Dr. Elissa Epel
speaker
631 appearances
3 recordings
2 series
first heard Nov 2024
last heard 23 Jun
Dr. Elissa Epel’s voice in public audio — every appearance, attributed to the second.
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recordings per month · last 12 monthsRecordings per month over the last 12 months — 1 in all, peaking in Jun 2026 with 1.
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She turned out to have one of the most striking positional components to sleep apnea I've ever seen. When she was on her side, her sleep was normal, but when she was on her back, she had respiratory events that count as either a slowing of airflow or a stopping of airflow more than 60 times an hour.
Yes, yes.
That's a lot. No wonder she was exhausted, right? So when you see a positional component like that, I have people who don't want to do a sleep study because they don't want to, I'd never wear that stupid mask. But for her, we said, okay, well, let's start with retraining you to learn to sleep on your side. And she tried that. There's some commercially available positional devices.
There are all kinds of strategies you can do.
Or the fanny pack with the pillow stuffed in it, yes. There's all kinds of strategies you could do. And of course, it's big business, right? You can buy a slumber bump or a bumper belt.
Even more sophisticated, there's now a biofeedback device that's a strap around that vibrates when you roll on your back. So it's sort of autogenic nighttime training to get you. So that's what she used, interestingly enough. And it helped a little, but she was still tired.
So as we're peeling the layers of the onion, she had some digestive symptoms, a lot of bloating, a lot of discomfort, and she had, we had done a full sleep study, she had restless legs and periodic limb movements. She turned out to have a very abnormal breath test for small intestinal bacterial overgrowth.
Where they don't belong, right, right.
Absolutely. And low iron. Her iron wasn't terribly low, but one of the sidebars here, I think the other thing we do in functional and integrative medicine is understand the difference between a normal blood test. I should put, quote, normal blood test and an optimal blood test. Ferritin is a classic example of that. Ferritin looks at your total tissue iron.
In your iron bank, your iron stores, right. And normal can be anywhere from 15 to 250. Yeah. So it's a big range. And what we know the threshold is for somebody who's got restless leg symptoms is you actually don't want to be normal.
You want to be over a hundred because there's some evidence, even comparing it head to head with those dopamine drugs we mentioned earlier, getting somebody's ferritin over a hundred was as effective as the dopamine medications.
That's amazing, right? As simple as correcting a nutrient deficiency, not to the normal range, but the optimal range for that condition.
And Mark, I think from the internal medicine standpoint too, it's equally important to say, don't just correct the iron, figure out the why. You don't want to miss blood loss somewhere. Yeah, she got a colon cancer. Absolutely.
know there was one other piece related to her story that i think is also important to call out addressing all of those things her sleep quality was still not what she wanted to be so we had a conversation and she relayed the fact that when she was growing up things were pretty unsettled in her home of origin.
There were a lot of late night parties, a lot of noise, and bedtime became a time where she didn't really feel safe and quiet and comfortable. So we also talked about referring her to a life management behavioral therapist to really talk about what it meant to be safe and regaining that sense of being okay being in bed. And I think that goes hidden as well that a previous
History of trauma or not feeling safe can also show up with insomnia and difficulty sleeping.
Sure. I think first and foremost, we have to recognize that sleep, you know, you and I trained in an era where sleep deprivation or how little sleep you could get by on was a badge of honor. Yeah. So we need to shift that internal dialogue that we all have that, oh, if I'm sleeping, I'm wasting my time and I'm not getting my stuff done.
So first, honor the importance of sleep for your overall health and well-being and even your ability to stick to your intentions around choosing healthy foods and sticking to your exercise plan. Then create a sanctuary that's really conducive for rest and relaxation.
dark, quiet, cool, ideally electronics out of the bedroom or turned off if you can, getting rid of all of the light exposures, even your chargers, you know, that had that little light.
I had a patient who told me she traveled around with black electrical tape whenever she went to a hotel and she would put it over all the little light sources in the hotel room.
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