Dhru Purohit Show - Sleep Master Class: How Poor Sleep Makes Us Hungry, Disrupts Our Blood Sugar, And Increases Our Risk For Alzheimer’s Disease With Sunjya Schweig, MD

Episode Date: March 13, 2023

This episode is brought to you by InsideTracker and ButcherBox.  Today on The Dhru Purohit Podcast, Dhru sits down with Dr. Sunjya Schweig for a masterclass on sleep and how it impacts every area of our health. Dhru and Dr. Schweig discuss why sleep is an underrated and overlooked pillar of wellness that’s foundational for living optimally and preventing chronic disease.  Dr. Schweig founded the Functional Medicine Research and Technology Center in 2021, which aims to prevent and reverse chronic illness through research, education, and innovation. Dr. Schweig graduated from the University of California, Berkeley, and completed his MD at the University of California. He is board certified in family practice, integrative, and holistic medicine (ABIHM). In this episode, Dhru and Dr. Schweig dive into: -Why sleep is an underrated aspect of health (2:33) -The link between sleep and Alzheimer’s disease (6:32) -The most common sleep disorders (13:01) -How sleep and shift work affect cancer risk (17:34) -Why good-quality sleep is critical for immune health (28:28) -Blood sugar imbalances and sleep health (38:27) -The different wearable devices for tracking sleep trends (54:04) -Flaws in the pharmaceutical approach to sleep disorders (59:06) -Sleep and cardiovascular health (1:06:48) -Poor-quality sleep and risk of psychiatric illnesses (1:13:43) -Sleep apnea (1:36:44) -The importance of having a bedtime routine (1:48:37) -Gut health and sleep (1:57:51) -How mindfulness can improve sleep quality (2:03:38) -Dr. Schweig’s supplements for better sleep (2:19:46) -Can CBD and cannabis truly support deeper sleep? (2:25:21) Also mentioned in this episode: -California Center for Functional Medicine  -Try This: Three Super Crazy Facts about Big Pharma -STOP-BANG Sleep Apnea Questionnaire  -How to Turn Your iPhone Screen Red (a step-by-step guide) -20-minute Yoga Nidra Practice (YouTube) For more on Dr. Schweig, follow the California Center for Functional Medicine (CCFM) on Instagram @ccfmed_ca, or through their website, https://www.ccfmed.com. InsideTracker provides detailed nutrition and lifestyle guidance based on your individual needs. In honor of Pi Day, they’re offering my podcast community 31% off Ultimate Bundles until 3/15. Just go to insidetracker.com/DHRU to get your discount and try it out for yourself. ButcherBox has a variety of different boxes, and you can choose your box and frequency. For a limited time, you can sign up today and get two pounds of ground beef free for a whole year PLUS $20 off by going to butcherbox.com/dhru. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Sleep problems precede a formal diagnosis of Alzheimer's for many people by many years. And over 60% of Alzheimer's patients have at least one clinical sleep disorder. Everyone knows when you don't get a good night's sleep, you're tired the next day, not as focused, not as sharp. But did you also know that there's a whole litany of things that you increase your risk for when that good night's sleep turns into a week or two, turns into a month or two, turns into a year of, turns into a decade. On today's podcast, we're diving deep into all the things that can happen and can go wrong when you don't optimize your sleep. Welcome to the Drew Proet podcast. Each week we explore the inner workings of the brain and the body with one of the brightest minds in wellness, medicine, and mindset. This week's guests giving us a masterclass on the topic of sleep

is Dr. Sanja Shwegg. Dr. Shwegg is the founder and president of the California Center for Functional medicine. He and his team provide personalized, precision, functional medicine care to help their patients recover from chronic illness and regain their health. The California Center for Functional medicine is a comprehensive care team combined with data and technology that delivers their patients a clear path to optimal health. And even though they're called the California Center for Functional Medicine, they work with patients all around the country of the United States through the power of telemedicine. And one of the number one things, they help their patients Optimize is the topic of sleep, and it starts first with education. And that's what Dr. Shwegg

is going to be doing on our podcast today. Now, a little bit more about Dr. Shwegg. He did his graduate at the University of California, Berkeley, and completed his MD at the University of California, Irvine, and his family medicine residency at the University of California, San Francisco, family practice residency in Santa Rosa. He's board certified in family medicine, integrative and holistic medicine, and he's also the founder of the functional medicine. Research and Technology Center, which aims to prevent and reverse chronic onus through research, education, and innovation. If you've been waiting for a sign that it's time to get serious about your sleep, today's podcast is that sign. Stay tuned for a fantastic conversation where Dr.

Sunja Shwegg, all on the topic of dialing in your sleep. Dr. Sunja, welcome to the podcast. It's a pleasure to have you here. I want to start off with a pretty profound statement that I'd love to get your reaction to. In the preparation for today's podcast, all about sleep, which we're going to take people through a whole sort of masterclass on this topic, you wrote in the note that sleep is the most underrated and underappreciated aspect of health. Number one, obviously you feel that's true because you wrote it, but tell us why. Yeah, so first of all, thanks, Drew, for having me here. It's a pleasure to be with you. And, you know, sleep is pretty amazingly important for so many different aspects of our health. And I think it's one that really takes a back burner. And I think

it's one which is really kind of a bellwether for how out of balance we are as a culture and our bodies and our health. We're so busy. We're so stressed out. We have so many things that we juggle. It's just go, go, go from the moment we wake up until the moment we go to bed, we're all on our screens. And so, you know, this element of properly preparing for sleep, which really begins the moment you wake up is lost. And I don't think we're paying attention to it. I don't think we're focusing on it. And I think that with some pretty simple techniques and habits that we can discuss today, I think we can really change that with profound implications for our health. Yeah. And I think the important thing to talk about when it comes to sleep is that we want to focus so much more on the

things that we think are sexy that are out there, right? People want to focus on what's the latest and new as supplement that's out there. What is the food that I should be eating or not be eating? What is this some new therapeutic that can radically change my life? But we forget that if sleep was a drug, it would be the number one most successful drug in the world. And that's why you wrote that it's the most, I'm going to read it again because it's that important. Sleep is the most underrated and underappreciated aspect of health. You know, you see patients all the time at your clinic, the California Center for Functional Medicine. Link in the show notes if people want to check it out. How many times do people come in and they're complaining about one other thing, or they're trying

to get that last 10% together right in their diet, or they're worried about what is the right supplement to take, but you find that just getting their sleep a little better has the most profound impact on their health? Yeah, I would say that's absolutely the majority of our patients. And it goes also for the fact that it's patients who I've been seeing for a long time. It's not just new patients. Sometimes I'll have a patient who I've been seeing for a year or more and I'll dig back in and say, okay, wait a minute, you know, what's happening with your sleep? What time you go into bed? What's

your nighttime routine? What's your morning routine? You know, what's your, you know, use of caffeine, et cetera, throughout the day and just realize, whoa, okay, we need to regroup on this and we need to really dial this back in because it slipped, you know, from all the things that we're juggling. And so absolutely new patients, the vast majority, have issues with sleep and as well as ongoing patients. It's something we all have to remind ourselves of, even myself, you know, when, when I try to dial in my sleep and I do a good job for a period of time and they might get a little lazy or I might get on my screen again in the evening time and before I know it, you know, an hour has passed. And so it really takes focus and consistent effort to make sure you're staying on target.

So most people know who are listening today that when they don't sleep, they don't feel good the next day. That can show up in a bunch of different reasons. But I want to take the first part of this podcast. And I want to really tease out some of the bigger reasons why sleep is so important, right? Again, we don't sleep well. We don't feel good the next day. we don't focus as well. Maybe we're a little bit more hungry. But there's a whole bunch of other things

that sleep is deeply tied into. And you put together a series of fantastic notes that I'd love to walk people through. And for anybody that's interested on how to reduce their risk of Alzheimer's, cancer, cardiovascular disease, pay attention because we're about to go. Immune system. Immune system. We're about to go deep into it. Okay. So let's go on the first one, Alzheimer's disease. You know, this podcast was originally called the Broken Brain Podcast, and it was all about how to not have your brain broken and that your brain isn't broken if you do the right things. So people are very interested in brain, cognitive health, and reducing the risk of Alzheimer's

and dementia in the future. So tell us, what do we know about Alzheimer's disease and its relationship to sleep? Yeah, so if you're not sleeping properly or adequately, you have an increased risk for dementia and for Alzheimer's disease. you know, sleep problems precede a formal diagnosis of Alzheimer's for many people by many years. And over 60% of Alzheimer's patients have at least one clinical sleep disorder. And so there's a bidirectional situation that's happening there. And additionally, you know, if you're getting decreased sleep, you have a decrease ability

to clear beta amyloid in the brain via the glymphatic system, which is like the brain's lymph system and the glymphatic system basically opens up and that drainage, that detox, that movement of toxins out of the brain is much more active at night if you're sleeping. Yeah, people have heard about it before on this podcast, but your brain has its own detoxification system. Which is active at night much more than during the day. And so if you're skipping out on sleep, you're not getting that flushing of those toxins from your brain. It's like the example that I've heard functional medicine doctors like yourself say is that at night is kind of when the city's asleep and all the trash collectors go around. It's all right. And they're picking up all the trash that's out there.

Yep. The streets are quiet. You know, not a lot of traffic. And yeah, exactly. I like that analogy. And your brain can do its job. But if you're not sleeping well and if you're not getting deep sleep, then your brain's detoxification system, which you mentioned is called the lymphatic system, can't do its thing. Exactly. Yeah. And it goes the other way too. So, So beta amyloid can accumulate in the medial prefrontal cortex region. And just as a reminder for people, because sometimes new people are listening to the podcast, what is beta amyloid? Why is it so important when it comes to cognitive decline?

So beta amyloid is one of the key proteins that can accumulate in brain cells and cause damage. And we don't totally know is the accumulation of the beta amyloid is that deposition itself, the primary factor or is there some other process that's going on that's causing that deposition? but we do know that this is one of the key findings with folks with Alzheimer's. And again, we do see that, you know, accumulating in the medial prefrontal cortex, which is a very important part of the brain that initiates deep non-REM sleep. And so then you get this sort of worsening cycle as you head down this pathway. You further exacerbate or, you know, lose that ability to get that deep sleep, which is so healing and so

cleansing. Yeah. Is it fair to say like the beta amyloid is like the rusting of our brain, sort of? I would agree with that, yeah. Right? It's almost like rust on metal and it's wear and tear. But also the question that you brought up was in sort of neuroscience and people who were doing research on Alzheimer's, for a long time, they thought, wow, if we develop drugs that get rid of this beta amyloid, then maybe we can reverse Alzheimer's. Maybe we can get to the root of it. But that didn't turn out to be true. Right. It's a very classical myopic, you know, magic bullet approach that convention. medicine takes, it's attractive because then you have a drug, which you can patent and market. But as our good friend and colleague, Dale Bredison, who I know you've had on your show, as he says, you know, it's not, you know, if you think of as the beta amyloid deposition as

one hole in a roof where you have a leak now, you can't just plug that one hole. There's probably like 36 different holes that need to be plugged, right? And so we do know that that's one part of the pathophysiology. But yes, as you said, you know, that didn't. pan out to be a magic bullet. So back to the drawing board. Back to the drawing board. You know, you mentioned sleep disorders. We're going to do a little deep dive on that, but just talk about some of the common sleep disorders that are out there that, you mentioned that 60% of Alzheimer's patients have at least one clinical sleep disorder. So it's the association between the sleep disorders and Alzheimer's. Right.

So what are some of the common sleep disorders that are out there? Yeah. So some of the most common sleep disorders that we really think about, and there are many, right? So, you know, you know, there's a variety of sleep disorders. These are basically conditions that affect your sleep timing, your sleep quality, your duration, the ability of a person to properly function when they're awake. They're, you know, the American Academy of Sleep Medicine has a international classification of sleep disorders, which lists 60 different specific sleep disorders, each with its own set of triggers of symptoms of physical and emotional effects. And most, you know, can be characterized by a course set of signs, which is trouble falling asleep or remaining asleep,

difficulty staying awake during the day because you're so tired. Sleep wake cycle imbalances that interfere with a healthy sleep schedule or unusual behaviors during sleep. Some of the most common sleep disorders include insomnia, which has a variety of different flavors or different subtypes, sleep apnea, which is surprisingly common and very, very important to diagnose for a variety of reasons. We also, you know, Restless Leg Syndrome is another common one. Narcolepsy is another common one. You know, in my prep for our talk today, I was thinking, you know, focusing mostly on insomnia and sleep apnea, which I think are two of the most common. Yeah, and we'll break those down. So, you know, just to tie it all together, if you have a sleep disorder, it seems that there's an association

where you're more likely, you know, to develop Alzheimer's. But the thing is, is that even if you don't have a diagnosed sleep disorder, which sleep disorders are tremendously underdiagnosed, even things like sleep apnea, we're going to talk about that later on. It's not just the heavy set, overweight male, older male. There's a lot of young people. Right. There's a lot of young people that are dealing with sleep apnea.

Who don't snore who are dealing with sleep apnea and things like that. So there's a bunch of people that were in this range of subclinical. sleep disorders that again, you're increasing your likelihood of something negatively happening to your brain in the future if you don't get to the root cause of it. Again, yes, happened to your brain also, happened to your metabolic system, happened to your immune system, happened to your risk of cancer. The list goes on of the things that your risk goes up for, your mortality goes up. And so your lifespan shortens if you're not getting proper sleep. And I think of it as sort of, you know, One of the things I'm super passionate about with functional medicine is it's not like,

you know, you either don't have it or you do have it, right? Right. There's this continuum that's happening, right? And so with all these conditions, you know, if you kind of take, if you back up and look from the 30,000 foot view, if you're not sleeping well and you're not sleeping enough, right, you're pushing your body through many different pathways towards imbalance, towards illness, towards, you know, these clinical conditions of which there is a long list, right? You know, your inflammation goes up, your immune system surveillance goes down, your brain

detoxively talked goes down, all these factors that are in play, your hormones become imbalanced, your, you know, insulin, leptin, grayland for, you know, satiety and hunger and, you know, blood sugar balance, they go wacky. And so, you know, all these things are pushing. It's not like either yes or no, it's like you're tipping towards that, but you can pull back, right? If you really die when you sleep and you get the right. treatment and diagnosis and lifestyle happening, you can reverse that. You can reveal that risk back and really do. And so one of the, we started off the podcast, you know, why is this, you know, so underappreciated or, you know, under recognized? It's because I don't think that people really

understand the vast implications and the vast connections of how many things are dialed in with how you're sleeping, right? Which is why we're going through this section in a way. It's kind of like sound the alarm a little bit. Yeah, absolutely. Exactly. I'm not here to fear longer, but also here to say like, this is how important sleep is. If you have not been paying attention, you know, there's always that, there's these different memes that are on the internet. It's like if you're waiting for a sign, this is it.

So if you're waiting for a sign to get serious about your sleep, this is the sign. All right, let's go to the next one. Cancer, one of the most scariest. Alzheimer's probably right up there. Cancer also very scary disease. Tell us what we know about cancer and sleep. You know, in particular, I was astonished to hear and kind of reading your notes in the preparation of this about how sleep was identified as a, as for night shift workers, right?

Night shift work itself was identified as a possible, as a probable carcinogen. Tell us about that by the World Health Organization. Yeah. So that's an important, important fact. And I just want to repeat that, which is that the WHO has. classified shift work as a probable carcinogen. So these are people, doctors, nurses, firefighters, police officers. These are people who-

Anyone who's working the night shift. Working the night shift. Which their circadian rhythm from day to night. And usually it's not like you're working every day. So then you try to switch back for part of the week so you can be with your family and your friends and have a quote normal life. Right. And then you're going back into that night shift mode.

And so these are people also on call. And, you know, so there's sleep disruption. there's loss of sleep, but that switch of trying to basically strong arm your body and brain from a daytime circadian rhythm, which is extremely hardwired, going back forever, right? You know, we're active in the day. We're not nocturnal beings. And so our entire brain is dialed for that. But when you try to switch that, it causes a number of different disruptions in the body,

which can lead to cancer. And, you know, this is one area that I'm super passionate about. We've done a lot of work with first responders, with firefighters and police. Through your clinic, you mean? Through our clinic, yeah. We have a program called Protect Wellness, where we put them through a four to six month long comprehensive health program, wellness program, to really target some of the key areas that are, you know, causing increased mortality and morbidity.

I don't know if you know, but the top two ways that firefighters die are cancer and suicide. Wow. I didn't know. And suicide is a top killer for all first responders, you know, across the board, firefighters, police, medical veterans, you know, it's just so and that risk, we can touch on that later, but there's also, you know, the risk of psychiatric disruption is also greater with sleep disruption. But to your question, you know, going back to cancer for a sec, you know, again, shift work, that disrupted circadian rhythm. You know, in fact, Denmark actually pays women who, who had to work night shifts.

If they get breast cancer, it pays them workers' compensation. That's crazy right there, right? Like, that's just nuts. Right. Well, hats off to Denmark. Right. But also, how crazy is that? And, you know, today's podcast is also about, it's sounding the alarm, but also, you know,

you're a doctor. I'm sure at some point in time in your career, residency, whatever it might have been, you were probably working at night, right? You probably are doing some sort of shift work. and your rotations or whatever it might be. And so there's some aspects of life that are just there. They're going to have to be there. And we're doing our best in between to minimize the damage.

Or if it was something that we did in the past, we're trying to correct that by being even more serious about our sleep now. Right? We can't change the past. You might even be in a situation where you have to be a shift worker, a nurse, a patrol guard, something like that. But at least when you can, you get serious about your life. your sleep for the protection of your health and also for the protection of your family's health,

too, because they depend on you. Yeah, exactly. Yeah, we could go deep on that, actually, some of the thoughts and ideas that we've worked in collaboration with firefighters to try to build them a more nuanced schedule and sort of interventions. For example, and to your point, yeah, in my medical school and medical residency, so many disrupted nights of sleep. And, you know, it still affects me to this day.

You know, I still, I would, you know, I'm not an awesome sleeper. I'm a light sleeper. I get disrupted easily. You know, but I've done a lot of work on myself and using wearables, using devices to show me the data and playing around with the different, you know, permutations of interventions, right? So, but for shift work, for example, we can spend them in on that, you know, on any shift, if you're up all night, there's kind of a fork in the road when it comes to the morning time, right? did you have a super busy night where you got very little sleep or did you have a quieter night where you got a decent amount of sleep and that dictates what you're going to do that day, right? So if you got a decent amount of sleep, you might go home and, you know, go for exercise,

have breakfast, hang out with your family, get some, you know, errands done, et cetera. But if you really just got trashed and didn't sleep at all, you know, you need to rest, right? And so we actually have a decision point in our work there with the with the firefighters and the police. of like, okay, make that decision first thing in the morning. What are you going to do when you get home, right? So first thing, make sure you're safe getting home. Like the risk of accidents is way, way higher. It's been documented in many studies.

When you don't sleep, your risk on accidents is higher. Absolutely, yeah, cardiovascular events and heart attacks and accidents are some of the two most, you know, concerning areas. But so with shift work, you know, if you had a difficult night and you didn't sleep much, we actually say okay when you're driving home again swimming you're safe rest if you can't drive home safely first

then you drive home but put your blue light blocking glasses on while you're driving home trying to keep your brain thinking that it's still you know not time to wake up right trying to block a little bit of that blue light from hitting your eyes and when you get home you know have a little bit of water maybe a light meal if you need it or don't if you can avoid it and go and sleep and don't sleep for too long sleep for two or three hours

and get that recharge and then get get up and treat that day as a very delicate day where you're not going to go big. You're not going to go for a big mountain bike ride. You're not going to exercise hard. You're going to try to avoid stressful situations. You're not going to drink alcohol. You're not going to eat sugar. So these are all other factors, which are stressors on the body, right?

So you really just pay attention to the whole menu, if you will, of what things are going to cause my body as an organism stress. And you really try to minimize those, right? and then the next day, hopefully, you know, you go to bed early, you know, you try to get that recharge on a normal cycle. And the next day, you go about having a normal day, right? But then as you're preparing for your next call day, you also go into that reset resilience mode. And so you avoid all those stressors, right?

You get up early, you get some morning light, you exercise, you avoid alcohol, you avoid sugar, you eat healthy diet, you time your meals right, all that stuff, right? So you can really sort of create this on-off switch of all the factors that we can control. We rely on our first responders and our medical workers and all these folks are working overnight. There's not really a choice of do you or don't you have them do it, but there's a lot of variables along the way that you can play with and mitigate from a lifestyle or a functional medicine point of view. It's a great reminder, and I love that protocol.

That's awesome. That's going to help a lot of people. All right. Let's talk about natural killer cells as it's related to cancer. answer because that's another thing that sleep does. Can you chat about that? Yeah. So natural killer cells are sort of this roving, you know, part of our immune system that goes out searching for, you know, things either to kill, you know, bacteria, fungi, viruses, et cetera, or also for cancer cells, for aberrant cells that shouldn't be there, right? And studies have shown that just with one night of poor

sleep, they actually see about a 70% reduction in the activity of these natural killer cells. So pretty profound of just that surveillance system. And I think this is for a variety of reasons. There's the immune side of it, but there's also the hormonal side, right? So not sleeping is a stressor on your body and therefore we are going to have an increase of cortisol and stress hormones. and this part of your immune system, much of your immune system is most active at night, similar to the brain lymphatic system, in part because that's when your cortisol is the lowest. And cortisol, as we know, from taking a steroid is suppressive to the immune system. So cortisol is low, immune system comes up, the tone of the immune system.

These cells are actually what's called diapidesis. They're roving through the walls of vessels and kind of moving through the vessels and cruising around, looking for these aberrant cells and, you know, again, things that shouldn't be there and taking care of them, you know, eliminating them or calling in a signal for other immune cells to come. So that decrease of those natural killer cells is pretty profound. They've also shown, you know, in a mice study that the, you know, cancers of mice who were sleep deprived grew 200% faster than those mice who had been receiving adequate sleep. You know, so there's a variety of different, of research in this area, which is pretty important

and telling. And, you know, again, multiple pathways, right. All right. You were talking about our immune system. There's other data outside of cancer that's related to sleep and the immune system. And again, our goal here is to give you a sign, to give you a reminder. You know, we're not sharing anything on this podcast here that people don't know about. But in one podcast episode on sleep and really diving it in and presenting this masterclass, the goal is to remind you to take something that, we don't often take seriously or don't take seriously enough. And there are so many forces in our modern life that are working against having good sleep. So that's another reason why we need that reminder to pay attention to the basics. So let's talk about sleep and the weakening of our immune

system. Yeah, no, I think that's a great segue. I don't like to scare people. That's not my style. But I do think it helps to know this information, right? And to have it in front of us. and to realize the depth of the importance of this, you know, again, you know, from how we started this discussion, sleep is kind of taken a back burner and we've kind of forgotten, you know, it's almost like, you know, a pain to have to sleep so much, right? So, you know, so it's more productive or people who need less sleep, you know, some people might look at them and say, gosh, you know, I wish I didn't need as much sleep to function because I would get so much more done because our society is very achievement oriented and it's very, you know, you know, get more

done oriented. It's not focused on the rest and reset and, you know, community aspects, right? So, but yeah, so weakening of the immune system, you know, studies have shown that people who sleep five hours on average were 250% more likely to catch the flu than those sleeping eight hours per night with an identical exposure protocol. And we've seen that in a lot of different studies. your resilience to external pathogens or, you know, coming down with a sickness when you have been exposed is definitely higher if you're not rested. You know, I see this a lot with, there's friends of mine who have kind of persistent canker sores.

Yeah. Right. And usually the first sign of their canker sore coming up is one or two nights of not great sleep. Yep. And then a canker sore, which is, is a herpes virus? Is it? There's a variety of viruses, but frequently, yeah, there's a, Herpes viruses is a very large family.

It's a large family. But yes, frequently caused by a virus or herpes. And so that virus can, kind of like in the world of functional medicine, the thought is that when the immune system is weakened, then viruses that are there in the body, it's not like you contracted a new virus. They can sort of show themselves and express themselves. And that's one way. And for a lot of people, that's the earliest sign, the canary in the coal mine that they need

more sleep if they specifically deal with this persistent sort of. cancass sores or cold sores. Absolutely. Yeah, that's a great example. Yeah, so many, many viruses enter our bodies, infect us, and then never go away. And, you know, they're in their dormant state. You know, one of the most common, two most common examples would be shingles, right, with the varicella virus, and then cold sores or, you know, genital lesions with herpes simplex, usually herpes simplex one or two viruses, right? So, yes. you know, under stresses to the body, whether it's sleep or whether it's psychological or whether it's sunlight stress, right, stress of sunlight sometimes can activate herpes viruses, et cetera.

Those viruses are more than happy to come out of their box and reactivate. And we see that, you know, those are simple examples. It gets a lot more complex. You know, there's been a lot of research on HHV6 with ME-CFS, chronic fatigue syndrome. And then this, you know, sort of big back and forth to. discussion of what is or is not happening with SARS-CoV-2. But there's some very compelling evidence that that virus has also has the opportunity to be persistent and to reside.

But yes, anything, those viruses, again, are going to be there. And then anything that stresses you, whether it's lack of sleep, the cancors, or example, some people also experience chemical stressors. For example, a toothpaste which has sodium laurel sulfate in it can be a trigger. So sometimes that's one of the first things I do is say, you know, a brand of toothpaste, it does not have any sodium laurel sulfate. Some people will experience that as a benefit. But yeah, they're basically just kind of just under the radar. And in my opinion, like a cancassar or those kinds of things that are poking their head up again are kind of like

the warning light on the dashboard of the car. It's just, it's not the indicator that the cancrasor is the problem necessarily as the primary problem. It's more the indicator that the load, the allostatic load on your body has gotten too high. And now you're man. manifesting symptoms from those underlying issues. Allostatic load. Can you explain that for people who aren't familiar? Yeah. So, you know, the way backing up for a second, the way I think about that is that it's pretty

amazing to me how much our bodies can handle. We throw a lot at our bodies, at our brains. We live so far out of balance from where we evolved, right? with our routines, with our, you know, community isolation for a lot of people, with the food that we're feeding ourselves, with the screen exposure, with the pollution. I mean, the list goes on, right? So those all contribute to this allostatic load of what our organism is feeling and dealing with.

And, you know, basically when that passes a certain threshold, then you start to have reactions, whether they're psychological, whether they're physical. and stresses trauma, again, if we think about the first responder example or the medical worker example, there's little T trauma and there's big T trauma, right? But those all contribute to this allostatic load, which is sort of like this backpack on our shoulders that we're carrying, right? And so we have the opportunity to make choices which load that backpack up or to make choices which unload that backpack and make our load a little lighter and give us the opportunity to carry forward more easily. The other example that you often hear in the world of functional medicine when doctors like yourself are explaining to patients, it's like, okay, we all have a cup.

And then that cup gets filled up with water. Now, water is a good thing, but imagine that the water is polluted. And the water in this case is like processed foods, alcohol, then you have a little bit of other stuff. And that cup drip, drip, drip, builds up, builds up, builds up. And then you have a period of your life, which, you know, we'll chat about this a little later on. There are genuine periods of life. You have a kid. You're not sleeping as much.

other things like that, there's things that you just can't avoid. You're not always going to have perfect sleep. But when you can control things, you know, which is the vast majority of the time, if you don't focus on healthy sleep hygiene and sleeping well and you have poor sleep, that's another load that's there to the cup. And all of a sudden one day, your cup overflows and you go to the doctor's office because knock on wood, I hope this doesn't happen anybody, but we know out there it does, somebody finds a lump in the breast tissue or in the prostate or somebody, you know, gets this diagnosis that their memory is not doing well and they get sent in for, you know, do they have Alzheimer's?

And it turns out yes, or they have a heart attack. So our cup fills up, fills up, fills up, and then it overflows. And that's what we call disease when it overflows. But it's been building up this whole entire time to these contributing factors, one of the main ones being sleep. There's another thing that you mentioned about sleep is that you talked about getting the flu, but also interestingly enough, the flu shot doesn't work as well on people who don't have adequate sleep. Yeah, absolutely. So, you know, basically if you get a vaccine of some sort, it's injecting, you know, some aspect of this virus or bacteria into basically exposing your immune system to this element.

that you're then asking the immune system to respond to and make an immune response or antibodies, either a B-cell response with antibodies or a T-cell response, which is then, you know, that will generate some degree of memory. And that's why a lot of vaccines require multiple priming points because you get sort of a certain percent, maybe 50, 60 percent response with the first shot, you bump it up to 80-90 with the second one, you bumped it up to 99 plus, you know, whatever it is with the third shot, et cetera. But you're asking the immune system to kick. it's not just like oh here's your shot and you're good right and so if there are factors of which we've talked about which are negatively affecting your immune system or stressing your immune system

that will you know impair your ability to mount that response to the to the vaccine as a side note you know asking your body to make an immune response from a shot is not a really natural thing for your body to do right it's a stressor it's a stressor but more nuanced than that it requires a little bit of like a kick in pants. So when they give you these shots, they frequently add what's called an adjuvant, which is like this thing that like just kind of pisses off the immune system. So it like generates this more of an immune response. To try to have a memory. So that you generate that, yeah, that immune response to the shot. But we do know that, you know, people who aren't sleeping well or people who are under significant stress, that they'll have a blunted immune response. And it's

the same thing as we age, right? So elderly people have less of an immune response to vaccines, right? Yeah. And so when we, you know, when we were preparing our patients, which tend to, who tend to be more sensitive and more chronically ill, not as a rule, but frequently, to get vaccines of any type, especially as we went through the pandemic, you know, we had them dial in as much of their lifestyle ahead of time two or three weeks before. Make sure you're sleeping. Make sure you're eating super clean.

Make sure you're hydrating. Make sure you're taking a key group of supplements, antioxidants, vitamin C, magnesium, but all the things you would think of, right? which the crazy thing is if you were doing all those things anyway, you know, I mean, this is not the focus of today's podcast, but kind of like if you're doing all those things anyway, you may not, you really don't even need the flu vaccine, right? I'm not here to give medical advice and you're not here to give medical advice either. And vaccines is such an individual, you know, conversation that people have. But the flu vaccine in particular is kind of like to me, I'm not, you don't

have to respond to this because I'm not trying to put you on the spot, but I'm just saying it for the record, I kind of see it as like a little bit of a joke, right? Like if you're willing to sleep well, eat healthy, other stuff. And even then still, I think the statistics are, it only works like 50% of the time, right? Because they're trying to guess in advance what it is. And so, you know, that's not to throw all vaccines under the bus, but the, you know, if we can sleep more, if we can have a good diet, other stuff, we're not going to be as reliant on things like the flu vaccine. And independent of whether we're talking about vaccines or not, hands down, no matter what, completely not controversial, you are going to do better from an immune point of view if you're

doing all those things. Get sleep, avoid ultra-processed foods, move. Avoid pollution. Have community. Yeah. You know, those are the things that make a difference. Mindfulness, gratitude. Totally.

Amazing. Amazing. But we come back to the basics, which is really sleep. Sleep is a core, core, core, core basic. All right, let's go. You know, we're going down a list of things of when we don't have them, when we don't have proper sleep, our likelihood of these things. We already talked about Alzheimer's.

We talked about cognitive decline. We talked about cancer. We talked about weakening of immune system. There's also, we've done many episodes on this podcast about the importance of maintaining a more balanced blood sugar, an optimized fasting insulin. So tell us what we know about blood sugar and sleep. Yeah. So, and this is one of the areas where the research really shines. Like, it's very, very clear that if you don't sleep enough or you get poor sleep, that you will disrupt your metabolic pathways through a variety of different mechanisms.

You know, there was one study just to drive this home where, you know, people, participants were recruited. They had no preexisting issues regulating their blood sugar. And they were forced to sleep four hours a night for six nights. And after that time period, less than one week, they had such poor blood sugar regulation that they would have fallen into the pre-diabetic glucose range, right? And so this is happening through a variety of pathways. One of it is inflammatory, so more inflammation, you know, decreased metabolic signaling and balance. But also specifically through, you know, these hormones, ones called graylin, which regulates our hunger and our cravings. Another one called leptin, which regulates our satiety or our, hey, I'm full signal, right?

And studies have shown that individuals who are sleep deprived, you know, don't get those signals properly. and they have more cravings and they don't their body can't listen as well to the signal of I'm full. They end up consuming up to 300 calories per day more. And there was a crossover study where the separate study where the participants first slept eight and a half hours and then they slept four and a half hours. And they basically experienced far greater subjective hunger following the sleep deprivation, despite having received the exact same amount of food and exercise. So they controlled for food and exercise. And then they tested the hormone grailin, which and leptin,

and showed that they had significantly more grailin. So that's like the I'm hungry, go get food cravings hormone, and significantly less leptin, which is that I'm full hormone. Right. So very specific information showing these set points, which are pretty dialed in a lot of people. Again, they'll go off balance if we push them too hard, right? But, you know, sleep is one of those factors which can really push those, those metabolic.

I even seen this in myself. You know, I wear a CGM. You know, I'm an investor in the company levels. I love their app and their system. So I use their CGM. And there are periods of time where my sleep is thrown off maybe because we're traveling and I have jet lag or, you know, could be. It happens very rarely now, but there are still times. There's been times where my wife and I are helping out.

We don't have kids yet, but we help out with her sister's kids, where we help out with my sister's kids. And you just don't sleep as much, you know, when you're in that situation, you're babysitting and things like that. And I've seen my CGM the next day, and my glucose is already starting off in the morning where I'll typically be around like, you know, 80 is, you know, my readings that are typically in the morning, morning. And normally when you get up in the morning, you have a little bit of a cortisol spike.

And so your glucose goes up a little bit, and then it kind of comes down and you get settled. But I'll wake up in the morning sometimes and my glucose is already like 95, you know. So it's a big jump. Yeah. It's a big jump. Yeah. Right. So it's, have you ever seen that?

I know you use CGMs and stuff? Yes. Absolutely. Yeah. So even for people that consider themselves pretty healthy, pretty much immediately your body can have a strong response to not having sleep. Now, the counter to that is that generally, if you're avoiding ultra-processed foods, if you get back on track, if you're not drinking alcohol or you're minimizing your alcohol greatly, if you have some form of movement in your life, we are designed to be resilient. We can handle these moments and situations.

It's not that we're so fragile that one, two, three, even six months of not sleeping well. Sure, it'll take its damage that's there, but plenty of people don't sleep that well when they first have kids. so it's not freak out. It's that, no, your body is resilient. And just when you can, do your best to get back on track. And it's not all or nothing. Even when you have disruptive sleep, and this is part of what we're going to go through in the solutions.

We have a whole list of solutions that you've put together that we're going to cover in a little bit. There's so many things that you can do with what little sleep you have to try to optimize it and make it better if there is a period of your life where you're not sleeping as well. So I think that's an important reminder. Yeah, no, I love that point. And it flips the other way too, right?

So if you have somebody who, for a variety of other health reasons, you know, they're tipping towards metabolic syndrome or pre-biate diabetes or even, you know, diabetes, you know, or other cardiovascular metabolic issues, you know, that is one of the levers that we want to pull in order to help to back that off to try to reverse it, right? And or to minimize the negative effect of that condition is dialing in your sleep, right, because of all those exact factors, right? So it's so true. I think the thing that that, you know, we talked about these long-term things, which are super important, cancer, Alzheimer's, but even in the short term, if you're trying to understand how to dial in your diet and feelings of hunger, just know you don't sleep well,

you're going to be more hungry the next day. You're going to want to overeat. And in particular, it seems that people crave carbs. Yeah. No, absolutely. That seems to be something that they crave when they don't sleep well. I know that's the case for me, for sure. And then you're in a vicious cycle, right, because you crave those carbs, they cause blood sugar excursions and balances, the insulin's chasing at, you're on this roller coaster. You know, when you eat carbs, they maybe make you tired for a variety of reasons, right? If you're eating a lot of carbs. You're not a carb phobia or anything like that. Right. And thank you. And to differentiate also between healthy carbs and unhealthy carbs, right, if you're eating a lot of white sugar or, you know, pasta or crackers or chips or cake or cookies.

Too much white flour. Too much white flour. Too much refined flour. without a balance of healthy fat, healthy protein, et cetera. Yeah. You go on these excursions. You're on this hormonal roller coaster, which is also inflammatory and which actually also generates this compound called adenosine, which creates our sleep drive. And that makes you more sleepy. And so then you're kind of on this, you know, now you're chasing that.

You have the dip and you're trying to chase it now with more sugar. And so, yeah, a lot of folks get on that roller coaster and they, when they flip that around, they realize, okay, if I really dial this in and I keep my blood sugar as, steady as possible. You know, those cravings go away. My sleep improves. My energy improves. My brain function improves.

And so just a really nice feedback loop there. On the other side of things in a good way that I just want to share is that since my sleep was always pretty good. My sleep was good. It was the movement piece that I had not developed a regular strength training practice. And I'm working with the group over here in Brentwood called Ultimate Performance. and I've like really dialed in my, you know, 150 minutes a week, right? For me, it's like going three times, three times a week, which also working out has,

you know, can improve your sleep quality too. Oh, absolutely. We could chat about that. Yeah. So when I work out and I get my strength training in, excuse me, and on top of that, I'm sleeping well, my blood sugar is my blood sugar baseline is lower and I can get away with eating more carbohydrates. Yeah, because you need it because you're using it. Because I'm using it. And it doesn't have an impact, not just on my blood sugar, but also I measure my fasting insulin pretty regularly, like every

other month through my like blood work and stuff. And my fasting insulin stays in sort of the optimal range. I just measured it recently. It was like, it was three, even though I'm probably eating now twice as many carbohydrates than I was previously. And that's just another reminder that you like you can get away. You can get away with, again, not carbs are bad, but you. But you, you can get away with more leniency on your diet when your sleep and your movement is more dialed in. Absolutely. And there's a variety of interesting mechanisms on that too. One that I want to point out for your audience is, you know, blood sugar balance, right? So we eat carbs, we eat simple sugars or carbs are broken down into sugar in our body. We have, you know, sugar that's in our blood now

in order to tell that sugar to go into the cells, use a hormone called insulin, which is released from the pancreas. And when that axis gets bent or broken, then you're on the road to metabolic syndrome or even type 2 diabetes. Completely separate from the insulin signal, which is sort of the key that opens up the cellular lock to let the sugar in, totally separate from that, completely non-dependent on insulin, is a glucose transporter called the glute four transporter, which if you're working out and lifting weights is expressed more in your muscles, and we'll just basically like suck up sugar because it needs it. It needs to build those muscles. Muscle uses glucose. And it has a non-insulin dependent transporter. So it's a really weight training is a super, so many amazing benefits,

but super important factor for metabolic health. Yeah, a friend of ours who's been on the podcast before. I don't know if you guys know each other, Dr. Gabriel Lyon. I don't. She, you know, she says like muscle is really the organ of longevity. Yeah. Right. Like we went through this phase in the world of sort of eating. I definitely was there too where we kind of like de-prioritized protein, right? We thought protein's not that great.

Even a lot of longevity researchers were talking about you don't want too much protein, EMTOR, this, that inside of the diet, and definitely in the plant-based community. But I feel like people are starting to shift and realize that protein is so essential for building muscle, regardless of how people want to, you know, get it. They can get it through vegetarian, which is a little bit trickier. tougher. I was vegetarian for a long time. I know firsthand. Yeah, it was too. And yeah, we could chat about that or you can get it from, you know, inclusion of targeted clean animal protein inside of your diet. I agree. And building and maintaining muscle mass is so important as we age for all

sorts of things, but especially as you mentioned, you know, blood sugar and insulin. I want to pivot here for a second. And I want to, you know, we're going to get into cardiovascular disease next. But before we do, and we'll also talk about psychiatric and mental health. I want to take a pause here for a second. You know, generally, I think most people know that, you know, are they sleep, if they have a night of sleep that is thrown off, right? Like, I didn't sleep that well. In fact, I saw Dr. Andrew Huberman tweet this one time.

He said, instead of next time you catch up with somebody, don't ask them how you're doing or what's new, right? If you really want to create connection with somebody, ask them, How'd you sleep last night? Yeah. Right. Everybody's got a story about that, right? It'll open up more of a dialogue.

You'll learn a lot more interesting things about them. So shout out to Andrew, who's been on the podcast before. But one thing that people are not good at, it's that whole frog and boiling water thing, which I don't know if it's true or not, but we get used to our environment. So a lot of people don't know over the long term if this disruptive sleep that they have is either normal or if there's actually something wrong. So how do you know if you're sleeping well? When you sit with patients at the California Center for Functional Medicine and you're talking to them or you're having them fill out questionnaires, what are some of the questions that you're asking them

to know, is their sleep good or is it off in some ways? Yeah, that's a great point. And there's so many reasons that we could we could unpack that for a while of why people lose touch with their their internal state and and then how they're feeling right you know many folks with chronic illnesses are just sort of in this soup of unpredictability and and things are there's a lot of moving parts they don't always quite know what to expect um and then you know we also have a lot of coping mechanism and compensations that they're that are you know psychological or physical that are hard to unpack or unwind um but the Basic things that I like to know from somebody is, you know, first of all, how do you feel? How do you feel? And my wife teases me because I'm a huge wearable geek and I love the data.

I use ordering and I'm just always playing with some other wearable, you know, usually wearing more than one and comparing. She's like, I don't need a wearable. I don't need the data. I know how I feel, right? How do you feel when you wake up in the morning? Do you feel rested? Do you feel ready to go, right? Which may be right for her. Right. Right. I saw this tweet. Tessas. See if you can find this tweet. It's Mark Sisson is the founder of primal kitchen and considered like the grandfather of paleo. It's something I'm going to paraphrase here. We'll see if we can find it. If I ever need a device to tell me how I slept last night, please shoot me. But there's other people on the other side that they don't have strong interception or maybe their sleep was thrown off previously. As you mentioned, you were working at night sometimes. And there's other people who just genuinely enjoy the data because they're always looking. That's kind of me.

I love to test my whoop with my aura ring and try this because I'm always looking at what can I learn from different ones. And then people ask me all the time, which one should I use? So this one's better for this and this one's better for that. But it's funny what your wife said because I think that a lot of people feel that way too, which is great. If she sleeps well and feels good and doesn't need devices to tell her how she's doing, like more power to her. And the flip side for me is like I know there are mornings when I don't feel rested. And as a side, we can get into that. but I'll frequently, you know, target a midday power nap for 10 or 15 minutes only and probably

don't even fall asleep, but just that rest and reset is like I had a cup of coffee. But for me, I know there are nights when I haven't slept well and I'm going to sort of get through my day, but having the data longitudinally helps me make decisions around what I'm doing, when I'm doing it, how I'm doing it, and isolate factors that are really key for my own health and my own sleep. And you can see the data change over time. And so what I, you know, for me, just as a short rundown, the things that are really important are morning light with some gentle movement for 10 or 15 minutes. And then, you know, the evening wind down, right? Not having a meal after six or seven, not having screen exposure, doing some wind down, you know, not drinking

too much fluids late in the evening. You know, all those factors are really key for me. Doing some breathing, you know, gratitude practice right before bed. I do that every night. So, but what I tell my patience is like, okay, I want you to get this device. You know, if you want, to look at the app every morning and look at the data, that's fine. Go for it. I don't need you to. What I'm more interested in is like, what does that data look like in a month? What does that data look like in six months? And can we go back now and say, okay, we're doing this now. What parameters have changed compared to the past and what's working? What's not working? So you want to know more about what are their averages over the course of a month? Trends.

Yeah. Trends. And then when we dial back on alcohol or when we eat earlier or when we get morning light and we're doing some of these habits. Now let's look at the next month and see how are you doing? So you're kind of looking at their baseline and then you're comparing that. Do you have a favorite one of the apps or trackers that you like to recommend for people that you find the easiest to use? I like the aura ring a lot. You know, the form factor is great. It's small. It's light. You forget about it. And the fact, more importantly for me, the fact that it's on your finger, we get a signal directly from the digital artery, which is a much louder signal for the sensors to pick up. And so you get a higher fidelity reading on the heart rate and on the heart rate variability.

And the heart rate variability is the metric which I care the most about, HRV. Really amazing marker for a variety of different indications on your balance of your sympathetic and parasympathetic nervous system. And the wrist mounted devices are good. But again, you're picking that up from a capillary signal, which is sometimes a little bit not as loud and a little bit noisier. The breakdown of all these devices, in my opinion, is when they try to move from, here's your raw data to here's your score here's your sleep score here's your readiness score here you know and and because those are now based on an algorithm that's proprietary to that company and my own internal experience of that is doesn't always match right and so I feel much clearer about the raw data and

what that says about how I'm doing and how I'm feeling yeah but they're getting better right so I think we're in the early phases of this whole journey right now and and I'm very confident that you know the data is going to really prove out. And, you know, even, you know, many of the currently available commercial devices have improved pretty dramatically over the last few years. Yeah. Yeah, but one thing that's fascinating for me also, when we did our cohort programs, whether with patients or with firefighters and police, you know, we had them all wearing wearables and we had the same thing. If you want to look at it great. If you don't, don't, but we're going to pull that data and we're going to look at that data. And we could show this really incredible

response to simply getting them moving and getting cleaning up their diet, putting them on a 30-day whole foods, you know, anti-inflammatory nutritional reset. We saw a dramatic increase of heart rate variability. You know, so increased HRV is good. It's a sign of relaxation nervous system kicking in, less stress, less allostatic load. And over the course of that program, we were able to demonstrate as a cohort a drop of eight beats per minute of the rest of the rest of, heart rate, increase of HRV by 22%, and then increased markers of sleep. So 36% improved deep sleep, 35% less time it took them to fall asleep, so improving in sleep latency, et cetera.

So that's where I love the data, right? That's where I think the data really shines. And I think that we, and I'm generally just very excited and passionate about the data. I think that there's so much that we're doing in functional medicine and in in these functional medicine clinics, and we're all working on trying to solve this really, really thorny problem of chronic illness, which is going to bankrupt the health system if we don't do better, right? The allopathic conventional medical system is simply not set up to handle that. You know, alopathic system is awesome when it comes to an urgent situation, a surgery, you know,

you need the ER, your cardiac event, et cetera. You know, amazing, amazing, amazing work. but the chronic illness side is where it falls apart. Totally. And if we can pull in data and sort of build it now a data dashboard, which is kind of acting like one of our ultra-modern cars, right, where there's all these sensors figuring out what's happening as an intranormal view, and that's labs and that's, you know, patient reported symptoms or patient report outcome measures, proms, and that's wearable data.

And I think it can even go bigger than that, and it will go bigger than that. It can go to social and social use. and, you know, having gauges of how much are people moving around, like just following the GPS and seeing like, okay, lots of excursions versus someone who's bedbound is moving very little at all. And how does that change with different treatments and starting to generate visibility and insight into what is working, what's not working. Yeah, so it goes deep. There's a lot of, you know.

It goes deep, but it brings up this, you know, it brings up this important point that I think a lot of our listeners are going to resonate with is that, and then, you know, we'll jump into cardiovascular and mental health and psychiatric. Tessa, there's this article that I wrote on my website. I try this newsletter was called Three Crazy Facts about Big Pharma. John Abramson wrote a book called The Sickening. And inside of that book, he takes on really the pharmaceutical industry specifically around SSRIs, medications, like just the corruption that's in pharmaceutical. He's a Harvard guest lecturer and professor at Harvard Medical School. And you might have to search for it.

It's John Abramson crazy facts about pharma, big pharma. You can type in that as well. And if you don't find a test, no worries. I'll try to do my best. So so much, you know, you're talking. turn on the news, you turn on daytime TV, there's this running joke that it's all sponsored by Big Pharma, right? It's not a joke, it's true, but you'll see these memes online, like brought to you by Pfizer, brought to you by Pfizer, drugs are so pervasive in our culture. And obviously, drugs have

allowed a lot of really great things that happen. I'm sure you have family members that are on different pharmaceutical drugs. But it's when these pharmaceutical drugs are nefariously promoted as the right solution when they're not addressed as compared to what. Yeah. Right? So one of the big, I'll see if you scroll down a little bit here. I'll try to read it. Okay.

So I'm just going to read this real quick because this is like an area that I'm very passionate about. And this is an excerpt from his book. Okay. So one of the questions that's being left out of the conversation when it comes to pharmaceutical research is how does this drug intervention compare to lifestyle recommendations? Because the FDA doesn't require drug companies to explore this question, many doctors walk away

with the notion that a drug intervention is often the best option. And that's soft interventions, by the way, people think of sleep as a soft intervention, like eating healthy, sleep, exercise don't work. Many doctors also develop the false belief that patients have zero interest in doing the hard work because again, we don't have studies on it and are only interested in quick fixes. So here's an excerpt from Dr. J. Abramson's book who's been on this podcast. We'll link to him the show notes. So it says,

The definitive study showing how best to reduce the incidence of diabetes was done in the 1990s. The Diabetes Prevention Program Research Group publicly rather than commercially funded, randomly assigned more than 3,000 people at high risk of developing diabetes to one of three groups. Standard lifestyle recommendations plus placebo. standard lifestyle recommendations plus metformin, which if you guys don't know about that, it's a blood sugar-lowering medication, or an intensive counseling about healthy diet, exercise, and behavior modifications plus placebo. The primary outcome was the difference in the percentage of people who develop diabetes

in each group after three years. So here's what ended up happening. And this is what they found from this study. And again, remember, this is the definitive study on this topic. The studies was highly unusual that its goal was determined the best way to decrease the risk of diabetes, instead of just trying to prove the efficacy of a particular drug. Fast forward, the results were stunning. First, they resoundingly debunk the conventional wisdom that people won't change their habits

and that physician's efforts to get them to do so are a waste of time. At the end of three years, people assigned to the intensive lifestyle modification group lost an average of 12 pounds and significantly increased their physical exercise compared to the other two groups. And to conclude, and second, the study showed by far the best way to prevent diabetes is through positive lifestyle changes. So why I thought about this is that, you know, you're talking about the data. And I think that one of the things that everybody's excited about the future is if we can somehow organize these independent sort of clinical trials that people can opt into using their wearables, we can start to see the lifestyle modification components that people are doing.

And we could see that if we had a national emergency around sleep or like, let's say, processed foods, could these things work better than the best known drugs that are out there and available to us? And then we would have the data. And now, well-meaning and well-intentioned practitioners and doctors that are out there are like, no, actually, let me put in and the insurance companies would get behind it. Let's put in that extra bit of effort. because this works far better than anything else. I just thought that the excerpt from the book, which is really talking about a lot of the corruption

that's inside of Big Pharma, and there's a lot of good things too. Just was a reminder of what's possible when we lean into these soft, these things that are considered soft, but actually have a profound impact on our health. Yeah, that's so important. I love that article and that book.

There's a lot of hurdles in the medical system to that, and for doctors, it's time. And it's also, you know, the money incentive from big pharma. They're pushed to prescribe the drugs. And these big pharma companies are spending, you know, just untold billions of dollars developing these drugs. And so their job then is to recoup the money for their shareholders, et cetera. You know, so they, you know, they're not incentivized or even able, you know, from the

pharmacy or from the doctor's side to really do those intensive counseling, intensive behavioral modifications. And, you know, but that's totally fixable, right? it's not a complicated problem to solve. And the doctors should not be the one who's doing that work, right? Because they are too busy and they're doing these others extremely important roles. I think in general, you know, most, if not, you know, the vast majority of medical professionals are very wonderful, you know, carrying supportive people who are in a career

of service, right? But they are also stressed and crunched and don't have the time and they're in this sort of mill of moving people through, right? So what needs to happen is to have support around that. And that's one thing that we have done a really careful job about building at our clinic. Yeah, you guys do a good job about that. We try. We really work on it.

Can you explain it a little bit for those that are listening? And if they want to work with your clinic, they can kind of get a preview of how you guys work. Sure, yeah. You know, so we mentioned the technology side. So I think of that as like the high tech side. But then the counterbalance to that is what we call the high touch side, right? And, you know, I really firmly believe that everybody should be working at the top of license and of their ability. And so then what we have is a care team. And we have a really amazing

team of people who I get the pleasure of working with every day. You know, we have physicians, we have nurse practitioners, we have PAs, we have health coaches, we have nutritionists, and we have a really amazing admin team. And so the person when they come to work with us has multiple touch points along the way, right? And so they do a deep dive intake. They start to do their comprehensive of lab testing that we order, they immediately go to work with the nutritionists. After they've done that, they've sort of been downloaded, okay, here's what we want to do in terms of testing and in terms of nutrition interventions. Then they go to see the coach because now they're probably feeling a little bit overwhelmed

and we've given them a lot of to-do items and it's somewhat complicated. And so they then go and work with our coach and help to put the plan into place. And then when all that data comes back, they come back to the clinician and get that interpretation and next steps of the plan, right? And so that's one aspect of this high, high touch point of view. I think there's also a lot of opportunity to really dig into questions around learning theory and the science of health behavior change. And what does it actually take to be successful at that?

Because it's not easy, right? We all hit the ground running at the start gate, whether it's New Year's or it's engaging with a new clinician or it's, you know, reading an awesome book that gives us some inspiration or, you know, one of your podcasts or, you know, all these opportunities to get this information, but then putting that into place and then following through and sticking with it is where things get harder, right? And so we know a lot about habit change and how to be successful with that. And I really believe that there's this role here for both that high touch side, as well as this high tech side to really make an incredible difference in the, you know, how we're taking care of

folks with chronic illness and helping them get their lives back. Yeah, well said. All right, well, we teased about it. Let's get back to it. Sleep and our increased risk of all sorts of things. We talked about a bunch. Let's go to cardiovascular disease next. Everybody wants to protect their heart. Everybody wants to be heart attack proof or try to step into that as best as it can. What do we found out when it comes to cardiovascular disease and sleep? Yeah, so there's a lot of data out there. I'll touch on a few. You know, we've shown, studies have shown, that adults over 45 who sleep less than six hours. per night are 200% more likely to suffer a heart attack or a stroke than those who are sleeping seven or eight hours per night. Yeah, it's wild. You know, when I think about that, some of the stuff that comes up for me is that I've generally been someone who tends to be more like the six to seven hours. But even at six hours, I often find that my body, especially as I've gotten older, and I've been working on this, you know, I recently got a metabolite test done to

to make sure that my gut is working optimally. And one of the metabolites that's related to serotonin, again, I don't know the whole science around it, was low in my sort of reading. This was a blood test that I did. And I was mentioning to the group that was kind of walking me through it, I was mentioning like, you know, I've been having this thing for like the last like,

probably four or five years where I wake up at 3 a.m., like pretty much all the time. like without like just as without an alarm clock like I wake up it's like 3 a.m. I end up having to go use the bathroom pee, whatever. And then I go back to bed and it takes me about 30 minutes or so. 30 minutes so and then I kind of fall fall asleep. Right. I feel rested.

My energy is good. Like I don't feel like I need a lot of I don't take naps or the things like that unless I'm really tired. Is that anything that I should be doctor? Is that anything I should be worried about? Yes. A couple of questions that come up. What time do you?

what's your last food that you eat in the evening? I generally finish my dinner before 7.30. Okay. And what time do you lay down for bed? I get into bed pretty early, even before the pandemic. Like most nights, like I'm in bed probably by like nine and I fall asleep by like 9.30. Yeah. So I'm like there.

So I guess so let's say like let's say I'm asleep by 10. Yeah. That's great. So 10 and 11. How much fluid do you drink before in that after? after dinner or around dinner towards his bedtime. Yeah, I try to minimize it, but I naturally end up having like a little bit of like for my final supplements or so. Like I try to keep the last hour fluid, you know, fluid free. But like two hours beforehand, I'm taking my magnesium. I'm taking

my 5HTP. I'm taking, you know, different things that are there. I know the goal is to try to minimize fluid. That's one of the recommendations so you don't have to get up in pee. But I find that, you know, I have to kind of take some of those things. Maybe I should bump them up a little earlier. But yeah, I take, I take them about like two hours before bed. I drink a little, probably like a half glass of water to take all my supplements. Okay, okay. And hopefully last question. Yes, please, please.

Um, how much caffeine do you drink and when? So I have an iced coffee here. I generally only have one cup of coffee. Usually it's like an espresso at home, which I know has a little bit less caffeine. This is iced coffee, so it has a little bit more caffeine. And I'm done. I'll probably nurse that right up until. 12 noon, right?

But it's just one, one glass, right? One cup. Sometimes I don't even finish it. Like, this is the coffee that I've had today. I won't even probably finish it since it's like 1130 right now as we're recording. But noon is like my caffeine curfew. Yeah, okay. Yeah.

So there's definitely some discussion out there is, you know, so insomnia, right? You know, difficulty falling asleep, difficulty staying asleep. You know, but there's different flavors, right? There's sleep onset insomnia, which is difficulty falling asleep, and then there's sleep maintenance insomnia and people can wake up at any time during the night but you know one to three a.m. is a very common time four to five a.m. is another one and then waking up too early and not being able to fall back asleep. So that's called terminal insomnia is is another one. The one to three am, you know, it's kind of where I start to think about the half life of caffeine as one question. So

I'm sure you know this, but caffeine is a half life in most people's bodies of about eight hours. Right. And so if you drink one cup of coffee in the morning, by the time you're going to bed, you still have about a quarter cup of coffee in your system, right? Now, that caffeine is, you know, basically, we talked briefly about this compound called adenosine, which is basically sleep pressure, causes our sleep pressure, and it builds up over the course of a day. And so you're starting to feel tired, you're feeling sleepy, you're feeling groggy, you know, you want to go to bed. That's what helps us go to sleep as part of our circadian rhythm, right? So the adenosine is binding to these receptors and is telling your body you're sleepy, right? Now you go to sleep,

and you have this adenicine dissociation curve. And so the ddenicine starts to pop off the receptors because it's like, cool, there's not sleepy anymore. But if you still have caffeine around, caffeine is like, ooh, look at that receptor. And it's going to jump on the receptor and it's going to wake you up, right? And that's going to be compounded if you've had some fluid because now your bladder is going to be telling you, hey, you have to go pee. You might want to wake up, right?

So it's kind of whispering in your ear. You know, but also other things that we think about are thyroid. So sometimes we see that 1 to 3 a.m. awakening with, with low thyroid function, either subclinical or clinical, but also liver, right? So 3am is a kind of a classic, you know, traditional Chinese medicine liver meridian time. And so sometimes when I see that, I'll have people, again, you know, careful about the caffeine, careful about the fluids, you know, dial your evening routine, you know, but maybe take some milk thistle in the evening.

And I'll do a relatively high dose, you know, like up to 1,100 or 1,200 milligrams of milk thistle in the evening time. that's also a big reason why it's healthier for your body to not eat late number one but also not eat a huge meal when you have dinner which is really hard for me personally because i always grew up with the family dinner i was lucky in that way but dinner is always my biggest meal right but the old adage is that you should have breakfast like a king or a queen lunch like a prince or a princess and dinner like a pauper because your your liver function is actually dramatically decreasing after about 3 to 4 p.m. in the afternoon. So just some some things to think about there.

Totally. It could also be, you know, something that's that's kind of jacking up your neuropenephrine, so one of your stress hormones, right? And that goes down a whole other, you know, pathway of, you know, what's stress in your body, what's causing inflammation, are their gut infections, et cetera. Yeah. And temperature is another big one. Temperature is a huge one. We'll get to that in a minute. You can't, that's one on your list of items. Yeah. Okay, cool. We still have a couple more things that I want to touch on here that you've really highlighted again, when we don't have sleep, our risk of these things increases. People don't think about this often, but psychiatric illnesses, depression, anxiety,

bipolar disorder, and even suicidality, right? Talk to us about that. You mentioned that with also the first responders. So tell us how our risk of depression, anxiety, all these mental health disorders increase when sleep is not dialed in. Yeah, so big picture view. You know, sleep and not having enough sleep, having inadequate sleep, contributes to nearly every major psychiatric illness, depression, anxiety, bipolar disorder, suicidality, schizophrenia, et cetera. And there's a lot of data on this. There was a research team in Italy that was working with bipolar patients. And after just one night of inducing sleep deprivation, a large portion of these subjects spiraled either into a manic episode or a depressive episode. And I think, you know, what we know is that part of

of what's happening is that, you know, there's a lot of communication and signaling that's happening in the brain. The prefrontal cortex, which is responsible for rational thought, for logical decision-making is normally coupled to the amygdala. And the amygdala is our reptilian ancient brain, which basically has three choices, fight, flight, freeze, right? It's our sympathetic nervous system, you know, signaling for emergencies. So that coupling is usually nicely in place. You know, but we see that when there's sleep deprivation, that balance is broken down, right? And so in sleep deprived individuals,

there's about a 60% increase, some studies have shown, of amygdala activation compared to individuals given a full night's sleep. And this pretty strong coupling between these two countering brain centers is weakened. And you can also see a lot of emotional mobility, right? I think this is part, not just being tired,

but like you're crabby, you're grumpy, you're like, with anything more on my plate right now. Basically, you don't sleep. You kind of become an asshole to the people around you, including the people that you love. Absolutely. And you don't feel good. You just feel like blah, you know, like this is not a good day.

Like, I can't wait to try to get back in bed and do over, right? You know, so, you know, but there's a researcher over at UC Berkeley who Alison Harvey, Dr. Allison Harvey, who's done a lot of work with cognitive behavioral therapy for insomnia, CBTI, which is really important for people to know about, CBTI. in the treatment of a lot of different psychiatric conditions. So just getting these people to sleep better by improving their sleep quantity, by improving their sleep quality, their sleep regularity. Dr. Harvey's protocols have really shown a lot of improvement in symptoms of people with

depression, with bipolar, with anxiety, even suicidal ideation, right? So really, really profound. It's the same goes with substance abuse. And before you get to substance abuse, are you aware at all of the literature? around hypnosis and improving sleep. There's a gentleman that we had on the podcast. I'm blanking on his name, but maybe Tesla you could find it. The website's called Reverie is the name of the app that he built.

And it's free for, you know, I have no association, but it's free for people to try for like, I think, two weeks if they want to do it. And click on if you can see like the About team, maybe in the footer. But you can see those, for those that are watching the video version of this, It's Reverie, R-E-V-E-R-I. And one of the gentleman is a, you were talking about Allison Harvey up at UC Berkeley. This gentleman is at Stanford. And the name will come back to us.

And Tessa, no worries if you can't find it. But he has done a whole group of studies around reducing anxiety, using hypnotherapy in this app that he's built, as well as getting us to kind of quiet our mind. mind, which is one of the list of things that you said that people have a David Spiegel. That's the gentleman here. David Spiegel is co-founder of Reverie and Chiefs Scientific Officer. I love David Spiegel's work. Yeah, he's really great and he's done a lot of stuff on hypnosis.

But yeah, just made me think that, you know, there are tools that are out there. Like you were talking about cognitive behavioral therapy, right? Hypnosis, which sounds crazy, but, you know, it works for people that can help individuals get to bed quicker, quiet the mind, and even potentially like stay asleep longer. Absolutely. Yeah. No, I have not seen reverie, but that looks amazing. There's another app that we've worked with called breathe, breathe, with two ease. Like a breath work app? So, but it also captures, it does do some breathing and mindfulness, but it also captures some hypnosis and aspects and also some aspects of CBTI, you know, cognitive behavioral therapy for insomnia. And so absolutely, it's just, it's really about

accessing, again, these different levers that we can pull that can have a beneficial effect. And, you know, you absolutely can reprogram those aspects of your brain and you can retrain those neural networks, right? It's all about neuroplasticity. The brain is happy to learn and grow and change some of the wiring that's there if we give it the right information and the right practice and the right repetition, right? So I'm a huge fan of neuroplasticity in general. However, you know, when we, the thing that I really like to think about is that, and Matthew Walker

in his book, Why We Sleep, said this. I love it. I'm just going to, you know, make sure that we all know is, you know, from him. But he said, you know, getting ourselves to sleep is like landing a plane, right? So if you're on a flight and you're flying from Los Angeles to New York and you have the flight and then you get, you know, towards your destination, there's a whole series of different checkpoints that happen well in advance of, you know, the actual hitting the ground that are necessary and, you know, happen in a very, very important sequence to get that playing safely

on the ground and effectively on the ground, right? So sleep is the same thing. And we need to have a system. We need to have a plan and we need to have some, you know, support and habits and, you know, different checkpoints in terms of time and behaviors that we can implement that will will much more effectively get us asleep. And it's really, like, if you think about it that way, it makes total sense, and it's really not a surprise that a lot of people are having trouble sleeping. When we work hard, we maybe exercise, hopefully, maybe not. We don't eat great food. We're feeding that, you know, intense information into our body. We get home, you know, we maybe late five or six, seven, you know, we try to eat a quick bite. Maybe we have some alcohol.

maybe not. And then we're watching TV or on our laptop or checking some more emails or we're doing some social because that's our wind down and the way we relax and, you know, and we have our lights on in our house and they're super bright. And, you know, there's all these factors that we're just completely neglecting the, hey, I'm going to try to land this plane into bed and go to sleep. And then, and then boom, we had, you know, last minute, we shut off our screen. We brush our teeth and, you know, hit the pillow. But, oh, pick up the phone because I want to set the alarm and then maybe you spend another 15 or 20 minutes on TikTok or Instagram, you know, scrolling your amazing posts. And, you know, so, you know, we're all consuming this, all this information and content is just

flooding us. It's like trying to land a plane by crashing. Right. Right. So then you lay down in bed and your mind is just racing, right? Your mind's just going. And you have done nothing to start that process of slowing it down, right? Which naturally happened in our environment hundreds or thousands of years ago before the advent of, advent of electricity.

but now we have to sort of fight for it. Yeah. Right. We're fighting for it. You know, I was laughing when you were talking about your lights because I was recently at a friend's place for dinner. And, and I was, I was, you know, I was sure I ate at restaurants and things like that. And I'm, like, expecting that it's going to be a little brighter and stuff.

But I hadn't been over to a friend's place for dinner in, like, a little while, right? It's been a few months. And when I got there and our dinner was a little late, the lights were so bright compared to like how I usually start to wind down the lights and close the lights down, you know. It's not about you don't need to have red lights everywhere, but if you do, great. But if you don't, just even dimming the lights, not having the overhead lights on. Exactly. Really bright. And their lights were not just so bright, but it was that white, fluorescent type light. Yeah, yeah. And I remember going in and I did not sleep well last night. I really had a hard time falling asleep because I, you know, we were out late. and I was super overstimulated by, you know, these lights. And it just was another reminder of like, wow, I'm so glad that in my routine,

I wind those lights down, which is a big part of your recommendations. Yeah, I mean, yeah, so first of all, I'm sorry, I didn't sleep well. I know how that can feel. And, you know, but the, yeah, to your point of like, that's just one amazing aspect of how out of balance we are with our natural environment, right? So that landing the plane analogy, if you're, you know, we're not living outside these days. But like, for example, when I go camping, I love camping, right?

You go camping. I don't know if you do you, do you like camping? I love the idea of camping. I just never have been. Really? Okay. Oh my God. I'm going to take you camping.

Well, that's so much fun. It's awesome. I camped in. I flew to Kenya for a group trip. That's where I was originally born. It was the first time I had been back. And I had the, I've never camped in my life. And then I had the most epic camping experience.

I was camping in the middle of this million square mile elephant, like refuge. And they tell you like, okay, for those that are open to it, we're going to set you up with a tent outside. And listen, like the elephants are probably going to come and check it out because they're curious. But as long as you don't freak out, like they're not going to do anything. And I remember like sleeping. And then I heard like this rustling outside and I looked out my tent window. And I was in the tent by myself. and it was a massive elephant.

Beautiful. That was just checking out the tent. And I was like, this is fucking crazy, but also like how exciting and amazing. What a good reason to have your sleep interrupted and elephant is outside. And I went back to sleep. So I've not camped outside of that. I need to do more camping in my life. Yes.

So one of the thing that is amazing about that is you just get a taste of what it was like and what it can be like, right? Where, you know, darkness comes and you don't have light around you. You know, maybe you have a headlamp or, you know, you brought a lantern to to wash up the dishes, but pretty quickly then, you all settle around the campfire and you're just sitting there kind of staring into the embers and the light's super low and maybe someone's playing the guitar and the music is nice and, you know, but your body's getting that, getting into alignment with the light day, you know, the light, dark cycle of the day. And, and you're not

being exposed to these super bright lights, which, you know, your eyes, you know, so we can get into melatonin a little bit but your eyes you know you're sensing what's around you they're sensing light and that information is processed by the brain and there's this part of the brain called the super chasmatic nucleus which sits right above that crossing of those optic nerves and is sensing the light from your environment and and then that super chasmatic nucleus is when things start to get dark signals to the pinnial gland to say hey make some make melatonin right the dark is coming it's going to be time to go to sleep soon. And so you get this natural rise of melatonin, which, you know, is a little bit misused in terms of a sleep aid. It's not really something that necessarily helps people stay asleep.

It's more like the mark of the start sleeping. But you didn't get that mark last night of start sleeping. And so, right, because your melatonin was probably unnaturally suppressed, especially since it sounds like you do a really nice job of trying to optimize that during your normal life. So it was a, it was a difference, right? Your body was like, whoa, this is pretty different. when I'm used to seeing. And so you had that, you know, activation and, you know, experience of having trouble falling asleep. Absolutely. You know, you have this diagram that you shared with me in the notes that you sent over and you were walking us through like, what is, like, sleep look like, right? I think it's worth touching on for a second. You know, we, you hinted out of it a little bit,

but just like, walk us through, like, what is happening, you know, sleep is not one thing. It's kind of many different cycles that are all happening there. Can you give us a little bit of an overview? Yeah, sure. Yeah, absolutely. So the current consensus is that there's about four different stages of sleep, and these are grouped into wakefulness, REM sleep, light sleep, and deep sleep. And in a normal night of sleep, we will cycle multiple times through these different phases, and the different phases will happen with different duration during different parts of the night. For example, it's common to go pretty quickly from wakefulness down into deep sleep

and get a couple of cycles, longer cycles of deep sleep early in the night. And then later in the night, you tend to get a little bit more REM sleep. And so, you know, basically, you know, with a regular sleep cycle, we go through these multiple times. But if you're not getting to bed on time, you're not going to bed until midnight one. You're actually, even if you get eight hours, you're going to lose out on some of that deep sleep. You're not going to get it. And so it kind of talks to the importance of,

of getting not just enough sleep, but the right timing of sleep. I also heard that especially for those that are interested in, you know, we talked about muscle mass, everything like that, you know, but it's not just muscle mass. It's related to so many other things. Regular sleep time also plays a role in your body's production of growth hormone. Yes, absolutely. And if you are constantly varying it, your body may not optimize the release of growth hormone, which happens within the first, you know, first phase of sleep, I believe, in the first hour. that you sleep, your body's kind of releasing some of that growth hormone that's there. Yeah, it cycles. But yeah, in addition, cortisol, you know, testosterone, estrogen, progesterone,

DHA, pregnant, I mean, all these are, have a circadian cycle to them. Got it. So first takeaway, if you are sleeping at different times, that right there is already one thing that everybody can do. If you can, again, there's different situations that people are, you know, not going to be able to do that, but if you have a huge variety of what time you sleep, setting sort of not just a sleep time, but actually I find that it's important to set a wind down time. Yeah. Right. There should be a time where it's like, okay, it's time to start winding down, no different than how we do with kids.

Yeah. So I think it's important. Yeah. My wife for many years was investment banker, you know, staying up in New York, 2 a.m., you know, working, putting a deal together, et cetera. So her dialing into, and she's been very open about this and the impact that it's had, her dialing in and just setting a time of like, okay, I know I work a lot. I know I'm starting a new business. I know I have a podcast and I have this.

This is the time that everything starts to wind down. In our house, it's usually around 8 o'clock. And it's like, you know, we're going to start to, I'm going to pass for the blue light blockers. I'm going to start to dim the lights around like, you know, around that time period. we're going to start to wind down on technology, TV, and just get ready for, as you mentioned, landing the plane. Yeah, that's awesome. Do you guys do that? Do you guys do anything in your house?

Is there a time period? I know your kids are a little bit older. Yep. Is there a time that you set? And what time do you typically, what time do you fall asleep? Yeah, I usually will turn off the lights 10, 15 to 11, which to be honest is a little late for me. I do need about eight hours of sleep to function optimally. and so my ideal wind down will look something like, you know, no food after 7 o'clock.

Again, no, try to not have any fluids after about 8. Try to be off screens, which honestly is a struggle. I'm, you know, be very transparent about that. I'm not always good at it. But I do really notice the difference when I can do it well and when I don't. Doing some stretching, doing putting some music on, you know, some gentle exercise in the living room, doing some, you know, floor work is awesome. I love that.

and you know but basically you know getting in bed with a book um just you know reading uh with a not not a very bright light you know so i'm not exposed to that that's super helpful um and the nights when i do that are pretty you know clearly better than the nights when i don't and yeah you know so it's it's again it goes towards that's part of why i'm so interested in that health behavior change side of it like what do we do to make this a more of a reliable thing that's possible for somebody to accomplish so have you seen this hack we'll link to it in the the show notes for you know most people have iPhones so there's this there's this hack which again you know you you set you set yourself and I'm not promoting screen time but I'm also want to be honest with people

yeah is that I often am looking at my phone as somebody who's a CEO has a lot of people on my team I'm kind of checking on stuff before I you know close down I'm not like on my laptop but there's this hack where basically you can set your phone you know people have blue light blocking glasses and that's great, but often at night, you know, I wear them kind of gearing up to bed and then we have a red light on in our room. And there's this hack where you basically can set your iPhone to do an automatic red light. Oh, cool. That you just like, so we'll link to that. It's a stupid little hack, but even having that because there's night shift mode on the iPhone, but it doesn't get that red. No. This is like a total red filter. So everything is blocked up there.

Yeah, it's super red, totally red screen, which is very cool. You can't see it on the screen over here, but like everything is red on there. And it's a little, it's a little hack. Actually, shout out to Max Lugavir, who was the one that showed me. We were out at dinner one time. He's like, oh, check this out. You could do this on your phone. But the reason I bring that up is that as much as I know that screen time is not helpful,

I also have been very honest on this podcast that one of the ways that my wife and I wind down is I'll usually throughout the week, I'll find these like interesting sort of slow-paced, like almost like documentary style you know short things that are put together like business insider does a bunch of them it's sometimes it's like how something is made there's also this guy that I follow on Facebook who makes these like very chill videos about what life is like in Japan and it's a very relaxing thing we find it very relaxing you're like traveling a little bit if you're getting that dopamine feel and and so what we'll do is I'll tee them up I'll save them and one of our rituals is that Once she gets into bed, I'm usually in bed first, we'll watch like one or two of those together

with the red light filter on. They're not stimulating. They're not like scary. They're not news. They're not that. They're very calming videos where a very creative sort of film storyteller is talking about some interesting thing. They usually have nice light level music that's there in the background.

We watch one, we watch two, and then we're like, all right, we feel like kind of sleepy. So it's part of our soothing thing, but it is on a screen. And my wife mentioned to me when we first, you know, moved into our new place. She's like, you know what, we should put a, we should put a TV in here. Then we could watch them on there. I'm like, that's just going to be a really, really bright light. I'd rather just watch it on our phone. Sure, is it ideal?

No, but it works for us. So I'm just being transparent about that. Yeah, no, that's super interesting. And I think your point is great, which is like we all have to find what works for us, right? We start off this, you know, discussion around a lot of the sort of scary stuff about, you know, sleep and not getting enough across a wide variety of health conditions, right? and so there's certainly people who are really poor sleepers we want to be more aggressive and more careful about things and then there's people who are you know relatively don't have an

issue who still could benefit from some of this but it's not as urgent right so yeah the most effective best case scenario is going to be you know do it all do it perfectly that's going to be the you know most robust outcome for your sleep and then the least effective thing is to do none of it right and then there's this whole somewhere in between right where we get to the end of one of like what's good for us as an individual. If you would say the three biggest things that have had an impact on your sleep for the better, like your personal sleep, right? What would you, what would you say? Yeah, easy. 10 or 15 minutes of morning light exposure. That's number one. Yeah. That has, and how long have you been doing that? I've doing it, I've been doing it somewhat

irregularly for a couple of years and got much more invested in it recently. After some discussions I had with a really amazing researcher colleague of mine who said that he's done some research on HRV and shown that that hands down of all the sleep hygiene hacks was the most effective for bumping up HRV and improving sleep. So I was like, okay, cool. I'm going to get back into this. That's great to hear that that's your number one. Yeah. Because we have a whole section that you've put together where you're walking us through all that, but it's nice to know as we're sort of in the middle of the podcast, like for everybody who's listening, like that is your number one. So that, I would say it's tied. So it's tied with that. So it's just

because they're both light. So it's tied with that, you know, get that morning light exposure with not having the evening light exposure. And to your point, I'm curious to check out that red screen because for me, it's pretty clear that even if I use the night shift mode on my phone, which I actually keep it on 24 hours a day because it just feels better on my eyes, even if I use that with blue light blocking glasses, that's not as effective for me as not being on my screens. Oh, I think not being on your screen is definitely. So I want people to just have that in the back of their minds because we can cheat the system a little bit, but you're not going to totally get away with it, right? Totally.

So, you know, try, try 10 days, two weeks, if you can go as long as a month of simply, you know, setting a timer when you just don't get on your phone. I think for me, what gets tricky with that piece is like I still use my phone as my alarm to wake up in the morning. As most people do. Right. But just having it there by the bedside and, you know, pick it up to put the alarm on. And, you know, not all the time, but maybe 30, 40, 50 percent of time, I will,

end up doing something on my phone for anywhere from two to 10 or 15 minutes, which I didn't intend to do because it grabs me and it sucks me in. And the devices are just so powerful for that for how they're designed to capture us and capture our attention, right? So I think one hack on that is to literally get an analog alarm clock and preferably one that's not lit up, doesn't have those red letters. Like anytime I go to hotel, I'll cover that with my washcloth from the bathroom, whatever, right? So, you know, but just doesn't generate light in your room and it's analog. And it's, you know, If you can, just leave your phone out of the bedroom. I think that would be super effective.

So that's one and two tied. And then the third one for me is not having any food after 7 o'clock. That's really effective. That's awesome. I love it. Anything you wanted to say more about like the sleep cycles and stages. If not, I think that, you know, we're, I think we're good to go into breaking down some of the, actually, before we break down some of the tips, I think it's worthwhile touching on sleep apnea under the context of sleep disorders.

because it's so pervasive. And I'm sure you probably find many patients who think that they're doing everything right, but sleep apnea in particular being one of the biggest disorders that's impacting people's sleep. So we mentioned that a lot of people know of like sleep apnea and think of, you know, an overweight, often male who's wearing a machine, you know, sleep apnea machine, but there's this whole subclassification of even healthy people who are dealing with a lot of sleep apnea. Do you see a lot of those in your clinic? We see a lot of sleep disorders, yes, and it frequently surprises us. Yeah, younger, non-male, non-overweight. And I think that, you know, there's a lot of, it can be a lot of correlation with other conditions, other health conditions, too.

Did you read the book, Breath by James Nestor? Love that book. Yeah. Such a good book. I'll just try, you know, we've had them on the podcast before, but one of the big things that he's saying is that the reason that we're having so much disordered sleeping and sleep disorders is a big thing. There's a lot of different things that fall into it. But the narrowing of the jaws and that impacting our ability to sleep properly and actually as part of landing that plane, you know, our mouth and our tongue getting into the right position and allowing us to breathe properly. And when we're breathing through the nose and our tongue is pinned to the roof of the mouth, we're much more likely to be breathing properly, which allows good sleep. And when we're not and our tongue is flappy or our tongue is too big for our mouth, which our jaw is too small, that can cause a lot of issues. And then some people have a tongue tie that was never corrected. Anything else you want to say on the jaw, sleep connection, sleep apnea connection?

Yeah, no, great points. you know, if you haven't read James Nestor's book, and I've heard it both ways, whether breath or breathe, the title, but, you know, just an incredibly well research, really fast-paced, really fun book to read. And there's a lot of factors there that he talks about that are not in our control, right? It's evolutionary, in part, you know, the shape of our skulls as we went from being, you know, walking around on four legs up to standing up on our feet and legs, and then the growth of the brain and then how that pushed the nasal cavity forward. You know, so a lot of that, you know,

contributes to the mouth structure and the narrowing of the airway. But there's a lot that is in our control. And, you know, pretty interesting things around breastfeeding, right? So, you know, duration of breastfeeding is definitely associated with development of the whole oral cavity and the strength and the tone of the muscles and the tongue also, which then sets you up later in life to have less airway issues. same with what are we feeding ourselves as children or feeding our kids and what are we eating ourselves and if we're eating a really soft processed food diet and we're not chewing our food carefully

we're not developing these muscles which are also important for keeping that that that happened to me I have a very narrow jaw and I've been you know working with dentist I have a I have a dental appliance yeah like an alf or it's a custom made one there's a dentist over here in to expand my palate because my jaw was narrow. And it wasn't really an issue growing up. I didn't notice it too much. I always slept great. I didn't have any sort of sleep apnea type things.

But then something maybe happened in my late 30s where I started to notice that it was creating a lot of almost TMJ type symptoms. And then I went and I got referred to this dentist and he created this dental appliance and around the same time from another dentist, Dr. Mark Bahena, who's up in the Bay Area. I don't know if you guys have met each other, but he was the one that really got me into mouth taping, which has been a total game changer for me at night. And we've done episodes and other things on that. Yeah.

So if we're breathing through our mouth as opposed to our nose, the nasal tissue actually gets more swollen and boggy. And then it sort of propagates that cycle. It gets harder. And we're not producing nitric oxide when we're breathing through our mouth and a whole bunch of other things. So one other thing, and then we can move on. But like the other thing I think is really interesting, you know, and pretty

rapidly, we've seen problems with airways around screen use. And so, you know, because our posture should really be like a J-shaped posture, you know, straight and then kind of curved into the bottom, you know, from like this. Whereas if we're on our screens and we're, you know, kind of, you've seen everyone with like screen neck, right? Where we're kind of tipping forward. Tech neck, right? Yeah. And that's creating an S-shaped curve, which further closes off the airway. Wow. So another thing you can do is, you know, posture is incredibly important. You know, sitting up straight, keeping your shoulders back, standing with your head, you know, almost like you had a plum line dropped from the crown of your head all the way down through your shoulders, your diaphragm, your hips, your knees, your feet. So you have a nice straight posture there.

Which it feels like, you know, a lot of people try to work on posture during the day. But I found that in my anecdotal, just watching people, really if you want to fix your posture, it's walking more in life, like not sitting as much. and then working out. Core. Because if you work out, core work, but also strengthening your shoulders, that's naturally going to lift you up and not so much tension that's going to be there on your neck. And stretching too, because again, we are unbelievably dominant in terms of like this hunched over position.

We're always looking down, we're typing, we're on our phones, or reading something, you know, in this developed, you know, modernized culture that we live in, right? So, you know, at the end of the day, one thing I like to do, it's part of my wind-down routine, is do something that's the opposite of that. You know, lay on your stomach and, and clench your shoulder, pinch your shoulder blades together as if you're like pinching a tennis ball between them and activate those back muscles that are the counter muscles to this kind of collapse, right? You know, lay on blocks that keep your arms up like this and it just pushes your shoulders back.

You can do that when you're driving too. Just like literally push your elbows into the seat of your car to activate those muscles in the back. And, you know, so that can be helpful to, again, counteract that, you know, general tendency that we all have. It's a great tip. There's a dentist name, Stephen Lynn, who's based out of Australia, and he had a great post on social media on the topic of sleep disorders and sleep apnea. He said, if you're snoring, you have to think of snoring as choking. Yeah. Snoring is choking. Anytime you hear somebody snoring, that's choking. Yeah. Airways clothing is vibrating the tissue. That's the sound. And we wouldn't treat it as something that's just

funny or annoying or whatever. Even my dad for years in his life was snoring. And my mom would always joke about it and like, you know, she can't sleep as well, but she got used to it. And finally my dad went in for a sleep study and saw that his sleep was dramatically being impacted and the choking that was happening with him snoring. And then he ended up getting a CPAP machine. And now there's so much better. These devices, they're so much smaller. There's so much easier to travel with, they're easier to use. In fact, one of my buddies that I wrote about in my newsletter, his name is me here, M-I-H-I-R, he was willing to put his story out there. And his journey of weight loss, he hit a plateau, and then he found out that his sleep apnea, his functional medicine

doctor helped him understand that his sleep apnea was connected to weight loss. He fixed it by getting a CPAP machine, mal-taping a few other things. He lost an extra 10 more pounds just by fixing his sleep. Inflammation hormones, yeah. It's all connected to each other. All right, Before we go through solutions, anything else that you want to touch on for sleep disorders that you want to mention to people? Yeah, again, I want to just kind of go through. There's this questionnaire called the stop bang questionnaire. I think everyone should just go check that out and run themselves through it.

You can do it online. Stop bang. Stop bang. You know, so it's a mnemonic. So S is for, do you snore loudly? Again, our discussion is important, which you don't have to snore, but it is definitely a tip-off. I think your point is great. That's a sign of joking.

So this is like a yes or no questionnaire. We can link to it in the show notes as well. So you're answering like, do you snore loudly? Do you snore loudly? Do you often feel tired, tired, fatigued or sleepy during the day? Yep. O, as far as anyone observed, you stop breathing during sleep because that's apnea. It's like a halt with sometimes a gasp, right?

And then the P is for, have you ever been treated for high blood pressure? And then the B is for BMI. You know, is your BMI? Are you heavy? Are you overweight? Are you obese? That's a risk factor. The A is for age.

you know, over 50 is a risk factor. Next circumference we talked about is a risk factor. You can look at the parameters there online for men versus women. And then gender being male is also a risk factor. So I think it's just getting yourself screened, figuring out what your score is. Could this be a problem? How is my sleep? Do I snore?

You know, as anyone said, I'd stop breathing. You know, as my wife, you know, annoyed at sleeping next, you know, my husband, etc., you know, get a sleep test because there's so much profound benefit that can happen from that one intervention that you just talked about, it's just so easy and high yield. Here's another one that'll add in. And again, I just know this from James Nestor. We were on a panel together at the Milken Conference. And he's saying, I'm seeing this epidemic of young, healthy women, again, with narrow jaws. They're not only are they not overweight, some of that might even be considered underweight, right? So they're not in a classic sort of thing. They're

young. They're in their like 20s and 30s. And they're waking up first thing in the morning with like a lot of anxiety. Yeah. And if you're waking up first thing in the morning, you have a lot of anxiety, it's a sign that your body was stressed out the whole night. Your cortisol spiked, yep. And you have not been able to relax. And that could be an airway issue. Absolutely. And you need to dig into it a little bit. You might be missed by your normal doctor if they're looking for all the classic examples of sleep apnea. But again, you could pick up his book and listen to our podcast. We talked about a little bit more over there. Yeah. And sleep ap can be very, very helpful and really important. But there's, you know, more simple things too, like, you know, various oral

appliances, you know, working with a person, someone who's called an oral, myofunctional therapist. They actually teach you to do exercises and to work on the strength and tone of your muscles in your mouth and throat. And mouth taping is really amazing. And being evaluated for a tongue tie. You mentioned that, you know, but that's like where there's a little tight connection at the bottom of the tongue, which is surprisingly common. And it prevents. the tongue from going to its most beneficial place, which is again up at the top of the roof of the mouth against the front teeth. That also helps to open up your jaw. That pressure over time, like water on a rock over the course of your life, is going to push your teeth out and open up your

whole jaw. And if that's not happening, you could have a small jaw, a small airway. West Ender Price was an amazing dentist, you know, nourishing traditions, West Ender Price Foundation. He showed that it's kind of a modern disease. It's largely related to our lifestyles, our nutrition, poor nutrition, you know, a lot of us do have smaller jaws and airway issues too. Definitely. I'm in that boat, and I've been fighting against it. I'm glad you know about it and you're working on it. Yeah, totally. So we've mentioned a lot of these solutions. Right now, we're going to get into solutions here. We've talked a lot about these. So some you might just want to give a little bit of a refresher. and then if there's some new information you want to share on it, great.

So I'm going to walk through a list that you gave me. So one of the first ones on the list is, again, the importance of having a bedtime routine, right? We talked about your top two, which are part of this as well, but I'm just going, you know, listically through the list that you have. So the importance of a bedtime routine, a regular predictable time that you are falling asleep, but also a time that you're winding down to get into, as you've mentioned from Matthew Walker, sleep is not like switching the lights off, but it's more like landing the plane. Anything else that you want to share when it comes to the topic of having a bedtime routine?

Yeah. So I think we have gone through a lot of that and we've given a lot of good information on that. I think just reemphasizing that the bedtime routine actually starts in the morning. And so, you know, because a lot of people, you know, might, you know, not recognize that, but that importance of how you structure the first part of your day, you know, timing of the whole course of your day, really. And that means like the getting the morning light. Getting the morning light, timing of caffeine, timing of food, you know, blood sugar balance. Yep.

Yep. Stress. And for your morning light, are you leading your house? Are you sitting on your balcony? How are you typically doing it? Yeah. I find for me the best, it works the best if I go outside and I walk. You walk.

That's how you enjoy. Yeah, walk. And I'm very fortunate. I live in an area right next to open. space so I can literally walk up into the hills and be in nature. And so there's a whole other level of you know, shinron yoku forest bathing, um, being in among trees and grass and wildlife, which is a whole another set of benefits for, you know, health and neurotransmitters, et cetera. But you don't have to be in nature, just being outside, being in the sun. If you don't wear sunglasses, um, don't wear a hat. Um,

you know, if you, if you wear prescription glasses that also have some blue light blocking built into them, try to not wear those if you can safely. I don't want you to trip and fall. But, um, You know, if you have a pair of glasses that don't have that blue light blocker in there, you know, wear those. And how important do you think it is, you know, Andrew Huberman, who's really been kind of been really championing a lot of this and his work at the Huberman Lab, he typically says within the first 30 minutes, right? From the time that you wake up, like try to get out, you know, again, that's what he's

saying is like an ideal situation is to try to get morning sunlight without like a window blocking you or anything else like that, sunglasses within the first 30 minutes. I think it is important, but it's not required. Okay. You know, again, that idea of, you know, the worst, you know, the least effective is going to be not do it at all. Totally. So just get out sometime in the morning, go for a walk.

If you can walk, great. If you can't walk, just sit outside. Sure. If you can sit somewhere outside. If you can do some stretching, that's great. Also, don't, don't, it doesn't have to be in the sunlight, right? So if it's a cloudy day, you know, you don't necessarily get a free pass, you know, because just being outside, even if there's a cloud cover, will still have those.

benefits for and again what humans talking about with the timing is that the sooner you do it to when you wake up is you're basically activating this receptor in the back of the retina which is called the melanopsin receptor and this receptor you know again is that start point of your circadian rhythm it's saying drawing the line here is the start of the day so that your body kind of knows where that is so it knows then better when the end of the day is but in addition when those melanopsin receptors are actually activated, you start to clear more rapidly any residual melatonin from natural sleep. And so you feel more awake, you feel more rested, you feel less groggy, and you wake up, right? And so, yeah, get outside

any way you can do it, you know, and when it's dumping rain and I'm not necessarily going to gear up and go outside, I'll just sit by a window where there's, there is some good light coming in and do some stretching there, right? But it is, yeah, I feel it. I don't feel as, as, I don't feel it as powerfully at that point. I love it. We've touched on light a lot, but let's talk about any of the things when it comes to the light that's around us. We talked about morning light and the sun. Any general practices like you talked about turning the lights off at a particular time, but do you try to dim the lights? Do you avoid super stimulating lights, especially at night? Yeah, I think your point really drove at home was that if you're in an environment where there are a lot of really bright, you know, these sort of blue

light white light you know LED lights they're creating this kind of like wow it's so bright and I can see everything almost daylight environment and they're coming from an overhead position where this so they're directly hitting your eyes that those are more stimulating for for sure so you know if you have some floor lamps that have you know a hue of light that is more soft you know there's more yellow orange etc there's a bunch of these you can purchase from a variety of different manufacturers, there's even some which you can set to change tones at different times of the day, you know, by, from the super manufacturers. I don't think those are completely necessary. They're more expensive. But, you know, again, something which is not going directly from above

into your eyes and is not super bright and white. So you have a variety of lighting options. Do you have a favorite type of blue light blocking glasses? I use a couple of different ones. I have the big ones that, you know, look like you're a grandpa and you're driving the old station wagon, they kind of cover everything in sides too. I don't use those as much. I have ones from Swanwick that I like that are more of a, you know,

a stylish form factor for what that's worth. You know, but, you know, again, there's a lot of options out there. There's a lot of good manufacturers. But they should,

I would definitely recommend that you get somewhere, you put them on and the lens looks orange, right? Because there's some which advertised as being blue light blocking, but they are, they're clear. And so you can't really see it, right? And those are not going to be as effective.

You know, there's some wiggle happening in this field. I think there's some research coming out recently, too, that question maybe the efficacy of the blue light blocking glasses. You know, but I still think, you know, added together with all these different factors, it can be potentially beneficial. So I'm going to pivot and we're going to go to diet. You talked about that previously, but tell us what you recommend to your patients when it comes to diet and how it's related to sleep. one of the first recommendations that you shared was like not eating too close to bedtime. Yeah. So that one you've talked about.

Is there anything else we should be thinking about with diet? Yeah, I think one of the other very important factors is to consider, you know, what's happening with your blood sugar. We talked about that a lot, but you can get some clues into how your body is handling carbs and sugar by asking a few questions, right? So, you know, what happens to you during the night? You know, there's some clues that blood sugar or carb intolerance might be affecting you. are you waking up consistently two or three in the morning right we talked about that earlier but blood

sugar imbalances can also be another factor for that um do you wake up uh to pee but then you feel really hungry right um some of my patients will actually get up and have a meal or have a snack in the middle of night because they're super hungry right um when you what's going on there i think a lot of people there's there's people there's people that are dealing with that i've never dealt with that before but what's typically happening when you notice that yeah so again disregulation of those hormones that are cluing you into either I'm full or I'm satiated, right? So maybe too much blood sugar roller coaster throughout the day? Blood sugar roller coaster, yep, insulin, you know, so basically if you're on this blood sugar

roller coaster and you eat a simple carbohydrate, you know, and your blood sugar rises, you maybe without a fat or a protein, your blood sugar rises. And then that's chased by insulin. The insulin tries to catch up with it to bring the blood sugar back down. But then the blood sugar drops. Now the incident is a little bit of a lag to how quickly it pulls back. It's still some residual. So blood sugar might drop too low.

And then you might want some sugar. You'll crave something sweet or, you know, carve. Or you have to mobilize some stress hormones in order to pull some, you know, some carb or some glucose out of storage in the liver, right? And so you'd be on this, like, you're basically chasing your tail throughout the whole day. Do you ever find, I hear anecdotally sometimes for people that say if I don't have some carbs at night, I don't sleep as well. Like if I don't have like sweet potato or something or even sometimes people say like, you know, I'll have a little bit of pasta and I sleep much better. Do you ever notice that for patients? Yeah. What's typically going on there? Yeah. So that's a flip side, which is that,

you know, some of the precursors to hormones, right, like serotonin and neurotransmitters like serotonin or melatonin are, you know, do need those carbohydrates. And that when you also prime the pump and kind to give yourself enough of that sustenance to get through the night. So there's a couple of different factors involved. And then obviously in that instance, if that's you and people can experiment, you're just looking for whole food sources of carbohydrates. Exactly. Like he mentioned, you know, sweet potato or some yucca or some plantain, you know, but trying to avoid the, you know, as Mark said, I think in ultra metabolism, his first, you know, one of his first books, it might have been his first book. Gosh, you know, avoid the white menace, right?

Let's talk about gut health. People don't think of gut health as being related to sleep. What do you want to talk about when it comes to that area? Yeah, so obviously just a really incredible time. You know, it keeps building in terms of the literature around the microbiota, the microbiome, and how important all the organisms that are in us, on us, and around us are for our overall health. But, you know, there's really some interesting research on gut bacteria and that they can be responsible for helping us to create vitamins, especially B vitamins, and also neurotransmitters like GABA or 5HTP, which is the precursor

to serotonin. And then these are all linked to better sleep, right? B vitamins are linked to sleep quality and duration and also are needed for production of melatonin and cortisol. And if we don't have those B vitamins either from, you know, manufacture by our gut bacteria or we're not getting them in our food or by supplementation, we might have a deficit in those processes, which will then have this cascade into our sleep. You know, the gut actually has a huge amount of melatonin in it. It's a production site for melatonin in addition to the pineal gland, right?

And so if your gut health is poor, you have dysregulation there, you're also going to kind of go into your night or your week or your month with a low store of melatonin, which is going to give you trouble marking, again, that start point of sleep and, you know, helping you get to sleep. You know, so, you know, there's a lot of interactions there with GABA. Again, 5HTP. You know, there's also a huge amount of 5HTP and serotonin that's manufactured in the gut. And so again, you know, dysregulated gut and inflamed gut, a situation we have intestinal permeability. You have that local production disruption, but then you also have a systemic, you know, circulatory deficit as well as now you start to develop brain permeability. And, and, and,

you know, sort of a leaky blood brain barrier with further inflammation and further disruption of sleep. So just, you know, we're not going to do a whole deep dive on gut health. Maybe we'll have you back for that in the future. But just top one or two or three things that support gut health, like things that you either want to do or things that you want to not do. Let's start off with the not do, things that we want to avoid to have just like, you know, the best gut health that we can. So I think the number one would probably be like just being mindful of ultra-processed foods. Right. Ultra-processed foods on a regular basis is going to throw your gut health off. Anything else that you want people to be thinking about when it comes to the, you know,

staying away from or avoiding side? Yeah. So if you know that there are foods that cause you any reaction, you definitely want to avoid those because this is causing inflammation that's going to contribute to intestinal permeability. Absolutely all the processed foods, you know, pesticides, you know, coloring agents, preservative, et cetera. Those are toxic to your gut and will cause damage to your gut cells with downstream negative

effects. And, you know, any, you know, other factors which, you know, I would say sugar is a big one as well, you know, sugar, again, leading to imbalances of the gut bacteria and dysregulation in the gut bacteria would then a sort of stair step process into inflammation, intestinal permeability. I think the things to, you know, to work on, in addition, would be finding out if you have things that need to be removed. And those are, you know, any hidden infections, any any bacterial imbalances or dysbiosis, any parasites, you know, or fungal overgrowth or, you know, things that you've accumulated over the course of your lifespan, almost like barnacles on a ship, which are causing a drain on your system and causing inflammation and intestinal permeability.

And in most cases, you know, that's probably something that you're going to be best off working with a practitioner to help you kind of dive into. It can get very complicated. It's a very, you know, there's plenty of things you can do on your own, right? Like, actually, maybe let's list a few. Like we know generally, you know, getting adequate level of it was of fiber, right? We had Dr. Will Bolshevitz on the podcast. Yeah, that was a great show.

I love that one. Deep dive on fiber and how to get it. Sliable and insoluble, especially soluble, which feeds our, you know, buterate producing bacteria and creates an anti-inflammatory environment in the gut as well as the whole body. Yep. So, I mean, fiber is really one of the best ones that are there. Yeah. And they can, if you can tolerate it, you know, or working yourself up to some regular inclusion of fermented foods.

Yeah. fermented foods, yep, yeah, probiotics, prebiotics, ideally in dietary source, right? Yeah. But as supplements, too, if you, if those are helpful to you, you know, and then, you know, making sure you're moving your bowels, like super important, as Dr. B said, you know, if you're not pooping regularly, ideally at least once a day with a nice form bowel movement, you know, check out the Bristol stool scale and kind of rate your bowel movements and see where you land.

And, you know, you want to be in that three or four range. And if you're not, there's a clue there's something going on that you want to problem solve. That has really incredible downstream importance for, you know, almost every health condition. Okay, we talked about movement big picture, but anything specific that you want to mention about, you know, just exercise and its relationship to sleep that we didn't touch on? Yeah. So, I mean, just, you know, pretty profound benefits and pretty profound, you know, sort of, you know, do this and have this outcome in terms of if you're exercising, you know, decreasing sleep latency,

increasing deep sleep, increasing sleep duration, improving your blood sugar balance, a couple mechanisms we talked about, increasing your adenosine, that compound that we talked about that bumps up your sleep drive, right? That's kind of why you feel more sleepy or more tired later in the day when you've had a good workout or have gone for a good hike, et cetera. So, yeah, those are some of the key factors there. Awesome. Mindset, shift, and practicing mindfulness. I know this is something that you're a big fan of.

You know, people notice that one of the reasons that they have a hard time falling asleep is that their mind is just so busy or they feel that their mind is so busy. And often that's because they're trying to crash land the plane after, you know, it being super stimulated and the mind doing a lot of different things. So that plays a part into it. But for people who still feel like, you know, my, my, my mind is too busy or I'm having a lot of anxious thoughts at night. Are there things that can be helpful for them?

Yeah. So teasing apart those two things. You know, mindset shift and mindfulness is one thing. And then sort of brain dumping or getting rid of the mental noise is another one. And, you know, the research around gratitude and appreciation, so mindset shifting and also mindfulness is staggering. It's, you know, hands down, super robust. but it's also extremely simple.

And one of the things that I adopted a number of years ago that I saw on Kelly McGonagall's Twitter, she wrote the book, The Upside of Stress. Exercise, yeah, that was a newer one. The earlier one that she did, she says there's several amazing books, but it's called The Upside of Stress. And the power of shifting our perception of stress

and our mindset, the power of mindset, and how that can affect how we experience our external environment. right um i did this last night i do it almost every single night um sometimes i fall asleep even before i'm done but you know put a sticky note on your bedside table or on your lamp um after a while it becomes second nature and the sticky note just says someone something myself and so then the goal is just to before you go to bed when you're laying there in bed think of someone you're grateful for and why something you're grateful for and why or that you appreciate and then something that you're grateful for or that you appreciate about yourself. And the more you can activate that feeling,

I mean, like, really, like, put your hand on your chest and, like, really, like, you know, being grateful to yourself, be like, I did great job today. You know, like, it's a little hokey. But if you can activate that sensory experience and those brain pathways, really incredible release of feel good neurochemicals, oxytocin, serotonin, you know, et cetera, which really help with sleep. I love it. You know, we're not great at celebrating. ourselves. Yeah. And there's so many people that are out there that speak worse to themselves than they would

an enemy. Absolutely. Right? Yeah. You speak so harshly to yourself. You don't acknowledge yourself. You would never speak to a child that way. You would never speak to your partner that way.

You know, you'd be way more encouraging. Well, we want to be encouraging with ourselves. And part of that is gratitude and acknowledging. Who was it? I forgot his name. He's been on this podcast a couple of times. He says the brain is like Velcro for negative. Yeah.

No, our negativity bias. Our negativity bias. It's a survival. And Teflon for positive things, right? The positive things in our life just slide right off. The negative things, they stick to us. So we have to wind down and be grateful for the things that are positive in our life. Yeah, we need to be our own cheerleader.

And we need to recognize Richard Schwartz. If you have not had him on the podcast, you might look for him. he's the creator of internal family systems work, which is basically like his book is called The Sum of Our Parts, and that there's no bad parts of ourselves. They're all there for a reason. They've all been created from some historical event or maybe trauma as a protector. And so if you have a voice inside your head that's anxious or negative or telling you bad things,

you have to kind of go towards them. Like, I hear you. Thank you for trying to help me. I appreciate what you're trying to do. but would you mind just like stepping to the side a little bit? I want to talk to this other voice or I want to get this thing done today. You know, so yeah, they're all there for a reason. Yeah, you know, our thoughts that go crazy at night, one thing I've found that's been helpful

for me, I learned this from a mentor of mine, Serano Kelly, many years ago, and people have different takes on this, but it's basically a brain dump. And the one that he kind of taught us more specifically around sleep is that let's say you have a journal or even a piece of paper and let's say your mind is very out. active. Well, a lot of that activity is your own ego, your default neural network, kind of worried about what's going to happen in the future if you don't address stuff. And I think a really good practice is to take a piece of paper and just start writing it all down. So I'll write at the beginning of the sheet. I'll write, you know, just brain dump or mind dump. I'll write it down. I'll keep

on writing. I'll keep on writing. Okay, this other thought, okay, I'll write it. I'll write it. And a lot of people do that. But I think the thing that really works, especially at night when you're sleeping is make sure it's a piece of paper. You're not doing this on your phone. You fold it up and then go take it outside of the room and put it on your kitchen table, go put it somewhere else or put it in a drawer. And literally I've told friends this, you know, you just put it away and you say, tomorrow's another day. Yeah. Right. You have a whole other shot tomorrow to tackle all this stuff. And I find that when you capture it, your mind starts to quiet down naturally because it's not so worried that you're not going to do something about it.

Or you're going to forget it. Or you're going to forget it. Yeah, right? Because it's trying to hold on to them and make sure, oh, make sure in the morning, I remember to do so and so, right? Yes, exactly. Don't have it be your phone because you'll get distracted and you're activated by light. But yeah, that brain dump and also like stream of consciousness, like you'd be surprised

what comes up. Try to keep the pen moving. Just keep it moving for, you know, if you can do 10 minutes, that's great. Your point, I love that actually. I haven't done it, like, put it outside of the room. That's a nice psychological move. Put it outside the room, like physically, I'll come back to this another time. And the other thing I do actually like also is to actually have something by the bedside table.

For those people, my patients who do wake up in the middle of the night with their mind racing and trying to, you know, keep track of everything, they're anxious or worried. You know, you can buy pens that have a light in the tip of it. So you just click the pen and a little red light will come on. You can buy them in different colors. Definitely get the red ones. And then you can have a little, you know, book or a little journal with this light up tip pen. And if something comes up in the middle of the night and you want to jot it down, You can put it down. That way you're, it's safe. You know it's there.

You're going to get it in the morning. You don't have to think about it. You don't have to hold on to it. You let it go. Brain dumping, right? And so that's really profound because, again, that landing in the plane analogy, like, we're coming into bed with like this swarm of things in our head that's going on that we're processing and everything from social media memes to, you know,

emails we have to send to stressful relationship, whatever it is, right? And so having a home for that, having a place to put it as a ritual is really powerful. Let's talk about temperature and cooling down before sleep. I think this is one area that in particular seems to impact a lot of men. When I get hot at night, I immediately will wake up. And so dialing in my temperature, for me, the biggest game changes have been temperature, which means like getting the house to be cool, cooling down my core body temperature, which sometimes can happen by heating up and then kind of cooling down a little bit.

You'll chat a little bit more about that. but then also at night, you know, I have no affiliation with them, but I use like an eight sleep, like something to keep my side of the bed, not my wife's, otherwise she would smack me, but my side of the bed cool and I can end up sleeping a little bit longer. And then when I can, opening the windows to also let in a little bit of fresh air. But what do we know about cooling down before sleep and how that's related to better quality sleep? Yeah, so temperature is one of the things as a key part of your circadian rhythm.

and it fluctuates during the day on a very regular cycle, along with a number of the other factors that we've talked about. And a drop in body temperature, which again, evolutionarily is, you know, happens because you're outside and you are being exposed to elements and that's just what the environment is doing. But that drop of body temperature that our body sinks up with creates sleepiness and helps you fall asleep. And so if we're keeping our house warm and, you know, we get under warm covers and, you know, don't have any fresh air, we're not experiencing the opportunity to augment that or to harness that,

right? And so, yeah, to your point, you can, you can hack that, right, by taking a hot shower or getting in the hot tub, you know, 20 to 30 minutes before you want to go to sleep or even up to 60 minutes before, because then you have heated your body up and then getting out is a relative cooling. And so that relative cooling that kicks in tells your body, okay, sleep's coming, you know, get ready to go to sleep, right? And so certainly there's, devices out there now. I haven't actually personally used one, either the eight bed or the chili pad is another one. But, you know, certainly like keeping the room cool, cracking the window, cracking the door, getting some air in there. You know, the temperature ideally should be, you know,

down in, you know, mid to high 60s, ideally, in my opinion. Yeah. I also notice that, you know, if you sleep in the bed with somebody else, I think sometimes, you know, you have one person that prefers it a little warmer, one person that prefers it a little bit cooler. And you know, these devices ate sleep chili pad. They're expensive for people. And if you don't, if you can't crack open your window or that doesn't get it cool enough, I tell people, you know, have separate comforters or one person just have nearby the bed, a lighter blanket so that by the time you fall asleep, you can just switch over to that and you can keep cool and then your partner can stay warmer. Right. Like, but if you're both under the same sheet or the same comforter, I find that you will also raise a little bit of

radiate each other's heat and then both people get hotter. Yeah. And if one of the person is a restless sleeper and they're tugging on the blankets, so I'm a big fan of at the minimum separate blankets, you know, so that you're not, you know, moving the other person around during the night. That way you can also adjust temperature. But, you know, I want to also destigmatize the concept of sleeping in separate beds, you know, and so some couples, you know, will choose, especially if one of them is a restless sleeper,

will choose to sleep in a separate bed. and you can still have cuddle time and intimate time and then, you know, you know, maybe you spend part of the night together, but then, you know, switch beds, et cetera, really important because I think there is some stress that develops, right? There's some, you know, interpersonal stuff that can happen where the person who's maybe the more steady sleeper is getting a little annoyed, they want to just be able to sleep. And then the person who's the lighter sleeper has also been a little worried, okay, I'm not going to try not to not to move because I don't want to wake up, you know, my partner and, you know, so that's, it's not, it's not, you know, there's some fear around that.

Like, does this mean we're going to get a divorce or we're going to split up, you know, et cetera, so if anything, it might be the opposite. It might be actually a healthy response to, especially if somebody has sleep happening and they're snoring all night, you know, don't be shy about getting your own space. So you can sleep well. It's, again, super important. We're going to go through a few things. Just maybe rapid fire.

Yeah. That we've touched on a little bit, but just if there's anything that you want to chat about, you know, caffeine, I think that you're, Big takeaway is, again, Kathleen has a half-life. I've heard like eight to nine hours. I think I wrote nine hours one time in my newsletter, but maybe I had it off. But it's around there somewhere. A little bit variable depending on genetics, yeah. Depending on genetics. So typically what's the curfew that you tell your patients to kind of cut things off at? 10 a.m. 10 a. Okay, great. So I have to like take my 12 noon and I got to move it up a couple hours to be in an optimal position and then see

if it makes an impact. Alcohol reduction or elimination. What do you want to say about that? Yeah. So alcohol is a sedative and it doesn't really help sleep. It doesn't really help any of the physiological aspects of sleep. In fact, it may harm some of them. It might, you know, alter your sleep cycles. You know, ideally eliminate, you know, there's a recent study that came out that there might be increased mortality risk even after just two drinks a week. And so, you know, the people always ask, is that include red wine, et cetera. And in fact, I think it did. And so, you know, minimal alcohol, you know, once in a while, you make the choice, you know, to have fun and to have that stress reliever, that's fine, right? But if it's a four or five night a week

thing, I think that does potentially, and you're having trouble sleeping, I think it does play an important role. Use your bed for two things. One of the two things we want to use our bed with to really bring a sacredness to our bed. Yeah, ideally the bed should be reserved for sleep and sex. And what are you, what are people using it separate from those things like that, that are maybe bad habits? Yeah, well, so we talked about some of them today, right? But, you know, you might go into your bedroom and have a big TV in there, right, and watch movies or be on your devices or sitting in your in your bed with your laptop on your lap doing some emails or, you know, you know, reading, I'm a big fan of reading, but what's your choice of what you're reading, right?

Are you reading a high-paced, you know, Jason Bourne adventure, which is getting you all keyed up and excited and you know, you can't put it down as because of violence and action or are you reading, you know, something much more, you know, calm and mellow and even romantic or, you know, So there's things there are eating, obviously. Don't eat or drink in your bedroom. And besides the fact that these can all have specific effects, negative effects on your sleep, there's also this idea around you're telling your brain what to expect. Right.

So if you're having trouble sleeping, if those are the only two things that are happening in the bedroom and everything else is happening outside of the bedroom, over time, relatively quickly, your brain learns that these are the things that happen in the bedroom. And you have a much easier time of landing that plane. right because you're not having this kind of distraction happening totally all right there's an ultra bath idea that you have which can be a super useful way to help people get ready for bed yeah super simple again if you're a bather um you know absent salts um taking a couple of cups of absent salts which are magnesium um some baking soda a little bit of lavender oil uh essential oil um you know and and doing that

taking a hot bath with those in it and so you're absorbing a bunch of of magnesium through your skin. The lavender is super calming. And then the, you know, the baking soda can also be helpful for detoxification and for cleansing. So that can hit a number of different points there. When my wife doesn't do it every night, but when she's had a more stressful day, she's gotten now into the habit of really like, don't even think about it. Immediately like start winding down the lights a little bit, light a candle. And this basically is the exact type of bath she takes. Absum salt. She doesn't put the baking soda. What's the purpose of that? Yeah, so again, it has a little bit of a detox aspect to it.

Got it. Yeah. It opens up some of your lymphatic and detox pathways. But she does do the lavender oil. And the lavender oil too, you can just literally have a little bottle and just smell it. Yeah. And take a deep breath in. And you can actually, I can feel this sort of calming wave happen, which is really sweet.

Do you ever use tools like Yoga Nidra? You know, like these non-sleep, this is sort of like to initiate sort of the winding down, like these guided meditations. Do you ever recommend any of those for people? I haven't done a lot of that, but I think that falls into the pace breathing. Pace breathing for me as well. They're like,

I don't know if you've done Yoga Nidja yourself, but it's like a body scan. Yeah, yeah. So it's like you know, like it's like there's some really great ones that are on YouTube that don't have ads in between them. So you're like, even if you don't have YouTube premium,

you can like, I'll link to a couple in the show notes to have one that's like 30 minutes. And then sometimes when I really have like my mind is so active, I'll even do one that's like an hour, you know, to like help me really kind of wind down, even sometimes midday if I've had like a very active day and I need that. But it's like a body scan. Yeah. That makes total sense.

You're starting with the top, going down, notice your shoulders, breathing. Yeah, that's a combination of mindfulness and also just paying attention to any areas of tension or stress. And you can really, and it has some hypnosis aspects to it too, I think. You can basically get into a very nice, calmed, you know, parasympathetic state that way. So there's a lot of great things here. I'm going to switch over to supplements unless there's anything else that you wanted to mention that time.

No, let's do it. Okay. What supplements have you found to be helpful for sleep? And what are the supplements that might be a little bit overrated in how they're being used right now for sleep? Yeah. So let's start with melatonin. I think that's a little bit overrated.

And it can be helpful in some cases. But again, I think it's a little bit of a misconception. It's one of the first things that people reach for. And I think that, you know, they're thinking of this is something that's going to to keep me asleep when in fact it's more designed just to kind of mark the start of the night. And I think that, you know, consumer reports has looked at this and there's a huge variation of what is in something that says a certain number of milligrams of melatonin. But also, you know, sometimes it's way overshooting.

So you're taking a lot more than you thought. And that can lead to some significant groginess the next day, right? And so it probably doesn't, studies have shown, it probably does not feed back to the pineal gland to downshift your own natural production of melatonin, but it does increase the melatonin pool that's available and therefore trigger those receptors more actively, right? And so you can actually see a little bit of downshifting, possibly of some of those receptors.

So if you're going to use melatonin, if it's helpful for you, probably not an regular thing. I think it's more indicated for travel and for changing time zones because you can kind of use that as an artificial, hey, body, now we're here kind of thing. for that line. Also, there's some concerns, right, with synthetic melatonin.

Melatonin is like a hormone. Yeah. And so these are mouse studies. And I know like 50% of mouse studies when they're translated into human studies don't end up, you know, the findings don't end up staying true. But I heard Andrew Huberman on the Joe Rogan podcast talk about how some mouse trials, again, it's not human trials, showing that consistent melatonin use at a higher dose. was like shrinking the testicles of these mice. Oh, wow. Again, you know, it's a mouse study too.

I look that up. I have not read that. But I've heard more and more functional medicine doctors saying, like, we really need to be mindful about melatonin because it's a hormone. I've seen an interesting alternative that I learned about through Dr. Deanna Minnick, who's a Institute of Functional Medicine educator. She's affiliated with a company that makes a product called herbitonin. And that is my go-toe for jet lag.

Like if I go to like New York, if I, sorry, not New York, if I go to like London or like I have to travel to Italy and I really, really need to like time my sleep on the flight. It's a plant-based melatonin and it works great. I don't feel that groginess that's there. Sometimes people take melatonin. What's up with this? There's this joke on like you take melatonin, especially the lower quality one from like Walmart or Costco.

People have like crazy, crazy dreams. Yeah, definitely can increase vivid dreams for sure. Yeah. That's one aspect of it. Probably because of some of the effects is having on improving REM sleep in particular. Yeah, early. Okay, so it's a little overrated. A little overrated, but if you do need it, if you do find it's helpful, you might also look for a time release one.

So you can better, you know, but again, I think that the way you're using it, you know, and the thing that's tricky about melatonin, too, is that it's very well known. It's sort of the thing that everyone has heard about now, and you can go to any pharmacy, and you know, there's like a whole shelf or several shelves of different melatonins of different strengths. usually, you know, really poor quality. And so just make sure you're getting, you know, a really good quality product from a reputable distributor or manufacturer. And then, you know, also the product you mentioned sounds interesting as well.

Yeah. Magnesium, which ones are the best forms? And how is magnesium helpful for, or could be helpful for sleep? Yeah. So there are many different forms of magnesium. And you touched on this with Dr. B on the fiber, you know, that you did recently, you know, magnesium citrate and magnesium oxide are going to be more for bowel regularity and constipation for brain and for sleep. You want to look more towards a magnesium

bisglycinate or a magnesium threonate. These are more highly absorbed and more active in the central nervous system as well as the nervous system in general. You know, very calming. It's really lacking in our diets and so we're not getting enough and this is probably part of the sleep epidemic problem that we're seeing, you know, but you can take this orally. You can also take it as a bath we talked about. You could take it even as a cream or a lotion. Great. You had a few other things listed under additional herbal support. We already talked about lavender. Lemon bomb. Lemon bomb, herbal lemon bomb. A very nice has been used, you know, for centuries to help address insomnia. So very calming. You can get this in obviously a variety of different forms, including essential oils.

and it's also frequently combined in some of these sleep formulas with other things such as Valerian or hops or even Elthianine. So yeah, there's one that I reach for. Another one, phosphatil serine is really helpful in particular if you have high cortisol around either bedtime, nighttime, or during the night. If you take phosphatil serine that can help to lower your cortisol levels. This is one I don't always just give, you know, off the cuff. frequently they will use this guided on based on testing. I am pretty intentional about how we work with people when they have adrenal issues because that can be a key factor. But yeah, phosphocerine can be super effective. What about CBD? And then also if you touch on the topic of, you know,

cannabis, separate from CBD. You know, a lot of people use weed to help them sort of relax at night. But let's first talk about CBD and what we know about that when it comes to sleep. Yeah. So both both cannabis and CBD are acting on the endocannabinoid system in the body, which is really, really amazing and complex. You know, like there's just so many different receptors in so many different sites. And so the research on this is actually really impressive and it kind of exploding right now. There's a number of thoughts and concerns around how these compounds are extracted and what the plant sources and, you know, you know, pesticides, you know, pollutants, et cetera, toxins. But, you know, taking it on face value, you know, thinking about these cannabino

receptors as different parts of that system. You know, CB1, CB2 are in particular most likely connected to the sleep wake cycle. So taking some CBD can help activate that and potentially help. I'm a little cautious with it. I think that while there potentially is some upside, there's also a lot of potential downside to definitely to regular marijuana use and possibly to regular CBD use. There can be some, you know, psychological blunting, some memory issues, and some lack of motivation, you know, that happens. And so, you know, I think it's a, it's not for everybody, but I think of it as one option in the toolkit. And a high quality CBD is not really going to have any of the THC that we're really worried about when it comes to the, you know, marijuana

straight up. And generally I've heard that functional medicine practitioners say, like, look for like a broad spectrum, high quality, trusted sort of full hemp extract because there's all these, uh, cannabinoids that we just don't know about that are included. And if you get it from like a good broad spectrum hemp extract, you're going to get all of them even if we maybe don't know, you know, haven't isolated every single one that's there. Is that, do you have? I think so. There's also some interesting research around CBN for sleep. But but hemp is a little tricky also because in order to get enough of these active compounds, you actually have to process a huge amount of the plant. And so if that plant was not growing,

own, you know, organically, free of pesticides, in clean soil, you know, you really actually can bioaccumulate a lot of toxins. Oh, that's great to know. Yeah. And so some people actually prefer CBD that's actually extracted from the marijuana plant. And so, you know, just a thought there. Any companies that you know of that are good or anything like that? Or people just be looking for like organic, right?

Yeah, we use, there's a company out in Ohio, actually, that we like a lot that's been helpful for, and again, it's just a tincture droppers. Okay, well, if you think about it later on, let us know. It's called Ohio Energetics. I'll check that. Okay, all right, yeah, we'll look it up and we'll put in the show notes for people that are looking for that. We'll mention two more here, Valerian root and hops have been mentioned. So Valerian root.

Yeah, so both of these are sort of the herbal pharmacopoeia for anxiety, for calming, and also for sedation. You know, Valerian has a mild hypnotic effect, similar to, to a benzodiazepine, so it kind of acts on that gaba receptor, but without any of the risks of tolerance or, you know, addiction, etc. The benzodiazepine medicines are really like a hammer hitting on those receptors and they are impressively effective in the short term, but very, very quickly lead to tolerance and can be extremely difficult to get off of. And so I'm really cautious. I just really, really cringe. Anytime I hear a patient who comes to me and says, I went to my doctor,

told my trouble sleeping, they gave me some Xanax or they gave me some clonopin or Ativan, et cetera. And, you know, without any like guardrails on it. Just so here's dirty pills, you know, because that's super dangerous, you know, and we have, we see people who have really just a long, like months to years of difficult time trying to taper off. A lot of celebrities that have been, you know, potentially their suicide or other things seem to be have associated with these benzos. Yeah. Crazy. Scary. Yeah. So, but, you know, Valerian can be helpful. Um, you know, You know, usually around 4 to 900 milligrams, a couple hours before bedtime hops also can have a mild hypnotic effect. So a lot of times these are used in synergy too.

That's kind of the beauty of plant medicine. A lot of these plants will communicate to the body synergistically. And they have, you know, hundreds of active compounds that work together. And so, you know, these aren't perfect for everybody. But in some people who just need that extra nudge after they've done everything we've talked about to kind of help them wind down, you know, these can be great. What do you want to say about medications, the classic medications that people get prescribed on, maybe a lot of people that are listening today are listening to this podcast because they're on a medication. You know, where should be really people be wary of these medications?

Yeah, and it's a really important point because, again, kind of going back to how does our medical system work, how much time does a doctor have? What are they going to dig in on with people? And so very, very frequently people go to their doctor's office. They say they have trouble sleeping and they're prescribed a sleeping pill because that's the quickest thing to do, the easiest thing to do, it takes a minute or two. And then, hey, what's the next thing you want to talk about? Okay, thank you very much. So people are sent home with commonly, you know, Ambien, Lunesta, Sonata. And these are not safe medicines. You know, they can be helpful, you know, but we've all heard

stories of people having weird stuff happen to them, right? You know, they've taken Ambien and they didn't get in bed quick enough. And before they know what they're like driving around, you know, doing crazy stuff and not having zero recollection of it the next day, right? So that's one small aspect. But beyond that, you know, there's studies showing that there's increased risk of cancer and increased risk of mortality with even not very regular use of these medicines. And beyond those risks, they're not really helping us sleep. They're mostly just kind of turning off the being awake. And so they're not helping us get into the proper sleep stages and get the benefits that we need to from sleep. and so we frequently, we do use sleep medications when we need to, but we'll frequently reach for,

you know, sort of off-label uses of things like gabapentin. You know, so 1 to 300 milligrams of gabapentin can be quite helpful. Low doses of something like trazodone or even an alpha-blocking medicine called clonidine. Clonidine is particularly helpful for people who have that experience of, you know, it's 8 o'clock, and instead of getting more sleepy, they, are waking up. They're like, I'm ready to go. Like I'm like jazz and energetic and little revved up. And, you know, so that's an alpha adrenergic state. And so that medicine can be helpful. It's not without potential side effects. It's also a potential blood pressure lowering drug.

And so as we're working with the dosing, if we're using that, we tell them, hey, be careful if you're getting out of bed in the middle of the night, you know, sit up, stay there for a few seconds, you know, 15, 30 seconds, make sure you're not dizzy, get up slowly kind of thing until we find the right dose. But the thing I like about that, and this is what we do a lot in our practice. use, we always reach for the lifestyle and the natural remedies first, but we're not shy about using prescriptions, right? I think that's the beauty of functional medicine, integrative medicines, integration of these different sides, but we're also frequently not using the mainstream medicines, we're using sort of a repurposing or creative use of other more safe

medicines. And I think that's where a lot of the nuance happens. Totally. It is, you know, my mom was working with a functional medicine doctor and there was a lot of stuff that was going on in her life. You know, we had recently, this is a couple years ago, we had my aunt passed away, her sister. And so naturally that's going to be something. And she had a long battle with cancer. So my mom's like sleep was thrown off for quite a bit of time. Naturally, as you would expect, right? That's just a natural response to a loss, anxiety, other stuff that's there. And then she had this bout of sort of acid reflux start. And then, you know, she was getting a lot of anxiety during the day. And there was really well intention, well meaning, well-trained. Well-meaning, well-trained.

trained psychiatrist that we ended up referring to, you know, just integrated psychiatrist to sort of just talk to her a little bit more, like what's going on with her? Why is she having this anxiety during the day? My mom was like, you know, I don't really feel like this is related to, you know, my sister passing, but I'm happy to talk about it. And she talked and she was working. And then she was prescribed for short term. I forgot exactly what medication it was, but something to like help her out a little bit with anxiety. Now that medication, one of the known side effects was like kind of throws off your sleep a little bit more and kind of increases the acid reflux.

So her acid reflux got worse and her sleep got worse. Finally, I ended up finding somebody who was an integrative E&T who specializes in acid reflux, right? He was like, I don't think your mom has anxiety. I think she, I don't think she has anxiety from loss. She has anxiety because she can't sleep because her acid reflux keeps on waking her up throughout the night. He modified her diet a little bit, you know, said, don't have these spicy foods, stay away from green tea, which is generally really good, but in her case was causing some acid reflux,

don't have chocolate, you know, and then also let's avoid caffeine for a little while. They've made all these modifications, switched some things around, and then put her on sort of a slanted pillow, which is very helpful. You know, there's these acid reflux type pillows that you could buy on Amazon. And she did a week of that, and her acid reflux went away, and then she was no longer having anxiety anymore. That's beautiful. And the anxiety was just a natural response to, of course, some of it could be related to the loss of our aunt, you know, who she loved and we all missed. But it was just when your sleep gets thrown off, all hell breaks loose. It's terrifying. We literally thought my mom, who's this sweet person who just had never dealt with any kind of depression, anxiety, other stuff. She felt like she was going crazy. And that's just how important sleep is to our life. And when it gets thrown off, we can do all sorts of crazy things. So there's another example. And also, she wouldn't have been able to unpack that. And also, she wouldn't have been able to unpack that. And also, she wouldn't have been able to unpack that. And. And also, she wouldn't have been able to unpack that. And. And. And also. And also,

without a clinician who was really willing to dig into it with her, which is another reason that I wanted you to come on is that I've had so many people that have worked with you that I've talked about or heard that you guys really like lean in and you like dig because it's not, you know, it's not often, hey, just avoid these foods, take this supplement and everything is good. For more complicated things, you really have to have somebody that knows what they're doing and kind of puts on their detective hat and holds up their magnifying glass and really tries to look at the root issues that are there. Yeah, thank you.

I appreciate that. thing that we do. We see a lot of folks with really persistent health issues that they've had for a long time, whether it's, you know, imbalances or infections. And our motto and our team is amazing at this is, you know, if we're dealing with these persistent problems, we're just going to have to be more persistent. So true. You know, there's so much more we can go on this topic here. But I think we've given the audience, like, plenty of food for thought. There's a bunch that if you work with the right practitioner, there's tests that you can run. There's additional things you can do. But I think that in terms of the practical things that people can start today, I think we literally have given the definitive

list at least on stuff that people can do at home. One of the thing I wanted to mention, there's a really exciting endeavor that I'm involved with as an advisor. It's a company called Miri. And really what we're looking at is trying to find a way to harness that possibility of using the support that people need and also technology, and in this case, artificial intelligence, to create an experience, a curate experience that basically, you know, augments or leverages the provider, coaches, nutritionists, et cetera, with technology being part of the platform. And we're really excited because we think that, you know, so many people need this information. And as we're able to try to get that into the hands and brains

of more people in a personalized way, we, you know, I think it has the opportunity to kind of upend the way we're absorbing information and the way we are, you know, you know, digesting content from, our regular sources, whether it's reading or podcasts, et cetera, watching videos. So yeah, it's been a really fun endeavor to be part of. I want to thank you for coming on the podcast for sharing any final words about sleep and just what is possible in your life when you have a doubt in. You know, we spent the first two-thirds of this podcast talking about everything that goes wrong when you don't have sleep.

Increased risk of cancer, increased risk of Alzheimer's, increased risk of cardiovascular disease, increased risk of accidents and blood sugar issues and poor insulin response. But let's leave on a positive note, which is what's possible for us in our life when we pay attention to this thing that so many people think is soft, but it's actually so core to our health and well-being. Yeah. And this is something that I've learned personally, and it sounds like you have as well. But you can feel so much better.

And you have the, you know, with relatively simple changes. you have the opportunity to make your current day-to-day life much more vibrant and alive and fulfilling, as well as prolong your health span and your lifespan. And, you know, so try not to be overwhelmed. I'm a huge fan of incremental change. And, you know, just take what you can do now, try one thing at a time, lock that in, and then try the next thing. And I think you'll really be surprisingly, you know, pleased of what can happen.

Amazing. Tell everybody about your clinic and how. they can get in touch if they want to work with you guys or follow you guys on social media. Yeah, so we are the California Center for Functional Medicine. Our website is CCFMed.com. We have a variety of different social handles you can find on our webpage. And yeah, give us a call, check out our content, whatever feels appropriate. I'm a big fan of just meeting people where they are and very, very passionate about doing our best to help you or anyone out there who's listening.

you know, live your best life. And I do hold space that that is possible. Awesome. Thank you again for coming on the podcast. And thank you for sharing this masterclass on sleep with our audience. I wish the best night of rest for everybody who's listening. Thanks, Drew. That was a really fun deep dive. Thanks for having me.