CEimpact Podcast

Sleep Disorders - A Public Health Crisis

September 16, 2024

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According to the National Heart, Lung, and Blood Institute (NHLBI), 50–70 million Americans have sleep disorders, and one in three adults don't get enough uninterrupted sleep to maintain their health. 

Listen in to this week’s GC episode to learn the physiology of sleep, why we need sleep, and what our role is in educating patients on sleep hygiene sleep disorders, and OTC vs. Non-OTC options. 

HOST
Jen Moulton, BSPharm
President
CEimpact

GUEST
Ezequiel Medina, PharmD
Sleep Coach and Pharmacist
Live Love Sleep

Pharmacist Members, REDEEM YOUR CPE HERE!
 
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)


CPE INFORMATION
 Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Identify common sleep disorders and their impact on patient health and outcomes.
2. Explain strategies for managing sleep disorders through pharmacological and non-pharmacological interventions in pharmacy practice.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-263-H01-P
Initial release date: 9/16/2024
Expiration date: 9/16/2025
Additional CPE details can be found here.

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Speaker 1:

Hey, ce Impact subscribers, welcome to the Game Changers Clinical Conversations podcast. I'm your host, jen Moulton, and I know I always say I'm excited about each week's topic, and I do truly mean that. But this week I'm really excited and that is because this is something that everybody is talking about, which is sleep. And when I say everybody's talking about it, I thought to myself okay, maybe it's just my age, or maybe it's the people I surround myself with. But then I looked at the data and it turns out that 50 to 70 million adult Americans, which is one in three people, don't get enough uninterrupted sleep to maintain their health enough uninterrupted sleep to maintain their health, and I would say that's a public health crisis. So I am excited to dig in for that reason. But the other reason I'm excited about this topic is because I think that pharmacists can really have an impact on this.

Speaker 1:

Our practices see patients buying over-the-counter medications and supplements in hopes of better sleep. We dispense prescription medications in hopes of better sleep. We dispense prescription medications in hopes of better sleep, and we see drug therapy problems that potentially include serious consequences, such as falls, in patients who take sleep medications when perhaps they shouldn't. So I think there's just so many opportunities for us as pharmacists, to interact with this topic with our patients and really help them get better outcomes when it comes to sleep, which then translate to better health. So it's a huge opportunity for us and we could talk about it all day, but we only have a half an hour, so we're going to jump in and try to get to as much as we can. We might have to make this a multi part series, but with me today to talk about taking advantage of that opportunity for pharmacists to help patients in this area is someone who specializes in this practice and so he does it every day Zeke Medina, welcome.

Speaker 2:

Hi, I'm excited to be here.

Speaker 1:

Well, I am excited to have you. I think your practice is fascinating the more I've learned about it, and I'm happy for you to share that with our listeners today. But first I want to give a little background to how we met each other. I mentioned that I'm passionate about this topic and it really it kind of goes back to I think it was oh gosh, at least five years ago, if not more.

Speaker 1:

We did an educational program on sleep and I remember the speaker saying there are no medications that we prescribe for sleep that have more benefit than they do risk, and that really scared me and I just thought, okay, but we've got all these people on all these sleep medications, and so I have been wanting to address this topic for so long, because I just don't think that we think about it that way. And so when I got connected with Zika on LinkedIn, I thought, okay, this is somebody that can finally help us figure this out. So talk to me and talk to our listeners about how you became, how you got to be a sleep coach. How did this even come about?

Speaker 2:

It's kind of like the Holy grail of health. If you can get your sleep fixed, you have everything going for you and it's just a great foundation. I have always had my sleep issues, um, ever since I was a teenager. Then I went to the army and I worked night shift. Then I was in pharmacy school and I was on multiple medications to just manage my day, and one day I realized that if my daughter could be trained and learn how to sleep through the night, maybe I can do the same. And when I did, those three medications that I was on completely disappeared and I started becoming more curious. In my practice as a pharmacist is as we're able to view the entire medication profile at times and when I saw chronic disease medications like blood pressure, diabetes, cholesterol, and then I would also see, one time or another, a sleep med. And.

Speaker 2:

I got curious and I started asking my patients. You know, how is your sleep, How's everything going? And.

Speaker 2:

I heard the same answers Sleep pill didn't work, doctor can't prescribe anything stronger and I'm still just going without sleep. And when we look at everything, there's just so much that can be done, but it's always that time constraint. So I felt like it was just my life's duty to just do it on the side and really build up the practice of teaching people what sleep is and what work needs to be put in to get the sleep for our bodies to function optimally.

Speaker 1:

Yeah, it's such a great analogy. You know, we train babies how to sleep and they're you know, they're up all night and we're up all night and you know, I just remember those days and I had never. You know, you never think about it as an adult, that you have different reasons why you're not sleeping. So I think that's really cool. So what does your practice look like in this regard?

Speaker 2:

So it's kind of evolved over the years. I mean it started out in a pharmacy where I was just doing group lessons.

Speaker 2:

Then my wife opened up her business in 2016, teaching babies how to sleep, and around 2018, I had learned enough, but I wanted to just get something under my belt of a certification, so I worked with her mentor to become an adult sleep consultant. I eventually became their mentor, so I was training new sleep consultants, coming out and just kind of helping them, you know, formulate kind of coaching plans for them, and then from here I've started it on the side, where I will work one-on-one with somebody from six to sometimes longer six weeks to longer to kind of get those behaviors nailed down, kind of taking away those self-limiting beliefs that we seem to do really well as humans, to kind of sabotage our sleep and our ability to do things that we used to do but now we can't.

Speaker 2:

And from here I've started taking on more faculty roles where, like you said, it's hard to get to everybody one-on-one, but when there's an ability to kind of reach a much more larger audience and help people that way.

Speaker 2:

Reach a much more larger audience and help people that way. I'm starting to create courses, do live one-on-ones with bigger organizations, so that's been really fun really just going out there and doing seminars and teaching people and big groups on what we need to do to get that optimal sleep that that I've been teaching my clients for years yeah, that is so cool, so cool.

Speaker 1:

Well, let's dig into it. So why is sleep so important and why are we not getting it? Oh, man.

Speaker 2:

So this is the magic question, right? Um, you know, sleep is just so restorative for the just the body itself, right, it's self-healing for our cardiovascular system, it's extremely beneficial for our metabolic health and we also know that it helps clean out toxic protein in our brain. So let's expand on that. You know, getting enough sleep has shown to increase growth hormone while we sleep. And we know growth hormone is something that repairs our arteries, repairs our cells. It really helps to rejuvenate our body. That all the damage that we've done in that 24 hour period. It also balances out the autonomic nervous system.

Speaker 2:

If we don't get enough sleep, our sympathetic nervous system is in overdrive. That increases our blood pressure, does a little bit of inflammation and chronically that can really mess us up. We know to sensitize our insulin receptors so we have better glucose regulation. We've seen studies where we had individuals with two to four hours of poor sleep and what happens? They almost have the blood sugar of a pre-diabetic. Those spikes, as you know, are dangerous. They cause glycation, they cause inflammation, they cause so many things to occur and we need to help regulate that. And sleep does that. And then, I think a couple years ago there was research showing that you know. Deep sleep especially helps to stimulate the glymphatic system in our brains to really wash out some of those toxic amyloid proteins that are responsible for dementia and Alzheimer's. So there's a lot of benefit there. There's a lot of benefit when it comes to memory and critical thinking.

Speaker 2:

And we know, you know, like I said, hormones like growth hormone, testosterone they typically peak when you get the right amount of sleep and we need those for those anabolic states, especially if you're dealing with a kid at home that's an athlete, or any child that is still growing, or if even yourself, if you're going to the gym and you're looking for results and looking for muscle because, as we know, as adults we have to start building muscle we're really looking for that total rejuvenation of sleep, so having that testosterone peak at night with the growth hormone to really wake us up ready for the day. And then, of course, you know, it helps to really regulate our hormones, especially the ones that keep us awake and the ones that are responsible for sleeping. So I think I can go on, but I'm going to just stop there.

Speaker 1:

Well, it is a vicious cycle, so it's yeah, it's for everything. So why are we not getting the good sleep? I mean why you know there's so many books. I feel like out on this now too, like what. Why are we, as a society, not getting good sleep?

Speaker 2:

Yeah, I think you know we we really battle with a lot of things that are really easy for us and therefore we seem to go and gravitate for those.

Speaker 2:

I mean, we have these little world devices in our pocket that can really soak our attentions for hours, and they have these dopamine hits of these little red dots that say, hey, you have an alert or a like, and when we get those, that allows us to be more drawn to it.

Speaker 2:

So the biggest thing is, you know, we have advances in technology. They benefit us in many ways, but then, on the other end, they really take away from our attention and therefore can really impact our ability to be more disciplined when we had maybe, let's say, a set bedtime routine where we might have wind down, but now we're on, you know, our devices a little bit longer. In addition to that, you know it as stress. We have so many types of stressors that can really go crazy during the day where we might think of it as a fire, and when this fire goes so much, you know to where you know we can't manage it, I call that a stress. It can bleed into the times where you need to relax and go to bed, so that can be very hard to kind of tackle as well.

Speaker 1:

Yeah, yeah, particularly for us as pharmacists, those day you're in fight or flight all day long and then be able to settle down in order to sleep. So can you talk a little bit about? You know, I think there's like not getting enough sleep, but then there's also insomnia. So from you know, from a diagnosis standpoint, so can can you just talk about what are the different types of of insomnia? I guess you, if you want to call it, or or categorize people in terms of what is inhibiting them from sleeping?

Speaker 2:

So I like to categorize it, as you know different things Now. There can be insomnia where someone is battling their natural chronotype you probably heard of the early bird or the night owl. Well, there are more expensive versions of that, where they might have delayed or advanced sleep-wake cycle and therefore they're trying to do a normal work day and therefore they have to wake up earlier than what their bedtime is actually set to internally. This is a small percentage, but leave it up to a sleep know get the rarest of any patient. So I do see these a lot. The other ones, where it really impacts us as pharmacists is you can have insomnia due to medications or maybe stimulating substances or alcohol. So you know. Just quick example of that, you know, let's say, corticosteroids. You know you might be on corticosteroids and no one told you to take them in the early morning with food. You might've been taking them in the evening time. Then one touchy subject is alcohol. It always is alcohol. We have normalized alcohol so much, so when you start telling patients to pull that back because it is destroying their sleep quality, you might get some resistance right. So there's those substances that we as pharmacists know so well because we know the physiology of a lot of these, these medications and these substances, so that to me is like rule number one in my job.

Speaker 2:

And then you have insomnia due to predisposing factors. You know these typically aren't enough to give you insomnia in the long run, but can increase your chances if you have multiple factors. So it's things like chronic pain or an injury. You could have depression or anxiety or trauma, things like PTSD or a common one that I see is people that ruminate on certain things for long periods of time. You know just those types of things.

Speaker 2:

The other two I would say is, you know, any perpetuating factors. This typically will turn from short-term to long-term insomnia and it's things that we know as like sleep hygiene Maybe spending too much time in the bed doing things other than sleeping, maybe just trying too hard to fall asleep, or being sedentary, napping too much or having too high of an expectation on your sleep. A lot of these things we just kind of ball into like I need this so badly and then we can't have it. And then, lastly, precipitating factors. These are typically temporary, but you put all these into one pot. You can have chronic insomnia and that can be things like job stress, moving, traveling, divorce or even marriage or just being a caretaker and doing things like that. So typically temporary, but they can turn into long-term.

Speaker 1:

Sometimes I hear about people talk about. So can you not fall asleep? Or do you wake up in the middle of the night and not be able to go back to sleep? Like, is there a differentiation in terms of what you talk to people about, depending on where that comes?

Speaker 2:

Yeah, I think so. So when you think about falling asleep, we're thinking about are we setting up our brains and our bodies all the way up until we go to bed? And I say many of us try to go from 100 miles per hour down to zero right at bedtime and expect to go to sleep. Now, many people can do that because they say, oh man, I fall asleep as soon as my head hits the floor and I go floor bed and I go, if that's the case, within five minutes.

Speaker 2:

that's telling us that your body is so exhausted that it needs rest and we should probably be thinking about prioritizing this or maybe relieving some of that stress.

Speaker 2:

So I always mention that to clients.

Speaker 2:

If you're having trouble falling asleep, you know, number one, we need to lessen the stress in our day and then build a time, maybe an hour before, to where you can slowly wind down and get to bed, nice and gentle anything from 10 to 20 minutes right Now. The second thing that I see a lot is that other stressors, like fluctuating blood sugars, can really wreak havoc at night or in the middle of the night. And since I deal with a lot of metabolic clients clients that might have type 2 diabetes or insulin resistance, or maybe there's a hint of metabolic syndrome or insulin resistance, or maybe there's a hint of metabolic syndrome or insulin resistance and I'm trying to see okay, what are you eating at night and is that spiking your blood sugar and then extending, and then we have a drop at night that wakes you up or it causes you to have restless sleep. So there's so many things that can occur and I think that's where kind of working with somebody that's experienced can really dial down, and it all starts with a detailed patient history.

Speaker 1:

Yeah, there are so many questions. Can you talk a little bit more about that? Because I think that, as pharmacists and that's why I want to try to get into that a little bit too and talk about medications that can interrupt sleep, or meds you know to steer away from, but you know a lot of people have patients who have type two diabetes. So what, what is that? You know, if they, if they are having trouble sleeping, what? What does that look like? Like? What should a good, you know, evening food regimen look like in order for that to not happen?

Speaker 2:

Yeah, I love this question because one thing that we're trying to do is not have blood sugar spikes.

Speaker 2:

right, we know blood sugar spikes as something that can cause so much damage in our arteries for one. But when you start to get that crash because ultimately your insulin is going to kick in and it's going to drop your blood sugar fast, that drop typically will trigger a stress response in your body which will cause cortisol to release and then now we're not sleeping at all, right. So when I'm looking at dinner time I always tell my clients I say you know, everyone says you can start winding down an hour before bed, which is true, but three hours is typically when you really want to start winding down. An hour before bed, which is true, but three hours is typically when you really want to start winding down. That means start eating your food and giving yourself at least three hours before you're about to go to bed. But as someone with insulin resistance, like type two diabetics, we may want to start focusing on a meal where we can eat our fibrous vegetables first or, if we don't have any, try to put some in there, because when we can chew and really digest that before anything else hits our stomach, it's going to really coat the mucosal layer of our intestines and really slow the absorption of other things After you get those fibrous vegetables.

Speaker 2:

I really like lean proteins or healthy fats. So, if you have your avous vegetables, I really like lean proteins or healthy fats. So if you have your avocados, your olive oil, this is really going to help with sustaining that blood sugar. For any sweets or starchy foods next or last, I typically will try to save those for last. But when have you ever saw someone lay down a plate of mashed potatoes? Right, they typically head for those soft mashed potatoes that are buttery and salty, and you know that. So we get the orders wrong. But we do need to start educating our patients that you know. We have to think of fun ways to do vegetables, or maybe starter packs of vegetables where we eat those while we're cooking the main food and then, after we've had our vegetable servings, then we can go ahead and eat our proteins and fats. And then, lastly, if there's any room for starch or sugars, we can have a little bit of those, but it's all moderation when it comes to that.

Speaker 2:

But, I'm typically looking at that wind down period three hours of relaxed activity, dim or not so bright light, because I want to set that circadian rhythm and then with that you know, you can really start to deeply relax one hour before bed.

Speaker 1:

So when you talk about medications, let's go into that a little bit. So, as pharmacists, what are the things that we should be looking for in patients who are having trouble sleeping? Or they may not even be telling us that, right, they might just come up to the pharmacy with sleep aids. It's really a conversation that comes up right. So what are the things, what are the red flags, what are the medications that we should be looking for and how can we help patients?

Speaker 2:

Yeah, I think so. When you look at medications, a lot of it surrounds cardiovascular disease, blood pressure issues. So if I see somebody that's picking up a sleeping aid, but I also see things like beta blockers or clonidine or even diuretics. You know I'm counseling on diuretics and going are you making sure to only take these in the morning time so it's out of your system by the time you're going to bed, right? The other things about diuretics, whether it's hydrochlorothiazide or furosemide or anything like that, is that it will leach out a lot of electrolytes which can cause cramping at night for some patients. So you might want to just be curious and ask them about that. But we know clonidine as a blood pressure medication now for two and it can cause some daytime drowsiness but, it really affects sleep quality as well, whereas beta blockers themselves can affect melatonin production.

Speaker 2:

So, knowing that as a pharmacist you can either see if they truly do need a beta blocker or maybe we can go to a calcium channel blocker or assist them in finding the right melatonin for them. And typically women will have much lower doses than men. But I try not to go above three milligrams of melatonin, I mean, despite what all the people say about it's harmless and this and that.

Speaker 2:

I definitely want to be careful with melatonin, especially in adolescents and teenagers. There's animal models to show that it reduces puberty or it slows down puberty in animal models and we're animals. So I'm not trying to experiment with humans here. But I mentioned already alcohol, corticosteroids, you know those are stimulants, migraine medications, individuals that might have consistent or chronic migraines. A lot of migraine medications may contain caffeine, a lot of the maintenance stuff and then just caffeine in general, being that it's six to eight hours of half-life before it's cut in half. We find people that have very restless type sleep and you know, when I think about caffeine I also think about theophylline. It's kind of in that same category. So it's kind of in that same category.

Speaker 2:

It's an old drug but my goodness, I still see a lot of elderly patients that will be like I am not giving up this. This saved my life and I'm always going to be on it. You know we see antidepressant or anti-anxiety medications where it might make you drowsy during the day, so I'll recommend taking those at night, or vice versa. They'll feel pretty wired and have rest of sleep and I'm like all right, you know, you know what to do. Put it in the morning. So we have to really think about that. And then I would say the last two is any HDHD stimulants. Obviously those trigger a lot of norepinephrine and things like that in your brain and could keep you awake.

Speaker 2:

But one thing that sometimes not often seen is you know your thyroid medication, people starting on thyroid medicine. If your thyroid goes too high, it's gonna mess with your sleep, it's gonna make you very restless. It's going to mess with your sleep, it's going to make you very restless, it's going to overheat you. And I've had a pharmacist counsel, one of his patients, and he was telling them oh man, this lady was taking her thyroid medicine with her food and she was also taking some supplements along with it and I was like, like what? You know, her calcium or multivitamin. So she hasn hasn't been doing that, but she's been feeling real sick and I go yeah, we just made a lot more thyroid bio available to her system and she's getting hit. We need to adjust the dose. So it's things like that that us, as pharmacists, are in just in a real key position to make those recommendations or spot them before they even happen real key position to make those recommendations or spot them before they even happen?

Speaker 1:

Yeah, absolutely Absolutely, and I think it's just such a good reminder to be looking for those things and you know, even making a cheat sheet, you know about what to look for. So you mentioned melatonin, and one of the things that was interesting when you and I were chatting offline was you know, you talked about, you hear about melatonin, you hear about magnesium, and you know all the things that are out there and that for each person it works differently and so it's not a one size fits all, which I think is what tends to make sleep complicated, like any other health behavior. It's like, oh, there's not a one size fits all, so I'm just not going to do any of it. So can you talk through a little bit about what you mean by that individualized approach and maybe how we can help patients to figure out what does work for them, whether it's melatonin, magnesium, some other supplements?

Speaker 2:

yeah, I think just kind of identifying what these supplements can do in the body um when I start out and I'm asking my clients all the questions, right, you know I I try to also reiterate these supplements are only as good as your lifestyle choices. So if you think you can come to me and get your sleep fixed but not put in any work other than take supplements, then we're going to be wasting your time and I don't want to do that. So that's first thing. Now, when you think about things like magnesium, you are typically looking for something that absorbs, and one thing that's kind of outdated is the RDA of magnesium. It's given an average weight of I think men are 140, is their recommendation 140 pounds? So they recommend much less magnesium. So it should be higher to about 500 to 600. And with our food sources being so minuscule when it comes to magnesium even the ones that are supposed to be high in magnesium we just don't get it. So I typically will try to recommend a chelated form of magnesium. I believe magnesium glycinate for sleep is probably one of the most common ones recommended by most practitioners, but oftentimes you'll see magnesium oxide, which does a great job in the bowels but not so much in the bloodstream. So I do feel magnesium is definitely low in a lot of humans, especially if you eat and consume ultra processed foods, because that puts a lot of stress and work on the body to get rid of those and process those.

Speaker 2:

And then you know I can say things like complex B vitamins and how they're so active with things like tryptophan, which will then convert to serotonin and then to melatonin. So taking those during the day to help that process, to build up your serotonin. We know vitamin D as nothing that's directly impacted with sleep, but it's strongly related to our circadian rhythm and getting light during the day. So vitamin D during the day might be extremely beneficial. So checking those vitamin D levels, because if you're barely over 20, you're probably not optimized for good health and you should probably be looking at much higher.

Speaker 2:

And then we know healthy fats, omega-3s has good for brain function, and what is our body trying to do when we sleep is get everything situated. And then, of course, you mentioned melatonin. It's not going to sedate you. It is more of a hormone that gets everything ready in your body, gets all the circadian rhythms in your cells ready to go. So when you are tired enough and you fall asleep, boom, it gets to work right. So and it helps to sustain the sleep and not, you know, initiate it it, yeah, so talking a little bit about prescription medications for sleep, can you?

Speaker 1:

you know I started with that and I just remember you know the pharmacist saying you know, if you look at the risk versus benefit, there really aren't any, that the benefits outweigh the risk. There's always risk. So can you talk a little bit about that?

Speaker 2:

Yeah. So let's just talk about some of the I'm using air quotes here safer alternatives, which are typically the Z-hypnotics, because to get away from benzodiazepines it has been a huge leap, because when I have to get patients or clients off of benzodiazepines number one, I have to switch it over to something that's more long acting. And when I'm thinking in my head we can probably do this in six weeks, I am almost always wrong because when we start weaning somebody off, they start having withdrawal effects almost right away. Therefore, slowing these weaning process to you know anywhere from I mean I just finished with a lady that was over a year and a half. So it's, it is has a very um, it's a chemically I wouldn't say addicting, but it has a very potent bind to those receptors, to where the body has to create more receptors, and when it doesn't get what it's needed, then you see glutamate just take over and when you're not ready for that, it can be very painful to watch somebody that's going through benzo withdrawals. So I'm so glad those are kind of being phased out, but you'll see people still on them. But the Z hypnotics I mean they are slightly better, but when you think about the risk I see it a lot with chronic users or users that have increased the dose to the maximum and sometimes will take more. You'll see them sleepwalking, You'll see them sleep talking, You'll see them sleep driving. You'll hear reports of somebody taking it on an airplane and not remember anything and have all these pictures of him having fun with everybody, and so there are so many things, um, that really scare me. And now it's one of the main reasons that scared me when I had children is I did not want to be on these medications, my kid crying and then I'm trying to help them and God knows what could have happened. So I knew that was the biggest reason to get off. But we have newer, um, I would say less addicting.

Speaker 2:

We classify this drug class as the orexin receptor antagonist and typically what these are doing is you have an alert like system in your brain that kind of keeps you alert, and we're trying to calm that down in the middle of the night and it seems to help. It seems to give you just a little bit more sleep, just like normal sleeping pills. But I have seen patients come to me and say you know, it's just not my sleeping pill. It makes me extremely drowsy, it takes a while for me to like feel like I'm awake once I wake up. And it makes sense because they're constantly being inhibited of alertness, Like they don't have that alertness and it seems to last, even though that half-life will say you know a couple hours or whatnot. But we all know everyone's individualized, they metabolize things different, and cytochrome, P450, there's hundreds of these things and everyone responds differently to different drugs.

Speaker 1:

Yeah, well, and it's, you know, remembering why we had them in the first place. I mean, when we think about like traveling internationally or you know, like very short term use, you know, I feel like they're really not intended for chronic use and that's where we've gone, and so it's just really difficult to get people off of them for all the reasons that you said. So it sounds to me like you're saying the best sleep med is no sleep med.

Speaker 2:

The best med um, yeah, is really good health, good physical and mental health that allows you to relax naturally, and I think that's that's one of the things that we we seem to just forget as adults is that we get so good at our jobs.

Speaker 2:

I think pharmacists are probably one of the top professionals that are almost burning out because they are passionate, they have so much empathy for the patients they're taking care of, but they're also perfectionists and they expect something highly of them, and I found myself trying to carry that same attitude over to when I wanted to go to sleep and when I didn't get sleep, it frustrated me and I found myself not sleeping. And it's just simple as that, just taking that same attitude. We can't do that with our health, especially something that actually requires you to go from sympathetic dominance to parasympathetic, that rest and digest. So there's a lot that we have to practice and that's why a lot of professionals and there's these breath work coaches, there's yoga coaches and there's these breath work coaches, there's yoga coaches, there's meditation coaches because there is actually a huge benefit of doing this regularly during the day to exercise that parasympathetic tone, so at night you can easily activate it, get relaxed, feel sedated and fall asleep naturally.

Speaker 1:

Yeah, that makes a lot of sense. I had not thought about it in that respect, but exercising that, practicing that, you know, throughout the day, that makes a lot of sense. Well, we could talk all day. I have so many more questions, but that we're going to have to save it for another episode, or maybe even you know a course or something that we could do to dig to save it for another episode, or maybe even you know a course or something that we could do to dig a little bit more into this. I think there's so much here and really, you know, like I said at the beginning, so much we can do as pharmacists in this space. I, you know, I, I think about, you know, in the past, I think we're getting better as a society of prioritizing sleep. You know, I think we used to think about sleep as for the week, the least amount of time that we could sleep, the better, because then the more we got done, and I think that has changed. Luckily, Like I said, there's a lot of books, there's a lot of focus on sleep and the importance of that for, as you mentioned, restorative health and just everything, Everything that you know inflammation and blood glucose levels, everything. So that's the good news. But I think in order to get there, it's still hard. You know it's still hard to have a healthy lifestyle. So I love the coaching that you're doing. We'll put a link to that in our show notes if people are interested in learning more about that, because I think that's really cool and I think it's a way that we could, as pharmacists, really help our patients. So thank you so much for sharing this One question that I ask all of our guests at the end of the podcast, because it is called Game Changers.

Speaker 1:

So what would you say? I think you know there's so much here and we were only able to touch on the surface of kind of a lot of topics. We went an inch deep and a mile wide. What would you say is the one game changer in this space? So, for pharmacists that are listening today, what's the one thing that you want them to take away?

Speaker 2:

You know, I think when you start looking at, let's just say, sleep hygiene, things that can improve your sleep, what you'll find is there has been a research to show that it is also beneficial for overall health.

Speaker 2:

So if you just start with anything, even if it's sleep hygiene and that's one part of the equation you're never going to be wrong. You just pick a habit, even if it's the easiest, when you've been mastering that for two or three weeks. Pick another sleep habit that you know you need to fix and just build upon that and let it snowball, because before you know it, you're going to be sleeping well, you're going to feel better, you're going to do great. So start with the first and the easiest sleep habit and let it build.

Speaker 1:

I love that. That's good advice for anything, particularly for this, because I think you're right, I think it's just overwhelming and it's like, oh, I just I don't know where to go. So picking one thing and trying it for a certain amount of time, that's a great, that's great advice. Well, thank you so much. I am so grateful that we were introduced to each other and I've learned so much from you already and I look forward to hopefully working with you a little bit more in the future. So thank you for being with us today. It was, um, it's been a great, um great first step into this topic. I think there's so much more that we can talk about, so I appreciate it absolutely thank you for having me have a great one that is it for this week.

Speaker 1:

If you for having me have a great one. That is it for this week. If you are a CE plan subscriber, be sure to claim your CE credit for this episode by logging in at CE impactcom. And, as always, have a great week and keep learning and get good sleep. We'll talk to you next week.

Speaker 3:

Thanks for listening in. Claim your CE credit by clicking on the link in the show notes and check out CE Impact's other education at CEImpactcom, where we curate the most important information in pharmacy and medicine to deliver straight to you. Join today to connect your learning to practice.