Improving Sleep with Dr. Jose Colon: Rational Wellness Podcast 70
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Dr. Jose Colon talks about how to improve your sleep with Dr. Ben Weitz.
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Podcast Highlights
1:49 Sleep is very important. We spend a third of our lives sleeping and there’s a lot of regenerative processes, and encoding of memories, and healing the body that occur with sleep. A 12 mth old should be getting about 11 hours plus a nap in the daytime. A 10 year old should be getting about 10 hours of sleep. A ninth grader should be getting about 9 hours of sleep. Adults should be shooting for 8 hours and the elderly should get at least 7 hours of sleep per night.
5:06 The consequences of poor sleep can include cognitive problems in thinking and thought processing. ADHD when the diagnosis is made as an adult and pseudodementia can both be related to sleep problems.
7:17 Sleep quality is as important as the amount of sleep. You need to have uninterrupted cycles of REM, when your brain is actually very active and we are encoding our memories with emotions and we have our testosterone secretion, etc. and non-REM sleep cycles, which is our deepest sleep where our brain wave is really slow and we have growth hormone and gastric acid secretion and myoprotein synthesis.
9:03 One of the biggest disturbances of REM sleep is untreated sleep apnea. Antidepressants tend to decrease REM sleep, as does light exposure during sleep.
10:49 Some of the most important effects of sleep deprivation is poor memory, poor performance such as driving, increased inflammation (CRP, IL6, TNF), decreased testosterone production in men, alterations in the menstrual cycle in women, increased cardiovascular risk, and increased insulin resistance.
14:19 The most important factors that affect sleep include electronics and perhaps most important is stress and stressing out over the fact that you are not sleeping. Dr. Colon recommends instructing your patients that if they can’t fall asleep, to do some relaxation training like awareness of breath meditation, which will tend to slow down your respiratory rate, which will put you into that parasympathetic mode.
19:14 I asked Dr. Colon if everyone who gets a sleep study has sleep apnea and is prescribed a C-Pap machine? Dr. Colon explained that sleep apnea is when you stop breathing in your sleep and he answered that not everyone who goes through a sleep study comes out with a diagnosis of sleep apnea and for those who do have sleep apnea, not every treatment is with a CPAP machine.
22:59 Vitamin D deficiency can affect sleep and even induce sleep apnea.
25:15 Restless legs syndrome can affect sleep and this is often related to inadequate ferritin levels, which Dr. Colon recommends to get the ferritin levels above 50 by treating with iron.
26:58 Cognitive Behavioral Therapy is the gold standard for treating insomnia. Another emerging treatment for insomnia is mindfulness based treatment for insomnia, which was created by Jason Ong.
29:15 Circadian rhythm entrainment
33:11 Some of the more effective supplements for sleep are zinc, magnesium, lavender, melatonin, but it is more effective to run a Micronutrient test or an adrenal profile or a melatonin test or a urine neurotransmitter profile and find out what your individual patient needs and treat that.
Dr. Jose Colon is an MD who’s board-certified in Sleep Medicine and Neurology. He teaches for the Institute of Functional Medicine and he’s the author of books for women’s sleep (The Sleep Diet – A Novel Approach to Insomnia), sleep and mindfullness in children, and sleep for infants. He’s the founder of Paradise Sleep, on organization dedicated to the education of sleep and wellness. www.paradisesleep.com
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcripts
Dr. Weitz: This is Dr. Ben Weitz with the Rational Wellness Podcast. Bringing you the cutting edge information on health and nutrition, from the latest scientific research and by interviewing the top experts in the field. Re-subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.
Hello Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and leave us a ratings or review so more people can find out about the Rational Wellness Podcast. Today our topic is sleep. How important sleep is, how much sleep do we really need, what factors affect our sleep, and what we can do to improve our sleep. We’ll be interviewing Dr. Jose Colon, who’s an expert at sleep. He’s an MD who’s board certified in sleep medicine and neurology. He teaches for the Institute of Functional Medicine, and he’s the author of books for women’s sleep, sleep and mindfulness in children, and sleep for infants. He’s also the founder of Paradise Sleep, an organization dedicated to the education of sleep and wellness. Dr. Colon, thank you so much for joining us today.
Dr. Colon: Hey, thank you. It’s wonderful to be here, and I appreciate your podcasting.
Dr. Weitz: Great. So how much sleep do we really need? And I know it differs for kids versus adults.
Dr. Colon: Yeah, so of course sleep is important. It’s a third of our lives and even more of that in kids. There’s a lot of regenerative processes, and encoding of memories, and healing the body that we’re having with sleep, so it is important. And when we ask how much sleep someone needs, I have to say it really is variable. There are things that we like to tell people. We want to tell everyone to get eight hours of sleep, to get seven to eight hours of sleep. And that’s true. That’s a good recommendation, but it really is variable. It’s also variable across the different ages. I like things that are easy to remember, so I’m gonna give you a couple of numbers that are easy to remember, but then we’re gonna talk a little bit more specifically about bright, okay? So easy to remember is that a 12 month old should get 11 plus one. 11 hours of sleep plus one nap in the daytime. A 10 year old should be getting about 10 hours of sleep. A ninth grader through high school, okay, your teenager, should be getting about nine hours of sleep. That’s a perfect storm of a lot of different problems because they’re asking them to wake up during non, you know, unphysiological times. When you have your eight to four job, okay, eight hour days into adulthood, you should be getting about eight hours of sleep. In your elderly, in your 70s, we try to shoot for about seven hours of sleep. And it’s not so much that the elderly need less sleep, it’s just that there are factors, medical factors, that occur that we get more sleep intrusions … sleep arousals, fragmented sleep, but seven hours is a number that’s easy to remember, plus it’s normal to reintroduce naps into the elderly period.
Now, all of these numbers that I gave you, you can plus or minus one of them. And many times it’s minus one of them. And even then, having said that, different people say different things. You know, Dr. Mark Hyman mentions that everyone should get about eight hours of sleep, and American Academy of Sleep Medicine and National Sleep Foundation reiterate that. Dr. Andrew Weil talks about how there are some people that can get less than six hours of sleep and have no ill effect, and he’s right, because international classification for sleep disorders also does have short sleep syndrome as a normal variant. There are some people that get less than six hours of sleep and have no adverse effects. Now, to classify for that diagnosis you need to have no adverse effects, of course.
Dr. Weitz: I talk to people all the time who say, “I get five six hours that’s all I need”, but how do they really know if that’s really true? What are some of the things that they might not even be noticing that could be affecting them?
Dr. Colon: Yeah, so let’s talk about consequences of poor sleep. And we all know consequences can be cognitive, they can be problems in thinking and problems in thought process. There’s a lot of diagnosis of adult ADHD that is made as an adult, where they haven’t had the symptoms before. And that’s someone that you really want to get a sleep study on and see how much sleep they’ve been having. Same thing with pseudodementia, I was taught that, in medical school, that if someone complains that they’re having dementia, the fact that they’re complaining means that they know it, so they may be depressed. Well, not so fast, you may want to make sure that they don’t have an untreated sleep apnea that’s causing that. Other factors-
Dr. Weitz: What was that term you used, pseudodementia?
Dr. Colon: Yes, pseudodementia. Pseudodementia. Yeah. And-
Dr. Weitz: So these are people who don’t truly have dementia, they just have dementia because they’re not sleeping enough?
Dr. Colon: Well, they complain of memory concerns, but then they do a … you know they do the cognitive testing and it turns out to be normal, so they diagnose them with pseudodementia, and they say that is from depression. And to put them on an antidepressant. But you know, I mean, it really could be an untreated sleep apnea. The other thing it could be, it could be mild cognitive impairment. Or subject cognitive impairment, as Dr. Bredison talks about in his book The End of Alzheimer’s.
Dr. Weitz: And those are the beginning stages, before you get to full blown dementia, right?
Dr. Colon: Yeah, correct, correct. Other consequences of disruptive sleep are insulin resistance. So if you’re seeing … any evidence of insulin resistance, unfortunately many times people will just check the hemoglobin A1C, but fasting insulin levels are higher before that. So these are all factors that you would look into, if they’re not sleeping well, take a look at their cognitive status, metabolic status, and that can tell you if it’s affected or not.
Dr. Weitz: Interesting. So not only the amount of sleep, but there’s also the quality of sleep, and I know there’s the importance of getting the REM sleep, and can you explain what are some of the most important factors in the quality of sleep?
Dr. Colon: Yeah, so that’s something that people commonly ask me. They’ll be like, “Dr. Colon, tell me about REM sleep”, and all the cycles are important. People many times think that REM is your deep sleep, but it’s actually a very active brain time. Very active brain time. And we’re taking today’s information and we’re encoding memories, in particular memories with emotions. In our REM sleep we also have increased blood flow that’s going through our organs. In that first REM cycle you have testosterone that is secreted. But this is all in balance with your non-REM sleep as well. The non-REM sleep, just like a washing machine has a deep soak, our deepest sleep is at the beginning where our brain wave is really slow and we have growth hormone secretion, we have gastric acid secretion, so all of this is important. And you have this really rhythmic setting to where you have this gastric acid secretion in the beginning of the of the myoprotein synthesis, and then with our REM sleep we have increased blood flow, delivering it to our body for healing our body. So it’s all very important.
Dr. Weitz: What are some of the, how does your REM sleep get disturbed? Like can you get a normal amount of sleep but it’s just not the quality of sleep? What happens there?
Dr. Colon: One of the biggest disturbances of REM sleep is actually a untreated sleep apnea. And the reason for this is because in REM, our body has less muscle tone, so you don’t act out your dreams, it’s a protective mechanism. But when we decrease our muscle tone, our muscle tone in our airway also decreases as well. So some of the problems that can occur with REM sleep can be an untreated sleep apnea. Other things that can affect our REM sleep are antidepressants decrease REM sleep, and that’s one of the major factors there. Another thing that can affect your sleep in general, whether it’s your REM sleep or your non-REM sleep, is light exposure. If you’re sleeping with light exposure, some new studies have shown that that increases insulin resistance as well.
Dr. Weitz: Yes, so your room should be very dark, maybe even wear a sleep mask or something like that if it’s not.
Dr. Colon: Absolutely. A quiet, dark room is helpful. Sleep masks can be helpful if they’re tolerated, I was actually in Iceland where they had 24 hours of sunlight, and I could not keep that on my face. And I’m like, I’m a sleep specialist, I need to get to sleep, you know, but I couldn’t keep it on my face. But other people can, other people sleep very well with it.
Dr. Weitz: Yeah, I’ve got one from Tempurpedic, and it sort of pushes gently on your eyelid, and if you push gently on your eyelid it actually stimulates that oculocardiac reflex that causes you to relax.
Dr. Colon: That’s a good tip, that’s a great tip, I’m gonna use that in my clinic.
Dr. Weitz: So let’s go through some of the negative effects of what happens when you don’t get enough sleep. I know I was, I listened to your lecture and I was looking at your Powerpoint and you talked about decrease in performance, you talked about memory problems, maybe we could go through some of the more important ones.
Dr. Colon: Yeah, one of the things that you see really early on is memory. And it’s been shown that sleep deprivation, when people do different functional memory tests and cognitive tests, that they work as if they’re impaired, sometimes worse than someone who is intoxicated. And they’ve actually done these studies where they give one group of people alcohol and they sleep deprive another group, and they put them on driving simulators, and consistently the sleep deprived group does worse. So if you combine sleep deprivation with alcohol, then that’s even worse. Other things that can affect, that can be affected if you have poor sleep is-
Dr. Weitz: By the way, when it comes to memory, is it more long-term, short- term, or both?
Dr. Colon: Definitely clearly short-term, you see some problems, like okay, I went to the kitchen to get something, what did I go to get? You don’t forget your own name, but I guess … both can be affected. But immediately you see short-term memory issues.
Dr. Weitz: Okay. And then go ahead, you were gonna say something else?
Dr. Colon: Well, other things that poor sleep affects and decreased sleep is your inflammation status. Inflammation and sleep are really bi-directional, where inflammatory disorders are associated with more sleep concerns, but likewise if you have short sleep, you have higher markers of c-reactive protein, Interleukins, and measures of inflammation such as Tumor Necrosis Factor alpha. That affects cardiovascular status as well, so they’re … doing findings that when you treat your sleep apnea with CPAP, that that also improves your cardiac status, but beyond that, when you treat insomnia with cognitive behavior therapy for insomnia in cardiac patients, they have better cardiac outcomes as well. I also can’t emphasize enough the insulin resistance. Poor sleep really affects insulin resistance as well.
Dr. Weitz: So you can be working with somebody who is a type 2 diabetic or a pre-diabetic, and maybe controlling their, let’s say you’re a Functional Medicine practitioner and you’ve got them on a low carb diet and still they’re waking up with high fasting blood sugar, it could be their sleep that’s actually affecting that?
Dr. Colon: Yeah, and same thing with Polycystic Ovarian Disease. You know, likewise, all of those things, you’re very correct.
Dr. Weitz: So it, can it directly affect your hormone levels?
Dr. Colon: Yeah, absolutely. You know, for men you have that first REM cycle where you’re secreting the testosterone, and untreated sleep apnea has been associated with testosterone that’s low. And then also with women, I mean women have what, a 28 day cycle, that’s the lunar calendar. So I mean, yes, sleep does affect it, yeah.
Dr. Weitz: So in men, is it more likely to affect total or free testosterone, or both, or?
Dr. Colon: Both.
Dr. Weitz: Interesting. So what are some of the most important factors that affect sleep? You talked about light, what about electronics, EMFs, what are some of the other factors?
Dr. Colon: So all of those are really important. The light, the electronics, EMF, every single study that I read about electronics and sleep, there’s nothing positive, I mean nothing is, everything comes back that electronics really disturb sleep. But you asked me another question, you asked me what are some of the most important factors that affect sleep? And I gotta tell you, in my experience, the most important factor that a stress … that causes problems with sleep, is stressing out about sleep pattern, is people, some people can’t sleep because something’s bothering them and what’s bothering them is that they’re not asleep. And sometimes we overemphasize, you can’t overemphasize sleep, yet sometimes we overemphasize it to the point that it causes sleeplessness. So it’s important for patients to know this, it’s important for them to know that yes, we’re gonna try, we’re shooting for our seven to eight hours of sleep per night. But if you have a night that you haven’t slept, you’re not gonna drop dead the next day. You’re gonna be okay. You know, if you’ve gotten those first four hours, the core sleep is within your first four to five hours. If you’ve gotten that, this is gonna help you, at least for the next day. Do we want to do that chronically? No. But some people literally lose sleep over not sleeping.
Dr. Weitz: Right. So maybe you should say to yourself, if you had a poor night of sleep, don’t worry about it, and even if you just … I usually like to tell the patients, look, even if you just lay there and rest, that’s beneficial to your body. And don’t worry about the fact that you didn’t sleep.
Dr. Colon: You know, so let me add something to what you just said. Alright, this is gonna help your patients, okay? You’re correct. Even if you’re not asleep, if you’re resting, that’s helpful. Everyone has a heart rate, everyone has a brain, okay, and these are interconnected with our breathing. So you can instruct them, if you’re not asleep, this is the time to do some relaxation training. This is the time to do an awareness of breath meditation. And when you do this, you’re naturally gonna start to notice your breathing. When you notice your breathing, your respiratory rate slows down. As your respiratory rate slows down, you’re hitting that parasympathetic response. And this is so clutch, because if you’re not asleep, you’re at this parallel where one of two things are gonna happen. You’re either gonna stress about it, and you’re gonna go up at the sympathetic stress, or you can elicit that relaxation response and then at least you’re getting the decrease in cortisol, you’re getting the decrease in heart rate, and you’re starting to relax. So you’re right, if they’re not asleep, you can have them do some type of relaxation response and they’re still getting some R and R, some rest and restoration.
Dr. Weitz: So I have heard about the importance of breathing through your nose as opposed to mouth breathing and some people even tape their mouth, what do you think about those techniques?
Dr. Colon: That … you know, so sometimes we use chinstraps so your mouth doesn’t open if they have an untreated sleep apnea, because-
Dr. Weitz: People actually put tape over their mouth.
Dr. Colon: Yeah, I don’t recommend that. I haven’t heard of tape over their mouth. You know, we prefer to breathe through our nose, it’s more natural to breathe through our nose. Some people have some congestion to where they need to breathe through their mouth. Recently when I was in Lima, I told you that I had some congestion from some of the pollution that was over there, well one of the nights I woke up in the middle of the night and I had a lot of congestion. I had to breathe through my mouth. Now chronically you don’t want to do that, you’re right. Chronically you don’t want to do that. And if you have that congestion, ideally you want to figure out what’s causing that congestion. Do we have too much gluten or dairy in our diet? Do we have environmental exposures? What can we do to reduce that?
Dr. Weitz: Yeah, I’ve always been a mouth breather for a number of years, and I took some training on breathing with a Butyeko breathing coach, and it really helped.
Dr. Colon: That’s great. At the same time, I also have some people that are retired boxers that they’re not going to breathe through their nose. So you have to work with the clients where they’re at.
Dr. Weitz: Right. So can you talk about sleep apnea and what exactly happens when you get a sleep study, and does everybody who goes through a sleep study end up with a CPAP machine, and what are some of the other concerns people have with that?
Dr. Colon: So not everyone who has a, who goes through a sleep study comes out with a diagnosis of sleep apnea. And even people who have sleep apnea, not every treatment is with CPAP. But sleep apnea is where you stop breathing in your sleep. Your airway collapses while you’re in your sleep, and it’s restrictive, and you have less oxygen. That can induce cortical arousal so it affects your brain. And then the known method, the single best known method for treating it is the CPAP machine, which cushions your airway open. But there’s other people that can wear a dental device, a dental device that advances your jaw forward and just to kind of give a demonstration, okay, if I’m asleep, my jaw comes back. Okay you hear a snoring sound? Now if I move my jaw forward, now I’m not making that snoring sound there. So these are very effective, and … yes, they’re very effective for mild to moderate sleep apnea. So you need a sleep study to see where you’re at. But the compliance of those have been shown to be better than that of CPAP, actually.
There are some patients that the sleep apnea may be positional only. So I do have some patients that I’ve treated successfully with a positional sleeping to avoid sleeping on their back, now they sleep on their side, and there’s positional devices that have been studied and have some robust literature. I typically tell people to get a full body pillow. When you have a full body pillow, that’s gonna align your shoulders to your knees, so you know what that does for your back, preserves your back and make it so you can stay in that position throughout the night. So those are the main treatments. There are of course some sleep apnea surgeries that are not really highly recommended. There are-
Dr. Weitz: I’v had some patients get those surgeries recently where they carved out part of the back of their throat, and you know, tried to make some more room there.
Dr. Colon: They’re serious surgeries … that I have referred some patients for it, and I’ve yet to have a surgeon in my area want to do it. They’re like, “No, why don’t you go back to Dr. Colon and work on that CPAP a little bit more.” They don’t have very good track records.
Dr. Weitz: I just had a patient see a sleep expert who gave them some sort of device that stretches out the upper palate.
Dr. Colon: So rapid palatal expansion is something that is very well established in the pediatric age group that decreases the incidence of obstructive sleep apnea and the severity, and I do advocate for that. In the adults, that is, I feel is an emerging topic. It is not being talked about by sleep experts. It’s being talked about more within functional dentistry, and I think that it has a bright future, but the sleep experts don’t have the data on that at this time.
Dr. Weitz: I also interviewed a functional dentist who told me that he thinks that a fairly decent percentage of patients with sleep apnea really just have vitamin D deficiency.
Dr. Colon: I have … the answer is yes, vitamin D deficiency affects sleep. In particular, sleep apnea. It also causes inflammation to where you can get tonsillar hypertrophy, which further affects sleep apnea. I had a patient that I saw for multiple, well I saw him for sleep. The patient has multiple sclerosis. Now when I diagnosed him with sleep apnea, and it was a marginal sleep apnea, but it was definitely present. It was present. And knowing that he has multiple sclerosis, knowing the functional medicine background that I have, I know that vitamin D can affect multiple sclerosis. So I got a vitamin D level on him, I started treating him with vitamin D, and his multiple sclerosis doctor endorsed it. “Yes, yes, let’s go ahead and treat.” Now, interesting. Something happened with his insurance company that they stopped paying for the CPAP machine. What happened, I don’t know, you can’t make sense out of nonsense, so don’t try. Regardless, it got denied. So I had to repeat a sleep study on him, and when I repeated it, sleep apnea was no longer there. This was after several months treatment on that vitamin D.
Dr. Weitz: How much vitamin D were you giving him?
Dr. Colon: We were doing … it was, I think, conservative. I think we were doing like 5000 units.
Dr. Weitz: Okay.
Dr. Colon: And some people will say, “Oh, 2000’s conservative.” No, I think 5000 was conservative. But even then, you know, it was only that much, and it was after several months of treatment, we repeated it, and it was negative. So what was wrong? I mean, was my sleep study wrong? No, I mean I looked at it, I read it. Both of them were quality, and I went back and looked at both of them. And the measurements were there. But he just didn’t have the sleep apnea. And he didn’t lose weight either.
Dr. Weitz: So one of the things that can interfere with sleep is restless leg syndrome. And I know there’s some controversy over exactly what the causes are, and I saw one article that found a correlation between IBS/SIBO and restless leg syndrome, which I thought was really interesting, because I end up treating a lot of cases of IBS and SIBO. Can you talk about restless leg syndrome for a minute?
Dr. Colon: Restless legs are uncomfortable sensations in your legs that are worse at night, worse when you rest, and they’re relieved by movement or by mental activity. There are many causes, and even then there’s two kinds, familial or non-familial. And there’s many causes, one of the main causes that everyone with restless legs needs to be evaluated is ferritin is deficient. And notice I didn’t say iron deficiencies, because you can not have anemia but still have less ferritin. And if you don’t have the … enough ferritin you can have-
Dr. Weitz: What’s the distinction there?
Dr. Colon: So what are the main treatments that, medical treatments that people give, is the dopaminergic medications, right? Well you know, the dopamine receptor has ferritin in there, and further, so low CNS ferritin has been shown to cause restless legs and treating that. So the ranges, when you look at ferritin, you know it says that the range may be to 10 to 20, or if you’re at 20 that’s normal, but if you have restless legs, 50 and below, you know below 50, that’s symptomatic, and you want to be treating with iron in those patients.
Dr. Weitz: Interesting. So how, besides restless legs syndrome, let’s go over some of the … I know you mentioned a few of these, but let’s go over some of the therapies to restore better sleep. You mentioned cognitive behavioral therapy, what exactly is that, and how does that work?
Dr. Colon: Yeah, so CBTI is the gold standard for treating insomnia. And CBTI is working with a psychologist that really kind of helps retool sleep. That’s what I explain to patients. But one of the things that these therapists is doing is that they’re addressing our attitudes, our concerns, about sleep. You know how I said that some people don’t sleep because they’re stressed about sleep? Well, yeah, that’s what the psychologist works with. They’re like, “Okay so what’s gonna happen if you don’t sleep?” They’re like, “Well, if I don’t sleep I’m not gonna function the next day.” “Okay, and then what’s gonna happen?” “Well, I’m gonna go to work and I won’t be able to function. And if I can’t function, I’m gonna be fired, and if I’m fired, I’m gonna be homeless.” And literally people with insomnia can have some degree of catastrophic thinking that occurs. And the CBTI helps out with that.
And another emerging treatment in insomnia is gonna be MBTI, or mindfulness based treatment for insomnia. This was created by Jason Ong. And there is a perception, yet misperception that we can meditate ourselves to sleep. I mean, yeah, you can induce a relaxation response or sleep, and relaxation therapy and relaxation training is good for sleep, and I teach my patients how to do that. But MBTI is different, because you’re actually doing a practice of mindfulness, an eight week practice of mindfulness. What are some of the core concepts of mindfulness? Non-judgment. So if you stop judging yourself, you know that you’re not asleep, you stop … you worry about the present moment, don’t think so much about the future, the MBTI has been shown to be very helpful for insomnia as well.
Dr. Weitz: Great, great. What is circadian rhythm training?
Dr. Colon: Circadian rhythm entrainment is that we all have a 24 hour cycle. Everyone lives in a 24 hour society. Believe it or not, actually, our internal clock has a tendency to go 25 hours. So if you put people in a cave and you take them away from light cues, you disrupt their light cues, they stay up later, and later, and later, an hour later the next day. And what resets our cycle is that morning light, and then the darkness at night. So I’ll use, and even then, you really do have some people who are night people, and some people who are morning. You know, people have different circadian clock genes that predispose their circadian cycles. So circadian entrainment is trying to work on a particular wake up time with light exposure and you can even add melatonin, based on where their melatonin secretion should be coming out. When should they secrete melatonin? There’s a very, very helpful tool called a morningness-eveningness questionnaire. It has a German name to it that I can’t pronounce, so I just call it the morningness-eveningness questionnaire. And you can go online and get it, it’s called the AutoMEQ, M-E-Q, Auto M-E-Q.
Dr. Weitz: Cool. And you talk about sleep restriction, restricting your time in bed, I guess this is for somebody whose sleep cycle’s all messed up, and if they’re having trouble sleeping at night and then they end up sleeping during the day, how does that work?
Dr. Colon: So let’s, before we talk about how it works, let’s talk about what does not work, okay? So there are some people that spend extra time in bed, because they want to sleep more. And that sounds logical, okay if I’m not getting to sleep til … I’m throwing numbers out. If I’m not getting to sleep til midnight, let me go to bed earlier, so I can eventually get to sleep. The problem with that is that you’re spending more time in that bed learning not to sleep. And training your brain to not be asleep. So the key is to … the time. Restrict the time that you’re in bed until the times that we are going to be asleep. So that’s what we mean by sleep restriction, as well as also having a very strict wake up time, because that helps with the circadian entrainment as well.
So another thing that people say is, well if I didn’t sleep until this time, I need to sleep in longer. That sounds logical, but it’s causing a cascade of problems that’s disrupting your circadian system, which we have a natural tendency to run at 25 hour cycles, so if you didn’t get to sleep til whatever time, it doesn’t matter, wake up at the same time. And if you do that on a regular basis, that’s going to help your sleep drive, get to sleep a little bit earlier. So sleep restriction isn’t so much sleep depriving people, although you do go through a period of time where they might get a little bit less sleep, but you do that in a way that they end up getting to sleep on a regular time, a little bit early on a regular basis.
Now that is something that I would do either with a board certified physician in sleep medicine, or that would be a great period to find someone who, through the Society for Behavioral Sleep Medicine, a sleep psychologist.
Dr. Weitz: Cool. What are some of your most effective herbal or nutritional supplements for sleep?
Dr. Colon: You know, so whenever someone asks me what is the best supplement for sleep, I always say what are you deficient in? So I will commonly run some micronutrient analysis to see. I can show you evidence that zinc has been helpful for sleep, that magnesium has been helpful for sleep, lavender is helpful for sleep, melatonin is helpful. Everything that’s out there I can show you evidence. But what is it in your patient? So you run a micronutrient analysis and you look for a specific deficiency. Or you may run an adrenal profile, and you can find that they’re epinephrine or norepinephrines are high, or their cortisols are high, you know, some ashwaganda is gonna be good for them, or some rhodiola. If their cortisol is high, lavender has been shown to decrease the cortisol. Run a melatonin profile, and if their melatonin is normal, then giving them more melatonin is not gonna help out. If you see that their melatonin is low, okay then that’s someone that we may want to supplement with melatonin, or have them eat more foods that have both tryptophan to make your own melatonin, as well as also natural melatonin such as tomatoes, cherry juice, walnuts.
Dr. Weitz: You do do urine neurotransmitter testing to see if their serotonin or GABA is low?
Dr. Colon: I have, and the context that I do that is I’m saying, “Look, I’ve been seeing you, you’ve done the sleep hygiene, we’ve done the sleep studies, we’ve done the standard of care, and you’re still having some issues, do you want to do a little bit more?” And some people say, “Yeah, yeah, okay let’s do more.” And I’ve had a patient that their glycine was low. Alright, well let’s supplement glycine. Other patients that their serotonin could be off. I had one patient with excessive sleepiness that had high, really high GABA levels, well GABA is inhibitory. So they were complaining of insomnia, but in essence they were sleeping during the evening, it’s just that they were tired during the daytime. And we ran it, the GABA was high, well DHA can attenuate that response. So we targeted individualized treatment.
Dr. Weitz: Interesting. GABA can also help with sleep, and some people use it in sleep formulas.
Dr. Colon: Correct. GABA can help with sleep, but also if you have chronically high GABA levels, which many patients with idiopathic hypersomnia can have defective, overactive kind of GABA receptors.
Dr. Weitz: So just like many things, not too much, not too little, gotta get it in that sweet range.
Dr. Colon: Yeah, that and what are we treating? So I get the question a lot, “Dr. Colon, what’s the one big thing that we can do with sleep?” And number one is not worry about it, but number two is what are we treating? Are we treating … do we have an unknown sleep apnea, if we have restless legs, do we have SIBO as you mentioned, do we have magnesium deficiencies, keratin deficiencies, and even sometimes throwing in micronutrient analysis and also the neurotransmitter profiles.
Dr. Weitz: Right. So basically try to get at the root cause, do a careful history-
Dr. Colon: Yes, sir.
Dr. Weitz: Do a certain amount of, you know, a reasonable amount of testing, and then let’s try to have some real target for what … you know, that we can really try to intervene and get to those root causes, which is really what functional medicine’s all about.
Dr. Colon: You hit the nail on the head, doc.
Dr. Weitz: Okay, Jose. So for those listening or watching this podcast, how can they get a hold of you? And how can they get a hold of your books and your training programs?
Dr. Colon: Yeah, so all of my books are on Amazon. They’re also from my publisher, Halo Publishing, and yeah, I wrote a book for women for insomnia called The Sleep Diet a Novel Approach to Insomnia, which I wrote it at a time when I had no idea about nutrition, so it’s not so much about diet but about different lifestyle aspects. And I have, as you mentioned, children’s sleep book and a book for infant sleep. And I also put information on my website on sleep tips for free on paradisesleep.com.
Dr. Weitz: And are you available for consultations in person and over the phone, or via Skype, or?
Dr. Colon: I do work for a health system, so all of my consultations are within my clinic, actually.
Dr. Weitz: Oh, okay. Great, excellent. And what’s your website?
Dr. Colon: Www.paradisesleep.com
Dr. Weitz: Excellent, thank you Dr. Colon, thanks for spending the time with us.
Dr. Colon: My pleasure, you have a great one.
