Ep 169 – Sleep Strategies with Dr. Ellen Vora

0:00:00.2 Kristin Coverly: The Elements Massage brand believes massage therapists deserve a supportive team, business and marketing resources, linens, lotions, and the chance to learn as much as they want. So many Elements Massage studios offer continuing education too. What's better, they're hiring. To get your foot in the door, let them know we sent you by visiting elementsmassage.com/abmp. That's elementsmassage.com/abmp.

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0:00:41.4 Darren Buford: I'm Darren Buford.

0:00:42.5 KC: And I'm Kristin Coverly.

0:00:43.7 DB: And welcome to the ABMP podcast, a podcast where we speak with a massage and bodywork profession. Our guest today is Dr. Ellen Vora. Dr. Vora attended Columbia University for medical school and received her BA in English from Yale University. She's a board-certified psychiatrist, acupuncturist and yoga teacher. Dr. Vora takes a functional medicine approach to mental health, considering the whole person, and addressing the problem at the root, rather than reflexively prescribing medication to suppress symptoms. Dr. Vora focuses on everything from physical health, sleep, nutrition, digestion, thought patterns, relationships and community to our connection with nature and creativity, and the ways we find meaning in life. For more information, visit ellenvora.com. Listeners, sometimes on the ABMP podcast, we like to veer slightly askew of talking about massage and bodywork into the realm of simply being human. And what's more important in being human than talking about today's topic, sleep? The importance of it, how we get more of it, and the dos and don'ts of optimizing our health. And with that, hello, Dr. Vora, hello, Kristin.

0:01:56.9 Ellen Vora: Hi, Darren and Kristin. Thanks for having me today.

0:01:58.4 KC: Thank you so much for being here. We are really excited to talk to you about this, because 99.9% of the population and our listeners need help with our sleep patterns. So we're very grateful that you're here. Let's jump right in. We've all heard so many different bits and pieces and nuggets from news stories and different sources about why sleep is so important. But let's hear from the expert. Can you please tell us why is sleep so important?

0:02:25.6 EV: Yeah. And that's definitely... That is science, that what you quoted there, the 99.9%. That is the official statistic. [chuckle]

0:02:33.2 KC: Hey. Good guess on my part.

0:02:34.6 DB: Nice. Doing that research in the background.

0:02:36.7 EV: Some weirdo out there is like, Sleep? No problem. The rest of us, some problem. So why is sleep important? I'm gonna do a little tap dance for a little while, and tell you a lot of the science that we do have about why it's important. But the real takeaway here is, part of it is we are a black box we don't fully understand. We do know that we do it, in spite of the fact that it's very radically maladaptive to be unconscious, vulnerable, lying down in the dark at night while our predators circle around on the proverbial savanna of evolution. And yet, it is required. We would die if we didn't sleep. We would get infections and non-healing ulcers. And so there must be some good reason. What we know, some of the things that we do now, there's memory consolidation that occurs while we sleep. It's really when our immune system does most of its work, so that's when we fight off infections and even nascent cancers and different things that don't belong in our bodies get handled while we sleep, muscle repair, all of that.

0:03:36.0 EV: One thing that I find particularly fascinating is the glymphatic system, and you guys as massage therapists, know about the lymphatic system, and you're helping all of us kind of move that slodgy-ness, that inherent passive fluid around our bodies. But that we have that in our brains as well. And that was not really appreciated until relatively recently. And the glymphatic system basically comes online while we sleep. So we're not detoxifying our brain during our waking hours. Our ability to detoxify your brain is also compromised when we're under stress. But basically, it's... I think of it like the garbage trucks that go through the brain. And if the brain is like this little city with lots of commerce and restaurants and shops and houses, at the end of every day, we put out these trash bags into the alleyways of the brain, and we're like, here's the residue from the activities of today. And then only at night while we're asleep, the garbage trucks go around these alleyways of the brain, clear out the trash bags, and then the next morning, we start the day fresh city with alleyways that are not piled up with trash. And if we don't sleep, you can feel it. After a bad night of sleep, we're walking around, trying to think and have patience and be kind, but our brain is covered in trash bags, and it makes it difficult to do all of that. So to me, that's one of the most compelling reasons that we sleep.

0:05:01.5 DB: So, Ellen, how much sleep is important?

0:05:06.3 EV: As in how much sleep do we need?

0:05:08.1 DB: Yes.

0:05:09.4 EV: So controversial, but what we seem to know, it will vary, based on the kinds of demands our bodies are under. If we are fighting an infection, if we just did intense exercise, if we're coming off of a long stretch of sleep debt. And it will vary by individual. We have different chronotypes, we have different sleep needs. I once heard it described as a sleep shoe size, and I really love that analogy. It's like you have your shoe size. You might be a seven, you might be a nine. And if you are a size nine, sleep shoe size, and you walk around all day, every day in a size seven, it hurts. And that's what I think many of us do. So a big part of my approach to sleep is to identify those people in the world who are sleep size nine, and just give them the encouragement. Own it. Know it. Don't resist it. Take that precious sleep that you need. Don't walk around all day in shoes that are two sizes too small.

0:06:07.8 EV: But basically, it seems to be a bell curve distribution where about 95% of the population needs between seven hours and nine hours of sleep, with most hitting around eight hours of sleep. And you don't just get to choose. It's not a menu at a restaurant, you're like, I'll have the seven hours 'cause that sounds more fun, you get more out of life. You don't get to choose. It's who you are. You can kind of see tracings of it throughout your family. And you just have to kinda know what your sleep shoe size is, and then protect that fiercely and unapologetically. There are very few people in the population who do need more than nine hours of sleep or less than seven. It's not as many people as I know who get less than seven hours of sleep a night, so.

0:06:51.9 EV: Very few people actually fit in that category. And you'll sometimes hear people talking about such a thing as too much sleep, and I think that that is a complicated concept. But basically, I'm more inclined to shame our culture than shame our bodies. If our bodies seem to want more than nine hours of sleep, or let's call it too much sleep. Sometimes even people would say nine hours is too much. If our bodies seem to want more sleep than other people, first, just ask yourself, "Is this just the right amount of sleep for my body?" And then there's no shame in it. And maybe our culture is obsessed with productivity, but we don't need to buy into that whole worldview. And then sometimes the need for excessive sleep is really just a marker of our body dealing with something. It's a marker of an underlying process. So maybe you have COVID long haul symptoms. Maybe you have chronic Lyme or chronic Epstein-Barr virus. Maybe you're on a medication, like certain psychiatric medications that give your body a need for extra sleep. Maybe you have sleep apnea and not much of your sleep is actually good quality sleep.

0:07:55.5 EV: So there's a lot of different ways to think about it. Maybe you have hypothyroidism. So when somebody needs more than nine hours of sleep, I'm not here to say that person is wrong, and it's bad for you to sleep that much, give your body the sleep it's asking for, but open up the inquiry. Start to look under the hood and investigate why is your body needing excess sleep.

0:08:15.5 DB: Just a quick follow-up on that. Is there any way I should feel or know that I've hit my optimal sleep number?

0:08:21.1 EV: I love that question. Rested. [chuckle] And I don't know, I can't... I'm not a morning bird. So I've never really known the feeling of you wake up and you're just like... Like, "What should I do today?" There's always that feeling of, "The bed feels so good and so comfortable, and I would like to stay here another five, six, seven hours." But I think it's basically once you get your engine started and you start to go through your day, you wanna feel rested, you wanna feel clear. You don't wanna find yourself falling asleep any time you're sitting down doing something boring or driving. And you kinda want it to be a rhythm that runs in kind of a maintenance mode way, like you get tired at an appropriate time at night, you fall asleep easily, you sleep deeply through the night, you wake up at a regular time, and even if it's cozy in your bed, you're like, "Yeah, I can do this. It doesn't hurt to get up and start my day." And then you're feeling rested and kind of activated and energized during the day.

0:09:24.1 KC: And I'm gonna jump in and ask, I've never had the ability to nap myself, but I know listeners who are nappers are already starting to do the math in their heads, and they're wondering if they can add nighttime sleep with nap sleep to get their ultimate... And I love how you said sleep shoe size. So if they can meet their sleep shoe size with those two numbers, or does it... Are we really talking just overnight sleep here?

0:09:47.5 EV: Yeah. So napping. Shockingly controversial. Here's my hot take on it. I think that there's nothing inherently wrong with napping. I think that you need kind of a lifestyle that can support it if you wanna count on it as filling out your sleep needs in the long-term. I think the occasional, like you had a bad night of sleep 'cause you were up with a teething infant and you need a nap the next day, if you can manage to get a nap the next day, is fine. But if you're looking to patch together enough sleep by having a daily nap, then you need a daily life that will allow you to have that nap. Otherwise it's gonna be helter skelter, and some days you're gonna get what you need, and some days you're not. It seems to be, in our society, a little bit easier to consistently block out enough hours over night to get the sleep we need. But I'm not opposed to naps. And I think that if you wanna keep it beneficial, you wanna push it generally a little earlier in the day. It's more of an early afternoon timing, and keep it a little shorter, like 20 minutes, 30 minutes, maybe an hour. But once you're taking a two hour nap at 4:00 PM, we all know that feeling, you wake up, you feel kinda hot and super groggy, and you're just like, "What happened?" And your body basically thought it went to sleep for the night and then woke up two hours later, and it just screws with our circadian rhythm.

0:11:03.9 DB: Let's take a short break to hear a word from our sponsors.

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0:11:41.3 DB: Now, let's get back to the podcast.

0:11:43.9 DB: Dr. Vora, let's talk some no-nos, or don'ts for today. What are some things to absolutely avoid when setting ourself up for success in getting a better nights sleep?

0:11:56.4 EV: I'm a realist who's out here in the world working with real people, so I'll never say 100% no to anything. I'm a sleep specialist, and I do all of these no-nos. So in real life, sometimes we have to do them. But I do think a big one that's under-appreciated is just the role that blue spectrum light plays in regulating our circadian rhythm. So what I mean by that is basically fire, moonlight isn't gonna do too much to disrupt our circadian rhythm. We evolved seeing that after sunset. But on the proverbial Savannah of evolution, the sun set and it was dark, and that's what cued our whole sleep-wake cycle. And that's the design. We can't really mess with that. It would take us another couple million years to change the design. So we're living in an awkward growth phase right now where we still have that design in our genes, but we have a phone, and it has TikTok on it and Netflix.

0:12:48.1 EV: So we have a problem. And so basically, after sunset, when we're bathing our eyes in blue spectrum light from our phones and our TVs and our computers and the overhead lighting, it's really confusing our circadian rhythm, which is constantly scanning the landscape and looking for light cues to understand what time of day it is. And basically all it knows is darkness means nighttime means melatonin means get tired. And these days, we're looking at our phones, so we never experience darkness, so we don't get that hit of melatonin and get sleepy, and it messes up the whole system. So the no-no is basically, if you're struggling with sleep and you wanna fall asleep, so you're lying in bed scanning social media, you're making it pretty tough for your brain to figure out, "Okay, it's time to get sleepy."

0:13:32.9 EV: Other no-nos, I'll say two tiny ones. One is a late bedtime. And this one is kinda hippy-dippy, but our body seems to be optimized for being in sync with the Sun and the Moon. And when you look at the remaining hunter-gatherer societies on Earth, they tend to go to bed at a consistent bedtime around three hours after sunset. So that will vary geographically, by the time of year, but more or less, you wanna look for your body's tired signs. When you're yawning, rubbing your eyes, right around three hours after sunset, and if you catch that window, that sweet spot when you're perfectly tired, it'll make it easy to fall asleep and stay asleep. And if you push past that window, which most of us have a habit of doing, then you get what's called over-tired. Your body releases the stress hormone cortisol, and you suddenly feel tired but wired. You get that second wind feeling. You feel a little warm, you wanna suddenly go down an internet rabbit hole or clean the kitchen for an hour, and it makes it really hard to fall asleep and stay asleep. So just pushing for a slightly earlier bedtime can go a long way.

0:14:33.8 EV: And the last no-no that nobody wants to talk about is the role of alcohol and caffeine in sleep. That's all I say. Never mind. That's it.

[laughter]

0:14:43.4 DB: What? Oh, no, we're not done with that yet. We're coming back to that.

[laughter]

0:14:49.0 KC: So those were some great don'ts. Let's focus now on some dos. How can we really set ourselves up for success and a great night's sleep?

0:14:57.4 EV: Yeah, okay. So I really like the role of the morning in how well we're gonna sleep at night. Ideally, we're waking up at a consistent time. Ideally, it's somewhat early. Early meaning prior to 7:00, 7:30 AM It's not always realistic, but that's generally a good phase to be waking up. And then you wanna get sunshine into your eyeballs first thing in the morning. So you open your shade, and if you possibly can, you get outside. And if that's just part of your life and your commute, it's built-in, do it, try not to wear sunglasses. If it's not part of your life, if you're working from home these days, then actually build it into your life. And you can make it very minimal. This doesn't have to be a 45-minute walk through the neighborhood. You really just need to get outside. You can stand on your front stoop in pajamas. You can take one single loop around the block, but get the sunshine into your eyeballs. That starts our circadian rhythm. It's almost like starts a clock that ticks throughout the day and helps you get tired at night.

0:15:55.3 EV: One other do that has helped a lot of my patients is to supplement with magnesium glycinate at bedtime. It's basically this very affordable, very safe supplement that is replacing something we're missing. Most of us are deficient in magnesium. That's because our food is deficient, it's because our soil is deficient. So if you're living in Sicily right now and eating tomatoes grown in soil that is nourished by a volcano, then you're probably good on magnesium. But if you're relying on the anemic agrobusiness of the United States, then you probably would benefit from supplementing with magnesium glycinate. Most people start around 100 milligrams at bedtime. You can keep going up to about 600, even 700 or 800. You'll know that you're taking too much if you get loose stool, so then dial it back down. If you don't wanna take a pill, you can have an Epsom salt bath, and that's another great way to absorb magnesium.

0:16:45.4 EV: And one other really good do is to manage your blood sugar overnight. So we all know that experience of feeling hangry when you're hungry, angry and picking a fight with your partner, if that's familiar to anybody. So basically, we are going a long stretch of not eating overnight. So if we are known for being dysglycemic or having swings in our blood sugar during the day, you better believe it's also happening overnight. And sometimes that's the cause of waking up in the middle of the night. So if you're waking up at 3:00 AM and you feel sort of edgy, racing thoughts, anxious, uncomfortable, it's probably blood sugar, and a great way to diagnose and treat that all at the same time is to just take something like a spoonful of almond butter or coconut oil right before bed. Keeps your blood sugar... Gives it a steady safety net that'll buffer any blood sugar crashes overnight.

0:17:37.7 DB: What about temperature? I hear a lot of people talking about optimal temperatures to sleep.

0:17:43.9 EV: Yeah. So this also goes back to our hard wiring and the evolutionary conditions. But basically, when the Sun sets, a little while after that, the temperature drops. Sometimes the Sun was warming us, and then there's a little bit of infrared heat that the Earth traps, that's then released from the Earth. I'm getting very high tech here. Not even sure if these details are correct. I think I learned this in eighth grade. But basically, it's then releasing some amount of heat, and so we're still a little warm for a little while after the Sun sets. But then there's this precipitous drop in temperature. And that has cued our bodies, it is time to curl up under your woolly mammoth blanket next to your partner and go to sleep. And so it helps our bodies to have that drop in temperature, helps cue our circadian rhythm, helps us get tired.

0:18:28.1 EV: And so the studies say humans sleep optionally around 65 degrees Fahrenheit, which is pretty chilly. And honestly, I'll give you a pass if you wanna sleep to 67, 68. I think that's fine, but... And it doesn't mean you need to be shivering. You basically want to be in a cold room, but have some kind of cozy set up. So you have a warm blanket, but the room around you is cold. If you can achieve that through an open window, I feel like that's bonus points, because then it's free and environmentally friendly, and there's benefits to breathing fresh air overnight. If that's not possible or if it's like Summer in Mississippi, then a little bit of air conditioning can be helpful. I think that there's a lot of nice products these days, like the Chilipad and Eight Sleep, and all these different cooling pads that can cool down your bed, which is sometimes a really nice direct way to create that cool setting for sleep.

0:19:18.3 DB: So, Ellen, if we could put together kind of a complete pre-bedtime routine, is that something we should do to maximize our sleep effort? And what does that look like? What does that look like shutting down, getting ready for bed? Does that mean... What order of things or what things to do?

0:19:37.0 EV: Yeah. So I'm gonna contradict myself right now. On one level, I hate giving people routines. When someone tells me, "Here's a good idea for a morning routine," I'm like, "Hahaha."

0:19:46.7 EV: That's not what my life looks like in the morning. So if this just is gonna add to somebody's stress and overwhelm, don't worry about it. Just figure out a way to get yourself in bed consistently. But if you want steps to help kind of wind yourself down, here's a good way to think about it. You wanna set almost like a bedtime alarm around 8:30 or 9:00 PM. Something not too jarring that can go off on your phone, that can just tell you, "Hey, now would be a really nice time to power down electronics and start your winding down process." And then, if this involves a shower, if it involves essential oils, kind of whatever floats your boat. Take your magnesium at this point, take your almond butter spoon, brush your teeth, floss. That's a separate conversation, but we should all hold each other accountable. We should all be flossing.

0:20:32.7 EV: And then what I think is actually an underappreciated thing to do would be, first of all, definitely do not bring your phone into your bedroom. So you set up your charger in some other area of your home, and then pretty close after your bedtime alarm, you're gonna kiss your phone goodnight. "Phone, I love you. I'm gonna miss you." And you put it away, and then you don't even think about it or look at it again. No doom scrolling close to bed, no getting sucked into the endless scroll where there's no natural stopping point. It's designed to hook us in, we're the attention economy. So brilliant people have realized that if they design their apps in this way, we'll never say to ourselves, "I got to the end of TikTok, so now I should go to sleep." No, it's not how it works. We'll scroll endlessly, and we'll never get tired.

0:21:16.3 EV: But I think that just writing down those things that we're juggling in our minds, can be really helpful. A lot of us hit the pillow, and then our brain is suddenly like, "Oh God. I just remembered. I have to respond to that text message that got buried in my text messages. And I have to remember to schedule this doctor's appointment." And so we're like, "Okay. So I'll just lie here for the next eight hours, juggling these balls, so that I'll remember them in the morning." And then it's really hard to fall asleep. So a simple pad of paper and a pencil, cut your losses, turn down your bedside lamp, and just jot it down. In that way, your brain recognizes it has been effectively outsourced onto the piece of paper, and it doesn't need to keep juggling these balls overnight, and then your brain can calm down. So that's a nice part to add into your bedtime routine.

0:22:02.0 KC: What about eating before bed? Is there a certain cutoff for a large meal or sort of a big snack, number of hours before we're aiming at our bedtime goal?

0:22:11.2 EV: Yeah. Let's say, do as I say, not as I do. I think that there definitely are advantages to pushing dinner a little bit earlier. That gives your body a decent amount of time to digest. If you can have a 20-minute walk after dinner, there's studies that show that that helps us with insulin sensitivity, really just helps with our... They call it a constitutional. It helps at a better digestion to have that kind of motion. But I think some people... We're all little different in terms of how we've trained our body's management of metabolism, and whether it's fueling... Or based on glucose or based on ketones. And I think that we're all a little bit different. In my practice, what I've noticed is that I have a lot of men who have really benefited from intermittent fasting. And it doesn't have to be so aggressive, it can really just be circadian fasting, meaning, generally wanna be eating between the hours of, call it, maybe 7:00 AM to 7:00 PM or 8:00 AM to 8:00 PM, and not snacking after that. I have women, post-menopausal women, who also do really well with this formula.

0:23:16.6 EV: When it comes to women of reproductive age in my practice, this is full of caveats. And I have some women in my practice, of reproductive age, who've really committed to intermittent fasting or have committed to a keto diet, and they're doing really well with this. They're in a good rhythm, and they can eat earlier and not snack, and they do great. I have a lot of women of reproductive age, whose bodies, when they start to feel that intermittent fasting kind of scarcity creep in on their eating habits, or if they're just not doing it with enough healthy fats or enough carbohydrate or enough calories in general, then I see their sleep actually suffer, and they start to have worsening anxiety, their cycles can get disregulated. So for women of reproductive age, you wanna be pretty careful around this, and just really listen to your body and see what works for you.

0:24:07.9 DB: Alright. You knew I wasn't gonna let you off the hook here. We're gonna have to circle back around to alcohol. [chuckle] Is it okay to have a nightcap or a hot toddy or to drink alcohol before bed? Is that a bad idea?

0:24:21.5 EV: Yes. It's a bad idea. I think the trouble with alcohol is that... Recognize that my overarching health philosophy here, is that I like to arm people with the knowledge of, here's how to physiologically set our bodies up to be optimal. So, you have that knowledge. And then real life happens, and you make decisions according to, in any given moment, what is the choice that is a radical act of self-love? What is the choice that creates your most fulfilling life? So a lot of times, it's gonna be, Don't drink alcohol at night. Don't drink alcohol at all. The evidence is in. The evidence is not funded by the wine and spirits industry. That industry has funded a lot of evidence that tells us five ounces of red wine is heart healthy and blah, blah, blah. No. It all increases mortality. It shortens our lifespan, it shortens our health span. It's carcinogenic. It promotes dementia, promotes heart disease. Alcohol is not actually healthy in any amounts, and we need to start talking about that publicly. But a fulfilling life, connecting with friends, having a sense of ritual, all of that can be beneficial to life. And we have the studies from the Blue Zones where people that have their little nightcap or they have their cocktail at sunset with their friends while they're playing, I don't know, checkers, they're living longer than the rest of us. So sometimes, it works for you.

0:25:42.6 EV: So it's a delicate balance, but basically, the substance itself, alcohol, not all that beneficial. But sometimes, it might be the right choice if it's truly adding to a fulfilling life for you. But it does impact sleep quality. It changes sleep architecture. It causes a rush of something called GABA in our synapses, which the brain then converts to something called glutamate, which is excitatory, and that's why the second half of the night is always such crummy sleep after we drink, because our brain is like, "Arrggh." Now, it's full of glutamate, and we're having a blood sugar crash related to the alcohol, and we just feel lousy and we don't sleep deeply. And so that's the skinny on alcohol. I'm sorry.

0:26:22.3 DB: Another controversial topic, caffeine.

0:26:25.7 EV: Yeah. So caffeine is less of a one zero. It's not an inherently bad substance. It's not inherently shortening our lifespan or causing cancer or anything like that, but we're all really different in how we metabolize caffeine. So one person can have their digestive espresso after a large Italian meal and go to sleep, no problem, and that must be fun to have that life. Must be nice. Some people are like me, and if I had a coffee last week, I'm not sleeping tonight. So we're all different. Some of us are rapid metabolizers, some of us are slow metabolizers. If you're sensitive to caffeine, it's kind of like being a size nine shoe size, just own it, start being realistic and honest with yourself about it, and just start to chip back at it. We think of caffeine as our one true friend in the world. The ritual, the smell, the taste, we love it, but part of the reason it feels so awesome is that it is the antidote to its own withdrawal, so just recognize that's why it's awesome. And it's creating a problem and then it's solving it. And we're like, "Yay, you're the hero!", but it's like, Is it? It caused the problem in the first place.

0:27:32.5 EV: So I think that if you know that caffeine isn't actually serving you, maybe it's impacting your sleep quality, maybe it's causing anxiety, you just wanna slowly gradually reduce the overall amount you're drinking and pushing a little bit earlier in the day, 'cause caffeine is something with a long half-life, so we metabolize it slowly over the course of about five or six hours. And so, if you drink a coffee at 8:00 AM, there's some caffeine buzzing around your brain while you're sleeping at night, but not a whole lot. But if you have that coffee at 3:00 PM, significantly more caffeine will be buzzing around your brain overnight.

0:28:05.4 KC: Okay. Now we're gonna get into some competitive sleep talk. I am very jealous of the people who can just sleep through the night and never wake up. I am not that person, I wake up a couple of times a night. How bad is that? Talk to us about that, please.

0:28:20.8 EV: I'm also jealous of that. So let's first normalize middle sleep. So middle sleep, basically, there's been interesting research into this, not perfect research, but interesting. And basically, what we understand is that, for many of us, what's normal is to have two separate blocks of consolidated sleep. So if you're an eight-hour a night shoe size, you might have two blocks of four hours, which means say... Okay, this is gonna be a lot of math on the fly. Let's say you go to bed at ten, so then you're waking up at two in the morning. So then around 2:00 AM, your body is waking up, and you're like, "Oh, I'm awake. Oh, I have to pee." And sometimes we think we woke up because we had to pee. Nah, we kinda had to pee the whole night. We woke up and then we were aware of our full bladder.

0:29:07.8 EV: So then we go pee. And then, what happens next, I think is what's most important. We can tell ourselves, this is middle sleep, this is normal physiologic break between two consolidated chunks of sleep, I'm going to lie here and meditate or do a breathing exercise or rest or read poetry by candlelight, or try to cuddle my partner for five, 10, 15, 60 minutes, and then I will fall asleep, no drama, no big deal, I will still go on to have a good day tomorrow. Or we can be like, "Oh no, I'm up. It's 2:00 AM. Let me look at my phone. Oh my God, look at what's wrong in the world, look at what they're talking about in the comment section of Instagram. Oh no." And now I'm not gonna sleep and I'm gonna have a terrible night of sleep, and I'm gonna have a terrible day tomorrow. And all of that gets us into this mindset that's not exactly conducive to falling back asleep. And then, of course, the phone disrupts our circadian rhythm. So we create big problems for ourselves in our attitude and our framing of what that middle-of-the-night wake up means.

0:30:04.5 EV: So I too would love to sleep all the way through the night. At this point, as a woman in my early 40s, and hormones are starting to do interesting and different things, I think it's just a thing of the past. But overall, I think that you just want to normalize, be okay with it, don't add a degree of drama, and if you're really waking up throughout the night, start to look at the role of blood sugar, caffeine, alcohol and stress. And that spoonful of almond butter might make the difference. Pushing out caffeine a little bit earlier in the day might make a difference. Reducing, eliminating, throwing all alcohol out the window might make the difference. And then, the more you can manage stress during the day will help the body not be in a state of cortisol overnight. And one more is, going to bed earlier can also make the difference.

0:30:49.1 DB: I wanna thank our guest today, Dr. Ellen Vora. To find out more information about her and the work that she does, visit ellenvora.com. Thanks, Ellen, and thanks, Kristen.

0:30:58.7 EV: Thank you guys both so much.

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