Sleep & Dreams #48

Dr. Gary Astrachan:

Jung referred to dreams as compensatory. They are attempts on the part of the deep, broad psyche of the unconscious that is to compensate to provide for what is missing and needed in our waking lives, which we need to try to understand in order that our lives might more creatively and meaningfully flow.

Dr. Thad Shattuck:

The question is, wow, is snoring ever really benign or is it just a continuum? You do have, you know, what we call simple snoring all the way to severe sleep apnea where somebody stops breathing 100 times an hour.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and podcast number 48, Sleep and Dreams, airing for the first time on August 12, 2012 on WLOB and WPEI Radio Portland, Maine. And today to discuss sleep and dreams with me is my co host, Genevieve Morgan. Hi Genevieve.

Genevieve Morgan:

Hi Lisa. Did you have a good night's sleep last night?

Dr. Lisa Belisle:

Well, I actually didn't. And part of it was because I'm reacting to something in the carpet in my house and it's summertime and the stuff is coming up and I know I'm not the only one out there who has this sort of thing that happens at night.

Genevieve Morgan:

It's interesting how frequent sleep disturbances happen. I mean, you must see them all the time at your practice.

Dr. Lisa Belisle:

Well, I see them all the time in my practice and you know, just thinking about my own situation, I mean, it's such a minor thing that I have this little cough and it just interrupts me all night long. And I think about all the people who have something much bigger than a little cough and it is constant for them, something physiologic, something, you know, like maybe a sleep apnea issue or maybe congestive heart failure, something really big. I do. I see this all the time in my practice.

Genevieve Morgan:

Well, and even the mind running away with problems. I always find that if I start to think Before I go to bed, my mind just keeps me up and I can't stop thinking. And it's a way everything gets out of control much faster in the wee hours of the night.

Dr. Lisa Belisle:

This is true. And it does have something to do with our conscious mind being able to kind of suppress things for us and enable us to function as we go through our daily lives. But at night our conscious mind rests and our subconscious mind sort of comes about to sometimes torment us, sometimes remind us of things we should be doing. It gives us. Some people believe, Freud and Jung believe that dreams actually had an impact on giving people clues to what their lives should look like. So it's a very interesting field and one that's been expanding rapidly.

Genevieve Morgan:

How do you deal with sleep disturbances in your practice?

Dr. Lisa Belisle:

Before I trained in Chinese medicine, I was a family medicine doctor. And I spend a lot of time dealing with patients and talking about sleep hygiene and no electronics in the bedroom and having a bedtime the same every night and waking up the same time every morning darkening the rooms. And all of these things are very important, starting at bed baseline with sleep hygiene. And then the next line was medication. And we know that medication is a very widely prescribed sleep medication, anti anxiety medication, very widely prescribed in Western medicine. But as I became more familiar with Chinese medicine, I understood that if it wasn't a physiologic problem, if it wasn't pain or congestive heart failure or sleep apnea that was keeping somebody up at night, the shen or the spirit actually had a much bigger impact on somebody's ability to sleep than perhaps is recognized in Western medicine. And so that's what I deal with in my practice. When people come in with sleep disturbances, I talk with them about their spirit or their shen.

Genevieve Morgan:

Does acupuncture help?

Dr. Lisa Belisle:

Acupuncture does help. And it also helps to come in and have a conversation with an acupuncturist or somebody like me who does integrative medicine about maybe some things that are going on in your life. I mean, maybe you're not sleeping well because there's some kind of something that needs to be addressed, something that needs to be changed, something that perhaps you've been avoiding or maybe you don't even know about. But even speaking it out loud and naming it, that's kind of the first step.

Genevieve Morgan:

And maybe your dreams can help you figure that out.

Dr. Lisa Belisle:

Maybe your dreams can help you figure it out. And then acupuncture is very helpful because we're finding out more and more research to support this thousands year old medical modality that suggests that it's a rebalancing thing, that these needles do relatively painless and relatively risk free. So it can be a very helpful thing for sleep. On today's show we have Dr. Gary Ostrakhan, who is a clinical psychologist and Jungian analyst with a private practice here in Portland, Maine. And we also have Dr. Thad Shattuck, who is a sleep specialist out of Lewiston, Maine. Very interesting approaches to sleep and dreams. Very different approaches to sleep and dreams. And those of you who are listening, I think you're going to get some interesting tips and interesting thoughts. Very thought provoking and hopefully it won't disturb your sleep. So thank you for joining us today. The Dr. Lisa Radio Hour and Podcast is proud to be sponsored by the University of New England. As part of our affiliation with the University of New England, we feature a segment we call Wellness Innovations. This week's Wellness Innovation comes from Psychology Today. What do your dreams say about who you are? Dreams? They're bizarre. Powerful. Mundane. Emotional. Sexual. Frightening. Elating and devastating. Scientists and laymen have puzzled over the mystery of dreams for centuries. Why do we have them, and more importantly, what do they mean? If anything, we do know that, like all perceived experience, you have your unique brain to thank for the experience of dreaming. Though we may not know whether our dream should be interpreted as meaningful in the psychoanalytic sense, they may tell us something about who we are as individuals. We know that people's brains are systematically different from one another and that such differences correspond with personality trait variance. Thus, the neurobiology of dreaming points to a surprising parallel with core ideas of psychoanalysis. The virtual absence of self monitoring in dreams, combined with the apparent trait like aspects of their content, indicates a world in which our dreams represent an experience of our more uninhibited and unbridled concerns and emotions. The science indicates that it is interesting and worthwhile to observe themes and patterns that occur in the dreams you may remember. They could be telling you something about yourself that would otherwise be filed away out of consciousness. For more information on this Wellness Innovation, visit drlisabelisle.com for information on the University of New England, visit une.edu

Dr. Lisa Belisle:

our Sleep and Dreams show, we have in the studio with us Dr. Gary Astrakhan, a clinical Psychologist and Jungian analyst in private practice in Portland, Maine. Dr. Ostrakhan is a faculty member and supervising and training analyst at the Jung Institute in Boston and lectures and teaches widely through North America and Europe. He's also the author of numerous scholarly articles in professional journals and books, and writes particularly on the relationship between analytical psychology and Greek mythology, poetry, painting, film, postmodernism and critical theory. Thank you for coming in today.

Dr. Gary Astrachan:

It's my pleasure to be here.

Dr. Lisa Belisle:

And I have Genevieve Morgan sitting next to me, the wellness editor for Maine Magazine.

Genevieve Morgan:

I have to admit that I felt particular pressure to remember my dreams last night.

Dr. Gary Astrachan:

Oh, so did I.

Dr. Lisa Belisle:

Now, do you try to remember your dreams on a regular basis?

Dr. Gary Astrachan:

I do, actually, yes. I make it as part of a daily practice. Not that I remember them every day, but it is a practice and even if I don't remember them every day, I'll spend some time with what I don't remember.

Dr. Lisa Belisle:

Well, let's back up just a little bit. For people who are not familiar with Jungian analysis and Dr. Jung. Can you give us some background on that?

Dr. Thad Shattuck:

Sure.

Dr. Gary Astrachan:

Well, C.G. jung was a student, a disciple and a mentee, if there is such a word, of Juan Sigmund Freud, who's the person who put the notion of dreams and the unconscious and the psyche in general on the map for all of us, for 20th century and 21st century human beings, and so created a pretty bold new terrain for exploration for all contemporary people. And Jung was, as I said, a follower of his and disciple and was the crown prince until they came to a parting of the ways and Jung struck off on his own. And one of the points of difference, you might say, was the significance of dreams that Jung saw his teacher, Sigmund Freud, taking in a more personalistic way than he was then just beginning to explore for himself. CG Jung, through the crisis of his separation from Freud and through his own turmoil, ended up birthing, over a period of several years, in the nineteen teens into the early twenties, what is called to this day analytical psychology. And that was that. The whole school and theoretical framework of psychology that in a way separates or differentiates himself from psychoanalysis is what Freud really founded and birthed. And Freud, by the way, gave birth to psychoanalysis out of his own depth. Journey or crisis, if you will, personal crisis, result as a result of the death of his father, the breakup of a close friendship of his own, and out of his own kind of underworld journey, really gave birth to what became the Interpretation of Dreams. That book, which puts its indelible mark in the 20th century. In that book, Freud writes that dreams are what he calls the via regia, or the royal road to the unconscious. And that's a position that Jung very much drank in and still would subscribe to, that dreams are the royal road to the unconscious or the psyche, of the world of the soul.

Dr. Lisa Belisle:

And psychoanalysis and analytic psychology, those are very different from other types of psychology and therapy that are available in the world today. Those are very specific types of therapy that's available to people.

Dr. Gary Astrachan:

Yes, they are, they're very different. But yeah, in some respects they're not so different. And sometimes if you're a fly on the wall and you're sitting in the consulting room of a psychoanalyst, an orthodox Freudian psychoanalyst, or myself, perhaps a Jungian psychoanalyst, you might not differentiate it a whole lot from what would look like garden variety psychotherapy at times. But what's different is an orientation, a focus, a feeling attitude that attempts to be attentive to and respond to really what I would call the depth dimension of the psyche. So psychoanalysis and analytical psychology, Jungian psychology, that is, are kind of journeys or explorations that one undertakes and embarks upon that have no certain time for how long they'll take, or more importantly, for how deep they may need to go for any one individual.

Dr. Lisa Belisle:

And this brings us back to this idea of dreams, which are reflecting a depth in someone's psyche that you aren't necessarily going to be able to identify at any particular moment. Somebody might come into your office with a dream that they've had the night before and it may or may not be related to some thread that you started talking with them about weeks previous.

Dr. Gary Astrachan:

Yeah. The dreams reveal a realm and a place and a space that we, with our conscious minds, neither myself as an analyst or the patient, can have any access to whatsoever with our ordinary conscious, rational waking mind. So they offer a whole other dimensional world that I, in collaboration with the analyse and kind of look towards for guidance, direction, purpose and meaning as to where and how they may need to be going in their own lives, because I surely can't, especially someone who I started working with, say initially, I have no idea where they need to go, what's going on for them or what they need to do. And I can't say that with my own conscious mind and they're not sure themselves what's going on for them. They might know that they just went through a separation or a divorce or something and they're kind of reeling from that and they have Some issues they want to talk about. So we kind of join together and become partners in an exploration of a whole other medium that is bigger than both of us, that in fact forms a kind of third entity in the consulting room and whose boundaries and borders we really have no idea, no one really does at this point, we really can't discern and whose parameters we can't adequately describe. But we look towards that realm for messages, indications, signs, and in particular, in the form of dreams that try to give us a message of kind of where we are and in particular, where the patient or the analyst is in the process of their life.

Genevieve Morgan:

Have you seen in your treatment of patients a progression? If you have a new analysand and you start to tune them to their dream life as they move through the analysis process, do their dreams change?

Dr. Gary Astrachan:

Absolutely. Not only what changes, which is really interesting is a lot of people come in. A lot of people come to see me who typically might not know that I'm a Jungian or a Jungian analyst at all. They'll come because they want to do therapy. Something's going on in their lives. They're in a midlife crisis, they want a job change. An issue has come up with some symptomatology or something, and they will not be conversant, have remembered a dream in their entire lifetime. And I may talk about dreams because I'm feeling out front and transparent about kind of what is my particular passion and what I do best, what I work with. Well, we'll let people know clearly, and even at the first session that I would look to the realm of dreams, as strange as that may sound to you, about where we may need to go in this process. And it's about looking together towards this medium that we're both contained in. It's not as if dreams are contained in you and dreams are in me. Like your psyche is in you and your psyche is in me. But we are both here now, as we're talking, or all of us here in this room now too, contained in the realm of what I would call psyche or soul, that we're in this realm, and it's a medium in which we move and live. Just as much as we feel and taste and breathe and smell, we're moving in this medium of psyche. So in getting a person to begin to even relate to this other, this other kind of dimension, this other sense of world which is much, much bigger than our conscious waking self might heretofore have been willing to acknowledge, they are beginning to establish, even in the first session A kind of relationship to this other, perhaps somewhat strange realm, but a realm which nevertheless can possibly give them some directions or ideas or images or symbols about what's going on in their lives that would need some kind of decoding and deciphering. So I will suggest that a person, okay, well, why don't you start just seeing if you can remember a dream. Put a pad and pencil by the pen by the side of the bed, a nice little night light, and that already signals to the psyche that, okay, I'm ready and willing if you are, and if something comes, I'm going to be ready to kind of catch it. And people start remembering dreams, and the way they remember dreams or the style in which they dream, you can see changes fairly significantly over the course of a therapy or an analysis. The way people remember their dreams. They become acquainted with the people who populate their dreams, their dream characters, the major players in their life, both in their personal lives, but also, you might say, archetypally, the figures and what I would call really the topography of the dreamscape starts to emerge for them. What kind of places do they dream about? Typically a childhood home or their current apartment or a foreign place. And one tries to get the analyse and to become familiar with their own inner world, in general, the whole inner world. And who populates that inner world, this kind of inner world that is this stream of thinking that we're basically often engaging in for most of the parts of our day that's kind of just going on to begin to tune into that, begin to see that all those thoughts and ideas and moods and feelings that we're having going on, that is the material, that is the matter. That's what matters in our psychic life. And we have to take that matter seriously and turn that matter, that material, transform it into something other, something else. Turn matter into soul, turn matter. This is about the transformation of matter into psyche.

Genevieve Morgan:

I find it fascinating that we have every night available to us a tool that helps us examine ourself. Because I was reading some data about dream research that they're thinking that many mammals have dreams. But the idea that we have of dreaming has to do with the sense of self. So even if you aren't in analysis as a part of your own self care, you have at your disposal every night a little window. And I'm interested in for people who start to track their dreams. For instance, let's get very basic. A bad dream. Is a bad dream necessarily bad? Does it mean that you're having bad things happening in your life, or is it just another tool?

Dr. Gary Astrachan:

Well, I think it's a good point, Genevieve, because it is amazing that we have at our disposal this incredible storehouse since time immemorial, since the dawning of consciousness available to us kind of little people going around here in 2012 through the realm of dreams, that is that at our fingertips and all mammals, in fact, dream. All mammals have REM sleep. And you can see when your dog is sleeping that their eyelids are fluttering. They're actually dreaming. Now, unlike human beings, you can't wake them up and say, what were you dreaming? But if you could, they say, oh, I was chasing a cat around the house or something, or whatever. But all mammals dream. Now. I don't really think there is such a thing, frankly speaking, to cut to the chase as a bad dream, I don't think such a thing as a good dream necessarily either. I think dreams, that's the, the amazing thing about them, they are the language of pure, unvarnished inner nature, which is neither good nor bad. It's neither in a way positive nor negative. And it's not right or wrong. These dreams say it the way it is. They just put it out there, what's going on with you. They are this kind of snapshot of the psyche in a particular moment of time. But they also give the kind of a big picture, the kind of wide angle, a sort of Technicolor 3D version of whatever's going on in our lives. And that's up to us to kind of try to grasp as much as that big picture as possible. But I don't think there is such a thing as bad dreams. And part of the way I think it's important to cultivate an attitude and a relationship to the realm of dreams and the realm of psyche is to embrace it all, to just accept it, tolerate whatever comes without judgment, to make room for it, to make space for psyche, however weird or strange it may be, but just to embrace it, because it just is. That's the way it is. That's what psyche is saying. And so a lot of seemingly bad, dark, negative, scary, frightening things will come up in dreams. But the only way to approach it without making it worse is to make room for it. You don't tighten up and want to push it away or psychically amputate it. You kind of make more space for it, to take it all on, say, okay, what could this be about? And to sit with it, just spend time with it.

Genevieve Morgan:

Dreams are, as we've said, a daily tool, and they can indicate the self. But these concepts can be very intimidating to some people. And the idea of entering psychoanalysis or analysis can be intimidating, mostly because it's uncomfortable to go to those dark places. It's uncomfortable to have nightmares. Why is that a necessary part of finding satisfaction in life?

Dr. Gary Astrachan:

It may not be necessary to have intensely negative experiences, but it is important if one is going to undertake the journey, to be prepared for the descent. Because none of us wants to go down there. None of us really wants to go into the realm of nightmare and boogeyman and dark, deep stuff that we may have safely tucked away and just gone about our lives. So typically, I think no one goes, except for kicking and screaming. So it is a difficult and slow descent, but it's one that's also richly rewarding. And unless one is willing to make the descent, then, as I said before, as I mentioned a moment ago, the descent is something that's kind of very alien to our culture, which wants to basically oftentimes put a band aid on things and just carry on, or take medication and just carry on. But these kind of band aids don't really work because the depth dimension is kind of. It's like a wound. And it's about going into the wound and going down into the realm of depth. And down there you don't have much orientation because it's kind of dark. And if you're going to really undertake it seriously, that's why one typically enter psychotherapy or analysis to begin with. And there, hopefully, optimally, you will have a guide, at least for the journey. But no matter who you have or choose for a guide, it's nevertheless going to be a journey downwards into the realm of depth, because depth is the realm. It's also the realm of death, it's the realm of soul, and it's a realm that's deep.

Dr. Lisa Belisle:

And would this be considered the journey of the hero where first you have to go underground before you can come up above the ground again and live? Yeah, and this is something that has been around since the Greeks and the Romans and probably before then.

Dr. Gary Astrachan:

Aeneas descends to the underworld and Dante descends to the underworld with Beatrice and. Yes, and they both had guides. And Aeneas had Virgil as. Anias had Virgil as his guide. No, Dante had Virgil as his guide. So it's important to go with a guide. But it's a difficult journey. No one says would ever say that it's easy.

Genevieve Morgan:

And how does this relate to creativity?

Dr. Gary Astrachan:

Well, very often, for example, one of the most common. Illnesses of our time or problems of our time, you could say, is generally depression. Depression, when you take it totally seriously, means that one is being pressed down. One is literally being pressed down. And when one is depressed, it's because psychic energy, life vitality energy, is somehow gotten blocked up. It's gotten dmed up in the psyche. The only way to find it is not to take a pill and pop right out and think that's going to do it, or to take some drug or to go shopping and think that's going to get you out of it. But it's to undertake to take being pressed down totally seriously and allow oneself to be pressed down long enough and deeply enough so that one gets what's really down there. And what's really down there is. Is the treasure. The treasure had to attain which is oneself, one's meaning in life. That flow of life, the elixir of life, the fountain of youth, whatever the image is, the gold, and that is the creativity of one's life can come back, but only through going down and finding where and how it's gotten lost, misplaced, hung up.

Dr. Lisa Belisle:

That all sounds great. The gold and the self. And that's the good part of this. But as someone who I suspect acts as a guide, this is a complex process. Why did you decide to go into this field? What is it about this field that called to you in some way and what have been some of the challenges you've experienced in your life because of it?

Dr. Gary Astrachan:

Well, the choice or the vocation to enter this field is. Is always personal. It's because that one has to go down for oneself in one's life. The crux of being analysis is in fact one's own analysis. For Jung, you might say the goal or the purpose of the analysis is what he would call individuation, which means becoming whatever or whoever one is supposed to be becoming quintessentially and uniquely an individual, which means unlike any other person in the world and willing to separate oneself from everything in one's life that's collective, which means all your attitudes and beliefs and values and ideas have to be taken out of the attic and spring cleaned and see if you want to dust them off or put them back or junk them. It means really honing and working on and refining and sharpening one's individuality in contrast to the collective.

Genevieve Morgan:

Do people often have this desire or this sense of midlife? Is that really what the midlife crisis is about?

Dr. Gary Astrachan:

I think most people have this absolutely. Most people who ask those questions or are important, embark upon this journey have those kinds of issues going on in their lives that they're wanting and needing to explore.

Dr. Lisa Belisle:

And this manifests itself in various other ways, like divorce, separation, job loss, ends

Dr. Gary Astrachan:

of relationships, whatever the symptoms, crises of all sorts. Very often it takes a crisis. The person kind of usually has to hit the wall before they realize that something's going awry.

Dr. Lisa Belisle:

And will dreams sometimes lead up to that point of crisis? So if people start to dream, they will try.

Dr. Gary Astrachan:

They will try to. They will be coming. Dreams are definitely a signal and message of what's going on in lives, as are, in fact, nightmares. Nightmares, which wake us up from dreams so that dreams don't complete themselves, don't have an ending, are attempts to chew on, to metabolize, to digest something that's in the psyche, that's like a foreign piece of material, like shrapnel that's in the psyche that's lodged there. And so nightmares, which are very often repetitive and recurrent, as in, for example, in post traumatic stress syndrome, are tempts of the psyche tempting, like crazy to digest and work with. This incident experience that overwhelmed the psyche at a certain time and that needs to be kind of broken down and metabolized by the psyche over a long period of time.

Genevieve Morgan:

For someone who's interested in looking at their dreams in a more serious way, how do they start? What's the first step?

Dr. Gary Astrachan:

One, the most basic first step is to try to remember. If one is serious about remembering one's dreams, taking them seriously, even the smallest, most insignificant fragment, little piece or piece you want. Oh, that was weird. That's nothing. I think I always say when someone has just a little fragment of dream, literally an image, just one image that flashes through one's mind that there's gold in them. There are hills that there's some little nugget of gold even in the smallest fragment, which one would be tempted to discard and throw on the trash heap. But I really urge people to just take seriously the contents of their psyche, including emotions and moods and feelings and thoughts and ideas and fantasies. And all of that stuff can be mined for its soul value, its soul content. But mining is kind of hard work. It means kind of taking it out of the earth, then subjecting the ore to high temperatures and refining it and hammering it and beating it and shining it and polishing it and working with it. And I would say it's similar with dreams. One pulls back a dream. It's kind of like on an archaeological dig where you. You unearth an artifact from the earth, you take out it's a fragment, a piece of pottery. You don't know what it belonged to, what it was a part of, but you take it out, you brush it off very gently, and then you look at it and you hold it and you try to fill in the context, the missing pieces of it. In fact, the word symbol, which dreams are obviously full of, comes from the Greek word cymbalon, which, upon parting two friends in ancient Greek Greece, would break a piece of pottery and each would take a half of it or a fragment of it. And then when they would get together at some point in the future, they would reunite it. Well, that fragment is a cymbalon. So a cymbalon is a fragment of a much larger whole. It's a fragment of something that points beyond us towards something larger and bigger and in the future and as not yet conscious, something which is still unconscious. And dreams are like that. They're like that fragment of pottery which is unearthed and excavated from the earth and needs to be kind of held and respected and looked at and imaged and played with and imagined around and maybe smashed some more. And then put the pieces together another way. You put them in part of a bigger collage. And you do whatever it takes to get the psyche going again to create psychic movement, because the psyche needs to keep moving. It's death to the psyche for it to get bogged down, to get stuck. That's what we typically call depression. When things get stuck, life doesn't flow. So dreams are coming in some ways to show us where and how psyche needs to flow, where perhaps the impediments or obstacles are coming from. Jung referred to dreams compensatory. They are attempts on the part of the deep, broad psyche of the unconscious that is to compensate, to provide for what is missing and needed in our waking lives. So they are this upsurge of material and meaning which we need to try to understand in order that our lives might more creatively and meaningfully flow. And, you know, just the simple fact of starting to remember dreams, acknowledge that the fact that there is a reality there, there is something to be gained from is the first step is the beginning.

Dr. Lisa Belisle:

We've been speaking with Dr. Gary Astrakhan, clinical psychologist and Jungian analyst on the subject of sleep and dreams. I'm sure that our listeners are feeling pretty intrigued right now and perhaps are going to go on and spend some time in their waking hours thinking about their sleeping hours. So thank you for coming in and stimulating that in our listeners.

Dr. Gary Astrachan:

Thank you very much for having me. It's been a pleasure indeed.

Dr. Lisa Belisle:

as part of our Sleep and Dream show today, we are interviewing Dr. Thad Shattuck from St. Mary's center for Sleep Disorders. Dr. Shadduck earned his master's in public health from the Dartmouth Institute and his medical degree from Dartmouth Medical School. He completed his fellowship in sleep medicine at the Beth Israel Deaconess Medical center in Boston and did his residency in psychiatry at Brown University where he was chief resident in his final year of training. He is a member of the American Psychiatric association and the American Academy of Sleep Medicine. He's also board certified in psychiatry and board eligible in sleep medicine. Thank you for joining us today.

Dr. Thad Shattuck:

Thank you for having me.

Dr. Lisa Belisle:

That is a lot of education it takes to get to be able to practice the type of medicine you practice.

Dr. Thad Shattuck:

Yeah. Felt like it took a long time. Yeah.

Dr. Lisa Belisle:

Kind of put you to sleep a

Dr. Thad Shattuck:

little bit at times. It was definitely sleep inducing.

Dr. Lisa Belisle:

Yeah. You knew I had to go there with that joke, Right.

Dr. Thad Shattuck:

Of course.

Dr. Lisa Belisle:

You never heard that before, Right.

Dr. Thad Shattuck:

We get a lot of the sleep doctor jokes. Yeah.

Dr. Lisa Belisle:

But it is interesting that you did psychiatry as opposed to internal medicine. You didn't go the route. A lot of people who do sleep medicine or many go the route of pulmonary medicine, you know, lung based medicine or that, but you did psychiatry. That's. That's a different way of going about it.

Dr. Thad Shattuck:

Yeah, a lot of people are surprised by that. And then I like to kind of come back and say that really sleep initially grew out of psychiatry. So really the early sleep researchers, like William Dement, who's considered the father of sleep medicine, trained as a psychiatrist. And so my feeling, of course, I'm biased, is that sleep is really, it's about the brain. So sleep apnea is. It's about the upper airway in lungs. But there's more to sleep medicine than just sleep apnea. So I think it kind of. It's a multidisciplinary specialty, which I like about it, But I think psychiatry certainly has its place there.

Dr. Lisa Belisle:

Well, talk to me a little bit about the stages of sleep. I'm going to back up and do something that's more sort of physiologic, biologic and origin. Tell us what happens when you go to sleep. What happens to people biologically?

Dr. Thad Shattuck:

Yeah, good question. And I think the most honest answer is that, you know, we're not entirely sure what the. What sleep is for. I mean, we know it's restorative in some ways. We know it happens when you don't sleep, which is eventually bad things will happen to your body. Your blood pressure will go up, you can become depressed, and there will be other biological perturbations. But basically, sleep is a state where your metabolic rate goes down for most people, except in insomnia, perhaps. So your heart rate slows down, your blood pressure dips, it goes down. That's physiologically normal. Your brain waves slow. So we think that's associated with restoration. And I think a lot of the theories coming out now are that it's associated with certain kinds of memory consolidation, perhaps pruning of certain memories, certain synapses, and strengthening of others. And that might be different kinds of memory, might be specific to certain sleep stages. So really, stage one sleep is kind of a light transitional stage where brain waves slow down. And there's really nothing that remarkable about it. Stage two sleep is probably its most preponderant stage. And that's where we think a lot of probably motor sequence learning is consolidated. And this is sort of the cycle in which you go through sleep stages. And then stage three. Sleep used to be stage three and four. Now it's been consolidated. Just in. Stage three is where we have a lot of these big slow waves. And that's felt to be the most restorative part of sleep, where you feel more rested. That's the kind of sleep that's fragmented in fibromyalgia, chronic fatigue syndrome, where people have probably diminishments in that proportion of sleep. And then REM sleep is where your body is essentially paralyzed, including your upper airway is a little bit more flaccid, and you have more dreams. So that's. You have dreams. You can't have dreams in every sleep stage, but they're most common in rem,

Dr. Lisa Belisle:

and REM stands for rapid eye movement. So this is when we see people and they're actually looking like they're deeply asleep and their eyelids flutter. That's. That's that REM sleep you're talking about.

Dr. Thad Shattuck:

Exactly. Yeah. Or if you're a pet owner and you have a dog, and you see your dog who's asleep, and your dog starts kind of running in his dog bed, he's probably in REM sleep, but he's not. His muscles aren't fully inhibited.

Dr. Lisa Belisle:

So you started in psychiatry, and now you've gone towards sleep disorders. Why?

Dr. Thad Shattuck:

You know, when I was doing my residency, there were so many people who had complaints about sleep sleep. And I felt sort of ill equipped to go ahead and try and figure out what to do with them. So I became interested. I was always interested in eeg. And we have like a, you know, a pretty elaborate EE montage and sleep medicine. So I just always kind of captured my fascination. You know, I think also the sleep disorders that we think of, particularly REM behavior disorder, narcolepsy, I think they're interesting. So I kind of like the overlap, and I like how it involved a lot of more general Medicine, too.

Dr. Lisa Belisle:

And EEG is the brainwave measuring that you do.

Dr. Thad Shattuck:

Exactly, yeah.

Dr. Lisa Belisle:

And that's part of sleep studies.

Dr. Thad Shattuck:

It is. We don't do quite as an elaborate montage as you would if you're trying to capture a seizure. But we do monitor central frontal occipital leads. So sometimes we do see seizures.

Dr. Lisa Belisle:

So the pictures that we see of people with little things pasted all over their heads, that's the occipital frontal. Those are the leads that are getting you the brainwave information.

Dr. Thad Shattuck:

Exactly, yes. And we use those. They can incidentally capture seizures. So we are looking for that. But there are more to go ahead and figure out how active your brain waves are. So they're for sleep staging. And so the sleep stages we just talked about, there's very discreet brainwave changes that take place in stage one, stage two, stage three, rem.

Genevieve Morgan:

I've heard of narcolepsy and sleep apnea, but what is REM Disruption disorder?

Dr. Thad Shattuck:

Rem, Sleep Behavior Disorder. Great question. That's basically when REM is sort of a discrete stage, and it's when sort of the boundaries of REM are no longer as effective as they used to be. So certain phenomena of REM intrude into waking life, into other aspects of your life. So REM really involves complete muscle paralysis. And that's why we don't act out our dreams. For some people, because of various causes, sometimes because of a stroke in the posterior part of their brain or Parkinson's disease or other neurological disorders, they will go ahead and they will start to act out their dreams. So when they're having a dream, and usually the dreams sort of change in content, so they become a little bit more frightening, sometimes violent, and they start to act out the dreams. So that's actually. That's REM behavior disorder. But usually it's only. It's not that common. More frequent in older men, and sometimes it predates the development of something like Parkinson's disease or dementia with Lewy bodies.

Dr. Lisa Belisle:

Well, that's fascinating. I'd never heard of that before. That. This. That what is happening in some of these situations is people are actually acting out something that is sort of unconscious for them.

Dr. Thad Shattuck:

Yeah, yeah, exactly. You know, some people will go as far as to kind of, you know, basically tie themselves up in a sleeping bag at night and sleep on the floor, lock the door because they're worried they're going to jump out the window. They've jumped out of bed repeatedly, thinking that they're being chased or they're being attacked. And there is Kind of an evolution of people's dreams as the sort of progresses where the dreams do change in character and seem more threatening, where they feel like they're constantly being chased and they've got to defend themselves. So a very common story is that an older male will end up hitting his wife or kicking his wife and not realizing he's doing the species of sleep. There's actually a fairly well known comedian, Dave Birbiglia, who's done a whole show, it's called Sleepwalk with Me, about the fact that he's got REM behavior disorder and he tells very funny but sort of alarming stories about acting out his dreams.

Genevieve Morgan:

How does it differ from sleepwalking or nonviolent action when people are sleeping?

Dr. Thad Shattuck:

Good question. And it kind of goes back to the sleep stages. So sleepwalking is almost, I wouldn't say, you know, it's quite normal, depends on how frequent it happens. But you know, a lot of people have a couple instances of that when they're a young kid. And sleepwalking typically happens at a slow wave sleep. So we have a lot of slow wave sleep. It's load in the first portion of the night. And so you sort of act out and over learned motor program that's pretty basic, like walking, sometimes eating or running. But it's really the same thing as a night terror or a confusional arousal where you wake up, you're confused and you sort of do something that's a very pre programmed behavior, but that's from slow wave sleep and remote things that are probably a little bit more complex. But you're in dream sleep so it's a different brain state.

Dr. Lisa Belisle:

Is there a relationship between genetics and how one sleeps? Do bad sleepers, quote unquote bad sleepers run in a family or does sleepwalking run in a family?

Dr. Thad Shattuck:

Yeah, there is definitely a big genetic component to sleepwalking. So there's a family history of sleepwalking and somebody sleepwalks as an adult. Yeah, there's definitely a correlation. And there are people that are just genetically bad sleepers. I mean sort of the sleep machinery in your brain for some people just doesn't function as well. So there's certain people that have what we call idiopathic insomnia and they will have a family history of just really poor sleep. It's not related to stress, it's not related to poor sleep hygiene. They just tend to be short sleepers and have very disrupted sleep.

Dr. Lisa Belisle:

Are these people who tend to be sort of what we would call hyper aroused, like, you know, from an energetic standpoint, you know, people who are maybe more easily startled or people that just can't seem to calm themselves down,

Dr. Thad Shattuck:

you know, with the idiopathic insomniacs, I don't think so. I think that a lot of people who have the hyperarousal are people who have chronic insomnia. And you know, that's gone through various different stages of labeling, but it's called primary insomnia or psychophysiological insomnia. But I think that really involves the hyperarousal, where people get conditioned and, and they get in bed and they anticipate a really poor night of sleep. And getting in bed sometimes is enough to make them feel more anxious, elevate heart rate, sometimes even induce a panic attack. But those people also tend to feel a little bit more activated during the day or they have that state of hyperarousal insomnia. This kind of insomnia is associated with an increased metabolic rate. And so these people are breathing more heavily during the day. They're just burning more energy. They can't really calm themselves or slow themselves down.

Genevieve Morgan:

So what kind of remedies are available for people who are going through that

Dr. Thad Shattuck:

for insomnia? I think the issue has been pretty muddied because there's been such a big push from pharmaceutical companies to market medications. So I do think there's a role for medications, you know, in short term insomnia. So we call transient insomnia or like insomnia due to some kind of adjustment disorder. But really if you have chronic insomnia, the first line treatment should be what we call cognitive behavioral therapy for insomnia. So that is a treatment that I offer. The problem is there aren't a lot of practitioners that offer this because it's multi session. So it's great to talk about. Everybody agrees that people should get this treatment, but it's just not very accessible. So I think the real challenge at this point is trying to figure out platforms, certainly the Internet, where people can go ahead and they can engage interactively in doing this kind of treatment online. But it's very effective. But I think there's also an expectation from some patients that they're going to get a pill that's going to fix their insomnia. So it involves, I think, some kind of some therapy and some negotiation to change that mindset.

Dr. Lisa Belisle:

Talk to me about sleep and depression. As a family practice resident, as a family practice doctor, we were taught this mnemonic sigecaps, which was all the different questions you asked about depression. And one of them, one of the S's stood for sleep. So sleep disturbances were often an indication of some sort of a depressive problem. What's the relationship?

Dr. Thad Shattuck:

Yeah, it's really, I think it's complicated. I think that the teaching that I certainly had in residency was that if you have the sleep disturbance is usually secondary to the depression. And I think in many cases that's true. But I think now people are starting to acknowledge that maybe it's bi directional and that in some cases of depression, if you have insomnia, that could lead to depression. And I certainly think there are some people who develop insomnia and insomnia we know is a risk factor for depression who develop depression. So that's one aspect of it. We know that people who have a depression that's partially remitted, who still have sleep disruption, are at risk for relapse to depression. So I don't think we really fully know. We know that the only real clear biomarker that we have for depression, there's been some research on cortisol and stuff, but it's been sort of erratic. But we know that people who have a shortened REM latency, that's a clear marker, usually a pretty severe depression, melancholic depression. So we know there's alterations, but we don't know why that happens or what exactly it means. You know the medications that are most prescribed for depression, the selective serotonin reuptake inhibitors, they suppress rem. So it's not known if that's kind of a phenomena of just another mechanism or if that actually is therapeutic. The fact that they delay the onset of REM during sleep, REM usually comes later in the night and depression, it seems to come earlier for some reason.

Dr. Lisa Belisle:

And isn't it true that some of the medications that are prescribed, especially the serotonin, selective serotonin reuptake inhibitors, the SSRIs like Prozac and Zoloft and things like that, can actually cause sleep problems in people who are perhaps predisposed to them?

Dr. Thad Shattuck:

Yeah, absolutely. And it's not very well studied. But we do know that they can cause sleep problems. I would say that if you have moderate to severe depression and you go on an SSRI selective serotonin reuptake inhibitor, the chances are if you respond to it, it's going to help your sleep overall. But they sometimes can really disrupt sleep, so they can cause more activation during sleep. So sometimes we'll see people who have a. A tendency towards REM behavior disorder. We'll see them have more muscle twitchiness or actually have frank dream enactment during rem. By the same token, because they cause more activation, they can cause periodic limb movement disorder. We'll see people who will kick their legs every 20 to 30 seconds. And it's really thought that that can disrupt sleep as well. So, you know, they are not benign to sleep, as we once thought as.

Dr. Lisa Belisle:

And we also have seen there are medications that are used for depression that were also used for smoking cessation. And we saw that there are impacts on sleep for some people with those medications as well.

Dr. Thad Shattuck:

Yeah, absolutely. You know, it's really. It's almost hard to think of a medication like a psychotropic medication that doesn't have sleep effects. But, yeah, Chantix can cause very vivid dreams and Zyban or bupropion can really disrupt sleep, make it hard to fall asleep. So, yeah, they all seem to do something.

Genevieve Morgan:

What about the more common sleep disruptor? Snoring?

Dr. Thad Shattuck:

Yeah, snoring.

Genevieve Morgan:

Do you have a lot of people coming to the clinic with sleep apnea and snoring?

Dr. Thad Shattuck:

Yeah. I would say that the model of how sleep medicine is delivered now is tilted pretty heavily towards sleep disorder breathing. So I do see a lot of insomnia and some of these other parasomnias, the abnormal activity. But I see a lot of sleep disorder breathing. So, I mean, it's a question that I ask everybody. So there's a lot of snoring. I think some of the question is, wow, is snoring ever really benign or is it just a continuum? You do have what we call simple snoring all the way to severe sleep apnea, where somebody stops breathing 100 times an hour. And there's some evidence that maybe just the vibration from snoring is associated with increased thickness of the carotid artery. So we don't really know that kind of continued vibration. Does it predispose to other problems later on? We're not really sure, but I tend to think that there probably is just a simple form of snoring. But if it's benign over time, I don't know.

Dr. Lisa Belisle:

And isn't it true that people who do have disruptions in their sleep due to employment, such as being a medical resident or maybe you're a truck driver or you're a shift worker, isn't it true that that can have, over time, an impact on your health?

Dr. Thad Shattuck:

Yeah, definitely. There are some people who seem to be able to adjust well to both sleep deprivation and shift work, and then some people who don't adjust well, and it becomes more difficult to adjust over time, but it can have long term effects on your health. And there's been lots of research with different cohorts of people and workers, and we know that there's decreased fertility rates in nurses who work the night shift, increased rates of obesity, hypertension, and there's some evidence, sort of epidemiological evidence that maybe there's increased rates of cancer. So I think, you know, the real issue is being out of phase with what your normal circadian rhythm is. And we know that if some people can adjust, some people can't. And if every cell in your body's got a circadian rhythm and if they're sort of out of sync, then things are not working as efficiently and you're probably prone to weight gain and other problems.

Dr. Lisa Belisle:

And it can also impact other people around you. I mean, they changed all of the medical students and resident work hours because of problems that happen when people didn't get enough sleep and were trying to administer medications and other treatments. And also if you sleep, if you don't sleep well and you're gonna go out and drive a truck or drive a plane. So there's all kinds of things that we know impact other people by not sleeping well in our own lives.

Dr. Thad Shattuck:

Yeah. Yeah.

Genevieve Morgan:

Well, how do you feel about napping? Can you make up sleep and naps?

Dr. Thad Shattuck:

Yeah, I think napping can be very effective. I think it's great if you're sleep deprived. I'm very cautious about it with people who have insomnia because there's sometimes this compensatory mindset where people feel like, I'm not sleeping enough, I got to sleep more. So they'll go ahead and they'll try and sleep any opportunity they can, and they end up providing themselves more and more opportunity, but they end up spending a lot of time in bed when they're not sleeping. And that backfires, basically. But I think that if you're sleep deprived and you're about to go on a long trip, or even if you're driving and you're sleep deprived and you're starting to feel drowsy. Taking a power nap is a great idea and I think when you're older it's harder to get more consecutive hours of sleep, though your sleep need doesn't actually change. So napping in the afternoon is a great idea for a lot of people.

Dr. Lisa Belisle:

How can people find out more about sleep issues, sleep problems, and specifically where you practice? At St. Mary's center for Sleep Disorders,

Dr. Thad Shattuck:

we do have a website, so I think if you look at www.you'll be able to go ahead and find us there and contact us if you have a sleep disorder and you're interested in getting evaluated. In general, I think good resources are the American Academy of Sleep Medicine, so I believe it's www.aasm.net. the National Sleep foundation also has some good resources, so I would also try them.

Dr. Lisa Belisle:

Well, we've been talking with Dr. Thad Shattuck from the St. Mary's center for Sleep Disorders, which is up in Lewiston. Yes, and we appreciate your coming in and talking to us about sleep and dreams. I'm sure that people who have been listening will not have been put to sleep. In fact exactly the opposite, because you've been so fascinating in what you've had to tell us.

Dr. Thad Shattuck:

Thanks for having me.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you have been listening to the Dr. Lisa Radio Hour and podcast show number 48, Sleep and Dreams, airing for the first time time on August 12, 2012 on WLOB and WPEI Radio Portland, Maine. Today's guests have included Dr. Gary Ostrakhan and Dr. Thad Shattuck. If you would like more information about one of these individuals, please Visit our website drlisabelisle.com to let us know what you think about our show or perhaps suggest a future show. Go to our Facebook page DrLisa like us and send us a little note or perhaps send a comment to infodoctorlisabelial.com thank you for listening to our Sleep and Dreams show this week. We hope it's been thought provoking for you. We know it's been thought provoking for us. This is Dr. Lisa Belisle. Thank you for being part of our world. May you have a bountiful life.