About this video

• Video Title: Why You Can’t Sleep (and How to Fix It) | Dr. Michael Grandner
• Channel: FoundMyFitness
• Speakers: Dr. Michael Grandner, Dr. George E. Haggarty
• Duration: 03:41:18

Overview

This video features a discussion between Dr. Michael Grandner, a sleep science expert, and Dr. George Haggarty, covering various aspects of sleep, insomnia, sleep disorders, and strategies for improving sleep quality. They discuss the causes and treatments for insomnia, the impact of sleep on cognitive function and physical performance, and the role of sleep hygiene and technology in sleep management. The conversation also touches upon supplements, the effects of substances like THC and alcohol on sleep, and practical advice for shift workers and those dealing with jet lag.

Key takeaways

• Insomnia vs. Poor Sleep: Insomnia disorder is defined by persistent difficulty initiating or maintaining sleep, occurring at least three nights a week for at least three months, and causing daytime dysfunction. Acute insomnia can have numerous causes, but chronic insomnia is often linked to conditioned arousal.
• The Enemy of Sleep is Effort: Trying too hard to sleep can be counterproductive. Sleep is something that happens when conditions are right, not something to be forced.
• Stimulus Control for Insomnia: The bedroom should be strictly associated with sleep. If unable to sleep after 30 minutes, getting out of bed and engaging in a non-stimulating activity until sleepy is recommended. This helps break the negative association between bed and wakefulness.
• Sleep Apnea is Common: Approximately one in three people in the US experience sleep complaints, with sleep apnea being a significant, often unnoticed, contributor. Symptoms can include daytime fatigue and awakenings with a gasp or snort.
• CBTI is the Gold Standard: Cognitive Behavioral Therapy for Insomnia (CBTI) is the most effective evidence-based treatment for insomnia, focusing on retraining sleep patterns rather than just sedation.
• Melatonin's Role: Melatonin is a hormone of darkness and a nighttime signal, not a sedative. Low doses (0.5mg) taken in the evening can help set circadian rhythms, while higher doses can be sleep-promoting but may lead to grogginess if not metabolized properly.
• Wearable Sleep Trackers: While valuable for tracking trends over time, wearable sleep trackers' sleep stage data and derived scores should be interpreted with caution due to limitations in accuracy and transparency of algorithms.
• Sleep as a Performance Enhancer: Adequate sleep is crucial for athletic and cognitive performance, aiding in recovery, reaction time, decision-making, and injury prevention.
• Harmful Habits: Late-night eating, excessive alcohol consumption, and taking certain supplements like B12 or glutamine at night can negatively impact sleep. Caffeine's timing is also critical, with a 4-6 hour window before bed recommended for avoidance.
• Jet Lag and Shift Work Management: Strategic use of light, melatonin, and exercise can help manage jet lag. For shift workers, maintaining consistency where possible and using naps strategically is advised.

Here's advice related to maintenance insomnia, difficulty falling back asleep, early awakenings, and overall sleep quality, based on the transcript:

For Maintenance Insomnia & Difficulty Falling Back Asleep:

• Get out of bed if you can't fall back asleep: If you wake up and can't fall back asleep, especially if you're ruminating or stressed, get out of bed. Sleep is something that happens when the situation allows for it, not something you can force.
• Surrender control and don't panic: Recognize that you cannot control your ability to fall asleep by trying harder. Panicking or stressing about not sleeping adds activation, making it harder to fall asleep. Trust that your body knows how to sleep, and you will eventually fall back asleep when you're ready.
• Avoid associating your bed with wakefulness: If you are awake for more than a few minutes in bed, get up and do something else in dim light until you feel sleepy. This helps maintain the association between your bed and sleep.
• Break the cycle of conditioned arousal: Chronic insomnia is often due to conditioned arousal, where the bed becomes a cue for stress and wakefulness. CBTI aims to reprogram this cycle by re-establishing a healthy association with the bed.
• Manage performance anxiety: The fear or anxiety about not sleeping is often the primary driver of maintenance insomnia. Reducing this performance anxiety is a key component of effective treatment.

For Early Awakenings:

• Rule out underlying medical issues: Early awakenings can sometimes be linked to underlying conditions like untreated sleep apnea, which causes respiratory events that can lead to awakenings.
• Assess environmental factors: Check if your bedroom environment is conducive to sleep. Issues like light exposure (even from electronics), noise, or an uncomfortable bed temperature can cause awakenings.
• Evaluate your wind-down routine: Engaging in mentally stimulating activities or exercising too close to bedtime can elevate heart rate and core body temperature, preventing the body from naturally winding down and potentially leading to early awakenings. Ensure a relaxing wind-down routine is in place.

For Improving Overall Sleep Quality:

• Prioritize daytime light exposure: Getting bright light, especially from outdoors, in the morning helps set your circadian rhythm, making it easier to sleep at night. Aim for at least 15-30 minutes of morning light exposure.
• Implement a consistent wind-down routine: Dim your lights and engage in relaxing activities for at least 30 minutes before bed. This "metaphorical dimming" signals to your body that it's time to prepare for sleep.
• Be rigorous with stimulus control: Ensure your bed is primarily associated with sleep. Avoid working, eating, or engaging in other stimulating activities in bed.
• Manage your environment: Keep your bedroom dark, cool, and quiet. Consider using an eye mask and earplugs to mitigate environmental disturbances.
• Consider supplements cautiously: While behavioral interventions are primary, supplements like magnesium, glycine, or L-theanine might offer some benefits for sleep quality or relaxation for some individuals, but they are not cures for insomnia.
• Limit or avoid caffeine later in the day: Caffeine can disrupt sleep quality, even if you don't feel jittery. It's best to avoid it at least 4-6 hours before bedtime, and potentially longer depending on your individual metabolism.
• Avoid alcohol as a sleep aid: While alcohol may help you fall asleep faster initially, it disrupts sleep architecture, leading to awakenings and poorer sleep quality later in the night.
• Regular Exercise and Healthy Eating: Engaging in physical activity earlier in the day and maintaining a healthy diet, avoiding heavy or metabolically active foods close to bedtime, can significantly improve sleep quality.
• Address underlying conditions: If you suspect conditions like sleep apnea or chronic pain, getting them diagnosed and treated is crucial for improving sleep quality.