← Feel Better, Live More with Dr Rangan Chatterjee
Feel Better, Live More with Dr Rangan Chatterjee
How To Finally Fix Your Sleep, Wake Up Rested & Transform Your Life with Dr Michael Breus #672
01:59:32
“Sleep is a lot like love: the less you look for it, the more it shows up.” So says my guest on this episode, one of the world's leading sleep doctors, who’s here to reveal the five common traps that are stopping us getting the rest we need.
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- [00:00]
Dr. Rangan Chatterjee
Before we get into this week's episode, I am really excited to share that I am bringing my Thrive Tour Transform your health and Happiness to Canada and Europe this September and November. It's a live, interactive, uplifting show that over 20,000 people came to last year across the UK and Australia. I'll be sharing powerful stories, life changing insights and simple tools that will inspire you to feel better, think clearer and live with more intention and joy. To get your tickets right now and see all of the dates and venues go to Dr. Chatterjee.com forward/live. I really hope that you can join
- [00:45]
Dr. Michael Bruce
me Literally every person on earth wakes up between 1 and 3 o' clock in the morning. Most people burp for fart, roll over and go back to sleep, right? However, between 10 and 20% of the population has difficulty at that moment falling back to sleep. Nobody out there did anything wrong. This is your biology and so the less you think about it, the less you freak out about it, the more likely you are going to be able to get your body back to sleep.
- [01:16]
Dr. Rangan Chatterjee
Hey guys, how you doing? Hope you're having a good week so far. My name is Dr. Rangan Chatterjee and this is my podcast Feel Better Live. More sleep is a lot like love. The less you look for it, the more it shows up. So says my guest on this week's brand new episode. Dr. Michael Bruce is a clinical psychologist and sleep specialist based in California. He's the author of several books including his latest sleep drink Breathe and over the course of his 25 year career he's helped thousands of people transform their wellbeing by changing the way they sleep. In our conversation we explore so many different topics, including the most common mistakes people tend to make when it comes to their sleep. Why sleeping in at the weekend could be doing you more harm than good. What's really happening in your body when when you wake up between 1 and 3am Why a sleep apnea diagnosis is not something to be feared, and why freaking out about sleep is probably the worst thing that you can do. Michael is someone who is incredibly passionate about spreading the message that we can all improve our sleep quality, no matter our starting point. And this is a warm and uplifting conversation that provides some fresh and reassuring perspectives on this most fundamental pillar of health. Let's just start off by going through some of the common mistakes you see people make, perhaps inadvertently that is getting in the way of them having a good night's sleep.
- [03:08]
Dr. Michael Bruce
Oh, it's a great question. This is. There's a few, I think the biggest one is people get locked and loaded with the idea that they have to get eight hours of sleep. And what ends up happening is, for example, if they stay up late, then they just add more sleep to the end of their sleep period. So as an example, if they normally go to bed at, let's say 10 o' clock and get up at 6, they get 8 hours. But let's say it's Friday night or it's Saturday night, they stay up till midnight. What do they end up doing? They end up sleeping in by a couple of hours in order to try to capture that extra supposed missed sleep. And I would argue that's probably one of the worst ideas that you can possibly have. Let me explain why. When you wake up in the morning, sunlight hits your eye and you have a special cell in your eye called a melanopsin cell. And this cell sends a signal to the back of your brain to turn off the melatonin faucet in your head. But it sets a Timer for approximately 14 hours later. It's called the melatonin phase response curve. Right. So what I just said was the time that you wake up directly determines when melatonin, which is your internal, you know, sleep hormone turns on. Right? So if you have a variable wake up time, because you're trying to capture that eight hours of sleep, you end up with variable melatonin time in the evening time. And that becomes highly problematic. There is a lower level limit. I don't want people to get less than about five and a half to six hours of sleep. However, if for whatever reason, one night you get six hours, it's not gonna be the end of the world.
- [04:40]
Dr. Rangan Chatterjee
In I think your latest book, Sleep, Drink, Breathe, you have these top five sleep traps. And I wonder if we could go through those because I kind of feel that people are often doing things without realizing that it's negatively affecting their sleep. So the five you put in the book are living out of sync with circadian rhythms.
- [05:02]
Dr. Michael Bruce
That's the one we just talked about.
- [05:03]
Dr. Rangan Chatterjee
Playing catch up, freaking out. I mean, we can go through more, but maybe let's go to those cnettes. What's, what's playing catch up and what's freaking out?
- [05:13]
Dr. Michael Bruce
So playing catch up is where you only get five and a half hours during the week. And then you say to yourself, okay, I'm just going to catch up on my sleep over the weekend and add a couple of three hours and hopefully cumulatively across the week I will get the amount of sleep that I need. And, and the truth of the matter Is we have an argument about this in sleep medicine. Every couple of years, some people say you can catch up, some people say you cannot catch up. It. Quite honestly, if I was the consumer, I would be incredibly frustrated because every couple of years, it seems to change one way or another. Here's what I'll tell you. You can do, you can catch up some, but what you don't want to do is sleep in for a long period of time. So as an example, if you wanted to catch up for, let's say, 30 to 45 minutes of extra sleep in, I don't think I have a huge problem with it. It's when somebody who normally gets up at 6, gets up at 9. They've completely thrown off their internal circadian rhythm. And you do that more than one night in a row, and you get what's called social jet lag, where your entire circadian system shifts. And now, Mondays are horrible. So as an example, stay up late on Friday, sleep in on Saturday, stay up late on Saturday, sleep in on Sunday. Monday sucks, because guess what your body wants to do. So stay up late on Sunday and sleep in. And that makes it even more difficult. So the weekend catch up. I think you can catch up for some, but I wouldn't say you can catch up for all. So my official recommendation is, yes, you can sleep in for between 30 and 45 minutes, but no longer than that, for sure.
- [06:40]
Dr. Rangan Chatterjee
Okay, so circadian rhythms, very important. We're gonna talk more about them throughout this conversation. We've just dealt with number two, which is, you know, be careful with how much you try and catch up at a weekend. Okay, Correct. But. But then the third one I think is really interesting and perhaps, I don't know if you'd agree, but perhaps might be one of the biggest ones of all, which is freaking out. What do you mean when you say freaking out is a sleep trap?
- [07:08]
Dr. Michael Bruce
So a lot of people get really upset about their sleep, right? And so as an example, they wake up in the middle of the night, which, by the way, happens regularly for them, and they get very, very upset about it. They're like, this is unbelievable. I keep having problems. And what happens is that escalates heart rate, which makes it harder to fall asleep, Right? So there's three main ways that we can get people to fall asleep through lowering heart rate, lowering temperature, lowering anxiety. Those are the three, right? And so when we look at those three in particular, lowering heart rate, lowering temperature, and lowering anxiety, freaking out affects all three. So when people start to get really upset about their Sleep people. Guess what happens? Their anxiety increases. When your anxiety increases, so does your core body temperature and so does your heart rate. Now you're moving further and further away from the actual sleep. I have a saying that I tell people all the time that I think is appropriate here. I tell people all the time. Sleep is a lot like love. The less you look for it, the more it shows up, right? So when you're out there in the world trying to find your perfect relationship, right? You can never do it, but the second you stop looking so hard, that person wanders right into your universe. The same holds true with sleep. The more you think about it, the more you worry about it, the more you freak out about it, the less likely you are going to be able to get your body to sleep. Now, don't. Don't get me wrong. There are environmental issues, like, you need to have a good setup in your bedroom. And also there are circadian rhythm issues. You need to know what timing is. But at the end of the day, I would argue 75% of sleep is between your ears, right? It's your mental state. It's your. How do you create a mental state in order to allow your body to then fall into an unconscious state?
- [08:53]
Dr. Rangan Chatterjee
Yeah. One thing I was hoping to talk to you about, Michael, is this. It's something I've thought about in nutrition for a number of years now, which I think we can apply to sleep, which is this idea that we never used to need nutrition experts. Right? You would learn nutrition from your family and culture. You know, your grandparents, your grandmother would
- [09:16]
Dr. Michael Bruce
make great food, you have family dinners, the whole thing.
- [09:19]
Dr. Rangan Chatterjee
Exactly. And I sort of feel it might be similar with sleep. Like, I'm sure in more traditional societies who haven't been as affected by modernity, did they have all of these sleep problems? Did they need all of these hacks? So what does it say about us as a society where we actually need people like you and me to actually help them do something? That's very basic.
- [09:47]
Dr. Michael Bruce
Well, it's such a great question, right? Is like, you know, do we really need a sleep expert, right. Or a sleep doctor? And the truth of the matter is maybe for some pathology, like for sleep apnea or narcolepsy, that makes intuitive sense for me, but for the general public, no, like, let's be fair, 90% of the time I'm reminding people about something that their mother told them or their grandmother told them, right? Like go to bed without the television on or go to bed at the same time or wake up at the same Time, you know, here's some warm milk. Like all of those things, right, are real and they all really work. If we just let me, let me say it a different way. We all used to know how to sleep until we grew up. And then life seemed to get in the way.
- [10:31]
Dr. Rangan Chatterjee
Yeah, right.
- [10:32]
Dr. Michael Bruce
And so I think that's what ends up happening. And when we look at these cultures that have not a level of modern technology like what we do, they sleep better. Like I've got news for you. Like if you look back at the data, like I'll take the ultimate piece of technology, that kind of idiot, Thomas Edison, he invented that thing called the light bulb. He screwed it up for everybody, okay? Because as soon as you could work in the dark, people stop sleeping as much. So I think we're, as a society we have a tendency to put something in our own way, a hurdle, if you will. Whether that's caffeine abuse, whether that's using alcohol to help us relax, whether that's playing on our phones until 3 o' clock in the morning, whatever it is, we're putting our own hurdles in front of us. And let's be fair, dude, like the basics are very straightforward. Go to bed when you're tired, wake up when the sun comes up, you know, exercise during the day, hydrate, have a few good meals, you should be fine.
- [11:31]
Dr. Rangan Chatterjee
Yeah, we just touched on there sleep trap number four, sleep disrupting habits. And I'm sure all of those things you mentioned, we could go into a lot more detail which we will do later on. But let's just go to that fifth sleep trap that you write about in Sleep Drink Breathe, hoping the problem will go away on its own. Are you specifically talking about sleep disorders there or are you talking about more lifestyle related sleep issues or a bit of pain?
- [12:00]
Dr. Michael Bruce
I think, I think both, if I'm being super honest with you. I think both like an example of a sleep problem that goes away on its own because there are some that do. As an example is if your child doesn't want to stay in bed at night, right? Like most children don't at college age wander into their parents bedroom and say, mom, I can't sleep, right? Like it. Eventually it goes away, right? But something like sleep apnea, that probably doesn't just go away on its own type of thing. So a lot of people avoid the idea of even sleep testing. Rangan. This is also another thing I think is kind of an interesting topic to bring up, which is a lot of people come to me and they're like, they have Obvious symptomatology of a sleep disorder. So the first question I have is, well, why haven't you, why haven't you gotten sleep tested yet? And they say, oh, I don't want to get sleep tested. I said, well, why? And they said, well, I'm going to end up on a CPAP machine, right? And so just for your audience members to understand, most people are fearful that if they have a sleep test, they're going to end up with the diagnosis of something called sleep apnea. Right? Now, sleep apnea, for folks who don't know it, is a situation where you stop breathing in your sleep. This is very serious. We want all of our patients to breathe, but most people will say, oh, I don't want to do that sleep test because I'm going to end up with the treatment for sleep apnea, which is a mask that you wear on your face that helps you breathe at night. Now, I want to be clear about a couple of different things. I want to kind of double tap on a few things here. Number one, not everybody who has sleep apnea sleeps with a mask on their face. There are a whole host of protocols that we use nowadays to treat sleep apnea that are extremely effective and do not involve sleeping with something covering your face. But the most effective treatment that's out there happens to be a CPAP machine. So I think there's a lot of people out there who just are fearful of the answer and even more so fearful of the protocol that could follow, which would be the treatment, which, by the way, would make them feel like a million bucks.
- [13:53]
Dr. Rangan Chatterjee
And.
- [13:53]
Dr. Michael Bruce
Right. So it's like, it's so funny because people are like, oh, I don't want it, I'm claustrophobic, I can't handle it. And then at the end of it all, once we get them on treatment, whether it's a CPAP machine or not, it turns out that they do really, really well. That's something that doesn't just go away. Right? Now I will tell you that a lot of people turn to me with sleep apnea and they say, well, what if I just lose weight, Michael? And you know what? Weight loss can definitely help. But as a general guideline, you can still lose weight and have rip roaring sleep apnea, right? So let me give you another example of myself, right? So I personally, Dr. Michael Bruce, I have sleep apnea. I stop breathing in my sleep 26 times an hour, which is quite a bit if you look at it, right? And guess what? I sleep with the CPAP machine. I wore it last Night. You could probably see the marks on my face still. They're from this morning. Right. And so at the end of the day, you don't want to be fearful thinking that something is just going to magically disappear because nothing, a health related situation, usually magically disappears.
- [14:56]
Dr. Rangan Chatterjee
Yeah, that word, sleep apnea. Could you explain what exactly sleep apnea is?
- [15:03]
Dr. Michael Bruce
Sure.
- [15:04]
Dr. Rangan Chatterjee
But also what are the signs that people may be experiencing, you know, that might indicate they've got sleep apnea?
- [15:14]
Dr. Michael Bruce
Absolutely. So there's a tricky one which everybody says, and I want to say it first, but I want to put a caveat on it, which, which is snoring. Okay. So not everybody that snores has sleep apnea. However, I'm honest with you, most people that have sleep apnea do snore. So it's kind of like it's a two way street, but the traffic is different on one side of the street than on the other side of the street. But snoring is one. Waking up in the morning with the headache, that's another symptom. Waking up and being tired during the day or waking up hitting the snooze button four or five times because you just can't get your butt out of bed. Mood disruption. So up and down moods, where there's some irregularity, there also difficulty focus, difficulty with attention. There's quite a few symptoms that are, that are out there. Also, let's be fair, most people kind of wake up and say, oh my God, I got a terrible night's sleep last night. That's something that sleep apnea people report all the time. Now what is sleep apnea? In effect, when you breathe in through your nose, you form a vacuum which pulls all of the tissue slightly back just a little bit. If you are a large person, if you have big tonsils, if you have a deviated septum, all of these different scenarios. When you pull that tissue backwards, you can push it to the back of the throat and actually close the throat. Most sleep apnea is the back of your tongue touching the back of your throat. So what we have to do is open up the pipe Right now there's a lot of different ways to do that. One is with a mask on your face, pushes air up your nose and when it hits that area, it just ever so slightly opens it up, keeps you breathing all night long. But that's not the only way to do things. There's also something called an oral appliance. This is like a mouth guard, like, you know, like you see the football players wear. But it's an upper and a lower. And the lower is slightly forward. And when you move the jaw slightly forward, you open up the posterior airway space. Again, opening up the pipe is another way of doing it. Most surgical interventions do something, once again, to open up the pipe. So that's really what we're talking about here, is anything that we can do to mechanically open up, open this area up to allow people to breathe better. And that usually works, actually, quite well.
- [17:21]
Dr. Rangan Chatterjee
Yeah, I really appreciate how open you are. Sharing your own story with sleep apnea. No, because, you know, it's really interesting. You're saying a lot of people are scared. They don't want to get tested. Cause they don't want to have a CPAP machine. But I think there's also, with health, sometimes, like an embarrassment, a shame, a guilt. Right. And what's.
- [17:43]
Dr. Michael Bruce
Oh, yeah.
- [17:43]
Dr. Rangan Chatterjee
And you are, you know, you are the sleep doctor. Right.
- [17:47]
Dr. Michael Bruce
I know it's kind of ironic, but it is.
- [17:50]
Dr. Rangan Chatterjee
But it's also, I think, quite empowering. It's quite reassuring to go, oh, even though he is an expert in sleep, he also has this sleep condition that requires treatment. And I think another point there, which I think is interesting, is a lot of people associate sleep apnea with people who are overweight or obese.
- [18:11]
Dr. Michael Bruce
And.
- [18:12]
Dr. Rangan Chatterjee
And you, of course, are neither.
- [18:14]
Dr. Michael Bruce
No, not at all. So let me tell you the story because it's kind of an interesting story, right? So I call my doctor. So I have a concierge doctor, the woman who takes care of me. Her name is Dr. Kerry Bordenko. And I call Carrie up. And I said, carrie, God, my workouts aren't as good as they used to be. I feel like I'm slowing down. I don't feel like I'm as. I've got as much, you know, kind of piss and vinegar in me. Like, I usually. I'm a pretty energetic guy. And she said, well, let's run some blood work. Let's make. Maybe something's going on. So we run some blood work. Maybe she thinks maybe I'm anemic. Something's going on. We get the blood work back. And my Testosterone was at 400. Now, for folks listening, low T is 300 or less. So I wasn't in the low testosterone area, but it's not like I had high testosterone. So she said, let's try some testosterone. You're 58 years old. Or actually, I was 57 at the time. Like, let's try. Let's see. That's probably it. So I'm like, okay, fine. I'M not a big needles guy. So I did the oral. Testosterone. They were little gummies, right? So I did that for about four or five months. Noticed no difference. She said, look, the oral doesn't work as well as the injectable. Stop being such a wimp. Just do the injectable. So I'm like, okay, fine, I'll stop and do the injectable. So I start doing the injectable, go for three months. Only thing that happens, I lose more hair. Okay? This is not the response I'm looking for, okay? Like, I'm looking for libido increase. I'm looking for energy and all these things. None of it happens. And so I call her back up, and I'm like, look, it's. Nothing's going on in the right direction. And she said, hey, Sleep Doctor, when was the last time you had a sleep study? And I was like, you know what? It's been a minute, right? So I haven't had a sleep laboratory in about six or eight years. And usually when you have a sleep laboratory, you test out equipment. I'm used to testing out. I hadn't tested any equipment out in, like, eight or 10 years. So I call up my buddy who actually is over at Sleep Doctor, which is where we actually run sleep tests for people. Zane's Holland. And I said, holland, send me a test. So he sends me a test. I wear it overnight. Boom. I get this number back of stopping breathing in my sleep 26 times an hour. So you know what I did then? I didn't believe the test. I didn't. I swear to God, I was like, something's wrong with this test. Come on, I need another test. So I called Holland back up. And I'm like, holland, clearly there's something wrong with this test. Send me another test. He's like, Dr. Bruce, there's nothing wrong with the test. I'm like, no, seriously, dude, send me another test. So he sends me another test, dead on, same number.
- [20:46]
Dr. Rangan Chatterjee
Wow.
- [20:47]
Dr. Michael Bruce
So look, I. Even me. Even me as the sleep doctor, I denied my first test result. Like, I was convinced. Like, I'm not that guy. Like, I'm not. I'm not a bigger person. I don't have, you know, these terrible snoring. My wife doesn't hear me waking up, stopping breathing, none of this stuff. But sure enough, I've got moderate to severe sleep apnea, right? And it came across as low energy, right? And so that becomes important for people because you need to start looking down those paths and seeing what's going on. Do I look like an apnea patient? No, of course I don't look like an apnea patient. But to be fair, what does an apnea patient look like anymore? Like, I feel like anybody could be a sleep apnea patient. And we need to be thoughtful. And, you know, nowadays sleep tests are so cheap, they're less than $200 to have them sent to your home. And you can have it done in the privacy of your own home these days. So it's. It really is quite remarkable. But, yeah, that was kind of my story is I was not expecting. Like, when I got those test results back, I was kind of upset.
- [21:49]
Dr. Rangan Chatterjee
Do you have any theories as to why you have sleep apnea?
- [21:52]
Dr. Michael Bruce
I do. So. So I went and I had another physician look in my throat. And so there's a couple different things that we think might be going on. So there. It looks like I may have some excess tissue towards the back of my throat. And that's where we think is the pinches going on right now. One question people ask me all the time is, well, why did you use. Why are you on CPAP machine? So let's talk about that for a second, because it's kind of a funny story. So. So I've been putting people on CPAP machines for 26 years, right? And so I. And I've been talking about intelligence, and I even slept with one for a little while just to kind of get used to it, but it wasn't on, and I didn't have apnea at the time, so I didn't really know what the experience was like. Right now I have a very different understanding and appreciation for being not just the doctor, but also being the patient. So here's the funny story is about a year ago, not, well, maybe less than a year ago, we got a new puppy. And so in our house, as people have heard me say before, there's a big screen TV that's on all night long. Cause that's what my wife watches all night long. And both of our French bulldogs sleep in our bed, okay? And so the puppy wanders up, and he likes to fall asleep in between my pillow and my wife's pillow. That's his favorite spot, okay? And he likes to put his head on my wife's pillow, okay, so what does that mean? That means that I get the rear end of the dog, a bulldog who farts all night long in my face, okay? So when somebody said, hey, Michael, you want to put a mask on your face that's got filtered cool air that's coming in, I jumped at the chance. Are you kidding me? I was like, let's go. I adapted to it super fast, but I had a kind of a unique situation going on for me. But I think almost anybody can adapt, I think. And by the way, it might not be the optimal treatment modality for you. It was what I wanted to try first. I enjoyed it. I done well with it. You can see I've got good energy. As you mentioned before we got on the podcast, I'm more of a night owl. And here it's we're filming this morning at 7 o' clock in the morning and I've got great energy. Why? Cause I wore my sleep AP last night.
- [24:00]
Dr. Rangan Chatterjee
You know, at some point we need to talk about the sleep doctor. Sleeping in a bed with bulldogs and having a big plasma screen on in our room. Let's just park that for a minute. Right. In terms of what people come in to see you with, I've heard you say that one of the commonest things people come in to see you with is they say, look, I can get to sleep fine, but I wake up between 1 and 3am yeah, tell us about that. You know, just how common is this? What are the causes of this? And then what can you actually do about it? Today's episode is sponsored by Lingo by Abbott. As many of you know, when glucose is relatively stable, you feel better day to day with steadier energy, mood and focus. But over time, unstable and elevated glucose can impair your metabolic health and increase the risk of type 2 diabetes and cardiovascular disease. Globally, more than 760 million adults are estimated to have prediabetes, and 6.3 million people in the UK are estimated to be living with prediabetes, many without symptoms or a diagnosis. Now, the problem is that our healthcare system often waits until you get sick before taking action, when we should take a proactive approach to prevent problems before they start. Now, most of us don't have access to our own glucose data and therefore don't have clear feedback on how our everyday choices impact our glucose. That's where Lingo by Abbott comes in. Lingo is a biosensor and app that helps you see how food, movement and lifestyle choices affect your glucose in real time so you can notice patterns and build healthier habits in the moment. With Lingo, you can get to know your glucose to build healthier habits for today and tomorrow. For listeners in the US and UK, Lingo by Abbott is offering an exclusive D10% off a four week plan. Just visit Halolingo.comLiveMore for more information, terms and conditions apply. Again, that's Halolingo.comLiveMore Today's episode is sponsored by DO Health, the preventative health app that I have helped to create to transform the way we think about health. Now, as you've probably heard me say before, there are specific blood markers that can show you you're at elevated cardiovascular risk years before you ever feel a symptom. In fact, 46% of DU Health members had hidden cardiovascular risk. They potentially had no idea. About over 25% of members had suboptimal homocysteine levels, which is really important because elevated homocysteine is linked to an increased risk of Alzheimer's. And it's actually really simple to bring it down once you know it's elevated. And this is exactly why I decided to build duHealth to help people understand when things are starting to move in the wrong direction inside their bodies. Instead of waiting until they get sick, DO Health takes everything I know about health, including my four pillars, and makes it personal to you. An initial blood test screens for over 50 biomarkers, then zeroes in on the 11 core markers that relate to your metabolic health. And poor metabolic health sits at the heart of most of the chronic diseases that afflict us these days, including heart attacks, strokes, dementia and many forms of cancer. Every four months, we retest your blood to see what's changing and what is not. And in between tests, you have unlimited coaching with our in app coach, Joy, and together we help you build a lifestyle plan personalized to you. Many of you have already started your dohealth journey and I have loved reading your feedback. If you haven't yet, you can sign up to the wait list today. All you have to do is go to DoHealth Co LiveMore and use the code live more.
- [28:41]
Dr. Michael Bruce
Absolutely. So this is Rangan, the number one question I get asked and I think I understand the reason why. But let's talk about what is actually going on biologically and why do people wake up somewhere between 1 and 3 o' clock in the morning? So sleep follows your core body temperature cycle, right? So as your core body temperature rises, rises, rises towards the end of the evening, it will hit a peak right around 10, 10, 30. Depending upon your chronotype, it can be a little earlier or a little later. But let's just for the math, let's say right around 10 o', clock, right Is where you hit your peak. When you hit your peak, then the core body temperature begins to drop. That drop is actually a signal to your brain to, to release melatonin. Your core body temperature continues to drop, drop, drop, drop, drop. At some point, if your core body temperature doesn't heat your body up, you go hypothermic and you die. Okay, guess what time that is? Somewhere between one and three o'clock in the morning. So literally every person on Earth, on earth wakes up between one and three o'clock in the morning. But here's what happens. Most people burp, fart, roll over and go back to sleep. Right? However, there's a group of people, believe it or not, between 10 and 20% of the population that has difficulty at that moment falling back to sleep. So let's talk about that particular situation now that everybody understands you didn't do anything wrong. I want to be clear. Nobody out there did anything wrong to wake up in the middle of the night. This is your biology. What we need is a good strategy to get you back to sleep. Allow the natural sleep process to take over. So step number one, and this is going to sound a little strange, don't go pee. Yep, you heard it here. Don't go pee. Now you. Everybody's saying, wait a second, Michael, what if I have to go to the bathroom? So here's the deal is, remember the three things that help us fall asleep. Lowered heart rate, lowered temperature, Lowered anxiety. Right? What do you think happens to your heart rate when you go from a lying position to a seated position to a standing position? You walk across the room to go to the bathroom, right?
- [30:43]
Dr. Rangan Chatterjee
Yeah.
- [30:43]
Dr. Michael Bruce
Your heart rate goes up, right. Inevitably, by the way, so does your temperature. Right. So now you've got, your body is going in the wrong direction. Here's the reason I say don't go pee. Most people actually don't have to. Most people, what they say is, I'm up, I might as well go pee. Right? This is a terrible idea. I want to be super clear. If you got to go pee, please go pee. I, I had somebody asked me this question. It was funny. They were like, well, should I put on those adult diapers? No, no, please go to the bathroom. Okay. But if you don't actually have to go to the bathroom, there's really no reason to do so. So go ahead and stay in bed. So that's hint number one. Number two, don't look at the clock. Now this is hard for most people. So what they do is they grab their cell phone and they go to the restroom, right? Or they hit the loo. And what happens the second you pick up your cell phone? You see the time and Then you immediately do the mental math, and now you've got anxiety, right? Oh, crap, it's 3:30 in the morning. Once again, I'm awake. Sleep, sleep, sleep. And you try to force yourself, rank it in the. In the history of time, nobody has ever forced themselves to sleep without, like, anesthesia, right? So, like, when you start to think about it, people are moving in the wrong direction when they look at the clock because they immediately get that level of anxiety. So number one, don't go pee unless you really need to. Number two, please don't look at the clock. Don't look at your phone. Okay, didn't look at the clock. I'm lying in bed, Michael. What do I do? So we need to get your heart rate to go down, your temperature to go down, and we need to stop something called monkey mind. Now, I don't have a formal definition for monkey mind, but I have a feeling most people know what it is, right? It's this weird list of things that pops into your head in the middle of the night that you start thinking about. Maybe it's one of your kids, maybe it's your partner, maybe it's business, maybe it's what you were watching on tv, Maybe it's the grocery list. I don't know. But for some reason, you just start thinking, thinking, thinking. We want to avoid that. My favorite technique for avoiding this is called 4, 7, 8, breathing. Now, I know you've talked about breathing techniques before on the show, and by the way, love the show, love all the practicality that we get from your show. And this is one of those situations where I'm going to teach everybody how, how to do this. Four, seven, eight, breathing. I think you might have mentioned it to people before, but I want to do a quick double tap on it so people can understand it. It's exactly what it sounds like. You slowly breathe in through the nose for a count of four. You then hold for a count of seven. Then you gently push out through your mouth for a count of eight. All right? Four, seven, eight, breathing. Now, I'm going to be honest with you and Rangan. You know me, so you know this is true. I have a little bit of anxiety sometimes. And so when I first started this technique, I couldn't hold my breath for seven seconds and I certainly couldn't push for eight. So I modified the technique. So everybody out there needs to understand, number one, you can modify this technique. So this is one of those. It worked in research and now we're using it in the field type of scenarios. So Instead of doing 4, 7, 8 breathing, start out with 4, 5, 6 breathing. So 8 in for 4, hold for 5, out for 6. Do this for two weeks, then move to 4, 6, 7, then move to 4, 7, 8. So then you don't have any anxiety about your breathing. So that's one thing that's really important is to change the count so that you're the most comfortable with the count. Because what we don't want to do is cause anxiety. We want to lower anxiety. That's number one. Number two, I lose count. So it turns out you need 22 zero cycles of, of this four, seven, eight breathing. And then your heart rate dumps to around 60. By the way, that's the magic number for sleep. In order to enter into a state of unconsciousness, people need a heart rate of about 60 or below. And this technique does that. However, you need 20 cycles to get there. So how do you remember 20 cycles? Because I lose count halfway through. Then I get pissed off. Now I've got anxiety. Now the technique isn't working very well for me. So what I do is I take my hands and, and I gently make two light fists and I put them down by my side. And when I do 1, 4, 7, 8, I stick out a finger. And then the second one I stick out a finger. And before I know it, I've gotten to ten fingers. And then when I wrap them back, I've made it to 20. Most of the time I've fallen back asleep at this point. And by the way, you've noticed me saying me, I use this technique myself. Do I have problems sleeping in the middle of the night Occasionally? Sure. Like to be fair, dude, like if something's going on with my daughter or something's going on with my son, I don't sleep well. Right. That's a pretty normal occurrence, right? So 4, 7, 8 can be super, super duper helpful there. The other thing I tell people to do is to picture the number in their mind. Now this turns out to be the single most important aspect to the breathing technique is picture a number four, then a number three, then a number two, then a number one. Then picture the seven going down, then picture the eight coming back. When you picture the number, you're using your hands. You have distracted yourself so much from any of these monkey mind thinking. And if you follow your own guideline, you're lowering your heart rate. Before you know it, you're out cold. It's pretty impressive if you want to know the truth of the matter. So 4, 7, 8 breathing with the modifications of using the hands to keep track, Right? Maybe changing the number schema just so that it works well for you. And picturing the number in your head works incredibly, incredibly well. But let's say for half a second you've tried it all, you got through 20 cycles and it still didn't work. Michael, what should I do? Well, there's now data on something called non sleep deep rest. We used to call it yoga nidra. Okay, and what is that? That's lying in a corpse pose on the. On your bed. Quiet, relaxed, cool, dark room. Believe it or not, it's rejuvenative. Like it's not as good as sleep. But if you do that for an hour, it's worth about 20 minutes of sleep. So even if you're lying there not sleeping, I'm here to tell you you're doing something good for your body that helps lower that anxiety, right? And then finally, stay positive. Now, I know this sounds a little ridiculous, you know, stay positive? What, what is that supposed to mean? Here's the thing. When was the last time you Woke up at 3 o' clock in the morning for a good reason, right? Never, right? Nobody runs into your room at 3 o' clock in the morning and yells, happy birthday, you just got a raise. You know, some good piece of news, right? When you, when your body wakes up at 3 o' clock in the morning, there's a problem, right? There's an emergency, there's something going wrong, there's a noise, there's a shout, whatever. And so your body immediately is negative in the middle of the night. And so as a cognitive behavioral therapist, one of the things that I know is it's very difficult to stop your first thought, but you can stop your second thought, right? So, so if the first thought is, crap, I'm up, it's 3:30 in the morning. Here's what your second thought can be, is you can turn to yourself and tell yourself, okay, I've been here before. It's not like my head is going to explode. I may have a good night. I may not have such a good night. But I know after listening to that awesome podcast that if I try my 4, 7, 8 breathing, or if I can just relax here and let the natural sleep process take over, I'm going to be fine.
- [37:54]
Dr. Rangan Chatterjee
Right?
- [37:54]
Dr. Michael Bruce
That lowers your anxiety, lowers your heart rate, lowers your temperature, allows the natural sleep process to come back in.
- [38:00]
Dr. Rangan Chatterjee
Yeah. So many helpful nuggets in what you just said, Michael, which I kind of feel apply at other times of the day as well. Like, sure, they help you if you're up in the middle of the night.
- [38:12]
Dr. Michael Bruce
Right, right, right.
- [38:13]
Dr. Rangan Chatterjee
But they're going to help us in other aspects of our life as well. And one thought I had when you were just talking about, you know, acceptance and having that positive mindset.
- [38:24]
Dr. Michael Bruce
Yes.
- [38:25]
Dr. Rangan Chatterjee
Is it possible to say in a compassionate way, not in a judgmental way, that generally people who struggle with their sleep are a little bit stressy?
- [38:36]
Dr. Michael Bruce
Yeah. Oh, I think that's easy. I mean, I think you're being kind. I would argue.
- [38:40]
Dr. Rangan Chatterjee
I'm trying to be kind.
- [38:42]
Dr. Michael Bruce
I think you're kind. I think they're a hot mess. Are you kidding me? But you're hitting on something that I think is important. Positive mindset works, okay? If you always have a negative mindset, there's a very high likelihood you're not a great sleeper. Now what's interesting about that is we know that when you become sleep deprived, you have a far greater likelihood of being depressed and being more negative. So this is a, this is a cycle. This is a watching machine that you can get caught up in is you don't sleep well, you have a negative affect, then you. That negative affects makes you not sleep well, and then you just, it just kind of compounds on itself.
- [39:15]
Dr. Rangan Chatterjee
Yeah. And I think that's a really important point, isn't it? It may be that you started off or maybe five, 10 years ago, you were upbeat, you had a positive mindset, but then you started to have what you call sleep disrupting habits. Too much caffeine, too much alcohol late in the evening, and then your sleep gets affected. And therefore because you're sleep deprived, your mood goes down, you feel less emotionally good and optimistic about the world, and then as you say, it becomes a self reinforcing cycle. So I think that's important to acknowledge that it does work both ways. But if we just go back to what you were talking about there. If you wake up in the middle of the night, okay, the first thing you were saying was that this is entirely normal. Okay. So no need to worry. The second thing I thought about as you were explaining, you know, your process for helping people is that we as humans get good at what we practice, we get good at what we repeat, don't we? And so you say, don't pee unless you absolutely need to. Right. And we're talking about this through the lens of sleep. But for the people who actually are frustrated with how much they get up to pee at night, which of course then disrupts your sleep, yes. There can be all kinds of factors Going on, which we can think about and go through. But I have had so much success, Michael, with people over the years by giving them that same piece of advice. Say, look, if you think you need to pee, just wait. Right. Because if you. If you do get up and then go and pee, you are reinforcing that behavior. Right. So some people, not everyone, but some people can change that behavior.
- [41:08]
Dr. Michael Bruce
Absolutely.
- [41:08]
Dr. Rangan Chatterjee
Just by training themselves. No, I'm not gonna go. I don't really need to go. Ten minutes later, they're falling asleep. And I can remember one lady, like a few years ago who literally, that's all she had to do. And suddenly she's sleeping eight hours a night and not getting up to pee when previously she was getting up three or four times a night.
- [41:25]
Dr. Michael Bruce
Yeah, yeah. It's that habit. It's that habitual behavior, I think, is what you're tapping into that we can oftentimes tell people is probably not the best idea. Right. Also, I mean, for those types of patients also, the very first thing I look at on the practical side of things is like, when do you stop fluids?
- [41:41]
Dr. Rangan Chatterjee
Yeah.
- [41:41]
Dr. Michael Bruce
You know, so many people are like, I got to get my water in. And so it's, you know, it's nine o' clock at night, you know, and they're trying to get their water, and I'm like, bro, you're going to be up all night. Like, this is a bad idea.
- [41:52]
Dr. Rangan Chatterjee
And it literally can be sometimes concert. The most basic advice. Don't be drinking a load of fluid in the two, three hours before bed.
- [42:01]
Dr. Michael Bruce
You know? Exactly.
- [42:03]
Dr. Rangan Chatterjee
Yeah. The other theme that came up when you were describing what to do when you're up in the middle of the night is this idea of a monkey mind. Right. A busy mind. And of course, that can be one of the reasons why people don't fall asleep in the first place. You know, if I reflect on my own sleep, I would say the biggest thing that I've noticed over the last few years is for me is what do I do in that one hour before bed? If my one hour before bed is nothing to do with work or emotionally agitating topics, if it is relaxation, I'm generally sleeping really well.
- [42:46]
Dr. Michael Bruce
Oh, yeah. How you are before bed is how you will fall asleep. So if you're frantic and crazy and that then you will have difficulty falling asleep, what I tell people all the time is you need Runway to land the plane. Okay. Like, that's how I like people to think about it. Right. Is you've got to have some time to yourself. Like, sleep is not an on off switch, right? It's more like slowly pulling your foot off the gas and slowly putting your foot on the brake. There's a process that should occur there. By the way, if you fall asleep really, really quickly, that's not a good sign. A funny story, I was on stage with Oprah Winfrey, of all people, many, many, many years ago, and she said to me, steadman falls asleep in a minute, 37 seconds. And I said, oh, that's not good. She said, really? I said, that means he's sleep deprived, right? Because again, if you fall asleep super, super fast, don't get me wrong, there's some people out there that are fast sleepers. But generally speaking, if you fall asleep really quickly, it's probably a sign that you're sleep deprived and, and that you may need to get a little bit more sleep. But when we look at the time period right before bed, I've broken it down into what I call the power down hour, right? So let's say you're going to bed at 10, starting at around 9 o', clock. I break that last hour up into three 20 minute segments. So 20 minutes for just stuff you gotta do, right? So maybe it's last minute emails, maybe it's, you know, getting kids backpacks together, getting lunches together, finding sports equipment, you know, lots of stuff that you'd have normally going on in your house. I like to lay my clothes out for the next morning, things like that. So stuff that will reduce your stress the next day, then 20 minutes for hygiene, right? So brush your teeth, wash your face, maybe take an evening bath or shower. And then 20 minutes for some form of meditation, relaxation, prayer, whatever gets you there. Read a book, watch a show. I don't honestly care what you do in that last 20 minutes. But it doesn't, it doesn't have a big level of engagement to it, right? So a lot of people say, well, wait a second, you said people can watch a show. What about scrolling on their phone? Well, I'll tell you, the level of engagement that you have with your electronic device directly affects how well you're able to fall asleep or stay asleep. So basically, if you're trying to get your high score on Candy Crush, you know, you ain't trying to go to bed, right? And so what we want is, is we want people doing something that's relaxing, that's not important in their life, that's not intrusive in their life. So that way they can kind of trail off. That's why I personally always recommend reading A book. Because what's nice about reading a book is you can just turn it over and be done with it, you know, and. And close your eyes and turn off the light and fall asleep. And it's. It's a very easy, simple process. But people should have some type of a routine before bed. What we don't want people doing is falling asleep on the couch, watching TV in their normal day clothes, right? Then they stagger, you know, they pull their clothes off as they're getting to their bedroom. Maybe they brush their teeth, maybe they don't, and then they just fall into bed. That's not really the process that we really want people to be doing. And that happens a lot more often than you think.
- [45:59]
Dr. Rangan Chatterjee
The way I used to explain it to patients, Michael, was I would say, look, do you have kids? And if they said yes, I would say, okay, so when your kids were younger, I'm guessing what you did was dim the lights, lower the tone of your voice, read them a story, right? Create this ambiance to say, hey, you sort of prepare it, as you say, Runway to land the plane. Yeah, we know that kids need a routine for beds. Somehow as adults, we think, oh, no, no, we're immune. Like, we're now grown up. We don't need a routine for bed. And then you look at the statistics on how many people struggle with this, that you go, well, maybe there's something to that. And I guess what I shared with you before about that one hour before bed, for me, you can think about that as a routine. That is absolutely. That is my. Well, it's my evening routine. And I guess going back to that theme before that, we get good at what we practice 100%. I think people also forget, and I know you're a clinical psychologist as well as a sleep expert, I think people forget that, you know, the brain is an associative organ, right. So it associates certain behaviors with certain locations and with certain times. So if you can start to create that sort of ritual that. That repeatable lifestyle each night. And I also want to acknowledge that not everyone can for a variety of different reasons. You're just going to start conditioning this response, which is, oh, you know, when he starts to chill out and he puts his laptop down and he reads a book. Now I'm about to prepare myself for sleep.
- [47:34]
Dr. Michael Bruce
Exactly. And here's what's great about it, is any routine that you develop for yourself probably works. Now, to be fair, drinking an espresso before bed probably does not. Right. But most routines that people will do Whatever it is that calms you down, that is always the goal here, is some level of relaxation. Basically, we want your heart rate to go down, right, because then your temperature goes down, then your anxiety goes down, and then you fall asleep.
- [48:03]
Dr. Rangan Chatterjee
One of the things I have noticed quite a bit over the past maybe five to 10 years is that people will often say that they fell asleep fine and they think they slept through the nights, but they're waking up feeling exhausted. Now. I noticed that if patients were mentally quite stimulated before bed, even if they slept for seven hours or seven and a half hours, they still weren't fully refreshed compared to if they'd had that power down hour. Have you seen that as well?
- [48:42]
Dr. Michael Bruce
So this is a fantastic observation and it's 100% correct. So what I have discovered over the course of time is that there are some people that are, they're just going, going, going, going, going, going, going before bed. They do not report refreshing sleep. But the people who do take some time and who do allow themselves to relax, they oftentimes report more refreshing sleep. Now, I don't have any data that I can put my finger on, particularly to say, hey, this works or this doesn't work, but what I can tell you is as a clinician at you as well as a clinician, what you've observed is definitely what we see in the field all the time, is it's very difficult for people, if you've got a crazy, crazy world going on, to close your eyes and move from, like, let's be fair, Nobody moves from 150 miles an hour to zero in a good way, right? Like that doesn't, like, you know when you're in a car and you slam on the brakes, it's not a good feeling, right? But if you slow the car down, you can, you can come to a nice casual stop and be just fine.
- [49:43]
Dr. Rangan Chatterjee
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- [53:32]
Dr. Michael Bruce
So the first night effect is pretty interesting. So this is something that we see in sleep laboratories all the time, but a lot of people experience it. It's when you are in a new environment and your brain is not used to it. Right? So I have, I experience this a lot when I travel. So for folks out there who do any travel so you know summertime is coming up a Lot of people are about ready to get into the travel of it all and. Or maybe they're already out there traveling and having a good time with it. When you don't have the same noises, when you don't have the same light, when you don't have the same environment. Your brain as you said, is an adaptive organ, right. It's an associative organ. So it's saying, where's my associated sleep environment? Right. Because you're in a hotel or you're, you have a different situation going on. So that's oftentimes what happens. First night effect originally came from when we brought people into the sleep laboratory and they would have a really crappy night the first night. So sometimes we'd have to have them in for two nights.
- [54:25]
Dr. Rangan Chatterjee
Yeah. If and when I go to London for work, I always stay in the same hotel. It's literally about familiarity. And I tell you, literally it was four weeks ago, but the very first time ever I didn't stay in that hotel. Long story. I did not sleep well at all. Now there could be a number of reasons for that. Of course this is not like a randomized controlled trial. This is a one of experiment. But there will be someone listening to this, Michael, who does travel regularly to the same location for work. And if you're able to and it works for you cost wise and all that kind of stuff, I definitely think it's a hack that people don't think about enough.
- [55:05]
Dr. Michael Bruce
I would even go one step further because I do the same thing. So I, I travel roughly every six weeks to Seattle, Washington and I. Not only do I stay in the same hotel, I stay in the same room.
- [55:18]
Dr. Rangan Chatterjee
Yeah.
- [55:19]
Dr. Michael Bruce
And that familiarity lowers my stress level. Right. So as an example, since I know the hotel I'm staying at in the room that I'm going to be in if my flight is delayed, I don't, it doesn't stress me out, Right. Because I'm not trying to figure out where am I going. I know exactly where I'm going, right. I go into the hotel. The person who's a night person knows me because I come in every six weeks. They're like, hey Michael, I'm like, hey, how's it going? You know, they're like, oh, we got you room 245. I'm like, perfect, that's what I want. Like, and it just lowers my stress level. Remember, stress is one of those things that has to lower for sleep. Right. Another word for stress is anxiety. What are the three things that affect our sleep? Right. Heart rate, temperature, and anxiety. Right. So what you're tapping into is, is a way for us to add an additional layer that lowers our anxiety with that familiarity.
- [56:10]
Dr. Rangan Chatterjee
What's your take for people who, let's say, don't have that luxury, or they travel for work, but they're constantly going to different hotels and different locations, could they perhaps bring stuff from home, like scents and things that they use at home?
- [56:25]
Dr. Michael Bruce
You got it. Yeah, absolutely. So if I travel for more than three days, I actually bring my own pillow. So first thing that people should understand, when you travel, like most of the hotels, they overstuff their pillows because then they have to buy them less frequently. Right? And so what ends up happening is you've got the perfect pillow at home, and it works well because you're a side sleeper, you're a back sleeper, and your neck is just. Just kind of right. But most of the time when you go to a hotel, the pillows are overstepped, so the loft in the pillow is very high, which pushes your head forward if you're a back sleeper. And that can make it difficult to breathe. So I bring a pillow if I'm staying for longer than three days. Number two, I bring an eye mask. Right. I actually, believe it or not, I know this sounds a little crazy, but I am a sleep doctor, so I'm allowed to be a little crazy. I bring my own sleep kits with me to almost everywhere I go. And so what my sleep kit? So I have different sleep kits when I travel international, and then different sleep kits when I travel domestically. So if I'm traveling just domestically, here's what I know that I need. I usually have an eye mask. I have earplugs. I have a little clip for the drapes in the room, because a lot of times the drapes will open up in the middle of the night and sunlight will come through. I walk into the room, I check the alarm clock first because some idiot has set the alarm for 4 o' clock in the morning, you know, wakes me up. I. I also asked the front desk, hey, who are my neighbors? Not their names, but, like, is the. Is the baseball team next to me? Because if they are, I'd love to move into a different part of the hotel, you know, so I can have, again, a nice quiet, you know, environment. But it works. It works surprisingly well. But also in my sleep kit, I carry stomach, like Tums. So if I have an upset stomach, but, you know, you arrive at a hotel, it's late. I carry a little bit of Advil or Tylenol in case I have a headache, and I carry a nasal spray in case I have any nasal congestion. And that's my domestic sleep kit that I bring with me everywhere. And that familiarity of having those things for my routine makes it so that I can sleep almost anywhere.
- [58:30]
Dr. Rangan Chatterjee
If we think about you traveling with your pillow, someone listening might think, hey, this is a little excessive.
- [58:38]
Dr. Michael Bruce
Right? Right.
- [58:39]
Dr. Rangan Chatterjee
Okay. You are, you know, you sort of. Yes, you're the sleep doctor. Yes, you like your sleep, but do you really need to travel with the pillow? I want you to sort of make the case to them. Sure, I guess. Why you think that is such a good investment of your time and energy to do so?
- [58:58]
Dr. Michael Bruce
Absolutely. So. So to be clear, if you remember, I said only if I'm staying for three days or longer, Right. So if it's a. If it's a quick trip, I don't bring a pillow with me. But I do have a hack that I can teach people to do in, in the hotel room as well. So first of all, I only take my pillow if it's three days. If it's shorter than three days, here's what I do is I walk into the bathroom of the hotel and you know, there's three types of towels in the bathroom. There's the washcloth, right? There's the hand towel, and then there's the bigger towel for, like, you know, when you dry yourself off in a shower. So I take the middle towel, the hand towel, and I lay it out and I roll it up so that I have a long, like, tube. And then I put it into the pillow along the horizon of the pillow, and it gives me an extra neck support. And then because I have a pillow at home that has neck support, my whole neck starts to relax and I'm able to fall back, fall asleep pretty easily if I want to. If I'm staying for longer than three days, then I actually check my bag and I have a bigger suitcase because I can't fit my pillow into a carry on. So that is a kind of a disruptor. And then I bring it along. I actually bought my luggage so that I could have a pillow that I knew would fit into it. But I'm a sleep doctor, you know, like, it sleeps a big deal for me.
- [60:13]
Dr. Rangan Chatterjee
So, yeah, Michael, I was asking the question to sort of play devil's advocate. I actually don't have an issue with you doing that at all. Because I think if you are someone who needs that pillow to increase the chances of you sleeping well, I think that's a perfectly reasonable Trade to make. Now someone else may go, that's bloody ridiculous. I'm never going to do that. Okay, fine, Fine for them. You don't have to do it. But do you know what I mean?
- [60:40]
Dr. Michael Bruce
Yeah. Well, the funniest thing is like, if I. So if I can't fit my pillow into my suitcase and I bring it with me on the airplane, like, let's say I'm doing an overnight flight, I like to bring my pillow on the overnight flights. So, like, when we do part two of this and I come and visit you, I'll. You'll see me walking off the plane with. With my pillow underneath my arm. Here's the funny thing is it's a great conversation starter. I can't count the number of people that are like, wow, you're really committed to sleep. And I said, well, I'm a sleep doctor, then it's game over. Now we're talking sleep. We're having a whole conversation, you know, the whole thing. Yeah, look, it makes.
- [61:17]
Dr. Rangan Chatterjee
It makes me think, well, I don't travel with my pillow. I never have done.
- [61:21]
Dr. Michael Bruce
Maybe you should.
- [61:21]
Dr. Rangan Chatterjee
Yeah, well, actually, you're making me think now. Maybe for the right trip at the right time, it might make sense. Speaking of people who do things a little bit differently to others, Brian Johnson came to mind early on in this conversation. Oh, yeah, right.
- [61:38]
Dr. Michael Bruce
Absolutely. He lives right by me. Yeah.
- [61:40]
Dr. Rangan Chatterjee
Well, you mentioned before these three things that need to come down to fall asleep. Okay. Heart rate needs to come down, temperature needs to come down, Anxiety needs to come down.
- [61:52]
Dr. Michael Bruce
You bet.
- [61:53]
Dr. Rangan Chatterjee
Now, Brian, for people who don't know, is a wealthy individual who is spending a lot of money each year trying to age as well as possible. Now, one of the things Brian has said publicly for many years now is that his resting heart rate before bed is one of the strongest predictors of how well he's going to sleep. So the lower his resting heart rate, the better his sleep quality is. Now, he says that the way he does it is he stops eating his final meal at 11am, not p.m. 11am he's crazy. Right? But okay. But to be fair to Brian, I think he would acknowledge that not everyone has to do that.
- [62:36]
Dr. Michael Bruce
Yeah. And I learned a lot from Brian Johnson, which is to say, which is kind of interesting for somebody like me because he's. He has no medical background whatsoever. Right. He's running this experiment on himself. It seems like he's kind of gone off the deep end, if I'm being super honest with you. But he is the biggest sleep advocate I've Ever seen. Everywhere he goes he's like, sleep, sleep, sleep. And I'm like, let's go brother. So I'm a fan of his, but I agree with you. Stopping food at 11 o' clock in the morning would be difficult. But it shows an interesting point, right? Which is the metabolic process is probably increasing his heart rate, which is probably affecting his ability to fall asleep. It's also increasing his core body temperature because your body heats up when it's digesting food. So I think what he's saying makes a lot of sense. I'm just not sure practically how we do that. So that's why I have people stop food, water and alcohol three to four hours before bed.
- [63:35]
Dr. Rangan Chatterjee
So let's just talk about that then. How do you get the body calm before, but how do you get that heart rate down? So you mentioned that food, how important is it to stop eating in the hours before bed in your opinion?
- [63:50]
Dr. Michael Bruce
I think it's huge. And I think it's a big, big issue that a lot of people don't look at. So a lot of people might have their dinner at a normal time, let's say 6, 6:30, 7 o'. Clock. But what a lot of people don't take into account is snacking. Right. And so a lot of people are late night snackers and they end up eating things that are so complex that their body is digesting and that makes it very difficult to sleep. I mean Rangan, I've got one patient who actually wakes up in the middle of the night to eat and then eat something and then is able to fall back asleep. We, we started to look at it and what we discovered was is they were having a blood sugar drop in the middle of the night and then their cortisol was kicking into gear and waking them up. And so we keep now a few saltine crackers by her bedside and guess what? She wakes up, she has a little orange juice that she's diabetic. So she has a little orange juice there, a little cracker, she takes it, she's able to fall right back to sleep. That's the extreme case. But for most people, again, make sure you check with your doctor. You should probably stop all food three to four hours ahead of time. Alcohol for sure. You want to have stopped three to four hours ahead of time and probably water at least two hours ahead of time. And make sure you go to the bathroom at least once before you lay down.
- [65:06]
Dr. Rangan Chatterjee
Yeah, you know before when we were talking about people who wake up between 1 and 3am and that, that's a natural phenomena to do with body temperature.
- [65:19]
Dr. Michael Bruce
Correct.
- [65:20]
Dr. Rangan Chatterjee
I've also seen many patients wake up in the night, I can't say for sure between 1 and 3am, but certainly wake up in the middle of the night. And it is, like you said, with that patient, to do with blood sugar dropping. And so sometimes I found with patients like that, they don't always have to eat in the night, but sometimes they're having something quite high glycemic before they go to bed. Right. So their blood sugar is. Or their blood glucose is going up, and maybe two, three, four hours later, it's plummeting quite sharply, which of course is a stress response to the body, and it wakes them up. So sometimes it wasn't about, you know, adding more food in at night. It would say, hey, listen, let's not create a blood sugar roller coaster through the night. If you really are hungry before bed, let's have some nuts or, you know, some like, carrots at home. Something that is a bit more blood sugar stable than something that's high glycemic.
- [66:18]
Dr. Michael Bruce
And along those lines, which I think is something that I've started to recommend to my patients lately, but I think you would agree with, is sometimes what I do is when I've got somebody that's disruptive like that, I have them get a continuous glucose monitor, a cgm, and then we figure out which foods spike their sugar the most. Then we avoid those in the evening time, if at all possible.
- [66:41]
Dr. Rangan Chatterjee
Right.
- [66:42]
Dr. Michael Bruce
And that seems to help quite. And here's what I found that I think is just so remarkable. And I'm a real big proponent of people going out there and getting these, these continuous glucose monitors. Because here's the thing, you have no idea what spikes your sugar. Like, when I did it, I had no, like bananas, do nothing. Like, I can have a banana right before bed and I have no blood sugar spike, but if I have an apple, I'm in trouble. Right.
- [67:06]
Dr. Rangan Chatterjee
Yeah, I completely agree. I honestly don't think, and I've said this before, but I'll say it again, I have not seen a more powerful behavior change tool than a cgm. Because you learn stuff about yourself that you can't suddenly unlearn. You know, through the lens of sleep sleep, if you find you're waking up at the same time every night or regularly, and you then look at your data, you might actually see that your sugar actually is dipping at that time. Actually, all it is is a blood sugar drop. And there are many ways that we can avoid that blood sugar drop. Right. For some people. And of course, if you look at the rates of metabolic dysfunction that exist out there, there's a lot of people who aren't able to manage their blood sugar effectively. So for some people, of course, this is a very quick win.
- [67:52]
Dr. Michael Bruce
Michael.
- [67:52]
Dr. Rangan Chatterjee
When I told my audience you were coming on the show, there was a lot of excitement and I have a whole ton of questions here, so.
- [67:58]
Dr. Michael Bruce
Fantastic.
- [67:59]
Dr. Rangan Chatterjee
There's other topics I wanted to discuss, but I kind of feel that they all come out of us answering these questions. So is it okay if I put a few of them to you?
- [68:07]
Dr. Michael Bruce
Throw it out there, brother.
- [68:09]
Dr. Rangan Chatterjee
Okay. Rachel says, how accurate are the sleep scores on fitness devices and wearables?
- [68:18]
Dr. Michael Bruce
I love this question. So, to be clear, they are not. They are not accurate. However, they're still useful. So. And that sounds like a little bit of an oxymoron, me saying they're not accurate, but they're still useful. So let me explain to everyone so you can see I've got an aura ring on. I've got an apple watch. You know, people have got Fitbits or Whoop straps or whatever the tracker of the day happens to be, right. So I want to be super duper clear trackers. And if you look in the medical literature, you can find the studies are decent at telling you when you fall asleep and when you wake up. They're not particularly good at depth of sleep. So they're really not good at telling you how much deep sleep you got and how much REM sleep you got. And the reason is, is because we measure those from brain waves, we measure those from eeg. It's really hard to get EEG from your finger, right from your wrist. So what ends up happening is they take a piece of data that is accurate in those particular areas and then they approximate what they think sleep stage you might be in. And so what ends up happening is you have a bit of variability there. So what I tell people all the time is do not, I repeat, do not look at your tracker information every day. First of all, you're going to drive yourself crazy. I'd say once a week, probably Sundays is probably the best day you want to look at across the week. And you want to look for the trend. You do not want to look for individual numbers. Dude, I can't count the number of people who walk up to me and they're like, Dr. Bruce, my ring says I got a 37 last night. Am I going to die? Well, yeah, you're going to die, but probably not from that, right? You know Like, I only got 37 minutes of deep sleep. Well, what did you get the night before? 35. Okay, well what did you get the night before? 40. Then you're fine. Right. Like it's being consistently inaccurate. Right. What I want to know is if you went from 40 minutes every night to three minutes, I want to know what happened that night.
- [70:17]
Dr. Rangan Chatterjee
Yeah, Right.
- [70:18]
Dr. Michael Bruce
So I'm looking for the delta, I'm looking for the deflection in the data. If you're consistent, even if it's consistently inaccurate, I don't think I care. However, I will tell you that I think these are going to get more accurate as time goes on. I feel like we're starting to see these companies are putting out bigger, better algorithms, they've got more AI, more machine learning behind it. And I think, I would argue probably in 12 to 18 months, we would probably start to see the accuracy level start to increase in many of these tracking devices. So I'm a fan, but I'm not live or die by your data, type of, type of person, at least this data, because it's got so much variability to it.
- [71:00]
Dr. Rangan Chatterjee
Yeah. I spoke to Tommy woods recently. He's a neuroscientist medical doctor. And he also, like you, likes the approach that you look at this stuff once a week, right. You look at it for trends, not for that day to day variation. And it can drive you crazy and it can drive certain personalities more crazy than others. And of course, going back to the three things, things you want lowered if you're gonna sleep, right, One of them is anxiety. So if your wearable is increasing your anxiety, it may be informing you off your sleep, but it may not be helping you get more sleep. And again, to be clear, I like wearables, right. I personally choose not to wear them all the time because I don't ever want to become dependent on these things. But I have learned a ton. And I think one thing I'm sure you found with your clients as well, Michael, is that when a wearable shows you what alcohol late in the evening is doing to yourself, I've seen that change people's alcohol habits like nothing else. Do you know what I mean? So I think they can have value. That's another question, right? Which I think kind of relates to this. Val wrote in to say how much deep sleep and REM is optimal and is it different with age? I imagine that Val's asking probably for her health wearable, because otherwise how would you even know how much deep sleep and REM you're having? So, you know we have to acknowledge you're saying that the sleep staging on these wearables at the moment is not that accurate. Correct. Okay, so take it with a pinch of salt. But more broadly, you know how much deep sleep in REM is optimal, and is that even a reasonable question?
- [72:50]
Dr. Michael Bruce
So I can answer the question, but what I will tell you is it's not a good question. Right. And nothing against Val, by the way. I want to be super clear, Val, I get asked this question all the time. Nothing against you. It's a great question, but it's not the right question to be asking because of exactly what you're saying. Here's what I'll tell you is my firm belief is, I think that we are our best doctors. I think when we wake up in the morning, we know if we've slept well or we haven't slept well. I don't. I don't need a. I don't need a ring or a watch to tell me if I got a good night's sleep. Right. I know kind of what's going on there. Our body, every night as we're falling asleep, it kind of scans itself and it determines how much of each stage you need, because different things happen in different stages. As an example, we know that in stage three, four sleep, this is where something called the glymphatic system comes in, scoops out all the proteins, and washes out your brain. We know that during deep sleep, this is where the largest bolus of growth hormone is emitted. And that's why the deep sleep is considered your physical restoration. But to be fair, if you haven't done anything that requires a ton of physical restoration, you might not get as much deep sleep. Right. Same with REM sleep. REM sleep is your mental restoration. This is where we move information from our short term memory to our long term memory. We kind of create this, like, organizational substructure like, like a filing cabinet in your head so you can put data in there. Right. And so we. What are the percentages? Roughly 25% of each of the night is what you're kind of looking for. Roughly 25% REM. Roughly 23% deep sleep. But I hesitate to even throw those numbers out there because somebody is going to now pick up their phone, look at their wearable data and say, oh, crap, I only got 13 minutes of deep sleep. Am I going to die? No, you're not going to die, but it might be something to shoot for. The other big thing to remember is most of these parameters were developed on white men. Between the ages of 25 and 45. So to be clear, I'm not convinced that the data is accurate from a comparison standpoint. Right? Now the other thing that the other part of her question, which I thought was really important, was what happens when we age. Guess what? It all changes, right? We get less deep sleep as we age. In fact, Rengan, this is kind of an interesting point, is in sleep medicine, we actually have to change the scoring criteria of the EEG when people are over the age of 55 because the amplitude of the waveforms changes and it falls out of the classic criteria for a delta wave. I know I'm getting a little technical for people here, but basically what I'm saying here is sleep doctors have to change the way we look at people's sleep past age 55 because it's so different. Right. It's specifically in the deep sleep area. So one of the things I want people to know is your sleep is going to change as we get older. Unfortunately, sleep doesn't always get better. Sometimes it can get worse. Now the question becomes why? A lot of times that has to do with medical frailty, right? So look, if you've got a medical situation, it's going to affect your sleep. If you're taking medications, it's going to affect your sleep. Add stress, add caffeine, add alcohol, all of these things are going to have effects. So when I'm working with patients, so as, as a reminder, I'm 58 years old, right? So when I work with patients that are my age or older, my big thing is don't put any obstacles in your way, right. You're already, your body isn't going to be sleeping like it was when you were 25. So do yourself a favor, stop caffeine by 10:00am or 12:00', clock, right. Or even 2:00 clock if that's the latest you can handle it. Stop alcohol three hours before bed. Don't put obstacles in the way of your sleep that can get in the way because you're already not going to be having as good asleep as you once had.
- [76:40]
Dr. Rangan Chatterjee
Yeah. And also I think a key point there is as we get older, sometimes we don't tolerate the things that we used to tolerate as well. Right?
- [76:50]
Dr. Michael Bruce
Oh, that's for sure.
- [76:51]
Dr. Rangan Chatterjee
You might have tolerated a 4pm cup of tea when you were 20.
- [76:56]
Dr. Michael Bruce
Absolutely.
- [76:57]
Dr. Rangan Chatterjee
Right. But maybe at 55 you don't, maybe at 65 you don't. Right. So I think just understanding that our body changes with age and what we can tolerate changes, I think it's a really important point for people to remember.
- [77:11]
Dr. Michael Bruce
Yeah. So I want to double tap on this in one particular area that we haven't had a chance to talk about yet, which is menopause. Okay. So when we look at women who are getting older, who go through the life cycle change of menopause, it's very, very interesting. So here's one of the things that I tell every menopausal woman that I see. Caffeine affects menopausal women differently. Your body is different. Your body is metabolizing it differently. It's having different effects on you. It is different. Both caffeine and alcohol change in your body over time in terms of your body's reactivity to it. So menopause, perfect example. I have a lot of women who are like, oh, my God, Michael, my day is so stressful. My hormones are all over the place. I'm just going to have a glass of wine to relax. I'm like, hold on a second. That glass of wine might actually do you more damage than good. Right. And they'll say, well, I used to. I've always had a glass of wine. Well, as we get older, that's going to have more and more effects in the direction that you don't necessarily want. Caffeine is the same way. Now, don't get me wrong, menopause is a hormonal disruption, and it causes all kinds of things. And we can talk about menopause and sleep if you'd like. I'm happy to do so. But using the examples of caffeine and alcohol and when our bodies change over time and it doesn't have the same reaction to us, it's a great example.
- [78:30]
Dr. Rangan Chatterjee
That leads me to two questions, actually, that we had in specifically around menopause and perimenopause. Okay. So Shimmerish wrote in and said, Dr. Bruce, how do we overcome perimenopausal sleep?
- [78:46]
Dr. Michael Bruce
Yep.
- [78:46]
Dr. Rangan Chatterjee
And Hanukkah said, I had to stop with my HRT since I wake up several times in the night. What should I do? So, two sort of related questions there. I wonder if you could give us some thoughts on both.
- [78:59]
Dr. Michael Bruce
Absolutely. So I think there's a couple of different things here. So the first part of the question, my answer would have been, have you considered HRT therapy? Right. So one of the things that we know is, so I want to take a. I want to take a. A mini break here for half a second and say to everybody, hey, there's been some bad data out there that we all need to recognize. So for years and years and years, doctors were telling women that hormone replacement therapy was not a good idea and that they could end up getting cancer from it. And that data is not true. Okay. Hormone replacement therapy is a perfectly acceptable, perfectly safe thing to do. Obviously you need to have discussions with your doctor, but historically we used to tell women, never, never, never. One of the things we recognize is, guess what? When you have no progesterone in your body, your body doesn't sleep too well. Progesterone helps with sleep. There's no if, ands, or buts about it. So being able to get on HRT can absolutely help people with their sleep. That's one of the first things that I recommend. Next, get tested for sleep apnea. This is such an important aspect. People don't realize this, but when women go into the menopausal state, the ratio increases by 100% in terms of apneic diagnosis. So before women go into menopause, every two men that have apnea, one woman has apnea. Once women hit menopause, it's a one to one ratio. Women, their hormones change, their, they gain weight and they end up having potentially sleep apnea. A lot of women, by the way, we don't have the right criteria to diagnose women with sleep apnea because we use men criteria for it. So what ends up happening with a lot of perimenopausal women is they have undiagnosed sleep apnea. They have no idea that they have it. And if they had just had a sleep study at the beginning of their menopausal journey, they might have learned a whole bit. So one thing I recommend is hormone replacement therapy. If your doctor says it's okay for you. Number two is get a sleep test. Again, you don't realize this, but your body has changed. And that's something that, by the way, isn't your fault. Like, so many women are like, oh my God, I'm going through menopause. Like it's a, like it's an attack. This is a natural biological change. Like this. This is nothing to be ashamed about. This is, this is something that happens to your body on, on the regular, every single day. And over the course of time, you, you should be able to understand kind of what's happening there. The third thing that I tell people to do is to regularize your bedtime. Be careful about alcohol and caffeine are two big things that are going to be important for her as well.
- [81:35]
Dr. Rangan Chatterjee
Yeah, you shared earlier your own sleep apnea journey just to make it super clear for people. I imagine there's some women who just heard what you said and were thinking, oh, I never really considered that I may have sleep apnea.
- [81:52]
Dr. Michael Bruce
Correct.
- [81:53]
Dr. Rangan Chatterjee
Practically speaking, how does somebody get tested?
- [81:57]
Dr. Michael Bruce
Great question. So first of all, it depends upon what country you live in, right? So there's different health insurances and healthcare works differently in different countries. Here in the United States we've got two different methodologies. We've got the at home sleep study and we've got the in laboratory sleep study. I don't know what is going on in each individual's country, but you can absolutely ask your doctor where to get a sleep study done. Your general primary care physician will know or have somebody to refer you to. And it could be in home or it could be in the lab.
- [82:31]
Dr. Rangan Chatterjee
Is there anything that we might see unaware that might give us a clue that we might have something like obstructive sleep apnea?
- [82:41]
Dr. Michael Bruce
Yeah, there is. So it depends upon the wearable. But as an example, I've got an Apple Watch on. So Apple Watch actually has the ability to measure your oxygen levels at night. And if you know how to turn it on, there's a specific place inside the Apple software where you can turn this on. And it will tell you, hey, we have a suspicion that you might have sleep apnea and it'll tell you to go to your doctor. Now let's say you don't. You have a tracker that's not an Apple Watch and you see multiple awakenings throughout the night, like four, five, six times that it says you woke up and fell back asleep, woke up and fell back asleep. That could be a sign of sleep apnea. The thing that I have a tendency to look at on all of the trackers because one metric that almost every tracker does really, really well is heart rate. I look for something called brady tachycardia. So I look for. Because when you stop breathing in your sleep, when you have sleep apnea, your heart rate slows down or does what was called bradycardia in extreme cases. Then your brain says, oh crap, there's no air. So your heart rate speeds up and, and could go into tachycardia. So what I'm looking for is I take the most accurate thing I can find on a tracker, which is usually heart rate, and I look for speeding up and slowing down throughout the night if it doesn't already measure Something that I want to learn about sleep apnea from.
- [83:55]
Dr. Rangan Chatterjee
Yeah, okay, thank you. Okay, let's go to this question from Pernitan. And I really love this Question. Because I think it will apply to so many people, this idea that there's what we should be doing if our life was perfect and optimal. And then there's the reality of the situation many people find themselves in. Okay, so Pernitan's question is this. Being a full time carer for my patients, I only get three to four hours sleep a night.
- [84:24]
Dr. Michael Bruce
Oh, wow.
- [84:25]
Dr. Rangan Chatterjee
How can I avoid the negative effects?
- [84:29]
Dr. Michael Bruce
You can't. At three or four hours a night, you are absolutely depriving your body of sleep. And that's at an extreme, if I'm honest with you. You're definitely doing some level of potential damage to your body by not getting enough sleep. Now, there are. There's one situation, one out there. It's a rare genetic problem, and people can be short sleepers. So there are, believe it or not, people who survive just fine on two to three hours of sleep. I want to be clear. These are rare, rare sleep people. I've been doing this for 26 years. I think I've met one in my entire career. Now. I have met, Reagan, many people who think they are short sleepers, who tell me, oh, I'm one of those genetic short sleepers, Michael. No, you're not. I can assure you, you're not. Okay. But for folks like this person who says, hey, I can only sleep three or four hours a night because I'm taking care of people, so number one, you've got to make sleep a priority. I can assure you that the quality of the care that you are giving somebody when you only have three hours of sleep is not your best care. Right. And depending upon the medical severity or complexity of the individual that you might be caring for, you could miss something. Right. When somebody's only had three hours of sleep, they can mix up meds very easily. Right. They can do the wrong protocol very easily. So what I would tell somebody there is, number one, if you can extend your sleep from three to four hours to four to five hours, if you cannot, napping is probably not the worst idea for you. So strategic naps placed throughout the daytime for 25 minutes here and there could definitely be helpful for you. But if you sleep longer, like a 90 minute nap, you're going to feel terrible when you wake up. So you're going to want to keep those naps short and sweet, about 25 minutes in length, maybe two of them in the daytime to help you make up for some of that lost sleep. But generally speaking, remember when we were talking earlier, we talked about, could you make up for sleep on the weekends. This is a person I would have making up sleep on the weekends.
- [86:36]
Dr. Rangan Chatterjee
Yeah. What about non sleep deep rest or yoga nidra that you mentioned before? So we've got an individual definitely could help this human. Yeah, because I think a lot of people with the best intentions and you know, this is one example full time carer for her parents, right?
- [86:55]
Dr. Michael Bruce
Yes.
- [86:55]
Dr. Rangan Chatterjee
But I'm sure there's hundreds of other examples out there of people who feel that, you know what, I know I should, but I can't. So I guess it's what you said, you know, they can take some naps. Right. Yoga nidra, also known more recently as non sleep deep breaths. Although some people get annoyed that an old yoga term has been called that. But that's a separate issue altogether. Right, but also so, but also I'd love to know your, your take on even periods of downtime. So let's say someone is a carer. And of course there can be a tendency when you are no longer on duty to catch up with life emails, this scroll, social media, wherever it is. And I understand all those things, but of course nothing is quite the same as sleep. But even if you sat in a dark room or you sat on the sofa with your eyes shut, maybe with some relaxing Music on for 20 minutes, you're still getting some benefit, aren't you?
- [87:54]
Dr. Michael Bruce
100%. 100%, you're getting some level of benefit. The key factor for those situations is safety. So just make sure that if you're going to do that, if you're going to put on an eye mask, you know, and be in a dark room, number one, people should know where you are. So that way, you know, God forbid something happens. And number two, you need to know how much time is going on during that period of time. Because what you don't want to do is fall asleep and sleep for three hours type of thing. But absolutely, you can definitely have those periods of time that are what we call quiescent. They're just relaxing times. Good for your brain, good for your body. For sure, you don't even have to sleep.
- [88:31]
Dr. Rangan Chatterjee
Okay. Then there are a series of questions to do with supplements and prescription medication.
- [88:36]
Dr. Michael Bruce
Okay, sure, let's talk.
- [88:38]
Dr. Rangan Chatterjee
Let's start with Dave's question, which is, since then, taking SSRIs, a very common, you know, class of what would colloquially be called antidepressants for people who don't know that term since taking SSRIs, I wake up at night a lot. Do you have any idea why?
- [88:58]
Dr. Michael Bruce
Great question. So first of all, to be clear, I am not your doctor, so I cannot tell you what to do or not do about your medications. However, if you were a patient that came into my clinic and you said to me, these were some of the problems, one of the very first things that I would look at is what is the timing of your administration of your medication? As an example, some SSRIs are very alerting. For example, something called Wellbutrin, which is actually technically an snri, is one of those medications where if you took it in the evening time, it would be disruptive of your sleep. So in some cases, one of the first things I do is I tell the patient, hey, who is your prescribing doctor? Let's talk with your prescribing doctor and say, can we take this medication in the morning? Or if I'm taking it in the morning, can I take it in the evening and see over the course of a week, does that have a big effect? So that's. Step number one is timing of administration. Step number two is talking with your doctor about, could you change to a different sleep friendly ssri, because different people react to different medications in different ways. And so you might find one that still works with your depression and anxiety, but doesn't have a level of disruption to your sleep. Right? Now, in the most extreme cases, there are situations where we would actually consider administering a sleeping tablet during that particular period of time. So as an example, if I have somebody who's a bipolar person, right, who's on significant medication for their mental health situation, they may require a still Knox or an Ambien or a sleeping tablet because of their mental health situation. And I want to be very, very clear, there is nothing wrong with taking a sleeping tablet. If you and your doctor have come to the conclusion that that is something that makes sense for you in your particular situation, don't beat yourself up about it. Take the medication as directed, right? I tell people all the time because a lot of people come to me and they're like, I don't want to take a sleeping pill. I don't want to get addicted to sleeping pills. I'm like, totally understand where you're coming from. Let me give you a scenario. I believe that insomnia in a lot of ways is like high blood pressure, right? So you can eat, right? You can exercise. You can still have high blood pressure and need to be on a medication to lower your blood pressure. Look, if you do all the right sleep hygiene things that we've been talking about, you get in bed at the right time and you still can't sleep. You might need a sleeping pill. Does that mean you're addicted? Is anybody addicted to their blood pressure medication? Probably not. Right? So I don't want people to, you know, make these assumptions and necessarily go in the. In the wrong direction here. But, yes, there are situations where, if you're taking an ssri, I would talk with your doctor about timing of administration and maybe swapping it out to see if there's something else that could be more effective and less affecting on your sleep.
- [91:51]
Dr. Rangan Chatterjee
Some sleep researchers, Michael, would say that if you fall asleep after taking a prescription sleeping medication, you're not getting the same quality of sleep as you might do if you were falling asleep naturally. What's your take on that?
- [92:10]
Dr. Michael Bruce
So I would argue that they're correct, but some sleep is better than no sleep. So I agree with you that most of the medications out there have an effect on what we call sleep architecture. So they change the amount of stages of sleep that you get. So as an example, if you're taking an older something, what we call a benzodiazepine, which would be like a Restoril or a Xanax or an Ativan, those medications actually change deep sleep. You actually get less deep sleep. In fact, um, SSRIs, like what we were talking about before, those decrease REM sleep. So there are many different medications out there that can have a pretty decent effect on your deep sleep or your REM sleep. And you need to just be thoughtful in understanding those.
- [92:57]
Dr. Rangan Chatterjee
Hannah is asking, does magnesium really help with sleep?
- [93:02]
Dr. Michael Bruce
Such a great question. So here's what we know is if you have a magnesium deficiency, it does. If you do not have a magnesium deficiency, it's not nearly as helpful. Now, here's the thing. Most people have a magnesium deficiency, and so the very first thing. So this gets us into the topic of supplementation, which is one of my favorite topics, and my very first thing I tell everybody that talks to me is, go do blood work. Okay? Like, remember, the whole idea behind supplementation is if we're not getting it in our diet, then we supplement it with these powders or pills, which are usually a combination of vitamins, minerals, and herbs. Right? Now, to be clear, depending upon what you're trying to supplement, you don't oftentimes know unless you do the blood work. So blood work becomes very important. So before anybody does any supplementation, here's the three to four things I would recommend. You want to look at your magnesium. You want to look at your vitamin D. You want to look at your Iron. And you want to look at your melatonin if you can. Melatonin is a little bit more difficult from a blood work standpoint. A lot of times you have to do a saliva test and you have to do it at night because melatonin only comes out at night. But if you just did those three, which is magnesium, vitamin D and iron, if you have deficiencies in any of those areas, I would argue, dude, 15 to 20% of the time, all I do is fix those deficiencies, sleep gets better and I don't have to do anything else.
- [94:29]
Dr. Rangan Chatterjee
Yeah, I think the problem with magnesium, certainly if I look at it through a UK lens, it's not that easy. If you went to your NHS primary care doctor and asked them for a magnesium check, you know, I don't think it's going to be easy for people to get. And also, I think with magnesium, it's not just a serum magnesium you're looking for. I think to get a really accurate idea, you've got to look at red cell magnesium on. And so I get it. At the same time, I don't think for most people supplementing magnesium is harmful.
- [95:00]
Dr. Michael Bruce
I agree with you. There's only one caveat is for some people, if you have too much magnesium, you can get diarrhea and that can be problematic as well. So I try to tell people, keep it within like a 200 to 250 milligram range. It may change during the summertime. One of the things that I've looked into the literature on is that if you're a heavy sweater and you do a lot of outside activity, you may need extra magnesium. So as an example, when I work out every day and I sweat a ton and so I lose a lot of magnesium, so I only take three supplements a day. I take magnesium, I take vitamin D and I take omegas. That's it.
- [95:38]
Dr. Rangan Chatterjee
For people who wish to try a magnesium supplement for sleep. Is there a particular form of magnesium that you like to recommend?
- [95:47]
Dr. Michael Bruce
So here is the problem is there are 13 different types of magnesium out there.
- [95:52]
Dr. Rangan Chatterjee
Yeah.
- [95:54]
Dr. Michael Bruce
All right. And all kinds of stuff is. Is available in all kinds of different forms and formats. I'm going to give you some general guidelines and then I'll give you a few brands specific that I use. So general guidelines. I like people to start with magnesium glycinate for a couple of different reasons. Number one, magnesium glycinate is easier on the stomach. Also the glycine is helps with temperature regulation. So it's kind of. You get a twofer, you get Your magnesium, which can help with your deficiency, and you can get a thermoregulator, which can be helpful in the glycine. So I start most people on magnesium glycinate with about 150 to 200 milligrams. If they do that well, I may move them over to magnesium citrate. Or if they're fine, I just kind of leave them alone.
- [96:36]
Dr. Rangan Chatterjee
Okay, great. Are there any other supplements you recommend for sleep, just out of interest?
- [96:40]
Dr. Michael Bruce
So what I do is I do the blood work, I fix the deficiencies. If the deficiencies are gone and they still have some level of sleep disruption, then there are certain things that I look at. One of my favorites or one of the ones that's probably the most well studied is valerian root. There's a lot of data on valerian. If you include hops, like the hops you find in beer, that seems to make it even more effective. So a valerian hops combination product I think would work really well. The problem I usually have is many of the supplements out there are multi ingredient supplements. I call them kitchen sinks because it's like throwing everything into the kitchen sink and kind of hoping that things work. I would rather people use single to two ingredient supplements. So that way we really have an understanding of what's happening.
- [97:26]
Dr. Rangan Chatterjee
Okay, let's get through some more of these questions. Lauren says, what is your best tip, Michael, for a busy mind preventing you from going to sleep?
- [97:36]
Dr. Michael Bruce
So I like 4, 7, 8, breathing. That's. And we talked a lot about it. But I'll tell you another one that I'd use all the time for people. Now, I know this is gonna sound crazy, but I promise you that it really works. Count backwards from 300 by 30rees.
- [97:50]
Dr. Rangan Chatterjee
Yeah.
- [97:52]
Dr. Michael Bruce
All right. Now, it is mathematically so complicated you can't think of anything else. And it's so damn boring. You're out like a light. It works like a charm. I use it with a lot of my patients who are trying to fall asleep on an airplane or things like that. I have them count backwards or if they just have a hard time falling asleep, it's kind of great for monkey mind. There's also something else called cognitive shuffling. This is an interesting technique where you pick a word. So let's pick the word, I don't know, sunflower. Then what you do is in your mind, you see the word sunflower, Then you come up with five words that start with the letter S. Then you come up with five words that start with the letter U. Then five words that start with the letter N. So you walk yourself spelling down the word sunflower by finding five words for each letter. It's again so complicated. You can't have the monkey mind. And it's usually so damn boring. You're out like a light.
- [98:46]
Dr. Rangan Chatterjee
Yeah. I guess the point is with those exercises is that if you did them in the morning after a good night's sleep, they're not gonna send you to sleep at that point.
- [98:56]
Dr. Michael Bruce
Absolutely not. They'll relax you.
- [98:58]
Dr. Rangan Chatterjee
Yeah, but the point is, I guess you're trying to say at night whether it's because you've woken up at 2am or because you can't switch your mind off just before going to bed, there are certain techniques out there that can be helpful to help switch off that monkey mind. Right, exactly. So if you can switch it off, then the natural sleep drive that has accumulated throughout the day is allowed to run its course and help you fall asleep. Right. So I think that's a key point to sort of make with those exercises. They're not sleep inducing in and of themselves, are they?
- [99:32]
Dr. Michael Bruce
No, they are anxiety reducing in and of themselves and then the natural sleep process can come in and take over.
- [99:38]
Dr. Rangan Chatterjee
Okay, few more questions. Prelikat says what is the main reason for frequent wake ups during the night? And we could do two hours on this, but what's your top line answer to that?
- [99:50]
Dr. Michael Bruce
So again, I think there's a couple of different things that can happen as awakening through the night. Let's go through the list of things that it could be. So number one, could be too much fluid. Right. So you've drank some water too close to bedtime, it's waking you up. Number two, it could be your digestive process. Maybe you're eating too close to bedtime. Right. Number three is you could be having a very emotional discussion with your partner. Right. If you, if you decide to have a great big talk about, you know, where to go to college or whether or not you're going to get a divorce or whether or not to have kids, like big decisions, those are not reserved for evening times. That, that is not an easy way to have Runway to land the plane as, as we've been talking about. Right. So avoid those emotional discussions and also, you know, make sure that you're giving yourself some space. But those are the things that I tell people all the time is you really, you just need to. I liked your idea. What do your kids do before they fall asleep? Do they run around like crazy? No. The lights come down, it's bath time, it's story time. It's say your prayers and go to bed. Right. That works.
- [100:58]
Dr. Rangan Chatterjee
Yeah. I'll tell you what I'm doing at the moment, right. And I'm pretty sure people in my family think I'm a little crazy for this, but we are in the peak of, well, the British spring and summer as we have this conversation. We've had glorious weather for about three weeks. It does not get dark until about 10pm at the moment. And my son is in the middle of his GCSE examinations, which are the sort of exams you take at 15 or 16 here in the UK. Now, I know how important sleep is, is for his performance in an exam. Right. So what I'm doing. And look, instead of, you know, I'll tell you what I do and then you can tell me your opinion on this.
- [101:43]
Dr. Michael Bruce
Yep.
- [101:44]
Dr. Rangan Chatterjee
Once it gets to around probably about seven, maybe sometimes quarter to seven and a half, six, I'm going around the house and I'm pulling the curtains, Right.
- [101:54]
Dr. Michael Bruce
I love it.
- [101:55]
Dr. Rangan Chatterjee
So I go to the. All the bedrooms upstairs, I pull all the curtains, I put the bedside lights on, so it's, you know, there's not much light in the upstairs. And then if we're downstairs, you know, in the main, in our. In our living room, I'll pull the curtain so it starts to feel dark.
- [102:14]
Dr. Michael Bruce
Right.
- [102:14]
Dr. Rangan Chatterjee
I am absolutely convinced that since I started doing that, their willingness to want to go to bed has increased. And I am certain that this is having an impact on their hormonal physiology.
- [102:30]
Dr. Michael Bruce
Oh, yeah.
- [102:31]
Dr. Rangan Chatterjee
Which will then be impacting their ability to sleep and therefore, for my son, his performance in his exams. You're the sleep doctor, Michael, tell me, what do you think?
- [102:43]
Dr. Michael Bruce
So I love the idea, and I think you're also being a good model. So you're showing your children and you're showing your partner what to do. And that is a behavior that they're going to adopt over time. So it's going to be valuable. Also, I want to commend you for doing something else that I think. I don't know if you even realize that you're doing it, but a lot of parents, especially when there's a big exam coming up, so here in the United States, we have something called the sat, which is a big exam that you take at the end of high school. Helps with entrances to college, things like that. So it's a little bit on the similar side. It's all about the sleep that you got for the two weeks before the test. It's almost nothing to do with what happened the night before the Test, because a lot of kids, they get anticipatory anxiety, right? They're like, oh no, I got my, my test tomorrow, am I going to do well? And they ramp themselves up. Right. But a well prepared, well slept child, number one, their anxiety isn't nearly as high as the children who aren't well slept. But number two, they've been learning during a well sleeping environment, so they have a much greater likelihood of being able to recall and things of that nature.
- [103:51]
Dr. Rangan Chatterjee
Yeah. It reminds me of something a top running coach once said to me, which is, you know, the night before a marathon, doesn't matter if you don't sleep well. It's about, how did you sleep earlier on in the week, Right? That's right. It's a similar principle and I think that's a wider principle out there which we need to be conscious of when we talk about sleep. We've not gone into detail today on the negatives of long term sleep deprivation. I have done it on many podcasts over the years, so I'm pretty sure my audience will be familiar with chronic sleep deprivation, how it pretty much increases your risk of every single chronic disease that we have. Again, I say chronic. So if you're a parent of young children and you have it for a few months, that is not chronic. That is a short period in your life that you have to do it for. Right. So, but, but I think this wider point of resilience I think is so important, isn't it, where. Yeah, you know what? Yeah, one night sleep deprivation, you can get research showing the impact it will have on natural killer cells, part of your immune system and all kinds of other things. And at the same time, we are pretty damn resilient. We can cope. You know, if you have a bad night's sleep, okay, it happens, it will happen. And you can still get on and do your job.
- [105:09]
Dr. Michael Bruce
Of course.
- [105:11]
Dr. Rangan Chatterjee
Few more questions which we'll try and get through if possible. Judy and Balance Yogi have kind of asked the same question using different words. Okay. So Judy says, why do I wake up feeling exhausted every morning? Okay. And Balance Yogi says, why do I never wake up feeling rested? My Garmin says I'm stressed in my sleep.
- [105:34]
Dr. Michael Bruce
I would say in both of these cases, I would want to do a sleep study on them. Because if you've gotten six and a half to seven and a half hours of sleep for, let's say a week and you wake up and you're still exhausted, then there's something about the quality of the sleep that you are getting that is wrong. That could be a sleep disorder, like undiagnosed sleep apnea. That could be a disorder like narcolepsy, by the way. Could be depression. Right. Let's not forget that mental health oftentimes looks like exhaustion. Right. So there's that. And that's a possibility. Right. As well. So there's a whole host of things, but if you wake up regularly exhausted, you definitely want to go talk to a sleep doctor. No question.
- [106:17]
Dr. Rangan Chatterjee
Four more sort of quick topics I think I would like to cover, if we can, which are to do with night shifts, pregnancy, ADHD and restless leg syndrome. Okay. Andrea says I work night shifts. What kind of advice can you give me for improving my sleep?
- [106:35]
Dr. Michael Bruce
Super good question. So first of all, night shift work is a whole different ballgame. And there's quite a few people who work on the night shift. I'm not sure your audience probably knows that, but there's a tremendous number of people that work while all of us are asleep. And by the way, the body was not meant to do that. That is not like our, we should not be awake when it's dark out. Right. And so we're doing also, by the way, most of the shift workers, they have higher incidence of depression, higher incidence of suicidality, higher incidence of all cause mortality. So shift work is not necessarily a fantastic thing for you to be doing to your body. However, you make more money at it and sometimes you don't have a choice. Right. Sometimes when you walk into a job, you end up on the night shift. So what do I do about working on the night shift? So first of all, there are some websites that have a tremendous amount of information just about shift work. My favorite is called circadian.com I have no affiliation with them, but boy, the information is really good for people there. But there's a couple things that I tell people that they should kind of understand about shift work. So what most shift workers try to do, and I get it, I get it, is when they're not working, they try to flip back so that way they can spend time with their family and their loved ones. So they kind of live in and out of this environment, right? This time zone, if you will. And that can be very, very disruptive. So what you want to try to do is stay as, as much on the evening time zone as possible, which is problematic because if you want to have a relationship and your person that you're having a relationship isn't a shift worker, that can be very, very difficult. So what I have a lot of people do is when they come off their shift, they drive home, they get home. Instead of going immediately to bed, I have them actually spend time with their families. Because think about it, when you get home from work, let's say it's six o', clock, you don't go to bed until like 9:30, 10, right? And so you've got time to spend with your family. So they get home at 9:00 in the morning. Let them spend time until, let's say, 10:30, 11:00', clock. Everybody's gone off to school or gone off to work. Now, in their home, they should have a cave, right? They should have a place where it's dark, it's cool, it's quiet, and then they can get the rest that they need. So there's a lot of lifestyle adaptations that have to go on. Also, there's an app out there specifically for shift workers to tell them when to have caffeine and when to have life. It's called Time Shifter. The guy who runs it is one of my close friends. So that's an affiliation for sure.
- [109:05]
Dr. Rangan Chatterjee
Okay. Jessica says, any tips for sleeping during pregnancy?
- [109:11]
Dr. Michael Bruce
Oh, good luck. So here's what I'll tell you is first trimester, it's usually not a problem. Get as much sleep as you possibly can during your second trimester because in the third trimester, you're uncomfortable, you got baby in front of you. It's hard to get, you know, comfortable on bed. Your whole body is reacting differently. So get as much sleep as you can in the second trimester is usually my first piece of advice. My second piece of advice is don't try to do too much. Okay. Like you're pregnant. Like, relax. Like, you don't have to be super mom while you're pregnant. You can ask for help. You can do that. But get sleep when you can, because sleep can get very disruptive. And it's disruptive based on which trimester that you're going through.
- [109:57]
Dr. Rangan Chatterjee
Usually. Yeah. Thank you. Ange says, how do we help children with ADHD who struggle with their sleep?
- [110:07]
Dr. Michael Bruce
Okay, so this is a big question, and I probably don't have enough time to give a complete answer here, but there's a few things that I would want to think about. So number one is if you do have a child with ADD or adhd, number one, you need to have a really good relationship with their doctor who is providing medication support if. If in fact, that's the path that you're taking. And you need to understand what medication your child or is on and what time do they Take these medications. As an example, I had a patient who was taking Adderall in the morning and Ritalin in the afternoon as prescribed by their doctor. And the Ritalin in the afternoon was having an effect on their sleep. So we had to move it earlier in terms of timing of administration. So sometimes that is something that occurs. So medication management absolutely becomes important specifically to sleep. The other big thing, and this is unfortunate, but, and parents usually already know this, but it's true, is if you have an ADHD child and they don't sleep well, the symptomatology gets much worse. And so educating the child on why sleep is so important, because they don't like how they feel either. So a lot of these kids are like, I don't understand. I can't sit still, or I can't focus in school. I can't do this and I can't do that. Educating them on, hey, sleep is one of those things that can be helpful because they don't know that. And once you educate them on that and you start to get into a routine like, hey, you're doing something for yourself, that's going to help with your add, giving them a responsibility within the diagnosis can be very helpful. And them understanding that a good night's sleep can be helpful for them can actually enroll them into therapy and help them out quite a bit.
- [111:51]
Dr. Rangan Chatterjee
Yeah. Thank you. Okay, last question is from Carolyn. What is the best solution for repetitive restless leg syndrome at night?
- [112:01]
Dr. Michael Bruce
Sure. So, first of all, just so people know, what is restless leg syndrome? So restless leg syndrome is when you get sedentary, either sitting down or lying down, and you get this weird, creepy, crawly feeling on your legs or on your arms. And the only way to get rid of it is to stand up and walk around or to move. Okay. Now, obviously, that's problematic if every time you lie down, you have to stand up, because it's really hard to go to sleep standing up. Right. So the first thing we do is we make sure that there is a formal diagnosis. Second thing we do is we do blood work. So it turns out that when you have anything less than 60 of ferritin, which is a specific type of iron, it feels like restless leg symptomatology. Even though ferritin is normal from 5 to 300, anything under 60 becomes a problem. So with every person that comes to me that says, hey, I have a creepy, crawly feeling on my legs, very first thing I do is run blood work. I look at ferritin in particular, and I make sure that it's greater than 60. If it's not greater than 60, then I might consider some type of iron supplementation and that oftentimes can be super duper helpful. Let's say it's been diagnosed and it's not Ferritin. What do you do about it? As of right now, we use medication to help with a lot of that. There's a lot of different medications out there that people have tried. I'm not the biggest fan because these medications are usually used for people with Parkinson's syndrome. So these are big, powerful medications, not something that just be taken lightly. Yeah. There is also some lifestyle things that you can do to change your world from. In a restless leg thing, believe it or not, doing crossword puzzles before bed and Word find before bed helps lower your restless leg symptomatology. So what does that tell us? Distraction.
- [113:46]
Dr. Rangan Chatterjee
Right.
- [113:47]
Dr. Michael Bruce
Focus on something else is definitely going to be one of those things that's helpful. And obviously avoidance of caffeine late in the day.
- [113:53]
Dr. Rangan Chatterjee
Yeah, super useful. You know, what you said about ferritin really speaks to this idea that we've covered quite a bit recently on the podcast, which is the difference between normal and optimal. Right. A, you know, the normal range of ferritin can be quite large. Right. You can have a ferritin of 30 and your doctor will say that that's normal. And it may well be normal. But as you're saying, if it's not 60 or above, it might be one of the reasons why you're getting these symptoms. I remember maybe 10, 12 years ago now chatting to an expert in London on hair and he would see a lot of patients, a lot of female patients in their 30s and 40s who were losing hair. And I remember he said to me, until a ferritin is above 70, it may well be the cause of that woman's hair loss. And I never forgot that.
- [114:45]
Dr. Michael Bruce
Oh, fascinating.
- [114:46]
Dr. Rangan Chatterjee
Yeah. And again, it doesn't mean it's the cause, but it means while it's under 70, you don't know if it is. So I found that super interesting. Michael, I could talk to you for hours. Honestly, I love your energy, your enthusiasm, your passion for helping people to sleep better. There are so many topics we have not spoken about yet, which we are going to park and leave for our part two, which we're definitely going to have at some point to finish off. Michael, listen, you gave so much helpful advice today for someone who has been listening, who has realized that perhaps they haven't given their sleep as much attention as they could have done, and they are now, wanting to change things, you gave a lot of advice today. Are there some simple places for them to start?
- [115:33]
Dr. Michael Bruce
Yes, I have a five step plan that I think makes a lot of sense for everybody here. So step number one is to wake up at the same time seven days a week. We talked a little bit about why that's so important. That's the timing of melatonin issues. So everybody out there can set an alarm and get up at the same time seven days a week. Step number two, stop caffeine by 2pm Right. This is a general guideline, but most people, caffeine has a half life of between six and eight hours. So most people, they're going to bed around 10. If they stop at two, they're going to be a lot better off. Step number three is to stop alcohol three hours before bed. It would be great if you don't have any alcohol, that would be ideal. But I'm not going to be so foolish as to think that nobody's going to drink alcohol. So if you can limit yourself to two drinks and stop three hours before bed. Step number four has to do with exercise. The best thing to improve sleep quality is daily exercise. But if you do it too close to bedtime, you increase core body temperature and that makes it very difficult. So you want to stop exercise four hours before bed. And then step number five is a morning wake up routine. I call it the 3:15. Right. So when you wake up in the morning, you want to take 15 deep breaths, you want to have 15 ounces of water and you want to get 15 minutes of sunlight. All of those have got real biological consequences that can be helpful. 15 minutes is exactly the amount you need to create vitamin D. 15 ounces of water helps you hydrate and the sunshine in and of itself helps move that brain fog out pretty quickly.
- [117:02]
Dr. Rangan Chatterjee
Amazing. Super helpful, super practical. And last question. Michael, you've written, I believe, six books. Now if someone at the end of this conversation wanted to choose one of your six books to get started with, which book would you point them to?
- [117:21]
Dr. Michael Bruce
It's a great question. I think my most recent book does kind of the most holistic job. And I feel like this is a very holistic show. So I think Sleep, Drink, Breathe is probably the best one because it goes over sleep, it goes over the importance of hydration. It goes. And then it also goes over the importance of breathwork. I'm kind of fanning out a little bit to get people to do more. Right.
- [117:43]
Dr. Rangan Chatterjee
So that was the last question and one more's popped into My head. Because I opened that door before and haven't closed it. You said that in your room is a plasma television which stays on at night.
- [117:58]
Dr. Michael Bruce
Do French bulldog.
- [117:59]
Dr. Rangan Chatterjee
And you sleep with dogs in your beds.
- [118:01]
Dr. Michael Bruce
I do.
- [118:02]
Dr. Rangan Chatterjee
I know we're at the end of the conversation. I want to be respectful to your time. We can go into these in detail in part two, for sure. But top line, why does the sleep doctor have a plasma television on when he's trying to fall asleep?
- [118:15]
Dr. Michael Bruce
Because sleep is flexible, right? And that's something that everybody needs to understand is you can sleep in almost any environment. The reason I have my environment the way I do is because of my bed partner. So when I met my wife, she said, michael, if we ever have a sleepover, I need you to know that I sleep with the television on. I said, oh, Lauren, I'm going to. I'm going to become a sleep doctor. I'm going to fix that. I don't know about you, but have you ever tried to fix something in your life, partner? Yeah.
- [118:41]
Dr. Rangan Chatterjee
They're coming.
- [118:42]
Dr. Michael Bruce
Go. Well, so I pulled the TV out. She said, michael, if you ever want to get in this bed again, I suggest you put the. I put the TV right back in. And I studied her, right? Because that's what I do in my house, is I look to see, okay, what are the different things that. That she needs and why do I not need them, or are they going to be disruptive to me? So, number one, I can sleep through noise. That doesn't seem to bother me. For her, she listens. She avoids monkey mind by listening to an old episode of Seinfeld. Now, here's the trick that she doesn't always know is I have a timer on the TV. So I just set the time. You know, most TVs have got a timer built into the software. I just set the timer, and the TV will turn off in the middle of the night. And she doesn't know it, and I'm fine. So that's why we do it. Our dogs. We just couldn't sleep without our dogs. Believe it or not, there's data to show that people sleep better with animals in the room. Not necessarily in the bed, but in the room. Seems to be. Seems to be quite helpful. Oh, and there's, you know, there's one thing that we forgot to talk about, which I think is probably worthwhile, which is thermoregulation. A lot of. I think about it when I think about my dogs, because my dogs, they'll lie close to me to stay warm throughout the night. And that's one of the things that people should be thoughtful about is the cooler your environment, generally speaking, the better your sleep. And believe it or not, they now have these devices like toppers and things like that that you can have in your bed that can make you cooler or warmer based on your circadian rhythm. We'll talk about it at our next pod, but there's definitely some really interesting products on the marketplace that can be helpful for sleep that help you with your temperature.
- [120:16]
Dr. Rangan Chatterjee
Yeah, love it. Michael, honestly love what you do. Love that you've been spreading the word about good and better sleep for a number of years now, several decades. Thank you for all that you do. And thank you so much for coming onto the show.
- [120:29]
Dr. Michael Bruce
Thanks for having me.
- [120:34]
Dr. Rangan Chatterjee
Really hope you enjoyed that conversation. Do think about one thing that you can take away and apply into your own life and also have a think about one thing from this conversation that you can teach to somebody else. Remember, when you teach someone, it not only helps them, it also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday 5. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I've been consuming, and quotes that have caused me to stop and reflect. And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if that sounds like something you you would like to receive each and every Friday, you can sign up for free@drchatterjee.com Friday 5 Now if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world covering all kinds of different topics. Happiness, food, stress, sleep, behavior change and movement, weight loss, and so much more support. Please do take a moment to check them out. They are all available as paperbacks, ebooks and as audiobooks which I am narrating. If you enjoyed today's episode, it is always appreciated if you can take a moment to share the podcast with your friends and family or leave a review on Apple Podcasts. Thank you so much for listening. Have a wonderful week. And please note that if you want to listen to this show without any adverse at all, that option is now available for a small monthly fee on Apple and on Android. All you have to do is click the link in the episode notes in your podcast app. And always remember, you are the architect of your own health. Making lifestyle change is always worth it because when you feel better, you live more
- [122:49]
Dr. Michael Bruce
SA.