About this video

• Video Title: How To Cure Insomnia & Fall Asleep Fast | Dr. Michael Grandner
• Channel: FoundMyFitness
• Speakers: Dr. Michael Grandner, Dr. Paul Saladino
• Duration: 03:41:18

Overview

This video features a conversation between Dr. Paul Saladino and Dr. Michael Grandner, a sleep science expert, discussing various aspects of sleep, insomnia, and related health issues. They cover topics like the definition and causes of insomnia, the principles of Cognitive Behavioral Therapy for Insomnia (CBT-I), sleep apnea, sleep stages, the impact of lifestyle choices on sleep, and the role of supplements and technology in sleep management. Dr. Grandner also shares insights on optimizing sleep for athletic and cognitive performance.

Key takeaways

• Understanding Insomnia: Insomnia disorder is characterized by persistent difficulty initiating or maintaining sleep, occurring at least three nights a week for over three months, and causing daytime functional problems. Chronic insomnia is often caused by conditioned arousal, where the bed becomes associated with stress and wakefulness due to past sleep difficulties.
• CBT-I and Stimulus Control: Cognitive Behavioral Therapy for Insomnia (CBT-I) is presented as the most effective evidence-based treatment. A core component, stimulus control, involves re-associating the bed exclusively with sleep by getting out of bed if unable to sleep, thus breaking the learned association between the bed and wakefulness/stress.
• Sleep Apnea and Its Impact: Sleep apnea is common and can lead to various health issues. Less obvious symptoms include waking up at night due to respiratory events, followed by stress or difficulty falling back asleep, even without reporting daytime sleepiness.
• Sleep Hygiene and Predictability: While basic sleep hygiene is important, advanced strategies focus on building predictability through consistent routines and environmental cues. For those with chaotic schedules, creating predictable nighttime routines and utilizing morning light exposure are key.
• Melatonin and Supplements: Melatonin's primary role is as a darkness signal, not a sedative. While it can help with sleep onset by strengthening the nighttime signal, it's often ineffective for insomnia with conditioned arousal. Low doses (0.5mg) are suggested for circadian rhythm signaling, while higher doses are more for sleep promotion. Research on other supplements for sleep is ongoing and often limited.
• Wearable Sleep Trackers: While wearable devices can provide useful data on sleep continuity (wake vs. sleep), their accuracy in sleep staging is ballpark (60-80%), and metrics like "sleep scores" should be interpreted with caution due to their proprietary and unvetted algorithms. Over-reliance on these metrics can lead to "orthosomnia," worsening sleep due to anxiety about the data.
• Sleep and Performance: Sleep is crucial for cognitive and physical performance. Improving sleep quality and quantity, even by small amounts, can enhance reaction time, focus, and resilience, particularly in younger individuals and athletes. Sleep banking, or accumulating good sleep over time, is more beneficial than trying to catch up on sleep just before an important event.
• Circadian Rhythms and Lifestyle: Aligning lifestyle with chronotype is important. Morning light exposure, consistent routines, and strategic use of caffeine and naps can help regulate the circadian rhythm. For shift workers, minimizing schedule changes and managing light/dark exposure is critical.
• THC and Sleep: THC can promote sleep onset and duration but may suppress REM sleep, with its effectiveness fading over time and potential for withdrawal-induced insomnia and nightmares.
• Alcohol and Sleep: Alcohol can initially aid sleep onset but often leads to fragmented sleep and rebound wakefulness later in the night due to its rapid metabolism and stimulating byproducts.
• Shift Work and Health: Shift work is detrimental to health, increasing risks for various diseases and impairing decision-making, especially regarding food choices, due to circadian disruption.

Key messages for maintenance insomnia

• Understand Conditioned Arousal: Maintenance insomnia often stems from a learned association between your bed and wakefulness/stress, rather than a direct physiological inability to sleep. Your body has become conditioned to be alert when you're in bed.
• Bedroom Association is Key: The core principle for overcoming maintenance insomnia is to re-establish the association between your bed and sleep. Your bed should be reserved only for sleep and intimacy.
• Stimulus Control is Crucial: Strictly adhere to stimulus control principles:
  • Get out of bed if you can't sleep: If you're not asleep within about 20-30 minutes, get out of bed and go to another room.
  • Return only when sleepy: Go back to bed only when you feel genuinely sleepy.
  • Avoid other activities in bed: Do not work, eat, watch TV, or use your phone in bed. Reserve it solely for sleep.
• Manage Effort and Anxiety: Trying too hard to sleep is counterproductive. The "enemy of sleep is effort." Reduce the pressure and anxiety around sleep by surrendering the need to "control" it. Sleep is something that happens when the situation allows.
• Consistency in Mornings: While a consistent bedtime can be difficult, prioritize a consistent wake-up time. Morning light exposure is a powerful signal for your circadian rhythm.
• Consider CBT-I: Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold standard treatment, incorporating stimulus control, sleep restriction therapy (optimizing time in bed), sleep hygiene, and cognitive restructuring to address the underlying issues of maintenance insomnia.
• Supplements are Supportive, Not Curative: While supplements like magnesium or glycine might offer mild sleep support, they are unlikely to cure maintenance insomnia driven by conditioned arousal. Focus on behavioral changes first.
• Wearable Data Caution: Be mindful of wearable sleep tracker data. Over-analyzing or becoming anxious about the numbers (orthosomnia) can worsen insomnia. Use the data for general trends rather than precise minute-by-minute analysis.

Turning these messages into a tweet:

Maintenance Insomnia? 😴 Your bed = sleep ONLY. Can't sleep? Get up! Re-associate bed w/ sleep via Stimulus Control (CBT-I). Reduce effort & anxiety. Prioritize consistent mornings & light exposure. Supplements are secondary. Don't obsess over wearables (orthosomnia)! #SleepTips #Insomnia