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

20 years ago, this little purple box saved my life. It all happened in one

night

, the most restful

night

of sleep I had ever known. That same day I was speaking with my friend and colleague, Dr. Thomas Meade, a pioneer in dental sleep medicine. I was criticizing Tom with my two-year battle with chronic insomnia, frequent a

wake

nings, trips to the bathroom, struggling to get back to sleep, exhausted in the morning and tired and sleepy all day, plus two tied car accidents. to lack of sleep Tom's Cheshire Cat smile told me he had heard this story before when he pulled this magic box out of his oversized briefcase, opened it, took out this piece of plastic, dropped it into a cup of water , boiled it in a microwave and then handed it to me and said, bite into this after gritting your teeth into the warm plastic mold.

He handed it back to him, smoothed out the surface and handed it back to me and said, well, let's see if you breathe easier tonight, which was a strange thought to me. someone complaining of insomnia that night was so memorable that I can still imagine in my mind waking up, turning over and asking my wife Jessica what happened nothing happened that night no

wake

-ups or trips to the bathroom I felt incredibly rested from the best sleep I've ever had. It had been two years, actually 35 years, when I finally realized the true nature of my sleep disorder, this exact moment changed my life dramatically because that day I experienced a huge burst of energy in my mind and in my body as something I never dreamed possible for my own health.

This moment also revolutionized my thinking practice and research in the field of sleep medicine. The irony is that dr. Christian gman Oh made this discovery linking breathing during sleep and insomnia in 1973, almost 50 years later, we are here discussing how something physical could cause insomnia, an idea that has gone unnoticed by the general medical profession and even parts of sleep medicine. community, all because this singular question was not asked: why do you wake up at night? why do you wake up? How common are awakenings in this audience? At least probably a third of you struggle with sleep or going to the bathroom still because there are so many. of us wake up we think it's normal well, here's news number one if you wake up you suffer from sleep interruptions trips to the bathroom you're tired and sleepy the next day you suffer from a serious sleep disorder chronic insomnia a devastating and costly condition insomnia Chronic harms your brain and heart Worse anxiety and depression Even inhibits your ability to fight infections Billions of health care dollars are spent because sleepless nights take a toll on your physical and mental health Billions more are They lose financially through sick days, workplace accidents, and decreased productivity, and of course, billions more are spent in the desperate search for sleep aids over-the-counter medications prescription sedatives vitamins mineral supplements herbal remedies, but few find truly lasting relief mental health patients suffer the most from insomnia and yet more tranquilizing medications are prescribed antidepressants antipsychotics anticonvulsant medications can help mental health but these medications cause side effects that worsen sleep millions more insomniacs They believe or are made to believe that the only solution to sleepless nights is medications and yet they suffer for years without finding a cure and often I have never heard of other options, so if drugs are not the answer to this very condition irritant that drives some people so crazy that they become suicidal or makes some people feel crazy from the shame and fear of not being able to sleep, what is the answer? or for these psychological problems, cognitive behavioral therapy for insomnia, CBT-i is a powerful tool because many insomniacs get frustrated being awake in bed, tossing and turning, looking at the clock trying to force sleep, everything. which only aggravates his insomnia.

CBT-i empowers them to You are far beyond drug therapy because it teaches you to stop losing sleep for the sake of losing sleep, but neither CBT nor medications answer our question: Why do you get up in the morning? evening? Sleepers normally wake up and go back to sleep. Because? Because they are sleepy. The insomniacs. They wake up and go from zero to 60 in about two seconds, not only are they wide awake, but they can also suffer from racing thoughts, heart palpitations, anxiety, stress, worries, all because they have been brought out of their sleep and are fully alert.

Normally, we gradually ascend from If you sleep to waking up in the morning with or without coffee, why would you wake up suddenly in the night unless something was waking you up? This clue would have explained the insomnia, but it was ignored for a long time. Research shows that insomniacs line up on the usual list of Suspects to Explain Awakenings Anxiety Stress Worries Racing Thoughts But even insomniacs are asleep before they wake up, so they don't know for sure why they wake up and remain perplexed by being completely alert in the middle of the night. I looked for insomniacs in the sleep lab and monitored them before, during and after these awakenings and the results were impressive, not only did they wake up more times than normal sleepers, but they suffered hundreds of mini awakenings, what we call arousal, which fractured your sleep and destroyed your sleep quality and if you're ready, force breaking news number two, 90% of your awakenings and arousals were caused by please take a deep breath, that's what They didn't, their breathing was compromised and obstructed because they suffered from obstructive sleep apnea.

The same condition that fueled my insomnia twenty years ago. In this graph you will see the three main respiratory events of sleep apnea. At the top, breathing is normal. Smooth, rounded curves up and down, suggesting you inhale and exhale. At the bottom, apnea is flat, complete asphyxiation. As his throat collapses, obviously anyone would wake up from that blockage. Next are hypopneas, a 50% reduction, and then flow limitation, a 25% reduction. All of these breathing events can wake you up. Insomniacs have more of the moderate type, so you might be asking: a 25% reduction in your breathing wakes you up fine, let's try this experiment, go ahead, put your hands in front of you, take a moment, now bring them to your throat and start choking around 25, okay, you understand breathing.

It's good not to breathe it's life threatening which explains where all the skepticism about this theory comes from because how is it possible that you can wake up all night with a breathing problem and not know it? Consider well the case of severe sleep apnea, they suffer hundreds of asphyxiations. throughout the night complete loss of breathing when they seek help at a sleep center alone after someone in their room gets scared looking at them and hearing them not breathing and then they seek help a few months later no, how about a few years later no? Only after suffering from a life-threatening disorder for about a decade can they seek help, so if the worst-case scenario doesn't get it, how would insomniacs detect the problem when they only suffer from this more moderate respiratory disturbance that still wakes them up?

Let's slow down our understanding of the link between insomnia and breathing problems during sleep. We now understand that many insomniacs suffer from two disorders in one. It is easy to see the psychological side when you are awake, but the physiological side is hidden because you are asleep. The radical change of paradigm and knowledge demands a new term to designate the complexity of this problem, that is why we call it complex insomnia, which indicates the need to perform in-depth physiological tests, a study of sleep during the night to identify and diagnose what wakes you up, for any die-hard skeptics still out there.

There we have one last and surprising piece of the puzzle. Remember that insomniacs go to the bathroom and complain about it. It's called nocturia. The repetition of dream number three. Who would have thought that sleep apnea causes nocturia? Sleep apnea pushes excess blood flow toward the heart. Throughout the night, the heart responds by releasing a natural diuretic that causes the kidneys to work overtime during the night, which is why sleep apnea causes insomnia and nocturia. It's actually a pretty good two-for-one deal when it comes to treatment. There are three levels of therapy to treat breathing during sleep. first, focus on nasal breathing, saline nasal rinses, neti washes, prescription nasal sprays will eradicate chronic congestion, lastly, we highly recommend nasal strips because we study insomniacs with moderate respiratory symptoms during sleep and 75 % of them reported a decrease in insomnia simply by using the nasal strip on a nightly basis, mandibular advancement devices, or oral appliance therapy like the one dr.

Mead, these are becoming a first-line therapy: they gently anchor to the dental arches and push the jaw forward, opening the airway, allowing more air to pass and eradicating most respiratory events. The last one is positive airway pressure pappi, the gold standard that most know is CPAP. The C means continuous or constant pressure when inhaling and exhaling and that is the problem. You probably know someone whose CPAP failed because he couldn't tolerate exhaling in the face of that constant pressure. Mental health patients and insomnia patients cannot tolerate CPAP and develop panic. It attacks claustrophobia and even traumatic experiences so harmful to them that they will abandon care for a few years right after a brief exposure to CPAP.

Unfortunately, some insurance companies and even some sleep centers do not recognize these side effects and instead blame patients for not using CPAP. Fortunately technology has found a better way in 2005 we switched all our patients to dual pressure level devices, high pressure when you inhale and low pressure when you exhale, this matches your natural breathing pattern, there are even advanced level devices that They monitor your breathing and adjust pressures throughout the night. Ultimate Sleep technology has expanded with numerous masks that can fit over your nose or as full face masks and there are mask liners that improve comfort.

Virtually anyone can learn. to use the gold standard respiratory treatment if they were prescribed the precise pressure settings of the correct PAP device and the best fit of the mask. Are you ready to put this to bed? I trust you have learned three things. Insomnia is a common disorder with serious consequences for your physical and mental health, but you've probably won. Do not seek treatment until you realize that frequent awakenings and interrupted sleep are not normal. Second insomnia and sleep apnea meet at the hip. Using this term complex insomnia will encourage you and your providers to attack the mental and physical part of your long sleepless nights.

Many of you who suffer from insomnia, as incredible as it may seem, it is not only in your mind, but also in your airways. There are many treatment options available and all produce good results. I would like to finish by saying that I sincerely believe. that if you apply this information with the help of your doctors, dentists and sleep medicine professionals you will overcome insomnia and discover and experience the rest of your life, thank you.