Shelby Harris Quotes

The other option we have are medication treatments. So you'll have the treatments such as Ambien, Lunesta, Sonata, and we'll also have Rozerem and for some patients we use Benzodiazopine/Clonazepam. Things like that to help with anxiety.

So, sleep deprivation, and sometimes an insomnia, which is a little bit of a different form, but just getting a lack of sleep, can lead to a number of different decrements.

So there's a few different ways that we treat insomnia. The first thing that we always do is we look at the cause.

So, it's not every patient that I see, but I'd say a good 70% to 80% of the patients when they go to bed it's like a stereo is playing at an 11 or 12 and they can't turn it down, at all. So it makes it very hard for their body to down regulate to be able to go to bed at night.

Now circadian rhythms become very interesting and problematic for patients because when you become a teenager, your rhythms actually tend to naturally shift.

If there's a lot of fear that's going on, if there's a lot of anxiety, it's manifesting itself in your nocturnal world so that analyzing it can help open up basically thoughts about what you need to do during the day. So a lot of people who subscribe to the psychoanalysis, the Jungian thought will really focus a lot on dreams, the meaning, and how it can be used to help you during the day.

So the older models, when you look at Freudian, when you look at Jungian thought, and there's still people who really - who really use the Jungian thought of dream analysis, is really that you would analyze the dreams. The dreams are there for a purpose.

So it's like your brain has a large filing cabinet and it's opening up each drawer and it's taking in various images and memories from the day, consolidating what it needs to and puts in whatever file. And then if there's something that doesn't fit in any of the files and doesn't really belong, you'll forget about it. So it's a way of really getting a succinct way of storing things in your brain.

There's a new line of research showing that people who don't get enough sleep, they're body doesn't metabolize as well. And so they actually - it leads to weight gain. So if you're not getting enough sleep, you might have difficulty losing weight.

And you cycle throughout so that you do about five to six cycles throughout the night. And we spend more time in REM later on in the night than we do earlier on.

There are people who have repetitive nightmares. And what happens is their brain is trying to process the stress and help their brain actually deal with what happens if this stress happens again, so their brain's preparing them to deal with it in case the stress happens again, but it's so scary that they awaken from it.

Night terrors are in deep sleep, and they're more common in kids, as are nightmares, but what happens in a night terror is like a flash - we think a flash of some image or something happens in the brain. We don't really quite know what. And it usually ends up with the child screaming almost like screaming bloody murder. It's very scary for the parents or whoever else is around.

So someone who is a child usually goes to bed about 8:00 or 9:00 at night, but then when they have a circadian rhythm shift, it shifts later. And this is natural. And they start to go to bed at 11:00, 12:00, 1:00 and they want to sleep later. So we see this a lot in teens.

So a lot of people who work rotating shifts and they work at night, their bodies are set to want to be awake during the day and sleep at night. So there are some people who have a lot of trouble adjusting their rhythms and they have trouble working the night shift, they're sleepy, they're drowsy driving home.

So when you go to sleep at night, if you're someone who hasn't had any sleep deprivation, you have a very normal sleep pattern, what we tend to see is that, in adults, they go to bed and they start off by going into the deeper stages sleep.

There's some debate as to whether you need to awaken from them because there are some patients who are actually starting to say, "I had these horrible nightmares, but I never woke up from them." But they can still recall them when they get up in the morning. So there's still some debate in the field.

There are some patients who just have insomnia and they've had it since they were a kid and we don't quite know why. So when we look at the cause, we definitely want to treat whatever else is going on, but insomnia often because it becomes its own diagnosis and that requires its own treatment.

Narcolepsy is a disorder that affects many different areas of life. So in typical patients with narcolepsy, they have something called "excessive daytime sleepiness." So, they're very sleepy during the day. Yet, at night, they're still sleepy, but their sleep is very broken.

Jet lag depends on which direction you're going and it can be a little complicated, but there are a few different treatments. So one would be if you're going somewhere - sorry it's hard to think about it.

So we go through in the beginning of the night, we go into the really deep stages of sleep and we actually cycle through. So, when you go down to the deep stage, then you go back up and you actually come into something called REM sleep, which is after about 90 minutes.

We try not using medications initially, and we use something called behavioral therapy for insomnia. This changes behaviors people do in bed, none of the tossing and turning.

Now narcolepsy is really hard though because they're very tired during the day, they're sleepy during the day and it's managed mostly with medications. So we use medications to help them sleep better at night and to stay away during the day. But there are behavioral things you can do also by changing diet, exercise, having an actual nap schedule.

Really, a nightmare just really has to evoke some sort of, we call it, dysphoric emotion or something uncomfortable. You could be sad, you could be unhappy; you could be scared, anxious. But traditionally, the definition is you have to awaken from this nightmare.

We actually don't know the function of sleep all that well yet, but sleep is a time of quiescence in the brain.

We're not really sure why it [broken circadian rhythm] continues, but when they become adults, we usually have to treat it because many people need to get up early to go to work and they can't be sleeping until 11:00 or 12:00. So we use treatments like bright light therapy, melatonin, things like that that are very effective.

When you're in the more deeper stages of sleep - REM sleep, your body is quiet, but your mind is actually very active. So it's a time when your body and your brain is restoring itself. It's repairing any cell damage that happened during the day, it's really repairing, like I said, repairing your body, but also helps with digestion, helps with memory.

There are other people that think that dreams actually do serve a purpose. But what that purpose is, we're not really sure. So some people believe that it actually does have some psychological representation of what's going on in the day, but there's no need to sit and really analyze it.

So when it comes to circadian rhythms, it's a clock that's basically programmed in our body. So if you think back to times when people lived on farms and we didn't have electricity.

There's confusional arousals, there are states in deeper sleep that can happen where people will go and they'll disappear and they'll take on some other persona. They'll commit some crime, but it's all when they are in a very deep stage of sleep. So you really need to have a very thorough evaluation.

When it comes to the reason why we have nightmares, we're still debating that. It's a new area of research, nightmares. And the way I like to think about it is, our brain - we have stress during the day and our brain needs to learn to process this stress.

So if somebody has chronic pain, we want to manage the pain, but we still want to treat the insomnia separately. So what we'll tend to do in our sleep lab is we'll do a thorough evaluation and we usually have myself, who is a Psychologist and a Sleep Behavioral Sleep Specialist, I treat the patients first.

So when you're in REM sleep, your brain is very active, our body is quiet, but your brain is really processing a lot of things, a lot of emotions; we dream the most in REM sleep. And then you go back down in the deep stages, and so on and so forth.

We'll work on relaxation strategies and also changing the times you go to bed will actually make them sleep a little bit less for a few nights so their body's natural sleep drive starts to kick in. That is very effective in about 60% to 70% of patients who do it, four to eight sessions, not even every week; it works for 60% to 70% of patients.

We haven't really - it's harder for us to set those rhythms. So it's really important to keep a steady bedtime and wake time to really lock in those rhythms.

For some people they say, it's about wish fulfillment, it's about the things you are never able to do in your day you are actually fulfilling at night. There are other people who will say that it's actually telling you something.

So, more times than not, but not every time, it can be linked to a medical problem, such as menopause, cancer, chronic pain, it can be linked to anxiety and depression. Those are the more common causes.

We've looked at sleep diaries of patients with insomnia, and they'll say that they don't sleep for one or two days. And the body actually has a natural function, after about the third day to start catching up and you get a little bit more sleep the third night. And that's usually what I tell my patients.

People went to bed when the sun went down and they woke up when the sun came up. That's what our bodies are naturally programmed to do. However, with all the new stresses in life with electricity, with technology, we tend to override that system and we'll stay up later and we'll get up earlier or later, and we use alarm clocks, we use the light.

We have other opposite problems with circadian rhythms that can happen when you - a lot of times with older adults. They start to go to bed at 6:00, 7:00 at night and they wake up at 2:00 in the morning. And they're rhythms actually shift earlier, but sometime it can just kind of miss the mark and shift too much earlier and that's when we need to treat it with bright light.

Nightmares are distinctly different from dreams in the way that people feel them and experience them. So a lot of people think that a nightmare is something where something is chasing them and you have to wake up screaming. Yes, that's one of the more common nightmares that we see is the person chasing someone or they're being chased.

Some patients will report that they have sleep paralysis. If we see sleep paralysis alone and nothing else, we don't really think all that much of it, but if we see other symptoms, then it might be a red flag for something else that's going on.

I'll work on patient's thoughts about sleep, "So I must get eight hours of sleep tonight or I won't sleep tomorrow." That sometimes - or "I won't function tomorrow." That sometimes makes it very difficult for you to sleep at night

So you have Sleep Stage One, Two, and then Three/Four. One is a little bit lighter stage of the quiet, non-REM sleep and then Three/Four is really deep, deep sleep. And what you want is, you actually want a number of - you want to go through all of these stages throughout the night.

There's a problem for them [teens] when they have to get up and go to school in the morning, they're very sleepy, yet on the weekends, they'll sleep 12 hours, they'll sleep late and then go to bed late and wake up late. And on vacations, it's not a problem.

Night terrors are very different from nightmares. A lot of people will think they're the same, but they're really not. Night terrors - you want to look at the time of night when you're having the problem. Night Terrors happen in deep sleep. Nightmares tend to happen in a lighter REM sleep.

In general, there are patients with insomnia who - many patients with insomnia will actually over report the lack of sleep that they are getting.

There are some that are - REM Behavior Disorder, we'll see some court documented cases. And they really need to have a thorough evaluation with a sleep specialist.

People tend to remember their dreams in the morning a little bit better and if earlier in the night, when you're in a lot of deep sleep, if someone wakes you, or the phone rings or something, you're really confused.