Updated: Dec 3, 2018
Jody: Hahahahah. Got you. Love the click bait. No, you can’t get the perfect night’s sleep with 1 simple trick. I know that for a fact because I googled it. Luckily, my homeboy docs are obsessed with sleep and they’re going to help me.
Matt: Look, everyone talks about how important sleep is, but no one actually does it. I feel like it’s one of those things that everyone understands, but no one implements.
Mike: Well, how are we gonna change that?
Matt: Jody, why don’t you make up a bunch of random stats about not getting enough sleep to scare the crap out of people. Like:
(speed slowly speeds up as Jody reading this list)
Jody: I can do that:
You have 4 times higher risk of dying in the next decade if you get less than 6 hours per night
You have a 48% higher chance of dying from heart disease if you sleep less than 6 hours per night.
You have a significantly higher risk of stroke with less than 6 hours. Do you want to use your left side?
An all nighter reduces your ability to remember new facts by 40%
It exponentially increases your risk of dying in a car accident and leads to 100,000 car accidents per year. 20% of all accidents involve drowsy drivers, similar to alcohol.
It makes you weak, destroys your bones, and weakens your skin.
It makes you fat
People who take sleeping pills are 35% more likely to be diagnosed with cancer
About half a million deaths in the US were caused by sleeping pills in 2010
75% of depressed people don’t get enough sleep.
It increases your risk of prostate and breast cancer
Sleep deprivation costs the US $411billion annually. It costs you money.
It increases chronic pain
It kills creativity
It decreases your ability to deal with stress and makes you emotionally labile
It increases inflammation in the body leading to numerous other medical conditions and diseases
It makes you depresses and significantly raises your risk for depression
It decreases emotional control as much as hard drugs
It causes memory loss
It weakens your immune system
It makes you ugly by permanently damaging your skin
It makes your brain dirty and you stupid by not allowing clearing of toxins
It reduces the effectiveness of vaccines
It significantly slows reaction time
It causes high blood pressure
Mike: Wow, that is scary. Glad that’s all made up.
Matt: Except…..it’s not made up. That’s just a small sampling of the proven harms of not getting enough sleep. Wake up people! I...mean…..go to sleep people.
Jody: So, after reading that list I realized that potentially the biggest benefit of this entire podcast that we do is just how boring you two guys are and how many people you probably put to sleep.
Matt: Hilarious. This is no laughing matter, man. You should be as obsessed with this as I am. It makes an amazing difference to people’s quality of life. In fact, this has bothered me for years. As much as I love emergency medicine, the shift work component bothers me so much. It’s not really painful per se, but as someone obsessed with health and performance optimization it eats at my soul knowing how much I’m giving up by working night shifts.
Mike: I hear you. In 2007, the World Health Organization classified shift work as probably carcinogenic. I really would like to eliminate it from my life as well. The problem is that there are a lot of people who just have to work shifts. We should do a podcast specifically on how to mitigate those risks. We’ve been living that for over a decade now.
Matt: For sure. But for all the people who don’t work shifts at night, there are so many little things you can do to improve and optimize sleep. Like darkness. It sounds simple, but I think very few people understand what I mean when I say that.
Jody: clap, clap. Like that, right? What else? You mean no night light.
Mike: Absolutely no night light! Look man, people think they close their eyes and their eyelids do enough. That’s 100% not correct. It’s not enough. Even if you get to sleep with some light in the room, there’s really good studies showing that the quality of your sleep and how much deep and restorative sleep you get is not enough.
Jody: Ok, so no night light.
Mike: Yeah, but I really mean no light. Like not even night lights sort of no light. It was like a 6 month battle with my wife to finally turn off the night lights in the hall for the kids.
Matt: NIghtlights? Absolutely not! At my house I have tape over any leds. So, go to your bedroom, turn out the lights and look around. I guarantee you there a ton of leds still on. The little light on the smoke alarm on the ceiling. The electric strip in the corner. The little light on your computer charging in the corner. The electronic thermostat. Your alarm clock. I either completely cover these, put black tape over them, remove the computer to another room, and I put a black sock over my thermostat every night. Black them out. And you have to have blackout curtains. The amount of light pollution that is just outside your window destroying your sleep architecture and your health is crazy. This is fundamental and absolutely step one. Get it dark.
Jody: I hear you. But what about kids who are scared of the dark. You can’t take a kids night light away right?
Matt: Well, I get it. I’ve got 4 kids. But technically, kids eyes are more sensitive to light than adults. And we know that light at night has been linked to depression, increased cancer risk, and disrupted hormones. Light through the eyelids is still enough to disrupt melatonin production, which is very important for sleep quality and quantity. At the same time, I get it if a kid literally freaks out and it leads to increased stress at bedtime, probably exacerbating the exact thing, sleep, that we’re trying to promote, so there are some hacks.
Jody: Please, do tell. I’ll be honest with you. I’m not sure the “disrupted hormones” argument is going to be a sufficient counterargument to my kids “monsters under my bed” line of reasoning.
Matt: So, a few things.
Start early. You may have already damaged your kid beyond all repair, Jody. I’m joking. But seriously, if you start with blackout curtains and good light hygiene as a baby, then it’s easier to continue indefinitely than to try and make a sudden change.
Turn out all the lights after they’re asleep. If you lose the battle with them, then do the next best thing. Make it pitch black as soon as they’re out. You’ll at least improve their quality for the rest of the night.
Use a red night light. If they absolutely refuse to sleep without a night light or totally freak out when they wake up in the dark and need to use the bedroom, then at least have a better spectrum of light in the room. Blue light has a much worse affect on sleep quality and hormonal disruption than red light. It’s a very simple change that you probably won’t get much argument from the kids over.
Jody: Alright, i can totally do that. Just ordered a red night light from Amazon.
Matt: Well, don’t finalize your purchase yet. I did this exact thing because honestly, if I get up to go to the bathroom I don’t want to miss and pee all in the floor, but I also don’t want to flip the lights on in the middle of the night and make it harder to get back to sleep. So, I have motion sensing red night lights that only come on when I get out of bed. So, pitch black while sleeping, tiny bit of red light when getting up in the night. That’s optimal in my mind. Make sure you get the motion sensing one. This also keeps people from thinking I’m running a prostitution ring with all the red lights.
Mike: And while we’re talking about blue lights, turn your phone off. Don’t shine massive amounts of blue light into your eyes right up to bedtime by reading on your phone. Luckily I think a lot of phones have default setting that goes to “night shift” where it dims it and changes the spectrum to be somewhat less harmful, but you can take that further and increase how much it shifts. in your iphone go to settings, display and brightness, and then you click on night shift. Make sure you set the night shift on early enough, like 6pm, and the warmer you set it the better. If you really want to optimize this get some blue blocking glasses. Thats what I use when I’m on the screen at night or when I switching between night shifts. But make sure you get the real ones. The lens’ need to be deep orange to really block the blue light.
Matt: It’s not just screens, though. Artificial light in general in your house has a lot of blue light in it. You mentioned those glasses mike, the orange ones that look look ridiculous, so I have another pair that looks less ridiculous that I wear if I’m around other people. If you truly wanted to go all out and completely optimize your environment from a light perspective then you would have zero lights on after dark and only use candles. That natural light is much less harmful. Not completely practical, but anything you do to get closer to that, like the glasses or just using warmer light in your bulbs at home. The best bulbs for sleep are:
Red light like I mentioned. Of course if you don’t want your house to look like a house of ill reputes, then the next best is simple incandescent. Obviously, the problem with these is the energy inefficiency of them, but it is clearly best for your health.
I know people don’t want to hear this, but CFB’s, which everyone has switched to because they’re efficient is really not great. They emit a ton of blue light. If you have to use these, then at least switch to a different light a couple hours before bed. And LEDs, yes they’re efficient, but they have a lot of blue lights.
I realize there’s a slight conflict here between the energy efficiency and your health, but it is what it is. I’m just here to give you the info.
Jody: Alright. So, blackout curtains, tape over leds, red light, candles, or incandescent. Motion sensing red night light. Crazy orange glasses, what else?
Mike: Temperature. Obviously everyone is different, but there is significant evidence that you really should have the room pretty cold for truly optimal sleep. To get specific, most studies show that between 60-67 is the best temperature. Your body temperature decreases to initiate sleep, so you can help it along. I keep my room at 65 degrees and I’ve been looking into getting one of those cooling pads for the bed to try to save on electricity to keep the room that cold. It’s crucial the room is that cold when your trying to go the sleep, not as much so after you fall asleep, unless youre the sort of person that wakes up sweating.
Matt: Have you ever done cryo or a cold shower right before bed?
Jody: That sounds horrible. Cold shower? Seems like a warm shower would be better to relax.
Matt: I’m telling you, try a cold shower, or cryo right before bed. I guarantee you you’ll sleep better and get to sleep quicker.
Matt: Oh yeah. Actually, we should do a whole podcast on cryotherapy. Let’s add it to the list. A cold shower or bath should do it, though. I realize that not many people have access to cryotherapy. We have a machine at the castle, and I wish everyone had acces to this.
Jody: Well, they don’t. I’ll try the cold shower, though.
Mike: And it’s not just initiation of sleep. The quality of your REM sleep is going to be lower if you have the temperature too high.
Jody: Cold and dark. Got it. What else.
Matt: Quiet. It’s helpful to think about sleeping in a cave. Your ancestors sleeping in caves had it right. Deep in a cave it’s dark, cool, and quiet. I live in the woods, so this isn’t as much of an issue, but if you live in the city, noise pollution can be a big problem. Just get a nice pair of earplugs and use them.
Mike: Well, I actually don’t like the quiet. I sleep better with some white noise.
Matt: Well, I think that’s a good alternative to the earplugs I mentioned. There was a study of sleep quality with white noise in ICU patients that showed a really good result. Of course, ICU units are horrible places to sleep with beeps, lights, and disturbances. So, I guess not all that different than a busy cityscape. Personally, I don’t like the white noise, but obviously it works for some people.
Jody: Cave like. With or without running water through the cave.. Done. Actually, what about music or other sounds? I’ve heard of binaural beats entraining the brain to help with deep sleep. Does this work?
Mike: Um…..I don’t know. So, to be honest, I’ve tried this. Used it a bunch in college. There was all this stuff about taking a 30 min nap with the binaural beats and how it’s worth hours of sleep. I liked it. The problem is that I don’t think the science really supports it. Of course, similar to white noise, it’s probably a distractor that keeps other disruptive noises out. So, it may help. I guess I don’t think it’s harmful, so worth a try. But don’t try it in a way that would cause harm. By that I mean spending a ton of money on it or wearing uncomfortable headphones to bed that may be a detriment to sleep. And I can’t say it doesn’t work. It’s definitely worth a try. There are a few small studies showing benefits of binaural beats in general. I’m just not 100% convinced by the science yet.
Jody: Ok, may give it a shot. What else?
Mike: Well, the body is a very complex system that’s affected by light, temperature, and sound. But it’s also affected by chemicals. When you rattled off the problems with sleep loss, you mentioend the dangers of sleeping pills. That’s a shortcut to get to sleep, but there are serious risks. There are other chemical signals and hacks you can use to improve sleep. I’ve found that if I don’t eat for several hours before sleep that I get much more deep sleep. The body isn’t having to deal with the complicated process of digestion and it can focus on the restoration associated with sleep. But there are drinks that can help with sleep.
Jody: Jack Daniels. Don’t worry. I’m all over it.
Matt: Actually, no. That’s one of the worst things you can do. You may fell like you fell asleep more quickly, but alcohol will absolutely destroy your sleep architecture and your quality will be trash. You won’t be rested. What Mike’s talking about is natural sleep aids like chamomile, valerian root, melatonin, magnesium, lavender, and reishi.
Mike: Yeah, I’ve used melatonin quite a bit to help with jet lag and recovering from shift work. I take it 2-3 hours before I want to go to sleep, and I usually only take 1 mg. But, let me be clear, I do not take it on a regular basis. I worry that regular melatonin supplementation messes with your bodies ability to make it itself and that that could alter your circadian rhythm, which we know is super important for a host of things, even including gene transcription, diet and even insulin sensitivity.
Matt: I think that’s defintiely the way to use it if you do. Honestly, I’m a little hesitant to use it because it is a hormone. Definitely better than sleeping pills like ambien as it’s natural. I also take magnesium every night. Magnesium is one of the those vitamins that a lot of people tend to be deficient in and the risks are super low. For the vast majority of people the benefits far outweigh the risk when it comes to magnesium. Studies have show it to help elderly and people with restless leg syndrome fall asleep faster. It increases the neurotransmitter GABA in the brain, which helps you slow your thinking down and fall asleep.
Jody: So, I should take magnesium?
Mike: Well, probably. Of course, you could also just get your mag level tested. That’s probably the best way to make that decision if you’re getting labs done for other reasons anyway.
Matt: I also take Reishi mushroom in a tea. Honestly, I haven’t found great evidence for it’s effectiveness when I research the literature, but reishi does seem to have positive benefits for immunity, gut health, heart health, and is anti-inflammatory, and I feel like it helps me unwind, so I take it. It’s a nice alternative to a late night drink to unwind.
Jody: What about scents? I’ve heard lavender is good?
Mike: yeah, there’s more evidence for this than reishi, and it’s another one that seems to have other health benefits as well without much of a downside. I don’t personally use it, but I think it’s a great adjunct if you’re trying to totally optimize. You can diffuse it with very little risks.
Matt: Or what I do sometimes is dab a few dabs on the oil under my pillow or on the other side. I prefer to keep sounds and as many electronics out of the room while sleeping as possible, so I do this instead of a diffuser. Or even better, we actually grow it and I’ll put it in a little vase by my bed.
Mike: That’s adorable, Matt. I’m picturing you with you eyemask, earplugs, and little cute vase of lavender.
Matt: Dude, I take sleep seriously.
Jody: Alright, this is a lot. Are we done?
Mike: Nope. Good sleep hygiene starts way before the couple of hours right before bed. If you really want to set yourself up for success start much earlier in the day. Yoga has been shown to help with sleep quality and exercise in general can have a really beneficial effect. You’re meant to move. Sleep is one of the many things that intense exercise helps with.
Matt: The timing of that is important. Intense exercise right before bed could delay your sleep onset, but yeah, for me, nothing helps me sleep better than intense exercise earlier in the day. It’s a must.
Mike: But don’t just exercise your body. Exercise your mind as well. There are tons of great guided meditations to help you sleep. And if you want to combine Yoga like we mentioned earlier with meditation, then you should try Yoga Nidra. It combines the two and many people find it to be a super powerful way to get to sleep
Jody: So…..what is that? Can you explain how to do it?
Jody: snoring sound……
Jody: Oh, sorry. Alright, aright. I got it. I’m gonna be honest, though. You all went overboard. There’s no way I’m going to be able to do all this. I need me some Pareto squared on this. What’s most important.
Matt: Ok, so with most things we talk about, it’s all about the cryptonite first. Eliminate the really bad stuff for 80% of the benefit.
Don’t drink alcohol before bed
Put on blue blocking glasses and don’t look at a screen for 2 hours prior to bed.
Black out your room.
Those 3 things will get you 80% of the benefits.
Mike: And we need to measure this. Just do your normal stuff for a couple weeks first, and then do these things. We’ve got you an aura ring to track your sleep.
Jody: What about the squared part. What are the next level things to do to get me to 96% benefit?
Mike: Well, temperature for sure. Make your room 66 degrees. After that, I’d say some sort of intense exercise earlier in the day. And finally, meditation or Yoga nidra at bedtime. All the other things like reishi, essential oils, and the like are cool to do if you enjoy them, but that’s going to be the final 4%.
Jody: Ok, so there was so much, walk me through an ideal day for sleep.
Matt: OK, so the day starts with waking up a consistent time. Get some sunlight ASAP. We didn’t talk about this, but getting light during the day may be nearly as important as the pitch black night to regulate your hormones and circadian rhythms.
Then get some intense exercise during the day. Don’t take alcohol. Eat your dinner at least 3 hours prior to bedtime and limit liquid after that so you don’t have to wake to go to the bedroom later.. Put blue blocking glasses on and turn off all screens 2 hours prior to bed. Diffuse some lavender essential oil and have a small cup of reishi elixir 1 hour prior to sleep. Make sure all electronics are out of your room and that you have blacked out all lights. Make it completely silent or pick out your favorite white noise. Drift off at a consistent time with some Yoga nidra at bedtime. Did I forget anything?
Mike: I think you got it all. Jody, seriously, there’s very few things that will improve your life as much as incorporating some of these key things into your routine. We gotta track it, though. Report back on how it goes.
Matt: Sleep tight.
Jody: Now I just need to figure out how to get control of my sleep fartnea.