73: Is Sleep the Missing Vital Sign? – How Poor Sleep Wrecks Hormones, Brain Health & Longevity with Dr. Christian Jenski

If you're not getting adequate sleep, it's going to affect longevity. You know, you use the word all cause mortality. You know, that's a fancy way of saying dying for any cause, dying for cancer, dying for heart attacks, dying for strokes, dying for diabetes. Like if you don't get adequate sleep, your all cause mortality goes up. Welcome back once again everybody. We are today going to take another deep dive into another super important topic that affects how your body heals, how it repairs, affects your hormones, affects your brain, affects everything. And it's sleep. It's one of the vital signs, it's one of the things we're supposed to look at. Just like your blood pressure and your pulse and your temperature. Yet it's something we don't really understand quite that much about. So we're gonna have a fun time, Dr. Jensky and myself, talking about all things sleep. But first we want to talk about just what is sleep? Why is it important? Because I feel like a lot of people, I mean, I grew up, you know, when we did our training, we talked about this earlier. You know, I'll sleep when I'm dead. When I was in the military, I was sleeping for six hours at night. Was me, for me, was, was good. I get up at 4 in the morning, go run, go work on my master's a little bit, get to the clinic at 7 in the morning, go to bed at 11 or 12 at night. Like that was normal for me. Little did I know that that's actually worse for me than drinking for my health, you know, so, so I want to talk about like what it does just to convince people that sleep is important because I feel like still now people overall don't really quite understand like how critically important sleep is. And if you're not getting accurate sleep, that's gonna affect longevity. You know, you used the word all cause mortality, you know, earlier on today, a couple episodes ago at this stage. But you know, that's a fancy word way of saying dying for any cause, dying for cancer, dying for heart attacks, dying for strokes, dying for diabetes. Like if you don't get adequate sleep, your all cause mortality goes up. So it's a really, really big deal. So those are my introductory remarks on sleep. I don't know if you have anything you want to start off with.

Yeah, it's going back to what you said about your personal life. Mine was similar. I went to med school, same as you. And then you do your rotations and you're in ICU rotations as I was in ER doc and taking 36 hour call and it was like, suck it up. And you're just caffeinating. You don't sleep, you go home, you crash, you come back the next day, two, three days later, rinse and repeat and then you go on to practice a career where you are doing shift work. But those shifts are never change or ever changing. So I might do a couple of day shifts which were great and sought after, but then I might get stuck with a bunch of night shifts, overnights, and then you go to a couple afternoons and it just, it wrecks your circadian rhythms, it wrecks your sleep pattern and, and I am living proof that it can wreck you physiologically and physically and let's just say emotionally too. And those are better now because my sleep is exponentially better. It's the immune aspect, it's the hormonal aspect, it's the metabolic aspect, longevity, as you mentioned, cardiovascular aspect. All these things are so, so, so much affected by sleep and sleep quality. Yeah.

The thing is that we have a national deficiency in sleep. You know, we talk about 42% of Americans being vitamin D deficiency, but vitamin D deficient, if you're over 60, it's something like almost 80%. Anywhere from 80 to 90% of Americans are magnesium deficient. You know, 90 plus percent. And this, these numbers is kind of crazy from the US RDA that 90 plus percent of Americans are potassium deficient. You know, when do we talk about sleep deficiency? You know, it's really interesting. In the mid-1800s, the average American slept eight, half to nine hours at night. Now the average American is sleeping six to six and a half hours at night. And what we know from just getting one hour less of sleep, so instead of getting eight, you get seven. It's equivalent to having like half a beer to beer drinking. And if you get six versus eight, it's almost like drinking two beers and going driving. So your cognitive, your response times, driving on six hours of sleep every night, it's equivalent to. Actually you would. Yeah. As far as your reaction time to driving. So there's, it's a big, big deal. It's really interesting on daylight savings time. I think spring forward is coming sometime soon and you know, I'm not sure if you have any thoughts about daylight savings, but I, you know, it's, it's.

I'm not as emotional about it as everybody else seems to be these days. Well, it's, it's, I, I adapt. I don't love it, but I adapt.

But it's interesting nationwide when you look at epidemiological information. There are more heart attacks, more car accidents, more strokes the day after around these time shifts. Yeah, it's the spring forward when we lose the hour. And so it's interesting you see it every. So it's one of those things where it's like it actually has a health impact on the. Now me and you are fine because you know, we get our good sleep or whatever, but as a nation of people it actually is detrimental to. We'll see if anything happens in the next year with daylight. I'm not super emotional about it, but I would just like it to go away because it's owls. It seems kind of dumb these days. It keeps on dumb. I agree, I don't disagree with that. But you know, I wrote some numbers down. You know, the Average adult sleeps 6 to 6.2 hours. It was interesting because I was looking at these numbers up early on when I was doing my blogs and stuff and it was giving me the number like five and a half to six hours a night was what the average adult slept. But I think the thing that's crazy, the average high schooler sleeps six and a half hours a night and they need eight to 10 hours asleep for proper brain development. And children between six and 12 sleep 8.4 hours at night on average and they need nine to 12 hours of sleep.

So they're not even hitting the low end of that spectrum.

No. And so we have because of just the way schools are set up, all the elementary worse than high school, but all the kids basically are sleep deprived. Could that be a part of, you know, the add? Add, Anxiety, Depression, oppositional, defiant, poor performance. You know, and if you got, you know, young boys typically developmentally are about 18 months behind women, very young girls. So you know, you have a, you know, a three year old girl and she's like talking and doing house and three year old boys like you know, pretty much every young.

I wonder how much this is affecting all the metabolic trends that we're seeing as well. It's called obesity, obesity, type 2 diabetes, fatty liver disease.

I don't think it's a major player. I think all the food, chemicals, yeah, all that kind of stuff are major, but it contributes. But the point is that children more than adults, but in general the average person in our country is not getting adequate sleep. So let's. What is sleep? You know, could you define sleep for us?

How do you define sleep? I mean, as basic as I can break it down. It's. It is an established part of your circadian rhythm. It's the part of your daily 24 hour cycle where your body is trying to repair and restore itself. In particular the brain. It's when the brain is activating the glymphatic system, which is its version of the lymphatic system. So housekeeping and cleaning is being activated. You are consolidating emotions and memories. You're repairing and restoring those tissues that are repairable and restorable. Melatonin is spiking, so we're shifting towards a more Th1 adaptogenic immune response. So any sort of chronic infections we might have are being fought. The body's surveilling and the immune system's kind of on alert a little bit. Melatonin is also anti inflammatory and antioxidants. So we're getting some of that on board. So it's the ability to have this state of the body where whatever we're doing through the course of the day is now able to be repaired so that we can get up the next day and go after it again.

Yeah. Actually when I was thinking about this, I had to look up a definition because I was like, what is sleep? And it's a natural reversible state of reduced responsiveness and activity. Essential for life. The thing that sticks out to me is essential for life. I remember this one study I was looking at actually military recruits because there's only some things you can do with military recruits. And they forced them to stay awake for two weeks. And in the two weeks some of them were going psychotic. They were having psychological breakdowns. You know, and you remember sleep deprivation is a form of torture. So a certain way we, you know, at a national level we're having this sleep deprived state that actually is bad for our mental health, that's bad for our general well being. I and sleep is essential for life. You literally cannot live without this.

Isn't that the standard of care for diagnosing epilepsy or seizures is that they sleep deprived and then do EEG studies.

You're sleep deprived and it lowers your seizure threshold and you look for these spikes to break through cause you're more prone to pick them up on a sleep deprived eeg? Yeah, I mean if you don't get accurate sleep, you get more migraines, you know it's gonna affect your gut health. You know, it's, you know, people with autoimmune issues tend to have more sleep disturbances. That's one of the hallmarks for chronic fatigue and fibromyalgia, for myalgia and stuff about myelitis. Part of that Definition of that entity is a sleep disturbance. So it's sleep's ridiculously important. And in general, we don't, as Americans, don't get accurate sleep. So the stage of sleep, we talked about this before we started recording rem, non rem, deep sleep, light sleep. You know, why don't you kind of. I don't want to go this. We're trying to keep this usable for regular people, so let's kind of keep it.

We're not even talking about waves.

We're talking about waves. I'm talking about, you know, I am.

Not a sleep specialist. I just know a lot about a lot and a little bit about a lot. And my understanding is, you know, the stages of sleep, obviously you want to cycle through and you're going anywhere from I'm awake to light sleep to REM to deep sleep and on back up. And the goal is to get adequate REM and adequate deep sleep because that's really where restoration is truly happening. That's where the glymphatic system is truly kicking in. You will spend, and this is appropriate to do so the bulk of your night sleeping when you are sleeping in light sleep. But that REM sleep is really important. And it's a state where your body is reversibly paralyzed, your physical body. So you're acting out these dreams in your head, but your body's not responding in any way, shape or form. So that's when you're dreaming. That's rapid eye movement. That's what REM stands for. And then non REM would be the other stages, including deep sleep, when you're really deep down and the body's really doing the housekeeping. But a lot of repair and restoration is happening at that point in time too. And that's where, if you're getting adequate deep sleep is when you wake up feeling refreshed and when you wake up feeling right, and I got a good night's sleep. But it also is dependent, as you were mentioning, on how you feel going to bed that night. Do you feel safe? Do you feel like you can sleep well? Or are you almost hyper vigilant to the point where you're never getting into these deeper stages of restorative sleep or dreaming? And that's problematic. And a lot of my patients talk about this all the time. It's like, I'm dreaming again, Doc. And they say it like they just won the lottery. I'm dreaming again. And that's important because they know their sleep is repairing and they're feeling that. And I know that that's translating into their physiology repairing as well. And that's with a lot of the work that we do based on managing their stress or improving their sleep hygiene is some of the things that we're going to touch on and have already touched on. But how would you kind of talk about that a little bit with the stages or add to what I said?

One thing that's interesting about the stages is that you tend to have the deep sleep front loaded in the front part of the night and you tend to have the REM backload in the back part of the night. So all of a sudden it makes, when you go to bed and the consistency of that super important. Because I track my sleep every night with my ring and I see when I try to go to bed, it's really interesting. The nights I go to bed late, my REM is horrible, deep sleep is less, but my body tries to preserve that. And when I go to bed like in my normal time, but I wake up, you know, early, I'm not getting my deep sleep. And it's really interesting to watch that they're out. You, you really need your sleep to be roughly going to bed at the same time and gamble at the same time on a consistent basis.

Is there a perfect or an optimal time for someone to want that, that people should be going to bed and waking up, or is that dependent on the individual?

There are different chronotypes and that's, you know, a little deeper than we're going to go here. There are certain people, people use their dysfunctional sleep more as an excuse and say, I'm a night owl. There's not a lot of night owls. We have one third of the population. Yeah, but the average, you know, whatever, but, but the thing about it is that, you know, typically your body is going, your, your cortisol's gonna be going down, your melatonin will start going up. So typically you wanna go to bed within an hour of the sun setting. Um, the interesting thing about our sleep requirements is they change throughout the year as well. You know, when the days are shorter, your body actually needs a little less sleep. There's a natural sleepiness that builds up throughout the day that, you know, you're, this is when people talk about adenosine levels. Um, and this is one of the things that caffeine does is caffeine blocks the effects of adenosine as it builds up in your body during the day, which makes you. The sleepiness. Which is one of the reasons, one of the reasons that caffeine Actually helps with sleepiness because it actually counteracts on the impact of adenosine. But typically it's like, you know, during the summertime you need less sleep and the wintertime you need a little more. And we don't change our sleep. We, we have artificial lights. So ideally like in the wintertime it's interesting, in the wintertime I can sleep, my kids actually sleep like an extra two hours in the wintertime. In the summertime they, and because they're, it's they, they naturally get up when. And the sun, sun comes up. Yeah, and that's what we're supposed to do. Now there are some people typically naturally you'll wake up slightly before sun. If you're getting adequate sleep, your body will typically start waking up 30 minutes plus or minus before sunrise if you're doing things the right way, you know, which means. And that will change a little bit throughout, throughout the year. Now is that practical to do all year long? You know, probably not. That's the goal to shoot for.

Yeah, I think a good goal for most people is getting too bad by 9, maybe falling asleep by 9:30, 10 o'.

Clock.

This is my personal opinion, this is how mine's set up. So I'm in bed by 9:30 the latest, I'm asleep by 10, ideally sometimes earlier, but somewhere in that 9 to 10 gap and then I'm physiologically waking up. I set an alarm as a backup plan but I'm waking up before it six out of seven days a week between the, the hours of 5:30 and 6:00am and for me that's a nice window. It gives me my eight hours, sometimes it's seven. Either way my body seems to be okay with them and I haven't had such a kind of consolidated, structured, consistent sleep like this at any point in my life. And my body has yearned for something like this and I can feel it physiologically. So I think it's, it's important to kind of identify where you belong.

And as the important thing is consistency, you know, the most important thing is to make your wake up time consistent. The next most important thing is to have your time you're going to bed be consistent. Yeah. And that's where I think people like if I didn't make my kids go to bed at a certain time they would, you know, it'd vary a whole lot. So but that's one of the things I think with the sleep is that the nuance I'd attitude is that the rim is front loaded, the deep is back loaded and so if you're cutting off on either one of those, going to bed late, waking up early, you're missing one of those two parts of either the rim, you know, which is when you do your dreaming, it's when you do emotional processing, your memory consolidation, or your non rem, which is when you do your physical restoration, your immune support. And you mentioned the whole lymphatic system, the brain, when you take the trash out, some of those things which are beta amyloid, which is, you know, what builds up in Alzheimer's patients, right. So it's important to get that deep non REM sleep. So what this great, you know, not getting enough sleep is associated with dying for new calls and autoimmune issues and stuff. But the reality is, is like, we just don't know so much about sleep. Most of what, what happens with sleep, we still don't quite understand issues like narcolepsy, that it's kind of. We're using medications actually now to act like, you know, to work through the orexin system to help induce sleep.

Have you ever lost trust in your own body or in the doctors who were supposed to help you heal? It happens to millions of people who are stuck in the cycle of prescriptions, tests and. And more questions than answers. That's why Dr. Aaron Hartman wrote his new book, Uncurable. As a physician and a parent, he's lived through the pain of being told there's nothing more we can do. But instead of accepting that, he built a new path, one that combines traditional and functional medicine to uncover what's really driving illness. Uncurable is more than a book. It's a roadmap to help you find the root causes your doctor might have missed, reactivate your body's natural healing systems, and finally believe in what's possible again. If you've lost hope or trust in the system, this book will help you take back control. Go to UncurableBook.com and grab your copy along with Dr. Hartman's free resources to help you start your healing journey today.

Let's talk about sleep apnea real quick because that's something that, you know, I learned about in medical school and basically was just obese males with thick necks, but we see it all the time. Well, you talk about dreaming. I didn't start dreaming. I used to say again, dumb things you say when you're a young, young guy. You know, my mind is, is I have the superior mind. I don't need to dream. Huh? I said in the past, don't you.

Writing all these down are you going to have a memoirs? Dumb things I've said. Is there enough of them?

There's, there's so many you've heard, you're hearing all these things. But, and when I got checked for, because I hey, let me try this, I checked myself. My apnea hypop index was four and a half or five, which doesn't meet American College of Chest Physicians criteria. I only desat it to 92%, which doesn't meet that criteria. But I'm like, well, this is weird because I'm having four and a half to five. That seems a little suboptimal. And my oxygen's desegted 92%. I have to hold my breath. You know, I do experiments, you know, 30, 45 seconds. So I went on and got a dental mouth thing made for myself. I started dreaming after I put that.

In, I actually was diagnosed with sleep apnea. That's why I said, like me, I was 230 pounds. I was literally 65 pounds heavier than I am now. And I had the weight and the short thick neck and the excessive posterior soft tissue. And ultimately it led to a diagnosis of severe sleep apnea. And so I used a CPAP machine because I wanted to get better. And as much as I hated that device, I used it. And as I cut the weight, I in my mind thought that I was reversing this condition. And I went and all excited, let's get another sleep study to prove, prove myself right. And I was wrong. I still had sleep apnea, but it was mild. And so by losing the weight and improving, I wound up having a much less severe diagnosis and qualified for an oral sleep appliance, which I use to this day. And I took it a step further and I did a sleep study with the oral appliance in to prove that it was actually working. And my apnea was gone. And so I went from severe undiagnosed to treat it to much better still treated to the treatment I'm using that's portable, easy, called the oral sleep appliance is treating my condition and all my all cause mortality went down. Blood pressure got better, cognition improved, metabolically, I got better, immunologically, I got better. Obviously things like mood and energy, they all kind of followed suit. Sleep is my religion at this point in time. This obstructive sleep apnea diagnosis, I mean, are we diagnosing it appropriately? Are we picking up on all these people? I mean, who's, what do you think? Who's coming through that? You see, is it, is everybody the Stereotypical or are you picking it up on everybody and how do you go about doing that?

I got really good early on in my family medicine career at picking up the. You're doing your, these Aries tests which is a little sleep apnea questionnaire people fill out. And after a while I got pretty good just looking at someone because your neck is thick and you look in the mouth and they have a small airway and it's usually an overweight male, you know. But when I started doing the functional medicine stuff and started learning about upper airway resistance syndrome which is people with petite airways and learning about hypermobility which maybe 20% of the population has, that changed my perspective on. So when I'd start seeing people with chronic fatigue and fibro. These are usually women now slender sometimes that are double jointed, hypermobile, whose tissues are super soft, have like velvety skin. I started finding an unusual number of these individuals with severe sleep apnea. One of them, with one that you know, struck me was a actually a female physician who just, you know, she's a mom young kid, she just, you know you're supposed to be tired when you're you know, a female and a physician and a mom like that. She's accepted that as her normal her. She decided to. 72%. Yeah. It was like one of the worst cases of sleep apnea I've seen. And it was like she wasn't overweight, slender neck, but she had very small oropharyn opening her mouth, had a high arch dental palate. She had dental narrowing. And now when I know about that, that's reflecting the facial structures. So now I'm diagnosing sleep apnea, but not with this Aries people looking. We still fill it out to get insurance to pay for it. Right. But it's looking at your teeth. Do you grind your teeth? One of the things your body does when you have sleep apnea night is you actually your masseter muscle will engage and you'll tense up. You might have headaches and stuff and get migraines. But the just as you're kind of tensing up these muscles to open the airway. Airway. Well we now have a medically approved FDA device now that actually they'll put a little pacer thing and put things and it'll actually contract your muscles to open your airways out. Then you can actually get your friendly local ENT to put that device in and you. To treat your sleep apnea, right? Yeah, but it's like a whole group population of individuals are set up for this and so I think, you know, sleep apnea is hugely underdiagnosed because we're only looking at obese individuals with big necks and big tongues and we're not looking at hypermobility. And so in my clinical practice, if you have a chronic health issue, which is what our clinic is, and you're, you have hypermobility, I'm checking you. And probably from 60% are coming back with sleep apnea and they're not overweight and a lot of them are slender.

Yeah. I don't know if it's just pre selection based on our demographic, but the reality is that it is incredibly rare that I order a sleep study and it comes back normal.

Yeah. I think on our clinical experience here, I personally, one of my, you know, everybody gets a colonoscopically when they're 40 or 45. You know, everybody gets their A1C screen for diabetes. You know, starting when you're. These days, like, you know, 38% of.

Kids are pre diabetic.

Diabetic now.

I mean, awesome.

Yeah. So. But everybody should get a sleep apnea test sometime in their adulthood, at least by the time you're 50, maybe earlier.

I like that and I like coronary art, calcium CT scores. If we're doing anything cardiometabolically or whole person medicine, you need some of that stuff. Or all of it, in my opinion. To me it's. It's baseline that's not even fancy or expanded. It's like this should be your baseline testing.

Where it gets tricky though, is that it's not covered by insurance. And so that's. Sometimes it's a hard sell when people are like, well, why? My insurance said this is experimental, it's not medically necessary. Why are you ordering this test on me?

It's like, I mean, but how much of what we do is that same scenario. We just gotta work around, push through, do. Do what we do.

Yeah. What I tell people is screening. Doing a screening. A1C for diabetes is still considered experimental by CMS and it's insane. Which, you know, I literally have to make up a diagnosis of elevated sugar. And it's usually elevated. So I'm. I don't know, I'm predicting, you know, but a good screen test should be. You don't have to fudge. You say screening A1C and it gets covered.

You know, you shouldn't have to wait for evidence of disease to screen. The whole point is of screening is prevention. It's moronic. I don't know how else to say it.

That's A standard of care.

There you go. That's the nice way of saying yeah.

But, but a couple of thoughts about sleep and sleep apnea. Sleep apnea also tells us all the things that poor sleep can be associated with. We know sleep apnea is associated with the sudden death syndrome.

Yeah.

I hear about a, you know, middle aged male who falls over, suddenly dies. It's. And you kind of look at things afterwards. It's typically had sleep apnea that was undiagnosed. Yeah. You know, it's increases your risk for diabetes. It's increased, associated with increased risk for epithelial cell cancer. So breast, colon, prostate, dementia, dementia. So poor sleep. You know, sleep apnea is like the worst. The worst. But how many people don't get adequate sleep? And the answer, I just told you is a lot. Yeah, the average person. So all of a sudden just getting better sleep is going to affect everything, which is one of the reasons why sleep is one of the, you know, the foundations, it's, you know, foundation of functional medicine within that, the triangle of health, which is like the most important of the most important. Yeah.

So, so how are we talking about how in this one or in the next one? How, how do we get good sleep? What do we do?

That's the next, next one.

Okay, okay.

So why is it important? Memory, learning, attention, emotional regulation. You know, let's talk about that briefly. Kids.

Yeah.

How many kids have emotional regulation issues these these days?

A lot.

A lot. How many kids have ADD and adhd? A lot. How many kids have depression, anxiety right now? A lot. Lot. You know, and so it's like how.

Many of them are getting sleep?

Not well, according to the data. So according to the data, most of them are not getting accurate sleep. And so they get a lot of Adderall. Yeah.

And you combine that with the nutrient deficiency statistics that you gave in, in our, in our podcast. I don't know if it was this one or the last one about magnesium and potassium and all of these calming electrolytes. Right. And things like omega 3 fatty acids, which are also calming and anti inflammatory. Like you combine the nutritional deficiencies with the sleep inadequacies and then all of a sudden you have diagnostic entities that we're throwing pharmaceuticals at, not correcting these other problems.

What's interesting with the adhd, there's a prescription drug called Virin that's been FDA approved to treat adhd and it's a prescription fish oil.

Yeah.

So my question is, do we have a epidemic of omega 3 deficiency in these kids?

Yes.

Yes. And we do Omega 3 levels on.

Our patients as a routine low on everybody.

So many people have low levels. And it's like, do you, you know, do you give them, you know, Ritalin, Adderall, Stratter, or do you say, get.

Your omega 3s in, eat some salmon, eat some walnuts, and take this and get. Supplement and get some sleep.

Get some sleep. Yeah. And so all of a sudden, like, the basics are ridiculously powerful.

Yeah.

So admissional, physical, immune, hormonal balance. One thing I think is really big. A lot of our patients, we. We have a. You know, we've become hormone experts just because we see lots of hormonal dysregulation. And 80% of our patient population are. Are females. You know, talk about sleeping hormones. Cause I think that's something where I have a hard. It's a hard sell with patients where it's like, you check your levels, they're off.

Yeah.

Having hot flashes. Maybe you can talk about how hot flashes and cortisol.

Oh, that plays a role. I mean, it's the easiest way. I don't feel like I have to sell it. The easiest way is to just explain to them in the vein of it being the hormone hierarchy, which we know exists. And. And so essentially, the way that the body is structured, the way that physiologically it's structured, and the way that we test, or at least the way that I test, is that we're looking at the adrenals, we're looking at thyroid, we're looking at sex hormones, all of which are influenced by sleep. They're all influenced by gut and nutrition and everything else, too. But that being said in this conversation about sleep, if your sleep is off, your HPA axis is gonna be off, your adrenals are gonna be off, your sleep, wake cycle, your cortisol, your melatonin production, which we can also measure by the way, is gonna be off, and that's gonna then trickle down and affect these other things. So you're gonna see maybe suboptimal thyroid or frank hypothyroidism or hyper, depending on what's going on. Or maybe that person already has a diagnosis and you're struggling to get them optimized because that layer of sleep and stress and circadian is not balanced yet. The sex hormones for sure are influenced by this. Melatonin is breast protective. Melatonin in and of itself is one of these things that, you know, in the literature, using high doses can be really helpful in breast cancer patients as adjunct therapy. I mean, I use whopping doses just to get people to sleep. But sometimes I use it in the setting of COVID in infectious etiology. I'll use melatonin in the setting of someone who's chronically inflamed and oxidative and not sleeping. And they're like, really that much. I was only taking 1 milligram. You're gonna be fine. And you just kind of get them to the point where they're sleeping and then you can reverse, titrate. You're not gonna hurt that person. But the trickle down on these other hormone cascades, and then there's a bottom up mechanism as well, is that you get these loops that happen and one begets the other and you just get kind of caught or stuck in it. The vasomotor symptoms associated with hormonal withdrawal absolutely wreck someone's sleep. That make them stressed, that make their sex hormone symptoms even worse. Because perimenopause is a transition, and it can be anywhere from one to three to maybe as long as seven years in certain individuals. That transition and how that happens, whether it's gentle and slow or precipitous and fast, is going to determine whether that person has not only the symptoms associated with it, like vasomotor sleep disruption, but then the concomitant and resultant other cardiometabolic ramifications. Weight gain. Now all of a sudden my A1C is creeping up. Now all of a sudden they're telling me my bones are thin. And that is also secondary to lack of sleep because the catabolic nature of excess cortisol and what it's doing to your bone health or the inflammation that's coming along with that weight gain that's now affecting everything else. It just all becomes this interwoven layer of hormone on hormone on hormone crime that we have to find out who's the criminal and what are we going to do about it?

Right? Well, two things I want to say add to that with the melatonin and the hot flash part. Now I'm working on a, a personalized medicine fellowship right now at the usf. And the first thing was just hormones for it was probably 60 lectures on hormones. So it was just a deep dive in. And one thing I did not realize was that, I mean, I remember hearing it like every cell in your body makes, makes melatonin, right? But the cells in your GI tract make melatonin ten to a hundred times levels ten to a hundred times higher than those in your blood. And there's actually literature on using oral melatonin to treat stomach ulcers. And, and leaky gut stuff. And so all of a sudden it's like, yes, I understand the one to three to help you sleep, but you can use it for lots of other reasons. You mentioned the breath, breast health thing.

But melatonin, nocturnal dyspepsia, it tightens the lower esophageal sphincter. So clearly it has GI receptors.

Yeah. And so it's, it's, it's a powerful antioxidant. And with our COVID patients, that was one of the first things we learned to block down some of the systemic brain inflammation. Post concussive patients with post concussive syndrome. It's helpful. And like my kids with autism and pandas and horrible sleep issues, melatonin can be super calming for them and help calm their inflamed brains down. Well, guess what, if you're not getting adequate sleep, you lose all that. You know, in the hospital. You know, when I was doing hospital work for like 15 years, I did that, you know, stress induced ulcers in the hospital because of who sleeps in the hospital, you know, and the cortisol gets high. On the flashing side of things, it's interesting how as you get older in women, as their estrogen kind of goes down, it's like the buffer. You can be 22 and, you know, have a career and be professional and have kids, and you don't flash because you've got all your, your superpowers, which are your sex hormones, as, as a female. But as your, your estrogen kind of comes down, you, you lose that buffer between cortisol causing a release of your epinephrine, norepinephrine, your catecholamines, and they are what causes the flashing phenomenon. So the flashing phenomena that happens that can be horrible isn't primarily a low estrogen phenomenon. It's a low estrogen in the face of high cortisol, which drives up the catecholamines. If you're not getting accurate sleep, you're gonna do that. So all of a sudden, adequate sleep can be part of the treatment for hot flashes in women with low estrogen levels.

But if you're not sleeping because of the hot flashes, then what?

You're not seeing the hot flashes? Well, then you can use things like rhubarb extract to help with the flash.

Yeah, or bioidentical hormone replacement therapy. Right. Like in the right population.

The thing is, the most rapid bone loss for women that leads to osteoporosis is in the first two years post menopause. So at that, it's not really for debate. People can debate how long you want to be on it, but there's really not a debate during that time. It's really critical to. For the bare minimum, minimizing bone loss. If you look at early menopause, when you lose your hormones as a woman, the earlier you lose them, you also have a higher incidence for carvascular disease, neurovascular disease, dementia. And so all of a sudden, if you're going through early menopause, like dysfunction. Yeah. Bioidentical hormones become a bigger issue. If you're like 52, 55, and going through it, we can talk about that. Depends on your symptoms. But if you're like 40, which a lot of our patients are. Yeah. Going through early, then that early. Going through menopause 10 years young, earlier means that when you're 65 and 70, big problems. Bones might be 75 or 80.

You know, I love progesterone for sleep. I mean, and. And that's also withdrawing. Right. Like, you're still making these in your adrenals at this point in your life. Right. When you're perimenop, your ovarian production is going down. Hopefully the adrenals are pulling some of that weight. Inevitably, the ovarian production stops. And all of it comes from the adrenals. And it's kind of like going to your retirement fund. But you didn't save up enough money. And now all of a sudden, you have this big, steep, steep drop off. But you also don't have the supply to gain the same benefits that you were getting. Progesterone converts into allopregnanolone, converts into hit my GABA receptors, and I'm gonna be calm, less anxious, and sleep like a baby. That's really important. And you lose that. That's why we start to see sleep disruption. Same reason that we start to see some of these other things. So it's just, it's all interwoven. The body is a complex system of systems. That's why we do what we do.

Memory, hormone balance, immune system stuff. So I think the takeaway from this session, this session is how important sleep is. It is a vital sign. You know, blood pressure, pulse, temperature, your weight. How's your sleep?

Yeah.

And it's. In our current healthcare system. We don't really address it enough. Unless you see a sleep specialist in the. In the functional medicine world, it's one of the key cornerstones. And I think next we'll talk about is actually what can we do to treat that? Yes. Cause I think. I think if you have a sleep problem, people usually know and the frustration is so what? So I think next we're talking about the so what? So we can give people some actionable.

Yeah.

Ideas. So hopefully this information was helpful. Again, if this was useful, please like share subscribe below. Don't forget to put your questions. I need to say this at the beginning, actually, because we'll be answering those during our Q and A session that will come up later. So just put them below and we will talk to y' all soon. Take care.