We speak with Michael Breus, PhD about sleep and his new book The Power of When. Dr. Breus discusses how to determine your own specific chronotype and specific tweaks to bring your daily schedule in line with your natural physiological rhythms in order to improve your health, productivity and happiness. (See full transcript below.)

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Transcript

Randall:   

Hello, everyone. This is Randall Redfield, Co-Founder and CEO of Integrated Listening Systems, with Karen Onderko, our Director of Research and Education. Today we welcome Dr. Michael Breus, often referred to as The Sleep Doctor. He is a clinical psychologist with a specialty in sleep disorders. He is a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine. In addition to his private practice, where he treats athletes, celebrities, and others, he also trains other sleep doctors and consults with organizations to provide better sleep for their customers and staff.

Dedicated to raising awareness of both sleep disorders and what he calls ‘disordered sleep”, Dr. Breus is on a mission to develop innovative education and communication programs. You may have seen him on CNN, Oprah, “The View” and “Dr. Oz.” He’s a wellness coach on AOL and a sleep expert for WebMD Health. His blogs can be found at The Huffington Post, Psychology Today, and The Insomnia Blog, among others. Today is the release of his third book, entitled The Power of When in which he helps us understand our own personal inner clock and how we can best manage it to live happy and productive lives. Welcome, Dr. Breus.

Dr. Breus:  

Thanks, Randall. I’m excited to be here.

Randall: 

Pleasure to have you.

Karen:

Dr. Breus, Dr. Mehmet Oz writes the forward to your book, and he praises you for being “out in front of cutting edge information about sleep and sleep disorders”. In this case, it’s circadian science. Your book is about the understanding of the rhythm of your biology as set by your biological clocks, and you give advice on how to sync the rhythm of your day with the rhythm of your biology. Can you describe a little bit more about what this means?

Dr. Breus:

Of course. When you look at something like a chronotype … First of all, let me back up for just a second. A lot of people might not even know what a chronotype is, so it’s probably good to explain that. Believe it or not, most people have actually heard of them before. If anybody out there has ever heard of an early bird or a night owl, then you’re actually very familiar with what a chronotype actually is, but historically we’ve only known about two of them. When you only know about two of something, and they only represent about 25 to 30% of the population, there’s a bunch of people out there that are not covered by that. When I started to dig into the literature, what I discovered was actually there are four different chronotypes.

Once I was able to identify them and give people an assessment tool to figure it out, then things started to happen really in a very interesting way. Your chronotype really is a label that you can put on yourself for your body’s internal circadian rhythm and the schedule that it’s on. Some people are more early morning people. Some people are right in the middle, and some people are late night people. Then there are some people who are just not great sleepers, who’ve got wonky schedules all over the place. Once you know what your chronotype is, then you know how your hormone levels will distribute throughout any given day. That’s how you align yourself with your biology is knowing your chronotype tells you about your hormone distribution. Once you know about your hormone distribution, then you can do some pretty interesting things along the way that can be really helpful for you.

Randall:

Interesting, so you’ve developed the four chronotypes in line with four different animals. I wanted to ask you if you would explain a little bit about those four different types, as well as how you developed them.

Dr. Breus:

Sure.

Randall:

How you came to describe them, perhaps, is the better way to ask that.

Dr. Breus:

Sure. What I did was I looked for animals within the animal kingdom that actually followed the chronotypes that we find in humans. I chose mammals in particular because we’re mammals. I didn’t really relate well to birds, personally. What we found was, lions are very early morning creatures. Their first kill is at dawn. They can get lazy throughout the middle of the day and on into the evening. Bears have a tendency to get up as the sun rises, eat all day, and go to bed as the sun sets, which is what my bear chronotype is, which makes up about 50 to 55% of the population.

Wolves are primarily nocturnal creatures. These represent my night owl types of people, and so they hunt at night. They hunt in packs. They do a lot of what they do at night, so they’re the more creative, yet introverted types. We chose dolphins because most people don’t know it, but dolphins sleep unihemispherically, meaning that half of their brain is asleep while the other half is awake and looking for predators. What we discovered was is that was a great metaphor for people who aren’t great sleepers. They’re never quite asleep but they’re never quite awake. We thought that using those mammals, all of these mammals that people wouldn’t mind being associated with, and all would represent the actual chronotype itself.

Karen:

When you describe these chronotypes – I’m a bear – I did my online assessment on your website, which was terrific, thepowerofwhen.com.  But I recognized in other people, for instance, my parents, both were bears when they were younger, but now they’ve turned into maybe lions. Does your chronotype change over your lifespan?

Dr. Breus:

It’s really interesting. Your chronotype doesn’t really get set until about age 18. As you watch your children, what you’ll discover is that your children will go through several different chronotypes. Then, once you hit the 55, 60 age-range, your chronotype changes again, which is also very interesting. First of all, the progressions that you feel like your parents went through is perfectly normal. Most of the population are bears, 50 to 55%. Then once you hit the 55 to 60-year-old age range, a lot of my bears turn into lions. This is not an uncommon scenario, right?

You think about people who are seniors or in that age range, a lot of them are going to bed early, waking up early, getting stuff done as the sun comes up, so it’s probably not a huge surprise that you’re able to transition. Personally, I think that may have something to do with the melatonin decrease in production that occurs once you hit that age range. We know that many people, once they hit the 55, 60 age range, their ability to produce melatonin actually declines pretty rapidly, so melatonin supplementation at that time might not be such a bad idea.

When we look at the other end of the spectrum and we look at kids, it’s really interesting. I have a 12-year-old and a 14-year-old, and they’re both wolves. This is super common for adolescents. They like to stay up until 1:00 AM and sleep until 11:00. That’s a characteristic wolfish type behavior, so the long-winded answer to your question is, yes, we do transition, but between 18 and about 50, 55, we’re pretty stable. That’s genetically based on the PDR3 gene, and the length of that gene tells us a lot about their sleep drive and their circadian rhythms.

Karen:

If it’s genetically-influenced … and I use the word influenced because I want to set it up for my next question, which is: can you change anything about your chronotype, or do you have to understand it and live within it? For instance, sleep drive, that must also be genetically-influenced, and I think a lot of people would love to be able to change the number of hours that they need to sleep in a day.

Dr. Breus:   

Absolutely. You can change it, but it’s one of those, you don’t want to mess with Mother Nature scenarios. Let’s be honest. Most of my wolf patients try to change their wolf chronotype, because they don’t want to go to bed until 1:00 and sleep until 8:00 or 9:00. That’s not going to work too well in the world if you’ve got kids or a job or things like that, so I would argue that there are literally millions of people out there who are trying to force their chronotype into a bearish world. It’s interesting because bears fall perfectly in line with our societal norms, and it makes sense because they’re the largest chronotype. It’s unfortunate for the people who are at the extremes, my lions, my wolves, and my dolphins, but it definitely happens that people try to change it.

If you absolutely positively wanted to change yourself, you really can’t skip over a chronotype. You can probably go one in either direction, so if you’re a wolf, you could probably move yourself to a bear, but you’re never going to get yourself to a lion. If you’re a lion, you could probably get yourself to a bear, but you’re never going to make it as a wolf. The way you do that is by using light therapy and melatonin, but it’s really not something that I recommend. I’m more of a go-with-the-flow type of person, and what I find is, specifically with these chronotypes, is if you figure out what your chronotype is and you just change a couple of things … I’m not say change your entire life, because nobody is going to do that.

What I am saying, though, is that if you change a few things, you may find that your performance in those areas increases fairly dramatically. A classic example is the time you have your first cup of coffee. There’s lots of people out there who drink coffee, and I don’t have any problems with it, but if you actually knew the appropriate time to drink that coffee, you might actually get more benefit from it than otherwise.

Karen:  

It’s so interesting. You describe the perfect day for each of the chronotypes, and it is really interesting to see how very different each of the days for each chronotype looks, but there are some commonalities. What you just mentioned about coffee is one of them, which was surprising to me. You recommend really for every chronotype to drink water over coffee, at least in the early morning, which is likely the opposite of what most people do.

Dr. Breus:

Right, exactly, and it’s so funny. If you think about it, the worst thing that you could do is actually drink coffee as the first liquid that you put in your system, for a couple of different reasons. Number one, we know that we breathe out almost a full liter of water when we sleep, so when we wake up, the reason that your lips are oftentimes chapped isn’t because you turned the heat on. It’s actually because you’re dehydrated. Adding a caffeinated beverage, which is a diuretic, to that situation is not a great idea. What it will actually do is dehydrate you more.

The very first thing that you should do when you wake up in the morning is slowly lift your body up and swing your legs over to the side of the bed. Take three of four good deep breaths. Get your heart rate starting to go a little bit faster. Get your respiration going. Then stand up, and you should have either a bottle or a glass of maybe eight to ten ounces of room temperature water. While you’re drinking that water, stand over by the window. Preferably put on a robe and pajamas and get some direct sunlight. Direct sunlight is one of those great circadian pacemakers, and that actually helps your clock readjust for the day. That’s an ideal pathway to take, whether you’re getting up at 6:00 in the morning, and you’re a lion, or 8:00 in the morning, and you’re a wolf. That particular scenario can be very helpful for a morning routine.

Karen:

Another morning routine that you prescribe, which is also probably the opposite of what most people do, is to eat a protein-heavy, low-carb breakfast.

Dr. Breus:

Exactly. What most people also don’t know is carbohydrates have a direct link to sleep in that when you have a large amount of carbohydrates, and by large I mean 250, 350 calories worth, it actually increases your level of serotonin which is the calming hormone, and it makes you feel sleepy. With my wolves who are already really sleepy in the morning, if they eat a bagel for breakfast, they’re just going to be dragging. Whereas if I have a high-protein, high-fat breakfast, the fat is really brain food. The protein is really getting your system going and getting your muscles going and getting everything fed. You’re actually going to find that you’ll have a lot more energy. An egg white omelet with avocado or spinach would be a great type of a morning meal that could be very energy-promoting.

Randall:

A cup of coffee and a really, really big burrito is probably exactly the worst thing you could do.

Dr. Breus:

That would not be what I would be wanting you to do. No. It’s so funny when you look at the breakfast foods that are out there, especially for kids. This morning, I made my daughter scrambled eggs and goat cheese, and my son, I made him what’s called Rocky Mountain Toast. You carve out the middle of the toast, and you put an egg in there with goat cheese on top. That’s really great brain food. The toast probably wasn’t the best, but he likes it. That’s how we get them there. Most breakfast foods are cereal and milk or muffins or bagels or things like that. Don’t get me wrong. It’s not like I hate those foods. I’m just saying, don’t eat them in the morning because they’re going to slow you down.

Randall:

Not to mention that the cereal typically has like 15 grams of sugar or so.

Dr. Breus:

Exactly.

Randall:

It’s like, “Let’s wake up and have some carbs and sugar.” So much of your book was fascinating to me. The part about napping raises all kinds of questions with me. I don’t have the luxury of having a job where I am tempted by naps a lot during the day, but on the weekends, every once in a while, naps are really a delicious thing. I know Google, Huff Post, a lot of different companies have nap rooms and are thinking in that direction. I’ve heard Arianna Huffington speak or write positively about them. It looks like in the book you really say that only bears are the ones that are advised to nap. Can you explain that a little bit?

Dr. Breus:

Sure. There is a lot of data to show that when you nap, the time that you are last asleep directly affects how long it takes you to fall asleep. Let’s take a look at two of the chronotypes that absolutely, positively should not nap. The dolphins, who are not great sleepers to begin with, if they take a nap during the day, even if they’re super exhausted, it will absolutely affect their ability to fall asleep in the evening. They’re already not getting good sleep, so they absolutely, positively shouldn’t nap.

The wolves also should not be nappers because they’re finally starting to get some energy around 11:00, 11:30 in the morning, 12:00. If they go ahead and take a nap at 2:30 or 3:00 and they’re already not going to bed until 12:30 or 1:00, they’re pretty much not going to fall asleep until 2:00 in the morning. Those two chronotypes in particular don’t nap particularly well. Lions don’t usually need a nap. They’re good strong sleepers. They happen to wake up early, 5:30, 6:00 in the morning, but they have a good bit of energy throughout the daytime. It’s really interesting. Bears are probably the people who are the best nappers, if you will.

You have to be careful when you nap. You want to stay either in a 25-minute nap or a 90-minute nap. You really don’t want to nap any amount of time in between. Ninety minutes is because the average full sleep cycle is approximately 90 minutes, but the 25 minutes is more of a power nap. What it does is it gives you enough Stage 1 and Stage 2 in order to decrease the amount of adenosine in your system to keep you going, but it doesn’t get you into the deeper stages of sleep. Many people if they nap too long, they feel terrible when they wake up from their nap, and that’s something that we want to obviously avoid.

Karen:

I think you even say for bears that 2:00 is the right time to take a nap. It’s apparent that chronobiology drives the best time to do almost everything. In the second part of your book, you focus on about 50 different activities and chart the best time for doing them and why, based on circadian rhythms. As I read through that part, I thought, “Well, don’t a lot of these activities depend on the chronotype of the other person that you might be doing them with?” I wonder. Do you find that people unknowingly choose mates with synchrony to their own life rhythms, like do bears tend to marry bears?

Dr. Breus:

Yeah. It’s interesting. Bears aside, because they make up such a large percentage of the population, there’s a decent likelihood out of two people is a bear, but what’s interesting, as an example, both my wife and I are more on the wolfish side. It made sense because when we were dating, I would pick her up at 8:00, and we would go to an 8:30 movie. We’d get out at 10:00, and then we’d go have dinner. It was nothing for us to be out until 12:30, 1:00 at night. We were both awake and active and having fun, so it made a lot of sense, because that’s just the way we did things. When we found each other, it was, “Oh, you like to stay up late, too. Oh, cool.” That was how it worked, so I think people do it without even meaning to.

Lions do the same thing. Lions have some social issues, because they’re exhausted by 8:30. They’re not going to do dinner and a movie. They’re lucky to make it through dinner before they’re really pretty tired because they’ve been up since 5:30 in the morning. I do think that couples do have a tendency to find one another if they can in their chronotypes.

Randall:

I was surprised to read about the medication point that you make in the book, and I’m surprised that we haven’t heard more about this, just out there in general, in terms of the best time to take medication, the best time to have a test done. You give the example of blood pressure medication with some research showing that those who took the medication at night had a 33% lowered risk of heart attack, compared to morning pill takers. It’s kind of amazing. Why is it that we haven’t heard more about that, do you think?

Dr. Breus:

It’s very interesting. First of all, it’s an excellent question. Just to divert for a little bit, there’s even more serious scenarios than blood pressure. Not that blood pressure isn’t serious, but we now know that if we administer chemotherapy at very particular times in the circadian cycle, it’s actually more effective, and you have to use less of it. For anybody out there who’s going through some type of chemotherapy, it’s really interesting when you start looking at those data. When you look at something like blood pressure, which millions and millions of people have issues with them, and lots of people are on beta blockers and different blood pressure pills, the problem is that the research on this really hasn’t come to life within the last probably ten years, so most of everybody’s practitioners that are out there have been out of school for a very long period of time.

By the way, chronotypes are not being taught in school, either, in medical school in particular. What’s happening is that the doctor says, “Take your medication once a day.” What people do is they take all of their medication one time a day, or if they take it twice a day, they take it in the morning and right before bed. If it’s three times a day, it’s at breakfast, lunch, and dinner. Really, it’s a matter of convenience that people are doing it, as opposed to being educated and discovering what could be actually more healthy and actually help them be treated for their situation a lot better. It’s kind of amazing.

I’ll tell you also that when we’re looking at blood tests, we’re starting to slowly see time stamping when the specimen is being collected. That’s critical because, as an example, if you’re going to test somebody’s thyroid and you test it in the morning or you went in to your blood draw, and you had it tested at 2:00 in the afternoon, it could be a tremendous difference between those two variables. If you’re a physician and you’re diagnosing somebody with let’s say, Hashimoto-type Thyroiditis, trying to understand their values, in conjunction with the timing that the specimen was taken can actually really help the patient.

Randall:

Do you foresee a day when your chronotype, just like your blood type, for example, is part of your profile?

Dr. Breus:

Yes.

Randall:

It is on record with your family doc, so that every time that you go to see a specialist or any kind of medical question that you’re addressing, your chronotype is part of the conversation?

Dr. Breus:

I do. I think that that makes a lot of sense. We’re probably not going to see it happen too quickly in conventional medicine, but we will start to see it more in sleep medicine. We’ll start to see it more in nonconventional medicine, more like functional medicine. We’ll also see it in more of the Eastern types of medicine that are being done. It’s also really interesting. If you really go back historically and you look into Ayurvedics and Ayurvedic medicine, these chronotypes have been around for thousands of years. The chronotypes that I talked about actually line up really well with several of the Ayurvedic theories and thought processes. It’s very interesting to see.

We’re behind here in the West, looking at some of our medical techniques. I would really hope that we’ll start to take advantage of this because I believe that less medicine is better. If we can get less pharmaceuticals into a person’s body and be more effective in the ways that we’re doing it, why shouldn’t we?

Randall:

Sure. Your whole approach here aligns with this alternative view, from what you’re saying, which is fantastic. Reading through the book, it was interesting to see the way you’ve laid content out. It’s done, it seems to me, in a very intentional way, to make for easy reading, easy digesting, if you will. The data is in graphics. You’ve got recaps at the back of every chapter. Can you tell us a little bit about your design on that level?

Dr. Breus:

Sure. The book is not meant to be read cover to cover. There are plenty of parts of the book that may not apply to you, but they might apply to your bed partner or your child or your parents or something like that. What’s interesting is the way we did it is, I really wanted to structure it so that once you figured out your chronotype, then you could go to a day in the life of that chronotype and start to really understand how you could use your chronotype to your advantage. Then it’s really about picking and choosing one or two different activities.

The activity categories are fun. We’ve got everything from relationships to fitness, health, sleep, work, creativity, money, and fun, so this book is meant to be the legacy book where it covers a tremendous number of topics, 50 different activities, but I’m already finding that people are asking me from a business perspective. They’re saying, “Could you come into our business and chronotype all of our employees so that way, we know when to have creative meetings and analytic meetings and get more done?” The answer is, “Yes, I can do that.” What’s really fun about this is understanding and applying these types of things to people in all kinds of situations, whether it’s a work situation or a home situation, family situation. It can actually be a lot of fun and pretty effective.

Karen:

Fun and fascinating seem to be two words that describe the area where you find yourself. How did you end up getting into sleep medicine?

Dr. Breus:

Oh, gosh. It was very serendipitous. I went to the University of Georgia, which is where I got my PhD. I was very interested in sports psychology. I have a PhD in clinical psychology, and one of the better sports psychology programs was at a school that also had a sleep rotation in it. I had gotten into the school, and I couldn’t get into the sports psychology rotation first. I had to take it on my second half of the year, and they said, “Would you have any interest in doing the sleep rotation?” I had worked my way through graduate school in the electrophysiology department so I knew how to work EKG machines and EEG machines. In a sleep laboratory, those are exactly the assessment tools that you use, so I said, “Sure. I think it will be fun.” I always had an interest in sleep. I didn’t really know a lot about it, but I thought it was one of those fun, cool topics.

By the second day, I had absolutely fallen in love with clinical sleep medicine. I have such a unique opportunity because I can literally help people in 48 hours. Not very many clinical psychologists have that ability to be able to literally change somebody’s life in that short a period of time. I just thought it was this cool gift that the university plopped down in my lap. I was drawn to it and started working in it and have enjoyed it ever since. I’ve been practicing for 16 years as an actively practicing sleep specialist. My subject matter, that is my specialty, is insomnia, and that also led me into the chronotype world.

Randall:

It certainly does seem serendipitous in that you had all of those years clinically to prepare yourself for what you’re doing now and really for sleep becoming such a big topic, as it is.

Dr. Breus:

Yeah.

Randall:

You’ve been very kind over the last half year or year or two to be a supporter of the Dreampad, the iLs Dreampad.

Dr. Breus:

Absolutely.

Randall:

You’ve tried it. You’ve talked about how you like it. Tell me. What role do you think it can play in terms of the general field of sleep medicine?

Dr. Breus:

Oh, gosh. First of all, from a chronotypical standpoint, I think my dolphins would do very well with utilizing the Dreampad technology. First of all, it’s fascinating work. It’s got real science behind it. I’m all about the data. As soon as I was able to get it, play with it, look at the studies, understand what’s going on, that really made a big difference for me, personally. I’m not a big fan of the pharmaceuticals. I’m not saying that there isn’t a place for them, and I’m not saying that people shouldn’t use them for certain particular situations. If I’ve got a patient who’s bipolar or schizophrenic or major depression, anxiety disorder, we may need a pharmaceutical to break the cycle of insomnia, but that’s not my choice because if you’ve got a sleep problem, and then you start taking medication, now sometimes you have two problems. You have a sleep problem. You have a pill problem.

Looking for more natural ways to address these types of issues, number one is critical for overall health, but number two really makes a lot of sense. Almost every single person I talk to says, “I don’t like the fact that I have to take a sleeping pill every day.” That really bothers them quite a bit, so we’re trying to find ways to do that. I think the Dreampad is a great solution for that.

Karen:

Thank you. You said you’re all about data. I am, too. I love reading research. You’ve done such a terrific job of scanning the whole field of research on this topic and picking out compelling studies to highlight. Thank you for such a wide-reaching and important tour of ways to approach our own chronobiology. Your book is a real gift. Thank you.

Dr. Breus:

Thank you for saying that. You’re very sweet. I really enjoyed putting it together, and I really feel like this is going to be one of my foundational works. From here, the next step is probably, “The Power of When for Business,” or “The Power of When for Teenagers,” or “The Power of When for New Moms.” Things like that, I think, are going to be very, very interesting to see how it works for people, but I’m excited. The book is going live soon, and we’ve had a lot of interest with it, a lot of media surrounding it, so I’ve been very excited to see it blossom like this.

Randall:

You must be excited. It’s been a real pleasure to have you on the podcast series here today. I think just this conversation will be of great interest to a lot of the iLs therapists and parents that would benefit, not only from this little summary of the book through the podcast, but also of course reading your book. The book is released by Little Brown on September 13th. You have our sincerest congratulations on a job well done. Really nice.

Dr. Breus:

Thank you. I’m excited to have it. I certainly appreciate you guys having me on. For listeners out there, if they wanted to take the quiz to learn what their chronotype is for free, you just go to thepowerofwhenquiz.com and you can take the quiz. It takes less than a minute and you’ll learn what your chronotype is right then and there.

Wonderful.  Thank you so much Dr. Breus.

Thank you!

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