Episode 028 – Dr. Michael Grandner: The Sleep Doctor
“A lot of sleep issues emerge because of a dissonance between our society and our biology.” – Dr. Michael Grandner
“Sleep, nutrition, and exercise are three legs on the same stool. If you’re not sleeping well, it’s like trying to sit on a two-legged stool.”
Dr. Michael Grandner is the Director of the Sleep and Health Research Program and an Associate Professor in the Department of Psychiatry at the University of Arizona College of Medicine.
He’s published hundreds of articles relating to sleep and health and you’ve seen him on every major news platform such as ABC, CNN, FOX, and the BBC.
His research focuses on how sleep and sleep-related behaviors are related to cardiovascular disease, diabetes, obesity, neurocognitive functioning, mental health, and longevity.
In this episode, Dr. Grandner breaks down the causes of sleep disturbances and sleep apnea and discusses effective alternatives to the overly-prescribed CPAP machines.
How effective is CBD in treating sleep disorders? Well, we get into all of it.
If you like what you’re hearing, subscribe and share this show with your friends because it doesn’t go anywhere without you.
Until next time, be nice and do good stuff.
- Website: michaelgrandner.com
About Dr. Michael Grandner
Dr. Grandner is a highly-regarded sleep and health researcher, Director of the Sleep and Health Research Program at the University of Arizona, and Director of the Behavioral Sleep Medicine Clinic at the Banner-University Medical Center.
His research explores the connection between sleep and various health outcomes such as cardiovascular disease, diabetes, obesity, and mental health. He has published over 175 articles and chapters and has received numerous awards for his work, including from the Sleep Research Society and the American Heart Association.
Dr. Grandner is a sought-after speaker and consultant and is an active member of several professional organizations, including the American Heart Association and the American Academy of Sleep Medicine.
[00:00:00] Chris DiCroce: Welcome to The Mind Unset. If you love long walks on short piers, you have found your people. Let’s get into it.
[00:00:12] Hey everyone, welcome to the show. I’m gonna get right to it. Today’s topic is close to my heart as a lifelong sufferer of poor sleep. I’m really excited to speak with this week’s guest, Dr. Michael Grander. Is the director of the Sleep and Health Research Program and an associate professor in the Department of Psychiatry at the University of Arizona College of Medicine.
[00:00:32] He’s published hundreds of articles relating to sleep and health, and you’ve seen him on every major news platform such as abc, cnn, Fox, bbc. His research focuses on how sleep and sleep related behaviors are related to cardiovascular disease, diabetes, obesity, neurocognitive functioning, mental health, and our longevity.
[00:00:53] I have a ton of questions and from the emails I received requesting an episode on sleep. I guess many of you have questions as well. I hope we’ll get to answer some of those today, and I will have links to all of the resources Dr. Graner mentions in our show notes email@example.com. Okay, enough of my yaking.
[00:01:10] Please enjoy my conversation with Dr. Michael Graner. Thank you so much for being here and um, I can’t tell you from the amount. Feedback I had from listeners and my email list, um, about when I told them that you were, um, just gonna have a sleep expert on Awesome. Um, they, um, uh, I’m amazed at how many of my friends, uh, aren’t sleeping well.
[00:01:37] Dr. Michael Grandner: Um, yeah, I, I, I, I’m not, um, because we live in a society where it’s actually quite common, I. You know, this is sort of the one thing about being a sleep person where you walk into a room and someone asks what you do. You have to sort of be a little careful because it depends on, on if you gotta go anywhere, because, uh, if, if you say something every, everyone’s got a story.
[00:02:00] Everyone’s got something. and we could talk later why? But, but yeah, it’s a thing. No,
[00:02:06] Chris DiCroce: it’s like when you go to the doctor and someone says, Hey, I’m a doc. And you go, oh man, my back hurts. It’s like, yeah, you’re stuck, man. , you, you can’t go to Home Depot and when your check out in the checkout lane and talk to the girl and say you’re a sleep expert, cuz you’re gonna hear about it.
[00:02:18] So, um, do you ha do you have any numbers? Like, say, is it just too, too, um, broad to make an assessment, but is there like 50% of 75% of Americans or people in the
[00:02:30] Dr. Michael Grandner: world. So, that’s a good question. Um, the, the problem is that there’s no one data set that asks all the different questions. So you’re, you’re, you’re, you’re cobbling things together.
[00:02:41] But, um, most recent estimates suggest that about a third of the US population is below sort of the recommendations for, for the amount of sleep that they’re getting. That’s separate from. Or overlaps with, but it’s a separate issue from about a third of people are, are saying that they have, um, some sort of insomnia problem with about one in 10 people probably needing criteria for an insomnia diagnosis that probably requires treatment.
[00:03:14] Um, and then separate from that, the, the other most common. Sleep problem is sleep apnea, which is just growing in the US as, as it’s tied with body size. And so, you know, so the, the, the most recent estimates I saw projected something like one out of five or six men over 30 has at least some sleep-related breathing issue.
[00:03:37] And you know, at least one out of every 15 or 20 women over 30 might. You know, some sleep related breathing issue, which only becomes more common as you get older and, and also as you gain weight. So, yeah, I mean, I think it’s safe to say that in our society, um, it’s about half the people you’ll run into maybe even more, have at least some sleep related or circadian problem that they’re dealing.
[00:04:06] and, and, and I say in this society because I don’t, I don’t think it’s inevitable. I don’t think it’s just, you know, humans have these problems. I think the, the, the thing is a lot of these sleep issues emerge because of a dissonance between our society and our biology. And it, it brings things out. It brings these issues out.
[00:04:29] And that
[00:04:29] Chris DiCroce: is, um, Yeah, there’s so much there I want to touch on, um, the circadian thing. Well, the circadian thing, I, I, I would imagine, I don’t want, I want to touch on the sleep apnea too, but, um, yeah, the circadian thing comes from the screen time, right. We’re constantly plugged in all the time.
[00:04:46] Dr. Michael Grandner: Partially. So, so the way to think about, so I remember, so as a, as a psychologist, like I, I, um,
[00:04:54] I came into sleep from psychology and then into circadian rhythms, which is actually kind of a separate thing, but related. And it took me a while to wrap my head around circadian rhythms. But really all it is is these 24 hour daily rhythms. And to understand why they’re important and how they get influenced, I think it’s important to understand why they exist.
[00:05:18] Um, and the reason CI and, and you see circadian rhythm, In pretty much any, um, any life on earth that has some exposure to, um, sunlight ever. You know, you, you, you have these rhythms, you see it in, in microscopic organisms all the way through, through plants and animals and humans. You know, we have these rhythms and so, Well, evolution figured out a very long time ago.
[00:05:52] Then when life is a sprint, it’s short, and so we, we evolve rest activity rhythms where we can’t, we can’t just be sprinting all the time. . Um, we need, you know, sometimes it’s much more efficient to change your car’s oil while you’re not still driving it. And again, evolution figured this out a long time ago, um, back when we were, you know, cells floating around in the primordial soup.
[00:06:17] Um, it, it was, that was, that was sort of an easy answer. And so we had rhythms, um, where we would go and then pause, grow, and then pause. And then that had to do with, with development, it had to do with adaptation to the environ. It’s like if you’re running and you’re not watching where you’re going, you bump into things and every once in a while you have to pause.
[00:06:38] So we have these rest activity rhythms that you even see in non circadian species. But then we also had this other thing. So one, one like continent have risen, fallen dinosaurs came in, went. But the one thing about life on earth that has not changed in the billions of years is that the earth spins on its axis and goes around the sun in an extremely predictable.
[00:07:00] and again, evolution figured this out a long time ago. If evolution and, and biology is all about adaptation to the environment, what was happening in the environment in a predictable way, you know, you had this light dark cycles, but we call them light dark cycles because we’re humans and we’re visual creatures.
[00:07:18] Vision didn’t have to exist. Um, it’s, they’re not light dark cycles. It’s energy cycles, it’s radiation cycles. So like you had, you had energy from the. And then the energy pulled back, right? And this was repeatable. And so if you were an organism that harnessed that energy for movement, for reproduction, for finding food, for all of these things, you know, you wanted to rest when you weren’t getting energy and move.
[00:07:45] When you were getting energy. And so out of this emerged that the rest activity rhythms and these energy cycles, Coincided with each other because it made sense, not because, not because, oh, it was convenient. It was like, it actually makes a lot of sense from an engineering perspective. Like, no wonder why, you know, all so many species fell into that because it makes sense.
[00:08:08] Um, then you get nocturnal animals cuz then you have these social pressures and shows that these rhythms, um, in, in the more simple organisms. , you know, they’re a little simpler, but as the organisms get more complex, the rhythms get more complex. So like you have nocturnal prey animals where, well, if everyone’s out during the day, so are your predators.
[00:08:28] So maybe that’s a good time to hide and maybe you should, you know, adapt to maybe being active in a time when you normally wouldn’t be. Um, and that shows that there are other cues than just light. Um, and so that’s what takes us to humans. So we have these rhythm. Probably every physiologic system in our body runs on these rhythms.
[00:08:48] Again, anything that requires maintenance or regulation probably has rhythms to it in terms of, of cycles and maintenance and all of these things that are built to coincide with each other and run like a machine, like a finely tuned machine that’s flexible and adaptable to the environment. And so, You know, even the, the rhythm at which our cells take glucose across cell membranes to fuel cells has a rhythm to it.
[00:09:17] Um, so John Hogan, who’s this amazing researcher in Cincinnati, like, he studies clocks in, in cells all over the body. And, and one of the things that he talks about is, About half of the human genome is probably rhythmic, at least in some tissue. It’s not always rhythmic everywhere. The genes aren’t always rhythmic, but so much of our body is rhythmic because that’s what keeps us functioning and the rhythms aren’t absolute.
[00:09:44] This is what gets into to our society. The rhythms aren’t absolute. Um, they’re modifiable, they’re adaptable. Humans are very adaptable. The problem is we created a world that. Tried to adapt to, that’s counter to our biology. So the main input to the system is light. I mean, we have our own internal rhythm, um, but it’s constantly resetting.
[00:10:07] Its, uh, itself based on what it’s perceiving from the environment. The main source of that information is light so that if it sees bright light melatonin gets suppressed and it’s like, oh, this is a daytime signal. It sees an absence of light. It says, oh, I wonder if it’s night. , um, because you have an internal clock, you have a guess.
[00:10:28] So if it’s the middle of the day and you walk into a dark room, your brain, unlike the parrot putting the, the, uh, the bird, putting the, uh, blanket over its cage, your brain’s not gonna get confused. You know, it’s still daytime. You’re not gonna just immediately start falling asleep unless that darkness goes on for too.
[00:10:45] Or you’re sleepy or something else. Just like in the middle of the night, if you turn on a light for two minutes, you can probably fall back asleep relatively quickly cuz your body knew it was night. But around the transitions, that’s where it’s not sure. That’s where the probability becomes greater, that it’s one or the other.
[00:11:04] So that’s why when you, when you wake up in the morning, the first thing you should do is get some bright lights and that daytime signals, if you’re lingering in bed with the curtains drawn for a long period of. You never got that morning signal. Just l but, and then that gets into that. Finally, I finally wound up from sort of where we started with these screens at night and detaching.
[00:11:26] And what happens is we’re getting light at night. Now. Humans have been getting light at night for thousands of years, tens of thousands of years ever since fire. Right? We, we’ve made the night sort of optional. , but the difference is fire is mostly orange and red and yellow. Uh, candlelight is fire in candescent light bulbs.
[00:11:48] Even with the advent of electric lights were mostly yellow cuz they were generating light through heat. It’s only really been the last generation or so with the advent of LEDs where we had light that was much brighter, that wasn’t giving off too much heat. So like again, if you had light, that was very.
[00:12:08] Up until very recently, we couldn’t get too close to it at night cause it was too hot. It would hurt us. But when you have light that’s really bright, that doesn’t generate heat, that is in the blue green spectrum, which is what our eyes perceive as daylight, that’s where we start running into these problems.
[00:12:25] Where, this is why you don’t have a problem with a with a yellow room lamp, but you will with a blue l e d. That’s meaning because we have a sensor in our eye that’s looking for daylight. It’s not looking for orange and red. That’s not the color of day. It’s not looking for that. It’s looking for blue cuz that’s the sky, that’s the sea.
[00:12:45] That’s the, the blue green is the natural world. That’s the color. Those are the frequencies of light. Our eyes saw. For, for throughout evolution through for millions of years, those were the frequencies of light that meant daytime, not orange or red. And so now we’re seeing those at the wrong time, and it’s sending a daytime signal when our body’s looking for, is it, is it nighttime yet?
[00:13:08] And what it does is it like extends the day, but there’s a word that you use that I think is even more important. And that’s detaching because it’s more than just the light. The light is, is a thing. But the mental activity and the mental engagement with that. I think is, is equally important, if not the data are suggesting maybe even more so that it’s the inability to mentally detach, which is also keeping us up and keeping us from getting the sleep that our body wants.
[00:13:38] Chris DiCroce: so I’m, I I’ve, I’ve gotten old as I’ve gotten older, um, I’ve figured out that, you know, I I, I spent 25 years in the music business and I was up till two in the morning playing and, and now that I’m not there anymore, I, I find myself queuing. 10 30 every night, like I’ve kind of programmed myself.
[00:13:58] Mm-hmm. and I fall asleep now. I used to have a lot of trouble falling. . But now I fall asleep. Easy. And what I find with a lot of the people that have contacted me about this is I, nobody’s, we don’t stay asleep. What is with the waking up at the same time every night? Yeah. 3 3, 3 15, 3 13. You’re right. Three 17 every single night.
[00:14:20] Well, I’ll tell you why that is, that just your cycles. Yeah. So
[00:14:24] Dr. Michael Grandner: sleep isn’t one thing. Sleep is a collection of different states that cycle through the night. Um, So you have different sleep stages and, and the really important thing to know about sleep stages is you cycle from sort of light sleep into deep sleep, back to light sleep into rem, which is neither light nor deep, it’s its own thing.
[00:14:44] And then you sort of cycle through the night from light to deep back up to rem, down to deep back up to REM with light sort of in the middle. The first couple of tho those cycles last between, you know, usually around an hour and a half, but they could be a little shorter. They can be as short as maybe an hour or as long as maybe two hours.
[00:15:05] They’re not, they’re not predictable. They’re not, they’re not clockwork. Um, the other thing that’s different about them is that the, the first couple cycles are mostly, usually, mostly, Um, which decreases as you get older, but that’s where most of your deep sleep happens. The REM sleep happens more sort of at the end of the night, and, uh, it’s very hard to wake up during deep sleep.
[00:15:29] It’s much easier to wake up during lighter sleep or REM sleep. That’s why if you’re gonna fall asleep, it’s less likely you’re gonna wake up in the first couple hours because that’s when you’re probably getting the deeper sleep and your body’s protecting it and making it really hard to wake up. If you ever wake up from a deep sleep, it’s really hard to do.
[00:15:47] Um, and when you are, you’re very disoriented and, and you can be very emotionally dysregulated cuz like the thinking parts of your brain are, are sort of offline and they take a while to sort of come back. Um, the rest of the stages of sleep are much easier to wake up from. That’s why you’re not gonna wake up usually in the first three hours of the night or so.
[00:16:07] But, um, at stage transitions, there’s almost always some sort of arousal and an awakening. Um, at the end of each cycle. It’s really not uncommon to have an awakening, especially, um, after the second and third cycle. , um, where, where, you know, it’s sort of like you come down into deep, deeper sleep, then you’re coming up into REM and just sort of as you’re transitioning in and out of the, the lighter sleep into rem, those stage transitions become sort of vulnerable and we have awakenings.
[00:16:39] The typical adult will wake up 10, 20 times a night or more. They just don’t remember. They’re short. It’s 30 seconds. It’s you wake. , look around. No bear, go back to sleep and roll over or whatever. Again, a long time ago that like, this is when we’re really vulnerable, so we have a backup system to alert us of danger.
[00:17:04] And so we have these periodical awakenings during the night, which are completely irrelevant. They don’t matter. They don’t, they don’t like you can have them, they’re, you will have no memory for an event that lasts under about two, two and a half minutes. You won’t remember it, it won’t impact your perception of the night, anything, but you’ll have them multiple times a night that the awakening happens is actually normal.
[00:17:29] The problem isn’t that the awakening occurs at three something in the morning cuz everyone’s having those because that’s, that’s where some of, for you, that’s probably a relatively predictable place of stage transitions. The question is, why are you remembering it? And that’s the issue. And so as you get older, That, that happens more where some of those stage transitions just become, um, more likely to become an opening for something else.
[00:18:00] So when you’re conscious, when you’re awake, even if it’s a relatively brief period, a few things could happen. This is when your bladder will say like, Hey, now that, now that you’re. I’ve been waiting. Now it’s time. Now. Now, now I want you to go to the bathroom. Yeah. Like people think they wake up because they have to go to the bathroom.
[00:18:18] That’s probably not the case. What’s more likely is you have a natural awakening that because you’re awake, your body’s like, all right, you’re awake. You might as well go to the bathroom now. Um, yeah,
[00:18:28] Chris DiCroce: we’re up. Now’s a
[00:18:29] Dr. Michael Grandner: good time. Yeah. Same thing with hot flashes and women. Um, if, if you look at the data, it looks like the awakening triggers the hot flash, not the other way around.
[00:18:40] The other, the other thing that happens during this time is people with a lot of stress. And so when you’re asleep and you’re unconscious, you’re not really thinking. But sometimes those thoughts are hanging, hanging out just outside of our awareness. And then as soon as we have a little bit of consciousness, it’s sort of like,
[00:18:59] It’s like anyone with a small kid who’s sitting, who’s standing there next to your bedside waiting for you to wake up. Cause they had a bad dream and they didn’t wanna wake you up or something. Or like mm-hmm. the dog that needs to go out in the morning and is sitting there waiting for you to be awake.
[00:19:11] And as soon as they hear a move, they’re like, okay, you’re up. Take me out. You know? Right. It’s been waiting. And so when people sa when, when people say, I get woken up by stress, what’s actually more likely is you were woken up by a natural awakening and your stress seized on that opportu. Yeah,
[00:19:27] Chris DiCroce: they steps in your brain starts to function as a, an opportunity.
[00:19:30] Oh, yep. He’s. , what does it do to the repair cycle? Yeah. When you have these awakenings, like, is, when does the, when does the repair happen? Is it in rem or is it in the deep
[00:19:40] Dr. Michael Grandner: sleep? It actually happens across in all the different stages though though a little bit differently. So, so the deep sleep is, is, and it’s ca like deep is sort of misnomer.
[00:19:49] It’s just called deep because it’s harder to wake up from and, and you’re more disoriented. It’s not that it’s more important, it just, um, this is where the growth hormone is secreted a lot of the cellular repairs happening. But it looks. A lot of that also requires REM sleep later in the night. Cause remember, we have more REM later in the night and it requires some of that REM two to actually take hold in work.
[00:20:10] Um, but the good news is a lot of these awakenings don’t seem to be that big of a deal until they become, um, until they really start getting in the way. Um, having occasional awakenings during the night, two to three awakenings during the night, if you’re up for less than a half an hour. I’m not really worried about that.
[00:20:32] Um, again, evolution figured this stuff out a long time ago. Um, I mean, sure, yeah. There, there’s a reason why most of the problems that are, you know, now that we’ve, we’ve, uh, come a long way with infectious diseases and injuries, which were the main causes of death for most of human history. Now we’ve got chronic illness and heart disease and cancer and Alzheimer’s, and, and notice these things are really hard to prevent.
[00:20:58] um, and don’t really start becoming problems until after age, after sort of reproductive age. And that’s because they were never selected for like, evolution fixed all the other stuff cuz it needed to, but it never needed to fix these things. Same thing with like, you know, younger people, they, you know, no one when, when people say, I wanna sleep like a baby, um, they’ve clearly never had children.
[00:21:20] Um, because exactly no one wants to sleep like a baby . But what they, what they mean is they wanna sleep like an a. And, and that’s because that’s prime development time. And, um, when we get older, we have more sleep interruptions. We would, it doesn’t seem to correlate with too much unless, unless there, you know, where the line is, is unclear, but there’s a line at which it becomes problematic.
[00:21:45] Um, I would say that a, a, a, a good guess for where that line is, is either. You develop insomnia or you have excessive daytime sleepiness, or both. So excessive daytime sleepiness means that you have a really hard time maintaining consciousness during the day. Like any opportunity your body take, your body is so starved for sleep.
[00:22:10] Imagine you are so hungry that you’re like eating everything in sight. Um, you, you, no one can leave a crumb on the table without, without you eating. Um, if you saw that in somebody, you’d be like, what, what is wrong with your, your nutrition? Like, are you starving to death or what, like, what’s going on?
[00:22:31] Because your, that, that the body is craving it E excessively and people do that with sleep, but like, if you know someone, it’s like they can’t sit down. Cuz once they sit down they sort of nod off. They can’t watch a show, they can’t watch a movie, they can’t sit in the meeting. I mean, I’ve had patients where they’re falling asleep while talking to.
[00:22:50] Chris DiCroce: yeah, I have a family member that, that is struggling with this. He’s struggling with sleep apnea too, as well. Yep. And he’s just exhausted during
[00:22:57] Dr. Michael Grandner: the day. Right. And, and so, so I’ll get into the sleep apnea cause that’s a very common cause of this. So daytime sleepiness, think of it as that hunger and when you see someone that hungry, something’s wrong with their diet.
[00:23:08] It should. They shouldn’t be that hungry when someone is that sleepy. Yeah, right. Something’s wrong with their sleep. So daytime sleepiness is a cue that something is up with your sleep at night. You know, as we get older, we, you know, there is some normal amount of sleepiness. I mean, humans have siesta again for thousands of years, having a break in the middle of the day, you know, having all day awake and all night asleep.
[00:23:30] You know, anyone who has a pet knows that that’s actually not normal in the animal. Um, we sort
[00:23:36] Chris DiCroce: of indus, Hey, I’m a big fan of the Siesta. Yeah. I’m a big fan of the Ssta.
[00:23:40] Dr. Michael Grandner: This is, but I don’t think this is the Industrial Revolution. The Industrial Revolution sort of ban that. And like we, we got, um, there, there’s a, there’s a sleep researcher in um, In Germany till Berg.
[00:23:52] He’s an amazing sleep circadian researcher, but he said something to me once that I’ll never forget, and he said like, you Americans are so capitalistic about your sleep. You’re always trying to make it more efficient and, and like rather than It’s true man. And, and it’s, it’s, it’s, it’s, you’re very capitalistic about it.
[00:24:08] And, and it always struck me that like we kind of are as a society and. That’s not the way humans were for most of human history, but anyway, but excessive sleepiness where it’s inappropriate, where you’re not trying to lay down you, you feel like you have to keep moving or else you’ll fall asleep. That’s a sign that whatever those interruptions were at night, they’re causing problems.
[00:24:28] The other thing is insomnia. So insomnia. Confuses a lot of people because it’s a word that’s used a lot. It’s like depression where it’s a word that means a lot of things, but means something relatively specific clinically. So insomnia, what I would call insomnia with a lowercase eye is just having trouble sleeping sometimes.
[00:24:49] But once insomnia has that capital I in, in, we would call it insomnia disorder. Um, That’s where insomnia is causing daytime problems. And so what is the line? Usually the, the, the metric we use is about 30 minutes. So if it’s taking you at least 30 minutes to fall asleep or you’re awake for at least 30 minutes during the night trying to sleep, like getting up and getting a drink of water, that’s not trying to, but like if you’re spending more than 30 minutes sitting there trying to sleep and it’s not working, Um, and if that’s gone on for, if it’s hap that happens at least three nights a week and it’s gone on for at least three months and it’s causing you some problems, you know, the likelihood that it’s gonna resolve on its own is relatively low at that point.
[00:25:35] Um, most people get insomnia at some point in their life, and it usually resolves, but sometimes it becomes chronic. And there’s one thing that, uh, of the millions of causes of insomnia, there’s, there actually seems to be really one cause of chronic insomnia. . Um, and, and, and I mean the, some people have have an active disturbance all the time, like, you know, they’re in active pain or something, but that’s usually not it.
[00:26:01] It’s usually actually just conditioned arousal that, uh, cause whatever caused you to be awake, led to sleep, becoming predictably stressful once sleep becomes predictably stress. You can’t talk yourself out of it. It’s your, your brain knows it’s not an idiot. It knows that it’s a pattern recognition machine.
[00:26:20] It’s recognizing a pattern that when I try to sleep, I often fail. That creates stress, and what that does is that makes it so the stress gets triggered. by trying to fall asleep, either consciously or unconsciously, which creates activation, which creates the very activation that makes it harder to fall asleep against.
[00:26:44] So it becomes the self-perpetuating cycle of
[00:26:47] Chris DiCroce: whatever. That’s what I was gonna ask exactly. Is, is if you, if you, I didn’t mean to interrupt you, but I wanna just, so you’re saying that you know, you, as you prepare for bed and you have problems every night sleeping anyway, you’re all automatically winding your brain up to condition.
[00:27:03] This is becoming a stressful thing. I have to go to bed, I’m starting to get anxiety because I’m going to bed. And then therefore you’re almost yourself fulfilling the prophecy that you are going to wake up and have trouble sleeping. Exactly.
[00:27:15] Dr. Michael Grandner: Right. And that’s the problem. That’s what happens in chronic in.
[00:27:18] Where, where the sleep, where the bed becomes the dentist chair, where it’s so reliably tied with a mental and physical state that is incompatible with sleep, that, um, it, it becomes a self-fulfilling prophecy. And, um, and that’s why the treatments actually the most successful treatments for insomnia are all actually just about relearning that association and, and reprogram.
[00:27:43] Chris DiCroce: That’s exactly where I was gonna go to next. So we just covered this whole thing , and aside from sleep apnea, because I’m sure sleep apnea gets put under the umbrella of insomnia, but it’s not correct. Right. So a setting it’s different. Sleep. Sleep apnea aside as its own condition. What are the treatments?
[00:27:59] What do you suggest? Like I saw, I have a question about your. Natural you, you mentioned in your, one of your speeches or one of your talks, somem, where the natural non-medication remedies for sleep. So since we’re in this, this area of discussion right now, what would you, what do you tell people? That, that, that have this condition that isn’t related to like, you know, something like acid reflux or a medical condition that is keeping you awake.
[00:28:23] Dr. Michael Grandner: Yeah. So, so if, if you, if you’re having an active particip, a precipitant to your sleep, try and get that resolved and see if your sleep resolves. If it doesn’t, you might already have this condition. Arousal, it looks like three months seems to be the. that it takes to sort of train that in. Um, so, so how do you treat insomnia?
[00:28:43] Actually, a lot of things that people do to fix their insomnia are actually not helpful. So first of all, there’s things like melatonin. . Um, and a lot of other supplements there, there’s no supplement on the market that fixes an insomnia disorder. Um, they can improve sleep. There’s actually great data on some supplements showing that people who don’t necessarily have insomnia but might have some sleep difficulties, they could benefit maybe from some of these.
[00:29:09] Melatonin is, is a tricky one cuz melatonin doesn’t make you sleepy. Melatonin tells your body it’s night. For some people that makes them sleepy. The the paradox is the more likely you have in, the more you’re insomnia, the less likely melatonin is gonna work because your body already knows it’s nighttime and still can’t sleep.
[00:29:28] Um, that’s why melatonin can, can help you fall asleep faster and stay asleep longer. But for a lot of people with insomnia, it’s completely in.
[00:29:37] Chris DiCroce: And doesn’t, the fact that you take a melatonin supplement, doesn’t that do harm to your own body’s natural production of melatonin? Does it shut that down? I’ve heard that rumor.
[00:29:46] Yeah. It’s, or I’ve heard that premise put forth. Yeah. People
[00:29:49] Dr. Michael Grandner: talk about that. The, the data on that really aren’t super clear from, from what I’ve seen. It doesn’t seem to, um, fortunately, okay. . Um, but I mean, you know, it, it’s hard to study people. What about people who’ve been using it for decades? You know, it’s hard to know.
[00:30:04] Um, but it seems like that’s not really the, the issue, the main issue is like people can, can become psychologically dependent on it, or, or it, it can mess up your rhythms in other ways. But melatonin also has a lot of benefits too. Melatonin, it seems. Melatonins function may function through the animal kingdom, and, and even in plants might be as, as anti-inflammatory antioxidant as, as you know it, it actually does have some of these powerful properties, which is why.
[00:30:32] Um, the data showed that people who were taking melatonin got less covid. Um, and, and it helped. Wow. You know, like, okay, I didn’t know that it was used as an adjunctive treat. It’s actually a, a, a, a, a really powerful, um, healing molecule in the, in the, in the cardiovascular system. But the main thing it does in humans is it sends a nighttime signal to the body.
[00:30:52] Um, also if you’re gonna take melatonin any way, lower doses tend to be better. More isn’t more. , um, more actually just confuses the system because you’re in the, you’re, you’re not in the range where it’s actually working for sleep. But anyway, that’s a whole other thing. So what does work? If you looked at any, any scientific or medical organization that has any req, any recommendations based on the available data, they all say the exact same thing.
[00:31:20] Um, and it’s not medications. Medications might work for insomnia, um, but they don’t tend to work as well as those people think. Um, the thing that has the strongest data to support it is something called cognitive behavior therapy for insomnia, which is not like cognitive behavior therapy for like depression or anxiety.
[00:31:36] It’s actually totally different What, what C B T I is. It’s a set of tools that essentially reteach you to sleep. So it’s like nobody got to sleep faster by trying harder. Um, it, it, it, it, it sort of diffuses that. And what it does is it, It’s more like physical therapy than psychotherapy. It’s, it’s more about stuff you do to reprogram your, your brain to be able to sleep naturally.
[00:32:01] Um, it, it’s, it’s about removing the barriers, um, but not from a sleep hygiene perspective. Cause that’s another thing people talk about a lot is sleep hygiene. Sleep hygiene is great. . Um, this is all like the sleep tips about keeping a regular schedule and, and, and, you know, not drinking caffeine and like all this other stuff, but hygiene is hygiene.
[00:32:21] Hygiene isn’t medicine. Brushing your teeth is hygiene. Everyone should do that. But you can’t brush your way outta braces. And if you have insomnia, sleep hygiene is usually so useless. We actually use it as our placebo control in, in trials cause everyone thinks it’s doing something. But once you have insomnia, once you have a conditioned arousal, sleep hygiene is about removing the barriers.
[00:32:44] It’s not about reprogramming your your own brain.
[00:32:47] Chris DiCroce: That’s a really great way to say it. Just you, you can brush your teeth every night, but it doesn’t keep you from getting braces. Right. And so you can, you should still do it though. We should all, we sh Yeah, absolutely. We, but we all know you don’t drink caffeine, especially if you’re caffeine reactive.
[00:33:01] You all know that. Yeah. If you’re sleep, going to bed at different times. So those are all things on the level that we already know. And then, you know, you, you said something in one of your talks where you said that, um, it’s a three-legged stool. Yeah. Naturally it’s nutrition. Exercise and sleep. Yep. There.
[00:33:17] And if, when you, when you miss one, what I really loved was it made it so clear when you miss one, you’re trying to sit on a two-legged stool. Exactly. Exactly right. So, so it’s. . Okay. Exactly,
[00:33:28] Dr. Michael Grandner: exactly. And so, so what C B T I does. So, um, there, there’s the main, the main techniques, there’s sets of techniques.
[00:33:36] And, and, and the core of what they’re doing is they’re trying to, um, have you unlearn that going into bed is associated with staying awake in bed. So one, so a, a very simple in theory idea, but complicated practice is something called stimulus control. This is bang for your. Probably the best sleep tip I could give anybody is stimulus control.
[00:33:59] And what it means is, and people have heard this by now, that if you can’t sleep, get out of bed. But what they don’t understand is that it’s actually getting out of bed isn’t gonna help you fall asleep faster. Getting out of bed is gonna start, is gonna start breaking that cycle when you get into bed.
[00:34:16] You wait until you’re sleepy before you get into bed. You don’t go into bed because it’s. You go, and if you don’t think you’re gonna fall asleep, wait, wait until you’re so tired you can’t keep your eyes open. Then get into bed, then get up at your regular time in the morning, even if you’re sleeping a little less, what’s gonna happen is over time you’re gonna start being able to fill that time with sleep a little more reliably, cuz you’ll be a little more tired and.
[00:34:42] Times you go to bed will be more reliably paired to falling asleep. So if you fall asleep and then you wake up at three o’clock in the morning, if you know you’re not gonna fall asleep within the next hour, stop trying. Why are you trying? You’re just, you’re adding energy into the system. Scan up, do something else.
[00:34:57] Take a break. I mean, if you’re eating and you can’t eat anymore, Sitting there and staring at your food for an hour, waiting for yourself to get hungry again, it doesn’t help. It just makes eating stressful. And then you start avoiding meal times because you know it becomes stressful. Instead, if you’re done eating and there’s still food left, you know you’re gonna be hungry later.
[00:35:23] That’s fine. Push it aside. Get up, do something else for a little bit, go back. Right? And so a lot of people sleep in two
[00:35:29] Chris DiCroce: chips. And when you get out of bed though, the, you’re, the, the key is to not go sit and look at your phone, . Right. You don’t get up and that’s the stimulus. Right. You don’t, okay, I’m out of bed, so now I’m gonna go hit my face with a bunch of blue
[00:35:43] Dr. Michael Grandner: light.
[00:35:44] Yeah. That’s, that’s not the right time for that, that, that will make it, that will make it take longer. The most important thing, and this is what I tell patients, the most important thing you can do when you get up, either when you’re trying to fall asleep or in the middle of the night or toward the end of the night, if it’s two hours before your alarm goes off and you’re not falling back asleep and you’re panicking and you have to get up anyway, um, the most important thing you can do is, is the same thing as if you’re not hungry and you need to eat.
[00:36:13] And a hint is okay if you’re not hungry, how do you make yourself more? You can’t, there’s no like hungry jumping jacks you can do. There’s no exercise you can do to make yourself more hungry. You just have to wait. And so the most important thing you can do when you get out of bed is you allow sufficient time to pass so that your natural hunger for sleep starts building again and can take you to a high enough level that you can get back to sleep.
[00:36:39] That’s the most important thing to do, is to let time pass what you do during that time. That’s up to you. But there are some things you can do that can slow it so the bright light slows it down because you’re, cuz you’re not building that sleep pressure in the same way. Um, or you’re counteracting it with a wake drive.
[00:36:57] Um, doing something that’s super mentally engaging and emotionally engaging, like watching the most exciting show and then watching two episodes and then watching four, and then watching, like, that’s gonna, that’s gonna make you stay up longer. Um, but. You don’t have to sit there in the dark and meditate for an hour either.
[00:37:16] I mean, you know. Right. If you’re gonna be on, if you’re gonna be on a screen, turn the brightness all the way down. You don’t need it to be bright. Keep the light as dim
[00:37:24] Chris DiCroce: as possible. Oh, okay. So, Okay, cool. I would’ve thought that would’ve been like an absolute nose to just, because you’re just putting this information back into your head and getting yourself Yeah.
[00:37:34] Back into, into the cognitive process. When you’re trying to wind all that down, it seems counterproductive.
[00:37:39] Dr. Michael Grandner: It, it’s, it’s ideal to like not be on screens. Like the best thing would be like, Reading, reading is perfect cuz it’s self-paced. You can’t do it while your eyes are closing. Um, you’ll notice your head nodding.
[00:37:52] You’ll notice you’re like wanting to lie down when you’re reading. That’s your body telling you you’re ready. Like reading is is probably the best activity. Listening to an audio book, probably second best. But I am, I, I also live in, in the same society as all of us do. And I know telling people that screens are forbidden is, is gonna be a non-starter for the majority of people.
[00:38:13] Sure, sure, sure. So I’m gonna say, if you’re gonna do it, Like, so it’s like if you’re going to eat the cheeseburger, maybe get it without mayo. You know, like if you’re gonna do it this way, yeah. The less bad way to do it is if then this turn, turn the brightness down and, and don’t do anything that you’re not gonna be able to pull yourself.
[00:38:29] That’s why video games are really hard, especially modern video games that are endless. Like, like it takes hours to do anything. And so because of that, like hours go by that didn’t need. .
[00:38:44] Chris DiCroce: And so let’s go back to the sleep apnea. Yeah. Fitting in. Is it, is it just a natural, is it just a given that we’re all gonna, as we get older, uh, experience sleep apnea or is there something that triggers it other than weight?
[00:38:57] Um, or Yeah,
[00:38:59] Dr. Michael Grandner: that’s a good question. How does that, and yeah. There, there is a normal, like it is, it is actually up to five respiratory events. An hour is normal per. Five events per hour all night. That’s normal range. And hmm. And even being above that, as we get older, we’re gonna get more because of neuromuscular control slows down and the, the muscle tone becomes a little bit less as we age.
[00:39:24] All these sorts of things. Um, and actually the data show that relatively mild sleep apnea not only is common in older adults, but it doesn’t have the same health risks as if it was diagnosed in your forties and 50. Um, or, or even earlier, if you are getting diagnosed for the first time with sleep apnea in your sixties or seventies and it’s not causing you daytime problems, it’s actually the data are really iffy on whether it’s even worth treating at that point.
[00:39:56] Chris DiCroce: what about for younger people in their, let’s say someone’s in their thirties and they’re, because you, uh, what I’m trying to get to is the link between, I read a quote, you said insomnia is to depression. Yep. What cholesterol is to heart. You’re right. Disease, you’re right. So like if apnea, if sleep apnea, you’re 35 years old and you, and you’re having this trouble, what does it, what does it do for the long-term success of you as far as your mental, cognitive and your.
[00:40:21] Um, you know, bouts of depression and stuff like that. Cause it’s a cycle, right? You get depressed, you don’t sleep, you don’t sleep, you don’t eat well, you don’t exercise. Exactly. Then you’re just a downward spiral. It’s all connected. Yeah.
[00:40:31] Dr. Michael Grandner: So insomnia predicts depression. But the, the thing with sleep apnea is, and one of the reasons why it’s especially important to treat it, um, at when you’re younger is every time you have a respiratory.
[00:40:47] Um, your airway, your airway drops, your blood, oxygen starts dropping a couple percentage points. Your, all the cells in your body that rely on oxygen, which is all of them, start worrying. They’re like, Hmm, something’s not going on right here. And so they start, they start, they, you don’t get, you’re not hypoxic.
[00:41:07] It’s not like you’re suffocating, but it’s sending a stress signal. And that’s creating, for example, these, the, the, the reactive oxygen species and the oxidative stress. But then within a few seconds, an apnea lasts a minimum, you know, can last, you know, 10 to 30 seconds. a hypophonia glass, usually at least 30 seconds where it’s, where it’s your, your respiratory efforts reduced, but not blocked all the way, which causes that drop in oxygen.
[00:41:34] Um, and then it resolves, and then it happens again. Then it resolves, then it happens again, then it resolves. And, you know, mild sleep apnea is, you know, five to 15 times an hour. This is happening severe sleep apnea, which is, which is where most of the risk seems to. You’re having events a minimum of 30 times an hour, so a minimum of on average every two minutes across the night.
[00:41:58] And so every few minutes you have this little stress on this little bit of stress on the cells and it resolves little bit of stress, then it resolves. But this stress is starting to accumulate cuz it doesn’t, all these reactive oxygen species don’t get, um, dealt with before the next event happens. So then you’re accumulating That’s accumulative.
[00:42:20] Yeah. Yeah. So that’s why. . And so like one night is it gonna kill you? A week isn’t gonna kill you a year, it’s gonna start stressing out your, your, you know, your kidneys, your liver, your heart, your vasculature, your brain, every cell that depends on oxygen is gonna start getting a little stressed, less able to heal.
[00:42:41] Sort of like chronic pain where, where your body is dealing with stuff rather than trying to do its. . And that’s why, you know, after a decade or two or three or four of, of this, this is why people with sleep apnea are more likely to have heart attacks and strokes, more likely to have memory problems and dementia, more likely to have kidney problems and liver problems.
[00:43:06] You know, you go into a diabetes clinic, a few studies have done this. Um, the lowest percentage of patients in the diabetes clinic was 65%. Um, the lowest percentage that was found. You just test everyone sitting with sleep apnea, you just test everyone in the waiting room. They probably all have sleep apnea.
[00:43:24] Wow. Um, wow. Probably with the over, and then with the, the obesity issue compounds it because now you’re putting more weight on the airway. So if the airway was going to collapse, now it’s, it’s, it’s sort of like, um, trying to think of a, like a, you know, you, you’re, you’re, you’re already. Um, likely to fall, you know, you’re a fall risk and now you just put a 50 pound backpack on a fall risk, right?
[00:43:52] Chris DiCroce: So that, sure. Or you just like stacking bricks on your chest, right? Like you’re, you’re already having difficulty breathing. So then you stack a bunch of bricks on your chest. That’s why you gotta say bad weight is, is the sl, is the C P A P machine the only way to treat this thing? No, just that. Is that, is there any other science that is going along that that, because I mean, I know so many people that, I mean, they try the C P A P, but they just can’t sleep.
[00:44:16] I mean, I could never, thank God I don’t have to deal with that yet or whatever, but I could never sleep with a big face mask on my face. Yeah. I just don’t know how it’s possible. Yeah. So, so CP is a
[00:44:26] Dr. Michael Grandner: alternative. where what C P A P does is it creates a pillow of air in your airway. So even if it wants to collapse, it doesn’t, and it stays open.
[00:44:37] Um, the thing with c a P is you gotta have the right pressure. Cause if it’s not enough pressure, then you have the irritation of air going through your airway in the wrong direction. Without enough pressure to keep it open. So you’ve still got the events and the irritation, or if the pressure’s too high, wow.
[00:44:52] Yeah, your airway never collapses, but you’re forcing air down your throat at such a pressure that it’s causing irritation. So you gotta get the right balance. Amazing. And masks. So what they do now, because the way that our insurance system works in the us, Um, insurance reimburses for the diagnosis, but not really much for the treatment.
[00:45:12] So what happens is you do this overnight study, it’s so frustrating, and then they throw a device at you, a machine at you saying, here, good luck. They’re not gonna pay us for much follow up. It’s
[00:45:22] Chris DiCroce: just like prescribing antidepressants rights. Like, here, here, take a pill, pill luck. And it, it’s have fun. It’s so frustrating.
[00:45:27] Dr. Michael Grandner: And, and the thing is, there are over 200 different kinds of masks and so most mask problems, I, I, in my experience I’ve seen, I’ve seen hundreds of different. Patients with mask issues, um, it is extremely unusual that there’s no, so when there’s no solution to a mask issue, it’s just usually when people say, I tried it and it didn’t work, means I tried the mask they gave me at the pressure they gave me.
[00:45:53] I didn’t tweak it at all. and it didn’t work. The fir the first, it’s like, we don’t do that with antidepressants. You know, you give someone, you give someone Lexapro that doesn’t work. You know, maybe you’ll go to citalopram, maybe you’ll go to search like, or whatever, right? Because everyone’s a little bit different.
[00:46:07] But with the mask, it’s like people give up as part, and especially men, men don’t like stuff on their face. But then, but C P A P isn’t the only solution. The next most common solution are what are called oral appliances, where these are usually, um, give you, get them from a dentist. Where what they do is, it’s sort of like a retainer you wear at night, but what it does is it pushes your jaw forward during the night, which does a couple of things, but not only does it open up the airway a little bit while you’re asleep, um, it also, um, creates tone, muscle tone in the airway because of the stress you’re putting it under.
[00:46:46] Um, It, it tends not to be as effective. It’s not as blunt of an instrument to see PEP is. So, um, there’s some people who have severe sleep apnea. One of these fixes it all the way, most of the time it takes a lot off, but it tends to be better for more mild to moderate cases. It might not be quite enough for severe.
[00:47:07] Um, another, another treatment that you’ll see, there’s lots of commercials for it, is sort of an implantable device. It’s sort of like a pacemaker for your tongue muscle. And so what it does is it’s that this is the inspired device, is what it’s called. It’s a nerve stimulator where it’s, like I said, it’s essentially like a pacemaker.
[00:47:23] And what it does is when it senses that your airways being blocked, it sends a jolt to your tongue muscle to like open up. Um, so for people who, whose obstruction happens to be in the right spot, um, the, if, if, if the obstructions you’re getting happen to fit what this device could be good at. You could be a really good candidate for it.
[00:47:48] And then you don’t have to wear a machine. Um, there are some surgeries, uh, you would think that the obvious solution to, if something isn’t blocking it, just cut it out and then it’s not blocking it anymore. Turns out surgery was not a very simple solution for sleep apnea. Most of the time the scar tissue ended up being worse than the blockage and people died.
[00:48:06] Uh, but um, yeah, that seems like a drastic, but a, a, as the knowledge improved, there are. There are some surgeries that are done from with e n T people, um, for sleep apnea. Uh, it’s just, again, you have to, what they learned was it has to be the right kind of obstruction in the right kind of spot that’s fixable by this particular surgical technique.
[00:48:29] And then you might be fine. So you can ask your doctor if, like, do you fit into any of these buckets? Um, and actually the one thing that a lot of people don’t talk about as a relatively effective treatment for sleep AP. Is weight loss. Um, you know, it’s, it’s much easier to prescribe a machine or a device or something cuz you can, you know, you can use that.
[00:48:51] Uh, but actually if you look at the data, the, the, the interaction between the respiratory stuff and, and the obesity just makes everything way worse. Um, and it’s just, it’s just hard for you do,
[00:49:04] Chris DiCroce: I mean, it’s an obvious, it seems like, you know, as with everything. , the, you know, Occam’s razor. Right. The most, the simplest answer is always, the best answer is usually the best answer, which is nutrition.
[00:49:18] Yep. Everything in our, I think everything in our lives Yep. Can be associated to nutrition, exercise, and rest. Yeah. I mean, it’s, it’s, we can, we can try to work around it. We can try to trick ourselves and we can, we can treat the symptoms, but when it gets down to brass tack, um, what you put in your. Affects how your engine runs.
[00:49:41] Yeah. Just like bad gas in a car. Your analogy earlier about the car is, yeah. Is, you know, if you got shitty tires on your car, your car’s gonna handle poorly. If you run bad gas, it’s gonna drive like crap. And so, and it’s gonna be uncomfortable if your seats are torn up. So it’s just like your body, it’s, yeah.
[00:49:57] It’s, it’s the obvious. It’s the obvious. But, you know, there’s so many things out there like C, B, D. Yeah. Like all of these treatments, does that even work? Uh, or is that just another placebo? Or does it just like, you know, if you’re triggering the nervous system with the THC or whatever’s in the C B D, you’re gonna naturally have a, um, a relaxing effect, which a, triggers this effect and triggers that effect.
[00:50:20] But so, so two things. Um,
[00:50:23] Dr. Michael Grandner: There’s a difference between relaxing and calming and sleep. So a lot of people confuse them, and a lot of companies that are selling products confuse them as well. They assume that, well, PE reason people can’t sleep is because they’re not relaxed enough. If we increase relaxation, we increase sleep.
[00:50:39] But actually, if you look at the data, they’re totally different things where you can be the most relaxed. I mean, talk to someone with insomnia. You can be really relaxed. You still can. Um, and so a lot of stuff that’s calming might have a slight benefit to sleep, especially if they don’t also have, uh, like a more severe insomnia.
[00:51:00] So like things like altheine or like magnesium and, and like some of these other supplements have calming effects and or five HCP maybe like they have calming effects that might translate into some sleep improve. Not because they’re impacting sleep, but because they’re impacting a barrier to sleep. Um, C B, D and THC are a little more complicated.
[00:51:25] So THC actually has a bunch of data on sleep. It does seem to, at least in the short term, help people fall asleep faster, um, have more consolidated sleep. Um, but there’s a couple problems with thc. One is the sleep effects start habituating rather quickly, where I’m not quite sure, like in the data, I haven’t seen clear date on when exactly.
[00:51:47] Is it a couple weeks? Is it a couple months? Not quite sure, but it stops working and so people start escalating doses.
[00:51:54] Chris DiCroce: Um, so they’re tolerance. You start to build up a tolerance just to put it in. Yeah. You start to build up a tolerance to it. So you do more and more and more, and then you
[00:52:01] Dr. Michael Grandner: get the counter effects.
[00:52:02] Yeah. So then you get more side effects. One of the ne one of the other effects sure, of THC is it’s a potent REM sleep. Um, just like a lot of antidepressants, most people don’t realize, most antidepressants kill your REM sleep by at least 50% or more. Um, and that might actually be part of their benefit.
[00:52:18] Uh, but that’s a whole other rabbit hole of why do they do that and, and if REM sleep is so important. If not, why is knocking out most of your rem sleep by an antidepressant? Actually a good thing like, but. , whole other rabbit hole. Um, but thc,
[00:52:32] Chris DiCroce: yeah, we could talk for hours on that. It’s confounding. Yeah.
[00:52:35] Dr. Michael Grandner: THC does that too. It knocks out your REM sleep. Um, so people will sometimes report vivid dreams because what’s happening is as the THC is exiting the system, you might get a REM rebound. More commonly though, what happens is that as the, um, the, the REM suppression doesn’t develop a tolerance, so you still have it, even if it’s not helping you sleep.
[00:52:56] So then what happens is people stop using thc. and they get this flood of crazy nightmares and dreams because their REM has been suppressed for so long. Now it’s sort of breaking free. And so then once they say, I need to smoke, I need to use t h C to, to keep my nightmares away, when the nightmares were a withdrawal symptom, um, that that would’ve gone away on their own.
[00:53:18] And then you’re just, you’re just keeping them at bay with, with the thing that was causing them. Um, CBD is different. CBD does seem to have some anxiety effects and calming effects. The c d data on sleep are super murky. There have been a bunch of studies now, um, when you combine all the studies together, it’s no different from placebo, but that’s not because all the studies showed no different from placebo.
[00:53:40] Some studies showed that it worked great for sleep. Some studies show that it actually made sleep worse. A lot of studies show showed that it did next to nothing. It seems to be highly dependent on the dose. Um, higher doses might be actually be worse. Um, it seems also dependent on the person. Um, it, it seems to be interacting with something that we don’t quite understand what it is yet.
[00:54:02] So, um, I’ve got patients who use it, who like it, and I’m not gonna say whatever you do, don’t do it. But I also have a lot of patients who say, I tried it and it didn’t, didn’t help. And I’m like, well that doesn’t surprise me. Um, not saying it’s crap. It’s probably doing something, but we don’t know enough how to target it appropriately.
[00:54:23] So sometimes, you know, you could throw, you could throw a bunch of stuff at the target, you know, you’ll throw it, you’ll hit the target a few times with C, B, D, um, but, but a lot of people are gonna miss with it.
[00:54:33] Chris DiCroce: Sure. Um, so, um, before I let you go, I wanna mention your book, sleep in Health. You can find that on Amazon and, um, at your website, michael graner.com.
[00:54:44] Um, is there anything you’re working on that you’re exciting, uh, you’re excited about? Yeah,
[00:54:48] Dr. Michael Grandner: I got, I got a lot of books. What’s going on? Stuff. Um, the thing that I’m most excited about right now is we’re studying a thing we’re calling the Mind After Midnight, which is why is it that bad things happen between two and five in the morning and.
[00:55:00] because we found that suicides spike. Then we’re also, we also found that, you know, homicides spike then, and we’re studying food intake. So why does nobody crave a salad at two o’clock in the morning? Turns out that there’s probably a whole neuroscience to being awake when our body wants to be asleep. So for anyone who’s listening, if you’re awake at two or three in the morning, don’t make any important decisions.
[00:55:22] You know, if you’re blowing things out of proportion. Yeah. Tell yourself this is, this is the, this is the night talking this. This isn’t reality. Don’t make any rash decisions in the middle of the night. Um, and hopefully we can find a way to ameliorate this and, and, and help the Lewis shift workers and other people.
[00:55:39] So that’s one of the things we’re working on. We’re doing all kinds of stuff, wearables, other stuff too, but it’s all fun stuff.
[00:55:45] Chris DiCroce: No, it’s really amazing because we, I could have kept you for hours, , because your area of main study, one of the areas of main study is your relationships with sleep disorders as they relate to suicide.
[00:55:56] Yeah. And that’s a, that’s a really key component in your message. And we didn’t, we didn’t really talk about that today as far as just. The suicide rates and, and how, um, you know, um, you say that over half of the suicides show that there’s no record of mental illness. Yeah. Which all of this stuff is correlative.
[00:56:15] And again, we could, yeah, we could talk for hours about how they relate, but I appreciate your time so much. Thank It was, thank you. It was a fascinating, you, I, so many people I hope get a lot from and just get a lot from your discussion and your clear, your, your concise, um, explanations on it. The real. . It is just where do people go?
[00:56:35] Yeah. When they feel this, right? Like if you’re suffering sleep apnea. Yeah. If you are having problems sleeping, like, like the problem I think, which I should have asked you earlier is where do people go? Like, do people feel like they have to go to a psychologist because there’s a stigma attached to that, so they don’t get help because they go, oh, I have to go get therapy because I can’t sleep.
[00:56:55] And then they, they just prolong, they delay. Yeah. So, so you
[00:56:58] Dr. Michael Grandner: mentioned the book. It’s got a ton of great information, but it’s a textbook, so it’s. So it’s, you know, so publisher has a textbook price on it, so I apologize to anyone who’s looking it up. Um, if anybody has any questions, like, I’m easily googleable, you can shoot me an email, um, and, and to answer something.
[00:57:14] But if someone really wants help to find help, if you, there’s two different, um, resources. If you’re looking for a sleep physician, like an md, like a doctor who can, who they mostly specialize in sleep apnea, but they do the other stuff too. Go to a website called sleep education.com. It’s sponsored by an organization called the American Academy of Sleep Medicine, which is the main organization of sleep doctors.
[00:57:40] Um, I’m a member. Every, any sleep doctor you meet is probably a member of the A A S M. There’s a search tool where you can find an accredited sleep center near you. If you, if your main issue is insomnia, um, actually I would recommend searching for a behavioral sleep medicine expert. Um, because like the psychologist that reprogramming stuff, that’s what we do and that’s the recommended treatment for insomnia.
[00:58:03] A lot of the physicians don’t do that cuz they, you know, you have a seven, 10 minute visit with an md, they can’t do that. Uh, but we do that. So I would look, look for the organization called the Society of Behavioral Sleep Medicine. Uh, it’s behavioral sleep.org. Uh, they have a directory on their website, um, for anywhere in the world.
[00:58:22] Uh, where are there people who have training and have expertise in behavioral sleep medicine. Um, another website to go to that’s maintained, uh, by a colleague at the University of Pennsylvania. It’s just the website is just cbt. I like cognitive behavioral therapy for insomnia, cbti.directory, and that’s another directory of people who’ve had training in CB t i, whether or not they’re sleep specialists.
[00:58:48] They’ve at least had some training in cbt. I, um, if you just type in CBT i.directory, it’ll take you there.
[00:58:55] Chris DiCroce: And we’ll link to all the, I’ll link to all of those in the show notes so that nobody has to go anywhere, uh, and do a bunch of searching. We’re gonna link directly to that. We’ll also link directly to your website, Dr.
[00:59:05] Grander. Michael, it was an awesome conversation. Thank you so much for your time. I really appreciate it. Thank you. Thanks for
[00:59:10] Dr. Michael Grandner: having me, and I hope I can be helpful.
[00:59:15] Chris DiCroce: Hey, thanks for listening. If you like what you’re hearing, make sure to subscribe or follow us on Apple Podcasts, Spotify, or wherever you listen to your favorite podcast. Share it and tell your friends because the show doesn’t go anywhere without you. We drop new episodes every Wednesday. If you wanna listen to back episodes or find out how you can support the show, you can do firstname.lastname@example.org.
[00:59:37] Okay? Next week I’m flying solo, and until then, be nice. Do good stuff.
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