About this video

• Video Title: How To Cure Insomnia Without Pills & Fall Asleep | Dr. Michael Grandner
• Channel: FoundMyFitness
• Speakers: Dr. Michael Grandner, Dr. Paul Saladino
• Duration: 03:41:18

Overview

In this comprehensive discussion, Dr. Michael Grandner, a leading sleep expert, shares insights into various aspects of sleep, insomnia, and sleep disorders with Dr. Paul Saladino. The conversation covers the definition and causes of insomnia, the principles of Cognitive Behavioral Therapy for Insomnia (CBT-I), and strategies for improving sleep hygiene. They also discuss sleep apnea, its impact on sleep architecture, and potential treatments. Additionally, the video touches on the role of supplements, the effects of substances like THC and alcohol on sleep, the optimal use of caffeine, and the benefits of strategic napping. The discussion also explores circadian rhythms, the use of sleep trackers, and practical advice for enhancing sleep quality and overall health.

Key takeaways

• Understanding Insomnia: Insomnia disorder is defined by persistent difficulties 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 a trigger for wakefulness due to a negative association with sleep.
• CBT-I and Stimulus Control: Cognitive Behavioral Therapy for Insomnia (CBT-I) is highly effective. A core component, stimulus control, involves strengthening the association between the bed and sleep by only using the bed for sleep (and sex) and getting out of bed if unable to sleep.
• Sleep Apnea and Its Impact: Sleep apnea is surprisingly common and can lead to various health issues due to intermittent oxygen deprivation. Less obvious symptoms include waking up in the night due to stress or respiratory events, which can be mistaken for anxiety.
• Sleep Architecture and Its Importance: Sleep consists of different stages (Stage 1, Stage 2, Stage 3/Slow-Wave Sleep, REM). Each stage plays a crucial role in cognitive function, memory consolidation, and physical recovery. Sleep apnea can disrupt this architecture by reducing deep and REM sleep and increasing lighter sleep stages.
• Melatonin and Its Nuances: Melatonin is a hormone of darkness, not directly a sleep hormone. While low doses can signal nighttime to the body and aid in circadian rhythm regulation, higher doses are often ineffective for insomnia due to conditioned arousal and can cause side effects like grogginess.
• Supplements and Their Efficacy: While some supplements like magnesium, glycine, and L-theanine may promote sleep or relaxation, robust evidence proving their effectiveness in treating insomnia is limited. Their impact is often secondary through calming effects rather than direct sleep-inducing properties.
• Caffeine and Alcohol Timing: Caffeine's effects peak about 30 minutes after consumption and can last for hours, potentially disrupting sleep if consumed too late in the day. Alcohol may aid initial sleep onset but disrupts sleep architecture later in the night, leading to awakenings.
• Wearable Sleep Trackers: While wrist-based devices can accurately track sleep versus wakefulness and are generally good at estimating sleep stages (60-80% accuracy), the aggregated "sleep scores" are often unreliable and should be interpreted with caution, as they can sometimes contribute to orthosomnia (obsessive worry about sleep data).
• Sleep for Performance: Improving sleep quality and quantity, especially in younger individuals, can significantly enhance athletic and cognitive performance, reaction time, and resilience. Consistent morning routines, including light exposure, are key to regulating circadian rhythms.
• Addressing Sleep Issues: For persistent sleep problems, consulting a sleep specialist is recommended. Strategies like stimulus control, proper sleep hygiene, and managing underlying conditions like sleep apnea are crucial for improving sleep health.

Topics and Tags

"Orthosomnia" is a term used to describe an unhealthy obsession with achieving perfect sleep, often driven by data from sleep-tracking devices. This fixation can lead to increased anxiety about sleep, which paradoxically causes arousal and makes it harder to fall asleep, thereby worsening sleep quality. The constant worry about sleep metrics, which are often imprecise estimates, can create a negative feedback loop where the anxiety about not meeting perceived "ideal" sleep data leads to poorer sleep.

Untreated sleep apnea can contribute to nighttime urination (nocturia) primarily because the frequent arousals and respiratory events associated with the condition can disrupt normal sleep patterns. When the body experiences these arousals, it can lead to a physiological response that signals the bladder to empty. Essentially, waking up due to apnea might coincide with the urge to urinate, or the overall disruption of sleep can make individuals more aware of bodily functions they would typically ignore during consolidated sleep. It's suggested that the body's attempt to signal distress through these arousals can sometimes trigger the bladder to empty, especially if the individual is already awake.

Here's a summary of what was discussed about THC and CBD in the video:

THC:

• Effects on Sleep: THC can help individuals fall asleep faster, stay asleep, and feel more refreshed, which is unsurprising to those who have used it.
• Downsides:
  • Fading Effects & Tolerance: The sleep-promoting effects of THC tend to diminish over time, leading some users to increase their dosage.
  • REM Sleep Suppression: THC can be a potent suppressor of REM sleep in many individuals. This is comparable to how most antidepressants also suppress REM sleep. The exact implications of this REM suppression on memory and cognitive function are still murky, as the relationship between REM sleep and these processes is complex.
  • Withdrawal and Rebound: Discontinuing THC can lead to insomnia rebound and vivid nightmares due to the REM sleep suppression, potentially creating a psychological dependence where users feel they need THC to avoid worsened insomnia.
  • Injury Risk (Athletes): For athletes, THC use may be linked to increased injury risk due to potential effects on coordination and motivation, leading to poor decision-making or reduced focus.
• Research Status: Research on THC and sleep is still developing due to its past classification as a scheduled substance, which limited scientific study. More data is expected to emerge in the coming years.

CBD:

• Effects on Sleep: The data on CBD's effects on sleep are described as "extremely murky." About half of the studies show potential benefits for sleep, while the other half show no benefit or even a worsening of sleep.
• Dose and Timing: The effectiveness of CBD seems to be influenced by dose and timing, with potential for doses that are too high or too low to be ineffective or detrimental.
• Mechanism: CBD's reported effects on sleep are likely secondary, primarily through reducing anxiety and stress, rather than directly impacting sleep-wake regulation.
• User Experiences: Many patients who have tried CBD for sleep report minimal or no benefit.
• Research Limitations: Due to the lack of standardized doses, timing, and high-quality, well-controlled studies, it's difficult to draw firm conclusions about CBD's efficacy for sleep.
• Comparison to THC: Unlike THC, CBD does not appear to have significant REM sleep suppression effects.

Here are actionable steps based on the information in the video to guide what to do and what not to do for better sleep:

What TO Do:

• Establish Stimulus Control:

  • Reserve the bed for sleep (and sex) only. Avoid working, eating, or watching TV in bed.
  • Get out of bed if you can't sleep: If you're awake in bed for more than 20-30 minutes, get up, go to another room, and do a relaxing activity in dim light. Return to bed only when you feel sleepy.
  • Maintain a consistent wake-up time: While a consistent bedtime is ideal, a consistent wake-up time, especially with morning light exposure, is more crucial for setting your circadian rhythm.
  • Use the bed as a conditioned stimulus: Aim for a strong, predictable association between being in bed (head on pillow, under covers, eyes closed) and falling asleep quickly.

• Optimize Your Environment and Routine:

  • Dim lights and reduce blue light exposure 1-2 hours before bed: Use orange or red-tinted glasses if necessary.
  • Get bright light exposure in the morning: Aim for at least 15-30 minutes of outdoor light shortly after waking to help regulate your circadian rhythm.
  • Create a wind-down routine: Allow at least 30 minutes before bed to relax and detach from stimulating activities. This could include reading a physical book or engaging in calming activities.
  • Manage your internal environment: If you're not feeling sleepy, don't force it. Get out of bed and return when you feel sleepy signals. This includes recognizing when you're not ready to sleep and taking a break.
  • Consider "sleep banking": Gradually increase your time in bed, especially for athletes or those with demanding schedules, by adding 15 minutes at a time, focusing on advancing bedtime.
  • Take strategic naps: Keep naps short (e.g., 15-20 minutes for power naps) and avoid them close to your regular bedtime, as they can interfere with nighttime sleep drive. For shift workers, longer "sleep replacement naps" that go through a full sleep cycle might be beneficial if timed correctly.
  • Use dark, cool, and quiet environments for sleep: Ensure your bedroom is conducive to sleep.
  • Consider environmental aids: Eye masks and earplugs can help insulate your sleep from minor disturbances and improve consolidation.
  • Manage physical comfort: Ensure your mattress is comfortable and address any physical discomfort or pain that might be disrupting sleep.
  • Practice relaxation techniques: Incorporate activities like deep breathing, stretching, yoga, meditation, or progressive muscle relaxation into your evening routine.

• Address Underlying Issues:

  • Get tested for sleep apnea: If you experience frequent awakenings, daytime sleepiness, or suspect breathing issues during sleep, seek a sleep apnea diagnosis.
  • Review medications: Some medications can interfere with sleep; consult with a doctor about timing or alternatives.
  • Manage diet: Avoid eating metabolically active foods too close to bedtime. Aim to finish eating at least 3 hours before sleep.

What NOT TO Do:

• Don't try to force sleep: Trying too hard to sleep increases effort and arousal, which is counterproductive. Sleep is something that happens when conditions are right, not something you can achieve through willpower.
• Don't stay in bed if you can't sleep: Lying in bed awake and frustrated creates a negative association with your bed and sleep, worsening insomnia.
• Don't use your bed for non-sleep activities: This weakens the association between your bed and sleep, making it harder to fall asleep when you intend to.
• Don't rely solely on sedatives or sleep medications: While they can sometimes provide short-term relief, they don't address the underlying causes of chronic insomnia and can have side effects. CBT-I is the first-line evidence-based treatment.
• Don't consume caffeine late in the day: Generally, avoid caffeine at least 4-6 hours before bed, and potentially longer for sensitive individuals, as it can disrupt sleep onset and quality.
• Don't drink alcohol as a regular sleep aid: While it may induce initial sleepiness, alcohol disrupts sleep architecture later in the night, leading to awakenings and poorer overall sleep quality.
• Don't obsess over wearable sleep tracker data: While trackers can offer some insights, fixating on the numbers can lead to orthosomnia and increased anxiety, counteracting the goal of better sleep. Focus on trends and actionable insights rather than precise minute-by-minute data.
• Don't ignore daytime sleepiness: Persistent daytime sleepiness, even if you believe you're getting enough sleep at night, can be a sign of an underlying sleep disorder and is linked to increased injury risk.
• Don't overschedule your evenings: Avoid mentally stimulating or emotionally activating activities too close to bedtime, as this can hinder your ability to wind down.
• Don't ignore potential medical issues: If you suspect sleep apnea, chronic pain, or other medical conditions are affecting your sleep, seek professional medical advice.
• Don't take B vitamins (especially B12) at night: B vitamins can be activating and interfere with natural melatonin production, potentially hindering sleep. Take them in the morning instead.
• Don't have excessive environmental stimulation: Be mindful of light, noise, and temperature in your bedroom, and address issues like partner movement or pets in the bed if they disrupt your sleep.
• Don't expect perfection: Sleep doesn't need to be perfect to be perfectly fine. Focus on overall trends and good sleep habits rather than striving for an unattainable ideal.