← The Dr. Gabrielle Lyon Show
The Dr. Gabrielle Lyon Show
The Truth About Sleep: Myths, Tips, and Longevity Secrets with Dr. Rebecca Robbins
01:13:29
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- [00:00]
A
One of our biggest myths is that when our head hits the pillow, our brain just kind of checks out for the night. If you're falling asleep right away, you're probably starved for sleep.
- [00:10]
B
Do you have tips or tricks? I mean, I want to share mine that I think will solve everybody's sleep problems. Number one, sleep is just the ultimate.
- [00:19]
A
Accelerator of good health. The quality and quantity of our sleep is one of the strongest predictors of our longevity.
- [00:25]
B
You have talked a lot in the past about cognitive health, Alzheimer's, mortality. Are there sleep biomarkers?
- [00:33]
A
The truth is sleep is not going to be perfect every night. But the key is getting back on track towards those four components. Sleep is a product of two processes. The first is called the homeostatic sleep drive. For the risks of circadian desynchrony, the difficulties for our bodies to really repair and get good sleep. Shift work has been named a probable carcinogenic.
- [00:55]
B
Do you have a position on sleep medications?
- [00:59]
A
The research that pits those two treatments head to headpharmacological intervention and behavior change. Those two patients sufferers of insomnia, and we compare them over time. The behavioral treatment wins out.
- [01:19]
B
Why should we sleep?
- [01:20]
A
Well, sleep is one of the most important parts of a typical 24 hour day. But unfortunately, so many of us, whether we choose on our own volition to curtail sleep, whether it's watching Netflix, staying up for another hour to do another report or something, a professional obligation, a personal obligation, or out of necessity, if you're working multiple jobs, your time to sleep is going to be crunch. But sleep is one of the most vitally important parts of our typical 24 hour day. Over the course of our sleep at night, our blood pressure drops to its lowest point in the 24 hour day is just one example. And that natural dipping of blood pressure is vitally important for us to wake up and maintain a healthy blood pressure. Our emotional regulation gets out of sync. Our ability to maintain a healthy appetite is thrown off when we're not getting enough sleep. But when we can reverse that, when we can put sleep at the forefront and higher on our to do list, higher on our priority list, so many positive things fall in line. Our emotions, our relationships, our productivity. So often I laugh. People say, you know what's the best productivity hack? In the afternoon when I'm sleepy, I'm like, just take a nap. It's so interesting that we push back so hard against the idea of a good night's rest. But couple that with the fact that in at least the United States, we really don't have proper education about sleep. We're really not informed about evidence based principles when it comes to sleep. For instance, I don't know if your mother ever told you this growing up. We love your mother, but my mom would always say if you're struggling to sleep at night, stay in bed. You'll get some sleep. Stay in bed. But wrong. If you're experiencing insomnia, we want you out of bed, we want you to reset, to go do something relaxing and build up what we call sleep pressure and get back into bed when you're ready and give it a shot again. It should take you about 15 minutes to fall asleep and much longer than that. We want to break the cycle. We want to get you out and then trying again when you're ready.
- [03:15]
B
We do hear a lot about sleep now, probably more than we ever have. How long have you been in sleep science?
- [03:22]
A
I admittedly was interested in other areas of medicine earlier on in my career. Exercise physiology, nutrition, nutritional sciences or other areas broadly, really interested in health behaviors and how to promote health behaviors in a western society where we are taught to treat treat diseases. So that really was a big driver of my going to graduate school. And I just became amazed by the research in sleep and I took a class that was taught by Dr. James Moss. We tragically just lost him. He was older and has had an amazing career, but he was larger than life. At Cornell, where I went to undergrad, and he was known as the sleep professor. And he coined the term power naps in the 1980s in response to the power breakfast and power lunches. He said, take a power nap in the afternoon to boost your productivity. And he was just an incredible guy. He taught Psych 101, promoted awareness about sleep in the context of this course.
- [04:12]
B
Definitely when I was in my fellowship training and when I was in my residency training, we don't talk about sleep. So, oh, you're tired. Too bad you're gonna work the night shift. Sorry for you.
- [04:21]
A
I was there. I did it for, you know, five years. Now it's your turn, right?
- [04:25]
B
Yeah. There seems to have been a turning point in our understanding about sleep, brain function, sleep metabolism, that at least for the general population as well as medical providers, there's been a turning point. And I'm curious as if you've seen that from before to now. And if you see us still moving forward.
- [04:52]
A
Sleep medicine is a really exciting field. It seems as though we're advancing our understanding of what happens in the body and in the brain. Almost every week there are fascinating, exciting new Discoveries and it's a really exciting field to be. It hasn't always been as hot, admittedly as it is now. I think only recently have we really collectively woken up to the importance of sleep. And sleep is also a relatively new field compared to other areas of medicine. Some of our seminal discoveries were in the late 70s, 40, 45 years ago. We didn't know what contributed to our circadian rhythms. We didn't know the importance of blue spectrum light as the strongest input to our circadian rhythms. We thought it was behavioral patterns and that helped us align our sleep and wake cycles in a typical 24 hour day. A lot of our discoveries have only recently taken place and it seems as though we're uncovering new and fascinating insights. Virtually every every week almost are new exciting findings coming out about the connection between sleep and any number of areas of our waking lives.
- [05:52]
B
Curious as to how much we actually should sleep because there seems to be a wide range. And I also have heard that there is a genetic mutation that some people need less sleep. Have you heard this? And they. Of course.
- [06:08]
A
And it's so funny because it always seems to be someone who's not. It's not you personally or you know, someone you know, often it's this person who's a friend of a friend. And they. Did you know that they can sleep for four or five hours?
- [06:19]
B
But I would say our community, the military community. Oh yes, that the operators, they seem to function. I know it's not great, but they. It's almost as if there is a natural pattern, maybe four to five hours of sleep.
- [06:33]
A
There are so many aspects of active duty that makes sleep difficult. You know, of course you're sleeping in an uncertain environment with threats around you. And those are two of the biggest culprits of sleep difficulties. When you're in an environment or you're kind of, you're nervous, you're on edge. If you think about maybe before a big deadline for any of us, you get stressed and worried. There are so many profound and very real barriers to sleep in the military population. If you think about active duty and all the number of stressors that are so real and so profound, they of course take an enormous toll on sleep. And then sometimes there are patrols that you have to go on in the middle of the night. And so in many ways you might be on kind of a shift work like schedule, which can dramatically disrupt your circadian rhythm. Because sleep at the end of the day is all about feeling at peace, about feeling, you know, at peace with your surroundings, safe and Comfortable. And when those pieces aren't there, it's very difficult to calm your mind and be able to drift off into sleep.
- [07:34]
B
If you were to convince me that I need to sleep, what is the average American sleep?
- [07:40]
A
Adults need somewhere between seven and nine hours for optimal health, alertness, well being and not, you know, well being today to tomorrow and into the future. The quality and quantity of our sleep is one of the strongest predictors of our longevity. Not only how long we're going to live, but the quality of those years. And that sweet spot for sleep for adults is somewhere between seven and nine hours. And now it's a range because you might have, it's in large part genetically determined. If you've had two parents that are shorter sleepers, and I say shorter meaning about seven hours, you might be lucky and be fine on seven hours of sleep. But there are many people who have a little bit of a longer sleep need, physiologically hardwired sleep need and need to meet that night in and night out. And if that's nine hours, and again, if you had two parents who are longer sleepers, you might be on that longer end of the spectrum. Now we recommend a range, and finding where you are in that range is vitally important. And if you're listening, you might be far from that range. And so think about where you are right now. If you're really getting five or six hours of sleep. We don't want to move in sweeping changes towards a new sleep duration, because our sleep is all about routine. Sleep is a product of two processes. The first is called the homeostatic sleep drive. Now, if you imagine having a backpack on and you wake up in the morning, and each additional hour I put another brick in that backpack such that by the end of the day you are dragging. That's the idea of homeostatic sleep pressure. It's the feeling of sleepiness. But that's not all. And anyone who's traveled internationally to a new time zone, you could have been traveling for 12, 14, 24 hours, be physically exhausted, but not be able to sleep. And that's because the second opposing or synergistic process is the circadian rhythm. Now, humans have evolved over hundreds of thousands of years of life on Earth to an approximately 24 hour day. Other planets have different durations, haven't been there. Yeah. But on Earth, we have evolved to operating on a 24 hour cycle. Now, it serves us from an evolutionary standpoint to match our surroundings, have periods of time where we are off, our cells are repairing, our body is repairing and regenerating itself over the course of our sleep at and then when we're awake and our ancestors were looking for food, we're defending the village from predators. So, and it serves us to not simply kind of operate in a linear fashion, our performance increasing with each additional hour awake, but instead there's a real rhythm to our lives. And we refer to this as our circadian rhythm, because virtually every cell in the body operates in this circadian fashion. Circadian is Latin for about a day, referring to processes that ebb and fl approximate 24 hour day. Our sleep is one such circadian rhythm. And the hormones underlying our fundamental ability to be awake or be asleep also oscillate around that 24 hour cycle. And the best thing for that cycle is routine. So falling asleep at the same time, eating your meals at the same time, exercising around the same time every day, and then having a time where you enter a cold, dark room, ideally, and you fall asleep. And the hormone melatonin plays a large role in that. And that hormone melatonin is secreted in the brain. When we approach our habitual bedtime, the sun sets in our environment and we slip into our bedroom and we fall asleep and we wake up and the melatonin stops in the morning. And then we're able to go about our day. But those two processes interact and result in our fundamental ability to sleep.
- [11:20]
B
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- [13:01]
A
It really is a sensitive system. And if we for instance, one of the most common mistakes that a lot of people make is sleeping in on the weekends. And I think we are kind of enamored with this as a society actually. Oh, the idea of sleeping in or the British, you know, all lion. I think this, you know, it's interesting, almost every society has a term for this and it's always cast in a very positive light. So what that does unfortunately from a circulation rhythm standpoint is delaying your rising time by more than an hour will start to give your circadian system information that you have hopped in an airplane and you've flown to a new time zone and that your. So your body is then going to be working actively against you the next night because it thinks that you're shifting to a later time zone. Your regular bedtime is going to roll around and you're going to experience insomnia.
- [13:46]
B
And you're going to stay awake and you're going to watch that movie because you have this burst of energy.
- [13:50]
A
So many people in our society fall victim of this because they think sleeping in is a good thing. I'm gonna do that, I'm gonna catch up on lost sleep. And up until a point if you maybe wanna add 30 or 45 minutes to your wake up time, that's fine. But really much longer than that does put you in the kind of in the risk area for what we refer to as social jet lag where we self impose jet lag like symptoms because we've in essence given our body our physiological cues that we're trying to adjust and we're kind of experien jet lag symptoms often for social reasons because we often are staying up late to go out to a movie to you know, spend time with our loved ones, which are all wonderful things. But then resultingly we'll wake up later in the next day and then maybe suffer from some insomnia symptoms the next night.
- [14:37]
B
What about this idea that I'll take my husband as an example, he's a third year urology resident, wasn't on call last night but he finished at 1 o'. Clock. All the surgeries got pushed later in the day he was exhausted but he still had to get up at 5:30 this morning. He'll go, he'll do that now for the next five days. At some point as we just think about our lives. Is there a way to repay that sleep debt? And if so, how does someone do that?
- [15:10]
A
Medical residents are some of the most sleep deprived in our society, but they are being trained to go out into the medical field and save our lives. In the case of your husband or sir, surgeons or do life saving treatments. But so often our medical professionals are trained in these environments that are fraught with sleep deprivation. And if you're a general healthcare provider and you've come of age in this system, you're probably struggling with sleep yourself. If you were on a series of rotating night shifts, and that is a huge risk factor for insomnia. In many cases, we find patients who are struggling with sleep difficulties. They go speak to their doctor, and their doctors are prescribing sleep medications because they might be on them themselves or they're struggling. And there is a time and place for sleep medication. But the frontline for sleep difficulties is, according to the American Academy of Sleep Medicine, behavior change.
- [16:00]
B
So, for example, he wants to sleep. He wants to sleep. And after that, after having four or five hours of sleep a night, would he then be able to recoup that?
- [16:12]
A
Well, your husband is doing something that is really challenging. It sounds like it's rotating shift work, which is the case for many medical residents. And it's part of the fabric of our medical. But my team has published research in the New England Medical Journal to show that those types of schedules and sleep disruptions for medical residents are a significant predictor of medical errors. And so we really have to ask ourselves, you know, how can we set our young people up, the people who are getting their training, especially in the medical field, for success, not only for their health and their wellbeing, but the health of their patients also. And so what he's doing right now is rotating shift work, which is the most difficult type of shift work, because your circadian rhythm can't align itself with any pattern of normalcy in a typical week. So in the case of your husband, it is gonna be making up for lost sleep whenever and wherever he can.
- [17:02]
B
He's gonna be very happy to hear that.
- [17:04]
A
Yes, please fully endorse this. Sleeping in and also making up for lost sleep with naps, their shorter nap. If he's, you know, he got a little bit of sleep the night before, he's not, you know, too much in the dangerous zone of, you know, really falling asleep, being just absolutely exhausted. And if he has time for a longer nap, then a 90 minute nap is wonderful in the afternoon, say on a weekend, if he's off to to make up for a lost sleep.
- [17:25]
B
It's interesting in the way that on one hand you want a consistent sleep wake cycle is what I'm hearing you say. And that is almost separate if you cannot have that. If you are someone who does not have a consistent sleep wake cycle, you want to sleep. That would be an indication to sleep in or an indication to sleep when you can.
- [17:50]
A
Totally. And we work with a lot of shift worker populations, whether it's truck drivers or medical professionals. And in those situations the best recommendation is to try to find. To look at periods where you're maybe on a rotating shift schedule is a shorter term situation. And moving into at least patterns of shifts that are predictable. That is the best case scenario because our society is really powered by individuals on shift schedules outside the traditional nine to five. It's how we have 24, seven access to food or customer service hotlines or medical help and attention. And so we owe our shift work a debt of gratitude in our society. But their sleep really suffers. And unfortunately we have determined that for the risks of circadian desynchrony, the difficulties for our bodies to really repair and get good sleep. Shift work has been named a probable carcinogen. So really moving off these schedules as quickly as possible and into a schedule at least of consistent shifts or ideally shifts that emulate the pattern of light and darkness around us where possible.
- [18:54]
B
I would love to hear what happens to the brain when we sleep.
- [18:58]
A
One of our biggest myths is that when our head hits the pillow, our brain just kind of checks out for the night and our body. And we're in this monolithic state of sleep. Wrong. There's so much rich and diverse activity in the body and the brain and it changes over the course of our sleep. At night sleep is characterized by patterns of electrophysiological activity. And each of those are nuanced across sleep stages. We distinguish over the course of a typical episode of sleep at night between. Between rapid eye movement sleep and non rapid eye movement sleep. Rapid eye movement sleep is where, as the name suggests, our eyes are darting back and forth, back and forth. And there's a tremendous amount of activity in the brain, as much if not more so than when we're awake. It's fascinating.
- [19:43]
B
Wow, really?
- [19:44]
A
And we call it paradoxical sleep because there's so much activity happening in the brain and very little activity happening in the body. You're essentially immobile during rapid rapid eye movement sleep. Other health behaviors, you have to get on a treadmill, you have to buy healthy food. But sleep can be Free and start tonight. There are sleep disorders. There are more than 80 differentially diagnosable sleep disorders that are limiting many millions of Americans from getting good quality sleep. But once we can remove barriers, occupational barriers, personal barriers, cultivate healthy sleep habits, we're able to make significant gains not only in sleep, but in daytime success, which is what we're all about. If we were to welcome you into our laboratory in Boston, we would hook you up with electrodes. And the gold standard of sleep measurement is what we call polysomnography. So we would be able to measure your brain waves, your respiratory effort, and a number of other things, bodily movements, et cetera. And what we would see as your brain starts to slowly enter some of the lighter stages of sleep. You're drifting off into sleep as the pens of the electrodes start to slowly and the amplitude of your brain wave starts to increase. The amplitudes being the space between a peak and a trough of a brainwave, start to lengthen, indicating that you're starting to slow down the brain activity. And then the frequency slows. And then in stage one, sleep is kind of a way station between the awake and the asleep state. And then as you slowly drift into stage two sleep, and then stage three is the deepest sleep of the night. I think it's what we think of stereotypically when we think of sleep. Very long spaces between the peak and trough of a brain wave. So very slow, very high amplitude brain waves really looking and sounding like you're asleep. Now, during stage three, deep sleep is where we get a lot of the benefits from the standpoint of muscular regeneration, then something fascinating happens. After about 20 minutes in a healthy sleeper, I will start to see signs of rapid eye movement sleep. As the name suggests, your eyes are darting back and forth under your eyelids, eyelids. And that movement in your eyes is indicating a rich amount of activity in your brain. Your brain during rapid eye movement sleep is as active, if not more so, than the waking brain, which is fascinating. And then we cycle in and out of those different stages several times over the course of the night with two kind of high level differences. In the first half of the night, in a healthy sleeper, we'll see that period of time rich in deep sleep. And then the second half of the night, we see rich and rapid eye movement sleep sleep. So when people come to us and say, oh, you know, I'm getting three or four hours of sleep at night, or five, and I, you know, I feel okay, but, you know, I think I'm doing all right and you might feel okay, but you're virtually robbing yourself of your potential because rapid eye movement sleep is where we get so many benefits cognitively from our sleep, memory consolidation, et cetera. And that period is predominating right before we wake up. If we're getting seven to nine hours.
- [22:37]
B
Hours, they REM sleep is the consolidation of memory. These software updates, however you want to call it software hardware updates of the brain, do they happen in other stages? Is it as bifurcated as it sounds?
- [22:51]
A
Well, if you think about it, that's kind of a difficult study to do to really isolate each unique stage. But we do see the more rapid eye movement sleep you get, the more likely you are to achieve insights. If I teach you something before you fall into asleep and then quiz you on it the next day, the more rapid eye movement sleep you get, the stronger those connections and the better your performance the next day on cognitive tests. The gold standard of measurement of sleep is polysomnography. But I do think that there's an important qualitative piece to sleep that sometimes we forget. And now the development of sleep trackers gives us such an amazing insight into the quantitative component of our sleep. How long did you sleep? How long did it sleep take you to fall asleep? Did you wake up? Did you spend much time in deep sleep or rapid eye movement sleep? This is amazing information that a typical consumer didn't have access to, you know, five, you know, 10 years ago. But I think that the quantitative piece is ideally coupled with a qualitative evaluation of our sleep. Quite simply asking yourself, how do I feel in the morning?
- [23:50]
B
Tired.
- [23:53]
A
Do I feel restored? And then if that's the answer, you know, truly, you know, we need to add a little bit more time and I hope that, you know, you call me after and you're like, rebecca, we did it, I got more sleep, I feel great.
- [24:05]
B
How much sleep do children need?
- [24:08]
A
So our sleep duration need does ebb and flow across the lifespan. Very little. Babies need virtually to be sleeping almost all day long, as you remember. And then as children age, they need a little bit less. And up until the kind of school age period or time of a child's life, they need somewhere between 6 and 12 hours of sleep. But there are a lot of individual differences. Some kids will do well on that lower end of the spectrum and other kids will do well on the higher end. And this is where I love to think about N of 1 experiments. What works for you, for your kid after a night of eight hours of sleep, do you find that they are bright eyed and bushy tailed as the saying goes, when they wake up or do you find that they're dragging and moving, maybe in the car in the afternoon, do they fall asleep? Those would be signs that they're just not getting quite enough. And then maybe start that next night and try to start the bedtime process a little bit earlier and the bedtime routine a little bit earlier.
- [25:02]
B
Do you think there is a time that is universally good for kids? And what do I mean by this? Meaning we talked a little bit about this circadian rhythm which is this 24 hour cycle here in Texas. The sun goes down, let's say six o'. Clock, let's say the sun goes down in Boston or New York. I'm just making this up. At 8 o'.
- [25:25]
A
Clock.
- [25:25]
B
Does the location dictate the time we should begin to think about putting our children to sleep? Because listen, mine didn't come with a manual.
- [25:34]
A
It would be so much easier, wouldn't it?
- [25:36]
B
So much easier. But perhaps if at 6pm when the sun is going down, even though it's not convenient, maybe that's the time that we begin to wind them down. Do you know what I'm saying in terms of like, what if we're kind of doing it wrong? It's not our children. They can't regulate. They don't. My kid, she'll want to stay up and read Princess books and literally one like one eye is falling asleep, you know.
- [26:03]
A
Well, I love that. I love it sounds like a great bedtime routine. But young kids are very susceptible to light is one thing to keep in mind. So make sure and this does not have to be expensive for everyone listening. You can get great blackout shades at Target for very little. But do make sure your children have sleep proofed environment and an environment. You just showed me your daughter's bedroom. It's so amazing and so cozy and so fabulous. You want children just like all of us to walk in and feel soothed, have elements that comfort them, their favorite stuffy, their favorite lovey. And the book that helps them also feel, you know, at peace and safe. And that's gonna change as they grow, of course. But I think this is where kind of back to The n of 1 experiments thinking about workshopping your kids. Sleep until you find the sweet spot. And whether that's a 6pm fall asleep time or if that's a 9pm fall asleep time. And one of the key things is your children are young. But what might be happening is all of us have in large part genetically predetermined preferences for chronotypes. Now this is a term that refers to each of our personal preference for being alert or asleep within a 24 hour day. What is yours? I am a very severe morning type. How about you?
- [27:15]
B
Same, same.
- [27:17]
A
Right.
- [27:17]
B
I was like, oh, we should have hung out this morning at 5:00am I, I was at the gym by 7.
- [27:24]
A
I love it. So that is a kind of part of this equation also. And your children, those types might be presenting themselves.
- [27:30]
B
What are the other types? There is a morning person.
- [27:33]
A
We generally model it on a spectrum from what we call morningness to eveningness. And the biggest question, the best question for figuring out where you are within that spectrum is, is when do you do your best work? And if you would probably tell me first thing in the morning, right. Would you say or interesting. How would you answer that question?
- [27:51]
B
That in a month I can tell you that.
- [27:53]
A
Okay.
- [27:54]
B
Because I don't sleep well. I have the two little kids, you know, whether my husband is on call or not. But I'm hoping once I finish this episode I can call you and I'm going to implement same sleep, wake cycle, blackout shades. I'm not exactly sure what I'm doing with my kids, but then I'm going to call you and tell you I can't wait.
- [28:13]
A
And let's text along the way until you get there because all of this is really all about workshopping and finding the sweet spot for you, for your kids, for your partner, and factoring in also your professional obligations, your personal obligations and maybe also unwinding. You know yourself as a mom because we do stuff for everyone around us, you know, all day long as moms.
- [28:32]
B
The fascinating thing that you said is there is a genetic predetermination for amount and chronotype. How much movement can we make when people have dysregulated sleep from a nutritional science standpoint? Again, we see people all the time in our clinic that have abnormal lipids, abnormal blood pressure, glucose, partially because they're either doing shift work or.
- [28:58]
A
It's so interesting how this appears in blood work. Yes.
- [29:01]
B
Oh, what's that? Oh, that's my heart.
- [29:05]
A
Heart.
- [29:05]
B
How many of you miss that over caffeinated feeling of your heart pounding out of your chest? Or you maybe you're on another caffeine detox. Maybe you miss feeling really tired. I'm so grateful to Mud Water, one of the sponsors of the show, and I have two little kids. Therefore I don't have a perfectly structured morning routine. Sometimes I need something that supports focus, clarity and energy without wrecking my nervous system. That's Where Mud Water comes in, it's not coffee. It is something different and it makes me feel great throughout the day. I use it in the afternoon so I get good sleep. Mud Water is made from functional mushrooms. No, not that kind. Adaptogenic and organic ingredients like cacao and turmeric. No sugar, no artificial junk, just clean focused energy. It gives me that mental lift without the crash. I love that it supports my mood immunity and focus. But what I really appreciate it is that I'm not. Is that my pulse at 200? Almost everyone has experienced too much caffeine. Go to mudwater.com if only you are interested in cutting back your caffeine and want something that works and use the code doctorline to get up to, you guessed it, 40 off your starter kit mudw.com code drlion you'll feel the difference. When do we consider jet lag? Is it a two hour time difference? Three hours? Would there be a time that we say, okay, this is jet lag?
- [30:37]
A
When you're traveling, one of the big questions is how long is the trip going to be? If you're going to London for a 24 hour trip and coming back, I don't know that you have to adjust. I'd say just rip off the band aid, do your best, okay? But if it's a longer period of time and you want to really align, then the best thing to do is in the week before you travel and it's really more than three, maybe three time zones away. But look, New York to California can be difficult. And if you have a big important meeting, I'd say consider these protocols. And the way you do that is in the week leading up to your trip, you think about where you're traveling and you start to move your fall asleep and wake up times in the direction of that new time zone. Just 15 minutes. So if you're going to London, push your bedtime, you know, just 15 minutes later, the first night in the week before and then another 15 and then another 15.
- [31:21]
B
So that'll get you just over an hour to California. You are flying back. You're going to go there, you're going to be there for a week. Would you move up bedtime from 8 to 8:15 or you move it the opposite, 7:45.
- [31:38]
A
Well, when you're moving to the, you know, backward to California, New York to California, you're going to try to push your schedules to be a little bit later. So I'd wear sunglasses in the morning. If you live in New York City and you're going for a Big work trip to California and the week beforehand, you're trying to move small increments 15 minutes in the direction of your new time zone. And that's sleep times and wake times, but it's also meals. So maybe try to push your dinner to be a little bit it later. If you're taking a red eye, for instance, from New York to London, they're going to be surging. I try to avoid them, but there are situations where it's possible.
- [32:14]
B
Every time I book a red eye, I think of you. I'm just like, oh, I know this isn't good.
- [32:21]
A
If you have the luxury or the ability to choose, flying during the day is ideal. And then getting to your new destination and when you're there, do you know again, live, eat and sleep on your new destination time zone and realize that sleep is not going to be perfect. I don't have a cure for jet lag. I wouldn't be a professor if I had a cure for jet lag, but so you might experience some sleep difficulties. So when you're on your new destination, you land and maybe you experience some insomnia. You wake up at 2, 3 o' clock in the morning. The protocol is the same. If we experience that in the US in our home time zone, take it in stride. Try not to beat yourself up. It's so easy to look at the alarm clock and just be like, no, I'm up. But try to have, I think self talk is actually really important here. You know, no big deal, I'm up. But it's okay, of course I'm up. It makes sense. Do something that will hopefully make you sleepy. Reading a book, Melatonin, yoga poses. The best use case for melatonin is travel and combating jet lag. So we do recommend melatonin for that specific use case. And taking it as you prepare for your trip could be a good idea. To facilitate the transition of melatonin in the direction of your new time zone. And when you land at your new destination, do keep a couple things in mind as it comes to melatonin. Number one, if you can find it pharmaceutical grade, melatonin is critical. There have been research studies that decompose melatonin tablets that you can find that are not regulated in the nutraceutical category in drugstores. And they found that what's stated on the label varies up to 300% than what's actually in the supplement. So keep in mind that purity varies widely. So pharmaceutical grade will allow you to be confident that what you're Getting is pure and it is not. More the better. So look for something that's 500 micrograms. Oh, my goodness, we gotta stop that.
- [34:10]
B
Calling you out.
- [34:11]
A
So 500 micrograms or 1 to 2 milligrams, but not much more. And lastly, taken before bedtime in advance, it's not right before bedtime, but it's kind of when sun is setting in your new environment is when you, you should be taking melatonin a couple hours before you want to be falling asleep.
- [34:27]
B
I didn't realize it was a few hours before. What you're saying is you don't take melatonin right before you. Okay, I'm going to pop my melatonin and go to sleep. You want to plan in advance and.
- [34:38]
A
Facilitate that internal secretion of melatonin and adjustment to your new time zone.
- [34:43]
B
I am only aware of one thing that suppresses melatonin and that would be light. Is there something else? Does cortisol suppress melatonin? Are there other?
- [34:52]
A
Do we know the two things that have the biggest impact on our circadian rhythm are? Number one, blue light, blue daylight spectrum light, and that is the strongest, what we call life giver or zeitgeber to our circadian system. So light comes in through the eyeballs and it travels along the optic chiasm to a tiny region of the brain called the suprachiasmatic nucleus. And that's the circadian rhythm home in the brain. And then that kind of fires the secretion of melatonin if the eyes detect absence of blue daylight spectrum light. But if bedtime approaches and you open up a computer screen that has full brightness, you're going to be giving yourself a physiological cue to become alert and awake because the eyeballs will receive blue daylight spectrum light from that screen and think it's time to become alert and awake. And so we're virtually shooting ourselves in the foot when we use blue light emitting devices before bedtime. There's a free software called Flux F L U S and it's free, widely available. I'm not affiliated with them, but I personally use the technology. You do? Amazing. And what that will do is it will take away the blue from a computer screen. So if you must be working before bedtime, do consider flux. And what's nice is you can set it up so that it just goes on automatically. And as the sun sets in your time on your laptop or your tablet, then the screen will become warmer. So blue daylight spectrum light is the strongest input to our circadian system and exposure to blue light at inappropriate times will disrupt the flow of melatonin. The second is meal timing. A meal consumed too late will disrupt the circadian system and could make it difficult to fall asleep that night and experience consolidated restorative sleep.
- [36:35]
B
That would make a lot of sense. And we do see a lot of dysregulated eating in general. I think not only do we have a ton of extra light exposure, I don't know, is fluorescent also blue? I mean there's light pollution everywhere, everywhere.
- [36:52]
A
And it takes a lot of effort in there. I think there's also a lot of confusion because there are a lot of devices that say there are circadian lights or they're, you know, sleep promoting lights, which, you know, also are quite bright. And then maybe someone's using that before bedtime. So the best thing for your bedroom is to go to a department store or a drugstore and buy a sleep friendly light bulb and put that into your.
- [37:13]
B
Your red light. Almost a red nightstand.
- [37:15]
A
Yes, it's a red spectrum. Red colors are measured in temperature. So it's a warm light. It's reds, it's maybe oranges. Those are kind of sleep inducing colors. And use that in your bedroom if you're reading before bedtime. And then when you wake up in the morning, do you need one of these circadian lights? I don't know. But I think that, you know, generally is, if you have one and love it, amazing. But getting outside into the natural blue daylight spectrum light kind of as soon as possible is great for helping our. Helping align our internal circadian resources.
- [37:48]
B
I do that with the kids every day. I don't know if you think about. Do you do that too with your kids?
- [37:54]
A
I love that right outside as much as I can. Yeah.
- [37:55]
B
Okay. All right guys, let's go out.
- [37:58]
A
Also, just getting them out of the house is sometimes the best.
- [38:00]
B
Bye agree with you. Do we know the impact of exercise and the types of exercise on sleep quality?
- [38:10]
A
This is a great question. For so long in sleep, we would discourage exercise at night. Now I think the research is still emerging. But what, what we've found is that generally if you're getting exercise, that's the most important predictor of good sleep quality. We really care less when you get it. There have been a couple studies. One in vigorous activity, for instance, doing a very vigorous high intensity workout before bedtime is ill advised. That does have some negative impact on sleep. But by and large just making time for exercise. I'm really not worried about when you do it as long as you get it in. And this Question is related to our circadian rhythm preference, our chronotype. Because if you're a true morning person, one of the other questions I like to ask that's a great predictor of where you are on the spectrum from morningness to eveningness is when you do your best work and when you want to work out. A true morning person will say, oh, you know, the morning. Or an evening person will say, I love to get a workout in after work.
- [39:06]
B
I don't think I've ever, a handful of times. Have you ever worked out after work?
- [39:10]
A
Oh my God. It's very hard. I need a lot of motivation.
- [39:12]
B
I already know it's not gonna happen.
- [39:13]
A
I'm exhausted.
- [39:15]
B
I'd rather get up at 4 to train than I would rather train at.
- [39:19]
A
5Pm I also think, you know, our poor evening people in our society. I feel like I want to advocate for even true evening types because there's so many things in society that privilege a morning person. Even, you know, our figures of speech. The early bird gets the worm and there's so many people, the true evening types. The idea of a 9am Wake up is very stressful. And then think about a commute to get to a 9 to 5 office job. For a young professional who's a true evening type, it's really hard. I dream of a workplace where the quality of our work will be the biggest predictor of schedules. You know, if you're doing enough, I don't really care where you are or, you know, when you're doing it, as long as you're able to get the sleep that you need. And that's the biggest, most important question employers should be asking. How can we set our employees up for success? I think there's such a focus on, you know, being at the office, but, you know, the hours aren't ideal for many, many millions of Americans.
- [40:16]
B
Do you think that the environment matters in the way that if we are exposed all the time to blue light under fluorescent light, do we wear, we use flux in the evening, do we wear red light glasses, blue light blocking glasses? Should we be spending four hours or more of our time outside to combat this light?
- [40:40]
A
This is a great question. I think sometimes we can get too in our head about things. And I think the bottom line is more fresh air, the better. And natural fresh air. What comes with that often during the daytime at least, is exposure to blue daylight spectrum light, getting more fresh air, more sunlight exposure over the course of the day, the better. So think about ways to build that into your daily routine. Routine. So you can kind of behavioral economics can, you know, fall into place and you can just reap the benefits if that means, you know, if you're like, look, I work in an office building. I don't have a lot of opportunity to get outside. One simple way to get a little bit more fresh air is to, if you live in a city, walk one extra subway stop or park your car far away from the entrance and walk for five minutes, take a call that you can off video and go outside. So I'm really the more the better. And in the morning is terrific, but sunlight exposure in the afternoon is also great. So many people are reaching for a coffee or, you know, a sugary sweetened beverage in the afternoon. And I get it, we all experience a little bit of dip in alertness. But if we combated that with either a power nap if you're really tired, or simply going outside and walking around the block and getting exposure to sunlight can have the energizing benefits of caffeine without the jitters or the adverse implications for your sleep that night.
- [41:58]
B
Hydration isn't just about drinking Coke Zero or other sugar free sweetened beverages like Red Bull. Now I'm saying this for a friend, or it's not even about drinking more water. It's about keeping the right balance of electrolytes and fluids during life's most demanding season. Like, I don't know, parenting, maybe pregnancy or postpartum. Your body is going through massive changes. Blood volume increases, hormones shift, breastfeeding demands. You know, all those things, all of these life transitions. You probably need more and better hydration. And you need electrolytes like sodium, magnesium and potassium. Element is formulated to replenish what you actually lose without sugar fillers and junk that you don't need. It's a clean, effective way to stay hydrated. And for men, again, it's not just about hydration. It's also about performance, recovery, mental clarity, and yes, even energy. Whether you're hitting the gym, chasing kids, or grinding through your workday, maybe even your teeth, dehydration can quietly sabotage your focus and endurance. Element helps you stay sharp, strong and ready. We use Element because it works, tastes amazing, and it's no nonsense, just science fact, hydration that actually makes a difference. And right now, Element is offering a free sample pack with any purchase. That's eight flavors to try on the house. Go to drinklmnt.comdrlion to claim yours. That's drinklmnt.comdrLion Stay hydrated, stay strong, and as Goggins would say, stay hard. The power nap is interesting. Does it have to be 20 minutes? If you're tired enough, could you fall asleep for 10?
- [43:40]
A
What's so interesting about naps is maybe even less is beneficial. And in a little bit of a different way. Research from MIT just revealed that brief naps, I'm talking seconds, moments of sleep over the course of the day, allow you a tiny bit of what we call hypnagogia sleep. It's that way station from sleep to wakefulness, or the other way, it's that way station between wakefulness and sleep. And we're finding the research is showing that bone moments, seconds in hypnagogia sleep is associated with bursts in creativity and the ability to come up with solutions to complex problems. And what I love about that research is it really lowers the stakes. So many people say, oh, I can't nap. I see the research, I wish I could, but I can't. And what that says is, don't worry, if you can get a couple minutes, you are in great shape to crush the rest of your day.
- [44:35]
B
It doesn't matter when you do it.
- [44:37]
A
The ideal time for a nap is in the dip in our circadian rhythm in the afternoon, which we all experience. Whether you're a true evening person or a true morning person, we all simply experience a dip in our alertness in the afternoon. Why? Because we've been up for, you know, so many hours so far in the day, we've consumed a lot of information. There's a small drop in our core body temperature in the afternoon. So it's kind of the perfect storm for a nap. And that's also a really good litmus test for whether you're getting enough sleep. How do you feel in the afternoon? Are you exhausted? Are you like, listen, I need something to get me through through. That's a really good barometer for whether you're getting enough sleep at night.
- [45:16]
B
20 minutes is considered a power nap.
- [45:18]
A
So moments are, have been shown to be beneficial. And then what we call a power nap generally go under the bed.
- [45:24]
B
Can you imagine? All right guys, just give me a second and my husband can do it. He, he could fall asleep right here for two minutes.
- [45:31]
A
I love it, I love it. But he, he needs a lot more sleep. He will get it once he's done with his residency. Yes, he needs a lot and he's doing such a amazing job. And remember, these periods of life are fortunately, fortunately short lived for many of us.
- [45:45]
B
The reality is most of us are not getting enough sleep and I don't want anyone to Feel bad as they're listening to this going, oh, I wish I get more sleep. Is there a way to recover? And I don't just mean in the short term, the brain function, the executive function, you know, from years of lack of sleep, of doing all of the things I don't know from being in high school, school.
- [46:08]
A
All of the research is showing that sleep, the quantity and quality of our sleep at night is a significant predictor of our health, our well being today, tomorrow and well into the future. But importantly, sleep is not going to be perfect every night. And that's because sleep is part of the fabric of the human condition and stress is all around us, I think now more than ever. And if you've been experiencing stress, you could have done everything else right. But you go into your bedroom and you slip in between the sheets and you toss and turn and it could be because of something a co worker said or maybe stress that you weren't managing over the course of the day or some a negative experience as you approach bedtime, you know, a scary Netflix show, the list goes on. But all of those definitely don't watch those. Sometimes there are things that are out of our control.
- [46:54]
B
Do you have tips or tricks? I mean I want to share mine because I have a handful that I think will solve everybody's sleep problems. It doesn't include alcohol. Number 11 sheets. I know that sounds ridiculous, but the sheets have to be cool and they have to be really silky. Again, maybe it's a personal preference. It just makes if you are physically so comfortable. That's incredible.
- [47:20]
A
I couldn't agree more. And you want your bedroom to be the place that you look forward to. I can tell that you love your sheets and what a beautiful hack. Like that's one thing that's easy to change. Sometimes it's hard for all of us to go out and get a new mattress. But by the way, we should be sleeping on a mattress for maybe seven, maybe eight, maybe nine years, but not much longer than that. But we did some research recently and we found that one in three Americans have had their mattress for far too long. But a mattress is expensive. And I think some of the other elements of your bedroom environment, your pillows, your sheets, you can upgrade and they're, they don't have to be expensive. But I do encourage go to whatever store, find sheets that you love just like you love yours and you want to look at your so badly to get it and look forward to sleep.
- [48:06]
B
Does it matter the kind of mattress? Does it matter if it's firm or not firm. Is there any data that would support people sleep better with X or at a 5% incline on a pillow?
- [48:21]
A
We are actually doing some of these studies right now to look at the best sleep surfaces and the components of an ideal mattress springs. You know, what is the topper? Those types of questions, so stay tuned. But bottom line, there is a lot of individual. If you're talking about a really plush surface versus a, you know, a really firm surface, there is a lot of individual difference. And some people, you know, really look forward to a plush, you know, would love a plush experience, meaning something very soft. Others much prefer a firm surface. And I do think that your sleep position matters. So if you're a side sleeper, imagine your body on its side on the mattress. Are you a side sleeper?
- [48:59]
B
I am a stomach sleeper. Are you?
- [49:01]
A
Amazing. You're part of the minority. There aren't a lot of stomach sleepers.
- [49:05]
B
I don't even know how that is possible.
- [49:07]
A
No, I think it's cool. I think it's fascinating that we all have these preferences that we just move into. I'm a side sleeper, and specifically, I kind of curl into the fetal position covered by pillows. My husband gives me such a hard time for it. He sleeps with one, and I have, like, 16 on my side.
- [49:21]
B
Wait, then what about the kisser? Then? What position is this?
- [49:24]
A
That is. It's so funny. They're. There's actually scientific research on this. One of my favorite studies looked at different sleeper positions and had all these cute names for all the different types, and that is called the starfish pose.
- [49:34]
B
My kids are 100% starfish pose.
- [49:38]
A
Is Shane also.
- [49:39]
B
No. My husband doesn't move. He is a back sleeper.
- [49:42]
A
Okay, interesting. And you both. You have two starfish. That's so interesting. And this research was. It was interesting. They. They delivered the Big 5 personality assessment and then asked questions about your sleeper position. They found that extroverts were associated. The starfish pose was, you're more likely to be an extrovert if you slept as a starfish. So there you go. You have two extroverts, maybe on your hands.
- [50:02]
B
And then. What about the rest?
- [50:04]
A
I have to go back to the paper for all the other. I think you're more introverted if you're. If you sleep like I do, actually. Which is. Which is true. I think I'm an extroverted introvert, I'd say. But the fetal position, you're a little bit more introverted.
- [50:14]
B
No, I'm face down. Nobody touch me. I'm just in my silky Sheets, eye mask. So I wear an eye mask. And earplugs. I love only wax earplugs when Shane is home.
- [50:28]
A
I love that so much because that is your routine. And what you've actually done is you've classically conditioned yourself to put in your earplugs, put on your eye mask, slip into your sheets, assume your position, and go to sleep. And these little things make such a difference. And what I also love about that routine is you can take it with you on the road.
- [50:47]
B
I do. It's already packed.
- [50:49]
A
There we go.
- [50:49]
B
It stays packed.
- [50:50]
A
It's beautiful. And then you can have some protection because you never can guarantee a quiet bedroom when you're traveling. The light environment. So many even really nice hotels often have that sliver of light. What about air quality? We do see a strong association between the quality of our environment and our sleep. So if there's poor air quality, if it's stuffy, if they're out allergens, we do see that that does interrupt our sleep. So buying an air purifier that can promote good airflow and air quality can be useful.
- [51:20]
B
Do you usually use air filter?
- [51:23]
A
I do. I do like. And that's part of my sleep routine. I also do earplugs and eye mask every night. And I have brands that I love and I know, you know, that I can. They're my go to things and then I take those with me when I travel. I also do like a little bit of background noise. And so that is one nice thing that an air purifier provides is a little bit of background noise to attenuate any interruptions. You know, a siren, even a town over you can sometimes hear, you know, in the country or if you're in an urban environment, there are definitely going to be noises.
- [51:51]
B
Is there any data that would support it enhances sleep or does something to the brain while the brain is going through its cognitive processes or consolidation.
- [51:59]
A
There's some research to show that pink noise, which are generally kind of natural sounds, can be associated with memory consolidation, believe it or not.
- [52:07]
B
What's the difference between pink and white noise?
- [52:10]
A
Basically a different frequency of sound. White noise tends to be a little bit more of a static or mechanic noise, whereas pink noise is typically a natural sound.
- [52:19]
B
It does make sense because white noise is a little jarring. Yes.
- [52:22]
A
So one of the biggest differences is that pink noise has more power at lower frequencies. It's typically natural sounds. Rain or a babbling brook. And research has shown associations between the use of pink noise and memory consolidation.
- [52:35]
B
Believe it or not, you have talked a lot in the past about cognitive health, Alzheimer's, sleep mortality. Are there sleep biomarkers that we would be able to look for?
- [52:49]
A
Sleep is a really rich process, and I think we often kind of hyper focus on duration. Getting enough duration is a really important part of the equation. For the vast majority of adults, that's between seven and nine hours. And finding where you are on that spectrum and ideally meeting it as many nights of the week as possible, realizing not every night is going to be perfect, but doing your best. Now, in addition to getting enough sleep, is consistent sleep. That is another vitally important thumbprint of what constitutes good sleep health. Consistent sleep, meaning falling asleep at the same time and waking up at the same time as many nights of the week as possible, and keeping those times as close together as possible, varying by maybe 15 minutes here, 30 minutes there, an hour, but really no longer than that. Now, in addition, I want you to wake up and I want you to feel good from sleep. I want you to tell me that you feel restorative. Now, in addition to duration, to the consistency of our sleep, to being satisfied with our sleep, consolidated sleep is also vitally important. Sleep is as much as possible in one consolidated period of sleep that's not interrupted by multiple prolonged awakenings. Waking up from time to time is not a problem as long as you keep the lights low. It's typically to use the bathroom and come back to bed as soon as you can. Those are the four markers of what we call a good night's sleep. And doing your best to meet those as many nights of the week as possible. But I think one of the things that we do is we kind of will hyperfocus on duration, and we'll talk about all of the dangerous and scary things that happen if you don't meet those things. But the truth is sleep is not going to be perfect every night. But the key is getting back on track as quickly as possible towards those four components. Now, those are kind of the manifestations of a good night's sleep. But the interesting thing about sleep as a health behavior is it's also intimately related to a constellation of other things. I mean, I like to say that good sleep really starts when you wake up and getting plenty of blue light, natural sunlight exposure over the course of the day, the timing of your meals, this is your work, the composition of your meals, managing your stress over the course of the day. I think one of the most powerful tools that is really not widely understood is meditation and mindfulness. And those tools allow you to find. Find peace in a moment.
- [55:11]
B
Do you meditate before sleep?
- [55:12]
A
I do.
- [55:12]
B
I do too.
- [55:13]
A
I'm very regimented. What's your pre sleep routine?
- [55:16]
B
Well, after the kids are asleep, I do the whole. You wash my face. I use this essential oil. Yes, I do.
- [55:25]
A
Looks amazing.
- [55:26]
B
And sometimes I use the wax earplug, sometimes I don't. I only use it when my husband is home.
- [55:31]
A
Does he snore? Is that why. Yeah, we love him.
- [55:33]
B
No, he actually has sleep apnea.
- [55:35]
A
Really?
- [55:36]
B
Yes.
- [55:36]
A
Okay.
- [55:37]
B
Yes.
- [55:37]
A
Oh, that's a whole other.
- [55:38]
B
It is a whole. I mean, he has. I don't know, his neck is like 18 inches. But does he CPAP? We have. Yes, he does.
- [55:45]
A
Amazing.
- [55:46]
B
Every which way. It's very romantic. Always has like the sleeves, eye mask.
- [55:53]
A
But I love that. That's great news.
- [55:55]
B
Yeah. The other aspect is I'll put on a meditation before I go to sleep.
- [56:00]
A
I Love, love that.
- [56:01]
B
15, 20 minutes.
- [56:02]
A
The same one. Do you use?
- [56:03]
B
No, I just. I'll switch it up. Or that or some kind of noise. Not white noise, but some kind of.
- [56:09]
A
And what's so beautiful about that is that it's your routine and you've classically conditioned yourself to wash your face, to start your meditation, to put on your eye mask. And then your brain starts to understand that what follows is sleep. And I think sometimes we're. I mean, look, we have busy days now more than ever, filled with information and all, all of this stuff. And then our day comes to a screeching halt at night. And I think that whole bedtime procrastination trend emerged because especially younger generations who are being told to do things all day long and then they finally have some agency at night and they kind of push back on the idea of needing to sleep or needing to keep a bedtime. But a good night's rest is the strongest predictor of so many aspects of our waking. So success, better productivity, better mental health, better mood, better exercise. When you exercise, you're going to get more out of your sleep if you're well rested. So many positive things when you can put sleep first, but our days are busy and then they come to a screeching halt. And I think that the time between, you know, you send the last email. And for us as moms putting our kids to bed, it's so easy to think, you know, oh, I'd love to have a, you know, watch a show or, you know, but then unfortunately, what can happen is a lot of times that the next show will start and suddenly there's not a Lot of awareness, your bedtime for many people.
- [57:28]
B
I don't watch shows for that reason.
- [57:30]
A
It's so dangerous. It's a risky game. Right? Because then you want to know what happens next.
- [57:34]
B
Nope, I do not. If it's a show, I'm out. Nope.
- [57:38]
A
I love that. And finding ways to relax and kind of fuel your soul and prepare you for sleep so that you can get the rest that your body needs.
- [57:47]
B
If an individual is sleeping, is there a way to see if there's an improvement in brain function? Would that be on eeg? Again, that's probably outside of what would happen at sleep. But assuming that you can see the health of the brain while it's sleeping is that this is a great question.
- [58:09]
A
Now, of course we need to be measuring brain activity to really know without a shadow of a doubt where you are in terms of light sleep, deep sleep, rapid eye movement sleep. Now, as it relates to brain health and function and structure. What. But I think the response I'd make is kind of twofold. First, if you take someone who has maybe what we call yo yo sleep schedules which are keeping one bedtime one night, falling asleep at 10pm one night, 2am the next night, waking up at 10am one morning, 6am the next morning. So all over the map, which is quite common. So an irregular sleep schedule or maybe not getting enough sleep. So if you take someone who is maintaining a schedule like that kind of sleep and wake times all over the map, sleep duration all over the map and you move them into a regimented sleep schedule during sleep, what's going to change is the structure is going to improve so that we're going to see a healthy cycling in and out of all the stages at the times that we would expect to see those stages again. Deep sleep predominating in the first half of the night and rapid eye movement sleep in the second half of the night. So the structure of your brain activity over the of course course of the night will become more regulated and you'll. You're going to get more out of your sleep. Also, if you move someone from even someone getting enough sleep but keeping that what we call yo yo sleep schedule, falling asleep at different times all over the week, waking up at different times all over the week. We take someone like that who's getting enough sleep, but we look at their, this, the structure of their sleep, it's going to be all over the map. And if we move that person even to a slightly shorter sleep schedule, but a consistent one, so many things improve and their brain starts to understand oh, this is when I'm going to fall asleep. And then it can align itself within that period in a much more efficient way. So that sleeper is going to move, even if they're getting a little less sleep, into a schedule that's more consistent and more regulated and wake up and probably have more energy than the person who is maybe even getting more sleep, but sleeping all over the map.
- [60:05]
B
Is there any data, and this might be very hard to study, but that glymphatic system cleanage, the cellular turnover, do we know if it's more effective that mirrors that regular consistent sleep?
- [60:20]
A
What we do know is in lab studies, and these have been done in rodents because we can inject the brains of rodents.
- [60:26]
B
You don't want to do that to humans.
- [60:27]
A
So. Not quite, no. But what those, and what's so interesting is these findings were developed by a neuroscientist who wasn't necessarily a sleep scientist, but had this amazing finding. And in rodents, they found that the brains of these rodents in their studies that were sleep deprived compared to well rested there was an accelerated clearance of toxic particles which are observed, of course, in greater deposition in humans with Alzheimer's disease and related dementia as compared to healthy controls. So there is this increased clearance of these neural toxins in the rodents that were allowed to sleep to the children tune of 60% greater clearance in the well rested rodents as compared to the sleep deprived. Isn't that fascinating? It is. And mechanistically what's happening there is there's this fluid, I like to think of it as like Drano. It's washing through the networks of our brain and the glial cells expand when we're sleeping, allowing for accelerated clearance of those toxic particles. And that accelerated removal then results in better brain health over time. And we've looked at this in human humans and we found that in cohorts of older adults. We've published several papers on this where individuals enter the cohort at age 65 and we, we monitor them over time. And those individuals that are maintaining poor sleep schedules, they're struggling to get good sleep, maintaining inconsistent sleep schedules, they're at a market increased risk for dementia as compared to the individuals who are getting consistent and regular healthy sleep.
- [61:51]
B
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- [63:21]
A
This is a great question and there are many millions of Americans who are using sleep medications and there is a time and a place for medication and for some patients it is a lifeline. If someone is really struggling with sleep and has been for many years. So the first answer is talk to your healthcare provider and create a plan that works for you. Some of the research shows that in the longer term it is advantageous to move onto a behavioral change regime. But what is interesting in individuals who have the option and think they might be open to behavioral intervention or medication. The research that pits those two treatments head to headpharmacological intervention and behavior change, specifically cognitive behavioral change for better sleep. We refer to this as cognitive behavioral therapy for insomnia, or cbti. When we take that change treatment and we compare it to pharmacological intervention, those two patients suffers of insomnia and we compare them over time. The behavioral treatment wins out in the short and especially in the longer term. The unfortunate thing is we have a dearth of sleep providers that can provide this treatment. So it's one of the interesting and exciting applications of artificial intelligence for the future to think about providing some of these behavioral I was going to ask.
- [64:34]
B
You what is you're very involved in sleep sleep nationally, sleep globally. Where do you think that the future is going in terms of tracking, improving outcomes, testing? What is on the forefront of sleep?
- [64:48]
A
I am really excited about the intersection of some of the new technologies we're seeing and sleep and specifically in my work, which is behavioral interventions. One of my areas of Expertise is designing interventions to nudge and navigate patients and populations towards better sleep. And I am so excited at the idea of developing an avatar that could deliver tailored, personalized recommendations. It could help you make sense and act on your information from your wearable device. I mean, how exciting to take the problem, which is a dearth of sleep providers, and think about sleep interventions at scale. I also think the trend towards sleep tracking is incredibly exciting. These devices are increasingly relied upon by many millions of Americans. We published data in 2019 to show that one in three Americans were tracking their sleep with some sort of wearable technology. And I think that that number has only increased since that time. And so ensuring that these devices are increasingly accurate, increasingly small, and increasingly scalable. And soon, I hope, also able to detect signs and signals for sleep disorders that people might not even be aware they have and might be limiting their sleep quality.
- [66:01]
B
What would be one of those disorders?
- [66:04]
A
There are more than 80 differentially diagnosable sleep disorders, But a couple of the big ones are insomnia. Number one, it impacts anywhere between 30 and 40% of the population, depending on how we're measuring it and studying it, and in what population. But it's a condition that is depilating for many. It is characterized by a chronic experience of difficulty falling asleep, so taking longer than 30, 45 minutes night in and night out, difficulty maintaining sleep. So maybe being able to fall asleep, but then waking up and fighting, struggling to get back to sleep, waking up too early in the morning and not being able to fall back asleep. And those are typically also accompanied with feelings of exhaustion during the day. Individuals who suffer, suffer from insomnia will tell us that they are absolutely exhausted. And the frontline treatment for insomnia is cognitive behavioral therapy for insomnia, when available, or pharmacological intervention, and then kind of titrating to get onto a behavioral regime. Often with insomnia, we're trying to do away with maladaptive cognitions about sleep. Someone with insomnia will walk into their bedroom and their cortisol will spike, which we, we know, interrupts your ability to relax and prepare for sleep. The second most concerning sleep disorder is obstructive sleep apnea. And that is, you know, as a condition marked by often loud snoring, loud raucous snoring, but also interruptions or pauses in breath.
- [67:31]
B
Very scary.
- [67:32]
A
Yes, yes. As a spouse. And so if those symptoms sound familiar to anyone listening, there are treatments. It's imminently treatable, which is the good news. And there are a range of options. But do find a sleep professional to coach you on the available options for your personal needs and treatment is a significant predictor of better quality of life. Better sleep, of course, better heart health. Often in patients with untreated sleep apnea, blood pressure can become uncontrolled. Many issues start to snowball when you're not not getting proper treatment for obstructive sleep apnea.
- [68:09]
B
That's absolutely true. Blood pressure, hemoglobin, hematocrit, people, they just don't feel well. Low testosterone. Do you guys use the Upworth sleep score or no?
- [68:19]
A
We do. You know, the good news is there are a lot of, you know, very easy to deliver questionnaires that are very sensitive for your risk for these things. So you don't often even have to go into a sleep lab just to get a sense of if you're at risk for, for some of these conditions. The Epworth Sleepiness Scale, the Insomnia Severity Index for any providers or clinicians listening, the Berlin Questionnaire, the Stop Bang Questionnaire, are all widely used, validated questionnaires that can give you, for instance, if you're a primary care provider, could give you a really good sense of whether a patient you're seeing is at risk for any of these disorders.
- [68:54]
B
I want to close out this podcast with some common sleep myths. What is your top three myths that you hear?
- [69:05]
A
Number one is this belief that there's some people out there somewhere, somehow, that do well on less than seven hours. And there might be. They're very poorly studied if they are out there, people who truly, truly need less than seven hours and they have a kind of appropriate health profile. But we do find there are several notable figures. Um, Thomas Edison was one and there have been others in, across, across history, people who brag about not getting enough sleep. But Thomas Edison, yes, he probably slept around four hours at night, but he had a cot in his office and he was known for taking protracted naps. So it is not, in fact true that he was only sleeping for four hours a day. He simply wore that on his shoulder as a valor of honor somehow, despite all of the health concerns, but was in fact likely sleeping closer to seven. So really, duration, we can't. There's no cure, there's no silver bullet. We do need to spend the time sleeping. But the secret is if you can combine a healthy duration of sleep with consistent sleep, you start to maybe need a little bit less sleep overall because your sleep will become so consolidated and so efficient within the time that we're provided. The idea of being bedtime routines and the time before sleep. We don't often factor that in, but it is a vitally important part of a sleep routine. We're really not made to fall asleep immediately, quickly, right away, but we need to set ourselves up for success. And just knowing that can be helpful. And then creating a relaxing bedtime ritual, whether that's doing a couple breathing exercises, reading a couple pages in a book. One simple thing that I love to talk about is just one good thing from your day. I think sometimes at nighttime, all the bad stuff can snowball. But if you close your eyes and breathe and focus on one person that touched you in some way, you know, touched your heart, was kind to you, was thoughtful, one nice thing that you did can also sometimes make us feel good ourselves. That can just put you in the right headspace to drift off to sleep. And then number two, I'd say is this myth that falling asleep quickly is a sign of good sleep. So often people say, oh, you know, I'm such a bad sleeper, it takes me 15, 20 minutes. Minutes. I'm like, yoo hoo. It takes the healthy sleeper 15 to 20 minutes to fall asleep. But I think that, that some people think of that as, you know, what's wrong with me? So falling asleep quickly, just as if you were underfed and you were presented with a buffet and you helped yourself to a ton, you know, ate ton of food right away and you were starved for food. So similarly, if you're falling asleep right away, you're probably starving. Carved for sleep. And the third myth is snoozing. So many people at dinner parties or, you know, wherever will open their phone and show me a dozen snooze alarms. And they're like, look at me, I get all this extra sleep. And that is another myth that hitting the snooze alarm will give you more sleep. What the vast majority of us are doing if we're using the snooze alarm is, is you're looking at your schedule. Say you have to get up at 7 o' clock for work. And that's a non negotiable to, to commute, to get ready to all do all of your things. So what people are typically doing is setting their first alarm for 6:30 and then for 6:40 and then 6:45. And I'm like, guys, let's just set it for 7 and find the latest possible time. Set your alarm, and then it's gonna be tough. You've gotta get your butt outta bed. But just commit. Say, you know, I'm gonna maximize my sleep and maybe put my phone on the other side of the room so.
- [72:29]
B
I'm not news again. It's genius. We're all inspired to sleep more. And you know what? You don't make it sound painful.
- [72:36]
A
Oh, thank you. That means so much to me.
- [72:38]
B
It's just important. You're really on this mission to improve cognition through sleep and just better life. And if we can get ahead of it, then we can get ahead of.
- [72:48]
A
It for our children. Absolutely.
- [72:49]
B
And set them up for a more resilient life.
- [72:51]
A
Absolutely. If we can do that. It's the biggest gift as parents, giving them a good sleep.
- [72:56]
B
Think about it. When they are dysregulated, it's oftentimes when they're tired.
- [73:00]
A
100%.
- [73:02]
B
Dr. Rebecca Robbins, you're just a joy. And likewise, it's so fun to be able to sit down with my friends and people that I just respect and admire the work that they're doing in the world. So to this, I would say good day, but I'm going to say good night.
- [73:17]
A
Good night. And can we add sweet rhythm? Sam?