Top Sleep Doctor's Brain Dump - Michael Breus, Ph.D

Sleep is the most natural process that you can do other than breathing. Like breathing, we don’t need technology to help us sleep. The reason many people don’t sleep is because of what’s between their ears – their mental stability, anguish, or stress. Do you fall asleep easily or does the slightest noise wake you up? Dr. Michael Breus, gives me a full brain dump as I try to learn everything I can about sleep in one session. He takes on taboo ideas like polyphasic sleep and the role of nutrition and the microbiome in having a good night’s rest, how melatonin, CBD, and some pharmaceutical interventions such as Zolpidem affect the sleep process, how much sleep we should have, and more.

Pablos: The thing I’m trying to go after is that at least my way of seeing the world is through all these problems that we have. This is a pile of problems that are possibly growing. We also have this other pile, which is tools and technologies, and it’s also growing because of what I mentioned. The job for us is to figure out how we sit in the middle and connect to those things. If we have some optimism that it’s possible and we can demystify the problems so people understand what the real problems are, we can demystify the technology so they’re not terrifying and complicated.

People then can build that sense of optimism about how we could make the future better. That’s how I think about things a lot. Not only the idea here is to give people some insight into how we think about things and our experiences. One of the things I’m curious about is that years ago, there was no such thing as a sleep doctor. Maybe there were some researchers or whatever, but it wasn’t a legitimate career track. How did you end up being a sleep doctor? What does that mean?

Michael: What’s interesting about the field of sleep medicine in general is it’s an incredibly small new field. The very first sleep lab in 1945, Walla Walla, Washington, built demand on narcolepsy. It wasn’t even about sleep apnea. When you look at medicine and you think about Hippocrates. Thousands of years of innovations in medicine, we’re literally at the sperm and egg stage of sleep medicine. That’s where it was. I fell into it by accident. I was doing my residency. I was getting my PhD in Clinical Psychology at the University of Georgia and I was interested in Sports Psychology. I had no interest in sleep at all. I wanted to tell athletes how to get the mental game of sports and run faster into all this cool shit with psychology.

I went to the University of Georgia, the top twenty programs. The best internship residency program, believe it or not, is the University of Mississippi Medical Center in Jackson, Mississippi. They had an eating disorders and athletes program that I was fascinated with. This was going to be an interesting area for me to get into and understand more about, but I couldn’t get into the program. Harvard, Yale, Princeton, they all got in the program. I went to Georgia’s top twenty programs, but to be fair, it wasn’t Harvard.

It wasn’t even top seventeen.

I’m sitting there, I’m looking through the application and they have like a specialty track for sleep medicine and a specialty track for neuropsychological testing. I didn’t know anything about sleep medicine in Jackson.

You figured out, “I can’t get on a program I want, but I can at least go to Jackson.”

I had an ulterior motive because when I saw this thing, I had worked my way through graduate school in the Electrophysiology department. I’m the kid who used to take the old rotary phones apart, put them back together, there would be 4 or 5 pieces on the side, and this thing would work like a gem.

I took the phone apart for different reasons and did not get it back together.  

I like to tinker with stuff. I like to measure stuff. I have that kind of a brain. When I saw that there was a sleep track that used those machines, I said, “I’m going to sell myself as a sleep guy. I’m going to transfer as soon as I get there. Just because you didn’t let me in the fucking place, that doesn’t mean I’m not going to get in.” I get in on the sleep side. I get there and they say, “You have to start on the sleep side. If you want to transfer, you can do it later.” By the third day, I fell in love.

You haven’t gotten around to transferring back. You gave up on that and sticking with sleep. This was many years ago. Tell me what research was going on there.  

Back in those days, the field of sleep medicine is an interesting one because it was taken over. There are two sides, research and clinical. What’s difficult about the clinical is it pretty much only treats sleep apnea.

In the world of sleep medicine, we’ve figured out how to treat sleep apnea. That’s primarily what is going on. When you say clinical, that means we’ve got actual patients, we’re trying to help them. On the research side, we’ve got people with problems and we’re trying to understand them. We may or may not be able to help them. That might be a way of describing the difference.  

When you look at clinical sleep medicine, we’ve identified 88 different sleep disorders. You can fuck up your sleep, which is amazing when you think about it. We were starting to design protocols for each one of the diagnostics to be able to start to lower the symptomatology. That’s the basics of medicine.

Meaning, you are down with each of those 88 things you have.  

Sleep is recovery. You have to have something to recover from.

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The assessment narrows it down. What I’m talking about is the treatment side of things.

You are good at figuring out which of the 88 things you have.  

We’re good at that, but the problem is that I believe that there are sleep disorders and what I call disordered sleep. Sleep disorders are diagnosable apnea, narcolepsy and insomnia. Disordered sleep is I went to that room in the back of my house. I was there for 6, maybe 7 hours. My eyes were closed. I come out, I don’t feel great. Why? How do I fix that? That’s been my area of specialty for the last six years where I’m only focusing on how do I improve the quality of sleep. There are probably about 6,000 guys and gals out there who are board-certified sleep specialists. They treat apnea and narcolepsy. In some cases, insomnia.

We’ve got pros who can do that, but the things that don’t fit into that rubric. Are you talking about the 89th thing?

To be fair, I don’t think it’s a diagnosis. It has to do with lifestyle. It has to do with intensity.

I don’t have an actual physical problem that maps to my diet, but it could be better. You could have more energy or better results if you improve your diet, but I don’t necessarily have a clinical problem.  

That’s how I look at sleep in certain ways. I’m a high-performance sleep coach. I used to be a sleep doctor, apnea, narcolepsy, insomnia. Now, people come to me and they’re like, “I know that I need eight hours to get good sleep, but I only have six. Can you do that?” The answer is, “Yes, you can.” What science has shown us is that there are certain scheduling swim lanes for your sleep schedule. This is based on something called your chronotype. Chronotype might not be a term that people are familiar with being called an early bird or a night owl. Those are chronotypes. It turns out those are genetic. There’s a variation on the PER3 gene. There’s a particular snip that is altered and that can make your entire body schedule go early or make your entire body schedule go late.

If I have 23andme, I can look it up and explain why I’m a night person.

That’s the cool part of science, but what the fuck do you do with it? That’s where I come in. I love that science and I was tinkering around with it. I was doing it all myself. I said, “What happens if I only sleep during my chronotypical sleeping hours?” I’m a night owl. That meant I had to go to bed at midnight. I decided not to have an alarm because I was going to check if my body wakes up naturally and see what happens. The first month I started this experiment, I went to bed at midnight and woke up at 7:30. Within 40 days or so, all of a sudden, I was waking up at 7:15 on my own. I am still going to bed at midnight. All of a sudden, it was 7:00, and then it was 6:45. I get up at 6:13 every single morning now with no alarm. I could close my eyes at midnight. That midnight I wake up at 6:13 AM. The punchline is it won’t go lower. At age 52, in my shape, my body only needs 6 hours and 13 minutes of high-quality sleep because I’m sleeping in that swim lane. Here’s what happens, when I stay up until 1:00 in the morning, I still get up at 6:30.

That’s what I experienced. I’m tuned for the wake-up time.  

That’s what you’re supposed to be because that’s the circadian anchor. When the sun hits the melanopsin cells in your eyeballs and turns off the melatonin faucet in your brain, there’s a whole circadian side of things that has to agree with that. When it doesn’t, you got involved.

I should tune my wake-up time to maybe the sun, although that moves around all year. Maybe I could do it to a grow light or whatever so I have a consistent wake-up time. I don’t seem to be able to change that one as much. That one stays the same. I can go to bed whenever I want. For fifteen years, I was dancing salsa, probably at least every other night. The better you get at salsa, the later you go. On a Tuesday night, I would show up at midnight until 2:00 in the morning. It didn’t matter. If I danced, I’d go to bed at 2:00, I would get up at 8:00. If I didn’t dance, I go to bed at 11:00 or 12:00 and get up at 8:00. I felt like what was happening was, “If I dance, I need less sleep,” but you wouldn’t diagnose it that way.

Here’s what I would tell you is if you dance, you’d get higher quality sleep. One of the biggest things we now know is movement. Sleep is recovery. You have to have something to recover from. On the nights when you were salsa-ing, what I would do is I’d love to put a tracker on you on the nights when you’re dancing and the nights when you’re not. I would like to look at the different stages of sleep because we probably see a much bigger increase in stage 3 or 4 sleep, which is your physical restoration because of the salsa dancing. We then might see less mental restoration on the REM sleep side of things, but we can change those at will.

If I could do anything I wanted having no sleep problem, pretend I have no constraints on when I sleep pretty much, whatever, what do you think would be the optimal thing for a guy to do? I’m not trying to solve any problems. I’ve got no issues, but I am going to get older at some point. Should I do something like you described? No alarm, see what happens, go to bed at a consistent time every day, and see where I land over the course of six months?

It was less than six months. It slowly happened at first and all of a sudden, it was quick. What ended up happening was it took a grand total of 90 days. All of a sudden, my entire sleep schedule had shrunk and it was improved in quality. One thing to tell every reader is about the consistency of your wake up time. At first, you might have to set an alarm to wake up at a particular time, but then when you start waking up before the alarm, and then it starts to scoot further behind, we’re in the money here. That’s where we want to be. It all has to do with this chronotypical swim lane of a schedule that you follow.

As we get older, the swim lane changes. Our circadian rhythms dial back because our body’s ability to produce melatonin begins to decline. We have two options at this point. We can rotate our schedule backwards or we can use supplemental melatonin to help us on the front end and try to keep that schedule. There are two schools of thought about how you want to do that. To be fair, if I want to wake somebody up in the mornings, I can use a blue light. They’re commercially available out there. It is easy to get your hands on to basically turn off my melatonin faucet in the morning. You can lower blue light by wearing things like blue light blocking glasses and have the red light and things like that. There’s a lot of biohackingness that can be done within the sleep universe.

I like those Wi-Fi smart lights and stuff that they’ll do blue. I could have that to be my alarm instead of be obnoxious.  

What a lot of people have found is those sunrise alarm clocks are cool. What you can do is put on a timer with a dimmer in it.

What about this? My girlfriend needs to wake up earlier than me. Is there a product that seems like I need a vibrating watch on each person or something?

There are pillow vibrating alarms. There are these little disks and you slide them in your pillow. It’s got an alarm on it and it will just vibrate. It doesn’t wake up your neighbor. Also, there’s a new product by Bose. They’re called Sleepbuds. They’re earbuds that you wear all night long. They have a private sound library. I’m helping them with it, and then there’s an alarm that only you hear in your ear.

Is that available now?

It’s commercially available now. You’ll love them.

I have got a couple of lines of inquiry here. Go back to the phone when you were a kid. I remember disassembling rotary phones for a variety of reasons. One, I wanted to be able to make that bell go and harass people. I wanted to make it sound like I had a phone ringing in my car, which at that time didn’t exist. I mounted a rotary phone to the dash in my car in 1985, something like that. There were bag phones or car phones at that point, but they were $7,000. They were huge, but I just had a rotary phone with a windy cord on it. The thing is we had learned to trick the phone network a little bit. There were things you could accomplish by taking the phone apart and getting control of the switch hook and something like that. What I think about now is my daughter is raised in a world where you take the screws out of something and there’s nothing observable. It’s a pile of computer chips. For you and I, taking the rotary phone apart, you could see how it worked.  

You can see the coils wrapped around the magnet. You could see the bells. I remember it distinctly. You could see the rotors and when they finally came out with push buttons. All these wires were coming out and you’re like, “That connects to that, and that goes to this.”

It was 40 hours to assemble a touch-tone phone. I think of that as being a gift because all these devices were observable. I could take them apart, play with them, fuck with them, and then put them back together. I learned a lot from that and I feel like in the world our kids are growing up in, why would you bother to take an iPad apart? You are going to find more computer chips. It’s the same, everything is computers. Even computers, when I was a kid, the code was all observable. You learn by looking at the ones and zeros literally. That’s also obfuscated behind a pretty cartoon interface and stuff. If that’s what you described, you learned about this taking phones apart and stuff, and then that attracted you to the machines being used, can you talk about what were those machines?  

The machines were things that took vital signs. I was particularly curious about how a signal could come from your body and be then translated into this idea. When I started, it was all paper. It wasn’t digital. There were pens on the paper. You had these inkwells. You would have to pump the inkwells to get the pressure to go through and then they would be squiggling along. I remember the first night I worked in the sleep lab on my residency. I went in and my dad or my mom had bought me this beautiful new white doctor’s coat. I was excited. I was on my internship. People are going to call me doctor and I go up to the thing. I’m working in and then what happened was the patient turned and the pens went fucking crazy and ink went flying.

I had ink all down my thing and everybody was laughing because they knew the joke. It was fun. Back at that time, when I was learning about sleep, we would have a paper record. It would be a thousand pages long of one night, 30 seconds per page. There was an art to it. It was called throwing paper. You knew how to grab one sheet and you created the scroll yourself manually. I’m throwing paper and I’m watching EEG go by and I’m like, “Apnea.”

You learned to flip a thousand pages in a couple of minutes and spot the apnea.

Those machines were machines that were telling me something that wasn’t a machine and that was interesting to me.

You were monitoring an analog device for humans. This is something super fascinating and snuck upon us. You’re talking about essentially a primitive monitoring device compared to now standards. In the last couple of years, I see an extraordinary explosion in sensor development. A lot of it came from MEMS because that’s where we got our IMUs with the accelerometers and the gyros delivered chips before a MEMS-based accelerometer. That was a $15,000 thing that weighed 80 pounds and was on a bench or in a cruise missile. Now, we have them in phones almost speculatively. When the first accelerometers were on the iPhone, we didn’t have an application for it. It was just there because it was cheap to do it, and might as well try it.  

Many people don’t sleep because of what’s between their ears – their mental stability, their anguish, and their stress.

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Now, they’re in everything which is cool. Beyond that, for almost every day, we get new sensors and there’s almost nothing we can’t measure with extreme precision. We have networks to bring that data back to giant supercomputers to analyze it. I feel like maybe one of the things that makes this particular point in time, the inflection point for a sleep study, is that now we have the tools to do it better. We have those sensors. We have those data science, which is a thing now too. In a way, that’s different than what it was before, many years ago.

My prediction is that sleep laboratories will go away to a certain degree.

Is it because we’ll learn so much?

No. It is because technology is advancing quickly. When you go into a sleep laboratory, we put 27 electrodes. At first, we had to glue them onto your body with something called collodion. When we had to pull them up, it rips up hair, skin, and all that. It was terrible many years ago. Now, there’s a home study. You send it if they have a nasal cannula, they have something on their finger and they have a box on their chest, and we’re almost done. The technology advancing in the assessment is great. Unfortunately, technology in the treatment has not gone well.

That’s the order of operations.

When we look at technology and we look at the influx of technology into the idea of sleep, here’s part of the problem. Technology is great for sleep disorders but not great for disordered sleep.

Why is that?

Sleep is the most natural process that you can do other than breathing. We don’t need technology to help us breathe. The reason many people don’t sleep is because of what’s between their ears. It’s their mental stability. It’s their anguish. It’s their stress. Seventy-five percent of insomnia is either depression or anxiety. My goal is to try to help people figure out how to not just lower their anxiety in the acute state, but to help them figure out how to lower their anxiety in a chronic state, and that’s hard.

That gets you back to that psychology and the same interventions people are using for anxiety in general. They need to improve their sleep with all the stuff around meditation and breathing and those things that people are taking on.  

They have to be tweaked because when you do traditional meditation and traditional breathing, it doesn’t make you sleepy. It brings you to the present. It makes you relaxed. Being present, being relaxed, and being unconscious are three separate states.

Does being present, relaxed, and unconscious show up differently on your monitoring devices?

It does.

If I have that device on when I’m meditating and it makes me feel present, that’s not getting me ready to sleep.  

I would argue that there are certain meditations that you would do prior to bed and there might be ones that you do in the morning. I would say that there are breathing techniques that make more sense in the evening versus the morning. Sleep works in the sympathetic nervous system and parasympathetic nervous system. There are two systems, sympathetic and parasympathetic. Sympathetic, I always think of as energy, and parasympathetic is relaxed. I always think of it as Sympathy for the Devil, that song from the Rolling Stones. That makes me think of going in dancing. When we’re looking at parasympathetic, that’s the relaxed situation, and relaxing is different than sleep. Relaxation primes the pump for the sleep process. It all comes down to some physiology, believe it or not. If you can get your heart rate below 60 for a period of time, the sleep process will institute.

It’s literally that simple sometimes. When you’ve got people who’ve got high blood pressure, stressed, and got anxiety. What’s the thing that is up? Their heart rate. Heart rate variability becomes an interesting issue. When you start to look at heart rate, you want it to go down and get to 60 because when it’s at 60, you slip the car into third gear and the brain clicks on. That’s when things like growth hormone are emitted during a phase 3 sleep or 4 sleep, which is all that physical restoration. During REM sleep, that’s when you start to move information from your short-term memory to your long-term memory. That’s where it gets interesting.

People come to me sometimes and they’re like, “I’m not as concerned about the physical. Do I have Alzheimer’s, Michael? What’s going on? My memory is shot. I’m 40 years old.” I’m like, “How much do you sleep?” They say, “I sleep 5.5 to 6 hours.” I’m like, “There’s your problem. Can we extend your sleep a little bit? Give it three months and let’s see how your memory does.” What people don’t realize is REM happens in the last half of the night. If you only started the first half and you wake up after six hours, you’re missing that last two hours of REM sleep. That’s where the problem comes in.

I have a couple of questions here. I have low blood pressure. I have a low heart rate.

You should be sleeping all time.

I sleep all the time. I lay down flat and I’m asleep. It is easy. I don’t feel like I need as much sleep as I get, but I’d take it because I can. It seems like it’s not hurting anything. There’s not a lot to do now. It might be easier for me because my heart rate and blood pressure are low in general. I don’t have a lot of anxiety or problems and things that keep me freaking out. It’s going smoothly. Michael, I want to up my quality. What would I do?

We would get you again in your chronotypical swim lane. We’d start to look at what’s going on in your body. I’d look at your vitamin D, magnesium, iron, and melatonin levels. Let’s make sure that you’re not deficient. I think it’s something 80% of the US is deficient in magnesium and vitamin D. We’ve got to get you back up to par levels and see if your unit is functioning right. If you’ve got low energy, vitamin D would be a good thing for you to have every morning.

I’ve been doing it, but I didn’t necessarily know to do it in the morning.  

I prefer mine in the morning. It’s a fat-soluble vitamin so you have to have a little bit of food with it. If you’re an intermittent faster, that may or may not work for you.

I don’t eat anything for sixteen hours. I only eat lunch and dinner.

I’m the same way and my body is used to it. I would try it out with you and see. Most people take 5,000 international units every single morning.

I could do that maybe with lunch.  

I take it in the morning without food. You’re supposed to take it with food for absorption, but you can get higher absorbing stuff.

What about magnesium? I started taking magnesium because I figured it will be good for my muscles.

It will be good for your muscles, but you’re deficient in it because most people are. Unfortunately, our soil has been over tilled. Magnesium doesn’t appear to be coming up through the roots and getting into the stocks for our fruits, vegetables, and things like that. I do supplemental magnesium. I had a cardiac event years ago. We think that the reason that I had it was because of low magnesium in my cardiac muscle. When you have marathoners who dropped dead in the middle of a marathon and you autopsy them, it turns out that they have low magnesium in their cardiac. We wanted to avoid that. I take 250 milligrams of magnesium with vitamin B12. That helps catalyze it in. It helps absorption, but it also helps with the rapidity of metabolism. It speeds up overall metabolism, which is interesting. I take them together in the mornings and it’s been highly effective for me. Once I’ve checked you out and decided what’s going on with you, and you’re at par level, then you say to me, “Michael, now I want to up my game,” I’m going to look at your alcohol and caffeine and try to understand where do those play a role in your 24-hour cycle.

I never had a drink.

What about caffeine?

Melatonin is the key that starts the engine for sleep.

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I have caffeine every afternoon.

What time?

Between 1:00 and 2:00, after lunch.  

Do you feel like you need caffeine in the mornings?

No. I feel like if I don’t take it by 2:00 or 3:00, I’m going to have a headache. I’m feeling like I need a nap.

Do you get a headache from not having caffeine? How much do you take at night or in the afternoon?

Probably 250.

You are at 2.5 cups of coffee.

I never had a cup of coffee, but I drink either Red Bull or an energy shot or something.  

There are two things I would do with that. It’s not a bad practice if that’s what helps you get there, but I’d rather find more natural sources of caffeine for you than a Red Bull because you get a ton of sugar.

No, I take the sugar out. I’m on a sugar-free energy shot.  

That’s better, but there are some better like green coffee, green tea extracts if that’s what your goal was, I’d rather see you taking that long-term. When we look at caffeine, here’s the thing to remember. Depending upon how quick of a metabolizer you are, caffeine has a half-life between 6 and 8 hours for half of it to be out of your system. When we’re talking about refining our sleep, caffeine is a stimulant. It doesn’t matter how you slice it. I’ve got lots of people who say to me, “Fuck, Michael. I can have a cup of coffee at 8:00 at night and still fall right to sleep. Caffeine doesn’t affect me.” Let’s be clear, caffeine is a stimulant and affects everybody. People have different sensitivities and amounts and metabolism is which changes the variability of the effect.

Somebody who’s lean like you and takes 250 milligrams of caffeine, you’re at the upper dose of what a human should have in a day. I would look at the timing of that. If I could, I might start to dial it back a little bit. Maybe you don’t need 250. Maybe we’d start with 200 and see how you feel. Maybe we go to 150. The goal then is to start to look at how much what’s called alpha intrusion that we see into your EEG. What caffeine does is it makes your brain waves go a little fast. When we’re sleeping, we want our brainwaves to go slow. What happens is it’s hard to get that. Sometimes the fast brainwaves lay over the slow brain waves, or they push out the slow brainwaves and all we have is fast brainwaves. When all we have is fast brainwaves, we don’t get stage 3 or 4 sleep, which means we don’t get that physical restoration. We then wake up in the morning and feel like shit, and we want to drink more caffeine.

Caffeine is a way to speed up the brainwaves. Is melatonin a way to slow them down? Can you think of them as the opposite of caffeine in some sense? Is that what you use to slow down your brain waves?

With melatonin, it’s a circadian pacemaker. Melatonin has an effect on certain neurotransmitters that cause a cascade of reactions to start the sleep process. Melatonin is the key that starts the engine for sleep. You still have to have oil and all these other things when you have an electric car, maybe not. It does seem mild, but remember it’s a hormone. It’s not supposed to act like a sleeping pill. It’s not a drug. It’s supposed to act like a hormone. It is supposed to be subtle and be able to have an overarching and reaching effect across the body. The biggest thing about melatonin is understanding when you take it.

The moment of ingestion, it begins to be absorbed, it’s going to be sending signals to different parts of your brain to say, “We’re going to change that internal schedule.” Caffeine is the opposite. What I would say the opposing from caffeine is something called adenosine. As you go throughout your day, your brain accumulates adenosine. When a cell eats a piece of glucose, something comes out of the backend. One of those things is adenosine. It works its way through the system. It goes to a specific area in your brain. As it accumulates, you get sleepier. If I was looking for the opposite of caffeine, it would be that.

Why don’t people take that?

When you look at the molecular structure of adenosine and caffeine, it dropped by one molecule. Caffeine fits right into the adenosine receptor sites. That’s why caffeine blocks sleep. That’s biology, which is interesting. I haven’t ever seen anybody make.

You’ve explained to me before with melatonin, people are doing it wrong. They’re taking a bunch when they’re tired or when they want to go to sleep. You’ve said that they should start earlier in the night to take it.

It’s like 90 minutes beforehand. It takes about 90 minutes for the plasma concentration levels. If you’re taking it in a pill form, you’re looking at 90 minutes for you to reach plasma concentration. If you’re taking it in a tincture or liquid form that you put under your tongue or sublingual, it would be 30 to 40 minutes for better absorption.

I’ve never done melatonin, but you’ve said that 1.5 hours before taking one pill and an hour before taking another and a half hour before you want to be asleep. Is that right?

No, take it one time an hour and a half before.

I misunderstood. What are the other things that are meaningfully effective for people if they want to take a pill to affect their sleep and what’s up with Ambien?

There are a lot of different ways we can walk down that path. There’s a pharmaceutical intervention. When we look at something like Ambien or what’s called zolpidem, it’s a particular compound that was built to affect the benzodiazepine, alpha 1 and alpha 2 receptor sites. The compound has a molecule that can fit into that receptor site and turn it on. By turning that benzodiazepine receptor site on, it lowers anxiety. In this specific 1 and 2, it increases the possibility of sleep. When you look at benzodiazepine receptors as a whole, it’s an anti-anxiety thing. The first sleeping pills were anti-anxiety drugs. What happens if people get so chill that they fall asleep and then people are like, “Maybe there’s a second use for that. Let’s do sleeping pills.” That was what was all the benzodiazepine universe. Now we get an Ambien called a non-benzodiazepine hypnotic. The difference between the old benzos and the new non-benzos is the addictive potential. It’s better technology. It is cleaner. It’s the right receptors that move through. The next question becomes, when are we going to get to the drugs that improve sleep, not just put us to sleep? I call those the Frankenstein drugs.

Why?

I’m not convinced that our brain isn’t the best regulator of how much sleep we should have.

Do you think your brain could do the job? It just needs a little training sometimes.

My concern is, what if you’re not supposed to have more stage 3 or 4 sleep than your body has? You’re not supposed to have REM sleep than your body has. Mother Nature is good at shit. When I look at those types of structures, I want to go forward but with mild, healthy trepidation and concern. One of the things that happen is when you start to improve on a natural process, you end up with a supernatural result. Sometimes supernatural results are positive and sometimes they are not. That’s when we have real problems.

When you say you’re less optimistic about technology helping with the sleep issues that you’re attacking, which are less clinical problems and more life habits and patterns that people have established, resolving anxiety and things like that. Maybe it’s true that you would not look to pharmaceutical innovations necessarily.  

There are holistic technologies that are coming up that are interesting to look at. I started working with this company and it was all of it. I’ve learned a lot. Let’s say you get into a car accident, your head cracks open, you go into the ER. One of the first things they do is they wrap your head nice. The reason they wrap your head nice is to slow down all of the blood flow and all of the fluid that’s going on because they’ve got to figure out what’s the problem. They’ve got to fix it up. That’s how that works. It’s called the neuroprotective effect of cold. It’s important.

The question becomes, when are we going to get the drugs that improve sleep, not just put us to sleep?

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There’s a sleep researcher, Dr. Eric Nofsinger, who has been doing this for many years. His main interest was what we call ruminative thought. “I can’t turn off my brain before I go to bed.” It’s the number one complaint I ever hear in my office. We call that ruminative thought. It was like, “My brain is going. I can’t slow it down. I can’t get to sleep.” We know what that’s doing is it’s causing a lot of autonomic arousals. That sympathetic nervous system is kicking into gear because you’re in bed. Nobody is talking to you. Nobody is asking you to do anything. Thoughts come flooding out like, “What am I going to do with this problem?” It’s anxious. We want that blood. He did MRIs on these people while they’re trying to fall asleep. He discovered massive blood flow in the frontal cortex. He said, “I used to work in the ER and they had this thing called the neuroprotective effect of cold. What happens if I cool their head?” He did and it worked.

They fall asleep with their head freezing.

Ten years’ worth of research, they’ve had 12 or 15 publications in real journals, real science. Here’s what they discovered. It was almost like a headband that goes around your head. There was a string that came down and it came down here and there’s a unit here. It would throw liquid in this thing that goes around your head and it would make your head cooler throughout the night. It’s a little bulky, cumbersome, whatnot. They discovered that people who could turn off the brain, turned off the brain and went to sleep. What they’ve done is they’ve miniaturized it and they’ve got it into a traveler pack.

This is a product now. I don’t just need an ice pack on my forehead.

That wouldn’t even work.

Why?

It is because you have to have a particular temperature and it changes throughout the night based on your circadian rhythm. There’s real science.

What’s that product called?

It’s called Ebb therapeutics. They came to me and they’re like, “Michael, we want you to test our device.” I said, “I don’t have ruminative thought.” They said, “We just want you to wear it and tell us what your experience is.” I put this thing on and to be fair, it looks damn goofy. It’s like 2 inches off my forehead, a big black thing. It’s got a cord, it’s battery operated and I have to click the button, but it’s not as bad as the first one was. I’m like, “This is going to be ridiculous. How am I going to sleep with this thing on my head all night long? My wife is looking at me like I’m crazy,” because I test out all this shit all the time. I put it on, I turned it on, and I closed my eyes. When I opened my eyes, it was 6:13.

It’s a luck. People are going to love that thing.  

I said, “I’m not going to wear it the next night.” The next night didn’t work the same. I woke up multiple times, and that stuff. I tried it again.

You put it on people with bigger problems than you?

Yep. It takes about three weeks. We discovered that over the course of time, it helps keep people’s foreheads cool.

Does it train them to do a better job on their own or do they need to keep with it as a habit?  

What’s great about this product is there’s counseling that comes along with it. You use the product and use the counseling, and then eventually you come off the product.

It sounds harmless to do.

It’s super harmless. It has no side effects.

Most people seem to have their brains have frozen already.

They found out it’s working well for migraines and they started using it for menopausal women. They’re reducing hot flashes in the middle of the night.

This is incredible.  

It was cold, but that’s it. I love the technology aspect that I think is interesting for sleep. We’re going to come up with better drugs. By the way, I think we should, because most people think insomnia has just one flavor. There are like 30 flavors of insomnia. If we can dial in, if there’s insomnia associated with pain, if we had a special pharmaceutical that could break that cycle, then we can teach people how to deal with their pain and get them off that drug. That would be a fucking miracle. Why can’t we have more sleep drugs that are more personalized to people’s problems? That’s great in the pharmaceutical universe, but that’s fifteen years and $15 billion to get down that path. I’m also interested in some of these more holistic things like cold, breathwork, meditation, circadian timing, things like that.

What are the quack things that you see people are trying?

CBD. One of the biggest things that drive me crazy is I had a company come to me and they said, “Michael, we want you to endorse this product. It’s a CBD pillow.” I said, “What? I don’t get it.” They said, “What we’ve done is we’ve soaked the pillow in CBD. When you turn it on your head, this break open, and then you breathe in the CBD.” I said, “That is the biggest crap of shit I’ve ever heard. Tell me, how much CBD did you put in the whole pillow?” They said, “You’re going to love it, 300 milligrams in the whole pillow.” I said, “That’s a dose for one night.” They’re like, “What?” I’m like, “Did you read the literature? I haven’t seen CBD effects in sleep in anything less than 200 to 250 milligrams of CBD. That’s like a whole bottle.”

Have you seen it have an effect on people if there’s no THC content?

I have. I’ll tell you where I’ve seen it the best is in pain patients because it helps lower inflammation. A lot of people in pain got three problems when it comes to sleep. Number one, they’re anxious that they’re not going to be able to get comfortable. Number two, they’re anxious that they’re going to have a painful event in the middle of the night, which is going to wake them up and there’s a lot of anxiety associated with that. The third aspect that’s for sleep with them, usually has to do with what a pain medication that they’re taking that can have a side effect or an effect on their abilities. We’re always trying to