Episode #6: Is poor sleep interfering with weight loss success?

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1:56: What happens when we’re sleeping?
3:07: Brief discussion on dreams
5:55: Unsolved mysteries of dreaming
7:34: How do we know if we’re getting enough sleep?
9:19: Sleep deprivation, carbohydrate cravings and weight gain
17:04: Other problems that can interfere with sleep (restless leg syndrome, sleep apnea)
18:27: Steps to readjust our circadian rhythm
20:42: Recognizing the difference between feeling tired and sleepy
22:07: Sleep and sex zones
24:25: Is your pillow the source of your problem?
27:54: Bed partners
29:55: Aging couples and caregivers
33:15: Vitamin D and sleep
37:10: Magnesium
41:19: Tryptophan
43:53: Tart cherry juice

Judi: Hello, and welcome to the D.I.E.T. podcast, where we explore an important question for those who are pursuing a whole, healthy and happy life. And that question is “Did I enrich today?”  I’m Judi.

Allison: I’m Allison.

Bert: And I’m Bert.

Judi: Getting the right amount of quality sleep is one of the key ingredients for living a rich, full and rewarding life. Optimal sleep duration remains a subject of debate, but according to a joint consensus statement that the American Academy of Sleep Medicine and the Sleep Research Society released in 2015, adults should sleep 7 or more hours per night on a regular basis to promote optimal health. The report noted that for adults who are between the ages of 18 and 60 years, routinely sleeping less than seven hours per night is associated with health problems, including weight gain and obesity,

diabetes, high blood pressure, heart disease, stroke, depression, problems with the immune system, increased pain and a higher than average risk of sustaining accidents or dying.

There’s a growing body of evidence that suggests that sleep disruption may interfere with the feeding and satiety signals in the crosstalk between the gut, the brain and the microbiome. And that matters, because according to a 2016 CDC report of U.S. sleeping habits, more than one-third of adults sleep less than seven hours in a 24-hour period.

So, we decided to take a look at sleep. We’ll talk about why we need it, what sorts of things can interfere with sleep and how poor sleep can get in the way of success for those who are working to lose weight and maintain a lean weight. Then, we’ll explore some steps one can take to try to improve their sleep. To kick off the conversation, Bert, will you please talk

about what goes on when we’re sleeping?

Bert: Sure, let’s start with a definition of sleep. The scientific communities have some very complicated definitions that cover a lot of the various nuances, but we can keep it simple. When people sleep, they are transiently disengaged from their environment with her eyes closed, usually staying still and most commonly lying down. Quality sleep includes a mix of what is called REM sleep–R-E-M sleep–for rapid eye movements–and non-REM (NREM) sleep.  

During REM sleep, people dream and their muscles completely relax. During NREM sleep, the brain’s activity slows way down compared to the activity when the person’s awake. That’s a broad generalization and there are exceptions that are coming to light with sleep research. A paper in the Journal of Neuroscience in 2018 showed that some dreaming does take

place during NREM sleep and that dreams during this time–during the NREM sleep–may be the ones that we actually remember.

Allison: Speaking of dreams Bert, what do you think about dedicating an entire episode entirely to dreams?

Bert: We should do that. It’s a great idea.

Allison: Cool. Is dream interpretation a science, like do the things that I dream about at night mean the same thing to other people and other cultures?

Judi:  It’s interesting because dream science is becoming a really broad aspect of study. There’s a lot of work going into dreams, particularly as the technology has changed that allows sleep medicine doctors to detect different activities during sleep.

Allison: That’s really cool. One of my favorite weird movies—I don’t know if anyone else has seen this, but there’s a film by Wim Wenders called Until the End of the World where people watch their–they’ve found a way to record their dreams and people get addicted to watching their dreams. That’s all they want to do—is to watch the dreams

that they had and they all go crazy. Anyway, that’s another–

Judi: That’s a they’re not surprising. I mean ‘cause it’s very escapist until it’s not.

Allison: Right.

 Judi: It’s escapist when it’s a fun dream, but then of course there’s always the not so fun dreams.

Allison: Last night, I had a dream that I went on a trip and I forgot all of my clothes, so I was naked on the

plane, but I didn’t realize that I was bare naked until I actually got to where I was going.

Judi: Naked dreams are the worst.

Allison: They are the worst. One other recurring dream I have–I know this is probably so interesting to everyone listening: what my dreams are–but, I’m sure someone else has had this dream.  I have this dream all the time. I’m at a baseball stadium–Dodger Stadium, in the parking lot, or at a giant mall–and I have lost my car in the parking lot. And so, I spend what seems like hours in my dream searching for my car. And I can’t find–any way I don’t know what it means, but I would be very interested to have this conversation in another episode so we can talk about–

Judi: I think we should.

Allison: Okay, cool.

Judi: Absolutely. I am–it’s funny–hearing your enthusiasm for that makes me kind of connect with mine, too. I love–lots of people do. If you talk just casually to people on the

street, not like, “Hey guy, what do you think?” but, I mean, people that you’re just having conversations with, people really, really, really connect with their dreams!

Allison: They do!

Judi: Understandably!

Bert: Mm-hmm.

Allison: But do they connect with other people’s dreams? Like, would I be so interested in really knowing about what you guys dream about? I think my dreams are very fascinating, but I don’t know if anybody else would want to hear. Maybe we should ask. Do you guys want to have an episode where we talk about dream science, and maybe I’ll kind of, you know, try to tamper down the amount of information I give you about my own personal dreams?

Judi: Me too. I’ll try not to over share.

Allison: Okay, cool.

Judi: And Bert, of course, you haven’t said a word, Bert, about your dreams. We probably–

Allison: We need to know. Inquiring minds need to know…

Judi: …about your dreams.

Bert: I have a dream.

Judi: Oh, Bert.

Allison: All right. All right.

Judi: Okay. Okay. Okay. So that’s a topic for another time, right?

Allison: Yeah. Yeah. Anyway…

Judi: All right.

Allison: Why we dream and why our bodies need sleep or still unsolved mysteries and topics

of heated scientific debate as you can tell by our little conversation here. Theories that have gained a lot of enthusiasm focus on function of the brain that happen when were asleep and don’t necessarily happen when we’re awake. Those are things like regulating the strength of connections between our brain cells and brain maintenance and recovery work. Those are things like restoring our brain’s supply of essential molecules and fuel substrates. We use some of those up while we’re awake. Another brain maintenance and recovery function would be removing potentially harmful waste byproducts from our system.

Judi: When you talk about the connections in the brain, if I can, I’d like to just give an example of that.

Allison: Yeah, yeah.

Judi: Okay. One time–I wasn’t even there, but I have heard the story from Bert. Bert and one of our kids went on a ski trip with some friends. Our kid had never skied before. On day one, there was all this– sort of lessons about skiing and practice and this and that. Bert, you should probably tell this ‘cause you were there, but day 2, it was very different. Right?

Bert: Right. She

was all clumsy and awkward the first day and then she was tired and slept well and got up. Next day she was zooming like she’d been doing it all her life.

Allison: That’s cool.

Judi: It’s pretty amazing to me, ‘cause– I mean, what we talked about at the time, which was now– what, probably 20 years ago. But, what we talked about that at the time was the amazing kind of consolidation of memories and skills that happen while we sleep.

Allison: Mm-hmm. Interesting. Sleep is definitely essential and it’s essential to living well. So, it’s worth whatever effort we have to spend to make sure that we’re getting enough.

Judi: Absolutely.

Allison: But how do we we’re not getting enough? Before we can solve that problem, we need to actually recognize that we have one. So, when I’m wide awake staring at the ceiling all night, that’s one thing, but if I’m not fully awake and aware that I’m not sleeping, how can I be sure I’m not getting enough?

Judi: It’s a great question, Allison and, like you said, sometimes it’s obvious. There are people who know. They lie down. They don’t go to sleep. They keep

watching the clock and two hours later, they are still watching the clock. They eventually go to sleep, and then three hours later, they wake up. So, they know they’ve only slept for three hours. But, there are people who experience poor sleep and don’t know it. The clues aren’t always obvious. Some of them are– like yawning or feeling tired or fatigued or not having energy in the daytime. That’s one of the pretty obvious ones. Some people notice that they’re irritable or depressed or moody or they just can’t figure out why they’re feeling grouchy. Having trouble learning new concepts can be a sign that one isn’t sleeping well or having trouble concentrating or remembering things. Some people call it “fuzzy head.”

Allison: Mm-hmm.

Judi: I’ve felt that fuzzy head sometimes when I don’t get enough sleep. I just am sort of out of sorts.

Allison: When you are reading the same sentence five or six times before it starts clicking in. Your brain is just so tired.

Judi: Exactly. Exactly. Those can all be clues that someone is sleeping poorly. Some people talk about having

little energy, not the kind of can’t get up and move across the room, but just feeling no motivation for getting things done or to do the things that usually are fun to them. They just lose interest. That can be something that is a clue that sleep is poor, because during the day there’s just not this reserve for doing fun things.

One of the things people mention in that regard is a disinterest in sex or not having enough energy for sex. They kind of feel motivated. They think about it, but it’s just not enough to activate them toward pursuing that activity.

A very common clue that is often not recognized as a sign of poor sleep is increased appetite and carbohydrate cravings and weight gain. This is particularly relevant for people who are doing all of the right things to lose weight, but it’s not working for them. That’s a time when looking closely at sleep hygiene makes a lot of sense. Interestingly, I read one study that talked about cravings for chocolate. That’s a pretty

specific craving.

Allison: That’s interesting.

Judi: Yeah, surprising to me–and then weight gain. Weight gain can be sometimes something that happens and the real, underlying problem is not enough sleep—driving behaviors in such a way that that it favors energy storage rather than energy burning. For people who have hit a weight loss plateau, we encourage them to look at their sleep. One can be going along just fine losing weight, thriving, expecting to step on the scale and everything’s just as it was last week, which is a little bit of a drop and it stalls. Sometimes sleep can be the underlying problem for that, so taking a really close look at sleep hygiene is good for anybody—particularly someone who has one of these signs of not sleeping well.

Bert: That’s a good point, Judi. I enjoy getting up early and like getting up with a sun, but really have to pay attention to keeping a proper bedtime to get that 7 or 8 hours in to get up that early. It

means sometimes missing out on late night TV, which can be a real temptation and a habit we have to avoid falling into. But also, people who have adapted to the Fast-5 lifestyle, where they’re eating all of their food intake within five consecutive hours and they’re losing weight as expected, or maintaining– when they’re losing it’s about a pound per week–that all works pretty well most of the time. Sometimes, they haven’t achieved appetite correction and one of our recommendations when they are not feeling appetite correction, is that they look at their sleep quality. Sometimes sleep is the missing ingredient that’s keeping them from achieving appetite correction.

Allison: I’d like to mention for anyone who isn’t familiar yet with the concept of appetite correction, you can learn more at DidIEnrichToday.com and we’ve also got show notes and links there for you, too.

Bert: Thanks, Allison. Appetite correction is important in that it lets your body do the work of adjusting your appetite according to your body’s need. Achieving appetite correction

makes losing weight and maintaining weight very simple. You don’t have to count calories or anything. For some people, sleep quality is the critical factor that they need to facilitate their success.

Getting enough sleep is not only associated with a decreased appetite, but it also seems to impact on what our food preferences are. There was a study in the American Journal of Nutrition in 2018–these were not overweight people. They had a BMI between 18 and 25. The study was based on two groups. One was a control and one was the intervention group. In the intervention group, the only intervention was a consultation with a health psychologist about sleep. The goal was to extend sleep by one to one and a half hours nightly. And again, this group is people who had sleep problems. They weren’t sleeping well to start with. Other than this consultation, the groups were otherwise matched.  Just that consultation made

an average extension of the sleep duration by about 50 minutes. That’s five-oh minutes. Their appetites changed a bit and their interest in sugar consumption decreased by about 10 grams every day. Ten grams of sugar–that’s about 40 calories worth. That can add up to serious pounds over time. The control group didn’t get this consultation and they didn’t have any change in their sleep duration and no change in their sugar intake. So, it’s not like we can make a huge sweeping conclusion about sleep and appetite choices, but it at least suggests that quality sleep helps us make good food choices and avoid that kind of interest in carbohydrate and sugar intake.

Judi: Carbohydrate and sugar intake have a big impact on a lot of things as we’ve seen, like hunger the next day. That’s not really what we’re talking about here, but decreasing the craving for sweet foods is

certainly something that impacts one’s ability to have appetite work well.

I don’t know about you guys, but I have a lot of experience with sleep debt. This is just an anecdote, but I think it’s worth sharing. I’ve lived the appetite correction/Fast-5/intermittent fasting lifestyle for 20 years now. That part of my life has been a constant, but my sleep pattern has changed. Until eight years ago, I was routinely and pretty significantly sleep deprived. I’m happy to say that I’ve made some lifestyle changes and have, to a large degree, corrected that. The reason I’m bringing this up is that, as I look at my appetite and my food preferences when I was sleep deprived compared to now, it’s really a night-and-day difference. So, I’m not surprised that the pilot study showed what it did about free sugars. I can certainly, on a personal level, relate to the many studies that have revealed decreased appetite with better sleep.

It’s completely how

I experienced it in the days when I was very sleep-deprived. Some life circumstances lead to a higher likelihood that someone will have poor sleep and some of those might be surprising. One that’s not a surprise is shift work. It is one of the notorious reasons that people say their sleep is disrupted. You guys know of others that people have mentioned?

Allison: Well, the example of shift workers is a classic one, Judi. For shift workers it can be really hard for them to keep the signals that regulate the circadian rhythm in tune. And, it’s similar for people who change time zones a lot, like pilots and flight attendants. I have a lot of friends who are military and commercial pilots and they shift between day and night flights and it is definitely not easy. They work really hard to maintain good sleep hygiene. Their life and the lives of others are on the line.

Beyond jobs that interfere with sleep, there’s a variety of traits that are just plain, old human nature. Night owls and chronic worriers might go through periods of really low-quality sleep.

Also, people whogive a hundred and ten percent throughout the day and then collapse without a wind-down before going to bed—they all have a higher-than-average risk of not getting enough quality sleep as well.

Judi: Allison, you mentioned the pilots. You said their life is on the line and people’s lives are on the line. You know, it’s true and I think the degree to which sleep dysfunction can impair one’s performance has been very well recognized in that group and in the groups of you know, doctors and residents. And so, there are rules in place for people in those communities to make sure that they get enough sleep, because it’s totally critical. Yeah.

Allison: Absolutely. And I know that these people that do these jobs, they see doctors, and they do check-ins a lot to make sure that they have adequate sleep hygiene–that they’re healthy and that they’re getting enough sleep. I’m not saying that pilots are all tired. I’m just saying that that is one of the parts of their job that they that is really critical, is sleep.

Judi: And they invest,

not only intention, but habit and the system invests in making sure it happens.

Bert: Yeah, that makes sense. There are other problems that can interfere with sleep even if you’re tuned into getting to sleep and trying to keep a good schedule. People have restless legs sometimes that keep them awake. Others have sleep apnea—they stop breathingat some point while they’re sleeping. What they may not recognize when they wake up is that even though they’ve been eyes-closed and looked like they’re sleeping, they’ve really been fighting to breathe for part of their resting time. That doesn’t provide quality sleep at all and can lead to all those problems we talked about earlier.

Judi: Bert, when you talk about quality sleep– There’s this whole sleep architecture that is consistent with healthy quality sleep. For people with sleep apnea, if I’m understanding it correctly, they don’t go into a deep REM sleep. Is that—is that your understanding?

Bert: Yes. Their sleep structure just doesn’t have the same patterns, because they don’t

get long stretches where they’re flipping back and forth like most people between REM and NREM sleep. Sometimes genetics can play a role in sleep problems, too. We don’t have a genetic test for that yet, so we can’t just pick out those people easily.

Judi: Yeah, it’s kind of funny that genetics influence outcomes so much. It’s one of those reminders that we humans are very complex and we’re very individual and distinctive biologic creatures.  Once we’ve identified a sleep problem—so, once we know we have one, the next question becomes what can we do about it? We can take behavioral steps with an eye toward working with our bodies to set a natural clock and to readjust our circadian rhythm to one that works. In the days long ago, we got up with the sun and went to sleep in the dark, but now we have a very different world that isn’t governed by the Earth’s rhythm as much as it is by the rhythms of modern life.

One way

to reset our natural clocks or to let our bodies work with our natural clock is to get up at the same time every day, on weekdays and on weekends. And we can adopt a bedtime routine that begins two hours before our planned sleep time, taking steps like disconnecting from electronic devices: cell phones, tablets, TV and using programs that reduce blue light exposure. We also sleep better in rooms that are cool, quiet and dark. If we’re in an area like a city or a brightly lit environment, then using things like white noise and blackout curtains can be helpful. If we’re going to work with our natural clock, then creating an environment and a habit before we go to bed to work with our circadian rhythm can be helpful.

Allison: Yeah, I recently moved to a new house and we don’t live very far from some train tracks. The trains run all night long and I just–

I could not fall asleep. So, I stuck a fan in my room and just blast the fan– even though the room is already cool–but now, just having that white noise of the fan is really helpful.

Judi: Yeah–it can be a really big difference, yeah.

Bert: Blackout curtains made a big difference for me. I’m very sensitive to increasing light in the morning. It almost always awakens me. Having blackout curtains–we put those up and the next day I slept two hours longer—

Allison: Oh wow.

Bert: –and was really surprised how solid and good it felt.

Judi:  Blackout curtains aren’t complicated. They’re not ugly. Like Bert said, we had to do that. There’s a lot of variety and it’s not an expensive thing to do. It can be a small intervention for a really big yield.

Allison: Mm-hmm. Another thing that can be helpful when we’re working to align our behavior with our own natural clock is to recognize the difference between feeling tired and feeling sleepy. If we think about it, most of us can probably recognize those as two different feelings.

Judi: Yeah.

Allison: I feel tired after I work out–a really good workout. I feel tired. But I feel sleepy when I have to sit for a really long time doing something that I don’t find particularly interesting. We’re more likely to drift off to sleep if we go to bed when we’re sleepy and not just tired. If our worries or thoughts or our endless to-do lists are interfering with our sleep or interfering with our ability to even fall asleep, one way that can sometimes quiet our mind is to write a plan for the next day or write a list of things that you’re just going to set aside and think about later. So, I think of it as like a mini mind dump before bed.

Judi: Huh. I like that.

Allison: I just drain my brain of all the stuff that I know is going to keep me awake and I think, “It’ll be there for me when I wake up, so I’m not going to worry about it now.”

Judi: Someone could add that to their two hours prep before bed. Add that to the list: Get into the habit of that little mini mind dump. That’s great.

Allison: Mm-hmm. And for people who say they have trouble staying awake while they’re meditating, this is

perfect. It’s a perfect use!

So, they can try meditating or using breathing techniques when they’re having a hard time falling asleep.

Judi: Yeah.

Allison: Sleep experts make a point of designating the bed as a place for sleeping and having sex– if that’s something you’re into. It’s the sleep and sex zone. When you stop eating, reading or binge-watching 90 Day Fiancé in bed—not that I have done that for the last five days—but, you can maintain a behavioral reminder that daytime activities belong in daytime spaces.

Judi: Okay, so I’m imagining putting a sign on the room, on the bedroom. What is it? “SLEEP AND SEX ZONE.”  

Allison: Yeah.

Judi: Then, when our family comes over, there will be complete clarity about what goes on in there.

Allison: So, it’s no longer, “This is where the magic happens.” It’s straight up “This is my sleep and sex zone. You are entering the sleep and sex zone.”

Bert: Right.

Judi: I love it. “The magic happens.” All right. All right. I have one other thing. So, did you say daytime activities belong in daytime spaces?

Allison: Yeah.

Judi: So is—I’m sorry. I’m just mashing it up here—Is sex ever a daytime activity?

Allison: Oh, yeah!

Judi: Those feel a little mutually exclusive to me. If the sleep and sex happens in the bedroom—I guess sometimes the sleep and sex zone is a daytime space?

Allison: Well, you can wash your hands in the bathroom and you can wash your hands in the kitchen.

Judi:  Got it. I’m totally there. I understand now. We have totally—Hey Bert?

Bert: Yes.

Judi: Sorry. We’re just—we’re just taking over the whole episode. Sorry!

Bert: That’s fine.

Judi: We’re having a little—uh, sex zone fest.

Bert: We’re not talking potato peeling anymore.

Judi: Preparing potatoes, not potato peeling.

Right?

Bert: Well, isn’t peeling the potatoes part of preparing the potatoes?

Judi: It depends! Not if you’re baking the potato!

Bert: Well, for baking the potato, you take a potato, you put it in the microwave. You hit “go,” and there’s no—no other preparation, So to me, p—

Allison: Bert, you’re an expert at alliteration. I want to hear that one again.

Bert: You peel the potato, put it in the microwave, and then pop it on your plate when you’re done.

Allison: Hey, can I just mention one more thing that might be helpful?

Judi: Sure.

Allison: Sometimes your pillow can be the source of your problem. I have a lot of neck issues and for a while I was sitting almost straight up. I had a giant pillow and it was making my neck kind of like—my chin would be almost up to my chest. So, I—

Judi: Oh, wow.

Allison: —decided to get a—and for me that was really comfortable to fall asleep, but then I would wake up and think “What’s wrong?” So, one thing I did was to get a special cervical

neck pillow. One other thing to mention is that for people who suffer from allergies and sleep issues, is that you can put your pillows in the dryer. You can actually wash them, but, if you just want to fluff up and to get rid of some allergens, you can put your pillow in the dryer. It doesn’t even have to be on a hot setting to fluff it up get those dust mites and dust particles out of there before you sleep on it—if your pillow has become uncomfortable. And—another thing about pillows—is that you shouldn’t keep your pillow for years on end. Pillows are just—

Judi: —consumables.

Allison: Yeah, they are consumables and you shouldn’t keep it forever. Just, when your pillow starts getting icky and flat or dirty, either wash it and fluff it or get a new pillow. Find something else to use that pillow for, but you need a new pillow.

Judi: You can do something—You can make a throw pillow out of it then. So, it doesn’t have to be such a—

Allison: Or—here’s an idea, Judi. You can donate it to a dog shelter. Donate to a shelter. Shelters are always looking for pillows.

It can be a little sleeping bed for a cute little dog that needs a home.

Judi: That is a great idea!

Bert: A pillow can be too fluffy, too. One of the things to keep in mind is that when we’re sleeping, we’re unconscious. And an unconscious person doesn’t have real good attention to their airway. If you bend your head up quite sharply, so your neck is bent forward, that can interfere with your breathing. Somebody who’s tending towards sleep apnea, or concerned that they might have sleep apnea, might be best with a very minimal fluffy pillow, like a flat pillow or moving the pillow, so it’s a bit under their shoulders, so it’s supporting their head softly, but not creating a big angle between the head and neck.

Judi: That’s where the cervical pillow would preserve that angle, I think.

Allison: Exactly. A lot of people that have the same neck issue that I have just do away with pillows altogether and they get a blanket and roll the blanket and just put it under that little area of the neck, so that you’re not really

propping your head up, but you’re supporting your neck. Maybe you don’t even need a pillow. Maybe you need something else.

Judi: If you watch people who are settling in for sleep, or dogs—we’ve watched one of your dogs, Allison, settle in for sleep and it’s a totally hilarious thing, but there’s this whole settling in thing that people and animals do in preparing their body to rest at that really lowest energy state. And sometimes just a pillow to the side of the head—so, no pillow under the head, but a pillow to the side of the head—where there’s a place that holds the head from flopping to one side or the other. So, pillows really matter. Good point, Allison.  

Mattresses are another thing. In fact, there’s a whole mat—my goodness is there a mattress industry.

Allison: Oh, geez—the mattress racket, yeah.

Judi: There is a mattress racket.

Allison: Maybe we could find some sponsors and make that a new episode.

Judi: Now, there’s an interesting thought. You know, what else matters is bed partners.

Allison: Yeah. Oh, yeah.

Judi: It matters

on so many levels.

Bert: Yeah. How have you been sleeping lately, Judi?

Judi: Yeah. There’s this tradition, a long-held tradition that people who pair up—partners—sleep in the same bed. There are big, wide king-size beds and queen-size beds and twin beds. There’s lots of different sizes of beds and many beds are for two people. They’re designed for two people and, yet, sometimes people’s sleeping habits aren’t compatible. So, one of the things that is worth evaluating if one is having poor sleep and if they happen to sleep in a bed with somebody else—is there sleep compatibility? Or sleep incompatibility? If there is sleep incompatibility, then going back to the zones of the bedroom, one could imagine two bedrooms and then either a third bedroom or one bedroom or both bedrooms designated as multi-activity. Is this making any sense?

Allison: Oh yes, absolutely!

Judi: So, if it is that you’re sleeping with somebody

whose sleep habits are ruining your sleep or vice versa, then there’s no rule that says there’s anything—in fact, it makes only Intuitive and pragmatic sense to sleep in two different spaces.

Allison: Absolutely.

Judi:  Yes, spend time together other ways in the same space.

Allison: It’s just that one of our cultural norms that married couples are expected to sleep together. But like you said, Judi, if it’s impacting your ability to sleep well, then what then why do it?

Judi: Right.

Bert: If it winds up happening as a predictable outcome, that one person is leaving the shared bed routinely, then it’s worth making sure that that person has a good place to sleep and they’re not just trying to eek it out on the couch or something. Just accepting that that’s the way it’s going to be and making a quality place to sleep nightly would be a better option than just trying to—

 Allison: Yeah.

Bert: —make it work with a couch that doesn’t work well.

Judi: We’re being light about this a little bit, but I’ll tell you a circumstance where this really comes into

play often and that is in couples as they age. One of the things that can happen is one becomes a caregiver of the other. It’s not an unusual pattern with advanced aging. The person who is the caregiver, because of cultural patterns and a sense of—lots of things. This is a this could be a whole episode in itself—caregiving and the psychology of caregiving—but in a sense of duty or a sense of holding on to what was and grieving the decline of one of the members of this partnership, both members—the caregiver and the person who is receiving the caregiving—often spend a much longer time still sleeping in the same bed than is healthy for either of them. Definitely, there are times when just recognizing that we’re in a phase of life—like we say, we’re complex creatures. When two complex creatures get together, then it’s doubly complex or

compounded and so, just looking at

that and saying, “There’s no judgment. There’s no failure. This is just a reality.”

Allison: There’s nothing wrong with your relationship.

Judi: Right.

Allison: You just need healthy sleep and you’ll see each other in the morning.

Bert: Right.

Judi: Right. Yeah, nothing wrong with the relationship, like you said, Allison.

Sleep experts also tell us that substances can get in the way of optimal sleep and I think probably that’s one of those intuitively obvious things. Some things to avoid in order to make sure that sleep is optimized are things like caffeine and alcohol. Minimizing those—

Allison: Mm-hmm.

Judi: —can certainly improve sleep, if someone is having sleep difficulty. Alcohol is interesting in that it’s a sedative.  I have heard individuals say, “It helps me go to sleep.” Well, it does, but one of the downsides is that it disrupts sleep architecture. So, it’s not just a matter of getting quantity of sleep, one also has to get quality of sleep. So, alcohol and

caffeine can change sleep architecture in ways that aren’t necessarily detectable except with the daytime signs that you’re not getting enough sleep. Smoking has also been associated with poor sleep. So, for smokers who might happen to be looking for motivation to stop, sleep is a good one. Now. I’m just going to add a quick aside because, I know smokers and I haven’t met one who if it were easy or even if it were hard, but something that was achievable as a predictable outcome, they would already have quit. So, this is not an indictment of smokers by any means. I’m just saying sometimes there’s something that pushes one to the next phase of a higher probability of success. And so, if trying to improve one’s sleep is the magic change that helps a smoker quit, I’m all-in. It’s a tough battle and sleep unfortunately is one of bits of collateral damage in the habit of smoking.

Adding regular

exercise to one’s life has been associated with improved sleep hygiene. So, one can improve their sleep with exercise and there are also some supplements that have been associated with improvements in sleep, things like melatonin and tryptophan. Before we talk about those, Bert, tell us about vitamin D and sleep. That’s one of those things that comes up that people talk about as a supplement for sleeping, but I think that’s not as clear as many.

Bert: I agree. The reason that you see vitamin D added to milk is that vitamin D deficiency used to be very common, and it’s still fairly common, especially in people who don’t get much sun exposure. Low vitamin D levels have been associated with a risk of short sleep duration and poor sleep efficiency, which means not sleeping well or consistently—and also, with taking a long time to fall asleep. Some studies have shown that vitamin D supplements can improve sleep, so it’s tempting to imagine that if you have a low vitamin D

level and some sleep problems, then vitamin D is likely the solution. It’s worth a try, but the body’s very complex and everybody’s different. Just because something worked in a study doesn’t mean it’s going to be the magic answer for any one person. It’s something that you’re going to have to put to the test and you might want to work with your doctor to help sort it out.

There was a study reported in Preventive Medicine in 2016 that pointed this out. The main question the study was designed to answer was whether supplementing vitamin D in women who were postmenopausal, overweight, on a steady, light exercise program and vitamin D deficient helped them to lose weight. The study ran for a year and found no significant difference in weight loss between the women who were taking vitamin D and those who weren’t.

I mentioned the earlier studies that had seen some good effects of vitamin D on sleep. Other studies didn’t agree,

so the researchers in this one also looked at the effects of vitamin D on sleep. They found that women who had the biggest rise in their vitamin D levels were more likely to have problems with their sleep quality and to take medicines to help them sleep. Women whose vitamin D level reached the normal range reported worse sleep quality than those whose vitamin D levels didn’t get back to normal. 

For one thing, this study reminds us that lab values don’t tell the full story about health. One can have perfect lab tests and be very sick, and one can have some wacky lab values and be very healthy. Lab values are just tiny pixels in one frame in a big, ever-changing and very complex picture of health.

The other thing to note is that in the study, each woman responded a little differently from the rest. That’s nothing new—it happens in most studies. But,

when we look at averages and statistics, we can forget that within a study group, there’s a wide range of different responses. Some women reached normal levels of vitamin D and some didn’t. Some developed sleep problems and some didn’t. The reason for these differences isn’t just genetic. There are differences in dietary habits, home and work environments, relationships and in the types and diversity of microbes in the gut. One person’s best path to health may be quite different from someone who is geographically or genetically close to them.

This study’s just one example where a treatment you’d expect to help–or at least not cause any problems, appeared to add to sleep problems in some people.

Judi: Bert, that’s a really good point.  Sometimes what seems like should happen is just not what happens.

So, for our audience, I think the take home is that people are different and

how one will respond to something isn’t necessarily consistent with what we would just predict. This is one of those times that applying the Study of One becomes very important.

Allison: Magnesium is a mineral that has been studied relative to sleep, also. It’s interesting in the context of people who are pursuing weight loss. You know, in the past we’ve talked about the importance of gut health in achieving weight loss and, in some settings, we’ve suggested that magnesium supplementation may be part of the key to unlocking success in some people. Well, it also may have a role in improving sleep. A 2012 double-blind, placebo-controlled study looked at seniors with insomnia. This was a small study, but it was really meaningful and informative nonetheless. And check the show notes because we’ll have links to the study. In this study, a total of 46 people were randomized into two groups and for an eight-week period, one group took a placebo and the other took 500 milligrams of magnesium.

For people in the magnesium supplement group, their sleep time and sleep efficiency improved and their sleep latency—the time that it took them to fall asleep—decreased. Among other interesting changes their levels of melatonin increased, while cortisol, which is a stress hormone, went down.

Judi: Well, that’s good news for me, Allison, I’ll have to say. I take 500 mg of magnesium citrate in a gelcap form each day. I started taking that for the potential that it would help with my headaches. And it has. I’ve had fewer headaches and quite healthy bowel function, I’ll have to say and—

Allison: Good to know.

Judi: —not too much not too little. A little TMI—but now I’m wondering if it has also provided a sleep advantage that I was unaware of.

Allison: I wouldn’t be surprised, Judi, magnesium is an important mineral. A cation is an ion, which is a part of an electrolyte with a positive charge. And

magnesium is the fourth most abundant cation in the body and the second most abundant cation inside of our cells. It’s involved in more than 300 biochemical reactions of the body. And you hear a lot of concern about getting adequate electrolytes and people talk about maintaining physical fitness and staying hydrated and even brain function. So, this is just a tiny science lesson, but the point is that magnesium is important when it comes to the biochemistry in our body.

Judi: It really is and thank you. I appreciate that little science lesson. Thank you very much. Another supplement that comes up when people talk about addressing sleep problems is melatonin. Our recent look at the state of the science regarding melatonin brought to light a nice review paper published in 2014. The authors followed standard procedures for grading the quality and the robustness of the many papers that have been looking at melatonin as a potential sleep aid. The authors drew two conclusions. The first is

that there’s weak evidence for possible benefit for people with insomnia in taking melatonin. And the second is that in healthy people who are trying to improve their sleep initiation—so how fast they fall asleep—or their sleep efficiency, there’s also weak evidence for a possible benefit. The authors also made note that there needed to be bigger and longer duration trials, randomized clinical trials, to characterize the benefits of melatonin in a definitive way and they wouldn’t wholeheartedly make recommendations for melatonin in young healthy adults. There was a 2018 study in the journal Molecules that revealed that one gram of phytomelatonin, which is a plant-based melatonin, taken daily for 30 days didn’t have any adverse effects on the study population. Although, some people did report somnolence—which obviously is a benefit if one’s taking it for sleep—and headaches.

What we take from those studies is that there’s weak evidence

that melatonin may have some benefit. And there is some evidence that a gram of phytomelatonin—that’s a plant-based type of melatonin—for 30 days didn’t cause any harm. Out of that, what we would invite you to do is to decide for yourself if it is worth giving a try.

Tryptophan is one of the molecules our bodies use to make melatonin and it’s involved in a wide variety of critical pathways that make our bodies work right. It’s an amino acid. So, that means it’s one of the building blocks of protein. And it’s an essential amino acid, which means that our bodies can’t make it. We have to get it from the food that we eat.

Allison: Like turkey on Thanksgiving!

Judi: Exactly, like turkey on Thanksgiving! A famous source of tryptophan that has everyone snoozing after the big Thanksgiving Day meal. In the clinical setting, it’s been used to treat a lot of things, including insomnia and other sleep problems. And doses mentioned in at least one paper in

2009 in the International Journal of Tryptophan Research—

Allison: Mmm.

Judi: Much to my surprise, there’s so much tryptophan research going on that there’s an entire journal dedicated to that research. Those doses ranged from two and a half milligrams to a gram depending on the study and the condition being treated. So that’s a range of doses that people have used in studies to treat insomnia and other sleep problems. It’s available over the counter as a supplement and it’s marketed with a lot of claims. In 1990, tryptophan was

pulled from the market because of safety concerns. We certainly don’t make any kind of endorsement or any big statements about tryptophan, but we thought it made sense to include this in this episode, because it is one of the supplements that comes up and is associated with a lot of sleep claims.

Allison: So, it was pulled from the market in 1990 and then subsequently put back on the market?

Bert: Right. It’s available now.

Judi: It is available now and also, when it was pulled from the market, the information that surrounded that recall suggested that it wasn’t the tryptophan, but one of the associated parts of the compound that was the source of problem. It’s important for us to talk about tryptophan and to mention it because it is something that is out there with a lot of claims, but I don’t think that the three of us certainly would make any assertion about whether it’s a good idea or a bad idea. It’s best for anyone who is considering tryptophan as one of the ways to try to improve sleep to work with your doctor, so you do it safely. And remember that it’s one of the molecules that’s used to make melatonin, so if you’re just deciding to not consult with your doctor and you’re thinking, “Should I consider tryptophan or melatonin?” Maybe melatonin is the more straightforward approach.

Allison: Thanks, Judi.

Judi: Sure.

Bert: There’s another option. It’s another supplement that’s tryptophan-related, but doesn’t have any history of

product recalls and that’s tart cherry juice. There’s a study—

Judi: What? Did you say “tart cherry juice?”

Bert: I did say “tart cherry juice.”

Judi: Well, that’s a whole lot less heavy than tryptophan.

Bert: Well, did you think I said chart terry juice?

Judi: No.

Bert: There was a study published in 2018 that looked at people over 50 who had insomnia and drinking 240 mL of the tart cherry juice, which had a quantity of an active ingredient called procyanidin. That resulted in an increase in sleep time of 84 minutes and an increase of sleep efficiency. Now, these are people who had insomnia, so any benefit was a big deal. They increased their sleep time by an average of 84 minutes, so that’s pretty substantial.

Allison: That is amazing! And I just have one question. I don’t know if you’ve ever had tart cherry juice before, but I’m just wondering for those IF-ers

that we have out there, how much—

Bert: How tart is it?

Allison:  How much sugar—how tart is it—How much sugar is in tart cherry juice? Is it truly tart? What kind of impact would that have? Would someone have to account for that in their five hours?

Judi: Oh, yeah.

Bert: Definitely.

Judi: No question there.

Bert: Yeah. Yeah, any fruit juice, but except maybe lemon juice, would have enough calorie content to consider it eating.

Allison: Mm-hmm. Okay.

Judi: Well that certainly sounds like a tasty way to tackle a sleep problem if it works.

That closes out this episode of the D.I.E.T. Podcast. We are delighted that you joined us. We hope that you found some ideas in here that might help you to do it yourself in improving your sleep. But, if the do-it-yourself approach doesn’t work, then seeing your doctor is an option that’s probably worth pursuing. One of the things that’s important to know is that sleep medicine as a subspecialty has been growing significantly over the last number of years. So, either see your primary care doctor or, if you don’t find

answers there, it’s worth considering seeing a certified behavioral sleep medicine specialist. Behavioral sleep medicine specialists use cognitive behavioral therapy techniques and have been very successful in helping some people to overcome sleep problems that they could not overcome themselves. So, it’s probably worth consideration. Thanks for joining us and we are delighted that you were here today with the D.I.E.T. Podcast and we look forward to you joining us next time.

Allison: Yeah. Thanks for listening. We’ve also got a ton of resources for you at DidIEnrichToday.com, including information about intermittent fasting and links to purchase AC: The Power of Appetite Correction on Amazon and Audible. Please sign up for the newsletter, and we’ll let you know about upcoming events, and when new episodes are available. Bye-bye!

Bert: Bye!

Judi: Bye!