Why do you wake up at night? | Barry Krakow | TEDxABQ

20 years ago this little purple box saved my life it all happened in one night a night of the most restful sleep I'd ever known earlier that day I was talking with my friend and colleague dr. Thomas Meade a pioneer in dental sleep medicine I was belaboring Tom with my two-year running battle with chronic insomnia frequent awakenings trips to the bathroom struggling to get back to sleep exhausted in the morning and tired and sleepy throughout the day plus two car accidents tied to sleep deprivation Tom's Cheshire Cat grin told me he'd heard this story before as he pulled this magic box out of his oversized briefcase he pulled it open took out this piece of plastic plopped it in a mug of water boiled it in a microwave and then he handed it to me and said bite this after clenching my teeth into the warm plastic mold I handed it back he smooth the surface handed it back to me and he said well let's see if you breathe any easier tonight which was a strange thought to someone who is complaining about insomnia that night was so memorable I can still picture in my mind's eye waking up turning over and asking my wife Jessica what happened nothing happened that night there were no awakenings no trips to the bathroom I felt incredibly rested from the best sleep I'd had in two years really 35 years as the true nature of my sleep disorder finally dawned on me this exact moment changed my life dramatically because that day I experienced an enormous burst of energy in my mind and in my body the likes of which I never dreamed possible for my own health this moment also revolutionized my thinking practice and research in the field of sleep medicine the irony is dr. Christian gman Oh made this discovery linking sleep breathing and insomnia in 1973 nearly 50 years later we're here discussing how something physical could cause insomnia an idea that has flown so far below the radar of the general medical profession and even portions of the sleep medicine community all because of the failure to ask this singular question why do you wake up at night why do you wake up how common are awakenings in this audience at minimum probably one third of you struggle with sleep or make trips to the bathroom yet because so many of us wake up we think it's normal well here's newsflash number one if you wake up suffer from broken sleep trips to the bathroom you're tired and sleepy the next day you suffer from a serious sleep disorder chronic insomnia a devastating and costly condition chronic insomnia damages your brain and your heart it worsens anxiety and depression it even inhibits your ability to fight off infections billions of healthcare dollars are used up through the ravages of sleepless nights on your mental and physical health billions more are lost economically from sick days workplace accidents and decreased productivity and of course billions more are spent in the desperate search for sleep aids over-the-counter drugs prescription sedatives vitamins mineral supplements herbal remedies yet few find truly lasting relief mental health patients suffered the most from insomnia yet more drugs are prescribed tranquilizers antidepressants antipsychotics anti-seizure drugs they may help mental health but these drugs cause side effects to worsen your sleep millions more insomniacs believe or are led to believe that the only solution to sleepless nights are drugs and yet they suffer for years without finding a cure and often never hearing of any other options so if drugs are not the answer to this very vexing condition that drives some people so crazy they become suicidal or make some people feel crazy out of the embarrassment shame and fear from not being able to sleep what is the answer or for these psychological problems cognitive behavioral therapy for insomnia cbt-i is a potent tool because so many insomniacs frustrate themselves lying awake in bed tossing and turning checking the clock trying to force sleep all of which just aggravates their sleeplessness cbt-i is empowering to you far beyond drug therapy because it teaches you to stop losing sleep over losing sleep yet neither cbt-i nor drugs answer our question why do you get up at night normal sleepers wake up and go right back to sleep why because they're sleepy insomniacs wake up and go from zero to 60 in about two seconds not only are they wide-awake but they may suffer racing thoughts heart palpitations anxiety stress worries all because they've been jarred out of their sleep to being fully alert normally we gradually ascend from slumber into waking consciousness in the morning with or without coffee so why would you suddenly wake up at night unless something was waking you up this clue would have explained insomnia but was ignored for a long time research does show that insomniacs line up the usual list of suspects to explain awakenings anxiety stress worries racing thoughts but even insomniac snow they are asleep before they wake up so they don't know with certainty why they're waking up and they remain perplexed about being fully alert in the middle of the night we he searched insomniacs in the sleep lab and monitored them before during and after these awakenings and the results were breathtaking not only did they wake up more times than normal sleepers but they suffered hundreds of mini awakenings what we call arousal there were fracturing their sleep and destroying their sleep quality and if you're ready force newsflash number two 90% of their awakenings and arousal 'z were caused by please take a deep breath that's what they didn't do their breathing was compromised and obstructed because they suffered from obstructive sleep apnea the same condition that fueled my insomnia twenty years ago on this graphic you will see the three main breathing events of sleep apnea at the top is normal breathing smooth rounded curves up and down suggesting breathing in and out at the bottom is the apnea a flatline complete suffocation as your throat collapses obviously anyone would awaken from that blockage next are the hypopneas a 50% reduction and then the flow limitation a 25% reduction all of these breathing events can awaken you insomniacs have more of the moderate type so perhaps you're asking would a 25% reduction in your breathing wake you up well let's try this experiment go ahead put your put your hands out in front of you just take a moment now bring them up to your throat and start choking yourself about 25 okay you get the picture breathing is good not breathing is life-threatening which explains where all the skepticism comes about this theory because how could you possibly wake up all night long from a breathing problem and not know about it well consider the case of severe sleep apnea they suffer hundreds of Suffocation's all night long complete loss of their breathing when do they seek help at a sleep center only after someone in their bedroom freaks out watching and listening to them not breathe and afterwards do they seek help a few months later no how about a few years later no only after suffering a life-threatening disorder for about a decade might they seek help so if the worst case doesn't get it how would insomniacs detect the problem when they only suffer this more moderate breathing disruption that still wakes them up this recognition gap caused us to delay our understanding of the link between insomnia and sleep breathing problems now we comprehend that so many insomniacs suffer two disorders in one the psychological side is easy to see you're awake but the physiological side is hidden from you because you are asleep this radical paradigm shift and knowledge demands a new term to designate the complexity of this problem so we call it complex insomnia which indicates the need for in-depth physiological testing an overnight sleep study to identify and diagnose what's waking you up for any diehard skeptics still out there we've got one final and astonishing piece to the puzzle remember insomniacs make trips to the bathroom and complain about it that's called nocturia snooze flash number three who would have thought it sleep apnea causes nocturia sleep apnea pushes excess blood flow into your heart all night long the heart responds by releasing a natural diuretic making the kidneys work overtime throughout the night so sleep apnea causes insomnia and nocturia actually a very nice two-for-one deal when it comes to treatment there are three levels of therapy to treat sleep breathing first focus on nasal breathing nasal saline rinses neti washes prescription nasal sprays will eradicate chronic congestion last we strongly recommend nasal strips because we studied insomniacs with moderate sleep breathing symptoms and 75% of them reported a decrease in insomnia just by using the nasal strip on a nightly basis next or mandibular advancement devices or oral appliance therapy like the type provided to me by dr. Mead these are becoming first-line therapy they gently anchor on to your dental arches and thrust the jaw forward opening the airway permitting more air through and eradicating the majority of your breathing events last is pappi positive airway pressure the gold standard most know it is CPAP the C stands for continuous or constant pressure breathing in and breathing out and that's the problem you probably know someone who's failed CPAP because they couldn't tolerate breathing out against that constant pressure mental health patients and insomnia patients can't tolerate CPAP they develop panic attacks claustrophobia and even traumatizing experiences so harmful to them they will drop out of care for a few years just after a brief exposure to CPAP unfortunately some insurance carriers and even some sleep centers do not recognize these side effects and instead blame patients for not using CPAP fortunately technology has found a better way in 2005 we switched all of our patients over to by level devices dual pressure high pressure when you breathe in and low pressure when you breathe out this matches your natural breathing pattern there are even advanced by level devices that monitor your breathing and adjust pressures all night long last sleep technology has expanded with numerous masks that can fit into your nose over your nose or as full face masks and there are mask liners that enhance comfort virtually anyone can learn to use the gold standard breathing treatment if they are prescribed the right PAP device accurate pressure settings and the best mask fit are you ready to put this to bed I trust you've learned three things insomnia is a common disorder with serious consequences to your mental and physical health but you probably won't seek treatment until you realize that frequent awakenings and broken sleep are not normal second insomnia and sleep apnea are joined at the hip using this term complex insomnia will encourage you and your providers to attack the mental and the physical part of your sleepless nights for so many of you that suffer as incredible as it sounds insomnia is not only in your mind it's also in your airway last there are plenty of treatment options available and all of them produce good - great results I would like to close by saying I sincerely believe sincerely that if you apply this information with the aid of your doctors dentists and sleep medicine professionals you will conquer insomnia and discover and experience the rest of your life thank you

Channel: TEDx Talks

Views: 322,341

Rating: 4.7070999 out of 5

Keywords: TEDxTalks, English, Health, Happiness, Medicine, Science

Id: izgtCxsLVd0

Length: 14min 58sec (898 seconds)

Published: Wed Dec 20 2017