.

.

>> Good evening.

I'm psychiatrist Jay Fawver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now in its 25th year Are Matters of the Mind is a live call in program where you have the chance to choose the topic for discussion.

So if you have any questions concerning mental health issues, give me a call.

>> PBS 49 PBS Fort Wayne by dialing in the Fort Wayne area at (969) 27 two zero or if you're calling any place coast to coast you may dial toll free at 866- (969) to seven to zero.

>> Now on a fairly regular basis I am broadcasting every Monday night from our spectacular PBS Fort Wayne studios which lie in the shadows of the Purdue Fort Wayne campus and if you'd like to contact me with an email question that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at WFA ECG that's matters of the mind at WSW or I'll start tonight's program with an email I recently received.

>> It reads Dear to the Father We're in our late 60s.

What's the best evening routine to get good sleep to bed and what time is it OK to watch TV or read before going to bed?

>> What about food or dessert in the evening?

Any general guidelines for this?

I have a lot of ideas concerning anybody in their late sixties who's oh maybe having difficulty with sleeping because it used to be thought and I'm thinking decades ago it used to be thought that as we get older we don't need as much sleep.

That's not true as we get older we still need the sleep.

It's just that we don't sleep as well.

>> We don't have as much deep sleep.

We don't sometimes have as much dream sleep and deep sleep recharges the body dream sleep recharges the brain so they have their different functions and we need that for quality sleep all the cycles that you're needing to receive as you get older.

So what do you do?

We talk we call it sleep hygiene and as we get older sometimes we have less structured activity.

We don't have to get up for work necessarily the first thing in the morning.

>> So you get up whatever you want.

That's OK.

It's just that your brain wants to go to bed the same time every night and get at the same time every morning.

Now let's say you're a night owl.

You like the quiet and solitude of the world around you and stay up till 2:00 a.m. That's OK.

But you're going to need to sleep until 10 a.m. and the world gets going around seven or eight a.m. sometimes and that will cause you a disruption and sometimes daily obligations other people might want to get together.

People might start calling you at eight or eight thirty about extraneous things and that'll disturb your sleep.

So if you don't have obligations awakening you before 10 a.m. you can sleep until 10 a.m. and it's OK to do that but you still need those eight hours of solid sleep having a dark room with limited noise is always helpful.

So if you do sleep in in the morning and it's getting light you need to have the dark curtains and ideally a sound machine, a sound machine or some kind of means of buffering background distractions you'd asked concerning a television?

Well, television is something where you have to be careful about it.

You don't want to watch television in bed.

I know so many people do that that's something you really shouldn't do because you should associate bed primarily with sleeping sexual activity.

Obviously can be done in bed but you don't want to have any other activities in bed because your brain needs to associate bed with being able to sleep.

>> So if you watch television you can do so before you go to bed but you need about a 30 minute expected wind down period during that wind down period you're to relax, be very careful to not get on the cell phone if you can avoid it.

>> It's so tempting to get on YouTube or some kind of social media as you're trying to wind down go to sleep.

That might be your routine every night.

But keep in mind the social media has algorithms where they know how to keep you engaged and they know how to keep you excited about what you're seeing so you'll see something and that'll go to something else.

>> Something else is related.

Next thing you know, 40 minutes have gone by and you've lost a good amount of sleep in your brain's wide awake.

The screen brightness of the of the cell phone can keep you awake if you have a tablet if you have a laptop, the brightness of the screen can keep you awake and that's actually one of the issues concerning television as well.

>> Now some people can watch television where it's the same kind of sitcom perhaps every night they've seen that particular episode four times.

>> It's a means of getting their mind off of their daily activities so they've had this stressful day.

They've all these things going on so they just watch a mind numbing sitcom that maybe came out thirty, forty years ago.

They know the episode and they'll watch that as a means of kind of distracting themselves from the daily stress.

If you do that, do it in a separate room as you're getting ready for bed perhaps and that for some people works.

Everybody has a different nighttime routine.

So it's important to identify what works for you having pets in the room.

I know it's it's it's nice to have a snuggly little dog beside you but the dog can keep you awake at night.

Dog sigh They they do things they walk around, they keep you awake at night so you might want to keep the dogs in a separate room.

I'm a big fan of dogs for the emotional health though because you take a dog out in the first thing in the morning for a walk and that can actually improve your mental health because getting you some exposure to early morning light and some fresh air first thing in the morning that's a great way to wake up the brain in many cases is actually as good if not better than coffee or tea.

So just getting out and walking a dog in the morning is great if you don't have a dog go out and walk yourself.

So the idea is to get some fresh air and some early early morning light in the morning.

Exercising in the morning is remarkable for sleep quality at night as we get older I've certainly found this to be the case.

It's hard to exercise at night .

>> I mean as we get older if you exercise past six or seven pm very intensely you have trouble sleeping.

Back in the old days when I was in my twenties I could run several miles at ten thirty at night and go right to sleep afterwards.

I can't do that anymore and I think that's where it is for a lot of people as after they get over forty five or fifty they have a hard time exercising at night.

>> How about eating at nighttime?

If you eat something at nighttime try to have some protein if you have a dessert and I keep you awake might have some heartburn with that a high carbohydrate meal at night not uncommon.

They will keep people awake so if you're going to have something cheese or some kind of meat is the ideal type of food as long as it's not spicy that's the ideal type of food to have before you go to bed.

>> But keep in mind there's no harm with fasting from the time that you have dinner all the way into the next day at noon because that would give you about a 20 hour fast and for many people that could be very, very effective in helping them lose weight.

So 16 to 20 hour fast is something that is actually good for the brain and many times and in many ways good for the sleep overall looking around it as some possible other ideas if you drink coffee or you have any caffeine, try not to drink any coffee or caffeine after about four or five pm some people have to shut down the caffeine content even before then.

But if you have caffeine of any type into the evening it might keep you awake at night and again everybody has different sensitivities.

Everybody has a different routine.

So that's something that's important for you to try to understand what works for you versus everybody else.

But probably the most important advice I could give you concerning any sleep routine is to get to bed the same time every night, give you 30 minutes to wind down before you go to bed.

Ideally don't look at electronic screens such as cell phone, laptop, tablet or television but read back in the old days, you know, we have these things called books and books are a wonderful way to wind down because the light on the book is not flashing the brightness into your eyes to such a degree it can keep you awake and it's also not trying to tempt you to go to something else and go to something else to something else.

>> Read a book ideally a book that has chapters in it so that a certain at a certain point you can put it down because that chapter is done.

>> If you read a novel it might actually get you more excited to go on and on and on.

>> So I recommend reading books for that thirty minutes or so before going to bed and that's can be your quiet time overall obviously you need to have a cool room, have the right number of sheets on your blankets if you do have a loved one who is sleeping with you.

>> If that loved one snore is number one yeah you could go to a different room that's the easy way out.

>> But make sure that a loved one is snoring and keeping you awake.

Get that loved one assessed.

Go to the primary care clinician and ask about a condition called sleep apnea.

Sleep apnea is where your airway kind of closed off at night.

You don't get enough air flow to the lungs and that decreases oxygen to the brain and that will make you more irritable and tired and depressed the next day.

So if your loved one is snoring and that's keeping you awake, yeah, you can go to another room and sleep and that's OK. That doesn't mean that your marriage is over.

You can always sleep in separate rooms but most importantly make sure the loved ones getting assessed for sleep apnea and if you are awakening at night gagging and you having difficulty sleeping off and on, make sure that maybe you get assessed for any sleep disturbances overall if you are awakening at night because you still got things on your mind No one try to get those things off your mind earlier in the day many people will notice that at nighttime it's the darkness around them.

>> It's the first time during the day they finally have some peace and quiet so they start thinking and they start thinking and they start thinking and that's the time where they do a lot.

They're thinking try to get your thinking done in a quiet, uncorrupted, uninterrupted manner earlier in the day so you get that stuff off your mind and ideally write down stuff and write down your particular concerns or problems for the day very importantly then write down what you think you can do about them and sort out what you can do about things and what you can't do about things and be done with it.

Journaling is marvelous to try to help with some of those worries and I often recommend that people keep a worry diary if they're prone to worrying about things because you write down things that are concerning for you and you're going to find that many things you can't really solve especially in the middle of the night where you're trying to think through things many think people will think extensively at nighttime in the ruminate because not only is a dark and quiet but they want to make sure they keep things in their minds so they don't want to forget these things so they try to go over and over again to try to remember all these concerns and these so-called solutions they might have that's fine to have concerns and solutions but write them down and be done with them then going to sleep is kind of like catching a train if you have a train that comes by about every hour and a half.

>> All right.

If you don't catch that train at ten thirty, let's say that's your usual sleep time.

>> Ten thirty at night if you don't catch that train at ten thirty at night and because you're looking at a YouTube video you're watching a baseball game you're doing something is keeping you awake and next thing you know it's eleven o'clock.

Chances are you're not going to be able to get to sleep till about new midnight or so because there's an hour and a half cycle though many people will notice it's during that hour and a half cycle.

They need that amount of time to be able to get back to sleep .

>> So if you wake in the middle of the night at two a.m. might take an hour or so if you go back to sleep.

So the best thing you can do is to get up but don't watch television, don't exercise, don't look at it, don't look at your screen on your smartphone or tablet.

>> Get up and read something and the dim lighting until you start getting tired again and when you have a hard time comprehending what you're reading that's when you go back to bed.

>> Thanks for your email.

Let's go to our first caller.

Hello Jackson.

Welcome to Matters of Mind.

>> Dr. Isles going tonight.

Hi Jackson.

I'm doing OK.

Thanks.

I had a couple comments you can kind of put them into when I hang up.

Sure.

During the cold, you know, telling everybody don't leave your house, watch what you touch and all that kind of stuff.

So I really had a lot of nitrogenous workload going on because nobody could go out and I just started staying up all night and early in the morning around 7:00 I'd go to bed and I got into the routine like a third shift worker almost only I was working for it once that broke free to go to put all that aside, my point is now I'm really basically working on about four hours of sleep mid forty to fifty year old male and it's working but I know eight hours is the recommended amount of sleep.

I heard you talking about sleep so I thought I would call in.

But my point is how safe is that four hours going to be and it's been lost and it hasn't like really caught up with me yet but I know somewhere down the line is my body not getting the cycle rest it needs a certain is going to set in because I'm not getting that right amount of rest and that's basically that's the emphasis ball.

My point you just if you could maybe brush over again how long a person should be sleeping and then as you're older and more people sleep less and feel like they can stay up longer, I leave you with that.

>> Thanks a lot.

>> Have a blessed night.

Thank you Jackson.

Those are outstanding points.

Yeah.

The bottom line is what's the right amount of sleep for you?

Many people did notice that their sleep cycle was horribly disturbed with the covid restrictions and they had more stay at home work.

They didn't have to get up as early to go to work and they didn't have that drive time.

>> So many people did change their sleep cycles during that time and if four or five hours is enough for you and you're doing OK with it, that's fine.

>> Some fortunate people are able to get by on four and five hours for their entire lives.

It's just that a lot of people have a hard time doing that.

>> How do you know it's not enough if you feel tired the next day if you feel like you're half asleep as the day goes on, you need long extended naps during the day if you're having trouble with irritability or personality changes due to the lack of sleep.

>> Yeah, that's where it's a problem.

Not only does lack of sleep affect you emotionally, it affects you physically because eventually lack of sleep can cause you to have more stress with more stress.

>> The stress hormone cortisol gets released and that causes detrimental effects for blood pressure.

>> Blood sugars increase the risk for diabetes and even heart disease on down the line.

So the key for you is really keep it out and gauge on how well you're doing with the amount of sleep you're getting four or five hours maybe you doing some of the other right things where when you are sleeping you're sleeping really well.

That's fantastic.

A lot of people don't sleep that deeply throughout the night so they do need the full eight sometimes even nine hours but everybody's a bit different but the average is seven or eight hours and if you slept seven or eight hours ten years ago, that's probably what you still need.

Again, the misconception, Jackson, is that as we get older we don't need as much sleep.

It's not that we don't need as much sleep.

It's just that we don't have the need to get up at the same early hour, especially if you're in a job where perhaps you don't need to get an as early the next morning or with the older folks maybe they're retired.

They just don't have to get up as early the next morning.

It's just that they still need the amount of sleep they need to be able to preserve their memory, their heart condition, their physical condition overall.

And that's where you want to try to sort how sleepy or how tired you are during the day to be able to gauge how much sleep you really need.

But you're exactly right, Jackson.

A lot of people were thrown off with the covid restrictions because many of them were off work for quite some time and they didn't need to get up as early as they did before.

And for some people after two and a half years of those restrictions, they're just now starting to recover from that.

>> I've seen some people have horrible anxiety is an after effect of all that first two or three months of the khodary directions people were doing OK.

They they kind of looked at as a prolonged staycation so to speak, where they were able to stay at home and just kind of rest for a while.

But then it got kind of problematic for a lot of people and they started developing more social anxiety.

They're more reluctant to leave the house and in cases like yours, their sleep was all over the place because they were able to nap for two hours during the day, maybe do a little bit of work from home, stay up late at night and right now people are starting to get back into the routine.

>> Jackson, appreciate your call.

Let's go to next caller.

Hello, Karen.

Welcome to Mars.

The mind.

Hey, I've got a phobia that I'd really like to get on top of and I need to know what can I do to help what what are what is available?

Is there like talk therapy or medication?

>> What can I do because it really I need to get on top of it.

What kind of phobia is it there may I ask?

Well I've said this before and you don't like know about it.

I'm afraid of things about eyes and I had cataract surgery.

>> Oh well welcome back again Karen.

You have the cataract surgery yet?

>> No, because I can't I can't even watch people put in context.

Oh yeah.

Yeah.

The best way to get over any phobia is to expose yourself to that phobia and just do it hard for you to do because you're actually concerned and apprehensive about a medical procedure and as I mentioned to you before care be reassured they can give you medications prior to that surgery where you just won't care and you won't really be like you won't feel like you're participating in the cataract surgery I've had both eyes have cataract surgery.

>> Don't know if I told you that before or not but during the cataract surgery itself you don't care and you're very calm.

>> You're very relaxed.

Most of the anxiety involving cataract surgery is the anxiety prior to the procedure itself during the procedure itself you don't care at all and then the medication they give you wears off and then you're OK.

So it's not like you'll have to lie really still and keep your eyes focused on something while they operate on your eyes because they take care of all that for you.

They give you something very relaxing.

They paralyze your eyes ability to be able to move during that time I think for you yeah you have to look at the pros and cons of getting cataract surgery but as I mentioned to you to you before care and if you get that lens replacement and you have cloudy lenses now it's all it's worthwhile to be able to get the cataract surgery because you have clear vision and it's a good quality of life.

And the good thing about that is I dealt with a couple of people today who had phobias of driving and heights so they had a lot of apprehension about getting in the car .

So I was coaching them on how to get in the car more often, take short trips, maybe stay go on the interstate perhaps when it's not as crowded at certain times just to practice, practice, practice and the more you expose yourself to a particular fear or phobia the less likely it becomes problematic for you.

A classic phobia is the fear of flying where people have such a difficult time getting on that plane and granted it can be very apprehensive to step into the the jet plane and the fuselage is just a big metal tube and makes you really anxious.

But the more and more and more you fly it's not that big of a deal even if you encounter turbulence which still scares a lot of people when they encounter it.

But the more you fly the less fear you have about it.

>> In your case you're talking about a one and done procedure .

>> Talk to your clinician about giving you something for anxiety especially the day before.

>> But if I was you, Karen, I'd get as scheduled to get it done because the procedure itself is quite simple and you won't have anxiety during the procedure.

>> I think they can pretty much guarantee that you won't have anxiety during the procedure itself.

Karen, I wish you the best.

Thanks for calling.

Let's go to our next caller.

>> Hello Tony.

Welcome to Matters of Mind.

Tony, you mentioned that you take Lexapro that's also known as escitalopram but you find yourself getting agitated even still is that's supposed to help with that?

If not, what else would I recommend?

>> Well, Tony, Lexapro is a medication that increases a chemical by the name of serotonin.

>> If you increase serotonin, you have a bit of a calming effect.

You have a feeling of kind of bliss, fulness.

>> You just kind of calm you down.

And for some people that works great generally works in about one out of three people.

Two out of three people don't get that good of an effect from Lexapro.

My bigger concern for Lexapro and particularly for people who find it not that useful is if you take Lexapro and it's not a good fit for you, it can actually make you more restless and agitated and we call that serotonin toxicity where you're getting excessive serotonin for your needs.

>> So we have to kind of sort that out if you're taking Lexapro due to agitation, you might need to go to a different mechanism of action.

Lexapro has an antidepressant effect but it also is used for anxiety.

There's many other medications out there for anxiety such as gabapentin and as an anti histamine there's lamotrigine which is another medication that we commonly use for people with agitation is an anti seizure medication.

So we have a lot of other options out there outside of Lexapro.

So the question for your clinician would be is it worth it to increase the dosage of Lexapro because you're not feeling any better with it?

>> But if you're not feeling any worse you could increase the dosage the higher dose you've Lexapro could give you that calming effect without the agitation in some cases if you're a good fit for him but other options can be available out there.

We try to stay away from the so-called benzodiazepine medications, the medications that work really well for agitation, anxiety.

It's just that they can sometimes cause you to get used to them and you can have trouble with getting more tolerant to them and eating more and more.

>> So we try to stay away from those medications the best we can.

But there's a lot of good medications out there for agitation, irritability, difficulty with stress tolerance.

Obviously talk therapy or counseling can always be helpful to Tony, thanks for your call.

>> Let's go our next caller.

Hello Tom.

Welcome to Matters of Mind.

Tom, you had asked any thoughts on chronic fatigue disorder as it relates to insomnia?

>> Bottom line is, Tom, if somebody has chronic fatigue which is kind of a catchall term as term implies, you're tired all the time if you're tired or sleepy all the time.

>> I want to know when no one do you have sleep apnea again, sleep apnea is where you're not getting adequate airflow to the lungs at night because your snoring or your collapsing in your breathing tube and that gives you lack of oxygen to the brain, makes you tired all day.

So that's the number one thing I'm always thinking about with fatigue and tiredness.

Number two is low thyroid low thyroid is more particularly concerning for women that men do get low thyroid sometimes so low thyroid be a factor diabetes of undiagnosed if you have high or low blood sugars sometimes noticed by the type of diet you've consumed that you feel really tired an hour or two later that can be from blood sugar problems.

So that can be a factor.

You can have chronic fatigue from low iron if you have a gastrointestinal bleed for instance or women who were heavily menstruating they can have low iron that will make them tired.

So I'm looking for all these different medical reasons why somebody might have chronic fatigue if it's due to your having poor sleep.

>> Yeah, lack of sleep will make you tired the next day.

So we're always want to address lack of sleep and finally something that we often will find as psychiatrists if somebody has depression a symptom of depression for many people can indeed be where they're not sleeping well they're tired during the day and those kind of symptoms for depression can be remedied for a lot of people with activating energizing type of antidepressants.

>> Tom, thanks for your call.

Let's go our last caller.

>> Hello, Ernie.

Welcome to Matters of Mind.

Ernie, you had mentioned that your wife is having memory problems.

Any way to help out Ernie if a woman is having memory problems again, going back to my prior answer have her checked out for thyroid disturbances, glucose, low iron and even sleep apnea for that matter because as we get older we're more likely to have those kind of problems and a lot of cases.

>> So make sure she's checked out medically overall if she is indeed having any symptoms of dementia, she needs to see a neurologist as soon as possible.

>> There are some medications now available that can least well stall out and hinder the progress of dementia symptoms and there are some newer medications I might actually start to reverse it so get it checked out by a neurologist.

Sometimes a neurologist will refer somebody to a neuropsychologist who can do a specific memory testing as a means of trying to see to what degree their problem might be there.

And I see a lot of patients myself who have been to a neuropsychologist because of memory problems and they don't have dementia, they have depression.

So if depression is setting in a little bit difficulty, depression will cause you to have difficulty with memory disturbances and they call it pseudo dementia where it looks like dementia but it's not actually dementia.

It's due to depression itself.

So Ernie, get her checked out first by primary care clinician who might refer to a neurologist.

Ernie, thanks for your call.

Unfortunately I'm out I'm out of time for this evening.

If you have any questions concerning mental health issues that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at www ECG I'm psychiatrist Jeff Offer and you've been watching matters of the mind on PBS .

Fort Wayne God willing on PBS will be back again next week.

Thanks for watching.

Goodnight