What follows is a transcript for the podcast: The Science of Better Sleep: Brain Hacks for Sleep and Anxiety
Sub-section topics within the interview include the following:
- Definition of EEG, qEEG and ERP
- Training the Brain with Biofeedback
- How Does Neurofeedback Help Sleep?
- Are the Results of Neurofeedback Permanent?
- Why is it Important to Get Good Sleep?
- How Lack of Sleep Contributes to Cognitive Decline
- Tips to Improve Your Sleep: Light, Meal Timing and Movement
- Do Women Need More Sleep Than Men?
- Are Naps Good for You?
- Sleep Tracking Devices
- Meal Timing and Nutrients for Optimal Sleep
- Practical Tips for Better Sleep
- The Issues with Benzos and Alcohol
- Downsides to Using Melatonin for Sleep
- Sleep Hacks
- Coping with Jet Lag
- Coffee is Good for You: How it Affects Sleep
- Meal Timing to Improve Your Sleep
- The Best New Technologies for Sleep
Definition of EEG, qEEG and ERP
Heather Sandison, ND: Welcome to Collective Insights. I'm your host today, Dr. Heather Sandison. And I'm thrilled, delighted to have Dr. Andrew Hill with us. Welcome, Andrew.
Andrew Hill, Ph.D.: Thanks for having me. I appreciate it.
Heather Sandison, ND: He is one of the top peak performance coaches in the country. He's got a PhD in cognitive neuroscience from UCLA's department of psychology and continues to do research today on attention and cognition. The research methodology includes EEG, qEEG and ERP. Can I just stop right there and can you explain those acronyms? Can you just define them and let us know what we're talking about?
Andrew Hill, Ph.D.: Right. So EEG broadly is brainwaves or electricity your brain produces. And we don't really understand EEG. Brain scientists who study the brain using electricity are managing phenomena more than really looking at discreet things we understand deeply. So we're often describing things we observe and not knowing why we observe them. But EEG historically was really around a sleep science, so most of the things we do today in EEG are informed by 80 years of sleep analysis historically. So the number of channels in the head or electrodes in the head we use for most of the analyses, the way we measure electricity, a lot of that is driven by old school sleep science. So broadly, EEG is brainwaves.
qEEG, which stands for quantitative EEG, is a way of looking at resting brainwaves and then comparing many of the parameters, the amounts of those brainwaves, the patterns in the head, the connectivity between those regions on the head. You compare those to a normative database of a few hundred or thousand people and see how unusual one person is to look for the population level outliers in their resources. So qEEG is a hypothesis generation to look for all the weird things in your brain.
It's kind of like the difference between a discreet doctor, a physician, and a functional medicine doc, the functional medicine doc will grab lots of data and then try to find the big patterns that might be meaningful for the thing that you care about, but maybe not quite as discreetly as like finding a virus or finding a dominant or recessive trait. It's often, "Well, this can often mean X or it might mean Y," when you're working with a functional medicine doc, and their job is to spot the traits, the patterns and give you things that can affect the underlying system.
And for qEEG, that's what we do, we look at your brain and say, "Oh hey, here's something that's unusual for you." And for some people, this unusual pattern can present this particular kind of resource bottleneck. And some of the patterns we see in brain mapping or qEEG are almost valid, they're almost diagnostic, like the markers for ADHD. Blindly, you can sort people into buckets of ADHD and non ADHD, thousands of people, never asking them one question or measuring their attention at all, simply looking at the single measurement of the ratio of theta brain waves to beta brain waves at the top of the head. That one measurement is 94% accurate for sorting people into buckets of ADHD and non ADHD, corresponding with diagnostic interviews with psychologists, obviously.
So that's qEEG, it gives us discriminants or statistics and go, "Oh, that's interesting. Here's an unusual feature for you to tease apart where things might land." And then ERP is another EEG technology event related or evoked potential, and that's the brain having a moment of either binding to information in the outside world or attending to something or making a choice, so that's the brain reacting in real time, within milliseconds to something you're observing or thinking or deciding to do or noticing a grammatical error or being startled. The brain has these little blips where it responds within between 50 and about 350 or 450 milliseconds to every event around it that you're perceiving, as well as internal events.
And that's what ERP is, is looking at the subtle music the brain is playing in response to the input, output of information. And that ERP is really a scientific endeavor to understand the basics of how the brain works, where qEEG is science to understand maybe how you work. And then EEG is this broad science. And then we do EEG biofeedback or neurofeedback to change your brain by exercising the resources and actually physically changing your brain over many weeks or months. So there's all different ways we use EEG. I use EEG in my different areas.
Training the Brain with Biofeedback
Heather Sandison, ND: So tell me more about the exercise. You're speaking from the perspective of like an athletic coach or a physical trainer, a personal trainer, what does that exercise look like?
Andrew Hill, Ph.D.: So the biofeedback broadly to do a session of EEG-based biofeedback, you would come in and sit in a chair and you would put three or four or five wires on. So we put a couple of ear clips on your ears and then we would stick one or two wires to the spot on your head we want to exercise, and we'll measure the brainwaves under those electrodes in real time. And your brain is changing moment to moment. So the most valid, again, marker in brain mapping is ADHD. The ratio of theta brainwaves to beta brainwave. Theta is a slow brainwave, it runs at about six or seven cycles per second, beta that we're talking about is about twice that, 12 to 15 cycles per second.
If the ratio of theta to beta is above about two or two and a half in an adult, it's ADHD. If it's below that, it's probably not. So you can measure the amount of theta you're making moment to moment, it's going to fluctuate. And whenever it happens on its own to drift down for half a second, the biofeedback machine goes, "Good job brain," and makes something happen on a screen. So you might be watching a pack of many dots or a spaceship fly across a Lake or a dragon or something fly or maybe your car is zipping around off-road tracks, hitting zombies or something. And whenever your brain happens briefly to trend in a little more in the right direction, the software runs. And when your brain trends in the wrong direction briefly, the software stops.
So it's going, "Good job, brain. Good job, brain." "Nope." "Ooh, good job, brain. Good job, brain. Good job, brain." "Nope." And the brain's like, "Hey, why is that keep stopping?" And it figures out within about 10 minutes that whatever it happens to drop, its theta, for instance, stuff happens in the outside world. It doesn't know it's virtual, so it's going, "Oh hey, wait a minute. That's me. Whenever I drop theta, stuff happens." And then it starts to drop its data more. And the trick here is that every few seconds we moved the goalposts. So this is operant conditioning.
We're setting up a goal and saying, "Okay, move your theta down a little bit, brain. Okay, good job." And then moving the goalposts further so the brain's getting information about the desired trend very gently. We don't zap the brain, there are techniques that impose electricity, we don't, we just measure what your brain is doing and gently applaud it with the audio and visuals for certain movements it's already making. And so it happens because the brain likes input, tomorrow the brain does a little more of what produced increased input today. And your job as smart, intelligent, aware person is to go, "Ooh, I noticed this. My sleep was different, or my stress response was different, or I had fewer seizures, or my migraines didn't show up."
And you report back what you're noticing and then we iterate like a personal trainer would try some more things, build up workouts, stack them, and then go back and map your brain every 20 sessions of neurofeedback. So at Peak Brain, typically we do about 40 sessions to begin three months, and that takes three times a week, about 40 sessions. And we map the brain at least twice along the way, every 20 sessions. And typically, from the beginning to about the month three mark, almost everyone with stress, attention, sleep, basic problems, we'll make somewhere between two and three standard deviations of change on brain mapping at rest as well as on executive function tests.
And so really massive resources can be shifted in a very dramatic short amount of time. We almost eliminate executive function difficulty in most people in like a three to six-month timeframe. So it's not instantaneous the way a medication is, you don't feel it kick in the first moment, but it's closer to like, deciding to change your body and get some abs and get some shoulder strength or something and work at it for a few months. It's all very slow change, but after a few months of continual slow change that you're pushing on, intuiting, and chasing, you're in a very, very different place at the end. And most of the things I've seen are permanent in terms of effects, executive functions, stress response.
Seizures and migraines are often quite as permanent because you're working on more of the deep brain stuff and it's more injuries often, with seizures certainly. And there is a lot of wear and tear, concussions and things, it can often take a little bit longer, four to six months is the minimum when there's wear and tear. But for things like ADHD and anxiety, it's usually a three to four-month process to make a pretty big permanent change.
How Does Neurofeedback Help Sleep?
Heather Sandison, ND: What about sleep? Sleep is one of the most common complaints that I get in my office as a clinician. I'm curious how neurofeedback might affect sleep and what you're seeing symptomatically as well as in the mapping.
Andrew Hill, Ph.D.: Yeah, so I will often, sometimes I'll see sleep indicators in the maps where I can guess that someone has a sleep difficulty. Some of the more reliable things that show up are anxiety features and the brain map because we have specific circuits for noticing the environment, switching our attention. They get a little bit ramped up when we experience anxiety. There's no real depression feature in the brain, I can't see depression as a marker, but I can see rumination, perception, hypervigilance, those sorts of features of anxiety. Sometimes those come along with, some of the stress features will come along with markers that suggest difficulty with sleep onset or with the maintenance, the depth of sleep.
Those are often common features that co-occur with anxiety complaints. So those will show up in anxiety. Also, in ADHD, there's some good theories these days that ADHD is a failure of sleep spindle stabilization, one of the core theories, SMR, that's 12 to 15 hertz that we actually used to eliminate ADHD seems to be a bit impaired in sleep. So everybody who does neurofeedback, the way that we do it gets sleep benefits, everybody, whether or not you come in with a sleep problem. And if you come in with a sleep problem, this is often the best sleep you've ever gotten in your life after getting the first couple of weeks.
Are the Results of Neurofeedback Permanent?
Heather Sandison, ND: And you mentioned that a lot of this is permanent. Now, do you see the same thing in sleep?
Andrew Hill, Ph.D.: We do. Yeah. Anything you regulate enough tends to stay regulated because the brain is practicing it, so to speak, every day. It's like if you had a torn knee and you went to physical therapy for six months, at the end of that process, you have a nice strong knee probably, and now you're walking around every day, you're keeping your knees strong. If you start staying up all night long, do things that are counter to circadian entrainment, eat late at night, don't exercise. After a few weeks, you absolutely would have eroded your sleep quality. But often I find when there's a significant sleep issue, two things, one is everyone's got sleep issues that are worse than they think, and the people that really have bad sleep issues, it's not the sleep anymore that's the issue, it's the anxiety around the sleep issue. That's the real big problem.
So in the mild to the subacute, "Yeah, I got a sleep issue." But depending how bad it is, everyone gets amazing regulation, they stop sleeping like really well. And the folks for whom it's really an anxiety, a sleep anxiety phenomena now, we often drop the anxiety before we drop the sleep, and we don't get the sleep changes until the anxiety drops because what started off as a sleep problem, it's flipped over into becoming an anxiety problem in the brain in terms of where it's being maintained, if you will, in the brain.
Why is it Important to Get Good Sleep?
Heather Sandison, ND: Can you tell us why it's important to get good sleep, and what the science is around that?
Andrew Hill, Ph.D.: Why it's important to get good sleep?
Heather Sandison, ND: Yeah.
Andrew Hill, Ph.D.: There's many reasons. Sleep serves many features in the brain. Among the most recent discoveries is that the brain has an agitation cycle it goes into every night, kind of like a washing machine, and the cerebral spinal fluid in delta waves will wash through the ventricles and through osmotic pressure, leach out all of the metabolic byproducts that built up all day long. So you have to have this little washing cycle to pull out all the metabolic byproducts. One of the things that triggers is memory consolidation, so as you move from your first not slow sleep and your first chunk of slow sleep, which happens about an hour and a half into the night, if you have that first slow way or deep or dreamless sleep chunk, during that chunk, you get pulled into a very, very deep sleep for the first time and you have a strong growth hormone release.
And when that growth hormone gets released, all the weak memories in the brain is shaken up like an Etch-A-Sketch and reset, all the somewhat strong ones gets cemented. So that's the consolidation of memories and also it helps the busy cloudy mind at the end of the day get wiped away because you actually end up with a huge number of partial synapses every day that get to reset, to have your fresh clean mind every morning. And the ones that are reinforced are then reinforced.
How Lack of Sleep Contributes to Cognitive Decline
Heather Sandison, ND: So you mentioned memory. It sounds like with inadequate sleep, you might be at risk of cognitive decline or memory impairment.
Andrew Hill, Ph.D.: Absolutely. And it's even worse than that because with lack of deep sleep over time, you start producing... If you don't make good delta at night, you start producing slowed alpha as well. And so first of all, you feel tired and you feel burnt out and you wake up tired in the morning. Second of all, when your alpha slows down, you end up with speed or processing issues as a consequence of sleep. So people come in with slowed alpha waves and they report lots of afternoon burnout, lots of naming and word finding and verbal fluency issues and delayed recall of names. That's not a memory issue, it's a speed of processing. But speed of processing is one of the three big human cognitive resources we can actually measure.
Speed processing is a real thing. Intelligence, not so real. Speed of processing, valid. Working memory, speed of processing, implicit learning, those are the three big human things. But intelligence, meh, that's a construct. Speed of processing will drag down everything, you can't load up your working memory, you can't grab words out of your mind, you can't recall items very quickly. So when speed of processing is a problem, it's a big problem usually, it causes a major issue. So I'll look at someone's brain and see extra fast delta waves because they aren't getting good deep sleep and the alpha waves have slowed down because of it. And all their beta waves, their thinking waves will be a combination of really slow because they're burned out and really fast because they're cranked up driving through the fog.
So the metaphor I'll use for some people when I see this is like they're a sports car driving down the highway with the emergency brake, on and they have the gas pedal on the floor to make up for it. So they arrive at their destination fine, but they arrive, they're out of gas, shaky, nervous, hot, burnt out. And this is a classic subacute sleep issue I see in many, many people, they're brute forcing their resources. And so while they have fine performance, it's not the most efficient performance, so we tease apart the ways in which it falls over, if you will, once we do some assessments.
Tips to Improve Your Sleep: Light, Meal Timing and Movement
Heather Sandison, ND: So it sounds like it's pretty important to stay on a sleep schedule. I hear a lot of people say, if you get to sleep before midnight, you get more benefit from those hours there.
Andrew Hill, Ph.D.: True.
Heather Sandison, ND: Is any science?
Andrew Hill, Ph.D.: There is...
Heather Sandison, ND: Can you break up-
Andrew Hill, Ph.D.: But has the science wrong? I'm sorry to tell you that everyone gives the wrong advice.
Heather Sandison, ND: Enlighten us.
Andrew Hill, Ph.D.: Yeah. The most important thing about circadian regulation has very little to do with light, first of all. I don't care about your blue blocking glasses. I'm sorry, Daniel's going to hate me when I say that.
Heather Sandison, ND: And I love you because I can't stand wearing them.
Andrew Hill, Ph.D.: Yeah, they're horrible. They're horrible. But I know that a lot of people in our biohacking community are big fans of managing light. I just don't think it's a big deal. There was a study out not too long ago showing some mice and rats who were engineered to make not any melatonin at all still had plenty good circadian entrainment and sleep cycles and things. It's an effect, but it's not a big effect, the melatonin cycle. I'm much more concerned about when you eat-
Heather Sandison, ND: Oh interesting.
Andrew Hill, Ph.D.: ... than I am about light? That's by far the strongest zeitgeber time giver for the brain is when you eat. So the most important thing for circadian entrainment is to fast for three to four hours before bed. Fasting in the morning is not that important, but fast in the evening is. So for all the IF people, they're doing it wrong. You're supposed to fast at the end of the day, not the beginning of the day, first of all. So if you have to do one thing, fast for three to four hours before bed. If you need some flavor or ritual, make some herbal tea. No calories for at least three hours. Second most important thing, get up the same time roughly every morning plus or minus half an hour.
I don't care when you go to bed, but I want you to getting up early because the light that matters is the morning light, not the evening light.
Heather Sandison, ND: So the morning light does matter?
Andrew Hill, Ph.D.: It does, but not as much as not eating at night.
Heather Sandison, ND: Okay. All right, good. You can put these in order.
Andrew Hill, Ph.D.: And third in order is get some exercise in the morning before you eat.
Heather Sandison, ND: Oh, okay. Okay. And so there's a couple of things, clinically, I have seen that some people who eat a little bit of protein right before they go to bed, they won't wake up either with high blood sugar or they won't wake up in the middle of the night. They get better sleep maintenance. Can you help me square that circle?
Andrew Hill, Ph.D.: Yeah. They have lousy insulin, basically. Have more fat earlier in the day, you won't have a dip and insulin before bed and have to feed yourself some protein. They probably have such a low blood sugar they go into protein neogenesis for glucose instead. If you go to bed with some blood sugar at all high, basically if you go to bed full, you wake up hungry and tired. If you go to bed hungry, you wake up full refreshed. And if you're unable to fall asleep because you're hungry or waking up in the middle of the night because of a drop in blood sugar, your blood sugar is not stable enough, it should be able to handle fasting like that, the growth hormone surge that happens 90 minutes in should allow you to handle no problems with energy. So I would say you should be eating more fat earlier in the day.
Heather Sandison, ND: And then what about getting outside? Personally, I feel so much better if I get some sunlight, if I'm getting light regularly versus being trapped inside all day. And I hear that from a lot of people. So is light really not what it is? Is it something else about being outside?
Andrew Hill, Ph.D.:It's activity more than anything else? That's a stronger circadian cue than light activity is. That's why I want you exercise in the morning before you eat. But morning light, there's a special frequency or temperature light that's in the air within one hour of dawn, it's very prevalent after that it's pretty much gone because the sun is higher in the sky and it gets reflected back into space. But this blue light, there's a structure above the optic chiasm, the nerves that cross behind the eyes, the optic acts as the chi, so the optic chiasm. And above the optic chiasm, you have a nucleus called the suprachiasmatic nucleus, the SCN, and the SCN's job is to monitor the temperature of light hitting the retina. And it's very specially tuned to react strongly to a certain frequency of light that's only there at the beginning of the day.
And so it's the strong, "Hey, it's morning," kind of signal. This SCN does this really strong entrainment thing. The evening melatonin stuff is about stretching your circadian rhythm. That's all it's doing. And women have to be a little more careful for evening light and evening eating because you have a short circadian than compared to men, a little bit shorter, like 45 minutes or half an hour shorter. So if you do late night eating women, it's a little more damaging because you're already at the end of your circadian rhythms, so it gets stretched more easily than it would for men.
Do Women Need More Sleep Than Men?
Heather Sandison, ND: But is this the reason why I need more sleep?
Andrew Hill, Ph.D.: No, that's just that. Sorry, no. There's very little difference in the brain of men and women, almost none. There are some differences, but the amount of sleep is not one, that's just your quirky, wonderful self needing a little more sleep.
Heather Sandison, ND: Maybe.
Andrew Hill, Ph.D.: Yes, that's definitely... I think we have a good hypothesis. Yes, that'll definitely do some things.
Are Naps Good for You?
Heather Sandison, ND: Okay. So what about taking naps? Like middle of the day sleeping? You're saying light doesn't have a lot to do with it, it's more about when you're eating. So can people take an afternoon nap and be all right?
Andrew Hill, Ph.D.: I think so. I think you can throw out your circadian rhythm. I think most Westerners are already pretty poorly entrained, misaligned with circadian stuff because we evolved to have like a 10 hour, 11 hour, 12 hour window of light, and that was it. And then we'd go to bed when the sun went down, and we would get up in the middle of the night for an hour or two after sleeping for four hours and we would like spend an hour or two praying, soaking the beans, writing our journal by candlelight, having sex, and then go to sleep and then sleep for four more hours and wake up at dawn and milk the cows, whatever.
But we have these weird split periods of sleep, theoretically, historically. Some ideas that we don't actually need to sleep in a big chunk. That being said, I don't know of any research that suggests napping is all that beneficial. And I know some people who swear by napping and they need it, other folks who they hate it. I would encourage folks that have a strong feeling about napping one way or the other to look at their nighttime sleep first. And my hunch is you grab an Oura Ring or a Whoop or something or a bio strap, you'll discover you aren't getting good deep sleep, and your urge to nap is the micro sleeping pushing back because you aren't getting good deep sleep at night.
I think humans can easily regulate any slight sleep schedule. We can become larks or owls or we can sleep in one chunk or we can be Socrates and sleep 20 minutes before hours if we want to. We're very adaptable. But I think in a modern world, most of us, adults north of 16 or something, should probably be asleep in one chunk roughly most nights and napping is probably not the most efficient for most people. But that's more of a theory. I don't have good science behind that.
Sleep Tracking Devices
Heather Sandison, ND: So you mentioned some devices you can use at home to track your sleep. What are your favorites?
Andrew Hill, Ph.D.: Basically anything that tracks HRV, heart rate variability, is an okay way of tracking sleep stage. There's no good EEG sleep trackers for the home user anymore. There were some at the market 10 years ago, but not currently. So the HRV trackers that are I think best in class, you can go cheap and get a Fitbit, which is like 150 bucks. Those are actually pretty good, or you can get really high-end and go with like a Whoop, which is a for athletes and hyper performance, it's a wrist strap you wear all the time, and it measures your heart rate when you're exercising and measure your heart rate variability today and it tells you about your sleep stages.
Tells about your body's strain if you're ready to hit the gym hard that day or you should relax because your heart rate variability suggested you haven't recovered yet from the previous workout. And then the Oura Ring is a biohacker's style device which does some sleep tracking as well. The Oura Ring only tracks at night, so you can't use it during workouts. It relies on some biomechanical tricks like the fingers swelling up at night to get good data. So I'm not a huge fan of the Oura Ring as a sleep tracker because it's not continuous day and day out. But I have certain friends in the biohacker world who will only use the Oura because they can turn off the Bluetooth on it, and they don't want to have any electromagnetic signals.
That's another thing that I don't care about that all my biohacker friends are really hot on is electromagnetic signals. I don't think there's any issue with the EM.
Heather Sandison, ND: And 5G?
Andrew Hill, Ph.D.: 5G, EM, cell phones, none of it, because I know how damn hard it is to get anything in or out of the skull. It's nearly impossible to get electricity and out of the skull, it's so hard. My entire life has been trying to get little tiny micro cycles out of the skull and avoiding contamination in the environment. There was a study last summer showing you can do TMS across the skull, the corpse, and none of the electricity gets in, it goes around the skull, not through the skull. So I just don't think that Em's a big deal, I'm not concerned about it, essentially visible or invisible, I'm not concerned about EM as a big driver, not when we have so much more control over when we eat, when we sleep, when we're active.
And those do move things rapidly and obviously. There's no science question about activity and eating. There is some question about light, but it being a big deal, but eating, that's not well understood for decades about the biggest zeitgeber or time giver.
Meal Timing and Nutrients for Optimal Sleep
Heather Sandison, ND: Let's talk more specifically about eating and what nutrients influence how well we sleep?
Andrew Hill, Ph.D.: Well, we need to have not been in a starvation mode consistently to sleep well, but humans are adaptable, we can go two or three days without eating and sleep very well. If we're in a good insulin state, you can generate ketones. You can be somebody else who's eating crappily all the time and eats carbs to fall asleep, wakes up hungry, snacks and cabs really long, top of their blood sugar, is always in an inflammation state. That's not going to work great long term, but you can perform that way as a human if you need to, you can handle starches. It's a little bit variable, some people can handle starches better than others without having any negative consequence, you have a more reactive insulin system or you have APOE genetic status that means your fats are oxidized more readily.
Those are factors, but they're not huge factors in health and wellness of the brain. The biggest features are for aging and performance is to minimize all the sugars in your environment and your dietary environment to zero or too close to it, low amounts of carbs. The carbs you get to come from vegetables and from starchy and water-filled fruit, not from sugary things, not from grains, not from cereals essentially. But people are variable.
Heather Sandison, ND: Is that more of a Paleo?
Andrew Hill, Ph.D.: I think you can or should eat Paleo or primal or Keto however you want to, but the only brain diet that I don't think is all that well established in literature like I don't think there's any good reason to for a health reason, for brain health reason is vegan. I think you're going to kill yourself being vegan for your brain, it's really bad for you, for my opinion, unless you're extremely careful, but you're doing more harm to the environment by eating all the engineered foods, and they got your nutritional gaps probably if you're vegan anyways. I want to know why you're vegan if you're vegan aggressively because it doesn't make sense to me.
And if you are vegan and you're hearing this and you're getting ready to send me hate mail, you're in nutritional deficit probably, unless you're very, very careful. And I would encourage you, all my vegan friends are actually now vegan plus muscles.
Heather Sandison, ND: Oh, segue muscles.
Andrew Hill, Ph.D.: Because muscles have a very primitive nervous system, don't feel much pain, they're sedentary, they can be farmed with almost no impact to the environment and they're self-replenishing. So they fit all the same criteria that my friends use to select food, there's no faces, etc, etc. So I have certain groups of friends now that are vegan plus certain types of non-plant matter that fits the same criteria. And I encourage you, if you are vegan, you should probably be building in some of those foods. You aren't vegan, then you should be building in some of the organ meat foods to get trace nutrients; liver, heart, kidney, that kind of stuff.
Heather Sandison, ND: Can you see exactly what those nutrients are and can you supplement them or is that just a process for trying to get these nutrients?
Andrew Hill, Ph.D.: If you're supplying things you would get from organ meats, you're basically just supplementing desiccated organ meat. So you might as well just learn how to cook liver or you go to your butcher and have them grind up a half pound of beef heart and three pounds of beef or something because you hide it in your hamburgers or something. But offal are organ meat, incredibly good for micronutrients and for lots and lots of minerals essentially that you can't really get in any other way. So if all yours are eating white chicken and red meat and vegetables, you're actually missing out a huge swaths of other nutrients.
So you should go into the micronutrient vegetables or organ meats or both, bone marrow, livers, hearts, all kinds of interesting things.
Heather Sandison, ND: So liver and bone marrow, when I think about that, I worry about toxins that might be concentrated in those organs in certain animals. Is that not a problem?
Andrew Hill, Ph.D.: Think of bone marrow very much, you can concentrate certain things, but bone marrow is also a generator of tissue largely. So I'm not concerned about bone marrow itself unless you've been having a cow in a radioactive farm or something. Livers are regenerative. livers are the only organ that basically regenerates itself continuously. So you don't trap toxins in your liver forever, all food, even plants contains toxins and can lead to the metabolic byproducts of that organisms metabolism. Now, livers got metabolic byproducts in it, but I'd rather have some nice pasture raised chicken livers than I would go to an industrial farm and eat like pen-raised cattle liver. That's not going to be good for you, but not so much because it's the liver, but because all the other stuff the cow is eating.
So I care more about the overall environment, I eat lots of meat, I'm very frank about it, but I'm incredibly careful about where I get my meat from. It comes from known sources, I have a freezer in my kitchen, I don't buy random meat. I buy a certain sources and I'm careful with it and I get good quality because I don't want to be contributing to all the other things that are a problem with the meat industry, with grain-fed meats, for health reasons. There's lots of problems in meat, health and industrial reasons, I try to minimize those. And we have to, but life is an exercise and harm reduction, it really is. Everything will kill you, don't take life seriously, you will knock it out alive. Everything's going to kill you.
So it's about harm reduction and making choices to minimize risks and maximize gains versus being orthorexic with your diet or something.
Practical Tips for Better Sleep
Heather Sandison, ND: Yeah. That probably would contribute to the anxiety that will keep you from sleeping, right? Now we're back to the sleep problem. What can we do if we are having trouble falling asleep at night? You mentioned that most people have sleep issues that maybe are subclinical and they're not complaining about outright, but maybe are optimal for having good function throughout the day. So if I want to get to sleep easier tonight and get better sleep tonight, what can I do before I go to bed?
Andrew Hill, Ph.D.: Well, it takes a while to adjust your sleep. If your sleep has not been good, your sleep architecture, the habits around sleep, when you crave carbs, when you're awake, how deeply is your sleep, that's a learning process. In some ways, your first nervous system is that is involved, your enteric nervous system, your gut is involved with learning to be hungry at certain times of the day, so you have to teach yourself over time how to fix your sleep. But the easiest way to do it is simply to get up before you want to consistently, several days a week, like get up at 4:00 AM for a week. You will have a different sleep regulation a week later, I guarantee.
If you focus on your morning more than your evening, and that again, it gets you away from this anxiety around sleep. Don't worry so much if you can't fall asleep. You can't not sleep, you really can't. If you go three or four days without sleeping, you will get psychotic or seven or eight?
Heather Sandison, ND: What would you do?
Andrew Hill, Ph.D.: Yeah, it'll happen, you'll get crazy. So don't worry about it, you'll fall asleep sooner or later, it'll happen. If your mind is busy, that's anxiety, if your body's tight, it could be stressed. There's lots of things you can do to shift states, like a meditative, progressive body scan, putting your mind in each muscle and relaxing it can allow people to shift to the sleep. Or if you find you're anxious instead of resisting the anxiety and beating yourself up for not falling asleep in the bed, you can find things to distract yourself, or you can do other exercises around meditative things or use the time... I have really great sleep these days, I to go to bed at 9:00 PM, wake up at 4:00 to 4:15 without an alarm, every single day now.
That's the best regulative I've ever been in my life, I've never this good. Years ago I used to work in bakeries at 3:00 and 4:00 AM, I would never get cleanly as like a person in my teens or 20s. But in my 40s, I've figured out all the tricks and I wake up easily without any issues. But it's about the morning, it really is, you have to protect your morning to keep your sleep tight. Evening is much less important, I don't care if you're up to 4:00 in the morning on the internet and with lights blaring in your eyes once a week, one, big, big deal if you're keeping track of all the other stuff the rest of the nights.
Heather Sandison, ND: And then what about people who wake up, this may be the same answer, but people who can't maintain their sleep, is that the same thing you want them waking up at 4:00 AM to just get out of bed?
Andrew Hill, Ph.D.: I do, but those people have sleep maintenance that's usually anxiety, it's a generalized anxiety. Often the brain's had a peeking through the veil of sleep all night long and white knuckling the world, not letting go of the world. The person's often a bit hyper-vigilant, and what you're getting is a sleep disruption because the brain is anxious and peering around all night long. And that usually comes along with a lot of crappy, deep sleep, a lot of fatigue. So I would actually want to have the person examine what's provoking or supporting the anxiety, more than the sleep when it's a sleep maintenance issue. Sleep onset can be sleep stuff, regulation of sleep stuff and anxiety too, but sleep onset contain insomnia, but maintenance of sleep, I almost always find has features of generalized anxiety that goes along with it.
And so I'd want to figure out how to work on that, be it a feedback or neurofeedback or therapy or something else to work on those more palliative ways of dissolving that stress response.
The Issues with Benzos and Alcohol
Heather Sandison, ND: I'm curious your opinion about benzos and really generally GABA receptor agonists, so alcohol, phenyl GABA, Ambien and Klonopin.
Andrew Hill, Ph.D.: Naturally, they cause problems. That's your answer.
Heather Sandison, ND: They might get you a little bit of relief tonight, but over time it's going to cause more problems.
Andrew Hill, Ph.D.: Very short. For days or weeks you'll get benefits and then you'll end up in trouble. Now, not all of them are habit forming, many are. And that's, you get in second level of trouble if these are habit forming. Most GABA agonists are fairly habit forming. Also GABA's inhibitory neurotransmitters, so you get dis-inhibited a little bit. So what's the joke? Five drunk guys start a fight, five strong guys start a band? So GABA agonist, the brain tends to require its GABA to be at a fairly stable level moment to moment. If your GABA goes up at all, you pass out, if your GABA goes down at all, you have a seizure, because the GABA glutamate are in tight balance and they're very tightly regulated. They can't be shifted much at all.
I'm not a big fan of monkeying with GABA with external exogenous chemicals because it's such a powerful system that re-regulate itself to keep the GABA internally at the same level because it can't handle a change. This is why alcoholism produces a shaky nervous, a person who can't fall asleep after a few years, because that's GABA, the brain stops freezing GABA with the alcohol releasing the GABA. For folks that are listening, that smooth warm feeling you have a couple drinks in, that's GABA being released in your brain, it feels good. But if you keep doing that, the brains [inaudible 00:43:31] and you can produce GABA and it's supposed to ramp its glutamate up to compensate for the alcohol you're drinking, so you have a glutamatergic, if you will, [inaudible 00:43:39] increase.
In the absence of drinking, you're shaking, you're nervous, your cardiovascular system spikes, you have seizures, you can't fall asleep. That's all a failure of your own and dodginess GABA agonist production. So I'm not a big fan of people... I work with tons of people come through my office having done lots of GABA agonist are still on them. And those people that have done them for any length of time are addicted and almost everyone who's been taking them for years has no effect from them, they're still taking them. They're on Xanax every night to get some sleep because if they don't take Xanax, they will have anxiety attacks for the first three hours of the night. But they are getting better sleep because of it, they've just been addicted to Xanax for 10 years.
Heather Sandison, ND: And there's an argument that you might be getting worse sleep if you're taking a benzo, right?
Andrew Hill, Ph.D.: Absolutely. You're in hypnotic state, there is no drug that causes sleep. So benzos kick anxiety out of the way, theoretically you're tired, then you fall asleep, but there are no drugs trigger the sleep state. So any drug that causes sleep-like states, there have not had a drug that produces a state that is not actually asleep. And you might spend all night long and a hypnotic trance, wake up having not rested, feel like ambient, all those other next generation of sleep drugs, those are just hypnotics. They're not producing sleep they are producing a rubber mallet to your mind so you can GABA your own way a little bit, maybe fall asleep later.
Downsides to Using Melatonin for Sleep
Andrew Hill, Ph.D.: Also even melatonin for sleep. People take massively too many doses. The effective dose of melatonin is 300 micrograms, 3.3 milligrams. That's it. But there's a bi-modal dose curve, people get a response at about three to 500 micrograms and they get another response at about like five to 50. There's nothing in between in terms of responses, but if you take five, 10, 15, 20 milligrams, you get effects melatonin two or three days later in rebound versus taking 0.3 milligrams, you have a nice strong effect that wears off the same night. So everyone's using melatonin wrong, first of all, almost everybody because you're overdosing it because they're essentially abusing a fairly innocuously, but abusing a drug that you're body uses the signal. So I think that people are getting into trouble with melatonin as much as they are Xanax.
Heather Sandison, ND: Wow. That's a big call.
Andrew Hill, Ph.D.: The consequences of that trouble are much reduced, the consequences of melatonin issues are just continued crappy deep sleep and sleep onset. The consequences of Xanax abuse are much higher obviously, but I think that it's a bigger problem, probably melatonin than Xanax for more people.
Heather Sandison, ND: Just because it's more of a ubiquitous, you don't need a prescription for it.
Andrew Hill, Ph.D.: Because more people are abusing it, most people are using it wrong.
Heather Sandison, ND: And with melatonin, does it interfere with your quality of sleep to the degree that benzodiazepine does?
Andrew Hill, Ph.D.: It probably interferes with the quality of your sleep the second night, not the first night. I'm also a little concerned that melatonin could down-regulate serotonin because melatonin in the brain is produced from serotonin as the raw material. So neurotransmitters are constructed by enzymes, which will create one thing, convert to the next, to the next, to the next, like tyrosine's converted into dopamine. Well, serotonin is converted into melatonin, it's raw material. So all serotonin neurons in the body have an auto-receptor, receptor that listen, same amount of neurotransmitter, that same neurons releasing into the synapse, and if it releases too much, it down-regulates.
So this is why SSRI after you take it for several weeks, Prozac and whatever, you actually have lower serotonin amounts in your body than before because the auto-receptors actually down-regulate serotonin production when you boost it with drugs.
Heather Sandison, ND: That's a great segue into Trazadone and Doxepin and those an SSRI for sleep, opinion there.
Andrew Hill, Ph.D.: I don't think they work that well except in short term, and it's just usually when it works, it's because the person was depressed or anxious and you're breaking that state. I think Trazadone is probably the least habit forming of all those, and I've seen tons of people on Trazadone for sleep who aren't getting great effects, "I've been thinking, are you taking something for sleep?" "Yeah, I'm taking Trazadone." "How long?" "Oh, about six years." "Oh, really? How's it working?" "I don't sleep." "Oh, okay." And it worked for the first week and then it stopped working, but they kept taking it. That's very common for sleep meds is the efficacy goes away, but the person keeps taking it.
Heather Sandison, ND: Are there any other tips or hacks that you have for getting better sleep? Let's just go through them real quick. So fast for three hours before you get to bed, wake up at 4:00 AM.
Andrew Hill, Ph.D.: Wake up consistently early, roughly the same time every day.
Heather Sandison, ND: Earlier than you want to.
Andrew Hill, Ph.D.: Earlier than you want to, yeah. Or the sun.
Heather Sandison, ND: We're about to go into the winter, summer versus winter. Do you want to get up earlier in the summer than in the winter? And can you sleep a little later in the winter because of the light or you're saying light has absolutely nothing to do with it?
Andrew Hill, Ph.D.: Light has absolutely nothing to do with it, and the light that matters is the light in the first hour after dawn. But I think by the time dawn happens, you should been up already. So yes, things do change, summer and winter, and that's really a function of society more than anything else. You see that accidents the day after daylight savings time kicks in, the accident rates go way, way up the next day all across the country. More people die the day after you change the time zone in this country than if you didn't change. So there's several proposals now to either get rid of daylight savings time or make it consistently 100 % daylight savings time a year round in this country. I think that will actually help us a lot.
Yes we adjust in the winter, of course it's darker earlier and light earlier in the day as well. I find it easier to adhere to an early morning schedule in the winter, but that's just probably me in terms of the cues, I just find it easier. I don't think it matters all that much and I don't think that we can have it matter. I think most of us use our jobs as the big timer of our lives, and if you work 8:00 to 5:00 or something, well, you're not going to get up at 4:00 AM sometimes in the year, and 7:00 AM other times of the year because you can't. So you have to pick out... I have two offices for instance, my big peak rate offices are in Los Angeles and St. Louis, they're the two biggest offices, I go back and forth, the two hour time zone difference and I have the same wake time consistently every day of the week no matter what state I'm in. So I'm up at 4:00 AM in Los Angeles and 6:00 AM in St. Louis.
Coping with Jet Lag
Heather Sandison, ND: Yeah. That was another question with travel. Do you have any hacks for that like melatonin? Would you consider using melatonin if you're going to London tomorrow?
Andrew Hill, Ph.D.: No. I'm going to London about three weeks to speak at the Health Optimization Summit, and I will use an app called Timeshifter, which is crib one of our NASA astronauts. And I'll tell it how many days I had ahead time that I want to start shifting and how many days after I got there I want to use for shifting, and it will have me adjust my sleep phases, my caffeine, my light exposure. If I want to use melatonin, it allow that in for me as well, and have me push the circadian cues up and down faster, we can brute force, we're just naturally adjust about one time zone per day. I go back and forth a lot, I have a qEEG office in Southern Sweden, which is nine hours ahead of us in Los Angeles, and I go out there about twice a year.
Before I started bringing all my tricks on board, it would take me about three days to adjust once I got there, about six days to adjust when I got back. And now using Timeshifter and some very careful use of sleep hacks, I can usually adjust in about a day and a half when I got there, at about three days when I got back.
Heather Sandison, ND: Okay. So you can cut it in half?
Andrew Hill, Ph.D.: Just about, yeah. And some of that was learning how to keep my sleep cycle consistent no matter where I was in the world. I do flip my sleep cycle when I go to Europe, I do adjust my time zone. I don't adjust it when I go to the Central Time zone or East Coast because I travel so much every month, at least once. So I don't adjust for a couple hours, I just adjust my Google Calendar so I can tell the time and day is where I am. That's it.
Heather Sandison, ND: And so then are you using, if you do go to the other side of the world, if you are going to Europe then will you use 300 micrograms of melatonin?
Andrew Hill, Ph.D.: I won't. I don't find melatonin does very much for me, I don't think it's the strongest. I'll be very cautious about having sunglasses to hand when I want to cut on light and when I sleep and when I wake, activity is the big one there for me. And I also drink a lot of caffeine, so I have to remember not to just reach for the next cup of coffee, if it's the wrong time of day, that will throw me off. I drink a lot of caffeine, I'm also fairly sensitive to caffeine, so I know if I land in London or Denmark or something and it's 4:00 PM there and I have a cup of coffee, which I want, it's going to push my circadian in the back by a day. So I have to be careful some of those cues. But for me, caffeine, activity and when I sleep are the big ones.
Coffee is Good for You: How it Affects Sleep
Heather Sandison, ND: And in caffeine, do you see that being a major player in your office? Are you telling people to cut back on caffeine or use strategizing? No. You're shaking your head
Andrew Hill, Ph.D.: I tell them to use more caffeine sometimes. Coffee is good for you, basically, if you aren't putting sugar and crap in your coffee, it's good for you. Westerners get more antioxidants from caffeine, from coffee rather, but I think from all other dietary sources combined. So caffeine or coffee specifically is really, really good for you, two to four cups a day, cuts your lifelong risk of things like Alzheimer's, Parkinson's, cancer, diabetes down in a measurable way dramatically. And the study out a couple of months ago showing the upper limits of caffeine across large populations of heavy caffeine drinkers like in Finland, the upper limits before health risks started to accrue for caffeine, I think were 26 cups a day.
Heather Sandison, ND: What if it gives you anxiety?
Andrew Hill, Ph.D.: Well, then you're having other issues, gut issues or cardiac issues. But for many people, if you're getting anxiety from caffeine, I would wonder if it's just the caffeine.
Heather Sandison, ND: Or if you just have anxiety.
Andrew Hill, Ph.D.: Yeah, or you just have anxiety, it's just cranking up.
Heather Sandison, ND: And you think do some neurofeedback and deal with that?
Andrew Hill, Ph.D.: Exactly. Or you want to add some L-theanine capsules to your cup of coffee or just swallow it and then you can-
Heather Sandison, ND: So then what about having green tea or your latte, is that naturally occurring balance of caffeine and-
Andrew Hill, Ph.D.: Great. It's wonderful. It's wonderful. I think coffee is better for you than tea. So I'd rather you have lots of coffee to lots of tea because I think the antioxidant into the roasted beans are much healthier than what you get in tea.
Heather Sandison, ND: And then what about adding fat to that? Does that increase or do-
Andrew Hill, Ph.D.: I think that's nonsense? I think that's fine for you, but I think that A, you should be fasting in the morning, not having fat, too bad for you to have calories all day long every day, you need to fast, you need to have moments of not eating hours.
Heather Sandison, ND: Did you say you want to do that later in the evening and that people should be having breakfast?
Andrew Hill, Ph.D.: No. You should be fasting in the morning as well.
Meal Timing to Improve Your Sleep
Heather Sandison, ND: So when is the ideal time to eat? Because I'm sorry, I was thinking-
Andrew Hill, Ph.D.: It depends on how you're doing it. It depends on how you're doing it. If you're intermittent fasting and you're a man, you probably want to do like a good eight hours window, a woman, 10 hour window roughly, it work backwards. So if you're going to bed at like let's say, 10:00 PM, you want to a three hour fasting windows, so you finish eating at 7:00 PM, and you start eating at 11:00 AM if you were a guy or I can't do math, 9:00 AM if you're a woman. That's not a hard window, 9:00 AM to 7:00 PM.
Heather Sandison, ND: No, not at all. But then you're waking up at 4:00 or 5:00 AM.
Andrew Hill, Ph.D.: Exactly. Waking up, working out, having some time to hydrate and rest, kick in all your insulin, ride that ghrelin then eat only after a few hours have gone by.
Heather Sandison, ND: And are you having coffee in that window before when you're still fasting?
Andrew Hill, Ph.D.: Yeah, because black coffee is no calories, really.
Heather Sandison, ND: Okay. But if you're going to have-
Andrew Hill, Ph.D.: Yeah. Water, black coffee, tea.
Heather Sandison, ND: Okay. If you're putting fat in your coffee, then you want to do that starting at 9:00 or 10:00 AM?
Andrew Hill, Ph.D.: Exactly. No calories before your fasting window, none at all. So basically it's time restricted feeding, but anything that doesn't cause an insulin spike, 30 calories roughly causes an insulin spike or can or causes digestion to kick in. Usually 20 grams of carbs is insulin, but 30 kilo calories will cause digestion often. So coffee doesn't have any calories really, black coffee.
The Best New Technologies for Sleep
Heather Sandison, ND: Okay. Are there any exciting technologies for sleep optimization that you're interested in?
Andrew Hill, Ph.D.: Just this proliferation of sleep hackers we're getting access to, I think that there's a lot on the horizon, I think I'm very excited about what the Whoop and the Oura are doing. There's another company up here in Santa Barbara, the Biostrap, interesting technology as well. And then my guess is that over the next year or two we'll be having more and more access to self-quantify tech to understand more about what's happening for ourselves.
Heather Sandison, ND: And what about sleep studies, what is your feeling about a inpatient like overnight sleep study in a hospital versus the at home ones? How relevant do you think those are?
Andrew Hill, Ph.D.: It's expensive a little bit and you might not sleep your natural amount, so what you'll have to do... I mean, it depends on why. If you think you have apnea, go get a sleep study, but if you just wondering about your sleep quality, buy a cheap sleep tracker and it's a lifestyle thing. These things aren't perfectly accurate, but they're accurate the way a body fat scale would be. If you submit a body fat scale today and it says 20% and tomorrow it says 18%, you've probably had about a 2% drop. It wasn't actually accurate numbers either way, but it's roughly a change. So I would look at the sleep trackers and go, "Oh cool, hour and a half of deep sleep." And then you have like three glasses of wine tonight, it's more like, "Ooh, an hour of deep sleep. Okay." And you learn from it.
I don't care what the quality of the data is so much these days, but what I don't want... I have a couple of clients who've done this and I have to read them the riot act because I have people that will buy 17 different devices to track the same thing and they'll track all the different data streams in all the devices. And I'm like, "How's your sleep?" "I don't know." "What do you mean? You're tracking it, right?" "Yeah." "Well, how's your sleep?" "Well, on which device?"
Heather Sandison, ND: Yeah. I've been noticing the same thing that it doesn't seem like they're overall super, super accurate, but that baseline and then the measurable difference from night to night based on different variables that change is super informative.
Andrew Hill, Ph.D.: Right. And I think the Whoop and the Oura, which tend to converge pretty well, seem to have some good validity. My guess is all the devices are getting better and better these days or over the next couple of years.
Heather Sandison, ND: Yeah, as we get more data. I know you are a busy man and you have to go, I have one last question for you. If you could get any study done on sleep with an unlimited budget, what would it be? What do you think we're missing in the research?
Andrew Hill, Ph.D.: I think we need a good sense of what day-to-day things are affecting sleep. I want people to carry around a day trackers and look at their carbohydrate consumption, their exercise, their stress, their screens or alcohol and correlate that kind of stuff with sleep. Unlimited money, I'll give everyone a really high-end quantified self-device that would tie into their sleep trackers. Then track lifestyle factors we know affects sleep. If you're fasting, what you're eating, when you're exercising, and look at how those, because we know these are the big zeitgebers, we just don't necessarily know how they combine or who sends it to which ones. So that can be teased apart a lot further, I think.
Heather Sandison, ND: What fun. Well, we will look forward to that happening someday. So we all know how to get the best sleep.
Andrew Hill, Ph.D.: That's right.
Heather Sandison, ND: Andrew, thank you so much for your time and for sharing all of your expertise and wisdom today, it's been an absolute pleasure.
Andrew Hill, Ph.D.: My pleasure. Thanks for having me. I appreciate it.
Heather Sandison, ND: Awesome. Take care. Talk to you soon. Bye.