Sound Sleep Guru

04/25/2026

❄️Cold plunging since 2013

-Cold plunging is, among many things an invigorating experience. I love the way it makes me feel, but I’m also acutely aware of how it can be dangerous having experienced mild hypothermia from swimming in the Puget Sound and reading about someone dying in Lake Colchuck just last summer. I’ve also had it trigger and manic episode in the patient of mine.

-The first cold sauna in North America was and I made a special trip there when it opened and I remember one of my friends who was on the trip made fun of me for spending $40 for a 10 minute experience.

-What I realize now is that using a cold sauna is a much safer and controlled experience. And it’s amazing they are more widely available in the U.S. now.

-Have you ever tried cold plunging?

04/24/2026

🔄SLEEP and the MENSTRUAL CYCLE

-The menstrual cycle is not just a reproductive event!

-But the relationship is not simple. Some women have no obvious sleep change across the cycle. Some notice worse sleep around ovulation. Others have the most trouble in the premenstrual or menstrual window.

-Cycle related sleep disruption is often most noticeable when other symptoms are present — cramps, heavy bleeding, PMS/PMDD, irregular cycles, PCOS, or perimenopause.

-Have you noticed a change in sleep with your cycle?



REF: Alzueta & Baker, The Menstrual Cycle and Sleep, Sleep Medicine Clinics, 2023.

04/24/2026

1️⃣The most popular ring and watch based sleep trackers don’t measure sleep, they measure a proxy for sleep.

2️⃣Sleep scores are analogous to beauty standards. Not everyone should be measuring themselves against one standard (mostly young healthy men) and doing so causes harm and in many cases worsens sleep.

3️⃣Buying a sleep tracker won’t diagnose or treat any known sleep disorder.

4️⃣Fixating on % deep sleep or REM sleep doesn’t make sense if you understand the mutlidimensional nature of sleep quality and people who fixate on it might as well chase their own tail.

5️⃣Sleep trackers can cause a sleep disorder called orthosomnia.

04/23/2026

💊Dual Orexin Receptor Antagonists

-I’m hearing chatter about DORAs as longevity drugs and even getting patients asking me about it.

-Orexin antagonism is not a novel concept, Orexin deficiency the root cause of narcolepsy, an incurable neurological disease with increased cardiovascular co-morbidity. So I’m not betting on it.

-With time we’ll find out but I’m skeptical for now, as we should be if we are familiar with the historical use of sleeping pills.

04/18/2026

New substack post it up! Please subscribe to support my writing!

Why Some Songs Feel Like Memory Itself

04/17/2026

💊I recently started taking a statin even though my biomarkers aren’t “that bad.”

-Yesterday I unfollowed a family medicine physician with large following who was dissing longevity medicine saying she can do what they do within the current healthcare system. Which made me wonder how you can practice in corporate medicine, see how insurance companies are dictating care, gatekeeping lifesaving care, and not reimbursing at all for behavioral/mental health, and squeezing doctors into 10-15 minute visits and calling that the same thing.

-The pervading culture in our current model is to take care of acutely sick people not to aggressively prevent disease. If I’ve learned anything as a board certified neurologist, it’s that vascular health is the cornerstone of brain health. And we wait too long to prevent it, “watching and waiting” and not challenging people’s reticence to “not have to take something.”

-My Lipid Panel:

Total cholesterol = 176

LDL=78

HDL=81

Tri=84

LP(a)=39

-Not that bad but here’s the kicker. I recently went the longevity way and had a cardiac CT angiogram and I already have soft plaque up to 20% in several of my coronary arteries. Not really surprising knowing I’m almost 50 and don’t know my family history.

-Here’s the part I want to make sure you hear. I’m extremely fit, I pride myself in being able to say I maintain a fitness level of being able to run a half marathon or climb Mt. Rainier any weekend want to.

-Vascular disease is coming no matter who you are. We have tests that are not within the standard of care /covered by insurnace to help us make this risk/benefit decisions.

-I’ll give you some examples from sleep medicine in the coming weeks.

-TAKEAWAY: At the very least go get your lipid panel, Lpa, Apo B, and HrCRP measured. Even if you’re only 25.

04/16/2026

📍NEXT HEALTH BELLEVUE

-What an incredible night celebrating the opening of Next Health in Bellevue, WA! Next Health Bellevue

-I like to say that longevity medicine is preventative medicine rebranded. As a sleep neurologist, that message resonates with me deeply, a shared mission not to replace the traditional healthcare model, but to supplement it with wellness care and to ignite discussions about prevention and health-span.

-The CEO of Next Health Darshan Shah, MD has created a space many of us in medicine have dreamed about!

-For my patients I’m excited they can offer hyperbaric oxygen for those undergoing sleep apnea surgery and finally having a place I can send my patients to for IV iron infusions since none of the hospital systems or local infusion centers want to offer the formulation recommended in the AASM guidelines.

-Special bonus meeting Kelly Casperson, MD➖Urologist Austin Perlmutter, MD Tommy Wood

04/11/2026

I’m officially bringing my writing to Substack.

Introducing Modern Sleep: Sleep and Its Discontents — my new space for deeper writing on sleep, insomnia, sleeping pills, modern sleep culture, and the gap between sedation and true rest.

If you’re interested in smarter conversations about sleep beyond hacks, headlines, and oversimplified advice, this is where I’ll be.

Click on the link to read my first post and to subscribe.

And my mission to change it

04/11/2026

💤MODERN SLEEP

👩🏻‍💻 officially bringing my writing to Substack.

-Introducing Modern Sleep: Sleep and Its Discontents — my new space for deeper writing on sleep, insomnia, sleeping pills, modern sleep culture, and the gap between sedation and true rest.

-If you’re interested in smarter conversations about sleep beyond hacks, headlines, and oversimplified advice, this is where I’ll be.

-Link in bio to subscribe or to read my first post!

04/09/2026

📚My Personal Sleep Story

-I know some of you followed my MARPE journey in 2024 but I haven’t talked as much about living my entire childhood with an undiagnosed sleep disorder. And how transformational it was finally have it recognized, of all places and of all times doing post graduate training in the Stanford Sleep Clinic.

-Far too many people living with a sleep disorder get labeled as having depression, anxiety, post-partum anxiety/depression, headaches, chronic fatigue, ADHD or even called a GREAT SLEEPER due to lack of education and knowledge around DIAGNOSING AND TREATING SLEEP DISORDERS!

04/08/2026

💊SLEEPING PILLS are more common than you think and we need to talk about it!

‼️A nation this medicated for sleep is telling us something

📉In 2020, 8.4% of U.S. adults took sleep medication most days or every day. The numbers were higher in women, higher with age, and higher in some lower-income groups. The scale of medication use should make us pause. This is not just about insomnia. It is about the undiagnosed conditions being missed!

-There’s a lot of stigma and shame about sleeping pills and I’m here to tell you this a problem we can fix, we are not waiting for a cure. We have the technology and knowledge to solve this problem so let’s change it.



Reuben C, Elgaddal N, Black LI. Sleep medication use in adults aged 18 and over: United States, 2020. NCHS Data Brief No. 462. National Center for Health Statistics; 2023.

04/06/2026

⏪Rebound insomnia is one of the biggest reasons people feel trapped by sleep medications.

-Not because the medication was “working so well” for sleep itself, but because when you stop it, your sleep can temporarily get worse than it was before.

That rebound can look like:
-worsening difficulty falling asleep, more nighttime awakenings, lighter sleep, anxiety about bedtime, and the terrifying feeling that your body has “forgotten” how to sleep on its own.

-But that does not mean you are broken.

-And it does not mean you need the medication forever.

-In many cases, it means your brain and body are reacting to the sudden absence of a substance they adapted to. That reaction can feel so intense it can feel like a medical emergency.

-This is why people need better education around sleep meds:
withdrawal insomnia is often mistaken for proof that the medication is necessary.