Ologies with Alie Ward - Somnology (SLEEP) Part 1 with W. Chris Winter

Episode Date: October 16, 2018

Birds do it. Bees do it. Why the hell can't we do it? Called "The Sleep Whisperer," neurologist and sleep specialist Dr. W. Chris Winter joins Alie for a thrilling 2-parter about why we need sleep, the ideal amount of it, what sleep does to the brain, insomnia, sleep stages, ideal bedtime conditions, and even the historical lore around sleep paralysis. Next week, we'll answer listener questions about everything from sleeping pills to brain performance to insomnia cures to apnea to sleepwalking to parenthood and shift work. Think of it as a free seminar to fix your life. Maybe.Dr. W. Chris Winter's sleep clinicDr. W. Chris Winter's bookFollow twitter.com/sportsleepdocBecome a patron of Ologies for as little as a buck a month: www.Patreon.com/ologiesOlogiesMerch.com has hats, shirts, pins, totes!Follow @Ologies on Twitter or InstagramFollow @AlieWard on Twitter or InstagramMore links at www.alieward.comSound editing by Steven Ray MorrisTheme song by Nick ThorburnSupport the show: http://Patreon.com/ologies

Oh hey, it's your little step-brother who tries to trade you their calcified banana flavor now and later for your mini Reese's Peanut Butter Cups and you're like, little dude, step all the way off. That's not how life works. Alleyboard. Back for another episode of Allergies. So this is coming out in October. So let's get deep into something that happens usually in the dead of night.

If you're lucky, sleep. You do it every day or night, probably, and it should be an exercise in comfort and restoration and flirting with death's hotter, friendlier twin. But just looking at the word sleep probably made your bells drop with dread because you know you're screwing it up a little bit. We kind of all are. So in the next two episodes, that's right. Part two with your questions comes out next week.

We are going to go head to head with the Sandman. But first, let's get ready for bed with a little business. First things first. Happy, happy birthday to my amazing mom, Nancy Ward, who's so funny and so smart and inspiring and accepts me even though I swear like filth on this podcast. She also gave me the best cure for insomnia. It has never failed me. We don't talk about it in part one of this sleep episode, so you're going to have to

wait until part two next week, but it is an actual lifesaver. I can't wait to tell you, happy birthday mom, me and my sisters and pop love you a bunch. So thank you also to the patrons at patreon.com for donating as little as one shiny American quarter in episode to help fund the show. And thank you to all who are sporting oligies' wares from oligiesmerch.com. And thanks to the people who post on Instagram and tweet about it. You can tell a friend, you can tell a foe. I don't care.

Scream into the night about it and rate and subscribe and review. That all helps get the show in others' ears. And very often, you make my day with your nice words in the reviews. So like a succubus, I pluck one every week to read from the bunch. And this week, TPaF says, 10 out of 10 would scream about sharks in my car again. They say, while I love so many different podcasts, none have the something for everybody enjoyability of oligies. I recommend this podcast to anybody and everybody.

As stated above, 10 out of 10 would look like a complete nut job, scream crying in laughter about sharks in my car again. So thank you. Please continue TPaF to do that. And thanks to everyone who left reviews that I savored individually over a cup of herbal tea this week. I just appreciate them so much. Okay.

Sumnology. Very much a thing. It's the study of how we sleep. And I looked up the etymology of it just after I wrote that intro and holy smokes, you guys. Somnus is the Roman god of sleep. And yes, the brother of death. I had no idea when I wrote that a few minutes ago. So there you go.

Also, Somnos, probably a remake of the Greek myth of Hypnos, who was the Greek god of sleep. Also the half brother of Thanatos, death. So Hypnos lived in a dark grotto in the underworld. What a bachelor. It was kind of a helper of humans. He was a good dude. His dad was darkness and his mother was nicks or night. And even Zeus was afraid of her.

Zeus was like, damn, lady, you're kind of a bitch, but I respect that. And so Somnology is the study of the god that comes in darkness to incapacitate and recharge us. And it seems to vex us more and more. So yes, we have cars and antibiotics. But when it comes to sleep, we're kind of boning ourselves, fam. So in this two-parter episode, I'm determined to help fix your sleep. And by your, I mean our.

I appall my own friends, physicians. I appall my own Fitbit with my poor sleep habits. And as a result, I sometimes forget which month it is. And I have eaten more stickers on produce than you need to know about. So you're going to learn the difference between deep sleep, light sleep, REM sleep, what aspects of sleep hygiene are important, the root of insomnia, how much sleep you really need, if you should go somewhere to get wires taped to your head while a stranger watches you, and how to help the molecular janitors that live in your skull.

This guest has been called the Sleep Whisperer and works with professional athletes and normies alike to perform better and to remedy their sleep issues. He has literally written the book on sleep. It's called The Sleep Solution, Why Your Sleep is Broken and How to Fix It. He's based in Virginia. He's the owner of the Charlottesville Neurology and Sleep Medicine Clinic. So we scheduled this interview months in advance for a time he was going to be in Southern California to give a talk.

We met up at a hotel and I barraged him with so many questions that he was held physically captive answering them for me for close to two hours. And I was like, yes, double episode. So get cozy. Wipe up your onesies and get ready for part one with the gently Southern voiced dulcimer wisdom of neurologist and somnologist, Dr. William Chris Winter. You are a neurologist, but you're also a somnologist. Correct.

Because you study sleep. Correct. Why sleep? For you. Because I read your book, which is great. Your book is, by the way, so funny. I was like, oh my God, this is keeping me up because it's so funny. Why and you mentioned the book that you like sleeping, you're a good sleeper.

So what drew you to this field if you have no problems in it? So what drew me to the field is just because I have a problem with it doesn't mean I don't love it. Number one. Okay. I came into the field completely accidentally. I decided around third grade that I would become a doctor and I'm pretty certain that there was a phenomenon going on.

My parents were both the first people in their families, I believe, to go to college on both sides. So Dr. Winter says that he didn't grow up in a family of academics, but that his Appalachian Mima and Papa supported big dreams for little whippersnappers. We go out and visit Grandma and Grandpa and the remote reaches of West Virginia. If you told them that you would be a doctor, they would give you a quarter and some candy. So I think from a very young age, I realized if I tell Papa that I'm going to be a doctor, he gets really excited.

He calls Mama and I get some candy and some money and this is awesome. So I think that that probably had a big role in shaping. So I went to be a doctor. I didn't really want to be a sleep doctor or neurologist, but I started doing research and sleep just to get beer money and biology credit hours as an undergraduate. So quick question. How much does this pay? According to one USA Today article I read, about 150 bucks a day is the going rate for

research studies, but there are accounts of folks making over three grand for a nine-day sleep study. But based on the fact that the article was titled, quote, How to Get Paid to Sleep, I'm guessing that the job competition might be stiff, like grueling, farting and unconscious, but stiff. A guy said here, they'll pay you to do some research and you can get some cool things for your med school resume. So it was just completely accidental, but the field is fun.

The people within it are inviting. It was a new field. So anything you sort of dreamt up dreamt up had never really been looked at before. At what point did you get to start doing research on humans? And what was your end goal? Did you want people to sleep better and thus be happier? What did you want to do as a neurologist? Sure.

So that was my undergraduate experience. From there I went to medical school down at Emory and was introduced to Don Blighwise and David Rye, who were sort of, they run the Sleep Center down there. Now, when I was an undergraduate, I was working at a sleep lab, was mainly pulmonary, looked at breathing. These gentlemen were more neurology oriented. So that was my first taste of neurology. I really thought that the brain was really cool.

So I would go to medical school during the day and then at night I would run these studies. One of them was, and so this is when I first started interacting with real human subjects, one was the idea of if you pull an all nighter and stay up all night, or if you have a night where your sleep is fragmented, like being on call or something of that nature, how was that? Sorry, I just dreamed it was my life. No, no, no. It's good.

Yeah, I'm sure it is. I've heard all about you. You've got a lot going on. So the question was, how is that affecting our brain's blood flow in the morning? So we would bring my, a lot of these were my friends, they were medical students who were looking for a little bit of money. And I would say, hey, you should come do the sleep study. So the sleep study consisted of three nights.

The first night you would sleep normally, the second night you would not sleep at all. The third night we would fragment your sleep. And the way we did that was we had these little C-3PO alarms that made this unbelievably grating sound. Oh my God, that is the worst. I'm so glad I looked this up. And we had them bolted underneath the subject's bed. And so my job was on the fragment, on the sleep deprivation night, I just had to make

sure they were doing whatever they wanted to do, they just couldn't sleep. On the fragmented night, I had to watch them and every time they would fall asleep, I would give them five, you know, five minutes and then we would start sounding the alarms. So they would get little five minute chunks of sleep throughout the entire night. And the funny thing was all my friends would make these big arrangements for the sleep deprivation night. But for the fragmented night, they're like, so I get to sleep, right? I'm like, yes, you do.

But as soon as you fall asleep, you'll sleep for a little while and we're going to wake you up, but you can go right back to sleep after that. They would make arrangements for that. They were a mess after those studies. One guy actually woke up and walked out of the sleep center with all the wires hooked to him and it was trying to get into his car. He had no idea what he was doing. Another person actually got up and went to the bathroom hooked up with everything.

It was just, they were absolutely hysterical. And what we found was it was much more dangerous from a blood flow perspective to have fragmented sleep than it was to actually just stay up. In fact, when you stayed up all night and never slept for the first few hours of the morning, your brain blood flow was really happening. It was really, so I think that's sort of the background. You pull an eye for a test the next day, you feel kind of euphoric for a while and then you crash.

So real quick, as if being a walking skeleton covered in raw hamburger isn't chilling enough, please take a moment to remember that the thought sponge nested in your skull is soaked in blood. So during some stages of sleep, the blood volume goes down, but in REM, it can be engorged with more blood than when you're awake. So yes, you're snoozing and your brain has a dream boner, unless some factor screws it up like a creep in a lab coat with a C-3PO alarm clock. But that fragmented night, and when you think about that in relation to people who are on

call or a new mother with a baby that's crying out throughout the night, it's a real risk factor potentially for things like stroke. So just not a healthy situation to be in. Oof. Do you have kids? I have three, yes. How did this affect you? Because it's not just new mothers, I imagine, like Papa's got to get up too, right?

Papa does. This Papa, I always felt so not helpful and somewhat inadequate during the whole situation that I would always get up, even when my first child, my daughter was born when I was a third year medical student, I would get up and just sit with my wife while she nursed because I felt like, okay, well, you go take care of this creation I put inside of you, and I'll be getting some sleep over here. So I felt really guilty by that, even though I would often kind of not off as we were talking. The guilt really started from the birth of my daughter.

At one point I fell asleep during labor, and my wife said, did you just fall asleep? I said, and this is what I said, I was so sleep deprived from being a medical student, I said something like, I just didn't know it was going to take this long. I just didn't know it was going to take this long. Oh no. Those are those words that leave your mouth and you're trying to grab them as they leave to shove back in your face. So I think that part of the guilt stemmed from that comment.

Oh, and I imagine also as a med student, I feel like there's no one who is more sleep deprived than a medical student. Like you have these insane long shifts and hours, and then it's like, okay, you haven't slept in 36 hours, fix this person so they don't die. Correct. So yes, we were very sleep deprived. It's not an accident that a lot of mistakes are made because of sleep deprivation in hospitals. At one point I was at a computer entering medications for a patient, and I got a call

on the phone right next to me, and I picked it up and this woman said, who is this? I said, this is Dr. Winter, who's this? She goes, this is Phyllis in the cafeteria. Why are you sending us medications through the cafeteria pathway? So I had somehow in my sleep deprived haze gotten into the completely wrong system on the computer, and instead of sending dietary orders to the cafeteria, was putting all their medications through there, which unfortunately didn't hurt anybody, but I had no idea what I was doing.

It was really bizarre. Scone, scone with Cialis in it, just like a poppy seed clonopin. That's right. Good for you. You're fine. These are great. I'm sure they sell well. These would sell really well, actually, I think.

Now, tell me a little bit about what is sleep? I mean, that's like the golden question, because it does seem crazy that for eight hours of the day we just kind of semi-die. It seems we're so vulnerable to predation. We just clock out. What is sleep exactly? I don't think people really know. There's all kinds of theories in terms of sleep being something important for energy

balance. There's a metabolic sort of pathway that sleep is very important for. We get some insight into the answer to that question. If we look at sleep deprivation models, where you take something, they used to put these little mice on these rotating platforms over water, and if they fell asleep, the platform would rotate and push them into the water, which he really didn't like. We found that after a very short period of time, there's a lot of brain dysregulation that starts to happen, particularly with the brain.

It's regulation of our cardiovascular system. Our body temperature gets really screwed up. We have difficulty fighting infection, and generally organisms die fairly quickly with sleep deprivation. I don't know that we necessarily know exactly what it is, but it's a very important thing for sort of re-establishing balance within our body throughout organ systems. Every organism does it. They do it differently.

Some fish that have to continue to always swim, they'll sleep one half their brain and then the other at other times, and really fascinating things like that. But it's this very preserved process that kind of allows us to sort of reset and go forward about our day. But to answer that definitively, I don't think anybody really can, which is shocking. It's something like you said so basic that we don't really know why we do it. We don't know. Is this true?

I fact-checked it, and yes, pretty much all legit scientific papers start with, even though how and why we sleep is a fucking mystery, for real. But we do know that there are different stages of sleep. So what happens in the different sleep stages? I just got a Fitbit to track my sleep because I'm very bad at sleep. I see you're wearing it. Yeah, I am. It's like you've made 200 steps this week.

The different stages of sleep were kind of elusive to me. Can you go through the different stages of sleep really quick and when they happen to you in night or the day? So it's easy to think about sleep in terms of three stages. There's light sleep, deep sleep, and dream sleep. So a lot of people think dream sleep and deep sleep are kind of the same thing. They're not. So very distinct.

So we spend about half of our night in light sleep. Half in light sleep is normal. That just blew me away. Light sleep is like the shoe that you wear most days. Like versatile, essential, not the fanciest, but you need it. And that's sort of the sleep that sort of moves us through all the different stages. So we're awake and we fall into light sleep and from there we might dream and then we'll go back to light sleep and then we might have deep sleep.

Back to light sleep and maybe wake up and go to the bathroom. So light sleep is not only the sort of the foundation of our sleep, but it's also the portal through which we move to the different stages. About 90 minutes after we fall asleep, if we're on a schedule and relatively well rested, we'll have dream or REM sleep. So REM sleep, rapid eye movement sleep and dream sleep are the same thing. So generally, at nine minutes after you fall asleep, you'll have your first dream. It's a very short dream, typically very fragile.

So if you're in an uncomfortable situation, a lot of anxiety in your life, you're sleeping in a bad hotel, you may drop that first cycle quite a bit. And then every hour to hour and a half, we'll have another cycle of dreaming usually lasts somewhere between 25 to 45 minutes and those get longer and longer as the night goes on. So light sleep starts as a stage called N1 as you're starting to drift off and you might have like a quick, funky dream that kind of like, oh shit, yay, I'm falling asleep. Nothing is real feeling. And then your brain waves slow down and then a little deeper light sleep is called N2

and your breath and your heart rate slow down. Almost half of your night is spent in N2, but it's not terribly restorative. Now what is with this N1 and N2? What are the ends? They're short for non REM sleep. So all stages of sleep that aren't REM are called non REM, which is like if you had four kids and you just named the best, most interesting one Jeremy and then all the rest were just like non Jeremy one, non Jeremy two, that one's non Jeremy three, like sure, they all

have their place in this family, your life wouldn't be the same without them, you know, but they're not as interesting as Jeremy. So think of light sleep as your day to day shoe, nothing fancy, but it works. Now another kind of shoe in your sleep closet, let's say the ug of the shoes is deep sleep. Now also called slow wave sleep or Delta sleep, or if we're being an asshole, N3, not REM three. This stage of deep sleep happens more at the beginning of the night. And during this deep sleep stage, our bodies repair and they heal themselves.

We release human growth hormone, which is dope for free, no shady prescription necessary. And the more of this deep sleep we get, those first few hours in bed, usually around 25% of the night, the more chipper and refreshed and not sleepy or groggy or crawling toward a triple espresso we feel. In the first three hours of our night is predominantly when we have deep sleep. So if you sort of track somebody through a typical night, hop into bed, should take you about 10 to 15 minutes to fall asleep. You go into sort of transitional or light sleep into deep sleep about nine minutes later,

you'll have your first little cycle of dreaming back to light sleep. Some more deep sleep, maybe a little bit less this time, a bit longer cycle of dreaming. So as the night goes on, we're having bigger, bigger cycles of dreaming, smaller cycles of deep sleep. So if you cut the night in half, and I often ask this question to patients, if you're having difficulty with your sleep, do you feel like the first half of your night's better or the second half? And depending on their answer, the first half is predominantly deep sleep.

The second half is predominantly REM sleep. So you can get a little bit of a sense of what might be going on with somebody's sleep. And in terms of the function of a deep sleep is what makes us feel rested. So if somebody's nodding off listening to your podcast. Ouch. Unless, of course, your dearest scooter churning out the sleep with me podcast, who is a one man human flock of sheep. If you're falling asleep at a stoplight or in church or wherever you like to fall asleep,

you know very quickly that person did not get enough deep sleep, either because they didn't get enough sleep or there's something inhibiting their deep sleep. And then REM sleep has a lot more to do with focus, concentration, mood, even pain perception. So it's a little bit more of a finesse sort of situation, which is probably why it's second in the night. Your brain really needs the deep sleep to make the motor go to find the food, to get through your day. The second half of the night is a little bit more detail oriented.

So if light sleep is like an everyday sneaker and deep sleep is a comfortable hug, REM sleep is like the shimmering dress shoe just full of dreams, increased breathing and heart rates, more blood in your brain, and our eyes are just like darting around like kittens under our eyelids. Now, REM sleep was discovered by a scientist only in the 1950s. Pretty recently, he was just watching children sleep. So that's a job. Just go to the office to watch baby's dream.

And he's like, hey, look at that. Maybe there's like a rapid eye movement stage of sleep. And they're like, well, boy, howdy hot dang there is. So in this state, our brain is as active as when we're awake. And REM sleep, they think, is supposed to help with memory and concentration and also mood. Now, if you're like, what's up with REM, the band? If that's confused you, you're not alone because up until about five minutes ago, I

wasn't sure if it was called REM or REM sleep. I had no idea and I would just never say it out loud. Just flipped to the dictionary, added periods between the letters and confused us all for decades. So the band is REM, the sleep is REM. This would not have happened if REM had stuck to their original name, which was Jars of Piss. That's a true story.

So the dress shoes takes care of memory and mood and it happens for about 25% of the night. Now the cushy, comfy UG, deep sleep or N3, also 25% of the night, repairs your bod and keeps you from feeling sleepy. So yes, that light sleep is the majority of the night at 50%, but what does it do? And then what is happening during light sleep? So light sleep is important. Again, like I said, it's sort of the foundation of sleep. There are a lot of processes going on, I don't want to use the word filler, but it's a lot

of sort of just the general rest of our body, our bodies being inactive for a period of time. Light sleep is for a lot of individuals who struggle with their sleep, they will misperceive light sleep as being wakefulness. And we all do that. I mean, my wife would sit down on the couch and put on property brothers got that show. It's the same episode every time. It's just no shocker here, you know, they're going to get thousands of dollars of worth

of renovation for like 600 bucks and I don't know what place they're living in. I'm kidding. I love property. They're good for you guys. This is just jealousy talking. Come out here. Get your pool. She sits down to watch, you know, property brothers, she'll fall asleep.

I'll grab the remote, I'll flip it over to the Dodgers game and after 20 minutes she'll wake up and say, why did you do that? I was watching that show and like, no, you weren't. You were sound asleep. She goes, I was not asleep. I know everything that's going on. Then she'll flip it back over to property brothers. Now it's new property brothers, new couple.

And she's so proud she will not admit the fact that that is not the couple you were looking at before. I thought the little rancher that they're renovating, we're all like the coastal, you know, whatever. So we all have that perception, but some people, particularly if they have a lot of anxiety, can really misperceive that 50% of our night as being wakefulness. So these are the people that often tell you, oh gosh, you know, if the last six weeks I've not been able to sleep, I can sleep an hour or two.

But when you look at them, they don't look particularly impaired. And that's a problem. We often refer to it as paradoxical insomnia. It's just not the problem that often they think they have. So with paradoxical insomnia, you're like, yo, I am up all night thinking about my props, doc. But it turns out you're actually asleep. You're just in light sleep that you think is wakefulness.

So it's a small percentage of insomnia patients, but it does happen. And insomnia itself is something that plagues a lot of people, most of whom don't fully understand it. And so when people come to you, are they usually having trouble sleeping? Is it mostly insomnia that you have to deal with? What's the big thing that brings people to you? So I think you're about to say it. It's really 50-50.

People who walk through our door, it's one of two things. Insomnia, or I can't sleep, is a huge problem. And then the flip side is the individual who sleeps too much. They're nodding off at work and getting in trouble. They can't stay awake during their college classes. They nodded off during an Aerosmith concert. I mean, name the situation. I said, I promise we've heard it.

I mean, I just told you I fell asleep during childbirth, my first daughter, you know, intercourse during your own wedding. Like there's really some interesting things that people fall asleep doing. There are entire Reddit threads devoted to this topic. If you need some tales about drowsy pilots or people waking up in Halloween coffins and bathtubs, now, your own uncle Allie has fallen asleep in her car in the driveway after pulling in on multiple occasions. I've fallen asleep on the bathroom floor with a toothbrush in my hand.

Somehow, I have fallen asleep face first in the laundry pile more than once. I once snoozed at a Gothic industrial club while skinny puppy was blasting. All while sober. Now, patron saint of podcasts, oligies editor Stephen Ray Morris, texted me while I was writing this to tell me that he fell asleep standing up once at Disneyland as an employee, which is the most Stephen Ray Morris story I have ever heard. Now it's all cute and fun until you get the bill. Sleep deprivation bumps up the risk of us screwing up and it has an economic wallop.

You ready for this? $50 billion yearly in the United States just from like sleepy, sleepy, oopsie daisies. Now as for car accidents, it's estimated that 6,000 people could die annually just because of drowsy driving. So staying on your couch when you're not up to party is literally saving lives, because trust me, even a skinny puppy soundtrack might not be enough to keep you alert. All good people are asleep and dreaming. So those are the sort of the flips, the too much sleep and the perception of not enough

sleep or the two main things that people are coming to see us about. When did our sleep start really getting screwed up? Has it been in the last century since we've had lights, since we've had jobs and factories? When did things start getting dysregulated? Because everyone always hears that study of farmers used to wake up in the middle of the night for three hours and then they'd piece out like, how are we supposed to be sleeping? So that's a great question. I think our sleep has always been screwed up.

I think the farmer that you're describing, he's got so much on his plate, he's tuberculosis everywhere and crop blight and money's bad. So I think that they just never really thought about their sleep. I think that as we've moved forward, two things have happened. One, we've put a lot of barriers in front of our sleep, including podcasts that you're like, gosh, I should stop now, but I'm going to listen to one more episode of this awesome podcast Allie's put together. And then I'll go to bed, you know.

Thanks, but you'll get that sleep on dad's orders. So we have this much more technology at our fingertips. I mean, if I could have communicated with my girlfriend in middle school on a computer while we were both in bed and I could have watched the movie Star Wars anytime I wanted to, I would not be talking to you today. There's no way I could have been. It just would be too much for me. So I think that people are trying to deal with a lot more distraction.

And then also, so the 24 hour culture really sort of gets in the way of us prioritizing our sleep. I think a lot of people want to do the right thing. They're just incapable of doing it because of all these barriers in front of us. So there was a study published just last year that had tracked the sleep of 94 people in Bolivia and Tanzania who were living hunter-gatherer lifestyles. They wanted to get a sense of pre-industrialization sleep habits and it turned out their average sleep was only 6.4 hours a night, but they were all in good health.

So they went to sleep about three hours after sunset and then they got up before dawn and they slept pretty well through the night. And as for insomnia, incredibly rare, so much so that they didn't even have a word for it in any of their languages. So how can this change your life? Now the researchers think that the sleep patterns have less to do with sunlight and more to do with temperature, which is tightly controlled in our houses. It does not match outdoor temperatures by design.

One article I read recommended sleeping in a room that was 60 to 73 degrees Fahrenheit, which could help you get more restorative sleep. It's more natural. So this is, I guess, just another reason to bundle up. Turn the heater down a skosh, maybe keep a window open. I mean, as a person who sleeps like shit and also turns hotel room thermostats up to 80 degrees, I feel personally called out. I feel attacked by myself.

And I know this is still, I feel like this is still such a basic question, but what is the big difference like in brainwaves or whatever, when we are awake and talking and functioning and like dodging things coming at our heads, then the difference between that when we are stone cold out. Yeah. Why does that sometimes happen in the, literally the blink of an eye? Sure. You know, it can happen in the blink of an eye generally because you've developed a drive

for sleep. So I always kind of compare sleep and hunger. If somebody says I'm hungry and I offer them, well, here, I've got a sandwich, I don't want you on it. And they're like, I don't want your sandwich. It'd be hard to sort of argue that they're that hungry. Yeah. If you're looking and notice somebody kind of looking at a trash can for something to

eat, they must be very driven to eat. So sleep is kind of like that. We can really enhance our drive to sleep. And one of the things I always tell people is that sleep always wins. I mean, if you push yourself hard enough and get yourself sleepy enough, it's not something that you really have a lot of control over. And you're right. It can happen in the blink of an eye when you're driving down the road, which is why

a lot of people come to our clinic after there's been some sort of car accident. I was driving back from the concert, I felt okay. And the next thing I know, I was in a median or I was in the oncoming lane of traffic. So sleep can sleep, sleep happens, we're not in danger of not sleeping. I think that for a lot of, when you look at sleep in terms of the wavelengths, like you're talking about, what's interesting is when you look at somebody's brain activity when they're awake, it looks very different from somebody who's in deep sleep, deep sleep. You can see the sort of the consciousness part of your brain taking a backseat to the

more primitive parts of the brain we share, like with an earthworm. So we have these big slow waves, which is why some people call deep sleep, slow wave sleep, consciousness is really suspended, your brain is really taking care of much more primitive aspects of itself. But when you look at REM sleep, it's almost impossible to discern the brain activity of somebody dreaming versus the brain activity of somebody who's awake. Really? Yeah.

Which is why it's really interesting when people say REM sleep or deep sleep, they could not be more different. In fact, one of the only ways you can tell that somebody's dreaming, if you're just looking at their brain, is to look at their muscle tone, because when we dream we're paralyzed. So it's obvious from looking at a videotape, oh, she's dreaming and she's awake. That's pretty obvious. But to purely look at the brain's activity, it's very difficult to discern. And not to mention there's eye movement.

So these very unusual, bold eye movements that happen when we're dreaming that we don't see when we're awake. But really that muscle tone is the biggest way we differentiate somebody electro-graphically as to whether or not they're sleeping or they're awake, which is fascinating. So when you dream, you're taking the test naked and it was a test you didn't know you were going to have. And your friend's like, we're going to take our test and you're enrolled in the class and my god, I didn't even know I was going to.

This is my recurring dream. You know, and you're sitting there taking a test or whatever, you're being chased by wolves or whatever you like to dream about. You actually can't move when those things are happening, nor can we really regulate our body temperature, which is kind of interesting too. Why can't we move? And what is sleep paralysis? So sleep paralysis has to do with that.

So technically, all of us are experiencing a quote unquote sleep paralysis when we dream. So what's happening is as we dream, our brain is sending this signal down our spine that paralyzes voluntary muscles, which is really interesting. Yeah. So you were talking about creepy sleep studies a minute ago. I love that. I use the word creepy all the time. It's such a good word.

It's also a bemused glance from your beloved, fine. But as an extended occupation, it's really only fitting for stalker vampire heartthrobs or someone in a lab coat with a clipboard. I like watching you sleep. It's kind of fascinating to me. The studies that you used to sort of discern dreaming in the past were that you come in, fall asleep, and we will walk around while you sleep and look at you. And if we see your eyes moving quickly underneath your eyelids, and you can find a friend, say

close your eyes, move your eyelids, eyeballs back and forth, you can see them moving under eyelids. At that point, they would wake somebody up and say, what's going on? And the person would wake up and say, oh my God, I was taking the test naked or whatever their thing was. So that's how they determined that, oh, wow, it looks like when these eyes are moving, your people are dreaming, but they realized very quickly that every other muscle pretty much was not, except for a tiny little muscle in the ear, there's a tiny little muscle in

the voice box, our diaphragm's work so we can breathe, and then our sphincter's work so we don't have to clean up the next day. But outside of that, everything voluntary is completely shut down. So sleep paralysis, what you're referring to is when people experience this, they experience a recovery of consciousness before that paralysis has a chance to go away. So what happens is you go to bed and usually it's happening during stressful times in your life. And when you wake up, you hear the alarm clock going off, but you're powerless to move to

turn it off. It can often feel like something's like on your chest, like sitting on you, it can be a terrifying experience, it usually only lasts about 30 seconds, a minute maybe, and then it passes. But for a lot of people who have those kind of fluctuating lifestyles and difficult schedules, they can feel it a lot. It is a classic sign of narcolepsies. If you get it a lot and you're excessively sleepy, it could be a sign of that.

And interestingly, predominantly in the Southern African American community, they often talk about something called the witch-riding you, which is awesome. I was just going to say, what if it's an invisible witch, but I didn't even know that was a thing. If you look at antiquity, and one of the cool things about sleep is this awesome intersection between science and mythology. If you look at sleep, there's this idea of the witch-riding you, so they would think that a witch was literally sitting on your chest when you slept at night, riding you. So I looked into this, and nearly every culture has a name for this nocturnal perpetrator

of sleep paralysis. In Scandinavian culture, it's a mare or a damned woman, and in Fiji, it's a demon. In Thailand, it's a ghost. In Britain, it's an old hag, and in Eastern Asia, it's a little breath-stealing mouse. Spain blames it on a cat, but officially, the Wikipedia for this is just titled, Casually Night Hag, which honestly sounds like the kind of down-to-earth, self-aware lady who'd be fun to drink margs with and go to the disco. Now as an Italian from Northern California, I'd never heard of this very common Southern

United States colloquialism about a witch riding your back, but I did do a little further research. Now according to one 2005 study, recurrent sleep paralysis was reported by 23% of African-American volunteers in the study, but only 6% of Caucasian volunteers, and it can be linked to panic disorder. So what causes panic disorder? The study states that significantly more early life stressors were reported by African-Americans than Caucasians, and it went on to say that higher levels of psychosocial stressors, including racism and acculturation, may contribute to the higher rates of sleep paralysis experienced

by African-Americans. So just another reminder that privilege is sneaky, and scientists are wonderful for turning over rocks and looking at the stuff because the solutions might not be right under our literal noses. And a couple of people have told me that the way you would keep the witch away is to keep a knife, a fork, and a spoon under your pillow, which is so cool. I love that kind of stuff. But even like, you know, incubus and succubus, when you read about these demons that would

kind of visit people during the night, their feelings of paralysis, or there's some really great Renaissance paintings of these demons sitting on top of people's chests, there's one called the nightmare, and that was the thought that this thing was sitting on you, which is why you felt the weight, but it was actually the paralysis of the muscles in between your ribs, making your rib cage less easy to expand when you breathe, so it felt like weight on you, which is really interesting. Is that what happened to you? I don't know.

I don't think so. If it did, it never really inspired any kind of fear, and I've certainly woken up and felt kind of incapacitated, but I don't know that I've ever had sleep paralysis. Yeah, it happened to me once, and it was horrifying. It was like, oh, I'm going to have sleep. When did it happen? When did it happen? It happened.

Oddly, I was on vacation, but I was on vacation with a boyfriend I broke up with shortly thereafter, so maybe it was stress. Maybe he's on your chest in a weird way. I don't know. He was a ghost boyfriend, but I remember just being like, oh, this is the thing that people talk about, but it just is so crazy because you feel like you're dead, but alive. You feel like a ghost. Absolutely.

So when we talk about sleep, one thing that's fun to think about is sleep is not a light switch. So we're not awake, and then the light switch goes off, and now we're asleep, like it's a state on off. It's really sleep as a mechanism in our brain, but then vigilance or wakefulness is too. So it's really two switches. So when you're awake and we're sitting here talking, our wake switch is turned on, our sleep switch is turned off, and when we sleep vice versa, now sleep paralysis is the wake

and the sleep switch being turned on at the same time. Oh my God. Isn't that cool? Are these switches kind of like, instead of binary switches, they're more like levers that go kind of go up and down like in a continuum? And they're affecting each other. So as the sleep switch gets turned on and we start to accumulate chemicals like adenosine, that is feeding back to make the other switch.

It's like the, I don't know if you've ever been like a water park, like an indoor water park often has this massive bucket in the middle of it that's constantly getting filled with water and every, you know, seven minutes it just dumps it on everybody. So that's kind of how sleep, you know, sleep and wakefulness, as we are awake and talking, we're accumulating chemicals that are making that sleep bucket wanting to tip over more and more, which is why we are a lot sleepier at 11 p.m. than maybe 11 a.m. And so what happens in sleep that is kind of like a janitorial system? Like I've read something about how with Alzheimer's and other brain diseases that your brain kind

of like rinses off plaques, perhaps. I don't know. Absolutely. What kind of things are we cleaning? And I'm also asking you this as a way to get myself to sleep more to scare myself because I know I've got like a grimy ass brain and I'm like, how can I clean this thing? That's great. So much to unpack there.

Sorry. Yes. When I was in medical school back in the late 90s, I remember the lecture on the lymphatic system with an L, lymphatic, which is the cleaning janitorial system of our body. It's getting rid of waste products, kind of flushing it out. And I remember our lecture saying, but interestingly, the brain doesn't have one. And then we went on to the next topic and I remember sitting there thinking, wait a minute, the most important organ of our body does not have this janitorial system.

So it turns out that he in science was wrong. This fantastic researcher in Maryland, she discovered it. And I'm blanking on her name right now, Nittergaard, I believe was her name. Danish neuroscientist Dr. Micken Nittergaard in 2013 for anyone who just wants to get a tattoo of a new science hero. And she discovered it. She said it's hard to find because the way we would prepare cadavers, you wouldn't see it.

So she not only discovered it, she named it the glimphatic system with a G and realized very quickly that not only is it pumping out waste products, but it's 10 times more active when we sleep at night than when we're awake. So we've always known, science is really good about knowing stuff. We just don't know why. So we've always known that people who didn't sleep particularly well often lent themselves to developing things like dementia and Alzheimer's disease. So now we've got this really interesting theory that if you are the shift worker, you're staying

up late playing video games at night, kind of abusing yourself, you're not allowing your body to engage this waste removal system effectively. So the question becomes, what waste product are we removing? We are removing a product called beta amyloid, which is exactly what you said, the constituent of plaque in Alzheimer's disease. So if you have a busy schedule, you don't value sleep. And it's interesting because I'm getting the sense from you reading about you and learning more about you is that you kind of look at people on a scale of the horrible insomnia

patient, can't sleep, tries like crazy, desperate for sleep, dreads going to bed at night. And then you've got sort of you, the alley, the neurosurgeon, which is the person who's like, you know, if I can get two hours of sleep, I'm pretty good. We want you to be in the middle, but we want you to find as you start getting into your 30s and 40s, that middle ground of just because I can do it, probably doesn't mean I should. So one major thing you can do to ease insomnia, you ready for this? Stop being afraid of it. Dr. Winter says that the main cause of insomnia is anxiety and fear.

You can see the Fiorology episode with Mary Poff and Roth for a one, two punch on dealing with that. She's incredible. I mean, also on the same token, if you think you can get away with four hours of sleep, go ahead and try getting more. Let your brains clean up, crew, get to work. Now what exactly, what other things are we cleaning out other than the plaques? Like what, how does that affect our memory and our motor coordination and like our ability

to think quickly by having a clean brain? Sure. Yeah. So all those things you mentioned are true. So and you can look at science in one of two ways. You look at the science that either deprived or restricted sleep, or you can look at sort of newer science where you force people to sleep longer and even just rest longer. But even within sleep medicine, my specialty is sleep and performance.

So I work with a lot of professional sports teams, not that I really care that much about athletes. I care about them. I care about everybody. I'm not sort of rabid athletic fan. But what I like about athletes, when you study it and you improve their sleep, we can immediately measure how well they're doing. So I've never seen the, the alley baseball card, you know, how's she doing, 2014 was

a good year for her. She, you know, she batted this, she ran this, she scored as many runs, you know. So we're all doing things that require performance, athletes, we just tend to measure it more. So when you actually get an individual to restrict their sleep, so we don't do a lot of sleep deprivation experiments anymore because they're kind of difficult and inhumane and frankly somewhat dangerous, but even if you just restrict sleep, those things to me are much more meaningful. I think most people believe that if you stay up all night, you don't work that well the

next day. But what if you got four or five hours of sleep for several days in a row? So I use a Fitbit and this was actually me all last week, averaged four hours a night for an entire week. I was so foggy that I confused my itinerary. I missed my first flight in 10 years and then I cried in an airport bathroom out of frustration at myself like a big, weepy, cranky baby. So does lack of sleep make me a weak person though?

Well, physically, yes. It's been shown that bench press drops by 20 to 30 pounds. We make three times more attention errors. We have a much more impaired ability to read the emotions and cues of others. You should do these experiments where you would hear, you know, the person would say something like, that's a great idea or that's a great idea. You know. Wow, this info is really helpful.

Our ability to kind of read cues to emotionally attach to other people becomes very impaired when we don't sleep. Now the flip side is what if you do sleep, what if you do spend more time in bed? What if you're forced to spend 10 hours in bed, no matter what, sleeping or resting and it shows that people run faster, they swim faster, they react to things quicker, their accuracy in terms of aspects of their life improve, they're happier, they have better ideas. It's just amazing.

They even lose weight. I mean, so the idea that difficulties in sleep is not affecting some part of your body is probably not true. Do you think that depression or anxiety are related to a lack of sleep? Like I know that depression, anxieties are problems that a lot of people face. It seems like more and more so many people are on antidepressants, anti-anxiety medications and also our sleep is kind of crappy. Side note, asking for myself.

Is there any correlation with that or is what does one cause the other? I think it works both ways. I think it's not. And most people who are struggling with depression, mood disturbance, anxiety will tell you things like, if I could just sleep, I would feel better. And now you set up this very vicious cycle of you're depressed, you're anxious, you're not sleeping well and that's going to feedback into making those depression anxiety worse and it makes you really not sleep well.

So there is a downward spiral that can be set up there too. But I also think that the relationship works oppositely. I think that individuals who are depressed and who have difficulty with mood disturbance, their disorder is creating a lot of sleep disturbances as well as the sleep disturbances helping to facilitate the disorder. I mean it's very unusual to find somebody who has significant insomnia who doesn't have some degree of anxiety. Insomnia theory would tell you that step one in terms of developing insomnia is you have

a predisposition to it. You're a type A, you've got a lot on your plate and type A is a good thing. I mean I want my surgeon who's got to take the tumor out of my brain to be very type A. I don't want the, oh well, we'll get to it when we get to it. I'm going to follow the dead this summer and hacky sack flip flop Jack Johnson. I don't want that person. I want the really kind of hyper focused type A attention to detail person managing my finances, doing my surgeries, what not.

So that type A tendency makes the world around, successful people have it. When they start to apply that type A to the insomnia, it becomes a real problem. So I think that individuals who are struggling with mood disturbance, I think it's important to understand and have an open mind to it working in both ways. Some people are, oh I don't have depression Dr. Winter, I'm not anxious, it's just my sleep is really messed up and they may be right, but I think it's also okay to sort of open yourself up to the idea that maybe this is also playing a cause that role in it too.

So there's a huge connection between those two things. So lack of sleep can make you anxious and depressed. According to one study, just skimping on your sleep excites your amygdala and your insular cortex. Those are the parts of the brain that fire up your fight or flight response, but anxiety and depression can also cause insomnia. So the primary cause of just blinking awake in bed according to Dr. Winter is anxiety. Now there are secondary causes like pain that doesn't allow you to fall asleep and those

have to be addressed as a pain issue rather than a sleep issue. But primarily insomnia is an anxiety issue. Now my personal issue with sleep, if we're going to get confessional, is I learned this recently, it's called sleep avoidance or sleep procrastination. This is when you're tired and you need to sleep, but you just keep delaying it, either watching movies or scrolling or working or reading. Now there are a few causes of this. One might be workaholism and not being able to admit that the day is done or it could

be loneliness and scrolling helps you feel connected to others. Also I do that. Or even a busy day tending to a lot of people can leave you needing alone time and staying up well past what is prudent is the only way for some people to get it. So hypnosis is like, yo, this is why I hang out in a cave in Hades, nobody books me. So what are better sleep habits? The CDC has some hot tips. Centers for Disease Control who apparently considers not sleeping enough kind of a disease

says be consistent, go to bed at the same time each night, including weekends if you can, make sure that your bedroom is quiet, dark and relaxing and at a comfortable temperature. We've learned colder is better. Who knew remove TVs, computers, smartphones from the bedroom. The CDC says to throw them into the simmering caldera of a volcano if you have one. Also avoid big meals and caffeine and booze before bedtime. We all kind of know that we're supposed to do those things. I'm trying to shift the way I'm thinking about sleep to thinking of it as a free thing

you can do to make your brain sharper and your skin glowier and your future less addled with disease. So if sleep hygiene were a thing you could buy and just not do, we would all be so pumped for it. We would Amazon prime this shit out of it, but really it's just a behavior. So we have to see value in the behavior. How much does sleep hygiene affect how much you actually sleep? When you have to prescribe sleep hygiene, what do you tell people to do?

Yeah. So what I would say about sleep hygiene is this. The media focuses a lot of attention on sleep hygiene because it's sort of a digestible little bite-sized nugget, hey, having trouble sleeping, make sure your room is this temperature and here's a study that shows that, great, moving on to the next topic or whatever. So sleep hygiene is great. I would say that in terms of its ability to solve a problem, 20%. So I would say of the people out there who are struggling with their sleep that 20% of

people if they did something related to sleep hygiene could make their problem much better or solve it. And what I mean by that too is also the idea that it's sort of like knee pain if you're a runner. My knee is starting to hurt. So what are you going to do? You'll take some ibuprofen. Maybe you'll buy a brace at CVS.

You'll ice it. You'll take a couple of days off. You're running. Well, you know, if you're doing all those things and still hearing this clicking sound and having this excruciating pain in your knee, eventually you're going to say, I don't know that this is within my ability to solve. You go see a specialist. They do an MRI.

You've got a big piece of cartilage sticking into your joint. So to me, that's sort of the sleep hygiene is we sort of have this message out there that every one of your sleep problems is solvable if you just get the right mattress and the right pajamas and the right noise machine and your earplugs and those are all fine. I just think that for the other 80% of people, it's very anxiety provoking that you've invested in the $5,000 mattress. You've got Tom Brady's special pajamas that he wears and my God, he's a quarterback married to a model.

So it's got to work. Without the sleepwear, I don't really feel like I would be able to achieve the things that I have done it. You know, and you got all this stuff going on and it's not working. I think that creates a lot of anxiety to like where I'm hopeless, like nothing work. I've read 20 different books, which is why I didn't put a lot of sleep hygiene in my book just because I thought, I think we all know these things now. It's kind of getting to the point of common knowledge.

You know, oh, what? Not having the TV on really loud all night long. That's not good. Okay. If you're surprised by that, where have you been? So anyway, so I think sleep hygiene is important. We want to set the stage for good sleep. We want to have positive thoughts about sleep.

Like sleep is great. I mean, we shouldn't be dreading it or fearing it. I think it's even strange to be kind of neutral about sleep. I mean, be neutral about brushing your teeth, but sleep, ah, it's the best thing in the world to get in bed and you know, whatnot. And so I think that we need to cultivate that attitude, but understand that it has its limitations. Now, how dark and quiet should your room be though? You know, again, I think that if you're struggling with your sleep, really dark and really quiet.

Um, you know, people ask about noise machines or things like that. I mean, we're always going to sleep better in a quiet environment. So, um, and our brains pay attention to sound. So if somebody says, well, I really like listening to a podcast when I go to bed at night, that's fine. You could set it. So after 15 minutes, it turns itself off. Dark rooms are really important.

My parents, I think I talked about this in the book, my parents like redid their basement when I was growing up. We had this like unfinished basement. They finished it themselves and kind of did it, you know, outside the, you know, the, the law, I think, you know, so one of the bedrooms, the bedroom down there has no way to get out. So it's like surrounded by earth on two sides and there's a door, but there's zero window. It is incredibly dark, incredibly quiet, incredibly cool.

And I remember going there like when I would come in for like college breaks and falling asleep in there and waking up at noon, you know, and being like, well, what time is it? And they're like, where have you been? You know, so even the smallest little bit of light coming in through a door or underneath a blind can really impair our sleep. So side note, we're going to get all into blue light and how it affects sleep in next week's part two. Also, stick around to this episode after the credits and I'm going to tell you an only a little bit gross secret about my eye mask.

Anyway, sleeping with the lights on, very confusing to your brain. So if you're a shift worker, you know, especially and you're sleeping a lot during the day, you want that room to be so dark that you cannot see your hand in front of your face. And quiet, maybe with earplugs and quiet. And if you can't do that, then, you know, like I said, earplugs or a mask over your eyes is probably just as good. And in your book, you mentioned it's OK to not sleep in the same room as a spouse or a partner. It is. I mean, I always I'm a doctor who practices in Virginia.

So I consider that the south and you got to be very careful about the way you speak to people. They always give you that look like you're trying to steal my wife. Like, you know, it's got to look like no. And it's, you know, so I have I think sleeping with somebody is fantastic. I do find it sort of strange that we have evolved to do that. Like, you know, I don't necessarily feel the urge to do other things. Like, let's sit in the same chair, honey, and eat this from the same plate. You know, it's OK to be like, you sit over there and eat your thing.

I'll eat over here. There's a lot of things we do separately. Oh, you do it over there. I'll do my thing over here. Even our bathrooms have two different sinks sometimes. You know, you know, so I do think it's funny that we've evolved to kind of create this thing that we need to sleep in the same bed. And maybe it was evolutionary that, you know, houses were small.

You were conserving heat or things of that nature like that. But, you know, I think that you can love somebody intensely and not be in the same bed with them or, you know, what I always tell people is some things that's a little bit more palatable for some couples is let's pick Thursday. Thursday will be the day we watch Handmaid's Tale, but then we sleep separately so we can consider what that means in terms of society, independent of one another. And over breakfast, we'll talk about the episode and how we feel about it. I was asleep before.

That's how we let it happen. You know, whatever. So so that way there's no guilt. It's like, oh, it's Thursday night. We're going to sleep separately. And it's kind of fun to get back together on Friday night, you know, kind of thing. So when I was on call as a doctor, I would always sleep in the basement in a guest bedroom that had a window, by the way. And I know my wife was secretly thrilled when I would not be there.

You know, you can stretch out and somebody's not moaning or pagers going off and whatnot. So I think it's OK. I mean, somebody says, look, I really like sleeping with my partner. I don't want to sleep away from him or her. That's perfectly fine. But I think it's also you are we are capable of loving somebody and not be in the same mattress. I think you do that. Save some marriages right there.

Yeah, we've got a sleepcation. I think my wife came with that word called a sleepcation. It's kind of exotic, like when they're up to tonight and, you know, and I always tell people, you can get in bed and read and maybe fool around. And then when it's time to sleep, you know, kind of do the thing like, well, I'm going to leave now. And it doesn't mean you don't love them or want to be with them. And my wife hates me being anywhere near her at night.

And for some reason, kind of gravitate over to her side of the bed and she's like, get away, you know, I just don't want that. And so I don't mean I don't think I don't think it means she doesn't love me. But, you know, I think that people just need to sleep and do what's right for their sleep and not necessarily have some, you know, guy breathing and hanging over top. You know, I think it's probably a good thing. And if you do this, side note, you're not alone. I read one study that said almost 14 percent of couples

who live together sleep apart, mostly because of snoring. And I read this one tip that said sleeping on your back can cause snoring and you can wear a t-shirt with a pocket backwards and put a tennis ball in the pocket to train you not to sleep in Shavasana corpse pose. Now, if it works or if you have Wimbledon nightmares, please let me know. Now, what about naps good or bad? I so my definition of so I think a nap is good if you're an efficient sleeper.

What I mean by that is if you're somebody who gets in bed, falls asleep in a time that's that's that's pleasing to you, you sleep relatively well. And then you still feel like you need sleep on top of that. I think a nap is a great thing. You know, if you can build it into your day at a designated time and have a little place where you can do it, that's kind of special. And I think that's great. I think it's a bad idea when somebody says I went to bed last night.

I was really upset about a decision on the voice and I can't believe they sent her home because she's so much better than that guy. Who's saying Doc of the Bay, for God's sakes. He got through seeing Doc of the Bay. I don't believe it. And she completely reworked that Christina or anyway, digressing. So you're really upset about that thing. And and you go to bed and it takes you three hours to fall asleep.

You know, you were up all night because of that. You can't believe the decision. And then you take a nap the next day because you couldn't sleep last night. Now, you had the opportunity to sleep. But for whatever reason, your brain decided it didn't want to. I think that's a dangerous path to go down. You see that a lot with retired people. And there's no kids in the house anymore.

I love old people. They can get up at three o'clock the more if they want to. They can go to bed six o'clock after MacNeil Lair if they want to. They can do whatever the hell they want to. They've earned it, for God's sakes. But the problem is when they have no sort of constraints on their sleep, if they have a bad night, when they just sleep in or take a massive four hour nap right before, you know, at five o'clock in the afternoon and now it's 11 o'clock.

They want to go to bed. They can't. Now they're frustrated. And so the cycle sort of begins. And so I think napping is great. Try to keep it relatively short 20, 25, 30 minutes closer to the beginning of the day. So we're adding on to last night, not subtracting from the upcoming night. And I think naps are great. I mean, there's such a such a wonderful thing to, you know,

kind of sleep at a time when you're not supposed to. And I think it's also interesting to pay attention to how you fall asleep when you nap, meaning I've got a lot of people who it takes them four hours to fall asleep at night and they feel completely dependent on sleeping pills. But they'll say things like I was, you know, sitting the other day. It's hard for me to, you know, I come up from church. I'm so exhausted. I take a nap and I was asking, well, what pill do you take to take your nap after church

and look at you like, oh, I don't take a pill then. Well, why do you think you're able to fall asleep after church, but you're not able to fall asleep 11 o'clock when you want to go to bed? And it's always interesting. The answers they give you, you know, because we think of nap as being this sort of extra credit. You know, a teacher gives you some problems and the last two problems on the test are extra credit. Well, I've got some time. I'll do it. No pressure and you to get those right.

Because it's like, if you get them great, if you don't, it's not that big a deal. It's extra credit. Naps sort of like our sleep extra credit. You know, it's bonus sleep. But boy, you know, the final exam is our sleep at night. We got to sleep now. Like we want to kind of get out of that place. So that's not a good place. So the anxiety of sleeping doesn't let you sleep.

Doesn't let you sleep. And so we don't want to, we don't want nap to facilitate the process. So to recap, naps are fine, but not if they mess up your bedtime. So do it earlier or just save that sleepiness for sweet, sweet night slumber. Now, if sleep is an issue for you or for someone in your life, maybe take like a nerdy approach first and just gather some data. And so what is the best way to track it? Because knowledge of your sleep will probably

motivate you to get better sleep. Are Fitbit trackers good? Should you wear like a headband with electronics on it? Should you just try to keep a journal next to your bed? And like, what's the best way to figure out if you're getting enough? So all those things are good. I think the person, the best way to figure out if you're getting enough sleep is to look up either in my book or online, something called the Epworth sleeping scale.

So I was hoping that this quick test was named for like a Lord Epworth, the Duke of Naps, who fell asleep playing croquet. But it was actually coined by an Australian, Dr. Murray Johns for the hospital that he works at. OK, a little bit of a snooze bust on that backstory. Anyway, you can take it at epworthsleepinessscale.com. I myself scored an 11 mild, excessive daytime sleepiness. Now, Dr.

Winter explains what this scale is and which is a series of scenarios that you might find yourself in. And the question is how likely would you fall asleep if you were in that situation? How likely would it be for you to fall asleep reading a book, watching television, and passing it in a car for an hour? If you're answering the question all the time, always fall asleep, can't read because I fall asleep as soon as I start reading, I really can't sit down the evening or I'll fall asleep.

That's probably a good indication that you're not getting enough sleep. There's something wrong with it. So I think all those modalities that you mentioned, sleep diaries, fitbit tracker, I'm wearing one that's made by Nokia, which I think is outstanding because it uses movement and some heart rate variability. All those things are great. You just need to understand sort of what they're built to do and what they're not built to do.

But they're a great way. All these things do such a good job of keeping us honest about our sleep. I mean, I would go around and tell people I get seven hours of sleep at night, go to bed at 11 o'clock, get up around six, which is such a lie. Like when I started wearing these, wore several trackers on my arm for a month to see which ones were good and not so good. And then I did a sleep study of myself on the last night, wearing all of them to see how they compared to the actual sleep study.

And the thing I learned the most about that process was what a liar I was about my own sleep, you know, and not even knowing that I'm not deceiving people intentionally. It's just that, yes, ideally, I would like to go to bed 11 to get up at six. But my son swims, he's got to get driven to the pool early. Or Stephen Colbert looks really funny. So I'm watching some of his monologue. And by the time you get the dog put away and I get some water and kind of get things turned lights off for my wife who's falling asleep on the couch.

Check on the kids. Oh, God, check one more email and see what's going on here. It's closer to midnight or even later sometimes. So I think those things do a very nice job of kind of keeping us honest about how much sleep are we really getting? And I think that can be a very valuable first step in terms of solving a problem. But I do think that there's a lot of questions you can, you know, do you sleep well at home versus at your girlfriend's place? Do you sleep better after a bunch of beers?

Because you feel like you do versus when you don't drink. And I think, you know, posing a question to something like a Fitbit can be really interesting. I'm really on an exercise kick. Let me look how my sleep looks now versus a few weeks ago before I started. Oh, wow, it looks a lot more efficient. Or I seem to have more deep sleep or I fall asleep a lot faster. Generally, they work best when you're comparing data to itself, like your own data, pre this guy I'm dating, post this guy I'm dating.

Pre this supplement I'm taking post. That's where it tends to work its best, I think. And if in general, if someone's saying, I'm having trouble sleeping, I'm having trouble falling asleep, I'm having trouble getting the right amount of sleep. Is there like a one basic piece of advice that you're like, start here and see if that helps? Yeah, it's interesting. I think if somebody says to me, I'm having trouble sleeping. They've already sort of moved past the biggest barrier,

which is the person who comes to me and says, I can't sleep. Dr. Winter says that a lot of times we're getting a little more sleep than we think we are, because if you literally did not sleep, you would not be alive. Wait, what's the record? I mean, the world record is something like 11 days. And even that was a sham. The investigator said we couldn't keep him awake. He kept having these little micro sleeps, even when he was standing on his feet. So provided that we're not seeking the world's attention by not sleeping,

how much should we sleep? A lot of people are seeking 10 hours of sleep at night, but they're only capable of getting six hours and 45 minutes. So that difference of three hours and 15 minutes, I think, is insomnia. It's also important to make sure that there aren't things that are happening within your body that are impairing your ability to sleep as well, too. That can be something from insomnia to restless leg syndrome to sleep apnea. There's a lot of things that happen at night that can impair our ability to sleep.

And how necessary is a sleep study usually? Is it like, go figure out what it is? I mean, I really work hard to keep people out of a sleep center. I think most, you know, we learn as doctors, most of the diagnosing and treatment of problems has to do with the clinical interview. So that's why we spend a lot of time talking to our patients because we need to understand what the problem is. You know, the sleep study is often confirmatory.

Like I already think this is what's going on. We'll do sleep study to confirm it. Or sadly, in 2018, a lot of times the study is done because that's the only way you can get insurance to pay for something. They won't take the expert's word for it. They want proof that this person has narcolepsy. They want proof this person has restless leg syndrome, even though clearly from their story, that's exactly what's going on.

So not everybody who has a sleep problem needs a sleep study. And of the people who need sleep studies, many of them can be done in your own home with these little simple devices. So don't let that be a stopper in terms of getting help. But, you know, when they're necessary, they can be incredibly helpful. So sleep studies can be a great ally in terms of convincing doctors that you do indeed have a serious issue. They can also be a little bit like Mr. Snuffleopagus.

And if insomnia is caused by anxiety in your life, taking a break and sleeping in a hotel room like environment can be just the vacation you need from your usual mental anguish. Even if you have a bouquet of wires taped to your face. So if you want to start small, you can jot down the hours you sleep, of course, or you can try a sleep tracker. I bought my Fitbit at Bed Bath Beyond with one of those 20% off coupons that my neighbor left near the mailboxes for a week.

And it's been a nice gaze into the underworld of my sleep issues. Now tune in next week for part two, which features more remedies to your sleep issues. Patrons wrote in with over 200 questions. We got to as many as we could. We covered sleeping pills, supplements, genetic factors in sleep, blue light, making good habits, stick, alcohol to get you drowsy, sleepwalking, sleep talking, the best positions for snoozing. And of course, my mom, birthday girl, Nancy Ward's magic cure for insomnia

that I use all the time when I've had too much caffeine or at 7 p.m. But I have to go to sleep to get out for the airport. So all of that is next week. So make sure to come back. The extra hour or so for part two could add years back onto your life. Now, meanwhile, Dr. Chris Winter is at Sports Sleep Doc on Twitter, and his book is called The Sleep Solution, Why Your Sleep Is Broken

and How to Fix It. Now, you can follow oligies at oligies on Twitter and Instagram. I'm Ali Ward with 1L on Twitter and Instagram too. I'm also the host of Did I Mention Invention, which is on every Saturday morning on the CW. It just premiered last week, so I'm still pretty squealy about it, and I thought I would let you know. You can get a comfy oligies t-shirt to sleep in at oligiesmerge.com.

Thank you, Shannon Feltas and Bonnie Judge, for so many great designs that are up. You can join the oligies podcast Facebook group, which is just a haven for benevolent and curious nerds on Facebook. I love each and every one of you in there. Thank you, Erin Talbert and Hannah Lippo for admitting. Thank you to editor Stephen Ray Morris for Losing Sleep. Piecing this all together each week. He's also responsible for a little Easter eggs at the end of the show.

He surprises me each week. It's just delightful. He hosts the podcast See Jurassic Right about dinos and the percast about cats. And they are also great. Nick Thorburn of the band Islands wrote and performed the theme music. And now at the end of each episode, I tell you a secret. And this is part life hack and part you. But OK, so sleep masks always annoy me.

They fall off, the Velcro gets stuck in my buffalo hair. And so a few years ago, I started using a sock. You take a knee high sock. Mine have all been worn on my feet before. I just don't care. I washed them. Anyway, take a knee high and you pin it in a big loop like a snake eating its butt. Put a safety pin in it and then you pop that thing on your head and it stays all night. It is weird if you begin dating someone and you're like, good night.

I'm putting this old sock on my face now. So if you're crafty, you could probably artfully sew it together. If you don't have knee socks, invest in a pair. Wear them on your face. Bonus, if you lose one, you have a spare and they're very machine washable. So if you do this, please take a photo for me and tag it. Hashtag, ology sock face. I promise to post one also.

OK, just go get some sleep. Just go get some sleep. You have earned it. Bye bye. Lethargy, technology. Meteorology, technology. Nephrology, serology. Cellulogy.