Shelby Harris Quotes

Night terrors are in deep sleep, and they're more common in kids, as are nightmares, but what happens in a night terror is like a flash - we think a flash of some image or something happens in the brain. We don't really quite know what. And it usually ends up with the child screaming almost like screaming bloody murder. It's very scary for the parents or whoever else is around.

When they [people with insomnia] start worrying about not sleeping, I'll say, "Say the mantra to myself; if I don't sleep tonight, I'll likely sleep tomorrow, and if not tomorrow then definitely the third" because our body has a way of naturally catching up.

Narcolepsy is a disorder that affects many different areas of life. So in typical patients with narcolepsy, they have something called "excessive daytime sleepiness." So, they're very sleepy during the day. Yet, at night, they're still sleepy, but their sleep is very broken.

So if somebody has chronic pain, we want to manage the pain, but we still want to treat the insomnia separately. So what we'll tend to do in our sleep lab is we'll do a thorough evaluation and we usually have myself, who is a Psychologist and a Sleep Behavioral Sleep Specialist, I treat the patients first.

So, more times than not, but not every time, it can be linked to a medical problem, such as menopause, cancer, chronic pain, it can be linked to anxiety and depression. Those are the more common causes.

We're not really sure why it [broken circadian rhythm] continues, but when they become adults, we usually have to treat it because many people need to get up early to go to work and they can't be sleeping until 11:00 or 12:00. So we use treatments like bright light therapy, melatonin, things like that that are very effective.

Now narcolepsy is really hard though because they're very tired during the day, they're sleepy during the day and it's managed mostly with medications. So we use medications to help them sleep better at night and to stay away during the day. But there are behavioral things you can do also by changing diet, exercise, having an actual nap schedule.

So, sleep deprivation, and sometimes an insomnia, which is a little bit of a different form, but just getting a lack of sleep, can lead to a number of different decrements.

So someone who is a child usually goes to bed about 8:00 or 9:00 at night, but then when they have a circadian rhythm shift, it shifts later. And this is natural. And they start to go to bed at 11:00, 12:00, 1:00 and they want to sleep later. So we see this a lot in teens.

Some patients are still having insomnia, but it's seems worse to them than actually it is. So, if they say they're sleep deprived, they haven't slept at all in three days; if we actually take them into a lab, most of the time we actually do see they're sleeping on and off here and there.

So when you go to sleep at night, if you're someone who hasn't had any sleep deprivation, you have a very normal sleep pattern, what we tend to see is that, in adults, they go to bed and they start off by going into the deeper stages sleep.

Workplace accidents with people who are sleep deprived or people who work shifts and they don't get the right amount of sleep during the day or at night.

For some people they say, it's about wish fulfillment, it's about the things you are never able to do in your day you are actually fulfilling at night. There are other people who will say that it's actually telling you something.

So the older models, when you look at Freudian, when you look at Jungian thought, and there's still people who really - who really use the Jungian thought of dream analysis, is really that you would analyze the dreams. The dreams are there for a purpose.

Honestly, what we use a lot is melatonin. So we use lower dosages of melatonin, taking it at different times, depending upon where we are traveling and that can really help adjust the body's rhythm to wherever you are going.

If you're going somewhere East from here, generally what you want to do is you want to try to have your bed time earlier and earlier so what we'll do is I'll have someone adjust for a week or two by going to be 15 minutes earlier and getting up 15 minutes earlier every night. So that can be a really simple thing.

Jet lag depends on which direction you're going and it can be a little complicated, but there are a few different treatments. So one would be if you're going somewhere - sorry it's hard to think about it.

It's uncommon, but there are some people who just have a delayed circadian rhythm and they just - they sleep better during the day then they do at night. So they've - a lot of those people with delayed sleep phase disorder they start to work in bars, they work some of the late night shifts, they sort of adjust to doing it more and more as time goes on.

We have other opposite problems with circadian rhythms that can happen when you - a lot of times with older adults. They start to go to bed at 6:00, 7:00 at night and they wake up at 2:00 in the morning. And they're rhythms actually shift earlier, but sometime it can just kind of miss the mark and shift too much earlier and that's when we need to treat it with bright light.

There's a problem for them [teens] when they have to get up and go to school in the morning, they're very sleepy, yet on the weekends, they'll sleep 12 hours, they'll sleep late and then go to bed late and wake up late. And on vacations, it's not a problem.

There are some people who believe that dreams really are just kind of a throwaway thing. They are just a way of your brain processing what's happening during the day, but there's really no meaning to them; a lot of imagery of just flashes of what happened.

So it's like your brain has a large filing cabinet and it's opening up each drawer and it's taking in various images and memories from the day, consolidating what it needs to and puts in whatever file. And then if there's something that doesn't fit in any of the files and doesn't really belong, you'll forget about it. So it's a way of really getting a succinct way of storing things in your brain.

Sleep paralysis is something that is actually very common. Many people have it, I've had it myself. And what happens is, when you're in that REM stage of sleep, your brain is very active. You're dreaming your most during that stage, you're mind, your eyes are moving, there's a lot going on. It's like fireworks going on in your brain.

Now there's some night terrors that happen in adults. And if it starts as an adult and you've never had them before, then there might be other things that are happening; it might be anxiety, depression, stress. And that's when you might have more of a thorough psychological evaluation.

We think is happening in the brain, the way I like to think about it is, it's almost like, you're brain is going through all these stages of sleep and it's developing in children so fast that it's almost like you're shifting gears in a car. And at some point, you actually stall out a little bit, and that's kind of what happens during a night terror.

Night terrors are very different from nightmares. A lot of people will think they're the same, but they're really not. Night terrors - you want to look at the time of night when you're having the problem. Night Terrors happen in deep sleep. Nightmares tend to happen in a lighter REM sleep.

In general, there are patients with insomnia who - many patients with insomnia will actually over report the lack of sleep that they are getting.

We haven't really - it's harder for us to set those rhythms. So it's really important to keep a steady bedtime and wake time to really lock in those rhythms.

People went to bed when the sun went down and they woke up when the sun came up. That's what our bodies are naturally programmed to do. However, with all the new stresses in life with electricity, with technology, we tend to override that system and we'll stay up later and we'll get up earlier or later, and we use alarm clocks, we use the light.

So when it comes to circadian rhythms, it's a clock that's basically programmed in our body. So if you think back to times when people lived on farms and we didn't have electricity.

The other option we have are medication treatments. So you'll have the treatments such as Ambien, Lunesta, Sonata, and we'll also have Rozerem and for some patients we use Benzodiazopine/Clonazepam. Things like that to help with anxiety.

We'll work on relaxation strategies and also changing the times you go to bed will actually make them sleep a little bit less for a few nights so their body's natural sleep drive starts to kick in. That is very effective in about 60% to 70% of patients who do it, four to eight sessions, not even every week; it works for 60% to 70% of patients.

I'll work on patient's thoughts about sleep, "So I must get eight hours of sleep tonight or I won't sleep tomorrow." That sometimes - or "I won't function tomorrow." That sometimes makes it very difficult for you to sleep at night

We try not using medications initially, and we use something called behavioral therapy for insomnia. This changes behaviors people do in bed, none of the tossing and turning.

There are some patients who just have insomnia and they've had it since they were a kid and we don't quite know why. So when we look at the cause, we definitely want to treat whatever else is going on, but insomnia often because it becomes its own diagnosis and that requires its own treatment.

There are other people that think that dreams actually do serve a purpose. But what that purpose is, we're not really sure. So some people believe that it actually does have some psychological representation of what's going on in the day, but there's no need to sit and really analyze it.

There are people who have repetitive nightmares. And what happens is their brain is trying to process the stress and help their brain actually deal with what happens if this stress happens again, so their brain's preparing them to deal with it in case the stress happens again, but it's so scary that they awaken from it.

There are some that are - REM Behavior Disorder, we'll see some court documented cases. And they really need to have a thorough evaluation with a sleep specialist.

When it comes to the reason why we have nightmares, we're still debating that. It's a new area of research, nightmares. And the way I like to think about it is, our brain - we have stress during the day and our brain needs to learn to process this stress.

There's some debate as to whether you need to awaken from them because there are some patients who are actually starting to say, "I had these horrible nightmares, but I never woke up from them." But they can still recall them when they get up in the morning. So there's still some debate in the field.

So you have it, you awaken from it and you can recall, in detail, what just happened, that's a nightmare. So it's very different from a dream where you generally don't wake up from it and you don't have this dysphoric emotion.

Really, a nightmare just really has to evoke some sort of, we call it, dysphoric emotion or something uncomfortable. You could be sad, you could be unhappy; you could be scared, anxious. But traditionally, the definition is you have to awaken from this nightmare.

Nightmares are distinctly different from dreams in the way that people feel them and experience them. So a lot of people think that a nightmare is something where something is chasing them and you have to wake up screaming. Yes, that's one of the more common nightmares that we see is the person chasing someone or they're being chased.

There's confusional arousals, there are states in deeper sleep that can happen where people will go and they'll disappear and they'll take on some other persona. They'll commit some crime, but it's all when they are in a very deep stage of sleep. So you really need to have a very thorough evaluation.

Now circadian rhythms become very interesting and problematic for patients because when you become a teenager, your rhythms actually tend to naturally shift.

There's a new line of research showing that people who don't get enough sleep, they're body doesn't metabolize as well. And so they actually - it leads to weight gain. So if you're not getting enough sleep, you might have difficulty losing weight.

Decrements in attention and concentration, being able to learn more efficiently, that's just not as good. Also, there are motor vehicle accidents, workplace accidents, we see that a lot.

When you're in the more deeper stages of sleep - REM sleep, your body is quiet, but your mind is actually very active. So it's a time when your body and your brain is restoring itself. It's repairing any cell damage that happened during the day, it's really repairing, like I said, repairing your body, but also helps with digestion, helps with memory.

We actually don't know the function of sleep all that well yet, but sleep is a time of quiescence in the brain.

Really if it's an hour or two after you've fallen asleep because you're in such a deep sleep at that point.