Tired but Wired: How to Re-Think Sleep

Dr. Robert Rountree

This is the Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet, supplements, and lifestyle approaches to good health. I'm Dr. Robert Rountree, Chief Medical Advisor at Thorne and functional medicine doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure or prevent any disease.

Hi, everyone, and welcome to the Thorne Podcast. Joining me once again, we have Dr. Mary Kay Ross. Dr. Ross is the Chief Medical Officer at Thorne. She's an expert on brain health, and she's also a good friend and colleague. Thank you, Mary Kay, for doing another episode with us.

Dr. Mary Kay Ross

Thank you for having me, Bob. I love doing this with you. It's an honor to be here.

Dr. Robert Rountree

Terrific. Let's get into the main discussion for this week, which is really pertinent to your background, a deep dive into the world of sleep. Just to borrow the title of Matthew Walker's book, why do we sleep? What do you think, why do we sleep?

Dr. Mary Kay Ross

I think sleeping is an opportunity for lots of things that happen to reset in our body. I think about our glymphatic system, which is kind of like the lymph of the brain, if you will, it bathes the brain. It's an opportunity for autophagy. It's where we do our house cleaning. When you think about the brain and you think about our body, certainly day to day, going through life, there's debris that accumulates, cells die, toxins, all kinds of things. When we're sleeping, it's an opportunity for the glymphatic system, it is when it happens, to wash away things, to clean things. I think that is critical to our brain. A lot of that happens during our deep sleep, there's different phases in sleep. As we get older, we don't sleep as well. It's just a phenomena that occurs.

Dr. Robert Rountree

I've noticed that.

Dr. Mary Kay Ross

It happens and you really have to, well, we'll get into it, but you really have to work at sleep, as crazy as it sounds. It's critical to maintain good sleep throughout your life.

Dr. Robert Rountree

Now, you've used the term several times, the glymphatic system. I want to make sure people understand that you weren't just flubbing your words, you meant to say glymphatic, which sounds a lot like lymphatic, but what's the glymphatic system? The G lymphatic system,

Dr. Mary Kay Ross

It actually is a system that, as I said, it bathes the brain and cleanses things away, it washes things away. Lymph, our lymph system, helps carry away things and is part of really our immune system as well. In our brain, the glymphatic system, there's been MRIs that have been done, and when you're asleep, and they've been able to differentiate the different phases of sleep, and when you're in that deep sleep, they can actually see the fluid come in and bathe, it opens more.

Dr. Robert Rountree

It's a bath, you're taking a bath for your brain.

Dr. Mary Kay Ross

You're taking a bath basically. It's a housekeeping thing, you're really washing things away. That is an optimal time for that to occur. As we get older, and of course if we have other pathological problems, if we have Alzheimer's for example, we do not get into deep sleep as much, that goes hand in hand. I think that perpetuates the problem, so then you're not really doing the housekeeping that you need to do to keep your brain healthy. It's a very important thing to be able to sleep and get adequate amounts of deep sleep and REM.

Dr. Robert Rountree

Is the poor sleep a consequence of Alzheimer's or is it the other way around, or is it both?

Dr. Mary Kay Ross

It's a great question. It's sort of like which came first, the chicken or the egg? I think that it's probably both, because I think definitely if you develop Alzheimer's, you are not able to sleep as well, but as you age, you're not able to sleep as well. Unfortunately, I think most people, unless they are a biohacker and [inaudible 00:05:06] medicine, you might not look at that until it is a problem. Do you what I'm saying?

Dr. Robert Rountree

Mm-hmm, mm-hmm.

Dr. Mary Kay Ross

I think that is probably true for most people. Most of my patients, when they come to me, they've never really done a lot of thought about sleep, and we work on that, actively work on it. It's a big part of what I do.

Dr. Robert Rountree

Dr. Matthew Walker, I mentioned, probably one of the world's experts on sleep. He says it's a society-wide problem because you have a lot of people that believe that sleep is irrelevant, that it's all about productivity. A lot of people really do believe that sleep is not important, and so they work as late as they can and they get up as early as they can and they brag about not getting enough sleep. Why is that such a bad thing?

Dr. Mary Kay Ross

Well, like I said, sleep is huge. We need sleep for a chance for autophagy to occur.

Dr. Robert Rountree

What's that?

Dr. Mary Kay Ross

That is when our cells clean house, if you will.

Dr. Robert Rountree

The garbage disposal.

Dr. Mary Kay Ross

The garbage disposal. It's like the housekeeping comes out and starts sweeping away all of the debris and cleaning things up, and that's critical. But sleep is where we can create memories, sleep is so important for metabolic functions. People that don't sleep are much more at risk for cardiovascular disease, hypertension. Then the other thing to make sure that people know is where they stand, do you have sleep apnea is another thing, because that also puts you a huge risk for Alzheimer's disease and sudden death. It's one of those things where people may not realize that they're not sleeping well and that they're having apneic events, and therefore you go through this period where you have daytime somnolence and other problems.

Dr. Robert Rountree

Maybe this is time for a public service announcement. How would you know if you had sleep apnea? What kind of symptoms would you have? Or what would a spouse or the person who's sleeping nearby, what kind of things would they report that raise red flags so a person would think they're having sleep apnea? What does it look like?

Dr. Mary Kay Ross

When you have sleep apnea, oftentimes people will, like I said, they'll have daytime somnolence. Okay?

Dr. Robert Rountree

They're tired all the time.

Dr. Mary Kay Ross

[inaudible 00:07:39] day, you wake up in the morning and I'm not rested. Their spouse may say you snore during the night, you have episodes where you stop breathing. Obviously, if you are that person, you may not recognize that. Although, many patients will say, "I wake myself up, I'm snoring and all of a sudden I gasp and I wake myself up." That is certainly something that needs to be evaluated. You need a sleep study. During COVID, well, really prior to COVID, but there's ways to do it at home and there's ways to do it in a sleep environment, through a sleep specialist, but it's certainly something that is easy to do that I would highly recommend if there's any concerns about it, because when you don't sleep well, first of all, it can affect your cortisol, which can affect your blood sugar and can affect blood pressure and all kinds of problems. It's this vicious cycle. If you have sleep apnea, you are much higher risk, and I don't remember the exact percentage, for sudden death. So many things, right?

Dr. Robert Rountree

Right.

Dr. Mary Kay Ross

That is a key right there. I've done a lot of work over the last probably three years with dentists, because this is a big concern that we all need to address.

Dr. Robert Rountree

Just to reiterate, if there's certain medical problems that might make a doctor think sleep apnea, and if you're a person who's experiencing those problems, you might think of it. Even if you're not necessarily tired and you don't know if you snore, but if you've got high blood pressure.

Dr. Mary Kay Ross

That's right.

Dr. Robert Rountree

If you've got high blood sugar that doesn't seem to be coming under control even with a good diet, if you can't seem to lose weight and you're not sure why, then again, you might think about sleep apnea. It doesn't have to just show up with snoring, tossing and turning, that sort of thing.

Dr. Mary Kay Ross

No, but those are the things that a spouse might see in the middle of the night.

Dr. Robert Rountree

Yeah. Yeah, the spouse would know that, but maybe if a person lives alone and then they find out they've got high blood pressure, then you have to ask, well, are there any other factors that could be raising the blood pressure?

Dr. Mary Kay Ross

That's right. A really simple way to start looking at that, possibly doing a nocturnal pulse oxymetry.

Dr. Robert Rountree

Yep, yep.

Dr. Mary Kay Ross

Very simple.

Dr. Robert Rountree

Now, I love the fact that a lot of this testing is available to a person without seeing a doctor. Nothing against doctors, but nowadays people are finding that it takes months to get in to see a doctor. If they want to see a sleep specialist, it can take them even longer, six month wait to see a sleep specialist. You can go on the internet and you can order an oximeter, a little thing that clips on your finger and tells you your oxygen. There are some of them will measure your oxygen all night long. You can do a very crude version of what you might get by working with a dedicated facility.

I recommend this all the time to people who say, "Well, I don't really have the time for sleep study. What do I do?" Well, now you can always start with one of these oximeters that you just clip on your finger and you get a readout. You look on your phone in the morning and it tells you if your oxygen is dropping during the night. There's no reason that that shouldn't be accessible to anybody. There are also companies that have a disposable home sleep study, there's a company called Itamar. We've worked with them in the past, they're a legitimate company. I found it really interesting, you get the equipment from them in the mail. I don't think that's who the provider is, but if you do a search for home sleep study, they send you the equipment, you wear it for a night, the data gets uploaded, gets sent back to them, and then they can say, "Well, you look okay," or, "Hey, you are one of the people that really need a formal sleep study."

Dr. Mary Kay Ross

That's right, and they'll have a sleep specialist actually read it. Then you can even go a step further and do the test at home, the complete test, and actually have a CPAP recommended for you.

Dr. Robert Rountree

If you need that.

Dr. Mary Kay Ross

If you need that, that's what I'm saying. In other words, that full circle, you can do the whole thing at home if need be. Certainly, I think that's of great value for people, to be able to do that.

Dr. Robert Rountree

That's one type of sleep disorder, which is a problem where the person stops breathing, their oxygen level drops. What about other kinds of sleep problems? What's the value of doing hormone testing to see what's causing those sleep problems?

Dr. Mary Kay Ross

Certainly, you can have insomnia, you could have the other extreme and have narcolepsy, but insomnia is probably more pertinent to what we're talking about. There's plenty of people with that. Looking at their melatonin level, looking at their cortisol level is huge, especially when I'm talking about brain health, which is just something I can't get away from. Cortisol is really toxic to your hippocampus if it's high all the time, it's not good for you.

It's our stress hormone and it's meant to go up in times of stress. If you see a horrible thing happen in front of you, a car accident, you're going to have a surge of cortisol, but you shouldn't walk around and live and sleep in high levels of cortisol all the time. It's going to affect your blood sugar, it's going to affect your weight, it's going to affect your blood pressure, it's going to affect so many things. That is what someone with insomnia deals with. To be honest with you, when I worked in the emergency room for many, many years, I didn't think sleep was so important. I always didn't want to miss the day, but I was at work at night. I had a cortisol problem, a big one. It's something to think about.

Those are things that we look at. We have a stress test that we look at. It looks at your melatonin levels, which is a hormone, which actually often people use it for jet lag and for sleep. Then we also look at the cortisol. When we look at the cortisol, there's a curve that is very well known. You look at the cortisol at four different times during the day. First thing in the morning really is when our cortisol should be at its highest. When you go to bed at night, you need just enough cortisol and not too much, it's that Goldilocks thing. It's really important to know your curve and understand it, but also, I think people, we all need to step back and look at how do we prepare for sleep. I think that it's really important.

Dr. Robert Rountree

Yeah. That makes me laugh because, yeah, I know what you're talking about, unwinding.

Dr. Mary Kay Ross

Yes. You have to really practice sleep hygiene, you have to really think about it, because if you don't, before you know it, you'll look at the clock and go, "Oh, it's 10:00," and you'll stop, turn off your computer and your TV and unwind. There's no time now, you know what I'm saying?

Dr. Robert Rountree

No transition.

Dr. Mary Kay Ross

That's exactly right. It needs to start earlier in the evening. We need to eat earlier, we need to wind down, especially for somebody that has trouble sleeping. There's a whole way to think about this. Your bedroom should be your refuge, it should be a haven. You don't want to walk in and have laundry sitting everywhere and the TV blaring, you shouldn't have a TV in your bedroom. These are things that we all make our habits and we need to really do it differently, we have to relearn it.

Dr. Robert Rountree

I think that's something, again, that Dr. Walker talks about a lot, is that we have built in transitions in our society. He really rails on the school system for making kids get up so early, because he says that it's just not how the teenage brain works or the adolescent brain. It doesn't work if you've got to get up at 5:00 in the morning and start school at 7:30, it's just not good for the teen brain. They need to sleep in, and they're not lazy because they want to sleep in, they need the transition time.

I think we've got evidence from cortisol studies, which are ... I should say, we talk about doing cortisol, which you can measure in spit and urine, those are very well-accepted in the medical community. These are not fringe tests, there's nothing way out there about them. This is in the medical literature, that doing this kind of testing is totally valuable and means something.

You're saying we've got what should be a normal curve, where it goes up in the morning and then gradually comes down and lowest at night. What do you do if you do that test and your levels are high all day, or maybe they're slow to get started and then they spike up and stay up, what do you do?

Dr. Mary Kay Ross

I think that's a really good question, because in my mind, the way that you address cortisone ... As I said, I am that person, my curve was above the entire graph all day and night.

Dr. Robert Rountree

Off the chart.

Dr. Mary Kay Ross

It was off the chart. What does that mean? That means that your adrenal glands are making cortisol, but they also make epinephrine and norepinephrine. It's a very supercharged fight-or-flight thing. In order to change it takes a lot of effort, you're going to have to rewire the way you approach things. You're going have to practice some mindfulness, you're going to take adaptogenic herbs. We have Phytisone here, and that's something that I use for my patients.

Then there's the other side of cortisol, that it can be too low. Sometimes people that have really high cortisols will go through a period and then they just bottom out. Then what happens there? Those are people that get up in the morning, they have no energy, they have nothing left. With those patients, again, it's the same thing, it really does come down to looking into turning over all the stones, so to speak. If you're sleeping and having sleep apnea or other things that are bothering this, you need to look at it, you need to do that evaluation. But I think that mindfulness is a huge factor in managing cortisol.

Dr. Robert Rountree

Now, I have to say, one supplement that I've had some success with is phosphatidylserine.

Dr. Mary Kay Ross

Yes.

Dr. Robert Rountree

Right? Sounds like an esoteric kind of thing. I think Thorne calls it Iso-Phos.

Dr. Mary Kay Ross

Iso-Phos.

Dr. Robert Rountree

Iso-Phos.

Dr. Mary Kay Ross

Yep.

Dr. Robert Rountree

There actually is published research showing that it can lower cortisol.

Dr. Mary Kay Ross

Yep.

Dr. Robert Rountree

For that patient whose sleep study shows that their cortisol is spiking at night, which is of course going to keep you from sleeping, I tell them to take one to 300 milligrams of the Iso-Phos several hours before sleep. It's not the kind of thing where you get in bed and you go, "Oh, maybe I'll take this now and it'll help me," you've got to start planning, just like with melatonin, if you're going to take melatonin to help you sleep, it needs to be an hour before you get in bed.

Dr. Mary Kay Ross

An hour before you go to bed, absolutely. Well, I am not a big fan of people taking pills as soon as they get in bed. Anything that you're taking for bedtime should be at least an hour before bed.

What do you do for any kind of mindfulness, if people can't sleep at night and they're laying there? I have my recommendations, I truly do use mindfulness as well when they're in bed, I recommend you don't get up and go get on your TV or your computer. It's a rewiring, in some way, of yourself.

Dr. Robert Rountree

Well, I can tell you what helps me, and this is just personal preference, is listening to certain kinds of almost monotonous music, like Tibetan bells or that kind of thing. There are apps that'll do that. I have an Oura ring that I use for tracking my sleep and it's actually got some built in soundscapes that you can use. You can set it for 20 minutes and then it goes off. I love listening to that sort of thing. I find it very soothing and healing. Now, other people like listening to someone who's gently talking, you're feeling very calm.

Dr. Mary Kay Ross

Bedtime story.

Dr. Robert Rountree

Yeah, bedtime story. There are a number of apps, like the Calm app, on the phone.

Dr. Mary Kay Ross

I have it, yes.

Dr. Robert Rountree

You've got that one.

Dr. Mary Kay Ross

I do.

Dr. Robert Rountree

Yeah, so I do tend to recommend those kind of things for people who can't do it on their own. There is something about having this external sound or an external person talking that might be a little different than just quietly laying there and hoping that you'll get there on your own with mindfulness techniques.

Dr. Mary Kay Ross

Oh yeah. When I say mindfulness though, to me, honestly, that's not necessarily what you need to do at one in the morning when you can't sleep.

Dr. Robert Rountree

Yeah.

Dr. Mary Kay Ross

But I think thinking about it during the day and figuring out some sort of a way to work on breathing techniques and ways to manage stress better might be helpful. I definitely use the Oura ring for every one of my patients. I have Oura ring data on everybody, I think it's really interesting. Then it helps me, and I have a coach that works with me, to look at that data and figure out what are we doing, how can we help you get more deep sleep or more REM, and I think that's really a helpful approach as well.

I like listening to the bedtime stories when I can't sleep. I love the soft voice and the calming effect that it has.

Dr. Robert Rountree

Yeah, I am a big fan of mindfulness. I do mindfulness exercises every single day, focus on breathing, box breathing, all that stuff is helpful, but I do find that I've got to do that in the daytime.

Dr. Mary Kay Ross

Yeah, absolutely.

Dr. Robert Rountree

If I'm laying in bed and I can't fall asleep, it's too late for me. I've got to listen to something.

Dr. Mary Kay Ross

I do too.

Dr. Robert Rountree

I've got to hear something.

I think we need to take a break right now. When we come back we'll answer some questions from our listeners that will go into these issues in a little bit more detail.

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We're back. Now it's time to answer some questions from the community. Our first question this week comes from a listener who asks, "What is the difference between a sleep test like the one that Thorne does and a sleep study like the one that you mentioned?"

Dr. Mary Kay Ross

The difference is this. The sleep test that we have at Thorne is really looking at your melatonin level and it's also looking at your cortisol levels. It's looking at that whole cortisol curve four different times during the day. That is completely different than the sleep study, that it's really looking at how you're doing during the different stages of sleep and what your oxygenation level is. It's completely different. The other thing that we want to know also during the night is our blood pressure. We should be dippers. These are other more medical studies, if you will, when you do a sleep study that you're looking at, versus the response that your body is having, so cortisol is your stress hormone and how your cortisol is doing during the day, which definitely impacts your sleep.

Dr. Robert Rountree

The two are perfect compliments, right? Because they're giving you information that is all going to fit together into one big picture of exactly what's going on. Right?

Dr. Mary Kay Ross

That's right.

Dr. Robert Rountree

The sleep study, I say that's kind of a mechanical thing, like do you stop breathing?

Dr. Mary Kay Ross

That's right.

Dr. Robert Rountree

Does your oxygen drop? The sleep test is what's happening with your hormones, what's happening with your adrenal glands, what's happening with your pituitary, how are all those things influencing.

Dr. Mary Kay Ross

That's right.

Dr. Robert Rountree

The two are just really the perfect compliment. I would say anybody that has trouble with sleep, daytime tiredness, the things that we talked about, they may easily want to do both of these.

Dr. Mary Kay Ross

Yep.

Dr. Robert Rountree

If a person has sleep apnea, the next question is, "Can I fix sleep apnea on my own with diet or supplements?"

Dr. Mary Kay Ross

That's a great question. Honestly, I think not. I don't think that you can fix it with diet or supplements, with the caveat that if you are that person that is very heavy, certainly that can affect sleep apnea risk as well, but there are plenty of people that are very thin and have sleep apnea. With those people, you certainly cannot fix it with diet or supplements.

Dr. Robert Rountree

Yeah, I have to agree, that at least at this stage, it's not a problem that is a biochemical one, shall we say. If it was a simple biochemical problem ... Regular insomnia, difficulty falling asleep, staying asleep, without sleep apnea, is more of a hormonal, biochemical problem. Sleep apnea is a different beast entirely. I haven't found a lot of supplements that help. I have found certain mechanical things that will help, like sometimes acupuncture can be helpful. There's some new techniques that dentists are working on, there's like appliances that people can wear that hold their mouth open, hold their jaw open. There are other options besides CPAP.

Dr. Mary Kay Ross

Oh, yes.

Dr. Robert Rountree

I bring that up because people go, "Oh my god, CPAP, it's noisy, it's expensive, it's a hassle. Is that my only option?" It's not your only option.

Dr. Mary Kay Ross

No, the dental appliance is definitely an option. There's surgery, which is not always my favorite, but that's an option. There are things that you can do. Certainly, losing weight would be one of them as well.

Dr. Robert Rountree

There's this device that gets implanted in your neck that stimulates your vagus nerve. I think it's called Inspire or something like that. It's getting to be really big right now. I ask the question, well, if stimulating the vagus nerve during the night, if that helps sleep apnea, what about some of these techniques that the TCM practitioners use that stimulate the vagus nerve through the ear, like these little beads that you wear in your ear? I think it's something worth exploring.

Dr. Mary Kay Ross

Yeah. No, that's really interesting, yeah,

Dr. Robert Rountree

I'm totally intrigued by vagus nerve stimulators, but maybe not necessarily the implantable ones, which is-

Dr. Mary Kay Ross

The implantable ones?

Dr. Robert Rountree

Yeah, for somebody that's really in bad shape, maybe. Are afternoon naps a good idea or do we not recommend them?

Dr. Mary Kay Ross

I don't have a problem with afternoon naps. I am not a nap person, but afternoon naps can be refreshing for people.

Dr. Robert Rountree

I love naps, okay, I have to say, because if I have a day when I'm seeing patients all day, it can be really stressful in my brain to make a lot of decisions that have a big impact on a person's life. I think, well, if I make the wrong recommendation, the consequences could potentially be harmful. I'm sure that drives my cortisol. Hours and hours of doing that, all I can think about is I need a 15-minute nap. I think the main caveats that we get from hearing Matthew Walker speak is you don't want the nap to be too long.

Dr. Mary Kay Ross

That's right.

Dr. Robert Rountree

15 minutes is probably long enough, 20 minutes, you don't probably want to do an hour, hour and a half, and you don't want it to be too late in the day. When it gets to be 4:30, 5:00, then it's a little riskier because then your brain's going, "Wait a minute, I'm losing my sleep signal."

Dr. Mary Kay Ross

That's right.

Dr. Robert Rountree

Your sleep signal is a chemical, I think it's adenosine, am I right?

Dr. Mary Kay Ross

Yep.

Dr. Robert Rountree

That you get a build up of this chemical called adenosine, and adenosine gives you what Dr. Walker calls sleep pressure. Sleep pressure is the signal that says, "Time to go to bed now." If you take that nap too late in the day, you lose the sleep pressure. That's the only downside, is if you take the nap too late in the day.

Dr. Mary Kay Ross

Totally agree. No, I think it has to be a midday nap. I can do a 10 minute if I do and just feel completely recharged. There are some people that when they lay down, they can't wake back up again. For those people, probably not a good idea to do at all.

Dr. Robert Rountree

Not a good idea.

Dr. Mary Kay Ross

Nope.

Dr. Robert Rountree

This person asked, "Why am I exhausted during the day, but then I can't fall asleep at night." Tired, but wired, they call it. Yep, it's a term I hear all the time. It makes no sense to me. Why am I tired, but then I can't fall asleep and then I'm wired all day? Have you ever heard that before, heard that complaint?

Dr. Mary Kay Ross

Absolutely, absolutely.

Dr. Robert Rountree

Yeah.

Dr. Mary Kay Ross

It's really an interesting thing. The person is exhausted and then they go to bed and they can't go to sleep. They toss, they turn, they get up and they can't sleep at night. This is completely related to cortisol. One of the things I think is really interesting for people to know is that when your lights come on, let's say you get up in the middle of the night and you turn the light on, you're changing really your cortisol and your melatonin, your circadian rhythm gets messed up. This could be just a huge cortisol problem, and it also could be also melatonin, because the less time you spend in the dark sleeping, the less you're going to have. This is a perfect person really for the sleep test, perfect person. Then it's easy to make recommendations on things that they can do, if you know more about what they're doing, that could really make a difference.

Dr. Robert Rountree

I have to confess, I had this problem and I got an Oura ring, and the Oura ring told me that even though I was in bed for eight hours, I wasn't getting eight hours of sleep. That was, to me, the single biggest aha from the Oura ring, is that just because of my lifestyle and how much I'm going, I wasn't allowing enough transition time. If I was going to get the minimum recommended number of hours of sleep, seven plus hours, which is how much I'd need to get an adequate amount of both the deep sleep and REM, I needed to be in bed for over eight hours. Right?

Dr. Mary Kay Ross

Right.

Dr. Robert Rountree

That was a big aha for me, is even though I was in bed and I would say I seem to be getting sleep, I really wasn't getting enough sleep. I think a lot of people, having trouble on top of that just unwinding, they're basically not experiencing good circadian rhythms.

I think the normal thing is you've got this up and down and in that circadian rhythm you need to have well over an hour of deep sleep, well over an hour of REM. When you get out of that, then the body just goes into full cortisol mode all the time. There's no longer an up and down, it's just on all the time, until you reset that by bringing in the transition time that we've been talking about, the unwinding, the mindfulness, allowing extra time in bed and just going, "Okay, maybe it's going to take me an hour to fall asleep." When I started doing that for myself, okay, it may take me a while to fall asleep and I accept that, but if I lay in bed for 10 minutes, I'm not asleep, what's the problem? Oh my God, why can't I sleep? It's been 10 minutes, I'm not asleep. Oh my God, what should I do? Should I listen to music? Maybe I need to go work out?

Dr. Mary Kay Ross

That's what happens, is people-

Dr. Robert Rountree

What happened?

Dr. Mary Kay Ross

Yeah. I don't think people put all of that together, Bob. Then what happens is they get up and they may go get on a computer. Some people think, "Oh, I should get out of bed if I can't sleep, so I'm going to go out here and do this." Really, that's detrimental to ever getting sleep. I think of sleep as something that we are all so busy all during the day and we get home and then you've got to cook dinner and you've got to do this, you've got to do that, and you're doing laundry and you're rushing around getting ready for tomorrow, and sleep is an afterthought. Suddenly, now I'm going to bed and it's like, "Oh, it's time to go to bed, but now I can't go to sleep." Well, if you had gone home and thought, "You know what? I've been having trouble sleeping. I'm going to put this effort forward," I think it makes a big difference. I'm a huge believer in that unwind time and the transitions. There's lots of things you can do to make it better.

Dr. Robert Rountree

Yeah, maybe if you've got access to a hot tub or even just putting some warm water in your regular bathtub and soaking in there, putting a little lavender, there's evidence that lavender really helps the body unwind, I recommended that, listening to quiet music. But we've got to allow the transition time.

Dr. Mary Kay Ross

That's right.

Dr. Robert Rountree

We've got to do that.

Dr. Mary Kay Ross

Yeah.

Dr. Robert Rountree

What's the difference between melatonin and serotonin, and which one is better for sleep?

Dr. Mary Kay Ross

Well, melatonin helps us sleep and serotonin helps us wake up. Melatonin is what we want to take for sleep, melatonin is our sleep hormone. A lot of people use it when they're coming from Europe and trying to get through the jet lag. It helps you sleep, and so you would definitely use melatonin. Serotonin is what we use, really, serotonin reuptake inhibitors are used for antidepressants, it's a pickup. It's not going to help you sleep.

Dr. Robert Rountree

Melatonin is really just the signal that says it's time to go to sleep, but taking melatonin doesn't knock you out.

Dr. Mary Kay Ross

No.

Dr. Robert Rountree

And it doesn't maintain sleep.

Dr. Mary Kay Ross

No.

Dr. Robert Rountree

Here's the thing that has never been quite clear to me. When a person takes a drug like Prozac or Zoloft or Paxil, which raises serotonin in the brain, at least that's what we think they do, when they start taking that, it's not uncommon for them to say, "I can't sleep." That fits with what you're saying, okay, you're raising serotonin in the brain, you can't sleep. Yet on the other hand, tryptophan and 5-hydroxytryptamine are used as sleeping aids. How does that work? There must be some other signal that's going on. I've wondered about this for years. I have taken 5-HTP at night-

Dr. Mary Kay Ross

I have too.

... and it does help me sleep. I wonder if it's doing more than just raising serotonin or if it's the drugs are raising serotonin in a different place.

Dr. Mary Kay Ross

It's a really good question, and I don't know that I have the definite answer, but it seems to me that it's a different place. It is blocking-

Dr. Robert Rountree

Different place in the brain.

Dr. Mary Kay Ross

Yes, that would make sense to me. But you're right, it's interesting.

Dr. Robert Rountree

It's almost a paradoxical thing, but again, I usually tell people, if you're on Prozac or something, take it in the morning, don't take it at night.

Dr. Mary Kay Ross

Don't take it at night, you're absolutely right.

Dr. Robert Rountree

Don't take it at night, yeah. Melatonin is the sleep signal, I think that's the critical thing. 5-HTP, we're not exactly sure what it does, but there's pretty good data on it helping sleep.

Dr. Mary Kay Ross

Mm-hmm.

Dr. Robert Rountree

What's the difference between a sleeping pill and melatonin? Then part of that is can you overdose on melatonin?

Dr. Mary Kay Ross

I think it's funny, sometimes the more you know, the less you know, if that makes sense. I'm thinking of a sleep specialist that I had come and talk to my patients. She's completely against melatonin.

Dr. Robert Rountree

Against it?

Dr. Mary Kay Ross

Against it, taking it, because she feels that we should have such a balance. But I really feel like melatonin is safe. I take melatonin and it does help me. Sleeping pills, honestly, aren't really helping any of the problems, I'm taking that messenger to get to sleep, but sleeping pills are something you can definitely overdose on. I don't feel that they're safe, I think some of them can actually, and Dale feels, Dale Bredesen, that some of them can actually be more of a dementogen, especially if you take over the counter sleeping aids as well, diphenhydramine, which is Benadryl. Excuse me. I think melatonin is much safer than taking sleeping pills and I think that it has a wide range. You could certainly argue that you shouldn't take too much melatonin. Most people it's around a three milligram, three to five milligrams. Yet, if you did take more, I don't think that it's as dangerous, it doesn't have the danger. Does that make sense?

Dr. Robert Rountree

Melatonin is basically working on entirely different pathways in the brain.

Dr. Mary Kay Ross

Oh yeah, absolutely.

Dr. Robert Rountree

Yeah, all the melatonin is doing is telling the body that-

Dr. Mary Kay Ross

Your signal.

Dr. Robert Rountree

Yeah, it's time to go to sleep, it's nighttime, because melatonin normally goes up when it's nighttime in people that live in a natural environment, not a computer-driven environment.

Dr. Mary Kay Ross

Where it's dark.

Dr. Robert Rountree

If you live out in the woods, it gets dark in the winter, it's getting dark 7:00, 6:00, so your brain starts making more melatonin, getting you ready for sleep. In our artificial environment, that's all screwed up. That's part of the reason for doing a sleep study, is to find out what's happening with your melatonin. Taking melatonin, I think, helps correct the abnormal circadian rhythms induced by our society.

Can you overdose on it? Well, there was an article in the news about a month ago about melatonin poisoning. I read that and I thought, "This is crazy." They didn't make a case for melatonin poisoning. If you ate the whole bottle of melatonin capsules, you might not feel well, but there's no evidence that I know of anyone that's been seriously harmed by taking excessive amounts. You wouldn't feel well, but it's not taking a bottle of Valium.

Dr. Mary Kay Ross

Oh, no, no, no.

Dr. Robert Rountree

It's not going to cause liver failure or any other things that we associate with poisoning. Yeah, you don't want to take the whole bottle. The paradox of melatonin is that for sleep, less is more, if you're using it for sleep. If three to five milligrams isn't working for sleep, then 10 isn't necessarily going to work better. In fact, sometimes less will work better, sometimes a milligram is all you need for that sleep signal.

Dr. Mary Kay Ross

Right, right. No, that's true, that's true.

Dr. Robert Rountree

Now then the last question, "I regularly wake up in the middle of the night wide awake and then I have trouble falling asleep again. Is there anything I can do to stop waking up?"

Dr. Mary Kay Ross

This is a big problem. I've had this problem, where you wake up-

Dr. Robert Rountree

Yeah, the 3:00 AM.

Dr. Mary Kay Ross

3:00 AM. I'm like, "What is going on with this 3:00 AM thing?" I do find that I can go back to sleep, but it can be difficult. Seems to me there's lots of things that you can do. You can certainly switch over and listen to calming music, you can certainly do the Calm thing with listening to a story, but you can also try taking a time-release melatonin, which can help as well and act a little bit longer.

You also need to look at why you're waking up, some people wake up to go to the bathroom and they drink a lot of liquid right before they go to bed. There's just different reasons, and you need to really give sleep a thought as to why these behaviors are happening. Then if there's no answer, then I definitely don't recommend getting out of bed and turning the lights on and getting up, because really and truly, that makes the problem worse. Lights are very bad for your cortisone, your melatonin.

I like the idea of the time release melatonin. I like L-theanine for sleep. Magnesium is great, magnesium, helps with sleep tremendously. These are all things that people can look at and find their individual way to help with their sleep problems.

Dr. Robert Rountree

Those are excellent ideas. I also find that when somebody's waking up in the middle of the night, it's often because something is bubbling up from the unconscious. Even in a person who says, "I'm not thinking about anything." First question I ask is, "What thoughts are running through your mind when you wake up?" A lot of times they say, "Nothing. I'm just hearing the furnace blowing or listening to my spouse breathing. I'm not thinking anything," but I can almost guarantee you that your unconscious mind is processing something. The first question I ask is, "What's unresolved that your unconscious mind is chewing on like a bone?" Because for some reason when you get into that really deep sleep, that's when that bubbles up and then wakes you up. All is, well, I feel unsettled, but I don't know why. You have to ask yourself the question, why, why is my brain processing this?

Then the second thing for stuff to do, often I will tell people, just keep some melatonin by your bedside. The minute you wake up, you want to take a small amount of melatonin with a little bit of water. Often that's enough of a signal to the brain that says, "Okay, go back to sleep."

Dr. Mary Kay Ross

Go back to sleep, sure. That's a great idea.

Dr. Robert Rountree

Go back to sleep.

The other thing I really like that I do when this happens to me is I take PharmaGABA. I don't know how that stuff works, but I love it. I can take two capsules, or sometimes more, of the 250 milligrams. I don't see any ill effects from it and it can work like a charm. It's one last little tidbit I'd recommend to people.

Dr. Mary Kay Ross

Yeah, that's interesting. I have patients that love it. I can't take it, I get a headache when I take GABA. It's crazy, but I guess we're all such individuals.

Dr. Robert Rountree

Biochemical individuals.

Dr. Mary Kay Ross

That's it.

Dr. Robert Rountree

All right, folks, that's all the time we have this week. Dr. Ross, thanks again for coming back on the podcast. I always ask this, but if people want to know more about what you're up to, how do they follow you, and especially the new brain health program that's evolving, how can they find out about that?

Dr. Mary Kay Ross

Well, Bob, certainly I'm at Thorne and they can always go to our Thorne website. We have Take 5 dailies, which give information about topics that we're doing actively, and certainly I'll be on the podcast, but we have a brain program that is being created direct to consumer for people that are concerned about cognition. Lots of people out there, for instance, people that have parents that have had Alzheimer's disease or family members, or people that are worried and they know their APOE status, whatever the problem may be, we are creating a program that is easy, simple, that can be done in the home, privacy of your own home, and we'll support you. But you don't have to go to a doctor and it's something that will help you identify your risks and mitigate them.

Dr. Robert Rountree

Terrific. Everybody stay tuned for that, I think some very exciting things are going to be unveiled in the near future. Great. That was Thorne's Chief Medical Officer, Dr. Mary Kay Ross, talking to us about the importance of sleep. As always, thank you everyone for listening, and we hope you'll tune in next time.

Thanks for listening to the Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice. If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @ThorneHealth. You can also learn more about the topics we discussed by visiting Thorne.com and checking out the latest news videos and stories on Thorne's Take 5 Daily blog. Once again, thanks for tuning in and don't forget to join us next time for another episode of the Thorne Podcast.