Arielle Greenleaf (00:00.084)
I did that too, yes.

Craig Canapari MD (00:05.6)
Okay, well, welcome back to the Sleep Edit podcast where we tackle complicated sleep topics for tired parents. I'm Dr. Craig Canapari.

Arielle Greenleaf (00:15.422)
and I'm Arielle Greenleaf.

Craig Canapari MD (00:17.826)
So Arielle , what is our topic today?

Arielle Greenleaf (00:21.106)
boy. Well, it's one that I could talk about forever and ever and ever. Bad online sleep advice and information, things that we see regularly on social media or in moms groups that are continually talked about, repeated and shared that have various merit to them. know, there's there is some sometimes they're slightly true, but

in many cases, they are more misleading than helpful.

Craig Canapari MD (00:57.612)
I think a common thread with many of the things we're gonna talk about is that very simple statements are appealing and they spread much more effectively on social media than nuance does. And if children were just little robots where you put in an input and you get the same output every time.

Arielle Greenleaf (01:14.987)
Mm-hmm.

Craig Canapari MD (01:24.834)
those all of those absolute things, those things that people say may make sense. But I think there are the fact is it's really hard to sometimes to deal with your child's sleep problems and.

In clinic yesterday, we just had a patient, a teenager with a bad insomnia, and there's this sort of problem, and these are often the case with pediatric sleeve problems. It's simple to understand what to do, but it's actually hard to do it. And often the things that are espoused online have the promise of being either quick fixes or explanations that sort of support a certain worldview.

Arielle Greenleaf (01:55.968)
Mmm.

Arielle Greenleaf (02:08.583)
And I think, you know, I was thinking about this too, because I saw someone on threads talking about teething, right? So why does everything get blamed on teething? And I think, you know, when we're dealing with nonverbal or preverbal children, it's very difficult to not have answers, to not have them be able to say what they want or what they need. And so as parents, we want an explanation. And like you said, the simple explanations make more sense. If someone else has gone through it.

and that was their experience and it's similar to yours, then okay, it must be true, like obviously. Because tired parents can't digest big long explanations of things.

Craig Canapari MD (02:51.438)
Yeah, no, I feel like teething is kind of like ill humours, like 500 years ago. We're like, something's not going good. mean, like, yeah, look at that guy. He's got too much phlegm. He's got too much of the black bile. That's why he's acting that way. You know, you should start. Maybe we could get really rich, actually, and like, yeah, this child can't sleep because they have an excess of yellow bile.

Arielle Greenleaf (03:08.275)
Yeah, but it happens all the time.

Craig Canapari MD (03:18.91)
Really, really, this is part of my tight five on the relationship between modern medical misinformation and the four humors. So I'll be here all week, people.

Arielle Greenleaf (03:27.413)
Love it.

Craig Canapari MD (03:33.166)
So speaking of ill-humors, I think there was a substance that you wanted to talk about today, Arielle

Arielle Greenleaf (03:33.909)
So why don't I jump into, yeah, sorry, go ahead.

Arielle Greenleaf (03:44.156)
substance. This is such a hot topic. The, you know, there's so many buzzwords and buzz phrases, but I would say like one of the top three is overtired and its connection to cortisol. So it's very difficult because I will say that

Many sleep consultant training programs do teach that when a child becomes overtired, their body floods with cortisol. And the cortisol prevents them from falling asleep, staying asleep, and it could cause early wakeups. And I will fully admit that this was in my program. And it was also in my daughter's sleep plan. I went back and looked at an 11-year-old sleep plan, and there it was.

telling me to watch out for being overtired because of the cortisol. And so many of the parents that I see have already worked with other sleep consultants or they've seen Reddit or Google or Instagram, anywhere, anywhere. And just to give you an example, this is what it does. My recent client, we finally figured out her son's 24 hour sleep needs and they were lower sleep needs. So.

Things weren't working for her because she was scared because she thought her child to become overtired. She said, I think it's drilled into our brains how scary and dangerous overtired is that I always resorted back to over being overtired. I remember being so anxious with my daughter that we were late to bedtime and she was going to be overtired. Looking back, her split nights could have been fixed way sooner if we better understood how much sleep she needed and didn't always think she was overtired. So.

Doctor, let's talk about it. Can you break it down for us?

Craig Canapari MD (05:42.389)
there's a lot to cover here. Hold on. I gotta fix my light. cause I'm like, my eyes look really dark. Let's see we can get this without making my lights.

without a reflection in my eyes. Okay, I think that's So.

Arielle Greenleaf (05:54.901)
I think you're, yeah.

Craig Canapari MD (05:59.682)
The cortisol story is a complicated one. So cortisol is also like another hormone that we've talked about in this topic, melatonin, in that it has a circadian pattern of secretion. In the evenings, generally our cortisol are low, and then before we wake, they start to rise, and around mid-morning is the peak. Cortisol is the hormone of stress. It is secreted by your adrenal glands, which are these little tiny glands that sit on top of the kidneys, and having enough cortisol is actually very important.

So for people who have low cortisol, it's actually dangerous for them to get infections. It has a normal role in helping our bodies manage stress. Now I feel like there's a couple of domains in which cortisol has become very misunderstood in the sleep domain. And the first actually is in the relationship between sleep training and cortisol.

Arielle Greenleaf (06:36.019)
Hmm.

Craig Canapari MD (06:53.524)
So this is a there's a study from 2012 by Middlemiss et al that is always cited by people who are against sleep training opponents. And in this study, they took I think it was around 20 kids and put them in an in-person sleep training program. So in Australia and New Zealand, they have these inpatient sleep training programs. So for parents that are struggling to sleep, you can actually go in with your baby.

and there are nurses there and they'll teach you about sleep and actually help you through the sleep training process. Which is cool actually. Sure.

Arielle Greenleaf (07:27.029)
Excuse me, let me ask a question. Is that a hospital setting though? Like are they, they're not in their home setting, so they're in a different setting, correct? Okay, okay.

Craig Canapari MD (07:32.65)
well, yes, you're correct. So in this study, they put the children in for unmodified extinction. So pure cry it out without consoling. And they the moms and the babies that were four to 10 months of age stayed in the hospital for I think three to four days. It's a little bit unclear from the study and

What they were looking at was the relationship between mom's cortisol and baby's cortisol. Because there's this idea that there's a synchrony between moods and also some physiologic markers between babies and infants. So there does seem to be some truth to this. And the big finding of the study was that the infants, so here's what happened.

The mothers got the babies ready for sleep. Their cortisol were a certain level. Then the babies were taken to another room by a nurse that they didn't know and put down, allowed to cry. Their cortisol went up and mom's cortisol went up, right? It's a natural response to stress. Then two nights later, they measured again and they measured mom and baby's cortisol before bedtime and after bedtime.

Arielle Greenleaf (08:46.034)
Yes!

Craig Canapari MD (09:00.462)
And what they found was that mom's cortisol was lower than previously. And the baby's cortisol was lower, but not as much lower as mom's. Sorry, let me rephrase that. So basically the finding was is that the baby's cortisol was higher than the mom's was relatively, but it still went down.

Arielle Greenleaf (09:16.2)
I understand what you're saying.

Craig Canapari MD (09:29.038)
And this has been touted as the fact that, these babies are still stressed even though they're not crying. So we've taught them to be helpless. We've taught them they're experiencing this horrible hormone that's so destructive pumping through their bodies and they're just not crying anymore. What horrible people we all are who consider sleep training our children.

And actually, I'm gonna throw in the chat, I actually plotted this data, because it's not plotted in the study. And it is not that dramatic, if you look at it. And there was no sort of, this study has been used endlessly to say, well, we are giving this horrible hormone to kids, and we're gonna ruin attachment, we're gonna ruin their brains. This was a big part of Dr. Sear, the study's from 2012.

Arielle Greenleaf (10:00.111)
cool.

Craig Canapari MD (10:23.448)
But in the 90s, which was the first wave of attachment parenting, Dr. Sears was saying that, well, if you don't respond to your children's needs, if you let them cry, that actually they will have developmental and attachmental, they will have developmental, if you let your children cry, they will have developmental and attachment problems when they are older. And Dr. Sears was basing this on research of

Arielle Greenleaf (10:48.487)
insecure attachment.

Craig Canapari MD (10:52.298)
infants in orphanages in Russia who would go for days without being picked up. The American Academy of Pediatrics has documents on toxic stress in childhood. Toxic stress is when children are chronically stressed, think over weeks to months to years, and that is associated with bad developmental outcomes, and chronically high cortisol may be a part of this. Here's the thing.

If you are picking up your kid and loving them and taking care of them, except for the two or three nights of sleep training, they do not have toxic stress. They have a brief physiologic stress. So you don't get from this Middlemiss study to a child that hasn't been picked up or hugged for six months that does maybe have a lower IQ as a result. These are apples and oranges problems. These are actually like, I don't know, like apples in the moons of Jupiter sort of.

problems here. Not to mention, there's a couple of major problems with the Middlemiss study. The first is that this was not like sleep training that we do in the United States. These kids were in a hospital, not at home, and they were being cared for and handled by people they did not know. It's not like if you're sleep training your child and you're doing graduated extinction, you're actually going in and checking on them. Or in the middle of the night, if they need you, you're going to get them. So this is not

Arielle Greenleaf (11:50.9)
Hahaha

Craig Canapari MD (12:20.022)
reflective of what we actually do. The other thing is there are no controls. So there were no kids who were admitted for the same period of time who did not sleep train. We might've seen this exact same pattern of cortisol secretion just for the kids being in a new place. I remember when my, when we would take my older son who's now 18 to his grandmother's every night, the first night he'd have a night terror. He'd be screaming

Arielle Greenleaf (12:48.564)
Hmm.

Craig Canapari MD (12:49.888)
I don't think it's because of my in-laws energy. It was, maybe it was, I don't know. But it was probably just the stress of travel, which is like, you know, that's a, sometimes you have a bad day. It's not gonna harm your child. So, and actually, let me just, I can, I just wanna show you this. I don't know if I can screen share or not here. I'll drop in the chat this actual.

Arielle Greenleaf (12:56.262)
You

Craig Canapari MD (13:19.042)
diagram but it is not here. We'll put this in the.

Arielle Greenleaf (13:19.604)
Looks like you can.

Craig Canapari MD (13:27.726)
in the show notes, I can't do it. I'll drop it in the YouTube version. But anyway, you're looking at this and you're like, I can't even see the differences here. Everybody got less stressed the next day. The parents got stressed less quickly. That's probably because they were grownups and understood what was going on. So that is the cortisol.

Arielle Greenleaf (13:29.396)
the show notes.

Arielle Greenleaf (13:33.244)
Okay, no worries.

Arielle Greenleaf (13:52.02)
Correct. Right.

Craig Canapari MD (13:57.022)
sleep training story. The other problem with this is there have been multiple other studies that did have controls that looked at sleep training that did not show an elevation of infant cortisol. And in fact, the Gradistar study, which I'll put in the show notes, had more infants had controls was done in the home and show that infants cortisol actually went down after sleep training, it didn't go up. So that is part one of

cortisol and sleep. So second part is this concept of overtiredness. like overtiredness is one of those things like what was the famous Supreme Court decision? What's the definition of pornography? I know it when I see it. It's like what's the definition of overtiredness? It isn't a medical term, right? But if you have a young kid, you know what overtired looks like. It's when your kid is freaking out because

Arielle Greenleaf (14:27.507)
You

Arielle Greenleaf (14:46.589)
That... Yeah.

Craig Canapari MD (14:55.51)
They didn't sleep well last night. They missed their nap. Their bedtime is pushed a little bit later, right? Like we all know that this happens. So there's probably a couple of different components of this. There does seem to be some prefrontal cortex dysfunction. So the prefrontal cortex, the front of your brain, it's like the Butler. It keeps everything running and it's not that strong until you're in your twenties anyway. Like,

Arielle Greenleaf (15:21.39)
Mmm, shocker.

Craig Canapari MD (15:23.886)
I was much more likely to smack my brother when I was a kid than I am now. Although under both sets of circumstances, he may be equally deserving of a smack because my prefrontal cortex was less developed and that can still regulate when you're sleep deprived. This is, you know, this happens in adults too. Like where I was a lot, you have a lot more hedonic drive, pleasure seeking drive when you're sleep deprived. That's why when I was a resident, I was a lot more likely to eat that five day old donut in the break room when I was post call.

Arielle Greenleaf (15:52.413)
Bye.

Craig Canapari MD (15:53.078)
than the before. So also in kids, they've looked at something they call amygdala hyperreactivity. So the amygdala is the part of your, it's kind of the obvious, the amygdala is kind of the opposite of the prefrontal cortex. Prefrontal cortex is logical, and any neuroscientist here, I'm not a neuroscientist, give me a break, but the prefrontal cortex is logic, it keeps everything, the train's running on time. The amygdala is like,

It's like fear and anger and strong emotions, right? Again, amygdala is very well developed in children relative to the prefrontal cortex. As anyone who dealt with toddler tantrums knows. And there was a study using functional MRI showing that seven to 11 year olds who were experimentally sleep deprived had increased activation of their amygdala. And there may be some activation of the thalamus as well.

Arielle Greenleaf (16:26.419)
Hmm.

Arielle Greenleaf (16:31.795)
Hmm.

Craig Canapari MD (16:50.838)
similar to kids in ADHD. And it does seem that children who have short sleep deprivation may have some elevation in the cortisol. This is not at all surprising to me because it's a stressor, right? If you are sleep deprived, it's a physiologic stress. Your body is seeking homeostasis, which is the fancy way of it's trying to get everything in equilibrium.

Arielle Greenleaf (16:53.469)
Great.

Craig Canapari MD (17:20.798)
Sleep has an important function in keeping everything in its right place from a physiologic standpoint. When you're sleeping yet less, your body is stressed, you will make more cortisol. It just makes sense that that's the case. However, over tiredness, to me, it's a nuisance. It's not damaging to your child. Your child being stressed is not going to damage them.

if most of the time they're not stressed. So, and if you are interested enough to listen to a podcast about your child's sleep, I'm confident that you are loving and appropriate to them. And it is that care that parents give of being loving and appropriate and supportive of their children. That is the buffer against toxic stress. So if your child is overtired on one night, that make bedtime difficult? Sure.

I mean, my kids, when they were younger, if they went upstairs to bed 20 minutes late, there would inevitably be a fight at the sink about brushing teeth every time. But I wasn't worried that they were becoming brain damaged as a result. It's just a nuisance that we deal with and we maybe make an adjustment later. I find this so baffling, this idea that your child has to be so perfectly optimized and

managed to, for them to thrive. It seems crazy to me. I saw this thing on Instagram and it was a post of like, someone's like proud of all the things they're not using with their kids. And it's like no changing tables, no car seats, no, you know, all of this stuff. I'm like, you know, why are people, why is there so much pressure?

Arielle Greenleaf (19:07.741)
Yeah.

Craig Canapari MD (19:18.488)
to do everything yourself and have everything be perfect all the time. I feel it's very disturbing to me right now that the tenor of things online.

Arielle Greenleaf (19:27.763)
I 100 % agree. think when it comes to, I definitely understand the overtired specifically in like toddlers, preschoolers, even my own child who's 11, you know, as she's gotten older, but she, know, staying up late, she's not good at staying up late. She's better now, but you know, she melts down. But I think the problem that I see is

way more granular in that sleep coaches are teaching parents that if they don't put their baby down at this exact wake window or this exact time, their child will be overtired, they will fight sleep, and then their cortisol spikes and it's like this crazy overtired mess that continues and perpetuates. And I think this is...

I think this is a misunderstanding of how it works, first of all. And second of all, it's also a lack of understanding of 24 hour sleep. In my experience, specifically lately, if a child is fighting sleep, particularly at like nap time or something, it's often that they're being put down too early, too soon. Their sleep drive is not strong enough. And so

that this just like to jump to the fact that your your child is taking 30 minutes 30 minute naps is because they're overtired. The fact that your child is taking 25 minutes to fall asleep at bedtime is because they're overtired. It's like everything is because your child is overtired. Let's back everything up, make everything earlier. I just had a sleep consultant send me this insane question that was from a sleep consultant training group. And the person said, I don't know what to do. I'm this baby is

taking their first nap at eight and it's only 25, it's a seven month old baby. Baby is taking their first nap at eight, the nap is 25 minutes, the second nap's at 11.25, the nap is 25 minutes. And then now we're having to put him to bed at 4.30 because he's so tired, but he's waking at 4.30. How do I get him to wake later? And I'm just like, my mind is just kind of like blown there that.

Arielle Greenleaf (21:49.747)
she was so concerned about making him over tired that she didn't want to push the naps or push bedtime or add a third nap to push bedtime to get the wake up later. It's like this lack of understanding and instead it's all this fear around making a child over tired. So I just feel like parents are scared. I mean, I just read to you what one of my clients said. They make it feel that these

consultants make it feel like it's dangerous.

Craig Canapari MD (22:21.324)
Yeah, I mean, I think that the, to me, the elevated cortisol is a function of like not having the sleep quite right and not the cause of it, right? Like it's, I can tell you at no point in my career have been like, wow, this kid's sleeping terribly. I better get a salivary cortisol level on him because that's going to give me the answer. This is just, this is one of those weird disconnects where it's something that

Arielle Greenleaf (22:41.778)
Yeah. Right.

Craig Canapari MD (22:48.622)
People have taken some stuff from the medical literature and really misunderstood the significance of it. It's like, yes, you could be sleep deprived and your cortisol is high, but that doesn't mean the high cortisol is causing the sleep deprivation. It's much more likely to be the opposite direction than, it's just.

Arielle Greenleaf (23:01.906)
Mm-hmm, right.

Arielle Greenleaf (23:06.183)
Yeah.

Craig Canapari MD (23:16.142)
I was going to say it's much more likely that sleep deprivation is causing the high cortisol and not vice versa. It is not something that we're worried about clinically at all.

Arielle Greenleaf (23:26.972)
Right. But that's a piece of it because people think sleep deprivation is causing the cortisol and then the cortisol is causing the sleep deprivation. It's like this crazy, weird, co-mingling thing where, uh-oh, don't make them over tired because their cortisol rises and when their cortisol rises, they're going to lose more sleep. So it's like saying that they both cause each other to happen.

Craig Canapari MD (23:54.742)
Yeah, I would say to parents is don't worry about your kids cortisol at all. Worry about getting the timing of when they go to bed, right? then work towards the goal of independent sleep. Let me take it away from you that you have to think about your child's cortisol at all. Trust that the child's cortisol is being secreted appropriately. You know, one thing I'll drop in the show notes to is there was an interesting study that was looking at the reactivity of infant cortisol to various stressors and it was showing that generally

Infant cortisol doesn't move that much with different stresses. So a lot of these papers looking at the cortisol stories like sleep deprivation cortisol, these are like school age kids. These are not infants. People are not doing experimental sleep deprivation trials on babies. So we actually don't know what's going on.

Arielle Greenleaf (24:34.118)
Mm-hmm, yeah. Right.

Arielle Greenleaf (24:41.298)
All right. Yeah, everything I was looking at as far as studies were concerned was like basically preschool and up.

Craig Canapari MD (24:50.838)
Yeah, no, think that it's, parents, if you're worried about this, this is not to criticize you. I feel like you're being sold a bill of goods here that there's this hormone going on that your doctors are keeping from you, and it's the secret to unlocking better sleep for your kids. The fact is, is whether or not you cortisol existed, you would still know what the right things are to do, which is to

Find an appropriate bedtime for your child, work towards independent sleep at bedtime, make sure that their sleep needs are being met, and then provide care and support to your child. And their cortisol secretions are gonna be fine. We're not seeing kids with like Cushing's syndrome, is like hypercholesterolemia coming in because like they missed their nap, you know?

Arielle Greenleaf (25:41.602)
Right? Yeah. Or their nap was five minutes late.

Craig Canapari MD (25:44.642)
Yeah, totally. I've got the endocrine department on speed dial. I've got a kid that missed his nap today. Yeah, I'm sorry. I shouldn't joke, but...

Arielle Greenleaf (25:52.7)
Yeah, right, yeah.

No, it's I mean, I I it's you shouldn't joke about it. But it's also like we also should not have parents that are so anxious that they are like I've had several people say I have to rewire my brain because I'm so scared that your schedule is going to make my baby or my toddler overtired. In those cases, it's because they're looking at wake windows, which we'll talk about in a little bit, that are too short for their child. And

They, so I'm asking them to keep their child up 30 minutes later or something like that. And they're terrified that that's going to cause a problem. But then when I show them their data and the child's 24 hour sleep logs, they're like, yeah, you're right. He does only need 12 and a half hours of sleep and not 16 hours of sleep in a 24 hour period. So I see now why he needs this much more awake time than a child that needs more sleep. So, but they're terrified to try it.

because they're terrified that they're damaging their child.

Craig Canapari MD (26:59.95)
Well, you know whose cortisol is high? It's mom and dad's. yours maybe as well hearing this, yeah, it is such a non-factor to worry about. I mean, it is not that your child's sleep is a problem. It probably is. If you feel like your child's sleep isn't good enough, you should work towards improving that. But don't worry about their cortisol.

Arielle Greenleaf (27:02.906)
Mine.

Craig Canapari MD (27:28.812)
and kids' bodies are these magical machines and they work really well in managing things like hormone levels. You don't need to manage that. You need to manage the macro levels of parenting of deciding what bedtime is for your toddler. Right? Like that's the decision you have to make.

So yeah, cortisol, there it is.

Arielle Greenleaf (27:47.314)
All right, put that one to bed, ha ha.

Let's see. What's next? What else can we come up with? That's advice that makes me crazy. Absolutes. And I think you mentioned absolutes earlier in even talking about the cortisol and things like that. But I see so many things that, again, cause anxiety. I feel like so many of these things

are anxiety producing for no reason in many cases. I saw this three, six, nine rule recently where it suggests that all babies go through growth spurts that can cause sleep disruption at three weeks, six weeks, nine weeks, and three months, six months, and nine months. And I'm just like, what? What? What? What?

And people believe it. I don't blame anybody for believing it because they're looking, again, they're looking, why is my three-week-old or my three-month-old or my seven-month-old doing XYZ? Another example would be the Wonder Weeks, which pretty much gives you storm clouds until your child is 18 months. And it's based on just their age. Like, they're six months. So this is exactly what your child is going through at six months.

Craig Canapari MD (29:02.594)
Oof, yeah.

Arielle Greenleaf (29:15.794)
And then of course it goes back to your child is four months, eight months, whatever. Here are their wake windows. And those are just absolutes. Talk to me about absolutes.

Craig Canapari MD (29:29.056)
Yeah, I mean, it's funny in medicine we do. We do love these rules and we're teaching like basic stuff to our interns, but not usually about. I mean, people are really people are really complicated, right? Like and the idea of like a heuristic or a decision making rule that makes things simple for you is very appealing and this stuff. It's like wildfire on social media because people are like, this cool rule explains everything going on and then.

Arielle Greenleaf (29:40.434)
Yeah.

Craig Canapari MD (29:56.398)
And it may explain it, you you might have a parent that's child has a growth spurt of three, six and nine weeks and three, six and nine months. But you're going to have lots of parents where that is not the case. And they're going to be like, what's wrong with my kid? Their their growth spurt happened at four, seven and 10 months. I must be a terrible parent. And sound bites are so great for social media. And this is what's hard as a physician communicator or you know,

Arielle Greenleaf (30:14.61)
Mm-hmm.

Craig Canapari MD (30:24.01)
somebody like you, Arielle , who's evidence based is like, it's a lot harder to go viral when you're like, well, and sometimes it's this and other times it's this, but that's just real life. I think that you want to talk about wake windows. So wake windows are based on this physiologic idea. So you alluded to sleep drive. When we think about the timing of sleep and wake, we often use something called the two process model of sleep and wake regulation.

And it means that there's two major factors determining when someone's going to fall asleep or wake up. And the first is your sleep drive. So the longer that you're awake, the more likely you are to fall asleep. The extremes of this, it's really easy to understand. If you're a resident, you've been awake for 36 hours. You could fall asleep even if it's the middle of your day. Yeah, unless you're overtired. your cortisol is high. Just kidding. Your cortisol is terribly high coming off a call shift. I can tell you, and you can still go to bed.

Arielle Greenleaf (31:13.596)
unless you're overtired.

Sorry.

Craig Canapari MD (31:25.113)
Or if you've been awake for five minutes in the morning, once you're up, you probably can't go back to bed. The other process is, and that's called process S, and there's process C, which is the circadian signal to wakefulness signal. Where this gets interesting is in little kids, where sleep drive accumulates much more quickly the younger you are. So that's why newborns need very frequent naps, toddlers maybe need one nap a day, and most of us aren't napping if we have enough sleep.

night. The circadian clock is less of a factor until you get into adolescence except in rare cases. But it can be for teenagers certainly. So wake windows are this idea that well there is probably an optimal time for your child to take a nap on a given day and it's a they have to be awake for a certain period before they've accumulated enough sleep drive to fall asleep again.

And that is true, right? Like you can't just give your kid a nap whenever you want. There are times when they're more likely to nap and less likely to nap. Where I get into a problem is when parents talk about wake windows, they're often talking about these elaborate systems where you put in your child's age, the measurement of their big toe, their star sign, and it is spitting out the exact right schedule for your kid. And

Sometimes these systems work for some people. And I think that's because any plan is often better than no plan. But so often I have parents who are like really stressing about their kids wake window being exactly right. And then they're not looking and seeing if their child is rubbing their eyes or actually sleepy or not. And then they're unhappy when they've been told that they have to sleep on this very set schedule that's been generated.

Arielle Greenleaf (33:14.097)
Mm-hmm.

Craig Canapari MD (33:22.196)
somewhere on the internet and that's not how things work. I mean there's no research generating wake windows formulas.

Arielle Greenleaf (33:30.361)
Yeah, I wanted to ask you if you could share a little bit. I know you did a deep dive in figuring out when did that term even come into existence.

Craig Canapari MD (33:40.505)
I'll tell you right now,

I often like to look at Google, Google trends is sort of a good way to sort of see when people start talking about stuff. And just looking at my site, I'd say this was probably a little bit pre pandemic. I can't see on the timeline here. So this is pretty, pretty recent stuff here. Napping is really hard, right? Like Arielle , I felt like it was easy for me to get.

Arielle Greenleaf (33:48.313)
Right, that's, yeah.

Craig Canapari MD (34:15.298)
bedtime right and understand my kids timing at night, but nap time is tricky. What do we know about kids naps? They're gonna go for, they're gonna take fewer and fewer naps as they get older. So if you have a baby taking four naps a day, then they'll take three, then they'll take two, then they'll take one, then they'll take none. As to when that occurs, that is highly variable depending on the child. Even if you look at the normal value, the ranges for dropping naps, like they're sort of,

Arielle Greenleaf (34:38.321)
Mm-hmm.

Craig Canapari MD (34:43.766)
Iglowstein paper, which is where they followed like a zillion Swiss kids. They looked at the percentage of kids when they gave up their, I'm just looking at this data here, when they gave up their first nap and there's anywhere between six and 18 months. So that's a really wide range. And look, you can agree with this data. This was a homogeneous group. my point is every kid is different. don't, you know, it's hard to, you can't just meet a kid.

Arielle Greenleaf (35:04.287)
It's... Yeah.

Craig Canapari MD (35:13.28)
and say, you're going to drop your nap next month because the Wonder Week said you are or something.

Arielle Greenleaf (35:19.313)
Right, exactly. And I think, you know, I got kicked out of a subreddit because I was arguing, not arguing, I was educating about sleep needs. And there was a seven month, a mother of a seven month old, and she was struggling with timing of things. And it was clear that the child was giving her X amount of sleep. Like it was like, I don't know, 13 hours of sleep in a 24 hour period. And

Instead of people looking at that data, the admins instead were like, that's not enough sleep for that age. That child needs 14 hours of sleep in a 24 hour period. And I was like, I don't understand why you would say that. This is how much sleep the child's been giving her. And they said, well, all seven-month-olds, that's the average sleep need for that age. Of course, they need 14 hours. And they said, that's the average sleep total.

between 12 and 16 hours, which is what's recommended for that age, but that's not the average sleep for that child. So I just, see it and I get it. I do understand it. Logically, I understand parents want to figure out their child's schedule, but in so many cases, it's unrealistic. The wake windows causes, again, anxiety. My child is not fitting into the schedule. What is wrong with my child? What is wrong with me?

I'm doing something wrong, I'm a bad parent, I don't know what's wrong with my kid, should I take him to the doctor? And it's really just that they're so focused on these wake windows and being overtired and cortisol that they're not watching their child, like you were saying. They're not paying attention, they're all logging their sleep, but they're not really paying attention to those sleep logs and understanding and getting a realistic picture of what their child gives them, averaging out, you know, seven, 14 days.

Huckleberry gives you like seven, 14, 30, and 90. It's excellent. And it's crazy because I can show people to their face, look, your child really had their sleep needs really haven't changed that much over this amount of time. And so those wake windows that you're following just aren't right because they don't match your child's sleep needs.

Craig Canapari MD (37:34.198)
You mean the Huckleberry sleep diary.

Arielle Greenleaf (37:37.359)
That log, sleep log app, yeah.

Craig Canapari MD (37:39.106)
Gotcha. Yeah, no, think it's, which is not to say that this stuff is really hard, right? Like that's why parents were desperate.

Arielle Greenleaf (37:48.201)
it's very, yeah, yeah. That's what I do. I mean, that's what I educate parents on. And it's always like a light bulb goes off. Like this person who was saying that the split nights would have been fixed if she understood this and wasn't scared about pushing wake windows and the overtired thing. So, you know, my goal is to alleviate that by educating. But again, like that doesn't fly on social media. can't.

explain that as easily in one singular post.

Craig Canapari MD (38:20.482)
Yeah, I think it's just hard, right? And our algorithmic social media just pushes simple punchy messages to the top. And it's not always helpful.

Arielle Greenleaf (38:33.538)
Mm-hmm. Absolutely.

Like the next topic.

Craig Canapari MD (38:41.418)
yeah.

Arielle Greenleaf (38:41.434)
which we've touched on before, but I continue to see even though you educated everybody, the whole world. Let's talk about magnesium and magnesium lotion and melatonin as...

quick fixes for regular children.

Craig Canapari MD (39:01.518)
Is there, are there melatonin lotions? Okay, thank God. Okay.

Arielle Greenleaf (39:06.316)
No, not melatonin lotion, magnesium lotion. Sorry, I misspoke. Well, there probably is. Actually, there's like melatonin in my Dr. Teals bath stuff. It says there's melatonin in it. I can show you the label.

Craig Canapari MD (39:21.929)
Just, I'm just laughing about the fact that, know, Epsom salts will raise people's blood magnesium levels and the mechanism is because you're absorbing it through your mucus membranes that are in the bath. So everyone do the math on that. Just, so anyway, yeah, I mean, I'll link to a previous episode where we covered this at length, but I would say that magnesium, there's been a lot of interest in it.

There is not too much evidence that is really helpful for sleeping kids whatsoever. It's a mineral. You probably can't hurt your kid with it, but I don't really routinely recommend it for people. Although children with very picky diets may benefit from supplementation, it's not clear they will supplement benefit in terms of their sleep. The lotions.

There's really no evidence that a magnesium lotion spray or rub is going to raise your child's blood magnesium whatsoever. Save your money. It's snake oil. As for melatonin. Melatonin is a hormone that is frequently given over the counter in the US. There's a whole story about melatonin that I'll give you guys some links to. Long story short, it is not recommended in otherwise healthy children for routine sleep problems.

It is always supposed to be coupled with a behavioral intervention first and should be supervised by a physician. So I'd say that if you are, you don't need to freak out if your child is taking melatonin, but please let your doctor know. And if you are contemplating melatonin, this stuff isn't anesthesia here. You're still going to have to make behavior changes. And for most kids who are neurotypical, the behavior changes are enough and do not require giving your child a hormonal supplement to get them to sleep.

Arielle Greenleaf (40:50.352)
Hmm.

Craig Canapari MD (41:12.632)
because melatonin, like cortisol, is a hormone.

Arielle Greenleaf (41:16.624)
Right? Yeah. Absolutely.

Craig Canapari MD (41:22.124)
So yeah, magnesium is the, and I just wrote an article from my website too about theanine, which has even less evidence for it. So don't give that to your kids either.

Arielle Greenleaf (41:22.479)
Arielle Greenleaf (41:33.04)
I thought you said L-theodine had more evidence.

Craig Canapari MD (41:36.534)
Not it has zero evidence in kids. So I mean, there's it's it's it's it's all pretty soft stuff. What theanine seems to do in adults is improves satisfaction with sleep, although it does not actually increase the amount of sleep that you get. So it looks like you feel like your sleep was more restful, but you don't necessarily sleep any more Then you do if you don't take that.

Arielle Greenleaf (41:38.946)
No, but for adults.

Arielle Greenleaf (42:02.586)
So is it like playing with your dopamine or something? Making you like...

Craig Canapari MD (42:05.55)
Um, you know, it, it does have to do with, think like GABA as magnesium does. So GABA is a hormone. GABA is a neurotransmitters associated with sleep and restfulness. So, so yeah, I mean, you know, I, I, I honestly, I started taking theanine a few years ago. I felt like it helped with my anxiety. So I'm like, you know, I, I, I, but I think it's different to recommend it to give it to your child just cause there's really no evidence for it in kids.

Arielle Greenleaf (42:11.866)
Yeah.

Arielle Greenleaf (42:27.15)
Interesting.

Arielle Greenleaf (42:36.366)
Yeah, I mean, I just it's it's hard for me when I see anybody just randomly, your kid isn't sleeping. Take melatonin. your kid isn't sleeping. Use this supplement, you know, from Target. Yes. Like these rest gummies. And it's just it makes it makes my heart hurt, honestly, because they could probably more easily fix the sleep permanently if they had.

Craig Canapari MD (42:49.698)
Yeah, have this rest coming.

Arielle Greenleaf (43:04.482)
some understanding of behavioral sleep modifications.

Craig Canapari MD (43:08.31)
Well, I just gave a talk for NYU, on supplements and sleep. And melatonin is the most common accidental ingestion in children now in the US. It's gone up a ton in the last 10 years. It comes in gummies. It looks like candy. It tastes like candy. And there are real risks. So please, you are giving your child melatonin, make sure you talk to your doctor. Make sure you keep it in a safe place where your child cannot access.

Arielle Greenleaf (43:36.368)
Good advice, doc.

Craig Canapari MD (43:38.414)
So I think you want to talk a little bit about bedtime, because bedtime is what, honestly, feel like getting bedtime right is one of those things that's actually incredibly valuable. I would say that in general for kids before puberty, the preponderance of the evidence suggests that a bedtime between 730 and 830 works pretty well. A lot of studies have looked at

Arielle Greenleaf (43:42.148)
I do.

Craig Canapari MD (44:08.332)
What's the adverse effects of later bedtime? And often they'll say they're looking at kids who have bedtimes before 8.30 or after 8.30, before nine or after nine. So it's not really that granular, right? They're not like comparing kids with a 7.30 bedtime versus an eight o'clock bedtime. In general, feel like adjusting your child's bedtime, like if your child's bedtime is like before seven and they can't fall asleep, you're probably.

Arielle Greenleaf (44:25.615)
Right.

Craig Canapari MD (44:36.994)
Probably a good idea to move it later.

Arielle Greenleaf (44:38.97)
Right. I mean, I think that one thing that I've seen actually lately is, and I hear it from clients, it's that bedtime is always seven o'clock no matter what. And we know a consistent bedtime is super important. So we prioritize that no matter what. And I'm like, where did the seven o'clock thing come from? I don't know where it came from. And in most cases, like I'm working with someone right now, it takes the child.

Well, it was taking her 45 minutes to an hour to fall asleep. So I told them to move bedtime later. And it actually needs to be a little bit more a little bit later, too. But it was taking her 45 minutes. So we put her down later and she fell asleep much more quickly. So I just think it's another one of those nuanced things. You got to do what works for your kid. Like you're saying, if you're you're putting your child down at 630 and they're not falling asleep until seven thirty, eight

you're putting your child down too soon. And it's not a matter of the child misbehaving in many cases. It's often that they're not tired enough. It's not necessarily that they're over tired.

Craig Canapari MD (45:46.269)
You're also saying.

You're also setting yourself up for conflict and for failure, right? You're showing your child up to not succeed. If you, I think it's very rare, let's take the example, let's take a very simple example. Parents are putting their five-year-old to bed at 730, there's a lot of conflict around bedtime, the child is up coming out of the bedroom doing curtain calls till 830. Falls asleep at 830. If you move bedtime to 815, it would be

the result would not be that your child would be falling asleep at 9 15. The result would be that you have 45 minutes less of conflict and argument with your child at night. I think where this maybe falls apart a little bit is for younger kids who sometimes have ended up with a really late bedtime. And often those kids are having that there's this circadian second wind phenomenon. So we talked about the circadian or body clock as a wakefulness signal. So you can get like

Arielle Greenleaf (46:36.122)
Yeah, absolutely.

Craig Canapari MD (46:47.63)
a little bit of surge of wakefulness if you miss your bedtime. So I have someone, one mom said to me on Facebook once, she's like, my kids need to be in bed by 730 or after nine, nothing works in between. So there is this sort of idea of a circadian forbidden zone where bedtime is not going to work. if you feel your kid's bedtime is quite late, I'd say like for a little kid, like nine or 10, by moving that significantly earlier to like 730, you might

Arielle Greenleaf (47:00.048)
Mmm.

Craig Canapari MD (47:18.078)
Sometimes I've seen that work where like, I'm not worried about their cortisol, but I'm worried their parents are missing, I almost said a window. They are missing a window where it'd be easier for their child to fall asleep. Their wake window is too long.

Arielle Greenleaf (47:27.44)
Well, it is a window. Yeah. mean, but we also, but that also comes, comes with the importance of a morning wake time too, because if, if your morning wake time is significantly different every single day, that messes bedtime up. So, you know, if you're, if sometimes I get people who come to me and they're like, well, sometimes she wakes up at six and sometimes she wakes up at eight. And it's like, well, how does she have a consistent day if some days like,

Her naps aren't the same time, bedtime's not the same time, and then what does her body do? Her body is confused. In order to have a consistent, predictable routine and have your child be consistent for you, you need to provide consistency. So if you want the child to have an earlier bedtime, then you need to make sure you're not putting them to bed at 10 and then letting them sleep till 10, because then that's going to cause a problem.

But that morning wake time is important. I think the consistency piece is important at bedtime, but it's also important for the rest of the day as well.

Craig Canapari MD (48:37.326)
And I think that's a very good point. But I do want to be clear that like some children can really tolerate a little bit of variability in their wake time. So if your kid like sleep is variable and it works for you and you're not having struggles with bedtime or nap time, I think that's fine. But if you're if some beds, if you're the nap seems to be all over the place, sometimes they fall asleep easily at night, sometimes they don't, then I think that's where you need to clamp down.

Because I felt like my kids were great sleepers and I don't think I had much to do it, but they would, they could take like a three hour nap in the afternoon and go to bed two hours later. And like.

Arielle Greenleaf (49:14.007)
Yeah, well those aren't the people that I'm seeing.

Craig Canapari MD (49:16.826)
No, no, my point is if you're listening to this because you're idly interested, but you have no concerns about your child's sleep, you don't need to change anything. It's more like if you feel you're not happy with your child's sleep is, or your child seems tired, irritable, that they're struggling. That's when you need

Arielle Greenleaf (49:36.495)
Right. Absolutely. It's not a problem unless it's a problem.

Craig Canapari MD (49:42.038)
And I think I know you you posted this link to various interventions that bedtimes do seem to have a modest effect on increasing sleep time if you have bedtimes earlier across studies. It's an interesting review article. I think the point is, is that little kids, it's easier, they're tend not to sleep in. So it's easier to get them more sleep by moving the bedtime earlier. Teenagers are a different story. They're sort of like

Arielle Greenleaf (50:09.807)
Mm-hmm.

Craig Canapari MD (50:11.392)
often can't fall asleep before a certain time. We should have some of the Start School Later people on to really talk about teens and sleep problems. I think we could do a whole podcast and that actually would be pretty interesting. that's why, if you're having to wake up your little kid, and I'm talking about a kid that is up through elementary school, if you have to wake them up on weekdays, they're probably not getting enough sleep.

Arielle Greenleaf (50:17.367)
Yeah, I would love that.

Craig Canapari MD (50:39.847)
or their sleep is disruptive. Like if they're snoring, they might have sleep apnea. But pre- puberty I generally expect kids to wake up on their own.

Arielle Greenleaf (50:50.125)
I think also when you're considering bedtime, have to consider, again, morning wake time. If you have to wake a child, I've had some people that have to wake their kid up at 530 in the morning because they need to be at work by seven. And so that child probably needs a, if it's an infant or a toddler, they probably need a significantly earlier bedtime than someone, know, some of their peers that can sleep till 630 or seven. So considering that, keeping that in play is important when you're

when you're trying to figure out bedtime. And that's true too for older kids. But the problem that you talk about is sleep onset. Sleep onset is pushed later for prepubescent and pubescent teenagers beyond. They can't fall asleep at 7.30. But they still need a lot of sleep.

Craig Canapari MD (51:36.526)
Yeah, they do. often, between activities, their natural biology, and the fact that school starts inappropriately early for the majority of teenagers in the US, it's a recipe for chronic sleep deprivation across the board. I want to just talk about, I think this is a really good question, is how, for parents who are struggling with this stuff, in the media landscape,

How do you know who to trust? Like how do know if something's a good source of information? I mean, I have some ideas, mean, besides us, of course.

Arielle Greenleaf (52:13.753)
I don't know if you saw the news at what's going on over in the UK, I guess this big, think her name is like the Magic Sleep Fairy or something like that. There was like this whole investigative report that went on. If you go to the BBC, you'll find it. And in fact, one of our listeners who I enjoy chatting with,

regularly about sleep stuff was involved in helping to bring this to light. this consultant was literally telling parents to put their babies down on their stomachs. But this was during consultations, and the investigative reporter was having a consultation with her and got it on camera. And I guess she regularly has photos of unsafe sleep spaces and things like that.

So, but she's got, you know, I guess hundreds of thousands of followers. Are they real? I don't know. Are they fake? I don't know. But the fact of the matter is there are loads of people that are giving really bad information out there and they're at the top of your algorithm. I honestly struggle with how to answer this question because parents are tired.

And when you keep seeing the same things over and over and over again, wake windows, melatonin, all these things, then of course it just becomes regular to you and you're like, okay, well, I guess I should try it. So I'd love to hear your advice on this because I mean, I've been, because of this UK thing, I've been riled up again about how I feel it's so important to regulate this industry, but that's a whole.

beast in and of itself.

Craig Canapari MD (54:07.63)
Well, this is idea of the Overton window. And it's the idea that like there's certain, I'm not gonna explain this well, but there's a certain amount of discourse. If it moves in a certain direction, say left or right in the political spectrum, that kind of normalizes more and more extreme views. And I feel like with the sort of Overton window of like what is considered like normal sleep practices has moved to a lot of quackery lately because of what people are seeing. And I would say, look, the first,

place you should, the first person you should be talking to is your child's pediatrician. They know way more about them than anyone on the internet, including us. And they know your child's medical history, they know you, they know your other children, they know your community, and they should be your first stop when trying to find information about sleep problems. I would say that look, credentials are nice. Like if you find a

a sleep provider in your community, like if you're lucky enough to have like a sleep physician or APRN who does this sort of work, that can be very helpful. But I mean, you know, there's certainly a lot of physicians out there to hawking snake oil. So I think that that's also something to be aware of MD after your name does not mean that everything you say is the truth. How do you think that parents who are maybe interested in hiring a sleep consultant can find someone who

is gonna be evidence-based.

Arielle Greenleaf (55:37.067)
really struggle with this. I've been thinking about it the last, even the last day because I had a very interesting consultation, a good great consultation yesterday with a family, but it was you know they had they were asking about cortisol. They were asking about all these things that we're talking about. I honestly don't know because I don't really feel like there is a body of

people or experts that I would fully trust to say, to that website and you'll find someone there. That's going to be good. Because in most cases, it's just that the consultant is paying the association or the networking group to have their seal on their saying like, this provider falls under our association and we think that they're great.

I also don't feel like there's training courses that I 100 % feel aligned with, feel they're truly evidence-based. I got so many messages today because of this UK thing about courses that just telling me what's in the courses and how they wish there was something more that they could take here. The UK has higher level.

training for for consultants which i haven't looked into yet but in the us there's no like higher level training for us you just go to a sleep consultant training course and there are so many now so i it's a struggle for me i i'm not and i feel frustrated that i can't say this is how you do it because

because I want to give parents really good information. And so that's why I don't feel comfortable recommending any one singular place to go look and find a sleep consultant. But I would say that, I mean, if you're listening to this podcast, then you're, probably learned a lot from us. And I would recommend going back and listening to other podcasts that have similar topics that you might be interested in. And then

Arielle Greenleaf (57:59.605)
have a conversation with that consultant. Talk to a few of them. See what they offer. See what their philosophy is. Ask them if they only look at wake windows or if they're by the clock schedule only or if they're really looking at the full picture of your child. Because everyone says they're evidence-based now. Every single coach out there I see is evidence-based.

I think it's really unfortunately up to the parent to have those conversations. I would also say word of mouth. So like if you have anybody that you trust and they've used someone, then definitely have a conversation with that person. And again, any providers that you have. A lot of times there will be, I've been, people have been referring me, I've had doctors refer me to people.

So see if they have any referrals, but it's tough out there. It's very, very different than when I started 10 years ago. Very, very different. And it's very hard to know what's good and what's not.

Craig Canapari MD (59:09.846)
Yeah, I think that's a thing we got it. So anything you want to share with with people this week, Arielle .

Arielle Greenleaf (59:18.946)
Happy Mother's Day, but by the time this comes out, it'll probably be Father's Day. So happy Mother's and Father's Day.

Craig Canapari MD (59:21.88)
Definitely give me, yeah.

Craig Canapari MD (59:27.842)
No, any resources on your website you want people to look at or?

Arielle Greenleaf (59:31.326)
Yeah, you can always find my 24 hour sleep. I have a free 24 hour sleep guide that we talk. I talk about that nonstop, but you can download that for free and it gives you a good understanding of how to do that for yourself. And then of course, if you want to reach me, you can come to my website, expect to sleep.com and or DM me on Instagram. I'm happy to answer any questions.

Craig Canapari MD (59:55.598)
I'd say for me, have a, well, after a lot of work, I have a brand shiny new website. So come say hi. I have a, link to the show notes. I have a sleep training jumpstart, totally free for people. And yeah, check it out. And hopefully next time when I send an email, it'll actually work. Like the first one I did.

Arielle Greenleaf (01:00:16.77)
And you can email us at thesleepeditshow at gmail.com.

Craig Canapari MD (01:00:23.47)
thesleepyouttachow.gmail.com. One day I'll remember that. Okay, that's it. Thanks for listening.

Arielle Greenleaf (01:00:25.846)
Yeah. Great.

Arielle Greenleaf (01:00:32.76)
There we go.

Craig Canapari MD (01:00:34.382)
I'm just trying to remember if there's anything that I flubbed in the cortisol, because I'm sorry, was kind of monologuing there. Okay.

Arielle Greenleaf (01:00:36.396)
I just check and see. No, I don't think you did. I really don't think you did. I think we'll need to edit. Well, we always need to edit. But I think it was very thorough. I'm gonna check our email. There's nothing.

Craig Canapari MD (01:00:50.38)
You know, it's a, there's there's lots to talk about. I had no idea that people were actually taught to be afraid of cortisol and overtiredness. That's crazy.

Arielle Greenleaf (01:01:01.218)
Yeah, yeah, did you see?

Craig Canapari MD (01:01:03.403)
Where you get where are you hearing are you hearing this from parents because I'm like my algorithm is not serving this to me

Arielle Greenleaf (01:01:07.774)
yeah. yeah, yeah, yeah. Well, I mean, the parents aren't, well, they say it in mom's groups and things like that, but I just want to.

Arielle Greenleaf (01:01:22.286)
Ashley's.

Her sleep plan says...

Arielle Greenleaf (01:01:38.092)
One of the most important things we do during this process is keep her bedtime flexible so that she will not become overtired during this process. The early bedtime tool is one of the best tools that you have to always ensure your child remains well rested and can make up any lost sleep that may have occurred during the day. An overtired child releases the hormone cortisol and has a much harder time falling asleep, staying asleep, and may even wake up earlier, not later than normal.

Craig Canapari MD (01:02:08.982)
Yeah, mean, you know, it's funny to me, like, everything sounded reasonable up until then. And it's almost like cortisol is like the veneer of of like science that's being put on top of this idea. Because I think that I think the idea of, well, you know, your child, your child seems tired, put them put them to bed a little earlier, she night, anything, make up sleep totally reasonable.

Arielle Greenleaf (01:02:09.399)
So.

Arielle Greenleaf (01:02:26.796)
Yeah.

Arielle Greenleaf (01:02:30.412)
Wuh.

Arielle Greenleaf (01:02:36.715)
Yeah, yeah, but...

Craig Canapari MD (01:02:38.423)
But then blaming it on the Boogeyman cortisol, that's the problem.

Arielle Greenleaf (01:02:41.197)
cortisol, but then that word has a bad connotation because of the cortisol middle-mist study, which seems to be coming back around, which I can't stand. And a lot of my clients are scared of crying. They don't want any crying. And that's new. I'm like, just shut the door.

Craig Canapari MD (01:02:51.021)
Yeah.

Craig Canapari MD (01:03:03.864)
Sure man, mean, should've wrecked your kid's brain.

Yes.

Arielle Greenleaf (01:03:09.909)
cry. We're still recording. You'll be done in two nights. And then they're like, they want to, you know, they want to, they want gentle. And I'm like, well, then it's going to take you two months instead of two nights. You do what you, you do you.

Craig Canapari MD (01:03:13.91)
You be like, you wanna cry your fifth report?

Craig Canapari MD (01:03:24.302)
Yeah, mean, yeah, I true story is where Down syndrome comes from. So those kids cry too much when they're babies. No. Yeah, okay. I'll edit this one. I can share something now from our new opus clip and we'll keep bleeding them out. yeah, good. Thanks for organizing this. Maybe, I think in July is when I got a bug, Beth Malo about

Arielle Greenleaf (01:03:30.49)
Stop. Get out of here.

Arielle Greenleaf (01:03:43.49)
Yeah.

Arielle Greenleaf (01:03:47.362)
Yeah.

Craig Canapari MD (01:03:53.57)
The autism one, the start time one would be like.

Arielle Greenleaf (01:03:55.884)
Yeah, I'm like basically unavailable in July. So if you wanted to do it without me, you could do that. But I'm on vacation the last two weeks. I have Ashley the week before that two weeks.

Craig Canapari MD (01:04:08.46)
Yeah, I mean, I'll let you know. She's hard to get. like, that's kind of more in my domain anyway. But if you want to give me questions, I will, I will do it. And the start time one might be a bit, a might be a good thing to do because I know the start time people, they've got a book coming out.

Arielle Greenleaf (01:04:19.317)
What about this?

Arielle Greenleaf (01:04:25.591)
That's what I was just going to say. what if we did that in August? Back to school.

Craig Canapari MD (01:04:30.742)
August, August would be a time. mean, I'm also going to see those three meeting in June, but yeah, I'm like, what would, I guess what would we tape next? Do you think we have anything else in the hopper?

Arielle Greenleaf (01:04:35.532)
I

Arielle Greenleaf (01:04:40.851)
No, but I'm sure we can come up with something. I'm sure we have something somewhere on a Trello board or something.

Craig Canapari MD (01:04:51.182)
Yeah, because I'm saying I could probably get them in June too, like Tara Ziparin would be. And they owe me, because I'm doing a bunch of shit for them.

Arielle Greenleaf (01:04:55.454)
okay, I'm gonna do it in June.

Arielle Greenleaf (01:05:02.384)
well then, yeah. Whatever.

Craig Canapari MD (01:05:04.312)
So yeah, we don't have to do it next, but if we can't think of something else to

Arielle Greenleaf (01:05:10.925)
I don't care, it doesn't matter to me. However we wanna do it is fine.

Craig Canapari MD (01:05:14.252)
Yeah, no, it's just good to be consistent. cool, cool, All right.

Arielle Greenleaf (01:05:19.391)
reach out to them. think the autism one is great. then shoot, there was one. I would love to get Bloom Doc, what's her name?

Craig Canapari MD (01:05:32.002)
yeah, Lauren Hughes.

Arielle Greenleaf (01:05:33.515)
Lauren Hughes, I feel like we should get her on here for something. I don't know what, but maybe we'll talk about politics. don't know.

Craig Canapari MD (01:05:38.134)
Yes, you will.

I think maybe sleep in primary care. What are the issues that people face? Because don't know, whenever she shares one of my posts, she makes it rain!

Arielle Greenleaf (01:05:45.124)
that's a great idea. Yeah.

Yeah.

Arielle Greenleaf (01:05:53.001)
Yeah, well she, yeah, I mean, I've gotten followers from her for sure. So. All right.

Craig Canapari MD (01:05:57.314)
Yeah, you know, that's good. I don't think it should be too hard to get either.

Arielle Greenleaf (01:06:03.661)
Well, I would let you do that outreach.

Craig Canapari MD (01:06:05.42)
Yeah, no, mean, like, you know, I'm sure you could ask it to you,

Arielle Greenleaf (01:06:09.397)
You're super popular, so I'm just a nobody.

Craig Canapari MD (01:06:13.392)
my god, so nice to hear.

Arielle Greenleaf (01:06:15.391)
I wanna go to a sleep conference with you. I wish sleep coaches could go.

Craig Canapari MD (01:06:20.142)
Yeah, I have nobody to sleep conference. I'm not some big ass researcher, believe me. But it is, I gotta go to the sleep meeting in Baltimore and try to recruit someone to come work with us. So I don't particularly wanna go this year, because Baltimore is not that exciting to me, but I have to go take people to for coffee, lunch and dinner.

Arielle Greenleaf (01:06:26.347)
I know.

Arielle Greenleaf (01:06:32.785)
really? You're going to be down a person?

Arielle Greenleaf (01:06:42.406)
boy. What are you hiring for?

Craig Canapari MD (01:06:45.686)
we need more docs. So we need at least one. We hired, we just interviewed somebody who might be good, but they need like a, they needed a visa. So J1 visas for like foreign medical graduates, was really the only people going to pediatric pulmonology and sleep. The visas have gotten very difficult to get. So you have to start a year in advance to try to get them.

Arielle Greenleaf (01:06:53.555)
that's tough. Yeah.

Yeah.

Craig Canapari MD (01:07:07.18)
So yeah, it's crazy stuff. yeah, you didn't have...

Arielle Greenleaf (01:07:09.292)
I did my Zoller today. I'm gonna go sit at the damn office for two hours.