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[00:00] You're doing what you're supposed to do, you're in bed for 70 hours, and yet you wake up feeling unrefreshed, foggy, like you could go right back to sleep. Now in most cases, it's not about how long you're sleeping, it's about the quality of that sleep. Welcome to Office Hours. This is our dedicated 101 space to go deeper, get clearer and explore what truly moves the needle for your health. I'm Dr. Mark Hyman, and each week, we're gonna pull back the curtain and share the insights, the research, the lessons that don't always make it into our conversations with guests. Because at the end of the day, you are the CEO of your own health. And for many of you, your family's health too. And you might not feel it all the time, but you have far more power and agency than you realize. I'm glad you're here. Sleep is one of the most important foundations of your health. And honestly, one of the most frustrating. Now, if you struggle to fall asleep, if you struggle to stay asleep, if you wake up feeling exhausted, I promise you, you're not alone. And despite what social media tells you, poor sleep isn't just caused by one bad habit or one missing supplement. It's the result of a few biological systems that are out of sync. So in today's office hours, we're going to slow things down. We're going to answer the most common questions about sleep, what's actually going on in your body and what helps in your life. Now, this isn't about perfect sleep routines. It's about understanding your sleep patterns and giving your body what it needs to rest and to repair. Now, here's why sleep breaks down. This is a big picture. Sleep problems usually come from a few things. First is circadian rhythm disruption. Now, your body runs on this internal clock that's guided by light, by darkness, by consistent timing, which is really hard, particularly for me, I travel all over the place. And when that clock is off, because of late nights, because of screens, because of irregular schedules, or not getting morning light, your sleep becomes harder to initiate, and it also becomes harder to sustain it through the night. The next thing that often occurs that screws up sleep is your nervous system being overactive. If your body's stuck in this stress response, if you're always on it, right, if you've got high cortisol, high adrenaline, your body doesn't think it's safe to power down, right? Because your body's in stress, you're chasing, running from a tiger, right, or you're fighting or fleeing. Now you might feel exhausted, but your brain stays alert. And that's why so many people feel tired all day and wired at night. We call that tired and wired. I have felt that, I promise you, it's awful. The next thing that often screws up sleep is your blood sugar being unstable. Now blood sugar instability is a common overlook cause. Now if your blood sugar drops overnight, guess what happens? It's a life-fitting emergency and your body releases stress hormones. That brings your blood sugar back up, which is fine, except your cortisol is high and your body is like, oh, danger or it's wake up time because in the morning your cortisol goes up naturally. And that often occurs between two and four in the morning and your mind races, you're really alert. And this is true for people often have high insulin, they eat big meals, they kind of have a big spike in their blood sugar, their insulin spikes and it crashes and then you often get this. And I had a guy who had night sweats because as a patient and obviously he wants to go through menopause and he'd have cancer or TB which are the other causes and it was because he had hypoglycemia in the middle of the night and that causes night sweats and their life threatening version. The next big thing that screws up sleep are hormone imbalances. Now, these play a big role in your sleep quality and there's a lot of hormones that are involved. Cortisol as we just mentioned, the stress hormone, melatonin which we know affects sleep and is important for sleep initiation, progesterone, estrogen, sex hormones. And we know a lot of women through menopause often have sleep disruption and thyroid. It can often, if it's too high, it can make you not sleep, if it's too low, it can make you sleep too much or actually paradoxically cause insomnia. So, all these hormones are like this incredible, beautiful symphony of molecules that should be imbalanced. When they're out of balance, they screw you up. And they all influence when you feel sleepy, how deeply you sleep, how rested you feel in the morning. And in these shift, right, they shift during perimenopause, menopause, chronic stress, all these things can disrupt sleep. The next big category of things that disrupt sleep are actually two different categories. One is inflammation and the other is nutrient depletion. Inflammation is a big factor because almost all brain dysfunction, whether it's depression or autism or Alzheimer's or schizophrenia or anxiety, whatever you want to call a brain dysfunction, is usually linked in some way or another or caused by inflammation, and that includes sleep disruption. That's a big one. There's a lot of causes for it, and often people don't realize what they are. They can be toxins and allergens, infections and the microbiome changes and inflammatory diet and stress. I mean, there's a whole list of things that cause inflammation. The other thing is nutrient depletion. That's a big one. A lot of people are nutritionally deficient. In fact, at Function, where we test everybody for a lot of nutrients that your doctor usually does not test for, like omega-3 fats and B vitamins, homocysteine, methylic acid, B12, folate, vitamin D, and many others, we find that almost 70 percent of our population, which is generally health-seeking people, 70 percent have a nutritional deficiency at the level that the RDA considers a nutritional deficiency disease. Not what's optimal, but just what's enough to get scurvy or rickets. So we're talking a massive amount of nutritional deficiency or insufficiency in the population, probably over 90 percent. So when you have low levels of nutrients like magnesium, and over 45 percent are low in magnesium, and we do test that. Iron affects sleep. If your iron is low, then we check your ferritin levels, which is really important. Your doctor usually never checks this. It's on function panel. Your ferritin level is less than 45. Even though the normal code normal is 16, you're going to have sleep issues. It's one of the big hidden cause of insomnia, and a lot of the population has iron deficiency up to half, especially children and many others. B vitamins, also a big role in sleep, and omega 3s. All these affect your nervous system and your brain and affect your ability to sleep. So really important to focus on these things. Sleep isn't something you force. It's something that happens when the body feels supported and safe. That's the key here. All right, so let's get to it. What are the most common sleep questions? Number one, why can't I fall asleep even when I'm tired? And trust me, I have experiences, so I get it. Here's the thing, you get really tired, you're exhausted all day, you finally get into bed. Instead of just passing out and drifting off, your mind turns off, or maybe it just never turned off. Thoughts raise, your body feels tired, your brain won't shut down. And what's usually happening here is that your body's physically tired, but your nervous system is still in the on mode, right? You can't turn your brain off, your anxiety, your stress response is automatic. And the thing about our society is that almost everything going on, whether it's our jobs, our relationships, our diet, obviously, which causes tremendous amount of stress in our system, our inflammatory high sugar process diet, literally raises cortisol. Even if you're meditating all day long and you eat that, you're going to have high cortisol. All the stresses in the world, wars and traumas and I mean, just the news that makes me stress. So pretty much everything going on is automatically making your nervous system on hijack. And it takes deliberate effort to turn on your relaxation system. It's not something that happens automatically. It's an active process. I do it every morning. I do breath work. I do meditation. It's work. I mean, it's relaxing, but it's work. It's not just going to happen automatically. Whereas stress, you don't have to do anything. It's just there. So what happens when you have high stress levels? Well, cortisol is the stress hormone that goes up at night. Normally, cortisol should go down at night. Your body has basically a biphasic rhythm where it's up in the morning and down at night, except when you're screwed up and then it goes up at night and down in the morning and you're all messed up. So cortisol is basically not functioning right. But when you have chronic stress, when you're having regular schedules, when you're not having bedtime early enough, when you're staying up really late, or if your blood sugar swings because you're eating lots of carbs and sugar, it can screw up that whole rhythm. And that makes cortisol go up when you're trying to go down. When you're trying to go to bed, it goes up. So what happens? Well, your nervous system gets stuck in the on mode. When your nervous system is overactive, because your day is packed with stimulation, with stress, with constant mental inputs, your body doesn't automatically know how to shift down at night. Even when you're tired, your system doesn't really feel safe to let go, even though you might think you are. So learning how to regulate your nervous system and manage your stress response is a really important part of just being alive and a human, that we naturally did, living in the woods, watching the sunset, the sun rises, not having constant chronic stress. There's a book by a great scientist, Robert Sapolsky called Why Zebras Don't Get Ulcers. Essentially, the idea is that I actually was in Africa a couple of years ago and I literally saw this. You see a lion chasing a bunch of zebras. They go crazy. They're running as fast as they can. Their hearts are racing. They're going to die. They're scared as hell. Then the lion catches one of the zebras. Then it's literally laying there dead and then the lion is eating the zebra. All the other zebras are just hanging around the lion while it's eating the zebra. They know it's not their turn. They're just relaxed. It's an acute stress. Their stress hormones go up. They discharge them. They run and then they're fine. We don't do that. We just stay in chronic stress mode. The other big thing is blue light and mental stimulation. Blue light and mental stimulation are also playing a big role. Now, when you're on screens, when you have bright lights, when you're dealing with work emails at night, or even having an intense conversation with your partner or spouse, that can really cause trouble. That can suppress melatonin and it basically signals to the brain that it's still daytime. Because when you raise cortisol, that's daytime. When you have all this mental stimulation and we have blue light, it's daytime. There's actually a great book I read called Lights Out years ago, just talking about the initial light bulb being the cause of the rise of chronic disease, including heart disease, diabetes, and many other things, because of how it affects our nervous system, our hormones, and so forth. The only thing that's really common that causes trouble is not going to bed at the same time and not waking at the same time. It's one of the most important things, and I'm really crappy at this, but it's one of the most important things if your sleep's not good, to get your sleep right. If you have inconsistent sleep timing, it matters more than most people really know. So going to bed and wake up at different times, especially on weekends, makes your whole internal clock confused and heart rate, your body recognize when it's time to sleep. So given all that, what actually helps you sleep better? Well, going to bed and waking up at the same time every day. 10 and 6 are good, 9 and 5, 11 and 7, whatever works for you is really important. Next is getting morning sunlight. You've heard this before, but I can't over-emphasize the importance of getting at least 15 minutes of morning sunlight, even if there's clouds out, within half an hour to an hour of waking up. Now, you're in the North Pole and there's no light, they have full spectrum light boxes you can use, but aside from that, unless you live in Sweden or Norway or somewhere in Greenland, probably you can get morning sunlight. Downshift at night. Do breath work, do stretching, yoga, take a hot bath. My favorite is Epsom salt bath, lavender oil which has magnesium and lavender actually lowers cortisol. They've studied this, Johnson and Johnson has a baby bath with lavender in it because it works to reduce cortisol. Comes to maybe take magnesium at night, magnesium glycinate or 3 and 8. These are great forms of magnesium to take at night. If you're tired and wired, your body isn't broken, it's just dysregulated. When you focus on calming your nervous system and supporting your natural rhythms then falling asleep is going to get a lot easier. Second big question is, why do I wake up at 4 in the morning, like between 2 and 4 in the morning and why can't I fall back asleep? Well, this was by far the most common sleep question that you all submitted and for good reason. Waking up between 2 and 4 in the morning, often with a racing mind or a sudden test of being alert, is incredibly common. And the important thing to understand is this, most of the time, it's not insomnia, it's your body sending a signal. And what are those signals? Well, the causes for this are blood sugar drops. We talked about that, but blood sugar drives a lot of wakefulness in the middle of the night because your blood sugar drops, your dinner's too low in protein or fat and you had sugar, alcohol in the evening and your blood sugar dips. And then what happens, your insulin goes up and your cortisol goes up and you're off to the races. Then you got hypoglycemia and you get stress hormones going up and basically your blood sugar becomes normal but you're awake. The second is cortisol spikes. Now cortisol naturally starts to rise early in the morning to wake you up, but chronic stress can push that rise earlier than it should right in the middle of the night. Instead of being at six in the morning, it's two to four in the morning. Alcohol, another big one, it helps you maybe fall asleep, but it screws up your sleep architecture. I have an oral ring and I know that when I drink and I don't actually anymore, I don't remember last time I had a drink, I always see even a little bit actually screws up my sleep, so it's not worth it. Small amounts of alcohol fragments sleep and they trigger this early morning waking. As soon as the alcohol goes down in your system, then stress hormones bounce up and you get weak in the middle of the night. The next is hormone shifts, perimenopause, menopause. Now for many women, these hormone shifts, especially during perimenopause and menopause, are big contributors to waking up in the middle of the night. It can be just waking up, it can be hot flashes. These hormones affect blood sugar, they affect your temperature control, they affect cortisol. All those can disrupt your sleep in those early morning hours. So what helps fix all that? Well, a good dinner with protein and fat, not a carb rich dinner. I mean, it can have carbs, but you can't just have carbs alone and you don't want to be eating tons of sugar at night. Late night sugar or alcohol, also bad news. Even any alcohol, you want to get yourself probably at least four hours before bed. Magnesium can help as well as we mentioned. And those stress responses that we talked about, how do you deal with your stress load throughout your life? Look at your life as a whole, where can you cut out things that are stressful? Where can you introduce things that are helping you relax? Not just bedtime habits, but just throughout your life. The key takeaway is this. If you wake up in the middle of the night, it's often metabolic or hormonal, not a personal failure or simply insomnia. When you address these underlying signals your body is sending, then your sleep starts to repair itself. All right. The next question we get is, why do I sleep seven or eight hours, but I still wake up feeling exhausted? It's a really common and kind of a confusing sleep question. You're doing what you're supposed to do, you're in bed for seven or eight hours, and yet you wake up feeling unrefreshed, foggy, like you could go right back to sleep. Now in most cases, it's not about how long you're sleeping, it's about the quality of that sleep. One of the major causes of not feeling refreshed in the morning is not getting enough deep sleep or REM sleep. Now these stages are when your brain and your body repair, when they regulate hormones, when they consolidate memory, when they clear up inflammation. It's an amazing system that your brain has to heal and repair, but if you're not having quality sleep, it's not doing it. If your sleep is fragmented or shallow, you can get plenty of time in bed and you don't feel restored. The next thing that can cause poor quality sleep is inflammation. Chronic inflammation is driven by stress, by poor diet, which is what most of us eat in America, our gut problems, poor microbiome health, infections, toxins, all these things can drive inflammation. They can interfere with sleep architecture and they make sleep less restorative. I know when I had mercury poisoning in my 30s, I could not sleep at all and I needed drugs. It was terrible. I knew that it was the mercury once I figured it out, but it was scary. Toxins and all these things can drive inflammation in the brain that really interrupts sleep. The next thing is hidden sleep issues that you might not really have, especially if you live alone, which is sleep apnea, which means you don't breathe at night for short periods of time. Your sleep is interrupted by periods of non-breathing. In other words, you just hold your breath. Snoring, you don't breathe for a bit. You've seen people like this and these are really common. It can be caused by nasal congestion, allergies, by mouth breathing, sleep apnea. It can all affect your oxygen delivery and they can fragment sleep. Even if you don't think you're waking up at night, your sleep is scrappy. Then of course, there's nutritional deficiencies, hormonal issues, things like iron, B12, thyroid issues. They can cause persistent fatigue. It just might be a clue that there's something wrong that you need to track. That's why we have Function and Function Health. You go to functionhealth.com and it's now only $1 a day, $365 a year to get a full panel. It looks at all these things that we're talking about, including iron, ferritin, B12, thyroid and many, many other factors, magnesium, all that affect your sleep. These can make you feel exhausted no matter how many hours of sleep you get. What helps fix this? Well, track your sleep trends, not just one night so you see what's happening. If you're a nasal breather, you got nasal congestion, sinus issues, allergies, it could be your diet, food sensitivities, environmental allergies, mold. Check it out. Check your labs. It's always good to get a baseline. Alcohol, if you're really not feeling rested in the morning, just cut on alcohol for a while and see how you do. The key takeaway is this. If you're sleeping enough hours, but you're still waking up exhausted, your body's asking for deep repair, not more time in bed. When you focus on sleep quality and your underlying health, then your energy often starts to come back. Next big question I got was, what supplements actually help with sleep? Now supplements can be helpful, but only when they're used in the right context. They work best to support, not as a substitute for healthy sleep habits and circadian rhythms. That's why they're called supplements, not replacements. Now here's the most helpful ones, magnesium. Probably about 45 percent of the population is low in magnesium. So what causes below? We don't need magnesium rich foods like greens and beans, nuts and seeds. We do a lot of things that cause us to lose magnesium, alcohol, sugar, stress, caffeine, all that causes us to deplete magnesium. It's one of the most consistently helpful nutrients for sleep, and you can use forms like magnesium glycinate or threonate. Helps relax the nervous system, quies your brain at night. The next is L-Pheny. Now that comes from green tea, and that's why there's tea ceremonies and green tea can be relaxing. There's no caffeine, but this is without the caffeine. So L-Pheny is a great option, especially if your mind races at night. It helps promote a calm, relaxed state. Doesn't cause you to be too sedated, but it makes you calm. The next one is glycine. Most people have never heard of it, but it's an amino acid, and it can really help support sleep quality. It can help lower your core body temperature, promotes deeper sleep, more restorative sleep for some people. It's a great hack. Low dose melatonin and short term only. I don't recommend melatonin regularly, but it can be helpful in certain situations and dose and duration of matter. Low dose, even half a milligram, can be used short term and can help reset your circadian rhythm, especially if you're traveling. I just flew to South Africa, so I did one dose of melatonin last night to help reset my circadian rhythm and jet lag. If you're traveling or you have a scheduled disruption, it can help and more is not necessarily better and not really for a long-term solution. All right, what should you avoid? As I mentioned, melatonin is good in low doses, not high doses. High doses, taking up a long time, can really disrupt your body's natural production and it can lead to grogginess, vivid dreams, and revalid sleep issues. You don't want to stay away from doing that. Then random stacking supplements without a plan. You can take lots of sleep supplements. You can be taking everything on the market and it may not help. When I work with someone, if you're really struggling to find out the cause, and they're not just supplements as a pile on to fix it all. Here's the takeaway. Supplements support sleep, but they don't replace the foundations of sleep hygiene. If the basics aren't in place like light exposure in the morning, avoiding blue light at night, regulating stress response, balancing with blood sugar, having a cool environment in your bedroom, having dark blackout shades, having low noise or noise canceling or earplugs, all those things really make a difference. No supplements are going to fix the problem if you don't address those things. But if you use them thoughtfully, then the right supplements help make sleep easier and more restorative. What are the quick takeaways that good sleep actually requires? Well, I want to kind of go over the basics here. Here's a big idea. Sleep isn't about being perfect. It's about a few key systems that work together and small consistent habits matter more than a bunch of hacks. Great sleep starts the minute you wake up, not when your head hits the pillow. So what are the five pillars of good sleep? Number one, light exposure. Morning sunlight helps reset your circadian rhythm. That means getting outside, even if it's cloudy, without sunglasses, without contacts, and letting those sun rays hit your retina and work on your brain to properly regulate your hormones through your pineal gland. Then at night, low light exposure. Now, that sometimes means changing the light bulbs in your house. Candle light is cool. I like that. There's a lot of ways to do this, but make sure you can deal with this bright evening light, which is not good. It makes your body think it's still daytime. The next key takeaway here is stabilize your blood sugar. This is true for everything and every disease, period. If you know my work, you know all about this. You're writing about it for 30 years. Balance your blood sugar. That means lots of protein, fat and fiber, low refined starches, low sugar. I'm not a no guy. I'm a low guy. Especially at night and dinner, don't eat a ton of starch and sugar without properly balancing with fat and car protein and obviously don't eat a lot of refined starches and sugars. Also, don't eat sugar before bed and don't drink at night. Also, don't have late night sugar and alcohol, bad news. The third big idea here is to learn how to regulate your nervous system. Stress happens, relaxation doesn't. Your sleep happens when your body feels safe. Learning how to regulate your stress response throughout the day matters. It can be simple. It can be a simple breath practice in the morning, meditation, some gentle yoga, stretching. It can be meditation later at night or what Andrew Hubern calls a non-sleep deep rest or often it's called yoga nidra, which is essentially an ancient practice to do a body scan and reset your nervous system. Whatever works for you, I take a hot bath, have some salt, lavender oil, get a massage, get your feet rubbed if you're lucky enough. Whatever it is, learn how to downregulate your nervous system at night. The fourth big idea is get your hormones in balance. Cortisol, melatonin, progesterone, estrogen, thyroid, these all affect sleep. If they're out of whack, you need to know. functionhealth.com is a great way to check all these. If they're out of whack, there's some simple things you can do to fix them. If you need to see a doctor, sometimes you need to get hormone replacement or thyroid, that's fine. If your hormones are really messed up, you really need to get those fixed. The fifth big idea is be consistent, don't be perfect. Try to sleep and wake at the same time every day. Consistency is one of the biggest sleep hacks there is, so try your best. I try to get in bed at 10, I wake up at 6.37. Really important if I can do it, that's my favorite way to live life. Of course, sometimes I'll stay out at night, I'm going to a wedding this weekend, I'll be partying, but not on a regular basis. What's the quick return on investment here? What are the quick wins? If you do nothing else, start here. Good morning, sunlight, and then half an hour, an hour waking up, eat protein, dinner to make sure your blood sugar doesn't crash, reduce alcohol, even small amounts, and try to consistently sleep in the same sleep window, including weekends. And use magnesium because that's the easiest, best sleep hack. Now, just remember, sleep is not a luxury, it's a biological requirement. If you're struggling with sleep, it doesn't mean you're broken, it means your body needs some help. So get curious, don't be frustrated, small changes done consistently can really transform how you rest, how you feel, how you recover. And I'd love to hear from you, what sleep questions you want to answer next, what's been the hardest things for you about sleep? Office Hours is our space to get clear, to ask better questions, take control of our health together. You're the CEO of your own health and better sleep changes everything. Thanks for joining me for Office Hours. I love diving into these topics with you. Remember, you are the CEO of your own health. And every choice you make can move you closer to healing and vitality. I want to keep these episodes as relevant and useful as possible. So tell me, what do you want to explore next? What questions are you wrestling with? What breakthroughs are you chasing? Share your ideas in the comments on social media or through the link in the show notes. I'm listening. Until next time, keep taking charge, keep asking questions and keep showing up for your health. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to The Dr. Hyman Show wherever you get your podcasts. Thank you so much again for tuning in. We'll see you next time on The Doctor Hyman Show. This podcast is separate from my YouTube channel. I'm Dr. Mark Hyman. We'll see you next time on The Doctor Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health, where I am Chief Medical Officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at ultrawellnesscenter.com and request to become a patient. It's important to have someone in your corner who is a trained licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public. I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.