The Dr. Hyman Show - What Is Driving Your Poor Sleep And How Can You Fix It? with Dr. Cindy Geyer

Starting point is 00:00:00 Coming up on this episode of The Doctor's Pharmacy. The clocks in the brain and the clocks in the body that are ideally going to be working in sync with each other, they're influenced by light, by movement, and by food. So when we line all those things up during the day, it's going to help us get the rest that we need at night. Hey everybody, it's Dr. Mark. Now one of today's episode sponsors is ButcherBox. I love this company because they make eating high quality meat and seafood accessible, affordable, and most importantly, really delicious. When I talk about high quality animal protein, that means caring for the lives of the animals and the livelihoods of the farmers, reducing our impact on the environment

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Starting point is 00:02:09 patients, a multivitamin mineral as nutritional insurance. It covers the basics for all our day-to-day body functions, all the things that we need that our food might be missing. But there are so many products out there I wouldn't go near because they contain artificial fillers or inactive ingredients and you have to be pretty picky. The one I trust and take myself is Athletic Greens. They use high quality, highly absorbable forms of vitamins and nutrients from real whole foods. Athletic Greens comes in a powder that tastes great and mixes easily with water or smoothies and specifically supports my gut health, immunity, energy, and recovery. And it's not just vitamins and minerals. It has phytonutrient-rich superfoods and adaptogens and pre and probiotics and even digestive enzymes.

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Starting point is 00:04:20 That's pharmacy with an F, a place for conversations that matter. And if you struggle with sleep, you better listen up because this conversation is for you. And it's with my friend and colleague, Dr. Cindy Geyer. Cindy is an extraordinary woman who I've known for decades now, hired originally at Canyon Ranch to be a doctor there. She became the medical director and has been there for 23 years, leading the way there in functional medicine and

Starting point is 00:04:45 has recently joined the Ultra Wellness Center. We're just so happy to have her. She's triple board certified in internal medicine, integrative medicine, and lifestyle medicine. She's on the faculty of the Center for Mind-Body Medicine, teaches all over the country and the world, and is one of the best doctors I know. And I am just so excited, one, that she's joined the Ultra Wellness Center, and two, that we're having her here on the Doctors Pharmacy Podcast. Welcome, Cindy. Thank you, Mark. It's my honor and pleasure to be here. All right. So we're in a special episode of the Doctors Pharmacy called House Call, where we dive deep into clinical topics and talk about how functional medicine takes a little bit of a different

Starting point is 00:05:26 approach to thinking about diagnosing and treating problems than traditional care and why traditional care often misses the boat for things that are mostly driven by lifestyle and environment and are not acute illnesses. You get hit by a truck, you go to the emergency room. You have pneumonia, you need an antibiotic but most of the stuff we're dealing with is lifestyle or environmental driven and really we struggle to take care of these things. We push all these pills on people and often it misses the underlying cause and it's often not what you think. So today we're going to talk about

Starting point is 00:05:57 sleep concerns particularly for women because if you haven't noticed, men and women are different. And actually, there was an NIH director, the first woman, Bernadine Healy, she was a cardiologist, and she was like, you know, we really haven't done much research on women. We just do all our studies on 70-kilogram white males from Iowa, and maybe we should think about studying women. And she initiated the Women's Health Initiative, which was a billion dollar study and just really started the whole conversation, which you think would have been

Starting point is 00:06:29 started a long time ago. So let's talk about what are the challenges that you see in your clinical practice around women and sleep? And what are the main reasons that you're finding? And some of them aren't expected. And then let's go into how, you into how there would be traditionally approached by conventional medicine. And then we'll dive into functional medicine. Sure.

Starting point is 00:06:52 So I think the first thing is that some common sleep conditions like insomnia and restless legs, they disproportionately affect women. And they can have a connection to lifestyle. Sleep apnea, interestingly enough, gets underdiagnosed for women. And there's a lot of reasons which you can dive into it, but some of it has to do with stereotypes on the part of clinicians of thinking about sleep apnea being a man's condition. A big, heavy old guy.

Starting point is 00:07:17 Especially if you're overweight. Right, especially if you're putting weight on around. 300 pounds. Right. But lean women can get sleep apnea too, and it may show up very differently. Yeah. There's also the idea that when we look at times of hormonal fluctuation for women, whether that's before their periods or during pregnancy or the postpartum or the menopause

Starting point is 00:07:35 transition, that can also cause an uptick in disrupted sleep. So hormone balance and regulating hormones can play a huge role in improving sleep quality. And finally, you know, disproportionately in the past, caregiving demands have fallen on the shoulders of women. And I think that really became manifest or evident during the COVID-19 pandemic, when you saw a bigger proportion of women than men experiencing an uptick in insomnia, anxiety, and depression. So they're all interconnected. Yeah. So women take on the burden of the families. They often, especially during the perimenopausal years, become the sandwich generation between raising their kids

Starting point is 00:08:14 and taking care of their elder parents. And you're kind of in the middle of that, a little bit toward the tail end of it, but you kind of went through that. And it puts a lot of stress on women. Also, I think there's some unusual causes of sleep that get missed by traditional medicine. And so, like, if you were a woman and you went to the doctor, like, I'm having insomnia, what are they going to tell you? They'll probably tell you to take a sleeping pill.

Starting point is 00:08:37 A little Ambien. A little Ambien, yes. A little Valium, right? And maybe they'll give you an antidepressant, right? Right, right. And, of course, those come with side effects. They're addictive. They impair cognition.

Starting point is 00:08:51 They have all kinds of long-term effects. I mean, the benzos or things like Valium or Azepam or Ativan, they may lead to increased cognitive problems like dementia when you get older. And, you know, we heard all the stories about people wandering around doing stuff they shouldn't do in the middle of the night and uh it's it's unfortunate that that uh there are other things too that traditional medicine misses that affect sleep um you talked about the big ones which are the stress and the sleep apnea and the hormonal issues but there there's really more that we know about sleep disruption and the hormonal issues but there's really more that we know about sleep disruption and the difference with functional medicine is that we tend to take a detective approach we don't just

Starting point is 00:09:30 stop at the diagnosis insomnia is a symptom it's not a disease right right and so we go oh i know it's why you can't sleep you have insomnia no that's just the name of it silly that's not the cause and so we we kind of have a different approach. And over the years, there are things we've really uncovered in functional medicine that play a role in sleep that are mostly ignored. And so you shared a little bit about it earlier when we were chatting, but what are the kinds of other things that we see underlying the root causes of insomnia? So if we think about insomnia, about 80% of people who develop chronic insomnia, there's an initial inciting event, but it leads to a stressful event, for example.

Starting point is 00:10:07 Like a death or divorce. Right. Or a transition with the job. And I think the pandemic has contributed to it as well. But then what happens is there's this upregulation of the HPA axis and this chronic overproduction of cortisol. HPA is? Hypothalamic Pituitary Adrenal Axis. So it's the brain's command center that tells the body what to do.

Starting point is 00:10:31 Absolutely. So it's that connection between what our brain is registering as a threat and how that impacts our need to respond to that threat by pumping out these hormones that then in turn keep us ready to deal with a threat that may not be there anymore. So basically, if you're in fight or flight, your job isn't to go take a nap. It is not. It's to stay on alert and wait for the next thing that's going to threaten you. So that activated sympathetic nervous system is huge.

Starting point is 00:10:57 And our culture just does that. But the phone is like a dopamine pump. It's like a dopamine pump that keeps your blood pressure up. I mean, when people are dying in the intensive care unit, the drug we give them to keep their heart going is dopamine. That's a great analogy. It's like at the very end of life. If everything else, epinephrine fail, you give dopamine because it's so powerful at keeping you awake and alive.

Starting point is 00:11:30 And so everything in our life is the sugar, the phones, all the news. Like it's just we're constantly in a dopamine barrage. You know, it's funny you said that because I've had people tell me, you know, I wake up at 1.30 every night. I said, well, how do you know it's 1.30? Because I look at my phone and it says 1.30. And that, again, perpetuates the cycle because then you're thinking, oh, it's 1.30. Oh, crap.

Starting point is 00:11:53 I'm awake. I should be asleep. And then it just becomes. Yeah. You know, the best thing I ever did for my sleep issues, because I struggle with them as well, is putting my phone and my watch off. Like just taking everything out and like i'm not knowing what time it is and just letting my body do its thing i think that's brilliant mark and even even sleep trackers for some people it can be a double-edged sword because you're thinking

Starting point is 00:12:18 okay what's my tracker show me how well did i sleep last night so it's that learned pattern okay so we have that chronic stress what else. What else is driving this insomnia pandemic, which is huge, right? I mean, 70, 90 million people are struggling with insomnia. Right. So I do think that there's a need to address underlying contributors to anxiety and depression independent of their impact on sleep. So talking about what's going on, bringing in some kind of breath-based practice, whether that's yoga or Tai Chi or meditation, just to ratchet everything down. That's another important component of it. And thirdly, you've already touched on a little bit about the dopamine with the phone, but it's also the dysregulation in our circadian rhythms. There's been a lot of research about how I there's been a lot of research about how important it is to avoid light exposure at night, for example. But everything we do during the day, and when we do it, is ultimately going to

Starting point is 00:13:13 influence our ability to go to sleep when we want to and get the rest that we want to. So in other words, when we're eating all day long and snacking late at night and watching TV at night, that's signaling on our computers, that's telling our bodies and brain that it's day, it's day, it's day. So we want to actually reestablish a consistent circadian rhythm. Meal timing, so we're eating earlier in the day and then building in a fasting interval before we go to bed. So don't eat three hours before bed.

Starting point is 00:13:42 No. Interestingly enough, as you know there's a connection as well with digestive function that eating late at night not only disrupts your sleep but it's contributing to higher reflux which can also interrupt sleep so everything's interconnected i mean last night actually because i went hiking and it's summer and it's so beautiful and it's late light so we were like didn't get down from the mountain till eight o'clock at night and I'm like oh let's go eat I'm hungry but then by the time we ate it was like nine o'clock and I like last night I tossed and turned for a couple hours before I went to bed which I usually don't do.

Starting point is 00:14:16 Isn't that interesting. I was like oh it was the you know it was eating late at night. So there's eating late night there's the circadian rhythm disruption and this morning I went out and sat on my deck and the sunshine was out. So getting light in the morning is so important. Absolutely. So we don't do that. We're all like on our phones or computers right away.

Starting point is 00:14:31 We need the natural light to reset our brain. It makes a big difference. Because light is medicine, right? It is. Light is medicine. It is. And also it could be bad medicine if it's the wrong light at the wrong time, right? Exactly.

Starting point is 00:14:41 So we have all this like, there's this great book called lights out that i read years ago uh cindy that was really talking about the advent of light bulb driving chronic disease because of the disruption in our rhythms and so on it's interesting they even looked at led street lights disrupting the circadian rhythm of animals and insects too so it's not just humans that are being impacted by this and there's some other weird stuff that affects sleep that we don't think about. Like what else? Well, one of the conditions is restless leg syndrome. And it's hard to diagnose. It's more of what we call a clinical diagnosis. People describe this creepy crawly sensation in their legs or this irresistible urge to rub their feet together. And typically, it's treated with dopamine medications. It's connected to relatively

Starting point is 00:15:26 low dopamine levels in the brain. Dopamine, yes, revs you up, but dopamine also seems to play a role with movement. So it's treated with some of the same medications they use to treat Parkinson's disease. But it turns out that that can be more prevalent in people who have autoimmune conditions, in which case we want to address the underlying autoimmune conditions. There are some nutrient deficiencies that are going to make the symptom of restless legs more significant. Low iron, low vitamin D, low folic acid, low magnesium. So we really want to look at somebody's nutritional status. Yeah. And by the way, 80% of the population is efficient vitamin D,

Starting point is 00:16:11 50% in magnesium, you know, like 20% in iron. I mean, it's like a lot of people are deficient in B vitamins and they don't even know it. Right. You know, and you go to your doctor, you have insomnia, they're not checking those things. Exactly. And there's even weirder things in nutritional stuff, right? So if we identify a nutrient deficiency, for example, the next step is why? What's the why that somebody's nutrients might be low? And there we come back, like so many other things, to the function of the gut. And interestingly enough, there is a higher correlation in people who have small intestinal bacterial overgrowth also having restless leg syndrome. Maybe because it's contributing to ongoing inflammation.

Starting point is 00:16:46 Maybe because it's also contributing to difficulty absorbing those nutrients from your food. So we're even going to go a step further and say, is there an underlying issue with digestive function absorption and assimilation of nutrients that are- So if your gut's a mess, it can also cause insomnia. Absolutely. And then heavy metals are another big one that we don't really hear about. Right. Lead, mercury, things that are under the radar for many, many people and unfortunately can be a problem. Yeah. And I had that. We talked about it on the show, but I've had mercury

Starting point is 00:17:18 poisoning 30 years ago almost. And it really totally screwed up my sleep. What happened with your sleep? I just couldn't sleep. Like I just really couldn't fall asleep, couldn't stay asleep, never felt rested, had chronic fatigue syndrome. Until I got the mercury out, got my fillings out, chelation, everything, I couldn't sleep. And it really took a long time to reset that.

Starting point is 00:17:43 Okay, so we've got all these different things that traditional medicine is ignoring hormonal fluctuations the the gut issues heavy metals nutrient deficiencies i mean doctors know about sleep apnea but they often miss it in thin women because that's not the archetype of someone who actually like the pickwickian figure with you know a huge belly and a thick throat and size 17 neck i mean you know uh so there's all these issues and and yet um you know this continues to be such a struggle for so many people um and the and the traditional treatments really are just stop gap they don't really address the cause so in functional medicine the way we think about things is to look at some of these other factors so so in your practice, how do you start to dig down? What are the kinds of diagnostic things you look at differently? We talked about

Starting point is 00:18:30 all these different factors, but how do you identify what's the problem in this or that particular person? Well, I think it's the time to take a history and really understand all of the other interconnectedness that could be going on. For example, somebody with sleep concerns might also have digestive concerns, and then we might be thinking about assessing their digestive function, looking at a nutritional assessment. But I think there's a time and a place, and there's tremendous value in screening somebody with a portable sleep study, because that gives you a tremendous amount of information. And we're using it, yes, to diagnose sleep apnea, but also to say,

Starting point is 00:19:05 how often do you wake up during the night? How much percentage of time are you spending in REM sleep and deep sleep? Are you tossing and turning all night long? So it can give us a tremendous overview in terms of somebody's sleep throughout the night. And from that, we can also decide, okay, what else do we need to explore? And then we do some testing, right? You can look at nutritional levels. You can look at these vitamin D and magnesium and folate and iron studies. You can look at, obviously, the sleep apnea test.

Starting point is 00:19:38 And there's home tests now you can do that are really great. We look at heavy metals, right? And the hormones. You can really get a sense of what's going on with hormones for people. If they're estrogen and progesterone is all out of balance, it just happens in menopause, you see a lot of sleep issues. Heavy metals, like I said, we can test. So there's a lot of ways we can diagnose using functional medicine testing that you don't really get with traditional doctors that can help get underneath things. So tell me about this patient you had, because it sort of speaks to a lot of the issues that we're talking about.

Starting point is 00:20:09 And it gives you a little unusual approach to insomnia, something you wouldn't really get from a traditional doctor. Right. So this is somebody that, and one of the things I want to plant the seed for is sometimes we start with what we think is the most likely issue, and we gradually uncover more potential contributing issues and peel the layers of the onion. And this was a woman that I had known for years. She was pretty healthy in terms of her lifestyle.

Starting point is 00:20:32 She exercised. She wasn't overweight. She ate a healthy diet. She didn't drink any alcohol. She was treated with antidepressants. She was on a serotonin reuptake inhibitor and Welbutrin for her depression. And she was also on hormone replacement therapy. She was postmenopausal in her 60s.

Starting point is 00:20:55 And she started complaining of fatigue and difficulty concentrating and just felt scattered. And by Sundays, she would have the need to take a three-hour nap. So, well, that's unusual. So we did some of the usual testing for causes of fatigue. We tested her thyroid. It was okay. We looked at her iron levels or sugar levels. They were okay. So I decided to do screen her with a sleep study. And it turned out you would not have looked at her and said, Oh, yes, she is the poster child for sleep apnea. She turned out to have one of the most striking positional components to sleep apnea I've ever seen. When she was on her side, her sleep was normal. But when she was on her back,

Starting point is 00:21:29 she had respiratory events that count as either a slowing of airflow or stopping of airflow more than 60 times an hour. Wow. She stopped breathing 60 times an hour. Yes. Yes. Like once a minute. That's a lot. No wonder she was exhausted, right? So when you see a positional component like that, you know, I have people who don't want to do a sleep study because they don't want to, I don't, I'd never wear that stupid mask. But for her, we said, okay, well, let's start with retraining you to learn to sleep on your side. And she tried that. There's some commercially available positional devices. There are all kinds of strategies you can do. There's a very, very sophisticated technology. It's called the tennis ball strategy, where you sew a tennis ball into a t-shirt on the back. So if you roll

Starting point is 00:22:14 over on your back, it makes you flip over to your side. Or the fanny pack with the pillow stuffed in it. Yes. There's all kinds of strategies you could do. And of course, it's big business, right? You can buy a slumber bump or a bumper belt. Oh, I didn't know they had those. I was on the tennis ball track. Even more sophisticated, there's now a biofeedback device that's a strap around that vibrates when you roll on your back. So it's sort of autogenic nighttime training to get you.

Starting point is 00:22:39 So that's what she used, interestingly enough. And it helped a little, but she was still tired. So as we're peeling the layers of the onion, she had some digestive symptoms, a lot of bloating, a lot of discomfort. And she had, we had done a full sleep study. She had restless legs and periodic limb movements. She turned out to have a very abnormal breath test for small intestinal bacterial overgrowth. That means bugs growing in your small intestine where they really shouldn't grow. Where they don't belong, right.

Starting point is 00:23:06 Which can cause inflammation. Absolutely. And low iron. Her iron wasn't terribly low, but one of the sidebars here, I think the other thing we do in functional and integrative medicine is understand the difference between a normal blood test, I should put, quote, normal blood test, and an optimal blood test. Yeah. Ferritin is a classic example of that.

Starting point is 00:23:26 Ferritin looks at your total tissue iron. How much iron is in your iron bank, in your body? In your iron bank, your iron stores, right. And normal can be anywhere from 15 to 250. Yeah. It's a big range. It's a big range. And what we know the threshold is for somebody who's got restless leg symptoms is you actually

Starting point is 00:23:46 don't want to be normal. You want to be over 100 because there's some evidence, even comparing it head to head with those dopamine drugs we mentioned earlier, getting somebody's ferritin over 100 was as effective as the dopamine medications. That's amazing. That's amazing, right? As simple as correcting a nutrient deficiency, not to the normal range, but the optimal range for that condition. Yeah, what's interesting is, you know, heme iron is the best absorbed kind of iron, but that usually comes from meat.

Starting point is 00:24:13 Right. And people who are vegan, the plant forms of iron aren't as well absorbed. Right. And you often see very significant iron deficiency in these patients, especially women who are menstruating. And I think that, you know i learned actually in traditional medicine that ferritin was connected to sleep actually interesting i learned that uh in a lecture on insomnia that i went to by some drug company that's great i was like well that's interesting but but uh yeah i think it's it's something that's often overlooked and it's an easy blood test to check your ferritin which most doctors won't look at and mark i think from the internal medicine standpoint too it's equally important to say don't just correct the iron figure out the why right you don't want to miss yeah she got colon

Starting point is 00:24:53 cancer absolutely a stomach ulcer she's just menstruating heavily that she has a bladder cancer or just like something right so i think that's really important you're right just don't look at the symptom look at the cause. Because low iron is a symptom. It's not a cause. Low iron may cause insomnia, but what causes low iron? So that's what functional medicine does. It keeps going upstream. And you said something a couple of times that I just want to come back to,

Starting point is 00:25:15 which is peeling the onion. So one of the principles of functional medicine from our mentor, Sid Baker, who is this cool old guy, Yale professor uh erudite super smart one of the most thoughtful men in medicine people in medicine period and he said you know we we have the tack rules that help us sort of determine how to figure things out one is if you're standing on a tack it takes a lot of aspirin to make you feel better right take out the tack so if you know the bacterial overgrowth is causing the restless leg syndrome you can take a lot of these traditional medications but you can take a lot of medication to make it away or if you fix the bacterial

Starting point is 00:25:54 overgrowth and the you know that'll help but then also if you're standing on two tacks taking one of them out doesn't make you 50% better. So she had bacterial overgrowth and she had iron and she had the positional thing. So it's like usually three or four or five things. And the problem with medicine is we are so focused on the one thing. You know, there was one other piece related to her story that I think is also important to call out. Addressing all of those things, her sleep quality was still not what she wanted to be. So we had a conversation and she relayed the fact that when she was growing up, things were pretty unsettled in her home of origin. There were a lot of late night parties,

Starting point is 00:26:36 a lot of noise, and bedtime became a time where she didn't really feel safe and quiet and comfortable. So we also talked about referring her to a life management behavioral therapist to really talk about what it meant to be safe and regaining that sense of being okay being in bed. And I think that goes hidden as well, that a previous history of trauma or not feeling safe can also show up with insomnia and difficulty sleeping. Yeah. And I think that's a big thing for a lot of people. There's a questionnaire you can do online called the ACE questionnaire.

Starting point is 00:27:10 It's Adverse Childhood Events. And you get a score. And if you have a high score, it means you've had a crappy childhood and you probably have some level of trauma. And different people respond differently to the trauma. Of course. But PTSD is so prevalent. And our nervous systems are so jacked up in general. people respond differently to the trauma of course but you know ptsd is so prevalent and and our

Starting point is 00:27:25 nervous systems are so jacked up in general so it's sort of like acute on chronic absolutely we've got like our acute stresses on this chronic level of ptsd and it leads to so many physical psychological emotional stresses for people that and there's a lot of ways to sort of access that you know i mean there's you you shared about how you use cognitive behavioral therapy or yoga or meditation or breath work or, you know, emotional freedom techniques. There's all kinds of techniques out there. But now people are exploring, you know, psychedelic assisted therapy, MDMA, psilocybin therapy. It's legal in Oregon now. And, you know, there's some interesting research going on.

Starting point is 00:28:03 Johns Hopkins and NYU and others are really looking at how do we help people with some of these chronic long-term traumatic events and experiences. And I think, you know, sort of listening to, it's just so interesting to hear that dealing with, you know, something as simple as insomnia can be quite complicated. You have to look at inflammation in the body. It's like, where's it coming from? Is it the gut? Is it heavy metals? Is it hormonal changes? Is it nutrient deficiencies? Is it, maybe it's food sensitivities or allergies. Maybe it's low thyroid. There's things that we, you know, we just don't often think about. And so what's so satisfying with functional medicine is we're able to actually dig into these things and look and see the why. You know, we say functional

Starting point is 00:28:43 medicine is the medicine of why not what not what disease you have which is helpful but it's not the end of the story we go why do you have that disease like you know and that's the challenge of traditional medicine it's like you make the diagnosis and you stop thinking okay you've got depression here's antidepressant you've got insomnia take the sleep pill oh you've got rheumatoid arthritis take the rheumatoid arthritis pill like not why do you have insomnia or depression or rheumatoid arthritis or migraines but like why and and that's what's so powerful so and then you sort of there's some basic sleep practices that are really good we've covered some of this but i think it'd be good to go over it and i think um you know and i think

Starting point is 00:29:21 it's important to emphasize that everything matters, sleep, exercise, stress, obviously your diet, the huge role, nutrient status. And that's what we do in functional medicine. So we dig down into it. So talk about some of the other factors around sleep hygiene that we sort of haven't touched on in terms of diet and lifestyle and food and exercise. Sure. I think first and foremost, we have to recognize that sleep, you know, you and I trained in

Starting point is 00:29:50 an era where sleep deprivation or how little sleep you could get by on was a badge of honor. Yeah. So we need to shift that internal dialogue that we all have that, oh, if I'm sleeping, I'm wasting my time and I'm not getting my stuff done. So first honor the importance of sleep for your overall health and well-being and even your ability to stick to your intentions around choosing healthy foods and sticking to your exercise plan. Then create a sanctuary that's really conducive for rest and relaxation. Dark, quiet, cool, ideally electronics out of the bedroom or turned off if you can. Getting rid of all of the light exposures, even your chargers, you know, that had that

Starting point is 00:30:28 little light. Yeah, like those like lights, like those red, green lights on different devices. I'm like, that drives me crazy. I used to, I had a patient who told me she traveled around with black electrical tape whenever she went to a hotel and she would put it over all the little light sources. I travel with eye shades because you never know where you're going to be. So those two, quiet, calming. And I think this idea that you go, go, go, go, go, go, hop in bed and turn it off like a switch, that doesn't work either. So building in a transition

Starting point is 00:30:57 to rest and relaxation. If you can do an hour, that's great. And getting off the devices, not watching TV, maybe reading a book or journaling or doing something, taking a bath, stretching in the tub. I mean, there's all kinds of wonderful ways to ease into the rest of the relaxation. I like the hot Epsom salt bath and lavender drops because the lavender lowers your cortisol, the magnesium relaxes you and the sulfur and the Epsom salt helps you detox. That's my favorite as well. And then you go to your cool bedroom and you do your legs up the wall yoga, restorative yoga position and bingo, you've got your transition to rest and relaxation. So powerful. And alcohol obviously is a good

Starting point is 00:31:36 practice for people. Yeah, that's a tough one. That's a tough one. So the rough analogy is this, it's funny, when they asked partners of people with insomnia, how many of them were suggesting that they have a drink to go to sleep? It was about a third of them. So people think alcohol is going to help you sleep. And it might make you fall asleep. But then as it clears out of your system, there's an arousal, it can exacerbate hypoglycemia, it makes you wake up, it's going to make sleep apnea worse. If you're a woman in midlife, oh boy, it's a bladder irritant. It's a hot flash trigger. So it's really affecting sleep in a lot of ways.

Starting point is 00:32:12 The rough equivalent is there's about an hour of sedation followed by an hour of arousal. Yeah. So if you had a glass of wine at six and you go to bed at 10, it's probably not going to impact your sleep as much as if you have two glasses at eight or like your late dinner last night if you had a glass or two of wine yeah you're here yeah that has another impact on your sleep i just noticed it actually i had an aura ring for a while i was tracking my sleep and i noticed whenever i drank my sleep's pattern was so disrupted quality of sleep the depth of sleep the amount of REM sleep deep sleep snoring you know all that it's really. And then caffeine also is another big one, right?

Starting point is 00:32:49 Yeah, absolutely. And we're all different in terms of our caffeine metabolism ability. Some people are really fast metabolizers. I happen to be one of those. But if you're a slow metabolizer, half of your cup of coffee from noon could still be in your system at 9 o'clock at night. And most of the time, we're not thinking back to that new cup of coffee. With food, it's really about quality, quantity, and timing of food. It's all three. Yet another area that's impacted with the health of the gut microbiome is sleep.

Starting point is 00:33:25 And data is suggesting that people who eat a wide variety of colorful fruits and vegetables tend to have better sleep quality, whereas a highly processed standard American diet is associated with more sleep disruptions and less deep sleep. So quality matters. We already touched a little bit on the timing of eating. So eating your calories earlier in the day also helps re-regulate those circadian rhythms. So the clocks in the brain and the clocks in the body that are ideally going to be working in sync with each other, they're influenced by light, by movement, and by food. So when we line all those things up during the day, it's going to help us get the rest that we need at night.

Starting point is 00:34:06 So important. This is such good information. I want to close by something you probably should have done at the beginning, which is why is not sleeping so bad for you? And why is sleeping so good for you? Probably should do that, yes. So sleep is when we're repairing the powers of both the mind and the body. Sleep is when we reduce inflammation, repair tissues. The discovery of the glymphatic

Starting point is 00:34:34 system in 2012, 2013 is this passive channel that runs alongside our arteries and veins in the brain that fills with fluid when we're in deep sleep and allows a washing out of debris we may have accumulated during the day. So all those bad thoughts get washed out? Well, not the bad thoughts. No, but the amyloid plaque, that sticky plaque that we secrete in response to inflammation or injury, if it accumulates, of course, it can damage surrounding neurons and is associated with neurodegenerative disease and Alzheimer's disease.

Starting point is 00:35:06 So in English, that means if you don't sleep, you're likely to get demented. It's definitely playing a role. And this concept of bidirectionality, we know that sleep disruption, circadian rhythm disruption, sleep apnea is present in two-thirds of people with insulin resistance, prediabetes, diabetes. And it is a chicken and the egg thing. It is driving the bus. You know, we used to think, well, you get the sleep apnea because you have insulin resistance and gain weight.

Starting point is 00:35:30 But if you have disrupted sleep, your insulins are higher, your cortisols are higher, your glucose is higher. You're looking for highly processed, quick, energy-dense foods and less able to resist them. Wow, so not sleeping is a risk factor for obesity. Absolutely. And heart disease. Yes. And cancer. And cancer. And dementia. And flares of autoimmune conditions. Yeah. And chronic pain. Yeah. And fibromyalgia. So it, and anxiety and depression. I mean, it really affects everything. Oh my God. If I don't sleep, I'm depressed and anxious.

Starting point is 00:36:01 But the more you worry about it, the harder it gets to sleep. Yeah, it's true. So it's like when you get a good night's sleep, it's like the world just looks rosy. And when you don't, it looks depressing. Great. And you know, that's an important thing too. If you pay attention to how you feel. So you mentioned the aura ring. People ask me, how good are these trackers for telling you about your sleep? They don't diagnose a sleep condition, but sometimes you can gain some insights. For you, you gave a great example of this. You found, oh, look at this one. I've had alcohol.

Starting point is 00:36:32 My sleep is not as good. My heart rate, variability, everything. And then you pay attention. Well, how did I feel the day after? Yeah, I was more tired. Yeah, I was more irritable. I was looking for different foods. So I think the more you build that internal awareness of that connection between your

Starting point is 00:36:46 sleep and how you feel the next day, that's a win. That's really how you learn to prioritize it. Yeah, I just take home here is that sleep is the most underappreciated fourth pillar of lifestyle medicine. I agree. It's diet, exercise, stress reduction, and sleep. And it really is important. And I think I feel like a lot of my health issues in part were driven by lack of sleep.

Starting point is 00:37:12 I think as doctors, we were just so trained to overcome our natural instinct to sleep. We have to stay up all night alert, seeing patients. You either pound the coffee or you just will your way through. And I remember like working in the ER on weird shifts like 11 to 2 in the morning. And I'd be like driving home with like tooth, holding my eyes up like this, forcing myself to not fall asleep. And that just messes with you in a big way. I remember the box of donuts at the nurse's station because you needed the quick energy

Starting point is 00:37:44 to stay awake. And then the bottle of Maylax locks right next to it because your stomach just felt awful. And you'd wolf the donut, swing the Maalox, and go do your work. Sounds like a great lifestyle plan. Yeah, isn't it great? You have to unlearn all of that. Well, Cindy, so much fun having you on the Doctors Pharmacy Podcast on this special episode

Starting point is 00:38:01 of House Call. We are so thrilled that you're joining the Ultra Wellness Center. For those of you listening, if you love this conversation and you're struggling with sleep, well, we are here at the Ultra Wellness Center to help you. And now we're doing a lot of virtual consults. Unfortunately, we have a long waiting list, but we're working on that and figuring out ways to help get you in. We would love to hear from you. Please share comments about how you've overcome your sleep challenges. Subscribe wherever you get your podcasts. Share this with your friends and family. It might help them too. And we'll see you next week on The Doctor's Pharmacy.

Starting point is 00:38:36 Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff

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Starting point is 00:39:23 you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search

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The Dr. Hyman Show - What Is Driving Your Poor Sleep And How Can You Fix It? with Dr. Cindy Geyer

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