Creating Great Habits for Sleep: An Interview with Molly Maloof, MD

Creating Great Habits for Sleep: An Interview with Molly Maloof, MD

What follows is a transcript for the podcast The Science of Sleep - Dr. Molly Maloof - Sleep

Topics include the following:

  1. Why Is Sleeping a Challenge for Most People?
  2. What to Eat in the Morning for Good Sleep
  3. What Are the Four Sleep Chronotypes?
  4. How Hyperarousal Hurts Sleep Quality
  5. Greg and Molly’s Experience of Sleep Deprivation
  6. Why Do I Feel More Tired if I Get More Sleep?
  7. What Is the Homeostatic Sleep Drive?
  8. The Benefits of Balance
  9. Creating an Evening Routine
  10. Creating Safe and Comfortable Environments for Sleep
  11. Mitochondria and Sleep
  12. What’s the Best Way to Start Your Day?
  13. How Does Lighting Impact Your Circadian Rhythm?
  14. Evening Routine Tips
  15. About Dr. Molly Maloof

Why Is Sleeping a Challenge for Most People?

Greg Kelly, ND: This is Dr. Greg Kelly, director of product development at Neurohacker Collective, and we're really lucky to have Dr. Molly Maloof with us today. I get an opportunity to be in this really smart person WhatsApp group on anti-aging with Dr. Molly, and see her great contributions, and her and I have done a couple of collective insight times together, so I'm really looking forward to sharing Dr. Molly with you today. We're going to talk about evening rituals, and sleep biohacks, and other cool things, so that you'll better understand both how sleep works and how to have a better quality night's sleep. So, with that, Dr. Molly, welcome.

Molly Maloof, MD: Hi. Thanks for having me. It's a pleasure to be back. I've really loved every podcast that we've done together. You guys just have such amazing products, and the research that goes into them is so unbelievable. I always learn about new ingredients through you guys, and I know that you guys have a whole team of researchers, and I think that's what it really takes to bring these new products to market, is to really have people who can dig deep into really the fundamentals of the problems that you're trying to solve with the ingredients and supplements that you've created.

One of the first things I tell anybody who's trying to optimize their sleep is, you've got to get a handle on your stress, and you have to get a handle on what are your sources of stress, right? Because this is part of why people suffer at night, is they can't turn off, and their bodies also feel like there's unsafety, and so they wake up, and their bodies are trying to protect them. Their bodies are trying to be extra vigilant, because in primitive times, being extra vigilant would have saved your life in the midst of potential danger. The difference is, the danger we have now are things like stress.

And so, the problem with a lot of people's sleep is actually their daytime stress.

What to Eat in the Morning for Good Sleep

Greg Kelly, ND: One of the things, when I used to work more directly with people for sleep, that I would often try to hammer home is, how you start your day is going to make an outsized impact on how you end your day.

So, I know for me, two tips I would always give people for starting their day is, you want to get some kind of protein early in the day. So, a starchy carb breakfast, not ideal if you're struggling with sleep. It doesn't have to be a lot of protein, but something, and that's because tryptophan, which is in most protein-containing foods, is really important at the beginning of the day.

And the other thing is morning bright light. Again, it doesn't have to be a lot, but ideally, if you can even get outside for a 10-minute walk and get oriented to that morning light, that actually sets our circadian system. It anchors it in the beginning of the day, and the ripple effect of that is the circadian system at the end of the day tends to perform better.

Do you have any other morning tips?

Molly Maloof, MD: I mean, I think we should throw out daylight savings time, personally. I think it's out of date. I think it's just so silly. I don't get light in the morning, I just feel my mood is way, way lower. So, a lot of people aren't getting sunlight because it's wintertime now, so light boxes are really good options. There's actually some websites that you can check your chronotype, and a lot of people don't even know whether they're a morning type or evening type, and that does make a difference in terms of ... I mean, what do you get, what do you feel the best?

What Are the Four Sleep Chronotypes?

Greg Kelly, ND: I'm a lion. Like Dr. Breus's work, the Power of When. I test out as a lion. I think that I used to be a bear. For the audience, [crosstalk 00:08:13], but I'll just give quickly his four chronotypes. So, lions would be people that naturally wake early, ready to go, hard chargers. Definitely morning people. Bears would be the more normal distribution, half of adults. The wolves are people that would be, you're classic night owls and do well. And then, dolphins are people that typically, similar to what you mentioned with the hyperarousal, their brains almost are constantly scanning the environment for safety and other things.

Molly Maloof, MD: Oh, interesting.

Greg Kelly, ND: So, that would be his four prototypes. In a lot of chronotype research, they use birds, so night owls, morning larks.

Molly Maloof, MD: That makes sense.

Greg Kelly, ND: To change the archetypes a little bit. But you know what?

Molly Maloof, MD: Yeah?

Greg Kelly, ND: They're not something that's set in stone for our entire life.

Molly Maloof, MD: Right. I used to be a total night owl, but I think a lot of it was bad habits around sleep. Like typically, when I see people go to college, and they just drop into these terrible habits, because they're going out late on the weekends, or sleeping in, and then they go and they study late, and they're in light time, there's computers in their face until late at night. And then before they know it, they're night shifted.

But when I first started working for myself in, gosh, I think it was 2012 or so, I remember fixing my sleep was a big priority, and I started letting myself go to bed earlier and waking up later, or waking up earlier in the morning, and start. So, I became, over the years, I've actually become a morning person, where I typically get up around 6:30. I feel really good in the morning. And I like to go to bed early. I like to go to bed at like, 9:30 or 10:00. To me, sleep right now is such a luxury. Anybody who's been under a lot of stress needs a little bit more sleep than they realize.

In terms of why you guys included things like holy basil and schisandra, as well. I would say these are my top three adaptogens that I prescribe my patients, because they just work. They are so consistently helpful for getting people to feel more balanced, in terms of their stress system, that it was really nice to see that you guys had those. And also, things like magnesium, which a lot of people are deficient in, and then I'm guessing you picked B6 for the production of melatonin, because of that tryptophan and serotonergic system?

Greg Kelly, ND: Yeah. B6 is variably for any neurotransmitters that are trying to make their B6-dependent enzymes.

Molly Maloof, MD: Yeah, that makes sense.

How Hyperarousal Hurts Sleep Quality

Greg Kelly, ND: And it goes really well with magnesium as a combo in neurotransmitter support. You mentioned the hyperarousal again, so before we go any further, I want to give our audience just a quick layout of hyperarousal. So, hyperarousal simply means that aspects of our brain, or our physiology, or our emotional state are a little bit more on alert, like more aroused than they should be. And when we have that going into the evening hours, it can really make it difficult to fall asleep and get good quality sleep. So, what you would classically see is a lot of people that are challenged with sleep and have significant, long-lasting challenges would have some aspect of hyperarousal. They tend to go end to end. And as Dr. Molly mentioned, when we were designing Qualia Night, hyperarousal was a big focus.

Molly Maloof, MD: Yeah. And then, you've included things like L-theanine, which is a pretty, it's one of those supplements that most people can really feel. Like, when I have L-theanine, I'm like, oh, wow. I generally feel more relaxed. I just feel better. Do you want to talk a little bit about L-theanine? It seems like it's in everything these days, but it just seems to make me feel so calm. Do you know why that is?

Greg Kelly, ND: Yeah, I mean, one of the early studies on it have to do with shifting our brain into a more calm state, so supporting healthy brainwaves.

Molly Maloof, MD: That's cool.

Greg Kelly, ND: It's a really good stress. It for sure has interactions with the GABA system, which is like our braking system for the brain. So, it starts to slow it down and make it so that our brain is not as driven. A much less-known action is that it actually is really supportive of the immune system. It does a super [crosstalk 00:13:02] on boosting a subset of T-cells called gamma delta cells, and the best way for our audience to think of those is, our immune system is capable of becoming fitter and smarter, and when challenged by certain compounds, some immune cells literally get bigger, stronger, and faster. And L-theanine happens to be one of the main things that does it for gamma delta T-cells. So, that's not why it was, per se, in Night, but it's a nice, positive side effect to be getting immune support, as well.

Greg and Molly’s Experience of Sleep Deprivation

Greg Kelly, ND: One thing I wanted to do also, before we move too far, is I'm sure ... We already mentioned you were a night owl when you were in college.

Molly Maloof, MD: Yeah.

Greg Kelly, ND: I was, too. I was through the Navy. Even through most of my naturopathic degree. So, until my, say, early 30s, I was a night owl.

Molly Maloof, MD: Oh, me too.

Greg Kelly, ND: So, it's not a problem falling asleep or staying asleep, but my circumstances did not allow for nearly as much as my body would need to thrive. Part of that was in the Navy. Being an officer, being out at sea, being rotating shift work. Part was when I was in naturopathic school, and the long, crazy hours then. Part was taking a job at one point during naturopathic school to pay for some extra room and board, et cetera, and working three nights a week from 8:00 in the night until 8:00 in the morning, and still having to go to class and do clinical shifts and things like that.

So, I lump all that in as sleep neglect, right? There's not a problem falling asleep. Sleep is just being neglected, either because of circumstances, or because we're not aware that sleep should be, like you said, like you look forward to sleep. So, tell a little bit about your sleep adventures.

Molly Maloof, MD: I mean, the reality is that I had terrible sleep when I was ... I mean, I was one of those kids who was like, oh man, if I could just not sleep, I would be so much more productive. And I would just sacrifice sleep for what I called productivity. Like, you think you're getting more work done, but you're actually damaging your performance. And I was in med school, and I was just pretty burned out. It was about halfway through med school. I was like, something's not working.

And so, by the time I took my second board exam, I had fixed my sleep, and my performance was in the top percentile. So, everybody was kind of like, "What did you do? Did you cheat?" I'm like, no, I actually just changed my lifestyle. I started sleeping. I started exercising. I started eating normal at mealtimes, and stopped drinking so much coffee, and I did better.

I think one of the things that's really motivated me to be a doctor dedicated to health, instead of just disease only, is just knowing that if you sleep better, if you actually get better-quality sleep, if you take care of yourself, if you're not constantly relying on caffeine to give your body the impression it's got wakefulness, even though it's really just suppressing the adenosine drive by blocking the adenosine receptors, if you really just stop doing the things that your body ...

Kind of like, what we're doing wrong, unfortunately, with our society is, we're kind of using our bodies, we're kind of exploiting them as a means for productivity. We're kind of saying, it's just a body. It's here to do work, and we're here to eke every single inch of productivity out of this device. But that's led to burnout and breakdown.

So, yeah, for me, getting sleep right frankly was a huge, huge, huge performance enhancement experience. And it's so funny to me, because I thought sleep was something you had to sacrifice for better performance, and now I know that sleep is literally the path to better performance. And so, because it was one of the first things that I optimized, I stopped thinking about it, and I stopped caring about it, because it was so dialed that, wow, it was something that I just do.

But now, I'm starting to ... For years, it's still always been a big part of my worldview on health. Sleep, plus exercise, plus proper nutrition, divided by stress, is obviously wellness. And it's really how we create more bioenergetic capacity. Now, I haven't proved that necessarily with science, but I've seen it clinically really make a difference. If your sleep isn't good, you'll never fully recover. You'll always have issues with cortisol regulation. Your metabolism will never be perfect. You won't have the energy to exercise. In fact, you're more likely to get injured if you exercise sleep-deprived. So, it's just so fundamental to health that we must pay attention to it if we want to live as long as possible.

Greg Kelly, ND: Well, and I think ... I go back to my time in the Navy, where on a good week out at sea, I would maybe get allowed four hours of sleep, right? That was your window to sleep, and were still likely to be woken up by sailors because they needed your attention for something. And I remember, at one point I was in practice in Connecticut. I lived right by Yale in New Haven, taught naturopathic students at the University of Bridgeport, as part of their degree. And so, one of the things I remember, this was in a Starbucks, literally right across from the main gate at Yale, and I knew some nurses, just to have tea, coffee with, from seeing them there, and they knew some of the doctors, or medical students.

But I remembered essentially saying that they'd been told during residency to expect that most of them would gain weight. Maybe 10% at most would gain significant weight. And at the time, it fascinated me, because they hadn't made the connection it was because of the sleep deprivation. They'd made the connection this stressful situation was going it. But now, we know that in a very real sense, we're in a sense hibernatory animals. If we don't get enough sleep over the next month, six months, yeah, or longer, I believe there's a part of our brain that literally thinks at some point, Greg's going to pay the sleep back, so I've got to store extra fat and energy for when he hibernates.

Molly Maloof, MD: Oh, wow.

Greg Kelly, ND: That's my story about sleep. Now, I think we all have stories that help us. And so, with that story, at that time, when I was post the Navy, post naturopathic school, it finally dawned on me how important sleep was. So, this was about ... I think it was after reading T. S. Wiley's book, Lights Out, so sometime in 2000-ish. But I literally, one winter in New Haven, decided that I was going to hibernate. My start was, okay, it was winter. It was pretty easy. But that come 6:00, 7:00 at night, I was going to just turn off the lights and see if I could go to sleep.

And my recollection, and this was 20 years ago, was that on the first 10 days to two weeks, I slept close to 12 hours a night, then slowly 11, and by three, four weeks in, I was back to sleeping closer to my normal eight hours before. And my hands were always cold. I was diagnosed at some point between the Navy and naturopathic school, I used to be horrified, my hands would be like these icicles.

Molly Maloof, MD: Yeah, I used to have the same problem, by the way.

Greg Kelly, ND: Yeah, and so, that winter, all of the sudden, my hands became warm for the first time I could remember in my adult life. And these other things also kind of fell in place. So, that idea of hibernating, I think, to my baseline story, is that if Greg can sleep, Greg needs sleep.

Molly Maloof, MD: Yeah.

Why Do I Feel More Tired if I Get More Sleep?

Greg Kelly, ND: And what I often saw when I would coach a patient or friend to sleep more, is their initial response was quite often, they felt more tired than before. I have my story about why that would be, but do you have any insight why that might be?

Molly Maloof, MD: Can you repeat the question real fast?

Greg Kelly, ND: When someone that's really sleep deprived sleeps more, it's not unusual that they would experience being more tired than normal. My story is, if you can sleep, you need sleep. So, how do you ... I know how I make sense of those two, but I was wondering if you might.

Molly Maloof, MD: Well, typically when I see someone who's really sleep deprived, I usually have them wear a wearable to see ... Really, I think wearables do two really good things. They do sleep amount, like what's the total amount of sleep that you're in bed, and they let you know the latency, so how quickly did you fall asleep? I don't think they're really good for REM, or for deep sleep. I get totally opposite numbers on Whoop, versus the Oura ring, so I'm really not sure who to trust. So, I don't really totally believe those devices really know how to measure REM or deep sleep. I think you have to wear that on your head. But I do think that when someone is sleep deprived, their latency is like, boom. They'll go right to bed. Alternatively, there's people who just don't fall asleep properly.

Greg Kelly, ND: Yeah, that's the one higher, right?

Molly Maloof, MD: Your body accumulates a sleep debt. And I think the biggest thing that, it sounds like what you went through, what I would interpret that as is your body was under a lot of stress, clearly, by the way that you were living your life, and by giving yourself the time to heal through sleep, which is what it needed, you were able to re-regulate the autonomic nervous system, which needed far more parasympathetic activation than it was probably getting.

And this is really problematic for the majority of Americans right now, is like everyone is in fight or flight 24/7. They're going to bed working, they're waking up on their phones, they're looking at their Gmail. They're nonstop all day long, and then they don't take breaks throughout the day. They're sitting all day long. And then, before you know it, they just can't turn off. They just have this internal dialogue they can't turn off. 

Hyperarousal, these type of can't turn off, can't relax, it's really an autonomic nervous system disruption, and that certainly relates back to cortisol dysregulation, catecholamine access. Just not living a lifestyle of enough rest and digest. You often see gut dysfunction in these individuals. I know I had some gut dysfunction this year, because of the amount of stress that I put myself under.

We really do need to balance the fight or flight with the rest and digest, and we often don't do that. We don't do that because, frankly, I didn't do that for the majority of my 20s, while I was in med school, and residency, and college. There's just so much. I just remember the majority of my youthful years ... I'm still pretty young, I'm 36. But since high school, college, to medical school, to residency, it was just like incredible amounts of work, and then burnout. Incredible amounts of work, and then burnout.

I would collapse on vacation with my family. I would literally just sleep the entire week. I would be on the couch like a slug, because I just couldn't move. And inevitably, I got sick that week, because my immune system was finally given the space to actually react. So, yeah, it was super interesting.

Greg Kelly, ND: Yeah, I've seen that pattern of getting sick on vacation quite frequently, actually. So, my story is ... What you were just describing was like the sprint, the mad dash. I've actually been in some job situations for startups, where it was just one sprint after another. It was just endless sprints, right? Where now I'm much more, I think of myself as a grinder. I was obviously when I was younger, but even by the time I did my master's degree pre-being a naturopath, I was one of those people, I would start on my term paper week two, and have it done before school ended. I would just do a little every day, just grind away at it. And so, I like the turtle approach to things. I'm not, don't make me sprint repeatedly.

Molly Maloof, MD: Oh, yeah, no. I mean, it's taken me years to develop the brain and lifestyle habits to actually get my work done on time and early. To get to meetings on time and early. To just be ... I just have to basically get everything done ahead of schedule. I set early deadlines for myself, so that I don't end up procrastinating. That's a hugely problematic that a lot of people have.

Greg Kelly, ND: I had it when I was younger, and I think something about being in the Navy helped me.

Molly Maloof, MD: Yeah, discipline. Discipline is everything.

Greg Kelly, ND: My story is that from a mind-body perspective, at least, our being is going to try to hold it together, and when we get to where it finally feels like, okay, I don't have to, I can just relax, then that's when sometimes that minor sickness.

Molly Maloof, MD: Right.

Greg Kelly, ND: So then, I had asked about the people that, when sleeping more, all of the sudden were giving feedback to me, "Dr. Greg, I'm feeling even more tired. There's something wrong with my sleep." So again, that's my story, is that when that part realizes, oh, sleep is all of the sudden going to be a priority, I can start to pull out of the closet all of this accumulated sleep debt, and start paying it back. Now you experience, for the first time maybe in a while, how tired you are, where before your body was essentially combating that. And so, I tend to look at it as, if someone said, "Dr. Greg, when I started sleeping more, I felt even more tired," that's someone that really needs extra sleep. They probably have a big accumulated debt that they need to pay back, like I would have had, maybe, in naturopathic school.

So, with those two things, there was a couple of other things you mentioned that I want to give some attention to.

Molly Maloof, MD: Sure.

What Is the Homeostatic Sleep Drive?

Greg Kelly, ND: You mentioned adenosine, really in passing. I do want to make sure our audience understands that. That's called the homeostatic sleep drive. Adenosine is a molecule in that, and I'll turn it over to you just give a quick what you know of that system.

Molly Maloof, MD: Okay, so as a lifelong coffee drinker since sixth grade, I recently realized that coffee was no longer doing me any favors of health. I think I'm estrogen dominant this year for the first time. I had developed some ... my HPA, my [inaudible 00:30:22] to adrenal access was a little thrown off by the amount of stress that I've been under for the last couple of years, and so it was a pretty strong signal that when I was drinking like, three cups of coffee, I would start feeling my kidneys. I would be like, oh crap, I can feel literally the pain in my back. Chinese medicine would tell you that you're too yang energy. You need a little bit more yin. It's funny, this year, I just totally poured myself into so many projects.

So, as I've been trying to cut back on coffee, I've been trying to understand the first principles of how coffee works in the body, so what's the underlying mechanisms? What is the sort of reason why coffee makes us feel awake? And I discovered that coffee essentially, it inhibits the ... it basically binds to the same receptor as adenosine. Now, when adenosine binds over time, it builds up throughout the day, it will make us feel sleepier. But when we block that receptor site with caffeine, we just stay ... we get the sensation that we're awake. It just gives us the sensation of wakefulness. So, it's blocking the wakefulness inhibition, right? It's kind of hard to explain that way, but essentially, it's blocking adenosine's ability to bind, so that it suppresses the tiredness we would get throughout the day from more adenosine building up.

Greg Kelly, ND: Yeah, the way I think of it, I'm going to oversimplify it to the point that this is probably wrong, but it's more understandable, more understandable for me. It's called the homeostatic sleep drive, but I think of it as an accounting system. So, the general sense is, thing of sleep like an account, like financial. It can never run in the black, so we can never profit, we can only create a debt. That's often referred to as sleep debt. And so, from the minute we wake in the morning, we start to accumulate that debt, and that's what adenosine does. As it builds up, it's essentially the signal in our brain that we're going deeper into the red. And then ideally, when we go to sleep, we would pay back that accounting and wake up, the books would be back balanced.

So, adenosine is the key molecule in that sleep accounting system, and as you mentioned, when we take anything with a lot of caffeine, so coffee obviously being the common example, we're essentially putting a little bit of error into the bookkeeping system, for lack of a better way to describe it, and especially if we start to drink a lot of caffeine late in the day or in the evening, we're going to for sure throw a wrench in the system.

Molly Maloof, MD: Oh, yeah. And a lot of this has to do with different genetic markers. There's obviously the caffeine detoxification enzyme, I think it's CYP12A, or something. I might be wrong on that number. But basically, it's if you're a fast or slow metabolizer. I'm a fast metabolizer of caffeine, but I still do not feel well when I drink too much coffee late in the day. Now, if you're a slow metabolizer, if you have any caffeine, it tends to last a lot longer in the system.

So, what I've been reading about, as people go off of caffeine, one of the things that most people notice is this massive improvement in sleep. And so, I'm going to be doing a full detox soon, when I have a little bit of space from work to do that this winter. I'm very nervous about it, but I'm also excited, because it's almost like I'm giving my body the ability to fully rest for the first time in a long time.

I think everybody could probably benefit from doing this a few times a year. Actually, Daniel [inaudible 00:34:18] told me personally that he felt that people should do a caffeine detox a few times a year, just to reset the adenosine systems in the brain, and enable the brain to start regulating properly. So, what do you think of that?

Greg Kelly, ND: Yeah, Daniel still, last time I spoke with him, he still advocated that. So, we even did that for our product, Mind, that has caffeine, that people take, every quarter or so, at least a week to 10 days or two weeks off, to just give the adenosine system a break. It's not a hard and fast rule, but it's certainly one that I think is an advantage to integrate in.

The other thing, when you were speaking about this on Audible, one of the books for Audible members, it was probably this time last year that came out was Michael Pollan on caffeine.

Molly Maloof, MD: Oh, yeah.

Greg Kelly, ND: It was released, it was just an Audible project, and it was brilliant.

Molly Maloof, MD: I'm going to have to listen to that.

Greg Kelly, ND: He actually went off caffeine to write this mini-book on caffeine, and one of the things he found is that for him, caffeine actually helped him be more productive, to be motivated.

Molly Maloof, MD: Why does it make you more productive? Because it helps, it actually affects the dopaminergic system. It plays a role in that, in actually modulating the dopaminergic system, which we know makes us more motivated. It also released catacholamines, right? Catacholamines get you to move, they get you to act. So it's like, focus and motivation leads to performance, right?

This is part of the reason why I personally have lived most of my life packing my schedule with so many things, so that I can get my own body to produce dopamine and catacholamines. I wouldn't recommend it, but I would definitely ... I have to be honest, I'm definitely for the first time in my life really approaching performance from a place of balance, rather than from a place of exploiting my body for productivity. And I think that we have to shift the wellness industry towards a new model, because a lot of the biohackers that I know, a lot of the health leaders that I know, everybody's taking stimulants. Everybody's kind of addicted to their source of stimulation, in order to pump out more work.

The Benefits of Balance

Molly Maloof, MD: It's funny, because if you ask ... There's this great book on, there's this woman who wrote a book on the five regrets of the dying, and she was a palliative care nurse. She basically discovered that one of the main regrets of most people is that they wished they would have worked less. So it's like, I'm all for performance, and I am certainly an ambitious young lady, but I really think that we'd all benefit from more balance, at least between our sleep and our wake. Our wakefulness and our sleep cycles, our circadian rhythms, our stress and our rest. I think the whole country would benefit from better balance.

I think the difference between me and the vast majority of people that I know is, I have lived multiple lifetimes, and I'm only 36. The last 10 years, when I left the mainstream medical and healthcare system, and I started working for myself, I truly started living. I truly started doing things on my own terms. And I was supporting myself. I had full autonomy.

And I'm not necessarily recommending everybody drop out of their industries, or leave their corporate jobs, or leave the hospitals they're working in. But I get an email at least every week from some student, or some resident, or some doctor, who's like, "How do I do what you do? How do I be the kind of doctor that you are?" And I'm like, "Well, you're going to have to sign up for a very different type of lifestyle than you're used to."

Because you have to be in charge of your existence, and by being autonomous and being in charge of my own life, I've gotten to travel the world. I've been to 18 countries. I've been to all sorts of cool conferences. I've met incredible entrepreneurs. I mean, I've met the most amazing patients. I've had patients that have accomplished enormous feats. And I've been able to live in some of the coolest cities in the world.

I mean, I believe that fortune favors the bold, but I don't recommend doing what I did unless you are willing to take major risks. I think part of it is luck, but also, part of it seeing other doctors like me do things differently, that gives people inspiration. I think life should be ... I think most people would benefit if they balanced their life with quarterly vacations, and did something where they completely went off of work, they just completely disconnected from work, and they really went out in the world and did something exciting and learned a new skill.

I'm very, very, very fortunate. I admit that it's almost like I feel like I'm bragging saying this, but I've even gotten to go on vacations for my job, as I teach for different groups. I've taught, I'm about to teach with Canyon Ranch this year at Woodside in California. I've taught with this group called Chosen Experiences, where they take you on these incredible vacations, where I basically, I'm teaching people how to optimize their health while we're at these spectacular locations.

So, I do think that my generation, at least my friends and my friend group that I've become friends with, these are the people that are frankly thrivingAll my friends left America, and they went to Puerto Rico, they went to Costa Rica, they went to Hawaii, they went to Mexico, and they're having a great existence because they really value living, instead of just working.

So, I think there's definitely an important ... I think you can work really hard, but you can also have balance in your life, and I think the millennial generation in particular has shifted their desire for things towards really wanting experiences, and part of that might be just a product of the fact that it's hard to buy a house when you're young. It's become really ... This is a whole other discussion about societal norms and changes. But I think there's definitely a shift in my age group and in younger people to wanting to live a little bit more, and also not wait until you retire to actually start living. It definitely is a difference in thinking, for sure.

Greg Kelly, ND: Yeah, which in that mid-'80s time frame, that would have been the norm. The Navy retirement was all the rage, just because of how the military works. But still, I knew a lot of people that every was on hold until they did their 20 years.

Molly Maloof, MD: Yeah. That's super common, I think.

Greg Kelly, ND: That wasn't for me, but I was, at the time, felt like I was a lone wolf, or swimming the wrong way upstream.

Molly Maloof, MD: Yeah. And typically, you have to be, if you want to be different, if you want to have a more vibrant life and have more experiences. But I think a lot of people just need examples of what's possible, so that they can know that life can be different. People often need permission. Like, I have to prescribe vacations to patients. I'm like, "You need to go on vacation. Literally telling you I want you to go offline and go on a vacation. I want you to spend time having fun." They'll be like, "What's fun?"

But anyway, I do have a few more questions about this formula you've designed. There's some ingredients here I've never seen before.

Greg Kelly, ND: Sure, we can talk about that, and then I want to get a little bit into creating a nighttime routine and ritual.

Creating an Evening Routine

Molly Maloof, MD: Oh, yeah. Well, I mean, first off, I think a lot of people, when they first notice, when they first get this supplement, they notice that you guys recommend that they take it earlier in the evening than right before bed. And I really, we can talk that after the evening routine, but I think that that's something that's kind of cool, because I actually tell people, you need to start thinking about going to sleep much earlier than right before you put your head on the pillow. So, having an evening routine is pretty important, and very few people do it properly, because it's just not taught. I mean, it is taught in some ways, right? When you're a kid, your parents kind of make you have an evening routine. But then, when you essentially grow up, you kind of forget it, and then you have to relearn it, right? You have to relearn to tuck yourself back into bed.

So, I tell people, turn off your screens fairly early in the evening. Please do it before 8:00 PM, because you really want to give your brain the ability to start producing melatonin properly, and that's just not got happen if you've got bright blue light in your face. And if you can't do that, then you need to get blue blockers. Either wear blue blockers, you need to block off your screens, exactly, or you can put blue blockers on your screens, you can get blue blocking software that will lower your screens. My Apple products actually naturally turn down the blue. There's apps like Flux, which will work for most computers.

And then, if you're going to work in a room that has a lot of light, make sure you use darker, dimmer lights. You can get yellow light bulbs. You can get red light bulbs if you want. Dimmer switches are important. I'm a huge ... I just hate having bright light at night in a house. So, so annoying.

Try not to watch a ton of TV before bed. It's so much easier said than done. But TV would be better to watch earlier in the evening, maybe when you're cooking, or right around dinner, rather than later at night. Reading before bed would be much better.

Using your bed for only sleep, sex, and just resting, going to sleep. And taking a bath before going to bed. Winding down. Journaling. Doing something that's not requiring a ton of brainpower. Giving your brain the time to turn off. That's, to me, really important, and yet, just so many people do it so poorly. They eat late at night, which we know that eating late at night disrupts sleep. And so, people drink too much at night. We know that reduces REM.

These are just the pro tips that I give people, but there's also a ton of sleep tips I could give people. Like, a lot of people don't realize they need air quality in their room to be proper. They need proper air quality. They need to make sure that they don't end up with ... a lot of people don't realize that the air quality in their house is actually really not good. So, that needs to be addressed, too.

And then, for a lot of men in particular, they're too hot at night, so you need to make sure you cool yourself off, turn the temperature down if you can. There's a company called Eight Sleep that all my investor friends are freaking out about, and it's one of those ChiliPad 2.0 companies. So, really cool off your body if you need to, if you're a hot sleeper. But yeah, just giving yourself this wind-down routine, where you can turn off your brain gradually.

Greg Kelly, ND: I think, for me, I've always been one of those people, my Oura ring shows that I fall asleep 3-5 minutes sleep latency, and I've always been able to fall asleep really as soon as I intend to. And I would say every once in a while, there's a night that's an exception, but it's definitely not my norm. So, that's just not a problem to me. I could really watch an action movie, turn it off, and be asleep five minutes later.

Molly Maloof, MD: Do you think that ... Sorry to interrupt you, but do you think that ... I actually think that medical school training and military training are very similar, and because you get so sleep deprived, you train yourself to just, boom, I'm going to sleep anywhere at any time. I'm so like that, by the way. If I need to sleep on a plane in an uncomfortable position, I just start sleeping. So, it's interesting. I think there might be a training that happens to us, because I do seem to have pretty low latency, and I sleep plenty every night.

Greg Kelly, ND: Now, I have friends where that's not the case. Something that I could watch would not allow them to fall asleep. So, we're all a little bit different there, but I think in general, most of us do better ... I guess one time, a long time girlfriend that I was with, she couldn't watch what I could comfortably watch, but a Frasier episode would be the right thing to transition her into ...

Molly Maloof, MD: Yeah.

Creating Safe and Comfortable Environments for Sleep

Greg Kelly, ND: But I tend to think, and you mentioned these two words right at the beginning: safety and comfort. So, when I think of whatever the environment and the circumstances leading up to sleep, the more that they can convince my body and spirit that we're safe and that we're comfortable, the more that's going to allow us to fall asleep and have good quality sleep. We've talked a little bit about vigilance and alertness with caffeine. If it's not sure that things are safe and comfortable, then it's going to be a little bit more vigilant. And so, there's a common thing that happens when people are on vacation or traveling for work, and their first night in a hotel room, they won't get sound sleep. They'll feel like their brain was more active. And that's actually exactly what happens. Our brain is literally making sure that we're safe. It's not as sure about that environment, so it's not going to allow us to sleep, right?

Molly Maloof, MD: Yeah, exactly.

Greg Kelly, ND: So, the brain is going to always try to do the best, given the circumstances. My story would be if it's my job that I've convinced it that where I'm going to lay down for the night is safe and comfortable, and does that go to the point of reassuring it, if it's my first night in a new place. I'll literally self-talk and tell my brain, "All right, we're in a hotel, the door is locked, completely safe. Do whatever you need to do, but I just want to let you know that the safety thing is covered."

Molly Maloof, MD: I definitely feel like noise pollution is a big thing, too, that people overlook, in cities in particular. I used to live in a neighborhood that was really loud, and I never fully slept well in that neighborhood, because it was just constantly sending me unsafety signals. I was like, I don't know what that sound is. So, I think it's really important to get proper, block the light and block the sound in your room if you can. Earplugs, if you need to. Just, you've got to get your body to have a sense of just minimal stimulation as possible.

Greg Kelly, ND: Yeah. I think of the brain's job one is protecting us, right? So, we spend a lot of brain energy on our senses, but while we're sleeping, our auditory system is still working really, really hard at scanning the environment to make sure that we're safe. So, you're right, background noises can be a real tipping point for people.

Mitochondria and Sleep

Greg Kelly, ND: One of the other things, when we first ... We've talked a little bit about different things that happen during sleep, but one of the things that was news to me when I was working on the Qualia Night product that came up during the research was that our brain actually makes or puts out a huge burst of ATP right as we go into non-REM sleep, so that we can get into stages of sleep.

And when you start to think about what the brain does for work, like one of the things during non-REM sleep that occurs is that short term memories, things that we would have experienced or learned cramming at medical school that day, they get moved more from short term into long term in that evening sleep. And there's these huge energy bursts called sleep spindles that act to literally move that information from the front of our brain to the back of our brain, wherever it needs to be stored, and that takes a lot of energy.

So, I know one of the things that was important to me when we were designing Qualia Night was supporting mitochondrial health, because we need, even though we're not alert, our brain is still doing a ton of work while we're sleeping.

Molly Maloof, MD: Right.

Greg Kelly, ND: My guess would be, part of the issue especially with sleep as we get older is that is not making enough ATP to allow the important jobs that we need to do to get a quality night's sleep. So, I know Dave Asprey talks about mitochondria and sleep periodically on Bulletproof Radio, but I'm willing to be that mitochondria play a big role in getting good sleep, and converting sleep.

Molly Maloof, MD: Well, it makes a lot of sense, right?There's got to be a relationship between sleep and mitochondria, I mean, it's so complex, but I definitely need to do more research on sleep and mitochondria, because I'm writing a book a lot about mitochondria, and Dave Asprey us actually going to write the foreword, so I'm stoked about it.

What’s the Best Way to Start Your Day?

Greg Kelly, ND: As I mentioned early on, I think it's super important to get some kind of protein early in the day, as opposed to just a carb breakfast. Or the other thing I've consistently seen is people that skip breakfast, or do intermittent fasting and start eating a little bit later or in the early afternoon. The one thing that I'd pay attention to then is how they're craving food in the evening, because what tends to happen is if we have food earlier in the day, it anchors or swings the appetite earlier, and if we have food later, it tends to cause those appetite rhythms to drift later. So, if you're doing intermittent fasting and that's not an issue, then great, it's working for you. But if you're doing it and you feel like at night, you're all of the sudden really hungry or need a snack, then that could be maybe something that would be fixed or made better by shifting food earlier in the day.

Molly Maloof, MD: You know, I actually agree with you here. In particular, I really have been doing just tons of thoughts on fasting, because fasting is becoming such a fad, right? Now, fasting has been a part of Russian healthcare for many, many, many years. It's a huge health intervention for people. So, it's like, fasting has been around since the beginning of humanity, so fasting is not new. But stress at the level that we're experiencing really is a fairly new phenomenon, the last few hundred years, and so I don't feel like enough people talk about how intermittent fasting and prolonged fasting can affect sleep significantly.

I once did an experiment where I did every other day fasting for like a month, and when I was not eating, I was not sleeping very well. Now, I lost a bunch of weight. Obviously, I gained it back after I stopped the practice. But yeah, if you're not eating, your body is in a heightened alert state, and our eating rhythms do play a role in our circadian rhythms and our cortisol rhythms.

So, I always tell people it's really good to get your cortisol rhythm checked before you decide to embark on a fasting regimen, because if you are burned out or under more stress than you realize, fasting is going to raise your cortisol, and fasting is going to raise these counterregulatory hormones, which can actually be problematic if you don't have proper recovery, if you have too much stress existing in your lifestyle. I'm all for fasting as a health intervention, but with the caveat that you have to balance it with the amount of stress that you're under, and if you put too much fasting into a body, and you combine it with too much stress, you will make a person very sick.

And women in particular also need to be very careful with how much they fast, because we are super sensitive to nutrient availability, because they signal whether or not we can be fertile or not. So, I definitely think that people need to take into account the amount of stress they're dealing with, and if someone is under a lot of stress, fasting is not the first thing I would recommend for them. I would recommend mastering their stress response.

Greg Kelly, ND: There's ...

Molly Maloof, MD: Yeah?

Greg Kelly, ND: There's a study, I call it the Army ranger study. I don't know what the actual name was. But basically, Army rangers, any of the special forces in the military, go through really incredibly stressful things as part of their training. One of the things, the crux of this paper, was during this training, they were sleep deprived, out in the field, so exposed to the elements, cold exposure. Exercised a ton, and calorie deprived. So, that's all part of this training that was occurring that these people were on.

And one of the things that led to this research was, a lot of Army rangers would say, after Army ranger training, they would become fatter than they had every been before. These are great shape, right? And so, they studied this, and what they found is that yes, this is exactly what happened. Cortisol levels went crazy. Thyroid hormones went way down. They lost weight during this, because of that acute stress, but as soon as they were able to rest and recover and eat again, they regained what they had lost, but just in fat. So, it's referred to body fat overshoot.

I've always kept that in mind, that yeah, stresses accumulate. So, well-rested, not exercising particularly hard, fasting is a better fit to me than someone that already has the Army ranger problem going on.

Molly Maloof, MD: Yeah. I mean, it's interesting, because I've seen fasting change people's lives, but I've also seen it dysregulate people. So, I think at least for my clients that have cortisol dysregulation, I just tell them, I want you to eat something in the morning. Nothing crazy. A little bit of protein is good. So, we agree with that for sure. But we don't need to snack as much as we're snacking, for sure. There's definitely this snacking obsession in our culture, and I do think that it leads to, it can contribute to metabolic dysfunction if it's the wrong snack foods, like packaged, processed stuff that's not healthy.

Greg Kelly, ND: Good. And then, light exposure was something else I'd mentioned, and you also said a solution could be a light box. So, for people that want to experiment with a light box, you can find them on Amazon. Usually you put them about one and a half, two feet away, and about 30 minutes of morning light exposure with a light box is often enough to really cement and lock in your circadian rhythms. And some case studies of people who have night eating syndrome, so a huge compulsion to eat most of their calories in the darkest hours, that's been improved with use of a morning light box.

Molly Maloof, MD: Interesting.

Greg Kelly, ND: So, don't overlook the importance of light for affecting things, the morning light for affecting things in the evening. It will vary, again, maybe depending on Dr. Breus's chronotypes, but I know for me as a lion, and most bears, it would be an advantage to get outside and even just to a little walk around the block.

Molly Maloof, MD: Oh my gosh, absolutely.

Greg Kelly, ND: My routine is to walk to a coffee shop, or take my bike and bike down to the coffee shop.

Molly Maloof, MD: Yeah. I mean, morning exercise is fabulous.

Greg Kelly, ND: And so ...

Molly Maloof, MD: I would ...

Greg Kelly, ND: And then, for me, I'm one of those caffeine sensitive people. So, I think that enzyme that you mentioned is inducible. I know some people, especially my old Navy buddies, they could drink a pot of coffee and sleep fine, but I'm not that person. So, I've learned through the school of hard knocks that my body does fine with coffee, say, 11:00 in the morning and earlier. But at noon and after, it will affect my sleep for sure. Even coffee ice cream would affect my sleep, if I had coffee ice cream.

Molly Maloof, MD: Oh, yeah, totally.

Greg Kelly, ND: And for me, the way that that works out is, I have more difficulty falling asleep, and then wake up much earlier than normal. So, I tend to get hit on both ends of the sleep thing. So, for me, while I would love to be able to have an espresso after a nice dinner, it's just not worth it. So, I think for a lot of people, they would be more sensitive like me if they ran that experiment and paid attention.

How Does Lighting Impact Your Circadian Rhythm?

So, those are a few morning or daytime things to pay attention to. You've mentioned some really cool things for the evening. One of the things, we've talked about TV and turning that off earlier. Dimming the lights, again, super powerful. I remember seeing two different studies 15 years ago or so. One had to do with eating lunch in a dimmer or brighter environment, and what they found was, during lunch, a brighter environment led to better digestion of that meal.

Molly Maloof, MD: Interesting.

Greg Kelly, ND: Then the study looked at dim or bright light, but eating an evening meal, and in the evening, dimmer light led to better digestion. So, lighting ...

Molly Maloof, MD: You know what, that makes a lot of sense, if you think about it. We're really not supposed to be experiencing these weird light patterns that we're experiencing in modern life, right? We're not supposed to have so much LED lighting in our cities. It literally sends signals that we're in daytime all the time. Our phones are in our face, so it's daytime all the time. It's not daytime all the time. I really, fundamentally believe that we're supposed to live in accordance with our circadian rhythms of the earth, and our bodies are in alignment with those clocks. We have clocks internally that are synchronized with light cycles, so when these things get thrown off, that's when our health gets affected.

Greg Kelly, ND: When I think of lighting, especially at night, it's naturalistic lighting, so better than a fluorescent light, as an example.

Molly Maloof, MD: Yeah. Even incandescent light is better than LED, although I love LED lights, at night time. Candle. I mean, candles are tricky. You don't want to burn down your house. But just dimmers. Just not so much bright blue light in your face, not so many screens in your face. I mean, we are all so addicted to our screens, and we're Zooming more than ever, so just really, really important that people understand that we need to live in accordance with these natural cycles, and we don't need to ... the blue light is really hard. It's really problematic for health.

That's one of the things that I tell most people, is hey, if you don't get your sleep in line, your brain isn't going to be taking out the garbage of your daytime. So, it's very, very important to recognize that your brain needs this sleep to take out the garbage through the lymphatic system.

Evening Routine Tips

Greg Kelly, ND: Yeah. And then, the last thing that I wanted to mention, and then we'll call it a day, because I think we've covered a lot, is that the three to four hours before your normal bedtime is often referred in research as the forbidden zone of sleep. And what that means is, assuming you weren't sleep deprived, it actually becomes more difficult to fall asleep in that window than it would in the afternoon or early evening. And when we designed Qualia Night, we really designed something to be taken at the beginning of that forbidden zone, of that three to four hours before your desired bedtime.

But then, as you mentioned, that could be part of your evening ritual, and as you also mentioned, from that point on, everything that you do is starting to transition into that safety and comfort and de-stressed, ideally, physiology that we want to induce a good, quality night sleep. So, what I really try to lock into, personally, is to focus on that forbidden zone of sleep, and make sure as I'm starting to move deeper into that, that I'm doing things that are going to be less stimulating.

Molly Maloof, MD: Right. I think one is just not digesting super late at night.

Greg Kelly, ND: Oh, that's, at least on my Oura ring, looking at heart rate and heart rate variability, the two things that make the biggest negative impact. You mentioned alcohol. That for sure is.

Molly Maloof, MD: Oh, yeah. Oh my god, my HRB after alcohol was like 20, and I was like, it's supposed to be like, 60, and that's not good. And I definitely feel it. I mean, I feel it for sure. I do have to say though that if you've been under social isolation for many, many months, and you just saw all your friends, it's okay to drink here and there. It's kind of worth it once in a while.

Greg Kelly, ND: [crosstalk 01:05:26].

Molly Maloof, MD: Yeah.

Greg Kelly, ND: But the other thing I've noticed for me, too, would be what I eat and when I eat it. The bigger the meal and the later I eat it, or the closer to my normal bedtime, and like you, I'm more like 10:00 or so most nights, the more likely that my heart rate through sleep will be elevated. Conversely, I did a cycle of the fasting mimicking diet of Valter Longo's, probably about six weeks ago. This isn't a complete fast. this would be lower calories for three to five days, so about 40-50% of your normal calories. And during that fasting mimicking diet, those nights, my resting heart rate was about four or five beats lower.

So, that seemed, from a stress perspective, that getting the benefits of fasting without not eating completely seemed to agree with me, both for quality sleep and my physiology during it, where ... we haven't touched on gravity blankets, and I don't want to spend much time on it, but a lot of Neurohacker Collective is big fans of gravity blankets. They get the gravity blanket, sleep better.

The one thing that I never score well on my Oura ring is restlessness. It always feels orange. Literally, I don't think it's ever been green since I've had my Oura ring. So, not surprising there, or not surprising to me, maybe. But my explanation, gravity blankets do not work well for me. I don't get as restful sleep, subjectively. My heart rate is much higher. And I think because I'm naturally restless for some reason during sleep, that extra weight must prevent me from moving enough that my physiology has to work more.

Bottom line is, gravity blankets, I'm the unusual person that I know that they didn't work for. They actually seem to make my sleep worse. And so, that's the key thing I want to just leave as a final message, that sleep is really complicated.

Molly Maloof, MD: Totally.

Greg Kelly, ND: There's lots of places, different chronotypes. They all have different needs, in terms of their schedules and the biohacks that are going to optimize them, but the key thing I just want to let our audience know is, what works for me may not work for you. So, be flexible and experiment. And ultimately, the thing I do believe in is communicate with your body. Wheen you do get a good night's sleep, what I do is, I thank my body. I literally tell it, "Great job. Please do that again."

Molly Maloof, MD: Yeah, definitely take advantage of the subconscious as well, right? Right before you go to bed, that place between sleep and wake is such an effective place for using your sleep to perform. I always look at sleep as a very functional place of actually doing really great work. I get some of my best ideas from sleeping really well, and waking up in the morning and being like, oh yeah, that makes so much sense.

I also tell people to use their sleep as a reflection of their life. Typically, my dreams are a very, very strong reflection of how well my life is going. So, when you're dreaming well, and you're waking up refreshed, and things are positive, that's a pretty good sign that your life is going well. But when things start shifting in your dreams, then take note in your daily life. You may need to change something.

Greg Kelly, ND: Yeah. I know. I was one of those mathletes in high school, so I was good in math. We used to, we did competitions where we would go to one of the other schools, and there would be mathletes from all the schools competing. But we also did take home competitions, and I can remember two different times being stumped, and literally waking up in the middle of the night with the answer all preformed, and just ready to go. So, I learned back then, letting my brain, like having something near to write down things. My brain is going to try to figure things out while I'm sleeping. So, letting it know, we got tons of information today. We just had this really cool biohacking seminar. We learned all this new information. These couple things are the only important things that I need you to really work on tonight, and make sure you move around. The reset, not so important.

It's like, to be intentional, because my brain, your brain, Molly's brain, it's going to try to do a lot of work while we're sleeping, and I believe one of the reasons that, especially the people that have more of the classic symptoms of sleep challenges, difficulty falling asleep, waking at night, inability to fall back asleep, their brain is trying to do a lot of things, and sending messages to the brain that right now is not the time to do that can be one of the steps along the path.

Molly Maloof, MD: For sure.

About Dr. Molly Maloof

Greg Kelly, ND: I want to let you and this. It's been an absolute pleasure on my end. So, anything that you would like to leave as a parting message to the Collective Insights podcast fans?

Molly Maloof, MD: I would follow me on Instagram, D-R-M-O-L-L-Y.C-O, or if you want to contact me, you can find me at Sorry, Sorry about that. Www.D-R-M-O-L-L-Y.C-O.

Greg Kelly, ND: Wonderful. Well, thank you, audience, for joining us. It's been great to have Dr. Molly here with me, and to share some of our insights on sleep, evening rituals, and other things related to higher performance. So, with that, bye.



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