The Dr. Hyman Show - Simple Practices And Tips For Better Sleep

Episode Date: September 19, 2022

This episode is brought to you by Rupa Health, ButcherBox, and Mitopure.   Sleep is a keystone of health. Most people know they should get more high-quality sleep, but they don’t really know where to start. But understanding the way our brain and neurotransmitters work means we can hack our sleep to not just feel amazing but to level up our focus, skills, and knowledge. And it’s not all about what happens at night, either—getting the right exposure to light at the right times has a profound impact on our circadian rhythms and the way our bodies transition to sleep.   In today’s episode, I talk with Dr. Roger Seheult, Dhru Purohit, and Dr. Andrew Huberman about why optimizing your sleep should be prioritized and how you can get better sleep.   Dr. Roger Seheult is currently an associate clinical professor at the University of California, Riverside School of Medicine, and an assistant clinical professor at the School of Medicine and Allied Health at Loma Linda University. Dr. Seheult is quadruple board certified in Internal Medicine, Pulmonary Diseases, Critical Care Medicine, and Sleep Medicine through the American Board of Internal Medicine. He is also the cofounder of MedCram, an online medical education company that helps healthcare professionals and laypeople understand medical topics clearly.   Dhru Purohit is a podcast host, serial entrepreneur, and investor in the health and wellness industry. His podcast, The Dhru Purohit Podcast, is a top 50 global health podcast with over 30 million unique downloads. His interviews focus on the inner workings of the brain and the body and feature the brightest minds in wellness, medicine, and mindset.   Dr. Andrew Huberman is a McKnight Foundation and Pew Foundation Fellow and was awarded the Cogan Award in 2017, which is given to the scientist making the largest discoveries in the study of vision. His lab’s most recent work focuses on the influence of vision and respiration on human performance and brain states such as fear and courage. Work from the Huberman Laboratory at Stanford University School of Medicine has been published in top journals including Nature, Science, and Cell and has been featured in TIME, BBC, Scientific American, Discover, and other top media outlets.   This episode is brought to you by Rupa Health, ButcherBox, and Mitopure.   You can check out a free, live demo with a Q&A or create an account at RupaHealth.com.   If you sign up at butcherbox.com/farmacy, ButcherBox will give you 2lbs of ground beef free for one whole year.   Get 10% off at timelinenutrition.com/drhyman and use code DRHYMAN10 at checkout.   Full-length episodes of these interviews can be found here: Dr. Roger Seheult Dhru Purohit Dr. Andrew Huberman

Coming up on this episode of The Doctor's Pharmacy. Sleep is not just an off switch. Sleep allows the body to do processes during the night that allows to do what you normally do during the day. Hey everyone, it's Dr. Mark. Like many of you, I'm terrifically busy throughout the week. I'm a doctor, a podcast host, a writer, a speaker, a father. And on top of all those commitments,

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forward slash pharmacy. That's butcherbox.com forward slash pharmacy, F-A-R-M-A-C-Y, to receive two pounds of ground beef for one whole year. Wow. And now let's get back to this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Theon, one of the producers of The Doctor's Pharmacy podcast. Getting quality sleep is something so many of us struggle with or compromise on. But sleep is one of our most basic human needs, and we're constantly learning more about how it impacts human health. We're also learning more about ways to improve it. In today's episode, we feature three conversations from the doctor's pharmacy on why we need to put the spotlight on sleep since it affects so many things, including our mood, cognition, hormones, weight, and so much more. Dr. Hyman speaks with Dr. Roger Schwalt on the connection between sleep and your immune system,

with Drew Prowitt on tips to get better sleep, and with Dr. Andrew Huberman on optimizing light exposure to sleep better. Let's dive in. A lot of us are deprived of sleep, but probably 70% of Americans don't get enough sleep. We used to sleep nine hours, now they average seven. And I think the sleep deprivation plays a big role. And we know when we're run down and we're stressed and we're tired and we are more likely to get sick. So what is the mechanism of that? How does sleep regulate our immune system and how much should we be getting and what should we be doing to upgrade our sleep game? Oh, wow. Okay.

So that's huge. Huge topic. You did a whole fellowship in it. So I get it. So everyone needs to understand this. And it's very important to understand. And that is that there is a clock in your brain that tells you when everything needs to happen.

So the best analogy I can use is Disneyland. Okay. I had a friend that used to work at Disneyland, but he didn't work there in the day. He worked there at night. And that should tell you something. During the day, everything's open. People go on the rides. You buy snacks. you do all that.

At night, there's a complete, complete different activity that goes on at night that gets it ready for the next day so they can do that again. And so people need to realize that sleep is not just an off switch. Sleep allows the body to do processes during the night that allows to do what you normally do during the day. And if you don't allow the body to do what it does at night, you're not going to have a good day the next day. All of that is orchestrated. Cortisol levels, melatonin levels, stress, exercise, all of those things, even eating and food, all of those are coordinated like a conductor of a very large symphony about what happens at what time of the night. And so what happens is,

is that when you go to bed at night, when you go to sleep, when the sun sets, your body has been trained to go to bed and to go to sleep. And what happens is, is that we're staying up, we're watching TV, we're looking at videos, we're on social media. And the problem is, is that light, which is one of the sources that the body uses to entrain that rhythm is going into the eyes. It's going back to the, to the master clock and it's saying it's still day. And so what happens is the body gets confused. It still thinks it's day. So it starts to delay the circadian rhythm. And when it's time for you to go to bed, you're going to bed at 11, 12 o'clock at night. And what happens is that now all of those processes that were supposed to occur at night

are now getting started at 12, one o'clock in the morning, instead of getting started at nine, 10 o'clock at night. And what happens? You still wake up at the same time and you're not allowing those processes to go. So the number one problem just to start off is the number of hours of sleep you should be getting. For an adult, it should be at least seven hours of sleep. Okay. Most of us gets much fewer than that. So we're chronically sleep deprived. Number one.

Number two is that when you start to go to bed later and later and later, one o'clock in the morning, 12 o'clock at night, you still have to get up early to go to work in the morning. So you're not getting the full hours of sleep, but it's even worse than that. Because if you decide that you want to go to bed earlier now that you've heard this talk, you say, Hey, I need to get more sleep. I'm instead of going to bed at one o'clock in the morning, I'm now going to go to bed at 10 o'clock at night.

You are now trying to go to bed when your master clock has been set further back. You now need to start to move your clock back. And one of the ways of doing that, two ways of doing it, number one is stop looking at light at night so that your clock rhythm starts to come back. And number two, another way of doing that is to when you wake up in the morning is to expose your eyes to bright light that has the opposite effect. So light in the morning tends to advance your circadian rhythm back to where it was, but exposing your eyes to bright light at night

tends to delay it back, back, back further so that you're getting to sleep later. And so that's a major, major issue is light at the wrong time. So basically, if people listen to you, Netflix stock would just tank. No, Netflix stock is, this is the beauty of Netflix. You can record it and watch it whenever you want. I know, but people at the end of the day, Netflix. You can record it and watch it whenever you want. I know, but people at the end of the day, they're not working. They want to come home, relax, watch TV. It's like, I get it.

I mean, it's tough because that's what I like to watch. And, you know, it's interesting because I think that we have such a culture of nonstop, 24-7, check emails at 11 o'clock at night, be on your phone, be on Instagram and social. And it's really messing up our biology because we are light-sensitive beings that respond to our environment in not just psycho-emotional ways, but in physiologic ways that disturb our normal biological rhythms that lead to disease. It's not just about not sleeping well. It's about the immune system. It's about the risk for heart disease, there's for obesity, diabetes, cancer, all of it is connected to sleep. So now we understand we should be getting sleep and it's important for cleanup and repair at night. It's important for immune system function, you know, but a lot of people struggle with sleep. So what are your, as a sleep doctor, because you're also

a sleep doctor, you're usually being a critical care medicine doctor and a million other things. What should we be doing to upgrade our sleep? What are the top tips you give your patients? Before we go out and just tell everybody you need to get seven hours of sleep, we've got to give them the tools that they need to be able to get the seven hours of sleep. And as I mentioned, if you go to bed at 12, one o'clock in the morning, you know, normally, if you go to bed at 10 or 11 o'clock at night, now to get that seven hours of sleep, you're just not going to be sleepy. And so what we need to do is we need to shift that circadian rhythm, advance that circadian rhythm.

So the number one thing that I would say is you need to get the right type of light at the right time of day. So that means turning down the lights after nine o'clock, making sure you're not on an e-reader reading at night. Use a very dim light and open up a regular book. If you have to put the light on, make sure it's low down. Make sure it's more in the red spectrum of light. And then in the morning time when you get up, make sure you're exposing your eyes to bright light. Get outside. Let the sunlight hit your eyes. You don't have to look at the sun, but get outside and get exposed

to bright light in the morning. Now, in the wintertime, that might not be the case, depending on where you live, you might not have sun. So it might be worthwhile to invest in a light box. They're known as SAD boxes or sad boxes, SAD standing for seasonal affective disorder, which is actually not uncommon for people to have in the wintertime because they're not getting exposed to light and that can cause depression. But these boxes are about 10,000 lux. That's how we measure light. And just 20 minutes in the morning in front of one of these light boxes about 11 to 15 inches away from it would be a good substitute to get that light into the eyes. You'll feel better at night.

You'll feel like you're ready to go to bed. You'll sleep better. There's been a number of studies that have actually shown this, that, that this type of light exposure is better for quality of sleep and for length of sleep. So that's where I would start off. The other thing is if you're having difficulty going to bed at night, falling asleep, making sure that your bedroom doesn't have a television in it, making sure you're not reading in the, in the bedroom, doing other things, use that for sleeping. And you'll notice that you'll be able to go to bed and that subconscious tie that you have to the bedroom will help you fall asleep as well. Yeah. I mean, I have blackout shades. I have eye mask. I have earplugs. I have a special reading light that

blocks out all the blue light so I can hook it to my book at night and read my without any lights on for the blue light. There's also red light bulbs you can get at night. You can put in your, in your bed, bedside table. So there's a lot of hacks. A cool room also is really helpful. I think 68 degrees or less sometimes. I often people sleep better and there's now these mattresses covers and cooling beds. And I've tried the eight sleep, which I love, which is really fun. And it's great because if you have a couple, it's one likes a hot one, like the cold, you can adjust each side of the bed, which is kind of fun. So getting the quality sleep and the light is important because I think we're all we have light pollution. And there's a really interesting book.

I don't know if you read it years ago. I read called lights out and it was a book about the science of how the light bulb has screwed up our health massively by keeping us out of our normal biological circadian rhythm so uh you know we really are and you know and then today it's kids you know they sleep with their phone in their bed they don't turn it off it's like i mean i tell them i'll like text someone i'll be in a different time zone in the middle of night i'm like they're answering your text. I'm like, what are you doing?

You should be sleeping, and you should have the phone next to you, and it should be on, and you should be looking at it. Hey, everyone, it's Dr. Mark. I always say I want it to be 120, but I really only want to do that as long as I'm feeling great and still able to do all the things I love. Aging well requires some mindfulness and intention, but that doesn't mean it has to be hard. As I've dug into the research on aging,

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now, Timeline Nutrition is offering my community 10% off MitoPure, which you can get in a capsule powder or protein blend at TimelineNutrition.com. That's TimelineNutrition.com, T-I-M-E-L-I-N-E.com, forward slash Dr. Hyman, D-R-H-Y-M-A-N. And use the code DrHyman10 to get the discount. I've been using it for almost a year now, and at 61, I feel stronger and more energized than ever. And now let's get back to this week's episode of The Doctor's Pharmacy. When you wake up, you should get 20 minutes of sunlight without sunglasses on because it resets your pineal gland, which makes melatonin, regulates your circadian rhythm. So we want to keep our circadian rhythms in balance. The second thing is, you know, our diet plays a huge role. And particularly, you know, if we're eating a diet that's, you know, high in starch and carbohydrate, we're having fluctuations in blood sugar. We may actually even at night get hypoglycemia and that can really disturb our

sleep. We can get night sweats. You know, men often get night sweats too, but that's often usually low sugar. And then the cortisol spikes and you get a spike in sugar in the morning. So that's a real problem. I think the other thing is, you know, people are probably consuming a lot of alcohol, caffeine, sugar, all these disturbed sleep, um, chronic stress. You know, if you're not actually discharging stress, a lot of people go to bed tired and wired and a lot of people have adrenal issues. So they're pushing so hard in their life that they actually don't have a chance to reset and relax their nervous system. And that leads to incredible amounts of cortisol production, cortisol disturbed sleep. I mean, if you take prednisone for whatever reason, it's going to mess up your sleep. So stress plays a huge role. Exercise, I mean, you don't want to exercise too

late in the day. That can often activate you. So there are a lot of things that can drive poor sleep. Lack of magnesium, which is common in the country. If we don't eat magnesium in the forms of greens and beans, greens, sorry, greens and beans, nuts and seeds, that we end up with magnesium deficiency, which affects about 45% of the population. And people don't sleep well when they have low magnesium. It can cause irritability and tension and stress. And then plus caffeine and chronic stress and smoking, a lot of other things will cause magnesium depletion. So you want to make sure you're getting plenty of magnesium. Talk about sleep in your life. What are the things that now at the age that you're at and your schedule, what are the things that throw your

sleep off? And what are the effects that you notice in your performance the next day when your sleep is thrown off? No, yeah. I mean, it's huge. I mean, if I'm traveling, I'm trying to stay in one place longer, but it depends on the bed and the pillows the sound the noise the the temperature i mean i i can get messed up and given all the years of screwing with my schedule and sort of staying up all night i definitely have sleep issues but i've learned how to actually mitigate them by you know making sure i do a bedtime wind down ritual by making sure i take my bedtime supplements like magnesium a little melatonin uh and and and if i don't get quality sleep i notice in the next day i can't focus i can't think my brain is like distracted it's hard for me to be present with other people it's hard for me to feel motivated to do anything i know as

i get a little depressed but it's not i know i'm not depressed i just know it's asleep like asleep so i i think you know very attentive to sleep but i think you know sometimes it's hard you know when you're out with friends and you're traveling you're on vacation it's a little tricky but mostly i i'm pretty good about getting to bed by 10 9 30 10 sometimes a little bit later and try to sleep you know read a little bit i have a i have a light which is a reading light that's a kind of an amber light that has no blue light in it. So I don't have to leave the light bulb on on the bed. So I try to calm down from the light. I have blue blocker glasses at night I use. That really helps. And so that all benefits me. Talk to us about how conventional medicine typically treats poor sleep when a patient is going through it and contrast that with functional medicine

and how a functional medicine doctor would look at addressing poor sleep quality with a patient. So from a traditional medical point of view, I mean, there are reasons for people's lack of sleep that a conventional doctor will look at, whether it's sleep apnea, restless leg syndrome, there's sleep studies that doctors do that can be very revealing a lot of people have undiagnosed sleep apnea at the ultra wellness center we now have a home sleep study kit which allows people to kind of get tested and do it at home which is great however um you know often there's really very little to do from a conventional perspective other than you know direct recognized basic sleep hygiene.

And then there's a CBT sort of approach, cognitive behavioral therapy, which helps people deal with sort of the mental aspects of insomnia. And that can be very effective. Cleveland Clinic has an online program. There's called SomRest, which is available. So there's a lot of really useful conventional approaches to help people reset their sleep. However, there may be a lot of other causes

from a functional medicine perspective for sleep disruption. The traditional medicine just says, oh, do therapy or take these sleep pills or practice better sleep hygiene, but they don't really say, well, why is your sleep disturbed in the first place? This is why we're so effective in functional medicine

because we don't want to know just what you have, insomnia, we don't know why. Why are you not sleeping? Is it because your thyroid's not working? is it because you have chronic stress and adrenal burnout is it because you have low magnesium is it because your microbiome is inflamed and causing inflammation in your brain is it because um you might be hypothyroid which can cause a little bit of sleep disruption or is it because you know you have um a bad sleep environment or because your your sleep habits are terrible or

because you know we go through all the underlying root causes um and then and then we and then we address those whatever they might be um you know it's amazing to me drew i i never would have thought this was the thing but when we put people on the 10-day detox diet when we put pill in elimination diet and get rid of you know processed food sugar dairy gluten grains etc it's amazing how many people report oh my sleep got so much better. I'm sleeping so much deeply. I feel so much better. I'm like, well, wow, I don't know about that.

But I think what happens is there's inflammation in the brain, and inflammation will interrupt sleep. And when you start to live an anti-inflammatory life, you actually will end up with a much better sleep quality. A little anecdote is that my dad, many years ago, when we put him on a version of the 10-day detox, and he had been eating bread his whole life because he grew up vegetarian and still was a vegetarian when he was doing the program, one interesting thing that he noticed is that when he had cut bread out of his diet, he noticed this chronic back pain

that he had at night that would make it harder for him to fall asleep, uh, went away because the inflammation went away and that then made it easier for him to fall asleep. And so he got a better night's rest. There you go. Yeah. Talk to us about another, uh, patient and a case study that you can think of where sleep was the missing link that allowed them to get into a better state of health. Anything that comes to mind? Well, I have two. too uh one one was this guy who was very smart editor of a major major sort of sunday kind of magazine newspaper i mean you would all know what it was and uh you know his team was like he's just falling asleep all day in the office i'm like it's terrible he's not he's not able to function well it's annoying he'll fall asleep at meetings.

Well, tell me about your life. He says, well, I drink 12 Cokes a day and have 12 cups of coffee a day. I'm like, oh, okay. Well, maybe caffeine is a problem. So we got him off the caffeine and we put him on an anti-inflammatory diet. And it was amazing. He just completely turned around and was able to you know be able to function again uh there's another case i remember a young uh well not young he's about a 50 year old that's young to me now but if he seems very young to me it's all relative and he was a lawyer and i'm like well tell me how you're doing he's like well i want to lose weight

i'm kind of overweight and he had you know the big belly and pre-diabetes and i'm like well tell me how you're doing he's like well I want to lose weight I'm kind of overweight and he had you know the big belly and pre-diabetes and I'm like well tell me about your life and well you know I said you sleep okay well yeah but um you know during the day I use a stand up desk this is before stand up desk where you must thing and because if I sit down I'll fall asleep while I'm working and I'm like wow okay you probably have sleep apnea so I said let's test you for sleep apnea and he sure enough had sleep apnea we put him on a CPAP machine which is a breathing machine just sort of stop CPAP he literally lost 50 pounds just like that and felt so much better and you know we corrected his underlying issues around sleep and metabolic health the thing is

if you don't sleep you also also crave carbohydrates, you crave sugar, you crave, you know, all the junk that's going to make you gain weight. And we know this even from studies on young, healthy adult college males who are not overweight when they deprived them of two hours sleep a night compared to the control group, the ones that had the two hour sleep deprivation ended up having higher levels of ghrelin, which makes you hungry, and PYY was lower, which is the appetite-suppressing hormone. And so they had hormonal changes that made them crave more carbohydrates, eat more food, be hungrier, gain more weight. And so really the key to often healthy metabolism and weight is

actually sleeping. A lot of people at night notice that their mind is running and it just won't get quiet. And that impacts their sleep. I know you have a lot of experience with meditation and different protocols that you've used either personally or recommended to people in the past. But is there something that you could suggest that those individuals could try when it comes to winding down at night and getting ready for bed? Absolutely. I mean, I think, you know, when you think about it, it's kind of silly. We like, go, go, go. We're answering emails at 11 o'clock at night. We're looking at our screens. We're engaged in all kinds of stressful, emotional, psychological things with our work or whatever.

And then we're like, okay, lights out, boom, go to sleep. And people people are exhausted but they often fall asleep but then often wake up frequently because they got the stress hormones going in their body so i i think really having a sleep ritual at night is so important for me it's it's very important i get off screens at least a couple hours before bed i i often will take a hot bath uh with epsom salt and lavender which calms my nervous system down i'll put the little kind of amber light that has no it's like a reading light that has no blue light turn all the other lights off i'll read a little bit in bed and and the reading and the calming down just calms it down the other thing i can do often is i'll i'll write a little before bed so i'll literally dump out

what's ever in my head i'll just write it all out and i'll just completely purge anything that is a negative thought pattern in my head and my worries for tomorrow what happened that day whatever whatever and i just try to let go uh and the other thing you can do is a little yoga stretching before bed a little deep breathing exercises before bed get a little massage before bed you know all those things can help um you know if you're a partner you can rub each other's feet that's a very relaxing thing to do i have a theragun i'll often use that to kind of relax my muscles and nervous system uh you have to find out what's right for you but it really requires some level of decompressing and unwinding before you get into

bed because if you just plop into bed after running 100 miles an hour, it's like you're not going to fall asleep or you'll fall asleep because you're exhausted and then you wake up because you're under chronic stress. You chatted about this earlier, but talk about your morning routine and how crucial it is for you to set up your circadian rhythm for the rest of the day. What are the things that you do that you found work well in the morning that end up helping you have better sleep at night? I mean, I think the key is, you know, I tend to meditate in the morning for 20 minutes. I'll have a cup of tea or maybe I'll have coffee and I'll do a little journaling and writing and just sort of get myself grounded for

the day. And then I'll often try to take a walk or be outside in sunlight for 20 minutes without sunglasses on to reset my circadian rhythms. And then I'll have a very low-starred sugar breakfast, mostly protein and fat. You know, there are avocados, eggs, and olive oil, or I'll have a protein shake that I make with fat in it. And that really helps me sort of set up my system for the day so I'm not craving the wrong food, so I'm not going off the reservation, and I'm actually keeping my system in balance. All right, Mark, this is the part of the episode where we go to some questions from our community. And let's jump in with the first one. Is going to bed at the same time every night important?

How do you discover what sleep time frame is right for your body yeah i mean historically we used to go to bed with the sun wake up with the sun that's probably a good thing you know um and i think you have into the light bulb and work schedules it's just it's kind of screwed us up so historically you know, if you really want to look at proper sleep hygiene and the way to set up a good sleep rhythm is to go to bed at the same time and wake up at the same time every day. And generally the sleep you get before midnight is much better. So I would say 10 is at least 10, maybe 9.30 in a bed, sleep by 10, get up at 6, 6.30. That will often help you sleep much better,

sleep much deeper than if you sort of stay up till 1 or 2 in the morning. But there are people whose circadian rhythms are shifted and they may do better as night people versus morning people. That's okay. But in general, I think it's really key to sort of establish a good morning routine to get yourself set up for a good night's sleep the rest of the day. All right. Next question. Is there a particular reason that we wake up intermittently as we age? And there's two sub questions underneath it, which are, is it normal to wake up and go to the bathroom every night? And the second question, what should I do if I'm going to bed early and still suffering from frequent wake-ups throughout the evening?

So this is all a question around waking up at night, especially at increasing as we age. So as we age, a bunch of things happen, right? We tend to have more belly fat. We tend to have loss of muscle. And when that happens, you get higher levels of insulin, more fluctuations in blood sugar, and lower growth hormone. And the reason that kids sleep so much and babies sleep so much is they have huge amounts of growth hormone. But when you lose muscle, you lose growth hormone and you get higher cortisol and you get higher insulin.

Cortisol will prevent you from sleeping. So when you lower growth hormone and raise cortisol through the aging process, you will actually have disrupted sleep. The reason that we do that is because we just don't, we're not active enough. Our diets aren't good. And so we're eating a high-start sugar diet. We're not weight training and strength training. But the truth is at any age, you can maintain your muscle mass. I'm very, I'm now I have way more muscle mass than I did 10 years ago or 20 years ago. And it's possible if you know what to do. So I'm very focused on maintaining my muscle math, which helps growth hormone, which which helps my testosterone helps cortisol stay low very very important I think if people are waking up frequently even if they go

to bed in time there may be something else going on there may be there may be metabolic issues around blood sugar there may be you know chronic stress that's not really being fully addressed there may be other factors that cause frequent wakening as far as urinating at night you know depends on when you drink chronic stress that's not really being fully addressed, or maybe other factors that cause frequent awakening. As far as urinating at night, it depends on when you drink, how late you drink, how much you drink, if you have a prostate issue or not, if you have an irritable bladder or not.

Normally, people can go through the night without peeing. Sometimes you get up once to go pee, it's not terrible. People can go back to sleep. But if you're going a lot more than that, it's worth getting checked out, because you could have a prostate enlargement if you're a man or cystitis if you're a woman. And it's good to make sure you get that check because unless you're, you know, if you're getting up two, three, four times a night to go pee, that's a problem. All right.

Next question. Can a person catch up, so to speak, from a previous night of poor sleep? I think yes and no. I mean, I think, you know, people anecdotally will say, look, if I didn't sleep six hours and I sleep 10 the next day, I feel better. So I think people will feel better. But the basic medical opinion is that no, you really can't catch up on lost sleep. You've got to just keep, you know, sleeping and then putting sleep in the bank. And actually, you know, over time, you'll feel better, but you really have to make sure you're not creating a lot

of sleep debt and that you're actually sleeping more when you need to, but realize that that's not necessarily going to fix all the sleep that you've had. So, you know, it's not great to say, well, I'm just going to step in, you know, six hours a night or five hours a night during the week and I'll sleep 10 hours on the weekend. It doesn't work like that. There's an undeniable truth about our nervous system, which is that our states of alertness and calmness set us up to be better or worse for certain kinds of events. So for instance, if you want to sit down and do focused work, if you're too calm, too sleepy, that's not good.

Your mind will drift. Similarly, if you want to relax and have a meal, if you're too stressed, if you're too alert, that's not good for all sorts of reasons as we know as well. So one of the things my lab has really been focused on is to try and figure out what are the levers, what are the entry points for people to be able

to deliberately adjust their level of alertness and calmness in this kind of seesaw like fashion and then to just elaborate on the seesaw analogy a little bit try and imagine oneself not as this seesaw but you're a person on the seesaw so you're right all day long basically you're moving back and forth you're kind of surfing this seesaw between alertness and calmness and one of the places where we see pathology acute stress turns to chronic stress or acute stress turns to chronic fatigue is when the hinge on the seesaw gets too tight and the thing gets locked at one side yeah okay and a lot of people are locked in the stress state locked in the stress state or locked in the fatigue there's too many people i see walking around too calm and relaxed right

because the hardest thing to do is an active process to be in the to surf the seesaw yeah this is what we you know the reason just a simple seesaw doesn't work as an analogy is because it's an active process you're literally making adjustments all the time. Like surfing. Exactly. And what happens in sleep is it's as if we get to climb off the seesaw and relax for the night and then get back on there and we're able to surf the seesaw again.

So we know there are a couple sort of foundational truths that can emerge from this model of how the brain works and how the mind works which is that if we don't sleep the hinge gets very loose on the seesaw like stress stress stress stress exhaustion stress stress exhausted it kind of bangs back and forth yeah and it gets harder to surf this seesaw and so sleep is sort of the foundational element of all waking states we often think about sleep as its kind of own thing but sleep is the thing that allows you to deliberately access waking states in a in a really um directed way we're going to get really deep into sleep yeah so that's

the way i i think about it and you know all of this um serves as an entry point to discussions about plasticity etc but one thing to emphasize is that the seesaw and surfing the seesaw is not a brain thing. It's not a body thing. It's a brain body thing, or more appropriately, as you said, a body brain thing. It's a loop. So we can't say that our states of alertness are because of what's going on in our head, because we've also got adrenal glands that are releasing adrenaline we can't say that states of calmness are just about relaxing the mind because it also involves turning off a number of systems in the body and

the nervous system is really what is responsible for that and so what's exciting is that there are now entry points where one can adjust the level of alertness or calmness yeah that one can get better at surfing the seesaw as as i'm referring to i've never really described like that but i think that's a very good description of something i've learned to do to actually manage my brain and my physical states and it and i developed all sorts of techniques over the years that work for me and they're different for different people. But, you know, for example, if I'm like working on a project, I'm just foggy and stuck. I'll like take a steam and I'll jump on an ice bath.

That'll change my state. Right. Well, the adrenaline from the ice bath will definitely put you in a more alert state. Or I meditate. Or I'll do yoga. Or I'll get a massage. Or I'll go sit by a river. Or there are mechanisms that I've learned that are ways to change my state. And even using food to change your brain states,

and using supplements, and using all kinds of hacks, essentially, to regulate the thing that we feel like we can't regulate. Because a lot of us feel powerless at the effect of our minds, and the effects of our cognitive states and we don't realize that there are all sorts of doorways that we can use to actually enter different brain and mind states by certain techniques whether it's breathing or you know hot and cold therapy or all the things that I mentioned so from your experience you know how do people start to learn those things? And what are the, what are the most important things you come across that are important for helping people

to regulate that process, that seesaw where they are, they're surfing instead of getting stuck? Yeah. So the, there are approaches that are going to work very quickly and there are approaches that are going to be slower. And you might say, well, I just want the fast ones, but the sort of health of the seesaw, if you will, the integrity of the seesaw and the ability to surf it relies mainly on a couple of foundational elements. And these are going to be slow acting systems in the body that I don't want to bring in too many analogies,

but the way I think about it is like, if you're, your wellbeing, um, if you will, it's sort of like a boat on the shore and the tide has to be in for the boat to get off the shore. And so there are things that you can do on a regular basis that establish a basic ability to operate the seesaw to surf the seesaw. and certainly sleep is going to be the number one variable it's amazing many people don't understand that yeah it's it's a it's a non-negotiable thing i think that many people are afraid to acknowledge it because people have now once you really appreciate how vital sleep is and how great life can be if you're getting good sleep and how terrible it it is for our health both both immediate and long term if you're getting good sleep, and how terrible it is for our health,

both immediate and long-term, if you're not, I think then it creates its own sleep anxiety. And so one of the things that I've been very active... I've had that for sure. Yeah, where you think... To be fair, the body and brain are resilient. If you don't get a good night's sleep every once in a while, it's fine. You can manage that.

Certainly new parents do just fine over time, although it's fine. You can manage that. Certainly new parents do just fine over time, although it's challenging, but there are a few things that really help with sleep. So in terms of, and there are a lot of causes of insomnia and things. So all the, so they're the basics like avoiding caffeine in the afternoon, if you're caffeine sensitive, et cetera. But one of them is to start to understand that this state of sleep is not something that you should be able to drop into unless you do a couple of other things properly. And based on the research done in part by my lab, but mainly a guy out at the National Institutes of Mental Health named Samer Hattar. He's the director of their chronobiology unit.

He's done these beautiful studies showing that light exposure early in the day, getting bright light exposure, ideally from sunlight within an hour, ideally within 30 minutes of waking up is vitally important for getting sleep later that night. And the reason is, is it basically once every 24 hours, you're going to have a spike in cortisol. It's non-negotiable. It's built into your genome. It's going to happen. So do people like Arizona sleep better than people in Seattle?

Well, they do actually. And a lot of people in Seattle need light boxes because if you're living in an area where you can't get sunlight first thing in the day, feel free to flip on artificial lights. But you want, basically the rule is you want as much bright, ideally natural, but if you can't get natural artificial light would be fine early in the day. And what

that does is it basically times this cortisol spike to wake you up. That spike in cortisol isn't to stress you out. It's to wake you up. And then it sets a timer on your melatonin release. So 14 to 16 hours after your bright light exposure, you're going to get a pulse of melatonin, which is the hormone, of course, that promotes sleepiness and puts you to sleep, independent of any supplementation of melatonin. Light inhibits melatonin through a direct pathway

through the eyes to the brainstem and then up to the pineal. It's a well-established pathway. So the number one thing is get bright light exposure to your eyes so no sunglasses eyeglasses or contacts are fine early in the day how long well it depends on how bright so anywhere from two minutes to 10 minutes ideally you're not looking at your phone during that time ideally it's sunlight but if you wake up before you know flip on a bunch of artificial lights and then get outside once the sunlight is out.

Who's outside taking a walk? You're not looking at the sun, right? You're not looking directly into the sun. You don't want to burn your retinas out. Indirect exposure is fine. But there's a class of neurons called the melanopsin ganglion cells that reset your circadian clock and time things nicely. They time the cortisol. They time the melatonin.

So that's the number one thing for, I wouldn't just say for sleep, but also for optimizing levels of alertness throughout the day. The other thing is that you really want to avoid bright light between the hours of 11 PM to 4 AM. If you're on a standard schedule, shift workers is totally different. The reason is Sammer's lab and a guy named David Burson at Brown university have shown that bright artificial light of any color, blue blockers or no, if there's bright artificial light, it activates a pathway in the brain involving this brain structure called the habenula. When I was an undergraduate, actually someone asked in neuroanatomy, what's the habenula

do? No one knew. The habenula is involved actually in generating our feelings of disappointment. It suppresses dopamine release for several days afterward. Now, if you have to go to the bathroom or you have to pull an emergency trip to the supermarket or something in the middle of the night, you don't have to worry about crushing your dopamine long term. It's a chronic thing. But you really want to dim the lights in the evening, starting at about 10 p.m.

So you're saying those blue blocker things that doesn't work. Well, the blue blockers will work, but if the lights are bright enough, it doesn't matter what wavelength they are. And this is because these melanopsin cells, these neurons in the eye, they do respond best to blue light, but they're very broad spectrum. The wavelengths that they will respond to, you can shine bright red light on one of these cells and it will signal to the brain time to wake up. Amazing. So it's really key to just dim things down and i always say blue blockers are

terrific but you don't want to wear them during the morning and early part of the day because blue light is the optimal stimulus for this wake-up signal so we took the blue blocker thing is great in principle but people kind of took it too far. So bright light when you want to be awake, and alert, and dim light when you want to be asleep. So like, so how many hours before bed? Because you know, people are up on their TVs and their screens, computers and phones. Yeah, so the subtle things that people can do

are to start dimming the lights in the evening, right about the time the sun goes down, is when you want to say, oh, the sun is going down outside, and if it's overcast, it's getting dark. Well, that's a time to dim the lights in the evening, right about the time the sun goes down is when you want to say, oh, the sun is going down outside and if it's overcast, it's getting dark. Well, that's a time to dim the lights in your home. The other thing is because of where these neurons are situated in the eye, overhead lights will activate this wake-up signal much more readily than lights down low.

So the Scandinavians have it right. In the evening, you want desk lamps. Most people aren't going to have floor lighting in their house. Desk lamps early in the day and throughout the evening, you want desk lamps. Most people aren't going to have floor lighting in their house. Desk lamps early in the day and throughout the day, that's when you would want overhead lights. So those two things are going to be very beneficial. A lot of bright light, overhead light throughout the day,

ideally from sunlight. And then in the evening, avoid bright lights of any color, any kind between 11 p.m. and 4 a.m. Don't get neurotic about it but many people find that just making these changes you don't have to like be off from like six o'clock at night no no no no and there's there's actually a the third uh tool which is also grounded in really nice work a paper published in scientific report shows that if you get some sunlight in your eyes in the evening right about the time of

sunset, and if you can't get it from the actual sunset, just go outside. You don't have to see the sun setting. You just need the light, the ambient light, the outdoor light in the morning is sufficient. There's so many photons out there, even on a cloudy day, you'd be amazed. In the evening, if you see or get outside and get some sunlight or you get some light in your eyes, that has an effect of lowering the sensitivity of the retina, of the neural part of the eye, and provides you a kind of insurance. It offsets a little bit of the late night bright light exposure. I call it sort of your Netflix inoculation.

It kind of protects you against some of the ill effects. Now, if someone's schedule is really messed up, I mean, they're not sleeping. They're really screwed up. There's a study out of the University of Colorado that showed that this is a little extreme, but going camping for two days reset these melatonin and cortisol rhythms for two weeks. It's pretty incredible. It's really incredible. I notice when I go camping or I go out in the wilderness or far away from technology i just sleep way better yeah um and we had a we had a

storm my house last summer and we got power out for four or five days and we just had candles at night and it was unbelievable i loved it and it felt so good to not have all that bright light at night and to go to sleep and sleep better and deeper. Yeah, you really reset. And you mentioned, I'm glad you mentioned candlelight. Candlelight in the evening is fine. Actually, not to turn people into geeky scientists, but there's a great app. I have no relationship to it, but it's completely free.

It's called a light meter. And you can run this experiment. You can download the app. You go outside on an overcast day in Boston in January and press the little button on light meter in the morning. And it'll show you that even though you don't see the sun, it looks like dense cloud cover. There'll be something like 5,000 Lux of light. You'll go inside. You'll point the thing at a really bright artificial light. And it'll say 300 Lux. Wow. Close the window to the outside and it reduces it by about 50 fold. So you don't want to do this through a window or a car window. And then you say, well, wait,

you just said that there's very little light intensity coming from artificial lights. Why is it so bad at night? I should be able to turn on every light in the house and it won't reset. Ah, but the clock and your eye get more sensitive as the day progresses. So you have to control it at both ends. And candlelight is fine. Dim light in the evening is fine. But throughout the day, you really want to try and get some bright light exposure.

And for many people whose schedules are just really screwed up, anchoring to these two or three things of bright light exposure and avoiding bright light in the evening hours between 11 p.m. and 4 a.m. often not always can really reset people's ability. And once you're sleeping well, everything else gets better. So that was kind of the first question you had.

The other one is that, I'd be remiss if I didn't mention, there are things that people can take. I'm sure you're familiar with several of these as well. Obviously, well, we have a doctor right here, so talk to a doctor. Obviously I'm not a physician. I don't, I'm a professor, but so don't prescribe anything. But the three things that have, have made a tremendous difference. I profess, I don't prescribe. That's right. That's what I usually say. Profess lots of things. The three things that I've certainly benefited from, and I know a number of other people have,

and for which there's really good research, are apigenin, A-P-I-G-E-N-I-N, which is, it's very inexpensive. It's chamomile extract. And it basically turns on a chloride channel mechanism in the brain. It turns off thinking. It's kind of the equivalent of an alcoholic drink.

It just turns off thinking. You could of the equivalent of an alcoholic drink it just turns off thinking you could still drive on the stuff but it makes people drowsy you drink chamomile tea or you have to take a concentrated um some people get that benefit from chamomile tea other people like the apigen and the other ones are the magnesium the magnesium and magnesium threonate and by glycinate in particular threonate spelled t-h-r-e-o-n-a-t-e and by glycinate in particular, three and eight spelled T-H-R-E-O-N-A-T-E. And biglycinate, I won't spell out, but it's sort of just as it sounds. Those cross the blood brain barrier more readily because you're ingesting this obviously into the gut. And then that magnesium needs to get into the brain. And basically the magnesium seems to act as a precursor to GABA,

the inhibitory neurotransmitter. And so for people who have a hard time turning off their thoughts, that can be very beneficial. So there's the kind of light, which is a kind of ancient mechanism by regulating alertness and getting into sleep. And then there's the modern thing, which is supplements.

And there's something sort of in between worth mentioning, which is there's a great tool that was developed by my colleague who's our associate chair of psychiatry at stanford his name is david spiegel he's actually a clinical hypnotist um he's done a lot of work on pain management and even breast cancer outcomes from hypnosis and he's developed a free app that's on Apple and on Android called Reveri, R-E-V-E-R-I. It's a 15 minute hypnosis that you do in waking, which trains the brain to sleep better. And I think that a lot of people hear hypnosis and get a little bit freaked out, but there are a lot of clinical data showing that

this can help people to learn to turn off their thoughts and to relax and go to sleep. And there's some other nice hypnosis scripts in there as well. It's David's voice and he kind of walks you through it. So those are, aside from the supplements, the light and the hypnosis are free resources that I think most everyone could benefit from. If I wake up in the middle of the night, oftentimes I will do one of these hypnosis scripts. And just one other thing about sleep. a lot of people wake up at 3 or 4 a.m and can't fall back asleep okay i never understood why that was and then i talked to the folks in the sleep lab at stanford and i talked to the chronic here's probably the reason yeah there's an asymmetry in this seesaw that we all equipped with internally which is that we can all push on

and stay awake more easily than we can just force ourselves to sleep right that's true right right at some point we fall asleep but if you're waking up at 3 or 4 a.m unless you're drinking too many fluids and that's the reason why chances are you are running out of melatonin at that point it's the levels of melatonin in your blood are dropping and what it means is you stayed up too late and you probably are one of these people that should be going to bed at 8.30 and waking up about 3.30 or 4 a.m.

And people don't like that answer because they think, no, but I want to be the person that goes to bed at 11. And there are ways to shift your circadian rhythm that we could talk about, but try and go to bed one hour earlier, and chances are you will wake up feeling better at 3 or 4 a.m. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below.

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