Sleep: the OG PED

Why should we care about sleep?

According to Dr. Matthew Walker, a prominent sleep scientist and professor of neuroscience and psychology at Cal Berkeley, sleep plays a vital role in cognitive function, memory consolidation, emotional regulation, immune function, metabolism, and overall physical and mental health. He explains that getting sufficient, high-quality sleep is essential for optimal brain function, emotional resilience, and maintaining a healthy body. Well damn, I guess spending 2 hours a night rewatching Ozark for the third time isn’t the answer.

Dr. Walker also discloses that studies show people sleeping less than 6 hours per night are 200% more likely to have cardiovascular disease or a heart attack, which is the #1 cause of death in the US. And if that isn’t enough, he notes that individuals sleeping less than 7 hours per night are 3x more likely to become infected by the rhinovirus (the common cold). Don’t be that guy calling a cold the rhinovirus now.

Important sleep terms

I’ll be brief since we both know you cheated on your Biology 101 exams in college.

• Circadian Rhythm - your body’s internal clock that runs on a roughly 24-hour cycle, influencing when you feel awake and sleepy.

• Sleep Cycle - consists of stages of Non-Rapid Eye Movement (NREM) sleep, the restorative part of our sleep cycle where our body repairs itself and our brain consolidates memories, this phase includes Deep Sleep. NREM is followed by Rapid Eye Movement (REM) sleep, which is when dreams typically happen.

Why hasn’t my doc talked more about sleep?

Although some universities are starting to address sleep, it’s not understood well by most medical professionals. The average medical resident in first world countries (including the US) only receives 1.5 to 2 hours of education on sleep, relative to their entire medical program.

I got 99 Problems…

According to the National Council on Aging, 1 in 3 adults aren’t getting the recommended 7 to 9 hours of sleep per night. It just so happens that midlife is when we start to see a decline in deep sleep.

Wondering if you have sleep a quality issue? Do you experience…

• Difficulty falling asleep?

• Waking often during the night due to bathroom trips, discomfort, or stress?

• Racing thoughts or an overactive mind, making it challenging to quiet the mind and get back to sleep?

• Sleep apnea which is the lack of oxygenation during sleep. Common in many overweight and/or heavily muscled individuals. If you think you may have sleep apnea, it is wise to consult your physician.

What are the benefits of improved sleep?

Simply put, good quality sleep works wonders for our energy and mood supplies. Plus, it boosts our ability to fend off viruses and keeps our thinking sharp, making it easier to process information. Therefore, Dr. Walker advocates for prioritizing sleep as a cornerstone of good health and emphasizes the importance of adopting healthy sleep habits to support overall well-being…“Turn the sleep dial up and all of the other health component dials will go up with it.”

How do we improve not only our sleep duration but our sleep quality?

Behavioral Recommendations

Maintain a Consistent Sleep Schedule: Go to bed and wake up at the same time every day, even on weekends. Consistency helps regulate your body's internal clock and improves sleep quality. I try to stay within 30 to 45 minutes of my regular bedtime and wake-time on weekends, although there are certainly exceptions. I typically go to bed at 8:45pm and wake up at 4:45am. This gives me a sleep opportunity of 8hrs…fully knowing some nights will be better than others.

The bedroom should be for the two S’s: sleep and sex. Take the television out of the room! This way your body and mind will be signaled to get ready to sleep as soon as you slip into bed.

Optimize Your Sleep Environment: Make your bedroom conducive to sleep by keeping it cool, dark, and quiet. Invest in…

• A comfortable mattress: Everyone has their preference for comfort. There are even beds available with duel comfort zones so that you and your partner can slumber in comfort at different levels of plushness.

• Suitable Pillows: I love the Coop Pillow my wife got me for Christmas, easily the most comfortable and supportive pillow I’ve ever slept on. I’m a side sleeper so I also take a page out of the pregnancy handbook and use a pillow (regular one) between my knees to ease the tension on my hips and lower back.

• A white noise machine or earplugs to dull disturbances: I use a Levoit Air Purifier in my bedroom which provides white noise in addition to it’s designed functionality. When traveling I use the Yogasleep by Rohm.

• Blackout curtains or eye masks are also recommended to block out any light. I don’t regularly wear an eye mask but I do have one for travel called the WAOAW Sleep Mask. It’s one of the more budget friendly brands with great reviews.

• Programmable thermostats make it easy to cool your bedroom down at bedtime and slowly warm it up when it comes time to wake up. The optimal room temperature for sleep typically falls between 60 to 67 degrees Fahrenheit. This range helps facilitate the body's natural temperature drop during sleep, promoting deeper and more restful slumber.

• Keep phones out of the bedroom and try not to look at the clock if you wake up in the middle of the night. This can create feelings of anxiousness around your ability to get the proper amount of sleep, it’s a vicious cycle!

Watch Your Caffeine and Alcohol Intake: For those that believe ignorance is bliss, you better skip this section. Limit consumption of caffeine and alcohol, especially in the hours leading up to bedtime. Both substances can disrupt sleep patterns and decrease sleep quality.

• Caffeine: It's beneficial to delay caffeine consumption in the morning for 90 minutes after waking. This will help reduce the probability of an afternoon crash. I don’t adhere to this recommendation because I workout early in the morning and prefer to have caffeine beforehand. I typically go to bed early (8:45pm), so I usually cut off caffeine by 11am or Noon. Consuming caffeine in the late afternoon/early evening can decrease the quality of your deep sleep by up to 20%. A general rule of thumb is to drop the coffee mug or Red Bull 8-12 hours prior to bedtime, depending on your caffeine sensitivity.

• Alcohol: Working in the beer industry, I would love to say that alcohol doesn’t impact sleep but based on the data, even one drink can have a measurable effect. I limit alcohol consumption to 1-2 drinks when imbibing, with exceptions for special events.

• Let’s visit nicotine while we’re here, which like caffeine is a stimulant. I know many of you out there are Zyn’in, as the youths would say. According to the Sleep Foundation, It’s best to suspend nicotine use 4 hours before lights out in order to promote better sleep quantity and quality.

3-2-1* Rule (debunked?)

• Consume your final meal/snack three hours before bed: eating too close to bedtime can disrupt sleep by causing heartburn and indigestion, as lying down facilitates stomach contents refluxing into the esophagus. It also disrupts the circadian rhythm, affecting sleep-regulating hormones and compromising sleep quality. Dr. Walker ultimately suggests to restrict eating within 45 minutes to two hours prior to bedtime to realize the majority of the benefits.

• Restrict drinking beverages two hours before bed: excessive liquid consumption can cause multiple sleep disruptions throughout the night to use the bathroom. Personally, my biggest sleep issue is falling back asleep once I get up. Therefore, I try to stick to this rule to the best of my ability to avoid multiple or any wake-ups to urinate.

• Limit exposure to screens one hour before bed: A 2013 study recommended avoiding electronic devices such as smartphones, tablets, and computers at least an hour before bedtime. The blue light emitted by these devices was linked to interference with your body's production of melatonin, a hormone that regulates sleep. However, a reevaluation of this study indicates little causation between screen use pre-sleep and sleep quality degradation. Despite a suppression in melatonin, little evidence was found that damaged sleep onset (time it takes to fall asleep).

Get out of bed: If you wake up in the middle of the night and can’t fall back asleep for 20-25 minutes, get out of bed and read a book or listen to a podcast in another room. Go back to bed when you feel sleepy. This will train your body and brain to associate your bed with sleep and not wakefulness.

Manage Stress Effectively: Practice stress-reducing techniques such as mindfulness, yoga, or journaling to help calm your mind and promote relaxation before bed. Managing stress can significantly improve sleep quality. There are many low-cost apps such as Headspace and Calm, both of which I’ve used before, that are very user-friendly. There are also great, free meditations on YouTube including yoga nidra, which is a type of Non-sleep Deep Rest (NSDR). I do 5-10 minutes of meditation or yoga nidra first thing in the morning to clear my head and focus.

Exercise Regularly: Engage in regular physical activity, but try to avoid vigorous exercise close to bedtime, as it can stimulate your body and make it harder to fall asleep. Aim for exercise earlier in the day to reap the sleep-promoting benefits.

Avoid Long Naps: Limit naps to no longer than 45 minutes (especially later in the day), as longer naps can disrupt your sleep cycle and circadian rhythm.

View Sunlight Outdoors within 30 to 60 minutes of waking: this will trigger a cortisol (stress hormone) increase to occur very early in the day, not later in the day…making it easier to fall asleep that night. I get up before the sun so I get under bright artificial lights as early as I can, this helps but does not replace the sunlight viewing. Recommended dosage is 5 to 10 minutes. Important to note that this tip comes from podcast host and professor of Neurobiology at Stanford, Dr. Andrew Huberman, who makes his own schedule and has no kids…must be nice Andy!

Keep your bedroom ventilated or open the door: Excess CO2 in the bedroom can negatively impact your sleep by increasing the likelihood of nighttime awakenings and reducing the overall quality of your sleep.

Mouth taping during sleep will not be covered in this issue because those people are lunatics.

Supplement recommendations and dosage

In the case that you are using all or most of the behavioral tools and still having trouble falling asleep and staying asleep, then you might try one of the supplements below. It’s best to try them one at a time to start so that you know whether or not they are having a positive effect on your sleep. Using single ingredient supplements also allows you to adjust the dosage of one component of a supplement stack without having to disrupt the dosage of another component. The ideal time to take these supplements is 30-60 min prior to bedtime.

• Magnesium Threonate (145mg): can decrease feelings of anxiety and improve sleep patterns, making it easier to fall and stay asleep.

• L-Theanine (100-400mg): helps increase calming brain chemicals and improve sleep efficiency by reducing stress and anxiety. This is also a supplement I use in combination with caffeine to reduce any “coffee jitters” early in the day.

• *Apigenin and Myo-Inositol have been recommended by Dr. Andrew Huberman as part of his “sleep stack”. However, there is very little evidence that these two supplements have an effect on sleep duration or quality.

I use Think Magnesium L-Threonate (144mg) and Sports Research L-Theanine (200mg) regularly.

Supplements to steer clear of

THC: can help you fall asleep fast but also tends to disrupt REM sleep. THC can also build a dependency tolerance, so you start to need more to get the same sleep benefit you have in the past. Also once you stop using THC it’s possible to get severe rebound insomnia.

Melatonin: a hormone that is made by the body but also produced synthetically. In a study that looked at over 20 brands of melatonin supplements here in the US, researchers found there was anywhere from 80% less to 460% more melatonin than what was on the label. It is still largely a safe supplement, even in heavy doses but can signal the body to produce less of the hormone naturally.

“Jury’s still out” supplements

CBD: has promise as a sleep supplement but more research is needed before solid conclusions are made. Early research suggests that it may increase the amount of deep sleep and you may not get the REM sleep deficiency or the dependency as you would from THC. CBD is very dose dependent and the optimal dose is still unclear. Some research points to 25mg and under being wake promoting while 50mg+ has been shown to be sleep enhancing. If you’re interested in exploring CBD as a sleep supplement, ensure that the product you choose is third party tested in order to confirm that what is on the label is what is in the bottle.

Pharmaceuticals

Ambien/Lunesta: these prescription drugs are recommended for acute, short-term, significant episodes such as a trauma or a bereavement. Unfortunately, it does not appear that this is the way they are being prescribed in the medical field.

Sleep Trackers

Sleep Trackers are useful to get a general idea of the overall duration of your sleep as well as your sleep architecture.

Apple Watch Series 9

• Geared for the person looking for a multi-function device

• More basic fitness and sleep data

• No subscription needed

• Amazon also has great deals on refurbished Apple Watches

  • I purchased a Lenovo ThinkPad and Apple iPad from Amazon Renewed in the last 6 months. Both devices came in great condition, saved me hundreds of dollars and have a minimum 90-day supplier-backed warranty.

Whoop 4.0

• Geared for hardcore athletes

• Extensive fitness and sleep data

• Subscription based

Oura Ring

• Geared for the average joe just getting into fitness

• Designed around restoring your body & mind

• Subscription based

I am comfortable wearing a watch at night and choose to use the Apple Watch due to it’s functionality outside of just sleep tracking. There’s a lot more detail to dive into here which I’ll do in a future issue.

I know there’s a lot to digest here. No one implements every single one of these practices let alone implements them all overnight (see what I did there). Think of them as tools in a tool belt. Pick one to try out this week and see how it effects your sleep, then next week, pick another one and build from there.

If you’re currently…

• sleeping 6 hours per night, let’s shoot for 6:20

• getting up 3x per night, let’s shoot for 2

• taking 1 hour to fall asleep, let’s try for 45 minutes

Progress is progress.

Ever since I’ve implemented many of these tips and practices into my routine, I’ve noticed a significant difference in my sleep quality and therefore better energy, mood, and cognition. I don’t hit for the cycle everyday, especially with 3 kids under 7, but on a weekly and monthly basis I’m batting well over .300. I know you will too.

Check out my Instagram, DK Does Midlife, for a free sleep checklist

If you’d like to explore this topic further, please check out Dr. Matt Walker’s interview on the Rich Roll Podcast here. Dr. Walker’s book Why We Sleep is also available here with the audio version available with Spotify Premium plans.

I’m here to support you on your journey to a healthier, fitter life. As always, I appreciate your feedback and suggestions. Let me know what topics you’d like me to cover in future issues by replying to this email.

Want to share this issue of DK Does Midlife via text, social media, or email? Just copy and paste this link: https://dkdml.beehiiv.com/

For additional content, follow me on Instagram here

Be well,

Dave

Please note: This newsletter is designed for informational purposes only and should not be taken as professional medical advice. Always consult with a healthcare provider for advice tailored to your health and fitness needs.