Welcome to the Hubertman Lab guest series where I and an expert guest discuss science and science based tools for everyday life.
I'm Andrew Hubertman and I'm a professor of neurobiology and
ophthalmology at Stanford School of Medicine.
Today marks the second episode in our six episode series all about sleep with our expert guest Dr. Matthew Walker.
During today's episode we discuss the dos and the do-nots of sleep.
Focusing for instance on how to use light and absence of light as well as temperature both of your sleep environment specifically the room you're in your body temperature and much more in order to regulate the timing and quality of your sleep.
And we discuss how things like alcohol, caffeine and cannabis impact sleep and the various stages of sleep.
And we discuss the various tools that exist now and that are rapidly becoming available to improve your sleep.
This episode is essential for anyone trying to optimize their sleep and when I say optimize your sleep, I mean trying to optimize the formula that was addressed in the first episode of the series which is the QQRT formula, the quality, quantity,
regularity and timing of your sleep.
Four variables that combine to determine whether or not your sleep is optimized for you and thereby providing the most restoration and improvement to your mental health, physical health and performance.
Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.
It is however part of my desire and effort to bring zero cost to consumer information about science and science related tools to the general public.
In keeping with that theme, I'd like to thank the sponsors of today's podcast.
Our first sponsor is Helix Sleep.
Helix Sleep makes mattresses and pillows that are customized to your unique sleep needs.
It's abundantly clear that sleep is the foundation of mental health, physical health and performance.
When we're getting enough quality sleep, everything in life goes so much better and when we are not getting enough quality sleep, everything in life is that much more challenging.
One of the key things to getting a great night's sleep is to have the appropriate mattress.
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It's not too hard, not too soft and I sleep so much better on my Helix mattress than on any other type of mattress I've used before.
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Today's episode is also brought to us by Woop.
Woop is a fitness wearable device that tracks your daily activity and sleep, but also goes beyond that by providing real-time feedback on how to adjust your training and sleep schedule to perform better.
I've been working with Woop on their scientific advisory council to try and help advance Woop's mission of unlocking human performance.
As a Woop user, I've experienced the health benefits of their technology firsthand for sleep tracking, for monitoring other features of my physiology,
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Again, that's join.woop.com slash huberman.
Today's episode is also brought to us by Waking Up. Waking Up is a meditation app that has hundreds of different meditations, as well as scripts for Yoganidra and non-sleep deep rest or NSDR protocols.
By now there's an abundance of data showing that even short daily meditations can greatly improve our mood, reduce anxiety, improve our ability to focus, and can improve our memory.
And while there are many different forms of meditation, most people find it difficult to find and stick to a meditation practice in a way that is most beneficial for them.
The Waking Up app makes it extremely easy to learn how to meditate and to carry out your daily meditation practice in a way that's going to be most effective and efficient for you.
It includes a variety of different types of meditations of different duration, as well as things like Yoganidra, which place the brain and body into a sort of pseudo sleep that allows you to emerge,
feeling incredibly mentally refreshed. In fact, the science around Yoganidra is really impressive showing that after a Yoganidra session, levels of dopamine in certain areas of the brain are enhanced by up to 60% which places the brain and body into a state of enhanced readiness for mental work and for physical work.
Another thing I really like about the Waking Up app is that it provides a 30-day introduction course.
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If you'd like to try the Waking Up app, you can go to WakingUp.com slash Huberman and access a free 30-day trial. Again, that's WakingUp.com slash Huberman.
And now for my conversation with Dr. Matthew Walker, Professor Matt Walker. Welcome back.
We're also happy to have you here. And in episode one, you beautifully described the biology of sleep. Why sleep is important? What happens when we don't get enough sleep? And you incentivized getting adequate amounts of great sleep.
And you defined what great sleep is. And you provided some excellent practical protocols and tools for getting great sleep. However, today you're going to tell us, I believe, about the protocols for sleep.
The protocols for really optimizing one sleep, both conventional tools and protocols and some, let's say, unconventional, not heretical, but unconventional tools for optimizing one sleep.
So let's start with the basics. What are the basics of what I think of her? You referred to previously as sleep hygiene.
I think we, many of us can resonate with the idea of dental hygiene, but turns out there's something called sleep hygiene. And there are probably, I would say five edicts of sleep hygiene.
They offer them as tools and not necessarily rules, because I don't think people respond to rules. People respond to reasons and not rules. So if it's okay, I'll probably just unpack each one of them rather than just sort of bark them at you and hope people assume that it's the right answer.
So people understand why it's important. So as I said, there are probably five things that you can start doing tonight to try to improve your sleep.
The first we've spoken a little bit about in that first episode. It's part of the four macros of good sleep. First piece of advice, regularity.
Go to bed at the same time and wake up at the same time, no matter whether it's the weekday or the weekend. Regularity is king.
And the reason is because when you feed your brain, the signals of timed regularity for your sleep, it will anchor your sleep and improve the quantity and the quality of that sleep.
Because part of that signal of regularity going into your brain in terms of that repeated behavior night after night sleep, in other words, helps train that central 24 hours circadian clock that we also spoke about in the first episode.
So that's the first piece of advice. Try to keep it as regular as you possibly can.
The second piece of advice is darkness. In my view, we are a dark deprived society in this modern era. And we need darkness at night as well you've spoken about to release a hormone called melatonin.
And melatonin will help time the regular onset of your sleep. So that sounds great, but what boots on the ground mat, what does that mean?
I would suggest the following in the last hour before bed, try to dim down 50% if not more of your lights in your home.
You will be quite surprised at how sleepy and so horrific that will make you feel I will do this in a regimented way I have a little reminder that pops up and tells me now is the time to dim the lights based on your bedtime.
I'll go around and I'll shut lights down in my bedroom. I will actually have a smart light bulb and it is way down to probably as little as maybe five looks when and looks is just a metric of the light.
It's way down there and it's also very deep orange sort of red and we can come on to why that's the case.
So that's the first thing even before you're thinking about sleep start to decrease the light. For example, if you were there at let's say for a standard sleep schedule at 10 p.m.
And normally you are getting into bed at 10 30 p.m. But you feel pretty wide awake. If there was an electrical blackout and you lost your phone magnetic to phone goes down lights go down total blackout.
My suspicion is that fairly soon you'd say gosh actually feel quite sleepy. Whereas if the lights were blazing you've got your phone televisions on lots of stimulation.
You're probably going to think 10 30 now I could I could probably push through for at least another hour. So try to dissipate that light.
And then if you need to wear an I mask blackout curtains always good as well. But we need that darkness at night because when you give the brain the signal of darkness it releases effectively a break pedal that break pedal has normally been applied by way of light on the release of that spigot of melatonin.
And when you take the break pedal off it starts starts pumping out into the brain. You can also then of course probably reverse engineer this trick in the morning.
And this is another component of why you've been I think so such a wonderful advocate for light in the morning it does many things but one of the things that it does is reapply that break on melatonin.
And therefore you lose the signal to your brain of darkness that's what melatonin in some ways is doing we often call it the hormone of darkness or the vampire hormone not necessarily because it makes you look longingly at people's necklines and want to to bite in which is great if you're into that but it's really simply about it's releasing melatonin which tells the brain.
My goodness it's nighttime but if you've got bright light on you come from your office you're driving home so you've got artificial light during the day which is probably not strong enough to stimulate you and bring you awake you come home and you've got again bright light but it's still strong enough now to prevent the release of melatonin you start to shift in your timing and you may have problems with your sleep so that's the second piece of advice I would love to ask you about that.
Morning light to and the alertness benefits I'm as a sleep researcher more focused on the evening component of light and decreasing it but you've done a great job I don't know if there's anything I get there a couple of quick points that are based on some what I consider really nice studies.
There's beautiful work in human showing that bright light exposure in the morning especially from sunlight but if one doesn't have access to sunlight for whatever reason there are commercially available so called sad lamps seasonal effective disorder lamps they range anywhere from 5000 to 10,000 locks very bright but certainly morning sunlight viewing and lamps of the sort I just described have been shown to increase the amplitude of the morning cortisol spike by as much as 50.
50% 50 so people here cortisol and they freak out they think that's not good I want my cortisol low but you actually want your cortisol highest in the morning and lower in the afternoon and evening and there's a lot of reason for that elevated mood focus in alertness in the morning and throughout the day and ease of getting to sleep at night lower anxiety lower depressive symptoms and so on so that bright light also serves to control the amplitude of cortisol in the direct light.
It in the direction you want in the early part of the day the other thing that's just more of a underlying dynamics of the circadian visual system which is a system that I worked on for years these wonderful cells in the eyes that are not for image forming but rather for detecting sunlight and bright light for sake of setting circadian rhythm is that the sensitivity of that system early in the day is actually quite low so you need a lot of bright light early in the day to effectively wake up your system and shut down the system.
And shut down the sleeping the signals such as melatonin but later in the day rather diabolical system it takes very little light even from artificial sources to disrupt your circadian rhythm and quash melatonin as little as 15 seconds of bright light in the evening I think Chuck's isolars laboratory at Harvard medical school showed can quash melatonin in the evening I don't want people to freak out and think that they go into a hotel bathroom which oftentimes those are very bright.
In the middle of the night flip on the light that they're going to completely screw up their circadian rhythms but if I'm honest they'd be much better off using their phone as a flashlight to navigate people always say well wait but the flashlight on the phone is very bright but let's just get logical here a light shown into your eyes such as a flashlight is very different than looking at a flashlight beam on the ground far and away difference.
So the point is that if you don't get enough bright sunlight or light in your eyes early in the day and then your indoors under artificial lighting you might think well this is really bright lighting this is the kind of lighting that could disrupt my circadian rhythm at night and therefore it's sufficient to wake up my system no early in the day throughout the day you need a lot of bright light as much as safely possible to avoid sunburn and things of that sort which you don't want.
But then as the evening comes around after sundown you need very little artificial light in order to disrupt your circadian rhythm and then just very quickly light from candles fireplaces is okay this is kind of interesting it seems bright it's but the but the measurements indicate that that's not going to shift your circadian rhythm much candles are great but of course don't burn your house down so that the orange and red tones in the evening way dimmed down that's the way to go early in the day.
Bright bright bright light as bright as you safely can tolerate and what I like about firstly your mention of cortisol you described how cortisol is rising in the morning and that's a great thing and it is a good thing and in the evening it's starting to drop and if you look right around your prototypical bedtime and we're going to speak later in this episode as to what your real natural bedtime is versus the one that you may be taking right now.
It's very interesting cortisol will almost hit its lowest point something that we call it's an idea it's the lowest point in that trough of its decline right around the time when you should be sleeping however.
So great study that looked at people with insomnia and in subsequent episodes we'll discuss this too but one of the ways that we think about conceptualize insomnia is in two different flavors sleep onset insomnia I can't fall asleep and sleep maintenance insomnia I wake up I can't get back to sleep.
And what they looked at was essentially cortisol levels they had a catheter in the arm and they were sampling it from the bloodstream and they were able to do that every 30 minutes so it's a little bit like time lapse photography and you're getting a data point every 30 minutes across the 24 hour period looking at cortisol cross now a full 24 hour period.
And sure enough when you look at healthy controls who can sleep well and insomnia patients they look almost identical across the day.
But then when it comes to falling asleep right around that bedtime period the healthy controls are going all the way down the insomnia patients go down and down and down and then they have a rise back up right around that sleep onset period.
And then they start to drop back down again just as the control group but then they also often will have a spike in the middle of the night which then comes down and then both of them are staying low throughout the early morning period and then it starts to rise back up so it's not as though net net overall there is a higher level of cortisol in people with insomnia it seems to be right at those trigger zones that map very nicely to sleep onset problems sleep maintenance.
Very interesting as somebody who wakes up in the middle of the night and sometimes has trouble getting back to sleep that resonates I have no trouble falling asleep whatsoever yeah knock on wood.
Super dishes about this at this point but I use tools like non sleep deep rest yoga knee draw long exhale breathing but you know it and I think these wake up.
That episode seemed to happen more when I'm processing a lot of stuff from my daily life that's right you know it's on the unconscious brain oftentimes is working through things and and we'll wake us up yeah I often think that.
Sleep maintenance insomnia that you've just described is the revenge of daytime emotions and unresolved.
So that would be so we're spoken about regularity we've spoken about darkness and we've spoken about the inverse of that in the morning which is light a little bit of cortisol so the third out of the five is going to be temperature and the advice here is keep it cool.
As we mentioned a little bit in the first episode and we will go into great detail when we speak not just about these conventional and unconventional tips but we're also going to go into the future of science and were sleep scientists taking goes to.
In fact optimize and even enhance our sleep we will speak a lot about temperature suffice to say that you need to.
Drop your core body temperature in your brain temperature by a little less than one degree Celsius two to three degrees Fahrenheit to get to sleep and stay asleep.
The general target that we have in sleep science if you look across the literature is somewhere around about the 67 degree Fahrenheit or I'm trying to do the calculation maybe 18.5 ish degrees Celsius now I know that that sounds cold.
It is but you can also worth thick socks to bed you can have a hot water bottle at the end of the bed that's great to but the ambient must be cold.
The fourth piece of advice is walk it out and here what I mean is do not stay in bed for long periods of time awake and I think we mentioned this perhaps in the first episode two.
When you are awake in your bed for long stretches of time because your brain is an incredibly associative device it will quickly learn that this thing caught my bed is the place where I'm awake and not asleep.
And what you need to do is break that association if you've learned that time and time again because you've stayed in bed and the rule of thumb it's just a rule of thumb about 20 25 minutes if you can't fall back asleep or you can't fall asleep it's okay just say tonight is not my night.
It's not a problem it's tomorrow is not completely shot it's fine I'm just going to get up get out of bed if you can if you're looking enough try to go to a different room and in dim light read a book listen to podcast whatever it is that relaxes you just do that don't check email don't eat because if you start eating that again trains your brain to start waking up and feeding at that time.
And only return to bed when you are sleepy and there is no time limit for that I don't want you to come back after half an hour when you are still awake and not feeling sleepy enough why because you're going to get back into bed and be in the same problem again and gradually if you do this and it's hard to do it.
You will re-learn the association that you had I'm sure as a child which is that your bed is this place of sleepiness because often people will be saying I feel so tired in the evening and then they get into bed and they say but now I can't fall asleep at all and I don't understand it in pod it's because of that learned association so that would be the fourth tip.
The fifth tip makes me even more unpopular as a personality character which is try to be mindful of your alcohol and caffeine now in a subsequent episode we'll go into great detail as to how caffeine works its mechanisms why it is sleep disruptive and why in fact I've even perhaps changed my mind on caffeine and it's benefits but it also does have significant details.
So the rule of thumb here would be try to cut yourself off from caffeine probably at least 10 or so hours before you expect to go to bed and you can just calculate back calculate that and try to limit it so the dose and the timing make the poison.
Cut yourself off after maybe two or three cups of coffee and then the timing component count yourself back.
Decaffinate a coffee not too bad if you find the right thing to if you need that fix alcohol is probably one of the most misunderstood sleep aids in quotes that that is it is no sleep aid at all now if I didn't understand what I know about alcohol and sleep I would think that too which is like when I have a night cap just before bed or two
even though I don't worry them I I may actually just fall asleep very easily it feels like I stay asleep very soundly across the night so it's a great sleep aid and it really helps me there are at least I would say three issues with alcohol the first is that alcohol is in a class of drugs that we call the sedatives and sedation is not sleep but when you take on board alcohol in the evening
you mistake the former for the latter and you think it helps you fall asleep the second thing is that because it's sedation actually is probably related to station if I were to show you the electrical signature of your deep sleep when you're just sleeping naturally versus when you have alcohol in your system it's not really the same it's not a naturalistic form of deep sleep it mimics it it looks not too dissimilar
but if I really do mine analyses and I almost like that pink Floyd album where I take the white light of electrical brain activity coming from your head as you're sleeping and split it apart into all of the different components there are some components that are no longer present or some that are abnormally present the second issue with alcohol is that it fragments your sleep so it will litter your sleep with all these punctuated awakenings throughout the night
the danger there is that many of those awakenings with alcohol you don't remember because they're too brief but then you wake up the next day and you think well I didn't have a problem falling asleep I didn't have a problem staying asleep but I just feel rough I just don't feel restored by my sleep and you don't add two and two together
the final concern with alcohol is that it's quite a potent blocker of your rapid eye movement sleep or REM sleep and in subsequent episodes we'll go into great detail as to the incredible learning and memory creativity benefits that come by way of REM sleep
also it's essential for our emotional regulation and recalibrating our moods so for all of those reasons I would say two things first if you are struggling with sleep not feeling restored by your sleep keep in mind your alcohol intake
and also just in general be mindful of that if you are thinking about your sleep and want to preserve it so much of what you just said resonates I confess that in my lifetime I've had periods of pretty spectacular sleep I characterize myself as somebody they could fall asleep anywhere anytime
but I've also experienced the extreme challenges of sleep and that relates to different things life circumstances etc. In fact recently I've had some challenges with sleep despite using the protocols that I and others suggest I hadn't heard some of the things that you're referring to here
and middle of the night waking has become more of an issue I communicated this to a former girlfriend of mine who was I was in relationship with when I was a junior professor meaning before I got tenure
and she said you don't remember you had a Andrew but I do you had a pattern back then of after I would fall asleep you would continue working on your laptop probably on grants
and then I would fall asleep working and then according to her I would wake up in the middle of the night and work a little bit until I get tired again and then fall asleep and then this would repeat so really stamping down the associative learning element that you talked about before
so that was probably the first period of time in my life in which I created this rather deleterious association of work in the middle of the night in bed
and then more recently I've had the experience of waking up probably due to these like daytime things that I'm waking up in the middle of the night thinking about
and now because of our discussion during the course of recording this series I get out of bed after even 10-15 minutes so that I can start to eliminate that association
and another piece is that I've always felt that when I get out of bed in the middle of the night because I can't sleep and I go to the sofa I often can sleep very well
and the reason being that the location of sleep is the association of wakefulness sleep in bed as opposed to on the sofa is a clear component and this is in an environment that's of equal temperature and it's not perfect experiment
and it's in a data as we say but I think that the associative piece is oh so strong for many people and so this is something to really take seriously.
I love that notion of people will often say I just get up I go to the couch of the sofa and that's where I'll wake up in the morning.
Also they'll say when I travel and I go to a hotel room I just can sleep fine out for some people it's the inverse but for those people it's the contextual difference meaning the change of the environment is so unfamiliar that it is not being bound to association of wakefulness it's related to sleep or at least the opportunity to sleep.
Sometimes even I've heard from some people and there's no studies or data on this even turning yourself around now this is hard if you have a partner in bed but you just switch top to bottom of the bed and you take your pillow and you pull the doofay all the way down and you put the pillow at the opposite end where your feet used to be and you get into bed and even just looking around and sort of having a difference that alone is so subtle but it can make a real difference.
So again just keep these things in my I know it sounds strange or this whole sort of get up get out of bed break the associate and we'll come on to something well actually I'll come onto it now because I think it's one of the unconventional tips and you mentioned it a lot of people say to me that all sounds great.
Science makes sense I just don't wait dark it's kind of cold I really don't want to get out of bed so give me some alternatives.
I think the single best piece of unconventional sleep advice I can give you is do anything that gets your mind off itself.
The whole reason that if you look at insomnia as a physiological condition or current working model mechanistically of how insomnia plays out is that you are in this state of almost low level anxiety and you are somewhat stressed and when you go to sleep where you try to go to sleep or you wake back up and you try to get back to sleep you just have this roll the decks of anxiety.
So in the world we are constantly on reception and very rarely do we do reflection.
And unfortunately for many of us and I've been guilty of this the only time we do reflection is when our head is placed on the pillow and we turn the light out and that is the last time you want to be doing reflection that's the worst moment.
At that point I think everyone can empathize with the idea of you turn the light out your under stress your mind goes to those few things in the darkness of night thoughts become almost 10 times worse than they do in the bright of day.
So at that moment you start to ruminate when you ruminate you begin to catastrophize when you catastrophize you're dead in the water for the next two hours.
So what do you do the problem is as I said your mind is on itself and it's going through these repeated loops anything you can do for example you can do some kind of a meditation.
When I was researching data for my books some years ago I did look into meditation and I wasn't a meditator I was a hard no scientist didn't really kind of embrace with that notion or even that group of people.
But time and again I read paper after paper and the date it was very strong and it was coming from research groups that I respected very much indeed so I thought well okay I should probably give this a try.
And that was six years ago and since then I now meditate for ten minutes every single night before bed I do a guided meditation because I'm not particularly skilled so I use an app that moves me through that.
But you can do whatever you have whatever meditation you like that's one example the second example is you can do breathing methods because again you're focused on your breath and what are you not focused on your thoughts.
And so anything that will allow you to explore some other focus maybe it's a body scan where you start at the top of your head or your feet and you work your way up and you just say you know moving through now my neck what sensations am I feeling now into my shoulders moving down into my chest now I can feel the ends of my fingers and I sensing anything.
And when you start doing that or any of these types of things the next thing that you remember is your alarm going off in the morning because you got your mind off itself so I would say that that's probably one of the unconventional tips but let me come back to the conventional anything else I've probably missed out or being unclear about the actually I should probably say one thing in terms of these not the not tips I don't like the word I know you don't either or hacks or.
So these are protocols and they're well informed scientific protocols in all of this discussion today you can get all of these things in place and still have problems with sleep.
The reason is because you may be suffering from a sleep disorder so the analogy would be let's say that I'm your athletic coach and your sport superstar I can perfect everything I can perfect your.
Higher your supplements we can perfect your technique we can perfect but if you've got a broken ankle.
None of those things are going to alter your performance right now you've got to get to a doctor and get that scene to and then we can come back to fine tuning your performance it's the same with sleep if you've got a sleep disorder such as snoring sleep apnea or insomnia we need to get you to a doctor first and then only after that come back once you're resolved then we can start.
That's the only other thing I probably should mention this is all very useful discussion because I think that.
Of course there will be those folks out there that just like what are they talking about I sleep so well and I you know consider yourself blessed many many people struggle with.
Challenges with sleep and I think it's fair to say that sooner or later most everybody experiences some challenges with sleep for whatever reason you look at the statistics that's highly likely in your lifetime you are more than likely to go through either a period of challenging sleep or in fact about of insomnia.
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You talked about alcohol I'm not a consumer of alcohol anymore.
No, I'm not because I have anything against it. Yeah many people do enjoy it and and no we're not calling judgment on them. I mean certainly much of the world enjoys alcohol.
We talk a little bit more about aside from demolishing REM sleep. Do we know that alcohol causes these disruptions and sleep directly meaning by changing the pattern of release of neurotransmitters like GABA things of that sort or is this an indirect effect like you know is this like through the gut microbiome that then impacts sleep.
And the reason I ask is maybe we could get to some more specific. Do's and do not protocols so for instance if somebody wants to have a cocktail how close to sleep can they get and not diminish their rapid eye movement sleep too much because people are still going to want to drink.
And with that said if people do have a couple of drinks and then they go to see if is there is there anything they can do prior to sleep to trying to rescue.
There are some of their quality sleep. Great question so in terms of the mechanism it seems actually not to be the alcohol but some of the metabolic byproducts of alcohol.
And we think that perhaps the main culprit maybe some of the aldehydes that are the metabolic separate consequences of alcohol metabolism.
So you make a good point though in terms of the dose response timing curve how late or how early do I have to cut myself off from alcohol people have done those studies and they have found that even an afternoon single glass of wine if you measure sleep in the way that we measure it at my center with high fidelity you can see compromises and impairments I wish I could tell you otherwise.
I would say that based on that data the principle protocol advice I would have for you is go to the pub in the morning that way by the time you're about to sleep the alcohol is out your system you can you know I would never as a as a public scientist I would never advocate necessarily for wanting I'm just kidding you but
that's that's sort of one of the unfortunate consequences that does seem to be an impact to say that there isn't is just me not being truthful about the data.
Again, if you think about the trade off here if you're going out or you're having friends over and you're going to make an incredible evening of memories and you're going to open a favor bottle of wine and have a couple of glasses of wine is just sleep going to be compromised yes it is.
But maybe that's worth the trade off for that specific night I would just not wish you to and you've spoken a lot and so is our dear friend Peter here and others there just doesn't seem to be any safe amount of alcohol.
But I would say think about that trade off simply however don't make it habit that you're doing it you know multiple nights a week or more that would probably be the advice great what about food and sleep how close to sleep is it okay to have a meal if you want to optimize your sleep I like to eat my final meal somewhere around six
thirty p.m. but and I go to sleep somewhere around eight thirty nine p.m. Yeah and an ideal world sometimes I go to sleep a bit later sometimes I eat a little bit later is this you know there's some variability with these but
put differently what is the relationship between food intake and sleep quality in terms of timing of food intake and then perhaps we can talk a little bit about food macro nutrients.
Very interesting there was somewhat of a dogma out there that we have to stop eating you know three or four hours before bed for optimal sleep if you look at the data data is quite a spread no pun intended there is there are some people for whom that works very well and if they eat even two hours before bed they just
get disrupted in terms of the sleep some of that is about people just feeling too full and not feeling comfortable other aspects of that when you become
recumbent when you lie down you have a high risk of gastric reflux coming back up and therefore you get heartburn and that's pretty miserable and people will describe that too by way of
close proximity of food intake relative to when you're falling asleep never the less if you look at the data and I did a recent very deep dive on this person in myself about 12 months ago it's not quite as extreme as the dogma
out if you eat two hours before bed on average it doesn't seem to necessarily harm your sleep now that's very different than saying what is best to improve or enhance your sleep but the way these
cities were designed it was looking at detriment they then went to 90 minutes before sleep onset and even there they didn't seem to be market impermanence 60 minutes you started to see maybe
some signs but on average the effect size was somewhat weak but then when you get close to sort of 45 minutes or so then things did start to deteriorate I think it depends hugely on your
type and also just on your appetite circadian rhythm preferences to I am someone who I do not feel very hungry when I first wake up in the morning I don't feel very hungry throughout most of the day and I will on board most of my calories probably
the hours probably in about a four hour period maybe less even three hour period and then I will cut myself off about 90 minutes before sleep so I classically I would have been considered as you know violating this sleep dogma
of cutting yourself off at least three hours I think it's very personal though just experiment with it you will know the situation as for macros and specific food components the data is a little bit mixed certainly what we know is that if you're eating a diet that is high in sugar
and low in protein your sleep is worse why would that be the case well one of the reasons that we think is that if you on board sugar it can be somewhat metabolically active and when it becomes
metabolically active it can increase your body temperature your core body temperature even just very subtly but that's enough to disrupt your sleep as we spoke about with temperature but I think in terms of really the you know what would be the ideal macro nutrient and even
micro nutrient dietary recommendation that I would have for you I don't think we have enough data yet above and beyond that statement yeah I I've experienced when I eat a very low carbohydrate diet which I've experimented within the past maybe in four ketogenic diet for real
we're brief periods of time although I'm an omnivore so I eat meat and eggs and aisle sweet starches pasta's rice etc but we know based on beautiful work from for example Chris Palmer from from Harvard Medical School who is a guest on this podcast
I listen to that there's great podcast yeah Chris is spectacular and has advocated the exploration of ketogenic diets for the treatment of various psychiatric conditions not all but psychiatric conditions
and and it seems and he agreed with me on this that when people go on very low starch very low carbohydrate diets that sometimes they can experience a bit of hypomania some people can and and challenges with sleep and sometimes there are
psychiatric reasons why people stay on those diets anyway and then they have to do other things to encourage their sleep by their pharmacology or supplementation or some combination
but I can say anecdotally for myself if I if I don't eat starches for a extended amount of time a couple of days I find it very hard to get quality sleep as indicated by sleep trackers
and and just sleep late late and see the fall asleep is longer than it is etc so I've opted to eat most of my carbohydrates later in the evening
which and violates you know every rule of you know eat your carbs early in the day and and I think there are some data to support that eating carbohydrates early in the day may actually have certain benefits for weight maintenance or weight loss so I realized that but those aren't my my goals at the moment I weight maintenance yes weight loss no so I think I certainly feel after eating a dinner that has a bit more starch pasta rice these things
that sort and a little bit lower protein as opposed to the inverse like eating a couple of rib steaks in a salad but no starch that my sleep is substantially better and I always
attributed that to the relationship between some of these starches and the trip to fans slash Sir Tony and palo there is some data on that with the carbohydrate intake in the evening and of course that that trip to fan and that carbohydrate intake will contain the precursor ingredients to something else that we've spoken about which is melatonin
and so that may actually help healthily boost that melatonin signal is a little bit of data on that to support it to we also did a study where we we were looking at night to night to night sleep and carbohydrate intake the next day and it did seem to support what you're describing in terms of some of the carbohydrate benefits we also found a strange result that was almost the opposite prediction that we made
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But I would say there's been a tide shift in terms of cannabis meaning that many people consume cannabis who are consuming it legally and consume it for a lot of reasons that other people consume alcohol in a sedative effect, a slight hypnotic effect. I mean, you know, the actual definition of what these drugs do. It goes by certain terms in the psychiatric literature course. But in order to quote unquote mellow out.
to feel more relaxed to reduce their anxiety. It's as far and away different to when I was growing up where I mean, you would get into a lot of trouble. If you would caught smoking a joint or taking a bong rip in the middle of the day. But not and I realize most people aren't doing that at work. I guess it depends on where you work. But it you know, edibles, tinctures. I mean, the consumption of THC and CBD is quite.
Quite robust in a lot of places. So with all the issues of legality and the fact that people who young people should not be consuming them even people 18 and younger, not just for legal reasons, but the brain is still developing.
What is the story with THC CBD cannabis edible smoked tinctures on sleep specifically.
It's very interesting if you look firstly at the motivational reasons why people use cannabis based on the published study somewhere in the top two reasons sleep to fall and stay.
Obviously, usually the principle first reason is just to get high and have the experience and the pleasure of being high if that's what sort of floats your.
But certainly it's you know, sleep as it and what we call a hypnotic to put you asleep from the Greek derivative of the God for sleep. That is high among the reasons that people will use. We currently don't recommend it.
And here is why certainly THC helps you fall asleep faster, very clear in the data. The problem is that first you start to develop tolerance and to get that same sleep onset benefit, you need to get use, I should say, a higher dose.
So you start to develop dependency and your dose regimen starts to increase.
The second issue with THC is that it's very good at blocking your dream sleep, your REM sleep.
In fact, many people when they come and they tell me, look, I was a heavy cannabis user, even a light cannabis user for some time. And then I stopped using.
And one of the strangest things happened to me, I just started to have the most wild, vivid, crazy dreams.
I didn't know what was going on. And it's a very simple explanation. As you've been using your brain has been compromised in the amount of REM sleep it's been getting.
And you've been building up chronically a REM sleep debt.
And your brain is smart in the sense that it does try to clock to some degree a counter of how much REM sleep you've lost.
And many people say, yeah, I don't really remember my dreams when I'm using. But when they stop, the brain finally, because it's been cleansed of the thing that's the road block to REM sleep.
Not only did they go back to having the normal amount of REM sleep that people would have, they have that.
Plus they have what we call a REM sleep rebound, which is even more and more intense REM sleep, which leads to more intense dreaming.
So it's a very, I suspect there's a lot of people who've had that experience listening if they have been users and they've stopped.
So that's the second reason we don't advocate it.
The third reason is that when you stop using, you also go through a very vicious insomnia withdrawal syndrome often many people will do.
Now that depends on how much you've been using for how long you've been using.
If you look at the data, and by the way, part of the clinical diagnostic, the psychiatric diagnostic description of cannabis withdrawal is insomnia.
That's how reliable this insomnia problem is when you come off cannabis.
And if you look at the data, one of the main reasons that people relapse and start using cannabis, again, even though they don't want to, is because they can't deal with the insomnia that withdrawal has given them.
So you don't want to get into that vicious cycle.
Should you wish again, it's your choice.
And THC, I think is not to be advised right now, CBD is interesting.
I don't think there's enough data yet for us to have a very strong opinion, but I can at least offer mine.
The data so far is a little bit mixed in what we call the effect size.
In other words, how reliable and how powerful is the benefit of CBD on sleep.
But it does seem to have some benefit.
What's interesting is that it doesn't seem to have the detriment that I just described for THC.
You've got to be looking at the data a little bit careful with CBD.
It has what's called a U-shaped function to it, which is that if you're taking too little, and again, I'm so mindful of not trying to be okay here are the numbers.
But if you look at them, I would say, you know, kind of cross your eyes, squint your eyes, maybe less than 25 milligrams,
you run into the danger of CBD being awake promoting, rather than sleep promoting.
But once you get past, if you look ish, 50 milligrams and above, then you start to go in the opposite direction where it seems to be sleep promoting.
And I mention that just because at least here in the United States and in many places in the world, that industry is not regulated.
So it may say 50 milligrams on the bottle.
You don't really know how some of those companies will have what's called third party laboratory testing where they'll send it out.
And you can scan a QR i code and you can look at an independent laboratory that tested it and show you the purity of it.
So that may be one way to go.
So CBD, I think, has some favorable evidence right now.
If that's the case, let's just assume that you and I speak in another five years time and there's really good date and now for this.
What could be the mechanisms?
I think there's at least, there's probably at least two, maybe three mechanisms.
But first is an indirect mechanism. CBD has been demonstrated very nicely in some fantastic studies to be an anxiolytic, which is a fancy term for saying it reduces down your anxiety.
And earlier you and I discussed that anxiety and stress is one of the things that will keep you awake.
So indirectly it removes this kind of gate that is preventing you from moving down the royal road of sleep.
And it opens back up the gate because it's removed that gate mechanism, which is high anxiety.
And by way of being an anxiolytic, it's often that anxiety and it's easier for you to fall asleep.
I think that's probably the principal mechanistic bet I would have right now.
Another indirect mechanism.
If you look at some of the studies in rats and we do human work at my sleep center.
So we don't do animal studies.
If you look at the data in the rats, CBD can be hypothermic, which means that it drops your core body temperature.
And just as we spoke about earlier in this episode, you need to drop your body temperature to get to sleep.
So I think that's the second reason.
I think the third reason is that it could have a direct sleep promoting mechanism.
I think it's unclear right now exactly how it's interacting with the sleep machinery of the brain.
The danger is again, it's just not a well regulated substance.
So I am actually just full disclosure.
I'm working with a company in the United Kingdom in collaboration with Kings College and the Institute of Psychiatry.
There are two to see if we can create an analog, a clean analog of CBD.
But I think the potential upside of it, not just for sleep, but for a number of different psychiatric conditions like anxiety.
It could be beneficial.
So I would say that that's right now the sort of the skinny on THC and CBD.
Okay.
So just to make sure that I have the basic list of sleep hygiene factors.
Correct.
I have regularity is king.
Yep.
Light and dark, meaning that one should optimize or at least seek to optimize their exposure to light.
In the morning and throughout the day and then in the evening to make things dim and dark.
Yes.
Temperature.
And there you have a, it's not a mantra, but what is it?
It's warm up to cool down to fall asleep.
And then it's stay cool, like Fonzie, stay cool to stay asleep.
And then a warm up to wake up.
Yep.
And we will come on to that I think in a little while again.
Then there's walk it out, which is if I understand correctly, if you're trying to fall asleep or fall back asleep.
And it's taking you longer than about 20, 25 minutes, you should just get out of bed and go elsewhere in the house do something else.
Maybe even lie down on a different surface in the house to try and see if you can sleep there.
But don't stay in bed.
Don't create a paired association of wakefulness and your bed, because that can lead to problems and subsequent nights.
Yeah.
And say that try to resist if you can, if you really want your bedroom to be the place where you now become consistently asleep, try not to start sleeping in some of the location consistently, because then all of a sudden you bond that with good sleep and you unbuckle this notion that we're trying to re-learn, which is no your bedroom is the place of sleep.
It's fine to go elsewhere, try to stay awake and force yourself to stay awake until you are absolutely sleepy, then go back to bed.
Okay. And then we discussed alcohol, food, caffeine and THC slash CBD, aka cannabis.
And with respect to alcohol, it's clear that none is best if you're going to have some, you don't want to drink too early in the day, but you don't want to drink too much or too close to bedtime, because it can disrupt rapid eye movement sleep.
Food seems that creating some sort of buffer between the your last bite of food and your to bed time by, anyway, somewhere between, you know, maybe two, three hours, but for some people it'll be more like 90 minutes.
And of course, that's going to depend on the size of the meal, et cetera, but eating a big meal and then going straight to bed, probably not a good idea.
So caffeine has this long half life, so if you're going to indulge, which I do do so early in the day, beware of the afternoon caffeine.
Yeah, do the human tape is what I'm going to call it right now, which is not an interpretive dense and some caffeine tape.
And then THC CBD does nothing good for your sleep architecture, although some people have the impression that it is good for their sleep because it makes it easier for them to fall asleep, but what they're unaware of is that it is disrupting the quality and architecture of the different stages of sleep in ways that are not serving people well.
That seems to be the case for THC and I think CBD, you know, has promised and research must try harder, including my own.
And you very kindly emphasize that you're not telling people what to do. They just should know what they're doing so that they can make changes if they so choose.
That's right. I would always say that I'm not trained to be a medical doctor. Any advice that I give is simply scientifically descriptive advice. It's not medically prescriptive nor lifestyle prescriptive advice.
I'm smiling because what I always say is I'm a scientist not a physician. So I don't prescribe anything, but I profess lots of things.
So, or as my good friend who's a musician, Tim Armstrong says, I'm not a cop. So do what you want. Okay.
What a wonderful list to leap off into the unconventional and more advanced tools for sleep enhancement. So let's go there.
So I think many people may have heard of some of the conventional, but what about the unconventional. I would probably offer five or six.
The first one I would say is that if you are struggling with sleep and you have had a bad night of sleep, the first recommendation is do nothing.
And what I mean by that is if you've had a bad night of sleep, you're awake for three hours, do not sleep in any later into the morning.
Do not go to bed any earlier. Do not increase your caffeine intake to try to offset it and do not nap during the day. Why am I telling you those things?
If you wake up later that following morning, your adenosine clock that we spoken about this building up of sleepiness that happens when we wake up is going to start later in the day.
So when it comes time for you to fall asleep at what would then be the next night at your normal time, you're not going to feel asleep. Why?
Because you woke up that much later and you're setting yourself up for failure again. Equally, don't go to bed any earlier.
If you have become accustomed and your brain has and you're circadian clock is becoming accustomed to going to bed at a certain time and hopefully you're doing it regularly, then getting into bed two or three hours early has the danger.
It's not a certainty, but a danger of you then getting into bed and thinking, well, I'm, I know I had a bad night of sleep last night, but I still can't fall asleep straight away.
So now you're spending another 90 minutes in bed at the beginning because you've gone to bed 90 minutes earlier thinking it's a good idea to compensate. Don't do that either.
Hold out, even if you do feel tired, my recommendation would be after that bad night of sleep, hold out for as long as you can as close to your natural bedtime as possible, then go to sleep and you'll give yourself highest chance of success. Don't overcaffeinate. That's the obvious one.
You're not alone with a beautiful human taper and then obviously try not to compensate with a nap. Why? Because that nap as happens when we sleep is going to remove some of that sleepiness that a dinner scene and once again you get into bed and you're not asleep because you're naturally bassy.
Then go through a bad night because you're struggling to sleep or you wake up and you can't get back because you've got less weight of sleepiness on your shoulders due to the nap that happened earlier. So I know it's hard, but I would say when the alarm goes off after a bad night, you just think, I do not want to get up.
I know it's a short term gain, but trust me, it's a long term loss because you're going to then just get into this vicious cycle. So that's the first unconventional tip.
I'm a little wide eyeed over here because I did not know any of that. Typically, if I get a poor night sleep, I'll do whatever I can to recover that sleep. I'll take a nap. I'll adjust my to bed time the next evening.
I hope everyone is paying careful attention to what Matt just said. That's an important list because I think one of the very common things is for people to just not get a great night sleep. And I think most people think, OK, I'll drink a little more caffeine.
I will go to bed a little earlier tonight, maybe catching a nap in the afternoon, this kind of thing.
I would have thought that too, and maybe even suggested that. And if you listen to the first episode, and where we, you know, I list in a Doomsday manner, the things that can happen by way of a short night, you would think that that's what I would then recommend, but it was really imprinted on me by a wonderful sleep clinician, Michael Pellis, who sort of described some of these features and exactly the reasons sort of underlying them.
I think I've just tried to bake that out into a formula that makes sense. Again, it's not about the rule. It's about explaining it because when you explain it, it first sounds contradictory and paradoxical.
When you understand it, it hopefully sounds logical and actionable. So that would be the first suggestion.
Could I just sorry to interrupt again, my audience hates when I interrupt, but I'm doing it on their behalf because I love it because I like to think that there's some value and some of at least what you say in response.
I saw a really terrific post from Dr. Ronda Patrick, who we both know and admire for her public education or public health education work.
She described a study whereby if people are, I think it was slightly sleep deprived, maybe by a few hours, that some of the disruption to morning blood glucose regulation that is known to accompany partial sleep deprivation, and certainly complete sleep deprivation.
But in this case, partial sleep deprivation could be offset by still exercising in the morning.
Which frankly, I have to say if I haven't slept that well, then normally I'm maybe today's the day I don't exercise. But now having heard that information, I make it a point to still exercise sometimes with a little bit less intensity.
Yeah, because I don't want to be completely exhausted in the afternoon and go to sleep at 4 p.m. or something really disrupt my schedule. But I thought that was really interesting because it's a sort of partial inoculation of the blood glucose disruption caused by sleep deprivation.
I'm so glad you brought it up. It's a fantastic study and I, I'm, I'm, I think you've tried to discuss it some years ago on a show, but I like it because it does offer some degree of actionable hope and a strategy.
Blood sugar, absolutely critical. It is very sensitive to sleep when you don't get enough. It goes in bad directions. You used a very specific word cleverly so that word was partially.
At first you hear or read that study and and Ronda was never suggesting this to I'm not saying that you think, well, if it offsets blood sugar and the study was saying exercise can nullify a lack of sleep, you conflate that single outcome benefit with the idea that well, but maybe it doesn't actually read or doesn't compensate for the deficits in immune function or cardiovascular.
Disease concerns or my hormonal health or my learning and memory or my emotional and brain health. Maybe it does, but maybe it doesn't. So I think I would always just caution people to saying when you hear a study like that, it's very natural to think, oh, that must mean that it translates to everything else in my body and everything else in my brain.
It may, but it also may not be terrific. So if you don't sleep that well, do your best to still get some exercise, but just be mindful of the fact that you know in the winter months, especially that might if you go too hard in the gym or on a run you might be a little bit immune compromised. Just be mindful of the fact that you're more vulnerable being when you're sleep deprived and that but that exercise can help adjust things in the right direction.
It's early in the day, presumably that's not going to disrupt your proper bedtime. And if it's later in the day, I suppose as long as you don't need caffeine in order to do that exercise and or if you're familiar with exercising later in the day, fine, I find if I exercise, I'm not one of these people can go for a run, you know, seven o'clock at night and then just show your morning type because I'm a morning type other people can.
Okay, we'll get into exercise a bit more in a later episode. We should do. Yeah, we'll be sure to do that, but nonetheless, that just raised that now. So what are some of the other unconventional protocols for sleep?
So I think other suggestions I would have after do nothing would be try to think about limiting your time in bed. If you are struggling with sleep, this is something that is used in the probably the most well validated psychological intervention for insomnia and it's called cognitive behavioral therapy for insomnia or CBTI for short.
So what happens is that you work with the clinician, they interview you, they assess all of the reasons that you may not be sleeping and then they create from their toolbox of many different options, a bespoke tailored sort of Savile Roe soup prescription for you for your treatment.
If you look at the studies of that collection of different tools in the CBTI box for intervention of insomnia and you ask of all of those which seems to carry the greatest impact on insomnia, which has the greatest sort of gravitas.
It seems to be this thing that we call bedtime rescheduling. It used to be known as sleep restriction therapy, but obviously if you come to me and you say, look, I am not sleeping very well, I've got insomnia, I say, I understand and I've got a treatment for you. It's called sleep restriction therapy.
You say, no, no, you didn't understand, I'm not getting enough sleep, but it's not quite that. Here's how it works. If you are spending so much time in bed, too much time in bed, you are not forcing your brain to be efficient.
By way of constraining your sleep window, even to let's say five hours a night to begin with, I brute force ruthless efficiency from your sleeping brain after several days.
So under the analogy would be, let's say you're trying to make a nice thin crust of pizza base and you put the dough on the table and you start rolling it out. If you roll it too thin, it starts to get gaps and holes in it. Why? Because you've spread it out too far and you've start to create these absences.
That's the same thing that happens and it's very natural as an insomnia patient, you would say, I'm just not getting enough sleep so I'm going to start spending more time in bed. It's the very worst idea.
Another way would be to say, I go to the gym and I spend about an hour and a half working out. But if I were to videotape you, a lot of people are doing the, I think you've coined it as your phrase, but the 11th rep where people, you know, do the 10 reps.
And then all of a sudden there's the selfie or there's the social media or, oh yeah, the texting they finished the last rep put down and straight away on the text.
And if you look, they're only working out for about let's say 45 minutes and the other is wasted. So what if the next day you came to the gym and I said, look, I'm sorry, there's some big bounce of guys at the door.
You are only allowed to work out for 40 minutes and then we're going to eject you. And the first day you go back and you do the same thing. And then you've only got through 30% of your workout.
So you get booted the next day you come back and you do a little bit more and you get booted again after about five or six days, you've built up such a strong desire and hunger to get your workout in.
You walk in, you put your phone on silent, you put it over in the corner and you just get to it. And that's the same thing that we're trying to do with sleep restriction therapy.
So you have to be a little bit careful, do it under supervision, especially if you're driving or you're operating heavy machinery. We just want to keep an eye. It's not necessarily a big concern, but we would say, okay, and through your currently spending almost total about eight,
it's it's your seven and a half hours in bed tonight. I'm going to restrict you down to five hours a night. We're going to do this for the next week.
And the way that we normally do it is I don't change your wake up time. I change your to bedtime. Why it's easier to stay awake longer than it is to wake up earlier.
So I put it on the front end to the compromise and at first things don't change. But after maybe about four or five days of going through this, I build up enough of a short term debt in your system that your system all of a sudden thinks, gosh, I just cannot be as lazy anymore.
I can't do this thing of waking up in the middle of the night and spending an hour and a half awake. I don't have the choice anymore. There's so much physiological build up and pressure to do this.
And gradually what happens is that you sleep longer. You don't wake up as much. And after maybe about two weeks of doing this, all of a sudden you go to bed. It was later time.
So for you, let's say you normally go to bed at eight. I'm going to have you go to bed at maybe 10 30 11, but we're still going to have you wake up at that sort of 4 30 AM mark that you would normally wake up.
And all of a sudden you go to bed at 10 30 11. You're out like a light. And then again, the next thing you remember is your alarm going off saying, I'm sorry, you've got to wake up.
And what happens by way of that reset is gradually we will then once you're stable, we will start to back it off. We'll start to have you go to bed at 10.
And if it stays stable, then 9 45, then 9 30 and titrate you back to where you were. And if there's any sign that you're starting to not sleep well, we zip it back up again.
The goal here is in some ways, almost like hitting the reset button on your Wi-Fi router. I'm trying to retrain your brain to better sleep.
Because when you are not sleeping well, you've lost your confidence in your ability to sleep. And when I do this technique with you, gradually your system and you cognitively re-learn that you are a good sleeper and you can trust in sleep.
And now your sleep does not control you. You control your sleep. The hard part, however, is that it's not easy to go through. And we have to be, we have to usually ask two questions with individuals. Firstly, what is your motivation for better sleep?
We need to know that you are really motivated. And then second, you just stay with a high-touch, wike, of frequency checking in on individuals and motivating them to keep going because it's very easy to fall off the wagon.
So that's the next suggestion. Sleep restriction therapy or bedtime rescheduling as we would call it.
You said it's difficult for people to go through. It takes a little bit of rigor, a little bit of attention. In some cases, getting less sleep than one would like. But as compared to something that, you know, sadly, I've experienced a lot in my life of having challenges with sleep and trying to get things back in order and looking at the bed and just going, oh my God, the battle ground.
I think it makes a lot of sense. And I love the analogy to the gym. Somehow, if there's a restriction to one hour in and out the door, or maybe 70 minutes in and out the door, because you need to put your stuff in the locker or something like that, it always, at least for me, gets done best when you just have those constraints.
I mean, there's something about the human brain that we don't do well in unrestrained systems that I really think guardrails are fantastic. I love deadlines, for instance, yeah, discipline. Yeah, it's essentially hard hard deadlines.
Like, or as they say in academia, because we, you know, right, grants all the time drop deadlines, which, who made up that term, but like, if you don't make it, that's it. It's like, there isn't a hey, I'll send this into my five PM specific time that website closes.
And you better have you get things done all of a sudden, it's surprising how much distraction you can, you know, pull out the noise and focus on the signal.
It's great signals noise ratio. Yeah, and I love the idea that you that one can control their sleep as opposed to sleep controlling them. I think that that's.
And this notion of sleep confidence.
And one's confidence in their ability to sleep. These are important terms and they're more than just terms because I think that a field and an area of health practice and gosh, what's more important than sleep is the foundation of mental health physical health and performance period.
And really thrives on a common, common nomenclature. And I really appreciate that you're, you know, peppering these episodes with it with new nomenclature that captures a lot of the essence of the protocols and the mechanisms.
So there, that's my editorial. Please continue.
And I say that in terms of other things, maybe just to go through them a little more quickly, we've spoken some about a wind down routine. Most people under appreciate the importance of a wind down routine.
We often think that sleep is like a light bulb that we dive into bed. We switch off the light bulb and sleep should appear just as quickly.
And it's untrue. Sleep in terms of a process is much more physiologically like trying to land a plane. It just takes time to come down onto the terra firmer of good sleep at night.
And it is you enjoy as a relaxation method, engage in it, could be listening to a podcast, could be reading a book, maybe it's a meditation, it's light stretching, maybe whatever it is that you do, just build it into your regiment.
And you would never, you know, be driving down the road and then pull into your garage at the same 40 mile an hour speed. You gradually decelerate and you come to a stop.
That's the same thing with sleeps you need to find some way to decelerate and we've spoken about methods already as to how to do that.
Tip is a little quirky and funny. Do not count sheep. There's a great study for my colleague, Dr. Alison Harvie at UC Berkeley and she put this to the test.
Didn't make people fall asleep faster. It made them take longer to fall asleep. However, she did find an alternative.
If you are not into meditation or podcast or sleep stories or whatever it is that you wish for, try taking yourself on a mental walk.
And it has to be a walk that you know very well. So let's say that you walk your dog every day and you know there's a couple of walks that you take with your dog.
Do it in a hyper detail. So close your eyes. You go to the front door. You clip in the dog to the leash. You walk out. You go down the steps out to the driveway.
Then you take a right, but you always cross over and you look to the left and the right because that's the place where traffic always comes. You cross over.
And now you're walking up and there's that strange sort of set of garbage that's been outside of that house for a long time and you don't know why it hasn't been cleared.
And then you move that type of high fidelity detail allows you to do what we said earlier, which is get your mind off itself.
And when you do that again, typically you fall asleep faster and that's what she found. It's a great, great study. I really enjoyed that.
I'm curious as to why it works so well. And I'm not challenging that it works. I can imagine having just closed my eyes and kind of imagine what that would be like. It's very pleasant.
There might be. I'm here. I'm just speculating something about engaging one's procedural memory because that's procedural memory. You're trying to remember how you do something as opposed to declarative memory, which is about facts.
You know, I remember this and this is going to happen tomorrow. I wonder whether or not there's something about using a procedural memory as opposed to a declarative memory visualization.
Somebody should do that study. They shared it. And I think it's certainly possible that when you're incorporating some aspects of the scene and the information is more sort of theoretical and maybe episode sort of episodic declarative memory. But when you're taking yourself from a mental walk, what is the fundamental premise of that it's a walk, it's motion, it's procedural memory.
And so maybe it's something to do about with being more attentive to becoming embodied because when you're out walking and you're moving, it is a more embodied experience than just sitting there at your desk, which is your mostly your head and very little your body.
So I think it's an intriguing idea and I think another tip that I now think of which also comes from the work of Dr. Alison Harvey.
When individuals come up to me after sort of public events or they see me at the airport, I'll say, look, every night for some strange reason at 2.45 am I wake up and it happens three or four nights a week.
My first question to them is, how do you know it's 2.45? And they say, well, look at the clock or I look at my phone. Best piece of advice next, remove all clock faces from the bedroom.
No matter how bad your sleep is going to be that night, knowing what time it is is only going to make matters worse, it is not going to make matters any better.
An anxiety trigger that you think it's 2.45 and then you're tossing and turning you look back at the clock and now it's 3.14 am and you think, I've got to be awake at 6. I've got that big meeting and now it's 5.20. Don't do that to yourself.
And I, even though I don't typically struggle with sleep, I have no clock faces in my bedroom. The phone that I use to help do the guided meditation is an old phone and it has only Wi-Fi connectivity and nothing else on it.
And I will only hit play and then I will never turn it around. I will not look at the clock face. Just doesn't help me.
Another incentive for keeping the phone out of the room. If one can. I understand their reasons when one would want the phone in the room if you know it's potentially signaling an emergency.
Well, I think it's a very important point and we've done some work in this area to what that phone does is create a low level of anxiety. It's what we call anticipatory anxiety.
One of the mechanism separate from that, well, it's related to that. If you look at teen phone use, one of the reasons that they don't sleep very well at night is that they're constantly checking their phones because of FOMO, a fear of missing out. What has gone on as I've been asleep and it's stunning the data.
But for most adults, the other reason I don't like advocating for phone use. When your alarm goes off in the morning, what is the first thing that you do as you're in bed, you swipe right or you unlock your phone and you instantly start checking social media emails, text messages.
And this tsunami of stress and anxiety just floods over you. It hits you like this wall of anxiety. And I bring this up because it again trains your brain for expectation of that.
Anticipatory anxiety has a consequence on your sleep and everyone knows this. Let's say that you've booked an early morning flight and you got to wake up at 5 a.m. when normally you wake up at 7 a.m.
Two things will usually happen first. You know that you're just not going to sleep as deeply that night because you're on edge. And this is for an interview or is for a critical, this is a non-negotiable trip that has to happen. You've got to wake up.
The second thing is that when you are expecting that that wave of sort of need to wake up and maybe it's just I'm expecting the phone again. You will wake up just a few minutes before you're alarm.
It's stunning how many people will say I had this big flight the next day and you almost know I'm going to wake up two minutes before my alarm goes off. Why? Because your brain has stayed in the shallow state of anticipatory anxiety and you don't get as much deep sleep.
And we've now demonstrated that when others when you have that low level anxiety, the depth of your deep sleep is not as deep. You don't get the good. So again, not to be trying to dictate what people do just be aware that when you do create that behavior and that regiment, it becomes almost like a knee jerk sort of trained habitual response.
Terrific. Let's talk about some of the advanced tools for sleep enhancement. What sorts of methods could one incorporate? What are some of the data? And is there any way that can sort of lump these into some framework or categories because I know there are a lot of different tools.
There are and I suppose this would be, you know, I know our friend Petro Tira is spoken about medicine three point. I think this would probably be sleep optimization three point. Oh, what is coming down the pike? What is in the research? And I think, you know, could make it to market or has made it to market.
But yet we're still right on the cusp. We've seen we again in the royal we have been able to augment human sleep in at least four different ways.
There are methods for electrical brain stimulation. There are methods for acoustic stimulation of sleep. So electrical stimulation of sleep acoustic stimulation of sleep. Thermal manipulation of sleep and then finally kinesthetic manipulation of sleep, meaning movement based stimulation.
Maybe I can just go into each one of those. The electrical stimulation is probably the most well rendered of all of those four.
In part because we started there and we and here it's not the royal we we have done a lot of work on this and I can tell you a little bit about a company emerging from that. But when you're trying to manipulate the human brain, the principal currency in which the brain communicates is electricity.
Now there are lots of things that help it do that, such as chemicals, but the principal language and a viabage of the brain is electricity. So if you're going to manipulate the brain, why don't you speak in its currency of electricity.
So we are others have developed a method based on something called direct current brain stimulation and specifically something called trans cranial direct current stimulation and I'll unpack that trans meaning movement. So if you've heard of transport, it's about moving things from one port to another trans Atlantic moving, you know, across the Atlantic.
So here the start of it is moving your moving something from one place to the next trans cranial means through your skull. So we're moving something through your skull trans cranial direct current is the type of voltage or the type of electrical impulse that we're putting in it could be alternating current or it could be direct current and early methods and those we use have been direct current.
So trans cranial direct current and then stimulation, we're trying to stimulate the brain specifically the cortex.
And the way that we do this is that we apply electro pads to your head and we insert a small amount of voltage into your brain. Now it's so small that you typically don't feel it, but it has a measurable impact on the electrical brain activity.
So very early on scientists and we want the first to do this by any means there was a great paper now famous paper in my field by wonderful scientist Jan Born in Germany and they took a group of subjects and they applied these electro pads and specifically to the front of the brain.
And I'll explain why we target the front of the brain with sleep electrical enhancement or the electro sustical as it were. They applied these electro pads to two groups of participants and then they let them go into sleep.
And as you remember we described that in the first two or three hours of sleep is when you get most of your deep sleep and they were targeting those deep slow brain waves that we spoke about there was big slow powerful waves that defined deep sleep.
And what they did in one of those groups the other group was the placebo group they still had the electrode supply they still went to sleep in the stimulation group they waited until those individuals went into deep sleep.
And I told you in the first episode that those deep sleep brain waves were going up and down very, very slowly maybe just once or twice a second.
So they started to stimulate the brain inputting the stimulation pulses at a very slow rhythm trying to match the rhythm of the brain in fact they were less than one hurts less than one cycle per second in terms of a pulse.
It's almost as though we're trying to act like a acquire to a flagging lead vocalist. And as these brain waves are going up and down you're trying to sing in time with those deep sleep brain waves and in doing so you're trying to boost and amplify the size of those deep sleep brain waves.
Now to begin with they just waited until they went into deep sleep and they started to stimulate at that frequency and I'll come back to why that's important in a second but sure enough what they demonstrated they were able to boost the electrical quality of that deep sleep by about 60% and they were also able to almost double the amount of memory benefit that sleep provided which is very impressive.
Now I should note that there was more recently a replication attempt of that paper and they did a very good job. They really did it to the letter and they weren't able to replicate the effects as powerfully.
However, subsequent studies have now taken a more nuanced approach and it's the one that we've taken to and it's called closed loop stimulation.
Close loop here simply means that I'm not going to just wait until you go into deep sleep and then just take a chance and start stimulating your brain not knowing of the synchrony of my pulses into your brain relative to the brain waves that you're experiencing.
Close loop does do that so what I'm doing is I'm measuring the electrical brain waves that are carrying and because they're nice and slow they're very predictable and I can program my algorithm and my brain stimulation machine to say I'm going to wait and wait and as soon as you are on this peak of your slow wave turns out to be the negative trough but I'll for go that we then try to strike at that point of midnight when you're going to be able to do that.
When you're going through the biggest sort of powerful sort of dip in the brain wave and we're trying to sort of enhance it and same with the peak so this is where we take we get it stimulus from the brain your electrical brain activity and then we create a timed response so it's a stimulus response to call and response loop.
By way of doing that it's a much smarter specific method than a more generalized I'm just going to stimulate and hope I catch those waves at the peaks.
The reason is important because different people have different speeds of their slow brain waves they're all slow but your speed of brain wave may be a little bit different to mine.
And if I'm off with my stimulation by let's say just half a second or a quarter of a second time and time again and maybe leaving some benefit on the table but close loops simulation creates this personalized electrical prescription of stimulation and when you do that you get very reliable benefits you can boost those deep slow brain waves you get the memory benefits but also what we found is you not only boost those deep sleep brain waves you boost.
Another electrical signature that I spoke about in the first episode called sleep spindles and it seems to be the combination of those two things by way of electrical stimulation that provides the benefits now I should know I haven't mentioned this before you can buy these devices on the internet DIY style do not do that if you go on to the internet too you can also find some horror stories people of miss appropriated the voltage they've got skim burns they've lost their eyesight.
For several weeks do not do this at home I promise you use you know wait until these products come out and that's one of the reasons why we've scaled it into a company and we're trying to do this we've got a long way to go yet huge number of trials that we have to do before you know I feel ready to to really lay it on the on the table and say you should absolutely buy this it's well worth it but we're getting very very close I would say
great what about thermal manipulations temperature I mean there's such a tight relationship between temperature and sleep and and wakefulness for that matter what sort of technologies tools protocols exist to that use thermal manipulation as a way to augment sleep I love this topic because there are high phi low phi and no phi technologies that you can use
the story of sleep and temperature as you mentioned before and reiterated in terms of the three part stands are that terse that I would describe is again you need to warm up to cool down to fall sleep you need to stay cool to stay asleep you need to warm up to wake up what that refers to technically in sleep science or what we call the thermal trigger zones so
warming up to cool down to fall sleep is what we call the sleep onset thermal trigger zone cooling down or staying cool to stay asleep is about the deep sleep trigger zone and then warming up to wake up is the activating alertness trigger zone
studies if you looked at them to begin with before they manipulated that found something fascinating if I take you Andrew human and I bring you into my lab and I remove your phone all your laptop and you say goodbye to your friends and family and you bring you into the center and there are no cues as to what time of day no windows no nothing and I'm just going to say look I'll keep asking you but
at the moment that you feel most sleepy just let me know it turns out that before that we've done the delightful intervention of inserting a rectal probe into you because that's the best way that we can measure your core body temperature
so we're measuring your core body temperature and sure enough despite you knowing nothing about what time it is the moment that you will tell me I am ready to go to bed and I am sleepy is the moment when you are on the greatest decelerating trajectory of your core body temperature it is highly predictive of how sleepy you will feel
the way that your body does this is by pushing blood out to the surface regions of your skin notably your hands and your feet because these are these highly vascular regions and you had a great podcast from one of my heroes and good friend Craig heller who's done some amazing work on this at Stanford
so naturally as we lie down blood races to our hands and our feet and also our head and we start to release that heat trapped in the core of our body and by releasing that heat of the surface our core body temperature drops
the outer surfaces of you hands feet and face have to warm up for your core to cool down for you to fall asleep and in fact there was a great nature paper some years ago they just measured the temperature of someone's feet
and they looked at how quickly they fell asleep and when they fell asleep sure enough the warmer your feet the faster you fell asleep
why because the warmness reflects the blood dilation and the pumping out of the blood to the periphery and then they did it in rats where they started to warm the pores of the rats and the rats fell asleep more quickly
I love this notion of again we don't do anymore for you know I love the notion of wrapping a beautiful little rat of incontinuol and I'm warming its feet with this pad and it's just blissed out and then poof he's gone he's after she I respect the privacy
so that was the early evidence that then led to a series of manipulations studies the most notable is brilliant it comes from a colleague in the Netherlands, Usfans Summer and his group
they created essentially what was a wet think about a wetsuit but that wetsuit is covered with all of these thin tubes almost like veins that go all over the suit to all territories of your body
and then what they would be able to do is perfuse water warm water or hot water exquisitely to different parts of the brain or the body
cool amazing yeah no pun intended so what they did was then they started to manipulate these peripheral regions sort of
and sure enough when they did this they were able to have individuals fall asleep 25% faster and these were healthy individuals who are normally sleeping within a very natural quick period of time
but they were able to lock off 25% of that time simply by warming these certain parts of the brain to lift the blood away from the core of the body and by doing that they accelerated the temperature core deceleration
and therefore increased or accelerated the speed with which sleep arrived to those individuals sleep appeared with much greater alacrity than it would have done otherwise even though it was quick anyway
so then not being satisfied with that they moved on to the deep sleep triggers own and this isn't you need to stay cool to stay asleep
and here now they started to just continue to cool the core the central aspects of the body
what they were able to do is increase the amount of deep sleep by somewhere between 25 to look at some of the data almost 40 minutes they were able to boost the amount of deep sleep with the thermal manipulation
and when they were measuring the electrical brain waves and they decomposed those brain waves even the power and the electrical quality of those slow waves was increased very impressive too
next not being satisfied with that they turned to older adults for the reasons that we've just described
what they found was that in those older adults when they were not manipulated with this thermal temperature
in the second half of the night there was a 50% probability that they were going to be awake for some part of the second half of the night
when they did the thermal manipulation they dropped that number down to 5% so they reduced a 50% probability of waking up down to 5% in older adults
and again they improved the quality of that deep sleep
think about by the way why that was so effective for older adults I guarantee you've probably seen you've been in a warm climate or you've been down on the beach
here in Los Angeles and people are out in shorts and t-shirts to crop tops
then occasionally there will be someone and I love seeing these sites where a child is wheeling along their elderly parents
beautiful sort of scene of caring but the older adult they're not dressed in the same way that everyone else is dressed on the beach
they are wrapped up some of them have a woolen hat on why older adults cannot thermo regulate anywhere near as well as young adults
that's alright and it's the reason that older adults will always be saying I'm just so cold and my hands are my feet especially are always cold
now that's a problem for sleep because if you cannot vasodilate at the level of your hands and your feet
you can't get the blood out from the core you can't drop your core body temperature as much
and we started to understand from those types of data that part of the aging sleep related problem equation is not just that the brain deteriorates in sleep related regions
which we've been doing most of our work on it's also part of a body equation and a thermo regulatory equation
there's also great study unrelated from Australia they looked it insomnia patients
and they put their hands or their feet in warm water and by doing that it's a manipulation you can see how quickly their hands and their feet
what we call vasodilate fill with blood
healthy people phasor diated very quickly in response that warm water meaning that their hands and their feet had this red
or at least for my feet they would be this red tone to them
however in the insomnia patients they did not vasodilate anywhere near as well
so once again it suggests that when you have problems with sleep part of the equation may be that you have impaired thermo regulatory ability
and we do see this in insomnia patients so that was I think a brilliant causal manipulation
the problem is that most of us don't have access to a sort of come to bed eyes thermal suit
so what can we do as a conscious please don't cut that
I'll get myself into terrible trouble rightly so I should be punished
what they did then was to say well okay let's look at this is this something that we could do that's cheaper and more accessible to the general public
and if you look there's a literature that preceded that manipulation and it's so reliable that we now have a term for it in sleep science
it's called the warm bath effect and many people will say look I love to have a warm bath or a hot shower before bed
and I think when I get out I'm nice and toasty and it's because I'm nice and warm that I fall asleep and I stay asleep
it's the exact opposite when you get out of the warm bath or the shower
you have once again vasodilated at the surface of your skin
you get out of the bath you get this huge thermal dump of heat away from the core
what happens you fall asleep and you stay asleep more soundly
now there are other reasons that that has a benefit it's relaxing you decompress just staying away from technology
etc but that is one of the thermal benefits and in fact there was studies by a legend in my field who passed away just a few years ago
Jim Horn at Lafbrie University in the UK and they did some of these pioneering studies
they were able to improve the amount of deep sleep by almost 40 minutes in some individuals
what was the protocol there as I recall I think they were in the bath for somewhere around or the bath duration time was somewhere around 30 minutes
but they were doing sort of segments where it was maybe it was 40 minutes, 10 minutes in and then you could sort of get out
I think the temperature because it was UK was around about 40 degrees Celsius somewhere in that region
I may be getting those numbers wrong because I know we like to protocolize so if this but they were able to show some really pleasant benefits to deep sleep
it also helped people fall asleep help them fall asleep by about 25 minutes faster in those people who are really having a hard time with sleep
I'm going to take a hot bath tonight I sometimes do the sauna in the evening before sleep
I'm a big fan of cold in the morning cold shower cold plunge in the morning
I'm going to reverse engineering the equation trapping the heat into the core of your body you're waking yourself up
and then the evening of used sauna the one issue with sauna is I really crank the heater the sauna
and then sometimes if you do that right before bed you take a warm shower right afterwards you get into bed
you oftentimes I'll wake up thirsty and then because it dehydrates you and then if I drink a lot of water to hydrate after I'm in the sauna
then I'm waking up too much in the middle of the night so I think sauna is great but right before bed
I would love to I don't have a sauna at how more nor an access to I mean there are soreners in and around where I live
but what I want to do is have it proximal to my bedtime and my bedtime because I'm a neutral type
you know sort of the round eleven issue nowhere is open and willing to allow me to sit in the so how long do you sit in there usually
I'm a little bonkers about this I well if it's in the evening and I just want to relax
I would say maybe 20 30 minutes and I tend to go really warm warmer than I want to say here
what does a pizza do a pizza to your friend I've done the same sauna cold plunger period usually does it in the evening
goes on a cold sauna cold sauna cold okay warm shower and I don't know how many nights a week he's doing that
but terms of the temperature of the sauna you know generally somewhere between 175 and 210 degrees
depending on how heat adapted you are but I think a hot bath is great we're a nice hot shower
yeah I'm certainly done that when I'm traveling with jet lag I will absolutely that's part of my sort of jet lag
protocol I'll make sure I do I'll because I don't really struggle too much with sleep at least at present
but when I go through jet lag and I go back home to to London of course it's tough the worst
I've realized the living daylights out of that and do as much as I can so I think that's probably the end of the
the thermal story although we are now trying to see if we can take low fire approaches where we're going to do some
foot warming we're trying to develop some foot warming technology that can be built into
maybe a mattress and some mattress companies and there are some great ones I know obviously Mateo at 8 sleep
you know they are doing amazing things I think his company again I have no affiliation but I we connect very well
he's brilliant so they're doing something like that I do use and love my 8 sleep
here's what I'd love somebody to engineer and we got a lot of people who listen to the podcast you think about product development
it would be wonderful to have a portable pair of socks so that you can use them when you travel or when you go
you know sleep anywhere at home or elsewhere that would warm your feet up at the beginning of the night so
this is a place for us to recap warm up to cool down to fall asleep right stay cool stay cool to stay asleep
and then warm up in the morning to wake up and so that is pretty straightforward to build into a pair of socks
somebody can do this somebody do this okay so that's what we've done electrical we've done
thermal what about auditory auditory so acoustic stimulation in a very similar way to electrical stimulation
where you're trying to target that deep sleep and see if you here's a better analogy is probably a metronome
and you're trying to see if you can kind of force the metronome further over and back and forth
with these types of technologies so auditory stimulation came on the map again I think probably
Jan Bonds Group in Germany was some of the first to do this they initially started with this same generalized approach
where they would take acoustic tones and they would first assess what is your level of awakening threshold
so you would be asleep and they would just have these tones very light tones like a sort of ping ping
and they would gradually increase the volume up and they would look to see what is the point where that volume of the tone wakes you up
and then they understood your specific threshold what's called an awakening threshold
and they would set the volume to a sub awakening threshold great so you've got that locked in place
and now you start and they did this within the first 90 minutes of people falling asleep
they started to play these sub awakening level volume levels of tones
but they were playing them at this very slow frequency as if again the trying to sink and match
the slow dancing rhythm of the slow brain waves and sure enough in that first to eat
and it was indiscriminate meaning they just set the tones playing like a metronome
set the tone and then set the volume and then set the cadence of the volume, the speed, the frequency of those tones
to just a little bit less than one hertz, a little bit less than one cycle per second
and then off you drifted to sleep and they played it for the first 90 minutes
because that's the rich phase of deep sleep and they were able to increase the amount of deep sleep significantly
the problem in that first study was that they also did a memory test because in all of these studies including my own
even if I boost your sleep tonight, Andrew Huberman, my next, if that's the result that you show me
I have four words for you as a scientist, yes and so what?
Is it functional? Because if I boost your sleep but it doesn't change anything to you the organism the next day
I'm going to suggest that that enhancement is epiphenomenal, not functional
So it has to improve some reasonable metric in wakefulness that like improved memory, improved task switching ability
So it's outcome measures, that strength, correct something
Yeah, so even if I for example, you know lower your blood pressure with a new drug
if I'm not changing your cardiovascular disease risk then the question is why am I just continuing on with the drug
if it's not really changing much
Same thing here and what they found was that when they did the memory test the next morning
by enhancing that deep sleep there actually wasn't a memory benefit
So perhaps what was happening is that this was just non-specific
so again they then returned and now others have returned to the closed loop mechanism
where now I've got electrodes on your head and I'm measuring your slow wave brain waves
and literally I am next door in the room and I'm watching those slow brainwaves go up and down
and then I've got a computer algorithm that is watching those watching in it
in it, quotes watching that too and it's predicting when the next wave is going to come
and when it does auditory tone click, sub awakening, you don't wake up
and sure enough when you sort of tone into the brain at that time you boost the the size of that brain wave
and once again they boosted the size of those deep sleep brain waves
they also improve those more quick burst of activity, the sleep spindles
and now sure enough they were able to improve memory
However, if you look at that paper and here's why I think the first method may not have worked very well
and why I don't suggest people start trying to set this up themselves
when they kept stimulating the brain, slow wave after slow wave
after about three or four strikes of the metronome to boost those slow waves
the benefits stopped and if they kept going you started to inhibit the amount of naturally occurring
deep sleep brain waves, why would it do this? Deep sleep brain waves I told you in the first episode
are an act of incredible neural coordination, it's mass coordination
now one of the extreme versions of mass coordinated propagated activity
that is maladaptive, that is pathological, is called neopoleptic seizure
and your brain has in place for the most part stop gaps to prevent that type of spread of vastness
of coordinated spontaneous electrical oscillations
because the brain is such a conductive device that once you get it going
you've got to be careful because it may start to conduct out of control
so we think that these checks and balances that were in place
even though you can artificially stimulate it for a while
after a while the brain says you've got to back off for a while
because this is getting a little bit out of control
you do a breath pause and then you restart again and you get the benefit and then you breath pause
so you've got to do it a little bit intimately now you've got to read the
what we call the supplemental materials of that paper you've got to go
it's like the fine print on a legal document if you dig into it
you can see that that was the case but it wasn't necessarily evident
so those were really the data on acoustic stimulation
and now with this closed loop acoustic stimulation that we've got going on
it seems to provide these nice benefits
some people then will probably be asking what about these noise machines
what about white noise etc. I've taken a look at this and so far
I think for white noise machines the data is equivocal
there was a recent study, a review article I think it looked at about 37 different
studies I could have this wrong and what they found was that
there was no reliable robust directional effect of white noise machines on sleep
some studies demonstrated that it helped sleep some studies didn't change sleep
some studies suggested it may make sleep a little bit worse just nothing reliable
but maybe it's masking external sound correct
so I think if and the one of the positive studies in that scenario
was a study that was done in New York City
and it was in a region where there was a lot of external sound pollution and noise
as you could well imagine it's New York City
and sure enough that's where they got some really nice benefits of the white noise machine
so I think it is your right context dependent
there was an interesting recent study that came out from
Eta Mann Learners Group at the University of Texas, San Antonio
and they didn't use white noise they used pink noise now what's the difference
pink noise has a little less what we call power or intensity
in the higher frequency ranges of the sound spectrum
and it's more enriched in the slower domain of that power spectrum
which you could argue is a bit more fitting with sleep
and I think this study may have been a naps study or maybe wrong
but anyway what they found was that they increased total sleep time by
I think it was close to 30 minutes with the pink noise
they did not change the amount of deep sleep
but they did enhance the amount of stage two non-normous sleep
which we have spoken about before and we will in subsequent episodes
that is beneficial for things like learning and memory including motor skills
and they increased the amount of REM sleep to a much more modest degree
but those changes were significant
so I'm not trying to rule out noise machines right now
and I have no affiliation with any company or anything in that space
I don't want to throw the baby out with the bath water
I just simply think that right now we don't have enough evidence
but as you and I know as scientists absence of evidence is not evidence of absence
just because it doesn't exist doesn't mean that I don't think that it's still
potential root these types of machines
what about kinesthetic
sipular
tools protocols
you know body position is something that has an interesting relationship
to propensity to fall asleep based on brain cooling
that we talked about in another episode
but what about manipulation of the body's movement
is there anything in that domain?
it sounds wacky at first
but I said it so
but you know
I still want to know
come on social media just be nice be friendly
I would say that if you look back and again the annals of human history
from the very early inception
you will see mentions of a child being rocked in a manger
or rocked in a crib
often parents will take their young infant
and you will quote and quote rock them to sleep
and we as adults
will sometimes get in a hammock
and if you're rocked
what happens you will fall asleep
it's that prototypical image of someone with their hat over their face
and hammock and they fall asleep
so it was very clear that something was going on in this space
and then a group from the University of Geneva
led by another fantastic sleep scientist Sophie Schwartz did
an epic study that again
it's one of those studies that I probably
once more wished I'd done
here's what they did
they took a bed frame
and then they suspended it on chains from the ceiling
now stick with me
I'm not going in that
you know there's no hot candle wax being applied here
don't worry I'll keep it PG again
and then the next thing that they did
was connect a rotating arm to that bed at the side of the bed
and that arm would start to
simply just push the bed
laterally from left to right
left straight and they started just swinging the bed in a very controlled manner
but here and I should ask Sophie exactly why they made this choice
they were rotating the bed
not at this sort of around one hertz
which is what we've done with electrical stimulation or acoustic stimulation
they were doing it at 0.25 hertz
which is much slower still
almost in percent
the bed is rocking
you know
once every four seconds
it's a very slow
low
and sure enough what they found
in the first series of studies they did a nap study
in 90 minute nap study
when you did this rocking motion versus when the bed was still
they increased the speed with which people fell asleep
they boosted the amount of deep sleep
and they boosted the amount of those sleep spindle oscillations that we described
not satisfied they then said
well what happens across a night of sleep
they did it then across a night of sleep
they replicated the same findings
and now they got a memory benefit
now the memory benefit
you could argue as modest
10% of a memory improvement benefit
when you woke up from sleep
relative to the already sizable benefit
that sleep naturally gives when you're not rocking the bed
but you think well 10%
if I were let's say a student
and I got
you know a B
and someone the professor said
look by the way
there is something that you can do
and we can increase your grade by 10%
and you can get to an A
or an A plus depending on the grading system
would you take it?
would you take 10% benefit?
absolutely you would
so grade point averaging increase
so it isn't trivial
necessarily
well I also am positively surprised how important this
but so what condition is for you sleep researchers
you know that enhancements in say deep sleep
or rapid eye movement sleep needs to translate to some daytime benefit
in order to really get you guys excited
but here's why I think that's great
it's always great to have a high threshold for excitement
but one of the things that
one could argue is that
you know there are only so many tests that you can have in the laboratory
of daytime functioning
I think I am on board the fact
that sleep is the better off of mental health physical health and performance
so an improvement in you know
statistically significant improvement in deep sleep or REM sleep
to me it just seems like that's got to be good for something
we might not know what that something is to test in the laboratory
but it could be that the threshold for improvement of say
gut microbiome production of neurotransmitters is
you know 0.1% improvement in deep sleep
we don't know I made that up so don't quote that statistic anyone
but I so admire the
kind of extreme thresholds of what you what gets you guys excited
I know your point is a very good one
because you could argue based on what I just went back and said
regarding the exercise study with Ronda Patrick
I've just reversed my own threshold logic
I said to you well okay exercise was able to overcome some of the deficits
that occur by way of sleep deprivation for your blood sugar
but don't assume that that necessarily means
that it's not a good thing to overcome the
the other detriment that you have for your homo health
your you know femuriculatory capacity
your cardiovascular disease your brain function
so I've just said simply you know one thing
doesn't mean that you've assessed all things
and now I'm saying okay if you don't show that it improved that one thing
then it's not functional but Matt by your own logic
but you didn't assess many of the other things so even if it didn't improve memory
as you said the bedrock of all things health
you need to assess all of them before you make your conclusion of the
yes and so what failed test so you're absolutely right to point that out
so what was interesting after that data came out in humans
which is usually the opposite way around they started to look in animal models
and you mentioned the vestibular system this ability for us to understand
motion and movement and there's lots of mechanisms for that
they looked at mice and they started doing this rocking again
I'm sure the mice fell asleep faster
but then they found a strain of mice that did not have the
lateral vestibular sensation mechanism and they rocked them just the same way
zero change in their sleep
because you could imagine well it's important to understand the mechanism here
is it that when you're rocking there is it's not just about vestibular simulation
maybe that rocking sort of modestly changes friction which changes
temperature you could come up with also to wacky reasons
this was a very clear causal manipulation of the lateral vestibular system
and if that is not in place you fail to get the benefit
so it clearly has something to do with the vestibular system
can I venture a guess as to why that is?
yeah I interrupted but in case that happened to be right by some chance
I previously talked about the need to lose a sense of one's
posture and relationship to gravity in order to fall asleep
might you have to go into this lack of proprioceptive awareness
in order to fall asleep, proprioception being the knowledge of where ones
limbs are relative to the body and body relative to other surfaces and gravity
and this is something that can be accomplished in these
you know flotation tanks and things like that
and other ways go down or space
but the cheaper version
so could it be that the rocking at that very slow frequency
is tapping into the vestibular system in a way that
proprioceptive feedback about body position is somehow
starts to vanish and because I'm intrigued by this idea that you have to lose
perception of your body's positioning and proprioceptive awareness
and you have to fall asleep and maybe your description earlier of a protocol
of going on a mental walk in order to fall asleep
I just feel like these things are starting to converge on some
themes here.
on your central column pathway that could be the absence of
I think it's entirely possible in some ways
right now we think that these two things are associated that as you're
asleep, gradually you will lose proprioceptive sensation but
simply the fact that two things are associated doesn't necessarily mean
that causal but your suggestion here isn't very elegant way of testing
that hypothesis which is that perhaps if you could show that the
symmetric of proprioception becomes compromised when you start doing
the lateral kinesthetic or movement stimulation that's a very powerful
demonstration that it's not just so here with the study in the
mice they lacked the lateral vestibular sensation and you lost the
sleep benefit but maybe there's one step down which is that when you
lose that vestibular stimulation you lose the benefit on the
thing that really is augmenting the sleep which is the change in
proprioception so this is the first step in a chain of command and
you've missed the final common trans actor of that ingredient called
better sleep.
I would say probably the four current bastions of sleep
augmentation hopefully that describes the listeners the range of
were sort of sleep 3.0 sleep enhancement 3.0 is going and
also describes the way in which we can come down the strata from
high friction low friction to no friction and also in terms of
cost where you can have high cost minimal cost low cost I mean
hot bath or a shower is pennies on the dollars so especially if
you take a cold shower in the morning and save on your heating
bills you can take a little bit longer hot shower in the evening and
then you net to zero difference.
It's just my way of saying take a cold shower in the morning feels
great when you get out.
What about some ways to enhance rapid eye movement sleep beyond
what you've covered up until now.
So I think there are probably two emerging data sets that I've
been intrigued by one of which we've been doing some work on and
it comes back to thermal what I failed to mention is not just
that you need to warm up to wake up what you do but you also need
to warm up to REM sleep but not too much if you take an organism
or a human being and you strip them of bed sheets and strip
them of clothes so they're basically almost own natural.
If you warm the body up to what we call the thermonutral point so
it tends to be and this sounds extreme in it you don't have to
do this because you're under sheets and that makes a world of
difference but if you warm the room to about 30 degrees Celsius
which gets close to at the surface ambient level for your skin
something that can bring your core body temperature up back
up to operating because I told you when you go when you're
in that deep sleep triggers on the middle zone your core
body temperature drops and it drops significantly and to wake
up you have to warm up but on the journey to warming up you
also have to get to thermonutrality for you to have REM sleep.
If I keep you too cold I can reduce the amount of REM sleep.
If I get you too hot I can impair the amount of REM sleep.
So it's a Goldilocks phenomenon not too little not too much
just the right amount if I keep you though in terms of your
thermal net neutrality I can boost your REM sleep.
Now that's fiendishly difficult when you're trying to solve
that equation as a commercial device because different people
are under different blankets they run at different hot
temperatures they've got different partner situations so you
need a closed loop system again but it's something that
were very interested in because almost all of the methods
that I've described and you are smart to pick this up all
target deep non-REM sleep but we spoke about in the first
episode every stage of sleep is important and in subsequent
episodes I'll tell you exactly why REM sleep is so critical.
So how can we boost that? That's one way that was starting
to explore it but nothing I think solid yet.
The other is some of the drugs the newest sleep medications
that have come onto the market and again I think I mentioned
that I did take to task and I feel perhaps rightfully so
about the classic sleep medications that if you look at
the scientific data if you can avoid them it's probably
best to do so. The right Ambien etc.
We call them the Z drugs because they all start their
generic names start with the Z. Ambien for example has a Z
at the start of its generic name but I don't want to
get into naming any necessarily.
They'll grant for me.
Yes I'll put them but Ambien what's interesting about
those medications again they're in a class of drugs that we
call the sedative hypnotics so again sedation not sleep
and also there's been some great work again by Dirk and
Dijk and colleagues if I were to show you that electrical
signature of your deep sleep it does look as though those
drugs kind of increase the amount of electrical activity
in that slower deep sleep range except once you go all the way
to the far left to the slowest of those slow brain movies
which turns out to be the types of waves that are most
beneficial for most health related brain and body functions
you get this huge dent in your electrical brain wave
activity it's almost as though those drugs take a bite
out of that realm of electrical activity and of course
there are issues with daytime sleepiness and some safety
related issues that's been health associations not
necessarily causal and so I was you know I offered one
scientific viewpoint of those medications in the book
and so be it it's not as though I've anti medication as
I said and some of the new medications are very interesting
brings me back to REM sleep there's a new class of sleep
medications called the doers and it stands for its
ORA small S and it stands for Jew Aurexin receptor
antagonists oh my goodness mouthful that just sounds like
words salad to anyone who's not a neuroscientist
Aurexin which is part of that set of words is a chemical
in the brain and Aurexin became prominent with the study
of narcolepsy and what we as the royal we people like
Emmanuel Mignot and others at Stanford what they discovered
was that no-colectic patients have a profound deficit
in this this chemical Aurexin and the receptor was
also called hypochreatin and it has a function both it turns
out for wakefulness and a function for feeding and eating
related behaviors hypochreatin was probably more related
to it when it was because it was discovered right around
the same time and really two different groups yes exactly
beautiful two different groups named it differently
but narcolepsy as some people may know is it's a
conditions asleep disorder and one of the symptoms is called
excessive daytime sleepiness where you have inappropriate
invasions of sleep during the day when you want to be
awake why well it turns out that this chemical Aurexin acts
like a finger on the light switch of all of the apparatus
in your brain that switches on to force you awake it reaches
down into the it's released from a central part of your
brain called a hypothalamus and it releases down into the
brain stem to activate what we call the ascending arousal
system or the reticular ascending arousal system of the brain
and when that lights up it's like the light switch which says
on for waking brain activity and so what was happening
was that this Aurexin up higher up was not
forcing the finger of wakefulness on during the day so
almost instead of a switch which is what you want
it was more like a dimmer switch and you know when you get
to that dimmer switch point right in the middle where it's flickering
it's on it's on it's on that's almost the state in which
the narcoleptic brain was because they had a deficiency of
Aurexin so that was the Aurexin story in narcolepsy so
why is it relevant for insomnia or people realized the
problem with narcolepsy is that they're asleep during the day
when they want to be awake but the opposite problem is
true of insomnia patients they want to be asleep at night
but they're awake so why don't we selectively develop a
drug that goes after this finger that flips the light switch
on for wakefulness but now let's block it at night so
we flick the switch back in the off position we turn out the
lights for the brain and we remove the problem of insomnia
which is excessive wakefulness at night which is one of its
problems but and therefore when you remove that indirectly
what comes in its place is this thing called more naturalistic
sleep and that's why it's been more favored now as the
principal drug it's still not necessarily well known by
physicians or it's not very well prescribed it's not very well
covered here in the United States unfortunately but insurance
so it's a very expensive option right now health providers
will choose not to do that unfortunately so what's interesting
about that drug though is that it is mixed in terms of the
studies but quite reliably it does seem to improve sleep very
much so but it seems to unlike those classic sleeping pills
which artificially look like they're increasing deep sleep
even though they're not doing sedation these drugs can
improve most all aspects of sleep but including REM sleep which
those classic sleeping pills did not why is it doing that we
still don't know but one of the things that the these
Dora drugs do that block the erection that take off the
the on position of the light switch and flip them off when
you switch it off it can actually then allow the activation
or the stimulation of something called melanin concentrated
hormone or mch in the brain and that where the
and that when it is triggered on can stimulate another
chemical called acetal colean in the brain which is a
neurotransmitter if there is one neurotransmitter in the
brain that seems to be responsible almost exclusively for
this thing called REM sleep or dominantly I should say
for REM sleep it is acetal colean and this was discovered
way back in the 1970s by my former one of my former mentors
Alan Hobson and Harvard and what this drug may be doing is
indirectly boosting the amounts of acetal colean in the
brain particularly in a region of the brain called the
basal four brain which is a REM sleep regulating region and
that's the reason that you get boosts in REM sleep and
people also report dreaming a little bit more to on those
medications so thermal manipulation getting you to net
neutral thermal zones helps increase REM sleep but also
some medications that were not necessarily designed for
REM sleep enhancements subsequently but there is evidence
that they do that so if you ask me where are we at with
REM it's it's certainly more bereft of methods than deep
non-rem sleep but we are starting to find some now.
Given what you just told us about the role of acetal colean
in rapid eye movement sleep what about taking precursors
to acetal colean I mean certainly a good number of them
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