Is Your Lack of Sleep Making You Fat? with Dr. Audrey Wells
TL;DR: In this episode of “Hormones, Metabolism, and You,” Dr. Cassie Smith, who specializes in functional medicine and endocrinology, teams up with Dr. Audrey Wells, an expert in sleep medicine, to delve into how sleep significantly influences mental health. They talk about how common sleep disorders are in the U.S., affecting between 50 to 70 million people, and how these disorders can contribute to anxiety and depression. The episode also touches on how much sleep we really need, the limitations of using sleep tracking devices, and the particular sleep issues that women often face. Dr. Wells stresses the importance of maintaining good sleep habits and shares practical tips for getting better sleep. She also points out the necessity of taking a comprehensive approach when diagnosing and treating sleep disorders.
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Relevant timestamps:
- (00:00:06) Dr. Cassie Smith introduces the podcast and highlights the significance of sleep disorders affecting many Americans.
- (00:01:20) How sleep issues relate to mental health disorders like anxiety and depression.
- (00:02:09) Understanding how much sleep individuals need, varying by sex and personal circumstances.
- (00:03:10) Symptoms and signs indicating potential sleep problems, including feedback from sleep partners.
- (00:07:31) Discussion of how sleep deprivation can exacerbate symptoms of anxiety, depression, and ADHD.
- (00:18:36) Impact of hormonal changes during menstruation, pregnancy, and menopause on sleep quality.
- (30:04) Exploration of how alcohol consumption negatively impacts sleep and heart rate variability.
- (32:44) Strategies to improve sleep quality, including managing negative thoughts and creating a calming environment.
- (40:43) Connection between sleep deprivation and emotional dysregulation, emphasizing the importance of adequate sleep for mental health.
- (00:49:10) How sleep deprivation affects healthcare professionals’ performance and well-being.
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Guest info and links:
Audrey Wells, MD attended University of Michigan Medical School and went on to train at Washington University School of Medicine in pediatrics and pediatric pulmonary medicine. It was during this time that she developed a specific interest in adult and pediatric sleep medicine. She returned to her home state of New Mexico to complete a sleep medicine fellowship. As Chief Medical Officer, she led the development of OmniSleep Medicine Centers to become a comprehensive sleep clinic for both adults and children from 2010 to 2018.
She then relocated to St. Paul Minnesota and worked for University of Minnesota Physicians. She completed an Obesity Medicine Fellowship at Columbia University and now holds three board certifications in pediatrics, sleep medicine, and obesity medicine. In 2021 she founded Super Sleep MD, an online platform for education, support, and group coaching experiences specifically for people struggling with obstructive sleep apnea treatments. She helps people with sleep apnea get fully treated without sacrificing comfort. Through Super Sleep MD, she offers a comprehensive library of self-directed courses, a group coaching program, and a private Facebook community. Dr. Wells also has an individual consultation program for physicians who want to optimize their sleep to improve performance, vitality, and well-being.
Transcript:
0:00 [Music]
0:06 welcome back to this week’s episode of hormones metabolism in you I’m your host Dr Cassie Smith I am a board-certified
0:13 endocrinologist who is now a functional medicine doctor and I’m based out at Oklahoma City the point of this podcast
0:19 is to help give you good medical information that is more holistic or functional medicine based I have had a
0:27 lot of people reach out to me about sleep issues Sleep disorders affect one
0:32 out of three Americans so it’s estimated that 50 to 70 million Americans struggle
0:38 with sleep issues every single day now why is that an issue let me tell you that mental health and sleep issues are
0:46 highly correlated I have a sleep expert today Dr audre Wells who is going to
0:51 talk to us about sleep medicine but also about hormones she said that there is not a single mental health disorder that
0:59 sleep is not affective Ed by now anxiety and depression are the most common mental health disorders in this country
1:05 18% of Americans struggle with anxiety and 21% struggle with depression so
1:12 that’s about one in five people who have mental health disorders that a lot of
1:17 times are worsened by Sleep issues and so sleep is very important I brought her
1:23 on because I wanted to ask her all the questions about sleep and I wanted to tie it to your hormones as well so I
1:28 asked her what happens when we sleep like why is sleep so important how long
1:35 do we really need to sleep how much sleep do we need you hear all sorts of different things six hours is fine you
1:40 need eight hours you need nine hours so she talks to us about how much sleep we actually need and it’s somewhat
1:46 dependent on our sex men and women need different amounts of sleep we talked about how do you know if you have sleep
1:52 issues like we’re sleeping so how do you know if you actually have issues she talks to us about like what types of
1:58 symptoms you could have during the day that could let you know you maybe have sleep issues so if you don’t have a sleep partner if you do have a sleep
2:05 partner some of the things they could tell you that would make you think you have sleep issues she talks about different types of testing that we could
2:11 do we talked a lot about sleep trackers so like the order rings things like that
2:16 should we wear them are they actual actually helpful are they factual are
2:21 they accurate so we talked about that she talked about how women actually have very non-specific sleep symptoms so
2:29 shocker women you know we have a lot of non-specific heart symptoms cardiac symptoms so two out of three women will
2:36 die of heart disease and onethird of those women have no symptoms prior to dying so we have very non-specific
2:42 symptoms in a lot of areas but sleep is no different so we talked about that and we talked about how women need more
2:49 sleep than men and why we talked about how testosterone can be related to that and so there was a good discussion about
2:56 hormones we talked about the different types of sleep again and we talked about HRV which is this new Buzz trending
3:03 topic what is HRV why is it important how does our sleep affect it so I thought that was a very powerful
3:10 conversation then I asked her all the things you guys want to know how does caffeine affect your sleep how does
3:16 stress affect your sleep how does alcohol affect our sleep so that’s a big one sleep hygiene tips I said to her
3:23 what can we do to fix our sleep hygiene What do we do if we can’t fall asleep what do we do if our mind races when we
3:29 lay down what do we do if we wake up at 3 3:00 a.m. in our minds racing like what can we do kind of shut off that
3:36 default brain is what she calls it so we talked about that she gave us some very
3:41 good information about health hazards if you sleep less than six hours so that
3:47 was something I thought was very powerful and then at the very end we had a conversation about how sleep actually
3:53 affects your hunger hormones not only your physiologic hormone of hunger like that I am literally hungry that is one
4:00 of the things that people use glp1 receptor Agonist for now but sleep actually also affects something called
4:06 your emotional hunger and so that emotional hunger when we eat from emotional you know like when we’re just
4:13 emotionally eating gp1s don’t fix that so that’s part of the reason why they don’t work on everyone but sleep is
4:19 actually tied to not only physiologic but emotional hunger so that was a very interesting conversation that we had
4:25 towards the end so we are going to talk about this so I hope that you find this
4:31 very informative I hope that you learn lots of things about sleep so here we go
4:37 Dr Audrey Wells is a triple board certified physician with over 15 years of experience in sleep medicine obesity
4:43 medicine and Pediatrics she’s a leading expert in sleep Health specializing in diagnosing and treating Sleep Disorders
4:50 like sleep apnea and insomnia her approach goes beyond traditional treatment integrative Cutting Edge
4:55 technology non-pharmaceutical therapies like cbti and lifestyle Innovations to
5:01 help patients achieve optimal sleep Dr Wells has led has held leadership roles
5:06 in clinical and digital Health initiatives where she’s been instrumental in developing Innovative sleep Health Solutions she’s a
5:13 recognized thought leader and accomplished speaker known for her engaging presentations to audiences ranging from medical professionals to
5:20 Business Leaders and consumers she also has a passion for empowering others through education building having built
5:28 comprehensive sleep Health platform forms and virtual programs that have helped thousands of individuals improve
5:33 their sleep Beyond her clinical experience or expertise Dr Wells is an advocate for Women’s Health and a
5:39 champion of holistic approaches to Patient Care her entrepreneurial mindset and collaborative Spirit have driven her
5:45 to push the boundaries of what’s possible in the Sleep Health industry she believes in leveraging creativity
5:51 technology and data to transform the patient journey and deliver high impact Sustainable Solutions so thank you for
5:57 joining us on this episode pleasure to be here I love talking about sleep and
6:03 so getting the opportunity to spread the word is something that makes me really
6:08 happy well I you know I think that sleep is so important and you know I I talk a
6:15 lot about this on my podcast and just in general when people come to functional medicine doctors like myself I’m pretty
6:21 clear with them that if you’re not doing what I call the basics which are eating whole nutritious food moving your body
6:28 getting sunlight managing your dress and sleeping well then you’re probably wasting your time my time and your money
6:33 because everything that we’re going to do is not going to work very well in the environment that you are creating um and
6:39 so sleep is one of those really important things and I just think it’s not you know they don’t teach us about
6:46 it in med school really right like we don’t I mean we know you need to do it but that’s all they tell you and there’s
6:51 not a lot of good resources for people about sleep in general right it’s like okay we’ll get off your phone but
6:56 there’s no real like good uh explanation as to why people have issues sleeping
7:02 why it happens at different times different things to do so I’m really happy that you agreed to come in and chat with our audience and in general I
7:10 want to kind of focus on anxiety depression brain fog type symptoms just like I can’t get anything done it’s my
7:18 understanding that a lot of these symptoms sometimes like not only can sleep affect them like it’s kind of like
7:24 this revolving door right like if you have these symptoms it could be from lack of sleep and if you’re not sleeping
7:30 well it can cause these symptoms so it’s like what caused what right yeah and I see this all the time
7:36 uh for people who come to consult with me they have um a host of non-specific
7:42 symptoms and they’re concerned about other diagnoses like ADHD depression
7:48 anxiety because there’s so much overlap with how those disorders
7:54 Express and sleep deprivation or an undiagnosed untreated Sleep Disorder so
8:00 part of my role is to sort of take a comprehensive look at a person’s
8:05 situation their medical history and even their mental health to figure out
8:12 exactly what’s attributable to sleep problems versus other things I like that
8:19 so so my first question for you is like in what ways do sleep anxiety depression
8:25 ADHD like how do they all interact can you give us like a you know I guess big
8:32 overview of that yeah you know there’s um there’s no
8:38 mental health disorder in which sleep is unaffected so every psychiatric
8:46 diagnosis out there has sleep disruption as one of the features and it’s a matter
8:51 of frequency and degree but it becomes sort of a a feed forward mechanism or
8:58 someone call it a Down W spiral because if you’re not sleeping well your brain doesn’t work well and if your brain
9:04 doesn’t work well you don’t sleep well and so this that feed forward Loop can really work somebody into a tough spot
9:11 where they’re using medications they’re using substances they’re using maladaptive coping mechanisms to try to
9:18 uh pull themselves out of the situation and one way to think about it
9:24 is sleep is an enhancer so if you’re getting good sleep you feel good and
9:29 that’s one of the natural Pleasures available to us in life that feeling of being well rested and feeling like you
9:37 were able to get that delicious deep sleep that we all deserve so that
9:43 enhances our life that makes us happier more um present with family emotionally
9:49 regulated and better decision makers on the other hand if you’re not getting
9:54 good sleep then that enhances things in a negative way so it makes the world
9:59 look darker our negativity bias is more profound and it really um sort of puts
10:06 the lid on creativity and problem solving that all of us need just to make it through the world as human beings so
10:13 it can make um uh situations of anxiety or depression worse because if you feel
10:20 like you’ve lost the ability to make good choices or troubleshoot things
10:26 going on in your life it really accentuates the depression or the
10:31 anxiety that you’re dealing with so sleep uh and an emphasis on doing good
10:38 behaviors to get healthy sleep is a health step that is foundational and to
10:44 your point it’s something that you need to address if you’re dealing with mental
10:49 health issues I would completely agree so how do you know if anxiety depression ADHD
10:58 uh are related to or made worse by like this sleep problem how would you know
11:05 that um I advise people to take a look at their nighttime symptoms and their
11:11 daytime symptoms so um sometimes just
11:16 having things uh reported to you can be insightful so snoring restlessness
11:22 during sleep some um sleep behaviors can occur that are kind of red flags for a
11:29 person’s Sleep Quality if you’re not getting enough sleep that can contribute
11:35 uh to mental health disorders and if you wake up with different symptoms like
11:41 wake up with um sore legs or restless legs wake up with gasping for breath uh
11:47 these are indicators that there’s a problem that needs to be addressed and it’s interesting because even though all
11:54 of us sleep all of us experience sleep because it’s a state of
12:00 unconsciousness it’s a blind spot in our lives so sometimes sleep testing is
12:05 necessary to take a deeper look on the flip side of things you have daytime symptoms so how alert do you feel um you
12:14 should look for your Peak alertness to be in the late morning usually around 10 to 11 o’clock in the morning um how well
12:22 are you able to concentrate during the day what’s your memory like how is your mood regulation so if those things are
12:29 suffering um and especially if you have sleep symptoms that go along with it then it makes sense to maybe have a
12:37 consult with someone like me who can work out what needs to be the next step in determining if sleep plays a
12:44 role I think those are good points for sure I think that a lot of times people
12:50 especially women if you’re listening to this like we maybe just negate those things or we just you know keep going
12:56 keep going we don’t really listen to ourselves and so if you I think a good point and correct me if I’m wrong like
13:02 if you’re somebody who wakes up and you have from the second you wake up you’re just having a hard time getting out of
13:08 bed you’re tired you’re cranky I mean that’s not normal if you’re getting good
13:13 sleep typically now if you only slept 4 hours that’s one thing but if you’re somebody who’s getting a proper amount
13:19 of sleep is and you wake up and you just don’t feel really rested or well then I
13:26 tell people all the time like there’s probably an issue with the architecture of your sleep or how you’re sleeping or like I need you to go talk to a sleep
13:32 doctor I need you to have a sleep study because I don’t know you know I’m not there watching you I I do have a
13:38 question for you though what are your thoughts on like aura rings and these devices that track people sleep do you think they are helpful and
13:45 beneficial I do and and I’ll um I I’m not a person who likes to sugarcoat
13:51 things so I’ll give you the straight answer which is that we are only really at the beginning of leveraging consumer
13:59 Health trackers to help us uncover features about our sleep um so I have
14:05 two rings that I’m wearing right now and I test these things all the time to figure out you know how well are they
14:13 performing so as a general rule uh sleep trackers like Aura Fitbit whoop uh I’m
14:20 triling the ultrahuman ring right now all of these uh trackers are pretty good
14:27 actually at determining when you fall asleep and when you wake up so kind of the bookends of your night now they
14:35 report sleep staging for example but they’re not that accurate right now maybe about 70% 80% accurate at best and
14:46 the closer you are to the population of people that the devices were sort of
14:52 researched on the more accurate they’re going to be so if you uh deviate from
14:58 that healthwise age wise weightwise or sex-wise then they are less accurate now
15:05 I want to Circle back to something that you said which I think is really important and that is advocating for
15:11 women’s sleep women have more nonspecific sleep wake symptoms and
15:20 those can get mischaracterized as depression anxiety ADHD bipolar disorder
15:27 or just periods of high stress and I see this routinely um because women uh just
15:35 present differently and historically all the research and clinical experience has
15:40 focused on men’s sleep so this is kind of the template on which we look at
15:46 sleep uh as a whole but women are different and it’s a little bit similar to how women have different symptoms of
15:53 a heart attack you know it may be more indigestion or back pain instead of the crushing pain radiating down the arm so
16:02 I really advocate for women being one but also caring for my patients who have
16:08 very different presentations of sleep disorders compared to
16:14 men so this non-specific sleep wake symptom is that like you know I hear
16:20 women say all the time I wake up at 3:00 a.m. and I can’t go back to sleep and I don’t know why I woke up is that a
16:25 non-specific sleep W wake symptom or what does that mean it could be um so
16:32 there’s an emotional and intellectual burden that women carry as well and this is part of the way that we’re socialized
16:40 we’re Caregivers for the generation above and Caregivers for the generation below and I think women’s Brains become
16:48 quite busy uh at the beginning of the night or in the middle of the night and that’s a direct uh competitor with
16:55 sleep um another example of a non-specific symptom is the whole concept of sleepiness during the day
17:04 it’s more typical for me to talk to a man who says I can’t stay awake in
17:09 meetings or I can’t stay awake when I’m watching TV at night women don’t usually
17:14 say that they will instead report feeling just tired or exhausted or they
17:20 don’t have enough energy but they’re not dozing off typically in fact it’s it’s
17:26 rare that I’ll have a woman say like I could nap at the drop of a hat it’s more
17:32 that tired symptom and that’s non-specific but if you scratch the
17:37 surface or do a sleep test oftentimes I find something that would have otherwise
17:42 gone unnoticed that’s true when I think about it like I can feel tired in my body but
17:49 it’s not like I’m ever going to take a nap whereas my husband can sit on and watch TV and just like take a nap and
17:55 the same thing that you said like our brains are very busy I tell him all the time like he lays down and we can be
18:02 talking and he’s like out you know and I’m like how did you do that like it’s just like they can like disconnect and
18:08 just like leave the world whereas like I’m sitting there thinking about all the things you know so that’s interesting
18:14 that you put it like that so how so then the symptoms of women’s
18:19 sleep and sleep problems in women are definitely different in than women and men are those the only ways that you
18:26 feel that they’re different are there other ways just by the things you were saying like how we describe the symptom
18:31 do we have other issues and how we sleep differently than men is any of it hormonally related oh definitely um so
18:38 you’re talking about reproductive hormones um there’s uh changes in sleep
18:44 architecture among women who are um men trating uh girls going through puberty
18:53 uh pregnancy par menopause and menopause all of these hormonal shifts have a
18:59 sleep component that goes with it and it might be good or bad for example uh
19:04 women going through par menopause and menopause typically notice a decline in
19:10 their sleep quality that’s not only related to hot flashes um or vasomotor
19:16 symptoms so there is a reproductive uh hormonal component but I also think that even
19:23 though uh we can measure lots of things about sleep it’s still a very young feeli
19:29 and we’re not measuring something when it comes to women’s sleep here’s an
19:35 example when big populations of men are compared to big populations of women
19:42 what’s found about women sleep is that we sleep a little bit longer that we have a little bit more slow wave deep
19:49 sleep and yet women consistantly report less Sleep Quality than men so we’re
19:58 limit a little bit by what we can actually measure when it comes to sleep and for women it seems that there’s
20:05 something missing there’s a blind spot that would more directly correlate with a woman’s experience of their
20:12 sleep I wonder if some of that and this is just me as an endocrinologist is related to
20:19 testosterone because I will tell you that and what I see in practice men with
20:24 lower testosterone have a lot of the same sleep symptoms as women like I wake up at a.m. they’re just tired it’s it’s
20:31 interesting and as soon as you fix their testosterone I feel like their sleep gets a lot better um and then women you
20:36 know lose testosterone just like men especially in their 40s and I’ve replaced testosterone in women sometimes
20:43 uh when we need to and I will tell you that I have a questionnaire that they fill out and one of the fastest things
20:50 that I see improve on that questionnaire which is interesting is sleep when you give a woman testosterone so I wonder if
20:56 some of it has to do with that right and that’s why they just like men just pass out and go in this lovely
21:02 land and and are just happy fine because they have way more testosterone than us
21:08 so and then obviously when you lose estrogen as a woman in progesterone is going to affect her sleep but I wonder
21:14 if that’s a lot of it as well so I I want to go back to the auring because you said something and I know people I
21:20 have this question you said that the closer you are to the population that they made it for like what was that
21:26 population is this like a 30-year-old male like what is the population that the aura ring is the most specific in
21:34 yeah AA has gotten much better I have to say a couple years I I remember it was the summertime I was I had been using
21:42 Aura routinely and I noticed there was a change to their algorithm and all of a sudden it was much more in line with my
21:50 experience of sleep but also I routinely test the aura against home sleep apnea
21:56 tests or um level two device and different other pieces of technology that would be considered medical grade
22:04 so um yes historically all sleep has been on like young men
22:11 subjects but things are improving so this is a bit of a moving Target and
22:17 there are different sort of success rates for Consumer Technologies for
22:22 example and not to throw shade to Garmin but historically Garmin is one of the
22:27 worst uh trackers for sleep and accurate sleep metrics Fitbit tends to be good
22:33 Ora tends to be good so you know I think we’re getting better things are moving the algorithms are expanding and if you
22:40 think about all of this Collective data we’re getting from people who are using the devices you would expect things to
22:47 improve so I think the wild card here then becomes like medical conditions um
22:54 some environmental factors that might affect sleep and as you know the human
22:59 body and The Human Experience with the external world is a very complex
23:05 situation so from one night to the next you can have remarkable variation in
23:11 your own sleep even a sleep medicine expert doesn’t get perfect sleep every
23:17 night even though I know all of the things to do it’s like we’re getting all this information but it’s on a backdrop
23:24 of variability anyway what I like about the consumer device
23:29 though is it brings sleep to the Forefront of our conversations and helps us to connect
23:37 what am I doing that improves my sleep or what am I doing that makes it worse
23:42 so it it’s a behavior modification tool and for that reason I think it’s well
23:47 worth it to track one sleep yeah to your point you know when I because I have an aura as well an aura
23:54 ring and when I start using that app especially when your sleep’s bad it will prompt you like what was different last
24:00 night did you have alcohol did you and I thought it was just doing that so that I would recognize the things that were
24:06 making my sleep worse which I have changed a lot of things but to your point they’re probably doing that to track things too and to figure out
24:12 variations and and for you know the the benefit of what they’re trying to learn too which is was pretty fascinating and
24:20 so then they’re they’re updating this information how do they know whether you’re in Rim sleep or deep sleep or
24:28 like how are they just assuming based on like how you’re moving you’re breathing your heart rate like how do they know
24:34 that yeah REM sleep is kind of my white whale if I’m Captain
24:41 Ahab and part of the reason is you know we all need REM sleep we all get REM
24:47 sleep uh we could all stand to have more of it but it’s one of the more vulnerable sleep stages uh especially in
24:54 terms of breathing um and a feature of REM sleep is you get some uh temperature
25:01 variability so that’s one of the correlates you have some heart rate variability that’s more consistent with
25:08 being awake and there’s an algorithm that kind of takes a bunch of metrics
25:15 and then predicts whether you’re in REM sleep or not we know that for humans in
25:21 the beginning of the night you’re going to have very short brief periods of rim and those will increase as the night
25:26 goes on so there’s a probability Factor there as well but um Rim sleep can be
25:33 tricky uh and it’s one of the least accurate sleep stages when it comes to consumer health
25:40 devices and if you look at kind of the opposite of REM sleep it’s slow wave
25:45 deep sleep where your heart rate is very regular tends to be a little bit slower
25:51 and your breathing is very regular as well which produces more regular uh
25:56 blood oxygen levels so that’s another algorithm where it’s spitting out like
26:02 this prediction that you’re in slow way deep sleep okay that makes sense so what can
26:12 you explain to people in general you said something about HRV I think changes
26:17 in HRV what is like in general HRV what is
26:23 it what number do we want and then what affects it when we’re sleeping like is it just part of sleep that changes HRV
26:30 like does that make sense yeah and with your aura you’ve probably seen that metric reported
26:39 so let me just say that the research on HRV is a little bit in its infancy right
26:45 now so we don’t have good normative values or even a lot of perspective on
26:51 what you can expect um based on your age or your um other components of Health
26:57 but uh what is known is that it’s better in general to have a bigger heart rate
27:03 variability that’s what H HRV stands for a bigger heart rate variability means in
27:10 general a slower heart rate with more space from one beat to the next and that
27:17 indicates a higher level of parasympathetic functioning so that’s
27:23 that rest and digest mode that we all want to spend most of our time in but we
27:28 have competing factors like stress alcohol sedentary lifestyle dehydration
27:36 poor diet all of these things can conspire to put us more in a sympathetic
27:42 nervous system state which is the opposite of parasympathetic State caffeine is is another thing that will
27:49 reduce your heart rate variability and it’s something that I counsel people on regularly as they’re kind of
27:54 self-medicating with caffeine to compensate for Sleep issues but I think the heart rate variability
28:01 um just looking into the future will be a bigger have more weight as a health
28:07 metric and really inform how well we’re doing with things like Stress Management
28:14 and heart health yeah it’s something that I definitely look at on my ordering um and
28:20 it will kind of tell you you know you’re ready a score and things like that I do think that sometimes I’m like I don’t
28:26 know that that’s accurate maybe I don’t know where that’s coming from but I mean you I don’t know sometimes maybe you’re
28:32 not really super in tune with your body either so I do think that the Rings are good I think that I’ve changed a lot of
28:38 things one thing in particular just to be honest with you is alcohol like you know I was never a huge drinker but I
28:46 would have it a glass of wine or you know whatever and every single time I
28:51 had alcohol it changed my HRV it changed my rim sleep it changed all sorts of stuff so I told my husband you know last
28:57 month I was like I’m not drinking anymore like I’m just not going to drink this year and my it hasn’t done weird
29:03 things to my HRV so I do think that being able to see that is is pretty interesting because it’s never it’s not
29:09 like I woke up you know with a headache or felt bad but sometimes I would wake up and be like oh I just don’t feel like
29:14 I got like the best sleep and when you can actually see that to your point caffeine sometimes I’ll have tea later I
29:20 don’t do that anymore um so I do think it’s it’s beneficial for people to see that for sure yeah I agree and and you
29:27 know I think the alcohol issue is one of the um biggest myths I dispel
29:36 as a sleep medicine physician this concept that oh alcohol helps me sleep you know the night cap is something that
29:43 people often use is um a way to get to sleep faster but that’s literally where
29:50 the benefit ends every uh drink that you have has more and more uh negative
29:56 effects on your sleep causes some dehydration during the night which makes your heartbeat faster and reduces your
30:04 HRV for sure makes you hot all sorts of things yeah so why do you think can you
30:11 for the women that are listening to this why do they wake up at 3:00 a.m. I know you said something about their brain’s
30:16 really busy in the middle of the night but is there like some loss in hormone that causes this 3:00 a.m. Awakening is
30:23 it something that they’re doing you know the women that are like oh I wake up every night at 3:00 a.m. some of them wake up anxious some of them wake up CU
30:29 they have to go to the bathroom but is there like something physiologically that’s going on something changing with their hormones how do you explain that
30:36 to people and then talk to us about what people can do to like improve their sleep and make that not
30:43 happen this would be uh what I would wave a magic wand at if I had one you so
30:50 you already listed some of the factors that prompt a a middle of the night
30:56 Awakening MH and the frustrating frustrating thing about it is it’s not
31:01 necessarily abnormal to wake up in the middle of the night I want everybody to hear that you know waking up in the
31:08 middle of the night doesn’t have to be abnormal especially as you enter your
31:14 fifth decade your sixth decade of life you know you can’t expect to sleep like
31:19 you’re in your 20s forever however if you wake up in the
31:25 middle of the night and you think uh here I am again it’s 3:30 in the morning
31:31 I’m never going to be able to get back to sleep if I get back to sleep within the next 30 minutes then I can get two more hours and I may be able to function
31:38 well do you see this selft talk that goes on and you add a layer of suffering
31:44 to the situation that only drives sleep further
31:49 away there’s this concept of a negativity bias that becomes really
31:56 prominent uh in the middle of the night and it’s like reverting to a toddler
32:02 form your brain is basically functioning like uh a toddler brain catastrophizing
32:08 overestimating worrying and it’s a period where you
32:14 know we make really make it hard on ourselves if we start thinking about the future or the past and that prolongs the
32:21 time that we’re awake women I think have a tendency to have that internal chatter
32:29 that selft talk that has a negative vibe and that just prolongs the Awakening
32:36 plus if you’ve already satisfied some of your sleep need by sleeping the few hours before it’s harder to get back to
32:42 sleep so what can you do about it well first of all um there are several
32:47 techniques and so you’ll need to do some self-experimentation to see what works best for you but if you tend to wake up
32:54 and catastrophize or worry it helps a lot to to get out of bed or even just
33:00 turn on a low light and stay in bed and write those things down does a couple of
33:05 things for your brain one is the writing slows your brain down and it makes it
33:13 your brain focus on getting the words on to paper the other thing that it does is
33:18 it helps you feel seen soothed and safe and those sorts of emotions are
33:26 consistent with with sleep so you may have a chance of getting back to sleep if you can calm your
33:34 physiology for extra credit sometimes uh for people I’ll recommend that they have
33:40 a highlighter and actually highlight things that they can do something about because a lot of the stuff your brain
33:46 comes up with you have no control over so making the distinction can be really
33:52 helpful because if you can’t do anything about it there is no point in let it bouncing around your
33:58 head uh sometimes getting up out of bed can be helpful to do a reset stretching
34:04 deep breathing and and that type of thing but if it’s happening routinely
34:10 you mentioned cell phones before so I want to say if your brain is coming up
34:16 and being busy in the middle of the night it may be an indicator that you don’t have enough white space to let
34:23 your mind relax during the day now I’m going to ask you something you tell me
34:28 if you’ve ever had this experience have you ever been like taking a shower and you’re kind of going
34:34 through your shower routine and then all of a sudden you realize oh my gosh that’s a really great idea or you solve
34:40 a problem that you’ve your mind’s been working on has that ever happened to you almost every
34:45 day I I have yes because I know this so I have a way that I try to make this
34:51 happen in the morning because I know I’m creative because I do this brain dumping but yes I know what you’re talking about yeah yeah so what’s happening is that
34:59 your default mode network is is being active and it’s like when your brain
35:05 gets a chance to like move the puzzle pieces around and find a piece that fits
35:12 if you’re always connected to your device or you’re trying to make it through a to-do list with 33 items on it
35:18 you don’t have that opportunity for your default mode Network to play during the
35:24 day you don’t have that white space so it’s going to come up at night and you’ll have a busy brain that you have
35:30 trouble turning off to go to sleep I like that default mode Network
35:37 yeah so how long will it take someone to see improvements in their sleep when
35:44 they start working on their Sleep Quality like let’s say somebody does all the things they’re supposed to do right like I’m going to go to bed at the right
35:50 time I’m not going to be on my cell phone I’m going to make sure I have white noise not going to have caffeine I’m not going to have alcohol you know
35:57 how long long I’m assuming this isn’t just like an instant thing so how long do you typically tell someone hey this
36:03 you know you’re going to have to do this before they start noticing differences in their sleep the first thing I want to
36:08 say is it’s worth it it’s worth it and it’s going to take you longer than you
36:14 want it to usually usually it’s going to take at least a week but more than
36:21 likely two to four weeks before you’re really like ah okay now now I’m hitting
36:28 my stride it takes a little while for you to establish or reestablish trust in
36:35 your sleep it’s kind of like you’re in a relationship right so you have to show up consistently you have to do all of
36:43 the unsexy things that it takes to sleep well so your brain can trust that it has
36:50 that time uh reserved to sleep yeah so you mentioned your brain’s
37:00 kind of like a toddler brain overnight I like that toddler brain um can you explain to people what happens when you
37:07 sleep in your brain because I think there’s a lot of misconception as to what’s happening like are we forming
37:12 memories are we not are we cleaning our brain is our brain just mushed like what
37:18 is actually happening because I think it’s important for people understand you know a lot of people say well sleep’s
37:23 not really that important I can sleep when I’m dead yada yada yada there’s actually a lot of of really important things that happen when you sleep
37:30 especially from a hormonal standpoint that I’m aware of but can you explain to people why it’s important for them to
37:35 get a set amount of sleep how long you think that adults should sleep and then you know what’s going on in their brain
37:41 when they’re sleeping yeah those sentiments like I’ll
37:47 sleep when I’m dead or you know if there’s some sort of um weakness about
37:52 sleeping that’s a a very clunky opinion
37:57 and it’s really been disproven by science
38:03 um adults need between seven and eight hours of sleep to not only be healthy from one
38:11 day to the next but also to preserve their long-term
38:16 mental uh cognitive cardiovascular and metabolic Health that’s well known when
38:24 you start getting less than six hours of sleep you’re really damaging your health in fact um a study was done since we
38:32 talked about young men earlier uh I’ll tell you there was a study done looking at uh a group of young men College age
38:41 totally healthy what happens if you sleep deprive them for four hours a
38:46 night six nights in a row well what happened was they became pre-diabetic so
38:52 there’s something really important about sleep and all of the things that you mention are things that happen uh the
38:58 brain washes itself cleanses the metabolites from all of the exposures
39:04 and and thinking that we do during the day uh it moves some short-term memories
39:09 to longterm it decides which uh pieces of information have importance and how
39:16 much importance to assign those things we lay down procedural memory it’s an
39:21 emotional regulation tool and one of the functions of dreaming is basically to
39:27 use this virtual reality function that our brain is capable of to process
39:34 experiences during the day including stressors all of these things are so
39:40 critically important to our mental and cognitive Health it kind of resets us
39:47 and makes us new for the next day so we need that uh sleep in order to function
39:55 our best the part of your brain that’s most vulnerable to sleep loss is your frontal
40:02 loes the parts that make decisions the parts that are um you know kind of the
40:08 intellectual uh part of you it’s and when that frontal lobe gets sleepy it
40:14 becomes leaky so then the middle part of the brain the emotional Center starts to act
40:21 up and that’s the toddler part the part that is going to be emotionally disregulated
40:28 so sleep is really for the newest parts of our brain the emotional regulation happens too but it’s it’s so important
40:37 that it takes up a third of our 24-hour day so I think honoring that is really important so when you aren’t sleeping
40:45 what I just heard you say too is then if you aren’t sleeping enough your frontal load becomes leaky so then your midbrain
40:50 is going to start acting up so you’re going to have emotional issues and behavior issues so if you’ve already are
40:56 having issues with anxiety depression and then we’re not sleeping on top of that it just makes it worse not to
41:01 mention when we’re not sleeping well we’re not stimulating a lot of growth hormone and growth hormone is actually
41:06 needed to make thyroid hormone and to make estrogen and testosterone and progesterone and all the things that we
41:11 need to make us feel better and function during the day and so that’s why it’s just this big you know negative feedback
41:19 unfortunately once you start sleeping it’s like the spiral so it is really really important for people to to get a
41:26 handle on it right and like you said it’s going to change when hormones change and so just making sure that we
41:32 have good coping mechanisms good ways to understand how to sleep and finding
41:37 providers to help you you know figure out if this is an issue and not just
41:42 like woo woo your symptoms like you said to begin with is really really important agree I beat my drum about
41:50 this all the time and it’s um I think the term sleep hygiene is a little bit
41:56 cringey to me because it’s so overused um but I think you know when you make a
42:02 choice to reform your sleep it’s like you’re casting a vote for your best self
42:08 every single night and over time that adds up it protects your longevity it
42:15 protects your mental and physical health and really it helps us be the people
42:20 that we are striving to be to maximize our potential yeah I like that I will
42:26 just say one last piece which is that sleep can affect your hunger hormones
42:33 this is very hot right now and it’s not just sort of um the physiologic hunger
42:41 it’s also uh the emotional hunger that is not addressed with medications like
42:48 glp1 Agonist or uh other the oral medications uh for people who are on any
42:55 kind of weight loss Journey you have physiologic hunger you have emotional hunger sleep gets uh to a root
43:04 cause that can help you lose weight by addressing both physiological and
43:09 emotional hunger I like that okay so that’s good
43:14 to know so if you’re somebody listening and you had a hard time losing weight and you maybe have even tried the glp
43:21 ones and you’re still having issues it could be some emotional hunger from lack of sleep and do you think that has
43:26 anything to do with again when we’re sleeping like we’re supposed to and our brain is able to clean itself out our
43:32 lymphatic system and all that and we’re actually able to make hormones appropriately then our leptin and our
43:38 gin and our insulin and our cortisol are actually regulated correctly and so maybe that has something to do with it
43:44 what are your thoughts about that it definitely has something to do with it and another component is that if you’re
43:51 getting healthy sleep while you’re losing weight it helps you preserve your
43:57 muscle tissue which is metabolically active so it it’s sort of an accentuator
44:05 to help with calorie burn because you’re going to keep your muscle around you’re not going to get the wasting that can
44:12 come with weight loss yeah that makes so much sense okay anything else that we
44:18 missed I think that about does it okay so I appreciate you coming and and
44:25 explaining this to everyone obviously will’ll make sure that all your stuff is linked so people know how to find you do
44:30 you want to tell people are you active on social media do you have a website
44:36 are you on YouTube like how can people find you if they want to learn more information uh I typically direct people
44:42 to my website suers sleep md.com I help people with obstructive sleep apnea and
44:49 insomnia get all the deep sleep they deserve I also have a limited um
44:54 coaching practice uh for if people are interested in that they can go to awells
45:00 md.com and sign up for a uh consultation
45:05 where we determine if it’s a good fit there’s three questions that I always ask my podcast guests and so I’m going
45:11 to ask you these questions I think it’ll be interesting for your answers and don’t overthink them just very easy
45:17 questions but the first question is what is one food that’s most beneficial and why for me I think avocado is what I’m
45:26 going to go with uh I love avocados they make things taste yummy they have the
45:31 fat content that I like they’ve got the color I think they you can do great
45:37 things with texture um so that’s top of mine for me
45:42 okay is there a food in particular that stands out to you that maybe helps with sleep there’s these ideas like tart
45:49 cherry or kiwi help with sleep and the truth is there’s no one single food
45:55 that’s going to move the needle that much so when I counsel people about eating to
46:00 sleep well I tell them eat uh low processed
46:05 foods get your fiber in get your healthy fats in and stop eating three hours before you go to sleep so those are kind
46:13 of the loow hanging fruit so to speak when it comes to uh managing your food and sleep together okay what is one
46:22 thing that anyone can do that will improve their sleep let’s say say I I
46:27 normally ask Health but what is one thing anyone can do that will improve their sleep that’s completely free I my
46:33 mind goes to exercise or light exposure both of these things improve sleep so
46:39 bright light exposure when you first wake up in the morning sets a little timer in your brain such that 16 hours
46:46 later you’re more likely to be sleepy and fall asleep well exercise kind of
46:53 the same effect right you’re you’re really kind of um getting your heart rate up you’re
46:59 getting your body temperature up and what that does is it pulls back the pendulum for
47:05 wakefulness such that it releases and swings for the other direction for sleep
47:11 so light and exercise are two things you can totally manage it can totally be
47:17 free to improve your Sleep Quality love both of those and then the
47:23 last question is what is one thing you wish you would have known about your health or health in general 20 years ago
47:30 that you would have done differently I I wish I would have known what it took to
47:36 get over my own insomnia that was a hard thing for me and it’s part of the reason I’m asleep
47:42 doctor now I have been through a couple things in my life uh that really knocked
47:49 me back and I’m prone to insomnia insomnia
47:55 was a huge problem for me and I had to dig deep to overcome it so
48:01 I like to say I’m not just book smart about sleep I’m Street Smart too um and I think when I was in it I
48:10 couldn’t see my way out now I know what it takes and I think it makes me a better doctor as a result for sure I
48:17 completely agree with that most of us that are really passionate and com you know compassionate about what we do are
48:24 it’s because we we’re helping somebody that we once were right so that makes
48:29 sense and you know to all the providers listening to this too and I’m sitting here thinking this most providers if
48:35 they’ve gone to medical school have suffered with some sort of sleep deprivation sleep insomnia like
48:40 especially if you went when I went when there were no workour rules right like you definitely stayed up and did shift
48:47 work and just did really bad things to your body so you know if don’t do that
48:54 like if you have the option don’t do that you know that’s what that’s one of the things I wish I would have known 20 49:00 years ago about my health is how important sleep was because I kind of was in that generation of like oh well
49:05 you can sleep when you’re dead it doesn’t matter go go go go go even if you do feel like physically tired and I
49:11 just wish that that’s something I would have you know really latched on to in my
49:16 20s and instead of you know worrying about what everyone was doing at 10:00 at night or 11 or 12 and all that I wish
49:23 I would have just went to bed like I do now cuz I have zero now I don’t care if it’s past 9:00 you will find me in bed
49:31 period you know I agree that’s a tough lesson to learn isn’t it I mean
49:36 especially for someone who has a high internal drive and I I talk to
49:43 Physicians um who you know to this day have sleep problems those who take call
49:48 those who have you know ICU oby Ed careers um sleep directly competes with
49:57 your decision making and your safety on the job your safety off the job as well
50:02 um so yeah I I applaud that uh I think that it’s a tough lesson to learn and
50:09 sometimes we don’t learn it until we’re in our the middle of our career but um
50:14 just for your well-being it’s so important I would agree well thank you Dr Wells for joining me and helping
50:22 educate all of our guests I appreciate you and then if you’re listening to this and you listen to this podcast and you
50:29 think this would be beneficial so if you know anyone who’s struggling with sleep which would be most women in their 40s
50:35 or 50s or you know anyone in general who this would help benefit then please make sure that you share this episode with
50:41 them make sure you leave us a review um and like or follow our show we’re on
50:47 every Sunday and then make sure you tune in next week for another episode thank you I hope that you found this episode
50:54 with Dr Audrey Wells as informative as I did I hope now that you understand and
50:59 have a little bit more basic knowledge about why sleep is so powerful why you need s to eight hours of sleep per night
51:06 and all the great benefits that sleep can give you including that control of emotional in
51:12 physiological hunger so if you thought this episode was good was beneficial you
51:19 know someone who struggles with sleep issues and you should because one in three Americans do please make sure that
51:24 you share this episode with them that’s we do this to educate so make sure that you share this episode with them make
51:31 sure that you know you’re listening to it make sure that you try to take away some of these key things that we discussed to make your sleep hygiene
51:37 better if you enjoy this podcast please make sure that you like it leave us a review so we know we’re doing a good job
51:44 make sure that you’re following us so that every week when the podcast comes out you’re getting notifications so you
51:50 don’t miss any of my great guests I have so many guests coming that I’m super excited about and if you are somebody
51:56 who’s struggling with sleep or any of the things that we discuss on this podcast especially hormone-based remember that modern endocrine now sees
52:04 people in 21 states we are still looking to expand but we have active licenses in 21 states those states are listed on our
52:11 website which you can find in the show notes we do do virtual visits if you are on in any of those 21 states if you are
52:18 not and you would like to become a patient you can come to Oklahoma City to our clinic for your first visit we would
52:23 be happy to see you and then we can see you virtually after that we would love the privilege to help you
52:29 in your medical journey and also just make sure that you tune in next week because again I’ve got a lot of great
52:35 episodes coming for you and they’re all things that you guys have asked about thank you so much for your time have a
52:41 great week the information presented including any materials discussed referenced or
52:48 linked within this podcast are for General educational purposes only not
52:53 the practice of medicine no doctor patient relationship is formed from you listening to this podcast or utilizing
52:59 any of the information provided I am a doctor but I am not talking to you as your doctor the information provided is
53:07 not intended to diagnose or treat health problems or take the place of the professional medical care provided by
53:14 your doctor if you are experiencing any health problems including problems you believe have been touched upon in any
53:21 respect within this podcast you should consult your doctor about the problems without delay you may ask your doctor
53:28 whether he or she believes the information I have provided would be helpful to you but you should still consult your doctor immediately and
53:35 follow his or her medical advice as your treating physician I’m just here to provide you basic knowledge about the
53:41 issues we discuss so you are more aware of them and can better discuss them with your doctor that’s why we call it back
53:48 to the basics join me on the next episode as we continue our journey
53:56 [Music]
Disclaimer:
The information presented including any materials discussed, referenced, or linked within this podcast are for general educational purposes only, not the practice of medicine.
No doctor-patient relationship is formed from you listening to this podcast or utilizing any of the information provided.
I am a doctor, but I am not talking to you as your doctor. The information provided is not intended to diagnose or treat health problems or take the place of the professional medical care provided by your doctor.
If you are experiencing any health problems, including problems you believe have been touched upon in any respect within this podcast, you should consult your doctor about the problems without delay. You may ask your doctor whether he or she believes the information I have provided would be helpful to you, but you should still consult your doctor immediately and follow his or her medical advice as your treating physician.
I’m just here to provide you with basic knowledge about the issues we discuss so you are more aware of them and can better discuss them with your doctor.
That’s why we call it Back to the Basics. Join me on the next episode as we continue our journey.