The Dr. Big Guy Podcast
"The Doctor Big Guy Podcast" offers listeners expert advice on injury prevention, healthy living, and longevity, all aimed at helping you avoid chronic illness and the need for surgery. Join Dr. Caleb Davis, AKA "Dr. Big Guy" as he shares insider tips from his experience as an orthopedic surgeon, provides a behind-the-scenes look at the life of a surgeon, and answers questions about health and medical careers. Whether you're interested in staying fit, curious about the medical field, or just want to live a healthier life, this podcast has something for you!
The Dr. Big Guy Podcast
Episode 4: Transforming Sleep: Relaxation Techniques, Apnea Insights, and Self-Care Strategies
Unlock the secrets to a restful night's sleep as we dive into the world of sleep hygiene and relaxation techniques. From calming music and meditation to yoga and mindful muscle relaxation, discover methods that can transform your bedtime routine. Hear personal stories about cyclic breathing and meditation. We'll also explore the benefits and pitfalls of supplements like melatonin and various forms of magnesium, alongside a candid discussion about benzodiazepines and their risks.
Join us for an exploration of sleep apnea, where we unravel common misconceptions and destigmatize the condition with humorous anecdotes. Picture an orthopedic surgeon's trivia night blunder or the chuckles of a pre-boarding flight mishap. Learn about the latest advancements in diagnosing this sleep disorder, including the comfort of home sleep studies, and how they can fit seamlessly into your life.
Get inspired by Nicole’s engaging journey toward better sleep, rooted in the support and routine of her husband Caleb, whose life was transformed by a CPAP machine. Nicole's narrative highlights the power of prioritizing sleep and self-care, driving home the message that a healthy lifestyle is within reach.
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so we've touched on sleep hygiene, which is a broad term that just means habits to keep around going to bed and sleeping, and I think something that I didn't talk about, that I wanted to, was some relaxation techniques before, and this can involve a lot of different things. It can involve listening to calm music. It can involve meditation, yoga, of different things. It can involve listening to calm music. It can involve meditation, yoga, stretching, if you're spiritual, religious prayer sometimes, but these are all different things that people can attempt to do. Visualize myself letting my muscles just relax and tell myself to let those tension out of my muscles. And as I focus on that intently, I fall asleep.
Speaker 1:I like the cyclic breathing as well for myself. If anybody here listening goes to yoga, they might be familiar with the savashana pose, where you're the corpse pose where you're lying on your back um who's getting the technical jargon now?
Speaker 2:I?
Speaker 1:don't know what that is. I just explained it, dr Big Guy, what?
Speaker 2:does that even mean the corpse pose? That sounds macabre.
Speaker 1:Yeah, you know, okay no-transcript and six exhale, and then you just keep doing that and typically for me, before I know it, I've fallen asleep.
Speaker 2:Yeah, I think that can be really useful, and you just have to be mindful and remember to do it and just try to push out all the thoughts and anxieties of the day out of your brain. Sometimes that's easier said than done, but doing the breathing exercise and the mindful relaxation of the muscles helps me do that. Sometimes I'll also replay like something I learned for the day. If I read something interesting or there's something I'm actively trying to remember, I'll replay that through my head, and that can also help me fall asleep too.
Speaker 1:so you bore yourself to death.
Speaker 2:I guess that's one way to phrase it. The one thing that backfires on me is, if I was doing jujitsu, I'll think about the grappling rolls that I did that day, the sparring I did that day, and then I get all tense up again because I was choked, someone choked me and I'm like now I'm all tense and I've just undone all my relaxation, so I do have to be careful for that one. So what do you think would be the number one supplement for sleep that people might take?
Speaker 1:Well, I'm familiar with melatonin.
Speaker 2:Melatonin's a popular one, yeah.
Speaker 1:Yeah, I don't really know any of the other ones. You, melatonin is a popular one.
Speaker 2:yeah, yeah, I don't really know any of the other ones. You ever heard of people?
Speaker 1:taking magnesium. I thought that that was for pooping.
Speaker 2:Well, you're ahead of the game because it sure is.
Speaker 2:Okay. Now there's different forms of magnesium. Some of them have to do with molecular size, Some of them have to do with how well the body absorbs them. So there's forms of magnesium that don't get absorbed out that well and they stay in your gut and they help you poop, Just like you said. So they're more of like a laxative. So if you've ever heard of magnesium citrate or milk of magnesia, those are laxatives. They do help you have bowel movements, as you so eloquently phrased it.
Speaker 1:Everybody poops.
Speaker 2:Everybody poops and if you don't, you're in big trouble and you should definitely see a doctor and turn off this podcast. The one that I see people taking most of the time for sleep is magnesium glycinate, because it's highly bioavailable it's absorbed well.
Speaker 1:Wait, what does bioavailable mean?
Speaker 2:I love when you're making faces. I mean to make sure the camera's on you when you make these faces. When I'm using bioavailable, so just because you take something into your body doesn't mean that it gets into your bloodstream and your body can utilize it. So that's what bioavailable means. So things that aren't bioavailable you may eat it or drink it, but it doesn't get spread throughout your body in a way that your cells can take it up inside themselves. So that's what bioavailable means. Glad you asked, the more you know.
Speaker 1:The more you know, the more you know.
Speaker 2:Where magnesium citrate and magnesium oxide, like we talked about, are more remaining in the gut, pulling water into the gut, making you poop. Another one that people take is called magnesium threonate, which you can find. These are all over the counter. You can buy all these and that one people tout as helping with cognitive function, but it can also help with sleep somewhat as well. But I would definitely avoid drinking a big bottle of magnesium citrate before bed or you're going to be in for a real bad time and so is anyone else who's sleeping with you.
Speaker 1:What do you know about benzodiazepine drugs?
Speaker 2:Benzos. I feel like I've heard of them referred to as benzos. Benzos you ever heard of Ativan or Xanax or Valium?
Speaker 1:Yeah, that's typically a very heavy prescription drug and I think it's used for severe anxiety, maybe panic attacks.
Speaker 2:Yeah, so it can be used for anxiety, it can be used for sedation, it can be used for sleep. I rarely prescribe it myself as a doctor, one because it's very addictive and the other because the side effects can be pretty significant and it has to be dosed very particularly. Probably the only time I prescribe it is I prescribe one pill, and that's for patients who need an MRI. I'll send them to get the MRI. I prescribe them one single pill so they can have some sedation. They're in a medical practice, they're in an office with other medical professionals around while they're getting their MRI.
Speaker 2:I don't routinely prescribe it for people with sleep disorders or anxiety disorders, although there are a lot of people who will prescribe it for anxiety disorders. The thing that's special about benzodiazepines it's one of the few drugs that withdrawal can actually kill you. Now, I'm not saying that to be alarmist and scare everybody. It's just people should be aware that with every drug comes risks. So even if it's a very effective sedative, it can come with risks involved and I don't generally recommend it for sleep unless you have no other recourse.
Speaker 1:But what about SSRIs? I think I had a sleep doctor specialist tell me once that SSRIs can increase nightmares or dreams or something related to sleep, and made it a little bit more challenging.
Speaker 2:Yeah, I've heard of some people having sleep disturbances with SSRIs, that's selective serotonin reuptake inhibitors. For everyone listening, by the way, since now Nicole's back on the medical jargon that is a very common class of drug that's prescribed for a number of different issues, most often depression and anxiety.
Speaker 1:So that's Sertraline, Zoloft. I don't know any of the other generic names for it.
Speaker 2:You know I only know the generic names, but I didn't really read up a lot on this so I don't want to get it wrong, but there are some that I've heard increase. You can be more easily disturbed from sleep where you wake up more easily, where you might have trouble falling asleep. Some of them even raise your core body temperature and you're sweating at night more, which we talked about. You need to have a lower core body temperature to be able to sleep effectively. So these are all things that can come into play. So if you're on an SSRI and having significant sleep problems, you might want to talk to your prescribing physician about that to see if that's something you can adjust and see if you can get any better sleep with it. I did want to touch briefly on melatonin. That's probably the most common sleep supplement that people try and it's effective. It'll help you get to sleep.
Speaker 2:I've definitely used melatonin in my life. Before residency, I had a lot of trouble sleeping. I don't know why, probably for a number of reasons Poor sleep hygiene, poor consistent time going to bed but once I became a resident I got cured of that, although I will note that I'll take melatonin if I say I need to get to sleep at a certain time and I don't feel tired. I will use it on occasion, but I try not to use it chronically every single night, if I can avoid it, because it makes you drowsy and it can sometimes also mess up your circadian rhythms, as we talked about, because melatonin is a naturally occurring hormone. If you're taking high doses of it frequently, you're going to mess up how your melatonin is being produced.
Speaker 1:In theory, yeah, drowsiness is an interesting topic in and of itself. I remember being in high school and not getting enough sleep, especially for an adolescent. I was probably getting five hours of sleep because of the amount of homework I had to do and just poor sleep hygiene on my part and all the extracurricular activities. I was in school and just constantly fighting that feeling of drowsiness. And I remember seeing a billboard in the last few years saying drowsy driving is like drunk driving or it's like something akin to that where drowsy driving is just as dangerous as drunk driving or being impaired. So I wonder with drowsiness, is this something in general? If somebody wakes up after trying to sleep, whether or not they've taken melatonin, is there any way to improve whether or not they wake up drowsy?
Speaker 2:I don't know if I have an answer for that. If you're taking melatonin, I think a lot of people experience drowsiness even with a good night's rest.
Speaker 1:Normally I have my little tablet of melatonin, because if I take a full 5 mg that's too much for me.
Speaker 2:Yeah, and you can experiment with what works for you. Ideally, you're going to do more of some of the other things we talked about that aren't drugs. Now it's time for Fractured Facts, Time to impress your friends with all of your orthopedic knowledge. It's time for the best and most exciting part of the show Time for Fractured Facts with Nicole Davis and Dr Big Guy. Nicole, did you know that the human hand has 27 bones, 34 muscles and over 100 ligaments and tendons?
Speaker 1:Whoa? No, I did not.
Speaker 2:The thing that I find really interesting and this is what comes up in trivia a lot is there are actually no muscles in your fingers, which I think a lot of people are taken aback when they find that out, because you know, when you look at your fingers they kind of have some bulk to them near the proximal or the near end, closer to the palm part of Self-correction.
Speaker 1:Thank you.
Speaker 2:Thank you. I saw you eyeballing me so I knew I had to fix it already. There's sort of some bulk to it, but it's actually all tissue that's not muscle. All the muscles are further up and they just pull on the tendons that help control your hand. I think there's a funny story about hand bones and trivia out there. I don't know if you're going to embarrass me in public, though.
Speaker 1:Well, I wasn't sure. I feel like that would make you lose your orthopedic surgeon card.
Speaker 2:Well, you know, it's funny, I think, with a lot of trivia. It's like people just memorize these answers, like people who are really good at trivia. It's like, oh yeah, there's 27 bones in the human hand. Well, I was, I was on a trivia. I was, we were at a trivia night on a cruise ship with me and my friend wesley, and they asked how many hands are in the in the, how many bones are in the human hand?
Speaker 2:So, of course, me being an orthopedic surgeon, I was like well, are they counting the carpus bones? Because that's in the wrist? Is that really the hand? Or do they count the sesamoid bones in the thumb? Like, what do they mean, are you know? So I got all over analytical and I'm sure there's plenty of people who are trivia veterans who were just like there's 27 bones in the hand. So what I did was I went and counted every bone in my wrist and hand. I'm like, okay, okay, all right, 26. And I named every bone in my hand and I remember all of them. I just can't count very well. You know, they don't teach counting in medical school Slightly alarming.
Speaker 1:Which was the bone that you missed, Caleb?
Speaker 2:No, I didn't miss any bones, I just literally didn't count, right.
Speaker 1:That's what I'm saying, I see.
Speaker 2:Yeah, I didn't miss any. Like I went back and was like yeah, I just counted wrong.
Speaker 1:Yeah, we shamed you pretty hard for the rest of that cruise.
Speaker 2:Yeah, and now the whole world knows. So there's that. I guess I have to quit my job now.
Speaker 1:Yeah.
Speaker 2:Well, yeah, at least nobody can hurt you with this information later, right?
Speaker 2:Well, I guess when it's out. There it's out. Yeah, this has been another humiliating fractured facts. Join us next time.
Speaker 2:So another common problem that people have when they're sleeping is sleep apnea. I think at this point a lot of people have heard of this but maybe aren't sure exactly what it means, which you could be going to bed and getting eight or nine hours of sleep and you still wake up feeling exhausted, like you tossed and turned all night long and didn't get any rest whatsoever. A very common culprit, especially in men and women, is sleep apnea, and there's a couple of different subtypes, but we're going to talk about obstructive sleep apnea, meaning the airway is getting blocked while you're sleeping, whether it be for a very short amount of time, even in seconds, versus long amounts of time. Usually, if it's a long amount of time, you wake up. Your body wakes yourself up because you're choking or you can't breathe, and so your brain wakes up because you're having some sort of stimulus that you have to return your airway to normal.
Speaker 2:Snoring, gasping for air during sleep, excessive daytime drowsiness, even if you got lots of sleep or even just stopping breathing can all be signs that you might have sleep apnea. Generally it's, I think. Generally a lot of people think, oh, that's for obese people, only obese people have sleep apnea, which is not necessarily true at all. You can definitely see it and if you're diagnosed with obesity you may have a higher risk for it. But you can see it in people without obesity as well Me myself. I have a very large neck and a large neck circumference, or a lot of redundant tissues in your soft palate or other parts of the anatomy inside your larynx, inside the airway, can contribute to sleep apnea too, even if you're not meeting criteria for obesity. I think a lot of people actually feel stigmatized when they're diagnosed with sleep apnea.
Speaker 1:Yeah, I think so.
Speaker 2:At least I did. I have sleep. I have obstructive sleep apnea and I was a little bit embarrassed when I was told and I came to realize that was stupid. That's just ridiculous, but it was there nonetheless.
Speaker 1:Sure, I also remember a funny time when we were traveling from Europe back to the States or something and we had to declare your sleep apnea device as a carry-on or whatever, and they called you up to pre-board the plane because they thought it was like some severe medical.
Speaker 2:Oh yeah, nicole is really fastidious when it comes to travel. She takes everything very seriously. If someone says there's a form that has to be filled out, nicole's filling out that form and she's going to do everything by the book because she's not going to leave anything to chance. And so she found out I think we were in Norway or I don't remember where we were connecting somewhere, and so she registered that I had a CPAP machine and so we're waiting to board this plane and they call me up. They call my name over the speaker. We're in Oslo at the airport and I go up there like hey, what's, what's going on? They're like you can board now. And I look back at my wife and my friends who are waiting and I was like wave, goodbye. I was like why?
Speaker 2:Apparently, I had some sort of medical exemption to board early because I have sleep apnea. I don't know if that was a miscommunication lost in translation, but that was a pretty funny story. But I think a lot of people are really hesitant to get tested because it used to be you had to go to a sleep lab. You actually have to go somewhere, go to sleep, which, let's face it, most people can't sleep in a sleep lab productively. But there's actually been a really big increase in the rise of home studies, where you hook up some stuff at home, you sleep in your bed, you sleep with this electronic monitoring system for three or four nights and they can diagnose you like that.
Speaker 2:That's how I did it. It and it changed my life. So I'm going to talk about that a little bit more later in the episode. So we'll move on from there. But if you're having excessive drowsiness and you have a lot of snoring or gasping for air or anything like that, I'd encourage you to at least ask your doctor about it and see if it's something that could be at least worked up.
Speaker 1:It's generally your bed partner who will notice it if you have like the gasping for air.
Speaker 2:Yeah, we'll talk about that a little bit later in another segment too. So we'll talk about that. That's a good story. Now it's time for lessons I learned in residency.
Speaker 1:Woo.
Speaker 2:So we've already been talking a lot about sleep. Actually, we've been talking and talking and talking. Probably everyone is asleep right now listening to this.
Speaker 1:Well, there you go, we achieved our goal.
Speaker 2:Well, if there's anything that we can add as a service is a sleep aid, so that's good at least. But I wanted to talk about sleep seriously and talk about my journey with sleep. I alluded to this a little bit before earlier that I had really poor sleep hygiene. I didn't take sleep seriously in college and med school. I stayed up all night studying, just cramming, and I didn't know that to consolidate learning and consolidating memory, sleep was so crucial. So I used to study all night before a test and it wasn't until later that I really learned the importance of really taking my sleep very seriously. So I think a lot of it did change in med school.
Speaker 2:But it really solidified in residency that I have to take my sleep really seriously because it's affecting my quality of life.
Speaker 2:It affects my performance and once I had the weight of patient care on my back I said I can't, this isn't an option. I have to take this really seriously because it's one thing to be yawning in class. It's another thing to be yawning in surgery and not being able to focus. Or if you've have to work a really long day at the hospital, then you can't go home because you're too tired to drive home or God forbid you're doing some sort of crucial procedure on a patient and you're drowsy. It's just not safe. So that made me take a really good look at the weight of not getting good enough sleep. Now, maybe not everyone has that in their life, but I'm hoping that some of the information we've talked about today can tell, can show you, that you could make some serious changes in your life and have an improvement in quality of life If you look at some of these habits we've talked about. But I wanted to ask Nicole to tell her story about my sleep apnea.
Speaker 1:Yes, all right. Well, I did not have good sleep hygiene up until probably last week, I don't know. I started just following Caleb's sleep schedule and that's actually very effective because he takes it seriously. But prior to that I would just stay up all night, probably until 2 or 3 am doing whatever, and then I would just sleep in later and I had a flexible remote position so I could start work at 10 am and it was no big deal. But yeah, with Caleb I would come to bed and I'd have to stumble my way through the dark to the bed because, as we've already established, he likes pitch blackness and he's a very light sleeper. So if I turned on a light I was going to wake him, and the wrath of Caleb is not something that you really want on you. I'm just kidding. He's actually quite nice and lovely.
Speaker 2:I've never hit anyone in my life want on you.
Speaker 1:I'm just kidding. He's actually quite nice and lovely.
Speaker 2:I've never hit anyone in my life, except for jujitsu. Like you choke people. There's no hitting in jujitsu. It's all breaking shoulders and choking people, and I've never choked my wife in my life either.
Speaker 1:No, anyway, I had to stumble my way through the dark to get to our bed and, like gingerly you know, find my way into bed, and I would have a hard time falling asleep because what I heard next to me was this awful sound of someone.
Speaker 2:You're not going to act this out. I was going to. I could see it. You're going to act it out, aren't you?
Speaker 1:I don't even know if I can do it justice, but just imagine somebody you love beside you and they're just making this horrible noise of Please, please, tell me you're watching this on video, not just audio.
Speaker 1:So it was terrible. It sounded like he would legit stop sleeping or stop breathing for several seconds and then gasp like a fish out of water and then take a breath and then sort of wheeze it out and then do it all over again. And every time he had that three-second pause where he was not breathing I was like I was listening. I'm like are you dead? Do I need to wake you up? I'm concerned. So it would affect my sleep too, because I was concerned my husband was about to die and I actually like him so I don't want him to die. So I kept trying to convince him yo, bro, like you got to go get this checked out.
Speaker 2:And he was like I think she did say yo bro.
Speaker 1:Yeah, I did Probably, but, as you refer to me, I am the queen of hyperbole, so he didn't take me seriously. So, ladies, one day what I did was I took my cell phone, I kept it dark, but I put the camera audio recording portion on and I just recorded him for a good two minutes of just his breathing while he was dead asleep, and I finally was like well, you don't believe me, but here's some evidence, bruh.
Speaker 2:I don't know what this personality change has been, but I'm thinking that our next episode should be on personality disorders. I have a lot of information about that I'm sure you do, or should I say multiple personality disorder.
Speaker 1:It's not even called that anymore. Caleb Jeez.
Speaker 2:I'm just going to let you write that episode and I'll just be here.
Speaker 1:All right.
Speaker 2:You may notice that Lessons I Learned in Residency has taken a little bit of a turn. You may notice that Lessons I Learned in Residency has taken a little bit of a turn. The last episode I made is the solemn monologue of great life lessons and now it's turned into Nicole just talking about how I snore. So big shift in the podcast. But really I think everyone can admit that everyone just wants to hear more Nicole, so I'm just letting her go.
Speaker 1:There you go, thank you. You're letting the full Nicole be unleashed. That might be a problem. Yeah, that's true, but anyway, you believed me when you heard this recording.
Speaker 2:Well, she played me the recording and I'm a doctor, believe it or not and I had listened to it. I was like, yep, that sounds like sleep apnea. So I got the test and, lo and behold, I have terrible sleep apnea Now. At this time, I should note, I weighed almost 300 pounds. I was in the middle of training to bench press 500 pounds. I was eating probably around 6,000 calories a day I think I calculated it and I was just training really hard, but I was real heavy.
Speaker 1:You looked like a refrigerator.
Speaker 2:I have been told that I look like a refrigerator, like just couldn't fit through doorways. So I'm told I don't know if that's more hyperbole, maybe I just thought I'm a resident, I'm working 100 hours a week. I just feel tired all the time. That's how you're supposed to feel? And lo and behold, that's not how you're supposed to feel, even if you are a resident. And once I got my CPAP machine CPAP, just briefly, that's continuous positive airway pressure machine, something that is a mask on your face that blows air to help keep your airway open. Probably most people have seen that but maybe didn't know exactly what it was doing. It's the pressures keeps the soft tissues at bay so that they're not closing up when you're sleeping Changed my life, just absolutely completely changed my life.
Speaker 2:And I think that's one of the reasons I take sleep so seriously, because I know what poor sleep quality can do and how it can just dramatically affect your mood, the quality of your work, your concentration, your learning, your motivation, your gym performance, everything. So I'm very grateful for Nicole for doing that and I'm ashamed to say I probably never would have believed her without the recording evidence. But here I am sheepishly telling you all that. So here we are Now. It's on tape forever, so she can tell me I was wrong and she was right.
Speaker 1:It's okay. This is a very rare incident, so we're reaching the end of the show.
Speaker 2:We had a good conversation about things that can negatively affect your sleep, and I think we talked about some really good, pretty easy to do strategies that can help your sleep too A lot of them that don't involve taking medication. So we'll just run down that briefly and we'll see if Nicole has anything to add at the very end. So we talked about sleep. It's very critical for your muscle repair, memory consolidation and hormone regulation, and it's essential to help heal from injuries, recover from surgeries and prevent injuries in the making.
Speaker 2:Sleep deprivation can increase your risk of chronic conditions like diabetes and other metabolic disorders and just general wear and tear injuries, and it can also impair your cognitive function and your mood. Establishing good sleep hygiene, like a consistent sleep schedule, creating a relaxing bedtime routine, minimizing alcohol before bed these can all really help with your sleep quality. You can supplement with things like magnesium and melatonin if you need to, but you should understand the risks and benefits and side effects. Benzodiazepines should be used very sparingly and with close consideration with a doctor, and you should think twice about using them as a sleep aid unless you've tried other methods and you consulted with someone who is keeping a close eye on you.
Speaker 2:Sleep apnea is a very serious condition and it's very common and unfortunately seems to be becoming more and more common. But it's becoming very easy to treat and it's becoming very easy to diagnose, with a lot less hassle and pain. So I'd encourage anybody out there to at least get it checked out, because it could change your life. Nicole, is there anything that you can think of that we didn't cover today?
Speaker 1:Please, for the love of all things that are good, don't mistake magnesium citrate for what was it that you recommend people maybe look into?
Speaker 2:Magnesium glycinate potentially.
Speaker 1:Yeah.
Speaker 2:I think that's probably a pretty good way to end the episode. Don't drink magnesium citrate before bed. Nicole, as always, it's a great pleasure to do this podcast with you. It's wonderful to do something I love so much with somebody so beautiful and talented as you. So thank you again for joining me here today. It's been a blast.
Speaker 1:Of course, dr Big Guy and, as I will repeat again a little later, talk shoulder to me.
Speaker 2:So today, why don't you try to make sleep a priority? And don't forget, be humble, be happy and be healthy. I'll see you next time. Hey, listeners, If you're enjoying the podcast, don't forget to like, subscribe and leave a review on whatever platform you're tuning in from. Your support helps us reach more people and bring you even more great content. Also, be sure to follow me on social media at Dr Big Guy podcast for updates, behind the scenes content and more. Thanks for listening.
