“No day is so bad it can’t be fixed with a nap.”
Today, we sit down with the world’s foremost authority on sleep for high performance.
Dr Michael Breus is a three-time bestselling author, clinical psychologist, and sleep educator. He has appeared all over television, including Oprah, The Today Show, and on The Dr Oz show more than 40 times. Dr Breus is also a regular contributor to major publications such as The New York Times, The Wall Street Journal, and The Washington Post.
When he’s not doing media appearances, Dr Breus works with some of the most successful individuals on the planet who want to perform at their peak with as little sleep as possible.
In this interview, we’ll go through:
- The exact moment Dr Breus realized he was going to change the world
- A five-point plan to improve your sleep right now
- The latest hacks in sleep science to help you perform at your best
- How people with PTSD and depression can sleep better
- The best way to wake up energized
- And a whole lot more!
🎁 YOUR CHANCE TO WIN:
We have three copies of Dr Breus’ book to giveaway! To enter, either leave a comment on YouTube or on Apple Podcasts with your #1 takeaway from this episode with Dr Breus. Three people will be selected and the book will be mailed to wherever you are in the world.
As we get started, remember the right bit of inspiration can completely transform someone’s life, so if there’s someone you know who needs to hear this – and I’m sure there is, since lack of quality sleep is a dangerous side effect of the stressful world we’re in today – share it with them right now.
Let’s WIN THE DAY with Dr Michael Breus!
Great to see you my friend. Thanks so much for being on the Win the Day show.
Dr. Michael Breus:
I am excited to be here. Thank you for having me.
To kick things off, is there a story from your childhood that encapsulates what life was like for you growing up?
That's a good question. So, I had a very interesting upbringing, which – now that you're making me think about it – has a lot to do with how I became the guy that I am. My parents were separated when I was nine, and I'm 53 years old now. Back in those days, very few kids ended up with their fathers, and my father ended up having full-time custody of me. It was just he and I against the world for a very long period of time.
I've played that role as the sleep doctor: I was the very first sleep blogger on the Huffington Post; I was one of the first clinical psychologists to take and pass the Sleep Medicine Boards; things of that nature. I'm very comfortable being the lone wolf – not to mention that I am a wolf chronotype, which we'll talk about in a moment. But that's a lot of who I am. I'm pretty confident and I feel comfortable in my own skin for sure.
Can you take us into the moment when you realized that you weren't just going to be a regular health professional – that you were going to actually drive the industry forward and change the lives of millions of people in the process?
It was interesting, the very first time I was on television, I walked off and it was like electric. It was one of the first appearances that I made, and I was so in the zone that I didn't even see the audience. I was so focused, I delivered this great information, and I just became so comfortable out there. It was like, "This is exactly where I need to be."
I don't know. Maybe I've got enough ego to pull it off! But I like getting in front of people, I like talking about sleep, I like mixing it up, I like controversial ideas surrounding sleep and sleep science.
Check out the YouTube or podcast version where Dr Michael Breus does the Win the Day Rocket Round, answering questions about his favorite quote, what advice he’d give his 18-year-old self, the one thing on his bucket list, and a whole lot more 🚀
Here's the thing that's cool for me as a topic. My wife says it all the time. She's like, "Honey, you wouldn't be nearly as interesting if you were a cardiologist." No disrespect to the cardio guys, I have one myself, but sleep is such an interesting topic, and it draws people in because one of the things we know is that, when you change your sleep, you change your life, right? So, if you have bad sleep and I'm able to give you some information, or lead you on a path that can help you with your sleep, I feel confident that I've changed your life in a positive way. Honestly, dude, that feels good, I just like doing that.
Early in my career, people would come and they would be so excited to tell me how much I had changed their lives. After a while, every single day, there would be five people, 10 people, 15 people, and I kind of said, " You know? I want to get the message out bigger." Because at the time I was practicing, you could only see about 30 patients in a day. I mean, let's be fair. I was seeing 30 patients a day, five days a week. and I was crushing through 150 people, good care of medicine, making sure that everybody's well treated, but it wasn't where I wanted to be or where I thought the world needed to hear.
When you change somebody's sleep, you literally change their life.
Oddly enough, one of my best friends got a vice-president job at a company that, at the time, was called Medscape. He turned it into this big old company called WebMD. He was like, "Hey Michael, have you checked out WebMD?" So I went on it and they didn't have anything about sleep on there. Being my lone wolf self, I decided to create a document that had all the places on the website where they needed to have more sleep information, and I sent it to my buddy, who apparently sent it to his boss. His boss then said, "Go hire that guy!"
That was how I became the WebMD sleep specialist. I was the WebMD sleep specialist from the time they launched for 15 years. That's a big audience, and it was so much fun. You remember back in the day when they had chat boards? I would answer questions live on chat boards in WebMD about sleep. We counted, I think, over 5,000 questions that I answered at one time. It's like I just feel the need to educate, and people are so receptive because it's just not an area where people get a chance to meet folks like me.
Again, not breaking my arm patting myself on the back, but I will say that I feel like I have a purpose, and I feel like I have a passion. For me, the point where purpose and passion hit was sleep, and that's what drives me in that direction.
It sounds like facilitating these transformations for others actually gives you a lot of energy along the way, too. Now that you've worked with regular folks right through to the celebrities at the highest level, is there a particular transformation that you're most proud of?
Oh, wow. There's a few actually. There's quite a few cases that were really ... there's some sad cases for sure, but there are quite a few cases that were pretty amazing. One of the more famous cases that I've worked on is Carson Daly from The Today Show. I was on The Today Show talking about time change or sleep or something like that, and Carson pulled me over to the side – we weren't on camera – and he was like, "Dude, I'm exhausted." And I was like, "Okay, let's hold tight."
We did the segment and I came back afterwards and we went over to his dressing room and I'm like, "Tell me what's going on?" He said he had gained a little bit of weight over the years but, and people don't know this, he's on The Today Show and he's the executive producer of The Voice at the same time. He flies every single week back and forth across the country.
Not only was he exhausted, but we could potentially have jet lag issues. There's all kinds of stuff that could be going on. So I dug in and it turned out he had sleep apnea. We worked with his doctor, got him sleep testing, the whole thing. Now we've got him on a solution that helps him sleep, and he's losing weight, he has more energy. He was really concerned about what he called his shelf life, as many people who are on television are.
I think now he can be on for quite a bit longer. I'm telling you something, dude, when you change somebody's sleep, you literally change their life.
Amazing, and thank you for sharing that.
In the peak performance realm, we often hear people talk about nutrition and fitness, yet there is so much misinformation out there on those two areas. We also spend one-third of our lives sleeping, so that definitely needs to be in the peak performance equation. Are there just as many misconceptions about sleep as there is for nutrition and fitness? And, if so, what are the biggest myths that need to be busted?
Yes, there are a ton of misconceptions about sleep. Some of the bigger myths, and we can even include nutrition in this, is things like, "Oh, turkey makes me feel sleepy because there's tryptophan in it,” or “Warm milk makes me feel sleepy." So, just to be clear, you'd have to eat a 40-pound turkey to get enough tryptophan to actually make it worth your while. It doesn't work well in the presence of protein anyway. So, I really wouldn't go for that one. And I think it's about a gallon and a half of milk to get enough tryptophan, so we're not even going to go there.
Also, there’s a lot of misinformation out there about melatonin, which a lot of people take. But what most people don't understand is melatonin is not a sleeping pill. Melatonin is a sleep regulator, not a sleep initiator. Melatonin doesn't make you sleepy. What melatonin does is it helps your brain think that it's bedtime from a circadian rhythm perspective.
We talked about Carson Daly already, so I'll give you another great example. If you're familiar with electronic dance music, you’ll know a DJ named Steve Aoki. He does almost 200 shows a year in different countries. His jet lag is unparalleled. But when we're talking about something like this, what we're looking at is scheduling, how to schedule flights, working through some of those different issues, and then trying to understand what to do. Well, melatonin is very, very helpful in that process of getting people adjusted to a new time zone, because it tells your brain it's bedtime when your brain didn't think that it was bedtime before.
That's great when you're Steve Aoki and your jet lag is all over the place, or you’re Carson Daly flying back and forth across the US. But when you're not crossing time zones and you're lying in bed not sleeping, you probably shouldn't be taking melatonin because that's not really what it's there for. So, that's a myth or misunderstanding that we see that can be very harmful to folks.
Then what happens is, if one doesn't work, they take two, and if two don't work, they take four. I mean, we were talking about WebMD, when I was on WebMD answering those questions, once a month, literally once a month, I got the question, "Is it okay to take a box of Benadryl a night?" 20, 10 milligram tabs? The answer is “No, it’s not okay!”
But, people are desperate, man. When you don't sleep, it hits you to your core. You turn into somebody who you don't like, and nobody around you is particularly thrilled with you either, so it's hard to not have sleep. Those who don't suffer from sleep problems, they really don't understand it. They're like, "What are you talking about? Close your eyes, just go to bed, come on. It's easy." Honestly, dude, people are tortured with some of their sleep related issues. Right now, when we're talking about the pandemic and what's going on in the universe, this is arguably the most stressful time any of us have ever had, and it's not stress that we're used to.
This is arguably the most stressful time any of us have ever had, and it's not stress that we're used to.
You and I were talking before we started. We live here in Los Angeles, and a big stress here in Los Angeles is traffic. But traffic doesn't mean crap compared to a pandemic. I'm worried about things like my entire family's health. Like my grandparents, my parents, my kids, my wife, my extended family. I've never had to worry about everybody all at the same time. I've had to worry about certain people here and there of course, as anyone would, but this is a different kind of worry. There’s also financial stress, because so many people are suffering incredibly financially right now.
What kind of weight does that put on your brain before you're getting in bed at night? Does that cause insomnia? You bet it causes insomnia. So, I would say that right now, if people turn to me and say, "Hey, Michael, I'm sleeping great." I'd be like, "What's your trick dude? Because nobody's sleeping great right now." We all have issues. I mean, I'm the sleep doctor, and let me tell you something, when the pandemic first hit, I didn't sleep so great. That's okay. The message here is, is that we're all humans. And sleep is a reaction for us.
Think about it like this. If you notice that your sleep is not so great, it could be a window into your health. It could be giving you clues about something that's going on for your mental health or physical health. But to be clear, if you're healthy, both mentally and physically, you should sleep pretty well, generally speaking.
What are some simple things that anyone watching this or listening to the podcast can do right now to improve the quality of their sleep?
Oh, this is an easy one, and it's not going to cost you anything! I got a five-step program. It's super simple, people are going to love it. Step one is to wake up at the same time every single day, including the weekends. I know that sucks for most people because they're like, "Oh, I want to catch up on my sleep on the weekends, Michael, come on." Here's the deal, if you wake up at the exact same time every single day, what will happen is that the quality of your sleep will improve because your circadian rhythm is consistent. Because remember, when you wake up, that's the reopening of the package. So, the new day comes, sunlight comes in, and then all of your hormones kick off and go into gear.
If you do that at the same time, every single day, your brain knows what's coming, it can prepare for it, and it's much more efficient. Also, by the way, if you wake up at the exact same time, every single day, what you will find is that the amount of sleep that you require begins to shrink. I did this experiment on myself. I'm a night owl, what I call a Wolf chronotype, and I go to bed around midnight every single night. That's just what I do. I really can't get in bed before midnight. That's just me. So, I got in bed at midnight and I woke up around 7:40am, after about a month of it, I was waking up at 7:20am. After another month of it, it was 7:00am.
If you wake up at the exact same time, every single day, what you will find is that the amount of sleep that you require begins to shrink.
I wake up now at 6:13am almost every single day. I'm not sure why it's 6:13am, people will always ask. I always look at the clock and I say, "Oh my God, it's 6:13." But my entire sleep cycle shrank by almost a full 90-minute cycle. I get six hours and 13 minutes of sleep, and I've looked at it on trackers, and my sleep is fantastic. What's happened is, the consolidation has occurred because of the consistency. That’s why step one is to wake up at the same time every single day. You will get higher quality sleep and you will probably need less of it, unless you have an underlying sleep disorder.
Step two has to do with caffeine. We already know that caffeine is a problem because it’s a stimulant. But what we know is, it's got a half-life of about six to eight hours. So, with a half-life like that, what we do is, we say stop caffeine by 2:00pm, and eight hours later it’s 10:00pm which is where most people in North America tend to go to bed. So that's the reasoning behind the recommendation.
Now I guarantee you there's a listener or a watcher out there who is thinking, "Huh! Sleep doctor? He doesn't know what he's talking about! I can have a cup of coffee, an espresso, or a cappuccino minutes before going to sleep and I can fall asleep, no problem."
I think I've said that before!
See, there you go! Let's bust that myth. Here's what's interesting, it turns out that people have different caffeine sensitivities. I had one patient who honestly could drink a pot of coffee and go to sleep, and I had another one who could eat a square piece of a chocolate bar and be up for days. So, that's the first thing. But here's the other thing, for my patient who could drink a pot of coffee and go to sleep, if you stick electrodes on somebody's head, caffeine is a stimulant, you can't stop the fact that it is stimulating, and what it does is it almost completely obliterates stage three/four sleep.
For folks out there who don't know, stage three/four sleep is your physical restoration. That is your wake up and feel great sleep. You do not want anything messing with that. And right now during COVID, I'll tell you why, even more importantly, during stages three/four sleep is where growth hormone is emitted, and this is where your killer T cells are produced. Killer T cells are what fight viral infection. Hello! We want as much stage three/four sleep as we can possibly get right now. So please, please, please slow down your caffeine, and if you could eliminate it altogether, that would be great.
Don't do it cold turkey. I had two patients end up in the ER, believe it or not, going cold turkey off of caffeine. One of them had a seizure and one of them just couldn't stop puking. It was a mess. So, if you're a heavy, heavy caffeine drinker, slow it down over the course of time. But if you can, stop caffeine by 2:00pm.
Step three has to do with alcohol. There's a really big difference, dude, between going to sleep and passing out, okay? People don't seem to understand that sometimes. It takes the average human approximately one hour to digest one alcoholic beverage. The data would suggest that the time between the last sip and when you close your eyes, that gap, is the most important amount of time when looking at alcohol's effects on your sleep.
If you notice that your sleep is not so great, it could be a window into your health.
Remember, alcohol is a depressant, so it will make you feel sleepy up until about two to three drinks. Once you get past the third drink, unfortunately it has a tendency to energize people or make them aggressive, so you really don't want to go over two drinks if you possibly can. That time period is very important. If it takes the average human one hour to digest one alcoholic beverage, here's how I run it: if you're going to have a glass or two of wine with dinner, let's say you finished by 7:00pm and you had two glasses of wine, then you would be able to go to sleep by 9:00pm.
Do me a favor, for every glass of wine, drink one glass of water. If you had two glasses of wine, drink two glasses of water, wait two hours. It's really very simple. It's the one-to-one-to-one rule. I found this to be very, very effective for people.
Also, let's be honest. If you're using alcohol as a sedative, you have a problem. Talk to your doctor. There are much better ways of helping you get a good night’s sleep than drinking yourself there. And you're not alone, since alcohol is the number one sleep aid in the world. More people use alcohol to make themselves fall asleep. Once again, you don't get that deep sleep. Just like with what caffeine does to stage three/four sleep, alcohol does the same thing, but it also screws up your REM sleep as well, which is why your memory is all messed up after a heavy night of drinking. So, if you can, stop alcohol three hours before bed.
Onto the more positive side of things! Exercising daily is incredibly important, and I would argue, especially during the pandemic, this is one of our biggest issues. I'm a huge fan of exercise, but the good news is, you don't have to run a marathon. Remember guys, sleep is recovery. If you do not do anything to recover from, your body is not going to sleep as deeply. It just doesn't work that way. So, get your butt outside. Sunlight is an important and good thing, so is fresh air, and so is exercise.
But if you're going to do your workouts, which I want you to do, you need to be careful, because remember, sleep follows the core body temperature cycle. As you fall asleep, your core body temperature begins to drop. Unfortunately, exercise raises our core body temperature, which is why we sweat. So, step four is to exercise daily, but stop exercise four hours before bed.
Finally, step five, is for waking up. When we wake up in the mornings, what we really want to make sure of is that we can clear the brain fog and get ourselves moving. Do not drink coffee as the first thing that you drink. Most people don't realize it, but sleep in and of itself is a dehydrative event; from the humidity in our breath, we lose almost a full liter of water every night. Sitting by your bedside, you should have about 20 to 30 ounces [600 ml to 900 ml] of room temperature water in a refillable glass or jug. Every single night, you should put one of those there.
When you wake up in the morning, take 5-10 deep breaths just to activate your respiratory system and orient yourself to space. Sit on the side of your bed, grab your water, walk to the window and get 15 minutes of sunlight. "Michael, why sunlight?" So the data would suggest that, blue light hits a particular cell in your eye called a melanopsin cell, which sends a signal to your brain to turn off the melatonin faucet in your head. We want the melatonin off when we wake up. This is why we like blue light in the morning, but why we don't really like blue light at night, because it suppresses melatonin as well.
Do me a favor, if you've gotten out of bed, grabbed your water and walked over to the window to get your sunlight, put on a robe! I'm just saying. I'm just saying, put on a robe.
- Wake up one time.
- Stop caffeine by 2:00pm.
- Stop alcohol three hours before bed.
- Exercise daily, but stop exercise four hours before bed.
- When you wake up, drink 30 ounces [900 ml] of water and give the sun a high five for 15 minutes.
So many amazing things to unpack there. You mentioned marathons. If someone does a marathon, or some other type of unusual event where they’re physically exhausted, should they set an alarm for their usual wake up time so they get up, or is it better to give the body one day off to sleep as long as it wants?
I would give your body one day off to sleep from a marathon because it's such an extended type of thing. When I work with professional athletes, usually the day after the game, contest, or race, we let them sleep in. Also, depending upon the competitive nature of it, they end up doing a lot of damage to their bodies and you know in marathon work, everybody gets hurt by the end of the marathon.
I’ve heard a lot of people talk about waking up and having lemon juice first thing. Can a tablespoon or two of lemon juice do anything!? Is that a myth that needs to be busted right here right now?
I've never heard of lemon juice being particularly effective in the morning. I will tell you though, that the vitamin C from lemons in the citrus actually has been shown to be helpful for keeping circadian rhythms in line. People ask me all the time about supplementation and vitamins, minerals, things like that. That's the only thing I could think of from a lemon juice perspective. I tried doing that apple cider vinegar in the mornings, and I almost puked!
You mentioned waking up and getting sunlight as soon as you can. If it's 5:00am in the middle of winter, with no sun to be found, is turning on a light a good substitute?
I've found even having something like a cold shower, which I do every single morning, does a good job of giving me an energy jolt. Plus, I’ve been trying to do what you recommend and wait 90 minutes or longer before having my coffee!
In the absence of sunlight, is there something else that can fill in?
There are commercially available light boxes, believe it or not. So you could go onto Amazon, and Phillips makes one called the GoLite. I think it's 90 bucks. I have one in my suitcase because I use it for jet lag when I travel. Because you can forward your circadian rhythm using light, caffeine, and melatonin, and sleep in particular patterns. That's how we work with people like Steve Aoki and Carson Daly, we mess with all of those things. We have an algorithm, it's actually pretty cool.
But when you look at those things, light is certainly one thing that would be helpful in the morning. The temperature challenge is definitely helpful in the morning. I do a temperature challenge most mornings. I don't do it for my entire shower, I do it for like the last 30 seconds type of thing. I don't have a cold plunge at my house, although I'd like one, it's a cool idea. It's definitely alerting, I can assure you of that.
Sleep is recovery. If you do not do anything to recover from, your body is not going to sleep as deeply.
For healthy ways to wake up in the morning, I also think that breathwork is something that I've personally found to be very helpful. I have a men's group that I meet with every morning on Zoom, and we do Wim Hof breathing together, followed by a small meditation of gratitude, and that's how I start my day. Honestly, I'm awake and alert and present. It's awesome.
Are there really people on this planet who wake up with immediate hits of energy and motivation!?
Based on the chronotype, yeah! So, I mean, we haven't really talked about chronotypes. I came up with this categorization of chronotypes. To be clear, there were chronotypes long before I came up with it. I ended up finding the fourth one. We used chronotypes, so things like early bird, night owl, people in the middle, and that's what we've been bantering back and forth about. About 15% of the population love getting up in the morning.
Honestly, dude, the only thing I hate more than mornings are morning people, right!? They’re so damn chipper. Even though I wake up at 6:13am, I don't want to talk to anybody, that's for sure.
How true is it that we all need eight hours of sleep a night?
Total horseshit. The math doesn't even work. The average sleep cycle is 90 minutes long, and the average human has five of them. So, five times 90 is 450 minutes, which is only seven and a half hours. The math doesn't even work on average to get you there.
I think the original recommendation came from a study done at Stanford in the 50s, where they put people in these self-contained chambers. What happened was, their sleep amount went up and then eventually came back down and their bodies would no longer allow them to sleep any longer than, I think it was like, eight hours and 13 minutes. So, I think that's where the recommendation of eight hours originally came from.
But to be fair, that's not a smart way of trying to figure that idea out. Number one, I think it was an all-male study. By the way, sleep has changed a lot since the 50s. Even thinking about it philosophically as a concept, remember – well, you’re young – but in the 50s, people slept in separate beds, and it was a whole different universe for sleep back then. Whereas now people have televisions in their bedrooms, they have video games, I mean, it's a whole different universe. Sleep has evolved.
So, as it continues to do so, and with these levels of stress that we're all experiencing, and with some of the environmental insanity that's going. There’s lights here, kids playing video games until 4:00am, and all that kind of stuff, so we’re going to see some sleep consequences for sure.
For a long time, studying peak performance has been a big part of my work. Several years ago, I downloaded a top-rated sleep tracker app on my iPhone, and I woke up the next day and felt pretty good. Then I looked at my phone, and it said that I had shitty sleep, which completely shifted my mood. Then the next day I woke up and I felt miserable, but when I looked at the app it said I had an amazing sleep, so I felt like crap anyway. I haven’t used a sleep tracker since.
Here's the thing about sleep trackers, it’s like the best of the worst. When you look at the history of sleep tracking, here's what we've discovered: people were tracking activity before they were tracking sleep. It's not too hard to measure steps. My daughter, she's 17 years old, she's pretty good at math. If I know the length of your leg and your gait, that's a calculus problem. I can figure out how to track your steps.
But if I'm going to track your sleep, what do I measure? How quickly you fell asleep? Is it how quickly you get to stage three/four? Is it how quickly you get to REM? Is it the number of REM periods? Is it your number of awakenings? Dude, I can go on for 30 or 40 more variables if you want me to. It's a complicated process. Thinking that a wristband, a ring, a pad, is going to do a great job of truly measuring our sleep is probably a fallacy at this point in time.
Will we see it in the future with a high level of accuracy? I think we will. How far is that future? I think it's less than 18-24 months away. I think we will get much, much better at this much, much faster. As machine learning, AI, and algorithms start to get more involved in crunching, some of those big data sets, I think we'll start to learn a whole lot more.
But here's what I tell people, if you've got a sleep tracker, it's still useful, and I'll explain to you how. Don't look at the absolute data, look at the relative data. So, if my sleep tracker says that I have 13 minutes of stage three/four sleep, every single night, I know that's inaccurate, but it's consistently inaccurate. However, if I got 13 minutes, one night and 407, 612, the next I want to know what's happening relatively speaking. Don't get caught up in the what it should be. Compare it to yourself.
You are your best scientist, so when you wake up in the morning, however you perceive you slept, it's probably pretty accurate. Sleep is a perception. There's a physical state of unconsciousness where lots of cool shit happens. But when you wake up in the morning, how you think you slept, I would argue, is probably the best marker of how you actually did sleep.
You are your best scientist.
So, trackers or no trackers, there's lots of things that we can do to improve our sleep and our performance. I would argue that consistency is certainly the biggest one. I have a high-performance sleep coaching practice here in Los Angeles, as you know. One of the things that we do is, we evaluate people right when they walk through the door.
A lot of people come to me, they're like, "Hey, Michael, I know I need eight hours and I only have six. What can you do?" Believe it or not, I can actually fix that problem. Like I was telling you earlier, it's learning what their chronotype is, getting them more consistent, and then I actually run blood work on people. I look at things like iron, magnesium, vitamin D, melatonin. All of those are things that, if you're deficient in them, are going to have a really big effect on your sleep.
Check out the YouTube or podcast version where Dr Michael Breus does the Win the Day Rocket Round, answering questions about his favorite quote, what advice he’d give his 18-year-old self, the one thing on his bucket list, and a whole lot more 🚀
We want to make sure that we're starting out at good levels, and then if everything looks good there, I do a full genetic screen. So, I take their DNA from a 23andme, ancestry.com, something like that. I run it through an algorithm with 74 different sleep markers, and I get a roadmap of what your sleep is going to look like now and what it's going to look like in the future. Then we taper to the future.
As an example, I had one fellow, a prominent CEO here in Los Angeles, and we discovered that he had a genetic propensity for sleep apnea. He's a lean guy, not somebody who you would ever expect to have sleep apnea. So what we do now is, we contacted his physician and at all of his appointments, we measure his neck size, because one of the big markers for sleep apnea is neck size. Anybody who has over a 17-and-a-half-inch neck has something like an 80% chance of having sleep apnea.
If I now monitor his neck and if he goes a bigger collar size, we get on it real quick, and we make sure that things are copacetic because we don't want him to get that sleep apnea. We had another one with somebody with restless legs, same thing, had the propensity, didn't have the symptomatology, make sure that we avoided in the future. That kind of stuff is pretty cool.
If you get someone who comes in who has PTSD, depression, or some type of other severe condition, do you change your approach or is it pretty similar to what you just outlined?
I do change my approach, especially with people who have PTSD. I did a lot of work with patients with PTSD during my residency at the University of Mississippi Medical Center in Jackson, Mississippi. I'll be honest with you, I'm going to say something that's a little on the controversial side, so I hope that's okay. One of the only things I was able to find for my veterans to help them sleep after they had been in an active theater of war was cannabis. We live in California, it's legal here, it's recreational here, and it's literally the only thing I've ever found that worked in my PTSD patients in particular.
There's this hypervigilant switch that pops in these folks. If you've been in an active theater of war, your head's on a swivel, you're making sure that you're okay at all times. That just doesn't turn off when you come home. I'm not suggesting everybody goes out and smokes weed to sleep. But what I am saying is, there's something there. There are lots of sleep related products in the dispensaries. Most of them, to be fair, don't work particularly well. I do believe that THC is an important component in reduction of anxiety. I believe that CBN, which is one of the cannabinoids, can be very important in helping with sleep. There's some interesting data to suggest that.
One of the only things I was able to find for my veterans to help them sleep after they had been in an active theater of war was cannabis.
Unfortunately, with CBD, you'd have to have a tremendous amount of it as far as the data is concerned for it to be really effective. But for PTSD, I think we're close. I'm excited to see some of those cannabis studies come out.
Depression is a whole different ball game. In my mind, I think of PTSD as more on the anxiety side of things. Depression in and of itself is very interesting when you look at it. For example, most people, you don't see REM sleep approach until about 80 minutes into the cycle. For people with depression, they're in REM sleep 30 minutes in.
Sometimes when we're in the sleep lab, we can identify somebody with depression before they even know they have it, which is an interesting concept. It's a biomarker, if you will, for depression, which I think is in and of itself, quite interesting as well. Again, there's lots of different ways to approach all of these different things. Obviously, it's all about good medicine and good science.
Is the delivery method of cannabis important?
Yes, great question. I would argue that the preferred administration method would probably be a tincture, like a dropper with a liquid that you could put underneath your tongue. Because for sleep, we have to get it up and into your brain fairly quickly. And so, if it's a gummy, you got to eat it, it's got to go down to your belly, it's got to mix around, it's got to get back up there. You're talking about 90 minutes or so.
I'd love to see a tincture that would work a little bit faster. Things of that nature, I think, would make sense.
For those who work late at night in front of a computer, is it the light of the computer (or whatever device they’re using) that’s keeping them awake? Or is it their brain being an absolute beehive of activity?
Dude, it's both. It's a two-factor thing here. So, I'm the only sleep doctor, I think, in the universe who says it's okay to fall asleep with the television on, because it's passive content. You're lying back, and content is just flowing over you.
You're watching an old episode of Seinfeld, you close your eyes, you're barely listening, and you fall asleep. That's very different than trying to get your high score on Candy Crush or get through as many work things as you can. That's an active engagement that I think we want to say “No thank you” too. It's both the blue light and the active brain.
Final question, what’s one thing you do to Win the Day?
Show up. I show up positive, and that's been a struggle for me for a long time, but that's really what I do every single day. I wear a bracelet and it's got ‘Positivity’ and ‘Patience’ on it. I think about those two things every day. If I can do those two things, I am good to go.
Resources / Links Mentioned:
📙 The Sleep Doctor blog.
📝 The Sleep Doctor Facebook.
📚 The Power of When by Dr Michael Breus.
💡 Philips SmartSleep Wake-up Light.
🧘 The Daily Stoic by Ryan Holiday.
👟 Shoe Dog by Phil Knight.
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