Unnamed Participant (3:22)

So that was interesting what you said, that the data really shows that adults are somewhere on the seven to nine hour spectrum. So if I regularly get seven hours and I feel okay about that, I shouldn't be nervous that I hear my friends say, well, I get nine hours every night. I shouldn't be saying, okay, well, I better get nine then.

Dr. Rebecca Robbins (3:41)

No. Sleep is very individual. We're very unique and kind of little snowflakes of a sleep duration requirement and imprint of what we really biologically truly need. And I think conversely, a lot of people can be worried that if they hear other people saying, oh, I get five or six hours, and I do great, because you hear that a lot. Unfortunately, we brag in our society about not getting enough sleep, and I hope at one point in my career I will see that change. I think we're starting to see signs of it even at the kind of upper echelons of the business world that's been known for bragging about not getting enough sleep and wearing their sleep deprivation like a badge of honor. And so I think it's easy for someone who's maybe getting seven or eight or nine hours to hear those stories and think, what's wrong with me? Why am I wasting all this time? Wrong. Anyone who's interested in performance must be interested in sleep. Because when you get your sleep schedules in line, you identify your personal sleep need. You're practicing consistent sleep, falling asleep ideally as close to the same time. Waking up is close to the same time. When you're doing those things right, you charge out of bed, you have more energy, you're more productive, creative, a better problem solver, so many good things happen. But I think the other interesting thing about sleep is that it's often miscommunicated in conversation. I think that if you ask someone how they are, they'll say, oh, I'M tired. And so you can kind of hear these battle stories of exhaustion and staying up late and cutting sleep short and think that that is a key to success. When all of the research shows that it's the opposite when we put sleep at the center of really all of our health behaviors. The dirty secret is you wake up, you wanna work out harder, you're gonna get more out of your workout, and you're gonna better manage your appetite also when you're well rested.

Unnamed Participant (5:28)

So are there certain types of people who sleep better or is it just the things that they do? Like, are there certain things you're supposed to do before you go to bed that mean you have better sleep or whatnot? Or are there different types of people that actually do better there?

Dr. Rebecca Robbins (5:43)

I'm not sure that this has been very well studied, but I think that there are some individuals who maybe are prone to struggling with their sleep a little bit more than others. We do have some data also that to show that women, after having children, their sleep becomes fundamentally a little bit lighter because they're on a little bit higher alert for sounds from babies, and then might struggle also to fall asleep as compared to their pre childbearing years. But all by way of saying, I think there are slight differences. Some people say up and down. I'm a great sleeper, easy, no worries, you know, as long as I'm practicing the dictates of healthy, you know, sleep hygiene and behaviors in terms of getting enough sleep, keeping consistent schedules. Whereas I think there is another group of people, it's not a huge proportion of the population for whom sleep is a little bit more of a struggle. So that could maybe mean working harder to calm your mind. If you're in that category, it could be, you know, making an effort to journal, write down your worries before bedtime if you fall in that category.

Unnamed Participant (6:41)

So, you know, I have this ring on this Oura ring and I think I saw. Do you have something, a wearable of some sort? So I get these sleep reports every morning. Are these reliable? Do they tell me when it says I was in deep sleep or light sleep or this or. I got a. Unfortunately, I think this morning it was a 62 recovery index.

Dr. Rebecca Robbins (7:00)

I've been there.

Unnamed Participant (7:01)

Are these reliable? Where does this data, how does this data work?

Dr. Rebecca Robbins (7:04)

Really good question. So in 2017, I published a paper that used nationally representative data and asked this representative sample of adults in America, do you track your sleep with some sort of smartphone app or wearable technology? And in 2017, about 28% of our sample, representative sample of adults in the US said that they were tracking their sleep with some sort of technology. Now, fast forward to where we are, and I would wager that that number has exploded. We don't have a good pulse on our population right now, and I think that study needs to be redone. But I would wager that it's a pretty high number of our proportion of our population are really interested in better understanding their sleep. And I think that that's almost a bellwether indicator of a growing collective interest and awakening to the importance of sleep. Because for so long in our society we have privileged exercise, nutrition above work, family, and in some cases that's very well founded. If you have deadlines or times in your life when you're having kids, et cetera, there are going to be periods of time where your sleep is not going to be great. But I think there's this really exciting collective awakening to the importance of sleep. And I think that's only a good sign that people are really becoming more interested in their sleep, better understanding it and improving it. Now, when it comes to sleep trackers, we published a paper this fall and it was funded by Oura Ring in full disclosure. And we compared the Oura Ring, Apple Watch and Fitbit to the gold standard, which is our laboratory at the Brigham and Women's Hospital. And we call the gold standard polysomnography, meaning many methods of measure. When you come into a sleep laboratory, you're connected to electrodes and heart rate measurements and respiratory effort to give us a really robust understanding of what's happening in the body and the brain during sleep. Now, when we pit those three commercial sleep trackers against the gold standard, one thing stood out very clearly, that these devices all do very, very well in comparing wake to sleep. More than a 95% correlation between what you're seeing from your tracker and the gold standard in terms of sleep wake detection. Now, as we go into the different sleep stages and compare the performance of each of the devices to the gold standard, a couple things stood out. Unfortunately, we, despite the devices being initialized, we had some data dropout. We weren't able to obtain data from several participants who wore Apple Watch and Fit Bit data. We didn't have that problem with Oura Ring and then a couple of the other observations as it relates to sleep stages is the devices each varied in terms of their performance in comparison to the gold standard on the specific sleep stages, from light to deep sleep, stage three to rapid eye movement sleep. Now, the performance ranged from somewhere about 50% performance or accuracy in Detecting certain stages as it related to the Apple Watch up to in the high 80s for some of the other devices. So there was a little bit of a range. But overall the devices are really improving in their ability to accurately measure these stages. But I will note they are not perfect because to truly understand if you're in rapid eye movement sleep or deep sleep, ideally I have some sense of your brain activity, but outside of a laboratory setting, it's not too shabby. So do be relatively confident in what you're seeing from these devices, but do also take them with a grain of salt. If you see one awakening and you're looking at your data and you're like, I don't think I was awake. Maybe that wasn't a true awakening. But it's actually not uncommon for us to wake up over the course of the night and maybe not remember it, you know, micro awakening and then going back to sleep. So I think of these tools as a really amazing opportunity to have something like a mini sleep lab on your finger, on your wrist at night. They're not perfect, but they are really powerful tools for really understanding our sleep because it's been a black box for so long. You know, we'd fall asleep and wake up and have a general sense of how much sleep we were getting. But I think one of the most powerful use cases for consumer sleep trackers is the fact that it takes the healthy sleeper about 15 to 20 minutes to fall asleep. And often when I speak, I like to ask people, how many hours of sleep are you getting? And I ask for a show of hands. And so often people say the entire room, I get seven hours almost. And actually, if you think you're getting seven hours, you're probably getting closer to six or six and a half because we don't factor in that time that it takes us to fall asleep.

Unnamed Participant (11:40)

Yeah, I know. That makes total sense. I was talking with my students about it the other day and it was shocking how little sleep these college kids are getting.

Dr. Rebecca Robbins (11:48)

Okay, in full disclosure, my sleep data last night my ring was like yelling at me. They're like, what's wrong? Because my kids have been sick and the past two nights they were up, and then last night I just woke up at the time that they've been waking up. It's amazing how we can fall into these ruts with our sleep. The important thing is kind of realizing that they happen. Sleep's not going to be perfect every night. I think that's another reason that the trackers are kind of powerful, to just promote awareness on the connection between what we do during the day and then our sleep. When you wake up and you get a bad score, then it prompts this automatic self reflection whereby you just reflect on what you did yesterday. And oh, I did have a little bit too much caffeine. I was pretty stressed last night yesterday. And how that might motivate successive behavioral changes is a really exciting application of these technologies.

Unnamed Participant (12:36)

No, absolutely. I found that the actions I've taken from my OURA ring have been that I see the sleep score that morning and it's. If it's a bad score, I always get into bed earlier that night because I go, oh, I got a bad night's sleep, I need to get more sleep tonight. That's always, that's been my action. So I imagine it's got to be doing something good.

Dr. Rebecca Robbins (12:55)

And that's a wonderful observation and I think another really helpful thing for all of us to keep in mind, because sleep is so psychological and it's easy to wake up and, you know, or I think some of the causes of kind of insomnia, like symptoms at night can be this fear of if you wake up, like, oh, I'm up, I want to be asleep, but I'm up. And then you kind of kick yourself and then your cortisol spikes and then you struggle to fall back asleep. But I think, you know, the self talk is really important that, you know, you got to, no big deal, take it in stride and then try to get back to sleep. But similarly, when we wake up after a night of poor sleep, it's easy to kind of spiral be like, oh, my day is going to be terrible, it's going to be ruined. One of the things to keep in mind, the human brain and body are just fascinating and can really operate quite well, actually on maybe a night or two of insufficient sleep. And so just tell yourself that after a poor night of sleep, I will get back on track. And then if you start to look forward to that night, I love it. Liberty getting to bed early and then just realizing that you need a reset that next night and that just that idea can sometimes help you power through. Good.

Unnamed Participant (14:01)

Then it's doing what it's supposed to do.

Dr. Rebecca Robbins (14:03)

I love that you're nailing it.

Unnamed Participant (14:05)

So I have to ask about pills, medication that people use to fall asleep. Whether it's over the counter Benadryl or whether Ambien and Halcyon and Xanax and everything that people are using. Should we be using these things? Are there ones that work better than others? Are there ones that help us get back onto track so that we're not having to take them. What does the data say on sleeping pills?

Dr. Rebecca Robbins (14:28)

The recommendation from the American Academy of Sleep Medicine is to speak to your healthcare provider. And there is a time and a place for these interventions. And for someone who's perhaps experiencing grief or struggling to manage their mental health because insufficient sleep and poor mental health are so closely linked. And if you just need to kind of get yourself back on track, and the big behavioral tips and strategies that we're talking about, you know, getting into bed a little bit earlier the next night, adding a little bit more sleep in your bank account, relaxing and unwinding before bedtime, if those recommendations are not enough. And people will say, often with insomnia that really need these sleeping medications will often say, I've tried everything and nothing is working. Now, the front line for insomnia care is actually a behavioral regime. It's called cognitive behavioral therapy for insomnia. And the data show that this is a wonder drug of a behavioral intervention because it really works. And when delivered with a licensed, experienced clinician, this therapy is amazingly beneficial to individuals with insomnia. Now, the downside is there are very few providers who offer this type of treatment. We have a kind of a dearth of sleep specialists. Unfortunately, in our country, not enough medical students are going into sleep specialties. And then within that cohort of already not enough physicians to supply the demand of sleep difficulties, there aren't enough healthcare providers that do CBTI to meet the demand. There are some novel approaches and companies that are emerging that are thinking really thoughtfully about maybe AI powered CBTI interventions or avatars or scalable ways to deliver cbti. But if we look at patients who have insomnia, after about two or three weeks of intensive cpti, their symptoms drop off dramatically. Now, what's interesting is that drop off in symptoms for insomnia patients is mirrored by individuals in a pharmacological intervention condition. So both the behavior and the pharmacological intervention do very well right away. What's interesting in the longer term for keeping insomnia symptoms at bay is the behavioral regime. The pharmacological intervention starts to kind of not be as powerful in the longer term. And that's such a really compelling, compelling narrative, A behavioral routine that really is as powerful as pharmacological intervention, if not more so in the longer term. But it comes back to some of the age old challenges in medicine and healthcare of providing these types of treatments at scale, because pharmacological intervention is much easier Think of a busy provider. A patient comes in, voices, sleep complaints. It is much easier to provide a pharmacological intervention. But again, there are very important use cases for this intervention. I think, generally speaking, depending on the condition, we try to think of a pharmacological intervention as a way to intervene and not as a longer term solution, but help someone during a difficult time. And again, it depends. So please speak to your healthcare provider always, because there are very valid cases where these interventions are going to be required in the longer term. But they are, again, a godsend for many patients suffering from insomnia, but not something that we recommend across the population.

Unnamed Participant (17:48)

You know, I. I'm pregnant and sleep has been a nightmare recently. So I have, and I've, I'm sure I've been Googling it. So now Instagram is targeting me with all these sleep trends and I've watched sort of countless videos online from people swearing by their own methods. And I've tried some of them, you know, so I tried blue light glasses and they gave me a headache. And I was about to start taking magnesium and then I decided I shouldn't do that for the baby. And then I did mouth tape, but I'm congested. So I woke up feeling like I couldn't breathe in the middle of the night. I'm like, oh my God, none of these are working. Are any of these trends really promising or are there any of these sort of online trends that are potentially harmful? Where have we sort of seen the data show something good or bad?

Dr. Rebecca Robbins (18:35)

Great question. And you're not alone, Liberty. During pregnancy. Oh my gosh, it's such a difficult time. I've been there. I have two young kids. I remember it all too well. Especially as you approach the third trimester where you just get uncomfortable, it's hard to find a position to be able to sleep. And if this has been your experience, we do also understand that babies in the womb are kind of rocked to sleep as mom walks around and then they can start to wake up when you want to be powering down at night. So then that can further, as the baby grows, hinder your ability to get a good night's sleep. So realize that you're not alone. I think you're doing everything you can. I love that you're looking at ways to improve your sleep. I will caution you against some of these hacks and things you see on TikTok and social media. We actually published a paper on the presence of misinformation about sleep on some of these common social media platforms. And we found that the presence of concerning misinformation about sleep was prevalent in videos that were produced by non experts like bloggers or content creators that might not have sleep expertise. It's just one example that one of the most kind of ridiculous claims and one of the most popular viewed by millions of people talked about a magical sleep button on your forehead. And so it's almost laughable, you know, some of this stuff, at least I.

Unnamed Participant (19:46)

Haven'T read that one.

Dr. Rebecca Robbins (19:49)

The mouth taping trend is a really interesting one because it really all came from a book called Breath. And in that book there is a journalist who described a bunch of different studies and reported on some research in a really thoughtful way on the importance of nostril breathing, avoiding mouth breathing for your health and for a number of different areas. And in one paragraph, I think it was described in a sentence or two. They'd interviewed a dentist who was encouraging a patient to breathe through their nose by applying duct tape to the patient's mouth at night. And I actually, I kind of come from the business world, so I'm, you know, I'm always intrigued now as a scientist thinking about how these huge industries emerge. That's how it happened, this mouth breathing trend. And then companies emerged that were creating these different, you know, products. And now it's a multi million dollar. Yeah. Industry. It's enormous. Some people swear by it. I just would love to study it. I would love to understand how it improves. Improves sleep, if it does. And you know, what might be the cautionary tales, Because I do think it would be important just to document any adverse events or anyone for whom mouth taping would really be something to discourage.

Unnamed Participant (20:57)

Absolutely. Yeah. Well, my $50 mouth tape has only gotten one use, so if anyone needs someone, let me know, I'll send it. Are there sort of modern sleep myths that researchers have debunked or things that we thought about sleep for a long time that we've now changed our tune on?

Dr. Rebecca Robbins (21:14)

We published a paper on the most common myths about sleep because as sleep scientists and specialists, one of the most common questions we get are often almost phrased as a myth. You know, I've heard that people can get by on five or six hours. Is that true? And so we spend a lot of our time debunking myths about sleep. And I think that would be true for any area of medicine or, you know, public health that maybe is kind of emerging and you know, growing in interest. And I think the case for Sleep now, which makes it an exciting place to be again because of this Kind of awakening about the importance of sleep and collective increased attention to it. But yeah, so we spent a lot of our time debunking myths. So we wrote a paper on the topic and one of the most common is the age old idea of that one person someone knows or the cousin of someone they know who sleeps for five hours and does great. We also have historical narratives about figures like Thomas Edison. Woodrow would brag about getting five hours of sleep, but what's not widely known is Thomas Edison had a cot in his office and would spend hours in the afternoon sleeping. And so I think we hear these. Yeah, these old wives tales that are passed down. And I mean, wouldn't that also be nice? Right. If you only needed four or five hours, we'd have so much more time in the day. But we don't yet have a treatment or any tool to kind of consolidate the benefits of sleep in a shorter period of time. We just have to spend the time sleeping. Another one of the common myths that we hear is alcohol, the kind of idea of a nightcap being good for your sleep. Alcohol is one of the most common and widespread sleep disruptors. One glass of wine or beer with dinner a couple hours before bedtime likely won't have a big impact, but depending on your body mass index, and if you have more than one, then it's going to start to fundamentally interrupt the architecture of your sleep. So if anyone you know had been out and drank a couple glasses and you maybe fell asleep quickly and you just woke up feeling awful after 9, 10 hours of sleep, why do I feel so bad? We feel so terrible because alcohol starts to interrupt some of the most restorative stages of sleep. It deprives us of rapid eye movement sleep and results in more awakenings, more trips to the bathroom. So you might spend a little bit more time sleeping, but it's not going to be good quality sleep.

Unnamed Participant (23:42)

Yeah, no, but pre pregnancy that was definitely me. So I think that's definitely true. You know, following up on your Thomas Edison thought here, is there research sort of about this split sleep schedule, like can you get the same benefit from a short nap and a little bit of sleep, or is it better if it's all in one go?

Dr. Rebecca Robbins (24:03)

We do have a lot of data to show that the most optimal health well being longevity outcomes come when we consolidate our sleep to one period that's ideally between seven and nine hours. And ideally we're meeting that as many nights of the week as possible. And in addition, finding a time that we can fall asleep and wake up and keep those times consistent as much as we can, as many nights and mornings of the week. Now, we do have historical evidence that our ancestors slept in two periods. They would fall asleep with the sun. And if you imagine Boston in the winter months in the 1700s, it would be hard to have one consolidated period of sleep because the sun would set at 4:00 and rise at maybe 7, 8:00 in the morning. So it's a lot of time without any sunlight. So the historical records are showing that many of our ancestors would fall asleep with the sunset and then they'd wake up in the middle of the night and they'd be up for maybe 30 minutes, maybe an hour, play games. We think a lot of children were conceived around this time, in the middle of the night, and then they would fall back asleep. And what was so prescient is many of these populations refer to the second period of sleep as sweet sleep. And in the architecture of a healthy night of sleep, we see that deep sleep predominates in the first half and then rapid eye movement sleep predominates in the second half. So if you're interrupting your sleep at the midpoint, you're going to have REM rich sleep in the morning, which is where we get all of the benefits cognitively of our sleep. And isn't that fascinating that our ancestors would be able to have some awareness that this sweet sleep in the morning is what allowed them to be kind of cognitively fresh after waking?

Unnamed Participant (25:48)

Yeah, it's amazing how that sort of works.

Dr. Rebecca Robbins (25:51)

But again, all of the benefits from the standpoint of our heart health, our body health, our brain health, all show that the consolidation of sleep is critical whenever possible. And thinking about adding in naps really is kind of a band aid. If you didn't sleep very well and you are dragging instead of leaning on a caffeinated beverage that might hurt your sleep the next night, the best strategy would be taking a nap. I always laugh when people say, what's the best energy drink or caffeine or when can I take it? Or a caffeine nap. It's so funny to me how we push back on the one evidence based way to alleviate sleepiness, sleep.

Unnamed Participant (26:27)

Take a nap.

Dr. Rebecca Robbins (26:28)

Yes. And there are a couple different naps you can take. Some research from our colleagues at MIT is showing that even a few seconds or moments in a nap, if you, you're just feeling a little sleepy, can give you a boost of creativity, believe it or not. And moments or seconds. And I love that research because it really lowers the bar right because so many people say, yeah, totally. They're like, no, I can't nap, I'm not a napper. Can't do it, not for me. But if you just lower the bar, set an alarm for 20 minutes, and if you sleep for the 20 minutes, we call that a power nap. But even if you sleep for a few seconds, you actually can wake up and be quite refreshed.

Unnamed Participant (27:00)

That's really cool to know. Well, I think I have 8 million more questions, but I am cognizant of your time. So I will end with sort of our final wrap up question that we always ask everyone. We ask everyone a magic wand question. So our question to you is if you could wave your magic wand and create your dream sleep tech so your own wearable, that you've created something that doesn't exist yet, what would it do you?

Dr. Rebecca Robbins (27:30)

I'm really inspired by the idea that with the fact that so many millions of Americans miss their annual doctor's visit, don't see their healthcare provider, and I'm very inspired by the idea that some of these wearable devices could be a sleep coach on your finger, on your wrist. And I think we do have a little bit of a ways to go to really leverage some of the insights that these wearables are providing and couple that with evidence based recommendations. Notice that you fall asleep about an hour later than normal last night. Let's get you back on track and really serve you up some very actionable, very accessible, personalized information. I think the future is so exciting for really being able to personalize behavioral interventions and support people's sleep. And sleep is connected to virtually every aspect of our health and well being. So by prioritizing that, I think it could do a world of good for the health of our nation or people, our populations, our communities. But right now, sleep does remain out of reach for many people. We talk about sleep often as a health disparity. Sleep is in many ways a luxury. Good individuals in lower income communities, where there are brighter lights, there are louder sounds, there's more crime, have lower sleep outcomes or worse sleep outcomes than do individuals in higher economic areas. So I think that that's one thing. The other area that I am extremely excited about is neuromodulation. It's the idea of using technology, auditory et cetera, to identify your brain waves and states and deliver some targeted interventions that might help improve the quality of the rest and the sleep that we are able to get. And that is to me the most exciting area for the future to get some of these devices to be really accessible, usable at a price point that's accessible to individuals across different economic strata.

Unnamed Participant (29:30)

Well, thank you. This has just been absolutely.

Dr. Rebecca Robbins (29:32)

Thank you for having me.

Unnamed Participant (29:33)

I'm glad Shelley wasn't here because he loves to drink before he goes to sleep, so that would have been.

Dr. Rebecca Robbins (29:37)

Oh no.

Unnamed Participant (29:38)

Horrible message for him to hear.

Liberty Vittert (29:45)

Thank you for listening to the Harvard Data Science Review Podcast. To stay updated with all things HTs, you can visit our website at HDSR, MITPress, MIT.edu, or follow us on X and Instagram @the HDSR. A special thanks to our executive producer, Rebecca McLeod, producers Tina, Toby Mack, Arianna Frank, Gavin Yang and Belle Reilly. If you liked this episode, please leave us a review on Spotify, Apple, or wherever you get your podcasts. This has been the Harvard Data Science Review. Everything Data Science and Data Science for Everyone.