These Sleep Experts Explain How to Get the Best Rest | Health Theory

Chronic sleep deprivation has system-wide effects. It sleep affects every organ system and every disease state. Let's be very clear here. Cancer cells multiply faster the more sleep deprived you are. Everybody, welcome to Health Theory. Today, we have a very special episode for you. We've got not one, but two amazing minds with us. First is clinical psychologist Dr. Michael Bruce, known as the sleep doctor. He's one of the youngest people to pass the board and his expertise has seen him featured on countless high-profile shows, including Oprah, Live with Kelly and Ryan, The Early Show, and about 40 appearances on Dr. Oz. Second, we have Dr. Jason McKeown, an accomplished neurologist, CEO of medical device startup Neurovalens, a good friend of mine, and the creator of what could be a revolutionary new sleep device, Modius Sleep. Gentlemen, welcome to the show. Thank you. Having us. Very good to have you both here. And we're going to be talking all about sleep. And we were just talking briefly about sleep efficiency. Yes. So, well, full disclosure, I'm on the board of Neurovalens, so everybody should know, but I hate sleep. And I actually want less sleep, not more. And the first time that I tried your device when it was for weight loss, it made me sleep more, which actually pissed me off, but then you started getting obsessed with it as something that could help with that. So, that I want to start with sleep efficiency. Sure. So, other than something like a device, what can we do to be more efficient with our sleep so that we don't need as much of it? So, let me tell you a little bit about my experience personally and how I became much more efficient at my own sleep. So, I'd go to bed around 11:30, I'd get up around 6:30, 7:00, 7 and 1/2 hours, 8 hours, thought I was doing okay, but what I discovered was that I wasn't following something called my chronotype. So, people out there may or may not have heard of the term chronotype, but it's early bird, night owl. Turns out there's not two, there's actually four of them, and my chronotype is a night owl. So, one of the things that I discovered is if I go to bed at my chronotyped time, and I'm super duper consistent about it, my entire sleep schedule begins to shrink. So, there's four non-REM stages of sleep, stages 1, 2, 3, and 4, and then there's REM. They all actually do different things, but stage 2 in particular makes up about 50% of the night. And so, that's the one that if you start to squelch it down, your entire sleep really where a lot of these efficiencies come in. I'm not saying that stage 2 is worthless, because it's certainly not, but at the end of the day, if you can get less stage 2, it actually shrinks your entire schedule. So, walk me through the four stages. What's going on in those stages exactly? So, stage 1 is a transitionary stage, right? It's just going from wake and getting into sleep. It really doesn't take very long, maybe 3 to 4% of the night maximum. So, if you wake up, you have to kind of get into stage 1 to go back into stage 2. Stage 2 makes up anywhere from 45 to 50% of the night. So, this is the biggest stage that you have. Stage 3 and 4 actually combine together, and this is your physical restoration. So, this is where the largest amount of growth hormone is emitted during stage 3-4 sleep. And to be clear, stage 3-4 sleep is mostly at the beginning of the night. Whoever decided and designed this whole thing, um, did it for a particular reason that stage 3 and 4 sleep at the beginning of the night helps with physical restoration. That way, if God forbid, you know, you got to get up after 3 hours, your body will still function, right? The latter part of the night is where we see a lot of REM sleep, which is the the probably the most popular stage of sleep, cuz people have either, you know, heard about it from dreaming or things things of that nature. And REM sleep is really your mental restoration. So, this is really where a a bunch of different things happen. One is you move information from your short-term memory to your long-term memory during REM sleep. Also, believe it or not, your brain is more active during REM than in any other stage. So, when I was looking at my sleep and trying to consolidate it a bit more, the stage that had the largest amount that didn't do the things that were super duper critical was stage two. So, that was the kind of the stage I wanted to see if I could, you know, squanch it down a little bit. What I discovered was if I went to bed at the time for my chronotype and I was consistent. So, that's one of the big things I want everybody out there to know is it's consistency in your sleep schedule that will begin to consolidate your sleep. Why is that? Why is consistency so important? So, here's what my theory on it is is historically we've always been told 8 hours, 8 hours, 8 hours. That's really not necessarily what everybody needs. We really need roughly 6, maybe 5:45 to 6:15 in terms of total sleep, but in order to get those stages, if you don't go to bed at the right time for your chronotype, it takes 8 hours to get them all. Mhm. If I go to bed at midnight without an alarm, I wake up at 6:17 every [ __ ] morning. It's ridiculous. I mean, I'm the sleep doctor and I sleep 6 hours and 15 minutes a night, right? Like, how can that be good? My body doesn't sleep longer than that because of the consistency of my sleep. All right, Dr. McCune, you and I have gone back and forth on this cuz you know my theory with sleep. I [ __ ] hate it. And [laughter] you also know my obsession with living forever and you've sent me articles basically trying to convince me that if I really want to live forever that I need to get more sleep even though I do not use an alarm. I have not used an alarm in any consistent fashion in probably more than 15 years. That's good. me an article one time that said, "If you read this, you'll get 8 hours a night every night. Like, you'll [ __ ] break yourself in half to make it happen." So, I actually didn't read the article because it freaked me out. So, do you agree with that cuz you were nodding? So, I think you need to take a step back and just ask the question, why does the body even need sleep? Uh and if you actually think like, you know, right across evolution for millions and millions of years, we honed down every part of our body. I mean, think of what the human body can now do. I mean, we've just run a marathon in under 2 hours. Like, it it is the most efficient machine ever. But yet, every night, we need to lie down and effectively become unconscious for a period of 6 to or whatever hours. So, you know, to say that actually sleep is maybe not that important, it's crazy to think that. If you look at what happens when you have restricted sleep, I mean, it literally just feeds into every health issue that we have. Every epidemic is potentially connected to to having bad sleep. Now, um as Dr. Bruce was saying, you as an individual, I mean, generally we're saying, you know, sort of let's say 6 to 8 hours or whatever, but you as an individual just need to get the right amount of sleep in the right way for you. So, how are we going to define that? So, It's genetic. Yeah. How much? Oh, a large part of it's genetic. If you look at people's genetic makeup, I mean, you can I I do sleep genetics on people all the time. I can take somebody's 23andMe data, I can run it through an algorithm, and I can tell you almost exactly how much sleep your body needs. What are you looking at? There's 74 different sleep markers. I'm looking at the PER3 gene in particular. So, if you look at for a snip, which is a single nucleotide polymorphism or a genetic variation, basically, if one of the building blocks of your DNA is out of order, it can make you into an early bird, it can make you into a night owl, it can make you into an insomniac, or it can make you into a kind of in the middle. Mhm. And see and and he's exactly right. You need the amount of sleep for you. I hate general recommendations. You know where 8 hours actually came from? It's a study done at Stanford in the '40s. Okay? I think our whole universe has changed quite a bit since then. So, when we start to look at it, I would argue that everybody has a different individual sleep need. Yours might be six, his might be seven, mine might be eight, right? If you don't get what you need, your body is not going to function. Again, some people hit the genetic lottery and they only need 5 and 1/2 hours. That's great for them, but if I got 5 and 1/2 hours, I I'd be a mess. So, without genetic testing, what do you recommend that people do? Like what I always tell people to do is just sleep without an alarm for a very long time. And correct me if I'm wrong, it really does feel like you need to catch up on sleep. So, I completely disagree with all of that and let me tell you why. So, there's a very easy experiment that people can do at home to figure out exactly how much sleep they need. So, most people have a socially determined wake-up time, right? In my house, it's around 6:30. So, when the dogs start getting up, I got to wake up my kids, things like that. So, we know that the average sleep cycle is 90 minutes long. We know that the average individual has five of these sleep cycles, right? 5 * 90 is 450 minutes / 60 is 7 and 1/2 hours. Okay? So, first of all, 8 hours is a myth because the math doesn't even work. Right? I mean, the math doesn't make sense. So, what I do is I take that 6:30 wake-up time and I count backwards 7 and 1/2 hours. And I tell people, "Okay, go to bed at 11:00 and see how it works." So, I did this experiment on myself. Now, literally a minute ago, I told everybody that I go to bed at midnight and I wake up at 6:17. So, Michael, what are you talking about? So, I ran the experiment and it didn't work. It failed miserably on me and I'm the guy who's creating the experiment, right? So, I went to bed at 11:00 and I woke up at 5:30. Went to bed at 11:00, woke up at 5:30 again. To be clear, I'm a night owl, okay? So, what I decided to do was move my bedtime from 11:00 to 12:00 and as soon as I did that, I woke up at 6:30. Aha. So, what did I learn about that? I was tracking my sleep when I discovered number one, I don't have as long a sleep cycle as 90 minutes. There's individual differences there. And when I was waking up without an alarm, similar to yourself, I had tons of energy, I felt good, everything worked out well. And I did two things. I shifted my schedule so it matched my chronotype of a night owl, and my sleep began to consolidate because I naturally allowed my body to fall asleep and to wake up. Yeah, one of the more interesting things I've heard you talk about is the story that you tell about the woman who went into her boss and said, "Hey, can I just run an experiment?" Or did they Did you get on the phone with them or something? It was crazy. So So, the way I got interested in circadian rhythmicity and the whole the power of when and chronotypes and all that was I had a patient who I couldn't fix. Like, she came to me, she was a terrible insomniac, and she couldn't fall asleep, and she was trying to get up, and she was dragging ass at work, she was getting in fights with her husband. Like, it was a mess, right? And we tried cognitive behavioral therapy, we tried sleep restriction, I you know, all the classic clinical psychologist who's a sleep specialist kind of things. And I failed at every one of them. And so, I brought her back in, and I was like, "Let's think through this." And she told me something that really kind of pinged me off, and she said, "Well, I feel like if I could just go to bed at 1:00 and sleep until, you know, 8:00 or 9:00." She said, "I think I'd be fine." And I was like, "Tell me more about that." And we started go down that path, and she was like, "Yeah, I think I'm I've always been a night owl. My mom told me never to take early classes in college, things like that." And so, I said, "Well, do you think your boss would ever let us just run the experiment?" And she said, "I'm going to be honest with you, I think I'm going to get fired." So, I said, "Well, can I call him?" She said, "Have at it." So, I literally I call her boss, and I'm like, "Dude, this is what I think is going on. Will you let me run the experiment?" And he said, "I'm firing her on Friday." Whoa. No pressure, right? [laughter] No Michael's not in a in a in a pressure cooker this one. I'm like, "All right, fine. Let's go for it." This was on a Monday. I talked to her on Friday. She said I could call him on Monday. And so, I said, "I want her to come in at 10:00, and I don't want her to leave until, you know, 6:00 or 7:00. Are you Are you cool with that?" He was like, "Whatever you want." We did it for a week. I called on Friday. And and it was really interesting what he said to me. He picks up the phone. I was like, "You know, how's it going?" He was like, "I have three other employees. Can you work with them?" That was the first words out of his mouth. There are 15% of the population are early birds, 15% of the population are night owls, and 10% of the population are insomniacs. Every employer out there has these people in their mix. And they're not capitalizing on them. They're not utilizing them when they when they would be most efficient. And that's what chronotypes did. Yeah, that's really interesting to me. So, one thing I have found as a kid, I would have told you I'm a thousand percent a night owl. I at one point in my early 20s, I was unemployed. And so, I stayed up late one night and woke up later. I stayed up later, woke up later. Literally until I had to set an alarm to make a 10:00 p.m. movie. [laughter] And I was like, "Whoa." And I started to feel super weird. I was out of rhythm with the world, which is more bizarre than you think it's going to be. And so, at that point in my life, it's pretty clear I was a night owl. Now, I am like desperate to go to bed around like 8:30. I'm like, "Do I really need to stay up until 9:00?" So, I never read anywhere. You're the first person I've heard say that like that level of consistency is important and that helps you shrink your time. But, because my wife isn't going to be happy if I'm going to bed early and I've sort of twisted her arm to go to bed consistently at 9:00 p.m., I go to bed at 9:00 even when I'm tired earlier. Um but that to me is weird that I went from like the ultimate extreme night owl having to set my alarm to make a 10:00 p.m. movie to now it's like my typical sleep pattern is from like 9:00 to 3:00 or 9:00 to 4:00. Mhm. So, first of all, that makes perfect sense to me, right? So, here's what's interesting is as humans, we go through almost all the chronotypes. So, one person will go through all the chronotypes? Yeah. So, think about when you have a baby. What do babies do? They go to bed early and they wake up early early. They're early birds. What happens when your children are middle schoolers? They go to bed at, you know, I don't know, 8:30, 9:00 and they get up at, you know, regular time, 6:30, 7:00. What do teenagers do? I have two of them. It sucks, right? What do they do? They stay up until midnight, 1:00 in the morning and it's hell to wake them up. So, look at the progression, right? Then what happens is around 20, 22, depending upon who you are, your chronotype stabilizes. And it stays stable until you're about 55, 60. And a lot of times what happens is is you start to go earlier, right? And so, the reason that they had they you see a lot of the old people at the diner at 5:00, right? Is because their circadian rhythm is telling them to eat earlier because they're going to be going to bed at 8:30. Now, is their circadian rhythm starting to break? Oh, no. what what would make it shift with age, though? So, it it's a biological phenomenon that seems to occur for people as as the aging process occurs, there's different things that happen. Probably the biggest one I would argue is melatonin production changes over the course of time, right? And so, when you look at melatonin production and anybody who's 50-plus, what you start to see is a decrease in melatonin production and your circadian rhythm, again, starts to fluctuate based on this hormone change that occurs based on age. So, that's probably the biggest factor as to why that occurs. And of course, with developing children, they they don't have all the hormones when they're babies and so, they start in one spot and then they get more and they get more and it just travels. Interesting. Jason, talk to me about like the brain itself. What is happening? So, what happens with shrinking of the brain and getting rid of the toxins and the detoxification process and all of that? And do you worry about that if somebody is doing something like this where it's optimizing your sleep, it's crushing the second part of the sleep cycle and they're getting less sleep than they may otherwise get? Um do you worry that the brain isn't able to get rid of the debris and all that stuff? For sure, but even before you you go into like the higher level sort of the cortex in the brain, you know, the actual start [clears throat] of all this would be the I'm sure you're familiar and the listeners will be familiar with the autonomic nervous system. So, the sort of stress response and the vagus, you know, the vagus nerve stimulation, a really popular thing. Um that's all in the brainstem and the it's the brainstem that really controls all these kind of automatic processes that you don't really think about, you know? So, as I'm chatting here and I am holding this cup, that's this top part of my brain making that decision. But while I'm doing that, I'm not thinking about how many breaths I take. I'm not thinking about my heartbeat. If I were if I had to think about that and something scared me, I'd forget and I'd like pass out. And but similarly, all these other processes that are automatic, circadian rhythm is one of them, actually starts in the brainstem. Um so, there are multiple nuclei in that area and even right up into another area called the hypothalamus. It's kind of the the the one if you're going to pick one control center, it's it's the hypothalamus. Um and that is what makes not to derail your point, but really fast, give me some of the things that the hypothalamus controls. Cuz the first time you broke these down for me, I was like, "What?" Like, the list is crazy. Yeah, I mean, the it it is literally crazy. I mean, just even the things we are interested in. So, on on the metabolic side, you've got like appetite, satiety, even things like your cravings. You've also got your metabolic rate. You've got how much thyroid hormone's released. You know, it actually at a top level controls things like cortisol and growth hormone and even insulin sensitivity, leptin sensitivity. That's just on the metabolic side. Then you've got all these other things like thermoregulation. You've got mood. You've got wakefulness. You've got, you know, your your sleep states. You've got circadian rhythm. I mean, it literally goes on and on and on and on and on. So, you know, you're just saying about sort of sleep health and how the brain works and how it sort of clear I suppose regenerates or what's the point of sleeping and how does it all start? So, it's actually that kind of core issue. Um now, a lot of the reason I'm saying this is a lot of people think it's actually this kind of top layer. So, you know, you've got your cortex and my memories and my mood and things that make me excited are all kind of up here. And people sometimes confuse, you know, having a kind of racing mind with actually bad sleep. So, they go and they put the head in the pillow and they're like anxious about something that happened and they think that's like the kind of core cause of the bad sleep. So, the solution would be let's take some sleeping tablets and just sedate the brain. But actually, that is the worst possible thing you could do because you've actually just ignored the problem which is down in the brainstem and the hypothalamus. You've just sedated your brain at the top. You'll get sleep. It might not be the greatest. In fact, you could almost guarantee it's going to be terrible sleep. And then the next morning you wake up and realize Why is it terrible? Are we disrupting something in in Dr. Bruce, maybe this is a better question for you, but Pharmaceutically based sleep and natural sleep are two different animals. What is happening that makes pharmaceutically induced sleep problematic? So, it depends upon the pharmaceutical. Okay. Right? So, let's use historic benzodiazepines. So, Restoril, Xanax, Valium, the the historic sleeping pills. They literally obliterate stage three, four sleep. I mean, they almost knock it out completely, right? That's kind of a problem. Is that what you were saying that pharmaceuticals are tied to Alzheimer's? Exactly. So, one of the big Well, and so only some pharmaceuticals, believe it or not, some over-the-counters are also tied to Alzheimer's. There's a lot of data now are they using? They use Benadryl, basically, diphenhydramine. So, anything that's got a PM on the end of it, right, is got the analgesic plus Benadryl, right? And when you get hooked on them and you have to take them all the time to help you with your sleep, they don't allow for stage three, four sleep, which is again that cleaning system, that glymphatic system that pulls tau and all these other proteins that we're now learning are leading to Alzheimer's, pulls them out. So, if you're taking a pill that doesn't allow the garbage to be taken out of your brain, it just doesn't seem like a great idea. All right, so going back to the hypothalamus, you had this whole hypothesis around stimulating um the hypothalamus by going through the vestibular nerve. Uh why would that work? So, one, help us understand the mechanism of why the that nerve actually stimulates the hypothalamus, and then why what why isn't it blind stimulation, which is to an ignorant person like myself is exactly what it sound seems like. You're just [ __ ] zapping it. Um, so how how did you get specific and you what have you done to the new device to make it actually for sleep and not the weight loss component, which is what you were focused on before? Okay, bear with me. I'm going to go back into neuroscience a little bit here. please. So, uh, a lot of people, as I said, would be familiar with the vagus nerve. Vagus nerve stimulation has been around for 30-plus years, and a really crude sense, you get like a pacemaker almost, you put it in, I'd say into the pec and below the pec muscle, attached to the vagus nerve in the neck, and then actually the vagus nerve carries the signal up to the brain stem. What's that used for? Uh, the first device was for epilepsy. Okay. Which is really interesting because effective with epilepsy? Yeah. Yeah, it's a It was FDA-approved 30 years ago. So, you know, having a seizure, say up in the cortical areas, you can actually send the signal from pretty much from your pec muscle into a nerve up to the brain stem, through the brain stem, right up into the cortex, and actually, you know, stop a seizure propagating. That's That's unbelievable. It's actually unbelievable. Like, it's not even that close and and anatomical terms, that's quite a distance to do that. Uh, so that technology then evolved over, you know, say the last 30 years, there are now devices for, um, like mental health, for anxiety and depression. Uh, more recently, actually, they've looked at systemic diseases. There's a company working on, uh, inflammation. So, like, arthritis and Crohn's disease, all while stimulating the the brain stem, the hypothalamus. You know, I I always find it strange that, you know, the body is literally made, particularly the nervous system, of nothing but electrochemical reactions. I mean, every memory, emotion, everything that I do, every touch, feeling, even all of this, that is a chain of little whisps of electrical signals throughout the brain and the brain stem. And in some weird evolutionary sense, somehow that's come together and has given us this conscious form in what is a symphony of we started to call it life, you know, but it is all electrical stimulation. Um but yet the go-to to treat this is to take drugs. It seems almost counterintuitive. Why why would you not be looking at using electricity to treat that? Um and the other thing is electric tell you why. [laughter] When I think of electricity, I think of on and off. When I think of chemistry, I think of life-giving like periodic table of the elements. And if there is some periodic table of electricity where there's like 72 different kinds of electricity, then maybe that would make sense. Again, that's ignorance, dude. I fully get that I am I do not know what the [ __ ] I'm talking about. But in terms of why it people would make the assumption, oh, chemistry would make sense because it's so varied, whereas electricity is like you touch it, it hurts. You don't touch it, you're fine. Like it just seems so binary. Sure, it's maybe just we're we're well used to farming now. You know, drugs are just easier. there that level of variability to electrical stimulation? And that was part of my core question. Like, how is when you were focused on weight loss, you said you changed the hertz? Yeah, the waveform. So the shape the So what you can change would be things like, you know, the voltage and current is obviously quite quite an obvious one. Um but within that you can change the shape of the wave, the direction of the wave, the polarity, how long the wave is on and off for. So you actually almost can have an infinite amount of different kind of waveform parameters And the the brain or whatever electrical system you're trying to communicate with interprets those things differently. Sure. Yeah. So one of the things that we now know about the brain is is that it's a very electrical, but it's also very chemical. And so you were talking about how chemistry sets make sense, periodic tables. Right, so one of the things we know is that electricity when it hits the brain, it does these things with these things called ions, right? So as you move along a a nerve, there are these channels that open and close, and that's how what's called a potential moves across a nerve ending. And then it has to hit the end of the nerve ending, and then the nerve has to put some stuff in the space, and then it has to skip over stuff is some sort of thing. serotonin, it could be norepinephrine, it could be it a whole host of different things depending upon the signal, where it came from, and the what chemicals that it affects along the way. So, once you start to understand that, what you can see is when you change the frequency, right? Very simple. Or you change the intensity, you get you affect different cells, which will do different things. All right, so let's go back to the concept of efficiency. Sure. What do you guys do to be more efficient in your sleep? Um well, I'll I'll naturally be be plugging the the headset. We [laughter] really do it. Don't [ __ ] Are you wearing it every day? Yeah, so it's really simple. I mean, 30 minutes to the device I say will work for an hour, but we're recommending 30 minutes basically every night or as often as you can before you go to bed. What time do you go to bed? Well, [laughter] sometimes it varies. So, anywhere from maybe like 10:00 to 1:00 a.m. Now, why does it vary so much? Uh travel. Okay. So, the only real um kind of regular thing is I say is around sort of 4:00 5:00 p.m. Try and cut out the caffeine. Um and then actually kind of switch try and switch off basically. Um the reason that is difficult for me because I'm in the UK and we have a What time do you try to switch off? Um after dinner. So, that's maybe like 5:00 6:00 p.m. Oh, wow. Um but So, you for 4 to 5 hours, you're just like in chill mode? Trying trying because what I've noticed is is that being kind of active post dinner has started to push me back and back and back, which is why then, you know, it's like 1:00 1:00 a.m. 2:00 a.m. Multiply that by traveling and jet lag, and it just becomes a mess. And what do you do to unwind? Um maybe just relax, chill, go a walk. Yeah, just like I'm not very impressed with this guy's routine, I'm not going to lie. So, Different strokes for different folks, my friend. Yeah. Yeah. All right, let's hear yours. So, I'm very I'm dialed into this. So, I have a very consistent bedtime. I go to bed at midnight. I wake up at 6:17, whether I like it or not. I stop caffeine by 2:00 p.m. every single day. Um I stop alcohol roughly 3 hours before bed, if I'm drinking. I'm not that big of a drinker, to be fair. Um I don't exercise in the evenings. I usually exercise, based on my chronotype, um around 10:30 11:00 in the mornings, and that actually helps me out quite a bit. Um and then when I wake up in the mornings, I get 15 minutes of sunlight and I drink a bottle of water. That's what I do. And it works. That's a routine. [laughter] Uh yeah, that all makes sense. So, talk to me about the the light exposure thing, which I think is really interesting. So, I found this I was recently in Tokyo. Okay. And I don't normally experience jet lag, and the first day that I got there, I woke up so rough. I was like, "Whoa, I feel like 10 lbs of ass." And so, I was like, "Okay, I know about daylight, so I'm going to go sit outside in daylight." And I'm talking I'm not joking, 90 seconds into the sunlight, I started to feel radically different. Yeah. So, sunlight So, here's the science behind it. Sunlight specifically blue light, which is part of the spectrum of sunlight, it's about 450 to about 480 nanometers. That actually hits a particular cell in your eye called a melanopsin cell, which turns off the melatonin faucet in your brain. So, if you're feeling like ass waking up in the morning, the likelihood is, especially if you just got to Tokyo, is your melatonin faucet is still on. Okay. So, looking at the light, seeing the light, that kind of thing matters. And also, there are now light bulbs that are made commercially available that have a filter inside them, so they can filter out the blue light. There are blue light blocking glasses that can be very helpful. Look, I tell people all the time, I think I'm the only sleep doctor in the universe that says it's okay to fall asleep with the television on. That's interesting. I've got people who need to watch The Simpsons to fall asleep. That's just what they need to do. It's amazing. If you turn it off, they're up all night. Like, it doesn't make any sense. Why would I recommend them to stop doing something that's effectively working for them? And by the way, they're having a television on in your room in the evening, there's these things called television timers. They're built into 99% of televisions today. Set the [ __ ] timer and go to bed. So, um when it comes to rebalancing through nature, Right. I heard you talk about this and I thought that it was really interesting. So, I'm not a forest bather. I'm far more of a city bather. Uh my idea of like the I can finally relax would be in Tokyo. Um but I actually do get the whole notion of getting in rhythm with nature. What do you have people do and I'd really like to hear about the nature rebalancing? So, there was a great study that was done. They took 20 insomniacs, they brought them into the woods, kept them there for 2 weeks. Lo and behold, at the end of the 2 weeks, almost none of them had insomnia anymore. Right? So, there's lots of different ideas as to what helped, what hurt, things like that. I would argue that the lack of external crazy stimulation, lights on, cars, noises, all of that was helpful. But I think they just entrain themselves to the sun going up and the sun going down. I mean, let's be fair. Very little insomnia ever occurred before the electric light bulb. Okay? So, if Edison did anything, he [ __ ] up people's sleep forever because there's all these other things that you can now do because we have the presence of light Mhm. consistently in the evenings. And so, entraining yourself to the natural cycle would be great, but let's be fair. People aren't walking into the woods for 2 or 3 weeks to fix their sleep. So, then what can we do along the way and how do we help these people with insomnia? The biggest problem is between your ears. Right? Every single patient that I talk to, they say, "Doctor Bruce, I can't turn off my brain." Right? That's not a surrounding problem. That doesn't have anything to do with blue light. That has to do with our inability to slow down. That has to do with our inability to deal with stress. So things like cognitive behavioral therapy are highly effective for these people. So cognitive behavioral therapy is a two-component process for insomnia. So we know that insomnia is what we call psychophysiologic insomnia. So psycho being something going on in the head, physiology in the body. So what we do is we create schedules for people. When should you go to bed and when should you wake up? And that's part one of the therapy. And to be fair, we actually restrict their sleep. You would like that cuz you don't like sleep, right? And so what we do is we tell them if you normally go to bed at 11:00 and you don't fall asleep until 1:00, don't get in bed until 1:00. Cuz all you're going to do is lie there and be pissed off anyway, right? So we restrict their sleep, we build up their sleep deprivation on purpose because we want that natural sleep deprivation to help them fall asleep and stay asleep. If that doesn't work, then we go to the cognitive portion. The cognitive portion is what do you think about sleep? A lot of people say, "Well, if I don't get 8 hours, it's going to peel, you know, years off the back end of my life." There's no data to show that. None. So what I do is we take all these dysfunctional thoughts and we ask the patient, "What are you thinking about sleep?" and we get them to rate them and then we give them the facts. 90% of the time they just don't know the facts, right? It's my job to educate as many people as I possibly can about what sleep really is and how sleep really works and why it's so important. And once we start educating people on that, it all falls into place. I've rarely had anybody turn to me who I've done full-on cognitive behavioral therapy on and been unsuccessful. If they've done all the things and if they paid attention and if they've done it, it's really pretty effective. More effective than sleeping pills. So the CBT is specifically like pattern interrupt. So you're catastrophizing and you have to have a way to one, recognize you're catastrophizing, two, interrupt it. So is it specifically a narrative around sleep or do you find that they have narratives around all kinds of things that you're helping them interrupt? So, as clinical psychologist, um I always find more there than just sleep. Um more times than not, to be honest with you, when somebody isn't sleeping well, it's pretty much a picture into something else that's going on in their life, right? I mean, look, I don't have sleep problems, generally speaking. People always wonder, "Is that how you got into the field?" No, it isn't. But, if something's going on with my daughter or my son, I don't [ __ ] sleep well, right? Like, that's a big deal to me. And so, everybody is going to have those instances in their lives where those types of things occur. Right. If they get less sleep than they need, however we figure that out, does that lead to negative long-term life expectancy? Well, we it's hard to test that, but what I can tell you that it does lead to is it absolutely leads to things like cardiovascular disease, dementia. I mean, it leads to a lot of [ __ ] you don't want. Um chronic sleep deprivation has system-wide effects. It Yeah, sleep affects every organ system and every disease state. Let's be very clear here. Cancer cells multiply faster the more sleep deprived you are. Right? So, not every situation is the same, right? If I have a patient who's getting chemotherapy done, they're going to have a very different sleep schedule than if I'm working with a professional athlete, right? Sleep is individual. And the biggest thing that I want people to remember is sleep is healing. That's what our body does in sleep. It heals physically and it heals mentally. So, it's it's interesting to me that you hate sleep because it's the thing that's going to get you the furthest and the longest. Yeah, so the my relationship with sleep goes like this. I prioritize it. It is the most important thing for me to get in terms of my wellness schedule, my wellness regime. The one thing I don't [ __ ] with is sleep, which is why I don't set an alarm. Do I wish that nature, in its infinite wisdom, Mr. McCune. Do I wish that it had figured out something through evolution so that we didn't need it? Yes. Do I admire the dolphins for sleeping one hemisphere at a time? Yes. Do I recognize that being tired is a unique form of torture? Yes. So, I have no interest in sleep deprivation. I don't get it. I make sure I get my sleep. My thing is, much like we've been talking about here with sleep efficiency, I believe in, you know, the that if you shorten the amount of time that you sleep, you will become less efficient and you will actually get less done than you would just by clocking the hours, getting the sleep that you need, and moving forward. But, I do think also about longevity. And so, if there is something to, look, cleaning the glymphatic system, it just takes a certain number of hours and you need to do it, and that's just that. Because I do worry in my own life that I am betraying This is a true statement. I am betraying myself and my desire to live forever by the way I live my life, which is at 1,000 miles an hour every day. But, it's going to be a U-shaped curve in a in a way, you know, Well, you So, you there's the benefit actually doesn't go on and on forever. So, with sleep, you're Yeah, well, there's two Well, let's say increasing or decreasing your sleep. There's going to be an optimal point. So, you know, your conflict is you want more hours in your day because you want to do really great things. But, you can't do really great things if you're tired, and you do need a certain amount of sleep. So, yes, you can peel it back. So, what what we're you know, I think it's quite clear we're not saying you must get your hours. Right. You should try and find the optimum amount for you. If that shortens it down and you you 6 hours is great for you, well, then you have an extra 2 hours in your day. If you then keep pushing and pushing and pushing and get down to like 4 hours, those 2 hours are not going to be your best performance, and it's probably going to actually affect the other hours in the day. So, there's a benefit where you can come down, but at some point you just can't keep scraping off hours and hours and hours. And I would also argue that this technology has potential to actually help people lower the amount of total sleep that they might need, right? And here's And here's where I would say That runs contrary with my experience with it. So, what how if if I were using it more So, here's where I'm going with it. So, the current state of your technology as you've described it is that you wear it for 30 minutes before bed and helps you fall asleep faster. We get people get higher quality sleep. Um and they actually get more sleep if I remember correctly. was my experience. So, here's where it gets interesting is what happens to those people over a year, right? How does it get more and more efficient? And by the way, if you make people fall asleep faster guess what? They're they're becoming more efficient, right? Have you noticed that you guys have been tracking people for a while now? Um have are people finding that over time that their sleep actually re-sort of calibrates and it becomes more efficient or getting less? Because I actually stopped using it because I didn't want to keep sleeping the extra hour. Yeah. Yeah. So, initially, so just to sort of highlight for everyone, this was our initial device for trying to suppress appetite. And as a side effect, we started getting lots of people reporting Literally the first thing I noticed I was like, "Jason, what the [ __ ] are you doing to me?" [laughter] Yeah, so side effect that I say must say is quite dismissive of this at the start because it was like, "Ah, it's maybe like uh people aren't sure and maybe they are sleeping." And then actually, you know, more and more and more and more and it's the same thing every time. I fall asleep really quickly. I don't waken up during the night and actually my my sleep is longer. I sleep right through. And then when I waken up, I feel really refreshed. And at that point, we started looking at it. Um and there's all this kind of disjointed effort across like animal studies and human studies. And it was like, "This frequency kind of does this and this frequency affects your deep sleep and your NREM sleep." Um and then the mice studies actually, if you remove the vestibular system, circadian rhythm just goes crazy. Uh so, actually we started then piecing all this together and actually find a frequency which we thought would be optimum for improving someone's sleep. Interestingly, another mouse paper came out pretty much looking at the same frequency and a human study came out where they they actually made the bed sort of rock side to side at the same frequency. So, a lot of people think your vestibular system is just a sense of balance. You know, people say your inner ear and that that's it's kind of dismissive, okay? But to give a picture of how important it is, there are only there are 12 cranial nerves, they're what they're called. They are not in the spinal cord. So, all the nerves, all the neurons that are in your brain that say go down to your toes, they all go down the spinal cord bar bar 12. 10 of those connect directly to your brain stem. The vagus is one of them. It's a very important nerve. The vestibular system, as I say, people say it's your sense of balance. Your vestibular system is one of the other nine nerves. It is an entire sensory input that goes right into the brain stem. It actually overlaps with the vagus. When you stimulate the vestibular system, you get vagus nerve neurons firing. So, it is far from this little sort of sense of balance that kind of let you know if you're going to tip over. It is a massive factor into the sensory input of the brain stem and the hypothalamus. And what it is actually doing amongst other things is letting your brain know how physically active your body is, both acute and chronic. Right. And that is really important information for your brain to know when it is regulating what your body does. Mhm. Yeah, that's super interesting. Knowing how deeply you've gone into sleep now, what's the most surprising thing that you came across? Maybe just the architecture. Like but I mean we went into that in great detail. I mean that is amazing. It's a bit of a symphony in a way, you know, how it all works and actually, you know, the various stages and your your deep sleep tends to be at the early stage. And I'd say as it shrinks and you get more and more REM. So, this this sort of cycle after cycle after cycle. So, it's not a case or what I found really interesting was it's not a case if you miss like say 2 hours of your sleep that it's just you've just missed a proportion. Depending on where you have actually missed at, you could have totally disrupted your sleep. So, if you missed the 2 hours at the start, you might have wiped out like 80% of your deep sleep. Or if you waking up 2 hours early, you've wiped out all of your REM sleep. You know, so it's not it's not just a case of my head's on the pillow and the next 8 hours are all the same. It's actually this as I say symphony of kind of neural activity that goes from almost nothing to your brain might as might as well be awake. Uh although you are totally, you know, paralyzed and unconscious. I mean, that is a beautiful thing although totally kind of scary and amazing. Agreed. Is there anything in your many years of researching sleep that really took you by surprise? Uh you know, I'll tell you what took me by surprise is that 2 years ago the Nobel Prize was given to circadian researchers. Really? That was [ __ ] cool. What did they learn? So, it's it's actually a pretty complicated process, but basically had to do with circadian rhythmicity and the ability to turn on and off mitochondria, which was actually kind of amazing. But when you start to think through the idea of sleep and sleep research, like I read sleep research every day. There's literally 15 to 20 studies that come out per month in this area. And you look at medical research, people been studying medicine since Hippocrates, right? Thousands of years. The first sleep lab was in 1940s. Wow. Right? So, we are at the precipice we are at the very beginning we're like the sperm and egg stage of what is sleep and what's going to happen with it. And lately my most my biggest interest lately has actually been about cannabis and sleep. I would argue that um Ambien is going to have a really big competitor. Um it's called weed and it's out and it's recreational in a couple of states. I live in, you know, California and it's very very interesting. Do you smoke? Sure. Interesting. Absolutely. What do you find that it does to your sleep? So, it depends on when you smoke it, what you smoke, and how much you smoke. Okay. So, it's all There's a lot of different things out there, but I've written extensively about if you're going to use marijuana to help you sleep, what should you look for? that. I've also broken down the cannabinoids. So, a lot of people out there are talking about CBD, CBD, CBD, right? Let me be clear. You'd have to have almost 200 mg of CBD to have any effect on sleep. Much lower dosage to help with pain. You want CBN. Okay. CBN, which turns out to be oxidized THC, helps with sleep much more. At least that's what the data would suggest. So, how does one oxidize THC? You let weed lie around for a little while, and it's basically CBN is old weed. Mhm. Now, to be fair, people are learning how to process it and make that process move quicker, but what we're starting to see is now we're starting to see cannabis like if you go into a cannabis dispensary and you say, "What have you got for sleep?" They have a section. [laughter] Right? Like when people my age, 50, 51 years old are walking into a dispensary, we're not going there to get high. We're going there because we got pain or we have sleep issues and we want and we want to use the medicine. Right? That's where the gold is. And so, when you start to really look at it like let's treat it like a medicine. Let's look at it in a way that can be helpful. I mean, we have an entire endocannabinoid system in our body that isn't being used except for with cannabinoids. Mhm. So, also to be fair, cannabinoids are in many other things besides marijuana, but they're really in marijuana. So, why shouldn't we start to walk down that path, create that technology, and help more people? All right. So, you've said that if you're going to drink alcohol, stop 3 hours before bed. What's the protocol with weed? So, I think it's going to be different and to be honest with you, I don't think I know yet. Um it's definitely something that I'm studying and I'm and I'm learning more and more and more about, but I would argue that the tinctures, like the the liquid that comes in the droppers that you can do sublingually, I would say that would be a place to start. even heard of that. Oh. You just drop it under your tongue? Yeah. You take it, drop it underneath your tongue, let it sit there, 60 seconds, and it, Close your eyes. Hm. Very interesting. This whole subject to me is is incredibly interesting. It's so important. As somebody obsessed with efficiency and productivity, it's like man, if you're not paying attention to your sleep, you're you're really really in trouble. Um where can people and Jason, I'll start with you. Where can people learn more about Modius Sleep? Um what's that sort of parting message you want them to check out? Yeah, so just really high-level, what we're trying to do then is non-invasively influence the brain stem. So, the the shift in that whole technology is can you actually make it non-invasive or less invasive or if if possible non-invasive. We, as I say, focus on the vestibular nerve uh because it's entirely non-invasive. The first device was based around can helping you lose weight by suppressing your appetite control in the hypothalamus that way. Uh but now I said the Modius Sleep device uh we have just launched to try and help people improve their sleep. So, we're on Indiegogo. You can check it out. You can go to Modius Modius sale for Modius Sleep. You can check it out. But, if you have some issues with your sleep, I really recommend that you try it. And Dr. Jason McKeown, so yeah. You can check me out on Twitter. All right, there we go. Dr. Bruce, where can people find you? thesleepdoctor.com, and then it's the same on all the social properties. So, the sleep doctor on Facebook, Twitter, Instagram, LinkedIn. Nice, very cool. And then final question for you amazing gentlemen, what is one thing you would have people change that would have the biggest impact on their health? Jason, we'll start with you. Well, the obvious thing is just to try and get on top of your sleep. And but but don't misread that as uh and I think we've covered this pretty well. Do not misread that as I need a X amount hours of sleep. Uh look at your sleep. Look at what sleep you need, and look about how you can make that more efficient. It is the single most in in my opinion most important thing that you could do easily, which will have a really positive impact as as we discussed in like literally every organ in your body. It reduces your risks just of so many comorbidities. For for someone who wants to be and a lot of your listeners are going to try and look at high performance output, if you are not managing your sleep, it is crazy to think that you can run at optimum efficiency. All right, so I'll slightly change it for you cuz I imagine your answer is going to be something to do with sleep. If it is, what is the one thing people should do that would have the biggest impact on their sleep? Know your chronotype, without question. It's super easy. Go to chronoquiz.com. It's my website. Um you'll learn in 30 questions what your chronotype is, and then you can figure out, I mean, in my book I tell people the best time to have sex, eat a cheeseburger, ask your boss for a raise, and sleep. So, it's useful in all facets of life. Nice. It's a great place to leave you all. Guys, sleep, man. I'm telling you, get it. It is the number one thing people are always asking me uh trying to accomplish as much as I'm trying to accomplish if I set an alarm. In fact, I stopped posting about how early I wake up because people are getting the wrong idea. They thought that I was setting an alarm to wake up at 3:00, which I do not. Uh get your sleep. And if you haven't already, be sure to subscribe. And until next time, my friends, be legendary. Take care. [applause] Thank you, guys, so much for watching and being a part of this community. If you haven't already, be sure to subscribe. You're going to get weekly videos on building a growth mindset, cultivating grit, and unlocking your full potential.