#107 Why You Can't Sleep (and How to Fix It) | Dr. Michael Grandner

0:03Welcome back to the podcast. Today, we're taking a deep dive into sleep, one of the most critical yet often misunderstood pillars of health, cognition, and performance. Joining me today is Dr. Michael Grandner, a renowned sleep expert and researcher whose work bridges academia and real-world applications in optimizing sleep for peak health and performance. Dr. Grandner serves as the director of the Sleep and Health Research Program at the University of Arizona, where he's also an associate professor in the departments of psychiatry, medicine, and nutritional sciences.

0:38Beyond academia, Dr. Grandner consults with professional athletes, elite performers, and high-level organizations to implement sleep strategies that directly improve athletic performance, cognitive function, and overall health. In today's episode, Michael and I cover an extensive range of critical topics, including differentiating clinical insomnia from common sleep disruptions, and the subtle yet significant signals used to identify underlining causes like hyperarousal, circadian misalignment, insufficient sleep drive. We discuss why cognitive behavioral therapy for insomnia, CBTI, is the gold standard treatment,

1:09its most potent mechanisms, and we also discuss key interventions that yield the greatest improvements in sleep quality. We discuss practical protocols for addressing common sleep disturbances like stimulus control, strategies for nighttime awakenings, and personalized sleep restriction methods. We also discuss recognizing and addressing sleep apnea, including non-obvious symptoms, data-driven red flags from wearable devices, and effective non-CPAP interventions like oral appliances, positional therapy, breathing training, and more. We discuss advanced evidence-based sleep hygiene practices, including actionable protocols involving temperature modulation, breathable techniques, and also precise timing of

1:45light exposure. We also evaluate popular sleep supplements and substances from melatonin dosing and timing of magnesium, lavender, glycine, as well as nuanced impacts of THC, CBD, alcohol, caffeine, and late night eating on sleep architecture. We also discuss actionable strategies to manage unavoidable disruptions of sleep like shift work and jet lag, the accuracy and limitations of best practices for interpreting and acting on data from consumer sleep tracking devices like the Oura Ring, Whoop,

2:15Apple Watch, Fitbit. And we talk about practical insights on how sleep consistency and strategic napping directly impact cognitive performance, athletic outcomes, injury prevention, and recovery. Whether you want to improve cognitive or athletic performance or achieve better cognitive health, by the end of this conversation, you'll have an arsenal of scientifically robust, actionable tools to transform your sleep. A quick reminder before we jump in, if you enjoy these conversations and want more practical health insights, consider signing

2:46up for my free weekly email newsletter. Each week, my team and I share fascinating, actionable health and performance research. Recent topics have included caffeine's impact on sleep quality, the metabolic effects of delayed eating, creatine's surprising benefits for Alzheimer's disease, and the importance of potassium for blood pressure. In short, it's useful and something I genuinely enjoy sharing each week. You can sign up at foundmyfitness.com forward slash newsletter. Once again, you can sign up at foundmyfitness.com forward slash n-e-w-s-l-e-t-t-e-r newsletter.

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3:51Michael Grandner on all things sleep. I'm pretty excited to be sitting here with Dr. Michael Grandner, who is one of the, I would say, foremost experts in sleep science, behavioral medicine. And he directs the sleep and health research program at the University of Arizona. His research focuses on, I couldn't even tell you everything, it focuses on all things sleep. But, you know, even, I think you're probably some, some of your research is some of the first to really

4:24kind of throw out this idea as using sleep as a performance enhancer, both athletic performance, cognitive performance. So I'm super excited to get into that today, as well as a lot of other topics on sleep. So thank you for coming to the show, Michael. Yeah, no, thanks for having me. I, as we were talking about earlier, I kind of wanted to start this episode talking about sleep problems. You know, you've got a lot of patients that come into your, your clinic with sleep problems, insomnia being probably

5:00one of the most prevalent ones. Um, when someone comes into your clinic and says, I have insomnia, what sort of data points or clinical features do you kind of look at to distinguish whether or not this person actually has insomnia versus all the other things that could just be causing poor sleep? Right. That's a great question. The way I think about it is that there's really two kinds of insomnia. Uh, I call it sort of insomnia with a lowercase I and insomnia with a capital I think of it.

5:35It's kind of like depression too, where it's a word, it's a word that we use to mean a lot of different things, but in a clinical context, it means something specific. So a lot of people will say, I have trouble sleeping, um, and I have insomnia, but is this an insomnia disorder is how we would call it? We'd call it an insomnia disorder. And the way to tell the difference is how they're presenting. So an insomnia disorder is defined as a persistent difficulty initiating or maintaining sleep or waking up too early.

6:10So it can happen anywhere in the night. The difficulty has to be there. Um, it has to occur at least three nights per week. It has to have gone on for at least three months to be considered a chronic insomnia. It has to cause some sort of daytime functioning problem could be almost anything, but it's got to cause problems. You have to give yourself adequate opportunity to sleep. So just sleep depriving yourself isn't insomnia. Um, and when you think about what that means in terms of difficulty falling asleep, there's no hard and fast

6:47rule, but a good rule of thumb we use is about 30 minutes. So if it's taking you at least 30 minutes to fall asleep or you're, or you're awake for at least 30 minutes during the night trying to sleep and you can't, that's a good sign that maybe what you have is an insomnia disorder where a lot of people will have occasional sleep difficulties sometimes, but, but that's really the difference where it's crosses the line to where it's really interfering with your function.

7:19And how do you just determine, um, you know, what is the underlying cause of someone's insomnia? I would imagine, you know, hyper aroused nervous system being one of them, but there's probably others. Yeah, there's, so there's actually something really interesting about chronic insomnia versus acute insomnia. So acute insomnia, there are an almost unlimited number of things that can cause acute insomnia for a very good reason. I mean, evolution figured out a long time ago that when, when we're under periods of stress and our

7:51survival is questioned and it's bedtime, we kind of should just keep going until we're safe. Right. And we have all these systems in place to protect ourselves. So under any kind of period of, of hyper arousal or stress or anything, whether it's mental, physical, or both, we have systems in place that can prolong wakefulness relatively safely, especially in the short term. And so there are a million causes of short-term insomnia, but there's only really one cause of chronic insomnia.

8:22And, and that's, there's a switch that flips from short-term insomnia to chronic insomnia. And that switch is all around the concept of a conditioned arousal. That's why when someone comes into the insomnia clinic, often the thing that caused their acute insomnia is actually no longer relevant. It's sort of like a ball is rolling, right? And if the ball is rolling down a hill and with the ball was pushed, shoved, kicked, leaned on heavily, whatever caused the ball to start moving is important because you want to prevent that in the future.

8:57But if you want to stop the ball from rolling, knowing what that is and doing anything about that is largely irrelevant. The problem you're dealing with now is gravity and momentum. And that's what happens with chronic insomnia. It takes on a life of its own because of this concept of conditioned arousal. Can you, can you give an example of that? So let's say, you know, someone has work-related stress or something, right? And maybe it's a project related, or maybe there's emotional related stress from a relationship and, and it does eventually

9:32kind of get better. And yet there's still kind of having problems fall asleep. Now, why, what, what would be the conditioned stimulus? So this is what happens. Something causes you to lose sleep, right? And what ends up happening is you exert effort to get that sleep back. Now, when you lose your keys, what do you do? You go looking for it. Where do you look for it? The last place you had it. And if you're losing sleep, where are you looking for it?

10:05You're looking for it in bed. But what's happening is you have this activation going on. You have this cortical or cognitive or physiologic or any combination of these arousal systems engaged. And when those are engaged, it is just physically harder to fall asleep. So even if you are tired, even if your natural sleep-wake drive is working just fine, you have this counterweight sort of keeping your mind and body sort of activated. So what ends up happening is the act of trying to fall asleep, whether it's the beginning of the night,

10:40middle of the night, or wherever, becomes predictably stressful. The brain's a pattern recognition machine. You feed it the pattern of sleep is difficult, sleep is stressful, sleep is hard to obtain, sleep is a battle. You feed it that over and over and over again. Even when you are exhausted and tired and sleepy, just getting into that mode will then wake you up. When sleep becomes predictably stressful, think of something else in your life that's predictably stressful. So a common analogy I like to use is that you go to the dentist's office.

11:16I have a friend who's a dentist who hates that I use this analogy, but people know what I'm talking about. Whatever that metaphorical dentist's office is for you, you go, you're there, nothing has happened yet. You're already in this heightened state of arousal. You're responding to a stimulus that hasn't even occurred because you're predicting that it's going to occur. You're in the waiting room. You're already kind of a little antsy. You're delaying making the phone call to make the appointment three months in

11:48the future because you're already responding to that future stimulus that's causing you stress. Being in a place that's predictably stressful, you anticipate it. You can predict it. And by predicting that stress, it creates arousal and activation. The difference is when you're in the dentist's office, no matter how activated or stressed you are, as long as you open your mouth, they can do their job, right? But in bed, it doesn't work that way. If you get into bed and you are dead tired, you are

12:20exhausted, you are sleepy, you are ready, and you get into bed and all of a sudden your body's like, oh, here we go again, or is this going to be a problem? Or whatever that automatic process starts happening, that predictable process happens, it builds activation. activation. That activation makes it just a little bit harder to fall asleep. You eventually fall asleep, baby. But the connection between activation and sleep is not weakened, but strengthened. And so you're a little stressed, you get into bed, have trouble falling asleep, eventually fall asleep.

12:55Getting into bed is predictably tied with stress. And by adding stress to it, you strengthen the prediction and it becomes a self-perpetuating cycle. So whatever the initial cause of the stress was, it's the stress about not sleeping itself that creates the very activation that makes it harder to fall asleep, which strengthens the connection with stress, which makes it harder to fall asleep, and it becomes a cycle. That's why the best treatments for insomnia aren't about sedating you, they're about reprogramming that whole cycle.

13:25Wow. You've just explained insomnia to me in a way that no one ever has, and it's like just clicked, and I'm like, this is... That's what happens. What happens, right. And so now I completely understand this concept of stimulus control. Right. So let's talk about CBTI, cognitive behavioral therapy for insomnia. Yeah. And obviously there's lots of components to it, one of them being the stimulus control, which now is like making so much more sense to me. Yeah. But let's talk about what that is, why it does work so

13:57well for people. And also, back to this whole training, this negative association, this negative stimulus, where you're like just the act of getting into bed is making you hyper aroused, is giving you anxiety. Is that also true then, let's say you do eventually fall asleep, then you wake up, whatever you have to repeat, whatever it is, it wakes you up, you're hot. And then all of a sudden you're still in that bed. And it's like, again, that negative association, right? And so it's like every time you wake up.

14:28And that's why some people, they fall asleep just fine because... So something for people to understand is that sleep-wake is not a unidimensional line where you're sleepy on one end and awake on the other end. There's actually two separate dimensions. Think of it like there's treble and there's bass. And it's not just mono. There's treble and there's bass. You have a wakefulness signal and you have a sleep signal that are separate from each other. They're related, but they do function somewhat independently. And so sedatives boost that sleepiness signal. A lot of times with insomity, what happens because of the excess activation

15:04arousal, your sleep signal could be just fine. It's your wake signal that might be too high. And so when someone is taking, say, a sedative medication, what you're doing is you're just, you're trying to drive up that sleepiness signal so high, it's just steamrolling over whatever activation you have. And often that may work. And the reason it can work long-term sometimes is if you steamroll it over enough, you can maybe break that learning. So it's not, so it isn't just the sedation, but for a lot of

15:34people, it's not sedation that's the problem. The problem is in the activation. And when you're doing therapy for insomnia, it's often not about, so, so patients will come in thinking like, how do you make me sleepier? Actually, I've got, we've got some tools for that and we'll talk about that. But often the magic isn't about making you sleepy. It's about making you less awake and it's a different process. And that's also why it doesn't work a hundred percent of the time. Nothing does, but that that's why CBTI is so effective because it's actually targeting the problem that the person actually

16:09has. Okay. Let's talk about it. Awesome. So, so here's the deal. Oh, a few, several decades ago now. So, so stimulus control was first published in 1972. This isn't new stuff. Um, and it was this, it was under this idea. The idea of stimulus control is if you're in a place where only a very limited number of things could possibly occur there, you will predict that they will occur and you get yourself in the zone. So we talked about the dentist chair, but a great positive example is going to the gym, right?

16:42Like if you're going to the training room or wherever you don't do anything else there. So even if you're kind of tired or if you're in a bad mood or whatever, once you start that process, you can usually finish the workout at the end and then you go back to your life. But when you're there, you can get in the zone and because it's because being there creates the conditions that are predictably tied with doing what you're going to do. And so when you're in a place where there's a limited number of options, those options become predictable.

17:17On the other side of stimulus control is if you're in a place where all kinds of options exist, none of them become predictable. So a great example of this I found is, especially over the pandemic and as people are working from home more, is the dining room table started also becoming where people work. And it wasn't just a place where you eat. So it used to be you sit down at the dining room table because all you do is eat there, you'd start getting hungry.

17:47But if that's also where you work and it's also where you watch TV and it's also where you're socializing, you sit down, you're thinking about work and you want to put the TV on and you may or may not be hungry. So it dilutes the ability of the place to have a response if you start increasing the number of things that occur there. And so the way this is applied to sleep is that if in bed, if being in bed is predictably tied to sleep, you can program that association.

18:20But if being in bed isn't predictably tied to sleep, you don't know what to predict. So here's an example. If I say bed sleep, bed sleep, bed sleep, bed sleep, I say bed, you say? Sleep. Correct. If I say bed sleep, bed wake, bed think, bed wake, bed sleep, bed wake, bed sleep, bed think, bed surf, maybe. Scroll. You have no idea. Right. You have no idea what's coming next. You can't predict the pattern. Human brains love patterns. And if you can't control the sleep side of the equation yet, at least you can

18:54control the bed side of the equation. Stimulus control therapy, which is one of the core components of CBTI, was built around that. And since that time, CBTI has emerged as sort of this multi-component toolbox. Stimulus control is one of the core components. But there's all these tools that we have that are essentially, it says therapy. It's a lot less like psychotherapy. It's a lot more like physical therapy, where we're teaching your body to do a thing it physically can do. It just doesn't know how anymore, or it forgot, or you need

19:27to build it back up again. So you have all, everything is there inside of you. I mean, when a patient comes in and says, I'm having trouble sleeping, it's like saying, I'm having trouble breathing. When someone says, I'm having trouble breathing, it's not just because like they suck at breathing and it's just a skill they never mastered, right? Like you were breathing when you were born. No one had to teach you. It's a part of how your body works. The trick is, why aren't you able to do this thing you were built to be able to do?

20:02What's in the way? What's preventing your body from working the way it's supposed to? And insomnia treatment is often like that. It's like, you can probably sleep just fine. You were built with this ability. There's a chance maybe there's something else, but most of the time you have everything in you you need to sleep fine. Something is in the way. Let's get out of your own way and clear that path. So do you, I was going to ask you a question about what you think the most important mechanism behind

20:34why CBTI works. It's through the conditioned arousal. It's teaching people that, that A, they can gain more control over their ability to sleep than they thought. But also paradoxically, it also teaches people how and when to surrender some control. So like, let's say you have a stomach bug and you have no appetite for a day, right? You're eating like toast and drinking tea or whatever. I just, if you eat anything, that would be bad. You don't think, what if I starve to death? That's not a thought you have.

21:07You don't think, oh, I have this stomach bug. What if I get a niacin deficiency and have permanent damage? Because no, you don't. What you think is, I don't have an appetite for a couple of days, but in a couple of days, it'll come back and I'll be fine. And when people deal with temporary sleep loss that same way, it's a similar system. The system can correct itself if you let it. But what ends up happening is when we start stressing about it, it starts creating these problems. And a lot of times it's us, it's us getting in our own way.

21:39Right. Um, it, let's say you had, you know, someone that has to work on their stimulus control. Yeah. Um, you know, there, there's someone that likes to get into bed. They have trouble falling asleep. So they pull out their phone, they're scrolling, they're looking at, you know, social media, whatever. And maybe they're ruminating. Yeah. Like what would be your, how would you approach that? Like what would you be, what would be like your two week fix? Great. So first of all, um, in addition to stimulus control, in terms of the other tools within CBTI, a

22:10lot of them focus on this idea that you want to drive your natural sleep drive, put that sleep drive in bed. And when you're not, when bed is not really going to be used for sleep, you get up. And so if you're going to be on your phone, the first thing I would say is try and separate the phone from the bed. Have the bed be the place where sleep is occurring, not where sleep is predictably not occurring. Cause it's not occurring when you're on your phone. See if you can do that. Um, if for some reason you have to be in bed when you're on

22:44your phone, I would say the thing to do is you still want to create that separation. The best way to do that is maybe stand next to your bed because like I say, stand it's silly and very rarely do people actually do it, but people sometimes do. And I do this because if you're standing, if, if, if being in that proximity is important for, for your ability to sort of wind down or whatever, but at least a, you're not in bed, but B the standing does something very important. And especially people in the athletic space will know this, that you don't lose touch with

23:18your body's communication to you. When you're standing, there will eventually come a point where you say, but I really want to sit down now. That's your body telling you that you're ready. Or you may be standing thinking like, what am I standing here? Like an idiot for? I've been here for a half an hour. What am I doing? That's your other signal that you're not ready. Sleep is not something that you do. Sleep is something that happens to you when the situation allows for this. That's a concept I, I borrowed from a colleague of mine, Lindsay Shaw, who's also a fantastic sleep person and

23:51sports psychophysiologist. I learned this from her. I use it all the time. It captures it really well. Sometimes sleep is, is not under your, your ability to sleep isn't under your control. You're awake. Like you need to wind down. Maybe you're just not ready. And if you're just not ready, laying there in bed, scrolling is going to help go do that somewhere else. If you are getting ready, respond to those body signals. If you can't stand next to your bed, if that's a little too silly for you, sit and sit up on your bed. Don't not like just a little propped up.

24:24Your head's not on a pillow. You're not under a blanket. Sit up. Again, you're not going to lose touch of your body's signals. And, and worst case scenario, at least you get the head bob. The head bob is, is, is your friend. The head bob means it's your body telling you you're ready. There's also like, if you're watching TV or on the couch or whatever, and you're within that zone where you might be wanting to go to bed, lean forward when you're watching TV or your movie or whatever, we're scrolling. Cause you'll get the head bob. You won't get it when you're leaning back, get it leaning forward.

24:59That's your signal that you're ready. And what happens if, you know, someone wakes up in the middle of the night and then they're ruminating. Yeah. Can't fall asleep. So again, sleep is not something you do. It's something that happens when the situation allows for it. And if the situation is not allowing for sleep in that moment, get up. If you're sitting there and you're eating and you have no appetite, you don't just sit there and stare at your food till you become hungry and it becomes more appetizing and actually backfires.

25:29So often when people wake up in the middle of the night, it's because it's because something naturally occurred to produce that awakening, whether, um, most commonly would probably be some sort of physical discomfort, like pain, or maybe you sunk into your mattress a little bit and, and, and it's just a little discomforting. You need to wake up and move. Sometimes it's untreated sleep apnea, super common. You have a respiratory event that you don't know you had. If you ever wake up suddenly for no reason, and you don't know why and can't get back to sleep,

26:02you know, we'll talk a little bit later about sleep apnea, but, but that can cause these awakenings. And when you have something that causes this awakening that arose from inside you, wasn't under your control. And what ends up happening is that that physical activation escalates and just like a snow globe, you know, you shake up the snow globe. It takes a little bit of time for it to come back down. And when your snow globe got shaken up while you were asleep and you're awake, you can't make it fall

26:33back down faster. There's nothing you can do. You can poke at it, make it go slower, but you can't make it go faster. You just have to wait till everything settles back down. And it often doesn't take as long as people think, but what ends up happening is as your snow globe is settling, then your stress starts rising again, slowly rising because like, why can't I sleep? What if I can't fall asleep? What if I'm up the rest of the night? Blah, blah, blah, blah, blah, blah. And then you start stressing and freaking out about it.

27:05So now your body is ready, but your mind isn't anymore. And I got to wait for that to come down and you just prolonged it. The, because you don't have control over this part, surrender that control, recognize that you're going to get up. You can get up, take a break, wait till you're ready. Try again. Just don't prolong it any more than is necessary. So sometimes surrendering control actually shortens the awakenings. Sometimes it doesn't. Sometimes, you know what, what if you're up for the entire rest of the night and you just don't go

27:37back to sleep? That's often people's fear. But the truth is, A, that's unlikely. And B, even if it does happen, you'll be fine the next day. And guess what happens if you're halfway through your dinner and you just lose your appetite and you just don't eat the rest of it? What happens the next day? You don't die. You just are a little more hungry and you'll eat a little more the next day and the system will correct itself. Over-correcting is the problem. So to kind of just, from my understanding, for the stimulus

28:09control, like the most important part of it, like for these, for these individuals that do have this like fear of like not sleeping or like it starts to, you know, they, they just immediately get like anxiety about it. The best thing is to surrender or is that like the, the strongest part of the stimulus control? Yeah. It's the performance anxiety. The fear is what's creating the activation that's getting in your own way. So, so recognizing that it's not under your control, trying to control it is not going to help.

28:39Nobody got to sleep faster by trying harder. The enemy of sleep is effort. If you're engaging in effort, you're adding energy into the system. And athletes especially are vulnerable to this because, you know, athletes are used to gaining control over their body and learning how to control their body in ways that most people just don't know how to, because they haven't been trained to. So there's always a solvable problem there. Sometimes it's like, like injury recovery. Sometimes you can't make it go faster. Like if you injure yourself, you got to do what you got to

29:11do to recover. You can't, there's no like dance you can do or, or book you can read that will make that recovery go faster. You got to give it the time it needs. Similarly, this is a process that's outside of your control. Trying to control it will actually make it go slower. Okay. And so the, the next part of, you know, CBTI that, you know, you hear about is the sleep restriction, which sounds awful. Worst name. I mean, so, so if you actually look to the original publication and they didn't, they didn't even call it sleep restriction therapy, they called it restriction of time in bed, which is really

29:44what it is. It's, it's a simple concept of, um, again, a lot of these things are simple in concept, but difficult than execution. But the concept of sleep restriction therapy, which I hate calling it that because it doesn't, it's, it's not about the restriction. And that's the thing. Sleep restriction could be part of it, but it isn't always the idea is let's say you're spending eight hours in bed, but six hours asleep. We know you physically can sleep six hours. Okay. Let me give you six hours time in bed. See if you can fill it. Let's get you to the point where you can fill it.

30:16And then we'll slowly increase it from there. Actually, sleep restriction therapy has more increasing of sleep than decreasing, but there's that, there's a decrease at first. The way I explain it to people is this. It's actually not super complicated. Let's say you're trying to eat your vegetables and you've got a kid who's not eating their broccoli, right? And you put 20 pieces of broccoli on their plate and they're not eating, they can eat one or two. And then they're like, Oh, I hate broccoli, blah, blah, blah. Then you say, okay, I need you to learn how to eat your broccoli tonight.

30:46I'm going to give you two pieces of broccoli. Can you, I know you can eat that because that's what you've been eating every day. I know you can eat that. So you eat the two pieces of broccoli and then they say, but I'm still hungry. And then you say, great, you will get three tomorrow. Let's see if you can eat those. Then they can eat the three pieces, but I'm still hungry. It's like, okay, hold off on, don't eat anything else. But the next day you'll be hungry enough to eat four. And then you slowly, you start with what they can already do, but you don't give the other stuff that,

31:19that will, so you, you don't let them stay in bed when they're not sleeping. At least give them the opportunity they're already able to fill. At first, all the mental blocks and stuff will be there. So it might drive down their sleep a little bit in the short term for, for several days, maybe even up to a couple of weeks, but they eventually, eventually they get hungry enough where they can eat all the broccoli on their plate. Cause you're not giving them anything else. Then all of a sudden you start introducing other foods back that they actually like, but they've gotten over their

31:50broccoli deal. And that's what it is with sleep. You drive up their natural sleep pressure. You separate out, um, the time in bed. That's not wake. You make it so that being in bed, you're so you go from not being able to fall asleep to not being able to stay awake because you drive up that natural sleep pressure. And it's like, well, you have problems with your appetite fast for a little bit. That'll help a lot of problems with your appetite. You're going to be hungry again. And so this idea of not having your phone in bed is part of that.

32:20Yeah. It's part of that because you don't want to do anything in bed that is not sleep. You want, you want, you want to make it so that when you get into bed, you put your head on the pillow, you're under a blanket, your eyes are closed, you're breathing through your nose, um, that, that, that feeling is so predictably tied with becoming unconscious in a very short amount of time that even when you get good at that. So this is, this is the power of this. When you get good at that, you're using the prediction, not just to solve a problem, but to create a

32:52benefit. Imagine you're a little bit stressed. You've got a big day tomorrow, but you've so trained yourself that that place is so predictably tied with sleep that you're stressed. You've got a big day. You've got stuff you're working on. You get into bed, close your eyes, head on pillow, under blankets, start breathing. Then all of a sudden you fall asleep. You've, you can, you can train yourself to get the outcome you want. And that gives you control. So let's say you got to wake up super early one day cause you're, you're, you're going somewhere, you got to practice or something.

33:22You need to go to bed an hour or so earlier than you really are used to. If you've got yourself well-trained, you can use the environment as a condition stimulus for sleep when you want it to be. So when, so how long does it take to, to, for most people to train themselves, like through the stimulus control, sleep restriction, where, you know, the bed is really just for, I've, I've heard sleep and sex. Yeah. So sex is fine. That's usually not the problem. Right. You know, do that in bed, out of bed, wherever you want. That's fine. Usually that's not taking up so much time.

33:54I mean, and it's, and it's not interfering with your ability to sleep. Sometimes it can help your ability to sleep, but that's fine. But, um, it's probably the phones that are the biggest problem. Right. It's, it's distractions. So distraction, the activation, all of this stuff, it's, you're adding energy in instead of taking energy out. Relaxation is fine to do in bed, but if it's brief, you know, if you're spending, you know, a half an hour meditating in bed, that might be a little too long. If you're, I've known people who like, they have this whole hour long routine that they do.

34:25Like by the time that hour is done, the bed is no longer predictably tied to sleep anymore. So yeah, it's about, it's about getting this stuff out. It doesn't, I'm not saying don't be on your phone, but I mean, I actually think does the sleep field telling everyone get off their phone for an hour before going to bed is not a helpful recommendation because no one's going to follow it. We should be talking about how to do it safely in a way that's not going to get in your way. And that comes down to what you were saying earlier, either being in another

34:57room or sitting up or standing. Yeah. And, and also it's what you're doing. That's important. You might want to create sort of boundaries. So like maybe within a half an hour of when you're planning on going to bed, maybe switch to something that's not too mentally activating. Like if, if you're the kind of person where you watch the news and it gets you all worked up and angry, don't do that before going to bed. Maybe do it the hour, you know, in the, in the earlier part of the evening. Um, I mean, the great thing now is TV isn't live anymore.

35:27Back when I was a kid, you had to watch it when it was on and that was it. Now we can watch, we can, we can gain more control over what we're exposing ourselves to media wise. The rule of thumb I use, and this is what I use for myself. If an alarm went off right now and said, okay, time to turn it off. Could I, if the answer is yes, then it's probably okay to do within that timeframe. Cause I can easily disconnect from it. If the answer is no, no, no, five more minutes, I want to see how it ends or I want to, you know, whatever.

36:01That's probably not the thing to watch in that buffer time. Watch it before the buffer time, but don't do that in the buffer time. Like if you're scrolling and you can easily put it down. I don't know that. I don't know that that's that big of a deal, but if you're scrolling and like half an hour will go by and you wouldn't even notice and you lose that time. And then you say you don't have time, but you just threw away some time, you know, that you didn't need. So like, those are the sort of things you want to, you want to make sure that you curate

36:33what you're doing so that it's not too activated. Why, why are a lot of people that have, that have insomnia, why are they prescribed, you know, these sedatives like, you know, Ambien or. Well, they don't not work. I mean, like I was saying, like what they do is they drive up that sleep drive so much it overpowers whatever's in the way. And it's kind of an easy solution. The thing is, honestly, it's much easier to write a prescription. Like you can go to any primary care anywhere and they can write a prescription. But if you, if you look at every medical organization that has any recommendation around how to treat insomnia and

37:08for athletes, you know, this includes like NCAA and IOC, who, who've put out sleep related materials. Um, they all say CBTI first. And that's because every study that has ever been done shows that when you compare, when you pool the data from CBTI trials, it works shockingly well. Not only does it work reliably well, it works when you have other, like, well, what about if you're in chronic pain? Like the pain is keeping you up. How is that? You don't have conditioned arousal. You have an active thing going on.

37:38Still works in, works in fibromyalgia, works in chronic pain, works in cancers. It actually might be better in cancer survivors than people who aren't cancer survivors. Cause they don't want to take these medications. They're more motivated. It works in sleep apnea. It works before your sleep apnea is even treated. It helps with your insomnia. Uh, find me a condition works in older people, works in younger people, works in, so like it's a blunt instrument. It's retraining yourself to sleep. It doesn't, it, and it works well by helping people gain control.

38:09It doesn't necessarily add hours to your night, but neither do sleeping pills either. What it does is it removes some of those barriers about, again, about 85% of the time, not a hundred percent, but it's also some people don't know how to get access to it or they read about it online and either the, the information they get isn't, isn't great, or they have exposure to it in that, you know, maybe, you know, maybe they're doing it by the book, but they might need a little flexibility with it or

38:40something, but there's lots of adaptations. I mean, we edited a textbook on how to adapt CBTI to different populations, but you know, a lot of people just don't know it exists. And the people who do don't really understand what it is or how to find someone who knows what they're doing. Is that the key? Do you really have to find someone that knows what they're doing or can you try this yourself? Yes. And yes. I mean, there are many people that I've talked to who've, um, tried it,

39:10done it with themselves. I mean, cause it's not rocket science. Um, the, there's an art to it, but the, the basics of it are relatively simple. It's bed, equal sleep, get out of bed. If you're not sleeping, you know, compress your window of, of opera, you're giving yourself too much opportunity. You're not filling it, compress your opportunity, but then expand it again, once you can fill it, um, some basic stuff like that. Uh, and some people could just do that on their own and that's all it takes. Some people, they need somebody who knows what they're doing.

39:44The problem is there's not a whole ton of people who are trained in this, despite it's being around for a long time, despite the fact that it's really well supported, there's not a ton of people who are well-trained. There are some online versions available where they can automate some, some aspect of this. It's a very, it'll be very by the book, but for a lot of people, that's all it takes. Um, you can do this over telehealth, any state that you're in, I can promise you there's someone who can

40:14do this via telehealth in your state. So it used to be very geographically restricted. It's not anymore. Um, there's a couple of good directories online of, if you're looking for somebody, um, we have a board certification, you can see who's board certified in this and we, it exists because it's not part of normal training. So to be able to say that you're good at, you have to like prove that you know what you're doing, but, um, yeah, you can look online for people. And again, there's, there's telehealth options too. So whatever state you're in, um, you can find somebody.

40:48What, what percentage of like the U S population has insomnia? It's a great question. Um, for decades, any population level study has generally found kind of the same thing mostly. And it hasn't, it doesn't seem to have mostly changed much that about one out of three people in the U S has some sort of sleep complaint or problem or something, whether it's falling asleep, staying asleep, not feeling refreshed, that seems to be about a third of the population at least. And it seems like about one in 10 people probably would meet the criteria for an insomnia disorder.

41:23If you, if you, if you assessed them. Um, and then what ends up happening is they start trying to fix it on their own and they start going down paths that end up being unhelpful. And then they get more frustrated and then sleep becomes more stressful and they give up and they say like, I'm a, I'm a hopeless case. I get one of these a week in clinic. So I'm the worst sleeper you've ever seen. I've tried everything. I've had this problem forever. And then six to eight sessions are better.

41:56Yeah. I, one in 10 is a lot. And, you know, I definitely think we're going to talk about some of these substances people then turn to because they think it's going to help treat their sleep problem, which they don't necessarily know is even insomnia. Right. And so they're, you know, turning to things like alcohol and, um, and that doesn't really help. So, um, but let's, before we get to that, um, sleep apnea, you mentioned, and that's another one that I wanted to talk about. I've known a lot of people, it seems that have had sleep

42:31apnea. I wonder how you can tell me how common that is as well. But, um, first I kind of wanted to ask you, like, what are some of the non-obvious presentations that, you know, of sleep apnea that you see, especially in people who like, maybe don't even report feeling sleepy. Right. So, so the thing with sleep apnea is the first thing to know about sleep apnea is it is shockingly common. It is very, very, very common. Um, the most recent data I've seen estimates that about one out

43:03of four or five men over 30 probably has at least some sleep related breathing issues, especially if their BMI is over 30, it's more like 50, 50. Um, it's really high women get it less often, but it's also shockingly common in women too. It might be more like one out of every 15 or 20 women. Um, and then as, as BMI goes up, it gets more common. Um, so it's, it's shockingly common. It's so common that my threshold for screening for it is very low, especially

43:34among otherwise fit people because the normal risk factors. So like as you gain weight, it, it, you get it more because it can crowd out your airway. Muscle too. Yeah. Muscle too. It's because think of it this way. So most mammals, their airway is a straight line, you know, from snout all the way up and, and to, to, to their lungs. It's a straight line from snout to their lungs. Humans by, by moving upright, we solved a lot of problems and we've gotten a lot of benefit from being

44:06upright, but we created, it created a problem with us in that our tube now has a 90 degree angle in it. And if you're designing a pipe and you put a 90 degree angle kink in your hose, where is it, where is it going to start having problems? It's going to have problems at that. And that's what happens. So like right around that spot here, that's where we get narrowing of the airway. And so like any mass, whether it's muscle or fat or whatever, any mass, I mean, there are people who

44:40look at MRIs of like tongue fat, like, like cheeks, like anything here that whether even skinnier people with smaller airways, you know, where it's a little more compressed, it just, it's, it's a, it's a vulnerability in, in the human physiology for breathing issues. And it's actually mostly fine in that you can have four or five breathing pauses per hour in the night and be in the normal range. It's actually a sleep apnea doesn't begin at five is mild begins the low end of mild.

45:11And it's not even until you get to 15 per hour that it becomes, start becoming moderate. So many people who are in the mild range don't even have any symptoms and might not be causing any problems. And we have a lot of flexibility in the system, but as you get older and neuromuscular control changes, as we put on more pressure here in the airway by gaining weight or whatever, it just becomes more and more common. And my guess is it's actually been common through history. It's just, we've written it off as something else, especially in people that don't have those obvious signs.

45:44So what are some of those less than obvious signs? I have a patient who comes in and they say, I fall asleep just fine. Actually, if I'm anything, I'm a little tired during the day, whatever. I fall asleep just fine. But then I wake up in the middle of the night because of stress. My stress wakes me up and then I have a hard time falling back asleep. When I hear that, I think there's greater than 50, 50 chance in my mind that that was a respiratory event. Stress doesn't wake you up. What happens is if you wake up and you're thinking I'm stressed, your brain

46:18is reading signals like elevated heart rate, elevated respiratory rate, the endorphins of the muscles getting tense. It's reading these physical signs. And then because we live in the society we live in, stress is readily available. We can fill that space really fast. But what was happening was, it wasn't the stress that woke you up. It was that your breathing was starting to get a little bit constrained. So then what happens is your airway tries to open itself up and it was trying and it wasn't, it wasn't successful. So it tried harder, still wasn't successful, tries a little harder, still not successful.

46:50Worst case you wake yourself up and you, and you can, you could wake up with a gasp because you can breathe when you're awake, just fine. It's a different neuromuscular control system. So as soon as you wake up, you sort of get that, that sudden awakening. Cause you just got that little sort of a shot of adrenaline to wake you up. And like, if I just shot you up with a little bit of adrenaline during the night, you'd wake up and you would not be able to fall back asleep. Your mind would start racing and you'd have all these physical signs, but it wasn't the stress that woke you

47:26up. The stress got superimposed on it later. So when I have a patient who comes in and describes that sensation of, I wake up in the middle of the night, either because of stress or for no reason, I don't know why something wakes me up. I have no idea, but I cannot get right back to sleep immediately. Like within a few minutes, I mean, something just happened. Some flare up just happened somewhere. Um, that's, that's what I look at in athletes. Often what I'll look at is I feel like my sleep is really shallow and I don't know why, because

47:58what's happening is you might be having lots of these low level respiratory. That's the thing when you get the more severe sleep apnea, like 30 events per hour or more with, with these other presentations, but you get a lot of the mild to moderate cases in people who, you know, don't have a lot of extra weight, aren't older and have neuromuscular control issues. Like, which just happens with age. They're younger, they're healthier, but they just might have a narrow airway. And, and so like, I'll never forget, like there was this, there was, uh, um, uh, an Olympic level athlete

48:30I was working with. She was, she was in the trials and she's like, she's not meeting the times. I think I should, she was still faster than everybody else. But she's like, my intuition is telling me something is in my way from reaching what I could be doing. I don't know what it is. And like, how are you sleeping? It's like, I feel like my sleep is kind of shallow. I fall asleep just fine, but I feel like I'm up a few times during the night and I don't really know if that's a problem or not. So I'm like, well, let's see what's going on.

49:04Turns out she had, she had mild sleep apnea, got that treated better. And she's like, oh, that was it. And, and in the real world, it would have been missed. It would have been someone just slogging through their day. They would have just been like, oh, you know, life is hard. I'm tired. Not sleeping is good. And then probably in 30 years, she would have gotten diagnosed by the time it was more obvious if she weren't an athlete. So what should a person do? Like how many, is this an every night thing where people are getting woken up? Like if they're having apnea, is this like an every night thing?

49:37Um, like what sort of, sort of symptom clusters, biomarkers can people look at, um, short of like going and getting the thing on your finger and measuring the oxygen and you know, the whole. Yeah. I mean, so, so here's the thing. It's normal for people to wake up in the middle of the night. Sometimes actually the typical adult will wake up 10 times a night or more during the night. They just don't remember. It's very short. I mean, again, evolution figured this out a long time ago. You wake up, no bear back to sleep. Like that's normal. But if you're remembering more of those awake, if you're remembering three, four awakenings, if you have an awakening, especially

50:12waking up like with a gasp, like if you wake up like that, or you wake up with a snort, if you wake up with something like that, um, if you, if, or if you feel like you just can't get enough sleep, like you try and sleep a little bit more, but it doesn't help. It's like, it's just, it's just empty calories. You know, like it's not about the amount anymore. There's like something that's keeping it artificially shallow. There's lots of things that could be, it's just sleep apnea. So common. Why not take tests? Why don't you just get tested?

50:42Just go get a referral, get tested. You can do them at home. Now it's easy enough. Um, in turn it's, it's, there's no real good biomarker for it yet. I know people are working on it. There's no real good biomarker except that, that sleep is shallow. It's fragmented and you don't know why. I mean, it could be something else could be inflammation. It could be pain. It could be environmental. There's lots of things. It's like, if you're not breathing, is there a problem with your lungs? Is there a problem with your airways or problem with the pollution in the air?

51:13So like, is it, is there something that's preventing your body from being able to sleep or, and, and, and if it is sleep apnea, it's so common. This is why my threshold for screening is just ultra low. Because, um, if it was that, and I do all the tips with you and I work out this and I do all this and you're still feeling like, oh, but my sleep just isn't good. And I knew when day one, that this was a possible reason why, then I'd feel like an idiot for not even checking. Cause I, we did all this work and we, maybe we didn't even need to.

51:45Do those, um, at home kind of, could have, I remember doing one once like years ago when I was in graduate school and I was, I think I was waking up because of stress, but, um, the test came out negative, but I wore this like ox pulse thing. I think I don't know what it was in my finger. So there's, there's a bunch of devices. They've gotten better and smaller over the years. Um, there's still people who do need to come into the lab. Those are usually reserved for when there's like another sleep disorder you're also looking for like narcolepsy or, or, or

52:16limb movements or something. Or if you're medically complicated, like you need supplemental oxygen, or if you might have heart failure or something where you need to kind of be monitored in the hospital while you're doing it for safety. Other than that, or, or the test you did at home was negative, but you still have a lot of symptoms and maybe it missed it. Cause the, the home tests aren't as sensitive. Like you'll, you won't get false pauses, but you might get false negatives. That's the only time you'd really need to come into the lab. Most of the time, usually they just give you the thing to take home.

52:49And these days you can wear it as a strap. They have ones that just go on your wrist and they measure, they measure, um, your oxygen levels during the night. And what you can see is how is your respiration tied with your O2? Cause respiration drops during the night too. And so does O2 a little bit, but if, if your respiration is dropping and then your O2 starts dipping and then it, then it opens back up again and gets recovered, like you look at these patterns of what's happening during the night and you can see in one night if someone's clearly has sleep apnea or not. Okay. It's easy enough.

53:22If you're working with someone who has obstructive sleep apnea, like how do you go about differentiating if it's like caused by allergies or positional or, you know, something, something like nasal congestion. I don't know. Like, yeah. Yeah. Especially when it's more on the mild to moderate side where, um, so the great thing is the, the, the ones that are on the strap, they usually have a gyroscope in it and they can measure your breathing separately on your side and on your back. There's a lot of people where it's just that it's on their back. That's the issue. And, um, for those people, there's actually really simple fixes.

53:53You can set, they sell these devices where the truly just a strap you wear in the old days, they used to sew a tennis ball on the back of a t-shirt and that's all it is. So like, whenever you rolled on it, you just roll off it. And they have like fancy versions of that now where that's essentially what it is, where it's, there's one, there's a couple of them where it's a strap, it's like a belt, but like the back of the belt has a little bump on it. And so like, whenever you roll on it, you just roll off. It just stays off your back. That's it. Um, you can't force yourself to stay off your back when you're

54:28asleep. You're like, well, I'm just going to fall asleep on my side. Well, you can't control it when you're unconscious. So like you can see if it's positional easily in the diagnosis. And if it is, then just try and treat it positionally. And then what I would do is retest using the positional device and see if it all goes away. Cause it might, might not. Um, if it's allergies, um, this is why the, the, the sleep docs, you know, we get a lot, they get a lot of training and, and I've gotten some of this too, when I rotated in sleep medicine, like you see what to look for.

55:00So like you look at nostrils, you look at their nose, you have them breathe in, you look inside the airway in the mouth and, and like, you can see where their soft palate is. You could see their tongue. You could, you can see some of these things. Um, and you know, sometimes, you know, there's a lot of sleep medicine that's using, you know, Flonase and, and some of this stuff to sort of clear up the nose. But remember the obstructions almost all the time are back here in that 90 degree angle in your airway. It's not up here. It's like people think snoring is a nose based thing.

55:31It really isn't. Sometimes you get like sort of floppy nostrils or whatever, but almost entirely it's the, the issues back here. It's the back of your tongue. That's also why on your back, it's worse often because gravity starts pulling stuff back or like when you open your mouth and your tongue falls back and can block the airway. So, so that's, so like you can do that in the physical exam when you go to the sleep topic and took a, take a look at your mouth and take a look at your nose and, and they'll be able to see, but I'll, but I'll tell you it is a vast, vast minority of the time where that's

56:04actually the cause. People want it to be, cause it's an easier fixed, but, um, that's usually not it. It, it, what happens if someone has untreated sleep apnea? So, I mean, what, what happens to their sleep architecture? I mean, first of all, maybe we should briefly mention like the sleep stages, but like, does it affect their sleep architecture? So here's the different sleep stages stage. So when you fall asleep, you enter stage one, stage one is super ultra light sleep. If you have sort of like nod off and someone bangs the table and you're like, well, what was that? That's stage one. When they say you were asleep and you say, no, I wasn't

56:37that's stage one. It's very light. Um, this is also where you get hypnic jerks and you, if you have one of those, you were in stage one sleep. Um, totally normal, medically harmless. Everyone gets them. Um, so that's stage one. It's a light transitionary stage. Then you drop into stage two. Now stage two, when you first drop into it, you're in it pretty quickly, but for most of the night, that's actually what you spend the most time in. Stage two is sometimes called light sleep. I don't like that name for it. I like just calling it normal sleep. It's regular sleep. It's vanilla sleep. It is more than 50% of the night.

57:11Most of the work that your brain does in sleep is done in stage two. Um, but then you drop into stage three, which is also, you know, in our world, we call it slow wave sleep because the brain waves are bigger and slower. Um, a lot of people also call it deep sleep. It's not called deep because it's the good one or the most restful one. Even it's called deep because your arousal threshold is the highest and it is hardest to wake you up from that sleep stage because the the thinking parts of your brain are largely like detached and offline.

57:44You're not, you're not thinking during that time. Your muscles are very relaxed. This is for athletes. This is super important because this is when growth hormone is secreted in N three sleep at stage three or non-rem stage three sleep. Um, but it's also highly protected. Even sleep deprived people are mostly getting all of the stage three sleep their body wants. Like it's, it's actually, again, evolution figured this out a long time ago. You, it's the hardest to wake up from and it front load, it front loads it into the night. So usually within the first few hours you're done with it anyway.

58:18So it's not a, so sleep deprivation doesn't actually eat into slow wave sleep or deep sleep very much. And people, so they don't need to worry about it so much. So anyway, you get into that and then you come out of that into an episode of REM, um, REM sleep. A lot of people have heard of now, um, is weird. REM sleep is just fundamentally weird. So like, this is where dreams and nightmares happen. Peak blood flow in the brain is actually REM sleep. Like your brain is extremely active. It's actually more like waking than many, any other sleep stage.

58:51Um, but the waves are very different from waking brain waves, but it is, it is more, more like that than, than, um, than other stages of sleep. You're also, your arousal threshold is different in that it's easier to wake up out of REM sleep, but there's also a couple of other weird things that happen that you're paralyzed. You're so, so if, if indeed in the deep sleep, your muscles were very relaxed, that's nothing compared to how much relaxed your muscles are in REM sleep, not because they're recovering, but because you're actively paralyzed.

59:21Uh, your alpha motor neurons are hyper-polarized. You cannot move. Uh, even if you wanted to, that's because otherwise you'd be acting out your dreams because you think they're real at the time. It's just part of your brain has its foot on the brake while it's jamming on the accelerator at the same time. And that's why it's not going anywhere. That's why sometimes you see twitches where it sort of breaks through a little bit, but that's it. Um, it's fascinating. And then also, that's also why you get sleep paralysis sometimes where you wake up at a

59:53REM sleep, but you're still a little bit paralyzed, but you're also conscious and that that switch forgot to get flipped really briefly. So anyway, so you get that in REM sleep. You also get the eye movements, which might be looking at things, but might not be it's the data are very mixed where when you, if you go looking to match eye movements and REM sleep to dream content, you can sometimes find it, but then sometimes you can't. It's, it's, it's fascinating. Um, but what seems to be happening in between deep sleep and REM sleep, there's a really, really interesting dichotomy

1:00:26where they're both important for, for different reasons, where one of the things, the main thing that seems to be happening in the deep sleep is synaptic pruning and synaptic homeostasis. So what, and, and in REM sleep, there's a lot of synaptic strengthening and connection building. And those two things work in concert with each other. Think of it this way. When you're experiencing the day, you're taking in lots of experiences and information. Some of those experiences and information are important. You will learn from are related to important things. Maybe they're not super important, but they're worth keeping. And a lot of those are not that important.

1:01:00Like that piece of equipment over there. I don't need to remember it tomorrow. It's not, I will remember it for the next few minutes, but it's not that important to my life. It will get filtered out. So what ends up happening in slow wave sleep and in the deep sleep, the, the, the experiences from the day and all those new things floating around, they sort of get sorted and the things that are important are kept and everything else gets let, it gets let to fade. Interestingly, this is a similar thing happens where the spaces between your brain cells actually increases and like sort of

1:01:32like a, like actually like a, like a filter, the, it increases and actually waste products can start clearing out of your brain. Is it because you're thinking parts of your brain are working a little bit less and it gives it the chance to do that? Who knows? But it seems to happen specifically during that time, just very protected at the beginning of the night. So when you're after a few hours into the night, that cleaning out process is done and then the cycles toward the end of the night. So drop down to deep up into REM and then you cycle through, but the cycles change.

1:02:04The second cycle, you'll have a little bit less deep and a little more stage two and a little more REM by your third cycle. You might have no deep left and it's all just stage two and REM, maybe a little stage one interspersed in there. If you wake up and the REM episodes get longer, the dreams get more interesting. That's why the dreams in the first half of the night, you, you, you probably won't remember them anyway, but if you did, they're usually a little more boring where the dreams at the end of the night are the cool ones, the ones with the stories and the characters and then, and, and the blend, the blurring

1:02:39of reality and all the, and emotion in the later parts of the night, like nightmares, nightmares to a sleep scientist. A nightmare is a dream that wakes you up. That's the definition of sort of a nightmare in our world, a dream that is so where the emotion is so powerful, it overcomes that, that process. Sorry, if this is sleep stages, you go through these during the night and in REM sleep, it takes those important experiences that you, that you segregated in deep sleep where you got rid of all the junk, kept the good stuff and REM sleep, what the dreams are doing is you're witnessing

1:03:11the brain rewire itself using what was left. So basically the dreams are among other things, essentially what's happening is, okay, here's what's left. How do I, what do I do with this? How is it, how does it connect to other things? How do I sort it? How do I file it? How do I process it? And the other stuff that's floating around that I was thinking about during the day, where's that? Where do I do with that? How do I process that? So dreams are, you're witnessing your brain rewiring itself, speaking to itself in its native language of ideas and metaphors

1:03:42and concepts and feelings and how they relate to each other without rules. Um, and so that's why all of the stages are important. And in stage two, that's not happening, but in stage two, it's happening. It's, it's a lot of, a lot of the recovery and repair stuff is also happening. Cause in REM, your brain's active doing this stuff. And in deep sleep, your brain's also active doing this other stuff. And in stage two is when it's, everything else gets to happen. Um, in a, in a more particular, so like all the stages are important. You cycle through them and it's about every 90 minutes.

1:04:14Anyone can Google that, but it's not exact. It's, they're different across the night. Um, and that's also why it's easier to wake up out of stage two and REM than deep sleep. But so if you woke up and you remember a dream, it's cause you woke up at a REM. That's all, that's all that means. So anyway, how does sleep apnea affect this? Can I, before you get to that, it's so fascinating. Um, particularly the part where you're talking about, you know, all the new information that you're learning every day, you know, you're during that transition between deep and, and REM, you kind of, your brain is like sorting it out

1:04:48and getting rid of the things that you don't really, aren't really that important to remember. And then during REM sleep, you're like using what's left and somehow attaching it to like other memories and stuff and concepts. And sometimes they don't even seem to make sense. Like you'll like, they may not make logical sense or, and maybe they're wrong. I mean, you're sorting through, you're, you're, you're playing stuff out. And that's also why, like when you're awake, a person is a person, a house is a house, a car is a car. But when you're in a dream, the rules of the universe don't apply.

1:05:21The concept of a car can also be the concept of a person. And that person can be somebody else too. And then it was me. And then it was my sister. And then we were in this house that I grew up in, but actually, no, it wasn't. It was really a mall. Like things can happen. It's because you're not bound by the rules of the universe. You're just bound by how your mind is organizing that information. Well, based on what you just said, I have now a new hypothesis for why we dream, but I want

1:05:56to ask you, why do we, why do you think we dream? I think we dream because evolution figured out a long time ago that you can learn a lot by reading all the words on the page, but you can, you can also learn some really important things by reading between the lines on the page, by reading things that aren't on the page and reading the concepts behind them. But when you're engaging in the day, so the way the brain works, which is fascinating is the brain works

1:06:27by shortcuts. It's extremely efficient. It's extremely efficient because it makes a gazillion guesses and shortcuts without actually doing any real work, except when it absolutely has to. So for example, it's like when you take a picture, your brain doesn't store every pixel. Your brain stores this line here, this line here, this sort of pattern of colors and a set of instructions and fills in the gap. Your brain stores the blueprints, not the house. And the blueprints are rolled up this, the house takes up, the building can take up a whole city block.

1:07:01That's why the brain is super efficient. It stores, it figures out what is the minimum amount of information it actually needs. And then what are all the assumptions it needs to make to fill in all the details. And the good thing is the universe works that like when things go farther away, they get smaller. And like, there's all kinds of rules of the way that like you are you and you will be you five minutes from now. And I don't have to assume, make any assumptions that that can change.

1:07:34There's rules to the universe. And when you're engaging with the world that way, it could be really efficient, but maybe there's, maybe there's connections that aren't explicit that might help you navigate your life. So like, let's say we're having this conversation now. Maybe you remind me of somebody who's a friend of mine from like years and years ago. And, but you're not that person. My conscious mind knows you're not that person. There's no question about that, but it may change how I speak

1:08:04or what my body language is going to look like, or how much I choose to ramble when I tell these stories like these sorts of things. Dreaming is about, I think it's about taking the actual written words on the page of life and sorting through those connections and sorting through those unspoken and, and, and details that don't actually exist, but do and inform our life. So dreams are the difference, I think, between memory and experience where it's, it's a difference between what you did and who you are.

1:08:36Like the dreams are what sort of make you that person who reacts to things based on your own history that, that forms those connections. But I don't know, that, that's my, that's my ramble of what I think. Well, thank you. Okay. So back to the sleep apnea, because you know, people having these awakenings where there are multiple wakings in the night, obviously this is happening during different stages. What, how does sleep apnea, untreated sleep apnea affect sleep, the sleep architecture. That is one of, sleep apnea is one of the few things that can artificially, reliably, dramatically reduce your slow

1:09:12wave, deep sleep because it prevents, because you can't detach because your bodies keep trying to get your attention. The other thing it does is it dramatically increases, it can dramatically increase stage one. Um, and it can also, because your sleep is more shallow and you have more of these arousals and awaken, even if you don't wake up all the way, your brain is still sort of moving around. The other thing it can do, it can dramatically reduce your REM sleep. Because remember what I said about muscles and REM sleep, even your respiratory muscles get weaker.

1:09:45That's why snoring is worse in REM and, or worse at the end of the night, because you have more REM at the end of the night. So if you're, if you're already in a floppy tube, trying to breathe out of this floppy tube, that's already having an issue. And then you make the muscles go extra limp, snoring is going to get worse. So you're going to have more awakenings out of REM. You're going to have less deep sleep and your sleep's just going to be more shallow overall.

1:10:16So that's why people with sleep apnea, they wake up and they feel like it's sort of like, I just ate a whole meal and I'm still hungry. Right. Yeah. I wonder if anyone's, or maybe you can tell me if anyone's ever looked at, you know, because you mentioned deep sleep is really important for this, you know, cleaning out the toxic waste, these are aggregate protein aggregates, amyloid beta 42 being one. Yep. Yep. I wonder if anyone's ever looked at like people with Alzheimer's disease to see

1:10:47if any of them have sleep apnea, like the untreated sleep apnea. Oh yeah. Untreated sleep apnea is a known risk factor for neurodegeneration, especially when it's more severe. So this is the thing, mild to moderate sleep apnea is a, is a gray area. Severe sleep apnea seems very, that's 30 events or more an hour seems very reliably tied to bad outcomes. Mild seems like it's really only tied to bad outcomes when you also have daytime symptoms. Like you're, you're mostly treating like the fatigue and the memory issues, whatever you can still get, um, cell death

1:11:20and you can get neuronal problems. Cause you're think of it this way. Every time you have one of these respiratory events and you're having it, you know, maybe dozens of times per hour in the night, your oxygen drops and it's not the hypoxia. That's the problem. This is what a lot of people get wrong about sleep apnea. It's not really the hypoxia. It's the intermittent hypoxia. So you're not hypoxic because what'll happen is you drop a few points. Most people, unless you have some other lungs, most people with sleep apnea, their O2 doesn't drop a

1:11:54lot for sustained amounts of time, unless you have like emphysema or something, it'll drop a few percentage points. Then your body wakes up and then it recovers. Then it drops again. Then your body wakes up and it recovers and it drops. So it's like, it's constantly putting out all these little fires all over the place. The fires are never burning any houses down. They're just sprouting up all over the place. But what ends up happening is all of these cells are releasing reactive oxygen species every time this happens.

1:12:25So you're releasing these reactive oxygen species. This oxidative stress is happening and then it's quelled and then it's stressed and then it's quelled and then it's stress and then it's quelled and it's stress. Then it's all night, four days or months or years or decades. Usually imagine the stress, like your cells are trying to do their job and they're constantly dealing with all this nonsense. Instead, imagine trying to do your job and you're constantly having to do all this other stuff. So you're not getting the recovery function that you were built for.

1:12:58And so your trajectory goes slightly off. So that's why sleep, not just sleep deprivation, but also sleep, untreated sleep apnea can lead to liver problems, kidney problems, brain problems, heart issues, you know, immune system problems, because all of the, every cell that relies on oxygen starts getting stressed and some of them are more sensitive than others. Right. And you're also disrupting your sleep architecture and not getting enough sleep. Right. So, so, so people with untreated sleep apnea then probably do have problems with working memory.

1:13:30Yeah. Yep. I mean, emotional regulation, motion regulation, executive function, attention. So this is the thing when you, when your sleep is poor, whether it's sleep deprivation or sleep apnea or fragmentation or whatever, the first brain function to go is vigilant attention. Your ability to maintain focus, especially when whatever you're focusing on, isn't super excited. That is usually the first brain function. That's the first warning sign that something's up and the re and that can start creating memory issues. But a lot of the memory issues are memory issues because sleep is really important

1:14:06in memory. Remember you're taking all this stuff I was talking about is all memory connected functions. It's about sorting through information, processing information, consolidating information, integrating information. And if you're not able to do those things, you're operating inefficiently. You're not performing those functions, but memory, but memory is also a function of attention where if you're not able to focus and attend, even if your memory machinery was working perfectly, you have nothing to process because it never

1:14:36got in there. This is the thing with people taking sedating medications. Sometimes it impairs memory. Sometimes it impairs attention, which also impairs memory. You mean, so it does that not while you're on it, but like that's it. It can. Yeah. Wow. So, I mean, that's why a lot of these medications and stuff, and really anything, anything that is impairing your ability to focus will have ripple effects to memory and decision-making as well, because the information you took in informs those other processes. I mean, just like most simply, you can't recall a memory that never

1:15:13got stored because your working memory couldn't process it because you didn't attend to it in the first place. Is this why men have a lot more attentional issues? Maybe. Maybe. I mean, there's a lot of untreated sleep apnea out there, and then there's a lot of other sleep problems too. And they all, I mean, sleep does a lot. We live in this society that sees sleep as an unproductive use of time, especially people who are training, especially

1:15:44people who are like trying to maximize their day. And sleep is not an unproductive use of time. Sleep is an extremely productive use of time. I mean, if you're working out and you're trying to get stronger, when you're working out, you're stressing the system so that it rebuilds back stronger, right? When do you think that other part happens? Not while you're working out. It's when you're recovering. It's the recovery. Sleep should be your number one recovery protocol for any kind of performance-driven

1:16:16person, whether it's physical performance, mental performance. I mean, when you sleep-deprived people, we trade sleep for work all the time, but you actually get less done. And we've actually measured this. You actually accomplish more on less time if you're well-rested and your brain is clear. Right. Okay. Well, let's talk about treating sleep apnea. I know we can talk about CPAP and what that is, and it certainly works. Yeah. It's a blunt instrument. It works. Long-term adherence, maybe not so great. What do you find to be some of the best evidence-based non-CPAP interventions?

1:16:52Yeah. So the thing about CPAP is it's a blunt instrument because it's, think of it, it's just a split that keeps open your airway. It creates a pillow of air that, so if your airway wants to collapse, it can't. And CPAP, it's continuous positive airway pressure. Continuous because it's blowing continuously. Positive airway pressure as opposed to negative pressure, which is sucking positive airway pressure is blowing. So it's just continuously blowing air in your airway to create a pillow of air to keep it open.

1:17:23That's all it is. It's a blunt instrument. If your airway wants to close, you, you, you blow enough air in there, it won't be able to close. But for some people, it's too uncomfortable or whatever. So there's other approaches. The one I tend to use the most, especially with athletes who are often presenting with more mild to moderate sleep apnea anyway, are what are called mandibular advancement devices. What these are, it's essentially a retainer you wear at night, mandibular, like your mandible advancement. So essentially it's a retainer that pushes your jaw forward.

1:17:54And in a nutshell, that's all it is. There's obviously a science behind it, but what it does is it creates a little muscle tone here, even when you don't want, well, even when you're trying to rest. So usually that's not a good thing, but it creates just not enough muscle tone to keep you awake, but enough muscle tone to keep this part of your airway open a little more than it normally would be. And for a lot of people with especially more mild sleep-related breathing issues does the trick. That's, that's all it takes to knock out at least enough of those events so that you don't end up

1:18:30noticing it anymore. And you don't have to plug it in. You don't have to switch out your hose every couple months. Like it's a little easier. You do have to get it adjusted. And as your jaw remodels, you might have to do some adjustments. You do it with a, there's a whole field called sleep dentistry. It's sleep medicine dentistry, not sedation dentistry, but sleep dentistry, where it's about people diagnosing and treating sleep apnea with these dental devices. That's a very common one. Um, there's an, there's, there's also, um, musculo myofacial therapy.

1:19:00So like you can use the musculoskeletal system and essentially exercise these muscles so that they just carry more muscle tone that can work. I mean, there's, there's very famous work done with like people who play the didgeridoo where they have to do the cyclical breathing. It ends up strengthening certain muscles that even when you're asleep, they're a little stronger and they can maintain a little more tone. So sometimes that can help, especially for more mild apnea cases. Um, there's a device, um, called, uh, excite OSA, uh, where, where it's, you put it on your tongue when

1:19:32you're awake and it's sort of electrically stimulates your tongue muscle. So then you go to bed, it keeps a little, it's like a tens unit kind of where it like, where it stimulates your tongue muscles so that when you go to bed, there's a little more muscle tone in there that seems to work. Okay. Um, there's a new device. People have maybe seen commercials called inspire, which just means breathe in, but, um, it's, it's sort of like a pacemaker that they install. So it's an implantable electrical device that they do surgery, but it's a sort of a

1:20:05pacemaker for your tongue muscle. And so what it does is when it detects that your tongue is falling back, it zaps it to open it up. And that also for people for whom it's a candidate for it, that can also, it's, you don't have to, again, there's no equipment to replace, but you do need surgery for it. And, and there's complications there sometimes, but it seems to work. Okay. Um, there's more options now than ever. And the technology is always getting better. Even with CPAP, there's more than 200 different kinds of masks out there.

1:20:36So for people who don't like their device and don't like their mask cause it's uncomfortable or whatever, it's rare that I find a mask problem that can't be fixed. If, if what you need is one of those. What about, um, mouth taping? Mouth taping. So, all right. Mouth taping. So mouth taping for decades in the sleep medicine field, we've been using chin straps, just like an elastic band at night for people who are snoring. That don't, that where it's just mild snoring and they don't have sleep apnea, um, or their sleep apnea is

1:21:07mild or their sleep apnea is due to them opening their mouth at night and their tongue falling back and they can breathe through their nose. Okay. Chin straps have been great. They're, they're, they've been, again, used for decades. Mouth taping, I think is just sort of the same thing where you're essentially just keeping your mouth closed. You're just keeping your mouth closed in a way that you can breathe through. Like it's, it's special tape where air flows through fine. If the problem is that you're opening your mouth, I have no problem with it. And it probably, it may help those people. But if the problem is that you actually have sleep apnea and

1:21:41if you don't open your mouth and you can't breathe, like, and you're opening your mouth to gasp for air, then that's probably not what you want. It's probably the opposite of what you want. If, if you need to open your mouth to breathe or else you're going to have your, your oxygen is going to plummet. Don't do that. But if for like more mild snoring cases or for people who are, it's mild enough, or if it helps you keep, like maybe you're using a nasal device or like, or like strips or, or, um, rhinomed makes these, these nasal splints where you can keep your nose open.

1:22:12Like if you're using one of those and you just need to keep your mouth closed, I have no real problem with it. I just don't think it's going to like cure cancer and save the world, but I feel like it's, it gets overblown by people. So yeah, it's gotten overblown and it sounds more like maybe for snoring than anything. And it's, it's, if you need, if keeping your mouth closed during the night solves your problem, go ahead. But if that's, but if you're hoping that keeping your mouth closed during the night will solve your problem and it doesn't, there are other options for you. Are there any, for people that are experimenting with some of

1:22:46these, perhaps the retainer or the myofunctional training? Um, we're going to get into sleep wearables, you know, soon, but like, how do they really know it's working to this? What's yeah, it's tough. The best way to know, and this is not a perfect way. Um, second best way to know is, are you, how do you feel during the day? How's your energy level? How's your ability to focus? Are you falling asleep whenever you stop moving? A lot of people sleep after you. They can't, they don't stop moving because then they'll, they'll fall asleep. They can't watch TV. They can't watch a movie. They can't go to a dark movie theater without nodding off.

1:23:19Like they have a hard time with that or meetings. They hate meetings because they have trouble keeping awake. If all of a sudden that's just not a problem for you, it's like your appetite isn't ramped up because you're starving all the time. You're actually getting good nutrition. So you're not starving. That's a good signal, but it's not a great signal. It's not, it's not a perfect signal because there's a lot of people where their sleep apnea seems to be treated just fine, but they still have some of those daytime symptoms and no one really exactly knows why. Um, but it seems just means we need to learn more about what this condition really is and what it's

1:23:53doing in the brain when what's permanent and what's not permanent. We don't know yet. And I say that second best, cause the best is just get retested. And a lot of people with sleep apnea, if it's been a couple of years, get to do it to do the test again, do it while you're using your treatment to see. And, and for a lot of those devices, insurance requires you to do that anyway, to make sure it's working fine. See if he needs to get adjusted because sometimes they need to get adjusted and they're not working great because your mouth changes or something. So that's one way.

1:24:24I mean, really, really, there's no other way besides either looking. I mean, you can, you might in the future might even be easier to look at the wearable data, check your oxygen levels during the night, check your heart rate during the night, see if you have these spikes that you used to have or see it. And most, most importantly, see how you feel the next day. All right. Um, I kind of wanted to shift gears. We're going to get into the supplements cause that's something everyone wants to know about. But before that, I kind of wanted to ask you a little bit about, you know, we've, a lot of

1:24:56people have heard about sleep hygiene and the most important things for sleep hygiene. I mean, rapid fire. I do good sleep hygiene. I do all the sleep hygiene or I, or my sleep hygiene is bad. Like people talk about this all the time, but yeah, but there's a difference between sleep hygiene and behavioral sleep medicine. They're different things. Right. Exactly. I mean, obviously people need to have sleep, good sleep hygiene too. Like that's important, but like, like everything you were talking about with CBTI, like that's just one. Yeah. The sleep hygiene is just something that already needs to be done.

1:25:29Yeah. Hygiene is hygiene. Hygiene isn't medicine. So like washing your hands is hygiene. Everyone should wash their hands more than once. You know, you should be, and if you're sick, wash your hands more, but washing your hands won't cure an infection. Right. But for people that perhaps don't have insomnia, have apnea, sleep hygiene. But everyone should still be washing their hands. Everyone should still be brushing your teeth. Even if you can't brush your way out of braces, it doesn't mean you shouldn't be brushing your teeth. So, so sleep hygiene is all about setting yourself up for success or dealing with some of these more minor

1:26:06problems. Right. So I was wondering if you had any tips on some more advanced type of sleep hygiene. Like we know, we all know dark, cold, quiet. Rocket science, right? Yeah. Rocket science. But like, are there any other sort of more advanced sleep hygiene techniques? Like, oh, maybe your resting heart rate or respiratory rate or something like that. Like people could. Some unconventional, the stuff, you know, if you Googled, if you Google sleep hygiene, what's some stuff that might not come up on those initial lists that would still be useful?

1:26:37One of the, one of the things that you'll see often on sleep hygiene lists is keep a regular schedule. Because predictability, the brain loves predictability. So if you keep a regular schedule, time itself becomes a cue. So like, if you want to eat lunch at noon every day, start eating at noon every day and your body will learn to get hungry at that time. But what if you can't keep a regular schedule? Well, an alternative approach I would take is find other ways of building predictability into your sleep.

1:27:08For example, so like, so one of the groups I do a lot of work with is Major League Baseball. And in Major League Baseball, when they're in season, they're constantly moving around and playing in different time zones and sleeping in different hotels. How do you keep regularity when you're constantly moving around? And so like, for people whose lives are like that, what do you do? Well, I usually say, okay, stop trying to keep a regular schedule, but, but find other ways to build predictability. And so maybe have a nighttime routine that is highly predictable, where you do the same things in the same

1:27:43order, even if you do them in different places, in a different hotel room or whatever. Especially if you can bring things with you, like bring the pillowcase with you, uh, as a, as a condition stimulus, um, use the same toothbrush that whether it's at home or on the road, if you travel a lot, use, do the same things in the same order. So even if they're at a different time in a different place, find alternate ways to build predictability. If time itself is not the predictable one.

1:28:13Um, another one is avoiding bright light at night. So what if you can't, um, so blue blocking glasses are great for this because, and by blue blocking glasses, they have to be orange or red. Most of the time, some of the other ones will work. Some of the yellow ones or brown ones will work, but if you put the glasses on and you look at something blue and you know that it's blue, it's not going to do its job from a circadian perspective. So some of them block blue for eye strain, but that's different, different thing.

1:28:47So if you put on say orange tinted glasses and you can't see the color blue, then the environmental light is not going to interfere with your sleep in the same way, because it's not going to send a daytime signal. Another one that even fewer people know about is bright light in the morning can help set your sleep up at night in three ways that are, that are actually a little unconventional. Number one, by having that morning be a regular timing and a strong daytime signal, I'm talking about daylight.

1:29:18I'm talking about like outdoor light, not just turn on the light in my bedroom light. That's a couple hundred lux step outside. It's thousands of lux of light. So getting that strong daytime signal in the morning at a predictable time starts a clock. And that clock, just like when you finish a meal, you'll start getting hungry a certain number of hours later. If you don't really have a really strong meal, you're sort of hungry all over the clock. You don't have that rhythm. But if you have a strong morning signal with some bright light at a predictable

1:29:52time, about 16 to 17 hours later, your body will expect to be ready for sleep. And if you can make that a little more regular, it makes, it's like if you want to be, if you want to throw, if you want someone to catch a ball downfield and you throw it the same amount of about the same distance every time, but you keep moving, the person downfield doesn't know where to stand. But if you stay still, they can predict where the ball is going to land.

1:30:22So like by setting that time, it creates, it sets you up for success by starting that timer. The second thing that it does is that it creates a circadian amplitude. So your circadian rhythm, this 24 hour cycle, it's like when you're on the couch in the dark all day, you don't have a strong daytime rhythm. So you don't have a strong nighttime rhythm. But if you get a strong daytime signal by being active and, and getting especially outside light, especially in the morning to start that curve going by the time nighttime comes, you'll have an even stronger nighttime signal.

1:30:57And then the third thing that it does that even fewer people know about is, you know, everyone knows that light at night is bad and that light in the morning is good, but light across the day matters where the more outdoor light, the more bright light, but it's mostly means outdoor light, the more light you get during the day, it inoculates you against light at night. Because if you've got a really strong light daytime signal, you can get all kinds of light from screens or whatever at night.

1:31:28And it actually won't matter for most people. You can actually, you can, so you, again, it's lesser known, but because the system knows where it is, it's not looking for information anymore and, and conflicting information will get thrown out as opposed to like, I don't know, it's, it's light now, but I didn't get a ton of light during the day. Maybe it's daytime. I don't know, but you can inoculate yourself against nighttime light by getting plenty of daytime light. That's fascinating. I've noticed that of course, when I'm traveling and I'm, I'm outside all the time.

1:32:02And then it's like being in my hotel, I don't usually have my dimming lot, my dimmers and everything that I usually have, but it doesn't matter because I am dead tired, you know, after being. This is humans lived for most of our existence in equatorial bright days, dark nights, relatively little seasonal variability all around, all around like the Mediterranean area and, and that part of the world, you know, we solved all kinds of problems by creating these walls and buildings and artificial lights and everything. We solved a lot of problems. We've created some new ones too, and we're still running the same code.

1:32:38Right. Um, a couple of questions, um, follow-up questions for that. Do you think the time of, of, um, morning light matters a lot? Like you wake up in the morning and like, is it like first thing you go outside and how long should you have to go outside for 30 minutes? Yeah. Morning light is key earlier. The better. Um, I mean, honestly, earlier, the better and how much I would say 15 minutes is probably fine. Um, 30 minutes is probably better. Like a morning walk or a morning run is actually probably perfect.

1:33:10Um, and cause what's happening, it's not only that day time. The other thing it's doing, and we'll talk about this when we talk about supplements, but melatonin. So melatonin naturally, your, your natural melatonin will drop in the morning down to like almost from its peak to almost nothing light suppresses melatonin naturally. That's what it does. And so the early, if your melatonin is still kind of high and it's dropping by getting that light, you accelerate its ability to drop. It's like coffee. Yeah, kind of. And, and actually this is also why I don't recommend that people caffeinate as soon as they wake up.

1:33:43I recommend people wait an hour because if, if you caffeinate as soon as you wake up, the, the amount of adenosine that that caffeine is blocking is still very low. You haven't produced enough yet to really have much of an effect. But if you drink caffeine, as soon as you wake up in the morning and you feel more alert, it's probably your sleep inertia naturally coming down and your melatonin naturally getting blocked and you're feeling the effects of it and you're attributing it to the caffeine. When actually you could have skipped the caffeine, you probably would have felt

1:34:14mostly the same. It's just the caffeine is still having effects later, but you've missed the caffeine peak. So like actually you tighten the caffeine a little bit later. So you're saying you want to use the caffeine for, you know, when, when you basically more need it, when you're working, maybe. Yeah. Adenosine builds up. Yeah. Use the caffeine. So adenosine builds across the day and you're at your lowest levels as soon as you wake up. Why are you going to block something that you're, you know, if caffeine works mostly by blocking adenosine and your lowest levels of adenosine are first thing in the morning, why would you recommend someone block it first thing in

1:34:49the morning? Wait till the, wait till it accumulates a little bit, especially if, if you, for most people, that natural sleep inertia will wear off within 10 to 60 minutes as soon as they wake up. And my favorite way to tell this story is like, you know how you wake up and you smell the coffee and then even that kind of perks you up a little bit. They say, yeah. And I say, did you know that there's a term for that? And they're like, oh, there is. And I say, yes, it's called placebo. And then, and then, so they laugh and like, well, what do you mean?

1:35:23I'm like, coffee doesn't work olfactory. It doesn't work through the nose. If you smell it and you start perking up, it's because you're predicting what its effects are going to be before you even ingested it. And which means when you, you're drinking that coffee, it's giving you a placebo effect as much as it's giving you anything else. So like, wait a little bit. Cause you're, cause you don't need it. That's why I drink decaf coffee, like, you know, at 11, 11 AM. And I feel like it's totally working. And I'm totally fine with that placebo.

1:35:53Right. Cause you had it in you all along. Right. So, so it sounds like the morning routine would be wake up, go outside, whether some water, you probably dehydrate a little bit, get some water, go outside, whether you're taking your puppy or dog out. I just got a new puppy, um, going for a run. Yeah. But go outside for at least 15 minutes and then, you know, wait a little bit. Then you make your coffee. Obviously there's some people are kind of rushing to get to work, but you can drink your coffee in the car on the way to work.

1:36:25Yeah. Or, or wait till you get there. Or wait till you get to work. Yeah. Okay. I'm going to try that. Yeah. I mean, and also you got to remember caffeine, caffeine doesn't reach its peak effects for at least like a half an hour after you ingest it. So, and then it'll last for a few hours afterwards. So if you want to, if you. Wait, say that again. So it doesn't reach its peak until 30 minutes later. About 30 minutes later. So if you feel it sort of right away, that wasn't, that wasn't sort of the

1:36:55effect of caffeine. Okay. Um, and then, and yeah, and then it'll trail off. Like it'll have some effects as it builds. So it's, there was something there, but it's actually the peak effects of caffeine, uh, for alertness or, are about a half an hour in. So that's why what a lot of people will do is they do the, the whole calf nap or the nappuccino or whatever they call it, where like they drink the coffee, take a nap for 15 to 20 minutes, wake up right when the coffee starts ramping up and then they, then they go.

1:37:25I've never heard of that. Oh yeah. It's a thing. Um, I mean, I don't do it, but I, not because I have any moral, um, you know, opposition to it, but it's a thing where, where, because they leverage the delay in, in the caffeine reaching its effectiveness. So, and they, and they use that to limit their nap time, but we can talk about strategic napping a little bit later. Okay. Well, let's talk about supplements. I mean, obviously we're talking about behavioral interventions being absolutely the best, um, the most likely to actually help. Okay. That's the way, that's, that's the way I think about it.

1:37:57It's like, they don't always work and other things may sedate you more faster, but there are the things that are most likely to solve your problem long-term with the least negative effects. What about, you know, you talk, you were talking about early light exposure, um, the timing of like going to bed at the same time versus waking up in the morning at the same time. How does that play a role? I would say focus more on starting the morning than timing your bedtime at the same time, because the morning will set up the evening and usually people have more control over that anyway.

1:38:28Um, and the way I like to think about the evening is I think about sleep as my commute to tomorrow where instead of thinking, so if you had to go to work, you don't think, well, I'm going to wake up when I want, I'm going to do everything I need to do around the house, pay all my bills, do all the dishes, do all my chores. And then when I happen to be done, hope that I make it into work in time. And then like, shoot, I ran out of time. Like that doesn't work. Instead, what you do, you think, what time do I need to leave the house?

1:39:02How long is it going to take me to get ready? What do I want to do in the morning? What do I want to go for that walk or whatever? What time do I need to wake up to make that happen? And that's how we should be thinking about sleep. Cause then you should be thinking, keep going and think, okay, how much sleep do I want to get? How much time do I need to budget with a couple of awakenings during the night or whatever that's normal to get that amount of sleep? When do I want to be in bed to be able to fall asleep when I want to be able

1:39:36to get all the sleep I need so that I wake up naturally when I want to be woken up fully refreshed. So when do I need to start winding down? So you think backwards. And so the, the, the nighttime routine regularity, I think is important, but I think more important is thinking strategically about it and start thinking based on my goals for tomorrow. When do I, when do I need to be up and when do I want to go to bed? But the morning routine building regularity will help set you up to be tired at the time you want to

1:40:06be. But going into bed at a regular time, when you're not ready for sleep, that's bad stimulus control. That'll set you up for problems later. So that's also why I don't stress the nighttime getting into bed. Cause what if you're not ready? If you're not ready, if you're not hungry, don't eat. Like if you're not ready, don't sit there and, and count sheep for an hour. That'll just make you stressed. So it's, that's why I focus the regularity on the morning. So you think people should try to have a consistent wake up time in the morning, possible, but not everyone,

1:40:37not everyone can. And like, and maybe your wake up time during the week is uncomfortably early and you want to sleep in on the weekends. I got no problem with that. Regularity is good. But like if, if it means you're, you're getting a little bit of extra recovery on the weekends, you know, it's, it's a, it's a trade-off. There might be a net positive there. But if they do, if they are waking up early in the morning, during the week, then you'd think they'd be, they're building up enough sleep pressure to fall asleep earlier. Right. You'd think, and it's just, that's if they, and if they, that assumes they're giving themselves permission to go

1:41:11to sleep at a time that is ideal for them. A lot of people don't give themselves permission to go to sleep. You know, we have this whole concept of revenge, bedtime procrastination, where you're only taking, you're taking revenge on your own day. Right. Right. And your own resentment of your life being too full of junk and crap to have no time for yourself. And it's tough. And, and the way, the way I put it though, is I think you're cutting off your nose to spite your face at that point. When people say, I know I should be going to bed earlier, but you're asking me to give up the

1:41:45one hour in my day, that's mine, that I need for my own mental health. What do you say to that? And I say, you're right. I am not going to ask you to give up time. What if I could give you some more of your time back? What if the reason why that is the only hour in your day that you have is because you could be more efficient and productive during the day, and you won't need as much buffer time on stuff if you were a little sharper. And actually that's what the data show that actually, instead of asking you for time.

1:42:16So we did this, we, I went into, um, to the university and to the division one athletes cross all the different sports. And I said, look, I'm not going to ask you to sleep more, but if you want to fall asleep faster, here's how you do it. And we'll get into what I said, but I'm sure you're going to ask, um, how do you fall asleep faster if you want to be, if you need to wake up early, how do you fall asleep earlier than your body wants to? How do you get moving during the day? Let me teach you how to do this so that you become

1:42:49your own sleep expert. And if you want to get more sleep, here's what some of the benefits would be if you're not getting enough, especially in students, especially in athletes. Um, but I'm not going to tell you what to do. Like, I don't know your life and I can't control your schedule, but here's how to make an informed choice. Um, on average time in bed increased by 40 minutes, total sleep time increased by over an hour. Most of the time they needed, they were already in bed anyway. And, and they gave, they gave up those extra 40. I didn't ask for it. They, they found what was useful for them and they, and actually they were rating

1:43:25themselves as their grades were better. They were more productive. Their social life was better after they were sleeping better. And so what did they do? What was the protocol? So first of all, I hammered stimulus control. Um, I normalized some things like, you know, they would, what would happen is they would freak out when they wake up during the night and they have trouble getting back to sleep. I said, don't freak out. Just take a break, five, 10 minutes, get a drink of water, whatever, go back to bed. Um, and like reducing that performance anxiety, hammering stimulus control, um, wind down routine stuff like dimming

1:43:57lights, um, gave them blue blockers, you know, we'd like, and in terms of morning routine, talked about getting light first thing in the morning. Um, a lot of that basic stuff, but really it was, and it also coupled it with some education of, we talked about how different sleep stages work, talked about how sleep works, not as like, uh, this is sleep one-on-one class, but it's more of a, look, you're an athlete. You're trying to do all this stuff with your body and have it in peak condition and understand what's going on to the hood. Let me teach you what you need to know about what we know about how the

1:44:31system works so that you can make the most informed choice that you can make. Teach them about how circadian rhythms work, teach them about how sleep propensity builds across the day, dissipates. And when they're awake in the middle of the night, it just because they haven't built up enough sleep pressure yet. So you got to give it a little bit of time before you can go back to sleep, like teach them how these processes work so that it demystifies it a little bit. So even if they have an awakening, it doesn't become a stressful one. And if they want to fall asleep earlier, they can learn to program that in and create those conditions.

1:45:06And we, like we, we hammered the don't lay down in bed. So like if you're going to college students, their bed is also their couch and it's also their desk and it's also their whatever. So we had a sleeping part of the bed, wake part of the bed. You know, when you're in the wake part of the bed, you're sitting up, you know, you can lean back, but you're not going to lay down with your head on a pillow unless you're planning it. Like, so we separated these things out, worked beautifully. How many weeks?

1:45:39We did it for a semester. So it was like, it was like eight to 10 weeks. Eight to 10 weeks. That's amazing. Yeah. That's like typically six to eight weeks is normal. That's usually even people who come in and say, my sleep is terrible often, you know, and I'll say like, look, it's extremely unusual for someone to walk in unless they have some other major medical complication that's getting in the way that within six to eight sessions, they're usually sleeping way better. Often by then they're like, you know, this isn't my problem anymore.

1:46:11And I'll say, you know where to find me if you need me. Oh, that's awesome. Yeah. Okay. Well, let's talk about, let's talk about a couple supplements. Um, I definitely want to get into jet lag in a little bit later, but, you know, obviously the most, the top of mind supplement people think about when they think about sleeve, I think melatonin. Melatonin. So melatonin is a hormone. It's a very old molecule. It's in plants. It's in other stuff. It's not a sleep hormone except by association.

1:46:42Melatonin is the hormone of darkness. Melatonin is a nighttime signal. You produce it at night. A great example of how it's not a sleep signal. It has no sedating properties whatsoever. Melatonin doesn't. You give melatonin to a nocturnal animal. It wakes them up because it's a nighttime signal to the degree to which your body gets a nighttime signal. And that makes you sleepy. Yes. It can promote sleep. Melatonin can promote sleep in humans for that reason. It can help you fall asleep faster. It can help you stay asleep. It can help you sleep more restfully because it's strengthening that nighttime signal.

1:47:17That's what it does. It's also why it is almost universally useless for insomnia. Because if you have a conditioned arousal, remember now, now, now everyone knows what conditioned arousal is. If you have a conditioned arousal, your body already knows it's nighttime, still can't sleep. So taking melatonin is almost never going to work to treat an insomnia condition. But if you don't have conditioned arousal, if you don't, if you just need a little bit of a boost, actually melatonin probably works just fine. It's also, you produce it natural.

1:47:48During the day, your levels are almost non-existent. They start rising in the early evening. They pick up, they peak during the night, and then they drop off right about the time you expect the sun to come up. And light suppresses it. So even if you're at peak levels during the night, turn on a bright bathroom light, plummets. Then you turn off the light. As long as the clock still thinks it's nighttime, it'll regenerate them again. Might take a delay, especially the older you get, the less flexible the system is.

1:48:19But that happens naturally. Now, some people, when they take melatonin, they might be taking the wrong dose at the wrong time. So the way we started using melatonin as a treatment for something was, our natural rhythms are about 24 hours. You know, so some creatures, they use light from the sun to, so like when you put a blanket over a bird's cage, they'll go to sleep because their natural melatonin starts spiking as soon as it's dark. And then it suppresses as soon as it's light. Humans, we have mammals, we have our own internal clock that

1:48:53guesses what time it is. So we could be in a cave and still keep a roughly 24-hour cycle. Otherwise, the systems in our body would get all out of crack. But it's not precise 24 hours. It's a biological clock that is slightly longer than 24 hours in almost everybody. Not quite 25 hours, but somewhere in that gray zone. But what happens is, so it's like, if you want to, if every day of your life is a string and every day is going to be 24 hours and you had to produce the string to be the exact

1:49:25same length, what you do is you make all the strings slightly long and trim the edges off. That way you can guarantee they're all going to be the same. And that's what physiology does to your rhythm. It makes it slightly longer than 24 hours, then resets it in the morning to start it all over again with the morning light as it hits the reset on the rhythm. So blind people who can't see light, they get this, their natural rhythm never gets reset. So it's slightly more than 24 hours. So if you were living a slightly more than 24-hour rhythm, you woke

1:49:59up at 6 o'clock today, you'd wake up at 6.30 tomorrow. You'd wake up at 7 the next day. And then eventually you're waking up at 2 in the afternoon. It's miserable. And then it's cycle around. It's called a non-24-hour circadian rhythm disorder, where you just can't reset your rhythm with light. They found is you give someone a third to a half a milligram of melatonin in the evening and a blind person fixes the whole thing, sends the nighttime signal at the time that it needs to see it, and the system responds beautifully to it. You're not trying to replace their natural melatonin.

1:50:32That half milligram dose is the signal. It's a clock signal. It's what tells your body, hey, nighttime now. And if you give it a little bit before you're naturally going to start producing it or right around that time, it sends the signal a little early. So it's sort of like your body responds of like, oh, I didn't realize it was nighttime yet. Better get started. And it starts your own natural process a little early. So that half milligram dose in the evening, like five hours before your bedtime, that's the evening signal.

1:51:03Where your evening hasn't even really started yet, you're giving your evening a little bit of boost. So it's basically like jet lagging yourself, where you're telling your body it's nighttime before it's actually nighttime. That's not what you're really telling it. You're telling it it's evening before it's actually evening, like right around dinner or like usually two to three hours before your typical bedtime is when you start producing melatonin. You give it a couple hours before that. It's in the zone where you're looking for it. Like give it in the middle of the day. Your body's not looking for it.

1:51:35It's in the zone where your body's looking for it. And you can confuse the system and think it's later than it really is. That also means you'll wake up a little earlier because the whole thing got shifted. Same thing is if you take that low dose melatonin, as soon as you wake up in the morning, that drop gets delayed a little bit. So it ends. So that ball lands a little further along than it expected to. So your day started a little bit later than it thought it was going to. So you'll stay up a little bit later the next night.

1:52:09So you can use that half dose, half milligram dose as a clock shifting dose. So then why is everything over the counter like five and 10? Well, A, people think more is more and sometimes more is less, especially with melatonin. If it's just a nighttime signal, more isn't more. Five, you can take closer to bedtime. That's a little more of a sleep promoting dose where it's more of like a, hey body, you idiot. If you didn't know it was nighttime already, I'm going to scream it in all capital letters for you and

1:52:39get your act together. And, and it'll boost that net, whatever natural sleep drive you have, um, that isn't interfered with by insomnia. It'll, it may boost it. So people who take that three to five milligrams with it, you know, closer to bedtime, it can have that sleep promoting effect. Not because the melatonin was sedating, was it sort of got, was that strong enough signal to kick you into gear a little bit. Now, a lot of times people will feel groggy in the morning with it. That's because you just couldn't metabolize it fast enough that you gave yourself such a big dose.

1:53:13You already were naturally producing it anyway. So you were, you were, oh, you overfilled your bucket. And, and so by the morning you still have melatonin floating around backfiring. So now you're telling your body it's nighttime when it's daytime because you couldn't get rid of the nighttime signal fast enough. And, and it had built up over time. So often when I say, if you're taking melatonin at night and it's helping you, but you're feeling groggy during the day, cut your dose in half. And then there's the other problem.

1:53:43There was like a few studies have been published where, I mean, almost all these melatonin supplements that are out on the market have huge variations. Some of them have like a hundred times more melatonin than it's actually what's on the label. Yeah. So, so that's the thing where there's a lot of them out there that can be unreliable, especially from some of the manufacturers that don't have the good quality control. It is regulated by the FDA. It's just, you know, there's just not enough money for enforcement. So there's not a ton of enforcement, but any of the larger companies, they're actually going to have pretty good

1:54:19quality control. And they are, if you look at those, the ones that are the bigger companies that are on the shelf, they're almost always right on target for what they should be. And I say that because what's on the bottle is actually not what's supposed to be in the bottle. And a lot of people don't know this, but the bigger companies that have the higher quality and the higher quality control are following the law. And the law says that the amount on the bottle has to be within

1:54:49a certain percentage of the amount that's in the pill at the expiration date. That is the definition. So if you have a supplement that's sitting on a shelf with a three-year expiration date, and you're working with a company that's trying to do everything really well and correctly, your chemists and food scientists have to calculate exactly how much they have to put in that pill so that as it degrades naturally over time, how much will it degrade to the point to hit the target two to three years out?

1:55:19That's actually the calculation they're making. So in melatonin, that answer is usually 30 to 50%. So when you buy melatonin off the shelf and it says five, it's probably closer to eight, seven or eight when you buy it. And then two to three years later, yeah, it's five because they did their job. They followed the law and they had really high standards in their manufacturing. But it's still the, you're probably taking a much, you're probably taking a higher dose and they can't tell you because the way the law is written, it's like, if you, if you tell people what's in there is different

1:55:55than what's on the bottle, you've now changed the label. And now you have to meet that. It's, it's, it's complicated. The law was written in the way that I think they didn't foresee this problem, but people need to know that actually, if it's a good brand, it's actually going to be higher than what's in the bottle because they're going to calculate in the overage needed to, to be able to degrade to the point that it hits the target. Isn't that great? Like people don't know this. So less is more for sure.

1:56:26Yeah. That's also why I say, if you're still having effects, actually your dose might be too high. Just cut it in half. Um, the other thing that's worth mentioning about melatonin is it's actually a very potent, um, cellular repair molecule. Those effects don't really seem, those defects seem to be stronger at the higher doses actually, like closer to the 10. Um, but that's where you get more side effects too. So most people don't need it. Like we have an immune system. Melatonin as a recovery molecule is a very old molecule.

1:56:57Uh, our immune system probably does, does the trick, but that's also why when people, take melatonin supplements, they get sick less. Um, it was seen as an adjunct treatment during COVID that didn't conflict with any of the other treatments, but actually made illness recovery better. Melatonin is a very, is a really cool molecule. It's just misunderstood. Yeah. It's a hormone. I think it's regularly like 500 different protein encoding. Yeah. It is a hormone. What other hormone do you just like buy over the counter and sort of unlimited

1:57:29amounts? Like it's weird. So when it comes to melatonin, I know there's like a lot of questions I get from people. Is well, if you're taking melatonin supplement, are you going to then stop making endogenous? Yeah, there is, to my knowledge, there is no evidence that this, that that actually ever happens to my knowledge. It's a worry, but melatonin is so, is so old that like you're going to produce it. Like the, the way to stop producing natural melatonin would be aging that reduces it.

1:58:00But to my knowledge, there is no data that shows that continual use of supplementary melatonin changes or reduces your ability to naturally produce it at night. What about, and that's also what the conclusion I came to. Um, what about the ability to like your melatonin receptors? Like, um, is there remodeling? I don't know. I haven't seen anything that's concerning in any way. I just, I just haven't like no one has, there's no finding that's a, that when, when people have looked, it doesn't really seem to be doing that. It's, it doesn't seem to change the same way other receptors do.

1:58:36Again, it's a very old system. It's an old built-in system that, that isn't, that is meant to adapt, that is meant to be able to deal with flexibility rather than respond to it super quickly. Um, I haven't seen anything either, but I haven't seen anything either. I mean, maybe like, maybe findings will come out in the future when people look at it. This is the other thing that other people need to know. This is about supplements in general, that research on supplements is scarce, especially really well done research in highly controlled

1:59:10conditions, not because to be honest, not because there's any sort of like conspiracy to keep the information out of people. It's just that research is extremely expensive to do. My day job is in research. That research is extremely expensive to do in pharma. It's because, you know, you can do some of that basic stuff, um, with, with research and pharma has the deep pockets to do this. And the reason they do is because they have IP racked around this, why drugs are so expensive, because it costs about $2 billion to bring a drug to market and 10 years, at least

1:59:47in supplements, you don't have that IP protection. You can't patent a supplement that naturally occurs. You might be able to patent a molecule as an, as an additive or something, but that's extremely rare in the supplement space. So supplement companies have no, they can't, a, they can't charge what drug companies can charge, they don't have the deep pockets to pay for this research. They don't have the IP protection around it, which would incentivize them. Why would, why would a manufacturer spend a, spend $2 million on a clinical trial that their competitor could just

2:00:21take the results from and claim is their own? Like, and NIH who funds, I mean, people need to understand how absolutely fundamental NIH is to all health research in the U S I mean, every, every bit of health research in the U S absolutely depends on a healthy NIH and NIH. As much as they fund whatever, I mean, they're, they're dramatically underfunded already compared to the need, but supplements don't seem to ever rate as high enough priority where like they're dealing with trying to cure cancer and Alzheimer's disease

2:00:54and, and other, and sleep apnea and other major health conditions and supplements by definition don't treat medical conditions. They promote health, but they don't treat, they might prevent, help prevent, they might could, they could, it's just, it's, it's people don't understand how competitive grant applications are for NIH. And so to survive that competition, studying supplements is really hard. So that's why like the, the deep pockets don't have as much of an incentive to study it. So it's not that, it's not that anyone's trying to hide the research.

2:01:24It's that it's really expensive to do and no one's stepped up willing to pay for it. Yeah. It's why there's not a lot of high quality studies out there on supplements and you always have to take it with a grain of salt. Right. And it's like, it's not the supplements fault. It's not the company's fault. It's just, you know, I would love for there, I would love for there to be more investment or, or, or if there was a public outcry that like, look, we need these studies. Yeah. Hopefully we'll get them. Well, with that said, are there any other, I mean, I've heard of a variety

2:01:58of supplements like magnesium, lavender, glycine, L-theanine, any, I mean, you know, moderate evidence that some of these were. So a lot, a lot of them have evidence that they're definitely not nothing. None of them have beaten placebo to treat insomnia. The closest that came was valerian. But when you pool the data, it still doesn't beat insomnia, placebo for insomnia. You're sort of, it can't, but it's sedating. It can be calming. Magnesium also does seem to promote sleep in a number of different ways, actually, more than just one way. Doesn't treat, and doesn't usually treat insomnia, but it can help promote sleep.

2:02:31Glycine also, great data on glycine, showing that people who take glycine, it can help fall asleep, help stay asleep a little bit better. Um, a lot of these supplements, it can help you fall asleep and stay asleep a little bit better. Some of them don't do anything to sleep per se, but they work in terms of calming. So calming isn't sleep inducing though for people who don't have insomnia, because if you have a conditioned arousal, you can be calm and still not sleep. But for people for whom a little bit of calming and relaxation is

2:03:02really helpful, that's where things like the L-theanine and some of these other more calming things, like the chamomile and some of that stuff that can be calming can actually be helpful. Um, even if they don't actually technically do anything on the sleep side, um, other things that can help promote sleep, things that have anti-inflammatory and, and anti-oxidating properties. Remember your body's doing a lot of that healing at night. And so if you can help give it those raw materials. So this is where there's certain supplements out there that actually seem to be, um, seem to have some of

2:03:34those, those anti-inflammatory properties. And when you take them, you might be sleeping better. I mean, when people take ibuprofen, they can also sleep a little bit better because like it, it, it, those awakenings and arousals due to discomfort might be just a little bit less and might help you sleep through the night a little bit more. Um, there's a few things like, but that's the difference where, where just because something is not nothing doesn't mean it is a cure-all. It's like not black and white. A lot of these supplements can be helpful. I recommend them for all of the things that they do, but

2:04:08I also recommend them for none of the things that they don't do. And I think there's a gray area that I think people have a hard time wrapping their head around. Yeah, no, we're, I'm definitely not talking about insomnia and, you know, some people just like to have a little bit of help and glycine is interesting. That's what I've been interested in. And have you seen any of the thermal regulation stuff on that? I haven't seen the thermal regulation stuff, but it seemed, so, so it's unclear to me whether that's a cause

2:04:38or an effect. Right. But, but either way, does it matter if that's what you're taking it for? It's more of a GABA and like more of that inhibitory. Yeah, it does, it does seem to promote that, those inhibitory, but so a lot of people who are taking workout supplements at night for recovery, like take one that's, if you're taking aminos at night, branch chain amino acids in general could be good for recovery, especially after training. And if it's got some extra glycine in it, all the better. But if it's got a lot of glutamine in it, you want to not be using that because glutamine is,

2:05:12is, is, is activating. And so, I mean, I've had athletes I've worked with who like complain, complained about their insomnia. Turns out they're taking these nighttime supplements with a whole bunch of glutamine in it. And that's sort of what's counter, that's, that's, what's getting in their way. So it's not just about supplements at night that can be helpful. It's avoiding stuff that can get them with like B12. B vitamins are good to take at night because they can help with recovery. B12 help boosts the ability of light to suppress melatonin. You don't want to take that at night. You want to take that in the morning.

2:05:47B12 is great in the morning because it can help wake you up a little more for a bunch of reasons, including its ability to help light suppress melatonin. But you don't want it at night when even a little bit of light can get, start getting in the way. Fascinating. So take your multivitamin in the morning, not in the evening. Yeah. If, if I, I have, I have this dream one day of having like an AM vitamin and a PM vitamin where like some stuff might be better at night. Like you want to, if, if sleep is all about recovery and repair, put those raw materials in play at

2:06:22the time you want to use them. If they're going to degrade, or you could just take them in the morning if they're going to hang out all day anyway. But yeah, I mean, some is some, the, the, that multivitamin you might want to take in the morning. Okay. Let's talk about substances that affect sleep. Yeah. This is another one. I mean, a lot of people will get into CBD cause that's like the biggest thing now that I mean, I just hear it in peer groups. I hear it on the internet. I hear it in just everywhere in the audience. Yeah.

2:06:54Um, but kind of even a step ahead of that, you know, was, was marijuana. Right. Like, which has CBD and THC. Right. They're two separate compounds. Totally separate. Right. And so I kind of want to start maybe with THC. Yeah. Like if someone's doing the whole thing. Yeah. THC is a good place to start because THC seems to have pretty reliable effects on sleep. Surprise is nobody who's used it when I say that, but it can help you fall asleep, can help you stay asleep, can help you feel more refreshed. THC does. However, there's three downsides of THC. Um, four, if you're an athlete, uh, one is that the sleep

2:07:30promoting effects fade over time. So often it works great for a, for a period of maybe a few weeks, but then you'll notice that it stops working in the same way. And so people start escalating doses for that reason. And so maybe, you know, I may it's short-term benefits and long-term benefits are different. That's number one. Number two, in a lot of people, not doesn't seem to be everybody, but in a lot of people it can be a very potent REM sleep suppressor. Um, a lot of people don't realize that antidepressants also, um, most antidepressants are potent REM suppressors.

2:08:02Like you can all, you can knock out 50 to 75% of all your REM sleep of the night by taking like Alexa pro or an SSRI, um, or THC. Does that affect memory? Because isn't REM important for incorporating? Isn't that weird, huh? Like why is it if REM sleep is so critically important and we'll get to this when we talk about sleep stages on wearables, if REM sleep was so critically important for what it seems to do, why is it that when, when all these people who are taking antidepressants are not falling down, not being

2:08:33able to remember things? Don't know. Um, what it means, my hypothesis is these processes are way more complicated than we realize. And when we see a decrease in REM sleep, what we're, we're not seeing a decrease in the process itself. We're seeing a decrease in an effect of the process and in a downs, like REM, what we call REM sleep as these, these physiologic signals and brainwave patterns, maybe it's downstream of whatever's happening under the hood. And just because you don't hear the downstream signal anymore, it doesn't mean the thing wasn't still happening to some

2:09:04degree. But then again, with depressed people, if their ability to process information is fundamentally flawed and cause you're, and I mean, this is like when people are depressed, they see a neutral stimulus, it feels negative to them and it makes their life more miserable. Well, just stop processing things emotionally then like, and at least, at least coming to neutral and blunting is better than it's like, who knows? The answer is who knows? Is that a benefit? Is it impacting memory? Might that be part of what's going on in terms of THC's impacts on brain neurochemistry and some of the

2:09:36negative effects? Maybe. I don't think anyone's been able to take the time to study that pathway. So anyway, that's the second one. The only, the third one I just did want to mention is when you stop using THC, you get just like any kind of sedating medication, you get an insomnia rebound. And with that insomnia rebound, because it was a REM suppressor, you get a REM rebound. So you can get vivid nightmares and like really unpleasant dreams and the worst insomnia you've ever had. So then you're like, I need to take this or else my insomnia comes back when the insomnia was a

2:10:09withdrawal symptom. So, so like, so that. So you could become dependent on it. Well, well, psychologically. So where it's just like you get that tolerance. So like you're taking it and you're sleeping sort of normal. And then when you take it away, your insomnia ramps up, but then it'll usually fade back to baseline. It was just a reaction, but you don't know that you think that you're using the THC to keep the bad insomnia away when really, whenever you pull that bandaid off, it's going to hurt for a little bit, but then it'll be fine. And then the only other thing I was going to mention for athletes is the increased

2:10:45injury risks due to THC because of the amotivation and the coordination stuff that you get sometimes that like, whatever your sleep problem is, if you're thinking of using THC for it, there's probably a better option that's less, less harmful. But is that if they're using the THC at night, is it, is it the THC directly affecting the coordination or is it the indirect effect of REM sleep? All I know is that people who are using it more, I mean, we don't have great data on the timing of use. That would be a cool, cool study to do, but it just does seem to be that

2:11:19there's more injuries. There's more, there's the, there's the daytime amotivation. There's the, and, and amotivation being like, not just like, you know, the stoner sitting around like, Oh, I don't want to do anything all day. But if you're an athlete on the field, you need every split second to make these choices, to be paying attention, to be thinking ahead and all that stuff. And if you've got just a fraction of a piece of a cloud there, it gets in your way. Like, and, and one wrong step, you know, could be twisting something, you know, I guess just just one of

2:11:52those things of like, there's probably a better option out there. I mean, I'm just saying, but, but that's THC. So THC does have effects on sleep. They could be relatively short term. They could produce a rebound when you stop taking it. And there could be REM effects. And, but having REM effects doesn't sound like it's a good thing though. Maybe not. Is it, is it, is it the same REM effects as you get with antidepressants? Not clear. It's, it's murky. The literature is murky. You got to remember until very recently, researchers were almost not

2:12:22even allowed to study it because it was, it was a scheduled substance and you weren't, it was federally illegal. So anyone who takes federal money for research, and it was again, NIH is the lifeblood of all research. You were essentially forbidden from even studying it. Now we can sort of start and, and that work is being done. Canada started it because they legalized it first. So they're actually doing a lot of really great THC research up there. Watch the space next 10 years. I think more stuff is going to come out. Okay. What about CBD? CBD, much more murky of a story.

2:12:56CBD is, is a legit molecule, especially in terms of the things that it does. But the sleep data from CBD are extremely murky, um, about, about half the studies that have used CBD have shown that it could benefit sleep. Um, the other half don't. Some of them actually show that it makes sleep worse. The dose and the timing seem to matter. Um, the individual differences seem to matter. Um, it also seems, so it's one of those things where like, if I have a patient who says, should I try this? I would say, I won't have any objection to you doing it.

2:13:29I just don't have super high hopes. And to be totally honest, most of the patients that I've had say, yeah, didn't really help and, or maybe helped a little bit. It's also the difference between relaxation and sleep promotion. So if you have insomnia, a little bit of relaxation isn't going to be enough, but you know, if a little bit of relaxation is all you need, maybe it'll help. What, what kind of dose and timing are we talking about here? I don't know. Lower dose better. Yeah. It looks like, it looks like, it looks like there's a sweet spot

2:14:02for dose. You can have a dose that's too high, which can actually make sleep worse. But then again, if it's too low, then it won't be doing anything. I, I don't know all the doses of the different studies. So that might, that's also why there was such murkiness in the literature where people are using different doses at different combinations at different times of day. I don't, I don't have any clear answers about CBD, except, um, I would keep, I'm just, I would keep an open mind with it, but expectations in check.

2:14:33How does it, how does it work? Does it, does it just reduce anxiety? I mean, is it like an L-theanine kind of thing? Yeah, it's, it's, it's from a sleep perspective, it doesn't, I haven't seen any strong data that shows that it does much to sleep-wake regulation itself, that its effects on sleep are usually secondary through anxiety and stress. Um, I could be wrong. I am not like, there are people, there are people who know way more about cannabis and sleep than me. Um, but from what I've seen, it seems to be going through that indirect path.

2:15:06And, um, does it affect sleep architecture at all? Like, does it have the REM stuff? I don't, I haven't seen anything that shows that it does in the same way. I mean, it's like most of the studies show it doesn't do much of anything to sleep anyway. Um, so unlike THC. Yeah. Okay. Um, another one that people use to help fall, help themselves fall asleep is alcohol. Yeah. Right. I mean, that's like. Alcohol is probably the most used sleep drug in the world. Right. Right. Um, so the thing about alcohol, alcohol, it would surprise nobody to tell you that alcohol can make

2:15:40you fall asleep faster and actually sleep a little bit deeper in the very beginning of the night. Um, but the thing about alcohol is, sorry for the fact that it's not good for you for all kinds of reasons, it gets out of your system very quickly. You metabolize it relatively quickly. And so what often happens with alcohol is when the alcohol leaves your system, it creates activation, creates a rebound. So often when people are drinking to fall asleep, they fall asleep fast, but then they wake up in the middle of the night and can't, can't get back to sleep.

2:16:14I mean, anyone who's had sort of too much to drink and fallen asleep will, they have that experience where you wake up and you're, and you're up and you're just like, oh, I don't want to be up, but you're not falling back asleep. And it's because the alcohol creates that reaction. One of the reasons it does that is as the, as the alcohol molecule metabolizes and becomes acetaldehyde, it can become a neural stimulant. The acetaldehyde could become acetate, which could become a neural stimulant. And as the liver is processing the alcohol, it can create a glutamine rebound, which can be activated.

2:16:48So like, there's all these things that can end up being activated from the alcohol a couple hours in. That's also why, like, it's not a, it's not a great sleep aid. I mean, a glass of wine after dinner is not going to, for almost everybody is not going to be that big of a deal. But if you're drinking enough where it's making you sleepy, that's how much it's going to be waking you up later. Probably. Do you think, um, timing it earlier helps? Like if you're not, so if you do it earlier than you're, if you're, if you're, if you're having wine

2:17:21at dinner and then you've still got a few hours, the alcohol is probably out of your system by the time you get to bed. The only thing you don't want is to time it so that, that the activating part of the alcohol being out of your system, isn't when you're going to bed. So like, that's sort of a tricky part too, but usually to be honest, the amount that most people are drinking, it's really not, that's not so much the issue, but what's really cool is that you can see if you drink before going to bed, um, what's great is some of the newer wearables, like they pick it up

2:17:55right away. You see that heart rate data, you see that, that lack of recovery happening. It was still a toxin that you're processing. And I've had a number of patients come in thinking like, well, I used to, you know, I used to drink some wine before going to bed and I thought that would mellow me out. And then I looked at my wearable data and realized it made my sleep crappy. It made my sleep terrible. And so I stopped. Um, and so getting that feedback can sometimes be helpful. Yeah. No, I mean, I. I will talk about wearables later.

2:18:25Yeah, we'll definitely get into that. Um, okay. I mean, any other of these, there's caffeine we could talk about. I mean, caffeine, probably the most used psychoactive substance in the world. Um, there's a reason why people use it. It works. It's relatively safe. Um, coffee is actually a great source of antioxidants and, and phenols. Um, especially if, if you're actually just, if you're drinking it from, from coffee, not just the isolated caffeine molecule. It picks up peaks at around 30 ish minutes, then trails off for most people, four to six hours before bed is the last time they should be caffeinating in any way.

2:18:58Um, some people, they can drink an espresso, go to bed. Just fine. People metabolize it differently. Um, for some people, 10 to 12 hours is actually too much, um, where they need to stop in the morning or else there's just, just enough floating around their system in the evening where they're not like jittery from caffeine. They just might have a harder time settling in. So that's a real thing. People can actually, because doesn't caffeine shift your circadian rhythm over as well? It's not a circadian signal as much as it can be like an alerting signal. And which can change your activity rhythm, which it's, which is more of the circadian signal.

2:19:32I don't think, I don't know. I haven't seen anything. I could be wrong, but I haven't seen anything with, with caffeine itself as a potent circadian marker, except that if you drink caffeine around the same time every day, you can make it one. Um, and it increases activity, which is itself a circadian marker. I thought there was one study, maybe, maybe in, it was like, they were giving men, um, caffeine. It was like nighttime, like close, it was evening. Yeah. And I think it somehow shifted their 45 minutes or so. Like it might've shifted. Well, my guess is it would have shifted.

2:20:03It would have delayed. They would have probably increased their activity level, increased their light exposure. Yeah. So, so yeah, so that's why I like it delayed sleep onset, but I don't know what it did to endogenous circadian timing, but I'll have to look, take a look. I don't remember, I don't remember a paper looking at, so like in, in my world, there's a difference between behavioral rhythms and circadian rhythms because there's like a circadian patterning, but like if did the melatonin rise at the normal time, it just got blunted because of the light you turned on and the activity you were engaging in,

2:20:35for example. Right. Yeah. Um, yeah. So I, I just, I never, doesn't, does caffeine not do anything to sleep architecture? If someone drinks. Yeah. I mean, like it'll, it'll, I mean, it increases fast frequency EG activity, so it'll make your sleep shallower. So it'll probably, I mean, I, I'd have to look at the literature, but like if I had to make a prediction, my guess is it would dramatically reduce slow sleep and deep sleep because you can't, you can't get into that stage if your brain's sort of still wired and active. So for those people that say, I can drink a cup of coffee and then go to bed 30 minutes

2:21:10later, it may be disrupting their sleep architecture. It might be, it might be. Um, but also again, people, there's huge variability in how people metabolize caffeine also. So some people might be more resistant to it. Some people like I'd be for those people, I would really be curious to see their data. Yeah. I mean, what's the quickest you could metabolize caffeine though? I mean, 30 minutes. Or, or, or I, I probably, I know that's when it's peaking. Right. Like, I don't, I don't know. They would never feel it.

2:21:41The effect. Or maybe, or maybe just the way it interacts with adenosine is different, or maybe they're just so sleepy. Their sleep drive is so high. It's the way adenosine is interfacing with their sleep-wake rate. Cause adenosine itself isn't sedating. It, it builds across the day and interfaces with that system. But the adenosine itself, like you can't like take adenosine and fall asleep. Like it's, that's not how it works. So maybe different, you know, humans are humans. We're all different. And, you know, our wire, some of the, sometimes some people, their system might be hooked in

2:22:14in a different way. You're talking about like one person here and a person there and like. Outliers. Getting 20 of them to come into the lab all at the same time and look at a systematic evaluation. So I don't know that anyone's ever really done, to be honest. Right. It's more like clinical reports, like, yeah, I could do this and sleep fine. And I've, and I've seen people who drink coffee at night and their sleep looks fine. So like, who knows? Um, another one that I've talked about with, um, Dr.

2:22:46Sachin Panda, who's been on the podcast a few times is late night eating. Yeah. And obviously food is a substance. Yeah. Um, and at least with my conversations with Sachin, it seems like a good sort of on average time to stop eating before you go to bed seems to be at least like three hours or so before you go to bed. Um, how does, how does food affect sleep? Yeah. I mean, so, so he is the world's leading expert on that, on that issue of the timing. And, and he tells these incredible stories about how just the cellular machinery

2:23:20of transporting glucose fuel into the cell is partially clock dependent. And, and, and from the first bite of the day, once that machinery starts, it has a certain window of maximum efficiency that just, that only fades. Like it's, it's fascinating work, but as a psychologist, I, I have other perspectives on this as well, where a lot of times people don't eat at night for metabolic reasons. They're eating at night for emotional reasons. They eat at night because they feel like it helps them wind down. They eat at night because they're stressed. And what's interesting is when you, in a sleep deprivation study, if you

2:23:56take somebody and you sleep deprive them, there've been a number of studies that did this and they look to see what you see, what calories they're consuming. And on average, people tend to consume about 350 to 600 extra calories per 24 hours when you sleep deprive them in the lab, not in the morning. If anything, they eat a little bit less first thing in the morning, not in the middle of the day, not snacking, not dinner, but after dinner, that's when all the snacking, the extra snacking seems to occur, especially when

2:24:28people are kept up past the point that their body wanted to go to sleep. So if you're up and all of a sudden, and it's getting late and all of a sudden you're really hungry, you probably should have been in bed already. That was your brain telling you, what are you doing up still? I guess you're going to have to have another meal if you're going to keep going, but because you're supposed to be in bed already. I was done. Like we checked out, like, are we doing another shift or

2:25:00what? So there, and there's reasons for this, but, but people start craving for, for a lot of years, people in the sleep world, we're talking about, is it carbs? Is it fat? Is it, I just think it's, it's energy. People are craving energy. They're craving calorie dense food. They're craving pleasurable food, food that feels good to eat, highly palatable food. Um, and especially sort of like the later at night it gets, I mean, there's a reason why people generally don't crave a salad at two o'clock in the morning, you know, even if they would during the

2:25:33day, it's your thinking and your emotional reasoning and your choices are fundamentally different. Especially between two and five in the morning, that time seems especially vulnerable. Um, in our lab, we're studying that, that vulnerable time. We're calling it the mind after midnight, like, and how you're, you make different choices in that zone. Um, all kinds of bad things like suicide spikes in that time, four times greater than you would expect by chance than any other time of day spikes in that time, violent crime also spikes during that time for maybe

2:26:05different reasons, but unhealthy eating also like 3am food. If I tell you this is the kind of food you want to eat at 3am, you know what kind of food I'm talking about and it's not healthy food. Why is that? Why is that, that there's this, and I don't think this is a pathological thing. I think this is a normal human function that when our brain is awake, when it wants to be asleep, especially when it's right there in that circadian dip of all kinds of other functions, it's this perfect storm of

2:26:38bad choices where we, it's reward seeking, but decreased reward processing. So we seek the thing that feels good, but it feels less good when we do it. So we seek it more and, and our decision-making is we're not thinking about tomorrow. This is also why people wake up in the middle of the night and they're all freaked out about stuff. And then in the morning they look back and they think, man, I was all worked up about that, but it's really not the end of the world. I can, I can solve this problem.

2:27:11Our brains, when we're kept awake, when we don't want to be that we're not our best self and it applies to food too. So how does this apply to shift working and people that have these irregular schedules? I mean, I know, I don't know. I mean, we've known for years that, that, so like if you ask a circadian scientist, is shift work worse for you than smoking? They will usually have to stop and think and be like, ha, good question. And then you were supposed to say, I didn't realize that was a hard question.

2:27:44I thought it was obvious that smoking is the worst thing ever. Like if you smoke, whatever else you do, it's the smoking and it's probably going to kill you. Shift work isn't good for you. Shift work is a problem. You know, shift, like we're the only species that shift works ourself on purpose. Like anyone who has a pet knows, like they might be up for a bit during the night, but not because they have to be because, you know, mammals sometimes sleep in bouts and humans also are awake in the

2:28:16middle of the night for a certain amount of time. But, you know, it's, it's forcing a square peg into a round hole and there's consequences. Some people may be more resilient. People who are more night owls, they might be more amenable to taking a night shift as long as they're able to go home at four o'clock in the morning and go to sleep. People who are early birds might be more amenable to taking a night shift as long as they're they can sleep between like nine, 8 PM and two in the morning.

2:28:48So for them, maybe it's not as extreme as shift work as, as, you know, maybe it's, it's not as extreme, but shift work in general, it's a carcine, known carcinogenic. It increases diabetes risk, increases dementia risk. Like shift, shift work isn't good, but yet we live in a society that demands it. Someone's got to man the phones. Someone's got to drive the fire truck. Someone's got to, someone's got to work the hospital. Um, you know, do all shift work occupations require shift work? I don't know. That's like, do all factories need to run 24 seven?

2:29:20Like, I don't know, but it's a trade-off. You know, there, there's this phenomenon in the hospital. I mean, it's just, it's just, that's the shift work that's closest to my life where someone brings the box of donuts at the start of the shift and no one touches them because everyone knows that like, they're bad for you. But by the end of the shift, they're all gone. Um, decision-making, it gets impaired, especially when, and what food is available in the middle of the night too, what would happen if we go into a shift working setting and set up palatable, but healthy food, you know, why

2:29:54don't we have nighttime snacks that are just healthier that feel good to eat that satisfy those cravings, but just don't do the same kind of damage. And why don't we make those available? I don't know. I mean, I don't know why this isn't, why everyone isn't doing this. It seems obvious to me. Just don't buy the bad processed food stuff and don't have it in your house. That's a good solution to not have it available. What, for, for shift workers, um, is there any way they can use these strategic kind of napping strategies to, you know, improve?

2:30:26Yeah. I mean, so the first thing for shift work is if you can keep a reliable shift, if you want to turn your day in tonight and make that permanent, that will actually minimize the damage. You're just in a different time zone. But if you stay in that time zone, it's the shifting around that causes the, it's the, it's the unsettling the system that causes the problem. So the more, the more infrequently you keep shifting. So I would say that. Most people have families and stuff and they don't, they can't do it.

2:30:56Yeah. That's the problem. So, um, but anyway, so, so napping, napping can be great. Um, now think of a nap, like a snack where our snacks good for you or bad for you. Well, it depends. Healthy snacks are great. A healthy snack in the middle of the day can help stave off hunger, increase your energy, increase your focus. Um, especially if it's kind of a healthy snack, high protein, some fiber, you don't, maybe a little bit of sugar or something in there to make it palatable, but you don't want to load it up with calories because you don't need them.

2:31:29Same thing with some, same thing with a nap, a nap on purpose that is restricted in time before you want it. You want to wake up before you drop down into that deep sleep. If you want to make it sort of like a power nap and, uh, you should remember you're dropping down to stage, but you want to wake up before you drop into stage three sleep. So how long would that nap be? So, so it depends in the middle of the day. It could be an hour. If it, the closer you get to where your body is trying to drop into

2:32:02it, that window shortens. So it could be just 15, 20 minutes. The later in the day, sometimes you're going to drop, like you can't, you shouldn't nap when you're, when you're in your biological night, don't expect to nap because you're going to drop straight into it. But the further out you are, the longer you can make it. And so that it can increase reaction time, increase focus, increase learning, increase training recovery that you can, you, there's data that shows like even in sleep deprived people, a decent nap in the middle of the day can dramatically

2:32:33improve metabolism, muscle strength, all this stuff. It can be, they can be great. And that's sort of a power nap. Um, if you're napping all the time, it's like, if you're snacking all the time, it's not the snack. That's the problem. It's why are you snacking? Um, there's also a different kind of nap that shift workers can use. And I call that a sleep replacement nap, sort of like a meal replacement shake, where no one looks at that and thinks that that looks like a meal. Uh, no one's confused that it's really a meal, but it

2:33:04does the trick in a pinch. And what a sleep replacement nap is athletes do this too, when they, um, uh, especially when they're, when they have late games and they have to wake up in the morning, college students do this one all the time where you go through a full cycle. You actually make it all and you get all, you get a whole cycle of deep sleep, which does exactly what it does at night too. It's not quite, quite as good, but it, it, it does the trick and you want to wake up after you've made it all the way through in the middle of the, at night

2:33:37during your regular sleep period, that'll take, you know, 90 to a hundred minutes during the day. It might take two to three hours to make it all the way through. Cause you're not expecting it. You're, you're, you're, you, you have, you have a system to protect yourself from dropping into deep sleep during the day. You don't, your body doesn't want it there because it's trying to protect you. But if you stay in your nap long enough, your body's like, all right, I guess we're doing this. And so it gets in it and you get all the way through.

2:34:07And if you, if you wake up out of that feeling pretty good, you know, that counts at almost the same as nighttime sleep. Um, it's just, most people don't have the three hours in the day to do that shift workers do. Um, and so, so they can do like either like right after a shift or before a shift or something, you can do that. Um, or even a strategic nap, like while you're on a shift, you can get a little bit of a nap and, and be sometimes be able to function. Um, sometimes you're, you're too much in the middle of your biological night and that one little nap, it's like

2:34:41you're starving and you only get one bite. And sometimes that's a little worse. Everyone's a little different, but think of a nap, like a snack and use it strategically like you'd strategically use a snack to stave off hunger and to make it through a shift. Okay. That's great. All right. As long as you're not drinking a lot of coffee. Right. Well that too, because then if you, a lot of times you could be drinking a lot of caffeine on your shift, but then you get home and you can't sleep. Right. And which makes you more tired on your next shift.

2:35:12So how should shift workers use coffee? Strategically. I mean, you should use it as, think of it as I will drink coffee in about 30 minutes. It'll have its peak effectiveness. And I, in about six, for at least the next six hours, I will not be in a sleep window. And so the higher the dose, the longer that window goes. So what you, you might want to like caffeinate at the start of the shift, but not in the second half. Okay. That makes sense. I want to kind of shift and talk about jet lag. Yeah. And we kind of were, you're talking a little bit about this sort of strategic timing of melatonin.

2:35:46Yeah. And light. Right. And light. Um, but I've heard you talk about jet lag in a way where you've talked about like when you get on a plane and you're going somewhere to a different time zone. Yeah. As soon as you get on the plane, you're, you need to mentally be in that time zone that you're going to be in. Yeah. Um, so I'd love for you to kind of walk us through, like, how does this relate? Let's say you're going, you know, to the east versus the flying eastward versus westward. Yeah. Um, like I'm going to be going to China.

2:36:17Yes. Soon. A 17 hour difference from where I'm at. Um, I mean, how am I going to get to that time zone? Um, so yeah, let's talk a little bit about, um, how can we, how can we help ourselves adjust to the new time zone? If you're only going somewhere for a day or two, should you try to adjust? So mostly the answer to that question is like, mostly no. Traveling a couple of time zones is totally different than traveling a bunch of time zones. It's like going to China or going to Europe is very from, from the west coast U S anyway, is

2:36:49very different than going from New York to LA. New York to LA. It's a few hours. And you'll adjust within a couple of days. You could adjust probably within two to three days. You're probably fine. Traveling that far. The circadian literature would say that it takes about an hour per day to adjust. Obviously faster going west, a little slower going east. But when you're traveling, when you're 10 to 15 time zones away, like what is day four versus day 12 look like? You're not going to slowly adjust. It's going to be in, it's going to be jerky.

2:37:20So what I would say is when you get on that plane, think of yourself as having had maybe just a very short day. I like sleep depriving myself a little bit before these long flights and you get on the plane. I like to try and schedule my flights so that it would be great if I, traveling to Europe, it's easier to do this where you, where you time the flight so that it lands in the morning local time. So you're taking off in the afternoon from the U.S. And it might be three, four, five, six in the afternoon, but you're landing at 10 a.m.

2:37:55local time. So as soon as I get on that plane, I'm like, okay, it's nighttime. I have this eight hour, eight, nine hour flight. This is going, this is my night. So I'm going to have crappy sleep. I'll sleep for sleep on the plane when I can. I got my earplugs, got my eye mask, got my melatonin, got like, you know, whatever. Um, I will do what, and, and I'll do whatever I can to catch a little bit of sleep on the plane. I'll have a crappy fragmented night of sleep on the plane, land in the morning local time, wake

2:38:29up. I'll make it through my day just fine. I'll power through the day because my sleep's generally good beforehand. So I'll be pretty resilient, make it through the day. I will be exhausted by nighttime local time, and I'm essentially brute forcing my sleep-wake homeostasis, even though I'm essentially, my circadian rhythm is way off, but I'm tired when I want to be asleep and I am awake when I want to go around during the day and I'm getting the light exposure during the day. And I, so I spent a lot of time outdoors when I travel and so I'm sort of brute forcing

2:39:04it a little bit. It's like, I'm not going to be fully adjusted and, you know, maybe if I'm there for a week, I will be, but, but those first few days, I mostly make myself sleepy when I want to be unconscious at night when it's dark, even though my body thinks it's daytime and be awake when the sun is out and be moving and don't nap. I do not nap for that reason, because I'm, I would be, it's sort of like, if you're taking a snack, don't, if you're going to have a light snack, don't

2:39:36have it be at dinnertime because that snack is going to be miserable because then you're going to wake up and you will have dropped into deep sleep. And so. So no naps when you're, when you're traveling. Yeah, I would, especially as you're still in the adjusting period, don't give yourself mixed signals, but try and, and if the, and, and if traveling to Asia is more complicated because the flight's so much longer. But think of it as local time. Think of when you're going to land. When do you want to wake up before you, you know, it could

2:40:09be a few hours off. That's, that's probably fine to adjust to, but like, you know, if your flight is going to be landing, say like in the afternoon, but you're going to be taking off like the day before or whatever on the clock. Think of it as you're going to be landing the next day, have some crappy sleep on the plane. The other thing that will help is planes are slightly hypoxic of an environment and oxygen rhythms. Actually, there's some great data. There's, there, there's a, there's a lab in Israel that's been working on this,

2:40:41especially showing oxygen itself is a circadian signal because oxygen dips during the night when you're asleep. So being in a slightly hypoxic environment for extended period of time, it's easier to trick your body into thinking it's nighttime than it's daytime. And then as soon as you leave the plane and they open the door and now it's normoxic again, that can be an alerting signal. So timing it that way is also helpful. What about exercise? Exercise too. Exercise is an awakening signal. So, so there's not much exercise you can do on the plane without

2:41:12annoying everybody, at least, I guess. But as soon as you get off the plane, that's a great time to be moving because you want to send that daytime, daytime, daytime signal, even though you're in your biological night. Say, no, no, no, it's daytime, daytime, daytime, and get light, suppress whatever natural melatonin you have, take the melatonin at night to, to, cause, cause you might still be producing some of the melatonin during your biological night, which is the environmental day and not producing that melatonin at night when you want to be.

2:41:43So that's, that's when you might supplement. Yeah. Which is why being outside is so important during the day when it's your biological night. Yes. Great. All right. Well, yeah, that's the thing with jet lag. Send yourself a daytime signal when you want your body to think it's daytime. Send yourself a nighttime signal when you want it to think that it's night. And, you know, so you can block light as a daytime signal or give light as a daytime signal or, and use melatonin as the nighttime signal. So no sunglasses in the morning.

2:42:15Right. Yeah. Or, or if you're going to use sunglasses, make them kind of blue tinted. So, so even if it's, even if like the, it's blocking the UV or whatever, at least the light, so it's the blue green frequency of light that sends information to the clock. That's why the orange lenses block it. But wear like a blue or green or tinted sunglasses if you're going to wear sunglasses in the morning. So that actually works where you can, there's no data on this. I just made that up, but, but it should work because as long as you're getting that frequency of light,

2:42:49that it's the bluish greenish light that sends the information to the clock. But it's also, I live in Arizona, some to sunglasses, if you don't want macular degeneration, you need to wear sunglasses when you're outside. So how do you get enough light to, to, to influence the clock without doing retinal damage? And, and so that's why, you know, I don't know. I'd love to see data on this. I don't know that anyone's actually studied this if they have. Um, I I'd love to see it, but that's my pet hypothesis.

2:43:20Yeah. Cause I would imagine, like you were saying earlier, obviously the early morning light, it's not as damaging. So you play don't meet sunglasses then, but you're talking about being outside long, like hours during the day and how that also protects you from the, um, the, you know, the blue light inhibiting melatonin later. Um, yeah. You want the blue light to inhibit melatonin. Right. Sorry. Where it. No, no, no. In the morning. Right. In the morning you want it to. In the evening you don't want it to. Yes. Yeah. Okay. Um, so let's talk about where we do have a lot of data and this is, uh,

2:43:56definitely, um, an area that you're an expert in as well. And that is these sleep tracking devices. Yes. Lots of them out there. Um, or, uh, the whoop. Yeah. What do we have? Apple watch, um, the Fitbit and pixel. You and I are both on the scientific, the scientific advisory for, uh, the Google, um, um, um, which is where we first met. But I want to know what metrics do you think are truly good at being captured accurately and which ones should we interpret with caution? Yes. Excellent question. Um, people need to know that using wrist-based movement to estimate whether

2:44:31someone was asleep or awake across a night has been around since the 1970s. That data has been well worked out. Those algorithms are pretty robust. It's actually shockingly good. You can predict with about 90% accuracy using movement alone. And this was analog devices with, with that were on a tape backup or eventually 64 kilobytes of memory on the whole watch. With that level of technology, you could get over 90% accuracy minute to minute. Were you awake or were you probably asleep relative to brainwave activity? Sleep versus wake. That's what these devices are best at.

2:45:03They've always been best at. That is the data that I would trust the most with the asterisk of. It's going to be different from the brainwave activity in that the brainwave activity will pick up lots of little awakenings that, that the, the, the movement detection probably won't. Um, there was, so, so it will underestimate wake time relative to looking at brainwave activity, but it will overestimate. Wake time versus your self report. So if I asked you how much you slept and you said seven hours

2:45:33and your watch says six and a half, that's not a problem. You're measuring two different things because the watch is probably picking up awakenings that you don't remember. So were you physiologically awake during that time? Probably. Could it have picked up stuff erroneously? Yeah, maybe. Uh, were you awake during that time? Probably. Does it matter? Probably not. Um, so, cause all of the guidelines and recommendations that people, you know, the seven hours of sleep guidelines. I mean, I, I, I was on one of the, the, the, the panels.

2:46:05I was on the ASM and SRS, the CD, the panel funded by the CDC to develop time recommendations. We were there in the room. We were arguing over this. And those recommendations are not based on wearable data. They're based on, on average, how much sleep do you feel like you get? Cause that is what's correlated with the health outcomes. The wearable data is a lot more murky in terms of its correlation with the health outcomes. It's different. So if you're, if you're targeting a certain amount of sleep based on guidelines, the wearable data can

2:46:38fall under that and you're totally fine. Like up to maybe an hour even under that and you should be totally fine. So that's, I trust it to be correct and accurate for what it is, but it doesn't mean it's measuring the same thing. And so I expect it to be a little different. So that's, and that is what the, what it's best at. The heart rate data are also really good. It's separate world in that the heart, you know, photoplephysmography for getting heart rate data, that science is really well developed and, you know, you can get really good heart rate data

2:47:14with pretty good resolution from the wrist and for even from the finger, you can get pretty good heart rate data. So, so yeah, terms of the other stuff, there's, there's sort of two levels of other stuff. One is the sleep staging data and the other one is other metrics like recovery or readiness or sleep score and all that sort of stuff. So the sleep staging data, it's actually, it's actually better than a lot of sleep people assume that it is in terms of its level.

2:47:45It's probably between 60 and 80% accurate. So it's not nothing. It's also not perfect, but it's also not garbage. Like it's, it's helpful. It's, it's probably ballpark. Correct. Um, gotta remember what sleep stages are. We're, we're looking at different patterns of brainwave activity. And then in the 1930s, people looked at these squiggly lines on paper and put them into four buckets and then it became five and then it was back to four. Um, just, are you stage one, two, three, or REM based on the pattern of squiggly lines?

2:48:16This is humans radiant. Do they exist in nature? No, we made them up. You know, this is how humans categorize stuff. Based on patterns of brain activity on the outer layers of the cortex that are fluctuating during sleep. The fact that you can look at heart rate fluctuations in combination with movement and get a really good estimate about which state of brainwave patterns you happen to be in at that moment. Even though two humans can't always agree when looking at the same squiggly lines, is that stage one or stage

2:48:48two? Is that REM? Is that REM or did they drift into stage two or stage one at this point? Eh, it looks kind of similar. I'll call it REM. Well, I'll call it stage two. You see this all the time. This is why we, we don't even use AI yet to rate these things because humans don't trust them because they can't even agree with each other. There's no gold standard that you can even train a lot of these AIs against because even the humans can't agree. So it's, it's a moving target anyway.

2:49:20So the fact that you can get that close from, from this stuff on the wrist, I think is a miracle, but you got to keep your expectations in check. Like this, it's like playing two games of telephone going in opposite directions and using the result of one game of telephone to guess not what the source was, but what the other game of telephone came up with. So the fact that they're even in the same ballpark, I think is great and useful. But what that also means is don't read too much into it.

2:49:50Like if you, if it shows very little deep, first of all, I can't distinguish stage one and stage two at all. So they call it light usually. And as I mentioned before, those are very different things. If you have a lot of stage one, that's bad because your sleep is super shallow. You have a lot of stage two, that's normal. That's what it should be most of what sleep is. And the deep sleep detection is only about 60 to 70% accurate at best in most people. So when people say like, it's not showing I'm getting enough deep sleep, I say, well, the algorithm isn't picking

2:50:24it up. It doesn't mean you're not, it doesn't mean you're not getting it. And B, if you weren't, as long as there's no barrier to your body obtaining, if you don't have untreated sleep apnea or chronic pain or an environmental stimulation to prevent that deep sleep from occurring or drinking alcohol or whatever, your body is doing whatever it wants to do. So if it doesn't want to take more, because as people get older, they take less anyway, you know, growing people, healing and recovering people usually need more. But if you're not getting it, A, does it matter?

2:50:56And B, how do I know you're not getting it? And so it's, you got to interpret it with that caution. So that's the caution with the sleep stages. If I show you what a brainwave tracing of sleep stages and a wearable tracing that you can, you could, if it's a good device, you can easily tell these are the same person on the same night if you looked at them. But if you actually counted the exact number of minutes, you would probably find that 20 to 30% at least of those minutes didn't exactly agree with each other. But you can tell visually.

2:51:29That's why clinically I look at it visually. I don't actually count the minutes because I don't depend on it. And actually one night of data, is it worth much? It's more about the weekly trend or like trending and changing over time. That's what I care about. So that's the sleep stages data. The third bin is the metrics like the scores. With very few exceptions, most of those scores are, I give almost no attention to those. I can be ungenerous and say they're mostly made up nonsense anyway. Can you repeat what scores we're talking about here? We're talking about anything that's called like sleep score, sleep quality,

2:52:03sleep needs, sleep readiness, recovery, any of that stuff. If I'm being ungenerous, I'm saying it's mostly made up nonsense to sell devices because telling people what they want to hear. But that's not the truth either. They're not nothing. They have a lot of these companies, not all of them, but a lot of these companies have smart people working for them who are not idiots, who know how to work with the data and are trying to make prediction algorithms that are actually useful. Thing is, none of these things are published. None of these things have been vetted.

2:52:34None of these things, it's like, it's kind of like at the trust us level of like, well, how do I know what you're putting in your algorithm and how to interpret those numbers? So like if I drink alcohol the night before, but I'm otherwise totally healthy and the number looks bad, should I worry or not? Am I, is it actually impairing my ability to perform or not? Or does it look like it is because of how the algorithm is using heart rate data? I don't know because none of it's transparent and forget the transparent.

2:53:05I know Google did a study with on the, that, that was a Google's Fitbit before it was Google, I think, where they had their sleep score and they correlated the actual global sleep score to an, to outcomes. And they presented the data at a conference as a global thing. I don't think they ever really followed up with it, but I don't know that, that, that, that, that's even that baseline level of, is this correlated with anything remotely useful? Is a step that, I mean, that, that they did, but I don't know that anyone else has ever really

2:53:35done that much. So as the literature is coming out, as more and more people are using these metrics and seeing what's it related to, what's it not related to, what does it predict reliably? What does it predict unreliably? What does it not predict at all, even though it thinks it does as a researcher, you give me a number. I don't know what to do with it unless I can, unless I understand how it works. So I guess what I'm saying is I don't trust these numbers almost at all. I almost a hundred percent of the time completely ignore them because they don't give me any information I can

2:54:09use because I don't know what they mean. Um, and at worst they're made up, but at best they're really good educated guesses made with assumptions that I don't totally know. So I don't know what to make of it because I, I mean, I'm trying to be fair and not throw them all under the bus. They probably aren't useless. They probably have value and they're probably not all incorrect either. It's just, you gave me a number and I don't know what to do with it. So I, I, I was going to ask you what big your, what the biggest misconception about these wearable devices

2:54:41you kind of wanted people to know like right now. And I'm thinking maybe this, yeah, that's the, that's the big one. It's also the, I think the biggest misconception is that accuracy matters. Um, it's not about, are they accurate or not accurate to relative to what accurate relative to your memory of the night or accurate relative to the physiology? Those predict different things. Um, and even if it is accurate relative to the physiology, does the number give you a useful metric that you can actually use to do anything with it? What are you going to do with that information and are,

2:55:13if you're going to make decisions based on it, you better know what it is. And, and I feel like a lot of companies like they're, they're stuck in a bind because if they're too transparent with their algorithms, other people are just going to copy it because you can't patent an algorithm. So what are you going to do? How do you maintain your competitive advantage? And I mean, that's a line to walk. And, and as these companies, they're just going to try and come up with better metrics and better metrics as a researcher. And as a scientist, and as a, as someone who cares about public health, who has family members who asked

2:55:48me what to do with this information, give me the data I need to make choices, to make an informed choice of what to do with this information. So that's probably a big misconception is that these numbers are what they say they are. Okay. Um, well, well, let's talk about actionables then. Like how can you practically advise people that are watching or listening to this to use their data? What data can they use and how can they make it actionable? Excellent question. So, um, another, another saying that I attribute to a colleague of mine, Amy Athey, who's a sports

2:56:19psychologist, who's a colleague of mine. Uh, and, and she's helped me a lot on a lot of sleep stuff. And, and I was explaining this wearable stuff to her. And, and, and so, as we were developing our own trainings with this, and she came up with this, the, this way of thinking about it as a bathroom scale is not a weight loss program. And just because these are measurement tools, measurement tools are not interventions. People, if you're buying this to give you information, to make a change and you don't know what to do with the, the number it's giving you, how is it going to make a change?

2:56:52You know, just because it gives you a number, just because it has a bit, just because it's a bathroom, a fancy bathroom scale that has an app and has all kinds of other metrics in it doesn't mean it's giving you useful information that you know what to do with. So, so the way, the first thing in terms of creating actionable steps out of this is first to realize that it's, it's spitting you out a number. It's measuring something to make an informed choice of what to do with that information. You have to know what that number means.

2:57:23So first is I got to teach you a little bit about what these numbers mean and what these numbers don't mean. Then just like, just like when you see the amount of sleep you got, what does that number mean? Does it, does it mean I'm meeting guidelines or not? No, it doesn't mean that. But does it, if I see it over time, if I see I'm usually hitting six and a half, six and a half, but today I was at five, what happened? It's like it, that is the number it's probably best at. So if I'm going to make a decision based on wearables, the first number I'm looking at is the, how

2:57:58much sleep did I get? And where did it detect the awakenings? Cause those were probably correct, especially if they were more than a couple of minutes and are there discrepancies between what my memory of the night was and what the device found. And in those discrepancies might be some wisdom. So sometimes people with insomnia feel like they were up all night, but they actually got more sleep than they thought cause they were up and down. So they could use the wearable device to sort of de-stress a little bit and find the sleep that they may not remember. On the flip side, if it's detecting awakening, if you're trying to figure out why you're tired,

2:58:34but you feel like you slept okay, you can look at the device and say like, oh, I see what's like, I'm up and down a lot during the night. This seems very fragmented. No wonder why I feel kind of, it's like you use that information. So like the, the continuity data, the, the wake versus sleep data can be used for all kinds of things that might not even be totally conventional. That's what, that's without even looking at the heart rate data, sleep, sleep stages data. Then I'd look at the heart rate. Heart rate should start relatively low in the evening compared to

2:59:06your resting. And then at some point you should have an inflection point where it sort of starts picking up again, probably around three or four in the morning. When a lot of people wake up around that time, maybe you're just kind of sensitive to that, that shift in your circadian rhythm where your, your daytime is starting up. And as some people get older, they might be more sensitive to it, or you might have a natural awakening around that time, but you don't have the same sleep pressure to get back to sleep. So also in that heart rate data, so like if it's staying, if your heart rate's staying high during the

2:59:41night, what's going on? If it's not dropping, what's going on? If it's rising during the night, what's really going on? If you see your heart rate data and it looks normal, then you have a couple of periods of, of intense fluctuation. What's going on in those periods of time? They might give you some insight that there's something, something under the hood that's, that's causing activation that's going on. If you see your sleep, your sleep stages, irrespective of what it gives you, if it shows that they're, they're highly variable across the night, something's up. If it's putting deep sleep in the second half of your night, something's

3:00:14up. If it's putting a big bout of REM sleep in your first three or four hours of the night, something's up. It doesn't belong there. Could be, but it's unlikely. And if, if anything that tells me that I don't know what's going on under the hood, but something is, something is aberrant there, not that your sleep stages are in the wrong place, but that the algorithm is finding them where they don't belong. And so why? Well, what's the algorithm using? If it's using movement and heart rate, it means there's something unusual going on with your movement and your heart

3:00:46rate in that time where it doesn't belong. And then you could start thinking about what that is. Could that be sleep apnea and you're jerking around or something, or you have limb movements, or maybe, you know, it's a bed partner who keeps rolling over or making noise. So like, it might give you a window into, you know, I was unconscious during this time, but something was going on during that time. And then you can start looking into what that could be. So if, let's say someone is, like, their heart rate isn't dropping like it's supposed to, or, you know, like,

3:01:18what sort of things can people do to try to help with that? Yeah. So first I would look to see, is there anything chemically in the way? Is there alcohol? Is there medication that you're taking at night that you should be moving earlier in the day, for example? I actually see this not uncommonly where people have trouble with sleep because a medication that is perfectly acceptable to prescribe in the evening is being taken in the evening. It's just, you're sensitive to it in a different way. So I see this a lot. So first see if there's something chemical or if you're eating, you're eating a

3:01:53metabol, a food that's too metabolically active, too close to bedtime, or you caffeinated too late. Yes, it was four hours ago, but it was still too late and it's still hanging around in there. Or something like that. Or you have something, something active going on. So, like, do you need, is there, is there a pain issue going on? Is there some inflammation going on? Is your mattress 10 years old and needs to get replaced and it's just uncomfortable and it's creating too much activation during the night? You know, there's, there's all kinds of reasons for that.

3:02:25And then if not, what's your relaxation wind down routine like? Why is your heart, are you exercising too late and your, and your, and your core body temperature and your heart rate is, is high because of what, what you happen to be doing where it's not dropping. Why not? Or maybe you need to introduce some more relaxation techniques into the evening, whether it's physical relaxation, like breathing exercises or stretching or yoga stuff or, or mental stuff. Like, you know, there's imagery exercises and other stuff and body scans or mindfulness exercises and meditation or like a

3:02:57mind body approach. Like, like, like I'm a huge fan of progressive muscle relaxation, um, where it's especially done right and false both. Um, maybe you're, maybe you're going to bed too hot and you need to, you need to chill out a little bit first, whether it's mentally, physically, or both. What about, I know we talked about the accuracy of the sleep state, being able to measure sleep stages anywhere between maybe 60 to 80%, which isn't terrible. No, it's not terrible, but it's nothing to, but it's not, it's not gold standard either. No, it's not gold standard. Um, but you know, let's say that someone is, we're not

3:03:33just talking about a night, but we're talking about weekly, like month, like we're seeing a consistent pattern of not getting enough, either deep or REM sleep. Right. And so the way I would interpret that is you may or may not be not getting enough, but you're definitely exhibiting a pattern where the algorithm is saying you're not getting enough. Why is it the problem with the algorithm? Is it a problem with maybe you are getting it, but there's something in the peripheral system that is like, maybe your heart rate is just too variable and it's not

3:04:05picking it up for, for other reasons or something. Um, I would say the way I do this is just like the breathing, the breathing example where it's like, if you're having trouble breathing, okay. Do you have a problem with your lungs? You have lung disease of any kind. Let's, if so, let's figure out what that is. Treat it. Okay. Lungs are fine. Do you have an airway disease? You have asthma. Do you have airway inflammation? That could be interfering with your ability of your lungs to be transferring oxygen correctly. Are those fine? If we'll let's identify any problems there, fix them.

3:04:39Okay. That's fine. Okay. Well, is your air very polluted in that case? In that case, you know, maybe you need an air purifier. So from a sleep perspective, it's, is there anything physically that's preventing you from getting deep sleep? If you wanted it, do you have some sort of systemic inflammation going on? Do you have untreated sleep apnea? Do you have chronic pain? Do you have some, are you taking a medication that could be suppressing this? Like, is there something that's a physical barrier? Or let's go down the list and rule them out because if

3:05:11there's something preventing you from getting deep sleep, let's get it out of the way. Let's unprevent it. Let's treat that condition. If there isn't, and we still see that there, then it's like, okay, well, maybe it's environmental. Do you have, is your room too hot? Is your bed too uncomfortable? Is your spouse too, snoring too loud or rolling over too much? Are you just too sensitive to light? Do you live on a street where you're asleep, but there's still cars driving by and that's creating that? It's like, is there something in your environment? If we go through with somebody and their environment is fine, their sleep continuity is fine.

3:05:45They're falling asleep fine. They're sleeping through the night. There's no medical reason that's preventing them from getting deep sleep at all. My perspective on it is don't worry about it. Your body's doing what it wants to do on its terms. If it wanted more, if it needed more, it would take it, but it doesn't. So forcing it may or may not be a good thing anyway. Well, this is a, this kind of leads into the next question, which is the pitfalls of these, of these sleep tracking devices. And I've known several people that have fallen into this pitfall and that is obsessing over their

3:06:18sleep data, which may not fall into what they want it to be or think it should be. And that actually causing worse sleep because they're just obsessed with it. And I've heard you refer to this as orthosomnia. Yeah, yeah. So that was a term developed and invented by a colleague of mine, Kelly Barron. She's at the University of Utah. She's, she's, she's like me. She studies sleep and sleep health and wearables and stuff. And so she came up with this idea, um, putting a name to what we would see in clinic of people who overly fixated on the data to the point of where it was sort of like orthorexia was the

3:06:53idea, um, where people are obsessing over food ingredients where it's like, you're, you're missing the point here. You know, like the degree of information that these data are giving you is not the level of precision you should be using that, that could even give you to be obsessing to this level of detail. It's, these are, these are rough estimates. That's a fuzzy picture at best. It's a fuzzy picture. That's probably true, but it's still a fuzzy picture. So just because you see things in there that, that might not be perfect, doesn't mean they're not fine.

3:07:23And sleep doesn't have to be perfect to be perfectly fine. So as you were talking about conditioned arousal, what do you think is going to happen when you start obsessing in bed over your sleep metrics, you're going to start developing arousal. And so orthosomnia can be a precipitant to insomnia and it's going to make your sleep worse. And then you're going to worry about it more. Actually, for a lot of those people, a lot of times we'll just say, take it off. Just take it off. It's not, it's a net loss for you. It's not a net gain, but I want, but I want.

3:07:56Like, you know what? You can't handle the truth, I guess. It's sort of like, let me teach you how to be happy with the sleep you're getting. Then you can put the device back on and you're approaching it from a place of happiness and you know your sleep is fine. And this is just giving you more information. It's not, and, and you know, your sleep is fine as opposed to relying on this information for what it can't give you. It can't give you those answers. We don't have that level of precision. Um, so there's, there's nothing worth worrying about. I mean, at least, I mean, if you're the way I think

3:08:31of it this way, if your device is giving you information, you think it's bad news, come see someone like me. We will probably, I'll look at your wearable data, but most people in my world don't even do that. They don't look at your wearable data because they don't care. If you have a problem with your sleep, I will ask you the questions I need to ask, do the tests I need to do to figure out what that problem is and use all the tools I have to fix that problem, irrespective of whatever your wearable sets. And if that wearable is what got you into the clinic

3:09:04in the first place to say, Hey, I thought my sleep was okay, but this, but now I'm a little worried about it. I will say, okay, well, I'll tell you if you need to worry. Well, I'll ask some questions, figure out what's going on. Sometimes I'll say like, you know what? You're, you have what we call normal and I can't fix normal. I might be able to optimize a little bit, can work on that. And actually de-stressing your, you, your sleep is, is more impaired because of the stress around your sleep than anything

3:09:34else that you're doing. It sounds much like the, the stimulus, negative stimulus, right? And so often that's the case. So like if you're, if you're looking at, if you're looking at your wearable data and you're not happy with what you see, if there is, if there's a problem that needs to be fixed. Don't come, come to a sleep specialist. We will find the problem. We will fix it. If there is no problem to be fixed. If you're within the normal range, a sleep clinician is probably not going to fix. It's not going to have anything to fix for you.

3:10:07Um, you might have to come to somebody who has a little more experience with optimization. If you really want, if, if, if your question isn't, is this bad, but could it be better? Then you might need to go to somebody who has more experience on the performance side, who can read those numbers, read those tea leaves and say, yeah, no, this is totally fine. I, I, I couldn't, I couldn't make these numbers better if I wanted to, or yeah, we could do something about this. Let's talk about making these numbers better. And I know that we've kind of talked, we've touched on

3:10:40it a little bit. So you tell me like, if there's more information that you want to share about it, but like using sleep as a cognitive performance enhancer. Yes. You talked a little bit about this. Yeah. I mean, think of, think of sleep is sleep should be a joy. Sleep should be your friend. Sleep is what helps you face the next day with as much resources and resilience as possible. That, um, a colleague of mine, Teresa Aurora, she led this project that I, that I also helped on. We looked at, we basically scoured the entire medical literature on resilience and sleep.

3:11:13But because everyone talks about not getting good sleep is bad, but is getting good sleep good. And basically what we found was cross the board. People, if you can sleep better, your resilience will improve. You can improve your level of resilience, whether it's physical or emotional or whatever. It was very, it was defined. However, the study, whatever the study defined it, any study, if you improve your sleep, you can improve your degree of resilience. You can improve your reaction time. You can go from normal to better. You can go from good to great.

3:11:43Um, there will be a ceiling, but especially athletes, especially younger athletes, like, like adolescents, young adults, you know, most people in elite sport are under 30. Younger people will benefit more from more sleep than older people will, to be honest. Um, if you're 20, it's, you know, I'm not saying more is always better, but too much is very rarely a problem for adolescents and young adults. Um, there is such thing as too much sleep, especially as you get older. And if you've ever like slept 10 hours in a row and woken up feeling groggy, they

3:12:14call it the Rip Van Winkle effect. You know, like you didn't, it's a real thing. You can't oversleep, but it's kind of hard for a 20 year old to oversleep. I mean, there've been studies where you take where they're already sleeping, maybe six, seven hours. If you get them up to like nine, 10 hours, they're faster, they're stronger, they're mentally sharper. Um, so, so you, so first of all, just sleeping a little bit more, if you're younger, that's probably the easiest thing you can do. And that's about budgeting time. And that's about planning your wind down routine so that you land where you want to land when you want

3:12:49to land there. So it might be thinking a little ahead and giving yourself permission to put stuff down. Is that harder for younger adults? Because they're, I mean, at least I know as you hit adolescence, your circadian rhythm is later. It shifts later. Yeah. So you're, I mean, I go to bed at midnight instead of, you know. So like when, when, when a typical adult looks at a clock and sees midnight, clock says midnight, their body says midnight. When a five-year-old looks at a clock, clock says midnight, their body's like, oh my gosh, it's

3:13:19three o'clock in the morning. Why are you awake? Right? Little kids go to bed early, wake up early. When an 18-year-old looks at a clock, clock says midnight, their body is like, it's only 9 p.m. Why are you going to bed now? And when it, when they have to wake up at seven, they're like, oh my gosh, it's four in the morning. Why are you trying to wake up? So yes, they are shifted and it changes with age. So yes, you can use light behavior and melatonin to physically shift that. You can do that, but they are more naturally inclined to stay up late.

3:13:52I mean, high school should not start before 9 a.m. Totally. 100%. Colleges shouldn't start before 9 a.m. 100%. It's developmentally inappropriate. It's, it's a lot. I mean, colleges, I can't speak for that, but for like high schools, it's, it's about the parents' work schedule. Yeah. It's, it's, it's logistics. It's not, it's not about what's better for learning or it's not about what's better for the student. I mean, and all of the data that shows that when you delay school start times, and California led the way on this. California took the step and, and at least pushed it to 830.

3:14:22Right. Um, no, I don't think any other states followed yet. Um, and, um, there's tons of data on this. Um, my colleague, Wendy Troxell, she has a fantastic Ted talk on this, um, on school start times. Um, it's just, it's wherever you look, you know, when you delay school start times, you improve everything, not just academics. Why do you think kids are so sleepy? Why do you think teenagers are falling asleep? You know, all these ADHD diagnoses, how many of them are just sleep deprivation, you know, mental health problems, depression and anxiety. How much of it is just, is just insufficient sleep and circadian phase shifting.

3:14:55So like you can actually improve these outcomes by getting kids at a time that actually works for them. So, so there's that. So yes, part of this is we live in a world mostly designed by old people who make all the rules. You know, if you look at who's in, who's in Congress, who's making all this legislation, it's not 20 year olds. And they weigh, they're like, I wake up at five, six in the morning, just fine. You know, so what's your problem? You're just lazy. You know, like, I'm not saying they say that. I'm just that we live in the society of like what

3:15:28early to bed, early to rise. Well, it's nice if you're 60, but if you're 20 early to bed, early to rise, you know, you might have a circadian rhythm problem. But you said you can sort of use strategically lights or early light exposure and then, you know, melatonin. Yeah. You can help with that. You can give people melatonin to, you can give melatonin low, that low dose half milligram melatonin is a phase shifting dose and light as a phase shifting dose of bright light. You can, you can do that. If you, if you get a 20 year old up early, flood them with

3:16:00bright light and movement, physical activity, exercise, movement is extremely powerful also as a phase shifter. What time of day? Early. Early, early exercise. Yeah. Early exercise. Get them, get them up, get them moving early. They will get tired a little earlier. Their circadian rhythm might still be a little bit off, but they'll be able to sleep. And over time, especially if you have the dim lights in the evening, those dim lights in the evening can help pave the way for, you know, even if their natural melatonin isn't going to rise, give a little bit of melatonin in the evening. Force that rise a little early.

3:16:32You can, I mean, you can essentially jet lag yourself on purpose without traveling by doing that, by giving light and melatonin at the time you want. I mean, that's good to know, right? I mean. Yeah. Some people are more resilient to it than others. Some people are more sensitive to it than others, but you can do it. Um, and actually, um, it peaks this, this delay seems to peak in the early twenties, like 22, but then after that, like you can, you can get, I mean, I work with athletes all the time. Athletes tend to be pretty good at getting up in the morning because they wake up, they get light, they

3:17:07get movement first thing in the morning. Um, and we did this study and looking at, looking at this called chronotype, which is like sort of where in the 24 hours are you chronotype and athletes, athletes, maybe it's also self-selection where the, the teenagers who were just super late. People were less likely to survive the, the training schedules to, to make it to the elite level, who knows, or maybe they're, they, they, they've adapted to it a little bit more, but yeah, athletes tend to be on average, not as much of a night owl as typical people their age.

3:17:38Right. What's the most, if we're talking about like athletic performance, what's the most consistent sleep. Hack you could, you know, get a little more, get a little more and see how you perform because the data show over and over again, that extending sleep, especially in younger elite athletes, when I'm talking about 60 year old, but I'm talking about like 20, 25 year olds, 19 year olds, 29 year olds, like do an experiment, get more sleep if you can. And I, there's some strategies for doing this, uh, because if I just say spend an extra hour in bed, we just talked about how you can't fill that time.

3:18:12You might actually create an insomnia, so you might want to slowly increase the amount of time you're spending in bed, unless you're tired enough that just spending an hour in bed, you'll knock out anything. So like 15 minutes a night? That's, that's how I like to do it. I like to, I like to extend it by 15 minutes. See if you do that, extend by another, because also you don't have to find an hour in the day. You can always find 15 minutes and that 15 minutes might buy you enough productivity where you could find the

3:18:43next 15 minutes. Do you go to bed earlier, 15 minutes? Usually that's what people have more control over. Okay. Usually when people wake up is not what they have control over. Usually they have to wake up at a specific time. So it's about, it's about advancing bedtime little by little, but the point is you're ready for it by the time you do it. But anyway, so, so sometimes it's like go to bed an hour earlier and if you're exhausted enough, you could do it. But over time that might make your sleep shallower and you might create more

3:19:14arousal if you can't fill that time. So you don't want to just, I don't want us to say like get more sleep because not everyone needs it and not, you don't know how much more. And you don't know if you can fill that time if you have insomnia anyway, but anyway. But the data consistently show that if you can bank a little extra sleep, first of all, on average, you might show up, it'll likely show up in your performance, but you might need to track it objectively using something like a tracker, like, or, or, or a stopwatch. Are you getting faster?

3:19:46Are you being able to lift better? It might not be perceptible by your memory, but it might, if, if you are 5% faster, you won't notice, but the stopwatch will, for example. Yeah. So that's the first thing I would say. The other, the other most important sleep hack for athletes is sort of comes after that and it's sleep banking, bank good sleep, um, get as much good sleep as you can while you can. Because if you have a competition tomorrow and it's high stakes, you're not going to sleep great. Probable. Maybe you will, but many athletes don't, even at the very elite level, they are not sleeping well

3:20:20right before competition. But if you've banged good sleep up before, like if you're already off balance and barely keeping on two feet and someone bumps into you, you're going to fall over. But if you're well planted and someone bumps into you, you can, you can recover pretty well. So one to two nights of short sleep does not dramatically impair performance. It might stress you out and you might psych yourself out that might impair your performance. But if you're coming from a place of strength, one or two nights dropping your sleep from eight down to

3:20:50like six or five hours, you might have some cognitive impairment, but it's going to be quite minor. A week out, it's going to be very pronounced. It builds, it's cumulative, but one or two nights isn't going to be that big of a deal. If you're coming from a place of strength. Is this, so, so it's really about the week before your, your week or two, a week or two. Okay. Yeah. Come from that same for a cognitive performance as well. Yeah. So sleep banking, really, it's not just about the day, the night before.

3:21:21Right. It's not about the night before. And that's great to know because so many people stress about the night before. Yeah. If they know that ahead of time. Come in with confidence. You know, it's like, it's like with nutrition. It's like, you know, it's not about what you ate today. It's about what you've been, right. I mean, it's, it's, it's the same thing with the sleep on the weekends where when people say, how much sleep do I need to make up on the weekends to, to make up for being sleep deprived during the week? I'm like, well, that's like saying how much kale do I need to

3:21:57eat on the weekends, but to make up for eating nothing but cheeseburgers and pizza all week. It's like, well, it's like I was saying about weekends, like it's better to do that than just having cheeseburgers and pizza all week. But that's not the answer. You know, and that's also why you don't recover right away. That's why it's, you know, it's not, it's not like a debt. Sleep debt isn't like a financial debt. It's not like you don't have to pay it all back, which is good. You just have to get back in balance and your body will start taking care of itself once you're

3:22:32doing the right thing. For in terms of like recovery, injury prevention, how strong is that data that, that you really do? So, yeah, it looks like sleep, first of all, sleep is critical for recovery and everyone knows that. Like when you're sick or when you're injured, you actually have an instinct to rest more. I mean, yes. But from injury prevention standpoint, sleep deprived people injure themselves more. We see this from all occupations. Like you, you, you crash your car more. And actually, if you ask people how well rested you think you are, but you, but you see how much

3:23:05sleep they're getting. It's how much sleep they're getting, not how well rested they think they are that predicts drowsy driving, for example. Like even if you say you're fully well rested, if you're getting five or six hours of sleep, you are three times as likely to nod off behind the wheel. Even if you say I am a hundred percent well rested, data don't bear that out. People are not a good judge of how impaired they are due to sleep deprivation. So how much sleep you get is important in terms of those sorts of things.

3:23:37In terms of athletics injuries, what seems to be a bigger driver actually is, are two variables, insomnia and daytime sleepiness, which are very common in college students. But actually, if you're sleepy during the day, even if you're getting, if you, and if you feel like you're getting plenty of sleep at night, if you're nodding off during the day, if you're having trouble staying awake, you're more likely to hurt yourself. If you're more likely to wink out, you're more likely to like not focus on something, you're more likely to hurt yourself. Same thing. If you have really bad insomnia, irrespective of how much sleep you're getting, that inability to

3:24:13sleep when you're trying is predictive. So, so one example, so we did probably what is the, like the biggest controlled study of this, where what we did was we, again, went into a division one school, measured everybody over the summer before they showed up for classes and training. And then we just combed through every interaction with any healthcare person and, and in this school, every, everything from I feel stressed to I twisted my ankle gets documented in their record, everything, every headache gets documented. So we just combed through to see what over the summer predicted concussions.

3:24:45And what we found was prior concussion history, being male and being in a high risk sport were the three biggest predictors of concussions, except for the sleep variables. Insomnia, having, having, having a high insomnia severity, and it's like, which is, which is a questionnaire we use to see like, how much is your, is your insomnia interfering with your functioning day during the day? And how much is it stressful for you? And daytime sleepiness saying at least two days a week, I think it was a week, at least two days

3:25:16in a period I'm having trouble staying awake. Those two, not amount of sleep, but those two were better predictors of whether you were going to get a concussion than even the concussion variables. Hasn't been replicated. No one's been able to do something this large since I'd love to do it. I'd love someone else to do it, but this is consistent with the literature that's coming out. That shows that it's not just the amount of sleep sets you up for acute sleep deprivation effects, but it's

3:25:48going to bear out in terms of daytime functioning. And if your daytime functioning is bad, then, you know, you're more likely to injure yourself and, and, and getting better sleep is the best way to not be sleepy. Yeah. That's, that's very interesting. Your study. Yeah. Well, and it was, it's actually inspired by a study that was done a bunch of years ago by a guy named Ben Potenciano, who's, who's actually a sports person. He's a sports psychologist. And he did this project and I read it when I was a postdoc and it

3:26:22was brilliant. He worked with a major league baseball. He still works in, in, in pro sports. He's a great guy. But he did this project where he gave sleepiness questionnaires to a whole bunch of MLB players, followed them up a couple of years later. I don't remember exactly the timeframe, just look, see who's still in the majors and you could see dose response. Every one point extra increase on that scale, the likelihood of no longer being in the majors. Wow. Um, and the ones who were in the clinical range who, who scored,

3:26:57uh, uh, over a 10 at that baseline time, 75% of them were not in the majors anymore. Incredible. One simple questionnaire more than a year in advance could predict someone's career trajectory. And so that, that's what gave that, that gave me the idea of like, wow, what other simple questionnaires can predict just at screening? Um, who's at risk? Yeah. Um, I want to ask you before getting onto the rapid fire audience questions. Sure. If you, um, the cognitive performance, when I'm very interested in just personal reasons and I'm

3:27:30wondering like, is there, let's say someone's getting pretty good ish sleep. Yeah. Like, would you have a couple of your top tips that do you, do you think they could still improve cognitive performance, um, with a couple of sleep tips? Yes. Um. And if so, what are they? Yes. So the first thing I'm going to say about the cognitive performance is caffeine can dramatically improve performance in some domains, but not others. You can, you can caffeinate things like attention, focus, reaction, time, speed, all that stuff, but data show over and

3:28:04over and over again, whether it's military samples, whether it's sports samples, you cannot caffeinate away complex decision-making. You just make bad decisions faster. That's what happens when you caffeinate a sleep-deprived person, um, over and over again, the data show this. You can, so like a great example, there's this great study where they did in tennis players, uh, semi-pro tennis players serving and when they took them down to five hours of sleep, impaired their serving accuracy by, if I remember correctly, something like 35%. Um, it recovered about a third of the loss was recovered

3:28:39when they caffeinated, but not all of it because there's other higher order stuff that's happened. Like that's the sort of stuff you see in the literature that it's not fixed by caffeine. Some stuff is, some stuff isn't. So caffeine is not the answer. Um, but what, one of the things that would be the answer is actually, and there's actually data on this, insulate yourself a little bit, bubble wrap your sleep a little bit. What does that mean? Um, if you can, if you can protect yourself against minor environmental disturbances during the night

3:29:13and protect the sleep you are getting, you can make it a little more consolidated, especially the deeper sleep and get a little more benefit from it. So here's a great example of a simple example, some of the best sleep technology on the market, simple cloth eye mask. There was a study, I think it was in Switzerland where they had a eye mask, just not just a plain old cloth eye mask. And they had a placebo eye mask where they cut the holes out in the middle, same strap, just cut

3:29:44the holes out. Improved sleep consolidation during the night. These weren't college students, so they were in sort of noisy environments anyway, but consolidated their sleep better in the night. Translated to better test scores the next day. Uh, that's just one example. Like I'm at, I'm ass and earplugs, some of the best cheap sleep technology that exists. Yeah. So darkness and dark. Well, but it's not, but it's also, you might need to just the extra layer of insulation. Yeah. Yeah. Like a white noise machine could be good for something like that.

3:30:15Don't have a puppy in your room. Yeah. Something like that. Like, yeah, anyone, anyone who, who has an animal in their room, another mammal in their room, like. Moving around. Yep. You're going to have more fragmented sleep. Okay. Awesome. Okay. Let's get to some of these rapid fire audience questions. Yes, let's do it. Best evidence-based way to fall asleep and stay asleep. Fall asleep faster and stay asleep. Yes. I'll give you two because one is cheating. The one is stimulus control, because if you can be rigorous about stimulus control, you can get into bed anytime,

3:30:48anywhere. It's like when I travel, like when I travel to a different time zone, even if I'm in a totally different time zone, I'm so rigorous about stimulus control. I can be at a very off time zone, but the lights are out. My eyes are closed. My head's on a pillow. It's a conditioned stimulus. I fall asleep fast. So you can train, if you can train yourself that that situation is reliably paired with sleep coming soon thereafter, you can make yourself, even if you're stressed, you can fall asleep faster by putting yourself

3:31:20in that situation. Rigorous, highly empirically supported, lots of data to support this. The other one I would say is allowing sufficient wind down time with nighttime signals, dimming lights literally and metaphorically for at least a half an hour before bed. Literally meaning you want them orange. You don't want them bright and blue. And metaphorically, I mean, give yourself time and space to detach. That is actually usually if you're going to bed at the right time or within your window of time, if you're having trouble or your mind's racing, it's because you're trying to go from 30,000 feet to parked at the

3:31:55gate right away. Just put a little bit of space in there. Let yourself come to a stop and you'll find it's way easier and you don't have to fight so hard. Those are great. If you're trying to stop at a stop sign, start braking more than one foot in front of the stop sign. You will find it's so much easier to brake wherever you want if you're coming in a little slower. I definitely do number two. I am definitely now going to, I'm going to be on top

3:32:25of this control thing because I'm super interested in it. Bang for your buck, sleep tip in the world. Great. Okay, awesome. Most effective pre-bed routine you've seen to shorten sleep onset? Yeah. So that I would say is orange lights, putting screens down if you can. Um, if you can put down screens, reading, reading, actual paper books is great before sleep. Unless you're me, I actually suck at reading before bed because I get into it. But for most normal people, the data actually support reading because it's self-paced. If you can't maintain muscle tone, you'll learn, you'll know it.

3:32:59And you'll, you will tap right into your body signals. You won't be overstimulated. And, and as soon as your body's ready, you'll know it and you can put stuff down. So reading, dimmer, orange light, um, the way to go. And that's, that's sort of the way to go. All right. Uh, best strategy to fall back asleep quickly after waking in the night. Um, if, if I were going to turn this into an algorithm, step one is if I wait, if I wake up in the middle of the night, what do I do? First step one is, okay, can I fall right back to sleep within the next two or three minutes?

3:33:33I try. And if I don't, then I, then I evaluate, okay, is there something going on my body right now that I actually need to get up or not? Is this something I can, and, and let whatever activation was right out. If it's going to be short, let it do not. And I guess the answer is do not add performance anxiety to it. Read the room. If you are, if, if you're not in control of your ability to fall asleep, if it is outside of your control, don't try and control it. Let it be. And don't panic. You will fall asleep just fine.

3:34:04If, if it's possible to fall asleep fine, if you didn't panic, you will. As soon as you start panicking, you're adding energy into the system. All right. Um, don't go to recap. Um, one proven method to increase deep sleep in healthy adults, proven method. So there is some really not, not that I think anyone really, whether or not people need it, I don't know, but the day there is some data you can improve the deep sleep, not improve. You could potentially get more of it and get it more consolidated besides the obvious is if you have a barrier, get rid of it. If it's sleep apnea or whatever, but in healthy adults, um, there's some actually cool

3:34:40data neural stimulation where you can induce more deep sleep activity using auditory stimulation by sort of tricking your brain to create those waves. Um, jury's still out on exactly, is it just creating the waveforms or are you actually getting the extra benefits of what looks like more deep sleep or does it just look like you're getting more deep sleep because your brain's creating the waveforms? Not quite, I'm not quite sure yet, but there's actually a bit of data. You can do that. Um, and, and actually, like I said, with the eye mask, the environmental bubble wrapping of your sleep, because if anything is going to prevent you from getting more deep sleep, it's, it's extra

3:35:14stimulation. With the auditory stimulation, is this something that you listen to while you're? Yeah. It's like, it's like the binaural beats kind of a thing where like it induces, it basically, um, sends waves that are in the waveforms that you want your brain to sort of create to, to echo them. Okay, cool. Yeah. It's like biofeedback, but, but for brainwaves. Um, most effective way to reduce nighttime urination and wake ups. Um, most people, when they are peeing a lot during the night, it's not because they have to pee a lot during the night. It's because they're awake during the night.

3:35:44Um, so what I would say is, first of all, see if there's something that's waking you up. Untreated sleep apnea are probably the leading cause of nocturnal frequent urination because you keep having these arousals at night and your bladder's like, okay, while you're awake, might as well. Um, if that, that usually comes afterwards. Um, the other thing is if you're used to getting up to go to the bathroom a lot, maybe you don't need to, and you might want to do an experiment and see if you can go back to sleep without going to the bathroom. If you don't need to, and then you can get used to that too.

3:36:18Cause if you can hold it till the morning, just hold it till the morning. I've done this before. Um, in fact, I used to go, I used to get up to go to the bathroom one time in the night and now I don't get up at all to go to the bathroom. And you know, I'll, I'll usually wake up and it's probably like around five ish or so. And I'll feel like, oh, I could go pee, but then I just like close my eyes and go back to sleep. And guess what? You're fine. I've made it. I've made it now months without having to do that.

3:36:50And that's, and that's the thing. It's actually, you've, you might've accidentally programmed yourself to do that. Remember what I said, the average person will wake up 10 times a night or more that the awakening occurs. It's not the problem that it's blossoming into something you're remembering as stressful as the problem. Take the stress out of it being like, oh, I just had one of my hundred awakenings during the night that I, I just happened to be conscious of this one, but nope, go back to sleep. And, and, and if you can train yourself to do that, it's actually shockingly effective.

3:37:20If you, if you reduce that performance, things are exactly like you talked to. Yeah. No, I'm, I'm going to be all over the stimulus control thing. That's going to be in my new, my new thing. Okay. One actionable change that measurably improves overall sweep, sleep quality. Overall sleep quality. I talked about a lot of stuff, whether it's nighttime routine, getting, you know, having the bed be a, be a good place for sleep. But in terms of sleep quality, actually daytime morning, have a day, get activity. Don't, don't sit around in the dark all day. Um, humans were not built for that. Eat well. People who, people who eat like crap, especially late at night,

3:37:55their, their, their sleep is more disturbed at night. Um, reduce systemic inflammation in your body. Your sleep will feel better. If you're sharing a bed with somebody and that somebody has sleep issues, drag them kicking and screaming to get tested for whatever it is they have and get it treated or get two twin XLs, put them next to each other. Sleep in a, you know, you can sleep with somebody, but not on the same mattress. You can just put them next to each other. Like people underestimate how much this environmental stuff is, is, is shallowing out their sleep quality.

3:38:26My husband and I, um, we have our own separate blankets. Yes. Yes. On our bed. See, there's nothing wrong with that. I, I, there, there's people who talk about this as if it's a bad thing, but actually from a sleep science perspective, you get all of the social positive human benefits of sleep. Humans were not really meant to sleep alone, but at the same time you get to be in your, you're essentially your own microclimate and environment where you get to be under control and not have it be. It's best of both worlds. Right. Where I'm not feeling the movement as much.

3:38:57Exactly. For sure. Um, okay. How can you quickly assess if you're getting enough sleep without a lab test? Uh, you couldn't even do that with a lab test. We don't have a good test of, are you getting enough sleep? Um, test number one, if I put you in an otherwise quiet, dark room for 20 minutes, could you stay conscious? If the answer is no, you're probably not getting enough sleep and it's not, might not be amount. It might be about quality because for people with a sleep disorder, like apnea, more isn't always better. More might just be, you can get an unlimited amount of sleep and still feel tired because the quality you're

3:39:32getting is poor. So it's just like nutrition that way. It's multidimensional, but by more, I mean more quality or quantity. So one is if you're having trouble staying awake during the day, or if you, if you put yourself in a situation where it would be really easy to fall asleep, could you, like, would you fall asleep right away? If the answer is yes, something like, why are you so hungry that like you put, if you, if you, if you put a plate of food in front of you, can you resist it? If you can't, what's up with your appetite? If it's not mealtime, you should be able to resist it.

3:40:06Um, the other thing is you can experiment and get a little more and see if you feel better. If you don't, okay, good to know. Um, another way to tell is if you fall asleep, as soon as your head hits the pillow, you probably waited too long. It's just like saying I cleaned my plate in 30 seconds. As soon as it was put in front of me, should have taken a little bit of time. So, so maybe you're going to bed too late. Maybe you're waiting a little too long. Um, yeah, that's how do you know you're getting off?

3:40:37Unfortunately, we don't have a good test for that. I like those. I like those. Yeah, it's practical. Do you really need eight hours of sleep? No. Um, first of all, the recommendation these days is seven, because when we looked at the data, there was no distinguishable difference in almost all cases between seven and eight. Plus people don't tend to have that. It's all based on recall anyway. So people don't have that much resolution. Seven's kind of the new eight. At six, people were starting to show problems on average. Are there people who sleep six hours and are fine?

3:41:07Yeah, I'm sure. Probably. Um, are there people who are sleeping five hours and are fine? Possibly. Is it you? Probably not. Um, think of it as a bell curve where you're probably somewhere in the middle. The chances that you're on an extreme outlier are low. Um, just because you're an outlier in one part of your life doesn't mean you're an outlier here. And athletes especially probably need more because they have a higher load on their recovery system. So you want to recover. You need to give yourself the time and space to do that. Do you need eight though? No. Do you need seven?

3:41:39Maybe. But then also need for what? How much sleep do you need to not die is different than the amount of sleep you need to be optimally functioning. Yeah. Optimally functioning. Optimally functioning. I would say most people probably need seven by self-report. That might mean six or six and a half on your wearable. Right. Okay. And then one practical tip for aligning lifestyle with your chronotype. Yeah. I mean, give yourself permission to schedule stuff out in different times. You may or may not have control. I mean, if you're a night owl and you have a job that

3:42:09works early in the morning, I don't know what to tell you. Um, but if you could control your day such that maybe you're doing certain things at certain times, we're adjusting meal times or adjusting where the heaviest workload of your day is scheduling meetings at certain times. Like you might be able to do that. I mean, if you're a heavy night owl, but you have to go to work in the morning, just wake up as soon, you know, give yourself as little time as possible to get there so you can stay up as late as possible and do all your household stuff at night,

3:42:41you know, and keep that schedule as consistent as possible seven days a week. Well, this has been very, very enlightening and interesting. I've actually learned quite a bit today. So thank you so much for coming on the show. You have a book coming out in, I think, October. Yeah. Yeah, it's, it's, it's planned. It's a textbook. So it's an academic book, but it's all about, so it's a wearables book. We also have. It's all about wearable sleep technology. Yeah. Yeah. We have, we also have, I've also edited a few other textbooks. There's one on sleep health, another one on sleep and sports, um, and, and another one on adapting CBTI for.

3:43:15Oh, great. Like if I'm an academic, you know, like this is what I've got. But, um, uh, if people are interested in them, uh, they're not priced like a regular book, they're priced for libraries and for academics. But so if people have any questions about anything in them, just shoot me an email. I'm actually easy to find. Um, and, and I'm happy to be responsive. Yeah. I'm, I mean, I'm looking forward to it. And a book on wearable sleep technology written by an academic who actually knows about it. It sounds interesting. It'll be fun. Um, so great. So people can look you up. You got your, your lab at the university of Arizona.

3:43:50Yep. Um, thank you so much for coming on the show and sharing all this really, really knowledgeable, um, you know, important information with everyone. And thank you for everything that you do. No, you're very welcome. Thanks for having me on. Thank you so much to Dr. Michael Grannner for sharing his incredible knowledge today. And thank you all for listening and supporting the podcast. If today's episode resonated with you and you're interested in even more practical science-based insights, don't forget to sign up for my free weekly email newsletter. We explore actionable topics like caffeine's effects on sleep, creatine and cognitive health and

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