Station 1902

[00:13] Speaker A: I want to welcome our listeners to the station 1902 podcast. I'm your host, Ed Mann, director of training and education for provident. Today. Our special guest is Doctor Ann Germain, founder and CEO of Noctom. Before Noctam, she was professor of psychiatry at the University of Pittsburgh School of Medicine and served as the director of the Pittsburgh Sleep and Behavioral Neuroscience Center. Doctor Jermaine, welcome to the show. Please tell our listeners more about yourself and the work you do.

[00:45] Speaker B: Well, thank you, Ed. It's really a pleasure to be here today. I am a sleep person. I have been in sleep research and sleep medicine for over two decades. I'm a clinical psychologist by training. As you mentioned, I was at the University of Pittsburgh, did a lot of studies on the relationship between stress and really traumatic stress and sleep, and how sleep treatments can improve not just sleep quality, but daytime functioning as well and overall well being. But eventually, I wanted to make sure that the treatments that we had developed validated, tested primarily in military service members, active duty, and veterans, that we could get these same effective treatments into the hands of all the healthcare providers out there so that they can treat their patients with sleep problems, and decided that the best way to do it was to start a company. And that's what noctum is.

[01:50] Speaker A: Okay, and for our listeners, and I asked you this earlier, what does noctum stand for?

[01:55] Speaker B: So, noctum is the latin for night. Everybody's familiar with the expression carpe diem, seize the day. Our tag is carpin. Noctum sees the night.

[02:07] Speaker A: Great. So I really want to take a deep dive into how sleep, or lack thereof, impacts first responders. I know from personal experience since I retired as a volunteer fire chief at the end of 2021, I sleep much better now than I did before. I don't think the majority of first responders really know or understand the negative impact of poor sleep. Please take a few minutes and explain to our listeners what those negative impacts are.

[02:39] Speaker B: Well, actually, your own experience saying, like when you're retired that you noticed a change in your sleep, but maybe before that, you didn't notice all the negative impacts that that not sleeping enough or having disrupted sleep had at the time. But really, the truth is, every single area of human functioning is negatively impacted by poor sleep. And it really doesn't matter what the cause of poor sleep is, whether it's job related stress or a sleep disorder or chronic pain or other kinds of challenges that people are experiencing. Poor sleep is bad sleep, and it has both short term and long term impacts in the short term. We've all noticed that after one bad night of sleep, our mood is different. The next day, we might be a little snappier, a little bit more irritable. We might get more stress or have these sticky thoughts, if you want, like rumination or worries that when we're well rested wouldn't necessarily bother us. We certainly notice memory lapses, having problems with concentration, having to read the same thing over and over again before it sticks, feeling that we don't have the energy, feeling fatigue like there's. Our brains are foggy, and we certainly get slower and with slower reaction times. Oftentimes, the way we make decisions is not as good, if you want, as when we're well rested. So people who are chronically sleep deprived or even acutely, if you have one night of bad sleep or several nights of bad sleep, our judgment changes, and we might actually take more risks and put ourselves at more risks in different situations. And then there are, like, thousands of studies by now that shows that over the long term, poor sleep is associated with weight gain, all sorts of body aches that were more prone to sickness, to accidents, to injuries. A lot of people have poor sleep, are at higher risk of developing high blood pressure, hypertension, or other kinds of cardiovascular problems, diabetes as well, and that there are also higher risk of dying earlier, early mortality with chronic or sleep that is unaddressed. And there are all those study, and I know it's true in first responders as well. Sleep poor sleep or chronic poor sleep is a risk factor for a higher vulnerability to all sorts of cancers. And then if we take a step back and look at what are the broader like outside of the one person, what are the impact of poor sleep? You know, it affects all of us, really. Like, we skip family events, it affects our family, it affects our friends or social activities. It affects work and how we perform at work. So they're, you know, the direct impact on the person, but they're the impacts, these impact on the person because of poor sleep also have consequences on their immediate family, friends, and work environments.

[05:56] Speaker A: Okay, well, thank you. I realize this question may seem silly to some, but I have to ask, what is sleep and what happens when I sleep?

[06:05] Speaker B: Oh, a lot happens during sleep. And sleep is really. We have to think of sleep as an absolutely essential, necessary biological state for maintaining health and well being. Think of sleep as the necessary state. We have to achieve to repair our bodies, our brain, and recover from everyday wear and tear. And actually, all living organisms sleep. We all need sleep to survive. It's not just this downtime that we can cut short here and there to be other things when we do that, there are costs to it. It's absolutely essential because there's a lot of different functions that happen either only during sleep or happen better or more efficient during sleep. So our ability, for example, to kind of reset and clear our brains, our ability to form new connections, to consolidate, to remember information that is critical to remember for the future, but also to be able to sort out the information that is kind of useless and that we can forget about. That happens during sleep. Without that happening, we're not set and ready to learn new information and react appropriately the following day. So it's really important when it comes to if you want, resetting the brain and allowing us to be fully sharp, alert, and ready for what comes the following day. We also know that sleep is really important when it comes to regulating all sorts of more emotion related functions. If you want, process some of the experiences, emotional experiences that we have during the day and oftentimes tame these emotions. We can have a big emotional reaction to an event during the day, and that attenuates over time. That attenuation happens during sleep. We're processing these emotions during sleep. And when sleep is disrupted, there's a higher likelihood that we'll have some kind of, like, mood or anxiety impact on the long term. And then there are a number of other functions, like immune functions. For example, our immune systems are active while we're sleeping, reset while we're sleeping as well. What regulates our heart and lungs functions are also happening during sleep. When we cut sleep short, we're actually cutting all of these if you want functions and processes short, which makes us not in the. Puts us in the suboptimal state if you want to face the following day.

[08:58] Speaker A: Well, I can attest to that. As I said earlier, when I retired as a fire chief at the end of 2021, I found that my sleep was better. Last year, I got some VA benefits. And part of that intake was that they did an interview to see. They screened me for PTSD, and one of the questions was, are you irritable? And I started to laugh, and I said, no, not anymore. And the lady asked me, why is that? Or give me an example. And I said, well, perfect example is, this morning, I couldn't get logged into my bank account information. Two years ago, I would have thrown the computer across the room. This morning, I just shut it down and restarted. And a few minutes later, I was able to get into it. And now, thinking about what you're telling me, I can tie that back to the lack of sleep, those things that kept me awake or woke me up in the middle of the night as a volunteer fire chief. And now I can tie that. Now I know why I was that way at times and why I'm not that way anymore. So thanks for the tip.

[10:10] Speaker B: My pleasure.

[10:11] Speaker A: Now that we know what sleep is, what is optimal sleep, and how many hours of sleep does one need?

[10:17] Speaker B: Oh, great questions. So, optimal sleep has four key elements, right? Optimal sleep is predictable, meaning that it's regular. We know when we're going to fall asleep. We know when we're going to wake up. Optimal sleep, the second key element is consolidated. And what that means is that once you all asleep, you stay asleep throughout the night. Now, we all have some awakenings. That's normal throughout the night. We need to move, we need to go to the bathroom. But as long as we go back to sleep pretty quickly and we feel like we had a solid, solid block of sleep, that's consolidated sleep and that's really key for optimal sleep. The third component is restorative sleep. And that means that when we wake up, we feel refreshed, sharp and ready for the day. And the last piece of it is sufficient sleep. And what that means is having really reserving an amount of time every day. That is sufficient. That is enough for the person to meet their sleep needs so that all of these functions I mentioned earlier can happen and be completed during sleep. So those elements are really sleep. Optimal sleep is predictable, consolidated, restorative and sufficient. And that raises your question, like, well, how much sleep does one need? And that's really dependent on the person. Now, the National Sleep foundation recommends that adults over the age of 18 get between seven to 9 hours of sleep every night. Now, 9 hours is on the long side. When we look at large surveys that have been done in hundreds of thousands of people, most adults feel at their best when they get between six and a half and seven and a half hours of sleep each night. And again, for some people it's going to be a little less. For some people it's going to be a little more. But it's a myth that we need to have a solid 8 hours every night. 8 hours is just the average between the very, very short sleepers of which they exist. But there are very few of them. People that need only 4 hours of sleep. And the very long sleeper, there are people who actually do need 12 hours and the average is eight. But the truth is, the vast majority of us do not need 8 hours hours of sleep every night. And actually, it's not uncommon to see people when they retire, for example, that because now they have the time, they try to spend a lot of time in bed trying to get to that 8 hours, that magic number of 8 hours of sleep. And effectively what it does is that it works against them. They start developing insomnia or anxiety about their sleep because they're really trying to sleep longer. But sleep is really a biological function. We can't will our way into sleep. Actually, the harder we try, the more awake we become. So it's really important for people to have dedicate enough sleep on a nightly basis to be able to meet their sleep needs. And again, for most of them, it's going to be between six and a half and seven and a half hours of sleep each night.

[13:46] Speaker A: And I know people that operate on 4 hours, and I know people that if they don't get 12 hours, they're like a bear that's angry with everybody. I often see the results of studies related to shift work and its impact on first responders, not only when on duty, but off duty as well. Are you aware of any studies that have been done related to volunteer first responders? And the reason I asked the question is, is obviously the volunteer works an eight hour job or a twelve hour shift. They get off work, they go home, they may eat a meal, they go to the firehouse, they do something at 130 in the morning, the pager goes off, they go to a call, they may be out for an hour or several hours, and then they go home, they may catch a cat nap and then go work their job again. So are there any studies there, or had there been any studies done on volunteer first responders?

[14:44] Speaker B: There are actually, there have been many studies on volunteer first responders as well as career first responders. And they get to the pretty consistent and pretty eye opening findings, actually. And these consistently show, these studies consistently shows that between 30 and 70%, now that's a wide range, depending on the study, but between 30 and 70% of first responders report poor sleep or symptoms of insomnia, problems falling and staying asleep, having daytime impairments, like feeling like we're not functioning at our best, and they're at higher risk of developing sleep apnea. And it's true across all the studies, at least all the studies that I've looked at. And interestingly, it's also true internationally. There are studies that have been done and looking at comparing results across five continents, and they consistently find that volunteer first responders have a higher rate of poor sleep or sleep disorders than the general population. And of course, shift work is always found to be a huge contributor to poor sleep and sleep disorders. To your point, it's not like when you're off duty, your sleep is so much better than when you're on duty, because there are other times that people do other things that people do with their sleep. And sleep doesn't necessarily bounce back just because you have the opportunity to sleep. Another kind of finding that comes across in these studies is that shift work and poor sleep quality are oftentimes a predictor or strong and not, or. And strongly associated with symptoms of post traumatic stress, depression, injury, and pain. That's consistent across all. All the studies. And then the last thing that is probably known to you and everybody else, but that was quite shocking to me, is that most of the studies also show, to your point, that off duty sleep is not any better than on duty sleep. So even if there's no alarm coming up when you're sleeping at home, that sleep quality is not better just because people are sleeping at home and they're not on duty. So to me, that means that even when people are off duty, when first responders are off duty, they still don't have necessarily the opportunity to recover the sleep that they lost while they were on duty, and they don't have an opportunity to necessarily be completely refreshed and 100% ready for their next shift on duty.

[17:52] Speaker A: So. So do you feel that when people, when they're off duty, that they're still on edge because they're expecting something to wake them up through the middle of the night?

[18:02] Speaker B: Absolutely. Yeah. Humans are creatures of habits, right? We. We respond to different cues in our environment. So if somebody is repeatedly in an environment where there's an alarm that goes off at random during the day and at night, our brain, our body learn to always be on the lookout for that signal, for that alert. So even when we're sleeping, it's almost like. It's not almost like what happens is that our brains stay a little bit more awake or a little less asleep than they should be to allow for to have optimal sleep and to be fully restorative. So we learn, our body, our brain learn to. You know, there's a reason why we say sleeping one eye with one eye open, I think, is the expression in English. That's this idea that even when we're sleeping, people learn to be vigilant for the cues that signals that they have to be ready to go and on duty. And unfortunately, that habit that develops does not. It's not like an on off switch that it's on only when you're on duty, and you can turn it off easily when you're off duty. So that's really something that can keep people sleeping less deeply than they otherwise would like you experience after retirement, because they get conditioned really to look for that signal to be ready to go even when they're sleeping.

[19:40] Speaker A: Let's give this some thought. So if you're a volunteer and you work shift work to begin with, and then you work rotating shifts. So one week you work daylight, the next week you go to a swing shift, and then the following week you go to a midnight shift, and that rotates. I mean, I know police officers that work that way. I mean, they work a twelve. They work twelve hour shifts from seven a to seven p, and then after a month they go from seven p to seven a. I'm going to make an assumption here that that would even compound the problem even further.

[20:17] Speaker B: Yes, it does. This is extremely challenging from a biological and a functional perspective to have, you know, rotating shift. Shift work. Just generally speaking, shift work is challenging. And there's also a reason why. I think there's a reason why some people can have first responders, police officers, as you mentioned, that can, or military service members can have a long and very productive career. My personal belief is that it requires tremendous resilience or the resistance to being able to function at a higher level despite these kinds of sleep challenges. Now, it doesn't matter that people don't have some of these consequences, but it means that they're able to function even when they have poor sleep and they shift work. Because it's not just the shift work is like when there is an opportunity to sleep, but it's at 02:00 in the afternoon. That's not. It's really hard to sleep when your brain is trying to keep you awake because you're supposed to be awake during the day or to stay awake at night very sharp and alert in the middle of the night when your brain is actually trying to get you to sleep because that's what you're supposed to do. It's extremely challenging. But I think people also have, that's totally personal belief, something that I've wanted to study for years when I was at the university, that I think people who are able to have careers where there's high risk, high tempo have this inherent higher capability to function even when their sleep is disabled, disrupted.

[22:05] Speaker A: So now that we have a better understanding of how lack of sleep can affect first responders and what sleep actually is, let's move on. To some steps first responders can take to get better sleep and to avoid the pitfalls of lack of sleep. So what are some of the strategies one can take to protect sleep when working shifts?

[22:26] Speaker B: So the first is, the first thing to do is to create the best possible sleep environment. So when the opportunity to sleep comes up, that the environment is not contributing to poor sleep. And what that means is having a bedroom that is sleeping in a bedroom or sleeping in a bed in a place where this is really dedicated to sleep, a place that is dark, that is very quiet, and that is relatively cool. Like most studies suggest that around 65 degrees is the ideal temperature while we're sleeping. So having a sleep environment that is comfortable, that is quiet, that is conducive to sleep is really the first thing to do. And that includes getting the pets out of the bedroom. Your pets are moving and they'll wake you up. So I know it's a hard one, but as much as possible, really optimizing the sleep environment so that there's no environmental factors that can disrupt sleep, given that people are trying to sleep when they shift work, maybe at a time that is not the best biological time to sleep, and then around there is really thinking of what are the cues that we have for sleep. So if you sleep at night, before bedtime, you'll have your bedtime routine, brushing your tooth, preparing your clothes for the next day, whatever you do in the evening. So having these same kind of routines before we have an opportunity to sleep, to give the cues to our brains through our body that sleep is coming. I said humans are creatures of habits, so recreating this habits and that signal that sleep is coming can be helpful to kind of wind down and get ready to sleep. It's also especially for people who shift work, there are two things, two additional things that are very important. One is exposure to light. Light is the most powerful cue for our brain to signal, or it's the most powerful signal that it's time to be awake. At the end of a night shift, for example, will recommend that people wear sunglasses or they're actually light blocking goggles that people can purchase on Amazon to block as much as the blue light as possible. Because that's the segment of the light spectrum, if you want, that is the most arousing for people that signals wakefulness. So blocking this to, again, give your brain the signal that it's nighttime or there's less light and less light is the cue to that sleep is coming. So if you get home, keeping the lights dim, keeping the goggles on or the sunglasses on to block that light as much as possible. Now, if you want to go to sleep in the morning, you want to, after a night shift, you want to minimize light exposure. If you're going to. If you're going to a night shift in the evening, then you want to maximize light exposure. Turn on the lights, have bright lights. That helps your brain be awake and really try to optimize this alertness. That's basically using the light to the advantage to signal to our, I don't want to say trick our brain, but signal to our brain that either sleep is coming or it's time to be awake. So light to be awake, dim light, darkness to help with sleep. And then when people do sleep during the day or they have night or rotating shifts, they need to also set, like, reasonable expectations when it comes to daytime sleep. Right? So when we have a normal schedule and we can sleep at night, then we'll spend maybe six, seven, seven and a half hours in bed. That's all good and fine, and we can expect that we'll sleep most of that time. But for people who work shifts, they're more likely to have more than one sleep episode. And that's. You gave an example of that earlier where you come home, you might sleep for maybe three and a half hours, 4 hours, four and a half hours. Then you can't sleep anymore because your brain will wake you up like it's time to be awake. So you can have you do other things, and then maybe later during the day, you can have another sleep episode of maybe two or 3 hours, like a very long nap to help kind of recover some of that sleep. Now, it's not consolidated sleep, but having these episodes, like, more than one block of sleep, if you want, can be very, very helpful. And actually, there is such a thing as prophylactic napping, if you want, before a shift, if you have a short tactical nap, that can also be helpful to maintain alertness when people are going to night shifts.

[27:42] Speaker A: I'm glad you mentioned naps, because I have found the older I get a 30 minutes, as my kids call it, happy nap on a Saturday afternoon or even on a day of the week, I wake up from it and feel pretty well rested. Now, if I sleep much longer than, let's say, an hour during one of those naps, I'm not near as well rested as I am with just a short nap. Uh, so you mentioned. I'm sorry, go ahead.

[28:11] Speaker B: No, I was gonna say that I'm not surprised to hear that, like, the 30 minutes nap, the strategic or tactical nap is just enough to reset longer than that. It's almost like your brain then thinks like, oh, well, I guess I can sleep longer. And then just waking up from that night and feeling alert again is going to take another 30 minutes. But it's better to keep those naps short. They're more effective in alleviating some of the sleepiness and the fatigue and waking up more rested and alert again.

[28:43] Speaker A: So earlier you mentioned blue lights, and I've read articles about this. I haven't seen any studies. Let's talk about our cell phones and being on the Internet prior to going to bed. When's a good time to shut that stuff off prior to going to bed? I mean, is there a good time? Isn't there a good time, or doesn't it make any difference?

[29:08] Speaker B: So we don't know, like the absolute answer to this. The general recommendation is to put the screens away an hour before bedtime so that people can focus on their bedtime routines and not have this extra stimulation. And actually, it's more than the blue light on the screen, because many of the tablets and smartphones now have some kind of blue light blocking function. Now, whether they're effective or not, is the jury still out there? But it's not just the light, it's also the content. If you're watching your screen, if you're watching something on your screen, what is it that you're watching and is that conducive to sleep? If you say, like, well, I'm listening to, or I'm watching a relaxation video, that's very different than I'm watching the news from the day from around the world, or I'm keeping up with the news of what's going on at the station. That's probably much more alerting than needed right before you go to sleep, we say an hour so that people have time to wind down, disconnect, there's less slight exposure, but there's also not that content that can be more activating than it should be before bedtime.

[30:29] Speaker A: Well, I know from my day's working shift and having been up several times during the night to respond to calls, I certainly wasn't doing my best during my time off as a volunteer. That was even worse because I had to get up to work my full time job. What are some of the strategies one can take to recover from a period of sleep deprivation?

[30:52] Speaker B: The only cure for sleep deprivation is sleep. That's the best remedy, but it's easier said than done. What people can do is to be mindful that when they know that they haven't slept as much as they want to, they need to be able to plan almost like your sleep vacation or your sleep recovery time, allowing enough time after a period of sleep deprivation to be able to recover some of that lost sleep. So we call that sleep extension. So, allowing more time in bed to be able to sleep longer, which we're going to be able to do when we haven't slept enough before. We won't recover everything that we lost, but we'll recover a portion of it. So, allowing for enough time to be able to do it, either spending more time in bed or allowing for naps to be able to recover some of that, of that sleep.

[31:52] Speaker A: So during my research for this podcast, I came across the term sleep banking. Doctor Jermaine, would you please explain what sleep banking is and why it can be a successful strategy?

[32:04] Speaker B: Well, that's another strategy that people can, can take to actually before a period of sleep deprivation. So it's kind of the prevention version of sleep recovery or sleep extension. So sleep banking in a strategy, as I said, that you can use both for when you know your sleep in the next few days is going to be shortened and it's allowing for more sleep, more time in bed before the known period of sleep deprivation. And that's actually a strategy that works well. So if you know that the next three nights you're going to be on shift, that you usually don't sleep more than maybe four or 5 hours over 24 hours during these three days, the next 324 hours period, the nights before you can allow yourself more time in bed to sleep a little bit longer, or include naps in the schedule to be able to get a little bit of sleep kind of banked, accumulated before the sleep deprivation. Now it's a true phenomenon. It doesn't cancel all the effects of sleep deprivations. People still need to be vigilant when they're sleep deprived, but it does reduce the effect or the short term negative effects of sleep deprivation. So it is a true strategy and it works great.

[33:29] Speaker A: I'm going to try that more often, and when I'm taking my naps, I'll tell everybody that I'm banking some. So, one last area that I'd like to touch on are sleep studies. Several years ago, my wife accused me of having apnea, etcetera. So I went and had a sleep study done. I was told I didn't have sleep apnea, but I was also told that actually when the lady woke me up, she said, I let you sleep longer. Usually you're out of here, but your best hours of sleep were the last 2 hours during the study. But I've always wondered how effective they are when you're in a clinical setting with all the wires and the cables attached to you, would you please talk about what a sleep study is and what is actually being studied and what the difference between a sleep study in a lab versus one conducted at home?

[34:22] Speaker B: Right? Yes, sure. So you're absolutely right. It sounds completely counterintuitive to think that to sleep in a strange bed in a sleep lab with all those wires attached to your head, your legs, the belts around your chest and belly, and there's sometimes a device on your finger, under your nose that all of that can actually get. Someone can measure sleep that we can interpret for when we look at possibility of sleep apnea or other sleep disorders. So it's true that it sounds counterintuitive, but actually also sounds much worse than it actually is to sleep with this. I used to tell people sleeping in the lab that it's like when you start wearing glasses, you know, you notice the frame, you notice the glasses, you feel them the first 510 minutes, but after a little while, you forget about them. And that's the same thing with all of those wires. Now, when people go to sleep, they might feel a little bit constrained, but I can assure you, those wires are well attached. You can move as much as you need, and they're not going to fall off, and then we're still going to have a good reading. And actually, all of these sensors that are attached to people measure different signals that we need to determine the quality of sleep, but also, more importantly, if there are sleep disorders that are happening during sleep, sleep apnea being one of the most common one. Those wires measure signals for brain activity. We can look at different stages of sleep, breathing, of course, to see if people have sleep apnea, they're going to stop breathing or if their breathing is attenuated, if their oxygen level goes down, if they snore, if they have leg movements, if they kick while they're sleeping. So that's why all those wires are there, to be able to have a full picture, if you want, of the purse of the biology, the physiology of the person sleeping. Now, in lab sleep studies are really the most precise way to detect if there is a sleep disorder. Again, I mentioned sleep apnea is the most common one for some people. There's also possibilities. There's a number of devices now that people or that doctors will recommend, will prescribe that can be sent to your home, and it's just a few sensors that are attached to you. You sleep in your bedroom, and then that information is sent back to the doctor to review and determine if there's a sleep problem. Those can be also effective, especially for people who have moderate to severe sleep apnea, for example. These devices are going to detect if there's an issue and based on these findings, then determine what is the best treatment option for a given person. I also want to mention that there are many sleep disorders that we can detect in the sleep lab that requires these wires, but there are many other sleep disorders that don't need to be evaluated with an overnight study in the sleep lab. Insomnia, which is actually more common than sleep apnea, is not measured or we don't need a sleep lab assessment for this. It's completely based on people's report of their sleep quality and their sleep habits.

[37:51] Speaker A: So you mentioned snoring, and I know I snore. I've actually woke myself up at times snoring. So. And I've seen this thing, of course, it's been on Facebook with this tape that you can buy to put across your mouth that keeps your lips pulled shut so you're not breathing through your mouth, and it allegedly helps you stop snoring. Is there any medical validity to any of that at all?

[38:22] Speaker B: Not that I know of. For light snorers, it's true that if you're, you know, snoring is the sound the air makes when it hits the tissue in the back of your throat. So that's where the snoring sound comes from. So it's true that if you don't breathe through your mouth and you're a light snorer, that may be helpful to keep your mouth shut. Nice and shut, basically, when you're sleeping and attenuate the snoring. But there are, for people who are loud snorers, even if you breathe through your nose, the air is going to hit something in the back of your throat and you're still going to have the. The snoring noise might be changed a little bit. And if that's the case, to your point, like snoring in and of itself, we used to say, oh, it's just snoring. It's not really a problem. But actually snoring can disrupt sleep, not just to your point of waking oneself up, but it also interferes with the airflow as we're sleeping. So there are different methods that are not necessarily the tape on the mouth that can be used to address snoring even when people don't have sleep apnea.

[39:37] Speaker A: Okay, so how does one go about getting a sleep study conducted? I mean, do they have to go to their primary care doctor and they have to order it or. And I know when I had mine done, my insurance covered it, but how does one go about arranging a sleep study?

[39:54] Speaker B: So exactly as you said, you can talk to your primary care doctor if you need a referral to go to a sleep clinic. I think you can also call directly a sleep clinic to schedule an appointment, depending on your insurance providers. And there are many sleep clinics that are also online. So virtual sleep clinics, if you want, where you'll have a telehealth appointment with the sleep doctors, they'll send you those like home testing device to evaluate your sleep. So there are different ways of doing it. It's really what's most convenient for people. Some places, if you call for a sleep study and they do it in the lab or they send it at home, home, sometimes you'll see the doctor. You'll see the sleep doctor before the sleep study. Sometimes you see them after the sleep study and it's equally good. So they'll ask you the same question. Some doctors prefer to have the sleep study results when they talk with the patients to have the full history and determine if there is an issue. What's the best treatment? Some doctors want to have the information ahead of time, and then they add the sleep study to the information they've already covered, collected. So it's really like seeing like what around you, depending on your insurance provider, where you are, do you need a referral? Or you can call a sleep clinic, whether a brigham or mortar sleep clinic or some of the virtual sleep clinics that are available.

[41:14] Speaker A: Okay, so I know we're, you're located in the Pittsburgh area, and I know we'll have your contact information as especially when we do the webinar. But for those people in western Pennsylvania who may be listening, how would they go about contacting you and your organization to get a sleep study done?

[41:32] Speaker B: So, through our company, noctam Health does not complete sleep studies. We work with people after they've already had a sleep studies or seen a sleep doctor that's made the determination that they actually have a sleep disorder that does not meet a CPAP or is best treated without medication. That's really our area of expertise. The best way to get in touch with me is, would actually to be sending me an email and I'll be able to guide people to where to find the resources that best fit what they're looking for. And they may end up working with us through their provider. They may end up working with another provider, but we'll make sure that they get to the medical care, medical sleep care that they need and that they get the right type of evaluation and the right type of treatment.

[42:25] Speaker A: So I'll make sure we include your email address if you're okay with it. With the notes that go out with this podcast.

[42:32] Speaker B: Yes, I am.

[42:33] Speaker A: Obviously, when we do your webinar in April, we'll make sure that we include that information as well. So basically, I go get a sleep study done somewhere and you help me, or you help the individual fix whatever was discovered during the sleep study.

[42:50] Speaker B: Correct? Based on the recommendations that they get from their doctors, yeah.

[42:53] Speaker A: Oh, all right. That's certainly different. I'm glad I asked that question. I may try to dig out my old sleep study and send it to.

[43:03] Speaker B: You, but if it sounds your sleep is like your sleep is pretty good, you seem like you have close to optimal sleep. If it's not optimal. Told me that it was, you know, when you fall asleep, it's consolidated, it's.

[43:15] Speaker A: Restored, it's much better, much better now than it was before, I'll give you that. There are times where I still have those issues. But one thing I've discovered, if I go to bed and I can't go to sleep, I get out of bed. I am rather, rather than laying in bed and fighting, trying to force myself to sleep, I just simply get out of bed. I may go watch tv, I may just go sit in the living room in the dark an hour, hour and a half later, go to bed, and then I can fall asleep.

[43:46] Speaker B: Well, sounds to me like you already have some of the key elements of good sleep, because that is exactly what we tell people to do. Your sleep and your bedroom, your bed should be only for sleep. If you're not sleeping, you're thinking, you're worrying, you're on the phone, get out of there, go to something. Because again, we're creatures of habits. We need to really reinforce the associations that when we're in bed, it's because we're sleepy or sleeping, and when we're not, we get out of bed and we stay in dim light, just like you said. Okay.

[44:18] Speaker A: Well, doctor Germain, I want to thank you. Well, let me back up. As we near the end of our podcast, do you have any last minute words of wisdom for our listeners?

[44:28] Speaker B: Yes, I do, actually. One is, I hope, if people retain a few messages, is that really sleep is not an option it's really critical for health and well being that the cure for sleep deprivation is sleep first and foremost, and that there are different strategies, including treatments to treat sleep disorders, to make sure that people can achieve the optimal sleep that they can achieve and really mitigate and reduce the chronic and the negative effect of poor sleep on daytime functioning, including safety and performance. I tell people that if the firefighting gear is your hardware, the software is your brain, your brain needs sleep to function optimally. It's no laughing matters. And it's not just something that we can cut. It's really important. Sleep is not optional.

[45:31] Speaker A: Well, Doctor Demaine, I want to thank you for taking the time to join me today. I look forward to our live webinar on April 29 at 07:00 p.m. Eastern Standard Time. To sign up for that webinar and view our previous recorded webinars, visit the link in our episode notes share this podcast with your colleagues. You can send them our subscription link, also found in the show notes. Lastly to our listeners, if you have any questions or need additional information, or if you have an idea for a future webinar or podcast, please email us@infoprovidentins.com. Station 1902 is signing off. Until next time, stay safe for your family's sake.