Selected Podcast
Are you Getting Enough Sleep?
Robert Newman (Night Supervisor, Sleep Disorder Center @ St. Joseph's Health)discusses sleep disorders. Mr. Newman talks about how common are sleep problems, How does the medical community define a sleep disorder, and gives tips to improve our sleep hygiene.
Featuring:
Robert Newman, BS, RRT, RPSGT
Robert Newman, BS, RRT, RPSGT is the Night Supervisor, Sleep Disorder Center @ St. Joseph's Health. Transcription:
Prakash chandran: Everyone needs a good night's rest every night. But believe it or not, many people struggle to either fall asleep or stay asleep. Sleeping disorders are more common than you probably think. And in fact, roughly 70 million Americans struggle with them. We're going to talk about it today with Bob Newman, the Night Shift Clinical Coordinator of the Sleep Disorder Center at St. Joseph's Health.
This is St. Joseph's Health MedCast from St. Joseph's Health. My name is Prakash Chandran. So, Bob, really appreciate you coming on today and sharing your wisdom with us. I wanted to get started by asking how common are sleep problems?
Robert Newman: Thank you for having me, Prakash. Well, you mentioned at the beginning that, you know, between 50 and 70 million people in the US suffer from chronic sleep disorders, and that's about one-fifth of our population. So, it's that common, up to 19% suffer with not getting enough sleep and about 40% fall asleep during the day at least once a month. So, there's some solid numbers there with people having chronic sleep disorders.
Prakash chandran: I have a more broad question around how you define a sleep problem. Is that when you're falling asleep during the day? Is it if you're not getting eight hours of sleep? How does medicine or the medical community define a sleep disorder or a sleep problem?
Robert Newman: Well, both of those questions that you posed actually fall under sleep problems. So sleeping when you're not supposed to and not getting proper sleep or sleeping enough when you should be sleeping. So when you're not working, not having family time or other time off your job and you're falling asleep, that shouldn't be. You know, the time you have alloted for sleep is when you should be sleeping. You should be able to get solid sleep with minimal interruption. So, that falls under sleep problems.
Prakash chandran: Okay. Understood. You know, especially at my age, is with people with kids, people just generally seem tired, right? Like, people are like, "I just always feel tired, and that's just part of life." Some people even without kids, they're like, "I'm just getting older. This is just how it is." At what point should they think about getting help?
Robert Newman: First of all, they should get help. They shouldn't just accept it as, "Well, it's just the way it is" or "I've got kids" or whatever. They should get some answers and check out if it is something more that can be helped. So, when it starts to become a problem with your normal functioning during the day, that is when they should get help. Talk to your general practitioner first. And if they don't feel comfortable or don't have enough knowledge, they would refer you to a sleep specialist and then go from there and talk to that sleep specialist about your situation, what complaints are, and then see what they think.
Prakash chandran: Yeah. You mentioned something there that I want to expand on. You know, a lot of general practitioners won't actually discuss sleep with their patients, but I'd love to get your opinion on how important it is for patients and doctors to talk about sleep in general.
Robert Newman: Well, it's very important. And yes, just like if you have any kind of a very specific health problem that your general practitioner can't answer. They will probably defer you and, like you said, maybe not feel comfortable, so they'll defer you to a specialist in whatever area that is. So it is important to talk about sleep with either a specialist or your GP if you're having obvious problems that you can tell are sleep-related, like fatigue during the day or like lack of concentration, you feel inattentive, then you can kind of count on it being a sleep issue.
But there's also some imperceptible issues with high blood pressure or cardiac arrhythmias, like we see commercials a lot now for medications for atrial fibrillation, or they abbreviate it AFib, that's heart issues with your rhythm being irregular, or even mood issues or depression. So, it is important for those reasons, and there are a lot of times you might not realize that sleep is the culprit or lack thereof behind what you're feeling.
Prakash chandran: It is pretty amazing to me that sleep seems to be tied to everything, like you were just alluding to. And I know personally when I get an amazing night of sleep, I just feel like a new person. I feel like I can conquer the day, conquer the world. I imagine that when people that haven't realized they've been suffering from a sleep disorder, once they get things resolved and are sleeping better, they feel like a new human being. Is that something that you notice?
Robert Newman: Yeah. I mean, I can speak firsthand to that as well. I like what you said, like a new person. I use the phrase reborn. It's like, "Oh my God, I forgot what a good night's sleep is like," and you really can tell the next day. Whatever you were feeling in the days leading up to that good night's sleep when you probably weren't getting any, like I said, the moods are just run down, can't think straight or concentrate or whatever and then all of a sudden you can. It's very noticeable.
And one of the big sleep issues is obstructive sleep apnea, which we treat with the most common method is CPAP, which is an acronym for continuous positive airway pressure. Sometimes we'll have people back some years later for different insurance reasons and such, and they'll say, "Oh my gosh, it's been a game changer. I didn't know what sleep was like until I got on this." I remember just starting out in sleep when I had a patient who had been a horrible snorer, bad sleep obstruction, and he told me the next morning, "I haven't slept like that in 20 years," and that made me feel great see how great he felt.
Prakash chandran: Wow. That is incredible, especially when you can make an impact like that off of something that is so important, such as sleep. This may just seem obvious, but can you just talk in more detail why sufficient sleep is so important and tied to good health?
Robert Newman: Well, I think the best way to think about it, that sleep, it's like let's say you're a truck driver and you're pulling into a refueling station, that's the time for your body to refuel. That's when your energy gets restored, your mental acuity or your ability to think sharply is restored. If you exercise, which everybody should, I know a lot of people don't, but that's when your muscles kind of recover. Your immune system, which is a big thing, especially both the season we're in now at least here in the northeast where I am, it's cold season, both temperature-wise and, you know, people get the head colds and the chest colds, but also with what we've been going through with the pandemic and everything. So, the immune system's functionality is very tied to sleep as well. So, all those reasons, people don't realize it, but sleep is your refueling time for so many of those functions of your body.
Prakash chandran: Yeah. Let's talk about tips to improve sleep hygiene. Do you have a few that you can share?
Robert Newman: Yes. And I like that you used that term sleep hygiene because I explain that to a lot of my patients when they come in. And I let them know it doesn't mean, you know, taking a shower or whatever and that sort of hygiene, but sleep hygiene is where it's the conditions that allow you to have optimal sleep. So, for example, get your environment conducive to sleep. So, you don't want it excessively warm, whether that means an air conditioner for you or a fan going or whatever. We have patients that every night it could be different. Some person says the room is too hot. Some say it's too cold. Some say it's just right. So, get it the right temperature. And your brain wants dark and quiet because light can cause stimulation and noise can cause stimulation. Have a consistent bedtime and a consistent wake time because you really kind of mess around with your body's circadian rhythms when you just are erratic with the times you wake up and the time you go to bed. It's kind of like a clock and you're resetting it all the time, and it likes consistency. Make going to sleep or getting enough sleep a priority. So, don't put it off when your bedtime is approaching, if you can help it. Sometimes, we have things going on with school or work where you do have to adjust it, but try to do that as little as possible.
Cut back on alcohol and caffeine before going to bed. Two different reasons there. You know, Obviously caffeine is a stimulant and you don't want to be stimulated when it's time for bed and you're trying to go to sleep and alcohol can kind of dampen your brain's response to-- Let's say, you do suffer from obstructive sleep apnea, your body's response is to finally chug hard and take a big breath when you're getting obstructed, and alcohol can dampen the response to that which will actually increase the length of time that you're not taking a breath, the length of time that you're having that apnea.
And you know, just do kind of relaxing activities before bed if you're going to do any activity at all, like reading, which I know for me will put me out like a light. Meditate. Some people say something very kind of relaxing, like knitting or whatever.
And the other thing that's really important is stopping your media. In this day and age, everybody's connected to their phone and, in some cases, laptops and then, having a TV in the bedroom, all those forms of media emit what's called a blue light spectrum. So light that comes from the blue spectrum on a color spectrum, that is no good for you because it suppresses the secretion of melatonin in your body, which is a hormone that actually is triggered with darkness and that kind of helps you keep in your circadian rhythm. You have that blue light on, it keeps away the melatonin and also messes up your sleep cycle. It gets it kind of off-kilter. So nowadays, I know a lot of people are into that with their phones in bed. I see our patients sometimes are doing that. You know, we give them a little bit of time, but then we kind of say, "You really need to turn off the phone and the television and let's get this study rolling." So, those are some things that you can do as well.
Prakash chandran: You mentioned dark and quiet, and you also mentioned the temperature. Is there like an ideal temperature that we all should be sleeping in?
Robert Newman: Well, like I mentioned before, everybody seems to kind of have their own personal thermostat with what their body is comfortable with. For example, our sleep lab is set at, I think it's between 69 and 72. It's set, it's on a program. You can think that you're adjusting it a couple of degrees, but it really kind just locks in. It reverts back to whatever the program temp is. And the reason I say that is because all of us sleep technologists will take two to three patients a night. Every room is exactly the same temperature. And I'll have one patient saying, "Oh my gosh, I'm freezing" and another one saying, "Oh my God, I'm dying. Can we turn the fan on?" The same temperature. So, it depends on their body type. You know, maybe somebody with a little more insulation might be hot. Someone who's really on the slender side might be cold. But it's whatever is comfortable for you. I don't know anybody yet that likes to sleep sweating and hot. For me, I do like it colder, and I know my wife is always freezing, so I might have a little less blankets on me than she does. But it's whatever makes you comfortable because sweating or freezing can impede your ability to relax and finally fall asleep.
Prakash chandran: Yeah. So you know there are going to be people that are listening to this that want to get checked out. So can you talk to us about how the process works once a patient is referred to the Sleep Disorder Center at St. Joseph's Health?
Robert Newman: So, yeah, I mean, it does start with them taking the first step and talking to whether it be their doctor, I mean, they don't necessarily have to get referred to a sleep specialist first. So, that's important to know because they might hear that and think, "Oh my gosh, I've got to get my doctor to refer me to a sleep specialist who will then decide if I need to come in or not." No. We have a form that their own general practitioner can request. They fill it out. It'll have some symptoms on there to see if they kind of meet the qualifications which insurance companies determine. And then, we submit it to the insurance company and, basically, they send back with an approval or a declination. But if they do get approved, then we contact the patient and set up a time with them that's convenient for them.
And the other thing that's important to know is myself included, I work night shifts, so people who are third shift workers or work on kind of an off-shift or some maybe evening shift or whatever, and they might be getting in a little late, we do studies during the day for night workers who sleep during the day. So really, the lab is only closed for about four hours between the end of day shift and the start of our night study shift. So we can accommodate both people.
And really, once the appointment is made, you come in with something that you are comfortable sleeping in that covers you up a little bit. We have had some people that want to sleep in next to nothing, but that can't fly. So, you know, shorts, t-shirt, pajamas, if it's colder season. We do say bring your own pillow. It's not that we don't have pillows. We do. They're vinyl and of course covered with a pillow case, but they don't breathe as well. So if you have a pillow that you are comfortable with, that's either made out of memory foam or some sort of fabric, you can use your pillow with our pillow.
And then, just be prepared to get the best night's sleep you can. We can get you hooked up with a good amount of sensors and electrodes. Nothing is shocking you, but I've had people ask me, "Oh, are these wires going to shock me?" And they're very interested to find out that they are actually the source of the electricity. We're not giving them any electricity. We're reading the electrical impulses from their heart, their muscles, their brain. And we all do a pretty good job of explaining to the patient every wire that's going on them as we hook them up. And they often find that very comforting and reassuring because a lot of folks will come in not knowing what to expect. It's not your, you know, regular visit to a hospital or a doctor's office. So, it's really a mystery to a lot of folks and I find it puts them at ease when I explain what everything is and it kind of leaves them in state of mind where they're like, "Oh gosh, this all really makes sense. Thanks for explaining it to me." And they feel a little more relaxed because there's nothing harder than trying to get to sleep when you just can't relax your mind and be at ease. So it's really simple. It may seem daunting at first to even approach this. And that's the hardest part really is just taking that first step as with anything that's daunting. Let take the first step and you'll see it's not really that hard at all.
Prakash chandran: Well, Bob, thank you so much for educating us today. We truly appreciate your time.
Robert Newman: Well, thank you, Prakash. It was a pleasure being here. And I'm glad I can dispense some information that hopefully is helpful to the listeners.
Prakash chandran: Yeah, absolutely. That was Bob Newman, the Night Shift Clinical Coordinator of the Sleep Disorder Center at St. Joseph's Health. Talk to your doctor if you think you need a sleep study. And for more information, you can call the Sleep Disorder Center at 315-218-9804. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been St. Joseph's Health MedCast from St. Joseph's Health. I'm Prakash Chandran. Thanks again and we'll talk soon.
Prakash chandran: Everyone needs a good night's rest every night. But believe it or not, many people struggle to either fall asleep or stay asleep. Sleeping disorders are more common than you probably think. And in fact, roughly 70 million Americans struggle with them. We're going to talk about it today with Bob Newman, the Night Shift Clinical Coordinator of the Sleep Disorder Center at St. Joseph's Health.
This is St. Joseph's Health MedCast from St. Joseph's Health. My name is Prakash Chandran. So, Bob, really appreciate you coming on today and sharing your wisdom with us. I wanted to get started by asking how common are sleep problems?
Robert Newman: Thank you for having me, Prakash. Well, you mentioned at the beginning that, you know, between 50 and 70 million people in the US suffer from chronic sleep disorders, and that's about one-fifth of our population. So, it's that common, up to 19% suffer with not getting enough sleep and about 40% fall asleep during the day at least once a month. So, there's some solid numbers there with people having chronic sleep disorders.
Prakash chandran: I have a more broad question around how you define a sleep problem. Is that when you're falling asleep during the day? Is it if you're not getting eight hours of sleep? How does medicine or the medical community define a sleep disorder or a sleep problem?
Robert Newman: Well, both of those questions that you posed actually fall under sleep problems. So sleeping when you're not supposed to and not getting proper sleep or sleeping enough when you should be sleeping. So when you're not working, not having family time or other time off your job and you're falling asleep, that shouldn't be. You know, the time you have alloted for sleep is when you should be sleeping. You should be able to get solid sleep with minimal interruption. So, that falls under sleep problems.
Prakash chandran: Okay. Understood. You know, especially at my age, is with people with kids, people just generally seem tired, right? Like, people are like, "I just always feel tired, and that's just part of life." Some people even without kids, they're like, "I'm just getting older. This is just how it is." At what point should they think about getting help?
Robert Newman: First of all, they should get help. They shouldn't just accept it as, "Well, it's just the way it is" or "I've got kids" or whatever. They should get some answers and check out if it is something more that can be helped. So, when it starts to become a problem with your normal functioning during the day, that is when they should get help. Talk to your general practitioner first. And if they don't feel comfortable or don't have enough knowledge, they would refer you to a sleep specialist and then go from there and talk to that sleep specialist about your situation, what complaints are, and then see what they think.
Prakash chandran: Yeah. You mentioned something there that I want to expand on. You know, a lot of general practitioners won't actually discuss sleep with their patients, but I'd love to get your opinion on how important it is for patients and doctors to talk about sleep in general.
Robert Newman: Well, it's very important. And yes, just like if you have any kind of a very specific health problem that your general practitioner can't answer. They will probably defer you and, like you said, maybe not feel comfortable, so they'll defer you to a specialist in whatever area that is. So it is important to talk about sleep with either a specialist or your GP if you're having obvious problems that you can tell are sleep-related, like fatigue during the day or like lack of concentration, you feel inattentive, then you can kind of count on it being a sleep issue.
But there's also some imperceptible issues with high blood pressure or cardiac arrhythmias, like we see commercials a lot now for medications for atrial fibrillation, or they abbreviate it AFib, that's heart issues with your rhythm being irregular, or even mood issues or depression. So, it is important for those reasons, and there are a lot of times you might not realize that sleep is the culprit or lack thereof behind what you're feeling.
Prakash chandran: It is pretty amazing to me that sleep seems to be tied to everything, like you were just alluding to. And I know personally when I get an amazing night of sleep, I just feel like a new person. I feel like I can conquer the day, conquer the world. I imagine that when people that haven't realized they've been suffering from a sleep disorder, once they get things resolved and are sleeping better, they feel like a new human being. Is that something that you notice?
Robert Newman: Yeah. I mean, I can speak firsthand to that as well. I like what you said, like a new person. I use the phrase reborn. It's like, "Oh my God, I forgot what a good night's sleep is like," and you really can tell the next day. Whatever you were feeling in the days leading up to that good night's sleep when you probably weren't getting any, like I said, the moods are just run down, can't think straight or concentrate or whatever and then all of a sudden you can. It's very noticeable.
And one of the big sleep issues is obstructive sleep apnea, which we treat with the most common method is CPAP, which is an acronym for continuous positive airway pressure. Sometimes we'll have people back some years later for different insurance reasons and such, and they'll say, "Oh my gosh, it's been a game changer. I didn't know what sleep was like until I got on this." I remember just starting out in sleep when I had a patient who had been a horrible snorer, bad sleep obstruction, and he told me the next morning, "I haven't slept like that in 20 years," and that made me feel great see how great he felt.
Prakash chandran: Wow. That is incredible, especially when you can make an impact like that off of something that is so important, such as sleep. This may just seem obvious, but can you just talk in more detail why sufficient sleep is so important and tied to good health?
Robert Newman: Well, I think the best way to think about it, that sleep, it's like let's say you're a truck driver and you're pulling into a refueling station, that's the time for your body to refuel. That's when your energy gets restored, your mental acuity or your ability to think sharply is restored. If you exercise, which everybody should, I know a lot of people don't, but that's when your muscles kind of recover. Your immune system, which is a big thing, especially both the season we're in now at least here in the northeast where I am, it's cold season, both temperature-wise and, you know, people get the head colds and the chest colds, but also with what we've been going through with the pandemic and everything. So, the immune system's functionality is very tied to sleep as well. So, all those reasons, people don't realize it, but sleep is your refueling time for so many of those functions of your body.
Prakash chandran: Yeah. Let's talk about tips to improve sleep hygiene. Do you have a few that you can share?
Robert Newman: Yes. And I like that you used that term sleep hygiene because I explain that to a lot of my patients when they come in. And I let them know it doesn't mean, you know, taking a shower or whatever and that sort of hygiene, but sleep hygiene is where it's the conditions that allow you to have optimal sleep. So, for example, get your environment conducive to sleep. So, you don't want it excessively warm, whether that means an air conditioner for you or a fan going or whatever. We have patients that every night it could be different. Some person says the room is too hot. Some say it's too cold. Some say it's just right. So, get it the right temperature. And your brain wants dark and quiet because light can cause stimulation and noise can cause stimulation. Have a consistent bedtime and a consistent wake time because you really kind of mess around with your body's circadian rhythms when you just are erratic with the times you wake up and the time you go to bed. It's kind of like a clock and you're resetting it all the time, and it likes consistency. Make going to sleep or getting enough sleep a priority. So, don't put it off when your bedtime is approaching, if you can help it. Sometimes, we have things going on with school or work where you do have to adjust it, but try to do that as little as possible.
Cut back on alcohol and caffeine before going to bed. Two different reasons there. You know, Obviously caffeine is a stimulant and you don't want to be stimulated when it's time for bed and you're trying to go to sleep and alcohol can kind of dampen your brain's response to-- Let's say, you do suffer from obstructive sleep apnea, your body's response is to finally chug hard and take a big breath when you're getting obstructed, and alcohol can dampen the response to that which will actually increase the length of time that you're not taking a breath, the length of time that you're having that apnea.
And you know, just do kind of relaxing activities before bed if you're going to do any activity at all, like reading, which I know for me will put me out like a light. Meditate. Some people say something very kind of relaxing, like knitting or whatever.
And the other thing that's really important is stopping your media. In this day and age, everybody's connected to their phone and, in some cases, laptops and then, having a TV in the bedroom, all those forms of media emit what's called a blue light spectrum. So light that comes from the blue spectrum on a color spectrum, that is no good for you because it suppresses the secretion of melatonin in your body, which is a hormone that actually is triggered with darkness and that kind of helps you keep in your circadian rhythm. You have that blue light on, it keeps away the melatonin and also messes up your sleep cycle. It gets it kind of off-kilter. So nowadays, I know a lot of people are into that with their phones in bed. I see our patients sometimes are doing that. You know, we give them a little bit of time, but then we kind of say, "You really need to turn off the phone and the television and let's get this study rolling." So, those are some things that you can do as well.
Prakash chandran: You mentioned dark and quiet, and you also mentioned the temperature. Is there like an ideal temperature that we all should be sleeping in?
Robert Newman: Well, like I mentioned before, everybody seems to kind of have their own personal thermostat with what their body is comfortable with. For example, our sleep lab is set at, I think it's between 69 and 72. It's set, it's on a program. You can think that you're adjusting it a couple of degrees, but it really kind just locks in. It reverts back to whatever the program temp is. And the reason I say that is because all of us sleep technologists will take two to three patients a night. Every room is exactly the same temperature. And I'll have one patient saying, "Oh my gosh, I'm freezing" and another one saying, "Oh my God, I'm dying. Can we turn the fan on?" The same temperature. So, it depends on their body type. You know, maybe somebody with a little more insulation might be hot. Someone who's really on the slender side might be cold. But it's whatever is comfortable for you. I don't know anybody yet that likes to sleep sweating and hot. For me, I do like it colder, and I know my wife is always freezing, so I might have a little less blankets on me than she does. But it's whatever makes you comfortable because sweating or freezing can impede your ability to relax and finally fall asleep.
Prakash chandran: Yeah. So you know there are going to be people that are listening to this that want to get checked out. So can you talk to us about how the process works once a patient is referred to the Sleep Disorder Center at St. Joseph's Health?
Robert Newman: So, yeah, I mean, it does start with them taking the first step and talking to whether it be their doctor, I mean, they don't necessarily have to get referred to a sleep specialist first. So, that's important to know because they might hear that and think, "Oh my gosh, I've got to get my doctor to refer me to a sleep specialist who will then decide if I need to come in or not." No. We have a form that their own general practitioner can request. They fill it out. It'll have some symptoms on there to see if they kind of meet the qualifications which insurance companies determine. And then, we submit it to the insurance company and, basically, they send back with an approval or a declination. But if they do get approved, then we contact the patient and set up a time with them that's convenient for them.
And the other thing that's important to know is myself included, I work night shifts, so people who are third shift workers or work on kind of an off-shift or some maybe evening shift or whatever, and they might be getting in a little late, we do studies during the day for night workers who sleep during the day. So really, the lab is only closed for about four hours between the end of day shift and the start of our night study shift. So we can accommodate both people.
And really, once the appointment is made, you come in with something that you are comfortable sleeping in that covers you up a little bit. We have had some people that want to sleep in next to nothing, but that can't fly. So, you know, shorts, t-shirt, pajamas, if it's colder season. We do say bring your own pillow. It's not that we don't have pillows. We do. They're vinyl and of course covered with a pillow case, but they don't breathe as well. So if you have a pillow that you are comfortable with, that's either made out of memory foam or some sort of fabric, you can use your pillow with our pillow.
And then, just be prepared to get the best night's sleep you can. We can get you hooked up with a good amount of sensors and electrodes. Nothing is shocking you, but I've had people ask me, "Oh, are these wires going to shock me?" And they're very interested to find out that they are actually the source of the electricity. We're not giving them any electricity. We're reading the electrical impulses from their heart, their muscles, their brain. And we all do a pretty good job of explaining to the patient every wire that's going on them as we hook them up. And they often find that very comforting and reassuring because a lot of folks will come in not knowing what to expect. It's not your, you know, regular visit to a hospital or a doctor's office. So, it's really a mystery to a lot of folks and I find it puts them at ease when I explain what everything is and it kind of leaves them in state of mind where they're like, "Oh gosh, this all really makes sense. Thanks for explaining it to me." And they feel a little more relaxed because there's nothing harder than trying to get to sleep when you just can't relax your mind and be at ease. So it's really simple. It may seem daunting at first to even approach this. And that's the hardest part really is just taking that first step as with anything that's daunting. Let take the first step and you'll see it's not really that hard at all.
Prakash chandran: Well, Bob, thank you so much for educating us today. We truly appreciate your time.
Robert Newman: Well, thank you, Prakash. It was a pleasure being here. And I'm glad I can dispense some information that hopefully is helpful to the listeners.
Prakash chandran: Yeah, absolutely. That was Bob Newman, the Night Shift Clinical Coordinator of the Sleep Disorder Center at St. Joseph's Health. Talk to your doctor if you think you need a sleep study. And for more information, you can call the Sleep Disorder Center at 315-218-9804. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been St. Joseph's Health MedCast from St. Joseph's Health. I'm Prakash Chandran. Thanks again and we'll talk soon.