Why Sleep REALLY Matters When You Have Autoimmune

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:06):
So the logical question is what can we do to
gain resilience so that we can neutralize the acute stress
response when it's not adaptive, and we can reduce the
chronic stress response, if you will, and lower our adrenaline, cortisol,
and other hormones that are related to stress and that
will help us enjoy better sleep, cue music, places and

(00:33):
everybody places. We're starting in three two.

Speaker 2 (00:39):
Welcome to the Autoimmune Hour, where we look at the
rise of autoimmune disorders. I've brought together top experts that
range from doctors, specialist, nutritionist, researchers, and even those recovering
from autoimmune to bring you the latest, most up to
date information about autoimmunity and how to live your life uninterrupted.

Speaker 3 (00:58):
Thank you for joining us here on the automut An
Hour with Sharon Sailor. Always seek sound, legal, medical, and
or professional advice regarding any problems, conditions, and any of
the recommendations you see here or read here on the
auto Immune Hour, Understanding Autoimmune and Life Interrupted Radio. Join
the Autoimmune Hours Courage Club. Sign up now at Understanding
autoimmune dot com. Now back to your host, Sharon Sailor.

Speaker 2 (01:23):
Welcome everyone to the Autoimmune hour. I'm Sharon Sailor from
Sharonsailor dot com and of course from Understanding Autoimmune dot com.
And as always, it's my honor and pleasure to be
with you here tonight on another brand new episode, and
I am so excited. We have doctor Greg Hammer on
and we're going to talk about sleep and sleep hygiene

(01:45):
and we'll explain what that is in a little bit.
But he's got an amazing bio and I want to
read it to you, so sorry if I come in
a little close to read the screen. You guys know
it's better than me trying to wing it right. Doctor
Greg Hammer is an MD and is a professor Stanford
University School of Medicine, a pediatric intensive care physician, pediatric anesthesiologist,

(02:07):
mindfulness expert, and the author of Gain Without Pain, the
Happiness Handbook for Healthcare Professionals. And he's a member of
the Stanford Well MD Initiative and Doctor Hammer is the
former chair of the Physician Wellness Task for the California
Society of Anesthesiologists. He has been a visiting professor and
lecturer on wellness at institutions worldwide and teaches gain GAI

(02:31):
N to medical students, residents and fellows at Stanford. I
could go on and it's an impressive bio. Doctor Hammer,
thank you so much for being on the show.

Speaker 1 (02:41):
Great pleasure.

Speaker 2 (02:41):
Thank you now, thank you for being on the show
about sleep and sleep hygiene. We don't talk about it enough.
I think I've only had in the ten years we've
been doing the show one expert on the show, and
that was a while ago. Because to me, sleep has
been at times when I'm having an automi and flair,
one of the hardest things to do, whether it's just

(03:02):
my own mind running away with me, like why am
I having another autoimmune flare or maybe I'm in pain?
But could you share with us the importance of sleep
in regeneration and our overall health.

Speaker 1 (03:13):
Yes, many people think that sleep is a passive process,
and it really is not. There's a lot going on
in our brain and certainly our body when we're asleep,
In particular during deep sleep, our brain is cleaning up itself,
cleaning up a lot of junk proteins that tend to accumulate.

(03:35):
Many people have heard about how and amyloid proteins because
they tend to accumulate in all of us as we age,
but in particular are markers of dementia. So these proteins
tend to cause so called tangles of neurons in our brain.
They're also prevalent in individuals with repeated head injury, notably

(03:57):
football players, many of whom who have accumulation of these
abnormal proteins do develop dementia relatively early in age. There's
been a lot of that in the press, and Parkinson's
disease is another manifestation of brain disease that's associated with
accumulation of tau and amyloid proteins. So when we're asleep,

(04:18):
our brain is clearing these proteins and it's also getting
rid of other material in the brain that really is
pro inflammatory. So when you talk about autoimmune diseases, of
course you're really talking about the bodies inflammatory response, which
was necessary, but when excessive, can cause disease and even death.

(04:42):
So sleep is associated with elimination of these proteins and
even aging cellular and subcellular components that tend to promote inflammation.
Of course, also there are memory processes going on when
we're asleep that that really depend on deep sleep, So
we're consolidating memories of experiences and thoughts that we had

(05:06):
during the day. So those are some of the brain
functions that occur when we're asleep, And of course there
are a lot of other restorative, bodily physiologic processes that
are going on as well. So sleep is a very
active process and very vital to our well being.

Speaker 2 (05:23):
Wow, that's so interesting because when you're asleep, I'm not
sure you realize all of that work is going on
behind the scenes.

Speaker 1 (05:31):
Welly, we're not aware almost by definition. Yes, you're right
about that.

Speaker 2 (05:35):
That's fascinating to me. Is there an ideal length of
time to sleep or is that kind of individually independent
on how people sleep?

Speaker 1 (05:46):
Of course there are individual variations, but in general, I
think the science supports that we need seven and a
half or eight hours of reasonably good quality sleep. And
like everything else in life and certainly in medicine, it's
a bell shaped curve. There are people on one end
of the bell curve that maybe don't need that much sleep,

(06:08):
maybe get by in five or six hours a night
without deleterious effects. And on the other extreme there are
people that undoubtedly need more than eight hours of sleep
a night to function optimally. But in general, we can
talk about the middle of the curve, the ninety five
percent of us that really do need seven and a
half or eight hours of sleep every night. I think

(06:28):
it's really crucial to focus on those conditions that promote
sleep and those that oppose good sleep.

Speaker 2 (06:38):
Well, I keep thinking about interrupted sleep, like, sometimes maybe
I'm in bed for eight hours, but it's not uninterrupted.
I'll either wake up and be able to go right
back to sleep, or maybe I have to use the
restroom or other things. Is that harmful where you're not
sleeping for the full seven and a half or eight hours.

Speaker 1 (06:59):
It would be deal if we slept uninterrupted for eight
hours and woke up in the same position we were
in when we fell asleep, But that is pretty uncommon.
It's quite common, and I guess you could say normal
to wake up once or twice during the night, maybe
get up and you have to pee. So a couple
of awakenings at night are certainly common, and I think

(07:23):
they would be considered normal. I often wake up more
often than that. I'm very sympathetic to people that wake
up relatively frequently, and usually I can go right back
to sleep, but not always, And I think this is
really a problem that almost all of us have. There
are people that just sleep through the night on a
routine basis, but for most of us, we do end

(07:43):
up awakening at least once or twice during the night,
and sometimes more frequently. And as to whether it's harmful,
I think it's really hard to say. It's just a
fact of life that we wake up during the night,
and I think that we wake up typically when we're
in lighter sleep, so hopefully that means we've had a

(08:03):
cycle or two or three of deeper sleep, rem sleep,
and those phases of sleep that we know are restorative.

Speaker 2 (08:11):
I know a common complaint of people with autoimmune is
what they call brain fog, and oftentimes, at least for
me personally, I've related it to either disrupted sleep or
a lack of sleep that my brain is much more
foggy in the morning that I have not felt I
slept well.

Speaker 1 (08:29):
Absolutely yes, And there are a lot of causes of
what people call brain fog, especially now that COVID is
so prevalent. A lot of people have residual effects of COVID,
whether it qualifies as long haul COVID or long COVID
or not. A lot of people have brain fog for
some period of time after COVID and other viral infections.
And there are certainly a lot of causes, metabolic, immune,

(08:53):
other causes, aging itself, cardiovascular disease can produce changes in
the brain. It may lead to what we call brain
fog and certainly lack of good quality sleep, and we
really need to consider the quality as well as the
duration of sleep. So when one or both of those
are deficient, brain fog is a common side effect.

Speaker 2 (09:15):
I'm putting that down that we're having you back on
to discuss brain fog because it sounds like I went
down a rabbit hole that's more deep and more wide
than we have the time. So we're going to bookmarkt there.
That has me fascinated. Okay, So now a couple of
other questions about sleep and what about dreams versus nightmares

(09:38):
versus vivid dreams. Are any of those like an indication
that something's wrong or are all those quite natural?

Speaker 1 (09:47):
I think those are all common, and I would say natural.
I'm not a psychiatrist. I'm not really an expert on
that domain. I think that you're entering into with regard
to how we interpret nightmares, sleep tears, such things, but
I think they're certainly very common. We do tend to

(10:08):
dream during certain cycles of sleep, during rem sleep, and
of course dreams are quite normal. And what exactly is
happening To explain the dreams that we have, why we
remember them or don't remember them? I think typically if
we wake up proximate to the time of that phase
of sleep when we're dreaming, we may remember it temporarily.

(10:29):
A lot of people will write them down so that
they don't forget. But as to the sort of psychologic
significance of the content of our dreams, I'll have to
defer to somebody with more expertise in that area.

Speaker 2 (10:40):
I remember a couple of times in certain medications I
was on. Now this is the science of share and community.
I want to say that while I was on and
my dreams were much more vivid and more memorable. Is
that uncommon to have? Maybe something you ate or took
during the date. The quality of sleeper and even the

(11:01):
quality or the intensity of things like dreaming.

Speaker 1 (11:05):
There are drugs that actually seem to be associated with
vivid dreaming. Certain antidepressant anti anxiety dreams may be associated
with vivid dreaming, and otherwise I think we all have
particularly vivid dreams at least occasionally, and as far as
our diet and other aspects of our lifestyle, I don't

(11:26):
think anybody really knows what the factors are that lead
to that kind of dreaming, other than certain medications seem
to be predisposing. I want to.

Speaker 2 (11:35):
Circle back, though you've got me totally fascinated about the
harmful proteins and aging mitochondria. Is there a way with
these proteins that are collecting in there is there a
way that we can help, either by diet, exercise, or
other lifestyle choices and good sleep that can help the
brain remove these harmful proteins.

Speaker 1 (11:56):
I think maybe if we just take the thirty thous
and foot view of dementia, what are the factors that
predisposed to dementia and those accumulation of those proteins, among
other things, is associated with dementia. Whether they're actually causative
or just an association, I don't know. I'm not sure

(12:18):
that's known. But really, in the entirety of our lifestyle
has to do with how we age, and the diseases
of aging are largely considered four. There's cardiovascular disease, there's
neurodegenerative disease, which includes dementia, things like Parkinson's et cetera.

(12:39):
Alzheimer's there is associated with aging. Cancer is certainly one,
and then there's metabolic disease, so called metabolic syndrome, which
is really obesity and type two diabetes. So cardiovascular disease,
neurologic or neuro degenerative diseases, metabolic syndrome, and cancer are

(12:59):
disease of aging, and in fact, aging itself may be
considered a disease. And when we look at the neurodegenerative diseases,
they may be associated with accumulation of these proteins town
and amyloid proteins, but also a number of other factors,
and they're very interrelated, these four classes of disease. So

(13:21):
cardiovascular disease may result in decreased microcirculation to the brain.
That is what's happening in the small blood vessels in
the brain and elsewhere in the body, but specifically related
to the brain, and the state of those small blood
vessels will have significant impact on oxygen delivery to brain

(13:42):
cells or neurons. And so when we have cardiovascular disease,
we're predisposed to neurovascular or neurodegenerative diseases like Alzheimer's in
other forms of dementia, Parkinson's disease, and so on. So
these four diseases of aging, these four categories are really
very closely related. And so when you talk about brain

(14:03):
fog and dementia, how can I reduce my chances of
having brain fog, decrease the frequency of being in that condition,
and how do I decrease the risk of dementia and
other neurodegenerative diseases. The answer is really having a comprehensive
lifestyle approach to wellness, and we can actually impact the

(14:26):
aging process itself by the way we live. And I
would simplify the important factors related to our lifestyle as
in the categories of sleep, exercise, and nutrition, and then
perhaps under the nutrition umbrella would be supplements. And then
there are actually drugs that may slow down the aging process.

(14:51):
But I think the main issues that most of us
really need to think about and address in our daily
life are sleep, exercise, and nutrition.

Speaker 2 (15:00):
Obvious question, and I think it's generalized, not for autoimmune specific.
But is it ever too late to start?

Speaker 1 (15:07):
No, it's not. In fact, there are always going to
be benefits of really focusing on good sleep hygiene, trying
to optimize our sleep our exercise, and that could be
a whole separate discussion what kinds of exercise our best
et cetera. And the way we eat, and that's also
a long discussion in terms of what is the optimum diet.

(15:27):
But I think having good sleep hygiene, planning on eight
hours a night, exercise on a regular basis, both resistance
training and aerobic or cardio training as we say, as
well as balance and core strengthening. And then in the
domain of diet, where are the most centenarians living in

(15:49):
these so called blue zones around the world and what
is their diet like? And generally the Mediterranean diet largely
plant based, some seafood, the right of fats, not a
lot of sugary foods, and not a lot of refined foods.
So those are all things that we can do to
slow the aging process in general, and that will have

(16:10):
and they're very interrelated as well, because there's a bidirectional
relationship between sleep, exercise, and nutrition, right, they're very closely interwoven.
So when we don't sleep well and we're fatigued, I
can tell you as far as what I eat when
I'm tired. When I've been up in the ICU most

(16:31):
of the night, and the next day, I'm walking past
a nursing station and a grateful family has been kind
enough to donate a large box of chocolate candies which
is sitting at the nursing station. There's nothing that hits
the spot like one of those chocolates, and that sugar
rush that you get, especially when you're tired, feels great.

(16:52):
And many of us crave sugary foods when we're really
sleep deprived. Of course, they may give us a temporary
boost and energy, and then we crash. I try not
to indulge too much. The relationship between sleep and way
we eat. Another function of sleep that affects how, what,
and when we eat is that the hormones many hormones

(17:13):
are actually regulated during sleep and rebalanced, and the hormones
that regulate our appetite and how full we are from eating.
Satiety is the technical term for that those hunger and
satiety hormones are rebalanced when we're asleep. When we don't
get enough sleep, the hunger hormones tend to take and
so we tend to want to eat more when we're tired,

(17:35):
and particularly sugary and fatty so called comfort food. So again, sleep,
exercise and nutrition very tightly interwoven, and good exercise promotes
good sleep, healthy eating promotes good sleep, and vice versa.

Speaker 2 (17:50):
Which I think we all know. But as you said,
there we all have these moments of weakness where some
comfort food from our past it really sounds good.

Speaker 1 (18:01):
Knowing and doing are two different things, so I think
I try to break things down for myself and when
I'm teaching and having conversations with people like you, into
sort of simple, not to coin a pun, but bite
sized components, if you will. And that's why, really our
health really relies simply on sleep, exercise, and nutrition as

(18:24):
being integral. And we know what to do, as you said,
but it's also important that we hear the truth repeatedly
to reinforce what we already know. I know when I
go to a medical or scientific meeting, a lot of
times I'm hearing what I already know, but it's reassuring
to hear it from some other expert, and it really

(18:45):
does tend to consolidate or fortify my knowledge in that area.
So yes, we know what to do. But we need
to be reminded, and then we need to be induced
mainly through ourselves, to do those things that promote good health.

Speaker 2 (19:02):
And I always like to say it sounds so simple,
but it's not always easy. I want to circle back
on something you said about sleep position. We didn't really
discuss that, but I am curious. Is there a particular
position that you recommend our side sleeper, left, front, front,
back or is that just a personal preference.

Speaker 1 (19:23):
It's a personal preference. I think certainly many of us,
especially as we age, developed some degree of what we
call sleep state airway obstruction, commonly manifest as snoring. And
certainly when we sleep on our back, our tongue tends
to fall by gravity, to obstruct our airway by falling

(19:45):
against the back of our throat, for example. So sleeping
on our back is not great if we tend to snore.
Sleeping on the front of our body, in other words,
being prone face down may not be good for our
back if we have low back issues, for example. So
there are specific things that are perhaps healthiest for certain individuals,

(20:10):
depending on whether they tend to have sleep airway obstruction
or orthopedic issues. Certainly, sleeping on your side. If you
have shoulder problems, it's the position, it's the mattress, et cetera.
But I think we all tend to find a position
of comfort.

Speaker 2 (20:26):
No, I definitely have a preferred position. I notice I
have to be in that position at least to fall asleep.
I don't always wake up in that position though. In
one of the comments you said is to be in
that position, it sounded like, okay for seven eight hours,
and I tend to move a lot more than that.

Speaker 1 (20:43):
Yeah, most of us do.

Speaker 2 (20:45):
As we're talking, you mentioned pillows. There are so many
options of pillows. Do you have a preference that you
suggest for people. I think before I found my favorite pillow,
I probably bought like ten pillows. It was crazy. I've
got a stack pillows that my grandkids love to jump
in because I just like, yeah, they're nice pillows, but
they just don't work for me.

Speaker 1 (21:06):
I think that's that's very common. I think it's trial
and error for sure. It's just like the mattress. Some
people do better with a very firm mattress, some people
do better with a softer mattress. I think if you
tend to sleep on your back, a firm mattress is good.
If you tend to sleep on your side, you might
want a little bit more yield in the mattress to

(21:26):
promote having a relatively straight spine that depends on your
body habitats, etc. So I think it's the same with pillows.
We all have our own preferences. I like a bulky,
medium firmness pillow myself that I can bunch up. Many people,
including myself, to sleep with a pillow between their knees.
It promotes good lower spine positioning. So it's really highly personal,

(21:50):
and as you suggested from your own experience, unfortunately, most
of us go through a bit of trial and error
before we settle on the pillows that we like best,
and we end up with a closet full of pillows
that we don't use.

Speaker 2 (22:05):
Yes, I won't bring up the argument over dual sleeping
and mattresses because that could get open a whole can
of worms. You mentioned about how people like different mattresses,
and the problem with it is when you have dual
sleeping or a sleeping partner.

Speaker 1 (22:20):
There are mattresses designed for that. I won't use a
brand name. There are mattresses I don't know. I don't
particularly think the quality is necessarily the best. But there's
an air mattress nestled in between layers of other material,
and you can inflate or deflate the air mattress component
according to the firmness you desire, and each partner may

(22:43):
be able to do that on their own independently. But yeah,
there are a lot of at an awful lot of
options out there for beds.

Speaker 2 (22:51):
As we're talking about mattresses that do magical things, what
about the ones that you can lift your knees, you
can lift your feet, you can lift your head. Is
just a personal preference too? Or is there harmed as
sleeping maybe in a more I would say somewhat seated
position or is position where you're beat or higher than
your head.

Speaker 1 (23:09):
I have one of those beds myself. It has the
ability to have the head and area under the knees
more or less elevated electronically. I think if you sleep
on your back, that's great, if you can sleep with
your head elevated. Again, if you change positions a lot
and you're gonna want to sleep on your side, having
the just the head of the bed elevated at an

(23:30):
angle of thirty degrees or so probably won't work for you,
But if you do tend to stay on your back,
especially if you have some sleep airway obstruction, having the
head of the bed elevated is great. Similarly, for your spine,
a particularly lumbar spine, having something under your knees, whether
that's the bed doing that or a pillow under your knees,

(23:51):
is helpful from an ergonomic standpoint. Again highly individualized. For me,
I use the mechanism to elevate the head of the
bed and elevate the portion under my knees, mainly if
I'm intending to sit up and read, for example, or
perhaps watch television. But for sleeping, because I do tend

(24:12):
to sleep on my side and I change positions a lot,
I need to have the bed flat. I imagine that
many people would share that preference.

Speaker 2 (24:21):
I've heard from other experts about when you mentioned television
and things like that, and I have to be honest,
I'm a TV in the bedroom kind of person myself.
But about all these different forms of ambient light that
are now there, like whether you have a air purifier
in the room that has a light, or your TV
admits a little light, or oh, my goodness, your phone.

(24:44):
What are your thoughts on all these ambient lights.

Speaker 1 (24:47):
People talk about not only ambient light, but electromagnetic radiation
in general, So that would include electronic devices that are
plugged in, whether or not they're actually turned down, they
may emit this electromagnetic radiation or EMR. And as a
scientist or somebody who's scientifically inclined, I'm not that impressed

(25:10):
with the data that EMR is particularly unhealthy for most
of us, but there are certainly those who would disagree.
As far as light is a form of electromagnetic radiation,
so it would be under the umbrella of MR. And
beyond that, we could say that the wavelength of light
may affect our circadian rhythm. I think that if it's

(25:30):
a tiny little light in a relatively distant part of
the bedroom, I doubt whether it has much effect unless
we're very light sleepers, in which case I would certainly
recommend an eyemask, since they're inexpensive and generally pretty comfortable
and help create a dark environment. But blue light, in particular,
the short wavelength light that's in the blue part of

(25:52):
the spectrum, does tend to activate us, so it does
affect our circadian rhythm. That's why many people recommend that
we get up in the morning, we immediately open the blinds,
that we go outside without sunglasses as early as we
can to get natural sunlight. One of the benefits of

(26:12):
that is that blue light, as part of the spectrum
of sunlight, is activating, so it tends to arouse us,
wake us up, and we don't want to have that
at night, and that's why one of the reasons that
it's recommended really to put your screens away is part
of good sleep hygiene at least an hour before you
want to go to sleep, So that means your phones,

(26:33):
your tablets, your laptop, and even television. There are, of
course blue light blocking glasses, so glasses that you can
wear that have a pretty clear lens, but they tend
to block out blue light selectively. I think for the
most part, those are not necessarily perfectly effective, So I

(26:53):
think that it's recommended still and I recommend putting your
screens away an hour before you go to sleep. Again,
these element of sleep hygiene are individualized. For example, for me, caffeine,
I'm very sensitive to caffeine. Caffeine has a very long
half life. If I had a cup of coffee at
one o'clock, in the afternoon, which I used to have

(27:14):
after lunch. We get that little sag and energy level
as the blood flow is diverted away from our brain
to our gut for digestion. Some coffee really hits the spot,
but caffeine has a half life of about five or
six hours. That means that the concentration that you have
in your bloodstream and your body a half hour or

(27:34):
forty five minutes after that one o'clock cup of coffee,
that blood concentration, half of that is still there at
six or seven o'clock in the evening, and a quarter
of it is still there at maybe eleven or twelve
o'clock at night. And so for me, since I'm sensitive
to caffeine, that definitely disrupts my sleep. So I stopped

(27:54):
having the cup of coffee after lunch, and I found
that my sleep was improved. Now there are people that
can and have a double espresso right before they go
to sleep and they're fine. So we're really talking about
the middle of that bell shaped curve. And for most
of us who are at least moderately sensitive to caffeine,
they should avoid it. Caffeine, alcohol, heavy meal all to

(28:16):
be avoided approximate to bedtime.

Speaker 2 (28:19):
I'm up in favor of the heavy meal, but I
must be on the far end of the bell curve.
But I don't notice caffeine. I could have an espresso
after dinner and be fine. So I guess I'm on
the far into the bell curve.

Speaker 1 (28:33):
People drinking coffee at night, and I'm assuming it doesn't
interfere with their sleep, otherwise they wouldn't be drinking it then.
But there are people like you who are not very
sensitive to caffeine.

Speaker 2 (28:43):
Yah send stuff to a lot of other things, but
not caffeine, which is amazing power. We're all so different.
You had mentioned circadian rhythm. I want also to talk
about sunlight in the morning, but you had mentioned circadian rhythms.
Is there a specific time we should go to bed
or how does one to turn and what their circadian
rhythm is to know how to maximize your sleep.

Speaker 1 (29:05):
That's a good question. People talk about being night owls
versus being a morning person, so I think it is individual.
For most people who work, they have to get up
at a certain time in order to get ready to
go to work. That determines when they have to get
up in the morning, which should then advise when they
should go to sleep at.

Speaker 2 (29:25):
Night, so they just count backwards exactly.

Speaker 1 (29:30):
So yeah, it's a skill, but get out your calculator
if you need to. But yes, count backwards to eight
in hours from when you have to get up, and
that's what time you should go to sleep. But if
it's if you don't have to get up at a
particular time to go to work, then I think you
should just listen to your body and what works well
for you. Obviously, for many of us, if any light

(29:50):
is getting into the room in the morning, it tends
to be arousing. I have blockout shades that do a
pretty good job, and then an iemask as well, because
I tend to be a light sleeper and light does
wake me up even when my eyes are closed, of course,
So no, I think you have to see what makes
sense for your own lifestyle and your schedule and just

(30:12):
try to establish a pattern. It is considered in the
Good Sleep Hygiene column to go to bed around the
same time and wake up around the same time every day.
So even if you have to get up at seven
o'clock in the morning to go to work during the week,
and you don't have to do anything that early in
the morning on the weekend. It's still advisable to get
up at the same time on the weekend.

Speaker 2 (30:33):
So you can't make up sleep.

Speaker 1 (30:36):
I guess there's two points. One is that it tends
to promote good sleep when we go to bed around
the same time and wake up around the same time
every day, including on the weekend, separately making up for
a sleep deficit to some extent if you're sleep deprived,
if you've had less than seven and a half or
so hours of sleep for one or more nights in

(30:57):
a row, or maybe have been up all night, you
do make up for the deficit to some extent by
getting extra sleep in the subsequent nights. But I think
there's a it's a relatively minimal catching up of sleep,
if you will, so I wouldn't recommend relying on that
and routinely getting maybe six hours of sleep during the

(31:17):
week because you like to stay up late and you
have to get up early, and then assuming you're going
to make up for it on the weekend, even if
you do sleep in on the weekend, it's not really
good sleep hygiene and it doesn't really make up for
your sleep deficit completely. You're probably still going to end
up being tired, sleepy, maybe have brain fog, et cetera,
even on the weekend when you've slept for maybe ten hours.

(31:40):
I think the science really supports getting around eight hours
of sleep every night and going to bed around the
same time, waking up around the same time on a
daily basis.

Speaker 2 (31:50):
And I can hear many of our community because I've
been there. Luckily I'm not there right now, but I
have been there saying, oh, to have five or six
hours of sleep would be great, let alone seven or eight. Oftentimes,
with autoimmune and the inflammation, our bodies are just so
sore that trying to get comfortable sitting, standing, or prone

(32:13):
is really difficult. Do you have tips for people that
deal with what I'll say either mild to moderate. We
could even go into extreme pain, but let's just talk
about mild or moderate discomfort.

Speaker 1 (32:24):
That's a tough one. Of course, they're not so individualized truly,
and I think not to minimize anybody's pain by any stretch,
so I don't mean to do that. But pain is
a subjective sensation by definition, so I think a comprehensive
approach to dealing with pain is very worth investigating and practicing.

(32:51):
Not that even under the best of well trained minds circumstances,
pain is going to disappear when you have a chronic
painful condition. But as far as sleep, aside from a
seed tominifin or the usual range of nonsteroil anti inflammatory
drugs at bedtime, there are selective COX two inhibitors like

(33:13):
Celebrecs that and pardon me for the brand name, but
sell a cooxib I guess I should say for people
that don't tolerate nonsteroidal anti inflammatory drugs in general, meaning
they get an upset stomach or gastritis, and that might
interfere with their sleep if you take ibuprofen or another
such and said at bedtime, But cell acoxib is one

(33:35):
that you can take that is less likely to bother
your stomach. So those things, and then I think it's
very interesting to look at the data regarding cannabinoids CBD
non THHC containing cannabinoids that interact with pain receptors and
provide some degree of pain relief and also are anti inflammatory.

(33:56):
So many people take CBD before they go to sleep night,
and I think for many people that is very helpful
and may help treat pain and inflammation. Overnight.

Speaker 2 (34:08):
Definitely want to speak to your doctor about bring those
ideas to them and let them help you sort out
your individual issues with getting quality sleep. And part of
what we have to do right now is take a
quick commercial break and we'll be back in two minutes
to find out more about sleep hygiene and ways to
improve our brain health, because I'm finding out that these

(34:29):
two are very closely related. So we'll be right back.

Speaker 3 (34:34):
The auto Immune Hour will return after these messages from
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Speaker 2 (35:52):
If that could be.

Speaker 5 (35:54):
You could be me, just one aur, if we could
find a way to get inside each other is mine.
Welcome mile in my shoes, Welcome all and my shoes.

(36:14):
Well before you abuse, criticize, and accused, welcome out and shoes.

Speaker 2 (36:24):
Welcome back everyone to the Autoimmune our. I'm sharing Sailor
from Understanding Autoimmune and you can find all of this
episode and all of the almost five hundred episodes over
at Understanding autoimmune dot com or on YouTube. And by
the way, if you're watching this on YouTube, please subscribe
because it really helps us build our community and get
the message out to a larger group that you are

(36:47):
not alone and that we are here to help support you,
and understanding that you can live a full and complete
life becoming a survivor to Thriver and have a great
life even with a diagnosis. So one of the things
that we're talking about has. Something that I've struggled with
off and on through the ten years of my diagnosis

(37:07):
is sleep. And that's why I asked doctor Greg Hammer
to come on the show and talk about sleep hygiene.
And he, as I said at the beginning, he's a
professor at Stanford University of Medicine, a pediatric intensive care physician,
pediatric anesthesiologist that's so hard to say, and mindfulness expert.
And there's a couple of things I want to talk

(37:28):
about mindfulness and sleep. If you would share some of
your thoughts on how we can use specific mindfulness practices
to prepare us to sleep or get us into that
mood to sleep.

Speaker 1 (37:40):
Sure that gets to the greater issue of stress in
our lives. And when we talk about stress, we can
talk about acute stress and chronic stress. Acute stress, as
you would imagine from the term, involves a rather sudden
response to something stressful. It involves a number of physiologic

(38:03):
responses such as a release of epinephrine also called adrenaline
in our body, among other things. And it's a response,
the acute stress response that evolved over probably hundreds of
thousands of years because it contributes to preparing us to
fight or flee, the so called fight or flight response,

(38:25):
and it also tends to cause a focus in our concentration.
This was adaptive when we were sitting in a cave
trying to keep the fire going, and there could be
a sabertoothed tiger lurking outside the mouth of our cave,
and in fact maybe poked its head in our cave.
We want to be able to respond quickly, activate our muscles,
get sugar to our muscles, and all those things in

(38:48):
order to fight or flee. The problem is that we
still have this acute stress response, but were rarely most
of us fortunately faced with an actual threat. So it
turns out out the acute stress response is mostly triggered
by our thoughts, so it is generally or often not adaptive.
We think of something stressful, anxiety provoking, and we get

(39:10):
a surge of adrenaline and so on, and that is
not necessarily adaptive. But if it's okay as long as
we have the resilience the tools to neutralize those acute
stress responses. Otherwise we're stuck with an elevated level of
adrenaline on a chronic basis. And back to the diseases
of aging. That promotes cardiovascular disease, and even the other

(39:33):
diseases of aging are promoted when we have chronic stress.
Cortisol is another component of acute and chronic stress. So
when we don't neutralize the acute stress response, our cortisol
tends to remain elevated. That has a lot to do
with our immune system, and actually cortisol and cortisol like
drugs are therapeutic for autoimmune diseases, but when they're given chronically,

(39:56):
they have a number of adverse effects, including suppressing our
immunity and maybe making cancer more likely. So, again long
winded way of saying that the acute stress response is
often maladaptive, but as long as we can neutralize it quickly,
that's okay. When we can't, we're stuck with this chronic

(40:16):
stress and that certainly interferes with our sleep. So the
logical question is what can we do to gain resilience
so that we can neutralize the acute stress response when
it's not adaptive, and we can reduce the chronic stress
response if you will, and lower our adrenaline, cortisol and

(40:37):
other hormones that are related to stress, and that will
help us enjoy better sleep.

Speaker 2 (40:44):
I know in the acute stress phase, what happens to
me is not only what's happening the saber tooth at
that moment, my brain's remembering every other saber tooth that
never happened. It almost becomes chronic because it's like this, okay,
rolling ball downhill.

Speaker 1 (41:02):
No, you're right. Its stress response is often not neutralized
when it's acute and does become chronic for most of us,
and two varying degrees, of course, but stress certainly interferes
with sleep. And then again this bidirectional relationship. When we're
not sleeping, well, we're predisposed to stress, so you get
this sort of self propagating positive feedback loop. So how

(41:27):
can you help ameliorate that? And one way is to
have a mindfulness meditation practice, and that's what my GAIN
practice is all about. It's based on a way of
breathing because when we're stressed, we have tight muscles in
our chests and diaphragm, and we can go for a
whole day without really taking a deep breath and breathing properly.

(41:49):
So the breath is key to essentially all forms of
meditation and stress relief as well. And so the GAIN
method employs healthy breathing and a self guided tour of
that for which we're grateful, the g and gain acceptance
of things that are unpleasant that cause us stress. That's

(42:11):
the A and gain, our intention, the eye and gain
and non judgment the en and gain. And so this
is a practice that can be done in three minutes.
We go to slow, deep, deliberate breathing, and then we
do self guided tour of that for which we're grateful
things we need to accept what is our intention, including

(42:32):
this practice, and then learning to drop judgments which tend
to be rather negative of others, the world and ourselves,
and then returning to pure focus on the breath. This
is a great way to relieve stress. Having a gain
practice or other mindfulness meditation practice proximate to the time
of sleep is wonderful. Even just a gratitude practice thinking

(42:55):
of three things that went well during the day and
things for which were greatful, thinking of three good things
writing them down. If you're a journaler, that has been
shown actually to promote healthy sleep. The more we can
really embrace this mindfulness practice, the better off we are.
The more we can reduce stress, the more we can

(43:16):
favorably impact the diseases of aging and aging itself and
importantly improve our sleep.

Speaker 2 (43:24):
And I love those gain Gai and all of those gratitude,
let's go over them again. So gratitude.

Speaker 1 (43:32):
I'm an acceptance.

Speaker 2 (43:33):
Acceptance. I was going to say attitude, attitude, intention and.

Speaker 1 (43:39):
Intention and non judgment.

Speaker 2 (43:41):
Non judgment. Okay, those are great. And what's interesting in
the work I do in my corporate life where one
of the things I talk about all the time is
the power of breathing. And whether we're trying to sleep
or whether we're trying to give a presentation, mindfully, being
aware of how we're breathing throughout the day and into

(44:02):
our rest time is critically important. And I don't think
people realize how fast our bodies will shift. For me,
two or three great deep breath, intended breast, mindful breath.
I'm amazed at how fast my body begins to recover
in just when I reset it.

Speaker 1 (44:20):
Absolutely, no, I think just any one of those components
of the game practice. Certainly the breath. Just taking a slow, deep,
deliberate breath and then maybe repeating as you said, that
by itself is great for relieving stress. So slow deep
inhalation to account of three through the nose, pausing to

(44:42):
account of three, and then just gently but deliberately letting
the breath go to account of four through the nose
or mouth, and repeating that inflating the chest and breathing
into the belly into account of three, pausing to account
of three, exhaling to account of four. That by itself
will activate our parasympathetic nervous system, the side of the

(45:06):
nervous system that helps balance the sympathetic or fight or
flight side of our sympathetic nervous system. So deep deliberate
breathing activates the vagus nerve and parasympathetic nervous system, tends
to slow our heart rate, reduce our blood pressure, lower
our adrenaline and cortisol levels, and thereby is a great

(45:28):
stress reliever in and of itself.

Speaker 2 (45:30):
Oh absolutely. One of the things that I like to
do is make sure that my I think people think
that they're deep breathing, but their ribcage is still not moving,
or their belly they oh, I don't want it, my
belly to protrude. I don't want to be fat and breathing.
But I like to think about when my children were

(45:50):
newborns and you'd see how they breathe. The whole torso
is involved. It's not just like from your mid chest up.
And unfortunately, I think so much of our modern society
people think they're deep breathing, even though really they're only
breathing with half of the structure.

Speaker 1 (46:07):
That's a good point. I think many people recommend visualizing
having the air go into the belly, breathing into the belly,
but of course your chest is expanding at the same time.
So yeah, with a real deep breath, if you just
focus on fully expanding your lungs and imagine breathing into
your belly, you're getting a very good breath.

Speaker 2 (46:28):
I have a few women clients are like, I don't
want my belly to look big. I'm like, if you're
in a meeting or whatever, nobody's paying attention to what
your belly's doing. I'd much rather have clarity of mind
from having enough oxygen in the brain than I would
worry about what the little half inch album my hips
protrude from breathing correctly. Wow, my goodness, this has been fascinating.

(46:50):
We're going to have you back because there's so many
questions I didn't get to ask, but we're down to
the last couple of minutes. Doctor Hammer, please share with
us with any final tips I'd like to share, or
something that I didn't ask often.

Speaker 1 (47:03):
When asked that at the end of the hour, I
will say that we all have a negativity bias. We
tend to remember the negative and forget the positive and
ruminate over negative things. And so for all of us
who are so afflicted, which is really all of us
to some degree, you're not alone. This is not your
dirty little secret. It's okay to have negative thoughts. It's

(47:25):
a matter of how we respond to them. And so again,
I think a mindfulness meditation practice is so vital, not
only for our sleep, but just how we respond, retraining
our brains to respond to stressful and what might be
negative and anxiety provoking stimuli during the day. And so

(47:46):
we all have work to do. We can all do better.
We're all in this together. But remember that there are
simple practices that will not only promote sleep, but also
reduce stress and healthier living.

Speaker 2 (47:59):
Thank you so much. Now, I know the title of
your book is Gained without Pain, the Happiness Handbook for
healthcare Professionals. But if we're not a healthcare professional, can
we also read it?

Speaker 1 (48:11):
Yes, you have my permission to read it. To the principle,
it's really all about the Gain method and reducing stress
and burnout, and so it's really a book for everyone.
It's just that my publisher at that time wanted me
to include a subtitle and target a particular segment. But
the book came out three and a half years ago,

(48:32):
and most of the TV, radio and podcast injuries I
do related to the book have nothing to do with
healthcare professionals.

Speaker 2 (48:40):
Well, other than your presence here with us today. So
where can we find the book?

Speaker 1 (48:46):
The book is on Amazon and elsewhere. My website is
Greg Hammer MD dot com g R E G h
A M M E R MD dot com. There's a
lot of media there, a lot of other useful information,
and a link to the book as well.

Speaker 2 (49:00):
Thank you so much, doctor Hammer for sharing all your
insights today. I think sleep is one of those things
that's often overlooked in how we got where we are
and how it can help us get back to where
we want to be.

Speaker 1 (49:13):
Thank you very much, my pleasure.

Speaker 2 (49:15):
Thank you everyone. Have a great week, whatever your adventures.
Enjoy

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