How to Improve Your Sleep with Dr. Damiana Corca: Rational Wellness Podcast 241
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Dr. Damiana Corca discusses How to Improve Your Sleep with Dr. Ben Weitz.
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Podcast Highlights
2:50 What is good sleep? It is falling to sleep within 10-20 min and sleeping for seven and a half to nine hours, depending upon the person and depending upon the season. Ideally you would like to sleep through the night, but it’s okay if you wake up once or twice briefly, such as to urinate, as long as you back to sleep pretty fast. Our sleep typically happens in cycles of about 90 minutes and we typically have 5 or 6 of these cycles. It is probably best not to wake up in the middle of one of these cycles.
6:34 There are very few people who only need 5 or 6 hours of sleep, despite claims from many that that is all they need. Most of these people are just very driven for work and they run on the stress hormone cortisol. But this is not that healthy.
10:18 Taking a 15 to 30 min nap is very beneficial, but take it no later than 1 or 2 pm in the afternoon. If the nap is too late, it might interfere with night time sleep.
Dr. Damiana Corca is a Holistic Sleep Specialist with training in acupuncture, Chinese medicine and functional medicine. She is committed to supporting people who struggle with sleep issues, by helping them discover the root cause of their sleep issue so they can get good sleep and continue to do so for the rest of their life. Damiana has a local private practice in Boulder, CO and serves her clients worldwide through private telemedicine consulting and group sleep programs. She is the Founder of the Corca Sleep Method Program. Her website is DamianaCorca.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 and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
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Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates, and to learn more, check out my site, drweitz.com. Thanks for joining me, and let’s jump into the podcast.
Hello, Rational Wellness podcasters. Today, we will be talking about sleep. We all know about the importance of sleep, and there are so many people have problems with sleep. In fact, it’s rare. when I talk to somebody who says their sleep is great and they never have any issues. Today, we have Dr. Damiana Corca, who’s a holistic sleep specialist, and she’s also trained in acupuncture, Chinese medicine and functional medicine. Dr. Corca is committed to supporting people who struggle with sleep issues by helping them discover the root cause of their sleep issue so they can get good sleep. Damiana has a local private practice in Boulder, Colorado, and sees clients through telemedicine and group sleep program. She’s the founder of the Corca Sleep Method program. Dr. Corca, thank you so much for joining us today.
Dr. Corca: Thank you for having me.
Dr. Weitz: So how did you come to specialize in sleep problems?
Dr. Corca: The people let me know that they have trouble with sleep, and I started learning more and more about it and loved it, and eventually decided to focus on this to be able to serve people better. I remember my very first patient in private practice, I was living in Chattanooga, Tennessee and I believe she had fibromyalgia and also had some sleepy issues and I remember thinking, I’ll never forget that sensation in my body or not only a mental explanation of it that, “Oh, if I could just get her to sleep well, I think her pain will get a lot better.” Of course there are other components to this, her gut health and so on, but it was exactly that. And then little by little, I kept noticing, even if people didn’t come in with sleep issues as their main complaint, I noticed that if I just got them to sleep better, somehow everything got better. So eventually over the years, I just decided to focus on this and specialize in this.
Dr. Weitz: Yeah, it’s really important to have a niche and it’s good to have a practice focus like that, and of course, sleep is so important for everything else. It allows our body to rejuvenate, our brain to heal and get rid of toxins and it’s just so important. Let’s start by defining what is good sleep?
Dr. Corca: Yeah, good sleep I would say it’s falling asleep within 10 to 20 minutes, 30 minutes maximum and sleeping for seven and a half to nine hours, depending on the season, depending on the person and sleeping through the night ideally, but it’s okay if you wake up once or twice either briefly or just to urinate, as long as you go back to sleep pretty fast.
Dr. Weitz: In fact, don’t we have these cycles of sleep throughout the night where we go at least into very light sleep?
Dr. Corca: Yeah. We do that all throughout the night. Typically, a sleep cycle lasts about 90 minutes. It can be a bit longer. That’s why I tell people if we sleep five of those chunks at seven and a half hours, if you want to sleep longer, you don’t want to just increase by half an hour, ideally increase by an hour and a half. So you respect these sleep cycles. And the same thing if you wake up half an hour before the alarm clock, it’s best not to try to go back to sleep because you’re just going to wake up usually groggier or frustrated if you don’t fall asleep. If your body wakes up without any-
Dr. Weitz: You mean because you’re in the middle of a cycle?
Dr. Corca: Right, yeah. If your body woke up half an hour before the usual time, it’s doing you a service. It probably just ended a cycle. And it says, “Okay, it’s about time. It’s not quite, but it’s there. We don’t have enough time for another hour and a half of sleep.”
Dr. Weitz: Now we’re going to get into the quality of sleep, but just for a minute to talk about the amount of sleep, most sleep experts say seven to nine hours. Is that what you think is a sweet spot?
Dr. Corca: Yeah, I would say seven and a half just because it gives you five hour and a half chunks of sleep. So I see when people thrive, when people do well, they do seven and a half to eight and that’s because it might take a few minutes to fall asleep, you might be up for a little bit, so usually it completes that amount of cycle. So seven, I feel like it’s on the shorter side, and definitely we are told sometimes that nine hours is too much, but especially in the winter, if you can, it’s really wonderful. I’ve had a lot going on myself and I’ve noticed over the last month of two, I go to sleep at 9:00 and wake up at 6:00 and I feel amazing, So I just do that, which something of my patients can’t do, so that’s what I’m trying to help them with.
Dr. Weitz: Now we know that taking too long to go to sleep is a problem. You were mentioning how long it takes to go to sleep, but apparently if you fall asleep right away, that’s not that good either. In fact, I’ve been tracking my sleep with an Oura ring in the last six months and I’m constantly finding out that I have low sleep latency because I fall asleep within one minute.
Dr. Corca: Yeah. When we fall asleep within one minute, maybe you’re a little bit sleep deprived possibly, maybe we need a little more sleep. I tell people that it should take our body like five, 10 minutes to fully relax, to fully go into sleep, to like fully assess the environment, but if you are reading right before that, and you’re very relaxed and you’re so sleepy you’re just about to fall asleep and then you put your head down and fall asleep within one or two minutes, then that I wouldn’t say that’s a problem. That’s a good thing.
Dr. Weitz: So what about people who say, “I sleep five, six hours. I’m fine. I don’t need more sleep.” What do you have to say to them?
Dr. Corca: Well, I’ve only met, I think, a couple of people, two people, in the last decade when I talked to them, I questioned them, I came to the conclusion that yes, I think they might have some genetic variant and truly they do fine with six hours. They didn’t say five. I’ve never met anyone that I thought they just need five hours and that’s it and they’re very healthy. Most people who run on five, six hours, they push themselves so hard and they run on the stress hormone cortisol and basically say it as kindly as possible, you’re basically lying to yourself. You’re so stressed and you’re pushing yourself so hard and maybe you are okay now, but it’s going to catch up with you. So it would be really wise to slow down because usually we get a lot more done actually, instead of putting all this physical and mental work, we can use our energy instead and life becomes a little easier. So then we don’t have to work so hard and keep telling ourselves that we only have so many hours in the day, we have to go faster and harder.
Dr. Weitz: Yeah, I think unfortunately our society is very driven for work and more work and less sleep. I think that there’s a tendency to actually look down upon people who don’t work as many hours and it’s a different attitude in other parts of the world. I know in Europe, for example, it’s common for people to take six, eight weeks of vacation.
Dr. Corca: Exactly.
Dr. Weitz: Certain countries, I think Switzerland requires a week of vacation for every six weeks of work and here in the United States, you almost looked down upon for taking a vacation or taking time off or not working. Now, unfortunately, because of this work at home thing, it seems like people are being asked to work longer hours, like just keep taking phone calls and emails into the evening when normally you would be off work.
Dr. Corca: Yes. It’s very important that we draw boundaries because otherwise there is always something to do. It never ends, truly, when you think like, “Okay, I’m all caught up on things and it’s all good,” and there is more and more and more, and of course at our place of work we can get asked to do more and more. So it’s up to us to draw boundaries.
Dr. Weitz: So especially now where so many more people are working from home, do you have any advice for them, how do they draw those boundaries?
Dr. Corca: Yeah. One of the most helpful things for my patients and people that I talk to and from my programs is to look at the day, to split it in 12 hour chunks. So if we have 24 hours, so let’s say 7:00 AM to 7:00 PM is more about activity and work. I’m not saying to work all of those 12 hours, but to fit everything that’s more active within those 12 hours, and then the other 12 hours to really slow down. We typically only slow down for seven or eight and maybe some of that we’re not even asleep. So that’s the first step, to have those clear boundaries and say, “I’m never opening my computer, unless I want to watch a movie or something, after 7:00 PM. I’m not going to answer some emails after dinner,” nothing like that. That’s one place.
The other thing that you can draw some good boundaries, especially if you’re at home, is when you take your lunch break after lunch to lay down for 15, 20 minutes. You are at home, you can lay in your bed, you can get cozy and you can just listen to a meditation. It’s so beautiful, so luxurious, can be so pleasurable and you can just feel your body relaxing. Many people in the past, they said, “Well, I don’t have time. I don’t have the space,” but if you are at home, this is perfect. Just take a break in the middle of the day.
Dr. Weitz: So you think, for example, taking a 30 minute nap is good for sleep?
Dr. Corca: It’s very good. It’s amazing. It’s actually-
Dr. Weitz: See, I’ve heard other sleep experts say, “No, no, no. It’ll take away from the sleep at night.”
Dr. Corca: I have done this with multiple, multiple people and for some of them has been life changing. The people who are very sleep deprived, say they can’t sleep at night. The problem when you sleep deprived and stressed, is that the more stress you are, the more tired you are, the harder it is to fall asleep. It actually takes the same amount of energy to fall asleep as to stay awake. So we feel as if falling asleep is this passive thing that happens, and it feels like that when we’re healthy and it’s easy to fall asleep, but actually it takes a lot of things that need to happen within our body and our brain to fall asleep. So if you’re stressed, if you’re sleep deprived, taking that 20 minute nap, I tell people to just set a timer for half an hour, 40 minutes at the maximum and lay down. It does not matter if you fall asleep or not, just focus on resting and maybe listening to a guided meditation, anything along those lines works. If you do it at least about eight hours before your bedtime, so typically, 1:00, 2:00 and you keep it under half an hour, I have never met a person that impacted them negatively. The problem arises when you sleep too long and too late in the day. People usually sometimes wait until they get really sleepy around 3:00, 4:00, 5:00. Well, that’s dangerous, that’s too late. Then the body feels like, “Oh, I took a good nap, now I have energy,” and then they have trouble falling asleep or [crosstalk 00:12:33]
Dr. Weitz: So it’s good to take a nap, but try to keep it to, say, 30 minutes and no later, say, then 3:00 in the afternoon?
Dr. Corca: Perfect.
Dr. Weitz: Okay.
Dr. Corca: Perfect and focus on resting, it’s okay. So many people, it took them weeks until… They said, “Oh, I can’t fall asleep. I can’t nap. That’s not a thing for me,” and I’m like, “You’re just focus on resting. Even if you’re just allowing to feel your breath, feel your body, it’s amazing the way you feel in the afternoon.” So it’s very valuable.
Dr. Weitz: Great. So let’s talk about quality of sleep and particular, two of the things that I’ve been tracking since I’ve been using the Oura ring is deep sleep versus REM sleep. Can you talk, what’s the significance of deep sleep and REM sleep and what do we need to know about them?
Dr. Corca: These devices are really wonderful in the sense that they’re able to help us track how we sleep, but-
Dr. Weitz: By the way, what is the best device for tracking sleep or devices?
Dr. Corca: The most important thing actually, is that we feel good the next day. That is the most important thing is how we feel. Do we have energy? Do we feel clear minded? Secondarily, if we have one of these devices, I don’t endorse any of these companies, a lot of my patients use the Oura ring and it looks beautiful, it gives really fairly accurate information, and this is fairly accurate in comparison with how they feel. I always warn everyone not to look at the data first, but rather see how they feel and then later look at the data because what we do, we look at it and then we decide, “Oh, it doesn’t look good. I should be feeling bad,” and you just want to like really feel, “How do I feel? I feel okay,” and then yes, we can look at the data. The Fitbit is good and there are a bunch of other ones out there that can be helpful.
Also, I ask everyone not to focus so much on how much deep sleep you have exactly, how much REM sleep. Yes, it’s important, but also these devices are not perfect. Also, some of us move a lot more and yes, that can tell us information in itself. So I have found that it’s important to look at the bigger picture. Now, if we don’t have enough REM sleep, deep sleep, it reasonably looks really low. Like let’s say you have friends and they have the same device and you’re like, “Whoa, I only have half an hour of deep sleep and you have an hour and a half,” we want to look at the bigger picture, what could be disrupting the function of the body and understand this. Functional medicine really looks at the whole body and take gut infections, just chronic low grade gut infections that don’t necessarily take you to the hospital or drive you into the doctor’s office, but something is not quite right. Maybe you feel bloated, maybe you’re restless at night. There can be things that can be improved, that can increase the amount of deep sleep that you have of REM sleep.
So we want to look at the whole function of the body, looking at the gut health, because as you know, like if you improve the gut health, you improve serotonin, production, 90-something percent of it is produced in the gut. So that’s the way I look and I ask everyone not to over focus on that data, but the data is very helpful, especially if you have been collecting data from the Oura ring, for example, and then you do things to change and then you can see the improvement. Then that’s really, really helpful.
Dr. Weitz: So what is the significance of deep sleep?
Dr. Corca: It helps with numerous, numerous functions in the body and memory consolidations and emotion processing. So with the REM sleep, it all has its own function. Even light sleep is very, very important and one thing that I want to point out is that we typically have more of the deep sleep at the beginning of the night and that’s important to remember because some of my patients come in and say, “Well, I don’t have any deep sleep later in the night. Is there something wrong?” And a lot of people know that you’re supposed to have that at the beginning of the night, some people don’t. And so you want to keep in mind-
Dr. Weitz: And then the REM sleep seems to occur more in the last several hours, right?
Dr. Corca: Exactly, and that’s also important to know because sometimes people say, “Well, I seem to be more aware of my environment in the morning,” and that’s partially because of that and also we have more dreams in the morning. So I like to bring some normalcy because when we have sleep issues, we build a lot of anxiety around it and then we attach meaning to everything that we’re looking at and how we feel.
Dr. Weitz: So, yeah, anxiety seems to be a factor that decreases our ability to sleep well. It’s interesting how anxiety and depression, which are often linked as common mood disorders, but they sort of have the opposite, it seems, significance with respect to sleep, whereas it seems like even though a lot of patients have both, patients who are anxious have more trouble sleeping, whereas patients who have depression tend to sleep more.
Dr. Corca: That can be true, definitely with depression, especially here where I live, because we have winter and less sun and colder days. Definitely environmental-
Dr. Weitz: And you’re in Colorado?
Dr. Corca: Yeah, in Colorado, the seasonal effective disorder, some people get more depressed, they sleep more. Unfortunately, some of those people who develop seasonal effective disorder, even though have depression, they can also develop insomnia, which makes the depression worse. And yes, with anxiety, we have this over activated nervous system being in fight and flight mode, and then it’s not safe to settle into sleep. If you think about it, in order to fall asleep and stay asleep, the body and mind and spirit has to feel fairly safe because we’re very vulnerable. Think about it. You’re laying there in bed, you’re not aware of your environment.
So a certain amount of deep safety, and I’m not even talking about safety in your room because we live in houses with doors that are locked, so there isn’t really… generally, depending on which neighborhood you live, of course, you’re generally safe. It’s more about the stresses from our daily life, and even these, as I mentioned, gut infections or hormonal imbalances or just not having enough nutrients or having a food sensitivity that’s constantly aggravating your body, all of those like stressors in the body as well.
So I just want to say that’s not only emotional stress because I work with people, they tell me, “But my life is so good. I just can’t sleep and have anxiety and I don’t understand why.” So partially that physiological aspect is very important, and of course there is trauma from the past as a result that people are not consciously aware, but it’s still residing in their body.
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Dr. Weitz: How important is it to respect our circadian rhythm for getting a good night’s sleep? I know that as it gets darker and the light tends to become a redder light, if you look at the sun setting, it’s redder and that tends to lead to melatonin secretion, which helps sleep, and then in the morning when the light comes up, we get the white light, which has a blue light, which stimulates cortisol, which tends to wake us up. How important is the timing of our sleep to, in some way, try to coordinate with our normal circadian rhythm?
Dr. Corca: It’s very, very important a routine signal safety to the body, having that chaotic schedule creates stress, so that’s very, very important and then in the evening, as I was talking earlier about slowing down after 7:00 PM, I like to call it life after 7:00 PM because it can be kind of a different life and something that you do for yourself, you want to have that slowing down process and then making sure that you dim the lights, that you don’t look at the screens as much. It’s okay to watch a movie or if you want to scroll a little bit on social media and such, but I would allow about 45 minutes to an hour or putting away electronics and having a dimer yellow light. There’s those blue blocking glasses that you can use as well, but it’s not only about the light, it’s also about the activity that comes at you.
So you want to calm it all down, read a book, listen to some music, do a little bit of stretching if you want to, whatever brings you pleasure. I always tell people you don’t want this to become another things or another thing that you have to do in the evening in order to fall asleep, but focus on what feels good because if you think about it, if you focus on what feels good for half an hour or an hour, that secretes a lot of feel good hormones and decreases cortisol, and as a result of that, you sleep better, but you also feel wonderful in the moment and that’s amazing.
This is what living in the moment is, it’s experiencing how you feel right here, right now. So that’s for the evening and again, kind of going at the same time to sleep consistently is important, but more important is also listening to your body. So if you’re not quite sleepy yet when it’s 10:00 and that’s your bedtime, don’t push it. Maybe you read a little longer, even if you’re going to be in bed a little shorter, because if you go to sleep a little slowly and your body’s not quite ready, then you’re laying in there and you can develop anxiety. So you don’t want to do that. So listening to your body and making sure you’re groggy and sleepy is very important.
Now, when you wake up in the morning, I would say it’s very, very important to keep it consistent and at the same time and not sleep in. If you need extra sleep, I’ll always tell people wind down earlier in the evening and go to sleep earlier and wake up at the same time because if you wake up at the same time the sleep becomes very efficient. Talking about increasing the quality of your sleep, that will increase the quality of your sleep because we have an internal clock and it kind of knows. I don’t know if you’ve slept well most of your life and a lot of you, you notice that you wake up at the same time no matter what, and that’s a really good thing. You want to honor that.
Dr. Weitz: What about your sleep window? What if you tend to go to sleep at 2:00 in the morning? Is that less than optimal, for example?
Dr. Corca: It is less than optimal, but some people have night jobs, and if that’s what it is, making sure you have your routine and consistency is very, very important. You’re not sleeping in, not fluctuating when you wake up and then it doesn’t matter if you wake up at 6:00 or 8:00 or 10:00 AM, to wake up at the same time and expose yourself to light, taking a walk, having some movement, eating breakfast, plenty of protein, 20 to 30 grams of protein is very important. If you are like me right now, like in Colorado, there is not enough light-
Dr. Weitz: Why is eating 20 to 30 grams of protein so important?
Dr. Corca: Because a lot of people do the opposite. They eat too much sugar, and then they have blood sugar fluctuations and that messes up with the cortisol, the stress hormone. So eating protein really sets up your body for stable energy, fully waking up and keeping your cortisol level steady, and then more so for the cortisol is just to eat in the morning. I know we live in a world where intermittent fasting is really popular and that can work too, I suppose, but for people who have sleep issues, I tell them for the time being to have breakfast. It doesn’t have to be a huge breakfast.
Dr. Weitz: Yeah, you’re referring to the fact that intermittent fasting right now is considered very trendy, especially in the functional medicine world for promoting longevity and a lot of people do it by skipping breakfast.
Dr. Corca: Right, yeah. And oftentimes, we go, we’re stressed in the morning and I think black coffee is allowed, so we just get this immense kick. We force the adrenal to give energy, but it’s also stressful to the body, so it’s not the healthiest way to go about it. Now, if you still want to do that, then you could do collagen powder, MCT oil in the coffee, doing two scoops of collagen powder gives you about 20 grams of protein. So that could be a possible alternative.
Dr. Weitz: Now why collagen powder?
Dr. Corca: The collagen powder gives you about 20 grams of protein and [inaudible 00:27:30] so-
Dr. Weitz: Could use why protein or other forms of protein?
Dr. Corca: You can, yes. I often recommend collagen powder just because a lot of people have issues with dairy products and even whey protein, so then collagen feels like the safest, but yeah, and it could be pea protein if you’re okay with the peas. So there are several choices there that could be replacing the full meal, but I do like to… I have a regular meal for breakfast, just some kind of a fish or meat and lots of vegetables. That’s typically my breakfast and it’s very helpful. So the other thing that I wanted to say about the morning is that if you don’t have access to the sun in-
Dr. Weitz: You mention you have meat or fish in the morning.
Dr. Corca: Yes.
Dr. Weitz: But for some reason when you talk to a lot of people at the out breakfast, they’ll say, “Well, that’s not breakfast food. I have to have breakfast food.”
Dr. Corca: I know.
Dr. Weitz: What’s breakfast food? “Breakfast food. I have to have cereal or waffles or toast, or I have to have all these carbs in the morning.”
Dr. Corca: I know, I get it and I certainly like I literally sometimes miss it, I think about it and I’m like, “Wouldn’t really nice to just have some waffles with some butter and some fruit. That sounds so amazing,” but especially for women and for myself… For men too, but more so for women, especially women who go through menopause, it just really causes blood sugar issues and then morning you are hungry again and you reach for more coffee, your energy drops and you might have some more sugar.
If you want to lose weight or have a steady weight, if you want to have good energy, if you have thyroid issues, and you have want to have good energy, just try. Just try for me, just for a week, try have that different kind of breakfast and see how you feel. Don’t take my word for it from my experience, but just try it and see if you feel amazing and crave less sugars throughout the day and feel more stable and energized and you reach less for the coffee and for the stimulants and even in the afternoon, then… And most people, when they realize how good it feels, then they just do that and have the occasional typical breakfast some days just as a treat.
Dr. Weitz: One thing, I don’t know why this came to mind for me, but among the people who have… A lot of people have trouble with sleep, but it seems like there’s a certain group of people that I’ve noticed and for me it tends to be women over the age of 70. I know a number of them have just given up, “That’s it, I don’t sleep. I’ve tried everything. Even if I get five hours, I’m happy.” Why do you think women and especially older women tend to have more problems with sleep?
Dr. Corca: Yeah. I think the functions on our body as we age, they’re just not working as well, they’re not optimized as well. Just, for example, the gut is not functioning as well, so maybe not enough probiotics to even make serotonin. They’re just, it’s just [crosstalk 00:30:48]
Dr. Weitz: Do you think it’s a hormonal thing, lack of estrogen and…
Dr. Corca: I think partially can be and partially neurotransmitters. I often do a neurotransmitter test, I look at GABA and serotonin and dopamine and histamine and all of that, and I think that’s partially what’s happening sometimes. I see those inflammatory kind of…
Dr. Weitz: So when you run a test like that, what kinds of results do you get and what types of changes do you make as a result of the results?
Dr. Corca: So to pick up on something that comes to mind, that this is a 70-something year old woman, I can’t remember exactly how old she is, one of the inflammatory markers that comes from the tryptophan kind of on the serotonin pathway, is very high, so that creates a certain amount of inflammation in the brain. I don’t think it allows us to sleep properly. So for her, I think just doing a high dose of procurement of active ingredient of Turmeric, it’s going to be really important, especially since she has pain as well.
Dr. Corca: So I think spot on that would be helpful for her and I think it will impact her sleep. And she always said, she says, “I’ve gone through menopause for so many years and still I have a little bit of a temperature fluctuation at night.” We don’t want someone at that age to go on hormone replacement therapy, but a little of support with herbs, just a little bit to optimize the function of the body can move the needle a little bit.
Dr. Weitz: So what kind of support will that be?
Dr. Corca: Just herbs that support, it could be even for some women Black Cohosh. do different herbs, different combinations-
Dr. Weitz: Okay. So many herbs that help with menopause?
Dr. Corca: Exactly, yeah. Some of the combinations, I have Chinese herbs in them that can be helpful.
Dr. Weitz: You used the rhubarb extract?
Dr. Corca: Yes. Yeah, I believe. What is that company? I can’t remember the Metagenics who has that?
Dr. Weitz: Yeah.
Dr. Corca: That’s a wonderful, wonderful one. Also, the other thing that I tell people as they get older is-
Dr. Weitz: Isn’t it amazing. I have some patients in that category too, that women in their 70s are still getting hot flashes or night sweats?
Dr. Corca: I know, right? Because we’re told that like once [crosstalk 00:33:18] menopause you-
Dr. Weitz: It can’t be because having big fluctuations in estrogen anymore. What is causing it?
Dr. Corca: It’s in the brain, there is the temperature regulation, actually that’s… Like there is this little window and it’s too narrow and I think different kind of hormone levels helps to regulate that a little bit. So once that’s off, the ratio, the space to regulate it is too small, and then we go back and forth too easily. The other thing that I really want to say about people who are any age, but really in the 70s and 80s, I think we’re told a lot like, “You’ve got to sleep. This is dementia prevention. Sleep is very, very important.” And yes, you can do various things as much as you can, but I don’t want people to obsess over it because that’s more stressful. If you just get a little short of sleep, but you feel wonderful, then I don’t want people to stress over that because the stress of it is literally worse. Again, I’m not saying not to do anything about it, but also not to [inaudible 00:34:21] for nine hours.
Dr. Weitz: Right. Stressing over sleep is the biggest disrupter of sleep.
Dr. Corca: Excuse me?
Dr. Weitz: Stressing about not sleeping is the biggest disrupter to keep you from sleeping.
Dr. Corca: Yeah. It’s all these ideas that we hear that are true in some cases, but there is more to it and, and it’s very important to, to understand these different aspects and not get anxiety over a particular idea, for sure.
Dr. Weitz: So you mentioned temperature regulation. One of the things that I’ve incorporated into my sleep routine is using something called a Chilly Pad, which actually he cools me because sometimes in the middle of the night, we’re either getting Santa Ana winds or something, but it seems like the temperature will go up five, 10 degrees, and that will tend to wake me up. So if I have this constant temperature, that seems to make it easier to not wake up.
Dr. Corca: Yeah. We have to have a lower body core temperature in order to settle into sleep. That happens naturally. That happens naturally actually a little bit in the afternoon and that’s why I believe we’re made for siestas, so that’s why I tell people to take a little nap.
Dr. Weitz: Do you recommend something like that to maintain temperature?
Dr. Corca: Yeah, it can be helpful. It definitely can be so helpful for people. I’ve heard a lot of good things about the Chilly Pad and there are other devices that are similar that can be truly a life saving, especially depending on where you live and the temperature of [crosstalk 00:36:02] for many people.
Dr. Weitz: What are the most effective nutritional supplements for sleep? I know you’ve talked about a few already in terms of herbs that help to regulate some of the hormonal issues, especially that women have and we talked a little bit about cortisol secretion. Do you ever do like the cortisol testing and do you try to use supplements for that and what other kinds of sleep supplements do you find or effective, A, for falling asleep and B, for staying asleep?
Dr. Corca: Yeah. So let’s talk about the cortisol. Yes, I do the saliva testing because it’s super helpful. It gives us valuable information. We don’t want to assume it’s always generally safe to take certain adaptogenic herbs like as Ashwagandha, Rhodiola, and Holy basil, but-
Dr. Weitz: So for doctors who say, “Oh, there’s no point in doing salivary testing.” I just listened to somebody else’s podcast who said, “Oh, this is a complete waste of time and money. If the patients are stressed, just give them some adaptogens.”
Dr. Corca: Yeah. I find value in testing because… Okay, let me think of another patient just a few days ago. On Friday, I reviewed the test with her and she’s very fatigued and then she has anxiety at night and I kind of assumed that probably her cortisol is too low in the morning and too high at night, but we don’t want to assume, because we want to look at the overall curve. It should be higher in the morning and then lower in the evening, but also we want to look at the total output because if, let’s say, we start clearing cortisol at night, it can backfire. If she doesn’t have enough of that total output, it clears it really fast and then the body says, “Ooh, we don’t have enough cortisol because cortisol is helping [crosstalk 00:38:00]
Dr. Weitz: So let me stop you right there. So what you’re saying is, is let’s say, you assume, “Oh, this person’s stressed and they’re having trouble with sleep. So I’ll just give them some adaptogens that are going to calm their cortisol secretion, and I’ll have them take it in the afternoon or the evening and that’ll help their sleep,” but maybe don’t don’t know that they actually have a very flat cortisol curve. They’re not producing enough cortisol, and now you’re down regulating their cortisol production even more by giving herbs like phosphatidylserine that are decreasing their cortisol. You might need to use a different set of nutritional supplements that help the body to produce more cortisol, to get that curve the way it’s supposed to be and you wouldn’t know that unless you did the salivary cortisol testing.
Dr. Corca: Exactly. That’s exactly right and if you use phosphatidylserine assuming their cortisol is high at night, but the total output is too low, then we need a certain amount of cortisol because it has a lot of different good functions and then the person will feel temporarily better and then hour later they’ll have more anxiety and be wide awake and they don’t know why. And also like-
Dr. Weitz: Then instead of using those adaptogenic herbs, which some people say, “Well, you can just use these for everybody,” you might need to use a different set of supplements. For example, you might want to use an adrenal supplement that includes licorice root, or glandulars or some combination of herbs that are better at building up cortisol production instead of calming it.
Dr. Corca: Exactly. Yeah, definitely. So there are all these different… Yeah, exactly, as you explained subtle aspects and there is really no… You can guess or you can make an educated guess, especially if you’ve done a lot of tests and have worked with people, but I like to test. It’s, what, $160, it gives us such valuable information and some of these tests, they actually even test in the middle of the night. If you wake up, you can take a sample, so then you can see is the reason why they wake up cortisol related or not and it’s not always. In fact, I find that more than half of the people, they’re not waking up or because of that, there is something else that wakes them up and [crosstalk 00:40:21]
Dr. Weitz: Right. There you go. So the cortisol testing may lead you to not use an adrenal adaptogen, or it may help with the timing of it. So for example, I just recently had a patient who is having trouble sleeping and falling asleep and I was thinking maybe he’s getting a cortisol rise in the evening, but it turns out he’s getting this big spike in the afternoon. So I may have used the same adrenal adaptogens, but I timed it more in the afternoon rather than in the evening. So the timing of the use of supplements may change depending upon the curve as well, and that’s another reason why, in this case, testing can be beneficial instead of just guessing.
Dr. Corca: Yeah and honestly, for sleep issues I don’t think I’ve never seen a perfect, maybe 1% of people they’re like, “I don’t have to do anything for your cortisol.” There is always something I can do, but it different degrees of it. So I always find it helpful. So yeah, the timing, the type of supplements, it’s so important and also having a baseline, it’s super crucial. So depending on that it can depend a lot-
Dr. Weitz: What are some of the other important supplements for regulating sleep? I know it changes depending upon the underlying causes and that’s super important. So if we have blood sugar problems, we’ll maybe need to use supplements to regulate blood sugar, as well as the right dietary approaches, exercise.
Dr. Corca: Yeah, exactly. We’re were looking at the gut, looking at the hormones that carry toxins, the liver, there are many things, but I do find myself often trying to supporting the calming neurotransmitters, like the serotonin and GABA, and for serotonin you can take 5-HTP, but that’s not always what I do. There are other things that sometimes, like supporting the gut, it’s very, very important, so I always do that, but [crosstalk 00:42:27]
Dr. Weitz: How do you support the gut? Do you use probiotics? Do you use other supplements?
Dr. Corca: Usually if there is a gut component, I’ll see what the problem is. Yes, I tend to use digestive enzymes if it’s needed, it the infection is cleared or the infections, if we need to do an elimination diet, do an elimination diet to food sensitivity [crosstalk 00:42:47]
Dr. Weitz: How will you clear infections? You use like antimicrobial herbs?
Dr. Corca: Yeah. So usually I do a stool test and so we look at the stool test, you probably do this as well, and we see what’s in there where the problem is and support that with herbs. Very rarely if there is a parasite or… Yeah, usually parasite is where I’ll recommend that maybe they get a short term prescription to support that, but in general, herbs and supplements seem to be super helpful to clear these imbalances and then support with probiotics and digestive enzymes and change the diet based on what they need. I try to not make it very restrictive because it’s hard on the people, but whatever I try to find whatever is the most helpful that moves the needle the most.
Dr. Weitz: And if you make it too restrictive, that’s another source of anxiety.
Dr. Corca: Exactly.
Dr. Weitz: Yeah. So what are some of the best herbs or what are some of the best nutritional supplements for falling asleep? You mentioned five HTP. If you use five HTP, well how, how many milligrams will you use and then why will you sometimes use it and sometimes not use it?
Dr. Corca: I tend to run this urinary test, [inaudible 00:44:07] he test, and that’s another test that if you look at some of the experts, they say, “Well, it’s not really representative of what’s happening in the brain,” and that’s true, especially because some of these, they get metabolized in the gut and the kidneys and all of that, but I have found it to be very helpful to give a general idea and I look at the trends rather than just taking everything literal.
Dr. Weitz: Okay. So give me a couple of examples of results you get and then how will you supplement differently?
Dr. Corca: Yeah. Like for example, this patient, I review the test just a few days ago. She had had dopamine, histamine and PEA, which is a neurotransmitter. They were all trending high and that told me that there is a methylation issue likely. And then we had another test where we could see that the B vitamins are a little bit off, which totally made sense. Now we need to help her body methylate better. She probably has a genetic mutation. So this is just a very complex process that happens in the body like, I don’t know, some huge number every second, every millisecond, so-
Dr. Weitz: So what did you do to give support for methylation?
Dr. Corca: I just gave her, to begin with, because she’s young and I think she’s going to respond well, just some B vitamins with TMG and a little bit of SAM-e.
Dr. Weitz: Like a B complex or a-
Dr. Corca: A B complex. I have Sam and TMG, so a couple of other nutrients that help make that-
Dr. Weitz: Oh, what particular supplement would that be?
Dr. Corca: Oh my gosh, I don’t remember the name, but-
Dr. Weitz: Okay, but a particular supplement that has B vitamins with TMG and SAM-e.
Dr. Corca: And SAM-e Yeah, that will help lower the histamine. It will help lower the dopamine. Dopamine is so wonderful to give you gust for life and having motivation, but if it’s too high, you will not feel well and you’ll get [inaudible 00:46:10]. So that’s one example and actually her serotonin was on the high end and she just so happens that she has gut issues. So if we have gut issues and bacteria, that imbalance is going to drive the serotonin high, which is also not good. We don’t want it to be too low or too high.
Dr. Weitz: So there’s a case where you did this testing. You might have used a nutritional supplement help with sleep that included 5-HTP, but in her case, because she had high serotonin, that’s something you would not do?
Dr. Corca: Exactly. Yeah, that person would say, “Oh my gosh, I did [crosstalk 00:46:45]
Dr. Weitz: Another example where you would change your recommendations based on the testing because testing rather than guessing can be helpful?
Dr. Corca: Yeah, exactly. And then I always take the testing and really think about the person. Like, does this make sense? If it doesn’t make sense, I do what makes sense at first and see how it changes and then we’ll go back and look at the results or retest and figure it out. So we take everything with the grain of salt, but I find testing super helpful and in time, the more you test you start, already seeing patterns before you even have the test-
Dr. Weitz: Which urinary neurotransmitter test will you use?
Dr. Corca: I use ZRT most of the time.
Dr. Weitz: What’s it called?
Dr. Corca: The ZRT lab. The lab called Z-R-T.
Dr. Weitz: Oh, ZRT. Yes. Good.
Dr. Corca: So I tried a few different ones and they’re pretty good, but that one is very complete and then also we get some neurotransmitter testing and the Dutch test we could do for hormones, and also we get the organic acid test. We get a little bit of data, but when I want to be specific, I go for the ZRT test.
Dr. Weitz: Right. Organic acid test. Do you get that through ZRT or you get that somewhere else?
Dr. Corca: From Great Plains laboratory.
Dr. Weitz: From Great Plains. Okay. Great. So maybe a couple of other hints on sleep. What about patients who have trouble staying asleep? Will you tend to use certain supplements for that and what about melatonin? Does melatonin help? When do you use melatonin?
Dr. Corca: Let’s see, I use melatonin when it shows more if I test it in the Dutch test and on older people, I do one milligram and see how they do with that. We don’t-
Dr. Weitz: One milligram, that’s really low.
Dr. Corca: I know. We only produced about, at the highest, as teenagers we produce 0.9 milligrams and then is adults around 0.4, 0.5, and then as we age even less. So I have the liposomal, where you can do drops and ask people to just do one milligram and then possibly increase to two or three.
Dr. Weitz: So liposomal melatonin?
Dr. Corca: Yeah. Quicksilver Scientific, they have a good product that I like, because then you can play with the dosages and also you can do it gradually. You can take one milligram, one drop at 9:00 and then another about a 9:30 if you want to do kind of a gradual. Yes, there is the time release one as well, but I like this one, it works really well. Also, when people travel using melatonin, I find that it’s helpful to help with the jet lag. As far as falling asleep and staying asleep, I would have to think about that. It almost doesn’t seem like they’re different necessarily.
Dr. Weitz: Yeah. I guess I’ve heard people say, “Oh, melatonin is better for falling asleep. Five HTP is better for staying asleep.” You haven’t really found that to be the case?
Dr. Corca: Not necessarily. Think about it. If you have no serotonin, you’re going to feel anxious and you might have to trouble fall asleep. What I do find though, is that people tend to have [inaudible 00:49:57] susceptibilities and tendencies. So like when people wake up around 1:00 or 2:00 AM, it’s more digestive issues, hormonal issues, more than anything. Yes, the neurotransmitters can also get affected, like serotonin and therefore use 5-HTP. And then when people wake up early in the morning, their there are certain patterns. It may be sleep apnea, it may be just a lot of emotional stress, it might be hormonals or digestion, it’s a combination of things, but it can vary and it comes down to that root cause that I’ve mentioned to you now, what exactly is happening with the person?
Dr. Weitz: Yeah. I know we’re close to wrapping up here, but we haven’t really mentioned sleep apnea and I know this can be an important player in a lot of people with sleep.
Dr. Corca: It is and I think a lot of us think that this applies only to people who are overweight and that’s so not true. Yes, it’s more likely people who are overweight, but if I have even the slightest possibility in my mind that the person has sleep apnea, I recommend that they do a sleep study. Nowadays they’re all done at home, it’s pretty easy, usually the insurance pays for them, but the very least I ask people to buy a continuous oxygen monitor. You can buy it online usually for around $150 and it’s not a sleep study, but it’s fairly good information. And with that, it measures your oxygen throughout the night. You can see if the saturation drops under 92%, and if it is, then you got to take steps in that direction because you can be working on various things from different angles, but you have to address that sleep apnea issue.
Dr. Weitz: I think a lot of people are apprehensive about getting tested for sleep apnea because all they’re thinking is, “I don’t want to use that CPAP machine.”
Dr. Corca: Yeah, it’s true, but there are other… Like in functional medicine, we always want to work on the inflammation and if it is that you have extra weight, we can decrease that, but at the root of it is inflammation and yes, it could be structural, and then as you age things get more slack around here, the tongue falls in the back of the throat more easily. If we have inflammation in that area or even gut inflammation, it can make it worse. So there’s things that we can do. Even blood sugar imbalance, then that can increase the inflammation. So there are a lot of things that we can do. And then the CPAP is not the only thing. We also have these mandibular devices that can pull your jaw forward and that can be super helpful for many people. So there are alternatives. It’s better to find out and know and do something about it instead of suffering and having other health effects over the years that you really don’t want to.
Dr. Weitz: And what do you think about drugs for sleep?
Dr. Corca: I think they can be helpful at the right moment. I’d rather have a person not develop severe anxiety or end up in the ER because they’re in such a distress. I don’t recommend them for long term because you’re not really addressing the root issues and it could be a dependency, even if it’s just mental, and you just want to leave… Sleeping is such a vital thing, something that we need every night, ideally you don’t want to be completely dependent on something [crosstalk 00:53:25]
Dr. Weitz: What about CBD and marijuana? I hear a lot of patients relying on these kinds of things for sleep.
Dr. Corca: CBD can be helpful. Again, in my mind CBD is something that it can be supportive naturally for a little while, until you figure out what’s happening in your body. THC, I find sometimes that with inflammation and temperature regulation issues in people and I’m not a big fan of it, but CBD can be helpful, and again, I never tell people to take CBD. It’s more like, “Yes, that’s that works for now. Let’s figure out why you can’t sleep, and let’s address the root cause.”
Dr. Weitz: Right. Great. Okay. Any final thoughts you have for our listeners and viewers about sleep?
Dr. Corca: Yeah, it’s to focus on how you feel the next day and there’s a lot of things that we didn’t get to touch on. Like, I don’t know, caffeine and just various things. I actually have these three gifts that I want to offer to you. I just kind of summarize a few myths around sleep, things that we think they’re true, they might not be true and what’s true about that. So if you go to damianacorca.com, D-A-M-I-A-N-A-C-O-R-CA.com/sleepmyths So that would be sleep M-Y-T-H-S, there is a wonderful handout that I have that I think would be further helpful. Those are kind of like some basic things that you can do immediately and make sure you’re aware off. So then I feel like if those basic things we don’t take care of, then you never know, it might be as easy as taking care of those things, like understanding really when to stop the caffeine and understanding like what’s enough good sleep for you. Simple things, like is it good to drink milk before bedtime? I think that’s a big one a lot of people ask me sometimes.
Dr. Weitz: Drink milk.
Dr. Corca: I know it’s funny. So I explain all of those things and it’s at that link at damianacorca.com/sleepmyths. Other than that, yeah, I’m happy to help if anyone has any specific questions. So can go to my website or email me at damiana@damianacorca.com. Do you have any final questions that come to mind for me?
Dr. Weitz: You just brought up like five other things that we could have covered, like caffeine and alcohol, and there’s a bunch, but there’s a lot of stuff that impacts sleep. I think we covered quite a bit.
Dr. Corca: Yes.
Dr. Weitz: Yeah. Good. Great. So, thanks for spending some time with us and making us more knowledgeable about sleep.
Dr. Corca: Great. Thank you for having me. I’m happy to be here with you.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness podcast. And if you enjoyed this podcast, please go to Apple podcast and give us a five star ratings and review. That way more people will be able to find this Rational Wellness podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition clinic. So if you’re interested, please call my office, (310) 395-3111, and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you and see you next week.