What Happens During Sleep: Brain 'Garbage' Clearance

The guest for this episode is sleep expert and medical communicator par excellence, Dr. Roger Seheult. With his certification in sleep medicine, he will tell you why you need to get enough sleep, along with how much is enough. If you find you have trouble sleeping, what can you do about it? Dr. Seheult has a lot of practical suggestions that go far beyond sleeping pills.

At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While our goal with these conversations is to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How to Listen:

You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Oct. 27, 2025.

Why Is Sleep Important?

Dr. Seheult likens our body to Disneyland. The Magic Kingdom requires a lot of upkeep–trash removed, rides inspected, shelves restocked, weeds pulled and so on–but it wouldn’t be nearly as magical if workers tried to do those chores during the day when visitors are present. Instead, they take care of all that maintenance at night when the park is closed. Our bodies also need a certain amount of “trash removal” and other upkeep. Some of that happens while we are sleeping.

Sleep is not the same throughout the night. We dream during REM sleep, but that doesn’t happen until we have been sleeping for a while. Non-REM sleep includes deep sleep as well as an earlier phase. We cycle through these different types of sleep throughout the night, with more REM sleep near the morning before we wake.

How Much Sleep Do We Need?

We do need different amounts of sleep during the life cycle. Most everyone knows that babies need a lot, while children need less bit by bit as they grow older. Teenagers still need more sleep than adults, although they don’t always get it. Often, their sleep cycles shift so they stay awake later and find it more difficult to get up early. Most adults need about seven hours of sleep a night, plus or minus an hour or so. You can tell if you are getting enough sleep if you feel refreshed when you wake up without an alarm clock.

One health problem that can keep people from getting the sleep they need is sleep apnea. In this condition, the tissues of the throat relax and obstruct breathing. Doctors often recommend a CPAP machine for their patients with sleep apnea. This provides Continuous Positive Airway Pressure that keeps the airways open and prevents interruptions in breathing. Not everyone appreciates the CPAP, though. A good seal requires careful fitting.

Insomnia Anxiety as a Vicious Cycle:

Knowing how important sleep is for our health can cause some people to become very anxious if they aren’t sleeping well. Anxiety is the enemy of sleep. Rather than stay in bed and worry about not being able to sleep, Dr. Seheult recommends getting up to do something not very exciting in another part of the home. The bedroom should be for only two activities, sex or sleep. Don’t learn to associate “not sleeping” with the bedroom.

Small Screens:

One thing to avoid is checking email or watching video in bed or just before bedtime. Small screens, computers and televisions emit blue light that has the effect of putting the brain on alert. In addition, dealing with difficult problems or exciting plots just before retiring does not help you relax.

Listening is another matter, though. Some people find that listening to music can be helpful, as long as it is not too rousing.

This Week’s Guest:

Dr. Seheult is an Associate Clinical Professor at the University of California, Riverside School of Medicine, and an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University.

Dr. Seheult is quadruple board-certified in Internal Medicine, Pulmonary Diseases, Critical Care Medicine, and Sleep Medicine through the American Board of Internal Medicine. HIs current practice is in Beaumont, California where he is a critical care physician, pulmonologist, and sleep physician at Optum California.

He lectures routinely across the country at conferences and for medical, PA, and RT societies, is the director of a sleep lab, and is the Medical Director for the Crafton Hills College Respiratory Care Program.

MedCram

In 2012 he and Kyle Allred founded MedCram L.L.C., a medical education company with CME-accredited videos that are utilized by hospitals, medical schools, and hundreds of thousands of medical professionals from all over the world (and over 1 million YouTube Subscribers). His passion is “demystifying” medical concepts and offering people the tools for staying healthy.

We have found Dr. Seheult’s MedCram videos amazing. He has done an extraordinary job explaining COVID and the science behind various treatments. But he also makes many other complex medical topics understandable. This is a skill that few of my professors in the University of Michigan’s Department of Pharmacology could claim.

Dr. Seheult was the recipient of the 2021 San Bernardino County Medical Society’s William L. Cover MD Award for Outstanding Contribution to Medicine and the 2022 UnitedHealth Group’s The Sages of Clinical Service Award. In 2022 both Roger Seheult and Kyle Allred received the HRH Prince Salmon bin Hamad Al Khalifa Medical Merit Medal from the Kingdom of Bahrain for their contribution to health policy in the Kingdom of Bahrain.

Listen to the Podcast:

The podcast of this program will be available Monday, Oct. 27, 2025, after broadcast on October 25. You can stream the show from this site and download the podcast for free. The podcast contains some additional information on cataplexy, sleep paralysis and kicking or moving in your sleep.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Transcript of Show 1393:

A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:01

I’m Joe Graedon.

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy.

Joe

00:06-00:26

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Do you wake up feeling refreshed and ready to take on the world? Or do you have to drag yourself out of bed each morning? This is The People’s Pharmacy with Terry and Joe Graedon.

Terry

00:34-00:41

More than one-third of Americans say they get less than seven hours of sleep a night. Where do you fall on that spectrum?

Joe

00:43-00:54

Why is it so important to get a good night’s sleep? Are sleeping pills like Ambien a good solution to insomnia? What about PM pain relievers?

Terry

00:55-01:02

Some people prefer a natural approach like melatonin. Are there any downsides to taking this hormone as a supplement?

Joe

01:03-01:08

Coming up on The People’s Pharmacy, how to get the sleep you need.

Terry

01:14-02:39

In The People’s Pharmacy health headlines, popular drugs approved for diabetes control and weight loss have many other effects on the body as well, according to a study of veterans.

The scientists analyzed health records of nearly 2 million veterans with diabetes. Approximately 216,000 of them started on a drug like semaglutide, known as Ozempic or Wegovy, or tirzepatide, known as Mounjaro or Zepbound. The database in the analysis included an average of about four years of health care, offering the opportunity to see if some conditions were less common for people on these medications, called GLP-1 agonists.

The investigators looked at 175 different health outcomes. In addition to cardiometabolic disorders, the drugs were associated with a lower likelihood of clotting problems, dementia, and other neurocognitive disorders, substance use and psychotic disorders, seizures, infectious illness, and respiratory problems. On the other hand, men taking these medicines were more susceptible to kidney problems, including kidney stones, digestive disorders, including pancreatitis and gastroparesis, arthritic disorders, and low blood pressure or fainting.

Joe

02:39-03:31

We don’t usually think of Alzheimer’s disease as infectious. New research suggests, though, that certain common infections may increase the risk of this degenerative condition. A study published in Cell Reports shows that a protein from the herpes simplex virus that causes cold sores increases with abnormal levels of tau. This is one marker for Alzheimer’s disease.

In laboratory experiments using brain organoids, cells that produce P-tau, that’s phosphorylated tau, help protect neurons from this infection. The researchers suggest that tau phosphorylation may be part of the brain’s innate immune response to infection. Neurofibrillary tangles made of phosphorylated tau are typical of Alzheimer’s disease pathology.

Terry

03:32-04:27

Household products, personal care products like body wash and shampoo, even dietary supplements contain compounds that can mimic our hormones and cause trouble.

A team of researchers in Nevada asked 140 adults to collect their urine for 24 hours. Then they analyzed the samples for endocrine-disrupting compounds. People who used more products with ingredients of concern had higher levels of a specific phthalate in their urine. Those who took more supplements had higher levels of methylparaben.

The people who reported their health as fair or poor had higher levels of such compounds in their urine than those who said their health is good. The scientists concluded more education among the general public is needed to make people aware of the presence of these chemicals in their everyday products so they can make efforts to avoid them.

Joe

04:28-05:21

When people, especially elite athletes, exercise vigorously, they may damage muscle tissue that can lead to pain and loss of strength in the affected muscles. It can take time for the inflammation to ease and for the muscles to recover.

A systematic review has found that athletes taking curcumin, the active ingredient in turmeric, recovered more quickly. Investigators included studies that featured either pre- or post-exercise curcumin consumption. Studies demonstrated better muscle recovery compared to placebo among people taking 1 to 4 grams of curcumin after exercise.

The researchers conclude that curcumin demonstrates a significant potential to relieve muscle-related symptoms. It also appears to have the capability to lower biomarkers associated with inflammation and boost antioxidant levels.

Terry

05:22-05:58

British researchers report that oral health appears to be associated with a lower risk of dementia. They analyzed bacteria living in the mouths of 115 older individuals. 55 of the participants were experiencing mild cognitive impairment, or MCI.

Those with more Neisseria bacteria in their mouths had better visual attention and executive function, despite MCI. These bacteria were associated with better working memory among volunteers without cognitive difficulties.

And that’s the health news from the People’s Pharmacy this week.

Joe

06:14-06:17

Welcome to The People’s Pharmacy. I’m Joe Graedon.

Terry

06:17-06:37

And I’m Terry Graedon. The National Council on Aging reports that roughly one-third of Americans have symptoms of insomnia. About 15% of us have difficulty falling asleep, and more than 20% of us have trouble staying asleep. That means millions of people feel tired most days.

Joe

06:38-07:18

To learn more about how to get the sleep you need, we turn to Dr. Roger Seheult. He’s an associate clinical professor at the University of California Riverside School of Medicine and an assistant clinical professor at the School of Medicine and Allied Health at Loma Linda University.

Dr. Seheult is quadruple board certified in internal medicine, pulmonary diseases, critical care medicine, and sleep medicine through the American Board of Internal Medicine. His current practice is in Beaumont, California, where he’s a critical care physician, pulmonologist, and sleep physician at Optum California.

Terry

07:19-07:22

Welcome back to The People’s Pharmacy, Dr. Roger Seheult.

Dr. Roger Seheult

07:23-07:25

Good to be here. Thanks for having me.

Joe

07:25-07:43

Dr. Seheult, you are renowned as a teacher of complex medical issues, but one of the things that really surprised us was to discover that you are a specialist in sleep medicine. Could you please give us some insight as to how you got interested in this particular field?

Dr. Roger Seheult

07:44-08:34

Well, it was almost out of necessity. I was a pulmonary and critical care graduate, went to a new job, and they said, you know, we need you to be basically competent in sleep medicine because of the amount of sleep medicine work that we have.

So a colleague of mine helped me in terms of over-reading studies and getting me board eligible, and I took boards, and I’m board certified now in sleep medicine. But here’s the interesting thing about that is that I didn’t really think sleep medicine was that important, but when I started to study it because I needed to know it, those sleep journals became far more interesting.

And it just it taught me something that things that don’t seem interesting are usually that way because we don’t personally know a lot about them. But once we study those things and start to investigate, those things become a lot more interesting.

Terry

08:35-08:54

Well, Dr. Seheult, whenever we talk to generalists about what should you do to stay healthy? They always tell us that getting a good night’s sleep is essential, just like our grandmothers told us. Why? Why is getting enough sleep so important?

Dr. Roger Seheult

08:55-09:32

You know, in a nutshell, I would say it’s because the actions, the properties, the reactions, the chemical reactions that occur in the body are not sustainable for a continuous amount of time. And there are many reasons why that is the case.

And so what the body needs is a period to readjust, to replenish, to renew, so that it can do the same level of intensity at another period of time at some point in the future. And that’s really it in a nutshell, if we look at why people need to sleep.

Joe

09:32-09:41

Well, you have used the Disneyland analogy to great effect. Could you explain why that’s relevant to sleep?

Dr. Roger Seheult

09:42-11:09

Yeah, I think that’s a great analogy in a number of ways. Like if you were to go to Disneyland or it’s any amusement park for that matter, you’ll find that there are all sorts of things that are going on in during the day, during the business hours and things like the rides are working. The people are buying things from the store. The flowers are blooming. The weeds are also growing as well.

All these things are not sustainable continuously, right? So if you were to go to a gift shop, you can buy things off the shelf, but somebody has to replenish those things. The rides can only run so many times before the engineers need to test it and make sure that it’s safe. The weeds can only grow so many hours before they have to be removed. And so again, it’s a situation where there is things that are happening that cannot continue on a continuous basis unless something has an intervention.

And I brought this up because my friend used to work at Disneyland and he worked at night. It’s kind of an interesting thing. He would work at night after the park closed. And during that process of renewal, it was a complete transformation of the park. There were people such as engineers working on the rides. There were gardeners coming in, trash people were emptying the cash registers, replenishing the stock on the shelves.

All of these things were essential if you wanted the park to open up the next day at eight o’clock in the morning, brand new, ready for visitors.

Terry

11:10-11:25

Well, Disneyland has at least those two different phases of daytime and nighttime, but we understand that sleep has separate stages as well. Could you briefly review those for us?

Dr. Roger Seheult

11:25-11:39

Yes. So sleep is basically divided into two major categories. There’s REM sleep and there is non-REM sleep. And that’s just to show you how important REM sleep is, is because there’s REM sleep and then there’s everything else.

Joe

11:39-11:42

And what does REM stand for, please?

Dr. Roger Seheult

11:42-13:09

Yeah. REM sleep stands for rapid eye movement. And it was named that because that was the most obvious thing to researchers when they first started to look, is that patients when they were in REM sleep had this rapid eye movement that they could see very clearly through the eyelids. But a lot more is going on in REM sleep.

And that’s not to say that non-REM sleep is unimportant. In fact, it’s extremely important, as we’ll talk about. But those are the two major phases of sleep. And even to just back up even more in terms of talking about this idea of Disneyland and there’s a nighttime and a daytime.

And this goes to an even bigger issue or idea, and that is of circadian rhythm. If you can imagine that there’s an orchestra and there’s a conductor conducting the different players in the orchestra, sleep would be one section of the orchestra, but there’s a whole host of other players in that orchestra that are supposed to be doing things exactly in time with what is going on with sleep.

And so the conductor is conducting these things. Sleep is essential to have. You can’t play Beethoven’s Ninth Symphony without the string section, But on the other hand, you also need the choir to be singing. And these are other processes that are occurring in the body that work best when sleep is occurring. And it maximizes the regenerative effects of all of these things.

Joe

13:10-13:29

Well, you mentioned REM, rapid eye movement sleep. And I think a lot of us associate REM sleep with dreaming sleep. And then there’s these other stages of sleep, deeper sleep. Give us a little background on all the different stages and what’s going on.

Dr. Roger Seheult

13:30-16:47

Yes. So there’s a stage of sleep that you go into immediately right under the surface when you’re sort of in that twilight that has what we call alpha waves and it’s stage one. It’s sort of a transitory sleep and usually lasts just a brief moment before it goes into something more substantial. And that would be stage two sleep.

Now, stage two sleep is a non-REM sleep, but it’s kind of a boring type of sleep where yes, you are asleep, but you’re not really getting the effects of REM sleep or even this deeper sleep that we’re about to talk about, which is slow wave sleep. So slow wave sleep would be like a stage three or known as N3. And this slow wave sleep is a type of non-REM sleep where you have a lot of physical restorative functions.

This is where, for instance, growth hormone is released and it has an effect on the human body. This is the type of sleep that you get that makes you feel well-rested. It gives you that feeling of being well-rested when you get up in the morning. And unfortunately, this type of sleep gets more rare as you get older. It’s very abundant in children, infants, teenagers even. But as you start to get into your 20s, 30s, 40s, it starts to decrease substantially. And that’s a normal thing to have happened.

Finally, there’s REM sleep. Now, REM sleep is very unusual to people looking at it electrically. If you were to look at the electrical signals of the brain, REM sleep actually looks very similar to being awake. As you mentioned, it’s when you dream. And as a result of you dreaming, you don’t want to be acting out your dreams. And so one of the principal characteristics of REM sleep is paralysis. So the patient doesn’t move. They may think that they’re trying to move, but they don’t move.

And this paralysis, this relaxation of the muscles is a very good thing because you don’t want to be acting out dreams. But on the other hand, it can also cause issues with people, for instance, with sleep apnea who really depend on the tension or the tone in their airway muscles to keep the airway open. And that’s another topic that we can talk about with sleep apnea.

But these are all things that are associated with these different stages of sleep. Now, just to further on that understanding of sleep, there’s a specific cycle that one goes through as they sleep normally. And that would typically be stage one, stage two, and then it might go to stage three, and then maybe back up to stage two. And then eventually, probably usually about 90 minutes or so into sleep, you’ll hit your first REM sleep, which is very, very short. And then you do these cycles throughout the night, like I just mentioned.

And as the cycles go through the night, the deep wave sleep, the slow wave sleep, the N3 becomes less and less common. However, the REM sleep as you go throughout the night becomes more and more common. And this is the reason why, for instance, your dreams, you typically are what you experience in the morning hours right before you wake up.

Joe

16:48-17:06

Dr. Seheult, you have referred to this Disneyland analogy of getting rid of the, for example, the garbage is picked up at night and the weeds are removed. Is there something similar during sleep? Is that garbage removal going on?

Dr. Roger Seheult

17:06-17:39

Oh, absolutely. Yeah. So there is lymph that is the byproduct, sort of the sewer system of the cells of the brain. And there are proteins. You might have heard of these type of proteins that’s involved with Alzheimer’s disease. Sleep is a time where the brain and its lymphatic system is able to get rid of those byproducts of thinking, those byproducts that can accumulate if they are not taken care of. There is definitely a very good analogy in terms of taking out the trash. Absolutely.

Terry

17:40-18:15

You’re listening to Dr. Roger Seheult. He’s an associate clinical professor at the University of California Riverside School of Medicine and an assistant clinical professor at the School of Medicine and Allied Health at Loma Linda University. Dr. Seheult practices in Beaumont, California, where he’s a critical care physician, pulmonologist, and sleep physician at Optum California. He’s co-founder of MedCram.com, where he presents complex medical concepts with clarity for both health care providers and patients.

Joe

18:16-18:19

After the break, we’ll explore the side effects of some sleeping pills.

Terry

18:20-18:22

If a medicine suppresses REM sleep, is that a problem?

Joe

18:23-18:25

We’ll also find out how much sleep we really need.

Terry

18:25-18:28

Sleep apnea can disrupt sleep. What are the best treatments?

Joe

18:29-18:33

Does worrying about getting enough sleep keep you awake?

Terry

18:39-18:43

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Joe

18:51-18:54

Welcome back to The People’s Pharmacy. I’m Joe Graedon.

Terry

18:54-19:16

And I’m Terry Graedon.

Joe

19:16-19:27

How would you know if you’re sleep-deprived? Do you wake up feeling refreshed, or do you have trouble dragging yourself out of bed most days? Does it even matter?

Terry

19:28-20:02

To learn more about how to get the sleep you need, we’re talking with Dr. Roger Seheult. He’s Associate Clinical Professor at the University of California Riverside School of Medicine and an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University.

His current practice is in Beaumont, California, where he’s a critical care physician, pulmonologist, and sleep physician at Optum California. Dr. Seheult is also co-founder of MedCram.com.

Joe

20:04-20:20

Dr. Seheult, there is a side effect of some medications. I think if my memory serves me correct, it would be the SSRI-type antidepressants, that they can actually suppress dreaming–or REM sleep. Are there any consequences to that?

Dr. Roger Seheult

20:21-21:43

Yes. So SSRIs are one type of medication that can do that. There are others like benzodiazepines that can also do that. And they will suppress REM sleep. And in fact, there is actually a therapeutic use of these medications in that type of situation. If a patient, for instance, has an issue with a REM sleep disorder, and that would be a situation, for instance, where they’re not paralyzed and they act out their dreams, this may be an indication where you want to give a medication that suppresses REM sleep in that particular situation.

But outside of that rare situation, we look at the ability of SSRIs and benzodiazepines of suppressing REM sleep, not as a good thing, but as a bad thing, but not necessarily absolutely contraindicating in that situation. We might notice that the patient may dream less, but I don’t believe there’s been any studies that have correlated a chronic reduction of REM sleep to any long-term effects down the road, which is interesting. And it could be simply because we don’t have the right studies or we don’t have enough studies to show that type of detriment to chronically suppressing REM sleep.

Terry

21:44-21:52

Dr. Seheult, we’ve talked a bit about why sleep is so important. How much sleep do we actually need?

Dr. Roger Seheult

21:53-23:06

Well, that’s a very good question. We have done studies that have looked at how long someone sleeps and the type of outcomes that occur from that. Now, you should realize, of course, that that’s a correlation type of study and not a causation because we’re not randomizing and doing it prospectively. We’re looking at who has what type of lifestyle in terms of sleep and what are the outcomes?

And what we find actually, interestingly, is a bell-shaped distribution. We find that people who sleep too little have poor outcomes–they don’t live as long. But we also notice on the flip side that people who sleep too long can actually have the same effect. We believe that’s because these people are medically ill to begin with, and they may sleep quite a lot because of that.

But if you look right in the middle, the people that seem to live the longest have the least amount of issues are the ones in terms of adults who sleep between seven and eight hours a night. And that seems like a lot, but according to research, about 50 to 60% of the population get about that amount of sleep, which is not much.

Joe

23:06-23:21

That suggests that a lot of people are not getting enough sleep. And you mentioned that they may not live as long as those who do get enough sleep. And I’m curious, what are some of the other negative outcomes of not getting adequate sleep?

Dr. Roger Seheult

23:21-24:21

Oh, yeah, this is a very wide list. I mean, cardiovascular, immune, let’s talk about immune system. We have very good studies and they’re actually randomized and controlled that show that even one night of loss of sleep can completely change hundreds of proteins in the body that regulate immune system, that regulate your metabolic health, et cetera.

We know that, for instance, here’s a study that was done out of the University of Pittsburgh where they took people who were about to get the flu vaccine and they basically looked at how many hours of sleep they had gotten in the last week or so. And those that had gotten seven to eight hours of sleep at least had twice the levels of antibodies against the flu vaccine after vaccination than those that did not get seven hours of sleep.

Terry

24:22-24:24

How can you tell if you’re getting enough sleep?

Dr. Roger Seheult

24:26-25:33

It’s hard. It’s easier, interestingly, when you’re young, because young people don’t mask the effects of lack of sleep as well as older people. That may be an advantage for older people because we seem to mask it better. We’re seeing the cope better with lack of sleep.

But if you’re trying to see whether or not you have a lack of sleep, it may actually not be a good idea to see and use that by itself. So the bottom answer is basically it’s hard to tell. There are a number of questionnaires that you can take that are available online. One of them is called the Epworth Sleepiness Scale. That’s one way of looking at it. And they just basically ask you what is the likelihood that you would fall asleep in certain situations.

And you add up the numbers and you get a number and you can look at the scale to see if that is excessive or regular or even not too excessive. But it’s not as direct and distinct as one might think. It’s possible to have a normal Epworth sleepiness scale score and still have some chronic sleep deprivation.

Terry

25:34-25:47

Do we need different amounts of sleep at different times of our life. For example, I’m assuming that we all know that babies need a lot of sleep. Do older people need a lot less sleep? What about teenagers?

Dr. Roger Seheult

25:47-26:27

Yeah, exactly. Great question. So once you hit adulthood, like 18, generally the recommendations based on the data recommend seven to eight hours of sleep per night. And that goes throughout the life. But you’re absolutely right.

So newborns need probably about 14 hours of sleep based on the recommendations. And from there, it goes down so that when you’re school age, you’re talking 10 hours, 12 hours of sleep, which is, if you think about some of the kids that we have in school today, I know my kids, they would be hard pressed to routinely get 10 to 12 hours of sleep, but yet that’s what the data shows.

Joe

26:27-26:36

How about these older folks who say, well, I only need five or six hours of sleep a night. I’m doing fine. Or are they kidding themselves?

Dr. Roger Seheult

26:37-27:36

Yeah. So I see this all the time and I have people in my sleep lab, sleep clinic, and for instance, with sleep apnea, which not only impedes, could impede the quantity, but also the quality of sleep. And for whatever reason, They don’t feel that they are that sleepy.

But when we make the diagnosis and they’re able to get on treatments and we’re able to get them the sleep that they need, they tell me, they say, I never realized how sleep deprived I actually was until I was able to treat it and see what life was like before. It’s very easy to assume that the feelings that you’re having of sleep deprivation, which would be fatigue, inability to concentrate.

These are very mild symptoms, but add it all up, they can really impede our quality of life. And until you actually show that that is not necessarily something that goes along with age, but lack of sleep, it’s very difficult to demonstrate that.

Terry

27:37-27:47

Well, you have just mentioned sleep apnea, and I hope that you will tell us what that is and what anyone could do about it.

Dr. Roger Seheult

27:47-28:47

Yeah, so sleep apnea is quite a common problem. It’s becoming an increasing problem. And it’s basically where when you are sleeping at night, the airway muscles that are responsible for keeping the airway open, they relax to the point that they collapse and close off. And usually they can become very close to each other right before they collapse. And as air is being sucked into the lung, they’ll cause a vibration that we commonly know as snoring.

So people who snore may be at increased risk for sleep apnea. But sleep apnea specifically is where no air is going into the lungs for a long period of time. And this can cause a drop in oxygenation, which then excites the brain because it doesn’t like to see that. And that causes a sympathetic release of things like norepinephrine, epinephrine. And this down the line causes cardiovascular consequences, which can lead to an early death, cardiovascular disease, things of that nature.

Joe

28:48-29:26

And what to do about it? I mean, I’ve got a dear friend who had a major jaw surgery. I mean, he had to eat out of a straw because his jaw was wired shut for many, many, many weeks. But I know that there are sleep apnea machines, CPAP machines, and there’s been a lot of controversy about one particular company and how there were particles of the foam that’s keeping the sound down that where people were inhaling them and there were lawsuits.

Give us the quick overview of what you do for your sleep apnea patients.

Dr. Roger Seheult

29:26-31:16

Yeah. So there are a variety of things that can fix sleep apnea or at least treat it. And it all boils down to the issue that in most cases, the tongue or the tissue is falling back into the back of the throat and it’s causing the area to collapse.

So because the tongue is attached to the jaw, the lower jaw, if we were to advance the jaw forward and either allow more room for the tongue or to pull the tongue forward or to put a basically a mask over the person’s nose or mouth or both to gently put air in to open up that airway and the patient to breathe, all of these are ways of overcoming the collapsing of that upper airway.

And so if that is done, the patient is then able to breathe without oxygen desaturation. You don’t get the arousals coming out of sleep. You don’t get the cardiovascular consequences. Now, the CPAP machine, which is one of those most common actually used and probably the most effective, is a machine that does that. It basically, thinking about inflating a flat tire: So you plug the hole, you put the machine on, and it gently puts in enough pressure just to keep the anterior portion of your airway off the posterior portion of your airway so that air can come in and out without being obstructed.

And so, yeah, there was a issue with the CPAP machine, some of them, where there was a foam that was breaking down and there was a possibility that these particles were going into the lungs and causing issues. I think that that is still theoretical. I haven’t seen any hard data that shows that that is actually happening, but it is a possibility.

Joe

31:17-31:28

A lot of people complain that they don’t much like their CPAP machine and they give up on it. Do you have any brands or any products that you especially like and are there any other strategies that also work?

Dr. Roger Seheult

31:28-32:37

Yeah. So I believe that the best way to overcome those is to dig down deep and to find out exactly what the issues are. Some people have issues with the CPAP machine because they don’t like the sensation of breathing against pressure. And there are ways of helping that where you can actually reduce the pressure at the end of exhalation to allow it to be more comfortable.

Other times people have air escaping around the mask and blowing into their face. Well, there we just need to work on a fit. So there’s a number of different complaints and it’s not just one issue. Now, if a patient completely doesn’t want to use a CPAP mask, there is for some people a dental device that we can use where we can advance the jaw forward as we’re mentioning. There are some side effects to that, but that’s another option.

There’s even an option that uses an implantable device that stimulates the nerve that goes to the muscle that protrudes your tongue so that when you are sleeping, this electrical stimulation will move the tongue forward off the back of the throat. That requires implantation of a device and some surgery.

Joe

32:38-33:20

Now, I do have one other question, and that has to do with what I call the trouble sleeping and the worry that goes with trouble sleeping. And that applies to people with sleep apnea, but it also applies to a lot of people with insomnia. In other words, I’m trying to fall asleep. I’m trying to fall asleep because if I don’t sleep, I’m going to have all these health problems. And now I can’t sleep because I’m worrying about falling asleep.

Or if I wake up at three in the morning, I go, oh, no. It’s three in the morning. I got to go to sleep. I’ve got a busy day tomorrow. And now I’m worrying about not getting enough sleep. So it’s the worry part of it. How do you handle that for your patients?

Dr. Roger Seheult

33:21-36:23

Yeah, this is a common problem. It’s known as psychophysiological insomnia. And the way I analogize this is imagine you’re going onto the stage of Carnegie Hall. And instead of playing the Moonlight Sonata in front of a packed house, there’s a bed on stage and you’re asked to go into that bed and fall asleep. That’s what it’s like. That’s what you’re describing. It’s like there’s a performance that you’re about to have and you’re very anxious about this performance.

But unfortunately, the performance is sleep and anxiety is the absolute worst thing to have. The reason why this happens, and by the way, one of the symptoms of this that’s very common is someone might feel very sleepy in their kitchen or in their living room and say, it’s time for me to get to bed. And as soon as they walk into their bedroom, they are wide awake and they can’t fall asleep.

And this has something to do with behavior that has antedated this, that has happened before, where people might have had some sort of an issue in their life, some sort of stressor. And what they did was they tried to go to sleep earlier and they went to the bedroom when it wasn’t time to sleep or they brought something else into the room to do so that they could try to get better sleep or get more sleep. And it’s because of this idea that the more sleep that they get, the healthier they’re going to be. And they’re very fixated on that, as you described.

The problem with this is that whenever you try to go into that bedroom and you’re going to be set up for failure, you’re going to associate those failures with the surroundings in your bedroom. It’s sort of a subconscious issue so that whenever you walk into that bedroom, all of those subconscious fears, anxieties are going to come back. And so the way we deconstruct that is, first of all, that term is actually known as cognitive behavioral therapy for insomnia, or CBTI.

And this is what we do on patients that have this issue is we decatastrophize the issue. For instance, if they said, I know that sleep is very important for my life. And if I don’t get enough sleep, I’m going to die if I don’t get sleep. And then I would just simply ask them, how long have you not been able to sleep? And they would say something like, oh, it’s been two years, three years. And then I would say, and you’re not dead yet. You’re still here. And so we tried to show that we’re taking away a lot of the excessive anxiety associated with trying to go to sleep.

And then, of course, we try to deconstruct the subconscious so that we only have successes in the bedroom. So in other words, we take out all of the things that they would normally be doing in the bedroom, like working on a laptop, watching television. And we say that if you can’t sleep, then you need to get out of the bedroom, go to another part of the house so that when you’re ready to go to sleep, you can come back to the bedroom. And then what we start to do is associate successes with the bedroom so that when they walk in the next time, they’re not going to be having these flood of subconscious thoughts of anxiety.

Terry

36:23-36:58

You’re listening to Dr. Roger Seheult, Associate Clinical Professor at the University of California Riverside School of Medicine and Assistant Clinical Professor at the School of Medicine, and Allied Health at Loma Linda University.

Dr. Seheult is certified in internal medicine, pulmonary diseases, critical care medicine, and sleep medicine through the American Board of Internal Medicine. Dr. Seheult is co-founder of MedCram.com, where he presents complex medical concepts with clarity.

Joe

36:59-37:07

After the break, we’ll find out about some common behaviors that are not helpful for sleeping. Are any of them keeping you awake?

Terry

37:08-37:11

How can you use melatonin to work with your circadian rhythm?

Joe

37:12-37:19

Some things like vigorous exercise or a big meal should be managed earlier in the day rather than just before bed.

Terry

37:20-37:25

Are over-the-counter sleep aids safer or better than prescription sleeping pills?

Joe

37:25-37:31

We’ll also find out what to do if you wake up too early and can’t get back to sleep.

Terry

37:39-37:55

You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Welcome back to The People’s Pharmacy. I’m Terry Graedon.

Joe

37:55-38:18

And I’m Joe Graedon.

Terry

38:19-38:39

We’re trying to help you get a good night’s sleep today on The People’s Pharmacy. Have you been taking a PM pain reliever to help you get to sleep? Millions of Americans have turned to over-the-counter medications such as Advil PM, Aleve PM, or Tylenol PM. What else could you use for better sleep?

Joe

38:39-39:18

We’re talking with Dr. Roger Seheult. He is an associate clinical professor at the University of California Riverside School of Medicine and an assistant clinical professor at the School of Medicine and Allied Health at Loma Linda University. His current practice is in Beaumont, California, where he’s a critical care physician, pulmonologist, and sleep physician at Optum California.

Dr. Seheult is co-founder of MedCram, an online resource that explains complex medical conditions in understandable language. Dr. Seheult developed an impressive following for his COVID-19 presentations.

Terry

39:19-39:56

Dr. Seheult, I want to ask you about some behaviors that I think have become pretty common, and I read that they’re not very helpful for sleep. What’s your take? One is watching our little screens, our tablets or our phones, watching something interesting on the screen. And the other is using those very same devices just to listen. A lot of people say, oh, I woke up in the middle of the night, I couldn’t get back to sleep, so I started to listen, and it put me to sleep.

Dr. Roger Seheult

39:57-41:15

Yeah, so those are two very different sensory inputs to our brain. The first one being vision is unfortunate because there are ganglion cells in the retina that when they are stimulated at a particular time of your circadian rhythm, at night particularly, it’s going to inhibit the secretion of melatonin, which is a very important antioxidant that the brain and the body uses at night. So that’s one reason why that’s a bad idea.

The other reason is, is that in doing so, in visualizing bright light, especially after nine o’clock at night, it tends to delay your circadian rhythm, which means that things that would normally happen at nine are eventually going to happen at 10 and 11. And that’s a recipe for falling asleep naturally later, which means that if you wanted to go to sleep earlier, you would not be able to, and that might cause you some insomnia.

Now, in terms of listening to things, I think that that’s fine. Some people need white noise to fall asleep. I used to fall asleep listening to classical music, which I loved. And I don’t think there’s a lot of evidence that shows that that’s detrimental. We do have lots of data showing that light exposure, light pollution, light surroundings at night, is not good.

Terry

41:15-41:22

Let’s talk a little bit about melatonin, which you just mentioned, and circadian rhythm. What should we know about this?

Joe

41:22-41:41

There are an awful lot of people who think, oh, I’ll just take 3 milligrams. Oh, if 3 milligrams is good, I’ll take 5 milligrams. Oh, wait a minute. Now there’s a 10 milligram melatonin pill or a gummy. And I know a lot of parents are giving their kids melatonin. So give us the melatonin upbeat.

Dr. Roger Seheult

41:42-42:39

So yes, melatonin is not, the adage that if a little is good, more is better does not work with melatonin. In fact, it actually makes it less effective. So the most effective doses are actually the lower doses. And giving melatonin is not a bad idea if you want to change your circadian rhythm. If you want to advance it, for instance, taking about 3, 5 milligrams, even less in the evening is actually very helpful for jet lag, especially if you’re going to travel east.

We actually talk about that in our MedCram channel. The thing about melatonin is that less is better and more is not generally as good. The other thing I would mention too about melatonin is that it’s not controlled by the FDA.

So if you’re going to get melatonin, make sure you get it from a reputable corporation or company that it gets third-party testing that shows that what you’re actually getting is melatonin.

Terry

42:40-42:54

Dr. Seheult, on your MedCram channel, you have talked about a “zeitgeber,” which sounds like a fancy German word. Maybe you could explain to us what it is and how we should approach it.

Dr. Roger Seheult

42:55-43:39

A zeitgeber, yes. A zeitgeber is something that affects your circadian rhythm. Your circadian rhythm is this thing that is running. It’s the conductor in your brain that is conducting the orchestra. And it needs cues from its environment to make sure that it is setting things off at the right time. Well, it needs to know when it’s day and when it’s night.

So the biggest zeitgeber is actually the light in your eyes. But there are other zeitgebers. For instance, when you eat, when you do social things, these are all cues– not as strong as light though is. And that’s why it’s important that if you want to maintain a very sound circadian rhythm, that you don’t confuse it by giving light to your eyes when the sun is down or vice versa.

Joe

43:40-44:29

Well, let’s talk a little bit about that cycling stuff because we’ve been told that intermittent fasting is good for us, helps us lose weight, might be good for cardiovascular functioning. And I’m just wondering, well, when should we stop eating before bedtime? Dagwood Bumstead used to make his famous sandwiches in the middle of the night.

What happens if we eat right before bed? And then what about exercise? A lot of people think, well, I’ll just hop on the stationary bike before I climb in the shower or maybe whenever just to get a little, you know, that extra time on my smartwatch, and complete all my rings. So exercise and food.

Dr. Roger Seheult

44:29-46:40

Yeah. So, and this again gets back to what we were saying with the orchestra and the conductor. So the string section is sleep and the circadian rhythm. The conductor is the circadian rhythm. And then the other players of the orchestra are like the metabolic factors. And so what you want to do is you want everyone playing at the same time. That’s when you are in concert, literally when everyone is playing together.

And so there are processes that occur in the human body that happen best and most when you’re sleeping, and they correspond best to processes that are regenerative at night and when you’re sleeping. The problem is, is that that regenerative force, for instance, the regenerative processes are shut down when the body is digesting. And so there’s this understanding that it is best to not be digesting food or storing that food when you are sleeping.

Because it takes about four or five hours for food that is ingested to pass through the system and to make sure that that is dealt with, there is this understanding that it’s best not to be eating after five or six o’clock in the evening. For some people, maybe seven. And that concentrating calorie intake in the morning is best to allow the processes that occur at night to occur maximally and to do what needs to happen.

There’s actually some really good research on this in terms of cancer, in terms of metabolic health. We know, for instance, that the time of day that the body is most sensitive to insulin is in the morning time. In other words, you can have a calorie in the morning and it is metabolized differently than a calorie in the evening.

We know that, for instance, women who have had breast cancer and are looking to see if they’re going to get a recurrence in breast cancer have a 30% reduction in breast cancer recurrence if they intermittently fast for at least 13 and a half hours a day. And so there is some of these study endpoints, but this is the understanding and the idea behind intermittent fasting and making sure that things are lined up in a circadian way.

Joe

46:41-46:42

And what about exercise?

Dr. Roger Seheult

46:43-47:24

Oh yeah. So exercise goes perfectly along with that. Exercise, interestingly, we used to say that exercise any time of day that you want, but we’re now understanding that the best time of day to exercise based on circadian rhythm and the benefits of that is actually in the morning time. That’s when cortisol levels are the highest. That’s when your body is set up for that.

But I would add, and the studies have shown this, that not exercising at all is worse than exercising in the evening. So if it’s the only time that you have to exercise because of your schedule, I would definitely not drop exercise if the evening time is the only time you can do that.

Terry

47:25-47:52

So it sounds like the deck is stacked in favor of the people who can leap out of bed, enjoy their breakfast, go out and exercise, and not so much for those who drag themselves out of bed and aren’t hungry until the middle of the afternoon.

Let me ask about people who have a hard time falling asleep. There are a lot of them. What can you do to help them?

Dr. Roger Seheult

47:53-49:52

Yes. So it depends on what the issue is with their sleep. For some people who have difficulty falling asleep, oftentimes their mind is racing and they cannot fall asleep because they have so many things on their mind. Other times it’s related to pain or it could be their environment or surroundings.

So what we do is a very detailed inventory of what’s going on, but here’s some general things that we can do. If you have a lot of things on your mind, write them down, put them on a piece of paper next to your bedside. This gives you permission, your brain almost, to put those aside and to put them out of your brain because you know that you’re going to pick them up again in the morning time.

Other things that you can do to make sure that you can fall asleep well is to increase the drive subconsciously that your bedroom is time to sleep. So I would often tell my patients this, and it’s kind of humorous, but really the only two things that you ought to be doing in the bedroom is sleep and sex. That’s it. And if you go into the bedroom and you can’t sleep, hey, the alternative is not so bad. That usually gets a chuckle out of them. But what we’re saying here is that what we want to do is that when you walk into that bedroom, we don’t want to distract you with things like, oh, it’s time to maybe open my laptop or it’s maybe time to watch television or maybe I’m going to work on that book a little bit.

For people who have no problem falling asleep, knock yourselves out. That’s fine. But for people who do have an issue falling asleep, these are some things that you can do to stack the deck in your favor. And for those who still have issues after these type of lifestyle changes, there are things that we can do, but usually it has to be supervised by physicians visit to visit.

One of those things is called sleep restriction therapy, where we actually basically sleep deprive someone so much so that they start to fall asleep. And when they start to fall asleep quickly, they start to get confidence that they can fall asleep. The anxiety goes away and then the issue goes away.

Terry

49:54-50:07

Well, one thing that a lot of people do if they’re having trouble falling asleep is take a medication. Some of those medications are prescribed by doctors. Some are over the counter. Give us your evaluation, please.

Joe

50:07-50:20

And in particular, Dr. Seheult, those PM pain relievers, Tylenol PM, Advil PM, Aleve PM, there’s so many PMs out there and they all contain diphenhydramine.

Dr. Roger Seheult

50:21-51:16

Yes, they do. And this is the bane of our existence is people who have difficulty falling asleep and they’re almost all of them are on some sort of sleep aid at night. And I’ll tell you, honestly, it’s the last thing that I change because if I take that away, it’s going to make them less likely to fall asleep.

But it is one thing that I do eventually do when they are able to fall asleep. My goal is to get them off of those sleeping medications. Now, specifically, when you are talking about things like diphenhydramine, these are antihistamines. I hate these with a passion. They may give you the sensation of falling asleep and feeling sleepy, but we do have some evidence that chronic antihistamine use over a long period of time can lead to things like dementia. And we do have evidence of that. And I would not recommend long-term use of Benadryl, antihistamines, things of that nature.

Joe

51:17-51:44

Very briefly, Dr. Seheult, you have talked about the value of heat for immune stimulation. And saunas, for example, and they even used to have that therapy when people came down with influenza during the big flu epidemic. What about heat prior to bedtime, like a hot shower, and then you cool down just before getting into bed?

Dr. Roger Seheult

51:44-52:24

Yeah, this is something that works very well. Actually, there’s been some recent research on this. The idea of this is that your core body temperature cools down to a level that is the lowest at around, for those who have a normal circadian rhythm, at about three, four o’clock in the morning.

And so by heating the body up and then cooling it down and being in a room that is generally cooler than when you started, the idea is to help the body get to that point and to improve sleep. If you’re sleeping in a room that is warmer than usual, then that could impede the body’s ability to get to that sleep state.

Terry

52:24-52:34

Speaking of three or four o’clock in the morning, a lot of people complain that they go to sleep just fine, but they wake up and they can’t get back to sleep. Any help for them?

Dr. Roger Seheult

52:34-53:34

Yeah. So this takes some investigation. Oftentimes it may be, and I see this quite often, that they will only have sleep apnea with REM sleep. As we talked about, REM sleep is when you become paralyzed.

And if the patient is going into REM sleep and causing the airways to become even more relaxed, maybe that’s when they’re getting the sleep apneas that are waking them up. And because REM sleep typically happens in its largest amounts and frequency at around three or four o’clock in the morning, that would be one of the things that I would consider in those type of patients.

The other thing that also is a possibility is that they could be very sleep shifted. So in other words, their circadian rhythm could be shifted very early. We see this often in elderly patients. They fall asleep at 7 or 8 o’clock at night, and they might feel like they need to wake up at 3 or 4 o’clock in the morning. By getting that type of history, we can actually shift their circadian rhythm so that they get into a more normal circulatory system.

Terry

53:35-54:11

Dr. Seheult, you have just suggested that during REM sleep when we’re dreaming, our bodies are not moving because we have to be paralyzed so that we’re not up and running around and doing all the things our brain thinks we’re doing during that dream.

We don’t want to hurt ourselves running into walls or doors or anything like that. What about people who aren’t perfectly paralyzed during their dreams? Who do punch or kick or move around, is there anything that can be done for them?

Dr. Roger Seheult

54:12-55:27

Yes. This is a condition known as REM behavior sleep disorder. And this is usually diagnosed with a sleep study that shows unequivocally that the patient is in REM sleep, but there is still movement and motion and activity.

The first thing that I do in these patients is to make sure that they’re safe. I usually have them sleep in a sleeping bag as a precaution until we can get them the proper treatment. Now, it used to be that we would put these patients on benzodiazepines, particularly clonidine, usually, sorry, Klonopin [clonazepam], half a milligram to one milligram every evening.

But the evidence seems to be showing now that actually, believe it or not, melatonin is actually quite effective for these patients. The caveat here is that many of these patients who develop this REM behavior sleep disorder on some cohorts and some studies have shown that they’ve gone on later in life to develop Parkinson’s disease.

And so this may be a early signal of some degeneration of the neurons that are keeping the patient paralyzed. And this may be a sign of further degenerative disease down the road.

Terry

55:28-55:33

What kind of workup would a person in this situation ideally get?

Dr. Roger Seheult

55:34-55:59

I think the first thing to do would be to take a history. And if the history is suggestive, then the next thing would be is to order a polysomnogram, which is a look at specifically them at night. And I would add a video as well so that the scorer or the person reading the study would be able to correlate the movement of the patient while they’re in REM sleep.

Joe

56:01-56:19

Dr. Seheult, sleep paralysis: some people wake up, but their body is paralyzed. It can be a very scary experience. What’s that about? And is there anything that can be done about it?

Dr. Roger Seheult

56:20-57:16

Yes. So this is almost the opposite problem of what we were just discussing. This was an issue where someone was asleep and not paralyzed. And what you’re referring to is when someone is awake and paralyzed. And it has to do, again, with REM.

REM sleep is where someone is asleep and they are paralyzed. And what’s going on here is that there is a dysregulation of the entrance of REM sleep into the patient so that here the patient is waking up, but one aspect of REM sleep is allowed to continue and the other part is not. In other words, the paralyzation portion of REM sleep is allowed to continue, but not the sleep portion of REM. And that’s something that we would see in, for instance, somebody with narcolepsy, but it is not specific to narcolepsy. You can also see that in people who are just very sleep deprived, for instance, or other medical conditions.

Joe

57:18-57:19

And is there anything that can be done for them?

Dr. Roger Seheult

57:20-58:23

Yes. So REM suppressive medications will work in this type of a situation. If it is narcolepsy, there are a number of strategies for treating that. If the patient also has cataplexy, then sodium oxybate is a treatment that has been used for many years with good success. And not only treating cataplexy, which is this idea of paralysis. Again, cataplexy would be this type of symptom where someone is awake, alert, they’re walking around.

And there’s a trigger that causes that aspect of the neurons of REM sleep to kick in where they start to feel weak and they’re ready to collapse. So dropping a cup when someone says a joke or falling to their knees when someone says something funny or emotional, this would be a trigger and that would be diagnosed as cataplexy.

That is very specific actually for narcolepsy, so much so that you could almost actually just make the diagnosis of narcolepsy based on that symptom alone.

Joe

58:23-58:31

We’ve heard of people falling asleep, walking across the street and collapsing in front of traffic. Pretty scary stuff.

Dr. Roger Seheult

58:32-58:43

Yes, it is. Although it’s pretty rare for someone to actually fall asleep. It’s usually uh, collapsing but still being awake. But yes, it’s possible.

Joe

58:44-58:54

We just have one minute left, Dr. Seheult. Your overview, the importance of sleep and what people can do if they’re having problems. Who do they go to?

Dr. Roger Seheult

58:54-59:34

Yeah, so sleep is important. It’s something that you do for a third of your life, hopefully. If you’re not doing it, you’re not getting the restore to benefits of it. Look, we all have issues trying to get enough sleep. We live in a technological society where it seems as though everything is working against us getting a good night’s sleep. But if we prioritize it, we can make some inroads and have better health.

If you’re not getting enough sleep, you need to talk to your doctor and let them know that you’re not getting enough sleep if the things that we’ve discussed and regular lifestyle changes that you can do in your own life aren’t working. And if they can’t help, then you can also be referred to a sleep specialist if there needs to be further testing done.

Terry

59:35-59:40

Dr. Roger Seheult, thank you very much for talking with us on The People’s Pharmacy today.

Dr. Roger Seheult

59:41-59:41

Thank you so much.

Joe

59:42-01:00:33

You’ve been listening to Dr. Roger Seheult, and let me spell that. It’s S-E-H-E-U-L-T, Seheult. He’s an associate clinical professor at the University of California Riverside School of Medicine and an assistant clinical professor at the School of Medicine and Allied Health at Loma Linda University.

Dr. Seheult is quadruple board certified in internal medicine, pulmonary diseases, critical care medicine, and sleep medicine through the American Board of Internal Medicine. His current practice is in Beaumont, California, where he’s a critical care physician, pulmonologist, and sleep physician at Optum California. Dr. Seheult is co-founder of MedCram.com.

Terry

01:00:34-01:00:43

Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music.

Joe

01:00:43-01:00:50

This show is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy.

Joe

01:01:12-01:01:28

Today’s show is number 1,393. You can find it online at peoplespharmacy.com. That’s where you can share your comments about today’s interviews. You can also reach us through email radio at peoplespharmacy.com.

Terry

01:01:29-01:01:46

Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning with additional information on why people kick or move in their sleep, as well as sleep paralysis and what can be done for that.

Joe

01:01:46-01:02:04

At peoplespharmacy.com, you can sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast so you can find out ahead of time what topics we’ll be covering. In Durham, North Carolina, I’m Joe Graedon.

Terry

01:02:05-01:02:38

And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

Joe

01:02:39-01:02:48

If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in.

Terry

01:02:49-01:02:53

All you have to do is go to peoplespharmacy.com/donate.

Joe

01:02:54-01:03:07

Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.