268: Dr. Michael J. Breus, PhD, The Sleep Doctor, Bestselling Author & Speaker: What To Do When You Wake Up At 3AM

 Welcome to the Sleep Is a Skill podcast. My name is Mollie Eastman. I am the founder of Sleep Is a Skill, a company that optimizes sleep through technology, accountability, and behavioral change. As an ex-sleep sufferer turned sleep course creator, I am on a mission to transform the way the world thinks about sleep.

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Each week, I'll be interviewing world-class experts ranging from researchers, doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper. Ultimately, I believe that living a circadian-aligned lifestyle is going to be one of the biggest trends in wellness, and I'm committed to keeping you up to date on all the things that you can do today to transform your circadian health and, by extension, allowing you to sleep and live better than ever before

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Welcome to the Sleep Is Skill podcast. Today we are joined by Dr. Michael Breus, also known as the Sleep Doctor, one of the world's leading sleep experts with nearly three decades of helping people transform their sleep, health, and performance. From sleep apnea and menopause to nightmares, lucid dreaming, and middle-of-the-night wake-ups, this conversation is packed with fascinating and practical insights that can genuinely change how you think about sleep.

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Why are so many women unknowingly struggling with sleep apnea? What do your dreams actually mean? And could your 3:00 a.m. wake-ups, hot flashes, anxiety, or reoccurring nightmares be pointing to something much deeper happening in your body and nervous system? Well, Dr. Breus breaks down the surprising connections between hormones, breathing, trauma, dreams, and sleep optimization in a way that is both eye-opening and actionable.

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If you've ever struggled with insomnia, waking up exhausted, anxiety around sleep, or feeling like something is, quote, "off" but you cannot figure out why, this episode is for you. Now make sure to subscribe, leave a review, and share this episode with someone who could benefit from better sleep, which probably is most of us.

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So without further ado, let's jump into the episode And welcome to the Sleep is a Skill podcast. We do not often have a lot of return guests, and yet ... this guest, uh, can come on as often as he would like. He is- ... not only one of the most renowned experts in the world of sleep, but also I am grateful to call him a friend and mentor in many ways.

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Right. So really, really thankful to have Dr. Michael Breus on the podcast. Hey, Molly. Just a regular occurrence, us getting a chance to catch up. But for those listeners who maybe are a little newer to the world of Dr. Michael Breus- Sure ... how could they be? You've been in the game for such a period of time, but, uh, a little background, how you became such an expert in the world of sleep.

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Sure. So thanks for telling people how old I am. I really appreciate that. Um- Wisdom. We are, we are becoming seasoned- Wisdom ... over the years. Wisdom. Wisdom. That's what it is. That's what it is. It's not old age. I agree. Um, so first of all, for all of you Sleep is a Skill, uh, listeners, Molly is one of my favorites of all time.

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Um, you have a great, great host here who is working well. And she... the thing I like about Molly is she's constantly curious. Mm. And she gets really interesting people to come on the pod, people that you wouldn't normally see in a lot of these sleep-related conversations. So I'm super thankful because I listen to the pod, um, and I learn stuff.

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Mm. Um, and so that, I think we should all take heed that Molly does an amazing job. Um, me personally, I've been in sleep for 26 years. Um, I started at this, oh my gosh, back in 2000. Believe it or not, it's been that long. So to give you a little bit of background on me, I have a PhD in clinical psychology, but I'm also, uh, board certified in clinical sleep disorders.

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Hmm. So that's might sound a little odd. So I am one of 168 people in the world who took the medical boards without going to medical school and passed. Mm. Um, I did it just in sleep and sleep medicine, and I've been an actively practicing sleep doctor for 26 years. And there's a difference, a slight difference between being a sleep doctor and being a sleep expert.

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Um, so I thought I might double tap a little quickly on that. Yeah, please. Sleep experts, who are awesome, awesome people and people who I learn a lot from, have a tendency to mostly spend their time in the laboratory. So they're running, uh, research projects, uh, reading, uh, learning more about sleep from the academic sense, uh, which I really value because what I do is I take all of their ideas and I pressure test them in the real world- Yeah

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'cause I see patients almost every day, um, and really try to get into it and try to figure out how do we get people to sleep better. So I feel like sometimes I'm a translator, uh- Yes ... in certain ways of some of the research and, uh, trying to figure out way, shapes, and forms for us to be able to hang out and, and learn more about sleep.

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Um, I do have a fun YouTube channel where people can go and learn all kinds of crazy information about sleep, and a website, and all that kind of good stuff, and we'll, we'll give you all that at the end. Um, but yeah, I've been an actively practicing sleep specialist for 26 years, and quite honestly, I love it.

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Um, it's fun being a sleep specialist. I don't know if you have this experience, Molly. I'm guessing that you do. But anytime I walk into a cocktail party and somebody figures out, um, I know anything about sleep, the line forms around. Question after question after question, and I love it. I have a great time with it.

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Um, so I'm super thankful that I've had the opportunity to be a sleep doctor. Ugh, so, so true. And, and we'll also share in the show notes, you have just mountains of resources for people between books and ways that they can get into the conversation of chronotypes and- Yeah ... really make this a way of life.

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So endless ways to interact with all the information you have. Yeah, really making a difference for people. And I know we were just chatting, you were... You've been on so many different part of publications, shows, podcasts, et cetera. We saw you on Diary of a CEO killing it and- Yeah ... Dr. Oz, all the things over the years.

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So wonderful work. Thanks. And I'm excited to hear more about what is lighting you up right now because- Yeah ... you have delved into many different arenas that can make a difference with sleep. I have. I love how you said that you kind of pressure test or get to actually see what really works on- Yeah. Yeah

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you know, with people day in, day out, which is so valuable because that's really our commitment here is, you know, the things I'm looking to get out is practical things- Yeah ... that can really move the needle. And so I know you have tons of those. So right now, what's really lighting you up at the moment when it comes to sleep?

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So it's kind of interesting. Um- I, I wouldn't have said this three or four weeks ago, but recently I've really been spending a lot of time learning about menopause and, um, learning more about women's health and sleep, uh, and some of the real problems within sleep medicine that are not addressed for women.

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Um, one example is we use the same criteria to assess women for sleep apnea as we do men, which makes absolutely no sense whatsoever. In fact, the way we rate sleep apnea, which is the number of apneas or hypopneas you have per hour, um, we don't have differentiation between men and women. And by the way, all of those numbers came from white men that we tested, you know, 30, 40 years ago.

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And so I've really been on this kind of I don't know if it's idea or if it's just tirade of we need to start thinking about women differently, and especially in sleep and sleep medicine. Um, I've had the, the fortunate opportunity to start to really think through menopause lately. I've had quite a few, uh, women come to me saying, "Hey, Michael, I got questions, and, um, I need you to, you know, help us figure this out."

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And so when we think about menopause as a, as a state, uh, and what's kind of going on for women there, there's a whole lot of things that happen. There's perimenopause, there's menopause, there's post-menopause, and there's different sleep problems that seem to go on throughout all of that. And so I've... what I've been trying to do is develop a protocol for women to start thinking about things a little bit differently.

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Um, a- and quite frankly, most of them haven't been educated about what is your sleep gonna look like during this crazy change in your lifetime, and what's normal, what's not normal, when should you try to fix something, when should you just kind of wait it out? So I've really been spending time there. So that's been one area of interest, and we can drill down into that if you'd like.

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Um, and then I've also been spending a lot of time thinking about dreams and, um, what do they mean, what do they mean to each individual, what can we learn from them, uh, things of that nature. So those are two areas that I've been kind of hot to trot on as you, uh, as you said- Yes ... engaged in my- Exactly.

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Well, yeah, maybe we'll start with the first one. I so appreciate you advocating for this awareness for women of some of the differences. So maybe even kind of sorting that out so that they can be aware of how might things stack up a little bit differently f- uh, when it comes to testing and beyond. Yeah.

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So I mean, let's... so let, let's get into the testing of it all, right? So number one, not enough people are getting sleep tested. Uh, I think you would definitely agree with me on that point. And, and, you know, here's what's interesting is there's a big problem, more for men than it is for women, but we'll get to the women's side of it, is most men don't wanna be tested 'cause they don't wanna end up on a CPAP machine, right?

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Like, that's the bottom line here is they're like, "I know I've got apnea or I've got something going on, and I don't wanna sleep with a mask on my face for the rest of my life. And what is that gonna look like to my partner, and how is that gonna make me feel?" And, and all the things associated with it.

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And, um, I'm here to tell you that not everybody ends up on a CPAP machine Um, like I've been doing this for 26 years. There are a lot of new treatments, especially right now. I mean, I know you and I have spoken before. There's a, there's a pill that's gonna be coming out in like 12 to 18 months that's gonna probably be quite helpful.

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There are dental devices. There are CPAP machines. There are surgical interventions. There's a whole host of different things out there that I think people, well, if I'm honest with you, they just don't know about them. Um, and the thing that they know about most is the CPAP machine, so they say, "Oh, shit, I don't wanna do that, so I'm just not gonna bother getting tested."

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That's a terrible idea. Do yourself a favor. Go get tested. First of all, used to be the tests were super-duper expensive. They're not, right? You can have a home sleep test done for you for 200 bucks or less these days, and it's really worth it to do so. I know you test a lot of your clients when they come through the door.

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I test most- Oh ... of my patients because so many people have undiagnosed sleep apnea, and they have no idea. And again, the only reason they're avoiding the test is because they think that they're gonna get stuck on one particular treatment, which again is not really the case. Now, one thing that's been interesting is sleep testing changed when COVID happened, right?

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So what ended up happening is COVID hit, and then nobody wanted to go to the sleep lab 'cause nobody wanted to sleep in bed of somebody who'd just been sleeping in that bed, right? So all the technology sped up super fast, and now we have these home sleep tests, what we call HSTs. There are probably six or seven different companies out there that make these devices.

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They're real, they r- actually work, and they're diagnostic. But I wanna be clear, they're primarily diagnostic for sleep apnea, right? Like if your doctor suspects that you have narcolepsy, eh, you're probably going into the sleep lab, right? If your doctor thinks you have periodic limb movements and restless leg syndrome, well, you're probably going into the sleep lab.

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But for apnea, which by the way, is the number one diagnosis in sleep laboratories, the good news is, is we can do this from your home. In fact, you actually never have to leave your house. You can have a consult through telemedicine. You can have a thing sent to you. It's all done in your house. You can actually throw it away 'cause it's disposable when it's done.

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So there's a lot of utility in knowing what's going on, and the cost isn't that much. Again, it used to be thousands of dollars. Now we're talking about 200 bucks, um, and most of the time your insurance covers it. So I wanna be clear, I think people should get sleep tested. And l- when we talk about women's health, that is actually one of the first things that I tell women, especially women going through menopause, because here's what's interesting is right when you hit menopause, your, uh, your chances for having sleep apnea as a female double.

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Double Underscoring that Right? Yes So it's unbelievable. Like, it goes from a two to one ratio to a one to one ratio. So women in menopause, one of the first things we like to do from a protocol standpoint, do a home sleep test. Let's kind of figure you out. Let's get your breathing right first. Because quite frankly, if you do have undiagnosed sleep apnea, it's almost impossible to fix everything else without fixing the apnea first, right?

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Yes, exactly. And, and we talk about some of these perils and some of the struggles for women as more kind of voices are coming out about these different periods for perimenopause, menopause, post-menopause, and this idea that this might be consistently missed year after- Right ... year after year, decade after decade- Yeah

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so we really have to shout that from the rooftops. Well, let's talk about why it gets missed for a half a second- Yeah, please ... because I don't think a lot of people out there know this, right? And so when you do a, when you have a sleep test done, we look at certain metrics. The biggest metric that we look at is the number of times you stop breathing in your sleep per hour.

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Mm-hmm. Right? It turns out that for men, that number naturally is higher than it is for women. Yeah. Um, generally speaking, unless you're a very large individual, and weight can have a factor on this. Mm-hmm. And by the way, we should also double tap on are GLP-1s the new CPAP, because I've been a- getting asked that question quite a bit- Yeah

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um, which is interesting, is the idea that women may not have large RDIs or AHIs, which is the, this metric- Mm-hmm ... of number of apneas per hour. And so a lot of doctors say to them, "Oh, you've got mild sleep apnea. You don't need anything. We're gonna put you on an antidepressant and send you on your way." Mm.

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Nothing could be worse. Mm-hmm. Nothing could be worse, right? So one of the things w- I wanna be clear about is even if you get sleep tested and you have mild sleep apnea, it's still worth treating. Yeah. Okay? And there are multiple ways to go about treating it. Yeah. So I don't want you to think, "Hey, I'm doomed now.

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Now as a female, I'm gonna have to wear a CPAP machine," because again, in most cases it's milder, and so a mouth, uh, guard would work very well, what we call a mandibular advancement device. So this is, uh, a upper and a lower that slowly moves your jaw forward by about a millimeter or two. Mm-hmm. That opens up a posterior airway space in the back of your throat, and, um, it's actually easy to w- easy to wear, easy to use, easy to travel with.

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So there's a lot of utility in some of these types of things for, for women. Um, here's another interesting thing that a lot of women don't know is hormone replacement therapy helps sleep apnea. Mm. There's actually data to show that women breathe better as soon as they s- as soon as they get on hormone replacement therapy.

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So let's double tap for half a second on hormone replacement therapy. For years and years and years, doctors have been telling women, "Don't do hormone replacement therapy, especially if you have any breast cancer in your family. You know, you're gonna get breast cancer and die." The, the data just doesn't support that.

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Mm-hmm. Um, there was a group of people who unfortunately really didn't read the data, started making recommendations, and I would argue there's an entire generation of women who did not take advantage of hormone replacement therapy when they could have- Mm-hmm ... and they were freaking miserable- Mm

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throughout all of this period of time. Now, one of the questions that a lot of people say to me is, "Well, Michael, why during menopause do women... does that, does that ratio go up so much?" Right. Right? Like, what, what's going on there? So one is hormone dysregulation. Mm-hmm. So we know that hormones affect our breathing as well as our weight.

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And the second component is weight gain. Mm-hmm. There's a lot of women who gain some weight while on, uh, while going through the menopausal process. That's not uncommon. Mm-hmm. Right? And again, this could be temporary, 'cause a lot of women, they gain a little bit of weight, and then it- they lose it once they get on HRT or once they have some sort of protocol that helps them out.

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So then people started to ask me, "Well, Michael, what about GLP-1s? Like, maybe I'll get on hormone replacement therapy, get on some GLP-1s, and really save the day." Right? "And how, what does something like that look like?" So number one, GLP-1s can be helpful. Um, I've even had some patients get on GLP-1s and get off of CPAP because they've lost so much weight.

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Mm-hmm. But I wanna be clear, it's not just a weight-dependent disorder. Mm-hmm. If you've got anatomy that is not particularly good for your, for sleep apnea, it doesn't matter how much weight you lose, you still have big tonsils or big adenoids or a deviated septum or things like that. And as you and I have discussed before, I have sleep apnea.

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Yes. Um, you know, a lot of people don't know this. I've got, you know, I, I stop breathing in my sleep 26 times an hour. Mm. Right? That's quite a bit. And- Yeah ... I'm not a big guy. Right. You know? Like, I'm 165 pounds soaking wet. Mm-hmm. So it's like when you start to think about it, you can't get, only think- Mm-hmm

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that it's the weight loss or gain of it all. You need to understand there's anatomy involved. And when you're not breathing well at night, everything else goes wrong. Everything else. So this really becomes fundamental to knowing and understanding, hey, have I got it or not? If I do, let's treat it, and then let's continue on with our lives and figure out what else we can do.

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Because by the way, there's other, unfortunately, sleep-related symptoms when women are going through perimenopause and menopause that aren't so much fun, that have nothing to do with sleep apnea, right? Right. One of those is hot flashes. I was just gonna say that. You took the words right out of my mouth.

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Exactly. Any solutions there? I'm sure people would be eager to hear. So the answer is yes, there actually are some solutions there, um, and things that people need to think about. So we've already talked about get sleep tested, so we, we got that one out of the way. "All right, Michael, I got sleep tested, and, uh, I do have mild sleep apnea and I'm treating that.

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What, what should I do about my hot flashes?" So number one, hot flashes will naturally go down as your sleep apnea is reduced. Mm. So a lot of people don't know this, but when your heart rate speeds up every night after you wake up from stopping breathing, that's one of the things that increases your likelihood of having a hot flash.

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So treating your sleep apnea will actually help your hot flashes, number one. But number two, start thinking about your environment. Mm. Right? So what are you wearing to bed? Right? So a lot of people turn to me and they're like, "Oh, I love my flannel pajamas. They're so comfy and cozy, and I hop in and I get under the covers."

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Bad idea. Mm. Less clothing turns out to be better during menopause because there's less for your body to have to thermoregulate through, right? Now, here's the crazy part, is socks turn out to be good, but the rest of clothing turns out to be not so good. So yes, you heard it here on Sleep Is A Skill podcast.

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Go to bed naked, but wear socks, uh- ... because, I, yeah, a little on the kinky side, for sure. Um, it's, uh, it's interesting, but there's data to suggest that if you warm your feet, it actually opens up the capillaries and allows more heat to escape, believe it or not. Mm. So warming your feet actually allows your body to cool down, which seems kinda strange, right, when you think about it, but believe it or not, it's true.

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Think about it like this. If you walked outside in wintertime in shorts and a T-shirt, what would your body do? It wouldn't get colder. It would get warmer. Mm. Right? So think now the opposite holds true when your body, when you put a lot of stuff on your body, your body tries to cool down. Mm-hmm. The problem is when you have too much, you can't do anything about it, and then you create this little mini sauna- Yes

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underneath the covers, right? So a lot of people don't realize it, but this unit that we're walking around in called our bodies runs at around 98.6 degrees. As soon as you go under the covers and you have this little tent, all you're doing is making the air around you 98.6 degrees. Mm. So number one, change your sheets.

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Change your comforter. Like, have a winter, you know, fall, and then have a spring/summer. Change your sheets to, uh, you want more cotton sheets. Believe it or not, you want less of a thread count during the summer and spring because it means that there's more air that can move through the sheet. Because when you have too high a thread count, it's difficult for air to pass through.

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Um- Also, you may even wanna consider changing your pillow, right? Mm. Some p- remember, memory foam pillows contain heat, like, and your head gives off a tremendous amount of heat, especially during the summertime. So maybe it's worth changing your pillows, and, you know, your environment can change a little bit.

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Now, one thing people say to me is, "Well, Michael, what if I turn the air conditioning on and I make it like a meat locker- ... in my bedroom, right? And make it super-duper cold and all that stuff." That can be helpful, but it's not changing the microclimate underneath the covers. Yes. So there are a couple of devices out there.

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One is a company I work with called Orion Sleep. There's one called Eight Sleep. There's something called a ChiliPad. So these are mattress toppers. They're about somewhere between an inch and, and two inches thick. They have a little tube that runs through them with water that's either hot or cold that runs through it that can either heat or cool your body.

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And so I'm a huge fan of these- Yeah ... especially for my menopausal patients. Mm-hmm. Um, again, I work with a company called Orion. We'll put some, uh, links in the show notes for people to check it out. Um, but I think it does a really, really good job of helping people thermoregulate. Um, so being thoughtful throughout the whole menopausal period time makes intuitive sense.

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There's a third problem that occurs. So we, we've mentioned apnea. We've mentioned thermoregulation. There's a third problem that happens, which is waking up. Yes. Right? The most- So, and I mean- ... common call-out for so many people, yes. Yeah. Tell us about waking up. Is they wake up at 3:00 in the morning, and they don't know why.

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Yeah. Right? So historically, we used to know exactly why people woke up at 3:00 AM, but for menopausal women, there's a few added features. Mm-hmm. So historically, here's what we know, is your core body temperature rises, rises, rises till about 10:30 at night, and it hits a peak, then it begins to drop. Yeah.

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That drop, um, is very important because it helps release melatonin from your brain, but your core body temperature keeps dropping, dropping, dropping. At some point in time, if your body doesn't heat up, you go hypothermic, and you die, okay? Mm. Guess what time that is? Pretty much three hours in the morning Between 1:00 and 3:00 in the morning Mm-hmm.

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Exactly Yeah, yeah Right? So every human on Earth wakes up at around somewhere between 2:00 and 3:00 in the morning- Mm-hmm ... but most people don't remember it. Why? Because they roll, they burp, they fart, they roll over, and they go back to sleep. Exactly. Right? But there's a lot of people who are like, "Ah," like, you know, and somebody turned the, the energy switch on and they wake up.

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I have an entire protocol for that. I'm gonna leave a link in the show notes because I, I, I walk people through that, and I've got an entire thing that I want them to do. Mm-hmm. But for menopausal women, there are additional factors. It's not just the, "Oh, my body decided to heat up. I moved into a lighter stage of sleep and I woke up."

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Right. There's three different things that can go on here. So number one, cortisol. Mm-hmm. So one of the things that we know for women is when they wake up, their cortisol will spike. When your cortisol spikes, remember, guys, cortisol is your fight or flight hormone. This is the energy hormone. This is the opposite of melatonin, okay?

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Mm-hmm. Like, this is where your sympathetic nervous system is going cuckoo versus your parasympathetic nervous system, which is what we want to be going on during the evening times, right? So cortisol can get out of whack, so can blood sugar. Mm. So what happens for a lot of women is they don't eat anything, let's say, for long periods of time before bed, and then their blood sugar in the middle of the night, their body says, "We need sugar," so it increases cortisol, wakes you up, and guess what?

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You're hungry at 3:00 in the morning. Mm-hmm. I, I hear this from a lot of menopausal women. So one of the things I'd have some of my menopausal women do is have a small snack before bed. Now, you're not, you don't, you don't wanna have large caloric intake here, so we're talking 150 to 200 calories or less- Mm-hmm

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right? And it should be something that's fairly straightforward and easy to digest that also has a little bit of carbs to it. So I like, for example, half an apple with some nut butter- Mm-hmm ... right, or a rice cake with some avocado or something like that. So something that's nice and healthy, relatively easy to digest, but won't spike your blood sugar, um, and then you have a problem with it.

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So make, just make sure, I mean, again, don't eat a whole meal before bed. Like, you should have your big meal, like, four to five hours before bed. But for a lot of women who find themselves waking up in the middle of the night, you know, a couple of saltine crackers is not gonna kill you, um, to have before bed to be able to kind of keep that blood sugar going.

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From a cortisol management standpoint- That can be a little bit more difficult, um, for, for a lot of women out there. There believe it or are some cortisol manager supplements that are out there that do show some promise- Mm ... but if I'm honest with you, there's not a lot of great data- Mm ... on the cortisol of it all.

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So you wanna avoid things like getting more upset. So as an example, when you wake up, don't get pissed off. Mm. Because if you get pissed off, you raise your cortisol even further. Now, I'm gonna be honest with you, it's kinda hard to not get pissed off, right? Right. Because you're just like, "This is ridiculous."

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Uh-huh. Like, "This is happening again." Yeah. And so there's a level of frustration that- Yes ... occurs. The thing that I like people to do here is to do something called 4-7-8 breathing. Mm-hmm. This is my favorite technique. I do this for non-menopausal people as well as menopausal people, but it really has a tendency to work.

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Mm-hmm. And so this is a technique was developed by Dr. Andrew Weil, Harvard trained- Mm-hmm ... natural doctor, super smarty, um, who came up with this idea, and what we do is we slowly breathe in through the nose for a count of four, we hold for a count of seven, and we breathe out through the mouth for a count of eight.

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Now, I wanna be clear, this is very gentle. Mm. Right? This is not hard pushes in and out. You're not, you know, trying to blow something across the room. This is, again, very, very gentle. Now, if I'm honest with you, Molly, and you know me well enough to know, I have a little bit of anxiety. Mm. And when I try this technique, it drives me a little bit crazy unless I do these caveats.

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Ooh. So let me teach everybody the caveats. Do share with a fellow anxious one. Exactly. So number one, I, first of all, I had a hard time holding my breath for a count of seven and pushing for a count of eight. Mm. So you can do 4-5-6 breathing- Mm ... for two weeks, then move to 4-6-7 breathing, then move to 4-7-8 breathing.

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So don't stress yourself out, right? And by the way, it doesn't matter how long it takes you to get there. The goal is to breathe in for four, then the hold for at least one count longer than the, than the, um, than the breathe in, and then push for one count longer than the hold. Mm. That's the, that's the magic behind this whole thing here, right?

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Sure. So don't force yourself to do something that you're uncomfortable with, 'cause it level- levels up your anxiety. Number two, picture the number in your mind's eye, okay? Hmm. This turns out to be the most critical factor to this whole technique that I never realized until one of my patients told me that they did that and it made it work even better.

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Hmm. So when you're breathing in, you picture a four, then you picture a three, then you picture a two, then you picture a one in your head. When, uh, every single step of the way, picture the number. Hmm. And then what you're doing is you're distracting yourself by thinking of the number- Not my biggest problem.

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This is by the reason why box breathing doesn't work. Yeah. Because it's the same damn number. Exactly. Hold for four, breathe for four, hold for four, breathe for four. You, you, you get too used to it. And by using this 4-7-8 methodology- Mm ... it works really, really well. Last caveat, you need about 22 zero cycles to get to the point where your heart rate drops to the point where you can enter into a state of unconsciousness.

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Mm. But I lose count. Yes. Right? That's fantastic. And then I get freaked out, and then I get pissed off, and now I'm back to where I started. So- ... here's how I manage that, is I take my hands and I make gentle fists, and when I go through one set of 4-7-8, I stick out a finger. Oh. The second one, I stick out a finger.

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And by the time I get to 10, when I wrap my fingers back and I've hit 20 cycles, and then usually I've fallen asleep. Ugh, okay. I love this. And I love that you made it more visual, and it, this kind of- It's tactile ... gamification. Yeah. Yep. Yeah. So what I'm doing is I'm, I'm distracting all the different systems.

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So by you using your fingers, by you using your, your imagination and your mind's eye- Mm ... and breathing all at the same time- Yeah ... you can't think of anything else. What a magician. That's a great- Okay ... call out. No, because I hear that for so many people, they'll, they'll... "I've done the whole breathing thing.

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I can't even..." Not like this. And they get, like, just they get right back into their rumination within just a- Right ... couple cycles. So to keep that way of staying engaged, I love. Amazing. You get to 20, see the number, do what's comfortable. Mm-hmm. You'll be s- you'll be pleasantly surprised at how easy it is to do and how well it works.

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I do 4-7-8 right before I do stressful events. Mm-hmm. Like just four or five of them- Yeah ... just to kind of- Sure ... calm me out and calm me down. Yeah. And by the way, it's not just for middle of the night. If people have a hard time falling asleep, you can do 4-7-8 then as well. That's great. I appreciate that. Okay.

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And in alignment with this wake-up kinda period of the night, we- Yep ... very likely might run into things like dreams. So I've been loving some of your content around dreams, would love to hear some more. So I have spent the last two years becoming a dream therapist. Mm-hmm. I wanna be clear, that is not dream interpretation.

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Yes. Right? That is not looking at dream symbolism. That is actually using dreams in the therapeutic context. Mm-hmm. Right? So I have respect for anybody out there who's a dream researcher, right? But my goal is to see what, what can I do with dreams in clinical session- Mm-hmm ... in clinical work. In particular, I've been spending a lot of time with people with nightmares.

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So nightmares are scary, um, by definition. Sure. But there are also many therapists don't wanna deal with nightmares because they don't really know how to. And to be fair, most sleep specialists have had zero training- Mm-hmm ... in dream therapy. Sure. Most sleep doctors are doctors, right? They're not psychologists.

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They're not thinking about that stuff. They haven't been tr- they're thinking about the apneas, the narcolepsies- Right ... the restless legs of the world. As a clinical psychologist, I'm fortunate because I do get the opportunity to think about dreams more so than many other people do, and there's a lot of different things that we've learned here.

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So first of all, dreams are active. In fact, REM sleep is the most active stage of sleep. Believe it or not, people don't know this, you burn more calories in REM sleep than you do in any other, uh, stage of sleep. Hmm. Because your brain is eating up the glucose, right? I mean, think about it. You're having to produce these movies- Yeah

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inside your head, right? And it takes a lot of energy for your brain to do something like that. Hmm. So it's, it's actually an incredibly active time for your brain. Uh, it's not... People call it the deepest stage of sleep. In fact, it's actually not the deepest stage of sleep. Um, but a lot of interesting things go on, uh, during the dream state and during REM sleep in particular.

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One thing that's kind of bizarre is some people act out their dreams. Yeah. So there's a situation called REM behavior disorder. I've had several patients who have had it, and this is crazy. Hmm. This is really interesting. So this is... So during REM sleep, you have a, a special mechanism that provides a situation called atonia, meaning your muscles don't move.

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The reason your muscles don't move is so you don't act out your dreams and hurt yourself, right? Right. So some people, this mechanism is broken, uh, and they actually act out their dreams. So I don't know if you know this, but I'm from a small area outside Atlanta, Georgia called Sandy Springs, Georgia. Hmm.

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And, um, in Sandy Springs, it's a decent size hunting community, and if you're a hunter and you shoot a deer and you don't kill it, the most humane thing to do is either crack its neck or slit its throat. Hmm. Right? So I was treating a hunter who woke up with his wife's head, ready to crack her neck. Oh, you're kidding me.

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What? I am not kidding you. So what is the first question? Did he kill her? Good news, no lives- Ooh ... have been spared for me to tell this story. Oh, my God. Second question, are they still married? She is a patient, patient woman. Um, here's what I can tell you, is with one medication called Klonopin, uh, half a milligram, we were able to completely silence the behavior.

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Hmm. But here's where it gets really interesting and why I think dreams are something that we need to all take a look at- Hmm ... is, um, in 35% of cases of REM behavior disorder, it's a precursor for Parkinson's syndrome. Oh, very important call-out. Yeah. Yep. And in this particular case, it was. Okay. Um, and we saw Parkinsonian symptomatology 10 years before we would've seen, uh, anything that would be- we would normally associate with Parkinson's by seeing it- Ah

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in their sleep. So we actually changed the course of his disease simply by getting him to the neurologist faster. And so the moral of the story is- If something's going on with your sleep, it's probably a sign that something bigger is going on with your health. Mm. And so I want people to be thoughtful.

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If you have a repetitive dream, as an example, right? This is probably a sign or symptom that something else is going on, right? Like something mental health wise. Mm-hmm. Like some level of stress. For example, if you have a dream where your teeth are falling out. Mm. Very common theme. Yes. This is crazy, Molly.

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I gave a lecture in, uh, Johannesburg, South Africa, then I went to, uh, Edinburgh, Scotland, then I was in, uh, The Bahamas, and then I was in Cincinnati. I asked every single audience member, "Have anybody in here ever had the teeth falling out dream?" 30 to 40% in every single audience- Oh, yeah ... is raising their hand.

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I've had that. Yeah, so have I. Oh, yeah. So it's cross-cultural. Mm. Which is- Wow ... interesting. Yeah. Right? It, it works in any language. It works anywhere, and so the question is, why? Mm-hmm. So I looked it up, and it turns out that the teeth falling out dream oftentimes is talking about your oral health. Mm. You could have a cavity.

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You could have gingivitis. You could have, uh, loose, loose teeth. You could have jaw problems like TMJ. Mm. You could be a grinder. Sure. You could have sleep apnea. Yeah. Like, it's unbelievable all the different manifestations- Mm ... that our brain interprets- Yeah ... right? As teeth falling out. I believe that dreams are emotional metabolism.

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Mm-hmm. Here's what I mean by that. Yeah. Is when you dream, you're moving information from your short-term memory to your long-term memory. That's one of the functions of REM sleep. So what's turned out to be so fascinating here is during that movement process, that's where you're actually processing those emotions.

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Mm. Right? And so a nightmare by definition is you're processing, processing, you get so scared, you wake up. You stop processing. Then you go back to the beginning of the dream, go, go, go, then you get so scared, you wake up and you stop. This is where- Mm ... the repetitive nature of nightmares come from is 'cause you never finish processing the dream.

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So wise, yeah. Right. So what do we do? So, so what do we do? Yeah. Great question. We can actually work in session to help somebody. So I've been trained in a particular, um, type of dream therapy, um, by a gentleman by the name of Eugene Gendlin. Um, he believes in a, a somatic response, meaning that your body has feelings during the dream that can be helpful for you to interpret and understand.

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Um, Dr., uh, Leslie Isaacks was the person who I spent over two years with, uh, doing her dream course work, which by the way was fantastic. Wow. And so here's what you do. is you have the pace- person come into session with you, and they write down everything they can about this disturbing dream. And, uh, you get into session, and you ask them to read.

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So s- let me step back for a second. Sure. So first thing I do is I have, I put them into a mild hypnotic state, usually through some level of relaxation, um, or some kind of, uh, hypnosis therapy. Nothing crazy, and I'm, it's not like they're in some... It's just relaxing to get them calm enough, right? Then I have them go through this written material that they provided, and they go through it in exquisite detail- Mm-hmm

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as much as they can. And I ask questions in the middle like, "Oh, tell me more about this. Oh, tell me more about that," until we get to the precipice, which is the point in which usually they've woken up. Mm. Then I turn to them and I say, "Okay, let's drop into the dream together." Mm. Now, I wanna be clear.

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Nobody's dropping anywhere, okay? This isn't Inception. I'm not zooming into your brain. But in their mind, they are very relaxed. They're in a very safe space. They've been talking about this traumatic thing that they've been thinking about. I'm just asking them to basically push play on this option. Mm. So the reason this works is, Molly, you've had this experience before.

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Have you ever daydreamed? Many a time. Right. So we use daydreaming and imagination to forward the dream. But let me give you a, an example so everybody can kind of see what happens. So I was working with this one patient, um, and her nightmare was she was running through a jungle, and she was being chased by some terrible creature.

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So we get to the point where she's being chased, and she usually wakes up, and I say, "Okay, let's drop into the dream together." So we drop into the dream together, and I say, "Well, step number one is I want you to scan your body." Meanwhile, she is here. I am here. I'm not doing... She just goes from the top of her head, and I say, "Find the warmest place on your body."

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L- usually it's center of chest. Sometimes it's abdomen. Sometimes it's the back of the neck. And I say to them, "That is your home base." Mm. "That is your safety spot. You know when you put your hand on there, you are safe." Mm. Soon as they know that they're safe, we have a... Because if the dream gets too scary, I want them to be able to come back to that safe spot.

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Okay, they've got their safe spot, and I say, "Let's figure out what else is going on in the dream. So I'm gonna ask you some questions." So we've dropped in, and she's found her safe spot. Now what I said to her is I start asking questions. So I ask the question, "Are there flowers in the jungle?" So you can see her.

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Her eyes are closed. She's looking around like this. "Yeah, there are flowers in the jungle." "Oh, can you tell me more about them?" So we're actually moving the dream forward. Because she never talked about flowers before- Yeah ... but now I've asked her if they're there, so her imagination, her daydream is moving the dream forward.

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Mm. So then I said to her, "You know, when we're in a jungle, there's usually animals. Are there any animals here?" And she says, "Actually, there are." And I said, "Is it the one that's chasing us?" She said, "No." I- She said, "I can see an animal over there." And I say, "Oh, tell me about that animal." She stops for a second and she says, "It's a lion."

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Again, we're progress- making progress inside the dream. So I said, "Can we go over it? Is the lion friendly?" "Yes, the lion is friendly." I'm like, "Oh, can we walk over and talk to the lion?" "Mm, yeah, actually we can." So in her head, we walk over and we're talking to the lion. So I turned to her and I said, um, "Does the lion have a name?"

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She stops me and said, "Yeah, the name, his name is Jack." And I turned to her and I said, "Does that name mean anything to you?" And then all of a sudden, boom, "Jack was my step-uncle, and he saved me from my stepfather raping me." Oh, come on. What? Now we're getting somewhere. Yeah, 100%. Right? So now I turn to her and I say, "Hold onto your warm spot.

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Find your safe place." Mm-hmm. Right? And then over the course of time, we can, with the lion, now turn and face the problem. Wow. I mean- Isn't that fascinating? That is fascinating. And you know, personally, that I'm often t- talking about some of my excitement around psychedelics for trauma in a safe- Mm-hmm ... and responsible way for only- Yeah, absolutely

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certain individuals. And so it just reminds me of some of the kind of directives in psychedelic- Yes ... journeys is really much to turn, when possible, to the scary thing and face that scary thing- Exactly ... and be able to work through that. So I love that you're doing that on the ground. And then do people then take these kind of breakthroughs, and then is there any kind of structure for them in the nights following to kinda go through- Yeah

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with how to think about those dreams? So there's an additional component that people can use called image rehearsal therapy. Hmm. So this was developed by Dr. Barry Krakow out of the University of New Mexico, and this is something that people can do on their own. They don't actually even have to go to a dream therapist to do it.

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So you take the, you write the dream down, and then you rescript the ending. So instead of being the victim where somebody just stabbed you, you're the victor and you get away. Mm. Or whatever positive ending that you can put on that dream, then you re-read the dream with the new ending a few times before bed, multiple nights in a row, and over the course of time, you actually change the content of the dream.

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Mm. It's remarkable. Wow. And so important, I mean, for so many people, but also, you know, people dealing with PTSD, veterans, et cetera, so love- So let's talk about that. Mm-hmm. So veterans are a particular interesting case study. Um, tragically, every single day, 18 veterans commit suicide. Mm, I didn't realize that.

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And, which is just awful. Mm-hmm. And, you know, when you look at them, almost all of them have post-traumatic stress disorder, and one of the top symptoms of PTSD are nightmares. Mm-hmm. Um, and let's be fair, they don't wanna go to sleep. Right? Like the movies that are in their head are scary there. Like, I get it, right?

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Mm-hmm. Like they're avoiding this. And so what's really fascinating is when you look at nightmare frequency and intensity, as it goes up, so does suicidality. Mm. Wow. By literally 105%, according to one study So when we're talking about veterans in particular, this dream therapy can be very effective- Mm ... for veterans.

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Um, and there's a lot of different options out there for people to look at, everything from EMDR, which is eye movement desensitization and reprocessing. I think you've had somebody on to talk- Yes ... about that before. Totally, yeah. And that can be very helpful in nightmare treatment therapy, as can cognitive behavioral therapy, as can this IRT, or image rehearsal therapy.

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So here's the good news for people. If you are suffering from nightmares, there's help. Um, and there's, and there's several different therapies out there- Mm ... and if you can find a good dream therapist, they can help- Yeah ... you decide which one works the best for you and your particular scenario. Um, so it's pretty cool.

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Like it used to be people would just say like, "Okay, we're just gonna give you drugs- Right ... and those drugs will just knock out REM sleep- Mm-hmm ... and then you won't have nightmares anymore." Like literally that was- Yes ... our therapy for a long, long time. Yeah. Good news. We're no longer doing that kind of work.

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Mm. Uh, I mean, don't get me wrong, there's still some people that may benefit from that. But generally speaking, I feel like there are much safer and more thoughtful interventions that we can do for people with nightmares, uh, in particular. One thing I do wanna double tap on, actually two things- Yeah, please

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is, um, there's a big difference between night terrors and nightmares. Mm. A lot of people don't know the difference. So a night terror is where an individual sits up, they scream- Mm ... bloody murder, and then they fall back asleep, and the next day they have almost no recollection of what happened. That is a night terror.

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Mm. And that usually happens, by the way, in the beginning of the night, the first two to three hours. A nightmare is very different. A nightmare, they sit up, they may yell or scream, but they know exactly what's going on. The next morning they know everything that happened, and it usually has a tendency to occur in the back half of the night.

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So nightmares are later with more fear involved. Night terrors are earlier, and there's very little- Mm ... fear involved and almost no recollection of the differences there. Mm. Um, a- but also there are positive dreams. Yeah. Like let's not just talk about the negative. Yeah, true. Like there are positive dreams that can be really interesting, um, and super fun and cool.

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One of the situations is one I think I know you have, uh, enjoyed and experienced, which is lucid dreaming. Yes. Right? Totally, yeah. Very. So lucid dreaming is super interesting and cool for people out there. And if you don't know what lucid dreaming is, lucid dreaming is where you actually become conscious inside the sleep state.

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So it's like you wake up inside your dream and you're like, "Oh, shit, I'm dreaming. This is pretty fun." Yeah. And you can do anything you want. Mm. Now, I will be honest with you, there's two known lucid dreams that most people do, which is they like to fly like Superman or Superwoman- Uh, and they like to sleep with a supermodel.

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Um, I know, I know. Little on the risque side here. Yeah. But what that is- Spill on the tea ... those are the- Yeah ... those are the, spill on the tea. Those are the two most popular lucid dreams. But to be clear, lucid dreaming is a skill set. Um, I can teach people how to lucid dream. Mm. There are weekend retreats that you can go to.

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There are devices that you can actually utilize. Um, actually, as a matter of fact, one of them I've got right here. Mm. I think I've showed you this group. They're called Next Sense. Yeah. These are earbuds that you wear during sleep. So what's interesting about these is these were developed to be worn while sleeping, so e- even if you're a side sleeper, they won't, you know, mess up your sleep.

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Mm. But what's cool about them is these in particular measure full-scale EEG while you sleep. So these are the only earbuds on the marketplace that can measure EEG, and they know when you're in a dream state, and then if you move out of that state, they can send a signal in to actually push you back down into it.

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Do you use those often or have a lot of clients using? I- You bring- I love them ... okay. I love them. And you've seen and felt the, the difference. Oh- Yeah ... absolutely. Very cool. Absolutely. It's kind of remarkable if you're, if you're, if I'm honest with you. Yeah. So this is a project, uh, so these, this company, I worked with them almost 15 years ago with- on the original technology when we worked at Google.

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Mm. So we were working on a, on a project at Google, um, where we were trying to have a communication tool with the dreamer. Uh, and we were actually somewhat successful in doing it, and that's where some of the tech for this actually came from. Wow. So- Fascinating ... there are very positive ways to dream out there.

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Mm. Lucid dreaming is, is a fun one. Um, but one of the ones I like to talk about are called precognitive dreams. Mm. This is where people can actually predict the future in their dream. Come on. No. Share more. I'm for real. This actually happens. Mm. Um, so it's interesting when you think about it, um, but, um, it actually has a lot to do with, uh, like deja vu.

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Like, you know what deja vu is, where you all of a sudden walk into a room and you feel like you've been there before- Yeah ... or you're having a conversation that you could swear you had these exact words at some other time. What, what's going on there most of the time is your brain has put together so many different ideas so quickly that things look familiar because you've al- you've already gotten there in your assumptions in your brain.

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Same, same can actually happen in your dream state, um, is where... Remember, you're moving information from your short-term memory to your long-term memory, so all of a sudden, all this information comes together and you're like, "Holy cow, I figured something out before." Now, I gotta be honest with you, you're probably not gonna predict the stock market.

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Right. Okay? You're, you're, you're probably not gonna... But in your life- Mm-hmm ... there are certain things that you will have an exceptional knowledge with, and then when you start bringing in these new pieces of information, you will actually be pretty good at predicting things that will happen to you. I'm not saying you're gonna get the lottery correct.

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Sure. Okay? Right. I, I, I wish, I wish that were the case- ... because then we'd all, we'd all win these massive lotteries and make lots of dough- Yeah ... and, and not have to worry about things. But you can actually be predictive of some things that go on in your life. And then the last positive dream that I always like to talk about, which is my personal favorite, um, is where you get to visit with people from the past.

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Hmm. Um, so I visit with my grandma sometimes- Aw ... in my dream. Heartwarming. I love that. She was a super great lady, and I still can get advice from her on occasion, and, um, talk with her and see her. And, and it's very real. Hmm. Um, and it's... I, I love it. Um, I value it, uh, oftentimes. So there are a lot of positives to dreams.

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There are some negatives to dreams. But all dreams don't mean something, but- I would take your dreams seriously. And when you have a dream, I would think about it and think, what could that mean to me, and what- how could I maybe change something for the, for the good in my life because of my dream? Hmm. And I think you'll probably find a significant amount of value there.

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I appreciate that. And if nothing else, I mean, I feel like that's a worthwhile exercise to kind of be reflective, right? Bare minimum. Absolutely. And then from a perspective of... I mean, the fact that we're largely all doing this every single night. There's gotta be- Every night ... something going on. Right. And just to your point around all the different ways that we can maybe be a little bit more thoughtful or more powerful, empowered as it relates to these dreams.

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Yeah. So I love it. Love it. Well, okay, so you brought so many amazing topics and things that can really be so transformative for people. Uh, was there anything that we left out of this conversation before we hear about how you're managing your own sleep nowadays? No, I think we, we- Yeah ... you know, we did a good job of covering things.

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I, I wanted to talk about women and sleep. Yes. I wanted to talk about dreams. I wanted to talk about sleep testing. All of these things are primary for me these days. We talked a little bit about GLT-1s. Hmm. We talked about CPAP. I feel like we, we- Yeah ... covered a, a lot of, a lot of ground there. Um, and, uh, no, I'm, I'm ready to talk about my sleep.

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Okay. Yes, 'cause it has been a while since we had you on before, and so got to hear a little bit back in the day. But I know, one, I mean, even just in that story of jumping to multiple continents and all these things, I mean, you got travel knowledge. You got all kinds- Yes ... of different environments that you find yourself in.

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Yeah. So really curious. And if anything's changed or shifted or evolved, anything to share. So our first question is: What does your nightly sleep routine look like right now? So I'll tell you what usually happens. So I sit with one of my dogs on the couch almost every night, and I check sports scores on ESPN, or I watch the last little bit of whatever it is that I'm interested in watching.

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Yeah. Um, then, um, I, uh, brush my teeth, wash my face, uh, get into my bed clothes. And then, uh, when I get into the bedroom, my wife is in there. She's got the big screen TV on- ... full blast. I love that you share about this. It's the best. Yeah. Both of my French Bulldogs are in the bed with us. Um, and, um, I've got at least four pillows, uh- Yeah

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that I maneuver- Uh-huh ... in a very particular way- Totally. Yeah ... in order for me to get comfortable. Uh, then I put on my eye mask. I put on my CPAP machine. And, um, I usually fall asleep pretty quickly. Um- Now most people would say, "Wait a second. You're the sleep doctor, and you said that the television is on and the dogs are in the bed.

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What is going on here?" So when I met my wife 26 years ago, actually 27 years ago- Mm-hmm ... 'cause we dated for a year before we were married, um, she said to me, "Michael, if we ever have a sleepover, I need you to know that I sleep with the television on." And I sleep with animals in the bed. At the time, she had two cats.

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And I said, "Oh, Lauren, don't worry about that. I'm gonna become a sleep doctor. I'm gonna fix that." Love it. I don't know about you, Molly, but- Me neither ... when you try to fix something- Oh, gosh ... in your sleep partner, it never goes quite according to plan. Oh, yeah. That's a toxic trait, yeah, for myself- It is ... as well.

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Yep. Yeah, so I took the television out of her bedroom, and she turned to me and she said, "If you ever wanna get back in this bed again, I suggest you put the television right back where it was," which I did. Um, and then I decided to study her- Hmm ... because I wanted to figure it out. Like, what is- what's the dealies?

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'Cause I never slept with a m- like, my s- both of my step-sisters slept with radios on. It was never a big thing for me. I knew a lot of people that slept with music on, things like that. I always slept in the quiet. It never really bothered me. Hmm. So I studied her, and what I discovered was she wasn't even watching it.

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Mm. She was listening to it out of what I call the corner of her ear. Yeah. So it was just enough of a distraction for her to avoid monkey mind- Mm-hmm ... and that was part of the way she did that. Now, I've tried getting her to do the breathing techniques that we were talking about. Yes. She's not much of a breathwork kinda girl.

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Yeah. Um, so she likes the television before bed. The pets in the bed is also an interesting thing to talk about, right? Mm-hmm. And so our bulldogs... Oh, by the way, the reason I adapted so quickly to the CPAP machine had to do with one of the bulldogs. Did I tell you this story? No, I didn't know that part, no.

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Okay. So we got a bulldog puppy about a year ago, uh, and that was about when I was diagnosed with apnea, and what he likes to do is he likes to wiggle his way, and he likes to fall asleep in between my pillow and my wife's pillow. Mm. However, he does like to put his head on my wife's pillow. What? Which means I get the ass end of the dog all night long.

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Oh, lord. And it's a bulldog. And bulldogs are a little on the gassy side- ... just to be clear. So when it was offered that I could put a mask on my face and I could get clean, filtered, cool, non-dog-fart air going into my system- ... I jumped at the chance, and it was very easy for me to adapt. Unusually excited about this proposition.

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Definitely. Exactly. Wow. But I think the big thing that people need to understand is sleep is flexible. Mm-hmm. Right? You don't need the same amount every night. You don't- Yeah ... uh, you know, quality is going to change based on a lot of different factors. Environment is going to change based on a lot of factors.

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And so when I get in bed at night, I'm... I have the mindset of being adaptive. Mm-hmm. And I also have the mindset of not letting something piss me off. Mm. Let me give you an example- Yeah ... of something that I learned from my wife, which actually worked out really, really well. So, um, we used to have an older French bulldog who snored like a freight train.

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And my wife sometimes goes back east to visit her family, and I stay with the dogs. And she turned to me, his name was Hugo, and she said, "Make sure that Hugo's snoring at night." And I'm like, "What are you talking about?" She said, "If he ain't snoring, it could be bad." Mm. So it changed the emotional valence of the snore.

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Yeah. When he was snoring before, I was thinking, "This dog is annoying as shit." But now my wife's not there, I'm responsible for this older dog. Sure. If he stops snoring, something bad could go on. So in this case, snoring was a good thing. Mm. Wow. L- literally by changing the emotional valence of the, of the event- Sure

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guess what? Now it doesn't bother me when the dogs snore. Mm. I think, "Oh, they're, they're doing okay." They're alive. Yeah. Right. It's... So the point here is, is if you, if you assign an annoyance- Yeah ... to something, it's gonna be annoying. Mm. So true. Right? Like, very basic stuff. But if you turn to yourself and you reframe- Mm-hmm

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and you say, "Hey, I can hear my dog snore, which means my dog is breathing, which means my dog is safe"- All of a sudden, the anxiety comes down, you're not being annoyed- Mm ... and then that's when sleep process comes in and takes over. I appreciate you sharing all this, 'cause I feel like there's so many people that are grateful to hear that it doesn't have to be this sterile, ridiculous- No

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sleep environment. And yeah. Come on. None of that. That's not- Right ... that's- what- where's the fun in that? Also, at the end of the day, your body adapts. Mm-hmm. Yeah. Like, think about when you were younger, right? Like, if, if any of our listeners have teenagers, they can sleep through anything, right? So true. I mean, they can literally be in a car, you know, laying like...

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I mean, it's unbelievable. Yes. Right? So our bodies are very adaptable. Don't talk yourself into an insomnia situation when in fact it's not necessary. Yes. Oh my gosh. And then for the second question is, what might your morning sleep routine, with the idea that how we start our day can impact our sleep, what might that look like?

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Okay. So I'm very regimented- Okay ... in my mornings. I'm just gonna warn everybody. I love it. And not everybody has the time that I have in my mornings. Look, I'm 58 years old, I'm kind of towards the end of my career, so I have a lot more time to do things than many people do. Yeah. But just follow my componentry.

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So I- if I'm wearing my eye mask, I'll sleep a little bit later 'cause it's darker. But if my eye mask comes off, I usually wake up somewhere between 6:00 and 6:15. Yes. If I keep the eye mask on, probably 6:30, 6:45- Mm-hmm ... something like that. Sure. I grab the puppy and I bring him outside, 'cause he usually ends up having to use the restroom.

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Then, um, the other older dog usually follows, and then we walk into my office and I meditate. Hmm. So I meditate almost every morning. Um- It's gonna sound a little weird that I meditate with my dogs. Ah, I love that. So one of the dogs, the puppy usually crawls into my lap, and he kind of nuzzles in and falls asleep.

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And so if I bring my breathing to his breathing, we have this really nice rhythm. The other dog is sitting there, and w- I- we're just kind of all breathing and meditating together. We... I do that for maybe anywhere from five to 25 minutes, depending upon what's going on in my day. Mm. Then I go, I feed them, take them for a walk.

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Um, I try to walk my dogs without, uh, earphones in just to listen to nature. I don't need to get a podcast in my head. I don't need to look at email. I don't need to see texts. I need to enjoy the natural of it all. Mm. Plus, having a walk in the morning, usually within 20 minutes of me getting up- Mm-hmm ... is great to get sunshine into my eyeballs.

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Yes. Helps reset my circadian rhythmicity. So I do that, come back, put the dogs away, and then I head to the gym. Um, I'm... I usually leave the house by 7:30, 7:45 most mornings. I'm at the gym by 8:00. I have a very specific routine that I do. 25 minutes of cardio to start, about 45 minutes of resistance training.

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Mm. Then I do sauna for between 10 and 15 minutes every day. Um, then I come home, and I have a full meal, um, usually a very high protein. So I usually eat three eggs, a third of a pound of turkey, and, uh, sauteed broccoli- Mm ... every morning with some jalapenos on top. Mm. Love that. And, uh, that's kind of my breakfast, and I'm in front of my desk by 10:00 AM, and that's when I start my day.

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Awesome. So those, very helpful to walk through. And in alignment with how you shared just the real deal about your bedroom or nighttime routine, which I love, one thing that I've shared, I just wanna double check that I'm sharing it correctly, but I've shared this with other clients, like when there's been this obsession with the eight hours, you know, the nine hours, the whole thing.

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Yeah, let's talk about it. Yeah. Your, your call, like, I'd love to... 'Cause I, I'll share you as an example. So look, at the end of the day, so many of my patients will say, "I gotta get eight hours. I gotta get eight hours." Absolutely incorrect. Most people don't actually need eight hours. It's a range. Seven to nine hours is where we see people.

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And if I'm being honest with you, most of my patients get six and a half, and they're fine, okay? But what you don't wanna do is say to yourself, "I'm up till 2:00 in the morning, therefore I must sleep until 10:00." This is a terrible idea. You want a consistent wake-up time seven days a week. Okay? Now, Molly, you and I have been on point with this for many, many years.

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We've been trying to get most people to do this forever because we are circadian aligned, meaning we know what a circadian rhythm is, and we wanna make sure people follow said circadian rhythm. So one of the things I talk to people about all the time is you... it's not about amount, it's about when, right, you get it and, and having consistency.

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I can't beat this horse dead enough. Consistency is the key for sleep. There's three things that make you fall asleep, right? Lower temperature, lower heart rate, and lower anxiety. It- it's all about that and keeping it consistent. If you do those three things and you do them consistently, you won't have any problem sleeping.

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So good. Thank you for double-tapping on all these really important things. You're hitting on some of the most common issues that we hear are these wake-ups, then how to fall asleep, and the consistency over necessarily be obsessed with duration and all this. So- Yeah ... really good. The third question would be what might we visually see in your environment, like on your nightstand, in your sleep space?

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So in my sleep space, what you will see is you will see my CPAP machine. Yes. You will see a bottle of distilled water because I'm putting it into the humidifier. You will see a bottle of regular water in case I get thirsty, because I definitely can get thirsty in the evening. Yeah. You'll see my sleep mask- Mm

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um, which is there. And then I have, uh, I have one thing that is ki- a little bit on the unique. Actually two things. Mm-hmm. I have usually these earbuds- Yes ... that I wear. But I have a sleeve for my phone. Mm. So I got this thing when I was at a conference. It's from a company called Lofty. Mm-hmm. Um, and it's really cool because you slide your phone in, and you can still plug your phone in, but it's covered, and it's electronically shielded.

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Yes. Good old Faraday cage. Okay. Right. It's like a little mini Faraday cage for my phone. Mm. But the reason I like it so much is when I wake up in the middle of the night, I can't read it. Ah. Because the, so the, the, the phone, the clock is blocked. That turns out to be very good and important for me. Yes. So I like to have a shielded, non-visible phone that's over there on the side.

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Yeah. If I don't have that sleeve, then I usually plug it in across the room. Sure. But as an example, I usually bring that with me when I travel. Ooh. So I actually throw it into my CPAP case. And that way I can pull it all out and kind of have it all there. But that's usually, I have it pretty clear- Yep ... um, other than the CPAP machine, the water, and then something for my phone.

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Seems to be such a theme that the less people are reliant on all the things- Yeah ... that often their, you know, their sleep's just kind of working, so that's great. Yeah. And then the last question, so far to date, what would you say has made the biggest change to how you're thinking about your sleep, relating to your sleep?

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Or said another way- Hmm ... maybe biggest aha moment in the way you're relating to your sleep? For me personally, I would say it was the diagnosis of sleep apnea. Yes. Yep. Right? And I'll tell you the story because it wasn't what you might think. So I would, my workouts weren't as good- Mm ... all of a sudden, like over time.

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Mm-hmm. And, like, I wasn't pushing weight. I was having a hard time running. Like, it just felt like things were harder to do. Yeah. I was feeling more fatigue during the day. I'm 58 years old. So I called my doctor, the woman who takes care of me. Her name is Carrie. And I said, "Carrie, I, I'm just not feeling it."

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She said, "Let's do some blood work." She's like, "Who knows? Like, let's figure out what's going on." So we do the blood work, and we're thinking that I'm gonna have anemia- Yeah ... or something like that. And it turned out that my testosterone was around 400. Mm-hmm. Now, low T is 300 or less, so I wasn't quite in the low testosterone kind of scenario Sure, sure But I said to her, "What do you think?"

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And she said, "Look, let's put you on a little bit of testosterone. Let's see that hopefully that will turn the tide." Mm-hmm. So I'm not a needles guy, so I said, "I'll, I'll take the oral tablets." Yes. So I started with the oral, which take twice as long to take in effect. Sure. So six months in, I'm not noticing a thing.

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Mm. It's not working. I call her up, I'm like, "Carrie, come on." She's like, "Why don't you stop being such a wimp and let's do the needles. Um, and it doesn't even hurt, and you won't even realize that you're doing it, so why don't you shut up and just do it, Michael?" And so I said, "Okay." So I did. You did. So I started with the needles, which by the way, she was right.

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It didn't hurt. It didn't have any problems. It was super easy. Um, after three months, again, nothing. In fact, I lost more hair. What? Yes. This is not the side effect I was looking for. Yes. Like, I have a little bit of hair as it is now. I don't need any less. Ah. So I turned to her and I'm like, "Carrie, what's going on?"

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She said, "Hey, Mr. Sleep Doctor, have you done a sleep test lately?" Mm. And I was like, "Oh, shit. No, I haven't." Like, back in the day- Yeah ... when I was seeing patients every single day- Sure ... I worked in a sleep lab, so every time we got new equipment, I would test it out. Mm-hmm. I don't have that here, so I hadn't really done a sleep test in probably five or six years.

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Sure. So I called up my company and I said, "Hey, we do sleep tests. Can you send me a sleep test?" So they sent me a sleep test. I wore it overnight, and all of a sudden I got these results that said I stop breathing in my sleep 26 times an hour. So you know what I did? I said, "The test must be incorrect." Fuck that.

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I mean, how can... I'm the freaking sleep doctor, right? Yes. Yeah. So I called and said, "Send me another test." So they send me a second test. Sure enough, dead on, exact same numbers. Yeah. So I'm like, "Oh, shit, looks like I've got sleep apnea." So I put myself on CPAP. Oh my God. I, again, love hearing these stories, 'cause instead of this l- you know, kind of pedestalizing of for when we're all in sleep, then we have this perfect sleep thing- No

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it's just not it. It's not it. So thank you for walking through that. And to your point, that's the other thing too, 'cause I've seen other people... Often when I speak to- with people, it's very rare when the people I'm chatting with that they've had sleep tests. Right. But if they have, they're like, "Oh, that's not a factor.

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I've- I've been tested. I don't h- deal with any of that stuff." You're- That's a perfect example of how you can have- Yeah ... many of these things can evolve and shift over time, just like we were just speaking- Yes ... about women, so very important. Oh, and you know, you bring up, I- I love the point that you're bringing up here, which is one I don't usually say- Mm-hmm

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but I- I think it's worth mentioning, is just 'cause you got sleep tested 15 years ago- Yeah ... doesn't mean you don't have sleep apnea now. Totally. Totally. Ugh, so good. And yes, that is such a game-changing, a kind of way of relating to your sleep, so I love that answer. And then lastly, because it's just so clear and evident the amount of information that you have to deliver to people on sleep.

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I know we only just scratched the surface every time I chat with you, but how can people be a part of your world, work with you- Yeah ... follow you, get your newsletter, all, whatever, all the things? So, uh, the easiest way is to swing over to the website, uh, sleepdoctor.com. Feel free to sign up for the website.

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I do have a quiz. Yes. Uh, the thing I'm most known for is this idea behind chronotypes. We didn't get a chance to talk about much- No ... of it today. Yeah. But there's a- there was lots of other things to talk about. But if you take my quiz at chronoquiz- .com, and we'll put that in the show notes- Yes ... um, for people to be able to do that.

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You'll get on my newsletter right away. Um, my YouTube channel, also called Sleep Doctor, um, I've literally got over 1,000 videos. Mm. Um, so you can learn from me there. And then every social media I'm also Sleep Doctor. So TikTok, Instagram, Facebook, all of the above. And we give different information on different social sites, uh, because the demographic is different, right?

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Sure. So Instagram has a younger demographic, so those are sleep tips for more people who are that age. Facebook is a little bit more my age- Mm-hmm ... so we have different tips there. Sure. So, you know, check it out. Um, I highly recommend the follow. Um, usually we're putting out super high quality, evidence-based information.

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Mm-hmm. It's not as Michael dreamed it up and decided- Yes ... to talk about it. It's real science- Yes ... uh, there and, and that's definitely one of the things that I- ways that people can get more information from me. But I also wanna tell people that they should consider signing up for your sleep audit. Oh, come on.

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Um- No, seriously, because I think it's really a worthwhile thing for you- for people out there to know and understand. So you may not know it, but Molly does this really cool thing where she will look at your Oura Ring data, look at your Whoop Strap data, and be able to give you an entire understanding and help you protocolize how to get better rest.

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Mm-hmm. And that's one of the same things that I do. So I highly, highly, highly recommend that you, uh, jump on there and get onto, uh, Molly's sleep group because she does a great job. Oh, come on. This guy, he's gonna make my head so big. So appreciate it, Michael. It's always a pleasure chatting with you. Yeah.

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You always bring just new insights and ways of framing things, but also just so practical at the same time. So it just is this beautiful hybrid. Really appreciate the work you do and taking the time to share it with our audience, so really means a lot. Absolutely. Thank you, Molly- Thank you ... for being a good mentee- Oh

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and for all the work that you do. You're doing some good stuff. It's important. Ah, game on, game on. Michael and Molly time, always a blast. Right. Appreciate it You've been listening to the Sleep Is a Skill podcast, the top podcast for people who want to take their sleep skills to the next level. Every Monday, I send out the Sleep Obsessions newsletter, which aims to be one of the most obsessive newsletters on the planet.

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Fun fact, I've never missed a Monday for over five years and counting, and it contains everything that you need to know in the fascinating world of sleep. Head on over to sleepisaskill.com/newsletter to sign up

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