July 2, 2019

Sleep Better

Sleep affects every system of the body — everything we do, we do better with a good night of sleep. Enter Dr. Michael J. Breus, aka The Sleep Doctor! With a specialty in Sleep Disorders, he is one of only 168 psychologists in the world with his credentials and distinction. Listen in to learn about chronotypes, supplements, and simple hacks to improve the quality of your rest.

To get the 50% off discount Dr. Breus mentioned in this episode, go to SleepDoctorGlasses.com and use the code “Sleepdr5”

Take a look at our online courses at onecommune.com.


TRANSCRIPT

Dr. Michael J. Breus: I think that sleep is becoming much more popular again. But I think it's not because it's a fashionable trend but because it's really the definition of better health. I believe as a society we're starting to understand what affects us by looking at the foods that we eat, the exercise that we do, the air that we breathe. We would be very foolish not to think that sleep was a pillar of that health.

Jeff Krasno: Welcome to Commune, a global wellness community and online course platform featuring some of the world’s greatest teachers. We’re on a mission to inspire, heal, pass down wisdom, and bring the world closer together. 

This is the Commune podcast, where each week we explore ideas and practices that help us live healthy, connected and purpose-filled lives. You can learn more about our courses, our community, and everything else we do at onecommune.com.

You’ll spend about 1/3rd of your life sleeping. And when you’re tired, you’re far from your best self. Basic tasks seem difficult, your thinking slows down, and you snap at the people you care about. Compound this over numerous nights and you quick spiral into crisis. I don’t know about you, but even though I know sleep is a vital component of health and well-being, it’s something I’ve really struggled with… until recently. 

Meet Dr. Michael J. Breus, aka The Sleep Doctor! He is a Clinical Psychologist, a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine. With a specialty in Sleep Disorders, he is one of only 168 psychologists in the world with his credentials and distinction. You’ve probably seen him on one of his numerous television appearances on Dr. Oz, or Oprah, and you might have landed on his website TheSleepDoctor.com while hunting for the latest research and tips for getting a good nights sleep.

And now, I’m so excited to announce, that you can also find him at OneCommune.com, where we’re launching his life-altering course, Sleep Better, that you can take for free from June 3-13!

The course teaches you actionable techniques for re-syncing with your natural rhythms and getting more energizing, restful sleep than ever before. 

In today’s episode, I sit down with Dr. Breus to learn more about his groundbreaking ideology and gain some valuable insights about ways to improve our sleep, and our health.

All that and more on today’s episode. I’m your host Jeff Krasno, and welcome to Commune. 


Michael Breus: So I am Dr. Michael Breus. I have a PhD in clinical psychology, and I am board-certified in clinical sleep disorders. So what that means is I took the medical specialty board without going to medical school, and passed. I'm one of 168 people in the world that have ever done it. And I've been an actively practicing sleep specialist for my entire now almost 20-year career. And I've had a lot of interesting cases. I've seen literally thousands of patients over the years.

Jeff Krasno: Yeah. And for a disorder that affects so many people ... I mean, I've read some statistics, like 50 to 70 million US adults have a sleep disorder, but sleep is not really something that gets discussed in medical schools, right? I mean, you brought that up.

Michael Breus: Right. Yeah. So yeah, it's kind of crazy. So if you look at the average medical- school education from when I was going through school in graduate school, they got approximately one hour across all four years. So not one hour per year, one hour across four years, about all 88 different sleep disorders. The good news is is that number has changed, and now we're up to four hours across four years.

Michael Breus: But yeah, that's part of the problem is many, many doctors, especially if you're going to an older physician, let's say somebody who's in their 50s, 60s, 70s, even, many of them were never trained in sleep disorders. You know, things like apnea and narcolepsy, restless legs, periodic limb movements, and many of them think that insomnia is a mental-health issue, not a sleep issue. And that's a whole nother side of this that that's very difficult for people, because when people go to talk to their doctor about sleep, and specifically insomnia, it's difficult. A lot of times they tell me things like, "Well, my doctor says that I'm depressed." "My doctor says that I'm anxious." "My doctor says that I need to go on antidepressant medication." Well, that might be the case, but it might be the case that you actually have a biologically based insomnia and that person unfortunately doesn't know how to be able to identify it.

Jeff Krasno: Yeah, I mean, you know, I've heard you talk about, you know, that experience that you have when you go and see your primary-care physician for your regular checkup, and they take blood samples, they'll take a urine sample, they'll ask you your general vital signs, but somehow sleep is not part of that equation. It's crazy.

Michael Breus: And sleep is such a big topic, right? I almost feel like I'm an internist of the night, you know, because I've got to cover things like if you wake up with a headache, if you've got to go to the bathroom, if you've got your stomach upset, oh, and then there's the whole sleeping process, you know? I mean, there's a lot of stuff that goes on. Not to mention how do you buy a mattress? How do you pick a pillow? You know, should I get an alarm clock? Is meditation a good thing? Is relaxation a bad thing? You know, like on and on and on and on. It's a complicated topic, unfortunately. But it's fun to talk about.

Jeff Krasno: Yeah, well, you're filling such an important niche that needs to be filled. So kind of stepping back, give us a broad idea of why sleep is so important, and what is the impact of of sleep deprivation?

Michael Breus: The impact in sleep is pretty amazing, and it's kind of fascinating, because we don't actually 100% know why we sleep. What we do know is what happens when we don't sleep, or don't get enough sleep. And that's what sleep deprivation is. The big thing to remember is sleep deprivation isn't only about the number of minutes that you miss, but also the quality of the sleep you're getting. I've got some people who might sleep seven hours a night, but the quality of their sleep is so bad, it's like them getting four hours a night, and I would consider them sleep-deprived.

Michael Breus: And that's the big thing too for people to remember is sleep deprivation is a personal definition. And here's what I mean by that. You know, I go to bed at midnight every night, and I wake up at around 6:17 every day, whether I like it or not. It's just when my body wakes up, right? If I slept for five hours, I would be sleep-deprived.

Michael Breus: But, for example, Jeff, if you tried to sleep when I sleep, you would be miserable, right? Because that's not what works with your chronotype. That's not what works with the length of sleep that you need. So my perfect could be your sleep-deprived. And so the point I'm trying to make for everybody out there is you need to figure out how much sleep you need.

Michael Breus: And actually we do that, I think it's either on the first or the second day, I explain to people how to calculate a bedtime and a wake-up time, identify their chronotype, and then all of a sudden everything gets much easier. But to answer your formal question about what happens to our bodies when we're sleep-deprived, sleep deprivation affects every organ system and every disease state. Literally, everything you do, you do better with a good night's sleep.

Michael Breus: So, it affects you cognitively. You don't think as clearly, you don't think as quickly, you make riskier decisions and more emotional-based decisions. From a physical standpoint, we know that with men, testosterone drops by a third when you're sleep-deprived. So, basically if you play basketball, and you're 25 years old and you're sleep-deprived, you're playing like a 35 year old, which is not probably good for your game. As far as reaction time is concerned, we know reaction time slows by almost a third. So if you're driving a vehicle or something along those lines, it can have an effect. Also, emotionally it has a big effect. The more sleep-deprived you are, quite honestly, the more grumpy you are, the worse mood you're in. There's even data to now show that you will view things in a negative light if sleep-deprived, even if the stimulation

Michael Breus: Is neutral or positive simply because you're sleep deprived, so literally, dude, it affects everything.

Jeff Krasno: Wow. That's crazy. Well, you mentioned something that I think is really, really important for people to understand in that every single individual has their own sleep wake cycle, and you talk about the concept of the chronotype. Can you explain what a chronotype is and how you determine what your personal chronotype is?

Michael Breus: Sure. So first of all, a lot of people out there may not have heard the word chronotype, but they actually do know what it is. If anybody out there has ever been called an early bird or a night owl, those are chronotypes. And so historically when we look in the medical and the psychology literature, what we discover is there's early birds, there's people in the middle that used to be called hummingbirds, and then there are night owls. My contribution to the literature is I felt like there was a large group of my patients that didn't fall into any of those categories, and those are the people with insomnia, and so what I decided to do was add insomnia to the category, and what we discovered very quickly was it's actually a category of its own.

Michael Breus: Now, here's what's also interesting is these are genetic. So, this isn't necessarily, "Oh, I'm in a bad environment, so I'm not sleeping well." There are plenty of people out there who genetically are not great sleepers, and once we identify which one of these that you are, everything becomes a lot easier because we know what your hormones look like throughout the day, and I can tell you when your melatonin is high and when it's low and when to go to bed and when not to. And so the way you discover this, I have an online quiz that people can go to. If you go to ChronoQuiz.com, you can take your own chronology, and you can figure out what your chronotype is and get some more information on it, which will be very helpful. But it's really one of the most critical aspects to trying to understand how does your sleep work and how can you make it benefit you the most.

Jeff Krasno: Yeah. So, I did this because I've suffered with insomnia for a number of years, and from my chronotype is ... I think it falls mostly into the lion category where if I can go to sleep at 9:00 PM more or less, that's kind of my sweet spot, and I can sleep pretty well and deeply and consistently til 5:00 AM, which of course, that might sound like a very sedentary and boring life, but I'll tell you, it beats brain fog and weight gain and all of the other things.

Jeff Krasno: And so if I'm understanding correctly, the natural rhythm of my body is essentially releasing the melatonin hormone or the sleep-inducing hormone around that time and then is secreting cortisol around 5:00, and the fact that now I've been able to identify that sleep window where my body is naturally excreting those hormones, that's what's helping me get a good night's sleep. Is that a decent understanding of it?

Michael Breus: Absolutely. That is 100% correct.

Jeff Krasno: Good. So, I know you've broken down these chronotypes into four different animals. I believe they are lions, bears, wolves, and dolphins. Is that right?

Michael Breus: Lions, bears, wolves, and dolphins. That's correct. And so what I decided to do was change the category because I'm a mammal not a bird, right? And so I wanted to use mammals, and I also chose animals, by the way, that actually have this as their actual chronotype. So, lions are my early risers. They replace early birds. They like to get up early. They like to make a list every day. They like to go from one to two to three to four. A little bit militant in their thinking on occasion, but just people who get things done have a tendency to be lions. They like to exercise. They like to be up early in the morning. That's where they find they have their most energy. 

Michael Breus: But it's not all fun and games being a lion because, as you said, socially, by 8:30, 8:45, you guys are ready to go to bed, and so dinner and a movie with a lion probably isn't going to happen, but maybe an early dinner or an early morning run with a lion or breakfast with a lion certainly can [inaudible 00:17:56]. A little bit easier for sure. So, one of the things I tell people all the time who have what we call lion envy is trust me, it's great to be a lion, but there's some drawbacks as well.

Michael Breus: The middle one, which used to be called the hummingbird, I call a bear, and we've had now over 750,000 people take the quiz, I think, and what we've discovered is there are early bears and there are late bears. So while a bear generally likes to go to bed around 10:30 and wake up around 7:00 and had some general characteristics of being more of an extrovert, these are the people that you like to have fun with, hang out with, are good friends, things like that. It turns out that there are some people who are a little bit on the early side and some people who are on the later side. So, some of my bears will go to bed at 9:00 while others will not go to bed until 11:30, so it seems to be there's some earliness and lateness that seems to vary with them a little bit.

Michael Breus: Then we get into our night owls, which is what I am, or what's called the wolf. So as I explained to you before, my bedtime is midnight almost every single night. Now, I will tell you that it's feeling like it's getting earlier as I get older. I'm 51 years old, and I can tell you that as I'm getting older, it's not as easy to stay up until midnight, and so sometimes I find myself asleep at 11:45, even 11:30, and so I can tell you that it's starting to creep back. And this is common with age, right? And so people have a tendency to go to bed earlier the older that they get. And we know that that happens with the circadian clock shift.

Michael Breus: But my night owls are very different. So we are the creatives. We are the actors, the authors, the musicians. We are the high risk takers. We're usually the least healthy of the bunch. We gain the most weight. We make the worst decisions, but we're also a lot of fun. Believe it or not, we're introverted more so than e xtroverted, meaning that we can get on a stage and do whatever it is we do, but maybe at a party we're not so great a conversation. That can certainly be something that happens quite a bit.

Michael Breus: And then the final category are what I call my dolphins, and so this is where I bring in the insomniacs. And so dolphins, most people don't know this, but dolphins sleep what's called unihemispherically. So, half of their brain is asleep while the other half is awake and looking for predators, and I felt like this was a great analogy of my insomniacs who are just never quite asleep, right? So they're trying really hard, constantly, constantly, constantly, but sometimes they're sleeping, sometimes they're not. That felt like a dolphin to me, and those are my problem children.

Michael Breus: So, those are the ones that the book The Power of When was written for where I started to do all of my real deep dive on chronobiology. And there's a lot of interesting things that can be done to help those people out, and believe it or not, some people who look like a dolphin, once we get them on a schedule and we get them doing the right sleep hygiene and doing all the things that we talk about in the course, their true chronotype comes out, and they're actually no longer a dolphin. It's pretty interesting

Jeff Krasno: That's what's happening to me right now.

Jeff Krasno: You're taking me out of my dolphin state, which I am very grateful. So, when you say sleep, and I think there's a popular conception that sleep is just sleep, but it's actually broken down into a number of different stages. Would you mind articulating what those stages are?

Michael Breus: Sure. Yeah, so we go from wake to stage one, then down into stage two, then we go into a combination of stages three and four. They're now together. Then we go back to stage two when we go into REM sleep, and that's called a cycle. A cycle takes roughly 90 minutes, and you'll learn a lot more about this in the course. Each one of those stages does something different for our bodies. The two areas that are the most important for us to learn about are stage three/four and stage REM. So stage three/four has a lot to do with our physical restoration, so this is where our body goes into the body shop and gets the scratches and the dinks and the dents pulled out of it, and we feel alive. We wake up and feel really good after having stage three/four sleep.

Michael Breus: Stage REM sleep is a little different. This is the mental restoration, so this is where we have a tendency to see, for example, information go from our short term memory to our long term memory. That's when that process occurs. And so very different uses of each stage for our body.

Michael Breus: A cycle runs roughly 90 minutes, and you have roughly five cycles across the night, right? So, right there, we learn that eight hours is a myth because if you multiply it out, it only equals seven and a half hours. So, I want everybody out there, and you're going to learn a lot about these myths, how they showed up and why they're not very helpful in the course, but eight hours is a myth. Everybody's sleep need is very, very different.

Jeff Krasno: Got it. And so to access REM, which is, as you described, that stage where short term memory can go into long term storage. How long does it take generally to hit stage REM within the cycle?

Michael Breus: So, if there are five cycles across the night, in the first two to three cycles, you should see REM between 80 and 120 minutes. So, sometimes the very first REM cycle is very short, 30 seconds, two minutes, and so sometimes, quite frankly, you miss them. But what I can tell you is that generally the entire cycle itself is 90 minutes long, but REM sleep, you get to somewhere between 80 and 120 minutes.

Jeff Krasno: And you can almost, if you're looking at that five cycles, 90 minutes per cycle, you can almost reverse engineer your sleep schedule, right? You're looking at your chronotype. You're determining what that is. That's giving you this really ideal optimal sleep window, and then you can even break down from there and look at these 90 minutes segments within that window.

Michael Breus: Yeah. I give people a formula to do that, for sure.

Jeff Krasno: So, let's talk about a little bit about the other elements in life that you can control because I think one of the really empowering messages that I hear from you is that this isn't something that's happening to you, that you actually have control over your sleep, and a lot of that is behavioral. So, let's talk about alcohol, caffeine, exercise, these proactive decisions or non-decisions that you can make and how they affect your sleep.

Michael Breus: So, here's what I'll tell you. When you look at alcohol, most people don't know, but it takes the average human body approximately one hour to digest one alcoholic

Michael Breus: ... beverage. So I'm not going to tell you that you cannot drink. I am going to show you in the course when to drink where it will not have a huge effect on your sleep, and then the method that I would that I could claim that you need to use, including hydration, to counterbalance the alcohol. Because one of the things that most people don't know is half of the reason that you have a hangover is because you drink too close to bedtime, which affects stage three and four, and the other half is due to dehydration, because alcohol is a diuretic. So by having your alcohol earlier in the evening at very specific times based on your chrono type, it can be much better for you in the long run, as well as better for your sleep.

Michael Breus: Caffeine turns out to be the exact same thing. I've got no problems with people using caffeine and using it wisely, but overuse of caffeine and overstimulating yourself can certainly be a pretty big problem when it comes to sleep. So in the course, I actually will give you guidelines as to when to drink caffeine, again, based on your chrono type, and when to stop. Generally speaking, I'm having most people stop around the 2:00 to 3:00 range, and this is because caffeine has a half life of six to eight hours. And in order to get that stuff out of your system, at least half of it, if you stop around 2:00 PM, your caffeine, then you have a far greater likelihood of being able to fall asleep a little bit easier in the evenings.

Jeff Krasno: And what about exercise?

Michael Breus: Exercise is the single best way to improve the quality of your sleep. Now, look, you don't have to go out and run a marathon, okay? But 20 minutes of cardio each day, assuming that your doctor says it's an okay think to do, turns out to be a wonderful way to improve your sleep quality. Not only helping you fall asleep, but to reach deeper stages of sleep and to have fewer interruptions. But, here's the thing. When you're sleep deprived, you don't want to exercise. In fact, exercising, the exact same thing. So let's say you went on a bike and you did a spin for 30 minutes at a particular resistance, and you don't have enough sleep in you. It's going to feel three times as difficult as if you do the same bike, the same resistance, but with sleep in you. So don't get discouraged when you first start exercising, because it's going to be even harder. But once you lock in your sleep schedule, figure out your exercise routine, that's when things are going to get easy, and you're going to see a lot better flow of energy.

Jeff Krasno: We hear a lot about technology and screen time and its association with sleep. Expound on that a little bit for me, if you could.

Michael Breus: Sure. So, when we look at technology, specifically technology that involves light, all light has within it a spectrum, and part of that spectrum is called blue light. When that wavelength hits your eye, it actually does something very specific to a certain group of cells called [melanopsin] cells, and it turns off the melatonin faucet in your brain. Right before bed, the last thing that we want to have happen is your melatonin faucet turning off, right? What we want is we want your melatonin faucet turning on at night and off in the morning. So better to use bright light exposure in the morning when you wake up by getting sunlight or using light therapy or a light box in the morning if you wake up when it's still dark out, and avoiding blue light at night.

Michael Breus: Now, that might be easier said than done. Here's what I can tell you is there are light bulbs available. You can buy them, they're 20 bucks, online, that have filters in them that filter out the blue light. But then I also use blue light blocking glasses, because I might look at my phone or I might watch television before bed, and I don't want that blue light to influence my ability to fall asleep. So roughly 90 minutes before bed, [inaudible] the blue light blocking glasses. Now, I didn't like the ones that were out in the marketplace, so I created my own. And so we'll have a special commune discount available for people if they go to SleepDoctorGlasses.com. And we'll have a special code that we can give people, as well.

Jeff Krasno: Great. And on the supplement tip, would you encourage people to supplement with melatonin if their melatonin faucet is not flowing?

Michael Breus: Well, so, here's the thing is 90% of people's melatonin faucet works just fine.

Jeff Krasno: Yeah.

Michael Breus: As we get older, so as we hit the 50, 55, 60 range, our melatonin production can slow down. So in some of those people, I'm recommending daily melatonin use. But for almost nobody is daily melatonin use necessary, unless you're doing something like shift work. So as an example, if you're a shift worker and you have to get in and go to work at midnight and work until 8:00 in the morning, well, then you're going to need melatonin to help you fall asleep during the daytime, for sure. But generally speaking, most people should not need melatonin.

Michael Breus: However, there are plenty of people that can benefit from supplementation for sleep. Some of the things that I talk about in the course are vitamin deficiencies, including vitamin D, in particular, has a very big effect on our ability to sleep. Vitamin D helps control our circadian rhythms in certain ways. From a mineral perspective, we know that magnesium appears to have a very interesting relationship with sleep, as does vitamin B. Vitamin B6 and B12 in particular. So when we've got people out there who don't digest these vitamins well because of certain genetic variations, that can also have a big effect on their sleep, as well.

Michael Breus: So, I mean, when you start to look at it, being healthy and just taking your vitamins and minerals on a daily basis, yes, I think that can be helpful for overall sleep quality. Now, if you're having problems sleeping, then some sleep supplementation could be very valuable to you. For example, using something like valerian or hops in combination with melatonin could be very, very helpful for people. So don't throw melatonin away, per se, when we're talking about sleep, because, for many people, melatonin can and will be a very helpful substance to utilize.

Jeff Krasno: Yeah. I want to ask you kind of a broader cultural question about sleep.

Michael Breus: Sure.

Jeff Krasno: Historically, sleep has been something that has been celebrated. Shakespeare talks about it. He calls it nature's soft nurse. Even in the bible, sleep is something that is ... It's during sleep that God seals in his instructions. And then the 20th century comes along and Thomas Edison invents the light bulb and he starts talking about how sleep kills productivity. And fast forward to the world of all-nighters and college. It's this badge of honor of how little sleep you can get. Where are we? Where are we on that spectrum? Are people now rediscovering how important sleep is? And what role are you playing in that discussion?

Michael Breus: So you did a good job of detailing the timeline. Unfortunately, Thomas Edison screwed us all up by inventing the light bulb and basically starting the industrial revolution. It is interesting, if you look back at some of his early writings, he thinks that sleep is a waste of time. While Thomas Edison was a smart dude, at the end of the day, he was pretty stupid when it came to sleep, because the exact opposite is actually true.

Michael Breus: Are we seeing a comeback for sleep? You bet we are.

Michael Breus: I think that sleep is becoming much more popular again. But I think it's not because it's a fashionable trend but because it's really the definition of better health. I believe as a society we're starting to understand what affects us by looking at the foods that we eat, the exercise that we do, the air that we breathe. We would be very foolish not to think that sleep was a pillar of that health.

Jeff Krasno: Yeah. Well, Michael, thank you so much for devoting yourself to the study of sleep, and also helping so many people foster a better night's sleep. I know how important this has been to me. I mean, it's been absolutely essentially to my vitality, to my creativity, to my relationships with my wife and my children and my coworkers. So this is something that I've said is very personal for me. But I'm just one person. This is affecting tens of millions of people, and you're on the front line addressing it, so thank you so much. I appreciate it.

Michael Breus: Thanks for giving me the opportunity to kind of spread the word. And one of the things that I tell people all the time that I think is kind of one of those good ways to end it is what did God do on the seventh day, right?

Jeff Krasno: Yeah.

Michael Breus: Right? It's like, we all need to rest. We all need to sleep. I mean can you imagine how cool a world it would be if everybody just got a good night's sleep? Just one night?

Jeff Krasno: Yeah.

Michael Breus: Honestly, I think the entire universe would change.

Jeff Krasno: There’s no doubt that sleep is the third pillar of health, right alongside diet and exercise. It’s where the body and mind can engage in deep healing and rejuvenation. And if you want to optimize the hours you’re awake, you need to put more focus on the hours you’re not.

To learn more, or to sign up to take Dr. Breus’s Sleep Better course, head over to One Commune.com.

And tune in next week where we’ll be releasing sections of the course, right here on the podcast!

Thanks for listening to the Commune Podcast, I’m your host Jeff Krasno. Sweet dreams and I’ll see you next time!

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