Sleep Talk w/ Dr. Smita Patel

Episode Information

June 17, 2021

Integrative Neurologist and Sleep Physician Dr. Smita Patel talks about the importance of sleep, how to practice good sleep hygiene, how she takes care of her physical and mental health, and more.

Topics Include:

• Why she got into medicine and why she believes in integrative medicine
• Why getting enough sleep is so important
• The effects of lack of sleep on metabolism
• The different stages of sleep
• REM sleep and why it’s important
• Practicing good sleep hygiene
• The loneliness epidemic
• How she takes care of her mental health
• Her plans for Doctorpedia’s Sleep Channel
• New innovations in sleep and wellbeing
• Her personal health philosophy

Highlights

• “If we didn’t need sleep, then we would have already evolved out of it. The fact that we haven’t is that we still critically need this for health and longevity.”
• “Sleep is really necessary. It really can change your look on the world.”
• “Kids are known to have a lot of deep sleep, slow wave sleep. And so when you have an environmental noise, like a fire alarm, it requires a really loud noise to wake them up because the threshold is so high for them, as opposed to an adult or an elderly person where they’re not having as much slow wave sleep as a child, and so the threshold to wake them up out of sleep isn’t that high.”
• “Working on lifestyle habits like reducing stress, having like a nice evening ritual before bedtime, maybe it’s listening to music or reading a book, taking a warm bath, helping yourself relax, and then staying on a sleep schedule, I think can help minimize your teeth grinding.”
• “We really want to kind of detach the electronics from the bedroom, if at all possible.”
• “Loneliness is probably like another epidemic or pandemic, which we may not have realized until COVID really enhanced it.”
• “I tell my patients to have a [bedtime] ritual. Some people meditate, some people do yoga stretches, exercises, and some people journal, even.”
• “I think sleep is a little underrepresented in minority groups. So I would like to bring more awareness about sleep in those demographics. And then I think we need to talk about some other [ways] to get better sleep.”
• “My triad is getting good sleep, exercising, and eating healthy. And so that’s what I feel like are my three pillars. And I wish that to everyone, because I do really think those three things are the foundation for good health.”
• “I’ve been using a lot more meditation apps. Right now I’m using Headspace and I find that does help me kind of recalibrate. I think like swimming or riding a bike, practice makes perfect, because I was probably one of those people who were like, “I can’t meditate. I can’t focus.” My mind keeps jumping around, but I do think that with practice, you do get a little better at it, so it is worth practicing and reaping some rewards out of it.

Relevant Links

• Doctorpedia Profile
• iNeuro Institute Website
• Dr. Patel’s Instagram
• Article: Insomnia Myths vs. Facts

Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

Daniel Lobell: (00:19)
Hello and welcome to the Doctorpedia podcast. I’m your host, Daniel Lobell and it is my great honor today to be joined on the phone by Dr. Smita Patel. How are you?

Dr. Smita Patel: (00:29)
I’m great. Thank you for having me here.

Daniel Lobell: (00:31)
I’m excited to talk to you. I am so excited about some of the things I’ve researched on you, and I know that you’re a big believer in the holistic approach to health, and I’m so curious about that stuff and I want to get into it, but I have to stop myself because I like to first hear a little background on the doctors I’m speaking to. So why don’t we start at the very beginning? Where are you from? Where were you born? Let’s start there.

Dr. Smita Patel: (00:57)
Okay. I grew up in the Midwest. I was born in Evanston, Illinois, and I grew up there, [?] specifically. And then I moved around a little bit, but didn’t go very far. So I did some neurology training at Medical College of Wisconsin, and then came back to university of Chicago for my sleep training. And then I did a two-year fellowship at the University of Arizona with Andrew Weil doing integrative medicine. And now I’m back in Chicago.

Daniel Lobell: (01:38)
What is integrative medicine?

Dr. Smita Patel: (01:40)
Integrative medicine is, I guess, defined as more of a healing oriented medicine. So it takes into account the whole body, the whole person, mind, body, and spirit, and then as well as aspects of lifestyle. And so we integrate it with conventional medicine and trying to find the right mixture of therapy to try to help you with healing.

Daniel Lobell: (02:08)
So that could be healing on about anything essentially.

Dr. Smita Patel: (02:13)
Exactly.

Daniel Lobell: (02:14)
It’s broad. Yeah. Go on. Sorry. You were going to say something.

Dr. Smita Patel: (02:19)
Yeah, I was just going to say so again, my focus has been more on the sleep and neurology mindset. But of course we do have to take into account your stomach and how you’re digesting… So there’s other aspects of sleep that I will bring into a conversation with my patients, because I want to take that whole body approach.

Daniel Lobell: (02:51)
So that’s really interesting to me. The gut plays a big part in the sleep process, I think that’s what you’re saying in summation. Is that a correct analysis?

Dr. Smita Patel: (03:01)
So, I mean, of course I was just giving an example, but sleep can impact our heart health, our immune system, our metabolism, and vice versa. So I wanna make sure that we take into account all of those systems when we come up with a therapy,

Daniel Lobell: (03:24)
It’s a shame that you’re so interesting so far, because if you weren’t, perhaps we could put the audience to sleep and that would be healthy for everybody.

Dr. Smita Patel: (03:33)
Of course!

Daniel Lobell: (03:36)
[Both laugh] Maybe we should play some kind of a trance in the background or…

Dr. Smita Patel: (03:43)
I was just going to say, you can’t have wellness without good sleep.

Daniel Lobell: (03:47)
And that has been my biggest struggle. Man. I’m so excited to talk about the sleep stuff. I’m going to stop myself. I’m going to go back. What made you decide to go into medicine? Let’s backtrack a little bit.

Dr. Smita Patel: (03:59)
So I went into medicine probably for a mixture of reasons. A little bit of family influence as well as my interest in math and science, which led me into medicine, and I couldn’t be happier. I feel as though there are times in my career where I probably felt a dip, when I wasn’t getting enough sleep and I just had negative thoughts, but really it’s not only my career now, but it’s really a hobby for me as well.

Daniel Lobell: (04:31)
So you are a sleep and wellness specialist. Is that the title that you would go by?

Dr. Smita Patel: (04:37)
I would go by that, or you can call me an integrative neurologist and sleep physician.

Daniel Lobell: (04:42)
So when you go to school to study sleep, if you sleep through the classes, is that an A? Is that like an instant A?

Dr. Smita Patel: (04:50)
No that wouldn’t probably be an A but, it’s a laughing matter now, but when I was in residency, I feel like I did sleep through a lot of classes. Only because of the amount of time that I spent not sleeping, just with taking call and overnight things where you have really disrupted sleep. So I really did think there was a problem with me, because I had a hard time staying awake. It wasn’t until later in residency that I learned about sleep and made me want to do a fellowship in it.

Daniel Lobell: (05:32)
So that’s when you decided to put your focus on sleep, it was because of medicine itself that pushed you towards sleep.

Dr. Smita Patel: (05:40)
It made me realize that we’re not messing around, sleep is really necessary. It really can change your look on the world.

Daniel Lobell: (05:52)
My biggest struggle has been getting a full night’s sleep. I always get a second wind right around 10 o’clock when I want to go to sleep. That’s when I get like super energized and I always tell myself, “I’m going to force myself. I’m going to push through it.” And day after day and week and month and year after year, I just don’t get to sleep until like midnight, one in the morning, two in the morning. What’s the trick? Is there some kind of trick to make yourself go to sleep at a certain time?

Dr. Smita Patel: (06:20)
I think what we should probably first talk about is that suprachiasmatic nucleus, right? That’s a big long word for the master clock in our brains, which really dictates our sleep schedule. And so when it sees light, it makes you want to be more awake and alert. And when it sees darkness, or the lack of light basically is darkness, and therefore, you tend to want to go to sleep. That’s when melatonin comes out and it kind of brings on this more of a sedative effect. And so this little clock in our brain is regulating all our other hormones and physiology in our body. And that’s what we need to try to retrain for you. If you’re really trying to go to bed earlier, it can be done, but it might take a little step-wise approach, following like a little calendar, if you will. And then also making sure that we’re regulating the light cycle, so that you can use that as your strongest modulator to try to help you get to sleep.

Daniel Lobell: (07:37)
So you mentioned the importance of sleep, but what we haven’t talked about is, why is it so important? Maybe we can break it down for the listeners in a way that would be informative and interesting rather than just to say, “Well, so you don’t feel tired when you sleep.” But what is really going on when we sleep and why is it so important?

Dr. Smita Patel: (07:57)
Well, first of all, I want to start with evolution. So if we didn’t need sleep, then we would have already evolved out of it. And the fact that we haven’t is that we still critically need this for health and longevity. And so there’s studies in people who have tried to stay awake for many days, and clearly it impacts them. So that’s first of all, and even if you just stay awake sometimes for a couple hours, maybe when you celebrated New Year’s, this past year, you know, you might’ve stayed awake a little longer than usual and the next day you’re feeling it. And luckily you get to sleep in if you didn’t have to go to work. But that’s when you’re starting to notice the importance of just even a little lack of sleep, trying to celebrate a major new year and you can feel the impact of it.

Daniel Lobell: (09:01)
So what is that impact that we’re feeling? What’s going on there?

Dr. Smita Patel: (09:07)
Sure. So when you don’t get enough sleep, there’s other — well, first of all, you might feel fatigue or sleepy. And we can distinguish the two as well, but really what we’re talking about when you don’t get enough sleep is that you’re feeling sleepy and you’re depriving yourself of the hormones that are regulated because of what happens when you go to sleep. So there’s influencers when we go to sleep, I don’t know how to break that down really… Like our immune system, our metabolism, all are impacted when we don’t get enough sleep.

Daniel Lobell: (09:50)
So when we talk about metabolism, the first thing that comes to my mind is, because I’ve always struggled with my weight, is weight loss. How connected is our weight to our sleep?

Dr. Smita Patel: (10:02)
So sleep and obesity, sleep loss and obesity, is very well documented, in the literature. And so we know that lack of sleep can impact your hormones which help you maintain weight. So, for example, again, just what we call partial sleep deprivation. That’s where you didn’t pull an all-nighter, but you deprived yourself of sleep by so many hours. And so if we just talk about if a person sleeps normally eight hours and they only got six or four hours that night, we know the impact that can happen on their hormones, which is a decrease in a hormone called leptin, which makes you feel full. So without that leptin hormone, you would feel hungry. And then there’s an increase of a hungry hormone, which is called ghrelin. And so with an increase of ghrelin, you’re feeling even hungrier. So it does lead to increased hunger and appetite, by you depriving yourself of sleep.

Daniel Lobell: (11:18)
What is really going on in the body when we’re sleeping? Are we — I know that cells are re — this is my very basic nonmedical understanding. Our cells are rejuvenating or our body is repairing itself? That’s about the extent that I understand. Is there more to it?

Dr. Smita Patel: (11:38)
I mean, there’s a lot of cleaning up going on, of course. And so our cells are rejuvenating and dead cells, if you will, are also being excluded. So we know that there’s something called the glymphatic system and that’s different from the lymphatic system. That’s a newer discovery, if you will, where, when we go to sleep — because it only happens when we go to sleep — the glymphatic system turns on and helps get rid of toxins. And these are the toxins that can impair memory and actually have been known to be associated with causing things like Alzheimer’s disease, for example.

Daniel Lobell: (12:21)
Can we restore them once they’ve been damaged? Can that be reversed?

Dr. Smita Patel: (12:26)
Well, I mean, I guess that’s a loaded question because I’m not sure how long what we’re talking about. So I do feel that there’s always hope that we can rejuvenate the brain by getting you proper sleep. But of course, if you’ve been doing certain damage, it might just take a little bit longer to repair. And of course, if you’ve already got the problem, let’s just say Alzheimer’s dementia, at this point, fixing your sleep might just be a lot harder, just because now the pathology has set in and there’s other complications going on when you have Alzheimer’s dementia.

Daniel Lobell: (13:04)
I remember learning as a kid from a rabbi that when you sleep, that’s 1/60th of death. Is there any corroboration between the science and religion on that? I’m just curious.

Dr. Smita Patel: (13:19)
I’m not aware of that. So again, when we sleep, we are doing a lot of repair as well. We spend a third of our lives sleeping. You can say that. Because we’re supposed to get about eight hours of sleep.

Daniel Lobell: (13:32)
I know that from a mattress salesman.

Dr. Smita Patel: (13:38)
[Both chuckle] So we do spend a lot of time sleeping.

Daniel Lobell: (13:41)
Uh huh. I wonder if they ever did invent a pill where you wouldn’t need to sleep, I guess it would still be destructive to your body, right?

Dr. Smita Patel: (13:53)
Absolutely. Because again, right now, sleep is really a basic need and we wouldn’t be able to have optimal health without it.

Daniel Lobell: (14:04)
I always think it’s so interesting that like, everybody just like powers down at the end of the day. It’s like the world is still here when you wake up. I just, I don’t know. For me it always kind of boggles my mind that everybody’s just like unconscious for a huge amount of their life or semi-conscious. How conscious are we when we sleep?

Dr. Smita Patel: (14:25)
Well, we shouldn’t be conscious when we sleep, because we’re going into sleep. So we’re not as in tune to the noises and things that are going on in our environment, unless it reaches a certain threshold, then we would be able to hear it. So for example, you’ve heard of people who can through fire alarms. Usually those are kids. Because they have so much deep sleep going on. So we need to have — when we are going to sleep, we have deep sleep. And so you need to reach a certain threshold when it wakes you up. So environmental noises, things like this can — you’re not in tune to them when you’re sleeping, unless it reaches that threshold for you. So for example, I was going to say with kids, they’re usually such deep sleepers because they have a lot of slow wave sleep and it requires a lot to wake you up from that. So they have been known to sleep —

Daniel Lobell: (15:34)
I want to pause you — did you say slow wave sleep?

Dr. Smita Patel: (15:39)
I did say slow wave sleep.

Daniel Lobell: (15:41)
What does that mean?

Dr. Smita Patel: (15:43)
Yeah, so we call it the different stages of sleep. And so we, in the sleep world, sleep positions, when we look at how you sleep, we put those electrodes on your head during a sleep study, we’re able to see the brainwave patterns. And off those brainwave patterns we can label it as light sleep, deep sleep or slow-wave sleep, and then REM sleep. So rapid eye movement. And so kids are known to have a lot of deep sleep, slow wave sleep. And so when you have an environmental noise, like a fire alarm, it requires a really loud noise to wake them up because the threshold is so high for them, as opposed to an adult or an elderly person where they’re not having as much slow wave sleep as a child, and so the threshold to wake them up out of sleep isn’t that high.

Daniel Lobell: (16:42)
I wonder if that’s because kids are not as scared as adults, they can trust that we’re going to take care of things. Whereas we are like, “No one’s taking care of things. We’d better get up.”

Dr. Smita Patel: (16:51)
Oh, it’s true. Maybe adults have a lot more worry and racing mind, thoughts of everything that’s going on. So it’s possible.

Daniel Lobell: (17:04)
So that’s where the term “sleep like a baby” comes from. I never knew that. Because I remember when my baby was born, she’d wake up screaming all the time. I’m like, “I don’t want to sleep like a baby, who came up with that term?” But now I get it. It’s slow wave sleep.

Dr. Smita Patel: (17:17)
Slow wave sleep, and the amount of REM sleep that babies have too, which is another form of deep sleep, if you will, they have a lot more of it. We all kind of even out when we become adults, but babies definitely have more.

Daniel Lobell: (17:34)
Slow wave sleep sounds like a radio station. Like “Slow wave sleep, playing all the hits.” One of those like cool jazz, relaxing, “Welcome to slow wave sleep CD 101.5.” I don’t know.

Dr. Smita Patel: (17:49)
[Both chuckle] That would be awesome.

Daniel Lobell: (17:53)
Those radio stations do put me to sleep, but REM sleep has always been interesting to me because I always thought of it as like a nightclub, like people always talking about, “Did you get REM?” Like, no, I didn’t get into REM. Like it’s like this exclusive kind of sleep. What is so good about REM sleep? Why is it that people want to get into REM so badly?

Dr. Smita Patel: (18:14)
So REM sleep is very interesting because, rapid eye movement sleep is what it stands for. And the only part of your body that’s moving when you’re in REM sleep is your eyes. Of course, you’re breathing. So your diaphragm is moving, but no other muscles are moving during that stage of sleep. So you’re paralyzed, if you will, but your eyeballs are moving. And this again is just — what some people think of it as is a stage where you’re dreaming, but other physiological things are happening during REM sleep. And again, that has to deal with memory, and repair and consolidation of memory. So that’s what’s so interesting about REM sleep. And when we become adults, about 25% of our sleep should be in that stage. Of course, these things change if you’re on medications and how you’ve slept the night before, other influencers can impact how much of the REM sleep we get in our lives.

Daniel Lobell: (19:28)
What are some of those influencers?

Dr. Smita Patel: (19:30)
So again, REM sleep can be influenced by medications, for example, people who take anti-depressant medications can have low amounts of REM sleep. So how you slept the night before, if you didn’t sleep that much, for example, you shortcut your sleep because you wanted to watch TV, you might not have gone into your full cycle that night. So now when you’re going to sleep the next night, you might have more REM sleep. So those are types of influencers that can happen in our sleep cycle. And overall what we want to truly try to aim for is a regular pattern of sleep. We want to make sure that you’re getting to bed at the same time and waking up at the same time and trying to follow your circadian rhythm.

Daniel Lobell: (20:29)
So before I ask you about the circadian rhythm, because that’s another one of those things that I’ve been hearing forever, and I just don’t even really understand what it is, but wouldn’t it stand to reason that if you got enough sleep, you’d be naturally not depressed. So taking the antidepressant, which is preventing you from getting the good sleep, is actually counter-intuitive, am I wrong?

Dr. Smita Patel: (20:56)
I guess it’s a little more complicated than that. I mean, for some people, the antidepressant does help them with their sleep, but it might impact the stages of their sleep. So I wouldn’t necessarily put electrodes on my patients just because they’re on medications, for example. So unless they’re telling me that they’re not sleeping well, or they have impact of it, that’s when we would try to investigate further.

Daniel Lobell: (21:27)
Yeah. I hear ya. So what’s the circadian rhythm? What does it mean? And does it come with blues? What’s the story?

Dr. Smita Patel: (21:39)
[Smita chuckles] Okay. So circadian rhythm is following our natural body clock. And so our circadian rhythm has a cycle, if you will. So during the day, once we wake up in the morning and we’re feeling our most energetic selves, as afternoon comes, we might kind of go into a little dip, just because again, that’s part of the rhythm where you might feel a little sleepy. And then you might cycle back up towards the evening and then, like dinner time-ish.

Daniel Lobell: (22:28)
That’s me.

Dr. Smita Patel: (22:28)
And then in the evening evening, when it’s time to go to bed, you’ll start feeling sleepy again.

Daniel Lobell: (22:35)
That’s not me.

Dr. Smita Patel: (22:35)
So it has kind of a oscillating type of rhythm to it. There’s another part to it though, of course, which is our homeostatic drive.

Dr. Smita Patel: (22:46)
So I often think of that as a battery. Everyone has a phone, mostly, these days. And so when you charge up your phone, you’re at a hundred percent, and as the phone is used, you’re draining the battery. And so again, that’s very much like our bodies, we’re kind of getting drained and then — but if you didn’t charge it with a nap, which I’m not telling you to do so or not so, but I’m just saying, if you don’t charge it and if you will, so by evening, you’re feeling sleepy and you’d want to go to sleep.

Daniel Lobell: (23:25)
Have there been any interesting studies that you’ve seen about people in Spain who have a dedicated siesta time and how their sleep is impacted and their health is impacted versus the rest of us who go right through the day?

Dr. Smita Patel: (23:43)
I have not looked into that research, but I have to say, I feel a little siesta time does give the body an ability to rejuvenate. So they are doing something that Americans really don’t do. And maybe we should be.

Daniel Lobell: (24:03)
I say, I’m for siesta and fiesta, any one of those things. [Smita chuckles] Come on, bring it on! All right. This is something I wanted to ask you, and I’ve been thinking about it since my dentist told me this the other day. I grind my teeth in my sleep, and I get a night guard for them. And he said, “You know, you can also train your brain not to grind your teeth in your sleep.” I said, “But I’m not aware. I’m not conscious that I’m doing it.” He said, “Well, we are somewhat aware in our sleep.” He said in the same way that you train yourself when you’re a child not to pee the bed, and then you know I got to wake up and use the bathroom, you can still train your brain not to grind your teeth. I thought that was so interesting. What else can we train our brain to do when we’re sleeping? And what is the medical understanding of all this?

Dr. Smita Patel: (24:55)
Well, first of all, when we talk about teeth grinding, I would say that, yes, the way you can train yourself is by having good sleep habits. And keeping on a regular schedule. Sometimes, have to have my patients who have teeth grinding wear a mouth guard just to protect their teeth.

Daniel Lobell: (25:17)
Right. That’s what I do.

Dr. Smita Patel: (25:17)
Yeah. So again, wearing that, working on lifestyle habits like reducing stress, having like a nice evening ritual before bedtime, maybe it’s listening to music or reading a book, taking a warm bath, helping yourself relax, and then staying on a sleep schedule, I think can help minimize your teeth grinding. So I think, again, when we’re talking about what else can we be doing to improve our sleep, it still really kinda comes down to following basic sleep hygiene, if you will, practices.

Dr. Smita Patel: (25:57)
So we talk about sleep hygiene, just like when we have other kinds of hygiene for our bodies. And so sleep is when we talk about how do we keep it clean or how to keep yourself on a routine. And so that’s where sleep hygiene comes into play. And so we want to be consistent with bedtime and wake time by sticking to a sleep schedule. If you have to take naps, I would say limit naps to 20, 30 minutes during the day. It’s really good habit to maybe turning off or dimming the lights, stepping away from electronics. These days, I think with coronavirus, we’ve been kind of attached to our computers and a lot of people are working from home. And so with a lack of space in their living environment, they might have to be on their bed. And so we really want to kind of detach the electronics from the bedroom, if at all possible.

Daniel Lobell: (27:03)
Like a dedicated sleep space, not to bring something else into it, because it will change the way you relate to the space.

Dr. Smita Patel: (27:12)
Yes. Because we make that association. So we really want to kind of preserve our sleep environment, nice healthy mattress… Like you did some mattress shopping and you want to have a cool room, you want to make sure that it’s conducive to sleep.

Daniel Lobell: (27:31)
You’re starting to make me think I should stop eating on the treadmill. [Both chuckle] I’m kidding, of course. It’s interesting you brought up COVID-19. I know that a lot of people’s mental health has been impacted for the worst over this time. What are some of the valuable coping mechanisms, tips, and strategies that you’ve been giving your patients over the past year?

Dr. Smita Patel: (27:59)
First of all, I think COVID has really enhanced or really brought light to another problem. The other problem is the amount of loneliness that’s been going on. And even before COVID, loneliness was still a problem. Now with COVID, it’s really just kind of highlighted that impact of loneliness, and that we’re being forced to separate from our friends and family, our activities and everything else. So this really kind of impacts our mood. And so we know that loneliness is associated with higher rates of depression and anxiety and that can impact your sleep. And so again, if you’re really anxious, for example, it might give you a little bit more difficulty falling asleep, maybe even staying asleep.

Dr. Smita Patel: (29:06)
And so we try to, again, from an integrated perspective, is looking at that whole picture, see what else is going on. And so I’ve been really kind of trying to tell my patients to have some social interaction with a friend, over FaceTime or with Zoom, if they have the ability to make that connection. They can go outside with a buddy, get some movement in the day, put your masks on and take a little walk. I think it’s also important to just try to learn something new, try to take your mind off of other things that are going on. And by learning something new, that gives you an opportunity to — another mental stimulating activity, right? And you can improve your skills that way, whether you’re learning a language or you’re playing an instrument, I think it’s very helpful and can kind of also help with going back to the problem. It helps your mood and it also maybe helps your sleep.

Daniel Lobell: (30:18)
Interesting. So really social interaction is playing a huge part in all of this.

Dr. Smita Patel: (30:24)
Well, of course. I mean where we are human beings and we do want that social interaction. And so these are things that — loneliness is probably like another epidemic or pandemic, which we may not have realized until COVID really enhanced it.

Daniel Lobell: (30:51)
And it also sounds like an album, the epidemic of loneliness, it sounds like an old jazz album. Here’s another question I have for you. My wife takes melatonin every night to go to sleep. Are you for that? Against it? And what’s it really doing for her?

Dr. Smita Patel: (31:06)
I’d like to ask your wife, does she feel any benefit from it? So a lot of times people take melatonin because it’s all they know. And it’s something that they think helps them. A lot of times my patients find that they’re taking it, but it doesn’t actually help them. And so usually I would say that melatonin probably works best for people who have a circadian rhythm problem. So that means, back to that sleep cycle, if they’re traveling different time zones, if they have a work where they’re doing shift work. So truck drivers or nurses, people who are working different shifts and those people may benefit from melatonin more so than, I feel, just anybody who can’t sleep.

Daniel Lobell: (32:00)
What is melatonin?

Dr. Smita Patel: (32:03)
Melatonin is a herb. It’s also a hormone, and our bodies do naturally make it, and it kind of peaks in the evening when there’s dimmer lights. Of course, if we’re constantly in front of light, then we might not make the melatonin that night. So again, that’s where sometimes people wear glasses to kind of block out the blue lights that can impact our staying awake and influence that circadian pacemaker, the suprachiasmatic nucleus. And so those are some little tricks that we can do. I think stepping away from the computer makes the most sense.

Daniel Lobell: (32:52)
So they’ve basically replicated the light that keeps us awake in the computer, is what you’re telling me.

Dr. Smita Patel: (32:58)
Yes.

Daniel Lobell: (32:59)
Wow. So there’s something — how do they do that? What’s going — blue light, I mean, where else do we find blue light? Is that from the sky and your computer and that’s about it?

Dr. Smita Patel: (33:11)
Honestly, I’m not the light expert by any means, so I’m not going to sit here and act like I am, but we do know that electronics, the TV, those are big sources of blue light. And so we really want to try to block some of that out as we’re trying to go to sleep. So in the evening hours, having a shutdown period where you’re kind of stopping all those electronics and doing something else, like reading a book, an actual book, not on your phone. Listening to some music, maybe doing some yoga stretches to try to help you kind of unwind, would be good strategies to try to try to do it before going to bed.

Daniel Lobell: (33:57)
So you mentioned yoga and that’s a good lead into something that I teased earlier in the interview when I said that you’re a big believer in the holistic approach to health. What are some holistic techniques that you often suggest to your patients?

Dr. Smita Patel: (34:12)
So again, I might change that based on what a patient has gone through, but absolutely, I would tell them to get into a ritual. Have a set bedtime, right before bedtime, there’s some things you might want to do. Could be read a book, it could be be just wash up and change into your favorite pajamas. Kind of following some kind of ritual that you might want to do. Some people meditate, some people do yoga stretches, exercises, and some people journal, even, so just kind of writing their thoughts out, whatever they’re grateful for. Those are some tips that I have shared with my patients.

Daniel Lobell: (35:01)
What are some standard treatments that you use?

Dr. Smita Patel: (35:04)
Well for sleep, again, I’m not necessarily pushing pills to try to help them sleep and there’s different kinds of sleep disorders. So it would change the way I can tell you about what we would do. We talk a lot about maybe insomnia or not getting enough sleep. But there’s other sleep disorders like sleep apnea and restless legs, narcolepsy, and so those would require different non holistic treatments that have its own guideline.

Daniel Lobell: (35:40)
Okay. Because I was looking on your website earlier and I think it said you integrate medication management with mindful techniques. And I was kind of curious, that’s what my question was leading to. What are these medication managements and mindful techniques and how do you merge them?

Dr. Smita Patel: (35:56)
So again, there’s some conversation with the patients usually, about what they’re able and willing to do, and not everyone is ready to meditate. But if you are, I do find that it’s a nice practice, to try to help you with relaxation. And so those could be some strategies that we discuss to try to help you with getting better sleep and better daytime feeling too.

Daniel Lobell: (36:26)
I want to shift for a second to talking about the doctor-patient relationship. What are some of the most important facets that you would say in the doctor-patient relationship?

Dr. Smita Patel: (36:37)
I think that there’s a couple of things that jump out to me in the doctor patient relationship, but first and foremost, I think trust. I think a patient needs to understand — well, first, I probably need to understand the patient, but also, patient needs to understand me as well, that I’m really there to listen and to guide and to advocate for their health. And so I think that is important for me.

Daniel Lobell: (37:15)
What’s the biggest compliment that a patient can give you?

Dr. Smita Patel: (37:18)
Oh, I guess a referral, to one of their loved ones… [Both laugh]

Daniel Lobell: (37:26)
I ask that question to all the doctors. It’s the first time I’ve gotten that answer. It’s funny. And it makes sense. Do you personally engage with any apps to monitor your health?

Dr. Smita Patel: (37:36)
I do. I’ve been using a lot more meditation apps. So right now I’m using Headspace and I find that does help me kind of recalibrate. I think like swimming or riding a bike, practice makes perfect, because I was probably one of those people who were like, “I can’t meditate. I can’t focus.” My mind keeps jumping around, but I do think that with practice, you do get a little better at it, so it is worth practicing and reaping some rewards out of it.

Daniel Lobell: (38:12)
So I bring up the online space, of course, to lead into Doctorpedia, which is — shout out to Doctorpedia, the podcast we’re doing. And congratulations, I hear that you are the newly appointed CMO of Doctorpedia’s Sleep and Wellbeing channel. So congrats on that!

Dr. Smita Patel: (38:27)
Thank you. We’re excited about it.

Daniel Lobell: (38:29)
Yeah. So what are some of the unique viewpoints you’re hoping to bring to the channel and what can people look forward to finding there?

Dr. Smita Patel: (38:35)
So I think sleep is a little underrepresented in the minority groups. So women, I think, other race and ethnicity groups, as well as the LGBTQ community. So I would like to bring more awareness about sleep in those demographics. And then I think we need to talk about some other wellbeing sources of how to get better sleep, and really discuss that.

Daniel Lobell: (39:17)
What are some tips, if you haven’t covered them already, that we can give the listeners to get better sleep? I know you said make a sleep schedule, get rid of blue light, keep a dedicated space — these are just some things that are coming to mind from the interview — that you sleep in, make sure it’s dark… What, if anything, have we not covered that you might want to add for listeners to pick up on?

Dr. Smita Patel: (39:43)
Yeah, I think we have been talking about good sleep habits throughout, and I would agree to the ones you already mentioned. I think we can also add just not having your heavy meal right before bedtime. So ideally I’d like to see your meal at least three hours before bedtime. I think that’s another healthy tip along with all the other ones you talked about.

Daniel Lobell: (40:13)
Does that go back to what we were talking briefly about at the beginning of the interview with regards to what’s going on in your gut when you sleep? Is that — I’m just spitballing of course, not a medical person, but just guessing. And if your body is too engaged in breaking down a big heavy meal, it’s taking away from the energy that you need to get good sleep. Is that a correct analysis?

Dr. Smita Patel: (40:37)
I understand the way you’re thinking and I would say yes, but I also think that again, we have research on food impacting your sleep. So what you choose to eat also determines how well you sleep. So for example, we know that from research that people who eat diets high in sugar and refined carbs tend to take longer to fall asleep and wake up more frequently during the night as well.

Daniel Lobell: (41:03)
That’s so interesting. Do you know why that is?

Dr. Smita Patel: (41:05)
So we know that, again, it gets into more of the metabolism of what’s happening and so that’s what I can say, when we looked at those people, having those diets and we’ve done sleep studies with them. So again, that’s kind of what we’re seeing, is that when we have two groups, two different modalities of what they’re doing, those are some of the findings.

Daniel Lobell: (41:32)
I know that anytime I eat meat before I go to sleep, I have like scarier dreams. And I just always kind of thought that was more like a spiritual thing. Like you’ve eaten murder essentially, and therefore it’s flowing around in your body. Is there anything scientific to that? Or is it just me?

Dr. Smita Patel: (41:51)
I think if you’re not sleeping well, for example, right, poor sleep can influence diet, so people who don’t sleep that well or are not getting enough sleep may intake more fat, protein, bad carbohydrates. And then are you just kind of putting yourself into a vicious cycle. So you’re eating that way and then you’re not sleeping well. And the cycle continues.

Daniel Lobell: (42:20)
Are nightmares associated with poor sleep, or can you have like really deep sleep, but a nightmare as well? What’s the connection between dreaming and sleeping?

Dr. Smita Patel: (42:28)
Well, I think nightmares might just be an independent thing. I think some people have nightmares and they might sleep, just get enough hours. I don’t think it’s necessarily related to their diet or something like this. I have some patients who take melatonin, for example, and they get some nightmares, so again, it can be influenced from other reasons. And so just evaluating and looking at that patient individually and figuring out how to try to minimize their nightmares is what I would do.

Daniel Lobell: (43:04)
I have a friend who suffers from sleep paralysis. What is that? And is it something that you deal with?

Dr. Smita Patel: (43:09)
That is something that a sleep specialist would deal with, yes.

Daniel Lobell: (43:13)
I didn’t mean you personally, but what’s going on there for my friend?

Dr. Smita Patel: (43:19)
So sleep paralysis is a nonspecific problem. So people who have sleep paralysis doesn’t mean that they have necessarily a specific sleep disorder, if you will. It is more tied to someone who has narcolepsy, so if someone is diagnosed with narcolepsy, they might have episodes of sleep paralysis. And that’s sounds exactly what it sounds like. Your body, you’re awake, but you’re not able to move your body. And that’s probably a strange feeling.

Daniel Lobell: (43:58)
What is narcolepsy?

Dr. Smita Patel: (43:59)
So narcolepsy is basically the inability to regulate your sleep wake cycle. So we like to think of narcolepsy as, I think, most people think of it as like these people just fall asleep. Well, yeah. But I think the problem is more that they’re unable to regulate their sleep wake cycle. So it’s not just they’re lazy or something else, it’s a genetic problem.

Daniel Lobell: (44:34)
Yeah. I remember it from the movie Rat Race, but I was wondering like what causes it and is it — you’re saying it’s genetic, yes?

Dr. Smita Patel: (44:42)
Yes.

Daniel Lobell: (44:43)
And is there any kind of treatment that you’ve found that has helped it, or anything to stop it?

Dr. Smita Patel: (44:52)
We don’t have necessarily a cure for narcolepsy, but we do have numerous medications to try to help you manage it. And we can manage it effectively, I feel. Luckily there’s always new medications coming out. And so those look promising and we’ll see how it works out.

Daniel Lobell: (45:14)
Are there any innovations coming up in the field of sleep and wellbeing that you’re super excited about?

Dr. Smita Patel: (45:21)
So there’s a big movement with the American Academy of Sleep Medicine where we want to not have to change our clocks. So right now we’re living in standard time come March. We would normally try to switch, not every state participates in this, but for those states that do, we would change our clocks to what we call daylight savings time. And spring forward, right? Fall back. So we wouldn’t have to hopefully change our clocks anymore, which has a variety of health benefits. So I’m looking forward to seeing what comes of that and where we go with that. So it would be nice to be able to talk to people in Arizona, for example, without having to say, “What time of year are we in? Are we two hours behind or one hour?” You know? So yeah.

Daniel Lobell: (46:26)
I remember actually to your point, reading an article that day with the highest rate of suicide per year is the day that the people change the clocks.

Dr. Smita Patel: (46:35)
Right. So even just that one hour change has, like I said, other health problems associated with it. And so I’d like to see what comes of this.

Daniel Lobell: (46:47)
It seems like there’s a really strong connection between mental health and sleep. Can you speak to that a little bit?

Dr. Smita Patel: (46:52)
I think I keep going back to, without sleep, you can’t have wellness. And so we know that when you don’t get enough sleep, good quality sleep, following your circadian rhythm, that you are more at risk for mood disorders, heart problems, immune system problem, your metabolism being impacted. And so there is all of those connections.

Daniel Lobell: (47:29)
That’s really interesting. Doctor, thank you so much for taking the time to speak to me. And again, you did anything but put me to sleep. It’s very interesting. I ask all the doctors this at the end of the interview, and I’ll ask you as well: What do you personally do to stay healthy?

Dr. Smita Patel: (47:47)
I really try to follow the triad. So my triad is getting good sleep, exercising, and eating healthy. And so that’s what I feel like are my three pillars. And I wish that to everyone, because I do really think those three things are the foundation for good health.

Daniel Lobell: (48:11)
And when you say eating healthy, is that basically also one of those things you’d say is different for every person, or are there certain things that you specifically recommend for everyone?

Dr. Smita Patel: (48:20)
Well, of course there could be individual differences, of course. Like people who have allergies or something to certain foods or sensitivities, but in general, I really would like to really stress leafy greens, fruits and vegetables, legumes, nuts and seeds, healthy fats. So those I think are good for everybody, minus the people who have an allergy to nuts, et cetera. So in general, those would be my recommendations.

Daniel Lobell: (48:53)
All right. Thank you so much, Dr. Patel, and I hope you enjoyed this interview as much as I did!

Dr. Smita Patel: (49:07)
I did, thank you very much!

Daniel Lobell: (49:07)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.