the question, well, is this thing I've got going on? Could be that related? I mean, even glaucoma, there's a form of glaucoma that's absolutely related to sleep apnea. And so people have got to realize their doctors just may not have this information.

Ben Smith (42:53):

Well, I think there's a lot of good tips in there, Dr. Krakow. And I think one thing obviously we want to do with our show, and especially for listeners who want to take that first step towards better sleep and healthier aging, want to just, if you were giving them like, Hey, I have a two minute answer that would say, here's some practical advice or tools, where would you recommend that they start with tonight to improve their sleep quality?

Dr. Barry Krakow (43:17):

I would say, I would say that they should buy my book Sleep,

Curtis Worcester (43:22):

Of course, of

Dr. Barry Krakow (43:23):

Course, number one, and spend a couple of minutes reading that. But I would say that on a psychological front, the life that we live in the 21st century tends to be ridiculously hectic. And even when you're retired, there's just still so much going on. And the thing about sleep is it absolutely should be sacred. Sleep is a time where you're trying to restore your body and your brain, and you have to ask yourself the question of, are you satisfied with today? If you're satisfied with today and you're looking forward to tomorrow, that alone is going to make you a better sleeper. And if you can get into bed, and some people feel very strongly about this, I know I do. Some people actually make special prayers when they're about to go to sleep or right before they go to sleep because they recognize that they've had this great opportunity to live a fulfilling day, and they're hoping that they can be a better person the next day, and they know that a good night's sleep will help them.

(44:24):

So that kind of thing, again, also helps with sleep. But ultimately, I will come back to be honest with yourself about your sleep. Don't write it off. Ask yourself the questions we've talked about in this program. Be honest with yourself and say, do I have the energy I want because my sleep gave it to me, or am I doing something else like drinking caffeinated beverages? And that's the thing that's really giving me my energy. And if I really was honest with myself, I'd realize I've got a sleep issue and I need to work on it. That's the most important thing because if you do that and you recognize there's something you can treat, you are going to be very thankful you put time and energy. I know I have been for now over 26 years, very thankful, putting in the time and energy, treating my own personal sleep problems.

Curtis Worcester (45:14):

I love that I know what I'm doing. I am not a good example here. I drink a lot of coffee. So now I'm going to try to focus on my sleep. How about that? So we have one kind of final question for you here. It's a little different naturally. The name of our show, the Retirement Success in Maine Podcast, I have to ask you a retirement question. The question is, doctor, how are you going to find your personal retirement success when that day comes?

Dr. Barry Krakow (45:48):

The question's a little bit tricky for me because I don't believe in the concept of retirement. It just doesn't occur to me why I would want to retire. I'm not saying I'm trying to overwork myself

Curtis Worcester (45:59):

Still,

Dr. Barry Krakow (46:00):

But I'm finishing up another book. I still want to be involved in research. I still coach clients online for sleep, and I still trained psychiatry residents in how a treated sleep disorder. So I personally believe that the word retirement doesn't fit my vocabulary. It may for many people, and I'm not in any way criticizing them for that, but I would say that for anybody, I believe you want to stay active.

(46:28):

I

(46:28):

Think it's very important to stay active in something that is you're passionate about, whether it's a cause, whether it's volunteer work, whether it's politics, whether it's a religious organization. I think staying very active is crucial to a successful retirement. I

Ben Smith (46:44):

Love that, Dr. That's an amazing answer. Appreciate you sharing that with us. And also just thank you for coming on our show. Really, really just insightful to hear a lot about your expertise around sleep. I know Curtis and I learned a lot today. I'm sure the listeners did too. But again, we will put all that links to your website, the book on our show notes, so folks can just kind of take a look with one click again, read more. I know there's a lot in there. We have our homework assignment too, as we're going to take a read and listen in. So Dr. Thank

Dr. Barry Krakow (47:21):

You. There's also a free newsletter on substack.

Ben Smith (47:25):

Yes. It's called

Dr. Barry Krakow (47:26):

Fast Sleep, do substack.com, and then my main website has a number of resources on it, including the sleep coaching, the Barry Krakow md.com. Thank you.

Ben Smith (47:35):

Awesome. Perfect. Thanks for mentioning that. So we'll post that there. But Dr. Krakow, thank you so much for coming on our show. We really appreciate it. We hope to catch up with you now the time.

Dr. Barry Krakow (47:44):

Good to be with you.

Ben Smith (47:45):

So I was really excited that we are able to get to Dr. Barry Krakow on today. He was, again, kind of sleep is something where I think every one of us, we could talk about it, and I'm sure there's a lot that all of us are doing wrong. I know I learned a lot from a breathing perspective, from the temperature stuff to medication, to caffeine, to sleep apnea, I mean

Curtis Worcester (48:11):

All really above.

Ben Smith (48:13):

Yeah, a lot to pick on there. So that was really awesome. And I know again, we've been wanting to get somebody in the sleep medicine side for some time and it's been really difficult to find somebody. So it was really excited when we were able to locate Dr. Krakow on this. Obviously we are 107 episodes in. We're keep rolling here and you can find more about Dr. Krakow himself and his websites. Again, his book, I know we mentioned this several times, he has a sleek newsletter,

Ben Smith (48:44):

Really useful. Just a little tidbit when he sends that out. That would be really awesome. So we'll have the links to all those things in our blog post. So you can go to blog dot guidance point llc.com/want zero seven, go to that website. You can find all the links there. You can listen to the show there as well. We really appreciate you tuning in. Hope you got as much out of this today as we did, and we will catch you next time.