573: Secrets from the Sleep Doctor | Michael Breus, Ph.D.
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Today's guest, Dr. Michael Bruce, also known as the Sleep Doctor, believes that true health starts with mastering the essentials, sleep, hydration, and breath. The Sleep Doctor is a diplomat of the American Board of Sleep Medicine, a fellow of the American Academy of Sleep Medicine, and an acclaimed author whose best-selling books include Good Night and his latest book, Sleep, Drink, Breathe, have helped countless transform their lives.

In today's show, Dr. Bruce will break down the non-negotiables for great sleep, from aligning with your chronotype to how waking up the same time every day is a game changer. We'll also cover why hydration affects everything from sleep stages to energy, and how breathing techniques can allow you to gain control over your nervous system. If you're tired or just want to sleep a little bit better, and you want to get back to the basics, understand what works. This conversation is for you. Let's get into it.

Okay, standard time and daylight savings. I've talked about this so many times on this show and in late breaking news over the past, you know, this will have aired probably a couple of weeks after the fact, President-elect Trump stated he wants to end daylight savings time.

So no matter where you are in the political spectrum, all the experts, including you, say this is a very positive thing. And I agree. I am excited. So let's talk about standard time and daylight savings. Sure. So number one, I'm

I'm thrilled that this is kind of where we're at. Historically, you know, we've been honestly sleep specialists have been trying to get rid of daylight savings forever. And it's kind of remarkable sort of the transformation. So number one, I think daylight savings has been around for like

over a hundred years or something like that. So remember when we were in agrarian society, so when we were a farming community, something like daylight savings could make some sense, right? Because you got up before the sun came up to get all the equipment ready, to be out in the field. As soon as the sun came up to be able to do the things that you needed to do, then you went to sleep really early and, and that made intuitive sense. Well, unfortunately,

That's just not how the world works anymore. And as a sleep physician, one of the things that we never, ever, ever want people to do is wake up in darkness. That is...

the cardinal sin because remember melatonin continues to be produced in a state of darkness and so when we have a time zone where people wake up and it's still dark outside but it's you know 6 30 in the morning or 7 o'clock in the morning which is their normal wake-up time their bodies

continue to produce this melatonin, which makes them very groggy, very sleepy. We even see this, we can even look at this from a school start time perspective, because when kids have to do this daylight savings time, they do terribly in school for the first few days afterwards. In fact, here's a crazy statistic, is the number one day for car accidents used to be the day after we lost an hour during daylight savings.

Crazy. So it's like if somebody hadn't decided to do this sooner or later, like it was nuts. So I'm thrilled. It

What was crazy was there was a bill, I think, either in the House or the Senate to actually do the opposite. Correct. You're correct. Yes. So I believe it was put forward by DeSantis or Rubio. I can't remember who. And every sleep physician in the universe wrote a letter and was like, dude, we love what you're thinking, but you're doing it wrong. Okay. He wanted to go to the regular daylight savings time. And that's not what would be good for everybody. Right.

And so hopefully with a little bit of luck, we will get the right timing in there and then we can end daylight savings and then people can kind of go on about their day. I'm so pumped for that one. And you mentioned kids, you know, our kids have to get to school early. And so...

But we're waking up kind of at the crack of dawn, like around 6 a.m., 6.30. And then when daylight savings is at play, it's even worse. Well, and also for new moms, it's really bad because babies don't know what time it is. And all of a sudden, when all the clocks change, but baby doesn't change, and you've got a newborn, this could be incredibly difficult for people. Yeah, I'm very excited about this. And so...

I want to get back to the book. All your books are amazing. I highly recommend them. Latest is Sleep, Drink, Breathe. I love the simplicity of it. So you start the book with this profound statement, which I find to be very accurate, quote, wellness is too effing complicated. Yes. And so with regards to sleep,

What are the non-negotiables, if you will, start there that everybody should have on their checklist for great sleep? So there are a few, but I want to, before I down into that, I want to say, number one, thank you for that acknowledgement. I certainly appreciate you and the books that you have produced. Also, we're very common because sleep, drink, breathe kind of reminds me of mind, body, green, right?

like in a lot of ways, this radical simplicity to get answers, I think is the thing that you and I like to drive towards. And I think that's really important. And so what are the non-negotiables for sleep that I can tell people right now? So there's a few of them. You know me, I'm the chronotype guy. So you want to sleep with

within your chronotypical swim lane, if at all possible, or as close to it as you can get. What do I mean by that? If you're a night owl, then you should be going to bed later and sleeping later. If you're an early bird, you should be going to bed earlier and waking up earlier.

If you don't know what your chronotype is, swing over to chronoquiz.com. We've talked about it a million times. People know what it is. But one thing I want people to do is sleep within their chronotype. Second thing, and this one's easy. If you don't want to figure out your chronotype, this is the easiest one you can do. Wake up at the same time seven days a week. Not five days a week. Don't sleep in on the weekends. You cannot catch up in the way you think you can. It's a mess.

So what I tell people all the time is why do you want to wake up at the same time every day? It's biology. So when you wake up in the morning at the same time, you set a timer in your brain for when melatonin will be produced that night. So let me repeat myself. The time in which you wake up directly determines when your body's internal sleep aid called melatonin kicks in.

So if there's a variable time waking up, then you get variable melatonin at night. As an example, if you sleep until eight o'clock on Saturday and your body's used to being up at six, guess what? Your melatonin Saturday night is gonna come two hours later

That is very disruptive when Monday shows up and you've got to get up at your normal time. So once again, if you can keep it all consistent in terms of your wake up time. The last I think the last one, because I know I'm going a little long on sleep, is don't think that your sleep problem is going to magically go away. It's not possible.

A lot of people say to me, "Oh, I got three kids. Of course I'm exhausted, Michael. I should be tired." That's incorrect.

Okay, just because you have a stressful job doesn't mean that you should have poor quality sleep. Nine times out of 10, what people happens with me is when somebody shows up in my office and they have a sleep issue, there's almost always a secondary issue. Sleep is a window into your physical and your mental health. If you wake up and you feel like crap, something's not working right.

Okay. Maybe you're putting a hurdle in front of yourself, like having caffeine too late in the evening or alcohol too late in the evening. But as a general guideline, if you're asleep and you're doing all the, you think right things and you're still not getting good quality sleep, there's a very high likelihood that something else either medically or mentally is going on. So it's often a symptom. Yes. Whether it's anxiety and we can go through some of the light, maybe it's

eating too late. Maybe it's alcohol. Maybe it's all of the, so let's go. I'm starting to get into some of the lifestyle. Yeah, let's do it. What comes to mind for me? So room, room temperature needs to be cool. Absolutely. So our core body temperature, sleep follows our core body temperature. So one of the big things is our core body temperature needs to drop as we're falling asleep. So if we're in a hot room, our core body temperature can't drop. This is one of the reasons, by the way, that we tell people not to exercise.

to exercise right before bed because it increases their core body temperature and makes it somewhat difficult for them to be able to relax and fall asleep. However, there is one piece of data out there that's interesting where sometimes we ask insomniacs to take a hot bath before bed because we artificially increase their core body temperature. That's very different than doing it through exercise, which takes much longer for your core body temperature to decrease. Doing a quick artificial one can actually work out really well.

But generally speaking, we want it to be cool, not warm. By the way, less clothing is probably better because there's less material between you and your ability to thermoregulate. So we've got...

cool a cool room we've got sundown we don't want lots of lights screens TVs all that stuff well let's talk about electronics for just a second because I'm I have a slightly different thought process on these than a lot of other people do so my wife falls asleep watching Seinfeld every single night okay big-screen TV and it's on most of the night we have two French Bulldogs in the bed with us okay so number one

sleep is flexible, okay? Everybody can adapt in different ways. I look at the data on my sleep and guess what? I sleep just fine with my wife's television on and the dogs in the bed. If I had poor quality sleep because of it, then yeah, I might have to change it. But what I discovered with her is she's not even watching the TV. She's listening to it out of what I call the corner of her ear, just enough to distract her from getting monkey mind. So,

I don't think I care if you fall asleep watching TV, just letting the content roll over you. But I do care if you're trying to get your high score on Candy Crush. You're pretty much not trying to go to bed at that point, right? I love it. And I love that you watch Seinfeld, one of my all-time favorite shows. But I think it speaks to the type of programming. Are you watching something that's a little bit light, maybe a little bit entertaining, funny versus the nightly news or something dark?

Gosh, no, do not watch the nightly news. Don't watch and don't watch, you know, like 48 hours and all these murder shows like no, like watch a comedy, watch it, watch the Big Bang Theory, watch Seinfeld, watch something that is as lighthearted and humorous, by the way.

Interesting fact, if you are doing things before bed that are optimistic and or humorous, you actually will fall asleep more quickly and have more positive dreams. So it's kind of a recipe for programming, right? So if you want to watch Seinfeld, maybe you'll have some good dreams.

I love it. It makes the case for great comedy before bed. And I love the flexibility there because, you know, look, if you have something on your mind, which most adults always do, and it's okay, go to bed, turn everything off. It's okay. Really? That's sometimes hard. I think that's every time hard.

At least it is for me. Because, you know, we all lead these crazy packed lives. Like I was thinking about, I watched a video the other day by this journalist, Johnny Harris, and he was talking about the number of decisions that we make now before we even get in our car in the morning. Like with back into caveman days, like all you did was kind of walk out, scratch your head, eat a few nuts and berries and sit by the fire. And that was your morning, right? You know, now you make hard

hundreds of decisions before you even get to work. And I think it's stressful and I think it's hard. And I think our brain gets into that mode. And then by the way, it's the end of the day, our brain is exhausted. It's full of all these proteins that have been building up all day called beta amyloid and tau, and it's waiting to sleep, right? And so what ends up happening is, is that a lot of people just kind of crash and

but aren't really cognizant or thinking about what's going on. But people are exhausted nowadays. And a lot of it has to do with, as you mentioned earlier, anxiety and stress. - And decision fatigue. - Yes, that's the word I was looking for. Thank you, decision fatigue. - I experience it. I don't run anxious necessarily, but towards the end of the day, I just am never typically in a good head space to make big, important decisions.

And I love that you talked about TV because it's something Colleen and I embrace. We like watching a little TV at night. I can't do anything a little dark if there's any mystery or anything involving like something terrible happens to a child ever since I became a parent. I'm like, just keep me away from this. I can't watch. And when I watch programming that is somewhat disturbing, it really affects my sleep. My HRV, my RHR, White Lotus, the show on which everyone loves.

I would watch that at night and that deeply impacted my recovery. Well, that's interesting. What happened? It's just so disturbing to me. I've never seen the show, so I don't know. It's pretty dark. It's funny. It's really dark and disturbing, but it's a really good show. My HRV would significantly decrease and my heart rate would increase at night. I was

Just found it disturbing. Yeah, yeah. So for folks out there who are wondering what the biology behind that is, this is an interesting thing. And so what Jason's describing is that normally during sleep, your heart rate goes down, which will increase your HRV, which is your heart rate variability. So the heart rate variability is a measure of the highest heart rate versus the lowest heart rate. And what he's saying is after watching this television show, his heart rate wasn't going down. It was staying elevated, which shrinks his HRV.

I do want to spend a moment on wearables and let's park. We'll park that for a second because I want to get like the lifestyle basics. So we covered the temperature, the screens, having a room that's relatively dark. The other big thing in my view is meal timing and alcohol. Oh, I'm glad you brought this up. So this is getting weirder and weirder as we go. So-

I agree with you. Meal timing turns out to be really interesting. And if you can fast before bed, you're actually doing yourself quite a big favor because number one, metabolically speaking, it definitely derives a lot of energy to go through the metabolic process. But I want to tell you a weird story.

So I was at an event where I was speaking and a fellow by the name of Brian Johnson was there. Now you may have seen him, he's on the internet. He's this super tested guy and he does all of these tests on himself and all of these different things and he's got this don't die thing going on, right? So I was listening to him. I actually ended up having dinner with him. He was at our table.

And one of the things he said, which was so interesting, was he said he stops eating at 11 a.m. Okay, 11 a.m. And here was the thing that I thought was the most weird about it is he said to the whole group, when I did that, it had the most profound effect on my sleep.

He said he immediately got more deep sleep, immediately got more REM sleep, and he tests at 100 on the aura. Now, I want to be clear about something. He's figured out how to work the algorithm to make him so that because the algorithm has got different factors to it that might make you have a higher score, like you're in bed longer or things like that. But needless to say,

His observation of no food for extended period of time before he goes to sleep, increasing his sleep overall, I think is really interesting. And it's something that we need to start thinking about more clearly. 11 a.m. is an aggressive ask, I think. Yes. Without question, what I've seen personally, and again, everyone's individual here and has their own set of unique experiences.

opportunities, if you will. My sleep thrives when there is greater distance. So if it's only two hours between meal and bed, probably not so good. Three hours better. If I get into like, if I need a reset, if you will, if I go like five hours or six hours, so maybe that's eating dinner at five and going to bed at 10, I'm golden. And also size of meal.

for me too. Oh, and there's data to support this. Like one of the things that people don't understand is like the, the digestion process is highly energy consumptive. So it, it like if,

The earlier in the day you do it, the better your organs are at doing it. Because remember, at night, everything kind of downshifts and doesn't do things nearly as well. As an example, during the daytime, if you drink a glass of alcohol, it'll take approximately one hour for that alcohol to get out of your system. But if you had alcohol right before bed and then went to sleep, it could take as long as three hours.

because your metabolic process slows that much. And of course, alcohol slows the process as well. So thinking about not just the food, but when are you partying, right? Like when are you having your last glass of wine or beer or spirit or what have you? And if that's something that you do on the regular, how is that having an effect on your sleep? 11 a.m. Yeah, I know, right. Day drinking. That's what we should be doing. Yeah.

That's the one thing is I've gotten, you know, look, I wear an aura, I wear a whoop. I have an eight sleep. We've got all the stuff. And that's the one thing I rarely, I still love a good glass of red wine or sparkly.

every once in a while, but that's or margarita. That's like the one thing I've really dialed back on. And if I am going to have a drink, it's probably going to be earlier in the day. If I have it later in the day, look, it's going to happen, but I'm just like, okay, it's not going to be good. Right. And once people start to understand that, then they start, it starts to make sense. You know, here's the funny thing about alcohol in general, and then we can continue on with lifestyle stuff is you

When I'm dealing with patients and I still see patients, that is always the number one negotiation that I have with them. The number one, they're like, I'll get up at whatever time you want and I'll eat here and there, but don't take away my wine. That's what people say. People will give up their sleeping pills before they will give up their alcohol, which when you get to that point with a patient, the very first question I say to them is I say, you realize this is an issue, right?

Because they don't. They just think, oh, I just have a drink at the end of the day or I have three glasses of wine at night and that's how I unwind. And it's like, yeah, it's not how to unwind. For me, if you said I had to give up my coffee, that would be a serious negotiation that I'd be willing to give on. I just love coffee. So...

It's a subway. So it's sleep, drink, breathe. So we're, so we're segueing into drinking. Yes, we are. Let's drink. What else should we talk about with drinking water and hydration? So I'll going to be honest with you, Jay. I, this wasn't my area of expertise. I mean, I've been a runner most of my adult life. And so you have to, especially when I lived in Arizona, you really had to have some level of hydration management. If you were going to run outside, uh,

at any point in time living in Arizona because you just lose water so fast that you really have to understand your body and what's going on. So I had some indications of hydration importance just from my mild athleticism of running. But what I really discovered when I was researching the book

and I'm the guy at the gym who's kind of annoying now is you'll see this happen. When you go to the gym, somebody grabs their water bottle and they run over to the machine to fill it up. They fill it up halfway and then they pull it back and then they, and they down it and then they put it in again to fill it up again. And I'm always standing behind the idiot that does this. And so I always turn to them and I say, Hey, you should sip, not drink.

Gulp, right? I'm that guy, right? And they always turn to me and they always say the exact same thing. They say, I'm just trying to get enough in, right? And what I turn to them and say is it's not going in, it's going through, right?

Let me explain. Your body is like, when you wake up in the morning, what your body is like a hard sponge. So like, you know, when you go to the kitchen and there's that sponge on the counter that you could basically, you know, bang nails with, right? If you put it under the faucet and you open up the faucet full blown, like you were gulping water, what happens? The water hits the sponge and bounces right off. It doesn't get absorbed, right? But if you, if you actually don't put the

faucet on full, but put the faucet on a drip, kind of like a sip, right? And it hits the sponge. What happens? The sponge absorbs it. The sponge grows. And now you have a useful tool. We are the sponge, okay? Every moment of the day. And so when we pound water thinking that we're doing something for ourselves, we're in fact not.

Secondarily, a lot of people think, okay, I've got this water commitment that I'm trying to make during the day. Oh crap, it's eight o'clock at night. And they try to get their ounces in then. All that does is cause disrupted sleep because guess what? It's going right through you. You're gonna have to pee in two hours and so it gets messed up. And so the hydration aspect is definitely what I've learned and total amount and how you do it seems to be valuable.

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So you feel completely in the zone the entire journey. Learn more at toyota.com slash toyota crown family. Again, that's toyota.com slash toyota crown family. So it sounds like if you're chugging water, it's just going to run through you. But however, I guess the call to action is just drink your water throughout the day and maybe don't necessarily, definitely don't backload it because if you backload it, you'll be in the bathroom all night.

Even if like, maybe don't even front load it. Don't front load it. Don't back load it. It should basically be somewhat even keel throughout the day in terms of your consumption. So tell me if what I do every day is not the best use of my time. As soon as I wake up, I will drink 32 ounces of water and I'll put some electrolytes in the bottom of that. Just because I've woken up, we wake up

Yeah, for sure. Sleep is a dehydrated event. So you're doing a good thing. My question is, how long does it take you to drink that 32 ounces of water? A couple of minutes. Is that too fast? It is. I think it's too fast. It's delaying my first cup of coffee, though. Come on, you got to help me out here.

That's a good thing, bro. Trust me. And by the way, your first cup of coffee counts for hydration. That's another thing that I learned is basically caffeine in terms of its usefulness as a diuretic, which means it makes you have to pee, doesn't really kick in until you hit about 150 to 200 milligrams of caffeine, which is about two to three cups of coffee. So you can actually have two cups of coffee and have it count towards your hydration and

Believe it or not. I love it. Let's end the show. We're done. That's amazing. But wait, we've got to get your 32 ounces of water down. So here's what I want you to do with your 32 ounces of water, okay? Is I have a morning routine. I've talked about it before, but I want to remind you of it. And I want you to include your 32 ounces of water in this routine. It's called the three...

What you do right after you wake up is you take 15 deep breaths merely to open up your respiratory system. You would drink 15 ounces of water. In your case, it's 32. And then you would go outside and you get 15 minutes of sunshine.

sunlight coming in through the eye turns off melatonin faucet in your head. So here's where I think you could slow down is during your 15 minutes of sunshine, that's when you drink your water. So don't drink it before and you have to finish your last sip at the end of the 15 minutes. So you're gonna be outside,

And by the way, while you're outside, you can do whatever you want. You can play with your, if your girls are outside and it's morning time and they want to hang out, great. Take off your shoes and be on the earth. You have a dog, go outside with your dog. You want to throw a ball? I don't care. But what you're doing is every minute you'll drink a couple of ounces and then you'll do your thing. Drink a couple of ounces and then do your thing. You will be shocked.

at how well hydrated you will be. - And what happens if you're like me and you wake up a little bit early around 6:00 a.m. and the sun's not really out yet, maybe it's peaking, does that count or do I have to fully wait for the sunrise? - So it depends upon your timing of your schedule. So for some people, they've gotta be up at a particular time to get out the door. We talked about it, daylight savings is not so great waking up in the dark. So for those people, I actually have them turn on all the lights.

Even though it's artificial light, it's still helpful in terms of helping your brain stop producing melatonin. You could buy a light box. I have a light box. They're about 90 bucks. And I use it when I travel internationally because then I can kind of get my sunlight whenever I want it. But generally speaking,

I don't have a problem. If you wake up at six and it's still dark, then what I would do is go into a room where there's lots and lots of lights and be able to do it in there. And Ben, if you can go outside, I would love to see you go outside because number one, being part of nature is without question helpful in many different ways, shapes and forms from a mental health perspective. But there's some data looking at it from a physiology perspective as well. And so why does hydration...

matter so much for sleep? Great question. So number one, hydration matters for bodily function. That's why it matters for sleep. So what a lot of people don't realize is that they're completely under hydrated because they're not listening to their thirst cues during the day. So every time your mouth gets dry, what a lot of people don't do is grab water. What they do is they'll grab food. They'll

They'll have coffee, something along those lines, which de-stimulates them. And so they don't think about having water. Why is water important to sleep? Our body is literally made up of almost all water. I think it's 94% water. And so as we become dehydrated, every single function of the body gets less and less efficient and effective. And so what ends up happening

happening is you actually end up in lighter stages of sleep when you're not well hydrated. You end up having far more awakenings when you're not well hydrated. And so people think like, oh, I'm not well hydrated. I won't wake up to pee. In fact, you actually wake up to pee more when you're dehydrated because your body has already ripped through the water that it has. It's in the end stages and you can't continue to reuse it. So there's a lot of reasons why hydration has a big effect on sleep. And

How does one assess how high, like how well they're doing here? Is it the urine color feeling? Yeah. So it's all about the color of your pee. Um, and so what I tell people is after you go to the bathroom, turn around and take a look. So if it's clear or a light tinge of yellow, boom, you are well hydrated and doing well. Um, as it gets darker and darker, that is a signal that you have, uh,

more condensed or less hydrated urine, which is a sign that's not going well. Now, I want to be clear. There are some supplements that people take out there that make their pee turn all these kind of crazy colors. So the urine color test won't work for them. But as a general guideline, when you look at your pee, if it's clear, you are definitely hydrated. A second thing is you can do something called a skin tugger.

test. So this is where you just take your hand and then you pinch the skin on the top, which is very thin skin. You raise it up a little bit. And then when you let it go, it should quickly form back to your hand. If it forms back within two seconds, you are well hydrated. If it takes significantly longer, then you probably need a glass of water. Interesting. So that's just, I'm going to hold my hand up for those watching on YouTube. So tug like this. Yep. Pull it up.

and then drop it. And one, two, it's back to normal. You're well hydrated. I'm well hydrated. All right. I'm doing something right. Maybe I look. Well, you like your morning coffee and I told you that it was good for hydration. I mean, honestly, drop the mic. Let's go. I love it. And so let's segue to breathing, how we breathe. Why so critical? Here's the deal. One of the big questions that I get asked about this book is, Michael, why did you write a book about stuff we already do?

right? Like our bodies already do this automatically. Like, shouldn't we already be doing this pretty well? So number one, the answer is no, we're not doing this particularly well. Number two, when I'm talking about breathing, I'm not just talking about oxygen carbon dioxide exchange. I'm talking about the way in which you do this. So I've been very fortunate in that I've had

breathwork teachers over the course of my career and lifetime that have taught me some amazing ways to control anxiety, to give me energy and things of that nature. I'm going to be super honest with you, Jay. I wish that when I was getting my PhD in clinical psychology, that we had coursework on breathwork and the importance of breath to mental and physical health because we did not. I could have saved so many more lives.

people's sleep had I just understand earlier in my career the importance of meditation, relaxation, and breath work. And so breathing is such a cool thing because not only does it keep us alive, but you can turn on or off your autonomic nervous system.

Remember, your autonomic nervous system is made up of two branches. There's the sympathetic and the parasympathetic. The sympathetic, I think of that song from the Rolling Stones, Sympathy for the Devil, so it makes you crazy and you're running away. And then the parasympathetic, I think of like paranormal, like ghosts and nighttime, and that makes me think of rest and digest. And so just by breathing different ways, and there's a whole host of different ways that you can learn how to breathe, you can turn these systems on or off. I

I'll give you an example that's not so woo-woo into breath work for some of our listeners out there. Let's say you're a runner, okay, and you're going to go for a run. When you start out and you're walking, your breath is probably in a very particular pace, in a very particular depth. Now you've moved to a slight jog.

What happens to your breathing? Your breathing changes in order for you to accomplish the goal of moving a little faster. Now you're in a full on gate and you're trying to get your personal best. What's happening here? Very different type of breathing, not only in terms of depth, but in terms of speed, in terms of recovery, all of these different things. And what's happening is it's teaching us how to accomplish these goals.

So breathing is fundamental to sleep, obviously, but also there's a second aspect to it that's important, which is sleep apnea. So my entire career, I've been diagnosing people with sleep apnea. One of the things...

lot of folks out there don't know is when you snore and you actually stop breathing in your sleep even if it's for just a second that is a very serious situation called obstructive sleep apnea syndrome this is something that we've been treating for many many years there's a lot of different treatment modalities for it but one of the things that people when they don't think about when they're thinking about their breathing is what is their breathing like while they

they are sleeping because that turns out to be an incredibly important question. And believe it or not, between 12 and 18% of the male population, that's like almost one in five people has undiagnosed obstructive sleep apnea. So how would one know about that if they're not doing the full-on apnea test?

Great question. So nine times out of 10, it's their bed partner. So somebody has said to them, hey, you snore like a freight train or you snore and then you have these brief pauses at night and I'm not really sure what's going on. I think you kind of die for a second and then you seem to wake back up. These are the descriptions I get in my office literally every single day. So

Nine times out of ten, it's your bed partner who's telling you, "Hey, something is going on." Let's say you don't have a bed partner and you're still concerned. If you wake up completely exhausted, feeling as though you haven't had a good night's rest, if you have a headache in the morning time, if you find yourself being moody, so your moods are up and down, not very steady stream, those are all signs and symptoms of obstructive sleep apnea. The good news is,

the testing for this is so much easier now since COVID. So once COVID hit, nobody really wanted to go to a sleep laboratory again because you didn't want to sleep in the bed that somebody else had been sleeping in the night before. So everything now is done in your home. So all of the testing equipment has become condensed and we have either things that you wear on your wrist. Believe it or not, there's a ring out there that's

equal to full nighttime polysomnography. It's going to probably be a competitor to Aura at some level, but you can actually... What's the name of the ring? Happy Ring, believe it or not. It's really cool. You should definitely check it out. I'll introduce you to the CEO. I just met him. So...

What's cool about what's going on here is that testing is now being able to be done everywhere. Anybody can order a test. Believe it or not, Jake, you can go to my website and for 200 bucks, literally 200 bucks, you push a button, you'll have a telemedicine consult with one of our doctors. We can send a test to your home. You do it in the privacy of your home. The next day you get online, you're talking with a doctor who's reviewed your data and you're moving forward with the solution.

This used to take seven weeks to eight weeks. I can now diagnose somebody and get them on protocol in 72 hours. And so if you snore, do you have sleep apnea? Is it that's not necessary? Great question, though. Important question, because 50 percent, five zero percent of people actually snore, but not that many have sleep apnea. So if you're a bed partner of somebody who snores, record them.

Like just use your little voice memo thing and record their snoring. Because if you hear the pauses, bring it to your doctor. I can almost assure you that they'll say, hey, go do a sleep study. Interesting. So personally, I've shared this before for our listeners. I'll share it with you. After Pernuvo, they wanted to get like my nasal cavity checked out. They said there may be something there. Nothing was there. So I landed at ENT. And he says...

you have a horribly deviated septum. You must be a terrible sleeper. And I was like, well, not really a terrible sleeper. And he's like, you must snore like crazy. And I said, well, I don't. I said, my wife snores. So

me maybe a little bit and then so he said to me he brought over a mirror he said breathe through your nose so i breathe through my nose and i have uh the septum so deviated i have nasal valve collapse yep so and and when you just did that your neck your your nares just went in like that and so you know i said is this from a you know injury from playing sports he said no i think you've had this your whole life

And I said, what, you know, what do I do? And he was like, you could get surgery, but I don't know if I'd recommend that. And so he landed on nasal strips for me. And so where I'm going is there are two things that you see a lot of social media. You see nasal strips, these things you could buy at any CVS and mouth tape. Two things, essentially the idea being nasal strips open up the nostrils. So you're breathing, easier to breathe the nostrils and then mouth tape essentially opens

closing the mouth to force function. What's your take on both? So I love...

The idea behind nasal strips, but there's actually a better way to do it. So historically, the nasal strips would go on the outside of your nose and it would, it would have a little piece of plastic or metal, which would stick to your nose and then help flare your nostrils out to open up your, to try to physically from the outside, open up your nostrils, right? That's, that's what that product does.

To be honest with you, I tried using that product. I have somewhat oily skin. And when it goes across my nose, the damn thing migrates halfway across my... One time I woke up, it was across my eye. Like it was kind of a mess. Yeah.

So for me, those things didn't work well. They now make internal nasal dilators. So think of a stent like, you know, what you would put in an artery to open it up and keep it open. It's a very small piece of plastic. It's 100% biodegradable and disposable. They go up and in. You wear them for just the evening time. Now, I will tell you, I wore them during my workout. I had a hell of a workout having these things in because it

It goes inside your nose, opens it up from the inside. And dude, you get so much air. You don't know what to do with. What's the, what's the brand I should check out. I'll go. It's called mute. Like hit the mute button.

on your snoring, mute snoring. So I have no affiliation with the company, but I will tell you, I personally use these things. And every time I drink whiskey, my wife says, go put your nose thingy in or you're not coming to bed. So it helps with that. The nasal strips too, what I found is I originally went for like the heavy duty ones and I was ripping the skin off my nose. I had to work

So let's talk about mouth tape because that's the biggest issue with mouth tape, right? So mouth tape is something that is fairly recent, like within the last, I'd say 18 months or so that people have started to kind of think about doing this. A lot of this comes from the work of James Nestor. He wrote a book,

called Breathe, which by the way, was an excellent book. His father's a pulmonologist. James and I have had many discussions about this, but he also agrees that taping your mouth shut and having not been previously screened for sleep apnea is a terrible, terrible idea. Number one, when you tape your, no, well, let me back up. Mouth tape is not being done correctly. If you're going to do it, it should be a vertical piece going from

The base of your nose to your chin, one small piece straight down. It should be micropore tape, usually made by 3M because otherwise when you pull it off, all the skin of your lips comes flying off. It's incredibly painful. Also, you can still snore with mouth tape on and you can still have apneic events, but they're masks.

So what ends up happening is when somebody puts a piece of tape across their mouth and they're not diagnosed of sleep apnea, we don't know that they have it or not. And let's say it's a mild case. The case will get worse and worse and worse. Their storing will stop and they may even feel a little bit better. But six months, a year down the road, they're going to have rip, roar and apnea. Interesting. The other one I've used.

and like is the one, I think it's Myotape, it's Patrick McEwen, who's another, it goes around the lips. So it's not on the lips or closing, it goes around the mouth, so you can actually open your mouth. - So his is of interest to me only from the standpoint of the uniqueness of the design. I believe it's like an orange or a yellow, and it goes around, almost looks like a lipstick would be around your lips, but it actually goes

above your lips and seems to be, seems to almost magnetically try to kind of get you there. I do like it. Patrick McKeown, excellent breathwork guy, knows his stuff when it comes to breathing. The only observation that I have

is I don't know if he recommends that people be screened for sleep apnea before they do mouth tape. It would be surprising if he doesn't because he's a pretty smart dude. Because generally speaking, everybody who's talking about mouth tape to set just get screened for sleep apnea first. So you mentioned wearables with it. He was happy ring. You mentioned, how do you think about wearables? They're useless, how we should all be, whether it's or a whoop happy, whatever someone is subscribing to you, how we should

interpret the data and what are some of the insights? Absolutely. So number one, the data is inaccurate. I want to be very, very clear about this. Okay. Nobody has broken that code yet on the tracker.

side of things that's commercially available. Okay. Now there are some people who've done it in the research world where you could actually have a ring that would give you full nighttime polysomnography every single night, but that's obviously not, that's not probably appropriate for kind of commercial use. So what we're talking about here is aura, whoop,

Fitbit, Garmin, all of these different ones, Apple, right? So here's the bottom line. None of them are accurate. They're not bad. They're directionally accurate. Well, that's what I'm getting to is that's what I think people do. So people come up to me all the time, Jay, and they're like, hey, Dr. Bruce, I got 14 minutes on my deep sleep on my oral ring. What does that mean?

I don't know. What I can tell you is if you got 14 minutes the night before and 14 minutes the night after, then here's what's happening is your ring is being consistently inaccurate, which is okay. As long as it's consistent, I don't think I care because I'm not interested in the number. I'm interested in the delta. So if you go from 14 to 407, I want to know what happened that night.

So looking at the trends, what you're looking for is the nights where something weird happens. And then you go back and you try to see, was there something behavioral? Was there a lot of light in the room? Did I drink alcohol late in the day? Did I have caffeine? Like that's what I use my trackers for. And to be clear, I put trackers on all of my patients.

because it's nice. I have a way of being able to dial into Aura's data so they can actually send me their data in the middle of the evening and I can actually take a look at it. So I have my patients all on Aura data, but when they're filling out their sleep diaries, they're not just copying their Aura data. They're actually writing their perception of

of sleep because that turns out to be more important. I don't know about you, but when I wake up in the morning and if my aura gives me a score of 47 and I feel pretty good, I'm now depressed.

You know what I'm saying? And so I think that's problematic for people. I think people should look at their data maybe once a week and then again, look for the trends. What's interesting that I found is more or less I sleep fine. My sleep worse are generally good, but I'm typically, I was just scanning through my data again. I'm always good on REM, always. Deep, not so much. I'm typically like,

Like maybe 40 to 50% of the time, I'm a little short on deep. How old are you? 50. So let me explain why you're short on deep. So one of the things that I don't know, this is a guess. I want to be super clear. I don't know this for a fact because I haven't talked to the CEO of Aura about it, but I'm gonna, is...

Many people don't know this, but when you hit the age 50 to 55 in the sleep laboratory, we actually changed the criteria of how to score deep sleep. Because when you hit that age, your brain does not have the amplitude of the waveforms that it used to have. And I'm pretty sure there is not a tracker in the universe that takes that into account. I don't know that as a fact, but in the...

Knowing sleep medicine and knowing the lab, when I walk into the lab at night, I can actually look at somebody's EEG and I can almost tell you, you know, if they're an older person, like 50, I'm 56. I can almost tell you if they're in the mid fifties, just based on looking at their EEG because it's compressed. And so,

If I have a ring and my ring is looking for that kind of data and I'm not understanding that there's an initial compression, I'm probably going to be giving you inaccurate data, especially in deep sleep.

So it feels like don't pay that much attention between the delineation between REM and deep. And if I sleep good, I'm good. Here's what I would say. When you wake up in the morning, if you feel good, you are. Love it. So in terms of all the things there, what's overrated? Ah, I'll tell you what's overrated. Eight hours. Now, it's strange to hear me say something like that, but people don't realize it. Sleep is flexible.

It's not about stagnating and forcing your body to get a certain amount of sleep. Here's something that a lot of people don't understand. Right before you go to bed, your brain basically scans your entire body and figures out what it needs, how much deep sleep it needs,

how much REM sleep it needs, based on the functions that happen during the daytime. Remember, deep sleep is your physical restoration. REM sleep is your mental restoration. So when you have days of hard mental stress, your brain knows that it might need a little bit more REM. Or on days when you have real physical stress, your brain might know that it needs a little bit more stage 3-4 sleep. So trust your body.

OK, now, if you had a cup of coffee at 11 o'clock at night, well, you're an idiot. OK, and you screwed it up. So stop doing stupid stuff. Right. But generally speaking, if you go to bed and you wake up at roughly the same times again, morning time is really the anchor to the entire process and you feel good. You are the best doctor in the room.

Okay. You know how you feel. I want to give everybody permission that if six and a half hours works for you, we're good. Well, not what's the minimum effective dose. Great. Great question. So I don't like to go below six hours for most people. And let me explain why. Because what ends up happening is once you go below getting six hours on the regular, you're driving less.

and your motor skills are definitely off. And so many people drive to work or do carpool or bring their kids to school that I really feel that it's important for a minimum, minimum, minimum for people to get six hours. And to be clear, that's not six hours in bed. That's actually six hours of actual sleep that you're getting because that's really, again, you're trying to rejuvenate this unit, right? So it drives me crazy that people are like, I don't have time for sleep.

It's like, dude, if you do not maintain that vehicle in a way, shape and form, it is going to crash on you. Okay. Like that is how this works. So sleep is recovery. Sleep is what your body needs. Stop avoiding it and start doing it. And what's underrated? Oh, what's underrated? Waking up early, maybe. Although I'm a night owl, so I don't really like waking up early. What's underrated?

Oh, I'll tell you what's underrated. Supplementation for better sleep. I think that's really a bad idea in most cases. Let me explain. Most people come to me and they're like, Michael, what supplement do I need? Hold on. Here's what I would say. Go to your doctor and do some blood work. Once you've done some blood work, see what you're deficient in. Then fix your deficiencies

first, then supplement to your heart's content. But if this unit isn't getting vitamin D, iron, magnesium, and melatonin, newsflash, you ain't gonna sleep. And no matter how much ashwagandha you take or valerian you take, it's not going to make your sleep better. So number one, find out what your deficiencies are.

then do appropriate supplementation. And I wanna be clear about something. I like supplementation. Magnesium in most people needs to be supplemented because you have to eat it and we just don't get enough of it in our diet. So it's not that I'm against supplementation. I just want you to do it intelligently. Well said. So we covered a lot today. Is there anything you didn't cover that you wanna touch on before we go or perhaps leave the audience with some words of wisdom? So I think the biggest thing for people to understand is

This is simple, right? If you're looking for a starting place for wellness, this is a great book for you because these are what I call the dominoes of wellness. My friend Joe Polish, you know Joe, he writes this book called Life Gives to the Giver where he talks about dominoes of health and dominoes of life. And when you learn this skill set, it opens up so many others. If you just learn how to tweak

your sleeping, your hydration, and your breathing, and make it just literally 1% better, almost every single health goal that you have will get better. So that's what I think people should do. Get the book. And I'll add too, even for someone who's embedded in this world, I appreciate a lot in the book. There was a lot I learned and I'm deep into it. So I suggest everyone go pick it up. I'll hold it up.

sleep, drink, breathe. Michael, always a pleasure. Let us know when you're in Miami. Absolutely, Jay. And I can't, number one, I just want to say thank you. Thank you. Thank you. MindBodyGreen has been an amazing support for me for many, many years. And I love your no-nonsense attitude and your get-to-the-truth attitude about sleep and about everything that you do. So I just want to say thank you to you and Colleen for so much great stuff.

and really helping the world with MindBodyGreen because I get a lot out of it. I actually read articles on there on a fairly regular basis. And I think other people should as well. Well, you're very kind. Thank you so much.