Podcast Drop Date: 2/19/2025
In this episode of the Functional Medicine Foundations Podcast, host Amber Warren, PA-C, is joined by Dr. Dan Bruce, D.D.S., and Dr. Kyle Davis, Ph.D., for an insightful conversation on the crucial role of sleep in overall health. They explore the different types of sleep, common sleep disorders, and how micronutrient testing can impact sleep quality. Plus, they discuss the effects of fitness trackers for monitoring sleep and the benefits of cognitive behavioral therapy in improving sleep patterns. Listen to Part 1 of this two-part series for practical strategies to improve your sleep and overall well-being.
Transcript:
Amber Warren, PA-C: Welcome to the Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts, and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper.
Amber Warren, PA-C: Welcome back everybody. Thanks so much for tuning in. I'm really, really excited about this conversation. So I have two specialists with us tonight. Dr. Dan Bruce is a general dentist who has been practicing in Boise for almost 20 years. His practice focuses on integrative dentistry, meaning he connects oral health to overall health and vice versa. This process involves analysis of potential sites of infection, toxicity, autoimmunity, and structural dysfunction such as airway and TMJ disorders. Dr. Bruce has a diplomat certification from the American Board of Dental Sleep Medicine. While not a recognized specialty in dentistry, completion of this rigorous certification program has been achieved by only a small percentage of dentists nationally. There's a lot more we can say about you, Dr. Bruce.
Amber Warren, PA-C: And then we have Dr. Kyle Davis. Kyle Davis, PhD, is a licensed clinical psychologist specializing in clinical health psychology and behavioral sleep medicine. Dr. Davis earned a bachelor's degree in psychology from Oklahoma State University, a PhD in clinical psychology from the University of Colorado Boulder, and completed specialized training in the treatment of sleep disorders at the University of California, San Diego. Dr. Davis has worked in a number of clinical settings, including primary care, outpatient, behavioral health, sleep medicine, and lifestyle medicine clinics. Dr. Davis currently lives in Boise, Idaho and works full time in his own private practice, Confluence Health Psychology, where he primarily focuses on the treatment of sleep disorders. Awesome.
Amber Warren, PA-C: So if you haven't picked it up by now, we're here to talk about sleep. The importance of sleep, why we sleep. I know you've given me a ton of great book recommendations on on on that topic, but we haven't actually fully addressed this in our podcast yet. We've done bits and pieces as sleep as it relates to metabolic health or brain health, but I just am so excited to have this conversation with both of you, because you guys are truly such wonderful resources for us to have here in the Treasure Valley. So let's just start with why. Why we need sleep and why it's absolutely pivotal to our to our health. Dr. Davis, you start. Take it away.
Dr. Kyle Davis, Ph.D: Wow.
Amber Warren, PA-C: I know it's a big question.
Dr. Kyle Davis, Ph.D: Why we sleep is, yeah, and why we need sleep is a really big question. Um. You know, but the way that I think about it is sleep is pretty much essential to all parts of our day to day functioning. And it's almost like easier to explain to people when you think more about, like, what happens to people when they're not getting adequate sleep. Right? And that's really like how we've learned more about the functions of sleep, in just terms of the problems that people start to run into. And so I think you can basically think almost about any facet of health and find that sleep helps you perform as well as possible in that area of your health.
Amber Warren, PA-C: Right. Yeah, I would agree. Dr. Bruce, do you have anything to add to that?
Dr. Dan Bruce, DDS: I mean, I think as a dentist, you know, I kind of back into it because I can't diagnose sleep apnea or sleep problems or any of that kind of stuff. But, um, I have many tools in order to treat it. And so a lot of the patients that come to me, you know, they're not sleeping, so they're in pain and then pain can cause them not to sleep. So it can be all these things are intertwined a lot. So I just, you know, I see the effects of poor sleep or whether it be from pathology or sleep apnea or any number of other medical issues. So I end up seeing a lot of these patients, concurrently. And it takes a team to get them back on track a lot of the times.
Amber Warren, PA-C: Back where they need to be. Yeah, I, I feel like sleep is an area of medicine that is finally getting the attention it has deserved for so long, right? We've talked about nutrition for so long and exercise, and there's just been, you know, supplementation, whatever. But I feel like sleep is finally like people are actually starting to talk about it and really dive into the science and what it does for the cardiovascular system and the brain and the body in general. So let's talk through the different stages of sleep and what's important in each of those stages.
Dr. Kyle Davis, Ph.D: Sure. Yeah. So you can think of sleep broadly in two categories. So non-REM sleep and then REM sleep. And within non-REM sleep we have three distinct stages. Stage one, two and three that get progressively deeper. So the way that I like to explain stage one sleep is like a bridge between being awake and being asleep. You've got to cross the bridge of stage one sleep to get into the deeper stages of sleep. And then we think of stage two sleep as an intermediate stage of sleep, where we're probably going to spend close to 50% of the night. There are other like really interesting things that happen during stage two sleep like procedural memory. Um, and so like learning how or I'm like thinking of these rats, like running through a maze and like, whenever, um, like, different research has been done, you can see, like, neurons firing in the pattern of that they're running in. Um, and so they're learning how that's, um, like learning the maze, like while they're sleeping as their memory is getting consolidated. And then anyways, um, stage three sleep is what we call deep sleep or slow wave sleep. And that's where we think we get most of our physiological, um, restoration.
Dr. Kyle Davis, Ph.D: And that's primarily going to occur in the first half of the night. And then you also have REM sleep or rapid eye movement sleep. Um, as the name implies, is characterized by rapid eye movements. Um, also interesting. Our bodies are partially paralyzed during REM sleep, and so we're not, um, acting out our dreams. Um, we think so. We do a lot of our dreaming during REM sleep. Um, and we think that REM sleep is really important for our emotional well-being. And, you know, sometimes I've heard, like, REM sleep referred to as, like, the overnight therapist. And it's, um, I think so many people have the experience of going to bed when they're stressed out about something or they're facing a big decision. Um, and, you know, they wake up in the morning and they've either come up with a new, um, answer to their problem, um, or the thing that felt so significant the night before feels a lot less significant. And we really think that sleep is helping facilitate that process or like, working through, um, different things that are going on in our lives.
Amber Warren, PA-C: So it's like the term, why don't you go sleep on it?
Dr. Kyle Davis, Ph.D: Exactly.
Amber Warren, PA-C: In your in your REM sleep is when that you're processing.
Dr. Kyle Davis, Ph.D: Yeah. People say that all the time, you know. But there's like really something to that. You know, that, um, sleep is helping facilitate either acceptance and or new solutions. Like, I'll talk to a lot of, like, engineering type folks, you know, who have lots of examples of they go to bed thinking about a problem, and they'll wake up during the middle of the night with the new solution.
Amber Warren, PA-C: I love that.
Dr. Kyle Davis, Ph.D: Yeah, their sleep is helping facilitate that.
Amber Warren, PA-C: Do you two think that these trackers that are tracking our non-REM and REM sleep are accurate? Some of the trackers that are out there on the market?
Dr. Dan Bruce, DDS: I mean, I listen to a course last year and I think they're pretty good. I mean, they're not as good as the sleep study.
Amber Warren, PA-C: Right, right. Um, but like the Apple Watch or some of these new watches that are out there, you think?
Dr. Kyle Davis, Ph.D: I think they're reasonable better, right. Real fast.
Amber Warren, PA-C: Technology continues to advance and they're getting better.
Dr. Kyle Davis, Ph.D: Like they're there's some pretty significant problems with the trackers, too. Um, there was a new sleep disorder characterized by obsession with, um, fitness tracker data, called Orthosomnia.
Amber Warren, PA-C: Totally.
Dr. Kyle Davis, Ph.D: Yeah. And I was I was working with a patient like this, a couple different patients like this. Um, recently one person was very focused on, um, their heart rate variability. And so but interestingly, it was his heart rate variability during sleep that he was concerned about. And so he was trying to improve his sleep to increase his heart rate variability, lower stress. And that's not really something that somebody has direct control over 100%. Um, and so when you go down the path of trying harder to, um, you know, change a function during sleep or get more deep sleep or get more REM sleep, um, then you can easily start running into problems with sleep because it kind of facilitates this idea that you can well, I guess it doesn't make people think they can try harder, but the kind of people that get caught up in that.
Amber Warren, PA-C: Those personalities.
Dr. Kyle Davis, Ph.D: Want to try harder to improve their sleep and then they can run into bigger problems with sleep.
Amber Warren, PA-C: Well, in my issue as well, with all the the new apps and devices and whatnot. The technology is we're all talking about avoiding the blue light at night, right? And then they're just setting up their phones, setting up their app, checking it, and you're exposing yourself to the blue light at night, and then you're just on your device. And we all know what our devices are doing to our nervous systems. And that's not helping our sleep or helping our nervous system at all. So yeah, I agree. There's I see so many clients that have this obsession over, over their whether it be HRV or their sleep quality. And it's like, oh man, I think you would benefit so much more from just taking a break.
Dr. Kyle Davis, Ph.D: Yeah. If you didn't have a watch and you just read a book instead.
Amber Warren, PA-C: Yes! Or go for a walk and not care how many steps it was, I don't know. That could be a whole nother podcast.
Dr. Dan Bruce, DDS: Yeah. My daughter runs track in college. You know, she freaks out about little changes in her heart rate. And I'm like, you can't really control it, so just forget about it.
Amber Warren, PA-C: Absolutely.
Dr. Dan Bruce, DDS: You're going to run, you're going to go run, and you're going to do what you're going to do, and your body's going to tell you how it's going to go.
Amber Warren, PA-C: And yeah.
Dr. Dan Bruce, DDS: Just enjoy it.
Amber Warren, PA-C: No, it's so true. Dr. Bruce, I know you have a lot of thoughts on supplementation for sleep, and I know you've been digging into the data on specifically magnesium and different forms of magnesium and how and how that can help sleep quality. Could you tell us a little bit about that?
Dr. Dan Bruce, DDS: Well, I just I just know that sleep is complex, right? So for me, I'm looking at a lot of the structural problems that happen. You know, when you've got soft palate obstruction, you've got collapsible airways. And so we try to do things to improve muscle tone, improve nervous system tone, all that kind of stuff through myofunctional therapy or through oral appliances or through expansion, orthodontics, you know, for kids. And so, um, however, you know, a lot of those things don't work if the building blocks for bone and for collagen and muscles are not there. So, um, you know, I know that a lot of the, the, like, the farmland that we're using can be stripped of minerals. And so people tend it seems like everyone is low in certain minerals. And we need all these things, you know, magnesium, iodine, all these things that need to be present for proper growth and development. So I guess my question for both of you guys is a lot of my patients come in and even, like clenching. Or, you know, restless legs or things like that. You know, they're low in iron. They're low in magnesium.
Dr. Dan Bruce, DDS: How do you what's the right type of magnesium? There's all sorts of them out there. How do you decide how much people need like, I mean, how do you guys manage that. So I'm more interested because I'm seeing it in my patients.
Amber Warren, PA-C: And you're seeing the signs and symptoms of magnesium deficiency or mineral deficiency in general?
Dr. Dan Bruce, DDS: Yes. That's actually I guess what I'm saying is, you know, I know magnesium does a ton of things for the body, specifically my patients. There's a certain subset of them that once they get their magnesium right, it really helps them sleep a lot better.
Amber Warren, PA-C: And, and do a lot of other things. They feel better, their anxiety is gone. Their brain functions better. They have more energy. Yeah. I mean, I definitely want to hear your opinion on this, Dr. Davis, but we have been we've been doing a ton over the last year, a lot of micronutrient testing in our clients. So above and beyond what just serum blood testing can do, because we want to look at red blood cell levels of these nutrients and serum levels and be able to compare between both, um, the other. The other thing that's becoming absolutely paramount is looking at heavy metals and environmental chemicals that can actually sit on the receptor sites of these micronutrients. So it's not always enough just to look at the nutrient panels on these clients. You also have to be looking at toxicities and then detoxing the body so that the minerals a client is taking and eating and supplementing with can actually be utilized by the body. So I'm actually noticing I have to do both to oftentimes to really get my clients to have benefit from the supplementation, whether it be oral or intravenous supplementation of these micronutrients. That's huge. And then stress you'll you'll pee on more magnesium when you're stressed out. So that's not helping anybody either. That's my take.
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Amber Warren, PA-C: I'm curious what you're seeing.
Dr. Kyle Davis, Ph.D: Yeah, it's super interesting. I'm honestly really naive to a lot of, you know, the supplements I don't have access to, um, or most of my patients, you know, don't are not doing this kind of testing. And so I don't know if they have deficiencies or not. Um, you know, and then the perspective that I'm taking is, you know, what can we do, um, with behavioral patterns, thought patterns, you know, to help somebody make their sleep as good as it can be, right? Um, so most of my experience with supplements is more anecdotal, um, than anything else. And, but I also totally recognize that I'm in a really biased position because the people that are coming to see me are still having problems with sleep. And so if they started taking a supplement and that solved their problems with sleep, they're probably not reaching out to me. Um, I only see people who are, you know, still having problems regardless of what other stuff they may have already tried?
Amber Warren, PA-C: Yeah, your approach is so different and it's so different than even, like Dr. Bruce and I. Can you explain a little bit about your the sleep program that you run that really works on sleep efficiency?
Dr. Kyle Davis, Ph.D: Oh sure.
Amber Warren, PA-C: Because it's I've had the clients I've sent. You have had tremendous luck. Um, when they're at their wits end.
Dr. Kyle Davis, Ph.D: Yeah. No. So the treatment I specialize in is called cognitive behavioral therapy for insomnia. And it's a so it comes from the family of cognitive behavioral therapy. But it's a really specific treatment protocol for insomnia. Um, and I think of it as having like two major components. And then a lot of other things that we do to help people out. Um, so the first of which is you people call it different things. I call it sleep efficiency therapy, because that sounds nicer than sleep restriction therapy. Um, but it's the same. And essentially what we do is we start measuring somebody or having them track their sleep. Um, the, their own self-report, you know, we don't rely on the devices to track sleep. We see how much sleep somebody is getting per night. On average, you know, per their best estimate. And then we'll put them on or I'll put them on a sleep schedule. That's a close match to their current sleep ability. So say, for example, um, Dr. Bruce was sleeping 6.5 hours a night on average. Um, I would likely put him on or recommend a seven hour sleep schedule to get started with. Okay, so we're going to try to set a consistent wake time. Um, work backwards instead of bedtime for him. Talk about routine before he goes to bed, what he's going to do in the morning to stick to that schedule even if he didn't sleep well. And during the initial part of treatment, we're trying to make him extra sleepy.
Dr. Kyle Davis, Ph.D: Um, because the sleepier we can make him, um, the easier it is for him to fall asleep and stay asleep during the time that we set aside. And then if we're successful in that, um, then we start adding time back into somebody's sleep schedule. And we usually do that in about 15 minute increments per week. So if we started off on a seven hour schedule, let's say 11 to 6, everything goes according to plan. Then we go 1045 to 6, then 1030 to 6. Um, and we keep doing that until somebody is Somebody is generally doing well with symptoms of insomnia, or if you had too much time into somebody's sleep schedule, they're going to start running into problems with sleep again. You just can't fill all that time that you're giving yourself with sleep. Um, so that's a huge component that gets overlooked all the time. Um, when helping people with sleep problems, um, the second thing that's super essential in cognitive behavioral therapy for insomnia is called stimulus control. And that's a fancy way of saying do nothing in bed but sleep and sex. Sleep nowhere but the bed, with the idea being your brain is constantly forming an association between where you're at and what you're doing. So oftentimes, people with insomnia have spent a lot of time in bed awake. Um, you know, sometimes they're scrolling on their phone, sometimes they're reading, um, more often than not, you know, people know they're not supposed to do those things, but they're laying there worrying about things, or they're planning things, and their mind will start to associate that with being in bed.
Dr. Kyle Davis, Ph.D: And so we try to help them associate being in bed with being asleep. Um, and the way that looks in treatment is, you know, if you're wide awake in bed, um, you've been there more than 20 or 30 minutes. You start feeling anxious, frustrated. We'll have you get up, do something else. Boring or relaxing? Um, wait until you start to feel sleepy, go back to bed and try again. And then the other important components of CBTI, sometimes you're talking about stress management in general. Sometimes you're talking about relaxation strategies. Sometimes you're talking about thoughts and beliefs and how that could interfere with somebody's ability to sleep. Like somebody may have the belief, I have to sleep eight hours tonight to perform well tomorrow. That person's average sleep ability is seven hours. They're going to continue to struggle because they've got this belief that they're trying to sleep more than their body is able to produce sleep. Um, we'll also make sure people have good sleep hygiene. Um, but like in my clinic, almost everybody has good sleep hygiene by the time they, they get to me. Um, but anyways, when you put all those different components together, um, that's CBTI, and it works really well, um, for helping people with insomnia.
Amber Warren, PA-C: So as part of that, sleep hygiene is part of it avoiding the artificial light at night, getting natural light exposure in the in the morning. Do you work on the don't eat three hours before bed? Don't do anything stressful. Like, do you build that into your program?
Dr. Kyle Davis, Ph.D: Sometimes, you know, I'm probably way less restrictive about some of those things than people would imagine. Um, especially, like blue light and sleep. Um, you know, I've seen, you know, recommendations where people avoid blue light four hours up until before bedtime or one hour before bedtime. Um, and I think what people tend to overlook when it comes to blue light is what they're doing with blue light exposure. And what I mean by that, you know, is if I'm, um, reading the news or responding to emails, you know, right before I go to bed, that cognitive stimulus of what I'm doing is going to have a much bigger impact on my sleep than the blue light exposure I'm getting from my phone. Um, and so if somebody's watching a television show that they're not super engaged in, you know, think about like a great example of reruns of The Office, um, for like, our generation, you know, it's. And so you can watch reruns of The Office up until the time you go to bed. It's relaxing. It's not keeping you on the edge of your seat, and the blue light exposure that you're getting from your television is probably not going to be significantly significant enough that it has a big impact on your sleep. Um, and so, you know, so I'm usually a lot more lenient. I'm actually telling people sometimes, you know, that I've been avoiding their light for four hours, like, hey, it's okay. Um, you can watch a show up until the time you go to bed. Um, and now, but I do draw a line. Like, if I added somebody earlier today, it's like an IT guy. He had two, like, big monitors, you know, like that. He was working like. And so if you have like, two computer screens in.
Amber Warren, PA-C: Your, in your face.
Dr. Kyle Davis, Ph.D: That's a different situation than watching a television from across the room.
Amber Warren, PA-C: That's a good point.
Dr. Kyle Davis, Ph.D: Um, but once again, you know, I think the effect of blue light has been overstated and what people are doing on their devices.
Amber Warren, PA-C: I think that's a really good point. Yeah. Are you out there watching Yellowstone where someone gets murdered every five minutes? That's impacting your your psyche? Yeah. No, that's a really good point. Are you on your phone having a stressful conversation with somebody and. Yeah.
Dr. Kyle Davis, Ph.D: Yeah. You could be wearing your blue light blocking glasses, you know, and like, writing a really stressful email to somebody or, you know, once. It's like, what do you think is going to have a bigger impact on your sleep or your ability to wind down? Yeah. It's once again, probably not blue light, but more, um, what you're doing or what you're thinking.
Amber Warren, PA-C: What you're filling your brain with, the toxic, the toxic things you're putting into your brain and your body. Yeah, that's such a good point. Yeah, I know that program. It's just phenomenal. I know it works really well.
Amber Warren, PA-C: Thanks so much for tuning in. We learned that this episode on Optimal Sleep was a little bit longer than we anticipated with all its wonderful content. So we're going to end part one. And please stay tuned for part two. Thank you for listening to the Functional Medicine Foundations podcast. For more information on topics covered today. Specialties available at the FMI center for Optimal Health and the highest quality of supplements and more, go to funmedfoundations.com.
Connect with Dr. Dan Bruce, D.D.S:
Website: https://www.boise-dentist.com/
Instagram: @boiseintegrativedentistry
Connect with Dr. Kyle Davis, Ph.D:
Website: https://www.kyledavisphd.com/