Dr. Ruscio and Susan delve deep into the topic of sleep in this episode of Dr. Ruscio Radio. Too much sleep might be as detrimental as too little sleep.
If need help improving your sleep, click here.
Dr. R’s Fast Facts
- The three most important factors associated with sleep are; duration, intensity and timing – meaning how long, how well and how consistent.
- For optimum sleep it’s important that you:
- Consistently sleep between 6 or 7 to 9 hours; sleeping more or less has been linked with ill health
- Sleep soundly
- Sleep and wake at roughly the same time; ideally going to bed around 10
- Poor sleep has been associated with cardiovascular disease, weight gain, obesity, diabetes and many other health conditions.
- If you find you consistently need more than 9 hours of sleep or can’t stay asleep for 7 hours – you should investigate an underlying illness or imbalance.
- Tips and strategies for optimum sleep:
- Light will impede melatonin secretion. Dimming lights, blue light filter, and amber glasses can all help with melatonin production.
- Temperature – cool
- Noise – quiet
- Non-stressful pre-bed activities
- Strive to be in bed by 10 or 11 and then sleep 7 to 9 hours, but remember if you constantly can’t get 7 or need more than 9 something might be off.
- If you are having sleep problems investigate:
- Hormonal imbalances; female hormones and adrenal hormones
- Female: herbal and adrenal support
- Adrenal: adrenal support, frequent meals and having a snack before bed
- Inflammatory or digestive issues
- Sleep disruptions can negatively alter the microbiota of humans
Too little and too much sleep show increased disease risk…..5:02
3 main components of sleep…..7:07
The research on sleep and disease…..12:46
Sleep – gut connection…..21:00
Sleep and the microbiota…..25:30
(13:04) Sleep and your heart:
Two different systemic reviews with meta-analyses have shown both long and short sleep duration associated with high blood pressure. http://www.ncbi.nlm.nih.gov/pubmed/23394772 / http://www.ncbi.nlm.nih.gov/pubmed/22763475
And two other SR with MA have found short or long sleep during associated with increased cardiovascular disease.
http://www.ncbi.nlm.nih.gov/pubmed/21300732 / http://www.ncbi.nlm.nih.gov/pubmed/26422535
(13:22) But remember it’s not just about the length or sleep aka duration. The quality is also important. Accordingly is has been shown poor sleep quality worsens hypertension.
(13:37) Here are a few additional fun facts exemplifying how poor sleep is bad for your heart and cardiovascular system:
- Moderate sleep restriction causes artery endothelial (blood vessel lining) dysfunction http://www.ncbi.nlm.nih.gov/pubmed/25424573
- Snoring is associated with increased risk of heart attack. Inadequate sleep also associated with increased risk of heart attack. http://www.ncbi.nlm.nih.gov/pubmed/24885282
- Insomnia increases your risk of cardiovascular disease. http://www.ncbi.nlm.nih.gov/pubmed/25424370
- Untreated sleep apnea increases chance of death and cardiovascular disease http://www.ncbi.nlm.nih.gov/pubmed/25409880
- Poor sleep has a negative effect on lipoproteins http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1035115/
(14:29) Sleep weight and metabolism
- A meta-analysis has shown short and long sleep associated with increased type 2 diabetes http://www.ncbi.nlm.nih.gov/pubmed/25715415
- A SR with MA has shown short or long sleep duration associated with increase risk of metabolic syndrome http://www.ncbi.nlm.nih.gov/pubmed/23890470
- A SR with MA showing short sleep duration associated with obesity in children http://www.ncbi.nlm.nih.gov/pubmed/25589359
- Sleeping less leads to increased sugary food intake http://www.ncbi.nlm.nih.gov/pubmed/25251317
- Sleep deprivation may increase fat mass http://www.ncbi.nlm.nih.gov/pubmed/23102177
And while there has been some criticism that the sleep studies are not perfect:
http://www.ncbi.nlm.nih.gov/pubmed/18239586 / http://www.ncbi.nlm.nih.gov/pubmed/22633283
…it still appears there is a strong and incontrovertible trend in the data showing poor sleep associated with weight gain, obesity and metabolic syndrome.
(16:32) Also, again remember it’s not just about the sleep duration, the quality is important here also. Studies have shown that:
- Sleep disruption has negative impact on metabolic health (review paper – summarizes many other studies) http://www.ncbi.nlm.nih.gov/pubmed/24937041
- Poor sleep quality may contribute to obesity http://www.ncbi.nlm.nih.gov/pubmed/25517022
- Poor sleep quality found to be an independent risk factor for obesity – even after controlling for other factors, like exercise http://www.ncbi.nlm.nih.gov/pubmed/25653493
- Sleep disruption is a risk factor for metabolic syndrome http://www.ncbi.nlm.nih.gov/pubmed/24958893
(16:51) Sleep and your brain
Here are a few fun facts connecting sleep and your brain:
- Poor quality sleep means poorer cognitive performance http://www.ncbi.nlm.nih.gov/pubmed/25325465
- Poor sleep in children decrease psychological health and increase health complaints http://www.ncbi.nlm.nih.gov/pubmed/25319339
- Sleep helps repair, rewire and clean toxin in the brain http://www.ncbi.nlm.nih.gov/pubmed/26237917
- Improved sleep patterns helps with ADHD http://www.ncbi.nlm.nih.gov/pubmed/24957753
(17:53) Sleep and your immune system
At this point hopefully it’s becoming clear that poor sleep does not help anything. It is worth mentioning however sleep disorders increase risk the of autoimmune conditions
http://www.ncbi.nlm.nih.gov/pubmed/25669189 / http://www.ncbi.nlm.nih.gov/pubmed/22521311
The less sleep you get the higher the risk of catching a cold.
Sleeping on your stomach, with the aid of a special pillow and mattress, may improve sleep quality for those with sleep apnea.
(21:27) Sleep and your gut
It has been shown that digestive tract inflammation decreases sleep quality. http://www.ncbi.nlm.nih.gov/pubmed/25701321 Another study provides a great visual to help you see the connection between your gut and sleep. http://www.ncbi.nlm.nih.gov/pubmed/21162647
The Melatonin connection
It has also been shown that poor sleep leads to lower melatonin which then directly correlates to leaky gut http://www.ncbi.nlm.nih.gov/pubmed/25907689 Conversely, higher melatonin levels correlated with less leaky gut. http://www.ncbi.nlm.nih.gov/pubmed/26276972 So, as melatonin goes up, leaky gut appears to go down.
(26:18) Sleep and your microbiota
In 2014 a paper was published in the journal Cell.
Right click on link and ‘Save As’
Sleep – Is too Much Just as Bad as Not Enough
Welcome to Dr. Ruscio Radio, discussing the cutting edge in health, nutrition, and functional medicine. To make sure you’re up to date on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.
The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor.
Now, let’s head to the show!
Dr. Michael Ruscio: Hey, guys. Dr. Ruscio. I just want to give you your quick fast facts on this episode about sleep and all the fun stuff associated with it.
The three most important factors associated with sleep are duration, intensity, and timing, meaning how long, how well, and how consistent.
For optimum sleep, it’s important that you consistently sleep between 6 or 7 to 9 hours, meaning you don’t want to sleep less than 6 or 7 and you don’t want to consistently sleep more than 9, as we’ll elaborate on in this episode. If you’re consistently over 9 or below 6 or 7, that’s been linked to many diseases. More sleep may not be good for you, and there’s also a reason for that we expand upon in the episode.
It’s important that you sleep soundly while you do sleep and that you sleep and wake at roughly around the same time every night.
Poor sleep has been associated with cardiovascular disease, weight gain, obesity, diabetes, and many other health conditions, like neurological complications.
If you find you consistently need to sleep more than 9 hours or you consistently can’t get or stay asleep for 6 to 7 hours, then you should investigate the underlying cause. There may be an underlying illness or imbalance that’s driving that.
And some strategies for optimum sleep: Hygiene is very important. You want to make sure that you don’t have bright light, or use a light filter for blue light. You want to mind the temperature and make sure that your room is not too hot. You also want to make sure you have a quiet room and have a non-stressful pre-bed routine.
You should strive to be in bed by 10 or 11 and then sleep 7 to 9 hours, but again remember, if you can’t do that, there might be an underlying reason for why.
And a few underlying reasons for why might be hormonal imbalances, like female hormone imbalances or adrenal hormone imbalances, or inflammatory or digestive issues, and so you may want to investigate an underlying inflammatory issue in the gut or an infection or a different type of digestive disorder.
Also it has been documented that changes in sleep can negatively affect your microbiota, and when the stool of human subjects that have had their sleep disrupted is transplanted into mice, it causes weight gain and elevations in blood sugar.
That’s your fast facts, and now let’s jump into the show. Thanks.
DR: Hey, folks. Welcome to Dr. Ruscio Radio. I am with here with the lovely Susan McCauley. Hey, Susan, how are you?
Susan McCauley: I’m doing good. I’m wondering when fall when arrive in California. How about you?
DR: I know. I guess we can’t really complain, but we’re having a pretty drawn-out summer here. Poor us, right?
SM: I know. It was, like, 100 degrees here yesterday.
DR: Yeah, I know. I know.
SM: I’m in shorts and a tank top still. It’s like my uniform. I don’t really like the cold weather, so I’m OK with it.
DR: Yeah, well, I’m not complaining either.
SM: So what do we have on tap for today?
DR: Well, I’ve been trying to work my way around to a few of the listener questions that are still kind of in the queue, and I’ve been really kind of working double time, trying to finish up the eBook on the microbiota, which just keeps growing and growing, and I’m incredibly excited about it, as people have heard me say probably numerous times now. The section on sleep and sleep’s impact on the microbiota is a section I’m just finishing up writing, and I do something crazy when I write and just in general. I fact-check things.
SM: Ooo, that’s really great! A lot of people don’t.
DR: I know it sounds crazy. It’s a lot easier just to reiterate and regurgitate the standard narrative, but I like to fact-check things, and you learn a lot, of course, by doing that.
Too little and too much sleep show increased disease risk
DR: So in going through the section on sleep, one of the things that really struck me—and there’s a number of things I want to talk about, and I want to work our way down to sleep and its impact on the microbiota because there’s a few really fascinating things about that—but one of the things that really struck me and I wanted to make people aware of and kind of give my interpretation on was the fact that we have extremely high-level scientific data that shows consistently if you’re not sleeping enough, yes, that’s linked with numerous different diseases, but more interesting and more surprising to me was people that sleep 9 or more hours consistently show those same increased risks for different diseases.
SM: Wow. Over 9 hours or… consistently 9 hours.
DR: Consistently above 9 hours. The studies vary slightly in what they define as long sleep duration. So it’s long sleep duration in addition to short sleep duration that has been repeatedly shown to be linked with cardiovascular disease, all-cause mortality and morbidity, which means your overall chance of disease or death, metabolic syndrome, overweight, obesity, type 2 diabetes. Now, short-duration sleep usually is defined as less than 6 or 7 hours consistently, and long-duration sleep is usually defined as over 9 hours consistently.
This is probably a little bit surprising, right, Susan?
SM: Right. My recommendation has always been 8 to 9 hours of quality sleep. Sometimes I’ll say 7 to 9 hours. I really don’t like to give people that leeway of the 7 because if you give them the 7, then they take the 6!
SM: But for me personally because I have a really set schedule, I get between 8 and 9 hours. I don’t think I over get over 9 because I wake up and I’m awake. I don’t wake up with an alarm. But over 9 hours—that is really, really, really interesting, so tell me more.
DR: All right. Now, I want to give people my interpretation in terms of how I account for this in a moment, but I’m sure there are probably some people listening saying, “Well, there’s no way that’s true,” or “That flies in the face of what I’ve heard,” so let me first paint a couple of perspectives regarding sleep and then dive into some of the literature. This will definitely be a more reference-heavy episode.
3 main components of sleep
DR: There are maybe three or four main components of sleep, and Dan Pardi, when he was on the podcast, discussed this with us.
Duration is one, so how long you sleep. It’s fairly clear, at least from the wealth of published literature on this, that consistently less than 6 or 7 or consistently more than 9 is potentially equally problematic. We’ll come back to that in a moment.
There’s also consistency, meaning do you go to bed and wake up roughly at the same time every night? There’s less data on this, but certainly we do observe and we do see that if you interrupt someone’s sleep rhythm—for example, working night shift—that has a deleterious effect on health. I’ve spoken about that. Dan’s spoken about that. Robb Wolf has spoken about that. Probably nothing incredibly new there.
DR: And then there’s also intensity, essentially meaning how well you sleep. Are you wakeful? Are you waking up every hour? Are you waking up every 2 hours? Do you not sleep soundly? Intensity is the third piece, and that has also been shown to be important.
These are the main components to look at: duration, consistency, and intensity. And how I interpret the finding that sleeping consistently more than 9 hours is linked with poor health is this. My thinking… and this is my speculation. We don’t really have a robust clinical trial or mechanistic study to bear this out, but this is how I piece this together. If people are needing to consistently sleep more than 9 hours, there is probably some underlying illness or problem that is necessitating them to need to sleep that long. Now, they may have hypothyroid. They may have a chronic inflammatory problem. They may have diabetes. They may have inflammatory bowel disease. They may have a gut infection. They may have really bad adrenal fatigue. They may have blood sugar irregularity. There is a multitude of things that, in my opinion, can interfere with someone’s sleep intensity or their sleep quality, and that can manifest itself as someone needing to sleep longer.
A really simple example of this one could be someone who is overtly hypothyroid and they are always exhausted. Even if they sleep 10 hours, they’re still tired. There, there’s a disease present, and the disease or the illness or the imbalance is what’s driving the need to sleep more like that. That’s how I interpret this.
Then what does that mean, or what do you do with that information? If you feel like you need to sleep 10 hours, does that mean if you sleep 7 you’re going to be healthy?
DR: Probably not, right? What that means is that you need to look into and investigate why it is that you consistently need more than 9 hours of sleep.
SM: So we’re saying pretty much then that it’s a chicken-and-the-egg syndrome. The illness or the chronic problem came first. Then the need to sleep more came second.
SM: It’s not the fact that you slept longer that now you’re in ill health. The ill health first.
DR: Exactly. That’s how I am interpreting this, anyway.
SM: That makes sense.
DR: And I think the most prudent recommendation here would be to sleep however much your body needs, but then observe. If you’re consistently unable to sleep at least 6 or 7 hours or you’re consistently needing to sleep more than 9 hours, then there’s probably something wrong.
SM: Right, and you probably know what it is, too, I’m assuming. I know that when I need to sleep longer, it’s usually because I have the flu or I have a cold or something and my body just needs more rest. People probably know that they’re hypothyroid or have Hashimoto’s or any of the other things that you spoke of.
DR: Right. For the longer, and then also on the people not being able to sleep enough, one of the most common things that I see is gastrointestinal distress or inflammation or just to use a general term, some sort of gastrointestinal problem and/or an adrenal problem. If people have adrenal fatigue, they oftentimes will have hypoglycemia or what’s called nocturnal hypoglycemia, meaning that they will not be able to regulate their blood sugar during the night. And when your blood sugar dips at nighttime, one of the backup hormones to bring blood sugar up is actually adrenaline.
SM: Exactly, and you wake up with that kind of racing heart rate sometimes. That’s a really good symptom that that might be going on.
DR: Exactly, and I notice the same thing. When I am overly stressed, working too much, drinking too much caffeine, I will start to see I wake up an hour before my alarm would go off, knowing that I need to sleep more and feeling like my body needs more sleep, but I’m unable to get that full sleep in.
DR: Right. And also female hormone imbalances. Of course, if a woman is waking up with hot flushing or hot flashing, then that’s something else that we want to look at and look into.
Let me kind of just dive through some of these references because I think these are really noteworthy.
We have two systemic reviews with meta-analyses. Again, a systemic review looks at a number of different studies, tries to really review all the available literature—high-quality literature, that is—and then the meta-analysis is a robust statistical analysis of the findings, so this is very, very high-level scientific data.
The research on sleep and disease
DR: Two systemic reviews with meta-analyses have found that sleeping less than 7 hours or more than 9 hours is associated with an increased risk of disease or death. I’ll put the links in there (1)(2)
Additionally, we have two (1)(2) different systemic reviews with meta-analyses showing that the same sleep imbalance is associated with high blood pressure and yet another systemic review with meta-analysis showing that it’s associated with cardiovascular disease in general (1) (2).
And it’s also important that I should mention there’s another study showing that when your quality of sleep is interrupted or you have poor sleep quality, that’s also been correlated with hypertension (1).
And a few other factoids I’ve picked out of the literature: A moderate sleep restriction has been shown to cause what’s known as endothelial dysfunction (1). The endothelium is the lining of your blood vessels, so in this case, specifically, they showed that the arterial endothelium, or the lining of your arteries, will become dysfunctional with just moderate sleep restriction.
Also, snoring is associated with increased risk of heart attack, obviously because of the interference that snoring has on quality sleep (1).
Insomnia increases the risk of cardiovascular disease (1), as does untreated sleep apnea (1). And also, in probably a note to what Robb Wolf is seeing with his cardiovascular risk assessment program, poor sleep has a negative effect on lipoproteins (1).
That’s some of the heart stuff. What about some of the metabolism stuff?
Another meta-analysis has shown that short or long sleep has been associated with type 2 diabetes (1). Another systemic review with meta-analysis has shown short or long sleep has been associated with increased risk of metabolic syndrome (1). Yet another systemic review with meta-analysis (has shown it to) be associated with obesity in children (1). It’s also been shown in other studies that sleeping less leads to an increase in sugary food intake (1) and that sleep deprivation has been shown to correlate directly with fat mass (1).
That’s some of the metabolic stuff. Do you want to ask me any questions there, Susan, or chime in?
SM: I just want to second the sugary treats or the sugary foods cravings because for me the clock is 7-1/2 hours. If I get less than 7-1/2 hours, I have to be super careful the entire next day to make sure to have my good fat and protein for breakfast and to watch out to not indulge in any kind of real starch too early in the day because I really want that calorie-dense food when it’s less than 7-1/2 hours’ sleep.
DR: Absolutely. I try to be really good about… because there have been other studies that have shown that you become a bit more insulin resistant, of course, when you have sleep deprivation, and so on a day where I haven’t gotten great sleep the night before, I try to really be good about ratcheting down the carbs, definitely.
SM: Right, and I also ratchet down any high-intensity or even weightlifting exercise if I don’t have 7-1/2 because it’s just too much stress. My body’s already under stress from the lack of sleep.
SM: And then you throw in exercise, and for me, because I can suffer from fatigue, it’ll just knock me out.
DR: Right, exactly. And along those same, similar lines, there’s also a number of studies—and I’ll put all the links in the show notes for people or accompanying with the transcript—but sleep disruption has also been correlated with obesity (1) (2). It’s been found to be an independent risk factor, actually, for obesity, even when you control for other factors, like exercise or diet (1), as well as metabolic syndrome (1).
And we even see impacts on the brain. Studies have shown that poor sleep quality correlates with decreased cognitive performance (1), and interestingly, poor sleep quality in children also decreases their psychological health and increases the amount of health complaints children have (1), so I thought that was pretty interesting.
SM: Yeah, and I think recently I’ve seen either on stuff that I’ve read online or on the news that they’ve really determined that our brain cleans itself out at night when we sleep, so the amyloid plaques that end up with Alzheimer’s or MS and some of those things that if we get adequate sleep that we’re less inclined for that to happen.
DR: Well, you took the words right out of my mouth because the next reference I wanted to go through shows exactly that!
DR: So kudos to your ability to read my mind, Susan!
SM: Oh, well, we’ve been doing this almost a year!
DR: I know, right?! I’ll put that link (1) in there also.
And then there are a couple of other research things, and then I’ll quit beating people over the head with the references, but there have also been two studies that I was able to find showing that sleep disorders put one at an increased risk for autoimmune conditions (1) (2), so certainly there’s a connection between sleep and autoimmunity.
There’s really a wealth of information showing sleep has a large impact on numerous health measures. Again, the more interesting thing to me, in looking at these studies, was that the longer sleep duration had an equal negative effect as a short sleep duration.
SM: You know, that’s funny because I know sometimes I wake up—you know, I go to bed at a reasonable hour, and so even on the weekends, I still wake up pretty early, but if I do, perchance, what I call sleep in, which is, like, 9:00, which isn’t really sleeping in, I kind of feel groggy. You know, if I’ve gotten more than, like, 10 hours of sleep, I just don’t feel right.
SM: It’s just, like, too much sleep.
DR: Yeah, and I think there certainly may be something to that observation as we’re seeing with all these research findings.
SM: And the funny thing is, so I suffer from mild obstructive sleep apnea. I just got diagnosed last year, and I’ve been going through all the rigmaroles of trying to figure out what’s the best form of treatment. I actually communicate often with Dan Pardi, him walking me through this process.
SM: I tried the CPAP, didn’t work, and so today, in fact—and it’s funny we’re talking about sleep today—I went and picked up a dental appliance that I had made to try and help me get better sleep, because although I do get my 8 hours, I still am tired a lot.
DR: Interesting. Well, there’s one reference in here that you may want to have a look at, and in this study they essentially created a mattress that would allow you to sleep face down or on your stomach, kind of like a massage table, you know, how you can put your head in the little hole.
DR: So they fashioned a special mattress with a pillow to allow people with sleep apnea—obstructive sleep apnea, that is—to sleep in that position, and they actually found that that correlated with a significant increase in sleep quality (1). I think that might be a nice option for people that really can’t do the CPAP or, I believe, the NPAP mask.
SM: Yeah, I tried that and it made me feel like I was hyperventilating because I really focus on breathing in meditation and all that crunchy stuff, so it really made me feel like I wasn’t breathing properly, and I was more exhausted.
SM: And they said, “Well, it takes about three months,” and I said, “You know, I don’t have three months to be exhausted.”
SM: So then Dan said, “There are some other alternatives you better look into,” so I’ll keep everybody posted!
DR: Yeah, please do, and have a look at that. I’ll put the link for that sleeping-on-your-face mattress thing that they were doing in that study, and that might be nice for you to try.
SM: Yeah, except we just spent a whole lot of money on a latex mattress last year, so I don’t see us spending a whole lot of money on another bed!
SM: You never know, though.
DR: It’s maybe something to keep in the back of your hat.
DR: OK, so now I want to try to segue us to what people can do if they are having sleep that’s either too long or too short, and the way I want to get us there is to start with some of the sleep-gut connection because for me personally and also for many of the patients I see in the clinic, improving gut health has a massive impact on sleep. And then I want to round out with some stuff on the microbiota and then a few closing tips.
I’ll put a few links in here, but it’s been documented that inflammation—specifically, C-reactive protein seen in some inflammatory disorders of the bowel—as inflammation increases, sleep quality decreases (1). This has been well documented, and I’ll actually put in another study (1) and a cool little graphic that shows increased inflammation or increased intestinal permeability, AKA leaky gut, or increased clinical disease activity—so if you have inflammatory bowel disease, let’s say, increased activity of that disease—or increased mucosal inflammation or gut inflammation or disruption of your circadian rhythm—all of those can lead into and have a very negative effect on your sleep quality. So this is a nice published reference because we’re starting to see that in the published literature it’s being recognized that gut problems can really be a strong contributing factor to sleep quality.
SM: It seems like everything always roundabout goes back to the gut, doesn’t it?
DR: Well, it’s part of the reason I place so much emphasis on the gut, because it’s just such an important issue, and I have talked before about how I used to have raging insomnia when I had the Entamoeba histolytica infection. I thought I was going to lose my mind. It was just unbearable, and it’s not fun. So, yes, definitely getting your gut right can be very impactful for your sleep.
Now, there are a couple of interesting things about IBS, or irritable bowel syndrome—so constipation, diarrhea, potentially an oscillation between the two, gas, bloating, abdominal pain, some of the most common symptoms of IBS. It has been shown that people working night shift have an increased risk of IBS (1) (2). They’re at a significantly higher risk of IBS. Again, this probably comes back to the importance of sleep on your gut, and what probably happens here is sleep problems detract from your gut health, and then we see IBS symptoms start to appear. And there may actually be a melatonin connection with this, again, melatonin being the hormone released by your pineal gland associated with sleep. And sometimes, of course, I’m sure people have heard that melatonin is used as a natural sleep aid.
DR: Now, there has been one clinical trial that has used melatonin supplementation and found it to be an effective therapy for IBS (1), so we see a little bit of this melatonin tie-in there. And it’s also been shown that poor sleep leads to lower melatonin, which then directly correlates with leaky gut (1), and conversely, those that have higher melatonin levels, it has been shown to correlate with less leaky gut (1), so there’s definitely a sleep-gut-melatonin connection here.
Is that all kind of making sense, Susan?
SM: Right, and it makes sense especially because melatonin is on the serotonin pathway and a lot of serotonin is made in your gut as well.
DR: Exactly. Absolutely. Yeah.
And so the way I look at some of this as I zoom way out, we’re learning more and more about how important the gut and the microbiota is for every other system of your body for just health in general. So maybe the reason why we see so many diseases associated with poor sleep is because poor sleep has a profound impact on the gut and then the gut has an impact on virtually every other system of your body.
DR: Is that an absolute rule? I don’t think so, but I certainly think that there’s definitely a strong grain of truth to that.
Sleep and the microbiota
DR: Now, let’s briefly talk about sleep and your microbiota and then round things out with a few recommendations for people.
There’s not a ton of research on sleep and your microbiota, and I really tried to limit… the research that I use to formulate clinical recommendations and recommendations in general, I try to really use human data because we can very easily be misled by animal data. That’s part of the reason why we used to think fat was bad, right?
DR: Because we fed rabbits a bunch of fat, but fat isn’t necessarily good for rabbits, and the rabbits got high cholesterol and died. So we were very misled by a rabbit model with some of the early cholesterol research, so I try not to get too pulled into animal data.
So there’s one human study (1) that also had an animal arm to it, which I want to go through with people. This was published in 2014 in the journal of Cell, and they took a group of humans and they had them go on an 8-hour flight, and they induced jet lag in this group of humans. And they tracked their microbiotas throughout this process. What they found was that there was a marked change in the microbiota after jet lag. Now, the question is, was this a negative or a deleterious change? To try and determine this, the researchers performed a fecal microbiotal transplant from these jet-lagged humans into a group of mice, OK?
DR: I’m sorry. Let me take one step back here. The mice that they did this in were germ-free mice, so these are mice that really don’t have a microbiota and you can supplant into them any kind of microbiota you want to study the effects.
DR: So when the microbiota from the jet-lagged humans was transplanted into mice, the mice gained weight and started to experience elevations in their blood sugar.
DR: Now, it could have just been that when we take a human microbiota and we put it into a mouse, bad things happen. So they had a control group where they used non-jet-lagged humans and performed a fecal transplant into mice also. No negative changes were seen in the group receiving the fecal transplant from the non-jet-lagged humans, so we can fairly definitively say that there was something about the jet lag that changed the human microbiota in a negative way, and then when that was transplanted into the mice, it had a negative metabolic effect. So this definitely suggests causality rather than just being associative.
SM: That’s really interesting. Every time I hear stuff like this, I try to put it into an ancestral perspective because if we were deprived of sleep, what is it about our microbiota that would need to change? Because our body’s job is just to protect ourselves and to keep us alive. So any clues on why our bodies would do something like that, to shift the microbiota?
DR: That’s a great question. I think what this very broadly may boil down to is that we see changes in the short term that are not good for the long term.
SM: Ah, that makes sense.
DR: So in the short term, it may have something to do with blood flow, or in the short term, this may upregulate certain immune pathways or divert blood flow, or potentially leaky gut in the short term may be healthful in a special situation, or potentially it’s just the stress of jet lag. The body doesn’t tend to delineate one type of stress from another.
SM: It doesn’t, yeah.
DR: Typically stress was more of a survival issue, and stress was always paired with needing to move, run, attack, what have you, so what I’m assuming is happening, my speculation is that there is a hormonal stress shift that occurs after jet lag, and those hormones have a positive effect on some parameters, but when you uncouple that from the fight-or-flight response and you do that chronically, that’s probably when we see these deleterious changes starting to occur.
SM: That makes sense. That makes sense.
DR: That’s a great question, by the way, Susan. You’re really making me think today!
SM: Well, something also came to mind. If we’re stressed and it’s the fight or flight and we’re in sympathetic mode, also our body usually tries to conserve energy because it’s thinking that food might be scarce, and so that’s where the metabolic problems usually come in, maybe.
DR: Right. And actually, this comes back to a video that we put out through the newsletter a few weeks ago, where it has been shown that when you exercise, that modulates these receptors in the gut known as TLRs, toll-like receptors.
DR: And that actually kind of causes the immune system to calm down a little bit. It causes a little bit of immunosuppression, and this is probably why we see in elite athletes—or athletes, potentially, in general—we see a more diverse microbiota because the exercise has an immunomodulatory effect, a somewhat immunosuppressive effect. So the right amount of exercise—again, this is my speculation based upon reading in between the lines in the published literature—but some exercise may cause a little bit of immunosuppression in the gut, allowing more bacteria to thrive and survive.
DR: However, if you exercise excessively, you have too much immunosuppression, and then you have an increased risk for infection, which has been very well documented.
SM: Oh, yeah. A lot of times after triathlons or marathons, people come down with really severe upper respiratory infections.
SM: Everything’s suppressed, suppressed, and the minute you relax… it’s like when you go on vacation and you get sick because you’ve been so stressed ahead of time.
DR: Right. So an appropriate amount of stress likely has a beneficial impact, but it’s when the stress becomes too prolonged and too chronic that I think we really run into some troubles.
DR: OK, so to kind of bring us back to center now, what are some things that you can do for optimum sleep?
Well, I’m sure people have probably heard some of these, but sleep hygiene. Not having a lot of light exposure before and during bed is very important because light, especially blue light, will impede melatonin secretion. So dimming your lights or having a blue light filter or just focusing on yellow light will help allow you to have optimum melatonin secretion.
Also temperature, having a cool temperature. People tend to sleep better when they’re a little bit on the cool side rather than the warm side.
Another fairly obvious one is noise. If you have a lot of noise that will wake you up throughout the night, you want to do your best to noise-proof your room.
And you want to have non-stressful pre-bed activities because we don’t want to be going into a stress response before we try to go to bed.
Trying to be in bed by the latest around 10 or 11 and then sleeping 7 to 9 hours, but remember, if you constantly can’t get 7 or need more than 9, you should probably look into what’s driving that. It might be a simple lifestyle solution. If it’s not, I would get myself to a highly trained functional medicine doctor and preferably one that’s very savvy with gastrointestinal conditions because that’s where I would start in most cases as a general rule. However, some other things to keep in mind, like we mentioned earlier, could be female hormone imbalances causing hot flashes or adrenal hormone imbalances causing nocturnal hypoglycemia, low blood sugar at night. And another thing is the modified mattress that may be helpful for people with sleep apnea who can’t tolerate the machine.
Also if you’re not sleeping well, napping is a viable option. There has been some research done showing that napping during the day can help prevent some of the negative effects from sleep deprivation (1).
SM: Right, and I’ve heard recently, too, like, I always thought if you’re having problems sleeping at night, don’t nap, but I think it was something that Dan Pardi wrote or talked about where he said that daytime napping does not affect nighttime sleeping.
DR: Yeah, and I think it’s a balance. And this is my own kind of observing what patients tell me and trying to reconcile the best strategy. I’ve had some patients that their nap is, like, 3 hours.
SM: That’s too long, yeah. That, I think, would affect nighttime sleeping!
DR: But I’ve also usually seen that accompany other diseases.
DR: So I’m thinking that if you’ve done your best to get the internal environment healthy, but you’ve missed a little bit of sleep and your body is tired during the next day, taking a 15-, 20-, 30-, maybe 40-minute nap seems reasonable to me, and so that’s what I’d recommend.
SM: And then also setting a bedtime, because for me growing up, I thought bedtime was after The Late Show was over. I didn’t understand, like, if I had to get up at 6:00 in the morning that I should be in bed by 10:00, and of course, we didn’t have DVRs and exciting things like that, so we had to watch ER when ER was on TV. But setting a bedtime and then subtracting that 7 to 9 hours, and subtract an hour from that—that’s when you need to start winding down. Don’t get in a financial discussion about money with your husband, or don’t have an in-depth conversation with your kids about what they’re not doing right. You know, all those things. Don’t get wrapped up and ramped up that late at night.
DR: Yeah, you’ve got to make it a priority because if you don’t, you just keep pushing the needle back farther and farther and farther, and before you know it, you’re going to bed at 1:00, and that can definitely be problematic because it’s not just how much sleep you get; it’s the rhythm and the consistency of the time to bed and the time to wake that’s going to be important. Definitely.
SM: I’ve gone through all the functional medicine stuff, and for me it was after I resolved the gut issues, got diagnosed with my IBD, worked on that, and I was still having sleep issues, it was, “Go get a sleep study.”
SM: Insurances are more than willing to pay for it these days because lack of sleep and poor sleep is linked with so many health conditions. Go get a sleep study if you’re still having problems after everything we’ve talked about today.
DR: Absolutely. That’s a great closing point, and I could not agree with you more on that, Susan.
SM: So anything else? Anything that we’ve left out to get everybody to get a great night’s sleep?
DR: I think that is the brunt of it, and I just want to say again, thank you to everyone that’s been listening to the podcast. The other day, I kind of did a review of our numbers, and we have just been growing at an alarming rate.
SM: That’s awesome!
DR: Yeah. For people listening, thank you so much. And if you haven’t yet and you feel inclined to do so, we would really appreciate a review on iTunes or any other sharing or what have you because we’re trying to reach as many people as we can and you guys are instrumental in that process, so thank you. And thank you, Susan, for doing such a great job of listening to me blow hot air for 40 minutes every week!
SM: Hey, my pleasure! It’s fun. I love doing things where I can learn and participate at the same time.
SM: OK, thanks, everybody.
DR: Thanks, guys.
SM: We’ll see you next week!
DR: All right, bye bye.
Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit DrRuscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.
If need help improving your sleep, click here.
What do you think? I would like to hear your thoughts or experience with this?