Can you explain that, that specialty and something that you focus on with, with people that come to you?

Yeah.

So CBT-I, cognitive behavior therapy for insomnia, is really, it's the gold standard treatment.

It's the first-line treatment for insomnia ahead of medication, believe it or not, and that even is important for women in perimenopause and menopause.

So we might sometimes use hormonal replacement.

We might also use CBT-I.

It really does work really well, even for women who are having hot flashes.

Mm-hmm.

What first drew you to sleep medicine and what continues to fascinate you about it?

So I was first drawn to sleep because I was a sleepwalker as a kid.

Pretty bad sleepwalker a lot of times.

And then when I had just graduated from college, I took a year off between college and graduate school.

And I was put on a research study that looked at treating insomnia in people who were in early recovery for alcohol dependence disorder.

And we found that I was going into rehabs at the time.

And we found that in the study, if you treated their sleep issues or insomnia early on in recovery, it actually helped to reduce relapse rates.

that we hear people complain about.

I think it's important for people to hear because that's where everyone goes, sleep hygiene.

Sleep hygiene, it is the control group in most studies.

It is not actually the active ingredient that treats the actual insomnia.

And Day in and day out, I have patients sit across from me, usually online, and they say to me, but I do everything right.

I'm doing all the things I need to be doing and I'm still not sleeping.

And I say, well, I'm not surprised because that stuff doesn't move the needle when it comes to insomnia.

And the reality is there are certain parts of sleep hygiene that that are more impactful than others.

But what do people kind of misunderstand about nightmares, do you think? I think...

What we see with girls and boys, pre-adolescents, is that the rates of sleep issues, trouble going to sleep and falling asleep, is the same.

But then once girls start to hit adolescence, they get their period, that's when things actually change, and that's when young women start to have a higher rate of insomnia.

Why? Because of hormonal changes.

And then moving into pregnancy, and you know pregnancy can throw everything off.

Then the baby comes, and then you're up and you're having broken sleep.

Your hormones are all over the place.

Mm-hmm

...

What is insomnia? Because a lot of people have variations of these symptoms, but what is insomnia, and what are some of the different types of insomnia that people experience in their life?

Yeah.

So insomnia in general, we used to have lots of different types of insomnia and all these different kind of classifications of it.

But we really more recently have lumped it all into just generally an insomnia.

We don't have, like, primary and secondary, all these other terms, because we treat it all pretty much the same way, and we think about it that way.

So insomnia in general is trouble falling asleep, staying asleep, and/or awakening earlier than you would like to.

And it has to happen at least three times a week for at least one month to be considered short-term, and at least three months to be considered chronic.

Mm.

Yeah.

And if that starts to happen, then your child's going to be sleep deprived.

They're going to be even more cranky the next day.

And then that's, it just starts a sequela of problems that can happen because of that.

So it's think about that.

Like even from an earlier age, right? Do, are there certain things that are so rigid that, that it can make it harder for babysitters or going away or whatever that might be and then the other thing that i start to think about is like okay maybe it wasn't an issue but or they just kind of families power through the grandparents visiting or going somewhere else and the parents not being there and they're like oh it's once in a while it's not a problem but then once you start to have a child who might have be like seven eight might if your family is okay with sleepovers yeah maybe your child's gonna start having sleepovers at some point And is your child still needing you to be there to be able to go to sleep? And that's when we really need to start doing something about it if your value is to have a sleepover or to have your kids sleep with cousins or whatever it might be.

Interestingly, the most busiest time that I have in my practice is right before sleepaway camp starts.

So what are some tips for that six-year-old who is not an independent sleeper?