Problems with congestion spike during seasonal allergy season, which then get amplified at night due to a combination of allergic, physiologic, and environmental factors.

Continue reading to learn about the causes, treatments, and practical tips to reduce nighttime congestion.

What Causes Congestion at Night?

Nighttime congestion is rarely due to a single cause. It’s usually a combination of allergens, anatomical or physiological reasons, and environmental factors.

Allergens that cause nighttime congestion

Allergens are the most common reason for congestion at night. They are especially worse at night due to close proximity to the allergens and prolonged exposure (~8 hours)

• Dust mites are arachnids that feed on dead skin cells and love to live in bedding, pillows, mattresses, stuffed animals, and other soft-textured things… like all the stuff humans like to sleep surrounded by. If your nose gets stuffy just as you put her head down on your pillow, there is a good chance you have allergy to dust mites.

• Pet dander is another common bedroom allergen, especially if pets sleep in the bed. Even for people who aren’t allergic to cat or dog dander, pets can bring other allergens in their fur or paws with them.

• Mold spores, especially in humid environments

• Pollen, which can be through open windows or carried indoors on hair or clothing. Some indoor plants may also release pollen that you may be allergic to.

Body position + physiology

The nasal air passages are already narrow to start with, and various nighttime factors can make things worse. Blood vessel (vascular), inflammatory, and autonomic mechanisms affect the size of the nasal passages, ie you can get and feel more blocked or congested, even with same amount of mucus.

• Lying flat increases nasal blood flow, leading to swelling of the nasal turbinates.

• Inflammation due to allergies, viruses, sinusitis, or non-allergic rhinitis cause both increased mucosal swelling and increased mucus — ie less space for more blockage

• Lying down on the back narrows the airway at the back of the mouth/nose. This means that the air needs to be drawn in faster through the nose, if you’re not mouth-breathing. Basically, airflow demand through the nose increases.

• Anatomical factors like a deviated septum turbinate hypertrophy, nasal polyp, or nasal valve collapse create a narrower air passage, which can get blocked off more easily. Some of these problems may be apparent during the day, but lying down at night may make them more prominent.

• For people who have mucus in the maxillary sinus (behind the cheeks) due to sinusitis, the mucus can’t drain out when they are upright, because the holes (exits) to the sinuses are at the top on the inside (nose side). When they lie down on their side at night, the mucus can drain out — this is good, but the nose will feel suddenly congested.

Environmental factors

• Dry air, especially in winter time or air-conditioned environments, can irritate nasal mucosa

• Bedpartners: Pets and people, all of whom might have have allergens on them, are often very close by at nighttime

How to treat nighttime nasal congestion

There is strong clinical trial evidence back up a few categories—and weaker or mixed evidence for others.

Intranasal corticosteroids (strongest evidence)

• Examples: fluticasone (flonase), budesonide (nasacort)

• Mechanism of action: reduces inflammation in nasal mucosa

• Multiple randomized trials show improvement in:

  • congestion

  • sleep quality in allergic rhinitis

• These are first-line treatments chronic nighttime congestion, especially if there is an allergic component

• Sleep doctor pro tips:

  • First clear out the gunk (see saline irrigation, next), then blow your nose, and then use corticosteroids. This way, the medication can actually reach the mucosa.

  • You won’t “feel” any difference immediately, more like over a couple weeks, as the steroids gradually reduce mucosal swelling

  • Start a couple weeks before seasonal allergies typically begin

  • If you have glaucoma, do not use without asking your doctor first

Saline irrigation (moderate evidence)

Saline irrigation means using salt water (so that it doesn’t sting) to rinse out mucus, allergens, and all the “gunk”.

• A Neti pot is probably the most effective and gentlest way to get the whole area flushed out including at the back/top of the nasal passages. People either love it or hate it… It is the cilantro of saline irrigation.

• A squeeze bottle is less “rinsy” but easier for most people.

• Saline spray is easiest to use but won’t do much if there is a lot of gunk in the way.

• Clinical studies show improved symptom scores and reduced need for medications, but studies are less rigorous than medications (because pharmaceutical companies don’t tend to invest in trials of non-pharmaceuticals)

• Sleep doctor pro tips:

  • Don’t use tap water (or god forbid, well water) due to the risk of infection, including by brain-infecting amoeba. Seriously!

  • Use distilled, sterilized, or boiled-then-cooled water.

  • You can purchase salt packets, or make your own with non-iodized salt.

  • Here’s a good guide from Mayo Clinic and a video from Cleveland Clinic on how to use a Neti pot. (Video 1:14 is the actual rinsing part).

  • Blow your nose when you’re done so that remnant moisture doesn’t drip out.

Antihistamines (mixed data)

• Examples: loratadine, cetirizine, fexofenadine, etc

• Antihistamines can be helpful if congestion is related to a histamine-driven, allergic response. Clues are if you also have sneezing, eye itching, and other allergic symptoms.

• Sleep doctor pro tips:

  • Antihistamines don’t work for congestion caused by non-allergic factors

  • Diphenhydramine (benadryl) and other antihistamines that affect brain histamine receptors will also make you drowsy. I do not recommend using these.

Decongestants: short-term only!

• Decongestants work by constricting the blood vessels.

• Examples: oxymetazoline (afrin), phenylephrine, neosynephrine

• You can feel them work pretty much immediately, so they are effective for rapid symptom relief.

• But, using more than ~3 days leads to a rebound syndrome called rhinitis medicamentosa, where your nose blood vessels get “addicted” to the drug and have a rebound dilation, leading to worse congestion.

• Sleep doctor pro tip:

  • Decongestant dependency is real and a very tough habit to break!

  • Only use for a couple days, like if you have a cold or seasonal allergies.

  • Do not use for chronic congestion. You are only making it worse.

How to reduce allergens that cause nighttime congestion

Getting rid of allergens is the highest-yield intervention, and unfortunately the most overlooked.

Clean bedding (*critical): Get rid of dust mites and other allergens

• Wash bedding weekly in hot water

• Wash or replace pillows every 3-6 months: Yes, the inside soft part! Here’s a guide from Martha Stewart.

• Use dust-mite-proof covers for pillow and mattress

• Don’t sleep with decorative pillows, blankets, or stuffed animals that aren’t washed

Air quality

• DAMP-dust every 3-6 months to remove dust: Mattress and boxspring, bed frame (yes, all the little nooks and crannies), blinds and other window decorations, ceiling fan, baseboards. Don’t dry dust, which just distributes allergens.

• Set up a HEPA air purifier, especially if you have pets or allergies

• Vacuum at least weekly with a vacuum with a hepa filter

• Plants filter the air! If you have sunlight in the bedroom, get some greenery, checking that you are not allergic to the specific plant.

• Keep humidity lower, ~40–50%, to reduce mold and mites

Behavioral changes

• Shower before bed

• Have bed partner shower before bed.

• Keep pets out of the bedroom, or at the very least, out of bed.

• Minimize soft things: wall-to-wall carpet, rugs, fabric curtains, upholstered furniture (especially bed frame)

• Minimize clutter that can collect dust: knick-knacks, books, dolls, stuffed animals, toys

• Don’t eat or drink in the bedroom, as crumbs will attract insects (cockroaches are a common allergen) and vermin.

Bedtime routine adjustments

• Elevate head of bed slightly

• Don’t sleep with decorative pillows, blankets, or stuffed animals that aren’t washed. Ideally, you would not have these in the bedroom at all.

• Use saline rinse (ideally with a neti pot) right before sleep

Putting It All Together

If you suffer from nighttime congestion, the most effective strategy is layered and consistent:

1. Now: HEPA air filter, dust mite-resistant mattress cover and pillow covers.

2. Now & every 3-6 months bulk reduce allergens: deep damp dusting, vacuum, pillow-washing.

3. Every week: wash bedding, vacuum, dust.

4. Every night: shower, saline rinse, raise head-of-bed, no pets

5. Use intranasal steroid if persistent

6. In case of an uptick (eg seasonal allergies or a cold):

   • increase or add intranasal steroid

   • non-drowsy antihistamines

   • brief (3 days max) nasal decongestant

7. If you have chronic or severe nasal congestion, consider seeing an ear, nose, throat specialist (otolaryngologist) to assess for anatomical causes

Not all “sleep teas” are created equal. Some have real evidence behind them, while others rely more on herbal history. In this post and episode, we’ll explore which teas may actually help with sleep, what the science says, and how to use an evening tea ritual to support better nights.

Modern research is now beginning to explain the brain pathways that certain plants—like chamomile, valerian, passionflower, and lavender—may act through to support sleep. And while the chemicals in the teas themselves can be helpful, the ritual of slowing down with a warm drink may be just as powerful.

Listen as we discuss:

• The ritual, mindfulness, relaxing routine of tea is just as important as what’s in the tea

• There is usually a big placebo effect on sleep. Enjoy it!

• Chamomile, valerian root, passionflower, and lavender have clinical trial data to support their use for improving sleep.

• Many of the clinical trials used capsules rather than teas, and the dose you get in teas may be substantially less.

• Why you should avoid chamomile if you have a ragweed allergy

• Tips for brewing tasty teas

• Individuals at risk for bleeding or take blood thinners should be aware that valerian root, magnolia bark, and other tisanes/herbals may increase their bleeding risk.

• Bonus: best name for a Cat Cafe ever

Listen to or watch the episode, or read the transcript (at the bottom, past the picture of 4 teas). Notes with references to the studies discussed are below the audio and video players.

And of course, all the teas we tasted, and many others, are available at Traveling Tea — you can order online or shop in person.

Teas and tisanes tasted

• Chamomile Lavender

• Sleep Tight: Chamomile, Spearmint, Lemon Balm, Valerian, Lemongrass, Passion Flowers, and Rose Petals

• Chamomile Ginger

• MauHaus #6: Catnip, Spearmint, Basil, Violet, Dandelion leaf, and flower petals

• GABA Oolong

Listen here

Watch here

Notes on specific teas

Chamomile (Matricaria chamomilla L.)

• Apigenin is the chemical in chamomile that seems to act on sleep, through GABA-A receptors.

• A meta-analysis of 10 studies with chamomile (total 772 patients) showed a reduction in Pittsburgh Sleep Quality Index (PSQI) of 1.88 points. (Kazemi 2024)

• One of the included studies was in nursing home residents (mean age 70-71) without specific sleep problems, who took chamomile 200mg capsules (or placebo) twice per day for 28 days. PSQI improved more in the chamomile group. (Adib-Hajbaghery 2017)

• Another included study was in 34 people (25 women) age 18-65 with primary insomnia. They took 270mg chamomile capsules (or placebo) twice per day for 28 days. There was no change in nighttime sleep, and a slight (but not statistically significant) improvement in daytime functioning. (Zick 2011)

Valerian root (Valeriana species)

• Multiple mechanisms to affect sleep: GABA-A receptor activation, adenosine receptors, serotonin receptors; recently two chemicals in valerian root (Hesperidine and valerosidate) also shown to bind to orexin receptors. (Shenoy 2025) Hops which are frequently combined with valerian may bind melatonin receptors.

• A randomized clinical trial of 41 people (22 women, mean age 37, all had abnormal sleep quality at baseline based on PSQI>5) who took a combination of valerian 500mg and hops 120mg (or placebo) for 21 days showed an increase in total sleep time of 7.2 minutes (6.73h post-treatment vs 6.61h pre-treatment) and 21 minute benefit over placebo.

• A double-blind, randomized clinical trial of 42 people tested a single dose of liquid valerian and hops extract plus honey in water (ie it was drunk as a tea or tisane) or placebo, and had sleep measured with a semi-automated scoring system. This showed an overall increase in total sleep time and time in deeper sleep with valerian & hops. (Dimpfel 2008)

• A randomized clinical trial in 16 women with insomnia (mean age 69) of just valerian (300mg) or placebo, taken 30 minutes before bedtime for 2 weeks, and using self-report, actigraphy, and polysomnography outcomes, showed no difference between groups. (Taibi 2009)

• A study in 64 people testing a combination of L-theanine, lemon balm, valerian, and saffron did not show benefit compared to placebo. (Gudierrez-Romero 2024).

• See study on triple combo of valerian, hops, and passionflower in “Passionflower” section below.

Lavender (Lavandula)

• Almost all of the 46 randomized controlled trials in pubmed are for aromatherapy

• A randomized controlled trial in 221 people with anxiety tested lavender oil (80mg per day for 10 weeks) vs placebo and showed that PSQI decreased (improved) by 5.5 points, versus 3.8 with placebo. (Kasper 2010)

• A randomized controlled trial of lavender flower powder (500mg), bitter orange powder, and placebo in 156 postmenopausal women showed that there was an improvement in the PSQI in the lavender and bitter orange groups. (Kamalifard 2017)

Passionflower (Passiflora incarnata Linnaeus)

• Randomized, double-blind placebo-controlled study of 110 people with insomnia (mean age 40, 54% female) tested passionflower versus placebo for 2 weeks. This study found there was 23 minutes increase in total sleep time with passionflower using polysomnography (vs -0.1 minute for placebo). (Lee 2020).

• Combination of valerian 300mg, hops 30mg, and passionflower 80mg was tested against zolpidem (Ambien) in 91 (63 male) people with insomnia. The two groups showed similar effect, with total sleep time increasing from 206 to 252 minutes for the herbal combination group, and 212 to 324 minutes in the zolpidem group. (Maroo 2013) *Note that the triple combo is sold as Kyatta-Sedativum® in German.

No randomized clinical trials for sleep found in Pubmed for

• Catnip – Nepeta cateria

• Linden flower – Tilia

• GABA Oolong

References

Adib-Hajbaghery M, Mousavi SN. The effects of chamomile extract on sleep quality among elderly people: A clinical trial. Complement Ther Med. 2017 Dec;35:109-114. doi: 10.1016/j.ctim.2017.09.010. Epub 2017 Oct 13. PMID: 29154054. Pubmed

Dimpfel W, Suter A. Sleep improving effects of a single dose administration of a valerian/hops fluid extract - a double blind, randomized, placebo-controlled sleep-EEG study in a parallel design using electrohypnograms. Eur J Med Res. 2008 May 26;13(5):200-4. PMID: 18559301. Pubmed

Gutiérrez-Romero SA, Torres-Narváez ES, Zamora-Gómez AC, Castillo-Castillo S, Latorre-Velásquez AL, Betancourt-Villamizar C, Mendivil CO. Effect of a nutraceutical combination on sleep quality among people with impaired sleep: a randomised, placebo-controlled trial. Sci Rep. 2024 Apr 5;14(1):8062. doi: 10.1038/s41598-024-58661-z. PMID: 38580720; PMCID: PMC10997602. Fulltext.

Kamalifard M, Farshbaf-Khalili A, Namadian M, Ranjbar Y, Herizchi S. Comparison of the effect of lavender and bitter orange on sleep quality in postmenopausal women: A triple-blind, randomized, controlled clinical trial. Women Health. 2018 Sep;58(8):851-865. doi: 10.1080/03630242.2017.1353575. Epub 2017 Aug 25. PMID: 28749734. Pubmed

Kasper S, Gastpar M, Müller WE, Volz HP, Möller HJ, Dienel A, Schläfke S. Silexan, an orally administered Lavandula oil preparation, is effective in the treatment of 'subsyndromal' anxiety disorder: a randomized, double-blind, placebo controlled trial. Int Clin Psychopharmacol. 2010 Sep;25(5):277-87. doi: 10.1097/YIC.0b013e32833b3242. PMID: 20512042. Pubmed

Kazemi A, Shojaei-Zarghani S, Eskandarzadeh P, Hashempur MH. Effects of chamomile (Matricaria chamomilla L.) on sleep: A systematic review and meta-analysis of clinical trials. Complement Ther Med. 2024 Sep;84:103071. doi: 10.1016/j.ctim.2024.103071. Epub 2024 Aug 4. PMID: 39106912. Pubmed. Fulltext.

Lee J, Jung HY, Lee SI, Choi JH, Kim SG. Effects of Passiflora incarnata Linnaeus on polysomnographic sleep parameters in subjects with insomnia disorder: a double-blind randomized placebo-controlled study. Int Clin Psychopharmacol. 2020 Jan;35(1):29-35. doi: 10.1097/YIC.0000000000000291. PMID: 31714321. Pubmed.

Maroo N, Hazra A, Das T. Efficacy and safety of a polyherbal sedative-hypnotic formulation NSF-3 in primary insomnia in comparison to zolpidem: a randomized controlled trial. Indian J Pharmacol. 2013 Jan-Feb;45(1):34-9. doi: 10.4103/0253-7613.106432. PMID: 23543804; PMCID: PMC3608291. Fulltext

Schicktanz N, Gerhards C, Schlitt T, Aerni A, Müggler E, de Quervain D, Papassotiropoulos A, Boonen G, Drewe J, Butterweck V. Effects of a Valerian-Hops Extract Combination (Ze 91019) on Sleep Duration and Daytime Cognitive and Psychological Parameters in Occasional Insomnia: A Randomized Controlled Feasibility Trial. Brain Behav. 2025 Jun;15(6):e70600. doi: 10.1002/brb3.70600. PMID: 40462685; PMCID: PMC12134488. Fulltext

Shenoy AG, Ravi V, Subair S, Varman DR, Raju R, Rehman N. Discovery of natural orexin 2 receptor antagonists from Valeriana species: A potential approach for insomnia treatment. Chronobiol Int. 2025 Aug;42(8):1107-1120. doi: 10.1080/07420528.2025.2529398. Epub 2025 Jul 16. PMID: 40667860. Pubmed.

Taibi DM, Vitiello MV, Barsness S, Elmer GW, Anderson GD, Landis CA. A randomized clinical trial of valerian fails to improve self-reported, polysomnographic, and actigraphic sleep in older women with insomnia. Sleep Med. 2009 Mar;10(3):319-28. doi: 10.1016/j.sleep.2008.02.001. Epub 2008 May 14. PMID: 18482867; PMCID: PMC2709274. Fulltext

Zick SM, Wright BD, Sen A, Arnedt JT. Preliminary examination of the efficacy and safety of a standardized chamomile extract for chronic primary insomnia: a randomized placebo-controlled pilot study. BMC Complement Altern Med. 2011 Sep 22;11:78. doi: 10.1186/1472-6882-11-78. PMID: 21939549; PMCID: PMC3198755. Fulltext

Transcript

Yo-El Ju: Hi Kateri.

Kateri Meyer: Hi Yo-El.

YJ: So this is our sleep or sleepy tea interview. I'm super excited. Do you want to introduce yourself?

KM: Kateri Meyer - Traveling Tea - been in business since 2009 and I've had this shop since 2013. As I mentioned a few minutes ago, with everything that's going on in the world my number of people coming in the door asking for sleep teas to help them sleep has doubled.

YJ: Yeah. After everything in the news, after every event, I get lots of messages or calls from friends or patients or whatever asking what can I do to sleep better? So I love tea and I figured this would be a fun thing to do.

So you can be the tea expert and then I looked up stuff about any clinical trials about different tea ingredients so we can go over the, well there's a limited amount of information -- we could go over the science..

KM: Right, a lot of it, it’s apocryphal or a historic herbalism thing. And that's the thing. I don't sell myself as an herbal shop. I have people coming in here asking. I’ve got a few tea leaves that I know the herbs have a history of helping with various things. If it’s people coming with major digestion stuff or whatever there's two good herbal shops less than a mile away… go there. They're trained in that stuff.

These teas historically, Chamomile, everybody knows about Chamomile and Valerian root. Those are the two big ones that everybody knows about.

Some people can't do chamomile, and this is something not everybody realizes, that if you have a ragweed allergy you shouldn't drink chamomile especially when ragweed's in bloom, because it's in the same plant family.

YJ: Yeah, so a lot of people have ragweed allergies, especially in the Midwest. I did not realize that there was a cross reactivity with chamomile so I looked it up. If you're allergic to Astericea, which is like sunflowers or ragweed.

KM: Sunflowers too? didn't realize that.

YJ: If you're allergic to ragweed, then instead of chamomile, what can you have?

KM: You can do linden flower. I used to have a linden flower blend and I don't know whether it was the flavor I just needed to tweak, but it wasn't very popular and so I discontinued it as of the end of last year, because I had to bring in all the ingredients just to make it and it just wasn't cost effective. You can get linden flower at herbal shops, and as I said they're less than a mile away.

I do have a blend I made for the Cat Cafe. It has catnip in it. And catnip is calming to the human nervous system as I understand it.

YJ: Is this for cats or humans?

KM: It's for humans! [Laughter] If humans have cats sometimes they have to fight their cats for their tea. They told me I can't do that one because my cat always gets into the tea bag or whatever you know. I have had people who repeat buy it and say that it's more calming for them than valerian root. You know that's just whether it's psychosomatic or what, you know, doesn't matter if it works, right?

YJ: Right. I guess the main thing is for teas for sleep you want not real tea which has caffeine in it. You want tisanes I guess. So other herbs or flowers or fruits that taste good and hopefully also help promote relaxation.

KM: Yes. I think if it doesn't have caffeine and if you enjoy it, it's relaxing to drink a nice hot cup of tea before you go to bed. It's gonna help.

YJ: Yeah, so I think like the main thing actually is not the tea. Like I'm gonna have some now and I don't expect I'll fall asleep driving home after this. Having tea as part of a nighttime routine where you kind of like catch the wave of drowsiness and have it as part of your usual wind down. That's how it really helps you, like it's not gonna knock you out.

KM: Although I understand Valerian root can be somewhat drowsy making, I don't really know.

YJ: I looked up the different mechanisms. I guess starting with chamomile... all of these plants have many, many different chemicals in them. And they've tried to identify which of those might be the ones that are active. So in chamomile, there is apigenin and that binds GABA receptors. So they think that is the main sleep promoting effect of chamomile, but then chamomile has a lot of other potential effects like, you know, anti-inflammatory effects, it has effects on kind of calming your GI tract and so on. But in terms of sleep, seems to be on the GABA receptors. GABA is the main inhibitory transmitter in the brain as opposed to excitatory like acetylcholine. Increasing GABA activity is sedating. Drugs that act on GABA are things like benzodiazepines, like Valium, or alcohol increases GABA activity, and so on. So it is expected that if you increase GABA activity, or receptor agonism, then it should make people more sedated.

KM: So that explains the tea, various teas, first one I was introduced to was GABA Oolong. There's also a GABA green from somewhere. I learned  from one of my friends… I believe it was the Japanese discovered that if they infuse the room with nitrogen while the tea leaves oxidizing is naturally occurring GABA properties within tea, multiple times.

YJ: Cool. But oolong has caffeine in it.

KM: The caffeine in tea is different because it goes to your brain rather than your heart. And it has L-theanine in it, that's calming.

It became so popular because it was spread through buddhism. Because the monks used it so they could stay alert for long hours of meditation and still not have it interfere with their with their meditation.

YJ: Not get all hopped up.

KM: Exactly.

YJ: All right, well, are we going to try one or more of these? Yeah. So let's see. This one is chamomile lavender. And ... and this is Sleep Tight, which is

KM the Valerian root.

YJ: It’s just Valerian?

KM: It’s Chamomile, spearmint, lemon balm, Valerian lemongrass, passion flower. It's got rose petals in it.

YJ: And this one's chamomile ginger; and then this is the catnip with mint, basil. And then this is the...

KM; The GABA oolong.

YJ: All right. What would you recommend? You're the expert.

KM: Well, let's go with flavors. I want you to try one of the Chamomiles and the Sleep Tight so you can Taste the difference because, that's the thing with a lot of medicinal tea, the herbs that actually do the work can tend to be little bitter. And so that's where they mix all that other stuff with it, the mint and everything else.

YJ: Chamomile tastes good though, you know, it’s very mild.

KM: Mm-hmm. A lot of people like chamomile.

YJ: I feel like my nose is not up to its usual functioning because I'm getting over a cold.

KM: I think ginger would be better rather than the Chamomile Lavender because then you got the ginger to help clear your stuff. Okay this is the chamomile ginger.

YJ: All right. Do you already have water?

KM: I have water ready, but I just got…

YJ: Okay. All right here. I'll go over the clinical trials for chamomile while you brew. So in terms of studies that I looked up, I wanted to find studies that were published in peer reviewed journals in PubMed, where it was randomized and controlled meaning they used a placebo to compare.

For chamomile there's a decent number of studies and they did a meta-analysis meaning they pooled data from several of these clinical trials. So there was a meta-analysis done in 2024 that combined 10 studies that had a total of 772 patients. So it's actually a pretty large meta-analysis and they found that there was an improvement or a reduction in a score called the PSQI which is the Pittsburgh Sleep Quality Index. That's probably the most commonly used scale of sleep quality. So that decreased close to two points across all these different studies. And then in four of the studies that looked at how fast people fell asleep, that improved in three out of the four studies.

And then there were no significant adverse or side effects. But they only use passive reporting, meaning they didn't specifically query for all the different things like you would in say like a drug trial in terms of side effects. Overall, there's pretty good data that there's an improvement in subjective sleep quality. I don't think any of these measured sleep objectively like with an actigraph, which is a motion sensor or with a sleep study. But still overall, I would say, you know, two point improvement in the PSQI is pretty good.

KM: What's the range?

YJ: So two points, I would say two is a small effect. And then in terms of the actual studies that were included, there were a couple. So some of the studies that they included were  specific patient populations like people who had chronic kidney disease or you know this or that So I tried to pull out the ones that were maybe more relevant to a general audience

There was one that they included that had 60 people who were older and they lived in kind of like an old folks home in Iran And they did 200 milligrams of chamomile extract in a capsule not a tea - so none of these studies used teas.

KM: None the studies used actual teas.

YJ: Yeah, or very few do. A lot use capsules or oils, which yeah, so it's, it's not exactly comparing apples to apples, I guess. And, and they took it twice a day, which I thought was interesting. But they found that the group that got the chamomile capsules versus the placebo capsules did have an improvement in their sleep quality. But these were just regular people. They didn't necessarily have sleep problems to start with. So that was one study. 

And then another study that they included was adults, so 18 to 65 years old. This was a small study, 34 people and about two thirds of them were women. And these are people who had insomnia, meaning they had problems sleeping. And they got 270 milligrams of chamomile, again, twice daily for a month.  And they followed, or the people kept track of their sleep with a sleep diary. And then they also measured daytime symptoms.

And in this study, when they took people who had insomnia, there was no difference in terms of their sleep and their sleep diary. But  there was a slight improvement in their daytime functioning. So I think the data are a little bit mixed -- when they pool all the studies together, there is a small benefit on sleep.  But I think when if you take people just who have true insomnia, where they would see a doctor for it, the effect probably is not strong enough to see.

KM: I wonder if instead of taking capsules, if they were actually having a tea and sitting down and having that intentional time. I think that would be much more productive.

YJ: I think so too. So I think that a lot of it is the actual ritual and the bedtime routine and the warm mug and all that stuff. That's like almost all the effect. 

KM: Yeah you have to pull your attention away from your day and you have to focus on making this cup of tea.

YJ: And enjoying it, you know, just being mindful and enjoying the smell and the feeling and the taste and everything.

I will also say that even in clinical trials of sleep drugs, Ambien, Lunesta all of these.  There is a significant placebo effect, which is really prominent for insomnia. So about two thirds of the effect is  placebo.

KM: With real drugs?

YJ: With real drugs! This is because there is so much of our expectation and anxiety and worry and you know our ability to kind of shut off our thinking that affects our sleep. It’s not uncommon to see 30 or 40 minutes of objectively measured sleep, like during a sleep study, and that benefit can be sustained over weeks during clinical trials with placebo. So our brains are actually very powerful and are able to improve our own sleep. Placebo is very strong, especially for sleep.

Alright, so ready?

KM: Probably a lot of what prevents sleep is a lot of mental.

YJ: Yeah.

KM: After you've ruled out physical things, physical aches and pains.

YJ: This is chamomile ginger.

I love that, the ginger is nice.

KM: This particular tea is from Nepal. It's all grown there and I buy it farm direct from Nepalese tea farmers.

YJ:So how do you source all of your teas? Like how do you know people in Nepal?

KM: Well, interestingly, Nepal, centuries ago, Nepalese workers, went to Darjeeling, which is the very northern part of India. These workers would travel to Darjeeling for work picking tea, and making tea. So they had the skills for it, but they weren't growing it. Well, the gentlemen who have formed this tea collective, they were the grandsons of a farmer who said, we should grow tea here. This is silly! We have the, we have the land, we have the same terroir, we can do this. He had a hard time convincing them, but over time he did.

He sent his grandsons off to the west to go to business school. And they came back to Nepal and said, okay we're doing this. And I can't remember how many years it's been now more than 10, I think. But they've gradually been building and building and so the farmers are making a much better living. So they travel and they go to the tea expos and things like that and that's how I met them.

Other teas, like the fruit tea, valerian, chamomile lavender.. those I have vendors who have been in the business longer than me. They source this stuff and make the blends, and I just buy them from them and repackage them.

YJ: And most of your stuff is organic because I know like you will actually note if it's not organic, right? So by default all your stuff is organic.

KM: Unless it says otherwise, right? Well, GABA (Oolong) might not be. I can't remember. It doesn't say, so it probably is.

But a lot of them, especially the Chinese teas and stuff that, I try to source from areas that are away from civilization and a little bit more wild.

YJ: Alright. Okay. So, let me go through my notes here. So, there are a couple other. So, besides chamomile, I think the next one that you mentioned was Valerian root or Valeriana species. So, this one actually the science was very cool because there's a lot.

In terms of the mechanism, it also acts on GABA receptors, but there's other compounds in valerian root that acts on adenosine receptors. That's what caffeine works on, but it acts on adenosine receptors the opposite way. Also serotonin receptors.

And then really recently, last year, they found that two of the compounds in valerian root, called Hesperidine and Valerosidate, they actually bind to orexin receptors. So there is this new, newer family of drugs called orexin antagonists. So orexin is a chemical that increases alertness in the brain. And more recently, they have developed a new class of sleep drugs that block those receptors to kind of shut down the waking pathways to help people sleep. And this is an interesting class of receptors because a lot of the research being done on the interaction of Alzheimer's proteins and sleep targets this receptor. Anyway, it's very interesting in that two of the compounds from valerian root seem to bind to this receptor very strongly, in a similar mechanism as this new class of sleep drugs.

KM: Cool.

YJ: So valerian root seems to have multiple mechanisms by which it may enhance sleep. There's pretty decent data. So it seems like at least in the clinical trials, a lot of times valerian root is mixed with hops. Did you know this? Hops like we would use in beer. Yeah, so there was one where they did a combination of valerian roots extract with hops.

KM: I'm sure it (extract) makes it easier for them to control the studies.

YJ: Yeah. And they took it, they had 41 people, half of them were women, and it was mean age of 37. So just like regular people, but they had to have a little bit of sleep problems to start with. And they took it an hour they took the extract an hour before bed. And the treatment group compared to the placebo group got 21 or 22 minutes more of sleep. And they actually used Fitbit tracker to measure this. So that's actually pretty good. So 21 minutes is pretty good.

KM: Do we know whether the hops had any effect?

YJ: We don't know. But it is interesting to me that the two have actually been tested a lot together.

And then there was another one where it was a combination of valerian roots and hops and this one they use sort of like a sleep study but it was like a semi automated computer thing. And again, they seemed to find an improvement in total sleep time and deeper sleep. And this one was interesting because this was liquid with honey, so it was as a tea.

And then there was a trial of just valerian extract versus placebo. This was just women who were older, like post-menopausal women who had insomnia, and this did not help them. So, yeah, so I think that in general, these clinical trials, tend to do better if the people don't have bad insomnia to start with.

KM: Right, yeah. So it's not going to cure your insomnia. It's not going to hurt it.

YJ: Yeah, it's not going to hurt it. It doesn't cure insomnia. I think that if people have significant clinical insomnia, there's a bunch of other things that need to be done in terms of addressing.

KM: And again, I'm going to go back to this, these studies are just doing single herbs and single this and single that. I did study with a shaman for a few years and he wrote a book and the book he talked about western medicine, some guy studying chemicals and stuff in South America or wherever with the shaman and the shaman was going through the jungle pointing out different plants and saying we use this for that and we use this for that and the guy's trying to write this down and get all this information and the shaman just laughed at him because it's not the single chemicals. It's the whole interaction of plant. So the studies they find active chemicals but the chemicals aren't actually just working by themselves, you know? So how valid is the study that's isolating one chemical?

YJ: Right. Alright, so this one (tea) is

KM: This is the Sleep Tight. This is one with valerian root and the chamomile and all the other stuff to make it taste good.

YJ: And this one has the passionflower too. So I actually looked up passionflower. Yes, so passionflower, I was very surprised to find out there is a lot of data on, not a lot, but I mean more than I expected. So passionflower is the flower that's on vines for passionfruit. I was also interested to find out that it doesn't increase passion. It's named passionflower because it has to do with like the number of petals or something represents different things in the Passion of the Christ according to missionaries who went to Brazil. So it's so not the kind of passion you thought it would be.

There was a double blind randomized placebo controlled trial where they used sleep studies, polysomnography, in 110 adults. This was published in 2020. It increases sleep time on sleep studies by 23 minutes. So passionflower actually has very high standard data to support its use. 

Also, there was another study that used a combination of valerian, hops and passionflower. So this is also a very common combo, these three. And the study of the the triple combo they went they went all out and they compared it against zolpidem, which is Ambien. So it was not placebo controlled, they tested it against zolpidem. And it actually did just as well as zolpidem. This was 91 people in the study with insomnia  and total sleep time increased from 206 minutes to 352. So that's a huge difference. So these people were really insomniac at baseline. And then for zolpidem, they went from 212 to 324 minutes. So it was a similar increase in this study.

And what I thought was notable is that they mentioned that in Germany, combination of Valerian, hops and passionflower is actually approved and sold under this name Kyatta-Sedativum(R)

So you know in Europe they have much better and tighter regulation of herbal supplements and nutritional supplements. So I thought it was interesting that they actually sell this combo of the valerian root, passionflower, and hops.

KM: Interesting. Yeah. Maybe I need to try to find some of that.

YJ: Yeah, or get some hops.

KM: Yeah, get some hops. I'm gonna ask them at the herbal shop and see if they use hops in it.

YJ: I was very surprised. I did not realize there was that much data for passionflower, but that one actually seems very, very strong scientific evidence, I would say, compared to the other, to the other teas. Alright, so this one also has the chamomile we talked about, it has the passionflower, and then the valerian. Okay.

KM: Right. It has mints in it for flavor. Although that’s a really good job because these ingredients are on here in order of volume you know so the chamomile is the primary ingredient and it tastes good.

YJ: I do like anything with lemongrass, it's so fresh.

KM: It's lemon balm.

YJ It’s is lemon balm? Oh and there’s lemon grass.

KM: is there lemon grass too? I missed that.

YJ: Okay. This one's good.

Alright, and then there were a couple others (teas) that I looked up. So lavender, obviously. So we have the chamomile lavender.  I found 46 randomized clinical trials in PubMed, but almost all of them were for aromatherapy. So there were a lot that used just the smell, or some actually used it in terms of like as a massage oil.

For actually eating it or drinking it, I found two studies. One of them was a trial in women. They did a trial of 52 post-menopausal women and they did a lavender flower powder or a bitter orange powder or a placebo. Sorry actually it was 52 people per group. So was a pretty large study. And they found that there was a decrease in the PSQI, the Pittsburgh Sleep Quality Index, they found there was a decrease in both the bitter orange and the lavender. Only the abstract is available. I couldn't read the full study, but I thought that was interesting that orally it seemed to work as well. So bitter orange is the other one.

KM: Interesting.

YJ: And then there was another study that it was by mouth. It was a lavender oil by mouth. So I don't think it was an oil. I think it was encapsulated.

KM: Yeah, I would think you would have to.

YJ: Yeah, and that one, this second study was in the International Clinical Psychopharmacology Journal. This was a large study. It was 221 adults with anxiety. They found that taking the lavender oil by mouth for 10 weeks decreased that PSQI score by five and a half points on average.

KM: I know there have been aromatherapy studies with lavender on kids with hyperactivity too.

YJ: Yeah. There aren't that much data for lavender by mouth.  The vast majority are using the smell.  But, you know, the studies that are there seem reasonable and if no bad side effects.

KM: Well there’s a little bit of an aroma, if you can smell it. Alright, where do you wanna go next?

YJ: Well should we do the Chamomile lavender? So do you have a kettle that just keeps it at the correct temperature?

KM: Yeah.

YJ: So what temperature do all these go? These aren't boiling.

KM: Well, they say nearly boiling. Nearly boiling. I'm doing them at 195.

YJ: As opposed to 212. Okay.

KM: This one says boiling. It could be near boiling. The thing with herbs is teas you want to, especially green teas, my gosh. The biggest thing that got me into the tea business was all the packages you buy in the grocery store for green tea say use boiling water. Don't use boiling water. You'll make a very bitter cup of tea. You want to use much less than boiling water, maybe more around 185 depending on the tea. There's lots of different green teas and they all do different things. And you're going do it for very short time, just a couple minutes, not three to five minutes, which is most black teas, you're going to do three to five minutes. You can't brew a green tea like you do a black tea. It makes it bitter.

It pulls out all those, I can't remember what the chemical word is, polyphenols maybe, and just makes a bitter cup of tea. Now herbal teas,  they can handle the hot water. You can't oversteep them. You could leave them sit for, and actually I think therapeutically,  if you really want therapeutic doses of herbs, you're gonna put it in the water and you're gonna simmer it on the stove for 20 minutes or something. I don't know how good that's gonna taste but you're gonna get all the chemicals out of those herbs.

YJ: Sludge.

KM: I know there's Chinese medicines that that's how you're supposed to take them. So, you know, that was the thing I wanted to ask you about. Did you find anything on any contraindications for any of these? Did you look up anything about contraindications?

YJ: Yeah, so the major one is for anyone on blood thinners or anyone who has hemophilia or some other bleeding disorder. Valerian root can interact and make it more likely that someone will bleed.  And that seemed to be like the main one with a lot of these is the potential for bleeding.

And then what was the other one? Oh, and then we haven't talked about magnolia bark yet, but that one and Valerian root were the main ones that thin your blood out.

And then of course the other ones can cause, know, drowsiness, dizziness, stomach upset, the cross reaction with people with ragweed allergy, like we mentioned. But I mean, I guess in general, the, you know, the teas we're talking about are all considered, they're kind of considered generally safe by the FDA.

KM: Yes.

YJ: They're like foods. They're regulated like carrots.

KM: That speaks to what I talked about with therapeutic doses. You're not really doing a huge therapeutic dose. That's also probably why they use extract to get therapeutic doses. All things in moderation. You do one cup of tea a day. The amount of actual chemicals that are going to interact with your medications are very small.

YJ: Yeah. And then for the oil especially, like with lavender oil, it can cause skin irritation.

KM: You’re not supposed to put them directly on the skin they're supposed to be in a carrier oil or something to thin it out.

YJ: But I mean overall it seems like these are pretty well tolerated and you know if if you're drinking tea to help yourself fall asleep then hopefully getting drowsy is not a bad thing.

KM: That is the goal.

YJ: So there was one other tea. That was the Magnolia Bark.

KM: Yeah, that's not something I'm familiar with.

YJ: I guess it's called Houpo in traditional Chinese medicine. The bark has a lot of different compounds with numerous different mechanisms, but the clear mechanism of action on sleep is not yet known. That's the other one.

Otherwise, I did look up GABA Oolong. There were no trials in adults. It looks like there has been one in children with autism spectrum.

And then there were no clinical trials for catnip or linden flower.

KM: Okay.

YJ: Do you like like all the little cups and things? ‚

KM: I have to have quite a variety of things.

YJ: Oh this one smells really good. Oh that's good.

Yeah, I've had this one a bunch before so I feel like this one is like the Pavlovian one that makes me feel relaxed.

KM: That been around since the beginning it's like the second vendor I ever took on. It's their blend.

YJ: So you've been open since 2009? My goodness.

This is yummy.

KM: I started with two vendors in 2009. And then now I'm up to like, I don't know, tried to count -- 10 or 12 vendors, including FarmDirect, because I have two or three sources for FarmDirect to them.

YJ: Do most people buy in person or is it online?

KM: Most people buy in person. I do have a decent online business. I ship out probably 10 packages a week. lot more during the holidays. But I'm still not... I see pictures from some other small businesses and they've got these big walls of boxes of stuff to go out the door and I'm like, that's not me. You get personal attention here because it's so small.

YJ: Yeah.

KM: So we also do single serving.

YJ: Cool. Happy throat lemon, I need that.

KM: That's a brand new one that's my own blend. I created that last year. For somebody who wanted -- I have a mint version that we've had for years and years and I have a number of singers who like that one a lot. Okay. And then I had well, a friend who doesn't like peppermint, doesn't like ginger, and doesn't want those things. And so I created the Happy Throat Lemon.

YJ: What's in the happy throat lemon?

KM: Marshmallow root, licorice root, lemon myrtle, echinacea, dandelion leaf, anise, hyssop, and sage. It works pretty well.

YJ: And how many ounces is this?

KM: That will make one 16-oz cup of tea.

YJ: One cup of tea. Okay.

KM: That's we offer those when somebody comes in and is brand new to tea and I suggest this is what you do: Just go through and pick some flavors or you want me to pick you some out I'll pick out some bestsellers and then you just start you drink them and you see if you like them and then and that seems to work really well for people

YJ: Yeah, because when you get the whole ounce, it’s a lot, 24 cups.

KM: Right. [Laughter]

Alrighty, so we've done everything except the GABA oolong. Oolongs are very interesting because most of them are tightly rolled.

YJ: Do they roll up on their own or?

KM: No, that's humans do that or machines. They have machines that do it too with humans overseeing it. It's not robotics yet.  And you'll see as I brew this, this is going to open up and be a whole leaf.

YJ: Oh cool!

KM: So they're kind of fun and you get lots of steeps out of it. Let's see now. I'm refreshing my memory on how many minutes for the first infusion. So there's two different ways you can do this too on this package. This is from a company out of England called My Leaf Tea and they give you both the Chinese way of doing it, called Gong Fu where you would use like five times that much leaf for the same amount of water and you just do a lot of short steeps. And so you get more steeps out of it. And the whole Gong Fu process is just relaxing too. Even though it's tea and it's got caffeine, it's just a relaxing process.

YJ: So do you use the metal infusers usually or?

KM: What I did with most of these is I have a side port, it's got a strainer on the inside. Personally at home I use a strainer like this. And this just fits in your cup, you know, and you just take it out and put it on the saucer.

YJ: I like these because then you don't have to throw out a bag every time. And I've recently become like terrified of microplastics.

KM: Right. plastic ones. Yeah. I have bags here that, they tell me they're certified, don't have any plastic in them. It's got a little bit of some kind of a plant-based glue that holds them together. But yeah, we've got a whole assortment of strainers and things we just started carrying last year.

YJ: Oh, these are so cute.

KM: They float.

YJ: Oh, I get it, they float.

KM: This is food grade silicone.

YJ: That is too cute. Aww.

KM: And so they work great in travel mugs because they float and the seal and everything, you know. Yeah. There's a cat.

YJ: What is this? Oh, another cat. Aww there's an otter!

KM: I think the otters are my best seller.

YJ: So when you started Traveling Tea, did you think that it would last for this long?

KM: I hoped it would. I actually had hoped that I would be able to quit my day job sooner than I did.

Yeah. See, so that was just one steep, that's how they opened up. I should have given it a rinse first. That would have helped it open up more. But I'll do another steep Let's see.

YJ: That's really good. It kind of tastes a little bit like, like seaweed. Kind of has that seaweed-y, nori-like flavor.

This is really good.

Do think you'll expand somewhere where people can sit down and have tea?

KM: I don't know yet. The only way I might do that is if the donut shop next door would go out of business. Because then I could do knock a hole through, knock a door through.

So, I don't know. I purposely take small because it's manageable this way. I had if I had twice the space, I'd have to have twice the employees and

YJ: You’d have to wash all the cups and everything.

KM: Exactly. It's a lot of washing up. It is.

But we do [events] -- I did a tea tasting yesterday for a lady. She gathered some friends at her condo and took some teas and talked about tea and tried different things. And we do, like I've done, date nights where they ahare a bunch of teas. I've done one for a birthday: two friends, one friend gifted to the other to create her own tea. I got some some guidelines and I had all of the ingredients and we played around. She made her own blend and then she got four ounces of that blend. As long as I have the ingredients I could remake the blend for her any time. Yeah, it was fun. They just paid a set fee and then they got the free tea to go with it.

This is round two. To taste the difference or see if you taste the difference.

YJ: Second round of the GABA Oolong

KM: Yes, now see how much that leaf has opened up. that's so cool.

YJ: Yeah, they unfurl That's cool.

KM: Yeah and so you can just keep steeping and steeping and steeping until it's basically not water.

YJ: This (second steep) tastes like more like tea, like I mean like "tea" tea you know.

KM: And lots of times you'll get your best flavor on like your third steep.

YJ: That's really good.

KM: Yeah, so let's see then. I guess you'll find out if it relaxes you.

I want to ask you, your whole focus since you started in medical school has been the sleep, hasn't it?

YJ: Yeah, well, I did neurology first and then sleep. You can do sleep from a variety of different specialties, different medical specialties,  including neurology. So I still do neurology when I'm on service in the hospital,  but otherwise all my outpatient practice is sleep.

KM: And why did you choose sleep?

YJ: Because it's the most interesting. I mean, it's a relatively young field in medical research.  And so I felt like there was a potential for being able to make a contribution, scientific contribution, within my lifetime, as opposed to some of these fields where there's lots of big famous people working in them, for years…

KM: For a tiny breakthrough.

YJ: Yeah, or sometimes big. I just thought it would be fun to do something that where I could discover new things and you know, there was like a good chance that I could. And also, it's a good clinical practice. You know, the actual sleep medical practice is, pretty pleasant. It's easy to balance with research. So I thought it would be a good way to stay in academic medicine and be able to do research and still have a clinical practice and be able to balance that well.

KM: Hmm. And is there something really interesting that you've learned so far? Or what's the most interesting thing you've learned?

YJ: What's the most interesting thing? Well, I guess I'm super biased by my own research. So I think it's interesting that sleep or sleep disturbances seem to predict or may be a risk factor for developing neurodegenerative diseases down the line.  And perhaps our behaviors during midlife actually physically affect the mechanisms by which people may develop neurodegenerative diseases.

So to me that's interesting because it's actionable. There's so many things that... There's so many things to be afraid of, right? And we don't want bad things to happen to us. But there aren't that many things that we can do today to reduce those risks, but sleep is one of those things. So I think it's interesting that it's something we do every day that we can do something about.

KM: We didn't do the catnip one. You can taste the catnip one, you can turn the back around and look at the ingredients. It's a little bit savory compared to most of my teas

YJ: We could do the catnip. Why is it savory? … It has catnip, spearmint, basil, violet, and dandelion leaf, and flower petals. And a portion of every purchase is donated to cat charities.

KM: Actually doesn't have violet, I need to update that. Yeah, when I very first created it, I had access to violet leaf and I put violet leaf in, but I haven't had access to violet leaf since like just before COVID. I don't know why...

YJ: Maybe COVID killed them (violets) all off. [Laughter]

KM: I don't know. Whoever was in commercial production for Violet Leaf probably went out of business.

YJ: Oh this has dandelion leaves.

KM: Yeah, so my thinking was this has all plants that if a cat were outside it could conceivably come in contact with.

YJ: Aah, okay.

KM: It's called MauHaus number six because when the cat cafe Mau Haus opened, the owners came in and we had all these different ingredients and we created this blend and this was the sixth try. Of the things that we tried. So they decided that's what they wanted to name it was MauHaus number six.

YJ: I went to the cat cafe for the first time with my kids fairly recently. They loved it. It was so fun. They came up with a good name for a cat cafe, which is Gato and Gateau. Like Gato means cat in Spanish and Gateau means cake in French. So that's their idea for a cat café: Gato & Gateau.

KM: You’d better trademark that.

YJ: That's my get rich quick scheme, is to run a cat cafe.

KM: Oh you'll get rich real quick for sure.

I was told by the owners that said that by having a cat cafe‚ she can't be called crazy cat lady for having multiple multiple cats

YJ: Yeah. [Laughter]

How long do these (teas)last?

KM: Okay, herbal teas you want to buy with something that you're going to use up within six to nine months. It's just like spices, you know that same kind of guideline. Keep them in a sealed container away from heat and light. They'll stay fresh.

YJ: I forgot to bring tins! I knew I forgot something! Alright, okay, I feel so bad.

KM: I can put it in paper bags for you and you take it. We do that all the time.

YJ: All right, so this is the MauHaus #6. So this is the catnip with mint, basil, dandelion, and flower petals.

Well this one's  nice and minty.

KM: Mm-hmm.

YJ: Do you have tea every day?

KM: I have some kind of tea every day. I would not be my best customer, truthfully. Yeah. I don't drink like four cups of tea a day like some of my customers do.  I like having the variety though, which was my big thing.

YJ: Yeah.

KM: I don't like to drink the same tea every day. People that drink the same tea every day. I'm like, how can you do that? That just seems so boring. Of course, that's different than coffee, right? You drink same coffee every day. Yeah, I guess. Drinking the same coffee for 40 years, you know?

YJ: This is nice. I do like the minty kinds. Alright, well I need to stock up on some teas.

KM: Okay, we can do that.

YJ: All right, well thank you Kateri.

KM: Thank you for inviting me to a part of this.

YJ: Traveling tea. So the website is travtea.com, T-R-A-V-T-E-A.

It's (The logo is) so cute, it’s a little traveling tea kettle.

KM: With his little hobo bag.

YJ: It's a man? It's male? I always thought it was a...

KM: It's kind of androgynous. No particular conceptions in mind.

YJ: It's non-binary. [Laughter] Did you draw him yourself?

KM: I did not, but that is the image that was in my head. When I was trying to decide how to start a tea shop and where to start a tea shop, I thought, oh, well, I could start at the farmers market. And as soon as I had that thought, this image popped in my head with the name Traveling Tea. And so I talked to a friend of mine who was a graphic artist and told her what I wanted and she did a few sketches. And I mean, that is exactly what was in my head. She did a fantastic job.

YJ: Wow, you have a lot of different teas. Well, thank you so much. This was fun.

KM: I'm glad. I hope it was helpful. I hope people find it to be helpful.

YJ: Hope so. well thank you. All right, well thanks so much. I hope this recorded. [Laughter]

View/listen to the interview.

It’s having schools start at a healthy time — a time that lines up with students’ circadian rhythms.

Saint Louis Magazine interviewed me about sleep health and science recently, and I had to bring up Healthy Start Times, the local (St Louis, Missouri) effort to shift school start times. Serendipitously, the St Louis Public Schools district is considering shifting school times later… right now, most high schools start at 7:15, which means that a lot of buses start picking up just after 5AM!

During adolescence, there is a normal shift in the circadian rhythm, where people become more night-owl-ish. Teenagers are not lazy because they tend to sleep later in in the morning, it’s normal biology!

Studies show that healthy school start times that align with  circadian rhythms during adolescence improve

• attendance

• academic performance 🧠

• athletic performance

• mood and behavioral health

• car accident rates

• local economy in the long run
  

I’ve been involved with the HealthyStartTimes STL, the Saint Louis-area effort to shift school times, because the science is absolutely clear that school start times that are excessively early (before 8:30 for teens) lead to poor outcomes.

If you’re an adult thinking “well when I was a kid I had to go to school early and I did fine”… Actually, school start times have crept earlier and earlier in the past few decades, so teens today often have to go to school much earlier than prior generations.

Healthy start times are super feasible! Many school districts, cities, and the entire state of California (by law, in 2022) have mandated later start times for middle- and high-school students, without ill effects.

School start times are a concrete and highly impactful way to improve public health (and happiness). In fact, all relevant healthcare and sleep science associations support school start times of 8:30 or later for teens.

Want to help? If you’re in St Louis, please support HealthyStartTimes STL. School start times for the next academic year are being discussed right now, so please visit website and join the mailing list for letter templates to contact Board of Education members to take action. Or, if you live somewhere else, support your local chapter of the Start School Later initiative.

[Read the St Louis Magazine interview.]

How does melatonin work?

While melatonin is marketed as a sleep supplement, it’s actually a circadian (internal clock) hormone. You make melatonin already, in your pineal gland deep in the center of your brain. In the evening, the pineal gland releases melatonin, setting the stage for sleep and other nighttime circadian activities.

Circadian effects of melatonin:

Taking extra (exogenous) melatonin has opposite effects on the circadian rhythm, depending on the time that it is taken. In the phase-response curve (PRC) below, the red line shows the effect of melatonin given at the time indicated on the X-axis.

As you can see, melatonin taken a couple hours before sleep (the red peak around 7-8pm) will have the strongest “advance” effect on the circadian rhythm. This means that it will make the circadian rhythm earlier.

So, for someone who is a night owl*, who typically has trouble falling asleep at the beginning of the night, melatonin can help advance their circadian rhythm and therefore fall asleep faster.

*aka delayed sleep phase syndrome (DSPS) or “circadian disorder, delayed sleep phase type”

In terms of science to back up use of melatonin in DSPS: A meta-analysis of 14 randomized clinical trials showed that the effect of melatonin on people with DSPS was falling asleep 39 minutes faster on average (Buscemi 2005).

Sleep effects of melatonin:

Melatonin has very mild sleep-promoting effects, meaning, it is not going to knock anyone asleep.

One main way melatonin promotes sleep is by lowering body temperature. There are other hypothesized mechanisms by which melatonin promotes sleep, but studies are not definitive, particularly because supplement-type melatonin is not frequently used in high-quality randomized clinical trials.

And the data aren’t great. For people with insomnia (not night owls), in the initial meta-analysis in 2005, the effect of melatonin was that they fell asleep 7 minutes faster. (Buscemi 2005). In the intervening years, a few more studies have been done with melatonin. A very high-quality, large meta-analysis of all sleep drugs in insomnia (De Crescenzo 2023) showed no effect of melatonin in people with insomnia.

To summarize: Melatonin is effective in helping people with delayed sleep phase fall asleep faster by advancing their circadian rhythms. It has minimal or no effect for people with insomnia due to other reasons.

What’s the right dose of melatonin to take?

As with any medication, the right dose is the lowest effective dose. A wide range of doses have been tested, and melatonin is additionally complicated by the fact that the effect depends on the time that it is taken.

In general, the doses tested have been in the 0.5 to 5mg range. (Cruz-Sanabria 2023). In a large meta-analysis of 26 randomized clinical trials (Cruz-Sanabria 2024), the dose response maxes out at 4mg.

Again, the effect is maximal if melatonin is taken a couple hours before bedtime, reinforcing that the best effect of melatonin is for advancing circadian phase.

In fact, too much melatonin can be harmful, particularly because melatonin has opposing effects later at night. If you look at the phase-response curve, there is a red “valley” from 2am to 2pm. This means that melatonin in the system will delay (make later) the circadian rhythm.

Taking too much melatonin at night so that it lasts for hours in the body sends mixed signals—both advancing and delaying the circadian rhythm—and may backfire and worsen insomnia.

In fact, in blind people who require consistent melatonin supplementation for their circadian rhythms, people who did not respond to a high (10mg) dose did better with a low (0.5mg) dose. (Lewy 2002)

Also, people who take an extra melatonin when they wake up in the middle of the night, are just confusing their circadian rhythms and may be making their insomnia worse.

To summarize: the right dose of melatonin is lowest effective dose in the 0.5 to 5mg range, a couple hours before bedtime.

Exceptions:

• People who have free-running circadian rhythm disorder (typically due to blindness) need low doses.

• People who take melatonin for REM sleep behavior disorder. The melatonin effect in this case is separate and higher/repeated doses may be needed

• I don’t comment on prescription prolonged-release melatonin which is not available in the US

What’s the best melatonin pill?

Unfortunately, melatonin is considered a nutritional supplement in the US, so what you can buy is not very well regulated. A study in the Journal of Clinical Sleep Medicine (Erland & Saxena 2017) tested 31 different melatonin supplements and found that 26% were contaminated with serotonin, and 71% contained wrong doses (more than 10% different from what was on the label).

That study was helpful in that we learned that the following will be most likely to get you better purity and consistent dosing:

• At least a 3mg tablet*

• Tablet formulation, not liquid, melty strips, or gummy

• Just melatonin, not a combo** with other supplements

*This means that to take a lower dose, you need to cut a tablet in half or quarters. Use a clean, dry, sharp knife (chef’s knife works better than a small knife, in my experience) or a pill cutter, NOT your teeth.

**The combination supplements had a high rate of contamination with serotonin.

As for the brand of melatonin: USP (US Pharmacopoeia) or NSF are both non-profit organizations that test supplements. You can search their websites for free.

Currently (February 2026), there is only one melatonin 3mg tablet formulation that is USP certified (NatureMade), so that is the one I take. To be clear, I have no financial or other relationship with NatureMade; I chose it based on the USP certification and formulation only.

Which brings me to… Importantly, don’t get melatonin (especially in a blended formulation) being peddled by someone who makes money from it! The American Medical Association prohibits sale of health-related items by physicians, due to ethical concerns. And definitely don’t get supplements being hawked by podcasters, sleepfluencers, and the like.

Any drug, even a supplement, with potential for help also has a potential for harm. Your health is important, so make careful decisions uninfluenced by those who will profit from you.

What are side effects of melatonin?

Fortunately, melatonin is generally well-tolerated, even at higher-than-necessary doses. But a death in 2023 of someone who intentionaly overdosed on melatonin and diphenhydramine (benadryl) was a sobering reminder that we need to be careful, even with supplements and OTC meds.

Technically the most common reported side effects of melatonin are drowsiness, change in dreams, headache, and stomach upset.

The most common complaints about melatonin that I hear as a sleep doctor are:

1. Feeling cold - yes, this happens, and is probably how it helps with sleep

2. Insomnia - this is usually in the early morning and in my experience is usually in people who are advanced circadian phase (“morning larks”) who accidentally pushed their circadian clocks earlier

3. “It doesn’t knock me out” - yup, this is a feature, not a bug.

The Takeaway

If you decide to try melatonin as a sleep/circadian supplement:

1. Get a plain tablet, at least 3mg, and start with half tablet. Use a sharp knife or a pill cutter.

2. Get a brand and formulation that is USP or NSF Certified

3. Do not combine with other sedatives including alcohol

4. Melatonin works best for night owls who have trouble initially falling asleep, especially if taken a couple hours before bedtime. Timing, and consistency of timing, is critical with melatonin!

5. If a low dose doesn’t work, you can gradually increase. But if 5mg (and certainly if 10mg) is not having any effect, melatonin does not work for you and you can throw in the towel.

References

Buscemi N, Vandermeer B, Hooton N, Pandya R, Tjosvold L, Hartling L, Baker G, Klassen TP, Vohra S. The efficacy and safety of exogenous melatonin for primary sleep disorders. A meta-analysis. J Gen Intern Med. 2005 Dec;20(12):1151-8. doi: 10.1111/j.1525-1497.2005.0243.x. PMID: 16423108; PMCID: PMC1490287. Fulltext.

Cruz-Sanabria F, Bruno S, Crippa A, Frumento P, Scarselli M, Skene DJ, Faraguna U. Optimizing the Time and Dose of Melatonin as a Sleep-Promoting Drug: A Systematic Review of Randomized Controlled Trials and Dose-Response Meta-Analysis. J Pineal Res. 2024 Aug;76(5):e12985. doi: 10.1111/jpi.12985. PMID: 38888087.

Cruz-Sanabria F, Carmassi C, Bruno S, Bazzani A, Carli M, Scarselli M, Faraguna U. Melatonin as a Chronobiotic with Sleep-promoting Properties. Curr Neuropharmacol. 2023;21(4):951-987. doi: 10.2174/1570159X20666220217152617. PMID: 35176989; PMCID: PMC10227911. Fulltext.

De Crescenzo F, D'Alò GL, Ostinelli EG, Ciabattini M, Di Franco V, Watanabe N, Kurtulmus A, Tomlinson A, Mitrova Z, Foti F, Del Giovane C, Quested DJ, Cowen PJ, Barbui C, Amato L, Efthimiou O, Cipriani A. Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis. Lancet. 2022 Jul 16;400(10347):170-184. doi: 10.1016/S0140-6736(22)00878-9. PMID: 35843245. Fulltext.

Erland LA, Saxena PK. Melatonin Natural Health Products and Supplements: Presence of Serotonin and Significant Variability of Melatonin Content. J Clin Sleep Med. 2017 Feb 15;13(2):275-281. doi: 10.5664/jcsm.6462. PMID: 27855744; PMCID: PMC5263083. Fulltext.

Lewy AJ, Emens JS, Sack RL, Hasler BP, Bernert RA. Low, but not high, doses of melatonin entrained a free-running blind person with a long circadian period. Chronobiol Int. 2002 May;19(3):649-58. doi: 10.1081/cbi-120004546. PMID: 12069043. Pubmed.

From a sleep medicine perspective, the answers are nuanced. Some elements of sleepmaxxing align with sleep medicine practice and circadian science. Others are unnecessary, unsupported, and may even backfire.

I’ll break down what sleepmaxxing is, which parts are grounded in science, which parts deserve skepticism, and what I recommend as a sleep doctor if your goal is better sleep for long-term brain health.

What Is Sleepmaxxing?

Sleepmaxxing is a catch-all term for optimizing sleep using behavioral strategies, technology, and products.

Popularized through social media and “sleepfluencers,” sleepmaxxing practices include:

• Strict bed and wake times

• Morning sunlight or light box exposure

• Evening blue-light avoidance or blocking with special glasses

• Wearable sleep trackers and apps to view (and share) data

• Smart mattresses, lamps, alarms, and other bedroom tech

• Supplements like magnesium, glycine, melatonin, L-theanine

• Mouth taping or nasal strips

• Cold, dark, highly-controlled sleep environments

• Highly structured pre-sleep routines

• Food or drink aids: kiwi, tart cherry juice, processed "nootropic” drinks

• Devices to “maxx” slow wave sleep

• For some, unusual sleep schedules, like sleeping 1 out of every 3 hours.

At its best, sleepmaxxing reflects a growing recognition that sleep is foundational to health. At its worst, it turns sleep into a performance metric: something to control, perfect, or “win.”

What Sleep Science Does Support for Sleepmaxxing

Several principles commonly bundled into sleepmaxxing are well supported by research.

Consistent Sleep Timing

Regular bed and wake times (especially wake times) help reinforce strong circadian rhythms, which in turn sets the window for good sleep. So the best sleep quality is obtained if you keep a regular wake time and bedtime, with bonus downstream benefits on metabolic and cognitive health.

Need help figuring out a good bedtime and wake time? Read “How much sleep do I need?”

Light Exposure

• Morning light is one of the strongest zeitgebers to reinforce for your circadian rhythm. Light from being outside or by a big bright window is best, so open the shades first thing in the morning! If it’s dark or dim, for whatever reason, you use a light box. Get at least a 5000 lux light, and use at arm’s length for about 30 minutes. Your eyes need to be open for light to send a message to your internal clock, but you shouldn’t look directly into the light (or sun).

• Evening light, particularly bright and blue-ish short-wavelength light, has the opposite effect in the evening. Evening light delay melatonins release and delays sleep onset when you do go to bed. You don’t need to spend money on special glasses, screen blockers, etc. Just set an alarm to remind yourself to turn down the lights and stop looking at screens a couple hours before bedtime. Make sure you have your phones and other screens set to switch to night mode in the evening.

Sleep Environment Basics

Your bedroom should be cool (mid-60’s F), quiet, dark, and calming. You should use the bedroom for sleeping and romance only — that’s it! If you find that there are certain things that wake you up (light from outside for example), take measures to take care of them (eye mask or blackout shades).

Wind-Down Routines

A bedtime routine helps you transition from all your waking activities to a relaxed, sleepy state. It doesn’t have to be elaborate… consistency is the most important! If you haven’t yet, get a free Bedtime Blueprint to devise a routine that works for you.

Where Sleepmaxxing Goes Off Track

Some popular sleepmaxxing practices drift beyond the evidence and can be expensive, unnecessary, or sometimes worsen sleep.

Over-Tracking Sleep

Wearables can be useful for identifying patterns, or for accountability to get enough time to sleep, but they aren’t perfect. The sleep scores are estimates that may not reflect your true sleep physiology, and may change based on external factors (like a change in the algorithm) that has nothing to do with you.

More importantly, obsessively monitoring sleep scores can increase anxiety and paradoxically worsen sleep—a phenomenon known as orthosomnia. If sleep data makes you more stressed about sleep, it’s doing harm, not good.

Read: Should I use a sleep tracker?

Other downsides of wearables besides orthosomnia:

• cost, especially if there is a subscription for an associated app;

• privacy concerns: who can see your personal data?

• losing the ability to feel and trust your own body as to how good your sleep was

Supplement Stacking & Sleepy Potions

Despite widespread promotion, evidence for most sleep supplements is limited or inconsistent. Melatonin in particular is often used at doses far exceeding what is physiologically necessary. Combining multiple supplements increases risks of drug interaction effects (yes, even for supplements!).

Additionally, in the US, supplements are not regulated like medications, so they may be contaminated and/or not contain the dose listed. A study in the Journal of Clinical Sleep Medicine (Erland & Saxena 2017, fulltext) tested 31 different melatonin supplements and found that 26% were contaminated with serotonin, and 71% contained wrong doses (more than 10% different from what was on the label).

As for various juices and nootropic drinks or potions… if they are part of your wind-down bedtime routine and they don’t have known bad side effects, you can do an experiment. Keeping everything else the same, do 1 week each with or without the drink, and write down in the morning how your sleep was. (Or alternate nights.) If it really helps you, great! Just watch out for extra calories (especially juice) from sugars.

Extreme Optimization

Rigid rules, like never eating or drinking in the evening, eliminating all evening light, or panicking over minor schedule disruptions, can ramp up anxiety about sleep. Sleep does not need to be a perfect performance every night to get benefits to support brain and body health.

Life happens: not every day is going to be identical, and not every night’s sleep will be perfect. Aiming for a 100% score on a complex sleepmaxxing routine will inevitably lead to disappointment and ramp up anxiety. Some people “fall off the wagon” in extreme sleepmaxxing, and rebound by breaking all the rules.

Instead, consistently try for the basics of healthy sleep. This is much more powerful than extreme measures that can’t be sustained.

Ignoring Daytime Factors

Sleepmaxxing often overemphasizes nighttime routines, supplements, and gadgets while underestimating the effects of daytime factors:

• Physical activity, or lack thereof. Exercise is really good for sleep! Read Part1, Part2, and Part3 of the series on Sleep and exercise.

• Alcohol, yes, even a little bit

• Stress levels

• Caffeine timing. If you think caffeine doesn’t affect you because you can fall asleep even if you drink it at night… that actually means you aren’t getting enough high quality sleep. Stop by 3pm, or if you’re sensitive, even earlier.

• Circadian regularity: meals, exercise, activities (like work) and other daily things act as zeitgebers for our circadian rhythms too, not just light. For a strong circadian rhythm for the best sleep, keep your daily schedule fairly consistent.

You can’t “hack” sleep at night if the rest of the day is misaligned.

Gadgets

Special sleep-enhancing headphones, goggles, smart alarm clocks, lamps that promise to optimize your circadian rhythm, smart beds (or not-so-smart beds, as in this case), smarter mattresses, white noise makers, pink noise makers, brown noise makers, vibrating pads, etc etc etc…

As you can imagine, I get a boatload of ads for these sorts of things… and I have yet to get any of them.

Again, you should do what you need to do for a cool, dark, quiet, and calm sleeping environment. This does not require fancy gadgets.

To my knowledge, there are no gadgets that have been tested in controlled trials in healthy populations and have been shown to improve objective sleep measures.

Similar to supplements or drinks, if there are no potential side effects and you are willing to shell out $$$ to be your own guinea pig, go ahead!

Sleep Doctor-approved sleepmaxxing tips

If you want the benefits of sleepmaxxing, focus on these sleep-doctor-approved sleep fundamentals:

1. Keep a consistent wake time

A consistent wake time, especially on weekends, is the most powerful way to reinforce your circadian rhythm, which in turn sets the stage for high quality sleep. At most, sleep in one hour later on non-work days.

Even if, or especially if, you didn’t go to bed until later, or you had trouble sleeping during the night, get out of bed on time.

2. Use light strategically

Get bright light in the morning and protect the evening hours from light including from screens. This matters more than any supplement.

3. Remove sleep wreckers before adding supplements: alcohol, nicotine, caffeine, drugs, stress, nighttime dopamine hits

4. Keep a bedtime routine

5. Set a dark, quiet, cool, and calming sleep environment: Usually this means

1. blackout shades or an eye mask;

2. ear plugs or fan/filter if your bedroom is noisy;

3. setting the thermostat to mid-60’s at night

4. keeping the bedroom and bed clean and comfortable.

5. use the bedroom for sleeping and romance only

6. Exercise! Seriously, just do it: Part1, Part2, and Part3

7. See a sleep doctor if you think you might need to

Don’t use nasal strips or mouth tape to mask snoring without being checked for sleep apnea. Don’t mask insomnia with sedatives and alcohol. If you’re getting sufficient, regularly-timed sleep and still feel sleepy and tired during the day, this warrants a visit to the sleep doctor.

Sleep fundamentals are enough for the majority of people to get good sleep, so if they aren’t for you, ask a professional for help!

By professional, I mean an actual sleep physician… Not an influencer with no medical background, or a social media personality (even if they have a doctorate) peddling supplements or gadgets. Your sleep health is too valuable!

The Bottom Line

Sleepmaxxing gets one thing right: good sleep is valuable for brain health, healthspan, and quality of life. But when optimization turns into obsession, it undermines the very process it’s trying to improve. The best sleepmaxxing strategy is the long-game: consistent, sustainable habits will win across a lifetime.

[ETA: Women’s Health interviewed me about how to take naps. Read the article here.]

Brain benefits of naps

Immediate (acute) cognitive benefits of naps.

A large meta-analysis of 54 studies examined the results of cognitive tests related to afternoon napping. Across age groups and regardless of whether people were habitual nappers, naps improved memory (both declarative and procedural), vigilance, and processing speed. (Leong 2022)

In older adults (age >50), pooled analysis of 35 studies showed that short or moderate (45-60minute) naps were associated with better cognitive function, compared to none or long (>1 hour) naps. (Li 2023)

Similarly, another pooled analysis of older adults (age 60-78) showed that naps were associated improvements in fatigue, cognitive abilities, and psychomotor speed and accuracy. (Souabni 2022)

Long-term health and cognitive effects of naps.

A very large meta-analysis study, including 1.86 million participants aged 20-86, found that habitual napping was associated with increased risk of death, cardiovascular disease, metabolic disease, and cancer. But, naps were associated with decreased risk of cognitive impairment and sarcopenia (muscle loss). Importantly, the increased risk of death and the other bad health effects disappeared when naps were <30 minutes. (Yang 2024)

Naps improve physical performance

Naps have restorative benefit for the rest of the body as well: if you’re an athlete or just want a physical boost, a strategic nap can boost athletic performance.

A large meta-analysis looked at 22 clinical trials involving 291 participants. Napping improved physical performance, cognitive performance (especially important for competitive sports), and perceived fatigue. (Mesas 2023).

Athletic benefits of napping were maximal when

• The nap was 30-60 minutes

• There was at least 1 hour between waking up and the physical activity.

Notably, napping helped athletic performance whether or not a person was sleep deprived the night before.

How long should I nap?

The key trade-off for the cognitive and physical benefit of naps is sleep inertia — the grogginess and impaired performance that happens when you wake up from a deeper sleep.

To find the right balance of nap cognitive benefit vs sleep inertia, a carefully-controlled study tested after-lunch naps of 0, 10, 30, and 60 minutes in young men who were habitual short sleepers. Nap duration was defined by actual sleep time measured by polysomnography, not just time in bed. Only the 30-minute nap improved memory performance. (On average, 30 minutes of sleep required 44 minutes in bed.) While sleep inertia occurred after both 30- and 60-minute naps, it resolved within about 30 minutes. All nap durations improved mood and reduced sleepiness. (Leong 2023)

Long-term studies of older adults also consistently show that naps are beneficial only if they are short or moderate in length. In the large (1.86 million people) meta-analysis mentioned above, naps under 30 minutes eliminated the potential adverse health associations (Yang 2024).

Bottom line: When all the data are considered together, the ideal nap length is ~30 minutes of sleep. If it takes you 10-15 minutes to fall asleep, you can add that time…but if you wake up feeling groggy, your naps are too long. Experiment to find a time that works best for you.

What’s the best time to take a nap?

Ideal nap timing is covered by the interaction between sleep drive and the circadian (internal clock) system.

Sleep drive (or sleep pressure) builds up the longer you are awake, and quickly dissipates as soon as you go to sleep. Meanwhile, the circadian system produces a natural dip in alertness in the early afternoon, followed by rising alertness later in the day.

To take advantage of both systems, the best time to take a nap is after lunch in the early afternoon. At this time, you have both some sleep drive and circadian dip to help you fall asleep, but you have plenty of time to build up sleep drive for your nighttime sleep.

If you take a nap too late in the day, you’re at risk of trouble falling asleep at bedtime. You will also be missing out on your best, most alert hours.

Why naps should be intentional

Effective naps are planned, not accidental.

Accidental dozing while watching tv in the evening is not a high-quality nap, and signals you are not getting sufficient (quantity or quality) sleep at night. Falling asleep unintentionally (even for a split second) while driving, working, conversing, or eating, is a serious symptom of pathological sleepiness and should not be ignored.

An intentional, scheduled nap allows you to create a sleep-conducive environment, just like you would for nighttime sleep. The ideal nap is taken in a dark, quiet, cool, and calm setting.

Are some people better nappers than others?

Unfortunately, yes.

Some people have high “sleepability” (seriously, a real term in sleep medicine): they fall asleep easily. Sleep ability is likely influenced by genetics, stress levels, sleep schedules, and other factors.

If you have insomnia at night, do not try to take naps. Napping can worsen insomnia by reducing nighttime sleep drive, and increasing frustration. It’s best to conserve sleep drive for the nighttime.

Good nappers can also wake up relatively easily, ie don’t get “sleep inertia” too quickly during their naps.

If you don’t know if you’re a good napper or not: try it once or twice. If you’re not asleep by the time the alarm goes off, or you wake feeling super groggy, napping is probably not for you at this time.

Caffeine naps (optional)

One strategy to reduce sleep inertia is the “caffeine nap” or “coffee nap”.

Caffeine effects start about 10-45 minutes after taking it, and peaks in about 1-2 hours.

In theory, having a small serving of caffeine immediately before your nap allows the stimulant effect to start around the time you wake up, reducing grogginess.

However, results vary widely. Caffeine has a half-life of 4-6 hours, but some people metabolize caffeine slower, or are highly sensitive even to very low levels of caffeine in their system. Some people have trouble sleeping at night even 10+ hours after their last caffeine dose. If caffeine interferes with your nighttime sleep, skip the caffeine.

Summary: Tips for the perfect power nap

1. Intentionality: Nap on purpose, in a quiet, dark, and calming environment. Accidental dozing is not restorative.

2. Timing: End naps by 3pm. If you are a true night owl, naps should end 6-7 hours before your bedtime.

3. Duration: Keep naps 30 minutes or less. Set an alarm and stick to it.

4. Person: Naps work best for people who can fall asleep and wake up easily. If you have insomnia, avoid naps.

5. Caffeine (Optional): A small dose before nap may reduce sleep inertia, but try it only if caffeine doesn’t disturb your nighttime sleep.

References:

Leong RLF, Lo JC, Chee MWL. Systematic review and meta-analyses on the effects of afternoon napping on cognition. Sleep Med Rev. 2022;65:101666. doi: 10.1016/j.smrv.2022.101666. Pubmed.

Leong RLF, Lau T, Dicom AR, Teo TB, Ong JL, Chee MWL. Influence of mid-afternoon nap duration and sleep parameters on memory encoding, mood, processing speed, and vigilance. Sleep. 2023;46(4):zsad025. Pubmed.

Li J, McPhillips MV, Deng Z, Fan F, Spira A. Daytime Napping and Cognitive Health in Older Adults: A Systematic Review. J Gerontol A Biol Sci Med Sci. 2023 ;78(10):1853-1860. Pubmed.

Souabni M, et al. Benefits and risks of napping in older adults: A systematic review. Front Aging Neurosci. 2022 Oct 21;14:1000707. Pubmed.

Yang YB et al. To nap or not? Evidence from a meta-analysis of cohort studies of habitual daytime napping and health outcomes. Sleep Med Rev. 2024 ;78:101989. Pubmed.

How common is alcohol use?

Alcohol use is common, but less than most people think. A recent 2025 Gallup Poll showed that just over half of American adults (54%) report drinking alcohol. This is an all-time low for the 90-year survey, down from the mid-60’s for most of that time. Among those who drink, 40% said their last drink was a week or more ago, and 24% had a drink in the past 24 hours. Doing the math, we can extrapolate that a third of American adults drink more than once per week (60% of 54%).

Younger people (Gen Z and later millennials) drink less than older people: 50% of those aged 18-34 reported drinking, versus 56% of people over 35. This is a reversal of prior trends, where regular drinking used to be highest in younger adults, based on CDC data.

Globally, the WHO estimates that 7% of the world population has alcohol use disorder, and alcohol contributed 2.6 million deaths per year (back in 2019).

Obviously, there is a difference between drinking a couple times per week and having alcohol use disorder or dependence (aka “being an alcoholic” in older parlance). But the difference is a slope, not a boundary. Because we sleep every night, using alcohol as a sedative to fall asleep makes the slope to harmful drinking very slippery.

From a sleep perspective, the most relevant drinking patterns are:

• Drinking in the evening or close to bedtime

• Consuming multiple drinks in a short window

• Using alcohol as a sleep aid

• Drinking regularly (more days than not)

These patterns are strongly associated with sleep disruption, even when overall weekly intake seems moderate.

Does alcohol help you fall asleep?

Yes, but briefly.

Alcohol has acute sedative effects that initially reduce sleep onset latency, meaning people tend to fall asleep faster after drinking. But people very rapidly develop tolerance to sedative effects of alcohol, meaning higher and higher doses are needed for the same effect. So people who drink regularly do not fall asleep any faster than if they did not drink at all. (For an excellent review, Roehrs & Roth 2001.)

The initial sedative effect is followed by rebound arousal as alcohol is metabolized. Classic polysomnography studies show that alcohol’s sleep-promoting effects wear off within a few hours, setting the stage for the dreaded 3AM awakenings. And at this point in the night, because “sleep drive” has been used up, it is really hard to fall back asleep.

How does alcohol affect sleep stages?

Alcohol reliably alters sleep architecture, based on multiple laboratory studies. One particularly relevant study used gold-standard polysomnography in adults who drank regularly, but did not have alcohol use disorder, to see how alcohol affects sleep stages. (McCullar et al 2024)

Early night, when blood alcohol levels are high:

• Suppressed REM sleep

• Increased slow-wave sleep

• Shorter time to sleep (*not in frequent drinkers - Brower 2001)

Second half of the night, as alcohol is cleared:

• Increased awakenings

• REM rebound - but in total over the night the amount of REM is still reduced

• Lighter, less stable sleep, with less slow-wave sleep

• Reduced sleep efficiency

Over the course of the night:

• there is less REM sleep, which is important for memory consolidation and mood regulation.

• Total sleep time is either unchanged or reduced

• Overall sleep is less restorative, which explains why people often wake feeling unrefreshed even if they aren’t necessarily “hung over.”

Why do you wake up at 3 AM after drinking?

Waking up in the early morning after drinking is so, so common, that drinking is the #1 thing I ask patients about if they tell me they wake up in the middle of the night. Alcohol causes middle-of-the-night awakenings by a variety of mechanisms:

• Alcohol increases activity in the sympathetic nervous system, so as the sedative effect wears off, people wake up in “fight or flight” mode, aka “hangxiety.

• Alcohol increases body temperature, increasing night sweats that can wake people up, especially (peri)-menopausal women who have hot flashes already.

• Alcohol is a diuretic so people wake because they have to urinate more.

• Relatedly, dehydration may wake people because they are thirsty.

• Alcohol relaxes the upper airway muscles, worsening snoring and sleep apnea. Once the sedative effect has worn off, the apneas (stopping breathing) can wake people up

• Sleep apnea is worst during REM sleep. Because of the REM rebound in the second half of the night after alcohol, there may be more apneas that wake people up.

• Restless legs syndrome (and related, periodic limb movements of sleep) are worsened by alcohol.

• In people with REM sleep behavior disorder, alcohol use can trigger episodes.

• Alcohol worsens gastric reflux, so people may wake with heartburn.

• As alcohol is metabolized, blood sugar levels increase, which can also cause awakenings.

• Alcohol suppresses melatonin release and increases cortisol levels, disrupting the circadian clock mechanisms that help keep you asleep in the second part of the night.

These mechanisms explain why alcohol-related insomnia often presents as middle-of-the-night awakenings, not difficulty falling asleep.

What happens to sleep with chronic drinking?

With chronic alcohol use, sleep disruption becomes entrenched.

People with alcohol use disorder frequently experience:

• Chronic insommnia: they have a physical dependence to alcohol for the sedative effects, so they have a lot of trouble falling asleep without alcohol, but the same dose doesn’t really help like before

• Reduced slow-wave sleep

• Reduced REM sleep

• Shortened total sleep time

• Under-treated or untreated sleep apnea

• Dysregulation of the circadian clock

If someone who drinks regularly stops drinking, their sleep does improve, but it takes time. Circadian disruptions take about a month to resolve (Meyrel 2020), and the sleep disturbances and alterations in sleep architecture can persist for months or years. (Brower 2001)

Persistent sleep problems may increase relapse risk, so people with insomnia trying to quit drinking should seek medical attention for sleep problems to maximize their chance of maintaining sobriety.

Can alcohol affect brain health through sleep?

Yes. Chronic alcohol use combined with long-term sleep disruption is associated with:

• Impaired attention and executive function

• Mood and anxiety disorders

• Dementia and cognitive vulnerability with aging

The link between alcohol and dementia has multiple potential pathways, including sleep disruption, inflammation, impaired glymphatic clearance, untreated sleep apnea, circadian disruption, and increased cardiovascular and cerebrovascular strain. Alcohol is itself a potent neurotoxin, ie alcohol kills brain cells.

While dose thresholds remain under investigation, the assumption that “moderate” drinking is neurologically benign is questionable at best.

Bottom line: Is alcohol worth it for sleep?

Absolutely not.

Alcohol may initially help you fall asleep faster, but it consistently worsens sleep quality, causes early morning awakenings, worsens sleep disorders, fragments the night, and reduces restorative sleep stages.

Over time, the effects compound, impacting mood, cognition, and long-term brain health. Also, because we sleep every night, using alcohol as a sleep aid is a shortcut to developing alcohol dependence and alcohol use disorder.

How much alcohol is “safe” for sleep?

There is no amount of alcohol that improves sleep quality.

However, alcohol-related sleep disruption is:

• Dose-dependent (more alcohol = worse sleep)

• Timing-dependent (closer to bedtime = greater disruption)

There is no “safe” amount of alcohol, just like there’s no “safe” number of cigarettes. Even one or two drinks have documented negative effects on sleep and increase awakenings, particularly in sensitive individuals.

What are tips to drink without wrecking your sleep?

If you choose to drink alcohol, here are some tips to reduce the bad effects on sleep and risks of alcohol abuse:

• Finish drinking at least 3–4 hours before bedtime

• Limit quantity. Depending on your individual sensitivity, this may be less than one drink.

• Choose low- or no-alcohol beverages. Zero-proof or non-alcoholic beverages are the fastest-growing segment of the drinks industry so there are a lot of choices.

• Alternate alcohol with water (or no-alcohol drinks) to reduce dehydration and awakenings

• Don’t binge-drink (more than 3 drinks)

• Schedule regular alcohol-free days. Alcohol-free days should greatly outnumber alcohol+ days.

• Don’t use alcohol to “treat” insomnia, anxiety, or stress, as this is liable to become a habit that’s tough to break.

How can I cut back on drinking?

If you’re thinking about cutting back on drinking, here are some tips to cut back alcohol, through the sleep lens.

• Dry January, Sober October, and other pre-set periods of abstinence from alcohol do help, including with sleep. In fact, the sleep and circadian benefits might not become apparent until after a few weeks, so hang in there for the full month+! Even light drinkers are often pleasantly surprised at how much sleep, mood, and energy improve after a month or more of no alcohol.

• Wearables: If you are motivated by data, you can compare your sleep quality, resting heart rate, or heart rate variability on nights with and without drinking. Better yet, try whole month increments.

• Don’t drink at home. Not having it accessible at home makes it less likely you will drink, especially close to bedtime.

• Spend time with people who don’t drink, especially in the evening. Remember, the majority of adults do not drink regularly.

• If you have trouble sleeping or suspect you have sleep apnea or another sleep disorder, see a sleep doctor.

• If you don’t have a good bedtime routine, make one! (Bedtime Blueprint here) This way, you have a routine to help you relax into bedtime that does not include alcohol.

References:

Brower KJ. Alcohol's effects on sleep in alcoholics. Alcohol Res Health. 2001;25(2):110-25. PMID: 11584550; PMCID: PMC2778757. Fulltext.

Li G, Chen Y, Tang X, Li CR. Alcohol use severity and the neural correlates of the effects of sleep disturbance on sustained visual attention. J Psychiatr Res. 2021 Oct;142:302-311. doi: 10.1016/j.jpsychires.2021.08.018. Epub 2021 Aug 16. PMID: 34416549; PMCID: PMC8429210. Fulltext.

McCullar KS, et al, Altered sleep architecture following consecutive nights of presleep alcohol. Sleep 2024: 47(4):zsae003. https://doi.org/10.1093/sleep/zsae003

Meyrel M, Rolland B, Geoffroy PA. Alterations in circadian rhythms following alcohol use: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry. 2020 Apr 20;99:109831. doi: 10.1016/j.pnpbp.2019.109831. Epub 2019 Dec 3. PMID: 31809833. Fulltext.

Roehrs T, Roth T. Sleep, sleepiness, sleep disorders and alcohol use and abuse. Sleep Med Rev. 2001 Aug;5(4):287-297. doi: 10.1053/smrv.2001.0162. PMID: 12530993. Pubmed.

Types of exercise in research studies on sleep.

Numerous research studies have examined the effect of exercise on sleep, including each of the main three broad categories of exercise: aerobic exercise, resistance training, and mind-body.

Aerobic exercise is a physical activity (usually repetitive) that raises heart rate and oxygen consumption: walking, running, cycling, swimming, dancing, "aerobics,” all the “cardio” machines. Aerobic exercise is categorized by intensity (light, moderate, vigorous) based on how hard it is. Moderate aerobic exercise is approximately one you can talk during, but not sing.

Resistance or strength training is any activity where muscles contract against a force. This may be against body weight (e.g. pushups, TRX), weights, resistance bands or springs (e.g. pilates), isometrics (holding a posture, e.g. planks), or plyometrics (explosive movements, e.g. box jumps).

Mind-body modalities combine mental focus with physical movement, often with controlled breathing to link the two. Mind-body activities come in many different flavors, with variable emphases on movement (e.g. Tai Chi), flexibility (e.g. Yoga, stretching), balance and posture (e.g. Yoga, Tai Chi), strength (e.g. pilates), controlled breathing (e.g. Qi gong), mindfulness, and mental focus.

Of course, people often combine the different exercises, and there are intentionally overlapping modalities, such as circuit training, high-intensity interval training (HIIT), or pilates. Many research studies also combine different exercise modalities, so there are a lot of data regardless of the exercise type.

The good news is that all three types of exercise have been tested in research studies and help with sleep, especially sleep quality.

What’s the best exercise for sleep?

Again, all types of exercise have been shown to help with sleep, and there aren’t many studies that have compared different exercise modalities head-to-head. The best data come from meta-analyses that methodically pool together different clinical trials.

Aerobic vs resistance training for sleep:

A meta-analysis of adults with sleep disorders (age 18+, but mostly middle and older age, including 1214 people) found that (Wang 2025)

• moderate-intensity aerobic exercise was the most effective at improving sleep quality measures (sleep efficiency and wake time after sleep onset).

• Peak benefit was seen with 8-12 weeks of 3 weekly sessions of 45-60 minutes.

• Exercising 4 or more times per week was associated with improved slow wave sleep.

In a large meta-analysis of older (age 60+) people with insomnia (Bahalayothin 2025)

• Both aerobic and resistance training, and a combination, improved sleep quality.

• Low-to-moderate intensity exercise had the strongest benefit on sleep

• Resistance training improved sleep quality more than aerobic or combination exercise. (-5.75 points on the PSQI, vs -3.21 or -4.28)

Short term: One of the rare clinical trials on this topic that used polysomnograms compared a single session of moderate and high intensity aerobic and resistance exercise, in people with chronic insomnia. They found that moderate aerobic exercise (50 minutes) improved sleep quality (sleep efficiency) and duration (total sleep time), in addition to pre-sleep anxiety. (Passos 2010)

Mind-body modalities vs aerobic exercise for sleep:

A large meta-analysis combined 22 studies (1806 adults) of different mind-body modalities such as yoga, tai-chi, and pilates, with studies of physical exercise which were mostly aerobic. They found that mind-body modalities and aerobic exercise modalities were equally effective. (Xie 2021)

Combination exercise regimens

Another reason we can’t parse out the “best” exercise is that some of the highest-quality clinical trials of exercise on sleep used combination exercise.

For example, another of the rare studies that used polysomnograms tested the effect of a year-long exercise program on sleep, in middle-older age adults with sleep problems. The exercise program consisted of two 60-minute classes per week of moderate-intensity aerobic exercise (30-40min) and stretching, strengthening, and balance exercises, plus three times per week of aerobic exercise at home for 30 minutes x 3 times per week, for a total of 5 exercise sessions per week. (King 2008)

Another study, the MEDEX study (Lenze 2022), was designed to look at whether mindfulness-based stress reduction (MBSR), exercise, or a combination would improve cognitive function in older adults. They also measured sleep objectively with actigraphs, and found that in the exercise group, there was 10 additional minutes of sleep time per night by the end of the study. The exercise program was 1.5-hour classes twice weekly, consisting of aerobic exercise, resistance training, and functional exercises; plus home exercise for a goal of at least 300 minutes per week.

TLDR: Aerobic, resistance, and mind-body exercise all improve sleep approximately the same amount. Overall, moderate-intensity aerobic exercise may have the strongest effect, however in older individuals with insomnia, resistance training had a stronger effect. High-quality data support using a combination of exercise modalities.

How much do I have to exercise to help with sleep?

While a single exercise session improves sleep (Passos 2010), ideally we want to improve our sleep over the long-term. Recently, a large meta-analysis (62 studies with 5005 adults) addressed the optimal dose of exercise to improve sleep. (Xiong 2025). They found that

• The optimal dose of exercise for sleep is 990 MET*min/week. (Of note, 990 MET*min/week is right in line with World Health Organization (WHO) recommendations for exercise, which come to 600-1200 MET*min/week. )

• Combination of aerobic exercise and resistance training was the most effective

Different activities have different MET values depending on how vigorous they are. Brisk walking is around 4 METs, as is resistance training. Movement-based mind-body exercise like tai-chi and yoga are around 3 MET. Jogging (moderate intensity aerobic) is around 8 MET.

You then multiply by the minutes of each activity to get the MET*min:

• Brisk walking (4 MET) for 40 minutes = 160 MET*min

• Jogging (8 MET) for 30 minutes = 240 MET*min

• Resistance training (4 MET) for 30 minutes = 120 MET*min

• Mind-body (3 MET) for 60 minutes = 180 MET*min

You need to add up enough sessions to get to 990 MET*min over the week. Scroll to the last section “Putting it all together”; we’ll do the math for some sample exercise plans.

What’s the best time to exercise for sleep?

The textbook advice is that vigorous exercise too close to bedtime might rev people up, increase sympathetic tone, etc and should be avoided.

Recently, a study was published that got some press because they reported that people who exercised late had worse sleep (Leota 2025). This study reported on sleep metrics from 14,689 people who 1) wore a specific sleep/activity tracker and 2) exercised aerobically at least once per week. (This is a highly select population.)

They found that people had worse sleep if they did “high” intensity or “maximal” intensity exercise within 4 hours before to 2 hours after their usual bedtime. If you look at their definitions of intensity though, “high” intensity was like a 10-mile run or 90 minutes in Zone 4, and “maximal” intensity was like a half-marathon or 120 minutes in Zone 4. Who is running half-marathons at or after their usual bedtime?! Is it possible they are not following their usual daily routines and that is why they slept worse?

The takeaway from this study for the vast majority of humans is that light and moderate aerobic exercise does not negatively affect sleep if it ends a couple hours before bedtime.

Also, there is a lack of data on the timing of resistance training and mind-body exercise and how they affect sleep. Many people do stretching or yoga right at bedtime, and it simply does not make sense that it would worsen sleep.

Since we don’t have data… In my experience as a sleep doctor, over the years, the number of patients and people in my life who have told me they have trouble sleeping because they exercise too late is… drumroll…

ZERO.

And in my experience as a human being, it is all-too easy to make reasons/excuses not to exercise! It seems it’s never too early in the day to say “Oh it’s too late, I don’t want to ruin my sleep.”

Personally, and I know it’s the same for many busy working adults, I can’t exercise regularly, unless I exercise at night.

So in my humble opinion: Maybe the super-intense workouts and triathlons should happen earlier in the day. But light-moderate exercise to help with sleep? You should do that any time.

Putting it together: exercise plan for improving sleep.

Combining all the information we have through clinical trials, the optimal exercise plan for sleep is: 990 MET*min/week, a combination of moderate aerobic, resistance, and mind-body modalities, and 3+ sessions per week.

Let’s do the math for some sample exercise plans:

Sample exercise plan with moderate aerobic exercise like jogging, elliptical, cycling, or swimming:

Each week, exercise on 6 days including

• 2 x 30-minute sessions of moderate aerobic exercise —> 2 x 240 MET*min = 480 MET*min

• 3 x 30-minute sessions of resistance training —> 3 x 120 MET*min = 360 MET*min

• 1 x 50-minute yoga or tai-chi —> 1 x 180 MET*min = 150 MET*min

• 1 rest day

= 990 MET*min over a week

Sample exercise plan that is low-impact, no equipment needed:

Every day:

• 20 minutes brisk walk —> 7 x 90 MET*min = 560 MET*min

• 10 minutes bodyweight exercises —> 7 x 40 MET*min = 280 MET*min

  • 3 x 1-minute rounds of squats, pushups (wall or chair is fine), lunges

  • 1 minute plank

• 5-10 minutes yoga/stretch (can do as part of bedtime routine) —> 7 x 21 MET*min = 150 MET*min

  = 990 MET*min over a week

The best exercise plan is the one you can do consistently. If you already exercise regularly and you’re happy with it… check that you’re getting enough MET*min per week, but otherwise, great, you don’t have to change!

If you currently do zero exercise, you are not alone. In fact, you will benefit the most in terms of your sleep if you start exercising! (Buman 2011)

Going from zero to a little bit is the hardest part: creating the habit. If you are in the no-exercise group right now, decide for yourself the bare minimum and keep track. Choose something that you can do, every day, no excuses, like 10 squats or wall-pushups while you wait for your coffee to brew. Once you get going, you’re much more likely to ride momentum and do more! Some exercise is better than no exercise.

Remember, exercise helps you sleep that same night, and you will continue to reap benefits in the short and long term. If only I could put exercise in a pill and sell it as a sleep potion! For now, take advantage of the incredible sleep boost that only exercise can give you!

References

Bahalayothin P, Nagaviroj K, Anothaisintawee T. Impact of different types of physical exercise on sleep quality in older population with insomnia: a systematic review and network meta-analysis of randomised controlled trials. Fam Med Community Health. 2025;13(1):e003056. Fulltext.

Buman MP, Hekler EB, Bliwise DL, King AC. Moderators and mediators of exercise-induced objective sleep improvements in midlife and older adults with sleep complaints. Health Psychol. 2011;30(5):579-87. Fulltext.

King AC, Pruitt LA, Woo S, Castro CM, Ahn DK, Vitiello MV, Woodward SH, Bliwise DL. Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. J Gerontol A Biol Sci Med Sci. 2008;63(9):997-1004. Fulltext.

Lenze EJ, Voegtle M, Miller JP, et al. Effects of Mindfulness Training and Exercise on Cognitive Function in Older Adults: A Randomized Clinical Trial. JAMA. 2022;328(22):2218–2229. doi:10.1001/jama.2022.21680

Leota, J., Presby, D.M., Le, F. et al. Dose-response relationship between evening exercise and sleep. Nat Commun 16, 3297 (2025). Fulltext.

Passos GS, Poyares D, Santana MG, Garbuio SA, Tufik S, Mello MT. Effect of acute physical exercise on patients with chronic primary insomnia. J Clin Sleep Med. 2010 15;6(3):270-5. Fulltext

Wang P, Chen Y, Zhang A, Xie C, Wang K. Comparative efficacy of exercise modalities on sleep architecture in adults with sleep disorders: a systematic review and network meta-analysis of randomized controlled trials. Sleep Med. 2025;134:106680. Pubmed.

Xie Y, Liu S, Chen XJ, Yu HH, Yang Y, Wang W. Effects of Exercise on Sleep Quality and Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Psychiatry. 2021;12:664499. Fulltext.

Xiong Z, Yuan Y, Qiu B, Yang Y, Bai Y, Wang J, Wang T, Liu H, ShangGuan Y, Jiang S, Wang F, Ding W, Wang Z, Li Y, Zhang L. Optimal exercise type and dose to improve sleep quality in older adults: a systematic review and network meta-analysis. BMC Geriatr. 2025 Nov 28;25(1):1031. doi: 10.1186/s12877-025-06607-z. PMID: 41316008; PMCID: PMC12715968. Fulltext.

How does exercise affect sleep biology?

Exercise is simply nature’s best sleep aid. Physical activity does not just make us tired. Exercise sets off a coordinated set of biological signals that affect slow wave sleep, circadian timing, autonomic balance, metabolism, immune and inflammation signaling, and emotional regulation. Through multiple overlapping pathways, exercise directly affects how well we sleep.

Myokines: How Your Muscles Talk to Your Brain

When we contract and stress skeletal muscle during exercise, muscle fibers release signaling molecules known as myokines. Myokines function much like hormones, sending messages near and far to regulate metabolic and other biological functions. In this way, skeletal muscle is the largest endocrine organ in our body, and one over which we have direct control!

Over the past 10-20 years, myokines have emerged as a critical link between physical activity, brain function, and sleep. There are likely other myokine mechanisms yet to be discovered, but so far, there are several key myokines that are involved in sleep regulation.

1. Irisin: Exercise → BDNF

Muscles release Irisin (named for the Greek goddess of the rainbow, Iris) during aerobic and resistance exercise, when the FNDC5 protein is cleaved into its active form. Irisin has several known effects, both on general body metabolism and in the brain.

• Irisin boosts BDNF (Brain-Derived Neurotrophic Factor), which boosts slow wave sleep
  Irisin gets past the blood-brain barrier and increases BDNF in several brain regions. BDNF is crucial for synaptic plasticity and is strongly linked to deep sleep (slow-wave sleep). BDNF promotes slow-wave sleep through direct action on cortical neurons. (ElGrawani 2023 Cell Reports) Slow wave sleep, particularly continuity and stability of deep sleep, improved in a human study of exercise. (Park 2021 Scientific Reports)

• BDNF also plays a key role in entrainment or adjustment of the circadian clock in the suprachiasmatic nucleus. (Inyushkin 2023 J Cell Res) Strengthening and reinforcing the circadian clock sets the stage for good, consolidated sleep.

• Irisin improves metabolic health
  Irisin promotes white fat to become “brown” fat — brown fat is highly metabolically active and burns rather than stores calories. Irisin improves insulin sensitivity and stabilizes glucose. Because metabolic dysregulation decreases sleep efficiency and increases nighttime awakenings, irisin’s metabolic benefits indirectly support better sleep. (Here’s a good review of Irisin’s metabolic effects.)

2. IL-6: The Good (from muscle) vs The Bad (from inflammation)

There are two forms of IL-6 that have very different effects.

• Muscle-derived IL-6, ie the myokine: increases anti-inflammatory cytokines (like IL-10).

• IL-6 from immune cells: increases systemic inflammation and is associated with sleep disruption.

Exercise-derived myokine IL-6 has multiple benefits, such as

• Increased cellular glucose uptake and improved metabolic flexibility

• Supports circadian alignment via effects on peripheral clocks

• Does not produce the pro-inflammatory sleep-fragmenting effects seen in chronic disease states

Overall, exercise shifts inflammatory/immune signaling toward the anti-inflammatory direction, which stabilizes sleep and reduces nighttime awakenings.

3. Myostatin

Myostatin inhibits muscle growth. Exercise, especially resistance training, reduces myostatin levels.

Lower myostatin is associated with:

• increased growth hormone secretion

• more anabolic repair during sleep

Animal models link lower myostatin to increased N3 (deep), though there are no human data yet on the effects of myostatin on sleep. We DO know that sleep deprivation and poor quality sleep inhibit effects of myostatin.

Basically, if you want to grow muscle, you need to combine resistance exercise with good sleep, so that reduced myostatin can do its thing.

Autonomic Nervous System Effects: Restoring Balance

Sleep depends on a delicate balance between the sympathetic (“fight or flight”) and parasympathetic (“rest and digest”) branches of the autonomic nervous system. Chronic stress, anxiety, and sedentary behavior tilt this balance toward sympathetic dominance, making it difficult to initiate and maintain sleep.

Regular exercise improves autonomic regulation by:

• Increasing vagal tone

• Lowering resting heart rate

• Improving heart rate variability (HRV)

These changes reflect a nervous system with greater parasympathetic tone that can downshift more effectively at night. Over time, exercise trains the body to transition more smoothly from daytime alertness to nighttime recovery.

This helps explain why exercise is particularly effective for people with hyperarousal-driven insomnia, even when sleep duration does not immediately increase.

Circadian Mechanisms: Exercise as a Timing Cue

Light is the dominant circadian signal, but it is not the only one. Exercise acts as a non-photic zeitgeber, or a time cue that helps strengthen the internal biological clock.

Physical activity influences circadian rhythms by:

• Modulating clock gene expression in muscle and peripheral tissues

• Affecting melatonin timing indirectly through temperature and autonomic pathways

• Reinforcing consistent daily rhythms when performed at regular times

• Phase shifting effects through BDNF, as mentioned above.

Mood, Anxiety, and the Sleep–Emotion Loop

Sleep and mental health are tightly interwoven. Anxiety and depression disrupt sleep, and poor sleep amplifies emotional dysregulation. Exercise improves sleep in part by acting directly on mood-related neurobiology.

Key mechanisms include:

• Increased BDNF and monoamine signaling

• Reduced amygdala reactivity to stress

• Improved prefrontal regulation of emotional responses

These changes can help reduce nighttime rumination and physiological hyperarousal, which are two major barriers to falling asleep. In clinical studies, exercise interventions often improve sleep before significant changes in mood scores are observed, suggesting a direct effect rather than a purely secondary one.

Putting It All Together

Exercise helps sleep through multiple overlapping biological systems:

• Muscle communicates with the brain via myokines

• Neurotrophic (BDNF) signaling increases restorative, slow wave sleep and brain plasticity

• Autonomic balance facilitates sleep initiation and stability

• Metabolic health improves, which also affects sleep depth

• Circadian rhythms are strengthened

• Mood and anxiety are biologically buffered

• Immune-Inflammation pathways tip towards anti-inflammatory, sleep-promoting actions

Takeaway

The key takeaway is not that more exercise is always better, but that regular movement sends multiple powerful signals to affect sleep biology. This is why

• Exercise-sleep benefits occur even in people who don’t lose weight or gain muscle

• Deep sleep often improves before subjective sleep quality catches up

• Sleep quality improves but not necessarily quantity

• Aerobic, resistance, and mind-body trainings all help sleep

When viewed through this lens, exercise is truly the best sleep medicine!

This is that time of year when we resolve to do better. If you don't exercise regularly already, maybe consider giving yourself the gift of myokines for your sleep? Check back soon for Part 3, when we will review the types & timing of exercises best for sleep.

What a treat! I recorded a cooking interview with the co-authors of Eat Better, Sleep Better: Dr. Marie-Pierre St. Onge from Columbia University and Kat Craddock of Saveur magazine. Please cook along with us—one of the recipes is shared below—while listening to the audio or watching the video interview! (For the readers, the transcript is at the very bottom of the page). Please watch or listen for all the details and beautiful foods, but here are the main takeaways.

Top tips for sleep-supportive eating

1. Eat colorful fruits and vegetables throughout the day. Bananas, oranges, and pineapples have especially been shown to increase melatonin.

2. Higher fiber, lower saturated fat: a more plant-forward diet will help you with both of these.

3. Combine a variety of proteins with carbohydrates throughout the day, so that tryptophan (necessary for melatonin production) can reach the brain.

4. Nuts! Nuts decrease insomnia, contain melatonin, and have healthy fats.

5. Less sugar. Get carbohydrates from fruits, veggies, and whole grains.

Top tips for making healthy foods delicious and easier

1. Use flavorful, satisfying substitutions: smoked paprika instead of bacon, smaller quantities of high-quality aged Parmesan instead of loads of cheese and butter

2. Make ahead condiments, compotes, finished sauces, and toppings for intense flavors and variety ready to go

3. Fried sage, sumac, nuts, and other textured or distinctively flavored toppings bring delight

4. Pre-cook and chill or freeze carbs (pastas, rice, etc) so they’re easy to re-heat and the carbs become healthier.

5. Eat with your eyes and nose first: make your food look and smell beautiful so they taste and satisfy better.

The cookbook distills sleep nutrition science in an approachable and mouthwatering fashion. The recipes are easy to follow, and there is a 28-day detailed meal-by-meal eating plan that takes away guesswork and makes it easy to eat a healthy, sleep-supporting diet. NPR recently listed it as a Top 10 self-help story of 2025!

Thanks to Banza who provided the chickpea (garbanzo) gemelli pasta.

And a huge thank-you to Dr. St-Onge and Kat Craddock for sharing their time and expertise!

Listen here:

Or watch here:

Chickpea Gemelli with Butternut Squash, Walnuts, and Parmesan

Serves 3–4

Total Time: 1 hr.

Kosher salt

8 oz. dried chickpea gemelli or other pasta

1 Tbsp. extra-virgin olive oil

8 fresh sage leaves

One 1-lb butternut squash, seeded, peeled, and cut in 1/2-in. cubes (about 2 cups)

1 small yellow onion, coarsely chopped

4 garlic cloves, thinly sliced

½ cup dry white wine

1 cup chicken or mushroom stock

1⁄3 cup coarsely grated Parmesan cheese

2 Tbsp. coarsely chopped walnuts (optional)

Smoked paprika or freshly ground black pepper

1. Bring a large pot of salted water to a boil, then add the pasta and cook, stirring occasionally, for 5 minutes; it will still be quite al dente at this point. Reserve 1 cup of the cooking liquid, then drain the pasta and set aside.

2. Return the pot to medium-high heat and add the oil. When the oil begins to shimmer, add the sage leaves and cook, stirring frequently, until fragrant and crispy, 2–4 minutes. Remove the leaves from the pot and set aside. To the same pot, add the squash, onion, and garlic, lower the heat to medium, and cook, stirring frequently, until the squash is just tender when poked with a fork, 8–10 minutes. Stir in the wine, using a wooden spoon to scrape up any browned bits from the bottom of the pot; cook until the alcohol has boiled off, 4–5 minutes, then add the stock and the reserved pasta water. Increase the heat to medium-high, bring to a boil, and continue cooking until the squash is very soft, about 10 minutes more.

3. Remove from heat and blend the vegetable mixture with an immersion blender until smooth. (Alternatively, transfer the mixture to a jug blender, blend until smooth, then return the purée to the pot.) Stir in the pasta, return to medium heat, and bring to a boil. Cook, stirring gently, until the pasta is just tender and the sauce is slightly thickened, 2–3 minutes more. Remove from heat and stir in half of the Parmesan. Ladle the pasta into wide bowls, top with the remaining Parmesan, walnuts, if using, and the reserved sage leaves. Sprinkle with smoked paprika or black pepper and serve hot.

Excerpted from EAT BETTER, SLEEP BETTER. Copyright © 2025, Marie-Pierre St-Onge and Kat Craddock. Photography Copyright © 2025 by David Malosh. Reproduced by permission of Simon Element, an imprint of Simon & Schuster. All rights reserved. 

Transcript

Yo-El Ju: Good morning. Welcome to Marie-Pierre St-Onge and Kat Craddock. Today we are cooking with the co-authors of Eat Better, Sleep Better. First I'll introduce Marie-Pierre St-Onge, who is a professor at Columbia University. Can you tell us a little bit about your background and what led you to write this cookbook?

Marie-Pierre St-Onge: Yeah, so I have a PhD in nutrition and my research focuses on the influence of sleep, on energy balance regulation, but also the bidirectionality of the association between sleep, obesity, and cardiometabolic risk factors. And a few years ago, I was quoted in the New York Times about some research related to diet and sleep and was approached by our book agent to write a book. And she put me in contact with Kat. She matched us up and we wrote Eat Better, Sleep Better together where I provide information on the science related to sleep and diet and Kat developed wonderful recipes to put all this information into action.

YJ: Great! And then Kat Craddock, can you tell us a little bit about yourself and how you came together to write the cookbook?

Kat Craddock: Sure. Yeah. I am the editor in chief and CEO of Saveur Magazine. I've been with the publication for about 10 years now. Prior to that, I was a French trained chef. So I studied at a French culinary school, Le Cordon Bleu, after college and worked in restaurants as a pastry chef and a bread baker for about a decade before I kind of gradually started moving over to the food media side of things. Now I head up editorial operations at Saveur. I'm also the owner of the publication now. We are a 30-year-old food and travel publication specializing in global cuisine. And we are as of two years ago, a fully independent publication as well.

During the pandemic, Marie-Pierre and I, as she mentioned, our book agent paired us up. I was looking for a cookbook writing project and our agent had a really great idea to match up the two of us. So we spent those weird pandemic days remotely developing these recipes together using Marie-Pierre's science and whatever training I kind of gleaned along the way working in food.

YJ: And I have the least amount of food and nutrition expertise here. I am a complete amateur home cook. So I'm really excited to cook with both of you. I'm a professor of neurology at WashU in St. Louis. I specialize in sleep medicine and I do research on how sleep interacts with neurodegenerative diseases. And right now I'm writing a book and a website targeted to the public, hopefully to help people, especially women, sleep better, feel better, and hopefully age better with good brain health. So I'm super excited.

Let's see, we are going to be cooking a couple different recipes today. So this is—I'm  going to show the book—here's the cookbook, Eat Better, Sleep Better. I guess we'll find out if the video got reversed on Zoom. So the first recipe we're gonna be cooking is a chickpea gemelli with butternut squash, walnuts, and Parmesan. And then Marie-Pierre, you are going to make the kale and pita salad. And then I also have a shortbread with banana, a compote recipe, which we'll get going after the chickpea gemelli starts.

So maybe Marie-Pierre, you can start us off with the pasta. So this is a gemelli. It kind of looks like mac and cheese, but actually has butternut squash in it. Why chickpea pasta as opposed to regular wheat pasta? Why would we select a different, bean-based pasta?

MPSO: Yes, we were looking for recipes that were more plant forward because our research is showing that healthy plant-based diets are associated with better sleep quality. And so I think it's important to have a blend of both. You know, we can have whole wheat pasta, but we can also have chickpea pasta that increases the the tryptophan protein content of the pasta. And also chickpeas are a rich source of micronutrients, magnesium, is also very important in chickpeas. At the same time, I'm cutting my kale stems to get cooking for my kale salad.

YJ: And then we have Banza which is a chickpea pasta made just from chickpeas. So Kat, I realize I salted the pasta water. Are we supposed to do that with the chickpea pasta just like for regular pasta?

KC: Yes, yeah, just like you're cooking regular pasta. There are a lot of different brands of chickpea and legume-based pastas. Banza is probably the most widely available. But when it comes to cooking -- we have some cooking instructions in the recipe—we cook it in salted water for five minutes. Always just read the instructions on the box too, just because it's a little less of a consistent product than your standard wheat flour pasta and they may all be a little bit different.

The goal of getting it cooked off first is to cook it until it's al dente. So just barely cooked, still a little bit of bite to it. Also be aware that chickpea pastas tend to cook a bit faster than wheat flour pastas do. This only cooks for five minutes to get to al dente, whereas a wheat pasta might take 8-10. And unlike wheat pasta that has gluten in it and is a little bit stretchier, when chickpea pasta is overcooked, it has a tendency to break down. So you really want to set a timer and make sure that you're erring on the side of underdone rather than overdone with this.

YJ: All right, so I'm setting my timer right now. All right, so five minutes. Okay, and then just in terms of, you know, legumes or beans, Marie-Pierre, can you tell us a little bit about, you know, the combining of proteins and carbs, which you discuss in the book?

What kinds of proteins should we be looking for and why and what kind of carbs should we be looking for when we combine them?

MPSO: We're trying to increase the absorption of tryptophan and transport to the brain, and that requires carbohydrates to be able to transfer other amino acids to the muscle while tryptophan is… while transporters are freed up for tryptophan to travel to the brain for the synthesis of melatonin. Tryptophan is a building block for melatonin. So that's why this amino acid in particular is very important from the diet, because we can't make tryptophan ourselves. We have to get it from the diet. So it's important to have protein rich foods along with carbohydrates. And we're trying to have, as much as possible, more whole grain carbohydrates, more complex carbohydrates.

So carbohydrates that come from whole grain foods, but also legumes and fruits and vegetables rather than simple carbohydrates that we get from the white stuff.

YJ: Okay. So we want to get tryptophan from protein and we want to try to get those from plant-based sources or a variety of sources. And then we need to pair those with carbohydrates, which are hopefully kind of more complex carbohydrates.

MPSO: Correct.

YJ: Okay, things that are brown or have fiber.

MPSO: Exactly. So your brown rice, brown wheat bread, brown pasta, legume based pastas are higher in fiber as well. And we're also looking for the more colorful vegetables because they are rich in polyphenolic compounds, antioxidants and anti-inflammatory compounds that are also very important for healthy sleep.

YJ: Okay, so I think something that's a great takeaway is that foods that are good for your sleep are probably good for your overall health as well. So I feel like there's like nothing good for your sleep that's bad for your overall health. So that's, that's really nice that everything is concordant with one another.

MPSO: It is good for your brain health too: the MIND diet is helpful for your brain and it's helpful for your sleep.

YJ: Great. And then it just in terms of the timing of the tryptophan we get... So obviously a lot of people take melatonin supplements in the evening and stuff. How should we be timing our tryptophan intake? Should we be binging on meat right before we go to bed?

MPSO: Yeah, so we often hear this story about Thanksgiving and falling asleep immediately after consuming turkey. It's not that quick. What you eat has to be processed, has to go through your gastrointestinal tract, right before it travels elsewhere in the body. And that process takes hours. So it's not this quick fix. So to me, my take on this, is to be able to have the nutrients on hand at the ready when it's time to produce melatonin, when it's time to fight infections, when it's time for healthy sleep.

It's just making sure that the nutrients are all available. And also what we eat, the plant-based foods influence our gut microbiome. That takes time. You want to modulate your gut microbiome to have a healthful gut microbiome that produces more short-chain fatty acids that then regulate circadian rhythms and improve sleep. So to me, it's a day-long affair. And that's why we have recipes from breakfast all the way to like good lunch options and dinner options, dessert options as well. So we should be getting our tryptophan and really, you know, a good diet throughout the day.

YJ: Something that my patients ask about is taking melatonin supplements and the best time to take it. The thing is, our pineal glands make melatonin all day, it's just the pineal gland saves up the melatonin and then releases it a couple hours before bedtime. And so we really need to be supporting our sleep and circadian health by, getting all the building blocks available 24 hours a day, as opposed to trying to supplement just at a certain time.

MPSO: Exactly. I'll turn on my oven because I realized I have to preheat to 450 and that's going to take some time.

YJ: Oh yeah. All right. Kat, can you talk a little bit about developing this chickpea gemelli recipe and how you came up with the different combination of ingredients? I don't think I've ever done, say, Parmesan cheese with butternut squash before.

KC: Sure, yeah, I think that one thing that was really interesting to me about putting Marie-Pierre's research into action was that there is such a great emphasis on diversity in our diet and making sure that there are a lot of different ingredients, maybe more ingredients than people could be used to cooking with if they're not regularly cooking. Since I've been working in food my whole career, first in restaurants and then in recipe testing and development, I always just kind of naturally get a lot of variety in my diet and a lot of different ingredients. That's a little bit, maybe a little bit more of a pivot for people to kind of get out there and start incorporating more ingredients into their cooking.

But what I was really trying to do is make sure that even though there were a lot of ingredients and a lot of combinations that we were incorporating into these recipes, that they still kind of scratched that like weeknight easy food fix. You know, this isn't only for mom or dad who may be not sleeping well, it's for the whole family. So everybody needs to be able to kind of enjoy this food. And I didn't want this to be overwhelming or daunting.

So I wanted something that kind of felt like macaroni and cheese, right? Comfort food, winter fare, rib sticking, comforting, carbs, right? We all love that kind of food. I have a background in cheese as well. Before I went to culinary school, I wanted to kind of be able to incorporate the flavor of cheese without all of the nutritional hazards that might come with it sometimes. So the color, obviously a butternut squash came to mind first. And I played with it a little bit, incorporating it with some of those savory flavors. I tried it with miso. I tried it with fermented black beans. But really at the end of the day, a little bit of Parmigiano Reggiano or good quality—there are a number of other similar cheeses, American style Parmesan or Grana Padano, which is another classic Italian grating cheese--they're so flavor dense that you really don't need a lot of it. So when I developed a recipe for a sauce that kind of got at that macaroni and cheese consistency, going with a really aged cheese like that and incorporating it into something a little bit sweet, a little bit starchy, really got at what we were trying to accomplish with that flavor.

This is a recipe that comes together in one pot. I’m doing it in two just to keep things moving a little bit quickly here, but I also wanted to make sure that this was not something that was going to take over your whole kitchen. Takes a little bit of time to prep, but all of the ingredients are [easy to prep]. I actually tested this out for this shoot. I wanted to see if I could get everything pretty easily already prepped out from the grocery store. I was able to get cleaned and cut squash all ready to go. I was able to get onions pre-chopped. You can either get them in the produce section or in the freezer section.

The one thing that I would recommend people do not cut corners on though is getting pre-grated cheese for this. Pre-grated cheese is totally fine for topping for a lot of different uses, but frequently, pre-grated Parmesan has some anti-caking agents, preservatives, things like that to keep it longer in the fridge and keep it from clumping. And those ingredients will kind of prevent it from melting nicely into your sauce. So I would recommend getting a hunk of Parmesan, whether it's Parmigiano Reggiano or BelGioioso -- that's an American brand that's pretty widely available and really reliable as well. Get the hunk, grate it yourself, and you're going to see a much smoother, silky cheese sauce using it that way. It's so easy to grate cheese directly. It's not like, you know, you don't save much time by just buying pre-grated cheese, in my opinion.

KC: Yeah, and I find it does last longer in the fridge too. A hunk of parmesan if you wrap it well, it's going to keep a lot better than the pre-grated stuff that has a lot more surface area to it.

YJ: Yeah, I also feel like food tastes better if you can kind of taste it with your eyes first, you know, to like see the cheese being grated. It just like makes you so hungry for it. I feel like that's like the best part of any dish: the ceremonial cheese dusting. And then Kat, you had mentioned that this is a recipe that could potentially be made ahead. So how would we modify the recipe if we wanted to make it ahead?

KC: Yeah, that's actually, it's a great idea that I think it works beautifully this time of year when you, know, potluck season or if you're feeding a big, if you're doing a big Thanksgiving or holiday meal. If you multiply this by 3 or 4 depending on the size of your pan, it works beautifully in kind of a big baking dish. did it in a big lasagna pan. It's in the oven right now. I can show it to you guys in a little bit. But if you just kind of multiply it by 3 or 4, tip the whole pasta into the roasting pan and put the cheese on top and throw it in the oven. It's like a big baked macaroni and cheese, right? And it works as a good side dish. It works as a main because it's much more protein-rich than wheat flour pasta.

So it's certainly impressive and it has the same kind of oven to table “Wow!” moment that a big baked macaroni and cheese would have as well.

YJ: So for that, would you make the fried sage leaves later and just add them on at the end or do they freeze okay? Yeah, I would make the fried sage, well, make the fried sage the same way you normally would, but don't put it on top of the pasta and don't put the walnuts on top of the pasta until it comes out of the oven, because they're more likely to burn in the oven. But you do want to fry the sage leaves ahead of time, which I'm going to do that right now. Because getting all of that beautiful sage flavor into the olive oil, I think really kind of elevates the macaroni and cheese and makes it good for grownups as much as it is good for kids. Sage, fried sage and butternut squash combination is very classic. It's very easy to do.

Just dropped a few sage leaves into hot olive oil. don't know if you guys can see it in there, but as soon as it goes into the pan, it just fills your kitchen with this beautiful, beautiful herbal aroma. And it's a very impressive kind of flex to top your pasta with frizzled delicious bright sage leaves at the end. Yeah, it smells so good right now. I'm doing my sage leaves.

I drained my pasta and now I'm doing the sage. And once that's done, then I guess I'll take those out and everything gets put back into the same pot, which is great. I'm going right in with my pasta now. Even even now I still set a timer. just encouraging everybody. It's not cheating. Do set a timer. Don't walk away from it. All right.

YJ: And then the other recipe I'm making, I made ahead. So let me see. Let me find my recipe.

This was a banana chamomile shortcake. And this is a recipe with biscuits that are super quick and it has oats in it. It has oats, whole wheat flour as well as all-purpose flour. And it's really easy because it has olive oil as opposed to using butter that you have to cut in. So it actually makes it a lot easier to use the healthier fats.

I made them ahead. I'm going to go grab them just to show them off.

MPSO: Can't wait to see those.

YJ: Yes, I haven't baked them yet. So this is a pre baked.

MPSO: Nice.

YJ: So I made 13 biscuits, not 12, but I wasn't going to start over. I'm to pop these in the oven now. Hang on one moment.

KC: The thing I love about that recipe too is you know, classic rolled out southern style biscuits. They take a lot more kind of skill and finesse and you don't want to overwork them too much. These are a drop biscuit. So you really can't mess it up. You just mix everything in a bowl and then scoop plop it and scoop it and plop it right into your, your cooking pan.

YJ: Yeah. It was so easy. I have like the, you know, the, the cylindrical shaped measuring cups. I just plopped em in. So that was super easy. Let me get myself organized here. How do you know when the sage leaves are done?

KC: You'll see them sort of getting a little bit darker not browning but they almost start to look a little bit translucent, I would say.

YJ: Okay.

And they'll be crispy, crispy and you don't quite want to get any more color on them than just that sort of like translucent the darker green. But once they're crispy, you can pull them out and set them on a little paper towel. You can make those ahead of time for sure.

MPSO: It does start to curl a little bit, no?

KC: Yep, they curl up a little bit. usually try and flatten them down a little bit with my spoon or whatever I'm using to scoop them out so that they get evenly crisped.

MPSO: The chickpea gemelli recipe is one of the two recipe rotation in my household because I absolutely, absolutely love squash, all squash. And the soy braised miso butternut squash is a recipe that I make pretty much every week during the fall, winter when it's squash season.

The butternut squash are always bigger than you expect them to be. So one squash to me gets me one recipe of just a butternut squash side dish. And then I use the other piece to make the chickpea jam. Wow.

YJ: Yeah, I have like half the squash left over. I forgot, like we should probably wear gloves at least one hand to cut butternut squash because you know like the orange flesh kind of stains your flesh and you have to scrub it off. So I've forgotten. I need to get back into squash eating mode this season.

KC: I should also mention that and the recipes is butternut because that's the most widely available all-year-round winter squash. But you can really use any winter squash for this dish. I'm using delicata right now because they were at the farmers market and beautiful. And butternut squash, usually, especially the really big ones, the skin is quite thick and you're definitely going to want to peel that with a vegetable peeler. The smaller butternut squash or any smaller winter squash like delicata, I've just been leaving the skin right on there. I'll cut them in half, stick everything out and cut the stem part off. But the skin is so thin that it'll blend up beautifully. And I don't know, Marie-Pierre, you can weigh in if there's more nutrition in the skin or not, or more fiber.

MPSO: But I never thought that the, never knew that the butternut squash skin was edible. I always, always peel it off. And, and I always liked that kabocha squash and acorn squash and those delicata squash that you can eat the skin. I love that, but never thought of, I thought that butternut squash because of the, I don't know the waxiness of it. You couldn't really eat it.

KC: Yeah, I would say the big big ones, it's probably going to be too tough. But sometimes you see the little baby butternuts. No, I've eaten those no problem. I've blitzed it into a soup. Maybe some of the ones that are I think sometimes at larger supermarket chains, they may wax them a little bit. And if it feels like there is actually wax on the outside, I just run that under hot water and give it a big scrub to remove it. But the skin is yeah, and it's not really that much different than a zucchini. They just leave it on the vine a little bit longer.

MPSO: I see.

YJ: Let me wait for Marie-Pierre to come back.

MPSO: My oven's ready, so I'm going to... okay.

YJ: Yeah, pop things in.

MPSO: This is like my one sheet pan of vegetables for the warm pita salad. Looks great, right?

YJ: That looks beautiful.

MPSO: Yeah, I'm gonna. Alright, so now this is 20 to 30 minutes. 20 to 40 minutes.

YJ: So I took out the sage leaves and now I'm cooking the onions, garlic and the butternut squash that's been and So I guess we do that for maybe eight to 10 minutes before we mash them all up.

KC: Yeah, and if you notice your onions start browning before then, you can cut this step a little bit shorter and just cook the squash longer once the liquid has been added.

My onions, my pan was maybe a little hot when I put the vegetables in and the onions are starting to caramelize. I don't want to get too much color on this because I still want to retain that nice golden orange color in the finished sauce. So I'm going to go right in with my wine right now. And Marie-Pierre do you want to talk a little bit about the wine that we've incorporated into a lot of these recipes. And I know that that you mentioned that there might be melatonin in that as well.

MPSO: Right. Yeah. So some wines and grapes, there's some melatonin. So some wines could have melatonin. There's also lot of polyphenols, mostly in the red wines. So we've been incorporating wine, also beer actually--in one of the muffin recipes, we use a stout. So they've been shown to have a lot of polyphenolic compounds, also melatonin. We've been including those in the recipes. It [the heat] kind of burns off the alcohol and you get the benefits of the polyphenolic compounds and melatonin.

YJ: Kat, what should be used for the flavor for the people who don't drink alcohol or don't have it around?

KC: Yeah, this recipe uses a dry white wine. I had a holiday party a couple days ago and I had some leftover bubbles in the fridge, so I actually put Prosecco in there. But you want to make sure it's not a sweet wine. You can also absolutely, if you're not an alcohol drinker, you can buy cooking wine at the grocery store. Just be aware that it has a lot of salt added to it to make it shelf stable.

So you're gonna wanna dial back the salt in the recipe and then just season to taste at the end so that you're not over seasoning.

YJ: I don't have any open wine, and I generally don't drink wine. So I have vermouth that I keep in the fridge, because you don't wanna keep like a half open bottle of wine. So I'm gonna [use vermouth].

MPSO: Kat, does it matter when you're cooking with wine? If it's an old bottle of wine, if it's, you know, stayed on your counter for a couple of weeks like you wouldn't drink it. But if you could cook with it, is that...?

KC: I would give it a sniff. If it has turned to vinegar, I wouldn't use it in the place of wine. And I usually will keep it in the fridge if I'm not going to drink it right away. I'll keep it in the fridge just knowing that I'm going to want to cook with it. But yeah, I mean, this is not the best bottle of wine that you want to open up to put in your macaroni on a Wednesday night. If you've got leftovers, great. You can pack it out into little kind of plastic containers and throw it in the freezer too if you're not moving through it quickly enough.

Fortified wines like vermouth will last a lot longer because they have some brandy added to them. So that is a preservative as well. I still keep my vermouths and port and fortified wines like that. My mom and dad always kept port in the liquor cabinet indefinitely. I wouldn't recommend that. I would keep it in the fridge just to keep it a little bit longer. But yeah, I mean, if it's been around for a few days, you're still fine to cook with that. Good to know.

YJ: Marie-Pierre, what kind of micronutrients or macronutrients are in squash in general?

MPSO: Squash is high in vitamin A. A lot of it has magnesium, vitamin B6, potassium, lot of potassium. So those are good, good micronutrients. So we're supporting sleep, vitamin B6, magnesium and zinc are relevant for conversion of tryptophan to melatonin. And they've also been shown to be associated with better sleep quality.

YJ: Are there certain squashes that are better than others?

I don't know. There might be some small differences between different squash. But to me, I feel like the darker orange colored squash, pretty much you can count on them having vitamin A and a lot of polyphenolic compounds.

YJ: Yeah, I feel like it's a nice shortcut. Just the more colorful stuff is generally better for you.

Kat, I wanted to ask about what are some tips to make healthy food more appealing? So I feel like it's always great when we can plan ahead and make healthy foods. But at the end of a long work day, it's a lot easier just to take out or make mac and cheese from the box. If we do take the time to make healthy food, how do we make it like taste as good and as appealing as something that's easier?

KC: I love this question. Like I mentioned, I have a French culinary training background, and I'm very used to cooking with a lot of bacon and cream and butter and a lot of things that maybe Marie-Pierre wouldn't recommend consuming the quantities that I'm used to cooking with. So as we were developing these recipes, we kind of went back and forth a little bit to try and figure out how to achieve those sort of same satisfying effects while having a more healthier outcome.

For example, bacon is an ingredient that I like to use in moderation, but pretty regularly. And it didn't necessarily add much to a lot of what we were doing. So instead of that, we decided that we were gonna start swapping in more olive oil and smoked paprika, which is an ingredient that's used in Spain. It's pretty widely available at well-stocked grocery stores or there are a couple of single origin spice companies that I really like. This is a flavor that really brings that kind of rich smokiness to a dish. Whether it's a clam chowder or macaroni and cheese, something where you might want that kind of bacon flavor to it without adding, and it's really just smoked ground red peppers.

So this particular dish, you can finish it with black pepper at the end. I really like to sprinkle a little bit of smoked paprika on. It gives it little bit more color. You eat with your eyes and your nose before you eat with your mouth so that that kind of fragrance and visual appeal is really, -- I think it really adds a lot to the experience.

We also have a whole chapter in the book of kind of make ahead pantry stuff. And if you spend maybe a Sunday afternoon work working through a couple of those dishes, there are some kind of condiments and toppings and finishing sauces that keep well either in your pantry or in your refrigerator so that when you do come home starving at 730 or 8 o'clock at night, you really need to get something healthy on the stove and in your stomach fast. Having some of those things made ahead of time and you really just do need to boil some pasta or cook some rice or just do the kind of last little bits that having those, having some of that heavy lifting done ahead of time really makes a big difference.

YJ: Something that I was really pleased to find out is that chilling or cooling down carbs makes them healthier. So for example, like plain white pasta or white rice, if you cook them and then you let them chill in the fridge overnight, or if you freeze them, then they actually kind of take longer to digest in your system and they spike your glucose less. So that's vgreat for me, because I like to cook those types of things ahead of time and freeze them. And that way I can just microwave them when I need them. So I think that's like a healthier way of eating that actually makes life easier in terms of how long it takes to cook.

All right, how do we know when to blitz this? I think mine needs to go a little bit longer before I blend them.

KC: I would give it a poke with the tip of a paring knife or a fork. And if it's tender, if it slides right off, then it's ready. And if it's still kind of firm, like a hard potato, keep going. And if you're losing liquid, if it's boiling off before the squash is soft, you can always add another splash. I don't know if you noticed that when I was draining the pasta, I reserved a cup of the pasta water. So that goes in there with some vegetable, with some broth. I call for either mushroom or chicken, but any stock you have around works just fine. That pasta water, there's a bit of starch in there that will help kind of bind the sauce a little bit, keep it from separating, keep it silky and smooth and help it cling to the pasta. So that stuff is gold. Don't dump it all down the drain, save a little bit of it. But if you need to add a little bit more tap water, that's totally fine. I think I'm actually going to do that a little bit because my squash was cut kind of large.

YJ: So even with the chickpea pasta, there's starch in the pasta water?

KC: Yes.

YJ: Oh ok. How long did it take to develop all the recipes and the science? What was the process for getting all of this together into the final product?

KC: I'll let Marie-Pierre speak to the science, maybe her whole career, probably.

MPSO: The science takes a long time. Writing it up is, you know, it took time too, but getting the science always takes a long time, right? Doing the research is what really takes time. writing the book took a few years. yeah, it took some time developing the recipes, testing them. Kat tested all of the recipes you know, to make sure that they were all proper, you know, with proper quantities and ratios. And then I tried them at home as well. I had my kids, my husband taste them, get their feedback, try to see how would a person who's doing this at home be able to do it? Is it something that we could do?

Like we were talking about, you know, coming home from work or ... or are those recipes too involved? And it was great because, you know, I could say confidently that a lot of the recipes, you know, although Kat was saying have a lot, seem to have a lot of ingredients, they're not very hard to put together and relatively quick to assemble for dinner. And there are some that are longer and they're more, you know, we keep them for the weekend. And often those recipes make a big batch. And thankfully you have leftovers for the rest of the week.

KC: Yeah, we haven't really talked about your meal plan, Marie-Pierre. I think that's an interesting topic to kind of delve into a little bit with that in mind that we did really kind of develop a schedule of how people can incorporate these recipes into a month's worth of eating, including using up their leftovers and not eating the same thing every single day because that's a really good way to burn out your palate and make you not want to continue eating this way.

YJ: Yeah, I do love that section that has, I think it's a 28 day eating plan where it just tells you day by day kind of what to eat and how to combine the different recipes so that you're getting novelty as well as a good nutritional balance. Marie-Pierre, how did you kind of balance out the different macronutrients, the different recipes, over those 28 days?

MPSO: Yeah, so all of the recipes, I actually ran them all through NDSR. It's Nutrient Database software for research where I knew the whole nutritional composition of each of the recipes down to its amino acid profile, different fatty acid profile, all the micronutrients that we're talking about. And then when I put together the meal plan, kind of assembled the recipes in such a way as to maximize how much tryptophan, magnesium, vitamin B6, zinc, fiber there would be in a single day and try to go at it that way. Because some recipes are higher in one nutrient than another. so mixing them in that way would maximize the proportions. And also thinking about, which are the recipes that take a little longer that could be done on the weekend and then that would have leftovers that you could use for lunch on a weekday or for dinner on a weekday for pre-preparing breakfast for the week or things like that. So that's how I kind of put it all together.

YJ: What would you recommend for the vegetarians or vegans? What are the plant-based protein sources that we should be looking for and combining? What are some easy swaps to do for the recipes?

MPSO: Yeah, so we have a different list of foods in the book that show which ones are higher in tryptophan and different vitamins, serotonin, melatonin, as well. But, you know, you could use some tofu in place of in place of some of the meats. When I was testing some of the recipes at home, my daughter wanted to be vegetarian for a year. At that time, think she was 12, around that age. And she said, I'd like to try to be vegetarian for one year. I'll start on January 1. So that way I know when my year starts. I was like, OK.

So there was a recipe that called for, one of the recipes I think calls for sausage, I think in the stuffed tomatoes, and for her I swapped it with tempeh. And so Kat, I don't know, you might wanna talk to different swaps that you can make for different recipes also that make it more vegetarian friendly.

***wifi woes***

YJ: Kat, we were just saying how the pita and kale recipe, it's one pan. This, the gemelli recipe, is one pot. And then the shortcake recipe also I made in one bowl where you know the wet ingredients were just added to the dry ones. So these are all great recipes. One less big bowl to wash.

KC: Yeah, working in professional kitchens, you get really used to having somebody else that does your dishes for you all the time, which is a real blessing.

I don't have that at home. I do have a dishwasher machine, but yeah, as much as we can streamline and as little dish, as few dishes as possible, it was definitely a goal here as well. We don't need to create more work and more anxiety and clutter for anybody with this project.

YJ: Kat, are you ready to blend?

KC: Yes, I was just gonna say, while I was working out my technical difficulties, I turned the stove off because this squash is nice and soft and ready to go.

I have a stick blender, which I use all the time. I like pureed soups a lot. So these are super duper handy. I particularly like this one because it's got a removable blade that's easy to clean. But I have it plugged in right next to the stove. I turned it off because we don't want it actively cooking while we blend. if you have an outlet by the stove, I find it just as easy to leave it there and not worry about moving it around. So this is going to be noisy for a minute. Excuse me.

YJ: All right, and then I'm going to blend too, so I'm going to go on mute.

KC: If you don't have a stick blender, a regular jug blender is totally fine for this. If you don't have extra appliances, you can also really do this with a potato masher and just leave it a little bit more shaggy and coarse. But if you want that nice silky consistency, blending it either with a stick blender or a classic blender will do you right.

I don't love this in a food processor. I find that it's too liquidy for something like that and they have a tendency to splash over the edges.

MPSO: All right, I'm all done with my recipe. The warm pita salad with kale, feta, tomatoes, and chickpeas. I think it came out nicely. I love the brightness of the greens here. There you go. Kat, I'm very proud of myself on this one.

KC: And then once that puree is nice and smooth, if you want to be really chefy about it, you can run it through a fine mesh sieve. We didn't do that. It's not necessary at all. And then I already have my pasta already cooked. So I add that to the sauce and turn it right back on to bring it up to a boil once more.

MPSO: Yeah, that sauce comes a lot comes together very well. It doesn't it's not runny or anything like that. It really is very creamy.

KC: Yeah, and if you're making a large batch and baking it and you want to reserve that kind of creaminess and not have it be like a dry baked macaroni and cheese, you can add another half cup or so of water. Just adjust the salt and pepper accordingly.

YJ: All right, I can unmute now. I love using the stick blender, but it was very noisy. All right. so let's see. after we blenderize then we put all the pasta back in, right?

KC: And mine is already starting to bubble again. It doesn't need to be a big rolling boil. It's not a ton of liquid in there, but it's once you see it a little action in there again, you're ready to go. And then you put half of your grated cheese in. A few tablespoons. I like to turn the heat off at that stage so the cheese melts a little bit more gently. Give it a taste, make sure that the seasoning is to your liking. that's so good. Do you want to talk a little bit about salt, Marie-Pierre? And we're a little bit kind of we season to taste a lot. not being really scientific with the quantities of salt and everything.

MPSO: When you cook at home, there's really very little salt in your, in your dishes because it's all fresh ingredients, hopefully. So you usually season to taste. You know, and salt is one of those, it's an acquired taste. And so you can cut down on salt…[Looking at baked shortcakes] those look very beautiful. They're nice…You can train your palate to eat less salt. And, using other spices can also be very useful to compensate for less salt in your cooking. So I think it's good to cut down on salt as much as possible, but salt does amplify the flavor of various dishes. So you don't need to put a lot, just a tiny bit and then compliment with other spices.

YJ: I have heard from a lot of my patients now who are taking GLP-1s that their ability to taste the salt has improved where... or they didn't realize how salty their foods were, especially when they ate out. And now they're like, wow, that is overpoweringly salty. So it's interesting how that class of drugs really changes the perception of taste.

MPSO: Yeah, I wasn't aware of that. Interesting. I'm sure it does the same for sugar too, right?

YJ: Yeah, I think so. But also, I feel like people kind of know that there's sugar in sweet treats, whereas, you know, it's gonna be…

[looking at Kat’s gemelli plated] Let me se, Kat, can you show it again? Oh, beautiful!...

Whereas people aren't always aware of how salty their savory foods are.

All right, I need to find my cheese. There we go. So we put half the cheese in, but after we take the heat off, right?

KC: Yes, yeah. Bring it back up to a boil with the pasta in there, then turn the heat off and stir in half of the cheese. And I put the smoked paprika, but I really like black pepper too, so I'm going to put a little bit of that on mine

MPSO: I love that the kale salad has sumac. I love sumac. It's such a wonderful spice.

YJ: What is Sumac?

KC: It's a berry that it grows on a tree. Different from poison sumac, kind of it's a tree like poison sumac, but it's a edible berry that grows. It's a red berry. It's used in Persian cooking a lot. And it's got kind of a bright lemony flavor to it. You can use it in place of lemon or you can, if you don't have sumac, can use lemon juice as well. But sprinkled over sweet or savory dishes, I like it. It adds a really kind of nice bright pop that can be, yeah, if you're trying to get more flavor in without adding more salt, I think that kind of brightness can really bring a lot to a dish. Great.

YJ: So for the pasta, we put into wide bowls, top with the remaining Parmesan and walnuts. Oh, let's talk about nuts! Marie-Pierre, tell us about nuts and why they are so good for us.

MPSO: Yeah, nuts contain melatonin and a lot of polyphenolic compounds. So walnuts actually are being studied now as a food that can increase melatonin levels. But there are other nuts, pistachios. I'm actually on the the board for the American pistachio growers. They're rich in polyphenolic compounds, phytomelatonin. They contain tryptophan. They have vitamin B6, magnesium. Studies are showing, actually we just published a paper showing that consuming a diet that's higher in, or that's closely aligned with a Mediterranean diet, but also dietary approaches to stop hypertension are associated with reduced risk of insomnia. And when we're looking at specific components of the diet, nuts are associated with lower risk of insomnia. Definitely adding nuts to the diet that I think, you know, in the US nuts are not consumed very widely, but in other cultures, very much so. And also they add a little bit of crunch to to the foods that you eat, it helps to also make things a little more satisfying, healthy fats, polyunsaturated fats, and lower in saturated fats for nuts. So they're good to include.

YJ: Nuts for me are my most potentially deadly snack because I love them so much. So you really do have to use a scale or something because it's so easy to keep just popping them in your mouth.

Here's my pasta.

MPSO: Very nice.

All: Oh great! All right.

MPSO: That's my, mine.

All: Oh, beautiful. Yum! All right.

YJ: And then let me assemble the shortcake. So I made these, this banana, these honey butter bananas before. Marie-Pierre, can you talk a little bit about bananas and why they're considered to be sleep-supporting?

MPSO: Yeah. So actually there was a study that was published a few years back that tested different types of fruits and juice from various fruits. And they tested pineapple, bananas, and oranges. The banana recipe actually has some pineapple juice. And they found that consuming the juice of those three different types of fruits increased melatonin levels in the blood.

YJ: Great, so banana, pineapple and...?

MPSO: Bananas, pineapples and oranges. Oranges were the three. They were the three fruits that were studied there. But there's other studies of fruits. know, tart cherries have been studied to increase melatonin, improve sleep quality. So we've been incorporating a lot of those fruits in the diets. So there’s compotes also [in the cookbook]: there's compotes with cherries, there's a compote with pineapples and mangoes. And those honey buttered bananas to help improve sleep. Yeah, versatile… use them on pancakes....

YJ: It smells like cinnamon rolls because it has butter and cinnamon. It smells so good. And then these will also have nuts on top, they get sliced almonds. So I'm going to try to assemble it so it looks pretty.

MPSO: Looking forward to seeing that.

KC: I love those honey butter bananas too. They're great this time of year. I'm always looking for edible gifts too -- and the compotes that we have, and the granola packed into jars, they're really lovely hostess gift around the holidays. Cause you can put it on breakfast. You can put on ice cream. You can fill a cake with it. It's, it's a real treat.

MPSO: Yeah. Or like my husband does it... come by the kitchen, grab a handful, grab a handful, grab a handful. Every time I make the granola, I make a double batch. It lasts less than a week. It lasts less than a week. Yeah. It's very versatile. I like it in my cereal in the morning. My husband likes it on his yogurt.

YJ: I think that granola is something that's great to make at home because it's super easy and store-bought granolas have a lot of stuff you don't necessarily want to be eating as “healthy” food. A lot of store-bought granolas have a lot of sugar and especially the ones with the yummy chocolate bits or whatever. They tend to, if you actually look at the nutritional label, they're not quite as healthy as we were led to believe granola was.

All right, so I put half of the biscuit down and then we are putting on chamomile ginger cordial. I am actually substituting with the chamomile tea with honey.

So chamomile is a flower actually, right? And it's drunk a lot as a tea or a tisane. Marie-Pierre, what data are there to back up using chamomile to help with sleep versus, know, tart cherry juice or any of these other sort of, you know, food or drink based sleep aids?

MPSO: Yes. At this point, I don't think we could say “versus” because no study has been done to compare, you know, chamomile tea versus tart cherry juice. But there are studies for tart cherry juice showing improvement in sleep quality, especially in individuals who report having poor sleep, elderly adults having better sleep after consuming tart cherry juice for a couple of weeks. And know, chamomile could also be useful for soothing and it I think it could be included as part of a of a ritual of winding down and a soothing bedtime routine.

YJ: Even if the data aren't, you know, super overwhelmingly great with thousands of people in the study, things like chamomile, tart cherry juice,.. these are generally pretty innocuous, without bad side effects. So, you know, I think it's definitely worth trying for people, especially if they find it helps them kind of wind down and it's part of their getting ready for bed routine.

I think a lot of people try, try to go from just being on the go, go, go, go, go during the day, and then they flop into bed at night expecting to fall asleep, and they get very frustrated that they can't. And just like babies and kids need a nice regular routine to kind of wind down and get their brains and their bodies ready for bed, adults need that too. So I think having a nice warm beverage or something that's like a little routine that helps people wind down and get ready for bed is great.

So this I'm going to show you step by step. I put half the biscuit down with the chamomile tea with honey. And there's a little bit of Greek yogurt on there. Greek yogurt is great because it has tons of protein compared to regular yogurt. And then do I do the bananas or the, I need to do the honey butter bananas, then the biscuit top. Okay, let me do that.

I'm vegetarian and so when I was pregnant, I really had to work to get enough protein and I ate so much Greek yogurt. For a couple of years afterwards, I just couldn't even look at it because it was just, it reminded me of just forcing myself to eat all this Greek yogurt. I would blend it up with even more protein powder and… ugh. But now I like it again.

All right, so here are the bananas.

MPSO: So versatile.

KC: I'm sure bananas are a good kind of all season filling for this dish, but if it's the middle of summer and you've got gorgeous nectarines from the farmer's market, just toss them with the chamomile tea or cordial and plop that on top and don't even bother turning the oven on for the bananas. The rest of it all comes together really beautifully depending on whatever fruit you have around.

YJ: Yeah, the bananas were super fast and I actually did them in my toaster oven last night.

I need to find my almonds. Where are they?

MPSO: And using different compotes, think would work out well, right?

YJ: For the people who don't know what a compote is, what is a compote?

KC: It's similar to a jam, but not cooked as much, and it doesn't have as much sugar in it. So it's more like a sweet relish, I would say, where maybe the fruit is a little bit cooked, or maybe it's just kind of tossed with seasonings and flavorings and a little bit of sugar to balance it out. Whereas a jam is more a much higher ratio of sugar to fruit that you cook down to get more of like a paste jelly consistency, a compote is more just kind of gently cooked fruit or fruit spices, seasonings, whatever you want to include in it. We have three different versions in the book and they are all endlessly riffable based on what you have and what you like.

MPSO: I make a recipe I freeze it in small batches.

YJ: Banana chamomile shortcake, I'm very excited.

All: Looks delicious.

YJ: Almonds on top.

I was thinking I made a cranberry relish for Thanksgiving. I like, that's my favorite part of the Thanksgiving meal. And it's not for a lot of other people. So I always have leftovers. But it's like, it has a little bit of orange peel and, and whole cranberries. So I think that would be good on these shortcakes as well.

KC: Yeah, definitely. We used so many cherries. I'm not sure if we have cranberries in the book. I don't remember.

MPSO: I don't think so. No.

YJ: really?

KC: Yeah, but I think cranberries would be great. Yeah, all right.

YJ: Well, I'll make up one of these short cakes with cranberries and at least take a picture for you guys. that'd be great. Yeah. All right. Are you guys ready to eat?

KC: Yeah, always.

YJ: All right. Well, let me get a fork out.All right, what should we eat first? guess I should eat the main meal.

KC: It’s [The big pasta bake is] just coming out of the oven now too. So we'll see if we need to…That's my big lasagna pan. So it's definitely a big guy.

YJ: Oooh, wow!.... How many recipes did you make?

KC: That was times four. Yeah. Three. And this is an extra deep nine by 13 pan. Like I said, it's a big lasagna pan. I think the regular kind of nine by 13 brownie pan, could fill it with times three should be fine. you cool this down, you can also cut it into squares and freeze it if you're a meal prep sort of if that fits into your life a little bit better, but I'm gonna bring this to a party this week. great.

YJ: All right, so I'm gonna try to get a bite that includes a little bit of everything. So the sage and the nuts and the pasta.

All: Mmmm.

KC: Had you both worked with chickpea pasta before?

YJ: Yeah. I have just, when I see it at the store. I think the selection at stores here in St. Louis probably is not as broad as in New York City. But when I see it, I'll try different pastas like, you know, made with, I've seen ones made with black beans or the rice based ones.

MPSO: I've seen with the lentils.

YJ: Oh yeah, and the lentil one. I do love just the chew of gluten in regular pasta, but I do try to get whole wheat pasta, especially for baked dishes because they taste essentially the same.

KC: We have a Soba noodle recipe in the book too that's buckwheat flour pasta. That's one of my favorite recipes. It's kind of more of a summer noodle salad.

YJ: This is good. Yeah, and I guess like the soba noodles, the buckwheat noodles, like Asian noodles, they're cooked a little bit differently from pasta pasta in that they are cooked to when they're soft, not al dente. So I think it's a little bit easier to cook non-wheat [Asian style] noodles or pastas, because of the texture.

Mmm, it's so good. Now I'm going to eat the shortcake. So it's brunch time so we need to have something sweet and something savory.

KC: Standing eating in the kitchen is very restaurant industry. I feel like we're all in between service right now.

YJ: And the little bit of Greek yogurt is so nice and creamy with the bananas. That is so good. And these biscuits are so, or shortcakes are so easy and I guess you can freeze them ahead as well, which makes it super easy for lazy mornings for brunch.

KC: Yeah, absolutely. You can freeze them both raw and if you have leftovers, you can freeze them baked. I wrap them tightly in plastic so they don't dry out in the freezer. Especially out of the freezer, would split them and maybe pop them in your toaster oven just to kind of freshen them up a little bit. But pouring that, cordial or the tea over it will, if it's dry, it won't be anymore.

YJ: Well, we are actually past time, so maybe we can wrap up and Marie-Pierre, can you tell us top three to five things that we should be keeping in mind as we cook to sleep better.

MPSO: Yeah, making sure you have a good amount of fruits and vegetables throughout the day is very important. Having high fiber intake, lower saturated fat intake -- so trying to eat more plant-forward diet is helpful for sleep.

YJ: Okay, great. And then Kat, what tips do you have for cooking foods that are delicious and appealing that will also support our health and sleep?

KC: I think the big takeaway for me working on this project was making sure that we're eating proteins and carbs in combinations. I don't know that we really got into that part of it, but maybe when it was offline, but how it's important to pair tryptophan rich foods with carbohydrates so that we can absorb them properly and use them to create our own melatonin and serotonin. So those low carb diets that I toyed with in high school and college, I've been trying to avoid that sort of thing these days and make sure that I am always pairing up healthy proteins with heart healthy carbs.

YJ: All right, great. So lots of fruits and veggies, especially colorful ones, lots of fiber. What was the third one, Marie-Pierre?

MPSO: Lower saturated fat, lower sugar.

YJ: Lower saturated fat, lower sugar. And then combining proteins with carbs to help that tryptophan get up to the brain.

All right, great. Well, thank you so much for cooking with me and teaching so much about eating well to sleep better.

I'm gonna sit down and finish eating all this food I just made.

All: Thank you, this was so much fun. Thank you. All right, take care, bye bye.

Unfortunately, we can’t “bank” or save up sleep. Just like we can’t pre-clean the kitchen so we have to do it every day, we can’t pre-sleep.

What we can do is pay back some of the chronic sleep debt that most of us tend to carry around… A study where people were given 12-16 hours to sleep each night, showed that it takes about a week to pay off average sleep debt, but after that people simply cannot sleep ahead extra. (Klerman 2021).

Still, it is worth paying off sleep debt if you can, so especially if you have some sleep deprivation coming up, get to bed earlier to catch some extra ZZZs!

Read the full CNN Health article.

Clinical trials about how exercise impacts sleep

We all know that exercise is good for our health, but most of us need some motivation. Let’s face it, it can take weeks, months, or years to get the cardiovascular and other health benefits of exercise. But exercise can improve sleep the very same night, so you can benefit right away! So what do the data show about the benefits of exercise on sleep?

There are a lot of clinical trials on exercise and sleep: as of today, there are 1748 clinical trials in Pubmed on this topic on human adults published in English. What scientists and physicians do in these situations is to look at meta-analyses, where data from multiple studies are methodically pooled together. So let’s look for meta-analyses that include studies that are

1. randomized: participants get randomly assigned to exercise or not

2. controlled: there is a comparison group that didn’t get exercise

3. exercise was clearly defined

4. for our purposes, enrolled middle-aged and older adults

5. validated sleep outcome measures.

6. published in the last few years

Regular exercise improves subjective sleep quality

In general, the studies are highly consistent — people feel like they sleep better after exercise. The most commonly used subjective sleep outcome measure is the Pittsburgh Sleep Quality Index (PSQI, which is pronounced “piss-key” according to Dr. Dan Buysse who co-developed it). You can try it out yourself at the link — it combines various measures of sleep duration, quality, and how you feel during the daytime, for a composite score of sleep quality.

Sleep quality improves with regular exercise in the general adult population: A meta-analysis of 22 trials of middle aged or older adults, that looked at >2 months of regular exercise, showed positive effects on sleep quality as rated by the PSQI, as well as the Insomnia Severity Index and the Epworth Sleepiness scale. (Xie 2021) There was no difference in the benefit on sleep whether the study included just women or both men and women (there was only 1 trial with just men so they couldn’t compare that one). There were similar effects whether the participants were elderly or middle-aged. Additionally, there were 6 studies that used actigraphy (activity monitor) to objectively measure sleep, and overall there was improved sleep efficiency (% of time in bed that someone is actually sleeping), reduced sleep onset latency (SOL - time to fall asleep), increased total sleep time, and reduced wake time after sleep onset (WASO - aggregate time awake in the middle of the night).

This is true even when only people with sleep disorders are studied: In a meta-analysis of studies including 1214 individuals, exercise improved sleep efficiency and WASO. (Wang 2025)

Or women: In a meta-analysis of 16 studies than enrolled women, exercise improved PSQI scores. Regular exercise for >12 weeks reduced sleep medication use. (Qiao 2025). Similar results were seen in a meta-analysis of peri and post-menopausal women (Zhou 2025).

Or older people: In a meta-analysis of 25 studies including 2170 people, PSQI improved with aerobic exercise, strength training, or a combination. (Bahalayothin 2025)

Or people with mild cognitive impairment: (Páez 2024): In a review of 20 studies and 13 of those included in a meta-analysis, exercise did improve sleep in individuals with mild cognitive impairment or early dementia.

The studies are overwhelmingly clear and consistent: exercise improves subjective sleep quality.

But what about objective measures of sleep? Do those change with exercise?

Exercise improves objective sleep measured by gold-standard polysomnography

Our perception of our sleep is not necessarily accurate, because… we are asleep when we are sleeping. The best quality, gold-standard objective information about sleep is measured through polysomnography, or a sleep study, done in a sleep lab. Clinical trials of exercise on sleep that use polysomnography are much less common, so we can review them individually.

To start off, in a study of 48 adults (mean age 44; 38 were women) with chronic insomnia, participants were randomized to moderate or high aerobic exercise, moderate resistance exercise, or control groups. They did polysomnography before and after ONE exercise session. The moderate aerobic exercise group fell asleep faster—SOL decreased from 37.6 to 16.8 minutes by polysomnography—whereas their subjective experience showed an even more dramatic change, decreasing from 80.8 to 49 minutes! Polysomnography also showed that sleep efficiency improved (71.8% to 80.9%), and total sleep time increased from 4.9 to 5.8 hours (their subjective recollection was also improved by around an hour, from 3.9 to 4.9 hours). (Passos 2010)

Another study very carefully examined the brain waves (EEG) during sleep with and without exercise. In this study, 14 participants (all men, age 20-40) were compared to themselves when they exercised for 40 minutes on an exercise bike daily for 5 days, versus 5 days without exercise (this was a crossover design study). They found that the nights after exercise, they had increased slow wave sleep. (Aritake-Okada 2019)

Of course, we need to sleep every night, so we need data on whether longer-term regular exercise is helpful for sleep. And it is: regular exercise over a year improves objective sleep. In a randomized clinical trial of middle-aged-to-older adults (age 55+, 66 people) with chronic sleep problems, participants were randomized to a moderate-intensity exercise program for a year or to a non-exercise educational program. Polysomnography showed a shift from lighter, stage N1, sleep, to deeper, more consolidated (stage N2) sleep. The exercise group also had improvements in subjective sleep quality based on the PSQI. (King 2008)

A subsequent further analysis of the same data showed that those who were more sedentary to start with, and had more sleep problems to start with, benefitted the most from exercise! (Buman 2011) So it’s never too late — the worse off someone is (in terms of exercise and sleep) to start, the more they stand to gain from exercise.

The takeaway:

Exercise improves sleep, including on the very first night. Regular, consistent exercise improves sleep quality. This improvement can be sustained over weeks, months, and years, based on numerous high-quality clinical trials, using both subjective and objective measures.

Longer-term studies of exercises interventions are hard, because well-designed studies use an intention-to-treat analysis. This means that people who were assigned to the exercise group, but didn’t stick with it, still get included in the exercise group for the final analysis. This makes it less likely that a difference will be seen between the exercise and non-exercise groups. So, it is even more remarkable that exercise studies on sleep are so consistent in showing a positive effect on sleep, whether using subjective or objective outcomes.

So we have no excuse! If you haven’t worked out today, please stand up and do a few squats or a couple yoga stretches! Do it for your sleep!

Next time, we’ll go over how exercise improves sleep, by doing a deep dive into the biological mechanisms that muscles use to talk to the brain..

References (alphabetical)

Aritake-Okada S, Tanabe K, Mochizuki Y, Ochiai R, Hibi M, Kozuma K, Katsuragi Y, Ganeko M, Takeda N, Uchida S. Diurnal repeated exercise promotes slow-wave activity and fast-sigma power during sleep with increase in body temperature: a human crossover trial. Journal of Applied Physiology 2019; 127:1168-177. Fulltext.

Bahalayothin P, Nagaviroj K, Anothaisintawee T. Impact of different types of physical exercise on sleep quality in older population with insomnia: a systematic review and network meta-analysis of randomised controlled trials. Fam Med Community Health. 2025;13(1):e003056. Fulltext.

Buman MP, Hekler EB, Bliwise DL, King AC. Moderators and mediators of exercise-induced objective sleep improvements in midlife and older adults with sleep complaints. Health Psychol. 2011;30(5):579-87. Fulltext.

King AC, Pruitt LA, Woo S, Castro CM, Ahn DK, Vitiello MV, Woodward SH, Bliwise DL. Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. J Gerontol A Biol Sci Med Sci. 2008;63(9):997-1004. Fulltext.

Páez A, Frimpong E, Mograss M, Dang-Vu TT. The effectiveness of exercise interventions targeting sleep in older adults with cognitive impairment or Alzheimer's disease and related dementias (AD/ADRD): A systematic review and meta-analysis. J Sleep Res. 2024;33(6):e14189. Fulltext.

Passos GS, Poyares D, Santana MG, Garbuio SA, Tufik S, Mello MT. Effect of acute physical exercise on patients with chronic primary insomnia. J Clin Sleep Med. 2010 15;6(3):270-5. Fulltext

Qiao Y, Wang C, Chen Q, Zhang P. Effects of exercise on sleep quality in women - A systematic review and meta-analysis. J Sci Med Sport. 2025;28(4):274-281. Pubmed.

Wang P, Chen Y, Zhang A, Xie C, Wang K. Comparative efficacy of exercise modalities on sleep architecture in adults with sleep disorders: a systematic review and network meta-analysis of randomized controlled trials. Sleep Med. 2025;134:106680. Pubmed.

Xie Y, Liu S, Chen XJ, Yu HH, Yang Y, Wang W. Effects of Exercise on Sleep Quality and Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Psychiatry. 2021;12:664499. Fulltext.

Zhou K, Ren Y, Zang L, Zhou Z. Sleep quality in perimenopausal and postmenopausal women: which exercise therapy is the most effective? A systematic review and network meta-analysis of 31 RCTs. Climacteric. 2025;28(5):516-528. Pubmed.

In my last post on jet lag traveling eastward, I explained why we get jet lag in the first place—our internal clocks, or circadian rhythms, are offset from our environment. Westward travel is slightly easier because, on average, human circadian rhythms are set just over 24 hours, meaning our clocks naturally drift later. Also, we gain rather than lose time when we travel west, which means we get some extra hours to sleep.

Still, especially if we travel west across enough time zones, the mismatch between our internal clocks and our surroundings means we will tend to wake up in the middle of the night, get groggy in the afternoon/evening, and feel “off” for a few days. In general, our bodies adjust about a time zone per day, meaning that a trip to 6-8 time zones away will take a whole week to get over the jet lag.

Thankfully, we can use circadian and sleep science ⏰🧪🎉 to cure jet lag faster!

Here’s the science-backed guide for curing jet lag traveling west 6-8 time zones: Europe to US, or Asia to Europe, or Continental US to Hawaii. Of note, this guide assumes you sleep regularly approximately 11pm-7am at home. If your usual sleep schedule is very different, or you have significant sleep problems already, you will need more individualized advice from a sleep doctor.

Read the last post for the science, especially the Phase Response Curve .

The takeaway: Timing is everything when it comes to using light and melatonin to shift our circadian rhythms.

In addition to our circadian clocks, we have a separate mechanism that affects sleep: sleep drive. This is a pressure that starts building up as soon as we wake up, and keeps building the longer we are continuously awake. As soon as we fall asleep, sleep drive dissipates quickly. Sleep drive is homeostatic, meaning your body (or brain) will always try to come back to a set point… if you nap, your sleep drive will be less, measurable as less slow wave sleep that night. If you are sleep deprived, your sleep drive will be high, and there will be more slow wave sleep that night. We need to use a combination of manipulating sleep drive and our circadian rhythm as we travel west.

Let’s all get on an imaginary plane. During the flight, avoid sleeping. Especially if it is light outside the plane windows, don’t sleep! If you are taking the rare red-eye flying west, I am so sorry! You can nap briefly, but don’t nap for more than an hour or so, since you will get a chance to sleep when you arrive. If you are going to nap, just try your best: wear an eye mask, wear ear plugs or noise-canceling headphones, and avoid alcohol. I do not recommend any sleep medications (including melatonin) on the plane heading west, so as to avoid excessive sleep on the plane or grogginess when you arrive.

Tada!! When the plane lands, the time has changed! Look at the X axis on the new PRC, which has shifted 6 hours. Since you have traveled west, you need to delay your circadian rhythm, which means doing the things below the X-axis, and avoiding things above the X-axis.

The most important jetlag cure flying west: expose yourself to bright light, preferably sunlight, in the late afternoon to evening.

As you can see on the graph, there is a yellow trough around 4-10pm, meaning that light exposure at that time will shift your circadian rhythm later. Wear sunscreen, but if you can tolerate it, take off sunglasses and let the light hit your eyes in the evening. Go for a long walk in the late afternoon, eat dinner al fresco, or use a light box in the evening. (Absolute bare minimum if you can’t bear to leave your hotel: pluck your eyebrows or some other self-care using in a lighted mirror.)

Second, avoid napping during the daytime. You want to build up your sleep drive as much as possible so that when you do go to bed, you will fall asleep into a heavy, deep sleep. If you are feeling really sluggish and absolutely must sleep, set an alarm to take a 1 hour-or-less nap, and end it before 3pm.

Third, you can boost the circadian effect by taking melatonin right at bedtime (if you’re going to bed around 10-11pm to midnight) which is right around the red valley on the graph, meaning melatonin will also delay your circadian rhythm. Amazingly, taking melatonin at bedtime works for both eastward and westward travel jetlag, for opposite reasons!

Again, please note that melatonin is considered a prescription medication in many countries, however lower doses can be sold over-the-counter in some countries. In terms of melatonin dose, a high-quality review of 10 clinical trials (link) found that 0.5 mg up to 5mg were effective, with the higher end being better for the sleep effect, and that slow-release formulations do NOT work well.

Fourth: Sleep drive puts you to sleep but your circadian rhythm keeps you asleep… this means that with westward jetlag, you’ll likely wake up earlier than you would like. To try to avoid interruptions to your sleep that will wake you up, try your best with eye mask, ear plugs, etc. Still, you may wake up early. If this happens, do NOT get bright light in the early morning! See the yellow mountain on the PRC from around midnight to 6am? That means that light at that time will advance your circadian rhythm—the opposite of what you want. If you can’t get back to sleep, get out of bed and do something quiet in dim light (reading, etc — NOT on a screen) until it’s time to actually get up for the day.

Recap: for travel westward ~6-8 time zones:

🌞 Get light in the late afternoon to evening (4pm-10pm)

🚫 Avoid napping during the daytime and on the plane trip there.

💊 Take melatonin right at bedtime.

📖 If you wake up in the early morning and can’t get back to sleep, do NOT get bright light, including from a screen. Read or do something else in dim light.

That’s it, pretty simple! If you follow the tips above for a couple days, your brain will cure itself of westward jetlag in a jiffy. Happy travels!

What Is Bedrotting?

“Bedrotting” (some say “bed rotting”) is a newer term for an old activity: hanging out in bed, or on the couch, for long stretches of time. Popularized on social media, bedrotting is sold as a form of self-care, to mentally check out from stress and overwhelming routines. Bedrotting isn’t necessarily sleeping (although there may be naps mixed in) but doing passive, low effort activities. Think: phone scrolling, binge-watching TV, snacking, ruminating, or just doing nothing.

Trends and surveys on bedrotting

A 2024 survey by the American Academy of Sleep Medicine revealed that 1 in 10 people have tried bedrotting, and bedrotting is especially common among Gen Z, where 1 in 4 reported trying bedrotting. In my experience as a sleep doctor though, it’s not just young people being "lazy,” it’s that they have a name for it.

Tens of millions of posts on social media use hashtags #bedrot or #bedrotting, creating a performance out of lingering in bed. While young people might know to call it bedrotting, people of all ages tell me about staying in bed all day to “take a mental health day,” “recharge my batteries,” or “get some me-time.”

Bedrotting is not the same as a sick day, when fever and other immune responses make you sleepy so that your body can heal better. Bedrotting is choosing to stay in bed.

When done right, bedrotting can be helpful in small doses (scroll to bottom). But a big concern from a sleep science perspective is how bedrotting might interfere with good nighttime sleep.

The Science Behind Sleep Drive and Naps

To understand the risk of turning to bedrotting as rest, it helps to know how sleep works.

Sleep Drive (Homeostatic Sleep Pressure)

Our brains build up a sleep drive (also called homeostatic sleep pressure) the longer we're awake. This is tied to adenosine, a chemical that accumulates in the brain during wakefulness and promotes sleepiness. The longer you are continuously awake, the higher the sleep drive builds up.

Sleep drive is the force that puts you to sleep, and as soon as you fall asleep, sleep drive rapidly dissipates. During normal nighttime sleep, we can measure sleep drive by the amount and intensity of slow wave sleep—the deep, restorative part of non-REM sleep. Slow wave sleep is critical for brain waste clearance, memory consolidation, and other crucial restorative sleep functions.

Think of sleep drive as gas in the car tank — the longer you are continuously awake, the more builds up.

Slow wave sleep is homeostatic, meaning that our bodies and brains have compensatory mechanisms to keep things even keel. So if someone is sleep deprived, their sleep drive will be very high, so they will fall asleep faster, and have more intense slow wave sleep compared to a regular night.

Naps Aren’t Equal to Full Sleep

On the other hand, if someone has already used up some of their sleep drive by napping earlier in the day, even if they can fall asleep at night, they will not get deep, intense slow wave sleep.

Even taking multiple naps throughout the day are not as effective as one continuous night of sleep. In a research study, people got more cumulative slow wave sleep in one night of continuous sleep, compared to when they took six naps. (Tarokh et al. J Sleep Res. 2021 Oct;30(5):e13295. Fulltext).

To explain: It takes a little while (around 30 minutes) of continuous sleep to build up to intense slow wave sleep. So in the car example, think of sleeping as a car that can only accelerate slowly — it takes some time to get to a high speed where you’re really covering the miles quickly. This explains why drifting to sleep off and on, or taking multiple naps during the day, simply doesn’t feel as restorative as a good night of sleep — with naps, the car never gets up to a speed where it can cover much ground, despite using up gas (sleep drive).

Even worse, if someone has napped during the day, they’ve used up some of the gas in the tank… so that night, when they go to bed, they can’t quite get the same deep sleep they would have if they hadn’t napped.

Other Reasons Why Bedrotting Is Bad for You

While bedrotting can feel restorative in the moment, it comes with potential downsides (in addition to less than ideal nighttime sleep), especially when done regularly:

1. Physical discomfort: Staying in bed too long can lead to stiffness and aching

2. Mental health risk: What starts as intentional rest can quickly morph into avoidance or isolation. Some mental health experts warn it could exacerbate depression or anxiety. Studies show that scrolling on social media passively, especially, worsens anxiety. (Lai et al. Int J Environ Res Public Health. 2023;20(4):3657. Pubmed).

3. Metabolic / weight concerns: Physical inactivity for long periods burns very little energy and makes your muscles atrophy. And for most people, snacking in bed usually means calorie-dense, low-nutrient foods.

4. Reinforcing poor habits for productivity & motivation: If bedrotting becomes a regular coping mechanism, it builds poor habits and makes engaging with daily tasks harder. Bedrotting may also become an all-too-easy escape from real-life responsibilities, where it gets harder and harder to get back to a productive daily routine.

Better Bedrotting

Being in bed isn’t bad, and it’s not lazy to need time to relax and recharge. But there’s a better way to bedrot. If you find yourself wanting to bedrot often, or if it’s starting to feel more like avoidance than rest, here are some healthier strategies to try:

1. Take intentional naps:

   • Set aside a time to nap on purpose, rather than dozing off. In one study, splitting sleep between the night and one afternoon nap helped memory task performance while reducing sleep pressure. (Cousins et al. Sci Rep. 2021;11(1):5275. Full text.)

   • Don’t nap too long, because if you get into really slow wave sleep you may have sleep inertia — grogginess when you wake up. The sweet spot is around 20-40 minutes.

   • Keep the nap early enough so that you can re-build sleep drive for the night. Naps should be done by 3pm at the latest, earlier if you have trouble falling asleep at night.

2. Set boundaries

   • Give yourself a time limit to bedrot. Set an alarm that you will need to leave the room to turn off.

   • Avoid bedrotting in the bed where you sleep at night. The bed should not be a default zone.

   • At the absolute least, don’t eat in bed.

   • Even in rest mode, get up every hour or so to stretch, walk, do a few squats, or at least reposition to avoid stiffness.

3. Choose restorative activities

   • Do something active and relaxing with your brain: reading, journaling, listening to music or podcasts.

   • This is a perfect time to practice meditation, breathing techniques, and other strategies to focus yet relax your mind

4. Address underlying stress or burnout

   • If you’re bedrotting to escape stress, anxiety, or depression, please take action to get help. It might take time, effort, big changes, therapy, medications, or all of the above, but things can get better if you take action.

   • If you have thoughts of suicide or harming yourself, call 988 for the Suicide & Crisis Lifeline.

What to do Instead of Bedrotting

Seek bliss, not bedrot: Instead of getting into bed, try other mental health boosts for a little bit of bliss.

• Get outside: nature, fresh air, and sunlight are powerful!

• Spend time with loved ones: Whether in person or electronically, social connection is an amazing brain boost!

• Create something: Draw, knit, write, cook, woodwork, sing… make something.

• Move: Stretch, walk, run, do 5 jumping jacks, do yoga, lift some weights, dance. You’ll feel better afterwards, guaranteed.

Final thoughts

Bedrotting is a modern cultural phenomenon that resonates with many in a society of burnout and constant digital stimulation. It can be a form of self-care, in moderation and with intention. We all need mental breaks and physical rest. But building in small mental breaks into our daily lives, and getting high-quality sleep each night, is a much more sustainable and healthy way of balancing our needs for restoration.

[Also see: What NOT to do if you wake up at 3am.]

When a patient comes to me for 3am awakenings, we first look for clues for the underlying cause or causes (there are often a combination of factors). Treating the correct underlying problem makes a huge difference in treatment success for insomnia. So rather than jumping to sedating medicines, it’s important to pinpoint and treat the specific causes of insomnia for effective, individualized treatment.

Here are 10 reasons you might be waking up at 3am, with clues and what to do for each one.

1. Your circadian rhythm (internal clock) is early

While your sleep drive puts you to sleep, your circadian rhythm—which is separate—keeps you asleep. If your circadian rhythm is early, it thinks 3am is morning time and time to get up for the day.

Clues you have an early circadian rhythm:

• You get tired and drowsy in the evening, and might even drift off to sleep on the couch before your official “bedtime.”

• You are a “morning lark” to start with, certainly never a “night owl.” You may come from the kind of family that enjoys breakfasting together.

• You’re middle or older age. This is when there is a normal shift in circadian rhythms, so especially if you’re early to start with.

• If you went to bed early enough, you feel refreshed even if you wake up at 3am.

What to do about an early circadian rhythm:

• If going to bed early and getting up early don’t interfere with your social life, family time, work, school or other activities, you don’t have to do anything! Enjoy the quiet hours in the morning. Just make sure you go to bed early enough so that you are getting enough sleep.

• Avoid melatonin in the evening which will make your circadian rhythm even earlier.

• If you do want to push your circadian clock later, light therapy is the strongest way to move your circadian rhythm. Use a light box, at least 5000 lux (the measurement of brightness), at arm’s length, for 30-60 minutes in the evening.

2. You have sleep apnea:

Obstructive sleep apnea is very, very common, estimated about 20% of the population. Men have roughly twice the rates of OSA as women until menopause. Then around menopause, women catch up to men in terms of OSA prevalence. This means that around the time of menopause, a lot of women get OSA. OSA is caused by collapse of the airway at the back of the mouth collapsing during sleep. This tends to be worse during REM (dreaming) sleep, and since there is relatively more REM sleep in the second part of the night, people with OSA will have more abnormal breathing in the second half of the night that might wake them up.

Clues you have obstructive sleep apnea (OSA) causing your 3am awakenings:

• You snore and/or wake up gasping, choking, or snorting. If someone else has seen you stop breathing in your sleep, pause your breathing/snoring, or breathe irregularly… this is a very strong sign you have OSA, even if it was just one time.

• You tend to wake up from a dream that you were drowning or suffocating, wake up covered in sweat, or wake feeling like you were struggling.

• You wake up with a sour metallic taste in your mouth, or with heartburn. This is the taste of acid reflux: when someone with OSA is trying to inhale against a closed airway, the negative pressure in the chest essentially sucks stomach acid up into the esophagus.

• You wake up with a headache that goes away after a little while.

What to do if you think you have obstructive sleep apnea (OSA)

• See a sleep medicine doctor for a sleep study. If you have sleep apnea, get it treated. (Find an accredited sleep center here.)

3. Alcohol

Alcohol is terrible for sleep. It suppresses REM sleep, so while there is alcohol in your system in the first few hours of the night, you end up with REM deprivation. Once the alcohol gets metabolized, there is REM rebound where there is a lot of REM in the second part of the night. So this might make any OSA worse (see #2) that wakes you up. When you do wake up in the middle of the night after drinking, you will often wake from an intense, anxious dream.

Alcohol fragments sleep, meaning you will have lots of awakenings, for no other reason. When this happens as the alcohol is wearing off, ie around 3am, people often have anxiety (aka hangxiety) from the withdrawal of the sedative effects of alcohol.

Lastly, alcohol makes you have to urinate more, so you might also be waking to use to the bathroom at 3am.

Clues alcohol is causing you to wake up at 3am.

• You drink alcohol. Even one drink can disrupt sleep, especially in the second half of the night.

• The 3am wakeup is more likely or more severe if you have more alcohol than usual.

What to do:

• Don’t drink alcohol. Seriously, just try it for a month and see how your sleep changes.

• If you drink on most days, you may have withdrawal if you stop abruptly. Talk to your doctor and/or seek assistance to quit safely.

4. Mood and anxiety disorders

Sleep changes are a common symptom of mood disorders like depression or bipolar disorder, or anxiety disorders. In fact, insomnia may be the first sign of depression: in a large meta-analysis (Pubmed link), insomnia signaled over twice the chance that someone would be diagnosed with depression.

Clues depression is causing 3am awakenings:

• The 3am awakenings are new, or similar to a prior bout of insomnia you had with a mood disorder

• Your mood is different: blue, apathetic, anhedonic (nothing brings pleasure), numb; or the opposite – euphoric

• You have other symptoms of depression: low energy or fatigue, change in sex drive, feeling of worthlessness, change in appetite

What to do:

• See a doctor or mental health professional for treatment ASAP.

• Don’t do nothing. Poor sleep puts people at higher risk of depression.

5.  Bed partner

Someone or someones in your bed is waking you up. This may be your partner (a snoring spouse is a common cause of 3am awakenings), kids, pets, etc.

Clues it’s not you, it’s them:

• You can pinpoint the noise, snoring, kicking, thrashing, or whatever someone did to wake you up.

• You would strangle your partner, if only you had the energy.

What to do if someone else if waking you up in the middle of the night:

• Use your words, in the daytime. Explain to your bed partner that they are causing you to wake up, and encourage them to seek appropriate help. Getting good sleep is important for our physical, mental, and emotional health.

• If it’s noise waking you, you can try earplugs, or a white noise machine or fan.

• You can try sleeping in separate beds, rooms, or abodes. In a 2025 survey by the American Academy of Sleep Medicine of >2000 people, a third of adults slept apart from their partner. Sleeping separately was even more common among Millenials (age 35-44 in the survey). In my experience, this is an underestimate because some people technically have a shared bedroom, but in practice sleep apart. Also, please don’t call it a “sleep divorce!” Many loving couples sleep apart… and are more loving that way.

• For pets and children: If you want them in your room, try having a separate bed for them within the room. Or, if you prefer to fall asleep with them, you can migrate to another location to sleep in the middle of the night.

• What NOT to do: suffer in silence and seethe with resentment, wake your partner in the middle of the night, take sedatives, drag them to the doctor yourself (this doesn’t work, I know, I’ve been that doctor many times).

6. Wearing off of sedatives may be waking you up at 3am.

If you take over-the-counter or prescription medications that makes you drowsy at bedtime, it will obviously help you fall asleep. But, as your body metabolizes the medication, the sedative effect will wear off, waking you up.

Clues: You take sedating medications or substances.

What to do:

• If you take a prescription medication, talk to your doctor about changing the medication or alternative treatments.

• If you take over-the-counter medication, please see a sleep doctor to evaluate the cause of your insomnia rather than masking it with a sedative.

• If the sedative is a recreational drug, stop it or get help to stop.

7. Hot flashes and other menopausal symptoms

Hot flashes are a sensation of extreme heat often accompanied by sweating or heart racing. Hot flashes are very, very common—they occur in about 80% of women eventually. They can occur at any time of night, but more so in the second half of the night. Interestingly (or annoyingly), hormone changes during (peri)menopause lead to more fragmented sleep, and awakenings actually precede the hot flashes, rather than the hot flash causing the awakening.

Clues menopause or perimenopause is waking you up:

• You are a woman in your 40’s or 50’s

• You feel hot and sweaty.

• Your periods have changed or you’ve noticed other symptoms of perimenopause.

What to do:

• Talk to your gynecologist. Hormone replacement therapy may be helpful but requires an individualized discussion of risks and benefits.

• Medications: there are two new medications specifically for hot flashes (fezolinetant and elinzanetant) which block neurokinins. Additionally, other medications like gabapentin, clonidine, or certain SSRIs can be helpful for hot flashes.

• If you smoke, quit! Hot flashes are more common in smokers.

• If you wear pajamas, select loose and cool pieces that you can change out of easily. (Have extras). Natural fibers such as cotton or linen for pajamas and sheets will help wick moisture and allow for air circulation. 

8. Spiritual window or witching hour

Some religious and spiritual traditions believe that the 2-4am zone is a time associated with supernatural events, a time of spiritual awakening, or time to receive messages from spiritual guides or angels.

Clues: This resonates with you.

What to do:

Nothing! If you want, you can pray, meditate, or otherwise take advantage of this opportunity. If this is a regular and prolonged occurrence that is cutting in to your sleep time, you may need to get to bed earlier or take an early-afternoon nap to make up for the sleep.

9. Normal awakenings

In normal sleep, people cycle through non-REM and REM, 4-5 times over the course of each night. At the end of each REM, most people wake up briefly. This is completely normal. Because each cycle is about the same length each night, normal awakenings will be at about the same time every night (12-1am and 3am being very common). If you wake up at the same time each night, you are normal and your brain is cycling normally through sleep cycles!

Clues you are having normal awakenings:

• You wake up at the same time(s) a lot.

• You often wake up during or at the end of a dream.

• You get back to sleep within 15-30 minutes (often within a couple minutes), and you feel refreshed in the morning if you get a full night of sleep.

What to do: Nothing! You are normal! Enjoy your good and normal sleep!

10.  Insomnia

Some people wake up at 3am, either as part of normal sleep cycles (as in #9) or due to other factors (e.g. pain, bathroom, blood sugar changes, anxiety, etc), and have trouble getting back to sleep. In general, taking more than 30 minutes to get back to sleep is considered abnormal, although the critical factor is whether your daytime functioning is affected.

If you are waking up and having trouble getting back to sleep, you should seek help from a sleep specialist, sooner rather than later. Insomnia may get worse the longer it goes untreated, especially if you are staying in bed awake for long periods.

This is listed last because a sleep doctor will assess for the other above causes of awakenings first, because they are so common and need to be addressed specifically.

If you do have true insomnia: it is treatable! The first-line treatment is not medication but cognitive behavioral therapy for insomnia (CBTI or CBT-I). In some cases medication is used, but in general CBTI should be the first-line treatment because studies show it is as effective as medications and the effects last longer.

Takeaway: There are lots of potential reasons why you may be waking at 3am. If it’s once in a while, and you don’t have any red-flag symptoms of sleep apnea, you can leave it alone. If it’s frequent—a couple times per week or more—you DO need to do something about it. See a sleep doctor, quit drinking, sleep separately, etc… now you know what you need to do. No matter what, do NOT linger in bed for long periods or do other things that you shouldn’t do at 3am, so that things don’t get worse!

The answer is: You should get a sleep tracker only if it’s going to help you.

Let me explain.

How sleep trackers might help

Some people—ok, a lot of people, myself included—don’t  always get to bed on time or stick to a regular sleep schedule. Having something to keep you accountable and track patterns over time may be helpful to stick to your sleep goals if you are trying to get more or more regular time in bed.

A perfectly good alternative is to keep a sleep diary (aka sleep log). You can simply jot down (or chart, if you’re a visual person) your bedtime and waketime each morning. Or, use the free American Academy of Sleep Medicine sleep log, which is very straightforward. Or, use one of the many free sleep diary apps out there. The simpler the better! Personally, I use a habit tracker to simply mark off if I got 8 hours in bed.

I have had multiple patients who insisted they got sufficient and regular sleep time, and it was simply not possible that their sleep habits were contributing to their fatigue and sluggishness during the day… Two weeks later, after keeping a sleep log, they sheepishly acknowledged that the random “one off” nights of working late, going out, travel, or other things that cut into their sleep time, actually happened a lot more than they had estimated.

So you really don’t need a sleep tracker, but if keeping a sleep log is too cumbersome, or if someone is unwilling/unable to do it, then a sleep tracker is reasonable to try if it will help you stick to a good sleep schedule.

Sleep tracker accuracy

A lot of people use sleep trackers nowadays, so in the sleep clinic, we end up hearing a lot of questions about them. In a survey of sleep doctors and sleep health providers (Addison et al 2023), 35.8% of patients used consumer sleep trackers, and 23% of new sleep patients were asking their doctors to review their sleep tracker data!

That means a lot of precious doctor-patient time is spent on discussing metrics from sleep trackers… that may not be accurate.

I use a lot of actigraphy for research, and those devices have been validated against in-lab polysomnograms (sleep studies), which are the gold standard. Many consumer sleep trackers don’t have any public information on how they validated their algorithms. The algorithms are proprietary so we don’t know how they match up between different devices. Or, the company may modify its algorithm, and the metrics that the user sees changes. This can lead to confusion and anxiety, especially when a sleep “score” suddenly drops.

If you want to know how sleep doctors feel about sleep tracker accuracy: In the survey of sleep doctors mentioned above, the perceived accuracy of sleep trackers was “moderately or very accurate” according to only 16% of respondents, and 47% rated sleep trackers as “definitely unhelpful or somewhat unhelpful”

Unfortunately, based on that maybe-accurate-maybe-not information from sleep trackers, people can become fixated on maximizing their sleep, and get upset when their score isn’t “perfect.” One of the most frustrating things is seeing a patient with insomnia who now falls asleep and stays asleep all night, but insists, “My sleep tracker says I’m not getting deep sleep,” or “My sleep score went down this past week, why is that?”

Orthosomnia

This brings us to the major problem with sleep trackers, which is the risk of orthosomnia. This is a newer word, combining “ortho” meaning correct, and “somnia” meaning sleep. Orthosomnia is a problem where someone becomes overly perfectionistic and preoccupied with sleep metrics from sleep trackers.

Orthosomnia can then cause anxiety about sleep that can ironically worsen insomnia.

Orthosomnia was introduced as a concept in 2017 by sleep researchers (Baron et al 2017). The idea marinated within the sleep community for a few years, and in the past 2-3 years a surge of publications have come out on orthosomnia and sleep trackers.

In the figure, you can see the number of publications that have increased in just the past 2-3 years.

Orthosomnia happens a lot. A large (897 people, mean age 47.5) study came out this year from a national survey representative of the US population. A whopping 56% of respondents reported using a sleep tracker. Among those who used a sleep tracker, 12.3% reported orthosomnia and worry related to sleep! (Kress et al 2025).

Stated another way: one in eight people who use a sleep tracker get orthosomnia.

If a medication or medical procedure worsened the problem it was supposed to treat in 1 of 8 people, that would be madness to use it willy-nilly in the majority of the population!

Just like how calorie-tracking apps can be enormously helpful to reinforce healthier eating habits for most people, but may contribute to disordered eating (orthorexia) in some people, sleep trackers can cause orthosomnia for some people.

In my opinion, just like people with an eating disorder should not use a calorie-tracking app, people with insomnia should not use a sleep tracker.

What to use instead of a sleep tracker

The problem is that when we have a tracker with a pretty app putting out scores and metrics, it gets easy to fixate on them, and forget about how we feel.

But we don’t need sleep trackers to tell us how good our sleep was. Our brains are remarkably sensitive to sleep disruption. You know if you have a bad night of sleep!

For example, in a study I did (Ju et al 2017), 17 people slept with a special setup that read their brain waves (EEG), and if they were in deep slow wave sleep, gave them beeps through earphones to nudge them out of slow wave sleep and into lighter sleep. On average they got 1177 ± 427 beeps over the course of the night! They also slept a separate night with the same setup, but with the mute button on. The participants didn’t wake up with the beeps, but the quality of their sleep was lighter, and their brains knew it – the next morning, the participants rated the quality of their sleep as 5.5/10 on the night with the beeps, compared to 7.4/10 on the sham night.

If you need to know how good your sleep was: seek the answer within yourself. Did you need to use an alarm? Do you feel refreshed? How is your energy level? Do you feel like your brain is swimming in molasses? Listen to your body.

If you are keeping a sleep log, you can rate your sleep quality, or how you feel during the day, or whatever metric is important to you, daily alongside the log. That’s the only data that really matters.

Other potential downsides of sleep trackers

·      Cost was identified as the most common downside in a large population based study of wearables, which is kind of a big deal since the actual benefit is hard to quantify.

·      Privacy: Information about you gets transmitted from the sleep tracker to your phone and then to a private company. What will happen to it? Will this information be made accessible to your health insurance company? What about your car insurance, which already might be tracking your driving through your phone, and doesn’t want you to drive tired?

·      Discomfort: A lot of trackers have little lights, hard edges, beeps, buzzes, or other features that are uncomfortable and slightly interrupt your sleep.

·      Rabbit hole: Once people open the app to look at their sleep tracker data, it’s just a quick swipe away to check social media, shop, or do any number of things that keep them on a screen, which at night in bed is especially bad for sleep.

 The takeaway

• If you need help with accountability for getting enough and regular time in bed, you can keep a written sleep log, or use a sleep tracker.

• Sleep tracker accuracy varies and specific metrics like “deep sleep” may change between devices and over time as algorithms change.

• 1 in 8 people who use sleep trackers report orthosomnia, a disorder where people have preoccupation and anxiety about their sleep.

• Don’t use a sleep tracker if you have trouble sleeping (if you have insomnia).

• Your own perception of sleep quality is more important than any metric from a sleep tracker.

Important: I don’t get any payment, own any stock in, or obtain any benefits from companies that make consumer sleep trackers, activity monitors, or related technology. Before you get a sleep tracker, think about who does benefit from your purchase and use of these devices.

References (alphabetical)

Addison et al. Sleep medicine provider perceptions and attitudes regarding consumer sleep technology. JCSM 2023;19(8):1457–1463. doi: 10.5664/jcsm.10604. Fulltext

Baron et al, JCSM, Orthosomnia: Are Some Patients Taking the Quantified Self Too Far? JCSM 2017 ;13(2):351–354. doi: 10.5664/jcsm.6472. Fulltext

Ju et al. Slow wave sleep disruption increases cerebrospinal fluid amyloid-β levels. Brain. 2017;140(8):2104-2111. doi: 10.1093/brain/awx148. PMID: 28899014; PMCID: PMC5790144. Fulltext.

Kress et al Perspectives regarding consumer sleep technology and barriers to its use or adoption among adults in the United States. Sleep Med 2025:128:165-173. doi: 10.1016/j.sleep.2025.02.004.) Pubmed

More and more research shows a link between sleep problems and dementia, and scientists (including myself) are working hard to sort out the mechanisms underlying this relationship. This is a very active area of research, and one near and dear to my heart. (In fact, this is my day job: the Barbara Burton and Reuben Morriss III Professorship was endowed by those donors to support research in Alzheimer’s Disease.) So, while this is a quick but deep dive into what we know so far about sleep and dementia, expect exciting updates in the near future.

First, a few definitions:

• Dementia means a decline in cognitive functions, most commonly memory, to the point a person needs help with their activities of daily living.

• Neurodegenerative disease: A progressive disease caused by dysfunction and death of a specific group of neurons. Different neurodegenerative diseases, such as Alzheimer’s disease (AD), Parkinson’s disease (PD), and Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig’s disease) are caused by death of different populations of neurons.

• The most common cause of dementia is Alzheimer’s disease (AD).

• Brain changes in AD begin years prior to the earliest symptoms. When neurodegenerative changes have started but there are no symptoms, this is called the preclinical stage of AD.

• Amyloid (also called amyloid-beta or beta-amyloid) and Tau are key proteins in AD. Clumping up of these proteins into amyloid plaques and tau tangles occurs during the preclinical stage of AD, and can be detected through various tests for about 20 years prior to AD symptoms.

Human research studies on sleep and dementia risk

Over the past two decades, a strong pattern linking sleep and dementia has emerged. The story begins with large studies of older adults: multiple studies have found that people with sleep problems were more likely to become cognitively impaired or diagnosed with dementia years later.

• A large study of older women who were followed for close to 5 years found that having sleep apnea increased the odds of cognitive impairment or dementia by over 2x, after accounting for baseline function. (Yaffe et al., 2011)

• In another community-based study, of older adults, those with the most disrupted sleep, as measured by an actigraph (wrist activity monitor) were about 1.5 times more likely to be diagnosed with AD over a 3-year followup. (Lim et al., 2013).

Moreover, even in the preclinical stage of AD, there is a relationship between poor sleep and AD.

• In a study I did with the WashU AD Research Center participants, poor sleep quality measured by actigraphy increased the odds by 5-fold of having preclinical AD as measured by cerebrospinal fluid markers of amyloid plaques. (Ju et al. 2013)

• In a follow-up study of the activity pattern over the 24-hour day, more fragmentation—meaning more activity at night and periods of inactivity during the day—was correlated with an AD-specific Tau/amyloid ratio. (Musiek et al. 2018)

• Self-reported poor sleep quality was associated with a greater amount of amyloid plaques on brain PET scans. (Spira et al., 2013).

None of these studies were designed to show causality, ie whether sleep problems cause dementia, but they show a consistent association including at the earliest, preclinical, stages of disease. Notably, since we now know that sleep disturbances occur during the preclinical stage of disease, which can last ~20 years, we don’t know whether the initial longitudinal studies were due to reverse causation (ie whether early AD was leading to sleep problems).

• More recently, a large (almost 8000 people) study with 25-year followup in the Whitehall cohort provided more evidence for a potential directional mechanism: those who slept 6 or fewer hours per night during mid-life (50’s and 60’s) had a 30% increase in dementia later in life, compared to those who slept 7+ hours. (Sabia et al., 2021).

Overall, multiple large human cohort studies support a strong link between sleep problems and AD. Likely, there is a bi-directional relationship between sleep problems and AD, but we need long-term studies with AD biomarker assessments from the beginning to fully address the question of direction.

Mechanistic studies in mice

Mouse experiments have filled the gap in understanding the mechanistic links between sleep disturbance and AD.

• A landmark study from the lab of my mentor, David Holtzman, showed that amyloid increases during wake and decreases during sleep. Medications to sleep-deprive mice caused amyloid levels to be elevated, and chronic sleep disruption led to more amyloid plaques. (Kang et al., 2009).

• More recently, the same lab showed that tau also increases with sleep deprivation. (Holth et al., 2019).

There is ongoing debate on why or how amyloid and tau levels increase with sleep disruption. One explanation is that these proteins are released by neurons during activity, so during sleep deprivation, relatively more is released compared to regular sleep. Another potential explanation is that the clearance of these proteins may be affected.

• A clearance system—termed the “glymphatic” system—was described in another landmark paper (Xie et al., 2013). The glymphatic system ramped up during sleep, including clearance of amyloid that had been injected into the brain.

How sleep reduces amyloid and tau is important to pinpoint, because it is a potential target for medications to prevent neurodegenerative diseases. Whether it is production, clearance, or something else, this is a very active ongoing area of debate.

Translational studies: how does changing sleep in humans affect amyloid and tau?

Based on the mouse studies, several scientific groups have translated them back into humans, with particular focus on amyloid and tau.

• Sleep deprivation increases cerebrospinal fluid levels of amyloid the next morning, in two separate studies, one by my WashU colleague Brendan Lucey (Lucey et al, 2018), and another by a group in the Netherlands (Ooms et al, 2014). A third study using amyloid PET showed similar results (Shokri-Kojori et al, 2018).

• My lab did a study of selectively disrupting slow-wave sleep, which is deep non-REM sleep. Compared to a regular night of sleep, cerebrospinal fluid levels of amyloid were higher the next morning after disruption slow-wave sleep.

• Lower slow wave sleep is associated with tau pathology in early and preclinical AD in a large cohort. (Lucey et al, 2019)

What we do not yet know is whether long-term sleep disruption in humans leads to more amyloid plaques, tau tangles, or dementia. After all, we can’t randomize people to different groups to get different amounts of sleep! Overall, these short-term studies support the mechanisms identified in mice, but do not prove that chronic sleep problems can cause AD in humans.

Active areas of research in sleep and AD

A major question is the chicken-and-egg one: do sleep disturbances lead to AD, or do AD changes such as amyloid plaques lead to sleep disturbances? Now that we have research cohorts with AD biomarkers (so we know who has preclinical AD or not) that have been followed for a decade, we can finally answer this question very soon!

Another critical question is if medications or other interventions to promote sleep can affect AD processes. There are multiple ongoing clinical trials of sleep medications and interventions at various stages of AD, or assessing effects on AD biomarkers (visit clinicaltrials.gov to search), but we certainly need more research along these lines to make a critical impact.

Sex effects: Both AD and sleep disturbances are both more common in women than men. We need more research on how sex affects the relationship of sleep and AD, and if/how hormone replacement can be optimized to reduce dementia risk.

We also know that having amyloid plaques decreases slow wave sleep and AD leads to damage to brain areas and circuits important for sleep. Research is ongoing on how to mitigate the impact of any existing AD on sleep, to break the feedback loop between sleep problems and AD.

Takeaways

• Sleep disturbances increase risk of dementia, and Alzheimer’s disease in particular.

• Deep slow wave sleep is important in modulating levels of amyloid and tau. Sleep disruption increases levels of amyloid and tau, key players in Alzheimer’s disease neurodegeneration.

• Sleep problems are detectable even in preclinical AD, prior to any memory symptoms.

We do not know for sure *yet* if improving sleep during mid-life will reduce dementia risk years later. But the animal studies, human biomarker studies, and large long-term cohort studies altogether support sleep as a plausible and modifiable risk factor for AD. Also, getting better sleep certainly won’t hurt, and we will have the benefit of feeling well and enjoying the best quality of life while we are young. So for your best brain health, now and in the future, get the best sleep you can, tonight and every night!

References (alphabetical)

Holth JK, et al. The sleep-wake cycle regulates brain interstitial fluid tau in mice and CSF tau in humans. Science. 2019;363(6429):880-884. doi: 10.1126/science.aav2546. PMID: 30679382; PMCID: PMC6410369. Full text.

Ju Y, et al. Sleep quality and preclinical Alzheimer disease. JAMA Neurol. 2013;70(5):587-93. doi: 10.1001/jamaneurol.2013.2334. PMID: 23479184; PMCID: PMC3676720. Full text link.

Ju Y, et al. Slow wave sleep disruption increases cerebrospinal fluid amyloid-β levels. Brain. 2017;140(8):2104-2111. doi: 10.1093/brain/awx148. PMID: 28899014; PMCID: PMC5790144. Full text.

Kang JE, et al. Science. 2009;326(5955):1005-7. doi: 10.1126/science.1180962. PMID: 19779148; PMCID: PMC2789838. Full text.

Lim AS, et al. Sleep Fragmentation and the Risk of Incident Alzheimer's Disease and Cognitive Decline in Older Persons. Sleep. 2013;36(7):1027-1032. doi: 10.5665/sleep.2802. PMID: 23814339; PMCID: PMC3669060. Full Text.

Lucey BP,e t al. Effect of sleep on overnight cerebrospinal fluid amyloid β kinetics. Ann Neurol. 2018;83(1):197-204. doi: 10.1002/ana.25117. PMID: 29220873; PMCID: PMC5876097. Full text.

Lucey BP. Reduced non-rapid eye movement sleep is associated with tau pathology in early Alzheimer's disease. Sci Transl Med. 2019;11(474):eaau6550. doi: 10.1126/scitranslmed.aau6550. Full text.

Musiek ES, et al. Circadian Rest-Activity Pattern Changes in Aging and Preclinical Alzheimer Disease. JAMA Neurol. 2018;75(5):582-590. doi: 10.1001/jamaneurol.2017.4719. PubMed PMID: 29379963; PubMed Central PMCID: PMC5885197. Full text.

Ooms S, et al. Effect of 1 night of total sleep deprivation on cerebrospinal fluid β-amyloid 42 in healthy middle-aged men: a randomized clinical trial. JAMA Neurol. 2014;71(8):971-7. doi: 10.1001/jamaneurol.2014.1173. PMID: 24887018. Full text.

Sabia S., et al. Association of sleep duration in middle and old age with incidence of dementia. Nat Commun.2021;12:2289. https://doi.org/10.1038/s41467-021-22354-2. Full text.

Shokri-Kojori M et al. β-Amyloid accumulation in the human brain after one night of sleep deprivation. PNAS. 2018;115 (17) 4483-4488. https://doi.org/10.1073/pnas.1721694115.  Full text.

Spira AP, et al. Self-reported sleep and β-amyloid deposition in community-dwelling older adults. JAMA Neurol. 2013 Dec;70(12):1537-43. doi: 10.1001/jamaneurol.2013.4258. PMID: 24145859; PMCID: PMC3918480. PMC

Xie L. Sleep drives metabolite clearance from the adult brain. Science. 2013;342(6156):373-7. doi: 10.1126/science.1241224. PMID: 24136970; PMCID: PMC3880190. Full text.

Yaffe K, et al. Sleep-Disordered Breathing, Hypoxia, and Risk of Mild Cognitive Impairment and Dementia in Older Women. JAMA. 2011;306(6):613–619. doi:10.1001/jama.2011.1115. Full text.

How Daylight Savings Time Harms Your Health

Our bodies run on an internal clock, called the circadian rhythm, which controls when we feel sleepy or alert, when hormones are released, our metabolism, and even how our immune system functions. The circadian rhythm is finely tuned to 24 hours, primarily by light and darkness.

When we “spring forward” or “fall back,” we are abruptly stressing our circadian rhythms, throwing a wrench in all those processes that rely on the 24-hour clock. Most obvious is our sleep: when we “fall back” we will go to bed an hour later, but our circadian rhythm will wake us up when it was set to, meaning we lose an hour of sleep. So the slight sleep deprivation piles on top of the many other disruptions to our body’s numerous functions. Most of us will seemingly shrug it off in a few days, but research shows that we are paying for DST with our health.

While an hour doesn’t sound like much, research shows that it takes a week or more for our bodies to adjust. For example, heart attacks and strokes are more common in the week after the time change, likely due to disruptions in circadian blood pressure regulation and hormone (such as cortisol) release. A recent paper from Stanford researchers(1) examined the health burden related to daylight savings time, and by their estimate, 300,000 (not a typo) strokes could be reduced per year in the US alone if we got rid of daylight savings time. This study, which modeled the prevalence of health problems county-by-county across each time zone, also showed that stopping daylight savings time would reduce obesity by 0.78%… which is 2.6 million people!

Fatal car accidents also increase in the week after time changes: a recent study(2) found there was a 12% increase in car accident deaths after the spring time change and actually a decrease in motor vehicle accident deaths in the autumn (-7%), however this is more than made up for increase in pedestrian and bicyclist deaths due to car crashes after the fall time change (13%). Overall, the pedestrian/bicyclist deaths appear more related to the amount of light, whereas the car accident deaths are more related to sleep loss.

Even if we avoid death by accident, and heart attacks and strokes, we still have some mental doldrums after the time change. One study of SAT scores found they tended to be lower after the time change. In working adults, decreased productivity lingers for about 2 weeks after the time change!

And then, there is just the general misery of the time change, which is especially acute for anyone with young children (or pets who expect to be fed on time). When my kids were little, it seemed they had only just settled into a good bedtime routine when the blasted time would change again!

Why do we have daylight savings anyway?

No, it’s not about the farmers! Initially, daylight savings started as an effort to save energy sources by having more sunlight available in the evenings, thereby reducing electricty/energy use. However, an analysis by the US Department of Energy showed that with our modern lifestyles, there are no significant energy savings.

Nowadays, the biggest proponents of daylight savings time are those who make money from extended evening hours. Retailers, restaurants, bars, entertainment venues, and outdoor recreation industries all generate aded revenue during the extended evening hours during daylight savings. Historically, groups like Chambers of Commerce have lobbied for extended DST, citing commercial benefits. However, while businesses may gain, the science is clear that the short-term economic cost comes at a real cost to our health.

How about we get rid of daylight savings?

Great idea!!

In the US, DST was standardized by the Uniform Time Act of 1966, which allowed states to opt out. Only Hawaii and (most of) Arizona have opted out. Dozens of states have now introduced bills to adopt a single permanent time, but federal law still requires congressional approval to make any nationwide change. If you want to contribute to getting rid of daylight savings, please check out what is going on in your own state — a great resource is SaveStandardTime, a non-profit devoted to permanent standard time.

Should we have permanent standard time or DST year-round?

Incredibly, the US has already done this experiment! In 1973, the Emergency Daylight Saving Time Energy Conservation Act was enacted, ostensibly to save energy, and “year-round” DST began in January of 1974. Unfortunately, legislators hadn’t realized that there is a big difference in morning light between summer and winter. Clocks being an hour earlier is no big deal in the summer. But with the short days in the wintertime, it quickly became apparent that setting clocks an hour earlier in the wintertime meant dark, cold, and dangerous mornings. Specifically, there was concern that children were walking to school in the dark, increasing risk of car accidents. Also, everyone was miserable. In less than a year, year-round daylight savings time was ended by Congress.

This experiment, as well as numerous scientific studies, support that permanent standard time is best for our health and happiness.

Tips for the upcoming “fall back” time change

Whether you like it or not, we will probably “fall back” an hour in a week or two. Some tips to make it easier and safer:

• Transition a few days in advance, by short increments (15-20 minutes) each day. This is especially helpful for babies/pets.

• Get light in the evening and early part of the night, to shift your circadian rhythm later. (Don’t do this if you have trouble falling asleep and/or a night owl already.)

• Avoid caffeine later in the day and alcohol, as they will contribute to sleep disruption.

• Avoid napping, which can spoil your sleep at night. If you think you will fall asleep in the evening because of the time change, plan an activity that is fun and preferably with other people, so that you don’t fall asleep accidentally.

• If you can, move any events requiring peak performance, such as a big work presentation or the SATs, to NOT the week immediately following the time change.

• Be really careful during your commute, especially your evening commute, especially if you are on foot or bike. If you can, move your evening commute earlier or work from home for a few days after the time change.

If you are a night owl, enjoy Fall Back Day! This year it lands on Halloween weekend. Whoooo! 🦉

1. Weed L, Zeitzer JM. Circadian-informed modeling predicts regional variation in obesity and stroke outcomes under different permanent US time policies, Proc. Natl. Acad. Sci. U.S.A. 122 (38) e2508293122, https://doi.org/10.1073/pnas.2508293122 (2025).

2. Woods AN, Weast RA, Monfort SS. Daylight saving time and fatal crashes: The impact of changing light conditions. J Safety Res. 2025 Jul;93:200-205. doi: 10.1016/j.jsr.2025.02.010. Epub 2025 Feb 25. PMID: 40483055.

Permalink

]]>Falling back: In defense of standard timeYO-EL JUTue, 14 Oct 2025 15:00:00 +0000https://yoelju.com/posts/how-to-cure-jet-lag-faster-eastward-edition682caaaf3810316191303369:685ede0fa029b00177f97e68:68ec727287ba6b5ee512e50aTravel seems like all fun and games, until you find yourself feeling exhausted, irritated, sleepy-yet-wired, and dull, and you wish you had never left home. Jet lag is miserable! Why do we get jet lagged, and how can we cure it so we can actually enjoy vacations?

Jet lag didn’t exist until humans figured out how to, ahem, jet across multiple time zones by plane. Our internal clocks, or circadian rhythms, are built into every cell in our bodies, and controlled by the “master” clock in the brain called the suprachiasmatic nucleus (SCN). Even when researchers have locked themselves in dark caves, they found that human circadian rhythms still tick on regularly, controlling when we can best sleep, eat, think, and exercise. Jet lag happens when our internal clocks mismatch with our environment due to rapid travel: not only do we feel “off” since we aren’t sleeping, eating, thinking, and exercising at the “right” times, there is the added frustration of not be able to sleep at night, and fatigue from sleep deprivation during the day.

A couple jet lag basics. It is typically worse when flying east than west, because there’s more sleep time lost. Some people get worse jet lag than others, it’s luck of the draw. Youth helps — children recover from jet lag faster than adults. More time zones means worse jet lag, and a longer recovery. Fortunately, our circadian rhythms aren’t set in stone, and eventually our clocks will adjust to the new place — this takes about a day per time zone. So for people traveling 7 times zones, that will be a week of jet lag, and if that is the duration of the trip, they will have to immediately reverse the process and have another week of jet lag when they return home!

So how can we cure jet lag (faster)? Use circadian science! ⏰🧪🎉 Here’s the science-backed guide for curing jet lag traveling east 6-8 time zones: US to Europe, or Europe to Asia. For illustration, let’s pretend we are traveling from St. Louis, Missouri (USA) to Paris, France, a 7-hour time difference. Of note, this guide assumes you sleep regularly approximately 11pm-7am at home. If your usual sleep schedule is very different, or you have significant sleep problems already, you will need more individualized advice from a sleep doctor. We will get to westward travel as well as opposite-side-of-world travel in future posts.

Here’s the science on how to shift our circadian rhythms:

This is a phase response curve (PRC). On the X axis is time. On the Y axis, in the positive direction, are things that shift the circadian rhythm earlier (or advance it). In the negative direction are things that shift the circadian rhythm later (or delay it). Light and melatonin are the strongest forces on the circadian rhythm, so they are plotted here, light in yellow and melatonin in red. The key concept is that light and melatonin have different effects on the circadian rhythm depending on the time. As you can see, the big yellow trough shows that light will delay the circadian rhythm if given before 4-5am (the core temperature nadir, which is about 2 hours before wake time), but then the big yellow mountain shows that light will advance the circadian rhythm if given after this time. Timing is everything! The same goes for melatonin — when given at evening/night it will advance the circadian rhythm, but it will delay the rhythm if given during the morning — and it also generally has the opposite effects as light.

Now back to our Paris trip! Let’s all get on an imaginary plane. During the flight, try to get as much good sleep as you can: wear an eye mask, wear ear plugs or noise-canceling headphones, and avoid alcohol. If you have previously taken a short-acting sleep aid safely without problems, this might be a good time to do so. Note that most prescription sleep medications and over-the-counter antihistamines (e.g. dramamine, diphenhydramine/benadryl) last much longer in your system than the flight and should be avoided. I have had to medically assist fellow passengers on two separate flights because they got completely zonked and confused after taking a sleep medication they weren’t used to. If you are accustomed to it, regular (not slow-release) melatonin is also okay to take on the plane. In general, try your best, but it won’t be a great night of sleep. That’s ok.

When the plane lands, the time has changed! Look at the X axis on the new table, which has shifted 6 hours. Typically, a flight from North America to Europe is a “red eye,” so let’s say we have arrived at 8am Paris time. This lines up with the deep yellow trough in the phase response curve, meaning that light in the morning will delay your circadian rhythm, making your jet lag worse! So be prepared and wear sunglasses in the morning, as much as you can from when the plane windows are opened for landing, through the airport (except for the security check of course), and especially outdoors en route to your hotel.

Then the most important jet-lag cure: expose yourself to bright light, preferably sunlight, in the early-mid afternoon. As you can see on the graph, there is a yellow peak around 12-4pm, meaning that light exposure at that time will shift your circadian rhythm earlier. Wear sunscreen (!) but if you can tolerate it, take off any sunglasses and let the light hit your eyes in the afternoon. Note the very steep slope of the yellow line — the location of where that line crosses zero will vary depending on your home circadian rhythm. The more time zones you are going east, the later in the afternoon you should get bright light. For example, someone from Los Angeles going to Paris (9 hour difference) should wait to get bright light until around 2-3PM. Any earlier will have the opposite effect and make their jet lag worse. Again, timing is everything! Also, avoid napping in the afternoon, so that you build up your “sleep drive” for the nighttime when it will be harder to fall asleep with the time change.

Last but not least, you can boost the effect by taking melatonin right at bedtime (if you’re going to bed around 11pm to midnight) which is right around the red “hill” on the graph, meaning melatonin will also advance your circadian rhythm. Bonus: melatonin has a mild soporific (sleep-inducing) effect, which will help you fall asleep since internally, it will be the afternoon so it will be harder than usual to fall asleep. The exception is anyone who stays up partying until the wee hours of the morning… melatonin may have an opposite effect at this time, so just skip it.

Note that melatonin is considered a prescription medication in many countries, however lower doses (<2mg) can be sold over-the-counter in some European countries (e.g. Italy, Spain, France). The OTC melatonin in Europe is subject to much stricter regulations than in the USA, where melatonin is loosely overseen as a nutritional supplement, not a medication. So if you’re in one of those countries… this is a great opportunity to stock up on better melatonin! If you plan to pack melatonin from home, please check ahead to ensure it is legal at your destination. In terms of melatonin dose, a high-quality review of 10 clinical trials (link) found that 0.5 mg up to 5mg were effective, with the higher end being better for the sleep effect, and that slow-release formulations do NOT work well.

At nighttime, again, try your best with eye mask, ear plugs, etc to get the best sleep you can. The next day, again avoid bright light in the morning. You may benefit from a little extra cafe au lait with your pain au chocolat. Then, again for the next couple days, time your outdoor excursions for the early afternoon for the biggest circadian boost. Jet leg can’t be cured instantly, but with the right timing of light (and melatonin), you will recover a lot faster!

Recap: for travel eastward ~6-8 time zones:

🌞 Get light in the early afternoon (noon to 4pm)

🕶️ Avoid light in the morning. Prepare dark sunglasses for your flight arrival.

💊 Take melatonin right at bedtime.

Additional tips:

1. Some people advance their circadian rhythms partially before departure for a day or two. You can do this by getting bright light first thing in the morning (at home) and taking melatonin a couple hours before bedtime (at home).

2. If you have a work presentation or similar event to be at peak performance for, consider partially pre-advancing your circadian rhythm (as in #1) and/or arriving a couple days early.

3. If you travel frequently and suffer a lot from jet lag, some prescription medications have been tested in clinical trials for this indication, so see a sleep doctor.

Bon voyages!!

PS: I don’t have space or time to go over all of the research studies that have been done on jet lag treatments, as I am skipping over the prescription medications (which the average person does not need for occasional travel), and many of the studies were done with “simulated” jet lag. Seriously, some studies had people sit in a lower-oxygen room in cramped conditions for the duration of a fake “flight”, then exposed them to a time zone change in the form of turning on the overhead lights at different times. Many studies are done on frequent air travelers (such as flight personnel) who are self-selected for not being badly affected by jet lag. Very few studies combine medication with appropriately-timed light exposure and avoidance, which is strange since light has the strongest effect on the circadian rhythm. One (in retrospect) humorous study was on 257 (!!!) Norwegian physicians who had flown from Norway to New York 5 days earlier for a medical conference, and different dosing schedules of melatonin were tested upon their eastward return flight to Norway. None of the melatonin doses worked better than placebo, which is no surprise since the study group’s circadian rhythms were already rattled by their recent travel west. Incidentally, the study researchers were at the New York Psychiatric Institute and Columbia P&S Medical school, and the first author of the study, Robert Spitzer, in addition to revolutionizing psychiatry by spearheading the Diagnostic and Statistical Manual of Mental Disorders (DSM-3), was later my psychiatry professor in medical school. It’s a small world!