Sleep Deprivation and Heart Health

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Hi, everyone thanks. So much for joining us this afternoon. My name is Danny hill. One of the health educators over at Optima health, and our health and preventive services department.

I think we do have a couple more folks that will probably hop on the call as we go, but wanted to be mindful of everyone's time. So we're gonna go ahead and get started.

I thought that this was a pretty interesting topic for February in particular

because it is heart month, a big celebration at the American Heart Association

and santera and Optima work with them as close partners to help deliver education and preventive measures that you can do to maintain your heart health

so this seems like a fitting topic for this time of year without further ado.

I'm going to go ahead and move into our objectives here. One quick note for you. I have muted everyone on entry into the WebEx and that's just to avoid any feedback.

And disruption for those that are on the call, if you do have any questions or comments that you'd like to share during the presentation

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Additionally, this presentation is being recorded, so within a week it will be posted on the Optima Health website on I'll send that out to you in an email as well.

So you'll have it that way, but That'll be a great time for you to go back and review, revisit this topic, or send it along to anyone that is interested. They do not have to have Optima insurance. They don't have to log in or anything like that available for anybody to view.

So. Let's go ahead and get into this.

What we're gonna talk about a little bit today is sleep deficiency versus sleep deprivation, outline the differences of those, and then really spend the bulk of the time today talking about the health risks specifically, as it relates to heart, as I mentioned.

And then we'll talk a little bit about what we can do to increase our sleep quality and make sure that we're getting the recommended amount of hours of sleep every night.

So, first, we're gonna talk about this difference here in deficiency and deprivation. How we can experience both sleep deprivation is a condition that occurs when you don't get enough sleep.

So, pretty straightforward sleep deficiency occurs when you have one or more of the situations or conditions going on, you see, listed here on the right hand side of your screen.

So that's gonna be you're constantly falling asleep at the wrong time of day. Your, so meaning that you're kind of at a sync with your body's natural clock, if you're not sleeping well, if you're not going through all of your sleep cycles

the way that your body needs, or if you have a, a sleep disorder, that's preventing you from getting enough sleep, or I lack in the quality of your sleep.

Those can all kind of fall into the categories sleep deficiency along with having sleep deprivation. Because sleep is a vital process.

Sleep deficiency can lead to health problems, both physical and mental, and that can lead to injuries loss of productivity, risk of death in some extreme cases. So I'm sure we've all at one point or another in our lives experience.

Sleep deprivation just gonna mute feedback. Everyone could go ahead and mute their phone. I'm trying to meet you on my end and it's not working.

Thank you so much. Alright. Let's talk a little bit about the access of sleep efficiency. It's a common public health problem in the US people of all ages report, not getting enough sleep.

In fact, there was a health survey done by the CDC. I think it was back in twenty, seventeen, and that report came out and it said that seven to nineteen percent of adults in the US reported not getting enough rest or sleep every day, which is just crazy.

And nearly forty percent of adults report, falling asleep during the day without meaning to at least once a month. Right? So, maybe if it's if you're a passenger in a car, you might fall asleep during a ride or you're sitting down watching a, a show or something like that. And you fall asleep doing that.

And so, when you think about that nearly forty percent having that happen, at least once a month, the NH did a study, kind of looking at at that population.

They estimated between fifty and seventy million Americans that have chronic or ongoing sleep disorders. So, it's definitely something that most of us can experience, you know, at one point in our life, and very common for those to experience on an ongoing basis sleep deficiency. If you see that third bullet here.

It is linked to lots of chronic health conditions that can be things like heart disease, obviously, as well as kidney disease high blood pressure, diabetes stroke depression. So there's lots of correlation between those.

It's also associated with a higher risk of injury. And that's kind of what we talked about just a slide ago about you're you're more prone to accidents an example that you may have seen before, or heard before on the news is driver sloppiness.

That doesn't mean necessarily related to alcohol. But that could be, you know, sometimes unfortunately we hear of those incidents with tractor trailer truck or something like that. And a truck driver falls asleep at the wheel.

And unfortunately, there's a car crash injuries and death response and in relation to that. So that can be difficult. An elderly sleep deficiency might be linked to an increase in falls or broken bones.

Alright, so, we, we see that in terms of accident injury as well. And then just human errors thinks about things that happened to you on the job, you forget a conference call or you forget, you know, you go to the wrong place, one day or something like that.

There's a common mess out there that people can learn to get by on little sleep with no negative effects. Like, your body's going to acclimate to that lack of sleep and our research shows. Otherwise, shows that getting enough quality sleep at the right.

Times is vital for your mental health, your physical health and the quality of life and your safety. So who's at risk. Sorry did not move me did it well

I'm sorry I didn't the slides not moving for me, but but when we talk about people that are at risk this picture here shows an example of the groups that might be so those that work as caregivers.

Right? So, not necessarily in a clinical setting, but also, if you are taking care of someone that maybe is chronically ill, whether it's a family member or close friend people that work long hours shift workers, is that travel a lot for work?

They have a harder time getting the amount of sleep that they need, because they've got some other things going on, or or working to schedule that falling outside of their normal biological clock.

And their, their circadian rhythm, which we'll talk about a little bit more and feature slides other folks that might have problems sleeping or be those that are taking certain medications or substance abuse users or those that just simply don't leave enough time for sleep that they've

they've put so much into their day, or they have so much going on in their day that it makes it difficult for them to get that window of time that they need there.

Are some folks that do you have conditions that are associated with sleep deficiency and heart disease high blood pressure stroke all of those cardiovascular indicators those can fall into that category as well as folks that are.

Obese they have diabetes, maybe if they have HD, there's some other mental disorders that, that might cause an interruption in your sleep.

So, let's go onto our health risk. We know that when you don't get enough sleep that it makes you feel tired, but there's definitely a lot more to that.

So, we have some of these mood impacts. I'm sure some of us have experienced at least one of these problems. I know. For me, I am a mother of two young kids.

I have a five year old, an eighteen month old and so I can tell you that I sometimes irritable when I wake up on a Saturday morning at five am, because my, the younger one in particular is ready to get up and party and I'm not but you know, that there could be some ongoing things going on with their, especially I know.

Well, as well having children, especially when you're in that newborn phase, it's got a bunch of friends that are in that newborn phase right now. And anxiety is certainly an associations. They are having right now with the lack of sleep.

Alright, the other kind of category that we see in terms of health effects for the physical health effects and research shows, obviously, that you're increasing your risk for all of these listed health conditions.

If you are getting poor quality sleep, it's not mentioned on this slide. But, again, when we talk about lock asleep our performance, our ability to think, clearly react quickly, even to form memories is also impacted.

So, as I have said, before there's lots of conditions that are impacted by, but we are gonna spend the rest of the presentations focused on heart health because it is.

Heart month alright. So, when we think about lack of sleep and health and and health problems, in terms of heart health, there's there's three kind of health problems that we tend to see most commonly in relation to our heart health and sleep.

And the first is high blood pressure so, normal sleep during normal sleep patterns. Your blood pressure goes down, right? So think about that you're typically more relaxed. Your calm.

You're not thinking about things that might cause you stress that might elevate your blood pressure having sleep problems means that your blood pressure is gonna stay higher for a longer amounts of time. Right?

So, we can see how that might cause a persistent high blood pressure situation. High blood pressure is one of the leading risks for heart disease and stroke. There's about seventy five million Americans, which is one in three adults, have high blood pressure.

So, we can see why that would be a big problem. The next would be type two diabetes and this is a disease. I'm sure as most of, you know, that causes sugar to build up in your blood and it's a condition that can damage your blood vessels.

So we see how there's a heart implication there, some studies show that getting enough sleep may help people improve their blood sugar control. So that's the link there. And then, lastly is metabolic syndrome and, or obesity.

These are not the same things. And I will, as we continue to move. Through the presentation talk a little bit about the differences between those two, but basically a lack of sleep can lead to unhealthy weight gain and that's especially true for children. And adolescence may need more sleep than adults, but not getting enough. Sleep.

May affect the part of the brain that controls hunger. So that's how we see the tie there and then with metabolic syndrome, not a health condition that specifically is linked to sleep apnea. So, we'll discuss a little bit more as we move through the presentation, as I mentioned, there are two sleep conditions that stand out in the literature in terms of their association with heart health and these risk factors.

The first one is sleep apnea, let's take a look at about at this condition and how it relates to the three risk factors that I mentioned previously.

So, what happens with sleep apnea is that your airway gets blocked repeatedly during sleep you get some background noise again.

And so it causes you to stop reading for short amounts of time. If you've ever listen to someone was sleep apnea, you typically you'll hear them snoring or heavy breathing and then they'll just stop.

And there are health risk related to that in terms of heart health. In terms of high blood pressure, or heart problems in general with sleep apnea, those sudden drops in blood oxygen levels that occurred during sleep apnea, increase blood pressure and they strain the cardiovascular system.

So, if you have particularly obstructive sleep apnea, you increase your risk of high blood pressure and also your risk of recurrent heart attack stroke, abnormal heartbeat, all kinds of things.

And if you have heart disease, multiple episodes of low blood oxygen, or that lack of oxygen getting into your bloodstream from that normal breathing pattern during sleep, can can lead to a regular heartbeat that can be, can cost us when we look at sleep apnea and type two diabetes what we see is that having sleep apnea and Chris increases your risk of developing insulin resistance and that can lead to type two diabetes.

Why is it happening? What the most common cause of heart disease in a person with diabetes is a hardening of the coronary arteries or atherosclerosis, which is basically a build up of cholesterol in the blood vessels that supply oxygen and nutrients to the heart.

And we tend to see atherosclerosis more commonly with folks that have diabetes and sleep apnea. And then lastly is metabolic syndrome and again, this is a disorder that's kind of a cluster of risk factors. Those can be high blood pressure, abnormal cholesterol levels, high blood, sugar and increase in your weight waist circumference. So, it kinda put your at risk for lots of different conditions.

One of those being a higher risks for heart disease and we tend to see metabolic and metabolic syndrome and sleep apnea, married together quite currently.

Our next sleep condition is insomnia, and as, you know, with insomnia, it just is basically saying that you're having a hard time going to sleep or staying asleep for long periods of time.

And I'm sure we've all probably experienced an episode of insomnia at some point in our lives, but when it relates to these three health conditions, there is some implication.

So, with high blood pressure, there's actually a recent study that showed those who slept for fewer than six hours, had more of what they called burden. And that's a mouthful. But I think I mentioned just previously that atherosclerosis is the build up of plaque in the arteries and so with high blood pressure in this study, what they determined is folks that had less than six hours of sleep.

We're building up more plaque in their arteries. Recent research has also found that blood pressure might be impacted through what they called disturbed, autonomic balance, which basically means that you're turning on what we call your fight or flight response, and that happens from stress.

So, when we get stressed out, we tend to elevate our heart rate. And that elevation in our heart rate is just putting a little bit more pressure on the party about are putting a little bit more strain on the cardiovascular system.

And those that have insomnia stay in increased stress state, more commonly. Lastly, we haven't typically with insomnia, we have increased body fat from weight gain, right? You can't sleep. So you go downstairs and you grab a snack and that can be attributed to.

Increasing your blood pressure as well next we have type two diabetes again. There's been some more recent research that found insufficient sleep is linked to an increase in type two diabetes development specifically again with sleep duration and quality.

They've emerged as predictors of levels of hemoglobin a one. C. so if you've ever had a once, you've done it's a fingerprint test. It gives us kind of a snapshot of what's gone on for usually the past three months. It's an important marker for blood sugar control.

And this recent research has suggested that if we increase your sleep duration and your your quality of sleep, it typically means that you have improved blood sugar control and a person with type two diabetes.

So, again, we talked about with type two diabetes. How's that? Relate to heart disease. A lot of it has to do with those higher sugar levels. They tend to put a little bit of stress on our arteries.

And then, lastly, obesity, this was a pretty interesting, a little bit of research that I read and I wanted to include it. So, what they typically found with obesity and insomnia is that if you get short duration sleep, you tend to see some some metabolic changes going on.

And what is this essentially that meant is that there's been a. There's, there's typically a more pronounced change and your metabolism over short periods of time, and that has been particularly seen with adolescence and a lot of that again has to do with that hormone regulation I talked about before was sleep apnea that we sometimes don't get the hormone response that tells us that we're full and so if that doesn't develop appropriately, especially in children and adolescence, then their hunger queues are turned off or they're not.

They're not regulated the way that they should be. So sometimes they may feel hungry when they're not or they may, even if they're not hungry, it's not regulated as much as it should be.

And so their appetite tends to increase, but their expenditure of energy, their, their ability to run around and get that energy out decreases because they're tired and they haven't gotten that quality sleep.

So, there are a few things that we need to keep in mind in terms of how much you need and how to get it. So, we're gonna walk through that. I'm sure that we've all heard of circadian rhythm. I just mentioned in a couple of slides ago as well, but circadian rhythm is the internal clock. That controls are daily ups and downs and several biological pattern.

That can be things from your body temperature to your blood pressure to the release of hormones. Circadian rhythm at the end of the day, it makes people's desire for sleep to be strongest during the night time hours specifically midnight to Don, and to be less tired throughout early morning into mid afternoon.

And there are three things three factors that impact our circadian rhythm. Those are light, so the exposure to light at the right time usually helps to keep our circadian clock in the correct time schedule. So, if you think about somebody that works night shift, for example, they're telling their bodies to go to bed, but it's daytime and their time their bodies to wake up. And it's night time they have a disturbance and that circadian rhythm.

And that a lot of times can lead to sleep problems that actually, if you think about even blind blind individuals, they would have a problem with that sleep wake pattern. Because the importance of light is is missing for them.

The next factor would be time as a person, reads the clock and learns how to read the clock as we, as we go through, you know, school and things like that. We tend to follow. The schedules of what the clock tells us, right? We know. At certain times, we gotta work at certain times. We leave work at certain times we eat, and we go to bed and the demands of our body kind of fall in sync with those certain task, or those certain social events, or family gatherings, or whatever that we set based on a clock.

And so there's a little bit of cognitive pressure to stay on schedule and that can impact our ability to sleep. And lastly is melatonin, melatonin levels, begin climbing after dark, and they start to fall off as the sun begins to rise. If you're familiar with. Exactly. What Melatonin is.

It's a hormone that induces drowsiness and scientists believe that it's daily, you know, that light sensitivity that we talked about before that helps to regulate our, melatonin and keep that sleep wake cycle on track people progress through a series of very distinct physiological stages during sleep.

Each stages sleep serves as an important, has an important purpose, and keeping our brain in our body healthy.

But if we look at our stages of sleep, where we can very easily divide them into two different types non REM, sleep or what some folks called quiet sleep. And then REM sleep, which I'm sure we've all heard about, which is dreaming sleep during the night, are quiet. Sleep are non REM sleep alternates with periods of REM sleep.

Quiet sleep is important, because it helps to restore our body while the REM sleep is also important, because it helps to restore the mind. It's important for both learning and memory. So we'll talk a little bit about these two cycles and while they're important.

So, during non REM sleep, our body moves from light, sleep to deep sleep and this occurs and stages. Usually, it's three to four stages, depending on where you're getting your literature from.

But during deep sleep breathing becomes more regular are blood pressure falls. The, the pulse is a slows down, it looks like it's about twenty to thirty percent below what it would be.

If we were awake and the blink, the brain is less responsive to external stimulant. So, it makes it more difficult for us to, to wake up. If we're asleep during this timeframe during the deep sleep timeframe, deep sleep, also, team tends to be the time and our body renews and repairs itself. Normally young people spend about twenty.

Percent of their sleep time and stretches of deep sleep and they can last up to half an hour. But deep sleep is nearly absent for those that are over age sixty five. So it's pretty interesting.

I think we can all kind of relate to that to how much harder you see a child sleeping, you know, how much harder to wake them up in the middle of their sleep versus someone that's getting older and older as you age through your life you might experience that as well, but when you sleep after a period of sleep deprivation, then you quickly pass through that light late stage into those deeper sleep stages and you spend greater proportions of time in that deep sleep.

That suggests that deep sleep plays a really important role in restoring our alertness and, you know, it gives us that ability to feel like we're functioning and our optimal level. During REM sleep, our brain is racing, we're thinking, we're dreaming our eyes name is back and forth. Pretty rapidly. Our body temperature increases.

Our blood pressure increases our heart rate increases almost to the, to what it would be at normal daytime levels, and that fight or flight response that I talked about before that is stimulated. And it's actually almost twice as active as it is when you're awake. So, despite all this activity that's going on, your body is hardly moving, except for maybe some little switches and muscles aren't aren't needed for breathing or eye movement or quiet.

So, just as with deep sleep, restores your body scientists believe that REM sleep are the streaming sleep restores your mind. And that's one way that I saw it phrase, which I thought was kinda cool is were it's helping to clear out you're relevant information from from your mind, which is kind of a good way of looking at it.

It was a study done recently on students. I believe that they were high school students, it has been college students, but it looked at their ability to solve complex puzzles involving, like, really abstracts shapes. So, not like your normal puzzles, but really weird shapes and the study looked at how how they were able to put those together.

When they had some of the kids that were got a good night sleep, and then they saw the puzzle and they were able to figure it out pretty quickly. And then they put another group and that they never allowed them to get into this room sleep. And they really struggled with putting together the same puzzle. So it's kinda interesting to see that. Maybe we couldn't clear out that irrelevant information from our brain.

So, it kinda gave us the foggy headedness that we weren't able to to focus on the task at hand as well. It was pretty interesting. If you're deprived of this REM sleep, and then allowed to get a subsequent night of undisturbed sleep, you enter this stage also. Very quickly earlier.

You spend more time there and a lot of people call that RAM rebound and the science medicine or sleep medicine. You know, field, so what we can learn with both of these is and we're sleep deprived. We go into deep sleep and into dreaming, sleep faster and we stay there longer.

So our body does crave both of these important stages of sleep. So, as I kind of just alluded to, what's important in the quality of your sleep is that you are gonna go through both of these stages and you should be going through both pages three to five times per night as an adult. So that means about every ninety minutes or so you should be entering into that RIM sleep.

Other interesting thing is that our sleep cycles. Happen in a pretty predictable pattern if you, I took a really cool looking chart and I tried to make a very rudimentary, a replica of it here on the slide. But experts chart, sleep stages with what's called a hip, new gram. And when I looked at it, I almost felt like a city skyline. If you think about kinda where the dips are, those are in between the buildings.

And then the spikes are are the taller buildings on, like, a city skyline, but a person that goes into REM sleep four times. That would be is what you're what you're seeing here.

So, those orange shaded sections are when they're going into there. Rem sleep. So, you can see that we start out a week if you can see my my mouse on it screen here we start out a week and then we go into our light sleep and then we drop into deep sleep. And then we shoot into REM sleep, and we kind of repeat that pattern.

But if you notice our stretches of RIM sleep are longest, you know, in the middle of our sleep time. Right? So that, that midnight to dawn timeframe, and then we shoot back out of them for shorter periods of time, as we get closer to the time that we wake up in the morning.

But you need changes over the lifespan as you can see here. And it varies from person to person, but this chart kind of shows more of a general recommendation on how much need for different ages, National sleep foundation recommends that adults get between seven and nine hours of sleep per night, any sleep duration that shorter or longer than that has been associated with a higher risk of sleep deprivation, sleep deficiency.

Like we mentioned before. If you sleep the less than what's needed, the sleep loss will add up and that's called sleep debt. So, to give me an example, losing two hours of sleep per night will give you a sleep debt of fourteen hours for a week. People that take naps to recover from that sleep debt.

They might get a little bit as a boost in there. Short term alertness or performance, but it doesn't recover that sleep debt that we were talking about. That's because napping is not really beneficial to the body in terms of the ways that we've talked about before. It's just a short term benefit that you get the other thing.

That a lot of us tend to do is if we have a day off, or if it's the weekend, we say, you know, I'm gonna make it for my sleep so I'm gonna sleep longer, or I'm gonna try to stay awake later at night. So, I can wake up later the next day and that doesn't really seem to have much benefit for us either, because we're not really making up for what we lost. You can't really do that. Some people may even sleep more, but those kind of.

>We'll have abnormal patterns that can throw off your body, circadian rhythm rhythm over periods of time. So that's why you may have heard in the past, you know, on the weekends, you really should go to bed around the same time as you do during the week, and wake up around the same time as you do during the week.

And that's why, because you're typically gonna get a better sleep. If you continue to follow that circadian rhythm that your body has set. So, what are some tips and tricks that now? We know these sleep cycles. We know how much sleep we need what can we do so we're gonna go through twelve quick tips pretty quickly here. Lots of you may have tried before, but maybe it's just not the right combination of them.

So the first six here go to bed at the same time every night wake over the same time every morning. Yeah that's what we just talked about. Obviously, keeping your bedroom quiet, dark and relaxing.

So that might mean turning off your electronics, or if you have an alarm clock, maybe turn it away from you. So that the bright light isn't hitting you and right in your eyes. But you can still hear the sound when your alarm goes off in the morning.

Obviously adjust the temperature to make sure it's not too hot or too cold when you're going to be comfortable and also using your bed for just sleeping. So avoid reading or watching TV or listening to music things like that.

You want to use your bed just for sleeping? I know. For me, my mind will race more if it's really quiet in the room. So, I might put some white noise on or a fan, or something like that just to kinda drum out me thinking on my own the next ones are to avoid a couple of things.

One would be larger heavy meals right? Before that you can have a light snack, but you wanna avoid meals, having meals about two hours before you go to sleep next would be to avoid alcohol. And you wanna also avoid nicotine, obviously, for all of the health reasons, but nicotine and caffeine or both stimulants, and that can interfere with your sleep.

That actually believe it or not. I saw when I was looking through this stuff, caffeine can last for as long as eight hours in your in your body. So, you can still feel the effects for eight hours after use, like, say you have a late afternoon cup of coffee, you can feel the effects of that all the way through until, you know, ten o'clock at night. If you had it at two o'clock in the afternoon, for example.

Obviously you want to make sure you're giving yourself enough time to sleep you know, that that beginning of that that dream. Excuse me that quiet sleep that non REM sleep that we talked about, we're going from light, sleep into deep sleep. It takes fifteen to twenty minutes to go through that transition. So don't give yourself just seven hours from the time you, you know, hit the bed until the time you wake up in the morning, you need a little bit of transition into that sleep.

And then try to stick to the same sleep schedule. Like we mentioned the recommendation with that is to limit yourself to no more than about an hour and difference. So, if you go to bed every night at ten o'clock during the week, try to do the same thing on the weekend.

So, let's say you wake up at five, am the next morning, give yourself until six and then get up. Saying up late leaping in, they can disrupt that sleep wake cycle that we talked about. This is a good one, because it makes me think of my kids use the hour before bed time as quiet time. So we tell ourselves do this all the time with babies, right?

When we're trying to teach them how to sleep, we say, you know, turn off the TV, have the light flow, do quiet time activities with them. Give them a bath, read them books. The same as is what we can say for ourselves strenuous exercise. You should avoid that and that last hour before bed, artificial light again, from the TV computers, cellphones that both stimulate our brain to stay awake.

So, you know, take a bath. If you can meditate do something quiet, keep your keep the noise low in your room. Spend time outside every day, when possible be physically active again if you're outside, you're getting the stimulation of that light during the day and that will really help your body to understand that. It's time to go to bed at night time.

When there's not as much light outside, but also just getting out and being physically active that will help your body to releases hormones in the appropriate way as well. That cascade appointments. And then mapping during the day email, you might get that immediate benefit in terms of better, alertness, better performance. But if you're having trouble sleeping at night, you want to limit your naps to know more than twenty minutes a day.

And have them earlier in the day. If you are a napper and that again is just to help your body fall into that appropriate circadian rhythm and to allow your body to trigger the responses on its own. But it needs in order to stay asleep.

Alright, there are a couple of resources here. That might be beneficial to you. One is the guide to help you sleep but this is available through the National heart, lung and blood Institute at age. It's a really great resource.

So, if you are interested in it, it's like sixty pages but it goes into a lot more detail than what I've done today and kind of walk you through any questions or different tips tricks things that you can use to stay asleep. And you can just just Google and age your guide to help you sleep and you should see a pop right up. The next are some wellness tools that are available on the optimal website at

My plan, there's a meditation CD in there. That might be a great thing that you can start to incorporate into that wine downtime before bed also some yoga, light, stretching things. Like that will really benefit you in terms of letting your body start to relax before sleep. And we have that available to you spree and lastly is your program you may or may not have Optima.

But if you don't have optimal, you can look at your program. You do have it's probably got some similar resources. But there's a lot of information usually available through those websites on different parts of sleeps different ways that you can benefit from sleep how you can get more sleep.

So you can find some more information there as well. And if you are having trouble sleeping, are you concerned about how it might be affecting your health? Obviously you want to make sure you're talking to your physician. Maybe getting a sleep study.

Might be the best way for you to go are there might be some other things going on maybe with medications or other instances other factors that you need to take into consideration to get the best sleep. Your physician would be a good person to work with you on that.

That brings us to the conclusion of the presentation. Does anyone have any questions about anything? You can use that chat feature to send them in if you'd like. Can you give it one more minute just to see if someone is in the middle of typing? I don't have any notice that anybody is typing, but I'm gonna keep it open for just a second.

As I mentioned this presentation is going to be recorded. So if you want to take a look at it again, it'll be posted on the Optima website. I will send it out to you in email tomorrow, along with the recorded presentation.

So, you'll have access to both of those you can always feel free to reach out to me with any questions that you might have about anything related to the presentation. I'll be happy to answer those.

And other than that, I thank you all so much for coming. And joining me today, I hope you have a wonderful day and I will see you next month are our presentation is gonna be on nutrition as it's national nutrition month in March. Thanks. So much guys.