Barbell Shrugged - [Sleep] Sleep Studies, Psychological Stressors, Supplements and How to Optimize Your Sleep w/ Josh Ruben, Anders Varner, Doug Larson and Dr. Andy Galpin Barbell Shrugged #674

Episode Date: December 21, 2022

Josh Ruben is the CEO and founder of Absolute Rest. The most comprehensive and advanced sleep assessment and solution technology on the planet. The only system ever designed that simultaneously diagnoses your sleep 1) environment (air quality, sound, particulates, CO2, etc.), 2) pathology (clinical-grade PSG), 3) behavior and 4) physiology (direct biometric measurements). To learn more, please go to https://rapidhealthreport.com Connect with our guests: Josh Ruben at Absolute Rest Anders Varner on Instagram Doug Larson on Instagram Coach Travis Mash on Instagram Dan Garner on Instagram

Shrugged family, this week on Barbell Shrug, Josh Rubin from Absolute Rest is coming in and we're doing a two-part series on how to get you to sleep better. You know what's really cool? Every single human being on this planet needs to sleep. And sleep is really, really important to getting the results that you want

in pretty much anything from mental clarity to your body actually recovering and growing with all the work that you're putting in at the gym and most importantly, just keeping you healthy. And I've seen at this point, hundreds and hundreds of people that have come into our program or looking to get healthier.

And there's like a single thing that most of them have in common and it's getting like six hours of sleep and doing that consistently for years and years and years. And over time, that just beats the crap out of your body. And I know this because I've got two little kids under four, and let's say my sleep isn't the greatest. And it totally affects the amount of energy motivation you have when it comes to training, the mental clarity. And in today's episode, Josh is going to enlighten us on everything that you need to know to

improve your sleep. I'm really excited because this is two parts here. Next week, we're coming back at you with sleep again as well. As always, get over to rapidehealthreport.com if you are interested in all things rapid health optimization. Friends, let's get into the show. Welcome to Barbell Shrugged. I'm Anders Varner, Dr. Andy Galpin. I totally spaced on Doug Larson being second. I was looking at him down there. He was just talking. And Josh Rubin. This is

terrible, Doug. I'm so sorry. After all these years come on terrible right today on Barbell Shrugged we're going to be talking about how you can optimize your sleep and know person better to bring in than how many sleep tests have you do you feel like you have done or like to get to the point

this thing started like SpaceX and NASA do those people need to sleep in space it turns out yeah they people need to sleep in space? It turns out, yeah, people need to sleep in space. Was that a fucking question? Was there even a question there? That was so nuts. There was no question there at all.

The space station? Zero gravity? That doesn't change things? Yeah, it changes a lot. I want to hear about uh where uh just to kick things off and how it led to absolute rest um learn on the sleep side of things when uh like what what made you dive so deep into this that then these these giant companies that are sending people into the space station or wherever need to really be dialing this in is sleep optimal in space.

Yeah, totally. Okay. Let's, let's, let's jump in. That sounds great. Yeah, let's go. Cool. You are off to a hot start there. What the fuck is all of that? No. How did we get here? For sure. Okay. So let me give you the kind of step-by-step. So I actually dropped out of school my sophomore year. I went to go work

for a neurotechnology company in Houston called BrainCheck. There we built a system that can diagnose traumatic brain injury, early stage dementia, and a variety of other things. I ended up leading the product team there, but I took two of my senior developers and started a company called Z3VR. And at Z3, we spent about five years developing a system that basically tracks micro movements in your eye and correlates those to different neurological and psychiatric conditions. Primary customer for that company was the federal government. So we did a lot of work with the Department of Defense and with NASA, as you've alluded to. Yes, astronauts still need to sleep in space.

Thanks for that. That confirms my original thinking that they did. So I appreciate that. Absolutely. They need to be tied down, but they still need to sleep. They do. In fact, they get tied to walls and sleeping bags. That's great. But really, so, you know, NASA used our device for a bunch of different things, one of which was to study the effects of sleep deprivation on cognition and on the brain. And so that was the original foray into sleep science. And so,

you know, from there, we, about a year and a half ago, now, we got introduced to this guy below me, Andy Galpin. And we basically had this really interesting conversation. And it was about the athletes that that Andy's worked with for the last couple of decades. So when Andy takes over a performance team, um, for, for an individual athlete, he's basically controlling every aspect of their life, like their nutrition, their, um, you know, their physical protocols, as far as like where, when, how they train. Um, I assume when they're allowed to see their friends and family and all the other things. Right. Um, but the one area that he really struggled with, and then he kind of told me about was sleep optimization. It's always been a pain point for him, when he's kind of optimizing his athletes

for their performances. And so primary reason for that, that we identified kind of in this original meeting was the fact that the tools that we have available to us today to monitor sleep and make recommendations around sleep are really inadequate. You know, if you think about it, even an athlete making $40 million a year is using the same wearable technology and, you know, and is interacting with the same kind of in lab sleep studies that maybe we'll get into in a moment um and so i even working at nasa and and with the department of defense i just assumed that you know an athlete making that much money would have access to some sort of like cryogenic chamber that they'd sleep in like a vampire and like emerge like wolverine in the morning but that that is not the case so um yeah basically basically, you know, we're talking about the inception of this project, Absolute Rest. Basically what we did is we pulled together a

team of top level scientists and clinicians from around the country and asked ourselves as a group, what are all of the external factors that influence sleep performance one way or the other? And we developed a new system that basically analyzes all of those factors and is able to make recommendations to optimize the sleep of athletes and high performers around the country. And so that's kind of the origin story, but happy to go into more depth if you have questions. Yeah, it seems like you kind of redesigned. Sorry, in a way, it seems like you kind of redesigned sleep studies a way it seems like you kind of redesigned sleep studies like based on first principles what do they need you just kind of built it from the

ground up like how is it what you do different than if you were to do a sleep study if you went into like a kind of a traditional sleep clinic totally well let's let's talk about like the way that sleep is currently assessed today and the way that a lot of your listeners probably assess their own sleep as well so i like to talk about it on a spectrum. So on one end of the spectrum, you've got devices like Aura, Whoop, and Garmin. These devices are really good at a few specific things. So when it comes to things like total sleep time, like HRV and heart rate monitoring and stuff like that, they're pretty effective there. They've got that down. However, when it comes to any of the deeper analytics that they purport to provide, like the sleep architecture or the recovery scores that they give you, many of your listeners probably look at these recovery scores and they may be a

little confused because even being in the sleep science space and being a partner of companies like Aura, we still don't fully understand those recovery scores and we don't find them very useful at the elite levels. Okay. So that's kind of one end of the spectrum. A lot of people are familiar with that. Something that a lot of people may not be familiar with, but I'm happy to introduce you to it is the world of clinical sleep testing. So this is where you actually go into a lab and get a sleep study done. So for anyone that has, have any of you done a sleep study by chance into a lab and get a sleep study done so um for anyone that has have any of you done a sleep study by chance in a lab never done no okay let me describe how this would work

my hunch is that i wouldn't sleep like i would sleep if i was at home is my guess yes okay okay okay okay so so basically what's going to happen is you're going to go to your primary care physician with 99% of the cases, the way you get to one of these clinics is through your primary care physician, right? So you start there, you're going to go in complaining about some sort of known sleep issue. So for example, I wake up 40 times a night, or I, you know, I'm having really low energy levels and I've had this for the last year and I don't know why, et cetera. So they're going to look at that. They'll be like, okay, we'll get you into a sleep clinic to see if there's any like disordered sleep happening here.

So in most cities around the U S you can expect an average wait time between three and six months before you actually get into one of these clinics. And here's kind of what you can expect. So because of that referral model that currently exists between the physician and the clinics, basically there's very little market pressure for these clinics to upgrade the technology that they work with. And what that functionally ends up meaning for the people that go to these studies is that they are covered from head to toe in electrodes. You may have seen pictures of sleep studies in the past where you just, you see someone with like draped in all of these cords and wires. So basically you're going to go to one of these clinics. They're going to set you up with that system. It's called a polysomnography system.

It's used to monitor your physiology while you sleep. They're going to hand you a little box that connects all the electrodes in and they'll waddle you in to sleep on a hospital bed in a windowless room. And then, oh, wait, we're also going to be behind this two-way mirror just to make sure nothing goes wrong with cameras fixed on you the entire night. And well, good night. That's basically what the experience is. So Doug, you said it best earlier. The core issue with that is it is just not representative of normal night of sleep for you. So what these, what these clinics can do is they can diagnose, you know, clinically relevant sleep disorders.

It doesn't actually matter if you're comfortable in these spaces, as long as you are asleep, they can get in most cases, the data that they need in order to come to this diagnostic conclusion. Right. Cause like, even if you're not sleeping a total amount of hours that you normally would, that's not what they're after. What they're after is when you are asleep, what's happening in your brain, if you will. And that that's why they can diagnose things. Exactly. So if you have something like sleep apnea, something like circadian phase disorder, narcolepsy, things like that, those are the places where those conditions get diagnosed effectively. However, when it comes to sleep performance, which is kind of the name of the

game for us at Upset Rest, these clinics have virtually nothing to say about that because of this discrepancy between the normal night of sleep that you're experiencing on a day-to-day basis and the night of sleep that you got there. Right. And so that's kind of the problem space that we're playing in. And so if you'd like, I can talk about kind of how we do things differently at Absolute Rest or we can go another direction. It's up to you. Yeah. You mentioned sleep performance a second ago. How are you defining that? What does that mean? Great. So I said earlier, we built this really robust team and we asked ourselves, what are all

of the external factors that influence sleep performance? And then we built this assessment that looks at all of these things. And so basically just to take you through the list of the things that we measure. So I think it's also important to note that. Yeah, well, I'll just take you through the list of things that we measure first. So the first thing that we do is we start with a pathological screener. So because this podcast is being published publicly, I have very expensive lawyers that require me to say that we do not diagnose or treat any medical conditions at absolute rest. However, we do work with some of the best sleep clinicians on the planet that I'll tell you about

maybe a little bit later. Oh, stop you and your lawyers. You can't say it. I can. Amazing. But yeah, so basically, they're going to be reviewing the data that we collect. And so if we see anything that is clinically relevant and concerning, we kind of always refer out to get that taken care of to a clinician in our customer's area or in our network. Okay. So we kind of start with that like baseline pathological screener. The second thing that we do is we look at your psychology in a pretty in-depth way. One of our other co-founders is a Harvard psychiatrist.

Um, he's developed a psychological screener specifically for absolute rest. And this is looking at all of the known psychological factors that influence sleep performance. So things like depression, anxiety, excessive stress, insomnia, all of these things, both in your past and your present. And we try and make a prediction as to how these factors will influence your future sleep performance as well. Okay, so that's like the second thing. The third thing we do is we look at your environment in a pretty in-depth way. So

we've developed a series of sensors that effectively just sit on the nightstand of the customer that we're working with. And this is looking at all of the known environmental factors that influence sleep performance. Things that, you know, probably everyone on this call is already controlling for on some level, but we're looking at things like light, sound, temperature, humidity. We look at atmospheric pressure. We look at air quality, like CO2 in the air,

particulate matter in the air, all of these different things, right? So we're monitoring that. Shark family, I want to take a quick break. If you are enjoying today's conversation, I want to invite you to come over to rapidhealthreport.com. When you get to rapidhealthreport.com, you will see an area for you to opt in, in which you can see Dan Garner read through my lab work. Now, you know that we've been working at Rapid Health Optimization on programs for optimizing health. Now, what does that actually mean?

It means in three parts, we're going to be doing a ton of deep dive into your labs. That means the inside out approach. So we're not going to be guessing your macros. We're not going to be guessing the total calories that you need. We're actually going to be doing all the work to uncover everything that you have going on inside you. Nutrition, supplementation, sleep. Then we're going to go through and analyze your lifestyle. Dr. Andy Galpin is going to build out a lifestyle protocol based on the severity of your concerns. And then we're going to also build out all the programs that go into that based on the most severe things first.

This truly is a world-class program. And we invite you to see step one of this process by going over to rapidhealthreport.com. You can see Dan reading my labs, the nutrition and supplementation that he has recommended that has radically shifted the way that I sleep, the energy that I have during the day, my total testosterone level, and just my ability to trust and have confidence in my health going forward. I really, really hope that you're able to go over to rapidhealthreport.com, watch the video of my labs, and see what is possible. And if it is something that you are interested in, please schedule a call with me on that page. Once again, it's rapidealthreport.com. And let's get back to the show. The fourth thing we look at is your physiology.

So all of the same data that's collectible in that clinical sleep setting, we're able to collect in your home using about an order of magnitude less electrodes that you'd find in that setting. So what that means is we're getting much closer to a normal night of sleep for you. So there we're monitoring things like brainwave activity, eye movements, facial muscle activation, your respiratory system, your heart, your major muscle groups in your legs. These are all of the physiological systems that are relevant to optimal sleep. So we look at all of those systems individually to optimize them individually, but then we also look at them in conjunction with

each other to make sure the entire system is working properly. And a really cool thing that we're able to do because we're monitoring your physiology and your environment at such a high resolution, we're actually able to start seeing this really cool interplay between the two. So any stimulus that we observe in your environment, we're able to see exactly how that influences your performance in sleep. And so that allows us to start making very accurate, specific recommendations around what an optimal environment looks like for you. So that's something that goes well beyond kind of just the standard sleep hygiene that you can easily Google and see like 65 to 68 degrees and, you know, specific sound stuff and all of

that. So kind of sticking to the theme of physiology, we go much deeper than just, you know, attaching sensors to you. We also look at blood biomarkers, both of signs of chronic sleep deprivation or a sleep issue in your blood work. And then we also look for factors in your physiology that may be contributing to a sleep issue. These are things like micronutrient deficiencies, mineral deficiencies, and variety of other things. We'll also collect saliva samples as well. So this is helping us to understand your body's ability to produce sleep-relevant hormones, namely DHEA, cortisol, melatonin, and a few other things as well. We also have this wonderful partnership with Aura, so we actually end up giving you an Aura ring, and then we use that to track over the course of several weeks after our initial

assessment. But that's kind of like this new approach to assessing sleep that we've built at absolute rest it's much more holistic in nature and takes into account everything that the literature currently says may influence your sleep performance so yeah so this is piggybacked off the model of making sure things like astronauts have perfect sleep right like you have to make sure their environment is perfect you have to make sure that's nothing to do with their stress levels or is this something biochemical slash nutritional, right? Sort of a similar thing up there.

So once you have this best diagnostic of how they're sleeping and then you understand exactly why they're sleeping that way, it makes it much easier to deploy effective and actually less pain in the ass solutions for quite honestly, right? Like you don't have to go do 700 things in your bedroom, to deploy effective and actually less pain in the ass solutions for quite honestly right like you don't have to go do 700 things in your bedroom have this giant ass routine because you're trying to make sure everything is correct because you don't know what's actually the problem you can just sniper it right you can go figure out this is the issue right here

bing bing bing now enjoy your night of sleep does that sound about right yeah man i mean the thing i think it makes sense that this would start at a place like NASA, because, you know, there are at any given moment, you know, 10, 12 people that are flying on a multibillion dollar spaceship in space called the International Space Station. Each one of these astronauts individually is just getting them up there costs tens of millions of dollars. And every second that they're operational is also costing a fortune for governments all over the world. So it's important that these people are performing at their absolute highest capacity. And a big component of that turns out to be sleep. And that also is one of the most difficult environments to sleep in that we currently know of. So it makes sense that something like this would come out of the space program.

And it certainly did. I think a lot of parents out there are thinking, oh, bullshit. I got a worse sleep environment for you. My house. Sleep in this hellhole. So you got this very comprehensive sleep study that you guys do and then uh what kind of stuff do you do you typically find uh especially stuff that would be more or less impossible to find otherwise that you've had success um improving or correcting

for people totally um that's a very long list of things that we find so sometimes they're like very easy fixes like those environmental scans that we do list of things that we find so sometimes they're like very easy fixes like those environmental scans that we do we find things that you know you know maybe people weren't aware of like their air conditioner kicks on at night and it's producing a sound that's waking up everyone in the house not to the point of consciousness but it's interacting with the fact that they're like just below consciousness but then going back into kind of normal sleep. So we've seen things like that where we're able to make recommendations around sound dampening. More serious things that we've observed is we've actually been able to see some really significant

clinical disorders in people that would otherwise not have known about it. You know, sleep disorders are a tricky business in that there are tens of millions of people in the US right now with very serious clinically disordered sleep that just go undiagnosed. It turns out it's really hard to catch these things because you're unconscious. And when the symptoms appear, you're not, the systems of your body that, you know, are kind of scanning for problems throughout the day are not active when you're sleeping. And so it's really hard to spot some of these things without an assessment like this. Can you give us an example?

Yeah, totally. I mean, one of the most common things that we see is, uh, is sleep disordered breathing. I I've, I've talked a lot about that, um, with, I guess each of you individually, but, um, you know, this is, this is kind of a situation where people are, they're not getting enough oxygen to the major systems of their body throughout the night. And this is causing a variety of issues, not least of which is just sleep fragmentation. So they're waking up multiple times throughout the night, maybe to use the restroom or to do other things, not connecting the dots between their breathing and the fact that they're waking up. Down the road, you know, leave this untreated long enough, and you start to see,

you know, very high incidence of cardiac dysfunction of, you know, cancer of a variety of other really scary things that this can lead to if left untreated. So that's something that we've seen. And, you know, we've actually been able to spot specifically sleep apnea that was so severe in some of our customers that otherwise reported that they got great sleep that, you know, the clinicians that we had on staff kind of privately said that, you know, they would have some serious, potentially life altering events in the course of five years if this was left untreated. So things like that are things we see all the time. In general, Doug, we love to hear the following. Like, I've slept like shit for the last 20 years, and I've tried everything and I don't know why. We are really effective at answering that question because of the kind of the thoroughness um that we're able to approach the problem with um so yeah those are a couple things um but i'm happy to talk about more

uh there was a leg movement one i remember oh there's i mean there's all sorts of things right yeah so like leg movements for sure so um there's a uh we we've we've worked with like executives and and uh athletes that have had um leg movements throughout the night so that there are a couple conditions of this to be associated with like restless leg syndrome is a pretty common one in the u.s um and it's basically um where you effectively like kick yourself out of sleep like like your muscles will fire. Spasm. Exactly. And, you know, this can be pretty serious and deleterious to your energy levels throughout the day as well. And so we were able to identify that and provide a series of solutions that were not pharmaceutical in nature to the people that

we've identified that in. So, definitely. Now that you said pharmaceutical. Yeah go ahead Doug no you're on I just wanted to the most common thing that comes across on when I'm talking to people always it comes down to ambient. And people still don't get good sleep, yet their doctor has prescribed them this specific drug, saying this is a sleep drug that's going to help you. Where's the disconnect in the pharmaceutical side compared to actual like real good sleep? Yeah, I think the disconnect comes in the way the doctors are trained today in the US. You know, it's really, it's not their fault. In fact, you know, I think they see the issue of sleep, and then they prescribe something that is indicated for improving sleep like Ambien.

The reality, though, is that sleep is such a fixture of human health. And yet in medical schools, if you look at the curriculum of a standard clinician as they come through the U.S. medical school system, they're spending in total about a week of time on sleep medicine, which is unbelievable considering that this is a third of where we spend our lives. And so that's why I mentioned earlier, when you have sleep problems, you go to your primary care physician. That should not be the case because these are not people that have deep expertise in sleep. So oftentimes what happens is a clinician like that will address the problem with a pharmaceutical.

Ambien is, in the vast majority of cases, a great drug for short-term use. So addressing an acute bout of insomnia or another sleep condition in reaction to something that's happening. However, we've had people come to us that have been on Ambien for 20 years. And that's just not how that drug is supposed to be used. And so I think the real issue there is the disconnect in kind of medical education today. Is there a process that you guys go through specifically to getting people off of it? Or is it something where there's such a chemical dependence after 20 years 10 years that it you're just that's just what you do i think i think 20 years is a special case but when it comes to like several months of being on

something like ambien there isn't actually a chemical dependence that is developed like what you'd see in, for example, like heroin addiction or something like that. It's actually more of a psychological one. So you get this idea in your head that I cannot sleep without my, you know, without my Ambien. Interestingly, this is also why a lot of people get hooked on something like melatonin, which is certainly not something you develop a chemical dependence on. But it's, you know, you get this idea in your head that I cannot go to sleep effectively without my melatonin, without my Ambien, without, you know, my rain dance or whatever else, you know. So that's a that's a big factor. Can you dig into the melatonin thing a little bit like sometimes i hear go take uh

not a big deal other times i hear don't ever touch it it's going to you're going to be stuck on melatonin forever and then you're tranquilizing yourself during the day is there is there i'm sure it depends person to person, lifestyle and all that, but is there kind of like a high level guidance on whether people should or should not use melatonin? Yeah, I think, man, this conversation around melatonin is such a, it's like a really unfortunately charged one. You know, I think a lot of people

have really strong opinions on this. The way that I do it is I don't take any of it. If someone handed it to me, I'd take a lot of it just to ensure the night is going to go fantastic. It's probably not the best. Yeah, probably not. There's none or all of it. That's been his drug strategy for his entire life. This is how he operates. Just take half all of it yeah well okay that's been his drug strategy for his entire life this is that this is how he operates just just take half the bottle that's that's andrew's approach i got it cool

they shouldn't put them in gummies if they wanted to be so enjoyable that's that's a really interesting thing you know you're there's actually you can overdose on melatonin and that's something that um some you know when you're giving this to kids um in gummy form and they eat the entire the entire packet of gum that is we have a friend who got his melatonin tested it was a hundred times what it was supposed to be it was a hundred times the the high end of the range yeah for sure okay he's like he's like i should probably not do this anymore i've seen that 50 times. We see that constantly. Yeah. More than that.

Let's talk about why. But first, let's talk about some baseline level setting things about melatonin. So first of all, you may have heard that you produce melatonin naturally in your brain. So there's a little gland called the pineal gland. It produces melatonin reliably every single night. Just for context on the order of like 60 to 80 picograms per milliliter. So there's very little melatonin that you're actually producing in comparison to like these superhuman doses that you're getting from like off the CVS shelf. In general, this is a very well researched and understood compound. It's relatively safe in that it is extremely safe to take even daily. So you're not going to have any

like, you know, major issue if you were to take a little bit of melatonin every night um the thing that i think a lot of people where they trip up is first of all they're not so one of the one of the biggest things that could be kind of underlying you know the situation that you both just described with the fact that you've got people that have, you know, 100, 200 times the melatonin that you're expecting kind of in their, in their blood, or in their saliva, is the way that supplements are managed in the US today. So if you're not getting your melatonin from a third party tested, you know you know, company, um, there have been a bunch of studies around the fact that, um, you know, a lot of the melatonin supplements that are sold out there, um, have upwards of a hundred times the amount of melatonin that they, they list on the bottle. So that's the first thing, like you may just be taking an enormous amount of melatonin and not

know it. Um, so it. So that's possible. Yeah, I think the data was something like somewhere between 70% to 85% melatonin supplements are off by up to 480%. Yeah. Which is like, so instead of taking, you know, if you look at the literature, you're talking like three to five milligrams dosage, maybe up to 10 or whatever. And then if you think back to the number that Josh talked about, which is the endogenous release, and then you think about the number you're trying to take as 10 milligrams, and then you're actually taking, who knows, whatever multiplier of that. You can just imagine what's happening here. Yeah, for sure. So there are two types of melatonin to mention. So there's a immediate release melatonin and there's an extended release melatonin. So if you have trouble falling asleep in general, melatonin is actually a really

effective strategy in the short term. So, you know, something like if you're, if you're laying in bed for an hour and you're, you're having trouble, um, falling asleep, that would be a good time to use specifically the immediate release melatonin. If you're having trouble staying asleep throughout the night, that's when extended release starts to become interesting. Um, but, uh, yeah, those are the two situations that, uh, wouldn't make sense. The other, the other thing that melatonin can be useful for is if you are

transitioning between time zones. So for example, I'm in Houston today, if I'm flying to Tokyo tomorrow, I would use melatonin in a very specific way in order to shift my circadian cycle. So that's another thing that we would use melatonin for. So yeah. What do you, do you have any more like specific questions about, about melatonin or is there something that you're getting out there? No, just in general, there's like a, I think you answered it. How should people be frame melatonin? they're going to hear many different opinions on whether it's good or bad and not understanding what they're actually taking every time that they go to the store. Like it says five milligrams, but it could be 25 and nobody has really any idea of how to do it. So I think you nailed it.

One additional thing that I do want to dig into is, is kind of like the psychological side of things and understanding how stress really plays into getting a good night's rest. I mean, I know we've talked about it, but stress and anxiety is something that I would say I never like really put what my brain into the idea of like, I have anxiety, but when my head hits the pillow,

there's many times where it won't just like spin and go and go. And that call that like one side of it. And then the stress is if there's like friction or something, even if it's like my wife and I have a disagreement of something, I will notice the next day that like my, the, the numbers that show up on my Fitbit are like, sure. You were in bed for eight hours, like two hours of that was actually quality. Like you can see that there's a legitimate difference with, um, I'm not getting to sleep quickly because I'm, my brain is just spending on

something at work or family. Um, and then if there is some sort of stress in the house or my wife and I don't see eye to eye on something and it's just creating a rift, that friction doesn't just stay siloed inside that conversation. But I'll go lay down and I can tell, oh, you and your wife got into an argument last night and it affected the entire night's sleep. I would love to just kind of hear your thoughts on like the psychological side of things. And that's not even getting into the more clinical side, but things that people are dealing with every single day. Yeah, definitely. So the idea that I think you may have heard of this concept between sympathetic nervous system activation and parasympathetic nervous system activation, right? So what you're describing in those stressful situations, these are inherently sympathetic activities where you're in a, an argument with your wife. It's the same

thing as if you're, you know, running from a tiger or working out or something else like that. Yeah. It's, These are sending alert signals in your brain. Sometimes when we are excessively stressed, we have trouble transitioning between that sympathetic state to the parasympathetic state, which is required for sleep. So what happens is you're coming off of that fight, you haven't wound down properly. And now you're in that state for hours laying in bed. And so a couple things can can happen here. So one of the other things to mention, I think it's been talked about on this program before, but there's this concept of allostatic load, which is the, you know, stress over a long duration of time, you know, it builds up and it makes your,

it basically makes your ability to manage stress and perform that transition between sympathetic and parasympathetic nervous system activation diminish. So that's something to watch out for is like, you want to make sure that you're not chronically in those, those situations of high stress activation, right? As far as how it impacts sleep, you know, it sounds like with you in particular, it's, it's influencing your what's called sleep latency. So your ability to like, lay down in bed, and then between the time that you lay down in bed, and you fall asleep, there are actually 1000 things that you can say about, about sleep and stress. And it's probably worth, you know, an entire podcast episode to talk about that relationship.

But in general, when you have excessive stress, that's present kind of in your life, it can, it affects basically every part of your sleep. So your ability to fall asleep, your ability to stay asleep, uh, the quality of your sleep and meaning like the depth, um, you'll see a significant reduction in both REM and deep sleep. Um, when you're excessively stressed, um, you'll often find that you'll wake up, um, at varying times, um, and with, uh, lethargy as well. So meaning these are the people that will wake up a couple hours before they normally do

or before their alarm. These are also people that when they, they have trouble getting out of bed sometimes when they are excessively stressed as well because that system is just out of whack. So many different things to say there. I would request that I would come back and have like a more in-depth conversation around stress and sleep. Cause I think it's a

really important thing that a lot of people struggle with today, but yeah. So you've taken all of this data on people. Uh, step two, we have to go, we have to go analyze it. Uh, what does that process look like for you guys and and kind of like the team how do you how do you actually come up with some sort of um strategies to go help people yeah definitely so that data collection process that i just i just kind of described before um we actually will send one of our scientists out to the home of the people of the person that we're working with in order to collect that data.

So the idea here is we're collecting more data than any other sleep assessment on the planet today. And we've kind of brought together some of the best sleep experts that exist at this intersection of performance and sleep. And so basically what we do to analyze that data is we've modeled our process after what a clinical case conference that you'd find in like a pathology department in a hospital setting. Basically what that means is we take all this data that we collected and we throw it up on a screen in a conference room. And there, my clinical and science team will have a furious

debate over what the core insights and optimizations are for the individual that we're working with. So the idea here is we collect all this data, we have the best people in the world to analyze it. And out of that meeting comes a series of recommendations and a performance plan for you. So this is a totally new take on how to optimize sleep in an individual, as opposed to just saying, you know, do these three things. We actually build a coaching protocol that we take you through. So with the vast majority of people, we can address the problems that we see over the

course of between eight and 16 weeks is kind of what we've been averaging with. So we will start by setting a series of goals for you. So based on all of the data, this is what we think your optimal sleep duration, your different quality metrics, and a variety of other things. This is what we feel is optimal for you. And then we are tasked with getting you there over the course of this coaching program. So we're doing two things really in this coaching program. The first is addressing any core issue that we see in your data. This can be something, as I mentioned, as small as an environmental factor or as large as, you know, a clinical issue that we kind of refer out for. And then the second half is all about optimization. And what optimization means to us is that we're providing a series of recommendations

and then testing the efficacy of those recommendations. So I mentioned this wonderful partnership that we have with Aura. We use that to monitor your sleep over the course of several weeks throughout this coaching program. We will prescribe to you supplements, behaviors, technologies that we'll purchase on your behalf, and then we'll monitor and assess over the course of several weeks if that's something that you should continue after working with us at Absolute Rest. So this is, to our knowledge, as I mentioned, kind of the most holistic approach to sleep optimization that we currently know about today.

But yeah, that's how we analyze data and that's kind of what we do with it. Can you think of any examples or would you mind sharing some examples of just some little, like some things that you have done that maybe people are not aware of or never heard before? Like everyone knows about having a cold and dark room and everyone knows to, you know, like don't watch a bunch of TV and blue blockers. Like, are you just telling people a bunch of stuff that they could Google in five seconds anyways? Not really. So I think a lot of what we, we end up doing is actually, um, we, we, we end up working

in some respects against the medical system that that's currently kind of created around sleep today. Um, meaning there are people that have come to us on CPAP machines that don't necessarily have to be on CPAP machines. There are people on Ambien, as Anders mentioned earlier, that certainly should not be on Ambien for the amount of time that they are.

And there are people that have struggled with sleep problems their entire life and just have not had answers. These are our favorite types of people to work with, as I reference. So yeah, as far as just to get really specific around kind of some of those things that I mentioned, you know, we have to get someone off of a CPAP device, just as an example, we have a series of exercises that we would prescribe. So both muscles in your tongue and your face. We also have specific ways of exercising just kind of lower down into your respiratory system.

So increasing lung function. We have, you know, protocols around, you know, mouth taping and getting snoring out of the picture as well. So there's a bunch of stuff like that that we'll end up doing to get someone off of the CPAP if it's at a severity level that's kind of appropriate for it. With things like primary insomnia, as an example, so we will do some pretty non-intuitive things sometimes, like we will purposely restrict the sleep of people that we work with, um, in order to get them back on track, we'll perform, um, circadian resets where we will kind of adjust for any issues that we see with someone's circadian cycle. Um, and there's a, there's a variety of other things that we would do as well so yeah this is like the

equivalent of uh so this is like the equivalent of if you're not in the fitness space of like finding a program and doing three sets of 10 and just doing that the rest of your life like that would be the equivalent of just being like oh okay so i wear blue blockers and i do etc etc etc that's not really a plan. That's just a whole bunch of things you're doing. And you're going to do that the rest of your life. Or you can go hire a coach who's going to intentionally tell you when to do three to 10 and intentionally do this. And they're going to phase out a program or six weeks.

They're going to build you into a new person. That's what this is actually doing, right? So it's intentionally building in different phases. So you can build a, not an optimal sleeper, but a resilient sleeper, right? This is the target is, is to do that. So, um, can you like, maybe like talk more about that part? Totally. Yeah. Yeah. I think you hit the nail on the head there. So a lot of people will come to us looking for something like optimal sleep. That's kind of a fool's errand. Um, optimal doesn't really exist today. We're not at that point yet. What we do instead with our clients is we, as you mentioned, turn them into resilient sleepers, meaning they know exactly how to respond to every unique facet in a way that's individualized for them. They know how to respond to that business trip that they have to take three times out of the year or that extremely important meeting that they have on Monday. They know exactly what they

need to do to sleep that weekend to perform effectively there. It's really about identifying all of the unique components of a person and then developing protocols around sleep for that. And then at the same time, maintaining a healthy baseline of great to optimal sleep, which we will sometimes get to. But yeah, that's a great point, Andy. For sure. I'd love to dig into, you mentioned the CPAP a little bit earlier, and I feel like that's such a common theme now. Like the number of people on CPAPs, my wife actually used to work

for a company that sold CPAPs. It's almost like just on trend right now. And it's not just like, I originally, when I started to think about that of like, oh, it's just people that are overweight. But it's not really the case. It kind of affects a very large group of people. And how do we kind of start to get away from CPAP machine? Why are they being like over prescribed? I guess you're prescribed a CPAP machine.

How do we, is there a way to get away from that and start kind of like building a better sleep pattern so that you don't have to be on one? I'm going to reframe this question because I don't mean to be negative on CPAP machines. They, these are devices that have fundamentally changed the lives of millions of people. They, they're extremely important. Um, however, I think they like Ambien, there is this, uh, it's almost like a knee jerk reaction to sleep, sleep, disordered breathing, and then prescribe something like a CPAP machine. These are not completely benign, you know, like when you're introducing positive airway pressure, you're losing muscle tone in your respiratory system, which unfortunately means

that if you're, if you were to get off of the CPAP machine later on, your sleep apnea might actually be worse if you're not in conjunction with its usage, performing some of the exercises that I was talking about earlier. Additionally, you know, I think the reason that a lot of those other exercises are not prescribed is because adherence is sometimes an issue. Absent a coaching program like the one that we provide, you know, if you look at like the clinical efficacy of some of these protocols, it turns out that people just don't follow them correctly. And so therefore they kind of relapse into their, um, the severity that they started with, with their, their sleep apnea.

So, um, that's another kind of component there. I think that when, when I, when I said what I said about it being overprescribed, if you have mild sleep apnea, moderate sleep apnea, there are so many solutions out there for addressing that that are just not discussed commonly in the medical system. And I think that I'd love to see that change over the next few years. And I hope know a company like ours is is kind of leading the charge there with like taking this more performance-based approach to sleep um as opposed to just putting a band-aid over um an otherwise fixable problem so yeah yeah i uh go ahead doug so say after you collect a bunch of data on people and figure out a plan and

and whatnot like how did how is all that delivered to the client is it like uh you sent them like some type of like a report breaking down all of their data and how how you came to your conclusions like what kind of their what kind of an education process is it for them so they know exactly why they're being advised the way they're being advised. Yeah. Education is an enormous component of what we do. So basically what we don't do is we don't just provide a single report with all of the findings on it. We found that that can get confusing for some of the people that we work with. And so the approach that we take instead is we tell our clients exactly what

they need to know in the stage of the coaching that they're in. So every single week, we'll collect all of this data. And then as I mentioned, we'll be monitoring longitudinal data as well. Every single week, we'll provide what you can think of as like a mini report, like, here's what we observed in your initial assessment. And here's what we observed in your longitudinal data. And this is exactly how we're addressing that problem over the course of the next two weeks so it's a very like handheld step-by-step approach um to delivering that data back to customers as well yeah and then and then every week you're you're making little tweaks and changes and and kind of just depending on how they're responding to the advice and suggestions and protocol given they're being coached for what you said between like eight and 16 weeks that we said earlier?

Yeah, roughly. Well, basically, you know, we will work with someone until we fix the issue that we've identified. So I say eight to 16 weeks weeks but we've had some that go you know beyond that we've had some that um you know will come in right at eight weeks but we hit the goals that we set out for so yeah got it so you're you're solving problems and that's just how long it typically takes yes exactly yeah so we're it differs from just simply saying here take this medication which is going to be symptom management right it is trying to get at the root cause whether that be environmental stuff um physiological stuff psychological stuff like all going back to sort of the beginning um

right that's that's correct right yeah exactly trying to get that root cause solution. Great. So would it be appropriate for people to think about, like, right, if I'm trying to do this on my own, how can I get some really quick diagnosis to figure out, like, do I even need to worry about this? How do I know if I'm even sleeping okay? Like, how do I know if this is, like, really, really bad? Like, what are some things I can look for? Maybe am I wearable? Maybe not. And then if so, like what, is there any guidance you can give them on like trying to do a step-by-step sleep coaching program on themselves where they don't have to just, you know, do all hundred thousand things they've heard

or sleep? Yeah, absolutely. So I think a good approach here is to become a scientist of your own data and really figure out the different protocols and optimizations that work for you. There's no short supply of them online. You can find a bunch. recommend to everyone is, is regardless really of whether or not you think you're a good sleeper or not, is to go and get screened for sleep disorders. This doesn't necessarily have to mean going into a lab. This means you're going through a series of questionnaires. So for example, like with something like sleep apnea, if you're concerned that you might have that, um, there are some clinically validated questionnaires like the Berlin sleep questionnaire. That's really effective, um, that you can use. These are things that you can just Google, um, and you'll find them. Um, these can be tools to have a

conversation with your doctor as well. So, um, for something like insomnia, looking at the insomnia severity index is a useful tool. If your partner has complained about you kicking around and moving excessively throughout the night, something like the Cambridge Hopkins Restless Leg Syndrome Questionnaire is useful there. If you have energy level issues throughout the day and you find yourself like, you know, taking naps where you otherwise wouldn't a few years ago, doing something like the Epworth sleepiness scale is also a useful tool. So these are all screeners that you can use just kind of at home that would be useful. Back to kind of becoming a scientist with your own data, you know, learning how to keep a sleep diary is a really important skill.

That's something that we actually will with all of our clients recommend as well for kind of continuing to optimize outside of our program. And basically, you know, that's something else that I'd recommend just, you know, typing into the Google search bar. It's a it's a free thing. Um, basically this is, this is helping you, um, every night to, um, take a subjective look at how your, your sleep, um, was, um, the time that you spent in bed, the amount of time that you think you were asleep, um, the amount of wake-ups that you had. So perform little experiments with yourself. You know, if you're interested in trying a magnesium supplement as an example so take a magnesium supplement for two weeks um while doing this sleep diary and see the impact that it had um things like that are something i always recommend um so that's awful

um dude uh before we wrap yeah oh it sounds about to and then doug came in with a new question i know i was gonna say i saw him he was trying to wrap it up i was gonna let him uh before we wrap this up uh it sounds like you got a good thing going here but what uh what does the future look like what what uh what like little tweaks or improvements or things that are on the horizon that you're excited about that are relevant to absolute rest yeah so i i think a lot of the things that we're excited about are new technologies that we're bringing online so one of the the big problems in sleep science today is that even with this assessment that I just referenced, we're collecting an enormous amount of data over the course of two days, but then we're relying on something like a wearable over the course of several weeks after

that. Basically the most exciting thing that we're doing at Absolute Rest in 2023 is we're taking a lot of the sensors that we're using on people in those two days, and we're miniaturizing them to the point and working with other companies that have done this that allow us to collect all of that data over the course of weeks. So we're going to be able to be extremely precise in the recommendations that we're giving and understanding exactly the impact that that's having. We think that this is going to fundamentally change how people view sleep optimization in the future. And we're really excited about it. So yeah, I think thanks for the question. That's

something we're all really pumped about. Where can people learn more? Get on the wait list? Totally. So we do have a wait list available for Absolute Rest. That is just at absoluterest.com. Yeah, for Barbell Shrugged listeners, like if you guys want to reach out to me personally, my email is just josh at absoluterest.com. Blow it up.

Are you not on the socials at all? What did I just do? The dude loves, loves having some foot pics sent his way. So get after him. Oh, no. He doesn't even want absolute at-rest inquiries. Just foot pics. Amazing.

No, you're not really on social, are you, Josh? Not really. I'm not in any significant capacity yet. We're also at Absolute Rest on Instagram. Dr. Andy Galpin. There it is, Dr. Andy Galpin, Instagram and Twitter. You bet. Josh, dude, stoked to have you on the show.

You fucking smashed that. You know, just like I want pretty much everyone I know that I care about to go through our executive program at Rapid Health, I pretty much want everyone that I know to go through the program with absolute rest. I just feel like it's a gangster program that provides a lot of value. So stoked you came on the show, man.

I'm happy for you with all your building over there. It's very cool. Thanks a lot, guys. I really appreciate it. This was fun. I'm Anders Varner at Anders Varner. We are Barbell Shrugged,

Barbell underscore Shrugged. Make sure you get over to rapidhealthreport.com where you can see Dan Garner read my labs over 90 minutes. And friends, we'll see you guys next week.