The Science of Sleep: Why You’re Waking Up at 3 A.M. (and What Actually Helps)

23:10Dr. Jesse Mills:This week on a special episode of Health Discovered, we're taking a closer look at a common form of lung cancer that accounts for 85 % of all cases. I'm Janet Freeman Daly, and I've been living with non-small cell lung cancer since 2011. Non-small cell lung cancer. It's a diagnosis that changes everything. and yet the conversation around it too often stops at the biology and misses what patients are actually living through every single day. There are some things you used to be able to do that you can't do anymore. It's easy to become depressed when you're dealing with all those losses. So mental health plays a really big role.

23:51Dr. Jesse Mills:So what does it really mean to advocate for yourself when you're living with non-small cell lung cancer? Listen to Health Discovered on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

24:30Dr. Jesse Mills:I to work. It screens thousands of stocks, builds a one of a kind index and lets you backtest it against the S &P 500. Then you can invest in a few clicks. Generated assets are like ETFs with infinite possibilities, completely customizable and based on your thesis, not someone else's. Go to public.com slash podcast and earn an uncapped 1 % bonus when you transfer your portfolio. That's public.com slash podcast. Paid for by public investing. Brokered services by open to the public investing Inc. Member FINRA and SIPC. Advisory services by public advisors, LLC, SEC

25:06Dr. Jesse Mills:Do you ever feel like you're drinking from a firehouse? PayCore's intelligent HR solution empowers leaders to turn down the pressure. Their unified platform includes payroll, talent management, compliance software, and a lot more, connecting you to the people, data, and expertise you need to drive long-term business results. Visit pacor.com slash leaders and go from work flood to work flow. That's pacor.com slash leaders.

25:57Dr. Jesse Mills:for an exclusive offer. That's orderlymeds.com slash podcast. Individual results may vary. Not medical advice. Eligibility required. See site for details.

26:17So what about the other end of the spectrum? Jordan's a young, healthy guy. He's getting away with it. Obviously, he's still contributing to society and living his life. but what about an older guy what about a 75 year old guy he's retired say he gets up three times a night to pee and he's his urologist said oh well here take some flomax or tamsulosin you'll be fine but he's still waking up and prostate is not an issue his urologist has clued this guy in but he's he's really just not resting tell me about the senior male and the guys that are listening out there because we play great in every demographic.

26:54So there is a 75 year old male out there other than my dad, who's listening to this right now, that wants to know what what to do with him and what's causing his wake ups. He also noticed just to make this kind of like a board certification question for you. Also noticed his ankles are a little bit more swollen at night. It doesn't mean chest pain or shortness of breath, but but definitely seeing that he's just fatigued and not walking as far as he used to. And he's getting up all the time. Is this a urologic issue? Is this a sleep issue? Unpack that for me, doctor.

27:24Dr. Jesse Mills:Great question. So, you know, there are definitely a few things that increase the incidence of sleep apnea or risk factors for sleep apnea. One of them is age above 50, regardless of gender. So that's definitely something to consider. As we get older, the integrity of the structures in our throat, the tongue and throat muscles, you know, they're not as toned and taut as they are when we're younger. And as a result, becoming more flabby, more saggy, more hangy, so to speak, and they're therefore more likely to block your airway when you're sleeping. So age is definitely a risk factor for sleep apnea, particularly once we're above 50.

27:57Dr. Jesse Mills:And male gender is a risk factor for sleep apnea. We just get sleep apnea more than females do. That being said, it's very underdiagnosed in the female population as well, which is a totally other issue. But with that said, definitely gender and age are two very common risk factors for sleep apnea. And if we're talking these risk factors accompanied by symptoms like daytime fatigue, daytime sleepiness, or disrupted nighttime sleep, well, most certainly at this point, we should definitely at least cross sleep apnea off of our list with just a one-night sleep study. So that would be my first recommendation is always just make sure just because of how common it is.

28:32Dr. Jesse Mills:Sleep apnea is being as underdiagnosed as it is. Studies show anywhere between 15 to 20 % of the world has sleep apnea. So all that to say that you can never really be sure of these things. Sleep symptoms or sleep-related symptoms are very nonspecific to sleep disorders themselves. Whether we're talking the dry mouth, the morning headaches, or the frequent awakenings, that could be sleep apnea or it could be a lot of other things. So that's why it's really important to have a good differential and always cross sleep apnea off your list, especially in a man that's above 50. So what does a guy do?

29:05So we're big empowering our audience to keep out of the doctor's office as much as they can. So where does nutrition, where does exercise, two things that you obviously practice, what you preach, how does that help a guy deal with sleep apnea or some of the other common sleep disorders? Are there things that he shouldn't eat, should eat? Unpack a little bit of that for me. Talk about weight loss. Yeah. Tell me what I can do for myself before I have to make an appointment with you. Because you're busy, man. You're busy. You got a big practice.

29:36Dr. Jesse Mills:Well, when it comes to sleep apnea specifically, I can say that excess body weight or being overweight or having obesity, these are definitely very common risk factors for sleep apnea. With that said, it's important to note that a lot of people have sleep apnea and do not have overweight or obesity because they just have anatomical features in their throat and airway that predispose them. Like, for example, having a larger tongue or having a more recessed or retrognathic jaw or even a micrognathic jaw. A lot of Chinese people, for example, or a lot of Asian populations have sleep apnea independent of body weight just because of the jaw and oropharyngeal anatomy.

30:13Dr. Jesse Mills:So that's one thing to keep in mind. However, here in the United States where we do have an obesity problem, excess body weight is a very common risk factor for sleep apnea just because the more fat that we store in our necks, well, now our airway is starting to get compressed and squeezed and kind of narrowed by that extra body fat. So in a case of somebody who has sleep apnea and does have excess body weight, losing that weight is always going to help reduce the severity of the sleep apnea and sometimes even eliminate the sleep apnea altogether. Because once again, as we start to break this fat out of the neck off and lose it, now our pipe and our airway starts to re-expand.

30:50Dr. Jesse Mills:So we've had many people with sleep apnea that were cured or had complete resolution of their sleep apnea with a really solid weight reduction plan, whether that was behavioral and lifestyle modifications, a supervised weight loss program, or even ZEP bound of Zempic and this whole new kind of craze about the GLP-1 medications that are really effective in promoting weight loss. We've been able to get a lot of people completely off of their CPAP or whatever treatment they're using for sleep apnea just through weight loss alone. So in the setting of sleep apnea associated with excess body weight, reducing that body weight is always going to improve and sometimes going to cure the sleep apnea.

31:28I'm right across from the GNC here. Why can't I go across a store and buy Sam Kashani's sleep supplements? Tell me, talk to me about melatonin. One of the things we love to do in this podcast is just give guys good information about what's fact, what's fiction. And, you know, there's a whole section in any store that are all about sleep aids. So am I wasting my money? Is there something that I should be taking if I have problems that's going to cure my snoring or cure my sleep apnea? Talk to me about that.

31:57Dr. Jesse Mills:That's a great question. Now, important to note that when we're talking about somebody who has broken sleep at nighttime or disrupted nighttime sleep, whether it's any of the forms that I was describing, difficulty falling asleep, difficulty staying asleep, If there is concern or suspicion or risk factors that would suggest that this person may also have sleep apnea, it's always good to do a test and make sure. But let's say you did that and you have somebody who just has disrupted nighttime sleep. They've done a sleep study already. It turns out that they don't have sleep apnea, but they just struggle at night with falling asleep and staying asleep.

32:29Dr. Jesse Mills:They'll wake up. They'll have prolonged periods of wakefulness at nighttime. Cumulus would be robbing them of sufficient sleep time and ending up with sleep deprivation and everything that goes with that the following day. in that particular setting. When it comes to treating insomnia, now supplements are totally fine to experiment, totally fine to try. As we know, the FDA doesn't really do a really thorough job of regulating these supplements. So is it okay to try things like melatonin, ashwagandha, valerian root, things that have been used for so many years for people to see if it helps them feel drowsy or helps ease them easier into sleep or reduce their latency to falling asleep?

33:04Dr. Jesse Mills:I think it's totally appropriate to try it and see if it works for you, provided, of course, it's not causing any problems for you. You're not having side effects. You're benefiting from it. You're not exceeding what's written on the manufacturer's bottle because these things are so poorly studied in terms of adequate doses and whatnot. But I would say that it's going to be very hit or miss because a lot of people take things like melatonin and valerian root and it does nothing for them. And then plenty of people take them and it helps. For the people that it helps, they never come to see me. but for the people that try these things and it doesn't work for them or you know they've tried all these other kind of biohacks and different methods to improve their insomnia or their sleep this ends up perpetuating more insomnia because now the person starts to develop a belief where even melatonin doesn't work on me even valerian root didn't work on me i've tried everything and this frustration and all this kind of dysfunctional perception of the sleep problem becomes bigger and bigger and you've got yourself a full full-blown insomniac who is convinced that they're unfixable So that's the person who shows up to my office.

34:03Dr. Jesse Mills:And at that point, I tell them there are two ways to treat insomnia, non-evidence-based ways and evidence-based ways. Clearly, you've already exhausted the former because that's why you're here. You've already gone to GNC and tried these different supplements. You've already gone online, read about different sleep hygiene tips and nighttime habits that you can do to improve your sleep and nothing's working. So if we're talking evidence-based ways to treat insomnia, we've got very few. Number one is medication. It's not the first line of therapy. It's not the first thing that we as sleep doctors recommend in terms of using a sleeping pill to treat the insomnia, but everyone is different.

34:38Dr. Jesse Mills:Everyone's preferences are different. And plenty of people will come and say, I just want a pill. I'm sure there's a non-pill way to do this, but I don't care. And this is what I want. Sure, no problem. There's a responsible and appropriate way to prescribe sleeping pills and to choose a specific one to ensure good follow-up and monitoring moving forward. However, if we want to talk about the most effective evidence-based way to treat insomnia in adults, it's called cognitive behavioral therapy for insomnia, also known as CBTI. CBTI is recommended as first-line treatment for adults with insomnia per the American Academy of Sleep Medicine.

35:12Dr. Jesse Mills:And there's been so much data, there have been so many studies on CBTI. You just have to literally Google those words and you'll see tons of articles even studies comparing its effectiveness head-to-head versus some of the most effective and commonly prescribed sleeping pills including zolvidem which is commonly sold under the brand name ambien esopiclone commonly sold under the brand name lunesta and even temazepam which is a benzodiazepine which we don't really prescribe too many of those anymore but in all of these studies cognitive behavioral therapy for insomnia has proven to be more effective so i always give people the choice yeah and you know you man you touched on so many crazy things there.

35:47And you, one of the things is, is you don't know the denominator. So, so again, my goal is never to bash on supplements. My goal is always to say, you know, what are the data? Are there data? But that was a very political answer you said, because there could be tons of guys out there that aren't going to see you that are doing great. And so try it. If it can't hurt, it helps. Great. One of the other things I think is such a critical recurring theme in this show is that as it get checked out first, make sure nothing worse is going on and then get into it. So that's fantastic. And then, uh, and then on the drugs, yeah, I want to ask you, well, first of all, you, you gave me a good segue is the, the number one, and maybe I'll put you on the spot and see if you know the answer to this.

36:31And if you don't, it's okay. But the number one, most feared drug that is in your toolbox to a urologist, Do you know what this drug is? It's a side effect that not a lot of physicians know about.

36:43Dr. Jesse Mills:Is it related to anticholinergic properties? Well, yeah, partially, yes. But specifically the trazodone, yes, and the priapism from trazodone. Oh, yeah. Trazodone. The trazodone, exactly right, yeah. So trazodones are very common. And any guy out listening that has sleep, please do something other than that because one of the side effects that not a lot of docs know, thankfully Sam does is that it can has a strange effect and and some of the other psychiatric medicines do the same thing on this anticholinergic pathway where they cause an erection that doesn't go away so it's not sexually provoked and and it can lead to pretty significant penile damage so so yeah if you're yeah I guarantee I almost guarantee that there's probably zero male urologists that have ever tried taking trazodone because the amount of time we spend in emergency serums, bringing down priapisms with other drugs to counteract it.

37:40So that's my public survey. That's my PSA for today, Jordan. But the second thing is what I always learned about the medications that you talked about is that you cannot get into deep delta or you can't get into REM sleep. You're kind of stuck between two and three or something. So they don't actually really make you as rested as cognitive-based therapy and the other techniques you're talking about. So is that true or is that a myth from med school that I forget?

38:08Dr. Jesse Mills:It's a good question. You know, it's actually when it comes to the effects on sleep architecture, which is the term that we use to describe the way that sleep staging is and the proportion and percentage of time that we spend in each stage versus the other. Sleeping pills, the ones that we know and the ones that we prescribe that are specifically indicated for insomnia, and I say that because trazodone, for example, I'm glad you brought that up, That's one of the most commonly used off-label prescription medications to treat insomnia. I've had plenty of patients who have been taking it long-term and do great on it, in which case, if they need me to refill it and there's no problems, that's fine.

38:41Dr. Jesse Mills:But if I'm starting a sleeping pill for somebody or starting an insomnia medication from somebody, I'm pretty boring in a sense that I usually pick from the eight specifically studied and indicated medications for insomnia, which I can go to later. So for that reason, I don't really prescribe that particular medication too much. But I would say that going back to your question, which was just that is the sleep architecture. Do these drugs allow you to get into REM sleep or do you fall short of that? So you feel OK, but not as deep as like, man, I was knocked out. Studies have not really shown a significant alteration of sleep staging and sleep architecture with these medications.

39:19Dr. Jesse Mills:Now, with that said, most of these meds have been studied for very short periods of time before they're approved. So overall longitudinal data or just long-term data looking at these medications, it doesn't really exist. And this really feeds more into the whole fear about dementia and cognitive and neurologic damage as a result of taking these medications long-term, which not to say that it's impossible. I mean, it's most certainly reasonable to consider that the risk exists because several of these medications that we use to treat insomnia work in the same part of the brain that benzodiazepines do.

39:51Dr. Jesse Mills:And we know that benzodiazepines have been associated with memory and cognitive issues long term. So it's definitely fair to assume that the risk exists with these medications. They are centrally acting at the end of the day. And most certainly there have been reports of people who take sleeping pills like Ambien or Lunesta and experience issues later on. But then again, we've got hundreds of thousands of people that have been taking medications like these for 30 or 40 years and are sharper than a razor blade and not having any kind of cognitive issues. In fact, I always think of, I have a couple, actually, a husband and a wife, and both of them have been taking Ambien for over 30 years.

40:26Dr. Jesse Mills:And the husband just turned 96, wife just turned 90. And I can tell you, these are the youngest 90 and 96-year-olds you'll ever meet. Very sharp cognition, very good memory, very functional, and not having any issues from it. So everybody is different, and that's why it's so important to, when you're making a choice to start a sleeping pill long-term, that there's good follow-up and clinical monitoring along with it. This is the individual results may vary disclaimer section of the program. Thank you.

41:23Dr. Jesse Mills:Metabolic testing solutions support early risk assessment and empower more informed decision making so you can focus on what matters most, your patients. Visit LabCorp.com to partner with LabCorp and simplify complex patient profiles. When I first heard the words, you have lung cancer, I was in shock. This week on a special episode of Health Discovered, we're taking a closer look at a common form of lung cancer that accounts for 85 % of all cases. I'm Janet Freeman-Daley, and I've been living with non-small cell lung cancer since 2011. Non-small cell lung cancer. It's a diagnosis that changes everything.

42:06Dr. Jesse Mills:And yet the conversation around it too often stops at the biology and misses what patients are actually living through every single day. There are some things you used to be able to do that you can't do anymore. It's easy to become depressed when you're dealing with all those losses. So mental health plays a really big role. So what does it really mean to advocate for yourself when you're living with non-small cell lung cancer? Listen to Health Discovered on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

42:51Dr. Jesse Mills:you to turn any idea into an investable index with AI. It all starts with your prompt from renewable energy companies with high free cashflow to semiconductor suppliers, growing revenue over 20 % year over year. You can literally type any prompt and put the AI to work. It screens thousands of stocks, builds a one of a kind index and lets you backtest it against the S and P 500. Then you can invest in a few clicks. Generated assets are like ETFs with infinite possibilities, completely customizable and based on your thesis, not someone else's go to public.com slash podcast and earn an uncapped 1 % bonus when you transfer your portfolio.

43:24Dr. Jesse Mills:That's public.com slash podcast. Paid for by Public Investing. Brokered services by Open to the Public Investing, Inc., member FINRA, and SIPC. Advisory services by Public Advisors, LLC, SEC Registered Advisor. Generated Assets is an interactive analysis tool. Output is for informational purposes only and is not an investment recommendation or advice. Complete disclosures available at public.com slash disclosures. Do you ever feel like you're drinking from a firehouse? PayCore's intelligent HR solution empowers leaders to turn down the pressure. Their unified platform includes payroll, talent management, compliance software, and a lot more, connecting you to the people, data, and expertise you need to drive long-term business results.

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44:51We always do a segment about, we kind of title it, am I going to be okay? Or am I probably going to be okay? And we ask the expert and usually I make up patients, but Jordan put himself out there. So I'm going to put myself out there with two habits that I got to ask you if I should be doing or not. And first one is, you know, I, I, ever since medical school, every night I read something non-medical, either literature, nonfiction books. But man, I gave up the paper turning books years ago and I've all in on on reading off of an iPad or a Kindle on a, you know, I do the whole black screen. And I don't think it messes me up, but but I'm told that like that's the worst thing is is to have, you know, devices at night.

45:34Everything I ever hear says is terrible. It doesn't seem to affect me. Am I going to be OK? Do I have to go back to buying books and having a little book light? Talk, you know, talk me off the ledge here, Sam.

45:44Dr. Jesse Mills:You're definitely going to be okay. In fact, I'm so glad you brought this up because it kind of makes me think of naps, for example. A lot of people think that, you know, naps are bad or naps are not good for you. Or like you said, things that you do at nighttime prior to going to bed or things that you're doing in bed before going to sleep are going to have some kind of major detriment on your sleep. And the bottom line truth is whatever you're doing at nighttime, if it does not interfere with your ability to initiate and maintain sleep through the night, what's the problem? It's the same thing with a nap.

46:15Dr. Jesse Mills:If a person loves to take a nap in the middle of the daytime for 20 or 30 minutes and they time it in a way that doesn't suppress their nocturnal sleep drive and it makes them feel better for the second part of their day, just like a shot of espresso would wake them up in the second half of the day. And no issues with sleep at nighttime, then it's not a problem at all. Oh, man. That was my second question. I love it. I actually have a coffee mug that some of my old fellows gave me. And, you know, this is a radio, but it has a little it has a little coffee bean on it. And it says it's three o 'clock somewhere because a part of my routine every day is to have three o 'clock coffees, two shots of espresso, kind of an Americano we thing.

46:57But, you know, I have a little thing in my office and I do that because I usually end up working out about five o 'clock, five thirty when I leave the office. and I heard too that yeah avoid all caffeine at night it's gonna wreck you and my wife who can't drink coffee after about 10 o 'clock or 11 o 'clock in the morning I get a little bit of this you know should you be doing that are you gonna be okay so you know we have a harmonious almost 40-year relationship my wife and I so you got to settle this can I say am I gonna be okay and I can still have my three o 'clock coffee or do I need to switch over to matcha or green tea or something like that.

47:32Absolutely.

47:33Dr. Jesse Mills:Absolutely. No, we know so many people that can drink coffee at nighttime and go right to sleep. And if it doesn't impact the nighttime sleep, then you're just the lucky one. I know I'm very sensitive to caffeine. I'm like your wife. If I have it past a certain time, it definitely will affect my sleep at night, but every single brain and body responds differently and metabolizes caffeine differently. So whatever the case may be, whether it's electronic devices, caffeine, daytime naps, as long as it doesn't affect your nighttime sleep and your internal sleep is stable and healthy, you don't have a problem at all.

48:03These are tears of joy that you see streaming down my cheek. It's not, you know, anything in the air. I'm literally crying happiness because it's, it's so for me, it's that it's almost meditative. It's sort of this grounding, like, you know, I'm going to burn through clinic, but three o 'clock, even in the OR, you know, in between cases, it usually three o 'clock rolls around. I get that. And it just, it's so centering and grounding to me, which, which is, I'm just delighted. And I know it's not messing up my sleep that much. That's amazing. All right. So give us like two to three. Well, my kids are both in their 20s.

48:36Now that we're talking family. So there I got 20, 21 year old, 28 year old almost. And what do I tell them now? I mean, what are their sleep habits that people should be doing in their 20s? So the time they're in their 50s, like their dad, they're, they're going to be okay.

48:52Dr. Jesse Mills:Yeah, you know, there's definitely the basic sleep hygiene tips that will suggest and recommend and these are really things just to kind of practice good sleep habits and good sleep health it should be noted that just having good habits and just improving your sleep hygiene and your nighttime routine alone is not going to fix 20 years of anxiety at nighttime and insomnia and everything that goes with it so you mean anxiety because i'm their dad is that what you're trying to say oh man sam we got to unpack this now i just i just won a long-standing the argument with my wife and now you're saying my kids are anxious.

49:24I'm sorry. Go ahead, please. Continue. Continue.

49:27Dr. Jesse Mills:But, you know, it's one of those things where I always liken good sleep habits to good dietary habits. Everybody should have good dietary habits, not just people with metabolic disease or people who struggle with obesity or overweight. It's for everybody. But is good dietary habits alone going to be the optimal complete solution for somebody who's 400 pounds? Of course not. It's going to take up more evidence-based and a more significant aggressive intervention to improve that person's situation. Good sleep habits are the same. If the person is having problems with sleep at nighttime, they're struggling to fall asleep, struggling to stay asleep, or always feeling tired despite having adequate nocturnal sleep duration, well, just improving your nighttime routine and sleep hygiene is not going to be enough.

50:09Dr. Jesse Mills:But for the general population, things like ensuring that your bedroom is a sleep-promoting environment, making sure that it's cool, dark, and quiet. We typically suggest keeping the room between 65 to 70 degrees at nighttime, just because the body actually hits its lowest temperature in the 24-hour circadian period during sleep. It's actually about two or three hours before the natural time of awakening. That's when your body hits its lowest temperature. So being in a warm environment, it's just not really in agreement with our natural physiology in that sense. And if there are things that are distracting or things that can be, you know, interruptive to the person's sleep, making sure that there are blackout curtains, keeping windows closed.

50:48Dr. Jesse Mills:Because if you know that the street sweeper comes at three o 'clock in the morning, every single Tuesday, your window is open and you have that environmental cue letting you know what time it is. Sometimes that can feed into the frustration in the middle of the night. And oh my God, now it's three, because I hear the street sweeper. Should I just get up already and start my day? Should I give it another 30 minutes or an hour? And then next thing you know, you find the person in kind of a little bit of a cycle of poor sleep. But all that to say that ensuring the bedroom is a sleep promoting environment, ensuring that there's not too much of significant deviation between the sleep-wake schedule on weeknights and weekdays versus weekends, and making sure that if there is a problem with our sleep beyond our control and beyond our ability to just have these good habits, if we're still having trouble falling asleep, staying asleep, or we always feel fatigued or sleeping during the daytime, this is when it's a good idea to talk to your doctor and perhaps pursue a sleep evaluation with a sleep study.

51:40What about white noise things? So, you know, I I live up in the hills here, so we've got coyotes and we've got owls, and they tend to be nocturnal. And I've got one vicious attack poodle who definitely lets the coyotes know that he's there to protect us and keep us safe. He's 50 pounds of red raw courage, as his sister who sleeps through the night is a 50-pound white poodle. She seems fine, but once the coyotes go and the owls go, and we keep our room cool for that reason, So we keep that beautiful Santa Monica mountain breeze air going at 65, 66. But should we have a white noise machine? Or what if you live by railroad tracks?

52:20Talk to me about people that live in urban noisy environments. Is there whale sounds or something you can go to bed with that actually has evidence?

52:31Dr. Jesse Mills:Nowadays, as far as evidence, unfortunately, these things are not as, even in general, just in sleep medicine, even for the common sleep disorders, there's limited data. out there for multifactorial reasons. But I would say that things that can help at nighttime with things like that, I mean, if there are environmental factors that you just can't do anything about, the railroad tracks are right near your room, or there's construction happening in the unit above you for a good nine months, for example. Things that you can do, definitely white noise machines. There are a lot of apps these days that can do things like guided meditation or deliver white noise through the person's AirPods, for example.

53:09Dr. Jesse Mills:But one thing that I think that is really, really helpful for a lot of people and that there is some evidence that is some form of meditative practice or some kind of a kind of specialized movement type of art form um russian say art form but i should say examples including yoga tai chi mindfulness things like this we can't asleep doctors and scientists truly explain how these things improve sleep but there have been studies looking at the effectiveness of things like tai chi in fact there was a big study that came out of UCLA about 10 years ago, comparing the effectiveness of Tai Chi directly head-to-head versus cognitive behavioral therapy for insomnia, the most effective treatment for insomnia.

53:49Dr. Jesse Mills:And in this particular study, it was determined that not only were the results in terms of improvements in insomnia and the outcomes almost identical between the Tai Chi group and the cognitive behavioral therapy group, but even inflammatory markers in the blood like ESR and CRP were actually lower in the group that did Tai Chi compared to CBTI. So it's one of those things where we have this belief that something like yoga, something like meditation, something like mindfulness can increase the arousal threshold and allow for a more deep and continuous restorative sleep. Oh, that's amazing. I love that.

54:23Again, not in the doctor's office. You can figure some of these things out with the right coaching. Well, you delivered on the mailroom, Dr. Kishani. I got one more question for you. The band you delivered that was amazing. So much fun. But I always ask all my guests, if they're physicians, or even if they're just guys that are have figured life out, what are your must haves on a daily basis? What do you do when you get up and say, I have to do this to have a good day?

54:54Dr. Jesse Mills:Absolutely. Well, I guess I'm a pretty simple guy. For me, as long as I have my morning coffee and my afternoon workout, that's the most important thing to keep me on a nice routine. As you know, I have a very busy practice. I love what I do as a sleep doctor. I love seeing patients and treating sleep disorders is extremely rewarding. So I consider myself very lucky for all of that. But ultimately, I, like I said, I usually just keep it simple. As long as I have my coffee and my afternoon workout, I wish I could do the morning workout. I'm jealous of all the guys out there who can wake up at four o 'clock in the morning, knock out the workout, then go get showered and go to work.

55:28Dr. Jesse Mills:But I usually like to ensure that I have, especially that tail end of my sleep as extended as possible before getting up to start. Hear me both, brother. That's rough. I mean, my older boy played football in high school. I don't think I had greater sacrifice for a kid than getting up at five in the morning and do morning workouts with him before dropping him off to high school and then me going to a full day in the OR. And man, I'm glad when he graduated high school. I cannot go back to morning workouts. It's just not not in my DNA. So so that's good. Just you got to get your reps in. It just, you know, just depends on when you want to do it.

56:04That makes sense. Well, where can people find you, Sam? Are you promoting anything? Are you doing any workshops? Anything outside of your practice that you want to you want to highlight on the mailroom?

56:12Dr. Jesse Mills:Absolutely. So I'm actually currently the president of the California Sleep Society, which is the largest professional sleep organization in the state of California. We have a lot of events and activities on our website. I'm also very active in terms of speaking in different cities and different conferences. You can find me on Instagram at Sam Kashani MD or on LinkedIn just by searching my name, Sam Kashani MD. Wow. It's amazing. We talked about it, Jordan. He delivered. Fantastic. I'm so glad that you're on our faculty and so glad that you gave us the last 45 or so minutes of your time, which was incredibly valuable.

56:50I think you helped a lot of guys today and I appreciate it. And also, the people that sleep next to those guys as well, I should say. So those are just as important. So thanks, Sam, so much. I'm sure I'll see you around campus and keep up the great work for everything you do in men's health and beyond. Thank you so much. Have a great rest of your day, brother.

57:06Dr. Jesse Mills:Be good. Appreciate you. You as well. Thank you so much. Take care. Bye-bye.

57:18Let's talk about it. Let's talk about it in the mailroom Let's talk about it Let's talk about it in the mailroom Let's talk about it Let's talk about it in the mailroom

57:40Dr. Jesse Mills:The Mailroom with Dr. Jesse Mills was a production of iHeartRadio. It was executive produced by Jordan Runtog. It was edited, mixed, and mastered by Bahid Frazier, and the theme was provided by Long Transit. If you liked what you heard, please subscribe and leave a review. For more podcasts from iHeartRadio, check out the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows. This program is intended for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Consult your health care provider for any medical or other related questions or concerns.

58:20Dr. Jesse Mills:The views and discussions aired on this podcast are those of Dr. Mills and do not represent the official positions of UCLA or UCLA Health.

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