The Checkup with Doctor Mike - What Your Bedtime Says About You with Professor Matt Walker

Episode Date: November 16, 2022

Professor Matthew Walker is a Professor of Neuroscience and Psychology at the University of California, Berkeley, USA. He is also the founder and director of the Center for Human Sleep Science. If you've got sleep questions, he's your guy. We talked about chronotypes, or the category of sleeper you may fall into. It turns out, whether you're an early riser or a night owl might not actually be your "fault", and in fact it may have been something you were born with. Don't forget to leave a 5 star review with a medical question in the body of it and I'll try to answer it in a future episode! Buy Professor Walker's book, "Why We Sleep" here: https://www.simonandschuster.com/books/Why-We-Sleep/Matthew-Walker/9781501144325 Follow Professor Walker here: Podcast: https://themattwalkerpodcast.buzzsprout.com/ Twitter: https://mobile.twitter.com/sleepdiplomat Instagram: https://www.instagram.com/drmattwalker/ Linked In: https://www.linkedin.com/in/sleepdiplomat/ Why We Sleep: https://www.amazon.com/dp/1501144316 Executive Producer and Host: Dr. Mike Varshavski Produced by Dan Owens and Sam Bowers Art by Caroline Weigum CONTACT: [e-mail]

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So many of my patients and honestly myself included struggle with getting good quality sleep. In fact, I would venture to say below back pain, the number one complaint that I get is about insomnia. So today I have a very special guest, Matthew Walker, PhD, a professor of neurology and psychology at UC Berkeley. He actually runs the center for human sleep science. On Twitter, his username is sleep diplomat. He has a podcast about sleep, but it's actually really exciting because a lot of the facts that he teaches

in his books and his podcasts all center around why we sleep. In fact, that's the name of his best-selling book that pointed me to his work and got me really excited for this conversation. We talk about the different types of sleepers that exist, including early birds, night owls, the differences between the two,

how society judges one versus the other. He gives legitimate sleep tips that actually work and are backed by some, science, and we talk about this evolving field of sleep supplementation and sleep biohacking. I think you're really going to enjoy this conversation, and you probably won't fall asleep during it, but you definitely will the night after. That's not a doctor point. That's a silly point.

Let's get started. What is sleep, and how did we, I guess, evolve to sleep? Sleep, I mean, well, actually, I'll take the second part first because it's fascinating. When you think of sleep from an evolutionary perspective, it is the most idiot. of all human behaviors. Because, you know, when we're asleep, we're not foraging for food, we're not finding a mate, we're not reproducing, we're not caring for our young, and worst of all, we're vulnerable to predation.

And so on any one of those grounds, but especially all of them collected together, sleep should have been strongly selected against in the course of evolution. However, what we've realized is that in every species that we've carefully studied to date, sleep is present, even very old, ancient evolutionary species. What this means is that sleep evolved with life itself on this planet and then has fought its way through heroically every step along the evolutionary path. And if that's true, it must mean that sleep serves an absolutely vital, function. Indeed, it's once been said that if sleep doesn't serve an incredibly vital set of

functions, then it is the biggest mistake the evolutionary process ever made. And now with 50 years of really great scientific research, we realized Mother Nature did not make a spectacular blunder in creating this thing called sleep to begin with. In terms of what sleep is, it's a very good question and an astute one because most of us, and I would think this if I were not a sleep scientist, when we go to bed, we lose consciousness and we think that our mind is dormant and our body gets some rest and that's really it. We wake up in the morning. So surely I can short change on some of this. Is it really that important? Well, that simplicity belies an incredible complexity because sleep in human beings is broadly separated into two main types. We have non-rapid eye movement sleep or non-REM sleep

and we have rapid eye movement sleep or REM sleep also thought of as dream sleep, which is the principal stage when we dream. And non-REM sleep has been further divided into four different stages, stages one through four because we're a creative bunch as a sleep researchers in terms of naming. One and two non-REM sleep, that's sort of light non-REM sleep. Three and four, that's deep non-REM sleep. And your brain goes on this incredible rollercoaster ride throughout the night. And so when you might go to bed tonight, you'll go firstly into the light stage of non-REM sleep, then the deeper stages, and then you'll stay there for a while.

And after about 50 or 60 minutes, you'll start to rise back up and then you'll have a short REM sleep period, a dream sleep period. And then back down you go again, down into non-REM. and up into REM. And that cycle of non-REM to REM plays out in about 90 minutes, at least in us human beings, it's different for different species. But what changes is the ratio of non-REM to REM within those 90-minute cycles as you move across the night.

And what I mean is that in the first half of the night, the majority of those 90-minute cycles are comprised of lots of deep non-REM sleep and very little dream sleep. But as you push through to the second half of the night, now that balance shifts over and you have much more rapid eye, much more dream sleep, REM sleep, and very little deep sleep. And the reason I bring that up is because many of us will feel, you know, the pressure of modernity. And modernity is desperately designed against sleep in lots of. of different ways, both through its stigmatization of sleep as lazy and also work schedules. But what that means is that most of us, if we're going to cut our sleep short, it's in those

early morning hours. We're waking up early to get a jumpstart on the day. So you may be losing, let's say, you know, 10 or 20 percent of your total sleep by doing that. But because REM sleep comes in the last few hours of the night, you may be losing 40, 50, 60. percent of all of your dream sleep. And as we'll probably discuss, dream sleep is critical for things like learning memory, your emotional health. REM sleep is the time when we all, both men and women, release our peak levels of testosterone. It's critical for our what we call endocrine health or our hormonal health. So I just want to paint the sort of the picture of both the beauty and the complexity of sleep. And then finally note, by the way, that

there is no one stage of sleep that's more important. Lots of people will say, how do I get more deep sleep or how do I get more dream sleep? And I can understand that natural urge. It turns out that what we've learned is different stages of sleep perform different functions for your brain and for your body at different times of night. They're all necessary. Otherwise, Mother Nature would have removed anything that was unnecessary long ago. Do you see outliers in people who experience these stages of sleep differently, either with shorter intervals, one versus the other, or perhaps not being accustomed to the 90-minute typical interval of the entire stage?

It's such a great question. You need to be a sleep research or do a sabbatical for a year. It's a great question, which is about what we call the variability. So you and I will probably be discussing the typical averages for the average adult. But around that sweet spot of the average, there's a huge amount of variability when it comes to sleep. The first is in terms of sleep need. And, you know, people like myself have probably been on record saying, you know, you need, you know, this sort of this on average, eight-hour sweet spot. And it seems to be on average about that. But the recommended range is somewhere between seven to nine hours of sleep. That's two hours of variability.

Some people can function perfectly well on seven hours. 15 minutes. Others can't. They need at least nine hours to function well. So there's variability in terms of total time of sleep. There's also variability in terms of the different stages of sleep. We know that genetically there is some predilection to you being a more powerful deep sleeper. So you'll have sort of the reason that we call it deep sleep in part is because the electrical brainwave as you go into deep non-REM sleep, stages three and four, all of a sudden, you get these huge, big, powerful, deep, slow brain waves. And depending on your genetic composition

and what you've been doing during the day and also your age, the size of those deep, slow brain waves is different. So there's variability there, too. There's variability in how much REM sleep that people will get. So it's a very good point. And the final aspect is there is variability in that 90-minute cycle. That's the average. Some people will have a sleep cycle consistently of maybe just 75 minutes, others all the

way up to, let's say, 105 minutes. So there is variability in that cycle. I know that some people would hear that, and then they've tried to architect their sleep so that they wake up with this metronome-like quality to say, okay, so when I fall asleep, then if I pattern out those 90-minute cycles at 7.35 in the morning, that's the time when I'm ending my last cycle. I should wait. It's not like that at all. There's variability. Yeah, like that biohacking hyper-optimization is very tough to achieve, if not impossible. In not just sleep, I would say in the majority of sciences, whether you're talking about nutrition,

diet, mental health. There's no such thing as perfect anything, really. Because anytime you strive for perfect, If you create a whole set of other problems, you probably didn't expect. Would you say that's the same for sleep about biohacking sleep? Yeah, very much so. And I really embrace what you're saying there about, you know, just biohacking in general. For me, biohacking, I still, you know, I think it's interesting and I think it's good for us to explore with technology, pharmacology. What aspects can we bend in terms of some of the rules? I doubt that there's anything that we can break in terms of the rules.

But what I also realize, too, is that it's probably hubris for us to think that within the short term of a lifespan, that we could create something better in terms of a sleep need and a sleep schedule than something that Mother Nature took more than 3.6 million years to evolve. And when you fight your biology, you know, let's say that you're trying to optimize your sleep in these ultra-short cycles. It's sometimes called the Uber Man cycle where you're sort of going in these 45-minute stretches, then you're awake for 90 or lots of variants of that. What we found is the evidence there is very clear. That type of sleeping is associated with poor mental health outcomes and poor physical health outcomes. So, you know, sleeping like a baby when you're adults is. a bad idea. That's what the Oman's schedule in some ways is. But overall, I think when you fight biology and the natural tendencies of how we've been designed, which you could argue

biohacking is a little bit of, you normally lose. And the way you know you've lost is disease, sickness, and ill health. So I try to stay away from it as much as possible for myself. We need to put that as a banner for the Silicon Valley folks that consistently pitched their Yeah, well, living here in Berkeley and not too far. And I have many different feet in those different worlds of technology with sleep, of course. So it's something I work on a lot and I think about a lot and work with companies and have some startups of my own that are trying to think about those ways. But always with this deep reverence, this incredible respect for the process of how we've evolved and not wanting to move. forward with that arrogance.

Absolutely. That's such a smart approach to it. Actually, refreshing to hear because a lot of times when you have experts in a given subject, they're quick to want to change everything or find that shortcut. So it's nice to see the approach from the other side of the spectrum. You know, we talked about the differences in the deep sleep, the REM sleep, the intervals. is there also differences by individuals who prefer morning, night, and then maybe as well in terms of not just the hours of sleep,

but the time of the day in which you sleep? Yes, there is. And that's a really important second feature of sleep, which is that it's not just about the quantity of sleep that you get in terms of hours. And also another important feature is quality of sleep, which we can come back to. But one thing that many of us forget is the timing of our sleep. And this comes back to a concept biologically well defined called your chronotype.

So are you a morning type, evening type, or somewhere in between? And depending on the data, it's about a third, third split across the population. I should probably note that before I move any further, less than anyone think that I'm biased, in what I'm about to say. I am, unfortunately, just like the rest of my pedantry in terms of personality. I'm desperately boring. I am completely vanilla. I'm a neutral.

I'm sort of like an 11 to 7 kind of guy. But your chronotype as to when you want to go to bed and wake up, it's not your fault. And it's not your choice. Because it turns out that it's genetically determined. and we now know that there are at least nine different genes that will dictate your morningness versus eveningness preference in terms of being a sleeper, what we call are you a night owl or are you a morning lark?

And it's gifted to you at birth, it's hardwired, and it's very difficult to change. And the reason this is important from a practical perspective for people to know, And by the way, if you want to know truly what type you are, you can go online and you can search for something called the M.E.Q. Or you can type it out, which stands for the morningness, eveningness questionnaire for chronotype. And it takes about three or four minutes, really easy. And you get your type. You can also do it in a quick fashion. You can just say, look, you know, if you or I were on a desert island, nothing to wake up for. We had, we could go to bed whenever we really want. to and whenever we really desired to wake up rather than when society forces us to go to bed and wake up, what time would that be? And for most people, that time as to when they would like to go to bed and like to wake up is very different than what time they actually are currently trying to go to bed and trying to wake up, which suggests that modernity has inserted

a wedge of a mismatch in terms of our sleep timing based on our chronotype, because society is desperately geared towards and biased towards morning types. You know, it's this, the early bird catches the worm. Those are the people that are praised. That leaves out in the cold and chastised wrongly so, as if it's their choice, the evening types. And the early bird may catch the worm, but I would also say that the second mouse gets the cheese. And so, you know, there's lots of ways that we should be much more kind to ourselves and others in society regarding evening types. The practical part of it comes to people that I'll see at my sleep center here who will

say, look, I am, I just have terrible insomnia. I have difficulty falling asleep. I go to bed and I'm just wide awake for the first hour. I just cannot fall asleep. And then I'll ask them a little bit more about that chronotype. And it turns out that there's someone who, at the weekend, finally, they would normally be going to bed about midnight, 1 a.m. But during the week, because of their schedule, of course,

and understandably so, they're forcing themselves to get into bed at 10 p.m., which is a two to three hour difference relative to your natural chronotype. So no wonder, your biology is not even yet ready to try and help you fall asleep, but you're sitting there in bed, just wishing it to happen. And you can't wish for sleep to happen and make it. It's not like a light switch in that sense. And so it masquerades almost like what we call a form of sleep onset insomnia.

There's also something called sleep maintenance insomnia. So do you have difficulties falling asleep or difficulties staying asleep? And they're not mutually exclusive, by the way. But people with a chronotype who are a night owl, they can sometimes have that challenge. They're in bed too early and they can't fall asleep. That's probably one of the most important points to discuss today because as a primary care physician, obviously insomnia, whether it's the start of sleep or disrupted sleep, not being able to fall asleep afterwards upon waking in the middle of the night, it's easy for me as a physician to either look just to lifestyle changes, talk about sleep hygiene, discuss caffeine usage, alcohol usage, things that would impact sleep from my training level. and maybe even mental health. That would be a step further that I go

that most physicians probably don't even get to in their 15-minute visits, unfortunately, in our current health care system. But should we be as physicians thinking about chronotype more? I think we should certainly be asking that as part of the equation and being sensitive to that

in terms of understanding it. It turns out that there's a whole field of chronobiology and chronology and chrono-pharmacology, because as we've now started to understand, drugs can have different potencies of effect on the basis of different times during the 24-hour cycle. And there may be more or less potent times for you to provide that medication. You know, sometimes for hypertensive medications, there's some evidence that time of day is important. There's a big field demonstrating that cancer a medication can have a chronotype dependency non-trivial in terms of its efficacy.

So I think that that's important. I also, you know, I love the way that you think about not just going to sleep hygiene, which is critical and being mindful of alcohol, which is no friend of sleep and caffeine, equally so. And then moving to mental health, because what we know is that perhaps one of the biggest common central pathways through which your body instigates this thing called insomnia is having an overactive fight or flight stress system within the body, which is part of the automatic nervous system. It's called the sympathetic nervous system. It's anything but

sympathetic. It's very agitating, aggravating. It's the fight or flight branch, together with something called the HBA axis, which is part of your hormonal axis, particularly regarding a hormone called cortisol, which is a stress-related hormone. And when those things are switched on, which sort of high levels of anxiety, worry and stress will very much do, sleep is almost impossible. And it results in people, the phenomenon that I would describe as tired but wired, where they are so desperately tired, but they're just so, from a mental health perspective, to your point. They're just so wired that they can't fall asleep. And until you actually target the treatment of the mental health component, it's going to be very difficult to, I mean, one could just

simply offer, you know, sedative sleep agents to try and knock the cortex out. But we know that there are increasingly better ways. And I think one of the things that physicians have maybe started doing is becoming aware of the current recommended alternative to sleeping pills, which is something called cognitive behavioral therapy for insomnia or CBTI for short. And I would say that for any sleep, sorry, for any general physician, any GP who is facing a patient who is saying that they are struggling with sleep, trying to at first direct them towards cognitive behavioral therapy for insomnia and trying to find a provider for that. I know it's a difficult. It turns out if you look at the number of people who can provide it, there is a mismatch

between demand and supply. It's not enough supply for the demand. Nevertheless, being aware of cognitive behavioral therapy for insomnia is critical. There are now some apps that you can use as well to help with that, to make it more convenient. That's the only thing I would add to that equation. Yeah, absolutely. I'm a big proponent of CBT. I even have been able to institute some introductory I wouldn't say they're introductory sessions, but maybe basic understandings that I can pass along to my patients until they're able to see a mental health provider about what's meeting is, how it works, where we work on thoughts as opposed to feelings. Because in reality, the mind-body connection is so much connected that we give it credit for

that patients oftentimes are ready to get a physical diagnosis and are really. really surprised or even shocked when everything comes up normal, the imaging, the lab tests, and it's only until we get to their mental health, do we figure out that's where the problem is at least beginning and then showing itself? So sleep is definitely one of this. I mean, that's so powerful, you know, to think that a physician in this day and age, and I know I'm not pointing any fingers, the job that you have is so immensely difficult within these compressed zip file time periods, you're supposed to go through this complex biological organism in front of you, quickly make a diagnosis, understand the treatment path outcome, prescribe and get a, you know,

so that someone like you is being already able to think about cognitive behavioral therapy and then give the stepping stone components to help them on their journey as they start to seek out that further. I mean, how much better would the world be? You know, if that was more common practice, I can't imagine. I think it would improve health outcomes significantly. That's why I'm a big proponent of increasing funding for primary care. Because, like, the struggle that a lot of physicians have is those 15-minute visits with patients that are unknown to them, that they don't have a history with, like,

the urgent care model, where a patient comes in to see a doctor they've never seen before, and somehow in 15 minutes this physician's supposed to create a rapport with this patient, learn about their condition, their symptoms, potentially connected to some sort of cause, create the treatment, make sure that the patient understands the treatment, that they can afford the treatment, they have access to the treatment,

and then document that entire interaction in 15 minutes, on what planet? And then make sure the insurance approves that treatment. Right, right. You know, what are we doing if our goal is to try to care for other human beings in the most medically sound way possible. So you are, I mean, heroes to keep doing that.

And thank you for what you do. Thank you. I appreciate you saying that. For the patients that are struggling with falling asleep, that potentially could be a different chronotype, is there something I should be recommending to those patients about changing maybe their job, maybe the times at which they sleep?

Is that as far as I should be going? with this? Or should I be looking for a pharmaceutical approach for those patients? What's your recommendation there? Usually, and again, I'm not a medical doctor. I'm not an MD. But I think that certainly the idea of moving to medication for that situation could be a few steps further down the path before the earlier low-hanging fruits are accomplished. One would be to see, you know, how can we try to just move your schedule, even just a little bit. And now post-pandemic, schedules are never more flexible. People have incredible control or much more astute control over their own schedule.

And so trying to see if you can prioritize that as best you can would be ideal to so that you yourself sleep in harmony with your chronotype rather than mismatched or out of sync with your chronotype. So I think having people become aware of it, firstly, most people aren't even aware that there is this thing, you know, chronotype and how it impacts. And second, once they become aware of it, this is real and you can do something about it and you will start to sleep better as a consequence. I think then also there are ways, although people have tried to make evening types more like morning types. And it's very difficult because it's genetically based. but you can help yourself.

You can start really try to limit your caffeine in the second half of the day and nix it in the evening. Try to stay away from alcohol in the evening. Again, I don't want to be puritanical. I'm not here to tell anyone how to live their life. And life is to be lived. But just keeping that in mind. The other thing is to try to really reduce down the light exposure.

So if you are a night owl and you're being forced to go to bed earlier than you, you would otherwise, start to already tell your brain that it's nighttime, because we are a dark deprived society in this modern era, and we need darkness at night to release a hormone called melatonin, which helps with the regulation of our sleep timing. And that's why for evening types, it's so important. And so the recommendation, in fact, for everyone, but particularly night owls trying to go to bed earlier, would be in the last hour before bed, shut down. almost all of the lights in your house. And of course, staying away from screens, but that's not enough.

And what you will find is that reduction of light at night will be surprisingly soporific. It will help you feel more sleepy and more tired. Because most of us are in this blaze of electrical light at night, then we shut it all off, we dive into bed and we hope for sleep. And that's also not going to happen in terms of a transition. So darkness at night is great. Then eye mask, ear plugs, blackout curtains, and finally get your room cold because your brain and your body need to drop their core temperature by about 1 degree Celsius or about 2 to 3 degrees Fahrenheit for you to fall asleep and then stay asleep. And if you look at chronotypes, people who are particularly night owls, their core body temperature drop is not starting to do.

descend until those early morning hours, you know, until midnight 1 a.m. But yet they're getting into bed at 10 when their core body temperature is not on its awesome down swing of sleep promotion. So you can help by having a really cool bedroom somewhere around about 65 degrees will help in that regard as well. So those are a number of things that you can try to recommend and do, you know, before one starts to move down the path of maybe thinking of pharmacology. I have two questions. The first being in moving, in these different chronotypes, when we're talking about someone who is a night chronotype versus a morning chronotype, how much of a difference of recommended

time to go to sleep are we talking about? Are we saying those people would prefer going to bed at 6 a.m.? Or is it a 2-hour difference from like an 11 p.m. to 1 a.m., as you said? it's it's actually a gradation and so um although i sort of mentioned these three buckets sleep science has now gone even further and thin sliced it into five buckets so you can be an extreme morning type a morning type a neutral an evening type or an extreme evening type so extreme morning types could be getting into bed around 8 p.m which is you know quite remarkable in some ways whereas as extreme evening types may not want to go to bed or even be ready to fall asleep until

3 a.m., maybe even 4 a.m. in the morning. So that is a vast difference. And then across those sort of more fine split, fine grain separations, the difference then will start to get closer and closer and less extreme as a consequence. But the distance between those two can be whopping. And that's, can sometimes be a problem, you know, if we'll see this too in couples who have very different chronotypes. It can obviously, it can be a very challenging situation because one of them is getting into bed, you know, at 9 p.m. in the evening. And then the other is getting into bed three hours later, just as that other person is now three hours into their nice, deep sleep cycles. And they're getting disrupted. And then come the morning, now the early bird, they're all

awake at, let's say, you know, four or five a.m. in the morning. And the evening type is now in their first ending half of the deep sleep cycle. And then they get woken up. And so there can be a real challenge based on when that mismatches is very, very different. But I would say it's more of a gradation in some ways rather than just sort of definitely categorically you are two hours different than sort of this person. Does that make some sense, Mike? No, absolutely. It's a spectrum of sleep, if you will. The concern I'm already having in my head predicting having conversations about chronotypes with my patients is that they're going to be quick to label themselves a specific type of sleeper and remove the recommendations about sleep hygiene or

whatever they potentially could be doing wrong or what could be going on in their mental health. and assume that it's because they're just not this type, and it becomes a self-fulfilling prophecy. Is there any way that in the research that this was controlled for, that these people weren't just the ones living on healthier lives or having higher levels of anxiety outside of their control, and they happen to be late sleepers, or is this definite genetic tie here? Yeah, it's a definite genetic tie, and you can see it in animal studies, you can manipulate those genes, and you can force. and you can force causally animals to become, you know, a different sort of circate, what we call circadian 24-hour rhythm. So it's definitely causal in terms of manipulation. I do think what's, and by the way, when you look at those studies for, let's say, evening types who are not sleeping as well as they could be, it is related to a significant number of market worse health outcomes,

High-risk evening types will have a higher risk of diabetes, markedly higher risk of depression, high risk of cardiovascular disease, higher risk of having a higher BMI or being obese. There are a number of associations here, and you can control for those things by inserting, you know, lifestyle, age, smoking history, exercise history, and those associations still typically hold out. And I would say that the sleep hygiene recommendations that you provide and many of the sleep suggestions that we've had regarding optimizing and bettering your sleep are applicable no matter whether you're a morning type or an evening type. They are efficacious in both types.

So it really is important for you to be able to sort of modulate that, modulate your sleep habits and your sleep beliefs. In other words, what we call sleep hygiene, if you want to try and get the very best out of your sleep, no matter whether you're an evening type or a morning type, if you are an evening type, do be aware of it, try to think about it, be cognizant, try to modulate a schedule, but also don't ignore those other things. Please don't feel that you need to be fatalistic about it to say, well, I'm just an evening type and that's me and I'm doomed in terms of my sleep. you are absolutely not doomed.

There's lots of things that you can do. Interesting. I wonder, maybe you can point me if a study like this exists. We know, I guess, in our literature, that those who work night shifts and develop either shift work work night shifts, they have worse health outcomes long term. Now, I wonder if that holds true for those who are a very extreme late-night chronotype would you still see those negative outcomes has that been studied it has been a little bit

and you it does seem to be that um there is some degree of lowered in now it depends on the night shift work because you know if it's a hundred percent out what we call out of phase where you're working at night and you're trying to sleep during the day then even if you're an extreme morning type or an extreme evening type on either side of that spectrum, your sleep is going to be much more of a struggle during the day because we are a nocturnal species. We're designed, sorry, we're a dional species, so we're designed to be sleeping during that sort of nocturn phase, that night phase. So no matter what, that's going to be a struggle. But let's say that you're working, you know, the early phase of the morning into

the sort of early afternoon. So you're having to wake up at 2 a.m. in the morning or 3 a.m. That is much easier if you are an extreme morning type because you're much closer to your typical, what we call sleep offset, in other words, your wake up time. Whereas if you are an extreme night owl and you're working that shift, then that's much more difficult. But if you are required to work from the sort of mid-evening until the early morning, hours. Now the opposite is true. That favors the night owl because they don't mind staying

away until 2, 3 in the morning. Whereas for a morning type who likes to go to bed at 9 p.m., staying awake until 2 or 3 is not the same thing. It's sort of, you know, it's like asking an evening type to then stay awake all the way through until 9, 10 a.m. in the morning. Even that's too extreme for them. So there is an accommodation that can happen based on chronotype. And it's sometimes been suggested that, now you can't do this legally or ethically, of course, but should we not be asking people about the chronotype and seeing if we can better match them to jobs that would fit the chronotype more? Now, that's me being asleep, you know, perfectionist and in an ideal world, that would be the case.

But, you know, I think there's some reasonable cause for something like that. Would it be reasonable to change the way we think of shifts? Maybe instead of a night shift and a day shift, we have like a middle of the night shift, late day shift, instead of, you know, from midnight to midday, you have from 3 a.m. to 3 p.m. Would that be more effective for most people then? It's a very good question, which is how should we better structure, you know, shift work on the basis of now what we know in terms of the deleterious outcomes. And people have studied this.

And they've studied it very well and they've studied it in depth. And I think what the evidence really points towards is that, firstly, you shouldn't flip-flop between extreme schedules very quickly. So you shouldn't do, you know, two, three days of night shifts and then have one day off and then switch to four days of daytime shifts and then switch back to three nights of nights, which is residency, you know, which is, that's shockingly bad.

You know, that's torture for your biology. Instead, the idea is, firstly, you should do longer stretches of one thing, then take a break, then longer stretches of the other, and then sort of go back and forth in a much more glacial pace. The other idea, which I think is even more nuanced and clever, is rather than doing these blocks where you're either doing the day shift or you're either doing

the night shift, in bed, you just rotate people around the 24 hour clock face. So now, you know, you start by doing the afternoon and evening shift and you do that for a while. Then you go on to the evening into early morning shift, into middle of the night shift, I guess would be the case. And then you shift over to from the middle of the night into the middle of the night into the the mid-morning hours, and then you just kind of keep cycling like that. That seems to be a way that you can perhaps be better adjusted or better acclimated, even though ultimately you just can't. There's no way that a human being within the space of 60 years of working shifts,

they're not going to accommodate because once again, it's been millions of years of biology in terms of evolution that have designed our circadian rhythm. It's very hardwired and it's very innate. Yeah, I'm curious about that. You can't just overcome it like that. Because if you have the circadian rhythm, which is like I guess my knowledge of what a chronotype is would be based on a circadian pattern, how did this wedge come to exist? Is there an evolutionary benefit to this wedge of chronotypes or is this an error on Mother Nature's part?

we don't think it's an error and I think I've written about this before and other people have spoken about it before I think it could be a very elegant design of mother nature to outsource the threat that we face when we are unconscious for eight hours what I mean by this is we as human beings we if you look in our history we were typically not solo sleepers or coupled sleepers. We were actually group sleepers. So we would typically sleep in groups as a tribe. And so if you think about this now, each one of those individuals in the tribe is going to be vulnerable at night for eight hour stretch, if we just assume eight hours. However, as a group, as a collective, if there are some people who are going to bed, you know, four or let's say, you know, three hours,

earlier, and then there are other people who are going to bed three hours later, then you've just taken that eight-hour vulnerability window, and now as a collective, there are going to be people who will be awake for the first three hours still, the night owls, and then people who are going to be waking up earlier, who will be awake for the last three hours of the sleep phase. So now you've got, as a group collective, the first three hours of sleep and the last three hours of sleep covered. And so you as a group as a collective, perhaps are only all sleeping at the same time for maybe just two hours of the night. So Mother Nature compressed the threat, the time threat, period, from eight hours, all the way down to two hours by creating this thing

that we call chronotype variability. Wow, that's so interesting. Who knew nature was like a natural hospital staffer to make sure that there was always someone to care for patients. Yeah, absolutely. You know, mother nature in terms of an administrative role of scheduling is absolute perfection. Yeah. It's a shame that life is so complicated and complex and so many things change that it can never be as perfect as designed. But wow, sleep is obviously very exciting.

Well, you know, talking about getting the adequate numbers of sleep, what happens when we don't? In your book, you talk about Alzheimer's. we talk about physical health outcomes. Can you shed some light on that? Yeah, you know, I think 50 or 60 years ago, we used to ask the question, why do we sleep? And back then, perhaps the unhelpful answer was that we sleep to cure sleepiness,

which is the nonsensical equivalence of saying, well, you eat to cure hunger. That tells you nothing about the nutritional benefits of food. But now, after 50, 60 years of, remarkable research from all of my colleagues, we've had to upend the question. And instead, we've had to ask, is there any operation of your mind and is there any major physiological system within your body that isn't wonderfully enhanced when you get sleep or demonstrably impaired when you don't get enough?

And the answer seems to be no. We know that the number of people who, let's say, could survive on less than six hours of sleep a night without showing any brain or body impairment rounded to a whole number and expressed as a percent of the population is zero yeah and so what that tells us is that sleep is non-negotiable it's unfortunately not an optional lifestyle luxury it's it's essential and when you look at the deleterious health outcomes firstly you could look at hormonal health and we know that men who are put on a limited amount of sleep, let's say, four or five hours a night for a week. They have a level of testosterone, which is that of someone 10 years, they're senior. So a lack of sleep will age

a man by a decade within just a week in terms of hormonal health. You see equivalent impairments in females in terms of lutenizing hormone, estrogen, follicle stimulating hormone. Or we can look at what we call the metabolic system. And what we've discovered is that, again, after one week of short sleep, let's say five hours a night each night, your blood sugar levels are so disrupted that someone like you, their GP, after doing a blood test, would actually classify them as being pre-diabetic. And that happens with what we call sort of, you know, people who are normative in terms of glucose profile. But after one week of bad sleep, they are on the path towards diabetes. There's another, I think, example I'll often give, which is a more extreme one,

but yet a more subtle one, which is the global experiment that is performed on many of us, in fact, about 1.6 billion of us across 75 countries, and it's done twice a year. And it's called daylight savings time. And there was one amazing research report that demonstrated that in the spring, when we lose just one hour of sleep, there was a 24% increase in heart attacks, a risk, relative risk, the next day. But yet in the fall, in the autumn, when we gain an hour of sleep, there was a 21% reduction in heart attack. It was bidirectional. And we've now found a very similar pattern during those transition periods for things like road traffic accidents on our streets, even suicide rates, in fact. So I think these are examples. You know, there's another

great study that was looking at the immune system. And what they found was that one night of just four hours of sleep dropped critical anti-cancer fighting immune cells that we call natural killer cells. It dropped them by up to 70%, which is quite a quick state of immune deficiency after a poor night of sleep. Now, you know, I offer these scientific pieces of evidence, you know, to support the case that it's critical for health. But I also know that in doing that, for those people who are struggling with sleep, you know, how do you balance that tension as a public communicator? Because now I don't want to get people even more stressed about the sleep that they're not getting.

So please, if you're struggling with sleep, firstly, turn my voice off. You can't stop listening. I'm sorry about the views and the clicks. But the second thing is, look, everyone has a bad. night of sleep, even I do, and I've had my bouts of insomnia throughout my life as well. You know, a bad night of sleep, it's okay. It happens to all of us. Don't worry, don't freak out, don't get too anxious. But if you are persistently struggling with sleep, go to see your doctor, ask about help for insomnia and particularly cognitive behavioral therapy for insomnia.

But I just want to put that out there. I don't miss Swight, a new movie inspired by the provocative real-life story of the visionary founder of online dating platform Bumble. Played by Lily James, Swiped introduces recent college grad Whitney Wolf as she uses grit and ingenuity to break into the male-dominated tech industry to become the youngest female self-made billionaire. An official selection of the Toronto International Film Festival, the Hulu original film Swiped, is now streaming only on Disney Plus. TD Bank knows that running a small business is a journey.

startup to growing and managing your business. That's why they have a dedicated small business advice hub on their website to provide tips and insights on business banking to entrepreneurs. No matter the stage of business you're in, visit td.com slash small business advice to find out more or to match with a TD small business banking account manager. I don't mean to be triggering. I don't mean to be alarmist. I just want to I want to build the case, the evidence-based case for sleep without necessarily, you know, making people too worried. I think that's such an important point to make because what's interesting about having not enough sleep is it harms your mental health. And then if you have issues with mental health,

that harms your sleep. So you're kind of in this cycle where if we're constantly talking about not getting enough sleep and how dangerous it is, it can actually hurt your ability to sleep, right? That's exactly the irony, which is that. And we've seen this, we've done a lot of work on sleep and mental health over the years. I think one of the striking findings there that we found was that in the past 20 years, we have not been able to discover a single psychiatric condition in which sleep is normal. And I think that tells us everything that we need to know about the relationship, the intimate relationship between our sleep health and our mental health or emotional health.

And it is bi-directional. What we've discovered is that if you, and we published the study a few years ago, demonstrating that if you took perfectly healthy people who have no signs of an anxiety disorder whatsoever, and you deprive them of sleep for just one night, almost 50% of them the next day classify as having an anxiety disorder because their anxiety is just skyrocketed. And we found out why? Because there are emotional changes within the brain,

these deep emotional anxiety centers, were just erupting in terms of their sensitivity and their reactivity. So insufficient sleep can lead to anxiety, and there's causal evidence for that now, but also having anxiety can then consequently lead to worse sleep. So, you know, sleep, poor sleep equals, you know, poor mental health, but separately, poor mental health can equal poor sleep at night. And when those two things begin, almost like two, you know, two bad kids conspiring together, it becomes this vicious cycle of a self-fulfilling prophecy of worse insomnia,

worse sleep difficulties. And if that's the case, increasingly worse depression or anxiety, which then just escalates the problem. Highlighting the importance of the CBTI that we can offer our patients. Correct. Before I asked my last question, this is more of a curiosity that I've had. and I've sort of blamed it on the sympathetic nervous system driving us when we don't get enough sleep so you can feel awake. But then when you, I guess let me ask the question and I'll sort of give you my theory and you tell me how wrong I am. Why when my patients, and I guess I have experiences for myself as well, when if you're going through a period of not getting enough sleep, sleeping five hours a night,

and then you have a night where you do sleep seven, eight hours or the correct amount of sleep for you, you feel more tired. the next day than when you, if you were to sleep to five, six hours. Isn't it fascinating? And although it's been less well documented in the science, it's so common in terms of anecdote that I think it's very clear. You know, it's sort of when you look, you know, at Amazon user reviews and you see, you know, 30,000 people have given it a 4.9 rating. You kind of got to think that it's probably a good product.

Well, when you get that number of people in the general public. saying this is happening, you've got to believe there's something to it. What we think is happening here is that each night after night when you're not sleeping well, you're building up what's called a sleep debt. And your body understands its sleep debt. Now, in part, sleep is not like the bank. You can't accumulate a debt and then hope to pay it off without consequence. How However, the body and the brain will try to get back some of the sleep that it's lost. So let's do the extreme example. You know, I take you tonight and I deprive you of sleep for eight hours.

And then I give you all of the recovery sleep that you want on the next night and the next night and the next night. And even the next night, will you sleep longer those subsequent nights? Absolutely. You'll have what's called a sleep rebound. But will you get back all of the eight hours of sleep that you've lost? Not even close. you mainly get back 50% of that lost sleep. In other words, you can make up some of that debt,

but you can never repay all of it. But what's interesting is that as you're repaying it, because you've built up such a strong debt, such a heavy weight of sleepiness and sleep pressure after two or three bad nights of sleep, then you sleep deeply. You have that sleep rebound effect. And because you've gone so deep into sleep,

The next morning when you wake up, you have something called sleep inertia, almost like sleep drunkenness. And as you describe, you almost feel worse as a consequence. Now, that is just the process of your brain and your body telling you, firstly, excellent. You had a great night of recovery sleep. But second, we're not done yet because you still need some more nights to wash out some of that lingering debt. and the grogginess and the sleepiness that you're feeling is still a reflection that you cleared some of that, but by no means all of it. And your brain, in fact, was still hungry for more and still wanted more.

You're just going to have to wait a few more nights before you get that back. But because we all naturally think, okay, it was that one night, but why am I still groggy? Why am I still sleepy the next day? We never think of sleep as having this sort of, you know, day after day night. night after night timeline to it. We think I had a few bad nights of sleep, I should be able to do it all in one recovery night and wake up feeling like the energizer bunny. It takes more time than that.

Does that make some? It does. It doesn't answer my question, though, why if I was to sleep five hours and not replenish my sleep, I wouldn't feel as tired. Is it because I didn't go into that deeper sleep? So there are two possible reasons. the first is that you still will have gone into that deep sleep very much so but you won't have had as much sleep so you won't have had as much sort of inertia momentous to have that effect the next morning the other issue is that yes when you are brute forcing yourself awake and you're not sleeping the amount that you need the nervous system will start to kick into higher gear and in some ways it's a threat detection system because human beings are the only species that will deliberately deprive

themselves of sleep for no good reason. And when you see other species doing this, it's usually under conditions of very high threat from predators or under conditions of starvation. And at that point, the brain and the body switch on the hyperact, the hyperdrive of the sympathetic nervous system to try and help keep you awake because you are telling your brain, you're by not sleeping enough, well, there must be a threat because the only time during evolution when I've not been sleeping enough is when I've been under attack. So no wonder I get wired and I feel pretty alert.

The second problem there, however, is that we say that we feel more alert. We say that we're operating and performing better. But your subjective sense of how well you're doing when you haven't got enough sleep is a miserable predictor of objectively how well you're doing with insufficient sleep. So this is kind of like this, you know, machismo attitude. I'm doing fine. But in truth, you know, it's a little bit like a drunk driver at a bar. They've had five or six shots. They pick up the car keys and they say, look, I think I'm fine to drive home. And your response is, I know that subjectively you think you're fine. Objectively, you're impaired. Don't worry. Let me take the car keys. I'll call you a

taxi. It'll be fine. The same is true with sleep. We don't know. sleep deprived, when we're sleep deprived in terms of impaired performance. Yeah, that's sort of the line I was thinking when I was saying it's the sympathetic response that makes you feel like you're awake when reality, your reaction time suffers, creativity, productivity, all of that. My last question before we wrap up here is about sleep supplements, sleep treatments, medications. For me, just to give you my bias, is I'm kind of against supplementary.

unless there's an absolute proven need to do so. And yet there's a market for a miracle cure-all product for everything these days. We try and push against that on this channel. For sleep, my patients will turn to CBD. Melatonin has cases where it works quite well for jet lag, sleep cycle issues. But in general, what are your thoughts on some of these over-counter medications, whether it's the chamomil teas, the melatonins, the CBD supplements, all those? Yeah, you know, I think that if there was this one incredible compound or set of supplement compounds, that was the holy grail for good sleep, that was the changriala of all sleep, you know, concoctions, then trust me, you know, the drug companies would have discovered it 20 or 30 years ago and it would now be a pharmaceutical that they're making billions from. And there is no such thing. So if, you know, if you're seeing the promise of the best night's sleep by taking this supplement,

chances are you going to be disappointed. The evidence is very mixed for most everything that you describe. We know that melatonin, you're absolutely right. It can be effective when you're traveling between different time zones. But once you're stable in a new time zone, melatonin is not the solution for most people's sleep problems. In fact, there was a meta-analysis, which is, a technique where we take all of the individual studies and we put them together and sum them all up. And what they found is that melatonin, I think if I'm remembering my numbers correctly,

only increased total amount of sleep by, it only increased the speed with which you fall asleep by about 3.9 minutes, which relative to placebo, you know, and then it only increased your sleep efficiency by 2.2%, which again, isn't much. Now, some people have said, and I understand it, that if you feel as though it's working for you, the placebo effect is one of the most reliable effects in all of pharmacology, short of probably an adrenaline injection to the heart. So, you know, no harm, no foul. The only thing with melatonin, I would say, is that because it's not regulated, you don't

know what you're getting. And there's a study that looked at lots of different brands. And what they found was that relative to what it said was on the label. Actually, what was inside of each tablet ranged from being 80% less than what it said to 460% more than what it said. And so you don't know what you're getting. We also know a recent report from my dear friend, a wonderful pediatric sleep specialist, Craig Canapari. If anyone is a young parent out there and you need sleep advice, go to Craig Canapari at Yale. He is a genius.

and he was just alerting people to the fact of a recent report showing that I think there was a 500% increase in the reported overdosing of children with melatonin because you can go down to the supermarket aisle these days and there are all sorts of gummies that's the thing and that's a great point actually Mike when it comes to melatonin and many of these other supplements you're taking what we would typically describe as a superphysiological dose a dose a dose that is far larger than anything that your body would create or see or produce. And one of the worries when you have superphysiological doses and your testosterone supplementation is an example here that once you start giving the body an outsourced version of that,

it has a feedback loop and it can shut down or at least decrease its own production. And so by taking too much melatonin, and most people do, they'll take maybe five milligrams or 10 milligrams, the optimal dose seems to be somewhere between about 0.8 and 3 milligrams, much less than what most people are taking. So keep that in mind. You want to just be very judicious, but also know that it doesn't seem to be that effective. You know, things like magnesium don't seem to be very effective if you look at the literature. Most magnesium compounds you buy out there don't even cross into your brain. They don't cross something called a blood brain barrier.

Magnesium 3 and 8, or mag tea, as it's known, that may be the one exception, and there's no good sleep data on that yet. Things like Valerian root, debatable, chamomile tea, not really. There is some evidence that I think is interesting in two areas. One is glycine, and there has been some good studies demonstrating from very good laboratories is that some degree of consistent benefit of glycine, anywhere, I think, from about one gram up to about three grams. But again, Wild West, you don't know what you're getting in the market space.

And it's no cure-all for insomnia or sleep difficulty. And then the other is tart cherry juice and kiwis. And I was looking at this evidence thinking, this is nonsense, absolute nonsense. But again, the people who are doing the study is very respectful. And the evidence was there in some animal studies and also in some human cities. Now, there's far too few studies for any of us to recommend people doing that. But let's just take it that it could. How could it do that?

Both of those things are packed full of something that we call antioxidants. And there's been a revelation in the past four years in the sleep field that antioxidants play a huge and powerful role in regulating our sleep. and even protecting us against the ravages of insufficient sleep. So I think that's an interesting space. The final thing I would note is THC and CBD. And I get asked this question quite a lot too, and I'm sure you do too. THC or tetrahydro-canavanol is the psychoactive component of cannabis.

That's the part that gets you high. That may help people help them fall asleep quicker or lose consciousness more quickly, but it is no friend of sleep. Firstly, you become tolerant and you become tolerant quite quickly and you start to have to take more to get the same sleep benefit. Worse, when you stop,

you get a vicious sleep rebound, sleep in insomnia syndrome. In fact, it's part of the cannabis withdrawal syndrome in the diagnostic manuals because it's so reliable. So the other aspect of THC is it can decrease or even block the amount of REM sleep,

dream sleep that you have, and we've discussed that that's critical. In fact, many cannabis users, heavy cannabis users will say to me, you know, I just stopped dreaming and I really don't remember my dreams anymore because you're not having much of that dream sleep. And then when they stop, they'll say, I'm having these incredible vivid dreams. It's so surreal. It's because your brain is trying to recover some of that REM sleep that's being deprived of for so long. CBD, not enough evidence, but it's interesting. And I'm very careful as to what I say here because, you know, when you have people like me and people say, okay, he seems to know a bit about sleep, then if he said something, then it must be, you know, right or scientific proof. We don't have anywhere near enough evidence on CBD to make any recommendations for sleep.

There is some evidence in animal studies in rats and some evidence in humans that in higher doses, that in higher doses, And I think those doses may have been, you know, above 25 milligrams, maybe more. It can be more sleep-inducing. But one of the dangers is that at lower doses, it seemed to actually be wake-promoting. So it has this bimodal distribution. And again, you don't know what you're getting. Are you getting CBD but too little? And it's going to cause you even worse sleep because you're going to be more awake.

Or is it going to be enough that it, you know, helps you with sleep? help because we i say in inverted comments because we don't know if it helps um i think there are companies and i'm you know i for a long time i've i realized the ill of my ways as a scientist i would get very once again kind of purist about it and say these are snake oil companies you know selling stuff you stay away from them because there's no good science well there's probably only going to be good scientists sorry good science if scientists themselves, stop having that mentality, that exclusionary mentality, and start working with some of these serious companies and help them do the studies.

And let's find out together. So I've actually started to work with a company that is really focused on very good medical practices with CBD, and we'll see where it goes. Let's think about a model where in 10 years time or 5 years time, we have evidence that CBT is beneficial for sleep. How could it be doing that mechanistically? And the evidence, I think, so far, is at least two interesting paths. One of the findings in the animal studies was that when you give those animals CBD,

it can sometimes drop the body temperature. It can make them more hypothermic. And as we discussed, you need to drop your body temperature to sleep and to sleep well. So maybe that's one of the paths. The second is that CBD and there is good science here. does seem to be what we call an anxiolytic. It's a fancy word for simply meaning it decreases your anxiety. And you can see that in these emotional brain centers and these anxiety centers.

Good brain imaging studies have demonstrated that. So, and we, you and I spoke about the fact that when you have this anxiety state of the brain and the body, it's going to be very difficult for you to sleep. So if you've got something that's helping decrease the anxiety, then in some ways you're removing the brake pedal for natural sleep to occur. So rather than being a sleep-generating agent itself, it's actually just removing one of the roadblocks to your ability to generate the sleep that you need.

But again, we have no idea right now what is going on with CBD. Lots more work needs to be done. Yeah, that's the future of it, as opposed to what patients want to take right now. So I think that's the important classification. Yeah. The short quick follow-up there is for my patients that look for prescription medications to help them sleep, I really try to avoid that to the highest degree.

I don't want them to build up a tolerance, a dependence, I want to find healthier ways to get them good sleep. In some cases, you do need to do it. In the cases that you do use those medications, do you find that it impacts any of the natural ways that we experience sleep? Does it change the cycle length? Does it change the restfulness of the sleep? Or is it the same quality of sleep, drug or no drug?

And it very much depends on which of the sleep drugs that are being used, but the sort of the typical ones, and I won't name any names that people would know. You're absolutely right. And again, here's a situation where I am not a medical doctor, but I have spoken to many medical doctors. And it's very clear in medicine that there can be a time and a place when those medications are a lifeline for people, when they are in really bad shape with their sleep. But we also know that medicine does not advocate for their long-term use.

It's weeks, you know, if you look at some of the recommendations, not months and certainly not years. And if you look at the average duration of sleeping pill user, it's in the years. So something's amiss in that regard. Well, that's why I want to hammer this point so strongly for that exact reason, because so many patients will find a physician that is willing to do that for the rest of their life. And I want them to be aware of, are they, A, getting the same good quality sleep without the, like with the medication versus without and getting good sleep? And obviously, I can talk about the medical aspects of the negative effect of taking those

medicines? Yeah. I think it's such a great question. We certainly know that you can build up a tolerance to them, and so you need sometimes more of the drug to get the same effect. Also, when you stop using it, you do typically get a pretty nasty insomnia rebound effect, where not only do you go back to the bad sleep that you were having can sometimes be even worse after a longer duration. One of the findings looking at some of these sleep medications is that if we go back to those deep electrical brainwaves that I was describing, I can sort of look at the electrical signature of your sleep by using electrodes on your head. And if you dose people with those typical sleep medications, sometimes you can get, depending on the medication, a sort of a dent

in the amount of deep sleep that they're getting in terms of the electrical brainwave patterns. So to your point, is it exactly the same type of sleep? You can argue from that data that from what we call an electrophysiological perspective, from the electrical quality of your sleep, it's not the same as natural sleep. It does seem to have differences. What are the consequences of those? We probably don't have enough evidence yet to understand that. And then there are also some side effects, of course,

that you're well aware of people have morning grogging us. They can have hangover effects. They can have impaired cognition during the day that they don't think particularly well or they don't, they can't think straight. And so these are things to be mindful of. And your physician, you know, if they're a physician as good as you, you know, will help people understand those risk versus reward sort of relationships. And then also know, you know, there are other options just as we spoke about cognitive behavioral therapy. That can help. And often cognitive behavioral therapy.

for insomnia is given in conjunction with to begin with some of these sleep medications just so that you really help, you know, throw a big safety net under that patient, capture them in, start to give them reassurance. Because there's nothing worse, and I've been through this with my bouts of insomnia, all of a sudden, when you lose all confidence in being able to sleep, it is miserable. And night after night, you go into the bedroom, you look at the bed, and the bedroom is just your enemy. You just don't want to be, you know what's coming.

And all of a sudden at that point, your sleep controls you. But with cognitive behavioral therapy for insomnia and these different approaches, you can turn the tables. Now you control your sleep. You regain your confidence in the ability that you once had that you can start to sleep better. There's anyone who feels more like the former and not the latter, there is hope for you. Speak to your doctor. You can get better. Yeah, that cognitive behavioral principle is so interesting for my patients, especially who believe that whether it's their mental

condition of anxiety, depression, or their insomnia, that there's a chemical imbalance. We can address chemical imbalances with CBT. Like, we've seen therapy impact chemicals, neurotransmitters, in our brains. And I'm sure that I can't speak exactly to the research, but I would expect that you would see the same in your sleep waves of an EEG pattern on a sleep study. Absolutely. You can see it in so many different sleep metrics. That's so well documented now. One of the benefits of cognitive behavioral therapy, unlike pharmacology, is that once you

start working with your therapist, and the classic approach is maybe that you see someone, you know, for an hour and maybe you have six, seven sessions of that. Once you're up and running, it's sort of in terms of, you know, you hit cruise control and you're on the freeway. At that point, you know, you can do very well, armed with all of this knowledge. And when you stop working with your therapist, those sleep benefits continue now. Some have been documented five years later. Whereas if you stop using the sleeping pills, pretty straight away, you go back to your bad sleep.

So I think those are some of the other advantages. Yeah, that's awesome. There's so much overlap with mental health and sleep. But that's why I'm very passionate about the subject. And obviously, Professor Walker, thank you so much for coming in, chatting about sleep. Thank you so much, Mike. We hope everyone checks out your book. We have it listed down below.

I really enjoyed reading it. You taught me a lot. So I want to thank you for your time. It's a privilege and delight. Thank you so much for having me. And thanks for what you do, Mike. Remember, having a podcast blowup is no easy feat. So I need your help.

I need you to leave five-star reviews. And when you do leave your review, don't forget to add a medical question to the body of that review because I answer them at the end of every podcast. In fact, let's get to some right now. We have Liz Walto asked the question, is a resting heart rate of 110 beats per minute too high? Liz, we have to be very careful here because I don't want to say what's normal for you because I don't know your age. I don't know what medical conditions you may have, but generally speaking, you want your beats per minute to be 60 to 100. That being said, do I have a patient that's slightly above 100, that we still consider it normal for them? Yes.

Do I have a patient who's in the 50s? That is normal for them. Yes. But remember, there's also a huge difference with ages because heart rates in those who are younger are higher and that could be the total norm for them. So that's why it's important to get more information when answering questions like this.

Mitch No, 2525. I'm currently in college for a degree in med lab sciences at the University of Washington and planning to go on med school and specialize in hematology. I also do undergraduate research part of the time and have begun training in martial arts after stopping for a few years. I can understand. Do you have any advice on how to navigate a busy schedule and avoid severe burnout, which has been an ever-looming threat for me and my peers? I think a lot of this is about balance and selection of what's taking up your time.

Like if you're so passionate about martial arts and the work that you're doing with your education, do not cut those things out of your life. But if you have certain things that you're doing that are lower on your list of priorities, definitely you're going to have to make some tough decisions here. For example, I used to watch the NFL or basketball a lot more often than I did after I started doing social media, boxing, all this stuff. I even used to do fantasy football. So things that I once enjoyed doing started taking a backseat in my life because of the priorities that I set for myself. So make sure that you're constantly doing a revaluation of what is. valuable to you, what is not, and constantly restructuring it, because sometimes those priorities

can flip, and that's totally okay. But as long as you're being insightful and checking in on yourself, that's as far as you can go when you're battling burnout, or at least preventing the battle for burnout. Mistress blush, medical question, why do I sneeze when I am really hungry, usually several times in a row, instead of my stomach growling? Interesting. I have no idea, to be honest. Most people, their stomachs don't even growl when they're hungry. That is more of like some pseudoscience that we've created because it happened and people have propagated that myth.

It can't happen though because some hormones do get released when you are hungry. There might be some kind of histamine-related response in relation to when you're hungry, but nothing that comes to the top of my head. Sorry, blush. Sims 1, 2, 3. how bad is diet soda actually how bad i don't like to ever say something is bad or good um because that's not really a full picture of what these things are i'll tell you why i try and avoid diet soda as much as i can uh in everyday life but if i had to choose between diet soda and a regular soda

diet soda is probably a better choice if you're trying to watch your sugars because diet soda is usually zero sugar and a regular soda has a ton of sugar. I think I just saw like a can of cola has like 12 teaspoons of sugar in it, which is an absurd amount of sugar. So I prefer diet soda in this case because I'm cognizant of the amount of sugars present and I don't want to bomb my body with sugar. But that could be different for other people. Diet soda, the issues that come up is you start getting artificial sugar as the sweetener being in there. And that can cause some issues with the bacteria that live naturally in your gut. It can make some changes to where the bacteria that are in your gut

that can get calories out of that sugar, the artificial sugar, and multiply, which means that you might start developing cravings for more sugary foods. Your taste buds will change. Because remember, a lot of these artificial sweeteners are at times even sweeter than regular sugar and that changes your psychology. Do we have research that this is really bad for you? Not really. My whole thing is just go for water, sparkling water if you need a little twist. And if you have a soda every now and then, I'm not going to be the doctor that attacks you for it because there's a lot of risks in life and we need to be very thorough and careful

about managing these risks. And if you have one soda once a month, that's not the risk I'm probably going to focus on with you as a patient. All righty, we answered some questions. Keep hitting me with those questions because I want more Lee five star reviews as always stay happy and healthy