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How A Precision Medicine Doctor Prioritizes Sleep For The Sake Of Her Metabolism, Mood & More

Florence Comite, MD
Author:
August 09, 2023
Florence Comite, MD
Precision Medicine Doctor
By Florence Comite, MD
Precision Medicine Doctor
Dr. Florence Comite is a clinician-scientist and innovator in the field of precision medicine. She is world-renowned for her expertise in predicting, preventing, and reversing chronic disease and the disorders associated with aging. In 2005, Dr. Comite founded the Comite Center for Precision Medicine & Health where she practices a clinically proven, academic approach to personalized healthcare, structured as a clinical trial. Dr. Comite is a graduate of Yale School of Medicine where she was a faculty member for 25 years, with a triple appointment in Endocrinology (Internal Medicine and Pediatrics) and Reproductive Endocrinology (Gynecology and Andrology). She trained at the National Institutes of Health (NIH) in Bethesda, Maryland. In 1992, Dr. Comite founded Women’s Health at Yale.
the wind down
Image by Alina Hvostikova / Stocksy
August 09, 2023
Our sleep series, The Wind Down, provides a minute-by-minute peek into the wind-down routines that get well-being experts ready for bed. Today, we're relaxing with Florence Comite, M.D., an endocrinologist and precision medicine specialist with a special interest in how a lack of sleep impacts glucose management.

Missing sleep is a fact of life for many physicians. Doctors are expected to be available at all hours of the day and night, addressing urgent requests from patients and answering texts and emails. That starts during our training as residents where, of course, we get very little sleep. We're working 100 or more hours a week; I remember frequently doing 24- to 48-hour shifts at Yale. Exhausting.

There's a price to surviving on too little sleep. Tracking my biological age revealed more rapid aging over three months with too little sleep back in 2021. Now, I strive for a minimum of six hours every weekday night, more on weekends.

Through my work in Precision Medicine, I've discovered how much critical cellular repair happens during sleep—immune function, metabolic processes, hormonal production and healing, rejuvenation, and creativity.

Tracking my biological age revealed more rapid aging over three months with too little sleep

Sleep is paramount for health, with much evidence to that effect in the scientific literature. Too little sleep ages us biologically and undermines our mood and sense of well-being. It even makes depression and anxiety worsen1. It becomes more difficult to rise to the demands of work or even play. Genes that must switch on through the night do not. Many scientific studies demonstrate that diabetes, heart attack, stroke, and other disorders2 associated with aging will kill us earlier in life if we shortchange ourselves on quality sleep.

I've seen sleep even trump food for a healthy mind and body. In my work at the Comite Center for Precision Medicine & Health, I look at a patient as a clinical trial of a single individual, an N-of-1 trial. I'll do a deep dive into an individual's medical history, family health history, lifestyle habits, extensive blood work, and other diagnostics. And the evidence is clear that deep sleep and REM sleep have a profound impact on patient health—starting with improved sugar, or glucose management. A 2019 study found that 62% of people with glucose levels in the prediabetes range are likely to have poor sleep. I have a disorder of carbohydrate metabolism3 (as most, if not all, people do).

Years ago, I started wearing a continuous glucose monitor (a CGM) long before they were available in the United States. Beginning in 2012, I downloaded a sleep app (after fracturing my shoulder skiing, which disrupted my sleep). I continue to monitor the stats and patterns each day to see what happens to my metabolism during the night. Sleep has a powerful impact on my metabolism, especially sugar and insulin control.

After buying an Oura ring so I could monitor my sleep more precisely, I saw a direct correlation between the nights I got the least deep sleep and higher sugar readings on my CGM. When I spend too few hours in bed, I tend to lose REM sleep but get sufficient deep sleep: that gives me energy to do all that I must. But I feel best when deep sleep and REM are both adequate and my dreams are vivid.

sleep stats written over line gradient
  • Average hours I sleep each weeknight: 6 but can range from 5 to 7
  • Ideal bedtime: 12 a.m. 
  • Ideal wake-up time: 6 a.m. 
  • Nightstand essentials: Currently, my nightstand includes my iPhone so I can keep track of my sugar (and my patients') through the continuous glucose monitor (CGM), worn on my upper arm, my Groq Health app, and typically a science fiction book. Stranger in a Strange Land by Robert Heinlein is my favorite.  
  • Favorite place I've ever slept: Always my cabin in Vermont on a snowy evening after a day of skiing. Rollerblading and water skiing are other seasonal favorites. 
  • Sleep bad habit: Staying up late to answer emails and texts. Getting up early to do the same!  
  • Caffeine consumption: No coffee at all. I do like jasmine green tea. I don't drink caffeinated soft drinks. My go-to beverage with caffeine is hot dark chocolate periodically—I love the rich taste and the benefits of antioxidant polyphenols.  
  • How I track my sleep: I wear an Oura ring and use a sleep app on my iPhone. 
  • The last product or habit that changed my sleep for the better: I stop eating two to three hours prior to bed, which changed the quality of my sleep via metabolic alterations.
  • The first thing I do when I wake up: l rest quietly, whether at a hotel or home, and figure out my day to absorb what I must to navigate effectively.  
my sleep routine written over gradient

Sunset helps me to switch from work into a more Zen mode in the evening. 

7:30 p.m.: Finish dinner. 

8 p.m.: I catch up on work. There's always unfinished business from the busy days working with my team and clients. Several times during the week and every weekend, I get together with family and friends for dinner, to catch up on our lives and laugh together! Laughing is great medicine for me and many others.

10:30 p.m.: Most nights, I take a warm bath and take my supplements and medications. I apply my evening facial skin routine set up by my twin sister, my dermatologist. My skin care practice also includes Prime Facial Magic, a metabolically active cream that has a phenomenal impact on skin and internal function. I use the cream on my face, hands, and arms at night and repeat in the morning. 

11 p.m.: After a bath, my energy will often recharge, and my creativity will kick in. I may catch up on a bit of writing or take time to do what I really love: read. In full transparency, I may jump on email and text one last time. Steven Colbert is a favorite to have on TV in the background. I am in my bed and fast asleep as soon as I close my eyes. I feel fortunate that I have always been able to go to sleep quickly. 

6 – 6:30 a.m.: Wake up. I often get another burst of creativity in the early morning related to my work. Typically, my routine is to step outside to be exposed to light. I will walk our rescue Maltese, though mostly my partner Marc gets to Oliver first.

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