What Your Chronotype Reveals About Your Hormones, Sleep, and Energy | Dr. Elisa Sacal

Dr. Brighten: [00:00:00] What if the real cause of insomnia isn't stress, but it's 

Elisa Sacal: actually what's happening in your gut? 90% of our serotonin levels, and we produce our melatonin from serotonin. Temperature needs to be dropped by Celsius or so in order for us to go into deep sleep. What about alcohol? Alcohol will bring our temperature up and it will fragment.

Our sleep light is really important. It's our best cue for our internal clock. 

Narrator: Dr. Elisa Sal Duani is redefining the science of rest, blending sleep, neuroscience, functional medicine, and lifestyle optimization to help people heal from the inside out. As co-founder of the Family Sleep Institute in Latin America, an author of Des de Raiz, she brings her expertise as a physician cancer survivor and mother of three to teach us how transforming sleep can transform life itself.

Elisa Sacal: When we sleep, our brain shrinks at night. The neurons tend to be closed together, so cerebral spinal fluid just go through neurons [00:01:00] and flushes out metabolic waste. Mm-hmm. That it's normal waste be myeloid T protein. So without enough sleep that will accumulate and increase our chances of have. 

Dr. Brighten: If someone's having trouble sleeping and they're like, okay, listen, I'm doing all the sleep hygiene.

It's still not working. What other things should they investigate? I think besides hormone, they need to check. Welcome to the Dr. Brighten Show, where we burn the BS in women's health to the ground. I'm your host, Dr. Jolene Brighten, and if you've ever been dismissed, told your symptoms are normal or just in your head or been told just to deal with it, this show is for you.

And if while listening to this, you decide you like this kind of content, I invite you to head over to dr Brighten.com where you'll find free guides, twice weekly podcast releases, and a ton of resources to support you on your journey. Let's dive in. What if the real cause of insomnia isn't stress, but it's actually what's happening in your [00:02:00] gut?

That's a great question 

Elisa Sacal: because actually the gut produces over 90% of our serotonin levels and we produce our melatonin from serotonin. So it's really important to have good balance, gut balance, and to have our microbiome stable so we can have good sleep quality 

Dr. Brighten: as well as good mood. So you just said serotonin is how we make melatonin and for some people it's gonna be the very first time they've ever heard that.

Can you explain that? 

Elisa Sacal: Yeah, sure. So serotonin is actually our precursor, precursor of melatonin and it actually builds up with tryptophan, which is an amino acid that we need to ingest to take with diet, with food, we can take, we can include in dinner, for example, Turkey nuts. Seeds to help us produce this.

And it's very important also to have gut balance and to expose us ourselves to light at morning because that's [00:03:00] the, that's an an important cue for us to produce serotonin and actually convert it to melatonin at night. Mm-hmm. So if we don't expose ourselves enough to enough light in the morning, outside light, actually it would be very difficult for us to produce enough melatonin, which is a darkness hormone.

Dr. Brighten: Yeah, you just said Turkey and everybody in the United States knows Trytophan, Turkey go to sleep. But I bet that it wasn't until this moment that a lot of people realized it's not trytophan to serotonin, to melatonin pathway that, you know, gets, gets called the reason why we all go into food comas at Thanksgiving.

But yes, we know that has a lot to do with overeating and a lot of carbohydrates going on as well. 

Elisa Sacal: Yeah. Also, glucose regulation is very, very important for sleep. And when we don't have good balance on dinner, we don't introduce car complex carbohydrates, protein, good fats, and also when we tend to eat too late and right [00:04:00] before sleeping, that would increase our body temperature and uh, that will.

Uh, affect our sleep quality. 

Dr. Brighten: Mm-hmm. I wanna talk more about body temperature, but I wanna go back to something that you said or just a few minutes ago, which was, getting light exposure is important for the cue at night for melatonin production. So, most people think we need sunlight for the circadian rhythm to spike cortisol, but it goes a layer deeper to how it actually affects melatonin.

Can you talk more about that? That's right. We need to, 

Elisa Sacal: uh, expose our retina to our ganglion cells, retinal ganglion cells, which are fo uh, intrinsic photo sensitive to light, because that's the main cue that is gonna signal our SEN to tell our pineal pineal gland to produce melatonin and then release it, uh, at, at evening.

Two or three hours before bedtime. So it's really important. Uh, few people know that our melatonin, our good sleep quality starts [00:05:00] with exposing ourselves to enough daylight. Mm-hmm. 

Dr. Brighten: So I wanna talk about body temperature, and I feel like it, it goes really well with the conversation of perimenopause and menopause as well.

Right. Why is it that some women in perimenopause are getting less sleep than new moms? Because actually, 

Elisa Sacal: in perimenopause, our hormone starts to fluctuate. So around 40, 45 years, we start with per early perimenopause. And estrogen is an important turmo regulator. So when we start floating, um, um, increasing and decreasing the, our hormones, estrogen is gonna stop regulating our, our temperature and also progesterone.

Um, especially at the first start. At the start of perimenopause first phase, we will decrease our progesterone levels, which naturally is our anxiolytic hormone, and it helps us help [00:06:00] us go to sleep. So. Uh, women might find difficult to stay asleep and maintain their sleep or wake up early so that, and temperature and night sweats, everything like that, it is gonna affect their sleep quality.

Dr. Brighten: So you said, uh, an anxiolytic and that is anti-anxiety hormone for people listening. So it's why you don't have racing thoughts when you fall asleep, you feel more sedated, sleepy, calm. So that progesterone to allop limb pathways so powerful. But what should people know? So, so women in, uh, women who are in late stage perimenopause, they're like, I know about hot flashes, I know about the night sweats.

I know how that disrupts my sleep. But it's not even that extreme of like, you have to have a hot flash to have poor quality sleep. Your body temperature, as you just said, eating too late at night and that being too close to bedtime, that can affect your body temperatures. So what, what is the role of body [00:07:00] temperature in getting good sleep?

And then what can we do environmentally to, to hack that? That's a 

Elisa Sacal: very good question because temperature needs to be dropped by, uh, degree Celsius. Celsius or so in order for us to go to, into deep sleep. And there's a few things that might prevent that. Uh, eating too late for sure. Also, exercise. Exercise is great for sleeping and it will improve our time.

Um, the latency, sleep latency, that's the the time that it take, that it will take you to fall asleep once you're in bed and then it will increase efficiency. Uh, but. The only thing is we need to stop doing exercise, uh, before going to bed at least three to four hours, or at least not intense workout.

Dr. Brighten: Great. That I was gonna ask you is like, does it matter on the type of exercise? Is it all exercise? Yeah. As long 

Elisa Sacal: as you're doing yoga, stretching and you don't sweat a lot, it will be fine. 

Dr. Brighten: Mm-hmm. Yeah. I do all my mobility exercises before bed. Usually when the kids [00:08:00] and everybody's in the bedroom or we're doing bedtime routine, I'm like, I'm gonna do some hip mobility 

Elisa Sacal: now.

And that might help you induce, uh, a more parasympathetic, parasympathetic system, right? Mm-hmm. Parasympathetic mode. And it will increase your relaxation mode. And it's very important for us to feel relaxed and safe. To go into deep sleep. Mm-hmm. And what about alcohol? Alcohol also will bring our temperature up.

It's also a diuretic and it will fragment our sleep, especially our REM sleep face. Um, at the beginning you might feel easier to fall asleep 'cause it's at sedative and it will knock your your frontal cortex. But after a while. In the second part of night, it might fragment it and it will affect your REM sleep.

So chronically it will affect and it's not a good idea. 

Dr. Brighten: Yeah. And a lot of women we see, especially in perimenopause, they start chasing alcohol night caps. You know, that's a thing that like people say in parts [00:09:00] of the world, and it's because it can work with GABA and it, but it's so temporary. So, uh, let's talk about the fragmented sleep.

So when you say fragmented sleep, what does that mean for people who haven't heard that? Okay, so while 

Elisa Sacal: we sleep, we're not in a passive state, it's just, it's actually a complex active state, and we have it in cycles. Each cycle is 90, between 90 to 110 minutes length, and we will have four to six cycles a night.

So between each cycle, we might have a small pause just to check everything out. We are finally, we are animals and we need to check our environment and everything that we make sure it's safe. So, um, between those cycles you might move a little bit. Um, how do you say, uh, cover yourself if you're, oh, you'll pull the covers up.

Yeah, pull the covers up and check everything is okay. And to check that everything as [00:10:00] is as. As you left it when you lose consciousness. So, um, you might have those pauses and you might have actually 15 to 20 minutes, uh, between all those cycles. As long as it doesn't take more than 20 minutes, it's okay to wake up and fall asleep.

Mm-hmm. Because a lot of people, um, get anxious about waking up and it, it is actually part of sleeping as long as it's continued one cycle after the other one and you don't remember it that much and it's, you don't struggle that much to fall asleep again, it's gonna be okay. But that continuously, um.

It's gonna bring you sleep quality, which is as much as important is, is as important as sleep quantity. 

Dr. Brighten: Mm-hmm. So what does it look like then when someone drinks alcohol? So that's the normal, like you, you're gonna wake up, you're gonna adjust the covers. Maybe you go to the bathroom, maybe you know, you, you kick one leg out, you know, you all the things we do when we sleep.

But when someone drinks [00:11:00] alcohol, how does that look different? Is it more frequency in waking up? Is it a more difficult time going back to sleep? Is it all of the above? 

Elisa Sacal: Uh, mainly all of the above. At the beginning of the night, your cycles, you're gonna cap rem sleep from your cycles. And at the second part of night, you're gonna have like a rebound on that REM sleep, which is a lighter, uh, type type of sleep.

So the sleep architecture overall is gonna get. Uh, messed up. 

Dr. Brighten: Mm-hmm. Yeah. And the other thing about alcohol, I, I found really interesting, I was reading recently that your heart rate variability can be messed up. Yeah. For two days after having a drink, which is really lame because it's even worse once you're in your forties and above and your resting heart rate goes up at night as well.

Can you talk about why those two variables are so impactful in, in terms of us actually waking up feeling rested and being resilient to stress? 

Elisa Sacal: Yes. Well, heart rate vari variability, [00:12:00] which is like the difference between between heartbeats, it actually reflects our possibility to activate parasympathetic mode.

So it's our resiliency, heart resiliency. So when you drink alcohol, you trigger cortisol, you trigger alert mode in a way, or at least metabolically speaking, and then harder variability will reflect that and is gonna decrease also. Heart. Heart rate's gonna go up and temperature is gonna go up as well.

And um, what were you talking about? Heart rate and what was 

Dr. Brighten: the question? Yeah, so your heart rate staying elevated at night and then the heart rate variability being, it drops. So, so I guess I should, uh, clarify that for people. So heart rate should go down at night and heart rate variability, you wanna be up, like, you just want that up, like how high can you get it?

Uh, with, when you drink alcohol, your heart rate actually goes up at night, right? So instead of being like 60, you might be like 68. And then your heart rate [00:13:00] variability. Maybe instead of being, you know, 50, it's dropping down to 30, right to 20. 

Elisa Sacal: Because in the cardiovascular system, it's really important for us to deep a little bit our blood pressure at night.

Mm-hmm. At least 10 to 20% if you have alcohol or nightcap that might stay up and then cardiovascular system won't relax and. Chronically, it will predispose you to have high blood pressure, hyper hypertension. 

Dr. Brighten: Mm-hmm. And as you were talking about this, you said, you know, the heart rate variability, that's a measure of our parasympathetic activity.

So heart rate going down, heart rate variability going up. You saying that's parasympathetic activity. That means that we are de-stressing and as you said, you drink alcohol, cortisol goes up, and then it stresses your cardiovascular system. And then there's also the raise in body temperature. So you think you've made a really good case of why ignite caps are lies?

They don't actually, 

Elisa Sacal: that's not a good idea. Yeah. Yeah. We should [00:14:00] stop alcohol. I mean, there's no good amount of alcohol and a safe amount of alcohol, but we should stop drinking at least two hours before bedtime. 

Dr. Brighten: Mm-hmm. So I wanna go back to the gut component because early on in this conversation you said that we produce the serotonin in our gut.

Is that crossing the blood brain barrier? Is the serotonin in our gut actually being utilized for sleep in the brain? Um, some say it, 

Elisa Sacal: it's not crossing as well as gaba, for example. It's not crossing the blood, blood brainin barrier, but we have neuro pot cells. How do you say, 

Dr. Brighten: are you talking about like vagus nerve?

Yeah. Communication. The neuro pots, 

Elisa Sacal: neuropath. 

Dr. Brighten: Nerves. 

Elisa Sacal: It's a new term that's the, well, maybe, I don't know this term. Um, the bag's nerve send like a signal, like, uh, a foot on the stomach. The stomach, and it senses how the ambient is. Mm-hmm. So we will say to the brain, how is everything? It's not direct, it's not directly that it [00:15:00] crosses.

That's why if you, for example, take gaba, it might not cross the blood bearing barrier. But the ne ne, the vagus nerve through his foot that he sends, it's called neuro pod. Neuro in Spanish. I'm not sure how to say 

Dr. Brighten: things. Yeah, which makes sense. So for people listening that when you say pod in medicine, we're talking about a nerve foot, right?

That's down there and seeded. Exactly, yeah. That's what I means. So 

Elisa Sacal: the vagus nerve will send a pod to the digestive system and it's going, it's gonna tell the gossip to the brain and it's gonna. Say how is environmentally speaking in neurotransmitters? And it's a signal directly to the brain so it knows how to react.

Mm-hmm. So it's really important for us to have enough serotonin be at that way. 

Dr. Brighten: Yeah. It's very interesting because your gut and the microbiome, it is producing so many neurotransmitters and forever we thought like there's, you know, medicines like your gut is separate from your brain and now we understand whatever the gut [00:16:00] environment is Absolutely.

Influences the brain environment. Sure. Also, inflammation, if you 

Elisa Sacal: have gut dysbiosis is gonna produce inflammation. You're gonna have, uh, cytokines over there and that will gonna mess up your hormones, it's gonna mess up your metabolic health and that as well is gonna affect your sleep. 

Dr. Brighten: Mm-hmm. For sure.

Can you say more about how inflammation is affecting people's sleep? Because we know the gut is one of the most like, hidden areas for inflammation, right? It's like where the immune system is hanging out, but most people think you have to have gut symptoms. It, you know, in order to have dysbiosis or to have problems.

So I, I, I think I'm asking two questions here. So firstly, uh, how is inflammation in the gut impacting the brain and impacting sleep? 

Elisa Sacal: Right. Well, inflammation is gonna activate HPA axis. So we're gonna have cortisol, um, overproduction, and it's gonna alter our glucose levels as well. So it's gonna activate sympathetic, [00:17:00] sympathetic, uh, tone, sympathetic tone, so.

That is opposite of what we need in order to fall asleep and to have good quality sleep. So HPA axis is one of them. And then inflammation also about, around talking about the glucose levels. We are gonna have insulin resistance. We might have hypoglycemia, reactive hypoglycemia at the beginning that might wake us up, especially those awakenings where we feel, uh, like night sweats or we feel hungry because people.

Uh, maybe a lot of people doesn't know that, but it's not normal to wake up and feel hungry or feel mm-hmm. Um, change on temperature. So insulin resistance as well. It's, uh, um, it will have an effect on sleep. 

Dr. Brighten: And then, so my second question that I was like, muddling together into one is. A lot of people think you must have gut symptoms in order for you to have gut dysbiosis or any kind of dysfunction, but we know the [00:18:00] gut can be a hidden place of inflammation.

So can you explain, you know, to people listening how gut symptoms might show up and why it is that that gut can be that hidden source of inflammation? Sure. 

Elisa Sacal: Gut symptoms might look like, uh, constipation, diarrhea, distension, not everything that it's affecting. The gut will show up in the gut. Sometimes you might look, you might see, uh, dermatitis, uh, like a rash, a skin rash mm-hmm.

Or something like that. It might affect your, your attention. You might feel. Fogginess or you might find, um, skin, skin, uh, skin rashes, might, uh, feel, uh, irr, IRR irritable. Also mood changes, mood swings. Um, you might find that. Um, I don't know. Tongue changes. 

Dr. Brighten: Yeah. Yeah. And then in terms of gut symptoms, let's talk about what is and isn't normal.

'cause I think [00:19:00] people live with some things that they think are like, this is totally normal. And yet when you explain to them like, no, like you, you shouldn't be so bloated that you have to like, have elastic pants on all the time, or, you know, that's like a little more extreme. But I think there's other things people live with day to day they don't realize are not normal.

Yeah, yeah, you're 

Elisa Sacal: right. I, I feel like a lot of my patients have normalized digestive issues, uh, screen problems, hair falling and appetite. Also cravings. They feel like they need sugar every time, so. They might normalize it. They, they just don't put attention because they have lived with it for so many years that they've normalized it.

Dr. Brighten: Mm-hmm. Yeah, and I think this is also important because, you know, everybody can have sleep issues, but I think we see a lot of sleep issues once women get into perimenopause becoming problematic. And we know with the decline of estrogen that you talked about with having hot flashes, that can also affect.[00:20:00] 

Gut microbial diversity. And so we can see a drop in diversity and we see women in their fifties with new onset IBS, but really what it is, is a change of hormones and affecting their gut. So I'm curious from you, just hearing how often in your clinical practice when people are having sleep issues, are you seeing that there's this co-occurring gut issue going on as well?

I might say 

Elisa Sacal: 80% of the time. Mm-hmm. Gut issues show up, uh, at the same time of sleep struggle and also stress problems. Like that's like the three digestive problems. Uh, stress manifest stress, um. Um, stress symptoms. Yeah. And sleep problems. Yeah. Sleep and stress are super related because when we have HPA access activation, we might feel anxious.

We will have racing thoughts and [00:21:00] actually a wind down routine is very important. I feel like today we're, we're losing our transitional stages. Mm-hmm. Like we used to go to, to work and then shut the laptop down or shut the, the computer down and then commute. Commute time, it will take like 20, 30 minutes.

But a lot of people's working is doing home, home office. Yeah. And they don't have these transitional stages anymore. So to change from sympathetic, sympathetic mode to parasympathetic, it's taking too. It's, it's been too hard for them. So a wind down, down routine might be very helpful and we need to be conscious about that and improve.

On timings and do do it in the same order every time. 

Dr. Brighten: Yeah. I wanna talk about wind down routines, but I really wanna underscore what you said. Basically, we lost guardrails. Definitely during the pandemic. This happened, right? Where people, you know, they had a routine of like, I leave the [00:22:00] house, then I stop, I'm doing work, and then when I get home I stop work.

And now, because so many people are working from home, we kind of see that bleed. Mm-hmm. I feel like schools very much indoctrinate this bad behavior in us, right. With giving homework. I'm like, and I think that like my son's school, I do have to say like, I really appreciate them because they're like no more than 30 minutes at home.

And I'm like, I think that's reasonable. But we see, um, that is something that in the US culture, a lot of people have criticized of, like it is to break down your boundaries and your sense of work versus home time. So. This started when we were children. Right. So anyone listening right now who's like, oh my God.

Like how do I come, how do I break free you from that? What is your advice to, to have that transition and to switch into that parasympathetic? 

Elisa Sacal: Yeah. I think we should activate, or our senses, we need to use our senses in order to activate that pathetic mode. So let's, for [00:23:00] example, say we're gonna do this routine for 20 to 30 minutes, in which we are gonna, uh, be conscious about light.

We're gonna dim light. Light is really important. It's a, it's our best cue for our, our internal clock. Our kidney is this before 

Dr. Brighten: bed, like 20, 30 minutes before bed, 20 to 30 

Elisa Sacal: minutes before bed. We're gonna dim lights. We are gonna, if we are gonna use light, uh, it is gonna be also amber lights or red light.

Mm-hmm. Which is gonna be easier for brain to, to increase our melatonin level. Because actually blue light will block it. And we know from research that it will block our melatonin by 50 per, it will cut it by 50% and it will stay like this for at least a hundred minutes for, so for an hour and a half, we're not gonna have good melatonin levels.

And that will try to, that will translate into bad sleep quality mm-hmm. For at least an hour, the first hour. So even if you fall asleep, it will be an [00:24:00] hour from eight probably, that you're not having a, you're gonna have like, um, um, not a great quality. So overall that means a lot. Also, um, we need to have a good environment, uh, conductive to sleep.

It's a great idea to do the same things in the same order for our brain to have predictability and help relax and activate our, our sleep mode. Also, um, maybe have some stretches, uh, or read in a dim light because we have also, uh, the comparation on, um, uh, paper, paper reading mm-hmm. And a tablet. Mm-hmm.

Yeah. And we know tablet might reduce melatonin levels as well. So every time everybody asks me, is it okay if I use my Kindle paper or so as long as it's not, uh, back litten mm-hmm. It's gonna be fine. [00:25:00] But yeah, we should introduce activities that are conducted to sleep and repeat the same order every day as much as we can so our brain can trigger.

Sleep mode. 

Dr. Brighten: Mm-hmm. Yeah. I use a Kindle to read at night and I, you can put it in a dark mode so it's all black on the screen. Um, but I have to say, you know, I have tried to read with paper books and I only, I fall asleep while I read and I will drop them on my face. And like, that's the idea. You wanna talk about like, getting into like sympathetic overdrive when you like, smack yourself in the face of 

Elisa Sacal: the phone 

Dr. Brighten: and I'm fine with the Kindle.

Like I just like kind of drifted off to the side. Mm-hmm. Um, but so I love the, the routine around bedtime. I think we need to back up though, because I think especially for parents listening, right? You get home from work, kids get home from school, and it feels like this very amped up time and it's like, I mean, you have kids so you know how it is.

It's like, do their best like, [00:26:00] like, oh my God, get them to bed so that I can get some time and then I know I can go to bed. What are ways that, like when we come home, we can kind of set up the environment to be more parasympathetic driven and to be conscious around that, of how like, 'cause I, I mean, I, I do wear, I have wearables, I have an aura ring.

Elisa Sacal: Yeah. The 

Dr. Brighten: most stressful time of my day. Is the end of the day. Yeah. And my aura, and it was the most gratifying thing ever. I was like, thank you Aura for letting me know that what I felt was very true. Yeah. And so it actually showed me like, your stress is spiking from five to 8:00 PM like that's the worst for you.

And I'm like, yes. There is so many moving parts. And so I've had to be really conscious about that. Um, and I imagine we have listeners right now who are like, yes, this is exactly when the cortisol problem starts for me in the day. 

Elisa Sacal: Right? Because we tend to rush everything into the last part of our day, especially if we are moms.

So environment is gonna help as well as, uh, hot bath, a warm bath, we know, uh, [00:27:00] taking an hour or two hours. Uh, before bed. It's gonna help our, our body, our carbo core body drop later when we fall asleep. And it will actually decrease latency, sleep latency. It will increase sleep efficiency and sleep duration, both for us and for our kids.

That could be a good tool and also to have in mind to have dinner. Not the last part of our day, but at least for kids an hour before, uh, going to sleep and maybe some meditation, journaling, or breathing techniques can activate the sympathetic mode we need. I love the 4, 7, 8 breathing technique. Mm-hmm.

Which is inhaling for four. Hold it four, seven, and then exhale for eight. And if you do four, seven cycles, at least three minutes before sleeping, it will be a good idea as well as if you wake up at at night. 

Dr. Brighten: And I'll say, uh, uh, the [00:28:00] wearables now, or even like your phone, you can set prompts. So my watch, I've set it so that it knows when I wake up and it's like, like this lovely little bell and it's like, you need to stop and you need to take some time to meditate.

And I'm like, yes, I do. Thank you very much. Like, but I think, you know, as a, as a mom, I definitely need those cues, but also because we can jumpstart the day thinking I, I've got it, like I have all this to do. And then at the end of the night, I think we. I think we sometimes get in bed and we just think like, okay, I'm in bed.

Like I should just fall asleep. But we, we need exactly what you're saying. Some of that parasympathetic, pathetic system priming. I know. Yeah. 

Elisa Sacal: I've heard Matthew Walker, this sleep expert said that you won't get to to table and wait there until you're hungry. You won't go to bed until you are sleepy. So we need to prepare ourselves to activate those hormones, switch that we need to prepare for, for, for sleep.

Dr. Brighten: Mm-hmm. And you were saying, you were [00:29:00] talking about how you, your melatonin rises at a certain time, but we know that there's different chronotypes. We know that like certain neurodivergent people have delayed sleep face syndrome where their melatonin doesn't get up until like 1:00 AM in the morning. So I, I'd like to talk a little bit about chronotypes because I think some people are gonna hear the sleep stuff that we, uh, we're just talking about and they're gonna be like.

Sure, that sounds great, but that doesn't fit who I am. Right. So can you first start by explaining what a chronotype is? 

Elisa Sacal: Yeah, that's a great question. I love it because chronotypes are like our sleep personality. Mm. Uh, we have different blood types, different eye colors, and we have different chronotype, which is a sleep propensity.

Um, the, our, yeah, it's like our internal clock timing, our preference to wake up at some times and go to sleep at a different time. And traditionally we have morning people [00:30:00] that are the ones that you go to the gym and everyone, and they're talking to everyone and they are really energized at mornings.

And then we have, by the way, 30% of of the people are, uh, morning larks. And then we have intermediate chronotype, which is 40% of the people, uh, comes here and they just go by the sun. And then we have night owls which have more energy at night. They tend to be more creative at night as well, and they probably will be fine sleeping around.

11 or 12 at night. Mm-hmm. And this chronotype is really important for us to, uh, make our sleep schedule and to, uh, take advantage of that, to be energized in the morning, to set meetings by the time we know we're gonna be better, uh, or, and more alert. It's determined genetically spec, uh, specifically per three gene has, um, that [00:31:00] information, for example, and then, uh, hormone and age, because you said, uh, neuro divergent people might have, uh, delayed sleep phase and also teens.

Mm-hmm. So it's pretty common for teens to go to sleep at 12 one or lead at least have that sleep drive at that. Uh, hour and then wake up at nine or 10. So they're not lazy. They're just have a sleep de fa sleep delay phase. Contrary on contrary for kids, for example, that they have advanced delay phase and they tend to go to sleep at 6, 7, 8, and they tend to wake up at seven.

Mm-hmm. That's why I see a lot of children and moms with children that tell me, um, couldn't I just uh, take him to sleep at 10 and he'll wake up at 10 if they need to sleep 12 hours, let's just move that. And no, because they're circadian clocked. They're chronotype, makes them [00:32:00] sleep early and wake up early.

Mm-hmm. So we need to align our circadian clock, our chronotype to our. Sleep schedule in order to have, uh, our best energy real awake. 

Dr. Brighten: Yeah. We are having this conversation right now. Last night my son just said to me, he's like, all my friends at school think it's weird. I go to bed at eight because they all don't go to sleep until 10.

And I was like, how old is he? He's, uh, gonna be 13 soon. Okay. Yeah. And he's like, they, they all think it's weird. And his kids in the class are like 11, 12. And I'm like, yeah, well, I bet not all of their parents are doctors who actually understand hormones and how significant sleep is on the brain. And I always tell him like, if you eat food and you're full of poop, would you like, would you skip going to the bathroom and just be full of it?

And he's like, no, on LinkedIn, why would you do that to your brain? Right. Which we'll talk about today, guys. Um, why I say weird things to my kids, it will make sense to you. And 

Elisa Sacal: also we've seen in on research that schools that tend to, to start later. [00:33:00] Yeah. For teens, they tend to see better score grades.

Mm-hmm. So it's really important to try to align our culture, our activities to that biological clock. 

Dr. Brighten: Yeah. I think about that. Um, I think about that research and I, even the American Academy of Pediatrics is like, school should not be starting before 8:00 AM Like this should not be a thing. And in high school I was in leadership classes.

I don't know why it got me nowhere in life. It was completely someone tell my 15-year-old self, it was dumb because I was getting up at like five something in the morning and some nights I wasn't going to bed until like close to midnight. And it's, you know how people are always like, what would you say to like your younger self?

I'm like, sleep. I would've said sleep because I love it so much. Yeah. And really was the same. I missed my opportunity there. 

Elisa Sacal: Yeah. I, whenever I was a, a medical student, I did the same. I was up all night to study for an exam that I. Actually needed sleep. Yeah. Because sleep is gonna be better for us than any study that you want because for, for cognitive performance, [00:34:00] the best you can do is sleep at least seven or eight hours a night.

Dr. Brighten: Totally. But this is the thing about medical school, right? In the first two years we're not getting any sleep and we're staying up and we're doing all this studying. And then it's like after those two years where they start teaching you about memory consolidation, and then you're like. Wait a minute, I was so, I needed to sleep to actually consolidate my memory.

Right. To actually like, have better cognitive performance. Um, we didn't have creatine research back then, so like I know, you know, 20 years ago it wasn't like down in creatine and like doing all of that. But, um, yeah, it's kind of the irony of medical school. I know it's also like when you go through medical school, like the way that they expect you to live is incongruent with what ha makes you healthy.

I know. They're like, we're gonna set you up for the worst health outcomes scenario. I know. I just see 

Elisa Sacal: how you do. I know, I, I sometimes fe sometimes feel like medical school is setting you up to learn everything about illness and nothing about health. Mm-hmm. So, and, and con building health actually, because all, all those pillars of lifestyle [00:35:00] will bring you out, bring out the best of you.

So. If you don't build your health on sleep as, as, as much as diet or exercise, you are building your health on San. There's actually a research that I like that many researcher that. Um, compare two groups, the one that, uh, both of them with the same diet and exercise, but one of the, of those groups, they limit their sleep time to five and a half hours of sleep.

And then the other one let them sleep eight and a half hours. And by having the same exercise and diet routine, uh, only because of this sleep difference, the group doesn't have sleep deprivation compared to the group that had enough sleep. They, the, the, the ones that sleep good, that, that had enough sufficient sleep, um, they burned.

Between 30 and 50% [00:36:00] more fat and they were able to build more muscle just because of sleep time, sleep, um, hours. Mm-hmm. So it's really important and we usually tend to, to not put enough attention. 

Dr. Brighten: Yeah. And I think that's important in the metabolic conversation because especially as it applies to women, when we have stressors.

Which can be many things, but lack of sleep can be one of 'em. We will see our hormones shift towards survival. So we've got the HPA activation you talked about before, and then you've got, we're gonna consolidate fat, right? I mean, I would argue body, like we should keep muscle, but the body's like, that's expensive and fat is a great reserve.

Like fat is gonna gimme more than that muscle's ever gonna give me if like, you know, I'm in a famine. So I think it's really important for women to hear that because sometimes they're like, exactly what you just said, I'm exercising like the same, I'm eating the same, but I'm not building muscle and I'm, I'm building [00:37:00] fat.

What's going on? Examining your sleep. I wanna bring it back to the chronotypes because I'm fascinated by this conversation. Let's help people right now. How can they know their chronotype? How can they identify it? Because most of us are living in an artificial like sleep scenario, right? That's like in imposed on us and it isn't true to what our nature is.

So how can you identify what's your chronotype? Okay, well it's pretty 

Elisa Sacal: intuitive. If you think about yourself in vacation mode for a month or so, think what will be your sleep schedule. What are your tendency to go to sleep at, let's say 9, 10, 11 pm And what, what will be your best wake up time with no alarm?

Other than that, we can go in online and do the morning. Morning next evening, next questionnaire, which is a questionnaire that will ask those questions are, um. What time do you feel more alert or you wanna go to [00:38:00] sleep? And that will tell you your best sleep schedule and your chronotype. And also you can look at your parents.

What are their preferred time for sleep? 'cause it's pretty genetically driven and um. Yeah, you were saying something about chronotypes and, 

Dr. Brighten: yeah. Well, I am glad, because I wanna go a little bit deeper here because what you said just prompted me to ask the question a lark. So what would be the ideal waking time for a lark?

Okay. The ideal meeting time. So like actually when would you schedule, like your meeting, whether it is like the parent-teacher conference or it is like, you know, your, your big presentation at work. Yeah. So I'd like to go through like based on the chronotypes, what's an ideal way to structure your life?

Elisa Sacal: Yeah, I will say for sleep schedule, uh, for morning LS and nine to five sleep time will be okay. They can be on the 5:00 AM club. Not everyone should be in, and I have a ton of patients that want to be at. The [00:39:00] 5:00 AM seven, wake up at five and meditate and do a lot of things before their children wake up.

And if you're not a morning chronotype, you are gonna just, um, mess with your sleep biologic with your biological clock. So nine to five for morning larynx, and I will say 11 to 12. Till seven, 8:00 AM four night owls. And then for e intermediate, anywhere between 10 and 11 and six or 7:00 AM to wake up.

And for morning persons, it's okay to have a meeting at mornings, probably 9, 8, 9 am And for night owls, it's better for, uh, for them to take decisions and do their creativity work at evenings. 

Dr. Brighten: Hmm. Okay. And then the intermediates, do they get more flexibility in terms of like, 

Elisa Sacal: yes. Yes, they do. Yeah. They can do it anywhere in between.

They just follow the sun. And then we also have Michael Brios, um, [00:40:00] chronotype idea. He's a sleep expert and he matches with animals, the animal energy. So lions are the morning types. Bears are like intermediate. They follow the sun. And then we have. Wolves, which are the night owls, and he adds an extra one, which is a dolphin.

And he, the dolphin, uh, it's a light sleeper and they tend to get more insomnia. 

Dr. Brighten: Mm-hmm. The dolphin. So you and I were talking, um, I think this was, uh, last week off camera. Uh, and you were, the dolphin's pretty controversial. I know. Why is it controversial? Uh, 

Elisa Sacal: I'm not sure if it's the way they're wired or it's their habits, their sleep hygiene.

So, um, I feel like sometimes I'm a dolphin because I'm aware every, all, all night, I'm. I'm alert, but I feel like it's because our HBA access is more activated. We are moms. We might skip, [00:41:00] uh, routines and things like that, and that might exacerbate our dolphin profile. 

Dr. Brighten: Yeah. Does your aura ring tell you your dolphin?

Uh. Yeah, sometimes, yeah. Mine tells me I'm a dolphin as well, but I actually, people on the internet are like, who is getting eight to 10 hours of sleep? I like to go to bed at nine or 10, and I wake up just naturally at seven, usually in my luteal phase. So my later luteal phase, I have to go to bed earlier.

I'm just naturally tired earlier. Um, which. My youngest is like a night owl. Um, he's the one, he drives me nuts 'cause I'm like, I sometimes I'm just like, we're reading stories, I fall asleep, I end up taking a nap, you want another one? And then I wake back up and he's still awake and I'm like, whatcha doing?

So, but I noticed that in my late luteal phase, I have to go to bed earlier, but I'll wake up usually like six 30. Um, and they will still work for me. So my question for you is these chronotypes, [00:42:00] you, you said like it changes with teenagers. So you said it's genetic, but does it change through your life cycle?

Yes. Okay. Say more 

Elisa Sacal: about that. You tend to go more advance early phase. I mean, you tend to go to bed early as you age. Okay. So after menopause, it's, you tend to go at 10 or nine and you become an early bird. Mm-hmm. And. It's a great idea to switch to, to change your sleep schedule and so it, that it matches an early bird.

Mm-hmm. Most of them. 

Dr. Brighten: Yeah. That's very interesting. Yeah. I always, my speculation of why that switches for me in the luteal phase is 'cause of progesterone and gaba and that I just think I have this GABA in the evening that's just like. We're just super, super calm out. And I think it also is that, um, in some ways when progesterone is right, the parasympathetic activities I engage in actually have a better effect.

Like it actually fills more [00:43:00] meaningful, uh, in terms of like, oh, I'm actually getting something out of this. Whereas I feel like other times in my cycle, you know, when estrogen is high and test, test testosterone's high that I'm doing these activities, but, but I already feel more stress resilient, so it doesn't feel like it's having that same kind of benefit for me.

Yes. 

Elisa Sacal: And I, I feel like we need to improve our melatonin secretion, especially in those stages of life. Mm-hmm. Because we tend to think, okay, what should I, uh, take and think supplements while lifestyle? It's the main, um, the specific that, that you need to put your attention on. Order to produce more of your own melatonin.

Yeah. Naturally. And melatonin is a darkness hormone, so it's really sensitive to light, especially blue light. Mm-hmm. And I feel like most of the people find really hard to stop using their cell phone. Mm-hmm. Or their, or or screens or TV or anything. And, um, we know that we need to stop at least an hour before [00:44:00] heading bedtime.

And, um, that and also change the color of the, of light. We said diming lights, but also. Red light or maybe filters, blue light filtering glasses. Mm-hmm. Screen filters in the, in the phone and curfews for digital. Or do a digital detox at least an hour before your bed. That's the main recommendation that I will do.

And I know that's the most difficult to do. Yeah. Because it feels like you need to sleep with your soul right next to you, but you don't. And it's better if you leave it in the bathroom or in another room for it not to be like, uh. Something that is distracting. 

Dr. Brighten: Yeah. We had a, a podcast guest that her plane got delayed and she asked me, um, can we just like do it tonight?

And it was, uh, she wanted to start the podcast at like 6:00 PM and as you sit in this room right now, I'm like, no, no, no, no, no. Like, I will not, my sleep will be awful. Like, I can't do that. Yeah. 

Elisa Sacal: We need to treasure our sleep. Yeah. [00:45:00] That's the best thing we can do for our health. And um, I feel like if you wake up feeling tired or you get tired often early in the, in the evening or so, we need to think about what's going on with our sleep quality and quantity because mm-hmm.

I was, I was seeing yesterday a video on Instagram, a lot of celebrities saying they were sleeping, most of them average said that they were sleeping six hours a night. Like if it was normal. And I, I feel like we need to know that, um, below seven it's gonna have some impact in our health is gonna increase our.

Chances of get, uh, a chronic disease like cardiovascular disease, diabetes, insulin resistant obesity, or things like that. So we need to have it in mind. 

Dr. Brighten: Mm-hmm. I think that's so important for you to know because there's a glorification of getting little sleep. Like, it's interesting to me because, um, I will [00:46:00] share about getting good sleep on the internet, and people will say to me, because I talk about how I'm trying to get nine to 10 hours, like I have multiple autoimmune diseases, I have endometriosis, like I need more restorative time.

And people are like, well, you're missing out on so much life. Like you're not even living your full life. I'm like, actually, I am getting so much done in the day. I am enjoying this full life because I'm not dragging cognitively. Right. I'm not exhausted. You don't catch me yawning all the time, and I'm actually functioning my body and explaining that to people and people being like, wait a minute.

Yeah, I'm just going through the motions instead of actually being present because my brain is so tired. Can we talk about what is happening when you sleep to your brain? Yes. 

Elisa Sacal: Yes. It's really important because a lot of people don't get that while you're sleep. You're actually boosting up your life, your, your awareness, your cognitive performance.

We know when, when we sleep, our brain shrinks [00:47:00] at night. At night. So our, okay. That sounds scary to people that explain why it's not bad. It shrinks a little bit. The neurons tend to be close together, so cepi spinal fluid just go through neurons and flushes out metabolic waste. Mm-hmm. That it's normal waste, be myeloid tau protein and things that accumulate and builds up only for being awake.

So without enough sleep that will accumulate and. Um, increase our chances of have brain aging and neurodegenerative diseases such as Alzheimer's, Parkinson, dementia. So it's really important. Right? And also in REM stage, which is our cognitive performance stage, the one where that is gonna help us with learning and memory and everything.

If we don't get enough sleep, our emotional balance is gonna get dis disrupted. Um, we know [00:48:00] that. We are more able to, to solve a problem three times more able to solve, solve a problem, and our reaction times as well. So, uh, a lot of time we, we tend to prevent our children to, to drive drunk, right? Yeah. Yeah.

And we, we wouldn't let them like drive drunk. Uh, that's in, in Mexico have like a chosen, um, designated driver. Yes. Yes. Designated driver. The designated driver. And we will be very proud if our child, if our kid is the designated driver. But how often do we ask them, um, how tired are, are they mm-hmm. Or ourselves?

When we are at the wheel, it's very important because we know after 17 hours awake, our cognitive performance will drop down and we will be, um, we will have. 50% less reaction time. So the chances of having a car accident increases after 19 hours or so, [00:49:00] four, four to five times. And after 24 hours a week, it will increase by 11 times.

Wow. So we should pay attention to that and. I think that our best tool for cognitive per performance is sleep 

Dr. Brighten: in the United States. Uh, they do daylight savings and they like to take away sleep from people. I am like, I am seriously the iest person on the internet about this. 'cause I'm like, I know. Stop doing this.

Stopped like a couple of 

Elisa Sacal: years ago 

Dr. Brighten: here. Yeah. Yeah. In Mexico they stopped. A lot of places they're stopping because they're like, not only is it bad for productivity, so Right. The government's like, bottom line, the money, this is a problem. Right? But it's so bad for your health. And we see that car accidents, spike, heart attacks, spike, like the first day back.

Suicide. Suicide. Like so many problems. And I think that this is a non-consensual experiment that is being done right year after year after year, that we've got the data and the evidence that anyone listening, like revolt, like just [00:50:00] revolt. And it's something that like, you know, with, um, with us, like we have people in our company that work all over the world, and when the time zones are switching, like I.

Don't live in places that switch the time zone. And I'm just like, stay what you're doing. Keep doing what you're doing. And uh, you know, we work it out. 'cause I'm like, there's no reason for you to like go losing an hour of sleep. I know. And I know. That's why I like to talk 

Elisa Sacal: also about, uh, social jet. Social jet lag.

Mm. Because social jet lag can be detrimental to our health because sometimes you might lose an hour. Yeah. Every week. So 

Dr. Brighten: that is what, lemme just say that's life in Mexico. Like, I know I have finally got my friend circle to stop making dinner reservations at nine. I know. And I'm like, can you move it up to eight?

I understood when I made dinner reservations at six for everybody. We were all trying to meet, but then we were all stuck in traffic for 90 minutes. I was like, I know. Oh, this is why, this is why it's later. But it is something, um, I, I lived in Spain for a bit and I could not, I was like, I cannot permanently live here [00:51:00] because this entire start your night at 10:00 PM 10.

Look, I can't do it. I 

Elisa Sacal: know the social jet lag is like this misaligning between our biological clock and the social clock. Mm-hmm. And we tend to go to sleep, let's say to wake up at 6:00 AM on weekday. On weekdays, and then to wake up at nine on weekends. And that difference is like if you are having jet lag, if you are traveling different time zones within the same city every week.

So that. Brings us inflammation that will lead us to a lot of sleep problems. And that's why also it's very difficult for us to go to sleep on Sundays. Mm-hmm. Because, you know, you have to go to sleep again early and then on Monday you couldn't, you weren't, you, you couldn't go to sleep at the same time on Sunday, but you will wake up at the same time on Monday and that's why everyone's miserable on Mondays.

Yeah. 'cause they tend to sleep an hour less. Well, 

Dr. Brighten: I [00:52:00] think there's also revenge, bedtime, procrastination that happens where you're just like, my work is about to steal my time, so I'm gonna steal it back and like stay up and like, enjoy myself. I know I caught myself in that. A lot of patients, uh, experience that it's well documented in the research that I always say we're just perpetual toddlers.

Like you, you think that you grow out of being a toddler, but you're really a toddler for life in a lot of ways. I know, 

Elisa Sacal: especially moms, whenever you go, you, you put your kid, your children to sleep, it's like, now it's me time. 

Dr. Brighten: Yeah. No. 

Elisa Sacal: Gonna take advantage of that. Two 

Dr. Brighten: 12. Uh, so I wanna ask you though, so people, we know, community is so good for your health, right?

Like one of the, like when we look at the blue zones, we're like, it is not so much their diet. Like, look at how they live in community, look at how they move. So with that in mind, there's people who are gonna be like, no, but I wanna have a girls' night out. I I want to be able to spend time with my friends.

What do you recommend to safeguard their sleep? And kind of like, you know, it's, it's harm reduction, right? There's things that we're gonna do that are not the best idea [00:53:00] for our health, but it's part of living the full human experience. So how can we reduce the impact? 

Elisa Sacal: Yeah, I was a. I, I like to use blue light filtering glasses and put in my car.

Whenever I'm going back from a dinner with friends, I will put them on so I can start my melatonin production. And it doesn't take me a while to fall asleep. I will not eat, I will not drink, um, for at least. An hour or two before bed. I think those are good tips. 

Dr. Brighten: I have to say. There's this, um, trick I have done my entire life, which is I order soda, water, and a lime and I'll ask for a salt land rim.

Mm-hmm. And then in Mexico it's ro everybody who's drinking that, I can't be as, um, as tricky but in the US so I would be out. Um, you know, there's sometimes conferences and parties and people are drinking and people, because if you don't drink, everyone's like, why are you not drinking uhhuh? Like, it's such a thing.

And so I would order that and people would think I was drinking a margarita all the time. I was like, I'm just drinking's a good idea. Water. [00:54:00] Yeah. And then here in Mexico is like this normal thing. So I'm like, well, people know what I'm up to here. Like, they're well aware, but I think, um, the hydrating is super important.

I love that. I love your, your tip of blue light blocking glasses. Sometimes I will just wear those if I am out at dinner with people, because I'm one of those people that when I leave the social interaction, I know I have like an hour of wind down when I get home. Like I have a hard time. So I'm like, if I can just wear those blue light blocking glasses, um, that can Yeah.

Elisa Sacal: It's a better idea than screen time. I feel like a lot of people Yeah. To wind down help, they think they're, they are helping themselves with the screen or with social media, and that will probably activate you more. Mm-hmm. It will increase your cortisol levels, so it's not a good idea. I know you feel like, like you're winding down and you're.

At least directing your thoughts, but it's not a great idea, biologically speaking. That's why reading is a better idea than that. Yeah. Or you're listening to a podcast. 

Dr. Brighten: Yeah. And [00:55:00] we, it's interesting the research showing that people who read before bed actually have better HPA access, so stress system response, and they have lower cortisol levels.

So it's that, that two for one, um, right there. And like I said, I fall asleep all the time when I'm reading. It's like my go to. I know. And the other thing that I do, like if I'm going out at night is I will actually, so I have an adrenal calm supplement, which has things that are like L-theanine, pro GABA supplements.

I love it. So not g. Self, but things that actually help with your own GABA generation and utilization. And that I will take, like, you know, it's the end of dinner, dessert is coming. I will take that. I would take that as well. Yeah. And so it just starts priming my body because again, I'm just like, once I end a social interaction, I feel like my default mode network in my brain is like, we have so much to process now.

And I'm like, we do. And I just go to sleep. I 

Elisa Sacal: know. Go 

Dr. Brighten: to sleep. 

Elisa Sacal: I sometimes use a, a sleep aid as a supplement. Mm-hmm. Or a her as well. I love [00:56:00] L-theanine. Um, a lot of people tend to think that melatonin is a good idea. I don't think for, for this is, uh, a good example because melatonin is a hormone. Mm-hmm.

And it tends to interact with other hormones in our systems. And it is actually a corbi, it won't help you stay asleep, it just gonna cure your. Your brain into sleep mode. But Lthe Nin is gonna increase. GABA is gonna act as an anxiolytic. I love to take 200, 400 mil milligrams of L-theanine. Some adapt adaptogens might help us also with this HPA axis regulation.

Um, I love ashwaganda, like reishi, um, and a mixture of, of things is a good idea. I like cha milk. Mm-hmm. Cha milk tea. But yeah, I see what you mean. And I, I need as well, something that cues my brain into. This rest mode. 

Dr. Brighten: Yeah. Well I appreciate you saying that about melatonin. 'cause I think people go to that first and it's something [00:57:00] that I'm, especially with women who are postpartum, they are in perimenopause or where they're having luteal face sleep problems.

I'm like, it's a GABA problem if you, you can fall asleep but you don't stay asleep, that's most women's problem. And so it's like you take melatonin, sure, that's gonna get you to sleep, but that won't sustain you through sleep. And so what you were saying, L-theanine, I also like passion flower, uh, for that as well.

I'm a big fat passion flower flatten, uh, holy basil. Holy basil is a great one too. 

Elisa Sacal: And brine root. I think for gaba, the best idea in, in perimenopause is progesterone. If it's indicated, I think that nothing is gonna beat that. And what I'm afraid most is people using more melatonin gummies for kids. Oh yeah.

That has increased a ton. We know that. Um, poison Control has received over 500% more calls regarding ingestion of melatonin, and there's research from last year, 2024 that [00:58:00] said that melatonin gummies, 88% of them are not, uh, adequately, um, labeled. Yeah. So they tend to have three times more than it used to, especially gummies.

And some of them even have C, BD without saying that clearly. Mm-hmm. On the label. So it's really important to take, um, this, take caution of that, especially in kids we know it will interact with, with their hormones. It might delay puberty. And there's no chronic studies, especially in children with melatonin.

Not especially not with that amount. We know our brain tends to. To release about 0.0, 0.1 to 0.3 milligrams of melatonin and this, um, um. Preparations tend to have between three to even 10. So it's 10 30 times more than mm-hmm. Our phys physiological dose. Yeah. We take caution of, of [00:59:00] that. 

Dr. Brighten: I appreciate you giving caution around that.

So I, I have a supplement company and we do a lot of manufacturing. Gummies are really hot. Everybody loves gummies, except all my dental friends are like, please don't do gummies so bad, so bad for your teeth. Um, and I've, I've considered certain things though, like people were like, oh, how about a prenatal?

Mm-hmm. When you look into it, so two things people need to know, they're incredibly unstable. Mm-hmm. That means the nutrients that are in there, the second they go in, they're degrading rapidly. Hmm. So because of that, you have to put more that is, you have to put more ingredients in there. So if you're, let's say you're using like B12, you're gonna put way more B12 in there.

Which is like fine, right? You pee that one out. Yeah, we don't worry about that one. But what the label says is what you're trying to catch with the degradation, the actual breakdown of it. So it's the same with melatonin. They're overshooting it because they're like, well, once it sits on the shelf for two years, it's de it's gonna be at that level.

Like that's where it's gonna be on. And so one [01:00:00] you're getting, oftentimes you don't know what you're getting when you take a gummy. It's very, it's because it's so unstable and the way manufacturing practices are sometimes it's way more sometimes and prenatal way less folate. No, I'm like, no, no, no. We would never, I would never mess with that.

So I think that that you're right to caution people about melatonin gummies. And I think especially when it comes to children and it's a common. You know, it's, it's one of those things where like a lot of parents would be like, oh, my kid's gonna fly, so I will give them Benadryl. Okay, that's not great.

Right. And so they were like, okay, doctors now say, don't use that. I'm gonna switch over to melatonin and a gummy. Of course the kid's gonna love a gummy, but there's actually liquids out there that are standardized that are third party tested that will work well. So if you do, if you are someone listening to this that you're like, okay, but what if like, it's just like an overnight flight or things like that.

Yeah. Just like is fine. 

Elisa Sacal: Yeah. But we, we need to go to microdosing of, of the, of melatonin. Mm-hmm. Especially in kids. I will never [01:01:00] go up over 0.5 or maybe one milligram even for adult. For adults. I feel like that's a better idea for the brain to actually speak his language with. Regarding of hormones, and before thinking about these kind of supplements, I think we need to rule out nutrition deficiencies, which are, um, everywhere nowadays, especially iron, for example.

For, for menstruating women, it's very important to rule out iron deficiency, ferritin, low levels of ferritin because it's sas, uh, associated with restless, restless leg syndrome. So it's pretty simple to, to. To level back and it's really impactful on sleep. Also, V vitamins really important. Uh, D three, vitamin D important to check out and ho hormone levels.

I feel like we need to check hormone levels, thyroid, progesterone, and check [01:02:00] that will actually impact sleep. 

Dr. Brighten: Yeah, so we have talked about chronotypes, sleep hygiene, nutrient deficiencies, hormones. If someone's having trouble sleeping and they're like, okay, listen, I'm doing all the sleep hygiene. It's still not working.

What other things should they investigate? 

Elisa Sacal: I think they, uh, besides hormone, they need to check glucose. Uh, balance. It's really important to check A1C hemoglobin A1C. Insulin, basic insulin, fasting insulin to check if they're on the right levels and they can jump into supplements. I feel like it's a better idea to start with supplements and sleep hygiene before heading to, to to sleep medication so you can start magnesium.

Most of the people, 50% of the people are depleted in magnesium. Magnesium or at least are not sufficient. Uh, magnesium is a mineral implicated in a ton of functions in for the [01:03:00] body and for cell health. Um, the thing with magnesium is you need to find the right kind of it. Mm-hmm. At least in Mexico it's not that easy.

We know that most of the forms of magnesium won't get absorbed, so glycinate ate, which is difficult to, to to have. Um, but glycinate is a good idea. Crate, if you are having some, uh, constipation problems might help too. 

Dr. Brighten: Yeah, I think that's important to know that not all magnesiums are created equal. Um, and then I, I'm wondering like at what point with your patients do you consider like doing a sleep study, investigating sleep apnea?

Yeah, if, 

Elisa Sacal: if you've done everything related to sleep hygiene, which we have talked, but environmentally speaking, your sleep environment is good. You did your wind down routine. You stop eating two or three hours before bed. You are exercising at morning and you're taking care of light and everything, and you [01:04:00] still waking up more than three times a week for more than three months.

You, you probably have insomnia and it's a good idea to check with, uh, nighttime. Poly ethnography if you're having any other problem, because sometimes it might be, uh, obstructive sleep apnea or rest leg syndrome, which in a, uh, nighttime polysomnography might, um, uh, came, come out. Mm-hmm. 

Dr. Brighten: I wanna talk about the specific sleep phases because you've mentioned REM sleep, but we didn't talk about, uh, you know, slow wave.

And I think these terms get thrown around a lot. So if you could just break us down, break that down for us and like what is ideal? 

Elisa Sacal: Right. So we don't have like a passive state. We have different states on our sleep architecture, and we have two main stages, non-REM sleep and REM sleep in non-REM sleep, which is a, the part of, uh, our body of our sleep that [01:05:00] will, uh, help tissue repair, hormone balance and everything.

It's divided itself in three and one, which is like a light, uh, stage of sleep. Of sleep is a transitional stage actually, and you will easily be waking up. Then we go into N two, which is light sleep. And most of our cycles, most of our nights, we tend to go into N two sleep. And this is where our heart rate breathing, uh, uh, blood pressure will start to drop.

And here we're gonna have sleep spindles, K complexes, which is, which are important for memory, um, processing. And also they will help us, uh, they will prevent us to wake up, uh, from external stimuli. Then we have end three and three in non rem. It's, it's where our deep sleep is gonna. It's gonna be, and we are gonna have delta waves.

And [01:06:00] here is where our growth hormone will spike. And it's really important for kids to grow, but for, for adults to, for muscle repair mm-hmm. We are gonna have our hormones reset. We're gonna have our immune system also reset and, and it's like, uh, housekeeping for, for our brain especially, and cognitive performance.

Um, this is gonna represent around fif 15 to 20% of our night. And it tends to be, uh, more at the beginning, the first part of the night, then we're having REM sleep. REM sleep is our rapid eye movement. We're gonna be paralyzed in the body except for the diaphragm eye muscles. Uh, we tend to have our dreams here.

80% of our most vivid dreams is gonna happen here. We are gonna have, um. Emotional balance, we are gonna keep our memories. Um, and learning, it's really important. [01:07:00] It's often, it's often called paradoxical, sleepy because our brain is as, as active as if we are awake. Mm-hmm. Almost. Mm-hmm. And, um, yeah, it's really important.

It tends to, we, we tend to have 15 to 20 minutes at the beginning of the night, and it gradually increases throughout the night. So by the last part of our night. We are having more REM sleep. That's, that's why we remember most of our dreams if we wake up in rem. 

Dr. Brighten: Mm-hmm. And why is REM sleep so important?

'cause you're like, the brain is really active and I think people often think like, no, but sleep is when our brain is supposed to like power down and it's supposed to get cleaned out. And but why is REM sleep so important for us? Especially 

Elisa Sacal: for, for cognitive performance, for learning, for memory, for attention, for emotional wellbeing.

It's like some say that it's like therapy for us because we tend to edit our, I love that you need therapy every night. I know. It's like, that's why they say sleep on it [01:08:00] because you tend to go to sleep and reframe things and see things other, yeah. In other perspective, 

Dr. Brighten: I actually never knew why they said sleep on it.

I thought they was like, just take some space from it. But like that makes. Sense. Uh, so there are women listening to this right now, and they're like, yes, everyone and their mother and their brother on the internet is like, women need to gain muscle, build muscle, do this like strength training. But sleep is so important for that.

So how can women get into that phase of sleep to help them build their muscle? 

Elisa Sacal: Okay. I, I always say that we have three things. We need three things to build muscle. First we need enough protein. I know we need protein to, from our diet, clean protein enough, and then we need to do some weights. We need to, to challenge our muscles to, for it in order to it to build, for it to build up.

And then we need to sleep and we need enough and three phase. So if that's the first part of your, of your night, the best [01:09:00] thing you can do is go to sleep early. Mm-hmm. Early for your chronotype. But when you tend to go, um, later to sleep, you cap that. Specific phase when you're building up your muscle.

Dr. Brighten: Okay. And to review the chronotypes to make sure I got this right. So if you are the morning person, nine to 10 is when you need to get to bed. If you are the intermediate, you're following more the sun. So 10 to 11. Okay. And then if you're the night owl, that might be more like 11 to 12. Uh, 

Elisa Sacal: yeah. I wouldn't go over 12 because mm-hmm.

We're, um, diurnal animals and our circadian rhythm will dictate that we need to sleep before 12 in order to have enough melatonin. That's the best time to have, uh, high melatonin, uh, in our brains. And, um. Yeah. So before midnight. 

Dr. Brighten: Before midnight. Yeah. Well I like that anyways. 'cause it's like you wanna get to bed before the next day.

Exactly. Like you should, you should be sleeping hopefully at the end of that day. Yeah. And 

Elisa Sacal: I will put attention [01:10:00] on waking up at the same time every time because regularity is key to sleep and it's key to sleep hygiene that will, uh, help us set our circadian clock and, uh. Yeah, you keep it in place.

Mm-hmm. 

Dr. Brighten: So we, you really highlighted the short term consequences of not sleeping. So less reaction time, uh, you know, more car accidents, mood swings. Mood swings. Yes. I think about that with like, oh, if you have teenagers right now, check their sleep if they're, if their moods are swinging. Yes. Um, but we don't, I mean, as, as women, if we don't get a, I think we've all been postpartum, um, in that phase, uh, and recognized ourselves in that, like for the bombs we all have been.

Um, and then for others, you know, there's always been that like one night you stayed up too late and, and you feel that you're more emotionally vulnerable. And I think in a lot of ways we, we sometimes pathologize that, right? And we're like, you're just being too sensitive. But if you consider that your brain [01:11:00] is running at a lower capacity.

It is more vulnerable, right? Your reaction to is 

Elisa Sacal: reduce actually your, your serial, your amygdala. Is it called like Yeah, amygdala? Yeah. So your amygdala amplifies everything. It says that, it said that 60% of the activity of the amygdala is gonna be amplified once you are not getting enough sleep. So you're gonna take everything personal, you're gonna see everything, uh, through a, a gray, um.

Like a, a great answer. So, so it's really important to not take that serious, uh, things after a bad night of sleep. Mm-hmm. You're less capable of, of solving a problem. You're, um, you're not a, a good team member, you know, when you don't have your best sleep. 

Dr. Brighten: Yeah. And so that was going to be my question is like, what is the long term impact here of, you know, so we're not talking about like, you know, three months of a newborn baby not getting good sleep, but what happens when it is just [01:12:00] month after month and there's no end to it?

The 

Elisa Sacal: thing is when we don't get enough sleep, we tend to, um, activate our, our alert mode. And for a couple of weeks it is okay. It is actually helpful to turn on our alert mode, our fight or flight, uh, system. But if you keep doing it, it will start to burn out Our systems, our organs. So for the heart, for example, you tend to, to keep your blood pressure up, you won't have that deep that we need at night.

So it will increase your chances of having high blood, high blood pressure for your liver. It is okay to. To release more glucose for a couple of weeks if you need it, if you haven't slept well. But as in long term, you're gonna be more prone to have insulin resistance, to have pre-diabetic diabetes or diabetes as well as cardiovascular disease and neurodegenerative diseases like Alzheimer's, dementia, [01:13:00] obesity, um, dyslipidemia.

I mean, every chronic disease is gonna, you're like, if you don't want it, that's what you're 

Dr. Brighten: gonna get, right? Yes. And for people listening to dyslipidemia, that's cholesterol levels that are unfavorable and not compatible with flake live long and prosper mon mantra there. Right. Um, I just think it's important for people to hear because, um, it's not often that people are choosing not, so, okay.

Two things. People don't often choose not to get. Mm-hmm. Uh, good sleep. There are two things that happen. One is physiologically something is going on that's disrupting it, or socially there's this pressure of mm-hmm. You like sleep when you're dead. Right. Hustle, culture, go, go, go. Yeah. These misconceptions are, yeah.

Yeah. And I think it's something that like, I think this is the most unfair thing of being a human is all the decisions we make in our twenties have the impact for our forties, fifties, sixties, and beyond. Right. So we think about like bone [01:14:00] consolidation and building your muscle mass like that gets talked about a lot.

Mm-hmm. But brain health and cognitive outcomes and the way that we slept or didn't sleep in those decades of life. Can have a major impact. So with all that said, and it sounds really scary, what can people do right now? So we've talked about the sleep stuff, but if they're like, I wanna prevent that, I wanna keep my brain healthy, what can they be doing right now?

Right. Because there's, we're plastic. We are, I know, always able to undo Yes. What we did in 

Elisa Sacal: our, our youth to a degree. I know the best time to set our sleep habits is now, whenever you're listening to this, because we can always improve. It's like a sport that you just sign in, you need to, uh, train for it and you need to perfection it.

And, uh, there's many things we can do. Sleep hygiene will be the first things. Uh, sleep regularity is very important to set your schedule to leave lights off, to actually to, to do your morning routine because [01:15:00] sometimes sleep night in, I mean, sleep. Starts with night, with morning routines. Yeah. Yeah. Wake up and expose yourself to light natural, light external.

Preferably, uh, the first hour or so. It's a good idea. That's why if you exercise at morning, you just hit in Spanish. We, we will say to hit two birds at once. Mm-hmm. That, yeah. Two bruise with 

Dr. Brighten: one stone. Yeah. 

Elisa Sacal: That one. So, uh, yeah. We'll do exercise and you expose yourself to, to light at morning. Set your circadian clock and uh, stop stimulants.

Caffeine is really important. It's the most consumed, uh, stimulant globally. So 80% of the people so consume it. And the thing with caffeine is. Most people tend to use it too late. 

Dr. Brighten: Okay, because that's gonna be a question. Are you a caffeine hater or is it just a too late problem? 

Elisa Sacal: I do love my coffee. I need to confess that I am not a, uh, a coffee person.

I'm a slow [01:16:00] metabolizer. Oh, actually, I did my genetic testing and I know I'm a slow metabolizer from years and from my sibling as well because we know that if we drink coffee, I will get anxiety and palpitations. And so I like the taste of it, but I don't consume it. The thing is, if we use it to, um, too late, it will affect our sleep quality.

Even if it doesn't prevent you to fall asleep and you could fall asleep. Uh, the first hours are gonna be, uh, driven by, by that small amount of caffeine. It might, uh, alter sleep architecture, and, um. And the deepness of of sleep. 

Dr. Brighten: So wait, that makes me connect that if we are consuming caffeine too late in the day, which is for a lot of people after 12:00 PM but we know definitely 3:00 PM is like bad news.

Elisa Sacal: A lot of, a lot of people take their coffee after after lunch, which in Mexico it's at 3:00 PM Yeah. So [01:17:00] they tend to have their last coffee at three or four. And I think it is too late for your sleep. 

Dr. Brighten: Absolutely. But you just said it's gonna negatively impact deep sleep, which is the exact sleep we were talking about for repairing your muscle.

So building muscle for helping, you know, your brain do it's detoxification like ever. All of these benefits of deep sleep, I'm like, I just realized that I wanna underscore for everybody. Your coffee too late in the day may prevent you from building your muscle mass. Yes. 

Elisa Sacal: Because it's wild. Also, we've talked a lot about circadian rhythm, which is like, um, part of the two processes that regulates sleep.

We have two processes, process C, which is circadian clock and circadian rhythm. And we know it's genetically the germanin and we need light and everything that we've talked about. But we have process s, which is like the homeostatic drive, the hemostatic system, and it's ruled by, um, adenosine, which is like a product of a TP degradate degradation and caffeine.

Then, uh, [01:18:00] when we wake up, we have, we start going throughout day and at the adenosine accumulates. Mm-hmm. So it will help us feel sleepy and when we go to sleep, that ene is gonna be washed out. We are gonna reset that caffeine. It is actually an antagonist of this, uh, adenosine. It will sit on the same receptors of the adenosine.

So it's had it's halflife, it's gonna be six between six to eight hours or so. And that means that if you take a cup of coffee at 4:00 PM by 10:00 PM you might have half of that caffeine, which is like 50 milligrams or so, and that could be enough to pull you out of that. Or prevent that you go into that deep sleep that we need to be, to feel repaired at least physically.

Dr. Brighten: Mm-hmm. That adenosine sleep pressure, so that's what it's called. It gets built up, but there's a big problem when we miss the window of when [01:19:00] adenosine builds up and it's like, go to bed. Talk to us about what happens when you ignore that signal. Yeah. 

Elisa Sacal: The thing is, if you ignore that, that signal, or you took coffee, actually it won.

Make you feel energized. The only thing is that you won't feel that tiredness. Mm-hmm. So when that caffeine washes out, uh, your atten is gonna come back like a tsunami helping you feel tired and you're gonna crash. And it's not the best way to fall asleep in, in that state. It's, it's better to. Transition softly.

So you might, you need to have your processing and your process as coordinated and as long as they, uh, fall into the same path, you're gonna have the best sleep quality you that you can. So you need to pair your chronotype with your adenosine, with your sleep drive, and find your best time to fall asleep.

Mm-hmm. 

Dr. Brighten: So, you know, the other thing, I think that, um, we, if you have toddlers, you've seen the second wind. Come on, right? Mm-hmm. [01:20:00] They're tired. They're tired. They're tired. Um, some of us have mistakenly been like, maybe if they skip their nap, they'll get better sleep. It doesn't happen that way. No. Explain why that second wind, like what is happening with the second wind.

Right. And why is it so hard for people to get sleep? Right. I, 

Elisa Sacal: I love to say with kids, that's sleepy. Sleepy gets sleep. Mm-hmm. Because once you miss that sleep window, cortisol is gonna spike and it's gonna kick in just to help them feel like they can go through that time that they're awake and they're not supposed to.

So if you miss that window with them or with you. Which is actually about, around for adults, 12 to 16 hours. If you pass that time, it will pro, you will probably activate your alarm system, which is gonna kick in with a, with cortisol, you're gonna, uh, release more glucose That will make you feel alert. So you can go through that couple of hours or, or so, but.

If you [01:21:00] go to sleep, actually at that time, you're gonna be, your sleep is gonna be driven by, by cortisol, which is gonna, uh, make, uh, your sleep more superficial and you are gonna have more fragmented sleep. You are gonna wake up and it might be difficult to fall back asleep. And to, to pair that cycles that we need in order to have good sleep quality and the whole eight hours with, um, with, with good, uh, hygiene, for example.

Dr. Brighten: Mm-hmm. And how long does it take to recover? Like if you have a bad night of sleep, how long is it taking the body to recover from that? 

Elisa Sacal: I feel like everyone's different and it might take a couple of days, but if you add, uh, alcohol, you add substances and things like that, it is gonna be more, it is gonna be difficult for your liver to flush at out everything.

Um, some might say that for every hour that you lose sleep or you go late [01:22:00] to sleep, it might take a couple of days, two days to recover from that hour of sleep. So do the, do the math. If you go to sleep three hours late, you need six days to re, to repair for that. But I think that everyone's diff different and you need like to build that sleep resiliency or sleep fitness in order to, to be capable to have, uh, a sleep night, a late sleep.

Night. Uh, every once in a while 

Dr. Brighten: there has been research saying that like, once you lose sleep, like you can't get it back. And also that you can't bank sleep. So you can't be like, oh, I'm not going to, you know, I know I have this like, bad flight scheduled and it's just the way it is. So I'm gonna sleep 10 hours tonight and I'll sleep six hours tomorrow.

Elisa Sacal: Yeah. I feel like we don't have like a bank account of, uh, of sleep, but you do have resiliency. Your heart rate vari variability for example, can tell you how resilient you are to these late [01:23:00] nights. And yes, you will have cell damage and inflammation for not going to sleep at this at the time you need to, but I feel like that is done, that damage is done regarding cells.

But, uh, regarding HPA axis and autonomous, uh uh. SNA, um, a NS, I'm sorry. Mm-hmm. What's, uh, autonomic nervous system. Yeah. Autonomic nervous system. You can build that resilience, especially if you know how to hack your VA nerve and to activate it more often. I think that will help a little bit with, uh, sleep deprivation.

Dr. Brighten: Now everybody wants to know how can you hack your vagus nerve? 

Elisa Sacal: I know, uh, vagus nerve. We know we, we can sort of train our baggage nerve into activate being activated more often. We used to think that it was completely, uh, uh, like autonomous, independent, but we can actually [01:24:00] drive, drive it towards, um, activating more often.

So we can gargle, for example, because the bag nerve will go through our throats and we can gargle, we can sing, we can say, um, mantras for example, for, for activating it. And we can, uh, at mornings we can use cold water in our face. We can, uh. Yeah. You know what I'm Oh, yeah. Talking about, okay. Yeah. I wouldn't do the whole cold plunge at mornings because I hate it.

But we can do our, our face. Um, what else? We can do a, a mustache every once in a while. Um, I, I love gargles because you just brush your teeth and gargle fall, uh, two minutes or three minutes or so, everything walk barefoot for 10 or 15 minutes at a every day. Mm-hmm. We know it's more important for everything, uh, to do it.

Um. How do you say, um, consistently? Mm-hmm. Than, [01:25:00] than a ton of time. 

Dr. Brighten: Yeah. Yeah. So consistency beats like the amount of time that you're doing. Yes. That's what I meant. I was gonna ask you, so can one bad night of sleep kind of throw your hormones off for days? Can, you've talked a bit about the HP axis, but I think for women listening they would like to know like, how does this affect my ovarian hormones and maybe even thyroid as well?

'cause we know that can be connected. 

Elisa Sacal: Yes. I know thyroid, um, can be affected because we need to convert T four, which is the inactive form two T three. And when we are stressed, which means that you didn't sleep, for example, when we, we are stressed, we. Um, we're gonna alter that conversion from T four to T three, and we might feel a lot of symptoms.

I don't know if it, if it will be, uh, for one night, but chronically, it definitely will alter thyroid hormones. It might [01:26:00] alter all hormones by, by one night, but we have some hormone resiliency. But chronically, you're gonna de deplete our sex hormones because cortisol is gonna steal everything the same. Um, how would you say the, the, like in Spanish is Ria prima, like the, the precursor, the metabolite, yeah.

That, not precursor, but the, the material that you use to build hormones. Mm-hmm. Cortisol, which is cholesterol, is gonna drive everything to, to do cortisol. Because if you're telling your system, then you need to be in fight or flight. That's a priority. And cortisol, it's above, uh, sex hormones really. Um, talking about.

Um, priorities and survival. So if you, um, favor cortisol that will deplete estrogen, progesterone, testosterone mm-hmm. And also the HEA, right? Yeah. So yeah, we, we, we can check cor cortisol at [01:27:00] EAM or do a, um, a curve mm-hmm. Salivary cortisol curve to check how is that still going on and if the, if cortisol is, um, stealing everything from this mat material that we need to build sex hormone.

Dr. Brighten: Yeah. And earlier in this conversation you also pointed out insulin as well. So we wanna remind people of that, that you talked about cortisol, we talked about insulin sex hormones. So estrogen, progesterone, certainly testosterone can be affected, you said DHEA, which is coming from the adrenal gland. So, uh, the takeaway is no hormone is untouched by poor sleep.

So I wanna ask you, some people have said that poor sleep is silently aging the brain as fast as smoking is. Why would people say that? Do you believe there's truth to that? I think 

Elisa Sacal: it's truth. Uh, oxidative stress that accumulates after a night of, of being awake, it could damage our cells. It will liberate more [01:28:00] radicals.

Oh, free radicals. Free radicals, yes. Thank you. So we will have more free radicals, um, attaching to our tissues and aging them. Also, we know that over hun, over 700 genes are being or not being activated at night. And those are genes that tend to, um, increase inflammation, chronic disease, oxidative uh, stress.

So also for longevity, it's not only brain aging and tissue aging, but for longevity, it's really important to keep those seven to nine hours of good sleep. 

Dr. Brighten: Yeah. Well, thank you so much for this conversation. This has been fantastic. You've given us so many practical tools, so I really appreciate you sharing your expertise and having the uncomfortable conversation People don't wanna hear is that you need to 

Elisa Sacal: go to bed.

I know. Thank you. Thank you so much for inviting me, having me here. I love to share this, this information. 

 

Dr. Brighten: Thank you so much for joining the [01:29:00] conversation. If you could like, subscribe or leave a review, it helps me so much in getting this information out to everyone who needs it. If you enjoyed this conversation, then I definitely want you to check out this.