Sleep Makes Everything Better: Prioritizing Sleep, Signs Of Sleep Issues, And Practical Tips To Improve Sleep Quality With Founder Of Sleephoria, Valerie Cacho M.D.

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Today I'm so excited to have Dr. Valerie Cacho with me. She's an integrative sleep MD, a women's sleep expert, and a writer and speaker on sleep health. She's the chief executive officer of Sleepphoria Health, which is a resource promoting women's sleep health and whole health Living. She's an integrative sleep physician and she practices in Iwā Beach, Hawaii. We're all jealous, right? She's a board-certified physician who trained at the Loma Linda University in California, and she's fellowship trained in integrative medicine at the University of Arizona. I'm so excited to talk to her today about how we can all get some restful sleep in these stressful times. Hi Valerie, I'm so excited to see you.

Thank you.

Valerie, it's so nice to see you. And you're all the way in Hawaii right now?

I actually— I moved to California. So about almost 2 years ago, 2 years in November, I moved to California. Originally from California.

Okay, great. I saw that you went to Loma Linda.

Yes.

For medical school. They did all those studies on the Blue Zone, right?

Yeah.

The Adventists. Pretty healthy diet lifestyle.

Yeah.

The Seventh-day Adventists.

Yes.

So Loma Linda is famous for all of that. I want to talk about how you started Sleepphoria and when you started. I know it was part of a personal journey, right?

Yeah, definitely. So, Sleepphoria was really an outgrowth of what I saw women going through in my clinical practice. When I was living in Hawaii, I was a medical director for one of the busiest sleep labs, sleep departments in the state. And there was a lot of women coming to see me really to rule out obstructive sleep apnea, or maybe they had insomnia and their doctor gave them some medication, and that was pretty much it, and they were still having a hard time sleeping.. And so, as I dug deeper into learning about really midlife women's sleep, there was just not a lot of data out there and just not a lot of resources. And so, I felt like, chucks, that's not cool. I mean, I think in general, women just get sort of outcasted, thrown to the side. A lot of the medical literature research isn't done on women. I think more so now that there's a lot of people discussing it, you know, Oprah has sort of made menopause one of her platforms, which is really helpful.

Oprah has a menopause platform?

Yeah, exactly. Yeah.

With her and—

Maria Shriver. Yeah. They did a whole panel with Dr. Heather Hirsch. It was pretty phenomenal. But yeah, I think just more and more people are talking about it as women get older. I think after we're done having our babies, I feel like our culture or maybe our healthcare system forgets about us. And I think that's certainly not the case because, you know—

Well, if Oprah can't sleep, maybe we're gonna have some good research on it now.

Maybe so.

And you know, that's funny what you brought up about the mothering. So you have kids, right? I do. How old are your kids?

I have a 3-year-old and a 6-year-old. So I guess that's—

Oh my God, it's so cute. Okay, so I'm a mom. My kids are like in college.

Oh, so nice.

I think a lot of us just kind of wake up a lot during the night and then you kind of forget that it's not normal to wake up throughout the night. So like when they're little, you're oftentimes waking up through the night and then the rest of your life you're kind of thinking that that might be normal.

Exactly. And I think that's one of my favorite things to talk about. It's because You don't have to be tired. I mean, certainly if you choose not to sleep for multiple reasons, if you have a side hustle, if you're watching shows on Netflix, you know, that's something else. But the sleep revenge thing, right? Revenge bedtime procrastination. But I think, yes, our peers, a lot of people our age are just really tired, but it's so commonplace they think it's normal. And I'm here to say that, you know, there could be an underlying medical condition or, you know, a disruption. I like to think of it as a disruption between the whole mind, body, and soul axis. And sometimes that can disrupt your your sleep. So, wow, that's really like the way I approach my patients and some of the information I put online for Sleepphoria.

People always say, I'm so tired, I'm exhausted, and they think it's normal. And sometimes it's even like a badge of honor. Like Arianna Huffington used to always say, like, she never slept until she had a, I don't know, some health crisis. So you're saying that we don't have to feel tired on a day-to-day basis?

No, exactly.

So even you have a 3 and a 6-year-old. Yeah. Do you get your sleep? And, and tell us about how you started on this journey, because I know it was because you had your own burnout, right?

Yeah, exactly. So it's just so interesting. I think for me, I don't know how far back we want to go, but a lot of what you do or what you think is the programming, I think, that your parents instilled in you. And, you know, personally speaking, my parents are immigrants. They're from the Philippines. My dad is actually a cardiologist. He's a little older now, so he doesn't do interventions anymore, but he was working I don't know, like 16, 17, 18 hours a day, come home, there would be a STEMI, go back to the hospital in the middle of the night. And then my mom raised 3 kids and it was pretty much, they were always on the go. She helped him in his practice as well, doing billing and office management work. But I think it was just instilled in me that you would just work like all the time. And when I had my first couple jobs being employed for hospital systems, I would just do the same. You know, when I started to have my kids, you know, they go down to sleep, I would just continue doing my notes, continue doing patient messages, read sleep studies till like midnight, and then go back to work 6:30, 7 o'clock, tell patients to sleep. And then I started to feel like, this isn't right, I feel like such a hypocrite. But I didn't realize that programming was pretty much instilled, and it was just like, you sacrificed your health to take care of others. And then it really got to me where I was also the medical director of doing pediatric sleep. And I just started to feel guilty that I'm taking care of other people's kids and then not even taking care of my own kids. Because I would have a sitter come on the weekend so I could, you know, catch up on the studies, catch up on the messages, and really build the program. And I think that just got to me in a sense that I'm all about taking care of your health. And then I wasn't able to because I was just working so much. So that whole self-care component, and I didn't even realize it was burnout. I just felt numb, which sounds a little bit funny because I think it's one of those things everyone around you is working just as hard. I think I was talking to a cardiologist and complaining about, oh, I have 50 notes to do. And you know, I just don't like that, how it's like sitting on top of me. And he's like, you know what, Val, I have 100 notes to do. He's like, you just need some perspective. He's like, I come in here every Saturday. And I'm like, no, that's not cool. I'm not okay with that. And then the pandemic hit and it was just like, okay, something has got to change.

And it's common, right? For especially, I mean, I myself feel like that, you know, sometimes I get off balance, but it's all about getting back on balance too, right? We can't be perfect. I definitely recommend and a lot of things that sometimes I get on and do those things, and sometimes I don't. Like, I fell off my eating schedule for a couple of months, you know, when I was like super stressed. But you're right, what we know about our brain and how the neuroscience works of training our minds through seeing our parents and how they raised us, right? So you were talking about those kind of habits, and obviously your parents have insane work ethic, and that is an excellent thing. And Suffice to say, there's still a lot, right?

Yeah, they're in their 70s.

So sometimes it's hard to say, you know, when you see things like that, like, well, they didn't sleep and they're still healthy and they're, you know, but it does take a toll, obviously. And they had a different way of looking at life, maybe. But definitely burnout is real. And tell us about what you did to switch out of that.

Yeah, I felt guilty about my own kids, but then also I felt guilty for my patients, which almost seems funny, but I think it just goes back to my programming. A lot of it was just self-sacrifice in service of others. And so I talked to a couple other older physicians within my group. And I remember one pediatrician who was probably working there for 30 years. She was like, Val, you know what you need to do? You need to take 50 minutes every day for yourself. And I looked at her almost in like disbelief. I was like, how am I going to find 50 minutes? I can barely have 5 minutes to go to the bathroom. And that just hit me. And she, I was like, well, she's been doing this for so long and I'm sure she's come through, you know, peaks and valleys within her own life, and she's recommending 50 minutes. So I really started to reflect on that.

That's really nice that you had a boss like that. I had a boss who was incredibly successful and smart and awesome, but she actually told me she didn't drink fluids because she didn't want to go to the bathroom. She had an insane work ethic. But I'm glad that she said that to you.

Yeah. Sometimes I think part of this is— Yeah, I think part of it is being in Hawaii. It's a little bit more chill and relax, and I'm probably bringing my mainland work ethic there. That's probably why the organization liked me so much. But then the pandemic hit, and then I had my second child, and I was just like, with two kids, there's no way going back to that lifestyle where staying up till 11, 12, going in early, and then really just feeling like a hypocrite telling people to sleep, telling people to exercise, take care of their body and health when I wasn't doing it. And I think that was probably the big turning point. I did practice— I do practice a lot of meditation, like self-reflection, really just through the Integrative Fellowship, and started to go back to those practices that got so busy and ignored for so long. And then it's really when you have that time and space, when you give yourself permission to take that time and place— space, it it's just interesting what your brain starts to offer up where you realize you don't have options, but there's so many options available to you and you don't have to sacrifice yourself anymore. And you can help people 3 days or 2 days, you know, however.

Maybe even help them more.

Exactly.

But also like, I just love that you mentioned this boss because it does sometimes take an outside voice. And you know, when, when they show the research on burnout, it really isn't Yes, you can control certain things about your own stress, and you know, that's a lot of what I teach, like changing perspectives and meditation, self-care, exercise, sleep, all that. But when you're in a system— burnout research— it's the system that the people you're working for, or the system you're working for, if they don't allow you to take that time for self-care, or somebody doesn't say, you know, you should really take 50 minutes for yourself, then you actually don't have that out. Like you were saying, you said you started to look for things and ways to take care of yourself, but when you're in that system, it can really feel like you're trapped. So, but I love that your boss said that in Hawaiian.

Yeah, I remember I had a different boss, my, uh, chief medical officer, and I think he just asked me how it was going. And, you know, I think he seemed to care, but not enough to hire me help, but I just told, I remember telling him, there's not enough Prozac in the world for this job. And then he was like, well, what do you want to do? And I was like, well, I don't know. And he's like, well, you know what? You could work at Starbucks.

Ouch. Well, we love Starbucks, but, um, yes, you went to medical school and you did an integrative medicine fellowship. Um, yes.

So I think that helped too. Just like, no, okay. You know, sometimes when people think, say things like that, it's like, oh no, I'm going to prove you're wrong. There's so many other things. I have so many other talents. I can figure this out. Yeah.

But tell us now about Sleepphoria.

Yes.

And how you got started on that and how you switched from full-time to part-time.

I left, I started my own practice, and it wasn't busy in the beginning. And given my whole programming, you know, I was itchy to do more.

So you just put up a shingle, like you just opened, you rented a space?

Yeah, we actually bought some property in Hawaii. So my clinic, even though I'm physically located in California, I do telehealth for California and Hawaii because I'm more established there. I was there for almost 7 years, so I just have a lot of referrals, and it's a doctor shortage state, so I feel like they really need me and people are really nice and so I'm comfortable there. So I do everything remotely. I have staff there and I do that about 3 days a week, 3 and a half depending, and I just hired someone else.

So you're still licensed in Hawaii and California, so that's amazing.

And if my kids are sick or if they're out of school, then I can just cut back my hours and it works pretty fantastically. Yeah. And so My side hustle, or really what I want to get into more, is teaching women about the importance of sleep, prioritizing sleep health, and just whole living. So ideally, they don't have to go into the same place as me, but almost to know that there are options where you don't have to be tired. If you have problems with your energy, could it be from your sleep? Could it be from, you know, the way that you're living your life? And Sleepora is really an online resource. It's really educational. I do a lot of podcast guestings, write blogs, I have a YouTube channel, and all the patient— I said not patient, I guess public-facing material is free because I feel like a lot of things that I say in my clinic are things that other women and other people want to hear. And so it shouldn't just be, you know, the one-on-one interactions I get.

Tell me how you got started, like, writing blogs for— I know you do some work for MindBodyGreen and things like that. So how did you get started on that? Did you pitch them?

Oh, that's a really good question. I had a friend who left the organization that I was working at before me, and she said, you know what, Val, like, once you leave, all these opportunities come. And I'm like, what do you mean?

You had some nice people. I'm moving to Hawaii.

Yeah, they're really supportive. And I was just thinking, like, what do you— like, I didn't understand that. Like, and I think it's just the energy you put out. It's like what you attract. So soon after, I started just a professional Instagram page.. And I got picked up by Athleta. So the, it's the women's athleisure brand for Gap. And they were starting this whole platform called Athleta Well, and they were looking for a sleep guide. And so they had a yoga person, a meditation person, a mental health person, and they, you know, did their market research and found that women, you know, adult women really wanted to learn more about sleep. And it was a hot topic.

Wonderful. So what did you do for them?

Create content. Yeah. So videos, questions. There's like live questions that we would do, short-form content. Yeah, it was pretty great. And I think it was really that invitation, that opportunity that got my feet wet. And I was like, I can do this. Like, people want it because I'm pretty a shy person actually. I'm really an introvert. So I haven't really pitched to people. I think probably that's the next step where I want to go with Sleepphoria. But yeah, it's just, you know, through connections, through network, and it's been great so far.

So they're reaching out to you, like Mindbodygreen reached out to you through Athleta.

Yeah, through that partnership. And then you just meet writers and then they meet other writers. And, you know, I think one writer, I said, oh, how did you even find out about me? And she's like, oh, I just posted in Twitter I needed a sleep expert and your name came up. And I'm like, I'm not even on Twitter, but I guess within the writing field, writing world. So I get asked by journalists YouTube and Instagram and actually Pinterest. I have a virtual assistant that does a lot on Pinterest. What I like about Pinterest is that it links directly to your website. So if they click on your pin, they can go directly and read that blog or go directly and read the YouTube.

Do you come up with your blog ideas from like your patients asking you questions?

Yeah, exactly. I think, you know, knowing who your client is, your customer is, and just, you know, serving their needs. But also, I have a friend who is a nurse practitioner in the menopause space, and same thing, she's like, well, talk— make a video about restless leg syndrome, or make a video about melatonin, make a video about clinical hypnotherapy for hot flashes. And I'm like, okay, because, you know, she sees them day in and day out, and they're asking the questions, and then I create the videos, and then she just shares it with them. So it's just really fun collaborative environment.

I love it, I love it. So what is the top question that you get? What is the biggest problem that people have when they come to see you?

Energy. Yeah. Well, in my practice, sleep apnea, snoring.

So their spouse is telling them they're snoring.

Yeah. Their spouse, or maybe they go on a trip with girlfriends and maybe they're in denial, but they're snoring. They're snoring and then they're just so tired despite how much sleep they get.

Oh, so from the snoring.

Yeah, definitely. Or, I mean, sleep deprivation is also a big part of it, um, but snoring definitely. So as we get older, as women go through perimenopause and menopause, we start to lose estrogen, progesterone, and that really does make our airway more floppy. So the rates of sleep apnea double to triple.

And I read that, like, you had written that even just 10% weight gain can cause sleep apnea. And that's, that's very little. So if you're like 120 pounds, if you gain 12 pounds, yeah.

Or it certainly can happen.

Yeah, I'm not 120, but just hypothetically. So if you're 150.

Especially if it's this, I mean, it depends on the distribution, but typically it's around the neck and throat.

I see. So I have to say that, you know, one of the reasons some people don't get sleep, and this is me included, is because you're spouse snores. So it was getting so bad, and my husband— I mean, he's the best guy, but he was snoring so much. Like, I had to, um, actually— and, and there was a miracle cure. Our dentist gave him this very, very flexible— it's not even like— one of his friends was like, go on CPAP. And we're like, no, we're not doing that, cuz my husband had a sleep study, which we'll get into because you do those, right?

Yeah, yeah, yeah.

It was not pathologic. It was close, but not—

oh, okay, borderline.

Yeah, like not even— yeah, he just couldn't get past like an actual pathology, which is great news because I'm so happy he doesn't have anything. Anyway, so he, you know, finally after me nagging him, he finally got this thing, which I guess it costs— I guess it costs a lot, like it's like $1,000, I don't know., but it was worth it because it totally stopped him from snoring.

Oh, that's awesome.

It's crazy. Plus he lost a little bit of weight.

Yeah, that's good. But yeah, those oral appliances, the dental devices, it just moves the tongue forward a little bit. You only really need to move the tongue a couple millimeters. You know, when you move the mandible forward, there's more space in the back of your throat. So yeah, it's fantastic. Um, it can move the teeth and jaw around. So hopefully he's seeing a good dentist. Uh, sometimes it's just positional. I'm actually getting together a talk for Grand Rounds in Hawaii about all the alternative options for sleep apnea. And some patients, 50% of their snoring and sleep apnea could be related to position.

Because they're sleeping on their back?

Yeah, when you're on your back, gravity's pulling back on the tongue. So sleep on your side. If you can get an adjustable bed, prop yourself up. It's really interesting talking about snoring. There was a recent article that I was reviewing about snoring in women. And the premise was, do women snore as loud as men? Actually did, you know, check the decibels in the lab and it was like—

I bet not.

Yeah, no, they do.

They do? Yeah, they do. It depends on so many things though, right?

Yeah.

Alcohol.

Yeah.

Right. Because you get the laxity in the throat. And I mean, I investigated this because I needed my husband to stop snoring.

Right.

I realized I was being woken up at 3 AM and that's tough for me. Right. So, and it's like bad for my health. Then it was reflux. So he needs to not eat close to bedtime and 3 hours or so and especially spicy foods or things like that. And then he lost a little bit of weight, um, and then he has to sleep on his side. I got him like a body pillow because I just wrote a blog about, um, sleep position and dementia. Oh, so there is, yeah, a correlation. They don't know if it's causation, but there is a correlation of sleeping on your back and Alzheimer's or neurodegenerative disorders. So they think that it might have something to do with the jugular vein pressure and the drainage with the glymphatic.

Yeah, I've heard that. Yeah, yeah.

So that's interesting that you talked about the sleep position. So give us a tip about how do you get somebody who's always on their— sleeping on their back to go on their side. Like, I got him a body pillow and sometimes I have to nudge them, but do you have any other tips?

Exactly. Well, just, I guess it depends on the type of person you are. There is technology. There's like a belt that you can wear that vibrates and it can sense when you're on your back versus your side. There's actually apps that say they can do that as well. I like pregnancy pillows because I think they're more comfortable. Back in the day, you know, like I said, old enough where we would say sew an old tennis Sew a tennis ball into a t-shirt to get you off your back.

But how do you do that?

You know, basically you want to be off of your back. So if you have tennis balls, like, you know, vertically in a shirt, it'll be uncomfortable to be on your back. Some people wear soft backpacks and put like a football or a soccer ball. So yeah, but there's more comfortable things. There's like things like bolsters. It's like a belt and it's like an inflatable thing. So it keeps you off your back.

I'm going to do that to my husband, put tennis balls in a shirt. I don't think he's gonna like that.

I think pregnancy pillows are probably the most—

anyway, he actually cured his problem because I guess because he was borderline and he did all those other lifestyle things, you know. I even had him singing.

Oh yeah, myofunctional therapy, singing, musical instruments, especially wind instruments. They've actually done studies with the didgeridoo, right?

Didgeridoo, what's that?

Yeah, the Aboriginal instrument, you know, in Australia, New Zealand, goes like, whoa, whoa, whoa, you know, basically it's a huge pipe. You have to blow push a lot of air through. So the muscles of your upper airway or pharynx have to be pretty strong. And so it's cured like up to moderate sleep apnea. Studies in Switzerland and Australia.

Nice. Okay. I love that. So what about a recorder? Can someone use a recorder, you think? Like one of those little things that—

I don't know if there's research for recorders. The most research for wind instruments are singing. So people in a choir and then, well, wind instruments typically like the didgeridoo, um, Like maybe the saxophone or the—

Nice. Okay, I'm getting my husband a didgeridoo. Didgeridoo. Didgeridoo.

You like the sound of that? I love it.

I mean, he enjoys singing in the shower, so—

Oh, okay. That's awesome.

But if you're the snorer, you definitely have to get checked out because— could you tell us more about that?

Yeah, well, because it can be associated with high blood pressure, can be associated with metabolic syndrome, actually disruption to the endothelial lining. So snoring is certainly not normal.

Can you explain to the general public, like, endothelial lining?

Yeah, so the— your blood vessels, right, can have stress from snoring, right? Is it from the vibrations? Is it potentially because you're waking up from snoring? You can have something called snore arousals that can disrupt your sleep, which is stressful for the body.

You just, like, wake yourself up.

Sometimes people do that.

And the endothelial lining is the lining of the blood vessels. So once somebody tells you, like, wow, you're snoring, you need to call a sleep doctor and you need to get a sleep study, which entails— you can do it at home now, right?

Yeah, definitely. They're, they're pretty straightforward to do. There are some that are so simple. Let me see if I actually have one here. It just goes on the tip of your finger. It's like a little button where you can just put it on the tip of your finger. Yeah, this is FDA approved for sleep apnea. Yeah, it's called the NightOwl. I'm more traditional. I like the flow sensor with the nasal cannula in the nose, a belt around your waist. But certainly technology is so good now that this is an option. There's another device called the WatchPAT that just goes on your wrist and then a pulse oximetry on your finger. So just depending, you know, what's available in your local area. Yeah, you know, I think I told a podcast host once that everybody should get a sleep study and she was like, what? I'm like, Well, I'm so biased because I see it so frequently. I'm more surprised when the study is normal rather than when it's positive, especially the people I see are a little bit older, right? I'd say 40s to 50s. If you're above 40 and you're tired, definitely worthwhile to rule out sleep apnea. It's so easy to do in the comfort of your own home. Certainly the home tests aren't 100%, but it's good enough. Some of them are about 80%, 90%. Yeah.

So once you have some issue, what are the steps like? What do you need to do depending on severity? Obviously, and obviously all the lifestyle things we talked about, like weight gain, alcohol, reflux, all those things.

I think one of them too is if you have allergies, you know, get that cleared because certainly a lot of times snoring and sleep apnea is in the tongue. But if you have a lot of nasal congestion, you know, treat that. And if it really is moderate to severe, meaning if you have difficulty breathing greater than 15 times an hour and up, you have a higher risk for things like high blood pressure, irregular heartbeat, heart failure, strokes. So those folks should really be on the CPAP machine. I know it's not comfortable, it's not sexy, but it really does in fact work and it can make you feel better. The number one reason why patients have a hard time or people have a hard time is because the mask doesn't fit well or it's uncomfortable, but there's so many different types of masks out there. So, you know, I always say give it a good college try. Um, there are oral appliance, you can see dentists, um, for this. There's actually a newer type device has actually been around for 10 years, but now it's covered by insurances. It's the hypoglossal nerve stimulator. So what happens with that, it's an implant sort of like a pacemaker with a wire that goes near the lungs. So when it senses your lungs moving, there's another wire that goes to the hypoglossal nerve, which is the motor nerve to the tongue. So instead of your tongue falling back, it gets it a stimulation to move it forward. So my people in Hawaii say you look like a gecko because your tongue is moving forward instead of—

Oh my God.

Do you—

so they implant this? Where does it go?

Yeah, they implant it in the right chest, sort of like a pacemaker. They put it on the right side. So in case you need a pacemaker on the left, you have that space. But yeah, it's just in your right.

That doesn't sound good to me.

No, but I, I can tell you, I saw a lady recently. She struggled with sleep apnea for over 10 years. It runs in her family. She tried the mask, she tried the mouthguard, was only sleeping 4 or 5 hours, 4 to 5 hours a night. Now with this device, she can sleep 8 hours. She can go on trips with her girlfriends and they're all happy because she's not snoring. That's amazing.

It depends on your— the severity and like how much you can change your lifestyle or not, right? Because honestly, if you can't sleep well, then you also can't lose weight, etc.

Yeah.

Okay, so Valerie, tell us more about being a mom and, you know, what are you teaching your kids now that you know all of this? I mean, so when I had my two babies, my first baby He's been like this ever since birth. So even as a baby, he really didn't want to nap. Like, I think 6 months, he dropped his second nap. Like, he just wouldn't sleep, and he was fine. He's super high functioning, no issues. He still doesn't need as much sleep, you know. My daughter, on the other hand, she was born at like 5 PM. She had to go to bed at 7 PM every single night when she was a baby, or you would think that she was— somebody was being murdered because she would scream. Like, and she's still like that. She's very very, you know, scheduled, and she needs her sleep. And now she's at college, and that's like kind of been messed up a little bit and caused her problems. So people definitely have a range, right, of like what they need. And some people are on the border edges. But what do you think? Like, you've seen so many people that, um, do you think that there is a little bit of controversy coming out now, like that you actually need 8 hours of and some people who sleep more than 8 hours, they've associated with increased death. And then, so I'm wondering, do you really need 7 hours of sleep or is it the quality of sleep? Like, what is it that we need or do we not know yet?

That's such a good question. Well, it always depends, right? In medicine, the answers are, it depends on who you're looking at. So I would say for adults, right, 18 years and above, the research does show 7 to 9 hours. In terms of mortality or morbidity, right? So death or being sick. But where are you along that curve, right? So less than 7 is certainly not ideal, but from a cardiovascular standpoint, people who have high blood pressure, irregular heartbeat, really the studies show at least 6 hours and above is beneficial. So sometimes I don't like people to feel like so guilty because they read something online. It's like, oh, if I don't sleep 8 hours, I'm gonna develop dementia or cancer. And then they're so worried that they can't sleep and it causes insomnia. So I sort of try to give them, well, you know, where are you along the spectrum? And some days it may look a little bit different than others. You know, the question is, how do you feel when you wake up in the morning? Do you have enough energy to get through the day? Do you need to nap? Do you need to drink more caffeine? Um, certainly for me, I do feel better between 8, 8.5 hours, but I also have big tonsils and I have sleep apnea. So having big tonsils can block up the airway. And now that my 3-year-old son is sleeping independently in his room, Um, I've been putting my CPAP on and I do notice I feel a lot better, especially in the afternoon. So there is something to it. Yeah, I do use the CPAP. I'm a little bit nervous to get my tonsils out because I have a lot of patients who have them removed and then still have sleep apnea.

Also, like, they've stopped taking it out so much because they've noticed that it doesn't really help stuff, like you said.

So it may not be a cure-all and it's really, really painful.

So you use a CPAP. So what's the downside of CPAP though, if forcing air in, is it causing any hypertensive issues like pulmonary or any downsides?

No, it really shouldn't. I mean, if you don't clean it, it's a little humbug to clean because there's, you know, different parts in the hose. And if you don't use the right kind of water, there can be calcifications and all that stuff goes into your lungs.

You could get infection then also.

Yeah, certainly you can get infection. So I'm a little bit cautious in like immunosuppressed people who use it. You know, like, you got to be really good about cleaning it. But generally there isn't. I mean, some people who have a mask and they move around a lot, they make it really, really tight, and then they get headaches and pressure can push on their jaw. But I would say there are workarounds for that. You know, there's little— it's— there's a lot of nuances to medicine, and especially sleep. Finding a mask that's comfortable for you, making it a little bit loose, lowering the pressure. I'm always about some treatment is better than no treatment. You know, if we can enhance the quality of your life by getting, you know, a little bit more sleep, then that's certainly good. But I think going back to your—

sounds like somebody should invent a better mask or something. Yeah.

You know, I think they're working on it in University of Michigan, but I think they're trying to look into facial recognition where they can actually like 3D print a mask based on your face.

Nice. What about just like increasing the oxygen level around your head? Does that work?

No, because you need forced air. So, you know, those balloons with like the waving arm balloons, usually by car dealership, that's really what it is. Because if you imagine like your throat collapsing at night, we actually have to force air in because some people, you know, don't want to use a mask. So they're like, can I just have oxygen? But it's like, yeah, we can give you oxygen, but at the same time, if your tongue is blocking it, the air can't go through. So it's not like the same. Yeah.

If you're not sleeping, then even that 10% weight loss that you need to do, that might actually be a problem because we all know that now sleep has a lot to do with metabolism and weight loss and hunger issues, right?

Like with ghrelin and definitely ghrelin and leptin. Ghrelin thinks like a gremlin, makes you want to eat more. Leptin puts a brake— putting the brake on your appetite. So leptin makes you feel full. Yeah, and we know that because they slept-deprived college kids, and they tend to eat more junk-type foods because it's quick fuel. And then, you know, nurses who work night shift tend to have higher BMIs, um, more metabolic syndrome, because we mistake it, right?

Because we mistake that tiredness for like needing food or something.

Exactly. Yep. And when you're up longer, you just you have more opportunities to eat. So I think that's the same thing too. Yeah.

And there's lots of food around.

Yeah, exactly. There's not a lack of food here in the US. But yeah, but I think going to question about your hours, is it the duration of your sleep? It's a couple of things. So there was a study that I reviewed about kids in college and during finals week, those who actually slept 8 hours reported better sleep quality and then also were more consistent. Consistent. Because that's one of the things a lot of us, you know, college kids and probably working adults, what we tend to do is maybe shortchange ourselves on sleep during the week and then try to make up for it on the weekends. Um, or the same thing too, you know, sleep, you know, the minimum amount during the week and then stay up later on the weekends. We call that actually social jet lag, and your body actually doesn't like that. We're creatures of routine. The more consistent we can be, the better it is overall. Um, and MIT, they took 100 chem students and they put a Fitbit on them. And they said exactly the same thing. Those with consistent sleep, those who slept longer, and actually for them, the slept longer was a little bit over 7 hours. So it doesn't necessarily have to be 8, and also reported better sleep quality, like did better. And the variance was about 24%.

Did better at school, right? Got better grades.

Yeah, if you want that edge, exactly. If you want that edge, try to get at least 7 hours. Be consistent and, you know, make sure the quality of your sleep is good.

And by consistency, we mean like within 30 minutes, right? That's like the CBT-I for insomnia, 30 minutes. But what about within an hour even, right? That should be good enough if you don't have insomnia.

Yeah. It's so funny. Like, I'm like really strict, so I'm like, oh, okay, within half an hour. I have a friend who's a pediatric sleep doc, and she does more adolescents and teens, and she says, okay, within an hour. She gives a little bit more wiggle room for things.

Yeah, because it's almost impossible. I mean, like, college life, wait till your kids get older. I mean, it's so hard. But I love going into this performance part. So, so memory consolidation with naps. Naps will help you memorize things that you didn't know very well, whereas it will actually— you will actually forget things that if you're just napping throughout the day before a final, you might forget things that you already knew. The naps really help you with the things that you kind of know. You need that 6 to 7 hours of sleep continuously to get that— the knowledge that you know already to consolidate, because your hippocampus is like playing it like a tape recorder onto your cortex. So that's what I thought. That was fascinating. I did not know. I think it was the MIT researchers who wrote that, pretty sure.

Yeah, MIT is great. I think it's all about, you know, memory consolidation, and I'm old enough where I remember filing cabinets, the way I think of it is your brain at night is putting all the files away where they're supposed to go.

I love that.

And if you're shortchanging yourself on sleep, you're going to miss that consolidation. And what you're looking at before you go to sleep also gets filtered down from your conscious to your subconscious. So it's really interesting. Let's say, I don't know, have you heard of Tara Swart? She's a— she actually works with— at MIT. She's a neuroscientist and a psychiatrist. She wrote a book called The Source, but basically it's a neuroscience about like manifestation. And so she recommends for her clients, she does executive coaching, to take your vision board or your action board, however you call it, and look at it at night before you go to sleep. Because those, those visions, those pictures that you see will filter down, and it's like training your brain. This is what I'm going to think about at night.

So it's like integrating into your, um, you know, long-term memory, short-term memory. Oh my God, that's so cool, because everybody always asks me about manifestation. I was out with some friends and they were asking me about that. I'm like, well, so because my research was in neuroscience when I was in medical school, and, um, I, I worked in the MEG lab. I don't know if you know the magnetoencephalogram. It's like it measures magnetic waves from your brain, and they still use it for research because the timing is so specific, and in milliseconds you can see where there's activity. Whereas like the MRI machine, there's a lag because they're just looking at blood flow. So I was like, well, manifestation is really, you know, your brain starts to pay attention and focus on something you're interested in, and so therefore you start to see things that you're interested in. And so let's say you decide, oh, now I'm interested in sleep medicine. You start to like read Valerie's blog, and then you start to listen to this podcast, and all of a sudden you meet people who are in sleep, and you're like, wow, this is happening. Like, look at all these people I'm running into. But it's actually your focus, your attention, and, and what you're looking and open to, because obviously we can't, we can't, we can't make sense of everything that comes in sensory-wise. Wise, because that would be overwhelming. So I, I love it. I'm gonna get that book.

Yeah, that's very cool. Let me send it to you. It's a great book.

Oh my God, you're so—

send me your address.

Yeah, you're the sweetest person. I love it. I can't wait. I hope to meet you in person.

Yeah, let me know if you're in New York. Yes.

Do you ever come to New York?

No, I'm, I'm sort of like a West Coast brat. Like, I stick together.

Okay, well, Hawaii because of Hawaii too, right? Yeah. Wait, do you grow up on the West Coast?

Yeah, I grew up in Northern California.

Okay, well, you gotta come visit New York with your kids. So I was there in December, so next time I go out there, I'll let you know. But let's go back to— so high achieving professional, which you are, um, and your kids are probably, you know, like, you probably care about their schoolwork and all that because you're— I know physician moms and lots of other moms, uh, but physician moms in specific. So about their health and wellness, like, what can you tell your kids? What are you going to tell them about the positive impact that sleep can have, not only, you know, on their grades, but like relationships, their, you know, happiness? I mean, like, what would you tell your kids? I already do.

I think when my daughter, who's 6 when she was 2 years old, I was basically telling her the connection between sleep and emotions. You know, she's a little bit more of a sensitive kid, and I think early on she picked up when she didn't sleep, she was a lot more angry. Like, she would have more tantrums. And so, yeah, we read a lot of books about emotion, emotional regulation. So I'm like, if you want to be in a better mood, you got to get better sleep because it just makes you feel better. And so that's certainly something I want to teach her.

Um, you know, she doesn't have a lot of homework yet, but Yeah, I think I'll send you this link for, um, there was a study showing like the brain and how it works and emotional regulation for on subjects who had sleep and subjects who didn't. So, you know, I'm gonna make it like into a little kitty thing and send it to you. Yeah.

So they, I think they know, they know that how important sleep is and, uh-huh. Yeah. I tell them I help, I help parents and kids who have a hard time sleeping and how important sleep is. 'cause it makes you feel better. Yeah. Gives you more energy to play. You'll have more fun if you're well rested. Yeah.

Mm-hmm. And then sports, like, I guess your kids are little still, but if you're an athlete, sleep is a big deal, right?

So important for, yeah, I mean, the studies are from the UK, some of the football teams, the soccer teams where if they are traveling and then they, you know, do some of their exercises and then they take a nap during lunch, the ones who take a nap and then do the afternoon exercises are less likely to, you know, get injured. You know, their times are better, their performance is better because your muscles need to relax and rest too and recover. Yeah. So sleep is really important for recovery. Yeah.

That's amazing. And they had that study with the Tour de France, right? Where they just tweaked sleep. And that whole team did so much better. And it was, that's all they had to tweak. Because they're talking about microseconds, I guess, right? Like one hair on their leg. Slowing them down.

It's amazing because sleep is free, right? It's accessible to all of us. I'm so sorry, people don't think it's free.

Oh, you have to go?

I do, I have a patient.

I know, I'm sorry. Can we just wrap up 2 seconds? Okay, so, um, one more thing. Oh, can you give us a key takeaway from this? Like, if you had 1, 2, or 3 things that you want to tell people, like, tricks, tips, what would you say?

Yeah, so my biggest recommendations around sleep is to figure out how many hours you need to feel good. And then we talked about this earlier, is it 7, is it 6 and a half, is it 9? And the way you know is you feel better the next day, right? You can do the work you need to do efficiently, you're not wanting to nap. I think that's really important. Self-awareness is always number one. And then can you after that figure the best timing for your sleep. Oftentimes I see a lot of people who try to go to bed at 8 o'clock or 9 o'clock, maybe because that's when their family goes to bed, or they need to wake up really early to commute into town for work. And then on the weekends they don't go to bed till midnight. And so for 3, 4 hours during the week, they're so frustrated that they can't sleep. But it really more is more of an issue with your circadian clock, and there's ways that you can actually shift your clock. So figure out how many hours you need and then match it with your own innate internal clock, with your circadian rhythm. That's super helpful. Probably the last is prioritize sleep. You know, we talked about how important sleep is for your brain health, your cognition, your performance, but really sleep, you know, I'm so biased, but sleep makes everything better. Your heart health, even for women who wake up urinating at night, you know, it's nothing that I didn't touch on, but obstructive sleep apnea can lead to nocturia. And sometimes if you don't even snore, you don't think you could have sleep apnea, but waking up to urinate 2 to 3 times a night is not normal, and it could potentially be from your airway.

So yeah, so there's sleep, like, basically affects every single part of your life.

Everything. Everything.

I mean, if you know somebody who doesn't sleep and is alive, you don't. That's why everybody needs sleep.

Everybody needs sleep.

This was so much fun talking to you. You're just like, have the most amazing energy. I feel like I made a friend and that's always the best thing about doing this podcast.

Oh, you're so kind.

More questions coming up. So I know you have to see a patient, so maybe I can send you those questions and you could just send me a recording, like an audio recording.

Or we can do a part 2. I'm happy to do a part 2. It's cuz we didn't even go to like actionable steps on like what to do. Yeah, let's do it.

Let's do it. Okay, talk soon. Bye.

Thank you so much for listening. Forward this to a friend, a family member, anyone who needs to stress less, and soon enough you'll be surrounded by more Zen people. Your support is literally what makes this possible. Subscribe and head on over to YouTube to my Fall Asleep Easy channel. Sign up for your updates at mindbodyspace.com and get special tips into your inbox once a month. Until next time, this is Dr. Juna Bobby MD. Wishing you wellness.