March 7, 2018

Addressing Sleep Issues in Clinical Practice: A discussion with Russell Jaffe, MD, PhD

Sponsored by PERQUE Integrative Health
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The Centers for Disease Control and Prevention has reported that a large number of Americans have sleep issues that are causing a wide range of health problems. There is a significant link between lack of sleep and hormonal, inflammatory, and immune system health. In this interview, Russell Jaffe, MD, PhD, describes the connection and then provides information about his comprehensive, integrative approach to sleep issues. Jaffe’s clinical approach features a combination of diet, dietary supplements, sleep hygiene strategies, and other lifestyle factors.

Approximate listening time: 38 minutes

Continuing Education Credits Available

This podcast interview qualifies for 0.5 general continuing education (CE) units. The Oregon Board of Naturopathic Medicine has approved this educational content for 0.5 “general” CE units for naturopathic physicians. Naturopathic physicians licensed in any U.S. state except California may obtain general CE by listening to this podcast and completing a 10-question test on the material contained within the clinical topic. Click the button below to take the test for FREE, thanks to an educational grant from PERQUE Integrative Health. Upon successful completion, you will receive an email confirming you passed. This CE approval may also qualify for the CE requirements of other practitioner types.

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About the Expert

Russell M. Jaffe, MD, PhD, is CEO and Chairman of PERQUE Integrative Health (PIH). He is considered one of the pioneers of integrative and regenerative medicine. Since inventing the world’s first single step amplified (ELISA) procedure in 1984, a process for measuring and monitoring all delayed allergies, Jaffe has continually sought new ways to help speed the transition from our current healthcare system’s symptom reactive model to a more functionally integrated, effective, and compassionate system. PIH is the outcome of years of Dr. Jaffe’s scientific research. It brings to market 3 decades of rethinking safer, more effective, novel, and proprietary dietary supplements, supplement delivery systems, diagnostic testing, and validation studies.

About the Sponsor

Perque Integrative Health

PERQUE Integrative Health (PIH) is dedicated to speeding the transition from sickness care to healthful caring. Delivering novel, personalized health solutions, PIH gives physicians and their patients the tools needed to achieve sustained optimal wellness. Combining the best in functional, evidence-based testing with premium professional supplements and healthful lifestyle guides, PIH solutions deliver successful outcomes in even the toughest cases.


Karolyn Gazella: Hello, I'm Karolyn Gazella, the publisher of The Natural Medicine Journal. Today, I have one of my favorite guests, Dr. Russell Jaffe, with me. Our topic is sleep. But before we begin, I'd like to thank the sponsor of this interview, who is PERQUE Integrative Health.

Dr. Jaffe, thank you so much for joining me.

Russell Jaffe, MD, PhD: A pleasure to be with you, Karolyn.

Gazella: Yes, it's always a pleasure. This is an important great topic. Now, the CDC has said that lack of sleep is a significant national health problem. It's reached epidemic proportions. Now, why do you think so many people today don't get enough quality sleep?

Jaffe: Well, first I commend my colleagues at the Center for Disease Control for waking up. Yes, sleep deprivation in our time, in this 21st century, it is at least epidemic, and it may be endemic. Endemic means beyond epidemic. If it becomes so usual that it's like the normal, we don't notice it.

Fortunately, CDC has noticed that sleep deprivation causes all sorts of "tsuris." That's a Yiddish word for problems. It causes all sorts of amplifications of dispositions to ill health. Not necessarily the sole cause or the single bullet in the problem that a person has, but anything you have will be made better by good restorative sleep. Anything, any health challenge you have, any performance issue, any life quality issue, will be made better by good quality of sleep and worse by a lack of restorative sleep. The emphasis here is on restorative, not just on being unconscious.

Gazella: Right, I would agree with that. I want to dig into some of the technical aspects of sleep. Can you first explain to us the intricacies of the hormonal regulation of sleep? What's going on?

Jaffe: Well, half a step back if you permit me, which is in biology, in life, it's always about proportion, or ratios, or balance or imbalance. We can, and I'm happy to talk about the hormones and the neurochemicals, and the sources of these neurochemicals that are amino acids. The sources of some of these neurohormones that are either a vitamin or a fatty acid, a dietary source again.

As Hippocrates said several millennia ago, "Let your food be your medicine. Let your medicine be your food." If you start with a healthy, all foods diet that you can digest, assimilate and eliminate, you will then take in a healthy balance of the precursors to all of these neurochemicals, neurohormones, et cetera, and the body will figure out how to utilize them in an efficient and effective way.

Now I know that's a kind of high level view. But when we talk about these rhythms, which sleep is a particular example of biological rhythms in action, we do know certain things. There are four phases to sleep. At the end of the fourth phase is the time when a release of growth hormone, a release of neurochemicals, a release of neurohormones occurs, and abnormal cells are identified and eliminated. It's called apoptosis for those of you who speak Greek. But it means that everybody makes abnormal cells, abnormal cells you could hear as cancer. But everyone makes abnormal cells every day. The reason we don't all have cancer is because at night we have a restorative and reparative system that also identifies abnormal cells and eliminates them.

Now I mentioned the importance of rhythm, and you asked me about hormones, which is the right question to ask for sure, one of them. One of the hormones we know in relation to stress resilience, and stress adaptation and stress response is cortisol coming out of the adrenal under the stimulation of the pituitary, which in turn is controlled by the pineal, and we'll get upstream at some point.

When cortisol goes up because we're under stress, if DHEA, the companion molecule on the other side, the source of the androgens and estrogens, if DHEA goes up in proportion to the cortisol going up, we're fine. It's when the stress hormone cortisol goes up and the DHEA is exhausted and cannot go up, that's when we have a first level of problem. That's when people feel invincible, but they're not. They're cruising for a bruising, but they're not aware of it because the cortisol overrides the commonsense of the DHEA and those androgen and estrogen compounds.

There are other hormone ... Go ahead.

Gazella: Yeah, that makes a lot of sense, and I was going to ask you, but are there hormonal connections, so please continue.

Jaffe: Oh. If I may, there are other modulators. One important balance point or ratio is the cortisol to DHEA. But then there are others including the adrenaline to serotonin. Now adrenaline derived from the amino acid tyrosine, derived from our dietary protein, adrenaline says, "Go and you can persevere until the success shall be won." In contrast, serotonin says, "Now hold on there. Maybe we don't have the fuel to go all the way to the end. Maybe we should be a little more sensible here and not get exhausted."

Now serotonin comes from tryptophan just like adrenaline comes from tyrosine. Both of these come from the proteins we eat. If we're a carnivore, we'll have more of those amino acids. If we're a vegan or a vegetarian, we'll have less. If you think your engine is burning too hot because of too much adrenaline, if you think that it would be better for you to be more on the calm than on the assertive side, my suggestion is try a plant based diet.

You might not want to be a vegan or a strict vegetarian cause I think you should have a wide variety of foods that you can digest, assimilate and eliminate without immune burden, and I'm not making any political statements about ... Although my personal preference is a more plant-based diet cause I think that's healthier. I think that's less polluted. I also think that's better for the planet.

But I put my little advertisement in, and now I'll get back to the fact that tryptophan becomes not just serotonin, the soothing counterbalance to adrenaline, but serotonin becomes melatonin in the pineal, this deep control center. We've learned about the pituitary as the master gland, but the mistress or the master of the master gland is the pineal, modulated through the thalamus and the hypothalamus. We can get into all those tracks if you want cause I really am a biochemist and a neuroanatomist.

But the point is that amino acids derived from our diet become the neurochemicals whose balance we express in our personality, in our resilience, or in the way in which we're distressed. The people who have mood issues, the people who have endurance issues, the people who are concerned that sometimes they, maybe either overreact, or they're just not in tune with what's going on and people misunderstand. In any of those situations, you have an imbalance of cortisol to DHEA and/or an imbalance of adrenaline to serotonin.

Gazella: Right, that makes a lot of sense. I love how you brought adrenaline and serotonin to life. That was perfect. I want to stick with the topic of amino acids here. You know, I've heard varying views about tryptophan versus 5-HTP regarding sleep. Can you clear up that confusion for us?

Jaffe: I absolutely can. There was a time when tryptophan was the favorite approach, the more natural approach to sleep, to sleep enhancement, sleep quality. Then it fell under a cloud because of something called Eosinophilia–myalgia Syndrome. At that time ... This was the late 80s, early 90s ... there was voluntary recall of tryptophan. At the same time, interestingly, that serotonin reuptake inhibitors were being advocated on the pharma side.

Tryptophan fell under a cloud until it became clear that due to a change in production techniques, one company called Takeda had inadvertently, not intentionally, but they had changed the way in which they produced tryptophan. It was cheaper for them to produce large bulk of tryptophan. But they also included what turned out to be something called Peak E, which was a dimer. It was two tryptophan molecules bridged by a small carbon bridge. The consequence was induction of pain, myalgia, muscle pain, and an allergic-like response, eosinophilia. The FDA, out of an excess of caution, asked the industry to voluntarily recall tryptophan and they did, which was the right thing to do, in my opinion.

At the same time, my group published a clinical observation, which is we had uncontaminated tryptophan, and we gave it to people with this Eosinophilia–myalgia Syndrome, and it helped them get better, and we published that. If tryptophan was the real culprit, then giving them tryptophan would have made them worse, and it made them better, and we published that.

Now the agency, the FDA did not yet know about the contaminate now known as Peak E, this dimer of tryptophan that somehow jangles things up or messes things up. In fact, we do know how it does that. It bridges across two receptors in a way that makes the cell very unhappy.

Out of an excess of caution, the FDA asked the industry to withdraw tryptophan. In the absence of tryptophan, 5-HTP became popular because it's a tryptophan derivative. That sounds okay. Until you learn that it most often goes to quinolinic acid, and a series of excito-neurotoxin consequences that are not so good. You don't get as much of the serotonin to melatonin conversion when you go through 5-HTP. It's actually better to go directly from tryptophan to melatonin and bypass the 5-HTP.

5-HTP is a supplement. It is available in health food stores and online today. It is not my preferred form because I always believed in tryptophan. I still believe in tryptophan. My recommendation is enhanced uptake tryptophan. Because it turns out when you have a little B6, a little B3, a little zinc, a little of the right fiber, then you double, triple or quadruple the uptake from the intestines into the body so you get smoother uptake and better total absorbability, or what we call bioavailability. That is basically what we recommend.

Gazella: Interesting. With the tryptophan, is there a dosage range for sleep that you typically recommend?

Jaffe: Well yes, in regard to the tryptophan ... And I do recommend the enhanced uptake and the chaperone delivery. But for the tryptophan itself, it's anywhere from 500 milligrams of free amino acid to 1,000, maybe even 2,000. It is absolutely safe for people to start at the lower end, which would be one capsule, say 500 milligrams, and go up anywhere from two to four, depending on their body mass, depending on their situation.

Then often people ask me the question, "Well, what if I get up in the middle of the night?" "Well, why did you get up in the middle of the night? If you got up to go to the bathroom, go to the bathroom and get back to bed. If you want, you can take a second dose of the tryptophan because the peak occurs at 30 minutes. It has really done its job after four hours. If you are in a deep sleep and you stay restorative in your sleep, you don't need more. But if you get up, for whatever reason, my suggestion is take another dose. Take another one, two, three, four capsules, whatever dose works for you, 500 to 2,000 milligrams per dose. You can take that two or three times in a night."

Now occasionally, people do tell us that if they take more than 500 milligrams, they sleep really soundly. But when they get up, they're a little bit groggy before they really get going. That feels, to me, like a little too much. "Metabolism does play into this individuality," as Roger Williams told us. Biochemical and individual natures of our metabolism, how robust is our liver, how effective is our spleen and kidney at any moment in time, these are important variables.

Gazella: Yeah, and I'm glad that you mentioned that about the breakthrough insomnia, because I think that a lot of people are affected by that, where they will wake up at 2:00 in the morning and then they're frustrated, so that's good to know about the tryptophan. Now are there any-

Jaffe: Well, let me add if I can jump in on that, cause it is very, very common. It is also very common in people who are more creative, more sensitive and more aware. Why? Because they're worrying. I think you know this, but the Dalai Lama is my daughter's godfather. One of the things he said to me is, "Don't worry."

Gazella: Good advice.

Jaffe: Good advice, hard to do. You have to practice it and that's the point. Sometimes two, three, four o'clock, maybe even five o'clock in the morning, it may feel early, but that's the preferred time for monks to meditate. They go to bed early, but they get up early.

If you're one of those people ... And I'm in that phase of my life. I tend to go to bed early now, and I tend to get up early. I find those few hours before dawn a delicious time to either relax, or stretch or meditate, or just have a few quiet moments to myself where the phone doesn't ring.

Gazella: Yeah, I would agree. Now are there any other amino acids that can be helpful with regulating sleep and mood?

Jaffe: Well, yes, and there's two parts to this discussion. There are the amino acids related to detoxification. Then there are the amino acids related to mood stability. If I can take those in reverse order, in regard to mood, it turns out that glycine, the simplest amino acid, is also a neurotransmitter. It's a soothing neurochemical. If the nerves are excited, glycine calms them down. If the nerves are exhausted, glycine provides an energy source to wake them back up. Glycine's really very important in the brain, also important in the gut nervous system.

In addition, if you combine glycine with methionine, a methylating detoxifying amino acid, and combine those two with magnesium aspartate, an amino acid that in its own right has been studied as a mood modulator, as an antidepressant. But when combined with the detoxifying methionine and the neuro-balancing glycine, that's a very interesting combo of simple amino acids that in combination with the tryptophan can give even deeper and more restorative sleep.

Gazella: Perfect. Then now you mentioned the detox side of things?

Jaffe: Right. Now the other side is there are three phases to detoxification, phase one, phase two, phase three. Within the detoxification system, you want sulfur containing amino acids like cysteine, C-Y-S-T-E-I-N-E, you want methionine, but you might want a little phenylalanine because in order for sleep to occur, you must have enough adrenaline in the deep brain sleep center so that the adrenaline falls at the same time that the serotonin rises. That's called going to sleep at the cellular, molecular, biochemical level.

Now what happens if the serotonin rises cause you're tired, and your body wants to go to bed, but there isn't enough phenylalanine-derived adrenaline to fall, you'll be exhausted, but you'll still be awake. What about the other side? What if the adrenaline falls, but you didn't take in enough tryptophan so the serotonin doesn't rise? You'll be groggy, but you won't have restorative sleep. We need to have the fall of adrenaline and the rise of serotonin at the time when we're horizontal, not vertical.

Gazella: Right. I want to kind of circle back to what's going on when we're sleeping because you mentioned previously when we're sleeping, the body is really quite active. I've read studies associated with inflammation for example. If you get six hours or less in just one night, you put your body in an inflamed state. We know that there's a strong connection between the immune system and the inflammatory system. What's going on with those two systems in particular, and why is it so damaging if we're not getting enough sleep?

Jaffe: A profound, important question, and a question for our time, our 21st century challenging time. There is so much that occupies people today, so many screens, so many calls, so many distractions, so many attractions, that most people do not appreciate that sleep is essential for quality of life. If you want to add life to years and you want add years to life, you must have a quality of sleep.

Most of us, at some point, we become tired and/or exhausted. We do get into bed. Most of us even take our clothes off before we do that. But most people ... And I'm the exception here and I would advocate being the exception. Most people do not have a roughly half an hour or so during which they prepare for a restive, restorative, rehabilitative sleep time. They might even dream. They might even be able to solve a problem and bring a solution back into waking time. It turns out you can do things called lucid dreaming if you're inclined towards that.

But the bottom line is that sleep, preparation for sleep, and appreciation of the importance of sleep has been massively devalued in our society. Where we're supposed to go as close to 24/7 as we can and sleeping is somehow either depreciated, deprecated, or seen as a sign of sloth.

Now when I was a young doctor in the academic medical world, I can tell you that I slept so little that when Rebecca and I got together ... Cause she's a fine artist who values her sleep, and she's a terrific human being if she gets 10 to 12 hours of sleep a day. At the time, I was sleeping about four hours a day and thought that was just fine, which meant we had to choreograph being together, but we figured it out.

My point is that very often the very people who would benefit from mindfulness and restorative sleep don't "have the time." They can't fit it in. They're too driven to succeed. Or, as the Dalai Lama says, "They sacrifice their health to gain wealth. Then they give back their wealth to regain their health and they are so busy living in the past or ruminating about the future, that when they pass in the moment, they have barely lived."

That's a classic Buddhist perspective. I'm not particularly Buddhist, although I've done of lot of mindfulness myself. I have found that it helps to not just to feel that I've indulged in sleep, but to know that with wisdom and more years, having the ability now to go to bed early and get up early is delicious. I don't miss going out to the Kennedy Center as much.

Occasionally, I still want to go out and socialize. I have friends over. I prefer to cook for them than to go to a restaurant cause when I cook, I know what they're going to eat. I know we're going to sleep better because it's going to be food you can digest, assimilate and eliminate without any burden. I'm even going to take into account what their biochemical individuality might be and sometimes I get it right, sometimes I don't, but I always try.

Sleep is our friend. Sleep is to be appreciated for the positive side, not for the absence of usual consciousness.

Gazella: You know, I want to get back to specific nutrients cause we've already talked a lot about amino acids. But before I talk about other nutrients, I'd like to talk about sleep medications. There are some pretty potent prescription sleep medications. There are over the counter sleep medications. Do you have an overarching view of these sleep medications and if they're helpful or if you think it's better to try to get patients off of these sleep medications? What's your view?

Jaffe: Well, actually it's interesting. My view is more or less the same as the FDA. The FDA's official view is if you can do without them, please do. If you can possibly do without them, do. Because the adverse effects are clearly known. The benefits are also statistically defined. If you absolutely need them, they are beneficial at least within the reductionist frame of our scientific method.

But while I agree with the FDA, I often find that if people will follow through on what we're talking about. Including, having a diet that's appropriate for them, that they can digest, assimilate, and eliminate without a burden.

When they have enough of the essential vitamins, include vitamin D, which is really a neural hormone and other essential nutrients. So that their cells can deal with the challenges and stresses of the day without being so overexcited or overexhausted, those are two extremes which we want to avoid. Being overexcited or overexhausted.

We want to be resilient, we want to be in the middle. Sleep is just really important for all of that. Now with regard to prescriptions, the most common question I get is, can we approach this nature, nurture, and wholeness approach to sleep ... these amino acids and these fatty acids that are the precursors for these complicated molecules.

Can I increase nature's sleep balancing, stress balancing molecules? The answer is yes, although in many cases—especially, in the cases of Ambien and other serotonin reuptake inhibitors—when you bring in nature's team, the full valet or symphony of life, very often you can taper the pharmaceutical hypnogogic sleep medicines.

Taper them, eliminate them slowly. The importance of that is that it's known and it's been proven in many scientific studies. That you do sleep, however you don't dream and you don't have the normal sleep rhythms phase one, two, three, four. You don't have the normal release of growth hormone, which is so important to identify abnormal cells and eliminate them.

So sleep prescriptive medicines are benefits with a cost. I usually find that when we bring in the essential nutrients that people can't make. That they must take in from their diet or supplements, that they can then taper safely and effectively, the pharmaceutical sleep medications.

Gazella: Yeah, that's good to know. Certainly long-term use is definitely not indicated with those pharmaceuticals. Talk a little bit about those specific nutrients that practitioners who are listening can use to help improve sleep quality.

Jaffe: Well, we've talked about amino acids, so I'd like to note turn towards the fats. Those essential fatty acids, the omega-3 and omega-6 fats are the sources for the prostaglandins. They're the sources for the thromboxanes, which are the really active but short lived molecules inside the body.

We can measure the balance of omega-3 to 6 in laboratories. Neil Harris has devoted decades to validating the omega-3 index. My colleague, Artemus Simopolous, has looked at the NHANES National Health and Nutrition survey data.

She says that Americans now, instead of having a balance of omega-3 to -6, because of edible oils, and fats in our diet, and these foods that are crisped, and chipped, and so forth. It's typical for Americans to have 20, 30, 50, 80 times more omega-6 than omega-3, which is pro-inflammatory.

That makes you feel worse faster. That makes you more inflamed, and creaky, and uncomfortable faster. Folks like me no longer use edible oils. We cook with wine, or we cook with broth, or we cook with beer, and whole foods.

When you do that, you can restore a typical four to one ratio and not be so pro-inflammatory. Many people that I meet today look, feel, and function as if their body is under assault, inflammatory assault as if it's not repairing itself.

Inflammatory is really repair deficit. When your body can repair itself, you don't have inflammation. So we don't want to have zero omega-6 intake, but we don't want to have 50 times omega-6 to omega-3.

There is an omega-3 index test. It's one of the eight predictive biomarkers. It can help you take in the sources of fat that are essential and good. By the way, there is good fat. Omega-3 and omega-6 fats are good unless they're damaged by air and oxygen, in which case they're bad.

So you want them distilled under nitrogen. You want them in whole food sources. You want them in the healthier forms so that your body can convert the omega-3 fats into the prostaglandins that repair you while you still have a little bit of omega-6 to activate the system. But not so much that it creates repair deficit commonly known as inflammation.

Gazella: Perfect. Now in addition to the EFAs, before I move on to my next question, are there any other nutrients that you'd like to highlight?

Jaffe: Well, yes and it's in the broad category of, life is connected at every level with every thing. But when we think about, say sleep, and how the systems that convert these amino acids or these fats into the quality of sleep molecules that we're looking for.

We must have enough antioxidant ascorbate in the cell to donate electrons and prevent free radical oxidative harm. We must have enough magnesium, choline, and citrate. We advocate advanced uptake in chaperone delivery of magnesium using choline citrate.

So that you can correct the acetylcholine/bile salt deficiency at the same time you've energized and alkalinized the cell, while bringing magnesium into the cell. When very often, there's too much calcium and too little magnesium.

In fact, calcium channel blockers are a major category of pharmaceuticals because there is a relative excess of calcium. But there's an absolute deficiency of magnesium. Magnesium in the diet, Dr. [Rah Aleem 00:06:51] has shown, has dropped half, by 50 percent in the last 50 years.

While the need for magnesium ... because of stress and medicines that waste magnesium. Like, proton pump inhibitors and H2 blockers, and many chemotherapies, and even hypertensive medicines like diuretics are known to waste minerals including magnesium. So, as my grandmother used to say, the rents are going up and the ceilings are coming down.

Gazella: It's true. So, you know the conversation between the patient and the doctor is an important one. I'm wondering for the Healthcare Professionals who are listening, what type of tips do you give patients to help them get a good night's sleep?

I know you believe that it's not just a matter of handing somebody a pill and calling it a day. It's a very comprehensive approach that you have to health. So, what type of advice do you give to people who are struggling with sleep?

Jaffe: Thanks for asking and yes, as important as I believe diet and supplementation are in the 21st century, it's about what you eat, drink, think, and do. So, let's talk about the doing part of preparing for sleep.

Here's what I do, I set aside the half an hour before I'm gonna get into bed. During that half hour, I want to get as much value as I can. So I set a salt and soda bath. I put a half to one cup of Epsom salts and a half to one cup of baking soda.

My skin isn't dry, but if my skin was dry, I might put in a drop of Rosemary or some other Emollient oil, an aromatic. I soak in there for about 20 minutes. While I'm soaking, I do five minutes of deep abdominal breathing.

If you want to know what abdominal breathing is like, get a video of a baby or watch a baby because they all do it correctly. They breathe abdominally. Then, do about 15 minutes of mindfulness practice, or active meditation, or whatever is your preference to let go of the day.

Very often, people fall into bed, reasonably tired and exhausted. But thinking about the stresses of the day and they bring that into the bedroom. In my bedroom, we actually have no screens, we have no clocks, we have no alarm clocks, we have no phones. I know this is hard to believe, but I actually when I go to bed, I don't need to hear the emails coming in on my phone.

I believe, if you can, at the place where you sleep should be a place of serenity. That you should give yourself a half an hour to let go of the day and really let it go. Then, have an active time of restoring yourself through sleep.

If you want the bonus round, it's the green dichromatic light that I learned about from [Banti Darmawarh 00:09:56]. A rather extraordinary monk. Green dichromatic light is known to go directly from the retina to the pineal gland. In the pineal gland, it says everything is okay.

Green is the harmonizing color. This has nothing to do with vision. It has everything to do with the retinal / pineal direct connection, which has been reconfirmed by others. As [Banti 00:10:25] said, well wisdom, new things, millennia ago, and science is catching up and that's a good thing.

Gazella: I have not heard of the green light. That's fascinating to me.

Jaffe: No, it is fascinating. You may have heard about light boxes. There are people with what's called Seasonal Affective Disorder or SAD?

Gazella: Sure.

Jaffe: Norman Rosenthal and NIHMINH, showed that if you stay in front of these fluorescent light boxes for three hours a day, it boosts your pineal, and you get a little more melatonin, and you're less depressed. Banti said, people don't have time for that 20 minutes twice a day in front of the green. That's what we recommend.

Gazella: Wow, that's awesome. What about other hygiene aspects? Like the temperature of the room? Light in the room? Are those valid?

Jaffe: Thanks for asking. The answer to the second question in regard to light. It should be as dark as possible. Now if for some reason, it is not pitch black in the room where you sleep, please get a comfortable eye mask.

You should not have photons of light hitting the retina while your eyes are closed during sleep. If that requires an eye mask, please. They're not expensive, they can be comfortable. Take a flight on the Air Singapore, they'll give them to you. At least in business class. That's the question of dark.

Now, the nature of the room itself, should be comfortable, cool, this is a situation where warm is not your friend. What I have is a latex mattress which is very firm and lets me float. That's a nice thing. I have a duvet, so I have ... Some goose donated some feathers and somebody sewed this together.

In Germany, this is routine. You have this light Duvet on top of you. You have a mattress that will support you. It's cool in the room, you don't want it warm. Does that address your question?

Gazella: Absolutely, absolutely. Those are some great tips that our Practitioners can keep in mind when talking to their patients. I'm just wondering, we're about ready to wrap up, is there anything else that you'd like to talk about sleep for our listeners today?

Jaffe: No. I thank you for the opportunity to come at it in this way. Restorative sleep is one of essentially components of a life well lived. As someone who didn't think that sleep was important for many decades of my life, I can tell you it was a mistake.

I'm correcting that now. But I do also believe there are different phases to a life. I think if you're an adolescent, you have a different sleep rhythm. My understanding today is that young people actually do go to bed later and get up later, although they may or may not be able to do that and still graduate from schools.

But I do think at different seasons of our life, we have different relationships between wake and sleep. I want both my wake time and my sleep time to be as productive as possible because this is the only life that I know I have at this time. Therefore, every moment to me is precious.

Gazella: Yeah, absolutely. Great point, great way to end. So once again, thank you Dr. Jaffe for joining me. I'd also like to thank the sponsor of this interview, Kirk Integrative Health. Thank you and have a great day.

Jaffe: Thank you, Karolyn. A pleasure.

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