Why You’re Waking Up In The Middle Of The Night And How To Get Better Sleep

Coming up on this episode of the Doctor's Pharmacy.

Our body's ability to have a good rhythm is key towards health. Light is the key thing. When you wake up, try to get exposure to sunlight early on within 20 to 30 minutes of awakening.

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Going to rupahealth.com that's R-U-P-A-Health.com hi, this is Lauren Feehan, one of the producers of the Doctors Pharmacy Podcast. Our bodies have a natural rhythm where there is a wake time and a rest time. When these times are interrupted or are even inconsistent, we miss out on high quality sleep that sets us up for a good day ahead and may even have long term effects on our health. In today's episode, we feature three conversations from the Doctor's Pharmacy about how to get quality sleep and why light is so vital for setting our circadian rhythm. Dr. Hyman speaks with Dr. Todd Lepine about why rhythm is so vital to our health and overall wellbeing. with Dr. Andrew Huberman about establishing a light plan for both day and night, and with Dr. Roger Sehgal about how to modify your circadian rhythm and upgrade your sleep.

Let's jump in. We have rhythms in nature. We have the rising of the sun and the setting of the sun and then the lunar cycles, and we have the months and the seasons and the year. So it only makes sense that our body has its own cycles and own seasons. and understanding that we have these internal clocks and we actually have genes, they're called clock genes, and they have to synchronize just like an orchestra. It's got a lot of different pieces. You know, we were talking earlier in a podcast about how many different chemical reactions are going on in the body. You have chemicals being made, you have chemicals being broken down, you have chemicals being detoxified, and you have all these rhythms going on in the body and they're happening in harmony, if you will. And just like when you have an orchestra, in order for an orchestra to make really good music, what do you need? You need a conductor. And this is understanding that the body's conductor is synchronizing the whole body in terms of the liver and the heart and the muscles and digestion, all of those factors. So, our body's ability to have a good rhythm is key towards health. and I learned this early on when I was in private practice because you probably had some patients like this too, Mark, is the patients that I could never ever help to get better, no matter what they came in for, were shifted. I'll never forget it because I was so frustrated. They came in and they were tired, they had diabetes, they had brain fog, they couldn't lose weight, you name it. and I'm banging my head against the wall and lo and behold, I figured out, you know what? Shift work is not good for you because don't mess with Mother Nature. You don't want to be eating when you should be sleeping and vice versa. That's really the bottom line. And, what happens is when you disrupt those circadian rhythms, and we know this ourselves, if you've ever had jet lag, you know that you don't feel good when you have jet lag. And, that's sort of an acute example of a circadian rhythm gone bad. You know, you're talking about breaking bad. Well, that's really a breaking bad. Yeah, it's not a good thing.

And.

So understanding shift work and jet lag really sort of will highlight the importance of getting your body into a good rhythm. And the things that are key for getting your body into rhythm, the primary thing is light. and what I would say is that most people are not getting enough light and specifically sunlight. Now, we do have patients, Mark, that they have what we call seasonal affective disorder. So, if you live in a high enough altitude or latitude, you can get seasonal affective disorder and that's where you don't get enough light and all of a sudden you start feeling lethargic and tired and depressed because the sun really affects your whole rhythm. And, there's a part of the brain called the suprachiasmatic nucleus and your eye is literally like the metronome to the body. It keeps the, the body in sync. So there are certain, and the German term is called Zettgerber, which is the, the, gets the, the clock synchronized. Light is the key thing. So I always tell my patients that when you wake up, try to get exposure to sunlight early on within 20 to 30 minutes of Awakening. And that exposure to light helps to get all of your, your body clocks in sync, if you will, so that the orchestra can produce really good music. So, light is a key thing. And then, one of the other key things is the timing of your food. And, what we're finding out now is it's not only what you eat, but it's when you eat. And, I can remember, Mark, when you were at Canyon Ranch, you always had the big saying which, you know, eat breakfast like a king, lunch like a queen, and dinner like a pauper. And, that's so, so true. Yeah, yeah, exactly. Very, very, very true. And one of the things that you'll see in patients who have problems losing weight is that they're eating when they should be sleeping. They're eating these late meals, big meals late at night, or they're sort of randomly having their food. It's also very important to time your food. So, each day you're having your meals at approximately the same time so that your body gets into a really good rhythm. and it's better to front load your kids.

Right, it's reminding me of these people who live to be 100 and whatever. They have a routine, they have the same thing every day, they do extra every day, they have their little schedule, and I think there's something to be said about that.

There's something to be said, exactly, yeah.

I mean, honestly, Todd, COVID is the first time in my adult life, really, that I've been able to be in a rhythm. In a good rhythm. In a good rhythm, because when I was younger, I was working as a family doc and staying up all night and working the ERs, and then traveling for decades, different time zones, different hotels, not having a rhythm or routine, it really took a toll on my health. And since COVID almost last year now, I've been more or less stationary and have been able to develop routines of taking care of myself, of eating, sleeping, working out. It's incredible how important chronobiology is to our health.

It absolutely is. I can remember you speaking about doing night shifts, because I can remember when I was doing in private practice and I used to do a call at night. It's one thing to be up at night when you should be sleeping. It's another thing to be up at night and you're dealing with someone who's having a life or death situation, a heart attack, heart failure, cardiac arrhythmia. So, I can remember distinctly that there was a big change in my health when I had to do call over extended periods of time. And not only was I up at night, but I was actually pumping out a lot of stress hormones. I was reaching, were you reaching for food at night, Mark, when you're on call? Yeah, give me some food. What are you doing? Reaching for sugary things, things that pick your your energy up. So, it's really-- oh, sure.

I mean, because you get high levels of ghrelin when you're not getting enough sleep, which makes you crave starch and sugar and carbohydrates for sure. I was doing that.

Yeah, reach for those donuts and whatever else you can find in the hospital, right?

Yeah, it was pretty bad. Yeah, so what's interesting also is you talk about the effects on timing of eating, sleeping, all the things we're doing, exercise. They're important. And what's also really striking is that the light thing you talked about was really important. The disturbances are a light, meaning we are exposed to artificial light in times when we should be not at night. And one of the books that I read years ago was called Lights Out. It was a fascinating book about how our health has degraded since the invention of the light bulb. That we stay up late at night. And now we're worse than the fricking light bulb. We've got the screens, the TVs, or devices with all this blue light that's causing us to shut down melatonin production, affect our sleep and our quality of our energy. So, there's a lot of things that disturb that.

Absolutely. You hit the nail on the head. In fact, I have some extra slides which they can post for the podcast about light pollution. And, there's some interesting slides looking from satellite imagery looking from the 1970s, 1980s, 1990s, and 2000. What you see is the whole world's lit up at night. It's very, very hard to find places at night. And I experienced this firsthand, I'll never forget it, when I was giving a lecture down in New York City. And it was like about 10 o'clock at night and I was going to be lecturing the next day. So I said, well, I'm just going to go down and I'll walk the streets of New York and I was, I'm out in Times Square. So if you've ever been in Times Square late at night, guess what? It is all lit up and whatever. And it's like, you got all the lights. Oh my god, yeah. Right. So I'm like, you know, I'm out there walking from like, you know, maybe about 10 o'clock to 11:30. I go back to my room, there was no way I could sleep. I mean, I just, I was, I could not sleep the entire night because all my melatonin was suppressed by all the LED lights on Broadway. It was like, that was like a, somebody hit me in the head with a hammer saying, yeah, wake up here. Lights are not good for you at night.

Yeah, for sure. Yeah. So, yeah. And what's also interesting is, you know, even, even, you know, more traditional medicine is coming around to this and, In chemotherapy, we're now learning that there are times where different cancers respond to different chemo drugs and the timing of cancer therapy has a huge impact on the outcomes with patients, which is really striking.

It took the words right out of my mouth. In fact, there was actually a recent article that we're talking about when's the best time to give a vaccination. Some people are getting the coronavirus vaccination. That's another topic unto itself. But it's thought that it's probably better to give a vaccination later on in the day because early on you have a jump up in your cortisol and cortisol is, suppresses your immune system. And it's thought that if you give a vaccination earlier in the day, you may not have as robust of an immune response to the vaccination. So for those people who wanna get any type of vaccination, it's probably better to delay it till about three o'clock or so.

Oh, the afternoon, okay, good. so people often in medicine, my experience in traditional medicines, we don't get taught how to reset people's Rhythm and the key aspects of resetting people's Rhythm and the importance of Rhythm in our health. And I think why don't we go through, you know, for example, a patient that might have had a Disturbed Rhythm and how do you help restore their Rhythm? What are the kinds of things we think about? What do you test for? And how do you start to treat them?

Yeah, so typically you can have patients who have, you know, like a delayed sleep onset or a circadian rhythm disturbance and, you know, sometimes what I'll have patients do is I'll have them, you know, if they're going to bed at like five o'clock in the morning, what I'll have them do is stay up the entire day until they're completely really tired and go to bed at like six or seven o'clock the following evening. Sometimes you also have to work, have a patient work with a behavioral therapist to change their behavior. I think naturally there are some people that are, what I would call morning people and people who are more night owls, there's a natural tendency of that, especially teenagers tend to want to stay up later at night. But in general, you want to get into the rising and the setting of the sun. So I usually tell people, when you look at the animal kingdom, what do the animals do? When the sun rises, they get up, they start tweeting, the birds run around, and they start finding their food. And when it's dark out, what do the animals do? They go to sleep. They don't sit up watching television. They're not on their smartphones and they're not raiding the refrigerator. So the things to do at least first get people aware of the fact that they're being sleep deprived. And in addition to being out of sync, what's oftentimes happening with people nowadays is they're not getting enough sleep. So sleep deprivation is probably epidemic in the United States. and what do we do nowadays that people are tired? We give them amphetamine, right? We just pump them up with either amphetamine or caffeine and just like they'll say keep going. What we do know is that you can take young, healthy college kids and if you sleep deprive them and only let them sleep for maybe four or five hours, within a matter of three days, they start becoming insulin resistant, which is like a form of prediabetes. So getting enough sleep and getting deep restorative sleep are really, really key. And part of the ability to do that is to have a good circadian rhythm. Another thing which I also wanted to talk about, Mark, is as it relates to the circadian rhythm is that there's a timing of when your body does things. And one of the most important things for me personally is to sleep in a cool room. I oftentimes will leave the window open and my room is pretty darn cold. And when you think about that from a, in fact, I think there are some companies out there that have these things called cooling mats. They basically have a chill pad and they basically lower your body temperature.

I have that, the cooler, I have that.

Yeah.

No, again, you know, just look at nature. I mean, if we didn't live in a house, if we were living the way Mother Nature designed us out in caves or whatever, the temperature goes down at night and our bodies cool off. And that's a very, very good thing to get your body into a deep, deep sleep. So keeping the temperature of the room too high at night is not a good thing for your circadian rhythm also.

Yeah, absolutely. So, waking at the same time, sleeping at the same time, making sure you get exposed to 20 minutes of morning light, making sure you're eating in rhythmic times, that you're not eating three hours before bed, that you don't exercise in the evening, that you get rid of all the blue light at night and use your blue blocker glasses and get off your screens. It takes time to retrain the circadian rhythms, but when you do, your overall well-being is so much higher. Sometimes we use herbs to help reset the adrenals because the adrenals really get screwed up in the whole we'll use melatonin and we'll use adrenal support to help people kind of recover from it.

Absolutely. And the other thing that I do, and this is actually, this is, I think, epidemic in the young kids because I, I've been, I, I'm still recovering from some knee surgery that I had done because of a ski injury. And I'm going to the gym, and there are several young people in there who are literally addicted to their phones. They are on their phones as they're exercising and they're texting and typing and doing all this stuff. And one of the things that I see in young people is that they are constantly checking their phones throughout the night. They're waking up and they're on social media and they're, I tell people, you turn your phone off and don't touch it in the entire night. Done. Put it in another room if you need to because it's literally, I mean.

You put airplane mode, I mean, it's terrible.

It really is. It really is. And it's like, you know, oh, I'm awake. I might as well just, you know, go onto Facebook or go onto social media or Twitter or whatever the heck they're doing.

And it's toxic. It's very, very toxic.

For a whole bunch of different reasons.

I mean, at worst, they'll leave their phone on so with the notifications. So they'll wake up at their text. So they'll wake up with their notifications.

Right, right, right.

And I call, sometimes I forget my nephew is in a different coast, whatever. I'll text them late at night. If I'm in Hawaii, he's like in California. I'm like, it's three in the morning and he's like answering my freaking texts.

And I'm like, what are you doing awake?

Exactly, exactly.

Yeah, yeah, yeah. So how would we begin to think.

About testing people's circadian rhythm?

Well, there's like, as you mentioned, the adrenals test. So we know that our adrenal glands produce cortisol and cortisol cortisol being the major one. And we have a thing called a cortisol awakening response. This is our get up and go hormone. It's the hormone that rises in the morning. There's a big peak in it, and then it gradually decreases as they goes on. And we do testing for checking for adrenal function throughout the day, and especially with that cortisol awakening response or they call it the car. And that rise should be about 50% or higher and it also should be very low at nighttime. And sometimes when you see that cortisol awakening response being blunted, then you know that there's a problem with their circadian rhythm. And then if you also see that cortisol response high up at night, those are people who oftentimes can't fall asleep because they're sort of wired. They need something to control that. so that's one way of doing it. Another thing that I do is I also will check melatonin levels. So melatonin is the hormone of darkness and it's a hormone. You can get melatonin as a over-the-counter supplement. It comes usually typically one to three milligrams. And I really almost never give a patient melatonin without checking their melatonin levels. Or some people, for whatever reasons, either age or pituitary or pineal problems where they're not producing enough melatonin. So, I don't use melatonin willy-nilly even though it's actually quite safe. There are certain circumstances where I'll use it. Things like jet lag, I oftentimes will use that myself if I'm going to go through several time zones to help to reset my body clock. But, checking melatonin levels is another thing that can be very, very helpful to make sure the person's body is.

You.

Know, in, in good sync. The other thing, which is also really important, is exercise. And this is a fascinating, a little, I call it a little scientific trivia, is that, our bodies, we talked about the mitochondria. Mitochondria really relate to energy. And mitochondria take food and make food into ATP or adenosine triphosphate. So adenosine is the base molecule, and we stick three phosphate groups onto it. and ATP is the fuel that runs our body. And as we have activity throughout the day, our ATP gets broken down into ADP or adenosine diphosphate, and then into adenosine monophosphate, and then into adenosine. And as those metabolic processes happen, our adenosine levels actually build up in the body. And that rise of adenosine is one of the things that induces sleep. and interestingly, caffeine, which we all know keeps you up, blocks adenosine. That's probably one of the major ways in which caffeine will actually keep people up at night is it's acting as an adenosine blocker.

So.

And for people who are caffeine sensitive, you know, we do some testing, but people oftentimes will know that. But we can determine by genetic polymorphism testing if somebody is a slow metabolizer or an intermediate metabolizer of caffeine. because caffeine in general has a half hour about six hours. So, if you have a cup of coffee at six o'clock at midnight, half of it's still going to be in your body. So, if you're a real ultra slow metabolizer of caffeine, you might want to have one cup of coffee no more than two really early in the day because that's still going to be in your body late at night and blocking adenosine's action.

Yeah, so incredible. So, this whole area of chronobiology and circadian rhythms, so important. People are really excited, interested about this topic. I encourage you to check out our mentor's book, the Circadian Prescription. And also, think about your own life. If you're feeling out of sorts or out of balance, what is your rhythm like? And, is that a source of some of your disease or unhappiness or mood issues or sleep issues or energy issues? And, often when we focus on the chronobiology piece and our rhythm, It can lead to profound healing for people. So it's often a neglected aspect of well-being, but I think it's super important. Hey everyone, it's Dr. Mark. Now is the time of year when sniffles and colds start to set in. Being inside all the time puts us in direct contact with tons of germs, which puts extra stress on our immune systems. So how can you beef up your immune system? I recommend Beekeeper's Naturals. I use their Propolis Throat Spray to get extra nutritional insurance that I need and feel more resilient during the long dark months. I also love their liposomal vitamin C plus propolis, which I use when I know I've been exposed to germs, which is a lot. Propolis acts as a protective lining for the beehive, keeping out foreign invaders and germs. It's the ultimate immunity hack of the beehive, and it can help do the same thing for your immune system too. Plus, it contains multiple compounds that are essential to immune health like vitamin C, zinc, iron, and more. Right now, Beekeeper's Naturals is giving my community an exclusive offer. Just go to beekeepersnaturals.com/immunity / hyman and enter the code hyman to get 20% off sitewide. That's B-E-K-E-E-P-E-R-S, N-A-T-U-R-A-L-S.com/hyman and enter the code hyman. Getting quality sleep is incredibly important to me. Sleep is really one of the pillars of good health. So you can imagine my frustration when I used to lie down at night but couldn't fall asleep because I was just too hot. But those sleepless nights are behind me now thanks to Cozy Earth. The bed sheets are made from temperature regulating fabric that keeps you comfortable all night long. I naturally run hot, But with Cozy Earth's breathable sheets, I cool off and get right to sleep and stay asleep much faster. Cozy Earth offers a variety of luxury pillows, sheets, blankets, and more, and their durable weave fabric won't pill for 10 years, guaranteed. Plus, they pride themselves on the ethical production of all their products, so you can feel good about your purchase knowing you're supporting a truly responsible company. And right now, Cozy Earth is providing an exclusive offer for my listeners. You can get 40% off site-wide when you use the code Dr. Hyman.

Just go to CozyEarth.com and use the code Dr. Hyman. That's D-R-H-Y-M-A-N. Now let's get back to.

This week's episode of the Doctor's Pharmacy.

Light exposure early in the day, getting bright light exposure ideally from sunlight within an hour, ideally within 30 minutes of waking up, is vitally important for getting sleep later that night. And the reason is, is it basically once every 24 hours you're going to have a spike in cortisol. It's non-negotiable. It's built in your genome. It's going to happen.

So, do people in Arizona sleep better than people in Seattle?

Well, they do, actually. And a lot of people in Seattle need light boxes because if you live in an area where you can't get sunlight first thing in the day, feel free to flip on artificial lights. But you want, basically the rule is you want as much bright, ideally natural, but if you can't get natural, artificial light would be fine early in the day. And what that does is it basically times this cortisol spike to wake you up. That spike in cortisol isn't to stress you out, it's to wake you up. And then it sets a timer on your melatonin release. So 14 to 16 hours after your bright light exposure, you're going to get a pulse of melatonin, which is the hormone, of course, that promotes sleepiness and puts you to sleep independent of any supplementation of melatonin. Light inhibits melatonin through a direct pathway through the eyes to the brainstem and then up to the pineal. well-established pathway. So, the number one thing is get bright light exposure to your eyes. So, no sunglasses, eyeglasses or contacts are fine early in the day. How long? Well, it depends on how bright. So, anywhere from two minutes to 10 minutes. Ideally, you're not looking at your phone during that time. Ideally, it's sunlight, but if you wake up before, you know, flip on a.

Bunch of artificial lights and then get.

Outside once the sunlight is out. Just outside taking a walk. You're not looking at the sun, right? You're not looking directly into the sun. You don't want to burn your retinas out. indirect exposure is fine, but there's a class of neurons called the melanopsin ganglion cells that reset your circadian clock and time things nicely. They time the cortisol, the time the melatonin. So that's the number one thing for, I wouldn't just say for sleep, but also for optimizing levels of alertness throughout the day. The other thing is that you really want to avoid bright light between the hours of 11:00 PM to 4:00 AM. if you're on a standard schedule, shift workers is totally different. The reason is Sammer's lab and a guy named David Berson at Brown University have shown that bright artificial light of any color, blue blockers or no, if there's bright artificial light, it activates a pathway in the brain involving this brain structure called the habenula. When I was an undergraduate, actually someone asked in neuroanatomy, what's the habenula do? No one knew. The habenula is involved actually in generating our feelings of disappointment, it suppresses dopamine release for several days afterward. Now, if you have to go to the bathroom or you have to pull an emergency trip to the supermarket or something in the middle of the night, you don't have to worry about crushing your dopamine long term. It's a chronic thing, but you really want to dim the lights in the evening starting at about 10 p.m. And so you're saying those blue blocker things, that doesn't work? Well, the blue blockers will work, but if the lights are bright enough, it doesn't matter what wavelength. they are. And this is because these melanopsin cells, these neurons in the eye, they do respond best to blue light, but they're very broad spectrum, the wavelengths that they will respond to. You can shine bright red light on one of these cells and it will signal to the brain time to wake up. Amazing. So it's really key to just dim things down. And I always say blue blockers are terrific, but you don't want to wear them during the morning and early part of the day because blue light is the optimal stimulus for this wake up signal. So we took, the blue blocker thing is great in principle, but people kind of took it too far. So bright light when you want to be awake, and alert and dim light when you want to be asleep.

So how many hours before bed? Because people are up on their TVs and their screens, computers and phones.

Yeah, so the subtle things that people can do are to start dimming the lights in the evening right about the time the sun goes down is when you want to say, oh, the sun is going down outside and if it's overcast, It's getting dark, well that's the time to dim the lights in your home. The other thing is because of the where these neurons are situated in the eye, overhead lights will activate this wake-up signal much more readily than lights down low. So the Scandinavians have it right. In the evening, you want desk lamps. Most people aren't going to have floor lighting in their house. Desk lamps, early in the day and throughout the day, that's when you would want overhead lights. So those two things are going to be very beneficial. A lot of bright light, overhead light throughout the day, ideally from sunlight and then in the evening avoid bright lights of any color, any kind between 11 p.m. and 4 a.m. Don't get neurotic about it, but many people find that just making these changes.

So you don't have to be off from like 6 o'clock at night?

No, no, no, no. And there's actually the third tool, which is also grounded in really nice work, a paper published in Scientific Report shows that if you get some sunlight in your eyes in the evening, right about the time of sunset. If you can't get it from the actual sunset, just go outside. You don't have to see the sun setting. You just need the light, the ambient light, the outdoor light in the morning is sufficient. There's so many photons out there, even on a cloudy day, you'd be amazed. In the evening, if you see or get outside and get some sunlight or you get some light in your eyes, that has an effect of lowering the sensitivity of the retina, of the neural part of the eye. and provides you a kind of insurance. It offsets a little bit of the late night bright light exposure. I call it sort of your Netflix inoculation. It kind of protects you against some of the the ill effects. Now, if someone's schedule is really messed up, I mean, they're not sleeping. They're really screwed up. There's a study out of the University of Colorado that showed that this is a little extreme, but going camping for two days, reset these melatonin and cortisol rhythms for two weeks.

It's pretty incredible.

It's really incredible.

I noticed when I go camping or I go out in the wilderness or far away from technology, I just sleep way better. We had a storm my house last summer and we got power out for four or five days and we just had candles at night and it was unbelievable. I loved it and it felt so good to not have all that bright light at night and to go to sleep and sleep better. and deeper.

Yeah, you really reset. And you mentioned, I'm glad you mentioned candlelight. Candlelight in the evening is fine. Actually, not to turn people into geeky scientists, but there's a great app. I have no relationship to it, but it's completely free. It's called a light meter. And, you can run this experiment. You can download the app. You go outside on an overcast day in Boston in January and press the little button on light meter in the morning, and it'll show you that even though you don't see the sun, it looks like dent cloud cover, there'll be something like 5,000 lux of light. You'll go inside, you'll point the thing at a really bright artificial light, and it'll say 300 lux. Close the window to the outside, and it reduces it by about 50 fold. So you don't want to do this through a window or a car window. And then you say, well, wait, you just said that there's very little light intensity coming from artificial lights. Why is it so bad at night? I should be able to turn on every light in the house, and it won't reset. Ah, But the clock and your eye get more sensitive as the day progresses. So you have to control it at both ends. And candlelight is fine, dim light in the evening is fine. But throughout the day, you really want to try and get some bright light exposure. And for many people whose schedules are just really screwed up, anchoring to these two or three things of bright light exposure and avoiding bright light in the evening hours between 11:00 p.m. and 4:00 a.m. often not always can really reset people's ability. And once you're sleeping well, everything else gets better. So that was kind of the first question you had. The other one is that I'd be remiss if I didn't mention there are things that people can take. I'm sure you're familiar with several of these as well. Obviously, well we have a doctor right here. So talk to a doctor. Obviously, I'm not a physician. I'm a professor, so I don't prescribe anything. the three things that have made a tremendous difference.

You profess, you don't profess.

I profess, I don't prescribe. That's right, that's how you usually say. Profess lots of things. The three things that I've certainly benefited from and I know a number of other people have and for which there's really good research are apigenin, A-P-I-G-E-N-I-N, which is, it's very inexpensive, it's chamomile extract, and it basically turns on a chloride channel mechanism in the brain. It turns off thinking. It's kind of the equivalent of an alcoholic drink. It just turns off thinking. You could still drive on the stuff.

But it makes people drowsy.

You drink chamomile tea or you have to take a concentrated one? Some people get that benefit from chamomile tea. Other people like the Apigenin. And the other ones are the magnesium and magnesium threonate and by glycinate in particular. Threonate spelled T-H-R-E-O-N-A-T-E. And, by glycinate, I won't spell out, but sort of just as it sounds, those cross the blood-brain barrier more readily because you're ingesting this obviously into the gut and then that magnesium needs to get into the brain. And basically the magnesium seems to act as a precursor to GABA, the inhibitory neurotransmitter. And so for people who have a hard time turning off their thoughts, that can be very beneficial. So there's the kind of light, which is a kind of ancient mechanism by regulating alertness and getting into sleep. And then there's the modern thing, which is supplements and there's something sort of in between worth mentioning, which is there's a great tool that was developed by my colleague who's our associate chair of psychiatry at Stanford. His name is David Spiegel. He's actually a clinical hypnotist. He's done a lot of work on pain management and even breast cancer outcomes from hypnosis, and he's developed a free app that's on Apple and on Android called Reverie, R-E-V-E-R-I. It's a 15-minute hypnosis that you do in waking, which trains the brain to sleep better. And I think that a lot of people hear hypnosis and get a little bit freaked out, but there are a lot of clinical data showing that this can help people to learn to turn off their thoughts and to relax and go to sleep. And there's some other nice hypnosis scripts in there as well. It's David's voice, and he kind of walks you through it. So those are, aside from the supplements, the light and the hypnosis are free resources that I think most everyone could benefit from. If I wake up in the middle of the night, oftentimes I will do one of these hypnosis scripts. And just one other thing about sleep. A lot of people wake up at 3 or 4 a.m. and can't fall back asleep. Okay. I never understood why that was. And then I talked to the folks in the sleep lab at Stanford, and I talked to the chronic. Here's probably the reason. Yeah. There's an asymmetry in this seesaw that we all equipped with internally, which is that. We can all push on and stay awake more easily than we can just force ourselves to sleep, right?

That's true, right?

At some point we fall asleep, but if you're waking up at 3:00 or 4:00 a.m., unless you're drinking too many fluids and that's the reason why, chances are you are running out of melatonin at that point. The levels of melatonin in your blood are dropping. And what it means is you stayed up too late And you probably are one of these people that should be going to bed at 8:30 and waking up about 3:30 or 4:00 a.m. And people don't like that answer because they think, no, but I want to be the person that goes to bed at 11. And there are ways to shift your circadian rhythm that we could talk about. But try and go to bed one hour earlier and chances are you will wake up feeling better at 3:00 or 4:00 a.m. Now, it's not exactly a solution. but if you're in an argument with your spouse or something about going to bed at one hour or the next, you can leverage biology or cite this discussion.

Wow. So we really have this sleep epidemic problem and people are struggling with figuring out how to deal with it. And your lab and you have worked really a lot on how do we navigate the landscape of sleep because as we're having this conversation, whatever I ask you, you keep coming back to sleep, which is fascinating to me as a foundation. And we always think diet's the foundation, exercise foundation, meditation, but sleep is sort of that neglected fourth leg of the table.

Well, and it's the thing that we've been encouraged to push through. And, I mean, there are some elements, I mean, that we could get down into the fine science of it. You know, we sleep in 90-minute cycles, ultradian cycles, better to wake up after six hours, then seven, right? You, you know, for most people, for sake of alertness. So waking up at the end of one of these 90 minute Cycles, you're going to feel more alert than you would say, if you slept into seven hours would mean you were about, you know, you weren't complete through your last ultradian cycle. But sleeping at 7 30 would be even better if you can, you know, so getting the right amount of sleep is it. It's a process that you want to master on average, right? You know, the one occasional all-nighter you'll be okay. You drink coffee too late, you'll be fine. But on average, you want to be sleeping. Most people, it's going to be anywhere from five to eight hours a night. Naps in the afternoon seem to be okay. The hypnosis script and the other things will really help people get centered around this. I think that the idea of breaking up one's sleep, there were these crazy sleep cycles that were promoted, not to be confused with Huberman, they called it the Uberman schedule. I just want to be very clear, not Huberman schedule. There was a study that came out recently that showed that it's incredibly detrimental to all sorts of inflammatory cytokine markers. To take a nap in it? Oh, no, to try and sleep two hours, wake up, sleep two hours, wake up, sleep to around the clock. There are people that they found they could compress their total sleep time. This was kind of a Silicon Valley thing, like trying to master one, you know.

You just- you- do you have these.

Human bodies, you've got to actually- yeah, you can't conquer that. But I think sleep is vitally important.

How does sleep regulate our immune system and how much should we be getting and what should we be doing to upgrade our sleep game?

Oh, wow.

Okay, so that's huge, huge topic.

You did a whole fellowship in it. So, I'm like, yeah, I get it.

So everyone needs to understand this and it's very important to understand and that is that there is a clock in your brain that tells you when everything needs to happen. So the best analogy I can use is is Disneyland. Okay, I had a friend that used to work at Disneyland, but he didn't work there in the day. He worked there at night. And that should tell you something. During the day, everything's open. People go on the rides, you buy snacks, you do all that. At night, there's a complete, complete different activity that goes on at night that gets it ready for the next day so they can do that again. And so people need to realize that sleep is not just an off switch. Sleep allows the body to do processes during the night that allows to do what you normally do during the day. and if you don't allow the body to do what it does at night, you're not going to have a good day the next day. All of that is orchestrated, cortisol levels, melatonin levels, stress, exercise, all of those things, even eating and food, all of those are coordinated like a conductor of a very large symphony about what happens at what time in the night. And so what happens is, is that when you go to bed at night, when you go to sleep, when the sun sets, your body has been trained to go to bed and to go to sleep. And what happens is that we're staying up, we're watching TV, we're looking at videos, we're on social media. And the problem is that light, which is one of the sources that the body uses to entrain that rhythm, is going into the eyes, it's going back to the master clock, and it's saying it's still day. And so what happens is the body gets confused. It still thinks it's day, so it starts to delay the circadian rhythm. And when it's time for you to go to bed, you're going to bed at 11, 12 o'clock, at night. And what happens is that now all of those processes that were supposed to occur at night are now getting started at 12:01 o'clock in the morning instead of getting started at 9:10 o'clock at night. And what happens, you still wake up at the same time and you're not allowing those processes to go. So the number one problem just to start off is the number of hours of sleep you should be getting. For an adult, it should be at least seven hours of sleep. Okay, most of us gets much fewer than that. So we're chronically sleep deprived, number one. Number two, is that when it's, when you start to go to bed later and later and later, 1 o'clock in the morning, 12 o'clock at night, you still have to get up early to go to work in the morning. So you're not getting the full hours of sleep. But it's even worse than that. Because if you decide that you want to go to bed earlier now that you've heard this talk, you say, hey, I need to get more sleep. I'm, instead of going to bed at 1 o'clock in the morning, I'm now going to go to bed at 10 o'clock at night. You are now trying to go to bed when your master clock has been set. further back. You now need to start to move your clock back. And one of the ways of doing that, two ways of doing it, number one is stop looking at light at night so that your clock rhythm starts to come back. And number two, though another way of doing that is to, when you wake up in the morning, is to expose your eyes to bright light that has the opposite effect. So light in the morning tends to advance your circadian rhythm back to where it was, but exposing your eyes to bright light at night tends to delay it back, back, back further. so that you're getting to sleep later. And so that's a major, major issue is light at the wrong time.

So basically, if people listen to you, Netflix stock would just tank.

No, Netflix stock is, this is the beauty of Netflix. You can record it and watch it whenever you want.

I know, but people at the end of the day, they're not working. They want to come home, relax, watch TV. It's like I get, I mean, I, it's tough because that's what I like to watch and, you know, It's interesting because I think that we have such a culture of nonstop 24/7, check emails at 11 o'clock at night, be on your phone, be on Instagram and social, and it's really messing up our biology because we are light sensitive beings that respond to our environment in not just sort of psycho-emotional ways, but in physiologic ways that disturb our normal biological rhythms that lead to disease. It's not just about not sleeping well, it's about the immune system, it's about the risk for heart disease, it's for obesity, diabetes, cancer, all of it. is connected to sleep. So now we understand we should be getting sleep and it's important for clean up and repair at night. It's important for immune system function, you know, but a lot of people struggle with sleep. So what are your top as a sleep doctor? Because you're also a sleep doctor in addition to being a critical care medicine doctor and a million other things. What should we be doing to upgrade our sleep?

What are the top tips you give your patients? Before we go out and just tell everybody you need to get seven hours of sleep, we've got to give them the tools that they need. to be able to get the seven hours of sleep. And as I mentioned, if you go to bed at 12, 1 o'clock in the morning, you know, normally, if you go to bed at 10 or 11 o'clock at night now to get that seven hours of sleep, you're just not going to be sleepy. And so what we need to do is we need to shift that circadian rhythm, advance that circadian rhythm. So the number one thing that I would say is you need to get the right type of light at the right time of day. So that means turning down the lights after nine o'clock. making sure you're not on an e-reader reading at night. Use a very dim light and open up a regular book. If you have to put the light on, make sure it's low down. Make sure it's more in the red spectrum of light. And then in the morning time when you get up, make sure you're exposing your eyes to bright light. Get outside. Let the sun light hit your eyes. You don't have to look at the sun, but get outside and get exposed to bright light. in the morning. Now, in the wintertime, that might not be the case depending on where you live. You might not have sun. So it might be worthwhile to invest in a light box. They're known as SAD boxes or SAD boxes. SAD standing for seasonal affective disorder, which is actually not uncommon for people to have in the wintertime because they're not getting exposed to light and that can cause depression. But these boxes are about 10,000 lux. That's how we measure light. And if just 20 minutes in the morning in front of one of these light boxes about 11 to 15 inches away from it would be a good substitute to get that light into the eyes. You'll feel better at night. You'll feel like you're ready to go to bed. You'll sleep better. There's been a number of studies that have actually shown this, that this type of light exposure is better for quality of sleep and for length of sleep. So that's where I would start off. The other thing is if you're having difficulty going to bed at night, falling asleep, Making sure that your bedroom doesn't have a television in it, making sure you're not reading in the bedroom, doing other things. Use that for sleeping and you'll notice that you'll be able to go to bed and that subconscious tie that you have to the bedroom will help you.

Fall asleep as well. Yeah, I mean, I have blackout shades, I have eye masks, I have earplugs, I have a special reading light that blocks out all the blue light so I can hook it to my book. at night and read my, without any lights on for the blue light. There's also red light bulbs you can get at night. You can put in your, in your bed bedside table. So there's a lot of hacks. A cool room also was really helpful. I think 68 degrees or less. Sometimes often people sleep better. And there's now these mattresses, covers and cooling beds. And I have tried the eight sleep, which I love, which is really fun. And it's great because if you have a couple, it's one like the hot one, like the cold, you can adjust each side of the bed. which is kind of fun. So, getting the quality sleep and the light is important because I think we're all, we have light pollution. And there's a really interesting book, I don't know if you read it, years ago I read called Lights Out. And it was a book about the science of how the light bulb has screwed up our health massively by keeping us out of our normal biological circadian rhythm. So, you know, we really are, and, you know, and then today as kids, you know, they sleep with their phone in their bed, they don't turn it off. It's like, I mean, I text someone, I'll be in a different time zone in the middle of the night. I'm like, they're answering your text. I'm like, what are you doing? You should be sleeping and you should.

Have the phone next to it. It should be on and you should be looking at it. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us.

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