Transcription
Okay, let's talk about substances that affect sleep. This is another one. I mean, a lot of people, we'll get into CBD because that's like the biggest thing now that I mean, I just hear it in peer groups. I hear it on the internet. I hear it in just everywhere in the audience.
Um, but kind of even a step ahead of that, you know, was was marijuana, right? Like, which has CBD and THC, right? They're two separate separate compounds, right? And so I kind of want to start maybe with THC. Yeah. Like if someone's doing the whole.
Yeah, THC is a good place to start because THC seems to have pretty reliable effects on sleep. Surprises nobody who's used it when I say that, but it can help you fall asleep, can help you stay asleep, can help you feel more refreshed. THC does. However, there's three downsides of THC. Um, four if you're an athlete. Uh, one is that the sleep-promoting effects fade over time. So often it works great for a for a period of maybe a few weeks but then you'll notice that it stops working in the same way and so people start escalating doses for that reason. And so maybe you know, I may it's short-term benefits and long-term benefits are different. That's number one.
Number two, in a lot of people, that doesn't seem to be everybody, but in a lot of people can be a very potent REM sleep suppressor. Um, a lot of people don't realize that anti-depressants also, um, most anti-depressants are potent REM suppressors. Like you can all you can knock out 50 to 75% of all your REM sleep of the night by taking like a Lexapro or an SSRI, um, or THC.
Does that affect memory? Because isn't REM important for incorporating? Weird, huh? Like why is it if REM sleep is so critically important and we'll get to this when we talk about sleep stages on wearables. If REM sleep was so critically important for what it seems to do, why is it that when when all these people who are taking anti-depressants are not falling down not being able to remember things? Don't know. Um, what it mean, my hypothesis is these processes are way more complicated than we realize. And when we see a decrease in REM sleep, what we're we're not seeing a decrease in the process itself. We're seeing a decrease in an effect of the process. And in a down like REM, what we call REM sleep as these these physiologic signals and brain wave patterns, maybe it's downstream of whatever is happening under the hood. And just because you don't hear the downstream signal anymore doesn't mean the thing wasn't still happening to some degree. But then again with depressed people if their ability to process information is fundamentally flawed and because you're and I mean this like when people are depressed they see a neutral stimulus it feels negative to them and it makes their life more miserable. Well, stop processing things emotionally then. Like, and at least at least coming to neutral and blunting is better than it's like, who knows? The answer is who knows. Is that a benefit? Is it impacting memory? Might that be part of what's going on in terms of THC's impacts on brain neurochemistry and some of the negative effects? Maybe. I don't think anyone's been able to take the time to study that pathway. So, anyway, that's the second one.
The only the third one I just did want to mention is when you stop using THC, you get just like any kind of sedating medication, you get an insomnia rebound. And with that insomnia rebound, because it was a REM suppressor, you get a REM rebound. So you can get vivid nightmares and like really unpleasant dreams and the worst insomnia you've ever had. So then you're like, I need to take this or else my insomnia comes back. When the insomnia was a withdrawal symptom. So, so like, so that.
So you could become dependent on? Well, well, psychologically, so where where it's just like you get that tolerance. So like you're taking it and you're sleeping sort of normal and then when you take it away, your insomnia ramps up, but then it'll usually fade back to baseline. It was just a reaction, but you don't know that. You think that you're using the THC to keep the bad insomnia away when really whenever you pull that band-aid off, it's going to hurt for a little bit, but then it'll be fine. And then the only other thing I was going to mention for athletes is the increased injury risks due to THC because of the amotivation and the coordination stuff that you get sometimes that like whatever your sleep problem is, if you're thinking of using THC for it, there's probably a better option that's less less harmful.
But is that if they're using the THC at night, is it is it the THC directly affecting their coordination or is it the indirect effect of REM sleep? All I know is that people who are using it more, I mean, we don't have great data on the timing of use. That would be a cool cool study to do, but it just does seem to me that there's more injuries, there's more there's the there's the daytime amotivation, there's the and and amotivation being like not just like, you know, the stoner sitting around like, I don't want to do anything all day, but if you're an athlete on the field, you need every split second to make these choices, to be paying attention, to be thinking ahead and all that stuff. And if you've got just a fraction of a piece of a cloud there, it gets in your way and and one wrong step, you know, could be twisting something, you know, like it's just just one of those things of like there's probably a better option out there. I mean, I'm just saying, but but that that's THC. So THC does have effects on sleep. They could be relatively short-term. They could produce a rebound when you stop taking it and there could be REM effects.
And but having REM effects doesn't sound like it's a good thing though. Maybe not. Is it Is it Is it the same REM effects as you get with anti-depressants? Not clear. It's it's murky. The literature is murky. You got to remember until very recently researchers were almost not even allowed to study it because it was it was a scheduled substance and you weren't it was federally illegal. So anyone who takes federal money for research and again NIH is the lifeblood of all research, you were essentially forbidden from even studying it. Now we can sort of start and and that work is being done. Canada started it because they legalized it first. So they're actually doing a lot of really great THC research up there. Um, watch the space next 10 years. I think more stuff is going to come out.
Another one that people use to help fall help themselves fall asleep is alcohol. Yeah. Right. I mean that's like.
Alcohol is probably the most used sleep drug in the world. Right. Right.
Um, so the thing about alcohol, alcohol, it would surprise nobody to tell you that alcohol can make you fall asleep faster and actually sleep a little bit deeper in the very beginning of the night. Um, but the thing about alcohol is sorry for the fact that it's not good for you for all kinds of reasons. It gets out of your system very quickly. You metabolize it relatively quickly. And so what often happens with alcohol is when the alcohol leaves your system, it creates activation, creates a rebound. So often when people are drinking to fall asleep, they fall asleep fast, but then they wake up in the middle of the night and can't can't get back to sleep. I mean, anyone who's had sort of too much to drink and fallen asleep will may have that experience where you wake up and you're and you're up and you're just like, "Gh, I don't want to be up, but you're not falling back asleep." And it's because the alcohol creates that reaction. One of the reasons it does that is as the as the alcohol molecule metabolizes and becomes acid aldehyde, it can become a neural stimulant. The acid aldehyde could become acetate which could become a neural stimulant and as the liver is processing the alcohol it can create a glutamine rebound which can be activating. So like there's all these things that can end up being activating from the alcohol a couple hours in. That's also why like it's not a it's not a great sleep aid. I mean, a glass of wine after dinner is not going to for almost everybody is not going to be that big of a deal. But if you're drinking enough where it's making you sleepy, that's how much it's going to be waking you up later probably.
Do you think um timing it earlier helps? Like if you're not? So if you do it earlier, then you're that. If if you're having wine at dinner and then you still got a few hours, the alcohol is probably out of your system by the time you get to bed. The only thing you don't want is to time it so that that the activating part of the alcohol being out of your system isn't when you're going to bed.
So like that's sort of a tricky part, too. But usually, to be honest, the amount that most people are drinking, it's really not that's not so much the issue. But what's really cool is that you can see if you drink before going to bed, um, what's great is some of the newer wearables, like they pick it up right away. You see that heart rate data, you see that that lack of recovery happening. It was still a toxin that you're processing. And I've had a number of patients come in thinking like, "Yeah, I used to, you know, I used to drink some wine before going to bed and I thought that would mellow me out." Then I looked at my wearable data and realized it made my sleep crappy. It made my sleep terrible. And so I stopped.