Transcription of Sleep & Dreams #48
Dr. Lisa: This is Dr. Lisa Belisle and you are listening to the Dr. Lisa radio hour and podcast number forty eight. Sleep and Dreams, airing for the first time on August 12, 2012 on WLOB and WPEI radio, Portland, Maine. Today to discuss Sleep and Dreams with me is my co-host Genevieve Morgan. Hi Genevieve.
Genevieve: Hi Lisa. Did you have a good night’s sleep last night?
Dr. Lisa: Well I actually didn’t and part of it is because I’m reacting to something in the carpet in my house. It’s summertime and the stuff is coming up and I know I’m not the only one out there who has this sort of thing that happens at night.
Genevieve: It’s interesting how frequent sleep disturbances happen. You must see them all the time at your practice.
Dr. Lisa: I see them all the time at my practice and just thinking about my own situation, it’s such a minor thing that I had this little cough and it just interrupts me all night long. I think that all the people who have something much bigger than a little cough, and it is constant for them, something physiologic, something like a sleep apnea issue or maybe congestive heart failure or something really big. I do, I see this all the time in my practice.
Genevieve: Even the mind running away with problems, I always find that if I start to think before I go to bed my mind just keeps me up and I can’t stop thinking and things get out of control must faster in the wee hours of the night.
Dr. Lisa: This is true and it does have something to do with our conscious mind being able to suppress things for us and enable us to function as we go through our daily lives, but at night our conscious mind rests and our subconscious mind comes about to sometimes torment us, sometimes remind us of things we should be doing. It gives us- some people believe, Freud and Jung believe that dreams actually had an impact on giving people clues to what their lives should look like.
It’s a very interesting field, one that’s been expanding rapidly.
Genevieve: How do you deal with sleep disturbances in your practice?
Dr. Lisa: Before I trained in Chinese medicine, I was a family medicine doctor and I spent a lot of time dealing with patients and talking about sleep hygiene and no electronics in the bedroom and having a bedtime the same every night and waking up the same time every morning, darkening the rooms. All of these things are very important starting a base plan with sleep hygiene.
The next line was medication. We know that medication is very widely prescribed. Sleep medication, anti-anxiety medication very widely prescribed in western medicine. As I became more familiar with Chinese medicine, I understood that if it wasn’t a physiologic problem, if it wasn’t pain or congestive heart failure or sleep apnea that was keeping somebody up at night, the shen or the spirit actually had a much bigger impact on somebody’s ability to sleep perhaps as recognized in western medicine.
That’s what I deal with in my practice. When people come in with sleep disturbances, I talk with them about their spirit or their shen.
Genevieve: Does acupuncture help?
Dr. Lisa: Acupuncture does help and it also helps to come in and have a conversation with an acupuncturist or somebody like me who does integrated medicine about maybe some things that are going on in your life. Maybe you’re not sleeping well because there’s some kind of something that needs to be addressed. Something that needs to be changed, something that perhaps you’ve been avoiding or maybe you don’t even know about. Even speaking it out loud and naming it, that’s kind of the first step.
Genevieve: Maybe your dreams can help you figure that out.
Dr. Lisa: Maybe your dreams can help you figure that out. Acupuncture is very helpful because we’re finding out more and more research to support this thousands year old medical modality that suggests that it’s a re-balancing thing that these needles do. Relatively painless and relatively risk free, so it can be a very helpful thing for sleep.
On today’s show, we have Dr. Gary Astrachan, who is a clinical psychologist and Jungian analyst with a private practice here in Portland, Maine. And we also have Dr. Thad Shattuck who is a sleep specialist out of Lewiston, Maine.
The very interesting approaches to sleep and dreams, the very different approaches to sleep and dreams, and those of you who are listening I think you’re going to get some interesting tips and interesting thoughts. Very thought provoking and hopefully it won’t disturb your sleep. So thank you for joining us today.
The Dr. Lisa radio and podcast is proud to be sponsored by the University of New England. As part of our affiliation with the University of New England, we feature a segment we call Wellness Innovations. This week’s wellness innovation comes from Psychology Today:
“What do your dreams say about who you are? Dreams, they’re bizarre, powerful, mundane, emotional, sexual, frightening, elating, and devastating. Scientists and laymen have puzzled over the mystery of dreams for centuries. Why do we have them? And more importantly what do they mean, if anything. We do know that like all perceived experience, you have your unique brain to thank for the experience of dreaming. Though we may not know whether our dreams should be interpreted as meaningful in the psycho-analytic sense, they may tell us something about who we are as individuals.
We know that people’s brains are systematically different from one another and that such differences correspond with personality trait variance. Thus, the neurobiology of dreaming points to a surprising parallel with core ideas of psycho-analysis. The virtual absence of self monitoring in dreams combine with the apparent treat-like aspects of their content indicates a world in which our dreams represent an experience of our more uninhibited and unbridled concerns and emotions.
The science indicates that it is interesting and worth while to observe themes and patterns that occur in the dreams you may remember. They could be telling you something about yourself that would otherwise be filed away out of consciousness.”
For more information on this Wellness Innovation visit doctorlisa.org. For information on the University of New England visit UNE.edu.
Speaker 1: This portion of the Dr. Lisa radio hour and podcast has been brought to you by the University of New England, UNE. An innovated health sciences university grounded in the liberal arts. UNE is in the number one educator of health professionals in Maine. Learn more about the University of New England at UNE.edu.
Dr. Lisa: Today as part of our Sleep and Dreams show, we have in the studio with us Dr. Gary Astrachan, a clinical psychologist and Jungian analyst in private practice in Portland, Maine. Dr. Astrachan is the faculty member and supervising and training analyst at the Jung Institute in Boston and lectures and teaches widely through North America and Europe.
He’s also the author of numerous scholarly articles and professional journals and books and writes particular on the relationship between analytical psychology and Greek mythology, poetry, painting, film, post-modernism, and critical theory. Thank you for coming in today.
Dr. Gary: It’s my pleasure to be here.
Dr. Lisa: And I have Genevieve Morgan sitting next to me, the wellness editor for Maine Magazine. If I had to admit that I felt particular pressure to remember my dreams last night.
Dr. Gary: Oh, so did I. (laughs)
Dr. Lisa: Now do you try to remember your dreams on a regular basis?
Dr. Gary: I do, actually. Yes, I think it’s part of the daily practice. Not that I remember them every day, but it is a practice and every if I don’t remember them every day I’ll spend sometimes with what I don’t remember.
Dr. Lisa: Let’s back up just a little bit for people who are not familiar with Jungian analysis and Dr. Jung. Can you give us some background on that?
Dr. Gary: Sure. Well C.G. Jung was a student, a disciple, and a mentee – if there’s such a word – of Sigmund Freud, who’s the person who put the notion of dreams and the unconscious and the psyche in general on the map for all of us. The twentieth century and twenty-first century human beings. And so created a pretty bold new terrain for exploration for all of contemporary people. Jung was a follower of his and disciple and was the crown prince until they came to a parting of the ways.
Jung struck off on his own and one of the points of difference you might say was the significance of dreams that Young saw his teacher Sigmund Freud taking in a more personalistic way then he was just then beginning to explore for himself. C.G. Jung through the crisis of his separation from Freud and through his own turmoil ended up birthing over a period of several years in the nineteen teens into the early twenties, what is called to this day analytical psychology.
That was the whole school and theoretical framework of psychology that in a way separates and differentiates himself from psycho-analysis is what Freud really founded and birthed. Freud by the way gave birth to psycho-analysis out of his own depth’s journey, or crisis if you will, personal crisis. As a result of the death of his father, the breakup of a close friendship of his own, and out of his own underworld journey gave birth to what became the interpretation of dreams. That book that puts it’s indelible mark on the twentieth century.
In that book, Freud writes that dreams are what he calls the via regia or the royal road to the unconscious and that’s a position that Jung very much drank in and would still subscribe to. That dreams are the royal road to the unconscious or the psyche of the world of the soul.
Dr. Lisa: Psycho-analysis and analytic psychology those are very different from other types of psychology and therapy that are available in the world today. Those are very specific types of therapy that’s available to people.
Dr. Gary: They’re very different but in some respects they’re not so different. Sometimes if you’re a fly on the world and you’re sitting in the consulting room of a psycho-analyst, a Freudian psycho-analyst or myself perhaps a Jungian psycho-analyst, you might not differentiate it a whole lot from what would look like garden variety psycho therapy at times. What’s different is the orientation, a focus. A feeling attitude that attempts to be attentive to and respond to really what we call the depth dimension of the psyche.
Psycho-analysis and analytical psychology in Jungian psychology that is are kind of journeys or explorations that one undertakes and embarks upon that have no certain time of how long they’ll take, or more importantly how deep they may need to go for any one individual.
Dr. Lisa: This brings us back to this idea of dreams which are reflecting a depth in someone’s psyche that you aren’t necessarily going to be able to identify at any particular moment. If somebody might come into your office with a dream that they’ve had the night before, and it may or may not be related to some thread that you started talking with them about weeks previous.
Dr. Gary: The dreams reveal a realm and a place and a space that we with our conscious minds neither myself as a psycho-analyst or the patient can have any access to whatsoever with our ordinary conscious rational waking mind. So they offer a whole other dimension, a world that I in collaboration with the analysis and kind of look towards for guidance, direction, purpose, and meaning as to where and how they may need to be going in their own lives.
I surely can’t, especially someone who I started working with initially, I have no idea where they need to go or what’s going on for them, what they need to do, and I can’t say that with my own conscious mind. They’re not sure themselves what’s going on for them. They might know that they just went through a separation or a divorce or something and they’re kind of reeling from that and they have some issues they want to talk about.
So we join together and become partners in an exploration of a whole other medium that is bigger than both of us. That in fact forms a kind of third entity in the consulting room. Whose boundaries and borders, we really have no idea – no one really does at this point. We really can’t discern who’s parameters we can’t adequately describe. We look towards that realm for messages, indications, signs, in particular in the form of dreams that try to give us the message of we are in a particular. The patient or the analyst is in the process of their life.
Dr. Lisa: Have you seen in your treatment of patients a progression? If you have a new analysand and you start to tune them to their dream life, as they move through the analysis process do their dreams change?
Dr. Gary: Absolutely. A lot of people come to see me who typically might not know I’m a Jungian or Jungian -analyst at all. They’ll come in for therapy, something’s gone on in their lives, they’re in a midlife crisis, they want a job change. Issues come up with symptomatology or something. They’ll not be conversant or have remembered a dream in their entire lifetime.
I may talk about dreams because I’m fairly upfront and transparent about what is my particular passion and what I do best, what I work with well. I’ll let people know clearly and even at the first session that I would look to the realm of dreams, as strange as that may sound to you, about where we may need to go in this process. It’s about looking together towards this medium that we’re both contained in, just as dreams are contained in you and dreams are in me, like your psyche is in you and your psyche is me.
But we are both here now as we’re talking or all of us here in this room now too contained in the realm of what I call psyche or soul. We’re in this realm and it’s a medium in which we move and live, just as much as we feel and taste and breathe and smell. We’re moving in this medium of psyche.
Getting a person to begin to even relate to this other kind of dimension, this other sense of world which is much much bigger than our conscious waking self might be willing to acknowledge, they are beginning to establish even in the first session a relationship to this other, perhaps somewhat strange realm. But a realm which nevertheless can possibly give them some directions or ideas or images or symbols about what’s going on in their lives that would need some kind of decoding or deciphering.
I will suggest that a person if they can remember a dream put a pad and pencil by the side of the bed, a nice little night light, and that already signals to the psyche, “Okay, I’m ready and willing if you are. If something comes then I’m going to be ready to catch it.”
People start remembering dreams and the way they start remembering dreams or the style in which they dream, you can see changes significantly over the course of a therapy or an analysis. The way people remember their dreams, they become to become acquainted with the people who populate the dreams – the dream characters, the major players in their life, both in their personal lives but also you might say archetypally. The figures and what I would call really the typography of the dreamscape starts to emerge for them.
What kind of places do they dream about typically? A childhood home, or their current apartment, or a foreign place. One tries to get the analysand to become familiar with their own inner world in general. The whole inner world and who populates that inner world? This dream of thinking that we’re basically operating through the parts of our day that’s just going on. They begin to tune into that and begin to see that all those thoughts and ideas and moods and feelings that we’re having and going on, that is the material. That is the matter.
That’s what matters in our psychic life and we have to take that matter seriously and turn that matter, that material, transform it into something other, something else. Turn matter into soul. It’s about the transformation of matter into psyche.
Speaker 1: We’ll return to our program after acknowledging the following generous sponsors. The Body Architect was founding on the belief that mindful exercise improves the health of the mind, body, and spirit. Housed in an open, light filled space in Portland, Maine, the Body Architect offers a cutting edge fitness center, expert personal trainers, nutrition counseling, and a full class schedule. Visit thebodyarchitect.com or call (207) 774-2196 and get started with the Body Architect today.
And by Dr. John Herzog of Orthopedic Specialists in Falmouth, Maine. At Orthopedic Specialists, ultrasound technology is taken to the highest degree with state of the art ultrasound equipment, small areas of tendinitis, muscle tears, ligaments, instability, and arthritic conditions can be easily found during examination. For more information visit orthocareme.com or call (207) 781-9077.
Dr. Lisa: I find it fascinating that we have every night available to us a tool that helps us examine ourself because I was reading some data about dream research that they’re thinking that many mammals have dreams, but the idea that we have of dreaming has to do with the sense of self. So even if you aren’t in analysis as a part of your own self care, you have at your disposal every night a little window.
I’m interested for people who start to track their dreams. For instance, let’s get very basic. A bad dream. Is a bad dream necessarily bad? Does it mean that you’re having bad things happening in your life or is it just another tool?
Dr. Gary: I think it’s a good point because it is amazing that we have at our disposal this incredible storehouse. Since the dawning of consciousness available to us, little people going around here in 2012, through the realm of dreams. That is at our fingertips.
All mammals in fact dream. All mammals have REM sleep and you can see when your dog is sleeping that their eyelids are fluttering. They’re actually dreaming. Now, unlike human beings you can wake them up to say, “What were you dreaming?” But if you could they would say, “Oh I was chasing a cat around the house,” or something. But all mammals dream.
I don’t really think there is such a thing frankly speaking as a bad dream. I don’t think there’s such a thing as a good dream necessarily either. I think dreams, that’s the amazing thing about them, they are the language of pure, unvarnished inner nature which is neither good nor bad. It’s neither in a way positive nor negative. It’s not right or wrong.
Dreams say it the way it is, they just put it out there. What’s going on with you. They are this kind of snapshot of the psyche in a particular moment of time, but they also give kind of a big picture. The kind of wide angle, a sort of Technicolor 3D version of whatever is going on in our lives. It’s up to us to grasp as much of that big picture as possible.
I don’t feel there’s such a thing as bad dreams and part of the way I think it’s important to cultivate an attitude and a relationship to the realm of dreams, the realm of psyche, is to embrace it is. Just accept it all, color it whatever comes without judgment. To make room for it, to make space for psyche however weird or strange it may be, but just to embrace it because it just is. That’s the way it is, that’s what psyche’s saying.
A lot of seemingly bad, dark, negative, scary, frightening things will come up in dreams, but the only way to approach it without making it worse is to make room for it. You don’t tighten up and want to push it away or psychically amputate it off. You make more space for it to take it all on. Say, “Okay. What could this be about?” And to sit with it. Just spend time with it.
Dr. Lisa: Dreams are as you said, a daily tool and they can indicate the self, but these concepts can be very intimidating to some people and the idea of entering psycho-analysis or analysis can be intimidating mostly because it’s uncomfortable to go to those dark places. It’s uncomfortable to have nightmares.
Why is that a necessary part of finding satisfaction in life?
Dr. Gary: It may not be necessary to have intensely negative experiences, but it is important if one is going to undertake the journey to be prepared for the descent. None of us want to go down there, none of us really want to go into the realm of nightmare and boogie men and dark, deep stuff that we may have safely tucked away and just gone about our lives.
Typically I think no one goes except for kicking and screaming. It is a difficult and slow descent, but it’s one that’s also richly rewarding. Unless one is willing to make the descent, as I mentioned a moment ago the descent is something that’s very alien to our culture, which wants to basically often times put a band-aid on things and just carry on or take medication. These kind of band-aids don’t really work because the depth of the dimension is kind of like a wound.
It’s about going into the wound and going down into the realm of depth. Down there, you don’t have much orientation because it’s dark and if you’re really going to undertake it seriously that’s why one typically enters psychotherapy or analysis to begin with. There hopefully, optimally, you will have a guide for the journey. No matter who you have or choose for a guide, it’s nevertheless going to be a journey downwards into the realm of depth because depth is also the realm of soul.
It’s a realm that’s deep.
Dr. Lisa: Would this be considered the journey of the hero where first you have to go underground before you can come up above the ground again and live?
Dr. Gary: Yeah.
Dr. Lisa: And this is something that has been around since the Greeks and the Romans and probably before then.
Dr. Gary: Aeneas descends to the underworld and Dante descends to the underworld with Beatrice. They both had guides and Aeneas had Virgil as his guide. It’s important to go with a guide but it is a difficult journey. No one ever said that it’s easy.
Dr. Lisa: How does this relate to creativity?
Dr. Gary: For example one of the most common illnesses of our time is generally depression. Depression when you take it totally seriously means that one is being pressed down. One is literally being pressed down. And when one is depressed it’s because psychic energy, live, vitality, energy is somehow gotten blocked up. It’s gotten jammed up in the psyche. The only way to find it is not to take a pill and pop right out and think that’s going to do it or to take some drug or go shopping and think that’s going to get you out of it, but it’s to undertake being pressed down totally seriously and allow ones self to be pressed down long enough and deeply enough so that one gets what’s really down there.
What’s really down there is the treasure. The treasure to obtain which is ones self, ones medium life, the flow of life, the elixir of life, the fountain of youth, whatever the image is. The gold. And that is the creativity of ones life that can come back, but only through going down and finding where and how it’s gotten lost, misplaced, hung up.
Dr. Lisa: That all sounds great, the gold and the self, that’s the good part of this. But as someone who I suspect acts as a guide, this is a complex process. Why did you decide to go into this field? What is it about this field that called to you in some way and what have been some of the challenges you’ve experienced in your life because of it?
Dr. Gary: The choice of the vocation to enter this field is always personal. It’s because one has to go down for ones self and ones life of being analysis is in fact ones own analysis. For Jung, the goal or the purpose of the analysis is what he would call individuation. Which means becoming whatever or whoever one is supposed to be. Becoming quintessentially and uniquely an individual which means unlike any other person in the world.
Willing to separate oneself from everything in one’s life that’s collective, which means all your attitude, and beliefs, and values, and ideas have to be taken out of the attic and spring cleaned and see if you want to dust them off or put them back or junk them. It means really honing and working on and refining and sharpening ones individuality in contrast to the collective.
Dr. Lisa: Do people often have this desire or this sense of life? Is that really what the midlife crisis is about?
Dr. Gary: I think most people have this, absolutely. Most people who ask those questions or embark upon this journey have those kinds of issues going on in their lives that they’re wanting or needing to explore.
Dr. Lisa: And this manifests itself in various other ways, like divorce, separation, job loss, ends of relationships, whatever the-
Dr. Gary: Symptoms of crisis of all sorts. Very often it takes in crisis, a person usually has to hit the wall before they realize that things are going awry.
Dr. Lisa: Will dreams sometimes lead up to that point of crisis?
Dr. Gary: They will try to. They will be coming. Dreams are definitely a signal and message of what’s going on as our, in fact, nightmares. Nightmares which wake us up from dreams so that dreams don’t complete themselves, don’t have an ending. Our attempts to chew on it, to metabolize, to digest something that’s in the psyche that’s like a foreign piece of material like shrapnel that’s lodged there in the psyche. Nightmares which are very often repetitive and recurrent as in for example, post traumatic stress syndrome, are temps of the psyche.
Tempting like crazy to digest and work with this experience that overwhelm the psyche at certain times and that needs to be broken down and metabolized by the psyche over a long period of time.
Dr. Lisa: For someone who’s interested in looking at their dreams in a more serious way, how do they start? What’s the first step?
Dr. Gary: The most basic first step is to try to remember, if one is serious about remember one’s dreams and taking them seriously. Even the smallest, most insignificant fragment, little piece or piece that makes them go, “Oh, that was weird, that’s nothing.” I always say when someone has just a little fragment, literally just an image that flashes through ones mind, that there’s gold in Them Thar Hills. That there’s some little nugget of gold even in the smallest fragment which one would be tempted to just discard and throw in the trash heap.
I really urge people to just take seriously the contents of their psyche, including emotions and moods and feelings and thoughts and ideas and fantasies and all of that stuff can be mined for its gold value, its soul content. Mining is hard work. It’s taking it out of the earth and then subjecting the ore to high temperatures and refining it and hammering and beating it and shining it and polishing it and working with it.
I always say it’s similar with dreams. When one pulls back a dream, it’s kind of like on an archaeological dig where you unearth an artifact from the earth. You take it out and it’s just a fragment, a piece of pottery. You don’t know what it belonged to, what it was a part of, but you take it out, you brush it off very gently and you look at it. You hold it and you try to fill in the context, the missing pieces of it. In fact, the word symbol which dreams are obviously full of, comes from the Greek word symbolon.
Which upon parting, two friends in ancient Greece would break a piece of pottery and each would take a half of it or a fragment of it. Then when they would get together at some point in the future, they would reunite it. Well that fragment is a symbolon. So a symbolon is a fragment of a much larger whole. It’s a fragment of something that points beyond us to something larger and bigger and in the future and is not yet conscious.
Dreams are like that fragment of pottery which is unearth and excavated from the earth. It needs to be held and respected and looked at and imaged and played with and imagined around and maybe smashed some more. Then put the pieces together another way, you put them in part of a bigger collage, and you do whatever it takes to get the psyche going again, to create psychic movement.
The psyche needs to keep moving. It’s death to the psyche for it to get bogged down, for it to get stuck. That’s what we typically call depression. When things get stuck, life doesn’t flow. Dreams are coming in some ways to show us where and how psyche needs to flow. Where perhaps the impediments or obstacles that are coming from.
You’ll refer to dreams as compensatory. They’re attempts at the part of the deep, broad psyche of the unconscious that is to compensate, to provide for what is missing and needed in our daily lives. They are this upsurge of material and meaning which we need to try to understand in order that our lives might more creatively and meaningfully flow.
Just the simple fact of starting to remember dreams, acknowledge that the fact that there is a reality there, there is something to be gained from is the first step. Is the beginning.
Dr. Lisa: We’ve been speaking with Dr. Gary Astrachan, Clinical psychologist and Jungian analyst on the subject of sleep and dreams. I’m sure that our listeners are feeling pretty intrigued by now and perhaps they’re going to go on and spend some time in their waking hours thinking about their sleeping hours. So thank you for coming in and stimulating that in our listeners.
Dr. Gary: Thank you very much for having me, it’s been a pleasure indeed.
Speaker 1: A chronic ache. Sleepless nights. A feeling of something not being quite right. You can treat the symptoms with traditional medications and feel better for a little while and continue on with your busy days. But have you ever stopped to consider the what that’s at the core of a health issue? Most times it goes much deeper than you think and when you don’t treat the root cause, the aches, sleeplessness, and that not quite right feeling come back. But they don’t have to. You can take a step towards a healthier, more centered life.
Schedule an appointment with Dr. Lisa Belisle and discover how a practice that combines traditional medicine with eastern healing practices can put you on the right path to better living. For more information please call the Body Architect in Portland at (207) 774-2196. Or visit doctorlisa.org today. Healthy living is a journey, take the first step.
This segment of the Dr. Lisa radio hour and podcast is brought to you by the following generous sponsors. Mike Lapage and Beth Franklin of Remax Heritage in Yarmouth, Maine. Honesty and integrity can take you home. With Remax Heritage it’s your move. Learn more at ourheritage.com.
And by Tom Shepard at Shepard Financial. With offices in Yarmouth, Maine, the Shepard Financial team is there to help you evolve with your money. For more information on Shepard Financial’s refreshing perspective on investing, please email [email protected].
Dr. Lisa: As part of our sleep and dream show, today we are interviewing Dr. Thad Shattuck from Saint Mary’s Center for Sleep Disorders. Dr. Shattuck earned his masters in public hearth from the Dartmouth Institute and his medical degree from Dartmouth medical school. He completed his fellowship in sleep medicine at the Beth Israel Deaconess Medical Center in Boston and did his residency in psychiatry at Brown University where he was chief resident in his final year of training.
He is a member of the American psychiatric association and the American academy of sleep medicine. He’s also board certified in psychiatry and board eligible in sleep medicine. Thank you for joining us today.
Dr. Thad: Thank you for having me.
Dr. Lisa: That is a lot of education it takes to get to be able to practice the type of medicine you practice.
Dr. Thad: Yeah, it felt like it took a long time.
Dr. Lisa: Yeah! It kind of put you to sleep a little bit?
Dr. Thad: At times, it was definitely sleep inducing.
Dr. Lisa: You knew I had to go there with that joke, right?
Dr. Thad: Of course.
Dr. Lisa: You’ve never heard that before. (laughs)
Dr. Thad: Right. We get a lot of the sleep doctor jokes.
Dr. Lisa: It is interesting that you did psychiatry as opposed to internal medicine. You didn’t go the route a lot of people who do sleep medicine – or many – go the route of pulmonary medicine. Lung based medicine or all that, but you do psychiatry, that’s a different way of going about it.
Dr. Thad: A lot of people are surprised by that and then I like to come back and say that really sleep initially grew out of psychiatry. Really the early sleep researchers like William Dement, who’s considered the father of sleep medicine, trained as a psychiatrist. My feeling, of course I’m biased, is that sleep is really about the brain, so sleep apnea is about the upper airway and lungs but there’s more to sleep medicine than just sleep apnea.
I think it’s multidisciplinary which is especially what I like about it, but I think psychiatry certainly has its place there.
Dr. Lisa: Talk to me a little bit about the stages of sleep. I’m going to back up and do something that more sort of physiologic, biologic in origin. Tell us what happens when you go to sleep. What happens to people biologically?
Dr. Thad: Good question. I think the most honest answer is that we’re not entirely sure what sleep is for. We know it’s restorative in some ways, we know what happens when you don’t sleep, which is eventually bad things will happen to your body. Your blood pressure will up, you can become depressed and there will be other biological prohibitions. Basically sleep is a state where your metabolic rate goes down for most people, except an insomnia perhaps. Your heart rate slows down, your blood pressure dips, it goes down. That’s physiologically normal.
Your brainwaves slow. So we think that it’s associated with restoration and I think a lot of the theories coming out now is that it’s associated with certain kinds of memory consolidation. Perhaps pruning of certain memories, certain synapses and strengthening of others. Different kinds of memory might be specific just during certain sleep stages.
Stage one sleep is a light transitional stage where brainwaves slow down and there’s really nothing that remarkable about it. Stage two sleep is probably the most pro-pondering stage and that’s where we think a lot, probably motor sequence learning is consolidated. This is the cycle you go through sleep stages.
Stage three sleep – it used to be stage three and four, now it’s been consolidated into just in stage three – is where we have a lot of these big slow waves. That’s felt to be the most restorative part of sleep where you feel more rested. That’s the kind of sleep that’s fragmented in fibromialgia, chronic fatigue syndrome, where people have probably diminishment in that proportion of sleep. Then REM sleep is where your body is essentially paralyzed, including your upper airways a little bit more flaccid and you have more dreams.
You can have dreams in every sleep stage, but they’re most common in REM.
Dr. Lisa: And REM stands for?
Dr. Thad: Rapid eye movement.
Dr. Lisa: So this is when we see people and they’re actually looking like they’re deeply asleep and their eyelids flutter. That’s that REM sleep you’re talking about.
Dr. Thad: Exactly. Or if you’re a pet owner and you have a dog who’s asleep and your dog starts running in his dog bed, he’s probably in REM sleep. His muscles aren’t fully inhibited.
Dr. Lisa: You started in psychiatry and now you’ve gone towards sleep disorders. Why?
Dr. Thad: When I was doing my residency, there’s so many people who had complaints about sleep and I felt sort of ill equipped to go ahead and try to figure out what to do with them. So I became interested, I was always interested in EEG. We have a pretty elaborate EE montage in sleep medicine. It just always sort of captured my fascination.
I think also the sleep disorders that we think of, particularly REM behavior disorder, narcolepsy, I think they’re interesting. I liked the overlap and I liked how it involved a lot of more general medicine too.
Dr. Lisa: An EEG is the brainwave measuring thing.
Dr. Thad: Exactly.
Dr. Lisa: That’s a part of sleep studies.
Dr. Thad: It is, we don’t do quite as an elaborate montage as you would if you’re trying to capture a seizer, but we do monitor central frontal occipital so sometimes we do see seizures.
Dr. Lisa: The pictures that we see of people with little things pasted all over their heads, that’s the occipital frontal… those are the leads that are giving you the brainwave information.
Dr. Thad: Exactly. Yes and they can incidentally capture seizures so we are looking for that, but they’re more to go ahead and figure out how active your brainwaves are, so they’re for sleep staging. The sleep staging we just talked about, there’s very discrete brainwave changes that take place in stage one, stage two, stage three, REM.
Dr. Lisa: I’ve heard of narcolepsy and sleep apnea, but what is REM disruption disorder?
Dr. Thad: REM sleep behavior disorder. Great question. REM is sort of a discrete stage and it’s when the boundaries of REM are no longer as effective as they used to be. Certain phenomena of REM intrude into waking life and into other aspects of your life. REM really involves complete muscle paralysis, so that’s why we don’t act out our dreams. For some people because of various causes, sometimes because of a stroke and the part of their brain or Parkinson’s disease or other neurological disorders, they will go ahead and they will start to act our their dreams.
When they’re having a dream, and usually the dreams change in content so they become a little bit more frightening, sometimes violent and they start to act out the dreams. That’s REM behavior disorder, but usually it’s not that common. More frequent in older men and sometimes it predates the development of something like Parkinson’s disease or dimentia.
Dr. Lisa: That’s fascinating, I had never heard of that before that what is happening in some of these situations these people are actually acting out something that is unconscious for them.
Dr. Thad: Yeah, exactly. Some people go as far as basically tie themselves up in a sleeping bag at night and sleep on the floor, lock the door, because they’re worried they’re going to jump out the window. They’ve jumped out of bed repeatedly thinking that they were being chased or they were being attacked. There is an evolution of people’s dreams as this progresses where the dreams do change in character and seem more threatening where they feel like they’re constantly being chased and they have to defend themselves.
A very common story is that an older male will end up hitting his wife or kicking his wife and not realizing he’s doing this because he’s asleep. There’s actually a fairly well known comedian, Dave Berbiglia who’s done a whole show, it’s called Sleep Walk With Me about the fact that he’s got REM behavior disorder. He tells very funny, but sort of alarming stories about acting out his dreams.
Dr. Lisa: How does it differ from sleep walking or non-violent action when people are sleeping?
Dr. Thad: Good question and it kind of goes back to the sleep stages, so sleep walking is almost… I wouldn’t say it’s quite normal, it depends on how frequent it happens, but a lot of people have a couple instances of that when they were a young kid. Sleep walking typically happens at a slow wave sleep. We have a lot of slow wave sleep that’s slowed in the first portion of the night so you sort of act out an over-learned motor program that’s pretty basic, like walking, sometimes eating or running.
It’s really the same thing as a night terror or confusional arousal where you wake up, you’re confused and you sort of do something that’s a very preprogrammed behavior. That’s from slow wave sleep and REM behavior disorder you’re acting out things that are probably a little bit more complex, but you’re in dream sleep so it’s a different brain state.
Dr. Lisa: Is there a relationship between genetics and how one sleeps? Do “bad sleepers” run in the family? Or does sleep walking run in the family?
Dr. Thad: Yeah, there is definitely a big genetic component to sleep walking. There’s a family history of sleep walking and somebody sleep walks as an adult, there’s definitely a correlation. There are people that are just genetically bad sleepers. Sort of the sleep machinery in your brain for some people just doesn’t function as well. There’s certain people that have what we call idiopathic insomnia.
They will have a family history of just really poor sleep, it’s not related to stress, it’s not related to poor sleep hygiene, they just tend to be short sleepers and have very disrupted sleep.
Dr. Lisa: Are these people who tend to be sort of what we would call hyper aroused, from an energetic standpoint, people who are maybe more easily startled or people just can’t seem to calm themselves down?
Dr. Thad: With the idiopathic insomniacs, I don’t think so. I think a lot of the people who have the hyper arousal are people who have chronic insomnia and that’s gone through various stages of labeling, but it’s called primary insomnia or psychophysiology insomnia. I think that really involves the hyper arousal where people get conditioned and they get in bed and they anticipate a really poor night of sleep and getting in bed sometimes is enough to make them feel more anxious, elevate heart rate, sometimes even induce a panic attack. Those people also tend to feel a little bit more activated during the day or they have the state of hyper arousal.
This kind of insomnia is associated with an increased metabolic rate, so these people are breathing more heavily during the day. They’re just burning more energy, they can’t really calm themselves or slow themselves down.
Dr. Lisa: What kind of remedies are available for people who are going through that?
Dr. Thad: For insomnia, I think the issue’s been pretty muddy because there’s been such a big push from pharmaceutical companies to market medication. I do think there’s a role for medications in short-term insomnia. We call transient insomnia, or an insomnia due to some kind of adjustment disorder. But if you have chronic insomnia, the first line of treatment should be what we call cognitive behavioral therapy for insomnia.
That is a treatment that I offer, the problem is there aren’t a lot of practitioners that offer this because it’s multi-session so it’s great to talk about everybody agrees that people should get this treatment, but it’s just not very accessible. I think the real challenge at this point is to figure out platforms. Certainly the Internet where people can go ahead and engage interactively in doing this kind of treatment on-line.
It’s very effective, but I think there’s also an expectation from some patients that they’re going to get a pill that’s going to fix their insomnia. It involves some therapy and some negotiation to change that mindset.
Speaker 1: We’ll return to our interview after acknowledging the following generous sponsors. Robin Hodgekins, senior vice president and financial advisor at Morgan Stanley Smith Barney in Portland, Maine. For you all your investment needs, call Robin Hodgekins at (207) 771-0888. Investments and services are offered through Morgan Stanley Smith Barney LLC. Member SIPC.
And by Booth. Accounting and business management services, payroll, and bookkeeping. Business is done better with Booth. Go to boothmaine.com for more information.
Dr. Lisa: Talk to me about sleep and depression. As a family practice resident and doctor, we were taught this mnemonic siggycaps, which was all the different questions you asked about depression and one of them, one of the S’s, stood for sleep. So sleep disturbances were often an indication of some sort of a depressive problem. What’s the relationship?
Dr. Thad: I think it’s complicated. I think that the teaching I certainly had in residency was that the sleep disturbance is usually secondary to the depression. I think in many cases that’s true, but I think now people are starting to acknowledge that maybe it’s bi-directional and that in some cases of depression, if you have insomnia that could lead to depression.
I certainly think are some people who developed insomnia and insomnia we know is a risk factor for depression. That’s one aspect of it. We know that people who have a depression that’s partially remitted, who still have sleep disruption are at risk for a relapse of depression.
I don’t think we really fully know. We know that the only really clear biomarker that we have for depression, there’s been some research on cortisol and stuff but it’s been erratic, but we know that people have a shorted REM latency, that’s a clear maker. Usually a pretty severe depression. Melancholic depression. We know there’s alterations but we don’t know why that happens or what exactly it means.
The medications that are most prescribed for depression, the TrypLE Select inhibitors, they suppress REM. So it’s not known if that’s a phenomena of another mechanism or if that actually is therapeutic the fact that they delay the onset of REM during sleep. REM usually comes later in the night and depression seems to come earlier for some reason.
Dr. Lisa: Isn’t it true that some of the medications that are prescribed, especially the selective serotonin reuptake inhibitors, the SSRIs like Prozac and Zoloft and things like that, can actually cause sleep problems in people who are perhaps predisposed of them.
Dr. Thad: Absolutely and it’s not very well studied, but we do know that they can cause sleep problems. I would say that if you have moderate to severe depression and you go on an SSRIs, like the serotonin reuptake inhibitor, the chances are if you respond to you it’s going to help your sleep overall. But they sometimes really can disrupt sleep.
They can cause more activation during sleep, so sometimes we’ll see people who have a tendency towards REM behavior disorder, we’ll see them have more muscle twitchiness or actually have frank dream enactment during REM. By the same token, because they cause more activation they can cause period limb movement disorder. Where we’ll see people who will kick their legs every twenty to thirty seconds. It’s really thought that that can disrupt sleep as well.
They are not benign to sleep as we once thought.
Dr. Lisa: We also have seen there are medication that are used for depression that are also used for smoking cessation. We saw that there are impacts on sleep for some people with those medications as well.
Dr. Thad: Absolutely. It’s almost hard to think of a medication, like a psychotrope medication that doesn’t have sleep effects. Chantix can cause very vivid dreams and Zyban can really disrupt sleep, make it hard to fall asleep. So they all seem to do something.
Dr. Lisa: What about the more common sleep disruptor, snoring? Do you have a lot of people coming to the clinic with sleep apnea and snoring?
Dr. Thad: Yeah, I would say that the model of how sleep medicine is delivered now is tilted pretty heavily towards sleep disorder breathing. I do see a lot of insomnia and some of these other parasomnias. I see a lot of sleep disorder breathing.
It’s a question that I ask everybody. There’s a lot of snoring, I think some of the question is, “Wow, is snoring ever really benign? Or is it just a continuum?” You do have what we call simple snoring all the way to severe sleep apnea where somebody stops breathing a hundred times and hour. There’s common evidence that maybe just the vibration from snoring is associated with increased thickness of the corroded artery.
We don’t really know. That kind of continued vibration is predisposed to other problems later on. We’re not really sure, but I tend to think that there probably is just a simple form of snoring but if it’s benign, over time I don’t know.
Dr. Lisa: Isn’t it true that people who do have disruptions in their sleep due to employment such as being a medical resident or maybe you’re a truck driver or you’re a shift worker. Isn’t it true that that can have an impact on your health over time?
Dr. Thad: Yeah, definitely. There are some people who seem to be able to adjust well to both sleep deprivation in shift work and then there are some people who don’t adjust well and it becomes more difficult to adjust over time. It can have long term effects on your health. There’s been lots of research with different cohorts of different people and workers and we know that there’s decreased fertility rates in nurses who work the night shift. Increased rates of obesity, hypertension.
Some evidence, some Epidemiology evidence, that maybe there’s increased rates of cancer. I think the real issue is being out of phase with what your normal circadian rhythm is. We know that if some people can adjust, some people can’t. If every cell in your body is good at circadian rhythm and if they’re sort of out of out of synch then things aren’t working as efficiently and you’re probably prone to weight gain and other problems.
Dr. Lisa: It can also impact other people around you. They changed all of the medical student and resident work hours because of problems that happened when people didn’t get enough sleep and were trying to administer medications and other treatments. And also if you don’t sleep well and you’re going to go out and drive a truck or drive a plane. So there’s all kinds of things that we know impact other people by not sleeping well in our own lives.
How do you feel about napping? Can you make up sleep in naps?
Dr. Thad: I think napping can be very effective. I think it’s great if you’re sleep deprived. I’m very cautious about it with people who have insomnia because sometimes there’s this compensatory mindset where people feel like, “I’m not sleeping enough, I’ve got to sleep more.” So they’re go ahead and try to sleep any opportunity they can and they end up providing themselves more and more opportunity, but they end up spending a lot of time in bed when they’re not sleeping and that backfires basically.
But I think that if you’re sleep deprived and you’re about to go on a long trip, or even if you’re driving and you’re sleep deprived or you certainly feel drowsy, taking a power nap is a great idea. I think when you’re older it’s harder to get more consecutive hours of sleep though your sleep need doesn’t actually change, so napping in the afternoon is a great idea for a lot of people.
Dr. Lisa: How can people find our more about sleep issues, sleep problems, and specifically where you practice at Saint Mary’s Center for Sleep Disorders.
Dr. Thad: We do have a website so I think if you look at www.saintmarys.com. You’ll be able to go ahead and find us there and contact us if you have a sleep disorder and you’re interested in getting evaluated. In general, I think good resources are the American academy of sleep medicine. I believe it’s www.aasm.net. The National Sleep Foundation also has some good resources, so I would also try them.
Dr. Lisa: We’ve been talking to Dr. Thad Shattuck from the Saint Mary’s Center for Sleep Disorders which is up in Lewiston and we appreciate you coming in and talking to us about sleep and dreams. I’m sure that people have been listening and have not been put to sleep, in fact exactly the opposite because you’ve been so fascinating in what you’ve had to tell us.
Dr. Thad: Thanks for having me.
Dr. Lisa: This is Dr. Lisa Belisle and you have been listening to the Dr. Lisa radio hour and podcast. Show number forty eight, sleep and dreams. Airing for the first time on August 12, 2012 on WLOB and WPEI radio Portland, Maine. Today’s guests have included Dr. Gary Astrachan and Dr. Thad Shattuck. If you’d like more information about one of these individuals, please visit our website doctorlisa.org.
To let us know about what you think about our show or perhaps suggest a future show, go to our Facebook page: Dr. Lisa. Like us and send us a little note, or perhaps in a comment to [email protected]. Thank you for listening to our sleep and dreams show this week. We hope it’s been thought provoking for you. We know it’s been thought provoking for us.
This is Dr. Lisa Belisle. Thank you for being part of our world. May you have a bountiful life.
Speaker 1: The Dr. Lisa radio hour and podcast is made possible by the support of the following generous sponsors: Maine Magazine, Mike Lapage and Beth Franklin at Remax Heritage, Robin Hodgekin at Morgan Stanley Smith Barney, Dr. John Herzog of Orthopedic Specialists, Booths, UNE the university of New England, Tom Shepard of Shepard Financial, and the Body Architect.
The Dr. Lisa radio hour and podcast is recorded in Downtown Portland at the offices of Maine Magazine at 75 Market St. It is produced by Kevin Thomas and Dr. Lisa Belisle. Editorial content produced by Genevieve Morgan. Audio production and original music by John C. McCain. For more information on our hosts, production team, Maine Magazine, or any of the guests featured here today, visit us at doctorlisa.org.
Download and become a podcast subscriber of Dr. Lisa Belisle through iTunes. See the Dr. Lisa website or Facebook page for details.