Sleep Scientist: "Sleep Isn't a Luxury — It's Your Strongest Longevity Lever" | Dr. Michael Grandner

“The sleep people are getting in the real world predicts how long they live better than almost anything else.” According to Dr. Michael Grandner, sleep isn't just rest. It's one of the strongest predictors of how long you'll live.

Yet most people fundamentally misunderstand what sleep is, why we need it, and what happens when we don't get enough of it. The consequences reach far beyond feeling tired, influencing everything from your brain function and metabolism to your immune system, long-term health, and lifespan.

In this episode, Chris Wharton sits down with Dr. Michael Grandner, Director of the Sleep and Health Research Program at the University of Arizona and the world's most cited sleep researcher Drawing from decades of research, Dr. Grandner unpacks what sleep is actually doing inside your body, why so many people struggle with it, and how improving it may be one of the most powerful things you can do for your health, performance, and longevity.
No wellness trends. No sleep hacks. Just the science behind one of the most important—and overlooked—drivers of human health.

In the episode, you'll learn: 
→ Why sleep is one of the strongest levers for longevity, performance, and disease prevention 
→ Why chronic sleep loss impairs decision-making, memory, metabolism, and emotional regulation before you notice it 
→ The difference between feeling tired and being objectively sleep-deprived 
→ Why trying harder to fall asleep can make insomnia worse 
→ How sleep apnea is often missed — especially when symptoms look like fatigue, anxiety, or depression 
→ What sleep trackers and wearables can tell you, and what they often get wrong 
→ Why melatonin, supplements, and sleep hygiene aren't always enough to fix a real sleep disorder 
→ How light, caffeine, alcohol, temperature, screens, and bedtime routines affect sleep quality 
→ Why better sleep often comes from doing less — reducing effort and getting out of your own way 

Dr. Grandner has published more than 250 academic papers, chaired the American Heart Association's Sleep Science Committee, and presented to the US Congress on sleep health. This episode is for anyone who wakes up tired, struggles with insomnia, relies on sleep trackers, or wants to understand how sleep really affects longevity, recovery, and daily performance.

Want more? Each month, we send a newsletter curated by our scientific council on what's 
actually advancing the science of human longevity — and what isn't. Subscribe at https://www.thewndrlab.com/mailing-list.

The WNDR Lab: https://www.thewndrlab.com/ 

Michael Grandner, PhD | University of Arizona

Michael Grandner, PhD, researches the connections between sleep and circadian health, including innovative strategies for improving sleep. The Director of the Sleep and Health Research Program and a tenured Associate Professor in the Department of Psychiatry with joint appointments in Medicine, Psychology, Nutritional Sciences, and Clinical and Translational Science at the University of Arizona College of Medicine, he is the Inaugural Chair of the American Heart Association’s Sleep Science Committee and the Past President of the Society of Behavioral Sleep Medicine, as well as an elected Fellow of the American Academy of Sleep Medicine and the Society of Behavioral Sleep Medicine. Dr. Grandner has over 250 academic journal publications, advises numerous companies, has presented to the US Congress multiple times on the topic of sleep health, and has co-authored position statements for the International Olympic Committee and the National Institutes of Health, among many others. He was recently awarded the Richard Bootzin Mid-Career Distinguished Scientific Achievement Award by the Society of Behavioral Sleep Medicine.

Dr. Michael Grandner's Instagram https://www.instagram.com/michaelgrandner/
Linkedin: https://www.linkedin.com/in/grandner/
Website: https://www.michaelgrandner.com/about.html
YouTube: https://www.youtube.com/@UCTET02GzjnNxSg3V157lUIw 

Transcript

SPEAKER_00 0:00

The sleep people are getting in the real world predicts how long you live better than almost anything else. The enemy of sleep is not wakefulness. You need wakefulness to be able to sleep. The enemy of sleep is effort. We trade sleep for work. Yeah. But we get less done when we do it. I've had to make this call many times. I know they're waiting on a response for me from this, but I've got to shut this down now so that I can get to bed when I need to, so that I can be effective tomorrow. Once sleep becomes predictably stressful, and you approach sleep from this place of stress without even realizing it. If you can't turn your mind off and this is a new thing, it's because your wind down routine didn't give you enough time and space to wind down. But if this is a chronic thing, maybe it's a learned response. The biggest myth I see about sleep is that sleep has a number of boxes it needs to check to be okay. Like you need to sleep at this time for this amount, that it has to be a certain way or else. Yeah. Actually, sleep is quite flexible. It's not about tonight, it's about the pattern. How do I know how much sleep I need? Why do we sleep? The answer of why we sleep is a very good idea.

SPEAKER_03 1:31

One of the most powerful yet misunderstood influences on our health, performance, and ultimately the pace at which we age. Now, I'm joined today by the most cited sleep scientist in the world. Dr. Michael Granner is a clinical psychologist and behavioral sleep medicine specialist. He's the director of the Sleep and Health Research Program at the University of Arizona and is the author of The Sleep Solution. And having published over 300 articles on the impact of sleep on our health, it's safe to say he's one of the world's leading authorities on the topic. His research has helped shape our understanding of how sleep impacts everything from metabolism and mental health to cardiovascular disease, cognitive performance, and ultimately how long we live. Today we're going to unpack what exactly happens to the body and brain when we sleep, why poor sleep may accelerate aging. And we're going to give you lots of practical strategies known to genuinely improve the way you look, feel, and perform today, and to keep it that way for years to come. Welcome, friends, to the living room. Michael, I've been welcome, firstly. Thank you. I've been really looking forward to this conversation, kind of selfishly for a couple of reasons. Um, you know, one, I think sleep seems to be one of the things that doesn't carry as much weight in um the collective psyche. I mean, nutrition, exercise, stress, human connection, we talk about so much. I think it's got better over the last 10 years, but it seems to be something that we sacrifice all too readily. And I say that because it's something that I often sacrifice. And so the selfish reason I've been so excited is um I know how brilliant you are at unpacking a very complicated topic. So thank you for joining us.

SPEAKER_00 3:15

No, thank you for having me. This is gonna this is gonna be a really fun conversation.

SPEAKER_03 3:19

Yeah, so let's start. Um, you know, not not everyone grows up thinking I want to spend my life studying sleep science. How did you end up here? I mean, how did you end up becoming the most cited sleep researcher in the world?

SPEAKER_00 3:35

Well, so when I was a kid, I was one I had lots of questions. I was one of those kids who had lots of questions about everything. And when I was in high school, I just thought dreams were the coolest thing ever. That there was this whole other side to reality that had answers, that had questions, that had insights. And if we could only find it, if we could only do the work and unpack it, I just thought that was the coolest thing ever. And then when I was in college, um, I was at the University of Rochester, and I had a friend who was very excited that she had gotten a job as a tech in the new sleep lab on campus. And my reaction was, wait, we have a sleep lab on campus. Why did I not know this? Like, this is cool. Can I see it? And um, and she was like, Yeah, and the guy who is is building it and one of the people running it, he's gonna be teaching a course. I'm like, you should like this is right up your alley. You should totally take this class. And so I did. And that was my that was Michael Perlis' sleep class that I took as an undergrad, the University of Rochester. Uh, little did I know this was this was somebody who was relatively early in their career, you know, teaching for the first time a class, someone who ended up becoming one of the most legendary teachers of the field, like winning awards for teaching. And like I was just lucky to be there. And when he taught, he taught the field not like a set of facts. It wasn't like for you know, here are the things to know. You know, it was taught like a story. Like, well, first it was this, and then this is how they got the EG signal, and this is what they learned from it. Then this happened, then this happened, then these people came in and thought this, but then they were wrong. But what they found was it was this amazing story with this crazy cast of characters, and that's how I learned what science was. Like that science isn't just about the list of bullet points, things that we know. Science is a story and it's constantly unfolding. And the thing about sleep was it was still unfolding, it wasn't received knowledge, it was most of the people in that story were still alive and still working and still writing. And I just thought, I don't know, there was something about sitting in that class where I felt like I wasn't learning, I was remembering. Yeah, you know, I felt like like this is just sort of where I need to be. So after the class, I went up and I said, Can I volunteer as a research assistant in the lab for research experience? And he's like, Well, I got no extra money. He's like, that's okay. I'm like, that's fine. I'm happy to volunteer. And it turned into an independent study, turned into an honors thesis. He's like, you know, this is if you want to do a career down this path, like you get a PhD in in psych and you work someplace that has someone who has a lab like this and go from there. And he mentored me and uh and then I went to grad school and and you know went from there.

SPEAKER_03 6:42

And you say, you know, that this is a story that is still going, and that you know, we don't know everything about this field. Do we even know what why we sleep, like what it is, like what's the purpose of it?

SPEAKER_00 6:54

Yeah, well, so that's an interesting question because why do we sleep? The answer of why we sleep is on the one hand known and not very interesting, but it also is very interesting. So, why do we sleep? We don't sleep because it's good for you, we don't sleep because we enjoy it, we don't sleep because we feel better after we do it. Um why do we breathe? Right? We breathe because all our cells need oxygen. Um, we breathe because we weren't born with all the oxygen we're gonna need in our life, and we need to get that from an outside source. So we breathe because we need to, and breathing is a fundamental part of our physiology. Um, we were born able to breathe. We never had to learn how to do it. It wasn't a skill we needed to master, it was just something we were born able to do because it was absolutely required since day one of our life, of everybody's life. Ever. You know, and sleep, we sleep for the same reason. We sleep because it's a fundamental part of our physiology. It's just it's just part of how we're built. We we're built to require it. Yeah. That the the why that's why I said that's why I said the answer to that question is there's many interesting answers to that question, but the most fundamental answer is actually kind of a boring answer where we sleep because we have to. We sleep because it's a biological imperative. We sleep because it's a requirement of human life. Again, it wasn't a skill we ever needed to learn. We were sleeping since the day we were born, and actually, probably before. It was nothing we ever needed to learn how to do, and we've had to do it since day one, just like breathing, just like you know, we we we sleep for the same reason we do other things we need to do to survive, because they're just fundamental to our ability to live. It's just something that our body requires. Now that's the uninteresting answer. We sleep because we have to, but the interesting answer is sort of the other one you were getting to is but why sleep? Like, why do we do that? Like, what what does that do that's so fundamental? And I think that the real answer, and then we can unpack that. Okay, but the real answer is I think we sleep for three reasons. Number one is rest activity rhythms. Evolution figured out a long time ago that when life is a sprint, it's short. And survival does not favor that. And you look at life across all kinds of species down to microscopic organisms, you'll see the concept of rest activity rhythms that are important for development, that that sometimes you're in you engage with the environment and you're taking in information and you're doing things. And sometimes you're not, there's periods of time where you're not doing that on purpose because you're doing things internally. Um, again, evolution figured this out a long time ago. It's much easier to change your car's oil while you're not still driving it. I mean, theoretically it's possible to do, but it's really inefficient. I mean, same thing. Like we can, it's really inefficient to fill up your car with gas while you're driving it. I mean, someone could have invented a way, and we do it with airplanes sometimes because it isn't less efficient that way sometimes in some of these military planes. But most of the time, it just makes more sense. Just stop and refill for now. The the logistics of having to like match speed and do it safely and like while you're doing other things and paying attention to the road, the logistics of that just don't make sense. It's much easier to just pull over, find a gas station. And the system found that out when we invented cars. And that's because this is a a feature of living in and adapting to an environment that actually there are these processes, there are maintenance processes that are much more efficient to do while you're not out there engaging in the world. So you have these rest activity rhythms all throughout life, all throughout nature. The second, so we need those. We need that period. And by rest, it's not just inactivity, it's these are active maintenance processes that are just much more efficient to do when you're disconnected from the environment. The second reason we sleep is because of circadian rhythms. Now, circadian rhythms are sort of 24-hour cycles. A lot of people have heard the circadian just circadia, just circle day. And they're just 24-hour-ish rhythms that, again, you see it all over life on Earth for a very important reason. That, you know, over millions of years that life has existed on Earth, um, you know, volcanoes created continents and dinosaurs came and went, and ice ages came and went, like and all and Pangea formed and and broke up, and um during all that time of a changing environment, one aspect of the environment has been extremely predictable and consistent, and that is that the earth spins on its axis and goes around the sun in a very predictable way. And if your early life on Earth, even going all the way back, and so we call it a light dark cycle. It's not a light dark cycle. We call it a light dark cycle because we're visual animals. It's but you know, microscopic organisms don't call it a light dark cycle because they don't see to them, it's an energy cycle. It's radiation energy from the sun, and then that energy goes away. And then they're bathed in energy, and then that energy goes away. And if you can figure out that pattern of when the energy is present and when it goes away, man, you can predict all kinds of things that's really useful for and again, evolution figured this out a long time ago. Instead of seeing the day and night as optional things, it was just a fact of the environment that it had to work around. So, pretty much any species that it that that relates to any kind of light-dark cycle, they start building internal rhythms around this. That, well, when you're bathed in energy, that's actually a good time to be moving around and engaging with the environment and in and you know, evolving vision to navigate the world. Because that's what you want to navigate the world when there's energy and you have more time for movement. And maybe when there's less energy is a time when you're not navigating the world. And so you have these circadian, and so if you look inside the human body, every cell has circadian clocks in it, multiple clocks. There's clocks all over the body. And uh, like there was this there's great work by by John Hoganesh and colleagues at at in Cincinnati about how about half the human genome seems to be rhythmic across 24 hours, at least somewhere in the body. Like we are rhythmic beings foundationally. Like the machinery that transports glucose across cell membranes, the the the act of taking energy into your cell is clock dependent. You know, like these these the basic functions of how our body works is clock dependent. And it and it is so for an obvious reason that you know we've adapted to our environment. So, okay, so we have rest activity rhythms, we have circadian rhythms, and then there's the the third one, which is kind of the secret sauce of what sleep really does, is that also evolution figured out that when you have these two things, you can get this period of time of lower energy and decreased interaction with the environment, which creates a great lab for maintenance functions that are all about adaptation to the environment. So it's like um when you're the person you are during the day, you don't just like switch off at night and then wake up a new person the next day. No, you're the same person all night. What's happening is you take in lots of stuff during the day, you take in information, you take in experiences, um, you take in food, you do do you do stuff. And then that, you know, changes your internal ecosystem. And then at night, what happens is you're like, okay, let's close the door on that. Now let's, what do we got here? What you know, what's all the mail that showed up today? Junk, junk, junk. Oh, that's a bill. You're like, and and and well, this is a cool magazine. Let me keep that one. And so you sort through everything that's gone through the day, toss out what doesn't need to be remembered, that doesn't need to have an impact on the system long term, because it was just an experience. And then, but other things have might have elements to them that are like, ooh, if I'm gonna meet tomorrow's challenges a little bit better, what happened today that I need to learn from? And so it's like it's like when you when you when you work out, when you train, I mean, when you're exercising, you're not building muscle. Yeah, you're working in. And then what happens is your body learns that, okay, here are the challenges that I need to face. What remodeling do I have to do to better meet those challenges? And so the growth, um, that's what's happening during sleep. You know, while you're engaging with the environment, you're just injuring yourself, like you're pushing the system. Yeah. It's during sleep that the system is like, all right, that happened. How do I make sure that that gets done better tomorrow? What little bit of remodeling could can I do to just push myself in the right direction? And that happens all over the body. That's how your immune system learns, it's how your muscles grow. I mean, that's how you're and that's how you learn things in the brain. That's where you take your experiences during the day and turn them into who you are and what you know and how you feel and and you're and who you are. And so we sleep because rest activity rhythms are are enhanced survival. We sleep because circadian rhythms have have for us made the night a time when that rest stuff is a good time for it to happen. And we sleep because that combination of things creates a great opportunity for adaptation to the environment.

SPEAKER_03 18:08

That's a really very clear way of putting it, actually. That's incredibly useful. One thing I would just be really curious, I've always been curious about is why do we need to be unconscious when that happens?

SPEAKER_00 18:20

Yeah, you're vulnerable. You're vulnerable in a way. So um, for well, there's a couple things. First of all, we're not as unconscious as people tend to think. Now, one of the most amazing things about sleep is how reversible it is. That like what other state of unconsciousness, whether it's whether it's anesthesia, coma, delirium, can you walk up to somebody in that state and go with your fingers? Yeah. And then within a moment, they're not in that state anymore. Like it doesn't work that way, but with sleep it does. Because, you know, we have these safeguards in place. The typical adult during the night, if you look at the arousals in the brain that are happening, they don't people come into the clinic all the time thinking, I want to fall asleep in 10, 15 minutes, sleep for eight hours in a row, and then wake up and start my day. And that's not how it works. Like, so with those people I ask, like, have you ever had a dog or a cat? And they'll be like, Yeah, I'm like, do they sleep like that? Do they sleep? They they lay down, fall asleep, sleep all at once, and then that's it. It's like, no, mammals don't sleep that way. Um, part of it is what happens is we wake up, look around, no bear, back to sleep. Yeah, we probably do that. Like, if you ask a person how many times they wake up during the night, they'll say, you know, if they're if you're young and healthy, you'll say zero, one, two. As you get older, three and four become less unusual and become normal. Um, but actually we wake up way more times than that than we remember. Um, any awakening lasting less than two to three minutes is not remembered. And we have a bunch of those during the night. That's why if you have a wearable and it's showing like lots of little tick marks of awakenings during the night means it's correct. Right. Um if you don't see that, it means it either didn't measure them or it's just not showing you because it doesn't want to freak you out. But that's normal. So part of that, part of it is yes, we are more vulnerable and we have a safeguard in that we don't totally disconnect for extended periods of time. The only time we're most disconnected is the first couple hours of the night. Um, that's where we have sort of the deepest stages of sleep, where the and it's called deep sleep not because it's the good one, where that's where it's not called deep sleep because that is the one where the important things happen. It's called deep because it's the hardest to wake up from. You're the deepest down in there, and it takes the most effort to bring you up. You know, the scientific term for it is you have the highest arousal threshold where where it requires the most effort to cross that threshold and bring you back into arousal and awakefulness. Because that's when stuff is happening that requires the most disconnection. And again, evolution figured out where's the most likely part you're gonna you are gonna be safe to be uninterrupted first couple hours, because you can delay bedtime to find safety. And once you found safety, okay, that's when you sleep. That's when you're least likely to be interrupted because you found a safe spot. Like, who knows what's gonna happen four, five, six hours later. Yeah. Um, but again, like this is just a really, really efficient system of if you need to be disconnected. But that gets to the question of why do you need to be disconnected? And it turns out there's there's really two forms of being disconnected. There's the disconnected that happens in the beginning of the night, where it's really hard to wake you up because you're really down in there. And why are you doing that? Well, it seems like some of the reasons why. Is what's happening in the brain is a thing called synaptic downscaling. Now, what that means is that as you take in information and stuff during the day, all your brain, uh all your brain cells, what they're doing is they're reacting to it and they're adapting to it. They're responding. And so now you have this whole long list of responses, millions and millions and millions of different reactions and responses to things that happen during the day. Now, what's one of the things that's happening in that stage of sleep is, you know, you're going through that list and figuring out, okay, which of these do I even need to pay attention to or not? Which of these are just noise and which of these are signal? Then you start, you filter all of them out, and then all of those changes sort of get weakened and washed away. And then what's left is this the next level of stuff to sort through, which is what is going to get what which of these reactions are important enough to keep and which of them are not. And so you there's there's a whole process that we're still learning about, but there's this process for sorting through that and then and sort of deleting them all, you know, throwing out the junk mail, you know, throw just throwing it and recycling or whatever. And so you're left with sort of what are the what were the responses to the environment that like we need to hold on to and do something about. To do that, oh, also during this time, you have an upregulation in a thing called the lymphatic system, which is which is a system in your brain that, because of the way the brain is structured, how it gets rid of waste products and and and and any kind of things it's trying to get rid of, the brain is very protected. So it's it's um the system isn't the same as the rest of the body. It has to flush stuff out in a very specific way. And while you're engaging with the environment, that's also hard to do. And what actually happens at night during that stage of sleep, the space between the cells opens up a little bit and it lets larger molecules pass through that you can't, I mean, this you can't really do that while you're engaging with the world. Because imagine if you were awake and conscious while your brain's doing all of this organization and maintenance, while the physical structure of the brain itself is changing, it would be very disorienting, probably. And again, evolution figured this out a long time ago. How about we do that over here, where you're not gonna know it that it's happening, it's not gonna freak you out, and it's not going to create all kinds of new negative experiences that are unnecessary. And so, yeah, we have to be largely offline, I think. Our thinking brain has to largely be offline for that to work properly. It just works more efficiently that way. Again, it's about it's about doing maintenance on your car while you're driving it. Actually, it's it's harder to do and you're more likely to make mistakes and like and all this stuff. So that's the beginning part of the night. Then the later part of the night, you're disconnected for a completely different reason in a very different way. So, in the sort of the deep sleep stage is in the beginning of the night, your your sensory like during sleep, your eyes, your ears, all your sensory apparatus work just fine. Uh, and a great way to test this is you go up to a sleeping person and you say a random word like popcorn or whatever, they're not going to wake up, but say their name and they will. Their ears were working fine the whole time. While you're asleep, you're seeing, you're hearing, all your senses are working. It's just there's there's guards at the gate, there's bouncers. And the bouncers, you know, are really aggressive during certain stages of sleep. It's like, no, you're not getting in unless it's like life or death. Protective. Yeah, and it and and it protects you. And so during the deep stage of sleep, what those bouncers do is they just try and block out anything. Um and but you can you can barge through if it's important, but it's it's more suppressed. So your muscles are more relaxed, your breathing is slowed because you're more disconnected. In the later part of the night, it's actually a very different way of being disconnected. Where um in the later part of the night is where you have more REM sleep. And REM sleep is where the dreams and nightmares happen, especially the the interesting ones with plots and characters and emotions. Those happen more toward the end of the night after maybe about six hours. That's why a lot of people sleeping less are mostly just missing out on their really good dreams. And what's happening there is remember the beginning of the night, they sorted through all the junk mail and figured out which are the bills, which are the magazines, which are the things you want to read, which are the greeting cards that I want to keep, and like all of the stuff in their mail. But you didn't do anything with it yet. You just sorted it through. And it looks like a lot of the doing with it part is happening toward the end of the night. And it looks like dreams are what's playing a really important role there. First, you figured out, okay, what's the pile I need to deal with, and now I deal with it. And and RESleep is just a fascinating opportunity to deal with this stuff because what you do in REM sleep, you're cut off from the environment again, but in a different way. Where with um where with deep sleep, it's just about, it's about um like the the quietest cell phone will still you could still wake you up out of deep sleep. Um it just needs to be a little bit louder, but you have context in there. But with REM sleep, it's just you have to bar, it's only about volume. So this is anything that has context information like your name, that won't wake you up as much in REM sleep. You'll just incorporate it into your dream. So people have their their alarms incorporating into their dream, or or they were sleeping on their arm weird and and their arm has pain in the morning, but they feel like they were being they're being like, you know.

SPEAKER_03 27:56

So it's harder to wake someone up from REM sleep than deep sleep.

SPEAKER_00 27:59

Uh it's different. Okay. It's it's it's a lighter stage of sleep, but it's it's you if you shake them, they'll wake up. Yeah. So like the amount of shaking is less in REM than deep, but context stuff is is is not relevant because it's not something that will wake you up because of what's happening in dreaming, where you're organizing this information, you're processing everything, you're sorting through it all, you're reading between the lines of everything, and you need to be disconnected for that to happen.

SPEAKER_03 28:29

So that's why sometimes, like you say, your alarm's going off, but that's actually just becomes part of your dream.

SPEAKER_00 28:34

Right. Because your brain's in the process of saying, okay, all this information I'm getting right now, let me sort through it, make some sense of it, um, categorize it, relate it to other things, and and experience. So dreams are like you're experiencing your own brain rewiring itself in real time in its native language of thoughts and ideas and metaphors. That's why there's no rules. Because when you're awake during the day, there's many rules to the universe, and there's so many millions of rules to the universe, we just take them for granted. Like I'm sitting here, you're sitting here, and I'm still sitting here, and that's a chair, and up is up and down is down, and like there's many things. And, you know, again, it's just a brilliant system that our brain has to read between the lines of our experience, where when we take in information from the world, it's under those rules. And in with dreams, we could be like, Well, what can I learn from these experiences outside the rules? Where the what if what if a person could also be a chair and then not? And then, but it's actually in the house you grew up in. Like, what if? And you can create a laboratory in your brain where there are no rules, and then find the connections and find how how is this actually related to this in a way that reality could never show me.

SPEAKER_03 29:55

Let's move on to evolution for the win is clearly very important. Um, always has been always.

SPEAKER_00 30:02

That's how it's tied into all these other domains of health. They're all they're all intimately connected with each other, and they're all related. It's like you can't get you can't get healthy if you're eating really badly. You can't get healthy if you're sitting all day and not doing anything. You can't get healthy if you're not sleeping.

SPEAKER_03 30:19

Well, it feels to me as well that you know sleep is one of those things that affects us so acutely when we don't sleep well. Like we can we can go for weeks without eating well or without working out, but you can't even go a couple of days without I mean, you can, then that compounds, I'm sure, but you you can't go a couple of days without sleeping at all. Can we can we touch on that? And also can we can you explain for the listeners what happens when we don't sleep enough? And I I would say, would I be right in saying that you would wager that sleep is the sort of most important lever for longevity or one of the most important. Why is that? And what happens to us?

SPEAKER_00 30:59

Yeah, it is it is I don't know that it's the most important, but it is clearly a really important lever for longevity. I mean, if you look at the we have data going back to the 1960s that shows that that the sleep people are getting in the real world predicts how long you live better than almost anything else. Um, maybe not better than smoking. Smoking will kill you faster than pretty much anything. Um it may outperform physical activity. Um, it may or may not outperform eating well, but it's it's in that constellation, and we've known this since since the 60s. Um so this the difference between sleep and breathing is that nobody says breathing is for lazy people who have too much free time on their hands. Like nobody, nobody judges people for taking deep breaths. Yeah, you know, nobody thinks that the people who don't breathe clean air must be harder workers. They must be better, they're just better people, you know. No one says things like, you know, I drink polluted water because like I'm fine with that. Like, who needs clean water? Um, like we don't say that, but we say this about sleep. And it's not because sleep is important. And this goes back to one of the very first things you said. There's this, there's this reawakening to sleep, and I totally intended that pun. Um but the I'll be honest with you everyone has a story, but it's but if you look at where people put their effort and their money, people will complain about their sleep and they might buy something, but engaging in real effort around their sleep is actually, you know, a lot of people complain about their sleep, but it's really hard to get them to do something, and part of it I think is cultural. That sleep is often seen as an unproductive use of time. Yeah. There's nothing worse in our culture than an unproductive use of time. Yeah. And that's the hurdle we need to get over. That sleep is actually not unproductive, it's highly productive. There's a lot of important stuff that's happening during sleep. And so in terms of longevity, in terms of its connection, um this is this is why this when you follow people over time, how they sleep predicts how long they'll live. It predicts, I mean, if you take so how much you sleep is an easy metric to track, especially on a survey where you can just ask people. Um, it doesn't mean that's the only important one. It's just that's the one where the most data are. So, um, so like for example, on average, people who say they sleep six hours or less are like 55% more likely to become obese if they weren't already. They're 20 more than 20% more likely to develop high blood pressure if they didn't have it already, compared to people who are sleeping seven to eight hours. They're about 30% more likely to become type 2 diabetic. I mean, pick an outcome. I mean, this is the the good and bad thing about the sleep world is is don't let me tell you what's important. You tell me what's important to you. I will tie it, I will show you the data that ties sleep to its basic ability to function. Look at mental health. I could you, you know, that that P that insomnia is not only a leading cause of depression and anxiety disorders, but insomnia predicts the new onset of depression, anxiety disorders, or new episodes of pretty much any episodic mental health condition better than mental health conditions predict poor sleep. It actually outperforms that. Um insomnia, triple suicide risk. Uh changes in in sleep predict changes in suicide risk better than changes in depression do. Um like that's mental health. Think about immunity. You know, there's there's great data from from, especially from Eric Prater at UCSF, showing that you can track someone's likelihood that they're going to catch a cold and get sick by just tracking their sleep. And you can see a dose response, the more sleep that they're getting, that there is an upper limit. But in the real world, you know, we most people aren't aren't past that upper limit. But the, you know, the less sleep you get, the more likely you are to get sick. This is colds, this is flus, this is ear infections. Vaccines work less if you're sleep deprived. Um, the immune system, hormones. Pick a hormone system with a few exceptions. I can tell you how it's partially sleep-regulated. You know, any sex hormones, testosterone and anything related to it, estrogen, everything related to it, cortisol and everything related to it, adrenaline, everything related to it, insulin, glucose, um, you know, you're looking at metabolic hormones. All of these systems are sleep-related for an obvious reason. So if sleep is all about adaptation and maintenance and reorganization, hormones are just are are part of that system. And so, so yeah, that's why it's related. Um, I mean, you know, cardiovascular system, you know, the there's a reason why your heart rate drops and dips during the night, not just to improve cellular repair in the endothelium, but also to give the heart a little bit of a rest. And when you're not able to do that, you know, you're more likely to have heart disease. Um you talked about something really interesting about the time course, where it's sort of like there's chronic, there's acute sleep loss and there's chronic sleep loss. Where acute it's sort of like acute pain and chronic pain or acute stress and chronic stress, where physiologically they might look very similar, but they actually function very differently. Like you stub your toe, you say ow, and then you don't, you, you, you're a little extra careful with it. Acute pain is mobilizing. Acute pain drives you to action, where chronic pain drives you to inaction. It's debilitating. Same thing with stress. And sleep problems are the same. Where short-term sleep loss, there's this paradox, where short-term sleep loss, you feel it right away. But actually, the data show that one or two nights of poor sleep actually impair your performance much less than you think they do, especially the older you get. Younger people are maybe more sensitive to it, but the older you get, actually you become a bit more resilient to sleep loss. You I might actually overestimate how impaired you are. I mean, I work with a lot of high performers and athletes. And like, look, if you're in the Olympic village and it's the night before your competition and you're sleeping really well, something's weird. Yeah. Like, but the good news is all the data show that one or two nights of poor sleep, unless you're like not sleeping at all, but like if your sleep is restricted or broken up in some way, one or two nights, not that big of a deal. You know, you're you're actually you're actually more likely to psych yourself out than actually have that much impaired performance. The real problem with sleep loss is the cumulative effects over time. It's like, you know, one cheeseburger doesn't give you heart disease, you know, it's or or a week of cheeseburgers isn't going to give you heart disease. It's more, it's more about the pattern. And and the same thing with diet. The longer you're in that pattern, the less you even notice it. And so when when when, and there's tons of data on this going back decades, that one or two nights of of sleep loss, not acute total sleep loss, because who stays up there? If you pull an all-nighter, yeah, your brain's gonna be fried. Yeah, um, but then just sleep, and then it's you'll you'll fix it. Um, but one or two nights where you're restricted or having crappy sleep, one or two nights doesn't do that much. One or two weeks, then you're really gonna start getting so you're gonna start falling apart. The other thing that's really incredible about this is that you just get worse and worse and worse. We have not yet found a time where where you stop actually becoming more impaired. Not only that, if you ask people how, I mean, it'll saturate, the function will saturate. It'll be like, you know, you'll get you'll get worse really fast for a few weeks, and you'll still get worse a month or two later, but it's not gonna be as fast as it was. Right. It's not, I mean, and everyone knows this that like you're not double the the badness over time, or else, you know, people who didn't sleep for three years would be falling apart. Yeah. But you're still really bad. But what happens if you ask people how they're doing? There's this weird thing that happens that after about four or five days of not sleeping well, people feel like they're starting to adjust, that they're leveling off, that, oh, my body's just started getting used to sleeping less. If you actually look objectively, though, their reaction time's getting worse, their memory is getting worse, their decision-making capacity is getting worse, uh, they're not able to weigh pros and cons, risks, and their strategic decision making is falling apart and they have no insight to it. They think they're fine. They've just recalibrated what they think is normal. And that that's the danger. It's that you get more impaired, but you don't know it. And you think that you're an exception to the rule. Yep. Yeah, yeah. But you're really not. I mean, you know, some people have other people around themselves to protect themselves from their own bad decisions when they're sleep deprived.

SPEAKER_03 40:43

But can can we double-click on this quickly? Because I think there are many people that we work with and probably many people listening in that position, right? That they've got so accustomed to shorter night sleep or disrupted sleep, say it's five and a half, six and a half hours, and they get used to that feeling. Would I be right in saying that you know you've got to pay the pie piper at some point? That like that that can often be decades later that we start seeing this cognitive decline that is much more acute. Yeah. And um HBA1C, I know, can shoot up later in in your like 70s, 80s, and beyond. But does that accumulate in that way? Is that how it works? Yeah, it's sort of like diet that way.

SPEAKER_00 41:23

It's like when people say, How much sleep do I need to get on the weekends to make up for you know having a sleep-deprived work week? I mean, that's like saying, like, how much kale do I eat on the weekends to eat to make up for eating nothing but like pizza all week? Yeah. It's like, well, that's better than doing that seven days a week. So if you look at the outcomes, yeah, people who sleep in on weekends live longer and are healthier than people who just sleep terrible seven days a week. Yeah. But that's still not the answer. Sure. And the answer is you gotta change the trajectory. Same thing with it's food analogies work really well with sleep because they're they're similar processes in the body. They're similarly foundational and they're then and they're similar in terms of some of their time courses. Yeah. The difference between food and sleep, though, is if you haven't slept well for a while, get one, two, three nights in a row of just really good, solid sleep, you will feel way better. It will feel like the debt is actually paid. It won't be because if you sleep deprive yourself again, you kind of pick up where you left off. Um, and there's data that shows this. Well, so you'd go straight back to that. Almost, it's not like exactly, but like you, it wasn't a real recovery. Right. You were you were on the right path, but you weren't all recovered yet. You will you will jump back into your first night of sleep deprivation is gonna look a lot more like your most recent night of sleep deprivation than your first one when you started.

SPEAKER_01 42:52

Sure. Yeah.

SPEAKER_00 42:53

Um, but you'll feel a lot better already after two days. And that's sort of like if you go on a diet after two days, you start losing a bunch of weight. Yeah. Um, but then if you eat poorly again, you're just gonna gain it all back. Right, yeah, yeah. It's like, well, that's good reinforcement. That's that's good feedback that your body's giving you of yes, thank you, finally. Yeah.

SPEAKER_02 43:14

Yeah.

SPEAKER_00 43:15

Um, and it's not a real recovery, but you can actually, so in terms of paying the debt back, you don't have to pay it all back. It's just like with just like with food, you don't have to pay back every excess calorie you ate by starving yourself for four years in a row and not eating anything. It doesn't work that way. But you just it's about balance. And if you get back to if you keep where you're supposed to be, the system will correct itself.

SPEAKER_03 43:40

How do we know where we're supposed to be? I mean, how what would you say is sort of gold standard? Because we hear big variations in that kind of advice.

SPEAKER_00 43:48

So, in terms of sleep duration, so amount of sleep, um, if I asked you how much sleep on average do you get, if you say seven or eight hours, you are In the lowest risk group. Does that mean people who say five hours are falling apart and they're all at risk? No, it just means on average, people who say that are more likely to be. But me asking you how much sleep you got on an average basis, and that's again where a lot of the data come from, and that predicts outcomes, but it's messy data and it's unreliable. And anyone listening to me would be like, but that's sort of probably the most imprecise way of measuring sleep. Correct. It's not useless, it's very useful. Um, and it does capture variability and all these things, but retrospective just summaries, they're valuable, but that would be a different number than if I asked you to track your sleep every day. When you wake up in the morning, when did you go to bed? When did you wake up? How long did you sleep? Even that one also being subjective, it would give me a different number. Yeah. Um, and I if I averaged a week of that or two weeks of that, that would give me a different number. Might be a little bit less than um than that. Um and then if I put a wearable on you, that would still give me a different number. Yeah. Because it's measuring sort of it's it's guessing at your physiological sleep. And even if it's completely accurate, and a lot of these are more accurate than people think in terms of measuring just whether you were awake or asleep. It's the other stuff where you get into more problems. But were you awake or asleep, it's probably correct most of the time. That number will be less. On average, people on a wearable, it'll show it might show between 15 and 60 minutes less than they would have thought they did.

SPEAKER_01 45:39

Yeah.

SPEAKER_00 45:40

And that's working perfectly fine because it might be capturing, but all those arousals I was talking about during the night that don't matter. It may be picking up a lot of awakening time that doesn't matter. And so, and you don't remember, and it doesn't have a negative impact. So, you know, there's a translation. So if a wearable says six hours, but if I if you didn't look at that wearable and I asked you how much you slept and you said seven hours, you're in the seven group. You're not in the six group. This, this, the, the group of recommendations is based only on self-report. The wearable data will be a little under that. So I just don't want to freak people out about that. Yeah. So so in terms of the recommendations, seven to eight hours, but not on a wearable by self-report. The wearable will be a little bit less, and that's okay.

SPEAKER_03 46:28

Yeah. I have three questions on duration. Sure. Firstly, is there a minimum effective dose? So what would you say is the because I think we're all trying to claim back time. Yeah. But we want to get all we want to get the return of the recovery.

SPEAKER_00 46:44

Yeah. So the bad news is that there's no good assay for sleep need. I mean, that's the billion-dollar question in sleep right now, which is how do I know how much sleep I need? Because remember, I said people who are very sleep deprived, if you ask them how they're doing, they a lot of them think they're doing fine. Yeah. So if I say, like, oh, well, if you feel fine, you're probably doing fine on five or six hours. Like, well, how you the data all show that how you feel is mostly irrelevant to are you impaired? Yes. Yeah. And then also need for what? You know, maybe the amount of sleep you need for your immune system is different than the amount of sleep you need for your heart, which might be different than the amount of sleep you need for your cognitive function, which might be different. Like all of these systems might need different amounts. So how do you know how much sleep you can get away with? Well, like I said, not everyone who's sleeping six hours or even five hours is, you know, falling apart or having lots of there's always there's risks to everything. Um but the risks at six hours on average are there, but not in everybody. The risks at five hours on average are there and are there most of the time, but not in everything and everybody. You know, like by the time you're getting to like less than five hours, it's extremely unlikely that you're gonna see anybody who's not have at least some important issue. Five hours, I would guess that most people who are only getting about five hours probably should be getting more. Yeah, six hours? Are there people who are getting six hours on average by self-report that are doing just fine? There's probably a lot of those. I don't, and how do you tell the difference between someone who's getting six hours and is doing fine, and someone who's getting six hours and who's not doing fine? We don't have a good test for that yet. But so you'd look for objective evidence. Things like the the best, the best um way objectively to know if someone's not sleeping enough, to know that someone's really not sleeping enough is if they can't stay awake. Sleepiness, so it's sort of like if you're really hungry, if you're not eating enough, you're gonna start getting hungry. The system is gonna try and correct itself, it's gonna try and seek balance. And if you're so sleepy that your consciousness, your brain is gonna try and take sleep anywhere it can. If you can't sit through a movie, if you when you sit down on the couch at the end of the day, if you're out, like if you if you have a long and boring meeting and you're doing this, you're doing head bobs in a meeting, if you're close, I'm just resting my eyes, like if you're doing that sort of stuff, you're it this is your brain being like, oh my gosh, I see that food there. I want it, I want it, I want it, I want it. Why do you want it so badly? Why are you so hungry? And so if you should be able to get through the day without struggling to stay awake at any point. There's an asterisk on the post-afternoon dip, but we could talk about that later. Yeah. But in general, you should be able to get through the day without fighting to stay awake ever, even if you're doing something boring. Boredom doesn't make you sleepy. Boredom just removes enough distraction that it does that you're not keeping moving. It's like you can people who are very sleepy, they just keep moving, moving, moving so they don't fall asleep. Yeah. But if you as soon as you stop, if like if I put you down in a quiet room and you could not keep your eyes open and you'd be passed out, you're starving. You're starving yourself. And there's the evidence. Um, that's probably like, or if you're the kind of person who says, Yeah, I fall asleep as soon as my head hits the pillow, well, that's like saying I finish my plate as soon as it's put in front of me. It's like, what? Yeah, slow down. Like why it should take a little bit of time.

SPEAKER_03 50:45

What's the sort of optimal sleep late like latency?

SPEAKER_00 50:48

Oh, yeah, yeah. So if it's taking you less than five minutes, some like something's up. Like you're you waited too long. If it's taking you 10 to 15 minutes, like that is that is probably good. 15 to 20 minutes, fine. Um, especially if you're a little older, 20 to 30 minutes, I usually don't worry about. 30 minutes is usually about the cutoff for where most people would say, this is too long.

SPEAKER_03 51:15

And just to be clear to the listeners, latency, we're we're talking about the time it takes you to fall asleep.

SPEAKER_00 51:20

Once you start trying, right, like laying there in bed reading doesn't count. You're not trying, you're not engaging in any effort. If you have to engage in a lot of effort to sleep, that's actually the issue. So this brings up a really important question about sleep health actually being multidimensional. It's not just about amount, it's about amount, it's about quality, it's about sleep continuity, which is sort of what you're talking about. Sleep continuity are the is the dimension of the timeline. How long does it take you to fall asleep? How much time are you awake? How many awakenings do you have? Like you could sleep eight hours, but take an hour to fall asleep and be up for two hours during the night. That's still a problem. Yeah. Um, you can you can sleep for eight hours in a row and that sleep be shallow and feel unrestful, and that's still a problem. Um, other dimensions to think about are regularity. Remember, all these systems in your body are trying to work together. Think of think of all these systems in your body as musicians, each good at their job, playing the music in front of them. But if the conductor keeps changing things and moving to sections or speeding up or slowing down in unpredictable ways, then music doesn't sound as good. Right. Even if the musicians are perfectly fine. Um, and when when sleep becomes a moving target, like if you know, it can create disruptions physiologically because the systems are trying to catch up to a changing environment. Then there's timing, which is not just, which is not just the irregularity, but it's the where in the 24 hours are you trying to sleep. Your body wants to sleep in your you have a biological night. You have an internal rhythm, these circadian rhythms, you have this internal rhythm of where it's predicting night is going to be. And if you sleep there, that's good because your body's expecting it there and and it's prepped for sleeping there. But all if all of a sudden you're sleeping over there, like at noon, if like shift workers do, then your body's like, whoa, whoa, whoa, we weren't we weren't prepped for this. And and that sleep during the day becomes more shallow and inefficient. And and so it can become more problematic, even if it's the right amount of time. So there's all these different dimensions. So when you talk about, so when you talk about some of these issues, some of the issues with sleep, some of them are about duration, some of them are about continuity and quality. So, like if it takes you a long time to fall asleep, that's the running the risk of developing an insomnia disorder. And insomnia, you know, it's it's just very common. And um, a lot of people think of insomnia as being a lack of sleep, but it's really not, it's a sleep continuity problem.

SPEAKER_03 54:00

Yeah. I a little bit, I have a bit of insomnia. So I don't I don't typically wear a wearable. Um, I have done over the last few days in prep for this this conversation. Um, you know, there is this concept ortho somnia, is that right? Um, which I'm certain some people listening will will have experience where, you know, I think this um constant analysis of your sleep data can actually become counterproductive, right? Because I will sometimes wake up from a seemingly good night's sleep and I will feel fine. And then I go onto my wearable dashboard and I'm like, you should feel like shit, mate, because your latency was all over the place, duration was too short, you woke up a bunch of times. Um, and so I I find that counterproductive sometimes. Sometimes that being said, I think doing it sporadically, you know, I'll I'll wear this for for two weeks every quarter just to get a reality check. I think that they're really valuable, but I think so many people listening will struggle with this domain of their health because they have so much else going on in their life, right? And we are we've become just victims to this like constantly on hustle busyness, um, and we fill our time with things that are always feeling urgent and important, and sleep goes to the wayside for that. And so I'd love to move on now to like talk about how we can best position ourselves to win here, you know, the strategies and tools that that we can use to counter that.

SPEAKER_00 55:37

And the first thing I want to say to that is if you're gonna use wearable data, use it wisely. Use it for what it can do well, and then there's things it can't do well. So wearables tend to be very good at knowing minute to minute where you likely awake or asleep physiologically. And remember, I just told you where physiologic wake for or sleep isn't always the most important variable. Actually, self-report. So, why is it that the self-report is sometimes better at predicting outcomes? Well, it's because there's a lot of things that are happening during sleep that we don't have the technology to measure yet. So it's like wearables are terrible at picking up insomnia because you can have a wearable tracing that looks totally normal, and the person's like, oh, I was up all night. Yeah. Which is correct. Well, you'd assume that the objective measure is more correct, but the objective measure can't pick up things like sensory and information processing during sleep. It can't pick up things like subcortical activation and local arousal and awakefulness and hyperarousal in the brain and perception of the passage of time and stress. It can't pick those things up. And they're very real and they do predict outcomes. That's why sometimes the self-reported data is more important than the objective data because we don't have the technology to measure everything that's relevant yet. So the device, if you want to know physiologically, were you probably awake or asleep at any given minute, that will it'll be good at telling you that. The sleep stages data are okay, ballpark. Like if I if I looked at your actual brainwave activity during the night and I superimpose it over your wearable data, if it's a good wearable, that you could tell that they're the same person on the same night, but they won't be exactly the same. They might be anywhere between 60 and 90 percent the same, depending on the person, depending on the night. So it's a it's a ballpark. Do you wear do you wear one all the time? No, I I I generally hate wearing things in general. It's just my own thing. But um, like I wear them sometimes. So I'm wearing one right now, you know, testing it out. We have a new study coming up, and I'm and I'm looking at looking at some of the data. What's your sleep score? Um, I have no idea. I never look at it because I don't care. Yeah, yeah, yeah. I know I sleep. Well, last night was issue because I'm driving I flew from Arizona to New York and I had a flight delay, so I didn't get in late. So last night wasn't my best night. But I can perform fine today because I know one night of getting in late and being jet lagged isn't gonna impair my performance if my sleep was fine beforehand. I actually never look at my score, not because I think it's a it's not a useful number. It's just because it's not a number that's useful to me because I know how I sleep. Yeah, I don't need someone to tell me. Um and so that that's the thing. Like people worrying about how many minutes of deep sleep are on this. Don't worry about it. Yeah. Um, like people worrying about like a readiness score or whatever, like uh use it for what it is as a guess, as as to give it the benefit of the doubt, uh maybe a highly educated guest. Sure, sure. But that's it, that's best case scenario. So don't let it change your perception of reality. It's just giving you a new piece of information. It's not supposed to, it's not supposed to replace your experience. Yeah, it's supposed to inform your experience. Oh, maybe I was up and down a lot during the night, but I dealt with it just fine. Like I was resilient.

SPEAKER_03 59:03

And I and I love what you're saying here that like even if there are nights where we're having slightly restricted or poor sleep, even if there are a couple in a row, don't give it too much credence. Don't don't let it carry too much weight because we can often power.

SPEAKER_00 59:16

I mean, if I fly from Arizona to here in New York and have a flight delay and get in late, yeah, I'm not gonna sleep as well. So what? Yeah, I'm fine today. Like, and that's that like when somebody like when someone has a stomach bug, whatever, and they and they can't eat anything and they're they're just eating tea and toast for a day. Like no one says, but what if I starve to death? Yeah. Like that's not a question that enters your mind. Like if you lose your appetite because you're because you have the flu or something for a week and you just don't have an appetite for a week, you don't think, shoot, what if I get brain damage from a vitamin deficiency? Like, you don't worry about it because you know instinctively the system is gonna correct itself, you're gonna get hungry, that the the negative consequences aren't that dire that fast. And you'll get, if you need something, you'll get hungry. And so you gotta let sleep do the same thing.

SPEAKER_03 1:00:08

So one thing I think everyone could probably resonate with is that, you know, we probably most people would like to improve their sleep quality and quantity. I think we can get through life, you know, with those ups and downs, but I think we would all like to feel like we're sharper, have more energy, feel more recovered, feel more rested. How what what would you say are the like very high-level strategies, tips, takeaways that you often see people not addressing as well as they should?

SPEAKER_00 1:00:41

Yeah, I mean, that's the thing. You can Google all kinds of stuff. Yeah. A lot of it will be, most of it is probably mostly true. A lot of it is very wrong. Um, some of it is very right. But I I think you asked the question very well where it's like, it's not about a specific tip because who knows what your situation is in your life, but what are the principles? What are the things to learn? Because that's how I do it. I don't think like, well, I need to do this at this time. It's how do I need to wrap my head around the system to make good choices? Yeah. So a few things. Um, and and I like to think about this sort of in terms of the timeline of the night. So, first thing before you're getting ready for bed is how you think about your sleep. And this I think is something that is underaddressed, but absolutely critically important. Do not see your sleep as a cost of time. And like I use over years I would say see sleep as an investment in time. And investments and costs are different things. But I I I've come up with a better analogy, I think, and it's that sleep is your commute to tomorrow. It's not it's not how much it's like at the end of my day, how much change do I got left in my pocket? What can I afford? Like, it's not that. If you have to get to work, you have you don't think, well, I'm gonna do everything I need to do, and then when I'm all done, I leave and go to work. It's like, no, you think when do I need to be there? Okay, if I need to get to work at a certain time, how long is it gonna take me to get there given some unpredictability of traffic or whatever? Okay. When do I need to be in the car? When do I need to be ready? When do I need to set my alarm for to wake up, to be ready, to get to work on time? That's how you need to think about it. And then you think about okay, if I want to give if I want to give myself a seven to eight hour sleep opportunity, when do I need to be in bed to budget enough time to fall asleep? When do I need to be winding down to budget enough time to be able to get into bed when I want? And that's actually the time. It's not about when you need to wake up, that's later. It's about when do you need to start your process so that you so that you land where you want to land in the condition you want to be. I mean, yeah, I mean, if if you lived your mornings like we live our sleep, everyone would be crashing their cars on their way to work because everyone will be speeding and driving recklessly. Yeah. Like, actually, no, that's not safe. That's not the best way to do it. Think backwards and give yourself permission to do that. And it's not just because it's me, the sleep person, saying that, it's that the data back me up consistently that even productivity and efficiency, the people who budget their time for sleep get more done. We we we trade sleep for work. Yeah, but we get less done when we do it. You're less effective, you're less productive. It's actually better to say, like, I've had to make this call many times where I'm like, all right, I gotta, I know they're waiting on a response for me from this, but I've gotta shut this down now so that I can get to bed when I need to, so that I can be effective tomorrow to do all the things I need to do. I think everyone finds that just so difficult.

SPEAKER_03 1:04:19

Like in practice, like what does that wind down look like? One thing I'm just so guilty of, and I promised myself I wouldn't do this last night, but I did it right up until I fell asleep was I was just in bed on my phone replying to emails until I fell asleep. I just know how bad that is for my performance.

SPEAKER_00 1:04:38

And so part of it is part of it is that we need to give ourselves permission to do it. And me, I I'm just such a data focused person. What I tell myself in those moments are well, the data say, the data show that when people do this, they're less effective tomorrow. I would much rather be less effective now for 20 minutes or an hour than less effective tomorrow for 10. Yeah. Um, and I just I'm just more of a pragmatist that way. Where I think actually, if I look, if I know I know the data, I know the cost benefit of doing this. It's sort of like if you need to leave to go to work and it takes you an hour, you're in New York, it takes a long time for people living in New York to get to work. But like my you know, my commute is what, like 20 minutes, because I live in Tucson, so it's not as much traffic. Okay, if I need to be at work and I need to be there in 30 minutes, I know it'll take me 20 minutes to get there, and I need to park. Do I start one more thing or not? Like, okay, can I get this done in a couple minutes? How many of those things do I do? Like, if it's 10 minutes before work starts, like, no, that was a bad choice. Like, there's no amount like think of it this way It's like when you watch a show at night and you want to watch the next episode because it ends on Cliffhanger. Yeah. Um, the show does not care whether you watch it or not, it exists outside of you. Um, the clef hanger exists to get you to watch the next one, not because you should. And so you're being emotionally manipulated by the situation for an outcome that's not actually to your benefit. And so, what I would say for a lot of those emails, it's that just like that episode of the show, in most cases, and I would I would predict, look, I'm not a CEO of a cool organization, like I'm not, but I'm busy too. We're all busy people. I would predict that a large portion of those emails at night could have waited to the morning and no one would have known the difference, or it wouldn't have had a major impact, except the difference is you would have been more well-rested when you hit send.

SPEAKER_03 1:06:55

Yeah, that's so true. Can I also be honest as well? Because you know, I say they're important emails or just emails in general. I actually like have got into this habit of just doom scrolling as well. Yeah.

SPEAKER_00 1:07:08

And I think You and everybody else.

SPEAKER_03 1:07:09

Yeah, and look, I think I think this is um something, again, I hope people resonate with, is like when we're busy, whether that's with family or work or socially, doesn't feel like there's any time to decompress. And I think that moment when you get in bed, um rightly or wrongly, and you feel like you've got 10 minutes to just like um decompress and just like do something mindless, that feels like the only time I have to do it. But that 10 minutes then turns into 45 minutes, and then I feel completely wired, and then actually just putting the phone down and switching off becomes very difficult.

SPEAKER_00 1:07:45

Yeah, it's not there to will relax you, it's there to gain your attention and maintain it. That's it is systematically engineered to maintain your attention. Yeah. Um, so this is this is all you also bring so so moving on the timeline as we get to the wind down period, like one of the things to to recognize is the difference between relaxation and distraction. Distraction is useful, but we don't need as much of it as we think we do. And distraction doesn't relax you, distraction just hits pause. And you know, it's fine to do, especially in this world, yes, it's okay to mindlessly do stuff for a little bit, but you gotta put boundaries on it or else like it'll go indefinitely. Um and so some tips that I have, things that I do to keep from doing that for myself, because all I'm also human and live in this world. Um number one is I've gotten to develop a sense that like I want to put a time limit on it where if it's going for more than like if I'm if I'm really want to do it for 10-15 minutes, do it for 10-15 minutes. If I'm engaging in an activity where an alarm would go off and says, okay, put this down now, if I can't, that means what I'm doing was too engaging. Yeah. And it was not what I should be doing before bed because I was I was too emotionally invested in it. Um for some people switch, you know, so you want you want to downshift into an activity, or if you're gonna be scrolling, like pick the social media channel that is less that has less of the stuff on it that's gonna be super engaging to you, you know. Um, you know, or or or do something that's a little more um where you can shift down. If if you got that alert and said, hey, put it down now, if you can't, that's not what you should be doing within 20 minutes of bedtime. Do that, find a time earlier to do that one. Yeah, that's not mindless. You feel like it's mindless, it's not. You're actually very emotionally engaged at that point. That's gonna make it harder to fall asleep and harder to disengage. So, first of all, is be able to set that boundary. The other one is if you can't. So, this is I this is something I do with a lot of patients who have real hard time disconnecting. Um, you know, plan A is change what they're doing on it. So, like um maybe the thing you shift to is so so what a lot of people do, they'll have like some sort of mobile game or something, some puzzle game where the puzzle will take them a few minutes up to 10 or 12 minutes to complete that puzzle and they know how long it's gonna take them, and they'll do, okay, I will do two puzzles and then I will put it down. Yeah. Where there's there's there's a break when the puzzle is done, it's a you know, they do the sudoku or they do or they or they do the minesweeper, whatever. Like there's an end there's a natural break point that you can either take or move or or or go over. And then, but that becomes a choice as opposed to endless scrolling. So you create a natural break point um in something that's relatively mindless. The other thing I will say to you, if I have to pull out bigger guns, I will do things like um doing drastically changing the color on the screen at a certain time. So like put there's the night shift stuff where you can take out the blue light, which we could talk about later if you want, but really I desaturate the color so much that it becomes less engaging. Right. Like I've had patients where I have to make their screen grayscale at night, or else they can't put it down. But once it's grayscale, it's much easier to put down. Right. And you realize all the colors and and stuff is engaging you.

SPEAKER_03 1:11:26

On that note with the blue light, do you how do you feel about like blue light glasses and you know that impact that that has on your brain and stops you from being able to so your circadian signal, um, your circadian rhythm internally um uses environmental light to guide itself.

SPEAKER_00 1:11:44

So it generally knows when daytime and nighttime is, and especially around transitions, it can sort of get confused, especially in artificial light, because it wasn't didn't evolve in artificial light, so it doesn't know what to do with it. Um and so when you get bright light at night, it can trick the clock and or can not trick the clock, but confuse the clock, and it can be unsure of how late it really is, and that can delay bedtime. Um, and so you this is why you wanted dim lights, especially in the more the orange spectrum, because it's actually the blue and green light that that stimulate that daytime signal. Sure. And this has never been a problem because you know, we we humans, you know, we were around fire and candles for many thousands of years, and those are all orange and red lights, those don't confuse the circadian system. Um, even the old incandescent light bulbs were mostly yellow and weren't that big of an issue. It's the newer LEDs that have a lot of blue in it, and the screens can have a lot of white. It's white because it has all the colors, including blue. So that's why white light has an issue because it has blue in it. So that's the issue. It can confuse the clock. Is it the most important thing? No. Look, it's probably on the issue of screens is probably at least, if not more, about what you're doing on the screens and the mental engagement. But the light isn't benign either. And especially if the light is bright, whether it's in the room or on your screen, it's more about the room than the screen, to be honest. Um, and that's where the blue light blocking glasses come in. Um, where what they'll do is they essentially filter out the blue-green light so that as far as your clock is concerned, it may as well be dark, even if there's even if there's actual light to see. Do you use blue light glasses? I usually don't because I don't need them, but they're but as I sometimes will when traveling. Yeah. Like if I if I want to send my brain an evening or dark signal and it's not dark enough, I think it's great for that. Um, I use them a lot with people who have just a real hard time winding down at night. I don't. I mean, I've spent years working on that. I used to, but you know, I don't anymore. But but for people who do have a hard time winding down, they can be a great way to at least remove that influence of light. And they have the added bonus of making the world a little less emotionally engaging because everything has a hue to it.

SPEAKER_02 1:14:11

Yeah.

SPEAKER_00 1:14:11

Um, but yeah, the blue block, but they only really work. Those glasses only really work if if you can't see the color blue when you're wearing them. If you put on glasses and you look at a blue thing and you can tell that it's blue, it's not going to suppress the clock effects of the blue light. Sure. Um, but there's because there's a lot of blue blocking glasses that can be very clear. Yeah, I've seen them. They're more for like eye strain and things like that. It's different kind of blue. They're blocking out mostly ultraviolet and the part of the blue that causes eye strain. But if you put them on and you and you and you look at something blue and you can't really tell that it's blue, they're probably fine.

SPEAKER_03 1:14:45

Yeah. Tell me about like other um sort of sleep hygiene tips. Like how how should people's, you know, it's it strikes me that you should just not have your phone in in your room. But I mean, that's easier said than done. What would be like gold standard room setup for that wind down?

SPEAKER_00 1:15:02

So the thing about sleep hygiene is hygiene is a treatment. Brushing your teeth is hygiene. Everyone should brush their teeth. It can prevent lots of problems, it can fix lots of problems. But if you have a cavity, there's no brushing you can do that will fix it. You still have to brush, yeah, but that's not going to fix your problem. Hand washing, hygiene. Everyone should wash their hands. It's, you know, it'll prevent infections, it'll, it'll fix problems. But if you have an active infection, hand washing won't replace an antibiotic or an antiviral medication. It's not, it won't cure an infection. That's hygiene. Sleep hygiene is similar. Sleep hygiene can fix a lot of minor problems, it's mostly preventative. Um, but I want to start with this that a lot of people think sleep hygiene is how to fix a sleep problem. And if you have a sleep problem, especially if you have an insomnia where you have a conditioned arousal, once you have that, the sleep hygiene isn't going to work. It's if anything, we use that as the control group in in a lot of clinical trials because it's so ineffective for insomnia. But if you don't have insomnia, like if you don't have a cavity, brushing your teeth is still a really good idea and everyone should do it. Um and so things to think about sleep hygiene. Sleep hygiene is about setting yourself up for success and removing barriers. Things like getting light during the day and avoiding light at night. It's about making your bedroom cool, dark, quiet, comfortable. That can mean different things for different people. Sometimes it can get too dark. Like it can mean different things for people, but think of those, think of those dimensions: cool, dark, quiet, and comfortable. How cool is cool? What's the so um temperature? The data show between 65 and 70 is probably ideal. Ask someone who grew up in Arizona what cool is at night, versus someone who grew up in New York, what cool is at night. You might get a different answer. But the the cooling and the fact that there's a rhythm to the temperature becomes important because it helps your body regulate its temperature as it's dropping. Um, you your body temperature drops in the early part of the night, and then it hits the bottom sort of toward the end of the night, and then it starts rising again. That's why you want to get sort of comfy, cozy at the beginning of the night, but then you're sticking your foot out of the bed in the middle of the night because as your body cooled down, it was shedding heat and it was all getting trapped, and then it was too hot, and then you had to release it. So you want to keep it cool, you want to keep it dark. Um, even if you got a bunch of light at night, so this is the other thing about the blue blockers, you can inoculate yourself against nighttime effects of light by just being outdoors during the day. This is like how our system evolved. Um, you know, if you get plenty of natural light during the day, it will take a lot of light at night to actually interfere with your sleep and rhythms because you already have a strong daytime signal. Your body knows where nighttime is, right? And light at night is less likely to confuse it. So it's just reinforcing that you are awake. So get light during the day is actually just as important as avoid light at night. It's to create, get your day so that your night knows where it is. Um cool, dark, uh, quiet. A lot of people will wake up from environmental noise and not realize that that's what's keeping their sleep shallow. Yeah. Because maybe the noise was over by the time they woke up or whatever. Like there was a there was a banging, there was a creak, there was a busy street, there was a snoring spouse, like whatever it is. Um, that can and comfortable, you know, you have mattresses and pillows, these things are really important. Yeah. And um, yes, we're way, we sleep on stuff that's way more comfortable than a hundred years ago, but you gotta know the mattress you get into at the beginning of the night isn't the same mattress you're in eight hours later because of gravity. And so sometimes people will say, Oh, I I love my mattress, it's so comfortable, but then I wake up at four o'clock in the morning, like a lot of people do. And sometimes the reason is because now they have discomfort at a time when they've sort of saturated a lot of their or satiated a lot of their sleep pressure and they they've already hit their body temperature minimum. It's at three, four a.m. time. There's a lot of waking up because there's a lot of things happening, and one of them could be the environment. Like, don't rule out the environment. It's like when a patient comes in and says, I'm having trouble breathing, it's not because they just suck at breathing and they just never learned how to do it. It's because uh, I mean, yes, there's breath work and you can get better at it, but like their ability to breathe from a health perspective, what's in the way? Do they have airway inflammation? Is there a lung problem, or is it an environmental air problem? And with sleep, it's the same thing. It's like, is there something in the environment or is there something internal going on? So anyway, cool, dark, quiet, comfortable. Um, there's the screens issue. The other thing I was saying, if if you're somebody who really likes screens in bed, just do screens on couch, then go into bed. Yeah. Like do it somewhere else. You could be in a chair right next to your bed, but keep it out only because um, and we'll get into this. The next thing I want to talk about is stimulus control, but we'll get to stimulus control after we talk about sleep hygiene. But um, you want to you want to use the bed for sleep. And so so another way of of maintaining good sleep hygiene is sort of avoiding other barriers like caffeine. Caffeine can impact your sleep 12 hours later. You just don't know it, you just don't feel it still, but it's still in there. And it could, especially if you've had it multiple times during the day. Um, nicotine, I mean, you shouldn't be smoking anyway. Um, but if a lot of people smoke to relax, but nicotine is a stimulant, and people who especially people who smoke at night sleep way worse. Alcohol. Alcohol is probably the most used uh sleep drug in the world, and it does help you fall asleep faster. But as it processes through your system, it makes your sleep shallow and choppy. So it actually, you know, you your insomnia might move from the beginning of the night to the middle of the night with alcohol. So, and you wake up feeling worse. Um you often wake up in at like 3 a.m. Yeah, you're more likely to do that because the what the alcohol as the alcohol processes through your system, it converts into other molecules, which could wake you up. Yeah. And so it becomes alerting a few hours later.

SPEAKER_03 1:21:19

Um we've all been there.

SPEAKER_00 1:21:21

Yeah. And then things like exercise. Exercise is good for sleep. You're gonna see tips about don't exercise too late. Mostly ignore that. Um, don't worry about it. If you exercise at night and sleep okay, you're fine. Um, if you exercise at night and can't sleep after you exercise, exercise another time.

SPEAKER_03 1:21:40

Yeah.

SPEAKER_00 1:21:40

But like for most people, it's fine. Yeah. Like that that that tip is is sort of um one that's really important though is about the clock. So one of the common sleep hygiene tips is to sort of get rid of the clock. Most people don't need to get rid of their clock. But what does everybody do when they wake up during the night? Which is the first thing they do.

SPEAKER_03 1:22:00

They look at the time.

SPEAKER_00 1:22:01

Right. What's the second thing they do? Math. Yeah, how many hours are they left? Right, yeah, you're right. So that's what everybody does. Yeah. And for most people, that is not gonna help you fall back to sleep. Yeah. It's gonna you're gonna, it's mostly gonna be stress. And whatever so usually what what I would say is if you need to get up, if if you're someone who's like looking at the clock and it's causing problems, turn it around. Because if you really need to see what time it is, you can turn it back. I've had people put it under the bed because they're so tempted. I've done that. Um because like if you really need to see the time, you've got to engage in some effort. You need a barrier.

SPEAKER_03 1:22:43

Um Do you think that's why when you know you've got something really important to wake up for very early, you find it much harder to get to sleep?

SPEAKER_00 1:22:51

Yes, because you have because remember, I said earlier that people have lots of natural breaks to their sleep during the night, which is natural and normal. We just usually sleep through them. But if you approach that from a place of stress and anticipation, you'll be like, was this the one? Was this the one? Was this the one? Like, there's a lot of pro athletes and a lot of elite athletes I work with who they have to train very early in the morning. Like they're in the gym or they're in the pool, like five o'clock in the morning. But biologically, that's not okay for that. It's like it's not appropriate to be up that early, especially for like 20-year-olds who are training for these things. Like for them, for a 20-year-old, 5 a.m. is like for a 40 or 50-year-old, 3 a.m. Yeah. You know, like it's it's like imagine waking up at 3 a.m. to go to work. And there are people who do it. Um, but it's hard and it's not supposed to be easy and and it's a problem. But anyway, what ends up happening is because they're waking up at an inappropriate time, it there's no, it isn't at a it's always at a time that is too early. So they're waking up and their body's like, oh, it's too early to be awake. Maybe I need to be awake. And then and then it triggers that response. And then before they know it, they're waking up every couple hours. Like when people come in and they say, I'm up every couple hours during the night. It's like, well, some of for some of those people, it's because they have these and they've gotten used to over the years having anticipated awakenings, and every awakening triggers this automatic activation response of like, should I be awake? Should I be awake? Okay, no, but that process shook up their snow globe, and then now they can't fall back to sleep again until it settles back in again.

SPEAKER_03 1:24:32

Yeah. Um, that's so difficult. I mean, I do this.

SPEAKER_00 1:24:35

A lot of people do, especially people who are who do, especially people who travel a lot, people who have high stakes things early in the morning. Like this is before any flight I have to take in the morning. I always have one of those. I've never missed a flight in the morning. But without fail, I will wake up like three or four times before I have to wake up. I mean, like today, I'm jet lagged, I'm three hours off from Tucson time. It's early. I you know, had a flight delay last night, came in late, but I was still up a half an hour before my alarm was set to go off. And I was, and I'm like, well, I'm just gonna get up and start.

SPEAKER_03 1:25:09

There is nothing more annoying than when you wake up. There's two annoying things. One is one is when you wake up like two hours before you're supposed to get up, and you're like, I might as well just fucking get up now. Like that is really difficult. And the other is when you wake up and you think you've got like another two or three hours and you're really sleepy and comfortable, and then you look at the clock and it's like five minutes before your alarm's going off. Oh, it's so infuriating. That happens a lot.

SPEAKER_00 1:25:35

Humans are the only ones who do this to ourselves. Yeah. Like, you know, we're the only ones who like we invented alarm clocks, you know, where we decided that we don't care what our body says, we're gonna be up now. So what I like to do is what I my my typical practice is I set an alarm for the latest time that I can wake up and still get to where I need to go. And if I wake up and I don't hear an alarm and I don't feel pretty awake, I don't look at the clock. I just go back to sleep. Yeah. Because there's no alarm. There's like clearly it's not time yet. But if I'm if I if I wake up and I'm like, ooh, I feel pretty awake, this was probably a natural breakpoint in my sleep. Okay, was this an awakening or am I done? Then I'll look at the clock. And if it's within, you know, if it's within an hour, if it's within 40 minutes of when I was supposed to get up, I'll just get up.

SPEAKER_03 1:26:31

Can we talk about that for a second? This like natural wake point, because you know, I've heard you speak multiple times in the past with patients members about these sort of sleep cycles and that we go throughout these sleep cycles throughout the night. Is there a world where it makes more sense that you know during one of those waking parts of the cycle that you don't go back to sleep because your alarm will wake you up when you're in a a sort of deeper sleep?

SPEAKER_00 1:26:55

Right. Well, that's the thing where it's like the alarm is gonna wake you, wake you up whatever, wherever you're at, whether you're ready or not. And it's sort of like, well, if I'm ready now. So the math that I do is okay, if I went back to sleep now, is the additional sleep that I'm going to get between now and my when my alarm goes off going to be worth the jarring awakening. And so, like, if I and this is this is part of how I budget my night, usually, not when I'm traveling, but usually it's like I'll budget it so that you know, if if I sleep all the way to my alarm, that will be longer than usual. Yeah. And I will actually budget my time so that I will arrive in the morning ready to wake up, probably around a half an hour before my alarm wakes up. So like I can wake up, I see that the sun, you know, sun's coming up, it's a little lighter, I feel awake, I'll look and be like, yeah, my alarm's gonna go off in a half an hour. Let me just get up now, leverage this natural break. And as opposed to Like, if I stay up late for some reason and I'm going to be sleeping a little bit less, I'm like, hmm, if I go to bed now and I get an extra 25 minutes, I'll I'll take it. I'll take those, I'll take those 25, those 25 minutes will be worth it, as opposed to nah, not worth it. I'm just gonna take it and get going. Because I also know that I'm generally well rested enough that those fluctuations are natural ebbs and flows to me and I'm working and I'm just fine.

SPEAKER_03 1:28:27

Can we talk about um the slightly more serious issues for a minute? Like where, you know, assuming that someone is doing all of those things, they're doing, you know, they're sticking to all of these pieces of advice, but yet they're still having this really difficult struggle. And you know, we we've game worked on a number of cases together with sleep apnea and insomnia and medications. And um, you know, at what point do we need to seek more guidance and help if we're already doing those things?

SPEAKER_00 1:28:56

Yeah, I mean, if you're doing all the things, if you're prepping for sleep, but not over prepping. I mean, but you know, but if you're if you're engaging in a reasonable amount of of doing all the things, um, maybe doing a few, maybe you might be taking some supplement or something. Uh, whatever it is you're doing, you're do, you're checking all the boxes, but you feel like something about your sleep is wrong, whether it's duration, timing, whether it's quality, whether just you wake up, you just don't feel right. Something's up. Maybe you have a sleep disorder. Sleep disorders are very common. And sleep hygiene will not fix sleep, just like hand washing won't treat an infection. Yeah, sleep hygiene and all of this stuff means supplements. Supplements exist to boost health, not to treat conditions. So they don't work for that usually. Um, a lot of these techniques, like fall asleep faster, using this technique, this breathing technique, or whatever, yeah, for more mild trans, but once you have a sleep disorder, that's not medicine. That's that's that's other stuff. So if you have insomnia or sleep, sleep apnea and insomnia are the two most common. I'll talk about sleep apnea first, really quickly, because it's something to get out of the way. It is shockingly common, especially in men, but way more common in women also than people think. In women, it's much more likely to be undiagnosed. It gets missed and gets called fatigue, gets called anxiety, gets called depression, gets called pain. Um, when people say, I wake up in the middle of the night for no reason and I have trouble getting back to sleep. See if you have that was a respiratory event that woke you up, and that's why you can't get back to sleep. Um, so it's very common, probably one out of four or five men over 30 might have at least mild sleep apnea. And that's before you, you know, you gain weight. Like people who are more in an obese range, if your BMI is over 30, the likelihood goes goes up as you get older. Likelihood goes up. If you're a male over 50 with a BMI over 30, you're at least 50-50. What is it? What is sleep apnea? So, what's sleep apnea is so really what it is, is that when we're awake during the day walking around, we can breathe just fine. But our airway has this 90 degree angle in it, which is which where a lot of, you know, most mammals got this right, and their breathing tube is a straight tube. It's much easier to blow air through a straight tube. But humans, we decided to walk upright. And with that, we have this little kink in our in the airway tube. And anyone who has a hose knows when you've got a kink in your tube, that's where the problems are going to happen. Then what you do is you take that tube with the the that angle, and then you lay it down, and then you have reduced muscle tone from sleeping. And then especially this is why it's one of the reasons why it's worse in men, you have you know, fat deposits around here and your neck, in the tongue, on the inside, which can crowd out the airway. So all of a sudden, you can breathe fine when you're awake, but then at night, that airway is just more flop, that tube is more floppy and it's more likely to close up. That's what snoring is. Snoring is the tube making a vibrating noise as the air is blowing through it. It's flopping together and it's and it's vibrating. It's blowing air through a tube and making a noise. Sometimes enough air is getting through just fine. It's just still making a noise. But it can be a sign that there isn't enough air getting through. It's you're you're you're trying harder and it gets blocked. So sleep apnea is where your airway gets blocked a lot more than you think it does. Yeah. Because you're unconscious when it happens, where it doesn't have to get totally blocked. Like you can get what's called an apnea where you you essentially stop breathing for a few seconds. And and spouses will see this often, where they they'll snore and then they'll stop. And that could last 10 seconds or whatever. And then there's a gasp where where, because and during that pause time, your body was fighting. It was fighting and it was fighting to open that airway, and eventually it breaks it open. Worst case scenario, you'll wake up. Like you're not gonna suffocate at night. You'll wake up, but it's all the work your body did to keep that airway open that's the problem with sleep apnea. Mild sleep apnea is where you have five events, and by events, it could be a full apnea or could just be partial, where your breathing was reduced, but you can see it in your blood oxygen. It's starting to drop, and your body's starting to get worried about it, and it tries to recover it. Those events, those respiratory events, they can happen a lot more than people think. They're like, oh, this happens to me a few times a week. It's like, no, mild apneas a few times an hour. Right. Wow. Severe apnea is 30 times an hour, um, which is very common, especially um, especially in men, but also in women. Um, and so if you have sleep apnea, gotta get it diagnosed. It's like if you have diabetes, getting the test for it won't give you diabetes. It will just tell you whether you need to change your eating patterns or not. Yeah. Um, people will say, like, oh, I don't want to get tested because I don't want to know the answer. Yeah. Same thing with that. Like, you do want to know the like not knowing the answer doesn't, you know, you can still choose not to do anything. Yeah, but so what do people how do people test for this? So in the old days, what you'd have to do is you'd have to go into a hospital and sleep overnight in the lab, hooked up to everything, and then they measure your breathing and your oxygen, your sleep, and and they measure how many of these events you have an hour in a lab. Now, some people still have to do that, especially if they're medically complicated, but almost everyone now they just take a device home. And sometimes it's a simple thing. You might wear it on your wrist, or it's just a strap you would wear, and you wear it for a night, ship it back. Sometimes they're disposable and it uploads through the cloud and you just do it for a night at home. There's ones that are even a ring that you can wear now that's diagnostic for sleep apnea because all you need to know is are you trying to breathe? You know, is it is is your airway becoming obstructed? Is it showing up? And is it is your O2 dropping and then recovering? You can measure that. Um, you can see if someone has sleep apnea. And if once you do, you know, then you can get it treated. And there's and you know, the most common treatment is sort of a CPAP mask, and there's a lot, there's 200 different kinds of masks. Like there's lots of types of masks. So if you if you're worried about it, there's probably one that's comfortable for you. But there's other treatments too now, especially if you can catch it earlier where it's more mild to moderate. There's other treatments around that could um could deal with it now before it gets worse.

SPEAKER_03 1:35:36

Given that the the mechanism by which it's being caused, I mean, weight loss is a pretty good treatment.

SPEAKER_00 1:35:41

Weight loss, actually, there was a great study that came out that showed that that weight loss medications that there's there's weight loss medications now, like GLP1s, that are FDA approved as a sleep apnea treatment, because the weight loss on those medications is so effective for treating their sleep apnea.

SPEAKER_03 1:35:58

So for the listeners, we'll add in the show notes a link to the tests that we use. Yeah, true variations.

SPEAKER_00 1:36:04

Yeah, so that's sleep apnea. It's like if sleep apnea is an elephant in the room because if you have sleep apnea common and it's untreated, whether you know it or not, if it's untreated, you're like, I did all the things and I still feel bad and I still sleep. Like, well, yes, because you can't breathe during the night. Like there's no, there's nothing I can do about that until I can get you breathing during the night. So like we got to clear that's that's also why my threshold for testing is very low. Yeah, because like we catch it. Yeah, like like we we we do it, we we see cases here, we you know, we see cases all the time where it wasn't even, even if it was a mild suspicion, we're like, oh, there it is. Now we know what to do, yeah, and now we know why you feel this way, and then we can work on the other part. So that's sleep apnea. Insomnia is also a very common sleep disorder, but insomnia is tricky because insomnia means two different things. Insomnia is I'm having trouble sleeping, which is normal sometimes when you're dealing with stress. Insomnia is also insomnia disorder. Now, for people for people listening and watching, so there's there's a a way to understand the difference between sort of a short-term situational insomnia and sort of chronic insomnia, insomnia disorder. There's a million things that can cause sort of short-term insomnia, but there's actually really one main cause of chronic insomnia. And once you have an insomnia disorder, once I explain what that is, you'll realize once you have it, why all of the other stuff doesn't work. Sure. Because people say, I tried everything. You tried everything for the other problem. Right. Yeah. And once you understand what insomnia disorder really is, it all makes sense. So the so so here's what it is. So short-term insomnia is caused by something that creates activation in your mind or body acutely. It could be stress. I mean, evolution figured out a long time ago that when you're running from the bear in the jungle and you know, and it's bedtime, you don't like oh, bedtime, gotta lay down. You can delay bedtime. Like you can, you can interrupt sleep for safety. Just right now, what we're running from is like deadlines and and whatever. Yeah, but it's still the same code that's running to enhance our survival. And so that's short-term insomnia. Short-term insomnia, it's like it's like you when you stub your toe, it's supposed to hurt. That's good. That means the system is working properly. If you stub your toe and it doesn't hurt, something's wrong. So short-term insomnia should be a reaction to an environment, should motivate you to change the environment or seek safety or whatever. But once it becomes chronic, what happens is when sleep becomes predictably stressful, a learning process occurs. So think of a place that you hate to go. Like this is what when I tell people, like, what's a place you hate to go? So a lot of patients will say, like, oh, the dentist, or they'll say, I had one one, uh I'll never forget one person said cold plunge. And then so I said, Okay, now imagine in the next room right there is a cold plunge, and I'm telling you to get in it. We're going there right now. And she's like, ugh. And I'm like, exactly. You're responding to the anticipation of an imagined event, not even a real event. You we've reversed cause and effect. Sure. You are now experiencing an effect with no cause. The cause is not the environment. It's like when you get to the dentist's office and you're stressed about being there, you're sort of stressed in the waiting room. You're in the chair.

SPEAKER_03 1:39:46

You're stressed about the concept of being there. Yeah.

SPEAKER_00 1:39:48

You're you're you're anticipating things to happen. It's not about what's actually happening yet. You're anticipating, you're preparing for it. Again, because the brain's a pattern recognition machine and it knows that if you can brace for impact, the imp you're more likely to survive it. So when something becomes predictably stressful, it creates a whole cascade of activation in your mind and in your body outside of your control. It's a condition, it's a Pavlovian response, essentially. You don't, and you may not even be aware it's happening. You're just sort of sitting there like this, you know, or or you know, but it's happening. But it's fine. If you're at the dentist's office, they can still do their job just fine. I mean, I have a friend who's a dentist, he hates that I use this analogy, but like people understand what I mean. Like they can do their job just fine if you're stressed, as long as they keep your mouth open. But once sleep becomes predictably stressful and you approach sleep from this place of stress without even realizing it, like this is when people say, Oh, I'm falling asleep on the couch, and then I get into bed and I just feel like I can't turn my mind off. It's like, well, if you can't turn your mind off and this is a new thing, it's because your wind down routine didn't give you enough time and space to wind down. But if this is a chronic thing, maybe it's a learned response that that even if you were sleepy, ready for sleep, you get into bed and oh, this is the battleground. And so you're bracing for impact, and that creates activation. That activation makes it physically harder to fall, just even just slightly physically harder to fall asleep, which then makes it harder to fall asleep, which then makes you sleep a little bit less, which then m strengthens the association, which then makes sleep more predictably stressful, which then increases your internal activation around sleep, which then makes it harder to fall asleep, which then strengthens the association, which then you approach it the sleep from a place of stress, and the cycle goes. Whatever caused the initial problem, whether it was stress, whether it was pain, whether it was whatever, those words were not in that cycle at all. Yeah, they didn't exist anymore. Maybe they're still going. That's a different issue. We could deal with that. But once you have this cycle, it's called conditioned arousal. Once you have conditioned arousal, you've trained yourself to be alert in the place you're trying to sleep, you've now contaminated it. And so it will keep going. No sleep hygiene in the world can fix conditioned arousal because it's a it's you've learned something. The only way to fix it is to unlearn it. So what we I in collaboration um with uh with a colleague of mine, where what we did was was um we tracked people over time who were all good sleepers. We followed them over a period of like a year to see who would develop short-term. Everyone develops some insomnia sometimes. Yeah. Who would develop short-term insomnia? And of those, who resolves who becomes chronic. And when we followed that, it was it was fat, like it was fascinating that there was really one thing that really predicted who like we people couldn't control whether they were gonna get short-term insomnia. Like I said, everyone gets it, it's normal. Yeah, but whose short-term insomnia became chronic, it was the ones who didn't self-restrict, the ones who stayed in bed and fought. So this is where conditioned arousal starts. Conditioned arousal starts when you have acute insomnia. You temporarily lose some of your sleep ability. And instead of being like, oh well, I guess I'm not hungry, I'm gonna try and eat less. Imagine if you had a stomach bug and you had no appetite, and you just tried shoving food down your throat, for like, I need food, food is good for me. You tried force feeding yourself, then it would make you sicker.

SPEAKER_03 1:43:55

Yeah. Yeah.

SPEAKER_00 1:43:56

Like that's not the actually eat less for a couple days, you'll be fine. But what happens is some people with short-term insomnia, they freak out about it and they fight it. And the enemy of sleep is not wakefulness. You need wakefulness to be able to sleep. You, you know, maybe you need to build up more sleep pressure by being awake longer. The enemy of sleep is effort. Sleep effort. Talk to someone who works in the insomnia world. You say the word sleep effort, they're like, ah, that's the bad one. That's that's the that's the real enemy of sleep is effort. And uh, colleague of mine, Don Posner, he's uh uh one of the greatest sleep teachers. And when he teaches this to other clinicians, what he says was no, okay. So he teaches this sort of in an auditorium of other psychologists and whatever to teach them these techniques. He's like, Okay, someone in the room, scratch dick, someone in your room, raise your hand if you're who's a really good sleeper, who sleeps really well. And so some people, sometimes sort of embarrassingly, they raise their hand. And he's like, You, okay. When you go to bed, you put your head, there's a time, there's a point at which you go to bed, you put your head on your pillow, turn off the lights, and then you go to sleep, right? Like, yes. It's like, okay. When you when you do that, when after you put your hand on your pillow, what do you do to fall asleep? And I've seen him do this a bunch of times, and a hundred percent of the time the answer is uh nothing. And he's like, exactly, nothing, you don't do anything. People who sleep well don't engage in effort. You don't need to engage in effort. If you find yourself engaging in effort, that's the danger. You're adding energy into the system instead of taking energy. Like really, you want to do a little breathing relaxation, you want to do something, that's okay. But there's a point at which it becomes a barrier more than a help. Like if you're doing that, if you're spinning around three times and doing this and doing, if you have this whole if you're doing too much, sometimes more is less. Sometimes a little bit more.

SPEAKER_03 1:46:02

Right. So so I doubt anyone is intentionally putting in more effort. So how do they stop doing that?

SPEAKER_00 1:46:07

Right. That's the trick. That's how you actually treat chronic insomnia, is actually you start with less, start doing less, and then the real answer is so I mentioned before I want to talk about stimulus control, and this is where I want to talk about stimulus control is the concept of gaining control over the stimulus value of the bed. If the bed is a wake stimulus and it's waking you up, how do you control that and make it a sleep one? And the short version of the story is the long version of the story is stimulus control therapy can be complicated. This is why you need a competent clinician to do it. This is why you a lot of people can't just do it themselves. Some people can, because the concept is relatively simple. If I say bed, sleep, bed, sleep, bed, sleep, bed, sleep, bed, sleep. If I say bed, what comes next? Bed sleep. Right. If I say bed sleep, bed wake, bed, wake, bed, sleep, bed, read, bed, sleep, bed, wake, bed, think, bed, think, bed, worry, bed, sleep, bed, what? You have no idea what comes next. It's on the There's no pattern. Like the bed stops becoming the sleep stimulus. You you you unlearn the pairing of sleep with the bed. And what ends up happening is what starts becoming predictable is thinking, is worrying. Is because when you get, if you get into bed, you can't sleep, you start thinking, you start trying, and then eventually you fall asleep. You get into bed, you can't fall asleep, you start thinking, you start worrying, you start trying, then you fall asleep. That becomes the predictable thing that happens. So when someone says, I get into bed and my mind just turns on like a light switch, yes, you just programmed that. You paired those things together so much that you made your bed the thinking place. And the simplest solution, which doesn't always work, and this is why the therapy part gets complicated, but if you're gonna do it this a simple way, start with getting all those things out. The bet bed equals you want it, if you want bed equals sleep, bed equals sleep, bed equals sleep, and you cannot yet control the sleep side of the equation. At least control the bed side of the equation. Yeah, yeah. I love that. And that's why when they say use the sleep only for sleep, or use the bed only for sleep, like NSX is fine too. But people misunderstand that, and they think what that means is if I get up, then that will help me fall back asleep. No, it doesn't. Getting up is like, oh, I got up and it didn't work. Didn't work for what? Well, I didn't get sleepy again. It's like, no, you didn't. It doesn't make you sleepy to get up. What it does is it prevents the learning process to happen. Interesting. And it and it's a process. It's it's it's like physical therapy. It's like, well, I did the exercise, but it hurt when I did it. It's like, it was supposed to. Like you're you're exercising that part of your body that's not working really well. You got to train it. It's a training protocol. Training protocols don't get, you know, you won't get the final results on day one. Yes. You're setting yourself up for success. The the a way to think about this. So I have a colleague, uh Lindsay Shaw, who who works with also works with a lot of hype performers, there's a there's a saying that she uses that I love and I use it all the time. Sleep is not something you do, sleep is something that happens to you when the situation allows for it. And nobody got to sleep faster by trying harder. That if the situation is something you can control that allows for sleep to happen, fine, do the breathing exercise, turn off the lights, you know, put a CPAP on your spouse who's snoring. Like whatever it is that you need to do to change the situation for sleep to be allowed, do it. But it's likely that the reason you're not able to sleep right now is because of a process that is out of your immediate control. You're not hungry. You can't make yourself hungry. If you you can't, there's nothing you can do to m speed up your metabolism by will. Like you can't like fight that infection.

SPEAKER_03 1:50:09

Like you can't will yourself to sleep.

SPEAKER_00 1:50:10

You can't will yourself to do a bodily function like that. If you're not ready for sleep, you're not ready for sleep. You can't make yourself ready. The only thing you can do is stop fighting it and follow it. And if you're it's like if you lose your appetite, don't try to force feed yourself. Follow it, let the system correct to trust the system. I love that.

SPEAKER_03 1:50:35

And so decondition yourself to that.

SPEAKER_00 1:50:37

And that is that is the surest way. So that's why the thing that prevented people from developing chronic insomnia when they had acute insomnia is when they couldn't sleep, they got up. They just didn't lay in bed for hours at a time. And they never developed the conditioning.

SPEAKER_03 1:50:54

Yeah. Quick fire questions. Rapid fire. And I've written them down because there's a number of them. Yes. I'm a little bit worried that these are very difficult to answer rapidly, but we'll give it. I'll give it a shot. Um, okay, here goes. What's something that the entire wellness industry gets wrong about sleep?

SPEAKER_00 1:51:10

That sleep, well, what they mostly get wrong is that if you just do this one thing, you will be able to sleep under your control how you want it. Sometimes what you need to do is let go. Sometimes it's not about more. I agree. I like that.

SPEAKER_03 1:51:28

Okay, good answer.

SPEAKER_00 1:51:29

What's the most overrated sleep hack? Using melatonin as a sedative. Melatonin is great for what it does. Um, and and it can actually help people sleep. But the paradox with melatonin is that it doesn't fix insomnia because once you have a condition around, melatonin works by telling your body it's nighttime. If you have a relatively normal sleep system, telling your body it's nighttime boosts the sleep signal really well. And then some people sleep great with it. But people who have insomnia, once you have conditioned arousal, their body knows it's nighttime, they still can't sleep. And they're like, this stuff doesn't work. And then the other one, the other part of that is increasing melatonin dose. Increasing dose does not increase the sedative effect. Melatonin has no sedative effect. You give melatonin to a nocturnal animal, it wakes them up because it tells your body it's nighttime. It doesn't induce sleep. So that's a it's it's overrated. Is melatonin as a way to fix a sleep problem? Melatonin could be great for healthy sleep or for clock shifting or for all the things it does. It's great for the immune system too, but is not an insomnia fix.

SPEAKER_03 1:52:37

What's the most underrated sleep hack?

SPEAKER_00 1:52:40

Most underrated is just getting out of bed. Yeah. Because people think that it should make them sleepy, but it doesn't. It's about preventing the problem. Okay. Supplements. Supplements.

SPEAKER_03 1:52:50

Worth worth thinking about for improving sleep or not.

SPEAKER_00 1:52:54

If your sleep is generally okay, yes. Um, there are a lot of supplements out there that are very much not nothing. Where when you compare them to a placebo, there is a real effect. There is no supplement on the market that has beaten a placebo for an insomnia disorder. Zero. Um there are some of them that when you give them to people with insomnia problems, it can make their sleep better. Um there, there's some studies on glycine, some studies on magnesium, there's some studies on Ashwagandha, there's some studies on there's even some studies on uh there's a bunch of botanicals, there's a bunch of stuff. Um, but but L-theanine, none of them have beaten placebo for actual insomnia disorder ever. Um, even valerian. Valerian came the closest. Valerian. Yeah, it came the closest. Uh, but it still in the meta-analysis did not beat uh placebo for insomnia disorder. I mean, and that's because supplements aren't made to fix a medical problem. They're made to support. It's the difference between supporting a healthy heart and lowering your blood pressure. Yeah. Like there's uh supporting healthy joints and relieving arthritis. Like it you can't make a medical claim because if they could have made a medical claim, they would have. The data just aren't there. I don't say supplements are all bad. I mean, I there's many times I'll recommend them to certain people for certain uses, but not to fix insomnia.

SPEAKER_03 1:54:25

But what if they haven't got insomnia? They're just looking to get the slight edge. What would which ones would what would be your stack?

SPEAKER_00 1:54:31

Before turning to any of that, I would do the behavioral stuff because that's way more effective. The data back then, that's what so I don't I don't take anything because I don't need to. I think just fine. But if I had to say, what are the things that are most not nothing? Um, which is which is sort of as much of an endorsement as I can sort of give sometimes, depending on the person. Um, if you're gonna go with the magnesium, do the magnesium that also has the glyconate, whether it's the bisglyconate or magnesium glyconate. That's why because glycine itself also has sleep-promoting properties, so it'll you get the double hit there. Um, there's good data on L-theanine. One thing to note is that a lot of things that are used for sleep are more calming than sleep. So people with insomnia, you can be calm but still awake. Yeah. And so a lot of stuff that's calming can be good for people who want that calming effect, but don't expect it to do much for sleep. So, like the the I'm trying to think of some other good ones that have some decent data on them. There's even um, there's a lot of stuff that has a little bit of data and not much that has a lot, like Valerian I mentioned, actually has a pretty sizable amount of data. Um a lot of people don't also realize that so tryptophan, tryptophan's a good one because tryptophan is the precursor to serotonin, which is the precursor to melatonin. So most people don't realize you make melatonin out of serotonin, and you make serotonin out of tryptophan, and you only get tryptophan from your diet.

SPEAKER_03 1:55:54

Turkey.

SPEAKER_00 1:55:54

Yeah. Well, it's actually about the same in all meats. It's about the the the turkey thing is a little bit, is a little bit more of the you eat a lot at Thanksgiving and you get the insulin spike, and like then you get sleepy sleep, yeah. But the tryptophan also might be there, but actually there's higher, there's high levels of tryptophan in certain cheeses and nuts and things. You can get natural melatonin in in things like the tart cherries and the pistachios and stuff. Um yeah, I mean, any and anything that sort of reduces inflammation, any kind of anti-inflammatory supplements. Um like so there's um there's a few of the methods. So there's there's one out there uh that we did some work on that um it's it's it's it's in a couple, it's an ingredient that's in a couple of things. And what we found was was that it, you know, it improves sleep and improved daytime function. Because most things that improve sleep do so by sedative effects, which might make daytime worse. Sure. But like if you're reducing like inflammation and things during the night, that might help you sleep better without impairing daytime function. Um, so if I was going to put something together, it might have some of that. There, there's there's a lot of stuff out there that has not enough data for me to trust, yeah, but it's enough to be interesting, but I'm still following it. Like some of the peptides, um, and some of this other stuff I'm just following.

SPEAKER_03 1:57:13

It's still not ready. The data aren't there yet.

SPEAKER_00 1:57:16

And anyone who says the data are there, uh they're being very optimistic.

SPEAKER_03 1:57:21

Yeah. What excites you most about the field of sleep medicine, sleep science right now? What do you think we haven't got quite enough data on yet, but you're really bullish on?

SPEAKER_00 1:57:32

I am super excited well, a lot of things, but the thing, if I had to pick one thing that I am the most excited about right now, I think it would be that we're about to unlock lots of data on lots of people on multidimensional sleep health. Yeah. And that's sort of like the idea of recognizing sleep being amount and quality and time, like being able, especially with wearables and with technology, we're gonna start to get a picture of multidimensional sleep health at scale that will help us make much better predictions about how to make some of these recommendations and how to, and really how to change behavior. Because once we have good wearable data on enough people to understand what this means, you know, wearables are measurement tools. A bathroom scale is not a weight loss program. Just because you're measuring something doesn't mean you're changing it, but that's the first step. Yeah. And so I'm super as a behavior person, I'm super excited to dig into some of these data to figure out how to make population level change.

SPEAKER_03 1:58:44

Yeah, we we've spoken about this on every episode so far. So much agency is coming because we're getting much better at collecting that data and seeing how it impacts these verticals. Michael, what is one or more of the biggest myths that you see in this space?

SPEAKER_00 1:58:59

The biggest myth I see about sleep is that sleep has a number of boxes it needs to check to be okay. Like you need to sleep at this time for this amount, you know, this regularity. So that it has to be a certain way or else. Yeah, yeah, yeah. And actually, sleep is quite flexible. Yes, if you're if you're outside of a lot of those ranges a lot, over time, the risk will accumulate. But it's not about tonight. That's the big thing. It's not about tonight, it's about the pattern. It's not about it has to be eight hours or else. Like seven and a half hours is just fine. Seven is just fine. If six and a half is your amount, if you're saying, look, I can only get six and a half, I want more. It's like, well, let's start with six and a half and like see if we can get you more. Yeah. You know, like with the things don't people feel the need to control what their sleep is. And that I think is the problem, is the biggest myth is that there's a number. Like, like there are these 90-minute sleep cycles. I had a conversation with someone yesterday about this. Like, well, I set my alarm to be at the end of my 90-minute sleep cycle. I'm like, why? Those don't exist that way. It's not, you're not a computer, you're not a machine, you're a biological organism adapting to its environment. And this is one of the things you're figured out. And these cycles are not mathematically precise. They're they're adapting and they're adaptive. Let them do their thing. Don't try and get in the way. I love that.

SPEAKER_03 2:00:27

And I think so many of the things that we're told to that, you know, these are absolute must-dos with absolute certainty. We would we would do far better giving ourselves a bit more self-compassion and just not taking it as quite as seriously. And exactly, you know, don't be so hard on yourself.

SPEAKER_00 2:00:45

Sleep doesn't have to be perfect to be perfectly fine. If it again, like I said, if it did, we would have died out a long time ago. Like, we need to give ourselves the space, like, and actually, sometimes you won't sleep well. That is normal.

SPEAKER_03 2:00:59

Last question. Yeah. If someone was tuning in right now, just for the last minute of this podcast, yeah. What would you want the takeaway message to be? What could people do tonight to start improving this?

SPEAKER_00 2:01:12

The thing for them to do tonight is less. It's just remember, sleep is worth uh prioritizing. It's a great investment. If I were gonna have them do one thing tonight, it would be in this crazy world, give yourself permission to get the sleep that you need to be optimally functional and effective tomorrow. That I think is the biggest barrier. Forget tips and tricks and whatever. We're in our own way more than anything else. Like, get out of your own way. I mean, the reason why a lot of treatments for insomnia work is not because your sleep is broken. It's because your sleep wig regulation is working just fine. It's just we're in our own way. We've created these patterns of learning and behavior that make sleep harder. Just get out of your own way. Like follow your natural, follow your body, figure out where your body wants to sleep, give it what it wants, give it what it needs, and see what it can do for you in return. Love, Michael.

SPEAKER_03 2:02:22

It has been a genuine pleasure and a privilege. Likewise, as always. Um, thank you so much.