In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Karin G. Johnson, MD, FAAN, who served as the guest editor of the August 2026 Sleep Neurology issue. They provide a preview of the issue, which publishes on August 3, 2026.
Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota.
Dr. Johnson is a Professor in the Department of Neurology at the University of Massachusetts Chan School of Medicine–Baystate and the Sleep Medicine Division Chief at Baystate Medical Center in Springfield, Massachusetts
Additional Resources
Read the issue: continuum.aan.com
Subscribe to Continuum®: shop.lww.com/Continuum
Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud
More about the American Academy of Neurology: aan.com
Social Media
Host: @LyellJ
Guest: @drsleepykarin
Full episode transcript available here
Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast.
Dr Albin: All right, welcome all. For the first time ever in the history of Continuum Audio, we are coming to you live from Chicago here at the AAN annual meeting. And now over to your host, the one and only editor-in-chief, Dr. Lyell Jones.
Dr Jones: Welcome, everybody. My name is Lyell Jones, editor-in-chief of Continuum, and I'm here today with Dr. Karin Johnson, and we're interviewing Dr. Johnson for the upcoming and recently published issue of Continuum on Sleep Neurology. We have been doing Continuum Audio for a while, but we're doing something different this time. As our listeners online can tell, we are recording this for the first time ever with a live studio audience at the American Academy of Neurology annual meeting in Chicago, Illinois. So, this is a fun experience for us. I hope it's been fun so far for you, Dr. Johnson.
Dr Johnson: Great to be here.
Dr Jones: It's great to have you. So, before we get into the interview, I do wanna introduce our team here for the live recording of the podcast. You've already heard Dr. Casey Albin's voice. Dr. Casey Albin is an associate professor of neurology at Emory University. Also serves as one of our associate editors at the journal and one of our Continuum Audio interviewers. So, she's going to be working the crowd today. Let's have a round of applause for Dr. Albin. And our guest of honor today is Dr. Karin Johnson. Dr. Johnson is a professor of neurology at UMass Chan Medical School and, Baystate Medical Center in Massachusetts. She is a world-renowned expert in sleep neurology and is the guest editor for the most recent issue of Continuum on Sleep Neurology. Dr. Johnson, welcome. Why don't you introduce yourself to our audience?
Dr Johnson: You did a great introduction, but I'm a clinical sleep medicine specialist. Spend my days seeing patients, taking care of people with narcolepsy, sleep apnea, restless legs, everything that comes my way. And then I have a side interest in doing sleep medicine advocacy, especially for permanent standard time.
Dr Jones: And we may get to that. I mean, that might be part of our conversation today. So, you've now read all of the articles in this issue, and it's a really great issue. There's a lot of new developments in sleep neurology. There are some updates for clinicians, people who see patients with sleep disorders that I think are, are timely and important updates. You have this unique view because you have just read all of these articles, really good articles by expert authors. When you read through these, Dr. Johnson, what was the biggest, what was the biggest thing that surprised you?
Dr Johnson: I think the biggest surprise for me is just so many changes in, in all of these articles. I realized how easy it was for us to make a journal that is so different from a few years ago. Whether it's Dr. Stahl's obstructive sleep apnea and new ways to think about endotyping sleep apnea that is gonna have treatment implications or the new treatments that are out there like tirzepatide, the changes that we're having with restless leg treatment. I particularly wanted to have a chapter on circadian neurology that Dr. Abbott did a great job really highlighting how if we think about the timing of when we give meds, the timing of when we eat, how that really can help neurological health, brain health, overall health, as well as mental health and cognition, especially as the AAN thinks about brain health as a whole, not just treating our patients, but how we can treat the population of people by improving sleep. I like how we hit on all these different areas in this issue.
Dr Jones: And I don't know how you managed to do it. They're just a small number of articles. We cover a lot of existing territory with well-characterized diseases, with new advances. But there's a lot of new stuff in sleep, and so somehow, it's all packed in there. It's really impressive. One of the things I was gonna ask you about was an evolution, and this has been a number of years now in how we manage restless leg syndrome. When I was training, it was all about dopamine agonists, and that was your first line. And over time, the evidence has supported moving away from that, and now we have more recent guidelines that have come out, and it's really the alpha-two delta-one calcium channel antagonists. How is that transition going? Do you still see people in practice who come in on dopamine agonists? How is that going? How's the field responding to that?
Dr Johnson: That's one of my most frequent restless leg consults. So even though it's been years since I have really initiated dopamine agonists in my patient, every day we get in people often on very high doses of dopamine agonists, and their doctors have just been escalating and escalating these meds over the years, and they come in with horrible augmentation. Their symptoms are much worse than they used to be, happening earlier in the day. And so, trying to get these patients off of these meds that are addictive, the way I like to teach about it is these dopamine agonists are the Fioricets of the sleep world. We know they work great, but in the long run, the patients are gonna be worse overall. And so, it's so hard to get people off these dopamine agonists, just like it's so hard to convince a headache patient that they don't need their Fioricet and that they're gonna be better off if we can get them off of it. What I think has really changed is we have more options to use. So, the alpha-delta-like agonists like gabapentin are now considered first line, but there's a lot of patients who they just don't work well enough with or they don't tolerate. And so, what do you do in that case? It's easy when that works, but and, when that doesn't work, we are being much more aggressive these days with iron replacement, potentially even trying to push ferritin levels in refractory patients up to three hundred, and using IV iron rather than just oral iron to get over the absorption issues to get the brain levels high enough. Motor stimulators, little cuffs that kind of go around the leg and stimulate the peroneal nerve in a certain way that not only can give people immediate relief, but also some data that suggests that over time it actually lessens their restless legs. We have agents like dipyridamole that work on the adenosine system in a sort of new novel pathway at addressing restless legs. And then the opiates, often meds like methadone or Suboxone can be used in some patients. But as we're getting more of these other options, often we don't need to go to those levels because we do have more to work with.
Dr Jones: So, the key point is lots of options. We're not starting with dopamine agonists anymore. And I think the fact that you're still seeing a lot of patients who have been initiated on that probably tells us there's an education gap field that we need to work on. So, another thing that I noticed reading through the issue was, and this feels like a change over the last few years, is the availability and the tendency to use in-home sleep apnea testing as opposed to formal, traditional in-lab. And that feels like a great new option, and maybe that increases and improves availability for patients who need access to the test. But how do you work through that?
Dr Johnson: So, I love in-home testing. We've been using it for over a decade. Other parts of the country where insurances didn't sort of mandate it are now being more mandated. I think the real change happened for a lot of places over the pandemic when labs closed down. But I think it's good because it brings a lot more patients to us. They get tested, they get tested quicker. People who would say, "I would never go into a lab. Oh, I'll do a home study." So, it just does bring more people in, and it gets them to treatment that they need that can really be life-changing. But it's not for everybody. The biggest people are people that have other bad pulmonary issues. If you're on oxygen therapy, you should not be getting a home study. That really should be a group of people that come in the lab. Similarly, if you have bad COPD, you probably should be getting a full in-lab study, so we can get more monitoring. Central sleep apnea is an interesting one. It can be very hard in some cases to differentiate the centrals and obstructive nature as well on a home study. Doesn't mean you can't do a home. So, if it's a person that just can't get an in-lab study easily, maybe you start with the home. If it looks purely obstructive, and you're all set, then you got an answer, and you can move on. But if you get back a home study that looks questionably central, they're gonna need to come into that lab. So, if you already know they're high risk because they're on narcotics, cause they have congestive heart failure, it's usually worth going straight to the lab. But again, you may consider a home study based on the patient. Patients that really cannot use the equipment can also be an issue. So, if they've had a debilitating stroke and have no one to help them put on that device, or cognitively they just can't handle the device, they're gonna be someone who's gonna benefit from coming into the lab and getting the help from the techs. So, those are the big populations that you might go starting for a home. And then the other thing that confuses a lot of people, the home is only for diagnostics. It really isn't for treatment. So, I have patients that say, "Oh, like, you can just titrate my CPAP with a home study." No. So if it's a treatment decision where they're not doing well on treatment, or I need to figure out do they need CPAP or BiPAP or IVAPS or one of these more complicated treatments, those are people that are gonna need to come into the lab to get that treatment portion of the evaluation.
Dr Jones: What a great summary. That's like everything I needed to know about who do I need to bring into the lab and who do I think maybe could do an at-home study. Really great. And speaking of devices, I think all of us who see patients in the room here and our listeners out there online have experienced patients, and this feels like a very recent phenomenon to me, are coming in with their commercial at-home wearable device. And they have printouts sometimes, and they show me their phone, and they give me some numbers that I don't really know how to interpret. Reading through this issue, I learned a couple of great new words. I learned about orthosomnia, right? So, people who become so preoccupied with their sleep, it keeps them awake at night, literally, right? I mean, it's a complete paradox. I learned about nearables, so things that aren't necessarily wearables that are just in the room while the patient is sleeping that monitor proxies for sleep quality, sleep stage, and other things. And I frankly, I'm not really sure what to tell patients. So, what do you tell patients who come in with all the data? Like, or how do you tell patients to use these?
Dr Johnson: I think these devices can go both ways. So, I do kind of say the pros and cons of these devices. I think for a lot of patients, they're empowering. It's getting them to think about sleep, to wanna know how good their sleep is. Are they getting enough sleep? So, if it's used in those ways, it's gonna be very helpful. I actually had a patient last week, and they noted that they're having big desats all night and could show me essentially an overnight oximetry data rather than me having to order it, and I had days of data, which sometimes can be too much. But in this case, it's like, oh, when he was on his side that night, he looked a lot better, so I can use that to give advice to the patient about particular treatments. He actually went down to Mexico, and a doctor friend gave him oxygen therapy while he was there randomly. And we could see on the nights that he had the oxygen therapy, it did really help his central sleep apnea pattern. And so that pushed us towards saying, "Let's qualify you for that up here in the States." So, I think in some cases it can give really important data. Now, I saw a posting on social media the other day of someone saying, "Can I get advice on how to improve my REM sleep? My tracker says I have no REM sleep, and I need to do something about it." There's really not data to support needing to do something about it. And so, I do think it can get some people on these wild goose chases, trying to get to a certain percentage of sleep. And these trackers, they're good in a lot of ways, but they're not perfect. He could be getting REM sleep that the tracker on him does not show. You want to relate it to what symptoms are they having. I think they can be very good for trying something out. So, let's say someone, has their tracker telling them they get five hours of sleep, and they try this intervention, and that helps them show that they got the seven hours of sleep, or they went from no REM to REM and it goes in the right direction. It can help give them that positive feedback that something they're trying, is working. But the absolutes for any given patient, it's hard to over-- What does it mean if it says you've got a 50% score versus a 70% score? That may or may not be meaningful in any given person, but again, they can compare themselves to themselves. If they were a lower score and now they're a higher sleep score because they did something that was meaningful, and that goes along with them feeling better, that can help give them that positive feedback to do something good.
Dr Jones: So, a little bit of a mixed picture.
Dr Johnson: Yeah.
Dr Jones: Sometimes they help. Sometimes they distract. Hopefully-
Dr Johnson: And as a provider, sometimes it can be overwhelming because they're like, "Come look at my year's worth of data." And you're like, "No."
Dr Jones: Yeah.
Dr Johnson: You know, let me see one page or two pages of data and be like, "Yep, okay, I get it."
Dr Jones: Just show of hands in the audience, who in the room wears a sleep device at night, like a ring or a, some kind of sleep monitoring app? That's about half the audience.
Dr Johnson: This is why they're here.
Dr Jones: So that's really helpful, and I think it is. You want to be supported by the data. You want to be supported by evidence and high-quality biometric evidence. Another big trend, and this has been a number of years in the making, is the understanding, Dr. Johnson, of the relationship between sleep physiology and neurodegenerative disease. One of the things I love about neurology is there's still so much left to learn about the normal physiologic functioning of the brain. So glymphatics and other aspects of sleep physiology that we didn't know about a decade or two ago. When you think about how that relationship has developed, sleep physiology, maybe sleep disorders and neurodegenerative disease, how has that changed your approach to talking to patients? Do you counsel patients differently now because of what we understand better about that?
Dr Johnson: Yeah, I mean, we are still limited with our data. We have so many studies that show the associations between whether it's not enough sleep, too much sleep, or having a sleep disorder like obstructive sleep apnea, and that being a risk factor for stroke or Alzheimer's or Parkinson's. But we still sort of lack the treatment trials that necessarily say, "If you treat obstructive sleep apnea, you're gonna have less dementia," or, "You're gonna be less likely to have that stroke." So, we have a lot of physiological studies, a lot of reasons why it makes sense, but we don't have that final, nail in the coffin to say, "If you do this, you'll definitely be better." So, we know certain groups are more at risk. If you have obstructive sleep apnea and you are symptomatic, you seem to have higher cardiovascular risk. If you have a person who's had a stroke and we find a milder case of sleep apnea, and they're someone that's totally asymptomatic. They say, "I sleep fine. I feel fine." There's not great data to say, "If you treat your sleep apnea, you're gonna be less likely to have a stroke." Now, if they come in and they're sleepy and their sleep apnea is really severe, and they have more hypoxic burden, which is also more connected with a lot of these risks, I'm going to say, "I think you are in the higher risk group of sleep apnea people who it's probably gonna be more likely to help your cardiovascular risk, your dementia risk." We can counsel them, and then it's really a personal decision. Some people are like, "No way. I'm never gonna use a CPAP machine, ever." And other people are like, "You know, my mom had a stroke. My dad had Alzheimer's. I want to do every possible thing I can to make it less likely that I have this outcome that I want to avoid." And so, you're going to take that in to, you know, do you want to try this treatment or not? It's a lot easier when you have outcomes that you can follow, like, "If I try CPAP, does my blood pressure get better? Do I stop having AFib attacks?" It's a lot harder when, will I or not get Alzheimer's ten years down the road or have that stroke?
Dr Jones: It's hard to get people to do things for kind of an abstract prevention down the road, but could be important. Are there trials going on that are going to assess this data?
Dr Johnson: Yeah. We currently have a big trial getting people right away, right after their stroke, on CPAP, and not only looking at prevention, but also looking at recovery outcome. It's been running for several years. Hopefully, we'll get enough data to close out the study coming up.
Dr Jones: We'll look forward to that.
Dr Johnson: Yeah.
Dr Jones: So, I'm really excited to get to our audience here, but before we do that, I do want to ask Dr. Johnson one more question. Dr. Johnson is famous for her advocacy for sleep in general, but specifically related to Standard Time. So, let's do a little experiment here. I didn't warn Dr. Johnson about this, so we'll see how she does. She does a ton of advocacy. She's a pro. So, pretend like we're in DC, and I'm a senator, and we just got in an elevator. You're going to give me your elevator pitch on what we should do.
Dr Johnson: So, you know, sleep is one of the few essential things in life. We need to eat, we need to drink, we need to have clean air, and we need to sleep and when we improve sleep, we can improve basically every outcome, whether it's academics, whether it's productivity, whether it's our physical health, our mental health. And the problem is we structure our lives in a way that really keep people, and especially our teenagers, from getting the sleep they need. And one of these structural things we do is permanent daylight savings time. Essentially, what you're doing is you're putting the sun out later, makes it harder to go to bed. I was just talking to someone, the sun's going down at 9:00, and you need to get your kid to sleep at 7:30, 8:00 so they can get the amount of sleep they need. That is almost an impossible task because their circadian rhythms are being pushed later, they can't fall asleep on time. Then you're setting their clocks an hour earlier, so when that alarm clock is going off at 6:00 AM in the morning, it's actually 5:00 AM in the morning. You're squeezing sleep from both sides, and it's basically impossible to get enough sleep. A lot of people think the only problem with daylight savings time is twice a year with the changes, and there are certainly harms related to that. So, a lot of people think if we went to permanent daylight savings time it would be better, and we got rid of those changes. What they don't realize is that permanent circadian misalignment by setting the sun more ahead, at 1:00 to 2:00 instead of at noon causes the sleep and circadian disruption all year round that leads to increased incidents of strokes, of heart attacks, of obesity, of cancer, of suicides, of depression, of worse academic grades. Again, pretty much every outcome you have there that relates to brain health, we have now data that shows that it's worse. And so, we can improve our lives if we can go to permanent Standard Time.
Dr Jones: You convinced me. How about that? If there were any skeptics in the room, I doubt there are any left. We only went to like the fifth floor there, and she... I'm like, "I'm voting for this. Whatever, whatever this bill is, I'm gonna vote for it." So, I'm excited to get to the audience here. Before we get to questions and answers, and we want you to get your questions ready for Dr. Johnson. I do have a couple of trivia questions. And we've been doing this for a little while now on the podcast. The first trivia question actually relates to arts and culture.
Dr Jones: What famous artist used transitions between sleep and wake states to inspire his art? Anybody know?
Guest Speaker 1: Is it Van Gogh?
Dr Jones: Not Van Gogh that I know of. There in the back.
Guest Speaker 2: Picasso.
Dr Jones: Picasso, not that I know of. Right here.
Guest Speaker 3: Salvador Dali.
Dr Jones: Salvador Dali. We have a winner. Thank you for your answer. So apparently, I read this. Salvador Dali would sit in a chair holding onto a metal key and wait until he fell asleep, and it would fall out of his hands and drop into a bowl, and it would wake him up. So, then he would pick it back up, and he would go in and out of sleep trying to generate hypnagogic hallucinations, basically, and he would use that to inspire his art. And you think about his art, maybe that kind of makes sense. All right, now I've got a neurology trivia question. Okay, so maybe we're a little more comfortable with the neurology trivia in here. What is the center in the brain that is responsible for REM sleep atonia?
Guest Speaker 4: The receptor is for erection in the lateral hypothalamus.
Dr Jones: That is not correct. REM sleep atonia. Right here.
Guest Speaker 4: Emilio Malgona, Hyannis, Massachusetts. Dorsal raphe nucleus.
Dr Jones: We'll give you credit for that. Very good. Excellent. So, the-
Dr Johnson: Well, no. That's actually the serotonin. He's talking about another one.
Dr Jones: Oh, I thought I heard, I thought I heard-
Dr Johnson: You heard dorsal
Dr Jones: ... I heard dorsolateral tegmental nucleus of the pod.
Dr Johnson: Not quite.
Dr Jones: You get a prize anyway, sir, just for, just for answering. Thank you very much. All right. So, we're all warmed up here. So, Dr. Albin, what do you think? Should we get some questions from the audience?
Dr Johnson: All right, we've got some questions.
Guest Speaker 5: I have a statement and a question.
Dr Jones: Please tell the podcast your name again, sir.
Guest Speaker 5: Steve Spar, New York City. The tyranny of the morning people. You don't want people, you don't want the sun to go down too late because it'll keep people up longer. I spent my whole life fighting people like you. I am a nighttime person. Why do I have to go to sleep earlier? I want to go to sleep later. I want to wake up later. I don't want to wake up at 7:00 in the morning. I want to wake up at 10:00. There's a certain tyranny that we must use circadian rhythms of the majority, and it persecutes people like me who are night people.
Dr Johnson: So that is a great question.
Guest Speaker 5: What say you?
Dr Johnson: What say me is actually the harms of daylight savings time are actually to the night owls, and don't really affect the morning people. I can still go to sleep on time and get up on time without that pressure of needing to go to work. The night owl people, they can't fall asleep until later. They want to sleep in earlier, but we're forcing them to get up an hour earlier for work and school. And because we're doing daylight savings time, you're not getting the morning light you need, you're getting too much light at night, and you are more sensitive to a delay in your circadian rhythm, which makes you even more of a night owl and increase the degree of social jet lag. So, we actually see that the harms and risks of things like depression, cardiovascular risks are much greater in night owls than they are in normal people or morning larks. And this is again why the risks are the highest for our teenagers, who are essentially all night owls. You're making it harder for them to fall asleep on time. You're making them more and more of a night owl that it becomes more out of line with our standard social schedule. So, what we can do for a night owl is say to our schools, say to life that we want to change our society norms of getting up early. But that has nothing to do with daylight savings time. That has to do with how we make our schedule
Dr Jones: All right, next question. And introduce yourself to the audience.
Guest Speaker 6: Sure. I'm Sanjay Rathi from New Haven area, Neurology. Movement disorders, Parkinson's disease, sleep disruptions, sleep-regulating REM, RBD issues, what are your recommendations? And as things get worse, what additional intervention should we do?
Dr Johnson: Yeah, I think it's hard with a lot of our neurodegenerative disorders, it's a two-way sleep. The disorders themselves often worsen sleep quality, have decrease in their sort of circadian amplitudes, and so that can affect sleep ability. And so, trying to do the things that promote sleep, like getting lights down in the evening, keeping things dark and quiet, doing cognitive behavioral sort of therapies if that's needed can all be helpful. Very high incidence of obstructive sleep apnea or other sleep-disordered breathing, whether it's Parkinson's or other neurodegenerative disorders, so evaluating and treating that if need be. And some of these people, especially as they get later on, you may end up considering medication for insomnia because their underlying disorders was causing it and there's, and you're not going to CBTI your way out of it. We do have the new orexin antagonist sleep agents, which are more recommended for older people and probably safer agents than your Z drugs and some of the other sleep meds out there. So, some people should be on some of those meds if their sleep is so disrupted. I've seen some sleep studies where it's basically like wake, sleep, wake, sleep, wake, sleep all night long. And it's like, wow, you really cannot sustain sleep, and we think it's not just a behavioral thing. I think it is part of their underlying Parkinson's and underlying disorders that can really cause major sleep disruption.
Dr Jones: It's a great question. Before we get more from the audience here, Dr. Albin, I'm just curious, you know, you got some questions from online. Don't know if any of those stood out to you. And the other thing is, I think about your practice, Dr. Albin, as a neurointensivist, there's some great content in this issue on how to maintain an adequate sleep environment in the hospital and the importance of that for the acute episode, maybe for some long-term outcomes. When I was reading the article, I didn't really didn't think about the ICU setting. That must be-- what do you do in the ICU?
Dr Albin: Well, we happen to have a question about just that.
Dr Jones: Well, there you go
Dr Albin: From Dr. Manners of Baltimore, Maryland. "What meds should I be giving patients in the ICU or the inpatient setting to preserve or recalibrate their sleep-wake cycles? Is there anything that we can do besides just getting them out of bed during the day?"
Dr Johnson: Meds are always hard cause as sleep doctors, we're usually the last one to recommend meds. But there are situations and scenarios where meds may be appropriate. I can't say what's one better than the other, and some of the meds we have probably aren't even available as options in the hospital. So, the, you know, again, the orexin antagonist may be a good class to try to use, but they may not be an option. There was a good study that looked at empowering the patient and whether or not the ICU patients are empowerable. But they give a card to the patients in the hospital and say, "Tell your nurse to turn off my TV and my lights. Do I need all the blood draws all throughout the night, or can it be put off to the morning?" And trying to empower the patient to ask for these things and do some of the behavioral things. And they found that doing that did improve the duration of sleep, did reduce some of the number of awakenings that people ended up having at night. So, I think the ICU is a very particular population where there's a lot of things you can't get rid of. But certainly, turning on the lights, turning off the lights, and trying to limit noises as much as you can, in those night hours, trying to give some sense of a 24-hour day. The other thing is feeding is really important to circadian rhythms. I had a patient that had a brain bleed and, after it, she just her circadian rhythms were just off, and part of it was she was getting tube feeds through the night. So, one of the very first interventions we did was to move her timing of her feeding so that it wasn't in sleep, and that really did help make a difference in getting her back on a pattern, along with light therapy and other behavioral techniques as well.
Dr Jones: It's a great question.
Dr Albin: Absolutely. I mean, I think that validates just that we spend a lot of time actually asking like, "Can we feed people during the day?" Or, "Can we, can we limit the amount of baths that are happening at 3:00 in the morning?" We also had another one from the audience that came from Dr. Lavina Singla of Mississippi, and I think a lot of our patients are asking this question. Is melatonin addictive?
Dr Johnson: Is melatonin safe? Is melatonin addictive? I think with any sleeping aid, people become addictive to what they perceive is the outcome. So, if they said, "This got me to sleep, and now I'm sleeping great, I don't want to come off of it." And so, you get this to meds that are truly addictive, but even meds that aren't felt to have that addiction, there is certainly a behavioral change. And that's a lot of what cognitive behavioral therapy is working with these patients on, is challenging that belief of maybe it isn't the med, maybe it's your internal belief and your worry about doing this. One thing about sleep is sleep happens when you are relaxed and calm and not worried. When you're worried about thinking that thing you're worried about is whether or not you're getting sleep, then you don't sleep. In terms of melatonin, if you don't need to use it, I wouldn't use it. If you are gonna use it, I'd try to use as low doses as possible. Do we know all the risks? We don't know. And especially I think there are potentially more risks in a growing child than, maybe someone who isn't having the same sort of hormonal, needs and growth needs. But then again, if you have, let's say, a kid with autism and melatonin helps him sleep, I'd much rather use melatonin than a lot of other agents, and if that really changes their functionality, that probably is very good for them and better than having them not get sleep. So, I think you have to weigh each individual situation and combine it, especially with the behavioral approaches so that hopefully this is not a long-term addictive thing you're on.
Dr Jones: So, it's complicated. Sounds like it.
Dr Albin: Not a straightforward answer.
Dr Jones: I thought that was gonna be just this hard no, but I guess it is something you have to think about. So, I want to really take a minute here to thank Dr. Karin Johnson, who has been our interviewee for this episode of the Continuum Audio Podcast sleep issue just came out. Really want to encourage our subscribers, our listeners, and our studio audience here to enjoy it. Thank you, Dr. Johnson, for joining us today. I want to give a big round of applause to Dr. Casey Albin for managing this crowd. Thank you to our listeners. Thank you to our subscribers. Thank you to you all for coming today.
Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.