Insomnia or Depression: Which Comes First?
In this podcast, Dr. Martin Katz and Dr. John Gildea discuss the interplay between sleep and mood. They highlight the various topics below:
3:00 Cognitive behavioral therapy as a treatment for depression & sleep https://pubmed.ncbi.nlm.nih.gov/28199710/
6:30 – Chemicals and deficiencies associated with sleep & depression
10:40 – How exercise and recovery impacts sleep and mood
12:40 – How sleep deprivation impacts your immune system
13:20 – How caffeine impacts sleep
16:45 – Berberine’s impact on sleep and mood
David Roberts: Hey there, it's David Roberts here with BrocElite and with me today are John Gildea and Martin Katz, co-founders as well, BrocElite and Mara Labs. And welcome guys, thanks for coming.
Martin Katz: Thank you for having us.
David Roberts: So today we're going to talk some about depression, sleep and the interplay there. Depression is kind of a big amorphous thing so we're not going to cover all that there is to know and to say about depression, but mainly how it interacts with sleep as well as supplementation, specifically B vitamins. That in itself is actually quite a big topic. And so let's dive in. Either of you can dive in on this, but one question I have is does the egg come first? Does the chicken come first? Is it sleep? Or is it depression?
Martin Katz: Yes. Good question. Good answer. Yeah, I don't think we know and I don't think the studies are clear. Certainly what the studies are clear about is the two interplay and that's for sure. And so if you have depression your chance of insomnia or hypersomnia are high, and if you have insomnia or something like sleep apnea your chance of having depression in the literature is anywhere from five to 10 times greater. So the two seem to interplay quite significantly.
Martin Katz: The other thing that's impressive obviously, is that if you are having sleep problems and you then are depressed, both have treatment options. The antidepressants unfortunately can also have an interplay in sleep and decreased REM sleep. And so, for us here at BrocElite, the most important thing is really looking to prevention is to how we can prevent these before we get into what came first, the chicken or the egg. So as you start having problems, making sure you're taking measures to limit the chances of having depression from insomnia, or if you have depression having insomnia, because then it's just going to cycle down and become worse and worse. And then the medications may work, but there's a chance they don't, if they're not, maybe because they're having a big impact on sleep. So again, prevention and really being intentional about your health being crucial here.
David Roberts: So, Martin, in your clinic, do you see one more than the other? Do you see somebody coming in depressed or do you see somebody who comes in with insomnia or some other sleep issue?
Martin Katz: We are seeing a lot of both. Unfortunately right now we're seeing a lot of depression, a lot of anxiety. And with that we're definitely seeing a lot of sleep concerns. And so, one of the treatments, interestingly enough, now for depression has been for many, many years, cognitive behavioral therapy. Lots of great studies on cognitive behavioral therapy and how well they've worked for mood issues. Well, what are we now doing for sleep? And what are some of the lead people on sleep now doing for insomnia? Cognitive behavioral therapy. And sort of how we approach sleep, how we think about sleep, the sort of cycles we get into our thought as to whether we are or are not sleeping. And so CBT helps to really work for both.
David Roberts: So cognitive behavioral therapy. Can you go into what that is? Is that like positive thinking or not freaking out if you're not sleeping? Counting sheep to go to sleep? What is that?
Martin Katz: So it's really starting to understand this whole idea of your thoughts or your feelings, which become your reality. So, a thought is a thought and we all have them, and sometimes they're really happy, sometimes they're fairly dark. Just understanding that thought, where it comes from, and then really what to do with it so it doesn't become your persistent feeling in your persistent ideation of who you are and what you are, and working with that understanding. So you can take a simple thought and work with that to shed it in a different light. And so, Jim Quick has this great thing that I love and it's this idea that we continuously lie to ourselves, and it's L-I-E, stands for limited ideas we entertain and these continuous thoughts that we have that we're entertaining and entertaining and then it becomes our feelings.
Martin Katz: And then lo and behold, it becomes our reality and our bogged down emotion all who and what we are. And so if we can sort of circumvent that, work with that, understand the genesis of it, and maybe help us understand what to do with those thoughts so that they don't bog us down, can be really helpful. It's the same with sleep where we get into these patterns of, "Oh my gosh, I'm not getting enough sleep." So we get anxious about it and then lo and behold, we get so stressed out we're not sleeping. And so it all plays into itself.
David Roberts: So they're the thought patterns that are huge in depression and sleep. Everyone is different, but maybe John if you can jump in on how much comes into play as far as the biochemistry, and maybe serotonin, dopamine, things that help with sleep that aren't there for some reasons.
John Gildea: It's amazingly complicated.
Martin Katz: I was wondering how you were going to put that.
David Roberts: I stumped him.
Martin Katz: You've asked him to answer a massive question in a short period of time.
John Gildea: No, it's a great question. I have my compartments where I can understand things pretty well. And one of those compartments, I think that might be a little bit likening is autistic kids. And it's pertinent for now too because the pathways that we're talking about with methylation, in one case methyl transferase is a known defect in autistic kids, so you're not getting methylation methyl groups transferred into the cell as well when you're inflamed especially. And then those B vitamins that all need a methylation step for a full paradoxical, then paradoxical biphosphate. There are methylation steps that are necessary for that whole metabolism to work well. And that can get incredibly complicated and hard to understand. But I think one of the things easier to understand is things like why interaction with humans is so important.
John Gildea: One of the defects that's been shown in autistic kids is they have defects in oxytocin. Well, oxytocin is the love hormone. It's like when your mother looks into her baby's eyes, that is turned on a lot. And that is like dopamine in that it feels really good. It's the social interaction. And right now we're devoid of a lot of that social interaction that we really need. And so it makes sense that that social interaction, that makes you work well makes you awake and satisfied. You know, you need your peers interacting with you to, to really get you such a central feature of feeling good. You know, it's dopamine. So it's the same pathway. Melatonin's in the same pathway. This methylation that's epigenetic. You have promoters that are turned on or off those are methylation.
John Gildea: CpG islands are medically turned off teams. So many things are in the middle of these biochemistry that has to do with both sleep, satiety, happiness, social interaction. And what's a good example of how difficult it is to manipulate those pathways are if you take a serotonin re-uptake inhibitor for depression, you'll get more dopamine. That helps a lot of kids. And if it's not helping you, you definitely don't want to withdraw it quickly, especially in young people, or else there's a much increased incidence of suicide. So the natural way of working through these pathways is I think the best way because you want to get it from food or a natural compound. Introduce, say a pharmaceutical into that and it's metabolized differently in different people and it's hard to predict how a person is going to behave from that.
John Gildea: But I'm just used to using the example of melatonin. Melatonin makes you sleepy. Sleep timing. I don't know what's better, that or keeping the shades really dark at night, or doing the red and blue blockers before getting off your screen time a couple hours before sleep. But it's really important, whatever that is. And then we don't want to chintz out on the other side too. Have your social interactions, get together with people that you really like hanging out with. Those are just really obvious things that you can do with those interactions. You're around people that you suddenly kind of feel depressed and judged by them, you know, maybe, maybe limit your interactions with them.
Martin Katz: Or news.
John Gildea: Yeah.
Martin Katz: Did we mention exercise as being positive? So kind of dig that.
John Gildea: That's really important.
David Roberts: What do you offer them? What about exercise and how it impacts sleep and depression?
Martin Katz: I mean, brain derived neurotrophic factor. I mean, there's so many pathways there. Its effect on glucose and then therefore melatonin, just circadian rhythm. And so I often tell my folks who are insomniacs are having trouble with sleep or having trouble with depression to really think about getting their exercise early in the morning and generally outside, not inside with this artificial might. Exactly. So, you know, there's tremendous benefit to exercising, especially exercising outside, especially exercising outside early in the day. Really following up with that with a really healthy meal can speed that recovery. You're increasing adenosine. And again, adenosine is this molecule that again helps push us towards sleep. And so the more you mount adenosine the better chance you have at night or feeling tired and getting to sleep. And that's where you got to be careful and eat healthy throughout the day and make sure you're getting enough hydration.
Martin Katz: Nice, cool glass of water if you're feeling sleepy. Making sure you're well hydrated. Not doing too many carbs at lunch. Just really well balanced so that you're not taking an afternoon nap so that will decrease adenosine. So that pressure cook adenosine, he thought of a pressure cooker, where you get a mounting response of increasing adenosine. Then at night you're appropriately fatigued and you're going to be able to fall asleep. And these things sometimes take time. They don't always happen like, "Hey, I did that doc." Well, I wanted to do it. I did it for a day. I didn't have any relief. So I went back to my old way. Sometimes these things take a little while and really sticking with it helps.
John Gildea: One thing that I often think about with sleep that's not kind of a normal association is if you are sleep deprived for a long period of time ... you're not allowed to do this to the animals anymore, but would use to be able to do that before these regulations for animal rights, all those animals, if you deprive them of sleep die of sepsis. So your immune system actually turns off and becomes non-functional the less amount of sleep that you have. So there's a connection to your immune system as well. And so Martin talking about adenosine and sleep pressure that it provides that made me think immediately of drinking coffee after dinner at night.
Martin Katz: Or even after two, three o'clock. Yeah.
John Gildea: So maybe that not everybody knows that's what caffeine does. Caffeine blocks adenosine. That's why it makes you feel awake. And so that sleep pressure is not there. It makes it harder to sleep.
David Roberts: So what would you say to the people that are like I can have that three o'clock or that after dinner cup of coffee and it doesn't affect my sleep.
Martin Katz: Same thing I tell people that say that about alcohol. The studies are showing it's affecting your sleep. And you know people who drink alcohol think it helps them sleep. It helps them get to sleep, but the studies are so amazing now on what is to sleep architecture, awakening through the night. And sleep is just way too important to limit disease as you get older, whether it's heart disease, depression which we're talking about, Alzheimer's disease. So these things are just too important.
David Roberts: So maybe even if you're not waking up at night, the quality of your sleep if you measure it is lacking. And if you drink coffee before bed or in the afternoon, even if you wake up and think I slept okay, it's not what it would have been had you not; the same with alcohol.
John Gildea: And like all personalized medicine, it affects some people more than others. I definitely know I can't have coffee after afternoon, or it really affects me. But maybe that would be how present it. You'd have to get a sleep monitor that is accurate and test it yourself.
David Roberts: What do you have on your wrist there, John? Show it to the camera.
John Gildea: The sleep monitor, Fitbit, Charge 4 was shown to be the most accurate.
Martin Katz: I think here when we get to the point where we're able to for all our employees, we'll be able to provide that Fitbit or Oura Ring where we can really watch and help our folks. And in my practice I hope to get to the where, and medicine's not quite there yet, it's not affordable for everybody to certainly be able to tell them how they should or how things affect them. But that's certainly the future.
David Roberts: Yes. So given this kind of chronicity in this epidemic of sleeplessness, insomnia, depression, one of the things that we're stepping into is providing a sleep product that we think is good, that's not quite out there in the capsule. And so, do you guys want to talk some about what you're most excited about in the SleepElite that we'll be releasing later this month? The SleepElite formula, what you're most excited about.
John Gildea: I think the biggest surprise for me was I knew that sleep is in mini hibernation, and that ended up being your blood glucose goes down, your metabolism ramps down, your digestive system turns off. That's also important, not eating close to bedtime. But the fact that taking a relatively small amount of berberine gets you prepared for your sleep and then it lowers blood glucose. So that was a first really big one for me, I thought. And we've tested. It seems to be a big player.
Martin Katz: Yeah. I'm not sure. I would say berberine is pretty big in its effect on both serotonin, dopamine and so that was exciting. These are all things that I'm learning as well along with you guys. But these are amazing things. I mean, berberine and its comparisons Metformin, as John was saying, seen decreasing blood sugar, just amazing effects. But I'm also really excited about the B vitamins. If you look at both its effect on the methyl transferase system, folate and, and its effect on homocysteine, but normally that was sulforaphane and detox, pretty important. And P-5-P (Vitamin B6) and its effect on the brain we're pretty excited about as another added benefit as well.
David Roberts: Gentle push too, so it's not a hammer, right? P-5-P being a methylated form of B6 vitamin.
Martin Katz: And I would say there's three very important B vitamins, folate, B9, B6 or P-5-P. And then vitamin B12.
David Roberts: Yeah, and in the formula we have a serotonin catalyst which is 5-HTP and, then a precursor to that is tryptophan, which is amino acid. We have some ashwagandha. And then as Martin and John mentioned, we have berberine and methyl-B6 as well as a methyl donor to help with methylating other B vitamins as well. And then some BrocElite sulforaphane, which is known to simulate BDNF, and really from what we've looked at and seen on sleep monitoring really impacts deep sleep. And that's the thing that the combo really impacts deep sleep, which is sort of the holy grail of sleep. I will say one other thing because we bought a few different formulas, looked at them. And the thing that is most shocking is how little of the actual substances are in the capsule.
David Roberts: There's one sleep supplement that I looked at 85% was pea protein [correction – actually 59%]. So we get complaints that we don't have enough capsules in the bottle, but a lot of these companies trick you and they fill their capsules with stuff other than what you think you're buying and they filled the bottle. You think okay, this bottle it seems like I'm buying more than I actually am. And so the thing that we do is we only put this stuff that we say we're putting in, in the capsules and we stuffed them in as much as we can. We did it. Because that's what we want. And one of the M-O's, modus operandi, of Mara Labs and our company is what would we want to offer our families and communities and then bring it out to you as well. And so that's, that's BrocElite.
Martin Katz: I'd say the other frustrating thing for me, David is, you know among my peers so often I hear that supplements and natural products just don't do anything. There's too many studies out there, there's too much evidence that would refute that. But part of the problem is these companies that are not putting what they should have in there. So they studied and they don't have an effect on when you're putting the goodness in. Well, that's a whole different ballgame.
David Roberts: Yeah, exactly. There's a disconnect between what's being offered on the marketplace and what's being seen in the science. And so what we're trying to do is bridge that with supplements that actually work, have a biologically proven effect.
David Roberts: So stay tuned. You guys want to say anything else about sleep, depression?
John Gildea: No I'm getting tired.
David Roberts: Need that mid afternoon nap. So thank you for listening, stay tuned. Feel free to comment below, click on the link if there are any below and, like, subscribe, and we are on Facebook and Instagram as well. All right. Take care.
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