Recommended Daily Dose
Recommended Daily Dose
Sleep is My Waking Passion with Dr. Alison Kole
We are back talking to our good friend, Dr. Alison Kole, Board Certified Sleep Medicine specialist and chronic insomniac turned sleep biohacker, who is on a mission to empower her listeners to improve their sleep naturally. We discuss her journey into Sleep Medicine, the importance of sleep in optimizing overall health and her Podcast, "Sleep Is My Waking Passion."
@askthesleepmd on all platforms
I want people to be able to be their own advocates, because for me it took like changing a job, really focusing on work-life balance, getting a regular schedule, really Decreasing that sympathetic overdrive I was in. I mean, I was like in fight-or-flight, if you will like, 24-7. I could not calm down. I was like an insane person and I really needed to be away for it, for it to work for me. Not everybody needs that, but this is 100 percent the right journey for me. You know, things evolve as they're meant to evolve is kind of my philosophy. So I learned a lot. I feel incredibly blessed to have had the career I had, the. I'm incredibly blessed to have had the opportunities that I have and I'm just going forward being like listen, at the end of this life I want to feel like I made an impact and for me I really. I still enjoy one-on-one patient care, but if I can impact Thousands or hundreds of thousands or millions of people by educating them, dude, that's a win. That's a win, isn't it like refreshing? And it really the conversations that you have. Sometimes you actually end up learning Things about yourself sometimes, things like, at least in my neck of the woods, with doing sleep, like I always prided myself and feeling like I was a really good sleep doc. I was like I really do a bang-up job, like I'm proud of myself, like I I put out quality work and I feel confident about that. And then I started talking to so many different people who are either in academics or just people who are in private practice but are academically minded, like myself in sleep, and I'm like boom, my world has just expanded. The amount of reading I'm doing, going to conferences, getting different insights into how people practice, what's the newest and greatest, and feeling confident with the newest and greatest things, like in medications, particularly in rare disease, like narcolepsy and i-h, where I really had.
Speaker 1:I've always enjoyed taking care of those patients. But you, because it's rare, you kind of have limited exposure. It's sort of that, that unicorn that you find that you can really but you know, evolve treatment for them. But at the same time it's like I can treat you but there's so many new things coming down the pike and you want to feel confident and comfortable about what you're doing and really kind of know what are people's experience with all this stuff and getting that opportunity. You know I can honestly say it was, it's been the best thing for me to transition out of what I was doing.
Speaker 1:You know I I do miss bedside clinical care quite a bit, um, but really in the sleep arena, you know. So I'm sure you I mean, if you're Doing hd and all that, I don't know how you guys had it during cove but I mean we, the whole first round, we kept on doing that thing that you do, where you're like, oh, we need to restrict fluids, and I never really agreed with that. I was like, no, these people are like sweating and febrile, they probably need more fluids, but because of their hypoxemia we're trying to do that like minimize fluids thing and inevitably with like a row of people with renal failure, I'm like, uh yeah, could have predicted that happening. Then we got smarter a bit, you know.
Speaker 2:Having a bit. You know, we we're like the episode on northeast and we were giving people Psythromycin. We're getting vitamin c, we're giving a magnesium black one oh we were getting black for a short period of time Ivermectin, uh, calitra, which is an old hiv drug, um you know. So we definitely learned a lot through that. But, by the way, that was an excellent intro, I think, to the start of our podcast.
Speaker 3:So we are gonna start the show by uh clit and once again you have to fix your collar, fix it, it's crooked.
Speaker 2:Come on, why you put, why you bring it.
Speaker 1:And look at you nerds with your set the scopes around your neck.
Speaker 3:Actually.
Speaker 1:Medicine doctors, right, the surgeons never have that and the medical the jibber guys ever joke about that.
Speaker 3:And trading it was always like they never use it.
Speaker 2:I might even sure clinton knows how to use it anymore, do you? I took a fish or fries To the yellow one.
Speaker 1:That's the one in s2. You don't hear that s4.
Speaker 2:I do a lot of great time maneuvers and all my patients Thank you.
Speaker 3:Are you done, doctor Suraj?
Speaker 2:I'm done. I'm done, go, go for infectious disease extraordinary.
Speaker 3:I'm dr Clinton Coleman. Welcome back to recommend a daily dose. We have an amazing guest today, dr Allison Cole. She's board certified sleep pulmonary and critical care physician. She says she is a chronic insomniac turned sleep bio hacker.
Speaker 2:That sounds cool, I like that.
Speaker 3:She's also the host of a podcast. Sleep is my waking passion. Welcome to the show, so welcome.
Speaker 1:Thank you so much for having me. I was Blissfully honored that you guys remembered who the heck I was and invited me to come on. I think it's super cool to chat about all things medicine and and it's so refreshing to see other people kind of venturing out and do another stuff besides what we do during the day. Very cool stuff.
Speaker 2:No, you're right, and uh, you know we want to know about your story, but you know you hit the nail on the head there with doing other things. I think this idea of side, when we talk about all time Side gigs, entrepreneurship, you know we do consulting, we do some media stuff, and so tell us a little bit about your journey. You, you have us. I think you went to Columbia right Then and then from there you ended up. We actually all were fortunate to work together for a short period of time, a very long ago, when I had more hair had hair in cladding.
Speaker 2:Didn't have to color his, but those days.
Speaker 3:I'll tell you a funny story.
Speaker 1:It's our guest. No, no, no, I don't hear the story. Go ahead, all right.
Speaker 3:So when I first started getting gray hair, I had my hair in my beard, so I thought it was cool to try and dye my hair. You ever dyed your hair and look out, see how ridiculous you look I look like everyone can tell yeah, everyone knows.
Speaker 1:Did you get that hair club? Not hair club for men, what's that one?
Speaker 2:The oh, you're talking just for men, that's what it was. Yeah, I answer that question a little too fast, but yeah.
Speaker 1:Oh man, I think you both look fabulous. We're aging gracefully, as they say, right.
Speaker 2:Allison, tell us what you've been up to since you know. We saw you initially when you were um an angle. Angle would oh yeah, yeah, yeah.
Speaker 1:So, um, just for clarification, I went to undergrad. I was a barnard grad and then I took off and I went to Tufts in Boston and then I ended up out on the west coast and did all my training at cedar sign. I actually and it was really thanks to Perry young she was a ruby to mine and we became really tight in med school and she was from SoCal. So it was a completely spontaneous Conversation with her she encouraged me to go out there and interview. I interviewed and I was like, oh my goodness, it's sunny all the time and I'm across the street from a mall and I just, you know, I saw a celebrity kind of yelling at a paparazzi and I was like this is magical, I need to come here and they let they just buy. Complete happenstance, I happen to get in.
Speaker 1:And so I was this Jersey transplant in Los Angeles and I was there all through internal medicine poem crit, yeah and then I worked. I came back. My dad had some health issues at that time, so I came back, took a job with someone I really wanted. I don't know if you guys ever experienced this, but like when I first finished poem crit fellowship at least I kind of felt like that imposter, a little bit like I'm okay, I'm passing things I've. You know I'm in this point that I'm like yeah or different I felt that probably the first five I wanted, almost 10 years like.
Speaker 1:You have to put in a time to feel validated right, so I really felt insecure, like I was like, can I really do this as an attending, you know?
Speaker 1:And so I was like, alright, I'm gonna. They had offered me an actual sleep position In the fellowship program because I, you know, they were saying, listen, if you're interested, come stay. That that time it was still veryo Santiago. He he retired used to call him Papa Santiago. So Papa Santiago had encouraged me to do it and, like my dad, I just was like you know what, let me. I need to be around my family right now and I need to feel like I could actually do this as an attending. So I found a job in the Marstown area and I work with the gentlemen who had split off from his group. And you know, first and foremost, that's kind of a hint like why did this person suddenly break off from their group? And what I came to realize is that just the model of medicine was a little bit more progressive in California. They had like Kaiser models and they were more organized and things were like sort of Groups were starting to form and it was less of the individual private practitioner.
Speaker 2:I'm sure is kind of a lot and that's changing to now, but for a long time was one of the last bastions of small independent practices, right?
Speaker 1:Exactly exactly. So at that time this was before everything started getting organized, so he had gone out on his own, he had hired someone, he needed someone else. So I interviewed with him. He seemed like a nice person and I was like I was new. I was like, alright, you know, let me try this out. So I had a two-year contract, which I honored, and this person, you know, really was a pulmonologist. But what I realized was that my role really was to allow him to do a lot more sleep medicine and we were gonna take over the poem crit responsibilities and at that time they didn't have closed ICU's or anything. So you know, it was again a very traditional old-school way things used to run.
Speaker 1:Yeah how Jersey ran for a long time. After a lot of parts of the country weren't running that way anymore, and you know it. It I was on call like 50% of a month and it was not a situation that was sustainable.
Speaker 2:Yeah, exactly.
Speaker 1:Yeah, and I just was like this is really not what I want to do forever and Literally I made a phone call and I called a Papa S. I said you know, papa Santiago? Of course they didn't call him that, but I was like so, very like, you know, talk to me about sleep. I really the one thing I have to say is as challenging a role as that first job was. I I learned a lot and I also came to appreciate sleep medicine on a level I didn't really understand before and and it was almost like that that, okay, now I can be. I figured out I could be a pulmonologist, I figured out you could do critical care, but the sleep piece was like this nebulous, like oh, I just don't know enough about it. And we did it in our fellowship. We, we had a sleep clinic and everything. But you know how it is like. Until you get that in-depth knowledge or you can really spend time on it, you just don't know.
Speaker 2:What the public awareness wasn't there, right like? Sleep is like all the rage these days, and I mean that in a very positive way, but Ten years ago people didn't really understand how important so true.
Speaker 1:And it was like all sleep, with sleep apnea too, and you're kind of like it's not really, but I didn't know what to look for, you know. So it's literally a phone call changed my life. He's like can you be here in June? And I was like, yes, and I was just like I'm piece and out, I'm going to do a sleep fellowship. And it was glorious and I'll, for multiple reasons.
Speaker 1:Yes, I was learning sleep and I was really into it, and I literally just came back this weekend from the sleep American American Academy of Sleep Medicine sleep disruptors meeting and it was really a Reunion. I was there with Vicente Santiago and Valcocho, hey guys, and those are two of my sleep co-fellows and I've not stopped talking to them since we were in sleep fellowship. So over a decade we've had this like tech stream where we're sharing ideas, going back and forth, just being in each other's lives. So I met some really cool people. But for me, yes, aside from the sleep you have to understand, think about this for the first time for an entire Year, the only call I really took was self-imposed because I wanted to keep up my critical care skills, so I did some moonlighting at another hospital just so I could, you know, be teaching and spending time with residents and fellows and still keeping that skill set. That's it. I did nothing for a year other than sleep fellowship I it was like a nine to five gig basically.
Speaker 3:You find it weird that critical care and sleep are like their hand-in-hand. I mean, I understand why pulmonologists going to sleep medicine, but it seems like polar opposites right? Critical care You're dealing with a whole different level of acuity and then you have to like slow it down to treat someone with a sleep disorder.
Speaker 2:Yeah, the feedback on that, can you do sleep fellowship like in primary care, or you have to do neurologists. I know some neurologists who do sleep right.
Speaker 1:Clinton, you're absolutely right. So internal medicine, sleep now. Family practice sleep, neurology sleep. There's psych sleep. I even met a gentleman who is cardiology sleep. So now there's a lot.
Speaker 1:It's like a subspecialty within specialty or you don't even have to do a specialty to do it. I think I think you know there's certain things that certain specialties, if you subspecialize and sleep you bring to the table. Like psych is very strong in the Cognitive therapy. They understand the intimate relationship between your mood and that I think that neurologists bring to the table that expertise in EEG reading. They often because a lot of central disorders of hypersomalins I alluded to them, narcolepsy and adiopathic hypersomnia are things that may come to a neurologist attention sooner before. And pulmonologists there is utility to that when you're talking about Advanced modes of ventilation, being really comfortable with anything from CPAP, a pap by pap, asv, you know non-invasive ventilators, these are things that pulmonologists deal with all the time so that you know neuromuscular disease with respiratory muscle weakness. So so I think we all lend ourselves to a certain skill set and that's one of the things I really love about sleep is that it kind of there's this intersection amongst specialties even, and we all sleep.
Speaker 1:Plus, clinton, you had alluded to it. It's very different than critical care, right? So the time I did in sleep fellowship actually just gave me this break from the. I mean, like I said, I was on call 50% of a month. Yeah, like you're incredibly busy, there's no time to breathe, and sometimes you need that space where you actually have time to like, breathe, reflect, figure out what you Want to do in the next stages of your life. And Some people are not into that slowness. Sleep may not be interesting to them. I found it fascinating and I also, honestly, was really rewarding to help someone with a sleep disorder and you're like I don't have to talk to you about, like cancer or you know, in stage of life Issues that occur and like the ICU.
Speaker 1:You know that it's all relevant is what I'm saying, but some of it's a little bit more challenging and I just kind of liked the pad on the back, if you will.
Speaker 2:Remind me after you did sleep, is that when you came back?
Speaker 1:That is when I came back and that is when I my very first job coming out of sleep fellowship Now is a seasoned, seasoned, quote-unquote pulmonary critical care doc and sleep doctor was to Englewood, and that's where I met you, gentlemen, did you drive like a?
Speaker 2:white car.
Speaker 1:I'm just all coming back to me. Oh my goodness, I have no idea why I.
Speaker 3:Wait, I can see him in the parking lot.
Speaker 2:We had this question about something, probably, and I remember you had this white car, I, I could, you and my maybe I make this up. Is that my correct?
Speaker 1:I have, I still have a Ford Mustang convertible. I knew it, I'm convenient car to have a New Jersey in the winter.
Speaker 3:That was my baby.
Speaker 1:Still have it. You know when I first drove it in wood.
Speaker 2:I saw the same car I had from like Red and Seen fellowship and there they were, like this is for attending's only. I'm like no, I honestly, this is actually my car Attending today. They almost didn't let me in Upgraded. So you did pulmonary critical care and you know, we always saw by people Because we're all probably the same stage of our careers, but what was it that, well, tells what you did there. I think you've done entrepreneurial things, you know, and that's what we love Really talking to physicians. I think anyone out there really just becomes inspiring to hear about people doing so many different things. In the old days, which was not long ago, it was kind of like you know, you come out of fellowship, you hang up a shingle and you do the same thing for 40 years, you know, and then right and then maybe you have a little time to yourself.
Speaker 2:I think a lot of docs Don't find that Professionally or personally, you're worth right, and so a lot of people are doing and getting into a lot of different things for a lot of Different reasons. So tell us some of yours.
Speaker 1:Yeah, I mean I Transition out of the part with Englewood, which I shared with you a little bit, because, you know, I really, you know, had this opportunity, as a person who is young and female, to have an opportunity to build a sleep program and and so I took off to do that. I was like this is the coolest thing ever. And in my mind when I left for that job, I was like this is my dream job, this is what I want to do, I want to run a program, I want to build it, I want to do all these cool, cool things and and it was that way for a long time. And Then you just start through your experiences and I'm sure you guys, I'm, I'm no, I'm not preaching to the choir when I say this there's been a huge shift in just how medicine works in In 10 years, 15 year, like since we started it's it's it's it's been a monumental change in a very quick, short, you know, a short amount of time, and this is even pre COVID and Just how things, what the focus was, how many time, how much time you have for a patient visit, the responsibilities of do you really have that Infrastructure of that staff You're not cherry picking these staff. When you grow large organization, they sign you people. Some people are better than others. That means some of the work life balance kind of goes out the window and and I found myself spending more time just seeing the patient and feeling as though I was overextending myself and less time on program building and Really figuring out interesting ways to manage an entire patient population, which is ultimately why I started out doing what I was doing. I thought I'd have that opportunity and I didn't feel like there was really room built in to make that happen.
Speaker 1:And Then COVID happened, obviously, and I call you know it. Was it all? Covid did, truth be told, and at least for me it was an accelerated process that had already been brewing. It's not like I wasn't feeling a certain way, it's just that then all of a sudden it's the Northeast. You guys know just as well as I did. I mean you know my hospital. We had a hundred people on ventilators. I mean we're using ventilators like that are like used for MRI. Machines are never geared to an ARDS patient. I mean we were going old school because we had no equipment you know they were using.
Speaker 2:The PB is like the whole drama of it all right one mask that we would have to wear If we keep a brown paper bag we walk around with the mask and yeah, totally, you know.
Speaker 1:We found creative ways to sort of survive that experience. Really snarky sense of humor, as we know.
Speaker 1:You know you got a laugh when you're crying inside, you know and a lot of really, really solid relationships were forged during that time, just amongst you know, being in the ICU and Really getting close with my ID peers and the nurses and another colleagues and everything. So there was good that came out of it. But it also, you know when, when you're thrust into the situation where, at least for me, my reflection was these are people that never thought a million years that this was how it was gonna go down. You know, and yet you never know when your time is gonna come, and I really started to feel For lack of a better term a little bit selfish.
Speaker 1:I was like I'm I give so much of my. I was giving like a hundred and fifty percent Everybody else. There was nothing left for me and maybe a fraction left even for my family, and at this time I had toddlers, so I literally had my mom being like when are you coming home? And I'm like when I get done and to have little kids that want to like hug mommy and I'm like don't touch mommy. Mommy Touched cove it, mommy needs to shower now and just that whole, you know psychology.
Speaker 2:I stay in the basement. I'm sure it's the same thing you know, or I should. Did you work in covered, or you actually took a little break?
Speaker 3:I work, we actually in our house. We have a different wing.
Speaker 1:You.
Speaker 2:Walk the door so.
Speaker 3:I can't know my son's older. So I can imagine having toddlers and explain to them that you know but now we just walk around with COVID all over our clothes and we now we're like whatever, I'm just gonna pick my booger and I'm fine.
Speaker 1:But you know, it was just a reflection period for me and I, I really truly like, came out of that going okay, now I'm gonna start advocating for myself. Now I'm noticing that that whole idea that we are taught throughout our training, right, post bono, it don't do that, it's okay, finish this and then you can do that. You'll be happy when you know all of that like it's the next step. It's the next step. Well, now we're attending like what's the next step? Right? So I started to advocate for myself and I started to say listen, I, I think I'd like to cut my hours down. Can I focus more on things that I enjoy, like the administrative part of the sleep program? Can I build that out? And it just was.
Speaker 1:My goals were not aligned with my organization at least that was my perception and I tried for about a year or so to try to make some of those changes. Once the kind of the dust settled and I no longer needed to do like as deep a COVID call situation and I just found my personality changing. Like I felt like I didn't really enjoy patient care anymore. I felt like I was too snippy with folks. I was like this is not me. I'm like a happy person, like where am I? What's happening? This is not any person that I recognize.
Speaker 2:I'm so glad you mentioned that because that is, I think, exceedingly important and and A delayed graphic as things are whole eyes were taught like just keep studying and keep Working, you know, and so and have fun later. And then I think all of us at some stage, you know, became impatient and then you start viewing patients instead of like a privilege to work with them, instead of they're looking as a burden, you know, and then you realize this is really affecting your personality and your mental well-being. So we appreciate you talking about that, you know, I mean yeah, I mean, I think it's really important.
Speaker 1:Yeah, I mean I and, and for me, like, literally, I'm not, I'm not even this. For me, this is like I got to the point where I'd be on rounds. I go to the hospital Dr Cole's here to save the day, march in, take care of my ICU patients, do this. Round up a have a break. I would find the quietest place. They had two little tiny rooms. They, I mean I mean they were smaller than my bathroom, like that's how small they were. They had a little desk with a computer. Right, it's in there, shut the door, because it's the only way to have privacy. Sometimes I would just like spontaneously find myself crying. Other times I would just stare in a space and I'd be like, what do I want to do? Is this it like? Is this, is this it like I like?
Speaker 1:Every time I try to do, make a change or advocate for myself, nobody seems to be appreciative that this is like for me. It's a big deal to extend myself this way. I'm not a person who admits defeat. I'm trying to admit defeat here, like I can't do this anymore and nobody seems to really take me seriously. And there's something about, there's something to resilience. There's something to saying to yourself I refuse to accept that this is the way it's gonna be forever. I'm not happy with the situation, but I also know that there's some part of me that won't give up. I just I refuse to give up. But that not giving up to me was like feeling like I use the analogy of like Hang on the side of a cliff by your fingernails, like I'm like what, what am I? How am I gonna hold on here?
Speaker 1:And it was a podcast. It was the sleep is my waking passion podcast. I spoke to about it with my husband. I'm like I don't know what I need. I don't know how to make this happen. I don't know anybody else who's really doing this, or at least I, you know.
Speaker 1:It felt so overwhelming that, you know, I just didn't have time to process at all and I just decided that that was what I was going to pursue. I didn't have a backup plan. I mean, you got a podcast, aren't free, right? You got to start thinking about how you're gonna, you know, monetize or how you're going to make a living and everything. And I and I thought to myself gee, this telemedicine thing is really a thing, and I've never built a program that's purely telemedicine. Do I think I could do it? Well, I don't know, but maybe I'll try.
Speaker 1:And so it was one of those things where I just decided it was time for a break and I just needed some time to think about it and I finished out my call cycle. I was given the opportunity to sort of really spend some quality time with the family, take a little time off, really process. I take care of myself and, for those listening that, there's no shame in admitting that sometimes you talk to a therapist, sometimes you take anti-depressants. These are things that really helped me and I'm not shying away from that. We shouldn't be ashamed to talk about it in the healthcare field.
Speaker 1:So I'm gonna bring it up. Um, and you know, I really sort of got my headscarf on straight and then, through that experience, I was able to have time. So now I'm like searching social media. My friend Matt has a podcast. Let me talk to him, let me reach out here, let me do this, let me see what's on youtube. And you start doing research and then the idea was born, the. I put very specific parameters around goals I wanted to accomplish. So that was something that I learned early on. Like you can't just like go into the ether and not have a plan, but sometimes, when you don't know what the plan is, it's helpful to brainstorm and say what am I hoping to accomplish in the next month, or in the next three months, or in the next six months, or in the next year?
Speaker 2:Did you do this on your own? I hear a lot about like career coaches, even physicians Hiring or utilizing career coaches. It doesn't normally in our psyche and how we think about looking. You know I made it to the top here.
Speaker 1:I'm triple board certified you know, but now there's actually.
Speaker 2:There could be more I don't have to be stuck where I am now. But how did I feel like what you did takes a lot of courage and a lot of physicians. I feel like you know, okay, well, I have a job now and I have a family, and so how did you make? I mean, did you utilize any help or was this all self self? You know here's retrospective, inward thinking and inward looking or did you utilize Any kind? Of external forces.
Speaker 1:I would say the external forces. Believe me, when you start doing things like this or you start trolling around, you know Like the internet knows things, so they start like populating you with messages. I did go through a program run by a woman called Julie Santiago and it was really about. What struck me was it was basically like are you a career woman who's burning out? Like, have you burnt out? What does that look like? How do you address it?
Speaker 1:So I really went through a burnout program, but it wasn't geared toward physicians or anything, it was just general. It was very expensive, but I felt like it was an investment within myself and and that's what I chose to do, and it does help that I, you know, have a husband. So I'm like, hey, guess what Girlfriend's taking a break? You can be paying the bails more, thank you. So it did help to have someone to that I felt like I had a safety net, like there was somebody else bringing income and I didn't have to do it all on my own.
Speaker 1:But that program is where I learned to really think about first of all, just to heal first, to give myself that time to heal and not just jump into something because I wanted to escape my feelings, which I think sometimes, if you're have a tendency to be a go-getter and you feel like you got to accomplish things, and then there's Sometimes you just don't get a chance to process your emotions all that well and I think I've been going heavy pretty much my entire life and it was just time to be like, oh Right, a little growing up to do you know, just in terms of healing how I felt and how I got to my plate and actually, to be honest with you, also, taking ownership like how did I contribute?
Speaker 1:Like I didn't have good boundaries, um, I kept saying yes to everything but I should have said no, like just little things that we don't think about. But taking ownership of where I fit into the paradigm. And you know, I tell people all the time I'm like listen, create the boundaries now, because it's really hard when you don't have any, to start putting guardrails around yourself, because people don't like it. They want the old version of you. That's what they're used to people don't like.
Speaker 2:Yeah, there's someone who's saying I'll take that, I'll be on that committee, I'll take this responsibility, I'll teach students, I'll teach the resident Right, I hear you. So that that that's, that's um.
Speaker 3:Yeah, there's a, there's an art form to saying no, so I'm glad that you found it. It looks like you found your passion. I want to get into the podcast.
Speaker 1:Yeah, please.
Speaker 3:I think for you it probably serves more than one purpose, as far as you know an outlet for you and creative outlet, but also Uh service as like an education form, because I know, as a primary care doctor, I'm pretty bad at sleeping, discussing sleep, you know like if someone says I have trouble sleeping, like if you tried melatonin and that's what stops, right. So I we really don't Learn it very well in our in medical school. Um but it is really important for you know, optimizing health and stuff.
Speaker 2:So let's, let's get into that like what do you say middle-aged man, who you may have just met?
Speaker 3:middle-aged.
Speaker 2:Yeah, comes to you and tells you he snores a little bit at night. He's been told by his wife and, um, he wakes up cranky a little bit, and when he wakes up at night, you know this is a common issue, right? So I mean, I mean so a how do you get the word out there? And then be you know what, give us some sleep tips and and pearls, if you will, because, um, as I've gotten, you know, past the 40 and 45 year old threshold, man, I am really realizing I don't sleep like I used to, and I'm realizing it more and more, and like anyone else out there, uh, how important sleep is for everything, right?
Speaker 1:Yeah, I mean whatever it is.
Speaker 2:So I'm telling there are.
Speaker 1:So there's so much to unpack here. So I'll do my best. But you know, clinton, you commented that we don't get a lot of this education. We totally don't, and it almost seems like, in a way, it's like they don't want you to know. Important sleep is because when you're going through med school, Stuff.
Speaker 3:It kind of feels like you know they don't want you to know that.
Speaker 1:What's that?
Speaker 3:I said maybe we just don't know how important it is. You know, it seems like there's been a I think uh sarasha alluded to this of a revolution in and sleep and sleep education.
Speaker 1:Correct. So I think you know it's. First of all, it needs to be emphasized more in medical schools, which it was not, and again, I think part of it was that our sleep was never prioritized when we were in training. You know, it was like if you're left in the dark you can't focus on it.
Speaker 2:It was a bad day of honor. I worked all night and you know I was before the 80 hour work week so we didn't have night float, it was you work all day, you work all night, you work the next day and maybe you leave whenever you're done. You know, and it was a bad day of honor that I had half an hour of sleep. I had an hour of sleep.
Speaker 1:Right, exactly. So what we're coming to find, just in terms of, like the literature on even sleep deprivation, is that it really affects multiple, multiple organ systems, right, and we're also learning from circadian science that all of our organ systems actually have somewhat of a circadian approach. So, even like our digestion, you know, when you're asleep it's supposed to be restorative. So we see, this is why, when we wake up and we're not sleeping well, we may have cognitive impairment or immune system doesn't function as well, and then there's a ton of a slew of cardiovascular risk associated Right, we have high blood pressure, stroke, myocardial infarction, congestive heart failure, atrial fibrillation, so cardiac arrhythmias. So there's a lot of things that are not good if we're really not getting, you know consistently Ask your friend how about the effects on the bladder?
Speaker 1:So that's very interesting, because how?
Speaker 2:many times do you wake up in the morning? I know Dr Urie is a real thing, right, so that's a real thing. Yeah, I wake up twice.
Speaker 1:Yeah.
Speaker 1:How I've experienced how I teach it and I you know forgive me if it's not perfect science, but how I understand it. Basically is that you know if you are having, particularly if it's associated with sleep disorder, breathing sleep apnea, which I'm about to talk to you about in a second, 20, about a quarter of men at all come or all lifetime are going to be at increased risk. Women it's about 9% premenopausal. It goes up to the same risk as men as their postmenopausal. So right out the gate you got a 25% chance roughly of developing sleep apnea at the course of your lifetime.
Speaker 2:But for peeing, for example, what we see is that if you that across all people, so because I'm learning more and more we always thought that someone with a bull neck and very thick or wide necks or conference. But I feel like more and more again asking for a friend some of us that are of normal BMI and have normal necks or conferences that BMI is not normal.
Speaker 3:Come on, have you seen data?
Speaker 1:So I'm just saying generally speaking across the population.
Speaker 1:So if you were looking, it's as the most recent study that was looking at the just general global worldwide assessment of sleep apnea, and this is mild all the way to severe. So we're talking about even more mild cases. It's estimated that a billion people in the world have sleep apnea and what we know is that phenotypes right, you're talking about a phenotype Obese, no neck, looks like snowman, if you will, a bowling ball on top of a bigger bowling ball kind of situation thick neck, as you described, some of those very sleepy sleeping all the time, snoring, stopping breathing, gasping, all those typical sort of things that we look at for sleep apnea. That is just but one phenotype, that's just one type of patient. But, especially if you're getting into South Asian, asian, african American, hispanic, when you're talking about the underserved, the minority population, there is a actually there's significant sleep apnea populations. In fact, it's higher than Caucasians when compared, and what we know is that and I'll tell you this from personal experience. Plus, we know people may not the next circumference issue that we always talk about with like stop being, and that's like one of the common ways that we screen for sleep apnea, and I'm sure you probably have to do this for all your people that are going in surgeries and stuff. But like the stop being questionnaire, the next size may not be maybe completely inaccurate.
Speaker 1:If you're female, premenopausal versus postmenopausal makes a difference. You can be thin. Females don't even have to snore. They may still have sleep disorder. Breathing Women are more commonly going to say, hey, I have insomnia, difficulty sleeping, than men are. Doesn't mean that men won't complain of insomnia, but it's more common in the ladies. Sometimes it has to do with your jaw. Sometimes it's really a family history thing. I've caught a ton of people who are sort of a normal body mass index, may not have a big neck, may not obviously have it, but you know, mom has it, dad, grandpa they didn't check back then but grandpa snored. They may have had some of the other issues hypertension, high cholesterol, diabetes. Those are some really common things that we associate with sleep apnea and I'll test them and we will find significant sleep apnea. I mean I've had people that soaking wet. They've got to be barely 100 pounds and be a thin Asian male, not a super small jaw. They look okay from the outside, boom, terrible sleep apnea. So you just never know.
Speaker 1:It's one of those things like if you're going to go back to that patient that you mentioned, that middle-aged patient just asking who may get up a couple of times to pee at night, for example, if you were having obstructive events at night. If you have untreated sleep apnea right, what's happening? Well, it's a relaxation of the air. This is the most common type of sleep apnea. So I'm kind of generalizing this.
Speaker 1:Speak of obstructive sleep apnea and just call it sleep apnea. But if you're having upper airway relaxation right, and that obstruction can be multiple places, anywhere from nasal all the way back, commonly it's going to be the tongue rolling back, closing off the airway. But that's not the whole piece of the puzzle. Okay, so if you have an upper airway relaxation muscle issue, right, and you're, even if it doesn't close off completely, if you're having at least a 3% drop in your oxygen levels, that your body may and again, I would imagine that you might see it more profoundly in someone who's more severe drops in oxygen levels right, not what we're coming to learn is that your airway could close off 30 times an hour, that severe sleep apnea.
Speaker 1:Maybe your O2 satinator, your lowest oxygen saturation, points 90%. Well, is that the same as a person who drops to 60% and has an AHI of 30? I would argue no. I think those are two phenotypes that we're dealing with. Somebody is getting much more hypoxemic, you know, and I think that might have, you know, worse implications potentially. That's what we're looking at. I mean, there may be data. I can't tell you that I know for sure, but I know these are things that are actively being studied. Like you know, there's other parameters.
Speaker 3:But when most of us think of sleep apnea, as far as severity, we think of apnea episodes we don't think of as a late, not a late, but not as an expert. We think of how many times just stop breathing. You don't think of the hypoxia associated with it.
Speaker 1:So and that's these are the things that we're actively studying in the sleep medicine world and I'm fascinated by because I've always suspected I'm like it seems like that person with the real low oxygen levels is there's something more severe about that person than the other person and that may have clinical significance. And they're going to look into that because I do think drops in oxygen levels and also, like you know, what's your heart rate response to that Some people have a bigger heart rate response, other people not it implies that there's a little bit more, you know, autonomic sympathetic nervous system activation, which might be worse for you in the long run.
Speaker 3:And I think we downplay the, the car, the long-term cardiac effects, right, I tend to see a lot of sleep apnea. I wouldn't say see a lot of sleep apnea, but part of the secondary work of hypertension is, you know, really I'll sleep apnea. So that's where I run into all of these patients who have who look like normal people have underlying sleep apnea, so I think it's worth an exploration.
Speaker 1:I really do. I'm like because it's low hanging fruit, like you know. It's like okay, you've got a problem with your breathing, let's fix it, as opposed to adding multiple. You know, because and sometimes that's where I catch them is they're on three medications for their blood pressure already. And I'm like, okay, and they're like coming to me because, oh, it's not really working. And you know, I don't think the arenal aureus stenosis or whatever workups happen in the back story to figure that out. You know, you're just sitting there going okay, well, what else is it? You know? But it wouldn't be nice if I see them from the get go, or even, ideally, if we could figure out are they having these subtle symptoms. If there was a way and this is what they're actively studying if there was a way to predict someone's going to be at a higher risk for high blood pressure based on something they haven't developed it yet, but certain parameters that might suggest sleep apnea, I think that's really fascinating research.
Speaker 2:Can you talk us through like, for instance, now like diagnosis and then let's put a hypothetical middle-aged male who wears nice shirts, like you know and then possible treatment options? But first and foremost, are you referring patients that you would suspect to an inpatient sleep lab or at the at home monitoring?
Speaker 1:is as that adequate for diagnosis of OSA.
Speaker 1:That is a great question so I do want to answer. You asked about nocturia. We didn't quite get to it, so I want to answer that first. But the nocturia, the frequency of urination, if you're having big drops in your oxygen levels, if what happens is that's a stress on the heart, right, the heart's going to sense that it's. You know, there's hypoxemia there, so it will. It's almost like it sort of releases hormones that make you have to pee. So that's just where I wanted that's my cursory understanding is it basically has to. It's almost like a transient heart failure piece. It's like, hey, you need to. It's almost like it's it's your body telling you like to have a diuretic effect, basically, and that wakes you up when you have to pee. Yeah, so it's. It's crazy when you think about stuff like that. But getting back to your point in terms of how we would diagnose it, so you know, in the there is the doctor answer and then there is what really rules the world, which is insurance answer. So I'm we're getting a bit into the weeds here, in my opinion, because which I don't mind doing, but it is, and again, this is just a dr Cole opinion but I'm very concerned that insurance does a bit too much dictating of how we Actually do our jobs. I do understand from the flip side, from a utilization management perspective, that if a physician is incentivized to have their own lab and fill that lab with tons of patients and the testing that they're Offering the in lab sleep study is very expensive and they're just milling people through the sleep lab, there is a profit to be made, and so you do need people who say is this an appropriate use of Limited resources? So there is an argument to be made on that side and I'm sure that's where the insurance plans would come in. But basically, if I had to wave a magic wand, what I'm looking at is if I really think your low probability of having sleep apnea theoretically I should be allowed to put you in the sleep lab and Based on that because the sleep lab is going to really eliminate Some of the downfalls of home sleep testing, which is an accuracy, particularly for people may have mild disease it's really the gold standard.
Speaker 1:Okay, so I'd rather have an in lab, but many insurance plans may say, listen, if you suspect sleep apnea, they have to have a home test. And so you know the home tests really vary in accuracy. But the limit the accuracy goes down when you're talking about very mild sleep apnea and there can be slight night-to-night Variability. For example, if I gave you a beer and told you go to sleep and you fell asleep on your back, I may have a certain number. If you are sober and sleeping on your side, I may get a different result. So there are some dependencies here and you can tease some of that information out.
Speaker 1:If you're not doing a home test, like if you're actually in the lab the flip side of the lab is then I hook you up to like 30 electrodes. You know there's all sorts of bands and wires all over you and I'm telling you to go to sleep with someone staring at you that you've never met before, that my that's called the first night effect and that's real. So some people might not do a lot with that. So there's a little bit of give-and-take here about what we need to do. But generally speaking, if I was suspicious I would start off with a home test, because most insurance pens will let me pass, go and do a home sleep study. That may change in the future, but that's where we're at right now. And then if it was negative and I really was concerned, I would pursue further testing.
Speaker 1:Ideally, ideally everyone get a second test. But you know, I really have that discussion with the patient because, for example, for insomnia, difficulty sleeping, either difficulty falling asleep or difficulty maintaining sleep, when, when I'm looking at that, it really kind of depends on what description you're giving. But again, like I said, some people they're just gonna say, well, I have trouble sleeping, doc, but they're gonna look thin, they're gonna have a good airway, they're gonna have a Malin potty one airway. They're gonna. That's their only complaint. Oh, my husband never says I snore, I don't know what you're talking about. I feel okay, I don't know why. I'm just, you know, I'm just generally not able to sleep at night. This is a classic thin Woman going through menopause. I can't tell you many people, these folks of these I've seen and I learned my lesson because I actually had a thin woman and I was like I really don't think this lady needs a sleep study. And I am telling you, her dentist did a sleep study. I've found that she had sleep apnea gave her.
Speaker 3:Because what? How does someone who specializes in sleep medicine as a pulmonary feel about dentists and as.
Speaker 1:You know, well, that's another, yeah treating with jaw devices and.
Speaker 1:I actually am very, very supportive of it because there's like over 10 years worth of literature that really supports that it could be helpful. Is it gonna work in every patient? No, and it depends on the severity of the patient. You know, if I don't really think I'm gonna get a good response, let's say they have an AHR of 100. I mean, if I reduce you by 50%, which is the average, right, if I give you an AHR 50, I guess that's better, but it's still pretty bad. Like what am I doing? You're still severe, right. Or I may have that patient who's like docalism, I really want to get an oral appliance and I'm like, yes, but your neck is like 24 inches and like moving your jaw forward, is that really gonna take care of the problem? But you'd be surprised. There are some people, even in the severe category, who may get a decent response from it in terms of, like dentists Just ordering test willy-nilly.
Speaker 1:I Believe it's really important for us to collaborate. There is a role for collaboration between dentists and sleep physicians. In fact, I'd like to see more of that because, especially for your more mild patients, you may really have a shot at getting some pretty good control of their disease and they may not want to wear a mask. You know masks. It really depends on who you look at, which institution In terms of efficacy, because it can be all over the board and it's generally pretty bad. I'd say it probably works in about 60% of patients. And again, it also depends on are you looking at one year out or five years out, because that that compliance may fall Considerably and we're looking at ways to predict who's gonna be more compliant with CPAP than others.
Speaker 2:You know, and then she's are getting smaller and supposedly more comfortable, right unless that is that is true.
Speaker 1:I mean they have portable units. Now those are generally not covered by insurance but if you have a deeper pockets than some, you can spend, like I don't know, 900 ish dollars and you can get, you know, a travel unit and the masks are. They have a lot of innovation in terms of masks.
Speaker 2:So what about different styles and everything comment? What about this pacemaker?
Speaker 1:that they can insert. You're talking about the inspire, yeah so right now there's inspire therapy for obstructive sleep apnea. There is a different device called remedy for central sleep apnea.
Speaker 1:We're not gonna get into the weeds with that. It's very new but the inspire therapy has been out now. It's probably been around a decade or so. I remember back in Englewood I was speaking to a thoracic surgeon who asked me about it and at that time they were very, very strict with who they rolled out inspire therapy to, meaning now you can get trained, you can become an inspire center. It's a lot easier than it was a decade ago but that's viable for patients with severe sleep apnea.
Speaker 1:It used to be that there was very specific criteria. Like you couldn't really be too, too obese, like I think you had a body mass index of like 32 or below. Sometimes it was 35 or below, based on some European data. Your AHI had a range I think the cap was around 65 in terms of severity and they would do something called a drug-induced sleep endoscopy. That's a procedure where they put you to sleep with anesthesia. They're giving you some Michael Jackson juice, a little propofol, lights adhesion, so you're not stopping breathe, they're just Lights adhesion, but they're mimicking what you might do with sleep. Right, you're relaxing the muscles and you're watching how the airway closes and if it was felt that your airway really showed Demonstrates that the tongue is really rolling back and kind of closing off your airway, then you'd be an appropriate candidate. The rules are looser now. You can have a higher BMI, I think.
Speaker 1:The AHI and I was like to a hundred. I'd like to see some outcome state. I'm sure they have them because the FDA approved them changing this protocol. I'd like to see if it still is effective for patients who have some of those who are really on the edges of being very, very severe. But at the same time it's just kind of like you use something if you can. The battery life is around 11 years.
Speaker 1:It's. You know, it's a smaller device. I actually Show in telltime. I'm telling you a huge nerd. Here you go. This is what it looks like. I'm holding it in my hand, okay, but that goes in a pacemaker pocket and it for the right patient it can be very Efficacious. Like we see, the goal here is to get them in the mild range. Really that's where they got positive data. But if you get them to it's, it's possible to resolve sleep apnea in the right patient too. So it's definitely something. I was one of the folks that helped to start the Inspire program at my previous organization. I felt so strongly it was necessary, and people are gonna go and get it anyway, so you may as well jump on the train and and see if we can keep those patients in house was and what about like Less invasive measures or over the counter stuff like nasal strips?
Speaker 2:I always hear this catchy thing on the radio, a ZIPA or something you know. Oh okay, All right.
Speaker 1:So I would say, okay, says the ZIPA. God, I hope these companies don't start hating on me.
Speaker 2:Um, let me or blame clean, no problem but the ZIPA.
Speaker 1:I just have personally not had any patients really be happy about that particular Product, so I would say it wouldn't be something I'd highly recommend. That is feedback from patients ZIPA people.
Speaker 2:For the marketing purposes. They have a great jingle. So I mean you know yeah, they do, I agree.
Speaker 1:And then there's something called the snore Rx. My friend, dr Val, turned me on to that and I've used that for some patients, the key with some of the over-the-counter Devices. They basically just move your jaw forward a little bit right. But a lot of them, like the snore Rx to use for an example, it literally just it's like a device. You, it's a boiling bite device. You make your own mold, essentially, and then you adjust it, so you kind of click it forward and then it keeps your bottom jaw forward Just in a little bit.
Speaker 1:It's not going to be as severe, let's say, is what you get with a dentist. It's not, as you know, molded to your teeth or as small, it's a little bit bulkier a device, yeah, but they can be okay in a certain patient. But if you grind your teeth, I say be very careful and talk to your dentist because remember, that's a lateral movement, right, brux's, if you're grinding your teeth, a lot of these over-the-counter devices don't allow for that movement. So if you're moving your jaw forward, but it's fixed, you're kind of like grinding. Anyway, you could actually kind of some people felt that their teeth got loose and stuff, so it could be doing some damage. So you just got to be careful. But in the right patient it could be helpful and helping with snoring, just keeping your jaw in a more optimal position. The breathe right strips my husband uses them. I don't know if I'm allowed to talk about that.
Speaker 2:No, go fine, Don't talk about him. I was considering buying some other day on Amazon.
Speaker 1:Yeah, so he, he has a little nasal valve incompetence, meaning that if you sniff Sometimes your nostrils kind of collapse in. That's an indicator the little valve in your nose may not be working properly. Oh, you have it.
Speaker 2:I have it I just saw it yeah oh my god your nose clock.
Speaker 1:Yeah, totally. If you think about stenting open the nose right, you're just flailing. You're just trying to keep the passage open. If you could breathe better through your nose, that tends to reduce upper airway resistance a little bit it's like a.
Speaker 1:It's like a built-in humidifier, if you will right. You got the little hairs and the cilia and all that, so that helps you breathe a little bit better if you can breathe your nose. It's just less upper airway resistance. It tends to be beneficial to you to breathe through your nose. So in that case it could be helpful and I know if he could breathe through his nose and he sleeps on his side.
Speaker 2:We're good to go, so you mentioned sleeping your side, so that's part of the. I think the last part we want to talk about was sleep hygiene. But do you recommend that people, uh, sleep on the side? Do you recommend like pillows so they're staying on their side? No fall backs.
Speaker 1:I think ultimately, a lot of people kind of know like, hey, my, my significant other says that if I'm on my side I seem to be okay. I always like to check. I want to know because be keep in mind, it's very difficult to stay in one position for eight hours, like I start off on my right side. My husband tells me all the time I end up on my back. I have no clue, I'm sleeping right, but I do end up on my back. It's very difficult. Plus, the people who stay on one side. They often complain of shoulder discomfort.
Speaker 1:So they make these different gadgets so that, like, if you roll onto your back, some of them will jiggle. There's one called the night balance from respironics, where it kind of vibrate to remind you to move over to your side without bothering you. They make belts to keep you in one position. Can you imagine strapping something your back? I have recommended it.
Speaker 1:I had a patient who was blind legally blind, and that was he couldn't really use any of the other gadgets, so he used a belt to keep him on his side. It worked really well for him. He used that in addition to a c-pap. Um, so it I would really. If somebody's really complaining. I want to test them and really see what's my hypothesis. Are they better on their side? And sometimes I've proved.
Speaker 1:I had a patient who really we did side therapy and oral appliance Boom, sleep apnea went away and that's, he couldn't tolerate a mask because that's what we did and it worked, so we stuck with it. So it's different strokes for different folks. Basically it's it's, and that's what I really like about sleep too is we're moving in a direction to try to get as personalized as we can, and that is, and remember, everybody cares about their sleep. Now, right, you said it in the beginning, so we're doing all these like commercial devices. Right, you have your aura ring and your what you know, your fitbit and your apple watch and all these parameters, and when you think about it, these Devices are really collecting a lot of data. So people are going in, it's being Depersonalized, and then they're actually trying to analyze data from millions of people to Establish any patterns that we see that might be helpful in managing people and maybe preventing disease in the future. So, very exciting.
Speaker 3:Well, how do you approach as a insomniac and biohacker, how do you approach insomnia? I mean, I, I have the whole sleep hygiene and you know.
Speaker 1:Yeah, I need you know that's a loaded question, because in two minutes hygiene alone is not going to work. Ok, but in two minutes, what I would tell you is not going to work. Focus on your behaviors. A regular wake up time is huge. Seven days a week, regular wake up time. Go to bed when you're seven days a week.
Speaker 3:I can't sleep A week.
Speaker 1:Keep your basically establish a routine. It is so, so helpful.
Speaker 2:I got into my routine with my kids, so I should your routine, you're looking at your phone in the middle of the night and I'm guessing.
Speaker 3:No, right, I started reading a miracle morning. Have you heard about that book?
Speaker 1:I have not. Should I be checking that out?
Speaker 3:Yeah, it's good, it's a I'm reading the audio version obviously OK.
Speaker 1:Me, because I always had trouble waking up.
Speaker 3:I mean I could not wake up, but I wake up tired and stuff like that. So it's more about you know being productive in the morning, you know how to wake up properly and just just being productive and act like being thankful for your friends and if you're a co host, your podcast, co host.
Speaker 1:Right and just really thankfulness goes a long way.
Speaker 2:Yeah, I tell them every day to thank you. You should be thankful. He knows me every day.
Speaker 3:Well, part of it is you know, journaling and you're waking up being grateful for something and planning out your day and it's done. I did it for a good week. I'm trying to get back onto it, but it's really helpful to wake to, to get good sleep and wake up. We feel like what about person?
Speaker 2:What is see? We're hitting you up with those random questions, but that's great. What's the optimum temperature a bedroom should be for sleep, oh shoot.
Speaker 1:There is some data on this. I want to say that it's 68 degrees, but we have it at 71 in my house.
Speaker 2:68 is nice. I like it cooler. Yeah, cold.
Speaker 1:Yeah, and they also. If you have a bed partner who disagrees, you can actually get a heated, or you can get a cooling or heated like mattress cover and they'll change the temperature so that a person who needs cooler can just kind of cool themselves and someone who needs it warmer, like you could. Compromise is what I'm saying it's funny.
Speaker 3:This is less about our audience and more about us now.
Speaker 1:We're talking about waking up to pee. Well, I would like to think of the temperature there you go.
Speaker 2:I would like to think our audience has the same questions, and so I think we could talk to you forever. We're going to have to have you back on, but how about one last question, which is what about a weighted blanket? I didn't say a teddy bear, but a weighted blanket. I've heard that these things are now being and my wife and I have to tell you I find it very Useful I was almost like cocooning yourself for having this way to blankets in the winter, and there's real data that supports it.
Speaker 1:Because when you think about it, we have these receptors on our skin and they kind of sense pressure and that can have a calming effect. I actually researched this because I was a gentleman from Quiet Mind. Reach out to me. That's a weighted pillow that he designed and he's like, hey, I want you to check this out. I'm like, oh, this is kind of quirky. Okay, cool, I'm into new gadgets, let me check it out. Let me check it out. And he made it, he designed it. He wanted to see about sleep because he found that he was sleeping better at ADHD. I use it to kind of calm my kids down and when I meditate I put it on my lap and I do find it somehow that connection helps, like it's almost like a physical sensation that helps keep me in the present, as opposed to my mind going around in different places so.
Speaker 1:I found it helpful for that. The weighted blanket, though, for people of difficulty sleeping, as long as you're not too hot underneath, that, it can be very helpful. Yeah, it can. There's actual data that supports it.
Speaker 3:I appreciate that we could talk to you forever. This is fine. We're going to have like a weekly episode.
Speaker 2:No, this hypothetical, this hypothetical middle aged guy really has gotten a lot of questions answered.
Speaker 1:So there you go. I think there's a. I think there's a homesleep apnea test in the future for this hypothetical middle aged guy. That's what I would do.
Speaker 3:I would be calling your office tomorrow.
Speaker 1:Yeah, I'm, I just to finish up, just so you are aware of what I'm doing now. So I did start a sleep telemedicine program and because I'm not part of a large group anymore and I'm just on my own, I partnered with a mental health company called Oak Health Center and it was just through my relationships with folks that I still know out in California. So they're based in California, but I always kept my California medical license all these years.
Speaker 1:So California, new Jersey and now I have one in Georgia, new York. What I will tell you in full transparency is that I'm a direct specialty care so people can submit to get reimbursed from their insurance. But I don't take insurance because you know what we try negotiating with Etna. They wanted to pay me ten dollars. Ten dollars.
Speaker 3:No sure, Not gas money. Dude and California.
Speaker 1:It's crazy, well, I mean it's a negotiating power. Yeah, I mean it's, it's, but that's. That's the situation that we're in in medicine.
Speaker 2:It's kind of messed up and a lot of talented people are going this route and you know, you explain the beginning of why you know and this idea and this is for another podcast but moral injury in medicine and really you know the old way of thinking that we have to everything for our patients at the expense of our own mental well-being and that's just not conducive for a long term career. So we really appreciate you sharing your journey. Can you tell us a little bit about where people might find you? Are listeners on social media, linkedin websites, et cetera.
Speaker 1:As of today, I actually launched a website. They're going to be more blog posts and it's going to be built out over time, but it's sort of my, my website person felt that we were ready to go go live and I'm really proud of it and you can. So you can get more information on ask the sleep mdcom, because my middle name is Sunkee, so ask the sleep mdcom. And you can also go to oak dot care, slash sleep. I do offer free 15 minute consultations, really just to triage, where I think you know I offer a lot of different services because different folks for you know different. You know what's what's that?
Speaker 1:Different strokes for different folks. Yes, I love that show.
Speaker 3:Great TV show. The world don't move to be like just one drum.
Speaker 1:So, in other words, like, if you're kind of curious about where you fit in, do you need a shorter console, a longer console? I will help you out with that, because I really try to practice holistic medicine and being a good steward, I don't want to just be pushing pills and stuff on people. So if I can fix you without medications, that's what I'm going to do and that's really what my services are geared toward. But yes, I'm happy to chat with you and, you know, make a.
Speaker 1:You can feel free to make an appointment with me if you want to see me in real time and see me with my services and I promise you I will. I will bring my A game and help you out.
Speaker 2:And so where can people find your podcast Like where are you? Apple.
Speaker 1:Spotify, youtube. Sleep is my waking passion.
Speaker 2:We love it, you know I feel like we had our own personal more than 50 minute evaluation by you, so we really there you go.
Speaker 3:Check us in the mail. Ten dollars is in the mail.
Speaker 2:No, but you know it was just so nice to reconnect after all this time and we've all gone different journeys but you know it's kind of like you come back together. So we're very happy to see you doing so well and doing such important work, because we try to always give our podcast light and joke around. But you know, clearly sleep and sleep disorders is a major issue, you know, for so many people, as you alluded to. You know talking over a potentially a billion people with some form of sleep apnea. So obviously it's inherently important to hear about more and more in the news and media and other health care providers. But I still think it's probably under studied and under, you know, publicized, not even just for the general public but even for health care providers.
Speaker 2:So you're doing an extremely valuable service and we appreciate it so much.
Speaker 1:That's the plan. I want people to be able to be their own advocates, because for me it took like changing a job, really focusing on work, life balance, getting a regular schedule, really decreasing that sympathetic overdrive I was in. I mean, I was like in fight or flight, if you will like 24 seven. I could not calm down. I was like an insane person and I really needed to be a way for it to work for me. Not everybody needs that, but this is 100 percent the right journey for me. And but things had to. You know, things evolve as they're meant to evolve. It's kind of my philosophy. So I learned a lot.
Speaker 1:I feel incredibly blessed to have had the career I had, the. I'm incredibly blessed to have had the opportunities that I have and I'm just going forward being like listen, at the end of this life I want to feel like I made an impact and for me I really. I still enjoy one on one patient care, but if I can impact thousands or hundreds of thousands or millions of people by educating them, dude, that's a win, that's a win. So you know that's what we're here to do and plus it's like fun. I'm really, really enjoying this. I had such a good chat with you guys.
Speaker 2:Oh well, your joy and what you're doing comes out in this podcast. We appreciate it so much. Dr Allison Cole thanks so much for coming on. Recommend daily dose with myself and my illustrious sidekick, dr Clinton Coleman. Please don't forget to rate, subscribe, listen, check out all of Dr Cole's. Her check out her podcast will include the social media handles when this comes out. Until next time, be well.