Download - The Truth About Sleeping Pills and OTC - New York, NY · sleeping pills or over the counter sleep aids. Recent studies show that that there’s this weird trend happening around sleeping

The Truth About Sleeping Pills and OTC [Podcast 71] © 2019 Steven Y. Park, MD. Doctorstevenpark.com

TheTruthAboutSleepingPillsandOTC[Podcast71]

Dr.Park’sBreatheBetter,SleepBetter,LiveBetterPodcast

KathyPark: 00:12 WelcometoDr.Park’sBreatheBetter,SleepBetter,LiveBetterpodcastwhereourgoalistohelpyougetthesleepyouneedforthelifeyouwant.MynameisKathyPark,yourcohostfortoday,andI'mhereinthestudiowithmyhusbandDr.StevenPark.HeySteve,howareyoudoingtoday?

Dr.Park: 00:28 I’mdoinggreat.Howaboutyou?

KathyPark: 00:29 Prettywell,thankyou.Ontoday’spodcastSteveisgoingtobetalkingaboutanothercontroversialtopicthatmanyofyouprobablyhavehadsomeexperiencewithatonetimeoranother.That’stheissueofsleepingpillsoroverthecountersleepaids.Recentstudiesshowthatthatthere’sthisweirdtrendhappeningaroundsleepingpillsandOTCaids,specificallythattheamountofprescriptionsbeingwritten,andthenumberofOTCaidsbeingsoldisincreasingatafasterratethanthenumberofpeoplebeingdiagnosedwithasleepproblemlikeinsomnia.

Well,Steve,beingthesleepmedicineresearcherthatheis,hasdoneextensiveresearchonhisownonthisparticularphenomenonand,ofcourse,he’sfound

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TheTruthAboutSleepingPillsandOTC[Podcast71]©2019StevenY.Park,MD

somegreatinsightsintothistopic.Sotoday’sepisodeisappropriatelyentitled:ThetruthaboutsleepingpillsandOTCsleepaids.Soifyou’veever,evertakensleepingpillsinthepast,thisisgoingtobeaveryeyeopeningshowforsure,andit’sonethatyouwillnotwanttomiss.

Butbeforewebegin,Iliketoremindourlistenersthattheinformationthatyouheartodayisforgeneraleducationandinformationpurposesonlyandshouldnotberelieduponaspersonalmedicaladvice.Pleaseconsultyourdoctorbeforefollowinganyadviceorregimengivenonthisshowasyourparticularcasemaybedifferentthantheonesgiven.

OkaySteve.SoIknowthatinsomniaisahugeprobleminthiscountryandit’sjustgrowingexponentiallyeachyear.Evenjustanecdotally,Ihearthisallthetimefromacquaintancesorfriendsthatthey'renotabletosleepmorethanlikethreetofourhoursanightandtheykeepwakingup.

Dr.Park: 02:20 Orinterrupted.

KathyPark: 02:21 Orinterrupted,right.Butyou'resayingthatwe’renotreallysleepingasleepepidemic,butasleepaidepidemictoo.Right?

Dr.Park: 02:29 Yes.

KathyPark: 02:30 Sotelluswhatyoufoundinyourresearch.

Dr.Park: 02:32 SoyourexperiencesmirrormyclinicalexperienceinmypracticewhereIwouldsayabouthalformorethanhalfofpatientsthatIseeareonsomekindofasleepaid,whetherdirectlyorindirectly.Whethertakingsleepingpills—prescriptionoroverthecounter—orantidepressantstohelpwithsleep,antihistaminestohelpwithsleep,evenalcoholtohelpthemsleep.

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KathyPark: 02:56 Sowe’renotjusttalkingaboutspecificallyprescriptionsleepaidsoroverthecountermedications,butsometimeswe’retakingtheminadvertentlythrough—likeyousaid—antidepressantsorsomepeoplearejustusingalcoholasawaytosleep.

Dr.Park: 03:11 Right.

KathyPark: 03:12 Sowe’reallexperiencingsomesleepproblems.

Dr.Park: 03:15 Right,right.

KathyPark: 03:16 That’swhatwe’rehearing.

Dr.Park: 03:16 SoI'mgoingtojustlumpeverythingintoonecategoryofapillorsomethingthatyoutakesothatyoucansleepbetter.

KathyPark: 03:22 Right.Well,youknow,Idounderstandwhythat’shappeningbecausetakingapillissomuchsimpler,right?


KathyPark: 03:32 Thanhavingtodealwiththisissue,especiallywhenpeoplearesoconfusedastowhythey'renotabletosleep.Right?Sowhydoyouthinkthesleepaidsaren’tworkingaswellaspeoplethinktheyshould?

Dr.Park: 03:47 Well,likeyousaid,everybodywantsapillforsomething.Ithinkmediaandthemedicalestablishmentshaveprettymuchconvincedusthatthere'sapillforeverything.

KathyPark: 03:56 Okay.

Dr.Park: 03:57 Now,oneoftheproblemswithmostmodernmedicationsisthat…Ithinkmostofthemoreseasonedresearchersandtheolderclinicalresearchersunderstandisthatthesethingsdon’treallycuretheproblem.Actually,I'mkindofthemindsetthat—andI

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learnedthisfromareallywiseteachermanyyearsago—thatinmedicinewedon’treallycureanything.Wecandelay,alleviate,orhelptheproblemgetbetter,butweneverreallycuredisease,right?Wejustkindofalleviateproblemsbecauseeveryonegetssick,everyonedies.Sointhesamewaywithsleepaids.You'rejustcoveringuptheproblem.Soformanypeople,thesethingsworkwithoutadoubt.Butyou'renotreallytreatingtherootcauseoftheproblem.

Ithinkoneoftheproblemswithmodernsocietythesedaysisjustthehectic,freneticpaceofmodernlife.We’resodistractedwithallthemodernconveniencesorlifestyles,stress,entertainment,media.Allthesethingsarecombiningtojustruinoursleepingeneral.Sowewantsomethingtofallasleepwhenyou'reintrouble.Soifyoucan'tfallasleep,youwanttotakesomething.

KathyPark: 05:10 Right.

Dr.Park: 05:11 Butthebestwayofhandlingthesethingsistosetupyourlifestyleandroutinesothatyoudon’tgetinthatsituationofhavinginsomniaproblemstobeginwith.

KathyPark: 05:19 SobasicallyIthinkwhatyou'resayinghereisthatwesortofsetourselvesupforfailureandthenwewantaquicksolution.


KathyPark: 05:27 Andwe’relookingtodoctors,anddoctorsdowanttohelpyou.They'refindingitdifficulttofigureoutwhetherit’sasleepproblemoranotherproblem,buttheywanttoaddressthesleepproblemandtheyhaveaprescriptionmedicationforthat.Sothey'reboundtooverprescribe,right?

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Dr.Park: 05:46 Well,notonlythat.Nowyougenerallyonlyhaveaboutfivetotenminutesperpatientvisit.

KathyPark: 05:50 That’sanotherissue,right.

Dr.Park: 05:51 Thenthemostoptimumwayofdealingwiththeseissuesistotalkaboutyourlifestyleandhabits.

KathyPark: 05:57 Butdoctorscan'tdothat.

Dr.Park: 05:58 Right.Thatwouldtakeabout30to45minutesorevenanhour.

KathyPark: 06:02 Wellnotonlythat,Ithinkdoctorsfeelthattheycan'treallyapproachthattopicoflifestyleissuesandhabitswiththepatient,especiallywhenthepatientiscominginforaclinicalissuewithadiagnosisofmaybetheyhaveaheartproblemorhighcholesterol.Idon’tthinkit’sanappropriatevenue.Ithinkthatmostpatientsfeelthat,andmostdoctorsfeelthatwaytoo.

Dr.Park: 06:27 But,youknow,whenIapproachthesekindsofsubjects,whenIconfrontpatientsabouttheseissues,they'reveryappreciative.

KathyPark: 06:33 Right.That’swhywe’readdressingthisonthispodcastbecauseIdothinkthatpeopleareawareenoughtoknowthatthesemedicationsarenotreallytheanswer.That’swhatwe’reseeing,right?


KathyPark: 06:47 Eveninthescientificstudies.

Dr.Park: 06:48 Right.Whatthegeneralgistofallthestudiesissayingthattheseprescriptionsleepaidsonlyhelpjustalittlebitanditdoesn’tlast.There’sanumberofpotentialsideeffects.Actually,notpotentialbutdefinitesideeffectsthatweseethatcanhaveverynegativeconsequencestoyourhealth.

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KathyPark: 07:06 Right.Socanyoutellusalittlebitaboutthosekindsofissuesthatwerunintowhenyou'retakingprescriptionsleepaidsandOTCmedications?Ithinkwe’vetalkedaboutthisinthepastinapreviouspodcastonhowtosleepbetterwithoutthemedicationsandhowmedicationsareharmingyou.Wedidtalkaboutsleepingpillsasoneofthosemedicationsthatarereallycausingmoreharmthangood,butcanyoujustfurtherexpandjustalittlebitaboutwhatkindofproblemswe’rehavingwhenwetakesleepaids.

Dr.Park: 07:40 Sure.SoI'mgoingtoovergeneralizeherebecausethestudy’sonzolpidem,whichisthegenericnameforAmbien.


Dr.Park: 07:49 That’sprobablythemostwellstudied.ButthisalsoappliestootherAmbienlikemedicationsbecausethey'reallverysimilarintermsofthemolecularcontent.NowAmbienorzolpidemisanon-benzodiazepine.SobenzodiazepineislikeValium.

KathyPark: 08:07 Wow,okay.

Dr.Park: 08:08 It’saverystrongsedative.Soit’ssimilar,butittargetsdifferentreceptorsinthebrain.Soyoudon’thavethememorylossissueliketheValiumdoes,butit’sasedative.Soittargetsreceptorsinthebrainthathelpsyoutofallasleep.

Now,onethingaboutneurotransmittersisthatifyoutargetoneparticularneurotransmitter,it’snotlikeaguidedmissilethattargetsonebunkeroronebuilding.


Dr.Park: 08:40 There'sthisscatteringeffect,thisresidualcollateraldamage,right.Soit’snotgoingtojusttargetthatone

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transmitter,buttheseneurotransmittersalsoareusedinotherpartsofthebraintoo.


Dr.Park: 08:53 Soyou'regonnahavesideeffectsbydefinition.NowoneofthemostpublicizedsideeffectsfromAmbieninthepastcoupleofyearshasbeenincreasedsleepwalking,sleepeating,sleeptexting,sleepdriving,sleepsexing.Justsomecrazystuffthat’sbeendocumentedtohappenasaresultofthesesleepingpills,andtherehavebeenanumberoflawsuitsasaresult.


Dr.Park: 09:16 Alsowhat’sbeenfoundrecentlyisthatwomenmetabolizeAmbienataverydifferentratethanmen.SorecentlytheFDAandthedrugcompaniesloweredthedosageforwomenfromtentofivemilligrams.Youcanalsoimaginewhathappenswhenyouwakeupandeatandyoudon’trealizeyou'reeating.What’sgoingtohappen?

KathyPark: 09:35 You'regonnagainweight.

Dr.Park: 09:36 Right.That’soneoftheknownsideeffectsofAmbien.

KathyPark: 09:39 Idon’tthinkit’sjustthatthey'reeatingmore.Ithinkthesamestudysaidthatit’snotthatsubjectswereeatingmorenecessarily.Itwasjustthatmaybetheyweremetabolizingthefoodtheywereeatingatadifferentrate.

Dr.Park: 09:53 Right.Alsowetalkedaboutthisinthepast.Whenyoueatbeforebedtimeorduringyournighttime,you'regoingtogainweight.

KathyPark: 09:59 Exactly,right.Soinappropriateeating.


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KathyPark: 10:03 Yeah.

Dr.Park: 10:04 Thenthere’sawholelistofotherstudies,andtheseyoumaynothaveheardabout.There'sarecentstudylinkingsleepingpillsandParkinson’sdisease.

KathyPark: 10:12 Wow.

Dr.Park: 10:13 It’s158%increasedrisk.Anotheroneshowedthreetofivetimeshigherriskofdyingifyoutakeasleepingpill.Now,there’salotofothercomorbidorothervariablesthatyouhavetocontrolfor.Obviouslyyoucan'tsaysleepingpillscausedeath,butthere’sthisassociation.

KathyPark: 10:32 Right.Wellifit’ssortof…Ifit’ssortofpromotingweightgainandit’skindofheadingyoutowardsobesity,weknowthatobesityisahugeknownfactorforothercomorbidproblems.Right?Diseases.

Dr.Park: 10:48 Right.Alsoinsomniahasbeenstronglylinkedtodepression,forexample,heartdisease,futureotherconditionslateron.Soitkindofmakessense.Obviouslyyoucan'tprovecauseandeffectwiththestudiesthatwedo.


Dr.Park: 11:02 Alsoothersideeffectswerememoryloss—andthat’sbeenprettywelldocumented—depression,andalsofractures.Thenumberoffracturesgoupabouttwotimescomparedtoifyoudon’ttakethesemedications.Now,again,youdon’twanttoreadintothisbythinkingthattheAmbiencausesit,butifyouhavetotakeasleepingpillthatmeansyouhaveotherconditionsonboardthatmakesyoupredisposedtotheseotherconditions.

KathyPark: 11:30 Nowbeforewestarttalkingaboutthepredispositiontowardsotherconditionsthatyoumayormaynot

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have—becausethat’swhatyou'regoingtotalkaboutnext—theinsomniamaynotbeinsomnia.Itmaynotbeasleepproblemnecessarily.Itmaybeanotherunaddressedproblemthatthesesleepingpillsarekindofhiding,bandaging.


KathyPark: 11:52 ButIwantedtohaveyoutalkabouttheefficacy.Sothereareallthesesideeffects,negativesideeffects,totakingsleepingpills,butphysiciansarestillprescribingthem.

Dr.Park: 12:04 Yes.

KathyPark: 12:05 Prettyeasilyitsoundslike.

Dr.Park: 12:07 Yes.

KathyPark: 12:08 Sotheymustbeeffective.Theymustbehelpingalotofpeople,right?Butwhathaveyoufound?

Dr.Park: 12:14 Well,firstofallI'mguiltyascharged.IdoprescribeAmbienonceinawhile.Very,veryselectively.


Dr.Park: 12:22 Overtheyears,myrateofprescribingsleepingpillshasdroppedexponentially.


Dr.Park: 12:28 Butinveryfewpatients,Idoprescribeit.Ifyoulookattheevidenceoutthere,andlookingattheselargescalestudies,prettywelldonestudiescomparingsleepingpills—sozolpidem—versuscognitivebehavioraltherapyforinsomnia—whichisabehavioralpsychotherapymethodthathelpspeoplewithinsomnia.SowhenyoucomparedpeoplewhohadbothsleepingpillsplusCBTversusCBTalone,what

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theyshowedwasthatifyoutakethesemedications,yousleepabout20minuteslonger.

KathyPark: 13:04 20minutes?

Dr.Park: 13:05 Yes,that’sit.

KathyPark: 13:06 That’sit?

Dr.Park: 13:07 Yes.Objectivelythat’swhattheyfound.

KathyPark: 13:09 20minutes?

Dr.Park: 13:09 Yes.

KathyPark: 13:10 Soyou'redealingwithalloftheseothernegativesideeffects,whicharehugebytheway.Imeanlikesleepwalking?Sleepeating?

Dr.Park: 13:18 Yeah.Sleepdriving.

KathyPark: 13:18 Sleepdriving.Imeanthosearelike,okay,butyou'regonnasleep20minutes.Okay.Goon.I'mjustlike…

Dr.Park: 13:26 Well,myunofficialtheoryastowhypeoplefeelliketheysleepbetterisbecausetheydon’trememberwakingup.

KathyPark: 13:32 Ohgosh.Okay.

Dr.Park: 13:34 That’salittlebitofunofficial--

KathyPark: 13:36 That’sevensadder,okay?

Dr.Park: 13:38 Becauseit’sanamnestic.Right?


Dr.Park: 13:42 Now,however—SowhattheyfoundwasthatCBTwasrelativelyequivalenttosleepingpillsintheshortterm.Butinthelongtermwhathappenedwasthatifyoudoboth,theeffectofthesleepingpillwearsoffafteracoupleofmonths.

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Dr.Park: 14:00 ButthenifyoucontinueCBTthenyouhavemuchbetterlongtermsuccessrates.

KathyPark: 14:05 Okay.Sochangingyourbehaviorandthoughtsmuchmoreeffectiveatgettingbettersleepoverthelonghaulthantakingonesleepingpillovertheshorthaul.Okay.

Dr.Park: 14:18 Right.SoI'mnotdoubtingtheexistenceofinsomnia.ImeanI’veexperiencedthatmyself.IthinkImentionedbeforeeverymajorstandardizedexamIsleptonlyfortwohours.Likebeforemysleepboardstest,Islepttwohours.Iwasreally,reallystressedaboutthat

KathyPark: 14:32 Sodon’tdothat.

Dr.Park: 14:34 Yeah.Alotofthereasonswhypeoplecometoseemeforisnotjuststressinducedinsomniabecausethatgoesawaybydefinition.


Dr.Park: 14:43 It’swhenyouhaveitformonthsoryearsordecades.Youcan'teitherfallasleeporstayasleep.

KathyPark: 14:48 Canitbepossible—Thisiskindoffonthesidenote.Canitbepossiblethatyoustartwithastressinducedinsomniathatleadsintoahabitualinsomniabecauseofbehavioralchanges?

Dr.Park: 15:02 Sure.WellthisgoesintothethreePsofinsomniathat’sbeentalkedaboutby—Oh,thenameslipsmymindrightnow.It’saclassicpaper.It’sthepredisposingfactors.


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Dr.Park: 15:20 I’msorry.Thepredisposingfactors,theprecipitatingfactors,andtheperpetuatingfactors.Sothatkindofencompasseseverythingthatyou'retalkingabout.


Dr.Park: 15:29 Ifyou'realreadypredisposed,you'regoingtobemoresusceptibletoaprecipitatingfactorlikestresssleepdeprivation.Butthentherearethesehabitsorthoughtprocessesthatperpetuateit.

KathyPark: 15:41 Soitmakestotalsensethatcognitivebehavioraltherapywouldworkbetteroverthelonghaulforpatientwhoissufferingfrominsomnia.

Dr.Park: 15:45 Exactly.

KathyPark: 15:49 Okay,great.Soaswestartedtomentionbeforeorasyoustartedtokindofhitatbefore,youweretalkingaboutanissuewithsleepproblems.Thatsometimesoursleepproblemsarenotreallyoriginatingfromasleepproblem.It’snotassimpleasallofthat.Sowhatdoyouthinkiscausingsomeofthesesleepproblems?

Dr.Park: 16:14 SothisisanissuethatI'vebeenthinkingaboutforthelast10years.EversinceIbecameboardedinsleepmedicine,Iwasreallyintriguedbyhowwellweunderstoodinsomniaandalltheresearchthat’sbeendone.WhatI'mrealizinginclinicalpracticeinreallifeisthatalotofthesepatientswhoactuallyhaveclinicallydiagnosedinsomnia—Imeantheseareclassicwelldiagnosedconditions.


Dr.Park: 16:38 Ifyoulookattheirbreathingatnight,it’snotreallyinsomnia.It’sabreathingproblem.SoIhadthissuspicion10yearsago,andthenIcameacrossDr.BarryKrakow’spapers.Hedoesalotofstudieson

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thesekindsofissues.Wementionedthisstudybeforewherehefoundthatpeoplewithtreatmentresistantinsomnia—sopeoplewhodidnotrespondtomedications.About80%ofthesepeoplehadclinicallysignificantundiagnosedsleepapnea.


Dr.Park: 17:06 Sonowthatwouldexplainwhytheywouldwakeupinthemiddleofthenight,butitmaynotexplainwhytheycan'tfallasleep.

KathyPark: 17:11 Fallbackasleep,right.

Dr.Park: 17:13 Thenit’saviscouscycle.Ifyoukeepwakingupatnight,youdon’tgetgoodsleep.Soyourbraingetskindofwired.Yougettiredbutwired.Thenyougetallstressedout.Somethingstressfulhappensandyoucan’tgetridofthatthought.


Dr.Park: 17:28 Right.Youhavetocheckallofyouremails.Youcan'tshutdownyourbrainbeforeyougotobed.

KathyPark: 17:31 Ialsothinkthatifyou'reconstantlywakingupatnightnomatterhowtiredyouare,yourbrainhasawayoftellingyouoh.Youdon’twanttofallasleep,intodeepsleep,becauseyou'regonnawakeup.

Dr.Park: 17:43 Becauseyou’vebeenchoking.


Dr.Park: 17:45 Peopledreamaboutchokinganddrowning.

KathyPark: 17:47 That’swhatImean.IthinkthatIhearthatalot.Alotofpeoplefeargoingtosleepbecausetheyknowthey'regonnawakeup.Sowhygotosleepinthefirstplacebecausetheyjustdon’tlikethatsensationof

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feelinglikethey'rebeingchokedtodeath.Nowonder,right?


KathyPark: 18:05 Thatmakestotalsense.Okay.Sowe’regonnahavealinkintheshownotestoyourpreviousinterviewtoDr.Krakow.

Dr.Park: 18:13 Krakow.

KathyPark: 18:14 Krakow,I'msorry.

Dr.Park: 18:15 Yes,yep.

KathyPark: 18:15 Whichwasveryeyeopeningbytheway.Ithinkeveryonelisteningtothisshouldtakealistentothatepisodeaswell.Sonowifthat’sreallythecasethatmanypeoplewhohaveinsomniayouthinkarenotaddressingtherootcauseoftheproblem,whatcantheydoinstead?Now,you’vereallyconfusedourlisteners.You’vetakenitanothernotch.Soit’snotjustthemedicationsthatareharmingthem,butit’sthesleepissuethattheymaybedealingwithmaybeanotherissueentirely.

Dr.Park: 18:45 WellbeforeItalkaboutsleepapnea,letmetalkaboutanothercondition.


Dr.Park: 18:49 ThisgoesalongwithastudythatwepublishedlastyearintheAmericanAcademyofOtolaryngologyHeadandNeckSurgeryintheOpenAccessJournal.Thisisthefindingthatpeoplewhodon’thavesleepapneaonasleepstudy.Sotheapneahypopneaindexislessthanfivewhodon’thavesleepapnea.Ifyoudodruginducedsleependoscopy,soweputthemunderanesthesia,andwelookattheirairwayswhenthey'rebreathingorsleeping.Wefindthatover80%have

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significantmultilevelobstructionintheirbreathingpassageways.

KathyPark: 19:21 Okay.Repeatthatagain.Over80%havemultilevel…

Dr.Park: 19:27 Upperairwayobstruction.

KathyPark: 19:28 Upperairwayobstructionmeaningthey’renotabletobreatheallthatwellbecausemultipleareasoftheirairwayarecollapsing.

Dr.Park: 19:35 Right.Numberonewaspalate.NumbertwowasIthinkitwaseitherepiglottis,andthenthreeistonguebased.Maybenotinthatorder,butthosearethethreemajorareasthatwereobstructing.

KathyPark: 19:47 Sowe’renoteventhinkingaboutthisaswe’resleeping.

Dr.Park: 19:49 No.

KathyPark: 19:50 Butallofthesedifferentsofttissueareasarecollapsingduringdeepsleep.

Dr.Park: 19:56 Right.Thisexplains—ItgoesalongwithDr.Guilleminault’sdescriptionofupperairwayresistancesyndrome.

KathyPark: 20:01 Uh-huh.

Dr.Park: 20:02 Young,thinpeoplewhoarenotoverweight--

KathyPark: 20:04 Right.Whocan'tbediagnosed.

Dr.Park: 20:07 Right,thatgenerallydon’tsnore,butthey'retiredandfatiguedallthetimewithheadaches,depression,anxiety,digestiveissues.Mostofthesepeoplegetapsychiatricdiagnosis.

KathyPark: 20:18 Well,IwouldhaveapsychiatricdiagnosisrightnowifIhadn’tbeenmarriedtoyouandIdidn’tgoonthisjourney10yearsago.Iwoulddefinitelybeonpsycho—

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Iwouldbeonlike15differentmedicationsbynow,definitely.

Dr.Park: 20:34 Well,Iseemanyofthesepatientsintheoffice.

KathyPark: 20:36 Rightbecauseyoucan'tbediagnosedwithsleepapneaeventhoughyou'retiredallthetime.Soyoudoyourduediligencetogoandgetasleepstudy,butitcomesbackhey,youdon’thavesleepapnea.Sothenwhatdoyoudo?

Dr.Park: 20:50 Right.Manyofthesepeoplehavedoneeverythingunderthesunincludingavery,veryhealthydiet.Areallyextremelyhealthydiet.Theyexerciseregularly,theydon’tsmoke.


Dr.Park: 21:04 They'rethecleanestlivingpeopleIknowintermsofhealthandwellness,andstilltheyjustfeellike--

KathyPark: 21:10 Yeah,andit’sfrustrating.It’sreallydisheartening.That’soneofthereasonswhyIfeltlike,youknow,Isupportyouinthisridiculousjourneythatwe’reon.Imeanwhowouldhaveeverthoughtthatyou’dbedoingapodcast,oryou’dbeevenwritingablogwhenyouwentintomedicine,right?ButImeantowatchthishappenandtoknowthatthisishappeningandforyoutonotspeakupaboutit,Ithink,ismalpracticeright.

Dr.Park: 21:38 Absolutely.It’sunethicalnottotalkaboutit.

KathyPark: 21:42 ButIthinkmostphysiciansaresobeleagueredbythehealthcaresystemthatwhattheydon’tknow,theydon’tknow.Iftheydon’tknow,thenhowarethepatientsgoingtoknow?

Dr.Park: 21:54 Right.That’soneofthereasonswhyI'mdoingthispodcastandwritingmybooks.BecauseinitiallyIwent

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intoacademiatotrytoeducatemycolleagues,andI'mfindingitreallychallenging.It’sjustthenatureofdoctorsandscientists.They'reveryskepticalaboutanythingthatkindofgoesagainstthegrain,whichthat’swhattheydo.Youhavetobelikethat,toquestioneverything.Butanykindofscientificprogresstakesdecadesormoretobecomefullyaccepted.

KathyPark: 22:22 Didn’tyoutellmethatthatparticularresearchthatyoujustcited,alotofyourcolleaguesjustsortofglossedoverit.

Dr.Park: 22:30 Yeah.

KathyPark: 22:31 Nobodyreallywantedtopayattentiontothisincrediblefinding.

Dr.Park: 22:34 Wellitwouldcompletelyturnourparadigmofbreathingandsleepupsidedown.


Dr.Park: 22:40 Ourbasicdefinitionsofsleepapnea,forexample.

KathyPark: 22:43 Imean80%.That’sprettysignificantbyanystandard.

Dr.Park: 22:46 Right.Thenoneofthecriticismswasthatthiswasaretrospectivestudyandeveryonekindofpoopoosordownplaysretrospectivestudies.

KathyPark: 22:53 Ohlet’snotgothereokay.Alright.Sothisisaproblem.Sowhataresomestepsthatpeoplecantaketogetoffthesemedicationsandstillgetbettersleep.

Dr.Park: 23:06 Well,firstofall,Iwouldstronglyrecommendgoingthroughthestepsthatyouneedtoaddressinsomnia.


Dr.Park: 23:13 Sothebasiclifestylehabits.Wetalkedaboutthismultipletimes.

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KathyPark: 23:16 Yeah.Podcast65,HowtoSleepBetterWithoutMedications.



Dr.Park: 23:21 Now,thenthegeneralCBT—cognitivebehavioraltherapyforinsomnia—thethreegeneralcategoriesaresleeprestriction,sleepreconditioning,andsleeprelaxation.

KathyPark: 23:34 SothreeRs.



Dr.Park: 23:36 Sosleeprestrictionthatifittakesyoutwohourstofallasleepinbed,don’tlaytherefortwohoursbecauseyou'reconditioningyourselftostayawake.Youknowyou'regoingtostayawakefortwohours.

KathyPark: 23:47 Ohgosh.Okay.

Dr.Park: 23:48 Soyouhavetogetintobedmaybe30minutesbeforeyournaturalsleeptime.

KathyPark: 23:52 Whydowedothat?Idothatallthetime.Ijustsittherecountingsheep.


KathyPark: 23:59 Butdon’tdothat.

Dr.Park: 24:00 Right.Youhavetoconditionyourselftofallasleepassoonaspossiblewhenyougetintobed,notstayawakefortwohours.

KathyPark: 24:04 Okay.Sowhat’sareasonabletimetobefallingasleep?

Dr.Park: 24:08 Welllet’ssayyounormallyfallasleepat10.Let’ssay10to6.That’syoureighthoursofsleepright.

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Dr.Park: 24:15 Soifittakesyouuntil12o’clocktofallasleepthengetintobedat11:30,butdon’twatchTV.

KathyPark: 24:22 Beforehand.


KathyPark: 24:23 Okay.Don’tdootherstuffbefore,okay.

Dr.Park: 24:25 Yeahjustreadabookindim,incandescentlight.


Dr.Park: 24:29 Meditation,listeningtomusic.

KathyPark: 24:31 Breathingexercises.

Dr.Park: 24:33 Yeah,right.Thenreconditioning.Soyouhavetotrainyourbodyandyourbraintoassociatethebedwithsleep,notanythingelse.Well,exceptforsex.


Dr.Park: 24:44 Sonoeatinginbed,noreadinginbed.

KathyPark: 24:27 Nocomputersinbed.

Dr.Park: 24:28 Nocomputers.Nostayingawakeinbed.

KathyPark: 24:50 NoiPhones.


KathyPark: 24:52 NoscrollingthroughInstagramorFacebook.

Dr.Park: 24:53 Right,yeah.

KathyPark: 24:55 Iknowthattherearepeopleouttherethataredoingthis.

Dr.Park: 24:58 Yeah.

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KathyPark: 24:59 That’sreallytough.Sohowdowemanage—RememberwehadaTVinourbedroom,inourmasterbedroom.

Dr.Park: 25:05 Oh,thatwasthebestthingwedidtogetridofit.

KathyPark: 25:08 Yeah.Wejustlikecutthecord,right?Weweren’tevengettingcableatthetime.Butwedecidedoneday—andStevedidthiswithmefightinghimeverystepofthewayandwesoldit.Itwaslikethebestthingthateverhappened.

Dr.Park: 25:25 Nowwestareatablank,largewall.

KathyPark: 25:27 Yeah.Well,wehavetodosomethingaboutthat.Thatwasoneofthehardestdecisions,butoneofthebestdecisionsinretrospect,right?

Dr.Park: 25:34 Absolutely.

KathyPark: 25:35 Tooursleep.

Dr.Park: 25:36 Yes,absolutely.ThelastRisrelaxation.Sowhateveryoudobeforebedtimeshouldberelaxing,notstimulatingordisturbingorexciting.


Dr.Park: 25:48 Solisteningtomusicinadarkroom,deepbreathingtechniques,meditation.There'salonglistofthingsthatyoucandobeforeyougotosleep.Thishasbeenfoundscientificallytohelpwithinsomnia,withsleeponsetinsomnia.

KathyPark: 26:01 Iwouldevenrecommendstretching.Doinglight,non-aggressivestretchingexercises.Likeyogastretches.TherearesomegreatvideosonYouTube.I’llgiveyousomelinksforyourshownotestoneckstretches,exercises,veryrelaxingIfind.

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Dr.Park: 26:25 Ithinkthat’sagreatidea.Ithinkthere’ssomesciencebehindthattoo.

KathyPark: 26:28 Right.Idon’tknow.Ijustfeellikeanytimeyou'redoinganysortofphysicalmovementthat’sverygentleitkindofhelpsyou,yourbody,toresetandgobackintorelaxationmoderight?

Dr.Park: 26:43 Sure,sure.Nowthere’stwootherconditionsthatI'mseeing,whichit’sshockinghowoftenIseeitinmypractice.Thishastodowiththefundamentalconceptthatourjawsareshrinking.Again,thisgoesbacktomalocclusionandcrookedteeth.Thesmalleryourjaws,themorecrookedteethyouhave,themorenarrowtheairway.SinceI'mdoingsleependoscopyprettyroutinelyonmypatientsthatIdooperationson,whatI'mseeingisthatbesidesthetypicalobstructionwhenyoubreathein—that’stheclassicsleepapneawhenthepalateorthetonguefallsbackwhenyoubreathein.


Dr.Park: 27:22 Butthere'sthesetwoadditionalvalve-likeconditions—I'vereadaboutthembefore—whereitwillpreventyoufrombreathingorusingCPAPordentalappliancesforsleepapnea.Sothetwoconditionsarepalatalobstructionwhenyouexhalethroughyournose.IlabeleditEPOorexpiratorypalatalobstruction.


Dr.Park: 27:42 Soit’slikeavalve.Asyoubreatheoutthroughyournose,thesoftpalatejustbacksupandclosesoffthepassagewayfromyourthroattoyournose.


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Dr.Park: 27:51 Sowhathappensisyourbreathingstopsallofasuddenmidnasalexhalation.Thenyouholdyourbreathacouplesecondsthenyoupuffairoutthroughyourmouthasabypass.


Dr.Park: 28:03 Soit’sprettyobviouswhenyouseeit.Spousessaythishappensallthetime.Theotheroneisepiglottisobstruction.Soontheinhale,theepiglottis—whichisthiscartilaginousvalvelikestructurebehindyourtongueontopofyourvoicebox—itflopsbackasyoubreathein.Soinbothdirectionsyou'regoingtohavethisvalvelikeclosures.I'veseenpatientswithbothconditions,inhaleandexhalations.

KathyPark: 28:28 Butyou'resayingthatthismayormaynotbepickedupbyaformalsleepstudyasabreathingcessation.

Dr.Park: 28:32 Itcan'tbe.Itwon't.Itwillnot.

KathyPark: 28:35 Becauseitwillnot.

Dr.Park: 28:36 No.

KathyPark: 28:37 Ithastobe10secondsorlongerandtheseareshorter?

Dr.Park: 28:38 Well,noteventhat.

KathyPark: 28:29 No?

Dr.Park: 28:40 Thesleepstudydoesn’ttellyouwheretheobstructionorwhatkindofobstructionitis.Justthatyou'reobstructing.That’sit.

KathyPark: 28:44 Ah.

Dr.Park: 28:45 Itdoesn’ttellyouanythingabouttheanatomy.

KathyPark: 28:47 Ah.

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Dr.Park: 28:48 Plustheseobstructionswilltypically—especiallytheepiglottis—willtypicallygiveyouobstructionsthatarelessthan10seconds.

KathyPark: 28:55 Doyouhavevideos?

Dr.Park: 28:57 Ohyeah.It’sonmywebsite.We’llputlinksontheshownotesaboutit.

KathyPark: 28:59 Okay.Ithinkitwouldbereallyinterestingforpeopletoactuallyseethishappeninginreallife.

Dr.Park: 29:03 Yes.

KathyPark: 29:04 Howsignificantthatis.Butthisishappeningdayinanddayout,minutebyminuteasyou’resleeping.


KathyPark: 29:11 Ohmygoodness.Nowonderpeoplearepetrifiedtogofallasleep.

Dr.Park: 29:16 Thesepeoplegenerallyareveryanxiousandverytired.

KathyPark: 29:19 Nowonder.Yeah.Sothat’ssomethingdefinitelyforpeopletolookintoifcognitivebehavioraltherapy,ifalloftheseotherprophylacticmethodstofallasleeparenotreallyhelpingyou.Right?EventheCPAP.


KathyPark: 29:36 BecauseIcanimaginepeoplewouldhavealotofproblemsusingCPAPiftheyhadthesekindsofobstructions.

Dr.Park: 29:41 Exactly,right.

KathyPark: 29:43 Breathingoutandbreathingin.Well,yousaidthatthatwasoneoftheissuesthatIcouldn’ttolerateCPAP.


KathyPark: 29:48 BecauseeverytimeItrytopushairout.

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Dr.Park: 29:50 Yeah.Youhavethispalateissue.

KathyPark: 29:52 Ido.Yep.Yep.Onemoreissue.No,I'mjustkidding.Soarethereanyotherstepsthatpeoplecantakebeforetheystarttakingmedicationsfortheirsleepproblemsbesidesthesofttissuecollapsebreathingissues.

Dr.Park: 30:11 Gothroughthechecklistofyourreallygoodsleephygienelistofthingstodo.Thedailyactivities,yourhabits.Youhavetoreallydecidetochangeyourlife.It’salifestyledecision,it’snotapillthat’sgoingtohelpyousleepbetter.


Dr.Park: 30:26 Sosurveyyoursleephabitsandroutines.Makeajournal.Justwritedownyourobservationsandjusthaveaplanofaction.Justtakeitonestepatatime.Don’tdotoomanythingsatonceotherwiseyou'renotgoingtobeabletofinishit.

Thenyougointothemorebreathingaspectsofsleep.Obviouslyifyoucan'tbreatheproperly,you'renotgoingtosleepproperly.That’sstartsfromyournoseallthewaydownintoyourthroat.Somakesureyoucanbreathereallywellthroughyournose.Ifyouhaveanydiagnosedmedicalconditionlikehighbloodpressure,diabetes,depression,anxiety,hypothyroidism,nighttimeurination,cancer,anyoftheseconditionsthinkaboutasleepbreathingproblem.BecausethereisstrongevidencethatuntreatedsleepapneacanleadtooraggravatealltheseconditionsthatIjusttalkedabout.

KathyPark: 31:19 SoIthinkit’ssafetosaythatbeforeyoutakethefirstlineapproach,whichistotakeasleepaid,weneedtostartconsideringthatitmaybealittlebitmorecomplicatedthanthat.Thatyoumaynotbeableto

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justsimplytreatyoursleepproblemswithonepillinotherwords.Imeanifit’sonlyhelpingyouget20minutesmoreofsleep.Soitwouldbebetterforthelonghaultoaddresstheseissuesfromthegroundup.

Dr.Park: 31:48 Right.Thinkofitthisway.Thinkofyourchronicinsomniaproblemasafirstsignofaheartattack20yearsearlier.

KathyPark: 31:57 Oh,okay.Ithinkthat’sagoodpoint.Ialsothinkthatnowthateveryoneknowsthetruthaboutsleepingpillsandoverthecountersleepaidsthentheyneedtotakeaction,right?Theyneedtodosomethingaboutitbecauseknowledgewithoutactionisuseless,Ithink.Alright.Anylastthoughtsbeforewewrapupfortoday?Ithinkthatwasalot.

Dr.Park: 32:25 Yeah.Iknowit’salotofsteps.Definitelygoovertheshownotes.We’llgiveyoualittleoutlineofeverythingwetalkedabout,especiallytherecommendationsofhowtogoabouttakingcareyoursleepproblem.Obviouslyifallthesethingsdon’thelpthenseeasleepdoctor.Gettestedforsleepapnea.Evenifyoudon’thavesleepapnea,itdoesn’tmeanthatyoudon’thaveasleepbreathingproblemlikeImentionedbefore.


Dr.Park: 32:46 Iwouldsaytheproportionofpeoplewhohavemajorbreathingproblemswithoutsleepapneaisbiggerthanthesleepapneapopulation,whichisacrazynumber.Also,lastly,afteryoutriedalltheseconservativeoptions,thinkaboutseeingasleepdoctorforcognitivebehaviortherapyforinsomnia.Soanyofthemajorsleeplabswillhaveabehavioralpsychologistthat’scertifiedinthistraining.Now,ifthat’snottooconvenient—andIknowthey'rekindofhardtofindinsomelocations—therearelotsofgoodonline

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programs.Soifyousearchforcognitivebehaviortherapyforinsomnia,there'ssomeprovenonlineprogramsthatcanbeveryhelpfulaswell.

KathyPark: 33:20 Okay.Terrific.Thankyou,again,everyonefortuningintoady.Ifyou’veenjoyedtoday’sconversation,youcangetalloftheshownotesandtheresourcesmentionedinthisprogramatdoctorstevenpark.com/sleepaids.Whileyou'rethere,checkoutalloftheresourceswehaveavailableatthewebsiteandsubscribetothepodcasteitheroniTunes,Stitcher,orDowncastorwhereveryoufinditeasytolistento.

Onelastthing.Iftheinformationyouheardtodayhashelpedyouinanyway,we’dloveforyoutogiveusaratingoniTunes.Butbetteryet,forwardthistoafriendorsomeoneyouknowwhocanbenefitfromthisinformation.Thankyouagainforhelpingsomeoneelsebreathebetterandsleepbetter.ThisisKathyParkonbehalfofDr.StevenParkthankingyouforspendingsometimewithustoday.Untilnexttime,wishingthatyoubreathebetterandsleepbettersothatyoucanlivebetter.Bye,bye.