Good Life Project - 7 Days to Unlock Your Best Sleep | Dr. Aric Prather

Episode Date: May 11, 2023

We want to hear from YOU! Take our survey.What if you could transform your sleep in just seven days? What if the key to unlocking your best rest lies within a simple yet powerful prescription, tailored by one of the world's leading sleep experts? What if sleep didn’t have to be something you struggle with and, instead, could become a powerful and friendly ally? Well, that’s exactly where we’re heading into today’s conversation as we open your eyes to the wonders of sleep and help you finally experience the restorative snooze time you've been craving.My guest today is Dr. Aric Prather, a Professor of Psychiatry and Behavioral Sciences at the University of California, San Francisco. In his new book, The Sleep Prescription: Seven Days to Unlocking Your Best Rest, Aric shares the powerful solutions he uses to help patients at his clinic achieve healing and restorative sleep. In this conversation, you'll discover things like:How your internal clock plays a crucial role in your sleep qualityThe importance of sleep transition and the activities that can help you wind down effectivelyThe surprising impact of blue light exposure on melatonin production, and the myths around itWhy it's essential to create a "shrine to sleep" and the consequences of not doing soHow to retrain your brain for better sleep through innovative techniquesWhy you might want to focus more on wake times than bedtimesAnd so much more.Don't miss this opportunity to gain insight into the mysteries of sleep and unlock the keys to your best rest. Join us as we explore the groundbreaking work of Dr. Aric Prather and learn how you can transform your sleep in just seven days.You can find Aric at: Website | TwitterIf you LOVED this episode you’ll also love the conversations we had with Light Watkins about finding calm wherever you are.Check out our offerings & partners: My New Book SparkedMy New Podcast SPARKEDVisit Our Sponsor Page For a Complete List of Vanity URLs & Discount Codes. Hosted on Acast. See acast.com/privacy for more information.

We don't get enough sleep, like little things feel like big things to us. And we're learning that those can have potentially a cost to our well being. And when people are sleep deprived, they're less likely to get exercise less likely to make kind of the right food choices. And you know, when they've looked in the brain doing like imaging studies, it seems like when people are sleep deprived, their brain is kind of like driven towards this like hedonic reward pathway, meaning that they have this tendency to crave and seek out things that are pleasurable, including high fat, high carbohydrate foods, which is also really consistent when people are stressed. So you know, kind of this like sleep deprived, feeling stressed out, which seems to be circular produces a lot of behaviors that ultimately might undermine our

health. But there will always be ups and downs, right? Like that's the nature of sleep and that's the nature of aging. And it gets harder as we age, but it doesn't mean that it can't be better than it is right now. So question for you, what if you could literally transform your sleep in just seven days? And what if the key to unlocking your best rest lies within a simple yet powerful prescription tailored by one of the world's leading sleep experts? And what if sleep didn't have to be something you struggle with and instead could become a powerful friend and ally? Well, that is exactly where we're heading in today's conversation as we open our eyes

to the wonders of sleep. Yes, I said wonders of sleep. Believe it or not, it can be wonderful and help you finally experience that restorative snooze time that we've all been craving a little more these days. and Behavioral Sciences at the University of California, San Francisco. He co-directs the UCSF Aging Metabolism and Emotion Center, is the interim director for the UCSF Center for Health and Community, and serves as a clinician at the UCSF Insomnia Clinic. His research, it focuses on the causes and consequences of insufficient sleep with a particular interest in how poor sleep impairs mental and physical health, including immunity and heart health. And his work has been featured everywhere from the New York Times to the Wall Street Journal, Today Show, NPR, and beyond. In his new book, The Sleep Prescription, Seven Days to Unlocking Your Best Rest, Eric shares the powerful solutions that he uses to help patients at his clinic achieve healing and restorative sleep. And in this conversation,

we'll not only debunk some common sleep myths, but also reveal science-backed secrets to optimizing your sleep. We'll talk about things like how your internal clock plays a role in sleep quality and the importance of sleep transition and the activities that can help you really wind down effectively. We'll look at the surprising impact of blue light exposure on melatonin production and the myths that a lot of people are telling around this. We look at why it's essential to create a shrine to sleep as he describes it and the consequences of not doing that. We explore how to retrain your brain for better sleep

through some pretty cool innovative techniques and why you might actually want to focus more on wait times than bedtimes, which is kind of counterintuitive. So don't miss this opportunity to really gain insight into the mysteries of sleep and unlock the keys to your best rest. Join us as we explore the groundbreaking work of Dr. Eric Prather and learn how to just really transform your sleep in just seven days. So excited to share this conversation with you. I'm Jonathan Fields, and this is Good Life Project. It's also the thinnest Apple Watch ever, making it even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest-charging Apple Watch, getting you 8 hours of charge in just 15 minutes.

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Sleep. When a lot of people think about that word, it is not a source of solace or contentment or fulfillment or satisfaction. It is one of those words where I would imagine the typical person, how was your sleep last night? You're either going to get a semi-lie or somebody will be honest and unhappy about it. At least that's my take in sort of an informal survey. You've been living in this world. Is that accurate or is that just, am I just surrounded by sleepless curmudgeons? No, I mean, I think that's one of the things

that is so interesting about sleep. I always say that like sleep is universal, but it's also really personal. And people have their kind their own relationship with sleep. And you're right. Many, many, many, too many are constantly chasing it. We're trying to figure out how to hack the system to be able to sleep well. And I think you're right on. I think I'm in the Department of Psychiatry here at UCSF.

And one of the things that's so important about our studying sleep is it's also kind of like people like to talk about it. Like it's like an entryway into kind of other things in people's lives. Like they don't want to maybe talk about their anxiety or their depression or kind of other things that are going on in life. People sure like talking about their sleep. And you're right. People are rarely kind of bragging about how wonderful it is. And then if they are, it's, it's probably not as accurate as when people talk about

how bad it is. Yeah. I mean, it's interesting that you made that comparison, you know, like if people are going through a depression or they're struggling with anxiety or OCD or any type of mental illness or temporary just unhappiness, we often tend to keep it secret. And I think part of that is as much as society, we're trying to normalize it, there's still some people feel this thing of shame around it. But sleep, it's almost like we assume that so many people struggle with it,

that it's almost normalized. And also it's the type of thing where I think there are so many popular remedies, whether they work or not, that everyone wants to trade, well, what did you try? What did you do? And attempt to try and figure this thing out. Before we dive into some of the things that we can really explore to potentially improve our sleep, What are we actually talking about when we're talking about sleep? Yeah, that's a good question, right? Like we all do it, right? We all kind of have a sense, our own personal experience of what sleep is. But, you know, as much as for many people, it's kind of a loss of consciousness to the

world. And then, you know, things go on in our brains. We might have some dreams and whatever. Like sleep is incredibly dynamic. You know, basically, you know, we go through sleep cycles. They typically last about 90 minutes a piece. And we dip into various levels of deepness of sleep, right? So we have terms for this.

You know, we have N1, 2, and 3. That's part of what's called non-REM sleep. And then we have REM sleep, which is kind of rapid eye movement sleep. And that's where people experience dreaming typically. But we cycle through it, you know, particularly in the first half of the night, we spend a disproportionate amount of time in N3 sleep, which is kind of our slow wave deep sleep, that real rich, restorative sleep that we all crave and is so important for our health and wellbeing. And so, you know, we cycle through that. We spend a lot of time in deep sleep in the first half of the night and the second half of the night, you know, it sleep becomes a little bit more fragmented. We tend to wake up a little bit more. And we also spend a lot of time in REM sleep and dreaming sleep. This is why, you know, when people remember their dreams, they typically remember ones that happened kind of in the early morning hours, just because by probability, you're more likely to be in coming out of REM sleep in that way. So that's kind of the

architecture of sleep. But then there's also kind of the other metrics that we tend to care about, kind of the amount, the duration of sleep, how consolidated our sleep is, meaning like of the time in bed that we spend for sleep, how consolidated our sleep is, meaning like of the time in bed that we spend for sleep, how much of it is actually sleep. One of the metrics that we use in our clinic is something called sleep efficiency, right? So like of the time, how much of that is actual sleep of that opportunity by a hundred. And so we get a percentage. So that's something that we use and we follow over time for people. And then of course there's the subjective quality, right? I mean, not every night of sleep, it feels the same. And that's actually something that we're still trying to understand, you know, I mean, for some people, they can have a short night of sleep that maybe doesn't seem but they feel great, right? Like it's just maybe it was really consolidated, and it gave them what they needed, where other people might spend a lot of time in bed, get kind of a high amount, but it's broken up or fragmented. And it actually makes people feel kind of run down and have some

of those daytime dysfunction symptoms that we worry about, like feeling tired or fatigued or having kind of difficulty with memory and cognition, or kind of, you know, being a little bit more irritable than we would have been had we gotten a with memory and cognition or kind of, you know, being a little bit more irritable than we would have been had we gotten a good night's sleep. And so, you know, all of those things that I mentioned are metrics that we try to understand kind of what it is that makes up what we think of as sleep. It's so interesting because it's, you're describing something which is really multi-layered, you know, and whereas I think if you ask the typical person, how is your sleep? You know, they're just going to give you a rating. You're like good, bad, like medium, terrible, awesome. But again, like you just described it, it is

fascinating. I've had nights where I slept four hours, woken up the next morning and felt great. And I've had nights where I slept nine hours, woken up the next morning and was just exhausted. You're trying to make sense of that. And it's hard to actually figure out what's really happening here. Yeah. I mean, I think part of it is that a lot of things go into our sleep. I mean, I think a good example is when people drink alcohol close to bedtime. That experience, it certainly helps people fall asleep. They may get kind of a high number of hours, but for any of us that have had too much alcohol before bed, I mean, certainly it's not a high number of hours. But you know, for any of us that have like had too much alcohol before bed, I mean, certainly, it's not a high quality of sleep, right? Like can be fragmented,

we get kind of REM suppression in the first part of the night. And all of those things can impact kind of what the quality is and how restorative that feels. But you know, there's lots of things like that, that kind of impact how people sleep. I think another thing that comes up a lot in our clinic is, you know, our sleep changes as we age, right? And but sometimes, our expectations don't move along with that, right? So it's like, I remember kind of when I slept really great in my 20s. And you know, now I'm in my 40s. And I'm like, you know, this is this doesn't feel so good. But I'm not comparing myself to like other people my age. I'm comparing it

against kind of what I remember being good sleep. And that's a really important thing. I mean, you know, a lot of folks that we treat in our clinics here, you know, they've been on sleep medications for a long time. And, you know, as we're getting them off it, you know, there is like some kind of, you know, reacquainting them with what is normal sleep feel like. And it probably doesn't feel like how it does when you take a heavy dose of like an Ambien or something like that. All of those things, those psychological components, those expectations are really important for how someone describes how their sleep feels to them. Now, that makes a lot of sense to me. So you brought up the notion of sleep aids.

My understanding is they're one of the most, well, not even prescribed anymore. Most of these are over the counter these days. They're one of the most taken things by a huge number of people. Do they really put us to sleep? Is it the functional equivalent of natural sleep or are they creating some sort of different state

that just lets us feel like we're doing the thing that we're supposed to call sleep? Yeah. I mean, they, they definitely, obviously they act on the brain, right. And they can produce kind of the feeling of sleep, but it's not the same as natural sleep. So, I mean, a good example is, you know, when people take high dose hypnotics, any kind of in that class of like Z drug, you know, people wake up throughout the night. You know, we usually, most people like don't have this experience of like falling asleep and then like all of a sudden, you know, eight hours later being like, oh, it's the world again.

I'm back. And, you know, people in that take those, if they wake up too, it's just, they never encode that memory. They never have any kind of recollection of that for a lot of people. Right. And so it's clearly doing something to the brain that is not the same as natural sleep. And also we're learning more and more about in particularly those drugs and things like benzodiazepines that may in fact carry a risk for your brain over time, like chronic use. And so, you know, this is why there have been development of kind of more warnings and providers

being more resistant to prescribing those types of things for sleep, particularly as we get older, just because of it may carry an additional risk. Also, there's also kind of like fall risks that people worry about, right? Like you're kind of zonked out and maybe more likely to fall if you get out of bed to use the bathroom or something like that, which you wouldn't necessarily do if you were sleeping naturally. So that kind of explains, because I was curious, you said people would come to you and part of what you're doing is trying to get them off aids like that. And so you're sort of describing some of the reasons that you might really want to consider it. But it is interesting that we're still drawn to just

experience something we call sleep. I almost wonder if part of it is psychologically, we just want to say that we've closed our eyes when it was dark out and opened them when it was light out. And what actually is happening there, we just count as sleep no matter how similar or different it really is. And it removes the psychological stress of saying I'm not sleeping. Yeah. You know, I mean, there's a lot of, obviously with insomnia, which is kind of where this all comes in. I mean, that distress is real, right? That anxiety is real and that's, no one wants that. And it's not just the anxiety of like what you do throughout the night. It's people's fears about what tomorrow is going to bring.

Right. Like it's going to be hard to manage through the day. But, you know, kind of once you flip that switch on that anxiety and beginning to kind of like, you know, running through like the worst case scenarios, I mean, you're in a bad position to try to get back to sleep. Right. Like the train has left the station in some cases. And oftentimes people take these medications because they want to avoid that. And that makes

sense. Like no one wants that. But I think there are like really important behavioral strategies that can help kind of mitigate that. I mean, I think other also related to this is a lot of these medications, they don't cause like a physiologic dependency. Like you don't start to crave them or have same withdrawal symptoms that you may have for other medications. But the psychological dependency is very real, right? And it's like almost immediate because it's like, oh, wow, I took this and this happened. And now what happens if I don't take it? And that just kind of feeds into this concern and kind of whittling away someone's self-efficacy around something that, you know, honestly, we don't do. Like sleep is not something you make happen.

Sleep is something that happens to you. kind of doers, we're fixers. We kind of bring in all those tools to try and make it happen, but it actually ends up in many cases kind of undermining how sleep works naturally. Something that you never even thought about how it worked until it stopped. Yeah, no, that makes a lot of sense. The Apple Watch Series 10 is here. It has the biggest display ever. It's also the thinnest Apple Watch ever, making it even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest-charging Apple Watch, getting you 8 hours of charge in just 15 minutes.

The Apple Watch Series 10. Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required. Charge time and actual results will vary. So you described sort of the architecture of sleep, the different phases, the deeper sleep, REM sleep. I think a lot of people just think about sleep. They're like, well, yeah, I feel better if I have a good night's sleep. I'm just more energized. What's actually happening in the brain when we get quality restore of sleep? Like what's it doing to

us and for us that is critically important for us to be okay? Honestly, this is like an open science, right? Like we're still kind of like, I mean, what goes on in the brain generally for anything is like hard to tell you, but you know, there's lots of evidence related to learning and memory, memory consolidation. You know, one of the things that, you know, seems to happen, particularly during REM sleep is kind of emotional memory processes and things like that. And then one of the most exciting discoveries in the last several years with respect to sleep is the role of sleep in what's called the glymphatic system. So the glymphatic system is, is it's kind of, it removes waste from the brain. And so when we sleep, the vesicles kind of expand

in a way that more cerebral spinal fluid, this kind of fluid that bathes the brain can kind of get in and wash out some of the metabolites that build up throughout the day. You know, that seems to play a critical role in kind of some of the restoration, at least at the level of the brain. And one of the things that it seems to wash away are things like amyloid, which builds up throughout the day and, you know, has been linked to the development of kind of neurodegenerative diseases like Alzheimer's. And so, you know, there had been this kind of the a lot of like

population level data linking kind of poor sleep or insufficient sleep and some of these neurodegenerative diseases, but we didn't have a clear mechanism how that could be how why would that happen. And so this seems to be kind of one of those potential mechanisms. And, you know, we're still kind of early on and trying to understand some of the electrophysiology that's happening at the brain. I mean, oftentimes, because we kind of rely on EEG kind of electrodes that go on the scalp, which then tries to, you know, we try to infer kind of deeper and deeper in the brain. Usually, when we do sleep studies, we don't have, you know, hundreds of these type of electrodes, but we are learning that, you know, things like slow wave oscillations may be really important, but we don't typically

look at those at using kind of traditional polysomnography. So I think there are kind of innovations that are happening at the signal level that may kind of begin to pinpoint what are some of the other benefits or why we see these sorts of benefits when people get the sleep they need. So that's sort of on a neurological level. How do some of these things, I mean, and you described, okay, so if it's sort of cleansing the brain of potential toxins or plaques or materials that build up that could potentially be precursors to various forms of dementia. Clearly, that's important for a lot of people. Whatever happens in the brain while we sleep, in terms of our behavior, in terms of our lifestyle, in terms of our capabilities or capacity, as we move through our waking days, how does this affect us? Yeah. I mean, gosh, how doesn't it affect us? Right? Like, I think that, I think that's the

better question. I mean, I think if you kind of, you know, a lot of this that we learn are both from kind of studies where we kind of track people out in the world and we kind of like measure their sleep over a long period of time. And we ask them lots of questions day in and day out. And then we also have kind of laboratory based studies where we say deprive people of sleep and see what happens to them. And in all cases, we see things that when people get the sleep they need, they're really kind of like the best versions of ourselves, right? We're kind of better parents, better partners. We're more productive at work. We're more creative thinkers, more sharper. And kind of one of the things that, you know,

we study a lot is our ability to deal with stressors, you know, And kind of one of the things that, you know, we study a lot is our ability to deal with stressors, you know, the kind of the slings and arrows of the day. We did a study where we kind of followed people for 21 days and measured their sleep using kind of a research grade Fitbit. It's called wrist actigraphy that gives us a good estimate of how much people sleep, how fragmented their sleep is. We had them report on their quality of sleep. But then we, every single day, ask them, what was the most stressful thing for you? And then when they answered that, then we asked, okay, well, how did you respond? How long did it last? How did it affect your mood in the evening? And things of that sort. And then one of the things that's challenging in stress research is

there's often this coupling of what people report is stressful and how they respond to it. And so it's not really objective. You know, people can't dissociate kind of what an actual event is from how it feels to them. We trained up all these coders to like, you know, to kind of evaluate all of these stressors. And what we found was that, you know, people who got less sleep than they typically did were kind of much more sensitive to stress. And particularly when the stressor was more minor, when people had a big thing happen to them, like they got in a car accident, it didn't matter how much sleep you got. It was stressful, but it was these like minor daily things, these kind of like,

you know, unfortunate events of traffic and like getting, you know, being feeling slighted at work or things of that nature that when people didn't get the sleep they need, that just felt really bad to them. And so, you know, it's kind of this idea that like, we don't get enough sleep, like little things feel like big things to us. And we're learning that those can have potentially a cost to kind of our well-being. And there are people that are more prone to this. So when we find people that are already kind of trait ruminators, meaning that there are people that kind of like when something happens, like they replay it, like that's their tendency. You know, that seems to make these little things worse, the impact of their sleep.

And we find that those same people, if we stress them out right before bed, those are the people that lose sleep. And that's so consistent with insomnia. Insomnia is really a disorder of like difficulty sleeping, but kind of the active mind, right? Kind of this tendency to worry, to be anxious in the evening, to kind of replay the day or things that happened years ago, as if you're going to be able to change them and doing them at a time that obviously you're not at your best and you're actually at your most vulnerable. All of the things I mentioned, you know, when people don't get the sleep,

that's what happens. I mean, like on the health behavior side, you know, certainly we know a lot about sleep and when people are sleep deprived, they're less likely to get exercise. They're less likely to kind of do that. And then around nutrition, there seems to be like a very strong relationship that, you know, when people are sleep deprived, they're kind of less likely to make kind of the right food choices. They tend to kind of consume more calories than would be in line with kind of the more metabolic activity that they might have by staying awake longer, right? You would think like, oh, well, you know, someone isn't getting their, you know, they're sleep deprived. So they're awake longer physically, that would make sense that they would eat more, but they actually eat like much more than even that need. And, you know, when they've looked in the brain doing like imaging studies, it seems like when people are sleep deprived, their brain is kind of like driven

towards this like hedonic reward pathway, meaning that they have this tendency to crave and seek out things that are kind of pleasurable, including kind of like high fat, high carbohydrate foods, which is, you know, also really consistent when people are stressed. So, you know, kind of like high fat, high carbohydrate foods, which is, you know, also really consistent when people are stressed. So, you know, kind of this like sleep deprived, feeling stressed out, which seems to be circular, you know, produces a lot of behaviors that ultimately might undermine our health. Yeah. I mean, it's your sense on that. And maybe there's science on this where you can answer directly from that, that, you know, if we're eating the wrong things, eating more of the wrong things, not really moving our body in the way that we know and we want to induce health, is that more about

us knowing that if we, for example, eat something, it's going to increase the chemistry in our brain that makes us feel good for a hot minute versus something about sleep affecting our executive function or self-regulation ability to actually make sort of like good rational choices that involve some level of self-regulation, not being as online as it could and should be, or maybe is it a combination of all the above? Yeah. I mean, there's evidence for both. You know, certainly, you know, I think about what we've learned about stress and stress eating, right? That like, you know, when people are stressed, and I think the same is true for sleep deprivation, but it hasn't been kind of as well

kind of studied. But when people are stressed, you know, they'll seek out high carbohydrate, high fat foods. And when they do that, it actually can dampen the cortisol response that people feel when they're stressed. So it like serves a function. And that's why kind of it, you know, it can be reinforced that way, because it does make people feel better and affects the stress system. So it's possible that like that's the same for sleep deprivation as well, because there's lots of hormonal systems that are just regulated as a consequence of insufficient sleep or fragmented sleep or something like that.

But I mean, I think the other arm is also true. And certainly they have seen this in the context of neuroimaging studies that when people are sleep deprived, you know, I think of it as kind of gas and brakes that like the gas of like, say the reward system or kind of the fear system, like the threat, threat related system is on, but the brakes, that prefrontal cortex, that link between them that helps provide that executive function, that helps provide that self-regulation that we think about, is not able to kind of down-regulate those brain regions when they do these tasks in people that are sleep-deprived compared to when they sleep normally. And so, you know, there's certainly that going on as well, based on the current evidence, it seems like it's,

you know, both. Yeah. I mean, it's fascinating. A bunch of years back, I remember talking to a adolescent psychiatrist and he described, he was actually sort of explaining that, you know, we used to have this notion of, well, the brain really reaches maturity and the prefrontal cortex kind of like really finds its place and is able to exercise self-control around the age of 18. But he said, the more recent research says, no, it's actually more like 25. And he used really similar language to you. He said, literally, like until you're about that, you're kind of all gas and no brakes. So what you're describing, it's almost like, you know, when you're really sleep deprived,

it's almost like it's bringing you back to adolescence, like temporarily. Yeah. I think that's, that can be right. Yeah. I mean, we're certainly have a tendency potentially towards more impulsivity and things like that. So I think that's fair, at least at the neural level. Right. And I would imagine that you're more inclined towards short-term thinking rather than sort of like long-term as well, in terms of like, I just need this thing now. One way that we've thought about this, like based on the literature is it's, and I think I used to have a postdoctoral fellow here who's now at the University of Michigan named Amy Gordon. And she was really focused on this idea that,

you know, when people are sleep deprived, you know, they really tend to look inward, right? Like it's about meeting your immediate needs. And she looked at that in the context of couples that, right? Like, and, and she would do these like couple conflicts, right? She would, one person would be sleep deprived. The other person would sleep normally. And they do this couple conflict. And the person who was sleep deprived just was much less likely to be empathetic and to be able to kind of see the other person's perspective on anything. It was like just this, you know, focused on kind of like, you know, I'm trying to survive here my way. So I think what you're saying, you know, it holds a lot of truth to it.

Yeah. I mean, as, as you're describing that immediately, I'm thinking about there are times where I know I haven't slept well and I will catch myself just being much quicker and shorter. And I'm generally very laid back and non-reactive, but I'll find myself dropping into a much more reactive state. What's interesting for me is I'm a long time meditator. And I find that through that practice, I almost have the ability to sort of like when I catch myself doing it, it's almost like I zoom the lens out and I'm like, is this actually a rational response to what's happening in front of me right now? And almost to the point, if I haven't slept well the night before, the answer is no. And it's kind of like, let me just kind of withdraw from people for the rest of the day

until I can knock in a good night's sleep and when I can feel a little bit more human. But the connection to empathy, I think is really interesting. So when you have a tough night of sleep, given that you notice that you're, you know, might be shorter with someone or more irritable, I would also imagine that it might be harder to kind of take that zoom out perspective that, you know, that's like additional cognitive resources. Cause that's like a, you know, such a healthy response, but we tend to find that those are not the defaults, right? No, I think you're definitely right. And my sense on that is just because it's

been such a long standing practice in my life and because I've developed that, it's almost like it's just a habit in my life. I tend to sort of like really examine my behavior when I'm, especially if I'm like reacting in a way that just doesn't feel like me. So I think more because it's almost like my default mode, then an effortful thing, it maybe comes a little bit more automatically or with, with less effort for me. But it's a really interesting question because in theory, you'd kind of figure that skill would be harder to access as well if you were sleep deprived, which is a bit of a double whammy. Yeah. It could be that it's your default, but it's also, you know, like maybe it's like muscle memory, right? Like, it's just like, you know,

you've kind of built this up over time. So, so well that it it's, you're kind of like finally tuned for these sorts of encounters. Yeah. I want to talk about one or two other things. And then I think we'll flip into some of the things that we can explore and do. But one of them is also the, the link between sleep or poor sleep quality and something I think so many of us have been really focused on and concerned about over the last few years, which is immune function. We're trying to do everything we can to be as healthy as we can so that we can resist whatever comes into our bodies. It sounds

like there's also a strong relationship between sleep and immunity. Yeah, that's certainly how I got into this. And there's kind of a longstanding literature linking sleep and how it affects our immune system. And so, you know, we've done kind of a series of different studies trying to understand this. And probably the one that gets the most kind of notoriety is, you know, we were really interested in sleep and whether it would predict whether someone would get sick if they were exposed to a live virus. So this was done in collaboration with Sheldon Cohen at Carnegie Mellon University, who's famous for doing these cold studies. But again, we kind of measured people's sleep using these

wrist devices that I mentioned earlier. We brought them into the lab. We exposed everyone to live rhinovirus, so the virus that causes the common cold. So we kind of shot it right into their nose and then we quarantined them in a hotel over kind of, usually it's over about six days or so. And we would track them every day to see who actually developed a cold. But it wasn't just based on their own symptoms that they reported that they didn't feel well. We actually objectively defined it. So we would collect tissues that they used every day and kind of weigh them out, kind of subtracting the weight of the tissue to get kind of mucus production.

And then every single day we would put a dye. We'd have them put their head back and then put a dye into their nose and time how long it took to get to the back of their throat. And the longer it took, the more congested they were. So if they showed evidence of infection, which we documented by looking in virus culture of their nose, nasal cells to see if the virus was replicating and then kind of met this threshold for kind of either mucus production or congestion, they were deemed to have biologically verified cold. And so it became this like, yes, no outcome. And what we found so conclusively was that, you know, people that slept fewer hours on average, kind of based on what we measured before, which we thought was a estimate of kind of their habitual sleep duration, like what people get chronically, the more likely to develop this cold, given though everyone got exposed, right? Like everyone got the same amount of virus. In fact, you know, people who slept six or fewer hours per night on average, were about four times

more likely to develop the cold compared to people who slept more than seven hours. And that's notable, because the American Academy of Sleep Medicine recommends at least seven hours per night to maintain optimal adult health. So it really did seem to kind of break there. And, you know, it seemed to be related to kind of someone's susceptibility to infections, you know, we've since gone on to look at vaccinations. And again, we see the same thing that like people who sleep fewer hours just don't mount the same level of antibody protection than people who sleep more. And this has been true for the hepatitis B vaccination series, the influenza vaccination

series. We just completed a study where we recruited people as they first were getting the COVID-19 vaccines. And so we'll get to look soon, hopefully in the next couple of weeks to know whether sleep plays a role there. And, you know, maybe it will, maybe it won't. I mean, that turns out the COVID-19 vaccine was really powerful when it came to mounting, you know, creating neutralization antibodies. So, so we'll see if, if there's enough variability for sleep to explain after accounting for all the other things that we know that are important, like someone's age and, you know, someone's smoking status, those sorts of things. Yeah. I mean, that's amazing to be able to know that not just from a symptom standpoint, but from literally being able to say that it affects the volume of antibodies that your body produces. So it's a compelling argument to get more sleep. The question is, as we flip into maybe what are some of the things that we can explore to actually get better sleep if we're not, if you're listening to this whole first

part of our conversation saying, like I was convinced before just because I was tired and cranky, but now you've given me a whole lot of other reasons to really pay attention to this. But still, so many people feel a sense of futility around it. Or they've tried this, or they've tried that. They've tried honey in the evening. They've tried all sorts of different things. And you make a really interesting distinction. I've heard this phrase, sleep hygiene, thrown around for a long time. It tends to be the same five or seven things. And it's not that you say that that doesn't matter, but you also make a distinction between what you call sleep hygiene and sleep pressure points. Yeah. Yeah. So I mean, right. So sleep hygiene is, you know, certainly a necessary thing, right? Like, I mean, all the things that I discuss and like sleep medicine providers discuss about

trying to get people sleep back on track won't typically work if you like don't do the basic things, right? So, you know, you know, sleeping in a room that's dark and quiet, and people do better when it's cooler, not drinking, you know, consuming caffeine too close to bedtime, not drinking too much alcohol too close to bedtime, don't, you know, not kind of exercising too close to bedtime, like all of those things are really important, because that could undermine the whole process, no matter what your best intentions are. But you know, this is particularly true for people that have have insomnia, and where, you know, they have the opportunity to sleep, but they just can't, right, which is, you know, very different than people that like, you know, for whatever circumstances, like just don't get to sleep.

And so they have short amounts of sleep. But those are like, it's out of their control. Right. And for people that have insomnia, certainly it feels like it's out of their control. But I guess I try to make the case that, you know, sleep is something that's so embedded in our genetic code. We can go longer without food and water than we can without sleep. Like it's that necessary for life that it's well regulated. And usually it is, you know, we tend to get in our own way. What I really try to focus on is like these behavioral things that we can do to kind of take the effort out of it. Oftentimes with insomnia, it's, it's the kind of the effort, the kind of wanting it so badly and the white knuckling it as much as we can that actually kind of works against us. And so, you know, these behavioral strategies are really to kind of take the effort out of it to like, you know, be like, okay, I'm going to do this.

I'm going to stick to this, this plan. And, you know, over time, it will increase the chances that on average, your sleep will improve. I just want to like, one of the ways to think about it, and this is like such a tough shift for people to make is this idea that like, you do these things and your sleep will improve on average. Because when people have insomnia, when people have like chronic sleep problems, they're only thinking about tonight, right?

Like, it's like, I don't care about tomorrow because I don't get a good sleep tonight, like all bets are off. And like that, like it just, we can't ever ensure that there's always something that can happen. Like you can get an email from work, like right before bed, you can get in an argument with your partner. You could, you know, the fire smoke alarm could go off like in the middle of the night, like all those things, like you can't prepare for all of it, you know, because our sleep is, has, is so kind of regulated by our biology. We can increase the chances that over time it will get better, but there'll always be ups and downs, right? Like that's the nature of sleep and that's the nature of aging and it gets harder as we age, but it doesn't mean that it can't be better than it is right now. Yeah, no, I love

that. And like, as you're describing, like when you're really exhausted or you've been up all night and you only care about like the next night, I think so many people can relate to that. You're going to be fun. On January 24th. Tell me how to fly this thing. Mark Wahlberg. You know what the difference between me and you is? You're going to die. Don't shoot him. We need him. Y'all need a pilot. Flight risk.

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Compared to previous generations, iPhone XS or later required, charge time and actual results will vary. The other thing that, and I want to actually walk through a couple of these things that you describe as behaviors is it's interesting also that many of them are sort of decoupled from the quote bedtime routine you know they're things that either they're connected to the waking routine or things that like you do throughout the day that have this ripple effect over time one of the big things you start at with actually is the thing that gets you up in the morning. In fact, it's the notion of focusing on your waking time and the critical importance of that. And I think a lot of people really, that's new information for a lot

of people. Yeah. So right. If there was one thing that I could tell people to like, that they should start doing to get their sleep back on track is to maintain a stable wake-up time seven days a week. And like, people do not love that idea, right? Like they like, well, but the weekend, what about that? But I mean, if you're trying to work on your sleep, like this is something that you can control. And the reason that we focus on that is because it involves the two main regulators of our sleep. So the first is our circadian rhythm or our internal clock. And like things work better for our body when things are consistent, when they're predictable. And so by maintaining a stable wake time, it kind of gets things moving in a good way. Because when people kind of like

move their wake up time, you know, swings by an hour or so every day, or even more for some people on the weekends, that's like inducing jet lag in your body, which we know doesn't feel good. And it actually impacts how well kind of your, you know, the rest of things go, including into the evening. And then the second thing that the other regulator that's so important is what's called our homeostatic sleep drive. And this is really a simple concept, but is it's kind of cool and kind of mysterious. It's, it's our need to sleep, right? Like, and I think of it, it kind of like a balloon. So when we wake up in the morning, our balloon is

flat. And then as we go throughout the day, it kind of fills up with sleepiness. Like every hour that goes by more sleepiness goes into this balloon. And until it gets to a really optimal amount, like in the evening, you feel these sleepiness cues. And then you go to sleep and kind of the sleepiness drains out throughout the day. But if you get up at different times every morning, your balloon starts building at different rates, right? And so that kind of throws off the experience of when you need to go to sleep. It makes your brain, which is really a predicting machine, it's kind of taking in information and trying to make predictions about what's going to happen next to keep you alive and thriving. It makes those predictions harder to

make. And so, you know, by maintaining a stable wake time, you can set those things in motion in a reliable and predictable way. And then the other thing that's important about, you know, maintaining a stable wake time is it's something you can control. Now, oftentimes people have heard things like, well, I should go to bed at the same time each night. And, you know, it turns out if you keep a stable wake time, you'll get sleepy around the same time each night because we, you know, we use energy similarly each day. And so it will become like this natural phenomenon of like, oh, I'm sleepy around the same time each night. But if you have insomnia, it can be really distressing to try to stick to a bedtime each night. Some nights we're not as sleepy. And so the last thing we want is people looking at the clock and being like, oh, the sleep doc told me to be asleep by 11. Oh my

God, it's 1045. Oh my gosh, it's 1050. Oh my gosh, it's 1055. And then, you know, they're kind of, their brain is just getting more and more active and really undermine the feeling of sleep. So because we can't control when we fall asleep, we don't focus on that, but we can control when we wake up. And so that's where we start. I mean, that's fascinating. And the image of sort of the sleep balloon, it's like you're sort of accumulating units

of air in that balloon, like for every waking minute. So it's almost the same size and it defl every waking minute. So it's almost the same size and it takes almost the same size to sort of like deflate or flow back into your sleep every night. It's a kind of cool image actually. It makes it visceral and visual for me. This is tied to, as you described, circadian rhythm, homeostatic systems in your body. I'm curious whether there's a relationship also between sleep and not just circadian rhythms, but the infradian rhythms, the longer-term rhythms, probably the most commonly talked about is menstruation, and whether you see relationships

with those longer-term rhythms as well. Interesting. I mean, it's certainly not the way in which we think about kind of circadian and rhythms when it comes to sleep. So I don't know. I mean, that's interesting. I mean, what do you imagine how that would work? I have no idea. I'm fascinated by, to me, logically, it's sort of like if you have a set of deeply ingrained repeated rhythms in your physiology and sleep is really powerfully tied to one, it just makes me really curious. Is it also linked in some way to some of the other recurring rhythms that you'll have for your entire life? The circadian rhythm that we focus on is like a master clock. It lives in kind of the deep end of the super chiasmatic nucleus of the hypothalamus in the brain. And it does set in time all the other rhythms in our body, right? So it

does make sense that that is a possibility, particularly given the fact that, you know, it's governing kind of physiology in that way. So, you know, all of our cells have rhythms, all of our organs, including ones involved in kind of reproductive function. Certainly the case that those may be tied together. It's not something that we think about in the context, at least I don't, in sleep. And it really, it's interesting because, you know, that you bring this up because it speaks to this. As a sleep medicine provider, we talk about the circadian rhythm and sleep. It's only recently that circadian scientists and sleep scientists have been, you know, coming together to focus on these clearly

interrelated things, right? Because historically, circadian scientists have really kind of dug super deep down into kind of single cell organisms and those sorts of things. But, you know, with the kind of the blooming of things like chronomedicine and this idea that there's these circadian regulators that might play a really unappreciated role in our health, I think the more that we'll begin to hear more about this and begin to understand where this overlap exists and where it doesn't. Yeah. So interesting. One of the other things that you talk about, and this relates back to something that you were talking about earlier in our conversation, is around rumination. And I

think so many of us have had the experience of saying, okay, I'm going to sleep. I'm going to sleep. And then all sorts of stuff starts spinning into our head. And it's like when we get quiet at night, which is the time where we're supposed to be like, okay, I'm kind of downregulating, I'm still in my mind. That's when all this stuff from the day starts to spin into you. And it keeps you, as you described, you're trying to calm down and all it does is just keeps arousing and arousing, arousing, creates a sort of negative thought death spiral, right? That eliminates the possibility of sleep. And then we pile on anxiety about the fact that we're not able to let it go, making it even worse. You have a really interesting approach to this about sort of like worrying earlier in the day

in sort of like discrete moments that I had never thought about or been exposed to. Yeah. I mean, it's this idea that we want to try to be preventative, right? Like for a lot of people, they can typically predict like what are the things that are going to crop up in the middle. I mean, sometimes they're things are like, wow, I haven't thought about this in 20 years. Like, why is this happening to me? But oftentimes it's things that we might be able to get out in front of. And so there's kind of two main ways that kind of, we typically approach this in my field. And the first is, you know, really trying to schedule time in the day where you just worry, right? So it's like making it intentional where you're going to sit down and use your time, put it in your schedule, sit down and to get those worries out, right? And if you

don't have anything to worry about, you still use that time. You can either write it down, you can kind of think it through, but you want to use that time for that purpose. And then in the middle of the night, if those begin to crop up, you can say like, look, I already did this today. I can let this go. I thought about this when I was at my best or better than now, and I have it scheduled tomorrow. So this can wait. And because I mean, I think everyone recognizes that rarely do we solve things in the middle of the night. We often don't remember what the solution was. And if we do remember the solution, it's often not the right one. And so, you know, being preventative in that way. The other way that we kind of approach this is more of a problem

solving where it's something called constructive worry where you actually, you know, it's an actual exercise where you write down kind of like the top three things that may come up in the middle of the night that you're kind of really working on in your brain. And rather than trying to solve everything, you actually, then you kind of write them out very clearly. And then you say, you identify like the first one or two steps that you would need to take to take to address that problem. And then there's something to the ritual of it, where, you know, people will kind of fold up the paper that they wrote it on, and they'll maybe put it by their bedside. So that if they wake up in the middle of the night, they have like a visual

cue to be like, look, I have it. It's there. Like I already thought through this. And if you kind of make that a habit, oftentimes it kind of reduces some of the power that those worries can hold over us and allow us to get back to sleep. I'm sort of in a particularly spinning moment in life, I would write down, you know, sort of like I just kind of sit there for 10 minutes and if there's stuff spinning in my head, I would write it down and feel like, okay, so it's almost like a process of extraction. I'm pulling it down from the cloud and putting it so it's documented. So knowing that like, I remember what it is, there's an issue that needs to be solved. As long as I remember, I'll be much calmer and be able to address it tomorrow. But what you're saying, which I really like, is that you almost like you just start to dip into the process of problem solving. So it's almost like you're creating a little bit of a good feeling around it. Like, yeah, like I'm actually starting to like figure this out. And it's almost like you eliminate the

notion of waking up the next day and having the problem solvers block or writers block and having to like look at the blank white page. And you're like, no, I'm already in this. It's okay. It feels like that would be qualitatively different. Like what you're saying. Cause I, I mean, I have a colleague here who, you know, we all have to do lots of writing, article writing, whatever. But like whenever she does that, when she stops, she always stops in the middle of a sentence so that when she comes back to it, she knows, you know, she doesn't have to start from scratch. Like what, like, what do I say next? It's like, oh, I can finish this sentence and it will get me back in the middle of a sentence so that when she comes back to it, she knows, you know, she doesn't have to start from scratch. Like what, like, what do I say next? It's like, oh, I can finish this sentence and it will get me back in the groove. And I think, you know, maybe that's partly what this, this is doing. Yeah. So that's actually classic. I'm a writer also, like a bunch

of books in years ago, I read this interview of Hemingway in the Paris review and he described his process of he ends every day having started the next chapter or the next page or whatever it is and being partway through it because he wakes up the next morning and there's no resistance. He's in it already. He's already gone through the grumbly part of figuring out how do I start the next thing. It's a really interesting technique, sleep-related, but also just for any creative process. I love that. Absolutely.

And the notion of sort of like pre-worrying in designated time. And it's based on the assumption that he said, they don't want to skip over, which is that the vast majority of things that we ruminate over, they're not new or different or surprising. We kind of know what they are. So you can probably pre-plan at least a whole bunch of it more than we think we can. Yeah. And I mean, I think it's also kind of the idea of kind of giving yourself the space, giving yourself the freedom to do that. Because, you know, when it's in the middle of the night, it doesn't feel like it's by choice. You know, it's happening to you. And I think by

kind of taking this sort of approach, you know, you're the one in control. Like you're the one that's choosing to do this. And in addition, it's serving this function. It doesn't need to happen in the middle of the night. Yeah. I love that. Sort of like you're, you're just reapportioning when it happens to your time, that's going to be a little less destructive to your ability to actually sleep. One of the other things that you explore, it's this notion of, I guess it's an acknowledgement of the fact that we as human beings really can't easily go from a state of arousal to a state of sleep by just basically saying, okay, it's time that there needs to be process

wrapped around that. And we need to create this sort of like transitional. I almost look at it as like a practice to be able to actually go from one state to another. Yeah, exactly. I mean, you want to really demarcate the end of the day and the start of that transition. We're not computers that we can just shut down. We need to kind of provide ourselves the opportunity for rest and relaxation to facilitate a good night of sleep. And a lot of it is like cuing your body. You know, you do have to wind down, you have to reduce that sympathetic nervous system, kind of enhance that parasympathetic rest and digest system. And oftentimes being consistent, kind of including

whatever rituals you have that kind of help facilitate that feeling for you are really important. It's unfortunate that so many of us are kind of in the mode of it's, you know, it's all about the productivity and kind of how do we squeeze in one more thing. My perspective is let's really take in the, like such a short view of things. The night, the sleep that we need is an investment in being your best self. And that way there should be the same level of enthusiasm for creating an environment and a practice that allows you to kind of enjoy and kind of benefit from all of the gifts that sleep provides us. But it does take being intentional and it may take some planning. It may take looking at your daytime. In this book, I use an example of like a former patient where it wasn't necessarily

her sleep that was the problem. It was her daytime that was the problem. She had a daytime problem where she was trying to be go, go, go all the way up until bedtime and just like could not make that transition. And it was a lot to do with the demands of her job, the demands that she put on herself and kind of her, the way that she thought that the world had to be, right? And so she did make some changes to be able to kind of get the sleep she needs. And I think a lot of us are in that position, right?

We have really busy lives. We have families, we have work, we have all these kind of obligations that we're dealing with. And so it can be hard. And some nights won't be as easy as others. But I think if you are intentional and planful of kind of protecting that time for transition to get to sleep over time and overall, you'll be better off.

That makes so much sense. And a lot of the things that you would talk about in that, like, what is that transition experience look like? It's some of the things you mentioned earlier that harken back to the sort of traditional sleep hygiene, you know, like the cool room, darkness, like wind down. And one of the things that you hear all the time is this notion of, okay, so pull off of screens, you know, give it a couple of hours beforehand. And the reason for that is because the damaging part is the blue light actually is disruptive in your ability to actually start to make that transition from arousal to the sleep system. But you offered something else, which I thought was interesting, which is the blue light

may not actually be the big problem. It's your just perpetual engagement with the content and the thoughts. The blue light's coming from a device and that device is sending content at you or interactions or dings or like communications. Where do you fall with sort of like the blue light being emitted from the devices that so many of us literally have in our hand until the moment we like lie in bed and some of us actually then lie in bed for a while with it versus actually like what you're viewing on the device contributing to the, why that's problematic. Yeah. I mean, there is accruing data to support kind of blue light exposure that come from these types of devices can impact our melatonin system and melatonin is released under darkness kind of sets the table

for falling asleep, right? And so, you know, to the extent that that blue light can impact that and shut that down, that's not a good thing. I think some people are more sensitive to that than others, but I think even in the cases when people use night shift filters that filters out this blue light, the content that people engage in is typically kind of one that is rewarding to your brain, that like your brain begins to crave, you know, the internet, like social media, they're developed to keep you there, right? Like to keep you coming back. It's masterful what it can do, but obviously that is

incompatible with being able to wind down and fall asleep. You know, it's probably a good idea, certainly to kind of unplug from like the day, unplug from your work, unplug from things that are going to kind of get your brain spinning, like get your reward system, that dopamine kind of like pulsing. And so focusing on kind of activities that are low arousal, slightly positive things that you can do for yourself, but aren't ones that are going to get you all worked up, right? You know, for some people, it's reading for some people, it's like listening to music for some people, it is being on those devices, I do suggest that people do put filters on in case you are someone who's sensitive to blue light and doing things that kind of that dopamine hit that is going to keep you awake. I suggest people watch television if

they want to, but like not start binging a new series that you're not going to be able to stop, right? Like maybe watch things that you've seen before. So you don't have to worry about what happens. All of those things that you enjoy being with your loved ones, doing things that are relaxing for you. And that's where, you know, it really does become this like personal thing. Like we know kind of a list of activities that might work for some people, but once in a while, those things that seem to work for some people may not work for you. Like I've had people that I always recommended reading and then found out that some people are just like voracious readers, like they cannot put a book down. And so that is not an example of something you should be doing

right when you're trying to go to sleep. Or if you have a sleep problem, this is not a way to help address that. And so really looking for these activities in this transition period, where you know, it's low arousal, slightly positive, things you enjoy, but aren't going to kind of get your brain all worked up. And then if possible, this is the best case to do them outside of bed. The bed is supposed to be a place for sleep and sex. It is something like a shrine to sleep. Some people have a tendency to kind of create a negative relationship with that bed, that it's not a place of slumber. It becomes a place of activity and your body notices, and that can impact your ability to sleep. Yeah. I mean, it's that whole notion of conditioning,

you know, and when the trigger becomes, you know, like the bed is the trigger for like, ooh, it's time to like work or to binge like this thing. Or your body just doesn't get the signal to say, no, that's actually not what we need to be doing right now. As developed as we are, we're basically Pavlov's dogs at the end of the day, right? You're not wrong. That's for sure. Well, there's so many other really just interesting ideas in your book, but I feel like folks can dive into that. It's a good time for us to wrap up and come full circle. So in this container of good life project, knowing that sleep is a really big, important part of living a good

life, but not wanting to bind you to that in any way, shape or form. As I asked my final question, if I offer up the phrase to live a good life, what comes up? Ooh, to live a good life. I think living a good life is, is living one with purpose. You know, for me, my purpose is my family. Like I have two little kids. And so that's like, definitely kind of the most important thing for me, this kind of talking about sleep and getting people excited about it and getting people to kind of try to make changes has been such an, a rewarding experience. Like I feel so grateful for the opportunity to be able to talk about this and to kind of be able to share kind of hope around what people can do.

And in that way, this is really been such an important and meaningful experience. And, you know, has really been such an important and meaningful experience. And what I would imagine is kind of part of the essence of a good life. Thank you. Absolutely. Hey, before you leave, if you love this episode, say that you'll also love the conversation we had with Light Watkins about finding calm wherever you are. You'll find a link to Light's episode in the show notes. And of course, if you haven't already done so, please go ahead and follow Good Life Project in your favorite listening app.

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all do it better together with more ease and more joy. Tell them to listen. Then even invite them to talk about what you've both discovered. Because when podcasts become conversations and conversations become action, that's how we all come alive together. Until next time, I'm Jonathan Fields, signing off for Good Life Project. The Apple Watch Series 10 is here. It has the biggest display ever. It's also the thinnest Apple Watch ever, making it even more comfortable on your wrist,

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