So give us your overall view on supplementation.

Absolutely.

So this is how I approach supplementation.

When I have a patient who comes to me, very first thing I wanna know is how's their body working? So vitamin D, iron, magnesium, and melatonin.

I test for all four.

That's the first thing I do.

So before we go out there and we say ashwagandha, valerian, melatonin, we need to see if your body is actually doing what it's supposed to be doing.

That's it.

Sure.

So I think, and there's also always with entrepreneurs, there's always like this weird time pressure, like they got to have made money yesterday, you know, type of thing.

Like it's very rare that I talk to an entrepreneur who's like, oh, we got lots of money in the bank.

Oh, things are going well.

Oh, everybody goes home at five and everybody goes to bed by 10.

Like, no.

Like people think that that's kind of what they're supposed to do.

Tell me about it.

In terms of consistent good quality sleep, what did you find make maybe the biggest difference? Like where do you usually start with people maybe asking certain questions to help them get the benefit as soon as possible?

Yeah.

So the first is I have kind of an assessment that I interview that I do with people and I have a symptom checklist.

So I go to the very first thing I want to do is I want to see if they have a sleep disorder.

Right.

So could they have undiagnosed sleep apnea? Could they have narcolepsy? Could they have restless legs, sleepwalking, sleep talking? I kind of go through that whole litany just to understand.

okay, am I moving them towards a medical treatment or am I moving them towards a behavioral treatment, right? Because if you've got narcolepsy, there are a couple things that you can do from a behavior standpoint, but you need a prescription to be able to sleep at night and be awake during the day.

But in terms of Okay, people are okay on all these fronts and they still wake up by in the middle of the night So what's usually the course and how do you address it?

And you developed the four different types of sleepers.

Yes.

So somewhat like you, I'm an explorer.

I just happen to like to explore inside the scientific universe of sleep.

And so also like you, I like to ask people a lot of questions, understand more what's going on and try to figure things out.

And I've been an actively practicing sleep doctor for 26 years.

I like to see patients to be able to understand more about what's going on in the world of sleep.

So is there an optimal amount of time that we should be sleeping or does it vary enough from person to person that we have to do a self-evaluation?

Yeah.

Okay.

So step number one, don't go pee.

All right.

Now, people love it when I say this.

I want to be very, very clear.

If you really have to pee, please go pee.

any miracle supplements that you recommend for people? Like, is it good for people to take melatonin and not take melatonin? I love

So enlighten us why this is happening now.

Yeah, well, so here's what's interesting.

So let's go back in time for half a second.

So first of all, we have a problem in sleep medicine, I would argue, my opinion.

We are using the incorrect criteria for diagnosis.

So what we're doing, or at least how everybody was taught, is we're using white male data.

So the only thing we really know is that white men, if they stop breathing in their sleep more than five times an hour, have sleep apnea.

Yeah.

Why are you so passionate about sleep? What is it for you that matters so much?

So here's the crazy part.

So number one, I didn't grow up saying, hey, I want to be a sleep doctor.

That was not exactly the plan.

So first of all, I want to make a clear distinction between being a sleep doctor and being a sleep expert, because those are two different things.

So sleep experts are...

Very important people, by the way, people that I really have a lot of affinity towards because they create all this amazing research.

help me or is that going to just make things worse?

[laughs]

I- One time I had somebody ask me a question, they're like, "Should I put on some Depends?" No.

Okay? Like, that's not the goal here.

The goal here is just don't go if you don't really need to go.

Step number two, don't look at the clock.

Now, this turns out to be much more difficult for people [laughs] than, than the not going to pee factor, because what they do is they grab their phone and they head to the can, right? Um, and here's the problem, is when you look at your phone, the very first thing that happens is you see a, your clock, and then you instantly do the mental math, and now you're pissed off, right? You're like, "Shit.

Okay, so I'm up again at the same time again." And your heart rate goes up, which means your temperature goes up, and your anxiety goes up, right? It all happens in the flash of an eye, okay? It's happened so quickly 'cause the second you see that number, you can't stop your brain from doing the mental math and seeing what time it is, and then you're off to the races in the wrong direction, right? So if at all possible, plug your phone in across the room.

Either duration or quality.

For real.

Try it out.

Step number three is, "Okay, Michael, I didn't go pee and I didn't look at my phone.

I'm still awake.

What do I do?" What I would want you to do is do something called 4-7-8 breathing.

This is my favorite breathing technique.

It's developed by a guy by the name of Dr. Andrew Weil, Harvard-trained naturalist, super smart guy, used it in the military to help them lower their heart rate, okay? Remember, we need a heart rate of 60 or below to enter into a state of unconsciousness.

No.

So right now, what's really lighting you up at the moment when it comes to sleep?

Mm-hmm.

So it's kind of interesting.

Um, I, I wouldn't have said this three or four weeks ago, but recently I've really been spending a lot of time learning about menopause and, um, learning more about women's health and sleep, uh, and some of the real problems within sleep medicine that are not addressed for women.

Um, one example is we use the same criteria to assess women for sleep apnea as we do men, which makes absolutely no sense whatsoever.

In fact, the way we rate sleep apnea, which is the number of apneas or hypopneas you have per hour, um, we don't have differentiation between men and women.

And by the way, all of those numbers came from white men that we tested, you know, 30, 40 years ago.

I so appreciate you advocating for this awareness for women of some of the differences, so maybe even kind of sorting that out so that they can be aware of how might things stack up a little bit differently f- uh, when it comes to testing and beyond.

But right now, I mean, in these turbulent times, right now, normal, you must be seeing what's going on right now in people's sleep.

Well, so first of all, thanks for having me back on this show.

This is one of my favorite shows.

I love the format.

I like quick bursts of good information that can be helpful to the people.

So thanks for having me.

So this is the question of the day that I've been asked for the last six months.

that? Now, do you see with the rise of caffeine consumption, do you see that also for alcohol? Yeah.

Are you specifically talking about sleep disorders there, or are you talking about more lifestyle-related sleep issues, or a bit of both?

both?I think both, if I'm being super honest with you, I think both.

Uh, like an example of a sleep problem that goes away on its own, 'cause there are some that do, for, as an example, is, uh, if your child doesn't wanna stay in bed at night, right? Like most children don't at college age wander into their parents' bedroom and say, "Mom, I can't sleep," right? Like it eventually it goes away, right? But something like sleep apnea, eh, that probably doesn't just go away on its own type of thing.

So a lot of people avoid the idea of even sleep testing, Rangan.

This is also another thing I think is kind of an interesting topic to bring up, which is a lot of people come to me and they're like, they have obvious symptomatology of a sleep disorder, so the first question I have is, "Well, why haven't you, why haven't you gotten sleep tested yet?" And they say, "Oh, I don't wanna get sleep tested." And I say, "Well, why?" And they say, "Well, I'm gonna end up on a CPAP machine," right? And so just for your audience members to understand, most people are fearful that if they have a sleep test they're gonna end up with a diagnosis of something called sleep apnea, right? Now, sleep apnea, for folks who don't know it, is a situation where you stop breathing in your sleep.

This is very serious.

Uh, we want all of our patients to breathe.

I'm generally sleeping really well.

Right.

Okay, there's where melatonin starts to make sense to me.

The third situation is a melatonin deficiency.

Well, that kinda makes sense, right? If your body's not producing melatonin, maybe it needs to have this exogenously where you take a pill.

A lot of times we see melatonin, uh, become slower in terms of production as we get older.

So I'm 58 years old.

Right around in your early 50s is when we start to see a decline.

Right.

So where's the relationship to the peak performance? And I'm just curious on your feedback on that.

So here's what I'll tell you is everything you do, you do better with a good night's sleep.

Everything.

There's not a single biological function that you don't do better when you sleep, which is why I developed this chronotype idea.

And so if you can follow your chronotype, that's the entire purpose of the chronotypes, is if you follow your chronotype, you are in- ... peak performance at all times because you now know when to do different things.

But as a general guideline, here's what I'll tell you.

Six and a half to seven hours of sleep should put you there unless you have a major medical problem, you have a training issue, an injury.

[laughs]

Okay.

I'll let you know.

Um, 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, "Gah, I can't wait to get back to 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 it would be worth figuring out.

The good news is there are about 7,000 sleep doctors in the United States alone, um, 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.

Oh.

So if you're the early bird, which is the lion, like can we frame out all four? 'Cause there's the bear, the wolf, the lion, and the dolphin.

Yeah, let's talk about them.

Uh-huh, absolutely.

So early birds are now lions, and the reason I chose lions is because, like I said, who wouldn't want to be the king or queen of the jungle? But we've learned a lot about lions, by the way.

So lions have a very interesting personality characteristic.

These are usually my COOs of a company, right? Not the CEO, not usually the founder, but the operator, okay? Why operator? Because these are the people that like to make a list every morning and go from step one to step two to step three to step four, right? They're very organized in their thinking.

You know if you have a lion in your life if you get an email at 6:00 AM, right? That was sent from somebody who's a lion.

[laughs]

Wow.

Yeah.

So chronotypes are this internal rhythm, and the reason I, I focused on, in on them is because it, it's when your melatonin turns off and your cortisol turns on to wake you up in the morning.

So for early birds, right, these people, this is happens, uh, about 90 minutes ahead of most of the world.

Then people in the middle, we used to call them hummingbirds.

That happens kind of on the regular.

And then for night owls, which is kinda what I am, it happens 90 minutes later.

Yes.

But let's start with what exactly is a chronotype and how did you figure this out?

So it all happened based on a patient.

So I had a patient come in and I'll be honest with you, I failed.

I mean, I failed, failed, failed.

We tried everything.

I had her MD prescribing medication, didn't work.

We did cognitive behavioral therapy, didn't work.

Right.

Yeah, yeah, yeah

... for my patients.

We tried medication, we tried sleep hygiene, we tried everything.

When I have a patient that doesn't do well, I bring 'em in for free and I just assess, assess, assess.

'Cause clearly I must have missed something, uh, that's going on here.

About halfway through the interview, she turns to me, and, and this is when I was practicing on the East Coast, she said, "Dr.

Breus," she said, "If I just lived in California, everything would be great." I'm like, "Explain that to me." She said, "Well, everything there is three hours later." She said, "If I could just go to work a couple hours later and stay a couple hours, I think it'd be fantastic for me." I said, "Well, why can't you do that?" She said, "Well, I don't think my boss would like it.

Why?

Mm.

So the biology answer is sleep affects every organ system and every disease state.

Literally everything you do, you do better with a good night's sleep.

You think better, your mental health is better, your physical health is better.

I can show you a dozen studies in any one of those categories that will show you how sleep, good quality sleep, and a decent quantity of sleep, will improve all of those areas.

That's the biol- biological answer, but I think I'd also like to, if it's okay with you, give you the slight philosophical answer.

So when we think about how we spend our lives, I would argue that time is the currency of life, right? So where we spend our time is kinda how we live our lives.

Mm

Do most people when they can't get to sleep within 30 minutes or they're waking up in the middle of the night, do they take something to mitigate that? Most of the people that you see in the beginning, has that been one of their strategies? [laughs]

I've seen every strategy in the book.

I will tell you there's a preponderance of people who either go to their general practitioner, who may or may not have any training in sleep whatsoever, and say, "I'm not sleeping.

This is horrible.

Everything is going to pot," and then the practitioner will just supply them with a sleeping pill.

Sometimes it's an antidepressant.

Sometimes it's a sleeping pill.

But what is the process for getting off the medication, like you were saying, and really, does cognitive reframing and behavioral therapy work for someone who has been stuck in that medication cycle for so long?

[laughs]

... um, you still might not get enough magnesium because in the fields now they've been what it's called over tilled, meaning that there's no magnesium left in the soil, so it doesn't come up through the root stalks anymore.

So even if you did eat a bushel of kale, you might not get the magnesium that you need.

So getting blood work done, there's four different things I tell people to check: magnesium, vitamin D, iron, and melatonin if you can find it.

Now, melatonin's not the easiest one to get blood work done on.

I'll, I'll let you know that ahead of time.

But the other three are pretty standard.

But I'd love to know your thoughts.

Can you talk a little bit more about that when it comes to sleep?

Absolutely.

So when we think about sleep quality, first of all, a lot of people are like, "Well, how do I measure that?" Right? So a lot of times people will come to me and they'll say, "Well, Michael, I'm killing myself to get eight hours." I would rather I have a patient or a friend or a comrade who, who gets six and a half hours of high-quality sleep than eight hours of crappy sleep, right? So the first question is, well, h- how do I measure quality? H- how do I know what the quality of my sleep is? To be clear, you are your best doctor, okay? When you wake up in the morning, how you feel is probably a pretty good indication of how well you slept, okay? Like, that is kind of bottom line.

Like, you wake up and you feel like crap, you probably slept like crap.

But let's get a little deeper.

Let's get a little bit more objective, right? So there are these trackers that are out there in the world.

There's on your wrist, there's on your finger, there's on your head.

Do we have any insight onto what's going on with that?

I mean, the advice everyone's always heard is, "Drink eight glasses of water a day, and you're good to go." Is that pretty good advice?

It's not the worst advice that I've heard.

Eight glasses of eight ounces of water puts you at sixty-four ounces, which is about, hmm, three-quarters of the way you probably want to be there, depending upon your height and weight, things of that nature.

Um, I will tell you, though, that here's the thing that I, I think most people don't understand, is it's not necessarily about amount, it's about quality, um, and, and timing.

So as an example, number one, what kind of water are you drinking? Um, if you're drinking water straight out of your tap, I would tell you that there are websites where you can put your zip code in, and you can learn exactly what is in the water in the-- coming out of your tap.

Um, to be clear, there's a lot of things that go into that water to clean it, um, in order for it to be usable again.

So for me, personally, I only drink filtered water.

I'm not dead.

... my sex," whatever it might be.

Yeah.

So parenting children and sleep are difficult to coexist, but they're not impossible.

It really has to do with discipline and kind of thinking through some ideas for yourself.

When my ki-- so I have a twenty-three-year-old son and a twenty-two-year-old daughter, so I'm a little bit out of the, the realm of having to deal with them every day.

Um, but I was... like I said before, I was in charge of mornings, uh, at our house, waking them up, and it's a lot, right? And so the very first thing that I try to explain to parents, especially if they have a child who has an irregular sleep pattern and is really causing chaos for the rest, like one child who won't go to sleep, and it's keeping every, the whole house up.

First thing you wanna do, educate the kid, right? A lot of kids don't know what they're doing is causing a lot of problems.

Yeah.