Sleeping Your Way to Success with Scott Baldridge, Sleep Medical Director at NeuroDiagnostic Laboratories

(Intro Narrator at 00:00:00) Today, we're talking to Sleep Medical Director Scott Baldridge about understanding why we sleep and why we need good sleep to be successful in life. You're listening to Joel Beasley, Modern CTO.

(Joel Beasley at 00:00:18) Yeah, let's do it. Why do we sleep? What are the purposes?

(Scott Baldridge at 00:00:22) Well, I usually say five good reasons. First one, we'll start with some common sense ones. Most of us who have tried to go without adequate sleep come to realize that it is as if in sleep we charge a battery, and if we don't charge it enough, we either run at half speed or we just run out of juice before the day's over. Going along with that electrical analogy, I call people's attention to if they've ever watched someone, particularly a small child in a car seat, fall asleep in the car. And what we see is as they get tired, they close their eyes and lean back.

(Scott Baldridge at 00:01:05) And as they start to enter sleep, their breathing becomes more regular. And then as they get into sleep, their head starts to do this. And as they get deeper into sleep, pretty soon they're hanging by their seatbelt. And what I'd like to highlight there is as we transition from awake to shallow sleep to deeper sleep, the muscles of our head and neck and shoulders and arms and legs all relax a little bit more and a little bit more. From a layman's perspective, you could imagine that as we drop the voltage going into our muscles, that allows us to push more energy into the charging of this theoretical battery.

(Scott Baldridge at 00:01:47) But I do like to take a moment to focus on this muscle relaxation because the second reason why we sleep is so that the body has an opportunity for growth, maintenance, and repair. And the most important change that occurs in sleep that allows that growth, maintenance, and repair is that the blood vessels—the muscles in the walls of the blood vessels—relax in sleep. That lowers the blood pressure but opens up the blood flow wide open. And this low pressure soaking watering system then allows us to flush the waste products and the garbage, the oxidizing chemicals and stuff, out of the tissue and bring the building blocks and the hormones in that then bring about that growth and maintenance and repair. It's interesting and important to focus—I don't know if anybody's ever heard of this thing called the blood-brain barrier, but as a protective mechanism against toxic chemicals getting into our brain while we're awake, it's as if the blood vessels in the brain are more tightly knit together.

(Scott Baldridge at 00:03:09) For that reason, yeah, we can get oxygen and sugar in, but the majority of the nutrients that need to be brought into the brain so we have what it takes to make the chemicals that fuel the brain, those have to be delivered into the brain and stockpiled during the night shift. And so it's very dependent on that vasodilation, that relaxation of the muscles of those vessels to the brain, which allows us to flush out the nervous system, the waste products from being biochemically very active during the daytime. There's a lot of chemicals that are left over that we need to flush out, and then that allows us to bring in the nutrients from which we build the neurotransmitters, the chemicals that fuel the brain biochemically.

(Joel Beasley at 00:04:01) So can I pause you there? Yeah, I want to make sure I'm tracking. So you've got the tube, and it cleans itself out, and so now you've got a clean tube, and then it uses that clean tube to send nutrients to the brain.

(Scott Baldridge at 00:04:14) Not necessarily that we clean it out. We just open it up and allow it to become more leaky, which then allows the fluid to come in and flush out the waste products. And that more leaky vessel allows us to transport bigger molecules into the brain, into the neurons of the brain, and those nutrients are what we make those neurotransmitters, those chemicals, out of.

(Joel Beasley at 00:04:42) So it's happening at the same time. It's both flushing the bad stuff and bringing in the good stuff at the same time.

(Scott Baldridge at 00:04:47) Yes, got it. But without vasodilation, the brain doesn't get fed and it doesn't get cleaned.

(Joel Beasley at 00:04:55) So at what point in your sleep phase do you get to that point?

(Scott Baldridge at 00:04:59) Once we enter sleep. Sleep is divided into stage one, stage two, stage three, and rapid eye movement. Stage one is really just a transition point. Stage two is really where we start to do that flushing and transporting of stuff in and out.

(Joel Beasley at 00:05:17) Okay, yeah. Sorry to interrupt you, but I've got three kids, and so when you gave that beautiful visual of the kids falling asleep, I see that in my rearview mirror on a daily basis.

(Scott Baldridge at 00:05:30) And we all have. And so I like to connect with patients with their real life experience. And so starting off with the battery and needing to get it charged, we've all tried to go without charging the battery. It doesn't work well. And we've all seen people falling asleep before our eyes. So we know for ourselves that this relaxation takes place, and carrying it to the internal mind's eye where we can visualize those blood vessels opening up, that's kind of why I use that lead in.

(Joel Beasley at 00:06:02) So why else do we sleep?

(Scott Baldridge at 00:06:04) So the third reason why we sleep: while we are awake, our mind is recording what's happening around us, what our senses tell us, and records what we ourselves are thinking and feeling emotionally. But it is in sleep, stage two of sleep, that we open up this temporary memory folder and sort through it and decide which of those moments in the day do we want to transfer to the long-term conscious memory banks. So in stage two, we are reviewing and selecting. In stage three, we take those selected moments of the day, relive them. We dream about what happened during the day, reliving that moment as we put it into the long-term conscious memory bank and etch it into the hard drive of our memory.

(Scott Baldridge at 00:07:02) So we process, select, and transfer key data that creates our long-term conscious memory. We do that in stage two and then stage three of sleep. Fourth reason why we sleep: rapid eye movement sleep. This is where we do our fantasy dreaming. I often tease that beyond just being a cool idea for movies, there's a purpose to it.

(Scott Baldridge at 00:07:31) Imagine that rapid eye movement sleep is the time and space where we can work through our emotions. I often give a silly vignette, but it carries the idea across to patients. Imagine I've got a neighbor that's not my favorite neighbor because he likes to take his dog poop and throw it over the wall into my backyard. The immature part of me gets very angry, frustrated by this, and it makes me want to gather it up, shove it in his mailbox, throw eggs at his car, and kick his dog. But because I'm trying to be a nice neighbor, I don't do that.

(Scott Baldridge at 00:08:17) I grit my teeth, I smile, I wave, and I hope that tomorrow he's going to be a better person. But when I get into my rapid eye movement sleep, my pent-up frustration from that moment has an opportunity to work itself out. And this opportunity to work through our emotions allows us as human beings to go through hard things and in the night become emotionally refreshed so in the morning I can wake up with faith and hope and courage to carry on.

(Scott Baldridge at 00:08:51) If I don't spend enough time in rapid eye movement sleep, I become emotionally overburdened, overwhelmed. My emotions build up to where they're very close to the surface, and either I'm tearful at the drop of a hat or I'm very reactionary, and I'll say or do things that I wouldn't do if I had better sleep and I was more emotionally grounded. This part of us understanding that as we transition into that rapid eye movement sleep so that we do not, like a dog in its dreams, be running in our bed or worse, get up and sleepwalk around the house—so that that does not occur, that's why the muscles relax the most in deep sleep. So it's necessary to understand there is purpose to this greater relaxation, but we'll come back to how that could bite us in relation to something else.

(Joel Beasley at 00:09:53) I've got questions. Can I jump in?

(Scott Baldridge at 00:09:56) Absolutely, alright.

(Joel Beasley at 00:09:58) Stage three, we relive, put things into long-term memory bank, but that is not dreaming.

(Scott Baldridge at 00:10:06) It is dreaming. It is dreaming, but we're dreaming concrete, real things that happened during the day. If you could watch, like sometimes in the movies you can see circuit boards and you see sparks flying down a wire and lighting a light up here and there—it is amazing how they've worked out that, let's take a person that likes playing a sport, and then let's do something easy. Like, I play basketball. So at the end of practice, my coach has me shoot 100 free throws to where I could shoot those free throws in the dark with my eyes closed. As I'm reliving that moment of practicing my free throws, not only is it being engraved on my conscious memory, but there are sparks that are flowing into my cerebellum, and that's how we build muscle memory. So this dreaming is concrete dreaming, but not only is it going into our memory so we can pull it back and remember it in the future, but it's going—some of it, if it's a muscle activity—into our cerebellum and being turned into an activity memory file. And when we want to do that activity, we can turn on that memory file, and it's like instinct that we can just go and we can shoot it without really thinking about it.

(Scott Baldridge at 00:11:28) So that muscle memory aspect is taking place in that stage three.

(Joel Beasley at 00:11:33) Does your body care? Will your body do all of these steps if it's a nap during the day versus a full-length sleep at night, or is it treated differently?

(Scott Baldridge at 00:11:41) That's a great question. To answer that question, we have to ask ourselves, what stages of sleep do we get into in that nap? Now, one of the things that's pathological that's called narcolepsy is a person who drops into REM sleep within less than eight minutes of falling asleep in a nap. Do we get into stage three very often during our naps? I don't really have a solid answer on that, but I suspect that we don't have very much time to open up the folder and select and then transfer.

(Scott Baldridge at 00:12:22) So we're probably only getting into stage two predominantly so that we can charge the battery enough for a quick charge and get up and have kind of a power nap.

(Joel Beasley at 00:12:33) And so do people iterate through the stages at varying intervals? Like, does it take different times for people to go through the stages?

(Scott Baldridge at 00:12:41) Yes. So it is normal for us to transition from wake to stage one to stage two, and then this idea of how do we break up our night into the different stages of sleep is called sleep architecture. I would tell you that it's considered normal to have six or less awakenings during the night. I would say that we do not always remember those awakenings because just because the mind gets into the awake mode does not mean that we are there long enough to turn on the recording device.

(Scott Baldridge at 00:13:23) So there is some amnesia of the final moments before we transition from wake to sleep, and there is some amnesia as we transition from sleep to wake. But having up to six fractures in our sleep where we come all the way awake is standard. Arousals are those moments when we transition from a deeper level of sleep into a shallower level of sleep, or just momentarily suspend or put static into the level of sleep that we're at. It's normal to have up to 15 arousals per hour of sleep, just quoting normal numbers. But maybe to better answer your question: we typically spend the majority of stage three of sleep in the first half of the night, and we typically spend the greatest amount of rapid eye movement sleep in the second half of the night.

(Scott Baldridge at 00:14:25) But it is normal to hit at least a short drink of rapid eye movement sleep within the first 90 to 120 minutes of initiating sleep.

(Joel Beasley at 00:14:37) So, I don't know—

(Scott Baldridge at 00:14:37) I don't know if that kind of answers your question.

(Joel Beasley at 00:14:39) I feel like maybe when we're hitting that in the first 90 minutes—there is, I'd say, twice a week maybe—I will fall asleep, I'll wake up thinking it's the morning, feel 100%, and I'll look at the clock and it'll have been like two hours. What's that? Why is that happening?

(Scott Baldridge at 00:15:02) It could be that something happened in your dream. Like, you hit that first little short drink of REM and something got you worked up enough that that aroused you all the way to awake. That'd be a guess.

(Joel Beasley at 00:15:18) Yeah. I love, as you're describing all of these things—just to bring you into my world, I have a wife, I have a five-year-old girl, a four-year-old boy, and a seven-month boy. And so when we're talking about sleeping through the night, it's like I laugh. I can't. It's kids. Yeah, I got small kids. I went on a trip for work to give this talk probably six weeks ago, and I was in a hotel by myself for the first time in like a year. And I slept through the whole night and I woke up feeling amazing, and my first thought was to pick up the phone and call my wife and tell her about it. But she's at home with three kids without me, and I pick up that phone and I'm like, not a smart move.

(Scott Baldridge at 00:16:03) I could be happy with you. She's going to trade places.

(Joel Beasley at 00:16:07) Yeah. But I did want to ask you—one of the things that my wife does, and it wakes me up, so it's like we're paired in the sense—is she'll stop breathing in her sleep for a minute. I'll wake up, I'll hear it, and I'll be like, "Hey." And then she'll wake up abruptly, kind of ticked off about it. And I was like, "You fell asleep, you weren't breathing or whatever," and it kind of freaked me out. What is that?

(Scott Baldridge at 00:16:31) That's what we're going to talk about as the most common medical condition that needs management related to sleep.

(Joel Beasley at 00:16:39) Alright.

(Scott Baldridge at 00:16:40) Yeah, we'll get to that in a few minutes. There. Okay, excellent, excellent. Leading question, but I got one more purpose for sleep left.

(Joel Beasley at 00:16:47) Let's do it.

(Scott Baldridge at 00:16:48) I tease there might be smarter people that could come up with more good reasons, but this is just me, Dr. Baldridge, coming up with my five best. So we've covered charging the battery, growth and repair maintenance, processing and creating lasting conscious memory, and processing emotion. Fifth one is this thing—the fancy name is called neurocreativity. So if I go, as I'm getting ready for bed, I've got a problem or a question or a concern in my mind.

(Scott Baldridge at 00:17:18) Then as I get into sleep, if I can get through with the four chores and I've got time left over at the end of the night where I do my rapid eye movement sleep, then I can open up my unabridged subconscious memory of my entire life. I can sort through it at light speed looking for the principles of wisdom that pertain to this question or this problem. And then using those principles, I can analyze that equation and try to come up with a solution. And that is what leads to us sometimes waking up at 3:00 in the morning going, "Ah, that's what I should do for this project or for this podcast or for this speech I'm going to give or whatever."

(Scott Baldridge at 00:18:00) But that synthesis that's taking place in our REM sleep after we finish working through our emotions is what brings out that solution. And because it is the product of ruminating thoughts in our rapid eye movement sleep, it is not part of our conscious memory. So if in those moments of insight, if we don't repeat it 10 times in our mind or put a word on a piece of paper in the dark on our nightstand, or if it's happening when we just wake up in the morning, if we don't jot down some little note, within an hour or two it's flown, because it was never part of our conscious memory. It was a byproduct of this neurocreativity that takes place in rapid eye movement sleep. How's that for cool?

(Joel Beasley at 00:19:06) Well, it makes me think, okay, well if the memory can exist but it's not committed to long-term, it's floating around in there—is it like a cell you could point to? Like, how does that work?

(Scott Baldridge at 00:19:21) That's part of the mystery of life. Like, this is getting metaphysical. I've heard of weighing a body while a person's near death and weighing it moments after they're dead, and it's lighter. Like, this metaphysical idea that there is a soul that is some kind of electromagnetic energy, and maybe those subconscious memories are written into that electromagnetic energy. I don't know.

(Scott Baldridge at 00:19:59) But this idea—I had this older gentleman. He's approaching 90. And he says, Scott, I am now having dreams about things when I'm a child that I had completely forgotten. But now that I dreamed it and I wake up, I do remember that now that it brought it back to my recollection. And it just helps us know that every moment of our life is somewhere engraven into us, into our soul, but our conscious memory is separate from that entire life experience.

(Scott Baldridge at 00:20:36) But sometimes we can access that entire life experience to get to the wisdom that we need to guide our decisions now. And I think that's like divine creation.

(Joel Beasley at 00:20:48) Yes. We've got a lot to talk about. So since we're on the metaphysical area, let's talk a little bit about that. When I was 11, I got hit by a car. They were going like 40, 50 miles an hour.

(Joel Beasley at 00:21:00) I was in a wheelchair for a year, broke a bunch of bones. When I came out of that whole experience, I remember what happened at the moment of me really getting hit. First of all, there was no pain, which was kind of beautiful in the sense that humans are really good at dying. We've been doing it for a long time. So I was like, oh, great. My body did something to flip off the pain switch. It definitely came on later when I woke up in the ambulance. But basically, the best way to describe it is, you know when you see in the movies and they'll relive the history of their life or they'll have this flashy moment. There was no bright light for me. But in the context of what you were talking about, the timeline review from start to finish or expansion of your life.

(Joel Beasley at 00:21:41) So I would say that the movies do the best job you could possibly do to try to explain it, but it wasn't exactly that, you know. But it was like that. Do you get what I'm saying? Like, it wasn't that, but it was like that. It was almost like it all happened, but in a condensed—it's almost like someone threw memory soup at my consciousness.

(Scott Baldridge at 00:22:05) And I will add in the other memory thing is I forget the name of the movie, but there's this movie about a dream within a dream within a dream.

(Joel Beasley at 00:22:14) Oh, Inception.

(Scott Baldridge at 00:22:15) Inception. Yeah. And so when we dream, we dream at 90 miles an hour. And that's why if we bounce out of our dream state into consciousness fast enough, we seem to remember an hour-long dream. But yet that was just the last few seconds before we bounced out so quickly that we still had the recollection of what we were dreaming.

(Scott Baldridge at 00:22:47) But we're dreaming at light speed.

(Joel Beasley at 00:22:49) Wow. When you were talking about we search through these files, I like consciousness. I was—I'm 35 just for an understanding of where I'm at in life. But I'd say in my late 20s is when I started really asking some questions, mid to late 20s, which pleasantly coincides with the formation of your frontal cortex. But when I started looking into what is—what we understand as a people about consciousness, I found that anesthesiologists were a general area that tended to deal a lot with that.

(Joel Beasley at 00:23:24) But I was so surprised at the lack of understanding that we as a species have of what consciousness actually is. Were you surprised when you started looking into this and you became a doctor?

(Scott Baldridge at 00:23:37) Yeah. And I think some of it is still a mystery to me because what drives my behavior in a situation, there's so much that I don't understand about why I do what I do. The one little piece of my consciousness that I am very aware of is this thing from psychology that's called transference. So if I have met a person in the past and had a good or bad experience, and then I meet a different person in the future that somehow consciously or subconsciously reminds me of that first person, I will transfer my feelings, good or bad, towards that new person. They haven't done anything to deserve either my love and adoration or my distrust and hate, but I transfer emotion to this new person because they subconsciously remind me of someone else, or I consciously allow them to remind me of somebody else.

(Scott Baldridge at 00:24:46) In my field of work, I use this because I tell every patient in my mind, once you come under my care, you are part of my family. So if you were my niece or grandchild or my uncle or my grandparent, I will try to do for you what I would do for my family member. And I intentionally try to allow positive transference to allow me to become emotionally engaged in doing my best for people. But this is, you know, this is a personal thing that I've kind of cultivated in myself. But we all do this subconsciously, this transference.

(Scott Baldridge at 00:25:27) And so we're not conscious of why we feel the way we do about whatever. There's so much. We're so deep that we don't even know how deep.

(Joel Beasley at 00:25:38) I'm taking notes, man. This is good. I'm going to—

(Scott Baldridge at 00:25:41) We can talk more. I mean, I love this stuff. And sleep medicine, I got drawn into it because I'd been a family doctor for years. And I came to realize little by little that what I was playing whack-a-mole with trying to improve were probably things that what was happening in sleep was driving. And if I didn't address what was happening in sleep, I was not having a lot of success helping people to become as healthy as I wanted to.

(Scott Baldridge at 00:26:11) And so that's what drove me to go back to a sleep medicine fellowship training program, like a residency for sleep medicine.

(Joel Beasley at 00:26:18) Mmhmm.

(Scott Baldridge at 00:26:18) And I was very thankful that I had the opportunity to go back and get trained. But I wanted to do that because I began to see that the three pillars of good health are good nutrition, good exercise, and good sleep. But if we don't get enough good sleep, we don't have the motivation to find, fix, and eat healthy food, and we don't have the nervous motivation to get up and move around and exercise. So I came to realize that the most important pillar of good health is sleep. And as I got into sleep medicine and I recognized these five purposes for sleep, I really became convinced that these things are why we sleep.

(Scott Baldridge at 00:27:06) And that's why I have to help people get good sleep. Because without those things, we cannot stay healthy, mind, body, and spirit.

(Joel Beasley at 00:27:15) I fully agree. Yeah. What's your job now today? Because I think I met the founder of the company, and then we had you on to talk. But what is the company?

(Joel Beasley at 00:27:25) What do you guys do today on a daily basis?

(Scott Baldridge at 00:27:28) So the company is called Neurodiagnostic Laboratories, and it has two main service lines, neurologic testing and sleep medicine testing and management of patients. And so I'm a sleep doctor, so I'm in service line number two. And as a sleep medicine physician and as the medical director, I'm the one that helps coach everyone on the sleep team how to play their roles very well so that we have a great team.

(Joel Beasley at 00:28:01) And so you will do those things, the sleep studies where people come in and sleep in the lab?

(Scott Baldridge at 00:28:05) So I interpret them. I get to read all the squiggles on the—now it's on a computer screen. It used to be on paper and pen, but I get to read all the squiggles to evaluate what's happening in sleep. But the sleep techs are the indispensable people who look into the chart, see what is needed for this patient. And when they come and spend the night in our house, they are the ones that hook them up with all the gadgetry that records the data.

(Scott Baldridge at 00:28:40) They're the ones that make sure that the data that's being recorded is clear enough and continuous enough so that we can really see into what's happening in the mind and body of this patient while they sleep. And they are the ones that do the initial highlighting of key events in that recorded data. And then I go back through it and make sure everything looks good, see if there's anything that got left out, and then I write the report that says, this is what we see, and this is what I would recommend based on what we see. And then I see patients when they're new patients. I see some of the patients for follow-up.

(Joel Beasley at 00:29:23) Let's talk about the experience I consistently have with my wife.

(Scott Baldridge at 00:29:27) So if we then very quickly say the three most common sleep problems that I'm aware of, number one, I don't allow myself enough time to sleep and recognizing that we do all this charging of the battery growth, maintenance, repair, processing of memory and creating conscious memory, processing of emotions, neuro-creativity. When we are newborns and infants, that's why we have to sleep at least 18 hours a day. We're growing and learning. Everything's new. Every experience is a new thing.

(Scott Baldridge at 00:30:04) So that's why we need to sleep so much of the 24-hour time frame. As we're getting close to kindergarten, we're usually weaned down to one nap. I can remember in kindergarten having a quiet time where you lay down with a blanket, and the teacher's hoping that you hold still and maybe go to sleep. But then as we go through the elementary school years, we still need at least 12 hours of sleep at night. And as we get into junior high, we're at that 10 to 12 hours of sleep at night.

(Scott Baldridge at 00:30:34) And even into high school and early 20s, we do best if we get eight to 10 hours of sleep. Consider that when I'm an adolescent, I'm growing quickly, I'm going through puberty, I'm going to school, and I'm getting all this stuff crammed into my head. And I'm getting into all sorts of new social situations, and I'm experiencing new feelings that come along with my maturing body. I need time to grow. I need time to process memory. I need time to process my feelings.

(Scott Baldridge at 00:31:07) So a lot of adolescents nowadays are only getting, you know, six hours of sleep because I got to get up early to get to school. And then after school, I've got sports or a part-time job, and I've got a social life. And pretty soon I don't allow myself enough time to sleep, to really get the work done that needs to be done in sleep as an adolescent. Understanding that the first half of the night is spent more on processing memory because I think evolutionarily, there were pieces of knowledge from yesterday that we needed to know for tomorrow so we could stay alive. So I think that's why God kind of organized the architecture of the sleep so we spend more time in the first half of the night processing the memory.

(Scott Baldridge at 00:31:53) And if we have time, we can process the emotion. But how many adolescents are suffering emotionally because they're not getting enough rapid eye movement sleep on the second half of their night? I think it's too many.

(Joel Beasley at 00:32:07) I was lucky because my schedule went like this. You know, several hours late to school. Get to school, fight with the attendance people about how I shouldn't get kicked out, then go home, sleep the afternoon away, wake up, have some dinner, play some video games, fall back asleep. I got a lot of sleep. My bed was my best friend going through high school.

(Joel Beasley at 00:32:33) Yeah.

(Scott Baldridge at 00:32:34) I can remember particularly during the wrestling season. I would get up early. I went to a thing called seminary before school, and then we'd go to school. School got out at 2:35, then I'd race home, do a paper route because I needed money. Then I'd take a nap, then I'd have wrestling practice, and then I'd stay up until midnight doing my homework.

(Scott Baldridge at 00:33:00) And then I'd get up at 5:45 the next day. And so I was getting this nap every afternoon before practice so that I could make up on some of those hours I missed at night. But I remember it being challenging to get enough sleep. I survived, but, you know, I might have been a little more emotionally stable had I gotten a little better sleep.

(Scott Baldridge at 00:33:22) But so most common problem around the world, all ages, not getting enough sleep. Adults, studies show that we need seven to nine hours in order to get the work of staying healthy done. And if we don't, if we're getting too little, we're not getting the work done. If we're needing more than that, it's probably indicating something is not healthy about us. So second most common sleep-related problem is transient insomnia.

(Scott Baldridge at 00:33:53) When I'm going through an episode or a chapter in my life when there's so much that I'm thinking about, external factors that I got so much on my mind that it's hard to shut my brain off and get to sleep, then I'm going to have an episode where I'm having a hard time falling asleep or staying asleep. But as those external stressors resolve themselves or as I adapt to those new environments that cause that stress, usually my sleep pattern will get back to normal. So for most healthy individuals, we have transient episodes of insomnia that get better on their own if we just practice good lifestyle. But the third most common problem that impacts sleep is a thing called sleep apnea. Now I often as I talk with people, and I don't know if it's appropriate to do this on a podcast, but—

(Joel Beasley at 00:34:47) Let's do it. Sign up to our YouTube, people.

(Scott Baldridge at 00:34:50) The word apnea is not English or Spanish or French or German. It's Greek. And if you break it into the parts of the word, the A by itself at the beginning means the absence of or to be without. And then the P-N-E is the root that means air or breath.

(Scott Baldridge at 00:35:13) So in Greek, a moment without breathing is an apnea. A similar event where I'm not getting enough air, the root in Greek that means not enough is hypo. So if I put hypo in front of P-N-E-A, it's pronounced hypopnea, but it means those moments when I'm not getting enough air. Now, of course, science, medicine, there's always definitions, right?

(Scott Baldridge at 00:35:43) So the technical definition of an apnea is compared to my normal breathing, air going in and out of my body. If there is a 90% reduction in airflow that lasts at least 10 seconds long, that is a pause in my breathing. That is a moment without air, an apnea. If there is a 30 to 90% reduction in airflow that lasts at least 10 seconds long and causes at least a three or 4% drop in my blood oxygen level. That's the technical definition of a hypopnea.

(Scott Baldridge at 00:36:22) But to the layman's terms, snoring is kind of evidence of hypopnea. It's happening because as my body is relaxing in sleep and the muscles of my tongue gravity are pulling them towards the back of my mouth and the muscles of what I call the McDonald's sign. So at the back, I tell my grandkids at the back of everyone's mouth, there's a McDonald's sign. And this edge of the soft palate and the uvula make up this M. And if the muscles of the soft palate relax enough in sleep, they're going to sag towards the back of my throat.

(Scott Baldridge at 00:37:09) And if the muscles of the upper part of my throat relax enough, particularly the part right behind where my tongue is, then that's going to cause the whole airway to collapse enough that pretty soon I'm not able to move enough air through there. If I pretend like I'm snoring and I pay attention to what I'm doing. What I'm doing is I'm allowing the back of my tongue to get close enough to the back of the roof of my mouth that the air movement is causing the tissue to vibrate. Just like wind causes the surface of water to get rippled, if I restrict the opening enough, pretty soon that movement of air is going to cause the soft tissue to ripple and I'm snoring. So heavy snoring is the sound of hypopnea, and pauses in snoring is the sound of apnea. Humans are not robots or computers, and so we don't do things exactly the same way every time.

(Scott Baldridge at 00:38:20) So for an adult to have between zero and five apneas or hypopneas per hour of sleep is normal. If it happens between five and 15 times an hour, that's mild, 15 to 30 is moderate, more than 30 times an hour is severe. When I first heard those numbers, I was thinking, wow, 30 times an hour, this guy must be almost dying in his sleep or something. But then I did some math and consider that in every minute, there are six 10-second intervals and there are 60 minutes in an hour. So every hour, I have 360 opportunities to breathe right or not breathe right.

(Scott Baldridge at 00:39:12) So what that brought me to realize is if having this happen as few times as five times an hour is enough to frustrate the purposes for sleep, sleep is really rather fragile. Now to wow you a little bit more, adults, we can get the work that we need done as long as we hold it down to under five. It's considered sleep apnea in children if it happens more than once an hour because they're growing so much. They're learning so much, and they have so many new emotions to deal with that more than once an hour is too much. That wows me.

(Joel Beasley at 00:40:01) What are the solutions?

(Scott Baldridge at 00:40:03) Well, if I just briefly—so the three things that contribute to me developing obstructive sleep apnea: how open is the back of my mouth to begin with? Just like we don't all look the same on the outside, we don't look the same on the inside. And this rating system is based on what does the back of my mouth look like if I open my mouth comfortably wide and breathe, just breathe slowly in and out. I'm not yawning. I'm not stretching the muscles at the back of my mouth.

(Scott Baldridge at 00:40:34) I'm just breathing. So some people call it a Mallampati score. There's other names for it, but how wide open is the back of my mouth? That's the first factor.

(Joel Beasley at 00:40:44) All right, put the thing up. I'll tell you what it is. I just did it.

(Scott Baldridge at 00:40:48) Let's see.

(Joel Beasley at 00:40:50) Oh, I'm on the class three or the—

(Scott Baldridge at 00:40:54) Okay. So if I can see all of the uvula, the hangy-down thing at the back of the mouth, that's a class one. If I can see at least half but not all, that's a class two. If I can see a quarter moon to a sliver moon of darkness on either side, that's a class three. And if when I open my mouth and breathe comfortably, I'm looking and all I see is the roof of my mouth and my tongue, that's a class four.

(Scott Baldridge at 00:41:17) Now, keeping that mental image in mind, the second factor: the normal relaxation of the body. Some people relax a little bit more in sleep than others. So maybe I've got a class two, but because my body relaxes more, the voltage drops more in my body than it does in someone else. I might still have so much relaxation of my tongue, soft palate, and the upper part of my throat that my airway is still falling enough that I can't move enough air to maintain my blood oxygen level at times throughout the night. And then the third factor is the age factor.

(Scott Baldridge at 00:41:53) Consider that the nerves in our body are like wires in a machine. And as the wires age, gradually, they do not carry as much electricity from the generator to the target muscle as they used to. And that's why maybe I had no problem with snoring when I was 15 or 25 or 35. But by the time I'm 45, I'm snoring a little bit on a regular night. And by the time I'm 55, I'm having frequent hypopnea.

(Scott Baldridge at 00:42:24) And by the time I'm 65, I'm having crazy bad sleep apnea. So there's an evolution of the problem based on time, as well as structure and function. And of course, I inherit the structure and the function from the blueprint that I get through my genes. So I basically inherit some of the risk factors for sleep apnea from my family.

(Joel Beasley at 00:42:49) Mm-hmm.

(Scott Baldridge at 00:42:50) And looking at the whole world in general, it seems that—in some parts of the world, this is me editorializing—but in some parts of the world, in order for me to live long enough to help my children have children, I had to have a sturdy enough body build to get through life. We do see that people with thicker muscles, thicker bones, and thicker necks are more likely to inherit the Mallampati three and Mallampati four anatomy. So if I want to walk through Walmart or walk through a church meeting or walk through any other large gathering of people, I could probably pick out with greater than 70% accuracy who's got or will get sleep apnea before they're age 50. Now, scary thing: when they've done population studies looking at what's the likelihood that people develop sleep apnea, these guys, if I live to 60, probably more than 90% of them get sleep apnea.

(Scott Baldridge at 00:44:00) These guys, by age 60, more than 70%. These guys, by age 60, more than 50%. And in good studies, if I reach the age of 60, my body mass index—my relationship between height and weight—is under 28. I have no high blood pressure, blood sugar, cholesterol. I have no heart problems, no congestive heart failure, no palpitations, regular heart rhythms.

(Scott Baldridge at 00:44:30) I've never had a heart attack or a stroke. I have no problems with anxiety or depression. My memory is crystal clear. I've got plenty of energy throughout the day. I'm not getting up to pee more than twice a night.

(Scott Baldridge at 00:44:42) And, again, my BMI is under 28. I'm a pretty healthy dude. I still have a greater than 30% chance of having sleep apnea even if I have a Mallampati one by age 60. So the prevalence or the incidence of sleep apnea is super common and very often not recognized until it's already moderate or severe. But I start to spout so much stuff.

(Joel Beasley at 00:45:13) That's why you're here. It's a talk show, man.

(Scott Baldridge at 00:45:16) If I was going to get up on a soapbox and talk about, hey, everybody, we need to realize that when we don't get enough air in our sleep, it causes—imagine when I'm awake, my conscious brain is controlling what I think about, what I do, and is recording those events so I can analyze them and create my memory of my day. Once I fall asleep, the conscious part of my brain is turned off, and the subconscious becomes my night watchman. The subconscious in psychology books and papers is referred to as the inner child because it thinks like a five-year-old. So to understand what this does to us on a gut level, I have to imagine: I'm in the dark, my eyes are closed, and the five-year-old in the back of my head is what's monitoring what's going on.

(Scott Baldridge at 00:46:13) If the muscles of my tongue and soft palate and throat relax so much that my airway is closing off, to the five-year-old in the back of my head, it feels like the boogeyman is reaching a hand from under my bed and is not letting me take a full breath or is clamping down so tight it's choking me out. That makes a five-year-old in the back of my head panic. If I was to be so cruel and do this experiment to my five-year-old—or I have a four-year-old grandson, he'll be five in November—but if I was to sneak into his bedroom in the dark and put my hand over his nose and mouth and not let him breathe, he is going to wake up flailing and kicking, trying to get air.

(Joel Beasley at 00:46:57) That's how Michelle wakes up, my wife.

(Scott Baldridge at 00:46:59) So every time we don't get enough air in our sleep, that five-year-old in the back of our head panics. That causes a surge in the release of adrenaline. The surge in adrenaline causes a surge in blood pressure and heart rate, causes vasoconstriction, kicks me out of the level of sleep I was at into a shallower level of sleep. When I get to that shallower level of sleep, more electricity gets to the muscles. I get more strength.

(Scott Baldridge at 00:47:25) My airway opens up. My brain says you're behind on your breathing. I take some deep breaths from my mouth because I'm behind, and then I'm going to try to simmer back down and get back into sleep again. And I could do this over and over again all night long. And sometimes I'm going to breathe so shallowly or pause in my breathing so long that that surge in adrenaline's going to cause me to wake up.

(Scott Baldridge at 00:47:48) And I'll wake up short of breath, and I won't know why. But every time we're doing this in our sleep, we're basically waterboarding our subconscious, and our subconscious can become afraid to fall asleep, afraid to sleep deeply. And if we understand that the mechanics of this is that our airway is collapsing, that helps us understand why the best long-term solution is to connect us to enough air pressure so it inflates our throat so that even if the muscles relax, it will not collapse. And so CPAP—many people have heard this thing, CPAP—but it's an abbreviation for continuous positive airway pressure. And by connecting me to something that can keep my upper throat inflated, then I can breathe throughout the night.

(Scott Baldridge at 00:48:46) No trouble. So I tell people often that subconscious part of our mind is not consciously, but subconsciously afraid that anything getting close to our nose and mouth in sleep could be the boogeyman. So initially, they're going to struggle to wear CPAP. Now what I've found very effective is if I tell these people, I want you to put your mask on and turn the pressure on while you're sitting up awake with the lights on and do this for an hour or two each evening. For the first few minutes, you're going to have to practice your yoga breathing.

(Scott Baldridge at 00:49:30) You're going to have to control how you breathe in and use your rib cage muscles and belly muscles to breathe out against the pressure, and then slowly breathe in and then slowly breathe out. But usually within five minutes or so, you're already getting the hang of it. And you can go back to watching TV or working on the computer or reading a book or listening to a book on tape or texting.

(Joel Beasley at 00:49:51) Listening to the podcast, man.

(Scott Baldridge at 00:49:52) Exactly. Yeah. But you could do this stuff. And while you're doing that, what you're doing is your conscious brain is willing yourself to do it while your subconscious is in the back seat of your mind. And hour by hour that you wear it while you're awake, gradually, that five-year-old has the courage to wear it through the dark.

(Scott Baldridge at 00:50:13) As we wear it through the dark through our sleep, pretty soon that five-year-old goes, when I wear this crazy thing, the boogeyman stays away. So I like this. So usually within a few months, we will subconsciously not want to go to sleep without it. Some people struggle longer. Sometimes it's because they have REM-predominant sleep apnea.

(Scott Baldridge at 00:50:40) So they have been more emotionally scarred by their pauses in their breathing because they're happening primarily just in their deepest sleep. Sometimes because maybe that five-year-old has been tortured for so many years, it's just not believing very quickly. But most people, if they take this strategy of wearing it while they're awake, they will get to where they do not want to sleep without it much faster. This is brilliant.

(Joel Beasley at 00:51:10) Yeah. God brought you here today to help Michelle, man. Because, look, she—all of those things are connecting in ways that I have yet to articulate because I'm just now experiencing it. But she'll often—not all the time, but a lot of the times—when she's waking up abruptly, she'll have had a nightmare.

(Scott Baldridge at 00:51:28) Yeah. Because when I'm holding my breath in my sleep, my subconscious mind is going to go to scary things because it's being scared. So I'm going to dream of drowning. I'm going to dream of a train that's got no brakes. I'm going to dream of a car that has no brakes.

(Scott Baldridge at 00:51:41) I'm going to dream of falling. I'm going to have these bad nightmare events where it's so scary that I'm catching my breath because I'm literally catching my breath.

(Joel Beasley at 00:51:51) And it's also another thing—small evidences that I'm seeing that are connecting to what you're saying—is she'll take her phone, and she knows that she doesn't want to scroll or put her phone away. But what she does is she just falls asleep scrolling through her phone. Like, I'll look over, and she'll be asleep like this. And I think what she's doing is she's just distracting herself enough to fall asleep.

(Scott Baldridge at 00:52:13) Yes. Because that five-year-old says, no. When you go to sleep, it's not pretty. The boogeyman comes for me every five minutes. Please don't go to sleep.

(Scott Baldridge at 00:52:23) I mean, that's what the subconscious is saying. And so the most common problem for persistent insomnia is sleep apnea because it makes us subconsciously not want to go to sleep.

(Joel Beasley at 00:52:38) I might go give her a hug after this because she's raising the kids and getting woken up and all this stuff. She gets it way harder than me. As far as what I should do on my side of things, should we go to a sleep doctor and talk about this as a situation?

(Joel Beasley at 00:52:54) She's doing it. She does it at least three times a week. Two times a week.

(Scott Baldridge at 00:52:57) Have I got five more minutes left of this?

(Joel Beasley at 00:53:00) We got as long as you want. Yeah.

(Scott Baldridge at 00:53:01) I want to cover something that's real important that many people don't realize. In our brain, we have brain and brain stem. We have sensors that measure the level of oxygen and the level of carbon dioxide. And together, they help us know how often and how deeply to breathe.

(Scott Baldridge at 00:53:20) But most people do not realize that we have oxygen sensors in our kidneys. Now, to understand the divine design here, the oxygen gets from my lungs to my kidneys as it's carried by the hemoglobin in the red blood cells. And in the kidneys, if the kidney is not getting enough oxygen, it's the only organ that can send a message, a hormone, to the bone marrow that says, hey, make a few more red cells for us. We need a little more delivery going on here.

(Scott Baldridge at 00:53:51) So this erythropoietin is sent from the kidneys to the bone marrow. The production of red blood cells requires iron, B6, B12, folate, and protein. But usually, the iron is the most limited resource. Now, the brain, in order to make the chemicals that fuel it during the day, during the night, it has to absorb iron, B12, folate, and protein. So when I develop this not breathing enough or often enough or deep enough in my sleep, normally—back up.

(Scott Baldridge at 00:54:30) Normally, the time when the oxygen is going to run low enough to kind of ring the bell to cause that erythropoietin to go to the bone marrow is when I'm engaged in anaerobic activities, strenuous physical activity, sprints, things where I'm really working the muscles so hard that I'm consuming the oxygen faster than I can breathe. So it turns into anaerobic exercise. But the other time that it naturally happens, all of us, because of the muscle relaxation in our body, we all breathe less often and less deeply in our sleep. So the normal time for us to lightly ring the bell and prompt the bone marrow to make just enough red cells to replace what we maybe used up, broke down during the daytime, is when we're in our sleep and maybe in our rapid eye movement sleep because that's when the body relaxes the most. But in normal healthy individuals, we're just going to kind of lightly ding that bell just once in a while.

(Scott Baldridge at 00:55:36) But once we develop sleep apnea, we're going to be ringing that bell loud and hard. So it's kind of sending a screaming loud signal to the bone marrow to make red blood cells. So not only is the disruption in my breathing causing repeated vasoconstriction, which is suspending the opportunity to flush out my brain and bring those iron, B12, folate, and protein into the brain, but I'm creating a requirement that I push as much resources into the production of red cells as possible so I can get enough oxygen to my kidneys. Now, in the hierarchy of demands for life, the highest requirement for survival from minute to minute is oxygen. If I don't get air for about a minute, I'm going to forget about almost everything else and start wondering how I can get another breath.

(Scott Baldridge at 00:56:41) Most of us, if we go two minutes without taking a breath, we're going to pass out. And if we go another five to seven minutes longer after that, a total of seven to nine minutes without breathing, things are going to start shutting down. So for survival, oxygen is a much higher requirement than being the smartest kid in the room. So when push comes to shove and there's limited resources, bone marrow's going to get first pick. So oftentimes, our ability to maintain wakefulness, our ability to maintain attention and focus, our ability to make the neurotransmitters so we can regulate our mood, our ability to make the neurotransmitters so we can make a good recording of what's happening throughout our day is going to be compromised by sleep apnea.

(Scott Baldridge at 00:57:36) And so when we were talking about what could I tell someone that could help them understand how their friends, their coworkers, they could live a better life and be more productive personally, at work, creativity-wise, we need to make sure that we're breathing right in our sleep because it impacts what's happening in our brain on a blood flow level, on a delivery of nutrients level, and on the level of processing memory and processing emotions. Can't stress that enough.

(Joel Beasley at 00:58:19) So you can have one of those abrupt waking-ups. It can happen once a week or twice a week, and you still have sleep apnea even though it's not happening—so it's not happening in the big expressive way so many times an hour. Let's make that clear for everybody. Right? You have these 360 opportunities, and you have to have a certain number within a certain time, but not every one of those moments is this big wake-up gasp, I-stop-breathing.

(Scott Baldridge at 00:58:44) Right. And that's why—and understanding the aging of the wiring system, it starts out very mild and very easy to not really even recognize it. In this handout that I didn't make, it was made by somebody smarter than me probably about 15, 20 years ago. But in it, it says 80% of people with obstructive sleep apnea snore loudly. I point out to people, that means 20% of them don't snore enough that anybody is making a deal out of it.

(Scott Baldridge at 00:59:17) So there's a lot of people out there that have unrecognized hypopnea predominant sleep apnea. And then the lesser condition that's less severe than that is what's called breathing related sleep disorder, where I'm not meeting criteria for apnea or hypopnea, but you can tell that there's a change in the graph of how my breathing's working. And when I'm not getting enough air, I will still get an arousal even though I'm not having a pause or I'm not having that three to 4% drop in my blood oxygen, but I could still be not breathing well enough that it's disrupting my sleep over and over again throughout the night. So that's breathing related sleep disorder. But these things are like on a spectrum. And there's normal, and then there's disruptions in sleep because of breathing.

(Scott Baldridge at 01:00:17) And then there's disruptions in sleep because of hypopnea and apnea.

(Joel Beasley at 01:00:22) What's the best multivitamin for sleep, or do you recommend just buying each of the important ones separately?

(Scott Baldridge at 01:00:29) I would recommend somebody—so if a patient comes in and they say, I'm feeling fatigued, that gives me permission to check B12 and folate. Iron, I could check B6. B6 deficiency is much less common. But even under a diagnosis code of fatigue, I could run all of those.

(Scott Baldridge at 01:00:58) And I could under a diagnosis code of sometimes I get tingles or not good feeling all the way out to the tips of my toes, I could use that as a diagnosis code to look into these things because they're relevant to how the brain is functioning and the nervous system's functioning. So I don't recommend that people just go hog wild. Now there's no harm in taking too much B12. We just pee out the extra.

(Scott Baldridge at 01:01:29) There's no harm in taking extra folate. We just pee it out. It's hard to get too much iron because there's a really good article in the Mayo Clinic proceedings, July 2021, that was titled Restless Leg Syndrome, A New Algorithm. But it cites some of the research about iron and iron absorption and so forth. And it basically says the research is showing that dosing iron more than once a day is counterproductive.

(Scott Baldridge at 01:02:04) Since the body does not have a natural way of getting rid of iron, if we're putting doses of iron into our gut more than once a day, it conveys to our gut the need to block the absorption of the iron. So anyone that's got iron deficiency and the provider is telling them to take it two or three times a day, they're actually doing them a disservice because it teaches the gut to block the absorption. If we really can't get to where we need to be with an oral supplement once a day, and they—because we absorb the iron into our brain while we sleep—they're recommending now that we take it at bedtime. And I might be able to tolerate taking two pills at bedtime instead of one pill at bedtime because I need so much iron. But dosing it more frequently than once a day actually makes our gut block the absorption because we have no natural way of getting rid of it once it's been absorbed.

(Joel Beasley at 01:03:12) So multivitamin or buy them individually?

(Scott Baldridge at 01:03:15) So to know what you would need, you'd have to actually measure the levels. Your diet might be good enough that you're getting those nutrients. And maybe you're tired and run down because something's interfering with the architecture of your sleep, not because you have a nutritional deficiency. The only way to know what you should supplement with would be to do the lab work enough to find out what are you really missing. So often I usually say, find out specifically what's running low and then supplement to meet that specific need.

(Scott Baldridge at 01:03:49) Now, if we want to take—now, let's talk about those of us who are 50, who might be at risk for, what do they call that—macular degeneration, then you might consider starting to take a once a day AREDS, age-related eye disease formulated multivitamin that basically has omega-threes, B12, C, zinc. And I think there's something else in them. They used to have vitamin A in them, but then the study showed that if I had been a smoker, if I take the vitamin A, it might increase my risk for lung cancer. So to be on the safe side, a lot of the manufacturers went away from putting the vitamin A in it, and they now put like antioxidants and xanthine and omega-threes.

(Scott Baldridge at 01:04:53) But anyways, so if you're over 50 and you're wondering what kind of a multivitamin should you take, get in the lab work to know if you're missing B12 or folate or iron or B6, but maybe taking an age-related eye disease formulated multivitamin, probably a good idea for all of us that like to spend time out in the sun, just to reduce our risk of developing macular degeneration down the road.

(Joel Beasley at 01:05:21) People are listening to this. They just took in a ton of information about sleep, sleep, sleep. They want to go buy something. They get to buy one thing. What would it be?

(Joel Beasley at 01:05:29) A sleep study, a CPAP machine, a better pillow? What do they go buy?

(Scott Baldridge at 01:05:35) I think I would buy a few minutes to find a questionnaire online related to what are the symptoms of possible sleep apnea. And I'd buy enough time to have somebody let me open my mouth, like I'm putting a cherry in my mouth or a strawberry in my mouth, and just let me relaxed, but with my mouth open wide, relax and breathe. Look at what does the back of my mouth look like and do a questionnaire related to what are the symptoms that might indicate that my sleep is not as good as it ought to be. And if those indicate we need to be looked at more closely, yeah, talk to your primary carer and think about getting referred to sleep medicine and getting that looked into.

(Joel Beasley at 01:06:25) How much caffeine do you consume a day?

(Scott Baldridge at 01:06:28) I don't. I'm LDS, so, you know, I'm not really saying—I don't drink coffee or tea or stuff like that. Coffee in moderation is not the devil, or caffeine in moderation is not the devil. They recommend not getting caffeine within six hours of bedtime because it still could have enough effect that it's keeping you a little revved up. So, but if you want one or two cups of coffee in the morning and you want a Dr Pepper at lunch or something, I'm not going to fault you that. But if you're finding that you cannot function well without it, you need to be asking yourself why.

(Scott Baldridge at 01:07:17) Because normally if you're eating right and exercising every day and trying to get a good night's sleep, allowing yourself enough time to sleep—if you don't feel raring to go, there might be something behind that.

(Joel Beasley at 01:07:30) You have been an absolutely brilliant wealth of knowledge, Scott. Dude, this is fantastic. I hope this is not our last conversation. I'll reach out to you like next year or something. We can catch up if that's cool with you.

(Scott Baldridge at 01:07:42) I hope not either. If someday, if I had my dream, I'd have the opportunity to have a conversation like this about diabetes or a conversation like this about anxiety and depression or a conversation about nutrition. There's so many topics that as a family doctor, I tried to learn how to give word images to help people to see in their mind's eye what's happening inside their body. So, yeah, if you ever want to talk with me about any of those topics just off camera and see if what I've got to say is worthwhile, hey. You're welcome to it.

(Scott Baldridge at 01:08:21) I once was told if I learn anything in my life that's worth knowing, I must pass it on to someone else or it will be lost when I die. So if as a physician, I've tried to pay attention and learn how to communicate things well to everyday people so they can understand their health, if I don't pass that on to other people, those stories, those anecdotes, those vignettes, they're going to be lost. So, yeah, you want to pick my brain? You're welcome to what's left of it.

(Joel Beasley at 01:08:56) Thank you so much for listening. And if you found this episode useful, please share it with a friend or colleague who you think would get value from it. And if you have topics that you'd like to hear discussed on the podcast, either add me on LinkedIn or send me an email [email protected]. Every time I get an email or LinkedIn message, it absolutely makes my day and inspires me to keep going.