episode#78

078: Dr. Anna Lembke, Bestselling Author, Psychiatrist & Stanford Professor: The Hidden Epidemic Of Benzodiazepines & How It’s Impacting Your Sleep

Benzodiazepines (often referred to as benzos) are often prescribed to treat anxiety, seizures, and sleep disorders. Some of the most common benzos include Xanax, Klonopin, Ativan, and Valium. In this episode, the Author of “Dopamine Nation” & “Drug Dealer, MD,” Psychiatrist & Stanford professor Dr. Anna Lembke, joins us to discuss the sleep-related drug benzos and why it's called a "Hidden Epidemic." Dr. Lembke notes that between 1990 and 2012, the rate of benzo use increased, leading to widespread addiction and overdose rates. Dr. Lembke discusses her journey as a therapist specializing in addictions and explains the risks associated with long-term benzodiazepine use and the process of helping patients get off these hugely addictive drugs. Thankfully, the latest neuroscience research has allowed her and others to understand better what's happening in the brain as we become addicted and what happens when we embark on the process of getting off of them. Benzodiazepines cause many physical changes in your body and brain. These can be unpleasant and frightening, but they can also be eased off gradually & responsibly with the support of trained professionals. If you or someone you know is struggling with long-term benzodiazepines, you will want to listen to this episode!

Benzodiazepines (often referred to as benzos) are often prescribed to treat anxiety, seizures, and sleep disorders. Some of the most common benzos include Xanax, Klonopin, Ativan, and Valium.

In this episode, the Author of “Dopamine Nation” & “Drug Dealer, MD,” Psychiatrist & Stanford professor Dr. Anna Lembke, joins us to discuss the sleep-related drug benzos and why it's called a "Hidden Epidemic." Dr. Lembke notes that between 1990 and 2012, the rate of benzo use increased, leading to widespread addiction and overdose rates.

Dr. Lembke discusses her journey as a therapist specializing in addictions and explains the risks associated with long-term benzodiazepine use and the process of helping patients get off these hugely addictive drugs.  

Thankfully, the latest neuroscience research has allowed her and others to understand better what's happening in the brain as we become addicted and what happens when we embark on the process of getting off of them.

Benzodiazepines cause many physical changes in your body and brain. These can be unpleasant and frightening, but they can also be eased off gradually & responsibly with the support of trained professionals.

If you or someone you know is struggling with long-term benzodiazepines, you will want to listen to this episode!

Biography

Anna Lembke, MD is professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. A clinician scholar, she is the author of more than a hundred peer-reviewed publications, has testified before the United States House of Representatives and Senate, has served as an expert witness in federal and state opioid litigation, and is an internationally recognized leader in addiction medicine treatment and education.

In 2016, she published Drug Dealer, MD – How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Johns Hopkins University Press, 2016), highlighted in the New York Times as one of the top five books to read to understand the opioid epidemic (Zuger, 2018).  Dr. Lembke appeared in the Netflix documentary The Social Dilemma, an unvarnished look at the impact of social media on our lives.  Her latest book, Dopamine Nation: Finding Balance in the Age of Indulgence (Dutton/Penguin Random House, August 2021), was an instant New York Times bestseller and explores how to moderate compulsive overconsumption in a dopamine-overloaded world.


SHOW NOTES:

💊Dr. Anna Lembke's journey as a therapist specializing in addictions

💊Dr. Lembke believed that healthcare providers need to be more educated about addiction treatment

💊Why she is calling the addition of benzodiazepines a "hidden epidemic."

💊What happens when benzos and opioids are combined

💊Withdrawal symptoms of benzodiazepines  in some individuals

💊What are the risks associated with benzodiazepine abuse, aside from cognitive impairment
💊Benzodiazepines for treating insomnia

💊How do we explore tapering safely and responsibly?

💊Helpful resource: Ashton Manual and Benzodiazepines Alliance

💊What is Dr. Lembke’s sleep-centric night and morning routine

And more!​


Website: annalembke.com

DISCLAIMER:The information contained on this podcast, our website, newsletter, and the resources available for download are not intended as, and shall not be understood or construed as, medical or health advice. The information contained on these platforms is not a substitute for medical or health advice from a professional who is aware of the facts and circumstances of your individual situation.

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Transcription

Welcome to the sleep is a skilled podcast. My name is Molly McLaughlin, and I own a company that optimizes sleep through technology, accountability, and behavioral change. Each week I'll be interviewing world class experts ranging from doctors, innovators, and thought leaders to give actionable tips and.

 

That you can implement to become a more skillful sleeper. Let's jump into your dose of practical sleep training.

 

Welcome to the sleep is a skilled podcast. My guest today was a huge thrill to have on. I can tell you that I was introduced to her work two ways, one by stumbling across her book, dopamine nation, her most recent. But also from the Huberman lab podcast. So many of you that listen to our podcast also might know of the Huberman lab podcast, fantastic podcast, highly recommend.

 

And Dr. Anna Lemke was also a recent guest on that podcast as well. You are in for a treat. Her knowledge is just immense on the topic that we really dive in with her. She has great knowledge in a lot of areas, but what we really focus on for today, Was the world of benzodiazepines. And what she is doing is really sounding the alarm on what she calls the hidden epidemic of benzodiazepines.

 

So I think you're gonna really be interested in this topic because many people that are struggling with their sleep. May have considered or may be on or may have been on for years, different types of benzodiazepines. So this is a really important conversation. So a little bit about Dr. Anna Leke. She is a professor of psychiatry at Stanford university school of medicine.

 

And chief of the Stanford addiction medicine, dual diagnosis, clinic, clinician, scholar. She is the author of more than a hundred peer reviewed publications has testified before the United States house of representatives and Senate. Has served as an expert witness in federal and state opioid litigation.

 

Now quick call out. She's also been in the conversation of opioid addiction. So that is a whole other area that we did not touch on today's podcast, but she is very knowledgeable in that area as well. If that's something that you're interested in, but back to her bio and she is an internationally recognized leader in addiction, medicine, treatment and education.

 

Now in 2016, she published drug dealer MD. How doctors were duped, patients got hooked and why it's so hard to stop. That was published through John Hopkins university press in 2016 and highlighted in the New York times as one of the top five books to read, to understand the opioid epidemic. Like I said, a high level of expertise in that area as well.

 

It's not one that we focused in on today's podcast, but certainly it's a fantastic resource. And Dr. Lemke appeared in the Netflix documentary, the social dilemma, an unvarnished look at the impact of social media on our lives, her latest book, dopamine nation finding balance in the age of indulgence. And this was an instant New York times bestseller and explores how to moderate compulsive over consumption in dopamine overloaded world.

 

So you're gonna really enjoy our conversation. Just a lot of resources provided in our talk today, and I cannot wait for you to jump right in. If you have any questions after listening, please don't hesitate to reach out as always, if you go to sleep as a skill.com in the lower right hand corner, we have a little, we like to call our sleep.

 

So you can ask any questions there and that will, it's not just a bot, like it will get to us and we'll be able to respond back to help support in any way we can in your journey to really whether improving your sleep, optimizing your sleep, getting your sleep back on track wherever you might be with your sleep.

 

We're really here to support. Now let's jump into the podcast. So I get a lot of questions around sleep supplements, and I'm very hesitant to just throw out a whole laundry list of possibilities. One, I don't think it's the most responsible thing to do. I really do believe in testing to see what types of supplements make sense for you.

 

And two, because I really truly believe that most of the things that you can do to improve your sleep are behavioral, psychological environmental in nature, and often don't cost a dime. However, there is one supplement that I personally take every day and that I do feel quite comfortable with suggesting for most individuals to experiment with because of a couple of reasons.

 

It's high safety profile and high rates of deficiencies in our modern society. Some put the numbers as somewhere around 80% of the population being deficient in this one area. And that is magnesium. So magnesium has been called the calming mineral and some report that magnesium can increase GABA, which encourages relaxation on a cellular level, which is critical for sleep.

 

Magnesium also plays a key role in regulating our bodies' stress response system. Those with magnesium deficiency usually have higher anxiety and stress levels, which negatively impacts sleep as well. Now before you go out and buy a magnesium supplement, it's important to understand that most magnesium products out there are either synthetic or they only have one to two forms of magnesium.

 

When in reality, your body needs all seven forms of this essential sleep mineral. So that's why I recommend a product for my friends over at bio optimizers, they have created something called the magnesium breakthrough and taking this magnesium before bed helps you relax and wake up, refresh and energize.

 

And while we don't recommend that you go two nuts on looking at all the sleep stage classifications on all your wearables. I will share anecdotally that many clients have reported improvements in their deep sleep trend numbers. Again, I don't want you going nuts on the sleep stage classification numbers on your wearables, but I do wanna let you know about that because I know that many of you do reach out on questions of how to improve your deep sleep.

 

So I also love that bio optimizers offers free shipping on select orders and they offer a 365 day money back guarantee on all their products. Plus they have a customer satisfaction rating of 99.3%. Very impressive. And you can get 10% off magnesium breakthrough. Again, this is the same magnesium that I use every single.

 

And finally you can get 10% off magnesium breakthrough. Again, that's the magnesium supplement that I use every single night by going to www dot mag M a G. So mag breakthrough.com/sleep is a skill and be sure to use the code. Sleep is a skill for 10% off. And welcome to the sleep is a skilled podcast. I cannot be more excited for today's conversation.

 

This is a huge privilege. So today we have Dr. Anna Lemke on the podcast to really just share her immense knowledge in a few areas. I think we're gonna get into today, but certainly in the area. Addictions addictions of different kinds. And what, you know, before we hit record in my conversations with Dr.

 

Lemke really going into particularly benzodiazepines and some of these sleep related sleep prescription drugs, or utilizing them as sleep prescription drugs. And in this conversation, what we can learn about that, how we can be aware of possible long term indications or contraindications of what might come out of the utilizing of that.

 

And. Certainly introducing anyone. That's not aware of the tremendous work that Anna is doing in the area of addiction. I could not be more excited. So thank you for taking the time. Oh my pleasure. Thank you for having me. Absolutely. So, first off, I would love to just kind of share with the listeners, how you found yourself to be such a expert in this area of addiction.

 

Many, you have a lot of expertise, certainly, but with your, really the success of your recent books, how did you find yourself interested in this arena? Well, if I'm being totally honest, it started out with my realization about 25 years ago that I was not a very good psychiatrist and I was not a very good psychiatrist cuz I was completely ignoring patients problems related to substance use and addiction more broadly.

 

I, I was operating under a kind of don't ask don't tell policy. I didn't ask. They didn't tell. I didn't wanna know cuz if they had a problem. I didn't know how to help them, cause I didn't learn about it in medical school. So it really wasn't until I had a patient who had a really bad outcome as a result of an opioid addiction that I wasn't even aware of.

 

Although I had spent many hours with her talking about every conversation she'd ever had with her mother that I realized I better learn something about this problem, if I'm gonna be able to help my patients. And so over the last 25 years, I have kind of. Educated myself. Uh, I've been educated by my patients, other experts in the field.

 

There's been actually an explosion in neuroscience research, which has allowed me and others to understand what's actually happening in the brain as we become addicted. And I've sort of harnessed all of that. And eventually sort of just became like the go to person in my department to address these issues in the context.

 

What was 20 years ago, the Dawn of the prescription drug epidemic, especially opioids and benzodiazepines. And then ultimately more recently, the problem that we're seeing with behavioral addictions, like gambling, sex pornography, um, shopping, gaming, all made much, much more severe by the advent of the internet and the smart.

 

Wow. Well, one, uh, thank you for your vulnerability and sharing the, kind of the Genesis of that. And then some of those moments when we can have that kind of upset and then yet to pivot into this area where you became one of the top of your field in this and the go-to person. So, so grateful for you to share your knowledge here today in this area that you really developed yourself in.

 

And so from that place, One of the areas that we get a ton of questions about are around benzodiazepines. And I know you've been calling it the hidden epidemic. And I'm wondering if you can share more about that. Why is it the hidden epidemic? Well, it's hidden because it really emerged in parallel with the current opioid epidemic, except nobody was talking about it.

 

Yeah. So starting in the late 1990s, till 2012 opioid prescribing quadrupled in this country and commensurate with that was a quadrupling in opioid related addiction and overdose death. During that time prescribing of benzodiazepines and sedatives like Xanax, Valium, Klonopin, a. Ambien also increased, not as much as opioids, but in parallel, and certainly contributed to the problem of Ben ezine addiction and related overdose deaths.

 

When we combine benzos and opioids, the risk of accidental overdose goes up. Both of those agents independently and then synergistically decrease, breathing, decrease heart rate people fall asleep and don't wake up again because they stop breathing and that's how people die. So there was this phenomenon where we were very focused on opioids, but nobody was talking about the hidden epidemic of benzodiazepines.

 

When it emerged in the, the music culture and various celebrities that were beginning to talk about their struggles with benzos like Xanax, or there were certain celebrities who, you know, tragically died of overdoses primarily related to benzodiazepines, like Xanax. Then I think there was a little bit more awareness, but prior to that, you know, only really in the last five to 10 years, There have been more notice of this also in about the last 10 years, there's been a much more vocal grassroots movements of individuals who be, who have become physically dependent on prescription Ben benzodiazepines, not meeting those criteria for addiction per se, but still really struggling to get off of benzos even when they're no longer working for them.

 

So a lot of the work that I've been doing is helping with the process of deprescribing. From Benza Daisy zines, which is for some individuals, a very laborious, painful, intensive, and long process. Absolutely. And I, I shared with you before we hit record that I have a very kind of personal connection to this topic.

 

I have very close family member who has gone through this and nearly died. Seizures did all the things, certainly not to do. Thankfully you're, uh, you know, kind of sharing some of the possible paths and not to say that it's easy. And there are steps that we can take mindfully. But sometimes when we see I have had the, I guess, could you say opportunity, have I have seen firsthand what that can look like when it is not done in that manner with that lacking of support?

 

So I'm just so grateful that your stand for that. And I'm wondering if you can share more about what does that look like and for so many. Had so many questions from people of, they say, well, who do I go to? How do I get this guidance? The doctor that I work with is the one that has been prescribing me these for years and years.

 

What do I do? So I'm wondering if you can help kind of paint that path for us. Yeah. So unfortunately in medical school, we get a lot of training about how to get patients on medications like benzodiazepines, and opioids, and much less training on how to get them off. And I know for most of my medical education and most of my colleagues, there really was not sufficient recognition of how difficult it can be.

 

A. Some patients to get off of benzodiazepines once they've been taking them chronically and not just benzodiazepines, other, other kinds of sedatives, like, like Ambien, sure. The Z drugs, which also are, uh, potentially addictive and work in a very similar way and work on the same receptor. So unfortunately the truth is there.

 

Aren't a lot of doctors out there who are even aware that this is a significant problem. Often minimize it when patients. Present saying, Hey, I'd like to get off of this medicine and I'm struggling to do it, minimize the need to get off of it, minimize it as a problem. And then unfortunately say to patients, well, if you wanna get off of it, you know, you can just taper over the course of two weeks or a month.

 

And some patients really can do that. Right. So there's enormous inter individual variability, but some patients, if you were to do that, it's. They, they might have life threatening seizures, but it's often more subtle than that. Sure. It's just that it's incredibly difficult. Debilitating. They may become, you know, very depressed, suicidal, anxious, panicky, even psychotic, you know, in some instances, uh, as a result of that withdrawal so that what we're doing now is really strongly recommending that that folks taper really slowly by going down no more than.

 

Once every month, um, knowing that in those first couple of weeks, their symptoms of insomnia anxiety or whatever, they're medicating will get worse before they get better while the brain struggles to adapt to that new, lower dose. But hopefully by week three or four, their brains will have readjusted to the.

 

Slightly lower dose. And then we can try to go down again, which means that I have patients who are on year three or more of tapering off of their Benza Daine, it's a very patient centered, slow taper that some people just really need in order to be able to get off of these drugs without overly stressing, uh, their.

 

Absolutely. Are there things that you've seen to be supportive for people during that process? And I hear you too, I'm sure it's a huge spectrum and length of time and very bio-individual, but are there certain, you know, diets that you recommend, um, practices that they engage in setting up their life in a particular way?

 

Anything that you've seen to be supportive for people during these often very challenging. Well, there are lots of things people can do that can be supportive. The fir the first step is sort of the logistics of the taper really matter. So for example, a lot of doctors will make that first decrement or that first decrease in dose.

 

They'll decrease it by a lot because they'll figure that well, Percentage wise, it's not that much, you know? So if a patient's on three milligrams of Xanax at bedtime, if we cut out one milligram of Xanax, that's only a third of their existing dose, as opposed to the next decrement. If we were to cut out one milligram, that would be 50% of their dose.

 

Right. Right. So that first decrement, they. They figure, well, that's, that's easy. You can take a big chunk away, but what I teach my residents and medical students and talk to my patients about is really what we wanna do with that very first decrement is go down by a teeny tiny little amount. And the reason for that is mainly psychological.

 

Once patients have made it to the point where they're needing a doctor's assistance to get. They've tried many times to stop on their own and stopped by too much, you know, maybe stopped completely or went down by half or more. Right. And then found that they couldn't tolerate it and then rebounded back up or rebounded even higher.

 

So the key is to have that first decrease in dose, be just a really, really baby dose so that patients realize they can do it. And they get that sense of like competence and efficacy and also hope. Right? Yeah. So that's really, really key. So that first decrease in dose, I make it really small. And I importantly, my patients have told me the most important thing that I have told them is that they're going to feel worse before they feel better.

 

So whatever the symptom is that the benzo is supposed to treat, we'll get worse if it's anxiety, if it's insomnia, but that's not the, that's not what they'll be left with, you know, off of the benzo. Basically withdrawal, mediated, anxiety and insomnia, because they're withdrawing from the last dose. So those are two really important things.

 

Also never go backwards. So patients will say, well, if I have a really bad night, can I go back up say, no, you can't because basically you're, you're training your brain to readjust to the lower dose. And if you go back up on a dose, you're gonna lose all those hard earned gains. And then of course, In conjunction with that, we recommend all the things that I'm sure you talk about all the time on your podcast.

 

Good sleep hygiene, exercise, a healthy diet, mindfulness, meditation practices, prayer. I mean, you name it, all those, all those things. Okay, great. And is, I know I've been a little benzo centric in this conversation, but you mentioned the hypnotics is, does the same rules do the same rules apply for those or anything else to be aware with, with that?

 

So hypnotics are a broad category. Yeah. That include Benza and ambience. They're all. Hypnotics. Yeah. It's sort of a, a not very exact term to encompass a medication that you take to help you go to sleep sure. To help you to put you into sleep. And yes, it includes Ambien. It includes all of the benzodiazepines.

 

There are some other Z drugs. Beam's actually in there too. I know people are always like, oh yeah, I can take that. But anything that's scheduled any scheduled drug ultimately is a drug that has the potential for addiction. That is why it is a scheduled drug, right? Because that's been recognized even Gabapentin, which is not a scheduled drug.

 

Has the potential for addiction. It's like benzo light. And I, we have, unfortunately seen patients become physically dependent on it, misuse it, get addicted to it. The sort of cousin of Gabapentin is Lyrica and Lyrica is scheduled. So that is a scheduled drug. I wouldn't be surprised if sometimes in the next 10 years, Gabapentin actually moves into the scheduled category.

 

Absolutely. And again, I know this is a big topic, uh, and so it's certainly hard, I'm sure to speak in a blanket way too. But do you often find that people that you do bring in things like Gabapentin or benzo light, do you bring those things in, in conjunction as people are weaning off? Or do you like to just have such a slow tapering process that you're not having to rein or introduce other drugs?

 

Into that, or is it just very dependent on the person it's dependent on the person, but as a general rule of thumb, our first strategy is to just tape extremely slowly, whatever the sedative or hypnotic is that they're on giving their brain time to adjust in between and simultaneously teaching them other skills non-pharmacologic skills for improving sleep.

 

If we do add another medication and we do that often. We add a medication that is not in the potential for addiction category, right? Mm-hmm  so we try to add non-addictive antidepressants. Sometimes we add what we call the antiepileptic drugs, um, that are used for seizures. Sometimes we add like a little bit of antihistamines, so we will use other medications, but in general, what we're trying to go for is non-chemical coping if possible, cuz there's always a risk.

 

For example, if we add Gabapentin. To help somebody come down, then that person, you know, will have to probably taper, spend some time tapering the Gabapentin. Usually that's not as hard. So sometimes that's just a better way to go to piggyback on it that way, shore them up with a little bit of an anti-seizure medicine like Gabapentin, and then slowly taper the Gabapentin.

 

Oh, wow. Okay. So I've been really curious if you have any resources for people listening. You know, I've had so many individuals because certainly this is far outside of our scope to be guiding people in this tapering conversation. So we'd like to just be able to offer resources of ways to find educated individuals like yourself that are gonna be able to be well versed in this topic of the latest research onto how to.

 

Get through this process with as much ease as possible. Is that a word we can use? So with that, have you found any sort of resource that's out there that's even like an aggregate or ways to find psychiatrists that are in this conversation? Cause I've just been really struggling to give people in, I don't know, Iowa access to someone that can help support them and go along for the ride on this topic.

 

So there are definitely resources out there. The first is the Ashton manual. Yes. This was written by yeah. Written by Heather Ashton, who recently died within the last five years, but she was a physician who worked one on one with patients to help them get off of. Benza Deines and really just took a very patient-centered approach, evolved the strategy of this very slow taper, governed by certain rules.

 

Like go slowly, take breaks, never go backwards. And she in fact wrote down like actual patient schedules of how they tapered and got off of their benzos. So that's a really great manual. Available for free online. And it's called the, the Ashton manual, Heather Ashton. And it has taper schedules. It has descriptions of benzodiazepines what they are, why they're hard to get off.

 

So that's a, the first really good resource. Yes. Especially if people are stuck kind of doing it themselves yes. And kinda devising their own tapers. Another good resource is the benzodiazepines Alliance. And this is. An organization. That's a combination of sort of grassroots. Let's say people in recovery from Benza Aines of various sorts and also experts in the field who study Benza Aines.

 

And I do believe that they have a treatment locator service or, or aid there on that. I'm so glad you said that, cuz we do have a representative from the organization scheduled. Oh good podcast. Students know. Right. I'm glad to hear, um, of your positive endorsement of that. That's fantastic. Yeah. They're great.

 

They do good work and they're very evidence based, so yeah. Yeah. Excellent. Okay. And. So from that, um, one, I love that you led with the hope factor. I'm wondering if you can just share from your experience, just any even percentages or examples of tough cases that have come out positive on the other side, you know, just the reason I say that is that so many people, the stories that we've heard is just.

 

They're focusing in on what they've seen of ill-fated attempts of getting off of these. And then actually now they're on higher medications or discussions of protracted symptoms and that they're gonna be plagued by this for life, just, you know, so if you can share some of the things that you've seen to help us kind of have that.

 

Oh, yeah. I mean, I we've, we've had many, many patients who have been able to taper off of Bensen successfully. Yeah. Who have found that after getting off their lives are much, much better that symptoms that they identified, that they were treating with the Benza Daisy Paines were actually being made worse by the, in Benza Daisy Paines.

 

And now that they're off, they've really a restored health that they hadn't. They hadn't been able to enjoy for decades. And now kind of reverting back to that. And even patients who let's say are hoping for the recovery of some faculties that they feel might have been attributable to Benza days means for example, we had a patient who was really motivated to get off because she was having some cognitive impairment, um, some lot memory.

 

Sure. And she, and she, and Benza days beans can do that. So she says, I wanna get off of these so that, you know, Mike can get my memory back. And over the course of a couple of years, we slowly tapered her off. You know, she, it was difficult, but she did it. And now that she's off, she will say, well, actually my memory's no better.

 

Yeah. But I'm really I'm, but I'm really glad that I'm off. Off of these medicines, cuz you know, this long list of other things is much better. My energy's, my energy level is better. My ability to be present is better. I, you know, I sleep better, all of these things and we do have patients who do really miraculously restore cognitive function.

 

Once they get off of benzodiazepines PSU, she just wasn't one of them, but she had a lot of other things, you know, that were much improved. So yeah. Uh, it's definitely right. And yeah. And ideally you don't wanna go into like the last decades of your. On chronic benzodiazepines, the data showed that the longer people are on them and the higher the dose, the more likely they are to suffer the adverse effects.

 

And of course the longer people are on them. The more likely they are to need a higher dose because of the development of tolerance over time. Sure and real clear. I know I threw out the, that protracted withdrawal kind of terminology. I'm wondering if you can speak to that real quick. Is, is that real, can you kind of help validate that for people that have that experience or are we moving into sometimes do people, um, start to attribute things in their life, you know, kind of misattribute, how do we think about how long these symptoms could be for people?

 

We have no way to measure right now, we have no way to measure, you know, this protracted Benza APEN withdrawal syndrome that people will describe. There are patients who will talk about, uh, how even months and years after they've stopped taking Benza they feel that they're still suffering. From the effects of those benzodiazepines, physical and mental, they might talk about ions or spasmodic movements or, um, uncontrollable restlessness, or ongoing irritability, anxiety, depression, you name it.

 

And I think it's possible. I mean, I do think it's possible that exposure to benzodiazepines may cause some long term neurological damage. , but I have also seen patients and more so in recent years who seem to become very obsessive about, uh, the Benza Daisy Paines and the impact on their lives. Yeah. And, you know, spend a lot of time online and chat rooms.

 

Yes. You know, some of which is too ultimately to their detriment. Yeah. Because then it seems like everything that's going wrong in their life, they then attribute to the Bens Daisy pain. I mean, it's very hard to know. Yeah. But sometimes I have to advise patient. Stop going into those chat rooms, stop reading about benzo, stop looking it up.

 

Yep. You know that at this point more information is not to be had really. And for you, it it's actually just making things worse. Oh, for sure. I mean, I can. From my own personal experience, my period of insomnia was rather acute. It was about, you know, three month period while traveling internationally. But during that time found myself at different clinics along the way of this, of this travel and Valium and Ambien were two of the things that were given out.

 

And I certainly granted, as I shared, I had some kind of family. Stuff in the background and a lot of fears for myself of going down that path. So I'd certainly added a ton of mass to it, but I did find myself in a lot of these forums and getting myself freaked out, absolutely freaked out and had to kind of pull myself out of that as I began to get out.

 

And certainly it was a baby dosage, but in the process of getting off of those had to be really careful to not swell the experience bigger and bigger. Needed to be, but so thank you for providing some of those tricks of the trade that sometimes that might not be helpful, maybe have a nocebo effect even.

 

Yeah. You know, so I mean, what we are paying attention to, that's where we're sending a blood flow and oxygen in our brains. Yeah. And we're, you know, what fires together, wires together. Yeah. So there's some level at which really in a way, distracting ourselves from these thoughts. And, uh, these symptoms is, is better than focusing on.

 

Okay. Great. And so, well, one, is there anything we left out about this topic that you wanna, uh, share? Or do you feel like we touched on it in depth? Well, I mean, there's a lot more, I know, I know. Yes . Yeah. Let's be clear to anyone listening. This is just scratch in the surface a hundred percent, but is there anything that we did not speak to or point to that you wanna make sure you leave the listener with?

 

As far as this particular topic? Well, I think, well, I always like to temper the message and say, you know, these are really useful tools. Yeah. They're evidence based for short term use. That means over a series of days to maybe a couple of weeks, we know they work for anxiety. They work for insomnia. They work for a cluster of other physical non-psychiatric, uh, problems.

 

They help to people who are in, you know, status epileptic as having seizure. Is there one of the most potent things you can do to bring somebody out of a seizure and seizures can be life threatening. So these are really, you know, wonderful to have in our Pharmacopia. We wouldn't wanna throw the baby out with the bathwater, but these are not evidence based solutions for daily, long term use.

 

And that's really where we get into trouble, where we're using them habitually for very long periods of time. Now we get into trouble in terms of the neurophysiology, but there. So a level on which, um, it becomes also a learned behavior where we then come to believe we can't sleep without these agents.

 

And so then we have anxiety about not sleeping and then you can get into a, a vicious spiral around that. Oh yeah, absolutely. Uh, well, I'm so grateful to, for the work that you're doing. And would you say Stanford is a particular. University now that thanks to some of the work that you're doing in others that is becoming more well versed on this.

 

Are there particular universities or places that you can point to that are really leading the charge on this? Or is it hard to say? I think it's hard to say. I think when you have people, I think that there's a growing national awareness about the potential risks of Bens and beans. Interestingly, You don't find that in many other countries.

 

So for example, in China, for example, it's extremely difficult to get opioids, but very easy to get Penns. And APEN Eastern Europe, very easy to get Penns and APEN so it's interesting how this kind of awareness around the potential dangers of this class of medications has. Made it to many other parts of the world.

 

Yeah. And even here in the United States, you know, there, there, there are a lot of, I think physicians and patient consumers who still, maybe aren't hearing this message. Absolutely. Well, I'm hoping that we can learn then from someone like yourself that has presumably explored healthy ways and healthy habits on, in their own life.

 

So we do ask every person that comes on the podcast for questions kind of sleep related. And so from someone. Like yourself that has thought deeply about these topics, excited to hear your answers. And the first question that we ask everyone is what is your nightly sleep routine? Looking like? I'm sure it changes with travel and various things, but anything that we can learn from your habit.

 

Well, I don't know if you can learn anything from my habits. I mean, I will say that sleep. The transition what's interesting to me about sleep is how it can be a source of anxiety. Yeah. Just anticipating that transition. Although we all want to fall asleep, how we get from being awake to falling asleep. I know for me is a bit of a trigger for very, very long time.

 

Probably most of my life I have read. I read to fall asleep. Yep. But sometimes that can get me into trouble. If I'm reading a book that's really exciting or really, you know, then I, then it can, I can, you know, pass through, uh, that, that zone. So I, I think, you know, one of the keys that I've learned is to read something that's not too exciting.

 

yes. In, in that little bit of time before I, I go to sleep and then I to occasionally try to disrupt my routine a little bit and try to sleep without reading anything at all, you know, which is really pretty scary for me, cuz it feels like sort of falling into the abyss. Yeah. And have my usual coping strategy as I fall asleep.

 

But I'm always surprised. I think it's gonna take a long time and then I'm like, oh I fell asleep. Yeah. Sleep is such a, a mystery, right? I mean, it's such a fascinating thing. Oh, absolutely. And so for you, the process of reading has been something that for years you've leaned into, but then sometimes the surprise and delight when you're able to even just kind of fall asleep without, um, that kind of need.

 

Right. And also just intentionally changing it up a little bit, right? Yeah. Yeah. Making sure I'm not reading something. That's, you know, again, too engaging, I've made that mistake too many times to count in my life. And then occasionally intentionally saying, okay, I'm not, I'm not gonna read tonight. I'm gonna disrupt my physiology and just try to go to sleep without a book.

 

I like that. Yeah. We have a lot of, kind of, um, biohackers that listen in and they like to cycle in, um, you know, maybe their caffeine use and cycle in cycle out, or, you know, try these different things so that they're not becoming dependent on whatever source. And I like that you're doing that even with something like, you know, habit.

 

So it's fantastic. And then what might we learn about your morning routine? Anything stand out. Yeah. So my morning routine, I usually get up before Dawn and I exercise. And as I say to my patients, and I say to myself, the best sleeping pill I can give anybody is morning exercise to get up and to expose ourself to early morning, sunlight sets up those circadian rhythms so that we're, you know, in harmony with the natural.

 

Rhythms of, of the universe. Part of the reason that travel is so incredibly disruptive to sleep is because it really confuses our, our circadian rhythms. So I try to get up and I try to exercise and that I feel like builds up the sleep debt that I need in order to be able to more easily fall asleep and at night, and to be sleepy, you know, at bedtime, which is really the key.

 

Absolutely. And that's something that you do largely every day, some sort of move. Yes. Okay. Yes, it is. Yeah. Great. I think one of the, one of the things to throw in there is I bet many people have experienced this. If I exercise very intensely that night, I may have more trouble falling asleep rather than less.

 

Yeah. And this is an interesting paradox, but I think what's happening there is if you've built up a lot of lactic acid yeah. You know, in your muscles, and then you've got a body that's not ready for sleep because it's kind of in, still in recovery mode. So that can. Confusing for people because they're like I did more exercise today, you know, than I do on any average given day.

 

And yet here I am lying wide, wake up and that's because exercise itself, if it's more than our routine, it can be very stimulating and then we're not ready for sleep. Uh, when night falls. And, and again, it's not nothing abnormal about that. Nothing to worry about. You know, if you don't sleep well, one night that's well, within the hu the scope of normal human sleep, you will make it up the next night or the night after that.

 

Well one, I appreciate you saying that. Cause I think, you know, we do see that a lot of people can get fixated on these topics. I mean, I was certainly one of them and then when it doesn't pan out, then the freak out emerging. Right. And so, uh, kinda easing that concern can be really, really helpful. And then also.

 

To your point of kind of not throwing something out, just because it's not working after, you know, one night or what have you. So we've seen the number of people that then will start bringing in saying, okay, sure, fine. I'll start exercising. Cause that's supposed to help me nicely begrudgingly doing it.

 

And then they do maybe overdo it for them and then it doesn't work out and then they kind of throw it out. So I appreciate you kind of sharing that. There's gonna be some ebbs and flows. Right. Fantastic. And then for you with anything noteworthy on your nightstand, or even proverbial nightstand apps, gadgets, ambience, anything, um, that we can learn there.

 

I have stacks and stacks of books on my nightstand. So that won't surprise you given that I, that I read to fall asleep, but importantly, I actually don't have any devices. I have no digital products, no lights, nothing ticking, nothing that needs a battery or is plugged in. So kind of like a tech free sort of station next to my bed, love that, the simplicity of that.

 

Fantastic. And I also love that a more in your vulnerability space in your book, dopa me nation sharing of your own struggles with particular types of addictions for yourself and what that can look like even as what can seem like not for some listeners might be like, oh, come on of different types of books or what have you.

 

Right. And yet, There to be, have that level of self awareness that all of these things that we choose to engage in, if they are having detrimental effects in any way, shape or form, certainly you called out and touched on the big one for many people that digital addiction, which is becoming more and more real for many, it's just really important to address.

 

And then even just have that awareness. And I think your book is such a great compliment for people that might be struggling with. Thank you. Yeah. Yeah, absolutely. And then the last question would be what has made the biggest change to your sleep game or maybe biggest aha moment that you've had as you're managing your sleep over your years of life?

 

Well, I think there have been many sort of milestones in, in sort of figuring out my own sleep, but probably one of the most important things is recognizing. Normal human sleep is characterized by a series of awakenings. Mm. And that, that we actually, we come in and out of different levels of sleep from deep, deep sleep to awakening.

 

And we do that multiple times through the night. So for example, a medication like ambient, doesn't actually ex. Extend our sleep by very much. In fact, it extends sleep by about seven to 14 minutes. But what it does do is it makes us amne or forgetful for the moments when we come out of deep sleep and our awake.

 

Yeah. So we have the perception, uh, that we have. Not woken in the night, but in fact, we just don't remember those awakenings. So for me, a real aha moment is to really just normalize and accept, especially as we age that being awake for parts of the night is totally normal and okay. And to not get anxious.

 

And to just use it as a time to rest. So I actually don't get up out of my bed when I can't sleep. I just use it just as a time to rest my body, even if my mind is still going. And I just know and hope that even though I can't sleep well on any one given night, I'll make up that sleep in the nights to come.

 

So I think that's really, really important. Also. I, an interesting, uh, colleague of mine did an interesting series of studies on sleep related to the cycle of the moon and found out. Full moon, um, is characterized by, um, people waking up more in the middle of the night. And his hypothesis is that from, you know, primordial era, we were actually meant to get up and like go hunting or have sex in the middle of the night with a full moon.

 

So that, that's why we're actually programmed to be more wakeful at different phases of the moon. I thought that was interesting because yeah, again, it speaks to the sort of, um, how. It's people have this perception that normal, healthy sleep is you rest your head on the pillow. You fall asleep instantly.

 

And the next thing you know, it's morning and you're perfectly refreshed, right? When in fact normal human sleep is characterized by movement by wakefulness, by on some phases of the moon, maybe extended periods of wakefulness. And that's all. Okay. Absolutely. And there's even those kind of noteworthy callouts around the Genesis of the word lunatic.

 

And could that have been connected to the lunar cycle and what have you, and certainly, and I know you were in Dr. Huberman podcast and he's been fantastic for kind of sounding the alarms for light and it's impact on sleep. So certain theories on could the, the output of light even relatively. Low as compared to what the types of lights that we're often now I'm exposed to throughout the evening, but over the course of history, could that have been times when that might signal more alerted wakeful, you know, wakeful periods.

 

And I really appreciate you speaking to this topic of kind of dulling our stress load or anxiety around those times, but we do wake up and I also love that you pointed. Your way of managing that I'm actually staying in bed and kind of just giving it some time to relax your body. Because I do think people when they're struggling with this area often might try to bring in a lot of the, the rules mm-hmm

 

And one of those things with C B T I. And lots of efficacy and, you know, lots of great experience for many individuals, but I was one of those people that did not do so well with the suggestion to, you know, get up, go walk around and kind of, you know, I'd have a lot of inner angst, just, I don't wanna be doing the dishes right now at three in the morning.

 

Wanna be in my bed resting. Yeah. Yeah. You know, no, same with me. Like that will, like, if you're, you know, only sleep in it have intimate, you know, encounters yours. Like no I'm gonna be resting in my bed.  yes. Yeah. And a CTR act for insomnia. We'll point to possible, you know, alternatives of how we can think about even just laying in a supine position and the blood, you know, our heart rate coming down and that all of this can kind of be restorative.

 

And the changes that happen in our brain is when we close our eyes and just having that time and is yeah. You know, and really practicing acceptance for the fact that we are awake and that, that can be okay. That's right. That's right. That's right. Fantastic. Well, so for anyone listening I've again, this is to be clear, we've only just scratched the surface on this huge area.

 

And you also have other books that go deeper in other topics that we did not even touch on today. So what are the best ways for people to learn more about you to follow what you're up to? Well, I would say read my books. I'm not on social media. So, um, that's probably the best you're leading by example folks.

 

There you go. There you go. Trying to . Yes. Okay. Fantastic. Well, we will be sure to link to your books and continue to follow the great work that you are doing. I know many people have become aware of you on the, your different podcast as well. In addition to the, the best selling books and all that you've gotten out there in this area.

 

Um, You know, decades of knowledge and information and the difference that you're making in this field. So thank you so much for taking the time to be here. Just appreciate what you're doing. Well, thank you. Thank you for your work too. Helping people sleep. Oh, thank you all. We'll have an amazing day and I hope you have an amazing night of sleep tonight.

 

Yes. Thank you.

 

You've been listening to the sleep is a skill podcast. The number one podcast for people who wanna take their sleep skills to the next level. Every Monday, I send out something that I call Molly's Monday, obsessions, continuing everything that I'm obsessing over in the world of sleep head on over to sleep is a skill.com to sign up.

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