Sleep Science: Mouth Taping, Melatonin & How to Sleep Better with Dr. Michael Breus

Summary

Podcast Summary: Sleep Science: Mouth Taping, Melatonin & How to Sleep Better

That Can't Be True with Chelsea Clinton
Lemonada Media & The Clinton Foundation
Guest: Dr. Michael Breus (“The Sleep Doctor”)
Date: June 11, 2026

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Overview

This episode centers on the science of sleep: what works, what’s all hype, and how to meaningfully improve your sleep quality. Dr. Michael Breus, clinical psychologist and renowned sleep expert, joins Chelsea Clinton to debunk viral sleep trends (like mouth taping and lettuce water), illuminate the true role of things like melatonin and magnesium, and offer actionable advice for anyone looking to sleep better. The conversation is lively, science-backed, and deeply practical, tackling both common misconceptions and genuine sleep struggles.

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Key Discussion Points & Insights

Dr. Breus’s Journey into Sleep Medicine

• Origin Story: Dr. Breus did not start out obsessed with sleep—instead, he fell into the field by chance after his initial goal (sports psychology) didn’t pan out. Three days into his sleep rotation, he realized “You change someone’s sleep and you change their life. It is fundamental to who they are as a human, and I loved having that level of impact.” [03:06]
• Personal Connection: Dr. Breus himself has sleep apnea and uses a CPAP machine (“I stopped breathing in my sleep 24 times an hour.” [03:23]), making his perspective both professional and personal.

Debunking Sleep Trends: Viral Fads vs. Science

“That Can’t Be True” Segment – Debunking Trends

• Lettuce Water: “There’s almost no evidence out there that that would make any sense whatsoever. Also, you really don’t want to be drinking large amounts of water before bed because it makes you wake up to have to pee most of the night long.” [06:37]
• Sleepy Girl Mocktail (Magnesium + Tart Cherry Juice + Sparkling Water): Potential for excessive magnesium (diarrhea risk), tart cherry juice “only works in specific doses, both morning and evening,” and “why drink water with bubbles before bed?...you’re going to be gassing [your partner] out.” [07:30]
• Mouth Taping: “This is stupid, all right?...If you haven’t been screened for sleep apnea, you could be having apneic events. Your disease could get significantly worse.” [07:53]
  • Memorable Quote: “Try to pass the mom test. Call your mom up and say, ‘Mom, I’m thinking about taping my mouth shut all night long while I sleep.’ What do you think?” [07:44]
• Sleep Maxing (Staying in bed for extra hours): Not recommended. Sleep is about quality, not quantity. Overextending time in bed often backfires.

Effective Techniques

• White Noise: Helps, but “you better keep it on your phone everywhere you travel, because you get habituated to it.” [09:38]
• Cold Room: Yes, within reason; “not like a meat locker…not below about 65 degrees.” The core temperature drop signals melatonin release and supports better sleep. [09:38]

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The Physiology of Sleep

• Everyone Wakes Up at Night: “Every single human on earth wakes up between one and three o’clock in the morning. Just most people don’t remember it.” [11:01]
• Diagnosing Insomnia (Rule of Threes):
  • It takes >30 min to fall asleep
  • Wake up >3 times/night, >30 min each
  • Happening >3 weeks for >3 months
    If so, may be chronic insomnia.
• Quality Over Quantity: “I don’t want people to think that sleep is a quantity game. I want them to think it’s a quality game.” [09:19]
• Feeling Tired in the Morning: “If you wake up and you’re like ‘I can’t wait to get back to sleep,’ you’ve got a problem on your hands.” [14:11]

Chronotypes & “Wiring”

• Chronotypes: Early birds vs. night owls; sleeping in sync with your chronotype means higher quality and less need for sleep.
• Glymphatic System: Dr. Breus describes how the brain “shrinks by a couple 3 millimeters” in deep sleep to allow cerebrospinal fluid to “wash out” toxins (beta-amyloid, tau)—key for protecting against Alzheimer’s. [16:17]

Wearables & Sleep Tracking

• Wearables (Aura Ring, Whoop, etc.): Good for trends, but not accurate minute-to-minute: "We measure deep sleep based on brainwaves...hard to get EEG from your finger." [17:07]

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Practical Sleep Improvement Tips

Determining If You Get Enough Sleep

• “When you wake up in the morning, within 30 seconds to a minute, how do you feel?” If you feel good/awake, you’re likely getting enough. [20:53]
• Consistent wake-up time is “more important than your bedtime.” Biological rhythms are set by wake time, not sleep time. [22:27]

Managing Variable Schedules: Jet Lag, Shift Work

• Timeshifter App: Dr. Breus recommends (and invested in) the Timeshifter app for complex schedules—“jet lag is a math problem,” solved by using “light, melatonin, caffeine and napping in a particular order.” [25:16]
• Rapid Shift Possible: With targeted light, full circadian rhythm shifts of 8+ hours are possible in advance of travel. [26:00]

Electronics Before Bed

• Blue Light Concerns: Phones and tablets emit blue light, but the real issue is engagement and activation of the sympathetic nervous system—i.e., highly stimulating content, not just the light. [27:10]
• Best Routine: Read a book before bed instead.

Environment and Equipment

• Mattresses, Cooling Pads: “Equipment matters.” Consider beds and bedding that support temperature regulation—but can also try the cheap “frozen water bottle in a tube sock on the hips” trick first. [29:07, 31:12]
• Room Temperature: 65 degrees is ideal.

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Food, Caffeine, Sugar & Supplements

• Food: Timing is key; finish eating 3–3.5 hours before bed for best sleep. Heavy, high-protein meals late impair sleep. [33:00]
  • Spicy foods before bed: “Can give you nightmares.” [31:52]
  • Carbs: Make you sleepy, but too much at breakfast can cause grogginess.
• Caffeine: Genetically variable. Rare individuals can tolerate coffee at night but “most people are reasonably efficient metabolizers.” Advice: Stop by 2pm, then slowly move earlier if needed. [34:25]
  • Memorable Quote: “Her body doesn’t have the enzyme that metabolizes caffeine...it just flies right through her…super duper rare.” [34:27]
• Sugar: Slows melatonin production; avoid at night.
• Supplements: Always check blood work first for deficiencies in vitamin D, iron, magnesium, melatonin. “Nobody on earth has a deficiency in ashwagandha.” [37:34]
  • Don’t self-medicate with random “sleep” supplements; dosage and form matter (e.g., 13 types of magnesium).
  • Too much magnesium = diarrhea risk.

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Fact or Fiction Segment (Rapid-fire Questions)

• Warm bath before bed helps sleep: (Fact) — “You’re artificially raising your core body temperature, then it drops and signals release of melatonin…Do it 90–120 minutes before lights out.” [39:44]
• Warm milk helps: (Conditional Fact) — Only via psychological association (“cognitive association” from childhood); you’d need a gallon of milk for enough tryptophan to have an effect. [40:24]
• Get out of bed if you can’t return to sleep: (Fact, with nuance) — Only if anxiety is rising. Try the “4-7-8” breathing technique first. [41:24]
• Breathing technique: "Slowly breathe in through the nose for a count of four, hold for seven, and lightly exhale for eight. Do 20 cycles. It distracts your brain and lowers your heart rate." [41:41]
• Catch up on “sleep debt” by sleeping more: (Nuance) — Works only for large deficits, but “not a one for one ratio.” Consistency is key. [44:03]

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Sleep Testing & Sleep Apnea Awareness

• Don’t fear sleep tests or CPAP: Many alternatives now exist (mouth guards, upcoming pills). "Not getting tested is really stupid…when you don’t get tested and your disease goes unchecked, you end up with cardiac issues." [44:55]
• Special Note for Women: Women often have “subclinical” apnea (wake up once every 15 min)—not enough to cross formal diagnostic threshold, but still worth treating. “Nothing could be worse” than being put on an antidepressant instead. [47:25]

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Notable Quotes & Memorable Moments

• “You change someone's sleep and you change their life.” (Dr. Breus, 03:06)
• “Call your mom up and say, ‘Mom, I’m thinking about taping my mouth shut all night long.’...She’s going to say...that sounds really stupid.” (Dr. Breus, 07:44)
• “I want people to think it’s a quality game, not a quantity game.” (Dr. Breus, 09:19)
• “Every single human on earth wakes up between one and three o’clock in the morning. Just most people don’t remember it.” (Dr. Breus, 11:01)
• “Nobody on earth has a deficiency in ashwagandha.” (Dr. Breus, 37:34)
• “Your brain can’t count and be upset at the same time.” (Dr. Breus, explaining “4-7-8 breathing,” 43:31)
• “Not getting tested is really stupid...There are mouth guards [for apnea]. There’s a pill coming. Don’t wait.” (Dr. Breus, 44:55)
• “If you or your partner...could possibly have a sleep disorder or disordered sleep, it’s probably worth...the test.” (Dr. Breus, 44:55)

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Timestamps for Key Segments

• Intro & Dr. Breus’s Sleep Origin Story: 00:10–03:06
• Why sleep matters, sleep as a superpower: 04:08–04:55
• Debunking Viral Trends (“That Can’t Be True” Segment): 05:11–09:38
• What actually works (white noise, room temp, core temperature): 09:38–11:01
• Physiology: Nighttime awakenings, insomnia “rule of threes”: 11:15–13:44
• Chronotypes, wearable tracking, glymphatic system: 14:14–18:42
• On sleep perception & self-diagnosis: 20:19–22:38
• Set wake up time > bedtime, melatonin timing: 22:27–24:21
• Travel, jet lag, Timeshifter app, blue light and circadian shifts: 24:36–27:10
• Tech in bedroom, engagement & sleep quality: 27:10–28:41
• Thermoregulatory beds, low-cost cooling hacks: 28:49–31:40
• How food affects sleep (spicy, protein, carbs): 31:47–34:09
• Caffeine, genetics, sugar, sleep supplements: 34:25–39:26
• Fact or Fiction: warm bath, milk before bed, getting up at night: 39:36–43:51
• Sleep debt: catching up or not?: 43:51–44:51
• Sleep testing, apnea, special note for women: 44:55–48:28

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Final Takeaway

Dr. Breus’s dream prescription: Focus on quality, not chasing more hours. Set a steady wake-up time. Address diet, caffeine, and sleep environment sensibly. Don’t fall for TikTok hacks—most won’t help, and some (mouth taping) could be dangerous. And don’t avoid sleep testing out of fear—effective treatments abound, and sleep is foundational to long-term health.

“Anything we can do to keep stage three and four high, or what we call deep sleep, higher is better.” (Dr. Breus, 16:29)

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For more science-backed myth-busting and clear advice, follow Dr. Michael Breus on socials at @thesleepdoctor.

Transcript

[Dr. Michael Bruce]

Lemonada.

[Chelsea Clinton]

Welcome to that Can't Be True, a show that sorts fact from fiction, especially on issues impacting our health. I'm Chelsea Clinton. Now, I know we all know that sleep is important to our health. I certainly feel that as a person and particularly as a mom, I know it's important that I get a good night's rest and that my kids get a good night's rest. But I don't know, as much as I wish I knew about why sleep is so important to our health and how I, and maybe all of us really should think about how to set ourselves up for a good night's rest. I'm really looking forward to the upcoming conversation with Dr. Michael Bruce. He's a double board certified clinical psychologist and clinical sleep specialist. In fact, you may know him as the sleep doctor on his YouTube and other socials. And he's got a podcast called Better in Bed, releasing this fall. Hi, Dr. Bruce.

[Dr. Michael Bruce]

Hey, how are you? Chelsea. Nice to meet you.

[Chelsea Clinton]

I'm great. Thank you so much for your time today.

[Dr. Michael Bruce]

Oh, it's my absolute pleasure. Real quick, before we start, one funny little tidbit was I was at your father's inauguration.

[Chelsea Clinton]

Oh, my gosh.

[Dr. Michael Bruce]

I was at the New York D.C. ball back in 93.

[Chelsea Clinton]

Oh, my gosh.

[Dr. Michael Bruce]

And I watched him play the saxophone with Clarence Clemens live on stage.

[Chelsea Clinton]

That's so, that's. That's a very, like, funny, nice, small world moment. Well, Dr. Bruce, thank you again for your time today.

[Dr. Michael Bruce]

Yeah, of course.

[Chelsea Clinton]

And I'm really excited to talk about sleep.

[Dr. Michael Bruce]

Oh, yeah.

[Chelsea Clinton]

And I'm curious, have you always been interested in sleep? Were you a kid and you're like, oh, did I get my 10 hours tonight?

[Dr. Michael Bruce]

Absolutely not.

[Chelsea Clinton]

Okay.

[Dr. Michael Bruce]

It was purely serendipitous. So I went to the University of Georgia. Go Bulldogs. And I was studying clinical psychology, getting my PhD at the time. And when you study for your PhD, you spend four years in coursework and then one year doing, like a residency or an internship program. And if I'm honest with you, the internship program I wanted to do was in sports psychology. I wanted to help athletes, you know, run faster in the mental gym.

[Chelsea Clinton]

You're like, I'm at the University of Georgia. Like, come on.

[Dr. Michael Bruce]

Yes, why wouldn't I? Exactly. But if I'm honest with you, I couldn't get into the internship that I wanted to. Only kind of the Harvards and the Princetons and the Yales of the world, Georgia's top 20 program, but it wasn't Harvard. But they had a sleep track on the End of it. That was fully funded, and I worked my way through the electrophysiology program at the University of Georgia. While I was there, I was working. And so I know how to take apart EKG machines and put them back together, and they use the same machines in sleep. So I was like, ah, perfect. I'll sell myself as a sleep guy, and then I'll transfer as soon as I get in. And by the third day, Chelsea, I absolutely fell in love with clinical sleep medicine. I knew I would never change, ever.

[Chelsea Clinton]

And so, Dr. Bruce, was that, like, you just had an amazing set of professors, mentors, did you meet patients? And you were like, oh, my gosh, sleep really is so critical, and I can be helpful. Like, three days is a pretty quick time.

[Dr. Michael Bruce]

Yeah. I'll tell you what happened is I discovered I can help people this fast. It's unbelievable. You change someone's sleep and you change their life. It is fundamental to who they are as a human, and I loved having that level of impact.

[Chelsea Clinton]

Are you a good sleeper?

[Dr. Michael Bruce]

I'm a pretty good sleeper. I'm 58 years old. I follow most of my own rules, but I'm human. I will tell you that there are times where I don't get a good night's sleep. To be fair, if there's something going on with my daughter, I sleep like crap. You know, like, there's anxiety there. Right. So I think we're all human and we all have those times. I will tell you, full disclosure. I have sleep apnea. Yeah. I stopped breathing in my sleep 24 times an hour. And so I sleep with the mask on my face every single night. A CPAP machine, by the way, just for folks out there. That's not the only. Only treatment out there. And we can talk about several different treatments and why people don't get sleep tested, but, you know, I've got a lot of reasons why sleep has kind of become my friend, but it's. It's really been a wonderful way to meet new people and share ideas and.

[Chelsea Clinton]

Dr. Bruce, have any athletes come knocking on your door? Have you still been able to help an athlete or two?

[Dr. Michael Bruce]

Oh, yeah. I mean, I can't say who, but

[Chelsea Clinton]

I. I would never ask, but I just think, you know, often when we listen to, you know, our most storied athletes, whether in professional sports or in the Olympics, how frequently many of them mention. Yes, like, sleep as a superpower.

[Dr. Michael Bruce]

Yeah. Here's what I'll tell you, is you're on or off the podium based on how you slept the night before. Almost every time. Almost every athlete I've ever talked to. Because when you hit that level of Olympic athlete, like, you're. You're jockeying for best in the world, you're within a quarter of a second to a tenth of a second most times of whoever you're going against. And so it really has to do with what happened the night before. How well did you sleep to be able to, you know, get yourself to the point where you could perform well?

[Chelsea Clinton]

Dr. Roos, you're certainly making me feel better. As one of those parents who is rather militant about my children's sleep, I have so many questions. But before.

[Dr. Michael Bruce]

Awesome.

[Chelsea Clinton]

Before we sort of get into them, I do want to start with our that can't be True segment, which is where we play some tape that's been circulating recently.

[Dr. Michael Bruce]

Sure.

[Chelsea Clinton]

Online and often in offline conversations and get your reaction. So this is a recent clip from season two of the Pit.

[Dr. Michael Bruce]

Oh, let's hear it.

[Chelsea Clinton]

All right. I should not be sick. I work so hard to stay healthy. Diet, exercise, eight hours of sleep. I can't remember the last time I got eight hours. Maybe you should try sleep maxing.

[Julia Louis-Dreyfus]

Oh, you definitely should.

[Chelsea Clinton]

Yeah. Cold room, white noise, eye shades, Kiwis before bedtime, Lettuce water, mouth taping.

[Julia Louis-Dreyfus]

Who do you follow for health?

[Chelsea Clinton]

A few naturopaths and some functional healers. So I'm curious, Dr. Bruce.

[Dr. Michael Bruce]

There's all kinds of problems with that one.

[Chelsea Clinton]

There's so much there.

[Dr. Michael Bruce]

There is.

[Chelsea Clinton]

I wonder what of the various, shall we say, interventions that are mentioned, have real evidence behind them?

[Dr. Michael Bruce]

Oh, none. Absolutely none. Yeah. So there you go. So let's talk about lettuce water for a second. So this was a. I mean, I

[Chelsea Clinton]

had never heard of lettuce water until I watched that.

[Dr. Michael Bruce]

You missed out. It was about a year and a half ago. It was all over TikTok and Instagram and all these things.

[Chelsea Clinton]

Well, then it reveals a lot about my consumption habits that I had not heard of. Lettuce water.

[Dr. Michael Bruce]

Exactly.

[Chelsea Clinton]

I like water, and I like lettuce, but I have a feeling.

[Dr. Michael Bruce]

Feeling, but not the two together.

[Chelsea Clinton]

Yeah. Okay, tell me more.

[Dr. Michael Bruce]

Yeah, so there was one study that looked at a particular type of lettuce. I think it was arugula, but I'm not 100% sure because it's been a minute.

[Chelsea Clinton]

I also like. I like arugula.

[Dr. Michael Bruce]

There you go.

[Chelsea Clinton]

I like arugula.

[Dr. Michael Bruce]

But it was mixed together with the water, and then it. Supposedly something from the lettuce would soak into the water and make you sleep. So there's almost no evidence out there that that would make any sense whatsoever. Also, you really don't want to be drinking large amounts of water before bed because it makes you wake up to have to pee most of the night long. So that's probably not really where you need to. Once again, I want to be thoughtful and say that while I understand that a lot of people out there want to try things and want to try to improve their sleep, there's actually some tried and true methodology versus trying the fringe types of things like lettuce water, or there's something out there called the sleepy girl mocktail. This is where you take a scoop of magnesium. Oh, yeah. You take a big scoop of magnesium tart cherry juice and sparkling water, and you create this cocktail that you drink before bed. Again, probably the worst idea. Not the worst idea, but one of the worst ideas I've heard in a while. So you don't have any idea of how much magnesium you're taking right before bed, which could cause diarrhea in the middle of the night. So that's problematic. For tart cherry juice, you're supposed to have 6 ounces, both in the morning and in the evening for it to have any level of effectiveness. Supposedly there's melatonin in there, which there is some data to suggest that that could be potentially helpful. But why drink water with bubbles before bed? Like, if you hate your bed partner, then you're going to be gassing them out probably most of the night. So it's probably not best idea. My favorite one in the pit, though, was mouth taping. So I want to be super duper clear. This is stupid, all right? I always have things. Try to pass the mom test. So call your mom up and say, mom, I'm thinking about taping my mouth shut all night long while I sleep. What do you think of this idea? She's going to say, well, during the day maybe, but at night, that sounds really stupid. Then you know, it's probably not the best idea out there. And the big reason there is that people mouth tape because they have a lot of nasal congestion, which makes their mouth pop open, and then they get dry mouth. And when they do tape their mouth shut to be clear, they do get better quality sleep. But the problem is, if you haven't been screened for sleep apnea, you could be having apneic events. Your disease could get significantly worse. And then you get. Then you. Then you have a big problem on your hands.

[Chelsea Clinton]

So scary.

[Dr. Michael Bruce]

Sleep maxing, which was the whole idea behind the clip, is Also not really the best idea. A lot of people will just stay in bed and stay in bed and stay in bed. Your body's really not designed to do that. Your body is designed to be in bed for a particular amount of time, which by the way varies across your age, across your gender. For women across your cycle. Like, I have a lot of women where they have one bedtime pre period and a second bedtime post period because they don't need as much sleep, right? So a lot of women are super exhausted before their cycle starts and then a lot of women have a lot of energy afterwards. Also, age depends a lot on how much you sleep. But I don't want people to think that sleep is a quantity game. I want them to think it's a quality game. And so doing things to improve your sleep quality is much more important than maxing out your sleep times.

[Chelsea Clinton]

And what about the other things mentioned in the clip? White noise or cold rooms?

[Dr. Michael Bruce]

So white noise is great. You can't, you can't really go wrong with white noise. But here's the issue. Once you get used to it, you better keep it on your phone with you everywhere you travel, because you get habituated to it. You do, you totally get habituated to it. Now. There's nothing wrong with it. It's not like you're addicted to white noise, right? There are plenty of things to get addicted from. That's probably not the worst. But just remember, for example, if you do that for your child, right? And your child has a certain thing that they like to listen to before bed and you go on vacation, you damn well better have that on your phone. Otherwise your kid is not falling asleep. Falling asleep in the cool is an interesting one. So yes, you should make your room as cool as you can, but not like a meat locker, right? So you don't want to go below about 65 degrees. The reason we want our bodies to cool down is as we're about to fall asleep, our core body temperature rises, rises, rises till about 10:30 at night, hits a peak and then it drops. That drop is actually a signal for our brain to release melatonin. Then our core body temperature continues to drop, drop, drop, drop, drop. If you're in a super hot environment, it doesn't drop. And that keeps you into a lighter stage of sleep, makes it easier to wake up. In fact, the number one question that I get asked everywhere I go is, Michael, I fall asleep just fine, but I wake up somewhere between 1 and 3 o' clock in the morning and I don't Know like how to fall back asleep. Believe it or not, that's where your core body temperature is. Drop, drop, drop. It hits a bottom and it has to go north, otherwise you go hypotherm.

[Chelsea Clinton]

Right.

[Dr. Michael Bruce]

It happens between 1 and 3 o' clock in the morning. Your body naturally gets into a lighter stage of sleep. So believe it or not, every single human on earth wakes up between one and three o'clock in the morning. Just most people don't remember it. You know, they burp, they fart, they roll over and they go back to sleep.

[Chelsea Clinton]

I wake up.

[Dr. Michael Bruce]

You do.

[Chelsea Clinton]

And I just don't know it.

[Dr. Michael Bruce]

Absolutely. Think about this. I was waking up 24 times an hour with sleep apnea and I didn't know it. Wow, it's remarkable.

[Chelsea Clinton]

I mean, I definitely am one of those people who. I just am having a revelation right here because I have always believed, until I guess like two minutes ago, that once I fell asleep, I stayed asleep. Cause I always have been like, no, I'm a very sound sleeper. I generally fall asleep pretty readily, which I realize I'm lucky to be able to say it's a gift, it's a gift, but I've always believed. But once I fall asleep, I just sleep. But now you're telling me that's not true.

[Dr. Michael Bruce]

No, it's not. Everybody wakes up at least once. And again it has to do with this core body temperature. It's only, it's not usually for a particularly long periods of time. Right. And by the way, you can be awake for 29 seconds and have no idea that you're awake. But kind of once you hit that 30th second, that seems to be for whatever reason.

[Chelsea Clinton]

So I'm awake for like, I could be awake for like 20 seconds and not have any idea.

[Dr. Michael Bruce]

Yeah, absolutely.

[Chelsea Clinton]

That is mind boggling to me.

[Dr. Michael Bruce]

Well, don't worry, you don't hurt yourself. You don't do anything bad. You just roll around.

[Chelsea Clinton]

No. Well, I mean, it sounds like there's nothing I can do about it, so I'm glad I'm not hurting myself. But just because you mentioned I was lucky that I do fall asleep generally pretty quickly. Most of the time you are. But I, I don't think I did anything really to earn that luck probably. So why, why do some people have a relatively easier time than others? And, and what advice do you have for people if they're like, oh my gosh, it always takes me, you know, 20, 30 or more minutes to fall asleep.

[Dr. Michael Bruce]

So there's a big difference between people who occasionally don't sleep particularly well because of something like an airplane flight or a child not doing well versus somebody who has, hey, Michael, I can't fall asleep or I can't stay asleep. Those are actually versions of insomnia, specifically to the diagnosis. And so the way we diagnose insomnia is we do something that I call the rule of threes. So you either have to wake up three times, it takes longer than 30 minutes to fall asleep. You wake up more than three times a night for longer than 30 minutes. And this happens for more than three weeks in a row for more than three months.

[Chelsea Clinton]

Oh, wow.

[Dr. Michael Bruce]

Yeah. So that's kind of chronic, both sleep onset and then potentially sleep maintenance. Insomnia, meaning just what happened when I wake up in the middle of the night and I can't return to sleep now? So then the question is, well, Michael, what's going on? Is this a formal, oh my gosh, I need a sleeping pill diagnosis, or is this, hey, I'm just kind of stressed out and what can I do?

[Chelsea Clinton]

And Dr. Woods, how do people know, Right? Because I think they don't. There's some people who might think, oh, I'm not a good sleeper, but it actually is situational stress related. And when someone might have a sleep disorder where a sleep doctor like you could help them.

[Dr. Michael Bruce]

Yeah, absolutely. Fair question, fair question. So I think it all has to do with when you wake up in the morning, how do you feel? Right? And so when you wake up in the morning, and I'm not talking like looking at your aura ring or your whoop strap or whatever wearable that you happen to have.

[Chelsea Clinton]

Okay. I'm now very curious how you feel about the wearables too. But I'll park.

[Dr. Michael Bruce]

Don't you worry. I'll let you know. Here's what I'll tell you is when you wake up in the morning, I think you are your best doctor. I think you know your body better than anybody else. And if you wake up and you're like, I can't wait to get back to sleep. Sleep, you've got a problem on your hands, right? So that's either a quantity problem or a quality problem. I don't know which yet, but we need to. That's something that would be worth figuring out. The good news is There are about 7,000 sleep doctors in the United States alone that are out there that are interested in trying to help you identify and help yourself if you've got these sleep related issues. But I spent the big majority of my beginning of my career just Focusing on sleep disorders, apnea, narcolepsy, REM behavior disorder, all these kind of fun, funky things. And what I see realized is after a while is a lot more people really have something that I call disordered sleep. So not a sleep disorder, but disordered sleep. So they're not diagnostic for insomnia, but they sleep like crap two nights a week, and they want to fix something like that, Right. And so in studying that, I discovered this whole idea of these things called chronotypes. So for folks out there who don't know what a chronotype is, you've actually heard of the term or the idea before, you might not have heard of the term. If anybody out there has ever been called an early bird or a night owl, those are chronotypes. And so. So if you can sleep within your chronotypical timeframe, you actually get higher quality sleep and require less sleep. And so, Chelsea, one of the first things I do is help people identify their chronotype. And I say, okay, let's get you to sleep within this sort of timeframe. So early birds wake up early and go to bed early. Night owls stay up later and sleep a little bit later. I get it. You might have work and there might be some things that you have to kind of maneuver around, but we can figure out ways to do that. Let's see if you feel better when you wake up. But as we get older, there's a couple different things that people want to think about. So, number one, there's a special system in your brain called the glymphatic system. So this is kind of like the washing machine for your brain. So every night when you hit deep sleep or stage 3, 4 sleep, your brain shrinks by a couple 3 millimeters. Cerebral spinal fluid comes in and washes it all out.

[Chelsea Clinton]

Our brain shrinks.

[Dr. Michael Bruce]

It does.

[Chelsea Clinton]

Every night?

[Dr. Michael Bruce]

Every night, I promise.

[Chelsea Clinton]

How didn't I know that either?

[Dr. Michael Bruce]

I'm just dropping knowledge bombs on you left and right, girl.

[Chelsea Clinton]

My brain shrinks.

[Dr. Michael Bruce]

Your brain shrinks every night. It's called the glymphatic system. But the important thing, especially for older adults. Sorry. Especially for older adults, is the proteins that it takes out are called beta, amyloid and tau. These turn out to be extremely important because as they accumulate, they wrap around the nerves. And that's called Alzheimer's disease, right? Yeah. So we want to avoid that. So anything we can do to keep stage three and four high, or what we call deep sleep, higher is better. Now, a lot of your listeners right now are checking Their aura ring and their whoop strap.

[Chelsea Clinton]

Yes, I was going to ask about that. Tell me about how useful you think wearables are.

[Dr. Michael Bruce]

So here's what I'll tell you. I think they're useful. I don't think they're accurate. So the finite number that you read is very different than what it actually is. Because, see, we measure deep sleep based on brainwaves, so EEG waveforms. It's hard to get EEG from your

[Chelsea Clinton]

finger, but you're wearing one.

[Dr. Michael Bruce]

I am. So I'll tell you and I'll explain to you why, because I look at trends over the course of time. So. And also I. I have an open API with aura. Most of my patients wear them and I and actually see what's going on. But I have them all by hand, fill out a sleep diary, and I have their aura data. So I make sure that they don't cheat and they just don't put their aura data into their sleep diary because a lot of them try to do that. I'm much more interested in your sleep perception. But once again, when we look at depth of sleep, here's the problem is, as we get older, believe it or not, our brain waves are not as powerful. The amplitude or the height of the brainwave is much less. And so even when we have people in the sleep laboratory, we have to change the scoring criteria for people who are over the age of 50. And I can assure you there is not one ring out there that probably does that. So once again, the accuracy level is low, so don't look. And if it says you only got 14 minutes of deep sleep, I don't think I care. Is it said, what did it say the night before? 16 minutes. What did it say the night before? 20 minutes? Then you're fine because it's being consistently inaccurate. It's when you had 30 minutes before and it drops down to two. That's what I want to know, what's going on. So we're looking for a trend analysis or a delta from that waveform.

[Julia Louis-Dreyfus]

Hey, it's Julia, Louis Dreyfus from wiser than me, etc. Just popping in with a little reality check. Food waste shouldn't exist. There is no reason that our leftovers should end up in a landfill. But that's the final destination for about a third of the food we grow. Our ancestors would be confused. They use their food scraps as compost or as animal feed or in weird soups, all the stuff we did before garbage was invented. But composting is hard work. Living With a bucket of rotten food on your counter is gross. Most food goes in the trash because it's easy. And these days, we'll take any easy we can get. But now there's something easier. Drop your scraps in a mill food recycler. It looks like a kitchen bin and an iPhone had a baby. It takes nearly anything, even meat and bones. It works automatically. You can keep filling it for weeks and it never smells. When you finally empty it, you've got these nutrient rich grounds. Use them in your garden, pour them in your green bin, or have mill get them to a small farm. So the food you don't eat can help grow the food you do. Just like it should be. It's why I own a mill, why I invest in mill, and why I'm still obsessed with my mill. If you want to get obsessed too, go to mill.com wiser to get $75 off. That's mill.com wiser for $75 off.

[Chelsea Clinton]

You talked earlier about how important you think quality of sleep is.

[Dr. Michael Bruce]

Oh, yeah.

[Chelsea Clinton]

And you care more about quality than quantity.

[Dr. Michael Bruce]

I do.

[Chelsea Clinton]

I sleep probably like six and a half to seven and a half hours a night. You'll tell me if that's too little.

[Dr. Michael Bruce]

How old are you?

[Chelsea Clinton]

46.

[Dr. Michael Bruce]

Okay, that's great.

[Chelsea Clinton]

But I've always thought I slept really well. I'm like, I don't need a lot of sleep. But I now am like, is that true? I don't know. So both for anyone listening, but also admittedly for me.

[Dr. Michael Bruce]

Okay, so we're gonna just start diagnosing you right now, Chelsea. So number one, when you wake up in the morning, within 30 seconds to a minute, how do you feel?

[Chelsea Clinton]

I feel good.

[Dr. Michael Bruce]

Do you feel awake? Do you?

[Chelsea Clinton]

Yeah, I feel awake.

[Dr. Michael Bruce]

So you are. Then you are getting the amount of sleep that you personally need.

[Chelsea Clinton]

And I wake up. I wake up generally before my alarm.

[Dr. Michael Bruce]

That was my next question. Good job.

[Chelsea Clinton]

But the caveat is, if I got woken up by a child earlier, yeah, that happens. Then I do need my alarm. But if I have not gotten woken up, I wake up before my alarm.

[Dr. Michael Bruce]

So that shows circadian consistency. So your brain knows what to do, when to do it. You're probably within your chronotypical timeframe of when you should be waking up. Between six and a half and seven. You said between six and a half and seven hours of sleep is generally what you get.

[Chelsea Clinton]

Six and a half to seven and a half.

[Dr. Michael Bruce]

You. You've got. I think you're actually better at this than you think you are. So here's the deal is you're starting to already pull in different pieces of information that could be valuable. One is how often have you run that week? Or did you do a long run or did you do a quick run? Right. Was it treadmill versus outside? All of those factors can make a difference in your motivation, in your ability to run and your performance, which of course has an effect on sleep. Sleep running in particular turns out to be really good. Now you probably run a little bit longer than many other people do, but all you have to run is about 25 minutes and then you will get the boost of sleep quality that you will get from cardio. So everybody who does Cardio for approximately 20, 25 minutes a day, we see an increase in their overall sleep quality. Believe it or not, it's the easiest way to improve sleep quality. Other than having a consistent wake time and bedtime, those turned out to be important. But believe it or not, your wake up time is much more important than your bedtime.

[Chelsea Clinton]

So explain that to me because that is true for me. Not to now make it all about me, but like I have noticed, you

[Dr. Michael Bruce]

know, it is your podcast.

[Chelsea Clinton]

Oh, well, thank you. I guess that's true. I do wake up around the same time.

[Dr. Michael Bruce]

Perfect.

[Chelsea Clinton]

And I really like to run in the mornings. I obviously don't do that when my husband is traveling. I'm not gonna leave my children by themselves. But even if I say to myself, like, oh, I could sleep later tomorrow, I don't like, I still wake up at like 5:30.

[Dr. Michael Bruce]

No, that's good. That's exactly where we want to be. So the reason that waking up is the more important than going to bed has to do with your biology. So when you wake up in the morning and your eyes open up, you have a special cell in your eye called a melanopsin cell. And it sends a signal to the back of your brain to turn off the melatonin faucet in your head. Right? It sets a Timer for exactly 14 hours later. It's called the melatonin phase response curve. And so, so 14 hours after you open your eyes is when melatonin starts. It takes about 90 minutes for it to get up and in. So let's say you're waking up at. Let's make the math simple. At 6 o' clock in the morning.

[Chelsea Clinton]

Okay.

[Dr. Michael Bruce]

Then at 8 o' clock at night is when melatonin starts. Takes till about 9:30 for it to get going in your brain. You start to get sleepy, you go to bed. By 10 right. So now you're sleeping 10ish, 11ish to 6. That works really, really well. Until Saturday shows up. And then Saturday you say to yourself, I don't want to get up at 6, 6, I'm gonna get up at 8. The problem is I don't do that. I know you don't.

[Chelsea Clinton]

I still wake up.

[Dr. Michael Bruce]

Yeah, that's good, that's good. But all for all the listeners out there who don't, that becomes problematic. Right. Because what we're, what we're showing here is the time that you wake up directly affects when your brain produces the hormone that makes you fall asleep. So by consistently waking up at the same time every morning, your body will consistently produce melatonin at a particular time at night. And that's what helps. By the way, if you're waking up at the same time every day, I can assure you you're not going to stay out until 2 o' clock in because you know you're gonna have to get up at whatever time and your body will do it anyway.

[Chelsea Clinton]

And Dr. Bruce, what about for people who travel a lot or who have jobs with variable hours? Like, what advice do you have for people who have different rhythms in their lives that then affect their circadian rhythms?

[Dr. Michael Bruce]

Absolutely. So I've taken care of a few rock and rollers in my day.

[Chelsea Clinton]

Quite literally, probably. You probably mean that literally.

[Dr. Michael Bruce]

Yeah, literally. Like one of them. I'm allowed to talk about my dear friend Steve Aoki. If he's a DJ, he doesn't go on stage until 11:30 at night and he doesn't come off stage until 2, 3 o' clock in the morning. And then I'm responsible for his energy to be able to get him back in bed, on an airplane and off to the next show. Right. And so he has a very odd, strange schedule. Now, to be fair, not everybody's got the same schedule. Steve Aoki does. Right. But let's say you're a shift worker,

[Chelsea Clinton]

or if you travel a lot for work, or you're a shift worker, what advice do you have?

[Dr. Michael Bruce]

So, believe it or not, this has been solved. There's an app that I use for this. Full disclosure, I'm both an investor and partial developer of said app. It's called Timeshifter. And so it's pretty interesting. We've actually discovered a way by using light, melatonin, caffeine and napping in a particular order, where it just turns out that, believe it or not, jet lag is a math problem.

[Chelsea Clinton]

It's so funny. I feel like My husband does all those things. He travels a lot for work. And now I'm going to have to tell him about your ex.

[Dr. Michael Bruce]

So here's what's fascinating is we learned about 20 years ago that if you take a particular frequency of light and shine it at your eyeballs for a particular period of time, we can actually move your entire circadian rhythm by almost eight hours. We literally move your internal biological.

[Chelsea Clinton]

What?

[Dr. Michael Bruce]

Yep.

[Chelsea Clinton]

I'm sorry, wait only 20 minutes and you can shift your whole circadian rhythm by eight hours?

[Dr. Michael Bruce]

Yep, that's about right.

[Chelsea Clinton]

Okay, tell me more.

[Dr. Michael Bruce]

So here's what ends up happening is melatonin cannot be produced in the presence of a particular frequency of light. Turns out it's blue. Blue light. It's not actually the color blue, it's the frequency. So 460-480nm of light. But what we've discovered is once we put this light in front of your eyeballs, your entire body circadian rhythm shifts, right? And then your body wants to go to bed eight hours different than when it did before. So if we know where you are. So let's say you're in New York and let's say he's going to Paris, right? And you've got like, what is that, a six, seven hour time difference there? So what we would do is for two days before he left, we would use light melatonin to help him fall asleep at this new time. Caffeine to keep him awake when he's supposed to be awake and napping, right in a particular order. I can have him land on Paris time, guaranteed. Every single time. The science is so clean on it, it's ridiculous.

[Chelsea Clinton]

That is so cool. All right, so there's a lot of talk about how you shouldn't be looking at your phone or your computer before bed. How does that relate to what you just said or the it totally different.

[Dr. Michael Bruce]

So it's somewhat similar, but really more different than similar. And so here's what I'll tell you is when you look at your phone, there's just not a tremendous amount of blue light that's coming from your phone that's going to make that big of a difference. However, if you're trying to get your high score on Candy Crush, you really ain't trying to go to bed, you know what I'm saying? Like, it's about engagement. And so if you're scrolling on Facebook or Insta and you're watching reels or all these other things, that actually produces a significant amount of energy inside what's called your sympathetic nervous system. So you're. You have a central nervous system that breaks out into sympathetic and parasympathetic. Parasympathetic is the rest and digest. Sympathetic is like the cortisol. Like fight or flight. Yep. And so when you're scrolling, you're hitting fight or flight right before bed, which really isn't particularly helpful. I'd rather you read a book. Like you said. I read a few pages of my book and then I start to get tired and then I go to sleep. That's honestly asleep. Probably the best way to do this. Now, full disclosure, once again, my wife falls asleep with the television on every single night. Big screen TV in our bedroom, our two French bulldogs in the bed with her every single night. And I'm the sleep doctor, for God's sakes.

[Chelsea Clinton]

Okay, so do you have to wait and then you turn off the tv?

[Dr. Michael Bruce]

So there is a timer built into the television and I do go to bed a little bit later than she does. So I walk in and sneak in and I click the timer and the dogs are usually right there snoring right next to me. So I've got my CPAP on. I can't hear a thing. It's all good.

[Chelsea Clinton]

You know, we talked about, you know, the, the cool room and, and why that actually has some real utility for people.

[Dr. Michael Bruce]

Yep.

[Chelsea Clinton]

I'm curious though. You know, I keep hearing about or have friends who have tried different beds that they say help them sleep.

[Dr. Michael Bruce]

Let's talk about that for a second.

[Chelsea Clinton]

Also different chairs.

[Dr. Michael Bruce]

Yeah. Here's what I'll tell you is you're a runner, right? I am. You could run a race in flip flops with the boombox on your arm, but your time wouldn't be too good. Right.

[Chelsea Clinton]

That sounds terrible to me, but yes, I could if I.

[Dr. Michael Bruce]

Right. Same holds true with sleep. Right. But if you have your asics on and your dry fit wear and some good tunes, you can lay it out there and really have a good time. Same holds true with sleep. Equipment matters. So if you're sitting underneath a polyester duvet that's trapping heat on you all night long, you are not going to sleep particularly well. Right. You should be changing your linens based on the seasons as an example. So having a thick duvet during spring and summer probably is. Isn't the smartest way to go about doing things. Right. Now, what you ask is a really interesting question, which is, what about these beds? And I've seen these thermoregulatory devices that are out there. Things that can make you hot, things that can make you cold. Michael, do they really work? The answer is yes, they do. So there's really three major factors that I would argue affect sleep, heart rate, temperature and anxiety. Those are the three big things that you all want to go down in order for your body to be able to sleep. And by the way, anxiety is directly related to heart rate and temperature. So if you just get your anxiety down, everything else has a tendency to come down. Now let's say that you run hot, like your body just runs hot. So there's definitely some things out there that I like. There's a product out there that's a pad that has a little tube that runs through it and you can run hot water or cold water through that tube. Remember, your circadian rhythm reaches a peak and then drops all night long until about 1 o' clock in the morning and then you wake up. So we can actually prevent sometimes those awakenings or those thermoregulatory problems with one of these types of pads. So I definitely recommend them. But I'm also going to tell you this, in some cases it might be easier to try this little trick first. So I'm going to give everybody kind of a super duper hack that doesn't cost any money. So what you do is you go out and you buy just a plastic bottle of water, two of them, stick them in the freezer, right? Freeze them up, then stick them into your kids like tube sock, like their athletic socks, and then take one and put them under the covers and put one on either hip. Oh, it's like having your own little mini air conditioner. And it lets you know, hey, is thermoregulation something? Because some of these pieces of equipment can, they can be a little on the pricey side. But I always tell people, try the frozen water bottle trick. And if that starts to help you sleep a little bit better, that's when you invest in one of those big thermoregulatory devices. But they work and they work well.

[Chelsea Clinton]

You know, Dr. Bruce, we talked about lettuce water and you know, tart cherry and sparkling water and whatever else is in that concoction.

[Dr. Michael Bruce]

Yes.

[Chelsea Clinton]

How much does food affect how people sleep?

[Dr. Michael Bruce]

So there's a lot. So believe it or not, spicy food can give you nightmares before bed, especially if you're eating something that you don't not used to eating. So for example, if you're of a particular ethnicity and you're constantly eating spicy hot food, then you're probably fine. But if you're me you go into your favorite Thai food restaurant and you happen to order the Thai food at a level of four versus a level of two. My sleep is going to be ruined for the night because I'll have such spicy stuff and that can have a big effect. Timing really probably has the bigger effect than the actual what you eat of it all. So the more time that you have between your last bite of consumption and lights out is going to really help you determine whether or not it affects your sleep. Because it affects your heart rate and it affects your temperature. Right? Remember, temperature, heart rate and anxiety are the three big things that have a big effect on your sleep. Now there are some people out there that stop eating at noon and don't eat anything all day. I know that is a stretch. I'm not advocating for that in any way, shape or form.

[Chelsea Clinton]

I eat three meals a day.

[Dr. Michael Bruce]

I advise nothing wrong with that.

[Chelsea Clinton]

Sort of old fashioned that way.

[Dr. Michael Bruce]

So what I'm here to tell you is, is if you stop food, food and drink approximately three to three and a half hours before lights out, you're going to be in much better shape and your body is going to sleep a whole lot better. What should you eat? I like meals with not too high levels of protein. If you're going to eat protein, you want protein that's high in omega 3s because that's going to be helpful for sleep. But it's if you're having a ribeye steak and then you're falling asleep an hour and a half later, you're not going to sleep well at all because your body has to actually increase your, its internal heat in order to actually digest that big lump of protein that you've kind of just put into your stomach. So having a lighter, on the lighter side, dinner, having your biggest meal at lunch is probably the best idea. I know not a lot of us have a tendency to do that, but that's definitely going to be certainly more helpful. Carbs, by the way, make you feel sleepy. So a lot of people and for breakfast they're like, oh, I'm going to go get a bagel, you know, for breakfast. Look, whenever I'm in New York, York, the best bagels in the world, I always love and I always enjoy it there. But as soon as I eat a bagel, like my eyes get heavy. Like, like that is a carb bomb. But you want to be thoughtful about the carbs for sure.

[Chelsea Clinton]

Talk to me about caffeine because I feel like, oh yeah, you know, some people are like, I can't drink coffee after 2 o'. Clock. And some people are like, I can have an espresso after dinner and still sleep fine. Is it idiosyncratic or are there real rules? We should be my.

[Dr. Michael Bruce]

It's genetic.

[Chelsea Clinton]

It's genetic.

[Dr. Michael Bruce]

Yeah, it's genetic. So my doctor, the woman who takes care of me, she has an espresso every single night before she goes to bed. And I'm like, carrie, what are you doing? I'm the freaking sleep doctor. Like, you can't keep doing this. And she's like, michael, caffeine doesn't affect me. And I'm like, bs of course it does. It affects everybody. And then I was like, okay, let's put your money where your mouth is. So I had her go do blood work. So I became the doctor in this patient becomes doctor in this particular scenario. And it turns out that her body doesn't have the enzyme that metabolizes caffeine. She was right. It just flies right through. Through her. It's super duper rare. I want to be very clear. It's super duper rare to have that. And a lot of people who tell me, oh, I can drink a cup of coffee and go right to sleep, usually what's honestly going on is they're so damn sleep deprived, they're overriding that caffeine. But when it's affecting your brain, it doesn't allow you to get into the deeper stages of sleep. And remember, as we get older, we want those deeper stages of sleep. We want to avoid the Alzheimer's and allow the glymphatic system to come in and clean out your shrunk pumpkin brain, by the way, we want that to happen. And caffeine is one of the things that can block that system as well. So we want to be thoughtful about having caffeine earlier and earlier in the day. Generally speaking, I tell people, stop by two because the half life of caffeine is between six and eight hours. And most people are reasonably efficient metabolizers. But as you get older, your metabolism slows down, so that can be later. So I tell people, stop at two and then after a couple months, stop at noon. And then after a couple months, stop at 10. And look, if you want to have caffeine from 8:30 to 10, I don't think I care one way or another. But if you stop by 10, you have a much greater shot at being able to fall asleep.

[Chelsea Clinton]

I try to not drink caffeine after two.

[Dr. Michael Bruce]

How's that go for you?

[Chelsea Clinton]

Most days? Okay, all right. But I'm not going to get to that before 10am window. I would set myself up for abysmal failure.

[Dr. Michael Bruce]

Well, just keep going where you are. You'll be just fine. I told you at the beginning of the pod, you're probably better off than you think. But just the fact that you stop at two really, really good. One of the things we didn't talk about, but we should, because it's in between food and caffeine, which is sugar, Right?

[Chelsea Clinton]

All right. Yeah, talk about sugar. And then I want to ask you all about supplements too.

[Dr. Michael Bruce]

Sure.

[Chelsea Clinton]

But talk about sugar.

[Dr. Michael Bruce]

Absolutely. Let's talk about sugar. Sugar actually slows down melatonin production and so that's not good. We don't want that to happen. And so I hate, hate, hate to say this because to be clear, ice cream is my Kryptonite. It just always has been. I don't know why. Haagen Dazs Swiss Almond. But anyway, if you have a lot of sugar right before be bed, it really has a lot of problems. Number one, the carbs make you feel sleepy. But unfortunately, the sugar slows melatonin production down. The dairy is probably not really good for me anyway, if it's ice cream. So it's probably not the best idea to have large, big chunks of sugar. Better that you have that earlier in the day, like before your run, for example, or right after a workout. That's probably the better time for you to have sugar. But we can talk about supplements if you want.

[Chelsea Clinton]

Yeah, talk to me about supplements. I mean, I think we've already talked a little bit about melatonin, magnesium. I know, though there are many others that at least I have seen in various claims. So what does the science tell us as it relates to supplements and sleep?

[Dr. Michael Bruce]

Great question. I'm so glad you asked. So I have a very staunch stance on supplements. I'm pretty clear about it. Everybody should just go do blood work. That's the place to start. The idea of supplementation is you're not getting something in your diet, so you supplement your diet by adding a vitamin or a mineral. To be clear, nobody on earth has a deficiency in ashwagandha. Okay? They may have a deficiency in vitamin D or magnesium or iron, but they don't have one in ashwagandha. That's my best joke too. So, like, that's what I try to tell people is go do blood work first and then see what's deficient. Right. Believe it or not, Chelsea, in 25% of the cases that I see, just fixing the deficiencies clears up the sleep problem right away. There's several that I look for. I do look for magnesium, I do look for iron, I do look for vitamin D and I do look for melatonin. Those are the biggies. Now, I'm going to also be honest with you, there's 13 different types of magnesium out there. And so a lot of people don't know what they should or shouldn't have and there's limited research. So I did a double blind placebo controlled study on a particular brand of magnesium. So I have high confidence that it's going to work in my patients. But people need to be thoughtful. You don't want to just go willy nilly trying because just because some supposed sleep expert says, oh, go try magnesium xyz doesn't necessarily mean that it's true. You should go and look up the studies and make sure that the dosage works for your gender at your age group and things like that. But I will also tell you most people are deficient in magnesium and most people are deficient in vitamin D. So it's probably not going to hurt you one way or another. But what I want to avoid is people overdosing because when you have too much magnesium, it causes diarrhea in the middle of the night and that can be highly disruptive.

[Chelsea Clinton]

I do want to move to our fact or fiction segment where I will throw some things out and you're going to tell me if they're fact or fiction or we don't know yet. Or nuance.

[Dr. Michael Bruce]

You bet.

[Chelsea Clinton]

Okay. Taking a warm bath before bed can help you go to sleep. Fact or fiction?

[Dr. Michael Bruce]

Fact. It absolutely will.

[Chelsea Clinton]

Even though you should be cool when you're in bed. But a warm bath before bed, yes.

[Dr. Michael Bruce]

Such a good listener. I love it.

[Chelsea Clinton]

I mean, I try, I try.

[Dr. Michael Bruce]

Yeah, you're doing it. So here's what you're doing is you're artificially raising your core body temperature by getting into a bath and then it drops and that signals your brain to release melatonin. There's been at least two placebo controlled studies that were done for people depending upon temperature and things like that. And it's been shown that it helps, but you need to do it like 90 to 120 minutes before lights out because you need to give your body time to tick down in temperature. You could even do a sauna if you wanted to.

[Chelsea Clinton]

At that time, we didn't even talk about saunas, which I feel like are also so much the rage at the moment. Warm milk before bed also can help you.

[Dr. Michael Bruce]

You get sleepy so it can, but there's a nuance here. So to be clear, what most people think is that there's a, there's a substance in it called tryptophan that makes you feel sleepy. You'd have to drink almost a gallon of milk to get enough tryptophan to make you feel sleepy. Okay. Milk itself, it's a lot of milk. It's kind of gross. I'm pretty sure nobody, nobody could do that. However. However, if when you were younger and you had a hard time sleeping, and let's say your grandma brought you warm milk at night, then that cognitive association will actually make you feel comfortable, calm, and then allow you to sleep. So to be clear, it's more situational if it happened to you when you were younger and it was worthwhile and it worked, versus the actual substance of milk itself.

[Chelsea Clinton]

If you wake up in the middle of the night and you can't go back to sleep, you should get out of bed for a bit. Fact or fiction?

[Dr. Michael Bruce]

So this has got some nuance in it, but I would say that it's fact, but only if you're starting to get anxious over time. So again, this is the number one thing that I get asked. And so I have a breathing technique that I teach people to do in the middle of the night.

[Chelsea Clinton]

Oh, tell me more about the breathing technique.

[Dr. Michael Bruce]

So I want to be clear, I did not create this technique. Dr. Andrew Weil, Harvard trained naturalist, came up with this idea. It's called 4, 7, 8 breathing. I'll send you a video so you can check it out. I think you'll like it. Okay, but it's exactly what it sounds like. Slowly breathe in through the nose for a count of four, hold for a count of seven, and then lightly push out through the mouth for a count of eight. You want to hit about 20 cycles

[Chelsea Clinton]

of that, but only in the middle of the night. This is not what you would recommend someone do if they're trying to fall asleep.

[Dr. Michael Bruce]

You could do it as you're, as you're trying to fall asleep. Here's what this does is it lowers heart rate in either situation. And by the way, you can use this technique and do five cycles of it just to lower your heart rate and become present. It's just getting to the 20 cycles that lowers your heart rate. Now, there's a couple of nuances here. Number one is when I do this technique, it's dark, right? It's quiet. I mean, it's in the middle of the night. Because I've had that problem myself on Occasion I lose count. And when I lose count, I get anxious. And when I get anxious, I get pissed off and then my heart rate goes up. So here's what I tell people is take your fists and make a light fist. And then when you get through one cycle, stick out a finger and another cycle, stick out a finger. And when you get to 10, then you wrap them back and then you're at 20. Also, you don't have to hold for seven and push eight on your first tries because that can be difficult. So I like to have people start doing 4, 5, 6 breathing, then move to 4, 6, 7 breathing, then to 4, 7, 8. Now a lot of people say, well, what about box breathing where I just breathe 4, 4, 4, 4? That does not work. Because what happens is you get so used to it, you can then start to think about other things. And that's when monkey mind comes into play. So monkey mind is when you're up in the middle of the night and you can't stop thinking. Right? And so the way you get rid of that is while doing 4, 7, 8 breathing, you pick picture the number on the count. So as you're breathing in, you picture a four, then a three, then a two, then a one, then you picture a seven, then a six, then a five, all the way down and you picture one back to eight, right? And so you do ascending, descending, ascending. And what ends up happening is your brain can't count and be upset at the same time. It's actually impossible to do. So you're doing a twofer, you're distracting your brain, your heart rate is going down and usually people fall. Right, right to sleep.

[Chelsea Clinton]

That is fascinating. It works if you haven't slept for a few nights, you can catch up on your sleep debt by sleeping more. Okay, tell me more.

[Dr. Michael Bruce]

Yeah, nuance here. So it depends on how little you slept. So if you only slept for like three hours, you know, every day for a week, then yes, you will catch up on some sleep on the weekends. But as an example, if your body needs, let's say seven and a half and you're getting six and a half, it's pretty difficult for you to catch that back up, right? So if you have large deficits, then you can catch up. But to be clear, it's not a one for one ratio. It's not like I missed 30 minutes, so I'm going to get 30 minutes. It really unfortunately doesn't work that way. We have this argument in sleep medicine every other year, some people say you can make up for sleep Debt. Some people say you can't. And it literally flips, flops back and forth with the research all the time. So what I tell people is, is wake up at the same time every single day, right? You will make yourself more consistent and you will learn exactly how much sleep you need and you'll be fine.

[Chelsea Clinton]

Dr. Bruce, what did we not talk about that we should have talked about?

[Dr. Michael Bruce]

I think the one thing that we should have talked about that I think is important for your audience is sleep testing. Most people refuse to get sleep tested because they're afraid that they're going to get diagnosed with sleep apnea and end up wearing a CPAP machine all night long. And so that's a terrible reason to not, not get tested. There are a lot of different ways that I can treat sleep apnea in a person without using a CPAP machine just to kind of go backwards. What is sleep apnea? Sleep apnea is a situation where your throat closes in the middle of the night and you stop breathing in your sleep. As I mentioned earlier, this happens to me quite a bit. And a CPAP machine is an air compressor with a little mask and a hose shoots air straight down your throat. And when it hits that area, it just ever so slightly opens it up. It doesn't hurt, it doesn't cause any side effects, works 99% of the time. But you sleep with a mask on your face all night long. And it's not the most sexy thing in the universe, okay? However it works. Now, to be clear, there are mouth guards that works for sleep apnea. There's a pill that's going to be out in the next 18 months for sleep apnea. So not getting tested is really stupid because when you don't get tested and your disease goes unchecked, you end up with cardiac issues. Then you end up with what's called an irregular heartbeat, then atrial fibrillation. And then once you get afib, it's really hard to move that train in a different direction. And then we're dealing with many more complicated factors. So I really want to double tap on the idea that if you or your partner, if you think either one of you could possibly have a sleep disorder or disordered sleep, it's probably worth spending the 200 bucks to have the sleep test done. By the way, you don't even have to do it in your house anymore. I can send a kit to your home. Any sleep doctor, by the way, can do these. They're called HSTs, home sleep tests, where you wear something on your wrist and it basically tells you if you've got sleep apnea or not. So I really want people to be thoughtful about. About that and kind of think about that. I also want to make a special point for women in particular. A lot of women, when they do these sleep tests, they have a score that's under what we would consider to be a threshold for diagnosis. But they don't get told what to do. So what happens is they say, well, you only stop breathing in your sleep four times an hour, so there must not be anything wrong with you. And they stick them on an antidepressant like, nothing could be worse because you've just discounted somebody completely. You've told them that they now need to be on an antidepressant depression drug, which is completely inappropriate, and they stop breathing in their sleep once every 15 minutes. Like, think about it like this, Chels. If you woke up once every 15 minutes, you'd feel like crap the next day, right?

[Chelsea Clinton]

Yes.

[Dr. Michael Bruce]

And that's not even. That doesn't even reach diagnostic criteria. You have to stop five times an hour. That's wild to do that. So I want women to know that if you do get a sleep test back that is subclinical, what we call subclinical, it's still worth treating. And by the way, it's not just weight loss, okay? Like, look at me, I'm 165 pounds soaking wet, not a big person. It's not just about losing weight. Now, will weight loss help? In many cases, it will. I will tell you that some of my patients who've been on GLP1s, that's helped them get to the point where they could either tolerate their CPAP better or, in some cases, gotten them off their CPAP.

[Chelsea Clinton]

Wow. Dr. Bruce, thank you so much. I've learned a lot. I certainly hope we have the chance to continue the conversation because I have no doubt that there's a lot more still to learn. Right. Really, just thank you for everything.

[Dr. Michael Bruce]

It's super fun. I love, obviously, have passion for the topic. Thank you for allowing your audience to hear from me. I certainly appreciate that. And I'm just excited about it all, you know, and also want to do one final thing and just wish all of your audience sweet dreams.

[Chelsea Clinton]

Oh, that's a great note to end on. Thank you, Dr. Bruce. You can follow Dr. Michael Bruce on YouTube and Instagram hesleepdoctor. Thanks for listening. Talk to you next week. That Can't Be True is a production of Limonada Media and the Clinton Foundation. The show is produced by Kathryn Barnes Mix and sound design by Johnny Vince Evans. Kristin Lepore is Senior Director of New Content and Jackie Danziger is VP of Narrative and Production. Maggie Kral Shore is our Managing Director of Partnerships. Executive producers are Jessica Cordova Kramer, Stephanie Woodles Wax, and me, Chelsea Clinton. Special thanks to Erika Goodmanson, Sara Horowitz, Francesca Ernst Kahn, Caroline Lewis, Sage Falter, Barry Lurie Westerberg, Emily Young, and the entire team at the Clinton Foundation. You can help others find our show by leaving us a rating and writing a review. And if you can think of someone who might benefit from today's episode, please go ahead and share it with them. There's more of that can't be true with Lemonada. Premium subscribers get exclusive access to bonus content when you subscribe on Apple Podcasts. You can also listen ad free on Amazon Music with your prime membership.