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  • If you're anything like me,

  • you probably have a love/hate relationship with sleep. You love the way it makes you feel,

  • but you hate that it seems to waste so much time,

  • or maybe it just doesn't come easily to you. As someone who has struggled with and ultimately conquered severe sleep onset insomnia,

  • here are the lessons I've learned.

  • Dr. Jubbal, MedSchoolInsiders.com. New research has illustrated just how important sleep is,

  • this is the part where you moan in annoyance as you've been told this time and time again. I won't belabor the point,

  • but I do want to leave you with three facts about the importance of sleep that are too interesting to omit.

  • First, drowsy driving accounts for more accidents than drunk driving or driving under the influence of other substances combined.

  • Second, you can function well without food for several weeks, without water for several days,

  • but you experience the most rapid decline in function without sleep. And third, despite millions of years of evolution,

  • we still spend one-third of our lives asleep

  • despite it being extremely costly. Think about it,

  • it must be necessary if evolution hasn't prioritized finding food, or finding a mate, or simply not being vulnerable to predation.

  • For more interesting sleep facts, check out the Peter Attia The Drive episode with Dr. Matthew Walker.

  • Link in the description.

  • Now, let's address your difficulty with getting good quality sleep or getting enough sleep, and don't tell me you are too busy to

  • prioritize your sleep. As someone who is actively growing two YouTube channels,

  • and growing three separate businesses while still getting seven to eight hours of sleep,

  • I'll be the first to say that it's less about you being busy and more about you being inefficient with your time.

  • A lot of viewers have asked me how I'm so productive and I'll be releasing a video about my strategies on the Kevin Jubbal, M.D. YouTube channel.

  • Make sure you're subscribed, so you don't miss it.

  • The discussion on sleep optimization has recently focused heavily on one's chronotype. As humans, or rather organisms on planet earth,

  • we run on a circadian rhythm. This 24-hour internal clock coordinates various physiologic functions related to sleep and wakefulness

  • from hormone levels to body temperature and much more. Approximately 40% of people have an advanced sleep chronotype,

  • meaning that they are morning people or early risers.

  • Approximately 30 percent of the population has a delayed sleep chronotype,

  • meaning they are night owls. The other 30% falls somewhere in the middle.

  • As Dr. Walker writes in his book Why We Sleep, night owls are not owls by choice.

  • They are bound to a delayed schedule by unavoidable DNA hardwiring.

  • It is not their conscious fault,

  • but rather their genetic fate. Chronotypes actually change over the course of your life.

  • Infants are predisposed to early chronotypes, teenagers are delayed chronotypes,

  • and once you pass the age of 50 or 60, you trend towards early again. Your chronotype in adulthood is set in your early

  • 20's and generally stays constant. Greater understanding of chronotypes is awesome, but it comes with good and bad news.

  • The good news is that it's backed by science and we understand that being a night owl doesn't mean you're lazy,

  • It just means you have a delayed sleep chronotype.

  • If you have a delayed sleep chronotype, there are even data suggesting your prefrontal cortex,

  • which is the part most important for your higher-level cognition won't function optimally when you're forced to wake up early.

  • But here's the bad news, the world doesn't care about your chronotype.

  • I don't consider myself an early bird, but I still had to wake up at 3:30 a.m

  • hundreds of days in a row while doing plastic surgery. The hospital and operating room didn't slow down just because I'm not a morning person.

  • That being said, all hope is not lost. In my first video about sleep optimization,

  • which now has over five million views, I explained how I grew to love waking up early

  • despite not being a morning person.

  • And in this video, I'll teach you the techniques to sleep like a pro regardless of your chronotype. When we speak about optimizing sleep,

  • we don't simply mean getting more shut-eye.

  • Surely, you've experienced nights where you slept for eight hours and felt great in the morning, and other nights where you slept eight hours

  • but somehow felt terrible.

  • The reason is that there are four pillars of sleep and sleep duration is only one of them. The four pillars are:

  • First, Sleep Depth and Quality. This is reflected in the quality of a sleep waves,

  • meaning alpha, beta, delta, theta waves, sleep spindles, k complexes, etc.

  • These are measured on an EEG. Number two, Sleep Duration. How long are you sleeping? For most adults,

  • this should be between seven to nine hours.

  • Number three, Continuity. Is your sleep continuous or interrupted, and number four, Regularity.

  • Falling asleep and waking up at the same time each day.

  • Falling short in any one of these four pillars will result in sub-optimal sleep and negative effects on your restfulness and overall health.

  • For example, say you have two scenarios where you sleep eight hours each night, on one night,

  • you sleep eight hours continuously without interruption. On the other night, you sleep the same amount of time

  • but over a longer nine hours with multiple small interruptions. The continuous sleep will result in far better restfulness.

  • Keep these four pillars in mind as we work through the five steps in optimizing your sleep.

  • There is no one single magic bullet and only you can decide how much you are willing to

  • prioritize your sleep. Some of these changes will come easier than others. That being said, if you follow these instructions,

  • you should experience a drastic improvement in how rested you feel.

  • First, determine what time you have to wake up in order to get to work or school on time, work backwards from there,

  • accounting for how long it takes to commute and get ready in the morning.

  • You should plan for seven to nine hours of sleep each night. By doing this exercise,

  • you will set up your target bed and wake times. This may not be optimized for your chronotype,

  • but setting these times will still be highly beneficial in improving the quality of your sleep.

  • As tempting as it is, do not deprive your sleep during the week only to binge and catch up on the weekends. This behavior

  • throws off your circadian rhythm,

  • resulting in reduced sleep pressure, meaning it's harder for you to fall asleep and stick to your schedule come Monday.

  • There's a reason this is Step 1.

  • This is arguably the most difficult step to implement,

  • but I have personally found it the most powerful. If there are days that you can go into work or school later,

  • I still suggest you sleep and wake up at your scheduled times.

  • Use that extra time in the morning to get studying or work done. This benefits your sleep schedule and you might as well start the

  • day off with a win. It's not uncommon to stay up late on Fridays and Saturdays for social events throwing off your sleep schedule,

  • I've done that too from time to time. However, during particularly stressful periods,

  • like when I was doing plastic surgery, plus growing Med School Insiders, plus building and running a biomedical incubator,

  • I prioritized sleep over social events. I wasn't writing off socializing and partying forever,

  • I simply was in a season in my life where I need it to grind hard.

  • What season are you in.

  • Step 2. Bedroom Optimization.

  • If you're serious about not feeling tired all the time, optimizing your bedroom should not be taken lightly.

  • Let's talk about lighting, sound, and temperature. In terms of lighting, you want your bedroom as dark as possible at night.

  • I bought blackout curtains in college mostly because my apartment was poorly insulated

  • but I soon realized the benefits of sleeping in complete darkness.

  • This also means turning off any lights from electronics that illuminate your room.

  • I placed electrical tape on various battery chargers and electronics in my bedroom that gave off even dim light. The results were

  • surprisingly drastic. For temperature, understand that your hypothalamus

  • reduces your core body temperature by

  • approximately 2 degrees Fahrenheit for sleep. Ever notice how it's terribly difficult to fall asleep in a hot room? To help your body get into

  • a more conducive state for sleep,

  • it helps to keep the room cool with most experts agreeing that the mid-60s are a good temperature to aim for. Or you can

  • do what I do, which is wear very little when going to sleep and use light bedding.

  • This means I can keep the room in the low 70s and still sleep like a baby. With regards to noise,

  • most people don't realize that noises that don't wake them up consciously still affect their sleep quality.

  • Remember continuity and depth from the four pillars?

  • I like to use a fan as white noise in my room, but you can also buy a white noise generator

  • which is what my housemate does. If it's still noisy,

  • I recommend using earplugs. Some people complain that earplugs poke them in the ears if they lay on their sides

  • but that's usually due to them not inserting

  • the earplugs deep enough. If earplugs still bother you, Tim Ferriss has recommended putty earplugs instead.

  • There are links to all of these items down in the description below.

  • Step 3, Pre-bedtime Routine. If your mind is racing while you lay in bed trying to sleep, I feel you.

  • I found pre-bedtime routines to be the most effective antidote. A good routine

  • not only relaxes you and activates your parasympathetic nervous system, preparing you for rest,

  • but it also acts as a classical conditioning stimulus to signal to your subconscious that it's time to sleep.

  • Substitute Pavlov ringing the bell and the dog salivating with you doing your bedtime routine and getting sleepy.

  • My personal bedtime routine is to set my bedroom lights to a dim red color, take a warm shower, and practice mindfulness meditation

  • for 10 minutes. Meditation has been demonstrated in clinical studies to reduce sleep latency,

  • meaning how long it takes for you to fall asleep and also improve the continuity of sleep.

  • I also keep a notebook and pen by my bedside so I can write down any lingering thoughts that may come up.

  • I find that by writing them down and trapping them on paper,

  • It's easier for me to let go of that thought. If you're wondering why I set my bedroom to red, it isn't for the sex

  • dungeon vibes although that is a welcome.

  • secondary effect. Blue light stimulates photoreceptors in your eyes that inhibit the release of melatonin

  • from your pineal gland. In short, using screens like your smartphone tablet computer or TV makes it harder for you to fall asleep.

  • You can adjust the color temperature on your screens. On Apple devices,

  • this is called nightshift, analogous to night mode on android devices, or flux on your computer. These work by turning your screen more yellow to

  • warmer colors thus reducing the amount of blue light emitted in the evening. While they are helpful,

  • a recent study has demonstrated that screens with night shift still suppress melatonin.

  • The best way around this is to simply stop using devices at least 60 minutes, but ideally

  • 120 minutes before bed. I know that is a long shot,

  • so the next best thing to do is wear blue light blocking glasses which make everything appear super orange.

  • These are the ones I wear and they aren't just super sexy, but they work great too. Link Below.

  • Be sure to also reduce the brightness on your devices as bright screens

  • regardless of light color will also suppress that sweet, sweet melatonin. I take this part

  • so seriously that I auto-scheduled "Do Not Disturb" mode on my phone every night after 9 p.m,

  • that means no notifications, messages or phone calls. I also charge my phone far away from my bed,

  • so I'm never tempted to pick it up. I don't even set my alarm by looking at my phone,

  • I always do it hands-free by activating Siri or Alexa through voice activation alone.

  • That way, I don't have to look at any screen. You may be wondering whether or not you should read in bed,

  • here are the guidelines: If you have sleep-onset insomnia, meaning you have difficulty falling asleep then avoid reading in bed.

  • You want to associate your bed only with sleep and sex. If you read in bed,

  • you'll begin to associate it with wakefulness. If you don't have sleep-onset insomnia, or if you have issues with sleep maintenance insomnia,

  • then you should be fine to read. That being said, remember to use a dim light and definitely do not read on an iPad or

  • other backlit screen, Kindles are okay. Now for the fun part, setting your wake routine.

  • I've used spin alarm clock which forces you to get up and spin in circles to turn the alarm off and

  • sleep cycle in the past. But nowadays, I just use my regular built-in alarm function of my phone with two big caveats.

  • First, I put my phone across the room, so I'm forced to get up to turn it off. Simple and effective.

  • Second, I have Philips Hue

  • smart lights integrated across my room, and actually across my entire apartment. Thirty minutes prior to waking up, my lights gradually increase in brightness,

  • simulating a sunrise. This results in a much softer and less violently jolting way of waking up.

  • Dare I say that waking up is even ...

  • pleasant.

  • If you don't want to go all out with smart lights, or if you're on a tighter budget,

  • you can also go with a wake-up light which is essentially a standalone alarm clock that gradually illuminates your whole room.

  • Step 5. Daily habits to improve sleep.

  • This is gonna be your least favorite part,

  • but probably the most important for you to hear. You need sleep pressure or sleep debt to fall asleep at night.

  • Adenosine is a compound that builds up in your brain during the day and it's cleared at night.

  • It's one of the factors responsible for why we feel tired or sleepy as the day progresses.

  • For this reason, if you struggle with sleep onset insomnia, avoid taking naps

  • particularly later in the day as this clears adenosine and reduces sleep pressure.

  • Caffeine, which blocks adenosine from acting on brain receptors should also be used carefully.

  • Caffeine has a half-life of about 6 to 8 hours.

  • We know you can sleep fine with blood concentrations of approximately half of your caffeine intake of the day,

  • otherwise, your sleep will be disrupted. Therefore, stop drinking any coffee or tea eight hours prior to bedtime. If you sleep at 10:00 p.m,

  • that means stop at 2 p.m.

  • Caffeine should not be a crutch you rely on but rather a tool you use when necessary.

  • I got through medical school and was in surgical residency drinking coffee only a couple times per year.

  • So, yes, you can do it too. Alcohol and sleep don't mix. While it may reduce sleep latency,

  • the quality of your sleep is highly compromised.

  • Remember the pillars? Alcohol inhibits REM sleep and also increases your body temperature,

  • which is the opposite of what we want. Is marijuana the wonder sleep drug that we've always wanted? Not quite. THC decreases sleep latency,

  • but it also inhibits REM sleep. There's also a dependency component regarding the latency,

  • meaning that when you stop using marijuana, you'll have rebound insomnia.

  • CBD, on the other hand,

  • decreases latency without inhibiting REM. It also helps to reduce body temperature and may contribute to restfulness through its anxiolytic,

  • meaning anxiety-reducing, effects. That being said, more research is required

  • before we can provide guidelines on whether CBD use is beneficial or not with regards to sleep.

  • If you found this video helpful, please let us know with a thumbs up as that keeps the YouTube gods happy.

  • There are links to all the items discussed in this video down in the description.

  • If you purchased using those links, we get a small kickback at no cost to you. Thank you guys for your support.

  • Let me know what you want me to cover in the next video.

  • Much love to you all and I will see you guys in that next one.

If you're anything like me,

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B1 sleep chronotype insomnia latency asleep temperature

Surgeon Sleep Secrets - The Art & Science of Sleep

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    Summer posted on 2020/05/05
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