Maybe this title was misleading. To be clear, this is your one stop guide for getting great sleep. If you came to this article looking for something else, I apologize, for nothing. Fixing broken sleep has been transformative, in terms of my health but also my mood, attitude, and overall life satisfaction. I didn’t even know my sleep was that bad, until I fixed it, and I’m pissed I didn’t fix it sooner. To put things in perspective, here are the top three things I have done to improve my health in the past ten years.
3 Minimized/eliminated processed foods, sugar, and wheat. Here’s why.
2 Engaged in regular time restricted eating and periodic longer fasts. Here’s the article.
1 Prioritized getting 8 hours of quality sleep. Here’s why.
That’s right, sleep is numero uno. If you take my advice, it can be life changing for you as well. Here are some unbelievable sleep facts followed by my best recommendations for getting great sleep.
Amazing fact #1. Did you know that when we set our clocks forward in the spring and collectively lose an hour of sleep for daylight savings time, the rates of car crashes doubles? You did? Damn. But did you know that the rates of heart attacks, suicides, strokes, hospital admissions, coffee consumption, and people being late to work all skyrocket on that day as well. All this, from just one hour of collective sleep loss. What’s even crazier is that when we turn the clocks back and get an extra hour of sleep, the heart attacks, strokes, suicides, crashes, and work tardiness collectively hit all-time lows. This daylight savings example shows the far-reaching and devastating effects of just one hour of sleep loss.
Amazing fact #2. All animals sleep, even sharks. As a kid, I loved shark week on the Discovery Channel. I was told that sharks don’t sleep because they’ll die if they stop swimming. False. In actuality, they sleep and swim at the same time. #sharkfacts.
Amazing fact #3. When scientists completely deprive rats of sleep, they die, after only 7 or 8 days. What’s most interesting is how they die. I would have guessed car crashes or drug overdose, but in actuality these rats suffer a breakdown of their immune system and get terrible intestinal infections leading to septic shock and eventually death. Our immune systems fail when we don’t get enough quality sleep as well. One study showed that cancer fighting cells (NKC’s) decreased by 70% after patients were limited to just four hours of sleep. Another study gave rats tumors and then cut their sleep by half. The sleep starved rats’ tumors grew 2-3 times faster than rested rats, and experienced metastasis (spreading to other parts of the body) whereas the normal sleeping rats had small tumors that didn’t spread. These studies show how poor sleep lowers our immune defenses, and not just for colds and flu, but also for cancer.
Amazing Fact#4. Sleeping pills can kill you. Taking sleeping pills is shown (in 24 different large studies) to greatly increase our risk of all cause mortality AKA death, which should be put on the label, but isn’t. Here are the studies, and here’s another one. Death is one of the worst side effects I can think of, right up there with hair loss, anal leakage, and the gum disease gingivitis. Exactly zero studies show any measurable health benefits from taking these meds. Even the best sleep medications don’t provide quality sleep and only beat placebo (sugar pill) by a few minutes in terms of how fast they get you to sleep, and that is using big pharma’s own data, which is likely bullshit.
So what are sleeping pills good for? Making big pharma rich. Ambien made 4 billion dollars in profits in just two years. There are 61 countries in the world who’s entire gross domestic product is less than Ambien, and that’s just one of many lucrative drugs. Here are some other big pharma stats that are ridiculous. In conclusion, sleep meds are dangerous, habit-forming, incredibly profitable, and they don’t work. Here are some things that do work and don’t require a prescription from someone like me.
- Get more light in the day and more dark at night. Our bodies are continually looking for cues about whether it’s night or day, in order to set our internal clock and control the release of melatonin, our natural sleep hormone. Before Edison’s lightbulb, our bodies knew what time it was. Now, not so much. Daylight has 50 times more lux (unit of light) than even our most brightly lit cubicles, offices, and Walmart Superstores. So even in a well lit room, our bodies are very confused. At night, the blue light from our smartphones and computers tricks our brain into thinking it’s daytime, because the blue light they emit suppresses our sleep hormone melatonin. I encourage my patients to get morning sun (without sunglasses) to help establish our circadian rhythm and to get outside periodically throughout the day. In the evening, I keep my rooms dimly lit, wear blue light blocking glasses (it’s a thing), and have night shade mode on the screens of my electronic devices, to increase my natural melatonin release. Also, I use an app call F.lux that will block blue light from my computer screen.
- Get Cold. Our core body temp must drop a couple degrees in order for us to go from light to deep sleep, and going to bed a little cold can also help us get to sleep faster. I use a dip in a cold pool or a cool shower to help achieve this. One study showed cooling down patients with terrible insomnia (using cooling headcaps) got them to sleep faster than people without insomnia, and no drugs were required. I also keep my AC on high most of the year in my bedroom to help me get to sleep and stay asleep. I aim for mid 60’s in my room.
- Don’t sleep completely naked. This really only applies to people who spend the night on my couch. I’m looking at you Handsome Eric. So feel free to sleep in the buck at your own house, however soft gloves and socks encourages blood flow to extremities and can help lower your temp, which is a good thing.
- Use your bedroom for sleeping and sex. Don’t use your bedroom for arguing, watching TV, studying, social media trolling, or blog writing. Sex can help us relax and also make us quite sleepy, even if you’re alone. If your sexual activities involve torture devices, cattle prods, or more than three people, then consider taking it to a basement, windowless van, or your local LaQuinta Inn and Suites and be sure to have a “safe word”. No judging. Did you know that in Spanish “LaQuinta” literally translates to “next to Denny’s”?
- No clock-watching. Take the clock faces out of your bedroom, as this can lead to increased angst regarding sleep and set your phone to “Do not disturb”, unless you get a lot of late night “you up?” texts.
- Listen to an “Adult Sleep Story”. This is not porn. I hate that the porn industry has stolen the word “adult”. Not all adults are into porn, and frankly that implication is disgusting. Statistically there are literally hundreds of men in the U.S. who don’t regularly look at porn. I use the “Calm” app (not porn) for these adult sleep stories and for my mindfulness practice, which is also good for sleep. This app has hundreds of stories that are just stimulating enough to hold your attention but soothing enough to put your sweet ass to sleep. They even have celeb guest readers like Matthew McConaughey, Bob Ross, and Sam Smith. My favorite stories are “Blue Gold”, “A Magical Winter’s Night”, or anything involving trains. Once again, this isn’t porn. The app is free, but has a premium membership as well. Also, there are sleep stories for kids on the app that are good as well. Here’s the link.
- Magnesium + Apple cider vinegar + Honey + Melatonin (5mg). This elixir is the go-to of Tim Ferris. I pretty much try whatever he suggests and this stuff really works. Magnesium is a natural relaxant and something your body needs anyway. Sometimes magnesium can cause you to poop too much, if this is an issue, try the more bioavailable topical magnesium, and you will be spared this side effect. I added the melatonin to this combination. It really will help, but most people are taking it incorrectly. The key is the timing. A lot of patients have told me it doesn’t work for them, but when I get them to take it earlier (like 2-4 hours before bedtime) then it works. The rest of us only need to take it 30 minutes to an hour before bed.
- Sleep Mask + Ear plugs + Lavender oil. I have turned my bed area into a sleep sanctuary. It’s important to get your room quiet and dark for sleep. My room is pretty dark, but sometimes road noise, cat fights, or my oldest child’s night screaming can disrupt my slumber. I use “Mack” ear plugs and a sleep mask with adjustable eye cups (GoZheek brand) as double protection against sleep disruptions. Lavender oil helps relax me. It’s been used for thousands of years for sleep and has some data behind it*. My brain has permanently linked the scent of lavender with sleep, not unlike how Guy Fieri associates the smell of bacon with intense sexual arousal.
- Alcohol. Alcohol is used by many of us to get to sleep, but drunk sleep isn’t restorative for a number of reasons. Just because we lose consciousness, doesn’t mean we are getting real sleep. A 2×4 wooden board applied with enough force to the side of our heads will induce sleep, but that isn’t quality sleep either. When I told my mother about alcohol’s negative effects on our sleep, the anger, desperation, and fear in her eyes told me that quitting Nana-juice was going to be a multi-step process, probably 12 or so. So instead of recommending abstinence to you and The Betty Ford Center to my Mom, I came up with some mitigation strategies. Here is Dr. Jimmy’s 5 point plan for boozing and still getting good sleep.
- Start early. Happy hour drinks are much less likely to mess with your sleep as compared with a night cap. So start your drinking earlier and stop well before bed with a goal of being soberish, by night-night time.
- Avoid beer, especially close to bedtime. Beer is mostly water and it irritates our bladder and that makes us pee a lot. Getting up to go pee in the middle of the night isn’t great for your sleep.
- Get colder than cold. Alcohol raises our core body temp a bit because its a vasodilator. As I mentioned, lower body temp is needed for deep sleep. To fight the warming effects of alcohol, keep your room extra cold and consider a cold shower or bath immediately before bed.
- Afrin + Nasal “Breathe Right” Strips + CPAP. Alcohol can induce snoring and worsen sleep apnea. If you have sleep apnea, be sure to wear your CPAP mask, especially when you’ve been drinking. For the rest of us, Afrin (OTC nasal spray) and the Breathe Right nasal strips can help keep our airway open and increase the oxygen to our brain. Don’t use Afrin too frequently, it can be habit forming, once a week is fine though.
- Don’t over do it. Too much alcohol stops us from getting into REM (dream) sleep which over time, leads to early dementia, and a host of mental health problems. Also, you know how upset your mom gets when you get puke on your Yoda pajamas.
- Make a Caffeine Adjustment. I love coffee. I wrote about why it’s good for us (here is the link) but if abused, it can screw up our sleep. I used to drink an espresso after dinner and be asleep in an hour, but I’ve stopped drinking caffeine past noon. Let me tell you why. Caffeine has a half-life of 6 hours and a quarter life of 12 hours. So if you have a Starbucks grande drip coffee (350mg) at 2PM, it’s like having a regular coffee at 8PM (175mg) or a shot of espresso at 2AM (87mg). Anyone with even a hint of insomnia really needs to consider these facts and stop the afternoon caffeine. But Dr. Jimmy you just said that you can fall asleep after an espresso, so what’s the big deal? I’ll tell you. Even if we can fall asleep with caffeine, the sleep we get is seriously degraded. That espresso ages me by 20 years, in terms of my sleep. This poor sleep makes us tired the following day, which encourages us to drink more coffee later in the day, which makes our sleep worse, and now we are in a vicious caffeine cycle.
- Workout in the AM. Even just five minutes can help set your body clock. I admittedly hate morning workouts, but I begrudgingly acknowledge that this helps. Also, avoid workouts within 4 hours of bedtime.
- Track your sleep. There are lots of sleep trackers out there (Fitbit, Apple Watch, WHOOP, Oura Ring). I suggest using one to monitor what helps your sleep and what doesn’t. I try to be in bed 8.5 hours prior to my wake up time. I don’t sweat it if I’m not asleep the whole time. I think this takes some of the pressure off, which helps me relax. My in-bed mantra is to relax and let go. When we try too hard to fall asleep, there’s increased stress and pressure which can make sleep elusive.
- Have a regular bedtime and wake time. This is impossible for many of us due to our work schedules. When I get very little sleep because of a night shift in the emergency department, I try to give myself at least one 90 minute nap in the daytime. 90 minutes is the length of one sleep cycle. While this situation isn’t optimal, it helps me to be more functional in the day while still being sleepy enough to not have insomnia at night. One of the downsides is that a 90 minute nap can cause something called sleep inertia where you feel groggy for a period of time, but once that is over, you will be better off, because 90 minutes allows your body to get into both REM and deep sleep. The shorter 20-30 minute “power nap” can be refreshing, spare you any sleep inertia, and can help you function later into the evening but it’s not a replacement for your night time sleep, the way a longer 90 minute nap can be. Also, if you have trouble falling asleep at night, try not to nap in the daytime.
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*Author’s rant: Many studies involving natural products are not taken seriously by the scientific community and I think that’s a mistake. They’re generally disregarded because the studies are small and often underfunded. They’re underfunded because the stuff they are testing aren’t billion dollar prescription medications or procedures. I am in favor of evidenced based medicine, however the bar for evidence should be raised and lowered based on the risk of the product being tested. If a study shows that carrots are helpful for weight loss but the study was only involving a few hundred people and only lasted a few years, this doesn’t mean we shouldn’t recommend eating carrots for weight loss because there’s not enough high quality data. We can say that there is some evidence for carrots We know carrots are good for us and the risk of the intervention (carrots) is low, so go ahead and give it a try. Instead, we disregard these small studies of benign interventions but freely prescribe sleep medications that have a high risk associated with them (and an FDA label) when in reality they need more high quality evidence showing benefit to be safely recommended.