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When you have problems with your sleep, it can affect your entire life, and often in ways you least expect. Stress, anxiety, and depression can be made so much worse when our sleeping habits are part of the problem, rather than a part of the solution. In this week’s 4-part podcast series, Dr. Daniel and Tana Amen are joined by sleep expert Dr. Michael Breus for a discussion on the most common sleep problems, and how you can fix them quickly to feel better immediately.
For more information on Dr. Michael Breus, visit https://thesleepdoctor.com/
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.
The Brain Warrior’s Way podcast is brought to you by Amen Clinics, where we have been transforming lives for 30 years using tools like brain SPECT imaging to personalize treatment to your brain. For more information, visit amenclinics.com.
The Brain Warrior’s Way podcast is also brought to you by BrainMD, where we produce the highest quality nutraceuticals to support the health of your brain and body. To learn more, go to brainmd.com.
Welcome everyone. Sleep with me week is, I think, we’ll call this with our good friend, Dr. Michael Breus, The Sleep Doctor. Michael and I got acquainted, my goodness, about a year ago.
Michael Breus, PhD:
And he helped us develop our bright light therapy lamp-
… for BrainMD, which people just love. Michael is a board certified sleep specialist who lives in Manhattan Beach. That’s got to be harsh. Author of three-
It’s terrible here. Nobody should come and visit.
Author of three best-selling books, Good Night: The Sleep Doctor’s 4-Week Program to Better Sleep and Better Health, The Sleep Doctor’s Diet Plan, Lose Weight through Better Sleep, The Power of When: Discover Your Chronotype. Dr. Breus appears regularly on the Dr. Oz Show, CNN, The Doctors, CBS This Morning and Huffington Post Live. He contributes to the Huffington Post, Psychology Today, and the Dr. Oz blogs. He is the official sleep expert for Princess Cruise Lines-
… where he helped to develop the Sleep by Princess Program and the Princess Luxury Bed. Michael has a podcast, Sleep Success, and also a quiz you can take to know your chronotype or know your sleep type.
We often talk here about brain types. So we’re going to get into all of that this week. We’re going to talk about COVID and nightmares and vivid dreams and the escalating incidence of depression. And then we’re going to answer a lot of the questions you have submitted. So Michael, welcome to the Brain Warrior’s Way Podcast.
Thank you. Thank you. Thank you. This is such a great opportunity. I’m so honored to be here with you, Dr. Amen, as well as with Tana. I can’t tell you how much fun… I’ve been looking forward to this for quite a while. And also, many of you don’t know, but Dr. Amen has actually been helping me. While he would never disclose this, I had a closed head injury many, many years ago, and I went to his clinic and he’s been helping me with hyperbaric oxygenation and looking at cognitive function.
And that’s also spurred me on to try to learn more about cognition and sleep. So I just wanted to say thank you for adding that to my areas of interest and I’m very excited to be here.
Well, thank you so much. One of the hallmark features of a brain healthy life is sleep. So we have a mnemonic with talk about a lot called BRIGHT MINDS, and the S in bright minds is sleep-
I love it.
Because if you don’t sleep, the brain doesn’t wash itself and day is a mess. So having you on just sort of fits our Brain Warrior mission of having better brains and better lives. So tell us your story. How did you become a sleep doctor?
So it’s a very weird path, to be clear. So most people don’t know, but I’m actually not an MD. I’m actually a PhD. I have a PhD in clinical psychology, but however, I actually took the Medical Boards in sleep without going to medical school and passed. So I’m one of 168 people in the world that’s ever done that and to be clear, that was not my intention.
So I went to graduate school as a sports psychologist. I wanted to work with athletes and have them throw harder and run faster and all the cool stuff that was with because I was a sports guy. I thought it was cool to get to hang out with athletes, all that stuff. And I was doing my residency and the best residency program in the country for sports psychology and eating disorders, which was kind of an area I was interested in, I couldn’t get into. Only the Harvards and the Yales and the Princetons folks went there.
I went to university of Georgia, top 20 program, but let’s be honest. It wasn’t Harvard, right? But they had a sleep track available and so I had worked my way through graduate school in the electrophysiology department. So I said to them, “I can run all of your sleep machines, so I’m going to come in and be your sleep guy.” Meanwhile, they didn’t know I was going to transfer as soon as I got there into the sports psychology program because just because you tell me I’m not going to be in your program, does not mean I’m not going to be in your program. It just means that I’m going to find a very creative way to get there.
Don’t [crosstalk [00:05:38] from like that.
Right? And so I got there and I started doing sleep and literally, Daniel, by the third day, I absolutely fell in love with clinical sleep medicine. I help people like this. It’s unbelievable. When you change someone’s sleep, you change their complete life-
… in every way, shape and form. And as a clinical psychologist-
It’s the name of a book, Change Your Sleep, Change Your Life.
Absolutely. No, I mean, it’s weird though. As a clinical psychologist, it might take weeks, months, even years to see treatment gains in people with depression, with anxiety, with phobias, all of these different things. Honestly, I can help some people in under 24 hours. That’s a gift, right? I mean, that’s just the coolest thing ever that I get a opportunity to do and so I just loved it, loved it, loved it. I went into clinical practice. I joined a group of MDs and I did that for seven years where I was seeing 30 patients a day, reading 15 sleep studies a night and really learning the medicine, right?
I did that for about five or six years and during that period of time, a friend of mine called and asked me if I’d be interested in working with him on a website that was called Medscape. Little did I know that Medscape six months later would turn into WebMD and they then asked me to be the sleep expert for WebMD. And all of the sudden, I started doing media and started getting more involved with people like Good Morning America and The Today Show and Dr. Oz and The Doctors and all the places that everybody sees you on as well, and really started to get involved with educating the public about sleep. To be honest with you, I’m a little bit of a ham anyway, so I loved it, right? I don’t mind the spotlight. As long as you know your stuff, right, you’re usually in pretty good shape.
I started doing a lot of that work and writing books and really trying to educate people on some of the most important research that’s out there that they can apply to their lives. Let’s be very, very clear. I believe that there are three common denominators in humans, right? Air, everybody’s got to breathe it. Water, everybody’s got to drink it and sleep, everybody’s got to do it.
I can appreciate the fact that everybody’s got to eat food, but let’s be honest. There’s a whole host of different ways that you can eat food, different types of food, different cultural aspects of food. I’m not saying that there aren’t, but what I am saying is there’s basically one way to sleep. There’s one way to breathe and there’s one way to drink water. If you can figure out how to do those three things really, really well, all of your performance is going to increase dramatically.
I love that.
I totally agree. I mean, well, you see that because if you deprive someone of sleep even for just 24 hours, you see their performance drop radically. I mean, just look at soldiers. They’ve done studies on that.
And just one hour less of sleep, their performance drops by 25%. That’s really scary when you’re putting guns in their hands. So…
Absolutely and what’s also interesting based on what of your backgrounds are, is when you look at sleep deprivation and the incidence of concussion and traumatic brain injury, we now know that sleep-deprived people, we can predict with a fair degree of accuracy, that they have a far greater likelihood to concuss and be concussed when they’re sleep-deprived than when they’re well slept. So it’s this really weird repetitive cycle. So they’re tired, they get concussed and guess what happens? That affects their sleep cycle. They have poor quality sleep, and then they’re still tired and then they get concussed again and again and again.
There’s also been a really interesting study that just came out looking at REM behavior disorder. This is a weird situation where people act out their dreams, which is kind of funky, right? Seems to happen in people when they’re early in the CES process, when they’re early in the concussion process. So again, sleep seems to be tied and related to mental health, neurology, concussion in so many ways. It’s pretty amazing and sleep deprivation seems to have a big effect.
So what are the most common problems people struggle with when it comes to sleep?
So I would say we could really categorize that into two different areas. One is kind of the physical aspects of what we call sleep disorders, right? So apnea, narcolepsy, restless leg syndrome, periodic limb movements. Many people don’t know this, apnea and for the male population in the United States, we’re thinking it could be almost 18% of the male population. I mean, that’s a lot of people out there, right? That has a lot to do with being a bigger person in some cases, has a lot to do with weight. It also has a lot to do with anatomy. Believe me, there are plenty of thin people with apnea, but apnea and snoring is a really, really big factor.
Then I think the second big factor within the sleep disorders realm is insomnia, right? And so the inability to either fall asleep or stay asleep. And I would argue that 75% of that is depression or anxiety that’s being manifested in difficulty with sleep. So those areas from a sleep disorders perspective are pretty common, but believe it or not, there’s actually a bigger area of sleep disorders out there and that’s what I call disordered sleep. So you may not meet the criteria for apnea or insomnia or restless legs, but you go into that room in the back of the house, you get six, maybe seven hours. You wake up and you don’t feel so good. How do you fix that is what I’ve been focusing quite a bit of my time on. And that seems to affect literally, almost 50% of the population.
So I have a question because when you’re talking about that, I mean, sleep for me is this whole thing, which… But it’s not just for me. Because of what we do, I hear this with so many women. They write in, they ask questions. I mean, sleep is a huge thing for women for so many reasons. I have a new book coming out called The Relentless Courage of the Scared Child and it talks about early childhood trauma and how that… I mean, I’ve talked a lot about how that affects… I’m not a sleep doctor, but how it affects your ability to sleep soundly later-
Of course it does.
… is crazy. But then just because we’re females, fast forward, menopause. [crosstalk [00:11:35]
So number one, I completely agree with you. So let’s unpack that for just a second. So women in general, completely different ball game when it comes to sleep and almost nobody is talking about it, right?
So first question is, how does menstrual cycle affect your sleep?
Oh, dear Lord.
Because guess what, it does, right? And so many women are not given this advice. I’ve got patients where I changed their bedtimes based on where they are in their 28 day cycle, right?
Because before it, they may need more sleep. After their period, they may need less sleep. Pregnancy, are you kidding me? Oh my God. I mean, sleep is all over the place during that. And then you walk into menopause later. I’ve written, right now, I’ve got eight articles that are about 2000 words a piece on all of the different aspects of sleep and menopause. So it’s a complicated issue, but the good news is, is that there is absolutely, positively ways that you can sleep better as you walk through the process being a woman. You just have to be educated and get your facts and then be able to lay out a plan.
So Michael, where can people find those articles?
Absolutely. So they can be found on my website, thesleepdoctor.com. If you go to the blogs and you just go to the search bar and type in menopause, they’ll pop right up.
Oh, that’s amazing.
Also, we can give you guys the-
I’ll send you all the links and then we can put them in the show notes if people and that way they can have a list of them. They can just click through them. That’s easy.
That is so helpful. Before we go off to the next episode, when should someone suspect they have sleep apnea?
So here’s what’s interesting about sleep apnea in particular is I would say that probably 75% of my patients don’t even know they have it. It’s their bed partner that has to tell them. And so usually they’re what we call heroic snorers, right? And so they are really loud from a decibel perspective in their snoring, which can be very disruptive to their bed partner, but then all of a sudden their bed partner hears them stop snoring. And then they hear complete silence. And then all of a sudden they hear this… And then they wake up gasping for air. I actually have had an apneic event myself, where I woke up and was gasping for air. So I know what that feeling is like and I don’t have apnea. There are many, many people who can do this hundreds of times a night and have absolutely no recollection.
So number one, ask your bed partner. Number two, there are some symptoms that you can recognize in yourself. So one of those is waking up just feeling terrible, right? Feeling unrefreshed based on a optimal level of sleep or any level of sleep. Number two, waking up with a headache in the morning due to the oxygen deprivation that occurs from sleep apnea is certainly something that’s going to be easy to spot. Depression and moodiness seems to be another thing that happens quite often with our apnea patients. And so what I always tell people to do is ask your bed partner, “Do I snore and have you ever heard me stop breathing in my sleep?” And to be clear, undiagnosed sleep apnea is a death sentence. And I don’t say that lightly. I’m not trying to be dramatic here. Okay? When you have undiagnosed sleep apnea, you put an increased load on your heart, right?
Because what ends up happening is you stop breathing, then your heart slows just to conserve oxygen in the system, and then your brain says, “Oh crap, no more air here,” and it wakes you up. And so your heart rate has to go up and down and up and down, which of course causes a increased load on the heart, left ventricular hypertrophy, and then you end up with something called atrial fibrillation. By the way, guys, if you get atrial fibrillation, this is not a good idea to have. Also, people [ought [00:15:13] the tendency with sleep apnea to have refractory hypertension, which means hypertension that cannot be controlled with medication. So you can see the path that we’re going down here with undiagnosed sleep apnea is one of cardiac and some significant anomalies, which I’ve seen lead to stroke and to even death.
What’s the gender ratio with sleep?
It’s definitely men over women, two to one, but here’s the interesting fact is as soon as we hit menopause, it breaks back down to one-to-one.
So we think there’s a hormonal aspect to it, but also a lot of women gain weight right around menopause and so it’s hard to tease out those two factors, whether it’s a hormonal issue or a weight issue or both.
So one of the reasons I became interested in it is I can see it on scans.
And you actually get low blood flow in the parietal area of the brain, the top back part of the brain, which is one of the first areas that dies in Alzheimer’s disease. And so if I see holes there, decreased blood flow, off to the sleep doctor they go. Do you have to have an overnight sleep study where you’re hooked up?
Is that the latest way to diagnose sleep apnea?
Oh, gosh. No.
Because so many of my patients won’t do it. How do you diagnose them?
So here’s the good news is very few people must go into a sleep laboratory any longer. We have what are called HSTs, home sleep tests. These can be mailed to you and you can actually put it on yourself. There’s a video that comes with it. I’ve used this many, many times with my patients. It’s very easy to self-instruct somebody to do this. They put it on. In the morning, they turn it off. They stick it into a box. They send it to you and you can record the data.
The thing is, it’s funny because I was just talking about this with somebody else. The actual sleep test that’s done in a lab, I would argue it’s the most inefficient test I’ve ever seen.
You attach 27 electrodes to somebody.
Yeah. How are you going to sleep?
You put a camera on them. Who’s going to sleep? I mean, come on. Right? Nobody’s going to sleep during that period of time. And then if you’ve got somebody with insomnia and you send them to a sleep lab, are you kidding me? They didn’t sleep well before. Can you imagine how bad it’s going to be after that?
I wondered about it.
Yeah. I do home sleep testing quite a bit. I also don’t mind using some of the trackers that are out there to help me understand a little bit more about a person’s sleep or I ask them to keep a sleep diary, which can be very good.
So let’s talk about the trackers when we come back.
We here with Dr. Michael Breus. How do people take know your chronotype tests? Where do they take it?
So if people want to learn about what their chronotype is, which by the way is your genetically predetermined sleep schedule, that’s if you’re an early bird or a night owl. I’ve actually done the research to help you figure that out. If you go to chronoquiz.com, you will learn everything you want to know about when you should do just about everything.
I love that. I’m going to take that.
Right when we’re done. All right. We’re here with Dr. Michael Breus, author of Good Night, The Sleep Doctor’s Diet Plan, and The Power of When: Discover Your Chronotype. Thesleepdoctor.com. Stay with us.
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Dr. Daniel Amen:
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