Podcasts about Trazodone

Trazodone started as an antidepressant but became one of the most prescribed sleep aids in the U.S. We explore how it works, its benefits over other medications, dosage considerations, and why it's not always a first-line treatment for insomnia. Learn more at https://missionconnectionhealthcare.com/mental-health/sleep-aids/trazodone/ Mission Connection City: San Juan Capistrano Address: 30310 Rancho Viejo Rd. Website: https://missionconnectionhealthcare.com/

In this episode, we explore four unique antidepressants that do not fit neatly into the traditional SSRI or SNRI categories: trazodone, nefazodone, vilazodone, and vortioxetine. Trazodone and nefazodone are classified as serotonin antagonist and reuptake inhibitors (SARIs), working primarily through blockade of 5-HT2 receptors while also inhibiting serotonin reuptake. Trazodone’s strong antihistamine and alpha-1 blocking properties make it highly sedating and commonly used off-label for insomnia, whereas nefazodone causes less sedation but is rarely prescribed today because of its association with severe and potentially fatal liver toxicity. Both agents are notable for producing less sexual dysfunction than many traditional SSRIs. We also discuss two newer multimodal antidepressants: vilazodone (Viibryd) and vortioxetine (Trintellix). Vilazodone combines serotonin reuptake inhibition with partial agonism at the 5-HT1A receptor, a mechanism often compared to combining an SSRI with buspirone. Vortioxetine has an even more complex pharmacology, acting as a serotonin reuptake inhibitor while modulating multiple serotonin receptor subtypes through agonist, partial agonist, and antagonist actions. This multimodal activity may contribute to benefits in cognitive symptoms associated with major depressive disorder. Throughout the episode, we compare receptor pharmacology, clinical applications, adverse effect profiles, and the unique characteristics that distinguish these medications from more commonly prescribed antidepressants. Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE! Support The Podcast and Check Out These Amazing Resources! NAPLEX Study Materials BCPS Study Materials BCACP Study Materials BCGP Study Materials BCMTMS Study Materials Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated) Guide to Drug Food Interactions (Amazon Best Seller) Pharmacy Technician Study Guide by Meded101

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this episode, Peter dives into the pharmacology of sleep, exploring where sleep medications fit within the broader framework of achieving healthy, restorative sleep. He explains why sleep is a biological imperative, why behavioral and environmental interventions must remain the foundation of good sleep, and how medications can serve as useful tools when carefully matched to a person's specific sleep problem. Peter examines the major classes of prescription sleep medications, including how they work, their effects on sleep architecture, their duration of action, side effects, and risks of tolerance and dependence. He also discusses the dangers of using sleep drugs without a clear understanding of the underlying problem being treated, the role of medications as short-term bridges during periods of acute stress, pain, or anxiety, and the promise that newer drugs like DORAs may hold for Alzheimer's prevention in high-risk individuals. Finally, Peter reviews the evidence for select off-label medications and supplements commonly used for sleep. We discuss: The biological foundations of sleep, the major drivers of sleep dysfunction, and the role sleep medications can play when appropriately matched to specific sleep problems [1:00]; Sleep hygiene, circadian alignment, and the medical causes of insomnia: building the foundation for effective sleep treatment [7:15]; Understanding insomnia: hyperarousal, CBT-I, paradoxical insomnia, and why different sleep problems require different treatments [12:45]; The difference between sedation and physiologic sleep: sleep architecture, restorative sleep stages, and matching medications to specific sleep problems [17:00]; Benzodiazepines for insomnia: mechanisms, effects on sleep architecture, and the risks of long-term use [18:45]; Z-drugs for insomnia: how Ambien, Sonata, and Lunesta work, and the ongoing risks of sleep medications targeting GABA systems [23:00]; Dual orexin receptor antagonists (DORAs) and the future of sleep medicine: orexin signaling, sleep architecture, and the emerging connection between sleep and Alzheimer's disease [27:15]; Melatonin for circadian timing: how timing signals differ from sedatives in the treatment of sleep disorders [36:30]; Trazodone for insomnia: preserving deep sleep while minimizing the risks of traditional sedative-hypnotics [42:00]; First-generation antihistamines for sleep: short-term sedation, anticholinergic risks, and concerns about long-term cognitive health [44:00]; Sleep supplements and the evidence behind them: glycine, magnesium, ashwagandha, phosphatidylserine, and more [45:45]; Takeaways: supplement quality, individualized sleep treatment, and the importance of matching interventions to the biology of insomnia [52:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

APR Health Solutions Peptides: www.aprhealthsolutions.com - code nyleOptimize HRT Clinic: https://members.optimize-hp.com - code nyleMerch: https://www.aykons.com/nylePlease share this episode if you liked it. To support the podcast, the best cost-free way is to subscribe and please rate the podcast 5* wherever you find your podcasts. Thanks for watching.To be part of any Q&A, follow trensparentpodcast or nylenayga on instagram and watch for Q&A prompts on the story  https://www.instagram.com/trensparentpodcast/Huge Supplements (Protein, Pre, Defend Cycle Support, Utilize GDA, Vital, Astragalus, Citrus Bergamot): https://www.hugesupplements.com/discount/NYLESupport code 'nyle' 10% off - proceeds go towards upgrading content productionYoungLA Clothes: https://www.youngla.com/discount/nyleCode ‘nyle' to support the podcastLet's chat about the Podcast:Instagram: https://www.instagram.com/trensparentpodcast/TikTok: https://www.tiktok.com/@transparentpodcastPersonalized Bodybuilding Program:  https://www.nylenaygafitness.comRP Hypertrophy Training App: rpstrength.com/nyle (code nyle)Timestamp:00:00:00 Intro00:04:05 Freak Genetics & Pound-a-Day Gains00:07:10 The Ultimate Off-Season Surge00:10:03 6000 Calories & Zero Insulin Resistance00:14:05 Apparel & Sponsorship Interlude00:15:50 Hacking M-TOR & Quitting Caffeine00:18:13 Forced Feeding & Gastric Failure00:21:01 Surviving Prep Sickness00:24:15 Gut Motility & Fat Timing Secrets00:30:21 Battling Sleep Apnea at 260lbs+00:33:13 Hair Transplants & Gear Selection00:34:27 Peptides for Organ Health00:36:02 10,000 Calorie Cheat Meals00:43:00 Using Chemo Drugs for Appetite00:44:20 The Sauerkraut Gut Hack00:47:23 Advanced Bloodwork Tracking00:52:47 Sleep is the Ultimate PED00:56:41 CPAP Therapy & Airway Optimization00:58:29 The 1500mg Off-Season Stack01:01:30 Curing PIP with Ultrasound Therapy01:06:16 The Truth About IGF-101:09:18 Curing Severe Gut Dysbiosis01:14:08 Why Vegetables Ruin Digestion01:18:16 Low Volume & High Intensity01:22:37 Neural Drive & Training with Big Ramy01:26:36 The Hypertrophy App Setup01:29:04 Raw Tuna over Chicken Breast01:31:12 The 8-Week Express Prep01:39:34 Hair-Safe Cycles & Muscle Memory01:41:38 Running Massive Gear with Zero AIs01:45:11 Eliminating Trenbolone Side Effects01:50:09 Peak Week Masteron & Halotestin01:54:23 Losing 17lbs in 10 Days01:57:07 Trazodone vs. Ambien for Deep Sleep02:00:35 Healing Tears with Red Light Therapy02:03:12 The Methylene Blue Disaster02:07:00 The Mustache Routine02:08:17 Test vs. Equipoise Ratios02:09:18 Deadlifts for Back Thickness02:17:27 Equine Estrogen Myths02:20:37 The Heaviest Cycles Run02:22:14 Short vs. Long Acting Insulin02:24:08 Nattokinase for Thick Blood02:25:09 The Ultimate Intra-Workout Shake02:30:49 Steps vs. Heart Rate Cardio02:31:09 Getting Peeled Fast & Fasted Glucose02:37:01 Taking Time Off Gear02:40:36 Final Words of Wisdom

Casaundra's insomnia first showed up in college. From then on, it would come and go during periods of stress. After getting married, insomnia showed up and this time it didn’t go away. Before long, Casaundra would notice a feeling of anxiety as soon as her head hit the pillow. Nights started to feel like a battle. In an effort to fix her sleep, Casaundra tried blackout curtains, headphones, melatonin, medication, no screens, less water, strict routines, and even six kiwis before bed. The more she tried to control sleep, the more sleep seemed to control her life. In this episode, Casaundra shares how things changed when she started making life bigger than insomnia. As sleep got less attention, her evenings opened up. Her days opened up. She reclaimed her identity — and sleep took care of itself. Click here for a full transcript of this episode. Transcript Martin: Welcome to the Insomnia Coach Podcast. My name is Martin Reed. I believe that by changing how we respond to insomnia and all the difficult thoughts and feelings that come with it, we can move away from struggling with insomnia and toward living the life we want to live. Martin: The content of this podcast is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. The statements and opinions expressed by guests are their own and are not necessarily endorsed by Insomnia Coach LLC. All content is provided “as is” and without warranties, either express or implied. Martin: ​Okay, Casaundra, thank you so much for taking the time out of your day to come onto the podcast. Casaundra: Thank you for having me. I’m super excited. Martin: Great to have you on. Let’s start right at the beginning as always. When did your sleep problems first begin, and what do you think caused those initial issues with sleep? Casaundra: Yeah, it’s been a long journey. I feel like, you know, as a kid I slept fine for the most part, but then you get to college and I think my like first bout of insomnia was probably like stress induced, it was like I was TAing for a class, I was training for a marathon. I was trying to keep really high grades and, and doing all these things. Casaundra: I’m like, I think I was just at the max and like it was just leading to me not being able to sleep because I was about all these things and all these projects and things to do. And so I think the stress kind of built and then that just started this like evolving journey of cycles of insomnia. Casaundra: So it would like come in different waves. Right. I remember leading my first team at work and. Going into another insomnia cycle. And that was like the first time I ever was put on Trazodone. then, you know, it went away. I think it would kind of ebb and flow, right? Like, oh, I, I would figure it out and it would go back to normal and then it would come back. but I had some really big life changes in like 20 22, 20 23. my, my grandmother who had raised me, had, had died. I had a relationship end that I’ve been in for years. And from all that I was also moving back to my home state, Ohio. And so you cram all of those things into a month and any normal person would probably struggle with sleep, but to me it wasn’t normal. Kind of put me into like this really bad insomnia cycle, right? And so I went back on Trazodone and it was like a year on Trazodone, which is a really long time to be on something like that. Then I finally like, we, we probably can talk more about how that went and what happened in it, but it kind of resolved a little bit. Casaundra: And then I married and I just went into like the hardest cycle of insomnia. And you know, for me it was like we didn’t live together before marriage. And so like having a person in my bed after I had just gotten my sleep, what felt like back on track was really like stressful to my body, I think. And it just was like, he could sleep anything all night long from like 8:00 PM on. And I was like trying to go to bed with him and like, you know, be married and, you know. Not stay up alone. And it just led to me trying even harder to sleep. And so those are, I think it’s been an ongoing thing, but those are kind of the most recent things. Martin: So there were these ups and downs. Maybe then you either adapted or you pulled back a little bit and then sleep had the chance to get back on track. Martin: But it felt like as time went on, when the sleep disruption showed up, it kind of morphed into its own thing. Like it didn’t respond quite as well to the changes that you made, the, the adaptions that you made, the efforts that you made to get things back on track. And then it soon became the main problem rather than all the actual stresses which had once triggered it. Casaundra: Absolutely. Sleep was like the number one thing on my mind during those times in my life, despite like all the other craziness in my life which just made it even more consuming. Martin: Was there such a thing as like an average night back then? If there was, what was it like? Casaundra: When I had that second to last bout of insomnia, where it was after all of those life changes, it was like, that was different because I had just gotten off Trazodone, but I like stopped like. did a hard stop. I didn’t taper, which to anyone listening, please don’t do that. Casaundra: Talk to your doctor about how to get, you know, taper down on medicine. But it kind of sent me into like, I wasn’t sleeping at all. Like there were two nights straight. I was like, did not sleep. And now I can look back at it and know it was probably the medicine. And there was probably nothing wrong with me outside of the fact that I stopped taking medicine inappropriately without tapering. But that was really hard. And so was really extreme in which the average night was like not sleeping. Where like my most recent bout was when I, you know, just got married and adjusting to living together and sleeping in the same bed. An average night was like, okay, I’m really tired. My husband’s going to bed, and I lay down and immediately just wake up. Right. It was like the adrenaline or the fight or flight. Like as soon as my head hit the pillow, I was immediately stressed and anxious about what that night was going to bring based on everything that I had experienced every night before that. Martin: Would you find that as the night was approaching you, maybe you were downstairs watch TV or doing whatever you’re doing, and you felt like sleepiness showing up, you felt like really drowsy, really sleepy, and then you went off to bed and then suddenly you felt wide awake. Casaundra: Yeah, and it was kind of a mix. Like I would be anxious, but I could feel tired, like I knew I was getting sleepy. Mm-hmm. But as soon as I felt sleepy, I got anxious, and as soon as I felt like I could go to bed, I put down my head on the pillow and it was, yeah. Complete anxiety about sleep and stress. Martin: It was like that problem solving brain just fires up and it starts to predict what the night is gonna bring or it starts to prepare you for the battle or the struggle that experience tells you is about to show up. Casaundra: Battle is such a good word for that. That is truly how it felt like so many nights. Martin: Anyone listening to this is gonna be all too aware that insomnia isn’t just a struggle that happens at night, and it also affects the days as well. I’m curious to hear from you when you found yourself in this struggle, what, what were the days like for you at that time? Casaundra: I think the biggest issue for me during the days was actually like the anxiety and like consuming thoughts around sleep. So for me, I like, I think I was like in such a high fight or flight and like high adrenaline mode that I didn’t feel tired, like I felt wound up despite not even, you know, consuming a ton of caffeine or doing anything crazy. Casaundra: I felt on edge all day and like I kind of looked at it like a blessing, like, thank God I can get through my days, but my mind was constantly consumed with researching sleep. What else could I do? What are people, what’s the new fad for getting to sleep and how could I adjust to make sure that I could go to sleep that night? Martin: A phrase associated with people struggling with insomnia is tired but wired. So it’s like you feel a real sense of tiredness or fatigue during the day, but at the same time you’re, you’re just completely wired, really alert. And like you shared, it can help get you through the day and in other ways it can also work against you perhaps if you kind of harness that energy to engage in ongoing problem solving and research, which is completely understandable ’cause you’ve identified a problem that you want to fix. But as we’ll probably explore a little bit more as the conversation progresses, it ends up consuming your attention and the focus of your day is no longer on doing the stuff that matters. Martin: It becomes on fixing this problem. Casaundra: And that’s exactly what happened to me. So it started with just those consuming thoughts, but then it completely changed what my evenings looked like and what I did and how I prepared to do all those things that I was researching. Martin: So connected to that. Moving on from that, what kind of things did you try in an attempt to get sleep back on track to deal with all these thoughts and these feelings that were showing up? Casaundra: I really feel like I did everything, and I’m sure you know, someone said something different, but I truly felt like anything that I read or someone told me, I was like. Open to try anything. Like I was so desperate that I would do anything to get my sleep back on track. And so it started with like environmental changes, right? The blackout curtains. Very expensive noise canceling like headphones for sleep because I lived in an apartment and I swore, well, like if something, just like, if I couldn’t hear anything and nothing could wake me up, then for sure I would sleep. And you know, it started with melatonin, but I had been on Trazodone before and eventually after that, those like sleepless, like absolutely sleepless nights, it led to Ambien after going to a sleep doctor and specialist. And oh my gosh. I feel like one of my coworkers was like, Casaundra, have you ever tried Kiwis? Like my boyfriend, he eats Kiwis before bed, like six Kiwis, and makes him go right to sleep. I’m like, oh my gosh. Kiwis must be magical. No. It turns out they just have like, they, you know, help you produce melatonin. And after I knew that, I’m like, I shouldn’t even waste my time because melatonin does nothing for me. But there was like several nights I ate six Kiwis every night. I have not had a Kiwi since. I, I’ve tried different foods, not eating before bed, phones for like, no phone, tv, anything screen related for like three hours before bed. It was to the point where I literally would stop drinking water at 6, 6 30 so that I wouldn’t have to get up to use the restroom during the night because I swore that was keeping me up. Right. If I didn’t have any more water, then I would, you know, not struggle to go to sleep. And then, you know, I was. also impacted my social life, right? I had a bible study that we would meet on Wednesdays starting at seven, which even now, like even after all of this, I don’t love late plans, but I really got anxious about anything starting at seven because that’s when my nighttime routine needed to start. That’s when I needed to like settle and not be excited. Casaundra: So the fact that I went and get home until 10 and showered and ready for bed until 11 was really stressful for me. So yeah, if, if you can name it, I tried it and you know, in that first bout where I wasn’t sleeping at all, I did like a CBT-I app. But it kind of missed the mark on the control piece or like how you’re thinking about it. Like they obviously had some pieces of that, but it was just still felt more like controlling you know, just knowing that sleep will eventually come and the more I try to control it, the less it’s going to work. Martin: There’s something, all of those things that you just share with us, they all have something in common, right? And it’s just this understandable attempt to control sleep to make a certain amount or a certain type of sleep happen. And that completely makes sense because you identified sleep as a problem. Martin: You are a problem solver. You wanted to fix it. So you put effort into trying to fix it. And where it sounds like you noticed you were getting stuck was no matter what you were trying, no matter what you were doing, it just wasn’t having the desired result. So that just led you to doing more, doing more, trying harder, trying harder, and your actions just became dominated by serving sleep rather than serve you and the life you want to live. So not only did you find the actions were creating more struggle, they were also kind of pulling you away from who you are and who you wanted to be and the life you wanted to live. Casaundra: Absolutely. I felt like a different person even, and especially that being like the first year that I was, or like first few months of being married, like I’m sure my husband was like, Who did I marry? Because everything we did, everything I ate, everything was about how could I sleep? And, you know, he slept like a rock. And I know it’s this cruel thing that, you know, all of us just marry someone that, you know, can sleep when we can’t sleep. he would, you know, be sleeping in bed and he’s the type of person that nothing bothers him. He could be woken up and go right back to bed. And so, like there were nights where I would just wake him up, just sobbing, right? Casaundra: Just absolutely sobbing and so frustrated and so angry, like so, so angry that I couldn’t sleep and he would just scratch my back and, you know, try and help me get back to sleep. And, and two minutes later he’d be asleep and I would still be awake. And it was just all consuming my whole personality. My whole church group knew about it. Casaundra: Like I was just the insomniac. Martin: It’s like it takes over your identity, your sense of self, who you are. Casaundra: Absolutely. Martin: I’m, I’m curious to know, did you ever ask your husband at that time, like what he did, like what his secret was to just sleeping in the way he did? Casaundra: You know, I, I never really asked him then because it was just like, he just went to sleep. Like no matter what, he would just, you know, be on his phone, do whatever, and he just went to sleep. But now, like, after your course, someone’s like talking to me about sleep or telling me to try something, you know, if we’re talking about my history with insomnia, and I’ll be like, well, like, you know, you sleep well. Casaundra: Like, what do you do? Sleep? So I didn’t ask him, but now I ask people that all the time when they’re like recommending something, because a lot of times they’re like, oh, I don’t do anything. I just, you know, go to sleep. And so. But it was something like, through your course, I, I realized so much. I’m like, oh my gosh, the kid’s doing nothing and it just comes to him and he’s not a kid. Casaundra: He’s a six seven grown man. But yeah, it was infuriating, also hopeful. Like I knew if he could sleep doing nothing and I could sleep. just wasn’t, which really made me feel like something was wrong with me for the longest time until I worked through a lot of things in this course. Martin: That’s the insight right there, isn’t it? If we do know someone who is a fantastic sleeper. When we’re struggling with insomnia, it often tends to be a, a bed partner or a, or a spouse if we’re in that situation, and you just kind of get a, a blank look when you ask someone who doesn’t struggle with sleep, like what they do to make that sleep happen, because the answer is they don’t do anything. Martin: And that can reveal opportunity and a new way forward if we feel like what we’re doing at the current time is keeping us stuck or not working for us. Martin: I think you touched upon it a little bit earlier, but I’m curious to know, you know, as you were doing all this problem solving and trying all these different things to get your sleep back on track, especially these things that you, you know, read about online that is shared with such confidence that this is the thing that will fix your sleep. When you tried those things and it just wasn’t working for you, what was that experience like? Casaundra: For me it was really difficult because I’ve always been like happy and you know, optimistic and able to look at things like with a glass like half full. with sleep, it was the first time I had some of those really dark thoughts. Like I felt not only alone, but hopeless, but also like. A different length, like level of anger that I’d never felt before. Casaundra: But part of that like came to a head and like literally wishing I was in the hospital or wishing something so bad would happen to me that I had to go to the hospital to be like put to sleep. And, you know, it’s amazing what a lack of sleep and all this trying and all these things that you’re doing when they don’t work make you feel when you can’t get to the result that you’re wanting. Casaundra: Like I had never been more desperate in my life. And, you know, as someone who loves your life and, and wants to live it to the fullest and was really scary to have those thoughts of, well, if I could just put an end to this whole not sleeping thing. And that was really eye-opening too for me. Like, I was like, wow, like I, I need some help and I need a way out of here. Martin: It is really difficult and it’s. It’s not just about the problem of sleep, not happening as you want it to. It’s about all the stuff that gets added on top. You know, all the, all the trying to fix the problem and that, that repeated experience of, I’m trying this, this isn’t working, I’m trying this, this isn’t working. Martin: You can just feel as though you’re completely out of options and that there’s no way out. It feels just, it just feels like you’re trapped. Casaundra: Absolutely. And everything else in my life, I’ve been able to work hard enough, right? hard enough at school, get the scholarship, work hard enough at X, Y, Z, like get the promotion, like in life. So many things in life, like you’re able to control that way. And it was really hard for me for this to be. Something I couldn’t control. So it was, it was a lot of growth there for me as well, which I’m sure we can talk about later in terms of just kind of this being a process in which learning that control isn’t the best option in every situation. Martin: Since you had already tried so much at this point, when you came across my website or my work, what made you think that there was something different here or something worth trying? Casaundra: I can remember finding your podcast on Spotify. Like any person, like struggling to sleep. I was like, let’s get a puppy. And so, you know, I had a puppy. I wasn’t sleeping even more because of the puppy, and I was taking him on a walk and was just searching on Spotify for insomnia, you know, solutions. Casaundra: And I, I found your podcast and I had already done the other like CBT-I app before this. And so I kind of recognized some of the things that you were talking about within that. But then there was this like resounding piece that everyone who shared their stories was sharing and it was this like relinquish of control. Like it doesn’t have as much weight on my life. And that felt really like encouraging and like hopeful because it was consuming so much of my life that I’m like, this seems different. Martin: First of all, it felt different, but it was also in that context of, here are people talking about my experience, they’re describing the kind of things that I am going through, that I’m struggling with. So if this is something that these people found useful, maybe it’s something I’ll find useful too. Casaundra: Yeah, and it was like, oh my gosh, like I felt like I found like the Disneyland of people who struggle with insomnia, and it was like the first time I saw heard actual stories of people working through insomnia that. It sounded so much like myself, right? And you find like certain episodes and you’re like, wow, this person’s so much like me and like my story. Casaundra: And on those bad days I would just like replay it, right? And now to this day, you know, it’s amazing how quickly you forget. But I can’t remember the name of that podcast, but I remember the hope that it gave me on my really hard days that there was a way out and people just like me found that. Martin: What showed up for you when you identified this theme of relinquishing control? Because after all, you were so invested in trying to fix this problem, and now you’re hearing, well, maybe the way to fix it is to give up this control. Like what did that feel like as, as an option or as a suggested way forward? Casaundra: You know, it was actually so hard, like as the person that’s used control, not in a negative way, but just in a, hey, in our circle of control in our lives, we can get to places we’ve never been, accomplish things we’ve never done, escape generational cycles, and I had done all that, right? And so for me, this idea that if I just stopped controlling it kind of scary, right? Casaundra: Like it, it was just born to the brain for me at least, right? It was something I’d always, I just always worked hard and if I, I work hard, it, it, it gets the result that I need. But then there was the second piece of it, right? So the first piece was like a shift from how I usually think. the second piece was, what does that actually mean? Casaundra: Like, I think part of me was kind of like angry, like, okay, like. Just stop trying to control it. Sounds really easy, except when you consider the human brain and how we focus on things that are important to us and, and how we want to improve it naturally without even realizing it when it’s negatively impacting us or how our body wants to protect us, right? Casaundra: So this thought of, oh, I’ll just stop controlling it frustrating because I’m like, but how, do I control, how do I stop, you know, controlling this or trying to control? So a lot of mixed emotions. Martin: The two big ones being hope and fear at the same time. You raise a really good point. How do I do this? Like, how do I put this into action? How do I relinquish control? What do I do instead? Because I have to do something. I can’t just do nothing. So I’m curious to hear from you what kind of things you did to put this whole idea of relinquishing control or moving away from resistance. Martin: How did you put that into action? Casaundra: It takes a long time, right? And that’s something like even by the end of your course, I wasn’t like, healed, right? It was like I wanted to be, heck, week one. I wanted to be. But it’s just not how it works because I just had to keep doing little things each week to make my life outside of sleep bigger than the sleep issue. And so like, that’s what it started to feel like to actually stop trying to control it, was to build up my life outside of sleep so that it just got less attention. And by giving it less attention, it got less control and sleep could kind of move in. And so, know, a few things, you know, mindset was huge, right? Casaundra: Just realizing and hearing and seeing the facts about like, I’m not gonna die because I’m not sleeping like I will survive. Like, that was a big one for me. Like, just hearing that and knowing like, I’m gonna be okay. Like all of these, you know, statistics that I’m seeing like does not mean that I am not going to be well, and plenty of people live long healthy lives without, you know, eight, nine hours of sleep. Casaundra: And so that was part of the mindset, like realizing it wasn’t going to hurt me and so I, I didn’t need to fix it. realizing I could just. Go about my days, right? Like I didn’t need to think about it like sleep was going to come. That that simple sentence of our bodies are going to sleep when they need to provided so much rest for me it, I no longer was like, I’m not going to sleep. I’m like, well maybe it’s not tonight, but it will, it will come eventually. Like I can’t this up forever and so it will come. And so those were a few things or a couple things that stuck out to me in like the mindset shift and then you get into like what actions, right? Casaundra: So the mindset kind of made room for new actions to come into play for me which sounds like trying to sleep, but it was like all actions to actually stop trying to force sleep. Like, so the first one I think that gets introduced is the sleep window, right? And this was like life changing for me, right? Casaundra: And I had done sleep for, I just, I hadn’t had that mindset shift, so it didn’t mean anything, you know? And so you can first have that mindset shift, then these things can come in and actually be effective. And so the sleep window, like I remember the first night was like excited, right? Like I was like, I have so much time to get stuff done. Casaundra: Like I’m a maximizer, right? And that goes into the problem solving all this stuff. And so the idea that, you know, I could cook and clean and do a hobby and take my dog Teddy on a walk, and I could just keep doing all these things until like 9:00 PM because I didn’t need to start a bedtime routine at like 6 30, 7, whatever time it was that night. so. That sleep window gave me more time in my day and I felt like, wow, like this is exciting. And, you know, started doing more yoga in the evenings afterwards and I had more time for my Bible study reading and shows if I, you know, wanted to stay up and watch it. ’cause I was actually allowed to, like, there were no rules, like everything before was, you can’t do this and don’t spend any time in your bedroom. Casaundra: Like, I loved my bedroom. Like, it was so aesthetic and pretty, and I would never spend any time in it because of all these rules I had in place around the, you know, they say like, the bedroom can only be for three things. And that’s like, you know, sleep, we can all use our imagination on the second one and then sickness, right? Casaundra: And so now I could just hang out in my bedroom. I could sit on my bed, I could watch a show if I wanted to, if I was really like just really needing to rest because other people did that, right? Like my husband could literally be on his phone, watch a horror film, like the craziest things before bed, and then like fall asleep. So like I could now, I had permission to do that. so the first action was kind of that sleep window, right? And it gave me a lot of freedom and just like time and what I could do and when I could do it. And also just, I wasn’t spending three hours trying to go to bed. Like part of the thing with getting married to my husband is that he likes to go to bed early, which I do too, but like he is an extreme degree of like. Eight 30, he can get in bed. And for most of us, that’s not good. And if we still to this day, like he’ll be like, I’m so tired, I’m gonna go to bed. I’m like, I’m gonna read because I am not tired yet. And I know that if I try to go to bed before I’m even naturally sleepy, like it’s probably not gonna be a good thing for me, even though I don’t say I struggle with insomnia anymore. So that was kind of all things into the sleep window. And then, you know, I dropped all the behavioral and environmental things. Casaundra: Okay. I have, I lied a little bit. I still like use the earplugs, but only because now it’s just like a comfort thing. I don’t feel like I need them. If I forget them, it’s no big deal. It’s just like. I kind of imagine like a kid with a stuffed animal, it’s just like, oh. It’s like, okay, bed. so it’s like there’s no attachment to needing those, but I don’t take melatonin. Or I didn’t then. Right. It’s part of the change of knowing it wasn’t helping. Don’t take any of the harder, like Ambien that I was prescribed, and I just, I don’t have to eat six Kiwis and that’s really nice. So a lot of things have kind of let up on the behavioral and environmental changes and I can hang out with my friends, like, what a blessing in life. And so that’s kind of the environmental, behavioral and then you get to just like, well, everything wasn’t just fixed, right? And so what happens when I’m still awake at night and I can’t sleep even after that wake window ends and I’m allowed to, you know, go to bed. And there came in like. The just experiencing being awake. And so I, I took pieces from everything, right? I would go back to the mindset of sleep’s eventually going to come, I could use any of those, you know, tools or hobbies that I used to kind of relax during my sleep, like before my sleep window started. So I could do that if I wasn’t sleeping. But I could also just let the thoughts be and thank them for being there without them being so infuriating, right? I was no longer angry about being awake. I could just be awake. And I, I think one of my favorite things too, from the course was like, so much freedom in how you do these things. Like you would say, Hey, you can stay in bed if that’s comfortable still. And I love that because I hate getting outta bed when I am cold or it’s like. I don’t know. I just love being cozy in bed. So like the permission to just staying in bed as long as that’s still serving me mm-hmm. Really went a long way. Casaundra: So those were a few of the things. I think there were definitely other things but those are some of the big things that impacted my recovery. Martin: Something that really stood out for you. I think one of the first things you said was, which kind of encompassed everything that you shared, I started to make my life bigger than sleep. Those actions that we were talking about earlier, that when they’re so focused on serving sleep, serving insomnia, you took them back. Martin: Those actions started to once again serve you. So you were, you know, reading more, you were doing yoga, watching tv, doing your Bible studies. The sleep window helped with that because it was one of those actions that moved you away from the chasing after sleep. You recognized that the amount of time you were allotting for sleep each night wasn’t really serving you. Martin: It was kind of setting you up for long periods of being awake in bed during the night. So by compressing that down and more closely matching it with the amount of sleep you’re currently getting, there was more opportunity for you to do these things that mattered. It opened up all this additional time that you had available to do things that served you and the life you wanted to live, and that in turn helped reduce the influence of sleep in your life. Martin: It was still there, like sleep or insomnia was still there, but now it was one of many things rather than the only thing. And like you touched upon that didn’t mean that suddenly there was this miraculous transformation and that sleep was happening exactly as you wanted it to, or the, all these difficult thoughts, difficult feelings, stopped showing up. Martin: But it’s got you started on this new way forward where you were reclaiming your life, where life was becoming bigger and opening up again. And I’m curious to hear a little bit more about how you were addressing all the thoughts and the feelings that show up at night. You know, especially when sleep isn’t happening as you want it to happen. Martin: You said that something changed there, where you kind of gave permission for those thoughts to exist. You even thanked them for showing up and that in turn kind of reduced how they were affecting you. Martin: What would you say to someone that might be sitting here listening to this thinking I can’t possibly open up or accept those things ’cause they’re really difficult. And it’s just the idea of opening up to them in itself is really scary. Casaundra: It is really scary, right? Because you’re like, I have fought this so hard, like, why would I, and, you know, invite them in. But it, it takes the power away, right? And, and they can’t hurt you, right? The more you let them in, the less they actually hold over you. I, I, I remember my thoughts would just kind of swirl and ruminate and, and keep going, but when I would actually like. Let them in and observe them and see what they were telling me, which is that sleep is important. And of course I have important things coming up in my life. Or you know, I wanna sleep for a certain reason. Telling me all these things were important to me. I could just thank them because I was like, yes, this is important. Casaundra: Thank you for showing me that. It is important, but I’m gonna let you go now. Right. And I, I don’t remember if it was part of the course or, and I think it probably was, but I would just like imagine them like going out the window, right? Like the breeze would kind of pull them out the window. And I think maybe some people would do like, you know, flowing down water or something. And just that visual, even though it sounds really silly, helped me to just kind of watch them go, right? I let them come in, I let them stay. We had a good talk, but now they could go and they might come right back. Sometimes they just like come around the window and start knocking on the door. And you’re allowed to just do the same thing. I found like if I didn’t let them in, it actually made it worse. And I actually just kept ruminating over what I thought it was going to be. And this has helped me in like other areas of my life too, right? I can sometimes be anxious about, you know, driving on the highway, right? And what if something bad happens to me? Casaundra: And just like recognizing, well, okay, that’s a really small chance that would happen, and what’s the worst thing that could happen, right? I go to be with Jesus and my family’s taken care of because all the things I’ve put in place, okay, that’s actually not that bad, right? And so it’s helped me in other ways too, of like not just insomnia, knowing, oh yeah, I’m gonna be fine tomorrow. Casaundra: Like no matter how tonight goes, I’m going to be fine. I’m gonna do all the things that I need to do no matter what. Martin: It sounds like you found it helpful to recognize that your brain wasn’t working against you. That all these thoughts and these feelings that were showing up, many of which can be really difficult to experience, don’t come from your brain working against you. It comes from your brain, like reminding you of what’s important, reminding you of what matters, looking out for you. Martin: And that in itself just acknowledge being aware of that, that my brain isn’t an adversary can help support you in responding differently with less resistance. Casaundra: Oh yeah. Even like to this day, you know, if I have a rough night or I’m just not sleeping as easy as sometimes I do. It’s like, oh yeah, like I’m, I was so excited about this new podcast I found, or something at work that’s happening, and so it’s like, oh yeah, like I’m excited or I’m stressed. Like this makes total sense. And you’re like, okay, yeah, maybe I don’t sleep the best at tonight, but it’s just because of X, Y, Z, not because I’m broken, not because I need to change anything or I can’t sleep. None of that’s true. It’s just the things that are now filling up my life. Martin: The approach that you took that you found helpful, which, which to summarize, it sounds like it was, first of all, just kind of acknowledging what your brain was telling you. Maybe thanking it for looking out for you, then being more of an observer of whatever these thoughts and these feelings were. Martin: You shared that as you did that it kind of lifted the weight of them a little bit, but you did notice that sometimes they would drift off, but then sometimes they would also come back. How did you respond to that experience of them coming back? Because I think often what can happen is when we practice this new approach of opening up, reducing our resistance, and we notice, wow, these thoughts, these feelings are losing their power. Martin: They’re losing their influence. Oh, they’re disappearing. When they come back, suddenly it can feel like uhoh, the brain goes into alert. This is another one of those things that’s not working. Now we have to do something different. I’m just curious to hear what your experience was like with that and how you responded. Casaundra: Yeah, I would love to say that every time I came back, I just did it all again and it worked just fine. The reality is sometimes they come back and it’s, it’s even more scary, right? Because there’s a part of insomnia that when little pieces that remind you of it come back into your life or a thought comes back up and it’s not easy. It’s like scary, right? Like you’re like, is tonight gonna be that night? Or is, you know, you start. Can start having negative thoughts about it. And so that did happen sometimes, right? Casaundra: I didn’t spend as much time in that really dark place. Right. Which was a really scary place for me. Remember, because it’s not who I am. I was so much kinder to myself, right? It, it didn’t have as much weight. I, I didn’t feel like I was broken or that it was my fault. was just the nature of, you know, being human. Martin: Were there any other changes that you wanted to mention or share that you found helpful on this journey of moving away from the struggle with insomnia? Casaundra: Yeah, I think one for me that sometimes just kind of gets looped into like the sleep window thing was the buffer zone. So having that hour before bedtime to just do tasks that were not only just enjoyable and like full of life, but also more relaxing and the way of just like signal signaling to my body that I was preparing for sleep without controlling it. Right? Just doing a little bit more relax. And I honestly still use this like out of all the techniques. This idea of a buffer zone of, Hey, I know I’m a person that’s really sensitive to my environment, right? Casaundra: My husband to this day can, you know, do what he does, but I know I need like a half an hour, an hour to just kind of relax and let my body be as it kind of prepares to feel naturally sleepy so that I am going to bed tired. so that zone or the idea that you have a window of time right before bed to just kinda relax and do things to bring you joy, really helped me. Martin: Setting aside some time to unwind and just do things that you personally find relaxing and enjoyable rather than giving yourself a rule that I’ve gotta be home an hour before I go to bed, and I’ve gotta spend an hour making myself relax, making myself feel sleepy, and making myself have the best possible chances of making sleep happen. Casaundra: Oh yeah, absolutely. Like now, sometimes it’s like five minutes, right? I’ll be like, well, I’m just gonna like wind down and I open the book and I’m like, oh, I am so tired. Close the book and go to bed. And other times where it’s like, oh, I’m really finding that’s enjoyable and that turns into more time, but it’s never something that has to start at 9:00 PM and it’s, you know, never something. Casaundra: I feel like, oh my gosh, if I don’t have this, then I’m not going to be able to sleep. Martin: And, and that’s the difference there, isn’t it? Because as we talk about any of this stuff for example, a buffer zone or like a time to unwind, where we can set the stage for struggle is with our intention. So if the intention with something like a buffer zones to make sleep happen, that might be an action that doesn’t really serve us. Martin: If the intention with the buffer zone is to just set aside some time in the evening that might have once been filled with struggle and effort and trying to just be a period of time where we can do whatever we want, something that we find enjoyable, relaxing, pleasant, that can be productive, then that can be useful, then that can be a workable thing to do. Casaundra: The intent changed so much for me and like not trying to force sleep and at first you, you’re gonna kind of be lying to yourself maybe for, you know, some people I, I’ll speak for myself, but at first it was like, my intent is not to sleep. Like, not to force sleep, but my intent was definitely to go to sleep at first. Casaundra: But it, it involves and so you kinda have to lie and, you know, kind of trick your brain for a little bit occasionally to start actually believing that. And that might not be true for everyone, but as a control freak, like you might start off like just speaking a different truth over your body than is actually going on. Martin: Something we touched upon earlier was about, you know, how in the insomnia struggle isn’t just a nighttime problem, it it, it’s a 24 7 problem. It goes into the days as well. And a change that you made with your days was to just really focus your attention on actions that served you, that were important to you, that mattered to you, rather than what might make a certain amount or a certain type of sleep happen. Martin: Something else that can make these days more difficult too, are the thoughts and those feelings that can show up. You know, the anxieties, the worry and the time traveling that from the brain, like predicting what the night is gonna be like tonight or what previous nights were like, and that in turn could just make things. Martin: More difficult and it makes it harder to do those things that matter. I’m curious to hear from you if you practiced anything or had this way of dealing with all those thoughts and feelings that would show up during the day. What did you find was a workable way to deal with them at that time? Casaundra: It was kind of just like, you know, noticing and observing it. It was kind of like the abbreviated version of what I would do at night, right? Casaundra: Like, I would observe what was happening, kind of ground myself back to my day and then just move forward. And I, I can’t remember it as much because I feel like my life was so busy, like between work and everything, the moment that I stopped you know, being so consumed about researching what could make me sleep, it gave me a lot more freedom in my days. Casaundra: But that being said, like I definitely still had to redirect. And this is the same exercise when I was saying help me with like, being in the car and driving. It’s kind of that similar thing of like, notice what you’re feeling and let it be and observe it, and kind of grounding yourself and what’s actually happening around you. Martin: It comes down again to less resistance. And every time you got that opportunity to practice developing that skill of reducing your resistance it kind of strips them of their power and their influence. You are better able to refocus. So you are noticing, first and foremost whatever thought and feeling was showing up. Martin: Then you are opening up, dropping that resistance, allowing it to be with you, and then just noticing or refocusing on where you are. What you were doing or what you wanted to be doing, even when that thought is still there. So your goal isn’t to kind of get rid of it. Although sometimes when we lower that resistance, it does make it easier to flow, to come and go, but it was just to refocus your attention when those thoughts and feelings showed up. Martin: So they didn’t kind of jerk you around so much. Casaundra: And so many times I would be like halfway through the exercise and it would already start kinda working, right? I’d be like, oh yeah, and I’m, now, I’m gonna think about this without planning on it, right? Instead of it just like coming at me so hard with me trying to push it away, like I definitely am the person to like push away negative. Casaundra: And so these like exercises helped a lot with me not pushing it away, but allowing it to come even though it was scary. Martin: You make a good point there that this stuff can still feel scary. It’s not about trying to make something not scary or trying to make a thought or a feeling disappear. It’s just about acknowledging or accepting that your experience seems to suggest that these thoughts and feelings and emotions are out of your direct control. Martin: There’s no magic switch that you can flick to turn them off. So continuing to try might be making them more difficult. So how about we respond in a different way? And that different way is really easy for us to talk about. It’s certainly a lot easier than putting it into practice, but with practice, we can develop this skill in experiencing all this difficult stuff with less of a struggle so it doesn’t have quite so much power and influence over us. Martin: How long would you say that it took for you to get to a point where it felt like you weren’t just in this endless struggle with sleep, you know that you were out of the struggle, you could live your life independently of sleep, no matter what kind of thoughts, no matter what kind of feelings were showing up. Casaundra: Like I said at the beginning of the call, like I wanted it to be week one, and I’m sure everyone listening is like, man, I, I hope it’s week one of this course. But for me, it, it really took like a month or two after, like, I can’t remember the exact time or date because once it stops being so big, you kind of stop remembering it, and so. For me, it was like ending the course and letting it not even be that big in my life. Right? Like there were a lot of tools I needed to learn, right? And all the videos and the how-tos, like all of those were so important and I needed to have all of those in my tool belt. But after that, I just needed more time to, to use those without a focus on it. Casaundra: Right? And as soon as I, I didn’t have those things that I needed to watch or do every week, the less and less sleep became a big deal and the farther I got away from thinking about it as much as I was. And so I would say about a month or two, probably after I finished maybe a little bit more it really kind of start to settle and the idea of, you know, no night is ever perfect, but I really didn’t feel like I was an insomniac anymore. Casaundra: I kind of felt just like a human with sleep. Martin: What did progress look like for you? What were your measures of progress? What told you that you were heading in the right direction? Casaundra: I think for me it was like the weight on me about my sleep. Like, did I wake up thinking I didn’t get enough? Or how big of an influence is this going to have? So, like early on that was really big for me. Like the progress within your course was measured by how was I feeling in my day and could I go about my day without this being bigger than the rest of my life? Casaundra: And so that was it. And as much as I wanna say that I, you know, didn’t look at the amount of sleep I was getting as like tracker of progress, you kind of do it naturally, but it wasn’t like. I need more sleep. It was just like, huh, wow. Casaundra: Like I slept really well last night. I didn’t do anything. So I think you kind of just notice it throughout your life anyways without putting too much of an emphasis on it. It really just also let me be a different person, right? Like my husband got back the person that he lost when we were first married, and I was struggling with insomnia. Martin: It was interesting hearing you share what your markers of progress were because you didn’t really say in there, oh, the nights when I got like seven hours of sleep, I knew that was progress. Martin: Or eight hours of sleep or six hours. There was no number of hours of sleep. You didn’t even describe the type of sleep. And that’s insightful because I think that for as long as we are measuring progress based on sleep, which, our experience, if we’ve been struggling with it, probably tells us is out of our control. Martin: Then it sets the stage for that ongoing struggle. But your markers of progress, as you were reflecting were, you know, I was just noticing sleep wasn’t a big deal. It wasn’t as big a deal. It was losing some of its power or some of its influence. It was more about what, what am I doing with my life? Like, what am I doing day to day? Martin: Are my actions serving me? Do they reflect my values? Do they reflect the life I wanna live? Are my actions moving me in the direction that I want to be heading? Martin: I think you summarized it as well towards the end. You know, I, I got my life back, you know, I am the person that I want to be and all of those things are a ction based. They’re all things that you can control. It’s so helpful to use things like that as measures of progress rather than what kind of sleep am I getting from night to night. Casaundra: Absolutely. And I think like, you know, even hearing on other people like them share on the podcast, it was, it was more about that too, right? Like it’s a beautiful thing of like, this is the power of not holding so much control over sleep. Martin: One more question about progress whilst we’re on that subject. Did you find that as you were practicing these new skills, that it was like every single day or every single night was just kind of like better than the previous one? Or about the same of, did you notice there were ups and downs? I’m just curious what the journey looked like for you in terms of progress. Casaundra: That’s probably two steps forward, one step back kind of thing. I, I, I don’t think I’ve ever heard anyone say, yeah, it was just smooth sailing from course on out. Like, that wasn’t my experience either, right? Every, every night looked a little bit different and some made me fearful that I was starting over at the beginning. Casaundra: But everything I learned taught me that, hey, that’s not the actual truth. Like this is normal and it will get better the more you keep working on these tools. So were definitely a lot of setbacks, but the mental mind shift, like the shift in mindset just makes it where it’s not as big of a deal. Martin: I’m curious to know what it was that kept you moving forward when those setbacks happened, especially those, the initial setbacks early on, you know, you’re noticing the progress. Then you have like your first kind of setback, or you notice you have that awareness that you’re getting pulled back into the struggle or that you are struggling again. Martin: How do you kind of reset or refocus and continue moving forward when that happens? Casaundra: It always would start with like the reminders. Like I, I would remind myself, I know sleep’s coming, like I know that this isn’t the truth over my life. But then comes like the motivation of like why I keep going, right? So what gets me to keep going, but then why is, is more of a, I just wanted my life back. Casaundra: Like, I hated being awake at night and wondering how the rest of the entire world had their lights off and were sleeping, and I just wanted to be that person with their lights off. And so I knew if I just kept putting one foot forward every day, I was bound to get there no matter if I had to go back a little bit every once in a while. Martin: It sounds like you found it helpful to remind yourself of why it’s important for you to respond in a certain way. Why this idea of reducing resistance, focusing on workable action actions that matter to you why that’s important, why it matters, and that’s what helped you stay focused on continuing to do the things that mattered and keeping you moving in the direction you want it to be heading. Casaundra: Absolutely. Martin: What would you say that you’ve learned from this whole experience and in what ways do you feel that you’ve grown from it, if any. Casaundra: Yeah, no a lot and summarize maybe two. So for me, like the perception of insomnia and, and what it actually is, and it’s, it’s shifted for me now. It’s not so much of a problem ’cause I know sleep’s going to come and if there is a disturbance in my sleep, it, it’s that, right? That word right there disturbance. Casaundra: It’s just something disturbing my sleep instead of insomnia or this like chronic thing that can’t be overcome. And so there’s a big perception change around what insomnia even is. And, then the second thing is just control, right? I, it has really helped me not try to control other things in my life. Just like with sleep, you know, there’s other things that kind of work the same, right? Stress or, I am trying to think of another good example, but stress is kind of the only other one I can think of that’s as similar. Like the more you focus on it, the worse it might get and sometimes you just have to let it go and it’s really helped me with that. Casaundra: Anxiety probably is another great example, honestly, better. So it’s really helped me with letting those things go and, and changing how I approach control. Casaundra: I wouldn’t wish insomnia on my worst enemy, but at the same time, I’m like so thankful for what I found and what I learned in your course and how it’s enabled me to react so differently to things that feel so impossible. Martin: I’m really grateful for the time you’ve taken at your day to come onto the podcast. I do have one last question for you, and then it’s this one. If someone with chronic insomnia is listening and they feel as though they’ve tried everything, they’re beyond help, that they’ll never be able to stop struggling with insomnia, what would you say to them? Casaundra: I would say, you know, our creator God, designed sleep, and it’s going to come eventually. And the more you can relinquish control of trying to get sleep by filling your life with joy regardless of what the nights look like and the more energy you spend bringing that effort and attention to those things that fill up your life, the less you’re going to be controlling your sleep, and then the more you will. Martin: thank you again for coming onto the podcast, Casaundra. It’s really appreciated. Thank you. Casaundra: Thank you so much. Martin: Thanks for listening to the Insomnia Coach Podcast. If you're ready to get your life back from insomnia, I would love to help. You can learn more about the sleep coaching programs I offer at Insomnia Coach — and, if you have any questions, you can email me. Martin: I hope you enjoyed this episode of the Insomnia Coach Podcast. I'm Martin Reed, and as always, I'd like to leave you with this important reminder — you are not alone and you can sleep. I want you to be the next insomnia success story I share! If you're ready to stop struggling with sleep and get your life back from insomnia, you can start my insomnia coaching course at insomniacoach.com. Please share this episode!

We are joined by Victoria, a member of our community and the Immunity program, who shares her powerful journey of overcoming chronic insomnia. Victoria's struggle began unexpectedly in September, leading her down a difficult path of relying on medications like Z-Quil, Trazodone, and Ambien, only to find they eventually stopped working and left her in a "rabbit hole" of worry and side effects. She opens up about the loneliness of insomnia, the pressure of work obligations, and why traditional CBT-I methods didn't provide the long-term relief she needed. Discover the turning point in Victoria's recovery—from taking a necessary leave from work to rebuild her confidence, to rediscovering joy and rhythm in her life. Her story is a testament to the fact that even when you feel like you'll never get out of the struggle, you can get through it. If you're new here and curious to learn more, our FREE video course, The Festival of Understanding, is the perfect place to start. Head over to https://buff.ly/pmsuvTZ and click the link at the very top of the page to begin your journey. If you're ready to leave insomnia for good, check out our coaching options. Head over to www.thesleepcoachschool.com and click on GET SLEEP in the menu. The Insomnia Immunity program is perfect if you like learning through video and want to join a group on your journey towards sleeping well. BedTyme is ideal if you like to learn via text and have a sleep coach in your pocket. The 1:1 Zoom based program is for you if you like to connect one on one with someone who has been where you are now. — Do you like learning by reading? If so, here are two books that offer breakthroughs! Tales of Courage by Daniel Erichsen https://www.amazon.com/Tales-Courage-... S et it & Forget it by Daniel Erichsen https://www.amazon.com/Set-Forget-rea... — Would you like to become a Sleep Hero by supporting the Natto movement on Patreon? If so, that's incredibly nice of you

Amber had always been someone people counted on. A nurse. A mom. For most of her life, sleep wasn't something she worried about. It just happened. Then life changed. After her second baby — who arrived early and had some health problems — nights became more difficult. She'd lie down only to wait for the next cry. It felt easier to stay awake than to sleep. Years working as a NICU nurse added another layer. More responsibility. More pressure to perform. Sleep felt increasingly fragile and one night she couldn't sleep at all. Panic showed up. Heart racing. Mind spinning. Insomnia became something to fix. She researched. Tightened her routine. Optimized sleep hygiene. Tried teas. Tried prescriptions. Got in and out of bed. Tried relaxing harder. Tried doing everything “right.” Nothing worked. In fact, the harder she tried, the more she struggled. Nights became lonely and exhausting. Life started to revolve around sleep. Then, in the middle of the night, searching for help, she stumbled across stories of people who weren't fixing sleep — they were changing how they responded to being awake. Less fighting. More flexibility. More focus on living. It wasn't quick. It wasn't perfect. But little by little, Amber’s struggle loosened. And sleep stopped being the boss. Click here for a full transcript of this episode. Transcript Martin: Welcome to the Insomnia Coach Podcast. My name is Martin Reed. I believe that by changing how we respond to insomnia and all the difficult thoughts and feelings that come with it, we can move away from struggling with insomnia and toward living the life we want to live. Martin: The content of this podcast is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. The statements and opinions expressed by guests are their own and are not necessarily endorsed by Insomnia Coach LLC. All content is provided “as is” and without warranties, either express or implied. Martin: Okay. So Amber, thank you so much for taking the time out for your day to come onto the podcast. Amber: Thank you. Martin: Let’s start right at the very beginning, as always. Can you tell us when your issues with sleep first began and what you think might have caused those initial issues with sleep? Amber: Yeah. For the most part I’ve been a pretty good sleeper. Amber: However, I’ve had some points in my life where it’s become a little bit hard and I would say the first time that I noticed a significant change was that was after I had my second baby, he was early, he had some health problems. And I noticed, that I started losing my sleep then. Obviously every new mother does anyways, but I was worried about feeding him. Amber: I was worried about him getting enough to eat. I would get him settled and then I would lay down and just be waiting for that next cry. And so it was like almost easier to stay awake in a way, but not in the long run. So that was the first time I noticed it. And then the bulk of my career I have been a NICU nurse, which also made me a little anxious about my newborns. Amber: Sometimes I would be a little bit anxious before certain shifts. Not always, ’cause I worked for 25 years and it was great. But occasionally I would be anxious about getting to bed and in time and getting enough sleep. And so I noticed it there. And then I went back to school a few years ago to become a nurse practitioner and I probably had a little bit of a harder time sleeping during school. Amber: I got a lot more sensitive to my husband’s snoring during that time and, very light sleeper. And then after that, when I got my first job as a nurse practitioner, I was very on edge and very anxious. And while I was orienting for that job, I did not get a lot of sleep. I still at that time wasn’t paying a lot of attention to the sleep itself. Amber: Just aware that I wasn’t sleeping enough. Then I would say a couple years ago is where it really came to a head. I had various just normal life stresses going on with various kids and things. And one night I just could not sleep. And I started to recognize that I was having a bit of panic attack and I had some experience with panic and anxiety in the past, like mainly around that baby that I told you about. Amber: I had learned to work through that and I really hadn’t experienced a lot of it for probably a good decade and a half, but I noticed it that night and that generated a real fear response to me. And I thought, I remember distinctly having thought, oh my gosh, is this gonna keep me from sleeping now? And that’s, that was the hallmark. Amber: That’s what started it. And it became its own beast from that point on. Martin: You can recall a lot of times in your life when there were some stressors going on, for want of a better word, and that impacted your sleep. But it tended to be the case that once those initial triggers were no longer present or as relevant, things tended to get back on track. Amber: I had experienced times in the past where my anxiety was higher and I have always known that my personality goes a little in that direction, but it was manageable. I had been able to manage it and I had learned to manage it pretty well previous to that. Amber: But this time it I think the fear that it was going to affect my sleep, I did not know how to deal with that, and that scared me on a whole new level. And so now I feel like I was dealing with two things, just, being an anxious sort and now not being able to sleep on top of that. Amber: I value my health and I work in healthcare and so I do pay attention to details for sure. Amber: And getting enough sleep was very important to me. I know all the health benefits of that I’ve, and so the thought of not being able to have that and trying to function without it was quite terrifying to me, especially thinking of taking care of other people’s health. Martin: So you’ve got that added pressure to perform sleep because it’s not just about you, it’s also about all the other people you’re interacting with and caring for each day. What were you doing to try and get things back on track? Amber: I just go right to trying to problem solve. And of course that’s an important part of my job. That’s how I’ve dealt with being a mother and any other role I’ve had is to figure out, okay, what do I need to do differently? Amber: I need to understand this better. I’m gonna research it. I’m going to read about it. I’m gonna see what other people do and I’m gonna try all those things just, and I’m gonna, I’m gonna fix this. That’s what I thought. I’m gonna fix it. And so I did several different things. A lot of things that I’ve heard described on your other episodes. Amber: Sleep hygiene was a big thing, and that is actually something I talked to patients about. And so I thought I need to make my sleep hygiene better and I need to make sure I get in bed at a certain time and have everyone be quiet. I can’t have my noise in my room. I need to be really relaxed, so I’ve got to force myself to be relaxed. Amber: Try some of the sleep herbal teas. I don’t love medication, so I was trying not to go there in the beginning. Eventually I did go and try some medication. I have plenty of nurse practitioner friends that could write me a prescription for something. And so I tried various things, but only briefly I will say I, because I quickly realized that there was no medication that was helping. Amber: It might help initially. And then very quickly I discovered that my alarm system was stronger than the medication. And I think I tried maybe two or three different things and I just thought, I’m not gonna do this anymore. ’cause I don’t really wanna be on it anyways and it’s not helping. So yeah, I tried all those things. Amber: It was a difficult time. Amber: There was one night where I tried Ambien. I had tried hydroxyzine, I had tried Trazodone. Those two didn’t help at all. Amber: And one night I tried Ambien and I knew as a professional that’s not a medication that you want to take for very long ’cause it can really be disrupted to sleep. But by that point I was so desperate that I thought maybe if I took it a couple nights, it would help reset me. And that was even the term that the provider I talked to and I had was that maybe I needed a couple nights of reset. Amber: And I, so the first night I tried it and I was really relieved knowing that I had it that night. So I think my anxiety went down quite a bit right there. ’cause I knew I had something that was going to help and I just slept like a log that night. And so I thought, great this is it. I’m gonna do this a couple nights, I’m gonna get rid of it and I’m gonna move on and be normal again. Amber: And the very next night I took it and I slept really hard for maybe two hours and then I was up the rest of the night and I was pretty blown away that I had overpowered that medication that I knew to be pretty strong. And so from, I just threw it out at that point because I thought this isn’t working and it’s not gonna, it’s gonna, give me side effects anyway, so I don’t want it. Amber: So yeah I was really to the end of my rope at that point. I didn’t know what else to do. Martin: I think a lot of people will identify with at least some kind of aspect of your experience with the medication there. You’ve got that thing and it can feel like a sense of relief. Martin: It’s almost like you’re delegating all of the effort that you might felt you had to put into sleep to try and make it happen, now it’s not your issue anymore, it’s down to whatever this thing is. So you take it and it’s that’s it. Now there’s no more effort. There’s no more trying, there’s no more pressure, there’s no more performance anxiety, and that in itself can just immediately create better conditions for sleep. Martin: Maybe the real issue is all the understandable trying and the pressure and the effort. Amber: Yeah that’s very true. And as you were talking, I actually was thinking of something else I tried. I had an another provider tell me to at night it was a CBT thing. It was to get out of bed when I started feeling those anxious feelings so that I wouldn’t associate my bed with that anxiety. Amber: And I thought that makes sense ’cause I’m really struggling when I’m laying in my bed. And she told me also to pull out the Old Testament and read Leviticus ’cause it’s really boring. And maybe that would help. And I did it and it was boring. But I found after a while it, it helped a bit initially, but I found after a while that the exercise of getting in and out of bed when I was feeling anxiety was adding to my anxiety. Amber: ’cause I was just like, oh, here I go again. I’ve, been in bed for 15 minutes. I gotta get out again. It was just something else I had to keep track of. Martin: Did it almost feel like an additional punishment on top of being awake, this kind of obligation that I should be getting out of bed as well? Amber: Yes, it did. Very much yeah, it was not relaxing to me. Martin: I’ve had guests on the podcast that have found it really helpful to get out of bed during the night, and I have other guests just like yourself that did not find it helpful to get out of bed during the night. Martin: And I think really it just comes down to what our intent is. If we are getting out of bed because we are trying to get rid of anxiety or thoughts or feelings or to get rid of insomnia, to make ourselves feel sleepy again, to make sleep happen, then we might be setting ourselves up for some struggle if our experience tells us that’s out of our control if we’re getting out of bed, just because to us, that feels like a more productive way of spending our time awake during the night. Martin: Maybe that is gonna be helpful for you. And if your goal is to just use that time awake in a way that’s more useful, that involves less struggling, we can then see that it doesn’t matter, does it? You can do that in bed. You can do that out of bed. Because our goal is just to experience this with less struggle. Martin: It’s the struggle that kind of adds all that extra difficulty on top. Amber: That is very true. And that is what I had to come to. It took me a while. And I know I actually emailed you a few times about, I wanted you to tell me exactly what to do and of course you won’t do that. Amber: Your answers are to help people search themselves to find out what they need to do because it is very individual. And I finally came to. I just need to see how I feel in the moment. If it feels better, if I want to stay in bed, then I’m gonna do that. But if the feelings of, I don’t know, anxiety or restlessness, get too much for me and I would rather do something out of my bed, then I’ll do that. Amber: So I really ended up not having a certain way of doing things, which I think was a key. Martin: You were giving yourself more flexibility. Whereas when we were in problem solving mode, it’s I have to do this, I have to do this, I have to do this. And they’ve got this long list, haven’t we? Amber: Yeah, the algorithm. Martin: Exactly. Yeah. But then when we start to ease up a little bit, don’t cling onto it quite so tightly, we can become a little bit more flexible. And that in itself can be quite freeing, right? Because Amber: it is Martin: now we realize we’ve got options again, and that just opens things up a little bit. Martin: That doesn’t mean that things are just immediately gonna change, but it can just relieve some of that weight from our shoulders and help us realize that we can choose what we want to do. Amber: It’s quite liberating actually, when you get to that point. Martin: Just to rewind a little bit, what was an average night like for you back then, if there was such a thing? Amber: In the beginning, just sheer difficulty. It was miserable. It was absolutely miserable. I felt very isolated and very alone because of course everyone else in my house is completely out sleeping beautifully. And I am not. Amber: And it seemed to me like everybody in the neighborhood was sleeping great too. And I am up pacing and walking the hallways or trying to, focus on something that I can’t focus on. Having a lot of an anxious feelings. It just was awful. And then dreading the next day when I was going to be exhausted and very certain I wasn’t going to be able to perform in any of my roles the way I wanted to. Amber: That was the beginning. As time went on, that very slowly improved, but I did still have a lot of difficult nights as I moved forward. Martin: How was this influencing your days when you were still tangled up in the struggle? Amber: Yeah, that was really hard. I called in sick the next day at work and I hardly ever call in sick. I think I’ve missed, gosh, two days and two and a half years. I really, but I didn’t think I could be capable of my job the next day, and I was terrified of myself and terrified of how I would let down other people. Amber: And so I stayed home and just continued to suffer at home. And then, I mentioned my job a lot. That’s a really important role to me. But of my most important role is that of mother. And as family member to my family. And I also felt like I was not able to do a good job there. I felt like I was not quite present. Amber: They could tell that I just wasn’t as happy or didn’t have the energy. I wasn’t doing things that I enjoyed as much. It was just really became enclosed in myself and an obsessed about how I could fix this problem, not a good way to live. Martin: It makes sense why you called in sick to work not only for yourself, for your own wellbeing. It felt what if I might make a mistake at work because I can’t really focus. I’m so distracted. So it’s completely understandable why you would do that. And then at the same time, when you call in sick, you’re not doing that career or that job that might feel important to you. Martin: That’s reflection of who you are. It’s all this stuff influences your actions in a way that you get pulled away from that life you want to live. And that could be your work, your home life, your family life, your identity. It just feels like your actions start to serve insomnia, sleep, all these thoughts and feelings rather than your actions serving you, who you are and the life you want to live. Martin: And that just makes it all so much more difficult. Amber: Yeah, that’s so true. It’s like insomnia became the boss. Amber: I wasn’t new to the sensation of anxiety or panic. I had episodes of that in the past and I was feeling pretty confident that I knew how to handle that. ’cause it had been so long and I had moved through some really difficult things in my life. Amber: And I did okay. So then this thing came along and it was mysterious because I’d had this confidence so I could handle anxiety and difficult things. But this was a whole new thing and it caused me to go right down to the bottom again and go, what is wrong with me? What is wrong with my brain? Amber: Why I felt like I wasn’t doing it to myself, but I couldn’t understand how or why I was doing it to myself. So yes, very mysterious and very difficult for me to understand in the beginning. Martin: When you came across my work, what made you think that there was something different or something new or opened up this possibility that there’s a new way forward here? Amber: As probably most people that encounter your work it was in the middle of the night while I was on, looking for help in the middle of the night because I was just desperate. And I stumbled upon some of your, maybe one of your YouTubes, I think, and you were interviewing somebody like this. Amber: I listened to the person’s story and I thought, oh my gosh, that sounds exactly like how I feel right now. They were really expressing how desperate they were in the beginning and how confusing all the feelings I was feeling at the time. And so that really grabbed my attention because I heard the same level of desperation in this person’s description of themself, and yet they were now being interviewed by you and having worked through that. Amber: And so it gave me hope. And as I listened to it more, I realized that it actually was very similar to how I had learned to manage anxious thoughts or anxiety in the past. And that was to let them happen. So it was a different level of learning how to let something happen. So that cognitive understanding started coming. Amber: The more I would listen to your things on YouTube and your podcasts, I had, I felt like it made sense. It resonated with me. Martin: This is why I’m just so grateful that people like yourself are willing to come on because it, it can be so powerful to hear these journeys and these stories. Martin: There’s that validation. There’s the acknowledgement that you’re not alone, and then there’s that hope, and you had the bonus of being familiar with an approach of opening up to insomnia, opening up to panic, fear, anxiety. Amber: It’s a paradoxical thing that, that is how you get through it is by actually allowing it to happen. Amber: So that, that was a pivotal moment for me and started my process of recovery, which certainly didn’t happen overnight. But the cognitive understanding was there. Martin: So in terms of allowing it to happen, in a practical sense, how do you allow insomnia, for example, to happen when you really don’t want it to happen. Martin: How do you allow anxiety to happen when you really don’t want it to happen? What does that look like in, in terms of practical action? Amber: Yeah. That that, that was the next big hurdle was trying to figure that out. I asked that question of myself and of you, I think several times again, and it’s not something that you can figure out overnight. Amber: It takes a lot of practice. I think ongoing practice, I don’t think that practice ever ends because there’s always a new layer of things. Amber: One of them was to not beat myself up for things, because I realized that when I would get really frustrated and go, why can’t I do this? Why can’t I? What’s, why do I think this? Amber: Why is my brain so busy? Why do I think I have to problem solve everything? Why? I realized that I was just throwing fuel on the fire. I was just putting more pressure on myself. Friend said to me one morning, something that stuck with me, and you actually repeated in an email something very similar. Amber: She said I would never change your problem solving mind. It makes you who you are and look at all the things you’ve been able to do and accomplish. Because of the way your mind works and who would you be without your mind the way you were? And you had said something pretty similar to me about that too. Amber: So from that point on, I started looking at that differently and not flogging myself for just being who I am and seeing the benefit of the way my brain works. That was a big realization for me. And then another one was to realize when I was starting to try to prob over problem solve, maybe, oh, it worked this night but this didn’t work that night. Amber: Maybe I did it a little bit wrong. Maybe you know, I’m not following the algorithm. It was frustrating ’cause professionally, I really do have to follow algorithms a lot. And so I was having to pull away from that natural way of thinking. And not get stuck in this loop of problem solving and just letting it be, not worrying about it so much. Martin: Step one perhaps was, not beating yourself up over something that your own experience is telling you is out of your control. If you could have made a certain amount or type of sleep happen, you would’ve, you’d be doing it, right? If you could magically and permanently delete anxiety from your mind, you would’ve done it. Martin: But your experience tells you that’s not possible. You tried and tried. The conclusion from your experience was that’s not possible. So it sounds like part of your journey towards opening up a little bit more to this difficult stuff that you’d rather not experience is to acknowledge that it is out of your control and that your mind isn’t working against you, it’s not your adversary, even though it can sometimes feel that way. Martin: Because anxiety generally speaking doesn’t feel good. We can see it as a negative thing or a bad thing. If only this anxiety will go away, I would be able to sleep. If only this anxiety would go away, I would be able to be the person I want to be. Martin: But the brain generates anxiety because it’s trying to give us information about something. It’s trying to remind us of something that’s important. It’s trying to protect us. It’s trying to look out for us. It’s trying to keep us safe, and it’s gonna do this whether there’s a real threat or not, because it’s hyper cautious. Martin: It’s focused on doom and gloom. ’cause all the good, happy, fluffy, safe stuff isn’t a threat or a concern. So the brain spends no time on that. It’s only ever gonna focus on what might happen or the worst possible outcome or the worst possible experience. Martin: If we feel anxious that maybe we left the gas stove on. And so we turn around in our driveway and we go back in, we find out we did leave the gas stove on. Is anxiety still a bad thing when it stopped our house from exploding? It’s like what we add on top of it that is the source of so much of our struggle. Amber: Yes, very true. I think, I started using an analogy in my head as I was figuring this out more as a NICU nurse, which. Amber: All those years, if you’ve ever been in, in a neonatal intensive care, there’s a lot of alarms that go off all the time. And so sometimes the nurses get a sense of whether it’s an alarm that needs to be paid attention to or not. And people who haven’t been in there are really on edge because they can just, why are we not getting on top of all these alarms, but the nurses like this one, this is okay. Amber: We’re okay. We don’t need to do anything about it. And I started to realize that’s what was probably going on in me is I, I had an alarm that had some value to it and at times I needed to, of course I need to attend to it. I don’t wanna not be fearful of anything. But it also can go off for things that are not really urgent or really emergent. Amber: It might be a mistake, it might be like in the nicu, maybe the baby’s wiggling and setting off their alarm, and it’s not a problem. So realizing that a little more was helpful to me. Martin: I think that’s a fantastic analogy and I love how you connected it to a real ongoing experience that’s relevant to your life. Martin: ‘Cause that always makes this stuff so much more powerful. And yeah, there’s, these alarms are going off. Sometimes they’re helpful, sometimes they’re useful, sometimes they’re less helpful, sometimes they’re not helpful, they’re not useful. Sometimes maybe they’re more of a distraction than anything else, but what are they? Martin: At the end of the day, they’re snippets of information and we get to decide how to respond. The alternative approach if you’re in that ward is to just be so focused on, I must not hear any alarms today. I can’t hear any alarms. That’s first of all, that’s just gonna take so much of your energy, focus and attention. Martin: How are you gonna be able to care for your patients and do the stuff that matters when your brain is, all of its capacity is on trying to avoid hearing an alarm. Amber: And as time went on, I think my alarm system got a little smarter. I wasn’t going off as much because it wasn’t bothering me as much. Amber: One other thing that’s come to me while we’ve been talking that I also realized I had a few different epiphanies while going through this, and I realized, I kept realizing different levels at which I was trying to force something to happen. Initially it was trying to force sleep. Amber: Then it was trying to force myself to relax and not have anxiety. And then when I started doing your program and going about it that way, then I was trying to force myself to be okay or maybe even being awake or be okay with the anxiety. And I wasn’t. And it took me a while to realize, oh, I don’t have to like this actually, I can acknowledge this is hard. Amber: It is not. This is not ideal. This is not what I wanna do. This is not how I wanna feel. And that’s okay. But I can make a choice here. I do have a choice in what I’m gonna do next. I can have a choice in my discernment. And that was probably one of the bigger epiphanies that I had. ’cause that one really carried out over into other parts of my life too. Martin: I’m glad you made that point because when we hear about this idea of reducing our resistance to something that we don’t really want to experience or to accept it, this whole philosophy of acceptance, a common reservation I guess that people have is but I’m not okay with this. How do I make myself be okay with something that I’m not okay with? Martin: I want to be asleep. I don’t want to be awake. And that’s where we can get tripped up. Because it’s not about pretending that you are okay with it. It’s not about pretending that you enjoy being awake pretending that fatigue doesn’t exist, pretending that anxiety doesn’t make things more difficult, that you enjoy it, that it’s great to experience. Martin: It’s about accepting that this stuff is gonna show up and it’s trying to fight it or avoid it just makes things more difficult. And it’s about, just as you touched upon, bringing your focus back to how you choose to respond to it when it shows up. Choosing to respond in a workable way, a way that isn’t going to layer on all these extra pieces of difficulty and struggle on top of it when it shows up. So I’m really glad you mentioned that because I think that is important. Amber: Yeah. Yeah. I think that is important. I think that’s a really common misconception when someone starts back on this journey, whether it’s insomnia or trying to deal with anxiety, is then trying to figure out how am I supposed to be okay and enjoying this? And you really can’t, that’s not, that’s really not what we’re trying to do here. Amber: It’s okay to acknowledge that it’s hard. Martin: It might even be essential to acknowledge that it’s hard and that in itself might be part of opening up to it. Amber: Yeah. Agreed. Amber: I have memory of when I was young, when as a child and I’d get the stomach flu and I had to throw up. It was just a horrible thing. I did not wanna throw up. I would fight it, and my mom would come with me to the toilet, she would hold my head up and she would just rub my back. Amber: And she would keep saying, just let it come. Just let it come. And I trusted her, and I would let it come, and I would let you know, have the release, and then I would feel better. And it’s more like that to me now. It’s I can let this happen. It doesn’t feel good right now. Might even feel worse before it’s done, but it’s not gonna stay this way. Amber: I know that now. So that’s a different thing. And then instead of getting really frustrated with my busy brains that likes to think about everything and figure out everything. Now it’s more oh, let’s just see what’s on, what’s on TV tonight? What’s on the brain tonight? Amber: I’m more like, wow, look at my busy brain. Isn’t that amazing? It can bounce back and forth. To this, that and the other. And it goes fast. Sometimes it’s a little fast for me, but I’m actually more grateful for it now ’cause it helps me keep track of a lot of things and stay on top of a lot of things. Amber: So I look at that differently as well. Amber: Another big learning point is what what I can control and what I cannot, and to, there are a lot of things we cannot control and to try to control them, escape from them, or numb yourself to them, distract yourself, it just adds to something that might already be difficult. Amber: So letting those things be, and then finding where I can control, which is my actions, my response I went into, when I started this out, I did try some meditation, but my understanding of meditation has changed so much in the beginning. I was trying to force myself to relax. I was trying to make my really naturally busy brain not think of anything, and it just doesn’t happen. Amber: And so that would become more and more frustrating to me. It was just a frustrating experience. I thought I’m never gonna get this down. Now. I choose to relax. I can relax my muscles and my body and I can let myself breathe. But it, you mentioned the word intent or motive in the beginning. My intent of my motive is different. Amber: It’s not to force total relaxation and calm and quiet my brain and not have thoughts. Now it’s, I am relaxing myself to allow them, if that makes sense. And it has been that has been a real game changer for me as well, because I realize the more I do that, oh, actually, I. I don’t really feel that anxious anymore. Amber: It’s just gotten better and better. It doesn’t mean I don’t have anxiety, but I’ve, I have a very different approach now and it feels so doable to me compared to the way it used to feel. Martin: Would you say it’s almost like you are practicing and building skill in experiencing, I’m just gonna say anxiety ’cause that’s the last one that you mentioned. Martin: Experiencing anxiety with less struggle. So it’s showing up, but it’s losing the more you practice experiencing it with less resistance, it’s almost like it starts to lose its power and influence. So it still shows up, but it’s not as strong, it’s not as distracting. It’s not got that power it once maybe held over you. Amber: That’s exactly what’s happening now. The thing if I, if for example, if I go to bed and I’m worried about one of my kids or a patient I saw, and it’s leaving me with this unrest inside. I, now we’ll just realize, okay, I’m going into one of these loops where I’m thinking about this a lot, worrying about it all. Amber: The worry in the world is not gonna change it. I’m gonna just name I’m feeling this way because this is going on, or this is happening and I’m just gonna allow it to happen. I’m gonna relax and allow it to happen. I can maybe think of some more solutions tomorrow, or I can check in on the thing. I just start coming up with things I can do. Amber: To help it. And it really has it has more of a profound effect on me in helping me get through this. Martin: Whilst you were talking, I was thinking back to that alarm analogy you were sharing, and I was thinking that maybe a brand new member of staff, maybe they’ve just finished their training and they’re in that ward for the first time, hearing all those alarms go off, it must be terrifying. Martin: It feels like you’ve really thrown in the deep end, but then as you build up that experience of listening to those alarms going off nonstop choosing through experience on how you’re responding to each of one, each of them, the alarms are still going off, but they’re not having that huge effect on you, that huge physiological effect on you anymore. Amber: Yeah, that’s exactly right. It’s very it’s very comparable to that experience. Martin: How does this transfer to sleep then? So we’ve talked about opening up to the thoughts and the feelings. How does that get you to a place where you are not struggling with sleep anymore? Amber: With sleep it’s really was the same thing. Amber: The, I bring up anxiety a lot because I feel like the anxiety and the lack of sleep was just so intertwined with this experience. I did have to become more okay with being awake and that took time. And your direction on choosing values, value-based activities was very helpful to me because I’m very aware of what my values are and you know what things lead me more towards those and that type of life I wanna live and. Amber: So I did go I went through a very sleepless period of time. I think there was one time where I felt like I didn’t get sleep for three nights in a row. Sometimes I don’t know that we’re totally aware of how much sleep we actually get, but that’s what it felt like to me. And I actually carried on. Amber: I didn’t feel my best. Of course it wasn’t great, but I carried on very normally for those days and I was able to see, wow, I was able to accomplish, these things at work, at home. I had connection with people. I laughed with people. I had some good conversations. And so that was a big confidence builder to see that I actually really can do a lot without sleep. Amber: It doesn’t feel, the way I like to feel, but I can do it. And so it took some of the fear out of that for me, and that was very helpful. Martin: Maybe it comes down to exploring what we can do that might make this whole experience a little bit less difficult or a little bit less traumatic. It sounds like one way that you moved toward that goal was by committing to actions that reflected your values, living the kind of life you wanted to live, even when sleep wasn’t showing up. Martin: And by doing that, I think a natural byproduct maybe, is that we do start to get a little bit more comfortable with being awake because it’s not having such a huge impact over our lives anymore. Even if it’s just a 10th of a percentage point better, we’ve got that 10th of a percentage point more control over our lives now. Martin: It can snowball. So we become a little bit more comfortable with being awake. That’s not to say we want to be awake, but we just start to get a little bit more comfortable with it. We are less resistant to it. It’s not gonna pull us into quite so much of a struggle and in effect. That kind lowers it down on our list of priorities, perhaps for our problem solving brain. Martin: Our brain’s oh, maybe we don’t have to fight this quite so hard. We don’t have to engage in this battle. And when we are not engaged in that battle conditions for sleep just become better because we’re not in the middle of a battleground at two o’clock in the morning. We’re awake. We’re experiencing all these thoughts and these feelings, but we’re not in a battleground anymore. Amber: That’s absolutely correct. And since then, my attitude now I’ve had a couple of circumstances with maybe a teenage child that’s, been late for curfew coming home or maybe a medical issue with somebody that I need to help with. It’s late in tonight. And instead of thinking, oh my gosh, I’m not gonna get sleep now, I’m like, bring it. I can stay up and I can handle tomorrow. I’ve done it for three nights in a row. Amber: I, it doesn’t scare me like it used to. So it’s a big shift in my perspective on that now. Martin: That is a really big shift. I’m curious to know, as you were practicing this whole new approach that we’ve been talking about, did you find that progress was just it was kinda like this up upward curve where things just progressively got better and easier and less struggle. Martin: Or was it more kind of ups and downs, or was it more just like someone had thrown a plate of spaghetti against the wall and it was just all over the place? What was it like for you? Amber: I like the spaghetti analogy that it probably felt like that for a while. All over the place. I keep using the term cognitive understanding because in my head I could understand what you were saying or what I was hearing from other people. Amber: It made sense to me. It resonated and I knew this was the way to do it, but anything else I’ve had to learn, whether it is becoming a nurse or a nurse practitioner or I used to run a lot of marathons, learning the best way to do that. Learning it in the book can make absolute sense. Amber: And you think you’ve got it, but then actually putting it into reality and doing it experientially is an entirely different thing. And that does not come as quickly and it takes a lot of practice. And that’s exactly what happened with this. It took a lot of practice and I had a lot of ups and downs. I have a plate of spaghetti. Martin: Yeah. And like when you’re learning any new skill there’s gonna be times when it maybe things feel easy, that you’re making great progress, you’re ahead of schedule, and then there’s gonna be times where it feels like nothing is working. You’re doomed to failure, you’re beyond help that you need to go back down that rabbit hole of looking for some something else to do instead. Martin: I love the fact that you drew in your experience, in marathon running in your own career, the skills, achievements, they take a lot of practice, they take a lot of action, they take a commitment to action, and they also come with ups and downs, and they also come with all those thoughts and feelings that I just gave a few examples of, this isn’t working. We should give in. Martin: If we think of where we’re most skilled in life, that wasn’t just immediately given to us, we had to earn it, and we earned it through committed action. Even if it’s just doing a little bit every day, it all adds up. It’s just continuing to do things that move us in the direction that we want to be heading. Amber: Absolutely. And I do think when you start making that initial improvement, so when I first started to improve and I had a few good nights of sleep and I thought, oh, this is it. I’ve arrived. I figured it out. And then you have your first whatever you wanna call it, set bump, or, barrier in the road and you have another bad night. Amber: It can be really deflating. ’cause you thought, oh, I figured this out and now this isn’t working, and what did I do wrong? You start, you catch yourself going through all of the same rabbit hole again. And so it is, there is a lot of patients required with those setbacks, they are going to continue to happen. Amber: And I heard. I don’t remember where I heard it, but I heard someone say that they those types of setbacks come up for a reason. It’s an opportunity to practice. It just means that you need to practice again. It’s not really a bad thing, it’s just an opportunity to refine a skill. And again, changing the way I looked at those, ’cause those were pretty, they’re pretty hard, those setbacks once you start on the road to recovery. Martin: 100%. And especially like you said early on especially if you’re really early in your journey and maybe you string some good nights together, or you have a few days where you notice you’re not completely overwhelmed with all these thoughts and feelings and you can feel really confident and motivated, yes, this is working, I’m doing really well. Martin: And it can be so deflating and difficult when the difficult stuff shows up again. And even when you are further along in your journey, there can be lots of ups and downs and it can feel like you’re, it’s almost like your brain is, whoa, you’re back to square one. Martin: Everything you’ve been doing up to this point was a complete waste of time, waste of effort. The truth is that it’s just your brain looking out for you. Again, the truth is you’ve just had this experience of some difficult nights or some nights where less sleep happened or some nights of no sleep, or you’ve noticed those thoughts and feelings showing up and gaining a little bit more power. Martin: That’s what’s happened. Anything else that you are getting from that is stuff that we are understandably adding on top because we still don’t want to experience it. But what matters is identifying this is a normal part of any journey and that it is about how we choose to respond. And that’s something that we always have power over. Martin: We have the power over our choice of actions, and it’s easy to respond in the way we wanna respond. When things feel good, when things feel easy, it’s when things feel difficult, that it’s most important we respond in the way that reflects how we wanna respond, and that’s really what counts. Martin: How long would you say it took for you to get to a point where insomnia and all the thoughts and the feelings that can show up with it and after it weren’t creating a struggle for you that you could do things that matter, live your life, do what’s important to you, independently off sleep, and even in the presence of uncomfortable, difficult thoughts and feelings. Amber: I think it’s hard to put a specific number on that because in the journey, I feel like I, I would go to that for quite a while and then maybe have a little, regression or whatever, and then I would go back to that. Amber: But I will say, I think over time those regressions would get further and further apart. And so maybe six to eight months is where I started feeling like I was settling in back into my more normal self, my more baseline self. Martin: Yeah, that’s helpful because I think it’s a reminder that really what we’ve been talking about this whole time are skills. They’re action-based skills and skills. Take time to learn, to develop, to practice. There’s gonna be ups and downs, there’s gonna be setbacks. And that takes time. We all obviously want immediate results. We wanna be able to just deal with this right now. Martin: If I could offer that to people, I would offer it. I’d be a trillionaire. But it doesn’t work that way. It’s not easy, it’s difficult, and it requires ongoing practice. Amber: I can honestly say that even though there were times where I just feel like this really brought me to my knees I wouldn’t change it now because of the benefit I’ve gotten from it. I don’t think there, there’s things that I don’t think I could have learned in another way. I think it’s benefited how I’m able to help others and of course my values, my roles, my role as mother. Amber: Professionally as nurse practitioner or family member or friend, the people in my life, those are really important to me. And so this outlook and this focus of what I can and cannot control and how to allow these things to move through, to just be able to move through them and not go down the rabbit hole has been really helpful. Amber: I’m very empathetic towards people that are going through something similar and it doesn’t have to be insomnia because so many struggles go down this road, right? They don’t necessarily have to be insomnia. And of course professionally I hear a lot about these types of things. I’m in that type of a position, and so I do, I have a lot of empathy. Amber: I understand how things feel how difficult thoughts and feelings can fill, and I can give better guidance and direction. I can do that for my children and other people in my life. Martin: It can be really hard to think of any positive aspects to this struggle when you are in the midst of it. It can almost sound disrespectful to think that there could be a growth opportunity, or it could have somehow have any positive impact on our lives. But a common theme that runs through so many of these podcast episodes is this sense of growth that can only come from that journey that has been experienced. Amber: I mentioned how when I have had setbacks with insomnia or anxiety, I can see it more as an opportunity to practice. And so now when other things occur in my life that are difficult I think I can go to that maybe a little more quicker now because of that experience that here’s another opportunity. Amber: This is happening. How can I go about handling it? What can I control, what can I not? And let myself move through it. And then I would say even just day to day, I think I take more I have more gratitude for things too, because. I’m not struggling with the battle and the calv calvary, as you mentioned. Amber: Now I have more awareness of things around me that are important to me, or even small things like, good weather or flower. It does, it opens your eyes to other things. Martin: These are transferable skills. Martin: They don’t exist only for insomnia, only for anxiety. They can enrich or enhance your life in so many other ways, and that’s where you can end up coming out ahead. So like you shared, maybe now you’re finding yourself better at practicing gratitude. You find yourself better able to focus on values-based action. Martin: Maybe you’re getting more from life because your values have just become more front and center. And so you’re ensuring that your actions reflect who you are, who you want to be and your, you focus, the focus of your attention is expanded. So maybe you are able to savor a few more of those moments that we might once have been on autopilot and missed out on. Martin: If someone with chronic insomnia is listening. And they feel as though they’ve tried everything. They’re beyond help. They’ll never be able to stop struggling with insomnia. Martin: What would you say to them? Amber: Yes, I’ve anticipated that question and that’s really the reason I did this. I was a little reluctant in saying yes, but because this helped me so much, I couldn’t say no to you. Because this is doable. Even though you may be at the point where you feel like you’re completely broken, you’re completely alone. Amber: No one understands. I’ve tried, A through Z, it’s not working. It is doable. It’s not gonna happen overnight. But it will happen. And it’s the key things that we’ve been talking about. It’s practicing, it’s being patient with yourself in the process. It’s being kind with yourself in the process. Amber: It’s identifying what you have control over and what you do not. And, practicing those things over and over is really what will help this settle down. It’s very doable. Martin: Great. Thank you again, Amber, for coming on. It’s just been a pleasure listening to you describe your journey and your transformation. So thank you. Amber: Thank you. Martin: Thanks for listening to the Insomnia Coach Podcast. If you're ready to get your life back from insomnia, I would love to help. You can learn more about the sleep coaching programs I offer at Insomnia Coach — and, if you have any questions, you can email me. Martin: I hope you enjoyed this episode of the Insomnia Coach Podcast. I'm Martin Reed, and as always, I'd like to leave you with this important reminder — you are not alone and you can sleep. I want you to be the next insomnia success story I share! If you're ready to stop struggling with sleep and get your life back from insomnia, you can start my insomnia coaching course at insomniacoach.com. Please share this episode!

Matt delves into insomnia, defining it as a persistent struggle to sleep despite having the opportunity. He presents "Cognitive Behavioral Therapy for Insomnia" (CBTI) as the scientifically validated gold standard, and details the five pillars: stimulus control to rebuild the bed-sleep association, time-in-bed restriction to boost efficiency, sleep hygiene, cognitive restructuring, and relaxation. These strategies retrain the brain to treat the bed as a sanctuary, deactivating the psychological triggers of wakefulness.The episode also addresses the physiological impacts of caffeine, alcohol, and nighttime rumination. Walker contrasts traditional "Z-drugs," which may hinder glymphatic housekeeping, with newer "DORAs" that target the orexin system like a dimmer switch. While discussing tools like Trazodone, he emphasizes that CBTI's aim is to restore the body's innate sleep signals. These evidence-based interventions offer a lasting payoff by aligning behavior with our deep biological needs.Please note that Matt is not a medical doctor, and none of the content in this podcast should be considered medical advice in any way, shape, or form, nor prescriptive in any way.Clean biological living requires precision. Podcast partner Caraway's non-toxic ceramic cookware eliminates deleterious "forever chemicals" for a seamless, slide-off-the-pan cooking experience. Save $190 on sets plus 10% off at Carawayhome.com/mattwalker. Caraway. Non-Toxic kitchenware made modern.In a supplement industry where trust is critical, Matt uses podcast supporter Puori. Their protein powders are free from hormones, GMOs, and pesticides, with every single batch third-party tested for over 200 contaminants. For protein you can trust, save 20% at puori.com/mattwalker.As always, if you have thoughts or feedback you'd like to share, please reach out to Matt:Matt: Instagram @drmattwalker, X @sleepdiplomat, YouTube: https://www.youtube.com/channel/UCA3FB1fOtY4Vd8yqLaUvolg

Dementia is often a highly burdensome disease process for patients, their caregivers and families, and the community at large. Palliating symptoms and providing guidance surrounding advance care planning and prognostication are integral components of the management plan. In this episode, Katie Grouse, MD, FAAN, speaks with Neal Weisbrod, MD, an author of the article "Neuropalliative Care in Dementia" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Weisbrod is a neurologist at Hartford Healthcare with the Ayer Neuroscience Institute in Mystic, Conneticut. Additional Resources Read the article: Neuropalliative Care in Dementia Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Neal Weisbrod about his article on neuropalliative care in dementia, which appears in the December 2025 Continuum issue on neuropalliative care. Welcome to the podcast, and please introduce yourself to our audience.  Dr Weisbrod: Thank you. I'm really excited to be here. I'm Neal Weisbrod. I'm a neurologist and palliative care physician currently working at Hartford Healthcare in Mystic, Connecticut. Dr Grouse: To start, I'd like to ask why you think it's important that neurologists read your article? Dr Weisbrod: The primary reason I think it's really important to read the article is because these are just really common problems that neurologists run into in clinical practice. So, Alzheimer disease and many other dementias are extremely common, and managing the burdensome symptoms and the complex discussions that we have to have with the patients and their families as they go through the course of dementia is something that is very common in clinical practice. And so my hope is that by reading this article, clinicians will pick up a few tools, a few new ideas for how to make these conversations easier and for how to help these patients get through the disease with a little bit less suffering. Dr Grouse: I learned a lot from reading your article, and I really encourage our listeners to check it out. But I was curious what you feel that you discussing your article would come as the biggest surprise to our listeners? Dr Weisbrod: So, I think that the most surprising thing a lot of people will see reading this article is the section on prognosis. A lot of times it seems families are counseled, when they're talking about the prognosis of Alzheimer disease, that it could be ten years or longer. But really, the data show that for many patients, the median prognosis is closer to three to eight years. And that is a little bit longer for Alzheimer disease than many other types of dementia, but also gets significantly shorter as patients get older. So, we're looking at a closer to three-year median prognosis for patients who are over eighty-five, whereas patients in their sixties are probably closer to the eight or nine-year median prognosis. And so I think that piece will hopefully help people give a little bit more accurate counseling about prognosis.  Dr Grouse: I'm glad you brought that up because I was wondering, why is it so important that we are careful to make sure that we're giving prognostic information for our patients and maybe even updating it as their clinical status changes? Dr Weisbrod: I think first of all, it's a really common thing that patients and families are thinking about and worried about. They don't necessarily always seem to ask as much as they want to know. I think there's a lot of fear around that conversation, even though it's really important. And then there's also often tension between the family and caregivers tend to want to know more than patients do. I think that it really helps people plan for the future as well as possible to know what their future might be. And we have a lot of limitations in predicting the future, but using the best information we can, laying out what we think the likely range is, allows people to make a lot more clear plans for their future. Dr Grouse: I'd imagine it's also pretty helpful for hospice referrals, too, having that data.  Dr Weisbrod: Yeah, definitely. And there's a lot of angst about when to refer patients who have dementia to hospice. The most important thing I think about when I'm making a hospice referral is that I don't have to be right. And I think it takes a lot of that concern off to just say, all I'm doing is making a connection, getting someone who's potentially interested in the hospice, who has a really advanced serious illness connected to a hospice agency. And then they can go through the full evaluation with the hospice and the hospice medical director and determine whether they're eligible. So, I think there are really helpful thresholds to think about that would be a good trigger. Like a patient who we think has advanced dementia, who has a hospitalization for pneumonia or a fracture of the hip or some other really serious acute medical condition, I think is a really good trigger to start to think about hospice. But most importantly, it's just the connection, and I tell the patients that upfront. I tell them that you're going to have a conversation and we'll decide whether you're a good fit, and if not, the hospice will usually just check in with you over time and decide when is the right time in the future. Dr Grouse: That's really helpful. And I think just a really great reminder to our listeners about thinking about hospice sooner or at certain critical points in their patient care rather than waiting, maybe, before it's gone on too long and may be of less use later on. I was wondering, in your own clinical practice, what do you think is the most challenging aspect of providing care to patients with dementia?  Dr Weisbrod: I think this one's easy. I would say managing the time has to be the most difficult part. I think that taking care of patients who have dementia is time-consuming. There's a lot of different priorities that we have to manage the time around. How much time are we going to spend doing cognitive testing? How much time are we going to spend doing counseling? How much time are we going to spend making up a treatment plan and discussing medications? How much time are we going to spend on advanced care planning? And the way I try to combat that is really just trying to think about what I'm going to prioritize in a certain visit and not try to accomplish everything. I'll tell patients and their families, the next time you come in, we're going to have a conversation focusing on advanced care planning. Or, the next time you come in, we're going to sit down and try to talk through all the questions you have about what the future might hold. That way I in that visit, I don't feel like, oh, I have to do updated cognitive testing and I have to review all the next steps in medication, and that allows me to take it in more bite-sized chunks. Dr Grouse: You made some of the great points, and specifically you mentioned advanced care planning. Your article makes a really strong case for the importance of advanced care planning, yet you definitely acknowledge the many barriers to initiating discussions that clinicians face. In your patients with dementia, can you walk us through how you integrate discussions about advanced care planning with your patients and their families?  Dr Weisbrod: Yeah, I think this is still something that is evolving in my practice, and I don't think there's any perfect way of doing it. I think there's a lot of right ways of doing it, and as long as we're thinking about it a lot and bringing it up periodically, that's probably the best. What I try to do, though, is after I discuss what I think is the most likely diagnosis with patients and their families, I try to have a fairly close follow-up visit after that. Allow them to digest that information, to often do a little bit of their own research, to talk about it as a family. And then when they come in for that next appointment, I try to at least lay some groundwork about advanced care planning, asking them what they've completed already, and then based on what they've already done to that point, talking to them about what I think the next step would be. If they have done nothing, usually it's just, hey, I really think you should start to think about who would be making decisions for you if you lose the ability to make your own decisions and counsel them about power of attorney paperwork and establishing a healthcare surrogate. When it's patients who have already done some of that initial prep, I think that it's really important to keep in mind it's a longitudinal discussion and you can take it in small pieces over time. Often that helps because you can really establish that rapport and that trust. And then I like to just keep checking in whenever there's major changes in the patient's health or condition, like admission to the hospital or transfer to an assisted living facility or memory care clinic. Those are good times to remember, hey, I really need to revisit this conversation.  Dr Grouse: It's probably good to also mention another really important point from your article, which was that impairment of decision-making in patients with dementia can actually start significantly even in the phase of mild cognitive impairment. Yet these patients will need to make many medical decisions with their neurologist as they go through this journey. How can we make sure our patients have capacity and make decisions appropriately regarding their care? Dr Weisbrod: Yeah, I think that's a definite challenge of taking care of patients with cognitive disorders of any type, including those with stroke and multiple sclerosis, that have some cognitive impairment. In my opinion, the most important way to help manage that is to make sure when we are making important decisions about the future that we're having a deep exploration of the values and the reasoning behind that. And definitely teach back is the most helpful way that I use to explore those values and the logic behind patients' decisions. So, I think we have to have a really low threshold to move on to a formal evaluation of capacity; if there's any inconsistency between what the patient's saying now and what their families say they've said in the past, or if they're having struggled to come up with a really clear logic behind their decision, then I think we have to have a low threshold to move on to a formal evaluation of capacity. So, I think having the family involved, having other people who know the patient really well, usually helps identify some of those periods where it seems like the patient's not making the decision that really reflects their true wishes. Dr Grouse: Now I wanted to switch gears a little bit and get into the management of neuropsychiatric symptoms, which you spend a lot of time on and I think a lot of neurologists find very challenging. What are some nonpharmacologic approaches that can help patients with significant neuropsychiatric symptoms?  Dr Weisbrod: I really like the DICE paradigm for coming up with nonpharmacologic approaches. The DICE paradigm is an acronym. The D is Describe, I is Investigate, C is Create, and E is Evaluate. The idea is that we're exploring what's happening behind the symptoms, we're creating a plan to intervene, and then we're evaluating the outcome of that plan and creating a sort of feedback loop there. But ultimately, I think, when we're creating a solution, thinking about how we can change the environment is the most important thing. We have very limited ability to change the way that someone who has severe cognitive dysfunction reacts to their environment, but we can often change the environment to not produce that reaction in the first place. One example is with wandering behaviors. Trying to change the environment where you put locks that don't have deadbolts that you can use on the inside of the house, you have to have a key on the inside of the house, and then the family can put that key somewhere safe where the patient is not likely to find it and be able to unlock the door and wander out unsafely. I also think it's really important to acknowledge that as doctors, we are maybe not the best people to always have the answer when it comes to changing a patient's environment. And so, I think we really need to rely on the wisdom of support groups and other people who are going through the challenge of dementia. Our interdisciplinary care teams like social workers and nurses who have experience in managing dementia, and really try to plug the caregivers into as many of these avenues as possible so that they can learn from all of that community of wealth and not always rely on the doctor to have the answer. Dr Grouse: Switching gears to pharmacologic management, which is a lot of what we do for patients as neurologists. Thinking about agitation, pharmacologic management of agitation can be very challenging. And reading your article, it reminds me how disheartening it is to reflect and how modest the effect of the available options are, along with the many potential risks of their use, When nonpharmacologic interventions fail, what should neurologists recommend for their patients with agitation? Dr Weisbrod: Yeah, I definitely agree. It's every time I go back and look at this literature and look at what's new, it is a bit disheartening. But even in the face of all that, I really feel like SSRIs are my first-line therapy for most of these patients. I always try to ask myself what might be causing the patient discomfort that they are then manifesting as agitation because they don't have a better way of expressing themselves. Often, I feel like that's anxiety or depression or some other psychological symptom that we might be able to address with an SSRI. So, I tend to use sertraline and escitalopram, start those early and as long as patients are tolerating it, give it a really good trial. Outside of that, escalating to other pharmacologic approaches, even though there's such controversy in the data about antipsychotics and even though there are very real risks, sometimes I think we essentially do need a chemical sedative. And I think that it's important to have a very frank conversation upfront with the caregivers and the medical decision maker for that patient. Make sure we are counseling them on the risk, the increased risk of mortality, and also to make it a time-limited trial. So, I think that saying we're going to try this medication (if the patient's decision maker agrees, obviously) for a month or two months or three months. But I definitely wouldn't want them to just have an open-ended plan where they're going to stay on it indefinitely. It should have some end point where we say, hey, is this working or not? And if it's working, then we'd make a decision, is the improvement in quality of life worth the risks? And if we're not seeing that improvement, then we definitely need to stop it. Dr Grouse: That seems very reasonable. And then thinking more towards some of the other types of symptoms that can be really challenging, I was really surprised to see how often uncontrolled pain is a significant contributor in patients with dementia. And certainly, both uncontrolled pain and poor sleep can worsen cognitive function and neuropsychiatric symptoms in general. But of course, there's ongoing concerns about side effects of these therapies and how they can also potentially worsen things. How should we be approaching management of pain and insomnia or poor sleep in these patients?  Dr Weisbrod: I think the key is just to start with really low burden treatments and escalate carefully and start with low doses of higher risk medications. So, when I think the low burden treatments for pain, scheduling acetaminophen, 1000 milligrams every eight hours, seems like a trivial thing to do, maybe? But it's actually surprising how much scheduled acetaminophen can take the edge off of pain and might be able to avoid some of these flare-ups of neuropsychiatric symptoms, may be able to really improve that pain a little bit. I do think it really has to be scheduled, though. Trying to rely on patients who have significant cognitive dysfunction to use a PRN medication is going to lead to a lot of problems and undertreatment. And then on the sleep disorder side, I think starting with low-dose Trazodone and gradually increasing the dose of Trazodone as a really safe way of initially approaching the insomnia. And then only when it's a more refractory case do I reach for the high-risk medications. Like for pain, we're talking about opiates. I think there's a lot of very reasonable concern about using opioids in patients who have cognitive dysfunction. But if there is a really good reason to think that they have severe pain, like they have a past pain disorder, I think that just like with antipsychotics, there are definitely real risks to these medications. But at the end of the day, if we are improving someone's quality of life dramatically and the patient's medical decision maker is willing to take on those risks, then we're really doing the patients a favor. Dr Grouse: Now, another issue that you mentioned in your article, which I see a lot and often struggle with myself, is how and when to deprescribe certain types of medications such as cholinesterase inhibitors and memantine. Any tips or tricks to how to approach this?  Dr Weisbrod: My approach to this has also evolved a bit over the years. The new data that cholinesterase inhibitors may have a mortality benefit in patients with Alzheimer disease has changed my thinking a little bit. But there are still lots of situations where it's just too burdensome or patients seem to be having side effects. And so, I think about deprescribing. The most important thing in my mind is really thorough counseling before deprescribing with the patient's family and medical decision maker. I think that letting them know that we might actually be holding things more stable with the medication than we realize, there could be a flare-up, that we can resume the medication if that flare-up happens but we don't always guarantee getting back to the same point. I think having that conversation ahead of time will ward off some of the worst issues that you have afterwards. And then I think doing a taper of cholinesterase inhibitors over two weeks to a month is probably the most prudent because of some of the data about withdrawal and exacerbation of neuropsychiatric symptoms or cognitive worsening. Memantine, I think the data is a lot more shaky on withdrawal. And so, I think it's less important to gradually taper memantine. But I think that once again, just having the conversation upfront and letting the family know these are the things we have to look out for and these are the risks is going to be the most important. Dr Grouse: That's really helpful and a great strategy to take advantage of. Another, I think, really difficult topic that I wanted to ask you about was the discussion around nutrition and whether or not to consider putting in some type of a permanent tube for tube feeds. How do you approach that conversation? Certainly a difficult one.  Dr Weisbrod: Yeah, I think it's easily one of the most difficult conversations to have in the care of patients who have dementia. And there's so much emotion in the families when they're having this discussion. And I think really acknowledging there's a huge emotional piece of the conversation is one key piece. For families and caregivers, they're thinking, I don't want my loved one to starve to death. That's usually the most important thing in their mind. We have to address that concern in the conversation, or they're never going to get to a point of satisfaction with the decision that's being made. So, I think while there is still some controversy in the literature about artificial nutrition for patients who have dementia, the bulk of data indicates that it is not helpful for patients. It may exacerbate dementia, it leads to more restraint. And so, I think unless there's some reversible medical condition that we're just trying to do artificial nutrition to get them through, like, they have a stroke and we're expecting that their dysphasia is going to improve because of the stroke is going to heal. Those situations might be a good reason, but if we really think that the driving factor behind their dysphasia is their dementia, I think we should be guiding the families away from that. And I think that explaining that as dementia gets really advanced, the body is slowly shutting down. The body is not needing as much nutrition, and forcing more nutrition in has not been shown to help people who have dementia. Really putting it in that sort of language is going to help the families understand and be comfortable with that decision. I also think that it's really helpful to consider talking to families about what they can do and not have the entire conversation be about what we're not doing or not putting in a feeding tube for artificial nutrition. So, I think really good counseling about, we can do comfort feeding, we can expand what food we're giving the person who has dementia and really focus on foods that they really enjoy and not worry so much about the health and nutrition anymore. I think that focus on what they can take control of can also help make the decision easier for families.  Dr Grouse: I really like that approach. And I agree, it does seem that it being such an emotional decision with just so much a concern about this underlying feeling of not caring for their family member. I think that is a really great way to look at it  and to kind of start off that conversation. Now, I'd love to hear more about what drew you to this field when you first got into your career as a neurologist. Dr Weisbrod: I had an interesting journey to doing neuropalliative care. Definitely didn't know that's what I was going to do when I started neurology residency. At University of Rochester, we had amazing palliative care physicians that were involved in medical school, and so I got a little bit of exposure to it early on. Then when I was in neurology residency, I first of all realized that I really enjoyed making sure that what we were doing respected a patient's wishes. And so, as other people seemed to run away from those conversations, I was really drawn to them. And so that definitely made me realize that that might be more of the right field for me. But also, as I went through neurology residency, I really discovered that I love so many different things in neurology, and that made me not want to subspecialize and focus on a narrower set of conditions in neurology. So, doing palliative care fellowship was a really good way of getting a specialist tool set and expanding my knowledge in one area, but staying a neurologist, generalist. And I think it also really enhances a lot of the other things I do in neurology. It gives me a lot of additional skills on how to counsel patients and how to prepare for the future in general. I think there's a lot about just good bedside manner in palliative care education. I feel like it helped me become a better neurologist, and I decided that I really loved the palliative care piece as well.  Dr Grouse: Well, we're certainly all grateful that you found this aspect of your career and have been able to share the skills you've honed with us as well. And we really appreciate you taking the time to talk with us about your excellent article today, which I encourage everybody to read.  Dr Weisbrod: Yeah, thank you. It's been wonderful to be on, and I hope that people can take away a few small points from the article. Dr Grouse: Again, today I've been interviewing Dr Neal Weisbrod about his article on neuropalliative care in dementia, which appears in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Erica, a nurse supervisor, went from crippling sleep panic to freedom. The shock of acute insomnia made her terrified of her bedroom. Traditional sleep rules and a CBTI app made her panic "ten times worse". She tried Trazodone and QUVIVIQ, but found true relief by completely stopping the time-checking and realizing she could have a "really good vacation" even with no sleep. If you're new here and curious to learn more, our FREE video course, The Festival of Understanding, is the perfect place to start. Head over to https://www.thesleepcoachschool.com and click the link at the very top of the page to begin your journey. If you're ready to leave insomnia for good, check out our coaching options.  Head over to www.thesleepcoachschool.com and click on GET SLEEP in the menu.  The Insomnia Immunity program is perfect if you like learning through video and want to join a group on your journey towards sleeping well. BedTyme is ideal if you like to learn via text and have a sleep coach in your pocket.  The 1:1 Zoom based program is for you if you like to connect one on one with someone who has been where you are now. — Do you like learning by reading? If so, here are two books that offer breakthroughs! Tales of Courage by Daniel Erichsen  https://www.amazon.com/Tales-Courage-Twenty-six-accounts-insomnia/dp/B09YDKJ3KX Set it & Forget it by Daniel Erichsen  https://www.amazon.com/Set-Forget-ready-transform-sleep/dp/B08BW8KWDJ — Would you like to become a Sleep Hero by supporting the Natto movement on Patreon? If so, that's incredibly nice of you

In this episode, we explore a head-to-head comparison of trazodone, doxepin, and melatonin for treating insomnia when benzodiazepines are off the table. Which non-benzodiazepine sleep aid offers the best balance of effectiveness and tolerability in real-world psychiatric patients? Faculty: Paul Zarkowski, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.75 CMEs: Quick Take Vol. 74 Melatonin, Trazodone, or Doxepin for Sleep Disorders

Learn how trazodone, originally an antidepressant, became one of America's most prescribed sleep aids. Understand the surprising science behind its effectiveness, optimal dosing strategies, and why it might be a safer alternative to traditional sleeping pills. Find out more at https://missionconnectionhealthcare.com/mental-health/sleep-aids/trazodone/ Mission Connection City: San Juan Capistrano Address: 30310 Rancho Viejo Rd. Website: https://missionconnectionhealthcare.com/

Struggling with sleep issues linked to depression? Trazodone effectively treats both problems at once by regulating serotonin levels at lower doses than used for depression alone. Unlike traditional sleep medications, it's non-addictive and can reduce time to fall asleep by 44%. Learn more at https://missionconnectionhealthcare.com/mental-health/sleep-aids/trazodone/ Mission Connection City: San Juan Capistrano Address: 30310 Rancho Viejo Rd. Website: https://missionconnectionhealthcare.com/

Dr. Casey Grover breaks down psychiatric medications and their role in addiction treatment, explaining how different medications work, when they're most appropriate, and which ones to avoid. He provides a practical overview based on his extensive experience treating patients with substance use disorders.• Psychiatric medications get developed through research on brain receptors and undergo rigorous testing before FDA approval• Medications often have "off-label" uses that weren't originally intended but provide benefits in certain situations• Antidepressants like SSRIs and SNRIs serve as the foundation for treating depression in people with addiction• Using non-addictive options like hydroxyzine, clonidine, and buspirone is crucial when treating anxiety in recovery• Trazodone and mirtazapine are preferred for sleep issues over benzodiazepines and "Z-drugs" that can create dependence• ADHD treatment requires careful consideration when patients have stimulant use disorder histories• Benzodiazepines should be avoided when possible as they paradoxically worsen anxiety over time• Medication selection should consider urgency of conditions, past medication responses, and potential side effects• Some psychiatric conditions may improve with therapy allowing medication reduction, while others require long-term treatmentThank you for taking the time to learn about addiction. It's a fight we cannot win without awareness and action. There's still so much we can do to improve how addiction is treated. Together we can make it happen. Remember, treating addiction saves lives.To contact Dr. Grover: ammadeeasy@fastmail.com

My client Maura came to me when she was struggling to fall asleep and would go days without sleeping if she wasn't taking a sleeping pill. She was taking Trazodone and Lexapro to sleep and feel calm. She was a mom to 2 young children and she had to take a leave from teaching because she wasn't sleeping. Her goal was to sleep 7 hours a night, get off meds, and not feel anxious about sleep. By the end of our time working together, she achieved all of these goals! "In 2 months I weaned off Trazodone. On average I'm sleeping 7-8 hours a night and feeling a lot better.”Her test results showed:Depleted sex hormonesLiver dysfunctionMold toxicity (from the school where she worked!)Mineral imbalancesH. pyloriDysbiosis (imbalance of good to bad gut bacteria)Gluten sensitivity All of these imbalances were affecting her sleep!I recommended supplements and diet changes which she immediately embraced. We also worked on stress about sleep and so her anxiety about sleep improved pretty quickly. She even slept well when she traveled to Ireland. She emailed me after her trip: “I returned from my trip to Ireland yesterday. I was so nervous about sleeping in various hotels in a different time zone. I did great and slept really well. Each night I slept between 7-8 hours. My anxiety about sleep is so much better."Maura was 100% committed to the process and because of that, she had great success!“I loved having a plan, knowing we're going to work together, slowly add supplements, then slowly take them away. I appreciated having support and being able to email you. Having someone in my court. I wasn't in this alone. And it doesn't take the whole time (6 months)."By the end of our time working together, Maura was back to work teaching when the school year started!You can listen to her story on the podcast.Maura loved the step-by-step, simple plan I gave her in the Complete Sleep Solution program because then she knew exactly what to do to get better.She was relieved that all she had to do was follow her protocol, without questioning if it was right for her.She stopped googling about how to sleep better and trying random supplements and gadgets because she had a plan customized for her life and body. If Maura can get better, you can, too! Schedule a free consultation on Zoom to get started so you can consistently sleep 7+ hours a night without drugs!I'll tell you exactly why everything you've tried so far hasn't worked (even though you're doing everything you can to sleep well) and how the Complete Sleep Solution program will find and fix all the root causes of your sleep and health issues once and for all. 00:00 Introduction: Overcoming Sleep Issues Without Drugs00:15 Meet Maura: A Journey to Better Sleep00:40 Understanding the Root Causes of Sleep Problems01:27 Personal Anecdote: The Importance of Good Sleep04:21 Maura's Struggles and Goals05:04 Identifying and Addressing Health Imbalances06:53 Overcoming Anxiety and Traveling Success07:46 Maura's Success and Return to Normalcy09:17 The Complete Sleep Solution Program09:42 Conclusion: How You Can Achieve Better Sleep

 You're at the end of your rope, so you head to the pharmacy for the help you so desperately need to sleep. But wait, you aren't sure if it's safe, if it works, and if there's a better way.  Stay tuned to learn about the benefits, side effects, and risk of sleep aids.   I'm Dr.Vickie Petz Kasper. If you're ready to take control of your health, you're in the right  place. I'll give you practical steps to start your own journey toward better health because healthy looks great on you.  This is episode 159, Sleeping Pills and Potions. What works and what doesn't. You know that poor sleep is associated with heart disease, cancer, diabetes, obesity, immune dysfunction, high blood pressure, anxiety, depression, fatigue, irritability, and good grief, I could go on and on. So, taking something to help you sleep sounds like a good idea, right?  Today, we'll discuss what you need to know before you go and get a prescription, supplement, or over the counter sleeping aid. Look, we have to sleep. Our very lives and health depend on it. But the struggle is real. Insomnia is one of the most common symptoms people go to the doctor or health care provider for treatment.   And what if I told you that good sleep is possible without medications? Well, it is. In fact, the first line treatment recommended to treat insomnia is not medication. The standard recommendation for managing insomnia is to eliminate things that go bump in the night and keep you awake.  Or, to treat underlying diseases that disrupt sleep. It's not recommended to start with behavioral therapy or medications until these other things are maximized. Ha! But good luck with that. If you go to your primary care provider and you don't get a prescription, I'll buy you a cup of coffee and we can both stay awake.  And, if you think you need to see a specialist, then you'll probably get to spend the night in a sleep lab hotel hooked up to a bunch of wires and you may get answers, like, a CPAP, and that's important if you have sleep apnea, but if not, you might not even hear from them. No wonder you're looking for a good solution to sleep.  And though medications are not the first line recommendation, that is the topic of today's episode. So let's get to it. We're going to start with prescription medications, then we'll talk about over the counter medications and wrap up with supplements.  There are three classes of drugs approved to treat insomnia. Benzodiazepine receptor agonist, histamine receptor antagonist, and melatonin receptor agonist. Listening to all that medical jargon may be sufficient to put you to sleep. But wait, let me explain. You'll understand more after we go to mini medical school today and learn about receptors.  These are made up of proteins and they receive chemical signals that produce a response.  Let me give you this analogy. You've got a lamp sitting on an end table, but it's not plugged in, so there's no light. And when you stick those two prongs into the socket, behold, now you can sit and read. And that's kind of how a receptor works. The plug fits into the plug in. So an agonist is like the plug. It fits. It turns it on. It lets the electricity flow.  But, if you had a toddler in the house, you might want to plug in one of those little plastic things so he doesn't stick a butter knife in there and get shocked. So that would be an antagonist.  Okay, now wake up and pay attention. We've got three classes of drugs to look at. Benzo receptor agonist and melatonin agonist. That plug in and histamine receptor antagonist that block the plugin. And then there's another category called other. We'll just call that the clapper, you know, clap, clap. And the light comes on, clap, clap, and the light goes off.  There are eight drugs in the benzodiazepine receptor agonist family. And the first five are about my age, you know, born in the 60s. They are Estazolam, which is Prosom, Florazepam, which is Dalmane, Quamazepam, which is Doral, Temazepam, which is Restoril and Triazolam, which is Halcion. Now the millennials aren't benzos, but they're still benzo receptor agonist. And you know, this generation got way more complicated spelling their kids' names, so I'm probably gonna have to sound them out like a first grade teacher on the first day of school.  Eszopiclone is Lunesta, Zaleplon is Sonata. Zolpidem is Ambien.  Those older drugs are crankier and cause more dependence although Restoril is the nicest in the category. There are other benzos which are technically prescribed for anxiety and  some people do use them to help them sleep. Do they work? Here's what the data says for the old guys. They help you fall asleep faster. A whole whopping 10 minutes faster. And they increase total sleep time by half an hour to an hour. That's it.  What about risk? Well, they make you sleepy, which is kind of the point, but also they can make you dizzy, which can make you fall if you get up and go to the bathroom during the night. And if you mix them with opioids, the reaction can be fatal.   Now, the younger guys function about as well as the older ones, but they have shorter half lives, so their effects don't wear out their welcome so much with daytime grogginess. And they aren't so deadly when socializing with opioids. But rarely, they do some bizarre things like compel you to shop or gamble in the middle of the night. All for 10 minutes faster to go to sleep and half hour to an hour longer sleeping.  Okay, clap on, clap off, let's talk about the other drugs.  These are dual orexin receptor antagonists.  Affectionately known as D O R A or Dora.  The first one is Suvarexant, which is called Belsomra. The next one is Derodorexant, which sounds a lot like deodorant to me, and that's exactly what I'm gonna call it because the brand name is Quviviq. And finally, there is Limboxerant, which has a really cool brand name, Dayvigo.  What? You've never heard of any of these? Well, that's probably because they're slightly less effective than the other drugs. They help you go to sleep seven minutes faster. But the main side effect is sleepiness, and people generally say they slept better. The next topic in pharmacology class in mini medical school is the histamine antagonist. You know, the little plastic thing that goes in the wall socket so your toddler doesn't.  Doxepin is a tricyclic antidepressant that functions this way, and even in low doses it causes the desirable effect of drowsiness. So, it's approved for the treatment of drowsiness deficit.  Unfortunately, there are some drugs it doesn't play nice with. But, it does increase sleep time by Drum roll please! 25 to 30 minutes. Womp, womp, womp. And, it helps people stay asleep toward the end of the sleep cycle.    And I think this underscores why one size does not fit all and prescriptions should be customized for individual needs.  The last class of drugs approved for the treatment of insomnia makes a lot of sense.  Ramelteon is a melatonin receptor agonist and the brand name Rosarem, get it? REM, R E M, as in rapid eye movement sleep. It's got a good mechanism of action, a good name. Problem is, it doesn't work any better than placebo. So, you can skip the potential for fatigue, nausea, and worsening of liver disease and just take a sugar pill.  So, am I saying it doesn't work at all? Of course not. Why would it be approved if it didn't work? Well, it's not in Europe, but it does work to lengthen sleep time by a grand total of seven minutes. And I don't know about you, but it's going to take more than seven minutes to get rid of the bags under these eyes.  So that's the gamut of drugs approved for the treatment of insomnia in the United States. But wait, there's more. Just because the FDA doesn't approve something for a particular indication, that doesn't mean that doctors can't prescribe it. And sometimes, off label prescribing is a really good thing, though it's a set up for a knock down, drag out fight with your insurance company for coverage. In addition to using the antidepressant Doxepin, many doctors prescribe other antidepressants for sleep. Things like Amitriptyline and Trazodone, even though the American Academy of Sleep Medicine advises against it because of side effects and no data showing that it works. Now, I always recommend that you consult with your health care provider regarding your medications. Always, always, always.  But, I also recommend that they consult with up to date society recommendations and guidelines. That's just fair. And while they're at it, they should look at the potential adverse reactions. So, now maybe you've decided to skip the copay and just help yourself to the sleep aid aisle of the pharmacy. You could even ask the pharmacist to guide you, and I recommend that. There are two over the counter medications approved to treat insomnia. They are diphenhydramine, commonly known as Benadryl, and doxalamine, commonly known as Unisom. Side note, over the counter medications are regulated  FDA, And both of these drugs are histamine blockers. Therefore, all of the fun side effects that come with that, like dry mouth, GI distress, dizziness, trouble emptying your bladder, and of course, sedation, which is the desired side effect. These medications are often combined with things like Advil or Tylenol with an added P. M. at the end, so you know what's in store for you. And here's what's in store for diphenhydramine. 8 less minutes to fall asleep and 12 more minutes of sleep. And for doxylamine, there's no data available. That's it. That's what we've got. So, maybe now you've decided just to take matters into your own hands and look for a supplement. And because you've listened to my previous podcast episode about dementia, you're gonna skip right over the Prevagen, right? Promise me. Now, in the supplement section, you're going to walk in understanding that claims, concentrations, and ingredients are not guaranteed. They're not regulated. They are, generally speaking, considered safe and ineffective. You heard that right. Safe. And ineffective. But what about melatonin? You swear it works, but does it?  Maybe. It is sedating in about 10 percent of people and in everyone else, it shifts the sleep phase. So, there is a place for that such as jet lag, and I have an episode on jet lag in the show notes.  But even though it may help you drift off to sleep, it probably isn't going to help you stay asleep. The half life is less than an hour, and in some people it causes stomach cramps, irritability, and even depression. It's best used in combination with other things that regulate your circadian rhythm. More to come on that. But a big one is light. And so this probably would be a great time to tell you about some exciting news I have for you. I have an upcoming series of live webinars to talk about six hidden things that keep you tossing and turning at night.   And soon you'll have access to an online course called Unlock the Secret to Sleep, your personal sleep solution. I have been working so hard on this for so long that I cannot wait to share it with you.  I want to help you reset your sleep and get your Z's. Now there are other supplements labeled as sleep aids and most of them again are safe and probably not effective. The exceptions on safety are kava and valerian root. Both of those have been associated with liver damage. Now it's rare, but it's very serious. Other things you might find on this aisle are chamomile, Glycine, Gryphonia, Hops,  , Kava, L theanine, Lavender, , Passionflower, Nightshade, Skullcap, Strymonium, Tryptophan, , and Wild Jujube Seeds.  They're all equally effective and work every bit as well as a sugar pill, but hey, sugar pills can have powerful placebo effects. And one last thing I want to mention, and that is cannabis. Bottom line is there's not enough research to say one way or another, whether it works. It does have the potential for addiction and it's not legal everywhere. So there's that.  But also it's a problem that if you quit, you'll likely experience sleep disturbances that can last for several months.     The bottom line is, I want you to know that you shouldn't have to choose between serious health consequences of poor sleep and the side effects and risk of sleeping pills and potions.  If you suffer from insomnia, I do encourage you not to stop any medications without medical supervision and to have an honest conversation with your doctor. And if they want access to my resources, just give them my email address. I'm happy to share and they're 100 percent legit, but if good sleep eludes you, I want you to know while there's no magic pill for perfect sleep, there is a proven path to natural, restorative rest that can transform your life. Imagine waking up energized, focused, and ready to tackle your day without relying on sleeping pills or potions.  Are you tired of tossing and turning at night? Desperately wishing for deep, restful sleep?  I'm hosting two exclusive live webinars where I'll share my evidence based approach to achieving consistent quality sleep. Join me on March 3rd or March 5th to discover how to fall asleep naturally. and wake up refreshed, practical strategies to boost your energy and mental clarity, and solutions to common sleep challenges that keep you awake at night.  Plus you'll get a chance to ask your most pressing sleep questions during a live Q& A session. So don't miss this opportunity. To revolutionize your sleep. Click the link in the show notes to save your spot now. Registration is required. And make sure you're on my email list to receive exclusive pre webinar insights and special bonuses. Your journey to better sleep starts here. Sign up right now and let's transform your nights and supercharge your days.  Because good sleep is crucial for good health and healthy looks great on you.   RESOURCES: FREE, live sleep masterclass registration Jet Lag Does Prevagen work? Why doctors prescribe a pill Meet Aunt Edna - Your holiday survival stress guide

Prednisolone is a corticosteroid that is often used in pediatrics. Hyperglycemia, insomnia, and GI upset are relatively common adverse effects. Ibuprofen is a commonly used OTC pain reliever. It is classified as an NSAID and can increase GI bleed risk and exacerbate heart failure. Aceon is the brand name for perindopril. ACE inhibitors are well known to cause drug induced cough and will cause hyperkalemia. Trazodone is classified as an antidepressant but is frequently used to treat insomnia because of its sedative properties. Pioglitazone is an oral anti-diabetes medication that should be avoided in patients with heart failure.

 Do you want to be proactive about your health, or do you just shrug your shoulders and figure you play the cards you're dealt? And the big question is, what difference does it make? Today we're going to look at 10 things that contribute to the development of dementia and what, if anything, you can do about it.  I'm Dr.Vickie Petz Kasper. I practiced obstetrics and gynecology for 20 years until I landed on the other side of the sheets   as a very sick patient. When my own body betrayed me, I took a handful of pills to manage my disease and another handful to counteract the side effects. My health was out of control. Through surgery, medications, and lots of prayers, I  regained my strength only to face another  diagnosis.  My doctor challenged me to make radical changes through lifestyle medicine. Now I feel great and I want to help you make changes that make a difference. Healthy Looks Great On You podcast takes you to mini medical school so you can learn the power of lifestyle medicine. If you're ready to take control of your health, you're in the right  place. Whether you're focused on prevention or you're trying to manage a condition. I'll give you practical steps to start your own journey toward better health because healthy looks great on you.   This is episode 155, Ten Must Know Risk Factors for Dementia.  Which ones can you alter, and which ones you just gotta accept. Here's the deal, dementia isn't just one condition with one cause, it's more like a puzzle with pieces that fit together differently for each person. And some of these pieces are fixed, but others, well, they're more like clay that you can reshape. And that's exactly what we're going to dive into today.   What if I told you that some of the choices you're making right now, today, could be tilting the scales either for or against your brain health. It's never too early or too late to make changes that affect your overall health, and that includes your brain health. So, whether you're in your 30s or in your 60s, stick around.  We're about to break down these 10 risk factors for dementia and what you can do about it. Number one on the list is age. Yeah, I know, there's not a thing in the world you can do about it. This is one you have to accept. And if you're a woman, aged 45, your chances of developing dementia during your lifetime are 1 in 5. If you're a man, it's one in 10. And even though I didn't include biologic sex in this list, clearly women are at increased risk, but there may be reasons for that that you can alter. Bottom line is age is the biggest risk factor for dementia and the older you get, the greater the risk. In fact, the chances double every five years after age 65.  To quote Andy Rooney, it's paradoxical that the idea of living a long life appeals to everyone. But the idea of getting old doesn't appeal to anyone. And that's generally true and with good reason. I mean, it's not called over the hill for nothing.  They say you should grow old gracefully. Ha! There's nothing graceful about some of the tolls the years take. And according to George Burns, you know you're getting old when you stoop over to tie your shoelaces and wonder what else could you do while you're down there.  George Burns, remember him? He lived to be 100 years old and was pretty healthy. We're gonna come back to that, so be sure you listen until the end. But age is just one risk factor you have to accept.  But while you're practicing acceptance, here's another one you can't control. Family history.   If someone in your family had dementia, then you are at increased risk. And if more than one somebody in your family had dementia, you're at even more risk. And you know what they say, you can't change the past, but you can change the future. You can start where you are and change the ending. And I want you to remember that quote as we talk through this, because even if you have a strong family history of dementia, your fate is not sealed, but it is at risk. So, think about your family history. You tend to inherit your lifestyle from your family. Okay, not always, but a lot of our habits are ingrained at an early age. We sort of eat the same things and live in similar environments.  Education levels and socioeconomic advantages or disadvantages are often generational, and those things are passed down, but they're not inherited like our genetic code. So I want to challenge you to start where you are and see if there's anything you can do to change the ending.     Number three is similar to family, but not exactly the same. Genetics. Pop quiz, true or false, you can alter your genes.  I want you to stay tuned next week because we are going to talk more about the genetics of Alzheimer's.  The best way to not miss an episode is to subscribe to my newsletter. You can visit my website,  www. healthylooksgreatonyou. com or I put a link in the show notes. I share tips, recipes, and lots of other resources. So why don't you just push pause right now on the podcast and do it before you get busy or forget. Each week on the podcast, I take you to mini medical school And this week, we're going to take a closer look at our  DNA. Don't worry. It's a short course and it's never boring. Do not argue with me. Science is fun if you do it right.  DNA stands for deoxyribonucleic acid. See if you can say that three times really fast. Deoxyribonucleic acid, deoxyribonucleic acid, deoxyribonucleic acid. Now you'll remember it, even if I did annoy you a little bit. I won't say it again. I'll just use the nickname, DNA. So what is it? It's like a double stranded helix, and I'm sure you've seen pictures before. Looks like a twisted ladder. It's a molecule made up of four nucleotides, C G A T. That's cytosine, guanine, adenosine, and thymine, and these little dudes are held together by hydrogen bonds in different combinations. And here's the exciting part. Every cell in your body follows the code that is written into your DNA. It's like an instruction manual. And each person's DNA is unique. That is why human life is so sacred. Because this coding determines your eye color. your hair color, facial features, and ultimate height, as well as whether or not you're born a boy or a girl.  And here's the deal, it's all determined at the moment of conception. When the egg is fertilized, wow, we are indeed fearfully and wonderfully made. Now, inside of each cell, there's this little part called the nucleus, and that's where most of the chromosome forming DNA lives.  And all of this is foundational to understand genetics but not only does your genetic code determine aspects of your health. But your environment, behavior, and lifestyle can impact genetic expression. Meaning genes can be turned off, turned on, regulated up, regulated down, and we call that epigenetics. It can even happen in the womb before you're born. So you really are what you eat, how you act, and what you do. DNA can also be damaged, so gene expression is affected by age, exposures, environment, and other factors that we're going to look at.  But since I mentioned environmental and exposure, let's move on to number four on the list of risk factors for dementia, and that is air pollution. I bet that surprised you. Turns out that pollution causes damage to the nervous system. Things like exhaust from cars in the city or wood burning in the country. And you want to know what else pollutes the air? cigarette smoke. Smoking is a risk factor for dementia as well as a host of other conditions. Your mind may go straight to cancer, but it also increases the risk of heart disease, stroke, diabetes, and even macular degeneration, which can lead to blindness.  And it turns out that number five on the list is uncorrected hearing loss.  and uncorrected vision loss. Remember when I snorted about growing old gracefully? Well, yeah, I'm over here putting in my hearing aids and groping around for my glasses and I don't think any of that is graceful,  but I do it anyway. Now I can't see without my glasses, so they're not optional, But,  uncorrected vision loss does increase the risk of dementia, and the worse the uncorrected vision loss, the worse the risk.   But again, this only applies to people with uncorrected vision loss, and I think most of us wouldn't skip wearing our glasses or contacts, But, I do see a lot of people skip on wearing hearing aids. Now, my husband would argue with this, but I can hear pretty well.  He just talks really soft.  And isn't that what everyone with hearing loss says?  Quit mumbling!  The deal is most people can get by with some hearing impairment. But it does increase the risk of dementia.  Why is that? Well, maybe because you're not processing spoken words and that part of your brain isn't getting used and it shrinks along with everything around it. Or maybe your brain is actually devoting all of its energy to try and understand those mumblers. And it neglects keeping the rest of the brain humming along at full speed.  Experts don't really know exactly why hearing loss is associated with dementia, but it's felt to be responsible for 8 percent of cases. So get over it. Go to the audiologist fork over the cash and get your hearing aids. Your brain's worth it.  Another theory about the impact of hearing loss is interference with social activity. I mean, if you can't hear, you can't participate in conversations or play games or just connect as well. And that leads us to number six, social isolation. We're created to be connected. Isolation is associated with an increased risk of dementia as well as a whole lot of other health conditions. When I say we need each other, I mean we need each other, but I want to make a point. I've talked about the impact of loneliness on this podcast before, and I'll link those episodes in the show notes. It contributes to high blood pressure, heart disease, obesity, anxiety, depression, increased inflammation in the body, and alterations in the immune system. But listen, loneliness and social isolation are not the same.  You can live alone. and not be lonely. And you can be surrounded by people and feel loneliness. It is connection that matters. So phone a friend, text a friend, or even send an email. Even simple things like that matter and they'll appreciate it. According to the National Institute on Aging, one in four people over 65 experience social isolation. Now, I picture someone sitting home alone watching TV. Social isolation decreases the opportunity for engaging activities like playing cards. And it decreases the likelihood of staying fit. Think about how many pieces of home exercise equipment serve as just a place to hang your clothes. Going to the gym is a way to get the body fit and connect socially. People who are socially connected typically smoke and drink less. And of course, that depends on who you hang out with, but clearly, people who are trying to quit benefit from community. We all do. And speaking of quitting, many people observe dry January, and it's a great idea because number seven is alcohol. Drinking alcohol does not increase your risk of Alzheimer's,  but it may worsen it.  But hold your beer. You might remember that Alzheimer's is a type of dementia, but not all dementia is Alzheimer's.  There are several other types of dementia and one uniquely occurs in people who consume heavier amounts of alcohol. It's even called alcohol related brain damage.  Here's what happens. Alcohol causes a loss of white matter. This is where the action happens. Neurons send signals to different parts of the brain and with heavy alcohol use the brain actually shrinks, and with less volume, there's less function.  Alcohol can cause atrophy of the cells, and inhibit the growth of new neurons via a process that we call neurogenesis. Alcohol ages the brain faster and contributes to other diseases that are associated with Alzheimer's dementia and other forms of dementia as well. These conditions are things like high blood pressure and heart disease.   But wait! I thought drinking red wine prevents dementia. And this is a hot topic of research and debate. I mean, when you look at the Mediterranean diet and all those blue zones, most of them are in areas where grapes are grown. And when the fruit of the vine is ripe, well, you know. So the debate continues. And whenever there's controversy, it helps a bit to understand statistics. There's something called a J curve, and the theory was that teetotalers had a slightly increased risk of things like heart disease and brain disease, which, by the way, go together. Then, it decreased with a glass or two of red wine a day, and then the swoop up in the letter J indicated an increased risk with heavy drinking. However, whether or not there's any benefit to consuming red wine is now being challenged. And many experts assert that there is no safe level of drinking.  And if you've ever met my mother, you know she agrees wholeheartedly.  But here's the deal. There is no question that excessive drinking increases the risk of,  you name it. And it's especially harmful in midlife. Besides that, it increases your risk of everything I'm going to mention for number eight on the list, which is head injury.  And it's more common than you might realize. Over 23 million adults over the age of 40 have had at least their bell rung. That's slang for a concussion. It can be from falling, car wrecks, or sports injuries. And the more times your brain gets conked, the greater the risk. That's what we call dose dependent. Preventable? Often. Wear a helmet if you're riding a bicycle, snowmobile, motorcycle, or snowboarding or skiing.  And always, always, always wear your seatbelt. But here's where the rubber meets the road.   And that's number nine, certain chronic medical conditions. And here's the deal. Anything that affects your blood vessels affects your heart and brain. So, things like high blood pressure and diabetes, which damage blood vessels, they aren't good for the old ticker and they aren't good for the noggin either.  Okay, I don't know about you, but I'm ready for some good news.  You too, huh?  Well, how about this? Everything that keeps your blood vessels healthy is affected by lifestyle. If you didn't know that was coming, I'd like to welcome you to your first episode of the Healthy Looks Great On You podcast. But seriously, not smoking, limiting alcohol use, maintaining physical fitness, social connectedness, managing stress and things like depression, as well as eating whole foods.  That's your best weapon to prevent dementia, protect your heart and maximize your overall health.  Now if you already have one of these conditions, hear me.  Sometimes, it's not necessarily too late. Remember You can't go back and change the beginning, but you can start where you are and change the ending. now, let me give you this caveat. Sometimes, it is too late, and conditions are not reversible, and that's often the case. So, prevention is super important.  And also, it's felt that 40 percent of dementia cases can be prevented. That leaves 60 percent that cannot.  Diabetes, high blood pressure, and obesity can be prevented, treated, and sometimes even reversed with lifestyle changes.  I won't go into each one now, but there are lots of episodes that address these six pillars of lifestyle medicine, as well as specific recommendations for each of these conditions. Just head over to my website, www. healthylooksgreatonyou.  com, and browse for them. Included is an episode on preventing cognitive decline, and I'll link this one in the show notes.  But, before we say goodbye Let's say goodnight, because number 10 on the list is sleep.  The first question is, does poor sleep increase the risk of dementia or does dementia interfere with good quality sleep? And the answer is yes, both are true.  On top of that, people have more difficulty sleeping as they age. And here's another conundrum. Do prescription medications for sleep increase the risk of dementia? I mean, if poor sleep is a risk factor, shouldn't we just head to the pharmacy and pick up a bottle of sleeping pills? Well, a recent study showed that certain sleeping medications increase the risk of dementia in white people to the tune of 79%.  Now, that's in people who either often or almost regularly took sleeping medications compared to people who rarely or never took sleeping pills.  And by the way, white people use way more medications for chronic insomnia. Medications like Xanax and Valium. Trazodone, Halcion, Dalmane, Ambien, and Resoril. They're prescribed to white people 10 times more often.  But, despite these risks, 10 percent of older adults regularly take sleeping medication. And, guess what? Women are the biggest users.  Okay, fine, what if you just take over the counter medications like Benadryl, or Diphenhydramine, or Tylenol PM?  The common ingredient, diphenhydramine, has some evidence that it's associated with a higher incidence of dementia.  So what are you supposed to do if poor sleep increases your risk and medication increases your risk too? Well, I'm so glad you asked.  Sleep is complicated, but it's essential. I'll share some previous links to episodes in the show notes if you struggle with sleep. I have some good news. Coming soon, I'm doing a month long series on sleep, so make sure you stay tuned because I'm going to do a series of live webinars, too.  And if you go to my website, there are a couple of downloads that you can snag. Three simple ways to improve your sleep and what to do if you're tossing and turning because your mind won't shut off.  Okay, before we finish, what about George Burns?  Well, he lived with good health and a sharp mind until he was 100 years old. Think he didn't have risk factors? Think again. He started smoking cigars when he was 14 years old, but never cigarettes, and like Bill Clinton's joint, he didn't inhale. He had two to three drinks a day, and sometimes more, but he says he never got drunk. And he had a serious head injury after falling out of the bathtub.  He adored his wife of 38 years and looked forward to joining her in heaven. In the meantime, he exercised daily. He swam, walked, and did sit ups and push ups.  But maybe, just maybe, his biggest strength was the laughter he generated. He says he didn't tell jokes, but rather anecdotes and lies.  But he was a funny guy.  Now, I'm not saying that laughter will keep you from getting dementia or make you live longer, but it sure will put more joy in your life.  So laugh and be healthy, because healthy looks great on you.       The information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or health care provider and take medication as prescribed. Though the information in this podcast is evidence based, new research may develop and recommendations may change. RESOURCES: The Deadly Epidemic of Loneliness From Loneliness to Belonging How to prevent, treat and reverse type 2 diabetes 4 Reasons to control your BP Preventing Cognitive Decline Why is Sleeping so Hard? The Mood Mechanic and the work of sleep Healthy Looks Great on You website Join the email list for all the resources  

*The passing of Jimmy Carter and the responsibility to be a better person *Ordinances to repair sidewalks approved *OHM Advisors will present State Road/Bailey Road Corridor analysis to Planning Commission on Feb 4 at Natatorium *7 Brew *Cuyahoga Falls Rapids Merchandise *Parking Meters on Parade winners *Ohio All-State Jazz Ensemble *Millennial Theatre Project presents Hairspray *Akronomicon Thank you for listening. We are always in the market for article submissions and suggestions for podcast interviews. If you are interested in volunteering with on The Falls Free Press or the Fallscast, or are a musician wishing to showcase your music on the podcast, drop us a line at fallsfreepress@gmail.com. If you enjoyed the show, be sure to rate and review us on Apple Podcasts to let others know to listen. Fallscast theme and composed and performed by Alex Hall. This episode recorded and edited by Bart Sullivan. "Trazodone" composed and performed by Tyler Yohey Hold music: "Golden Coast Melody" by DPStudioMusic. ℗2024 Pixabay Music. Royalty free.

Insomnia treatment often involves pills and when those pills fail to solve the problem (or even if them seem to help) the desire to discontinue the pills may arise. In this episode we will:Discuss the overall theory of sleeping pillsHighlight the use of Trazodone as a sleeping aidWalk through strategies and useful ways to discontinue sleeping pillsExplain why individuals wean oof of medicationsTouch upon the dangers and risks of discontinuing sleeping pillsExplore why discontinuing medications is difficultProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @drchriwinter Threads: @drchriswinter Bluesky: @drchriswinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

In this episode, I'm talking all about restlessness and anxiety in dogs—something I get a lot of questions about. I'm answering a listener's question on how we can use herbs to help with things like reactivity, separation anxiety, and just general restlessness. I share some of my go-to herbs, like nettles and chamomile, that support the kidneys and nervous system, plus some tips for calming your dog's anxiety. I also talk about how we, as dog owners, need to check in with our own stress levels because our dogs pick up on our energy. And of course, we go over why I'm not a huge fan of meds like Prozac and Trazodone for behavioral issues, and why natural remedies like flower essences and calming herbs are often the way to go. Show Links: Aconite and Arnica (by Adored Beast) Relax Formula Rescue Remedy Sponsored By: Goodness Gracious Real Mushrooms Check Out Rita SIGN UP FOR MY NEW BOOK Rita's Instagram Facebook Group My Courses My Website and Store Produced By: Drake Peterson

Join us as we discuss a commonly used class of medications for sleep, the H1 antagonists. This includes medications such as hydroxyzine, mirtazapine, doxepin and more Answer to Poll Question Below (SPOILER) —————————————————— Answer: Choice B (Doxepin)

Quinn comes to you LIVE to discuss Wheel of Fortune mishaps, botched trivia, and Kamala's alcoholism

Jesika Jones, 32, has been sentenced to 60 years in prison for intentionally poisoning her 4-year-old daughter in an effort to fake a seizure disorder. The sentencing was handed down by 485th District Court Judge Steve Jumes, who condemned Jones as a "determined recidivist." Jones, who referred to herself as a "habitual liar," had previously reached a plea deal with prosecutors in January, admitting guilt to charges of injury to a child with serious bodily harm and abandoning or endangering a child with reckless criminal negligence. The charges stemmed from her repeated administration of excessive amounts of Benadryl and other medications to her young daughter, causing severe health issues. Judge Jumes, in his remarks, highlighted Jones' continued dangerous behavior even while awaiting sentencing. He expressed grave concern over her ongoing attempts to gain access to children, noting that Jones had been caught administering medication to a 12-year-old girl as recently as July. "Because you are a determined recidivist and because I believe that you have a knack for finding situations where you can have access to children, I'm not confident giving you a prison sentence simply beyond a traditional dating range will protect the public," Judge Jumes stated. Authorities believe Jones may have victimized all five of her children in similar fashion. Despite being arrested over two years ago, Jones allegedly continued to poison children while out on bond, including the daughter of a man she was attempting to date. Detective Michael Weber of the Tarrant County Sheriff's Office revealed that Jones was caught in July giving medication to a 12-year-old girl who was not her own child. According to the girl's testimony, Jones, who posed as a nurse, administered medication that made her feel dizzy. “We found that she was meeting men and essentially becoming involved with them to gain access to their children,” Det. Weber said. Jones' estranged husband, Derek Jones, also addressed the court, speaking on behalf of their children. He described the profound impact of her actions, stating that their lives had been dominated by "fake sickness," replacing childhood experiences with hospital visits and fear. The case came to light after Jones repeatedly brought her daughter to the emergency room at Cook Children's Medical Center in Fort Worth, claiming the child suffered from chronic seizures. Medical staff discovered high levels of anti-allergy medication in the girl's system, leading to suspicions of poisoning. When questioned, Jones eventually admitted to dosing her daughter with Benadryl, Trazodone, and Hydroxyzine. Jones eventually confessed to police that she “needs help,” according to an affidavit. “I think I'm a horrible person,” she admitted. “I don't love myself. I don't like who I am. I'm tired of living like this. I'm tired of hurting people. I don't know. I really don't.” During the interview, Jones described herself as a “habitual liar.” Tarrant County Judge Steven Jumes expressed concern for public safety in rendering the 60-year sentence. “Unfortunately, I believe you are a determined recidivist,” he stated. Want to listen to ALL of our podcasts AD-FREE? Subscribe through APPLE PODCASTS, and try it for three days free: https://tinyurl.com/ycw626tj Follow Our Other Cases: https://www.truecrimetodaypod.com The latest on The Downfall of Diddy, The Trial of Karen Read, The Murder Of Maddie Soto, Catching the Long Island Serial Killer, Awaiting Admission: BTK's Unconfessed Crimes, Delphi Murders: Inside the Crime, Chad & Lori Daybell, The Murder of Ana Walshe, Alex Murdaugh, Bryan Kohberger, Lucy Letby, Kouri Richins, Malevolent Mormon Mommys, Justice for Harmony Montgomery, The Murder of Stephen Smith, The Murder of Madeline Kingsbury, and much more! Listen at https://www.truecrimetodaypod.com

Jesika Jones, 32, has been sentenced to 60 years in prison for intentionally poisoning her 4-year-old daughter in an effort to fake a seizure disorder. The sentencing was handed down by 485th District Court Judge Steve Jumes, who condemned Jones as a "determined recidivist." Jones, who referred to herself as a "habitual liar," had previously reached a plea deal with prosecutors in January, admitting guilt to charges of injury to a child with serious bodily harm and abandoning or endangering a child with reckless criminal negligence. The charges stemmed from her repeated administration of excessive amounts of Benadryl and other medications to her young daughter, causing severe health issues. Judge Jumes, in his remarks, highlighted Jones' continued dangerous behavior even while awaiting sentencing. He expressed grave concern over her ongoing attempts to gain access to children, noting that Jones had been caught administering medication to a 12-year-old girl as recently as July. "Because you are a determined recidivist and because I believe that you have a knack for finding situations where you can have access to children, I'm not confident giving you a prison sentence simply beyond a traditional dating range will protect the public," Judge Jumes stated. Authorities believe Jones may have victimized all five of her children in similar fashion. Despite being arrested over two years ago, Jones allegedly continued to poison children while out on bond, including the daughter of a man she was attempting to date. Detective Michael Weber of the Tarrant County Sheriff's Office revealed that Jones was caught in July giving medication to a 12-year-old girl who was not her own child. According to the girl's testimony, Jones, who posed as a nurse, administered medication that made her feel dizzy. “We found that she was meeting men and essentially becoming involved with them to gain access to their children,” Det. Weber said. Jones' estranged husband, Derek Jones, also addressed the court, speaking on behalf of their children. He described the profound impact of her actions, stating that their lives had been dominated by "fake sickness," replacing childhood experiences with hospital visits and fear. The case came to light after Jones repeatedly brought her daughter to the emergency room at Cook Children's Medical Center in Fort Worth, claiming the child suffered from chronic seizures. Medical staff discovered high levels of anti-allergy medication in the girl's system, leading to suspicions of poisoning. When questioned, Jones eventually admitted to dosing her daughter with Benadryl, Trazodone, and Hydroxyzine. Jones eventually confessed to police that she “needs help,” according to an affidavit. “I think I'm a horrible person,” she admitted. “I don't love myself. I don't like who I am. I'm tired of living like this. I'm tired of hurting people. I don't know. I really don't.” During the interview, Jones described herself as a “habitual liar.” Tarrant County Judge Steven Jumes expressed concern for public safety in rendering the 60-year sentence. “Unfortunately, I believe you are a determined recidivist,” he stated. Want to listen to ALL of our podcasts AD-FREE? Subscribe through APPLE PODCASTS, and try it for three days free: https://tinyurl.com/ycw626tj Follow Our Other Cases: https://www.truecrimetodaypod.com The latest on The Downfall of Diddy, The Trial of Karen Read, The Murder Of Maddie Soto, Catching the Long Island Serial Killer, Awaiting Admission: BTK's Unconfessed Crimes, Delphi Murders: Inside the Crime, Chad & Lori Daybell, The Murder of Ana Walshe, Alex Murdaugh, Bryan Kohberger, Lucy Letby, Kouri Richins, Malevolent Mormon Mommys, Justice for Harmony Montgomery, The Murder of Stephen Smith, The Murder of Madeline Kingsbury, and much more! Listen at https://www.truecrimetodaypod.com

Text me to ask a question, leave a comment or just say hello! Welcome back to *Stethoscopes and Strollers*! In this episode, I'm opening up about my personal battle with sleep issues and the journey I took to find restful sleep again. As a physician and a mom, I've faced the ups and downs of sleep deprivation, and I want to share my story to help you navigate your own sleep challenges.Episode Highlights:- Stress and Sleep: How high-stress periods affected my sleep patterns, and the shift that happened after having my daughter.- Unrestful Sleep: The constant chatter in my mind, the to-do lists, replaying arguments, and the anger that kept me awake.- Trial and Error: My attempts to improve sleep with various medications like doxylamine, melatonin, and Benadryl, and the realization that these were only temporary fixes.- Postpartum Anxiety: Exploring the possibility that my sleep issues were linked to postpartum anxiety and my decision to try Lexapro.- Professional Help: The pivotal moment when my therapist advised me to seek proper evaluation for my sleep issues.- Discovering Trazodone: My experience with Trazodone, which worked for a while but eventually stopped being effective.- Natural Remedies: Trying meditation, bedtime yoga, and even gummies suggested by my husband, and why these also fell short.- The Breakthrough: Finally seeking help from a sleep coach, Dr. Funke Afolabi Brown, and how her guidance in six sessions provided a lasting framework for better sleep.Key Messages:- Seek Help: Don't waste time trying to fix sleep issues on your own. Professional help can make a significant difference.- It's Not Normal: If you're getting less than six hours of sleep regularly, it's time to talk to someone.- Empower Yourself: Whether it's immediately postpartum or years later, there are solutions and people who can help you improve your sleep.Thank you for joining me on this journey. Let's change the narrative around sleep in this season of life. See you on the next episode of *Stethoscopes and Strollers*! Remember to subscribe to "Stethoscopes and Strollers" on your favorite podcast platform so you never miss an episode of encouragement and empowerment. Apple Podcast | Spotify | YouTube Connect with me. Website | Instagram | Facebook Join my Email list to get tips on navigating motherhood in the medical field. If you feel you need direct support or someone to talk through the unique challenges of being a physician mom, schedule a free coaching session. Free Coaching Session with Dr. Toya

Could there be an end in sight to the nightmare of sleeping disorders? Join Dr. Kevin Ban and Dr. John Cronin as they explore common sleep disorders and treatments that you can try tonight! In this second installment about how to get a better night's sleep, the doc's debunk common myths and ineffective self-treatment methods, emphasizing evidence-based approaches such as Cognitive Behavioral Therapy for Insomnia (CBT-I). Whether you struggle with falling asleep, staying asleep, or waking up too early, this episode offers practical advice and hope for achieving better sleep.For those who feel like they've tried it all, here's the short-list of benefits you'll get in the next 45 minutes: You'll see how sleep requirements differ; and that not everyone needs eight hours of sleep or moreYou'll learn how to avoid many popular self-treatment methods that actually make insomnia worseYou'll discover more about the restorative power of reconnecting with your circadian rhythm You'll learn about Cognitive Behavioral Therapy for Insomnia (CBT-I) as a way to fall asleep without the medsYou'll get actionable strategies that you can implement today for a great sleep tonightAnd so much moreLet's face it. Sleeping disorders can be a painful fact of life for all of us. The good news is that there's more you can do about it than you may have previously thought and you don't need a doctor, lengthy sleep studies, or medication. Don't miss this episode filled with expert advice and practical tips for achieving a good night's rest so that you can wake up to a new you, from here on out!Sharing Beauty:     • Dad Holding Space for His Daughter's ...  Contact email:  team@sickhealthshow.comExecutive Producer: Kevin Ban, MDProduction Director, Editor and Producer:  Bat-Sheva GuezGraphic designer: Leah VanWhyYouTube SEO: Lighthouse-Digitalmarketing.comSocial media: Rebekah PajakInterns: Nicole Berritto & Niccolo Ban* Select photos provided by Shutterstock *This show's content represents the personal opinions of Kevin Ban, MD. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not create a physician-patient relationship with Kevin Ban, MD. Always seek the advice of your physician or other health care qualified provider with any questions you may have regarding your medical condition or your general health.To see any images and leave your questions or comments, find us on YouTube at https://www.youtube.com/@SickHealthwithKevinBanMD

31-40 Round-Up  Quick summaries of Episodes 31-40.    31. Injection Drug Use Frequency Before and After Take-Home Naloxone Training    32. Trazodone for sleep disturbance in opioid dependent patients maintained on buprenorphine: A double blind, placebo-controlled trial.    33. Non-fatal overdose risk associated with prescribing opioid agonists concurrently with other medication: Cohort study conducted using linked primary care, secondary care and mortality records    34. Buprenorphine Dose and Time to Discontinuation Among Patients With Opioid Use Disorder in the Era of Fentanyl    35. Removal of Medicaid Prior Authorization Requirements and Buprenorphine Treatment for Opioid Use Disorder    36. Emotion dysregulation factors associated with problematic smartphone use severity: The mediating role of fear of missing out    37. Superiority and cost-effectiveness of monthly extended-release buprenorphine versus daily standard of care medication: a pragmatic, parallel-group, open-label, multicentre, randomised, controlled, phase 3 trial    38. Receipt of Opioid Use Disorder Treatments Prior to Fatal Overdoses and Comparison to No Treatment in Connecticut, 2016-17    39. Effects of Abstinence From Opioid on Neuropsychological Performance in Men With Opioid Use Disorder: A Longitudinal Study    40. Drug overdose risk with benzodiazepine treatment in young adults: Comparative analysis in privately and publicly insured individuals  ----------  31-40 Round-Up Credits:  Original theme music: composed and performed by Benjamin Kennedy  Audio production: Erin McCue  Executive Producer: Dr. Patrick Beeman  A podcast from Ars Longa Media  ----------  This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice.     The best part of any journal club is the conversation. Send us your comments on social media or join our Facebook group.    Email: addictionmedicinejournalclub@gmail.com   Facebook: @AddictionMedJC  Facebook Group: Addiction Medicine Journal Club  Instagram: @AddictionMedJC   Threads: @AddictionMedJC  Twitter/X: @AddictionMedJC    YouTube: addictionmedicinejournalclub    Addiction Medicine Journal Club is intended for educational purposes only and should not be considered medical advice. The views expressed here are our own and do not necessarily reflect those of our employers or the authors of the articles we review. All patient information has been modified to protect their identities. 

Trazodone is a very popular medication that is prescribed mostly for people who have depression. There are negative side effects with every drug, but this one seems to have more than others...    

Taylor Coronado met Shad Thyrion when they were in middle school and later dated one another in high school. Although that relationship didn't last, they did remain friends after high school. One night on February 21st, 2022 Taylor picked up Shad from his mother's house at around 9:30pm. They drove to her apartment on Eastman Avenue and there one of their friends joined them to hang out and smoke weed. After this friend left both Shad and Taylor smoked meth and injected Trazodone. After going back to Shad's mother's house, they engaged in sexual intercourse but one of them took things too far.

Dr. Gillett and Nurse Practitioner James O'Hara discuss sexual health, exploring a spectrum of strategies to optimize and enhance. 00:00 Intro01:43 Exploring Hypoactive Sexual Desire Disorder and the Sexual Function Triad05:02 Unveiling the Reel of PDE5 Inhibitors05:38 Navigating the Partner's Choice in Sexual Health13:04 Understanding the Role of Androgens in Men's Sexual Function19:27 Shedding Light on Testosterone's Impact on Women's Sexual Health25:40 Examining the Long-Term Safety of Sexual Health Interventions28:33 Unpacking Vyleesi: A Closer Look at its Mechanism32:56 Trazodone and PT-141: Exploring Alternative Approaches34:24 Addyi: Assessing its Role in Enhancing Female Libido37:30 Bupropion: An Overview of its Impact on Sexual Function41:43 Oxytocin and Apomorphine: Investigating Novel Approaches47:21 Addressing Anorgasmia in the Spectrum of Sexual Health50:14 Priapism: Understanding and Managing Persistent ErectionsFor High-quality labs:53:28 OutroStudies/References ► https://pubmed.ncbi.nlm.nih.gov/18312284/► https://pubmed.ncbi.nlm.nih.gov/26797204/► https://pubmed.ncbi.nlm.nih.gov/37589949/► https://www.liebertpub.com/doi/full/10.1089/andro.2021.0033► https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668626/► https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/486664► https://sci-hub.se/https://pubmed.ncbi.nlm.nih.gov/19108962/To order high quality labs:► https://gilletthealth.com/order-lab-panels/For information on the Gillett Health clinic, lab panels, and health coaching:► https://GillettHealth.comFollow Gillett Health for more content from James and Kyle► https://instagram.com/gilletthealth► https://www.tiktok.com/@gilletthealth► https://twitter.com/gilletthealth► https://www.facebook.com/gilletthealthFollow Kyle Gillett, MD► https://instagram.com/kylegillettmdFollow James O'Hara, NP► https://Instagram.com/jamesoharanpFor 10% off Gorilla Mind products including SIGMA: Use code “GH10”► https://gorillamind.com/For discounts on high-quality supplements►https://www.thorne.com/u/GillettHealth#podcast #optimization #libido #hormones #libido #gilletthealthAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

High Yield Psychiatric Medications Antidepressants Review for your PANCE, PANRE, Eor's and other Physician Assistant exams. Review includes SSRI's, SNRIs, TCAs, MAOIs, Atypical antidepressants, Serotonin modulators. TrueLearn PANCE/PANRE SmartBank:https://truelearn.referralrock.com/l/CRAMTHEPANCE/Discount code for 20% off: CRAMTHEPANCEIncluded in review: Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Desvenlafaxine, Duloxetine, Levomilnacipran , Milnacipran, Venlafaxine, Amitriptyline, Clomipramine, Doxepin, Imipramine, Trimipramine, Desipramine, Nortriptyline, Protriptyline, Tranylcypromine, Isocarboxazid, Phenelzine Selegiline, Bupropion, Mirtazapine, Trazodone

In this edition of Insomnia insight, Coach Daniel shares three teachings that apply when we wan't to come off medications like Ambien, Trazodone and Mirtazapine. We learn about delegation, conflict and how to practically proceed - MAPASTI — Would you like a roadmap from Insomnia to immunity? Download using below link. https://www.thesleepcoachschool.com/h...  Would you like to work with one of our certified sleep coach? Awesome! Here are some great options:  The Insomnia Immunity Group Coaching Program.  BedTyme, a sleep coaching app for iOS and Android offering 1:1 text based coaching.  Zoom based 1:1 coaching with Coach Michelle or Coach Daniel.   The Insomnia Immunity program is perfect if you like learning through video and want to join a group on your journey towards sleeping well. BedTyme is ideal if you like to learn via text and have a sleep coach in your pocket.   The 1:1 Zoom based program is for you if you like to connect one on one with someone who has been where you are now. Find out more about these programs here: https://www.thesleepcoachschool.com/  Do you like learning by reading? If so, here are two books that offer breakthroughs! Tales of Courage by Daniel Erichsen https://www.amazon.com/Tales-Courage-... Set it & Forget it by Daniel Erichsen https://www.amazon.com/Set-Forget-rea... — Would you like to become a Sleep Hero by supporting the Natto movement on Patreon? If so, that's incredibly nice of you

In episode 32 we discuss an article about trazodone for sleep in people with opioid use disorder on buprenorphine. Piyush Goyal, Dheeraj Kattula, Ravindra Rao, Roshan Bhad, Ashwani Kumar Mishra, Anju Dhawan. Trazodone for sleep disturbance in opioid dependent patients maintained on buprenorphine: A double blind, placebo-controlled trial. Drug and Alcohol Dependence. Volume 250. 2023. 110891. ISSN 0376-8716.  We also discuss the decriminalization of psychedelics and treating HCV in primary care. From the LA Times: California moves to decriminalize use of magic mushrooms and other natural psychedelics   From the AASLD/ISDA: Recommendations for Testing, Managing, and Treating Hepatitis C ---------- This podcast offers category 1 and MATE-ACT CME credits through MI CARES and Michigan State University. To get credit for this episode and others, go to this link to make your account, take a brief quiz, and claim your credit. To learn more about opportunities in addiction medicine, please visit MI CARES. ---------- Episode 32 Credits: Original theme music: composed and performed by Benjamin Kennedy Audio production: Erin McCue Executive Producer: Dr. Patrick Beeman A podcast from Ars Longa Media ---------- This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice.  The best part of any journal club is the conversation. Send us your comments on Twitter, Facebook, YouTube, Spotify, email, or join our Facebook group. Email: addictionmedicinejournalclub@gmail.com  Twitter/X: @AddictionMedJC  Facebook: @AddictionMedJC Facebook Group: Addiction Medicine Journal Club YouTube: addictionmedicinejournalclub Addiction Medicine Journal Club is intended for educational purposes only and should not be considered medical advice. The views expressed here are our own and do not necessarily reflect those of our employers or the authors of the articles we review. All patient information has been modified to protect their identities.

In a crime that has sent shockwaves through the Brown County community, 25-year-old Taylor Schabusiness has been sentenced to life without the possibility of parole. The sentencing, passed down by Judge Thomas Walsh, comes after Schabusiness was found guilty of the brutal murder and dismemberment of her ex-boyfriend, 24-year-old Shad Thyrion.    The Crime's Grisly Details  Thyrion's dismembered remains were discovered in his mother's basement, sparking a horrifying investigation that quickly zeroed in on Schabusiness as the primary suspect. The most haunting discovery of the investigation was made by the victim's mother, Tara Pakanich, and her boyfriend, Steve Hendricks, who found Thyrion's severed head and other body parts in a bucket.    Subsequent searches of the premises led to the discovery of additional body parts, evidence of drug use, and other incriminating items.    Tense Moments in Court    During her appearance in the Brown County Circuit Court, Schabusiness, clad in an orange prison jumpsuit, remained an enigmatic figure. While she chose not to address the court, her reactions varied from apparent smirks to shaking her head as the details of her crimes were read out.    The courtroom was a cauldron of emotion. Kelly Thyrion, the victim's uncle, voiced his contempt for Schabusiness, using derogatory terms. On the other hand, Shad's father, Michael, expressed a more compassionate stance, asking for leniency and forgiveness.    The Sentence and Judge's Remarks    Judge Thomas Walsh's decision to sentence Schabusiness to life without parole underscored the severity of the crime. He stated, "This crime offends human decency, dignity, and the community." Despite the defense's attempts to cite Schabusiness's history of drug abuse and trauma as mitigating factors, the judge emphasized the need to prioritize public safety.    Drugs and Their Role in the Crime    Throughout the trial, there were constant reminders of the destructive role of drugs. Schabusiness confessed to both smoking methamphetamine and injecting herself and the victim with Trazodone, a strong sedative. This drug-fueled environment was presented as a backdrop to the tragic events that ensued.    Despite this, Dr. Diane Lytton, who assessed Schabusiness's mental state, suggested that she was experiencing psychosis, complete with hallucinations. However, the jury was not swayed by this testimony, given the physical evidence at hand.    The Aftermath    The Brown County community now faces the grim task of coming to terms with this tragic event. As the details of this case reverberate through the area, many residents are hoping for a renewed focus on the dangers of drug addiction and its potentially catastrophic outcomes. Want to listen to ALL of our podcasts AD-FREE? Subscribe through APPLE PODCASTS, and try it for three days free: https://tinyurl.com/ycw626tj Follow Our Other Cases: https://www.truecrimetodaypod.com The latest on Catching the Long Island Serial Killer, Awaiting Admission: BTK's Unconfessed Crimes, Chad & Lori Daybell, The Murder of Ana Walshe, Alex Murdaugh, Bryan Kohberger, Lucy Letby, Kouri Richins, Justice for Harmony Montgomery, The Murder of Stephen Smith, The Murder of Madeline Kingsbury, and much more! Listen at https://www.truecrimetodaypod.com

In a crime that has sent shockwaves through the Brown County community, 25-year-old Taylor Schabusiness has been sentenced to life without the possibility of parole. The sentencing, passed down by Judge Thomas Walsh, comes after Schabusiness was found guilty of the brutal murder and dismemberment of her ex-boyfriend, 24-year-old Shad Thyrion.    The Crime's Grisly Details  Thyrion's dismembered remains were discovered in his mother's basement, sparking a horrifying investigation that quickly zeroed in on Schabusiness as the primary suspect. The most haunting discovery of the investigation was made by the victim's mother, Tara Pakanich, and her boyfriend, Steve Hendricks, who found Thyrion's severed head and other body parts in a bucket.    Subsequent searches of the premises led to the discovery of additional body parts, evidence of drug use, and other incriminating items.    Tense Moments in Court    During her appearance in the Brown County Circuit Court, Schabusiness, clad in an orange prison jumpsuit, remained an enigmatic figure. While she chose not to address the court, her reactions varied from apparent smirks to shaking her head as the details of her crimes were read out.    The courtroom was a cauldron of emotion. Kelly Thyrion, the victim's uncle, voiced his contempt for Schabusiness, using derogatory terms. On the other hand, Shad's father, Michael, expressed a more compassionate stance, asking for leniency and forgiveness.    The Sentence and Judge's Remarks    Judge Thomas Walsh's decision to sentence Schabusiness to life without parole underscored the severity of the crime. He stated, "This crime offends human decency, dignity, and the community." Despite the defense's attempts to cite Schabusiness's history of drug abuse and trauma as mitigating factors, the judge emphasized the need to prioritize public safety.    Drugs and Their Role in the Crime    Throughout the trial, there were constant reminders of the destructive role of drugs. Schabusiness confessed to both smoking methamphetamine and injecting herself and the victim with Trazodone, a strong sedative. This drug-fueled environment was presented as a backdrop to the tragic events that ensued.    Despite this, Dr. Diane Lytton, who assessed Schabusiness's mental state, suggested that she was experiencing psychosis, complete with hallucinations. However, the jury was not swayed by this testimony, given the physical evidence at hand.    The Aftermath    The Brown County community now faces the grim task of coming to terms with this tragic event. As the details of this case reverberate through the area, many residents are hoping for a renewed focus on the dangers of drug addiction and its potentially catastrophic outcomes. Want to listen to ALL of our podcasts AD-FREE? Subscribe through APPLE PODCASTS, and try it for three days free: https://tinyurl.com/ycw626tj Follow Our Other Cases: https://www.truecrimetodaypod.com The latest on Catching the Long Island Serial Killer, Awaiting Admission: BTK's Unconfessed Crimes, Chad & Lori Daybell, The Murder of Ana Walshe, Alex Murdaugh, Bryan Kohberger, Lucy Letby, Kouri Richins, Justice for Harmony Montgomery, The Murder of Stephen Smith, The Murder of Madeline Kingsbury, and much more! Listen at https://www.truecrimetodaypod.com

In a crime that has sent shockwaves through the Brown County community, 25-year-old Taylor Schabusiness has been sentenced to life without the possibility of parole. The sentencing, passed down by Judge Thomas Walsh, comes after Schabusiness was found guilty of the brutal murder and dismemberment of her ex-boyfriend, 24-year-old Shad Thyrion.    The Crime's Grisly Details  Thyrion's dismembered remains were discovered in his mother's basement, sparking a horrifying investigation that quickly zeroed in on Schabusiness as the primary suspect. The most haunting discovery of the investigation was made by the victim's mother, Tara Pakanich, and her boyfriend, Steve Hendricks, who found Thyrion's severed head and other body parts in a bucket.    Subsequent searches of the premises led to the discovery of additional body parts, evidence of drug use, and other incriminating items.    Tense Moments in Court    During her appearance in the Brown County Circuit Court, Schabusiness, clad in an orange prison jumpsuit, remained an enigmatic figure. While she chose not to address the court, her reactions varied from apparent smirks to shaking her head as the details of her crimes were read out.    The courtroom was a cauldron of emotion. Kelly Thyrion, the victim's uncle, voiced his contempt for Schabusiness, using derogatory terms. On the other hand, Shad's father, Michael, expressed a more compassionate stance, asking for leniency and forgiveness.    The Sentence and Judge's Remarks    Judge Thomas Walsh's decision to sentence Schabusiness to life without parole underscored the severity of the crime. He stated, "This crime offends human decency, dignity, and the community." Despite the defense's attempts to cite Schabusiness's history of drug abuse and trauma as mitigating factors, the judge emphasized the need to prioritize public safety.    Drugs and Their Role in the Crime    Throughout the trial, there were constant reminders of the destructive role of drugs. Schabusiness confessed to both smoking methamphetamine and injecting herself and the victim with Trazodone, a strong sedative. This drug-fueled environment was presented as a backdrop to the tragic events that ensued.    Despite this, Dr. Diane Lytton, who assessed Schabusiness's mental state, suggested that she was experiencing psychosis, complete with hallucinations. However, the jury was not swayed by this testimony, given the physical evidence at hand.    The Aftermath    The Brown County community now faces the grim task of coming to terms with this tragic event. As the details of this case reverberate through the area, many residents are hoping for a renewed focus on the dangers of drug addiction and its potentially catastrophic outcomes. Want to listen to ALL of our podcasts AD-FREE? Subscribe through APPLE PODCASTS, and try it for three days free: https://tinyurl.com/ycw626tj Follow Our Other Cases: https://www.truecrimetodaypod.com The latest on Catching the Long Island Serial Killer, Awaiting Admission: BTK's Unconfessed Crimes, Chad & Lori Daybell, The Murder of Ana Walshe, Alex Murdaugh, Bryan Kohberger, Lucy Letby, Kouri Richins, Justice for Harmony Montgomery, The Murder of Stephen Smith, The Murder of Madeline Kingsbury, and much more! Listen at https://www.truecrimetodaypod.com

In a crime that has sent shockwaves through the Brown County community, 25-year-old Taylor Schabusiness has been sentenced to life without the possibility of parole. The sentencing, passed down by Judge Thomas Walsh, comes after Schabusiness was found guilty of the brutal murder and dismemberment of her ex-boyfriend, 24-year-old Shad Thyrion.    The Crime's Grisly Details  Thyrion's dismembered remains were discovered in his mother's basement, sparking a horrifying investigation that quickly zeroed in on Schabusiness as the primary suspect. The most haunting discovery of the investigation was made by the victim's mother, Tara Pakanich, and her boyfriend, Steve Hendricks, who found Thyrion's severed head and other body parts in a bucket.    Subsequent searches of the premises led to the discovery of additional body parts, evidence of drug use, and other incriminating items.    Tense Moments in Court    During her appearance in the Brown County Circuit Court, Schabusiness, clad in an orange prison jumpsuit, remained an enigmatic figure. While she chose not to address the court, her reactions varied from apparent smirks to shaking her head as the details of her crimes were read out.    The courtroom was a cauldron of emotion. Kelly Thyrion, the victim's uncle, voiced his contempt for Schabusiness, using derogatory terms. On the other hand, Shad's father, Michael, expressed a more compassionate stance, asking for leniency and forgiveness.    The Sentence and Judge's Remarks    Judge Thomas Walsh's decision to sentence Schabusiness to life without parole underscored the severity of the crime. He stated, "This crime offends human decency, dignity, and the community." Despite the defense's attempts to cite Schabusiness's history of drug abuse and trauma as mitigating factors, the judge emphasized the need to prioritize public safety.    Drugs and Their Role in the Crime    Throughout the trial, there were constant reminders of the destructive role of drugs. Schabusiness confessed to both smoking methamphetamine and injecting herself and the victim with Trazodone, a strong sedative. This drug-fueled environment was presented as a backdrop to the tragic events that ensued.    Despite this, Dr. Diane Lytton, who assessed Schabusiness's mental state, suggested that she was experiencing psychosis, complete with hallucinations. However, the jury was not swayed by this testimony, given the physical evidence at hand.    The Aftermath    The Brown County community now faces the grim task of coming to terms with this tragic event. As the details of this case reverberate through the area, many residents are hoping for a renewed focus on the dangers of drug addiction and its potentially catastrophic outcomes. Want to listen to ALL of our podcasts AD-FREE? Subscribe through APPLE PODCASTS, and try it for three days free: https://tinyurl.com/ycw626tj Follow Our Other Cases: https://www.truecrimetodaypod.com The latest on Catching the Long Island Serial Killer, Awaiting Admission: BTK's Unconfessed Crimes, Chad & Lori Daybell, The Murder of Ana Walshe, Alex Murdaugh, Bryan Kohberger, Lucy Letby, Kouri Richins, Justice for Harmony Montgomery, The Murder of Stephen Smith, The Murder of Madeline Kingsbury, and much more! Listen at https://www.truecrimetodaypod.com

In a crime that has sent shockwaves through the Brown County community, 25-year-old Taylor Schabusiness has been sentenced to life without the possibility of parole. The sentencing, passed down by Judge Thomas Walsh, comes after Schabusiness was found guilty of the brutal murder and dismemberment of her ex-boyfriend, 24-year-old Shad Thyrion.    The Crime's Grisly Details  Thyrion's dismembered remains were discovered in his mother's basement, sparking a horrifying investigation that quickly zeroed in on Schabusiness as the primary suspect. The most haunting discovery of the investigation was made by the victim's mother, Tara Pakanich, and her boyfriend, Steve Hendricks, who found Thyrion's severed head and other body parts in a bucket.    Subsequent searches of the premises led to the discovery of additional body parts, evidence of drug use, and other incriminating items.    Tense Moments in Court    During her appearance in the Brown County Circuit Court, Schabusiness, clad in an orange prison jumpsuit, remained an enigmatic figure. While she chose not to address the court, her reactions varied from apparent smirks to shaking her head as the details of her crimes were read out.    The courtroom was a cauldron of emotion. Kelly Thyrion, the victim's uncle, voiced his contempt for Schabusiness, using derogatory terms. On the other hand, Shad's father, Michael, expressed a more compassionate stance, asking for leniency and forgiveness.    The Sentence and Judge's Remarks    Judge Thomas Walsh's decision to sentence Schabusiness to life without parole underscored the severity of the crime. He stated, "This crime offends human decency, dignity, and the community." Despite the defense's attempts to cite Schabusiness's history of drug abuse and trauma as mitigating factors, the judge emphasized the need to prioritize public safety.    Drugs and Their Role in the Crime    Throughout the trial, there were constant reminders of the destructive role of drugs. Schabusiness confessed to both smoking methamphetamine and injecting herself and the victim with Trazodone, a strong sedative. This drug-fueled environment was presented as a backdrop to the tragic events that ensued.    Despite this, Dr. Diane Lytton, who assessed Schabusiness's mental state, suggested that she was experiencing psychosis, complete with hallucinations. However, the jury was not swayed by this testimony, given the physical evidence at hand.    The Aftermath    The Brown County community now faces the grim task of coming to terms with this tragic event. As the details of this case reverberate through the area, many residents are hoping for a renewed focus on the dangers of drug addiction and its potentially catastrophic outcomes. Want to listen to ALL of our podcasts AD-FREE? Subscribe through APPLE PODCASTS, and try it for three days free: https://tinyurl.com/ycw626tj Follow Our Other Cases: https://www.truecrimetodaypod.com The latest on Catching the Long Island Serial Killer, Awaiting Admission: BTK's Unconfessed Crimes, Chad & Lori Daybell, The Murder of Ana Walshe, Alex Murdaugh, Bryan Kohberger, Lucy Letby, Kouri Richins, Justice for Harmony Montgomery, The Murder of Stephen Smith, The Murder of Madeline Kingsbury, and much more! Listen at https://www.truecrimetodaypod.com

In a crime that has sent shockwaves through the Brown County community, 25-year-old Taylor Schabusiness has been sentenced to life without the possibility of parole. The sentencing, passed down by Judge Thomas Walsh, comes after Schabusiness was found guilty of the brutal murder and dismemberment of her ex-boyfriend, 24-year-old Shad Thyrion.    The Crime's Grisly Details  Thyrion's dismembered remains were discovered in his mother's basement, sparking a horrifying investigation that quickly zeroed in on Schabusiness as the primary suspect. The most haunting discovery of the investigation was made by the victim's mother, Tara Pakanich, and her boyfriend, Steve Hendricks, who found Thyrion's severed head and other body parts in a bucket.    Subsequent searches of the premises led to the discovery of additional body parts, evidence of drug use, and other incriminating items.    Tense Moments in Court    During her appearance in the Brown County Circuit Court, Schabusiness, clad in an orange prison jumpsuit, remained an enigmatic figure. While she chose not to address the court, her reactions varied from apparent smirks to shaking her head as the details of her crimes were read out.    The courtroom was a cauldron of emotion. Kelly Thyrion, the victim's uncle, voiced his contempt for Schabusiness, using derogatory terms. On the other hand, Shad's father, Michael, expressed a more compassionate stance, asking for leniency and forgiveness.    The Sentence and Judge's Remarks    Judge Thomas Walsh's decision to sentence Schabusiness to life without parole underscored the severity of the crime. He stated, "This crime offends human decency, dignity, and the community." Despite the defense's attempts to cite Schabusiness's history of drug abuse and trauma as mitigating factors, the judge emphasized the need to prioritize public safety.    Drugs and Their Role in the Crime    Throughout the trial, there were constant reminders of the destructive role of drugs. Schabusiness confessed to both smoking methamphetamine and injecting herself and the victim with Trazodone, a strong sedative. This drug-fueled environment was presented as a backdrop to the tragic events that ensued.    Despite this, Dr. Diane Lytton, who assessed Schabusiness's mental state, suggested that she was experiencing psychosis, complete with hallucinations. However, the jury was not swayed by this testimony, given the physical evidence at hand.    The Aftermath    The Brown County community now faces the grim task of coming to terms with this tragic event. As the details of this case reverberate through the area, many residents are hoping for a renewed focus on the dangers of drug addiction and its potentially catastrophic outcomes. Want to listen to ALL of our podcasts AD-FREE? Subscribe through APPLE PODCASTS, and try it for three days free: https://tinyurl.com/ycw626tj Follow Our Other Cases: https://www.truecrimetodaypod.com The latest on Catching the Long Island Serial Killer, Awaiting Admission: BTK's Unconfessed Crimes, Chad & Lori Daybell, The Murder of Ana Walshe, Alex Murdaugh, Bryan Kohberger, Lucy Letby, Kouri Richins, Justice for Harmony Montgomery, The Murder of Stephen Smith, The Murder of Madeline Kingsbury, and much more! Listen at https://www.truecrimetodaypod.com

A new study from Science alert https://www.sciencealert.com And type Alzheimer and sleep. Also if you are having trouble falling asleep let your droctor know and ask him to to prescribe you Trazodone. This has help me. Give it a try. Next week a brand new week a brand new line of shows. HAVE A GREAT WEEK END AND HAPPY MOTHERS DAY .

Get out your composition books because it's getting educational! This week, Jackie discovers a pandemic of a new kind: standing too close to someone in line (back up Mary), while Kyle side eyes the ridiculously gendered marketing schemes (dude wipes, rugged mountain bike body wash, and piss in the back yard hand sanitizer). Only twenty-two episodes in and we've finally decided to talk about sleep. Kyle answers your burning questions about sleep: How does it work? How much sleep do I need? Can I take a nap? You probably won't like the answers but you'll stay for the fun. It's all about Trazodone (pronounced Tray-za-done), melatonin, screens, sleep stages, and just the overall suckiness of kids. You may just learn a thing or two to improve your own sleep (you tired flop). We'll end with a not-at-all-tired Fetch or Flop: Sleep Edition.Jackie and Kyle are taking a quick sabbatical for the month of May. Make sure to catch up on any episodes you may have missed and join them again in June (Hi Gay - Happy Pride!).Don't forget to connect with your two tired therapists through e-mail (twotiredtherapists@gmail.com), Instagram (@twotiredtherapists), and Facebook (Two Tired Therapists).“This episode is to help you sleep so you feel rested to deal with the tiredness of life.”-Kyle

This is the 11th podcast episode for the Psychiatric Medication Podcast Series. Series Description: Current literature indicates that podcasts can be an effective educational format to reach health professionals across the continuum of medical education, addressing a myriad of topics pertinent to providers. This episode serves as an overview of Trazodone. This podcast season is the second released by East Carolina University's Office of Continuing Medical Education and may be beneficial for physicians, residents, fellows, nurse practitioners, physician assistants, and nurses. This podcast season is comprised of approximately 30 episodes, each focusing on different psychiatric medications for the non-psychiatric provider. Those tuning into the podcast's second season will receive a primer on the "bread and butter" behavioral health medications for primary care: antidepressants, antipsychotics, and mood stabilizers. Episodes will be released weekly on Wednesdays.Nathan Harper, MD & Amrish Pipalia, MD

This episode is brought to you by 5-Bullet Friday, my very own email newsletter.Welcome to another episode of The Tim Ferriss Show, where it is my job to deconstruct world-class performers to tease out the routines, habits, et cetera that you can apply to your own life. This is a special inbetweenisode, which serves as a recap of the episodes from last month. It features a short clip from each conversation in one place so you can easily jump around to get a feel for the episode and guest.Based on your feedback, this format has been tweaked and improved since the first recap episode. For instance, @hypersundays on Twitter suggested that the bios for each guest can slow the momentum, so we moved all the bios to the end. See it as a teaser. Something to whet your appetite. If you like what you hear, you can of course find the full episodes at tim.blog/podcast. Please enjoy! *This episode is brought to you by 5-Bullet Friday, my very own email newsletter that every Friday features five bullet points highlighting cool things I've found that week, including apps, books, documentaries, gadgets, albums, articles, TV shows, new hacks or tricks, and—of course—all sorts of weird stuff I've dug up from around the world.It's free, it's always going to be free, and you can subscribe now at tim.blog/friday.*Timestamps: James Clear: 00:03:05Rick Rubin: 00:08:08Dr. Matthew Walker: 00:13:47Bill Gurley: 00:31:05Wade Davis: 00:36:36Full episode titles:James Clear, Atomic Habits — Simple Strategies for Building (and Breaking) Habits, Questions for Personal Mastery and Growth, Tactics for Writing and Launching a Mega-Bestseller, Finding Leverage, and More (#648)Rick Rubin, Legendary Producer — Timeless Methods for Unlocking Creativity, Secrets Hidden in Plain Sight, The Future with AI, Helpful Distractions, Working with Strong Personalities, Breaking Out of “The Sameness,” and More (#649)Dr. Matthew Walker, All Things Sleep — How to Improve Sleep, How Sleep Ties Into Alzheimer's Disease and Weight Gain, and How Medications (Ambien, Trazodone, etc.), Caffeine, THC/CBD, Psychedelics, Exercise, Smart Drugs, Fasting, and More Affect Sleep (#650)Legendary Investor Bill Gurley on Investing Rules, Finding Outliers, Insights from Jeff Bezos and Howard Marks, Must-Read Books, Creating True Competitive Advantages, Open-Source Strategies, Adapting Mental Models to New Realities, and More (#651)Famed Explorer Wade Davis — How to Become the Architect of Your Life, The Divine Leaf of Immortality, Rites of Passage, Voodoo Demystified, Optimism as the Purpose of Life, How to Be a Prolific Writer, Psychedelics, Monetizing the Creativity of Your Life, and More (#652)*For show notes and past guests on The Tim Ferriss Show, please visit tim.blog/podcast.For deals from sponsors of The Tim Ferriss Show, please visit tim.blog/podcast-sponsorsSign up for Tim's email newsletter (5-Bullet Friday) at tim.blog/friday.For transcripts of episodes, go to tim.blog/transcripts.Discover Tim's books: tim.blog/books.Follow Tim:Twitter: twitter.com/tferriss Instagram: instagram.com/timferrissYouTube: youtube.com/timferrissFacebook: facebook.com/timferriss LinkedIn: linkedin.com/in/timferrissPast guests on The Tim Ferriss Show include Jerry Seinfeld, Hugh Jackman, Dr. Jane Goodall, LeBron James, Kevin Hart, Doris Kearns Goodwin, Jamie Foxx, Matthew McConaughey, Esther Perel, Elizabeth Gilbert, Terry Crews, Sia, Yuval Noah Harari, Malcolm Gladwell, Madeleine Albright, Cheryl Strayed, Jim Collins, Mary Karr, Maria Popova, Sam Harris, Michael Phelps, Bob Iger, Edward Norton, Arnold Schwarzenegger, Neil Strauss, Ken Burns, Maria Sharapova, Marc Andreessen, Neil Gaiman, Neil de Grasse Tyson, Jocko Willink, Daniel Ek, Kelly Slater, Dr. Peter Attia, Seth Godin, Howard Marks, Dr. Brené Brown, Eric Schmidt, Michael Lewis, Joe Gebbia, Michael Pollan, Dr. Jordan Peterson, Vince Vaughn, Brian Koppelman, Ramit Sethi, Dax Shepard, Tony Robbins, Jim Dethmer, Dan Harris, Ray Dalio, Naval Ravikant, Vitalik Buterin, Elizabeth Lesser, Amanda Palmer, Katie Haun, Sir Richard Branson, Chuck Palahniuk, Arianna Huffington, Reid Hoffman, Bill Burr, Whitney Cummings, Rick Rubin, Dr. Vivek Murthy, Darren Aronofsky, Margaret Atwood, Mark Zuckerberg, Peter Thiel, Dr. Gabor Maté, Anne Lamott, Sarah Silverman, Dr. Andrew Huberman, and many more.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Brought to you by Eight Sleep's Pod Cover sleeping solution for dynamic cooling and heating, Athletic Greens all-in-one supplement, and LMNT electrolyte supplement.Matthew Walker, PhD (@sleepdiplomat), is professor of neuroscience at the University of California Berkeley and founder and director of the school's Center for Human Sleep Science. Walker is the author of the New York Times and international bestseller Why We Sleep: Unlocking the Power of Sleep and Dreams, which was recently listed by Bill Gates as one of his top five books of the year. His TED Talk, “Sleep is Your Superpower,” has garnered more than 17 million views. He has received numerous funding awards from the National Science Foundation and the National Institutes of Health and is a Kavli Fellow of the National Academy of Sciences. In 2020, Walker was awarded the Carl Sagan Prize for Science Achievements. Walker's research examines the impact of sleep on human health and disease. He has been featured on numerous television and radio outlets including 60 Minutes, Nat Geo TV, NOVA Science, NPR, and the BBC. He is also the host of the 5-star-rated podcast The Matt Walker Podcast, which is all about sleep, the brain, and the body.Please enjoy!Resources from this episode: https://tim.blog/2023/01/18/matthew-walker-sleep/*This episode is brought to you by LMNT! What is LMNT? It's a delicious, sugar-free electrolyte drink mix. I've stocked up on boxes and boxes of this and usually use it 1–2 times per day. LMNT is formulated to help anyone with their electrolyte needs and perfectly suited to folks following a keto, low-carb, or Paleo diet. If you are on a low-carb diet or fasting, electrolytes play a key role in relieving hunger, cramps, headaches, tiredness, and dizziness.LMNT came up with a very special offer for you, my dear listeners. For a limited time, you can get a free LMNT Sample Pack with any purchase. This special offer is available here: DrinkLMNT.com/Tim.*This episode is also brought to you by Eight Sleep! Eight Sleep's Pod Cover is the easiest and fastest way to sleep at the perfect temperature. It pairs dynamic cooling and heating with biometric tracking to offer the most advanced (and user-friendly) solution on the market. Simply add the Pod Cover to your current mattress and start sleeping as cool as 55°F or as hot as 110°F. It also splits your bed in half, so your partner can choose a totally different temperature.Go to EightSleep.com/Tim and save $250 on the Eight Sleep Pod Cover. Eight Sleep currently ships within the USA, Canada, the UK, select countries in the EU, and Australia.*This episode is also brought to you by Athletic Greens. I get asked all the time, “If you could use only one supplement, what would it be?” My answer is usually AG1 by Athletic Greens, my all-in-one nutritional insurance. I recommended it in The 4-Hour Body in 2010 and did not get paid to do so. I do my best with nutrient-dense meals, of course, but AG further covers my bases with vitamins, minerals, and whole-food-sourced micronutrients that support gut health and the immune system. Right now, Athletic Greens is offering you their Vitamin D Liquid Formula free with your first subscription purchase—a vital nutrient for a strong immune system and strong bones. Visit AthleticGreens.com/Tim to claim this special offer today and receive the free Vitamin D Liquid Formula (and ten free travel packs) with your first subscription purchase! That's up to a one-year supply of Vitamin D as added value when you try their delicious and comprehensive all-in-one daily greens product.*[05:55] Sleep and Alzheimer's disease.[19:55] What causes the decline of deep sleep as we age?[24:36] Are there any known species that don't require sleep?[29:15] Brain stimulation for more deep sleep, less insomnia.[41:01] Tips for better sleep without laboratory budget or access.[51:45] Ideal types of exercise for promoting deep sleep.[53:51] Matt's updated thoughts on caffeine and sleep.[1:11:12] Cannabis (CBD, THC, CBN) and sleep.[1:30:18] A crowdsourcing request of listeners.[1:36:17] If the bed's a-rocking…[1:41:45] The Da Vinci Code magic sleep device.[1:46:04] DARPA innovation.[1:46:32] Ensuring proper function in the glymphatic system.[1:50:42] Psychedelics and sleep.[2:01:20] How sleep affects food intake and weight fluctuation.[2:10:46] Orexin, I reckon.[2:22:11] Fainting goats and narcolepsy.[2:25:36] Modafinil.[2:30:32] How sleep medications affect sleep quality.[2:36:16] Trazodone.[2:46:26] Perilous polypharmacy.[2:49:04] Pregabalin and gabapentin.[2:54:33] The psychological value of emergency sleep medicine for insomniacs.[2:58:16] CBTI and the balancing role of pharmacology.[2:59:56] Parting thoughts and what to expect from a future round two.*For show notes and past guests on The Tim Ferriss Show, please visit tim.blog/podcast.For deals from sponsors of The Tim Ferriss Show, please visit tim.blog/podcast-sponsorsSign up for Tim's email newsletter (5-Bullet Friday) at tim.blog/friday.For transcripts of episodes, go to tim.blog/transcripts.Discover Tim's books: tim.blog/books.Follow Tim:Twitter: twitter.com/tferriss Instagram: instagram.com/timferrissYouTube: youtube.com/timferrissFacebook: facebook.com/timferriss LinkedIn: linkedin.com/in/timferrissPast guests on The Tim Ferriss Show include Jerry Seinfeld, Hugh Jackman, Dr. Jane Goodall, LeBron James, Kevin Hart, Doris Kearns Goodwin, Jamie Foxx, Matthew McConaughey, Esther Perel, Elizabeth Gilbert, Terry Crews, Sia, Yuval Noah Harari, Malcolm Gladwell, Madeleine Albright, Cheryl Strayed, Jim Collins, Mary Karr, Maria Popova, Sam Harris, Michael Phelps, Bob Iger, Edward Norton, Arnold Schwarzenegger, Neil Strauss, Ken Burns, Maria Sharapova, Marc Andreessen, Neil Gaiman, Neil de Grasse Tyson, Jocko Willink, Daniel Ek, Kelly Slater, Dr. Peter Attia, Seth Godin, Howard Marks, Dr. Brené Brown, Eric Schmidt, Michael Lewis, Joe Gebbia, Michael Pollan, Dr. Jordan Peterson, Vince Vaughn, Brian Koppelman, Ramit Sethi, Dax Shepard, Tony Robbins, Jim Dethmer, Dan Harris, Ray Dalio, Naval Ravikant, Vitalik Buterin, Elizabeth Lesser, Amanda Palmer, Katie Haun, Sir Richard Branson, Chuck Palahniuk, Arianna Huffington, Reid Hoffman, Bill Burr, Whitney Cummings, Rick Rubin, Dr. Vivek Murthy, Darren Aronofsky, Margaret Atwood, Mark Zuckerberg, Peter Thiel, Dr. Gabor Maté, Anne Lamott, Sarah Silverman, Dr. Andrew Huberman, and many more.DISCLAIMER: I'm not a doctor, nor do I play one on the Internet. None of the content in this podcast constitutes medical advice. Please consult your doctor before considering anything we discuss in this episode.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode Nick shares his journey from an ER visit and panic attacks to a place of peaceful sleep. However, the reason he joins the program is that he is on Trazodone and would like to come off. We have a discussion about general principles that can be helpful to know about for anyone wishing to wean off sleeping pills.

Farmaci Antidepressivi: quali sono le differenze tra le varie molecole antidepressive e quali sono dei possibili criteri di scelta del miglior farmaco antidepressivo?Nonostante la loro diffusione ed il loro utilizzo in ambito specialistico o meno, i farmaci antidepressivi non sono conosciuti cosí bene sul profilo neurobiochimico.Allo stesso modo la scelta del miglior farmaco antidepressivo non sempre segue dei criteri condivisi, con un buon razionale teorico e basati sulle evidenze.Per tutte queste ragioni ho pensato di fare un breve riassunto, rivolto principalmente ai medici in formazione e ai medici non specialisti, per cercare di fornire alcune indicazioni di base per riuscire a comprendere meglio il complesso mondo dei moderni antidepressivi.Potete considerare questo video come una breve lezione di psicofarmacologia o anche, come usa tanto al giorno d'oggi, uno spunto di psicofarmacologia per gli psicologi o altri operatori della salute mentale.In effetti dovrei, prima o poi, iniziare a fare un corso di psicofarmacologia per psicologi o, più in generale, per i vari operatori della salute mentale (educatori, tecnici della riabilitazione psichiatrica ed infermieri).#antidepressivi #psicofarmaciIl Dr. Valerio Rosso, su questo canale YouTube, si dedica a produrre delle brevi lezioni di psichiatria rivolte ai pazienti, agli operatori della salute mentale, ai famigliari dei pazienti, agli studenti di medicina, agli specializzandi in psichiatria e a chiunque sia interessato alla salute mentale, alla psichiatria ed alle neuroscienze.ISCRIVETEVI AL MIO CANALE ► https://bit.ly/2zGIJorVi interessano la Psichiatria e le Neuroscienze? Bene, allora iscrivetevi a questo podcast, al mio canale YouTube e seguitemi sul web tramite il mio blog https://www.valeriorosso.comScoprite tutti i miei libri: https://bit.ly/2JdjocYScoprite la mia Musica: https://bit.ly/2JMqNjZVisitate anche il mio blog: https://www.valeriorosso.comAvete mai sentito parlare del progetto psiq? Andate subito ad informarvi su https://psiq.it ed iscrivetevi alla newsletter.

Welcome to Reheated Beef!  JD says of her pick: “I picked this one, “The One Where Davis Falls Down The Stairs,” because I wanted a second chance to say…. Hahahahhahahahhahaah” JD's therapist recommends a book, Daggy Buttface bums out Coach on a family hike, and Davis takes an unplanned trip. The gang gangs up on the write-in beefer. This episode originally aired S1 Ep12 (June 17, 2020).

Scared pets at the vet are displaying perfectly normal fear responses, but it doesn't have to be like this. Pre-visit medications can be part of a plan to minimize fear, anxiety and stress when your dog or cat needs veterinary medical care. Fear Free certified veterinarian, Dr. Hope Jankunas joins us in this week's episode, which focuses on how pre-visit medications, such as pheromones, gabapentin, and trazodone, may help make your pet's trip to the vet as pleasant as it could be. Blog posts written by Dr. Jankunas: No More Scaredy Cats- https://companionpethospital.com/2018/08/01/springtime-2-2/ Fear Free Visits Promote Better Veterinary Care-https://companionpethospital.com/2017/03/13/fear-free-visits-promote-better-veterinary-care/ Website with images and transcript: https://www.yourvetwantsyoutoknow.com/previsit-medications Instagram: https://www.instagram.com/yourvetwantsyoutoknow Facebook group: https://www.facebook.com/groups/yourvetwantsyoutoknow Facebook page: https://www.facebook.com/yourvetwantsyoutoknow.com

Trazodone is an antidepressant that also is commonly used for insomnia (off-label). When treating MDD in adults the immediate release tablet is initiated at 50 mg twice daily and incrementally increased every 3-7 days to a typical dose range between 200-400 mg/day. If used for treating MDD and if the sedative effect is not desired it is recommended to have a smaller daytime dose and a larger bedtime dose. When treating insomnia dosing is initiated at 50-100 mg at bedtime. Most common side effects are sedation, dizziness, and low blood pressure. Serotonin syndrome is a concern so watch for symptoms such as agitation, hallucinations, coordination problems, fast heartbeat, sweating, fever, n/v/d, and tight muscles. Trazodone has a Black Box Warning for Suicidal Thoughts and Behaviors so patients should be monitored for clinical worsening and the emergence of suicidal thoughts and behaviors. Go to DrugCardsDaily.com to find past FREE PDFs of the drug card sheets that were used for the show. SUBSCRIBE on Spotify or Apple Podcasts or search for us on your favorite place to listen to podcasts. I plan to continue going over the Top 100-200 Drugs as well as occasionally throwing in one of the newly released drugs that peak my interest. Also, if you'd like to say hello, suggest a drug, or leave any constructive feedback on the show thus far I'd really appreciate it! Leave a message on my hosting site HERE. --- Send in a voice message: https://anchor.fm/drugcardsdaily/message

Drs Kurt DeVine & Heather Bell continue the series on drugs felt to be safe, but are not necessarily! In episode 4 of the series, we discuss Trazodone, originally developed and FDA approved as an antidepressant, although much more commonly prescribed for insomnia. Interestingly, it does have street value! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct and Facebook: @theaddictionconnectionhk

Drs Kurt DeVine & Heather Bell continue the series on drugs felt to be safe, but are not necessarily! In episode 4 of the series, we discuss Trazodone, originally developed and FDA approved as an antidepressant, although much more commonly prescribed for insomnia. Interestingly, it does have street value! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct and Facebook: @theaddictionconnectionhk

Trazodone is a depressant. Taking it together with certain other medicines such as anesthetics may enhance trazodone's CNS depressant effects. https://recoverypartnernetwork.com/drug/opioid/central-nervous-system-depressants

IN THIS HOUR: Fred & Joe Murray are broadcasting from the Town Fair Tires Studios in Dorchester. Rich is broadcasting remotely. Working from home for Fred was a total drag and advised listeners not to take Trazodone. Eagles players and staffers are at odds with Doug Pederson over the decision to pull Jalen Hurts. (14:18) Another political fart court to rule on. Is this person GUILTY or NOT GUILTY? (29:09) See omnystudio.com/listener for privacy information.

Drs. Magdalene Assimon and Jennifer Flythe summarize findings from their study "Zolpidem versus Trazodone Initiation and the Risk of Fall-Related Fractures among Individuals Receiving Maintenance Hemodialysis."

Drs. Magdalene Assimon and Jennifer Flythe summarize findings from their study "Zolpidem versus Trazodone Initiation and the Risk of Fall-Related Fractures among Individuals Receiving Maintenance Hemodialysis."

Let's Talk Daily HealthMedication Mix Up between antidepressant trazodone and erectile dysfunction medication sildenafil brand name Viagra occurred in a third party facility, has been recalled. Daily Health

Trazodone is a prescription drug used to treat major depressive disorder and in certain cases, insomnia - can antidepressants be addictive. Although it is generally safe and effective, it can still be misused and addiction or dependency may occur. Patients who do not follow specific instructions while taking this medication risk experiencing withdrawal symptoms or overdosing.TTC is different from other drug & alcohol treatment centers in Delray Beach, FL. We believe in the full-integrated recovery of each individual. We specialize in Medication-Assisted Treatment (MAT), psychological & psychiatric care, daily doctor's visits, and ongoing support from staff. We ensure each patient in our care has the chance to see a full recovery from beginning to long-term sobriety.Each individual in recovery is likely to have had a somewhat unique substance abuse program experience. There are a number of therapeutic variables, including treatment center setting and program duration.https://ttcdrugrehab.z13.web.core.windows.net/ https://batchgeo.com/map/681ecafc169a47b7124bbe82fd1e775fhttps://batchgeo.com/map/7274655833ed942b86e23474567769e6https://goo.gl/maps/Zb2urfFPGeHMYivM7https://goo.gl/maps/ZaKzHcCkYhYyP8Hu6https://goo.gl/maps/2p2DfA43JKddQHkF6https://t.co/lEJN5GqyYb#drug-rehab-delrayhttps://t.co/KJjDpfEvG9#trazodone-rehabhttps://t.co/5S14RaIRkO#antidepressant-addiction-treatmenthttps://earth.google.com/web/data=Mj8KPQo7CiExUEh1ZWdmQzNoZFY3U1h4TExLc1lKR1lzUmFUc09OWjUSFgoUMEMwQzVFMDU0NzE2N0NGNDE3OTEAlso, among people in recovery from addiction to alcohol, trazodone is the most commonly prescribed medication used to promote sleep. 2 However, trazodone may not be appropriate in all cases. Many users taking it to help them sleep may not realize that it is, in fact, an antidepressant and not a sedative-hypnotic medication formulated specifically to aid sleep (like Ambien, for example).Transformations Treatment Center14000 S Military Trail, Delray Beach, FL 33484FV9H+MC Delray Beach, Floridahttps://www.transformationstreatment.center/delray-beach-fl/Trazodone Addiction Treatment in Delray Beach, FLFind Transformations on Google Maps!Further Information:https://transformationstreatment1.blogspot.com/2020/10/trazodone-addiction-in-delray-beach-fl.htmlVideos:https://youtu.be/56Y9ZcBRvqIhttps://vimeo.com/470336519Support the show (https://www.google.com/maps?cid=9720609399900639450)

It’s risky business – giving sleep meds to the elderly and the medically ill – and today we have some reassuring data. [Link] Published On: 9/5/2020 Duration: 2 minutes, 22 seconds Got feedback? Take the feedback survey.

Michael wonders if having internal tremors when you are awake at night is common with anxiety. Haley desperately wants to get off Seroquel and Trazodone but whenever she has tried she’s become so emotionally distraught that she couldn’t. Christopher is doing well but still wakes up a few times and wonders - is this normal? Caroline asks what to do then you are restless at night. Malena has a little angel and devil in her shoulders, and she’s not afraid of the little devil anymore. Ahmed is in a the rabbit hole. How can he start climbing back up? Do you have trouble sleeping? Can’t sleep? Have questions about insomnia or sleep? Please leave a comment or send an email: questions@thesleepcoachschool.com I will be happy to share my thoughts as a video reply in an Ask Daniel episode. If you want to connect elsewhere I’m on Twitter @ErichsenDaniel, Instagram @Erichsen.Daniel, Facebook as Daniel Erichsen. Would you like to work with me? Awesome! I would love a chance to help you sleep fantastic. There are three ways we can work together: - The Self Coaching Master Program www.thesleepcoachschool.com - BedTyme, a sleep coaching app for iOS and Android. - Buy my book Set it & Forget it on Amazon. It includes a cell phone number where you can send questions. The self coaching program is perfect if you like learning through video and also if have mental wellness goals besides such has being less anxious. BedTyme is ideal if you like to learn via text and have a sleep coach in your pocket. Not sure where to start? Check out these playlists! Core curriculum - a collection of the most important insights, a great place to start. https://www.youtube.com/playlist?list... Success stories - if you need hope and inspiration, this is for you. https://www.youtube.com/playlist?list... Insomnia insight - a list of every single episode. https://www.youtube.com/playlist?list... Talking insomnia - guests with trouble sleeping or experts share their stories / tips. https://www.youtube.com/playlist?list... Hypnic jerks, sudden awareness of falling asleep and other common issues. https://www.youtube.com/playlist?list... Fatal insomnia - for those concerned about ffi and sfi. https://www.youtube.com/playlist?list... The self coaching model https://www.youtube.com/playlist?list... Best! This content does not constitute medical advice, diagnosis, or treatment, and should never replace any advice given to you by your physician or other qualified healthcare providers.

Butthole Sounding, Fingering Coaches and Bathroom TrystsSupport the show (https://www.patreon.com/degeneratenation?fan_landing=true)

The way that Big Pharma has trained their conventional doctors (a.k.a legal drug dealers) is CRIMINAL. The documentary on youtube that I refer to in the podcast is called:"The most SHOCKING psychiatry documentary ever"To schedule a consultation or to learn more about detoxification and personalized nutrition therapy, you can visit my website www.soreadyforhealth.comMy YouTube Channel: nabilinhoMy Telegram: nabilinhoSleep tight, don't let the eugenicists bite. Support the show (https://www.paypal.com/paypalme2/soreadyforhealth)

Episode 4 delves into Katie's longstanding insomnia and the ways in which her life has changed since starting Trazodone ® 25mg. --- Send in a voice message: https://anchor.fm/liza-chapa/message Support this podcast: https://anchor.fm/liza-chapa/support

JD’s therapist recommends a book, Daggy Buttface bums out Coach on a family hike, and Davis takes an unplanned trip. The gang gangs up on the write-in beefer. What’s Your Beef? is a Sassholes production brought to you by comedians Jenny Davis, Emily Davis, and Leah Kayajanian. For updates and bonus material, follow @SassholesShow on Instagram and Twitter and subscribe to our YouTube channel to keep up with the Sassholes web series. You Got Beef? EMAIL US! WhatsYourBeefPod@gmail.com Music and cover art by Andy Bar. Follow him on YouTube, Instagram @Werdnabar, and Soundcloud AndyTheBar.  

Trazodone Addiction Trazodone is an common antidepressant sold and prescribed under brand names such as Desyrel, Desyrel, Dividose, and Oleptro. https://worldsbest.rehab/trazodone-addiction/ Trazodone is used to treat depressive disorders with or without a manifestation of generalized or acute anxiety. Trazodone is also used off-label to treat alcoholism and sleep disorders. Trazodone is known by a number of brand names including Desyrel, Dividose, Oleptro, and Desyrel. All of these brand names simply offer users the same antidepressant medication. Doctors prescribe Trazodone to patients suffering from depression. Trazodone isn't simply used for mild or low forms of the mental disorder. The drug is prescribed to patients suffering from major bouts of depression that they struggle to overcome. Oftentimes, patients suffer anxiety along with depression and Trazodone can help both disorders. Along with depression, Trazodone can be prescribed to patients off-label to treat insomnia and alcoholism. Like other antidepressants, Trazodone is extremely addictive and users can become dependent on the medication. Trazodone is known as a selective serotonin re-uptake inhibitor (SSRI). Drugs that fall into the SSRI category alter the brain's chemical balance. Serotonin regulates emotions and people with low levels of it can experience depression and/or other mental disorders. Trazodone enables users to have more serotonin in their brains. The increased amount of serotonin enables users to be healthier and capable of overcoming disorders that produce depression, insomnia, and anxiety. How is Trazodone taken? Health practitioners can prescribe Trazodone in 25 mg, 50 mg, 100 mg, 150 mg, and 300 mg tablets. The medication is then taken orally and daily dosage is based on the user's response to the medication. Patients should take Trazodone with food. Although addiction and dependency can be created by taking Trazodone, it is claimed to be relatively safe for users. Research has found Trazodone to be very effective in the treatment of depression and sleep disorders such as insomnia. Misuse is often the reason patients can experience addiction, withdrawal when they stop taking it, and death if they overdose on it. Although Trazodone is said to be safe, there is a risk of dependency on the drug. Patients who misuse Trazodone and do not take it as prescribed, addiction can be created. Trazodone addiction withdrawal Once a patient stops taking Trazodone, they can experience signs of depression that look similar to depression and anxiety. When medication is stopped suddenly, these signs increase. Due to stopping Trazodone, individuals have a deficiency of serotonin in their brain. The body should adjust to the lack of serotonin but until it does, individuals can feel uncomfortable. Signs of Trazodone addiction withdrawal Dizziness/Vertigo/Difficulty walking Lightheadedness Nausea/Vomiting Jittery Thoughts of suicide Lack of concentration Headaches Short temper/Irritability Cold/Goosebumps/Chills Depersonalization Trazodone users can avoid withdrawal by taking the medication as prescribed. Patients shouldn't miss a dose as this can trigger withdrawal symptoms. Trazodone addiction withdrawal symptoms can begin just 24 hours after the last dose was taken and continue for up to three weeks. Tapering off the medication is the best way to end taking it. Trazodone Factsheet Support the show (https://worldsbest.rehab)

This week, I talk about my love of space and science, I break down my breakdown from 2018-2019 because it's Mental Health Awareness Month and the thing I'm into this week is money...YOUR money!

I’ll never forget, one time in my basement, when we were rolling our balls off and one of my guys was wigging the fuck out over something… and I told him to take a “chill pill”… and he popped two more rolls of X in his mouth… and said, “chill pill taken”. About 30 minutes later he was chasing me and my then GF around my basement with a butcher knife.Fun times.Ecstasy… and all that other shit… is bad as fuck for you.But you know what’s not bad?Seeing a God d*mn doctor and discussing your anxiety, depression, and loneliness with them.Jeff and I discuss the "happy" pills that we take. For me, it's generic Paxil (for anxiety) and Trazodone (depression and anxiety and sleep aid... a non-narcotic OBV). Did you know your PCP (Primary Care Physician) can prescribe you medications to help with your crabby ass shit? And even refer you to someone to discuss your crabby ass shit to more in-depth?It’s funny how people will shoot chemicals into their veins to feel better… but heaven fucking forbid they just go to the doctor and chat for 10minutes and try something their way.To each their own I guess.But seriously, check out this episode, and maybe a new idea will pop into your head.That’s all we’re trying to do here. Help kick some tires… maybe that’s all you need to try and change up something in your life.Let us pray.Need help? Question? Email Chris: cpondoff@pondoffsanonymous.comfacebook.com/pondoffsanonymousinstagram.com/pondoffsanonymouspondoffsanonymous.com

Deep vein thrombosis in an astronaut; Is strontium supplement good or bad for treating bone loss? More news about the Coronavirus problem -- detection is difficult; Premature and surgical menopause have increased risk of cardiovascular disease; A topical estrogen product caused her dog to have too much estrogen! The interesting problem of surfer myelopathy; 3D printing solution for skin replacement for wound and burn cases; 4D printing needles for drug delivery and biosensing; The difficult problem of 3D printing of complex whole organs; Human genome from 5700 year old chewing gum reveals interesting secrets! Does homework for Asian children cause them to become mypopic? How bacteria transmit antibiotic resistance and the problem of poor incentives for new antibiotics; The health benefits and possible problems of edible seaweed products; Trazodone is the most recommended sleep drug from Dr Dawn; Granulocytes induced to becoming fertilizable oocytes in mice; The common ACL tear can cause reduction in the corticospinal tract function; New science criticizes soybean oil

Deep vein thrombosis in an astronaut; Is strontium supplement good or bad for treating bone loss? More news about the Coronavirus problem -- detection is difficult; Premature and surgical menopause have increased risk of cardiovascular disease; A topical estrogen product caused her dog to have too much estrogen! The interesting problem of surfer myelopathy; 3D printing solution for skin replacement for wound and burn cases; 4D printing needles for drug delivery and biosensing; The difficult problem of 3D printing of complex whole organs; Human genome from 5700 year old chewing gum reveals interesting secrets! Does homework for Asian children cause them to become mypopic? How bacteria transmit antibiotic resistance and the problem of poor incentives for new antibiotics; The health benefits and possible problems of edible seaweed products; Trazodone is the most recommended sleep drug from Dr Dawn; Granulocytes induced to becoming fertilizable oocytes in mice; The common ACL tear can cause reduction in the corticospinal tract function; New science criticizes soybean oil

Topic - Get positive to have a baby Depression and infertility.  There's new research with two very important findings for those trying to conceive.  First is that men in the relationship should work to stay positive. Depression in the male partner can significantly lower the chances of conception.  Males being treated for major depression are 60% less likely to conceive. Depression wasn't an issue with females and conception. The second finding is that women who are taking Effexor, Serzone, Remeron or Trazodone for depression are about 3 and a half times more likely to have a first-trimester pregnancy loss than those who weren't taking an antidepressant.  Be prepared. Do some research about the role of depression and being treated for it and have candid conversations with your doctors about how these factors play a role in becoming a parent. --- Send in a voice message: https://anchor.fm/drclaudia/message

Porpoise Crispy Podcast Volume #8 Episode #15 Trazodone Curated by Bleepo Sarcophagus/Ryan Obermeyer September 17, 2019 Windowlicker Aphex Twin Aphex Twin Sesame Syrup Cigarettes After Sex Crush The Game of Love (Good BPM Edition) Daft Punk Daft Punk All Flowers In Time Jeff Buckley & Elizabeth Fraser B-sides Do You Know Where Your Children Are Michael Jackson zz - various artists SOS (Theatre Of Delays Remix) Portishead Third The Wild Ones The Push Kings zz - various artists Barracuda (live) Rasputina The Lost & Found Same Ol’ Mistakes Rihanna Rihanna Lullaby (Acoustic) The Cure The Cure (Acoustic) The pCrispy is only an hour of music so I know you’ve got time to enjoy to these bad asses of the Internets:  The Westerino Show Funkytown Bayerclan Squirreling Podcast Secretly Timid Getting It Out

Il trazodone, commercializzato in italia come Trittico o Trittico Contramid, è un farmaco antidepressivo molto interessante, versatile, efficace e ben tollerato. In questo breve post vi dico quali sono le caratteristiche principali, le indicazioni e gli effetti collaterali del trazodone.ISCRIVETEVI AL MIO CANALE ► https://bit.ly/2zGIJorVi interessano la Psichiatria e le Neuroscienze? Bene, allora iscrivetevi a questo podcast, al mio canale YouTube e seguitemi sul web tramite il mio blog https://www.valeriorosso.comInoltre andate su Amazon a dare un’occhiata ai miei libri:“Psicobiotica” - Un nuovo modo di intendere il rapporto tra la Mente ed il Corpo….andate su: https://amzn.to/2IZwjhm“Psichiatria Rock” - 50 pensieri off line dal mio blog….andate su: https://amzn.to/2IVKKmJ

Il trazodone, commercializzato in italia come Trittico o Trittico Contramid, è un farmaco antidepressivo molto interessante, versatile, efficace e ben tollerato. In questo breve post vi dico quali sono le caratteristiche principali, le indicazioni e gli effetti collaterali del trazodone.ISCRIVETEVI AL MIO CANALE ► https://bit.ly/2zGIJorVi interessano la Psichiatria e le Neuroscienze? Bene, allora iscrivetevi a questo podcast, al mio canale YouTube e seguitemi sul web tramite il mio blog https://www.valeriorosso.comInoltre andate su Amazon a dare un’occhiata ai miei libri:“Psicobiotica” - Un nuovo modo di intendere il rapporto tra la Mente ed il Corpo….andate su: https://amzn.to/2IZwjhm“Psichiatria Rock” - 50 pensieri off line dal mio blog….andate su: https://amzn.to/2IVKKmJ

Trazodone pharmacology is complex. It can inhibit serotonin reuptake, block histamine receptors, and possibly have alpha-blocking activity. Side effects of trazodone include sedation, dizziness, and dry mouth. Rarely, priapism may occur. I've seen this nugget come up on pharmacology exams! While trazodone is classified as antidepressant, it is often used to help manage insomnia. Trazodone can possibly prolong the QT interval. Risk of other medications and patient specific parameters should be considered. Trazodone concentrations can be increased with the use of CYP3A4 inhibitors and reduced with 3A4 inducers.

Older adults are often tormented by insomnia, pain, and other comorbidities that impact their quality of life.  Medication therapy is often sought to treat and manage these diseases, but healthcare providers often overlook the risks of prescribing medications to patients who are older, frail, and at high risk for falls.  Trazodone is increasingly prescribed for insomnia instead of benzodiazepines presumably because it is considered to be safer and it does not appear on either the Beers or STOP/START lists.  But is trazodone really safer for patients than benzodiazepines? Guest Authors:  Anthony M. Todd, PharmD and Nicole A Slater, PharmD, BCACP Music by Good Talk

Today’s question is: How to treat sleep disturbances in patients with PTSD?   Here is a summary of this episode: Prazosin is recommended as a first-line agent in sleep disturbances in PTSD with an average dose for men at 16 mg and for women, 7 mg titrated over 5 weeks. Trazodone can be used in patients with initial-sleep insomnia with PTSD at a starting dose of 50 mg. Avoid benzodiazepines due to its abuse potential. Also, its cognitive side effects may negatively affect psychotherapy effectiveness. Quetiapine should not be used first-line in the treatment of insomnia. It is associated with weight gain, which is not dose-related. Download a PDF of this interview here Become a premium member of the Psychopharmacology Institute 

In today's VETgirl online veterinary continuing education podcast, we interview Dr. Lisa Radosta, DACVB, Board-certified Veterinary Behaviorist at Florida Veterinary Behavior Service on the use of trazodone in cats. Most veterinary professionals advocate for sedation for stressed cats as a modality to help with "Fear Free;" however, what drugs should we be reaching for, and what the pros and cons are of some of these sedatives? Should we be reaching for gabapentin or trazodone?

In today's VETgirl online veterinary continuing education podcast, we interview Dr. Lisa Radosta, DACVB, Board-certified Veterinary Behaviorist at Florida Veterinary Behavior Service on the use of trazodone in cats. Most veterinary professionals advocate for sedation for stressed cats as a modality to help with "Fear Free;" however, what drugs should we be reaching for, and what the pros and cons are of some of these sedatives? Should we be reaching for gabapentin or trazodone?

In today's VETgirl online veterinary continuing education podcast, we interview Dr. Lisa Radosta, DACVB, Board-certified Veterinary Behaviorist at Florida Veterinary Behavior Service on the use of trazodone in cats. Most veterinary professionals advocate for sedation for stressed cats as a modality to help with "Fear Free;" however, what drugs should we be reaching for, and what the pros and cons are of some of these sedatives? Should we be reaching for gabapentin or trazodone?

Here are 5 tips to keep your pet safe (and yourself sane) this July 4: #1: PREPARE FOR A PET PRISON BREAK Katy Perry might like fireworks, but your pet doesn'tâ??that's why July 4 is one of the most popular days for pets to run away. Check your fences and gates to make sure there are no easy areas of escape, and try to keep your pets indoors. #2: DON'T LET YOUR PET EAT YOUR TRASH Make no bones about it: your pet will eat discarded BBQ bones, corn cobs, and anything else you leave lying around. Clean up your trash to reduce the risk of human foods getting stuck in your pet's GI tract and causing pancreatitis. #3: DRUGS ARE YOUR (PET'S) FRIEND If you know that your pet has high anxiety, it's okay to ask for sedation from your vet. You can also ask for anxiety reducing meds like Trazodone, Alprazolam, and Sileo. #4: BEWARE OF FLEAS AND DISEASE If you're taking your pet camping, make sure they've got their flea and tick preventative meds. Topical meds don't require an office visit, so don't be lazy: pick it up before your trip. #5: REMEMBER THAT YOUR PET IS AS THIRSTY AS YOU ARE 85 degrees might be fine for you, but it's too hot for your pet. Keep cool water around, and steer clear of hot pavement. If it burns your hand when you touch it, it's too hot to walk your pet! For clarity on these tips, and to ask any other questions about summer safety for your pet, text VET to 67076. The first question is free, and one of Ask.Vet's licensed veterinarians will text you back with customized advice within minutes. Feel free to download the 5 unconventional tips infographic here: https://prhacker.box.com/s/v9w56mbcy4eyo6xkjje4zbsp7rkflb97 For more information on how to keep your pet safe this July 4, I'm happy to set up an interview with Ask.Vet expert Dr. Cherice Roth. Cherice is available for phone, Skype, and email interviews until July 5.

In this special New Year's edition of Code Grey(s), we decide to look back on a miserable year and remind each other of the best things we saw, heard, read, and felt more generally. If you want to hear two cynical people do their best imitation of optimism, this is the podcast for you. Thanks to all our listeners and thanks especially to Asheville, NC; 22 A Million by Bon Iver; Jim Dale; Trazodone; The Lobster; Chance the Rapper; Octavia Butler; and the inimitable Lindy West. What'd you love this year? What are YOU trying to look forward to in 2017? Email us: codegreys@gmail.com

Do complaints of insomnia stress you out? Well, never fear. In this episode our guest is Dr. Karl Doghramji, Professor of Psychiatry, Neurology and Medicine and the Medical Director of the Sleep Disorders Center at Thomas Jefferson University Hospital in Philadelphia. With his help we deconstruct the “dread pirate” insomnia (as I call it) so you can dominate it in your daily practice. Disclosures: Dr. Doghramji reports recent relationships with Merck (stock) and consulting work for Merck, Xenoport, Jazz, Inspire, Teva and Pfizer. He has a current research grant from Inspire. Clinical Pearls: *Pathophysiology: Likely biological, neurobehavioral and psychological hyperarousal. Possible genetic component. *Depression, anxiety or PTSD may be their primary disorder. Many insomniacs unaware of their depression. Need a high index of suspicion. *Sleep apnea is probably cause in 10-20% of patients who present with insomnia. *GERD can present with insomnia and night time awakenings as its primary symptom. *CBT works as well as pharmacotherapy and has lasting potential even 1-2 years after discontinuation of therapy. *High yield nonpharmacologic therapy: Get up at the same time every morning. Don’t sleep in, even if bedtime or sleep onset was delayed. *Melatonin: It’s effect depends on time administered (see below). It’s not as safe as you think (insulin resistance, low sperm count) 1. Administer very low dose (under 3 mg) four to five hours prior to bed for delayed sleep phase (usually occurs in teens). 2. Administer higher dose (3-5 mg) one hour before bed for sleep initiation (adults with fragmented sleep). *Agents for sleep initiation: zaleplon, zolpidem, ramelteon *Agents for sleep maintenance: zolpidem ER, eszopiclone, doxepin (low dose of 3mg or 6mg), gabapentin (off label) *Suvorexant (orexin antagonist) treats both sleep initiation and maintenance: Start 10 mg and go up 5 mg every few weeks to max 20 mg daily. Orexins are deficient in narcolepsy. Orexins seem to mediate a switch system between arousal and sleepiness. *Doxepin, gabapentin and ramelteon have very lose risk for abuse.  *Off-label use of diphenhydramine for sleep is not recommended ("dirty drug"). Trazodone and mirtazapine also have uncertain benefit. *Mirtazapine 7.5 mg is the dose for insomnia (more sedating). Lower dose favors histamine receptor. Links from the Show: 1. This is one possible site for online CBT https://www.sleepio.com as referenced in this study 2. Melatonin associated with impaired glucose tolerance http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173928/ 3. American Academy of Sleep Medicine 4. This site below has easy to understand information on sleep related disorders and links to videos explaining sleep hygiene. You can also download sleep logs, get info. SleepEducation.org Website 5. Review on use of mindfulness and meditation for insomnia. http://www.ncbi.nlm.nih.gov/pubmed/26390335