5. Sleep smart, sleep healthy

How easily do you fall asleep? If you're like most of us, sometimes sleep overcomes you and sometimes you actually have to pursue sleep, just to "catch" a few good hours.  Today Drs. Lemanne and Gordon talk about the role sleep plays in their work with patients, addressing cognitive, metabolic, and cancer-related issues.

Links In this Episode

1.  Heart Disease more risky for women than breast cancer.

2.  Breast cancer usually not fatal.

3.  Breast cancer linked to disrupted circadian rhythm.

4.  Denmark compensates for breast cancer after night shift work.

5.  Artificial (neon & otherwise) light at night increases risk breast cancer.

6.  Healthy sleep stages help brain health.

7.  Glymphatic system cleans brain during sleep.

8.  Autophagy also part of the daily brain-cleaning during sleep.

9.  Older adults still add new brain cells.

10.  A week camping restores optimal sleep cycles.

11.  Breast cancer is seasonal

12.  Meal Timing Regulates the Human Circadian System.

13.  Night Eating Associated w/obesity and binge eating disorder.

14.  Relationship between body temperature & sleep.

15.  Set a wake-up time to re-train sleep habits.

16.  Sleep restriction a therapy for insomnia.

17.  Melatonin safety & utility in cancer treatment.
 
18.  Including: melatonin dosing does not down-regulate production and the pineal response to melatonin.

19.  Lack of evidence for antihistamines' harming cognition.

20.  Believing that you slept poorly affects your performance!

Dawn Lemanne, MD
Oregon Integrative Oncology
Leave no stone unturned.

Deborah Gordon, MD
Northwest Wellness and Memory Center
Building Healthy Brains

Chapters

• 2:13 Doctors chat about their own sleep histories
• 5:04 Some remarks about breast cancer risks
• 8:39 Sleep and cognition
• 12:00 Oxygenation during sleep
• 16:51 Solstice & equinox effects
• 20:00 Eating patterns & temperature: effects on sleep
• 24:00 Healing circadian rhythm problems
• 31:00 Resilience after a bad night of sleep
• 35:00 Sleep trackers

Transcript

[00:00:00.170] - Dr. Gordon

If you do have a bad night of sleep, there are a couple things that you can do the next day to optimize your slightly compromised brain.

[00:00:09.070] - Dr. Lemanne

OOH. Please tell.

[00:00:10.480] - Dr. Gordon

And one of them is the same as, you know, Deborah broken-record-protein Gordon,  you can eat a high protein diet the next day.

[00:00:18.500] - Dr. Lemanne

Okay?

[00:00:18.900] - Dr. Gordon

But the salient component of the protein, which you can take entirely by itself, is creatine monohydrate.

[00:00:26.090] - Dr. Lemanne

You have found your way to the Lemanne Gordon podcast, where Docs talk shop happy eavesdropping. I'm Dr. Dawn Lemanne. I treat cancer patients.

[00:00:44.890] - Dr. Gordon

I'm Dr. Deborah Gordon. I work with aging patients.

[00:00:48.680] - Dr. Lemanne

We've been in practice a long time.

[00:00:51.070] - Dr. Gordon

A very long time.

[00:00:52.740] - Dr. Lemanne

We learn so much talking to each other.

[00:00:54.900] - Dr. Gordon

We do. What if we let people listen in?

[00:01:02.680] - Dr. Gordon

Dr. Lemanne and I today talk about sleep, how we all benefit from good sleep and what we lose during compromised sleep. You won't be surprised to hear that sleep loss adversely affects our cognitive health and our immune system's ability to resist cancer. We don't stop there. There's lots to say about sleep. Let's listen. One of the things that has fascinated me and made me curious when I'm listening to a new podcast host speak about what got them into this, almost always it starts with a problem that they've had. You know, I used to be a skinny vegan, and then I finally learned that wasn't the way. When I was wasting away from inflammatory bowel disease and I healed myself or something like that. They had some challenge with their health, and they got better. And I've always thought to myself, ha ha, that's not true about me. I have always just been independently interested in health until I realized that I think my first health problem that I took seriously was not having an easy time getting to sleep.

[00:02:12.510] - Dr. Lemanne

You had sleep problems?

[00:02:13.960] – The doctors discuss their own sleep histories

[00:02:13.960] - Dr. Gordon

I had sleep problems in something like 7th grade. I remember thinking, I need to get to sleep.

[00:02:22.180] - Dr. Lemanne

Were you worried about it? At that age?

[00:02:23.760] - Dr. Gordon

I just wanted to go to sleep because I like to get up in the morning. And it was also boring to lie in bed at night just tossing and turning, and it just seemed like a problem to me.

[00:02:34.500] - Dr. Lemanne

So this is a lifelong it has.

[00:02:36.470] - Dr. Gordon

Been a lifelong challenge and interest of mine. And so, of course, it's motivated me to learn everything I can about sleep. And I believe I master it in fits and starts, and at times, it's much better than others, and then it's challenged again.

[00:02:53.430] - Dr. Lemanne

So we're going to hear about how you've managed your sleep issues a little.

[00:02:57.050] - Dr. Gordon

Bit, how I've managed mine, but really what I've learned about them, too. And I learned things from articles I read, podcasts I listen to, and I learned something from listening to my patients. So I've learned something recently from patients that's of interest about sleep. But let me back up, because you asked a really good question. Like, was I worried about it even in the 8th grade? And in the 8th grade I thought it was kind of stupid or lame or not cool to not be able to go to sleep and feel so powerless. Because sleep is something that you can't say, I'm just going to make three chocolate cakes this afternoon and do it. You can't say, I am just going to go to bed at 09:00 and be asleep by 930. You can't make yourself do it, can you? Are you one of those people who can do that?

[00:03:45.380] - Dr. Lemanne

No, but I don't remember being worried about it as a youngster. So that just points to the fact that you were going to become a doctor.

[00:03:52.730] - Dr. Gordon

I certainly didn't think that when I was in 8th grade. I never thought of going to medical school until I was well out of college with my English Literature degree and being a hippie. But somebody wrote a book about our high school class and they interviewed different class members about other class members, and somebody said to me, about me, oh, I bet she's a doctor now. And I thought, how did she know that I didn't know that when I was in high school.

[00:04:21.480] - Dr. Lemanne

Anyway, I see the signs. I think doctors are a very specific combination of nerdliness and hypochondriasis. So any 8th grader who's worried about their sleep, that certainly fits into both of those categories.

[00:04:34.470] - Dr. Gordon

Okay, right. And I think some of my other strong motivating interests have been when I've had AHA moments like, oh, it matters what you eat as food. It doesn't just fuel you. Like, quality of food matters. And my AHA moment? Well, I don't think it was an AHA moment. It was a fear moment when my mother had breast cancer and her mother had breast cancer. And I was taught in medical school that I would have breast cancer because.

[00:05:03.220] - Dr. Lemanne

Of the family history.

[00:05:04.340] - Dr. Gordon

Because of the family history. And I don't actually have the gene. I don't think my mother did either. I think it was more environmental. But I think I've devoted a lot of my curiosity in medicine to what's the optimal health picture that doesn't get breast cancer. I think the statistics are that it scares women more than heart disease, which is really more of a threat, kills more women.

[00:05:28.090] - Dr. Lemanne    

Most people with breast cancer don’t die of breast cancer but there are some who don't make it with that and makes the news and it scares us. Well, I think some healthy hypochondriasis is warranted in a situation like that. And one of the things that we do know about breast cancer is that there does seem to be a connection with circadian disruption  

So, for instance, if you are a flight attendant or a nurse in certain countries, I think Denmark is one of them and you are diagnosed with breast cancer, your job, which requires a lot of night work, is considered a risk 

factor and you get a particular pension for getting breast cancer related to your job. We do see some connections. They are tenuous, but they're reproducible to a certain extent between night work and certain cancers. Certainly certain metabolic disruptions that may play into cancer like glucose. Homeostasis seems to be affected for the worse with even missing just one night of sleep. We can measure a higher blood glucose the next day in that person. So we do know that sleep plays a very, very important role in overall health. And if anybody ever asked me nobody ever has, but if anybody ever asked, how can I make sure that I have a really high risk of getting cancer?

[00:06:37.700] - Dr. Lemanne

I would say make sure that your sleep is disrupted in some way over a long period of time. And that would probably set you up very nicely for some health catastrophe, including cancer.

[00:06:48.990] - Dr. Gordon

You know that book? The Guinness Book of World Records?

[00:06:51.500] - Dr. Lemanne

I've heard of it.

[00:06:52.280] - Dr. Gordon

There is a category that was in it when I was a child and has been removed from the Guinness Book of World Records. They no longer recognize ability to go continuously longer and longer periods without sleep as a notable achievement. Sleep avoidance is not in the Guinness Book of World Records because it's like asking someone to put a gun to their head.

[00:07:13.520] - Dr. Lemanne

So don't try this at home.

[00:07:14.800] - Dr. Gordon

Don't try this at home.

[00:07:16.240] - Dr. Lemanne

Yeah.

[00:07:16.810] - Dr. Gordon

Well, when we were in medical school.

[00:07:18.220] - Dr. Lemanne

Wasn'T there a saying going around, you know, I'll sleep when I'm dead.

[00:07:21.290] - Dr. Gordon

I'll sleep when I'm dead. It's so fascinating because we now understand there are so many ramifications of disrupted sleep. And I want to talk about that coin from both sides of it. One side of the coin is all the things that are wrong if you don't sleep well. And the other side of the coin is, don't worry if you don't sleep well, but I'm going to save that little juicy tidbit. The worry part that I understand now about not sleeping is that cognitively, I'm not going to perform so well the next day that I am going to be hungrier for crummy foods. So,  you talked about metabolic dysregulation is just that you have higher blood sugar levels and more dysregulated metabolism regardless of what you eat. But if allowed to eat to your choices, you will eat more sugary fast.

[00:08:12.010] - Dr. Lemanne

That will make things worse.

[00:08:13.130] - Dr. Gordon

You make things worse. I remember reading a study once that women who slept in a room with neon light, but also natural light coming in to their bedroom at night have a higher risk of breast cancer.

[00:08:24.680] - Dr. Lemanne

Really? So the light at night exposure and.

[00:08:26.770] - Dr. Gordon

Neon light, I think, really was more than moonlight.

[00:08:29.470] - Dr. Lemanne

So sleeping poorly makes you a little bit diabetic, makes you a little bit demented the next day. What about over the long term? I mean, there's a connection, isn't there, between dementia and sleep disorders?

[00:08:39.490] - Dr. Gordon

Definitely. And we could talk for a week. It's so complicated a process. How sleep contributes to the health of your brain pertinent to dementia. 

So when you first go to sleep, you have deep sleep. And deep sleep is what cleans out today's memories and puts them into the long term storage file catalog so you can access long term memories. And later in the night you have non deep REM sleep where you're dreaming. And that's when you hold on to the memories of the previous day. You have to sleep in the early part of the night to remember what you learned today. And you have to sleep in the later part of the night towards morning to be able to store those memories for later access. As people slide into dementia, they either sleep less and have broken sleep. Therefore you wonder kind of is the sleep causing their dementia or they have longer sleep. And the thought is, if we studied those people who are sleeping 910, 11 hours, that they wouldn't have good sleep architecture.

[00:09:45.380] - Dr. Lemanne

They were trying to make up for poor sleep.

[00:09:47.190] - Dr. Gordon

Exactly.

[00:09:47.900] - Dr. Lemanne

You said the sleep causes the dementia.

[00:09:50.630] - Dr. Gordon

You mean the lack of sleep, the pattern of sleep? Pattern of sleep, the broken sleep, the shortness of their sleep, their bad sleep patterns. So there are a very, very few people who genetically really can get away with five or 6 hours of sleep.

[00:10:06.460] - Dr. Lemanne

That's a rarity.

[00:10:07.350] - Dr. Gordon

That's a rarity.

[00:10:08.280] - Dr. Lemanne

We have a lot of machismo around missing sleep and working twenty four, seven and then some. But there are some mechanistic things that we know about what happens with deep sleep and REM sleep. Right. There are actually lymphatic systems called the glymphatic systems that have just been discovered in the past decade that actually clean out the brain at night, physically flush it, remove toxins such as glutamate and recycle GABA, and get things all back in order for the next day.

[00:10:33.040] - Dr. Gordon

Right. It helps a lot if you go to sleep with a relatively empty stomach, so your brain isn't processing incoming fuel, so you take away the stimulus of new food. And two things can happen in a properly sleeping brain. One of them is this newly discovered glymphatic system you talk about, and the other one is autophagy, which then contributes waste for the glymphatic system.  And in autophagy auto-phagy, the brain is eating parts of itself. Oh, that sounds gross. No, it's actually quite useful. 

[00:11:09.970] - Dr. Lemanne

So there's like emptying the garbage.

[00:11:10.420] - Dr. Gordon

Exactly.. It's like never cleaning your house if you don't get to do autophagy. And one of the targets of autophagy can be amyloid. Now, we could have a whole contentious discussion about what so you're saying that.

[00:11:23.950] - Dr. Lemanne

Amyloid builds up if you don't sleep?

[00:11:26.130] - Dr. Gordon

Amyloid builds up in all of our brains as we age. So say I have a week of stress and I'm not really eating very well and my brain is not really getting properly. Nourished. It might be that my nerve cells are a little frayed, so my body will give it a little bit of a Band Aid. And we call that bandaid amyloid. And some people make lots of amyloid. They usually have a genetic deficiency and a strong family history of Alzheimer's. And some people don't make that much amyloid. But a healthy body that is able to employ its own autophagy will clean up the amyloids. And in a healthy brain, that's a very useful purpose, because then the nerve—the  next day, which has been cleaned up of its amyloid overnight, can say, okay, I'm ready to regrow. We've learned recently in the last ten years with the Lymphatics that brains can continue to grow new brain cells at any age if properly cared for and properly fed.

[00:12:23.170] - Dr. Lemanne

So you've been researching reversal of the early stages of dementia in patients. What are some of the things that you will do with those patients to enhance their sleep or promote better sleep, higher quality sleep lengths? What are the things that you look at in their sleep?

[00:12:37.880] - Dr. Gordon

We do look at everyone's sleep. We give them some kind of a sleep study. And if there's any suspicion what kind.

[00:12:42.960] - Dr. Lemanne

Of a sleep study?

[00:12:43.910] - Dr. Gordon

Well, we send them home, or if they'd rather they can go to a sleep lab, we send them home with a little device that attaches to their finger and attaches to their wrist. 

Dr. Lemanne              Now, this is painless 

Dr. Gordon …non intrusive. They can go to sleep with it. And it's a pulse oximeter on their finger and a movement monitor. And you measure over the night what their oxygen saturation is. And if it goes significantly below 88%, that is highly suggestive of sleep apnea. And those people we might send to a real lab for real diagnosis. But if your oxygenation goes down a little bit and you roll over and it's all better, and all that happens in ten or 20 seconds, I don't really worry about it.

[00:13:27.090] - Dr. Lemanne

How much drop do you see in people who have a real problem with this?

[00:13:30.180] - Dr. Gordon

You can see it down to 85, and it's down there for a couple of minutes. And that's essentially like trying to suffocate somebody or hold them underwater for a couple of minutes.

[00:13:39.750] - Dr. Lemanne

And this happens once a night?

[00:13:41.190] - Dr. Gordon

Oh, it can happen multiple times during the night, and they can go through periods where they tend to do that more in the beginning of the night or the end of the night. And they are frequently those people that are more severe have a sleep partner that will say to us, I told you you were snoring.

[00:13:56.870] - Dr. Lemanne

The snoring is a signal that you might be having these kinds of episodes.

[00:14:00.320] - Dr. Gordon

Right, that you've got a collapsing upper airway or generally obstructed in some other way. And so we tend to think of, oh, it's only really obese people or people with gigantic chests who have sleep apnea, but it can be somebody who's kind of small and more on the frail side, and their airway is floppy, and so it collapses on itself.

[00:14:20.070] - Dr. Lemanne

So it could be the size of the neck and the chest and the abdomen, but it could also just be the weakness in those areas. The tissue is and 

[00:14:28.140] - Dr. Gordon

Snoring is The pinching or the fluttering of the airway. And sometimes people just snore a couple of times and then they'll write themselves and they'll be fine. And that can be totally normal in sleep. But the people who snore, snore, snore, snore, snore and then gasp for air, that's problematic.

[00:14:45.810] - Dr. Lemanne

So every time that happens, they're waking up and they're not getting into their deep sleep.

[00:14:49.460] - Dr. Gordon

You wake up so many times in the night that you don't realize, and if you're happy and you have a good satisfying sleep, you roll over and go back to sleep. But if somebody were following your brainwaves or you're wearing a tracking device, it'll show that, oh, you woke up at 215, you woke up at 345, you woke up at 515.

[00:15:10.080] - Dr. Lemanne

Is that normal sleep architecture?

[00:15:11.580] - Dr. Gordon

That can be very normal sleep architecture.

[00:15:13.690] - Dr. Lemanne

So let me just recap. You're saying we do our deep sleep earlier in the night and then later in the night we switch a little bit more to the REM, right?

[00:15:22.550] - Dr. Gordon

And there are many cycles within that, but yes, those are the predominant patterns.

[00:15:26.370] - Dr. Lemanne

So what about someone who goes to bed late every night and sleeps late in the morning?

[00:15:30.400] - Dr. Gordon

You are entering a contentious area. That was very interesting. In our recent study that we did with Alzheimer's patients, there were three clinicians and one head clinician, mentor clinician. One of us has sort of a normal they stay up till nine or 10:00 and sleep till seven or eight in the morning. I tend to stay up till eight or 830 at night and wake up at 530 to 630 in the morning. And the two other people, when I would get up in the morning, I would be able to have email exchanges with them because they stayed up till seven or eight in the morning and slept till the early afternoon.

[00:16:04.190] - Dr. Lemanne

Now, that's not ideal, is it? Metabolically?

[00:16:05.590] - Dr. Gordon

I would say it's not ideal, but they claim that it's their best time to work, it's their best time to sleep. They're metabolically healthy. Their brains are some of the top brains I've ever met. And there is evidently greater variety in circadian rhythm flexibility than there is “I can sleep when I die” kind of flexibility.

[00:16:31.210] - Dr. Lemanne

You may have heard of the study. There was a study that took people of varying chronotypes, the early risers, the late risers, and put them in a tent in the woods for a week and everybody recalibrated to the sunrise.

[00:16:44.110] - Dr. Gordon

I do tell people, if you're insomnia gets really stubborn, I'm just going to send you camping for a week or two. Yeah.

[00:16:51.410] - Dr. Lemanne

So the light and the dark obviously play a role in putting us to sleep. Those things change over the course of a year, though. In the winter, the days are short, the sun rises late and the sunset early. There are differences in the amounts of diagnoses of cancers. For instance, breast cancer is most commonly diagnosed at the two equinoxes and least commonly diagnosed at the solstices.

[00:17:13.730] - Dr. Gordon

For people who are not calendar nerds.

[00:17:16.150] - Dr. Lemanne

The Equinox is the beginning of spring.

[00:17:18.190] - Dr. Gordon

And fall when the days and the nights are of pretty equal in certain latitudes.

[00:17:22.420] - Dr. Lemanne

Right. And then the solstices are the deepest points of summer and winter. There's a summer solstice and the winter solstice respectively. The solstices are times when breast cancer diagnoses are less commonly made. We don't understand that. You'd think, well, maybe it's the changing of the light, but you'd think it would be in one direction or the other. For instance, more light is better or more light is worse. But the fact that it happens at both equinoxes suggests that it's actually the rate of change. 

So our bodies are perhaps having trouble dealing with the acceleration of the changes of ratios between light and dark at those times of year. That's something that needs to be looked at carefully. But I think it's really interesting that we're so affected by light and dark and we definitely need to pay attention to those two phases of the day when we are trying to stay healthy.

[00:18:10.390] - Dr. Gordon

That reminds me of my chickens. I have 13 chickens.

[00:18:14.100] - Dr. Lemanne

You have 13 chickens?

[00:18:15.060] - Dr. Gordon

Two geese and a turkey. And the two geese and the turkey are past their laying prime so they no longer bring us eggs but the 13 chickens when they've survived.

[00:18:23.830] - Dr. Lemanne

Because I know you're quite a carnivore.

[00:18:25.590] - Dr. Gordon

Yes, we raised turkeys for meat one year and we love them so much we got one as a pet and we will keep her into her teenage years when she's likely to keep living that long. But our 13 chickens are still layers. And what is interesting is I kind of expected that they would stop laying and if you are a chicken egg farmer, you might light your chicken house all winter to avoid this. But we let them live by natural light and they stop laying about the time of the equinox. They slow down their laying just as the dark takes more time over the day than the light and they totally shut down. They start laying a week before winter solstice. In other words, as the days are getting to their shortest, just before the light starts returning, they start laying again and it's very spotty. And then they really start laying again at the spring’s Equinox.

[00:19:29.600] - Dr. Lemanne

Interesting. Well, I love chickens. My affection is mostly culinary. But let's talk a little bit about nighttime eating. That's a problem for a lot of people. They'll wake up, they can't sleep, get up and go to the refrigerator. I think that's not a great idea.

[00:19:45.520] - Dr. Gordon

Exactly. I haven't seen the study since we've just really discovered the glymphatics. But autophagy turns off if you're recently eating food and I bet the glymphatics do, too.

[00:19:56.620] - Dr. Lemanne

Well, certainly the eating schedule tunes the circadian rhythm and strengthens it. 

So if you eat during the daytime when it's light, you're strengthening your circadian rhythm. You're more likely to sleep at night if you eat during night, at least in animal studies. If animals are fed during their natural resting period their metabolism and their sleep wake cycles are deranged much to the detriment of their overall health. That seems to be the case in people. People who eat at night who have a nighttime eating habit have more problems with obesity, diabetes, hypertension, those kinds of metabolic related conditions. 

[00:20:31.680] - Dr. Gordon

The advice used to be from some respectable, conventional and alternative medicine sources that if you can't sleep well at night, have a protein and carbohydrate snack at bedtime.

[00:20:41.910] - Dr. Lemanne

Oh, was that?

[00:20:42.940] - Dr. Gordon

That has been the advice.

[00:20:44.250] - Dr. Lemanne

Milkshake contract.

[00:20:46.590] - Dr. Gordon

I think turkey sandwich was more what they were thinking with white bread. Yeah. So that brings up something I wanted to share with you that I learned from three of my patients in the last month and I'm kind of curious to try it. These are patients whom I've worked with for sleep issues. Their successes rise and fall probably with the seasons. One of them actually set up a tent in his backyard to mimic the camping experiment. But the two of them and one other patient told me recently that they are now sleeping like a baby and have no more sleep problems. And it's all from a change they've made in their diet. They have increased their protein to a gram of protein per pound of body weight. One person just told me they're eating a lot of protein. These two people said when I reached 150 grams of protein I started sleeping like a baby.

[00:21:40.310] - Dr. Lemanne

Interesting.

[00:21:40.780] - Dr. Gordon

So there are about 150, 160 pound people who are physically very active and they're eating a lot of protein and their neurotransmitters are working better.

[00:21:49.830] - Dr. Lemanne

That's really interesting. And that kind of fits with what we know about muscle mass and protein intake and especially with aging. What about temperature? Nighttime temperature? I have found that taking a sauna and then a cold plunge about an hour or two before bed really helps me get to sleep. I'm sleepy an hour or so after I finished. That to the point where I cannot stay awake. And so I've found that to be really useful in terms of my own sleep quality. And I've read that cooling the body just before sleep is helpful in terms of deepening the sleep and enhancing the sleep onset.

[00:22:23.130] - Dr. Gordon

It's an interesting point of view about cooling the body because a pretty conventional sleep counsel is to take a warm bath or a warm shower before bed. But the point of that is to take all the circulation to the skin so that when you get out of the shower, you have effectively you've turned on the air conditioning. You've turned on the air conditioning. 

So the circulation that's all gone to the skin to contend with the heat is now faced with a cooler room and the heat evaporates, cooling both your core and your skin. So just a hot bath or a hot shower can cool the body. And of course, your routine has other health benefits. Yeah, cooling the body helps a lot with sleep and cooling the room that you sleep in. The advice is to cool it to at least 65 to 68 degrees. And if my room were that warm, I would have trouble sleeping in it. I like it below 60 to sleep.

[00:23:18.900] - Dr. Lemanne

Oh, that's really cold. Mine's 64. Yeah, but below 60, that's pretty chilly. So what do you tell patients who just are having so much trouble sleeping at their wits end? How can someone get their circadian rhythm back? What kinds of advice do you give them?

[00:23:34.890] - Dr. Gordon

This is a relationship, not an advice. Because really there are 50, 100 ways to solve sleep problems and each person is going to solve their sleep rhythm.

[00:23:45.920] - Dr. Lemanne

Is it better to make sure you go to bed early?

[00:23:48.270] - Dr. Gordon

No, but there is a wealth of information out there. The one thing that is pretty consistent is that is not the solution.

[00:23:57.170] - Dr. Lemanne

Now wait a minute. So I can't sleep. I'm not getting enough sleep. Why wouldn't I want to go to bed earlier?

[00:24:01.670] - Dr. Gordon

What I really want you to get--you who are having trouble sleeping is to have good solid sleep with good architecture that you can master at 6 hours and gradually expands to seven or eight, whatever you need. And the best way to ensure that you're going to get that concentrated high quality sleep is to not to go to bed at 08:00 because then you burn up your need for sleep by eleven or twelve or one and you're up. And then you can't sleep for the rest of the night. And then you go back to sleep at three and you sleep till eight or nine in the morning. And the whole thing is I'll disrupted. What's easiest to do is set yourself a get up time. 

You need to get up at 06:00 in the morning because you want to go to the gym before you see patients. And right now you're having trouble sleeping. You sleep somewhere between six and eight and a half hours a night, but sometimes it's really broken. You've got a good six. So you want to get up at 06:00 in the morning, you stay up till midnight.

[00:24:58.670] - Dr. Lemanne

So you restrict sleep, you make me want more sleep.

[00:25:03.130] - Dr. Gordon

And you get really good quality sleep and you do not let yourself sleep in past six, maybe one or two days a week, 30 to 45 minutes, something like that on the weekends. But you really make yourself get up and when you go, okay, that's working great, I'm sleeping great, but I am exhausted. Okay, start going to bed at 1130 and sleeping till six.

[00:25:22.340] - Dr. Lemanne

So you limit the sleep and make people really, really want it and then the sleep improves automatically. And you do that by making a set wake up time.

[00:25:30.160] - Dr. Gordon

… and being hard on yourself about the go to bedtime and only gradually expanding it. It's our lizard brain that controls a lot of sleep. And if you spend a lot of time lying in bed watching television, reading, doing other things than sleep, your lizard brain does not equate your bed with sleep. And what you want to do is have your lizard brain think that I'm in bed, I sleep, and when I wake up I get out of bed.

[00:25:58.580] - Dr. Lemanne

That's really helpful. I think that'll be useful for a lot of people who are struggling with sleep. What about drugs? Should we every now and then, should we just take a sleeping pill?

[00:26:06.450] - Dr. Gordon

There are so many sleep AIDS that are non druggy and that I think there are two prescriptions that are really pretty safe to use. But there's a plethora of sleep aids and in general melatonin is the most commonly known one. And in general I do recommend that older patients can be in a melatonin habit. From my point of view, it's a fine thing to do the dose that doesn't leave them sleepy the next day, which could be anywhere from one to ten milligrams, but helps them get to sleep. And I know it's used by some Naturopaths in cancer recovery. What's your point of view as an oncologist about melatonin?

[00:26:40.980] - Dr. Lemanne

Melatonin is one of the most studied supplements in oncology and almost all to the good in terms of cancer treatment effects and survival. Perhaps that's mediated by its effect on sleep. In oncology, we tend to use very high doses of melatonin, 20 milligrams a night. Some people are using 60. I don't know if we can say that bumping the dose up that high is really making a huge difference. But certainly melatonin is a big favorite amongst naturopathic oncologists and also cancer patients gravitate toward it. I think it's reasonably safe. It doesn't seem to produce a down regulation of the pituitary (Dr. Lemanne should have said “pineal” here ) melatonin output, so that's reassuring. I think melatonin is a pretty safe thing to use for most patients. Of course you want to check with your own doctor before you start taking anything, including melatonin, but for most patients it seems to be a reasonable thing that they can try to see if it helps them with their sleep. Sleep aids are a little bit iffy and possibly harmful, is that correct?

[00:27:35.730] - Dr. Gordon

I'd say in general that's really true for sleep prescriptions. The reason that these two have a generally regarded as safe kind of level of approval is that they generally can be undetectable if someone's in a sleep lab doing serious brain wave monitoring of their sleep and you pop them as an alternative kind of example. You pop them some Valium when they go to bed. The person looking at their sleep study will say, what did this person take before they went to bed? Because it shows on performance and I don't understand how exactly, but the two that don't seem to disrupt it that much and one of them, which is just enhancing a normal neurotransmitter, is Gabapentin. It has a pharmaceutical key that enables the very large molecule of GABA to get into the brain. You can buy GABA at the health food store and if it works great for you, that's actually not such a good sign because it's a big molecule. It shouldn't get you shouldn't be crossing.

[00:28:33.100] - Dr. Lemanne

The blood brain barrier.

[00:28:34.040] - Dr. Gordon

Exactly. So you should talk to your physician about that. But Gabapentin is usually I've given it to lots of people and I'd say about 10% of them have an adverse feeling of too sedated or depressed after a while of using it. It doesn't work for everybody, but for many people it's a useful contribution to their sleep routine. And the other one is Trazodone, which in higher doses is an antidepressant, but in doses of 25, 50, 75 milligrams, about half of the antidepressant dose, it can be helpful for some people with sleep.

[00:29:07.450] - Dr. Lemanne

And do you use it chronically or just once in a while?

[00:29:09.780] - Dr. Gordon

Both of those medications my patients have personal control over once we prescribe it and start monitoring it. So I have some people who use it just when they travel or occasionally, and other people who use it routinely.

[00:29:23.930] - Dr. Lemanne

What about over the counter sleep aid, though?

[00:29:26.180] - Dr. Gordon

There are so many. You go to your health food store and you go to the sleep section. Are there some that are better than others? Yes, but that's kind of individual  

[00:29:34.570] - Dr. Lemanne

Well, one thing that bothers me about those is a lot of them have antihistamine properties and aren't those toxic to the brain over the long term?

[00:29:40.880] - Dr. Gordon

You bring up a really good point. And when you go to the sleep section of your health food store because in your health food store sleep aids, those are all going to be herbs.

[00:29:49.620] - Dr. Lemanne

Oh, no, I was talking about the drugstore. Yeah.

[00:29:51.390] - Dr. Gordon

When you're in the drug store sleep section, you should approach those shelves with caution for exactly the reason that you mentioned:  antihistamines willy nilly, and all of them and some of the antihistamines have been completely vindicated. They're safe in sleep. But I don't completely trust that because science changes on that and others are definitely associated with cognitive impairment.

[00:30:15.290] - Dr. Lemanne

Well, this is a really interesting topic. I think we could talk about this for hours.

[00:30:18.950] - Dr. Gordon

I wanted to tell you about the other side of my coin. Remember I said one side of the coin is that you need to worry about sleep and the other side of the coin is that we don't need.

[00:30:27.220] - Dr. Lemanne

To worry about it.

[00:30:27.990] - Dr. Gordon

Don't worry about it. So there's several aspects to the side of the coin that says, don't worry about it. One of them is you really can do without sleep for a little bit and you are impaired the next day, but you can recover. So if you are on a cross the country trip and you have to make it in time for your sister's wedding and you're not sleeping so well, don't worry, don't panic, you'll get there. And the other reason not to panic, they've done a study where they've taken people and seemingly monitored their sleep and they've told half the group, you slept great. 

Oh, I wish I had your sleep. And they tell the other half of the group, you've really got some sleep issues, but we're going to give you all the same cognitive test anyway.

[00:31:08.280] - Dr. Lemanne

Oh, I can see where this is going.

[00:31:10.140] - Dr. Gordon

You exactly can see where this is going. It had no correlation with how well they really slept, it just had a correlation with how well they thought they slept.

[00:31:21.140] - Dr. Lemanne

So the moral of that study is choose your company well.

[00:31:23.660] - Dr. Gordon

Choose your company well. And I have a couple more little pearls. If you do have a bad night of sleep, there are a couple things that you can do the next day to optimize your slightly compromised brain.

[00:31:37.430] - Dr. Lemanne

OOH. Please tell.

[00:31:38.780] - Dr. Gordon

And one of them is the same as Deborah broken-record-proteinGordon. You can eat a high protein diet the next day.

[00:31:46.800] - Dr. Lemanne

Okay.

[00:31:47.160] - Dr. Gordon

But the salient component of the protein, which you can take entirely by itself, is creatine. monohydrate

[00:31:54.870] - Dr. Lemanne

Creatine!  I have used that when I've missed sleep and it does help.

[00:31:58.520] - Dr. Gordon

I recommend it when people have osteopenia or sarcopenia, and I say, you're going to do some exercise, and if you want it to do twice as much good as the time you've spent doing it, take creatine around the time you exercise. But there is a side effect. It's going to help you grow new brain cells.

[00:32:16.730] - Dr. Lemanne

I like the side effects of your treatments.

[00:32:18.890] - Dr. Gordon

So I like to think that sleep problems are not really the culprit so much as sleep ignorance, which means being careless with your sleep and to really value your own sleep resilience and to enhance it as much as you can. Protein, creatine. Getting back into your good habits. Go camping if you need to. Sleep with the moon and rise with the sun. But not addressing it, just deciding, oh, no, I'm just somebody who is up every night from midnight to four and I get two completely separate patterns of sleep.

[00:32:54.470] - Dr. Lemanne

What about someone, say, a doctor who has to work the night shift and maybe has to work the night shift for months on end, years on end?

[00:33:02.680] - Dr. Gordon

They should be double paid.

[00:33:04.570] - Dr. Lemanne

Because it's a health risk.

According to CDC considerations 

References to studies identifying risk, and suggestions of work-arounds for shift workers. 

[00:33:05.840] - Dr. Gordon

It really is a health risk.

[00:33:07.470] - Dr. Lemanne

There are a lot of professions that deal with that. Medicine.

[00:33:10.430] - Dr. Gordon

Medicine, nursing, all that stuff.

[00:33:12.010] - Dr. Lemanne

Aeronautics.

[00:33:12.770] - Dr. Gordon

Pilots flying while we're sleeping.

[00:33:15.750] - Dr. Lemanne

Exactly, yeah.

[00:33:17.630] - Dr. Gordon

I learned two more things that I want to just share with you, because one of them is so fascinating. We tell people to wind down before they go to sleep at night. One of the frequent complaints that people have to me is they have a sleep tracking device, and it tells them that they don't get much REM sleep, dream sleep. And they know that every part of sleep is important for their brain. How can you get more REM sleep? There is a big article I was reading about sleep, and they were talking about the one thing you can do to enhance your REM sleep. And this is actually something that's good for your brain in many ways, but somewhere in the late afternoon or evening, do something that is new to you and challenging on both a cognitive and physical level. 

And I don't mean arduous like climbing a mountain. I mean you're a musician. Play a piece that's hard for you for half an hour in the afternoon or evening.

[00:34:12.280] - Dr. Lemanne

So something novel that uses both the cognitive and the physical parts of the brain.

[00:34:16.920] - Dr. Gordon

Yes. It should be fine motor, not gross motor.

[00:34:19.550] - Dr. Lemanne

Okay.

[00:34:20.000] - Dr. Gordon

That helps REM sleep. The other thing that I learned about is there is a prescription that I think I'm going to have to experiment with some of my patients because it is covered by insurance.

[00:34:32.070] - Dr. Lemanne

That's always nice.

[00:34:33.080] - Dr. Gordon

Yes. It prevents you from ignoring the fact that you have a sleep problem. It is not medicated. It is a smartphone app called Somrist. S-O-M-R-Y-S-T. It's an FDA approved cognitive behavioral therapy program self-directed on your own smartphone.

[00:34:56.150] - Dr. Lemanne

So you learn with the feedback from your phone how to get a better night's sleep. Very nice.

[00:35:01.860] - Dr. Gordon

So if you have any patients that try that, please let me know.

[00:35:04.430] - Dr. Lemanne

I will. I'm going to try it myself.

[00:35:06.290] - Dr. Gordon

Yeah. All right.

[00:35:07.240] - Dr. Lemanne

What about little devices that monitor your sleep?

[00:35:09.820] - Dr. Gordon

I think they can be very useful as long as you're not one of those neurotic sorts that comes running to me saying, I haven't had any good REM sleep in two weeks. That's the kind of person that needs to chill. The monitors are not perfect.

[00:35:21.860] - Dr. Lemanne

Do you have any favorites?

[00:35:23.180] - Dr. Gordon

I like my OURA ring because I like to wear it at night. I have a good friend who likes the Whoop wrist device because what does.

[00:35:30.590] - Dr. Lemanne

What does the OURA ring do?

[00:35:31.840] - Dr. Gordon

It has nice little sensors that light up with green light or red light at night, but they're just receiving at night. They're not transporting.

[00:35:39.750] - Dr. Lemanne

What are they measuring?

[00:35:40.890] - Dr. Gordon

They're measuring my oxygen saturation, my heart rate variability. And that's another thing you can track with sleep. It categorizes when I'm awake, when I'm in deep sleep, when I'm in light sleep, which we didn't even talk about, but has its own benefits as well. I think that's where the little sleep spindles are that are good for brain cleaning and tells me how much REM sleep I get.

[00:36:01.140] - Dr. Lemanne

Oh, my goodness. So you look at your smartphone in.

[00:36:03.120] - Dr. Gordon

The morning, and first thing in the morning I run upstairs because I don't have my smartphone in my bedroom.

[00:36:07.500] - Dr. Lemanne

Now that's smart. So another good idea is to not have screens in the bedroom.

[00:36:11.310] - Dr. Gordon

Not have screens and not have WiFi. Some people are very sensitive to WiFi, so people who like to listen to their Audible book at night, I just tell them to put their phone on airplane mode.

[00:36:20.710] - Dr. Lemanne

And you also get more exercise because you have to run upstairs first thing in morning and find your smartphone and look at your sleep architecture.

[00:36:27.060] - Dr. Gordon

And look at my sleep architecture.

[00:36:28.630] - Dr. Lemanne

That's brilliant. I really like that.

[00:36:30.320] - Dr. Gordon

So Whoop and OURA, I think are the two main benefits, is Whoop similar. It's a wristwatch device. And the good thing about it is–my sport, as you know, is rowing, and I cannot wear my ring while I’m rowing, so I have to write.

[00:36:44.290] – Dr. Lemanne

Is it waterproof? Can you shower with it? Yes. Okay. 

[00:36:48.940] - Dr. Gordon

And the whoop goes around the wrist. Goes around the wrist.

[00:36:49.800] - Dr. Lemanne

Does it measure the same things as the OURA?

[00:36:51.500] - Dr. Gordon

I think pretty much it does. And it probably has some bells and whistles that the aura doesn't and vice versa. I think it's reasonable to do it as long as you have a good appraisal ahead of time of your own personal neurosis index.

[00:37:03.990] - Dr. Lemanne

People can get attached to the output of these devices and worry about them.

[00:37:08.640] - Dr. Gordon

And they forget that you are a resilient being, with sleep resilience right up there with everything else.

[00:37:16.000] - Dr. Lemanne

Factory programmed for that.

[00:37:17.290] - Dr. Gordon

Don't we do? Yeah, we're going to get better. We'll have a better day tomorrow.

[00:37:20.910] - Dr. Lemanne

Oh, that sounds good. Yeah, I like that. Today's not so bad.

[00:37:23.920] - Dr. Gordon

Today's a great day. We're moving into fall. All is good.

[00:37:26.940] - Dr. Lemanne

Yeah. How many chickens do you have?

[00:37:28.560] - Dr. Gordon

13.

[00:37:29.240] - Dr. Lemanne

Okay. You better keep them under chaperone.

[00:37:36.690] - Dr. Gordon

You have been listening to the Lemanne Gordon Podcast, where docs talk shop.

[00:37:42.500] - Dr. Lemanne

For podcast, transcripts, episode notes and links, and more, please visit the podcast website@dockstalkshop.com. Happy Eavesdropping. Everything presented in this podcast is for educational and informational purposes only and should not be construed as medical advice. No doctor patient relationship is established or implied. If you have a health or a medical concern, see a qualified professional promptly.

[00:38:18.740] - Dr. Gordon

We make no warranty as to the accuracy, adequacy, validity, reliability or completeness of the information presented in this podcast or found on the podcast website.

[00:38:30.770] - Dr. Lemanne

We accept no liability for loss or damage of any kind resulting from your use of the podcast or the information presented therein. Your use of any information presented in this podcast is at your own risk.

[00:38:45.340] - Dr. Gordon

Again, if you have any medical concerns, see your own provider or another qualified health professional promptly.

[00:38:52.160] - Dr. Lemanne

You must not take any action based on information in this podcast without first consulting your own qualified medical professional.