Lifestyle Medicine: Unveiling the Big Picture for Heart Health

Introduction and guest background 0:00

Welcome to the future Neri Health podcast. I have an incredible guest in store for you today, Doctor Michael Bruce. He's a clinical psychologist, a sleep medicine expert, and he's known as the sleep doctor. So welcome, Michael. Thanks for having me. I'm excited to be here. Awesome. Well, Michael has is on the American Board of Sleep medicine. He's a diplomat of it, a fellow of the American Academy of Sleep Medicine, and one of only 168 psychologists to pass the Sleep Medical specialty board without going to medical school.

He studied psychology at Skidmore College. He's a clinical. He has a PhD in clinical psychology from the University of Georgia, and he's been in private practice as a sleep doctor for nearly 25 years. He's a sought out lecturer, and I have seen so many of his great videos online. I was just sharing with Michael. I took his chronotype quiz and I Am a lion, which I already knew when I took the quiz, but chronotype I was going to be. But I am obsessed with sleep and I've been obsessed with sleep for years.

I studied Ayurvedic medicine. I did my master's and PhD in it, and then when I was done and my team was like, well, let's start making videos. What do you want to talk about? I taught a lot of I read that, and when I got to sleep and dove into the topic, I realized sleep is the key to all of it. And once I started practicing good sleep habits, my whole life changed. So I'm obsessed with your topic and I'm excited to have you on today. Well, thanks so much for having me. It's certainly an honor to be here.

And it's a lot of fun. And to be fair, I love your data. And, it was interesting when I started to look at the chrono types, which is kind of very diabetic in nature. I said to myself, you know, I don't know a lot about this. And then one of my friends came up and they said, you know, this is like, exactly like what goes on in your day. And I was like, I had no idea. So I started to look at it. And there's a tremendous number of similarities, which speaks to the idea that this is ancient wisdom.

This is something that's been around since the dawn of time, and it's something that we know works. It's interesting, and it's kind of like what I call the ultimate cheat code, if you will, for kind of knowing about sleep. And I really appreciate the fact that you understand the importance of sleep. So many people, they just kind of take sleep for granted. They're like, yeah, I'm going to close my eyes in that room in the back of the house where dark and maybe I can come out six hours, seven hours, eight hours later.

Hopefully some magic happens there and I wake up and I have been rejuvenated and I am back to my 18 year old self once again. Right. And that pretty much never happens. Well, it doesn't, it really doesn't. I think we take sleep for granted so many people over the years. When I started developing sleep formulas and sleep teas, I would launch them at events and I would say, how is your sleep? And everyone would say, my sleep is fine. And they say, really? My husband has a hard time sleeping, I'm fine.

And I thought, you know what? If your husband's having a hard time sleeping, guess what the quality of your sleep is and have you ever tested or measured your sleep? So I make everyone measure their sleep because you don't know the truth

Home sleep testing and sleep apnea basics 3:00

until you look great. Data. Yeah. And I want to let's let's double tap on that point just for a second, because there's a lot of data that you can get. And some of it feels difficult, some of it feels overwhelming. And let's, let's break that down so that it doesn't feel that way. So so first of all, you and I were talking a bit before the podcast, that you have a family member that you have concerns about. They may have sleep apnea. Right. And so one of the things we talked about was, this person's resistance to getting tested. Right.

And so my mom and my mom has all sorts of, of health issues. If you've ever listened to my content, my family is diabetic and has all the horrible health issues, but I'm certain she has sleep apnea and I've asked her ten times, please go get tested. What it means you go to sleep in a place and they hook you up like a lab rat. Exactly. Very uncomfortable. Well, not only is it uncomfortable, it's kind of intimidating. Right? And if you're an older female, do you really want to be in some weird place where people have got cameras on you with a bunch of wires attached to you?

By the way, we attached 27 electrodes to the average person for a sleep study. I mean, let's be fair. How great of a night's sleep are you gonna get with all of those wires all over you? Here's the good news. The one good thing that happened to sleep during Covid was that we actually completely eliminated most of what goes on in order to get to the sleep test. So historically, you'd have to go to your primary care or your general practitioner, and you'd have to tell them about your sleep problems, and then they'd have to say, okay, I think you may need to see a specialist.

Then you'd have to go see a specialist. Then the specialist would say the exact same thing. The primary care would say, I think you might need a sleep study. Then they would send you to the hospital, right. Which, by the way, has alarms going all night long, which has all. But it's not necessarily the best environment. Now, to be fair, there's some sleep labs out there that have amazing environments. They look like world class hotels. I'm not talking about those. I'm talking about some in-hospital things.

Again, the intimidation factor, the resistance of actually getting tested is I don't want to sleep in any hospital. I don't care if it is a four seasons. Right. Here's the great news is now we have these things called hosts home sleep tests. And that's exactly what they sound like. They mail the unit to your house. And here's the best part. You just put it on your wrist and there's a little plug that goes on your finger. Just a little clamp, by the way. There's no needles, nothing hurts. It's all very comfortable.

You push the on button. You have a telephone right by your bed. It sends data all night to the telephone. When you wake up, you push the off button. You can actually take the unit and throw it away. It's disposable. Now, believe it or not. I mean, it's crazy, but they also send you a box. If you don't want to throw it in the trash, you can send it back to them and it can get reused for, you know, ecological purposes and things like that, which I think is actually a pretty good thing. But guess what?

24 hours later, you're talking to a doctor who's reviewed your data and it's actually telling you, here's what's going on, and here's next steps for what you can do. You know, it's all on zoom. You don't even have to leave your house if you don't want to to be able to have a true diagnostic experience, especially when it comes to something like sleep apnea. Now, I also want to be kind of clear if if some somebody suspect you have narcolepsy, home sleep test is probably not the right move. It's probably better to be in lab because there are some there.

Because the home sleep test doesn't have 27 electrodes. It has five, right? It has some of the most important five, but it can only really diagnose sleep apnea. Well, all the other sleep disorders are probably better for you to go in for a full sleep study, with your doctor. So that way you really are looking at assessment of that particular diagnostic situation. Now, the other thing that you asked me was you said, okay, so let's say I get my mom to do the test. Michael. Yeah, she's going to have to wear a CPAp machine system. Right.

Because I've heard horrible things. I have friends who have it and it's uncomfortable and they don't want to do it. So yeah. So for your audience, let's explain what is sleep apnea and then what is this treatment. So sleep apnea is a situation where you actually stop breathing at night. Generally speaking we all like our patients to breathe. I'm just saying. And when you stop breathing a whole bunch of things happen. So when you stop breathing, your heart rate begins to slow down. Why is that? To conserve the oxygen in the system.

Because remember, oxygen is kind of the fuel for our brain and our bodies. And then your brain says, Holy crap, there's no more air coming in. And so it speeds your heart rate back up to wake you up. So your heart rate slows down, speeds up, slows down, speeds up. And depending upon how well you use oxygen through your lungs, some people, when they stop breathing, if they fall off a cliff in terms of their oxygen saturation level, whereas other people, it can take a very long time before that oxygen really gets low in the system.

So that can also be another factor that becomes important to understand. Now once you figure out, hey, what type of apnea I have, because there types there's something called obstructive, which means you got big tonsils or big adenoids or, you know, maybe you've got to carry a little extra weight around your neck. A lot of men have a tendency to carry weight right around the neck area. So that can, make things even worse. That can there's a lot of ways to treat these all these different types of apnea.

By the way, there's another type of apnea called central apnea. This is much more serious. This is where your brain tells your lungs stop breathing. That's a much bigger problem. It's treated in an almost completely different way. But you can assess it with these home tests. So don't worry, you can get the best assessments. No problem. Now how do we treat this thing? Well, when a throat closes in the middle of the night, we basically want to do something to open up the pipe, right? So a while back, a couple of people got together and they decided to take a pool filter, like one of those for a swimming pool.

Right. That usually sucks the water in and filters it and they stuck it in reverse. They put a oxygen mask on this young girl who was morbidly obese. She couldn't sleep lying flat because she had so much weight it would crush her lungs. So they stuck her in a, you know, La-Z-Boy chair. They stuck this thing on her and she slept all night long and they couldn't believe it. And this was the original formation of the CPAp machine, which stands for continuous positive airway pressure. So basically it's a hair dryer blowing up your nose all night long.

Now, I'm going to be honest with you, this is not a comfortable situation. Okay. Now I've slept with the CPAp machine because I figured if was going to make my patients try it, I better try it myself. It took me three full weeks to fall asleep and be able to stay asleep. With the mask and the head gear all on. I didn't even have the CPAp turned on. I was just trying to get used to sleeping with the mask. So there is an adjustment period. No question about it. Here's what I can tell you. The more severe your sleep apnea, the more people don't care about the adjustment period.

They're like, I feel so good waking up the next day. Chime in. It's the people with the mild and the moderate disease that don't like this CPAp treatment. And let's be fair, I kind of don't blame them. I mean, you're sleeping with the mask on your face. There's a hose that goes to a compressor that's by your bed. It kind of feels like you're in a hospital room, right? Like, what's sexy about that? Probably nothing. So you're kind of would love to say. Is there another alternative? Good news. There is alternatives specifically for the mild in the moderate.

They now make dental appliances, which are quite interesting. So, remember back in high school with football players, they have an upper teeth guard, but they also have a lower one. This had both of those, but the lower one is pushed forward by a few millimeters. And what it does is it opens up the posterior airway space by pushing the entire mandible just a few millimeters forward, moves your tongue forward, and then the back part of the area, which is usually the thing that collapses, stays open.

So what's really cool is as long as you don't have TMJ, or any tooth movement, you can actually work with a sleep qualified dentist. Believe it or not, they're sleep dental medicine boards because this whole area is very complicated. You really have to know what you're doing. And you can actually have an oral appliance made by one of these people. The third thing is surgery, which at first do you think to yourself, oh my gosh, are people going to actually get themselves cut open for sleep apnea?

I got to be honest with you, I would all day. I was shocked, because I got, I got approached, about ten, 12 years ago by this company called inspire, and they put this little, this little disc beneath your clavicle. They run a couple of wires up to the vagus nerve, and every time your tongue falls back, it pops a signal in there, maybe a very small microvolt. And it just tenses the tongue and pushes it forward. So you just turn it on and you go to sleep. There's no mask, there's no mouth guard, there's no nothing.

But it's a surgical intervention. I mean, we're implanting something. I honestly, when they came to me, I was like, there's no universe that people are going to do this. I was wrong, oh my gosh, was I wrong?

CPAP, oral appliances, and other apnea treatments 12:00

People are going in droves to get this thing done because they don't want to deal with the mask or the, you know, the headgear or the mouthpiece or things like that. So I want people to know that there are many options, and that getting a diagnosis is an important good step. Okay. Because you got to know what you got so that we can figure out how to make it work better in the long run. Because what we do know is that long term undiagnosed sleep apnea. Absolutely, absolutely leads to, refractory hypertension.

So that's high blood pressure. That medication does not treat well, it leads to diabetes. Because we know insulin resistance happens almost immediately when you're sleep deprived. And it heart attack, stroke, death, atrial fibrillation, you name it. No, nothing that anybody who's listening now wants to get. Trust me on this one. So if you can get yourself tested, like if you or your bed partner notices that you snore a lot, or do you wake up and you say to yourself, gosh, I wish my sleep was more refreshing for about 190 bucks you can actually.

Yeah, it's very reasonably priced. You can have a test sent to your home. That's highly accurate. Answer the question. That's amazing. And sleep apnea is a big deal. I have, a local woman. She lost her brother to sleep apnea and so she invites me to speak at a lot of events purely on sleep, because she's very passionate about people understanding how important sleep is. And you just help me with something because recently I went to the ENT doctor and I said, something is wrong. I have superwoman hearing abilities and it's driving me crazy.

And it's been true since the pandemic. Like, I can hear everything. I can hear pin drops in the middle of the night. And so I went to the ENT. They said, you have TMJ, you're grinding and you're causing the sensitivity. That's their belief. And I have it on my list of things to do to go get a mouth guard at night. But I kept thinking, I don't want to just go to any regular orthodontist for this. If I'm going to invest in this thing, I want someone to get it right because it sounds very annoying to me.

So so so you want to go to a sleep medicine dentist who's taking those boards and understands that whole area? And you will. You may learn a few things about yourself so that that could be good. And I also want people to understand that, you know, step one is diagnosis is assessment is let's figure out what it is. And then let's talk about the potential treatments. And by the way, sometimes a potential treatment is just weight loss. Sometimes a potential treatment might be positional therapy. So moving somebody from their back to their side, and doing things like that and believe it or not, some sleep apnea, it's sleep stage specific.

So there are some people who only have apnea in REM sleep. That's it. Only in REM sleep. So we can actually give them a medication to lower the amount of REM sleep that they have. And then the apnea gets within, reasonable levels. They still have enough REM sleep to be within reasonable levels, and they move forward. Interesting. There's so many new options, so much new technology and awareness. Yeah. That's awesome. Yeah. Well, and then and I mean, I think a lot of that has been like Covid driven and also like internet of Things driven.

So now we've got rings, we've got bands, we've got headbands, we've got you name it, you can track it. And definitely tracking your sleep. But I want to be clear to people out there, there's, there's pros and cons to tracking your sleep. Okay. So first of all, number one, get obsessive. You can freak out about it. I mean, I've got people who are like, they run up to me, they show me their phone and they're like, Michael, my aura ring says, I got 12 minutes of deep sleep. What should I do? I'm like, I don't know, I don't know, right?

You know, it's like, well, you also bring up a really good point, which is you can always try this again tomorrow night. Right? Like you get you get a redo every single day to do this again, it's kind of rare to have any activity in life that you get a redo every single day, except for maybe eating. And so it's kind of nice to kind of be able to do that. But accuracy of these devices becomes an important factor. Right? So not just okay, I'm looking at these numbers, but are these numbers real. And if so what do I need. How do I need to address them.

So I want to be very clear. If you get 14 minutes of deep sleep every single night, I don't care. Okay. And I'll tell you why I don't care. Because. Because you're getting more than 14 minutes. But the device is being consistently in accurate. That's okay. As long as it's consistent we can work with that. So if it says you got 14 minutes one night and you get 407 the next, I want to know what happened that next night. Right. That's what it's all about the delta or the change from the baseline. That's how we read these devices because quite frankly, the aura and the whoop straps of the world, they don't tell us what any of the data means.

They don't give us any videos. My biggest complaint, and I've complained to both companies, is I know exactly what that data means. Almost nobody else does. And so we've really got to start educating people about that. So number one, don't over analyze your data. Become obsessed with it and freak out about it. Okay. Sleep doesn't work that way. Sleep is sleep is a lot like love. The less you look for it, the more it shows up, right? So when you're out there trying to find that perfect person in your life, you never find them.

But the second you stop looking so hard, the universe just seems to put them into your life. Sleep is a lot like that in terms of it's not about performance per se. It's really about letting it happen and allowing your body and listening to your body. And that's where the idea of chronotype came in. Right? So the other thing that I've known about, and you mentioned earlier, was that you are a lion chronotype. So now might be a good time for me to talk to folks about events. Sure. But I have a question before you jump in.

But I do love the chronotype conversation you're saying, and this goes against what I believe. So I'm curious either way, that we do have to have a little bit of a song and dance and preparation around sleep to set up the most ideal situation for great sleep. So, for example, stopping caffeine early enough, being aware of our alcohol, no no no no no. So so you are 100% correct. We have to create an environment for sleep. Also, sleep is a performance activity in this way shape and form. So I'm a runner and I know that I can run a race in flip flops with a boombox on my arm, but my time is going to stick, right?

But if I've got my A6 on and I drive that way and I've got some good tunes, I can throw off a, you know, nine minute mile, no problem. Right. Because equipment matters in the performance of that task. Okay. Same holds true with sleep. If you sleep on a bed that looks like a taco with the windows open and you live near the airport, you are not going to sleep well. Okay, true. I don't care how great a sleeper you are, nobody sleeps well in that environment. So in that respect, absolutely. You want to set yourself up in a good environment and you want to set yourself up, with a good, mindset as well.

What I'm talking about is the overemphasis that a lot of people play on. How long they sleep, the depth of that sleep, and then what's going to happen to them the next day. So, so many people in the middle of the night wake up at 2:00 in the morning and they say, oh shit, I'm at it's 230 in the morning. I got to get up at six. We sleep and they try to force themselves to sleep. It never works and they're miserable. So. And that, by the way, is my bread and butter. That's what I fix. That's my that's the easiest thing that I do.

And that's stuff that I like to do the most, is helping that particular situation of folks in the middle of the night. So you got to kind of think through a whole host of of different options there. But I don't disagree. I'm a matter of fact, I firmly agree that there are certain things that we're going to want to do environmentally that's going to set us up for a better night's sleep. And I'll tell them that at the end of the podcast, I'll actually give you a five step plan, which includes all of those.

Awesome. Okay, good. And then when it comes to circadian rhythm and the chronotype, how did you come up with these chronotype, like what was the process of coming up with it. And will you go ahead and explain them. Yeah I will. So I was failing with a patient, with how the whole thing started. So you know how this works. We can't treat everybody and we can't treat everybody perfectly. I wish we could like it would be so cool if you could, but it just doesn't work that way. And I had failed with this patient numerous times.

And I finally brought her in, and I said, so when I fail with the patient, what I do is I bring them in for free for a two hour session, and all I do is ask as many questions as I possibly can. I ask questions I and I must have missed something along the way. That was kind of some detail point. And so we're about an hour and a half into the interview with this patient, and she turned to me. She said something that was just bizarre. And this is when I was practicing on the East Coast. I used to live in Atlanta.

She said, you know, if I just lived in California, my life would be great. It's like, what do you mean? She said, well, if I didn't have to be at work at eight, but I could be at work at, you know, 11, that would be easy. And if I didn't have to, you know, go to bed at this time and go to bed later, that would everything would work perfectly for me. I was like, really? She said, yeah, I said, so why don't you ask your boss if you can just come in later and stay later and talk with your spouse and find out if you know you can change things around.

And she said, well, my spouse is probably not all that interested in that, because that means that he would then have to deal with the kids in the morning and things like that, and that that's not how our kind of house is set up. And she said, and to be fair, I'm pretty sure I'm getting fired at the end of the week. And I was like, what do you mean? She said, I fall asleep in meetings. My work product is not great. Like, I know we're talking on Monday, but like, I'll be shocked if I have a job on Friday.

So I said, can I call your boss? She said, sure. She gave me the number I got on the phone. I called them up and the first words out of his mouth was I'm firing her. On Friday he said, we can do whatever you want. I said, great, can she come in two hours later?

Chronotypes and personalized sleep timing 22:00

Can she come in at ten and can she leave at seven? Then we talked with her, spouse and I said, you know, can she sleep later? And, you know, figure this out. Let's do a two week experiment or one week experiment. Everybody agreed to a one week experiment, so we did it. So come Friday, I call her boss. He picks up the phone. The first thing he says to me, I got three more employees. I want you to talk to you. First thing he says, right? He was like, this is unbelievable. He said, I had no idea that just by moving somebody time that we could change so much about their lives.

So I was like, this is awesome. I'm going to call her up at home and tell it looks like we saved your job. So I call her up at home and her husband grabs the phone. And you know what he said? He said, thank you for giving me my wife back. That's kind of powerful when you think about like, it gives me, like, you know, the hairs stand up, you know, it's like, wow. Like because he was like, she was such a pain and she was always grumpy. And that's not who she is. Like, that's not the person that I married.

That's not the person I want to rate children with. And she was he was like, sleep just had such a tremendous effect. So just by literally moving her sleep a little bit later, all was well. So then I started thinking, you know, I failed with other patients. I wonder if this could have been the issue. So in sleep medicine, we call this a phase advance or a phase delay. And we don't usually look we look at it as a spurious finding. It's not something that we would normally see that people, people have.

But it's biologically driven, things like that. So I said, you know, I wonder if she's just got a messed up prototype. So I started to go into the DNA of it all. And so it turns out that if you look at a very specific area on the human genome called the PR three area, that's where a lot of circadian timing happens to be clear, there's about 40 different genes that affect circadian timing. This is one of the biggies. And what we know is when you look at the building blocks, if they're flip flop one way, you're a night owl.

If they're flip flop another way, you're an early bird. Dude, this is genetic okay. And so I was like, oh, you can't really change your genes. So then it came to me. If people line themselves up with their personal chronotype, right. Everything works better. Charlie and so I was like, okay, well, I know the three. There are three chronotype, right? There's early bird, there's night owl, and there's people in the middle. But my, my patient doesn't fit in any of those. So I went digging into her DNA and I started looking around and I found a DNA very similar sequence.

Everybody's got insomnia. And guess what? They have this really weird sleep schedule. And so I was like, I think there's a fourth chronotype. So I said, how do I prove it? Well, with data. So I went out and I created a quiz and I, you know, did the validity thing that we've had 3.5 million people take the quiz at this point in time. So we have amazing statistics on this thing. And what we've discovered is Early Bird. By the way, I changed the naming of everything because I'm a mammal, not a bird.

And, you know, I wanted something that was kind of fun. Also, I wanted to choose an animal that represented the the chronotype itself in in their kingdom. So early birds become lions because lions have their first kill before dawn. And who doesn't want to be the king or queen of the jungle, right? Like that's a good one. True, right? Bears are folks in the middle, so they're not early and they're not late. Wolves. I happen to be a wolf. Or at least used to be, we are the night owls of the group.

And then dolphins are my insomniacs. And so people like dolphins, like I get wolves, I get lions. Why dolphins? So dolphins sleep uni hemispherical. So half of their brain is asleep while the other half is awake and looking for predators. And I thought that kind of represents my insomnia patients. You know, they're kind of never quite asleep. Like they've always got that radar going of what's happening. They're super light sleepers, things like that. Sure. So I create this quiz. And what we discover after having quite a few people take it is we have these clusters of types of folks based on the data, and it turns out to be really interesting.

And so then I was like, well, this is cool because I can tell people it's time to go to bed. I can tell people what time to get up because by the way, there's been over 300 studies looking at chrono types long before I even got here. So to be clear, chrono types have been around since the dawn of time, but really studied in the early 70s with something called The Morning this evening, this questionnaire, which was kind of our very first kind of look at it advancing down the line. Now, I say there's four chronotype, believe it or not, there's a group out of Germany that thinks there's eight.

So it really depends on how you kind of look at your data when you have eight chrono types, to be honest with you, it's just too damn complicated. I can't make heads or tails of it. Four buckets works perfect. And here's the other thing that I discovered, which is kind of crazy, is once you know your chronotype and you know the perfect timing of when to go to bed and when to wake up, your body follows a very predictive path in your hormones. So if you just change your activities to when your hormones happen to be naturally elevated, you do that activity significantly better.

So the big one that everybody always wants to know about is intimacy or sex, right. So Michael, when is the best time to have sex. So let's talk about it. So if you happen to be it's so interesting. That's not the question I would ask. My question would be, according to Irby, that when do I eat, when do I workout, when do I work and do my productive time? I am clients, I already know. Everything that you do in the morning is the best. And right around 6:00 the whole world just starts angling downwards.

And in my lately no one will sleep on time. Which is what I wanted to ask you about is if you're a lion and nobody's going to sleep on time, and you become a very mean, like they're not lions, but they have a different sleep schedule, so they're not supposed to sleep on your schedule. I know, but don't we have a melatonin release at 10:00 pm and we're all supposed to go to bed? No. Great question. So we have a melatonin release based on our chronotype. So you as a lion, you probably have a melatonin release.

What time do you wake up? Six. So you have a melatonin release at 8 p.m. at night. That. So that happens approximately. Yeah, it happens 14 hours later. So here's what's fascinating. A lot of people don't know. This is your core. Body temperature rises, rises, rises until it hits a peak at around 1030 or so. And then it begins to drop. Now for you as a lion thing up till 1030 is worthless. You would be trashed at that point, so you're never going to make it to that point. So again, your melatonin is kicking off earlier when you wake up in the morning and sunlight hits your eye, you have a special cell in your eye called a Mellanox.

And so and that turns off the melatonin faucet in your head. But what most people don't know is there's a timer on that cell and it kicks in 14 hours later. So if you wake up every day at 6 a.m. at 8 p.m., melatonin kicks off by 930, you're tired. You're falling asleep. However, if instead of waking up at 6 a.m. on Saturday, you decide to wake up at 8 a.m., melatonin doesn't kick off at eight. It kicks off at ten 14 hours later. So what ends up so the time that you wake up directly affects the time when melatonin is produced at night, and nobody on Earth has a timed time.

At 10 p.m., melatonin kicks off. What we do know is that for most people, at least here in North America and by the way, it changes based on country. Is that right around ten, 1030 is when you hit your highest, core body temperature peak and there's a drop, and that drop is consistent with melatonin production. So that's probably where that information went a little askew is that that is core body temperature across the board. But if you do it by chronotype it's extremely different. So you probably go to bed at nine 930.

I don't go to bed until midnight. I wish no one in this house will let me sleep. Everyone wants to sleep at 11 and I have learned now, how old are your kids? They're ten and 13, that's why. So let's talk about this. So everybody goes through all of the different prototypes throughout their lives. Think about it. When you had kids, what were they? When they were babies, they were lying. They went to bed early. They woke up early. Then what happened when they went to middle school? They became bears.

They kind of got up around seven, 730. They went to bed around seven, 730 at night. Now you've got one teenager and one almost teenager, which, by the way, is the worst age that you can possibly have for children. And guess what? All teenagers want to do is stay up late and sleep late. So your two children are never going to want to go to bed early, ever. It's horrible. Well, it isn't, it isn't. And there's there's ways to get through it. So as an example, as the sleep doctor. Right. I have two children, I have a 22 year old and a 20 year old.

So when my kids were your kid's age, a lot of people say, well, what did you do on the weekends? Did you did you wake them up? No. As an adult? Yes. Wake your butt up. But as a 13 year old, let them sleep. Let him sleep till noon. I don't honestly care. But do it on Saturday, not on Sunday. Let me explain. So if you let him sleep late on Saturday again, their melatonin is going to kick off later. If you let him sleep in on Sunday. Monday is going to be a nightmare. Totally okay, so what I try to do is I try to for my adolescent kids out there, I try to have them wake up within an hour of their weekday wake up time on Sunday, and then on Saturday I let him sleep as long as they want.

That's rough. Nobody's going to want to get with that program. But I hear you because you have to create that deep pressure. Yeah. I will tell you, I never have a problem instituting those because what usually what's interesting that happens is for a lot of the kids that want to stay up late, when you sit down and you talk to them and you try to like discover like why it's just because they're bored. It's not because, you know what I'm saying? Like they're not actually doing something. And in a lot of cases, if you teach them the importance of sleep and let's say you pair it with video games, if they're into video games or sports or music, theater, academics, whatever, we can show data that sleep makes any one of those better, right?

So whatever your child is interested in, pair it with better sleep and say, look, if you want to be the best trumpet player and you want to play like Wynton Marsalis, get some sleep, right. If you want to be a running back, get some sleep, right. If you want to get an A, get some sleep, right. That's how that works. And so we get kids involved and motivated for sleep as early as we can, because quite honestly, it's the most important skill set you've got. Absolutely. And I think so many people were never taught to sleep like in IAB, that.

Yeah. We talk about how sleep is the most important thing. Sleep is when you clear that ecosystem, it's an inflammation. You should wear loose fitting clothes. You should have no vices anywhere near you. And I feel like nowadays we're not even having those conversations. And so people are just sleeping in their workout clothes. It's worse than that. Phones next to their head and. Yeah. Oh yeah. And what I've got, I've got patients who get dressed for the gym and then go to bed because they don't want to deal with getting dressed in the morning, and they wear the tight, you know, like leggings.

And it's it's pretty restricted. What a lot of people don't realize is when you're in bed and you turn and you stay turned, like you're causing all kinds of strain and restriction here based on your clothing. Whereas if you had nice loose fitting clothing, you'd be in much better shape. In fact, there's some data to suggest that sleeping with no clothing is probably much better for you as a general rule. That being said, you got to change your sheets every week. A lot of people don't think about that, but you release a lot of sweat, oils, things like that, from your skin, and you want to make sure that you're sleeping.

It's good clean sheets. Sure. So one thing I was thinking when you were explaining the chronotype, you know, in IAB, the IAB, the taught about circadian rhythm thousands of years ago, the chronotype correlates so beautifully to the dosha, to our individual constitutions. We know a calf. A person needs more sleep and they need to sleep in. But we live in a society that says we need to like, wake up and be go getters. So what percentage? I mean, 3.5 million people filling out a quiz is it's like it makes me ecstatic to think of that level of data.

And what do you do? I know it's crazy. I push so hard for curcumin data and and you know, turmeric data, which is almost impossible to find, by the way. I mean, because, well, and the reason you can't find it is because no pharma companies is going to put out a turmeric product, and so they're not going to pay for the data. When we look at our data, here's what I can tell you that we find is our lions make up between 13 and 15% of the population. So only 13 to 15% of people actually get a natural orally between 430 and 530 in the morning and feel great doing it.

About 55% of people are bears that the folks in the middle, so it makes up the largest group by far. One out of two people is a bear. I'll explain why that's important in a second. We have about 12 to 15% are wolves.

Sleep habits, tracking, and the five-step plan 35:00

So that's the night creatures of it all. And then about 10% are dolphins. And so here's what's interesting is if you go back to caveman days, right? And you look at those villages, they actually had three of the four chrono types. So the hunters in the morning, they were the lions, right? They got out before dawn, they killed something, brought it back to the village. Right. And then the bears were all the people in the village who were minding the kids and building the town, and all of those kind of things.

The day people, if you will. And then who do you think the guards were at night? Those were the wolves. They were naturally up anyway, so they might as well stand and be a century and make sure that everybody is safe until 2:00 or 3:00 in the morning or whatever. Right? So when you think about this, this has been around right since the dawn of time. Now you bring in an idea like our data and it gets even more interesting. Right? So now we moved from that uncivilized world to a civilized world that is understanding the circadian rhythms of it all.

And it gets very, very interesting very, very quickly. I think it's fascinating because again, we're we're creating a society where when it comes to the dosages, we idealize certain temp. Yeah. And so what I and so and so back to your idea set here, which is acceptance of your chronotype or your dosha. Right. That becomes very, very important. And there's ways to do it. So as an example, you're an early bird right. But maybe somebody in your house that you care for isn't an early bird. So are you going to force them to wake up at your time.

No you don't because it's never going to work anyway. Right. Yeah. And so but there but but if you've got a 13 year old and they say mom I'm sleeping until 11:00 every day and not going to school, that's a problem too, right? Yeah. So we have to kind of understand that. So the biggest group that has the most problems, quite honestly, are the wolves, the people who are the night owls because they stay up until 12 one, 2:00 in the morning and then the rest of the world is getting up by 637, like whether anybody likes it or not, that's how life works, right?

And so from my wolves, I teach them how to take naps. Because a lot of times they can take a nap and actually do much, much better. But if a late night person takes a nap too late in the day, they may not fall asleep that night. So timing of your nap becomes very important based on your chronotype. So the good news here is, is that while some people might want to be a lion or have lion envy, right, they want to wake up at 430 5:00 and send those emails and work out and do all that cool, fun stuff.

The reality is, is 85% of the universe can't do that. Wow. So stop, right? Take the quiz. If you fall into the lion category, wake up at whatever time you want. I'll show you the perfect time for you to wake up. But don't force yourself to do this. I had a great conversation the other day with the author. His name is Hal Elrod of a book called The Miracle Morning, and how he's been a good friend of mine for a long time, and how has a very specific morning routine. And he talks about getting up at a particular time.

And I said, how you can't do that. And he's like, Michael, I learned that. Yeah. So how is how the friend was a patient, went through cancer, and we dealt with his sleep the whole time. And it was it was quite fascinating. What we discovered was that the miracle morning can start whenever you want it to. So if you're a lion, start your miracle morning at 5:00. But if you're a wolf started at 830 or 9, I don't think I care. Right. So. But the habits that Howe talks about become super duper important, right?

And valuable. It's just when you do them based on your internal biology. I mean, I gotta be honest with you, I remember going through school and, people told me how lazy I was. I never did I never did well, in my very first period class because I was exhausted. Usually fell asleep during that period of time. I mean, look, let's be fair. I took the medical boards without going to medical school and past. There's nothing lazy about me, right? And yet, my entire life, people told me this because I couldn't make it to a 730 in the morning meeting or an 8:00 class or things like that.

And let's be fair, it was based on my genetics. If I talked to my mom and my dad, guess what? Their night owls to I read. And when you start to think about it, I was like, gosh, I remember when I was ten years old, I'm an only child. I would walk into my parent's bedroom at 11:00 at night. My dad would be reading, my mom would be watching TV. I mean, the whole house was up, right? And it always was. And so that's also part of the cultural aspects to this. Right? So, you know, when we talk about Ayurveda, we talk about a whole different part of the world where that was kind of spawned and done.

There's a whole different cultural sleep aspect to different things. A perfect example is Latin America. We have siestas in the middle of the day. They eat much later at night and they go to bed later. And by the way, they're okay, right? So, like thinking through that, you can find a schedule. I think that works for you and that meets those genetic needs that you have. I love that I think you're taking away sleep judgment. You're saying, hey, it's different. It's your genetics. We all have different makeups.

I do try to make people sleep way earlier, and it's so funny because I laugh sometimes. It doesn't work, you know? It doesn't work for everyone. You have to adjust their schedule to them. But in our video, we also teach that 10 to 2 is bit the time on the clock. So we teach that it's such an important time to give your body enough deep sleep and enough rest. So does a night owl get enough deep sleep and deep rest for that healing opportunity? Yes they do. They just do it at a different time. And so again, don't focus too much on the strict clock times.

It was easy way back when to focus on clock times, because it was a great metric that kind of worked across that whole spectrum. Whereas now I think we can look at it a little bit differently, and we don't have to think of that data as that tended to. We just I would say we want to think of it as though those four hours are important for hours. And so for our night owls, that might be a little bit later. It might be from 11 to 3. Right, or 12 to 4. Whereas for our early bird that could be a little bit earlier.

Right. So maybe 9 to 1 things like that. So there's flexibility here to allow it to personalized to you. And by the way just try it out. If you don't like it change it like it's not. You know what I'm saying? Like it's not like, hey, this is permanent. It's it's I guess what we're doing. I love the idea that you just said is there's no sleep judgment. I can't count the number of people who have been like, thank you for giving me permission to get only six hours a night. My goal, and to go to bed from midnight to 6 a.m..

Thank you so much, because I felt so guilty and so horrible and I thought I was killing myself. There's no data to suggest that that's going to kill you. Okay, now there is data to suggest that if you think you got sleep apnea and you don't treat it, that's going to kill you. I think we talked about that earlier in the conversation, but changing your bed time and the amount of sleep that you get, there is absolutely no data to suggest that your head is going to pop off the next day. If you don't get eight hours of sleep, I can assure you of that.

Right? So, but in the middle of the night, people get the craziest thoughts, right? So they wake up at 2:00 in the morning and then they say, oh my gosh, I'm never going to fall back asleep. And then tomorrow I'm going to say something stupid and I'm going to get fired. Right? And I mean, and now when you and it's it's laughable. Right? It's comical when you think about this. Yeah. I guarantee you there is somebody listening to this podcast who had that happen to them. Right. Because it happens to all of us.

It's happened to me before and I'm the sleep doctor, for God's sakes. I mean, yeah, if I wake up at two in the morning, I'm like, that's not you have to go back to bed and you're right. We do create a lot of pressure on ourselves. And so I learned to have just sleep tools next to my bed. Either it's a sleep dummy that I know will give me 2 to 3 hours of sleep or. Or I'll go turn the temperature down, make it colder. So I have all sorts of little things I'll do to support going back to sleep, but I think so much of sleep comes down to what you do.

All day long to support that wind idea. So what I tell people all the time is sleep starts at the moment you wake up, okay? Because remember, I want you to wake up at a consistent time. Right. So and by the way, and I know we're running short on time, but if there's one thing that people should get from this entire conversation is you should wake up. Notice I didn't say, go to bed, wake up at the same time seven days a week. And if you can do it based on your chronotype, I have personally found that to be the most, important advice that I've actually ever given people.

And I found that it has the greatest effect. Now, while I'm here, I figured I'd give a five step plan, if that's okay for your kids, and then share where they can find this quiz, because I think it's fascinating. Sure. So you can find the quiz at Crono quiz.com. Or if you swing on over to the Sleep Doctor, which is my website, you can't miss it. It's right there on the front. So step one is to wake up based on one wake up time based on your chronotype. Step number two is to stop caffeine by 2 p.m..

Okay, Michael, how is this going to work? Now, you notice I didn't say get rid of caffeine because if I did, everybody would turn the podcast off. Nobody would listen to me ever again. Caffeine has a half life of between 6 and 8 hours for the average metabolism. So if you stop it two eight hours later is ten, which again is when most people are kind of figuring out it's bedtime because bears go to bed around 1030 and they make up 50% of the population, right? So it makes intuitive sense to get at least half of the caffeine out of your system.

Start it. Two stopping caffeine. Then after a month, move to 12, and after a month, move to ten and see if you can get the caffeine only in the front part or the morning of the daytime. You will be shocked if you need caffeine later than 2 p.m.. The quality of your sleep is probably all. Step number three has to do with alcohol. There's a really big difference between going to sleep and passing out. Okay, we don't like the passing out. We do like to going to sleep. So it takes the average human approximately one hour to digest one alcoholic beverage.

Now when we think about this alcohol basically destroys your sleep. I want to be super duper clear about this. Like, and the closer you drink to the time of closing your eyes, the worse the effect. Because now I'm not a teetotaler and I, while I'm not a big drinker, there are people who enjoy an adult beverage. I'm going to explain to you how to do that and still get good sleep. So step number three is to stop alcohol three hours before bed and limit yourself to two drinks. Here's how it works. You have one drink right?

Have a glass of water. So let's say you order your meal. You get a glass of wine. You have your glass of wine. You want a second glass, you finish your second glass. Now it's 8:00 at night. You've completed your dinner. You're done. Make sure you have a second glass of water. You go to bed at 11. You've had time to get rid of all of that alcohol, all of that water. It's going to have almost no effect on your sleep. You'll be able to fall asleep and still enjoy an adult beverage. So step number three is to stop alcohol three hours before bed.

Limit yourself to two drinks and have a glass of water in between. Step number four is my favorite wine. It has to do with exercise. I love exercise, it is the single best way to improve the quality of your sleep. But you don't have to run a marathon. Okay, 20 minutes of walking every day is honestly the start point for being able to get better and better sleep. The goal, honestly, is about daily consistency, more so than it is about distance, more than it is about intensity more. It is about longevity.

It's just about making activity a habit. Because when you make activity a habit, a lot of people don't know this. If you can time your exercise at roughly the same time every day, it turns out that exercise is also a circadian pacemaker, the same way that sunlight is. So you can actually use exercise to help pace your circadian rhythm. But if you exercise too close to bed, guess what? Your body heats up and it's really hard to sleep. So step number four is to stop exercise for hours before bed. Now my last one has to do with morning and waking up, and I like people to do what I call the three fifteens.

So the three fifteens are you put your feet on the ground, sitting on your bed and you take 15 deep breaths. So just bring yourself present, you know, do your thing, get your respiratory system woken up, drink 15oz of water. Most people don't know this, but sleep in and of itself as a dehydrated event. You lose almost a full liter of water just from the humidity in your breath that's coming out of your mouth. So I want you to hit that water and hit it hard. And I want you to get 15 minutes of sunlight, preferably outside.

Yeah. Why? When sun hits your eye, it turns off the melatonin faucet in your head. And 15 minutes is the exact amount of time that most people need to be able to make vitamin D. Vitamin D is an internal circadian pacemaker, and it will help you out. And most people are deficient in vitamin D. So in in summary, step number one is to wake up at the same day based on your chronotype every day. Step number two is to stop caffeine by 2 p.m.. Step number three is to stop alcohol three hours before bed.

Step number four is the daily exercise. Stop exercise for hours before bed. And step number five is to do my three fifteens which is 15 deep breaths. 15oz of water and 15 minutes in the sunshine. Amazing, amazing. You have summarized everything about getting perfect sleep so beautifully and I happen to be obsessed with sleep, and I feel like I'm going to have to have you back because the more of it eat, sleep, and the more we get people to understand that this is the key center to their health and winning at their health and optimizing their health, the better off the whole world will be.

Closing remarks and podcast outro 49:00

So thank you so much for coming on the podcast today. I love my hearing. Your absolute pleasure. Thank you so much. If folks want to learn more, you can swing on over to the sleep doctor.com. That's me. Also, I have the same handle on every social media site you can imagine. So Facebook and Twitter and I don't know what other TikTok, you name it, we've got. Oh, YouTube is a big one. I've got a lot of cool videos on YouTube. And we've been really working hard on those and making them really fun and interesting and explanatory.

So if you swing on over to YouTube, hit subscribe, you'll, you'll learn more about sleep than you ever want to know. Awesome. His YouTube is fantastic guys. So thanks so much Doctor Michael. You have been phenomenal and I can't wait to connect with you again soon and everyone follow him. His content is incredible. Thank you. Sweet dreams. Yes thank you. See you soon. Thanks for joining me for this episode. Check out our sponsor fusion Airy Formulas, the potent tumeric supplement used by doctors around the US for patients with pain and inflammation.

Fusion three formulas.com. I'm your host, Doctor Shivani Gupta. For more, visit Shivani gupta.com. Subscribe to this podcast in Spotify or Apple Podcasts, click the follow button or subscribe in any of the apps that you use. That's all I've got for you on the Fusion Health podcast this week. You have the power to transform your health and achieve vibrant health. Starting today.