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Description
There’s a lot of money to be made in the business of sleep. Take sunrise alarm clocks, fancy mattresses, REM-tracking wearables, and monthly deliveries of melatonin.
But should we really be investing this much in hopes of catching a few more Z’s?
In the final episode of season 8, we consult a bonafide sleep doctor on the matter and get a physician’s POV on a few questions keeping us up at night:
Why is there such a large market for catching some Z’s?
Can any of these products actually help us find rest?
Why do we need to sleep?
What’s happening in our brains and bodies while we dream?
Featuring
Rocio Fabbro is a staff writer at Quartz and the host of Season 8 of the Quartz Obsession podcast. She’s obsessed with etymology, matcha, and late ’90s-early ’00s romcoms.
Dr. Michael Breus is a double board-certified Clinical Psychologist and Clinical Sleep Specialist. He is one of only 168 psychologists in the world to have taken and passed the Sleep Medicine Boards without going to Medical School.
Show notes
The Sleep Doctor
Take the Chronotype Quiz
You should go to bed: A record number of Americans aren’t getting enough sleep
The forgotten medieval habit of ‘two sleeps’
SHUT I
Apollo Neuro
Transcript
Rocio: Sleep. Why is it so elusive? With insomnia on the rise, the sleep industry is booming. High tech gadgets, luxurious mattresses, sleep trackers, and melatonin are all vying for our attention. But no one can seem to agree on how many hours of shut eye we need. Some doctors say you need at least 8 hours, others say 6 is fine.
The industry is making a fortune, yet people are more confused than ever about how to get a good night’s sleep. And what a good night’s rest even is. To explore the mysteries of sleep, we’re joined by the sleep doctor, Dr. Michael Bruce.
Dr. B: Thanks for having me on the show. I’m excited to be here.
Rocio: A leading clinical psychologist and sleep expert, Dr. Breus will share the latest insights on insomnia, effective treatments, and practical tips for better sleep. Welcome. I’m Rocio Fabbro, and I’m your season eight host of The Quartz Obsession, where we’re taking a closer look at the technologies and ideas that define our lives. Today we’re traveling into the realm of sleep.
So Dr. Breus, a lack of good sleep seems to be a growing concern in modern society, even for me, actually especially for me. People are stressed, it’s hard to shut our minds off with constant distractions that are within arm’s reach, even when it’s time to get shuteye and power off. How has our understanding of insomnia evolved over time and especially in recent years?
Dr. B: Great question. And once again, thanks for having me on the show. So insomnia is interesting because it’s changed. We don’t have the same insomnia that we had a long time ago. To be really honest, there was this real idiot. His name was Thomas Edison, and he invented this thing called the light bulb, and he screwed up people’s sleep forever.
Before the industrial revolution, we didn’t have a tremendous amount of sleep disorders. In fact, they weren’t even recognized at that point in time. So, when we were able to work at night, all of a sudden, all bets were off and people started to have sleep disorders. Then a second invention came around, which a lot of people don’t know about, which was called overtime.
So when you worked longer hours, you got paid double. And when you worked the hours that nobody wants to work, which is usually in the middle of the night, you actually got a bonus for working that time. And so a lot of people would take the financial advantage, not ever considering the health disadvantage that they could be having.
And so we really started to see a lot of people start to have relatively high levels of sleep and sleep related problems. And then all of a sudden, people kind of moving along, everybody’s kind of doing their thing, we move into the 1900s, we move into the 1940s, 1950s, and then all of a sudden, sleep is changed again.
Like, if you think about sleep now and you think about sleep in the ‘40s, very different types of sleep, right? When you went into the master bedroom, there were usually two separate beds. Now we’ve got usually one king bed. Pros cons different ways of kind of looking at that everybody went to bed at a certain time every guy got up at a certain time. Now a lot of people have variable bedtimes.
Is that good? Is that bad? So things have really changed. The biggest thing that I think has changed in specific relationship to insomnia in particular, is stress. To be clear, we’ve never been this stressed before as a society. Not, not that I’m aware of. And I would say that it’s global. I don’t think this is U.S. centric.
I think this is global centric. I mean, I would argue that 75% of insomnia is going to be stress and some form of depression. The other 25% really seems to fall into environmental stuff, which has definitely gotten worse over the years. More people on screens, Things of that nature, more people staying up late, more alcoholic beverages, add cannabis to the mix.
Like there’s all kinds of different things that are out there. So I think environment plays a role. In terms of what do you put in your body and then what’s around your body. And then I also think that medicine plays a role. So if you’re medically frail, if you have a medical condition, almost every medical condition affects sleep and sleep affects almost every medical condition.
I tell people all the time, you know, sleep affects every organ system and every disease state. Literally everything you do, you do better with a good night’s sleep. And so if you’re taking medicine for another ailment, There’s a decent likelihood it could have an effect on your sleep.
Rocio: Right. I know for me especially, I keep my phone on my nightstand and whenever I can’t sleep.
Dr. B: Cardinal sin!
Rocio: Yeah, whenever I can’t sleep and my mind is racing and I want to stop the thoughts, I grab it and I go on Instagram and I’m scrolling through the reels. And I would like to know how, bad is that for me and my brain?
Dr. B: Great question. And this is a question that I get very often. And so I want to break this down because it’s an important thing, because lots and lots of people doom scroll. That’s what I’ve heard it’s called. Doom scrolling in the middle of the night.
So, first of all, a lot of people want to talk about the light that’s actually coming from the device itself. I want to be clear. It’s not that powerful. It probably doesn’t have nearly as big an effect as most people think. A lot of the light exposure at night has to do with how much light exposure cones and rods got during the daytime to be able to have that effect in the evening time.
However, it’s the engagement that I think is much more. Let’s be fair. If you’re trying to get your high score on Candy Crush, you are not trying to go to sleep, right? If you’re checking out what’s going on on Insta. Newsflash, right? You’re not trying to go to bed, right? I tell people all the time, you need runway to land the plane, okay?
And so that runway should be one that is not engaging. If anything, it should be slowing you down. Now, I’m going to throw a twist at you that you’re not expecting, which is: I am the only sleep doctor in the universe that says it’s okay to fall asleep with the television on. Let me explain why I’m okay with TV that’s across the room, but I’m not so okay with a phone that’s in your hand.
Okay. So number one, proximity has something to do with it. The amount of light that you’re getting right at your face. It’s probably not the best idea. TV all the way across the room. Yes, you’re getting light, but it’s really probably not as bright or intense as it would be right in front of your face.
Here’s the other thing with TV, it’s kind of like you’re just passively letting content flow over your brain, right? Cause I have to be honest with you. The reason that I’m okay with this is my wife sleeps with the television on every single night. I’m the sleep doctor for gosh sakes. I have to fix this, right?
So when we were dating, which was 25 years ago, I said, “Hey, hon, I’m going to fix this.” I don’t know about you, but if you’ve ever tried to fix something in your partner, bed partner, it doesn’t really go well. They have to be very willing. So I removed the television from the bedroom. And she said, “Michael, if you’d ever like to sleep in this bedroom again, I suggest you put the TV back.”
You bet. So I put it back and then I decided to study her. Okay. And here’s what I figured out. She doesn’t actually watch it. She listens to it out of what I call the corner of her ear. Right? So her eyes are closed, but it’s just enough of a distraction. To prevent what she calls monkey mind. Okay. And so monkey mind is like we were talking about before.
It’s the first time of day that nobody’s talking to you. And all of these thoughts start to come in. And one of the things I’ve also noticed, and I’ve heard this from my patients is when they’re thinking about things from the past, that feels very depressive to them. Like, “Oh, gosh, I said this,” or “Oh, I forgot to do that.”
Or, you know, blah, blah, blah. And then when they’re thinking about the future, It’s more anxiety provoking, right? So, “oh, I’ve got to make sure I’m on time for this tomorrow,” or “I’ve got to, you know, be ready for my presentation.” Right? And so what I try to teach people is when you’re going to bed, it’s best to just be present.
You don’t need to be thinking about things that are going on tomorrow. You don’t need to thinking about things that are going on in the past, being present is easily the best way to help with sleep.
Rocio: Can you share a little bit about your own experience with sleep and your own background and how that sparked your interest in doing what you do now?
Dr. B: So I’m a little bit different than the sleep doctors that are out there. 95% of the sleep doctors out there are medical doctors, so they have an MD.
So I have a PhD in clinical psychology. However, I am medically board certified, so I actually took the medical boards without going to medical school and passed. I’m one of 168 people in the world that have ever done it. I did it in sleep, in particular. Okay. And so when you’re talking with lots of different doctors out there about sleep and primarily what you’re getting is a medical perspective.
Okay. And I have a PhD in clinical psychology. Insomnia, we just started talking about it, right? It’s got a lot of anxiety. It’s got a lot of depression to it. There’s a medical side to insomnia, the biology, the medicine and things like that. So what I decided to do is I said, let’s combine the two. Maybe I would be more effective.
So the PhD in clinical psychology helps me understand the anxiety, the depression, all the things that mental health affect insomnia. And then all this stuff on the biology side, I learned by basically studying it for myself. And so for me, it’s amazing how fast I help people. It’s unbelievable. I talked to one fellow and in 24 hours I changed his entire life.
And that’s the other thing that’s really cool about sleep is when you change your sleep, you change your life. You change your sleep. I can change your life in minutes. Yeah, two to three days. Usually it’s quite amazing. And that felt so good to be able to have that kind of an effect that quickly and that had that big of an effect in someone’s life.
So to be honest with you, I like doing that and I like having a big effect on people’s lives. So that’s how I and why I got into sleep and sleep medicine. It was really more just by happenstance.
Rocio: That’s great. That’s always how you come upon the best things, I think. And so in your research, have you come across any sort of interesting historical or cultural perspectives on insomnia, and how have those kind of shaped the way you approach your practice?
Dr. B: You know, it’s interesting, especially when you start doing work outside of the United States, because the cultures have very different sleep thoughts, like what is sleep, how does sleep work, things like that. A perfect example is, when I work with people from Latin America, they have siestas during the day.
And so they don’t go to bed until much, much later. They get up much, much later. So you can’t force those practices into a culture that is not going to do it. What you have to do is adapt those practices into the culture. There’s also in some cultures, there’s something called a family bed where literally everybody sleeps in the same bed every night.
And as you can imagine. That’s kind of weird, at least for people on our end of the spectrum, because we’ve never seen something like that. And so being able to adapt into that becomes important. But I think some of the bigger things that we know from a cultural perspective is nobody taught anybody how to sleep since they were itty bitty teeny tiny, right?
It was, I’m going to put you in your crib, I’m going to put you in your bed at a particular bedtime, and then that was really the only guide rails that you got. So you really didn’t have any training, per se, in how to sleep. And so when you get into a new environment, culturally or otherwise, and something’s different, you might have some problems with sleep.
Rocio: And so you talked about some of those developments that have made sleep so drastically different today than it was before. How have different civilizations throughout history viewed and managed sleeplessness?
Dr. B: Great question. So, and it kind of leads into one of my areas of expertise, which is these things called chronotypes.
So what’s really interesting is if you go back to hunter gatherer days, like I’m talking way back now, we had these things in our bodies called chronotypes. Now, people may not have heard of this term, but you’ve actually heard of the concept before. If anybody out there has ever been called an early bird or a night owl, those are chronotypes.
Okay? And for folks who want to know what your chronotype is, if you go to my quiz, Chrono Quiz. You can learn it in about two minutes completely for free. We’ll put the link in the show notes so people can get to it, but it’s chronoquiz.com. But here’s, what’s fascinating is genetically speaking, we’ve discovered that you actually have a genetic sleep preference.
So. And that’s where this whole idea of early bird night, it’s actually in your genes. It’s not that, “Oh, I love to wake up at 4:30 every morning and get my day.” So like, who are those people? Right? I mean, come on. Like, I don’t like mornings. I don’t, I really don’t like morning people. They’re so chipper all the time.
I’m like, what is wrong with you people? But genetically speaking, that’s how they are. So what’s cool about that is once you unlock which genetic propensity that you have and you follow it as close as you can. What ends up happening is you don’t need as much sleep because you’re getting better, high quality sleep.
And that’s really where some of the magic can really start to happen. And that’s some of the concepts that we’ve actually started to learn that we’re now moving forward into today’s society. So now let’s go back to our hunter and gatherer as well. Who were the hunters? They were the early birds. They woke up before dawn.
Anyway, right. And so they’re out with their spears or their hammers or whatever they used back in those days, and they gathered, they got the food and they brought it back right as the whole village is starting to wake up. So who’s tending to the village and minding the kids and building the stuff? Well, those are the people in the middle, what I call a bear, right?
So I changed the vernacular of the system. So early birds are now called lions because who wouldn’t want to be king or queen of the jungle, right? I mean, I don’t want to be a bird. I want to be a king or queen of the jungle. So early birds are lions. People in the middle who tended to the village, they’re what I call bears.
And then people who kept security, right, who watched the safety of the village, they’re the night owls or what I call wolves, right? So I want to be clear about this. This has been going on since the dawn of time. Okay, but nobody has really taken a look at this and said, “Hmm, how can we adapt this to today’s society?”
That’s what my book, The Power of When, really went ahead and did, is I showed people, “Hey, by the way, there’s a fourth chronotype. I don’t think there’s three. I think there’s four.” And by the way, there are several people out there. Some people think there’s eight. Okay. So there’s a little bit of debate that’s going on on this, but I’ve had over 3.5 million people take the quiz and we’ve run the statistics on it.
And there really appear to be four distinct chronotypes. So there’s early birds or what I call lions. There’s people in the middle, what I call bears, there’s night owls, people I call wolves, and then there are people who have an irregular sleep schedule. And it’s genetic to be clear. This isn’t like they’re screwing up by drinking coffee at 5 o’clock in the afternoon.
They’re genetically not great sleepers. They fall into an entirely different category. I call them dolphins. So dolphins sleep unihemispherically, meaning half of their brain is asleep while the other half is awake and looking for predators. I thought that’s kind of like my insomnia patients. You know, they’re never quite asleep.
There’s always like the radar is on or whatever. They’re not getting great sleep. And so once you understand these four categories, literally everything else unlocks. I can tell you the perfect time to go to bed, the perfect time to wake up, the perfect time to nap. I can also tell you the perfect time to have sex, eat a cheeseburger, ask your boss for a raise.
You’d be shocked because here’s what happens is once we know your chronotype, we know when all of your hormones go in a very particular order. And so I can time when your hormone hits a particular height. So let’s say that you want to be intimate with your partner. You need certain hormones at certain levels in order to do that.
Why not do that when your hormones are naturally already at that level? And I just tell you what time to do it. And that’s the whole power. of when to do something.
Rocio: Yeah, you can hack into your whole life. Wow, that is cool. And so I’ve read that during medieval times, people would wake up during the middle of the night to do work.
And after doing the work that they needed to do, they could go back to sleep for a little bit. And this was called a biphasic sleep schedule. So they would split their night into two parts. And I found it interesting that, you know, almost none of us can afford to live our lives like that, even though, you know, now, like you said, we have the light bulb.
Dr. B: So let me tell you when that was popular and why it was popular. So when we were an agrarian society, meaning it was all farms, right? What would happen is, people would wake up when the sun came up, get out to the farm as quick as they could, work all day, get their, you know, dinner at night, as the sun went down, go to sleep, and do it all over again.
Well, number one, it’s dark for a very long time, so your body actually doesn’t need that much sleep. And so, historically, this has been called the second sleep. Okay. Or what you’ve named it, which is the correct scientific term, which is biphasic sleep. Here’s what’s interesting is I’ve read a lot of the literature and while they did do some work, what they usually would do is eat a meal or become intimate with their partner.
Then like an hour or so would pass, then they would go to bed and then wake up right as dawn was coming up, go out to the farm and kind of do their thing. So we know that biologically speaking, this actually occurred as our bodies wanted it to occur because our bodies woke us up. But our bodies don’t wake us up like that anymore.
Why? Over the course of literally evolution, we have evolved away from this whole second sleep. Now one thing that a lot of people say to me, they say, Dr. Bruce, I’ve got to be honest with you. I wake up at like 1:30 in the morning. I’m up for like an hour and a half. I can’t fall back to sleep. Then I finally fall back asleep and I feel like I’m doing this biphasic sleep problem.
That is my number one. one complaint. That is the number one thing that I fix. It’s my bread and butter. I fix it. It’s actually easier to fix than you might imagine, but I feel like it could be a little bit of a remnant from this whole idea of the second sleep. Also, there’s a biological process that occurs in the middle of the night that most people don’t know about.
So as your core body temperature rises, rises, rises, it hits a peak at around 10, 10:30 at night. That’s when most people are thinking about going to bed. Then it falls. It’s supposed to fall because it’s a signal to your brain to release melatonin, which is kind of that key that starts the engine for sleep.
Your core body temperature continues to fall, fall, fall. But if it keeps falling, you’re going to go hypothermic and you’re going to die, right? Not good. So what does your body do? It warms itself up and starts to bring the body temperature a little bit higher. Guess what that does. It brings you into a lighter stage of sleep, which makes it easier to arouse.
This happens to every human on earth. Everybody wakes up somewhere between 1 and 3 o’clock in the morning. However, most people don’t remember it because you’ve got to be awake for a full 30 seconds or so before you recognize that you’re awake, here’s where the problem comes in. Some people do what you do, which is they have a telephone next to their nightstand and they wake up and they grab it.
And what do they do? Let’s see what’s going on on Facebook. Have I gotten any messages? Maybe I’ve gotten an email from my boss. There is no universe where you need any of that information in the middle of the night. There’s none. There’s none. And I love it when people turn to me and they say, well, my phone is my alarm clock and I have to have it by my bedside.
You know what? You can go to Target and buy an alarm clock. For about eight bucks, okay? And it’s analog and it sits right on your bed stand and it doesn’t have Facebook on it or Insta on it or any of those other things that are going to blast blue light at your face in the middle of the night and make you engaged.
Again, it’s the engagement that we want to avoid. So in the middle of the night, I’m actually having people do things to help lower their heart rate.
So a lot of people don’t know this, and I know this is a long winded answer to your question about biphasic sleep, but it kind of gets into the idea of insomnia as well. Is. When your body wakes up at a very particular time in the morning, that dictates what time melatonin is produced at night. And most people don’t know that.
So one of the easiest ways to fix this middle of the night problem is to regularize your morning awakening and go to bed later. A lot of insomnia turns out to be to be anxiety, right? And so when you go to bed early, how do people do this? They say, Holy crap, I finally got away from the kids and the spouse.
I’m going to hop in bed at :30 and I’m going to get all the extra sleep I need. And guess what happens? You lie in bed, pissed off because you can’t fall asleep or you fall asleep for 45 minutes. You wake up and maybe 45 minutes to an hour later, and then you’re done. You can’t sleep for the rest of the night.
Right? So I get people to go to bed a little bit later, I have them regularize their wake up time, and all of a sudden we squish those two biphasic sleeps together and now we have a single bout of sleep. So a lot of people want to know, well, is a single bout of sleep, like, is it important? The data would suggest that having a single bout of sleep without a bunch of awakenings actually is more restorative in nature, biologically speaking.
Rocio: Yeah. It’s kind of important. What have been some of the most groundbreaking discoveries or crucial turning points in the study of insomnia?
Dr. B: Well, you know, I will have to say that there’s two kind of categories that we seem to see in research and things like that moving in insomnia. One is on the pharmaceutical side, and one is on the non pharmaceutical side.
So, number one, let’s talk about pharmaceuticals, right? So, to be clear, I’m a PhD. I do not prescribe pharmaceuticals. However, I want to be also very clear about something. If anybody who is listening to this is on a sleep aid, this is an important relationship that you have with your doctor and you and your doctor alone need to discuss, do you want to be on this?
Do you not want to be on this? And how do you get off of it? If you want to get off, do not ever, ever, ever cold turkey yourself off of a sleep aid. You will be up for three or four days. You will be absolutely miserable and you will be readdicted. In a way, shape, and form that’s more powerful than when you started.
Is pharmacy good for sleep? In some cases, you bet. It absolutely is. Let me be clear. If you’re a paranoid schizophrenic, And you need ambient to sleep. Take your ambient to sleep. Okay, like if you have bipolar disorder and it’s well controlled, and that includes you taking trasidone at night for sleep, take your trasidone at night for sleep.
Okay, like I’m not talking about those case instances. Situations, but I will say one thing. I think that the sleeping pills in the world today are over prescribed. Insomnia is what we call a door handle diagnosis. So that means that when the doctor’s got their hand on the door to leave, that’s when the patient says, Hey doc, by the way, I’m not sleeping so good.
And so the doctor’s like, Oh, they pull out their prescription pad. They write a script and they say, come back in 30 days. They don’t give the patient any information about how to do this, what to do, things like that. This is not the fault of the doctors because the doctors have not been trained. Okay, so this is where, buyer beware, you need to do some research on your own, you need to understand what’s going on, and again, have that relationship with your doctor.
Now, you asked about advances. Believe it or not, there are some new advances in insomnia medications, and let me explain how and why. So, historically, we used to use these things called benzodiazepines, which is an anti anxiety drug, and it’s kind of a shotgun approach, meaning when you ingest it, it hits you right in the front of your brain, and it affects all of your brain.
It’s not very specific. It doesn’t dial in, for example, to the sleep center. That’s what we used to use. Now we’re seeing newer medications come out that actually have some very good potential for being very, very specific. Now people like, well, you’re saying we need more insomnia drugs. Yes, I am. We do need more drugs because there are more types of insomnia.
There’s the, “I can’t fall asleep.” There’s the, “I can’t stay asleep.” There’s, “I wake up too early.” There’s insomnia associated with pain, insomnia associated with anxiety, insomnia associated with depression. I mean, I can go on for days, right? So, if we can figure out what the main core portion of the insomnia is and affect that, and there’s a medication that does it, in many cases, I don’t mind breaking the cycle.
Of the insomnia, keeping them on drug with in conjunction with their physician for 30, 60, 90 days, set their cycle up, then slowly taper their cycle while using something called cognitive behavioral therapy for insomnia to be able to get them through this. Now, I want to also be clear. You don’t have to have a drug to do this.
You can just use cognitive behavioral therapy for insomnia, which is the other side of the coin where a lot of other research has been getting done. And here’s what we’ve discovered. It works better than a pill. It just does, like the data is really interesting. Once you teach somebody about how they think about sleep, and let me be clear, cognitive behavioral therapy is where it looks at how you think about sleep, and it changes these things called cognitive distortions.
Okay, and let me give you an example of a cognitive distortion. You wake up, it’s 2 o’clock in the morning, you look at your phone, which you’re not supposed to, and then what do you say to yourself? Oh crap, I need to go to sleep. And you try to force yourself to sleep. Doesn’t really work very well. So what’s going on?
You start thinking, and that increases your energy. We want to decrease our energy, not increase our energy. And that’s really what we have to be thoughtful about is thinking about what are we thinking about in the middle of the night? Here’s an example. “Oh crap. If I don’t get eight hours of sleep by tomorrow, my presentation is going to suck and my boss is going to fire me.”
By the way, almost everybody has that one. And it sounds so ridiculous when we’re talking about it right now, but in the middle of the night, you’re not thinking straight because you’re sleep deprived. So you have to learn how to not trust your thoughts in the middle of the night, right? “What’s the evidence for this?” is what I always tell people to ask themselves.
“Has your boss ever told you that you were going to get fired from not doing a presentation correctly?” “Well, no, Dr. Breus, they haven’t.” “Okay, so, it’s probably pretty reasonable that even if you had the worst presentation in the universe, you’re probably not going to get fired, right?” And so cognitive behavioral therapy not only looks at your thoughts, your cognitions, but your behaviors as well.
So for behavioral part, that’s when we squish the time that you get in bed, right? We condense that time by using a technique called sleep restriction, which is within cognitive behavioral therapy. I want to be super clear. You need a trained cognitive behavioral therapist or the newest technology, which is what you were asking about, is we now have actually AI bots that can do cognitive behavioral therapy.
I’m using the term AI bots, but I want to be clear. I don’t think it’s AI. What it is is there are a few different programs out there that actually will ask you questions. It has an animated doctor that comes on. So it’s kind of like an AI, but it’s all based on real cognitive behavioral therapy, and it’s actually been tested and published in peer reviewed journals as being effective.
There’s a couple of different ones, one’s called SHUTI. There’s a few other ones, but that’s kind of a cool new advancement, because here’s the problem. There’s not enough cognitive behavioral therapists out there to do the cognitive behavioral therapy for these people. So, having it being able to be done automated and online can actually work out much, much better and affect more people.
So I would say we’re seeing new, more specific drugs on the pharmacy side of insomnia, but we’re also seeing a lot more advancements in the cognitive behavioral world, being able to attack that problem of not enough therapists out there. And so people will have options now to be able to decide, “Hey, how do I want to think about treating this?”
And hopefully their doctors will be able to turn to them and say, “Hey, here’s some different things you may want to think about.” But I do want to be clear with cognitive behavioral therapy, you gain a skillset. You learn how to sleep, and that’s with you for the rest of your life. When you’re on a pill, you’re on a pill.
Rocio: And you mentioned genetics and how big of a role they play in this as well. And so how might the knowledge of the genetic component of sleep influence the development of new treatments in the future?
Dr. B: Oh, absolutely. I’ve actually even done this myself. Like I had to modify some of my treatments. Once I started getting into chronotypes and really learning about them, I was like, what I usually do for my insomnia patients, isn’t going to work for a night owl because they’re naturally awake at night, right?
So understanding how that science affects my patients becomes very, very important, very, very quickly, and so I’ve had to adapt to a lot of different areas. I don’t know how many other people have gone out and, like, written books or adapted to new things in that area. At least in sleep, we don’t have a tendency to see a lot of people out there doing that.
We see that more in, like, the biohacking space or the habits space or things like that.
Rocio: Many people suffer from insomnia without realizing the full extent of its impact on their lives. What are some of those lesser known consequences of chronic insomnia on physical and mental health or whatever other systems it definitely impacts?
Dr. B: Yeah, it’s interesting because it seems as though people notice the physical effects before they notice the mental effects, right? So they’re like, “my eyes are heavy” or “I’m not motivated to work out” or “I might be a little bit more clumsy.” “I might get a tendency to get injured more,” things like that. But what really it is, it’s the mental stuff that gets you that you don’t even see coming.
So number one, if you have any mental health issues, they’re worse when you don’t sleep. There’s just no doubt about it. And so when you start thinking about that as an idea, right, then it starts to get very interesting about how can you get better sleep and more importantly, improve the quality of that sleep.
And I think that’s what a lot of people really need to think through. It’s not about amount. It’s about quality. I was just actually, I was just interviewing. Dave Asprey. So for folks out there who’d know Dave, he started a company a long time ago called Bulletproof Coffee. I now has a company called Danger Coffee, pretty interesting guy.
And we were talking about caffeine. How does that have an effect on sleep? Things of that nature. And so people don’t even think about these different things that could have the effect. People are like, “well, I stopped drinking coffee at 2 o’clock this afternoon. I should be fine. Right?” Well, coffee stays in your system for eight hours and that’s only half of it that it gets out. So at 10 o’clock at night, whatever you drank at 2 o’clock in the afternoon is still swimming around in your head. So I think a lot of people just don’t think about those types of things.
Rocio: And so we’ve talked now about the more insidious effects of insomnia. What are some of the myths around insomnia and the most common misconceptions?
Dr. B: Well, I think the biggest misconception is that everybody needs 8 hours. That’s bullshit. Okay, like straight up, that’s bullshit. So, at the end of the day, you need as much sleep as your body needs, and your body will teach you how to get that sleep, as long as you do it within a certain time frame. And so, what I tell people all the time is, don’t, don’t shoot for a number, shoot for a feeling.
So when you wake up, within three to four minutes, if you feel good, You slept enough. You got the right amount of sleep. You did it. You’re good, right? But if you wake up and you’re like, Oh, I want to hit the snooze button. That’s a big one. If you hit the snooze button more than once, you’re not getting good quality sleep.
We talked about one earlier, which is for insomniacs. Going to bed earlier is a good idea. It’s a terrible idea. Okay? It’s beyond a terrible idea. You should actually go to bed later, not earlier, as an insomniac. Why? Because you want to build that natural sleep deprivation up. Another big one is, if I get a bad night of sleep, something absolutely horrific is going to occur the next day.
We talked a little bit about this in the idea of cognitive distortions. And again, remember, your brain is not thinking straight in the middle of the night. That’s where you really have to kind of say, hold on, I don’t think I’m thinking this right.
Rocio: How can we work to kind of dispel these myths and create a better understanding around sleep, other than listening to this podcast, of course?
Dr. B: Right. Well, you know, I’ve been trying to do that for a while. It’s hard because some of these things are so ingrained in culture and in society. It’s kind of like the food pyramid, you know, that’s been around forever that we all know doesn’t really work or that everybody needs eight glasses of water.
Total BS. You know, so it’s like. We have to continue to fight the good fight of teaching people, Hey, there’s new data to suggest that this isn’t really the idea that we all thought it was. And I think that’s what we have to do. We have to have podcasts like yours where people say, “Hey, I want to explore this.”
I want to take a look at this. We’ve also got to be honest with you, be responsible for it a little bit ourselves. Nobody’s going to teach you how to sleep. Okay, you got to figure it out yourself. Now you can come and see a sleep doctor like me, but here’s what’s usually going to happen. By the time you’re coming to see a sleep doctor, you have a sleep disorder.
You’ve got apnea, you’ve got narcolepsy, you’ve got something major, and that’s why you’re ending up in a sleep doctor’s office. I’m not talking about this. I’m not talking about a sleep disorder. I’m talking about disordered sleep, right? So it’s the simple little itty bitty habits that you need to start getting going before you end up in my office.
Rocio: You talked a little bit about this, or you touched on it a little bit, but what are some of those practical tips and strategies that you think are particularly effective in helping people just get better sleep?
Dr. B: Easy. I’m going to give you a five step plan that every single person can do. It doesn’t cost a dime and you can start it tonight.
Step number one is wake up at the same time every single day based on your chronotype. So go to chronoquiz.com and I’ll tell you what time to wake up. And I want you to wake up at that time, seven days a week, not five, seven. Okay. And notice I didn’t say bedtime. I said, wake up time. Okay. Let me explain why this is important when you wake up.
That is exactly the determinant of when your body will begin producing melatonin later on approximately 14 hours later. So if you wake up at the same time every day, your body will kick off melatonin at the same time every day. But if you wake up at a variable wake up time, your body does not know when to go to sleep, so it does not know when to produce melatonin, which creates a variable bedtime, and that’s what a big problem is for insomniacs. A lot of insomniacs will say, “Oh, I only slept for, you know, 5.5 hours last night. I’m going to let my alarm go.” Bad idea. Bottom line, you should not get anything less than five and a half hours sleep. Stay in bed for at least five and a half hours as your lower level limit. But you can start looking at that. So step number one is have one wake up time, seven days a week.
Step number two is to stop caffeine by 2pm. I’d love it if you stopped caffeine by noon, but I’m not so stupid as to think that anybody out there is going to be really doing that. So I say start slow and stop by 2pm. Why? Eight hours later, half of that caffeine is out of your system, so that makes it a little bit easier to fall asleep. But starting at two is a good idea. Step number three has to do with alcohol. Okay, there’s a really big difference between going to sleep and passing out. Okay, we don’t like the passing out. We like the going to sleep.
So step number three is to stop alcohol 3 hours before bed.
Step number four has to do with exercise. The single best way to improve your sleep quality is with daily exercise, but you don’t have to run a marathon. And a lot of people out there are over exercising and over training and putting too much stress on their body, which has an effect on their sleep. So I don’t mind you exercising, but you want to keep it to about 30 minutes or so half cardio, half weight, something like that. And you want to stop exercising 4 hours before bed. Why your core body temperature raises when you exercise and it’s hard to go to bed with hot body.
Step number five has to do with, how do you wake up in the morning? And so I have people do what I call the three 15s. So when you wake up, you take, you sit on the side of your bed and you take 15 deep breaths. That is merely to wake yourself up, bring yourself present, kind of get your respiratory system kicked off in the morning on your bedside. You should have a glass of water. And so you should drink about 15 ounces of water. Okay, this is a great way to water load in the beginning of the day. But remember, sleep in and of itself is a dehydrative event. You lose almost a full liter of water just from the humidity in your breath. So you’ve got to hydrate before you caffeinate. So step number two, drink, sorry, part two of step number five is to drink 15 ounces of water. The last one is to go outside and get 15 minutes of sunlight. Why do we do that? When sun hits your eye, it turns off the melatonin faucet in your brain, and it helps with brain fog. Also, 15 minutes is just the right amount of time for your body to produce vitamin D, which is actually a circadian pacemaker and very important for a whole host of other functions that go on in your body.
So, I would say do that.
Rocio: I am definitely going to try all those things. I hope that they fix everything wrong with my life.
Dr. B: Well, I’m not sure it’s going to do that, but what I will tell you is if you do this practice for about 14 to 21 days, which is about what it takes for your body to reset its circadian rhythm, you will notice a marked improvement in your overall sleep, probably about by 40, 50%.
And if you really want to get the biggest bang for the buck, it’s all in step one of waking up at the same time, seven days a week, based on your chronotype.
Rocio: Yeah, that’s the hardest one, but I can imagine it has the biggest dividends. Looking towards the future, what are some of the most promising areas of research or the biggest advancements that you anticipate in the coming years?
Dr. B: Ah, interesting question. Well, you know, here’s what I’ll tell you is they’re doing interesting drug work, pharmaceutical work. For example, they’re using, they’re studying narcolepsy, right, where you sleep a lot to learn how to make people with insomnia sleep better. So that’s kind of interesting and cool.
We’re seeing some very interesting things there. We’re also seeing people moving forward with a pill for sleep apnea. Yeah. Believe it or not, as opposed to a CPAP machine that you’re wearing on your face or a dental appliance that you put in your mouth, those are two very new, interesting things that we’re seeing there also on the circadian rhythm side of things, there’s some very interesting new products that are out in the marketplace.
One of the ones I like a lot is something called the Apollo. So this is a wrist worn device that sends a haptic signal across your body that actually makes you feel more relaxed or makes you feel more energetic. I think we’re going to start seeing more of those. And then of course the trackers that are out there are going to become more and more accurate.
And I can’t wait to see what AI has to do with sleep. There might be an AI sleep doctor. There might be some scoring of sleep studies using AI, maybe reviewing medical records, things like that. So, I’m excited to see what’s going to happen in sleep medicine. I think there’s a great future for better sleep for all of us, but we have to be responsible for it.
It’s not just going to happen on our own. We have to give ourselves those guidelines and those guide rails, and we have to follow them. I promise you, if you can have the discipline to follow the five simple rules that we just discussed, I’m telling you something, in three weeks, You will thank me.
Rocio: It’s safe to say that you’re obsessed with sleep and insomnia. But other than that, can you give us any glimpse into any of your other obsessions?
Dr. B: So I’d say my obsessions are my kids, my dogs, my health, and then clearly my relationship with my wife is definitely something that I like to focus on.
Rocio: That’s great. Thank you so much. This was such a great session. Thank you so much for joining us and giving us all of the best insights into how to get the best night’s rest.
Dr. B: It’s my absolute pleasure. If people want to learn more about me or anything like that, head on over to TheSleepDoctor. com and please, please, please, take the chrono quiz. You will be shocked at how much interesting information you get. It’s completely free.
We’re not trying to do anything funky here. We just want to teach people about chrono text.
Rocio: Great. Dr. Michael Breus is the Sleep Doctor. This episode was produced by Podcast Fast Track with additional support from Jason Russum, Amy Perry, Liliana Zapata, Juan Palacios, and Lorena Caro. Our theme music is by Taka Yasuzawa and Alex Uguira.
If you like what you heard, please subscribe on Apple Podcasts, Spotify, Amazon Music, or wherever you’re listening. Tell your friends about us. Know someone who’s running on 4 hours of sleep? Share this episode with them. Then head to qz.com/obsession to sign up for Quartz’s weekly obsession email and browse hundreds of interesting backstories.
I’m Rocio Fabbro. Thanks for listening.
Credits
The Quartz Obsession is produced by Podcast Fast Track, with additional support from Jason Russum, Amy Perry, Liliana Zapata, Juan Palacios, and Lorena Caro. Our theme music is by Taka Yasuzawa and Alex Suguira. This episode was recorded at G/O Media headquarters in New York.