108- How to Get the Best Sleep of Your Life with Dr. Michael Grandner

Bryan Carroll: [00:00:15] How often do you feel rested? Like truly rested? You weren't hired in any way. You had the best sleep of your life. You woke up without an alarm clock and you are ready to take on the day is the answer.

Never. Or has it been so long since you've felt that rested? You have totally forgotten what it feels like to get good sleep? Sleep was one of the easiest things for us to sacrifice, and it has a profound impact on our health. Most people would absolutely love to have more sleep, but has found it difficult to stay asleep all night long.

What's up everyone. I'm Bryan Carroll and I'm here to help people move more, eat well, and be adventurous. And as you guessed it, today is all about sleep. Dr. Michael Grandner is a sleep specialist and I asked him an entire list of sleep related questions that I have heard from all of you. And if you are ready to figure out how to get the best sleep of your life, then you are listening to the right episode.

So let's dive into this conversation with Dr. Michael Grandner. Dr. Michael Grandner is a licensed clinical psychologist, certified in behavioral sleep medicine, director of the sleep and health research program, and associate professor of psychiatry psychology. Medicine, nutritional sciences, and clinical translational science at the university of Arizona.

His clinical work focuses on non-medication treatments for sleep disorders, and his research examines the real world relationships between sleep and obesity, diabetes, heart disease, daytime functioning, and the longevity. Thank you for coming onto the show, Michael. 

Michael Grandner: [00:01:58] Thanks for having me. 

Bryan Carroll: [00:01:59] Of course. And yeah.

Like I was telling you before we got on the call. Sleep seems to be a very big issue right now. And I love that you are super fascinated with their research and everything behind it. So what got you so interested in researching sleep? 

Michael Grandner: [00:02:15] Cause it's awesome and it's fun to do research. I mean, seriously. So when I was in back in high school, I used to think like dreams were the coolest thing ever.

And, and sleep was cool. And. I used to, you know, I used to, if I could find a book on it, I would read it. And that's how I sort of learned that, that I'm not just about dreams, but about how, like there was this whole world of sleep science and there's all this stuff going on, but I didn't realize it was like a job you could have, like, you could do this.

It was just something that was fun to read about until I was in college and I took, there was a course offered, On sleep and sleep science and sleep disorders. And, it was by a researcher who was working at that university. And I took the course and I thought it was the coolest thing ever that this whole world exists.

And I just remember thinking that like, what an incredible story this field is. And I, I just really want to be part of that story. I want to be one of those crazy cast of characters of scientists studying sleep. And could I do that? And so I volunteered to work in the lab. it turned into an independent study and an honors thesis, and, learn how to apply to grad school and sort of went from there.

Bryan Carroll: [00:03:32] It's kind of interesting with sleep because you know, if you look at like your pets, if they sleep all day, you always kind of make fun of them for all they do is sleep all day. And then we used to pride people on, you know, they work so hard, they never sleep and you can sleep when you're dead. But now we're running into a lot of health issues, and a lot of people that are sleep deprived.

So can you talk a little bit about sleep deprivation and what that can do to us health 

Michael Grandner: [00:03:58] wise? So there's. To take a step back. There's a reason why sleep loss, sleep deprivation, sleep disorders, you know, however you want to, whatever angle you want to look at, sleep problems, there's a reason why it impacts so many different aspects of functioning and health and mental health and all of these things.

And it's because sleep isn't just one thing in the body, right? Sleep. Is it just one, one nutrient that does serves one function. It's a fundamental part of how we're built. it's like, it's like breathing that way where, We breathe. Not because breathing is fun and we enjoy it. We breathe because we have to, because it's part of how our body works.

Without breathing, our bodies would not function. It's the same thing with sleep. Sleep is part of how our bodies function. And that's why it's connected to everything in that way. Just like with diet, you know, we need to eat because food and taking in food external to us is just fundamentally how our biology works.

We don't work, our biology does not function without ingesting food. So, Just like every cell in the body gets nutrition, you know, sleep is for the whole body too, and it affects all of these things. And going back to your other point, nobody says things like, you know what? Clean air is a luxury for people with too much free time, right?

Nobody says that. You know what? I will find clean water when I'm less busy. Right? I mean, we do sort of say this about food though. Like, I'll eat healthier when I've got more time, when my head is more clear, when I have more money, like all of these things, or I'll exercise more when I have more time. I mean, you know, these are, these are the sorts of decisions we're making and not because they're good decisions.

but because. we, we, we don't recognize how fundamental these things are to how our body works. 

Bryan Carroll: [00:05:57] Yeah. I don't remember the last time I ran out to the mud puddle outside, to add water into my water bottle because I was too busy to go and get fresh water. Right. So that's, yeah, that's a really good point.

But I mean, we push off sleep like it's no big deal all at the time. 

Michael Grandner: [00:06:13] Well, it's because humans are built to survive. And because of that. we're a highly adaptable or that we can change our schedules and change our environments, pretty easily and actually do pretty well. And, and w it won't kill us to have a cold winter one year, like many organisms won't survive.

We will, we'll figure it out. If we are, if we are in the dark, we're not going to suddenly fall asleep. unlike some, some animals, they're very highly liked, dark, sensitive in terms of their wake sleep cycle. we've evolved past that where we're sensitive to light and dark, but we're not a slave to it.

And, and that has enhanced our ability to survive. So if we're being chased by their, through the forest and the sun goes down, we don't go in line out. We find safety first and we can do that. We can prolonged wakefulness for quite a while before we start running into problems in the short term. But.

The thing is, we're not all running from bears in the proverbial jungle finding a proverbial cave. You know, that's not what we're doing anymore. We're doing this on purpose and it's not life or death, even though the systems that allow us to do it were what let us survive. We don't need it for survival anymore.

But that's why we can do it. and it wasn't really meant to be something that. we pushed to its limit. Just like everything else in biology, when you push it to its limit, you know, it stops working very efficiently. And unless, unless you can sort of reorient around it and with sleep there doesn't, there seems to be a limit as to how little you can go.

So sort of, sort of like pain, right? pain is, is adaptable because of helps motivate you to get help when you need it. Like if you're injured, you should. Right? You should not be moving. You should be resting. You should be healing. You should be getting help. You should be putting something on it if you're bleeding.

Right? pain motivates us and moves us to do those things that would help keep us surviving. But chronic pain is the opposite. Chronic pain. It's the same pain, but it's debilitating. Chronic pain keeps us from seeking help. Chronic pain keeps us in mobilize. And because of that, even though chronic pain and acute pain get felt in very similar ways, they have very different effects.

And that's sort of the thing with sleep deprivation where, you know, if you are, if you need to stay up one night, To do something really, really important, your body can handle that. And you'll, you might have some consequences the next day, but they'll be relatively mild as long as you're coming from a place where you're otherwise sleeping fine, and then you go back to a normal schedule.

But if you've disrupted your schedule consistently over time, That's where the problems start accumulating. It's like, just like with diet, you know, you know, humans can go without food for a day or so. You know, we'll survive. We're not going to die. But. If you, if, if you don't have a healthy diet for days and days and weeks and weeks and years and years, then things stop working properly and, and our body's just not able to do what it should do in the way that it should do it.

That's the same way with sleep where a short term, you know, we're, we're built to be able to not sleep if we choose not to for at least a period of time and to be flexible. But there could be longterm consequences. Yeah. That can come from that. 

Bryan Carroll: [00:09:50] Yeah, and that was going to be one of my questions to you is the difference between acute sleep deprivation and then chronic sleep deprivation.

So if someone is chronically sleep deprived to like you're talking about weeks, months, a years of not getting enough sleep, what are some. Health consequences that can show up from that, 

Michael Grandner: [00:10:12] right? Like if you have a healthy diet and then you eat a cheeseburger, nothing horrible is going to happen to you. But if you eat nothing but cheeseburgers for weeks and months, your body's going to start feeling those effects.

And that's sort of the same way with sleep. So, yeah, when you think about sleep, there's, you could think about effects on the brain. You can think about effects in the body. in the body, you get things like altered metabolism. So how your body manages energy, is, is highly sleep dependent. How your body manages hormones.

And the endocrine system is highly sleep dependent. So you got hormone imbalances, you get energy imbalances, you get metabolic changes. So like that's why people who are chronically sleep deprived are more likely to gain weight. They're more likely to become obese. They're more likely to have trouble losing weight, not just because they're tired, but because their metabolism changes.

Other things have happened is you're more likely to develop high blood pressure. I'm your, your cardiovascular system doesn't work quite as well because it's, it's tied into the sleep system to keep it functioning properly. the way your liver works, you know, it looks like the liver is highly rhythmic and sleep dependent in terms of how it processes things and, and, and generates cholesterol and like all these sorts of things.

All these functions are all tied together to promote your own maintenance. it's like, it's much harder to change your car's oil while you're still on the road. And evolution figured that out a long time ago. That's one of the reasons why we sleep. We sleep because it's actually much more efficient to perform maintenance when we're disconnected from the environment.

And so when you don't allow the system to perform those functions, Then you know, it's, it's like, you know, you go a little too long on your first oil change, no big deal. Your second oil change, no big deal there. An oil change, okay? Maybe little bit of a deal, but if you, if you do this over a few years.

And you know, you're, you're car isn't going to be working right, and it's going to die sooner. I mean, they're, they're going to be consequences. So, so in the body, the, the main things you want to think about are metabolism, energy, hormones, cardiovascular and immune function. and our ability to fight disease, our ability to stay healthy, our ability to regenerate because.

What are the main functions of the immune system? I mean, we think about it mostly in terms of disease and keeping us from getting viruses and bacteria and things like that, but that's actually only one side of the immune system. I ate another whole part of how the immune system is working. It's, you know, when your body is constantly regenerating itself and healing itself and, and every cell in your body has a life cycle where it gets born, it grows, it dies, it reproduces your body changes and adapts and it's constantly growing and changing.

And blood vessels are constantly adapting. It's the immune system. That's one of the main drivers of this. You know, the immune system is what helps target cells for deletion and protects them while they're growing and all these sorts of things. And so if your immune system gets disrupted because you're not sleeping because you're not able to perform proper maintenance, then your body's ability to adapt and grow and regenerate and replenish and repair systemically, it gets affected.

And that's why you see, chronic inflammation. And people getting more sick and for sicker for longer and have harder times to recover, things like that. So those are effects in the body, in the brain. There's a few things to think about there. A big one is mental health. another one is cognitive function.

and another one is actually just health of the brain. So from a mental health perspective, the aspect that's most closely linked to sleep is depression and mood. There's hundreds of scientific papers detailing all of the different ways in which, Difficulty sleeping is tied to depression. So much so that it's actually, it not only goes both ways where, you know, people who are depressed don't sleep as well.

Okay. People who don't sleep well are more likely to get depressed. And actually that effect is. Bigger, probably. and not only that, lack of sleep and insomnia is a major risk factor for the development of mood disorders. Even if you didn't have them before and you don't have other risk factors.

Insomnia itself is amazing. It's like, it's like having high cholesterol for heart disease. Like even if you exercise, if you've got really high cholesterol and your blood pressure's going up, you know, you're getting, you're getting risk for heart disease. so insomnia, depression, also suicide. So suicide risk is tied to sleep.

So people who don't sleep well or about triple the risk, we're not only thinking about suicide, but actually dying by suicide. And, and this is a huge public health problem, and it's not just about depression actually, where when you take out the overlaps statistically, you look at the overlap between difficulty sleeping, mood and suicide outcomes, and you take out mathematically every bit of that overlap between sleep and suicide that also overlapped with depression.

There's actually still about a doubling of risk. So it's a huge effect that we're just starting to uncover and figure out, well, wait, what else is going on here? And part of it may just be that when you're spending a whole lot of time awake, when your body wants to be sleeping, it's not able to do what it needs to do.

in terms of the brain, and that impacts things like cognitive function, meaning things like your ability to focus, reaction time, your thinking ability, your reasoning ability, your memory and learning. All these things are highly sleep dependent. So for example, converting short term memories into longterm memories seems to be a highly sleep dependent process for the same reason that we tell students, if you're going to pull it all night or don't do it the night before the exam because you're going to walk in there and you're not going to be able to think.

you're, you're gonna make dumb mistakes. You're not going to be able to integrate information without sleep. and, and you're not making good decisions. There's all kinds of data on sleep and decision making, even subtle types of decision making that you're not even really aware of, but you're just not making good decisions.

You're not weighing risks and benefits optimally. You're not doing these things. And that actually might be part of why. We have the suicide link where it's not just about how when you're not sleeping, you emotionally are dysregulated. You blow things out of proportion more. You have a shorter fuse. I mean, show me someone with a short fuse.

I'll show you someone who's probably not getting good sleep. Not only do you have that, but also you're, you're less able to think clearly, make good decisions. I mean, how many people say they wake up in the middle of the night and, and what's going through your mind when you wake up suddenly at three in the morning?

It's certainly usually not relaxing thoughts, you know, and you, and then in the morning you look back and you're like, what was I so freaked out about? and it's because in the middle of the night, you're not thinking as clearly. and then the third aspect is brain health. So there's a whole field now in neuroscience of what is it that sleep physically does to the brain, not just in terms of how the brain works, like in terms of memory and functioning, but the actual mechanics of the brain.

And it looks at things like immune functions in the brain where the brain has a very different type of immune system than the rest of the body does. And so getting rid of toxins, and, and waste products is a little more difficult for the brain than other parts of the body. Cause the brain is sequestered and it's, it's walled off a little bit from the main circulatory system.

So we have this system in the body that helps clear waste products out of the brain, but that's just build up during the day. And it seems to be highly sleep dependent. and then when, and this seems to be one of the biggest discoveries in the last 10 years, is how this system works. Where like even the spaces between the cells grow, while you're asleep, which allows, which allows the holes to open up where these things can filter through, for example, which might be why people, who aren't sleeping well might be at increased risk for things like Alzheimer's disease. As these waste products build up over years and years and years, eventually start causing symptoms. So, so sleep plays a lot of these sort of important roles. I mean, a good way to think of it as anytime there's some regulation or balance or feedback or some sort of maintenance function, sleep is probably in the mix somewhere.

Bryan Carroll: [00:19:02] Yeah. The interesting thing is, suicide. Kids and teens, I believe as a second leading cause for those ages. I actually think it's second leading cause for age 10 to 34 

Michael Grandner: [00:19:13] that's correct. According to the recent CDC data, it's the second leading cause of death for all age groups between 10 and 34 and that's just where it's the second it's, it's still pretty high for the next couple.

Bryan Carroll: [00:19:25] Yeah. Yeah. Which is super interesting because you have all these teenagers that stay up till two o'clock in the morning doing tech talks and Snapchat, and then they wake up at five to go to school or get ready for school. And I always say that suicide is a multifactorial. There's usually more than one thing that is going on.

But sleep is a huge piece of it, especially if you're getting three to four hours of sleep each night. 

Michael Grandner: [00:19:48] And not only that, not only is it about sleep loss and time awake when your body wants to be asleep, it's also, I mean, it's, it becomes this recipe for a problem because you all, you're also alone. you also don't have anyone to like be bouncing these things off of, and you don't have anyone to stop you and you don't have, you know, these social pressures.

So, so it creates this isolation on top of it. So the other thing I want to mention about, teenagers and young adults is that, their biological clocks are fundamentally different, as, as your age changes. So when you think about it, how everyone, you know, th. That everyone has what, what it would be called a biological night, where this is where your body thinks nighttime is, and it's you and there's a pier in that biological night.

It's when your body wants to sleep. No. for a typical adult, you can think of a typical sleep period of being like 11 to six or seven. Ish, like between 10 and seven, somewhere in there. Sort of very normal for a typical adult to have where their body prefers to sleep. Now, little kids wake up super early.

You know, having a six year old who wakes up at five o'clock in the morning is not unusual. That's normal. And then, but they also go to bed at like seven or eight o'clock at night. right. You know, that's what little kids do, and that's where they have their bedtime. It's not just because we want them to go to bed early.

It's because their biology, their biology sets them up to, the sleeping earlier. But then what happens as they get older, that biological night drifts later and later, and later and later and later. And by the time they're teenagers, their biological night is really late. So in, in when a typical adult sees midnight on the clock.

You know a, and we look at the clock and we say, it's eight o'clock it's time for the six year old to go to bed. That six year olds body sees eight o'clock but it feels more like 11 you know it, it feels later than it is because their, their night is moved, shifted over, and by the same token, I'm a teenager, they see eight o'clock but their body says it's six.

You know, and when it's 10, 11 o'clock at night, their body says it's eight, you know, and it's not time for sleep yet. And so their body might not want to sleep until like 11 or 12 or one, and then it wants to sleep until eight or nine or 10. but then we make them get up at five or six in the morning to get to school.

And. That's crazy. Imagine if you had to get up for work at three 30 in the morning every day, like you survive for a while, but after a while you'd be miserable. And, and here we take a stage of life where people are sort of miserable anyway, cause they're adolescents. And then we sleep deprive them, forced them to wake up super early in the morning, give them high stakes tests and stuff during the day under sleep deprivation conditions, and, and assume that they're going to turn out okay.

I mean, that's where all the school start time stuff is coming from. I mean, it's, it's one of the biggest no-brainers in science right now. Is it, in terms of science policy, it's that, should we be advocating for later school start times? Yeah. Yes, we should. There there's, there's very little disagreement here.

The disagreement is how late can we make it? And that's the same thing in colleges too. And I'm going to have a lot of athletes, for example, who are getting up very early in the morning to train where to run or to do whatever. And, but to them it might be too early, but that might be the only time they could do it.

So we create these problems. But yeah, so it's not just about the lack of sleep, it's also the timing. And, and we're, we're not. Well, actually, I would say we're not timing things properly, but we're starting to talk about it, and I think 10 years ago I remember having these conversations with other sleep researchers.

We'd be, I distinctly remember one time in particular, we're sitting around a table at lunch. This was more than 10 years ago. And we're talking about, you know, what, what the data really shows. We should be moving schools, but yeah, no one's ever going to pay attention to us. Nobody actually is going to do this.

That's, yeah. We laughed like, yeah, like anyone's ever going to do that. And then a few years later, Judy Owens, who's at Harvard right now, she was one of the people who got this movement started at a policy level, got one school district to move a half an hour  that got the ball rolling and it's actually happening.

Bryan Carroll: [00:24:18] Yeah, it's pretty interesting because up here in Washington a few years ago, they were talking about, swapping middle or elementary school and high school start times because here, elementary schools usually start later, and high schools start, the earliest. And they were talking about switching that.

So, because little kids are usually already up and Which would make sense, but then you run into the issues of, well, people have to work, and so how do they get back in time and yeah. Then do you extend elementary school times and shorten high school time? So there is a lot of logistics to it. What they ended up doing is just adding 20 minutes on, which is better than nothing, but still probably not as ideal as what you're talking about.

Michael Grandner: [00:25:02] First of all. Now you know why they're talking about switching because first of all, we have it backwards. The ones who need to sleep in. We make them start earlier, and the ones who've been options five in the morning, we make them start later, which makes no sense. But all the problems, they're not biological.

They're not scientific, and they're not even in terms of the kids, they're all logistics. It's all busing and afterschool activities and parent's work schedules. I mean, those are the problems. I mean, the problems have nothing to do with what's better for the kids. We know what's better for the kids. We know it's better for their health, for their mental health, for their academic success, for their graduation rates.

We know what's better. It's just now we have to figure out a way to make it happen. but in all the problems, you're right, the problems are all logistics. And in my mind, Those are solvable problems, which means, you know, we might not have the solutions, but at least they're solvable. 

Bryan Carroll: [00:25:55] So since different age groups have different biological asleep clocks, 

Michael Grandner: [00:26:00] yep.

Bryan Carroll: [00:26:01] That must also mean that there's, optimal amount of sleeps for different age groups as well. Is that true? 

Michael Grandner: [00:26:07] Yeah. Where were littler kids need more sleep? and where regular most adults probably need seven or more hours, where if you're younger, if you're more like an adolescent, you probably need more than like eight or nine to be optimally functional.

But, and littler kids need more. And then there's some controversy about older adults in terms of do they need a little bit less wear where that's not clear. they seem to be more resilient with a little less, but do they need less? That's, that's a different question, but where most adults probably need at least seven.

If you're younger, you probably need, if you're a younger adult or an adolescent, you probably need a little more Brompton will function. And then it just goes up. You know from, from there as you go down in age. 

Bryan Carroll: [00:26:53] And then, you mentioned earlier that waking up around two, three o'clock and stuff's on your mind.

And then when you wake up later in the morning, you don't even remember what world problems you are trying to solve. how can we improve our quality of sleep because it seems like adults have. So many issues with staying asleep. Once they do fall asleep and they are up down, they have to go to the bathroom.

All sorts of issues going on. So how can you improve the quality? 

Michael Grandner: [00:27:19] So, two things. One is to get a, to get your head around what it is that's actually happening. So a lot of people are thinking things like, why can't I sleep through the night a more? How do I fall asleep faster? And part of the answer to that.

Lies in understanding what's actually happening. So I mentioned before that we have these survival mechanisms that allow us two stay up later. which means that it's, if we get very activated and we need time to wind down before we can fall asleep. So for people who want to be able to get to sleep, a lot of times I'll get into bed and then they say that I can't turn my mind off.

Well usually that, that to me says you didn't allow yourself enough time to slow down before you got into bed. So it's sort of like, you know, you're in a car, you're trying to take a turn, and you're saying, well, I can't take the turn fast enough. Well, if you don't step on the brakes a while before, especially if you're going really fast, you're going to miss your turn.

You're not going to be able to take the turn fast enough. And so you need to give yourself more lead time. There's no escaping from that. The more you're doing the Mo from the more busy, distracted and and agitated and active that you are mentally and physically, the more time you need to give yourself to, to land, to wind down like, like an airplane is not a helicopter.

It doesn't just go straight down. Neat. Like you start coming in for a landing 20 minutes early. You know, before you're on the ground and you've got to think about giving yourself a solid, you know, 20 to 60 minutes at night where you're giving yourself the lead time you need, so that when you get into bed, you're actually ready for it.

You're actually, you know, landing as opposed to dropping out of the sky. so, cause otherwise you're gonna miss it. The other thing is he's waking up during the night. So. One thing I like to tell people is that waking up during the night is not the problem that you wake up. It's not the problem. A typical adult, well, wake up 10 to 20 times during the night that you woke up is not the issue.

You just don't remember. Most of those awakenings. You'll remember one to three awakenings probably as you get older, that number might go up a little bit, but those awakenings should be relatively brief.  not that troublesome. They shouldn't bother you too much, et cetera. So as long as they're, those awakenings are relatively short or totaling under like a half an hour.

I wouldn't spend any time worrying about it. If it means you have to budget a little more time budget a little more time. Th there's no expectation. No, no human has ever slept through an entire night without waking up, without being sedated. You know, it, it doesn't happen. You do wake up and some of those awakenings might last a few minutes.

If one of those awakenings will, you know, wake, you wake up and, and, and it becomes disruptive. That's where you start having a problem. So, there's a couple of things that can, cause this. One is if you're waking up a bunch of times during the night and you're having trouble getting back to sleep. And you're, especially if you have a bunch of different awakenings, there's a few things that you should think about. The first thing you should think about is untreated sleep apnea, which is incredibly common, which is much more common than the most we believe in real life. And if you've got untreated sleep apnea where you're having difficulty breathing across the night, you don't even realize it, but your body does, and it keeps waking you up because it's trying to breathe.

You don't know that. All you know is you keep waking up and sometimes you wake up and have a hard time winding back down, falling back to sleep because your body just worked really hard to wake you up and it's still agitated. so if you ha, especially if you wake up feeling tired during the day and have trouble staying awake and you feel like your sleep's a little choppy, get tested for sleep apnea, it doesn't hurt.

and at least, you know, the next most common thing that I think interferes is, pain. People with chronic pain, or other medical conditions where your body can never totally disengage, can keep your sleep shallow. and so that can get in the way. the third thing that can wake people up during the night, the third most common thing I think is the environment.

Where you know you have no sounds and noises and light and things, and a bed partner that moot rolls over, and by the time you're awake, you don't know what it was that woke you up. because the, the, the, the loud sound is over, like the car drove past 10 seconds ago and now you're awake and you don't even know what it was that woke you up, or your partner rolled over and that woke you up.

But now they're not moving and you don't know what it was. So sometimes it's things in the environment. that are making your sleep a little more shallow, but if it's that you have an awakening and then can't get back to sleep, There's one thing that you could be doing that could be making this much worse.

and that's. and that's contributing to insomnia. So insomnia, it's difficulty sleeping. It's difficulty falling asleep at the beginning of the night, or you wake up and you can't get back to sleep. That's insomnia. Now we're insomnia crosses the line into a condition that I would worry about  where it breaks 30 minutes.

So if it's taking you more than 30 minutes to fall asleep once you start trying, or you're awake for more than 30 minutes of the night trying to sleep, and this is happening. You know, more than half the time, so three nights a week or more. And it's causing the problems, you know, that that may be past the point of sleep tips.

Then you might need to see an insomnia specialist. And, and by the way, the main treatment for insomnia shouldn't be medications. The recommended first line treatment is actually something called CVTI, which I could, you know, we could talk about. but it's not medication, so it doesn't impair performance.

It doesn't have the same side effects that aside. If you're just having some trouble sleeping. there are a million things that could cause short term in song, any kind of, anything that can cause stress or physical Morales already. But it looks like there's one main cause of chronic insomnia, and that's something called conditioned arousal.

What that is, is that you accidentally program your brain to be awake in bed when it, when it should be sleeping. And the way you do that is. You, you start teaching yourself that the act of falling asleep results in wakefulness. and, and so, so let me walk you through how most people do that. Most people, they, they, they're not ready for sleep when they get into bed.

or if they're not ready for sleep when they get into bed and their body's sort of winding down or whatever. It might take awhile to fall asleep. And then they fall asleep. Then that happens again and again and again and again, and eventually your brain is not an idiot. It figures out, ah, the place, the, the bed, that's the place I go to want to sleep, but, but fail and lay there awake for awhile.

So even if you are tired, you've programmed your brain to wake up as soon as you get into bed. Same thing with awakenings during the night where and one can start causing the other. Where if you start teaching yourself that getting into bed. Well, I fall asleep. I don't know. Or pro or even worse, probably not.

if that's sort of where you've gotten to waking up in the middle of the night, one of those awakenings, if you don't have tons of sleep pressure to get yourself back to sleep, that that background thought starts kicking in. Oh, I'm in bed. I probably will have trouble falling back asleep. Yeah. Creates the problem.

So now all of a sudden your mind is active and expecting it to not work. And it's sort of like you trained yourself to be in that mental and physical state of being unable to sleep in bed. and to prevent this, I mean, you can treat it with CVTI and things like that, but if you are going to prevent this or if you have a minor problem of this, the thing that I would recommend, and this is something everyone should do, even if you don't have this cause it'll set you up for success later, is called stimulus control.

And a simplified version of stimulus control that everyone can do is this. If you are in bed and sleep is not imminent, get out. Like, do not set yourself up to learn that the bed is for being awake. If you're getting, if you're not ready for sleep, don't get into bed. If you are ready for sleep, get into bed.

If you, if you're not sure if your body's gonna fall asleep. Get into bed and give it a chance. And if you've gone 20 to 30 minutes and you're not asleep yet, get up, reset, try again. you don't ever want to be laying in bed for more than 20 to 40 minutes at most, not sleeping at any point. And then what happens is you strengthen this bed, equal sleep connection.

And if weekends, the bed equals not sleep connection, and eventually you start learning that the bed is the place. Where you sleep. It's like going to the gym where when you get to the gym, even if you're tired and hungry or whatever, once you yeah, there and walk in the door and start, you can make it to the end.

because you only do one thing there. You don't eat there. You don't rest there. You don't socialize there. You don't do all these other things there. You don't work there. You know, you, you, you just go through your workout. And because of that, you learn that that place is for that thing and that even if you're having trouble doing that thing, the place has the power to put you in that zone.

Because you've learned it, it's become, it's, it's becoming grained with the place. Same reason people hate going to the dentist cause when they're there, bad things happen. Even if you're, you're, you're in a bad mood and you're in the waiting room, nothing even happened yet and you're already reacting to the past.

You're reacting to what you learned happens there. You're in a bad mood. You haven't even gotten in the car yet. Because you've learned the power of that place, put you in a physical and mental state so thoroughly. It's bleeding out and you're not even there and it's already impacting. That's what you want the bed to do.

Do you want the bed to be the opposite of the dentist office where every time you're there, you're relaxed and you fall asleep? What happens is a lot of people are there and they're awake and they're alert and they're worried and they're thinking and they're doing all these things. That's what they learned.

So that when they get into bed, it's like getting in the dentist chair of nothing's happened yet, but you already are expecting it and you create it. You create the negative feeling, even if there was not because you trained it. Does that make sense? 

Bryan Carroll: [00:37:52] Yeah. And that's what I've been doing. So usually before bed I read a little bit and I used to read in bed.

and then hearing you talk before it made me think about, okay, maybe the bed should just be for sleeping. So, For a little while now, I will read away from the bed, not in the bedroom, and then when I'm ready for bed, then I put the book down and then I make my way to the bed and I feel like. I can get to sleep faster because it's got one purpose.

Michael Grandner: [00:38:22] Exactly. And, and you and your brain is a pattern recognition machine. It will recognize whatever pattern it sees. If you want to feed it a pattern to recognize, they will learn it. and so will you, the pattern you want to feed it is get into bed, fall asleep. So that, so, so, and people can use this to their advantage.

So let's say you have a day that was super stressful. And you want to get to bed, but your mind is all sort of wound up. If you get to the point where you train yourself to sleep in bed really thoroughly, the bed itself becomes a trigger for sleep as opposed to a trigger for wakefulness. The bed itself helped calm you down and put you to sleep.

Or let's say you're traveling and you're in a hotel room and it's a strange place and there's some noise or whatever. You get into bed and the bed itself becomes a trigger for sleep because you've learned that, that some of the things working against you, like the unfamiliar environment, you actually now have something in your corner.

You actually have some ammo on your side, to, to fight against that. Or if you wake up in the middle of the night, getting back to the original question, you're, you're up at two or three in the morning and like, you start worrying about something, if the bed itself can become a trigger for sleep.

You can use that as your ally to fall back to sleep in the middle of the night. Hmm. 

Bryan Carroll: [00:39:41] Yeah. I really liked that. I think, you know, so many people do read in bed. A lot of people play on their phones and like you're saying, you're teaching your brain the wrong habits for sleep, but I really liked the idea in the middle of the night, if you do wake up and you can't get back to bed to get up, yeah.

Michael Grandner: [00:40:02] And reset. Reset. I mean, and so everyone asks me, how long do I need to be up for it? And I say, my answer is, I don't care if, however long it takes, if it only takes you five minutes to reorient yourself, fine. If it takes you a half an hour, fine. If it takes you an hour, that's fine. the main thing is you don't want to go back into bed until you're ready, but if you're not sure if you're ready, that's okay.

Get back into bed anyway. And just know that if you're there too long, you get up. 

Bryan Carroll: [00:40:31] I want to go back to, the environment cause you said that can impact, the way you sleep. And I'm wondering if there's a way to improve our response to the environment so that we can sleep better. For instance, like my wife, she could hear a drop of water drip out of the faucet and wake up me.

On the other hand. We can have an earthquake and I won't wake up. So there is a big difference there obviously, and she wakes up more than I do because of all these weird little noises. So can you talk about 

Michael Grandner: [00:41:06] that? Some people are just lighter sleepers where their threshold is a little lower or they might have less of a thing called sleep inertia, which sort of protects your sleep for people like that.

two things I would say. One is, you know, it's sorta like. People who have genetically are more genetically prone to gum disease. You just got to brush. You gotta be really good about brushing. You can't Slack on it. so, you know, she should be extra careful about not only insulating her sleep, but also like in terms of having good sleep habits and having it be dark and having it be quiet.

but also that she might need to put up some barriers too to protect her with, if, if her natural protections. Aren't quite strong enough. she might need to come up with other ways to protect herself from getting these inputs. So one would be, the most obvious is earplugs. Earplugs are some of the best sleep technology on the market, and the cheapest.

I mean, you can buy a box of 200 of them for 15 bucks. I mean, like, it's, it's, they're great. they don't work great for everybody and some people, they need to get used to them a little bit, but they can be extremely effective for people who are light sleepers because all, mostly what they're doing is they're just insulating you from all that noise.

For people who can't tolerate them. The next best thing would be a white noise machine. where it creates a blanket of sound so that, that, do, you know, any other kinds of sounds can potentially get absorbed into, and, and the wider noise, the more the more of a, a of a blank sounded is the better, because you don't want it to be like TV or radio because, That that might end up backfiring. But having like a white noise machine where it really is more like a blanket of sound. where it's not supposed to be fun to listen to. It's supposed to serve a function. And that function is, it's like being carpet, like with carpet absorbing noise instead of letting it echo.

It protects you from those sounds. So I worked with a lot of patients who like veterans, who, who have. there are a lot of veterans who have anxiety at night and sometimes it's PTSD. Sometimes it's just, you know, they have elevated levels of arousal and they have a harder time winding down to fall asleep.

And so one of the things  and men in particular tend to have a harder time having things on them, like your plugs in. I'm asking some things. even though they work great for a lot of people, for some people that's just too much. So, with those people, we'll have a fan, we'll have white noise, we'll have something external to them that can, that can surround them, and protect them a little bit from this external stimulation.

Bryan Carroll: [00:43:52] Yeah, that makes a lot of sense. And then going back to his sleep apnea, I know a lot of people have a hard time sleeping with those machines. I'm curious if you have a different ways to make that machine more comfortable or if you've had any experience with a mouth taping. Cause I've heard a little bit about mouth taping, but I don't know much about it.

Michael Grandner: [00:44:12] So there's a, so first of all about the mask, so I've been working with sleep apnea patients for. Yeah. I don't know how many years. More than 10 years. I have yet to find an unsolvable math problem. Especially now since since the technology is getting so much better, the mass are so much more comfortable and there's so many more options now.

Then there were even five years ago versus five years before that most mass problems are solvable and most people don't realize that all they need to do, let's go back to their sleep doc and say, Hey, I don't like this mask, and if it's, and if your provider is any good. Which is pretty much everyone I've ever interacted with, but I know there's some that are not great, but everyone I've known would do this.

They'd say, Oh, let's try this one. Here's all this different sample models I have. Let's try one that's comfortable for you. And if that one doesn't work, come back. We'll try another one and then they'll keep giving you different ones until you find one that works. another thing is some people can't deal with it for more, more from a psychological level where they get very claustrophobic, for example, or where they even get phobic, where they feel like, you know, their body panics and they can't breathe and where they have a reaction to it that way.

It's sort of this sort of, psychologically induced. Physical reaction. There's actually ways of treating that where we're actually, there's, there's whole protocols we can do in the clinic to help the body relax with it on. For some people, their body, they, they are able to teach their body to relax with it on.

Some people need help with that and we actually have strategies for them. That's mask issues. But other options. So for th there's really clinically, there's two different kinds of sleep apnea. There's severe sleep apnea where you have more than like 30 breathing pauses, an hour, more than 30 respiratory events an hour, that's more severe.

it seems like using a machine like a C-PAP. Is one of the only things that will work when you're, when you're sleep apnea is that severe. cause you know, 30 times an hour is on average once every couple of minutes all night. Like there's a lot of events going on. sometimes surgery works. Not super often, but sometimes depends on where your blockages for example.

but the, but when you're dealing with more mild to moderate sleep apnea. Which when people are detecting it early and not waiting 20 years, that's more what, what, what we're seeing. and people with mild to moderate sleep apnea have many more options, because the disease isn't that severe yet. And so, There's a lot of options that say we'll cut your number of events and half. So under five events per hour is still seen as pretty normal range. So if you have 10 15 events per hour and you can cut that in half, you can make great progress where if you've got 30 50 events per hour cutting it in half, it's still way too high.

So. So those sorts of, those sorts of things. So one, probably the most common thing that is effective for especially mild to moderate sleep apnea, but sometimes even severe sleep apnea is, is what's called an oral appliance, where it's essentially like a retainer looking device that you just sort of.

Where in your mouth and it sort of juts your jaw forward and for actually quite a lot of people, that's just enough stimulation to open the airway just enough that it blocks a lot of the respiratory events. Where you usually get it from a dentist. It's a dentist that creates it and fits into your mouth.

Another option is for a lot of people's, you're talking about mouth taping, but really what it is, it's keeping your mouth closed. and so there's, there's all kinds of things like, you know, there's chin straps you can wear that kind of keep your mouth closed. it's cause people who open their mouth, what happens is that makes it more likely that it's gonna, you know, break the seal on the tongue, falls back and blocks the airway.

I mean, often like if that's your problem, then that'll work. But for a lot of people, the blockage is a little further down. but for people who, for whom that's a problem, there's all kinds of chin straps and stuff you could wear. And there's, there's like, even like little stickers you can put on that, that keep your mouth closed during the night, that like give a little support and they're disposable.

then also people talk about like the, the nasal strips. That is only really effective if your blockages is because you have a floppy nose. And some people do have floppy notes and their no, and their, their nose closes during the night. And it's not because it's congested, it's because it's having a hard time staying open for those people.

Those things were great. If that's not your problem, it's not going to do much. So there's, so for a lot of these more mild to moderate problems there, there are lots of other options. that people can do. There's a, there's also other devices. There's some where, you know, you know, it's sort of an, something you put Oh, up in your nose.

That sort of creates a different kind of a seal that creates some pressure inside that, that has sort of the effect of a C-PAP machine without the machine. And like in that sort of works for more mild to moderate cases. So there's lots of, actually, there's actually lots of options. the CPAP machines are the easiest to prescribe.

and we, and it's sort of a blunt instrument and we know it's going work. and for more severe cases, we don't really have a lot of additional options, but, for more mild to moderate cases, there's actually quite a few options. The other thing I didn't mention is weight loss. So weight loss can be extremely effective as a treatment for sleep apnea because it's highly tied to weight especially.

And one of the reasons it's more common in men, especially weight around your neck, and the upper part of your chest. Where, where that might restrict your lungs, ability to function and especially around your neck and chin because that crowds your airway and makes it harder to keep open. And so as you lose weight, that might actually help two.

Bryan Carroll: [00:50:11] Okay. So there's lots of good options there. and then. You work primarily with non-medication treatments, would you consider melatonin to be more of a medication side, or what would you consider that to be and what's your thoughts on melatonin? 

Michael Grandner: [00:50:26] So, so our clinic is a behavioral sleep medicine clinic. As a psychologist, I don't write prescriptions for medications.

I have many patients who are on medications and we work with, we do work with medications a lot. I don't write the prescriptions though. And so. So we, the treatments we do are basically everything, but the medications that we let the prescribing physician deal with, and usually by the time they come to see me, they've tried that stuff and it didn't work anyway.

in terms of melatonin, melatonin is sort of a middle ground in the United States. Melatonin's available without a prescription, pretty much everywhere else. It does require a prescription. It's a hormone. for someone reason in the U S it's, it's a dietary supplement. there's lots of data on melatonin.

So melatonin, your body produces melatonin. Naturally during the day you produce almost not very little, and then in the evening you're going to start ramping up your production of melatonin. When you're, when you're body's trying to tell you that nighttime is coming. So usually maybe around dinner time, you know you're going to start producing melatonin and then it's going to peak in the middle of the night.

And then right about the time it's okay. And then right about the time it's expecting Dawn to come. Your melatonin will start plummeting and then it'll be down to right about the time you wake up. it should be very low and then it'll stay low the whole day. So you have this, basically your melatonin is your body's signal that it's nighttime.

And so taking melatonin, w when you ingest melatonin, the melatonin in your system is essentially telling your body it's nighttime. So if you're taking melatonin and it's during your biological day, it's not going to really have much of an effect because your body knows it's not nighttime. If you're taking it right as you're going to bed or in the middle of the night, most of the time it's going to have little to no effect because your body already knows it's night time.

and if you can't sleep, that's why it's say it's usually a terrible treatment for insomnia and mostly useless for insomnia because most people with insomnia, their problem is this conditioned arousal, not that their body doesn't know whether or not it's nighttime. And so, Where melatonin is effective.

Is at the transition points when your body's not sure whether it's daytime or nighttime. That's where melatonin can really have an effect. So for example, if you take, if you take melatonin, right about the time you start producing it, it can trick the system into thinking that. That it's actually later than it really is like, huh, I thought my levels were X.

They're actually X plus five I guess it's actually later than I thought it was, and there it'll, it'll ramp the whole system up a little early. It'll kickstart it a little early. What that means is. You're not going to have more of it during the night. What you're going to do is you're going to shift the whole curve a little early, so, so it's going to ramp up a little faster.

It's going to peak earlier and drop earlier, which means for most people, if you're otherwise, if you don't have insomnia, what's probably gonna happen is you're going to fall asleep a little earlier cause your body's going to think it's nighttime. Earlier. And, but then you're also gonna wake up earlier because your body, thanks.

Nighttime is over a little early. similarly, if you're traveling and you want to stay up extra late, take a little bit of melatonin as soon as you wake up, because then it'll delay the end of your biological night. So your biological day starts a little later. And so it'll end a little later. so it's like more of a clock shifter, and it's also a higher dose is not better.

It all, you're not trying to overpower the system. You're trying to trick the system. And so you want it to be low dose. So actually, If you take it so, so, so what happens is we have this natural biological clock that melatonin is, is a clear marker of, But we use environmental light to help modify the clock and keep it within 24 hours.

So light suppresses melatonin. So that's why you have all this stuff about light at night and light on screens getting into the eyes. Because what that light is doing is it's, it's keeping melatonin a little bit suppressed because your body's sort of. Receiving a daytime signal. Just like when you get bright light, as soon as you wake up in the morning, it'll help you wake up faster because it'll, it'll rapidly suppress the rest of your melatonin.

and you'll start your day a little sooner. among other things too, but, but that's one of the main effects you get. That's also why when you wake up in the middle of the night to use the bathroom and you turn on a bright bathroom light, all of a sudden you're in the middle of the night. Melatonin is going to plummet.

it gets suppressed and it might take a little bit of time for it to recover. so that's where all the stuff about light at night, it's all about, a lot of it's about melatonin and clock shifting. So if you're taking a lower dose melatonin, You can shift the clock. Now, a totally blind person who cannot see light.

And so their melatonin rhythm is, is. It's working on their own internal clock and it can't sync to 24 hours cause we use light to stay on the same 24 hour day. Like why do we have the same biological night? Everybody is cause we all sync to the same external light source, which is the sun. So I'm blind people who can't see the sun.

They get this thing called non 24 hour circadian rhythm, which basically means it's their own biological rhythm that can't ever reset with light. So it's drifts around. so cause it's not tied to the 24 hour day because we don't, it doesn't, they don't get the same light rhythms and a half a milligram of melatonin.

In the evening is all it takes to completely normalize their rhythms. It doesn't take a lot. It just takes a nudge. And if anything, the larger doses tend not to work as well because you're out of the range of what your body's looking for for that nudge. and so, and so the only other thing that's going on, in terms of melatonin is.

That you could take there. There are two times you'd want to take a larger dose. One is, if your body already knows it's nighttime, but you want a little boost to help, maybe fall asleep a little sooner or maybe consolidate sleep a little more during the night. You could take something like five milligrams around, around a half an hour to an hour before going to bed.

and that might help. It might not, but it might. there is data that shows in a lot of people, like it can have a benefit there. It's, again, it's not going to fix insomnia, but it might help. and then the other thing is that we actually produce less melatonin as we get older on average. So like, you know, a typical person who's like over 65, they might, they won't have the same strong melatonin rhythm that a 20 year old will have.

And so sometimes taking nighttime melatonin can help sort of replace what they're not producing and, and help. the rhythms that way. Another thing is a lot of medications can suppress melatonin. So like a lot of blood pressure medications, beta blockers in particular suppress melatonin. So there's actually data, especially in older people who have naturally lower melatonin.

Yeah. And you should be taking blood pressure medication at night because it's more effective because of, remember how sleep impacts the immune system and the cardiovascular system. Actually, blood pressure medication works better when you take it at night. For those reasons, but if it's also suppressing melatonin, it might cause some sleep problems.

So there's actually data that says in a lot of these older people, if you actually pair that, that heart blood pressure medication with, I'm a melatonin, you can actually make up for that, for example. So there are other uses of melatonin, but mostly it's a clock shifter. It helps tell you that it's nighttime, it's most effective.

at the transition points closer, it's actually like a half a milligram. So at most three is what you'd want to take. And you probably want to take it earlier than you think cause you want it right when your body starts producing it, not when it's already producing it. Does that make sense? 

Bryan Carroll: [00:58:12] Yup. Totally.

And yeah. Thank you for going into detail on that. Cause I know a lot of people they. Almost eat it like it's candy and they try to use it every single night, but then those same people are like, it doesn't really help. Right. 

Michael Grandner: [00:58:25] Because that's exactly why taking it for the wrong thing. I mean, they're saying, my allergies aren't getting better.

No matter how much ibuprofen I take. It's like, well, yes, the ibuprofen will reduce inflammation and it might have an impact on how you react to allergies, but it's not allergy medication. you're taking the wrong thing. taking more isn't necessarily going to give you more of like, I took 20 milligrams and I'm like, well, you just overdosed yourself on melatonin and then, and you didn't, and now you just, you maybe have more side effects, but it didn't really help you.

I mean, if your body, and this is the thing with melatonin, if your body already knows it's nighttime. It's probably too late. and unless, you know, and if you take a five a little bit before bed, it might help, but if you're taking it to fix a sleep problem, you're probably doing it wrong. 

Bryan Carroll: [00:59:11] Well, there's been a lot of really good information in this podcast.

before we fully wrap up, can you share one actionable step most people can take starting tonight to improve their sleep? 

Michael Grandner: [00:59:22] Yeah. One thing that they can do is. Figure out when you need to get up in the morning, then count backwards by seven to eight hours. That's about when you should be getting into bed.

Now count backwards from that 30 to 45 minutes. That's when you should, you should set an alarm for that time on your phone or wherever. Set an alarm. And this should be, I need to start winding down now. So if you're working, wrap it up. This is where the, the, the person on the plane says, now's the time to power down your large electronic devices.

it doesn't mean you have to like sit there and meditate for half an hour, but start winding down, start dimming lights start. Yeah. Don't do anything too intense. Let your mind clear a little bit. Do something a little distracting, but not too distracting. Give yourself that time to wind down. So by the time you, you should be getting ready for bed, you'll be there.

Bryan Carroll: [01:00:14] Perfect. Well, thank you, Michael, so much people can find [email protected]. we'll definitely have to have you on again, and, I'm sure we'll get lots of questions from our listeners, sleep related questions and, and beef. Awesome to have you on and talk through some of those and get your opinion on some of it, but, 

Michael Grandner: [01:00:33] Oh, that'd be great.

Bryan Carroll: [01:00:35] Yeah, I, I love the information. I think the. If people recognize that sleeping puts you in maintenance mode and allows your body to, you know, repair and go through any maintenance that it needs. I think that little nugget right there is going to help people a lot. 

Michael Grandner: [01:00:54] A lot of people think about, you know, especially the people talking about how sleep is important.

There's often this message of get good sleep or else like, or else you're going to get heart disease and diabetes and obesity and Alzheimer's and all this stuff. And, and I want to have more of the message that you were just saying that, that getting good sleep. Is good. It gives your body what it wants.

It's a joy. It helps you, it makes you more productive. It gives you more of the things that you value in your life. It gives you more time. It gives you mental health, and it gives you all these good things and there's a reason to spend time on it. It's worth it. 

Bryan Carroll: [01:01:33] I totally agree. As you think through all the different ways that Dr.

Michael provided to help improve sleep, which ones do you think will be the most effective for you? Luckily you get to test out different options every single day. So hopefully you find one that works well for you. And now, if you enjoyed this episode, then make sure to tap on your podcast app and leave a rating and review those ratings.

Help us out all a lot and I would completely appreciate your help. Next week, dr Lori Bouchard is coming on the show to talk about different treatment options for cancer. So let's learn a little more about dr Laurie. I am here with dr Lori Bouchard. Hey, dr Lori, what is one unique thing about you that most people don't know?

Lori: [01:02:19] One unique thing is, 10 years of my life, I was a cheerleader and I would say those were by far the best years of my life. 

Bryan Carroll: [01:02:28] For 10 years. That must be like competitive cheer. 

Lori: [01:02:31] Yeah. So all throughout university, I cheerlead for Western Ontario and just the team environment and, being competitive, we were national champions.

So I, that's the best I, yeah, that's probably the most unique thing about me cause no one would suspect that. But, that's a big part of my life. Yeah. 

Bryan Carroll: [01:02:49] That's pretty awesome to have on your resume and that's, that's awesome. 

Lori: [01:02:53] Thank you. 

Bryan Carroll: [01:02:55] Well, what will we be learning about in our interview together? 

Lori: [01:02:58] So I'm excited to talk about strategies to live longer with cancer and things that you can do and change your life to prevent it.

Bryan Carroll: [01:03:06] And what are your favorite foods or nutrients that you think everyone should get more of in their diet? 

Lori: [01:03:11] Definitely want to look at gut foods, so any foods that are fermented. we also want to look at phytochemicals from vegetables. and even on top of that, I would say, even magnesium, I'd say magnesium is one thing that.

All every cell in our body needs. So when you're stressed, you need magnesium. If you can't sleep, you'll need that support, muscle function. So those are the top, the top nutrients. 

Bryan Carroll: [01:03:37] And then what are your, your top three health tips for anyone who wants to improve their overall wellness? 

Lori: [01:03:44] Number one, I would say.

Stop eating after 7:00 PM. Integrating some intermittent fasting into your life would be huge as far as insulin resistance and controlling, insulin and stress. The other thing is making sure that you are going to the bathroom every day. Poop quality is huge for immune and gut health. And I would say not to take life too seriously.

When you stress and you overwhelm yourself, that, that fear and, Damage into your system is actually exceeds anything else you do as far as diet and, diet and exercise. So learning to laugh and have fun with life is a huge part of healthy living. 

Bryan Carroll: [01:04:25] As we all know, cancer is a complicated disease, which dr Lori will break down into simple steps for us and also coming up on June 1st we will be opening enrollment for our nutrition coaching programs.

If you are ready to make nutritional changes at last and are ready to make the habit changes needed to reduce the overwhelm of dietary changes, then you can jump onto the wait list and be notified right when the program opens up. Go to summitforwellness.com/nutrition to learn more. We'll be back next week.

So until then, keep climbing to the peak of your health.