Why You Can't Sleep and How to Fix It on Any Shift

[0:00] Sleep is the one thing most of us are getting wrong, and it touches everything. Your weight, your mood, how long and how well you lived. And so my guest today lived that himself. Dr. Jerome Puryear is an obesity medicine physician and an author who burned out on night call, diagnosed his own sleep apnea, and then wrote a practical guide to fixing sleep no matter what shift you work. So this today's episode, this one is for the tired 45 year old, the night shift nurse, really anyone who lies awake at midnight, probably all of us, right? And can't figure out why.

[0:37] Health and wellness is confusing. There's a new trend every week. Everyone's got an opinion, and half the time, you can't tell what's legit and what's just good marketing. And we get it. We're in it too. Welcome to Dialed In Health. I'm Melissa Goodwin. Every episode, we bring in the people who actually do this work, providers, practitioners, the experts who see clients and patients every day. We ask the questions you'd ask if you were sitting across from them so you can find the right people, make better decisions, and feel confident about what's out there, whether it's peptides, gut health, water quality, ADHD, biohacking, or something you've never heard of, we're covering it. So let's get into it. Let's get Dialed In.

[1:14] So thank you, Dr. Puryear. Welcome to Dialed In Health. Thank you, I appreciate being here. So you're the doctor who lived it. So give us the high level version. Tell us a little bit about who you are and how you ended up literally writing a book on sleep. Yeah, I'm Jerome Puryear. I'm a obesity medicine specialist and interventional radiologist. And I think throughout life, things happen to you. You know, you have kids, sleep is disrupted when you're having kids.

[1:54] Through training, you have issues with sleep, sleep deprivation on surgical rounds and other rounds as well. In radiology, I had issues with night call, you know, being able to survive the night call. Believe it or not, most people don't even think that this is an issue, that shift work is an issue because, you know, we go to the hospital but we don't realize that those people are not working the nine to five shift, they're working other shifts. So their lives are affected as well. So I think because I was personally affected by sleep deprivation throughout life and there were symptoms and signs along the way, some of which I didn't recognize,

[2:33] you know, I was later diagnosed with sleep apnea. And so I think that in itself was really shocking to me to be a physician and to not really realize what the signs and symptoms are as you progress through training and through life. And I realized that through my obesity and medicine training, when we talked about, you know, the various dimensions of obesity, whether it's nutrition or exercise or sleep, that sleep is, you know, a cornerstone in this maze that should be addressed more often. Sleep is one of the disorders that's not commonly diagnosed as often as we would want it to be. So a lot of us go without sleep, you know, as you have kids or like you mentioned shift work, how do you know if sleep is a problem? Right, that's a very, very good question. For me, I didn't know that it was a problem until my doctor looked me in the face and he told me, he said, "Look, Jerry," he called me Jerry.

[3:42] Don't like the name Jerry, but he called me Jerry. He says, "Jerry, you are overweight." And to this day, I still remember what that feeling was like. I was so embarrassed. And he said I was pre-diabetic. And, you know, and then I kind of disclosed to him what was going on in my life. And, you know, I ended up seeing a sleep physician and the sleep physician ended up making the diagnosis. But looking back in retrospect, you know, I was always told, I was told in training that, you know, did you know you snore? And I was like, okay, so I snore. No, you really snore. And so I was like, okay, what is he trying to tell me? Or what was this person trying to tell me? And so it was that, and it was the weight gain, the, you know, not being able to breathe

[4:35] in the middle of the night. You know, I remember one specific incident where, you know, my spouse was in bed next to me and I got up and I just jumped out of bed because I couldn't breathe. You know, the reflux from probably eating late came up and it was almost like I was choking on my own, you know, gastric juices. And it seemed like it lasted forever.

[5:01] And at that point in time, I was like, this is the point and that's, you know, this is my moment where I have to change. Because at that point, the spouse couldn't, she was asleep. She couldn't do anything. And I felt like I could have died at that particular moment, you know? And so it was a series of events that I think. But if you're having sleep problems, and I come across people all the time and they, you know, think that some of their sleep issues are just how it is, you know, it's just how they, you know, want to, it's just how they have lived their life. And this is kind of, they've kind of accepted this. But it's not something that you need to accept. If you're someone who, you know, stays awake in the middle of the night or gets up early in the morning, you know, you don't feel rested. And this is going on for, let's say three or four times a week for several weeks, then you probably have a problem. You probably need to see, you know, you can see your general, you know, practice person, or you can see a sleep specialist.

[6:00] So you shared with me a story, an 18 Wheeler story, that was particularly moving for you. Can you tell us a little bit more about that story? And you mentioned shift work a little bit earlier. What night call can do to people? Yeah, absolutely. Well, this was an early morning, around five or six in the morning, and I was headed to work. I was refreshed and ready to go. I was headed down, I believe I-75.

[6:32] And it was close to a rest area. And I was approaching the rest area, maybe three hours, three miles before the rest area. And I saw this 18 Wheeler, you know, every now and then you'll see cars kind of, you know, swerve a little bit. This particular one swerved, but it swerved a lot. And it went off the road, but then it made a correction and came back. And I was behind it, and I was saying to myself, do I pass it or do I just stay back here? And, you know, do I honk? Well, you know, you have to decide kind of what you want to do. So before I could do anything, it did it again.

[7:06] And I was like, okay, this driver's falling asleep.

[7:09] And he's falling asleep. I was like, how do you handle that? And so he did it a third time. And the third time he had approached, we had approached the rest area and that rest area was full. So the trucks were parking on the side of the road. And so as he was approaching, he actually hit another 18 Wheeler at the time. And it happened so quickly. And a lot of the debris went into my lane and I had to make a quick decision to swerve into another lane. And another lady was swerving as well to miss all the debris and, you know, and prevent injury. But, you know, I can't say that that driver was asleep, but more likely than not, you know, he was probably undergoing what we call microsleeps. And microsleeps are when you're awake, but you're not conscious. We've all sometimes had those effects on the road or felt those effects on the road. It's like, you're tired. You probably need to go to, you know, you probably need to take a break, but you're asleep. You're having microsleeps. And when you're going 55 or 60 miles per hour, I mean, you can cover a lot of distances. You can cover a long distance in that short period of time, going that speed. Yeah. I remember when I was, for a while, I commuted to when I was younger in college and I was about an hour drive early in the morning, like five in the morning, and I would be driving. And then all of a sudden I would just like kind of like, jolt, what was, what happened that last? Like, it feels like, you know, how many miles I had driven, but I was either spacing out or who knows what, but that was kind of scary. I was a young, young kid at the time, but it's easy when you just get in that mode of driving too, especially to kind of zone out. I didn't know it was called microsleeps. How else might we be microsleeping and not realize it?

[9:03] Well, if you're behind the wheel and you don't know if you should take a break or not, the fact that you're asking the question should come to mind that perhaps I should take a break. But if you feel like you're tired, you're getting coffee, you're trying to stay awake,

[9:22] and you're looking out but you don't see anything, I mean, that's been my personal experience. You're looking out and your mind is asleep. And it's very dangerous. Yeah.

[9:34] So tell me, what was your, you know, when you think about sleep as the foundation for health, why is it so important that we get sleep? And, you know, what is it doing for us from a health perspective? What is happening when we're sleeping? Right. Sleep is extremely important, but it's just not the fact that you're getting sleep. It's the quality and the duration of your sleep. Both of those matter. I think when you talk about longevity, there are a lot of things that come to mind that play a part in that. Nutrition, genetics, social environment, exercise, a whole lot of things play a part in that. But sleep is central to all of that. And I say that because it affects your memory. The more restorative sleep you get, the more your memory is consolidated. So the less, you know, restorative sleep you have, you may have problems concentrating. You may have problems with your memory, or performance issues as it relates to that.

[10:43] How it affects your cardiovascular health. You know, your heart needs a break. So when you sleep and you get restorative sleep, your heart relaxes, your heart rate goes down, your blood pressure drops. But when you don't get that restorative sleep, that doesn't happen. And that increases your risk of cardiovascular disease and stroke.

[11:04] With regard to immunity, your immune system, your immune system has a couple of different phases.

[11:12] But, you know, if for some odd reason, you don't get the restorative sleep that you need, you can be more prone to infections.

[11:23] And of course, we've already talked about the safety issue that we, before, if you don't get enough sleep, you're putting not just your life at risk, but other lives as well. And I say that because every morning, or it seems like every morning in the city, I'm always hearing about an accident early in the morning that has happened. And, you know, sometimes you kind of wonder, was it because they were, you know, on their cell phone or, you know, were they texting or did they have a micro sleep? Right. What is the most dangerous time to be on the road as it relates to sleep? I would say between, well, according to the National Safety Transportation, they say that it's between 12 and 6 a.m. And my accident probably happened around six or 6.30 that morning. Wow. What, you know, many of us, when life gets busy, and, you know, all different stages, you know, sleep is the first thing to go.

[12:21] What advice do you have for people who, you know, you got like, I gotta get this done, I have to knock this out, there's this balance of life, and you experienced it yourself, you're a physician, so you have to show up for patients. How do you advise people or, you know, how much sleep do you say like you need to get? Right. I think it's different for everyone. For, if you're ill or you're elderly, or if you're a neonate, it just depends on age. But for the average person, as you mentioned at the beginning of the show, 40, 50 years old, I would say seven to nine hours of sleep is what's recommended. But it's not just the duration, it's the quality of the sleep as well. So you can say that you get seven hours of sleep, but you wake up fatigued, exhausted, and tired. That means the quality of your sleep is not what it should be. So you have to kind of have an internal clock to look to see if, you know, am I getting enough rest? And more importantly, how do I feel in the morning after the rest?

[13:28] So what if I'm not getting good quality sleep? What if I sleep nine hours, I wake up and I'm still hitting the snooze button? What do I do? Right. Well, I think sleep is something that has to be intentional. You know, a lot of people don't make it intentional. You know, what is your sleep plan? You know, most people would say they don't have a sleep plan,

[13:49] because I didn't have a sleep plan, but I have one now. What does that look like? Well, maybe setting alarm, letting you know that it's time to go to bed. You know, having in your mind what your standard anchor is for your wake up time. That is extremely important, to have a consistent wake up time so your circadian rhythm knows exactly what time you're gonna be getting up every morning.

[14:13] get rid of all the distractions. You know, one of the things that I found when I was working night shift, is there were so many distractions during the day.

[14:25] Somebody would ring the doorbell, FedEx would come.

[14:30] You know, someone else would call you on the telephone, your cell phone, the house phone. There's just so many things going on during the day that you don't really realize, but there's so many distractions during the day that it's like, how in the world can I sleep? You know, so your sleep is already kind of off the path because you're a shift worker and your circadian rhythm is not aligned with that. And then you have all these other distractions which further fragment your sleep. And so it becomes very challenging and very difficult to deal with on a daily basis if it's not intentional. So, you know, have a set wake up time. Prepare to go to bed.

[15:09] Don't drink, you know, coffee before you go, you know, before you go to bed. You know, everybody metabolizes coffee at a different rate.

[15:18] And so sometimes it's important to know, okay, I want my morning coffee, but when it comes to four or five, six o'clock, you know, what time do you plan on going to bed? You know, are you, is this coffee, is this caffeine in the coffee going to interfere with me sleeping? And I'm not just saying coffee. It could be tea, it could be candy. There are a lot of food products that have caffeine in them that we don't really consider, you know? So you may be eating, you know, some candy at the end of the day and you're thinking that it's not gonna, it will affect you. It will affect you. Yeah, and one thing I noticed from, there was a time where I was trying to sneak a workout in and I missed it. So I was like, I'll just do it quick, late at night. There was no way. Like once you get, it's like, I don't know if it's in your endorphins go up, but I was doing it like seven o'clock and I would not be able to sleep. So even a workout can affect your sleep too. Yeah, absolutely. I mean, everybody's a little different as to when they wanna work out. If you wanna work out in the evening, you have to plan it so that it doesn't affect your sleep. But again, that's part of the intentional plan that you have to have. You know, no alcohol before. If some people think, "Oh, I wanna drink alcohol before." And you know, cause I sleep, but you know, you have a better onset of sleep. Alcohol can sedate you and you can have a better onset of sleep. But alcohol makes your sleep fragmented. So you'd never get the deep restorative sleep. And I would challenge people to, you know, to plan it, you know, have a week or so where all your sleep is intentional, you know. There's no alcohol. There's, you know, you isolate yourself. You don't look at the blue light. Don't look at your phone, the TV, or any of that before you go to bed. You know, if it helps meditate prior to going to bed, have a noise machine in the background, you know, have the eye covers, you know, plan it however you see fit and do that for a week. And then if you drink alcohol, I'm not suggesting that you drink alcohol by any means, but if you do, see how well you sleep when you drink the alcohol and compare the two. And they are a vast difference. Yeah, I noticed that, you know, and I kind of quit, you know, I stopped drinking on a regular basis about 10 years ago. And then there was a couple of times where I would go to friends and have a couple of drinks and I would keep waking up. So I'd, you know, I'd fall asleep fast, but then I kept waking up throughout the night and that was super nice. So I was like, ah, enough of that.

[17:53] I'm curious because, you know, everyone has the wearables now, right? And your wearable tells you about your sleep. And it almost, I'm curious, if you're sleeping a lot, one of the things that I got, I got tripped up and I stopped wearing it. It was like, I kept telling me my sleep wasn't good, but I was sleeping a lot. And I wasn't sure what to do to fix that. What do you tell people if they're saying, hey, I'm getting eight or nine hours of sleep, but it looks like it might, my wearable says it's not good sleep. What do you do? Yeah, wearables can be good if they're the right wearable for you. Okay. You know, there are different types of wearables. There are different types of AI assisted devices. Wearables is one of them.

[18:33] And so you have to make sure that it's right for you and the price is right for you because many of them require subscriptions and other plans that you have to, you know, purchase. But one of the key questions I think is, you know, the purpose of the wearable is to change your habits, to make your habits better. And so you have to kind of go into it with that mindset. And if it's improving what you're doing, fantastic. But if it's not improving what you're doing or you're not really seeing the benefit of this wearable, then you have to question whether that wearable is for you. And more importantly, is a wearable accurate? You know, a wearable is gonna be, you know, provide you some preliminary data, you know, respiratory rate, VO2 max for some, you know, stages of sleep, that sort of thing. And so it can give you an idea as to what to modify. It can be like your own handheld coach, if you will. But it doesn't necessarily mean that all the data is correct or accurate for you or require you to make any habit changes. It's not a, you know, sleep test, you know, it's not anything that's clinical. It's just there to help you move in the direction that you want to move. And so, you know, I personally had a wearable before, it, you know, it was a ring that I put on my, and, you know, you had to download the software and look at it. And then you have kind of, I always wonder, is this data really helping me? You know, ultimately I end up, you know, it's a billion dollar industry. So I understand that people want to wear sleepables and that industry is really growing. And I think it can help people depending upon where, you know, where you are in your sleep cycle. But to me, the most important thing is how you feel in the morning.

[20:15] Right, okay. You know, and you have to be in tune with yourself to be able to know that, you know, the differences in how you feel. Are you moody? Are you irritable in the morning? And if so, is there a reason for that? You know, are you staying up all night and partying with whoever or talking on the phone or whatever and then having to get up early next day? And then you're feeling groggy and horrible. You're like, you know, oh my gosh, I feel horrible today. Why? Because your sleep wasn't on target.

[20:44] But you have to make those connections. Yeah, so I'm curious as a physician, you were probably used to sacrificing your own physical health for the sake of your job, right? So how did you get in touch with how you felt? Because you're probably just used to powering through. You guys have some of the craziest schedules in the middle of the night. You know, you're working at night, you're working during the day. Like you said, FedEx is coming. You're just constantly sacrificing. How did you reorient yourself? Yeah, I didn't reorient myself until I think COVID had a lot to do with it. Because through COVID, I end up taking additional coursework in obesity and medicine. And that in itself was an eye opener for me. I thought that, you know, the things that we talked about and the things that were absolutely key to longevity, were not really emphasized in medicine.

[21:43] You know, they're not really emphasized in medicine. And so that disturbed me. And so, you know, it was like this stuff, I mean, the things that we're learning here are so key.

[21:56] And one thing led to another thing. And so after that, I was very interested in meditation and behavioral changes and therapy. And so then I ended up getting the health and wellness coaching certificate and board certification. And that really brought me in tune with myself, you know. It really did. Because you're helping people change their behavior. And many times our behavior does not always reflect our goals and our values. You know, I've counseled quite a few men particularly, and their goal and the values to take care of their family. And do everything for their kids. But when you look at their lifestyle, their lifestyle is everything but, you know. It's doing everything but alcohol, tobacco, just running the race, not paying attention, just trying to make ends meet, just trying to do it. But when you sit them down and ask them,

[23:06] well, what you're doing does not reflect what you say your values are.

[23:12] So you keep doing this, the pre-diabetes, the cardiovascular disease, means you're not gonna be here, you know, you're not gonna be around later

[23:22] when your kids are older.

[23:25] Because you're on the road for premature death and morbidity and mortality. And so, you know, getting all those things aligned

[23:34] is key.

[23:37] What are the things, when you were doing that research, when you were getting your health and wellness certification and learning about longevity, what were the things that surprised you the most? What were the things that stuck out for you? We're just like, oh wow, I've been doing this wrong.

[23:57] I think how,

[24:00] I think it has to do with a lot of things that stuck out. But I think exercise, I think everyone thinks that the more you exercise, the more you're likely to lose weight.

[24:13] And I think that was, I mean, the research supports that, there's one of the issues of obesity is a little bit more complicated than just that.

[24:26] But there's a component of exercise that helps you maintain the weight that you've lost,

[24:34] but not necessarily contribute to the weight loss in and of itself.

[24:38] And so I think people don't separate that. Well, I went to the gym, I'm doing all these things, but I'm still not losing weight.

[24:45] And it's more complicated than just going to the gym. But I think people do it for commercial reasons. They do it because maybe they don't know. But it's more complicated than I'm going to the gym, I'm going to the gym, I'm going to the gym, not losing any weight, because that was me for a long time.

[25:02] That was me for a long time. It's like, well, why am I not losing weight? I don't really understand why this is happening. I did the keto diet, I did all these other things. Keto diet did work, but it was like the research shows, it's only a short time, it worked for maybe about a year. Then after that, it doesn't last that long where it didn't for me.

[25:19] And so I think learning fact from myth and fiction, I think was very helpful. And now I see it in commercials and just across the board, where people are advertising, and sometimes it can be misleading. And so, because it doesn't, it's not supported by the research.

[25:41] Right. So what are the things that people are doing every day? What are those everyday habits that we're all doing that is sabotaging our sleep? If you could just be like, stop doing these things, what would they be?

[25:57] (Laughing) Not having a plan. Okay. Not having a plan, being intentional about it, thinking about it beforehand, what am I gonna do for my sleep? I mean, you have to protect that time.

[26:10] Protect that time. And so, I mean, protected means if you have a spouse that snores or has restless leg syndrome or something that disrupts your sleep and you wake up irritable, moody, can't concentrate, having problems performing on the job or whatever, then maybe you need to sit back and think, hey, maybe I need to sleep in a different room.

[26:33] Okay. Or maybe that person needs, maybe that person has obstructive sleep apnea and doesn't know it, and maybe they need to be assessed.

[26:43] So I'm looking, I'm kind of looking beneath the surface of just someone snoring and you having interrupted sleep. We have to get back to what's the real cause?

[26:54] And I think sometimes people kind of don't really

[26:59] think about what the cause is or don't ask the right questions to figure out what the cause is to the right person.

[27:05] And so, I think, so there's a lot of things there that are unclear to some, but the key is to bring clarity to it and be intentional with your plan.

[27:18] So we don't have a sleep plan. I know the thing, the trap that I fall into is like, I'm going, going, going all day long. And then I finally get into bed and then I start doing this. And I know this is bad. I know it's bad, but it's sort of like, how do you, I'm sure, so I know that's another thing is just the scrolling, the doom scrolling at night, right?

[27:40] What other things are we doing that is interrupting our sleep? Drinking, you mentioned, you mentioned. Yeah, I can talk about the scrolling a little bit because everybody does that. It's just a habit.

[27:53] It's the light from the screen where there's the light from the screen that you're scrolling or whether it's the TV in the background, the bright light, the LED lights.

[28:02] Sleep has really changed with the industrial revolution in terms of the light and LED light now and all this light really suppresses melatonin. And so melatonin is the sleep hormone that is naturally secreted when it's time to go to bed. And so you suppress that when you are looking at the light. And so always imagine when you have your phone and you have this arrow going into your brain saying, you don't wanna go to sleep because this is gonna prevent you from going to sleep. But that's what's happening. It's going to a specific nucleus that releases that or a specific area in your brain that releases that.

[28:44] And it's preventing you from going to sleep. And I know so many people that sleep with the TV on. I mean, it's a distraction. It's keeping your mind going. You may be trying to go to sleep, but your mind and the background is still processing that. It's still hearing that.

[29:01] And it's keeping your brain awake and alert.

[29:07] Yeah, sort of like when you go to Las Vegas and they never, it's always bright and there's always the ding, ding, ding, ding, ding. You never know what time it is. There's the wild carpet. That's kind of what you're bringing into bed with you, right? It's like all of that Las Vegas into your bed. Right, right, right. Right, right. For those that are, and I'm really curious how you're going to answer this one. The differences between, you hear about insomnia,

[29:34] sleep apnea and other, like you're just, what's the difference between like a chronic sleep issue versus just being extra tired or being overly tired or not getting good sleep. What are the difference between these different sleep disorders? Right, I would say the difference between insomnia and sleep apnea are very different. Sleep apnea, I think as we already talked about is basically a collapse of your airway where you can't breathe because your airway is collapsing and you can't get any oxygen in, then that could cause apneic episodes where your brain doesn't get oxygen. And so there are times when people are snoring where they're closing off their airway, they're closing, they're diminishing that oxygen intake, gasping, and they're diminishing the oxygen to their brain. And so in those cases, those people need to be treated for sure. Other people who, lying in bed, can't get to sleep, if it's happening, like I mentioned earlier, if it's happening often enough, three or four times a week, over two or three weeks, then that's the time that someone needs to be treated and seen for treatment in those settings.

[30:46] If you're unsure, ask your primary care physician and if they are, if you think it's a serious problem and they brush you off, go see a specialist. Okay. Because that may mean that you may need additional testing. There are different types of sleep testing that they can do. You can do some at home, you can do some, you have to go into a sleep lab and they can,

[31:10] they'll have a sleep test for you in the sleep lab. That's kind of what I did.

[31:15] But some of that is determined by what your insurance will cover and how much the out-of-pocket expense is as to what you wanna do. But you may be able to get the same answer from either.

[31:28] I'm curious, you touched on a few things in terms of why sleep is important, right? So your immune system, your ability to navigate stressful situations and other things. What about things like, if you don't sleep enough, are you more prone to things like cancers and other kinds of illnesses? Is there research around that? I think sleep, because sleep is a hallmark for one of the aspects of obesity, I think. And if you, it's really a circle.

[32:03] When you don't get enough sleep, and this is often happens on shift work as well. You don't get enough sleep because your sleep is fragmented. Your hormones like ghrelin, which is your hunger hormone,

[32:16] which increases your hunger, and leptin, which does the opposite. Those hormones actually don't function as they should. And so you end up being more hungry. You end up eating more, taking in more calories, having more weight gain than normal. And weight is definitely associated with so many cancers.

[32:41] And I see that every day when I'm in the hospital. People don't often make the association. It's an association, not a causation. But it's important to realize that. Right. So you wrote a book. You wrote a book about sleep. Tell us a little bit about why you wrote the book. What's in it, and why did you write this book? I wrote the book because I think people are unaware that they may have a sleep problem. And because it's not one of those, if you have diabetes or something like that, it's very individual and it may not affect everyone. Sleep affects everyone.

[33:23] It affects everyone. If you drive a car, it affects you, whether you believe it or not. Because if you're riding down a two lane road

[33:35] at night, at night. Especially between 12 and six, right? Say that again. Especially between 12 and six, say yeah. Well, I mean, yeah, but I mean, and there are no lights on the road. And the person that's coming towards you has a microsleep.

[33:54] That is devastating, potentially devastating.

[34:00] Right. And so, I'm always thinking that when I go down these, when I go down the highway, it's like, this person's gonna be asleep. But you just never know, because it can happen in a split second. Somebody's in the wrong lane towards you and your life has changed.

[34:20] Right. So, is there any, you mentioned association, but not necessarily causation. What about like mental health and other things like that? Is there sleep associated with those kinds of things too? Absolutely. I mean, and that's why I mentioned before, when you mentioned is, how often should you sleep seven to nine hours is kind of what's recommended. But by the same token, if you're sleeping much longer than that, that can mean that you could be in a state of depression. And so, there are other medical conditions that you may have that can be associated with that, that need to be teased out. And so, that's what the physicians and the clinicians are, that's what their job is, is really to do.

[35:03] And so, if you have, and the book talks about, we talk about Huntington's, we talk about Parkinson's, we talk about stroke, we talk about a lot of different medical conditions. Many medical conditions can be impacted by sleep.

[35:16] And so, if you have restless leg syndrome, how do you manage that?

[35:23] If you have insomnia, and you don't know that you have insomnia, the book, it's not a diagnostic book, but it can help you say, if these things are happening to you, perhaps you need to see someone. And perhaps, more importantly, what we do is we talk about the various medical conditions that are common to most people, or in the hospital setting. Then we also talk about the common treatments. Because, again, it's not to saying that you need this specific treatment, but it's opening the door so that you can look in to see, okay, here are the treatments that are available. And if I go to my sleep medicine physician, and I say, oh, how about trying this medication? Or what do you think about this medication or this one? Or I wanna try, and I won't give out any names, but this class of medications. Because they all have their side effects, and you have to be willing to take those side effects on if you wanna try some of those prescription medications. Or other things that they may want you to try. So what were you not seeing in other books or other education that made you say, I need to put this information out there? What was missing? Oh, a lot of the chapters that are in the book, I mean, we talk about insomnia, we talk about sleep apnea, we talk about shift work.

[36:50] I don't think there are any books out on the market now shift work circadian rhythm disorders.

[36:57] And I know for a fact that I've talked to several colleagues and when I was working the night shift, I was asking them, what is it that you're doing to stay awake in the middle of the night? And they would tell me what they were doing, I was like, that's not what we should be doing.

[37:13] Right.

[37:15] They would tell me, I'm taking Benadryl, I'm like, that has side effects and that's not really what you need to be taking, that's not what you take for sleep, but that's what they were taking and of course they were always irritable and moody. And it was like, well, this is because you're taking this, but they didn't see the connection. Again, they're physicians, but they are not trained in any of this. And so again, it's another thing that I was like, okay, my colleagues are not aware of this. How do we expect the general public to be aware of this? Right. And so we cover a lot of the things, the disorders, we cover treatments, a variety of different treatments.

[37:50] And I tried to put in there some treatments that people don't often think about.

[37:55] And so I think there's some medications that are on the market that maybe some physicians may know about, but others may not know about, but I think it's helpful for clinicians as well.

[38:07] Got it. So it's primarily for the end user who's like, hey, I'm not sure if I might be having some sleep issues, but they haven't been able to find answers, they can pick up your book, also other providers can probably pick up a few pointers too. Tell me, I've heard this term sleep hygiene and I always kind of scoff when I hear that because it just feels like, honestly, it feels like a luxury for many of us that have kids, have jobs, run businesses, or maybe even just you're just busy.

[38:38] Tell me your take on sleep hygiene and what would be like, do these one or two things. If you were to give somebody like, this is what you need to do just to get some, get in the right ballpark for your sleep hygiene. Sleep hygiene to me just means developing habits, developing really good sleep habits. Okay. And I think you have to be intentional about it. And so if you're not intentional about it,

[39:08] you also have to be intentional about your health. You know, I believe in the concept of drifting. Most people are drifters. They're not really concerned about their health until something goes wrong.

[39:21] And then when they drift, they drift towards premature morbidity and mortality and death because they're not taking any action. They, you know, towards, whereas people who are not drifters are constantly aware about their health, constantly in tune with their health, constantly looking out, finding out what's best for them and moving towards, sometimes maybe moving towards health and wellness coaching and towards longevity and a better quality of life. And so that has to be taught because we're not really taught that in school or anywhere. You know, that's not something that people are aware of, or, you know, that's part of my platform is to help teach people some of these things that can prolong longevity.

[40:07] It's not prolong, scratch that. Help people so they can live a, not just a longer life, but a one that's of quality. I think that's extremely important.

[40:19] I love the idea of drifters because I feel like the crazier life gets, that's when those things start to fall away. Like you start working a few more longer hours or, you know, your food habits get a little worse because you're just, you're busy and you grab whatever's available or you miss your workout. And until things get bad, I know that a lot of us have that, so that makes sense. But the question becomes, you have to ask yourself the question,

[40:46] if you don't take care of yourself, who's going to?

[40:52] If you don't take care of yourself, who's going to?

[40:57] And if you have a good answer for that, I would love to hear it.

[41:03] That's fair, that's fair. Well, tell me, there's so many different sleep aids. You mentioned, you know, a lot of times people go to the doctor, get a Xanax or whatever they might need to sleep at night. What's the, there's like a one that starts with an H. Hydroxys, there's like a anti, I know there's a common one that they give for, it's like a, an anhistamine or something that also makes you sleep. There's all kinds of drugs, right? Most of the antihistamines do make you sleepy. Some of the newer ones don't, but. But there's melatonin and you know, I've heard things about, you know, melatonin is bad because it's just like a thousand times what your body naturally makes. If you take over the counter melatonin, you shouldn't do that. Prescription sleep meds, CBD, all the things out there. Tell me, what do people need to know about all of those sleep aids? What would you tell them? Well, I think it's very individual. I think it's important to know about whatever you're taking, you know, any over the counter supplement,

[42:08] you have to be aware of what's in the supplement. And because they're not FDA approved, sometimes you don't know what's in the supplement. And so I think that's, that's number one, just because it's on the shelf, doesn't necessarily mean that you know what's in it. And just because it has whatever label it is that's on it, doesn't mean that you know what's in it. And so I, there are third party verifiers that can tell you in the test, various supplements let you know what's in them because some of them have metals, they have carcinogens. You have no idea because they're not FDA approved. You can put whatever you want to in a bottle and sell it.

[42:43] And so it's very important to know what's in the supplement. Regarding to melatonin, I think that's very individual. I think sometimes people don't know what dose to take, you know, because it's not a prescription. So you take, you're prescribing yourself. And then that can have side effects as well. And so it's important to be aware of why you're taking it. You know, are you, are you covering up something that already exists? Have you seen some, have you seen someone that may say, okay, let's try this prescription drug. Maybe we need to pair that with cognitive behavioral therapy, which is kind of what we were talking about before about, you know, matching, you know, what your thoughts and values and behaviors are, you know, maybe we need to, so what's the treatment plan? Are we just self-treating and seeing what happens?

[43:31] Or are we really trying to create a plan with a definite outcome that we want? So I'm not saying that those products that you mentioned before can't be used. I mean, you know, whether you, THC can cause some sedation, but it's never gonna cause restorative sleep and there's no research to support that. CBD doesn't have, you know, is not FDA approved for any of that. And so, and when we talk about CBD gummies, that's a whole different story. CBD gummies, you know, you don't, the overall effect happens much later than when you take them. So if you're eating gummies, you're thinking you're not getting the effects, you start eating more and more and more of them. And then by the time the overall effect hits, you could have overdosed on it. Because you don't know what, you want, you don't know what the dose is, and so all that can be cumulative.

[44:25] And so, you know, what the, you know, when something is not prescribed, you're self-treating and you don't know what the dose is. And because of that, you don't know what effect it's going to have on you.

[44:38] And so I think people need to be very cautious about what they put in their bodies for that very reason. Right, that makes sense. Is there anything, you know, if you had a, is there anything that you would say, in general, this is what I would recommend from a supplement or medication perspective, or in every case, do you need to talk with you, with a sleep specialist? Well, I think, well, I wanna think it depends on what's going on with you. But I think there are some good prescription medications out there. I took ramelteon, it's a melatonin-like product. It hits the melatonin receptors and it mimics, you know, it can definitely help you go to sleep within 30 minutes, for sure. Okay. You know? And so I'm not pushing that, but I'm just simply saying that's in the book as well, so you know the difference between melatonin and this other prescription drug,

[45:30] that you can ask someone, "Hey, I'm having a problem falling asleep. "Will this medication help me?" But eventually I think, you know, it's always good to develop these habits, these, you know, the habits that are good, that are natural. Right.

[45:46] You know, if you start taking other products, if you're taking other products, how do those other products interfere with other medications that you're taking?

[45:54] You know, there could be a drug-to-drug interaction that you're not aware of. Right. And so I'm not a proponent of, you know, if you need a supplement because you're deficient in that, I think the science supports supplementing that. If you're so deficient in vitamin D, take the vitamin D supplement. But if you're not deficient in it, why are we taking it? And what are you taking specifically? Or do you even know that? Right. I'm gonna read you a few statements and you can tell me what you think about these statements. If you're very, very tired, you can catch up on lost sleep over the weekend.

[46:33] You can catch up on lost sleep because you're tired, yes. But it doesn't necessarily mean that it's gonna be restorative sleep.

[46:40] You know, that's the bottom line. I mean, you know, you need to try to anchor your sleep and get the amount of sleep, the duration of seven to nine hours, and make sure that you have sleep habits that accompany that and that reinforce that and that you have good quality sleep.

[47:03] So I have a partner that says they only need five to six hours of sleep. Is that, is it that, is the variety of the needs of sleep that different? Six hours, eight hours, nine hours, are we that? Is there that much of a swing? Well, I think sometimes when people say that they need five hours of sleep, what they don't assess is the ramifications behind not getting the seven to nine hours. And what would those be? That would be things like, you know, is your concentration impaired?

[47:33] Is your memory impaired? Is your performance impaired? Are you irritable? Are you moody the next day? You know?

[47:43] And so when you assess the whole picture, I would say that some people may say that the five hours is really not sufficient because they do have those other issues, but you have to be in tune with yourself to know that. Got it. So in general, most people need seven to nine hours. There's not like a five hour sleep person. No, I would say that I can't say that. I can't be that definitive about it because I think before it depends on illness, it depends on other things that are going on with your life as to how much you need. I'm just saying the recommended amount is seven to nine. Got it. All right, here's another statement. Snoring is harmless. It's just annoying. Yeah, snoring, all snoring is not sleep apnea, but if someone is snoring and they're gasping and they're, you know, have, you know, episodes where they have apneic episodes where they're not breathing at all, then it can be very problematic. And it's important that people assess whether if they are snoring, you know, do they, you know, raise the question, do I have sleep apnea? And they can raise that question to a appropriate clinician and then they could take it from there. But they, if they don't, if they, you know, nowadays with healthcare, you go in for a problem, they fix the problem, you know, how many people go into, you know, to the doctor's and say, doctor's office and say, I have a sleep problem. Or I'm not getting sleep, I'm tired, I'm, you know, I mean, you can say you're tired and you're fatigued, but that could be any number of, you know, metabolic things that's going on with you. And so they have to kind of rule out those other things. But if you come in and let's say you think you do have a sleep problem and you keep a diary and say, these are the days that, you know, I've not gotten really good sleep. I, you know, woke up at this, you know, two or three in the morning these days or whatever. And then you show them that, okay, look, here's my history, you know, what do you think about that?

[49:33] But if you come in and don't have any history, then the clinician is thinking about all these other things that could be affecting your sleep. I'm not saying they're not, but they need to see the whole picture. Right.

[49:44] If you work shift work, especially nights, you're just going to have bad sleep hygiene. There's no way to have good sleep hygiene with shift work. Yeah, I thought that for a long time. It's like, this is just part of the job, right? Actually it's not.

[50:00] I think the key to adjusting to it is being intentional about your sleep plan, you know, making sure that, you know, when you're awake, that, you know, there's, you know, bright light associated with it when it's not, then it's time to have those, you know, those curtains up. Make sure that, you know, have other things in place to help you go to sleep. Make sure that melatonin is releasing at the time that it needs to, you know, to release. I think, you know, getting rid of the environmental influences, as we mentioned before, I think that is absolutely key. If you're sleeping at a, you know, odd time.

[50:38] And, you know, your sleep hygiene is a little bit, you know, what changed because the hours in which you sleep change,

[50:46] but you have to be intentional about it. Even with eating, making sure that you have planned, a planned schedule for eating, you know, making sure that you're just not, because there was a point in time where I was just kind of eating throughout, I was eating throughout the night, you know? I wasn't hungry, but I was eating to stay awake. I was eating, I mean, I was just gaining calories for no reason. You know, and I was like, I know I'm doing this, but you know, what's, you know, so being intentional about, okay, I'm gonna set a plan, a meal. Here's what I'm gonna eat during this period of time. You know, and here's, you know, but being intentional about it, if you're not intentional about it, you find yourself eating, you know, I can imagine people eating candy, eating a lot of carbs, eating a bunch of things that they don't need, you know, or drinking caffeine at the wrong time. You still have to be mindful even with that, because you don't want the caffeine to stay in your system. It's time to go to sleep, but you just had a cup of coffee, or even decaffeinated coffee has some caffeine in it. And some people may think, well, I'm gonna just have some decaffeinated coffee, but that has a little bit of caffeine in it as well. And if you're caffeine sensitive, that can be enough to keep you awake.

[51:45] Okay. What about multiple naps throughout the day? Is that just as good as getting a, sleep a little bit at night and then take multiple naps? Right, I think that interferes,

[51:55] it can interfere with your sleep. It depends on how long the naps are. I think it's recommended that you take, what, 20, 30 minute naps, but no longer than that. No, really no longer than 20 minutes or so, because it just bleeds over into your regular disturbance of your sleep, circadian rhythm, you know? And so you don't want that to happen. So short naps for burst of energy, fine, but not longer ones and not more of them. Okay.

[52:24] All right, you're messing with my plans here.

[52:29] Dr. Puryear, because I, when I take a nap, like I like to take a long, good nap.

[52:36] (Laughing) I'm gonna be out for a while.

[52:39] I don't like that answer. All right, what is one, what is one bill, if you had a billboard to put up for people with regards to sleep, what would it say?

[52:50] A billboard that I put up, that's a good question. It would say something to the fact that, you know, asking people, do you feel tired, exhausted,

[53:07] can't focus, maybe it's a sleep issue that you have that's undiagnosed.

[53:14] Okay, so tell us the name of your book, where we can find it, when it's released, it's coming out here, tell us, can we find it on Amazon? Yeah. Where we can find it. Can we find it on Amazon? Yeah, it's sleep deprivation, a doctor's guide to why you can't sleep and how to get better sleep, available on August 31st on Amazon. Right now it's on pre-order on Amazon as well.

[53:38] And if we wanna find you, or if someone watches this episode and they wanna learn more about you and your work, where can we find you? Well, make sure to put that in the show notes as well. So if you're watching on YouTube, you can click on the description, we'll have all of it there. But why don't you share with us how to connect with you? Yeah, my website is drjeromepuryear.com.

[54:06] Fantastic, okay. Is there anything else that we haven't covered that you would really, you want people to know,

[54:14] now that we're all feeling terrible about our sleep habits and our sleep hygiene, anything else that you wanna share that you want us to know as it relates to sleep and how to get better sleep?

[54:24] No, I think,

[54:28] I mean, I want people to know everything about sleep, that's why I wrote the book. So I want you to know about the history of sleep, why we can't sleep in this, you know, in this industrial age that we live in. Because I think it helps you understand why we say, why we talk about the bright lights, the LED lights and how technology is advancing, but we have to advance with it. You know, we have to advance whether these are things that are happening, these are things that are disrupting our sleep, but it's also affecting our quality of life. And more importantly, it's affecting our health.

[54:58] It's affecting our health. And so if you wanna be health conscious, you have to be focused on what's happening around you, why it's happening and how to prevent it. Right, I love that. Well, thank you so much for being on the show, sharing your expertise. Again, if you wanna find Dr. Puryear's book, it's on Amazon, we'll make sure to have a link to that in the show notes. I'm sure we'll have lots of questions on this one. So really looking forward to the engagement and interaction here. Thank you again for being on the show. All right, thank you for having me. Absolutely.

[55:32] Hey, that's our show. If someone came to mind while you were listening to this, if you thought, "Hey, my sister needs to hear this," or, "I should send this to my mom," or, "My buddy would get a lot out of this," please share it with them. Just hit the share button and send it their way. You never know what one conversation, one episode, or one piece of information can do for someone who's been looking for answers. If you haven't subscribed yet, please do it now. It takes two seconds. It's free and it means you won't miss an episode. We've got incredible stuff coming up and I don't want you to miss any of it. If you're a health or wellness provider and you want to be on the show, we'd love to hear from you. There's a link in the show notes to get in touch. We're always looking for people doing interesting work who want to share what they know. One last thing, I get asked all the time about the products and brands I actually use, so I've put together a list of sponsors and favorite products that have worked for me and my family. If you're curious, that link is in the show notes too. Thank you for being here and I really mean that. I'm Melissa Goodwin. The line is open. See you next time.