• Home
  • For Patients
  • For Doctors
  • For Healthcare Organizations
  • Find a Doctor
    • Alabama
    • California
    • Connecticut
    • District of Columbia
    • Georgia
    • Florida
    • Illinois
    • Indiana
    • Kansas
    • Maryland
    • Michigan
    • Missouri
    • Nevada
    • New Jersey
    • New Mexico
    • New York
    • North Carolina
    • Ohio
    • Pennsylvania
    • South Carolina
    • Texas
    • Virginia
  • Contact Us
CHOICE MD
  • Home
  • For Patients
  • For Doctors
  • For Healthcare Organizations
  • Find a Doctor
    • Alabama
    • California
    • Connecticut
    • District of Columbia
    • Georgia
    • Florida
    • Illinois
    • Indiana
    • Kansas
    • Maryland
    • Michigan
    • Missouri
    • Nevada
    • New Jersey
    • New Mexico
    • New York
    • North Carolina
    • Ohio
    • Pennsylvania
    • South Carolina
    • Texas
    • Virginia
  • Contact Us
Picture

YOUR 2025 BRAIN BRAWN MINI  RESOLUTION: EXERCISE (Week 3)

5/12/2025

0 Comments

 
CHOOSE YOUR TRACK
 
We hope you're enjoying your exercise mini-resolution! Let's get started on Week 3 by choosing your track below!

 
CLICK FOR TRACK 1 • BEGINNER

 
CLICK FOR TRACK 2 • INTERMEDIATE

 
As a reminder, Track 1 is for those who do not already have an exercise habit, and the mini resolution is to walk 30 minutes a day. Today in Track 1, we discuss overcoming obstacles.

Track 2 is for those who already have an exercise habit, and the mini resolution is to optimize that habit by increasing your METs. Today in Track 2, we discuss cardio-respiratory exercise and intensity.

 
What's that smell??
 
Regardless of your chosen track, you may find that your workout clothes, well—they stink, even after washing and drying! Workout clothes may need a different approach to cleaning than your regular laundry. Here are a few tips to try.

There are also laundry detergents specifically made for gym clothes.
 

0 Comments

YOUR 2025 BRAIN BRAWN MINI RESOLUTION: EXERCISE

5/5/2025

0 Comments

 
CHOOSE YOUR TRACK

 We hope everyone had a nice weekend and that you're ready to dig into exercise!

As a reminder, Track 1 is for those who do not already have an exercise habit, and the mini resolution is to walk 30 minutes a day. Today in Track 1, we discuss overcoming obstacles.

Track 2 is for those who already have an exercise habit, and the mini resolution is to optimize that habit by increasing your METs. Today in Track 2, we discuss cardio-respiratory exercise and intensity.

 
CLICK FOR TRACK 1 • BEGINNER

 
CLICK FOR TRACK 2 • INTERMEDIATE

 
Considering A Gym Membership?

 Regardless of your chosen track, you may be considering a gym membership. We wanted to share with you that certain insurances might provide coverage or financial assistance with gym membership dues.
 
It's certainly worth calling your insurance carrier to see what is available to you!
0 Comments

YOUR 2025 BRAIN BRAWN MINI RESOLUTION: EXERCISE  WEEK 1

5/1/2025

0 Comments

 
Introducing your NEW Mini Resolution: Exercise!
 
We hope you've been enjoying the benefits of our Motivated Mondays Brain Brawn mini resolutions of eating less added sugar, sleeping better and stepping out into nature. It is now time to embark on your next mini resolution: exercise!

 
What to expect on Mondays during our Exercise Mini Resolution
Just like today, you'll receive one email with key insights about exercise and the brain. Within that email, you'll be instructed to choose to follow along with our beginner or intermediate track. Your selection will take you to your tailored Brain Brawn mini resolution log and tips.

 
CHOOSE YOUR TRACK
 
Select your tailored track below! Track 1 is for beginners—those starting a new routine, and track 2 is for intermediates—those optimizing an existing routine. Which one best suits you?

 
CLICK FOR TRACK 1 • BEGINNER

 
CLICK FOR TRACK 2 • INTERMEDIATE

 
IMPORTANT: Keep scrolling below to read on about exercise, inactivity and cognitive decline, including exercise's direct and indirect impacts on the brain!

 
Exercise, Inactivity and Cognitive Decline
 
Exercise is the most extensively researched lifestyle factor associated with cognitive decline. This data has shown that exercise yields a universal, positive impact on cognitive function.
 
In fact, a quick search within the National Library of Congress for search terms "exercise and cognitive function" yields 95,200,000 study results! The degree of impact to the individual in these studies is different based upon several variables, such as a history of previous physical activity, the intensity of the exercise, the modality of the exercise, the age, genetic susceptibility, biological sex of the participant and the degree of cognitive impairment already experienced (or not). However, as of this writing, the evidence is irrefutable: exercise improves cognitive function in one or more domains and can also decelerate cognitive decline.
 
Conversely, being sedentary (uninterrupted sitting for 5-6 or more hours a day) reduces cognitive function and increases one’s risk of cognitive decline. In epidemiology, 9 criteria exist for labeling an observed effect as causation. Sedentary behavior meets 5 of those criteria, meaning researchers are close to stating a sedentary lifestyle causes cognitive decline. Whoa! That’s significant! But guess what? Depending upon the time and intensity of your planned, intentional exercise, if you sit with minimal interruptions 5 -6 or more hours a day, all that sitting may override the benefits of exercise. Thus, one can be physically fit but still be at risk for diseases of a sedentary lifestyle, including cognitive decline. People who are fit but sit are defined as “active couch potatoes.” Thus, it is important to exercise and interrupt prolonged periods of sitting by standing, walking about or even with “exercise snacks.” Don’t worry, we have it all covered in the next few weeks!

 
 
How Exercise Directly and Indirectly Impacts the Brain
 
DIRECT benefits of exercise to the brain:

Myokines - These signaling molecules are secreted by muscles in response to movement which create adaptive responses in the body. Many cross the blood brain barrier influencing the brain directly, known as muscle brain cross talk. Because myokines are secreted by muscles, it is important to maintain muscle mass with age and to avoid sarcopenia, in particular. Some myokines reduce inflammation, others improve glucose and lipid metabolism, but the best known myokine is BDNF - Brain Derived Neurotrophic Factor, which stimulates neuroplasticity, meaning it encourages the brain to reorganize its structure and function to protect existing neurons and to grow new neurons. More neurons and reorganized structures equate to better communication between neurons. This occurs in most areas of the brain, but primarily in the hippocampus, the area of the brain associated with learning and memory. This positive association is particularly notable when individuals are active prior to age 50. BDNF is considered Miracle Grow for the brain!

Blood flow: It is true that what is good for your heart is good for your brain! One cardiovascular benefit of exercise is its ability to prevent arterial stiffness and improve blood flow. Likewise, there is a correlation between cerebral arterial stiffness/reduced cerebral blood flow and MCI and dementia. Blood brings with it vital oxygen and nutrients (including antioxidants which combat inflammation and growth factors which promote neurogenesis!) for your neurons. A lack of either can injure your neurons or prevent their repair. Injured neurons cannot communicate with one another effectively. Exercise induces increased blood flow to the brain and prevents stiffening of the arteries in the brain, just like in the heart. (Fun fact:  Our brains receive on average the equivalent of about 3 soda cans of blood per minute!)

Brain size: People who exercise not only have larger muscles but also larger brains! The hippocampus (the part of the brain associated with memory and learning) can experience age-related atrophy. Exercise has been shown to both stave off and reverse this shrinkage. Exercise also adds volume to the pre-frontal cortex, the area of the brain responsible for executive function, one of the 6 domains of cognition, and considered "the management system for the brain." Interestingly, the effect of exercise on executive function is more pronounced as age is increased-so you really are never too old!

Blood sugar management: We all know how important exercise is to managing levels of sugar in the blood. While we associate high blood sugar with diabetes, we recently learned in our February mini resolution of the negative impact of sugar on the brain. Physical activity "uses up" blood sugar and makes your body more insulin sensitive. Here is the link to our February 5th edition of Motivated Mondays, if you would like to revisit the impact of added sugar on cognitive health.
​
INDIRECT benefits of exercise to the brain:

Sleep: People who exercise tend to sleep better than those who do not exercise. You may recall from our resolution to “Sleep Better” that exercise increases the production of a neurotransmitter called adenosine, which builds the pressure for sleep. Thus, exercisers are tired at the end of the day, falling asleep faster and staying asleep longer. Sleep has a potent impact on the brain. It flushes the brain of toxins which can accumulate as a result of normal biophysical activities during waking hours. Here is the link to the March 10th edition about the importance of sleep to cognitive health.

Stress/Anxiety: People who exercise tend to manage their stress and anxiety better than those who do not. While exercise can be stimulating via the neurotransmitters produced (we have all heard of a "runner's high"), it can also reduce stress, anxiety and depression and improve self-confidence. This is in part because people who exercise sleep better and those who sleep better manage their emotional response to stressful situations better. It is also due to an improved ability to physiologically respond to the chemicals produced by stress. We will have a future Brain Brawn mini resolution focused on reducing stress.
0 Comments

YOUR 2025 BRAIN BRAWN MICRO RESOLUTION GET IN TOUCH WITH NATURE!

4/21/2025

0 Comments

 
Picture

Exposure to Nature

 
Happy Monday! We hope, with two resolutions under your belt, you are still enjoying meals with no added sugar and getting better quality sleep!

Before we tackle our next big resolution, we'd like to recognize Earth Day with a micro resolution to spend more time in nature.
 
It has been almost 170 years since Walden, Thoreau’s exploration of living simply surrounded by nature, was published. In it, he famously says, “We need the tonic of wilderness… we can never have enough of nature.” Regarding cognitive tasks, he was correct.

A growing body of evidence has shown that exposure to nature improves performance of cognitive tasks and urban exposure may be detrimental to cognitive tasks. For example, a recent study found that those who walked for 35 minutes outdoors scored significantly better on the Stroop cognitive task than those who walked indoors on a treadmill. And a follow-up study found that those who walked outside in a forest scored better on a cognitive task than those who walked in an urban environment.
 
As with many phenomena, the mechanism by which this works is poorly understood but theories abound. Each theory relates to how we perceive the color (hue and saturation) and softer lines (fewer edges, less linear) of natural vs. urban environments, as well as the reduced need to filter stimuli such as traffic, crowds and signage. These benefits are best achieved by immersion in nature, but some benefits can be achieved by simulated environments (e.g., virtual reality).

In addition:
  • Being outdoors provides daytime exposure to blue light, critical for the circadian rhythm which is responsible for the timeclocks in every single cell in the body and responsible for our sleep-wake cycles (you may remember we discussed this during the Sleep Better resolution).

  • Being outdoors reduces the stress response and associated negative physiological effects (such as inflammation)—chronically existing in the “fight or flight” response when we don’t actually need to fight or run.

  • Being outdoors exposes us to the terpenes of plants and trees and the aromatic compounds given off by them. Specifically, pinene found in rosemary, pine and basil has been found to have a bronchodilator effect (i.e., it makes breathing easier). The scents in terpenes also have a positive effect on mood (consider how sniffing an essential oil impacts you).
Picture
The Outdoors & Cognitive Decline
 
Those who reside in areas with high greenspace have a reduced risk of developing dementia. In those with dementia, time outdoors has shown to improve mood in a time-dependent fashion. An enriched environment has been shown to stimulate brain plasticity.
 
The health benefits of exposure to nature are so profound that some doctors have taken to prescribing time outdoors. Similarly, the Japanese practice of Forest Bathing has really taken off.
 
You might be a bit skeptical, but what do you have to lose? This week, once a day (bonus if after lunch) lace up those sneakers, grab a friend or the dog and head out to the green spaces in your neighborhood to see if it affects your mental outlook and ability to concentrate later in the day. Track it on the calendar below.
TRACK YOUR PROGRESS

YOUR MICRO RESOLUTION: GET IN TOUCH WITH NATURE

Log your time in nature each day and record what kind of activity you did. Be sure to continue logging meals without added sugar and time spent in bed.
Click or tap to view and download the log.
0 Comments

YOUR 2025 BRAIN BRAWN MINI RESOLUTION SLEEP BETTER: WEEK 6

4/14/2025

0 Comments

 
Picture
Short Sleep Genes, Sleeping Pills, and Coffee Naps... Oh My!

 We couldn’t conclude our sleep mini resolution without addressing a number of trends and miscellaneous tidbits of interesting information.
 
Don’t forget to keep logging in your calendar and trying our sleep tips each night.
  
CCP's Curated Sleep Tips

 
The short sleep genes
 
Can you imagine sleeping only 4-6 hours a night and waking up feeling refreshed, and also without suffering the negative physiological consequences of sleep debt? It is estimated that only 3% of the human population encodes for one of the known three “short sleep” genes mutations (DEC2, ADRB1, NPSR1). What a gift! In addition to not requiring sleep to feel refreshed, short sleepers have been found to be Type A personality types, driven, ambitious and also positive outgoing and optimistic.

 
Polyphasic sleep
 
Historians believe that monophasic sleeping (sleeping in a single block of time) didn’t become the norm until the 17th century. That notion, combined with erratic schedules and the need for productivity have led to a trend called polyphasic sleep whereby sleep is broken up into bursts over the course of the day (think single sleep cycles spread out over the course of the day)-much like an infant or animals in the wild. While this trend has many proponents, scientists agree the current research on groups of people who inadvertently follow this style of sleep because of their chosen careers (shift-workers, healthcare workers, emergency responders) is compelling enough to advise against this style of sleep. 

 
Sleeping pills
 
Oftentimes when people report difficulty falling asleep, they resort to sleeping pills. However, plainly and simply, sleeping pills are a crutch, allowing the user to mask a deeper physiological or psychological problem that is the source of their difficulty falling asleep.
 
Ironically, sleeping pills don’t actually provide people with more or deeper sleep. The net gain in sleep, depending on the brand, is roughly only 20 minutes of sleep. In actuality, sleeping pills provide sleep amnesia, where the individual forgets they haven’t slept. Sleeping pills can lead to “parasomnias,” whereby people walk, drive, eat, and do other activities while sleeping—talk about danger! Sleeping pills also interact adversely with a long list of over the counter or prescribed medications.
 
Reliance on sleeping pills is not without long-term health consequences either, such as memory problems, depression, hypertension, hormonal fluctuations and weight gain, just to name a few. You may recall from Week 1, that one study places the risk of developing dementia for sleeping pill users at 80%.
 
Worse yet, sleeping pills generally don’t fix the underlying cause of sleeplessness, rebound insomnia is usually inevitable. It is a good idea to have a chat with your concierge physician if you are using sleeping pills more than just a few times a year.

 
Dreams

 As discussed, we really don’t know why we sleep-we just know we need to get those Zzz's to stay alive and healthy. Unfortunately, we know even less about why we dream! There are more theories in existence about why we dream than we can count. We wanted to re-share this interesting piece of trivia about dreams. Dreaming occurs during the REM stage of sleep and is also called “paradoxical sleep” because the brain is very active, but the body is essentially paralyzed. Why is that? Probably so you don’t act out your dreams and injure yourself or others!

 
Stress

 Most people tend to find sleep difficult when under stress. However, there is a small subset of the population that when stressed, well, they fall asleep. Scientists don’t completely understand these “fear naps,” but if this is you, we wanted you to know you are not alone!

 
Coffee naps

 On a long road trip? Staying up late to study? Enter the coffee nap! It takes roughly 20 minutes for the caffeine in coffee to kick in, so the process is to have a cup of coffee, lay down for twenty minutes. Awaken refreshed and ready to go!
Picture

To recap our Sleep Better Mini Resolution:
​

  1. We reviewed the critical nature of sleep to brain health and preventing cognitive decline

  2. We addressed the concepts of: the need to fall asleep with relative ease, defined as latency, which is influenced by sleep pressure; the importance of staying asleep for most of the night to complete sleep cycles within our sleep architecture (defined as sleep quality); both prior points influence sleep efficiency (time in bed vs. time spend sleeping) to avoid sleep debt

  3. To achieve all of the above, we provided a list of tips and suggested trying at least one a week to determine if it might influence your sleep score.

Remember, our mini resolutions are intended to create habits that build upon one another toward “Brawny Brains.” To emphasize the nature of the curriculum, we will continue to log meals without added sugar as well as our sleeping habits as we begin our next resolution next week.

 
See you next week for a special edition! Until then, keep logging!
Picture
​
GLOSSARY OF SLEEP-RELATED TERMS

Circadian Rhythm. The 24-hour life cycle of an organism. It is most affected by lightness and darkness and impacts physical, mental and behavioral changes within the organism.
 
Sleep Pressure. The pressure to sleep. It is lowest in the morning upon rising and builds throughout the day to be highest at night.
 
Adenosine. A neurotransmitter that promotes sleep pressure. High amounts of adenosine promote sleep pressure.
 
Sleep Efficiency. The ratio between time spent sleeping vs. time spent in bed. Sleep efficiency of 85% or greater is considered ideal.
 
Sleep Latency. The time it takes a person to fall asleep. Less than 20 minutes is ideal.
 
Sleep Architecture. The basic pattern of normal sleep, divided into REM and non-REM sleep.
 
Glymphatic System. The waste clearance system for the central nervous system. It is most active at night during sleep.
 
Sleep Debt. The difference between the amount of sleep needed and the amount of sleep achieved.
Use the calendar below to log your time in bed. If you have a sleep tracker, log actual hours slept. Note that the benefits of each resolution build upon the others, and the habits we develop are meant to stay with us well beyond the month the resolution is held. We will continue to log meals without sugar alongside our sleep progress.

Feel free to email your Motivated Mondays Coach Michele at [email protected] with your individual questions.
TRACK YOUR PROGRESS

YOUR MINI RESOLUTION: SLEEP BETTER

Log how many hours you've slept each day, and record which sleep tip you followed from the above link. Click or tap to view and download the log.
0 Comments

YOUR 2025 BRAIN BRAWN MINI RESOLUTION SLEEP BETTER: WEEK 5

4/7/2025

0 Comments

 
Picture
The Architecture of Sleep

 
Good morning! We hope our sleep tips are helping you wake up feeling primed and ready for the day.

 
CCP's Curated Sleep Tips

 
So far, we’ve discussed sleep pressure (the increasing pressure to sleep during the day determined by rising levels of our neurotransmitter adenosine), circadian rhythm (the daily sleep/wake cycles impacting all human physiology influenced by light exposure) and sleep debt (the difference between how much sleep you need vs. how much you get).
 
Now we would like to discuss another sleep topic: sleep architecture.
 
Theories abound but no one really knows why we sleep. What we do know is what happens physiologically to the body during sleep and how this impacts health and vitality.
 
Human sleep is characterized by a succession of sleep cycles. Within each sleep cycle are 4 stages. Within each stage, different physiological changes happen to recharge, restore and repair the body. Completing each stage and cycle fully is the key to sleep quality.
 
FUN FACT: Newborns and those with narcolepsy are the exceptions to the sleep stages rule. Newborns have three stages specific to their age, and narcoleptics spend very little time in earlier sleep stages and almost go straight to REM.

 
Sleep Stages

For the rest of us, one full sleep cycle runs about 90 minutes, and we go through about 4-6 sleep cycles per night. One full cycle consists of these four stages:

 
STAGE 1
Lasts about 7 minutes

This is your “nodding off” stage, where you are easily awakened.

You know that sensation of falling and being awoken with a start? That is called a Hypnic jerk and happens in Stage 1. Fun Fact: These involuntary, rapid muscular movements fall into the same family as hiccups, called myoclonus.

Brain plasticity begins. Brain plasticity is the ability of the brain to re-wire itself (i.e., learn and modify behavior and as we already know this is critical for avoiding cognitive decline!)

STAGE 2
 Lasts about 10-25 minutes

Still light sleep, but deeper than Stage 1.

Blood pressure and body temperature drops (recall how a hot bath causes a sudden drop in body temperature inducing sleepiness).

Muscles relax.

Memories are consolidated from short to long term, also critical for preventing cognitive decline!

 
STAGE 3
Lasts about 20-40 minutes
Termed "slow wave sleep" (SWS)

It is quite difficult to be awoken from Stage 3 sleep and if you are awoken, you will be very groggy and likely will suffer from sleep inertia.

Stage 3 is where much of the sleep “magic” happens. 

Stress hormones are reduced, also critical for preventing cognitive decline as these hormones can create oxidative stress in the brain.

Toxins washed from brain, also critical to prevent cognitive decline (Fun Fact: your brain swells during the day and at night it shrinks to its normal size through this glymphatic system process).

HGH and testosterone are secreted, encouraging tissue repair, muscle growth and development.

Immune cells are at peak levels improving immunity, also critical for preventing cognitive decline by protecting the blood/brain barrier.

STAGE 4
Lasts up to 4 minutes
known as the Rapid Eye Movement (REM) stage where dreaming occurs
 
This is when you achieve paradoxical sleep where the brain is very active, but the body is paralyzed so you don’t act out your dreams and injure yourself or others.

Here, the brain further consolidates memories and processes information, integrates them into the person’s world view, high level abstractions are formed, creative discovery is enhanced and problem solving occurs (hence the expression “sleep on it”).

Importantly, mood regulation and emotional processing also occur here via the amygdala.

The stages happen in succession and adequate time in each stage is required for the body to achieve benefits of sleep.

 
The Effects of Inadequate Sleep Quality

 What happens if you sleep with a snorer, or have a dog that barks when the wind blows or live on a busy street and as a result, your cycles are disrupted? In other words, what if you get through stages 1 and 2, but as you are entering Stage 3 something arouses you? Well, you go back to Stage 1 and miss out on the “magic” of Stages 3 and REM… uh oh!

Fragmented sleep, i.e., failing to complete the sleep cycles by awakening frequently, ravages the body impacting all areas of our health-no cell is left unaffected.

In addition, recent longitudinal studies have learned that the amount of time spent in each cycle changes with age. As we get older we spend more time in Stage 1 and less time in the critical later stages and these changes are associated with cognitive decline.
 
To complete our sleep cycles and to spend enough time in the later sleep stages, we need to build sleep pressure to fall asleep with relative ease (latency) and stay asleep for most of the night (quality) to achieve efficiency (time in bed vs. time spent sleeping) and reap the magic that sleep brings us.

All our sleep tips help achieve those goals! But the one tip that has the greatest impact on fragmented sleep is alcohol consumption. While a nightcap may help you conk out faster, alcohol will likely prevent you from entering the deeper/later stages of sleep, waking you in the middle of the night, increasing sleep debt.

Alcohol needs time to be metabolized at an approximate rate of 0.016% per hour. If you choose to imbibe before bed, try calculating the time it will take for your blood alcohol concentration (BAC) to drop to negligible amounts. (Please note: we are not encouraging alcohol consumption) Blood Alcohol Content (BAC) Calculator (Beer, Wine & Liquor)
 
TRACK YOUR PROGRESS

Use the calendar below to log your time in bed. If you have a sleep tracker, log actual hours slept. Note that the benefits of each resolution build upon the others, and the habits we develop are meant to stay with us well beyond the month the resolution is held. We will continue to log meals without sugar alongside our sleep progress.

Feel free to email your Motivated Mondays Coach Michele at [email protected] with your individual questions.​
YOUR MINI RESOLUTION: SLEEP BETTER

Log how many hours you've slept each day, and record which sleep tip you followed from the above link. Click or tap to view and download the log
0 Comments

YOUR 2025 BRAIN BRAWN MINI RESOLUTION SLEEP BETTER: WEEK 4

3/31/2025

0 Comments

 
Picture
​Balance Your Sleep Spreadsheet and Stay Out of Sleep Debt

 Happy Monday and welcome to another month of our sleep mini resolution! We hope it is a good morning for you and that you are sleeping better! Once again, here is our list of sleep tips:

CCP's Curated Sleep Tips
 
Sleep debt is the difference between hours of sleep needed and the hours actually slept. Everyone has different requirements for sleep. It is unique to the individual and genetically determined—it's the sweet spot of sleep where you awaken refreshed and have energy throughout the day. Your individual need for sleep is best determined in a time and place where you can fall asleep when tired and awaken without an alarm (much like camping under the stars as we recommended in Week 2).
 
Let’s say for example, your requirement for sleep is 7 hours, but you get 6 hours of sleep. That means you are in sleep debt for one hour. Research has shown that it can take FOUR days to recover from one hour of sleep debt!

 
Can you get out of sleep debt?
 
Recent research says “sort of...” If you have had a night of lost sleep, your best strategy is to go to bed a little earlier each evening. In theory this should be doable because your sleep pressure should be high. However, it is not advisable to rely on “sleep bulimia” where your “binge and purge” on sleep (discussed last week) as your regular practice. The distinction is between a pattern of daily reliance use vs. occasional use.

 
Can naps help us recover from sleep debt?

 Yes, a nap might help but it is the same rationale: occasional use vs. a detrimental habit. If you are in sleep debt and need an occasional nap, here are a few things to consider:

  • Nap duration: in general, a 20 minute nap is ideal.

  • Nap timing: according to our Circadian Rhythm, the best time for a nap is roughly 5-7 hours after waking for the day.

  • Shaking off the nap: upon rising from a nap, just like in the morning, getting some daylight will help you to get going.

 
What habits increase your sleep debt exponentially?
 
Wrong light, wrong times. Blue light after sunset will delay your ability to fall asleep (latency) keeping you tossing and turning under the covers because it keeps you alert and delays melatonin release. (From Week 2)

Not exercising. As discussed last week, this adversely affects latency and efficiency by reducing sleep pressure.

Alcohol consumption. While a nightcap may help you conk out faster, alcohol will likely prevent you from entering the deeper/later stages of sleep, waking you in the middle of the night, increasing sleep debt.

Alcohol needs time to be metabolized at an approximate rate of 0.016% per hour. If you choose to imbibe before bed, try calculating the time it will take for your blood alcohol concentration (BAC) to drop to negligible amounts. (Please note: we are not encouraging alcohol consumption.)

Seeing is believing! Below is an image of Coach Michele’s sleep tracker on one night with consuming alcohol and the other night without. The stress response is measured by respiration, heart rate and heart rate variability.
Picture

PRO TIP: The best habits for minimizing sleep debt are increasing sleep pressure and honoring your circadian rhythm.
​
Picture
GLOSSARY OF SLEEP-RELATED TERMS
Circadian Rhythm. The 24-hour life cycle of an organism. It is most affected by lightness and darkness and impacts physical, mental and behavioral changes within the organism.
 
Sleep Pressure. The pressure to sleep. It is lowest in the morning upon rising and builds throughout the day to be highest at night.
 
Adenosine. A neurotransmitter that promotes sleep pressure. High amounts of adenosine promote sleep pressure.
 
Sleep Efficiency. The ratio between time spent sleeping vs. time spent in bed. Sleep efficiency of 85% or greater is considered ideal.
 
Sleep Latency. The time it takes a person to fall asleep. Less than 20 minutes is ideal.
 
Sleep Architecture. The basic pattern of normal sleep, divided into REM and non-REM sleep.
 
Glymphatic System. The waste clearance system for the central nervous system. It is most active at night during sleep.
 
Sleep Debt. The difference between the amount of sleep needed and the amount of sleep achieved.
TRACK YOUR PROGRESS

YOUR MINI RESOLUTION: SLEEP BETTER

Log how many hours you've slept each day, and record which sleep tip you followed from the above link. Click or tap to view and download the log.
0 Comments

YOUR 2025 BRAIN BRAWN MINI RESOLUTION SLEEP BETTER: WEEK 3

3/24/2025

0 Comments

 
Picture
Increasing Sleep Pressure

 Happy Monday! We hope it is a good morning for you and you are waking feeling more rested. Remember, we're challenging you to try at least one tip each night during our sleep resolution:

 
CCP's Curated Sleep Tips

 
As we mentioned last week, there are two primary drivers impacting alertness and sleepiness at the right times of day. One is the Circadian Rhythm (addressed last week) and the other is sleep pressure.
 
Sleep pressure is our need for sleep and is driven by the neurotransmitter, adenosine.
 
After an evening of sleep, our sleep pressure is typically lowest in the morning and, after a busy day, highest at night. Adenosine is the neurotransmitter responsible for sleep drive. It accumulates in the cells during the day, inducing sleepiness at night and is metabolized during sleep, encouraging wakefulness.
 
Essentially, the “pressure” for sleep rises as the day progresses and adenosine rises in our cells.
 
What do many people do to destroy their sleep pressure?
 
Nap! Naps can be an effective tool to refresh the brain and body on the occasion when you haven’t slept. However, naps become a problem when they replace and interfere with a good night’s sleep because naps reduce sleep pressure. Napping creates a vicious cycle of not sleeping, napping to recover and then not sleeping because you napped! Consistently relying on naps to make up for lost sleep is a sign of a deeper, underlying issue to be discussed with a healthcare professional.

 
How do we increase sleep pressure so we can fall asleep at bedtime?
 
Let's revisit those sleep tips from Week 1 which specifically apply to sleep pressure:
Be consistent.
 
Keep the same bed and wake times.
 
It is not unusual for people in today’s busy world to binge and purge on sleep, a habit known as “sleep bulimia.” In other words, they skimp on sleep most days (purge) and catch up when they can (binge). This may be a quick fix to offset sleep debt (discussed next week!), but as a regular habit it can lead to social jetlag or a misaligned circadian rhythm (discussed last week and in our Special Edition on Daylight Saving Time). The body prefers consistency, which means going to bed and rising at mostly the same time. Your body will reward your consistent sleep schedule with high sleep pressure at your chosen sleep time to help you fall asleep faster.
 
Exercise.
 
Exercise is so powerful at reducing sleep latency improving sleep quality and it is considered a valuable non-pharmaceutical weapon against sleeplessness. Why is that? Exercise promotes the secretion of adenosine!
 
The relationship between sleep and exercise is bi-directional.  Meaning exercise helps you sleep better and sleeping better helps you have the energy to exercise. Conversely, not exercising will prevent sleep pressure from building, interfering with your sleep and not sleeping will leave you without the energy to perform.
 
Be mindful of what you consume and when.
  • Caffeine – As we mentioned in Week 1, the half-life of caffeine is 12 hours. Meaning, half the caffeine from your 8 AM cup of coffee is still in your bloodstream at 8 PM! So, take into consideration the timing of your last cup of caffeine. How does caffeine promote alertness? Well, it blocks adenosine which we now know is important for increasing sleep pressure.

  • Sugar – Sugar and sleep also possess a bi-directional relationship, meaning excessive sugar consumption will impair sleep, and impaired sleep will increase sugar consumption—ugh! Why is that? Studies show consuming excessive sugar leads to longer sleep latency and worsened efficiency. One theory is that sugar decreases magnesium absorption while also increasing its excretion. Magnesium is considered one of nature’s many valiums and helpful for sleep. When you don’t sleep well, the body makes more hunger hormone (ghrelin), less satiety hormone (leptin) and the endocannabinoid system (munchies) is activated, leading you to consume on average 400-600 extra calories a day... typically in the form of sugar for energy.

  • Chocolate – Some people are stimulated by chocolate, mistakenly thinking that it contains caffeine, but there is a very small amount of caffeine in chocolate. Chocolate possesses a substance known as theobromine, which can also block adenosine.

  • Alcohol – While an alcoholic drink may help you fall asleep faster, it will keep you up later in the night reducing the total hours slept and will also impair entry into REM. It also greatly impacts sleep debt, which we will discuss next week!
Picture
​GLOSSARY OF SLEEP-RELATED TERMS

Circadian Rhythm. The 24-hour life cycle of an organism. It is most affected by lightness and darkness and impacts physical, mental and behavioral changes within the organism.
 
Sleep Pressure. The pressure to sleep. It is lowest in the morning upon rising and builds throughout the day to be highest at night.
 
Adenosine. A neurotransmitter that promotes sleep pressure. High amounts of adenosine promote sleep pressure.
 
Sleep Efficiency. The ratio between time spent sleeping vs. time spent in bed. Sleep efficiency of 85% or greater is considered ideal.
 
Sleep Latency. The time it takes a person to fall asleep. Less than 20 minutes is ideal.
 
Sleep Architecture. The basic pattern of normal sleep, divided into REM and non-REM sleep.
 
Glymphatic System. The waste clearance system for the central nervous system. It is most active at night during sleep.
 
Sleep Debt. The difference between the amount of sleep needed and the amount of sleep achieved.

Use the calendar below to log your time in bed. If you have a sleep tracker, log actual hours slept. Note that the benefits of each resolution build upon the others, and the habits we develop are meant to stay with us well beyond the month the resolution is held. We will continue to log meals without sugar alongside our sleep progress.

Feel free to email your Motivated Mondays Coach Michele at [email protected] with your individual questions.

TRACK YOUR PROGRESS

YOUR MINI RESOLUTION: SLEEP BETTER

Log how many hours you've slept each day, and record which sleep tip you followed from the above link. Click or tap to view and download the log
0 Comments

YOUR 2025 BRAIN BRAWN MINI RESOLUTION SLEEP BETTER: WEEK 2

3/17/2025

0 Comments

 
Picture
The Circadian Rhythm: Our 24-Hour Cycle of Life

 Happy Monday! We hope you tried at least one tip last week and are feeling its positive effects! Need that list of sleep tips again? Here it is:
  
CCP's Curated Sleep Tips
 
There are two primary drivers impacting alertness and sleepiness at the right times of day. One is sleep pressure (to be addressed next week) and the other is the Circadian Rhythm.

In 2017, the Nobel Prize in medicine was awarded to three scientists for their work on the circadian rhythm (CR). The circadian rhythm is the 24-hour cycle that drives the physiology of being alive. It is typically generated internally but can be modulated by external cues, such as sunlight and temperature. The hypothalamus in the brain is responsible for synchronizing the circadian rhythm. The Nobel Prize Committee’s announcement summarizes the importance of the circadian rhythm to our health and well-being:

“With exquisite precision, our inner clock adapts our physiology to the dramatically different phases of the day. The clock regulates circadian rhythmical functions such as behavior, hormone levels, sleep, body temperature and metabolism. Our well-being is affected when there is a temporary mismatch between our external environment and this internal biological clock. For example, when we travel across several time zones and experience 'jet lag.' There are also indications that chronic misalignment between our lifestyle and the rhythm dictated by our inner timekeeper is associated with increased risk for various diseases.”

For modern humans, this circadian rhythm misalignment between lifestyle and rhythm is driven by our exposure to the wrong amounts and types of light, at the wrong times of day.

The circadian rhythm is one of the many human primitive physiological systems, the stress response being another, that has not adapted to modern living. Cavemen and women rose with the dawn and slept with the sunset. Their days were spent outside and any light exposure at night was fireside. It is specifically the exposure to the blue spectrum of bright daylight in the AM and midday which drives wakefulness through cortisol secretion, and it is falling darkness that stimulates the release of melatonin, the sleep hormone.  Our bodies still require this type and timing of light exposure to function optimally. However, now we rise before the sun, spend most of our days indoors, and go to sleep long after the sun has set with long hours of exposure to blue light from our electronics throughout the day and well into the evening.

How can we balance modern living with our primitive physiology? The best way to reset our circadian rhythm is a week of camping under the stars, but we realize this isn’t exactly practical for our purposes here. So, let’s revisit those “Right Light at the Right Time” tips from Week 1, which relate specifically to the circadian rhythm.
RIGHT LIGHT AT THE RIGHT TIME

 Expose yourself to daylight at least twice a day.

Start with first-day sun exposure. It is ideal to nab a 10–15-minute walk outside once the sun is up. If you don’t have the time or if the weather isn’t conducive to outdoor activities, then try standing in front of a window and looking outdoors for a few minutes for a meaningful impact on the hypothalamus. Be sure not to look directly into the sun!

Light is measured in lux units. The approximate lux of the midday sun is 100,000 units and the lux of a typical office is 100-2,000 units—quite a difference! Walking outside for 10-15 minutes after lunch will not only trick the hypothalamus, but it will also have the added benefit of controlling post-prandial blood glucose and provide you with a mental health break. This bio-hack is so powerful we will repeat it often throughout the year!

If getting outside during peak blue daylight hours is not possible, light therapy is an option. Try Googling "Light Therapy Options" to research an indoor light option that can simulate daylight.

Curious to know the lux units in your office or home? Google “Lux Meter App Free” and see what is suitable for your device.

 
Minimize your evening blue light exposure.

All exposure to light after the sun sets affects the hypothalamus and melatonin production (the sleep hormone), and it is the blue light of our electronics that is especially harmful. Sunlight has strong blue light in its spectrum and is strongest from early AM to midday, primitively intended to produce the greatest amount of wakefulness in humans for productivity and safety. Unfortunately, for the purpose of energy conservation, in 1992 our electronics switched from a green light spectrum to a blue light spectrum. Thus, we are kept alert however long we spend on our phones/devices—and melatonin release is delayed and diminished. 

Eliminating our devices is not a practical solution, but there are options for minimizing the impact they have:

Try Googling your specific device to see if you have factory settings installed that allow you to adjust the display spectrum from cool blues to warmer reds. If not, consider searching your app store “Blue Light Filters” for your specific device selections.

Since blue light is in virtually every device as well as in our TVs and artificial lighting, it may be more effective to purchase a pair of blue light blocking glasses to wear after the sun sets. 

Your third option (and our favorite) is to simply shut it all down an hour before bedtime. Dim the lights, read instead of watching TV and recharge your devices in another room.

 Fun fact! Newborns do not have a circadian rhythm. It takes the first 2-3 months of life to entrain the circadian rhythm.
 
We’ll see you next week for a deep dive into increasing sleep pressure.
Picture
​
GLOSSARY OF SLEEP-RELATED TERMS

Circadian Rhythm. The 24-hour life cycle of an organism. It is most affected by lightness and darkness and impacts physical, mental and behavioral changes within the organism.
 
Sleep Pressure. The pressure to sleep. It is lowest in the morning upon rising and builds throughout the day to be highest at night.
 
Adenosine. A neurotransmitter that promotes sleep pressure. High amounts of adenosine promote sleep pressure.
 
Sleep Efficiency. The ratio between time spent sleeping vs. time spent in bed. Sleep efficiency of 85% or greater is considered ideal.
 
Sleep Latency. The time it takes a person to fall asleep. Less than 20 minutes is ideal.
 
Sleep Architecture. The basic pattern of normal sleep, divided into REM and non-REM sleep.
 
Glymphatic System. The waste clearance system for the central nervous system. It is most active at night during sleep.
 
Sleep Debt. The difference between the amount of sleep needed and the amount of sleep achieved.
TRACK YOUR PROGRESS

YOUR MINI RESOLUTION: SLEEP BETTER

Log how many hours you've slept each day, and record which sleep tip you followed from the above link. Click or tap to view and download the log.
0 Comments

YOUR 2025 BRAIN BRAWN MINI RESOLUTION SLEEP BETTER: WEEK 1

3/13/2025

0 Comments

 
Picture
Sweet Sleep 

Hello and Happy Monday!
 
It has been said that sleep is of the brain, by the brain and for the brain. As such, for our next resolution, we will explore what is currently understood about sleep and the brain, and what you can implement and avoid in order to improve your sleep.
 
We’ve curated tips to help improve your sleep, which we'll discuss in greater depth each week.

For our 7-week sleep resolution, we encourage you to try one of our sleep tips each day, as well as track the hours spent in bed.
 
You can view our tips and log at the bottom of our weekly emails. You can also view the tips by clicking here.
 
It is also important to consider the quality of sleep within the hours spent in bed. Variables affecting sleep quality include time to fall asleep, hours asleep vs. hours in bed, number of nocturnal wakings, and rising feeling refreshed. These variables are best measured by a sleep tracker. If you have an interest in obtaining one, here are a few to consider. If you prefer something more high tech, here are a few new tools out of the 2025 Consumer Electronics Show (CES).
Picture
​
GLOSSARY OF SLEEP-RELATED TERMS

Circadian Rhythm. The 24-hour life cycle of an organism. It is most affected by lightness and darkness and impacts physical, mental and behavioral changes within the organism. We address the Circadian Rhythm on March 17th.
 
Sleep Pressure. The pressure to sleep. It is lowest in the morning upon rising and builds throughout the day to be highest at night. We address sleep pressure on March 24th.
 
Adenosine. A neurotransmitter that promotes sleep pressure. High amounts of adenosine promote sleep pressure.
 
Sleep Efficiency. The ratio between time spent sleeping vs. time spent in bed. Sleep efficiency of 85% or greater is considered ideal.
 
Sleep Latency. The time it takes a person to fall asleep. Less than 20 minutes is ideal.
 
Sleep Architecture. The basic pattern of normal sleep, divided into REM and non-REM sleep. We address sleep architecture on April 7th.
 
Glymphatic System. The waste clearance system for the central nervous system. It is most active at night during sleep.
 
Sleep Debt. The difference between the amount of sleep needed and the amount of sleep achieved. We address sleep debt on March 31st.

​Sleep and Brain Health

No one really knows why we sleep. Theories abound, but the exact reason is unknown. However, we do know chronic sleep disruption leads to a litany of health disorders and absolute sleep deprivation can lead to death. Likewise, while the exact mechanism by which sleep protects the brain is unclear, it is known that sleep disruption is a critical risk factor for neurodegeneration. Interestingly, some theorize the brain is a biological computer and sleep is the reset button for the operating system.
Picture
Here are some highlights of what we currently understand about sleep and the brain:

  • Sleep is in fact so critical that it is considered an important preventive strategy and therapeutic intervention for Alzheimer’s Disease. Recommended interventions for improving sleep include cognitive behavioral therapy, exercise, socialization, melatonin and light therapy. Much of what we will cover here this month will include first line of defense behavioral strategies. We will not be addressing the medical conditions OSA and RLS.

  • Sleep is induced by neurons (brain cells).

  • It is thought that the relationship between sleep & neurodegeneration is bi-directional, meaning that sleep disturbances affect the development of neurodegeneration, and that neurodegeneration disrupts sleep. It is often unclear, however, as to which came first (the chicken or the egg?!). Sleep changes are considered a predictive, pre-clinical symptom of neurodegenerative conditions. And up to 45% of those diagnosed with neurodegenerative conditions experience sleep disturbances.

  • Adults who habitually nap are at high risk for cognitive disorders.

  • Those who habitually use sleeping pills are at high risk for neurodegenerative conditions (one study places the risk of developing dementia for sleeping pill users at 80%). Sleeping pills are NOT considered the first line of defense in older adults with sleep disorders.

  • The Goldilocks timeframe for protective sleep is 5-7 hours a night. High risk sleep times are 4 or fewer hours a night, or 10 or more. In studies, the more sleep is restricted, the worse cognitive performance gets on subsequent testing.

  • It is well-established that we consolidate and strengthen our memories during sleep. The two cognitive domains most affected by sleep loss are attention and memory.

  • Sleep loss leads to activation of the fight or flight system, thereby increasing cortisol and blood pressure. Activation of the fight or flight system also weakens the immune system which leads to an increase in oxidative stress and permeability of the blood brain barrier. Metabolic health is also impacted, leading to insulin resistance (last month we discussed how excessive blood sugar impacts the brain). One of the magical functions of sleep is to reduce metabolites from the brain. Essentially, sleep detoxifies the brain via the glymphatic system.

A bi-directional relationship also exists between sleep and exercise, and it deserves some extra attention here:
  • Exercise resyncs the Circadian Rhythm.

  • Exercise promotes sleep by regulating the central nervous system, endocrine system, metabolism and body temperature.

  • As people age, they tend to spend less time in the critical later sleep stages, but people who exercise spend more time in these later stages of sleep than those who do not exercise.

  • People who exercise have an enhanced “rest and digest” system, which is the counter to the “fight or flight” system, improving both sleep and mood.

  • Exercise can reverse cognitive decline induced by lack of sleep.

 With all this in mind, use the calendar below to log your time in bed. If you have a sleep tracker, log actual hours slept. Note that the benefits of each resolution build upon the others, and the habits we develop are meant to stay with us well beyond the month the resolution is held. We will continue to log meals without sugar alongside our sleep progress.

Feel free to email your Motivated Mondays Coach Michele at [email protected] with your individual questions. See you next week!

CCP's Curated Sleep Tips
TRACK YOUR PROGRESS

YOUR MINI RESOLUTION: SLEEP BETTER

Log how many hours you've slept each day, and record which sleep tip you followed
​from the above link.

Click or tap to view and download the log
0 Comments
<<Previous
    Picture

    MICHELE MCCAMBRIDGE, MPH, MS

    Michele is the Senior VP of Membership Development at Concierge Choice Physicians. She is also a professional in the areas of nutrition, fitness and wellness.

    ​With a Master’s in Public Health from Columbia University and more than 10 years of experience working with the public as a wellness advocate, personal trainer and chef, Michele is passionate about teaching patients the “how to” of health advice.

    She’s taught at NYU, placed in natural body building competitions, is certified in multiple styles of Yoga, and even completed the Natural Gourmet Institute Chef Training program. In addition, Michele recently completed a joint degree Master of Science in Human Nutrition and Functional Medicine.
     As Michele says “my passion is demonstrating how simple lifestyle choices can help people feel and live better.”

    Archives

    May 2025
    April 2025
    March 2025
    February 2025
    January 2025

    Categories

    All

    RSS Feed

Picture
CCP is a privately held company based in Rockville Centre, New York. We have consulted with and supported hundreds of practices nationally since 2005. For our current list of locations and physicians, please select “Find a Doctor” at the top of the page.​

Additional Links

Team
Careers
Media Kit
News
Contact Us

SOCIAL MEDIA

© Concierge Choice Physicians. All Rights Reserved.
  • Home
  • For Patients
  • For Doctors
  • For Healthcare Organizations
  • Find a Doctor
    • Alabama
    • California
    • Connecticut
    • District of Columbia
    • Georgia
    • Florida
    • Illinois
    • Indiana
    • Kansas
    • Maryland
    • Michigan
    • Missouri
    • Nevada
    • New Jersey
    • New Mexico
    • New York
    • North Carolina
    • Ohio
    • Pennsylvania
    • South Carolina
    • Texas
    • Virginia
  • Contact Us