Dr. Aaron Hartman: “Quality over Quantity”

Quality over Quantity, sort of. The total time in bed is not the most important thing — rather the amount of quality sleep. If you’re in bed for 10 hours, but only sleep four hours, that is not as good as someone being in bed for six hours and getting five and a half hours of quality sleep. […]

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Quality over Quantity, sort of. The total time in bed is not the most important thing — rather the amount of quality sleep. If you’re in bed for 10 hours, but only sleep four hours, that is not as good as someone being in bed for six hours and getting five and a half hours of quality sleep.

Getting a good night’s sleep has so many physical, emotional, and mental benefits. Yet with all of the distractions that demand our attention, going to sleep on time and getting enough rest has become extremely elusive to many of us. Why is sleep so important and how can we make it a priority?

In this interview series called “Sleep: Why You Should Make Getting A Good Night’s Sleep A Major Priority In Your Life, And How You Can Make That Happen” we are talking to medical and wellness professionals, sleep specialists, and business leaders who sell sleep accessories to share insights from their knowledge and experience about how to make getting a good night’s sleep a priority in your life.

As part of this interview series, we had the pleasure to interview Dr. Aaron Hartman, MD.

Dr. Aaron Hartman is a Board Certified Family Medicine and Integrative and Holistic Medicine practitioner and published clinical researcher who helps people with chronic issues restore their health. After adopting kids with special needs, he began to realize that our healthcare system, into which he had invested decades of his education and career, did not offer many answers for his children. He began to pursue training in functional medicine to help his family, and now uses that training to empower his patients with the information and resources they need to harness their own bodies’ power to heal.

Thank you so much for doing this with us! Before we dig in, our readers would like to ‘get to know you’. Can you tell us a bit about your background and your backstory?

I first discovered my love of medicine at 8 years old, when our family doctor made my strep throat go away. I witnessed him do his job, heard him talk to my mom and I thought, “I could do this!” In tenth grade, when “LA Law” was popular, I briefly entertained becoming a lawyer — until my science teacher, Mr. Smith, told me my pursuit of law would be a great loss to science, and I took his comment to heart. After finishing medical school, I served in the United States Air Force where I was deployed and held several positions both in the US and abroad. I ultimately earned the Meritorious Service Award, which recognizes distinguished service during my active duty commitment. This experience was extremely valuable and I truly believe it set me up to take on the challenges to come later in life and in the medical field.

Can you share a story with us about what brought you to this particular career path?

Before my honorary discharge from the military, I met (and later adopted) my first daughter, who has Cerebral Palsy (CP). Anna was a patient of my wife, Becky, a pediatric occupational therapist. Meeting Anna led me to question medical authority, and changed the course of my family life and professional life. I decided to pursue training in integrative and functional medicine — and I wouldn’t change a thing.

Similar stories played out again when we adopted our second daughter and our son. A lot of the developmental issues related to our kids’ birth histories have been treated through an integrative and functional medicine approach.

Can you share with our readers a bit about why you are an authority in the sleep and wellness fields? In your opinion, what is your unique contribution to the world of wellness?

Sleep and wellness are foundational principles of functional medicine, which emphasizes the whole person and individualized health care. This is what sets us apart from traditional medicine. As a certified Functional Medicine Practitioner and board-certified Integrative physician, I am trained for the areas of wellness and whole body health — including sleep.

Sleep is one of the five pillars of functional medicine (along with diet, exercise, stress reduction, and meaningful relationships). These pillars are the foundational non-negotiables for those who want to live healthy, happy lives.

My unique contribution to the world of wellness is my ability to take on “hopeless” cases that other doctors might have given up on, and spin them into success stories. The challenge of taking on those struggling with chronic illness and finding the root causes of those illnesses in each individual is something I am very passionate about — and seem to have a knack for. Because I’ve seen similar situations play out with my own wife and children, I don’t want anyone to suffer from a chronic illness or ailment that might actually have a fairly simple solution.

Is there a particular book that made a significant impact on you? Can you share a story or explain why it resonated with you so much?

There are so many books I’ve read that have impacted me, but the two biggest ones are Soil and Health by Sir Albert Howard and Nutrition and Physical Degeneration by Weston A. Price.

Both of these books address the importance of our environment on our health. Sir Albert Howard was an entomologist in the era immediately following WWI, whose field of expertise was insects, bacteria and fungus and how they affect crop production. He saw the beneficial health effects in both man and beast in areas with good soil care practices — and noticed the chronic illness in man and beast in areas of poor soil. Weston A. Price, a mid-twentieth century dentist, tracked how a westernized diet and lifestyle was related to a whole host of chronic illnesses. Both of these pioneers taught us that the environment — and the food you eat — are the biggest factors that determine your health and longevity.

The intricate dance between fungi, the soil, the plants that grow in the soil, the animals who eat those plants and our own health is outlined in these two masterfully written books. The concepts fall nicely into the world of functional medicine where we look at the whole person, the whole environment, and how it affects health and wellness.

Do you have a favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life or your work?

“For every complexity there is an answer that is simple, neat and wrong.” H.L. Menchen

For me, this quote applies to the intersection of conventional medicine and functional medicine.

In my traditional medical training, I was taught to look for one simple thing that explains a patient’s complaint — and once you find that, you have the solution to a patient’s illness. In functional medicine, however, we learn that we are complex humans, not complicated machines. As living organisms, we are a sea of metabolism and biochemistry and trying to find the one simple diagnosis or treatment for complex diseases, in our age of medicine, no longer works.

I see it all the time in my clinic where people with 10, 20, 30+ diagnoses come to see me and no one has done testing on nutrients, or checked their home for mold, or delved into their personal trauma, or even asked what food they ate in the last week. They were given syndrome names, diagnoses and treatments. But no wellness, no wholeness, no improvement in their overall health status was made.

Ok, thank you for all that. Now let’s move to the main focus of our interview. Let’s start with the basics. How much sleep should an adult get? Is there a difference between people who are young, middle-aged, or elderly?

The amount of sleep the average person needs can vary a little bit. Factors like stress, or the kind of work the person does, can impact this. Our need for sleep also changes as we age. Here’s a little breakdown of what’s recommended per night:

  • Infants: 16–18 hours
  • Elementary Aged Children: 10–12 hours
  • High School students: 8 ½ to 9 ½ hours
  • Adults under 60: 7 ½ to 8 ½
  • Adults 60+: 6 hours

Is the amount of hours the main criteria, or the time that you go to bed? For example, if there was a hypothetical choice between getting to bed at 10PM and getting up at 4AM, for a total of 6 hours, or going to bed at 2AM and getting up at 10AM for a total of 8 hours, is one a better choice for your health? Can you explain?

Quality over Quantity, sort of. The total time in bed is not the most important thing — rather the amount of quality sleep. If you’re in bed for 10 hours, but only sleep four hours, that is not as good as someone being in bed for six hours and getting five and a half hours of quality sleep.

Early to bed. The amount of sleep you get before midnight is more optimal than the sleep you get after midnight — as you tend to get deep sleep and REM sleep in this earlier sleep time. So you want to go to bed closer to the sunset and not closer to sunrise. This means people who go to bed late — even if they get a full eight hours of sleep — are not going to get the same quality of rest, though they may get the same hours of sleep.

There is also the issue of how much REM and deep sleep you get. REM sleep is when you cement the memories from the prior day. Deep sleep is when your brain and liver do most of their detoxification work and your immune system reboots for the upcoming day.

Time to Detox. Discussion around the concept of the brain detoxifying itself and having its own lymphatic system has only started in the last several years at the University of Virginia. This system is called the glacial lymphatic system. When you get to the deepest parts of sleep, this system actually improves flow of lymph fluids in your brain, and the cells in the brain ramp up detoxification. Without an adequate amount of sleep, your brain does not detoxify quite as well, making you at risk of everything from degenerative neurological conditions to immune disorders and more. Just one more reason why adequate, high quality sleep is critical for health and wellness.

Always ask yourself: Am I getting the right amounts of the right kind of sleep at the right time?

As an expert, this might be obvious to you, but I think it would be instructive to articulate this for our readers. Let’s imagine a hypothetical 35 year old adult who was not getting enough sleep. After working diligently at it for 6 months he or she began to sleep well and got the requisite hours of sleep. How will this person’s life improve? Can you help articulate some of the benefits this person will see after starting to get enough sleep? Can you explain?

For a typical 35-year-old adult, I typically see significant improvements in overall performance, both in one’s personal and professional life. There are noticeable boosts in their memory, energy levels and ability to be attentive to loved ones. Productivity and the ability to manage a variety of tasks, doing more quality work in less time, and staying focused also increases. In other words, one’s life will improve profoundly.

The tired, fatigued, professional mom, the dad who forgets appointments, the person who has a hard time remembering things or can’t stay focused — are all results of poor sleep quality. The mid-30s tend to be an especially busy stage of life, and the way we function in our daytime life is fed by nighttime sleep quality.

Many things provide benefits but they aren’t necessarily a priority. Should we make getting a good night’s sleep a major priority in our life? Can you explain what you mean?

Quality sleep has to be a priority. If you want to have maximal health and vitality, there’s really no way around it. It ranks up there with diet, lifestyle, exercise and stress reduction — these are the basic things that, if you don’t do well, feed into everything else in your life, including your mental, physical and hormonal health.

A few examples of ways we know sleep adversely affects your mental health and your physical health. There have been experiments with military recruits, where they were forced not to sleep for two weeks. At the end of two weeks, they became mentally unstable. One of the ways a neurologist will see if someone has seizures is to do a sleep-deprived EEG. Sleep deprivation lowers the seizure threshold and if someone has a seizure disorder, it pops up.

Sleep is also important for testosterone and estrogen production and other hormones (like thyroid). Hormonal health requires your brain to be recharged and your body refreshed with good quality sleep.

The truth is that most of us know that it’s important to get better sleep. But while we know it intellectually, it’s often difficult to put it into practice and make it a part of our daily habits. In your opinion what are the 3 main blockages that prevent us from taking the information that we all know, and integrating it into our lives? How should we remove those obstacles?

In my opinion, the three main blockages that prevent us from getting a good night’s sleep are (in no particular order):

1. Distraction: We say we want to be healthy and be high performers, but we’re distracted by our daytime goals and don’t focus on the essentials: delayed gratification versus immediate gratification. Sure we can skip a night’s rest to study longer, or cut off hours of our sleep so we have more time to work — but is that really what’s going to benefit us in the long run? Every career-driven person is guilty of this. Consistent quality sleep is essential for performance, so opt for rest over working late to help focus on that delayed gratification goal.

2. Technology: This has become so widespread and has major negative effects all its own. Not only does tech offer up a distraction that keeps us from even attempting to fall asleep, but stimulating blue lights from TVs, computers, phones and tablets activate our brains and make it difficult to shut down when it’s time for rest. All tech should be shut down at least two hours before bedtime (this means no email or work of any kind), and the hour before bedtime should be as calming as possible. No arguments or controversy of any sort.

3. Stress: Who’s not stressed these days? Daytime stress bleeds into the evening. If you wake in the middle of the night shortly after falling asleep, that’s the morning intruding into your night. This is common for people who have lost touch with nature and the daytime/nighttime cycles of their body. So getting in tune with your body and working on stress levels during the day are things that we all need to do in order to maintain good sleep patterns (and our general well-being).

Do you think getting “good sleep” is more difficult today than it was in the past?

Most definitely. One enormous factor for this is that modern-day technology exposes us to light earlier in the morning and later at night, messing up our natural circadian rhythms. The average American is now sleeping about six hours a night, compared to the eight and a half we were getting in the early 19th century.

Also, our current culture doesn’t value sleep. It values the “work hard, play hard” mentality. The all-nighters. Sleep deprivation is seen as a badge of honor.

Ok. Here is the main question of our discussion. Can you please share “5 things you need to know to get the sleep you need and wake up refreshed and energized”? If you can, kindly share a story or example for each.

1. Don’t sleep in. Getting up at the same time every morning sets you up for going to sleep at night. If you sleep in, you’re just pushing your “awake time” into your “sleep time.”

2. Go to bed as early as possible before midnight every night, and keep your bedtime as consistent as possible. The hours of sleep before midnight pack the most punch in terms of quality and your body’s restorative process. This will maximize your quality of sleep, allow your body to wake up earlier, will leave you feeling more rested, and sets you up for going to bed easily the next night.

3. Avoid alcohol and food 2 hours before bedtime, and no liquids 1-hour prior. Food and alcohol will affect when you go into REM and deep sleep cycles. You want to get this restorative sleep as soon as possible (before midnight) — but even if you go to bed early, food and alcohol close to bedtime will delay those beneficial cycles, robbing you of quality sleep.

4. No technology at least 1 hour prior to bedtime, if not two hours prior. This includes iPhones, iPads, and checking email. All tech activates your brain and can disrupt your sleep cycles.

5. Exercise regularly. If you have some sort of physical activity or workout during the day, it actually preps your body and mind for bed. But just try to keep said physical activity at least three hours prior to bedtime.

What would you advise someone who wakes up in the middle of the night and can’t fall back to sleep?

There are a couple of things you can try if you wake up in the middle of the night.

1. Try melatonin. Anywhere from one to three milligrams can help you to feel sleepy again.

2. Take magnesium. Magnesium, or magnesium glycinate, can have a calming effect to help get your brain back into the state of going to bed.

3. Keep a pen and paper by your bed. Some people wake up and have some good ideas racing through their mind. Taking some notes in a journal for a little bit resets the brain, so you can go back to sleep. I also have a book by my bed, so that if I wake up and I just can’t quite get to sleep, I’ll read a page or two in it — and that typically calms me back down and does the trick.

What are your thoughts about taking a nap during the day? Is that a good idea, or can it affect the ability to sleep well at night?

Napping throughout the day is generally not the best idea because it can push off the time that you go to bed at night. It also tends to be associated with delayed eating, which can also usually lead to pushing off bedtime.

One exception to this is caregivers or parents who may need to rest at times when they are not needed by those for whom they are caring, as well as those whose jobs demand they work odd hours (like firefighters, paramedics, and all kinds of shift workers). For these people, sneaking in roughly 90-minute blocks of sleep throughout the day can be helpful. They will have time to get into deep and REM sleep during these short periods. However, short cat naps that last 15 to 20 minutes should still be avoided. They may feel good, but they won’t achieve the healing physiologic responses that are required during appropriate sleep.

Those with chronic health illnesses are also candidates for daytime napping. When you are sick, your body is trying to heal, ramp up its immune system, repair broken tissue, and detoxify — and all of these actions require adequate sleep. For example, when someone has influenza, one of the reasons they get so tired is because the body’s trying to shift its energy from thinking and walking to boosting the immune system and bone marrow (which is also one of the reasons why the bones ache during certain illnesses). So listening to your body and giving it the extra sleep it needs to heal is key.

There are always examples of high producers, like Winston Churchill, who took a nap every day. But he also drank a fair amount of alcohol and worked late into the night — so he’s probably not the best role model when it comes to sleep hygiene!

Wonderful. We are nearly done. Is there a person in the world, or in the US, with whom you would like to have a private breakfast or lunch, and why? He or she might just see this, especially if we tag them. 🙂

More than a few times in recent months, my wife and I have remarked how we think we’d really enjoy sitting and chatting with Dave Asprey. There’s a lot we agree on, and probably a lot in which we could challenge one another and I think it would be a great conversation.

How can our readers further follow your work online?

I’ve created a free “Building Resilience” guide I offer to walk through the foundational concepts of sleep, diet/nutrition, movement/exercise, stress management, and healthy relationships. You can access the guide here. Our website is www.richmondfunctionalmedicine.com where I post weekly blog articles. I’m @rvaintegrative on Instagram and facebook.com/rvaintegrative as well.

This was very meaningful, thank you so much. We wish you only continued success on your great work!

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