Why Blame Our Patients for Their Own Bad Sleep?

One of the most surprising things about sleep is how little we know about it. It’s almost as though we in medicine and science have purposefully ignored it. Doctors in particular, after having to stay up all night to care for patients, know that they can’t really function without the normal amount of sleep, yet there is still heated debate about what sleep is for.  We don’t even ask our lab rats how they’ve slept because, of course they can’t tell us. But we do have hundreds of patients who can tell us how they sleep and how they feel. Why haven’t we started to ask them until recently? Over time doctors have been trained to discourage their patients from taking sleep medicines, I believe for very good reasons. But that leaves the patient only two choices; the fear and stigma of addiction or the horrible feelings of being tired, grumpy and discouraged every day.

So, one of the blocks to learning about sleep is that we doctors and scientists are humans too. We have shared human assumptions like “it’s natural to sleep”, so why even think about it?The main reason to think about it is that most of the world now has sleep issues. We were wrong to assume that we would just continue on sleeping normally. Now it is more “normal” to wake tired or to have trouble sleeping. The Center for Disease Control is now recognizing this as a major health need that is not being met. www.cdc.gov/features/dssleep/ . And, it is a global issue. It began in developed countries but is now showing up in undeveloped countries as well: www2.warwick.ac.uk/newsandevents/pressreleases/global_145sleeplessness_epidemic146/

Unfortunately, sleep apnea was first described in obese individuals. So the general trend has been to blame the patient. We are taught that obesity is a disorder of “self-control”. That being fat is an undesirable personality trait and if one “tries harder” weight loss is easy. Although it is true that self-control helps us to lose a few pounds this is not the whole story for people who are truly obese. Both appetite, and how much fat we store are controlled by the intestinal bacteria, not by the person eating the donut. Hunger, like sleep is actually involuntary. But, since we doctors know little about how hunger is controlled we blame the patient.  Many of my patients have struggled for years to lose weight. They tell me that they eat less than other family members and still don’t lose. We don’t want to believe them because then we have to open our minds to other possibilities. Could sleeping badly tell the body that it needs to store fat? Could a low vitamin D level or some other hormone we don’t really understand yet be ruining this poor person’s life? Could their poop be wrong? I mean really, who would ever even think of that?

The “fat neck” explanation of sleep apnea has reigned for 20 years. This has had two very bad results:  we have attached “shame”, to something that is actually a brain cell malfunction AND we completely missed apnea in normal weight individuals. My headache patients didn’t look anything like what I had been trained to look for so the idea that they might have sleep apnea wouldn’t have occurred to me. It is now quite clear that apnea is not because the neck is fat. That allows us to at least wonder: “Could there be another cause and therefore a different treatment?” Once we become brainwashed by the idea of CPAP masks we stop wondering if insomnia shares anything with apnea. They are both about sleep, could they be related? See the Vitamin D Hormone page or Sleep page to see how all sleep disorders are related.

Why Autism is linked to Insufficient Deep Sleep.

Sleep is of two types: “light sleep”, and “deep sleep”. During the two phases of deep sleep we are paralyzed. Deep sleep can be either Slow Wave Sleep, (the brain waves that are measured from the scalp during this phase appear in a slow rhythm), or Rapid Eye Movement (REM) sleep where our eyes are moving back and forth in a regular rhythm. Based on my patient experience, those who have less deep sleep than their body needs, wake up feeling tired. This suggests that we only repair our bodies during deep sleep.

Our bodies, and all of our individual cells do different things during the day than they do while we’re sleeping. During the day we use up our chemical stores. During the night we make repairs and make and store the chemicals we will need to function properly tomorrow. Surprisingly a fat cell, taken out of the body and grown in a dish, still knows what time it is. The cells grown in the dish still make certain chemicals during the day and different chemicals at night. This has been found to be the case for many other cell types as well.

We know that growth hormone is only secreted during slow wave sleep. This means that children only grow during that specific phase. If they don’t stay in slow wave sleep long enough they don’t grow normally. All children must also develop their brain while they sleep. So if the time spent in deep sleep is shortened the brain must decide what aspect of development to abandon. Based on the astounding increase in autism that has occurred in the last 20 years, the brain appears to leave off the normal development of social interaction. What we call “autism” refers to social awkwardness, an inability to recognize social cues and interactions that are very important for normal humans. Humans, like all primates, are inherently pack animals who are very sensitive to status, we can survive without those skills but our ability to mate or interact in community is very limited without them. We have seen a significant rise in the incidence of autism during the same time that sleep disorders have become epidemic. There is also quite a bit of literature linking vitamin D deficiency to autism. Based on my patient experience the brain still remembers what it is supposed to do, therefore given back the time in deep sleep and the necessary raw materials, the brain can make up for the deep sleep it missed and develop these skills even in teen years.

“Not a Morning Person” is actually an important sleep disorder !

Most children with milder sleep disorders just have a hard time getting out of bed.  That inability to wake up means the brain has really not finished what it needs to do, biologically the brain wanted to sleep until 10:00 am to finish last night’s tasks. More severe sleep disorders present as children who can’t fall asleep or can’t stay asleep. Bed-wetting means that the child is not getting into deep sleep to make anti-diuretic hormone, a hormone that limits our urine production during sleep, so we won’t have to get up and interrupt our period of repair. That hormone is only released in deep sleep. Children who cannot get into or stay in deep sleep make too much urine and wet the bed.

Over the last 10 years there has been a significant increase in gender dysphoria. This means feeling as though one’s “gender” does not match the sexual organs one was born with. Though babies are born with male or female genitalia the sexual development of the brain is dependent on the release of sex hormones during deep sleep throughout childhood.  Sexualizing the brain to match the genitalia is a nightly, chemical event that is followed by the pubertal physical changes that make us recognizably male or female. My patient experience has shown that teen boys who still have a feminine body shape, once sleeping normally, can transition to a masculine body shape even after significant pubertal delay. So both the social interaction and the body shape are determined by having the right amount of deep sleep during childhood.

Yes, Your Poop Bacteria Can Affect How Well You Sleep

How could our intestinal bacteria affect our sleep? The bacteria actually make chemicals that we steal from them in order to sleep normally; those chemicals are called the B vitamins. (And, those of you who don’t like vitamins and are about to skip this part, you do need to understand this or you will never sleep normally, or fix your headaches, or get out of your doctor’s office.)

The B vitamins are 8 chemicals that our bodies are unable to make. They were first discovered as bacterial “growth factors”, chemicals that had to be added to the petri dish to grow bacteria. Bacteria had just been discovered and scientists were experimenting with how many different types of bugs they could find and name after themselves. Just like making beer or bread, the recipe had to be just right. They discovered that the same yeast preparation we cooked with would encourage specific bacteria to grow. There were actually bacteria already in the yeast preparation, and those bacteria were making chemicals that other bacteria liked and needed.

Eventually the scientists figured out that our human cells needed these “growth factors” too. We couldn’t live without them but we couldn’t make them ourselves. (Which a bit odd when you think about it,  every cell in our body needs this chemical to run properly but we can’t make it ourselves? Sort of bad planning!) For humans they called these chemicals “vitamins”, instead of growth factors. Once they got around to purifying the different chemicals they started naming them the “B’s” because they came after vitamin A was named.(duh!) Several chemicals were eventually grouped together as “B vitamins”, partly because some came from the same yeast broth, partly because they were all water soluble but also because they seemed to need each other to do their jobs. There were originally more than 8 (thus cyanocobalamin was named B12) but some,  B4, B8, B10 and B11 that were originally numbered eventually lost their status as “vitamins” because it turned out we could make them ourselves after all, so now there are only 8 B vitamins.  They are numbered and named, which makes the whole thing very, very confusing! Thiamine is B1, riboflavin B2, niacin B3, pantothenic acid B5 , pyridoxine B6, biotin B7, folate B9, and cyanocobalamin B12. You do not need to memorize this, you just need to know that they were meant to come together as an “eight-pack”, the 8 chemicals work together. We learned about how these chemicals work together from the study of bacteria. Bacteria need these chemicals to make energy and grow, just like we do, and there are certain bacterial species that can make some of them but not all of them. The only one we can make ourselves but is still considered a vitamin is niacin (if we have protein in our diet we can make niacin from tryptophan).

The first microbiologists (study of tiny, living things) found that there were bacterial species that could make riboflavin, B2. The bacteria made it for their own use but also released it into their surroundings. Next, they discovered that the riboflavin-producing bacteria wouldn’t grow by itself in a petri dish because it couldn’t make folate, B9. But if there was a second type of bacteria, that did make folate (but couldn’t make riboflavin), and the two were grown together, they could trade riboflavin for folate and both would be happy. Because of their shared needs the two types of bacteria appeared together and were said to have a “commensal” relationship; they each benefited from the presence of the other.

Now, back to our intestinal bacteria……The reason why the same foursome of bacterial species is found in every human with a “healthy gut” all over the world, is because each of the four makes at least one B vitamin and needs other B vitamins that the other three make and share. In other words, they need each other. They are a “commensal foursome”. And, they are secreting those vitamins into our intestine, making a sort of “B vitamin soup”. Picture all those little bacteria happily growing in their vitamin soup, which happens to be inside us!  Why did they desert us? They were so happy in there, and we needed them!  They deserted us because we stopped giving them what they needed from us, they need our vitamin D. We give them vitamin D, they give us B vitamins, everybody wins, we’re both thriving and happy! We had a commensal relationship with the bacteria in our intestine. Then, oops….. we go inside, stop making vitamin D on our skin from the sun and we can no longer provide our side of the bargain. The good guys are now slowly replaced by bacteria that don’t need vitamin D. Now we have the “wrong” bacteria and all the bad things associated with that “wrong” bacteria; irritable bowel syndrome, multiple allergies, or autoimmune diseases. The B vitamins don’t really come from the food, they come from the normal bacteria inside us. It has been that way since the first multi-celled organisms evolved with bacteria in their gastrointestinal track. There was never any reason for us to make the B vitamins because we always carried our source inside us! Read more at: Why the American Diet does not deserve all the blame

Healthy Bacteria Healthy Sleep


At the same time that sleep problems have become more and more common our gut bacteria have also been changing. The four healthy bacterial species; Actinobacteria, Bacteroidetes, Firmicutes and Proteobacteria have been shown to appear spontaneously in babies by the time they’re 3 months old. How do they get there? (That baby is not taking probiotics!)  As the baby is born he passes through the birth canal and gets covered with mom’s bacteria. It is not just breast milk that helps build a healthy immune system for the baby. We now know that the right bacteria living on and in us play a very important role in protecting us from the “bad” bacteria. Because the healthy foursome of bacteria needs our vitamin D to thrive, if mom’s vitamin D level was too low during her pregnancy she only has the “wrong” bacteria. That means she only has the “wrong” bacteria to pass on to her baby and he starts his life at a disadvantage in both his digestion and his immune system. Our normal bacteria are able to dissolve certain starches in mom’s breast milk. Without those bacteria the baby is unable to break down and use those starches. That suggests that the normal bacteria help baby’s nutrition even while he’s feeding on mom’s breast milk. The normal bacteria have the same effects for adults. They help our digestion, our immune system, and also…. our sleep.

Probiotics in pill form are just purified poop bacteria.  Despite their widespread use, they have not been successful in bringing back the healthy foursome. You can supply the “right” bacteria every day but if you don’t provide what they need to flourish they will not grow to replace the bad guys. It is not the supply of bacteria that’s the problem, it is the intestinal environment. We should think of the intestinal environment as a petri dish (as pictured above). We have to provide the friendly bacteria what they need in order to flourish. If we provide the right raw materials they will grow to replace the “wrong” bacteria and we’ll have a healthy gut again. When we don’t make enough vitamin D on our skin, we don’t have “extra” to pass on, in the bile, to the intestinal bacteria. Instead we suck up every little bit of it for ourselves. If we have enough vitamin D to share with our bacteria it favors their growth over the “bad” bacteria that don’t need vitamin D. The normal foursome of bacteria also needs other vitamins that you will need to learn about to have a healthy gut and healthy sleep for the rest of your life.

Those of you who are saying to yourself, “This doesn’t apply to me, there’s nothing wrong with my gut”, if your sleep is not right, your gut is not right. Even though you have no belly symptoms now you will still benefit in the long run from understanding why I will ask you to do certain things to help you sleep normally again. So this part is still important for you to learn. Go to the blog:Yes, Your Poop Bacteria Can Affect How Well You Sleep to learn how the gut affects the sleep.


More Repairs, More Vitamins

While we are in deep sleep we make repairs. Every repair requires vitamins. Every cell in our body uses the B vitamins to make energy. Some B vitamins are used to make proteins or nucleic acids that repair our DNA. Vitamin D goes into the nucleus of the cell and tells it to make specific proteins. To repair every organ we have to repair every cell. We make cell membranes, cellular scaffolding, cellular transport systems. We repair every organ in every cell. To give you an idea of what is going on inside your cells go to:


The Walter and Eliza Hall Institute of Medical Research has sponsored a beautiful, animated video about the complexity of our cells, showing you just how complicated their daily life is. When we don’t stay in deep sleep long enough, we put off repairs. Every night that we don’t sleep normally our brain makes a list of everything that we’ve put off. When we return to deep sleep we will need enough vitamins to make all the repairs that we put off. Once there are many months of normal sleep and all the “extra repairs” have been successfully made we arrive at “normal, nightly maintenance”. At this point the amount of vitamins used every night will be less and we will need to reduce the supplements. (See following blogs about what happens when we take more B vitamins than we need.)

In the patient examples given in the blog  “Vitamins Can Hurt You”  both Steven and Evelyn have vitamin D blood levels of 20 ng/ml, but their stories are very different. Because Evelyn has been sicker longer it might take bigger vitamin D doses for a much longer period of time for Evelyn to get her D level up to 60 ng/ml. When Steven got his D level to 60 ng/ml he started to sleep better right away, but Evelyn’s sleep switches have been D deficient for so long that they have many repairs to make, and it will take much longer for Evelyn’s sleep to become normal, even after her D level is 60-80 ng/ml. She is much more likely to require a CPAP mask or an oral appliance or sleeping pills to coax her brain into normal sleep. Then, once the sleep switches are fully repaired she may need to lower the pressure on the CPAP machine or lower the dose of the sleeping medications.

In order to use the techniques described in this book you MUST be able to do vitamin D levels frequently. YOU must observe your own body and make records of what you did and what blood level resulted. (Your doctor does not know this material, so you cannot rely on his or her help. Even the vitamin D “experts” disagree on the “right” blood level.) The vitamins are only a part of the picture and none of the information on this site will fix a person who isn’t willing to put in many months of commitment.  There’s work involved, learning about your own body and responding to what it’s telling you.


Vitamins Can Hurt You!

Vitamin D is a hormone, not a vitamin. You would never dream of taking a neighbor’s thyroid pills or insulin or prednisone on a whim. You should think of vitamin D in the same way. Just because vitamin D is available without a prescription does not mean that the powers that be really know what they’re doing or that it could never hurt you. Vitamin D can potentially kill you! Take it seriously!

Vitamins are not benign pills that you can impulsively start, all of a sudden, when you get inspired: “I’m going to get healthy this week”. Supplemental vitamins are useful if you’re deficient, but they can be dangerous if you don’t need them. They are helpful to get your body to the right place but once you’re there if you continue supplementing, (for instance, still taking D while you’re lying on the beach in the summer), you will get worse! When your D gets too high you will have sleep problems again. If I can convince you that a low D level steals away your deep sleep and can make you sick then it makes sense that stealing your sleep away with a high D level will also make you sick. (And, it will feel just the same on the high end as the low end.) That means if you happen to go too fast, from a D level of 20 ng/ml to a D level of 95 ng/ml in a month or two, you will not feel any different. This is not a concept that you’ve seen before but it is exactly what happened to many of my patients before we learned how to use vitamin D to get the best results.

For my patients the Vitamin D blood level that brought “great sleep” was 60-80 ng/ml. The majority of my patients could eventually tell when their D level “wasn’t right”. But, it was still hard to know whether “not right” meant below 60 or above 80. It is keeping the vitamin D blood level in the “level to thrive” (60-80 ng/ml) AND using every other tool available to keep the sleep as perfect as possible that reverses disease. In other words it took you a long time to get here and depending on what’s wrong with you it may take a long time to fix everything.

The “correct” dose of vitamin D is unique for each person. YOU must determine your vitamin D dose based on YOUR blood levels! Also, the amount of extra D that a person needs slowly goes down, over years. It seems that the amount we need daily is related to the amount that we use. In my opinion, after doing thousands of blood levels in thousands of patients, it appears that we use more D when we make more repairs.


Steven is a 17 year old who presents in May for daily headache. He has never had sleep issues before but started to have trouble falling asleep last December. He has awakened with a headache every morning for the last two months. For two summers he was a lifeguard at a local swimming pool but last summer he got a “real job” packing boxes at a warehouse. Last summer’s job paid better but because we make D on our skin in the summer and use it up in the winter he ran out early. His level went low in December and he stopped sleeping and after three months of reduced REM sleep he started to have headaches. His stores of vitamin D were not enough to let him sleep normally all the way through to the following summer. Steven’s D level in May is 20 ng/ml.

Evelyn is a 49 year old with lupus and ulcerative colitis who has not slept normally since childhood. Evelyn’s D level in May is 20 ng/ml, even though she has been taking 2,000 IU of D for the last three years at her doctor’s insistence.

Both Steven and Evelyn have D levels of 20 ng/ml but they will need different doses of D for different spans of time before they get better. Evelyn has 49 years of incomplete repairs, she will need to be very attentive to her sleep for many years before her immune system behaves normally again. Steven will get his D level back up to 60ng/ml, he’ll start sleeping normally again and if he pays attention to getting as much sun exposure as possible this summer (without sunburn) he will probably not need to supplement further.

What is Healthy Sleep?

You know what sleep is, right? Sure you do, because all of us sleep.  Actually, most of us sleep. There are people who don’t sleep, and those people are aging faster. They’re dying faster than the rest of us. What’s really sad is that they feel like they’re dying. They’ve asked for help, but we don’t really know why they don’t sleep, so we can’t help them. There are also people who sleep but stop breathing. Those people have “sleep apnea”. Most of us have heard of them, and the “masks” they wear at night. We’re either related to them, sleep next to them, or are wearing one of those ourselves. The masks do help but they don’t really cure the  problem; we’re not supposed to stop breathing while we’re asleep. That’s a big problem!

There are also lots of people with sleep difficulties that have been completely ignored.  “I sleep fine but I’m still tired in the morning”, “I sleep fine” but “my memory is lousy”,  “ I sleep fine but I have a headache every day”, “I’m in a bad mood every day”. They’ve been ignored because we have no idea what to do. We focus on the headache, the mood,  the memory,  and make pills for them, but the problem is really the sleep. A healthy, happy person has healthy sleep every night. That healthy sleep means no medical problems and no pain. Take a pill for a medical problem? You’ve  had to start relying on outside help. That means your repair last night was not normal. It’s not that using outside help is wrong, but it is a message; “You’re not sleeping normally.”

We’re all miraculous “self-repairing beings”. Every night we’re supposed to get into deep sleep and repair everything. All the tools our cells use to do their individual jobs for us are made at night and stored. And, they  have to make enough stuff to last 18 hours! We need enough insulin to match the sugar we eat, enough serotonin to keep us content and curious, enough adrenaline to keep us alert and safe on the drive home. If we run out of insulin by 10:00 am we need a doctor to give us insulin, because we’re “diabetic”, if we run out of serotonin we’re given an antidepressant. They’re all just replacements for the chemicals we used to be able to make ourselves.

While we’re sleeping all the moving parts of our body get repaired too! Tendon fibers that broke when you lifted that suitcase re-make themselves. Lubricants in your joints get topped-up. Muscles that you ripped mend themselves. In order to make those repairs all of our moving parts have to get paralyzed. If you get paralyzed just right, every night, the repairs get done and you wake feeling great, physically and mentally! But what if we are unable to enter into and stay in deep sleep? What if the paralysis gets goofed up and we get “too paralyzed”, what happens then?

Sleep apnea is not due to being fat or having a fat neck. It is the result of being “too paralyzed” during deep sleep. Sleep apnea was first noticed in fat men.  We really had no idea why it was happening, but it seemed logical that it might be their “fat necks” getting in the way. Now we know that obesity and sleep apnea may come together, but fat is really not the cause of the apnea.  Both problems started to show up a lot more frequently in the early 1980’s as air conditioning and sunscreen changed us from “outside humans” into “inside humans”. Over the last forty years sleep disorders  are everywhere! They’re just as common in children as they are in adults, and they’re all over the world.

We have always lived outside, in the sun. We rely on the sun as much as plants do. Turns out we need the sun to have healthy sleep.  I will teach you how to use the hormone, vitamin D, that comes from the sun, to go back to repairing normally. RightSleep® is what I’ve called it. It’s a process that includes both advice and vitamins to get you back to sleeping normally. You can learn about RightSleep® on this site and you can schedule an informational session with me if you still have questions. Read further at: What if Your Poor Sleep is Not Really Your Fault?