[Angela Foster] (0:00 - 0:06)
Is deep sleep the most important stage for recovery, hormones, immune function and brain health?

[Juliane Hellhammer] (0:06 - 0:28)
Absolutely yes. 20-30 years ago we thought sleep was just a very inactive stage of the night phase. Nowadays we more and more realise how active the physiological function is taking place during the night and how very important it is to have a good and solid sleep in terms of maintaining our health.

[Angela Foster] (0:28 - 0:31)
Do we really need as much as seven to nine hours of sleep?

[Juliane Hellhammer] (0:31 - 0:38)
We are individuals and you might need nine hours of sleep and I may be functioning well with six hours of sleep.

[Angela Foster] (0:39 - 0:47)
You can eat well, you can train hard, you can take supplements, you can optimise everything, but if your deep sleep is off it's like trying to row a boat with the anchor down.

[Juliane Hellhammer] (0:48 - 1:00)
This sleep stage is very very important in terms of restoring immune function, repairing tissue and muscles, getting the whole body reset and recovered.

[Angela Foster] (1:01 - 1:04)
What does genuinely high quality sleep look like?

[Juliane Hellhammer] (1:04 - 1:08)
High quality sleep is a sleep which does include...

[Angela Foster] (1:08 - 1:41)
Dr. Hellhammer, you are a psychoneuroendocrinologist and specialise in the way that stress impacts our health. Much of your work has focused on sleep, stress and recovery. I'd love to start with stress because it's something that so many people are struggling with right now and there's so much noise out there about optimising your health from sleep hygiene, stress management, monitoring HRV levels, the list kind of goes on.

In your opinion, what's the most fundamental change you can make daily which is going to improve overall health?

[Juliane Hellhammer] (1:41 - 2:46)
Well, hi Angela and I think these are really very important issues we are addressing here. Life has nowadays become so hectic and everyone seems to be in the move during the whole time, more or less working on an efficient and improved lifestyle. So from my opinion, what we really lack nowadays very much and that's impacting on our health is the recovery phase, which actually at my opinion should be something we teach children at school that the systems in our body, these stress-associated systems have a pause and get to recover during the day already.

So if we manage stress in terms of keeping pauses, I think we do not have to fear stressful moments. But as it gets chronic, these always will impact on our health, just a matter of when and where.

[Angela Foster] (2:48 - 3:03)
So it's actually not kind of avoiding stress but it's that ability to switch between stress and then introducing some recovery to kind of balance our nervous system that as you say, I think so many of us are not doing enough because we're kind of caught up in our busy lives.

[Juliane Hellhammer] (3:03 - 3:51)
Absolutely and I think it's, you mentioned I'm a psychoneuroendocrinologist and that's looking at the physiological function. So stress activates and mobilises energies to be active and to perform well. But as soon as this system doesn't get some rest in between, it's not made for this way of handling the daily life and then it impacts on our stress systems in terms of overloading the physiological function of the sympathetic nervous system, for example, or the hormonal triggering, the hormone cortisol.

It's overdoing and not giving rest to the system.

[Angela Foster] (3:51 - 4:01)
And not getting enough. What is the impact of stress on sleep and why do so many people feel tired but wired at night?

[Juliane Hellhammer] (4:01 - 4:43)
Very good question. Stress and sleep come together very often nowadays. So whenever we see patients complaining about a high stress load, they will first sign they will have a disrupted sleep.

It's then getting somehow a vicious cycle because stress impacts often on sleep and disturbing sleep cycles. At the same time, bad sleep is impacting on our daily performance and this kind of gets a very vicious cycle in terms of making things worse and aggravating health issues.

[Angela Foster] (4:44 - 4:56)
It becomes a vicious cycle, as you say. Do we really need as much as seven to nine hours of sleep or is sleep quality itself the real driver of energy, mood, cognition and performance?

[Juliane Hellhammer] (4:57 - 5:54)
Very good question again because this comes to the question, what's normal sleep? And speaking about normal, we are individuals and you might need nine hours of sleep and I may be functioning well with six hours of sleep. So keep in mind that normal is giving us an approximate idea and every individual should adjust by himself what's normal to him.

So sleep length varies widely and there are different factors impacting on the sleep quality. Being active during the day, having these mentioned pauses in terms of not overdoing during the daytime, this is something we need and what we really suggest is that clinical trials should be performed in terms of finding out more about the sleep stages during the night.

[Angela Foster] (5:55 - 6:37)
It's really interesting what you say there and I think it will be kind of a relief to many people because our sleep duration does vary so widely. I saw a study in Nature that came out this month in May looking at UK Biobank data and actually saying that there was this kind of wide distribution in terms of the amount of sleep that women and men needed and I think women it was between 6.4 hours and 7.8 hours. For someone like me who's like a little bit of a short sleeper and I think there'll be people listening to this or watching this who are the same, you always have in the back of your mind am I not sleeping enough but I think it's quite reassuring for people to understand that we don't all have exactly the same sleep requirements.

[Juliane Hellhammer] (6:38 - 7:47)
Absolutely and what we find when we run at the stress centre we run something what we call a sleep education school or sleep education programme because very many people getting not enough sleep or being kind of tired even after sleep in the morning and not really being recovered they have an somehow unrealistic expectancy and then they start to focus more and more on sleep and sleep is much about relaxing. If you don't relax because you focus so much on your sleep habits then it's really a bad point and a bad thing to do.

So in order to sleep well you should be relaxed but kind of focussing on the sleep in terms of getting a good sleep is a bad player. So you should relax and kind of get relaxed into the sleep and not concentrate too much on what's normal how your sleep should be but rather evaluate how rested do I feel in the morning and how much do I feel recovered after sleep.

[Angela Foster] (7:48 - 8:21)
It's really interesting what you say there because I think so many of us will resonate with the fact that when you try to sleep it almost becomes impossible to do so. I've had this with my with my children I always say to them you know if you can't sleep you just need to kind of lie there relax and reassure yourself that your body and mind are getting all the rest it needs and it's just funny even saying like an affirmation like that how quickly you'll then fall asleep because suddenly the pressure's off do you know what I mean and you're not looking at the clock and thinking oh my goodness I've only got another four hours or whatever it is which then just makes it even harder doesn't it to fall asleep.

[Juliane Hellhammer] (8:22 - 9:08)
Yeah it's very interesting hearing you saying this because just a couple of weeks ago I gave a talk in Berlin at a scientific meeting and the title was somehow how can wearables disturb sleep habits so these kind of individuals really focussing and wanting to do a wanting to have a really good sleep wearing the wearables they will get information which is an estimation of the sleep stages for example a wearable cannot analyse sleep stages so actually focussing too much on these wearables in terms of sleep quality might be disturbing at the end.

[Angela Foster] (9:08 - 9:36)
And people can become kind of obsessed with the data right which may not be that accurate as you say. I think we know how we feel when we've had a really good night of sleep and we've really had deep sleep. I heard something recently that that resonated with me that is you know you can eat well, you can train hard, you can take supplements, you can optimise everything but if your deep sleep is off it's like trying to row a boat with the anchor down.

What are your thoughts on that?

[Juliane Hellhammer] (9:36 - 11:33)
I think it's a very good analogy. I think not being able to have this well I should mention nowadays the ASM guideline accumulates the N3 and the N4 stage. So nowadays we usually do not analyse the N4 deep sleep stage separately from the N3 stage.

So since in this clinical trial which we performed we were interested how very differentiated sleep stages will react to the compound we analysed the N4 sleep stage. Which is the most profound and slowest delta wave accumulation during the sleep. And therefore the most profound recovery phase for our whole body.

So this sleep stage is very, very important in terms of restoring immune function, repairing tissue and muscles, really getting the whole body reset and recovered. So disturbing or lacking these N4 stage, this very, very deep sleep stage is a very essential problem which we do realise when individuals grow very old. Because sleep changes over ageing and especially these important sleep stages like the N4 stage, the very, very deep stage of our sleep and also the rapid eye movement sleep.

They lack in older age and therefore this does impact on health as well.

[Angela Foster] (11:33 - 11:40)
Is deep sleep the most important stage for recovery hormones, immune function and brain health?

[Juliane Hellhammer] (11:41 - 12:35)
Absolutely yes. Just mentioning the deep sleep stage, the immune function, the muscle tissue repair work, all the physiological work. 20, 30 years ago we thought sleep was just a very inactive stage of our daily routine or of the night phase.

Nowadays we more and more realise how active the physiological function is taking place during the night and how very important it is to have a good and solid sleep in terms of maintaining our health. And this is the deep sleep stage is needed for the recovery of the physiological function and the emotional and psychological function is done mainly during the REM sleep, the rapid eye movement sleep.

[Angela Foster] (12:36 - 13:06)
That's very interesting what you're saying there around the REM sleep and the emotional regulation. And I think there's some things is there around memory as well because when people for example are socialising and drinking alcohol and then their sleep is kind of cut short, I've seen data that shows that they miss out often on REM sleep unless they're having sufficient time in bed because they sort of binge more of that deep sleep due to some of the things that they've been eating for example and also the overall sleep is that much shorter.

[Juliane Hellhammer] (13:07 - 13:25)
Yeah and it's especially the REM sleep which is kind of changing in older age and that's one of the main issues why memory function is declining and the emotional situation is changing very much for older people especially these very, very old people.

[Angela Foster] (13:26 - 13:30)
Very interesting. What does genuinely high quality sleep look like?

[Juliane Hellhammer] (13:31 - 15:56)
High quality sleep looks much like going to bed, having normal phase to go to sleep. So in general we say 15 minutes is still okay. Again keeping in mind what is normal sleep, normal sleep is a sleep which does include wake cycles.

They are usually so short we can't even remember in the morning. So asking people how often did you awake during your night's sleep, they often give you wrong information when you compare it to a sleep lab for example because we see that these mini arouses during the night time, they are absolutely normal but they are not being remembered the next day. Bad is if you are awake and you keep start thinking about stressful situations or you're ruminating about problems you might have in mind and that's kind of interfering with the hormonal cycle and bringing up the cortisol as a hormone which activates the cognitive function and therefore it's very important that the day life should have a certain rhythm.

Bedtime should be more or less regular. Getting up times and getting out of bed as well since we have this urinal cycle of our hormones during the night it's the melatonin being very active, during the day it's more the cortisol and the melatonin being low. So these cycles which we do have physiologically they should be supported by our habits and our traditional lifestyle.

At the same time we should be active during the daytime and you mentioned earlier a good nutrition, not having too heavy meals in the evening, not having too much alcohol in the evening are good ideas in terms of supporting the body to fulfil this essential work during the night and getting the recovery as well for the brain and the cognitive function emotionally and also for the organs and the repair work which needs to be done during the night.

[Angela Foster] (15:57 - 16:14)
You mentioned that wearables are not yet really able to track properly those sleep staging in terms of deep sleep and REM sleep cycles. Is there any merit to someone who's using a wearable because the data is on themselves to tracking against their own data? Is there any benefit to that?

[Juliane Hellhammer] (16:14 - 17:21)
Yes, sure. I think wearables are a very good indicator for example for sleep lengths and this matches their information on sleep which are quite accurate. We compared the wearable to a polysomnographic device which is what we call the sleep laboratory and we see quite a good correlation between sleep lengths for example, between movements during our sleep but it lacks giving us exact information about stages of our sleep and this can only be done with an EEG and that's something wearables don't have.

So, it's good in terms of the sleep lengths for example appropriate how disrupted is my sleep. They also are quite good in calculating the pulse transit time and the blood pressure. So, they are very helpful information in wearables but just the sleep stages cannot be analysed.

[Angela Foster] (17:22 - 17:28)
Interesting. Thank you. How can people naturally improve their sleep quality and increase deep sleep?

[Juliane Hellhammer] (17:29 - 19:01)
Well, first of all I mentioned the sleep education programme. That's always the first step checking whether everything is being done in a manner you would like individuals to do. Coping with stress, stress management is one of the main issues but then when it gets to getting to sleep and increase the deep sleep stages it needs relaxation techniques and you can support very many health functions on a very natural way in supplementing for example their herbal teas around.

There are many quite good herbals for example around which can support especially if these are special phases where you know there's a stressful episode I have to face now and then you might need some support in terms of an add-on with a quite beneficial but not harmful effect. Harmful would for example also be some kind of drowsiness during the early morning hours. So, getting some support for the sleep and having some aid for sleep patterns can affect the physiology in a way you would not need it in the morning.

So, you would like to sleep well but be awake and alert in the morning.

[Angela Foster] (19:01 - 19:27)
So, something that helps you sleep but as you say doesn't then lead to that morning grogginess. Right. In your recent study participants saw a 70% increase in deep sleep that N4 stage after just 14 days of taking sleep well without the grogginess the next day and they even saw improvements in mood and psychological tension.

What made those findings so significant?

[Juliane Hellhammer] (19:28 - 20:44)
Well, this was a 14-day intervention of a combination product and we had the polysomnography as the gold standard of sleep analysis being part of the study assessment. We were interested in comparing at the beginning of the intervention prior to the intervention the sleep patterns and the sleep waves we see in the polysomnography and after the 14-day intervention. And the very interesting thing was that especially the N4 stage, the very, very deep sleep stage with the main and most effective repair work being done during the day cycle and the night cycle, we were really impressed about this 70% increase.

So, I think that was a meaningful result in terms of having had an intervention which really improved this strongly delta wave driven stage of the sleep where we do the sleep and the repair work in our body.

[Angela Foster] (20:44 - 21:00)
Which is so, so important as you say for that repair and overall health and also is implicated right with ageing. We're naturally reducing that. Very interesting from my perspective as well that you saw that increase in such a short period of time within 14 days.

[Juliane Hellhammer] (21:00 - 21:39)
Yeah, we do quite a few studies. So, it was also for us it was very impressive to see these results and as I said, it's a vicious cycle. So, being really recovered in the morning is so essential to be resilient on the next day and perform well because stressful periods they need a recovered physiology in terms of perform well on the next day.

And so, this goes hand in hand kind of sleeping well and being able to handle daily stressful life events.

[Angela Foster] (21:39 - 22:10)
Yeah, absolutely. It really affects the way you can show up for yourself, for your work, for your family in addition to your long-term health. SleepWell, the intervention that you were using contains Lactuca Sativa or lettuce extract which has reportedly been used since ancient Greek and Egyptian times to support relaxation and sleep.

What do we know about how this ancient ingredient works and why was it such an interesting ingredient to include alongside the lemon balm, magnesium and L-tryptophan?

[Juliane Hellhammer] (22:10 - 23:16)
Yeah, it was a very interesting question we addressed in this clinical trial. The lemon balm, the magnesium and the L-tryptophan, they are well known to cause relaxation, support relaxation, to have somehow a sedative-like property in terms of supporting relaxation and stress relief. So, adding this compound or this herb was kind of adding a well known ingredient from traditional medicine and we do learn such a lot even nowadays by combining different origins of traditional medicine with our modern life and I think that turned out to be really beneficial because it had this very strong impact on the 14-day intervention and the health benefits especially on sleep.

[Angela Foster] (23:16 - 23:31)
Yeah, and that 70% increase in deep sleep which is pretty incredible. 2 to 4 a.m. wake-ups are particularly common in peri- and early post menopausal women. Does SleepWell help to reduce night-time wake-ups?

[Juliane Hellhammer] (23:31 - 24:44)
It is a very common phenomenon in peri- and early postmenopausal women. I absolutely agree and we have very often these women compaigning on waking up between 2 and 4 then start ruminating and kind of not falling back again to sleep very easily. We did not observe significant changes in our objective measures of night-time wake periods.

However, on a subjective level, the perceived level was strongly affected and we saw that the study participants reported a reduced number of wake-ups. So, there again is like I mentioned earlier, there is always not a one-to-one correlation between perceived information and what we can justify by measuring it objectively. But here we saw in this study a pronounced perceived relief and a perceived information on less wake-ups during the night.

[Angela Foster] (24:45 - 25:30)
That's super interesting because you kind of question then how much that psychologically affects the person the next day because if they believe that they're waking up less and that they sort of feel more able to cope with the day's challenges and then also I can see that that vicious cycle that is fed by you know in somebody who has insomnia or can't sleep and then is getting that anxiety as the evening's approaching thinking, oh my god, what if I can't sleep tonight?

I really hope I can sleep or they've got an early flight to catch or something like that and working themselves up that actually just that kind of psychological freedom of thinking I feel more rested, I'm waking up less in combination with the improvements that you saw in deep sleep is actually a very powerful combination.

[Juliane Hellhammer] (25:31 - 25:59)
Absolutely and the spirit you start your day with is so essential how you address colleagues at work, how you cope driving your car and so it's our daily life which is kind of affected by just the mindset already. So adding mindset plus sleep stages and changes there is really a very interesting and cool finding.

[Angela Foster] (25:59 - 26:10)
Very much so. I guess interesting to see what would happen with that data over the longer term. What emerging trends or breakthroughs in sleep science are you most excited about right now?

[Juliane Hellhammer] (26:10 - 27:23)
Well first of all I'm very happy that sleep is really a very high topic right now. It's a very important topic and we realise that many, many disease developments are caused by somehow adding sleep deficiencies and very disturbed sleep structure during our patients for example which we see. I think it's very important that we keep in mind that everything we analyse with our sleep for example or which we do is very individual.

Therefore for a very long time we are talking about personalised medicine and personalised approaches. I really appreciate that the herbals are getting a good ground in terms of being recognised and being promoted and supported by good clinical trial data and I really appreciate that this is being transferred to very many health related issues we discuss nowadays.

[Angela Foster] (27:24 - 27:41)
Yeah it's so good. I mean I myself, I'm like you, I'm just really pleased that sleep is taking more of a centre stage because it's so fundamental as you say to our health, our performance and our longevity. What are your top three evidence-based upgrades for better recovery, performance and long-term health?

[Juliane Hellhammer] (27:41 - 30:22)
That's a very good question. First of all my issue is stress and stress management so I think it's a very, very important part that we learn and integrate into our daily routine very profound and well-tailored individual stress management programme. I think if stress impacts for a very short period that's no problem, no issue.

But as soon as it gets chronic and there are really severe signs in our society nowadays that stress is impacting more and more and with all the wisdom and knowledge we have, still stress levels are increasing almost worldwide. So I think it's a very, very important first step to recognise where are my personal weaknesses in terms of stress reactivity and how can I cope with my individual stress individuality just to strengthen my resilience and my daily function. The second is what everyone knows, you should move, you should kind of be active.

Sitting most of the day is not a good idea. Nutrition is very, very important. This is something we do in our clinical trials quite vividly that we study how nutrients impact of supporting physiological functions.

So you can very well tailor your nutrients in terms of them being enjoyable but at the same time healthy and in a way supporting your individual weakness you might have. And then on a very long run, I think we should more and more teach individuals how important sleep is. That's what we do very often in terms of giving lectures, going to companies, teaching for example shift workers how they can have healthy sleep habits and keep this very, very important recovery stage of the sleep.

So I think a good knowledge on what good and normal sleep is goes along with stress management and a well-balanced lifestyle.

[Angela Foster] (30:22 - 31:02)
Really, really great tips. I'd love to ask you while you're here for someone who's thinking about trying the Sleep Well supplement that you used in the trial because it's an interesting supplement where actually you can pour this onto the tongue. So it's actually not difficult to take at all and I think it would be just really interesting for those watching and listening how you can use this without grogginess because my understanding is that you can use this before sleep but also if you do wake up in the night, you can sprinkle some of it on your tongue to sort of help yourself get back to sleep.

For someone who's thinking about trying it, what's the most optimal way to use it?

[Juliane Hellhammer] (31:03 - 32:06)
Well, I'm a scientist so what I see from this study, taking it in the evening with a meal is a very good idea. In addition, we did not study that but from what I know and from my experience, I think it would be very good to have it on the nightstand and in case you wake up and you find that you're kind of getting into old patterns again, I would use the drops and at the same time, I would recommend having a kind of easy reasing technique in terms of getting into the sleep again. And you know, once you change the pattern during the night, occasionally you won't need the drops anymore.

It might be reassuring enough to have them on the nightstand or any way you would feel capable of handling this very unpleasant phase in your night where you want to go to sleep and you can't really go to sleep because many things are interfering.

[Angela Foster] (32:06 - 32:36)
Yeah, interesting and if you have it on the nightstand and you're practising some breathing techniques, then over time, you may just naturally fall back asleep with that breath work that you're doing. Very interesting what you're saying there around having it with food because I think people often wonder like what's the best way to take something. Is that because the absorption is better if you're having that with meal or is it because it's going to give a little bit of time in that lead up to you going to bed for those ingredients calming effects to start to work?

[Juliane Hellhammer] (32:36 - 34:07)
Well, it can work in both ways, I think, but I think with the metabolism taking action, I think it's well metabolised taking it with a meal. So I think it's an optimal way of kind of not forgetting it, getting some kind of routine. Again, it's a signal, I'm taking something for a good sleep I will have tonight.

So it's psychologically again quite valuable having this at the end of the day with your light dinner in terms of bringing down the organism, getting prepared for the night and that's kind of the routine which should kind of accompany you to bed. Not having this TV being loud and noisy and distracting. Many people love to watch TV in the evening.

It's actually one of the most distracting moments because it's not bringing down the sympathetic nervous system. It's kind of still being active mentally and watching. So I think really getting this evening routine with relaxing methods, breathing techniques, relaxation techniques, having a nice book or make nice music and really bringing the daily routine in a sensitive but relaxing way to an end and getting prepared for the night.

[Angela Foster] (34:08 - 34:14)
Yeah, it makes such a difference and sometimes having a journal right and getting the thoughts out of your head onto paper so they're outside of you.

[Juliane Hellhammer] (34:15 - 34:15)
Right, right.

[Angela Foster] (34:15 - 34:17)
Yeah, minimise those.

[Juliane Hellhammer] (34:17 - 34:18)
Yeah, absolutely.

[Angela Foster] (34:19 - 34:29)
Yeah. Interesting. Thank you so much.

It's been very, very interesting speaking to you. Is there anything that we haven't spoken about in relation to sleep that you wish I'd asked you?

[Juliane Hellhammer] (34:29 - 35:30)
Well, there is so much you can talk about sleep but I think the very, the important main information is do not think too much about your sleep. Don't try too hard to work on your sleep because this is the most secure way to disrupt your sleep. So getting it more and more out of your mind, knowing you're doing your routines and it's such an essential stage of our 24-hour routine and so biologically driven and therefore I really like the product to get back to the study because it combines four elements which really have shown in a very, very nice way that it improves relaxation and going hand in hand our sleep.

[Angela Foster] (35:30 - 35:45)
Amazing. Thank you so much for coming on the show. It's been super interesting.

Dr. Hellhammer, where can people find you if they want to connect with everything that you're doing in terms of this really interesting area of psychoneuroendocrinology and sleep and stress?

[Juliane Hellhammer] (35:46 - 36:20)
Well, Angela, it was my pleasure. It was very interesting talking to you as well and and we are found in Germany and at the Moselle Valley in Trier where stress has been studied for decades at the university and where we still enjoy finding more small puzzle parts which help us maintain our health and we are happy to contribute to getting the information spread and hopefully it's beneficial for many, many people among us.

[Angela Foster] (36:20 - 36:26)
Yeah, amazing. It changes people's lives when they can start sleeping well again. Thank you so much.

Thanks again.

[Juliane Hellhammer] (36:26 - 36:30)
Very welcome, Angela. Have a good time. Bye-bye.

Bye.

Most women think poor sleep is inevitable as they get older. It isn't. It is your stress hormones, your cortisol cycle, and a specific stage of deep sleep called N4, and all three can be addressed.

I sit down with Dr. Juliane Hellhammer, a psycho-neuro-endocrinologist specialising in stress and sleep, and what he shares will make you rethink everything you thought you knew about rest and recovery. If you have ever woken at 2am with your mind racing, struggled to feel recovered no matter how much sleep you get, or wondered whether your wearable is actually telling you the truth about your sleep quality, this episode gives you the science and the solutions. Because what if the sleep stage that matters most is the one no one is talking about?

WHAT YOU’LL LEARN

• Why perimenopausal women wake up at 2am and what is actually driving it

• What N4 deep sleep is and why it matters after 40

• What destroys deep sleep quality in perimenopausal women and how to fix it

• Can wearables accurately measure deep sleep stages

• What poor sleep does to brain fog and fatigue in perimenopause

• Why trying too hard to sleep is keeping you awake

• What genuinely high quality sleep looks like