ANDREA BACELAR (PRIVAÇÃO DO SONO E BEM-ESTAR MENTAL) - PODPEOPLE #231

[Music] [Music] [Music] [Music] [Music] เฮ [Music] Before we start, I would like to ask everyone who is here to subscribe to the channel, share our content and activate the bell to receive all the news, okay because then we will be able to make more and more episodes that will be very good for everyone. Our guest today is a neurologist with training in clinical Medicine and sleep medicine. She is vice president of the Brazilian Sleep Association in Rio de Janeiro and also works in the coordination of technical content on sleep disorders aimed at updating professionals in

the area. In today's episode, we will talk about the impact of sleep deprivation on mental health, the excessive use of sleeping medications, the phases of sleep and the challenges of achieving healthier rest. With you, Dr. Andreia Bacelar [Music] [Music] Hello everyone, welcome to another episode of Pod People, a place where we meet to see and hear people, people who do things, people who make things happen, people who inspire . Today's guest is a neurologist specializing in sleep. Her name is Andreia Bacelar. How are you, my dear? Thank you very much for the invitation. I'm very

happy to be here. I hope it's very productive for everyone, because people need to know about sleep, and a lot. I think that in a society that has this thing of never stopping, people have never had So much misinformation about the importance of sleep. Not this 24/7, where people live 24 hours a day, 7 days a week. This is falling into disuse, right? The work that I have to do, the companies themselves are understanding that it's not possible. It's not going to be like this because it's going to depress. The truth is that it's going

to depress the brain. It's going to be absent. There's going to be a breakdown. It's going to be a breakdown, right? My dear. Before we start, I wanted to ask you a question. When was the first time you said something like: "My God, time is passing?" Look, it was menopause, menopause itself. Menopause. I mean, since I had already had a stereoectomy a long time ago, I didn't have this thing about regular menstruation, etc. Then suddenly, what all patients say, right? I'm waking up with those hot flashes. Take off the blanket, put on the blanket. Suddenly,

I found myself in this situation. That's true. Wow, I'm taking off the blanket, putting on the blanket. Sweating. What's up? I'm already this old. Why are we getting there? In the past, when we used to say, " 50 years old, 60 years old, grandma," and today we don't feel that way. Today, life gives us this Prevention, right? People who take care of themselves understand that the tripod of longevity is very important, right? Of course, you've already said this here 50,000 times, right? But we always have to remember the right things. The truths have to be

said over and over again. So, it's food, exercise, and sleep. And good sleep. That is, understanding this sleep as a situation, an involuntary, non-negotiable phenomenon. We need to understand that sleep is necessary. We spend 1/3 of our lives in sleep Why live the others 2/3 Produced And we lose a few things, right? For example, today I am a person who supplements some things. For example, I don't give up my omega-3. I don't think I give up my coenzyme, which is 10. Vitamin D, which is there for people in menopause, right? To avoid osteoporosis, which we

have to take care of ourselves. Vitamin E, which is this antioxidant, right? It's very good for the breasts, right? I've always had that thing, it's very good. So today we have a privilege. Today, we have your episode sponsored by Vita, which is a supplement company, right? One of the partners is Gustavo Borges, who is a guy who talks a lot about health. And it's Cool about Vita, it's a company that relies on scientific articles, so it's not like that, ah, supplements, because supplements don't have content. And there's also a cool thing that all their material

is internationally certified. So we can relax when it comes to using it, because there are things that age takes away from us, there's no way around it. We have to supplement. We have to complementary And they have a wonderful launch that you will win, which is omega3 and three in one that comes with an enzyme that is 10 vitamin D and vitamin E Oops I'm not going to walk around with that huge kit anymore Exactly In just one and in the right dose I'm traveling to Portugal soon to give some lectures I said people have

to start packing I had to put it with an enzyme that is 10 oga3 vitamin E vitamin D When they sent me this I said: "No but I 'm going to see if it's in the dose that I take and everything the dose is international" So two capsules a day we solve that At least it gives me a lot of practicality and I'm sure and in life we ​​have to go after it, you know, not waste this time with things that can help us, not supplements, right? Today we know the effect of omega on circulation

in the brain and the heart, cozimaquedica that gives this boost to metabolism, this vigor, this tension and concentration that can't be replaced by coffee, right because there are people who say: "Oh I'll have a coffee" But then they won't sleep Exactly Keep having coffee, coffee won't sleep We really like it, but we have to understand that it is a stimulant that gives you this disposition without that, right? Vitamin D, which in addition to the issue of health and osteopenia, also strengthens immunity and Vitamin S is an antioxidant, which is wonderful for us women, right? So

you will win. Look here, this little bag was sent here especially for you. Here is what I told you. Then check it out properly, because you are a fellow doctor, so you can check it out. Thank you. You can leave everything on the side and the children will fix it for you later. And there is more, Bru bia. Who is watching our podcast here, Pod People. Also remembering who is watching on Spotify Vita with H Vh i TT That's right. There is the official website vita.com.br where people can use the coupon. Our Podip coupon .

There is also the QRCode on the screen. Who is watching can use it on the official Vita website vhta.com.br. This is important because I don't know if you have ever experienced this, André. Eh, they put me to sell products that I have never used. I never know, especially with artificial intelligence. Then it simulates. Oh, horrible. There was a There was a month when I had to warn people every week. I'm not. I'm not. I haven't tried it. I don't know what it's about. That's why we aim for it so much. Vita is written as VHI

TA because there are so many people who will remove the H and send a scam because then they send the scam. The person deposits the money and doesn't receive anything. If they received it, they would also receive rubbish. So that's how we reinforce this even more because we end up being used for this, right? Today, today, you have to be very careful. Be very careful. But come on, my dear. I wanted you to tell me a little bit about medicine and about choosing the specialty of sleep. So, medicine, look, if I go to those children's

albums that we used to photograph and print in the past. I'm there, 3 or 4 years old, already with a stethoscope examining my dolls. And I come from a family where my father and mother, right? My father is deceased, but they were both doctors and neurologists. Both of them were neurologists. My mother is still working, my father has already passed away. And then I come to listen, right? The family was medicine, medicine, patient, hospital, that was it. Ours coffee, our lunch, my brothers are also there and medicine. I want to be a doctor. I want

to be a doctor. It was something that I, that today I think is genetic, you see, because after I went to school, I am the firstborn and then two more brothers, medicine. The brothers, medicine and neurology. I understand. So there are five neurologists in the family. I was born in the hospital where I went to college. I was born in Pedro Ernesto. Oh, you were born in Pedro Ernesto. I also studied Pedro Ernesto. My mother studied medicine in Ped. No. No. No. No. EEG at the time, right? Then Er. And then Erge.EE. I was born

in Pedro Ernesto. Then when I went to medicine in Erge. My teachers, who did my delivery room, were my teacher, who was my pediatrician. My teacher was my pediatrician at the time. So it was like that. I was at home, I was literally at home. And then my father Specialized in neurology. So at the time of the electroencephalogram, my father was a pioneer of the electroencephalogram in Rio de Janeiro. And then electromyography, which is the exam that gives the results. little shocks, right, to see peripheral neuropathies and polysomnography. So in 2000, in 2009, 25 years

that I've been doing sleep. Look how old age comes, right? In 2000, I decided to specialize in neurophysiology in this area of ​​sleep, doing this sleep exam, studying sleep, polysomnography, which was a paper, a lot of paperwork, look, imagine 8 hours of recording. We took a lot of paperwork that size and, logically, things were digitized and then they became easier, right, and easier to adjust the equipment. And we started doing polysomnography and studying the sleep of patients. 25 years ago, when I said: "Look, you come to sleep here in the sleep lab. People, like, sleep

outside the house, put on a bunch of wires, how come? How does the media, social networks, part of the press help us, right? I mean, there's the fake news, of course, but they help us a lot today to spread knowledge. Today, the patient comes to me, doctor, And I think I have apnea. I wanted to do the sleep exam I said: "Oh, you don't have to convince anyone, you know, sleep is important and since today people are much more concerned about sleep than they used to be, right? And you're saying that, you really were pioneers,

right ? When I started working in psychiatry, I put polysomnography as a protocol because, dear, those who don't sleep well don't have bipolar disorder, and you can stabilize the person by sleeping poorly. There's no depression that improves with the person sleeping poorly and getting out of that cycle of taking sleeping pills because those who take sleeping pills don't sleep well. They might not even wake up, but then saying they sleep well is another thing, it's artificial. Exactly. So I remember that it was very difficult and your clinic was the only one that had it. For

a while, you were the only ones that offered polysomnography. It was very difficult. I had a patient who had to go to São Paulo. It's true. Only in the past did I train in São Paulo at Unifest at the Sleep Institute. It was my house there. It was your house there, which was something I said, people, but it's something like that, right? You guys popularized this. I think it's a really cool thing. Your father brought up the issue of the electroencephalogram. There's no doubt about that. And then you came up with polysomnography. I wanted you

to tell us, for the public, what sleep is. What are these stages of sleep that everyone talks about but only talks about the kidney phase as if there were only one phase, and its importance. So sleep is an involuntary phenomenon, as I said. So we're going to sleep at some point. I can go on a hunger strike, but we won't go on a sleep strike. And then we, the human being, sleeps in the dark phase of the 24 hours. So it's at night. Sleep is at night. Those who work in shifts, which today is 20%

of our population. 1/5 of our population will be out of rhythm. That is to say, sleeping during the day, even if it's the same 8 hours, is not the same as sleeping at night. And we need some sleep time for this recovery, and that is also individual. It's a question that always comes up. How much time do I need to sleep to sleep well? That's individual. We know. that the adult between 40 and 60 years old is between 7 and 9 hours of sleep. That's 7 to that is an adequate amount of time. There are

Short sleepers who are not sick. I mean, I sleep 6 hours but I'm mentally and physically well to live that day. OK. You need it if it's always been like that. Exactly. And there are people who need 10 hours of sleep. They are exceptions, they are extremes of the curve, but there are these people and we have to evaluate because sometimes, oh, I'm exhausted, I have a sleep problem because I'm sleeping 7 hours but I need it, right? Or, oh, I'm coming here, doctor, because I only sleep 6 hours and they say I need to

sleep 8 hours. It's really 8 hours. And we're going to investigate and no, I don't need it and it's OK. The body is super well. And then in that sleep, that night, we live sleep cycles of four to six cycles. Within a cycle, we go through some stages. So, stage one is the transition, it's sleepiness, wakefulness, that little thing where we lie down and start to sleep, that little laziness. I think I'm going to sleep Stage two light sleep We spend 50% of the night in light sleep That's right, it's because the moment of the

periphery of what we lived and learned during the day goes to a region of the brain called the thalamus and it distributes it to the interested cortical areas Needed for this information that we have every day Information from every day So stage two stage three is deep sleep it is not sleep that is deep sleep So stage three is the moment when the brain rests it is the moment when the brain waves are slow it is the moment when the information arrives there in the brain and the body is already relaxed but not as relaxed

as stage R which is the sound in the huh This acronym in English R is rapid and movement which is a rapid movement of the eyes Laughing of the eyes There is a moment if we look at our dog our pet when he is moving his little eye like this oops he is asleep rê children too you put the child to sleep or go see if he is sleeping then the little eye is like this right exactly So sleep kingdom what happens in this stage body paralyzed So the body the muscles are paralyzed resting The

brain is in an activity similar to that of wakefulness so very fast wave That is why the dream the dream activity happens in REM sleep at this moment of sleep Because it is in activity in the dream Producing a dream is like producing a film, a short film, Exactly, That has no true content, but we are Dreaming at this moment. And one of the disorders that exist is called behavioral sleep disorder. I punch my wife, I kick the door, I get up and fall. This is what acts as a reality. If this happens, it is

because the paralysis of the muscles is not happening. So this is a discourse, a problem. So at the time of the dream, we are paralyzed, that is why we do not live the dream. This applies to nightmares. In a nightmare, you are paralyzed too. It is supposed to be paralyzed. Stuck, right? In this, in this, in a dream. It is bad content. Of the dream. Only this changes. Because I know people who, in all nightmares, want to punch someone in the face and throw someone out. No, this is a behavioral sleep disorder. In the king,

today I include a parenthesis here, right? Because I study neurology. Today we know that this is a predisposition for neurodegenerative diseases. So thinking about up to 10 years from now, having, for example, Parkinson's disease. Uh, having behavioral sleep disorder. sleep re turns on a yellow light prevention, right? Concern about having it there in front, trying to prevent as much as possible? Exactly, right? So stage One, stage two, stage three, which is the deep stage, where the brain recovers deeply. Exactly. And sleep rein, which is the moment of memory consolidation. But you're in stage three, right?

It's another stage R. Fourth stage, stage R, only in REM. It's the moment that consolidates memory. I mean, I took the information from it, it's not in REM. I'm going to put it in the folders there, right? I know that Ana Beatriz does the podcast. Now when I sleep, I'm going to put it like this: "Wow, I went to the studio, I met everyone, how wonderful." It's time for this one, go make the folder . That's not exactly Perfect. And then there are some more, no, they're not those. And then we live these stages, one

cycle, another cycle. So I can go through sleep rein four to six times. Oh, I don't dream. That's another very frequent thing. I don't dream. No, you dream. You don't remember the dream. Remember the dream. And why do we remember the last one, for example, because we wake up very close to it, right? When we live a cycle and move on to another, we don't necessarily wake up, right? I went to bed at midnight, woke up at 7, and slept straight through. So you Lived these cycles, but you didn't wake up after REM sleep in

the second cycle, but in the fifth cycle you woke up. Wow, I was dreaming about this. Then you can remember it close to the time, right? When you have the dream phase, close to the time of waking, you can remember it, it's much easier. Others don't. Others don't. So what's happening is always there. Exactly. Interesting . You talked about the behavioral disorder of REM sleep. Much more than people think. People have to understand that having this is not normal. During the dream, we don't move. If we are moving, we need to treat it first because

we can hurt our partner and we can hurt ourselves. We can fall. There are patients with a fractured clavicle. Patients with head trauma patient who puts his face in the glass of the door So this exists So it needs to be treated and we need to signal it, including doing a neurological exam to see if there is already any motor alteration that we can treat, try to prevent this degenerative disease thing You even mentioned Parkinson's, right, and it also applies to Alzheimer's, for example No, no Sleep-behavioral disorder Renucleinopathies There are dementias that are associated with

this alteration And I can have sleep-behavioral disorder and have dementia too But it is not Alzheimer's type dementia What has been studied the most is Parkinson's It is Parkinson's Dementia with Levi bodies, which is another type of dementia that I also have motor alteration, so I can also have a sleep disorder. I didn't know that Bru, you have this, no, no, that I stay like that, I don't remember my dreams It is rare for me to remember that I dreamed, but I don't usually wake up I have never faced someone sleeping next to you Fell

woke up fallen down There was one time that I caught myself snoring I was I woke up you know snoring I caught myself snoring Look at that, people rarely talk about it because when we talk like that, it's either our husband or wife who sleeps with us. You snore. I don't snore. We can't testify, people. We can. Exactly. I believe it. If someone tells me that I snored, I 'd say: "I was on my side, I was on my back." OK, because if you're on your back you 'll snore more. Because this region, the tongue

drops, narrows this space, which increases the Vibration of the roof of the mouth. The soft palate vibrates, which is snoring, right? So the vibration of this region, that 's snoring. But people who snore usually testify against saying that they don't snore. Oh, what nonsense, right? And we have to understand that snoring is not normal. Snoring is also a warning. Look, the air is passing through narrowed. Could it be obstructing the passage of air, stopping the oxygenation of the brain? Because that's what I used to tell patients to convince them to do a polyphonography, Andreia. Why

did I say it to them? But why did I say: "Honey, look, I don't know if you snore? No, I don't, but I don't know. I'm not with you. You live alone, so if that stops you from oxygenating your brain." Exactly. That can happen. I had a patient who had ischemia and only found out about the apnea after the ischemia. Many, many arrive with heart attacks or ischemic strokes, and then the doctor will do a polysomnography. 60 to 80 apneas per hour. Exactly. And that doesn't mean it didn't reach 60 from yesterday to today, right?

It's been 10 to 15 years of sleeping badly. And the most important thing, Ana, is that people don't make the association that I'm tired during the day, I'm sleepy, my blood pressure is High, I can't lose weight, I'm irritated, my mood is depressed, headache, headache, waking up, right? Morning headache has a lot to do with sleep apnea because it lacks oxygen. What do the vessels do? They dilate to get more blood. Then a transient cerebral edema is generated. So I wake up with that headache, then I drink caffeine, I start to feel exercising there improves

the pain So we don't make the connection with these complaints about the polls, could it be because my sleep is bad, could it be because of the quality, because then it's okay, you can even sleep at 7 or 9 o'clock? And the quality of sleep, how is it exactly? So people don't make this association and then they go to a bunch of colleagues who even have to treat because there are comorbidities, right? I have depression and insomnia, I have reflux, reflux and apnea, there's a huge association. So I'm going to treat the reflux, I'm going

to do an endoscopy, and you didn't treat the apnea that's causing reflux. Exactly. I had a patient, André, who peed a lot, it was strange. So I asked for a ultrasound exam for general apnea. People, look at you and out of the curve, you were there, tuned in because Nocturia, nocturia, he said, I'm always in the bathroom. Then I dosed normal insulin, normal glycated insulin. I said: "People, it's not a diabetes problem." I said: "No, sir, now you're going to have to do the polonography. You ran away at the beginning, but now I need to

know about this." Yes, but look, many people don't know that nocturia has a huge association with hypoxia. When you have an intermittent drop in oxygen, this increases the production of the natriuretic hormone, a hormone that increases urination. in the bladder So we have this reservoir that I pee before going to sleep 8 hours I wake up and go pee If it fills up early something is happening and sleep apnea loss of oxygen generates nocturia Exactly So it's another evaluation You go to the bathroom at dawn oh doctor you get up about two times three times

to go to the bathroom Oops That was five I said: "No if your glucose is normal you don't have an enlarged prostate." There is no enlarged prostate I'm sorry you're going to have to do it there nowadays there is still postography that you can do at home Ex That's it I would like to emphasize this because people come and say like this: "Oh doctor You haven't progressed you can't do it at home there is home polysomnography." The issue is that the vast majority of these exams are polygraphs. What is polygraphy? It doesn't have the word

sonography. So we don't know if someone is sleeping. We don't know the stage of sleep. It's a polygraph that records brain activity. It's a summary. We only see if they stop breathing or if they don't stop breathing. If oxygen drops, if their heart rate increases. That's what we can do. Uh-huh. But when there are these patients, I do this at home. The issue is that I have to be sure that this patient has moderate to severe apnea and that they don't have other comorbidities, such as a behavioral disorder. It won't see. It won't see. It

won't see. It won't see. It wo n't see. It won't see. It won't see. It won't see. It won't see. It won't see. It won't see. It won't see. It won't see. It won't see. It won't see. If I have restless legs, which is another syndrome, I 'll have abnormal movement at night. I won't see any of that. I won't see the stage of sleep. I won't see. I won't see. It ... I can, because I'll just assess the severity. But if I want a more complete exam, a supervised exam, let's do a proper exam

on a proper night, so I'll have many more variables to analyze to rule out problems than doing a summary and then I'll say: "But I prefer that you do this because I suspect that you have one more little thing." Exactly. So these differences are important. Perfect. Because there are people who don't leave the house, but it's one day. And in general, today's clinics are actually quite comfortable. There's support. We're not in a five-star hotel, but we try, right? Air conditioning. Darkness. TV, right? Television has a time to turn off. But TV was something like that

forbidden years ago, right? I'm from the old days and I was there. You can't have a TV in the room. You can't have a TV in your own room. You can't have a TV in the clinic. Today we know that television is a distraction. So it distracts, right? Some people relax, right? I'm there watching. I'm not thinking about my problem. You don't even see. Logically, I'm not going to put on the episode of the series that I want to watch. Then I'll go to an Action movie. war, right, why does this happen? But the fact

that I'm there, I'm turning off and I'm slowing down, I'm giving in to sleep, it can be beneficial for some. So we, right, don't just have more flexibility today. That's what we're flexible about. A little bit more. Now it 's good to turn off your cell phone, right? Oh, look at us, because the television was replaced by the cell phone. We have to understand that the cell phone has many issues. First, the brightness of the screen is a frequency of blue light, and it's a frequency that tells the retina that we have a sensor that

is our internal pacemaker that will tell the gland that produces melatonin immediately. This light is here, and it will say: "It's daytime, don't produce melatonin." It goes straight to the pineal gland and blocks melatonin production. What is melatonin? Melatonin is the dark hormone. People think it's the sleep hormone. So they take it. Every patient who's come to my office will say: "I've already taken melatonin and it didn't help, and I didn't sleep." But they took it and the condition didn't get darker. Melatonin is n't hormone to induce sleep Melatonin is the hormone that will tell

our cells In the central and peripheral nervous system It's night announcing the thing to lower the activities From here a little while you'll soon in about 2 hours you'll go to sleep Uh-huh So this neurohormone that we produce when I put a light on here it will say: "It's daylight, don't produce melatonin" This is one factor The other factor is the stimulus interest Wow who sent me a message how many people liked my post oh wow the person called me I'm going to call them I mean that's what I'm accelerating intense brain activity I'm activating

I have and depending on whether you're there on Instagram on TikTok there's the release of dopamine So you don't sleep you don't sleep Stimulation is and excitement right up to noradrenaline right which increases the heart rate the respiratory rate that melatonin will tell the lungs and the heart to slow down Now it's time to relax Now it's time to relax So two questions there First understand that melatonin is not a sleep inducer that melatonin is not a supplement you know melatonin is a neurohormone different from omega-3 bcaa creatine eh eh vitamins etc Uh-huh Eh We

're talking about a hormone that is produced to make us slow down to sleep. Then people go and buy it and take it and take it with 10 mg. It's not going to the United States. Here comes look, I got a good 10 mg. I said: "My Jesus, this is an overdose." It is an overdose, right? And the time, for example. Then we can talk about Bru's. Because Bruno goes to bed early. It's Bruno. Can I say Bruno? Of course. Bruno told me that he goes to bed at 8 and wakes up at 5. What

does this mean? Does this mean that his circadian rhythm is advanced? His melatonin is produced around 6 pm. The extreme is phase delay. The one who sleeps for 3 hours, melatonin starts to be produced at 1 am. Where Bruno is at the peak of melatonin, he is still starting to produce melatonin. So people have to understand their chronotype. Chronotype is your genetic preference for bedtime. That doesn't change, people. It's in your DNA. You've always been like this, Bru. So after the pandemic, I changed this sleep schedule because during the pandemic, it wasn't anymore. Before the

pandemic, before the pandemic, I slept at 11. No, but I want to explain something. Bruno is young, okay? Let's go. Look, He's young. During adolescence, regardless of your chronotype, there is a tendency to sleep later. This melatonin curve is delayed, regardless of your chronotype. So teenagers sleep later. In addition, teenagers have screens that they don't understand. They don't have this awareness that they need to put them down an hour before, right? Turn them off. An hour before going to sleep. We didn't have at least one hour before. And it's not like that, oh, because my

alarm clock is here, no, it doesn't set it. So this one can't be your alarm clock because you're not mature enough to leave it on the side. You'll get it. And the other issue that is very serious for teenagers is school schedules, you know, I, at the Brazilian Sleep Association, which is now the Brazilian Sleep Academy , we tried, through Brasilia, through politicians, to change this high school schedule. In the United States, in Europe, high school is already the law. Instead of this teenager going to bed at 7 in the morning, he goes to bed

at 8:30. I mean, this sleep cycle is essential for him to arrive and be alert, to be active He later That's what you said the peak of It's logical that what parents Say oh but then I'm going to let my son No you won't let him You're going to ask him to stop using his cell phone at 9 o'clock at night You're going to ask him to slow down to 10 10:30 at night he goes to sleep and wakes up at 6 7 o'clock because the math doesn't add up The teenager is not yet in

this age range of 7 to 9 hours He is in the range of 9 to 11 hours of sleep So he needs more sleep and sleeps less He sleeps later and needs to wake up at 5 6 o'clock to be in class at 7 The math doesn't add up So what's going to happen he's going to sleep the first few hours of class In the pandemic what happened he turned into asynchronous at night so he could attend class in the afternoon and then he attended classes online So we need to change this policy of this

schedule in high school at least in middle school because it happens because of this change in the melatonin melon curve is thrown forward It is thrown forward in the teenager So we Of course, parents have to discipline them. They have to take away their phones. They have to try to slow them down so they can go to bed earlier, since they won't be able to wake up at noon. They'll have to wake up at 7:30 to be In class at 8:30, but at least 8:30, not at 7. That's a crime. I think the ideal would

be 9. Well, it's a crime to wake up this teenager who is in the growth phase. This GH hormone, the growth hormone, is only produced in N3 in that deep phase, in that deep sleep. It's only there that it's produced. So if I'm sleep deprived, if I'm having less deep sleep, I'll produce less GH hormones and I'll delay all development. I'll delay development. So, people, it's physiological. We can't go against the physiology of the body. That's why André, who has this thing about teenagers having a lot of sleep. The parents talked a lot about it.

He was a great student. He entered adolescence and he's terrible. He sleeps in class. The teacher already told me to. It's a mess, it's a fight in the morning. And another important issue, Bia, is that teenagers are sleep deprived. Sometimes they don't have it. as much sleepiness as an adult, he has hyperactivity, agitation and irritability and poor school performance. Then he comes with a diagnosis, my son has ADHD, he's already had it. He didn't have it, right? Because you've always had ADHD. Then he started to have it. He started to Have it in adolescence. Why

is it that he's sleep deprived and then he comes with an ADHD diagnosis or is already taking psychostimulants. Say: "No, dear, he has to stop taking the psychostimulant and sleep more, and his agitation and hyperactivity will end." Exactly So, we have to become aware of the importance of sleep, right? Sleep is a priority, right? And logically, adults, especially you, are already over 40 and over 50. Is it worth it for me to go to this party? Is it worth it for me to stay up all night? Is it worth it? We start to consider whether

my sleep is worth it? My next day is literally ruined, tired, without memory, unable to produce, with diminished reflexes, domestic accidents in traffic, right? There is a study that shows that 25% of drivers are sleepy and very sleepy. So, if you understand, I stopped at a traffic light. There are four lanes. One of the four can fall asleep at the wheel at any time. Look how dangerous. Danger to him and to other people. That's a fact. That happens every day. Uh-huh. So, I think it's very, very appropriate, very serious for us to say, right? Don't

drink and drive. It's the second Leading cause of accidents, but the third very close is to drive. If you're sleepy, don't drive. Don't drive because drowsiness is similar to drunkenness. Very exactly, because alcohol is a depressant . central nervous system and we're there we need to sleep It's very common on Friday, right? You woke up at 6 o'clock, you worked all day but you gave up. I'm going to sleep now because you're screwed. Because besides sleeping badly, alcohol is a good sleep inducer but it doesn't keep you asleep. It doesn't reduce the amount of deep

sleep. It's that person. I woke up with a hangover, but it wasn't just because of the alcohol. You woke up with a hangover because you didn't have a deep sleep. So you slept badly. But that person, she didn't even drink, but she extended that sleep. She woke up at 6 o'clock. She was going to sleep at 10. But if I'm here, I'm going to go out and have fun and I'm only going to get in the car at 2 o'clock in the morning to go home. I'm drunk on sleep and I can doze off in

the fog of sleep. You said something fantastic because there is sleep drunkenness. There are no studies that show it, right? The longer you 're sleep deprived, the more alcohol you consume is proportional to it. Sleep drunkenness That's why The term drunkenness is totally compatible. Now imagine this: sleep deprivation with alcohol. Wow there it is, it is an announcement of the tragedy It is an announcement It is a tragedy that has been announced and we see it a lot, right? Today there are a lot of them in Rio. One thing that works is the blitz It

is the law Dry Law It works Maybe it is the only thing that works in Rio de Janeiro better than in the whole country And when it starts on Thursday, Friday, Saturday you will go out and there will be drought And if they educated themselves, people were educated in the same way as seat belts, which they didn't even wear now, it's a fine Exactly So let's put them on There is always someone who doesn't drink to take people I mean, great, it's even becoming more of a camaraderie because I I see this in our children's

generation, right? My children already have this, like, no, I'm not going to drink, I 'm going to drive or so-and-so will drive or we're going to take a taxi, an Uber, exactly, it already exists. It's beautiful because in our generation there was no such thing. It's true. In our generation it was the opposite. The kid who drank and drove well, we thought it was great. Like, so-and-so drinks, knows how to drink. Remember that, how can it be? And we thought, you see, he doesn't get high. He takes everyone home. How Reckless. Today, there are no

more people. Today I look and say, "I could have died so many times." It's true, right? In a silly accident and seatbelts weren't worn. There was nothing like that. So, that's really alcoholic drunkenness. It exists. It does. The other issue is professional drivers. I was going to say that, truck drivers, the great class, and those rivets that were banned. Anyway, it's difficult, it's difficult, but there's that parallel market there, right? And then caffeine and amphetamines, which are stimulants, improve alertness, they improve it to a certain point. Exactly. There comes a time when caffeine and amphetamines

are no use. The brain will get depressed and it will falling asleep That's what you said It's a phenomenon that imposes itself Sleep imposes itself It's a need of the brain to exist To continue functioning And then we have the so-called microsleeps driving Yes Yes Imagine I'm here 90 km/h The microsleep which is that slower blinking and opening the eye takes 5 seconds So imagine 5 seconds at 90 km/h I drove more than 100 m sleeping Sleeping That's right And then the nap is a serious accident Why because there are no brakes Most people who

dozed off have no brakes Because I'm sleeping then I Poof crashed And there's one thing for the driver Since he's relaxed he has a greater chance of not having more serious things For the person in the passenger seat The possibility has already seen that in many accidents the driver ends up almost injured Because if he had the microsleep he's a little relaxed The other one is desperate, right, he's seeing the thing happen So he tenses up all over when he crashes The impact is much greater I think we have to understand that this is this

omen, right the rules, right? First , I need to stop every 100 km. Try not to drive at night. Professional drivers today have a certain amount of driving time. They have to stop. There are spaces with lots of light. You know, the light inhibits melatonin. That's it. So, it gives you an alert. Have someone by your side, right? Have a second driver who stays there, attentive, who stays there, talking, who notices that you're quieter and more relaxed. It's because this thing of looking, I put my hand on the roof or I put the wind in

my face or I turned the music up loud. That doesn't prevent sleep. So understand that it's not like that. There are some cars now that have a sensor. It has to be exactly that. If you start to get off track, right? That already helps. It Helps. I think we're getting better. We're getting better. And people with this awareness of sleep, right? The biggest issue is, for example, we're talking about an issue that we talked about, about snoring from sleep apnea. Professional drivers usually eat very poorly, are overweight and don't exercise. So the chance of them

having sleep apnea is huge. If the We understand that 30% of the general adult population has, I'm talking about 1/3 of the population, stops breathing. Brazilian study point This population is more than 30% because they are still in that state. They are between 40 and 60 years old. They are overweight and probably have high blood pressure. They don't exercise. So we can say that I'm talking about half of the drivers. So they sleep badly and when they sleep they stop breathing. So they are potential accidents, and we see them every day. We see accidents involving

trucks with professional drivers every day. It's very common. It's very big. So this driving thing should be like this . I'm going to renew my license. For this group, Polysomnography should be mandatory. You know, there are some measures, like neck circumference measurement, abdominal measurement, and there is high blood pressure, but some places don't even do this assessment and then they renew the license just for ophthalmological reasons. You see, OK, renew it. Exactly. It should be much more rigorous, right? But much more. And today, polysomnography has become a exam for I routinely access it. It is

more accessible, right? The whole country has a sleep laboratory. Unfortunately, the SUS is lacking, but universities already have the service, right? The universities that every medical school has it generally have it. In Rio de Janeiro, we have it in São Paulo, and in the big capitals, there is one. So, seek help, right? Sometimes the professional driver comes to me and says: "Doctor, no one can know, but I want to know because I want to get treatment, because I've caught myself falling asleep at the wheel." And he's afraid of being fired, he needs to sustain his

path. If he has an accident, he'll be out of action for how long. And if the truck is his, look at the loss. So let's take care of it, right? We have to take care of this sleep. We Have to prevent serious issues, for sure. This is a driver who is even lucid and conscious. It 's not the majority. There's still this 30%, that's not the majority. It's not the majority. Bru. Let's see the images that we have here. First, your book, right? You do this sleep series, right? It's a series from diagnosis to treatment.

We have three, right? We have diagnostic methods. We only have treatment. Just one treatment book. And we're going to launch a book for non-specialist doctors, like clinical gynecologists, because women, for example, don't look for them. They go to gynecologists once a year and there they say: "I have insomnia." That's right, right? Or the geriatrician, the elderly person goes and looks at my sleep, it's not good, right? And the geriatrician also needs to ask this. So we have a series from the Brazilian Sleep Association that I and Dr. Luciano, we participated in all four, the fourth

one that will be released now at the Brazilian Congress. So it's very important, isn't it nice for colleagues, and not to be embarrassed to ask. And you can also ask for the exam to be referred to a sleep specialist, but it's already a good idea. Have you ever thought about it? The patient arrives with His polysomnography, look how much you've done? Yes, it's true. So it doesn't cost anything. That's why others who are not specialists make the specialist's life easier. It doesn't cost anything, right? The same doctor who stamps the order is the same one

who will order any other exam. But what I see a lot is that this doctor receives the exam and he doesn't have this training, he doesn't know if he wants to interpret it, and then, oh, okay. And then he doesn't value it, and the patient then looks for one two years later, oh, no, I've already done this exam. When we see moderate apnea, you know, hypersomnia, this patient is very sleepy, bruxism, very low oxygen saturation, right? After COVID, people understood what an oximeter was, right? Put your finger in. But then we see, look, look how

your oxygen dropped. That's a lot. serious, right? There are other markers besides the Aparelho de Estância index, it's how much oxygenation you have in that arrest. That 's exactly. Did you understand why some people say there weren't four arrests, but the arrest was 80? That's exactly. It's an important marker, not just the PINE index. Exactly. So I always asked, I knew how to interpret it correctly , but when something bigger came up, I said: "Don't go to the sleep specialist." I said: "Look, you won't even need to do the exam again, it's more expensive because

I'll have to do everything." No, you won't. Go to the solution. That's the Ateneu bookstore. Anywhere we can find any colleague and colleagues at the entire congress, right? You have that bench at Amazon. I believe so, because there it is. I believe I, I don't know. But I think there may be, but I think so, because today all the publishers, right? Are there, right? There's this one. There's another one, right? Bruno, which is therapeutic updates. That's it. That's it. That's just treatment. That 's it ... Now we're launching the fourth one, which is just the

diagnostic method. And now we're launching the fourth one , which is just for non-specialist doctors. It's great to get in touch. It's already being designed. It's ready to launch, but we should launch it at the Brazilian Congress of Perfect Sleep. So I'm already thinking that it's going to be in Salvador this year. Oh, so it's great. We always relax in Salvador, Right? I think they have fewer sleep problems than we do. They're more relaxed, less stressed That thing stress no stress no Our stress What's this next Bru There's the issue of apnea, right? I don't

know if this picture is good It's excellent Look so we can see we can breathe through the nose or breathe through the mouth Mouth There's the normal flow and not have apnea Look here the air is passing through Very good Thank you That's what apnea is Look Either the roof of the mouth touches the posterior wall It would be this soft part Soft or the tongue that touches and in the air So both conditions prevent the air from passing That's both what comes from the nose and comes from the mouth That's what sleep apnea is

That's what respiratory pause Perfect And that's it and then when oxygen drops carbon dioxide increases the brain notices this change in gases and does like this wake up and breathe And then ooo snoring is the resuscitation Exactly You resuscitate every minute of sleep with sleep apnea You have a respiratory arrest That's what I was saying people it's a stoppage Do you know what a stoppage is exactly When the person the person says it's as if I were drowning I didn't say your brain is Precisely preventing you from drowning Exactly But only 10% of people who

have apnea choke or suffocate Then I woke up without only 10% So 90% go by silently Whether it's silent or not, the partner notices that they snore, right, but they don't notice that they have the problem So it's very serious And that's why most patients arrive with moderate to severe apnea We can't make an early diagnosis of the problem Early Perfect Next Bru Here, this engraving that they selected, I think what looks cool there is the pineal gland, right exactly Look at what I said here Look at the light The light being captured Look at

the retina And right here is the pacemaker The pacemaker, which is this pacemaker here, is because this here comes the light, it's here, look It comes directly here to the pacemaker This internal pacemaker, which is the suprachiasmatic nucleus, it will tell the pineal gland: "Don't produce melatonin." When the light enters, when the light enters That's why I have to say there's no light, it's dark, it's a pacemaker Tell the pineal gland to produce melatonin that light This supranucleus that kills the nucleus that's here that's right next to the asthma, Right exactly It's really close to

the supranucleus It's really close to the pineal gland It tells the pineal gland to produce melatonin So the engraving is pretty Great, great Congratulations, huh Bru Congratulations You're coming out better than I ordered That I said: "What engraving is that?" I looked and said: "You don't see it, but I said: "It's cute, the pineal gland is here, right?" Then he said: "Pituitary gland." No, the pituitary gland is here. The pacemaker that you call it is above the pituitary gland, but the pineal gland is here, a little further back. Perfect. Next, Bru. Let's go. A super

interesting article. When we don't get enough sleep, our brain starts to eat itself. This is very serious, people. How does this work? This is what happens. We mean two discoveries in 2013, 2014, which means 10 years for medicine. This is very little time. It's nothing. So, 10 years ago, the glymphatic system was discovered , not the lymphatic system. Lymphatic is that lymph, that peripheral system that we bring and we don't get that edema, that swelling in the lower limbs. That's right. In the brain, we have this system called glymphatic, which comes from the glia, the

glia, the glia cell, the glia. Glia. So, in addition to the Artery that carries oxygen, glucose, and the oats that bring and leave from the brain and goes to the heart. We have this system. What does this system do? It toxin eliminates waste from the brain. And this system, right? The group there, in the United States, discovered that during deep sleep, this system increases in diameter by 60%. So I need to be in deep sleep for this waste to come out more easily. Imagine a filter like this to get the waste out. And a filter

like this to get the waste out. It comes out faster. It literally increases in size. It increases. Yes, it increases. Three times in size to get these toxins out. So, if I don't have deep sleep or if I 'm sleep deprived, I have a total amount of sleep time. It remains and it accumulates. And you know which one of these proteins is, that's why it eats neurons. It's the beta amyloid protein , which is the protein that accumulates in Alzheimer's type dementia. That's right. So what do we see? that individuals with chronic insomnia individuals with

severe sleep fragmentation sleep apnea individuals with voluntary deprivation look I can only sleep 5 hours because I'm working Late and have to wake up very early I'm accumulating toxins I'm accumulating betameloid bet that is not being cleaned it is not being cleaned You are accumulating it you are not cleaning it And then I have a greater chance of developing Alzheimer's type dementia in the medium and long term which is a dementia of age right? It is very small 10% of Alzheimer's is genetic There is genetic yes from earlier onset to even early onset We have

the apoprotein dosage and we have markers that define a genetic issue but the vast majority of Alzheimer's is age When we died at 60 years old we did not have dementia Now today 80 90 years old we know that at 80 years old almost 40% of people have a cognitive decline Why is dementia due to age part of it right? That's all you have to do is take much better care But if I don't take care of myself people I am generating dementia in everyone shaping the statistics, right? So that's true, right? That's the way

to reach the population by saying: "Look, I'm eating my neurons. I'm not thinning out. I'm not taking out the trash, right? And this trash, of course, is toxic to the cells. It's in that sense." It's in this sense But it's very Clear to the layman, right? It's eating, right? It's as if it were rotting. If I leave the trash inside the house, it will start to smell because it will rot. It will rot. I'll have a deep sleep, take care of it. Sometimes again, I can sleep at 8 o'clock. I worry about that, but the

quality of my sleep, if I don't have this deep sleep, this will also generate. So we have to investigate this good sleep architecture, which will necessarily give me a better chance of longevity and a healthy old age. Perfect Next Bru The use of controlled medications, often purchased without a prescription, has grown alarmingly in Brazil for everything, right? There's another one, go ahead, bru, which is sleeping pills, because like Brazilians, the neighbor had a pain and took I don't know what, he buys that anti-inflammatory, the muscle relaxant and also, unfortunately, the issue of sleeping pills. We

have to stop and draw the population's attention to it. Why did Anvisa change the prescription from white to blue in August of last year, that is, it put a black stripe on the hypnotic called zopd. Why? exactly We had 22 million Boxes sold in Brazil It was the best-selling medicine in Brazil Why is this okay The pandemic, right? It generated panic, mourning, fear and unemployment, anyway, disease, a lot of problems with little access to a doctor and then in many states we can buy it without a prescription It was without a prescription until it was

absurd for us to know about it And then people started: "What do I do to sleep? I'm not sleeping And then the neighbor, the friend because it became popular It became popular So Zdem became popular And then because of that people started saying: "Oh, I ate the dog's food. I have patients I ate the dog's food I bought on the internet I sent a message because I started having the so-called paraia what is this abnormal behavior, right? It's a waking awakening I'm sleeping and awake I have two stages at the same time So I'm not

aware of anything I do It's sleepwalking, right? So this medication caused this a lot because it is taken inappropriately, right, imagine I only sleep at 11 pm 8 pm I take this medicine I'm going to put to sleep but I'm alert So I end up having this intersection of two Simultaneous stages: wakefulness, awakeness and the sleep stage that we discussed here So I started doing all this and we started to have a lot of memes on the internet that I did this, that I did that, this shopping thing. I had a lot of patients. I

had one who went out and started the car and was caught in a blitz. Exactly. And then she woke up in the blitz thinking she was being robbed. Imagine. That's right. So all this abuse, this indiscriminate use, made us put the brakes on the black stripe. Understand that prescriptions are sold without a prescription, they'll also buy without a blue prescription, but the fact that it has a black stripe already puts a brake on it. People, look, black stripe is a medicine that I don't want because it creates dependence. So this is a very serious problem

because there is a lot of abuse. Every week, we sleep specialists receive people who take two boxes per night. Boxes. One box contains 20 pills. People who take 20 to 40 pills every 24 hours. And it was discovered that excessive use, using more than 30 mg, starts to stimulate other receptors. So it gives a feeling of well-being. So people taking it during the day, there is no addiction, it's not to sleep, not to sleep, To have that feeling, to have that feeling, that craving, right, that feeling of well-being. And many people are doing this, right,

during the day, the medication. People in the health area. I have many patients who go to the on-call service, yes, And they take medicine to go to the on-call service to take care of patients, nursing to take care of the patient. Anyway, this has become a serious problem, a serious problem. And so today we are reaching a consensus that we will also come out of drug deprescription, and so , how to deprescribe if you have a dependency, you will certainly have to have a criterion, a withdrawal protocol, a very difficult protocol that we have to

be very careful about. aligned with the patient and the family to achieve this withdrawal of this medication, and then we begin to see in the medium and long term not only for cognitive issues but also for dementia issues. It was seen that drug Z alters the lymphatic system, and this is a very recent publication that drug Z can alter the lymphatic system, making this cleansing difficult. So this is something we have to pay attention to. Do not use a prescription, it is from your neighbor or friend, right? You are the one who will pay a

price. We will have two problems, one to treat your insomnia properly, which is not the case, and the other is to wean yourself off this medication, which you will become dependent on. It is difficult, it is difficult, it is difficult. You are saying this. I had a patient a long time ago. She lived abroad and had a boyfriend who used a lot of drugs and she said: "No, I don't use them." Then he said: "So do the following: buy Opdem, take a lot and don't sleep because we will end up in the same vibe." That's

it. Crazy. Because it was already being prescribed in quotation marks, right? To get high . So, on the subject of getting high. Now this comes with very strong , Very, very strong ... azepine This was very common And then he starts to become dependent because he generates tolerance That dose of 0.5 soon doesn't have the same effect So I give myself 1.5 two and then I increase it progressively and we end up having a bigger problem So there is the anxiolytic effect There are several azepines that are even anticonvulsants That's why these patients who are

taking excessive doses often have to be hospitalized to withdraw them because they can have seizures if they stop abruptly It can So it's a very serious situation and much more common than we imagine A lot While the United States is very concerned about opioids, right, with morphine derivatives, which is their big problem there problem We don't Have that problem here That's great Thank God we don't have that problem here But we do have it with drugs and they didn't even have it that much We do have it It's because opioids are already so much bigger

that I think they skipped to a stage They didn't go through that, right, it's next Bru Care for people with intoxication due to abuse sleeping pills go up 34.9 That was when now Look 9/4 That's what's happening a lot is the combined intake of ZPD and alcohol Exactly Look at the situation The two central nervous system depressants at a time when the person wants to stay awake So it ends up having a hallucinogenic effect because I go to sleep but I 'm sleeping or I'm awake and I don't remember anything I do And then what's

happening is the person arrives at the emergency room not because I want to because I'm taken Exactly So they arrive in a more serious state of hospitalization Then we can document it, right then the surveillance is going to enter the documentation has to register There's a lot more There's a lot more that doesn't arrive at the hospital There's a lot more Hum what a nice smell BR try our tea Be careful it's very Warm This one here is just like Jô's mug Do you remember that everyone wanted to know what was in Jô's mug we

have here Mine only had water Yes When I went there, right, mine only had water But everything Me too Me too But I could ask for whatever I wanted, right, I had this Yeah, right, I didn't ask for anything I could ask whatever you wanted I was on J four times It was a privilege for us, right? What a privilege it was great to have been interviewed by Jogo No. And we were like that, I, I didn't even know until the first time I went, and when the audience clapped a lot, you went to the

next block or you stayed there. Exactly. I didn't know either. When he went, I don't remember that he said: "Let's go, we'll continue." I said: "Oh, okay, everything's fine." And it was something, right, because it was a maximum of 20 minutes because television time is totally different from podcast time, for example, which I think is much better because the information on television isn't like that, you know, you can't create a reasoning, explain it, people understand, but you can't explain it in such a short time. There we throw the information, the sentence, the statement, now contextualization.

Exactly. And I Think that this podcast thing is more sought after because people want to, they're interested, but you know, because the person learns, it has an educational function. Next, Bru. Now we're going to Reporter Pipinho. Let's go, Reporter Pipinho, it's that moment when we give voice to the community that we have sustainable human being that has 2300 people 2300 500 and that they have the right to know 15 days in advance that you are coming and to send questions Oops Ok So I hope I know how to answer them all If you don't know

no one else will know my dear So let's go First Bru What happens to the body and the brain when we don't enter sleep real good question It really is because it is usually asking what happens in sleep real right but what happens to our brain it is intelligent and it will preserve noble structures So when we are sleep deprived I spent two nights without sleeping when you sleep what happens while it takes you 1 hour and a half to fall asleep re you have relapse I understand So it is not going to enter sleep

real only if you have very serious sleep apnea and me and the brain tells me to wake up Because I need to breathe More than entering sleep real I need to take oxygen to the brain So what happens is you are very sleepy without memory exhausted the brain wanting you to sleep because it wants you to because it wants you to you fall asleep r So it's that person who is very ill and then dozes off on the couch and says: "Wow, I dreamed" That's it I dozed off and I dreamed because how can it

be, right? It takes an hour or 70 minutes to fall asleep r So this happens but most of the time if I'm sleep deprived I fall asleep faster Rein. Also, Bia, an interesting thing is that an early marker of depression is early relapse So before the patient has all those symptoms of depressed mood and seeks help, the relapse is a bad early occurrence faster than 70 or 90 minutes and early awakening I mean, I sleep, I sleep quickly, I sleep at midnight but like 5 in the morning I wake up and it's day and I

can't get back to the terminal It's or early awakening Exactly Early awakening there that most patients have is between 4 and 5 hours That's it So he wakes up That's true That's right Now this precocity of Rein sleep appears before, right? The brain will put it because it knows the importance of this stage, right? of this stage Next Bru Everyone sleeps but not everyone rests How can we know if we are going through the right phases of sleep or just falling asleep from tiredness? This is a really cool question. The best time for you to

know how much sleep you need and the genetic schedule you prefer is on vacation. Because like this, the weekend is the so-called social jet. That person, no, I can only sleep at midnight. I wake up at 5. Midnight is 5. I sleep 5. 5. 5 hours. Then when it comes from Friday to Saturday, I sleep 10 hours. 10 hours. I mean, I get the 50 hours a week. But lost sleep is lost sleep. That doesn't make up. It doesn't make up. So it's not 50 hours in 24 hours. It's a circadian rhythm. Every 24 hours,

that rhythm is as much as I can. I need to maintain that rhythm. So it's not on the weekend that we're going to know how much time I need. It's more on vacation. Because then I've already gone through this phase of deprivation. I've already entered my physiological mode. And then I'll know that I woke up well enough to live the day. My memory is fine. Good, I'm eager for knowledge, I'm creative , heh, heh, I can exercise, I want to live, I'm motivated to live. So this is the moment. Then you'll know that what you're

doing is not just lying down and waiting for the alarm clock to go off in 5 hours. Or you wake up exhausted, wanting to go back to bed because some people wake up dreaming in their pajamas. That's horrible. Back to something wrong. That 's horrible, right? And look for a sleep specialist too. If this is happening, look for a specialist because we'll certainly find a problem. And I think everyone should have a polyphonography in their life. Uh, I think it's like therapy, right? Everyone needs to go through it. It's like an electrocardiogram because when you're

going to take it off, it's normal, but I don't know if that was something you already had before. We have to have some things, they're parameters. It's not funny that, for example, you're going to have surgery and then your cardiovascular system is monitored, but you take an anesthetic that puts you in narcosis, which makes you conscious, but you don't monitor your brain waves. Exactly. I mean, now there's the so-called beep, right? which is an electrode that you place And the anesthesiologist, in short, must be trained to understand what the brain wave frequency is to see

look, there is a lot of anesthetic, that's why some people don't wake up. Or am I too superficial and I'm living, right? I'm not responding, but I'm feeling pain. So knowing what the limit is. Once you've done that, you're saying that should be mandatory. Mandatory, right? Monitoring the brain. How do you monitor if you're giving an anesthetic that's changing consciousness and you don't have your brain wave monitored? How come? Perfect. I'd never thought of that, Andreia. But it's all related. It's all related. And we could have so many studies on this, right? Those experiences have

patients who have near-death experiences with anesthesia. Yeah. So, understand that in large hospitals, right ? In qualified hospitals, we can already get this brain monitoring, but it has to be for everyone, right? It has to be. I don't even know if in large hospitals, I think they're the big ones and rare, because it also depends on the surgeon, it depends on the anesthesiologist team, it depends on a lot of things. And since you're in there, you don't know what's going on in there, my dear, you have no idea that You're already Taking that sublingual medication

that they put in. It's midazolam, which is a short-acting hypnotic azepine benzo. That's why you have amnesia. You know, that person here, I didn't remember how I left the room and got to the operating room. He won't even come back. Poor thing. Okay. So, it's this medication. Next, Bru. There are people who really want to stop taking sleeping pills, but just imagining a night without it makes them anxious. What makes this emotional and physical dependence so difficult to break? Because when we get to the patient, who is very rare, who is a treatment virgin. I

mean, I have chronic insomnia and I've never taken medication. This is ideal. Why? Because you're going to follow the protocol for treating chronic insomnia disorder. The treatment is non-pharmacological, but changing behavior is very difficult. Very difficult, right? You want to take a sleeping pill and a pill to wake up, right? I want to take a pill, oops, and I'll work fine now. Oops, I'll delete it. erase And what happens is that these people who take the hypnotic, right, that have that effect 10 15 minutes I passed out I don't even know how to sleep this

is not physiological sleep And then when this person Takes half an hour to fall asleep they already get anxious I won't sleep But this is normal The normal thing is for us to lie down, get ready to sleep and take 15 to 30 minutes to enter N2 I mean I'm there in slow sleep N1 and I'm going to enter light sleep N2 It's already every 15 to 30 minutes So you have to explain to this person first that it's normal that it's normal Second that they have to not unplug it and boom I'm going to

fall asleep now I turned it on now No you have a process and you have to help yourself in this process So what is it like to help yourself 6 hours before caffeine because caffeine is a stimulant it inhibits adenosine Which is adenosine is you know ATP the ATP that produces cell energy Energy So everyone wants to understand ATP I woke up full of ATP We're spending ATP and accumulates adenosine Adenosine inhibits this receptor that caffeine stimulates So caffeine makes me here adenosine adenosine caffeine Oops decrease adenosine So it gives an alert So we have

to spend 6 hours before consuming coffee caffeine in general In general It's two hours before the last meal Yes An hour before it and a lighter meal Too, for the love of God because there are people who will eat feijoada for lunch And then the big meal is an hour before bed All wrong An hour before electronics slow down Sometimes I tell my patients a lot you set the alarm to wake up every day, right? Set the alarm an hour before bed Sleep Uhum So I sleep at 11 10 o'clock Oops I have an hour

to get ready To get ready So ​​one hour I'll get off the computer I won't see the goal anymore resolve to study An hour before I took a shower I already ate my cell phone Oops I just finished answering here it's over And now I'm going to do monotonous activity in the dark so I can slow down So this It's important Sleep hygiene, right? Sleep hygiene and non-pharmacological treatment is cognitive behavioral therapy to change behaviors for insomnia. Exactly. There are eight sessions. Exactly. So there is this. Unfortunately, not everyone has access to this. But look,

when we do this adjunctive treatment to drugs, the appropriate medication for us to stop taking hypnotics, then things go. Things go. You have to want it. And she says one thing, he, she, I don't know. Emotional and physical dependence really exists. That's why we have to gradually, there's no point in taking it out of nowhere, because there are people now, it's going to be in the chest and in the race, they can have a seizure, depending on the chest, and today, as we have gout, because it's a problem, right? Also, spray, so I give three,

five sprays. I took five pills and the drop that people say, put in a little coffee spoon, because otherwise it's like this. I don't count something that falls. You count it slowly and in the dark. You don't count it. Exactly. I've seen people take a whole dropper Jum. It's a problem. So we have to have it. There's no way around it. You have to have it. Those who use gout have it. But it's cool. When the patient comes to you, he is already predisposed. I want to treat him, right? I don't know if he will

be asked about it. We already have wearables, right? Wearables, right? Nearbles, the next ones. So the person who says: "No, doctor, I already bought this little watch here, it measures my sleep, this bracelet and so on." Of course, we are going to explain to him that what he said: "Look, I didn't sleep, my God, I didn't sleep deeply." He is still not faithful, but The fact that he is worrying about this with sleep is already 50% And the fact that these devices define the total time of sleep awake and asleep, they get it right. So

we can adjust it. Look, you are taking a long time to fall asleep. You are stretching out in bed. Oh, I only slept 4 hours in the morning. I will wake up at 10 at night. And the pressure to sleep the next day is one of the issues: the time awake that makes us sleep. So if I don't sleep well, get up, wake up and let's wait for the next cycle. Because if I need 16 hours awake to be sleepy, should I get up at 6 and I only woke up at noon when midnight comes

I only have 12 hours awake I won't be sleepy for sure So it enters a vicious cycle of not sleeping well So one of the sleep hygiene techniques of the diaries I send I give a sleep diary Sleep diary Look, get up and say: "Ah, I only slept 4 hours." OK, so you're going to get up, you're not going to stay in bed until the next night. This day is going to be bad, okay, but we're in a process of constantly creating good days, right? It's like those people who say: "Oh, I sleep badly." On

the weekends, I also sleep all day. That doesn't exist. How can it be? I woke up at noon, ate some feijoada, then took a nap in the afternoon. Then, Sunday into Monday is the worst night for everyone, right? Because I'm leaving my leisure time, right? I'm here in my little box, protected, and I'm going to live a week with goals, objectives, projects. So, from Sunday to Monday is bad for everyone. Those who have insomnia, those who have anxiety, it's the worst time. And then, if I sleep badly, it's going to be a terrible night. I'm

going to start the week destroyed. Or then there's that person who stretches Sunday, right? Because tomorrow I start working, so I deserve it. I'm stretching it out, then I'm going to sleep for 1 hour, 2 hours in the morning. It's all wrong. It's all wrong. Next Bru. Is there any way to prevent sleep disorders before they become serious? become chronic, this question is very generic, right? Because when we talk about sleep disorders, there are several, there are 100. More than 100. If we take our international classification, we have more than 100 disorders. Now, any disorder,

any disorder, when treated initially, acute insomnia, adjustment insomnia, is much Easier to treat than that person who has had insomnia for 10 years taking tranquilizers and who comes looking for help because, finally, now their memory is gone. So, everything is better early, right? I started snoring because of a woman. Well, we know that the ratio is almost three to one in terms of apnea in men. Man, three, woman, one. Woman, one. Woman in menopause. Equal. Equal. Why? Because the female sex hormone protects the throat. So, the woman stops having estrogen and progesterone, it becomes more

flaccid, so complacency is greater, it obstructs the woman, but she starts to snore. Wow, I started to snore and I started to have apnea. She doesn't talk about the apnea, she'll talk about the snoring or her husband will talk about the snoring. Yes, Yes, only. that she started to have sleep apnea So this moment of the woman in menopause when sleep started to get bad seek help right away start to define do the polysomnography I have or don't have what is the problem that I have and treat it early That's the best Now you said

something wonderful So every woman I don't have post-menopausal post-sleep I will I'm here confessing I will I will I will I will It's not exactly right because I have a preview but it changes It changes and changes everything right you're saying That makes perfect sense I took it for myself Next Bru What to do when the body is exhausted but the mind doesn't cooperate this is very common right people who have generalized anxiety disorder people who are very busy during the day when you arrive physically exhausted and lie down that moment is yours you are

alone with yourself And then we call it rumination So we start to think about our problems think about our goals think about what I have to do So instead of slowing down I'm like I can't forget I can't forget it's more synapse I'm worried about more synapse and the moment I have to slow down nervous synapses That's why a tip that's in the book, okay, people, that's in the sleep hygiene compendiums, a little notebook of worries So use it: call my mother to make an appointment with the dentist, don't forget to talk to the patient,

or put a word there that reminds you of the problem You sent it, I can forget it's written down there, it's not on my cell phone, once again, because then I'll take a look at my cell phone Exactly So you went and put it in the notebook That's why I say This here, no, I have about 10 that I use per year Exactly I have it, I joke that it's the checklist I get home and I already make a checklist of everything that I couldn't solve that I have to solve tomorrow Because honey, I'm home,

I'm going to take a shower, I'm going to watch a very light, monotonous series or a movie that people say: "Oh, I liked it, but it's slow" I said: "Is that the one?" That's exactly what I want And then, without worrying, grab the notebook because I'll see it in the morning. The note in the morning. You'll get your life back. So that's what we have to do so that the brain also slows down because it's there. It's okay. Forgetting. You forgot it. No. The person will sleep like that. You can't forget it. You can't. It's

over. It releases adrenaline. You stay alert, right? This notebook thing is fantastic. Next Bru How to help a person who has been sleeping badly for years and has already given up on seeking treatment. It's not just you, my dear. It's a lot of people. A lot of people. Even because sleep medicine is also a new specialty, right? It's been in Brazil since 2000, right? In the United States, it's been in the 90s, but here since 2000, right? It's been in the 20th century. So, yeah, we need To understand that I need to seek help early

and that sleeping well is not a luxury, it's a necessity, right? It's a necessity, because you're going to sleep badly. If you have a predisposition to some genetic issue and you sleep badly, this will anticipate the manifestation of this disease. If we get it, and it's sleep disorders in us. pubmeds on the scientific article search sites cancer knows of course it is not to alarm the population because it is not one it is one more trigger It is that for that cell that is not good Ex Exactly If the immune system is not good You

have an immune system that knows how to identify the cancer cell and goes there and removes it Now if you sleep less and with less quality the number of cancer cells increases and you decrease the ability of the cleaning army to clean Because pandemic pandemic everyone is crazy for a vaccine so we can free ourselves, right but they did not say the following: when you are vaccinated you put an antigen inside the body and your immune system will generate antibodies for you to have defense against that that gene that that aggressive agent That is you

need to sleep Exactly If you do not Sleep you get vaccinated and if you do not sleep it means the vaccine does not work There are many publications showing this So you need the next night on the night of the vaccine especially that week to sleep well so that you have deep sleep for your immune system to work and you have defense cells So there was no point in getting vaccinated and staying awake Exactly And now it is not just COVID now we have initial respiratory virus H1N1 H epidemic I was reading yesterday that now

they are calling it G1 N1 It says that ooaa crowd of Lady Gaga said that a G1 came out I was seeing in Lula Serda's column you have G1 N1 I said: "Wait a minute guys I had H1N1 after the carnival when I was in Salvador normal happens So I so much that I already got my vaccine then I said people G1 because it is crowd people and it is easier to do." So understand that you are going to get vaccinated, set a date so that you can sleep, especially the next night and subsequent nights,

because it is the process of antibody formation. It's just that no one talks about sleep. But you have to talk about it. You are absolutely right. I took my herpes zoster vaccine a short time ago. First, It knocks you out, you sleep, because it really knocks you out. And I tell people that I took it in the gluteal region because in the arm, it's not possible. It was already difficult in the gluteal region, but this way I remember that I slept well this week. There is no point in making a sacrifice. Now you have to

take it. Some people say : "Ah, but the fever hurts." It hurts from the fever, but having post-herpetic neuritis is horrible. Only a neurologist knows what it is to treat who and who and who goes through it. It leaves after-effects. People really lose sensitivity and lose strength. No. And sometimes you have to be hospitalized if it is periorbital, right? If it is a problem. So I say, women, please, if you are over 50, take it. It hurts. OK, plan on three days there so that you can stay quiet because you have to take Next Is

there any relationship between mood disorders and the type of sleep a person has? There is a lot of relationship, right? We've already talked about some of them here, right? The architecture of sleep changes, so we have early relapse, we have more fragmented sleep, we have terminal insomnia, we have early awakening. And what's more, we have to understand that insomnia is comorbid with depression. What is comorbid? We have two problems And one makes the other worse. This is very important for psychiatrists, sleep doctors, and neurologists. What do I have to treat for depression and insomnia? There's

no point in treating them because the patient will go to the psychiatrist because he's depressed and he won't talk about sleep. Or he'll go to the sleep doctor to talk about it without talking about depression. So it's up to us to do a complete history so we can define comorbidity and treat both. We know that treating depression and staying asleep means I have three times more chance of relapse and not recovering from the episode. It's because the person says: "Oh, because I wasn't taking a shower, I wasn't leaving the house, I wasn't eating, I was

n't going to work. Oh, my gosh, I'm already doing this, I'm already happy." Exactly. But that's not it. And sleep. Oh, no, I'm still not sleeping well. Let's treat sleep, otherwise this could get worse and relapse. That's what we have to think about. Perfect. And it's important that our colleagues have this vision, right? It's very important. I don't believe in medicine that we don't talk to colleagues. I always called when I was seeing patients. I had colleagues who didn't answer because, Like, that's not my area. This is up to you I found it sad I

and psychiatry are like this direct contact Sad I found it sad like this But what a shame what a shame right but I also had great colleagues that you called became friends Uhum Right look I'm passing it on to you so so so so so Look it's evolving like this so so It has to be right it's the least For the good of the patient You may not even for the good of the patient Next Bru It's true that the brain continues working during sleep it's true We didn't talk about sleep kidney that the brain

activity is the same as when awake right we're going to differentiate in the polysomnography if you're sleeping or if you're awake by the rapid eye movement by the muscle atony because I'm paralyzed remember we said you're paralyzed so there are other parameters that make us define that you're in sleep but the brain is active We spend energy during sleep There is a one some work with a rocking bed that we sleep with a weight and if we sleep properly we wake up with less weight How cool is that We lose weight Why because we spend

energy while sleeping right And the opposite is also true If I sleep little I gain weight Yes Yes, because you are not cleaning out the toxins. Your basal metabolism is completely compromised, right? Those proteins, leptin and ghrelin, which are responsible for satiety and hunger, do not adjust if you do not sleep properly. So you gain weight if you sleep poorly and little. So it is fundamental. The endocrinologist is also very much in contact with us because he understands today, he understands this need for quality sleep to help with weight loss. Today, obesity is a public

health problem, right? A serious public health problem. That is why this epidemic, right? Of tizerpatide, of cimaglutide. Yes, this crazy race for this medication, which also has to be looked at very carefully. It does not have to be prescribed by a doctor. It has to be monitored. You have to know the right time because you lose weight, but you lose muscle, so you develop sarcopenia. There is no exercise. Where is the tripod? It is behavior. Food, exercise, sleep and behavior, right? Put it there because we have to understand that you cannot exercise for me. I

have something to exercise. Human beings were not made to sit behind a desk for 10 hours and then lie down, right? We were prepared for the fight for the escape for and the exercise is this compensation in the current days Exactly Exactly This walk Next Bru Those who work at night or have alternating shifts have how to recover a healthy sleep this is a challenge for the sleep specialist When a shift worker arrives and when he says alternating shifts then it is even worse because I can't define look so you will sleep at such and

such time doctor today I get it from midnight to 6 tomorrow I get it from three days from 6 to noon after noon God what time will this person sleep how are we going to set up a sleep schedule no it is the cycle right so let's sleep sleep is working in the dark phase of the 24 hours is unhealthy it is not worth it Daytime sleep is not the same as nighttime sleep We only produce there are some neurotransmitters and hormones that are only produced at night There are some that are only produced during

sleep So we have to make this middle ground Since it is not possible Well, we start to think about a Biphasic sleep So we will adjust according to the shifts of this individual, some time of sleep at night and some time of sleep during the day It is as if I were at war, you know, like health professionals in times of war we do shifts or people who work at sea, right? We start on board, we can't do it. I'll sleep 8 hours the boat hides it, right? So we do 4 hours awake and 2

hours sleeping, that is this sleep cycle. Of course we have to create a cycle, right? We have to train ourselves, there is no way We have to recreate a new rhythm and some people manage to adapt and we can somehow compensate for this lack of night sleep But the right thing would be, professions that use night shifts, they have a time, right? People can't always do that And that is what happens: doctors start working shifts until the moment they can get off duty because living on duty you are not that's why I say on duty

there is a time it is a period of your life you are there Exactly You have to know that you have to be you have to leave at some point let the new ones come in and this cycle will be renewed Renewing Exactly I always say that it is not a profession like the stock exchange when there was that trading floor Today things are like in the past it was live there on the trading floor In New York on the stock exchange you could only stay on the trading floor for a year then you went

back to the bureaucratic thing because people would freak out Stay stay So these are things that you have to prevent It is inevitable but there is the team oh you can handle going and even so organizing yourself Exactly Creating a new sleep protocol right biphase as you said Next Bru My daughter is 17 years old and sleeps more than 8 hours a night Why do teenagers need so much sleep and this is physiological right but if we explained right at the beginning if we go there and the recommendation of the Slip Foundation if we go

in anyone can find there is a table from newborn to elderly of sleep time with a range allowed for more and less So there is the recommendation and this range So this teenager is there between 9 and 11 hours of sleep This is the average normality Why because we are still forming, right? The brain, whether we like it or not, is still forming at this stage, right? We know that it is forming. After the Age of 23, we start to lose neurons. Understand that aging starts there, not in the elderly, no, but at this stage

they need to sleep. And unfortunately, they are forced to wake up for 6 hours. I feel sorry for waking up a teenager who is there in a deep sleep to wake up to go and learn. I mean, he needs everything he is going to do, not to learn, he needs this time to be able to learn later at 10 with 10 o'clock in the morning. You said something, but maybe this won't become law, but at least private schools and parents could. You know that when we did a campaign because every year is World Sleep Day,

we do a Brazilian campaign and one of the campaigns was aimed at one year, it was for this and we visited public schools and private schools. And you know that this campaign took on a dimension that some private schools adopted. This shift or at least it looks like this from 8 to 10 this subject is asynchronous So those who are morning people and can go but those who can't go have to watch and tick off after watching this subject in the afternoon So this made life much easier Because there are people who wake up early

in the Morning, not most teenagers but there are And ok, that's fantastic When is the campaign? It's every March, right? It depends on the moon, right? But it's also the World Sleep Society World Sleep Society sets the date, it's always on a Friday in March, World Sleep Day And we celebrate this in the world and in Brazil Next year, if we can participate in any way, we're available, just send it a little in advance and we 'll happily do the campaign. Good deal You're already invited because I think we have to help. It's a way

of providing a service to the population, I think Next Bru Ah We have now arrived at the Pipinho moment Now it is free association Okay, okay Now is the time when the team together with Pipinho and fished out words and some things here in our chat and we will throw whatever comes to mind The head at the time Oh no, but you can also pass If there is the slightest problem Everyone here is polite If you say pass, we will pass OK Look, if I have a trauma, I will pass That's right There is no

problem at all It will be understood with great care A Caution Look, it reminded me of the elderly You said caution I remembered the elderly, right? Today is a growing population, right? Our pyramid is changing So we have to have this look at the elderly, right? This careful look at them. Two Silence is essential for sleep, right? We need a dark, air-conditioned and silent environment to promote sleep Three Complete the sentence Sleeping well is non-negotiable I loved it There is no story Four Love Love is part of life Everything we do, we have to do

it with love, which is already there for it to work out True Five Happiness I think it is a search Happiness is a search It's not a moment, right? We look for and we live happy moments and we have to enjoy it, right? This is happiness. Here now. Here now. I'm happy to be here, right? We have to understand it too. Six. If the world ended tomorrow, what would you do today? Oh, I would get my kids together, stay with them, which is the thing I love most in life. Perfect. Seven. Quality time. I think

that's what we always have to look for, right? Sleep time has to be quality time. Work time has to be quality time. Leisure time has to be quality time. You have to be there, whole and complete. Exactly. Eight. Family Essence. Family everything. Nine. If you had a super power, what would it be and what would you do with it. Any one? Teleport me. I'm here. My son lives in Los Angeles. I want to be there now, right? I want to travel and not have to take two flights. We spent New Year's Eve in Australia. People,

that's crazy. You don't recommend it. You don't recommend it. Three flights and a 12-hour time difference. It's crazy. So if you teleported, I would really like it. It would make your life much easier. And 10. A phrase or a thought that you want to leave behind . for people, I think that doing what we do is waking up and understanding that I have to make a difference that day If you, if everyone thought this, the world would be different Much better Perfect My dear, I loved it Thank you very much Thank you very much It

was great learning from you I'm sure that people will become much more aware of the quality of sleep Now, some little gifts Let's go First, here's depressive minds And there's a chapter where I only talk about the issue of sleep because there's no way to treat depression without improving sleep Hey, thanks Another one here Is about happiness that I wrote during the pandemic when I said: "People, I'm not going to stay at home depressed and sad because some people started drinking, right? A lot in my building. Sometimes I was at the reception and I saw

boxes of wine arriving. I said: "Wow, people are celebrating the pandemic, it's not because I'm drinking because I relax." I said: "It won't work." High levels depress the nervous system and decrease sleep latency So the person falls asleep faster but the quality of sleep is superficial I said, people, this won't work. I'm going to write about happiness Good Look, I already have it here, right? And there's the latest one that was released at the end of last year, which is a time for me, 10 minutes a day of self-care, which are my phrases that I

write down. I have the notebook on my bedside table, and so when I always get up between 6 and 6:30, I mean, I wake up, but I get up at 7:00. So during this period, I always do my prayers, which I like. They're not traditional, but they're prayers. And then every now and then a phrase like that comes up, right? Then I write it down. Then last year, the editor said, "Oh, you're not going to release a book?" I said, "No, this year, it's too complicated." I said, "But I have phrases that I asked for,

I asked my son, I said, "I have phrases." He said, "74." I said, "I swear, because I 'm going to file everything." Yes. So we selected 365 and they all have space for you. interpret what that brought you that day So it's 10 minutes I'm Catholic It looks like the gospel I have the daily gospel and then I read the daily gospel and here it is for us it's that 10 minutes It even gives less but for the person to tune in with what I'm going to start here This here is the bracelet with time

for me so we don't forget, right, to look and remember Usually people go to the gym with their bracelet at the gym Be careful with sleep I'm going Exactly Take care of your sleep I'm going to remember to make one of these to give patient Beautiful Perfect Perfect Have you chosen the color Purple I love purple Purple So do purple Do purple Because it's something that the person The other day I was at the gym there was a person with this bracelet How cool so for me I said how cool He said: "My time is

here on the treadmill" You know he said: "But I'm here look" It's really good for Us to make a difference in the life of Very good So cool right there are more gifts Calm down You can put everything aside and the children will fix everything Everyone here knows that the basic requirement to work here is to be kind So they'll fix it all You'll leave with your bags all sorted Don't worry This here is an ecobag It's from Pod People It's our symbol And here is our logo Idea FA brand Happen and Inspire That you've

already done this, right Your father Your mother This here is a little notebook to take notes Bedside people This is from the bedside From the bedside And here is a little mug so when you drink your tea or coffee you remember us Look Up to 6 hours before with caffeine Then only After just a chamomile tea That doesn't have caffeine also helps with sleep, yes it helps Hot drinks and a warm bath, which is grandma's tip, it has a basis It works, right? It lowers temper You warm up and then lowers body temperature and that

promotes sleep Yes, it makes perfect sense, right? These things that are passed down from generation to generation are important We have to at least look Then science will come later and say it Was worth it My dear, now I want you to look at that camera over there Give all your messages Don't even look at me Okay then people, sleep is essential Eh, we have to prioritize sleep nowadays in this modern life In the same way that you prioritize your exercise now diet understand that you need to prioritize sleep Never self-medicate Self-medication will harm you

it will not treat your problem and you will have a second problem which is to stop taking this medication So seek medical help right if you go to a doctor only once a year because you do not have a disease right you go for prevention talk about your sleep right if your colleague does not ask say look my sleep is good and is everything okay or not so that we can investigate this studying sleep today is not precious it is a necessity and we can document your sleep So if you need to ask your doctor

I want to study my sleep Even if he does not know how to analyze someone will know to define: "Look your sleep is great you are doing very well or not" and that the vast majority of the population has some sleep problem So it is time for us to seek and prevent Because today medicine is preventive Thank you very much my dear Dears we are finishing another episode of P de Pipo and today it was with this wonderful Andreia Bacelar If you do not know It's time for you to immediately start following her on Instagram,

which is @andrea. Sorry, Andreiacelar. It's not all about two heliums. It's easy. It's very easy. You put it in and you'll find it. So why, as she said, sleep is non-negotiable. We live in a society where sleep is despised, but we're paying a very high price for it. We're living longer, and the longer we live, the more we'll need to sleep well. Here in the Podop community, we believe that only knowledge and self-knowledge can truly make us become better human beings. Thank you very much. If you 're not subscribed to the channel, subscribe, click the

bell, and share this chat with as many people as possible because people deserve to sleep well. Thank you very much, and until next time.