Fixing Sleep Disturbances & Optimizing Sleep For Combat Sports w/ Dr. Max Kerr (SSOF Ep. 9)

Dr. Max Kerr0:51

So it's a subset of dentistry called dental sleep medicine. I currently have four practices in Austin, Texas that help treat patients that have sleep-disordered breathing, and we also help diagnose and treat sleep apnea and stuff like that.

James de Lacey3:16

So how would I know then if I had sleep-disordered breathing? Would I need to go to a test, or would I be able to figure out at home?

Dr. Max Kerr3:16

So, I mean, your bed partner is going to tell you if you snore. That is an inefficient airflow from your nose to your lungs. So if you can imagine, we want a stream that is clear with no babble, no brook, no babbling brook. We want to make sure that that airflow goes straight from the nose to the lungs, and that's the most efficient airway or path of air.

Anything in the way of that will oftentimes lead to some degree of friction in the system. The problem with friction in the system is that the more kind of turbulence that's going on, the more likely it's going to pull against the walls of the airway and the more likely it's going to collapse, and that's what an apneic episode is.

So some people would say, snoring is a sleep disturbance. Waking up feeling unrefreshed, it means that you're not having efficient sleep. Waking up multiple times throughout the night means that you're having inefficient sleep. Waking up, especially at 1 a.m. and not being able to go back to sleep, means that at some point in time you kind of came off of it there a little bit, and you woke up.

And we'll get into that a little bit. And then also waking up and maybe feeling a headache or something like that, or maybe needing to take naps throughout the day, these are all signs of disease or unhealth.

And so this is who I treat, these are the people that I treat. Now, the traditional method of treating these individuals would be with a CPAP, and a CPAP is something that pressurizes the airway to prevent collapse. And what I do is I use an oral device to do that instead of a CPAP.

So how would you know if you had sleep-disordered breathing or how do you know if you're having healthy sleep? Well, ideally, if we go back to ideal, you close your eyes and within five minutes you're asleep. You wake up maybe once to go piss, and then you go back to sleep easily after you do so, and then you wake up ready to take on the day.

James de Lacey5:37

That's perfect.

Dr. Max Kerr5:37

Exactly. And then that should take anywhere from, some people say as little as six hours, some people say as much as nine hours, but anywhere from six to nine hours within that realm is probably okay. Me personally, I need to have as close to eight hours as possible. That's just kind of normal. This should follow relatively close to the sun setting and sun rising, depending on where you're living.

Now what ends up happening is people will ultimately have difficulty falling asleep, wake up multiple times throughout the night, or even wake up feeling just piss poor. And so whether it's one or all these symptoms, you can kind of dice out what could be occurring.

So if you have difficulty falling asleep, odds are that you're not in the circadian rhythm. So the circadian rhythm is something that the light, the angle of the light hits the eye. There's a retina, a subkazmic nucleus in the retina, I believe it what it is, and it judges when we should start producing melatonin from the pineal gland, I believe, or pituitary, one of those two.

And so what ends up happening is that starts getting us a little bit ready, and that gets, that's our 24-hour clock, and that tells us when we should go to sleep, and that's all judged by the rising and falling of the sun.

So if we're having trouble going to sleep, that could mean that our circadian rhythms are off. Now, if we're waking up in the middle of the night, that means that something is disturbing us. And if we can't go back to sleep, then that means something is putting us into sympathetic activation or maybe even a fight or flight response.

And so what is that thing that's causing us to have a fight or flight response in the middle of the night? Oftentimes, that's a sleep-disordered breathing situation. That means that our airway is being assaulted while we're asleep. And that's, yeah, I mean, your body's choking itself. And so when you wake up, your body's doing exactly what it should be. You wake up in the middle of the night, then all of a sudden you try to figure out what the hell was going on. You're startling, maybe your bed partner said you were snoring and you stopped breathing.

Well, you can't go back to sleep because evolutionarily, if you went back to sleep right after something started to choke you, then your gene pool is done, brother. So this is one of the things that we try to treat. We want to make sure that that airway is nice and open.

And then if you wake up feeling like [expletive], then a lot of times what's happening is something is not allowing it to be efficient within that parameter. Within some time from when you go to sleep to when you wake up, if you feel like you got to take a nap, then something went wrong the night before.

Really, I tell my patients a lot of times, it's okay to be tired throughout the day. It's okay to be worn out because you're working hard. But it's never okay to be sleepy throughout the day, unless you didn't sleep well the night before. So we want to bust our ass throughout the day. We want to do everything we need to do throughout the day, and if we need to take a nap, really we should just be able to mash through that. You need to take a nap, that means you probably didn't sleep all that well.

Are okay, but they're okay for some cognition. But really, I don't think we're designed for naps. There's not a whole lot of science out there for that.

James de Lacey9:05

That's interesting. It's an interesting take on it. Obviously napping in the sports performance world has some merit there, but interesting you say if you need to nap then there's probably some other underlying issue.

Dr. Max Kerr9:32

Yeah. If you're doing, if you want to nap because you're trying to maximize performance, I think that's fair. But if you need to nap because you can't keep your eyes open, something's wrong from the night before. That's a good call for the listeners there.

James de Lacey9:32

So then if someone's got sleep disorder breathing, what can they do about it? Is there somewhere they, I mean I'm sure at least in the States there's probably a lot of places maybe they can go to to get tested at least, or maybe there's some kind of intervention they can do?

Dr. Max Kerr9:32

Yeah, so right now man, it's so convoluted and it's a very young science. Right now, for the longest time, you had to go into a lab to have a sleep test. And this is a crazy experience. You have to sleep in the lab, somebody watching up in there. You have leads coming out of your head, you have leads all over your arms. It is not natural sleep at all.

And that has since fallen out of favor with insurance companies here in the States, which is probably a good thing because it was very expensive to pay somebody to stay up all night to watch you sleep. It's just kind of ridiculous.

So now there's some small devices that you can get. It needs to be prescribed by a physician, but they're home sleep tests. And that'll tell you how your oxygen saturation is while you're asleep, your heart rate while you're asleep, the flow, the inspiration and exhalation while you're asleep, and then also the snoring, what's going on from a snoring standpoint. So that really gives us a lot of information.

Now, not everybody's going to go to their primary care physician or anything like that to get this. And so if somebody just wanted to kind of do it at home, you can get a pulse oximeter and strap that on your finger and see how far you desat.

A young healthy man like yourself should not really drop into the 80s all that much on an oxygen saturation. Now, if you're dropping into the 70s, if you're dropping into the 60s, then something's wrong. Maybe touching the 80s, not the low 80s, maybe the high 80s is okay depending on, and then you take some subjective findings around that, like how do you feel.

But man, if your oxygen saturation ever really dips into the 70s, then the odds are that you have some degree of sleep problem, sleep disorder breathing. So I think you can do it a multitude of ways: you can get tested either traditionally through the lab, you could get tested from home with the home sleep test given to you by a physician, or you could just kind of, like I said, just do it at home with a pulse ox.

James de Lacey11:50

I didn't realize you could do that. I like that idea.

Dr. Max Kerr12:11

Yeah, I mean dude, you gotta know your own animal.

James de Lacey12:11

Say that again. What would you do if you say your oxygen saturation dropped below 80 or 70? What would you do then? Would you just go to the doctor or is that something...

Dr. Max Kerr12:11

Yeah, yeah. So, what do you do with this information, right? Whether it be from a traditional lab, from a home sleep test, or just a pulse ox that you strap to your finger.

So there's a few different ways to treat sleep disturbances, especially airway disturbances from breathing. So right now there's essentially three treatments for this.

So let's go back to what's actually going on. So there's three reasons that we know of currently, and there's probably a myriad of reasons why, but this is what science has dialed down right now: either the structure is messed up in your jaw and so the airway is compromised, so your mouth or your nose doesn't get enough flow. There's inflammation in the system. So as you know, everything with inflammation, it's going to swell. If there's any edema, then that's going to, and there's a tube that we're breathing through, and there's edema associated with it, that's going to make that tube, that diameter shrink.

Or there could be muscular fatigue. And so that tube that we breathe through is wrapped with muscle. There's muscles going everywhere. And so if that muscle, it should be fast twitch. If it turns to slow twitch, then what will end up happening is those muscles will actually kind of fail on us. And there can be a collapse in that airway, and that's what an apneic episode is or a disturbance would cause. Because then, if the airway closes, you go through the fight or flight response, heart rate goes up, you wake up, all that fun stuff.

And then we'll come back to why that could be going on. But there's a few theories up for that. But if one of these things happen, we essentially have three ways to fix it.

We can either create more room. So if it's a structural problem, I could break your jaws, fracture your upper jaw out, fracture your lower jaw, and give you more space to breathe. So this is kind of like if you have an H-back unit that can't get enough intake, well you add another intake or you make the intake bigger, right? Or you got a truck that doesn't have enough intake for the engine and the engine's overheating. So this is the same thing that's going on here. So I could, that's terribly expensive and very involved.

James de Lacey14:41

Do people do that for cosmetic reasons too?

Dr. Max Kerr14:41

Yeah, well, so I mean, once you start kind of seeing through the Matrix, what you'll see is somebody doesn't have a jaw. If they don't have a jaw, then odds are their lower jaw is too small and that tongue is being mashed back into the airway. And so if they cosmetically move that jaw forward, form follows function.

And so if somebody has a lower jaw that is not there, then they will likely have sleep apnea. Does that make sense? And so if their teeth are crowded up in the mouth, then they will likely, and they decide to do that jaw surgery, it will make them look better because it will make them more fit and give them better function. Therefore the form will look better or more aesthetically pleasing to the eye. You follow what I'm saying there?

I mean, the human wants to breed with the best human, right? We want to improve our genetic pool. And so you're always, subconsciously you're evaluating whether or not this individual is fit enough to carry on the genetic, the gene, so to speak. And so yeah, it's going to make people look better. It's going to change their dimensions and make their face look different.

So that's one way to do it. Now the second way to do it is we could do a CPAP. So a CPAP is essentially pressurized air. So it's a machine that pressurizes air and it pushes air through your nose and through your mouth, and it widens your airway in doing so. So it increases the pressure of the tube that you breathe through, like your airway, to greater than external pressure. So that way it resists any collapse. It's almost like you blew up a balloon and you stuck it in the middle of the airway, and then now all of a sudden that airway is patent.

Well, the problem with that is it's just a royal pain in the ass. I mean, I don't know if you have, you ever worked or hung out with anybody that had a CPAP?

James de Lacey16:34

Nope, thank God, no.

Dr. Max Kerr16:34

Yeah, no, exactly. I mean, not only do you not want to deal with it, you don't want your friend to have to deal with it. And so, because then you're lugging around a machine and you have to, it's like, like I said, it's a reverse vacuum. But, and you're tethered to a machine. And so you got to breathe through that.

And so what I specialize in is I move the jaw forward. So what I do is I bring the mandible, if the mandible is retruded and you imagine that the airway is back here and the mandible is retruded, then that's going to impact or put a kink in the hose. And so what I do is I move the lower jaw forward with an oral device. So I use kind of a mouthpiece, a nighttime mouthpiece that brings the lower jaw forward. And when that happens, that essentially takes that crimped hose and it widens it up.

And when we do that, we see it's about 80% effective for young healthy men that are not fat. In traditionally women that have this problem, what we run into, where we run into the problems with this, is the extent at which the body will allow us to move the jaw. So there's only so much movement I can move because of the joint. At some point in time there's just not going to be enough. And if there's a whole lot of fat and that's what's closing down the airway...

Airway, I can't move that dude. I tell patients moving fat, it's like pushing Jell-O across the table. Just ain't gonna work, dude. So what my device does is, like I said, it helps about 80% of the time. Older men, the fatter men where the tissue is just really flabby and loose, there's not a whole lot of help I can give with that. They have to usually go with the CPAP.

Now there's a new, there's a fourth intervention here, and it's kind of like a TENS unit or it's a shock therapy that you can do in your mouth. And it's called an Excite Osa and it's not painful. There's definitely, yeah, just like that. Exactly, exactly, that's exactly, I mean there's a sensation for sure, where you wear this mouthpiece and it's 20 minutes each day for six weeks.

And then that changes the muscle fiber or the tone of the muscle. Yeah. And so then all of a sudden now after six weeks that muscle fiber should have been at that point in time changed and then you can go to a maintenance dose where you're only doing it during the day, 20 minutes two times a week, which is a pretty neat deal.

There's not a whole lot of data on that one. They've been doing it in the UK for a while. I just came to the States recently though.

James de Lacey19:09

Yeah, because I've taken, they essentially taken that from the muscle or the Sports Rehab world, you know us using electro M stimulation on for example after an ACL, test stick it on your quads, doing biking or whatever it is. So yeah, it's an interesting.

Dr. Max Kerr19:31

So we're just trying to again, we're trying to make sure that that those muscles in the airway stay rigid. I like that, yeah. That's that's all. And then that way you don't have to do anything at night time. So you don't have to wear a CPAP, you don't have to wear an oral device. We're still kind of mapping the indications on that one though.

James de Lacey19:56

No, that's that's fair enough. So essentially if people have any of these issues, these are some of the solutions they could take. Some more invasive, some more...

Dr. Max Kerr19:56

Well, and I mean, if you just wanted to play around, they have some of these snore devices on Amazon. Like I've used in the past this little throwaway device called the Z Quiet, and you can see if repositioning your mandible forward actually brings better sleep or reduction in snoring or anything like that. You can see that it's a good way to test out to see if this thing is going to work.

Now ultimately, it's just, it's going to deform and it's going to be a pain in the ass, and that's why they sell it on Amazon. But if you come and find me, you know, you'll get a custom device that should last five or ten years.

James de Lacey20:50

Yep. Well my custom mouth guard's still lasting me from you, so that's all legit. But you mentioned the neck as well. So obviously, it's, I guess you could say it's common knowledge that a fat neck is probably going to, or it's going to increase your chances of sleep apnea because it's going to collapse on you. But what about a muscular neck? Is neck muscle become the problem if the neck gets too big? I mean, this could relate to certain maybe grapplers or fighters that maybe training their neck often. Could that be, could that be an issue?

Dr. Max Kerr21:16

Yeah, and I think that's a great question, and I can only, I don't see, I don't see any literature out there on this. Now neck circumference does indicate it's a predisposing factor for sleep apnea. Now that being said, the neck circumference that we're usually measuring is not like a, you know, a [expletive] wired, you know, grappler that, yeah, you know, a bull neck. You know, usually it's the truck driver. It's the guy that just doesn't, it's big in a bowling ball.

You know, I think anytime there's an affront, you know, look, muscle fibers, really they're they're going to grow everywhere, right? So if you strengthen your neck, there is going to be some impingement on the inside of the system as much as the outside of the system. So you're much more likely to see an affront on the neck or that pipe that we're trying to breathe through if there is some muscle development there.

Now that being said, these are usually the very, the healthiest of healthy individuals. Like I just from my experience alone, I know that, man, you can't be unhealthy and grapple. Like if you want to be somewhat successful, so we're going to see a reduction in in in real total inflammation or overall inflammation, probably a reduction in adipose tissue. So I'm wondering, you know, my question is will the loss in adipose tissue and the increase in rigidity because of the the actual fighting, will that offset any sort of movement of the muscle towards the the midline or towards the airway?

You know, I, you know, I don't know. I think that's an amazing question. You know, I think you, without really having to dice it up, you know, really the the neck size should not be the indicator for whether or not you have a problem. It should be subjectively how are you feeling. Does your bed partner say that you stopped breathing when you're, when do you snore a lot?

Do you wake up multiple times throughout the night? You know, like these are the things that, you know, if you got a big neck and you don't do any of that [expletive], don't [expletive] worry about it, man. Like you're, you know, go hard, keeps keep training that neck.

James de Lacey23:20

Exactly, yeah. Yeah, you've also talked about, at least through some of your Instagram stuff and previously, about nose breathing. And I know you had, I don't know if I'll call it a surgery, but that the the, what do you call that, the nose? It's called the Vivaer procedure.

Dr. Max Kerr23:47

Yeah. So, so there's there's there's a couple of things. So there's a the Cottle maneuver is actually like, like if you put your your fingers right here, dude.

James de Lacey23:47

I do that almost every night because I have one, I think I, from when I went the dog, I think I have one slightly deviated septum on this side. And if I do this when I lie down, then it just opens right up.

Dr. Max Kerr23:47

You're gonna breathe better.

Right, and so so if, apart from a deviated septum, if you do this and you can breathe better, then that's called the Cottle maneuver. And and what that does is that tells you if you are having like a nasal valve collapse. So these are our nasal valves. As you breathe in, if they close down, then you're much much less likely to be able to get the efficient, you know, change, exchange, gas exchange in your lungs.

So we are designed, human beings are designed to breathe through their nose. Patrick McKeown wrote an amazing book called Oxygen Advantage. I don't know if you got into that, James.

James de Lacey24:39

Nah.

Dr. Max Kerr24:39

Really did an amazing job. Did an amazing job with following up with Breath. Nasal breathing is is is so fundamentally important for the human organism that if we're not doing it effectively, it can really jack [expletive] up. I mean I'm talking it will produce disease like none other if we don't breathe through our nose.

And so so what I did, what I realized, and really it was just me more being a guinea pig more than anything, I went into my ENT or one of the ENTs I work with, I work with multiple of them, and I had this Vivaer procedure done. And what they did is they got an electrode and then they cauterized the inside of my nose, the outer, the outer surface of the inside of my nose, if that makes any sense, to prevent collapse. And it opened it up a little bit more, so that way I can gather more oxygen while breathing through my nose.

And it, it it has helped, it helped me breathe through my nose a little bit better. You know, I'm not, it wasn't a panacea by any means. Like if you have a deviated septum or if you have enlarged turbinates or you know if you can't breathe through your nose and they're normally stuffy, this isn't going to be the thing to do. You got to go get that thing cleaned out.

Because what we see is that individuals that that breathe through their mouth are much more likely to have a higher heart rate because the gas exchange is so fundamentally inefficient. You know, when you breathe deeply through your nose, it slows the oxygen down, it warms it up, it gets it ready for the lungs. Nitric oxide is inserted in the in in the mix there that allows for a more efficient gas exchange.

And really that's what we need more than anything, especially when we're we're driven in combat. I mean, you know, you gotta, you gotta huff and puff through your mouth for sure. But the more you can breathe through your nose, the more stable you're going to be, the smaller your mind is going to be, the less excited you're going to get.

And we'll actually see a whole lot of performance, especially when it when it comes to endurance or especially even fighting, if you're breathing through your nose. And so if there's any sort of issue within your nose, it's it's incumbent upon anybody to try to get that cleaned up. And and so this kind of leads back towards what I was speaking earlier, as you know, the three things that can impact sleep and breathing, especially through the airway. The first one I said was structure. Well, what we're seeing is

We're seeing that this lower face is gradually reducing and it's been reducing over the past thousand to five hundred to a thousand years. We believe the reason this is happening is because of the food supply. We're eating softer things, especially compared to our hunter-gatherer ancestors.

And so what's ultimately ended up happening is patients don't have, or people, humans don't have enough room for their wisdom teeth anymore. Now, sometimes to get straight teeth they're taking teeth out so they can fit all the teeth in there. And what ends up happening is as those teeth, we start losing the surface area, the volume for those teeth, that tongue just starts getting mashed back towards the airway.

And as the airway becomes compromised and the hole that we breathe through starts getting smaller and smaller and smaller, it's much more likely to collapse in on itself. And so the way we need to kind of make sure that, it's kind of like a stream. I mean, if the water doesn't run down the stream, it's never going to be open. You have to constantly and constantly remind yourself to breathe deeply through your nose to make sure that that stays open.

The less you breathe through your nose, the less likely you're going to breathe through your nose. The more you breathe through your mouth, the more likely you're going to breathe through your mouth. And so a normal position for breath is teeth slightly apart, lips lightly touching, tongue to the roof of your mouth and up towards the front of your teeth. Your tongue should be touching your front teeth slightly, and you should be breathing deeply and slowly through your nose. Slow inhale, very slow exhale.

And that's what's going to get us back into that sympathetic state, or that rest and digest state, where we can actually do the higher order processing and thinking that we need to do. The problem is when we get into that fight or flight response, driven by nose breathing or driven by quick breaths, especially mouth breathing, we'll start having really frantic thoughts.

Our heart rate's going to go up, blood pressure is going to rise. And this is just because, essentially, we're going into fight or flight response and so these are just kind of all the things that the body's supposed to do while it's trying to survive an assault to the airway.

James de Lacey29:11

Gotcha. Can you train the jaw then through, because we mentioned like soft foods, can I start eating more tough steaks every day or...?

Dr. Max Kerr29:39

Yeah, yeah. So you can train the musculature of the jaw. Now, there's not a whole lot of data out there to support that the bony structures will actually change. There's quite a few people that claim it can.

I just... well, so there's some new gum, there's some gums out there. So there's one of the fathers of some of this, individual, his first name was John, John Mew I believe his name is. He was an orthodontist who kind of chronologically followed all these individuals. And he had them chewing really hard gum, really mashing their tongue to the roof of their mouth, deep breathing through their nose.

And what ends up happening there is we start training the musculature to have the normal postures when we're breathing. And if that musculature is trained appropriately, just like if you or I were rolling, or if I'm, I'm an Olympic weightlifter, if I'm throwing a snatch, like after a while you start getting and hitting those neural connections that ultimately just happen, just like a golf swing even. Over time, that becomes normal.

And so if we constantly, if we're chewing on harder things, we're mashing our tongue to the roof of our mouth while we're breathing, we're breathing deeply through our nose, then that starts becoming the new normal, just like it becomes habitualized in the body. And that's where health happens. It happens incrementally each day, as opposed to a surgery or something like that.

While surgery is supposed to help, but that's more like a lifeguard jumping in to save you from a, save you in the ocean, as opposed to learning how to swim. The problem is it's just so tedious and it's so fundamental that a lot of times we just don't even think about it.

James de Lacey31:30

If you were going to go down that route and say, like, "All right, I'm going to try and improve, I guess, the structure of my jaw so I can practice my nose breathing more and more," how much would you have to do each day or say chewing? If you're chewing gum or you're looking, is there like a, I don't know, some kind of set time that you would recommend each day or...?

Dr. Max Kerr31:30

So I think, man, I think that there's some really hard gums out there, some like resiny, and that they're made purposely for this. They're made purposely for this. I've seen it come on my Instagram feed. I haven't really pulled the trigger, but I need to.

Personally, I chew that Lucy gum, that nicotine gum, because I really like nicotine. Yeah, it is. I mean, it's great. It's a great drug. You're just going to get hooked on it, but it's actually neuroprotective. But that's neither here nor there.

So I chew those. I chew about three or four of those a day. Now, that's a softer gum and it probably doesn't do a whole lot. The harder gums, if we go back to the hunter-gatherer type, what people claim, and there's no way to really know this, was that human beings were likely chewing up to an hour or two or even more per day.

So if you can imagine there was just a hard gnaw and chew over time. And I mean, if you, especially if you close your eyes and you think of some, an Aboriginal tribesman or a hunter-gatherer tribe and you imagine them smiling, you're going to see in your head, you're going to see a broad, you're going to see a really fit individual with a broad white smile and straight teeth.

And that's because these individuals have been chewing, whether it be a very ruddy vegetable, a very husky vegetable, or gnarly meats that have maybe only been cooked on the fire and not like we do in Texas here, smoke for 12 hours. We're not taking a brisket off of fat and cow and smoking it. This is an animal that ran, we had to run to go get it, and then we just cooked it on a fire really quickly and then we chewed on it for a while.

And so if we can somehow model that throughout the day, then we're going to see a lot more musculature firmness in the airway. So I just say find a gum that you like and chew on it. Make sure that you're not going overboard, so the difference between a tonic and a toxic is the dose, right? And so we don't want to just wear our teeth to hell. But at the same time, I think it's important to do a little bit of extra chewing throughout the day.

James de Lacey34:15

That's interesting. I know I'm just thinking now, like, man, I remember trying to eat chewy steaks and you'll be five minutes in, you'd be like, "Man, [expletive], what am I doing? I don't want to eat any more of this."

Dr. Max Kerr34:15

Yeah, exactly. Well, you're probably helping your jaws and helping your breathing and helping the overall system.

What we don't want is, a lot of times another thing that happens with sleep apnea is we clench and grind our teeth. And what happens is as the airway gets assaulted, or as the body feels as the airway's coming together, we tighten up, and especially our jaw. I mean, hell, in combat sports, I mean one of the first things you do when you're getting choked, you're bringing your teeth together.

Now, this is just a subconscious mechanism that's going on because we're trying to dilate those air, the muscles in our airway, to prevent from the assault or the collapse. And so if that's happening while you're sleeping all night, then what ends up happening is we're constantly clenching and grinding and biting our teeth together, trying to create that, this is the theory, again, there's no way to prove this. But we do see an apneic episode is a lot of times when there's an apnea, we see the clenching and grinding happen. We just believe that it's the body trying to keep the muscles...

James de Lacey35:31

Is there something people can do, other than the stuff we mentioned about, I guess, the sleep disturbances? They can do for teeth grinding and their sleep at night? Night guard, that's the only thing, or strengthen the system with all the other stuff that we spoke about?

Dr. Max Kerr35:31

This is the thing, is we're so far behind the eight ball on this one, it ain't ever going to change. Like, we would have to change all of food production in the modernized world to get back what we may, years, hundreds of thousands of years, to maybe get back what we had. We ain't doing that.

So now, what are we going to do to kind of optimize the system, the human organism, to be as effective as it can be in its modern environment? And so that's the game we got to play right now.

James de Lacey36:23

Do you have any sleep supplement recommendations as well that can help with people to fall asleep and stay asleep that aren't invasive sleep medication?

Dr. Max Kerr36:23

Yeah, dude. So I'm really out on all sleep medications. I think that they should always be used transiently. We should never be reliant upon them. The problem nowadays is a lot of times we become reliant upon any sort of sleep medication prescribed by a doctor. The issue with those is they're going to hijack something. You can't—you got to pay the piper always, whether once you take something it's going to take from you. It's just the way it is.

Even one of my devices, there's a side effect. If you wear my device, it could change the way you bite. It just is what it is. If you wear a CPAP, it could morph your face or change your face a little bit. This is just the way it is. So with sleep medications, they should be prescribed with a goal of getting off of them. And so I traditionally do not prescribe any sort of sleep medication.

But you were asking about supplementation. Now I think that there's some really good supplements out there. Everybody knows about melatonin, man. Melatonin is good only for one thing—there's a multitude of benefits from melatonin. They say that it can be—there's antihistamine effect. At higher doses, there's antioxidant—

James de Lacey37:51

What kind of doses are high doses for melatonin?

Dr. Max Kerr37:51

Anything over one milligram. Like, 0.5 to one milligram is really all we're taking. They sell those things in five milligram things now. That's crazy. Yeah, that's only—like literally you're not getting—you might get an antihistamine effect in that regard. And so what we're seeing with that is that will help kick off their circadian rhythm. And so this is something that you and I talked about earlier.

So there's two reasons we have any sort of sleep or that we are driven to sleep. One is the circadian cycle, and that's the rising and falling of the sun. The body gets into that. Then the other option is—or the other drive, we call it sleep drive. And that's as ATP is burnt or created or utilized in the mitochondria, adenosine builds up. And as adenosine builds up, we call that sleep drive.

And as adenosine continues to rise in the brain, we see that that drives the human to want to go to sleep. And so over time throughout the day, adenosine builds up, and along with circadian cycles, and as those things kind of coalesce, then we start getting really sleepy. Side note: coffee is an adenosine blocker, so it prevents the buildup of adenosine.

James de Lacey38:51

Coffee or caffeine?

Dr. Max Kerr38:51

Caffeine. Caffeine. So once that caffeine comes off of the—it's a—it competes for the site for adenosine to induce sleep. Once that comes off the site, then all that adenosine floods into that cell, and then we get really sleepy after the caffeine goes away.

James de Lacey39:27

What were you about to say? Is that like the caffeine crash thing?

Dr. Max Kerr39:27

Yeah, exactly. Yeah, that's exactly what's going on, because all that adenosine doesn't go anywhere. It's just waiting once it's off.

James de Lacey39:27

To release.

Dr. Max Kerr39:27

Yeah, exactly. So what I've been doing lately is I've been kind of focusing more on quieting the animal, right? So there's a few things that I personally like. Andrew Huberman got on Joe Rogan and mentioned three things.

He mentioned magnesium threonate. That's something that I definitely like to use. Humans are extremely deficient in magnesium. We need to supplement magnesium. Magnesium threonate happens, according to Huberman, to cross the blood-brain barrier. And with that, it will calm the mind down or get us away from that sympathetic charge.

Now, some people like CBDs, some people like THC. THC and CBDs tend to be one of these kind of—it'll do what the body needs at the time it needs it. The problem for me is that I'm traditionally downregulated, and so CBDs or THCs will actually upregulate me to where I will not be able to go to sleep if I use any of those. So you're going to have to play with that.

There's theanine, which is another thing that Huberman recommended on Joe Rogan's podcast. That's a GABA—it's a precursor to GABA, which GABA is a neurotransmitter that helps to induce deeper or REM sleep. And then what I've been really geeking out on is taurine lately.

There's a guy I follow, his name is Kevin Bass on Twitter. He actually—he's kind of a—he fights with Rhonda Patrick and—yeah, it's pretty interesting. And he's pretty bright when it comes to performance science, what it seems like, or at least supplementation. He's always trying to refute what they say. But that's neither here nor there.

But he came out with a really nice video about taurine. And with taurine, I'm using anywhere from one gram to two grams of taurine, depending on how much I'm trying to go to sleep. And what I've found is I get extremely deep sleep on taurine. And what we see there is it's an amino acid that's going to kind of reduce—it's like an anxiolytic, so it's going to reduce anxiety, create a little bit more CNS depression, and it's going to allow for that parasympathetic charge to kind of take over or reduce the sympathetic charge, so to speak. So just calming the body down and getting it—allowing it to kind of coast along with the circadian rhythm and the sleep drive.

James de Lacey42:01

That's really interesting, because there's one study that I reference quite a bit, and that is taurine's synergistic effect with caffeine. And the idea that the larger the dose of taurine, the less caffeine you need to see a performance enhancement.

Dr. Max Kerr42:30

No [expletive]! Dude, well, you know, maybe it's that same thing with CBDs with me. But man, I'm telling you, I take—right before I go to bed, I take 300 milligrams of magnesium threonate, 200 milligrams of theanine, and then one gram of taurine. And dude, I'm telling you, in 30 to 45 minutes, I am barely keeping my eyes open.

James de Lacey43:03

I'm gonna get Mona to try that.

Dr. Max Kerr43:03

Yeah. Yeah, let her be the guinea pig.

James de Lacey43:03

That's interesting, because theanine as well also has a synergistic effect with caffeine. So—I just had that now, actually. Theanine and caffeine together is like the original nootropic.

Dr. Max Kerr43:03

Yeah, well, and so, you know, here—what—so taurine is a precursor to GABA, right? And so is theanine. And so it might be that GABA—GABA along with caffeine—it must be something might be happening in that regard. But we do know GABA has to—GABA, has to be present for us to really get into full deep REM or that really brain-cleansing sleep.

James de Lacey43:03

Would you take then—would you take straight GABA, then, as a something?

Dr. Max Kerr43:03

So, supposedly, GABA gets broken down or it's not efficient—doesn't efficiently cross the blood-brain barrier or something like that. Just GABA itself, for whatever reason, does not produce the same effects as if you were to take the precursors of it. But it is prescribed oftentimes by sleep physicians. I just—usually what I've seen, people that have like a neural charge, like where one of their nerves just won't turn off, whether it be through pain or whether they just have really excitatory legs or anything like that, oftentimes we'll see the neurologist prescribe GABA. And the people that I see don't really find a whole lot of benefit from it. And it could be because of that.

You kind of step back a little bit. All these medications that we're giving individuals is to kind of supplement—really is trying to overcome some deficiency in environment, right? Some kind of lifestyle thing, right? So that's all it is. And so if we're taking the precursors to the things that we probably always needed, then the body is so efficient in making what it needs out of those things that it's better, instead of just giving the body the thing.

Right? Like exercise, right? You got to give the body the exercise to have the health. You don't just give the body the health. There's no way to do that, right? And so it's almost like the body—

Well, that's what we're doing in the West, right? And so, one of the things that I always tell my—I'm starting to—I'm so far into this now, this journey, that I don't really—I'm losing my give-a-shits. My give-a-shits are gone. But I've told my patients—and I work with a urologist—I tell my patients, like, you got to earn your sleep. And I mean you got to earn it.

Like you got to—that sleep drive has to be a thing. Like, you can't just pray for good sleep and then try to get a good sleep. No, you got to bust your ass. You got to wake up early in the morning, you got to do some work, you got to eat well, and then you probably get to sleep good.

And so my neurologist—or my urologist buddy, he says that all these guys come in here, they're fat, they're overweight, they can't get their dick up. It's like, dude, you got to—you got to earn the hard-on, man. Like, you can't just—you can't just come in here and—my daughter just showed up in here while I said that. That was good timing.

This is what happens when you earn the hard on. Get out of here. Love you, baby.

But man, you can't expect health when you're not willing to pay for it. You got to pay for health, man. But we're talking to Combat Sports veterans here, Combat Sports guys. Talk about brutal and really willing to go and work for it. Kind of preaching to the choir here.

James de Lacey46:44

Are there any other to finish, are there any other maybe sleep tips that aren't your typical don't look at your phone at night, do some medit or something like that? Do you have anything else maybe to add to that conversation that's not, everyone probably has heard?

Dr. Max Kerr46:44

Well, so this is such a natural thing. I mean, it's low-hanging fruit, man. Like we all have to do this. We do it a third of our lives, or we should be doing it a third of our lives. Our bodies pray, want sleep more than anything.

So one of the things, breathing is the most thing the thing that the body wants the most, water, then food, food, then sleep. Those are the way the body has to react. And so if you think about it, if we're not white knuckling this thing and we try to actually take a step back and look at how we evolved, where we came from, we came from waking up with the sun and going to bed with the sun. That's just the human, maybe sitting around a fire a little bit before we go to bed. But man, we're waking up when that sun comes up.

And so not wearing sunglasses first thing in the morning. Like we got to actually allow that low wavelength light or that light in the morning to hit our prism nucleus, or that light gatherer in our eye. So we need that sunlight to hit our eye first thing in the morning. If you can, you shouldn't be doing it through the glass really.

You should get out and try to walk. If you can't, you should if you walk for five or 10 minutes, you're getting enough sunlight to help set your circadian rhythms. And then if you have to look through the glass, I think it's like 20 to 30 minutes is important.

So that first morning light is very important. Now they do have, they do have some clocks that actually brighten the room like as a alarm. Sunrise clock. I think those can be effective, but there has to be like, or even you have these desk lamps that give you a certain amount of like 20,000 Lumen or lot light that's just blasting your face with light for like 20 or 30 minutes, man.

And then at night time while the sun's going down, it's a good idea to get outside a little bit. And really dude, you got to bust your ass, man. If you want to go to sleep, you got to work hard throughout the day. You got to have a reason to go to sleep. If you're just all day watching, sitting on the couch and watching TV, it ain't going to happen.

Well, THC, CBD, that's always a good thing. The supplements that we recommend. And definitely don't look at your phone at 10 o'clock. Phone should really like, you should at least, any sort of light after 10 is not ideal, or at least it needs to be far enough away to where it's not going to impact your sleep. But some people probably don't really recognize it doesn't, it isn't too much of an issue with that. You just got to feel yourself out and be willing to be the subject to your own experiment.

James de Lacey49:50

We should also add no sunglasses. They're good. Those polarized sunglasses are great and they look cool, but first thing in the morning, probably not ideal. Get the sun in your eyes. We weren't like, we weren't walking around with shades like sunglasses when we were together.

I was going to add, if you're competing and you're getting drug tested, avoid the THC and CBD supplements. If you're not competing, go for it.

Dr. Max Kerr50:24

Oh, also we should, depending on the state you're in, for sure. All the caveats we need to have. Like it's kind of like the drug commercials, we need to have the all the fine text showing all the side effects. Exactly, exactly.

James de Lacey50:24

No, this was awesome, Max. I appreciate you coming on. I think we pretty much covered everything. If people want to follow you, where can they find you?

Dr. Max Kerr50:24

So I primarily am cruising on Instagram. Dr. Max K, I believe is what it is. Dr. spelled out, Max, and then K. I'll link it up anyway. And then I'm the same, I believe I'm the same at Facebook.

And then I'm at the Max Kerr, M-A-X K-E-R-R, on Twitter. And really what I do is I just, I'll post something that I find on Instagram. I don't really come up with, I'm a clinician, so I don't come, I'm not a scientist, so I don't come up with this content. But I'll find, I'll be like a curator of content that I see out there and I'll repost it. And I'll make sure it hits my Facebook and I'll make sure it hits my Twitter. And so that's kind of my main hub of posting of anything.

James de Lacey51:22

Nice. I'll link it in the description for anyone interested as well. But thanks for coming on, Max. Really appreciate it.

Dr. Max Kerr51:22

Yeah, man. I had a great time. And like if you ever need a stand-in or a punching dummy, just let me know.

James de Lacey51:42

Perfect. Perfect. Cheers, Max.

Dr. Max Kerr51:42

All right, later buddy.