Sleep Expert: This Changes Everything Doctors Know About Your Sleep

0:00 Anybody with over a 17 and a half inch neck has an 83% chance of having sleep apnea. Your brain says, oh shit, no air, and it wakes you up. And this can happen hundreds of times a night. And people have no idea that they had it. Dr. Michael Brose is a clinical psychologist who has spent his entire career helping people take back their sleep and their lives.

0:18 I stopped breathing in my sleep 26 times an hour. A lot of people don't know this, but during this stage, your brain actually shrinks. Then you're kind of screwed. Are we taking too much melatonin? Absolutely we are. Melatonin interacts with every birth control out there. So I'm against melatonin in all children.

0:34 What are we gonna do in order to kind of make this a little bit better? Step number one. Michael, I have been inundated with sleep questions when I told everybody that you were coming on the podcast. Oh, great. I have both men and women. The men ask me, why do I keep waking up at 3 a.m. every morning?

0:55 Yes. The women are asking me, can you ask Dr. Bruce why my husband keeps waking up- Yep, at 3 in the morning. Between 3 to 4. So can you tell me what is going on here? So this is the number one question that I get asked no matter where I go, men or women. So let's just knock it out right at the beginning.

1:13 So I'm going to roll through an exact protocol of exactly what I use with my patients the whole way through. But first I want to explain the biology because the biology turns out to be pretty important for people. So most people don't realize it, but your core body temperature rises, rises, rises till about 1030 at night and hits a peak.

1:30 Once it hits that peak, it drops. That drop is a signal for your brain to release melatonin, right? Melatonin is kind of the key that starts the engine for sleep. You ain't got no melatonin. You ain't sleeping. I mean, there's other things that have to go on, but to be fair, you got to have your melatonin.

1:43 Your core body temperature continues to drop, drop, drop, drop, drop, drop. At some point in time, if your body doesn't heat up, you go hypothermic and you die. Guess what time that is? Three o'clock in the morning. Almost for everybody. Somewhere between one and three o'clock is where we see this interesting shift in thermoregulation where people all of a sudden start to heat up.

2:03 When their body heats up, they naturally go into a lighter stage of sleep automatically and then they feel bladder pressure. And that's when they wake up. Every human on earth wakes up. Not all of them have to pee though. Every single human on earth wakes up at that particular period of time. The question is, why do some people stay awake and some people go back to sleep?

2:25 Well, for me, I don't even feel it if that's happening to me. Right, right, right. No, and that's generally what we see. So most of my patients will, you know, quite honestly, without being too crass, they'll burp, they'll pass a little gas, they'll roll over, and then they fall back asleep. But there's a select group of people, believe it or not, about 10% of the entire population, That has a real problem with insomnia, specifically middle of the night insomnia.

2:49 So what are we going to do in order to kind of make this a little bit better? Step number one, don't go pee. Yep. You heard it here. Don't go pee. Now everybody is like, Michael, what are you talking about? Okay. To be clear, many people don't have to pee. There's three ways that I can get somebody to go back to sleep.

3:06 And there's three things that need to lower. One of them is anxiety. One of them is temperature. One of them is heart rate. Okay. All three of those elevate when you go from a lying position to a seated position to a standing position and go pee. And turn the lights on. And turn the lights on, which by the way is a terrible idea.

3:22 Yes. Right? So number one, don't go pee. But I want to be clear. If you really got to pee, please go pee. Somebody asked me one day, should I buy some Depends and put, no, no, no, no, no, no, no. Okay. We're not talking about that. All right. But what we want you to do is be thoughtful, right? And so what I have people do, most people sleep on their side, right?

3:41 And so they're kind of squanched up That's a technical term, squunched. And when they do that, they push on their bladder. When they push on their bladder, it makes them think they have to pee. So what I tell people, look, roll over to your back. count to 20. If you still have to pee, please get your butt up and go pee.

3:57 If you do, give me a strategically placed night light along the way, and maybe one in the water closet. Because if you flip the light on, you just told your brain it's morning, it stops producing melatonin almost instantly. And that makes it even more difficult to go back to sleep. But the floor lights don't do that?

4:13 The floor lights don't. Okay. Yeah, which is nice. And you can even get floor lights in different colors that can be actually helpful. So I like for those type of things, believe it or not, like a red actually works really, really well because you can still see without it having any kind of alerting frequencies in it.

4:28 So I like for people to do that. But if you have to pee, please go pee. Now you gotta come back. What are you supposed to do when you come back? Step number two, don't look at the clock. Now, this turns out to be much more difficult than anybody possibly imagined. Why? Because here's what happens. People grab their phone and they head to the can, right?

4:47 And when you look at your phone, what's the first thing you see? The clock. Like you can't help it. And you immediately do the mental math and now you're pissed off. Heart rate is now going up. Temperature is now going up. Anxiety is now going up. Why the fuck am I awake? It's three o'clock in the morning.

5:02 This sucks, right? And that's what ends up happening to people. And so we don't look at the clock to avoid that. It doesn't matter. If it's dark out, you're supposed to be asleep. Who cares, right? Don't pee, don't look at the clock. All right, Dr. Bruce, I followed your recommendations begrudgingly.

5:19 Now, what do I do? I'm getting monkey mind. Monkey mind, I'm not sure I have to define it. You might already know what it is, but it's this unbelievable list of things that you start to think about at three o'clock in the morning. Sometimes it's the most boring, dumb stuff you've ever seen. And then sometimes it's unbelievably important, emotional, like something's wrong with my child and I can't stop thinking about it stuff, neither of which is appropriate.

5:44 in the middle of the night. Here's the thing that a lot of people don't realize is if you wake up at three o'clock in the morning, your brain is trained to be negative. Think about it. Nobody runs into your bedroom at three o'clock in the morning and says, happy birthday, you got a raise, right? No way.

6:00 Like when something happens at three o'clock in the morning, it's almost always bad. Right. It's almost always bad. So your brain is on high alert when it wakes up. So it's always going to look at things in a negative vein. Yeah. So we have to do something to slow that down. My favorite thing. I did not invent this.

6:16 It's called 478 Breathing by Harvard trained naturalist, Dr. Andrew Weil. Super smarty guy. Came up with this whole thing. I had to learn it myself. There are a couple of caveats. Yeah. Have you ever done it? Never. All right, you wanna try it? Let's do it together. Okay, so both feet on the ground. Yep.

6:32 Right, and then you could put your hands gently on the table. And then what you're gonna do is it's exactly what it sounds like. You slowly breathe in through your nose for a count of four. You would hold for a count of seven. Then you gently push out through your nose for a count of eight. That's one round.

6:47 All right, we're going to try it. You ready? Let's do it. Ready? And close your eyes. And while your eyes are closed, I want you to picture the number while I'm walking you through it. So you're going to picture a four, then a three, then a two, then a one. And that turns out to be the most important part of the whole thing.

7:01 Oh my gosh. Okay. All right. You ready? Let's do it. My eyes are closed. Eyes closed. I'll close my eyes too. You ready? Yep. Three, two, one. Breathe in. Two, three, four. Hold. Two, three, four, five, six, seven. Push. Two, three, four, five, six, seven, eight. Perfect. Perfect. So I actually did that before I came on because it helped settle me down.

7:27 It's great for lowering your heart rate. You have to get to 20 cycles in order for your heart rate to drop to about 60 to fall asleep. Okay, now here's the problem. I lose count. Yes. And you end up falling asleep anyway? No, I end up getting pissed off and then I'm in trouble. So I came up with an idea.

7:45 So what I do is I take my hands like this and I make gentle fists and I put them down by my side. And when I do one round, I put out a finger. When I do a second round, I put out a figure. You're doing all of this in bed. Mm-hmm. Okay. It's distracting me from all the negative thoughts. As you might notice, I'm distally doing something.

8:01 I'm actually breathing and I'm keeping my mind occupied. This is a massive distraction technique that also lowers your heart rate because of the breath work. Oh, no way. So it's a twofer. Okay. Right? So there is hope for all the people who wrote in to me. Absolutely. Why is it that we see this upward curve of men who get older and the relationship between that and prostate size?

8:25 Is there anything there? Yes. So there definitely is something there. I think over the course, I mean, I'm not a urologist, so I'm not brought probably like, I don't wanna go too far afield, but what I can tell you is most guys end up with a slightly enlarged prostate at some point in time. And that is definitely part of what's going on in terms of having people pee.

8:41 One of the things I like to tell people is I ask them to follow what I call the three, two, one rule. Three hours before bed, you stop all food and drink. Two hours before bed, you stop all work. One hour before your bed, you stop all screens. If you can do that three, two, one, it falls nicely because if you stop drinking for three hours and you hopefully go to the bathroom before you go to bed, then maybe you can cut down one of those bathroom trips.

9:05 Yeah, that's really interesting. I mean, if you're compliant, it would work. If you're compliant. Then the other thought is you've got women who 60% of menopausal women will experience hot flashes. I know. So it's a completely different story then. Yeah, yeah, it's completely different story, but there's still some of the things that we can do similarly.

9:23 So as an example, 478 breathing works fantastic for women in the middle of the night. However, I will be honest with you, you're not gonna breathe away a hot flash, okay? It doesn't work that way. I wish it did. I wish it did. You're not going to breathe away a hot flesh, but what you can do is calm yourself down.

9:39 The key here is not, did I have the hot flesh? It's how am I going to react to it? And then how can I settle myself down in order to get myself back to sleep? Right. And I think that becomes really, really important. And when we look across Like menopause, like let's be fair, menopause is one day. We've got perimenopause, we've got menopause, we've got postmenopause.

9:57 And sleep is very different across all of those. And so if there are women out there who are struggling with sleep and they're in the perimenopause-ish stage, I'm here to tell you, unfortunately, that's how it is. Yeah. Yeah. Like this, like, well, because as you're coming to menopause, my limited understanding is you're basically running out of eggs, right?

10:15 And eggs are the things that produce all this estrogen. And so you don't have a lot of estrogen. You certainly don't have a lot of progesterone left over. And so what ends up happening, and this is, this sounds awful, by the way, is all of a sudden one day you've got plenty of estrogen, the next day you've got zero.

10:28 Then the next day you've got half as much as you used to have. And so women are stopping and starting and all over the place and having incredible difficulty. understanding what's gonna happen tonight, what's gonna happen tomorrow. So it's very irregular and that makes, it's really depressing sometimes because they're like, I tried this and it worked and now I tried this and it's not working.

10:47 And so we try to give people enough tools in the tool belt to be able to do it. A couple of things we know seem to work reasonably well from a sleep perspective for menopause. Again, I am not here to talk about menopause in general and hormone replacement therapy and all that. But I will tell you, hormone replacement therapy, specifically progesterone, helps with sleep.

11:06 Of course. It's just a big deal. If all you did was get into progesterone, again, with the advice of your doctor, not some standard dose, but a dose that's personalized for you, you'd be surprised at how well it can help with sleep. Other things that women don't think about during that period of time is circadian rhythms.

11:23 Right. And so if you get up at the same time every day, that's actually really helpful because all your hormones will follow that circadian rhythm. But if you get up at a variable time, your circadian rhythm becomes variable. Guys, I have been thinking a lot about vitamin D. I went and got my blood tested and it turns out I have a slight deficiency in vitamin D. So Michael talks a lot about light because our biology responds to the environment around us.

11:49 And one part of that conversation, we rarely discussed UVB. UVB helps stimulate the body's natural production of vitamin D. And that's why I have been so interested in Soleus. Soleus is an FDA cleared over-the-counter UVB panel, and it's really designed to stimulate natural vitamin D production. It's got a built-in optical sensor that analyzes your skin and it calculates an individualized UVB dose instead of just giving the same one to One session takes approximately five minutes once per week, giving you controlled, personalized UVB year round.

12:34 In a randomized placebo controlled study, participants using this device increased their vitamin D on average by 10.2 nanograms per milliliter. Individual results vary, but if you want to check this out, go to soleus.com slash neuro, use code neuro, and you'll get 10% off this at-home device. Yeah, I've actually heard you say that you don't care when people are falling asleep as long as you're getting up every day, which actually counters almost every argument that is being made on social media, which is you must go to sleep at the same time every day and you must wake up at the same time every day.

13:10 I wish it worked that way. I feel like bedtimes are kind of like a bag of chips. Once you break them, you're done. Yeah. Right. Like once you go past your 930 bedtime, it's time for Game of Thrones, a bucket of ice cream and let's go. Right. But people need to stop like but wake up time. I can control that in every single human on Earth.

13:27 It's called an alarm. Yeah. You stick it on your phone and it wakes your ass up like that's easy. What about if you snooze it? Let's talk about snoozes. So whenever I give lectures, I always ask people like, what's the largest number of snoozes? And I start, you know, one snooze, raise your hand, two snooze, raise your hand.

13:44 It's crazy how many people snooze, number one. By the way, it's the worst invention in all of sleep. No, do you want to know what the worst invention is? Yeah. Hey Siri, turn off my alarm. That is the worst invention. That is the worst invention, because then you're kind of screwed. But snoozing, the average snooze is seven to nine minutes long.

14:01 Your body can't get back into a deep enough stage of sleep during that period of time. So all you're doing is giving yourself light, crappy sleep every time you hit the snooze button. I'd rather you wait or do one snooze and then say, I got to get up or have an accountability partner say, hey, get your ass up.

14:17 that kind of thing. That's going to be much more helpful. But if you do have a very consistent wake-up time, which is what we kind of started the idea with, that becomes a metric to make you go to bed at the same time. Because here's the thing. If you know you're going to wake up on Saturday morning at 6.30, because that's what you wake up during the week, there's no universe you're staying out until 1.

14:35 No, that's exactly right. It's not going to happen. Tell the Louisa in her 20s that. Well, but the Louisa now is a little bit different. Very different. Right? More health-conscious, more thoughtful. Yeah. So we spoke about the number one complaint that people are having, which is this wake up time. Yeah.

14:49 What else do you see across the board? Like what's the second biggest complaint that people have when it comes to their sleep? I'd say, well, there's a few that kind of seem to drop down and fall into that category for me. I think one is, how do you get my bed partner to stop snoring? Oh yeah. Is a big, big, big one.

15:06 I have so many people who are, and it's not just like, hey, save my sleep. It's like, hey, they're doing something weird in their sleep, like they're gasping, they're choking, like I think they could have sleep apnea. So that's something that I think is very underdiagnosed that a lot of people don't think about, or they just avoid.

15:22 And I'll tell you why I think they avoid it, is because they don't want to sleep with a CPAP machine on their face, right? So just to back up for half a second for your audience, sleep apnea is a situation where you stop breathing in your sleep. Most people with sleep apnea snore, not everybody does, but most people do.

15:38 And sometimes snoring can lead to this collapse of the throat where there's no air going in, then your brain says, oh shit, no air, and it wakes you up. And this can happen hundreds of times a night. And people have no idea that they had it. I'm one of those people. Wow, really? So I got diagnosed about four months ago.

15:56 No, six months ago with moderate obstructive sleep apnea. I stopped breathing in my sleep 26 times an hour. What? An hour. Let me tell you the story of how I figured it out. So I called up my doctor, the woman who takes care of me, Carrie, and I say, Carrie, my workouts are kind of, they're not going so great.

16:14 Like my mile time keeps going up. My VO2 max doesn't look fantastic. Something's going on. She says, ah, let's run blood work. Maybe you're anemic, maybe you need some testosterone, maybe something's going on. Okay, so we look at my blood work and everything looked reasonable. My testosterone was like at 450.

16:30 I'm 58 years old. That's not terrible, but it's not, you know, fantastic. So she says, let's try on some testosterone. So I try testosterone. The only thing I end up doing is losing more hair. Okay. Gives me no more energy, nothing. So I turned to her and she's like, Hey. Yeah, I did. I did injectable.

16:49 I started out with the oral and then I went into the injectable and I didn't have a great response to it at all, quite honestly. And then I turned to her and I said, you know, what's next? And she said, hey, sleep doctor, have you had a sleep study lately? And I was like, oh shit, I hadn't had a sleep study.

17:03 When I had my own lab, I would test out all the equipment on myself. Yeah. Because you would never put a new piece of equipment on a patient. So I would I haven't had a lab in quite a while. So I was like, oh, my God, you're right. So I called up the my guys over at Sleep Doctor and I was like, hey, send me a sleep study because that's what we do over at Sleep Doctor.

17:19 You know, we give people sleep studies and CPAP and all that kind of stuff. And so I was like, send me a test. So he sends me a test and I take it and it says stop breathing and sleep 26 times. So you know what I did? Clearly, I had to get the test done again because it had to be wrong. Literally. Yeah.

17:31 How could I have sleep apnea? What are you kidding me? So he sends me the same test. I get the exact same number. And now I'm like, oh, shit, I really have sleep apnea. So I have a CPAP machine and I adapted to it pretty well. I was kind of surprised that I adapted as quickly as I did. But I have a story behind that one.

17:48 You know, I've got a lot of stories, right? Yes. Well, we're going to get into like the physiology of CPAPs and sleep apnea. I just want to know before we get into that, what's the third biggest complaint? So 3am CPAP, sleep apnea, what would be the third one? Be the third biggest complaint about sleep?

18:07 Might have to do with jet lag. I get a lot of questions about jet lag, people flying different places and having a lot of difficulty with that. I think that's probably definitely up there. Could you tell me a bit about your experience and why you do what you do? Sure. My experience being a sleep doctor?

18:23 Yeah. It's interesting, when I first got into the field, it was just super cool because it was like, I can actually help people with something that is demonstrable in their lives, right? You change somebody's sleep, you change their life. And it's fun and it's great. Like I'm a clinical psychologist, remember?

18:42 Like a lot of times, like you don't see treatment gains in depression or anxiety sometimes for weeks, months, even years. I change people's lives this fast. It's unbelievable. change your sleep, you change your life. And I'm a little addicted to that, if I have to be honest with you, it's super fun. I mean, people are so grateful and so happy that we teach them these things.

19:08 And in a lot of cases, it's just me holding their hand because they already knew what to do. So I really enjoyed that. And then I started to think about like, what does sleep mean? Why is sleep so important? Why when you change your sleep, do you change your life? Became a question in my head. Like that's why I do what I do.

19:27 I was watching this YouTube video, of course, of this philosopher guy. And he said, he said something that I thought was interesting. He said, the currency of life is time. That made sense to me, right? Where I spend my time is how I lead my life. He said, the currency of time is attention. So where I spend my attention is where I spend my time, which is where I have my life.

19:51 That's Buddhist, that's not him, right? Sleep, I think, is the currency of attention. If you have not well slept, there's no universe you're attending to anything. I can show it to you in ADD patients, ADHD patients. I can show you in focus and defocus patients. I can show you in all kinds of brain patients.

20:12 Like sleep really helps you zone in. And so that's why when you change your sleep, you change your attention, which changes your focus. It changes where you spend your time, which is how you spend your life, right? I love that, yes. So at the end of the day, if you work on your sleep, everything gets better.

20:34 So what was the moment where you first took a patient, for example, and saw their life change through a sleep protocol? Oh, I got it. This is a great story. So this is when I was practicing in Atlanta, Georgia. Yeah. And it was in my early years. And you think I look young now? I look like Doogie. You might not know who this is, but Doogie Howser was this TV show of this really young physician.

20:53 People used to call me Doogie. So I would come in, they had to give me a white coat that said Dr. Bruce, just so people. So I walk in, there's this guy in there, big guy. He was with an agency called the GBI, which is the Georgia Bureau of Investigation. It's like the FBI, but just for Georgia. And he had gotten sidelined because he was falling asleep on stakeouts.

21:11 Oh yeah. And they put him in the office and he was really getting depressed. And I mean, like when detectives get depressed, they don't do well with depression, right? And so, I looked at him in 30 seconds. I knew this guy had sleep apnea. I was like, dude, I'm gonna change your life. How did you look at him and know that he had sleep apnea?

21:31 So if I'm super duper honest with you, there's a great physical marker that is very easy to see. Anybody with over a 17 and a half inch neck has an 83% chance of having sleep apnea. What? Yeah. I can stand outside the big and tall store and just pass out my fricking card, okay? Like I'd be set. Wait a second, wait, so the longer your neck- The bigger circumference of your neck, the greater likelihood it is that you have sleep apnea.

21:57 Why? Well, think about it. All the adipose tissue that's there is gonna crush the throat and it's gonna lead to sleep apnea. So when I saw him, I was like, this guy's got sleep apnea. So what did I do? Send him to the sleep lab, got him a sleep study, got him on a CPAP machine, Remarkable change. But here's what the fun part was, is I walk into the room, and he was not a small man.

22:18 I'm 5'9", I weigh 165 pounds. I'm not a big guy, right? He was like 6'2", 6'3", like good, you know, 250, 300 pound guy. His wife was with him. Not a small woman either. She was about 5'10", 5'11". She was a good 180, 200 pounds. I walk into the room, she stands up and she engulfs me in this unbelievable hug.

22:42 Just unbelievable hug. And I'm like, oh, you know, I'm like trying to get through it. And she turns to me and she said, thank you for giving me my husband back. She said, I don't think I need these anymore. And she hands me papers. And as they're walking out, I open them up, divorce papers. I shit you not, divorce papers.

23:01 That's why I'm a sleep doctor. Wow, because you are saving marriages. Can I just, let's really go into sleep apnea because you yourself, your neck doesn't seem that big. No, it doesn't. You yourself could picture sleep apnea on another individual, but not yourself. Exactly. First of all, sleep apnea, you mentioned, it's waking up at night.

23:22 It's basically when you stop breathing. Correct. Several moments at night. It could be anywhere from what? Five, it starts at five an hour and can go to hundreds of times an hour and you won't even know it. Wow. And it has significant cardiovascular effects downstream. Yes. Right, because as you stop breathing, your heart rate slows down and speeds up to breathe again and then slows down and speeds up.

23:40 And so you put an extra load on your heart all night long, you end up with atrial fibrillation and now you're off to the races. By the way, there is also a direct relationship between this and brain health because you're pretty much starving your brain of oxygen. Probably a bad idea. Probably. Yes. Also, if we don't get into the right stages of sleep, we don't have that cool thing called the glymphatic system that comes in and washes out our brain.

24:02 And a lot of people with sleep apnea, their glymphatic system isn't kicking into gear because they're not getting into the deep enough stages because they're fall asleep, wake up, fall asleep, wake up, fall asleep, wake up. One of the most important things you can do for your biology, for your health span and your lifespan is optimize your mitochondria.

24:20 Sleep is one part of recovery, but recovery also happens at the cellular level. Every movement and every muscle contraction depends on mitochondrial energy. And mitochondrial function naturally declines as we age. That is the one reason I take Mitopure from Timeline Nutrition every single day. So Mitopure contains urolithin A, which supports this cellular process called mitophagy.

24:49 Mitophagy just helps your body remove damaged mitochondria, recycle cellular components, and support healthier mitochondrial function. I take this every single day. And that's because Timeline has spent more than 15 years researching mitochondrial health. In fact, in a four-month randomized trial in middle-aged adults, Uralithin A improved hamstring strength by up to 12% without changes to participants' exercise routine.

25:19 Recovery is not just about how many hours I sleep. It is about supporting the biology underneath performance. If you want to try this, go to timeline.com slash neuro to get 20% off when you subscribe and save. What other contributing factors increase your risk of sleep apnea? Sure. At first, being a male just seems to do it.

25:42 There's a two to one ratio, men to women. So twice as many men have sleep apnea until women reach menopause. And then it evens out because of the hormonal changes and the weight gain. Yeah, that's where it happens. What are the signs and symptoms of sleep apnea for men? And I'm glad we brought this up because I want to be very clear.

25:57 They're different for women. And that's a big issue that's going on right now in sleep medicine. So for men, it's snoring, observed apneas, tired during the day, grumpy. basically, right? Here's what's interesting for the last, I don't know, since the 40s was when the first sleep lab came around. We've been using white male criteria to evaluate women for sleep apnea.

26:22 Oh, I'm not surprised. Yeah, I know you're not surprised, but it's really bad idea. Yeah. Because here's what happens is a woman comes into a sleep lab and she doesn't have the signs or symptoms of sleep apnea. So the doctor doesn't know to send her for a sleep test because he's only been trained on male signs and symptoms.

26:40 So if he does do a sleep study and sends him for a sleep study, guess what happens? They show very, very mild disease, if any at all, because women don't have apneas the same way men seem to. This is something that we're just starting to learn now. And so the doctor turns to them and says, you have mild sleep apnea.

26:57 I'm just going to put you on an antidepressant. And now we're off on a completely different path that's completely inappropriate. So right now, there's a big argument inside of sleep medicine, and we're all trying to find what are the correct criteria for women to be diagnosed with sleep apnea. As an example, women don't report snoring or observed apneas.

27:18 They wake up with headaches in the morning. right, from the lack of oxygen. Women report, I don't feel like myself, not I'm depressed, not I'm anxious, like something is off here, right? So there's different symptomatology that we're trying to discover so that way we can accurately, you know, work with women and be able to help them out.

27:38 The big problem is nobody wants to get on a CPAP machine. Nobody wants to get diagnosed because they all think they're gonna end up on a CPAP machine. I'm here to tell you, number one, I'm on a CPAP machine. We'll talk about that in a second. But by the way, it's not the only treatment. Like I also have an oral appliance that I use when I travel.

27:54 And by the way, it works just as well. So then why don't you just use the aural appliance? Great question. So what I find is that sometimes I really like having that influx of air. It just feels better for me. Also, I adapted to CPAP really easily, and most people don't, but I have kind of a funny story as to why.

28:12 So when we got the CPAP machine, so we have two French bulldogs at our house. I've told you many stories about them, I think. And we got a puppy. We had a new one. And he sleeps in between Lauren and I, but he migrates up and he likes to sleep in between our pillows. Okay. And he likes to put his head on her pillow.

28:30 Okay. You know which end of the dog I get? Yes. The ass end of my French bulldog all night long. Bulldogs are known for farting, by the way. Did you know this? No, I didn't. Yeah. And so when somebody said to me, hey, Michael, I'm going to put a mask on your face with clean, filtered air. I was jumping at the chance.

28:45 Yes. So I jumped on and I became a CPAP user right away. Well, can you just define what the actual what it's delivering? Yeah. It's just straight up air. So it's literally a hairdryer blowing up your nose. It's not oxygen? You can pump oxygen in for people who need it. So what's interesting is just because you stop breathing at night doesn't necessarily mean that we need to punch oxygen in.

29:04 It just means we need to inflate the lungs and have the lungs breathing. But there are some people who their oxygen falls off a cliff And then we do have to add oxygen in for that. So there's a port inside the mask. So what I'm talking about here is your throat closes, right? So what is it? It's a mask that sits on your nose, a little air compressor on the side with the hose, shoots a thin stream of just air down your nose and where it's, Opens it up.

29:25 Yeah. Right. Breathe straight through. Okay. No problem. Now, to be clear, you got to sleep with a mask on your face all night long and there's a hairdryer blowing up your nose all the time. Exactly. It would be very difficult in the first week, I would say. Yeah. First two to three weeks is the compliance, like, make or break.

29:39 Yeah. And here's what I can tell you. Some people have been on CPAP for 15 years. They'd shoot you before they'd let you take their CPAP. Wow. Yeah. It's interesting. So it's a mask and then is it attached to anything? It's attached to a hose and an air compressor. So it's literally like a hairdryer.

29:55 I mean, it's much more, it's not a hairdryer, but it's literally just an air compressor that pushes clean, filtered, pressurized air at a particular pressure that it knows exactly how far to open. And so when somebody gets on a CPAP machine, let's say someone who's got severe sleep apnea. Sure. And what do they experience afterwards?

30:14 So it's really interesting. The worse your disease is, the better the experience is. Of course. Because when you're stopping breathing your sleep hundreds of times an hour, you're like, you're a zombie. So what usually ends up happening is within the first seven to 10 days, it's like an awakening. So what ends up happening with a lot of my patients is they sleep exorbitant amounts at first because their body hasn't gotten good sleep in so long.

30:35 So they might sleep eight, nine, even 10 hours for like the first week and a half or so. And then their body kind of gets back to it. and then they're back to normal. Then they're like a normal average, they wake up with energy, they feel good. I mean, yeah, you have to, there's some of- It's an adjustment period.

30:50 It's an adjustment period. And yeah, you have to change your mask out every once in a while. And yeah, you need to keep your machine clean so you're not breathing in bacteria. But again, that's not the only option. I have this mouth guard that I like. And also, by the way, mouth guards don't work the same in every person.

31:07 CPAP is a macro method, right? I'm gonna blow air down your throat. Nothing's getting in that way, right? But the mouth guard, what if you have TMJ? What if you have dentures? There's all kinds of differences that come in across here that become complications. So for some people, they try an oral appliance, it doesn't necessarily work.

31:26 There are also some minor surgeries out there, like not go under the big knife that work very, very well. And then there's some big knife surgeries as well. So for anybody listening that suspects that maybe they're thinking, wow, I wake up with headaches every morning now, or wow, my husband definitely has this.

31:41 Like, where do they go first? I think that's the biggest problem right now. I don't know if you see this, Michael, but like people don't know where to go. Which specialty do I go and see? Because now we've pretty much eliminated going to see a PCP because we can order our own blood. And unfortunately people are turning to AI for their analysis.

32:01 So where does somebody go? Do they have to go and get a sleep study? So here's what I'll tell you without being too self-promoting, swing on over to my site. That's what we do. So at sleepdoctor.com, you can buy a test for less than 200 bucks and it's covered by insurance. Oh, wow. Okay. And your CPAP is covered by insurance.

32:17 Is that an at-home sleep study? Uh-huh, yeah. So you send the equipment home? Yeah, it's great. So it's crazy. So you go on, you push the button, you say, I want to purchase. And then all of a sudden you are on a calendar. You have a calendar. We have doctors that are board certified in all 50 states.

32:30 You make an appointment online with one of my doctors. They decide, hey, do you really have sleep apnea? And they say, probably so. They push a button. Shh. goes to your house, it's disposable. You wear it one night and you throw it away. It's awesome. Can I tell you a funny story? Yeah. Back to my non-compliant father.

32:47 Indeed. So I believe he's got sleep apnea. But remember how I told you that he's non-compliant, he doesn't really want to try new things. my mum and I got him an at-home sleep study. Fantastic. But I don't know if it was the same one as you. Now, as a neurophysiologist, I have spent a year doing polysomnographies, right?

33:04 All night looking. Okay, we've got EOGs, we've got EEGs. There's so much equipment involved in this. It's ridiculous. setting my father up for this. We had to put this belt around him. It's changed. Yeah. Like literally 10 minutes into setting him up, he literally threw it off. He goes, that's it. I'm done.

33:23 He goes, I'm done. I would rather just die, choke me to death. I'm not doing this. So here's the good news. Since COVID, everything's gotten much simpler. Okay. So as soon as COVID hit, everybody was like, I'm not going to a fricking sleep lab. I'm not sleeping in a bed that somebody else was just sleeping in.

33:38 And so all the equipment, like all the manufacturers, like literally within six months, we had five or six different ones. There's a ring. There's one that looks like a watch. There's a band. Like, don't worry. Like it's not some crazy, because we used to have that. Used to be the mobile studies. You'd have belts across your chest.

33:55 You'd have a cap that you'd have to put on. Like it was nuts. what we were trying to do. Much simpler now. Okay. That seems good enough. And cheaper. Okay. So the next thing I want to tackle is something that I experience, which is jet lag. Yeah. So what can people do to help them overcome jet lag? So jet lag is fascinating because so many people come up to me and they say, Oh, I don't experience jet lag, Michael.

34:17 Bullshit. Okay. Everybody experiences jet lag, but there's a range. Some people, it affects them dramatically. Some people, it doesn't. Here's one of the few things that I will tell you is, number one, before you go on your trip, if you are very sleep deprived, jet lag will be much worse. Really? Much worse.

34:35 Your body doesn't react well to more displacement out of time, right? And so being well slept before you go on your journey is always a good idea. But to be clear, the night before your journey, nobody sleeps well. No. So you want to, for the six or seven days before you leave, right, get some good sleep.

34:53 Because the night before you're going to sleep like shit, everybody does. It's this anticipatory anxiety and you think you might have not packed something and all that stuff. So number one, get some good sleep. Number two, figure out how to sleep on an airplane becomes important because depending upon what time you're flying and the zones that you're flying in, you may have to sleep on the airplane.

35:11 Okay. What I do, I don't rely on the airline sleep kit. I bring my own sleep kit. Let me tell you what I put in it. So I have my own eye mask. I have my own earplugs. I have my own. I actually have earbuds so I can put meditation music in that are earbuds meant to sleep in. So believe it or not, they now make electronic earbuds.

35:29 I've seen them. Yeah. NextSense is the company that I use. And full disclosure, I'm their chief sleep officer and their stuff is super cool. And so I use those. I bring Afrin. What's that? Afrin is a nasal decongestant. It's here in the States. You might not know about it. It's super duper powerful. You can only use it for like a night or two.

35:47 Michael, I live in the United States of America. Well, I mean, but I know, but you're, you've got an Australian background. Yeah. They didn't have it over there. Well, I don't think they do. Yeah, that's why I was saying it. So Afrin, you can get it at any local drugstore, but you two squirts, you're done with congestion.

36:01 Right before you get on an airplane, the last thing you need is to get a sinus headache on a 12 hour flight. Yeah. So I always have a little thing of Afrin in there. I bring my melatonin because I use melatonin. And this is one of the only times that I think melatonin is appropriate. And we can definitely get into the melatonin of it all because there's a lot of stuff to talk about there.

36:21 But there's actually a schedule that you can create using caffeine, napping, melatonin, and light in a particular order based on where you are and where you're going. Jet lag is gone. I do that using TimeShift app. That's what I use. No affiliation whatsoever, but I really love it. I have lots of affiliation.

36:38 Okay, great. I don't know who put me on, and maybe it was you to begin with. It was me. Okay, great. When you told me about this, I'm like, because I was flying to Australia, and I'm like, come on, I'm not using this app. And it really did. It's unbelievable how well it works. And I stuck to it. And it was so funny.

36:51 I get to Australia, which is a 16-hour flight, and people are like, how are you functioning normal? I'm like, I'm great. It's amazing. The science is super duper hardcore. I will tell you, I've looked into like jet lag diets and things like that. I haven't found any great data on those. So if people are looking like I know a lot of people will go online and they'll say, hey, I want to I want to look around and see what I can do for jet lag.

37:13 Here's what I'll tell you. Create your own sleep kit. Oh, another thing to put in your sleep kit, compression socks. Yes. Okay. Okay. I don't care how old you are. Yeah. Stick them in there. Why? Because what ends up happening is when you're sitting for 16 hours, blood pools in your legs. Yeah. Right.

37:27 And that's, and if you have any proclivity for a DVT or anything like that in your history, you really don't want to have one of those in a tube that's flying over the ocean, you know, at 30,000 feet. Right. Right. So compression socks. The other thing I do is, and this is going to sound a little OCD, but maybe I am, is I bring my own food usually.

37:45 And I'll tell you why. And I never drink alcohol on an airplane either. There are multiple reasons for that. I bring my own food because I know what my stomach can handle. And what I don't want is to have a stomach problem. at 30,000 feet. Oh, hell no. Right. So I'm very careful about that. I have a little bit of a particular stomach, so I bring my own food with me and people don't seem to mind.

38:05 Everybody's fine with it. And then the other thing that I try to do is I try to dress appropriately. So a lot of people don't think about it. Like I bring basically scrubs that I'll change into, like I'll go into the bathroom and I'll change into them and I'll put on socks. And then I'll sleep when it's appropriate for me to sleep by using my melatonin, caffeine, napping and light in this particular order with time shifter.

38:27 And then I usually do pretty well. I'm the worst culprit of with what I wear. I wear jeans. I try and look. It's hard to do that because what happened for me anyway is they were they. So if I wear jeans, a little maybe too much, I'll unbutton the top. And that just gives me a little bit of room. I can finish working and still feel my brain running through the next 10 things that I have going on.

38:50 It's so stressful. And one thing I use when I want to downshift is Neuropod. It's a wearable neuromodulation device that clips to the left ear and sends gentle electrical signals to the vagus nerve, stimulating brainstem regions involved in your body's recovery response. I already know when I'm stressed, so I don't need another score.

39:15 I can use NeuroPod whilst doing something else. And I usually do this at night for around 15 up to 60 minutes a day, gradually increasing each session. So for those of you watching, this is Neuropod here. It's super fancy. It's super easy. It connects to your phone via an app so you can work everything out there.

39:35 It clips on your left ear very perfectly. And I have to tell you, this device is for anybody who struggles to calm their nervous system down. That is me. If you want to try this out, go to neuropod.com slash neuro for 5% off. There is also a 30-day money-back guarantee. For anybody who's struggling with whether it's jet lag, whether it's insomnia or any of the things that we've just spoken about.

40:03 Yeah. How do you feel about naps? Because I have to say, they are pretty controversial right now, like to nap or to not nap. Then, you know, two years ago, there was this widely accepted ritual called have a nappuccino, which was also great. Napa latte. Now, I brought up this study, which was a NASA study done on 12 people.

40:22 Okay, 12 astronauts where they implemented a 40 minute rest period. And for the others, they implemented a no rest period. The ones who did the 40 minute rest period, which I know you know the study, had a 34 to 35% increase in their cognitive scores, which that's amazing. Yeah, isn't that great? All you have to do is take a nap and you're 30% smarter.

40:43 Yeah, so how do you feel about naps? I love a good nap. Okay. I'm a big fan of napping. However, if you have insomnia, you cannot nap because what it does is it lowers the amount of sleep drive that you have. Remember, sleep is a two system situation, sleep drive and sleep rhythm. Sleep drive is primarily an adenosine buildup, right?

41:01 So when a cell eats a piece of glucose, something comes out the back end, there's adenosine in there. As the adenosine accumulates, you get sleepier and sleepier and sleepier, right? That's how sleepiness works. If you take a nap at, let's say, four o'clock in the afternoon, you lower the amount of adenosine that you have, and then it makes it more difficult for you to sleep at night if you have insomnia.

41:21 If you don't have insomnia, most of the time it's not bad. But I will tell you, and I'm going to give away this hint, my favorite time to nap, watching golf, right? Rory gets to the tee box. They're so quiet. And if you fall asleep, who cares? 30 minutes later, you're gonna catch up on ESPN anyway. So nap while golf, I mean, not while golfing, but while watching golf.

41:41 I love that. So naps are good. Naps are great, but not for insomniacs. Not for insomniacs, okay. So if I implement everything that you've said and I fixed my sleep tonight, how is that gonna change my life tomorrow? I mean, I'm pretty sure like your bank account, you're gonna find at least a million bucks in there.

41:58 You're gonna be running marathons. You're gonna be an Olympic athlete. No, here's what's gonna happen is it's not an overnight fix, but consistency is the name of the game here. It is if you can find the parameters that actually help you sleep better and you just double down on all of those, over the course of time, It will change your life.

42:18 What will you see immediately? Depends on how sleep deprived you were before you started. If you were reasonably not sleep deprived, I would say you'll start to see things happen over the course of two to three weeks. If you are really sleep deprived and you just wake up at the same time every single day and get roughly six and a half to seven hours of sleep when you were probably only getting five, you will feel like a million dollars.

42:40 I can assure you of that, right? Sleep is this undercurrent on every single system in the body. Every system in the body operates better when we sleep better. I mean, it just it happens that way. So it's clear that there is this huge epidemic happening. There is. Can you just tell me briefly what sleep actually is?

43:02 And we don't really need to go into every stage of sleep because I know that stage three and three sleep is the most important. Well, alongside REM sleep. Let's just talk about what they're actually doing to us. Sure. There's a lot of different ways we can think about sleep. Some people, as I was mentioning before, there's sleep drive and sleep rhythm.

43:20 And that seems to be the overall guiding principles. And then inside of sleep, we have sleep cycles. So roughly every 90 minutes, a repetition occurs of what we would consider to be a cycle. Generally speaking, we go from wake to stage one, stage two, stage three and four, which is your favorite, into stage two and then into REM, and then we're done.

43:40 for one cycle. Generally speaking, we have five cycles. Let's talk about what each one of those stages do for us. Why are they important at all? I'm gonna be honest with you, we're gonna bypass stage one because it lasts for about two minutes and it's literally opening the door to sleep. Okay, stage two, which makes up the majority of the night, like 50% or so, there's a lot of things that go on in there that aren't important for our audience, but it is important for them to know that stage two does a great job of acting as a buffer between REM and non-REM sleep, or what we call stage three, four sleep.

44:12 The important ones are your two favorites, non-REM sleep, or what we call stage three sleep, and REM sleep. Non-REM sleep is your physical restoration. This is your wake up and feel great sleep, right? This is where basically you bring the car into the body shop and you get the dinks and the dents and the all kind of pulled out, right?

44:31 Generally speaking, a couple of different things go on there. We know this is the largest bolus of growth hormone occurs during this period of time. So that's where a lot of those things are now happening. We also know that there's something called the glymphatic system, which is, I call it the waste management system of the brain.

44:47 A lot of people don't know this, but during this stage, your brain actually shrinks. This cerebral spinal fluid comes in, kind of does a little spin cycle and then pulls it all back down. And now you've got a clean brain. Now, why do you want to have a clean brain? That's more your area than my area.

45:00 What we don't want are these proteins that are left around called beta amyloid and tau. They seem to do some quite a bit of damage by strangling the nerves. And I believe that's called Alzheimer's. So we want to kind of avoid that. So what's fascinating is people need to protect their stage three for sleep.

45:16 And almost nobody does because caffeine obliterates it. But alcohol really crushes stage three for sleep. And cannabis doesn't do it any real favors. It has more of an effect on REM sleep. REM sleep is your mental restoration. This is actually where we've now discovered you move information from your short-term memory to your long-term memory.

45:35 That process of moving that information over creates this weird fantasy in your head called a dream. Uh-huh. Right? And it's this weird kind of thing that's going on in there. You're not really sure what it is, but you know, it's kind of happened. And some people say they have them and some people say they don't.

45:49 We can get into dreams if you want in a second. But when you look at the architecture of sleep, you want to have about 25% or so of stage three, four sleep and about 25% of REM. And then one and two can be about 50%. Now, I want to be clear. Don't look at your tracker every single day. I can't count the number of people who walk up there and go, Michael, I only got 13 minutes of deep sleep.

46:10 I don't care. Really? You're going to be okay. Because here's the thing. There isn't a tracker that's accurate enough to worry about it. Okay? There's no universe. You only got 13 minutes of deep sleep. But it is being consistently inaccurate. And I can work with that because all I have to do is look at the trend.

46:27 So if it's going to consistently tell me the wrong answer, if it consistently goes up, then I know something's happened. If it consistently goes down, I know something happened. So I don't care if it says 13 minutes. I care when it said 13 minutes and now it says two minutes. That's when I want you to show me what's going on there.

46:41 People have a tendency to obsess about the numbers. And to be fair, sleep's not a number game. Sleep's a quality game, not a quantity game. So many people are like, Michael, Michael, how many hours of sleep do I need? What am I going to do here? How do I... Relax. This unit that we're walking around in, it's really fucking smart and it knows how to do absolutely everything.

47:04 Don't worry. Every night before you go to bed, your brain scans your body and it's like, okay, I need this much stage three, four sleep to fix all the problems. I need this much REM sleep because I had this much emotion today. And it does it. Like relax. I think the whole sleep tracker phenomenon has really surprised me because sleep is a neurological event.

47:23 Right. And as a neurophysiologist who's done probably almost 10,000 EEGs right now, I think to myself, how are you planning to replicate that on a ring that's wrapped around your finger? Right. And I say that to people all the time. I'm like, look, we measure sleep from EEG. How do I get EEG from your finger?

47:40 Yeah. I don't. It's a proxy, right? So they look at heart rate. They look at, you know, HRV. They look at blood pressure, maybe temperature. And then it's a guesstimation as to where it is. This is why none of the trackers are particularly great. I would have to argue Aura is probably the best out of the bunch.

47:55 Well, I want to counter that. Actually, there's a lawsuit happening right now. I heard about that. Yeah, it's only just recent, a lawsuit saying that it's so inaccurate and they're selling false advertisements. So it's interesting. So my data comes from the actual published literature. So people have published literature on Oura rings and they do it versus polysomnography.

48:18 And it's pretty close. It's pretty close. It's pretty, it's probably in the 80, 82% range. And so I think it's getting better and better. Here's what I will tell you. It's going to get better over time. Yeah. Like, let's be clear. Like, we're not that far away from it. Oh, by the way, I forgot to mention over time something else.

48:35 Remember we were talking about sleep apnea before? Yeah. There's a pill coming out. For sleep apnea? It's gonna be out in probably the next nine to 12 months. And what does it do? It's pretty amazing. It actually strengthens the tendons inside of the throat and it helps with, there's three different ones.

48:51 I'm just talking about the one that I know about. It strengthens the tendons in the throat and makes the throat more taut so it doesn't collapse as much. Is that FDA, is it gonna be FDA? So it's phase three clinical trial. I think it's in phase four. It's in phase four, great. Speaking of pills, Right.

49:06 Let's talk about, I've brought some of my sleep concoctions, by the way, I've got so many more, but I want to talk to you about them first and foremost, in order for someone to increase their sleep. Yeah. Okay. Especially deep sleep. Yep. Yep. I particularly take a form of magnesium, and I want to talk about why magnesium is so good, but I take magnesium L3-in8.

49:26 So this has one gram of magteen in it, two capsules. Sometimes I take three, but it's got L-theanine in here as well, rhodiola. You can have a look at it. But why has this garnered so much attention, magteen? So it's interesting. So I'm glad you pointed out that it's Magteen. So there's only two companies that have ever done a double-blind placebo-controlled study on magnesium and Magteen is one of them.

49:51 Oh, great. So I'm taking the right one. You are absolutely. The other one is, believe it or not, it's a company called Upgraded Formulas. I ran their clinical trial for them. Oh, that's how you know. That's how I know about Magteen. And so here's what I'll tell you is there is data to suggest that a particular type of magnesium, Magteen has a proprietary way that they create it.

50:10 And so does this upgraded formulas. Believe it or not, the upgraded formulas one is magnesium chloride, of all things. I know. It's interesting. It's an interesting absorption. The problem is absorption, right? And so what people need to understand about magnesium is we have to eat our magnesium. Okay.

50:25 Our body doesn't produce it. And it's kind of hard to get it anymore because the soil has been so over tilled that magnesium isn't building up through the root stocks and we're not able to eat as much. You can eat a bushel of kale and you still probably might not get enough magnesium. So a lot of people ask me about supplementation, which I kind of think is where we were going here.

50:42 My theory on supplementation is a little bit different than most people's. I get everybody to do blood work first, right? Go to your physician and say, I want to do blood work. I want to look at iron. I want to look at magnesium. I want to look at melatonin if you can. And I want to look at vitamin D, right?

50:55 Those are the ones that have got enough clinical data for me to say, if you're deficient in one of those, let's fix your deficiency first. Got to be honest with you. Nobody's got a deficiency in ashwagandha. Well, ashwagandha really helps. It kind of binds, it's an adaptogen. I get it, I know what it does.

51:14 Just like rhodiola. Yeah, I get it. You know, it can bind to cortisol. If cortisol is too high, brings it down, relaxes you. I love it all, but at the end of the day- But there is definitely no deficiency. That's so funny that you said- There's no biomarker for that. That's right. So we're now going to move on and talk about a huge topic, melatonin.

51:34 I know it's big, and so many people have screwed it up. I'm glad we're getting a chance to talk about it. So what is melatonin? So melatonin is a hormone. Let's start out there. A lot of people don't know that this is a hormone. And when you, when something is labeled a hormone, that means it affects all systems in the body.

51:48 It's a lot like testosterone or estrogen. And there's a reason why we can't walk down to the local CVS or Walgreens and buy testosterone and estrogen because it has dramatic effects across the body. Unfortunately, in the 70s, a law got passed and melatonin slipped in under the guys. And now you can get it anywhere in the United States.

52:08 As you know, in Australia, it's by prescription only. Yeah. Right. And it probably should be right in a lot of instances. What people don't understand about melatonin. Well, there's many things. Let's start with interaction effects. Very few people understand this. Melatonin interacts with every birth control out there.

52:25 Every one. Melatonin interacts with every SSRI. Those are antidepressant and anti-anxiety medications for folks out there who don't know what an SSRI is. Every one of them. Diabetes medication and blood pressure medication. It's a circadian pacemaker. It tells your body that the time is different and the body has to react to it.

52:44 So of course, it's going to have major effects on all of these things. But somebody can walk to the local drugstore, could be on three different antidepressants, take this, and the whole thing goes cuckoo. It's absolutely possible to do. This is America. I know. What you said earlier to me was really startling.

53:04 You mentioned that melatonin can actually act as a contraceptive. Yeah. So in Germany at high dosages, higher dosages than when we see here, it's used as a contraceptive. What are the dosages and why Germany? I think they're in the, I don't know off the top of my head. So we might want to go look that up, but I think it's in the like 30 to 40, maybe even 50 milligram mark is where it's used.

53:25 Yeah. How is it a contraceptive? So apparently it has an effect on the reproductive system and the timing of the release of eggs. So it's pretty interesting. Again, this isn't my necessary area, but what it does tell me is we need to be thoughtful when we're prescribing this with children. So I'm against melatonin in all children.

53:46 Most children manufacture roughly four times the amount of melatonin that they need in the brain. By the way, melatonin is made in two different places. There's pineal melatonin, but there's also gut melatonin. A lot of people don't know that, right? Pineal melatonin is what affects sleep. Gut melatonin is a great antioxidant.

54:01 It helps with your microbiome and all that kind of good stuff. So many people may have seen literature or advertisements or things like that, like take melatonin for your microbiome. There is some data that suggests that it could be helpful there. Not my area of expertise, if I'm honest with you, so I don't know a tremendous amount about that.

54:18 But when we get back to dosage, that's where some of the problems lie. So there was a study that was done where they pulled 30 different brands of melatonin off the shelves. This was a while ago now. They opened them all up. None of them had the amounts that they said. Some had five times as much. Some had almost none.

54:34 So you need to be thoughtful on where you get your melatonin. And believe it or not, you can get it organically. So there's one company that makes, I have no association with them. It's called Herbatonin. and they make it from seagrass, believe it or not. I've talked to the guys that do it. They make it a couple times a year and they make it in the correct dosage.

54:51 Here's the thing, the data out of MIT would show that in order for plasma concentration levels to get to where you want them to be, you need about somewhere between a half and one and a half milligrams of melatonin. Dude, I can't find it for anything under three milligrams, six milligrams, nine milligrams, anywhere.

55:07 So now I'm telling patients, okay, if you're gonna go and get your melatonin, cut it in half. when you use it. There's only three instances when I think people should use it. One is jet lag, the other is shift work, and the other is if you have a melatonin deficiency. Why would a parent give their child melatonin to begin with?

55:23 Do you want the super duper like direct answer? Yeah. Because they're lazy. Here's the thing. It's easy to give your child this thing and say, this thing is going to make you now fall asleep. And then you don't have to do any of the parenting stuff that comes along with it. To be clear, if you give your child melatonin, you have just taught your child, they need a pill to sleep.

55:43 I don't think that's a good idea. And I'm not trying to knock on parents here. I get it. You've got a child that isn't sleeping well, and it is driving you nuts, right? Every single night, everybody's up all night long. You're exhausted. All you want to do is just shut the kid up and get him to sleep.

55:58 Not in a bad way, just get him to sleep. I totally understand where you're at with that. That's when a pediatric sleep specialist is good to come in. There are pediatric sleep doctors. Every single children's hospital in the United States has a sleep lab and pediatric sleep doctors associated with it.

56:14 Call the local children's hospital. I promise you they'll figure something out. So I have here a popular melatonin sleep gummy. Completely different to just taking a sleeping pill. This has magnesium citrate in it as well, melatonin five milligrams, but the dosage is two gummies and L-theanine 50 milligrams.

56:33 You can have a look at it. Obviously not looking at the sugar content there. Oh my God, that's funny. It has a funny name. Yes. So let's see what we've got here. So magnesium, 20 milligrams of magnesium. So just to be clear, that's not enough to do anything. And this is the problem that we see with a lot of these concoctions.

56:52 I call them kitchen sinks. If something's got more than three ingredients on it, it's probably not that good. Okay. Right? And so what they'll do is they'll put just enough in, I call it fairy dust. They put just enough in so that it makes it to the label, but not enough so that it's actually effective.

57:06 So like in this one, 20 milligrams of magnesium, that wouldn't be what I would actually, it would be significantly more, probably closer to 100. 150 um and then melatonin five milligrams that's way overdose and then l-theanine 50 is fine it's interesting l-theanine is something that's used in a lot of sleep preparations because it gives calm focus yeah especially if you're having a lot of caffeine right right it definitely helps offset caffeine by the way kind of a little side fact if you eat steamed broccoli after you've ingested caffeine it helps actually um remove the broccoli remove the caffeine from your system Not at night.

57:44 Uh, let's see what else is in here. Uh, chamomile extract. There's some data on chamomile. I would say of the teas, it's probably the best one, but it's more of the ritual. That's making you feel relaxed than it is actually, I would argue. Yeah. Lavender, um, lavender works better smelling it than eating it.

58:02 So there's at least one double blind placebo controlled study on lavender that shows that it can be effective. But I want to be clear to people like you don't just sniff something and pass out unless it's like. ether that's called anesthesia. Like we don't want to do that. But smelling something can give your body a relaxation response.

58:17 And then the natural sleep process can take over. The big thing I tell people with aromatherapy is you want to be very thoughtful. Candles and sleep don't mix, right? Fire and sleep is a bad idea. Really? You fall asleep with the lit candle. No, I was just imagining being on a, and it's so funny where my mind goes, like being at a ski lodge and like, you know, being in front of a fireplace.

58:38 Yeah, being in front of a fireplace, that's fine. Okay. Right, but if you're lighting candles to fall asleep to, that ain't so great. Terrible, terrible idea. We want to kind of stay out of that if we possibly can. And then elderberry, I have no, I've never seen any data on elderberry. I could be wrong, but I've never seen any data on elderberry.

58:54 But like, this is a classic example of something. If I have a patient who's got a problem, I'm usually using a single ingredient. One, I fix their deficiency. And then I'm probably using a single ingredient. If I have to use one ingredient, it's probably valerian. It's probably the most well studied in terms of helping people fall asleep versus stay asleep.

59:16 I would say melatonin would probably help more people stay asleep. But there's a lot of reasons why I wouldn't put melatonin in somebody, at least not right away. And we kind of delve through a lot of that. One of the best sleep hacks that I have that improved my life. Yeah. And I've never gone back on it is sleeping with a sleep mask.

59:34 I love it. I'm a big fan. Even if I'm in a pitch black room. Oh, yeah. I can't sleep without it. I like the pressure. Yeah. The light pressure on my eye. I like the way that feels. And I've slept with the sleep mask for a while. And I'll tell you why. My wife sleeps with the television on every single night.

59:51 she does not she does every night big screen tv big screen with the dogs in the bed i'm the sleep doctor for god's sakes it's crazy but that would then now i need to bring up another thing you believe in sleeping in separate beds on occasion yeah on occasion or like three or four nights a week like it depends let's talk about that yeah yeah let's depend so i want to be very clear the strength of your relationship has nothing to do with where you sleep Say it one more time.

1:00:17 The strength of your relationship has nothing to do with where you sleep. Okay, great. Because so many people think that, they also think that if they sleep in separate bedrooms, there'll be no intimacy left in the relationship. If I'm honest with you, there's more intimacy when you sleep apart, because here's what ends up happening.

1:00:32 You get some sleep. Then when you're together, you actually want to have sex. It's unbelievable versus I'm so damn tired. I really don't want to do this right now. So being able to give yourself that option is nice. You don't have to always do it. And by the way, it may only work a couple nights a week.

1:00:46 So for example, if I know I have an early flight or something like that, I might not sleep in the, I probably sleep in the guest room. Number one, I don't want to wake up the dogs, which is going to wake up my wife when I'm leaving in the morning. But also I've got that anticipatory anxiety. I know I'm not going to sleep well, so I'm going to be tossing and turning.

1:01:01 I really don't want to bother her. So I don't think there's anything wrong when people want to sleep in separate bedrooms, but you want to have that conversation and you want to make sure that all of your needs and concerns are addressed. And the big first one is intimacy. Lots of people are concerned about that, but getting back to the eye mask.

1:01:16 I love my eye mask. I try all kinds of different ones. I don't like the flimsy ones either. I like the kind of thick ones that are kind of cushy like Terry. They're the ones I have. Yeah, I cannot. I've had a I've had a I've had every mask and I've had a silk one. The worst ones are on the Delta flight.

1:01:32 Yes, they strangle my eyes. Oh, they slide off my face and then they wrap around my ears like my ears. It's horrible. Okay, next, even if it's not noisy, but sleeping with earplugs, how do you feel? So because I sleep next to a snoring bulldog, I'm a big fan of earplugs, generally speaking. But you have to be, again, sleep is flexible.

1:01:53 So you have to decide what works well for you or what doesn't work well for you. There was a time where the dogs really, really bothered me a lot. And I had to constantly wear earplugs because they bothered me. And I'll tell you how I fixed it. It was very interesting. So my wife went away back East to visit her family and we had an older dog and she said, and his name is Hugo.

1:02:11 And she said, if Hugo stops snoring, that's not good because he snores all night long and he has sleep apnea because he's a bulldog and all these other things. And the thing that was annoying me before, the emotional valence changed. Now I wanna make sure my buddy's okay. Because quite frankly, I love my dog and I wanna make sure he's good.

1:02:31 And so now when I hear the dog snore, it actually relaxes me. But before it used to piss me off. So the same stimulus- Psychology. Right, can change depending upon how you view it. And it's the same in the middle of the night. It's the same for all of these stressors. It's always, it's all about slow it down and see what does it really mean.

1:02:54 I heard that having sex before bed actually increases your sleep scores. So it does for men and not as much for women. You know what we always say? I knew you were going to say something like that. Like women just get the shit end of the stick already. Well, I'm not even going to make a comment on that one, but I will tell you is it's pretty interesting when you start to look at intimacy, sex, and sleep.

1:03:18 So in my book, The Power of When, I talk about what is the best time for sex, right? So a lot of people- Please don't say it's 11 a.m. I'm not gonna say it's 11 a.m., but here's what I am gonna tell you. Take a look, let's look at it from a biological standpoint first, right? So you need estrogen, progesterone, testosterone, adrenaline, and cortisol all to be elevated, and you need melatonin to be lower, right?

1:03:40 What time of day does that usually occur? You're gonna say 8 a.m. or something? I'm gonna say it definitely doesn't happen at 11 o'clock at night. No. Okay, that's hint number one. Hint number two, if you happen to be being intimate with somebody who was born biologically male, what do most of them wake up with in the morning?

1:03:55 An erection. If that's not mother nature telling you when to use that thing, I don't know what is. I mean, come on. So here's what I tell people. Brush your teeth, throw in a little mouthwash, hop back in bed. You're probably going to be better with it. In terms of performance, we did the study and we found that men actually perform better from an erectile perspective.

1:04:14 They have longer erections. They have a greater chance of achieving ejaculation if they've slept. Women find better connection, oddly enough. In the morning? Mm-hmm. Okay, so, but why before bed is it better for the male than the female? Because men have a tendency to feel exhausted post-ejaculation.

1:04:33 And that mixing, I think, of testosterone and oxytocin together just makes them fall asleep. The data would suggest that women actually get energized. Wow. Yeah. Okay. So you've heard it here, sex in the morning. Yeah, but- Sex for breakfast. Sex for breakfast. Oh, I like that. I'm gonna use that for now on sex for breakfast.

1:04:51 That's awesome. Something that I really, really loved is you've got this sleep cocktail that you've created. And I've actually brought all the ingredients here. So can you describe to me? And if anybody is listening and they want to watch, this is on YouTube and Spotify. You can come and watch this. Can you explain to me what I'm about to do?

1:05:10 Actually direct me. So we are gonna make a cup of banana tea. So what is banana tea? So banana tea is a better way to get your magnesium. So everybody needs more magnesium. And so what I'm gonna ask you to do is, I'm guessing that we've already washed off the outside of the banana. We washed this, yeah.

1:05:26 So we got all the pesticides off. So you cut off the tip and the step, right? The bottom and the top. Like this? Just like that. Yeah. Now I want you to cut it in half, but leave the peel on it and the fruit in it. So just one cut in the half. Like here. Perfect. Now take both of those two halves and drop them into that cup of boiling water.

1:05:43 This is boiling water, by the way. Yeah. Okay. And you're going to leave them there for about five or 10 minutes or until the banana turns brown. Uh-huh. What happens then is you steep the water and you drink the water. You don't have to eat the banana because it's gonna be pretty mushy and gross. Although some people like to make banana bread often afterwards, that's been a recipe that people have been floating around to me.

1:06:01 That's interesting. It's kinda cool. But yeah, if you drink the water, I call it banana tea. I wanna be clear, there's no actual tea in it. It's hot banana water. Wow. But it's loaded with phytosteroids that help you absorb the magnesium, which is really, really helpful because most people don't absorb enough magnesium.

1:06:17 So if I have this with my magnesium L3 and A, it could probably help? It could, but I would be careful. I would do banana tea first and make sure you don't end up with diarrhea because too much magnesium ends up with diarrhea. When is the best time prior to bed? Like how early are we talking that I should have this and the supplements?

1:06:38 Oh, maybe 90 minutes or so. Oh, nice. Yeah, nothing crazy. Yeah, but I mean, if it's a ritual, like what I have, a lot of my patients do with the banana tea is they'll create a ritual, right? And they'll be like, oh, I'm gonna make my banana tea and I'm gonna, you know, read my book. And then as my eyes get tired, I'll finish my tea and I'll brush my teeth and go to bed.

1:06:55 And that's part of their kind of wind down routine. You know, Dr. Bruce, you know me. I know you are. I'm a logical thinker. You are. I'm a scientist. I'm very black and white, people call me, right? I don't know if it's a good thing, but it's my personality. I like you. Mathematician by heart. I have a friend who is studying Carl Jung.

1:07:18 Right? And you probably know a lot about him. I do. And she speaks a lot about interpreting your dreams. And I tell her, I'm like, I don't dream often. And when I do, like last night, I had a terrible night's sleep, which is so ironic that I was interviewing. I was going to ask you. Last night was terrible.

1:07:34 I get really cold. I get really cold in my sleep. Maybe I'm hypoglycemic. I freeze. I'm generally, I'm always cold. So I sleep with a, with a heat. Oh, like a heating pad? A heating pad. Yeah. Oh, I love it. Like an old woman. I'm obsessed with it. But you know what? It turns off every 120 minutes. Oh, so you have to put it back on.

1:07:51 So I wake up and turn it back on. It's really annoying. You know, they make these things now underneath your bed and you can make them hotter or colder than last all night. You know how dumb I sound because I actually have a sleep, an eight sleep. That would work. Yeah, it would work. But we'll just go back to it.

1:08:04 So my I personally would use an Orion, but that's all another story. So last night I dreamt and I have a constant dream. Right. It's a reoccurring dream that I'm running late. It's either me in an airport and there's so many obstacles prior to me getting on the flight. And when you're running, are you running in slow motion?

1:08:22 Is that a real question? That's a real question. No, it's always like, I can see the gate and there's just something I have to, I'm like waiting. I don't know what it is, but I just, it's in my whole dream. And this is a constant one. So I dreamt that last night as well. You wanna know what it means?

1:08:38 Well, she's, you know, there's something to it, but she says that, you know, Carl Jung believes that this is like therapy, I think. So can you talk to me about dreams? I can. So I've spent the last two years studying dreams. Okay. And I became what's called a dream therapist, This is not bullshit. This is not like dream interpretation.

1:08:56 This is using the dream in the therapeutic context. So what we do is we have patients come in and they describe the dream. Now, your dream is an interesting one. It's what I would call a stress dream. So when you're stressed, you probably have a dream like that or something reasonably similar. I have a stress dream.

1:09:14 My stress dream is kind of funny. I'm in high school and... And I've got my biology books, the bell rings, and it's history class. And so I'm booking it down the hall to get to my locker to get my other book out, and I'm spinning the combination, and I can't remember the combination. No, really. And whenever I have that dream, it's a signal to me that something's going on in my life that's stressful.

1:09:34 So when you have that dream, you might be thinking, it might be acute stress, like something that was happening today. It could be something else that's going on in your life that could be important that you're thinking about or that's coming through. But here's the deal is everybody dreams and the dreams mean something, but they only mean something to you.

1:09:51 So there aren't these international symbols. Like if you're swimming in water, it means you hate your mother. It doesn't really work that way. Okay. Now I love Carl Jung and I love all the things that he did. He created the archetypes for dreams. Brilliant, brilliant work. Can't knock it a bit. But at the end of the day, my take on it is when I work with people with their dreams, especially people with nightmares, it gets really, really interesting really quickly because dreams are emotional metabolism.

1:10:22 So during the dream, you emote and you feel and you get all of that done so that when you wake up, you feel okay. And if you don't, you wake up in the middle and that's called a nightmare. That's why people wake up in the middle of the night. And then they go back to the beginning of the dream and they get to that scary point and they wake up again and all the emotional processing stops.

1:10:41 This is why people are tormented by nightmares is because they can't get through to the other side to emotionally take that baggage and be done with it. Right. The way I think about it is, remember, during REM sleep is when we move information from our short term memory to our long term memory. So this is, I think, what's going on here is this this process that's going on.

1:10:59 So it's it's it's a lot. There's a lot going on. And it's this created this crazy manifestation of a crazy movie that's inside your head. Right. And you're not sure what you're supposed to do with it. Everybody dreams every single night. You don't always remember your dreams. I can teach people how to remember their dreams, but I always warn people, be careful what you ask for, because it's one of those switches where once you kind of turn it on, it's hard to turn it off.

1:11:22 So if you want to remember your dreams, I can definitely show you how to do that, but you're going to remember your dreams. But if there is no correlation to the real life, only to us, then why would we want to remember them? So we learn a lot about ourselves from them. As an example, I have people who have dreams where it tells them what to do with the rest of their life.

1:11:41 We call those big dreams. So I've had multiple people have dreams where they were like, I saw something in my dream and that was my new path for my career. This was the path of the person I was supposed to be with. Oh yes. Oh yes, there's a lot to it. I get it, you're a logic-driven human, and I understand that, and I can really appreciate that, but at the same time, you already told me about a dream that you're having that's more emotion than logic, and it's coming through, right?

1:12:04 And so this is a part of you that we would bring into session, we would deal with and we'd say, okay, what's going on? Why are you having that dream? How often do you have that dream? And the good news is, is that we can actually help people with these dreams. There's a specific kind of therapy now called image rehearsal therapy.

1:12:20 This is fascinating where you write down the dream and then the very ending where you're getting like stabbed, like some bad thing is happening. You flip it and you re-script it and now go from being the victim to the victor. Wow. You read this before bed within seven to 10 weeks, your dream changes.

1:12:38 No shit. Your dream changes. I'm not joking. Just by rewriting the ending. Uh-huh. And you get the new ending. Sleep is pretty cool. So how do we remember dreams? So it's super duper interesting. And so I try to describe it to people, but the second you open your eyes, you've erased the whiteboard. Okay.

1:12:58 So the whiteboard is the thing that you're scribbling on all night long and you're creating this dream. When you open your eyes, new data comes in and it wipes all that out. So keep your eyes closed. And what you want to say to yourself is not what was I just dreaming about, but just what was I thinking about?

1:13:14 Because when you say dreaming about it, your brain now uses that as a concept and is looking for something different. When all you say to yourself is what was I thinking about? Remember, eyes closed, still dark. What was I thinking about? You lie there very still and relaxed. and just start to come back to the thought.

1:13:31 And if the thought was, what was yours? In an airport, rushing to get to the gate. Right, so the first thought was airport, and they're like, okay, I'm in the airport. Now you think, what am I doing in the airport? And it'll all come back to you, come back to you, come back to you. Then you can grab a voice recorder or a journal, and write it down, and then you can bring it into a therapeutic situation, especially for people who have significant nightmares, trauma, domestic violence, rape, like, like there's a lot of people out there who have a lot of scary dreams.

1:13:59 The goal here is to be able to help them remember them, to be able to process through them, so then they're gone. What do you think Jung understood about dreams? Jung did something that I thought was pretty interesting. He created these things called archetypes. And so think of him like an avatar, like we would think of an avatar now of these different kind of types of dreams and that people can fall into these types of dreams.

1:14:21 I think he was really the first person to begin to categorize dreams. I think many people have now taken his work and expanded it forward. But I think generally speaking, the thing that I liked the most about Jung and what he did was he helped people understand that there are different types of dreams.

1:14:35 and we can all have these different types of dreams. Are dreams actually trying to heal you? I think emotionally, yes. Remember, dreams are emotional metabolism. And so during the dream, you're trying as hard as you can to process through those emotions. And these emotions are whatever happened during the day or whatever happened during the day that triggered something big inside you, right?

1:14:57 And that's where it all starts to come out. I think that dreams, I think dreams are where everybody heals. I would argue that all healing probably goes on during sleep and dreams are a big part of that. Is there a reason why I'm telling you, yes, you probably say that I dream a lot. I don't, last night I remember the dream, but it's not often that I remember.

1:15:17 Yeah, me either. Okay. Yeah, it's okay. A lot of people don't remember their dreams. Again, if you want to, we can show you how, but everybody dreams every single night. Here's the other thing that's interesting, is people dream differently in different stages. So in stage three, four, the dreams are very procedural.

1:15:33 I'm walking on a hike. I'm riding a bike. I'm in my kitchen doing something. Whereas REM dreams are fantastical, where you might be in your kitchen and then you turn around and Harry Potter's at the front table and you're serving him an omelet or something crazy like that. That's a REM dream. So the content of the dreams can change based on the stages as well.

1:15:54 I think now is a really good time just to end this dream thing by talking about REM behavior disorder. Yeah, yeah, yeah. So I've treated REM behavior disorder in several clients before. It's super interesting. So many people out there don't know this, but during REM sleep, your body is completely atonic, which means it's paralyzed.

1:16:09 Yeah. So you don't act out your dreams. Now that's going to sound crazy, but it happens and it's very serious. Right. And so what a lot of people don't know, a lot of people think it's hilarious, like, oh, my uncle, he, he thinks, still thinks he's, you know, at work and he's, you know, working on something.

1:16:23 It's like, tell me a little bit more about what's going on with Uncle Joe because that could be a problem. So if somebody has a situation where they are literally acting out their dreams, which by the way, is different than sleepwalking and sleep talking. Yes. Right, so sleepwalking, sleep talking is more banal.

1:16:39 It's more trite. It's not, I mean, people aren't walking around like this, but it's not a full acting out of the dream. That also, by the way, usually happens in the first third of the night. REM behavior disorder has a greater tendency to happen in the last third because that's where more REM sleep has a tendency to be.

1:16:53 And the biggest problem with REM behavior disorder is it's a precursor for Parkinson's syndrome in 35% of the cases. And so it's very difficult when I have a patient who comes to me and they're acting out their dreams and it's 10 years before you see any Parkinsonian symptomatology. And I get to be the person that says, hey, guess what?

1:17:13 you could have a pretty significant situation. Now here's where the good news comes in, because I've actually done this on a couple of cases, is I've gotten somebody so early in their REM behavior disorder that when I get them to neurology, they do so much better. And they get all the treatment protocols earlier and everything works out much better.

1:17:33 So if somebody is listening and you've got a friend or a loved one or even you have been told, hey, you act out your dreams on the regular, and by on the regular, I mean at least once a month or maybe even once a week, it's probably worth talking to a neurologist who's also a sleep doctor.