Of all the ways to improve your overall health, making adjustments to your sleep routine is one of the easiest methods that can also have the most significant results. In the second episode in a series with “The Sleep Doctor” Michael Breus, he and the Amens dive into some simple steps you can add to your sleep routine in order to make a dramatic difference in the way you feel each day.
For more information on Dr. Michael Breus, visit https://thesleepdoctor.com/
Links to more information on the connection between sleep and menopause:
Daniel Amen, MD:
Welcome to the Brain Warrior’s Way podcast. I’m Dr. Daniel Amen.
Tana Amen, BSN RN:
And I’m Tana Amen. In our podcast, we provide you with the tools you need to become a warrior for the health of your brain and body.
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Welcome back. We are still here with Dr. Michael Breus, talking about sleep success. I just have to tell you, I love this topic. We could go on and on and on, because this is such a big issue for so many people.
In the last episode, we talked about sleep apnea, which is a huge issue for men more than women. But hormones; I mean, women go through so much. Either trauma early on, then pregnancy, then PMS, then menopause. Certainly I’ve experienced all of those, as have many of the people who follow me and send in questions to our podcast.
So I want to just touch again on that, if we could, Dr. Breus. It’s funny; sleep as a whole thing. Because of childhood trauma, I actually know several women who have written in who have the same thing.
She has six pillows that she sleeps with.
It’s a habit I developed as a child.
I sleep next to a [crosstalk [00:01:38] talk about pillows. It’s sort of like-
It’s a fort.
Michael Breus, PhD:
But that started as a child. That’s just a habit that goes on. But I hear from women all the time; I know one woman who doesn’t sleep well, and it actually brings on almost a psychosis type of reaction.
For me, I actually feel like I have the flu if I miss even one hour of sleep. I just can’t get through my day. And the problem is now at this age, which is where most of our listeners are, is around this age. A big majority of female listeners our age, my age, the hormone shift. I am so hot at night all the time. I just can’t sleep.
I mean, I’m ordering crazy cooling sheets and I’ve got the house set at 67 degrees. My family hates me. We’re complicated creatures.
Yes, you are.
Can you talk a little bit about our hormones and-
… with these things?
Absolutely. First of all, I’m glad you brought up the topic, because I think it’s an important topic. I also think it’s a topic that has not been talked about enough, nearly enough. Especially within the wonderful world of sleep and sleep medicine. So thank you for bringing it up.
I told you earlier, I’ve written extensively about this topic. Looking at menopause, particularly for women and their sleep, and some of the many challenges that they have.
Number one is, we’ve got some good information out there for people to be able to read. I’m sending all the links so they’ll be in the Show Notes for sure. But let’s talk about a couple of those issues that many women have from a menopausal perspective, that can be important to address.
The biggest one, which you mentioned, is heat, hot flashes. I’ve heard it called my power surge, my own personal summer. You name it, I’ve heard about it. So here’s the thing that we always have to start looking at is: Vasomotor symptoms, or hot flashes is what they’re called more specifically, are definitely something that many women will experience. Not all women will experience it. Many women will experience it.
Having the understanding of different strategies and what to do about that can actually be quite helpful. Aside from things like hormone replacement therapy; which is a big decision that you need to make with your doctor; understanding your background, your genetics, all of those different things. There are actually some products that are out there available that are not a bad thing to think about trying.
Interestingly enough, there are many companies that are now getting into the idea of thermoregulation and sleep, which is fascinating. Remember, the sleep cycle follows the core body temperature cycle almost exactly. As our core body temperature drops, our melatonin increases. There’s a crisscross effect there, and that’s when we start to fall asleep.
When women turn to me and they say, “Michael, I’m too hot,” I’m like, “We got to figure out a way to cool you down. Because it’s literally the opposite of what your body wants to do.”
I will tell you- [crosstalk [00:04:34]
I’m like covers on, covers off, covers on, covers off.
I’ve got something. I’ve got a product for you that I want you to learn about that I think you will find quite fascinating. It wasn’t originally developed for menopause. But there was a recent study done with menopausal women, and it showed tremendous effectiveness.
There’s a product called the Ebb Versa Cool Drift. This is by a company called Ebb Therapeutics. Very interestingly, Dr. Eric- [crosstalk [00:05:06]
I’m ready to [inaudible [00:05:06].
Don’t worry, I’ll send you a link. Dr. Eric Nofsinger, who’s one of the top sleep researchers in the world; I mean, this guy’s science is rock star science. He is a psychiatrist and he worked in the ER at times.
When people would come in with massive head injuries, he noticed that people would pack their heads in ice, a neuroprotective effect, to slow down the circulation of what’s going on, to be able to evaluate what’s happening.
He looked at that frontal activity and he said, “That’s rumination.” What’s the biggest thing that insomniacs tell me? “Dr. Breus, I can’t turn off my brain.”
So he said, “I wonder what would happen if I cooled people’s heads.” Three and a half years later, he came out with amazing research that showed that not only can he slow down people’s thinking by cooling their heads; which I know you guys are going to find pretty interesting; but they literally just published a study in the journal Sleep on menopause with this device. It was highly, highly effective.
Now I’m going to tell you, full disclosure: I’m a spokesperson for the company now, because the science was so damn good that I said, “I want to tell as many people as I can about this.” I personally use one now. I don’t have insomnia. That was the weirdest part. Is they were like, “Look, if you want to try it, you’re welcome to.”
I put it on. I got to tell you something, Tana. I’m a good sleeper. I don’t have any major sleep problems. I stuck that thing on. And I woke up the next day; not one interruption at night, by the way, which was interesting in and of itself.
You ever wake up and you’re like, “Damn, I got a good night’s sleep last night?”
Yes. Rarely, but yes.
I felt like that when I woke up after wearing this thing.
You wear it on your head?
You do. You wear it on your head all night long while you are sleeping. And it keeps a constant cool temperature across your forehead. Then it varies the temperature as you go through different circadian rhythms, and it will actually help you wake up or go to sleep. It’s unbelievable.
So I’m not a spokesperson, but I’m going to try this thing. And I’m going to get back to you on it, because this is just a huge issue for us.
Tell us the name of it again.
Ebb Therapeutics. E-B-B Therapeutics. It’s amazing. Honestly, somebody asked me to borrow mine and I told them to go buy their own.
Yeah. [crosstalk [00:07:32] I actually-
I’m not giving this thing up. I love it.
Well, I just spent a ridiculous amount of money buying some crazy bedding. Mattress, cover sheets, comforter- [crosstalk [00:07:44]
I think it’s like 350. I think it’s $350. And it’s a consumer version. Believe it or not, it used to be by prescription only.
And now they have a consumer version, so that’s cool. Literally, no pun intended.
It’s a great device. I mean, I really didn’t think it was going to work. I really did. I was like, “Come on, guys. You’re going to cool my forehead and people are going to sleep better?” I was like, “Dude, you could have knocked me over with a feather.”
And you can roll over with it and all that?
Yeah. I mean, I look pretty goofy.
I know. I don’t care. My wife’s used to me looking goofy. I tried all kinds of goofy stuff all the time. I was really impressed.
So menopause in and of itself, I really think, is an issue that should be treated: especially when it comes to sleep. We also know another side fact: is that when you are sleep deprived, the symptoms of menopause are perceived as worse.
They may be exactly the same, but you feel them worse.
Because if you’re feeling almost psychotic or you’re feeling like you have the flu. Then you tag on to that, menopausal symptoms; it’s going to feel miserable.
What about progesterone to help women sleep? What are your thoughts there?
Progesterone has a dramatic effect on sleep. When you have varying amounts of progesterone that go up and down in a crazy cycle, like menopause, you are absolutely going to see some massive, massive changes with sleep.
When you start to look at it from a strictly hormonal standpoint, what’s also interesting is estrogen and testosterone; which we know is flowing around in women as well; have a pretty big effect, too.
So when we’re looking at these circadian cycles, what we’re hoping for; unfortunately, women are not having these; is a rhythmicity or a predictability of things.
With guys, it’s pretty easy. I mean, our hormones have been flowing in a certain direction in a certain time for a very long, long period. And we can predict that with some relative ease.
Menopause is like this whole weird ball game. And to be fair, not a whole lot of people have studied it.
That’s so interesting. Let’s get back to insomnia-
… and COVID-19 anxiety, the social isolation, the financial stress. Now, some people have loved this time. They’re introverts; that being around other people stresses them out and drains their energy.
I’ve had many of my patients say, this is a historically good time for them. [crosstalk [00:10:15] They’re more bonded to their children. They have more time because they’re not fighting traffic and they’re not spending so much time getting ready.
But then I have this other group. They can’t sleep. We know depression has tripled in the last six months. I suspect that sleep is part of that, because they’re being assaulted with anxiety, negative news.
Then their [inaudible [00:10:48] actually did really well until the social unrest-
Yes. Triggered childhood stuff.
… became much more. Talk to us about what you’ve been thinking about during the pandemic as it relates to sleep.
Absolutely. Here’s the thing: is we all have the opportunity to make it through this in better shape than when we started, because we have an opportunity to really look at our sleep.
I will tell you with complete abandon, sleep dramatically affects the immune system. Period. End of story. During stages three and four is when you have the largest bolus of growth hormone that comes. It does all the repair.
But guess what? It also helps improve killer T-cell production. When you are sleep deprived, one of the things that goes down almost immediately is killer T-cell production. That is what we need to fight infection and virus.
So if you want to make it through this without getting COVID: Number one, get your sleep. That’s a lot. That’s very easy me to say, but not so easy for many people to do. There are some very simple guidelines that literally everybody could follow that will help ensure that they’re getting a better sleep.
Step number one: Wake up at the same time every damn day. I don’t care if you don’t have to commute. Wake up at what your normal time would have been. If you normally woke up at [6:30], why are you rolling out of bed at [7:30], eight o’clock? Because you can just throw on a picture on your Zoom and then only be audio and not ever even get your day started?
That’s not what our bodies need. Our bodies need reference points. Our bodies need structure. Our bodies need criteria. When we have those, everything seems to work better. So the number one recommendation that I have for people; that unfortunately, they haven’t been following; is continue to wake up at your same normal wake-up time … and do it on the weekends.
Having that circadian consistency has everything to do with all of the different aspects of your circadian system that could be affected by COVID. Moodiness, depression, anxiety; all of those are affected if you have an irregular sleep schedule. So that’s number one.
Number two: Give yourself a media diet 90 minutes before bed. You do not need to know anything about politics, anything about COVID, anything about anything 90 minutes before bed. Because-
All it does is set off all this autonomic arousal. You get pissed off and guess what? You can’t fall asleep when you’re pissed off. [crosstalk [00:13:26]
That was the most effective thing I did, stop watching the news. I grab headlines. I don’t watch the news.
Yeah. It’s just not effective to do it in the evenings before bed.
I would also argue that now is arguably the most stressful time that anybody has ever had. I mean, other than Holocaust survivors, we’re in a situation where impending doom is changing every other day, and the level of stress that that’s having on all of us. It’s a different kind of stress too, guys.
I mean, as you know, it’s not just like, “Oh, there’s traffic in LA today,” or, “Oh, I’m disappointed this didn’t happen.” It’s like, “Well, what if somebody I love gets sick? Could they die from this? What’s going on?” Completely different levels of stress. That’s causing a tremendous difficulty in not only falling asleep and staying asleep.
Then, people are doing two things that are even worse. They’re drinking a tremendous amount of caffeine and they’re drinking a lot of-
… alcohol. Those two have dramatic, dramatic effects on our sleep.
So when we think about caffeine, one of the things that we all have got to understand is caffeine has a half-life of between six and eight hours. When we drink it, we need to make sure that it’s out of our system before we go to sleep, or at least half of it is out of our system.
Now I guarantee you that you’ve got some listeners out there, and here’s what they’re thinking. “Sleep doctor, he’s going to tell me I can’t drink caffeine after 2:00 p.m. or something crazy like that. He doesn’t know I can have a cup of coffee with my dinner, and I can fall right to sleep.”
That might be true. But if I stuck electrodes on your head, and I looked at the quality of the sleep that you were getting while your brain was running around on caffeine, I can assure you. It is not good. It is not good-quality sleep, because caffeine directly knocks out stages three and four, at least lowers it. And we know that it can have some pretty definite effects on REM sleep.
Alcohol is an even bigger problem, because here’s what’s happening. People are stressed. They can’t sleep. They don’t know what to do. Alcohol is the number one sleep aid in the world. More people use alcohol to force themselves to sleep than any other substance out there.
To be clear, there’s a really big difference between going to sleep and passing out.
Oh, that’s so funny.
We try to make sure that nobody’s in the passing-out state and people are in the go-to-sleep stage. So I’ve got a strategy for you.
I like scotch and I like a good beer every once in a while. So here’s what I tell people. It takes the average human one hour to digest one alcoholic beverage. If you want to have a glass of wine with dinner, go for it. Have a glass of water after that. Remember, alcohol is a diuretic and our bodies function much better hydrated when we sleep than dehydrated when we sleep. And wait one hour.
If you have two glasses of wine, have two glasses of water and wait two hours. If you decide to go for the third glass, that’s when things have a tendency to get a little weird when it comes to sleep.
Number one we’ve seen with women in particular, when they hit that third drink, they actually get energized. They don’t get sleepy. That’s not a good thing. And with men [crosstalk [00:16:33] yeah, with men, not only do they get energized, but they can also get aggressive. Which again, is not the situation that you want to be having at home.
Doesn’t it affect blood sugar as well?
It does. Blood sugar is a really interesting thing that we talk about when we look at middle-of-the-night awakenings. How many of you have ever had the experience where; and you don’t have to raise your hand; but you passed out from drinking too close to your normal bedtime?
You woke up at four o’clock in the morning. You’re completely drenched in sweat. You walk over to the bathroom, you go to the bathroom, then you’re wide awake for the rest of the night. What’s going on there, Michael?
Here’s the problem. It’s like you anesthetized yourself. It’s like you took a needle and you stuck it into your arm. You then went to sleep and then the needle comes out and then you woke up.
Your body wasn’t expecting to be anesthetized by alcohol. So when it wakes up, it’s basically back to where you started drinking in your circadian rhythm. If you started drinking at, let’s say six o’clock at night, your body would never want to go to bed at six o’clock at night. And you woke up-
Oh, that’s so … it’s like you pause. It’s like you- [crosstalk [00:17:37]
That’s so fascinating.
So you just got to be careful. You got to be thoughtful about using these substances. Do I have coffee? Occasionally. To be honest with you, I don’t need it. I have this level of energy no matter what I’m doing, because I sleep really, really well. [crosstalk [00:17:54]
Well, I think if people slept well, they wouldn’t be as drawn to drinking.
That’s right. [crosstalk [00:18:00]
Having so much caffeine and alcohol.
Caffeine, because they’re sleep deprived.
It’s a vicious circle.
And alcohol to set them down.
But if they could-
Did you have the third thing? The first thing is wake up at the same time every day.
The second thing was give yourself a-
And the third thing was kill the caffeine and the alcohol.
Right. The specific ideas with caffeine and alcohol are very straightforward. Actually, I can put it all together in a five-step plan. Can I do that for you?
Let’s do it.
Our listeners would love that.
Step number one is to wake up on one specific time. Whatever that time is: it’s [6:30], if it’s seven, I don’t care.
Seven days a week.
You pick it, you pick it, seven days a week. Step number one: one wake-up time.
Step number two: Stop caffeine by 2:00 p.m. You stop by 2:00 p.m., that means that you’ve got eight hours before average bedtime, about 10 o’clock, to get that caffeine out of you.
Step number three is: Stop alcohol three hours before bed. That gives you the two drinks, plus a little bit of wiggle room in case you’re a little bit close to your bedtime.
Step number four has to do with exercise. I’m a huge, huge fan of exercise, and movement is helpful. That’s the other thing that nobody’s doing during COVID, Daniel. Is nobody’s moving.
And you know what? Sleep is recovery. If we have nothing to recover from, we don’t sleep well. So everybody needs to be moving, moving, moving, but you don’t want to move too close to bedtime. So step number four is: Stop exercise four hours before bed.
And step number five has to do with wake-ups. Wake-ups are big, big, big for me because I want to wake up with energy and excitement and be mindful of my day.
There’s two things that I do when I wake up. I drink 20 ounces of water, and I get 15 minutes of sunlight every morning.
Yeah. I like that.
I walk outside, and I do this weird thing. I walk outside with my dog, and I take off my shoes and I put my feet on the earth.
I love it.
I don’t have a lot of data.
I do the same thing. I go watch my hummingbirds and I walk in the grass and … yeah.
I just breathe. And I just give myself a positive intention for the day. And I say, “Hey, I’m a lucky guy. Things are going to go well today. I had a great night’s sleep. I’m ready.” And that’s [crosstalk [00:20:04] what I do in the morning.
[crosstalk [00:20:05] … for 20 minutes of sunshine in the morning and 20 ounces of water?
Yeah, when I make my smoothie, I make them really thin because I add a ton of water to it. Because it’s one of the best times for me to add that- [crosstalk [00:20:17] extra bolus.
If it’s winter, because we’re getting into fall now. You can’t go outside and put your feet on the ground because it’s frozen. That’s where the bright light therapy lamp.
Exactly. I love your therapy light. I told you about it before, and that would be what I would recommend for people during the winter months. On the fall, especially if you live in the Northeast.
I mean, let’s be fair, guys. I live in Los Angeles. Actually, I live in Manhattan Beach, which is even better than Los Angeles. I get all the sunlight I could possibly want. But if you live in upstate New York or Wisconsin, or all of these fun places, it’s not so much sunlight up there.
I really love that light therapy that you guys are using with people, to be able to use in the morning times to supplement. There’s also data now to show that if you’re depressed and sleep deprived, light therapy actually works even better than just light therapy for just people who are sleep deprived.
All right, when we come back, we are going to talk more about dreams and night [inaudible [00:21:22] with Dr. Michael Breus. I took the chronotype test. So chronoquiz.com. I’m a bear. So maybe-
Oh, that’s the best one to be.
… what a bear is. You can go to chronoquiz.com. It’s simple. It’s fun. It’ll give you a great report. Michael’s got lots of books, and his website is thesleepdoctor.com. Stay with us.
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Dr. Daniel Amen:
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