← Extend Podcast with Darshan Shah, MD
Extend Podcast with Darshan Shah, MD
171. Dr. Kristen Holmes: The Sleep Debt Problem Affecting Your Brain, Mood, and Relationships
00:59:14
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- [00:03]
A
Welcome to xtend with me, Dr. Darshan Shah. A podcast dedicated to cutting edge science research tools and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results. When it comes to your health span, we are living in a new era where we are creating a new healthcare system no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world renowned experts offering you a step by step guide to proactively avoid disease and most importantly, extend your health span. So you're tracking your workouts, you're checking your recovery score on your whoop scan, but those numbers aren't talking to each other and you're working with an incomplete picture. Probably the problem here is that recovery is not just a single metric. It's the product of how much strain you put on your body when you slept relative to your internal clock, and how consistently you're giving your nervous system space to adapt. Get any one of those wrong and the others stop working the way you expect. Dr. Kristin Holmes is a psychophysiologist and Global Head of Human Performance at wop, where she leads research on sleep circadian biology and recovery across professional sports teams, military units and elite performers. She holds a PhD in Psychology from the University of Queensland and has spent over a decade coaching at Princeton University where she built one of the most successful programs in Ivy League history. She's truly a unique individual and I'm so excited to have her on this podcast. In this conversation we're going to get into what recovery actually measures with Circadian timing is the most underused lever most people have and don't use, and how to translate your body signals into better decisions. So if you've ever looked at your recovery score and wondered why the number doesn't match how you feel or push through anyway and paid for it later, this conversation with Kristen will change how you read your own body and potentially even change your life. She's the author of a book that is now on pre sale. It's called Lime and it's going to be a game changer. It comes out on August 25th, so you have to order now. Kristen, thank you so much for joining me on this podcast.
- [02:35]
B
Dr. Shah, thank you so much. It's such an honor to be here.
- [02:39]
A
Yeah, I've been so excited to know you ever since I met you there at WOOP headquarters where you interviewed me. So thank you for that. I mean. Exactly. Exactly. Well, that was such a fun podcast, and I think this one's going to be a fun one too, just because I love interviewing people with a depth of knowledge and education that you have. I mean, you've had such an incredible career. You're one of the smartest people I know.
- [03:04]
B
Oh, my gosh. Well, thank you so much. That means a lot coming from you.
- [03:08]
A
Yeah. And I mean, I'm looking at you for the people that are listening, looking at you on this computer and seeing what's behind you. You have, like, equations behind you. What are you doing over there?
- [03:21]
B
Well, yeah, we, you know, part of a big role of my team is we generate evidence and health outcomes. So we're really interested in understanding, you know, does whoop actually work? You know, does it change behavior? Because ultimately, data for the sake of data is just really not that interesting. But, but do these data actually give you the insight that you need to. To modify how you're living so you can have more control over the trajectory of your health? And, you know, a lot of the work that we're. We're doing is just figuring out, you know, what does that. That pathway look like? What are the questions that we need to ask of the data to. To better understand, you know, whether or not it, you know, that the device itself is actually doing its job. But I think the other piece that we're really interested in is behavior. What are things like sleep debt, for example? And I think that the equation that's right behind me is exponential function to describe sleep debt, which is a function that was developed by this guy, Russell Holtz and his colleagues. But what we were trying to understand is, you know, basically, how does sleep debt build? And this is actually a paper that we have in review right now looking at this idea of sleep debt and how do we make up for lost sleep and what does that look like? So, you know, we're always asking these kind of questions so we can understand, I think, most importantly, like, how do you actually apply your effort? Right. If you are interested in having more control of their trajectory of your health, like, what are the things to pay attention to, you know, how important is, you know, morning light on cardiorespiratory fitness, for example, and, you know, what is zone two versus zone five? And, you know, where do you get the most return? And, you know, these are. We have such a large data set and People are so good at, you know, that. And we're passively collecting all sorts of data, you know, that you don't even have to interact, you know, with the app. All you have to do is just keep it on your wrist and keep it charged. And so we get all those data, and then we have a journal. That's where people can journal, you know, different types of behaviors, medications they might be taking, you know, different protocols they might be engaging in. And so we can kind of put together a story, you know, around, you know, various behaviors and how they impact the metrics that we know ladder up to longevity and health.
- [05:47]
A
Yeah, absolutely. I mean, I've been a huge fan of whoop, and it's kind of the official, unofficial, but hopefully we'll soon be the official. Been talking to your team over there, device of Nextel, because the data you get, like, you say, you don't have to look at it yourself if you don't want to every single day. This whole concept of data anxiety makes people anxious. Right. And. And like you said, but the data is still there. So even if you don't look at it, when they come and they sit with us, we can look at the data with them. Because you guys are so generous. You open up your API and we see the data, and we can sit there and be like, you know, out of the last 30 days, I noticed that your sleep score was low. And also a lot of that has to do with the time you're going to sleep. And so we can make connections for people and then encourage them to change their behavior. Right. And I think behavior change is so difficult to achieve. Even just, like, look in the mirror, I look at myself in the mirror. It takes a lot for me to change a behavior.
- [06:45]
B
It's hard.
- [06:46]
A
Right, right. And so the more. The more different ways you have to affect behavior change, the better. And we can talk about that forever. But I want to talk about recovery today, if that's okay with you.
- [06:56]
B
Okay, absolutely. Yeah.
- [06:58]
A
Fantastic. Okay, so I want to reframe recovery, and I want you to fact check me. One of the things I tell a lot of my patients and I say on this podcast all the time, is that recovery is one of the most misunderstood and underappreciated factors of health. And I think that's because we have in our mindset since, you know, I would say, five decades now, the more activities you put into your health, the better, the more healthier you are. Right. And really, we've kind of skewed our notion of health and our psychology around health, around doing things right, rather than actually sometimes not doing things and allowing our body time to recover. And so I talk a lot about parasympathetic and sympathetic nervous systems. And you know, as humans in our caveman ancestors days, there was a majority of our day was spent in the parasympathetic activity, and very little time was probably spent in sympathetic activity, from my understanding of the, you know, the evolutionary biology research. And we flipped that script where we're spending a lot more time active versus inactive. And so I would just, I wanted you to fact check me on some of that. And, and what are your thoughts around the amount of time we spend kind of in recovery mode versus active mode?
- [08:24]
B
Yeah, well, I mean, if, if we look at, if we look at evolutionary kind of biology, you know, I, I know, you know, men were walking, I think on average about 10 miles a day. Women were, you know, walking around 7.4 miles a day. So, you know, I think folks were really active. And you know, when you are active, you're, you're in a sympathetic state. You know, your heart rate variability is suppressed, which is a function, it originates the heart, but it's a function of the autonomic nervous system. And your, your heart variability is, is suppressed and your heart rate is increased. And that's, that's normal. That, that is actually how we should be functioning during the day. Generally speaking, we are in this kind of higher state of stress, but your body is anticipating and expecting that, and that's healthy. And I think sometimes we get, I think we, we get into this mindset that, you know, that stress is, is bad. And, and stress, stress is very, it can be very complicated in the sense that when we are stressed and we don't feel like we have control over our life or we perceive that stress as threatening, then yes, that is going to have a negative impact on our physiology and our biology. And we know from some research that we've done here at WHOOP that when we perceive our day as threatening, it actually impairs our sleep at night. So this signature of stress, when you're in a challenge, a challenging state versus a threatening straight state, when we look at the heart rate signature, it actually looks the same. The difference is how that negative stress versus positive stress manifests in sleep. We published this paper in Emotion last May where we looked at 36,000 people and we asked them if their day was threatening versus or if it was challenging. In individuals who perceived their day as threatening had less restorative sleep at night than the people who perceived their day as challenging, but their heart rate signature looked identical. So this idea that, you know, good stress, bad stress, it, the, the only thing that matters is how you perceive the stress. So this idea of reframing your stress and getting yourself into a challenging, less threatening state becomes really a big part of the story. Right. And that's why I'm a psychophysiologist. I look at the interrelationships between our psychological processes and our physiological responses and vice versa. And this study is a really good illustration of that, of these interrelationships in that dynamic. And so, you know. Yeah, so, so stress inherently isn't bad. And we are built to be active in moving during the day. Like that is. You want to create. When we look at this from a circadian perspective, you want to be active during the day, right? And you want a lot of contrast between active during the day and inactive at night. Right. And if you're active during the day, inactive at night, you are aligning with the natural light dark cycle. You're aligning your circadian rhythms in a way that, that takes, that allows the clocks in your body to do what they want to do. Right? They're expecting to be active during the day. They're expecting to be inactive during the night. And when you give them the wrong information, your clocks become confused and confused clocks is really the basis of aging and disease progression.
- [11:50]
A
Right.
- [11:51]
B
So, so I, you know, I, I very much come from the school of, of thought that circadian alignment is really one of the most important things to pursue if we want to manage our stress effectively, if we want our, the, the clocks in our body, the cells in our body to be functioning as, as effectively and efficiently as possible. We, we want to create this alignment as much as possible.
- [12:15]
A
Okay, that, that's amazing. And I have so many more follow up questions there. So. Okay, let me. I think maybe I misstated what I was saying. So is with. And I'm going to miss. I'm going to ask you a question to like clarify this. Okay, so you said, you know, obviously humans walked a lot during the day, which is absolutely true. That's why humans wandered all over this planet and every, every nook and cranny. Right? But is that walking, that walking activity, which obviously does increase your heart rate, decreases your hrv, but is that walking around considered stress in the traditional sense of like fight or flight stress? Or is walking actually considered definitely like stressful physiologically but not in flight or fright? Or is there more, is there, do they have more in common than they don't? Have in common?
- [13:05]
B
Well, I think it's, it's highly individual. Right. In terms of like what walking is for one person could be very different for another person. Right. So if you're really unfit or unhealthy, walking could put you into these higher heart rate zones, for example, and, and you would very much be in this kind of fight or flight. But I, I think what you're saying is that, you know, in these lower zones, like a zone one or two, you are in kind of a more of a parasympathetic state. And so that is really recovery promoting. So absolutely like, you know, walking is, is absolutely going to likely enhance recovery next day. It's going to increase your capacity to take on stress tomorrow. Right. When you are not stressing the system. That said, we do need some, you know, higher levels of stress. Right. In order to improve our resilience. Right. If we're not stressing our system enough during the day, we're constantly in this parasympathetic state. That's not a path to optimal autonomic nervous system functioning. Right. You know, which is really what we're again, what we're talking about when we're talking about the parasympathetic and the sympathetic branch. And a measure of that of course is heart rate variability, which a lot of the, the wearables have as a, as a measure, as a proxy measure of your autonomic nervous system function. Right. So heart variability is a function of the heart, but it originates in the autonomic nervous system and gives us a nice understanding of the health of your autonomic nervous system. You know, there's a paper that was just published in, in 2020 of December of 2025 that basically it was an opinion paper that looked at the theory of aging and it basically says that when we're, when our parasympathetic and sympathetic branches become deregulated, that is a basis for aging and disease. So it's kind of interesting that, you know, this notion of preserving the health of our autonomic nervous system is really important. And part of that, Dr. Shah, is I think what you're getting at is that we need this really good balance between restorative activity, like a walking and really high level activity, right. Where you're actually sprinting after the, after the prey. You know, if you're talking about being on the savannah. Right. But we need to be, you know, stressing the system, but then we need, in that, in the face of that stress, we need to make sure that we're, we're taking appropriate levels of recovering appropriately. Right. We're. We're balancing that strain with appropriate levels of rest.
- [15:35]
A
Right, Absolutely. And I just want to highlight again that. And correct me if I'm wrong, but you're saying just reframing stress as not necessarily a bad thing unless it's really affecting your sleep. Right? I mean, say that again. Yeah, exactly.
- [15:54]
B
This is wild. Yeah, yeah, yeah. So, you know, and this is. This is kind of like the. I believe this is the first study to, to really show this. And, and it was, it was fascinating because we, I think we anticipated. We expected. The hypothesis was that we'd see changes in blood pressure and we'd see changes in stress, you know, score in the face of this, like, negative kind of appraisal or this threatening appraisal of. Of the day. Right. But. But we really. There were no meaningful differences. Right. The only thing that we saw is that sleep quality was impaired in the folks who. Who perceive their day as threatening. So I think when we are in a scenario where. And I. And I think what a threatening state really taps is. Is potentially things like low efficacy, self efficacy. Right. We know that, you know, our, our feeling like we have the skills and resources to do what's asked of us is, of course, psychological needs. So if we're feeling like we, you know, don't necessarily have what we need to. To. To function across the day in a way that feels good to us, that will manifest in our. In our sleep that night. And, and so, yes, this skill of reframing and putting ourself into the challenging will obviously help us in lots of ways while we're awake, but it actually helps us have a more restorative night's sleep, which is, I think, a really important insight. And, you know, I think about this as a parent too. You know, do my kids feel like they have the skills and resources, you know, to. To navigate the day, their day? Right. And. And how do I help them understand how to reframe a scenario? And I'm not talking about being Pollyannish. You know, some things like stress, sometimes stuff is threatening. Right. And you're in a situation where all the reframing in the world is not going to get you to where you need. Right. But I think the awareness that, wow, these states of threat actually have a pretty profound impact on my ability to restore and regenerate is, I think, increases. I think the urgency to make sure that you're just paying attention to building a life where you have the skills and resources to meet the day in this kind of challenging mindset.
- [18:00]
A
Oh yeah. So how does one practically make that reframing happen? So say I'm an executive, I'm in front of my computer, things are not going well with my business. You know, I'm having millions of conversations and I just come home just defeated from the day. Right. Because things, no matter how hard I'm pushing, things are not going in the right direction. It's a lot of, you know, in air quote, stress.
- [18:25]
B
Yeah.
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A
How am I reframing that practically for this to not necessarily be such a negative thing? And it's actually gonna not lead to a skip negative sleep because those type of thoughts actually, in my experience, my personal experience, I would say lead to poor sleep quality.
- [18:43]
B
Yeah. Yeah. I mean, so I think, I think number one, you know, recognizing, I think there's oftentimes a lot more going right. Than we realize. Right. But we, we tend to, to focus on the negative. It's just how we're designed, right. It's, it's helps keep us safe and like, you know, there's a lot of evolutionary, you know, reasons for, for why we focus on the negative. But I, I think it's, it's recognizing, okay, what is actually going right here and what are the things that I, that I actually can't control, you know, that oftentimes in business and in life, you know, there are some things that we, that we worry about, that we stress about that are things that we really can't control. Right. So I think it's really understanding, okay, what do I actually have control over? What can I directly influence? And, and then building a strategy around that. And I think, you know, doing that potentially at the end of the day, end of a stressful day, you know, what's going, right, what's going wrong here? What are the things that I can influence? And making just a plan, right. It doesn't have to be a three page business plan, right. But it can just be a few points of like, all right, how am I gonna get myself in, in a, in a, into a better situation tomorrow? Right. What are the three things that I can control and I can affect directly? And, and usually that's enough to kind of calm the nervous system. And I would say if you pair kind of that type of exercise with some slow paced breathing, for example, now you're getting your, you're changing your state from an activated state to a deactiv, deactivated state. And I would argue that's a really good thing to do at the end of the day or throughout the Day in terms of being in a situation where you're kind of mapping this stress with, you know, moments, mini moments of rest throughout the day so you're not getting this negative stress accumulation that, you know, bubbles up at the end of the day. So you come home and you're reactive and you know, you maybe can't be present with your family or, you know, you're not as tolerant or kind as you might want to be. You know, just thinking about your day in, in ways that you can break up the stress throughout the day, I think is really, can be really helpful. And then, yeah, and I, and then I think that exercise at the end of the day, if it's been a particularly tough day, is, you know, what are the things that I can influence and control? Writing those things down. I think the other thing to ask is where do I need to ask for help? What are the resources that I, or skills that I don't have that I need is also a good exercise because I think oftentimes we maybe are slow to ask for help when we, I think generally speaking, people love helping other people. So I think not being shy, asking for help is definitely a way to get yourself from a threatening state into a challenging state a lot more quickly.
- [21:30]
A
I love that. So Kristen, what you're saying is taking that potentially what we perceive as negative stress and turning it into something positive, turning a negative stress into a challenge, using that word challenge. And there are many ways of doing this is just like you said, asking friends for help, writing down your three potential solutions, doing some breath work or taking a walk in between. You gave us so many great tips there that I think there's this whole movement around trying to de stress your life. But the reality for people especially like, you know, you're there a whoop with a million equations behind you trying to people like, the reality is this is hard to make happen in the day to day reality of life. And those are all excellent tips. Thank you for that. That, that's actually going to help me.
- [22:20]
B
Oh, I think it's, you know, I think it's generally, you know, there's no shortage of problems. Right. And it's like you kind of have to decide that, all right, I'm going to kind of, I'm going to give up on problems. I'm going to really think about solutions and, and I think just the knowledge that we are our brain will default to the negative is just a really important source of insight to just be aware of. Wow. There's actually a lot of good going on Here, you know, and, and, and just reminding yourself of the good is like almost enough to kind of shift your state and shift your mindset and kind of get yourself into a better, and into a better spot, you know, and I think a lot of that is, is almost a skill that we can build. And, you know, it doesn't mean that we ignore, you know, things that aren't going right. But, but I think focusing on the things that are going right is really important.
- [23:19]
A
Yeah, yeah. And you, you know, like you said, like, we're wired as humans, just focus on what's not going right and to always be hyper aware of the dangers around the corner and survival mode. Right. And so it's, we do tend to put on blinders and our spotlight just focuses on the bad things when you could be surrounded by so many good things.
- [23:40]
B
Yeah, it's well said.
- [23:41]
A
Yeah. This episode is brought to you by Momentous. So, as a doctor, one of the questions everyone always asks me is what, what supplements should I really be taking? And honestly, before you even pick what's the right supplements for your body, you always need to think about whether you can trust the brand that you're buying or not. Here's what most people don't really take into consideration. The supplement industry is barely regulated. Brands don't have to fully disclose every ingredient in their formulas, and most products are never tested for purity or accuracy. That means a lot of the products that you buy online, you're not actually getting what's on the label and that's absolutely not acceptable. And it shouldn't be acceptable to you either. That's why I partnered with Momentous. Momentous is a brand I really believe in. Why? Because they created their own standard which exceeds what the industry normally talks about. The Momentous standard means they source the highest quality ingredients, they use clinically validated formulations, and they test every single product and every single batch. Every Momentous product is also certified by NSF for Sport. This is the gold standard of third party testing. It checks for contaminants, heavy metals, banned substances, and verifies what's on the label as exactly what is actually in the product. And they publish those test results directly on their website so you can see it for yourself. You'll see there's no unnecessary fillers, there's no artificial additives. So you don't have to guess if your product is high quality or not. You know it is. When you pick Momentous, if you're going to invest in your health, trust the supplements you're taking and Momentous is built on trust. Go to livemomentous.com and use the code Dr. Shah for up to 35% off your next order. I want to go back to another topic that you were talking about, which is a topic behind you of sleep debt. Okay, so this is something that I think a lot of people recognize exists, right? I mean, you know, people catch up on sleep on the weekends is what I always hear. But I would love to hear from your, you know, from your vantage point, how do you really define sleep debt? Is it a time thing? Is it the amount of deep sleep? Is it sleep quality? All three together? What's the definition?
- [26:02]
B
So sleep debt is basically what you need versus what you actually got. You know that Delta is essentially sleep debt and everyone else has a different sleep need, Right? That is based on your genetics, there's a whole host of factors that influence how much time you need to spend in bed in order to get sufficient sleep so you are restored and regenerated in an optimal way, physically, mentally, emotionally, to tackle everything that you need to during the day. You know, we've done some really interesting experiments at whoop, where we've looked at the impact of sleep debt on leaders. And, you know, one of the things that we see is that when you are carrying sleep debt, you have less mental control the next day. Your executive function is actually compromised to the degree, to the tune of like 5 to 10% with every 45 minutes of missing your kind of sleep need. Right. So, you know, on whoop, and is this a perfect approximation, a perfect estimation? Probably not, but it's. It's, I think, directionally good in that, you know, we're able to basically, based on your baseline, based on your all of the behaviors, based on what we know, how much sleep you generally need to achieve a good recovery. When controlling for lots of other things, we're able to give you this, like, baseline sleep need. And in this study, we looked at leaders over the course of six months, and what we saw is when they had a accumulated 40 for every 45 minutes of sleep debt, they lost 5 to 10% in mental control the next day, measured by Stroop and Embach. So objective measures of executive function. So, so sleep debt, you know, like, it does impact how you function the next day. And there's obviously an. An enormous body of evidence, right, where we know sleep deprivation leads to poor performance every metric, and not to mention impacts health in meaningful ways. Right. We also see, though, the impact of sleep debt on other people. So the first six months we looked at this mental control, executive function and leaders. And we saw sleep debt emerge as like the predictor of mental control. And then the next study we did, we looked at the direct reports of these leaders, so their subordinates and we basically pulsed them with a, a questionnaire that measured their psychological safety so how safe they felt in their environment. And psychological safety is, is those measures were developed by a woman named Dr. Amy Ebenson out of Harvard. She is really the godmother of psychological safety. And, and what we saw using her measures is that again, for every 45 minutes of sleep debt the leader had, the subordinates felt less psychologically safe. So there was this relationship between sufficient sleep and psychological safety. So you can imagine if you're carrying around all of, if you're chronically under slept chronically in this kind of state where you're not meeting your sleep need, you, the people around you are going to feel less safe to be themselves.
- [29:12]
A
Yeah.
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B
And that I think is kind of like this really frightening notion because yeah, maybe you don't care as much in your work environment, but what about your home life? What about your kids, your partner? Right? There's just, you know, there's certain things that when you are carrying sleep debt, your face doesn't emote the same. Obviously your skin changes in meaningful ways. The eyes, you know, that just being able to kind of see the kindness in someone's eyes, like these are, are things that you kind of can feel, you know. And so, so sleep, that doesn't just impact you or me, you know, it impacts the people around us. And the other thing that I would say with that from a business perspective, which is really interesting, is Google did a study called Aristotle where they looked at, you know, basically they, they looked at the, all of the teams and they wanted to understand, you know, what made teams more effective. And they had this measure of psychological safety and the, the, the cycle psychological safe safety ended up being kind of the predictor of, of success on teams. And they found that the more psychologically safe the team felt, they brought in $4.3 million more than teams with less psychological safety. So, you know, it actually affects your bottom line of your business. So sleep really does matter. Now in terms of, we know that, you know, when we're talking about sufficient sleep, we know that timing does, does matter. Consistency really, really matters. And obviously, you know, some of those elements drive the quality of your sleep, which, which matters as well. And those are the, the main kind of four pillar, pillars of sleep that, that, that we talk about in, in sleep science. So yeah, just let me know what direction you want to go. But, but that sleep.
- [30:54]
A
Let's go, let's go and define quality of sleep. That's always the biggest question. Right?
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B
Okay.
- [31:00]
A
How do you define.
- [31:01]
B
And so quality of sleep is, is basically how much time you're spending in these deeper stages of sleep. And it's very normal to kind of cycle from, you know, I think we have this idea that light sleep isn't doing anything for us or we want to avoid light sleep. You know, over a 90 minute cycle you're going to go from, you know, you know, you're going to drop into these, you're going to go from light sleep, you know, basically N1 and you know, N2, and then you'll get into N3, which will be deeper sleep. This will be your slow wave sleep and then M4 will be your REM and you'll basically cycle through that 90 minute cycles over the course of the night. And all of those stages matter, right? And dropping into these deeper stages of sleep is, is. We call that sleep quality. And sleep quality is really necessary for, you know, all of the kind of the main regenerative processes that are happening over the course of the night in terms of memory consolidation and consolidating your learning and emotionally regulating from the day. Like a lot of emotions are processed during rem. In particular, slow wave sleep is where, you know, this physical restoration is happening. So preserving our sleep quality is obviously very, very important when we think about just the acute kind of performance demands of the next day. But certainly when we think about just long term health, right. Sleep is very, very important. And I don't, I don't think anyone will argue with that at this stage, but I feel like there's been a lot of really great education around the importance of sleep. I think what's even more important perhaps though is what actually drives quality of sleep, right? Like, how do we actually get a restorative night's sleep? And I always say, you know, one of my very first conversations that I had when I came to whoop was with Mike mancias, who is LeBron James's trainer. And you know, LeBron James already really good basketball player. And you know, Mike, like, how can you help LeBron? And I'm like, well, you know, I, I think, you know, sleep is an area that we could probably, you know, better understand, you know, what, what he needs, what he's getting. And you know, I said to Mike, I was like, listen, like LeBron's like, you have to understand that a good Night's sleep, a quality night's sleep, where you're optimally restoring and regenerating actually starts the moment you wake up.
- [33:15]
A
Yeah, right.
- [33:17]
B
You know, and, and, and so how in it, you know, we talk about threatened challenge, right? That impacts the quality of your sleep. Right. So being in a state of challenge, reframing your day is gonna drive quality sleep. You know, viewing light, getting a big bolus of light, you know, within 20 minutes of waking up is really important. And trying to do that at a consistent time every single day will enable you to fall asleep at a consistent time. It creates conditions for sleep consistency, which also drives quality of sleep. So a consistent sleep, wake time is also a really big driver of quality sleep. And we know that quality sleep is linearly correlated with heart rate variability. So again, your ability to kind of restore and regenerate and be able to, again, you know, adapt to the stress of the day in a functional way really does rest on the quality of your sleep. And then I think the other thing that impacts quality is just the proximity of your last calorie when you intend to sleep. If you're having, you know, really heavy meals close to bed, that could impact, you know, your ability to drop into, to REM and slowly sleep. And you know, your heart rate is, is higher. You're having to, your body's having to prioritize digestion, which is also a parasympathetic activity. So it's, your body is going to bias toward the digestion, which is going to take away from that quality of sleep. And then alcohol, of course, close to bedtime dehydration. So if you're not getting, you know, the hydration you need over the course of the day, then that could obviously impact the quality of your sleep. I think distributing macronutrients across the day based on your activity requirements is important. So not over fueling, not under fueling, but having, you know, a well distributed, you know, distribution of, sorry, having your macronutrients well distributed across the day is really important. And then leaving that buffer between, you know, your last calorie and when you attend to sleep would definitely help with the quality of your sleep. We do know that a high protein, you know, kind of high quality protein, like a casein protein 30 minutes before bed does not seem to impact quality sleep or markers of recovery. So if folks find themselves hungry, if they're, you know, doing multiple workouts a day or something, or don't get the macronutrients that they need throughout, throughout the day, a protein, you know, heavy kind of you know, 30 grams or whatever can satiate you and make sure you're not hungry waking up because that wouldn't be good for sleep either. So that seems to be totally fine in, you know, college age. I think this was college age folks. It was done at a lab down at Florida State. But so just in case that is relevant for someone listening. But yeah, love it. That's kind of sleep quality in a nutshell, I suppose.
- [36:02]
A
Yes, yes. I mean this is always a common topic of conversation in my clinic is we have people coming in with their sleep measurements and their sleep scores constant. And I think you hit on all the high points, you know, getting good quality morning light. Let's just dive in on that a little bit. I want to give you two or three questions on each one of these just so we can be super clear. How much time should someone be spending outside in the sun to get that dose? They need to affect their circadian rhythm. Is there a number that you're looking for there?
- [36:34]
B
Yeah, so yeah, so there, there's of mixed evidence but I think just principally you can impact the only light will only impact your circadian rhythm prior to 10am so it's important to get that bolus of light before 10:00am we call like 10:00am to you know, the sunset. That's like a circadian dead zone. Right. That said, it doesn't mean that light between 10am and the sunset doesn't matter. Um, it absolutely does. That impacts your, the amplitude which is your, the central clock so kind of separate from the suprachiasmatic nucleus, you know, and I, I can talk about that. But, but yeah, basically prior to 10am is really when we want to get that big bolt of light. And I would say you want to make that light if you are interested in sleep consistency, which we know sleep consistency is a greater predictor of all cause mortality than sleep duration. So consistency really, really matters. And this bubbles up in every single study that we do. You want to have a very, you want to have a consistent wake time and consistent light viewing time. That is super, super critical if you really want to maximize your health and stave off, you know, all sorts of different types of conditions and diseases. That is actually the place that I would tell people to start is consistent wake up view light. And I would say, you know, that people, I think sleeping circadian field is very sunny out, you know, probably 10 minutes more cloud covered, maybe less. But I Ideally, you know, 10 to 20 minutes in natural light within 20 minutes or so of waking up is basically enough to tell your clocks what they need to be doing. You have when you. And I guess if we back up, I think folks probably know what circadian rhythms are, but basically they're, they're mental, physical and kind of behavioral patterns that are happening over the course of 20, 24 hours. And you've got these time givers and you have the photic time givers, which is the light, right? And, and, and that is the most powerful time giver for your body. Your body, all the clocks in your body are basically like craving these cues. Okay, so when we peel it all back, right, in terms of like, what are the actual behaviors that really matter? Getting light at a specific time during the day is, is really, really powerful because it tells all the clocks in your body what it is that they need to do. And that information sends a, you know, cascade of, of messages and signaling that is, is really health promoting. Okay? And then we've got the non photic time givers, which is activity and meals, right? Sleep, wake time when you go to bed and when you wake up. And, and so when we, when we are basically doing those, we're, we're engaging those time givers that in a way that's consistent with what our body is anticipating and wants. Very hard to, to be unhealthy, very hard to get sick, very hard to, to, to develop a disease. Right? Because when all of these things are happening, when they should be happening. Did I say meal timing? Obviously food. Yes. Okay, yeah. Okay, good. Yeah. So food, activity and sleep, wake time absolutely central. So when we're doing all those things at a time that your clocks are anticipating, there's no cellular confusion, right? Like there, there's like you're, everything in your body is, is able to happen when it wants to happen. And, and to me, if you can just do that, like you get 60% of the way there to your health, like metabolic, cardiovascular, like, you know, you can be alert when you want to be alert, you can sleep when you want to sleep. You know, all of that, all of the circadian stuff is really, I think, what drives the ability for healthy sleep.
- [40:21]
A
Yeah, I totally, completely agree. And to your earlier point, you know, this circadian biology piece of our, our biology or human existence, it is a root cause of these diseases. Cardiovascular disease, neurodegenerative disease, cancer, autoimmune disease, all of it.
- [40:41]
B
And so all anyone needs to do is just type in circadian misalignment and health and you will see very, very clearly the power of aligning circadian rhythms and the cost of Not.
- [40:55]
A
Yeah, absolutely. Hi, Dr. Shah here. I want to take a minute to just talk to you about cellular health. So in my clinics I've actually seen 30 year old people with cells that look like they're pushing retirement. And I've also seen 60 year olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells you see are like phones and they have limited cell phone battery, poor sleep, stress, processed foods. All of these things can drain that battery way faster than it should. So this is the reason why I partnered with iM8. IM8 powers that cellular battery. It's not just another multivitamin. It's a comprehensive 92 ingredient formula designed specifically for cellular health and longevity. I'm talking 900 milligrams of vitamin C. That's like 20 oranges worth of DNA protection, the clinical dose of CoQ10 that you need to power your cellular engine. You also get zinc, selenium, vitamin E, alpha lipoic acid. All of these work synergistically for cellular repair and protecting your telomeres. So instead of taking a handful of pills every day and all these supplements, Im8 actually gives you everything that you need in one scientifically formulated system. And this isn't just a theory anymore. IMAID had partnered with Oxford University, the International Space Station San Francisco Research Institute, and they've done studies and they've gotten this NSF certified to truly power your health. Most people are aging twice as fast as they should. Unfortunately, you don't have to be one of them. Try ima. I actually have a discount secured for you if you go to drshaw.comima or go to im8health.com discount DrShaw and you can get 20% off with my discount code DrShaw. You can also find the link below. One more question. I get all the time and this is something that I do. I wake up at 5am and the sun is not out yet. What's the solution there? Is it a, one of these lights, the a hundred thousand lux lights or is it waiting till the sun comes up and going outside or. Yes, that light. Yes, the one that you showed me. Right.
- [43:09]
B
30 minutes, you know. Yeah. So they're definitely, you know, I live in northern latitude, so I definitely am in a scenario where I often wake up and, and there's no, it's dark outside. So you just bathe yourself in artificial light if you, that is if you want to kind of advance your circadian rhythm and that you want to kind of fall asleep at say 9pm and you want to feel asleep at 9pm then yeah, you, you kind of back up 16 hours and that's when you'd wake up and view as much light as possible. You know, 16, 17 hours. You know, generally speaking, after you wake up and view that big balls of light, your kind of clock starts. And 16 hours later you will start to feel sleepy. If of course, you are dimming lights after the sun goes down and exposing yourself to darkness, you basically set conditions that enable you to release that dim light, will release melatonin, which is also really important, not just to make you feel kind of sleepy, but also melatonin is one of the hormones that is, is, is one of, as a super powerful antioxidant, it's cancer protective. So I, I know that you, I know you know that you talk about this a lot. You know, it's, it's melatonin. You really want to preserve your melatonin, you want to protect it as much as possible. Circulating melatonin is so important. And, and I, I don't really know. I think exogenous melatonin can be supportive and helpful. Work with your primary care physician, your physician, you know, to be able to understand how to implement that. But, but you wanna, you wanna maintain your natural melatonin production as much as possible. And if you are constantly pushing past your natural pressure for sleep, right, to stay awake, to watch, you know, a few more shows on Netflix or you know, to just send that last email and to, to whatever, like when you push past the natural pressure of sleep, you're not gonna get that same release of melatonin. And maybe one day that doesn't matter, A couple days doesn't matter, you know, a year, it might not even matter, but it will catch up with you eventually and make you vulnerable to disease and to illness. And yeah, it's, for a lot of us, it's preventable, you know.
- [45:18]
A
Yeah, absolutely. Such is incredible advice. And so, you know, we talked a lot about circadian biology and recovery. We also talked about reframing stress and recovery. What are your, what is your third leg of this stool on recovery?
- [45:33]
B
Oh, we talked a little bit about, about slow paced breathing. I think that's really powerful is, you know, just being able to deactivate the nervous system, to calm the nervous system on demand is I think really important. I would say getting outside during the day as much as humanly possible is really important. We know that brighter days, darker nights is associated with, also with all cause mortality. And, and mental. In all sorts of measures of mental health, positive psychological functioning, you know, reduced psychiatric disorders. Right. Like, you know, this daytime natural light is, is just so important. And, you know, I'm. I'm a knowledge worker. I'm in an office. You know, fortunately, I literally, I was sitting outside for like, 20 minutes, you know, today. And, you know, it's. It's like we need. I think it's like 63 minutes or something. They've done this study, um, on average per day to like, maintain like, positive mental health. And, you know, I went for a long run outside this morning and, you know, like, I, I definitely, like, I'm just like, I try to, like, get 90 minutes of, of outdoor time every day as much as possible. I. I think that's really, I think that's really important. It. It just, yeah, it, it affects. It's one of the things that it impacts is the amplitude of our circadian rhythm. So, you know, we have. Every physiological variable that we contract has a rhythm right to it. So your, your blood pressure, your heart rate, and, and you want, you want this beautiful rhythm. And you can imagine. And I don't know, people probably just listen to this. They can't really see me, you know, with my hands, but. But basically what I'm doing, you know, you can imagine like, you know, just like rolling hills, right? And you want these, you want these really big, you know, you know, you want this really big amplitude and peak and really deep trough and you. And that is a really, a measure of health, right? Like, if you were to look at someone who's, you know, on their deathbed, they'd have no amplitude, right? So amplitude is a. Is. Is. Is something that you want to preserve if you're interested in slowing down your pace of aging. And one of the easiest ways to, to preserve amplitude is to be outside is to create a lot of contrast between the day and the night. So you want bright, bright days, dark, dark nights, and that contrast will actually help preserve amplitude, which will reduce your risk of all sorts of things we don't want to have to deal with.
- [48:14]
A
Exactly. Wow. So much great advice. I took like a hundred notes here, and I could talk to you forever about this because I know you have so much more in your brain that we can talk about. But I do want to spend some time talking about your book aligned. Could you tell me what people learn from reading your book? Yeah.
- [48:30]
B
So it basically is a journey that takes you through just the physiology and then the psychology. So the first half of the book is really about this stress and recovery and how to think about that in your own life and just really giving folks an understanding. Very much the conversation we kind of had today just of what are the basics around stress and how do we think about recovery in that context, right. And how do we match the demands in our life with appropriate levels of rest so we can adapt in a functional, positive way to stress, which is inevitable. Right. And then I go deep into sleep and circadian rhythms. You know, I talk about, you know, jet lag, I talk about chronotypes, I talk about, you know, a lot of the things that exist out there in terms of how we think about sleep and our rhythms. And I talk about shift work. And so I go deep in, in, into that. And then I talk about intelligent training, so how to think. You know, I really go deep on the five domains of intelligent training. And, you know, one of the domains that I love is exercise snacks that we talked about on our, on podcast a ton, but I'm so bullish on exercise snacks. You know, when you're in my office, you saw my floatboard and my walking treadmill and my, my kettlebells and my resistance bands. But I'm definitely really, I think on this, in this mindset of just like trying to build in movement throughout the day. So that's one of the domain, one of the five domains of intelligent training. And I really try to frame this notion of, of training as a, as kind of a responsibility that we have, you know, when we have education and we have resources, I think we have a responsibility to keep our body health healthy, you know, and, and, and I, the other thing that I weave into that, into that chapter is really, you know, figuring out what your why is. You know, we talked about behavior change and motivation and, you know, for me, I spent my whole life, my mom was sick, you know, and really, really sick. And you know, the amount of space that took up in my brain, you know, as a, as a child and as a young adult, and I just don't want my kids to have to worry about mom's health for as long as humanly possible. I want them to see me thriving and to see me healthy and engaged and present and doing the things that I love and supporting them in the way that they need to be supported. And that's my why, you know, that's why I, I resist the train. And you know, and, and not everyone obviously has my athletic background and, and I feel really fortunate that I've been lifting since I was a teen, you know, but, but it's never too late to, to learn. And, and I hope that this chapter like inspires and empowers people and gives them the, the tools and the frameworks to understand how to engage in an exercise program that will help them live longer and healthier. And then the second part of the book is really the, the, the Inner world. It really goes deep on and, and offers a few frameworks. I, I go deep into trauma. You know, my background is. I'm not a clinical psychologist, but I have a deep background in, in, in psychology and have navigated my own trauma and, and have a framework that I call Heal. That really takes kind of this, this idea that we need to heal our nervous system, you know, in parallel with our, with whatever talk therapy we might be engaging in or what other therapeutic intervention we're engaged in that our, our nervous system, you know, we need to be consciously thinking about how to, you know, get our autonomic nervous system back online. Right. And it's really hard to recover from trauma to. Because it often, trauma often manifests in the nervous system in very profound ways. And I, I, Daniel Ipov is a, is a, is a, is a gentleman who I really respect, admire out of Northwestern, who's done a lot of this type of work and has really shown, you know, when you can heal the nervous system, it has huge impact on just your mood and your, your, just your feelings of well being and your sleep. And you know, it, you just move more. Right. Like, so I talk about it from that lens and then, and then I go into, you know, trust and fear and how to, how to think about that. I talk about time and expectations, attachments, memory and how to think about those in really productive, pro, you know, helpful ways and just how they manifest in a healthy scenario and a really adaptive scenario and how they might manifest in a more maladaptive way and how they might be keeping you from, you know, accessing, you know, your best self and your most flourishing self. Yeah. And then the third part of the book is a workbook. So the workbook really, it's kind of chapter by chapter, you know, so you can kind of jump around and you know, if you really want to, you know, think about personal readiness, which is, you know, kind of the final chapter of like the inner architecture then and really want to go deep on identity and values. Then you focus maybe on that chapter and there's that part of the workbook. So each chapter kind of has their own workbook where you can integrate a lot of the teachings and there's lots of prompts on questions to ask of yourself that help you think about some of these concepts. And then most importantly, like, what do I do? What are the actions, you know, that are. That are associated with, like, getting on a better path, you know? And so I really, I really wanted folks to have just this, like, really clean understanding of the psychology and the physiology. Right. And how these two work together to impact our mindset and our energy production, our motivation and our attentional capacity. Right. And because if we can understand these influences and we can build an understanding and framework around it, then we're kind of in a. In a scenario where we can choose our level of. Of flourishing, you know, and that's really what I wanted to try to offer with this book.
- [54:16]
A
I can't wait to get my copy. I really cannot.
- [54:19]
B
I can't wait for you to read it.
- [54:21]
A
Yeah, I love it that you've thought through it in such a way and you put actually, you know, action items and workbooks in the back because I think that really draws you into the content. And sometimes you read a book like this and it could seem like it's hard to grasp. But the work abstract. Yeah, yeah, exactly. You have to. Giving people the action items makes the jump easier from theory to actually making a change. So I can't wait to get my copy.
- [54:45]
B
Thank you so much for giving me the opportunity to talk about it. I love it. I love it.
- [54:49]
A
Well, I know we have a lot more to talk about, so I am going to have my assistant reach out to you to schedule another episode.
- [54:57]
B
I know we really. Yeah, we kind of. Yeah, we just scratched the surface today, but that's okay. I know.
- [55:02]
A
I'm going to wait till after your book comes out because I want to definitely ask you questions after I read that. That would be fantastic. Well, you're such a rock star. Congratulations on everything you've done in your career and your career. Whoop. And everything you're doing for us. And I can't wait to get this podcast out and let people know. Where can they find you?
- [55:22]
B
Well, I. I'm on LinkedIn and I'm on Instagram. Just Dr. Kristin Holmes on. On both. There's another Kristen Holmes, but she is a CNN correspondent and that is not me. She has dark hair, too. But. But yeah, that's. I'm just. If you put Dr. In front of it, then it will come up. Yeah. And. Yeah. And. And I, I try to. I'm not like, great at, like, posting. I do more stories. Like, I'm. I'm not great at content, but I. I do my best to get stuff out there every now and again.
- [55:52]
A
You're amazing. And then what is the link that people can buy your book at the presale.
- [55:56]
B
Yes. So it's basically available if you just literally go onto Amazon, you know and just like Dr. Kristen Holmes aligned and but yeah, I can, I can definitely shoot you the the link. Penguin Random House, you know you can kind of get out of everywhere at this point on on pre sale.
- [56:12]
A
Awesome. Kristin, thank you so much for doing this. We'll see you soon.
- [56:16]
B
I know. Thank you so much Dr. Shah.
- [56:21]
A
I really enjoyed that episode with Kristen Holmes. Dr. Kristin Holmes, who is an incredible PhD psychologist and also very well regarded in her field and obviously has a very high position over at woohp. So here are my top five learnings from that episode. Number one Reframing Stress for Better Sleep so perceiving a stressful day as challenging rather than threatening significantly improves sleep quality. Even if the physiological stress response, which is your heart rate, stays the same, your mindset directly impacts your body's ability to restore itself. I'm going to be doing this one for sure in my day to day life. Number two sleep debt impacts more than just you. Every 45 minutes of sleep debt can reduce a leader's mental control by 5 to 10%. And critically, it actually makes your team members feel less psychologically safe. So your sleep habits have a ripple effect on those around you. Number three, Recovery starts when you wake up. Achieving quality restorative sleep isn't just about what you do before bed. It's actually influenced by your entire day. Consistent light exposure in the morning and reframing daily challenges set the stage for better sleep at night. Number four Balance activity and recovery for optimal health. So while being active is crucial, a constant sympathetic flight or fright state is not ideal. Optimal autonomic nervous system function requires a good balance between high stress activity and restorative activities like walking. And number five, asking for help. This can actually help you shift your mindset and reduce stress levels. When feeling overwhelmed by stress, ask for help. This can be a powerful way to shift from a threatening to a challenging mindset. Recognizing what you can control and leveraging your resources, including others, actually calms your nervous system. Thank you so much for listening to the Extend podcast and please share this episode with someone that you think might need to learn about sleep and stress. Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review. Review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or a on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.