How to Sleep According to Your Sleep Chronotype: An Interview with Michael Breus, PhD

What follows is a transcript for the podcast How to Sleep Better: Nutrition, Stress and Genetic Factors

Related Links:

• How Sleep Chronotypes Work
• Sleepdoctor.com

Sub-section topics within the interview include the following:

1. Why Does Sleep Matter?
2. What are the Different Sleep Chronotypes?
3. How Does Sleep Change Throughout Our Lives?
4. How Much Sleep Do We Need?
5. Keeping a Consistent Sleep Schedule
6. What Affects Our Sleep?
7. About Sleep Medications
8. How is REM Sleep Important For Your Brain?
9. Sleep Aids
10. Nutrition for Sleep
11. Is it Safe to Take Melatonin?
12. The Nap-a-Latte Sleep Hack
13. What are the Phases and Cycles of Sleep?
14. Can Sleep Trackers Accurately Measure Sleep?
15. How Can You Get Better Data to Measure Sleep?
16. What Type of Stress Management Strategies Will Help You Sleep Better?
17. Caffeine and Sleep
18. Alcohol and Sleep
19. How Can Your Diet Affect Your Sleep?
20. How Do You Get The Best Sleep?
21. About Dr. Breus

Why Does Sleep Matter?

Heather Sandison, ND: Welcome to Collective Insights. I'm your host today, Dr. Heather Sandison and I am joined by one of the paramount experts in sleep medicine, Dr. Breus today. Michael, thank you so much for being here with us to share all of your insights.

Michael Breus, Ph.D.: Oh, thank you for having me.

Heather Sandison, ND: So you have been on The Dr. Oz Show, you've been all over the networks talking about sleep. Why do you think that so many people have so many questions about sleep these days?

Michael Breus, Ph.D.: You know, it's really quite fascinating. I mean, if we're talking about current present time, why do people have so many questions about sleep? It's because people's sleep has been disrupted pretty dramatically with the quarantine and the social unrest and all of the things that are going. Historically before the times that we're talking about now, which I would argue are clearly unprecedented, sleep's kind of a mystery, right? I mean you go back to that room in the back of the house and you turn off all the lights and you emerge maybe six, maybe seven, maybe eight hours later and hopefully something magical has happened to your body. And now you can stand up and do all the things that you want to do and think and all of these great things. And so nobody really knows what goes on there, but raise my hand, I do.

I've spent 23 years studying it and learning a lot more about it. And so I think there's an inherent mysterious component to sleep. Also, I think people don't think about needing to learn how to sleep, right? Because we've been sleeping literally since day one. And so people think of it as this sort of this process that kind of takes over my body, puts me into that unconscious state and then releases me from that later on. The truth of the matter is there's a lot of things in between when you close your eyes and if you fall asleep and then upon awakening, there's a lot of science in there and it's pretty some pretty cool stuff.

What are the Different Sleep Chronotypes?

Heather Sandison, ND: So you described different chronotypes I think it's the lion, the Wolf, the bear, the dolphin [crosstalk 00:01:52].

Michael Breus, Ph.D.: Exactly.

Heather Sandison, ND: Can you break those down and tell me what means what? What are those representing? and which one am I?

Michael Breus, Ph.D.: Absolutely.

Heather Sandison, ND: And which one am I?

Michael Breus, Ph.D.: Well, you have to take a quiz and find out. So what we're talking about here are these things called chronotypes. And so for people who've never heard the term chronotype before you actually already know the concept, if anybody's ever in your lifetime called you an early bird or a night owl, or you ever heard those terms, those are actually chronotypes. So more specifically a chronotype is a genetic predisposition for a particular schedule that your entire circadian system follows. Right? And so for people who are early birds, it's not just that they wake up early it's that all of their hormones kick off early, whereas night owls, it's not that they just like to wake up late it's that all of their hormones kick off later. So you can imagine there's a pretty big disparity out there, right? Between early birds and night owls.

So my contribution to the literature is when we start looking back and we go into the 1970s, 1980s, there was something called the morningness, eveningness questionnaire. And this was developed by a group of scientists out of Germany, I believe. And what was so fascinating about it is they were able to pretty easily just with about 30 questions, identified these three categories. My contribution to the literature however, was I added a fourth category. So I felt like there was a genetic insomnia that wasn't being represented. An insomnia schedule, meaning somebody who's got low sleep drive, somebody who's got an erratic sleep schedule, things of that nature. And so when I slotted it in next to the other three I actually found the genetic underpinnings for it. So I went kind of deep into the science and started looking at the genetic snips or a single nucleotide polymorphisms.

And so when you start to look at those there's something called the PER3 genetic expression, that one gene in particular is a great one to focus in on, because if you have a short one or a long one, that means that you're an early bird or a night owl. Right? And so there's actually solid science behind these chronotypes. And so what I decided to do then was name them. I'm not a bird, I'm a mammal, and so I said, "Okay, let's pick some mammals that people can identify with in these four categories." Now here's the funny part that I think people will get a kick out of. So you can only imagine in writing the book and we're in the marketing meeting about the book, right? Because it's a business. And so they said, "What are the animals going to be?"

And we quickly discovered nobody wants to be a porcupine. You know what I'm saying? So, we had to choose animals that people could identify with and I was even more geeky out about it. And I said, "The animal actually has to follow the chronotype that it represents." So lions are early morning creatures. And so, one of the things we know about lions is they actually kill before Dawn. So they represent my early birds as lions. They hunt, they do all that kind of stuff early, early in the morning. Then when you get in kind of the middle, those are what I call the bears, right? And bears, believe it or not make up 50%. One in two people is a bear also known as the hummingbird, which was kind of the in between, between the early bird and the night owl, by the way, being a bear is the best chronotype to be because the entire world works on a bears schedule.

The night owls, I turned them into wolves because as we know, wolves are nocturnal creatures. They actually hunt in the evenings in the late, late evenings as well. Full disclosure, I'm a Wolf. I've been a night owl almost my entire life. Once I kind of hit adolescence, I just never seem to have left that kind of mindset in terms of my sleep schedule. And then the insomniacs are represented by an animal, a dolphin. And so number one, dolphins are super cool. But number two dolphin sleep uni hemispherically. So half of the brain is asleep while the other half is awake and looking for predators while they swim. And I thought, "Gee, this would make a really good representation of my insomnia patients who are just never quite asleep." Right? And so what's cool about it is if you go to chronoquiz.com, you can take the quiz.

We've had over 1.3 million people take the quiz now. So we've really kind of dialed it in and start to really understand things. But here's the coolest part, It's kind of like, "Well, Michael, that's nice. I mean, I can learn if I'm a lion or a bear or a dolphin or a Wolf, but, but what utility does that have? How can I leverage this information?" Here's where it gets really cool is we've got over 220 studies in the book. And what we've discovered is not just the best time for these chronotypes to sleep, but we figured out the best time to have sex, eat a cheeseburger, ask your boss for a raise. Literally you name it. Now that's going to sound kind of, "Oh my gosh, Michael, how can that possibly be?"

So what's cool about this is that chronotypes have been around since the '70s. So there's a tremendous amount of historical research on it. So we were able to pull all of that research in, and it's pretty amazing some of the things that you can learn, literally just by moving an activity at a different point in time in your schedule when your hormones are naturally at their peak.

How Does Sleep Change Throughout Our Lives?

Heather Sandison, ND: Wow. So one of the things that I have always wondered is we go through different seasons of our life. So I think there's a lot of new moms who would say, "I'm a dolphin right now," right? I'm never asleep because I'm worried about my baby. And you mentioned adolescents that a lot of adolescents are going to be more of a Wolf. So is there a rhythm to what to expect during different phases of our life in terms of how we would sleep?

Michael Breus, Ph.D.: Absolutely. So we call this chronolongevity. And so people actually go through all of the chronotypes throughout their lifetime, which is kind of fascinating. Right? But thinking about it from kind of an evolutionary perspective, right? And so what's fascinating here is when you have the itty bitty babies, they're all lions, right? They go to bed at seven o'clock. They wake up at five o'clock in the morning and guess what? That's what lions do. Right? Then they kind of get into the toddler and middle schooler, and then you can kind of get them to go to bed around eight, get them to get up around seven. And so then they become kind of in the middle then adolescence strikes. I have two teenagers, let me just tell you all out there. It's terrible. There's nothing fun about adolescents, teenagers wandering around your home.

I have two of them. I have, my son is 18 and my daughter is 16 and it's not easy, but one of the things is they love to sleep in. So I was talking with my daughter this morning and she stayed up until two o'clock in the morning and she slept until 9:30. And that works for her. Why? Because her entire circadian rhythm has shifted. And to be clear, this is what we're talking about. The science is all about circadian rhythmicity and understanding our circadian systems. Then your chronotype seems to set for a little while, and then you turn my age. So I turned 52 this year and all of a sudden something starts to happen. It doesn't necessarily happen at age 52, but as you start getting up in your years, what ends up happening is that you start to move backwards and you start to go to bed earlier and wake up earlier.

So if grandma or grandpa, and you wonder why they like to have dinner at 4:30 in the afternoon, guess what? They're moving backwards and becoming lions again, right? Because their chronotypes are moving, transitioning, if you will. Now you bring up a really interesting point, which is pregnancy, right? And so what is a mom supposed to do? Well, number one, it would be good to know your chronotype before you get pregnant. Once pregnancy hits all the hormones basically make it crazy for women to be able to follow some of these schedules, but there is level of consistency that turns out to be very, very important. And so, one of the things I do when I work with my patients who are pregnant and actually I've had several is figuring out ways to help lower their anxiety and keeping a consistent sleep schedule because here's the problem is first trimester a lot of women get morning sickness and their sleep is disrupted because they wake up in the morning, they're throwing up, it's not so much fun, blah, blah, blah.

Middle seems to actually be the best time for sleep. You're growing babies, growing hormones are moving in the right direction, everything's good. Unfortunately, third trimester is where it really starts to suck, right? Because you're starting to get bigger, you're starting to get more uncomfortable and it's just hard to find a position to be comfortable in. Also, the heat that's generated is tremendous during this period of time. And so what ends up happening is women become more and more sleep deprived during the final weeks before birth. And then, Oh, guess what? This little creature showed up and this is something that you have to take care of for every second of the day and you're compelled to do so.

Oh, and you've been sleep deprived for the last three months, because you've been pretty uncomfortable not being able to sleep. So the good thing here is disaster has not struck the day the baby is born. It's just that now you're transitioning again into a whole new kind of scenario. And I've got some strategies for women out there who want to talk about that as well.

How Much Sleep Do We Need?

Heather Sandison, ND: So how much sleep do we need?

Michael Breus, Ph.D.: It's a great question and it's not an easy answer. So we always like to say, "Oh, everybody needs eight hours." Let me tell you something, eight hours is a myth and it has been a myth for a long time. Let me give you an example of my sleep, right? And so believe it or not, I'm a night owl, but I have a tendency to wake up slightly early. So I literally don't get sleepy until midnight. My brain just doesn't get tired until then. And then I wake up naturally without an alarm clock at between 6:15 and 6:20 every single morning. It's just what my brain does. So for me, 52 year old, Michael, I need about six hours and 15 minutes of sleep. And to be clear, we're having this conversation now it's 11 o'clock, I've had zero coffee this morning. You can hear how much energy and passion that I have for the topic so I feel great on six hours and 15 minutes of sleep.

However, if my wife got six hours and 15 minutes of sleep, she'd be a disaster, right? That's not what works for her. So the point here is sleep need is individual. And most people have a kind of a good feeling for how much sleep they need, but there's a hack in here. And here's the hack is if you sleep based on your chronotype and you're consistent with it, you need less sleep and you feel better. What? What the heck are you talking about Dr. Breus?

Keeping a Consistent Sleep Schedule

Heather Sandison, ND: So that means if you are someone who needs to get to sleep a little earlier and you commit to doing that and you do it consistently, then you're going to wake up, feeling more refreshed versus if you change when you go to sleep at night.

Michael Breus, Ph.D.: Exactly. And you're going to need less sleep. So follow my logic. When I started doing this program for myself, I was going to bed at midnight. I wasn't waking up at 6:15. I was waking up at 7:30 after about three months of consistency. I mean, I pulled myself out of bed, pulled myself out of bed. All of a sudden, I didn't need an alarm clock. A month later, I was waking up at seven, a month later, I was waking up at 6:45. And what happened was, is my sleep began to consolidate because when you're sleeping at the right time for your internal circadian rhythm, everything works more efficiently, right? If you're really trying to hack your sleep and you don't know what your chronotype is, you'll never do it.

What Affects Our Sleep?

Heather Sandison, ND: What other things affect sleep? So caffeine, alcohol, light exercise.

Michael Breus, Ph.D.: Everything affects sleep, right? So I call sleep the great denominator, right? Because there's really only three things that the human body has to do in a very particular way. We have to breathe air, we have to drink water and we have to sleep. Right? And so what's so fascinating about sleep is it's affected by so many different things. We've got internal processes that affect our sleep, and we've got external processes that affect our sleep. And we can go in any different direction that you want. But here's the thing I can tell you is sleep affects every organ system and every disease state. Everything you do, you do better with a good night's sleep. when we talk about the science behind it, there's some fascinating work that's been going on right now. I'm not sure if you're aware, but two years ago, the Nobel prize in medicine was given to circadian researchers, right?

First time, "Yay, sleep," right? This first time something like that has ever happened, right? Because we're starting to understand it. We're starting to learn about how does it as internal biological clock work and how can we use it to our best advantage? But boy, there are a ton of things that affect our sleep light, absolutely, sound, you bet, temperature of course, smell, actually yes. The food that we eat, caffeine, alcohol, sugar, I mean, the list goes on and on and don't get me started. We could talk about melatonin and we can talk about iron, we can talk about magnesium. I mean, all of these things have effects on our sleep and so sometimes it can get a little overwhelming, to be honest with you. And so when I'm talking with somebody and they're saying, "Oh my gosh, what are all these things? Where do I start, Dr. Breus?"

That's simple, right? Number one, figure out what your chronotype is and see if you can fall asleep at that time, there's a fairly high likelihood that you can. Next thing, check your vitamin D and your magnesium. Right? So first of all, most people, at least here in the United States are notoriously bad and deficient rather in vitamin D and magnesium, there's a host of reasons for that. And we don't have to get into the weeds on that one. But what I can tell you is vitamin D specifically D3, which you can buy over the counter 5,000 international units is what I usually recommend to people is a circadian pacemaker. So all of the stuff we've been talking about Chronotypes and circadian rhythms, if you don't have enough vitamin D, that system is fragile. It's not static the way it should be.

If you have the appropriate amount of vitamin D that's one of the things that can be incredibly helpful for that. Magnesium turns out to be another one. Lots of people know a little bit about magnesium, but at the end of the day, most of us are deficient in magnesium. I think it operates over 300 different things that are going on inside of our bodies and so in many cases, we can't even eat enough magnesium. Most people don't know, we don't actually produce magnesium in our bodies, we have to eat it. And the soil has been so over tilled that the magnesium, the minerals are not going up through the stocks at the plants, and we're not being able to get on that. So the first thing I do is I run blood work on people, and I look at their vitamin D, I look at their magnesium.

For women, I look at their iron because there's a lot of iron related issues. I also look at thyroid for both men and women because hypo thyroid, or what's considered to be an underactive thyroid actually causes people to gain weight, be more sleepy and an underactive thyroid hyper thyroid... I'm sorry overactive is hyper thyroid. We see insomnia, we see energy, we see all these difficulties. So that's really where I start and then once I kind of get everybody at their par level, then we start fiddling around with different stuff and looking for things to play around with.

About Sleep Medications

Heather Sandison, ND: That's exciting. So another thing is menopause, right? Progesterone levels. And sometimes I'll use progesterone in my clinic to help with women getting to sleep. I'm curious what your thoughts are about other medications that are used for sleep. Things like benzodiazepines and histamines get used. SSRI sometimes get used like dxepin.Do you see that that is more of a bandaid or does it actually help?

Michael Breus, Ph.D.: Okay, so this is a big question and I'm going to unpack it for you. So what I'd like to do, if you're comfortable with it is I'm going to go through all of the different things that are out there. So I'm going to go through old school benzos, new school benzos. Then we're going to start to look at hormonal treatments and things like that. Okay? So when we start to look at sleeping pills or prescription sleep aids, let's be very clear. This is a last resort in most cases, right? This is not the first line of defense in my clinic, probably not in yours either. However, it is the first line of defense in most of the clinics that are out there. And so as a consumer, you need to be super duper careful if you're not sleeping well, there are a whole host of reasons that, that could be. Covering it up with a benzodiazepine or a prescription sleep aid unfortunately in many cases is not a great idea.

However, to be clear, I have lots of patients who are on prescription sleepaids because they have other medical or mental health issues that would require to make sure that they get a good night's sleep. As an example, if I'm treating somebody with bipolar depression, I have to have them on a sleep aid, because if they hit a manic episode, there's nothing that's going to put that person to sleep except for a prescription. If I've got a paranoid schizophrenic, absolutely that's the type of person that's going to require a sleep aid. So there are definitely situations where a prescription sleep aid is appropriate. Let's break those out. There are what are called benzodiazepines and then there are what are called non benzodiazepine hypnotics. Benzodiazepines, restoril Xanax, valium, those kinds of things.

Originally, antianxiety medications, believe it or not. And the side effect was that they made you so calm, you fell asleep. So some brilliant doctors said, "Hey, let's prescribe these to people who can't sleep and see what happens." Here's the biggest issue, tremendous addictive, potential. Tremendous. I had one patient... this is a true story. Who was a heroin addict who was also on Xanax and we were detoxing them and they said, "You can take my heroin, but I will kill you if you take my Xanax," exact words. So that gives you any understanding of the drive for these medications. When somebody starts on them, it's incredibly difficult to get them off of them. To be clear if there's anybody listening, who's on one of these medications do not take yourself off of this medication without talking with your doctor and having a specific taper plan in order to do that.

Sometimes people hear me talking about these medications and they say, "Oh my gosh, I don't want to take that anymore." And they go cold Turkey. That's a terrible, terrible idea. Talk with your prescribing doctor or find a doctor that will help you taper down off of these medications, because here's the truth of the matter. Very few people out there have what I call a broken sleeper, right? That switch in your head. Very few people have that thing that's broken in there that would require full time medication. The second category are the non benzodiazepine hypnotics. This is ambien, lunesta, sonata, these kinds of drugs. The good news is they have much less of an addictive potential to them on the physical side of things. However, let's be very, very clear if you haven't slept well and I give you a pill and you sleep really well, you're going to want that pill again and again, and again.

There's a psychological component to it right? And that's just like pushing the easy button on sleep. And at the end of the day, you kind of have to earn it right? If you really do the work, you can sleep extremely well without any medication whatsoever on almost any condition. Now, there are also some other problems with the non benzodiazepine hypnotics because a lot of people unfortunately mix them with alcohol. So you've probably heard of people take an ambien with a glass of wine and then all of a sudden they get in their car and God forbid they hit somebody or they walk into their kitchen. I had one patient, this was crazy. They walked into their kitchen and they made an omelet completely in their sleep, left the stove on right?

Went down... this is completely asleep, ate their food, left the dishes everywhere and walked back. The stove was on and ended up happening was the pan melted, the fire alarm went off and they went in and nobody was harmed. Thank God. But you can see the issues here, right? People don't think about sleeping medication as serious hardcore medication. This is a medication that brings your brain to the point of unconsciousness, right? It's not something to fool around with. I've had many patients say, "Oh, well I tried my friends, this drug, and I tried my friends that drug. And I think I want that one." And I look at them like, "Are you kidding me? Stop." Right? So be careful with the medications. If the doctors prescribed the medication for you, that's a conversation between you and your doctor.

But again, to be clear, most people don't seem to need that. 

How is REM Sleep Important For Your Brain?

Michael Breus, Ph.D.: Now you mentioned something called the SSRIs, right? So the serotonin specific re-uptake inhibitors. So for a long time we thought that insomnia in particular was either an anxiety or depression issue. To be clear, 75% of insomnia is between your ears. Okay? It really has a lot to do with stress, your mindset, how you think about things, things of that nature. But for a while, we started using medications for depression and anxiety to help lower that depression, anxiety, and then allow the natural sleep process to take over. Pros and cons here. Right? So if you look at the SSRIs in particular, there's a lot of data to show that it almost completely obliterates REM sleep. Almost completely. That's not good. Generally speaking guys, REM sleep is pretty important for your brain.

REM sleep is actually where we move information from our short term memory to our longterm memory. So a lot of people who are taking Prozacs and Zolofts and effectors of the world report Memorial difficulties, memory difficulties and they don't know why. That could have something to do with that missing REM sleep. 

Sleep Aids

Michael Breus, Ph.D.:  Trazodone turns out to be a very popular medication for sleep. This actually is what's called a Tetra cyclic. We used to back in the day before we had SSRIs, we had tricyclic antidepressants. Trazodone almost fell into that category happens to be a tetracycline. It was never a particularly effective for depression just to be clear. But for some reason it really makes people sleepy and doctors don't mind prescribing it. So doctors will prescribe it for years and years. Again, they're not following up, they're not necessarily teaching people how to sleep better, it's just a prescription for a pill. And for some people to be fair, it works right?

I don't think I have a tremendous problem with somebody being on trazodone for an extended period of time. However, you don't need it. So why are you on it? Right? I mean, here's the thing is if you put anything into your body food, medication, compounds, whatever it is, it's going to have an effect, right? If you don't need it, I'm kind of the mind maybe it shouldn't have it right? Moving forward then we start to look at over the counter sleep aids, right? The PMs, as it were, right, the Tylenol PMs, the Advil PMs, the PM whatevers. So here's the thing that's interesting about those. In most cases, the PM is actually just diphenhydramine or what we call Benadryl, right? So if you understand how this works, it's kind of interesting.

So Benadryl almost doesn't affect sleep at all, but it gives the side effect of fuzzy drug head. You know what I'm saying? That kind of full feeling like, "Oh, I'm a little loopy and Loggy." That relaxes people and then they fall asleep. Here's the big problem with using the PM medications. There's now significant data to show correlative evidence between longterm use of Benadryl and anti-histamines and Alzheimer's, Parkinson's and dementia. So guys, again, you can figure out how to do this on your own. I swear you don't have to have an added substance, especially a Benadryl to you in order to allow you to sleep. 

Nutrition for Sleep

Michael Breus, Ph.D.: Now, we walk into the herbs and supplements universe, right? And so I talked a little bit about supplementation being magnesium looking at vitamin D also, there's one other one that I want people to be aware of and that's the B as in boy vitamins.

All of the B vitamins, B6, B12, B4, folic acid, all of them have dramatic effects on sleep. And so making sure that you've got enough, vitamin B in your system is an important thing. Be careful for me, at least when I take vitamin B, it gives me energy. So I take my vitamin B in the morning time. You clearly don't want to be taking your vitamin B at night. And believe it or not, like we were talking about with chronotypes, there actually is a perfect time of day to take medication based on your chronotype and based on whether or not the supplement or medication is fat soluble or water soluble. So there's some really interesting stuff about that in the book. Moving on to herbs, right? You've got things like valerian, like Magnolia bark, jojobas, I mean, L-Theanine, GABA.

I mean the list goes on and on. To be really honest with you, I've actually done a 2000 word article on my blog about every single sleep-related herbal ingredient you can imagine. I've also done the same thing for the hormones and for the minerals and for the vitamins. So one of the things we'll do is in the show notes will lead you to a couple of blogs of some of the more popular ones. But if you head on over to my website, thesleepdoctor.com and you go into the blogs, you can literally find any ingredient there is. 

Is it Safe to Take Melatonin?

Michael Breus, Ph.D.:  And then the final one, I know this is a long winded answer, but it was a pretty complicated question. Is melatonin, right? So melatonin is a hormone. Now you notice I didn't talk about it in the supplements, I didn't talk about it in the vitamins, I didn't talk about in the prescriptions because it's different.

People need to understand this is a hormone, right? It's like walking into the local pharmacy and saying, "I'd like some testosterone or some estrogen please," right? They're not going to give it to you yet melatonin because the FDA considers it, a supplement allows it to come through. Lots of things we need to think about here. So, number one, there was a study done approximately a year ago where they pulled eight different melatonins off the shelf, all different brands and they tested them. Not one melatonin brand had the amount of melatonin that was stated on the bottle, not one. Okay? Many of them were over, some of them were under. So buyer beware, you need to find a brand that has consistency in the quality of what it is that you're taking.

So that's number one. Number two is timing. Most people don't realize that melatonin isn't a sleeping pill, right? If you take ambient, you take it right before bed, right? That's not what you do with melatonin, especially in tablet form. You have to put it down as to get into your stomach, be digested, and then come back up and have an effect. You're talking 90 minutes, easily, 90 minutes. So people take a melatonin right before bed and they wonder why it's not affecting them. That's because it's not supposed to be affecting you for 90 minutes. So take it 90 minutes before bed. Dosage becomes another big issue. Lots of people out there are claiming different dosages. The data out of MIT, Dr. Workman's lab in particular has discovered that in order to reach plasma, concentration levels all you need is about a third of a milligram of melatonin.

Generally speaking, I recommend between a half and one and a half milligrams, but I never go over one and a half milligrams for my patients. 95% of the melatonin that's available today is an over dosage format. It's in three, five and 10 milligrams. And I got to be honest with you. People call me all the time and they're like, "Hey, Dr. Breus, I took 20 milligrams of melatonin last night and I had these crazy dreams. Is that normal?" Well, considering that you're taking 20 times the recommended dose, you bet it's normal, by the way, that's the easiest way to know if you've overdosed on melatonin is the very vivid dreams. And then this very kind of loggy feeling in the morning, very difficult to wake up in the morning time. And a lot of people have difficulty with melatonin. To be clear, melatonin is not a sleep aid.

Melatonin is a sleep regulator, not a sleep initiator. What melatonin does is it tells your brain it's time for bed. That's very different than increasing your sleep drive. Increasing sleep drive is caused by something called adenosine. So when a cell eats a piece of glucose, something comes out the backend. One of those things is adenosine. Adenosine works its way through your system. It goes to a very specific receptor site in your brain. And as the adenosine accumulates, you get sleepier and sleepier and sleepier. That's kind of how it works. 

The Nap-a-Latte Sleep Hack

Michael Breus, Ph.D.:  Now, I'm going to throw in a hack here that's kind of interesting. If you look at the molecular structure of adenosine and the molecular structure of caffeine, they're off by one molecule, which is kind of interesting. So I created a hack that I call the Napa latte. So let me tell you what you do. If hopefully before about two o'clock, three o'clock in the afternoon, because you would not want to ingest caffeine this late in the day up until this particular point.

But what you do is you take a cup of drip, black coffee, throw in three ice cubes just to cool it down and slug it. Then immediately close your eyes for a 20 to 25 minute nap. Here's what happens, during the nap your brain burns through the adenosine. The caffeine is literally waiting there and since it's only off by one molecule, it will fit perfectly into that receptor site. It launches in you're good for four hours, guaranteed. It's amazing. I do it with every CEO I've ever worked with every celebrity, every athlete, people love it. To be clear, don't do a Napa latte every day. It really should be used for times when you need to get a boost of energy or you had a crappy night's sleep the night before. Does that make sense?

Heather Sandison, ND: Yeah. It sounds like something you should experiment with maybe before the day that you give a big speech or something.

Michael Breus, Ph.D.: Yeah, definitely.

What are the Phases and Cycles of Sleep?

Heather Sandison, ND: So you mentioned REM sleep. I'm curious about the phases of sleep. So people talk about needing deep sleep and how much, and then REM sleep and I don't know what are the other ones take us through-

Michael Breus, Ph.D.: There's a bunch [crosstalk 00:30:44].

Heather Sandison, ND: Yeah. Take us through a typical night and kind of what the goals are. And also is there an accurate way to measure these things?

Michael Breus, Ph.D.: Okay. So that's the Pandora's box of questions for sure. So we'll go through the stages and then ask me again about the trackers and then we'll get into the tracking because I'll forget. So when we're looking at stages of sleep, we could really dig deep, but let me give you the kind of the summary or the kind of the top level and then we can get a little bit deeper. Light sleep, what we call stages one and two sleep really is the pathway to get to deep sleep. Now, there are some things that go on in stage two that are important. These things called spindles and these things called K complexes, which are brainwave forms that kick off during this particular stage, there is some data to show that it might have to do with memory in some certain ways shapes and forms, but follow my logic.

Stage one gets you into sleep, stage two gets you to what we call deep sleep. Deep sleep is a combination of stages three and four of sleep. We've actually changed the scoring criteria and now it's all just called stage three or deep sleep. We no longer have stage four sleep, it's actually called N3 now for some strange reason. So when you look at this, what does it do for you is the real question. This is the physically restored... this is the wake up and feel great sleep, right? Stage three and four, that's the stuff you really want to get to. And by the way, that's the first thing that caffeine destroys and the first thing that alcohol destroys when you drink it too close to bedtime, but we'll get back to that in just a minute. So when we're talking about this stage three, four sleep, this is actually where all of your growth hormone is emitted.

The largest bolus of growth hormone is emitted during stage three, four sleep. So I kind of think of stage three, four sleep as like bringing the car to the body shop. It's like you're getting the dinks and the dents and the things kind of pulled out of it. And that's, what's great about deep sleep is also it's at the first third of the night. So it happens in the beginning of the night, not in the end of the night. So we don't know exactly this occurs, but my theory or my hypothesis is that when mother nature or whomever created this whole system that we're all living in the reason is because physical restoration has to happen at first. Because if you get woken up after three or four hours, you get your body's got to be able to do what it, what it's gotta be able to do.

So I feel like physical restoration occurs first. Now, one of the things we haven't talked about and I'm going to get to REM sleep in a second, our sleep cycles. So it's really quite fascinating. So you go from awake to stage one, to stage two into stage three, four back to stage two, and then REM sleep. At the end of the very first REM cycle, that's what we actually call a sleep cycle, right? You end up having four or five sleep cycles across the night. The average sleep cycle is about 90 minutes long. All of that information is going to become important when we start talking about trackers, because I'm going to show you actually how to use tracking information. Now let's talk about REM sleep, REM sleep is the mental restoration that you're really looking for. What's really fascinating. This was discovered about eight or 10 years ago is REM sleep appears to be at the time when we move information from our short term memory to our longterm memory, that's kind of where that happens.

Another interesting thing that happens in stage three, four or deep sleep is that there's a filtering process that goes on. So actually when something called your glymphatic system cleans out your brain during stage three, four sleep. And it takes some of that information that you don't want to save with it. REM sleep says, "Okay, you've sectioned out the information, this is the stuff that got to go to longterm memory, because maybe I need to answer a question with this information later or recall, or maybe this is how I learn, how to ride a bike or whatever." Right? And so that's what happens during REM sleep. Now people always say, "Well, you say that's what happens, Michael I mean, can we get a little bit more detailed?" So what it turns out is that when data comes in through our eyes or ears or our mouth it becomes electric and then it moves along to the particular place in our brain where we store our memories.

What's interesting though, is our brain has got to be able to take this memory, right? And it's got to find the right filing cabinet, if you will, the right file drawer and then the right file to deposit the information, right? Because it's got to be some sort of organizational substructure inside your head to retrieve information. Unfortunately, there are thousands and thousands and thousands of pieces of information that come through the door. And so sometimes your brain isn't so good at it, right? And so if you have a dream, for example, where you walk downstairs and your dog is eating a bowl of spaghetti with your second grade teacher at the kitchen table, here's probably what happened, right? Is you probably had Italian for dinner, right? Your dog may have jumped on your bed in the middle of the night, and your second grader was talking about school, which reminded you of your second grade teacher.

And so all that data ended up dumping onto the second grade teacher. And that's where the dream came from. It's very, very interesting when you start to look at that, dreams are a subject that a lot of people have interested in. They like to learn more about lucid dreaming, they like to understand more about dream content and then of course, dream interpretation. There's a lot of science on lucid dreaming on the process of dreaming. Unfortunately, there's just not a lot of great data on interpretation of dreams. I often tell people that you would be the best interpreter of your dreams because you're really going to start to understand what's going on. Sometimes getting a sounding board from people can be advantageous or sometimes not.

Here's, what's interesting also is that first third of the night where you get your deep sleep, the last third of the night is where you get your REM sleep. Interestingly REM is also the time when you're most creative specifically right after it. So when you wake up in the morning time, when you're still in bed and you still haven't had all of the CNNs and the all the information that comes at bombards you do a little creative thinking. You will be shocked at how much more creative you are at that early morning hour, right after REM sleep. It's kind of one of those things we learned about in terms of chronotypes, but when you start to fiddle around with the stages, then you'll kind of want to know, well, all right, Michael, how much of each one of these do I need and how do I know if I'm even getting good sleep? Right? So let's figure this out.

So stage one represents approximately 5% of the night, stage two represents about 50%, stages three and four is about 25 and stage REM about 20, right? And so that's kind of the basics of kind of how it all has a tendency to lay out, but remember it happens in cycles. And so the first third of the night is where we get the biggest chunk of that deep sleep. So probably 20 of the 25% happens in the first probably two sleep cycles. And then for REM sleep, the same thing happens, but in the last two sleep cycles. So here's where it gets interesting. "Well, Dr. Breus, what if I want to wake up early? I've heard that waking up at 5:00 AM, I can get my job done, I can work out, I can do all these great things," right?

Michael Breus, Ph.D.:  If your circadian rhythm, isn't a lion and isn't meant for you to wake up, you just chopped off probably at least the last sleep cycle, which is where most of your REM sleep is. Right? So this is, again, the reason why following your chronotypical schedule makes so much sense because it's what your body is trying to do. When you have an alarm that wakes you up at five o'clock in the morning, and you're a Wolf like me, it's a disaster, right? Because my body's not getting the nourishment that it needs. People just really don't understand sleep. I mean I said this statement before, and I'll say it again. It affects every organ system, every disease state, everything you do, you do better with a good night's sleep. Cancer is actually a really interesting area of study.

It's kind of a hobby of mine and what we've discovered is that if you administer chemotherapy at different times during the circadian cycle, you can use less chemo and it's more effective. Dude, less poison in the body. I'm all for just timing, it's all just timing. Sloan Kettering's adopted some of these circadian schedules for chemotherapy. I mean, it's amazing what we're learning out there. So now you want to talk about trackers, right? "So Michael, okay, now I understand all these different things. If I track them, what the heck do I do with them?" Right? So that's the biggest problem right now is tracking hasn't really caught up with doing yet. I would argue. So it all started when somebody came up with the brilliant idea that everybody needs to take 10,000 steps in a day, right?

Can Sleep Trackers Accurately Measure Sleep?

Michael Breus, Ph.D.: So some entrepreneurs said, I can figure out how to track that with your phone, right? Or, whatever. And so people started really getting into it. "Oh, I got my 10,000 steps." Let's be very clear when you track steps, that's a math equation, right? There's nothing hard about that. You need to know the size of the leg, you need to know your gate, That's a calculus problem that my daughter can do quite easily. Sleep, what's your metric? How do you measure it? Right? If I asked you, "How did you sleep last night?" You're going to say to me, "Eh, Okay," that's not a number. So if I say, "Give me a number." Based on what? So is it how quickly I fell asleep? And is it how quickly I got to deep sleep? Is it how quickly I got to REM sleep? Is it the amount of REM sleep? Is it the amount of deep sleep? Is it number of awakenings? Is it the length of time of my awakenings?

You can see, I could go on and on and on. The metric is a tough metric, so quite frankly, nobody does a good job of tracking. Full disclosure, I'm joining the scientific advisory board of one of the biggest tracking companies out there. And so I'm excited to work with them and help everybody kind of tune in and get better and better and better at it. The accuracy that is. But there's a secondary issue with all of these trackers. Let's just say, for example, that they were perfectly accurate, just for giggles, right? Every tracker out there can accurately measure my sleep 100% of the time. What do you do with the data? Right? I have people, they call me up all the time. "Dr. Breus, I get 14 minutes of REM sleep." Okay. What am I supposed to do with that? Right? So it has to be relative data, right? So number one, how does it work for my gender, my age, my ethnicity, is there a difference?

Because there are differences in all of those, right? So we need to comparative statistic. I like to compare myself to white males age 52, because that's what I am. And so I need to know and understand what each stage of sleep that they need. You might have a very different gender specific idea of what you want to get for sleep and so nobody's got that info. So step number one, it'd be great to have some comparative statistics, step number two, okay, so what if I'm not sleeping like other 52 year olds? How do I increase my sleep? How do I increase my deep sleep? How do I increase my REM sleep? Nobody knows.

To be very clear, there are very few people out there who've got any idea of how to do this. The good news is I do and it's not as terrible and horrible as you think it is, but it has to do with all of the things that we've been talking about today so far, which is consistency, knowing and understanding your chronotype. Those are two of the biggies, but we really need to look at alcohol and we need to look at caffeine because that's really where we see the biggest disruptors for sleep in general. When you start... Oh, go ahead.

How Can You Get Better Data to Measure Sleep?

Heather Sandison, ND: I'm curious about sleep studies. So a specialist people who have trained for decades essentially to figure out how you're sleeping and EGs, do we get any better data or any more actionable information if you go in and do an overnight sleep study in a hospital?

Michael Breus, Ph.D.: No. And I'll tell you why. Because hospitals and sleep laboratories are not designed to give you that information. 95% of sleep centers in the United States are apnea shops. That's it. All they want to do is diagnose sleep apnea. In fact, they won't... 99% of the time, the doctor will not even tell you anything about your sleep architecture. So the staging, they won't tell you anything about the cycles, and every once in a while, might tell you about some of the awakenings because they could be disruptive. But to be clear, if you don't have sleep apnea, there's almost nobody in the country that really wants to do anything with you. Now, if you have narcolepsy, if you have a major parasomnias sleep, walking sleep, talking, REM behavior disorder, those kinds of things don't get me wrong. They are absolutely neurology based centers that are great for sleep that are interested in that.

But to be fair, 95% of the sleep centers are really only looking for apnea so if you don't have apnea and you went to have a sleep study done, number one, your insurance wouldn't pay for it. So, you're talking about easily a grand, depending upon where you are and in some cases, even more and number two, the doctor is not going to be able to tell you a whole lot either. So you're kind of stuck looking at trackers, right? Trackers are less expensive, not as accurate, but here's the thing that trackers are that I like they are consistently inaccurate, right? And so if they track me and they say, "Michael, you got 14 minutes of REM sleep," but it's 14 minutes every single day. I don't think I care, right? Because it's probably not 14 minutes, but whatever it is, it's consistent.

It's about the relative data, right? Not the absolute data. So I'm always talking with people about those types of things. And then again, if you really want to talk about how do you improve some of those metrics and areas? I would argue that both caffeine and alcohol are the very first places that you need to look.

What Type of Stress Management Strategies Will Help You Sleep Better?

Heather Sandison, ND: And what about stress and stress management strategies?

Michael Breus, Ph.D.: Oh, stress has nothing to do with sleep. Are you kidding me? Stress is the biggest thing there is, I mean, it's ridiculous. Stress really runs insomnia, there's no question about it. And let's be really honest, we are right now in an unprecedented stressful time. I mean, I don't know about you, but I had a unique situation with COVID and with quarantine. My daughter who's 16 years old was up until January studying in Beijing. Yeah, and we were there with her for a certain period of time and we had to evacuate her. And so when you start to think about the stressors that are associated with that, now to be clear my daughter's perfectly fine, she's healthy, she's safe, everything is great.

But at the end of the day, when on earth would I have thought that I have to evacuate my child out of a country, right? When, if ever, has anybody had the ideas that, "Oh my gosh, I'm concerned about my health, I'm concerned about my family's health, I'm concerned about my career. I don't know when I'm going to get out of this place. Oh. And by the way, I've been locked for three months with my family in this house." Don't get me wrong. I love my fricking family, but I had no plans on being locked in with them for three months. Okay? So again, you're talking about stress, this is a powder keg of stress, right? Then you talk all the social unrest that's going on.

And we can't have a conversation without addressing that on some level, because guess what? It's stressful, right? I'm not here to talk politics, but what I am here to tell you is if you're not sleeping well, you're not making good decisions. I can guarantee you of that. Right? I can also tell you that when you're not sleeping well, you're emotionally over reactive, plenty of data to suggest that. So think about it like this, been in quarantine, not getting such great sleep, now we've got all these issues going on. This is arguably the most stressful time in most people's lives. So here's the idea that I can't quite figure out why on earth would you want to add a stimulant to that? Right?

People are jamming on caffeine right now. It's unbelievable. Coffee sales have been through the roof because what's happening? People are at home, they're not moving a whole lot. So they're feeling kind of, eh, kind of fatigued, kind of... because the more you move, the less fatigue you feel. Right? And so people are... I mean, I saw one celebrity tweeted the other day. She said, "I took 200 steps and it's two o'clock," right? Most people would have done 6,000 steps by two o'clock. Right? So the movement isn't there. So our body doesn't have a need to recover. So our sleep gets disrupted and we feel like crap.

Caffeine and Sleep

Michael Breus, Ph.D.:  So what do we do? We drink a stimulant to help wake us up to help push us through our day. No bueno. All right? And here's why. Caffeine's got a half life of between six and eight hours. Right? Most people don't even think about that. And people are ingesting more and more caffeine throughout the day. National Sleep Foundation recommendation is for about 250 milligrams. That's like two cups of coffee, two and a half cups of coffee. And to be clear, a cup is six ounces, right? It's not a mocha Grundy, rapid, whatever the heck it's called, right? Which by the way, almost as well, those are really a combination of just caffeine and sugar, right? In every way, shape and form that they can make them. Don't get me wrong, everybody likes a good Starbucks every now and then, but to be clear, it's definitely not helping your sleep in any way at all.

If you can curtail caffeine by about 2:00 PM, at least half of it is out of your system. And that will allow you a much easier way to fall asleep. Now, I guarantee you that there are some people who are listening and here's what they're thinking, "Sleep doctor, he doesn't know what he's talking about. I can have a cup of coffee or a cappuccino or espresso at dinner and I can fall right to sleep." So I'm going to tell you why that's not true. So while you may think that you're sleeping, if I stuck electrodes and put them all over your head, the quality of the sleep that you would be getting is terrible. Are you unconscious? You bet you're unconscious, but the quality of the unconscious state that you are in is not going to be restorative period. So when people are looking at caffeine, very simple recommendation stop by 2:00 PM.

Alcohol and Sleep

Michael Breus, Ph.D.: It's very easy, It doesn't matter your chronotype and you actually find that it can be very, very helpful. Of course, alcohol is another problem. So lots of people are drinking right now. And to be fair, alcohol is the number one sleep aid in the world. More people use alcohol to sleep than anything else. We were talking about the supplements and the medication. Oh no. Alcohol far outweighs all of that. Right? And so is it good? Is it bad? What should we do? What shouldn't we do? Here's the thing. When you start to look at alcohol, number one, alcohol is a diuretic, right? So as you drink your wine or your beer or your spirits, if you break the seal and you got to go to the bathroom, you're peeing all night long, right? Most people don't know this, sleeping in and of itself is a dehydrated event.

So the humidity in your breath, you lose almost a full liter of water every night. I know isn't that crazy just from sleeping and breathing, right? So if you drank alcohol before bed, right, and you peed, so you're dehydrated, then you sleep, you become more dehydrated. Then you wake up and what do most people do? Get a cup of coffee, what's coffee, coffee's a diuretic, right? And so you end up dehydrating your body and as well as everybody does that, dehydration is a massive problem for both cognitive performance, physical performance, and you just can't get away from it. So I really caution people about alcohol before bed, but that's not the only reason just because it makes you have to pee because quite frankly, you could just drink a glass of water for every alcoholic beverage. And you'd probably be okay, which by the way, is a recommendation of mine is to drink one glass of water with every alcoholic beverage.

Here's where it gets interesting. Once you go past two alcoholic beverages, there's several different things that happen. Number one, from a behavioral standpoint, from an emotional standpoint, one of the things that we know is people can get aggressive after two drinks and people can get activated after two drinks, right? And so it's not having the depressive, I want to mellow out effect. It's having the, I'm going to activate, I'm going to get up effect. Let's be clear. You really don't need to be doing that at nine o'clock at night. Right? So number one, if you can limit it to two, drink one glass of water in between each one and I'd lights out roughly three... stop drinking roughly three hours before bed. Why do I say that? It takes the human body approximately one hour to digest one alcoholic beverage. So if you have two drinks, let's say I have two glasses of wine with dinner, you wait two hours and you have two glasses of water, go to bed, you will be fine.

You can enjoy your adult beverage and it won't have a dramatic effect on your sleep. So go ahead.

How Can Your Diet Affect Your Sleep?

Heather Sandison, ND: What about diet?

Michael Breus, Ph.D.: So it's interesting. It depends upon your diet. And so fortunately I've written several blogs looking at vegetarian veganism, I've looked at keto and paleo, and I've also looked at sugar. And so what we know is that diet definitely has an effect on your sleep. But interestingly enough, when you eat appears to have as strong a component as what you eat. So I talk to people about this all the time, but the big thing to remember is you don't want to go to bed hungry ever, because it's just going to keep you awake. But if you go to bed too full, you're going to be uncomfortable as well.

So what I do is I finish my biggest meal and to be clear, I'm an intermittent faster. And that's my favorite way to maintain my energy as well as maintain my weight and keep the caloric content in check which by the way, has a great effect on sleep. There's some really interesting data looking at intermittent fasting and sleep. But when you look at all of these things, what I like to do is I stop eating about three hours before bed. And then I have a little snack. It's a 250 calorie snack and it should really comprise about 75% carbohydrates and about 25% protein or fat. "Michael you're telling me to eat carbs before bed. Why would I do that?" So it's really quite interesting. Carbohydrate ingestion causes a spike in serotonin and serotonin is the calming hormone.

So guess what? It helps you fall asleep. To be clear eating a Turkey sandwich, people say Turkey's got tryptophan in it, it should make you sleepy. You'd have to eat a 42 pound Turkey to get enough tryptophan in your system. Even on my best days in college, I couldn't eat entire Turkey by myself. And interestingly enough, tryptophan doesn't work well in the presence of protein. So if you did do it, all you do is get sick. And warm milk is the other one that people ask me about all the time. They're like, "Oh, I have a glass of warm milk and it's great." You'd have to drink a gallon and a half of warm milk to get enough tryptophan to actually have an effect. The reason that warm milk has an effect on you. It turns out that it's all dependent upon who used to give you the warm milk, right?

Because you have this association with a caring, loving person who would give you something to help you with sleep, which calms you down and allows you to sleep. By the way, the reason that you sleep so well after Thanksgiving, isn't because you had the big Turkey meal it's because your in-laws had finally left your home, the meal is over.

Heather Sandison, ND: There had to be an explanation.

Michael Breus, Ph.D.: That is the explanation for sure. So again, a 250 calorie snack before bed, 75% carbs, 25% protein. What I like to do is an apple with some nut butter, or a rice cake with some sliced avocado or something like that. Again, it doesn't have to be anything big, but if I do have a tinge of hunger, that'll quell it pretty quickly. And by the way, drinking a glass of water, usually quails it too.

How Do You Get The Best Sleep?

Heather Sandison, ND: What's the latest in the sleep research? What are we learning? What's on the cutting edge of how to get the best night's sleep?

Michael Breus, Ph.D.: So it's interesting because there are really several paths within sleep research, as I'm sure you can imagine as a discipline sleep is very interesting because for a long time, we really focused only on sleep disorders. So apnea, narcolepsy, restless leg syndrome, periodic limb movements, the parasomnias sleep, walking, sleep, talking, all of those kinds of things. And that was really the primary focus of most of the literature, I would say in the last 15 years or so. What we're starting to see is... well let me back up for a second. So I believe that there are two categories. There are sleep disorders and what I call disordered sleep, right? Sleep disorders, apnea, narcolepsy, all the stuff that they used to go on. Disordered sleep is, "I went to that room in the back of my house for seven hours, I came out and I feel like crap, Michael, how do we fix that?"

That's what I call a disordered sleep. And that's where I started to find literature. And to be fair, it hasn't been in the main academia of literature. It's been more on the fringes or in different countries or things like that. As an example in Germany, they have these things called the Commission E reports. This is where I get all of my data on supplements because they just do a better job of it over there. They do full on clinical trials of the vitamins, the minerals, the supplementation so I'm able to get a lot more better data from them that way. But what we've really started to see now are people looking at different things that are affecting sleep from the outside, not necessarily from the inside. There's a lot of data coming out about light, and how does light have an effect on sleep?

There's a lot of data on sound. How does sound affect sleep? Temperature is another big area of concern for people. Food is one, cannabis is one. So, I mean, honestly I love being asleep doctor because literally every single month, some absolutely miraculous thing is discovered in sleep. And it's unbelievable. I mean, it's pretty crazy. Right now everybody seems to be focused a lot on COVID and sleep and things like that, which would make sense. But it's really a lot of fun when you get to learn every week about something new that you can then kind of spread that to people and hopefully they can leverage it for their health.

About Michael Breus, PhD

Heather Sandison, ND: So where can people find more? Where can they take that quiz you were talking about to figure out their chronotype?

Michael Breus, Ph.D.: Sure. So if you go to chronoquiz.com, that's C-H-R-O-N-O-Q-U-I-Z. We'll put it in the show notes for you if you'd like. You can go there, it takes about two minutes, it's about 30 questions. And you will learn very quickly what your chronotype is. And then if you want to learn more 

just about sleep in general, my website is the sleep doctor... doctor's all spelled out dot com.

Heather Sandison, ND: And do you take on clients? Do you see patients?

Michael Breus, Ph.D.: So it's a good question. So I have a very, very, very small practice. To be clear, I have four patients. And so I'm, what's called a high performance sleep coach. So what I do is I work with, for example, athletes, CEOs people who are in kind of unique situations and I can tweak the crap out of their sleep. I can really kind of massage it and get into the point where they're sleeping five and a half to six hours. It's all super high quality sleep, they've got much more time in their day and their performances. Pretty amazing. It depends upon the person though, like for my athletes, I actually have to do something different. I actually have to get them more sleep because of the physical demands. And it also depends on the sport too, which is kind of interesting as well. Whereas with my CEO's, I'm oftentimes shrinking their sleep schedule so they have more efficiency and time. Whereas with my athletes, sometimes I'm expanding it, adding things like naps, supplementation, things like that.

Heather Sandison, ND: It sounds like sleep is really individualized. It's hard. I mean, you've written books and you have a lot of general recommendations, but really if you want to get down into it, a lot of it is pretty individualized and you might want to work with a coach or something. Is that something that's taking off is sleep coaches? I know we have business coaches and diet coaches and all of these different coaches. What about in your world?

Michael Breus, Ph.D.: So yes and no. So there are a bunch of people that are calling themselves sleep coaches but unfortunately you kind of have to do a little buyer beware. If you're looking for sleep coaching, I actually wrote an entire blog about how to discover a qualified sleep coach. But the most important thing that you want to understand from a sleep coach is if they are not trying to determine at the very outset, like the very first meeting, if you have a sleep disorder or not, they're not an appropriate coach for you because the very first thing that any coach should do is make sure that you don't have a medical disorder before they start their coaching practice with you and referring you to the appropriate specialist in your area. That's certainly one way. I do my form of sleep coaching, which of course is somewhat limited.

Michael Breus, Ph.D.: When you start to talk about people who are doing more sleep-related coaching. I think that online coursework can actually be quite beneficial for people because there really isn't that large, a number of people out there that have got the knowledge base that can be really good sleep coaches. And so for some people they can do an online course and actually get a tremendous amount of information and then have just a small amount of coaching on the backend. I actually offer those I have the online courses and I offer those online courses for people as well.

Heather Sandison, ND: Fantastic. Wonderful. Well, Dr. Breus, thank you so much for sharing your time with us today. This has been so insightful, some really, really unique offerings that you have. And thank you again for being here.

Michael Breus, Ph.D.: It's my pleasure. Thanks for having me, I am clearly a sleep geek and I dig all the science and if people have got questions or want to get in touch with me, come on over to thesleepdoctor.com and this is Dr. Michael Breus wishing everybody out there sweet dreams.

Heather Sandison, ND: Thank you.