AMA #16: Sleep, Vertigo, TBI, OCD, Tips for Travelers, Gut-Brain Axis & More
Dr. Andrew Huberman hosts an AMA from Sydney, Australia, discussing how to maintain health pillars while traveling, optimize sleep, manage vertigo, enhance brain function post-TBI, adjust circadian rhythms, and monitor hormone levels. He also covers fish oil dosage, gut-brain axis optimization, and tongue cleaning best practices.
Deep Dive Analysis
10 Topic Outline
Managing Key Health Pillars While Traveling
Improving Sleep Quality and Duration
Understanding and Managing Vertigo
Enhancing Brain Function Post-Traumatic Brain Injury (TBI)
Insights into the Causes and Treatments of OCD
Adjusting Circadian Rhythms for Time Zone Travel
Optimal Dosage and Benefits of Fish Oil Supplements
Recommended Protocol for Monitoring Hormone Levels
Strategies for Optimizing the Gut-Brain Axis
Best Practices for Tongue Cleaning and Oral Health
6 Key Concepts
Insomnia
Insomnia is defined as excessive daytime sleepiness that results from a lack of sleep at night. If one feels reasonably good throughout the day despite sleeping fewer hours, it may not be considered insomnia.
QQRT (Sleep Acronym)
QQRT stands for Quality, Quantity, Regularity, and Timing of sleep. These four factors are crucial for assessing and optimizing sleep health, influencing both physical and emotional recovery.
Vestibulo-Ocular Reflex (VOR)
The VOR is a magnificent built-in stabilization process in the body and brain that uses signals from the visual system and inner ear to perfectly stabilize images on the retina despite head movements, preventing blurry vision.
Otoliths
These are small stones located within three hula-hoop-like tubes in the inner ear. They roll around in response to head movements (pitch, yaw, and roll), sending neural signals that contribute to balance and the vestibulo-ocular reflex.
Glymphatic Outflow
This is a nightly 'washing' process of the brain that removes debris, reactive oxygen species, and metabolites from the extracellular space between neurons. It is particularly important for brain recovery, especially after a traumatic brain injury.
Neuroplasticity (in OCD)
Neuroplasticity refers to the brain's ability to change and reorganize neural networks. In the context of OCD, interventions aim to leverage neuroplasticity to 'rewire' the misconnections in the basal ganglia and dopamine reward system, allowing for new behavioral patterns.
10 Questions Answered
To maintain health pillars while traveling, prioritize morning sunlight exposure, incorporate movement (like a jog or walk), engage in social activities, and use caffeine or breakfast to amplify morning cortisol. In the evening, dim lights or use red light to lower cortisol for better sleep, and utilize non-sleep deep rest (NSDR) for stress control and recovery.
Whether five to six hours of sleep is enough depends on individual context; if you feel reasonably good and have enough energy throughout the day, it may be sufficient. Focus on the 'QQRT' of sleep (Quality, Quantity, Regularity, Timing). To improve quality and feel more rested, Dr. Huberman recommends a 10-30 minute non-sleep deep rest (NSDR) protocol before getting out of bed or at some point during the day.
Vertigo, a perception of spinning dizziness, often stems from issues in the visual system or inner ear, potentially caused by viruses, hormones, or dislodged otoliths. To manage it, anchor the visual part of the vestibulo-ocular reflex by fixating on a point (e.g., your finger) and slowly moving it closer to and further from your nose, forcing the visual component to dominate and allowing the inner ear to adjust.
The brain is robust and capable of neuroplasticity, allowing recovery from past damage. Focus on current healthy habits like excellent sleep (especially for glymphatic outflow), a good diet, and consider interventions such as transcranial magnetic stimulation, hyperbaric chambers, or 5-10 grams of creatine monohydrate daily. Elevating feet slightly (5-15 degrees) during sleep can also enhance glymphatic flow.
OCD is understood as a miswiring in the basal ganglia and dopamine reward system, where compulsions exacerbate obsessions. Treatment involves adjusting the pharmacology of neural circuits (e.g., with SSRIs to enhance neuroplasticity) combined with behavioral interventions like exposure and response prevention, often with the support of a therapist, to facilitate the necessary neural changes.
To shift your circadian rhythm for a three-hour time change, two days before travel, wake up an hour earlier than usual, get 5-10 minutes of bright light, then go back to sleep. Repeat this the next day. Upon arrival, force yourself to get up early, drink caffeine, exercise, and engage socially to align with the new time zone, allowing for a brief nap (30-90 minutes) if needed.
The optimal dosage for fish oil is 1 to 3 grams of EPA (eicosapentaenoic acid) per day, which is known to have a mild to moderate antidepressant effect and is crucial for brain and body health. It's important to check the supplement label for the actual EPA content, as it often requires multiple capsules or a full tablespoon of liquid form to reach this dosage.
In the absence of suspected endocrine dysfunction, establish baseline hormone levels once in your late teens, mid-20s, and age 30. After age 40, monitor hormone levels annually. For women, it's important to take blood samples consistently at the same point in your menstrual cycle (e.g., mid-follicular or mid-luteal) due to natural fluctuations.
To optimize the gut-brain axis, ensure you get enough sleep, avoid excessive antibiotic use (unless prescribed), and ingest one to four servings of low-sugar fermented foods daily (e.g., sauerkraut, kimchi, natto, kefir). Also, consume sufficient prebiotic and probiotic fibers from fruits and vegetables, and avoid overuse of antiseptic mouthwashes and hand rinses.
For tongue cleaning, it is advised to gently brush your tongue with a *separate* soft toothbrush rather than scraping too hard. You can use just water, or a little salt and baking soda. Replace your tongue brush every few weeks to months.
37 Actionable Insights
1. Daily Non-Sleep Deep Rest (NSDR)
Incorporate a daily non-sleep deep rest (NSDR) or yoga nidra protocol for 10-30 minutes to reduce stress, replenish dopamine, and enhance mental and physical vigor, either in the morning or later in the day.
2. Omega-3 (EPA) Supplementation
Supplement with 1-3 grams of EPA (eicosapentaenoic acid) per day, checking product labels for actual EPA content, to support brain and body health, provide building blocks for nerve cells, and potentially achieve a mild to moderate antidepressant effect. Choose high-quality fish oil tested for contaminants like mercury.
3. Morning Sunlight Exposure
Get morning sunlight as often as possible, even on overcast days, to help shift circadian rhythm and amplify morning cortisol/catecholamine release for improved mood, focus, and alertness.
4. Evening Red Light Use
Use a red light bulb unit or red party lights in the evening, switching off regular overhead lights, to quickly lower cortisol levels and make it easier to fall asleep.
5. Comprehensive Oral Hygiene
Brush and floss your teeth daily, with brushing before sleep being especially critical for remineralization, and avoid antiseptic alcohol-based mouthwashes.
6. Gentle Tongue Brushing
Gently brush your tongue with a separate soft toothbrush (different from your teeth brush) to remove bad bacteria and promote healthy bacterial turnover. Replace the tongue brush every few weeks to months.
7. Adequate Fiber Intake
Ensure you consume enough prebiotic and probiotic fibers from fruits and vegetables for gut motility and to offset gut cancers.
8. Probiotic-Rich Diet
Ingest 1-4 servings of low-sugar fermented foods daily (e.g., sauerkraut, kimchi, natto, kefir) to support gut health.
9. Limit Antiseptic Overuse
Avoid overusing antiseptics such as mouthwashes and hand rinses to maintain a healthy and diverse microbiome.
10. Increase Microbiome Diversity
Encourage microbiome diversity through safe environmental interactions, such as allowing children to play outside and eat with slightly dirty hands (in a safe environment), or owning pets.
11. Optimize Workout Intensity/Duration
If you feel excessively sleepy after morning workouts, reduce intensity or duration, aiming for 80-90% of your maximum output to maintain energy and vigor throughout the day, rather than pushing to failure and causing depletion.
12. Prioritize Injury Prevention
The most crucial aspect of fitness is to avoid injury, as getting hurt prevents you from training altogether.
13. Sustainable Workload Management
Determine your consistent daily workload capacity (e.g., 4-8 hours with weekend breaks) that allows you to maintain sleep, mental, and physical health, as this sustainable approach leads to greater long-term productivity than overworking.
14. Focus on Present Health Improvements
Do not dwell on past dietary or lifestyle mistakes, as biological systems are robust, and you can always improve your health, health span, and lifespan by making positive changes now.
15. Avoid Trans Fats
Eliminate trans fats from your diet, as there is universal agreement on their detrimental health effects.
16. Regular Hormone Level Monitoring
Get hormone levels checked once in late teens, mid-20s, and 30s for baseline, then annually after age 40, to monitor key markers like IGF-1, testosterone (total and free), estrogen (estradiol), DHT, cortisol (fasted morning), creatinine, LDL, ApoB, SHBG, and for women, progesterone and prolactin, always considering ratios and consistency in timing for women’s cycles.
17. Creatine for Brain Function
Consider taking 5-10 grams of creatine monohydrate per day (depending on body weight) to enhance creatine phosphate metabolism in the forebrain and improve brain function, especially under conditions of high altitude or TBI. Monitor for increased DHT if you experience hair thinning and stop use if concerned.
18. TBI Recovery Protocols
For traumatic brain injury (TBI) recovery, prioritize adequate sleep for glymphatic outflow, consider transcranial magnetic stimulation, hyperbaric chambers, or hyperoxygenation treatments if accessible, and elevate your feet 5-15 degrees during sleep to increase glymphatic flow and debris clearance. Avoid sleeping upright in a chair.
19. Cautious Turmeric/Curcumin Use
Be cautious with high-dose turmeric or curcumin supplementation due to potential negative effects (e.g., limiting DHT production) and lead contamination; check sourcing carefully, and cooking with it is generally fine.
20. OCD Treatment Strategy
Treat OCD by working with a psychiatrist for appropriate medication (e.g., SSRIs) to create a neurochemical environment conducive to plasticity, combined with behavioral interventions like exposure and response prevention (resisting compulsions with therapist support) or replacement behaviors, possibly augmented by transcranial magnetic stimulation.
21. Circadian Rhythm Shift Quadfecta
To quickly shift your circadian rhythm in a new place or become an early riser, combine morning sunlight, movement, social engagement, and caffeine (or breakfast if preferred).
22. Align with Local Meal Schedule
To quickly shift your circadian rhythm to a local schedule, try to align your meal times with the local schedule.
23. Pre-Travel Circadian Shift
When traveling east across time zones (e.g., San Francisco to New York), gradually shift your wake-up time earlier by an hour two days before, then another hour the day before, completing the shift upon arrival.
24. Light Exposure for Circadian Shift
To shift your circadian rhythm earlier for eastbound travel, identify your temperature minimum (approx. 2 hours before normal wake-up) and expose yourself to bright light for 5-10 minutes between this minimum and your normal wake-up time for a few days before travel, even if you go back to sleep. Avoid bright light before your temperature minimum.
25. “Brute Force” Jet Lag Adjustment
Alternatively, for eastbound travel, fly to your destination and immediately force yourself to wake up early, using caffeine, exercise, and social engagement to align with the local rhythm, but be prepared for late morning fatigue which can be mitigated by a 30-90 minute nap.
26. Distinguish Dizziness/Vertigo
If feeling dizzy, stop and sit (or stand bracing yourself) and close your eyes, then determine if you feel like falling straight down (lightheadedness) or spinning and falling (vertigo) to aid diagnosis.
27. Vertigo/Nausea Visual Fixation
To address vertigo or nausea, fixate your gaze on a point 3-4 feet away and move closer, or look at your finger held out and slowly move it towards your nose, then back out, to anchor the visual part of the vestibulo-ocular reflex.
28. Outdoor Fixation for Motion Sickness
If feeling nauseous, seasick, or generally unwell after being in a closed environment, get outside and look at a distant fixation point to help re-calibrate your visual system.
29. General Wellbeing Visual Anchoring
When feeling unwell (without fever), go outside and fixate on the furthest possible point, walking towards it if safe, or perform the finger-to-nose exercise to anchor the vestibular-ocular reflex.
30. Assess Sleep Needs by Daytime Function
If you feel reasonably good and aren’t falling asleep during the day, your 5-6 hours of sleep might be sufficient, possibly supplemented by a brief 10-30 minute afternoon nap.
31. Don’t Obsess Over Sleep Quantity
Do not obsess over specific sleep quantity (e.g., 7-8 hours) if you feel good, as individual sleep needs vary and less sleep doesn’t automatically lead to severe health issues like dementia.
32. Evaluate Sleep with QQRT Framework
When assessing your sleep, consider the QQRT framework: Quality (consistent sleep, slow-wave & REM), Quantity (how much you get), Regularity (consistent sleep/wake times), and Timing (sleep aligned with your chronotype).
33. Limit Nighttime Awakenings
One trip to the restroom at night is considered normal, but multiple awakenings or trips should be addressed to improve sleep quality.
34. Gauge REM Sleep by Emotional State
Assess if you feel emotionally rested upon waking as an indicator of whether you are getting sufficient rapid eye movement (REM) sleep, which is crucial for emotional recovery.
35. Delay Checking Sleep Tracker Scores
Wait until halfway through your day to check sleep tracker scores (e.g., Oura, Whoop) to avoid the ‘belief effect’ where a poor score can negatively impact performance regardless of actual sleep quality.
36. Consistent Sleep Timing
Ensure the timing of your sleep within the 24-hour cycle is correct for your chronotype and fairly consistent (regularity) for optimal benefit.
37. Oil Pulling (Optional)
Oil pulling is not strongly recommended by dentists due to lack of clear evidence for benefit, but it’s not considered particularly harmful if you enjoy it.
3 Key Quotes
The compulsion does not remove the obsession; rather, it exacerbates it.
Dr. Huberman
More important than training hard, more important than doing any particular exercises, more important than anything is to not get hurt because if you get hurt, you can't train.
Dr. Huberman
Your brain and body is a system. Everything's talking to everything else.
Dr. Huberman
1 Protocols
Circadian Rhythm Shift for Travel (3-Hour Time Change)
Dr. Huberman- Two days before travel, set an alarm to wake up one hour earlier than your normal wake-up time.
- Immediately upon waking, get 5-10 minutes of bright light exposure (from artificial sources or sunlight).
- Go back to sleep until your normal wake-up time.
- Repeat steps 1-3 the next day, shifting another hour earlier.
- Upon arrival at your destination, force yourself to get up early, drink caffeine, exercise, and engage in social activities to align with the local rhythm.
- If you feel depleted later in the morning, take a brief nap of 30 to 90 minutes.