 Wake up. It's mine pump time. Hey today's episode was really fun Look sleep is super important for your health, but we've heard it time and time again Reduce your blue light exposure. Make sure your room is cool. Don't eat before bed blah blah blah blah Well in today's episode we brought Dr. Michael Rousseau one of our favorite functional medicine practitioners to talk about some weird tricks That are inexpensive easy to use that should improve Improve most people's sleep. It's great episode. Also a giveaway. That's what we do on every single episode here on YouTube Today's giveaway is awesome because it's maps anabolic the most popular Maps workout program great for building muscle building strength Speeding up your metabolism and just generally making you look hot and sexy. So today's giveaway maps anabolic Here's how you win leave a comment below in the first 24 hours that we drop this episode make it a good comment Also subscribe to this channel turn on your notifications if we pick your comment You get free access to maps anabolic one more thing before we start the podcast two workout programs are on sale right now Maps performance map suspension both 50% off go find them at maps fitness products calm Just use the code September 50 that's September 5 0 with no space for that discount. All right. Enjoy the show Dr. Rousseau always good to have you on the show one of our favorite functional medicine Practitioners so we wanted to talk about or you said you want to talk a little bit about sleep with us which sleep is I Would say it's probably one of the most important things that can make or break your health Obviously if you have poor sleep, you could have the best diet and exercise And other aspects and you're just your health is gonna go strongly agreed Yeah, it's gonna totally go to crap and one of the things that is interesting with sleep That I've learned and I'd love your input on this is that we're humans are pretty good at Getting by with suboptimal sleep But that doesn't mean we should in other words we could drink caffeine we can like still kind of it's almost like we're functional Alcoholics like we could do stuff and we get away with it We do it for so long that we don't realize just how much you know how bad it is for our health I mean would you say that that's kind of a true statement for you? Yeah, it's it's totally fair. And this is something that I kind of dragged my feet on myself Which was I can go to bed at 12. It won't be that big of a deal Until you're consistently getting to bed maybe at 10 30 and then you're noticing, huh? That midday lull where it's like an hour of the day where it's kind of hard to get through and I you know It's harder to think I want to take a break. I want to have a coffee I think a lot of us hit that between maybe 12 and two is there's a midday slump that doesn't exist if I sleep well And I'm just laser-like focused all day and I don't kind of wave my hands when that comes going to the gym I just go you know what I mean? Like sometimes you need that like a 20 minute kind of play some music at myself up If you've slept well in my experience most of the time you're just all day focused all day disciplined and The subtle nuances in sleep kind of like you're leading to they're not super obvious. It could just be an hour Between you know, when you normally go to bed or when you go to bed at an optimized time But there's this other layer because I think most of us have heard don't eat too close to bed Don't exercise too close to bed don't have blue light before bed or wear your glasses or use your filters And all those things check check check are true, but there's another layer beyond that Which we've been experimenting with at the clinic, which is suboptimal respiration while sleeping and So you're going to bed on time. I get my eight hours, but it's the quality within that period of time It's a quality of breathing So you have a strong neck, right? You guys all have strong necks. In fact, I'm not gonna pick a fight with anyone here because it's pretty pretty big room, right? You'd lose but But my head but that actually is a impediment to sleep because those muscles as they grow they Occlude the airway. Yeah, I've heard this right. Yeah, so this is fairly common knowledge And what I think is being missed is that men have about double the snoring prevalence that women do and snoring is a red flag for some type of apnea or some type of sub Optimum respiration quality. Why I think many people don't look into this is they say well I don't want to do a CPAP that sounds torturous, right, but there's a big chasm of stuff you can do Without having to do CPAP and this is where I think Conventional medicine has been a bit lazy in that it's like well Do you have crippling fatigue high blood pressure and brain fog? Then we'll do an apnea test and if you have apnea, it will give you a CPAP But just as one example Using, you know, this this one a thing This is a positional change device It's it's a little magnet that you put on your back and it prevents you from sleeping on your back People tend to snore less and have less apnea episodes when they sleep on their sides So this $15 device is one thing that you could try So just prevents you you go to lay on your back now I've heard of people doing that with like a tennis balls. They like the same thing same thing So what's the difference with the magnet? What why this is might be a little easier where you can stick it on your shirt and then put your shirt on you Don't have to tape it. Okay. That's clever You know before we get into these devices because I see you brought a bunch of what seemed to be most of them inexpensive devices Thought they were sex toys No, I want to I want to get into this because as we were talking all fair some of the stuff I didn't even consider but before we do I want to talk about the the subtle health effects Yes, of suboptimal sleep because I think we all know I'll tell you what I I experienced this Just just through my wife because okay. We have a baby, right? So a 10 month old baby And he's still got some challenging sleep issues, but as you know in those early months That's probably the most sleep deprived. You'll ever be in your entire life. It's just it's a lot of it's crazy watching my wife's mental state literally deteriorate through that process where She didn't remember things her personality change It's it was extreme right and I've experienced sleep deprivation to where it does that but most of us don't get that level all the time It's much more subtle We might not notice and but I'd like to talk about the effects personally for myself What I notice and this is only because I podcast and do you know, YouTube on a regular basis I wouldn't have even noticed this had I not done this for a living my verbal fluency Drop 100% I am I can't recall words as quickly. I'm not as sharp I'm not as whatever. I can't perform as well charisma. Whatever you want to call it I notice a 10% Decrease in that and I'm only paying attention because I do this show if I had a desk job I don't think I would have noticed What are some of the the effects that just you know kind of low levels of consistent poor sleep can have on our bodies And it's such an important point that you raise because we want to flag these symptoms for people and cognition is definitely one It could be brain fog. It could be word search. It could be short-term memory as your wife experienced And it could also be just the ability of mood Meaning people are more depressive more anxious for some people they skew toward anxiety for some people with depression and that midday slump I think is kind of a Precursor to depression right if people get tired enough. It's this kind of fatigue depression where everything feels like a chore Right, you get a text with oh, you got to pick up our child from daycare early And it's like it feels crushing to you right because you don't have the energy just to run through it and get it done Cognition is a big one Fatigue is another big one and that just could be subtle fatigue, but you shouldn't feel tired in the middle of the day Right there shouldn't be a stretch where it feels hard just to live or to do stuff There should be an even keel of energy and so if you're having that I don't feel like working I don't feel like working out. I don't feel like doing this That's a flag that there could be something that's problematic with sleep not sure like we're all human We're gonna have a day here in there, but if it's consistent. Yeah, if it's fairly consistent High blood pressure is actually another one that Has been correlated now. Is this because You're bought you're trying to offset or at least your body's you're like giving your body signals I need to stay awake their form creating stress catacolamine production goes up increases Blood pressure kind of as a side effect of the fact that you're trying to offset being tired Yeah, I mean that could definitely be one mechanism There's also evidence that has shown when people sleep poorly. They make more poor food choices So it could be people eat higher glycemic foods Adam talks about all the time all the time I always notice whenever whenever I have like a really poor night's sleep I also have the most random like greasy fast food type of craving for the serotonin dopamine fix or whatever Thank you to kind of medicate very interesting now what about inflammation or Gut health this is an issue that I on and off deal with do we notice effects on Like for example gut health and digestion from porcelain Yeah, you know when I was writing healthy good health you we did a whole review of the evidence on sleep And it was pretty amazing to see Every facet of health that's been studied as it pertains to sleep Gets worse when sleep quality or timing is interrupted everything everything that we researched From heart disease to cancer to kind of decline to high blood pressure to IBS to IBD Everything and usually there was a meta-analysis meaning a summary of clinical trials that substantiated whether it is a gold standard Yeah, which is the highest level of scientific evidence So it's you know to your earlier point if you're talking about two or three of the most important levers for your health Diet exercise and sleep are gonna be the top three and I think sleep might actually be the most important Honestly, I think so what is what I mean since you are you're getting people in the clinic all the time And you and you guys have so many patients that you can assess this with what is the order of operation look like for you Like how does that I'm a patient? I call you I'm like so this is so key right because this wasn't this isn't my primary area my primary area is GI and I was noticing that my aura ring Attracting wedding band like sleep device. I was like a Best a B plus sleeper kind of gives you like a score like hundreds the best Yeah, and I was also in between C minus and B plus But I'm saying to myself geez I have to live like a nun or a monk to get like a B plus Maybe there's something going on with my respiration quality That's limiting my sleep. Well, so pause there for a second. Okay. What were you doing? What did you have to do before because you weren't looking at respiration quality before is what you're saying What were the things you had to do before that had to be perfect before you even paid attention? Well, so I was eating too late I was exercising too late and I was going to bed a little bit later than I should So I kind of had this rhythm and this this is where the the biometric tracking devices I think have a lot of merit They help you see the patterns that aren't serving you So I'd work all day and then I go to the gym maybe for 6 30 get home Maybe 7 45 then I go in my sauna wouldn't get out of the sauna until 8 15 And then best-case scenario, I'm done eating at 9 15 and I'm trying to go to bed at like 11 11 30 And that was just too much kind of consolidation of stimulation and eating too close to the bed window Got it So now I go to the gym during lunch and I'll go in the sauna at the end of my day at maybe 6 And I'll have my meal at 7 and be done eating maybe 7 30 and get the bed at 10 30 So I was just shifting some of those things It wasn't too hard to do but I needed the awareness to your earlier point because it wasn't super obvious I wasn't debilitatingly fatigued from doing this But I was noticing that my word recall and that kind of capaciousness of your vocabulary was a little bit more shrunken down And I'd hear maybe an interesting word or thought But then three days later be like, oh, what was that thing? Yes, right? That's the best way I can explain now It's like, oh, there it is Yes, I'll find myself having conversations with the guys on the show and there'll be a word that I want to use And I'm like, I don't have to use like a dumber sounding word To describe it and I was like, why couldn't I get that word out? And that's exactly what I noticed Yeah, so that's pretty wow. And so it was though. Yeah, it was those sorts of things I started to notice Um, but here's to your question of order of operations This is something that I think conventional medicine does well in the realm of conventional medicine Meaning, you know, colorectal cancer screenings heart attack screenings They they do well for shunting you into that and they have a good order of operations in integrative and alternative medicine That hasn't been developed So it's kind of like the wild west and as I started going out and doing consults with different Either orthodontist or dentists or physicians in sleep medicine It was absolutely crazy The one of the first consultants that I saw said you need to have your face cracked open to have mandibular maxillary advancement surgery to open up your airway That's a huge intervention huge intervention and juxtapose that with there are meta analyses So summaries of clinical trials that have found that what's what's known as myofunctional therapy Which is essentially physical therapy for your palate for your tongue and your throat to tonify those muscles is as effective as c-pap So I was being told to go beyond even c-pap and go to a surgery where they literally crack your face open It's like three months to recover and there was never a mention of well. Here's our baseline test. You're showing some moderate drops in your oxygen levels Let's have you do four weeks on myofunctional therapy Reassess the test reassess your your symptoms and then if you're feeling better great if not we can escalate And this is kind of your point there needs to be an intelligent order of operations And oftentimes an integrative health care. There's not yeah So again, let me pause you there because I want to emphasize this as trainers when you would get a client Who's obese wants to lose weight There's it's usually not one thing that's contributing To this issue. There's lots and lots of things that are contributing And one mistake that new trainers make all the time is they throw everything but the kitchen sink at the person Okay, here's your diet. Here's how you get sleep. Here's your workouts. Do it this way You're gonna walk this much We're gonna do mobility and it just doesn't work because it's too much all at once And there's no way someone can go from doing nothing to all that on a consistent basis It seems a lot of these physicians too. They they find something like that that really has helped a lot of their patients But then that becomes their first go-to and they jump past all these other You know protocol. Yeah, so you have to figure out as a trainer what adam said order operation. Okay I know we're gonna do one thing at a time So let's start with this because this is the most impactful And it's probably one you can stick to and then when you get that down and what you're talking about is Before you go and get this major Face surgery or then right wouldn't it make sense to do like some physical therapy? Yes So order operation is extremely important anytime you're helping anybody do anything especially in medicine So what have you have you pieced? Have you started to organize this and pieced together? And so so that's what I've done in in gut health care, which is you know, we'll call in health care and algorithm It's kind of like this cascade of decision trees Start here, you know, if better you're done if not good you can go here and then You know, you just keep cascading down and into your earlier comment You start with the interventions that are least expensive least invasive and will help the most people Shocking, right? And then you you proceed through And also to your point of doing one thing at a time and into the order of operations From each step you learn You're not doing seven things you're doing one thing So the the person's response gives you valuable insight that didn't work Hmm, it could suggest this or it did work. Hmm. It reinforces this right and so there, you know It's it's a little bit more tortoise Right, it's not like all this stuff out of the gate But you actually cross a finish line much more quickly when you when you proceed that way And you know, that's some of these devices that I brought to kind of articulate this Which um, so you have this yeah, let's start with the first one Okay, so this is something you you put on your under your shirt and there's a magnet So essentially you have this ball on your back that if while I'm in bed if I roll over to it I'm not going to want to lay on my back. It's going to feel uncomfortable or remind me to roll my side What kind of success first off? Let's talk about sleeping on your back. How big of an impact does that have on uh, sleep quality or what you were saying what was was what respiratory What was the term respiratory events? Yeah, so so how big of an impact is just sleeping on your back out on that? Well, what you'll see with either attended sleep studies or what we're using now, which is called the watch pat one home sleep test It's essentially a watch like device that's hooked up to a pulse oximeter that goes in your finger And a sticky note that goes in your chest to listen for respiration signs snoring and apnea events or where people stop breathing or are gasping for air You get a report for how many of those events occur on the back on the side or when they're on You know laying on their stomach and there's a pretty strong correlation where the most of those events occur when you're on your back And this is because if you think about all this musculature The tongue and the throat muscles slough down into the oral airway when you relax in this position Whereas if you're on your side The tongue can't kind of slither back into the throat Right and this is part of what that myofunctional therapy does some of the exercises are just like you're calling a dog And it's just you know getting some tone in that musculature Um, so I actually don't know how well studied this device has been but I do know that I could start someone with this Right have them On a nightly basis wear this ring that tracks their oxygen levels And see if after a week their data improves and if so great Maybe they don't have to do myofunctional therapy for a month if this positional device suffices So I don't know the actual stats on what is your experience? What have you seen anecdotally with your patients with with just that With this there it's still a little bit hard for me to say because we've been we're still kind of mapping out the algorithm So I don't want to speak too far outside of my clinical experience. We have I have I'd say six to eight patients right now We have baseline watch pat one data on who are either using myofunctional therapy or a positional change device And we're waiting here on them back so far two have reported back And the two for two have Almost experienced life changing results just from that now these were pretty well queued up where one gentleman had severe apnea and And this is actually a pretty interesting story He could not tolerate a cpap. They say it can take a few weeks to kind of acclimate Even after the acclimation period he could just not see because it was too uncomfortable for him. So We then had him do myofunctional therapy and within a month His debilitating fatigue and brain fog started to clear now It doesn't clear like that right because you're talking about because you're building muscle or strength. Yeah, so yeah, it takes a little while but he was you know pretty much on the Like man, I'm going to jump off a cliff here if something doesn't improve my life and After about a month. He's like, yeah, I feel pretty much back to normal. Wow. That's so I know for me I can't sleep on my back because if I do my wife will punch me because literally I 100% now I don't on my side I don't sleep on my stomach because it's super uncomfortable But I sleep on my side and on my back 100% I snore every single time So that would make it one other thing that you just reminded me. So I don't want to forget I was going to bring this. It's kind of large There's one trial with this device. It's called the smart nora It's a pillow that has a volume sensor and it will inflate. So your head tips when you start snoring Oh, wow That's interesting. So that is very I'm about to run an experiment with that myself just to see what kind of impact And I just came across that last week. Wait a minute. Is it recording like your your noises and sending it to some like tech company because I don't All of a sudden googles Who you're cursing in your sleep or is it whispering like, you know to sell me shit at night? No, that sounds interesting So it picks up your sound and it causes you to It just inflates the pillow so that it kind of pushes your head to the side Now this magnetic kind of half ball thing because that's similar similar to that This is going to be the cheapest entry point. I think this was like 20 bucks. The smart nora is about 300 Now, where do you put this like right in your back? Like you said like a t-shirt it attaches. No, no, but where in the middle of your back in your shoulder blades Okay, okay, so just to stop it to complete. Have you tried this? I have not tried this yet. No, very very interesting Okay. Um, all right. What else you showed me that ring. What does that ring do exactly about this ring? Because we want to be able to assess these things As best we can but not make it super expensive So Someone could argue. Well, if you think you have apnea, you should go into an overnight sleep study Yeah, but if you don't have insurance that can be at least 700 dollars if not a thousand And to get insurance to cover that sometimes it's just so much bs right where people give up after a while The watch pat won home sleep test or other similar home sleep tests give you proximal data It's not going to be perfect, but it's enough to say. Yeah, there's an issue here or no, there's not And then this device I think it's about a hundred dollars When you slide this on It starts It should turn on here. Yeah, so This will assess your heart rate and your oxygen levels and I sent you a picture of this Um, if you guys want to include it in the notes. So right now I'm at 82 beats per minute And I I use this the other night where I had a bad night's sleep What was so interesting about this was Once your oxygen levels drop below, I believe it's 85 percent That's fairly low. It's way lower than you want to be the ring will buzz to wake you up to pull you out of this How's it's like sensing your oxygen levels infrared, right? I believe it's infrared. Oh, wow. Okay. Yeah I mean the whatever the standard pulse oximeter. I believe pulse oximeter. They've been around for a while Yeah, yeah, that's what they're putting on people with uh, kovit. They're having them wear them And just just imagine because I just was you know, the old I mean, you had to do that through blood, you know the last time I right and and these sleep studies You know what turns me off about doing this because I probably have some form of sleep apnea. I've been told By you know, my wife tells me if I've ever you know, why don't you do anything? Okay, so here's so here's the thing so two things that helped me Two things that helped me one is not sleeping on my back two is being lean if I start to get heavy Not a supplement for it. Yeah That's why if I start to get heavy I can tell that my sleep quality kind of changes But here's the thing to do with sleep study where you go to a lab You got to go over there spend the night and don't they hook you up with a bunch of shit How the hell are you gonna sleep anyway? I so I'm like, I'm of course. I'm gonna have bad sleep I got all these wires hooked up to me and I'm sleeping in a weird room knowing that they're watching me But you still you still do get valuable data even though As I did I slept like crap when I did it and by the way, yeah, it's a ton It's like 20 minutes of a tech just hooking the wires and then they're like go to sleep relax And we're watching you. We'll just be watching But when you do have those short periods where you fall asleep It's that's what we're looking for in those short windows where you do fall asleep are that these, you know frank apnea events But you didn't want to do the sleep study. Is that the main? That's it. It's just a pain in the ass I'm the worst patient with it. I had a really healthy client who just did this like a month ago And found out she had severe sleep apnea from it. Oh, she said was life changing, right? Didn't she she worked right here that she was really bad and so you asked earlier like why are we doing this at the clinic or something? That effect it's because there's a small subset of patients We get their diet, right their lifestyle, right? We clean up their gut health and that's huge for a lot of people But there's a subset where they still got some fatigue. They still have some brain fog. They're not responding What else is it and one of the challenges in integrated medicine is There's so much lab and supplement company educational influence. So it's run this test It could be mthfr run this test could be a dream fatigue and I found a lot of this stuff is crap Is the jit not helpful But this is an area where it's like, hmm, we know that sleep is hugely impactful And we know that when we fix problems with apneas hugely impactful But people don't want to go in and do the overnights and people don't want to use the c-pap But there's all these other things. So another device here this mouth guard. I'll take it out. I'll take it out in a second Okay, um, it's called a mandibular advancement device So it's like a mouth guard that it brings a lower push to draw forward and if you sit up real straight Yeah, can you hear that? Yeah, yeah, right? That's how Adam breeze all the yeah So you've seen that's why the audience do that in the in the microphone. It's that guy over there But part of this is pretty endemic in western cultures It's kind of the the west and a price facial development due to nutritional Insufficiencies and the jaw may not form forward enough So this device has also been shown to be similarly effective as c-pap and it's just a mouth guard So this is what i'm so excited about the clinic where I didn't know this six months ago But there are all these things that can be done that are about as effective as c-pap and now the people who are Suspected to have a sleep problem, but are like, I don't want to be a frankenstein every night with that thing in my mouth Like there's options for them. This has been my fight Yeah, the whole time my dad was like raving about his c-pap because once he he started to use it It's like it was life changing for him a lot like your clients But like for him he had chronic acid reflux and had all these gut problems forever And all of a sudden it was like an overnight thing where he didn't have those issues And I thought that was really interesting And uh, he was trying to sell me on it, but i'm like i'm not going to be hooked up to a Darth Vader mask the rest of my life You'll never have sex again. That's how I feel like oh, honey. Let's go to bed With that thing like no, thanks. Yeah, so okay. So this is very interesting here So what you're seeing here these bands want to pull actually would be this way start So this is a top jaw and this band is pulling the bottom jaw forward And so that little bit of room now clears that just a little bit of resistance pulling the lower Can you hear that? Have you tried this? I have man and how does it feel to wear that? I don't love the way this feels right, but this is relative to doing nothing All right, so if this is relative to c-pap probably okay But this is what's been so insightful about doing this, which is okay if you have someone who's like doc I'm just so overwhelmed. I can't do 10 minutes of my own functional therapy per day Okay, then we'll give you a mouth guard, right? So we can kind of personalize it to the individual right like the type a who's like exercises sure I love exercises Great my functional therapy for the person who's like man. I got a kid. I'm super busy I'm barely like getting by wear this until things open up and then we'll go back to my Is that an expensive device? This is about $400. Okay, so it's not terribly expensive But it's also not $10 like the positional change Well, I want to know so you're you're just now starting this So you haven't had an opportunity to really test this because I'd be curious to see the the patterns that you find like What type of client like can I visually tell like oh this person's like really obese This tool will probably help them the most or if this person's got they're in great shape So maybe it has more to do with their jaw like you haven't seen that yet Have you but I'll tease some of that stuff out one of the things I try to do is really look at our Initial intake paperwork and try to tie that to these interventions and there are certain things that flag and paperwork. So if people have Fatigue that's unresponsive to anything else. That's one flag because a lot of the patients will see They're pretty savvy with health, right? They're not coming in like drinking syrups and smoking cigarettes Like they do paleo. They do crossfit. They're you know, they're pretty well to do and if there's still fatigue there That's one flag if they had a history of braces or headgear That's another flag because braces and headgear oftentimes pull everything back Oh, because you want aesthetics, but it's not necessarily. Yeah to straighten the teeth They pull things back rather than opening up the oral airway So braces headgear is another and then snoring Dry mouth or drool on the pillow. These are all also flags man. I got like four of those that you just He's a big drooler. Yeah, and so then you look at those and You say, okay, does this person also have irritable bowels? and Am I suspecting that they have a lot of histamine meaning if your guts really inflamed there's a lot of histamine That's a byproduct of all that inflammation and immune activity And when someone has a lot of inflammation and histamine it can cause Their nasal passageway to get a little bit more inflamed and stuff. Oh, sure, right? Sure So it's okay. Like this is probably not necessarily a structural issue. It's probably inflammatory So we'll start with going through the gut algorithm and then reassess But we'll have queued up in our problems list We go to the structural issues next if the gut work doesn't reduce the sleep You know the the what we're suspecting to be a sleep impediment. So we are starting to see some of these things kind of You know in terms of what are the early warning signs to how they map on you You know, what's interesting about some of the stuff that you're you're bringing out here when you're talking about Diet and exercise, which are the other pillars, right? Exercise oftentimes requires okay. There's lots of movement pattern exercise programming We got to make sure we do the right workout. Oh, you got to be consistent with it It's not something you can just put on and it's going to help you actually have to go and participate in it So there's that challenge But that's easier than diet diet's even harder diet is really complicated Especially when you include the psychology of the person that you're working with what kind of attachments they have with food How they value food do they self medicate with it? This is obviously something we worked with for years with clients very challenging You know as a trainer much easier to get somebody to be consistent with exercise, which is hard Then diet, which is even harder But what you're showing here is pretty cool because and i'm not saying you know fixing subtle sleep issues is necessarily easy however When you're talking about putting something on your shirt or wearing a mouth guard and that makes a difference Like that doesn't happen with exercise and diet and yet improving your sleep will have just as big of an impact On your health and listening to this is actually getting me kind of excited because I know I have issues With sleep. I don't want to do I don't want to do the sleep study. I don't want it to pain the ass or whatever I know I sound like a jerk. We'll send you a watch pat one. Okay. All right one night It's it's like I think 150 to do the test you wear a watch one night And you have baseline data. Wow, and then we can monitor you with this guy right here Which I think is $150 and this is what I'm excited about that we're figuring out in the clinic like we don't have to say Do a overnight sleep study and then do another one after six weeks Because like who's going to do that? It's just not practical. Are you noticing any connections to? Things that people use commonly to help them sleep melatonin marijuana not to cut you up, but on that one I've seen some people who are using way too high of a dose of melatonin the the 10 milligram dosing I've noticed make some people sleep worse. So I think people should be careful not to go much above maybe three milligrams But I also don't know if people have good sleep hygiene Meaning they have a good pre-bed routine wind down reduction of light and stimulation Which is rare by the way. They they shouldn't they shouldn't be Needing melatonin outside of a rare occasion And it doesn't have to be an intense like two hour wind down But I will say if you can watch the sunset that's something I've been doing up in Walnut Creek a few nights per week I'll um Sauna eat and then I'll walk up to this hilltop and watch the sunset You want to talk about a great way just to feel phenomenal and like your head's clear and see your sleep scores jump And your readiness scores jump It's that little bit of time Honestly, are you noticing with your with some of your patients when they improve their sleep? Justin brought up has dad had acid reflux that went away. Are you noticing things that normally we wouldn't connect To poor sleep improve like inflammation I don't see as much of the the gut specifically because we're going to be addressing a lot of that stuff early in our kind of therapeutic algorithm um But I wouldn't be surprised if if there is a whole array Of non responsive symptoms that you'll see respond because coming back to the earlier point where I said there was meta analyses on ibd ibs all these different things that improve Or correlate with poor sleep then I wouldn't think that there's anything that couldn't potentially respond Okay, so you so so so the ring you showed this ball this mouth piece, which is I see some tape Is that something else? Yeah, so mouth taping is something that can be done. I wish to do this with self for sure Yeah, you beat me to the job You just take a piece of Yeah, I'm Italian. I got my hands. This is good for relationships too. This is as a therapist You you just put a piece of tape over your lips at night And it discourages mouth breathing and for some people They will Not revert to mouth breathing if there's that resistance there they'll nasal breathe, which is better for respiration at night I've seen this how people Maybe 15 20% of the time it's not huge and I do think there's A number of people who are using mouth taping where it's not doing anything But because there's a lot of buzz right now about mouth taping I've seen it on the instagram post people like their shoulder, you know, I use um, I use those nasal Pathways to encourage that like if I though the ones that have like the aloe vera or whatever in them If I wear that it encourages me to breathe through my nose because if I'm at all in the slightest bit congested I won't breathe through my nose and I breathe through my mouth and I notice better quality sleep just from that Now what about combinations? What about okay? I'm going to use this ball the mouthpiece Yeah, definitely. So if someone's wearing this mandibular advancement device They might be a little bit more prone to mouth breathe So you have them put in the mouth guard and then mouth tape Right, so and this is where just some personalization and and having some data like this night overnight ring score And I'm trying to have most patients pair this with an oar ring Just so I have two different ways of looking at the data. They do give you different scores But you're looking for things to improve because the other side of this coin is you don't want someone doing a bunch of stuff To making it worse or or just like having no benefit, right? I didn't notice with mouth taping my oar ring scores changed at all So I stopped mouth taping and I think that's another important part of this equation Which is we don't want to do everything we can do kind of to your earlier point about as a trainer You don't do like seven things at once. Yeah, and if it's not working, we don't necessarily need to have them keep doing it Yeah, I know Doug wore a device that measured his sleep, but it actually Just wearing the device decreased the sleep quality. It was it was the oar ring It was when we all got the oar rings and he stopped headed. He stopped using it because he got it made him anxious Oh, I gotta get better sleep. I gotta look at my reading or whatever So that's that's I mean something to pay attention to right and that's where if someone's really anxious Then I might say, okay, we're not going to do this nightly We're just going to do that overnight watch pat one home test At day one and then at week six Yeah, and give them less data to kind of work themselves up with because yeah, it's a it's a good point You know what's interesting about just because I've looked into sleep apnea because I'm sure I have some level of it heart disease stroke heart attack cancer risks all go up from having uh, oh, yeah Poor sleep, which is kind of scary and obesity is another one that I haven't dug deeply enough to see Where the majority of the data are on this chicken or the egg because there is a chicken to the egg Right, if you're overweight, you're more likely to have apnea But if you have apnea or you're more likely to gain weight, it's probably both Oh, good point because I'd be I'd be shocked if absolutely didn't lead to weight gain to some degree Especially because of the overeating Well, like like sal been kind of avoiding this whole topic because of the you know the options were not too attractive But I actually found some there was some information out there that the didgeridoo Yes, actually helped in terms of like, yeah, like exercising the muscles there, you know, you know, that did the didgeridoo You know that one something from dr. Seuss. No, no, it's it's that instrument that Aborigines will use in in uh, australia australia. You've seen that right remember a crocodile That's another great point. So there's that study and another study that found that singers Have less osa or obstructive sleep apnea And that's another layer of intervention that we can you know consider having people start with which would be okay You're you don't want to do myofunctional therapy didgeridoo is another thing that we have built into our algorithm where when you have the discussion Okay, here's what we found here's your options Here's what I'd recommend based upon your personality Which would be you know, if you're someone that can't meditate doesn't want to sit still always wants to do something Learn didgeridoo, right? If like doing the exercises seems too boring to you something's easier for some people. Yeah, exactly Yeah, and that's like the art of medicine, right? Which is having all these different things and rather than saying well the test showed this So you must do that The test showed this and so there's a few different ways We can achieve the that that we're looking for and we're going to be a little bit open-minded and flexible And i'm not going to say well, there's more data on myofunctional therapy So you've got to do that and you can't do didgeridoo because i'm evidence-based like I really believe in being very Evidence-informed but not evidence limited. So didgeridoo. Let's do some speculating. I know you hate this You're you're super you're incredible integrity. So every time we ask you to speculate you're always like well I can't give you an answer because I like this studies, but we're gonna do it anyway We're gonna put just why do we okay? We always hear about how much worse sleep is today Oh, so there's this huge epidemic of poor sleep and people aren't sleeping. Well Is that true or is it just that we're more aware or is it or is modern life in our lifestyle Contributing to poor sleep or again, is it just awareness? Well, um Certainly I think there's a lot of possibility to the argument that With lighting and the ability to just skew your circadian rhythm to however you want that Yeah, our sleep to an extent is almost for certain worse than it used to be because A few hundred years ago, you couldn't be watching the television at night in a brightly lit home at like midnight All right, so there was natural factors that kind of encouraged us Encouraged us our to have that day and night circadian rhythm and that is huge That's another thing that's been found in the literature Which is you could have eight or nine hours of sleep and it's self reportedly refreshing But if you're a night shift worker All cause mortality death many cause goes up. Oh, yeah, right So I've seen that. Yeah. So so so some of these are easy to say yes to and then I think Matthew Walker has done a good job Of exposing how caffeine too late in the day Can decrease REM and deep sleep. So with you know, the overuse of caffeine or using caffeine too late in the day Plus the devices and bright light at night Plus our lifestyle is just being so much more Kind of hamster wheel On the internet rather than low level constant stress. Yeah So, yeah, I think it's pretty fair to say our sleep is worse than it was before I think some people take it too far And they're trying to Become almost exactly like a hunter gatherer like I've heard about some people Because I think it was aborigines that that found that it got colder Into the middle of the night and then it warmed up They try to set their thermometer stat to like replicate that Oscillation and temperature that's all fine and good, but that just seems like a bridge too far Whereas these things are probably more squarely hitting what most people need Dude, I so we work with a company called uh chili right so they make these chili pads Okay, so trip off this right so there's a there's a function on there where you can have it Warm up Like start to warm up about an hour So here's what I did and this was a game changer for me I have this alarm clock that doesn't like just jar you awake It slowly glows and it simulates the sunrise and I paired that with the oeler Which is one of the chili chili products that starts to warm up and I wake up like I'm not getting woken up by an alarm clock I kind of like just great. Yeah, which is you know kind of cool. So and I'm all for those things But if you're doing that before addressing potential apnea, there's been a really like inverted Order of operations. Yeah, that makes a lot of sense. Okay. Um, what about men versus women? Is it because you said that men tend to have more of these kind of this respiratory issues? Is it generally that men have more sleep or is it the other way around or the other factors? Well, yeah, again, I don't know all the nuances of this body of literature But it probably predominantly due to the fact that men have more muscle mass Men have more snoring and more apnea. So this is something that skews toward men Yeah, that's the stereotype right that the guys are the ones that are snoring and stuff like that hormonal issues Do we see it affect hormones and men low testosterone higher cortisol? I'm glad I'm glad you asked this so there are some clinics that They do two things sleep assessments and testosterone monitoring Because there's such a tight correlation between poor sleep and lower testosterone Now, how much you can move the needle with that? I've yet to see so as you may know, I'm very circumspect Right and try to be careful about well There was one study that found in mice that when we stopped interrupting the mice's sleep Their testosterone increased by 200 percent. Okay, great. Let's open a clinic It's okay. That's maybe going a little bit too far But it does make sense that you'd see perturbations sub optimization and testosterone in men who have apnea I'm just I haven't seen yet Whether you're going to talk about like how big of a 50 point jump a 200 point jump And I haven't dug into the literature yet to see but I'm assuming what I'll find when I do that Is there's at least some preliminary evidence showing a meaningful improvement in testosterone When you get rid of an apnea. Okay. I want to go back to caffeine You mentioned caffeine and I know this is something that you're You know somewhat well versed in because you You know, obviously when it comes to gut health when it comes to You know helping someone with their hormones. I know you look at caffeine quite often now We it looks like we're in this culture of caffeine nowadays when we were all kids Obviously, we didn't drink coffee. That's what teachers and adults drink right now caffeine seems to be consumed by everybody I think the only time I had caffeine would be I drink a coca-cola or something like that Um, and I noted and also we see lots of studies touting the the benefits of caffeine. Um, you know, it helps with brain health It's good for insulin sensitivity. Good for athletic performance blah blah blah I know as a trainer, there's a huge individual variance and some people do poorly with caffeine Do you can you get like a general guideline? Like what is the doses that you tend to see with your patients that tends to be okay and what tends to be too much? Well, I don't get that granular with monitoring their dose, but And and we just wrote an article on this so if people search My name and caffeine they should be able to find this review Because it is an important point and there are some that have said, you know, there's certain compounds in coffee and therefore you shouldn't drink it and You know, I don't mean to keep kind of being on this drum, but this is why Levels of evidence is so important, right? There's this one blog out there that got some attention because This blogger referenced a mechanism that coffee impacts that's pro-inflammatory or something like that If you weigh that against the meta analyses that have found Coffee is neutral to beneficial for metabolism for cognitive health Um Pretty much the data shows coffee the high quality data I mean, you know, not the mechanism and then we speculate But what happens when we look at free living humans who are either doing this or not doing this You see neutrality to benefit with coffee with one or two small caveats that are probably more so situational, which would be reflux IBS, especially diarrheal IBS But once you improve the health of the gut, then I don't find those conditions to be provocated by caffeine um, so The dose is another good question I think there was a good article. I believe it was With examine.com and I think they found that it was either 200 or 250 milligrams was kind of this cutoff point Which kind of resonated with me where I'll find You know, if I go beyond six shots of espresso in a day That's when I start to feel a little bit jittery and like I have less energy So I think everyone's going to be a little bit different um Listening to that person's body is probably the best way to suss that out once you have them Where they're more tolerant and that's where if someone does have a sensitive gut Caffeine can be a little bit simulatory potentially a little bit noxious But getting their gut sooth and healed then they should be able to tolerate that just like anybody else I notice my caffeine tolerance is way different when my gut is healthy. Yeah, like when I when it's off Uh, two 150 to 200 milligrams. I can get anxious Yep, when my gut is good 400 milligrams and I'm having a great workout So that's why the gut is the foundation of what I do because it's so so important Yeah, so so but so you're saying now though sleep is something that you're starting to include and with these people that you're Including working on this has been pretty profound then it has and I'm I'm actually really excited because so coming back to my story When I as a patient went into the world of sleep medicine It was crazy It was surgery is one option and then the other I didn't have a chance to tell you about was this essentially an expansive retainer That I'm sure would work But I would need six months of braces to restrain my teeth after wearing this And that seems like you know, if that's my only option, right? Maybe but it just baffled me that some of these other therapeutics weren't offered up And so that's why I took it upon myself to put together the sleep algorithm at the clinic because no one else is doing it So yeah, I'm I'm quite excited about it. Oh, that's good Well, I'm glad I'm glad you brought this and showed us because I we're always for things that are Less invasive less intrusive a little easier less expensive that have a good impact Before moving into some of the bigger stuff and I'm excited now Would you ever check these things before you do the gut stuff or you always do go into the gut first and then do this? well, I mean It would it would depend if someone had some pretty severe flags Where there was severe dry mouth severe fatigue severe snoring a family history of apnea Maybe they had a sleep study like two years ago and a diagnosed apnea But they never wanted to try the CPAP because they were scared. Yeah, then that might be okay Let's do these kind of in tandem. Yeah, so it would it would depend certainly I'm never going to force a gut solution upon someone but just knowing how Pivotally and foundationally important gut health is it's always going to be a thought. Yeah, definitely Yeah, I'm I'm wondering right now as we're talking I'm my wheels are spinning It could poor sleep could affect motility, right? Which would then potentially increase your risk for things like SIBO Yeah, and this is why we we see poor sleep increasing IBS prevalence and I'm assuming once the research gets a little bit more sophisticated And they're saying is that IBS along with SIBO will probably find That as the research has shown, maybe around 40 to 50 percent of IBS cases are underlie by SIBO. Wow. All right Very fascinating. Well, cool stuff. I'm glad you brought this stuff and this is something that for sure people watching right now can Implement for pretty inexpensive. I'm personally going to try I want to do the ring and I might try the mouthpiece Is one of the things I'd like to try but I'll talk to you and see what you can get you guys lined up And it'll be interesting to kind of look at you guys as The tip of the spear from the athletic, you know performance Cohort to see how much this has to benefit someone who's really got everything else Dialed it. I predict the three of us just the three hosts here have terror. I guarantee you see us all sure it's underlying Yeah, I've shared with you guys sleeper and I know I've had to do things where I put like on my nose Did you get me in a breeze so I sleep better so now you elect sleeper you guys generally elect sleepers Are you deep sleepers? You know, um, I used to now that have kids I guess I'm probably a light it depends on the sound that I hear but I'll pop up right away So I don't know if that has to do with being yeah, say what I say I'm out like a light Yeah, yeah, no, so I would say I'm probably a light sleeper now. Okay. Is there a correlation to that? I mean if you know, I don't know that that's what I'm trying That's what I'm asking because I'm trying to learn the correlation is between between the two I've always been a light sleeper myself, but I'm not sure if that's just constitution or if that's a flag They do say that teeth grinding or bruxism is one red flag that you have a problem with with apnea also Um, I can fall asleep anywhere at any time. I feel like that's a red flag I should not be able to fall asleep That is definitely a red flag daytime sleepiness. There's a I think it's called the epley um questionnaire And it's one of the kind of peer reviewed validated sleep questionnaires But I find it's a little bit too You have to be a little bit too severe to fully flag on it And that's what we've built in some of those other things like it's weird how he does it though Because I feel like he's got really good energy and mood is consistent and well and then but yet If we get on a plane before it even takes off, he's out or if we get in a car Drive somewhere he's asleep before we get around the corner. This is sell. Yeah Consistently, yeah, but that might be just all you know Firstly, I'm assuming pretty strong baseline constitution and then all these other excellent health practices But to your other point maybe that word recall and that that next level of cognition is really what's going to open up for you Yeah, and I'm also one of those people said if I get a little tired It makes me more wired and so it might come across as oh, he's energetic right now But in reality I'm fried but that depth of thinking and this is something I've noticed My depth of thinking has gotten so much more profound It's and especially now that the clinic is growing or pioneering some research initiatives and there's multiple people Um, I really have to have that kind of deep thinking where you're looking at all these complex gear wheels And how they kind of fit together And I don't think I could be doing this if I didn't have The sleep that I have now because it's like five years ago is more workhorse Just get the stuff done right. Yeah, but now grinding doesn't get me any farther. It's that very deep insightful thinking I was listening to a Lecture with Jeff Bezos and he said I am paid a lot of money to make very few but very important decisions And I think that's the evolution of most entrepreneurs You want to get to that point where it's not like hamster wheel like grinding It's now you're kind of sitting atop like the Ray Dalio principles book recommends You know, you're sitting atop at this complex machine and you're giving these very strategic inputs So there's not a lot of decisions, but the ones that you do maker so so Yeah, they can go one way in a big way or the other way in a big way. Exactly. Excellent. Well, sorry I don't want to get you but I just want to speak to the females for a moment that Females will have hormonally associated sleep problems. Obviously if they're having hot flashing And I just want to mention to women that there are herbal Options that can help to balance out female hormones like donkwai and black cohosh So there are options there for women who might say, well, I don't want to go on hormone replacement therapy. It scares me Okay, understandable I think with a low dose that can be done Pretty darn safely, especially if it's bio identical But there are also herbal options for women who might be and one of those two again in it black cohosh black cohosh And donkwai I use a formula called astro harmony Which has a kind of combination of those with white peony and licorice as just one option But for women If you're feeling that warmth at night Then and you're you know getting to your I'd say anywhere from your mid 30s on where just when it may start flagging What's that one supplement? I think it's it's it cuts with the v vitex. Thank you very much Also may help but vitex is more so something that will help spur Natural production on a progesterone But the the challenge of vitex is it works in the brain As a dopamine agonist meaning it helps agonize dopamine, which you want Stress can kind of tear down or use up dopamine And dopamine in the brain It's known as a tonic inhibitor of prolactin So if dopamine goes low In a roundabout way your prolactin goes high And that thwarts the ability of the brain to signal the ovaries to make progesterone Got it. But when you're post-menopausal that communication from the brain of the ovaries is kind of shut down So so chase through your vitex doesn't work In a menopausal cohort because it goes through the brain and that brain access is so waste of time So yeah, if you if you're pre menopausal then chase you can be helpful But if you're post-menopausal you either want to use the estrogen modulators like black cohosh and don quai Or a low-dose Hrt Excellent. Well, cool. This has been very informative and I'm excited to try this out So I'll give people update on how this affected my sleep. Love it. Yeah, thanks