On this episode, we explore a topic often underestimated but vital for endurance sports – sleep. In a world where nutrition and exercise usually claim the spotlight, we're here to shed light on the underrated role that sleep plays in optimizing health and fitness.
But why focus on sleep? Have you ever considered that sleep might be more influential than both food and exercise combined? The renowned Shawn Stevenson, a nutritionist and former collegiate track athlete, suggests just that.
To help explain how sleep impacts your endurance journey. we brought together Dr. Lori McGee Koch, an occupational therapist and lead coach for CES's run program, and Dr. Elise Toth from Align Modern Health, a functional medicine provider known for a holistic approach to health. Your host, Ryan Caturan, CES's lead coach at Lincoln Square and Director of Community Partnerships with Aligned Modern Health, guides this discussion.
On this episode, we explore a topic often underestimated but vital for endurance sports – sleep. In a world where nutrition and exercise usually claim the spotlight, we're here to shed light on the underrated role that sleep plays in optimizing health and fitness.
But why focus on sleep? Have you ever considered that sleep might be more influential than both food and exercise combined? The renowned Shawn Stevenson, a nutritionist and former collegiate track athlete, suggests just that.
To help explain how sleep impacts your endurance journey. we brought together Dr. Lori McGee Koch, an occupational therapist and lead coach for CES's run program, and Dr. Elise Toth from Align Modern Health, a functional medicine provider known for a holistic approach to health. Your host, Ryan Caturan, CES's lead coach at Lincoln Square and Director of Community Partnerships with Aligned Modern Health, guides this discussion.
Welcome to the Chicago Endurance Sports podcast. On this episode, we feature content from our recent seminar on sleep. A much overlooked and underrated factor in endurance sports performance. Enjoy.
Coach Ryan:So thank you everyone for joining us whether you're joining the recording or joining us live, why are we talking about sleep? I saw an awesome podcast, this nutritionist, collegiate track athlete, named Shawn Stevenson. And he's the author of the book, Sleep Smarter, says that sleep is arguably more beneficial for your overall health and fitness than food and exercise combined. Is he right? I do know that our panelists are big advocates to improving one's sleep habits, and they will help us understand and unlock a lot of the key benefits to sleep. So I would like to welcome our panelists today. I have with me the lead coach for Chicago Endurance Sports run program and occupational therapist, Dr. Lori McGee Koch. I also have from Align Modern Health, a functional medicine provider who practices out of our Andersonville and Vernon Hills locations, Dr. Elise Toth. Thank you for joining us today, both of you. And my name is Ryan Caturan. I'm the lead coach, for CES at Lincoln Square, and I'm also the Director of community Partnerships with Aligned Modern Health. And if you're not sure of what Aligned Modern Health is, we are an integrative health and wellness company here in Chicagoland. We have 18 locations where we practice all four services of functional medicine and clinical nutrition, chiropractic physical medicine, acupuncture and cupping and the hurts so good clinical massage therapy. We take a non surgical non pharmaceutical approach to the medicine we practice and, our approach is always to get to the root cause and treat from the root cause out. So if you ever need us, we're around the Chicagoland area. We also do practice via telemedicine for functional medicine. Alright, so let's start here. Doctors, how many people would you say lack in sleep and quality of sleep? I'll leave it out there for both of you.
Dr. Elise Toth:That's always one thing I ask in my new patient intake. I'm like, how was your sleep? And they're like, what? That's always the pause. I'm like, okay, let's talk about it. So I would say in my experience, it's very rare that someone comes in, they're like, I sleep great, fall asleep, great stay sleep, great, feel amazing when I wake up. That's the minority in my experience.
Coach Lori:I was trying to put a percentage on it and I think she nailed it. It's more than less. Even if people tell me oh I have no problems falling asleep, they will still report to me that they're not actually getting the recommended hours of sleep.
Coach Ryan:Yeah, absolutely. Would you even say that, even if someone says that they, yeah, I sleep well, if we ran tests on them, it would say otherwise? And what percentage would you throw out there?
Coach Lori:Of who does not probably get the recommended quality of sleep?
Coach Ryan:Yes.
Coach Lori:Probably 60 70% of people. Wow. Now, I don't know. Yeah. Okay. Someone could Google it and find a different number, but based on, just working with athletes and working in kind of a more professional world where there's a lot of stressors going on and the people I interact with, I would say that is a number that, I think it is. And some people don't know really what quality of sleep is. So we're going to kind of talk about that today.
Coach Ryan:Dr. Koch, why is sleep so important?
Coach Lori:So it is kind of this magnificent events of activities that take we were supposed to, in theory, spend about one third of our lives sleeping, which we really do. You think about 24 hour day, you're supposed to get seven to nine hours of sleep, but it's not just that, it's a nice little time to cuddle up with a blanket and then turn off the world, there's a lot of really incredible things actually happening during sleep. This is definitely when, we talk about memories and, learning and those being consolidated. So being consolidated is basically like anything that you learn during the day, especially this is great when you're in school, those things, actually, are enhanced by quality of sleep. And it's not just like getting sleep the night before and being well rested. It's also getting the sleep quality after you learn an activity. That's what they talk about with many memory consolidation. That's where a lot of events that you learn the day before actually come together and a more comprehensible way later down the line. The mental health and physical health is huge. You can talk about Just those two aspects, for hours, but mental health wise, it's just, if you get lack of sleep, this is where, you're at a higher risk, of developing some sort of anxiety or depression or having some short term anxiety and depression because you didn't sleep very well. Your metabolism is regulated so some people gaining weight or having the ability to maintain certain weights is going to oftentimes regulated by the quality of sleep that you're getting, concentrating and attention, if you haven't slept very well, the night before, everybody kind of knows it's very hard to concentrate without getting an obsessive amount of coffee, or they just have difficulties next day. And then a lot of this when a lot of our athletes are listening, the muscle repair and recovery is huge on this. I feel like there's a lot of athletes that I have interacted with and their poor quality of sleep in general, I think it puts them at a higher injury risk, takes longer to recover. And that's just because I think we talk about the next slide stages of sleep and how those coordinate together.
Coach Ryan:Dr. Toth, same thing for you, why is that such a main question that you ask your patients?
Dr. Elise Toth:Yeah, sleep and exercise, a lot of the patients I see are athletes. And I find a lot of times that people feel the exercise is more important. So they are like, okay, I'm going to cut my sleep short. I'm going to get up and exercise in the morning and then like Dr. Koch said, they're not repairing as well, their tissues, our muscles aren't repairing as well. And the analogy that I use and people roll their eyes at it, but if you're skipping sleep to exercise, you're basically stepping over a hundred dollar bills to pick up quarters. And the first time I said that to somebody, they looked at me, they were like, oh my, yes, and so, because I mean, sleep as it pertains to muscle repair, like growth hormone, is released from our brain into our bodies when we sleep, which helps to repair, muscles, bones, blood vessels We recover from inflammation better because we know inflammation happens when we're exercising. It stimulates, like I said, muscle repair and then, the glucose and glycogen that our muscles store up and our other tissues store up, it helps to restock that when we're sleeping because if we're cutting ourselves short, we're stopping in the middle of the healing process and so we may feel a little bit better, but not that much better the next morning. We get up, we do it all again. We're like, man, why is my endurance not great? Why do I not feel recovered? It's because we cut that recovery process short.
Coach Ryan:You just dropped a quote of the webinar right there. I, that, that one hit hard. You're stepping over$100 bills to pick up quarters.
Dr. Elise Toth:Yeah, I read that somewhere I can't take credit for it. I just don't remember who exactly said it first.
Coach Ryan:Oh, well, I'm giving you credit because you relayed that on to everyone that's going to be listening to this webinar. That's amazing. So, all right, let's keep moving. Great. That was good. Okay Dr. Koch, so what happens when we sleep?
Coach Lori:Yeah, again, I kind of mentioned it's really, it's not like just your brain turns off and that's it. There's this coordination of events and it's actually defined mostly by electrophysiological activity. If you do like an EEG, it'll tell you what these certain stages are, but you hear about REM sleep and non REM sleep. It goes back and forth between like talking about light sleep and deep sleep. So there's different terminologies to do this, but when you first fall asleep, your brain activity goes into these very deep cycles. And if you look at the electrophysiological activity, your brain waves during the day are like going crazy, very fast paced, because your brain has a lot of activity going on, but at night there's this, and nobody really knows, it's still kind of a mystery of exactly what it's doing, but, it coordinates these long, slow waves of activity, and it is a coordination of events, and there's other signatures in there, and people will probably read articles throughout time and say like, slow wave sleep and sleep spindles, but all of those things have signatures and something that's actually going on. So, when you're first falling asleep to stage one, that's what slow rolling eye movement is one of the first signs of that, and probably people who have taken a really boring class or try to stay awake during somebody else talking and they're super tired or experiences. So you're kind of dozing off. It's that slow rolling eye movements, but muscle activity slows down, your breathing slows down. And then when you're actually fully, fully on a sleep, it's called more of a stage two sleep and your, breathing patterns, your heart rate slows, and then what happens is your temperature also decreases at night too. I think we talk about tips later on how to make you sleep a little bit better, but temperature plays a huge role and actually, sleep quality and, fitting into people that might have, a little bit more struggle in sleeping and physical activity fits in that body temperature too, but I think we talked about that a little bit more and then stage three is really where I'm talking about that slow brainwave activity. The thing about non REM sleep is the stronger your activity is during the day, whether it's physical activity or you put a lot of mental effort in something, there is a strong association and having, deeper quality of stage three sleep when you fall asleep. And that's where a lot of growth hormone is actually released as well. And that's where, you know, the start of the coordination of activities, while you're sleeping actually plays the role into the rest and recovery that sleep is doing for your body. Then there is a stage four type of sleep. It's also kind of related to stage three. It gets a little bit deeper. And then there's the REM sleep, 25% of the night is actually the REM sleep. So you actually do a lot more non REM activity in the beginning of the night, and then towards the end of the night, you are having a lot more REM activity, and if you look at an EEG on that, your brain activity is actually moving very fast, but your body, your actual muscle activity is almost completely paralyzed, so your muscle activity completely decreases as well. And there's just so many fascinating signatures to talk about when these stages I could go on and on. That's all going to tell you that sleep is serving an absolute essential role in everything you're doing. And it should not be neglected. I
Coach Ryan:mean, that's such an amazing answer you just gave that so much color to the sleep cycles. Let's kind of keep this going a little bit. So what are some physiological changes that happen during sleep?
Coach Lori:So yeah, so just the cognitive functioning type of thing. So, you know, if you're getting poor sleep, your learning and memory or your concentration is affected, your mood is affected. So people are many a times more irritable if they haven't had sleep. I mean, I think that's what understands that now there is different, changes in inflammation in the body as well. And so immunity can be affected by that um, You're not getting good quality of sleep. Appetite, metabolism, obviously very, very affected to, we can talk a little bit more about that. I'll tell you, Dr. Toth talked up a little bit more on those things. There are some incredible webinars out there now and materials that talk about cancer risk. So people that are not either getting the good quality of sleep or they're not sleeping at the time that our human bodies are naturally thought about. So they call that shift work. There is, many, many materials out there will tell you your cancer risk is increased significantly. And then the heart health. There is a, professor out there who served on my PhD committee in the very beginning of my PhD. His name is Matt Walker. He talks a lot about the heart health, but he has a statistic out there that for daylight savings time, that when we lose an hour of sleep, the amount of cardiovascular problems, heart attacks actually increased by about 20%, 20, 25%. And when we get the extra hours sleep, they actually decrease by a certain percent. And they also talk about car accidents and, just mindful things that happen in the morning when you lose that hour of sleep and it's just kind of a lot of research is done across the board. So it's an interesting statistics to look up for people that are more interested in that kind of work.
Coach Ryan:That is really interesting. I mean, so it is going to be a pretty good benefit when we do away with it. Daylight savings pretty soon. I think it's supposed to be coming up this next year, right?
Coach Lori:Maybe. Dr. Talbot, do you have anything else to add to that? I know that you can go into a lot of the biology as well and knowledge of with working with your patients.
Dr. Elise Toth:Yeah, so yes, actually, I'm going to elaborate on quite a few points that you brought up. So the first one, especially as it pertains to, like appetite. I know that was one of the things you brought up as far as that's concerned. So our hunger hormones versus our satiety hormone. Sleep plays a big role in both of those. We've seen research that people that get less than seven hours of sleep at night, the next morning, that satiety hormone, which is. I'm like, I always get the two mixed up. Leptin tells you that you're full. Ritalin tells you that you're hungry. Leptin gets, not overwritten, but basically it's not as sensitive. You're not as sensitive to it if you don't sleep enough. So that's why oftentimes if you're sleep deprived the next day, you're really like sweet foods, carb, heavy foods, salty foods are usually what we're reaching for. And when we feel like we're just eating, eating, eating, eating, eating, because that hunger hormone is going, unopposed and we're really not creating protein rich and fat rich foods that we know we should be and we're kind of just reaching for garbage to kind of keep ourselves going throughout the day. So that's definitely one, big thing about sleep deprivation. And also, as it goes back as like, you had brought up with heart disease when you're sleep deprived our body goes into fight or flight mode, which is fine in short periods of time. It's fine when, you know, we're threatened physically, mentally, emotionally, whatever it may be. But chronically, when our stress hormones are released, cortisol specifically, it causes our blood pressure to increase. Growth hormone gets shot off, which right if we remember growth hormone helps to repair our blood vessels. So if our blood vessels aren't being prepared, right, we have a greater risk of things building up in their atherosclerosis or hardening of the arteries. And also our cells, when there's a lot of cortisol going on, our cells aren't as receptive to insulin. And that means there's higher blood sugar going on, which could also increase our risk of diabetes. So there's, there's all sorts of crazy, studies that have been done tracking people that sleep less than six hours a night. And they found that there was a greater than three times the risk of those people of suffering from a cardiovascular or coronary event, including sudden cardiac death, which is And sometimes even just cutting an hour or two out of our sleep and I go like, not a big deal, I've got a lot of work to do I have a big paper to like, whatever, it actually speeds up the contracting rate of a person's heart, which will increase their blood pressure. It'll increase their heart rate. And even if their cardiovascular system was super healthy the day before, just like one little night of too little sleep can start to play a role on the heart, which is kind of frightening.
Coach Ryan:Yeah, that is. I know we're talking about entertaining hours out of your sleep. And, when that happens, a lot of us would tend to go to a nap and we, take these little, you know, little power naps, wherever they might be. How does that affect our sleep at night? Is that a good thing to do to take naps during the day? Is that ideal? Or, like, how do you, how do you both feel about that?
Dr. Elise Toth:Dr. Koch, I'm going to defer to you on this one.
Coach Lori:From the perspective of the athlete, I want to tell you a lot of like professional athletes, they, they eat, they sleep, they run, they eat, they sleep, they run. And the reason why they do a lot of sleeping and napping in general goes back to a point I made about the stronger, the activity you do during the day and when you fall asleep, the stronger, the evidence of you are trying to sleep very hard. I guess for lack of a better term or more deep sleep, because of all those activities. So from the perspective of the athlete, the napping component actually probably puts you in a better place when it comes to recovery and repair, of your brain, of your cardiovascular system and then your muscles. In other cultures, other cultures nap during the day, and it's totally a cultural fine activity. Our culture still, even though there is good stuff out there about, We should sleep, we should sleep. And so much education is available for us, we're in a culture where, you know, sleep seven hours a night, six, seven hours a night, and don't nap during the day because we got to keep going, going, going, going, or if you're on an intense schedule where you have a very strong goal for like Chicago and maybe you're doing two a days or something you don't think napping is going to fit in there. But napping in general in the middle of the day, for sure, I think puts you at a higher ability to help make these other, components that are obviously coming together to repair your body and make it optimal, important. So now most of us don't have time to take a nap during the day. So that doesn't really help anybody. We're like, Oh, maybe I should take a nap during the day. But, I do think it puts you in a better place. Otherwise, then you have to make sure you're falling asleep at night and getting the optimal sleep and on top of it. What other questions would you have about that? What I just said, very specifically.
Coach Ryan:Yeah, you know what, that's so very fascinating and interesting because it sounds like if you need a little bit of a power nap, it's going to be okay if we do when we do. And if you have the time and ability to do it. But there's probably a threshold where, like, there is a consequence where it will cut out from, like, your ability to fall asleep at night. Is that right?
Coach Lori:That's true. So if you did take a nap, some people would have a harder time falling asleep until a little bit later. But I think also again, just getting the good quality sleep at night as well.
Coach Ryan:That's good. Seriously, these are wonderful answers. I love this.
Coach Lori:Sometimes too, when changing in age, like children take naps all the time. The amount of sleep that children are supposed to have are very different than when we become adults, and then sleep changes quite a bit to the older you get, and a lot of the times it's not really has to do with like your sleep is technically changing. It's more about a circadian rhythm, which is your circadian rhythm and sleep. They're not really the same thing, but they coordinate together and they go in hand in hand together.
Coach Ryan:And we'll definitely dive deeper into that. But, I want to throw this out there. This one actually hits a little bit closer to home. I had a couple runs that I can remember over the last year where I was coming off of just really poor sleep. You know, I just couldn't sleep at night. It was like two to three hours went out for a run and I felt like my muscles were seizing or even feel like I felt like they were restraining a little bit. Can you tell me how our physical abilities are affected by the lack of sleep? Dr. Koch, we'll start with you.
Coach Lori:Oh, so just like the cramping, I mean it goes back into the coordination of like just there's inflammation going on in your body and then even the lack of sleep can probably even make you a little bit more dehydrated or you're just at a different disadvantage. Your cardiovascular system, again, is so affected by, changes in your sleep rhythm. So I, sometimes I feel like cramping or other physical effects that you've noticed that seem to be correlated with, I didn't sleep very well last night. It has to do with all the factors are saying that sleep is helping your body completely restore for day to day use.
Coach Ryan:Right. Absolutely. All right. I know we want to dive deeper into this, and this topic. This could be a few different times. So let's just get right into this piece. Dr. Toth, what hormones are affected by sleep?
Dr. Elise Toth:Quite a few. So, during sleep, cortisol, norepinephrine, those two, so those will help us wake up, help us stay awake during the day, and then melatonin is the opposite of that. It helps us fall asleep and stay asleep overnight. Cortisol and melatonin are opposites of each other. They both have their own role we just have to make sure that, kind of going back to what Dr. Koch said before, that's kind of how the circadian rhythm also plays a role. Not that it's the same thing, but the two kind of play into each other so that way, you know, our bodies are following correctly what we're supposed to be awake, stay awake, fall asleep, stay asleep. So cortisol is dominant during the day. It should spike about an hour after we wake up in the morning. It'll be a little bit lower right when we first wake up as melatonin is still at its highest, but that's usually when we feel a little bit groggy when we wake up and then after about half an hour to an hour we're like, okay, I feel like a human again. Things are fine. I can actually keep on going with my day. Cortisol should kind of spike, so kind slow down, be the lowest before you go to bed at night, and that's where melatonin takes over. So backtrack for a second. Cortisol is stimulated by the light. Some lights, artificial light, whatever light that is entering your eyes and hitting certain parts of your brain, it's going to stimulate cortisol to be released. Melatonin is the opposite. Darkness is what stimulates melatonin. So as the sun goes down our lights in our, houses should be following that mimicking it because with the dark same thing hits the back of our eyes hits different parts of our brain Helps us to feel drowsy helps us to fall asleep helps us to stay asleep overnight So oftentimes when things like either, you know Having we talk about blue lights a lot if we're having a lot of either overhead light blue lights Whatever shining into our eyes our brain is like, oh, hey Cool, it's daytime and it's like, no, it's two in the morning. Or if we're exercising too close to bedtime, this exercise is going to release cortisol. So a lot of times people do too late of a workout. They're like, I was amped. I was up the entire night because it throws off our cortisol curve a little bit and doesn't allow melatonin to come out when it needs to come out. And that's where on the opposite end of that, a lot of times people, they so where by blackout shades, which is fine, that's not an issue. But oftentimes we need that sunlight coming in or something to let our brain know, Hey, light is here. It is daytime. Otherwise the blackout curtains, we could sleep until noon and not have any idea because that darkness is still there stimulating meletonin.
Coach Ryan:Dr. Koch, we're just talking about lights and different blue lights and things kind of coming in. I think that makes me think of like fragmented sleep, you know, waking up in the middle of the night. One can sleep eight hours a night, but get up one to two different times during the middle of the night. How does that differ than sleeping for eight straight hours?
Coach Lori:They're having sleep disruptions.
Coach Ryan:Yes.
Coach Lori:I think they're okay. So that goes back to like when we were talking about the sleep staging and I was talking about as a coordination of events. So you're going to go into deeper and lighter stages of sleep all the time. So you do wake up throughout the night. You just might not be aware of it. But if you do wake up in the middle of the night and you can't fall back to sleep, that ends up being a problem. This plays into the circadian rhythm too. Some older adults actually have a lot of problems with the circadian rhythm. It starts. It's at one point it was called, it was deteriorating over time. And so then, and you make, you know, people make, Oh, you know, and I've gotten this age now and I wake up at four in the morning, but it is true. It's because those, coordination events, and I think it has a lot more to do with circadian rhythm than actually your sleep, breaking down, but, it's natural to wake up in the middle of the night. Now, if you're finding out that you're waking up in the middle of the night because you have to go to the bathroom three times. That could disrupt your sleep and it takes you another 20 minutes to fall back to sleep. You know, you have to address both of those problems or address that problem. Maybe you're not drinking water right before you go to bed or, you know, figure out what all those issues are. Because you definitely don't want to wake up like four times in the middle of the night and then be up for 20 minutes each time. That will disrupt sort of the coordination of events that should naturally happen while you're sleeping.
Coach Ryan:That's so fascinating because, you know, I did hear, something along the lines of like, we don't wake up from needing to use the bathroom, we wake up and by routine use the bathroom is how much truth is to that. And like, Yeah, Dr. Cook Dr. Toth, if you can bring any light to that.
Dr. Elise Toth:When my patients tell me they're waking up a lot to use the bathroom, that's essentially the question I ask, does your bladder wake you up overnight? Or do you wake up and then you're like, oh, I should probably go pee? If their bladder is waking them up, that's something like Dr. Koch said, maybe they're drinking too much water too close to bedtime. Maybe there's something going on with their bladder in, older men, prostate issues. But oftentimes I've found where if they're waking up and, they're just like, Oh, like out of habit, they're going to the bathroom. Um, it oftentimes could be something going on with their stress hormones, with their adrenal glands. It could be, sleep apnea related, you know, and maybe they have to be worked up for that, or there's different things there too. And it's funny because I'll ask patients that they're like, that's a great question. I have to stop and think about that for a second. So it's basically just finding and addressing root cause of that disruption to sleep.
Coach Ryan:So what might be some root causes to, waking up in the middle of the night like that?
Coach Lori:Well, sleep apnea, and that is one that's actually a problem that needs to be addressed. Because that means it's probably happening throughout most of the night or definitely during certain sleep stages. Cause here's another thing about sleep staging. If you keep just going back into non REM sleep throughout the night and you keep getting disrupted, you never go into REM sleep. And that's a problem because that coordination of events actually needs to happen for you to have a proper night's sleep. Here's something that's kind of fascinating too, or if you ever noticed about yourself, Have you noticed that maybe you dream, you're like dreaming, and you usually wake up out of a dream? And it's usually later in the night, but you don't remember dreams earlier in the night? If you're really sleep deprived, this happens to a lot of people, and you've had like three bad nights of sleep, and those three bad nights of sleep you kept going into the non REM activity that needed to happen in your body, and then you really finally fall asleep, your body will actually go into REM first because it needed it so bad. This is like how smart our brains and our body is and how fascinating just biology is in general. The odd can nerd out about that forever, but sometimes you might fall asleep right away and you have this like really crazy dream. It might mean that you were REM deprived. Nobody really knows exactly what dreaming is and where it goes, but a lot of times most people only remember their dreams in REM sleep. But your brain activity is kind of going crazy during that. So your body will try to repair itself I guess this is my point too, but then your circadian rhythm that does go a long line with sleep and you keep waking up to the middle of the night, all of those activities that need to happen in your body completely go off and then all your other organs are affected by it too. There is a whole science now about biological sleep rhythms and sleep. Circadian rhythm in general isn't thought to just be in your brain. It's thought that every organ in your body has its own circadian rhythm. So if Your circadian rhythm is completely off your liver has its own circadian rhythm of how it wants to operate in itself. And then when it comes to the cortisol and melatonin has its own rhythm of how it wants to operate for itself. And when those things don't operate properly, it might affect your kidneys in a different way. It might affect in each one of them. It's thought that they have their own rhythm of activity, and it all has to coordinate together for your body to work properly.
Coach Ryan:Super intriguing. Dr. Toth, it looks like you might, you might have had something else to add into in terms of, what else might be a root cause, to breaking one's sleep?
Dr. Elise Toth:Sure a lot of times, the most obvious one and the one that everybody rolls their eyes at me until, when I ask until they finally are like, oh, caffeine. Caffeine is a big one. The mistake I've made many a time where we drink caffeine just a little bit too late because we need that boost. And we forget it takes our body about six to eight hours to actually like the half life of it to actually like release it out of our bodies. And so I was the queen of this back when I was in grad school was, go to Starbucks, get the strongest coffee with whatever espresso shots I could at 5 pm for a study session. And then I had like gas I convinced myself I had insomnia. And then I was like, wait, no, I just had my coffee at 5 pm and I'm trying to go to sleep at midnight and that clearly isn't happening. So oftentimes, bringing our caffeine intake, curbing it back, stopping it around noon gives us enough time to release it from our body and that is a very simple thing that I quite a few of my patients when I have them do that, then they're like, Oh, yes, you know, I'm falling asleep better, I'm staying asleep better overnight. Different stress just going back to adrenal health different stressors whether it's work stress family stress life stress different infections. The newest thing that I've been learning more about and treating more is mold toxicity and mold also messes with your sleep big time. That's a whole other. rabbit hole to dive down on a different day, but, different things like that will also, play around with sleep, both falling asleep and staying asleep overnight
Coach Ryan:yeah.
Coach Lori:Oh, I didn't know about the mold. That's the first time I ever heard about that.
Dr. Elise Toth:Yeah, it hijacks and that's where CPAP machines. And so that's where the exposure is for people. And so there's sleep apnea is getting worse and worse and worse. And can't figure out why it's happening. And yeah, it's pretty insane. I've been taking on quite a few more mold patients recently. And, that's almost every single one of them sleep is affected in some way, shape, or form. Because the mold hijacks pretty much all of our hormones, cortisol, melatonin also.
Coach Lori:So now, I have a question for you. The sleep apnea part because there's different, there's two couple different types of sleep apnea. There's kind of like a central apnea, which is like more, about, having a neurological problem and breathing throughout the night. And then there's kind of like the mechanical problem where, somebody has gained a lot of weight around their neck or just, you know, how physically they're built, they might have some sleep apnea. So does the mold effect where it's more of like a neurological type of apnea or is it both?
Dr. Elise Toth:It could be both, just because it's basically, it's the route of entry as it's going in, like through their mask and going in through their nose and through their mouth. And so their rest of their body's now exposed.
Coach Lori:Oh, because of the CPAP machine.
Dr. Elise Toth:Correct. It's not being cleaned properly. It, it can be route of exposure.
Coach Lori:Gotcha. Okay.
Coach Ryan:I love it. I love this banter we have going on here. You know, I think we, we did touch base on this a little bit, but maybe, go back to a little bit more. What should it like a typical night of sleep look like? And then conversely, I want to add into that what about night shift work and night shift workers? How does that affect our sleep and life in general?
Coach Lori:Well, there's two loaded questions, but in general, you would sleep seven to nine hours. Some people are genetically predisposed to that they're just fine with seven hours, but I'm seven to nine hours is pretty much hits most people, you wake up at a certain time and you have a routine and then you go to bed at the same certain time, but throughout the day you have moments of like, you feel a little drowsy, that's where you get that five o'clock coffee, depending on what you're doing. If you're still at work, you're at school. and the reason why I don't give you a time is because everybody's circadian rhythm is also slightly different. You, he'll hear people that are owls or larks. Like that's a term that's used. So if you're a night, night owls, right? So some people are just naturally night owls and some people are just early morning risers. And we talk about that amongst each other all the time. It's like, I wish I was more of a morning person. Oh, I wish I could stay up at night. But that all has to do with how your circadian rhythm also plays into your day. But ultimately whenever you wake up, that's When your blood pressure is at its highest. And that goes back to the hormones that Dr. Toth talked about. And then that changes throughout the day, the melatonin. So melatonin is going to help you relax and fall asleep at night, but that's going to lower, cortisol is going to sort of go up. You have the highest alertness after you wake up, after you've been up for a couple of hours. And then you have a dip during the day where your melatonin actually goes up and it, it makes you feel a little bit drowsy. The body temperature thing is super interesting in this because it also is in more and more pieces of information that we have about when it comes to sleep and circadian rhythms, because the temperature component also can fluctuate throughout the day. And for some people temperature is not a sensitive thing for them. For other people, temperature is a sensitive thing for them. So a lot of athletes that try to work out at night and then they can't fall asleep afterwards. There is a component, is thought that is because their temperature has rised in their body. So like for those athletes, your temperature is supposed to drop a certain degree or two to fall asleep quicker and, fall asleep in a way that you're entering sleep stages more optimally. And that's why sometimes, I say, Hey, if you can't fall asleep, turn down the temperature in your room. But those things, again, they all coordinate throughout the day. What an optimal day should look like. Dr. Toth, what would you like to kind of add to all of that?
Dr. Elise Toth:I don't think anything. I think you hit everything that I was going to bring up. So fantastic.
Coach Lori:Yeah, so I was doing some research studies before we were trying to actually monitor people's temperature to see, especially it was in a rehab institute perspective, to see if, after people had some neurological illness in the rehab place that it was at, whether or not their body's ability to change temperature because of maybe like a stroke or a TBI if those changes is one of the reasons why they were not getting optimal sleep on top of it, or if we can help improve their, temperature change capacity to see if we can improve their quality of sleep, but temperature, I think has been more of a popular term or topic to talk about and, just that whole aspect of improving sleep quality.
Coach Ryan:We touched base on this earlier, you know, we live in a digital world, there's blue lights in our face all the time, right, from our phone alone to iPads, computers, TV, things like that. So, Dr. Toth, are there any tools that would you say that can help? Offset the amount of digital that's in our face.
Dr. Elise Toth:Sure. Sure. Yeah, the easiest thing I recommend blue blocking glasses so they can either be in prescription. Like I know, I got all my glasses on Zeny, I just, I like them and that's an option. You can actually select blue blocking glasses, and so if you take off the glasses and you see the light hit, you'll see it's kind of like a yellowish tint On the lens because yellow blocks out the blue, and they may have a prescription non prescription. You can buy them over the counter. There's a whole bunch of different ones out there. The other option is like with our phones, we can set it to night mode. So that way it's not as bright of tones hitting, not like the blues and the whites. It's more of like the pinks and the warmer hues, because they're not as harsh and they're not emitting the same amount of blue light as some of those other things are. There's also, the Flux app, FL. UX. You can go and you can install that. And it's kind of cool where, you can install on your computer. I don't know if there's a phone compatible version of it, but I know computers and tablets you can install that. And it actually, it will go based on what the light outside is doing, what the sun is doing. At certain times, it will start to turn everything in the background more of like a warm hue. It'll tune out more of the blue lights. And then during the day when the sun's the brightest. It will have the blue lights and the lights and all of that. So that way it also follows, sun rhythm. It's supposed to help with your body circadian rhythm as well. And that's your, we can't avoid working on our computers later on into the night. That's kind of a way that we can offset a little bit.
Coach Ryan:I love those. Those are actually tools I use. There were like game changers from my sleep habits. Dr. Toth in your practice, what are some ways that you do test for sleep?
Dr. Elise Toth:So initially, it's really part of the questions I ask in my intake. So I'll ask when we talk about sleep, I'll ask if there's any trouble falling asleep, any trouble staying asleep overnight. I like to ask what time a person goes to bed, what time do they wake up in the morning? Do they feel rested upon waking or are they still exhausted? Is their first thought, when can I go take a nap? So that's kind of, sleep melatonin, and then I'll ask kind of piggyback off of it, we'll ask about energy. So I asked, what time of the day is your best energy, what time of the day is your worst energy? As Dr. Koch said, right, best energy, most mental clarity for most people who have their circadian rhythm and their cortisol rhythm is working properly. They'll say, oh, mornings are my best, you know, usually right after I wake up until maybe about like 10 noon, depending on how everyone's body clock is shifted a little bit. Most people will say that there's like a three or four o'clock dip five o'clock. Maybe everyone's a little bit different And then I ask if they get a second wind of energy and sometimes they look at me like i'm nuts and sometimes they're like Oh, yeah, I usually get one around like 7 or 8 p. m And so those are the questions that I ask. If the answers to those questions Are something that's really really off. I refer them out for a sleep study if it's necessary because sometimes it could be sleep apnea Or, look and see if there's any medications they're taking that is possibly, interacting with their sleep. Or like I said, if I'm suspecting some sort of like an infection or a mold toxicity or something to that degree, start to, to work on that a little bit more or get to the bottom of that.
Coach Ryan:That's good. What are some devices that can help with monitoring, one's sleep?
Coach Lori:Yeah. I mean, it's impressive. If you would ask you this four years ago, I'm like, yeah, you got your watch on and he's monitoring that, but I never really believed that it was actually monitoring it properly, but I really do think that they've gotten the algorithms down. So the most popular ones that a lot of people use is their smartwatch, whether it's an Apple Watch or a Garmin or, you know, just whatever smartwatch device that is out there. It does a pretty good job of monitoring your sleep. What it's basically doing is it's monitoring your heart rate, and changes in your rest activity and how that, fluctuates throughout the night and it's also monitoring movement too. So some watches try to go down to as close as saying that they know how you've been in REM and non REM sleep and I think that what the algorithm is actually doing is earlier I talked about how when you're in actual REM sleep your body's actually kind of completely paralyzed so you wouldn't have much movement at all in REM sleep but you might actually have more movement in non REM sleep and the algorithms your watches learn what your heart rate activity looks like and what that movement looks like, through that. Other ways to monitor sleep, if you are really having, trouble with it, sleep behavioral therapists, actually do exist out there and they would have you do a sleep diary. So you would. actually write down every time you fell asleep, went to bed and what your routine actually is. But I will say the devices have gotten really nice these days to be able to manage that.
Coach Ryan:For the ones that they sell over the counter, things like the Garmin,
Coach Lori:Yeah, I actually do. I've been pretty impressed. Again, if you would have asked me four or five years ago, I'm like, I don't know if they're gonna be able to hit that, but I really do think it hits it pretty nice. There are professional grade ones that they will actually give you in sleep clinics. So typically if you went to get a sleep consult, you might go to a sleep clinic. They might say, okay, I want you to write a sleep diary down and here we're going to give you a watch. And they're usually called like Acta watches. They've existed for a really long time. But what they're really doing is they're monitoring movement and they're monitoring the amount of light that you're actually getting during the day. So then sleep professionals will actually look at the amount of light coming in, through the report because they also want to monitor where your circadian rhythm activity is and see if light is affecting that. Because Again, Dr. Toth talked about light really influences the way the rhythms of your, hormones are working with your body. And then you would go in and actually like sleep for the night and they would hook you up to all the fancy stuff. Cause I kept talking about like EEGs still the most gold standard way to monitor actual sleep is putting the electrodes on your head and monitoring the brainwave activity and breathing to see if you have sleep apnea and then they also put EMGs on your legs because there's another thing called restless leg syndrome too and monitoring muscle activity. Sleep it's complicated everybody, you get it?
Coach Ryan:In that book. I'm Sleep Smarter I believe it was a study that was done at the University of Chicago. They were talking about light and they had, you know, certain amount of lights and they were showing that even like the smallest bit, like a nickels worth of light on the back of the knee would still affect your sleep. Something crazy like that. Have you experienced anything like that or learn anything about that?
Coach Lori:Yeah. I mean, I wonder who the group is in the University of Chicago because half of my collaboration, all the sleep work I've done was University of Chicago.
Coach Ryan:I would dive back into that book or encourage you to look at that book too, because he pulls a lot of interesting studies about that, so. Dr. Toth, let's talk about how food affects sleep. How should we be eating and things maybe potentially that we should be avoiding, and how to just better optimize our sleep.
Dr. Elise Toth:So, depending on what we're eating and at what time, there's going to be certain things that affect our sleep. So, like we said before, caffeine 100% will affect sleep because the half life in the body, it takes a while for us to flush it out. Blood sugar stability is going to play a really big role in helping us fall asleep and stay asleep. Oftentimes, and I don't know if anyone else is like this, but I know I tend more towards low blood sugar. And I know that if I'm kind of hungry, like if I'm going into my room, so I do my nighttime routine, I know I'm either not going to be able to fall asleep or I'm going to be up at three in the morning starving because I didn't have enough to eat overnight, you know, before I went to bed. And so, sugar is another thing kind of going back to blood sugar stability before we dive into strategies. Sugar spike and drop our blood sugar if it's unopposed, if we're eating sweet things before bed, if we're eating fruit on its own before bed or just anything, that is just, you know, has sugar in there. So that too, it can cause temporary feeling of satiety, but then after a while, and I've had patients before too, where they're like, I cannot figure out why I'm waking up at three in the morning. There's no, I don't have to go to the bathroom. There's no stress. There's nothing going on. And I recommend them like, okay, I want you within an hour going to bed because most people recommend to stop eating like an hour or two or three before bedtime, which for a lot of people, they have stomach issues is wonderful sound advice. However, and those of us who have lower blood sugar, or, were really super active during the day. I tell those people have something with protein and with a complex carb an hour before bed. So whether it's a spoonful of nut butter or some whole grain toast with like a nut butter and banana, or I always keep my fridge, I have deli turkey, I like to wrap it up in like a pickle spear or something. Have a little bit of that before you go to bed, not to the point where like you're over stuffed and full, but enough where you're satiated. And I found more often than not patients come back to me after a few weeks, they're like, yeah, I'm not waking up at three in the morning anymore. It turned out I was just hungry overnight and that was my brain's way of telling me that I was hungry. So kind of to foods to embrace are gonna be things like lean proteins, complex carbs, have whatever it is that your preference is with that, but some sort of combination of it within an hour, going to sleep overnight so that way you can fall asleep easier, stay asleep better. It gets your blood sugar more stable overnight instead of your brain waking you up to tell you was hungry.
Coach Ryan:That's good advice supplements that you would recommend that would help us sleep.
Dr. Elise Toth:There's a whole bunch of them. So for some people, melatonin is kind of the obvious where people go to it all the time. Melatonin is great. one downside to melatonin is if we take too much of it for too long, our brain stops creating its own melatonin. And so melatonin I like to recommend on a very case by case basis. Sometimes people need it. Oftentimes people don't. A really good way to help the brain to stimulate and create its own melatonin is cherry juice. And I know that's kind of exploded a lot, on Tik Tok and then things like that. Tart cherry juice is just great because tart cherries have melatonin in them. It helps, your brain to create its own. It's also in a time flammatory, right? I know, athletes have been known about like, duh, yeah, I use it for my muscle recovery and inflammation. Like I've known about this for years, but it does help with sleep. There's been studies done, double blind placebo trials where half, it's all people that have some degree of insomnia. I don't recall off the top of my head what, you know, how severe it was, but half the group drank 16 ounces or two glasses of tart cherry juice a day for two weeks. The other half of the group drank a controlled crystallite Kool Aid, something like that. At the end of the two weeks, the group that drank the tart cherry juice, they reported back on average experiencing about 80 minutes more of restful sleep per night. Which is not nothing if you think about it, just has to be, you know, you have to be compliant with it, granted it was a self report. So there is there's definitely, you know, there's room for error there as well. It's not like the best designed study, but it's fairly good, at least in preliminary studies. Something else that's really helpful supplement wise, magnesium, going back to the restless legs, like Dr. Koch said, restless legs. I've also oftentimes found the root cause of that is low magnesium. We need it to support our nerve endings. We needed to support our muscles. It prevents muscle cramping. So a lot of times when magnesium is deficient, which oftentimes it is, if we're not eating, green leafy vegetables and things like that. You could take it orally, but I recommend magnesium spray. The Now brand sells it in like a bottle Just spraying it on your legs, feet, anything like that. I was a dancer for many years, and so I would get those calf cramps that woke me up out of a deep sleep, and I found magnesium not only helps with that, but also will help with falling asleep, help with staying asleep, and that combination of tertiary use and magnesium sprays when I start with any of my patients that come in to see me for insomnia, that's generally right where we start, and then if that doesn't work, We'll bring in things like malaria. Maybe you'll bring in some chamomile. Maybe, you know, there's other more potent herbs out there, but those are usually the two baseline places.
Coach Ryan:That's good. Other things to help, improve our quality of sleep. I think we touched base on this a little bit earlier. Dr. Toth, what temperature should someone play with, to help improve their sleep?
Dr. Elise Toth:I have a range, like a wide range, just because everybody's body is a little bit different. The range that I have that I found is between 65 degrees to 73 degrees. Now some people like to sleep colder. Some people like to sleep hotter. I myself, I like my room is at like 73 degrees because I'm the type where like I'm bundled up in my sheets and my nose is cold and I can't fall asleep versus people that I know they're like, nope, if it's not at 65 degrees, I don't want to hear about it. So that's a good place. I made this recommendation for a patient of mine earlier. She just sleeps hot. Her partner sleeps cold. Chilly pads when you're on your bed, that's kind of a nice compromise because that way one person can sleep colder, one person can sleep hotter but in the research we're seeing is a pretty decent place for the room temperature to be.
Coach Ryan:We touched base on this earlier too, hard training might not be so great, right before sleep, but are there specific times that someone should get a workout in to get better sleep?
Coach Lori:I think you can answer this question in two different ways. For some people, if it's been a part of their routine forever and they already were getting good sleep and it's completely fine for, other people, if you are somebody that is more prone to having some more insomnia type of, symptoms, then you're probably going to want to get your workout in the morning. Because, if you're somebody that likes to go to bed a little bit earlier, and that's part of your circadian rhythm, then, hard training can disrupt that, and again, I think it goes back to, some people are more prone to being insomniacs and for someone like that, I would say getting your training in earlier in the day, it's going to be more beneficial to you because you might be more sensitive to the coordination of activity that should go on in your body to help you fall asleep sooner. So I know I probably didn't answer your question. Like, are you asking for like 5pm, 6pm, 4pm? It goes back to the same caffeine thing. It's like, okay, for people that are sensitive to those factors you'll hear the common recommendation is cut your caffeine intake before 2 pm. And so that would maybe the same thing too, if you notice in your routine that, oh, wait, yep, every night that I, I had a problem sleeping, it was because I did this certain hard workout or I did this extended workout, at this time. So that could be an indicator of why you were not falling asleep very well.
Coach Ryan:Let's talk about creating a good sleep sanctuary. Do either of you have, any good tips to creating that sleep sanctuary.
Dr. Elise Toth:Lighting is the first thing that I always go to. So the lights going on inside should mimic what's going on with the sun outside. So if right from the sun that is brightest, we can have lights on super bright inside. As we're getting closer to bedtime, as the sun starts to go down, the lights inside should also follow. So whether that means, we turn off overhead lights, we bring in string lights, we bring in pink Himalayan salt lamps or something softer of a glow because there's nothing worse than trying to get ready for bed. You've got these bright lights on overhead. You get turn them off. You get into bed. You're like, why am I not tired? Well, you're not tired because you're bringing daytime still. So that's that's 1st and foremost, both in living space, bathroom, bedroom, wherever that needs to be cooler temperatures like we had talked about before. Keeping work out of the bedroom, right? If our brain associates the bed of work, and that too, I'm guilty of doing this as well, of bringing my laptop into my bed, because I'm like, oh, I'm comfy here. I want to work. But then after a while, if we're working or if we're studying or if we're stressing about things, our brain makes that association and we have a hard time unwinding, a hard time sleeping. So work devices should stay out. Phones, there's an argument to be made with that. You can argue for and against it, but minimal phone time, screen time, should be, you know, should be followed. Wearing, if you need earplugs, like let's say if you're, if you're on a noisy street corner, like I live at a really, really busy street corner, and so sometimes earplugs just to kind of keep the traffic noise out. Or if your partner stores or whatever that may be. Eye mask if necessary if you for whatever reason can't keep ambient light out, fans, chilly pad, whatever that may be to keep the temperature where you need it to be. I know some people that swear by white noise machines. It helps them to fall asleep stay asleep. There's some really fancy alarm clocks out there that actually have, like, alpha waves and, like, different sounds and different sleep stories programmed in there, so that way, you know, they're using that to help them fall asleep and stay asleep. But those are just some, like, basic ideas of what I recommend, and there's always ways that can be elaborated off of that.
Coach Lori:I think that's covered the full package. Some people argue about not having a TV in your room, and especially, again, if you go, goes back to somebody that has. Tendency to have insomnia symptoms, then the TV should probably go, not looking at your phone. And then, this goes back to the work related thing though, but making sure that your bedroom is also sort of stress free and that could be not so cluttered or something that's going to stress you out because it's a mess and trying to maintain that environment so it does not stress you out either is going to also help kind of your brain tone down a little bit better.
Coach Ryan:Those are great. I do have a question and this might be a little tough. So, what if you're carrying just a lot on your shoulders and mind, I think a lot of us carry just stress with us in general, but you know how that can be when you have just a lot of, you know, work on your mind, family drama,. It can be something bigger, right? Like something, that's more in depth, like you maybe lost someone, and things are just on your mind and you're stressing you out. Is there anything that you can do to help improve your sleep at night? So, Dr. Toth, I'll start with you.
Dr. Elise Toth:Sure. Anything that's going to help, if the stress is the root cause of that difficulty sleeping, so whatever helps manage stress, whether it's exercise, whether it's working with a mental health professional, to medication or therapy or whatever, whatever tools in your toolbox to help with that. Also when a patient comes into my office and is dealing with a lot of things and they're already addressing that I work with an acupuncturist in my clinics, so I if they're not already undergoing acupuncture care for a lot of the stress and the emotional component of it, I send them across the hall and be like, hey, I highly recommend you start off on this because oftentimes, right, I can throw any herb at them that I want, but if we're not, if we're not addressing the emotional component, which I know acupuncture does very, very nicely, the, the co management of that I find works a lot better than just, you know, either of us doing it, working on it solo. And even just having some grace with yourself. Like there, there's a lot going on in your brain. There's a lot rattling around right now. And right when we're that amped up, right, there's a lot of stress hormones going on in our body, right? Stress hormones are preventing us from falling asleep. And so it's not any sort of moral failing that we have. It's just a matter of working through those stress hormones. So that would be feel our bodies feel that's in a safe place to actually fall asleep and stay asleep and allow melatonin to actually do its thing. And help us to become tired and be able to fall asleep effectively.
Coach Ryan:That's good. Dr. Koch, what about yourself?
Coach Lori:I think it's all about the toolbox as well. Just making, some other environmental type of things where, you know, a physical activity is something that relaxes you and you enjoy that. Then the physical activity is a really good one because physical activity will actually help you induce being tired and being in a, in a better biological rhythm in general. So trying to make sure that you're fitting that in, and especially if it's something that you enjoy. just activities that you enjoy, it helps you relax, be cognizant of that, and then that's going to also kind of tone down some of those stress hormones that, are associated with maybe some people having trouble falling asleep and staying asleep.
Dr. Elise Toth:Something else I just thought about that I actively resist, but I've been reading more and more about having a good cry. Crying basically balances out our stress hormones, and that's why we feel very relieved kind of like the calm after the storm after we cry. A lot of times we cry ourselves to sleep is what the, you know, what the saying is. So that being somebody I cannot stand crying, crying is like the one thing I will do anything to not do. But it has a time, it has a place, it has a purpose. And sometimes that can be the only thing that, with all the other tools in your toolbox and nothing else is working. It's allowing yourself, having a good cry, letting your body work through the emotions. And oftentimes we feel really, we kind of exhaust ourselves afterwards and we fall into that.
Coach Ryan:Yeah, awesome. We've come to the end. Thank you everyone for for joining us. If you would like to meet with Dr. Toth, she practices out of our Andersonville and our Vernon Hills locations. However. We do have 18 different locations around the city and suburbs, the whole Chicagoland area where any of our providers are happy to help. If you ever want to meet with, Dr. Koch, come out to a Chicago Endurance Sports run and, and catch her on the run. Doctors, that was a lot of information. That's a lot to take in. So what's one big important thing, that maybe encompasses everything that we just discussed? So one bit, one bit of advice. Dr. Koch, I'll start with you.
Coach Lori:It's just, Make sleep a priority and have a full understanding of how it fits into everything else that you're trying to accomplish. And when you make that a priority and understand how your own body works within that, a lot of other things are going to fall into place even better than you think. And from an athlete perspective too you'll be really surprised at how much it's going to enhance goals and accomplishments, that you're trying to pursue.
Coach Ryan:That's good. Dr. Toth, what about yourself?
Dr. Elise Toth:Yeah, what I always say is, it comes down to between sleep and exercise, sleep should win every single time. It's hands down, it's much more, not that exercise isn't important, but between the two, sleep is way more important for all the reasons we have just talked about.
Coach Ryan:Well, thank you again so much to our panelists, Dr. Elise Toth and Dr. Lori McGee Koch for sharing so much wonderful knowledge. I love the conversation. We learned so much today, and even though we've done this before, I would keep on learning more and more things from all of you. So everyone hope you enjoyed it. Feel free to go back and listen again, but don't forget to prioritize your sleep. Pick up those hundred dollar bills. Leave the quarters on the ground. Thank you so much. Y'all
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