Manage episode 273862798 series 1333691
Dr. Jose Colon discusses How to Improve Sleep Hygiene with Dr. Ben Weitz.
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1:59 We are seeing more sleep problems due to the coronavirus pandemic. People are losing sleep because of stress, being sedentary, and because of their economic situation. Working from home makes it harder to turn your brain off.
8:23 While you may not be able to control if you work from home or not, you should start with the things you can control. Keep to a regular sleep and wake schedule and don’t work in your bedroom. Your bedroom should be only for sleep and sex. Do some form of regular exercise.
11:31 How to analyse sleep. There are formal sleep studies. There are sleep logs that you can download from the National Sleep Foundation or the American Academy of Sleep Medicine. There’s sleep tracking with devices like Fitbit and the Oura Ring. Dr. Colon is most familiar with the Fitbit. It’s not monitoring brain activity directly but it tracks heart rate and movement, which are surrogate markers for sleep. It works best with women in the 30-50 years of age range and not as well for teens or for seniors.
17:44 Ideal sleep pattern. When you go into the first stage of sleep, your brain slows down and your heart rate slows. Throughout the night you cycle first into a deep slow wave sleep and then every 90 minutes into REM sleep. During deep sleep is where your lymphatic (glymphatic) system washes away toxins from the brain. This is also when you release growth hormone and it is the most restorative form of sleep. During REM sleep (rapid eye movement) your brain is quite active and the heart rate is almost as high as when you are awake.
20:20 When we do yoga breathing or mindfulness meditation, when you become aware of your breath, you’re slowing your respiratory rate down and calming your heart, which sends signals to your brain to calm.
22:59 Nobody sleeps through the night without some minor awakenings. The awakenings typically happen in the second half of the night. If you’re waking up a lot in the first two hours of sleep, that may be a sign of a sleep disorder, such as a periodic limb movement disorder or obstructive sleep apnea.
24:50 The benefits of REM sleep are that you are consolidating memories and it is also when you’re secreting testosterone. Memory issues can be an indication of not getting enough sleep. If you stop breathing during REM sleep, that can cause cortical arousals. This indicates sleep apnea and this can be corrected with a CPAP machine that opens your airways while you sleep. Untreated sleep apnea is a cardiovascular risk factor. A CPAP machine is the most common treatment for sleep apnea, but losing weight can sometimes correct the problem. There are also dental devices that advance the jaw forward to open the airway.
Dr. Jose Colon is an Integrative Medical Doctor who is board certified in sleep medicine and neurology. He teaches for the Institute of Functional Medicine and he is the author of books for women’s sleep, sleep and mindfulness in children, and infant sleep. He is the founder of Paradise Sleep, an organization dedicated to the education of sleep and wellness. He works at Lee Health in Fort Myers, Florida and his website is ParadiseSleep.com
Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com. Phone or video consulting with Dr. Weitz is available.
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast. Hello Rational Wellness podcasters. Thank you so much for joining me again today.
Today our topic is sleep, and, in fact, we’re going to also consider sleep during the pandemic. We’re here with sleep expert, Dr. Jose Colon. Dr. Colon, is that the right way to pronounce your name? Is it Colon or Colon?
Dr. Colon: Colon.
Dr. Weitz: Colon. Thank you. Perhaps you can introduce yourself and tell us a little bit about your background.
Dr. Colon: Thanks for having me, Dr. Jose Colon. I am a sleep disorder specialist, board certified in sleep medicine. I’m also board certified in neurology with special qualifications in child neurology. I’m triple board certified in lifestyle medicine as well through the American Board of Lifestyle Medicine. I’m also certified through the Institute of Functional Medicine, Certified Practitioner. I incorporate all of these aspects with my patients to help improve wellness.
Dr. Weitz: That’s great. We want to talk about sleep in general and get some updates on some of the latest concepts about how to analyze sleep, the importance of sleep and what to do about it. Maybe you want to talk about some of the sleep problems people are having right now since we’re still in the midst of this COVID-19 Coronavirus pandemic in the United States, in fact, around the world.
Dr. Colon: I opened up by saying thanks for having me, but actually thanks for having me back. We did talk for quite a bit about sleep and sleep disorders, but you’re right, things have changed now with this COVID-19 pandemic. There are some things that we are seeing right now and then there’s things that we’re going to see down the road. Some things that we’re seeing right now is we are seeing a lot of insomnia. We are seeing a lot of people losing sleep. The reason for that is threefold, actually. One is stress. The other is the sedentary effect that quarantine causes and then the other, station, where you’re at. You talk about all three. Stress and sleep, they’re not compatible.
Dr. Weitz: But some of this stress is not easy to deal with.
Dr. Colon: It’s not.
Dr. Weitz: If you’re out of work or you’re making less or you have your own business and your business has been affected or maybe it shut down or partially shut down or you’re worried about getting sick or you’re worried about your kids going to school or you’re having to deal with working from home, now maybe you’ve found out you’re going to be working at home for the next year. Your kids are at home too, and you’re trying to deal with all that. They’re going to school online. A lot of these are things that are real that you can’t change.
Dr. Colon: If you look at the classic model of insomnia, you have predisposing factors, you have triggering factors and you have perpetuating factors as well, kind of like we do in functional medicine. It’s pretty classic that insomnia, there’s some type of precipitating event, something that is life-altering or life-changing, something that causes some threat that causes insomnia. Threat doesn’t always mean that a lion is going to eat you or … You just mentioned a bunch of threats. Beyond the threat of getting sick, there is the threat of having less work. There is the threat of just everything that you had mentioned there. The sleep and the stress, that’s something that’s causing some more insomnia. The other thing that I mentioned is sedentary. During a bit, we were really encouraged not to leave the house and gyms were closed.
Dr. Weitz: Where we are in Southern California, gyms are still closed. For the most part, the tech industry is all working from home. For the most part, people are staying at home, even now.
Dr. Colon: Exercise is something that’s really very well-known to help with sleep, and, in particular, exercising 150 minutes per week. Not at one time, 150 minutes per week. I have to clarify that because I once said 150 minutes and people were like, “Oh wow, at once.” No, no, no. 150 minutes per week improves sleep quality and the depth of sleep. When we’re sedentary, we’re not getting that exercise, we’re not having the same amount of sleep drive in the evening. Luckily, our gyms have been able to be open to partial capacity. It’s funny, when they closed the gyms, I did go to the Play It Again Sports, the youth sports and trying to get gym equipment. It was all gone.
Dr. Weitz: Oh no. Same thing here. Very, very difficult to get dumbbells and plates and things like that. They’re charging five times what the normal price is supposed to be.
Dr. Colon: You know what I did, I went to Lowe’s and I bought a rope. I took that rope and hung it over my oak tree. I was doing the TRX bands, the TRX bands, just doing some pull-ups, turning around, push-ups, trying to get biceps in. Sedentary lifestyle does lead to difficulty sleeping as well. Then the last thing that I mentioned was station, where you’re stationed at. The more time that you spend at home, the harder it is to turn your brain off. The more that you’re working from home, the more work thoughts come into your daytime. The word dormitory, Latin root dorm is dorme. In Spanish, dorme means to sleep. The word dormitory refers to you go out and about your day and then you come to this place where you live at night to sleep. You have that association with sleep. Now, we’re working from home, we’re doing stuff at home. The amount of time that we’re spending there, what happens? You can’t shut the brain down.
Dr. Weitz: The problem is this may be permanent for a lot of people. I heard Michael Dell on TV this morning. He was saying how a lot of these companies realize that all these employees who are working from home, they’re doing fine, and it’s great for the companies because they can pay for less office space. These tech companies not only have massive amounts of office space, but they pay for lunch and meals and coffee and all these other things for their employees. Now that they’re working from home, these companies are going to be saving tons of money, and this is going to become permanent for a lot of people.
Dr. Colon: It can. Taking a look at those three things, there are some things that are not in our control, but what are things that are in our control. Start with station, with where you’re at. Do everything that you can to keep regular sleep/wake schedules, and do whatever you can to when you work, try not to work in the bedroom. If you can go out to your porch, do it. If you need to go to the kitchen table, do it. If you have a separate office, but that may be a luxury for some people, but if you have that-
Dr. Weitz: But if possible, if you could have a designated area where you go, “When I go over here, this is work. When I leave there, I don’t do work anymore.”
Dr. Colon: That’s basic sleep hygiene rules. They talk about the bed, try to use the bed for sleep and sex only. The more stuff that you do in your bedroom, the more ruminating thoughts that you’re going to have at the time that you go to sleep. You just lose the association with sleep. That’s one thing that you could do. Another, again, as I mentioned, exercise. Do what you can to incorporate some type of exercise. I couldn’t go to the gym for a period of time. As I said, I bought a rope and I worked out from the tree. I did more running at the time than I normally did. Just find something else that you can do exercise-wise to replace.
Dr. Weitz: By the way, Peloton Company is booming because that’s one alternative for exercising at home.
Dr. Colon: What was that?
Dr. Weitz: Peloton, that company is doing gangbusters. Basically you pay, I don’t know what it is, 30, $50 a month, and you get a bike or a treadmill and they have these videotape workouts and there’s other kinds of workouts that you can do.
Dr. Colon: I’ve known some people who were doing that beforehand and then they reached out to healthcare professionals, “Hey, you could log on.” Everything’s a business as a capitalist. It’s something that you can do, absolutely. Stress, of course, is do some type of practice of stress release: meditation, mindfulness. Those are my preferences. I’m certified in hypnosis as well. I work with patients in that. I use it myself as well.
Dr. Weitz: Can you hypnotize yourself?
Dr. Colon: All hypnosis is self-hypnosis. I cannot control anybody’s mind. I can guide a patient on how to enter into deeper stages of relaxation, into trance. Yes, all hypnosis is self-hypnosis.
Dr. Weitz: Interesting. I didn’t know that.
Dr. Colon: Glad we can contribute.
Dr. Weitz: How do we analyze sleep?
Dr. Colon: Analyzing sleep can be done in different ways. There’s formal sleep studies that you can get that take a look at one night. There are sleep logs that you can download from National Sleep Foundation or American Academy of Sleep Medicine. You can log wake times and sleep time. Then there’s also sleep tracking.
Dr. Weitz: What about all these devices and apps that a lot of people use?
Dr. Colon: The sleep trackers, I really like them. A lot of medical professionals say, no, don’t do that or go throw it away or don’t use it. I like it. I have one myself.
Dr. Weitz: Which ones do you think are the two or three best ones out there?
Dr. Colon: What I am most familiar with is Fitbit. I’m most familiar with it for two reasons. Number one, they started it, and then I had so many patients come in with their Fitbit and asking me what it is that they’re seeing, so I got one myself to be able to track my sleep to see what the hell it was about. Number one, they’ve been around and I’m familiar with it because I personally use the Fitbit. Number two, Fitbit actually has some pretty good data. They presented this data during a technology webinar through the American Academy of Sleep Medicine, and I was very impressed with their data. That said, the Fitbit gives you a surrogate marker for sleep. It’s not monitoring your brain activity. It does monitor movement and it does monitor heart rate. They have certain algorithms, that based on that, they’re able to track certain sleep. I’ve found it to be pretty accurate at times. The data says it’s 70% accurate. There’s times that I wake up from a dream and I look and I’m like, “Yup, I was in REM sleep.” I get called by the emergency room in the middle of the night and, yes, I see it, I see what stage of sleep I was in before that and then that I was woken up. The one thing to know about the sleep tracker is that the data, data is not one size fits all. When I do a sleep study on someone, I’m taking account heart rate norms, if they’re pediatric, if they’re geriatric. The norms are all different from person to person. Fitbit and all of the sleep trackers have universal data though. That data, those surrogate markers are derived based on who their purchaser is. Their main purchaser are women of middle age, so from 30 to 50 years of age. That’s where the Fitbit gives you the best, most accurate data. It’s important to know because in a pediatric patient and in a teen, the heart rate is higher. I’ve seen a lot of parents put a Fitbit on a kid, bring the kid in and say, “His sleep is horrible. He’s waking up a lot. He’s never getting into the deep …” It’s because his heart rate is higher and this data was derived based on a different population.
Dr. Weitz: How about the Oura Ring? Is that more direct data or is that similar to the Fitbit. The Oura Ring seems to have a higher level of detail.
Dr. Colon: I’ve heard a lot about the Oura Ring. I’m not familiar with it because I don’t have one personally, and I haven’t seen them produce any medical literature data. I think that there’s probably value to it. I’ve seen many people bring many different types of trackers. I’m able to go through it, and I know what I’m looking at. I’m trying to look for sleep cycles, and I make sense of it. The Fitbit is the one that I’m most familiar with, and I favor that one, but all of these devices have some degree of value to them, and remembering that they’re surrogate markers of sleep, not necessarily a direct measurement of sleep.
Dr. Weitz: Basically, my understanding, and maybe you can correct me on this, is the main things you get out of one of these devices is: A, the amount of sleep you get, how many times you wake up, and then to what extent you get into REM and/or deep sleep cycles, correct?
Dr. Colon: Yeah. The data that you get is your heart rate throughout the night, and that heart rate and movement throughout the night extrapolates into everything that you just said.
Dr. Weitz: Is that the way the Oura Ring works too? It’s all based on heart rate?
Dr. Colon: I’m not exactly sure because I don’t have an Oura Ring, but I don’t see how else it would work because it’s not connected to your forehead, it’s not connected to your brain activity. There’s no other way that I can see that it works.
Dr. Weitz: All based on heart rate. Your heart rate gets higher or lower when you’re in REM sleep versus deep sleep versus the other stages of sleep?
Dr. Colon: Heart rate and movement. There’s a device called actigraphy. That’s a real medical device that looks at movement. When you’re awake, you’re obviously moving more. During periods of quiescent, you’re moving less. It tracks based on movement. These devices, my understanding, it’s the combination of heart rate and movement.
Dr. Weitz: Basically, could you explain exactly what’s supposed to happen during the night when somebody has an ideal level of sleep?
Dr. Colon: As you go into the first stage of sleep, your brain slows down. As your brain slows down, your heart rate slows down as well. Your heart and your brain, they’re interconnected, what I call the heart rate and the brain rate. People have these stages and these cycles of sleep. If we’re not asleep, we are awake. Then we cycle through these. R is REM. People think your REM sleep is your deep sleep but it’s not. It’s actually very active brain time. All throughout the night, you’re cycling first into a deep sleep, then every 90 minutes into a REM period. Every 90 minutes we have another REM period. You have more awakenings in the second half of the night. Your brain starts to slow down. During this deep sleep, it’s when your brain activity is the slowest. That’s actually exactly what it’s called. It’s called deep slow wave sleep. Heart rates and brain rates are always inter-correlated.
Dr. Weitz: What’s the benefit of deep sleep?
Dr. Colon: The benefit of deep sleep, that where your lymphatic systems comes out, and you wash away the toxins into your brain. It’s also the time that you secret growth hormone, and it’s the most restorative part of sleep. Just like washing machines go through different cycles, your sleep goes through different cycles. Let’s say that you have your washing machine in the deep soak at the beginning, well, that deep sleep is what washes away the toxins and it’s the deepest part of sleep. Now, in REM, that’s a very active brain period. In fact, the heart rate, the brain rate in REM almost looks the same as that of awake. It’s a little slower, but these two almost look the same. Your heart rate is really elevated during that REM period as well. These trackers, what they’re doing is that they’re taking a look at both movement but also heart rate fluctuations. When your heart rate is the slowest, it’s saying that you’re in the deepest sleep. Then, all of a sudden, it’ll come up for a moment and it’ll say that you’re in REM. Then it’ll slow down. Even within deep sleep and light sleep, there’s different heart rate fluctuations as well.
Let me chime and say something else. Let’s get back to the subject of stress, sleep, meditation, mindfulness. That’s what we’re doing. When we do yoga breathing, when you do an awareness of breath, as you’re slowing your respiratory rate down, you’re calming your heart which sends signals to your brain, and it calms your brain down as well. Interesting. That’s why people sometimes fall asleep when they’re meditating, or people go to a yoga class, and then at the very end, you get into corpse pose and you do this imagery and you’re breathing slower and people fall asleep. Interestingly, there’s been times that I’ve woken up and I do a meditation. The Fitbit will tell me that I was asleep. Am I saying it’s wrong, it’s a false? No, I know that I was awake, I was meditating, but that’s the power of meditation that it puts your physiologic body and brain into states of relaxation.
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Now, back to our discussion.
Dr. Weitz: Based on what you showed us about the chart, it looked like the first two, three hours is when you get the most amount of deep sleep. When you have a client who’s having problems with sleep and you find out when they tend to wake up, is that really significant? If they say I wake up in the first hour or two as opposed to I wake up after four hours? Does that have a significance in terms of whether or not it’s more affecting deep sleep versus REM sleep.
Dr. Colon: You know, that actually has a very big significance. One, nobody sleeps through the night. Everyone has some degree of awakenings that occurs. That’s common to where it’s got a name called NWAK or number of awakenings. If someone actually wakes up four times in an evening, believe it or not, that’s normal. That’s important to know because sometimes people can’t sleep because something is bothering them, and what’s bothering them is that they’re not asleep or that they’ve had an awakening. Now, typically, you have more awakenings in the second half of the night as you’re transitioning into more of those REM periods. Someone who awakes in the middle of the night or in the early morning, that’s actually a normal phenomenon. We can meditate ourselves back into sleep. If you’re waking up a lot within the first two hours, that may be a sign of a sleep disorder, either periodic limb movement disorder or let’s say obstructive sleep apnea can do that as well. In obstructive sleep apnea, your airway is being compromised. Remember, in REM sleep, our body is paralyzed so that you don’t act out your dreams. The upper airway has less tone as well. Let me show you something actually.
Dr. Weitz: By the way, you talked about the benefits of deep sleep. Can you explain what some of the benefits of REM sleep are?
Dr. Colon: REM sleep, you’re secreting testosterone and in REM sleep, you’re also making memories. In REM sleep, if you remember what you did yesterday it’s because you went into REM sleep and you turned that into a memory. Then there’s some-
Dr. Weitz: On the opposite end, if you don’t remember what you did yesterday, then that’s an indication that you’re not getting enough REM sleep?
Dr. Colon: That could be that you’re not getting enough sleep. You’re exactly right. You’re exactly right. Normally, we breathe. Sometimes we stop breathing. If you stop breathing during the REM sleep, that can cause some cortical arousals. In kids, it’s tonsils and adenoids. In adults, it’s more the upper airway. Here, CPAP opens up the airway. Take a look over here. Look how this person’s going through their sleep cycles. Then look how the heart rate is below 80, and look how it stresses to the hundreds when the oxygen is coming down, and look how it relaxes into the 60s when you start to get the treatment with the CPAP there. If you look over here, orange are stop breathing events that are a little minor. Green are stop breathing events that are more severe and how it occurs during your REM sleep and that your oxygen is coming down. Untreated sleep apnea is a cardiovascular risk factor. That said, sometimes, again, regardless of the device, whether it’s Fitbit or I’ve had people come to me with all kinds of devices, and I’m looking at night to night. If I’m constantly seeing awakenings in the REM sleep, that’s not diagnostic for sleep apnea. That’s telling me you’d better get tested for sleep apnea. Many times, indeed, I’ve been correct when I see that.
Dr. Weitz: Now, a lot of patients hear sleep apnea or obstructive sleep issues, and their first thought is, “I don’t want to wear a CPAP machine. I don’t even want to get tested.” Are there alternatives to wearing a CPAP machine?
Dr. Colon: Yes, there are alternatives, but let me take a step back. I told you that during the COVID, I’m seeing a lot of insomnia but there’s also going to be a lot of down stream affects. I think it’s pretty well documented that during this whole COVID and the pandemic that weight is increasing. Guess what happens when weight increases? The incidence of sleep apnea is going to increase as well. If you do have sleep apnea, CPAP is the gold standard. There also are dental devices that are very effective in advancing your jaw forward and treating sleep apnea. These are more for mild to moderate. There’s these little implantable devices that is like a pacemaker for your upper airway. It’s connected to the phrenic nerve. You go to sleep, you turn it on, it stimulates your upper airway. You wake up, and you turn it off. There are some surgeries that are available. The surgeries are really not favorable because they don’t really have a high cure rate. What they do is that they make it so that your severity is less and you’re able to tolerate CPAP better. Even then, there’s other types of CPAP. There’s BIPAP as well. CPAP is continuous positive airway pressure. You breathe in, and the pressure’s eight. You breathe out, and the pressure continues to be eight. Bi means two, so you breathe in and the pressure’s eight, and as you breathe out, the pressure’s four. Bi means two.
Dr. Weitz: What are some of the symptoms people are going to … I know you covered some of the things in terms of issues with deep sleep and REM sleep, but in general, what are some of the most common symptoms you see when patients are having problems with sleep disorders?
Dr. Colon: Fatigue is one of the big ones. Sleepiness is another one, concentration, memory, high blood pressure. These are all symptoms that there could be a sleep disorder.
Dr. Weitz: Now, of course, those are symptoms that are very common. Fatigue could be 20 other things too. We just had a discussion about heavy metals last night. Of course, fatigue and memory issues came up as an issue of heavy metal toxicity as well as fatigue obviously could be a problem with liver problems, adrenal problems, hormones, blood sugar. How do you distinguish that it’s a sleep problem?
Dr. Colon: How do you find out that you have a problem with metals?
Dr. Weitz: You’ve got to test.
Dr. Colon: Yeah.
Dr. Weitz: You’ve got to [crosstalk 00:29:50].
Dr. Colon: You do a clinical history. You listen to exposures that a patient may have potentially to metals, whether it’s in the water supply or crappy protein powder or parks.
Dr. Weitz: I’ve heard about a couple of the protein powders that had lead in them. Is that what you’re referring to?
Dr. Colon: Yeah. You take a history. In the sleep history, are you snoring? How much are you sleeping? How long does it take for you to get to sleep? It’s part of the core part of the functional medicine matrix there, the lifestyle modifying factors.
Dr. Weitz: Now, do you find sometimes patients come in with sleep problems and it turns out to be something like heavy metal toxicity?
Dr. Colon: Yes. I see this because I have the different training. I’m not thinking only sleep apnea, only sleep apnea, only. No. There’s times that I treat sleep apnea and they come back and they’re like, “Doc, why am I still tired.” “Let’s take a look at your medication list.” We’ve got a couple of medications that are mitochondrial toxic: Metformin, the statins of which diabetes, having insulin resistant is toxic for the mitochondria as well. You do a history, and then sometimes you do find other things. I saw a girl the other day that she came to me, she’s got Lupus. We wanted to rule out sleep disorder. It was completely negative. I did a Genova NutrEval on her. Her mitochondria were shot: high oxidative stress, high lipid peroxisomes there, the OOHD was just sky high. You know what else? There was gasoline in … there was some toxicity. She had some gasoline in there probably from the water supply. When things don’t add up, you take a couple steps back, do a further history and you go to it.
Dr. Weitz: Is that one of your favorite screening tools for toxicities and nutritional deficiencies, a NutrEval?
Dr. Colon: I like it. I like it. It’s of several that can be done. Genova has some other expanded upon specific toxicity findings. It’s all individualized and basic. What do you use?
Dr. Weitz: I like the NutrEval. There’s a micronutrient test now that Vibrant Labs has that’s pretty cool. We stopped using SpectraCell because they’re on the verge of bankruptcy and taking months and months to get the results back. We used to use the SpectraCell micronutrient test, but I really like the NutrEval because you’ve got so much data.
Dr. Colon: I really like SpectraCell a lot and still utilize them. Sometimes the NutrEval gives me more information than I wanted and will confuse a patient. Sometimes it doesn’t give me as much of the nutrient information that I may get from SpectraCell.
Dr. Weitz: Take a look at the Vibrant version of the micronutrient test.
Dr. Colon: Okay, I’ll look into that.
Dr. Weitz: What do we do when we have patients with sleep disorders? What are some of the treatment protocols?
Dr. Colon: It all depends on the disorder. Number one, you’ve got to identify the disorder. If the disorder is sleep apnea, you get that treated in weight reduction, positional sleeping, CPAP. If the disorder is-
Dr. Weitz: In terms of weight loss, how much would you say on the average, let’s say you get a patient, a 5’9″ male weighing 260 pounds. Would he have to lose 10 pounds, 20 pounds, 40 pounds before he’d see a significant, just on average, difference?
Dr. Colon: There is no magic number at all. That doesn’t exist. People are going to lose a certain amount of weight, period. Once they’ve gotten to that, you can retest them. I had someone who had a sleep apnea that lost seven pounds. When I retested them, they were negative. I’ve had people lose 30 pounds and still have some residual sleep apnea. There is no magic number.
Dr. Weitz: We’ve got weight loss. What are some of the other treatments?
Dr. Colon: Let’s say that you have a different disorder. Let’s say you have restless legs or periodic limb movement disorder. There’s medical treatments, there’s pharmacological-
Dr. Weitz: Maybe you could explain what that is for folks who are not familiar with restless legs.
Dr. Colon: Restless legs are uncomfortable sensations in your legs. It’s worse at night, relieved by movement. Periodic limb movement disorders are limb movements that occur in your sleep that sometimes are associated with restless legs but not necessarily, and they can cause a lot of sleep fragmentation. Restless legs, uncomfortable sensations. Limb movements, we move. This person’s moving during the night. This one’s okay. The brain’s all right as opposed to this person, their leg movements are frequent enough and forceful enough to where it is disrupting sleep quality there. There is pharmacol therapy for that, but there’s also some nutritional deficiencies that can cause that. Magnesium deficiencies, iron deficiencies, they can cause restless legs and PLMD. Also, GI issues [crosstalk 00:36:13].
Dr. Weitz: Magnesium and iron, what are the best tests for magnesium status and iron status?
Dr. Colon: I’ll go back and say either a micronutrient profile are the best. Serum whole blood testing you can do, but with serum whole blood testing, you get a fluctuation of what you had over the last 24 hours. A micronutrient test is the best way to test for that.
Dr. Weitz: What about for iron?
Dr. Colon: Iron is just blood studies. Just flat out iron [crosstalk 00:36:51].
Dr. Weitz: Do you look at serum iron? Do you look at ferritin? Do you look at-
Dr. Colon: Ferritin. Ferritin. We actually look at ferritin. Ferritin is supposed to be normal if it’s 30 or 40; however, any ferritin under 70 can give you symptomatic restless legs.
Dr. Weitz: What other nutritional deficencies are there?
Dr. Colon: For insomnia, zinc is one. Oleic acid is a big one for insomnia as well. B vitamins-
Dr. Weitz: For some folks who don’t know what oleic acid is …
Dr. Colon: Oleic acid is just that.
Dr. Weitz: Basically it’s Omega-9 olive oil, right?
Dr. Colon: Yeah, yeah. You need it in order to make neurotransmitters. B vitamins can affect circadian patterns. B-6 helps improve dream recall, so it can affect REM sleep. Zinc I had mentioned as well. There’s a number of different micronutrient deficiencies that [crosstalk 00:38:05].
Dr. Weitz: What do you like the best marker of B vitamins? Again, you use the NutrEval or do you like homocysteine levels or …
Dr. Colon: I like micronutrient profiles.
Dr. Weitz: We got nutritional deficiencies. Are there specific dietary factors that can play a role?
Dr. Colon: Of course there’s dietary factors that can play a role. If your diet is depleted in something, you’re not going to absorb it, but equally, if your gut is not absorbing nutrients, then you’re going to be depleted. My girl with Lupus there, she had every single micronutrient deficiecy that we can have. She’s like, “But I eat healthy.” I’m like, “Listen, you’re not absorbing it. We’ve got to heal the gut.”
Dr. Weitz: What did you do for her?
Dr. Colon: Actually, what I did is first I slapped on, and I didn’t literally do it, but I prescribed multi-vitamin patches. Her gut isn’t absorbing it. We’re working with the micronutrient patch. Then the other thing that we’re going to do is we’re going to [crosstalk 00:39:17].
Dr. Weitz: Wait, where do you get micronutrient patches from? I’m not familiar with those.
Dr. Colon: Where do you get anything? You get it on the internet. If you don’t find it on the internet, it doesn’t exist.
Dr. Weitz: I know, but is there a particular company that you trust for micronutrient patches?
Dr. Colon: Patch MD multi-nutrient patches.
Dr. Weitz: Okay.
Dr. Colon: Patch MD. They also make melatonin patches as well which are good in these kids that can’t swallow pills and won’t take anything. We started with a multi-vitamin patch with her and then we’re going to fiber the gut, a little bit of Inflam-Eze from Nutri-dyn, probiotics, digestive enzymes. A month or two later, after we go through some of this treatment, then we’re going to revitalize the mitochondria and start taking in oral vitamins and Omegas. For right now, we’re just healing the gut and getting the nutrients through the patch.
Dr. Weitz: I interviewed a dentist at some point who also specializes in sleep apnea. He felt that Vitamin D was potentially a big factor in sleep problems as well.
Dr. Colon: Yeah, it is. Vitamin D is associated with fatigue but it’s also associated with poor upper airway tone. Vitamin D deficiency can provoke sleep apnea.
Dr. Weitz: Then, of course, we have blood sugar issues.
Dr. Colon: Yeah. An untreated sleep apnea can negatively affect blood sugar control.
Dr. Weitz: And probably [sersa 00:41:05] too, right? Blood sugar fluctuations can affect sleep. There’s a huge percentage of the population that’s diabetic or pre-diabetic or on their way to it.
Dr. Colon: The newest evidence shows that high carbohydrate diets really negatively affect sleep. High glycemic foods before bed likewise. Something [crosstalk 00:41:28].
Dr. Weitz: Now, you do have some people saying I need the carbohydrates to give me the serotonin release. What’s the reality there?
Dr. Colon: What happens with alcohol? Alcohol is sedating but then once the alcohol wears off, you get sympathetic surge. That sympathetic surge disrupts the second half of the evening. Likewise, high carbohydrate states, they may be sleep-inducing, but once the carbohydrate comes down, it plummets down, guess what comes up? Epinephrin and norepinephrine then comes up. Quality carbohydrates to make your serotonin, yes. Milk and cookies before bed, no.
Dr. Weitz: Or maybe better some quality fats.
Dr. Colon: Oleic acid.
Dr. Weitz: Especially when you have people with blood sugar issues or even type 2 diabetics, they sometimes have trouble maintaining an even blood sugar throughout the night. If their blood sugar drops too much, that can wake them up as well.
Dr. Colon: Dr. Ben, you know your stuff.
Dr. Weitz: I think those were the bulk of the questions that come to mind. What other issues would you like to cover, or do you think we pretty much covered it?
Dr. Colon: No, I appreciate you having me. We’ve covered it. There’s an epidemic of sleep loss during this COVID. Then that epidemic leads downstream to weight gain because of sedentary lifestyle and people being up late eating. That’s something called insomnia-nom-nom-nom-nom-nom-nom-nia.
Dr. Weitz: By the way, if somebody wakes up in the middle of the night, what is the best thing for them to do? Everybody seems to have something different. One person told me she likes to listen to the radio. Some people turn on the TV. Some people read. Some people get out of bed. Some people feel like if they eat something, it’s going to help them go back to sleep. What do we know about the science, about the best thing to do if you wake up in the middle of the night?
Dr. Colon: Meditation is great. I’ve been able to put myself [crosstalk 00:44:01].
Dr. Weitz: Is it better to stay in bed and meditate, or is it better to get out and get back in?
Dr. Colon: If you’re frustrated, get out of bed. If you’re able to stay calm, just stay in bed and meditate, either an awareness of breath or a body scan meditation. If you’re an anxious person, progressive muscle relaxation. That’s my go-to. If you want to look at botanicals, I really like L-Theanine. L-Theanine cuts down mind chatter. Athenian is good for reducing anxiety. It’s not sedating. You may say then why are you using it for sleep. You can use L-Theanine during the daytime and not be sedated, but if you wake up in the middle of the night, the last thing that you want is something that’s going to be really sedating because then you’re going to be groggy the next day. That’s when a liposomal L-Theanine will be helpful. Nutri-dyn makes a good one. Magnesium can be helpful as well. Again, not sedating but there’s things that are calming. Combining that with-
Dr. Weitz: Quicksilver makes a liposomal L-Theanine as well. In general, in terms of sleep supplements, we have melatonin, 5-HTP, magnesium, L-Theanine, we have these combination products. I think there’s a common thought in the functional medicine community. I’ve heard a lot of people say, and I’ve used this thought process as well, if you have trouble falling asleep, then melatonin is going to be helpful. If you have trouble waking up, then 5-HTP is going to be better. Do you have some thoughts about that or is it better to combine them? Is it useful to add GABA to that mix?
Dr. Colon: GABA can help reduce anxiety. Everything that you said is correct towards that particular person. Sometimes you can shotgun and try everything. Other times, don’t guess, test. I like doing neurotransmitter profiles. The ZRT neurotransmitter profile with the epinephrin and the melatonin cortisol profiles is money, man. I’ve seen some. It’s been really helpful. You were mentioning that there were a bunch of different products. Nutri-dyn, again, they make some really good ones. They have this Liposomal Sleep that’s incredible. It’s sublingual, it’s got five milligrams of melatonin, B vitamins, GABA that you mentioned, and then also oleic acid.
Dr. Weitz: Cool. Okay, Jose, Dr. Colon, how can patients get a hold of you if they want to contact you to get a sleep study or consult with you? You have a number of books available as well, right?
Dr. Colon: I do. I have some books available. We can go to paradisesleep.com. There, the books can be found. There’s some general inquiries that you can place in there. Actually, I work for Lee Health in southwest Florida. Essentially, I work for the state of Florida because it’s a government-owned medical system. I have to see my patients from Lee Health, but I do have a website called paradisesleep.com that has a lot of resources for sleep. There’s a place to reach out and ask a question if you need to.
Dr. Weitz: Do you have any training programs for practitioners?
Dr. Colon: I don’t have any training programs for practitioners. No, I don’t.
Dr. Weitz: That’s something you probably should add to your bucket list, do a training program for doctors. That would be something that would be in demand.
Dr. Colon: I’ll bounce it off of a friend of mine and we’ll see what we can do.
Dr. Weitz: Sounds good, doc. We’ll talk to you soon.
Dr. Colon: All right, my pleasure. Thanks for having me.