In this episode of NutriBullet Kitchen, Elynn DeMattia, Certified Functional Medicine Health Coach, interviews Sleep Doctor Michael Breus.
NutriBullet Kitchen Podcast Episode 2 Interview with Sleep Doctor Michael Breus
For more information on the Sleep Doctor, check out his page HERE.
To Purchase Dr. Michael Breus’ book The Power of When, click HERE.
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Follow Along with the Transcript:
Elynn: I’ve been here with Dr. Michael Breus aka the sleep doctor.
Dr. Michael Breus: That's me.
E: Thank you so much for coming. I'm really excited to have you here.
MB: Happy to do it.
E: Author of let's say we have all of them here... The Doctors Diet Plan Beauty Sleep and the Power of When.
MB: Yep those are me.
E: A lot of times people just say I'm a good sleeper, I'm a good sleeper, bad sleeper right. Do you think is any weight to overall sleeping definitions of this caliber.
MB: Well I think it's all perceptual right. Sleep is a perception. So when you wake up in the morning however you think you slept you're probably pretty close to how it was. The biggest problem with sleep these days is there's no metric for sleep right. You don't get on a scale, like when you get on a scale, you know how much you weigh. If you take 10000 steps you know how many steps you took. But if I ask you how well did you sleep. What do you say? 37, 94 or whatever. So there's really not a great metric out there and available for sleep. Although trackers are starting to try to get into that business if you will. I think people do have a general sense of it they're good sleepers or bad sleepers. The problem is what happens when you're in between? Right. What do you do about something like that.
E: And I imagine most people probably are in between.
MBL Yes. Most people actually are because nobody speaks perfect all the time. I mean I'm the sleep doctor for goodness sake and I certainly don't sleep perfect all the time and I never expected my patients to either.
E: In a lot of work. There's an association between weights and sleep. What is the relationship between the two?
MB: So it's really interesting so in the sleep doctors diet, lose weight through better sleep, we actually talk about the relationship between sleep deprivation and the metabolic process. So I want to unpack that a little bit for everybody. So when we look at sleep deprivation What is sleep deprivation. It turns out it's different for everybody. So I am naturally a six and a half to seven hours sleeper. How many hours a night do you sleep?
E: Seven when I feel good.
MB: So seven you feel good, but if you've got six, you would be sleep deprived. Right. But for somebody who gets six normally they wouldn't be sleep deprived. Right. That would be their normal amount. So sleep deprivation is a little bit on the relative side but most people can kind of get a handle on if they're sleep deprived because they wake up and they kind of got that brain fog they're not even slower throughout the day that kind of thing. So let's just say you know when you're sleep deprived. Here's what's really happened. Interesting that happens on a metabolic level. Five different things. So step number one happens when you're sleep deprived your metabolism slows down. Why does it do that? It’s trying to conserve the resources. It doesn't know why you're still awake but it figures you're going to need fuel so you better not use up all your fuel so metabolism slows down almost immediately. Not good for weight loss. Step number two is your cortisol increases which increases your appetite. Right? Because it wants you to get resources into not only trying to conserve the resources but it's trying to bring resources into you've got high appetite and low metabolism, it already doesn't sound like a good recipe for weight gain. The next thing is hormones. We are actually looking at these hormones there are two hormones in particular that are very important. One is called Guerlain that's spelled G H R E L I N and I remember Guerlain as the go hormone because Guerlain starts with G and goes starts with G and it makes you hungry. Believe it or not there's a difference between having an appetite and being hungry and Guerlain is part of that when you're sleep deprived. 20 percent increase in Guerlain in your system. There's another hormone called leptin. This is the hormone that tells you that you're full. This is incredibly important for dieting and weight loss and all those things 15 percent less leptin when you're sleep deprived. So let me just go over this in summary real quick, high cortisol high appetite when you're sleep deprived high Guerlain when you're sleep deprived which makes you hungry. Low metabolism when you're sleep deprived and low feelings of being full. I mean it doesn't really get much worse than that but it does. So here's where it gets even more interesting. Great study at the University of Chicago that showed that your snacking preferences change the more sleep deprived you are. So let's use you as an example. Right. If you're sleep deprived. What do you go for?
MB: Exactly. Anything sweet. High fat high calorie high carbohydrate. So here's what happens remember that cortisol I told you that's high and your brain doesn't like it when your cortisol is high. So it wants to produce serotonin to make it go down. The easiest way to produce serotonin is to eat a donut. All right. Hight carbohydrate high fat foods increase serotonin. That's why we call them comfort foods because they make us feel so comfortable. Right. So this is the process and that's with the entire book is about it's about if you are sleep deprived. It's almost impossible to lose weight.
E: Well we talked about the weight thing. Let's talk about the beauty thing. So what's the correlation between beauty and sleep?
MB: So it's really interesting when you start to look at the scientific research. If you took somebody. And this is actually done they did several studies where they took people no makeup same camera angle same length they took a picture of them and then they took another picture of them after they'd been awake for 36 hours.
E: Oh Wow.
MB: OK. Two pictures same person. Then they showed these two pictures to a separate group of who had never seen these people before. One hundred percent of the time they could pick out who was sleep deprived.
MB: And that's where beauty sleep really comes in it's the aesthetics. It's how do I look. And how does that look change the more sleep deprived I become? So what does that mean? It's dark circles under the eyes. Now let's be very straightforward here depending upon your cultural background. There are some cultures where the eyes are instead a little bit deeper so it'll cause a shadow it might look like that right. You might also have more subcutaneous fat around your eyes which is going to push that out. So it doesn't always happen with everybody but that's the thinnest skin in your body is the one that's right actually underneath your eyelids. And when you're sleep deprived blood pools underneath there and that's where the dark circles come from. So when you're not sleep deprived. Guess what dark circles have a tendency to go away. Same thing with the puffy eyes right. You have inflammation from sleep deprivation that makes your eyes pop out and all that kind of what I call under eye baggage occurs. Also when we look at skin tone. Now I'm a pretty pale person in general. But when you're sleep deprived your skin almost looks like an ashen grey. It doesn't look healthy. And when we know during sleep we actually have what is officially called beauty sleep which is stages three and for sleep. This is actually where growth hormone is the minute. And I kind of think a growth hormone to come going into the body shop right and getting up the scratches and the dings and the density of your car which is your body. That's what happens in stage 3 for sleep and that's really where beauty sleep occurs because that's where all the cellular repair occurs. And so it only happens in the first third of the night and it happens only with the emission of growth hormone which happens in stage 3 for sleep which is why the first three hours or so of the night is critical, critical, critical for looking great.
E: How do I know whether I just know somehow or through some type of apparatus that I'm actually getting a good night's sleep? And how would you determine?
MB: Alright. So quality of sleep is very different than quantity of sleep and right up until this point in the interview we've been talking a lot about quantity how many hours only minutes that comes up a quality turns out to be really, really, important. The only real way to know is do a sleep study and by the way attaching 27 electrodes all over your body having a camera on you and sleeping in a strange place is not necessarily conducive to a really great night of sleep. So these days we're using trackers in some of the trackers are becoming more and more sophisticated as time goes on and I think that's probably the best way for us to really start to understand the quality of our sleep. But I will be very honest with you. Sometimes you just know like you get up in the morning even if it's the same time that you normally get up and you're like oh well that was terrible. You know I felt like I was tossing and turning all night. You know when you haven't gotten a good night's rest I know because I can see it in your person. And also we know that a lot of different things don't work so well when you're sleep deprived like your coordination your thought process you become moodier. My daughter calls people grumpy fish when they don't get enough sleep. And I mean that's pretty accurate term right. And so when you start to look at it it's pretty interesting when you start to see it all come together.
E: Is there any truth to the concept when people say I woke up on the wrong side of the bed? Does that correlate with you?
MB: Not really. I mean they didn't get a good night's sleep or they were really worried about something before they went to bed and they woke up thinking about it again because the mood is really affected by it.
E: Which brings us to conversations you and I have had in the past about the different reasons that you're not sleeping at night whether it's like you're carrying all of the mental baggage from your day or the stuff that's coming tomorrow or hormones. Can we talk about I think you have four major areas or something?
MB: Oh there's a lot of them. So if we were trying to set ourselves up for a good night's sleep right what would we do in order to kind of do that so that we would follow into some good guidelines as well as be able to kind of get something from it. So I want to give everybody maybe five steps that people could take in order to get themselves right. So step number one is pick one schedule and stick to it. Right now consistency is the most important thing to see. Turns out your wakeup time consistency is more important than your going to bed consistency because your circadian clock which is that internal biological clock resets every morning with sunlight so sunlight is great. Sun light, it's like a cup of coffee for the brain okay and when it comes in it resets and turns off the melatonin faucet in your head helps you wake up so by waking up at the same time everyday including the weekends. I promise you it will work because if you can wake up without an alarm at roughly the same time every day your body gets in better sync. I'll give you an example. I only sleep six and a half hours a night and I've done this almost my entire adult life. And again I'm the sleep doctor right. How can I accomplish that and still have my level of energy and feel good. It's not that I just happened to hit the genetic lottery it's because I'm super consistent with my wakeup time because my brain knows when to sleep and when to wake up and it actually gets me there faster. I don't actually require as much sleep as I used to because my sleep is so consistent. So step number one consistent schedule including weekends.
Step number two has to do with caffeine. So a lot of people don't think about it but caffeine is a stimulant even though you might not feel jittery or whatever and it has a half life of between six and eight hours. Right. So if you have a cup of coffee at dinner right and you're wondering why you're getting up on the wrong side of the bed. That can definitely be one of those reasons right now. I guarantee you there's somebody out there who's going to sleep. Doctor what does he know. I can have a cup of coffee right before bed and I can fall asleep immediately and be out like a light all night. So first of all different people have different caffeine sensitivities. So that's not an uncommon thing. So some people are more or less sensitive. But here's the thing is if you can fall asleep after you've had a cup of coffee. Number one you're probably pretty sleep deprived. And number two if by stuck electrodes on your head and I looked at that sleep it's not good quality sleep. So stopping caffeine by 2:00 p.m. is really the best way of doing it because then by 10:00 at least half of his hours your system and about 75 percent of people fall asleep between 10 and 11 in the United States.
Step number three has to do with alcohol. Here's the deal with alcohol is there's a really big difference between going to sleep and passing out. Right. Right. Like passing out is bad. But I'm also not a teetotaler. I enjoy you know a nice glass of wine or spirit with dinner or something like that. So when you need to think about is the average human body it requires one hour to actually digest one alcoholic beverage. OK. So if you have two glasses of wine and you stop at eight by 10:00 you're going to get back. Right. And so that's how I want people to sort of start to think about it is you know and what I do is I give a general recommendation of stop drinking alcohol approximately three hours before bed because that way if you've had two / two and a half glasses of wine then you're good to go. You still get an enjoyable feeling enjoy the beverage but still go to sleep unaffected. So step number three is to stop alcohol three hours before that.
Step number four has to exercise the best way to improve the quality of your sleep is a daily exercise. I'm not talking about running a marathon. Ok I'm saying 20 minutes walk the dog park at the far end of the parking area at work and walk in take the stairs whatever you can do. There's a lot of data to show that consistent exercise really helps improve the quality of your sleep. However there is a little bit of a caveat. Some people if they exercise they get really energetic. Right. So if you don't want to exercise too close to bedtime. So step number four is to stop exercise four hours before bed. Right. That way you still get in your exercise. But it's not something that's too disruptive for you.
The last one has to do with sunlight. So I'd say step number five is to give the sun a high five every morning. What do I mean by that is within 30 minutes of waking up. If you can get about 15 minutes of direct sunlight that means walk outside and get don't stare at the sun just let the sunlight in because again it turns out that melatonin faucet in your right it really helps wake you up.
So in summary step number one stick to one schedule. Step number two stop caffeine. By 2:00 p.m.. Step number three stop alcohol three hours before bed. Step number four stop exercise for hours before bed. And step number five is give the sun a high five every morning for 15 minutes. You will sleep well.
E: Which brings me to the power of when. Could you explain for a second to common types so we can talk about this.
MB: Many people out there might not know what this term Krono type means. But they've actually heard of it before. If anybody out there has ever been called an early bird or a night owl. Those are Krono type. It turns out there are two there's four. So historically in the literature we've known about early birds and night owls and we kind of thought there was somebody that was in between. But I basically said we're forgetting about insomnia people with insomnia and so I brought in a fourth Krono type. Now here's the thing is these aren't things that you make. These are actually genetically pre-determined. If you look at your PDR three gene or the snippet in your gene it actually if it's longer you have a larger sleep drive if it's shorter or you have shorter sleep drive. So it actually determines how long you sleep and how deep you sleep which is kind of interesting and the timing of your sleep. And that's really where the key comes in. So early birds would be renamed as lions. These are my go getters these are people that wake up at four thirty five o'clock in the morning. These are the people that are usually the C O O's of a company. Their logistics, they’re type A. They like to make a list every day and go from step one step two to Step Three To Step Four like they are kind of militant in their thought process. They get a lot of stuff done in terms of management. They don't actually do a lot of the work but they're really good at getting people to do things and kind of motivating and kind of running a company like a COO would.
Bears are my in-between. That's you know I'll tell you why bears are the best the world is built on a bear's schedule right. Bear bears make up 55 percent of the population. Are they those lions only about 15 percent. Right. OK so 55 percent of the population are bears which is you. And the reason it's so good is because again everybody works on a bear's schedule so that 95 works perfect for a bear. Whereas for somebody like me and I'm the third prototype I'm what's called a wolf or like a night owl. I’m a late person. Like I said I hate mornings. Only about 10 to 15 percent of people are wolves and wolves have a tendency to be very different types of people but let me get back to real quick. So bears are extroverted. They get a lot of stuff done and they're really gregarious they're fun they're the people who say come on I'll buy you a drink or let's go to lunch together. They're really interested in social interaction and they work really really well with other people.
Wolves on the other hand like myself were late night people and we don't work well with other people we're introverts. But interestingly enough these are my most creative types so my actors my authors my musicians anybody who has a real spark of creativity they want to be up late, late, late, at night and then I'd said before I go to bed at midnight and I wake up at thirty every night like I can't go to bed before midnight it just doesn't work in my brain that way. And a lot of wolves are like that as well. The problem with being a wolf however is we are social outcasts right. We don't get up. I don't get up at you know super early in the morning and go for a run and have my you know miracle whatever. That's not what I do. Right. And we kind of get chastised for that sometimes as well. People think we're lazy people think we're not going to do things. And by the way when we make a list during the day we go from step 1 to step 12 step six to step 14. And it makes perfect sense to us. But it would make no sense to a lion for sure.
And then the last category are what I call my dolphins. Now by the way I've chosen these animals because these animals in the in the animal kingdom actually have these schedules. So Lions first kill is before dawn. Wolves we know are very nocturnal. Bears get up with the sun and go to sleep with as the moon comes up. Dolphins are really rather unique so most people don't know this but Dolphins sleep uni hemispheric. Meaning half of their brain is asleep while the other half is awake and looking for predators because you know they're constantly swimming. And I thought it would be a good representation of my insomniacs who are never quite asleep right. Right. And so these people are they're my problem children. I'll be honest with you and it's pretty miserable for them because they say wow I don't I can't get a sleep schedule going there often times high anxious. Usually a type A personality. There are a lot like lions but super anxious and a little bit of obsessive compulsive and it makes it so that they never feel like they've finished a project. That type of person is a dolphin. So once you know what your category is it gets really interesting.
So as an example when a line wakes up in a morning in the morning vs a Wolf let's say a line wakes up at six and a wolf wakes up at eight. Well there are hormone profiles are identical but at different times right. Right. Right. So here's where it gets really fascinating is what I did then as I discovered all the different times that you need hormones for specific activities when they're naturally high and I plotted them out for each specific prototype. I can tell you the best time of day to have sex eat a cheeseburger. Ask your boss for a raise. Run a mile. You name it.
E: But funny enough I printed out my bear. I think I've taken a lot of heat for certain things that I do. People are always at first like why do you think the red eye who takes the red eye and you get a little taken aback. And like I kind of like taking the red eye because I'm like tired when I got on the plane. I fly back there to see my family and by the time I get there. I'm awake. I'll take a little nap and then I'm not Time Zone. Right. And so that then I settle on my bear master clock. Here it is. Take red eye flights. And I also work out at 7 at night. That's when I meet with my trainer. People always like how do you work at 7. I don't know that’s just how it works for me so you justified me and I have my proof that I am scientifically accurate. But I think it's really interesting the way you did that and to see the different things that you know you know that asking for a raise. Fighting with your partner. Oh yeah cold calling someone getting a flu shot. I mean it's all in here. It's amazing.
MB: Absolutely. And it's all based on real science. We have over 300 studies in the book. And there are not studies that I did this study that I've aggregated literally from all over the world. Believe it or not just this year the Nobel Prize in medicine was given to circadian researchers who got this exact. So this is leading edge in terms of what we're talking about for medicine.
E: Well speaking of medicine so do you feel. And if so what is the link between sleep deprivation and being more susceptible to chronic disease.
MB: Oh it's super clear. So going back to the idea of Krono type again as an example we're now seeing in places like Sloan Kettering an M.D. Anderson big cancer centers we're now learning that we can actually administer chemotherapy at particular times in the circadian cycle. And it works better and you use less toxins. I mean come on that's pretty cool stuff. Right. So when you start to look at medicine what we're going to start to see happen as an example is when people are giving specimen samples right so urine saliva stool blood what have you. There are going to be time stamped because what level your hormones are out at eight o'clock in the morning could be dramatically different from 4:00 in the afternoon let's say you're going to get your thyroid checked and you're doing a blood draw. You could be in sync in the morning and you could be completely out of sync. Yet they only drew the blood in the morning and so no nobody knows what to do. So we're going to start to see from a medicine standpoint that a lot of things are going to be more involved with circadian rhythms in particular. They're starting to call it biological or circadian biology and circadian medicine which is really pretty exciting when you when you start to think about it. Also we know that on the other side the people who are administering the medicine they also have circadian cycles right. And so when do you want to do surgery right. Do you want to do it in the morning or do you want to do it in the after day. Wow. How old is your surgery.
How dexterous are they when are they going to have their skill set. You know really primed directive. So there's a lot of different areas that we're starting to look at now about that sleep deprivation definitely affects our immune system. The data is staggering. We now know that as an example the more sleep deprived you are the faster cancer cells multiply. Wow. Period end of story. OK. That data is in. So if you're sick get sleep and let's be honest when you're sick you want to sleep anyway right. I mean you just want to lay in bed. You know you want to sit there. And so what I'm oftentimes telling people is listen to your body. Respect your body. Caffeine is not a substitute for sleep especially when you're sick. You know your immune function is dramatically tied to the amount of sleep that you get.
E: Now are there certain things like say here over the course of the day you want to set the stage for a perfect night's sleep. You imagine your five tips. But are there certain things I know chocolate as opposed to like Ambien and a couple other things I staples and that warm cup of milk levy like the day I had to cut it off hours I think of that.
MB: OK. So let's dispel a few myths a few feet. So the first one I always get is Turkey. So I calculated it out. You'd have to eat an 18 pound turkey. The whole thing in order for you to get enough trip to tryptophan to actually make a difference and tryptophan doesn't work well in the presence of protein anyway. So even if you ate an 18 pound Turkey it still wouldn't work. So the reason that people get so tired after Thanksgiving is because their in-laws have been over and driving them crazy and they've been setting up for the meal and it's all stress and once it's over it's over and everybody can kind of relax up from that. Warm milk is interesting, warm milk also milk has tryptophan in it. You don't have to drink a gallon and a half which sounds really disgusting. A gallon of milk before bed. Right. Aside the fact that you'd be peeing all night long. Right. The reason warm milk actually does have an effect on people. Is it because who gave it to you. So when you were young and your grandma or your mom or your dad or somebody that you love those close to you gave it to you and said Here drink this it will help you sleep. You have that association and that association is still with you to this day. And that's why sometimes those types of things have a tendency to work. But it's not because there is cheap demand and it's bad. Now my favorite recipe if you will is something that I've developed to help people with magnesium deficiencies. So I call it banana tea. So here's what you do most people don't know this but bananas turn out to be nature's sleeping pill. They're loaded with potassium but they've got a ton of magnesium and magnesium really helps calm people down. And by the way most people don't have enough magnesium. Most people are magnesium deficient cause your body doesn't make it. You have to ingest it unless you're eating a bushel of kale a day. You know the chances are that you're probably not getting enough magnesium. Now that being said you probably make a super cool smoothie that would have all that good stuff in it. But just for a second if you look at bananas it turns out that the magnesium in it is not nearly as much as what's in the Peel. Turned up the Peel ratio three times the amount of magnesium as the fruit itself. No I'm not going to ask you to eat the peel. What I do is have people go buy an organic banana wash off the dirt cut off the stem and the tip cut it in half leave the fruit in and the peel on put in a little pot of boiling water for about three four minutes until it turns brown and then drink the water. You've got to like bananas because it's very banana-y as my daughter likes to say. And it works. It is. It's been done. Yeah it's awesome.
There are other foods though that you shouldn't have before bed. I do. So you were talking about chocolate. So I think I would get divorced if I told people that you cannot have chocolate before bed. It depends upon the amount of chocolate if you're eating an eight pound Hershey bar. You've got a problem on your hands right. I actually had a patient doing that in a sleep study one time and was wondering why they couldn't sleep. Swear to god they make this stuff up. Small square chocolate even dark chocolate is perfectly fine unless you're one of these super caffeine sensitive people otherwise enjoy your enjoy a little piece of chocolate at the end of the day. That's not a problem. Things you wouldn't want to watch out for things like spicy foods because it's stomach upset caused gastroesophageal reflux and that can be disruptive to. So but if you're from a culture where you've been eating spicy food for your whole life and you don't get any stock either way I don't have any problems with it. It's really about your own level of discomfort. The big thing that people have to remember is you don't want to have a super big meal right before bed because your body really wasn't meant to digest food lying down. It was meant to die beauty there sitting or standing. You've got to give your body the opportunity to digest through that food before you lie down. The other thing is there's a lot of data on carbo loading before bed and it turns out that carbs definitely make you sleepy. This is actually one of the reasons why in the mornings I tell people don't eat bagels don't eat muffins don't get a lot of bread because it's just going to make you tired. All right. You're much better off having a high protein breakfast meat. Because I'm a wolf. I can barely choke down breakfast like I never have an appetite for breakfast. So I actually make a smoothie.
E: What does the Sleep Doctor put in his smoothie?
MB: So actually it's a couple of different things. So I found this product that I really like called athletic greens. And know is a ton of really great stuff in it so I put that in there. I have some branch chain amino acid because I'm I train and I work out a lot and I need that for energy and muscle building and then I do high levels of omega and then I like blueberries strawberries and bananas. So I like my morning sugar.
E: Peeing during the night. Some people have to get up and pee when they are sleeping. And is this an issue? Is this normal?
MB: So for men if you have to wake up more than once a night to go to the bathroom you really want to look and see if you've got an enlarged prostate. So you want to go have a prostate exam checked if you're 50 years old you should be having starting to have these fairly regularly anyway. I know it's not the most pleasant experience in the universe but you definitely want to know because an enlarged prostate will push on the bladder. Cause that bladder pressure make you have to pee quite a bit. Another thing if you have to go to the bathroom multiple times that could be an early sign of diabetes. So you need to be very careful about that as well. What I'm doing with a lot of my patients where it becomes disruptive is I'm having them slow down and even stop fluids about two hours before bed again. Don't do this unless you've cleared it with your doctor because there are certain medications and situations where you're going to want to be drinking up until that time. But generally speaking ask your doctor if you can restrict fluids about two hours before bed. Make sure you go to the bathroom once before bed and then you know hopefully you won't have to pee.
Now there's a second strategy of what do you do if you do have to pee. Michael I know a couple of things to tell people to. Number one don't look at the clock. It's the number one thing that they instantly do the mental map and they're like it's 330 I got to give it six dog out three hours. I'm going to run in and pee real quick and then I'm going to go back to sleep. And all they've just jazz themselves up all that anxiety is they're all that kind of autonomic arousal is out there and they can't fall back asleep. So don't look at the clock. Honestly it should be across the room and turned around and really don't need it. Number two if you don't have to pee don't. But don't just because you wake up say oh well I'm up I might as well pee. Most people don't know. But in order to enter into a state of unconsciousness your heart needs to be at about 60 or below. Well if you go from lying down to sitting up to standing you are writing 60 anymore. Right. So you have to get it back down to that 60 level. But let's say you got to go. All right.
What I tell people to do is put a strategically placed nightlight along the way and one in the bathroom because if you actually turn on the light switch in the bathroom you just told your brain it's morning and it stops producing a melatonin and then it's even harder to get back to sleep. So strategically placed Night Lights go in. Do you need to do, come back and then what I have to actually recommend for people to do is to do deep diaphragmatic breathing to help them get that heartbeat back down. And so I like the 4 6 7 method which is where you breathe in for accounted for. Right. Hold it for a count of six and then breathe out for a count of seven. The breathing out longer actually helps dispel a lot of the carbon dioxide and really slow your heart down. If you don't have for about five or six cycles really start to get into a nice place and then you can use it to drift off to sleep.
E: So if you wake up not because you have to pee, you just wake up. Same rule? Don't look at the clock?
MB: Same rule Don't look at the clock. Don't pee if you don't have to. And try the breathing or meditation or something to allow you to relax but I also have a sneaky tip for some people. So it turns out that and this is I don't have a lot of data on this I can just tell you anecdotally this is what's been happening in my patient population is I have a lot of people who wake up like three thirty seven and they know the exact time because it seems to be the same time every night. So when I ask them what time their last meal was they usually tell me like 6 o'clock. Right. They've been fasting and their body is low on glucose. And so the reason that they're waking up is because their brain is saying I'm out of fuel. So jacks your cortisol up which wakes you up. Right. So here's a little tip that I've done for some people is believe it or not a teaspoon of raw honey has to be raw honey because it's harder for your body metabolized through it but it seems to keep your blood sugar stable longer. If honey isn't your thing you're diabetic or your Kito or whatever then guava leaf tea does the same thing. I mean it's something you can have again right before bed and if you don't like to eat a spoonful of honey you can actually take it and put it into some warm water with some lemon and make like a honey water like a warm honey water as a little treat before bed that works.
E: I wake up in the middle of night. What would be the best things to do? I'm trying to remember something I forgot and I don't want to get up and turn the light on because I'm done.
MB: So the number one complaint that I hear in my office is I can't turn off my brain which I think is kind of what you're described.
E: That is the number one?
MB: Number one complaint. And so I created this technique I got the power down hour so about one hour before bed take 20 minutes to do the things you just gotta do. Right. So that could be answering emails. It could be… in our house, it's getting backpacks together for the kids preschool finding shoes, sports equipment that kind of thing that the mornings are usually horrific in my house because I had two teenagers. 20 minutes I've just got to get done. Then 20 minutes for hygiene and then 20 minutes for some form of meditation or relaxation. Now that can be a whole host of things and so in your case one of the things that I recommend before this hour starts is what's called a worry journal so a worry journal is just a piece of paper you draw a line down the middle and you just write all the things that are on your mind on one side and then one solution or task on the other side it doesn't have to solve the problem. But what it does is it settles your brain enough to say OK I at least have a plan right for tomorrow. Like I'm not like all scattered how am I going to deal. I've kind of delineated that out. You put that aside and usually you should do that around 6:00 or 7:00 a.m. in the evening. You don't want to do too close to bedtime but during your last 20 minutes where you're doing your meditation or relaxation. My favorite thing to have people do is write a gratitude list. So there's actually some data to show that if you have positive thoughts before bed it actually influences your dreams in a very positive way. And there's nothing wrong with having little gratitude for it. So I kind of get people doing these systems. And remember sleep is not an on off switch. It's more like slowly pulling your foot off the gas and slowly putting your foot on the brake. There's a process that needs to occur there and so we really like people to understand that process and to kind of get into a rhythm or a groove because it makes it much easier.
E: So does the Sleep Doctor have a TV in his bedroom and does the Sleep Doctor drink coffee.
MB: Great question. So describe to my bedroom. All right. So we have a king size bed. I have me, my French bulldog is right next to me and my chihuahua is next to him. My wife is there and then the cat is next to her. OK.
E: The family bed?
MB: The family bed. On occasion a daughter or son will come from the bottom and they could end up in the bed at any given time at night. Right. We have a big screen TV in our room and it's on all night long. I'm the Sleep Doctor!
E: Oh my god I can't believe it! I thought you were going to say no tablets and nothing allowed.
MBL Let's talk about it. So here's the deal. When I first met my wife she said to me by the way Michael I fall asleep with the TV on. I was like Don't worry I'm asleep doctor I'll fix you of that. I don't know about anybody else out there but if you ever try to fix your partner of anything. Good luck. But I started to really watch her because I had a lot of patients who fall asleep with the television on and what I discovered was that she's not watching she's listening right. Her eyes are close and she's actually I called listening out of the corner of her ear and it's not like we have on something great. You know it's Law and Order, Seinfeld or something like that but it's something that's just distracting enough to stop that kind of worrying on the brain. Right. Ninety five percent of TVs have a television timer in the software. Just set the timer for 45 minutes if you've got a bed partner that needs to fall asleep with the TV right. Right. Let them fall asleep. It'll click off and then you're fine. The difference however is in the engagement and in the proximity. Right. So TVs all the way across the room and I'm listening I'm not really engaged with it but if I've got my phone or my tablet or my laptop and it's right in front of me number one that blue light source which is the problem much closer. Number two I'm engaged. Right. Like if I'm watching Game of Thrones and it's right here, like I'm going crazy or if I'm trying to get my high score on candy crush it's like I'm going for it right by going to bed. That's having a good time right. So you really need to think through sort of electronic devices right before bed. Again I'm probably the only Sleep Doctor in the universe that says television is OK. But all the other blue light devices probably not a good idea. Coffee is an interesting one. So actually in the book I tell you the perfect time of day to drink coffee based on your Krono type. So in order to exit sleep you have to hormones you have cortisol and adrenalin that raise very quickly to help you wake up. They're super duper powerful if you compared the adrenalin and cortisol to caffeine. It would be like comparing cocaine to tea. OK. So by adding caffeine as your first drink in the morning all it does is it gives you the jitters. It doesn't actually make you any more stimulate because it can't because you've already got two substances in your body actually that are far more stimulating. However both cortisol and adrenaline will actually start to drop about 90 minutes after you wake up. That's the perfect time to have a cup of coffee because having that little bit of stimulation will actually help raise those levels back up to almost pre sleep levels are right around when you wake up to give you a little bit of boost of energy. So don't drink coffee but maybe 90 minutes after you wake up. The thing you should drink when you wake up first is water. It turns out that through the humidity in our breath we lose almost a liter of water every night. So when you wake up you should have a bottle of water preferably room temperature on it and then stand in front of the window to get that direct sunlight. Do me ever put on a robe. That is that's really what you want your morning routine to be, then approximately 90 minutes later you would drink your caffeine. And again remember from before you want to stop caffeine by about 2:00 p.m. so it doesn't affect your sleep.
E: This has been riveting. Thank you so much. And we’ll have to do this again, because I can come up with a million more questions.
MB: Happy to do it.
E: Thank you Dr. Breus.