Melatonin for Sleep: Microdosing, Sleep Apnea, CPAP vs Inspire

Summary

The Dr. Gundry Podcast

Episode: Melatonin for Sleep: Microdosing, Sleep Apnea, CPAP vs Inspire
Date: November 4, 2025
Host: Dr. Steven Gundry

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Episode Overview

In this episode, Dr. Steven Gundry dives into the science of sleep as a critical pillar of energy, brain health, and longevity. He focuses on melatonin—dispelling myths about its use, sharing the benefits of microdosing, and explaining its vital role in mitochondrial health. The episode further explores simple, evidence-based habits for better sleep, delves into the causes and solutions for sleep apnea, and compares the traditional CPAP device to the newer Inspire implant. Dr. Gundry provides both clinical insights and practical tips for anyone looking to sleep better and live longer.

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Key Discussion Points & Insights

1. What is Melatonin Really?

• Not just a sleep hormone:
  • Most people think of melatonin as “the sleep hormone,” but Dr. Gundry emphasizes it is just as important as a mitochondrial antioxidant.
    • “Melatonin is not just the sleep hormone… melatonin is actually only one of two antioxidants in your mitochondria.” (06:55)
    • The other is glutathione.
• Melatonin production and blue light:
  • Melatonin is produced in the pineal gland in response to circadian rhythms, and crucially, to the absence of blue light.
    • Modern devices and lighting constantly emit blue light, disrupting this cycle.
    • “We’re constantly bombarded with that waking signal rather than the absence of that blue light with sundown, which normally would start the production of melatonin.” (05:24)

2. How Modern Lifestyles Attack Sleep

• The "Edison Effect":
  • The invention of the light bulb (specifically incandescent with its blue light spectrum) disrupted natural melatonin production.
    • Before artificial lighting, people only experienced yellow/red light after sunset, allowing natural sleep hormone release. (03:40-04:49)
• Aging and Melatonin:
  • Melatonin production diminishes with age, making good sleep and mitochondrial repair harder to achieve.
  • But Dr. Gundry suggests modern blue light overexposure, rather than just aging, is the main problem. (09:00-09:25)

3. Melatonin Supplementation: Dosage Matters

• Microdosing over megadosing:
  • Effective sleep induction usually only requires 0.1 to 0.3 mg.
    • “Very small doses of oral melatonin or sublingual melatonin, like 0.1 to 0.3 milligrams is really all you need to initiate the sleep cycle and that’s not much.” (09:56)
  • High doses (3mg, 5mg, 10mg+) often cause people to wake in the middle of the night when the effect wears off. (10:23-10:37)
  • Time-release formulations can help maintain sleep through the night but may cause morning grogginess for some.
    • “Try that out first… if you’re one of those people [who wake up groggy], then by all means think about the small doses, the 0.1 or 0.3 milligram.” (11:24)
• Potential cancer benefits:
  • Dr. Gundry references animal studies and personal clinical experience suggesting higher-dose melatonin (throughout the day) may offer anti-cancer effects, likely due to mitochondrial protection (11:45-12:13).

4. Melatonin in Foods and the Mediterranean Diet

• Food sources:
  • Pistachios have the highest melatonin content of any food; Dr. Gundry eats them daily (13:52-14:08)
    • “Pistachios have the highest melatonin content of any food. And you’re correct. I have a bowl of shelled pistachios every afternoon right before dinner.” (13:52)
  • Other sources include olive oil, red wine, and Mediterranean spices.
• Mediterranean Diet Theory:
  • Benefits may derive both from polyphenols and from a high dietary melatonin intake—both support mitochondrial health. (13:29-13:51)

5. Habits to Boost Natural Melatonin and Sleep Quality

• Light exposure management:
  • Dim screens and lights at night, use blue light blocking glasses
    • “There is a blue light dimming feature on every phone. Make sure to switch it on... particularly in your bedroom… put on a pair of blue blocking glasses.” (14:15-14:51)
• Get sunlight early:
  • “Try to get out early in the morning and get bright sunlight. That bright sunlight starts this circadian cycle. And get a dog. The dog will assure that you get out in bright sunlight.” (15:28)
  • For those in dark climates, consider a bright light box in the mornings (15:31-15:44).
• Avoid eating late:
  • Stop food intake 3 hours before bedtime.
    • “...we have created the perfect storm for not allowing our brain to recover every night in the way it’s supposed to recover.” (27:26)
• Supplement strategy:
  • Turkey (tryptophan converted to melatonin), pistachios, short-term use of low-dose melatonin, try timed-release melatonin for sustained effect. (15:53-16:20)

6. Why Good Sleep Adds Years to Your Life

• Memory, metabolism, and mood:
  • Poor sleep raises risk of cognitive decline, depression, metabolic issues, and even certain cancers (19:50).
  • REM sleep is vital for memory formation (24:09).
• Deep sleep “brain wash”:
  • During deep sleep, the brain “shrinks” up to 25%, squeezing out toxins including amyloid and tau proteins—a process crucial for dementia prevention.
    • “During deep sleep, we now know that the brain undergoes a wash cycle… the brain squishes out all the toxins that can accumulate, like amyloid, like tau, like bacterial toxins.” (24:07-27:26)
• Don’t eat late:
  • Digestion diverts blood flow from the brain, impeding this wash cycle and increasing long-term neurodegenerative risk (27:26-29:43).

7. Sleep Apnea: Causes, Risks, and Solutions

• What is sleep apnea?
  • Characterized by repeated pauses in breathing during sleep, often from the tongue falling back and blocking the airway (29:43).
    • Snoring, gasping, dry mouth, headache, choking, and daytime fatigue are warning signs.
• Physical and lifestyle risk factors:
  • Small lower jaw from evolutionary diet change (31:15-33:02)
  • Weight gain and fat deposition in the neck/tongue worsen airflow
  • Alcohol, sedatives, and reflux also exacerbate apnea
  • For women, postmenopausal hormone changes and weight gain are factors
• Health dangers:
  • Many people with sleep apnea are “totally unaware” they spend much of the night hypoxic.
  • Chronic, untreated apnea damages the heart and brain, seen even in subtle blood biomarkers like troponin I and NT-proBNP (37:39-40:52).
    • “Who would have guessed that every night their heart was basically having a mini heart attack that they were completely unaware of.” (37:39)
• Weight loss as therapy:
  • Losing fat from the neck and tongue often allows patients to stop using the CPAP device (40:52-41:19).
  • Side-sleeping, not back-sleeping, is also recommended, with specialized pillows to help.

8. Sleep Apnea Treatment Options: CPAP vs. Inspire

• CPAP remains the gold standard:
  • “It is the gold standard. It’s proven to reduce sleep apnea episodes. It lowers blood pressure, improves daytime energy…and reduces cardiovascular risk.” (45:01)
  • Drawbacks: mask discomfort, fitting/travel hassle, compliance.
• Lifestyle interventions can be curative:
  • Weight loss, avoiding alcohol, dietary changes, and physical sleep side positioning often allow patients to stop using CPAP.
  • “I’m amazed at how many people we can get off CPAP by simple dietary changes, by putting them on their left side, by weight loss.” (45:39)
• Inspire implant:
  • FDA-approved for those who cannot tolerate CPAP, but only for certain BMI and severity ranges.
  • Stimulates the hypoglossal nerve to keep the tongue forward and airway open.
    • “It uses a good principle that kind of pulling the tongue out of the way may be useful.” (49:44)
  • Pros: No mask or hose, improved quality of life for some.
  • Cons: Requires surgery and follow-up programming, expensive, possible surgical risks, not covered by insurance for all.
  • “But in the meantime, lifestyle modification is still the number one thing I do…” (51:35)

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Notable Quotes & Memorable Moments

• “Melatonin is not the sleep hormone, but melatonin is really the mitochondrial antioxidant that you want.” — Dr. Gundry (07:07)
• “More melatonin may actually not be better, just enough to initiate that sleep cycle is ideal.” — Dr. Gundry (10:02)
• “Pistachios have the highest melatonin content of any food…” — Dr. Gundry (13:52)
• “During deep sleep, we now know that the brain undergoes a wash cycle. The brain can shrink by as much as 25%, very much like squeezing out a sponge.” — Dr. Gundry (24:07)
• “Who would have guessed that every night their heart was basically having a mini heart attack that they were completely unaware of.” — Dr. Gundry (37:39)
• “I’m amazed at how many people we can get off CPAP by simple dietary changes, by putting them on their left side, by weight loss.” — Dr. Gundry (45:39)
• “Lifestyle modification is still the number one thing I do with my patients with sleep apnea…” — Dr. Gundry (51:35)

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Important Timestamps

• [02:17] — What is Melatonin? Its roles & why blue light matters
• [06:11] — Melatonin as a mitochondrial antioxidant
• [09:56] — Effective dosing: Why microdosing melatonin is best for sleep
• [13:04] — Melatonin-rich foods & Mediterranean diet synergy
• [14:15] — Strategies to boost natural melatonin & sleep hygiene tips
• [19:50] — How sleep deprivation shortens lifespan (mood, metabolism, memory)
• [24:07] — Explanation of sleep stages (REM, deep sleep, brain “wash”)
• [27:26] — Why eating before bed harms your brain
• [29:43] — Sleep Apnea: What it is, why it matters
• [37:39] — Heart risk markers: How sleep apnea can silently damage your organs
• [40:52] — Weight loss, physical factors, and alternative therapies
• [45:01] — CPAP as gold standard, compared with Inspire implant
• [49:44] — Pros and cons of Inspire implant
• [51:35] — Why lifestyle change remains the first choice

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Actionable Takeaways

• Use only the smallest effective dose of melatonin (0.1–0.3 mg) for sleep initiation.
• Try time-release melatonin if you have sleep maintenance issues, but be mindful of possible morning grogginess.
• Eat melatonin-rich foods (especially pistachios, olive oil, red wine, Mediterranean spices).
• Stop eating 3+ hours before bedtime for optimal brain “cleaning”.
• Limit blue light exposure at night: dim/don’t use screens, use blue light blocking glasses.
• Expose yourself to bright daylight early each morning.
• For sleep apnea: Try losing weight, switch to side sleeping, and address lifestyle factors before resorting to medical devices or surgery.
• If suspected sleep apnea, pursue a sleep study (at-home options are now available) and don’t ignore snoring or partner complaints.

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This episode delivers both scientific depth and practical advice, empowering listeners to take easy, meaningful steps for better sleep, stronger mitochondria, and improved longevity. Dr. Gundry’s blend of clinical stories, humor, and personal routines makes the science accessible and actionable.

Transcript

[Dr. Steven Gundry]

Welcome to the Dr. Gundry podcast where Dr. Steven Gundry shares his groundbreaking research from over 25 years of treating patients with diet and lifestyle changes alone. Dr. Gundry and other wellness experts offer inspiring stories, the latest scientific advancements and practical tips to empower you to take control of your health and live a long, happy life.

Today we're tackling one of the biggest levers for energy, brain health and longevity sleep. You've asked me a lot about melatonin. Should you take it and how much? I'll explain why melatonin isn't a bedtime candy, why more is not better, and how tiny microdoses may support your circadian rhythm without leaving you groggy. Then can fixing your sleep actually help you live longer? The short answer is yes. We'll cover the simple science backed habits that tune your internal clock, lower nighttime inflammation, and set you up for healthier days and years. We'll also also dig into sleep apnea. Is CPAP still the gold standard? For many it is, and I'll share practical tips to eventually stop needing it. But what about the flashy newcomer you've heard about? Inspire the surgical implant that stimulates the airway to keep it open. I'll give you my take, who it may help, where it falls short, and the questions to ask before considering it. Bottom line, Better sleep isn't a luxury, it's a longevity tool. Stick with me and I'll help you build a smarter plan from melatonin basics to apnea solutions so you wake up repaired, not just rested. Stay tuned. We'll be right back.

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Let's talk about Melatonin. It's in the news almost every day. It's a popular influencer subject. But what is melatonin? Why is it useful? Where do we get it?

How do we find it?

So let's go from there. So most of us think of melatonin as the sleep hormone. And it is true that some of our melatonin is produced in the pineal gland inside the brain. And melatonin is produced in response to.

The circadian rhythm, exposure to bright light.

That'S controlled by an area of our brain called the suprachiatic nucleus, the scn, that literally controls our awake and sleep cycle. And as you've heard me write about, as you've heard me speak about, our circadian cycle is completely screwed up these days. In fact, some people probably correctly say that Edison is the cause of many of our modern ailments because he invented the light bulb. And prior to the invention of the.

Light bulb, which had the incandescent light.

Had a great deal of blue light that wasn't present in the lighting systems.

Prior to incandescent light bulbs, for instance, think about it. Even if you look at old movies.

Or recreation of old movies where candlelight or fire light or lights from kerosene lanterns or oil lamps of various types, whale oil was a popular light source. These were all in the shades of yellows, oranges and even reds. The incandescent light brought in the spectrum of full sunlight with a lot of blue light. Now, blue light is great for activating this awake cycle, but it's the absence of blue light that actually starts the production of melatonin in your pineal gland, which should signal the onset of sleep. And that was a really good system.

And think about it, even if 100.

Years ago you ate by firelight or even read a book by firelight, you had no blue stimulation to stop the onset of melatonin production.

Now, however, all of our devices, almost.

All of our lighting, are heavily blue light. Your screen that you're watching this with right now is a blue light emitting screen. Your television screen is a blue light emission screen. Most of the lights in your house.

Are blue light emitting.

So we're constantly bombarded with that waking signal rather than the absence of that blue light with sundown, normally would start the production of melatonin and that would flow with the normal sleep cycle. So melatonin's pretty good if that old system works well. But the other thing I think people are missing is melatonin is not just a sleep hormone. Melatonin is actually only one of two antioxidants in your mitochondria. Just a refresher course. Mitochondria are the energy producing organelles in almost all of your cells. They produce ATP.

Now, I've written books about this.

Producing ATP in your mitochondria is hard work. It's very damaging work to the mitochondria. And there are two antioxidants within your mitochondria that either undo that damage or try to prevent that damage. One of those two antioxidants is melatonin, the sleep hormone. The other is glutathione. And don't get me started about glutathione infusions. So those are the only two antioxidants in your mitochondria. Antioxidants like vitamin E, like vitamin C.

Yes, they're antioxidants, but they have nothing.

To do with your mitochondria. Protection only melatonin and glutathione. So one of the things I want.

You to take away from this today.

Is that melatonin is not the sleep hormone, but melatonin is really the mitochondrial antioxidant that you want. In fact, as I've written about in.

The Energy Paradox, there's good evidence that.

The reason your melatonin production goes up at night is because you need repair of your mitochondria in the neurons of your brain during sleep. And it's the melatonin production that actually facilitates the repair that goes on during the sleep cycle. And let's be clear. You have to have sleep. No one can go very long without sleep without their brain sputtering and going on overload. Believe me, the longest I have ever gone without sleep as a surgical resident.

Was four days without sleep.

I do not recommend it. Luckily, in the modern era of training doctors, there are prescribed times when, just.

Like an airplane pilot, we have to go to sleep.

All right, so melatonin is a mitochondrial protective. And the more we think of melatonin in that way, the better we'll have.

A better feeling of how to use melatonin. Now, melatonin protects mitochondria. So what happens when you don't have enough melatonin production?

And quite frankly, as we age, our.

Melatonin production slowly goes down.

So your repair of your brain slows.

Down, your sleep initiation slows. Many studies show it is harder the.

Older we get to start the sleep cycle. Is that because we're not making enough melatonin or because we are so exposed to blue light that we never get the message to let melatonin be produced?

I fall into the second camp that it's the blue light exposure that's the.

Problem, not the fact that we're just.

Not capable of making melatonin?

Now, melatonin is available over the counter, and there's two, if you will, competing versions of melatonin. First of all, it does not take much melatonin to initiate the sleep cycle. Very small doses of oral melatonin or sublingual melatonin, like 0.11 to 0.3 milligrams is really all you need to initiate.

The sleep cycle and that's not much. On the other hand, you will see.

3Mg, 5mg, 10mg, you'll even see higher doses. What's up with that? Well, twofold, these higher doses will absolutely.

Put you to sleep for most people.

But in my patient population, what I usually see from these standard higher doses.

Is yes, you will go to sleep.

But when that dose wears off, you wake up, usually 1, 2 o' clock in the morning and you can't go back to sleep. That seems to be universal in so.

Many of my patients.

That's why if you want to try melatonin for sleep, I either recommend the.

Tiny amount or the time to Release.

Melatonin like 3 milligrams. And always look for the word timed release. When we use that, it usually results in a much longer sleep cycle and it doesn't wear off. Now, some people are very sensitive to the lingering effect of melatonin and they notice that they wake up groggy. If you're one of those people, then by all means think about the small doses, the 0.1 or 0.3 milligram and.

Try that out first.

As I've written about in the Energy Paradox, there is some fascinating evidence that melatonin, because it's so critical in repairing mitochondria and that the mitochondrial dysfunction theory of cancer is a very reasonable theory.

Theory of cancer causation, that there are some interesting animal studies showing that high.

Dose melatonin certainly used across the day.

Can have an anti cancer effect. And I have used this in one of my dogs successfully and I have used it in several of my patients successfully. And I do think it's because it's not the sleep hormone, it's actually the.

Mitochondrial repair and defense hormone where that's important. Finally, melatonin is present in large amounts of foods. And in my last two books I've given a list of where the most melatonin rich foods are. And one of the intriguing theories of the benefits of the of the Mediterranean diet has always been, well, the Mediterranean diet is rich in polyphenols. And if you follow me, you know, polyphenols are plant compounds that are now recognized as prebiotics for our gut bacteria. And our gut bacteria then change these polyphenols into absorbable compounds that protect our.

Mitochondria by becoming mitochondrial uncouplers.

On the other hand, almost all of the foods in the Mediterranean diet that are rich in polyphenols are also rich in melatonin, including olive oil, including red.

Wine, and I could go down the list including spices.

So a companion theory to the Mediterranean diet is good for you because of the polyphenols is that the Mediterranean diet is good for you because of the melatonin content. Why? Because both of these are actually working at the mitochondrial level to protect your mitochondria.

Fun fact.

Pistachios have the highest melatonin content of any food. And you're correct. I have a bowl of shelled pistachios every afternoon right before dinner. For number one, they taste good, but.

I'm eating them for their melatonin content. And no, they don't put me asleep. Good news. All right.

How do we boost melatonin production naturally? Well, number one is eating these melatonin rich foods. Number two, you got to dim your screens. There is a blue light dimming feature on every phone. Make sure to switch it on. Please change over to non blue light lights, particularly in your bedroom and particularly.

If you're going to watch TV or if you're on a screen device. Put on a pair of blue blocking glasses.

A lot of them are really cheap. A lot of them you can wear over your glasses. I have several blue light glasses with prescriptions in them. But don't hesitate to put them on. Nobody's going to see you. You can, you can look kind of cool and gorky in the privacy of your own home. The other thing, try. Try to get out early in the morning and get bright sunlight. That bright sunlight starts this circadian cycle. And get a dog. The dog will assure that you get out in bright sunlight.

If you don't have bright sunlight in the morning.

If you live in the northern United States, then consider getting yourself a bright light source for a morning and looking at that. There's also very good evidence that this.

Really helps with seasonal affective disorder.

Supplement strategy. Hey, pistachios are great. Turkey is a great way.

Melatonin is manufactured through the tryptophan pathway. Same pathway, the serotonin is manufactured. And isn't it interesting that people really want to take a nap after Thanksgiving dinner because of the tryptophan in Turkey being converted to melatonin. That'll help.

Finally, short term use, low doses. If you want to experiment with melatonin.

If you find it's useful, then consider.

The time to release melatonin. You'll Bathe your mitochondria with melatonin throughout the night. So these are Melatonin 101. But think of melatonin not as the sleep hormone. But think of melatonin being produced to repair your mitochondria during sleep. And anytime you can repair your mitochondria.

Is a good time. So go have a bowl of pistachios and please buy them in the shell.

It'll slow you down.

Don't eat them by the handful out.

Of the bag already.

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Could fixing your sleep extend your lifespan? Okay, you wash your car, your clothes, your house, your dog, your dishes, you. But do you wash your brain? That's right. If you're not getting enough sleep, you're not giving your brain the proper cleaning cycle. And I'm not telling you anything you don't already know. But without at least seven hours of sleep each night, it's literally cutting years off your life. And sadly, it's probably cutting years off of your memory. So how in the world does losing sleep shorten your lifespan?

Well, let me count the ways.

Studies show a higher risk of cognitive decline earlier than normal. Chronic lack of sleep can lead to depression, which can lead to skipping exercise and, quite frankly, poor eating choices. There's been phenomenal research on the lives of shift workers. The lack of sleep correlates strongly with insulin resistance, metabolic inflexibility, overeating, and dramatic increase of cancer in shift workers. Now, let me give you a personal example. As a resident in surgery and heart surgery in the United States, particularly as a chief resident in heart surgery, the chief resident was literally on call 24 hours a day, 365 days a year. That meant if someone came in with a heart attack in the middle of the night and you were asleep, that meant you were doing that operation. And if you had a full schedule, the next day, so what, you didn't sleep? The longest I ever went without sleep was four days. And then I got three hours of sleep and went back at it. So during that time, I kept myself awake by eating carbohydrates. I cannot tell you the number of times I went to the snack machines at the hospital and bought Ding Dongs and Hostess cupcakes and candy bars. And I gained a lot of weight. I then went to England to do my pediatric heart surgery fellowship. And the difference was night and day. The chief resident, the senior registrar, was only on call every third night and was only on call every third weekend. So two out of every three nights, you were at home, you were not allowed to be called two out of every three weekends. You were not allowed to come into the hospital. And imagine my shock type A personality showing up on Saturday morning, my first weekend off after I had operated on little babies and children the day before to see them. And I was literally stopped at the ICU door by my colleague who said, what are you doing here? And I said, well, I'm here to see my babies. They said, no, you're not allowed in the hospital. We'll see you Monday. And I said, but I operated on these kids, they said, no, you trust us, we trust you. You're off. I dealt with guilt for a few weeks, but then I got used to it. I lost 30 pounds in one year just by getting adequate sleep. Those two weekends off, two out of three nights, just the lack of sleep was killing me because I was killing myself trying to stay awake by eating sugary foods. Dramatic example that I'll never forget. But sleep is one thing. It's the type of sleep that makes a huge difference. There's essentially three types of sleep. There is light sleep. Now, first of all, light sleep is good for you because we're now beginning to realize that sleep is the time when your mitochondria, those energy producing organelles factories in all of you, but particularly in the neurons of your brain, do the repair work. And we're beginning to realize that the reason melatonin is produced during sleep and right before sleep is not so much.

To put you to sleep.

But it's been discovered that melatonin is one of the two antioxidants that actually repair your mitochondria. So as I talk about in unlocking the keto code, we need to stop thinking about melatonin as the sleep hormone, but talk about it as the brain neuron mitochondrial repair hormone. So even light sleep is when this takes place. Now, many people have heard of REM sleep, rapid eye movement sleep. This is the time when you dream. Now, what's important about dreaming is that dreaming is the time when memories are taken from basically our short term memory bank and deposited into our long term memory bank. And it's the time that neurons send out what are called dendritic processes to connect up with another neuron to solidify this memory. So without REM sleep, you're going to lose a lot of the memories that you should be storing. But perhaps the most important is deep sleep. Now, deep sleep usually occurs early in the sleep cycle. And during deep sleep, we now know that the brain undergoes a wash cycle. And during this wash cycle, the brain can shrink by as much as 25%, very much like squeezing out a sponge. And as that brain shrinks, the brain squishes out all the toxins that can accumulate, like amyloid, like tau, like bacterial toxins. And it's this wash cycle, this deep sleep, that's really critical long term in protecting your brain. Now here's the problem. This wash cycle requires huge amounts of blood flow. That blood flow needs to be available early in the sleep cycle. But eating and digestion requires huge amounts of blood flow. And so after you eat for about three hours, maybe four, most of the blood flow in your body is directed down towards your gut to do digestion. I've said this over and over again, but when I was a young kid, if you ate lunch, your mother would make you wait for one hour before you could go swimming. Because everybody knew that if you were went before that you would develop cramps and die. Now there was some truth to that old wives tale, that is that during digestion all that blood flow went to your gut and it wasn't available to your muscles to go swimming and you could get cramps.

Would you die?

No. But the point's well made. What happens if you're eating near bedtime? Your brain is going to get a cramp because it's not going to get the proper blood flow to do the wash cycle. And this system called the glymphatic system is now really one of the cornerstones of why you really need to stop eating about three hours before you go to bed. Now we are a nation of late night snackers. But part of the reason we have an epidemic of dementia, of Alzheimer's, of Parkinson's, is that we have created the perfect storm for not allowing our brain to recover every night in the way it's supposed to recover. Finally, we have inundated our eyes with blue light. Almost all of our light bulbs emit huge amounts of blue light. Our computer screens, our TV screens emit huge amounts of blue light. That blue light literally tells our brain not to shut off, not to do the things it's supposed to do. So what do you do? Try not to look at a screen before bed. If you are going to look at a screen, get yourself a pair of blue light blocking glasses. There's number of them out there that are really good quality. You can wear them over glasses, you can clip them on glasses. There's no excuse not for wearing them. Darken your room as much as possible. Get light blocking shades, get light blocking masks. Try time to release melatonin. Start with a small amount, say 3 to 5 milligrams if you need to work your way up to 10 milligrams. But make sure you buy time to release melatonin, not the straight stuff.

So let's talk about sleep apnea, something that I deal with with a lot of my patients. And I want to help you kind of make it through the muddy waters of what sleep apnea is, why you probably ought to know about it and probably why you ought to do something about it. If you have it so have you ever woken up in the middle of the night gasping for air, or noticing that your mouth is incredibly dry? Or worse, have been told that you snore like a chainsaw? Well, you might just have sleep apnea. Now, quick statistic. An estimated 1 billion people worldwide suffer from sleep apnea, and many are undiagnosed. So before we dive into this global epidemic, discussing what causes sleep apnea, why it's so common, what treatments work and which may not, and whether new high tech devices like, like Inspire are worth considering, please rate and review this podcast on the platform you're listening on, and make sure to tell your friends and family so they can enjoy it too, if you like it. So the definition of sleep apnea is actually repeated pauses in breathing during sleep. It's often due to the tongue falling back into the back of your mouth, blocking your airway. Now, there are many other causes of sleep apnea, including what's called central sleep apnea, which we're not going to talk about today because it's a totally different treatment. But most sleep apnea is caused by a disturbance in the upper airway. Now, this can be caused by multiple factors. Sometimes it's as simple that you have not a very large lower jaw, and that your lower jaw, interestingly enough, has been getting smaller and smaller with the passage of years. In studying humans like I do, we used to have a pretty big lower jaw. But one of the theories of why our lower jaw in particular has become smaller is we no longer need an aggressive jaw to eat the food we eat because most of our food is cooked and then pulverized into a fine powder or we're drinking a smoothie. So we really don't have much use for a large jaw anymore. Be that the case, many people who do have a smaller lower jaw do suffer from sleep apnea because quite frankly, there's not enough room in your mouth for your tongue. And that as your tongue rests literally on the back of your lower jaw, in some people when they sleep, the tongue tends to drift backwards, closing off the airway, and that causes oxygen levels to drop in your blood. And if you're lucky, that fall in the oxygen level suddenly stimulates you awake and you take one of those sudden deep breaths if you're lucky. Unfortunately, a great number of people, because it's happening for so long and so often that that reflex of either oxygen falling or carbon dioxide rising no longer is very vigorous. And so many of my patients with sleep apnea, when we do oxygen tracking on their sleep, will have SpO2s partial pressure of oxygen in the 70s or 80s, whereas really the lower limit of normal is about 90 to 92. And they're totally unaware that half of the time they're asleep, they're profoundly hypoxic, they're deprived of oxygen and they're totally unaware of it. In fact, I have a good friend who is a cardiologist who his wife really hated sleeping with him because he snored so bad and we happened to have gone on vacation with him and they were in the bedroom in the hotel next to our bedroom and we.

Could hear him through the room.

And because he's such a good friend, I said, do you know you have sleep apnea?

He said, oh no, I don't have sleep apnea.

Are you kidding? I said, I'm telling you, you got it, go get checked. Well, so he got sleep study and the doc who did a sleep study. So, you know, quite frankly, I can't imagine why you're alive and how you could possibly function as a cardiologist because you have some of the worst sleep apnea that I've ever seen in my life. And he had become so chronically used to this that what he thought was a normal day and how he felt going throughout the day and how tired he was was because he was very busy cardiovascular. But the point is he had severe sleep apnea and now that he's on a CPAP machine, luckily his wife now sleeps with him again because she couldn't take the snoring. But his activity at work is sterling compared to what he thought. He was just tired all the time from a busy practice.

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GUNDRY I first started getting into sleep apnea when we used to have a really fantastic blood test for very subtle myocardial ischemia. That means the heart muscle is not happy. Many of you know that if you think you're suffering from a heart attack, you go to the emergency room, we draw some blood on you looking for troponin T, which is a measurement of heart muscle damage. And if we see above a level or if we see it rising, boom, you have heart attack. Well, a particular company that's now out of business invented a test called troponin I, which was a hundred times more sensitive to this heart muscle damage than the test we used in the emergency room, Troponin T. And we used to get it on all of our patients. And one of the early striking findings is we'd have people with absolutely normal coronary arteries by a stress test, by ct, coronary angiogram, by a cardiac catheterization, and yet they'd have these low grade troponin I. And so I said, gee, I wonder what else could be causing this. It's certainly not coronary artery disease. And lo and behold, there were several papers implicating sleep apnea with elevation in troponin levels in patients. And so I started taking my patients with this elevated marker, getting a sleep study and finding almost universally, these patients had sleep apnea. And the minute we started treating their sleep apnea with a CPAP and showing that it was working, lo and behold, their troponin eyes went down to normal. And who would have guessed that every night their heart was basically having a mini heart attack that they were completely unaware of. And certainly I have known about it without that sleep test. The other reason I see it is we have another hormone that your heart makes called NT pro bnp, and I promise there won't be a test. We call it the heart happy hormone because it's a really good, subtle way of seeing how hard your heart's working. And we can use it to pick up leaks and valves. We can even use it to watch who's exercising, who's not exercising. We can use it to look for myocardial ischemia. But we also notice that patients with this slightly elevated BNP that we assume, yeah, they're just getting old and, you know, maybe they got a little leak in a valve. When we diagnose sleep apnea with them and put them on cpap, lo and behold, this heart happy horn hormone return to normal. So the reason I'm telling you about all this is this is a real silent killer of your heart and your brain and not just a problem with you snoring like a. Like a sailor, like a chainsaw. So that's why you should be interested in finding out if you have sleep apnea. Why doesn't everyone have it?

Well, everyone doesn't have a small jaw.

But one of the other factors that has prompted me to get sleep studies through the years is that amazingly early on, when we started having success in weight loss in my clinics, and again, I've been doing this for 30 years now, six days a week, lo and behold, the spouse or significant other would say, you know, the biggest benefit is, yeah, he feels better, but he doesn't snore anymore. And so one of the first things we did with people who we diagnose sleep apnea is put them on my weight loss program or people who were. Who hated their CPAP machine and wanted to get off of it. How did we do that? Well, we like to store a lot of fat in our mouth, in our neck. And that fat literally narrows the airway and makes quite frankly our tongue fattier. And just reducing that fat in the neck and the tongue area has significant benefit for a large number of people with sleep apnea. What else can do it? Well, alcohol is notorious for causing sleep apnea. Sedatives are notorious for causing sleep apnea because they really relax the airway muscles and a poor diet reflux can certainly contribute to sleep apnea. And one of the first things I do with my patients is I get them off of their back sleeping. Because think about it, when you're on your back sleeping, one of the first things that can happen is that your tongue can roll backwards. On the other hand, if you sleep on your side, particularly the left side, and there are now pillows that are specifically designed that you can order on Amazon, that will force you into a left sided sleeping position that not only keeps your tongue from rolling in the back of your mouth, but also is very effective at preventing reflux, which can cause spasm in your lower airway. Enlarged tonsils, enlarged adenoids. This is more a problem with my younger patients, but many people still have their tonsils and adenoids and this can be a factor as well. Now, interestingly enough, women seem to not get this until they become postmenopausal. Now, whether that's because so many postmenopausal women start to gain weight that they didn't have beforehand, that may be a factor, or it may be estrogen is a useful hormone to keep muscular tone in the head and neck. And I think the research is not clear yet. So what are the red flags? Well, I've told you all the ones that I see in blood work, but again, snoring is a classic. You're not supposed to snore. Gasping, choking sounds, morning headaches is a classic. Waking up with a dry mouth is almost certainly a sign that you are mouth breathing rather than nasal breathing. Daytime fatigue, poor focus, irritability. Again, my very good friend, the cardiologist thought that was a normal part of his busy cardio, you know, cardiac lifestyle. In fact, it was his sleep apnea. If your partner is complaining, please listen, do not say, ah, you're making it up. I don't snore. In fact, I always have the significant other in the exam room with my new patient because that's one of the first questions I ask, does he or she snore? And they usually say, yeah, like a chainsaw. And I do not. I've never snored in my life. So ask your partner, do you Snore and ask for an honest answer. Restless legs can be a sign of this. Tooth grinding can be a sign of this. And really weird mood swings can be a sign of this. Do you want to do a sleep study? Yes, you do. Now, let's be frank. Most sleep studies are a pain in the neck because they want you to come into a sleep lab. And I've never understood how anyone could possibly go to sleep in a sleep lab that wired up. Luckily, there are many sleep labs that now do at home studies. There are several companies that make some very interesting monitors to look for sleep apnea. There are even tracking devices like an aura ring or like a whoop band which is buried back here, that will look at oxygen changes during your sleep and quantify it and show how long it happens, how often it happens. Recently, I had one of my patients who had these devices, and the devices weren't really giving her much bad information. She got one of these oxygen trackers, sleep trackers, and brought it in to show me. And this is a very healthy, energetic woman. She had some of the most impressive drops in oxygen saturation in this healthy female that I'd ever seen. So needless to say, we're getting a sleep study on her. This is actually new information. So there's lots of ways now to start looking into whether this is happening. But one of the best ways is your partner telling you you snore. Okay, so what are the treatment options? So, the traditional treatment option is cpap, that stands for continuous positive airway pressure. Cpap. It's a machine that delivers pressurized air to a mask or to nasal plugs that keep the airway open. And it's titrated to exactly the amount of pressure that you need to keep your airway open. And so most sleep studies, if they find sleep apnea, automatically do a CPAP test and titration to see what will work for you. Quite frankly, many people don't like initially that feeling of that pressure. And so a good sleep study center will actually titrate your CPAP to what will work for you, but will also be tolerant for you. Now, it is the gold standard. It's proven to reduce sleep apnea episodes. It lowers blood pressure, it improves daytime energy, and there's no doubt about it, there are definitely cons. Some people hate the mass. They almost feel like they're smothering. Again, there are other options. Now there's nasal cpap, which is becoming more popular. There's fitting issues, and you've got to find a mask that's comfortable and fits and compliance issues. You got to keep the dumb thing clean. You have to travel with it. Luckily, there are many portable CPAP machines. You probably see them going down the aisles of most airlines these days. They're easy to travel with, but there's no doubt about it, you've got to get the benefit. You actually have to see the benefit either on blood work or how you feel for you to stay with it. It's safe overall, it reduces cardiovascular risk, and you got to use it consistently. There are certainly other approaches. Like I said, I'm amazed at how many people we can get off CPAP by simple dietary changes, by putting them on their left side, by weight loss. Even such things as mouth taping can be useful to force you to breathe through your nose. There are devices that trained dentists can develop and use to pull your jaw forward. I've even had one patient take the extreme effect of breaking both of his jaws and expanding his jaw to open up his mouth. Mouth. Now that's extreme. But it worked incredibly effectively and he had a very small lower jaw. So there are all these alternative approaches. Surgery can sometimes be used for taking out if it's lymphatic tissue, adenoids and tonsils that are the trouble. But that's really way down the line. Now, you've probably seen all these commercials for the new kid on the block, the inspired implant. And there's a bunch of these guys on CPAP having a meeting, and there's this young healthy guy saying, oh, geez, I don't use that anymore. And everybody's incredulous and they're tearing off their mask. He says, I've just got the inspire. What the heck is it? Well, it's an FDA approved implant that actually stimulates a little nerve in your neck called the hypoglossal nerve. And it actually is what stimulates your tongue. Now, I know a lot about the hypoglossal nerve because as a vascular surgeon in the head and neck, in the carotid artery, we always identify the hypoglossal nerve, which runs in the carotid sheath, because if we damage that nerve, your tongue on that side didn't work. But clever researchers learned that if you periodically stimulate that nerve, you will actually contract the tongue and the tongue will will not fall in the back of your throat. There's a sensor implanted in your chest under the skin. Now, the sensor detects breathing and it sends mild electrical signals to keep the tongue moving forward. Now the pros, there isn't any mask. Now it improves quality of life in people who can't tolerate cpap. And the evidence shows, and the reason it's been approved is that it does have a significant reduction in these apneic episodes and in daytime sleepiness. Are there cons and limitations? Well, yeah, it requires surgery, it requires follow up programming. It's not for everyone. The FDA has strict requirements. There are bmi, body mass index requirements, and you right now only qualify for moderate to severe sleep apnea, not just the everyday. And it's expensive. And so far it's iffy whether insurance will cover this, so you have to check. There are safety concerns. It does use mild electrical stimulation and like any implant, and I can tell you, having put thousands of pacemakers in implants in my patients, there are risks of infection with these devices, there's risk of discomfort from these devices and hardware can malfunction. But it uses a good principle that kind of pulling the tongue out of the way may be useful. But in the meantime, lifestyle modification is still the number one thing I do with my patients with sleep apnea, with my CPAP dependent patients who want to get off cpap. And it all comes down to, you know, take care of your body with the food you put into it and your body will usually reward you by taking care of you.

Now it's time for the question of the week. The question of the week comes from robertson4190 on YouTube about the benefits of eating mushrooms. He asked, what about chestnut mushrooms? Are these good or bad? Well, chestnut mushrooms are great. In fact, there's some, I won't say controversy, but certainly opinion about what family of mushrooms chestnut mushrooms belong into. Most think they're actually a form of portobello mushrooms, just not as big. And that's probably correct. But some people think they're actually more related to the crimini mushrooms. But sometimes people confuse crimini mushrooms with darker white mushrooms. So whoever they belong to, they're just as good for you as any other mushroom. The good news is the stems are edible and so use them like any other mushroom. But great question. Now it's time for the review of the week. The review of the week comes from Amaral 2498 on YouTube about the dangers of juicing. She said, thank you, Dr. Gundry. I have listened to your advice. I believe I got some benefit from not eating the seeds of some nightshade veggies. Thank you. Well, thank you for writing in again. We're trying to give you my experience over the last 30 years. Now treating patients 80% of whom now have autoimmune diseases when they came to see me and now don't, and I pass what I've learned from them on to you. So thanks for writing in.

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[Dr. Steven Gundry]

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I.

Hope you enjoyed this episode of the Dr. Gundry podcast. If you did, please share this with family and friends. You never know how one of these health tips can completely transform someone's life when you take the time to share it with them. There's also the Dr. Gundry Podcast YouTube channel where we have tens of thousands of free health insights that can help you and your loved ones live a long, vital life. Let's do this together.

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