Why Midlife Women Can’t Sleep: The Sleep Doctor’s Fix for the 3AM Wakeup Cycle with Dr. Michael Breus

Dr. Michael Breus: 00:00:00

Once you know your chronotype, you actually know the perfect time of day to have sex. Eat a cheeseburger, ask your boss for a raise, go to bed. I mean, talk to your kids. Like it's unbelievable.

Because what it does is it tells you where your hormones are in a very particular spot inside of your internal clock. Most people don't know this, but you lose a full liter of water every day from just the humidity in your breath.

Roxy: 00:00:23

Oh, wow. Through your breath.

Dr. Michael Breus: 00:00:26

From your breath. Oh my gosh, am I talking about day drinking? Yes, I am talking about day drinking.

Roxy: 00:00:31

Oh, really? Day drinking too? Damn it, that's under the best.

Dr. Michael Breus: 00:00:36

You want to be thoughtful. Yeah, you want to be thoughtful. If you're going to do day drinking, just make sure it's before 2 o'. Clock.

If all anybody did was just listen to this podcast and take that one piece of advice, I can almost guarantee you in three weeks your sleep will be better by between 20 and 30%. People are saying, hold on a second, why can't I have coffee be the first thing that crosses my lips in the morning? Michael. I love it. Gets me awake.

I like the smell, I like it all. I'll tell you why.

Roxy: 00:01:05

Okay.

If you've been wide awake at 3am with your mind racing, sweating through the sheets, or wondering why your once reliable sleep routine has completely imploded, this episode is your lifeline. Today we're getting into the real reasons midlife women can't sleep and what you can actually do about it.

Because this is more than just turn off your screen and drink some tea advice.

Dr. Michael Brouss, also known as the Sleep Doctor, is one of the world's leading sleep specialists, a clinical psychologist, bestselling author, and a go to expert for everyone from Oprah to elite athletes.

We're diving into what hormones, perimenopause, cortisol, anxiety and decades of over functioning do to a woman's sleep and how to fix it with science, not shame. If you've ever felt exhausted but wired or like sleep has become a nightly fight, this one's for you. Welcome to the iconic Midlife. How are you today?

Dr. Michael Breus: 00:02:09

I'm great. How are you?

Roxy: 00:02:10

I'm doing great. We woke up to rain this morning and so, you know, I felt like maybe I got a deeper sleep. But can the rain, does the rain help with our sleep at all?

Dr. Michael Breus: 00:02:22

So not really. Not, I mean in any super appreciable way. What we find is that when it's raining outside, we have there's less light and when there's less Light.

That means our brain hasn't been told to turn off the melatonin faucet in our head. So we have a tendency to want to stay asleep longer.

We have a tendency to want to be cozy and cuddly and get under the covers and do all of those kind of awesome things.

And so I would say that I'm not aware of any appreciable data, other than there might be some data looking at relative air pressure and barometric pressure that might, for some people, make it a little bit easier to sleep. But generally speaking, when it's raining, it's cloudy. When it's cloudy, there's no sun. And when there's no sun, it's time for sleep.

Roxy: 00:03:08

Fascinating. It all makes sense. It all comes together, hopefully. Well, that's one of the many, many sleep questions I have for you.

As you can imagine, I opened up my DMs and the floodgates open because it seems like sleep is one of the things we're chasing after in midlife. And it is.

Dr. Michael Breus: 00:03:28

It seems like it, isn't it?

Roxy: 00:03:29

Yes. And it is sometimes feels like it's impossible to get the quality good sleep that you need.

So I'm thrilled you're here because we've got so many question.

Dr. Michael Breus: 00:03:40

All right, well, I'm excited to answer and so you can just fire away.

Roxy: 00:03:45

Love it. Love it. Okay, first off, what is going on in midlife as it relates to sleep, especially for women? And, like, how much of it does it come down to?

The hormones versus lifestyle?

Dr. Michael Breus: 00:04:00

So it's both, but it's mostly hormones. And hormones drive a lot of lifestyle decisions. So I feel like it can have a lot to do with that.

So, first of all, it depends upon where on the spectrum of life you are as to, you know, how your sleep is going to go. It also has something to do with, by the way, your historical sleep. Right.

And so if you've not been a good sleeper historically, news flash, menopause is going to suck. Okay? Like, that's just the bottom line here.

So if you don't have great sleep habits, walking into this area of your life, number one, that's going to be a little bit of a hurdle. But number two, now's the time to start.

And there are some very, very straightforward, simple things that people can do that I would call them table stakes. Right. So if you ever play poker, you know that you have to throw in a chip as an Annie in order to just play. We call those table stakes.

So as we get older, there are certain table stakes for Sleep. I would say the biggest one, and this is an easy, easy, easy one.

It won't cost anybody listening a dime, is you wake up at the same time seven days a week. Notice I didn't say six, Notice I didn't say five. You do not, I repeat, you do not sleep in on the weekends.

Now, every single person who's listening is going to be like, oh, that stinks. Why did he have to start with that one? Turns out that that is the one that actually has the biggest influence. If all you did. If.

If all anybody did was just listen to this podcast and take that one piece of advice, I can almost guarantee you in three weeks, your sleep will be better by between 20 and 30%. Okay. Just by regularizing your sleep schedule. And the way we do it is not bedtime. You notice I didn't say bedtime.

I didn't say, hey, everybody's got to go to bed at the same time. I don't really care when you go to bed. What I do care about is when you wake up.

Let me explain exactly why, when we wake up in the morning, sunlight hits our eye. Remember, we're talking about sunlight. Because it's raining out and we have a special cell in our eye called a melanopsin cell.

This cell sends a signal to your brain to turn off the melatonin faucet in your head. This happens every single morning. And we want that to happen, right? Because if melatonin was still going, we'd be pretty sleepy.

During the daytime, however, it sets a Timer for approximately 14 hours later. It's called the melatonin phase response curve.

Now, nobody out there has to know that, but they have to remember this is a timer and not a clock clock. So if you wake up at 6am, 14 hours later is 8pm, right? Melatonin kicks into gear, takes 90 minutes for it to kind of get itself going.

tart to feel a little sleepy.: 10:00

And you say, you know what, I'm gonna sleep in. I'm gonna sleep in until 8 o', clock, right? And you go from 6 to 8 and you wake up, and by the way, you don't feel that much better, right?

Normally you actually feel kind of worse. You kind of say to yourself, well, I got that extra sleep, but man, I'm dragging, I need some coffee, blah, blah, blah.

But here's the most important biological thing that you just did. By waiting until 8 o', clock, you've now moved the schedule down for melatonin production.

It's no longer at 8 o' clock in the evening, it is now at 10 o' clock in the evening because it is a 14 hour timer, not a clock. So going at 6:00am, 6:00am it kicks off at 8. As soon as you change to 8:00am it kicks off at 10. And that's where the problems occur.

So you're basically by, let me, let me put it even more directly. The time that you wake up directly affects exactly when your melatonin is produced at night. So if you are consistent, you are consistent at night.

And that is the number one thing to do. I have a five step plan I'm going to roll out for everybody here.

Step number one, and it corresponds with the number one, is pick one wake up time and stick to it seven days a week.

Roxy: 00:07:53

You know, I've heard this other theory where it's like you should fill up your sleep bank.

Dr. Michael Breus: 00:07:57

That is an idea called sleep debt. Everybody has gone back and forth with that probably a dozen times, if I'm honest with you. I'm so tired of hearing the discussions about sleep debt.

It makes me sick. Okay. Nobody has been able to figure it out really one way or another. And nobody knows exactly how much sleep an individual needs.

Only you, as the individual knows that. I wouldn't worry about things.

Here's where this gets complicated is when people think about sleep debt, they say to themselves, oh well, I'm going to bed at 1 o' clock in the morning. I, I, I don't want to have even more sleep debt. So I'm going to extend my sleep.

Worst idea of the century, okay, is to extend your no wake up at the same time, seven days a week. I promise you, Promise you, promise you it will work.

Roxy: 00:08:42

It will work. Okay, this is good to know.

So, you know, as soon as I started entering perimenopause, you know, I started talking to my friends and I'm like, why am I waking up at 3am every night? It's like, yep, like clockwork, like that 3am number.

And I started polling my friends and they're like, yeah, it's always 3am 3am, what is that about?

Dr. Michael Breus: 00:09:05

ises, rises, rises till about: 10:30

That drop is a signal to your brain to release melatonin. Remember, we want melatonin, we have to prime the pump, it's ready to go, right, because it's 14 hours later.

However, we've got to have that increase in core body temperature with the decrease in core body temperature. So your core body temperature drops, melatonin is released, everything is fantastic. Your core body temperature is dropping, you are sleeping.

But at some point in time, your core body temperature has to raise, otherwise you go hypothermic and you die. Okay, guess what time it turns and starts to raise.

Roxy: 00:09:49

Is it always 3:00am it is between.

Dr. Michael Breus: 00:09:51

1 and 3:00am the morning.

Roxy: 00:09:53

Oh gosh.

Dr. Michael Breus: 00:09:55

For every human on earth. By the way, it's not just for menopausal women, it's every single human on earth.

However, however, we notice it more when we're in the midst of menopause. And here's why. Because we're already in light, crappy sleep, it's difficult to get back to sleep.

And a lot of women will have a hot flash in the middle of the night and now they're drenched in sweat and not knowing exactly what to do. So once again, this is a very common scenario. I see it all the time.

I happen to see it a little bit more in my perimenopausal and my menopausal, even some of my postmenopausal women. And I've got some strategies of things that you can do, right? So number one thing that you can do is check out your bedding first, right?

If you already know you're having hot flashes, don't put on three down comforters and a wool blanket, even if it's December. Okay? Like that's a bad idea, right?

So if you know that your body's internal furnace is going to be turning, kicking on throughout the night, it's probably the best idea to stay away from all of these piles of covers that are landing on top of you. You create what's called a micro climate underneath the covers.

And even if you turn the temperature in your bedroom to 68 degrees, you've got three blankets on. There's no universe that you're at 68 degrees. So number one, change your bedding. I would make sure that you have light like you.

For menopausal women and perimenopausal women, I have them use summer bedding during winter. And we find that the lightness of it and the fabrics that are used are much better for transferring heat. So it makes it significantly easier.

So that's number one is make sure that your bedding is okay. Number two is look at your pillow. If you have a memory foam pillow, remember, most heat dissipates through your head.

If you have a memory foam pillow, those sleep super duper hot, okay? And they conform the heat. And so when your head sticks in it, you become insulated and.

And boom, you're stuck in this pile of sweat, which is your head. So one other thing you can do, change your pillow. Don't use a memory foam pillow. I would use a down or a down alternative pillow.

They have a lot more air. There's a lot more airflow. It works a lot better. So again, looking at your sleep system is one thing to do.

Now, I will also tell you that there's a new product on the market that I just tested myself and I love it. It's called Orion Sleep, like the star constellation O r I O n Orion. And it is a thermoregulator for bed. So picture this.

It's like a topper that goes across your bed. You put your sheet over it, and then it has a little coil inside it and either sends hot water or cold water through it throughout the night.

Which is pretty cool when you're having a hot flash in the middle of the night because you can reach over, turn it on and cool yourself down almost immediately. So there are different things that women can do. So number one is think about your environment. Look at your sheets, look at your pillow.

Consider one of these thermoregulation devices, like an Orion. Okay? That's number one. Number two, hydrate. Make sure you are hydrated. You're going to sweat a lot. The last thing we need you to be is dehydrated.

That makes sleep even more difficult. You stay in lighter stages of sleep when you're dehydrated, so you really want to make sure that you've got enough water in you.

However, you want to stop drinking about three hours before bed. Otherwise you're going to be peeing all night long and that's going to be equally as disruptive. So there's a balance, right, that you've got to play.

Here again, I would set an alarm for three hours before lights out, and that's when you stop drinking water. Number three, consider magnesium. There's a lot of data to suggest that most people are magnesium deficient.

We know that magnesium definitely helps with this situation. So you do yourself a favor by looking at taking a magnesium supplement. Whether it's in the evening or in the morning time doesn't really matter.

But having magnesium on board can Be very, very helpful. I personally take a magnesium called Upgraded Formulas Magnesium.

The reason I take that one in particular is I ran a clinical trial on it and it actually works. It actually helps with sleep. It's the only one I've actually discovered that helps with sleep. We can put a link to it in the show notes if you want.

Roxy: 00:14:03

Yeah, sure.

Dr. Michael Breus: 00:14:03

We can also do a link to the show notes for Orion as well. I think people would find that useful as well. Right.

So get your supplementation down correctly, have your magnesium on board if that's what you need, and make sure that your environment is one that's conducive for sleep so it doesn't get too hot. All right, Michael, I've done those things. What else can I do, right? I'm in the middle of the night, I'm awake.

Now, I might not be super hot, but I'm awake and I'm having difficulty falling back to sleep. Okay? Remember, in order to enter into a state of unconsciousness, you need a heart rate of 60 or below, all right?

Which means you've got to get your heart rate lower in order for you to feel better. Now guess what? Your heart rate isn't very low when you wake up in the middle of the night because you're pissed off.

Because you're waking up in the middle of the night. Right? And that's exactly what you don't want to be doing. So what ends up happening is, here's what you do. Oh, I can't believe it. Here I am again.

It's three o' clock in the morning. I'm either sweating or I'm not sweating.

I have to pee or I don't have to pee, but I'm up and it's 3 o' clock in the morning, and I don't think I'm going back to sleep anytime soon. What do I do? All right, we're going to go through a plan right now for exactly what everybody out there should do.

Number one, do not look at the clock. Now, this is a hard thing to do. I recommend that you take your phone and you actually plug it in across the room.

You do not need it next to your bed table, okay? Every single person tells me that they do, and every person is wrong, okay? They say, oh, what if my children call in the middle of the night?

Number one, when has that happened? Almost never. Right? Almost never. But I get it. I'm a parent. Look, I've got two kids and they drive me crazy.

So sometimes they call in the middle of the night. What do we do phone plugged in across the room. Okay? That way if I need to look at it, fantastic. I can look at it. But you know what?

I have to get up and go to look at it if I need to. So leave your phone across from. Do not look at the clock. Now, you might be wondering why? Like, why does it matter? I'll tell you why it matters.

The second you look at the clock, you instantly do the mental math. And now you're pissed off. It's three o' clock in the morning. I'm up again. Sleep, sleep, sleep. And you try to force yourself to sleep.

Rox, in the history of time, nobody has been able to force themselves to sleep because of the thing I just told you. Your heart rate has to be at 60 or below. Guess what your heart rate does when you're pushing yourself to sleep. It's going up.

Guess what happens when you do the mental math and you get upset. Your heart rate's going up. Anything you can do to lower your heart rate in the middle of the night is the best thing you can possibly do. Okay?

Now, if you are in a full night sweat, I recommend having a extra thing of clothing right next to the bed. I also recommend that you have a nice, like a.

Not a warm but not a cool, like moist washcloth so you can kind of wipe the sweat up you so you just don't feel so grimy. Some women will go back to bed without any clothing on. Some women will just go back to bed with a T shirt on. Whatever works for you, I don't care.

But get the sweaty stuff off of you so you're not feeling gross. That's number two. Okay, then number three is breathwork.

There is a way using breathing that you can slow your heartbeat down and distract yourself from being so upset. My favorite form of breath work is called 4, 7, 8. Breathing. It's exactly what it sounds like.

I'm going to give you a video that you can link to for the show notes. That's going to teach everybody the technique. But I'm going to describe it right now, if that's okay.

Roxy: 00:17:28

Sure, that'd be great.

Dr. Michael Breus: 00:17:30

So what you do is you slowly breathe in for a count of four.

Now, while you're doing this, you have your eyes closed and in your mind you see the number four, then the number three, then the number two, then the number one. You want to be concentrating on the number, okay? While you're doing the breathing. What this does is it distracts you when you're counting.

You cannot get pissed off you cannot think about why am I awake? You cannot think about what did I say to my boss or my, my, you know, my bed partner's driving me crazy.

None of those thoughts can get into your head because that starts what we call monkey mind. And then you're in trouble, right? Then you're. Then you're an hour and a half later, you're finally starting to calm down.

We want to avoid that altogether. So once again, breathing in for a count of 4, 3, 2, 1. Then you hold for a count of 7, 6, 5, 4, 3, 2, 1.

Then you gently push out 1, 2, 3, 4, 5, 6, 7, 8. Okay? 4, 7, 8, breathing. Now, there's a couple of problems with 4, 7, 8 breathing. And I want to warn people ahead of time.

So first of all, when I tried this technique, I had a hard time holding for seven, and I had a really hard time pushing air out for eight. So modify it. Okay? Start with four, five, six. Breathing. It's easy. Breathe in for a count of four. Hold for a count of five.

Gently push out for a count of six. Okay? Once you can do that for a week straight, then you can move to 4, 6, 7, and then 4, 7, 8. But start out with 4, 5, 6, breathing. Okay, number two.

You need about 22 zero cycles of this for your heart rate to lower. How on earth are you going to count for 20 cycles, Michael?

When you're counting and you're breathing and you've got all this other stuff going on, I mean, come on, it's a lot of numbers. It's a lot of numbers. So here's what you do is you take your hands and you make gentle fists and you put them down by your side.

And when you are lying in bed and you go through one cycle of four, five, six, you stick out a finger. And then a second cycle, you stick out a finger. And by the time you get to ten fingers, you're halfway there.

Then you bring them back and you're asleep. The goal here is to lower your heart rate, distract your brain long enough for the natural sleep system to come in and take over.

Because your body wants to fall asleep in the middle of the night, it doesn't want to be awake. But you've created enough anxiety and raised your heart rate so you're going in the wrong direction.

We've got to take you, stop you, and then move you in the correct direction. The way we stop you is forcing you to count. Right? The way we move you in the right direction is to follow the breathing.

And all of a Sudden, before you know it, you're on a much better pathway than in the middle of the night waking up and being upset. Make sense?

Roxy: 00:20:09

Yes. Oh, oh my goodness. It's the. Yes, that's exactly the thought process.

At 3am it is like, oh my God, I need to make myself fall asleep and it turns into anxiety and.

Dr. Michael Breus: 00:20:21

Yes, that's exactly right.

Roxy: 00:20:22

Yes. It's like an endless cycle.

And it's interesting too because I do feel like anxiety is so proud present at this time of life, you know, with all these things going on.

So if we're already kind of suffering from anxiety as we're trying to even fall asleep at night, you know, at bedtime, what can we do to kind of combat that?

Dr. Michael Breus: 00:20:42

Great question. Yeah. So this gets back into my five step plan so I can add a few question things to my five step plan.

So step number two is to stop caffeine by 2pm Caffeine is problematic. Okay, why is it problematic?

Well, for a lot of people who are going through perimenopause, menopause, post menopause, they're exhausted and guess what? The only thing they can grab a hold of that's legal, right? Is caffeine. Right? Unless they're right.

Unless they're taking Adderall or you know, on ADD meds or something like that. But you know, they're grabbing the java, right? And here's what ends up happening is over the course of time, your body adapts.

You need more and more caffeine in order to make you feel good, right? So now you're escalating the dosage. Well, here's the problem.

Your body, even though it's adapting to the caffeine more and more, it doesn't excrete it in any faster way. So your body takes between six and eight hours to eliminate caffeine, period. Full stop. Okay, so here's the problem.

In the last year and a half, I've been drinking coffee to help me stay awake. I started out with one cup a morning Michael, and now I'm at three. Something's clearly going on here.

Well, it's problematic because you're also now saying to yourself, oh my gosh, it's 2 o' clock in the afternoon and you hit a caffeine crash, right? Because the caffeine has started to come out of your system. So what do you do? Re up. And you grab more caffeine at 2:30, 3 o'. Clock.

And if you're wondering why you can't fall asleep at night, this should start to become Pretty obvious at this point is there's just too much caffeine on board. So the average cup of coffee has 110mg of caffeine in it. That's just a regular cup of drip coffee has 110 milligrams of caffeine.

You want to limit yourself to two, right? So you want to wait, by the way, about 90 minutes after you wake up. Now people are saying, hold on a second.

Why can't I have coffee be the first thing that crosses my lips in the morning? Michael. I love it. It gets me awake. I like the smell. I like it all. I'll tell you why. Because sleep in and of itself is a dehydrative event.

Most people don't know this, but you lose a full liter of of water every day from just the humidity in your breath.

Roxy: 00:22:54

Oh, wow. Through your breath.

Dr. Michael Breus: 00:22:57

From your breath.

Roxy: 00:22:57

Oh my gosh.

Dr. Michael Breus: 00:22:58

So we got to be thoughtful about this here. We want to hydrate before we caffeinate.

So one of the steps, and it's not the next step, but it is eventual step, is to get 15 ounces of water every morning before you have caffeine. But step number two in order to get a good night's sleep is to eliminate caffeine after 2pm Just stop it, okay?

Just stop your caffeine at 2pm Now, I will be honest with you. If you're a six to seven cup of coffee per day drinker and you stop your caffeine at 2pm you're going to have a real problem on your hands.

So you may have to take some of those caffeinated beverages that you have later in the day and do half caffeinated and half decaf and get your body used to that and slowly do what we call caffeine fading. So step number two is to stop caffeine by 2pm Step number three has to do with alcohol.

So a lot of people are stressed and so what do they like to do? They like to have a glass of wine or a martini at night or, you know, a cocktail, maybe a beer, watching the football game.

It's football season, whatever, right? And it helps them relax. It's terrible for your sleep. Alcohol literally destroys stages three and four sleep, which is your physical restoration.

So half the reason you have a hangover is due to dehydration. The other half is because you're not getting deep sleep. The closer you are to lights out when you drink alcohol, the worse it is.

Very similar to caffeine, by the way. The closer to lights out you drink caffeine, the larger effect it has on your sleep, same holds true with alcohol. Here's the problem.

Alcohol makes you feel sleepy. Caffeine makes you feel awake, right? And so when you drink alcohol, you're like, oh, I'm so relaxed. Oh, I can just drift off to sleep.

And a lot of people will tell me, you know what, I sleep better if I have a drink before bed. So you think you sleep better, but if I put electrodes all over your head, here's what I can tell you. Your sleep is awful.

You're not getting into the deep stages of sleep. And this brings on those hot flashes we were just talking about. So. Because it causes sleep deprivation.

So the worst quality and quantity sleep that you get, the greater likelihood is that you're going to have all of these menopausal symptoms, right? So getting high, good quality sleep lowers your chances of having those things. And alcohol unfortunately is a real deterrent.

Now I'm not saying that you can't ever have a glass of wine. I just want you to do it, let's say three hours before lights out.

So if you get into bed at 10, your last sip of alcohol should be at 7 o', clock, right? Or 6:30, right? So am I talking about day drinking? Yes, I am talking about.

Roxy: 00:25:35

Oh really? Day drinking too? Damn it.

Dr. Michael Breus: 00:25:39

That's one of the best to be thoughtful. Yeah, you want to be thoughtful. If you're going to do day drinking, just make sure it's before 2 o'. Clock. Okay?

Now step number four is about exercise, okay? And look, I am a fan. I exercise every day. I just got back from the gym.

And by the way, exercise is the single best way way to improve your sleep quality. Single best way. However, you can't do it too close to bedtime because you raise your core body temperature.

And remember, we want our core body temperature to drop, not raise, before we go to bed. So exercise daily, but stop exercise four hours before bed. You notice step one is have one wakeup time. Step two is to stop caffeine by two.

Step three is to stop alcohol three hours before bed. And step four is to exercise daily and stop four hours before bed. Step number five has to do with wake up. And there's three things I want you to do.

I want you to wake up in the morning, I want you to drink 15 ounces of water. That's where that hydration thing comes in that we were talking about. And I want you to go outside and get sunlight. Yes, direct sunlight.

Although today wasn't the Best day here in Southern California for sunlight. Most days it is pretty good. You want to get some sunshine because that helps eliminate melatonin and it helps clear the brain fog in the morning.

And you want to take 15 deep breaths just to wake up your respiratory system. I promise you, if all you did was these five steps, the quality of your sleep would improve easily 20, 30, maybe even 40%.

Roxy: 00:27:06

Oh, wow. So that's like, I mean, those are takeaways that somebody could do tonight.

Dr. Michael Breus: 00:27:10

Absolutely, yeah. Yeah. And that's the goal is it doesn't have to be complicated. Like people seem to over complicate their sleep and the idea of sleep.

And at the end of the day, number one, sleep is flexible. Okay. People need to understand if you only get five hours, one night, you're not going to die. Okay? Your head's not going to pop off.

Like, I promise, like it's happened before. Like, why are you getting so upset about this thing? It's just bad if it's happening every single night, right?

And so what you really want to do is you really want to have some level of consistency. Sleep responds best to a consistent schedule. This is why I make wake up times so consistent.

And by the way, when you make your wake up time consistent, it makes your bedtime consistent whether you like it or not. Right?

Because here's the thing, if you know you're waking up at six o' clock in the morning on Saturday, you're probably not staying out until 3 o' clock in the morning on Friday night. And that starts to metric you and starts to limit you on your behaviors. Because what we're really talking about here is lifestyle behavior behaviors.

That's the biggest thing that affects sleep. Now there is another area that I think we, we haven't talked about that.

I want to take a break and I want to talk about that because I think it's important, which is a sleep disorder. So a lot of women don't know this, but the ratio of men to women for sleep apnea, it's two men for every single female that have sleep apnea.

However, that ratio completely changes when women go to menopause. And it's one to one. Really? Really. So here's what we think is going on. Number one, there's some weight gain. Number two, it's hormonal disruption.

And we think it may have something to do with the respiratory centers. So you want to be thoughtful when you hit menopause.

Number one, if somebody tells you that you snore, you might want to ask them, do I Stop breathing in my sleep. Because you could have sleep apnea. Sleep apnea is a serious situation. I mean, I don't want to scare anybody, but.

But I do want to tell you, many, many, many people who are listening to this show and their partners could easily have sleep apnea and have no idea that they have it because you don't recognize it. You don't wake up and say, oh, gosh, I must have stopped breathing in my sleep.

No, your bed partner is looking at you saying, holy shit, you scared the crap out of me last night because I thought you died 27 times. Right? Can you. Can you fix that already? Right? And that's what we. That's what we really want to do.

Now, here's the good news as well, is since COVID very few people have to actually go into a sleep laboratory any longer. Used to be we go to the hospital. We had a special lab set up.

You went in, I glued electrodes all over your body, I put belts across your chest, and I made you fall asleep. Not really the best environment, by the way, to get that data.

But as soon as Covid hit, nobody wanted to sleep in the bed that somebody else had slept in the night before. So all the technology shrank and became portable. Now, for $200. That's right, folks, for less than $200, you can actually have a consult on the.

On a zoom call. Just like what you and I are talking now. Doctor pushes the button, sends it. Sends the test to your house. You wear it on your wrist. That's it.

There's a little thing on your finger. That's the whole thing. I actually have one around here somewhere.

Roxy: 00:30:20

Oh, yeah? Let's see.

Dr. Michael Breus: 00:30:22

So this is what a sleep study looks like nowadays.

Roxy: 00:30:25

Oh, my. So it's not even like a big mask or anything like that?

Dr. Michael Breus: 00:30:29

Nothing like that.

Roxy: 00:30:30

Wow, look at this. It looks like a watch. It looks like a watch.

Dr. Michael Breus: 00:30:34

Exactly. It looks almost like an Apple watch, right?

Roxy: 00:30:38

Seriously? Yeah.

Dr. Michael Breus: 00:30:40

This is it. This is a sleep study.

Roxy: 00:30:42

Wow.

Dr. Michael Breus: 00:30:42

That's the whole thing. We send it to your house, you put this on, you wear it, all the information jumps to your phone in the morning, goes to the cloud.

24 hours later, you're meeting with one of our doctors who's giving you the results and walking you through possible treatment modalities. So this is easy. I want people to understand that. And it's something that you should consider. Now, you might be considering it for your bed partner.

You might consider it for yourself. I mean, the good news is, is that it's all it's all covered by insurance. It's less than 200 bucks.

So it's an easy lift for most people, and you can learn a lot of information about what's going on with you. So I really want to enforce the idea for people that, number one, it's not a bad idea to have a sleep study.

Number two, it's not expensive any longer. Number three, it's not difficult. It's not like it's a huge hassle.

It literally show up at your door, and then the next day you're talking about it with your doctor on. On the zoom.

Roxy: 00:31:35

Wow. So I did not realize that sleep apnea went up during menopause. Like the.

Dr. Michael Breus: 00:31:40

It does. It doubles for women. Wow.

Roxy: 00:31:42

So if we do find out that we have sleep apnea, what can we do to treat it?

Dr. Michael Breus: 00:31:47

Great question. So there's a whole host of different possible treatments. Let's talk about several of them now.

So the most popular and the one that works the best is something called a CPAP machine. This is a mask that you wear on your nose. So let me explain to everybody what sleep apnea is.

Sleep apnea is a situation where your throat collapses onto itself and it closes, and there's no air getting in. So we have to do something to open up your airway. There's three different ways that we can go about doing this.

Number one is by pushing air down your throat.

So if we put a mask on your face and we shoot air up your nose, it goes down, and when it hits that area, it just ever so slightly opens it up, shoots air straight to your lungs. It works 99% of the time. It's called a CPAP machine. That stands for continuous positive airway pressure.

Basically Rox, it's a hairdryer blowing up your nose all night long. Okay, now, I want to be clear. It's not hot air. It's cool air. It's moist air. And it's actually much more comfortable than you might imagine.

Now, there's a lot of people out there who are like, I can't sleep with a mask on my face. I've got claustrophobia. There's no way I can it do. Do this. Okay, fine. Just remember, CPAP is arguably the best treatment out there.

The second one is a dental appliance. This is a mouth guard like you see the football players wear, except it's an upper and a lower.

And the lower comes out just a little bit further than your upper. And what it does is when you do that move forward, it opens up your posterior airway space. So that area that was collapsing now becomes enlarged.

Right. So CPAP pushes air down and pushes all the tissue out of the way.

An oral appliance moves the mandible forward, thereby pushing all the tissue out of the way. So we're doing basically the same thing but with a different apparatus. Now, here's what's nice about these dental appliances.

It's not a mask sitting on your face. There's no air blowing up your nose. You just pop it in, go to sleep. The these need to be done by a dentist.

They need to be done by somebody who is board certified in dental certification sleep medicine. This is very, very important. Your run of the mill dentist.

Even if they tell you, oh, I make apnea devices all the time, they have no idea what they're doing. I want to be super duper clear about this.

People who are board certified in dental sleep medicine, they've actually taken an exam so that they know and understand everything there is to know about cpap. All of the issues with it, all the problems with it. CPAP is a medical diagnosis, not a dental diagnosis.

So you really want to work with the dentist who's been board certified as well. So that's a second option. Very easy. A third option is something called Excite OSA E X C I T E O S A dot com.

This is a stimulator that you put on your tongue during the daytime for about 40 minutes, and you wear it during the day. It vibrates across your tongue and it makes your tongue a little bit smaller.

It shrinks your tongue by about 2 millimeters, which again, opens up the oral cavity. If you notice every single thing that we're doing, we're either pushing air down to push stuff away.

We're moving the jaw forward to open it up, or we're shrinking the tongue to open up the space. So this is all very physical type of treatment modality, but it works really, really well. I like the Excite osa.

It replaces the CPAP machine completely. And I put it on to at least three doctors and they love it. So that's an option as well. You do that for about 45 days during the daytime.

And then you have. There's no cpap. There's no oral appliance there. There's nothing really.

Roxy: 00:35:12

That's it. 45 days, okay?

Dr. Michael Breus: 00:35:14

Yep. Then there is surgery. There are probably five to six different types of surgery. A lot of people have seen a commercial for something called Inspire.

You might have seen it on the History channel. I see it on sports channels. All the Time where they've got people and they're wearing CPAP masks and they're like, I'm tired of this.

I'm going to go get inspired. What most people don't understand is inspire is a surgery. This is a medical invasive procedure.

There is an incision that goes across your top part of your chest. They put a device underneath. Kind of looks like a pacemaker. It's about the size of a 50 cent piece.

Then they have to pull wires up through your neck and up through the back to your back of your tongue. And then when your tongue falls to the back of your throat, it senses it and it sends an electrical signal and pushes your tongue forward.

Now, to be clear, it's not like you're a frog and your tongue is flopping forward, you know, all night long. It moves. It just forward and up. It still stays in your mouth, but it's still. It is an invasive procedure. Meaning this is an indwelling thing.

You require stitches. It requires. It's quite a bit. Also, battery has to be replaced every 10 years, so you're in for a 10 year haul.

And then you got to go get it done again. And then you got to go get it done again.

So it's not my favorite, but it is the, it is the least invasive and one of the most effective surgeries out there. Once you get past that one, if I'm honest with you, there's not a lot of great options.

The best thing out there is something called the U triple P, where they basically carve out all of the tissue in the back of your throat. It's incredibly painful. It's a very vascular area. Also, half the time the tissue grows back.

So it's really not the best idea to be doing a sleep apnea surgery in my practice. And what I've recommended for the last 26 years is, is I tell people, try your. Try the cpap. Number one. Insurance covers it and we know it works.

It works 99% of the time. I mean, come on, like, I don't know of any other treatment in all of medicine that works that well. Go on it for six months and see how you do.

If you can't tolerate it, great. We can try an oral appliance, we can try an excite osa. And if you have really mild apnea, maybe we start with one of those instead of a CPAP machine.

It all depends upon the severity of your diagnosis and where the apnea is. Because apnea can be in the nose, it can be in the back of the mouth. Or it can be deep in the throat.

Roxy: 00:37:31

Oh. So if you have the CPAP machine, can you sleep on your side still.

Dr. Michael Breus: 00:37:36

Or is it like absolutely no problem? Yeah. So a lot of people wonder that, they're like, oh, do I have to sit here like this and not move? No, not at all.

So the way it works is there's a mask, and then on the top of your head, depending upon the mask, is a little swivel, and that has the tube that's coming down to your face. So you can swivel in any direction that you want and it's not a problem. And they've got hundreds of engineers who've developing these masks.

So they're expecting people to fall asleep on their side, on their back, on their stomach and be able to still do this. So, yeah, I don't think there's any problem, no matter what sleep position you happen to be in.

Roxy: 00:38:11

Okay, and what is the difference between like just regular snoring and sleep apnea or is there no difference?

Dr. Michael Breus: 00:38:16

Great question, great question. So there's a huge difference. So when we have just snoring is we call it a social nuisance, but in fact it really is a blockage of airway.

And so we do think of this as restriction in your airflow. Is it terrible? No, it's not terrible. Is it there? You bet it's there. Here's what it is. It's the start of sleep apnea, I would say 75% of the time.

Now, what are some things that people can do if it's just snoring? Well, number one, lose some weight.

Okay, here's one of the things that we know is while apnea is not just a big person's disease, when people are big, apnea is significantly worse and it contributes to the severity. So one of the things I tell people all the time is weight loss can definitely be helped. By the way, there's now a GLP one called zepbound.

I have no association with Zepbound, but this has been cleared. So if you have sleep apnea, you can get a GLP1 to help you lose weight, to help you with your sleep apnea.

Now, again, this is not the only way to treat it because sleep apnea is not 100% weight dependent. However heavy, people are going to have worse apnea. And so a GLP1 is probably not the worst idea.

Roxy: 00:39:30

Yeah. You know, I noticed too, when my husband has one or two cocktails close to bedtime.

Dr. Michael Breus: 00:39:34

Absolutely. So alcohol relaxes all of that tissue. It makes it very flappy. So it makes it much more likely to do that.

Now, let's say that you think your partner could have sleep apnea. What are the symptoms? So, number one, they snore. Well, 50% of America snore, so that doesn't help us that much.

Number two, have you ever seen them stop breathing in their sleep even one time? Right. This is where all of a sudden you hear a pause in the snoring. It's completely silent. And then they go and they make some crazy sound. Yep.

That is an apneic event. So to be clear, that's not normal. People shouldn't have those. And if you hear one or two of those events, it's time to do a sleep study.

Okay, let's say you don't hear one of those events, Right? Let's say you just hear snoring. Well, does your partner wake up the next morning with a headache because that's a sign of oxygen deprivation.

Are they tired during the day because that's a sign of sleep deprivation? Is their mood up and down? Because that's a sign of sleep deprivation. So all of these things are symptoms that we see when for sleep apnea.

So once again, screen your partner. Screen. Have them screen you. Make sure you don't have sleep apnea. Okay, Michael. I've screened him. I've screened her. We don't have sleep apnea, but we.

But he snores like a freight train. What do I do now? Okay, lot of different options here. So number one is you want to see where is the snoring coming from. Most of the time it's nasal.

It's some level of nasal congestion. So one of the first things I recommend to people is to get themselves on a nasal congestion, like a flonase or a nasal cort or something like that.

They're over the counter. You can buy them at any drugstore. It's one shot in each nostril in the morning, one shot each nostril at night.

Within five to seven days, all of your congestion should be gone, and then so should your snoring. So that should be helpful if your snoring is based in the nostril area.

If your snoring is based in the back of the mouth or deep in the throat, then you're definitely going to end up with sleep apnea. That's a lot harder to fix. The second thing I oftentimes have people do is there's a product out there called mute M U T E Mute snoring.

This is an internal nasal dilator. So it actually Goes up and into the nostrils and sits in there, and it keeps them open. You notice we're doing anything we can to open the pipe. Right.

That's the. That's the entire game here, is to just keep the airways open.

And so if you've got nasal congestion, if you stick one of these things up your nose, guess what? The congestion is moved to the side, and now you can breathe.

A third thing you can do, consider earplugs and a sound machine for you, because your partner's not going to hear it. They're not designed to hear themselves snoring. So you may require earplugs or you may require a sound machine of some sort. Okay. Yep.

The other thing to think about is creating a pillow wall. So put a pillow between you and your bed partner. So sound is a matter wave.

So if you put a wall and they're facing that wall, it will bounce off and it will come back to them, and they will eventually turn and go the other direction, which will help you. You want them to snore in the other direction of you and preferably on their side.

Most people snore worse on their back, so giving them the elbow and having them rotate to their side works. But have them face away from you in order for you to be able to not have to hear their snoring all night long. Yeah.

Roxy: 00:42:50

So it's not like a loudspeaker.

Dr. Michael Breus: 00:42:52

Exactly, exactly. And then there's the somewhat popular topic of what's been called a sleep divorce. So a sleep divorce is basically where you move into another room.

And I gotta be honest with you, the strength of your relationship does not depend upon what room you sleep in with your bed partner. Okay. Don't be fooled.

There are plenty of times if I've got a flight to catch or I've got make sure I get a really good night's sleep, I'll sleep in the guest room. I got no problems with that. And then come back in on the weekends.

Like, there's nothing wrong with having a separate place to sleep if you cannot get sleep.

So if your bed partner is snoring and it's preventing you from getting a good night's rest, either kick them out or you move out to the guest room or to a kid's room or whatever in order to finally get yourself some sleep. For me, what I recommend for people to do is ask the snorer to leave, because then they start to understand the impact that they are having on you.

The snore, or the person who has to listen to the snoring. Right. And so you can separate bedrooms and sometimes that can work out well, too.

Roxy: 00:43:58

Yeah, that's actually a good idea. That's becoming more and more popular. I feel like a lot of people are doing it now. What about with HRTs?

Because, you know, a lot of women are taking estrogen and testosterone and progesterone. Do any of those help with sleep? Once you kind of get started on.

Dr. Michael Breus: 00:44:15

Those cycles, yes, progesterone is the one. Once you get on progesterone, usually the hot flashes go away and the sleep gets better.

Now, we must also talk briefly about how women have been so misaligned with the data. So historically, doctors were telling women, don't take hrt, you're going to get cancer. It's going to be awful. All of that data has been refuted.

We do not think that that is the case any longer. HRT appears to be quite appropriate in many cases. Clearly, talk with your doctor about it and find a doctor that's willing to work with you on it.

But I don't have any problem with HRT whatsoever. In fact, I would say that 75% of my female patients, once they get on HRT, their sleep gets significantly better.

Roxy: 00:45:03

Oh, there is hope. And what about supplements? Do you recommend any, like melatonin supplements or any l theanine or any of those. Those kinds of things.

Dr. Michael Breus: 00:45:14

So here's my theory on supplementation, which a lot of people don't like, but I don't care. So here's what I tell people to do. Go do blood work, okay? That's step number one. And see where your deficiencies are.

If you are deficient in vitamin D, magnesium or iron, fix those and I will bet you 20 to 25% of the time your entire sleep cycle gets better. I fixed more people just by putting them on vitamin D and magnesium than just about anything else, because we know that they're deficient in them.

To be clear, there is not a person on earth who is deficient in ashwagandha, okay? It doesn't work that way. Okay? But you might be deficient in some vitamins and some minerals that are important for your body to function.

So before we walk down the road for supplementation, go get some blood work done and fix this unit first.

Again, vitamin D and magnesium are more than likely the things that you're going to want to be thinking about, because those are things that we know most people are deficient in. And vitamin D is a circadian pacemaker, and magnesium is a calming agent and helps you fall Asleep.

So I would start there in terms of your blood work and fix that first, long before you start playing around with valerian and L Theanine and all these different things. Because here's the thing is, once you get on them, you're stuck. Okay? And you're on them forever.

Like, it's no different than being on a sleeping pill, honestly. And I fix more people without sleeping pills than I do with sleeping pills.

Roxy: 00:46:44

Do you find yourself ever prescribing Ambien and, you know those types of things or.

Dr. Michael Breus: 00:46:49

Yeah, yeah. So to be clear, I'm a PhD, not an MD, but I work with MDs who do prescribe. And the answer is absolutely, positively.

There are people in this world who require a pill to sleep, and that is okay. All right, look, if you have major depression, if you have paranoid schizophrenia, if you're bipolar, guess what?

You get a sleeping pill, Great, no problem. But for the vast majority of people, sleeping pills have been over prescribed. Specifically, Ambien has.

And so there's a lot of people who are taking medicine that they don't need to be taking. And they've been taking it for a very, very long time. And the truth of the matter is, it's probably not working that well anymore.

Now, what I will tell you that happens often is I get somebody who comes into my clinic and they say, Dr. Bruce, I've been taking 15 milligrams of Ambien every night for 10 years. And I said, well, why are you in my office? You should be sleeping just fine. And they say, I can't sleep. I don't sleep longer than three hours.

And I say, then why are you still taking sleeping pills? And here's their answer. Can you imagine how bad my sleep would be if I didn't take them?

Roxy: 00:47:50

Oh, so they're almost scared to even try the other side. Wow.

Dr. Michael Breus: 00:47:54

Absolutely. They become addicted, and then psychologically, they become addicted. And now they've got a much bigger problem on their hands.

To be clear, every single person on earth can sleep without Ambien. Every one of them. Right. Because that's how we were born. Right. Everybody was born being able to sleep, I swear.

So it's just not that hard to think about it. But we use medicine sometimes appropriately, but sometimes inappropriately. And that ends up becoming problematic for people over time.

But to answer your question more succinctly, yes, there are plenty of people who require to be on medication. Now, Ambien may or may not be my first choice. Something like Trazodone is probably closer to my first Choice.

Trazodone is an old antidepressant that's not particularly addictive. Wasn't very effective as an antidepressant, but appears to be quite effective as a sleep aid.

We can leave people on Trazodone for 15, 20 years and it doesn't appear to be a big problem. Once again, not my goal. Right. Not what I want to do.

But I would be foolish to turn to you and say, nobody out there needs a sleeping pill because it's just not true.

Roxy: 00:48:57

You know, I was on your website and I did the chronotypes quiz, the sleep chronotypes, and I got a dolphin, but my sleep score wasn't that high. It was 62, which.

Dr. Michael Breus: 00:49:08

Yep, that's what dolphins get.

Roxy: 00:49:10

That's right, because dolphins don't get the best sleep, generally speaking.

Dr. Michael Breus: 00:49:14

They don't. They're my problem children.

Roxy: 00:49:15

Yeah, right. Yeah, right. So how can we, as dolphins and, you know, improve our sleep? And if you'll also just let people know about the chronotypes, too.

It's fascinating.

Dr. Michael Breus: 00:49:25

Absolutely. So a while back, I had a female patient and I failed. I mean, when I say I failed, I failed. I couldn't figure out how to get her to sleep.

We tried medication. We tried cognitive behavioral therapy. We tried everything. So when I fail, I go back in and I interview them for free.

And I. I must have missed something. Like, I must have missed a symptom. I must miss a test. What. What are we doing here? We need to run some more labs. What is it?

And I, during my interview, she turned to me and she said something I just thought was fascinating. She said, you know, Dr. Bruce, if I. This is when I was practicing on the East Coast.

She said, you know, Dr. Bruce, if I just lived in California, my life would be great. Like, what are you talking about? She's like, I just need a different time zone.

She's like, I live on the east coast, but my body seems to be on west coast time. If I could just wake up three hours later and go to work three hours later and do everything three hours later, I think it'd be fine.

So I turned to her and I said, well, why don't you do that? And she said, well, my boss wouldn't allow that. My husband and family wouldn't be too thrilled about that. Like, that's just not how my lifestyle is.

I said, well, what if we ran the experiment for, let's say, a week and we see how well you do? And she said, I'm going to be honest with you. I'm not doing very well at work.

I'm not sure my boss would be willing to even allow us to do that kind of experiment. So I said, give me the number, let me call.

So I got her permission, and I called, and I turned to her boss and I told him, you know, this is what I'm working with and this is what I want to do. And he said it was on Monday. And he said, you can do whatever you want. She can come in, you know, two hours later.

So instead of coming in, she normally came in at 8, she come in at 10, and she can leave at 8 at night or whatever. No, 6 at night. And I said, okay. I said, that's great. He said, but by the way, she's being fired at the end of the week. Like, oh, great. No pressure.

I call him up on Friday. And I said, how'd she do? And the first words out of his mouth were, I have three more people I want you to talk to. Okay?

So what I discovered was, is that some people live in a different chronotype. A chronotype is your genetic sleep schedule, by the way. You don't get to choose it.

I can look on your 23andMe or your ancestry.com and I can show you, based on your genetics, if you're an early bird, which is what I call a lion, a night owl, which is what I call a wolf, or somebody in the middle, which is what I call a bear. Now, I want to be honest with you. This is not new. This has been around since the 70s, okay?

People have been calling people early birds and night owls and people in the middle for a long, long time. All I did was I changed the birds to animals, okay? But what I did do is I discovered a fourth chronotype. Fourth chronotype are dolphins.

Now, people are wondering, why did. Why did you choose dolphins? Just out of curiosity. So it turns out dolphins sleep uni hemispherically.

So half of their brain is asleep while the other half is awake looking for predators. And that made me feel like my insomniac patients. So roughly 10% of the population has chronic insomnia, and I believe they're dolphins. Okay?

Now, you can also be a dolphin by circumstance. What do I mean by that? Well, you might not have the genetics to be a dolphin, but your surroundings may cause you to become a dolphin.

One of those surroundings is menopause, okay? You could have a perfectly normal sleep schedule. The second you hit menopause, everything goes cuckoo and you are in trouble.

That's when we And I wrote an entire book just about what to do if you're each one of these chronotypes and when to do it. So the book is called the Power of When. But if people want to learn what their chronotype is, it's easy.

Go to chronoquiz.com we'll put that in the show notes as well. And that's an easy. Takes three minutes and you can learn what your sleep score is, you can learn what your sleep animal is.

And I give you a lot of tips and tricks specifically for your chronotype. And I've been doing it now, we've been doing it now for about 15 years. We've had over 3 million people take the quiz.

It's been pretty interesting learning about these people and kind of their sleep animal. But what I will tell you is it's fun and I get the whole family to do it, right? And so don't you just do it once you figure out your sleep animal?

Figure out the whole family sleep animal because then you actually can know exactly what to do. So people tell me all the time like, well, what else can I do with this animal thing, Michael?

Well, once you know your chronotype, you actually know the perfect time of day to have sex, eat a cheeseburger, ask your boss for a raise, go to bed, I mean, talk to your kids. Like it's unbelievable because what it does is it tells you where your hormones are in a very particular spot inside of your internal clock, right?

And so as an example, some people are morning people and some people are not.

So for some people, if you're a lion and you're an early, more early riser, I'm going to have you work out in the morning and I'm going to have you do your detailed homework type of stuff like thinking about new ideas or doing bills or things like that in the morning. Because your attention to detail is going to be very good if you're an early riser.

But you're not going to want to do that activity at six o' clock at night, right? Because you don't have that energy.

But, but if you're a night owl, that's the perfect time to do that activity is 6 o' clock at night because you're just getting started. Because morning suck for you if you're a night owl, right?

So once you know and understand which one of these animal characteristics you are and your partner or your kids, life gets a lot easier.

Roxy: 00:54:32

That's really good to know. Also cortisol, there's so much talk about cortisol and the spikes, right. And how it wakes us up and all these things.

Do you have any practical tips for just maintaining cortisol so it doesn't wake us up? Okay.

Dr. Michael Breus: 00:54:48

The biggest thing to do is to wake up at the same time every day. Every single thing that I've said so far helps manage cortisol. Every single thing. Okay.

Cortisol is, is a hormone that is created during what's called fight or flight. So this is the oh shit, I've got to get out of here hormone. And so it gives you a lot of energy and gets you going.

You clearly do not want cortisol at night, right? That isn't helpful for you.

So the best things to do to manage cortisol, meditation, relaxation, hot bath, maintain hydration, stop meals, three hours before bed, all the stuff you already know to do that you know are healthy will help manage your cortisol. Is there any like cortisol plan that I can give people? Unfortunately, I don't have one of those in my back pocket today.

But I, I do think that my five step plan for sleep will absolutely help you manage your cortisol.

Roxy: 00:55:42

Okay, that's good to know. And I know you work with tons of athletes, celebrities, really high performers.

Are there any tips that those people in particular are using that we could also use? Anything different that they're doing?

Dr. Michael Breus: 00:55:56

So it's interesting because it depends upon the human, right? And so when I work with professional athletes, they're just different humans. Their bodies are different. The way they think is different.

It's very, very different. It's funny because a lot of people think, oh, I'm just going to follow this athlete's regimen because I want to be, look like this athlete.

That's a terrible idea. Okay. If your body isn't the same as that athlete, it's going to be very difficult to do it.

What I have learned from many of my athletes and my celebrities is sleep is sacred. If you don't get sleep, you will not perform. Doesn't matter what the activity is. Doesn't matter if you're Paris Hilton and you're doing a DJ thing.

It doesn't matter if you're Carson Daly and you're on the Voice. It doesn't matter if you're Steve Aoki and you're jumping out at a stadium show. Okay.

It doesn't matter if you don't get your sleep, your performance will suffer. And all of these people are performers. Whether it's athletic performance, entertainment performance, I think we're all in that level on some level.

And so what I would say to do, I'd say the biggest thing that celebrities and athletes do is they take sleep serious. And I think that's something that we should all do. Easy way to do it. Follow my five step plan, do the chrono quiz, you'll be in good shape.

Roxy: 00:57:10

Yeah, that's really good to know. Now, turning the tables on you. What advice would you give your 25 year old self?

Dr. Michael Breus: 00:57:17

Oh, what advice would I give my 25 year old self? Buy Tesla stock the second it IPOs. That's what I would tell myself. Buy it the second it IPOs and throw as much money into it as you possibly can.

That's my advice to my 25 year old. So.

Roxy: 00:57:33

Right. I mean, gosh, didn't we wouldn't. I mean if we all did that, we'd be in a much different place.

Dr. Michael Breus: 00:57:38

Come on. If I, if you wanted health advice, health advice would be, you know, it's okay to take sleep seriously in your 20s.

I'm 57 years old, so you would hit me around 30 something ish, right? 32. You know, when you're new to parenthood, when you're new to career world, when you're new to all that stuff, sleep has a tendency to suffer.

You just don't get enough. Do yourself a favor, don't blow your sleep, it's just going to blow your career.

Roxy: 00:58:04

Yeah, I mean we don't take, we don't take it seriously at all when we're that age. You know, it's like if it comes, it comes.

Dr. Michael Breus: 00:58:09

Well, we feel invincible. You know, we're like, oh, we can make it through. Who cares if I don't sleep, I'll just drink some more caffeine, you know, it'll be fine.

And the problem is, is it is fine for years. And then you hit like 35 or 40 and then the entire world dumps.

Roxy: 00:58:24

And it's like, oh, crap comes crashing down. It catches up. How are you living iconically right now?

Dr. Michael Breus: 00:58:31

Well, I guess the first thing I do is I, well I take care of myself. So every day I wake up at the same time I walk my dogs and then I meditate every single day for 15 minutes every day.

Then I do breath work, then I go to the gym. I have a very specific routine that I do at the gym. I stretch, I do cardio, I do weights. Then I hit the sauna.

I'm in the sauna for 15 minutes every day. Then I come home and I make a super high end Protein breakfast. I have ground turkey, eggs and broccoli every single morning.

And that's how I start my day. I don't take a call before 11. And that's how I live iconically.

Roxy: 00:59:12

That sounds like the greatest morning plan I've ever heard.

Dr. Michael Breus: 00:59:16

It's awesome.

Roxy: 00:59:17

Tell us about all the great projects you have coming up because you're always working on great things.

Dr. Michael Breus: 00:59:21

So I have. I have some really cool projects going on right. Right this moment.

That Orion Sleep I was talking about earlier, that thermoregulatory pad, that thing is awesome. That's something that I've been working on for almost a year now. I think that's something that people will really like. What else is going on?

I think the sleep test, the home sleep test, that's definitely something that's kind of new that a lot of people don't know about. That's inexpensive and a great way for people to. To be able to learn more. And then I would say go subscribe to my YouTube channel.

Every single week, we put out new videos about different aspects of sleep. This week, I'm doing something on loneliness and sleep.

It turns out that being lonely is almost as difficult as drinking too much caffeine at night before bed. It has that big of an effect on your ability to fall asleep and stay asleep.

Roxy: 01:00:10

Oh, wow. And so many people suffer that. I mean, that's so common.

Dr. Michael Breus: 01:00:14

So many people suffer from that. Yeah, absolutely. So it's definitely something to think about. About.

Roxy: 01:00:18

And everybody can find you at Sleep Doctor.

Dr. Michael Breus: 01:00:20

Yeah. So my YouTube channel is the Sleep Doctor, and my website is sleep doctor.com.

Roxy: 01:00:26

Wonderful. Well, thank you so much for joining us. No doubt you helped so many people who were listening because this is such a common problem that we all have.

Dr. Michael Breus: 01:00:35

It's a big deal. It's kind of funny because when I first started out doing this, people used to say, are you an anesthesiologist? I'm like, no.

Sleep apnea, narcolepsy, that kind of thing. So it's different, you know, it's. It's a fun area to be and study of.

But my wife tells me all the time, you wouldn't be nearly as interesting, you know, if you were a cardiologist, you know, at a cocktail party.

Roxy: 01:00:56

I know it's more unusual. You're unique. This is a good thing.

Dr. Michael Breus: 01:00:59

I am unique on certain days, for sure.

Roxy: 01:01:02

Fantastic. Well, thank you so much for joining us. It was wonderful. Thank you for all the information.

Dr. Michael Breus: 01:01:08

Thank you, Roxy. It's great to be on your show, and thanks again and wishing everybody out there. Check out chronoquiz.com and Sweet Dreams.

Roxy: 01:01:18

Listen, if this episode hit home for you, you're not alone. Midlife women are exhausted, burned out, and being told to just relax or try melatonin. But we deserve real answers and real support.

Dr. Bruce, thank you for giving us both truth without fear and science with heart.

If if this conversation helped you tap, follow on the iconic midlife, share it with a friend who's struggling and leave a review with your biggest aha. Moment. Reread, everyone. Sleep isn't a luxury, it's your foundation.

And you deserve to feel rested, strong, and in control of your life starting tonight. See you next week. And stay iconic.