WHOOP Podcast - How sleep affected mental health during the pandemic

Starting point is 00:00:00 Hello, folks. Welcome back to the Whoop podcast. I'm your host, Will Ahmed, founder and CEO of Whoop, where we are on a mission to unlock human performance. As many of you know, listening to this podcast, we love at Whoop to do research and important research, especially in the past year as it relates to COVID-19. So we've got an amazing podcast for you on that front. First, I want to remind you that you can get 15 percent off a WOOP membership if you use the code Will Ahmed. That's WI-L-L-A-H-M-E-D. Go to WOOP.com. Check out the wearable that helps you improve your health and performance. That is at WOOP.com. Use the code Will Ahmed. On this week's podcast, we detailed the findings of an important WOOP research effort,

Starting point is 00:00:52 the COVID resilience project. That's right. We collaborated with leading scientists at Harvard, Austin Health and Australia's Monash University to learn how the COVID-19 pandemic impacted our members' physical and mental health. We tracked the data of nearly 5,000 WOOP members before the pandemic and during the pandemic to see how their bodies adapted to the changes going on in the world. These volunteers also undertook surveys from the COVID resilience project. What we found was really, really fascinating, especially as it relates to sleep and mental health. And this podcast

Starting point is 00:01:34 gets into it in great detail. Those who slept sufficiently before the pandemic were less likely to experience a mental health decline, even if they slept less during the pandemic. So essentially, those who got more sleep before the pandemic occurred were more resilient going into the pandemic. And then we're not just talking about sleeping for long enough. We also found that, that sleep consistency, so going to bed and waking up at the same time, was a better predictor of mental health resilience during the pandemic than sleep duration. So we've talked a lot on this podcast about the importance of sleep consistency, but this study again found the importance of sleep consistency over sleep duration. Our brilliant VP of data science and research, Emily

Starting point is 00:02:23 Capitol Lupo, sits down with Mark Seisler of the COPE initiative to discuss these findings. The COPE initiative is an organization monitoring the mental and behavioral health aspects of the pandemic. Mental health is an extremely important topic. People are reporting three to four times the prevalence of anxiety and depression symptoms in the aftermath or during COVID-19. I think personally WOOP can play a big role in helping people understand their mental health. This is an area that we're going to continue to do research on and over time add product features too. This podcast is a great place to start. So I think you'll enjoy this episode without further ado. Here are Emily and Mark.

Starting point is 00:03:07 Hi, everybody. I'm Emily Capital Lupo, whoops VP of data science and research. And today I'm joined by the incredible Mark Seisler. Mark is a graduate student researcher at the School of Psychological Sciences in the Faculty of Medicine, Nursing, and Health Sciences at Monash University, an honorary research fellow at the Institute for Breathing and Sleep at Austin Health. He also has an appointment in the Department of Psychiatry at Harvard's Brigham and Women's Hospital. He was a 2020 Fulbright Postgraduate Scholar, supported by the Australian American Fulbright Commission and funded by the Kinghorn Foundation. He received his Bachelor in Arts in Neurobiology with a minor in Global Health and Health Policy

Starting point is 00:03:46 from Harvard College. During the pandemic, he co-authored 12 papers, some of which I've been lucky enough to collaborate, with him on, and today I'm very excited to talk about one of them, in particular, related to mental health resilience. Mark, thank you so much for joining us on the pod today. Thank you for having me. Yeah, it's a pleasure to be here. I'm excited to chat. So for those of you who have been listening to this podcast for a while, you might remember an episode last June in which we announced the COVID resilience project. But for those who are newer to the pod, Mark, can you catch everyone up on how our collaboration came together?

Starting point is 00:04:22 It started, I think, probably in late May or early June 2020, but there were really two simultaneous observations that were happening that kind of motivated the COVID resilience project. The first was led by you, and I think Dean Miller, in an analysis where you showed that during the first few months of the pandemic, there had been a kind of dramatic increase in sleep duration, some changes to sleep timing and also reduce social jet lag where the kind of misalignment of the circadian clock that happens sometimes when we have to get up for social commitments or work during the week and then stay up for social commitments during the weekend. That had kind of been reduced during those months as maybe people weren't commuting or didn't

Starting point is 00:05:15 have as many hard reasons to get up in the morning. then on weekends, maybe could have gone to bed a little bit earlier than they would have otherwise. And then the second observation was based on some work that we had been doing with the CDC in a public health surveillance activity called the COPE initiative. And we found that there had been considerably elevated levels of adverse mental health symptoms observed among U.S. adults, including three or four times the prevalence of anxiety depression symptoms, elevated substance use to cope with stress or emotions, and also two times higher prevalence of suicidal ideation. So really concerning from a public health

Starting point is 00:05:58 perspective that that kind of elevated prevalence of adverse mental health symptoms because mental health was already a really challenge for public health. And so we sought to try to better understand the relationship between some of these dramatic changes to sleep and to mental health during the pandemic, which is what led to the launch of the COVID resilience project in June of last year. And what's especially exciting about this project is that through WOOP, we have longitudinal objective sleep, wake data at very high resolution. So going into like the level of individual days,

Starting point is 00:06:41 which is rare to have a large sample. And then also through some surveys that were administered in June of last year, and thank you to everyone who was involved and everyone who participated. We were able to measure mental health using some validated instruments. Yeah. So for people who aren't really familiar with this kind of research, can you dig into a little bit more like what you mean when you're talking about, like the longitudinal data and why WOOP was able to sort of bring something that other

Starting point is 00:07:15 surveying techniques couldn't necessarily capture. For example, with the COPE initiative, we were interested in trying to launch public health surveillance activity that would capture kind of the initial phase of the pandemic, the first interval of lockdowns and everything that happened during that time. And so through a considerable effort, we were able to start in April and then have continued since then. But what's great about WOOP is that, you know, you have data in a lot of people that extends back to before the onset of the stay-at-home orders and a lot of what was happening during the pandemic. And that's very powerful because it allows for the analysis to include a comparison to baseline, which is missing in a lot of the COVID research that's been happening.

Starting point is 00:08:10 And we'll definitely link this in the show notes, but the paper that Mark was talking about was looking at behavior change during the pandemic, something that we did with our research partners at Central Queensland University in Australia, where we showed, as Mark said, that sleeping behavior changed dramatically during the pandemic. And as Mark had mentioned, a lot of this was due to changes in social obligation. So with physical distancing mandates, bars, closed, people weren't going out as much on weekends. And so you saw that people were going to bed a lot earlier on the weekends. And we also saw during the week that people were sleeping in later, likely because they weren't commuting,

Starting point is 00:08:50 something that used to take up a lot of time. But now that we're all working from our living rooms, you know, you got all that time back. And it does appear that a lot of that went to sleep. And so simultaneously, Marka and the COPE initiative team had started working. on these massive surveys, you know, tens of thousands of people at a time, really trying to understand how all of these physical distancing mandates, so really not COVID itself, but everything surrounded COVID, seem to be affecting people's mental health. You know, the flip side of physical distancing to prevent the spread of COVID also increases things like loneliness. It

Starting point is 00:09:28 decreases social connection and all of the support systems that a lot of us rely on to keep our mental health healthy. And so what this paper was is really the marriage of these two things. So what was unique that WOOP was able to bring to the table was because we had members on whoop, obviously, before the pandemic started, we knew what sleep looked like before the pandemic. And you can survey people and say like, oh, how are you sleeping now? How does this compare to how you were sleeping six months ago? But human memory is extremely faulty and that data, you know, is only gets you so far, but actually being able to look at the dynamics, you know, within tens of thousands of Woot members, like how was their sleep actually before the pandemic?

Starting point is 00:10:08 How did it compare, you know, on a Monday versus Sunday and all these things? And then how did that change at the onset of the pandemic? Really enabled like a unique analysis. And that's the paper that we just submitted. It's in peer review now, but we'll link the preprint in the show notes. And Mark, if you want to take it from here, what did we find? The main findings from a sleep perspective were consistent with what Emily had found. We split it into basically three intervals, so pre-COVID January through March 12th.

Starting point is 00:10:43 And then the acute pandemic onset interval was kind of that first month where the physical distancing measures were in place. And then mid-April through June, which is June is when we administered the survey. was kind of considered the early chronic pandemic interval. And what we found was that there was a dramatic increase in sleep duration during that first interval, about 15 minutes, mean increase per night, that then was attenuated to six minutes during that post-acute phase. And interestingly, though, the wake after sleep onset did not change as much as the sleep duration.

Starting point is 00:11:24 And that indicates that, you know, people weren't just spending a lot more time. in bed, they were actually sleep during this time, indicating that, you know, potentially they were making up for sleep deprivation or something like that. You said that sleep increased by about 15 minutes. That sounds small. Is that meaningful? That would be considered a large increase in sleep duration. If you have an intervention for insomnia or, you know, behavioral intervention or, you know,

Starting point is 00:11:58 pharmaceutical, pharmacological, a 15-minute increase would be, you know, in the intermediate, potentially, you know, clinically relevant increase in sleep duration. So that, especially over the course of a month and to have that sustained. So that's actually, it may not sound like it, but, you know, over the course of a week, that's nearly two hours and then, yeah, it adds up. And then with that increase in sleep duration, there was not as much of a change in wake after sleep onset, which is basically the time after the sleep episode has started. So after you initially fall asleep, how much time are you awake during the night? Because whether or not people remember that they wake up, people do wake up several times over the course of a sleep

Starting point is 00:12:50 episode. And so wake after sleep onset is one of the ways that people would define sleep quality because if you are spending a lot of time in bed and have a lot of that time being awake, then, you know, that would be a lower sleep quality than, you know, it's normal to have some time awake, but if that deviates too much, then it could be a sign of a sleep condition or something like that. So, but encouragingly, people were spending more time to sleep and not having a huge jump in wake after sleep onset, meaning that people weren't just spending 10 hours in that 10 hours a day in bed and then having only a 15-minute increase in sleep. Right. So what you're saying is they spent more time in bed and that added

Starting point is 00:13:41 time in bed or ended up being time sleeping, not just time kind of rolling around because you don't have to get up. And the fact that when they extend their sleep operations, they fill it with sleep may suggest that they had some like unmet sleep need, right? We're somewhat sleep deprived prior to the onset of the pandemic. So, you know, I know that it's been a rough year for everybody, but maybe a silver lining is decreased sleep debt. Yeah, exactly. And then the other things from a sleep perspective that were observers that bedtime was

Starting point is 00:14:16 about moved from about 10.50 p.m. to just before 11.10 p.m. And wake time during that first, and that was consistent during both intervals. So kind of this, this delay overall. And then wake time was about 36 minutes later in that first interval. And then that moved forward to 25 minute delay. So it's interesting because people had the ability to self-select their their bedtimes a little bit more and their work time. So, you know, most of the WOOP population, at least that we were working with was employed. And so, you know, if you're working remotely, maybe you have more flexibility. And when you can get your work done for at least me, I know a lot of people that meant spreading it out over the course of the day a little bit

Starting point is 00:15:11 more. And so people going to bed later, but then waking up even later than their delay, is why we observed an increase in total sleep time. Yeah, and I think this finding was particularly interesting because as Mark was saying sort of when commuting pressures and social pressures and all these things were removed during the physical distancing mandates, we saw that people started self-selecting to go to bed earlier and wake up later.

Starting point is 00:15:38 And that what that means is that life was sort of forcing us previously to be earlier, you know, earlier to bed, earlier to rise than our natural tendencies were. And so one of the potential takeaways here for, you know, as we quote unquote return to normal is that if people have this natural tendency to want to go to bed later and wake up later, if we shifted this nine to five to like a 10 to 6, so still keep your normal workday,

Starting point is 00:16:08 but shifted a little bit later, you might actually be catering to people's innate preferences better than this current default 9 to 5, which the data seems to suggest is actually physiologically misaligned with natural preferences. So that was definitely a cool finding. Yeah, and it's an interesting concept and one that I think has continued to be more salient as there's more artificial light at night and kind of more technology in the home and that sort of thing. And then the last thing was that sleep consistency, and I know that the WOOP community is very familiar with that concept, has increased by about three and a half points during that first month.

Starting point is 00:16:54 And then unlike the sleep duration or wake time, which kind of started to revert to closer to the pre-pandemic measures, sleep consistency continued to increase during that second interval up to about a four-point overall increase out of a hundred. So that was cool. Yeah, and we'll link this in the show notes, but we published on the locker, gosh, I think three years ago, two, three years ago, some early research showing that when you increase your sleep consistency, your sleep quality improves a lot. And so we see the more slow wave sleep, more REM sleep.

Starting point is 00:17:33 And so by, you know, taking away some of these social pressures that cause us to have really inconsistent sleep, mostly very different sleep schedules on weekend nights than on weeknights. We've probably improved the quality of our sleep by doing that. Yeah, yeah. Yeah, bringing in mental health, we found that adjusting for demographic and lifestyle variables, so that's things like gender, age, race, ethnicity, employment status, unpaid caregiver status, physical activity and alcohol use. So other things that may be contributing to differences in mental health that may be observed when you're looking at a population, we found that people who had persistently short sleep duration or low sleep

Starting point is 00:18:22 consistency had higher odds of adverse mental health symptoms. And so for each of these comparisons, we focused on sleep duration, which has a very established link or relationship with adverse mental health symptoms and then also sleep consistency, which is kind of more of an emerging measure to look at. So for sleep duration, comparing people who had slept for fewer than six hours per night before the pandemic and then also during the pandemic versus those who had slept for more than seven hours during both those times, the people in a short sleep group had 1.8 times the odds of anxiety or depression

Starting point is 00:19:07 symptoms and 1.6 times the odds of burnout symptoms compared to that, you know, sufficient sleeper group, I guess, we could call them. And then from a sleep consistency perspective, the kind of three groups were under 70, 70 to 80, and then over 80. And the group that was consistently under 70 compared with the group that was consistently over 80 had, again, 1.7 times the odds of anxiety or depression symptoms, 1.8 times the odds of burnout symptoms. And then also, there wasn't an association for sleep duration, but in sleep consistency, that low consistency group also had more than two times the odds of starting or increasing their use of substances to cope with stress or emotions during the pandemic.

Starting point is 00:20:00 So really robust associations with each of these measures, if we're looking at kind of short sleep duration and low sleep consistency. It's fascinating to see that there are things we can be doing, you know, in controlling our own sleep behaviors that, you know, may be protective of mental health. But, you know, for a good reason, a lot of the focus for the last year has been on the COVID pandemic. But I think, you know, an important message of all of your research has really been that there are other almost like concurrent pandemics going on. So I don't know if you want to talk about that

Starting point is 00:20:37 a little bit. In any given year, an estimated 18% of U.S. adults suffer from a mental health condition. And there's a 50% lifetime prevalence over the course of, you know, life. And this is not any given year. So, you know, as I mentioned earlier in the podcast, three to four times the prevalence of anxiety or depression symptoms, other adverse mental health symptoms and substance use have also increased during the pandemic. And so I think, you know, even before the pandemic, the loss productivity as a result of anxiety and depression alone cost the global economy a trillion dollars per year. And the total cost of all poor mental health is estimated at 2.5 trillion, and that's projected to increase to 6 trillion by 2030. That's before the

Starting point is 00:21:34 pandemic and its lasting effects. There is a lot of evidence suggesting that it's beneficial to, you know, there's a high benefit to cost ratio for investment in mental health resources with about a 4 to 1 return in terms of better health and productivity. But despite that kind of government spending across, you know, 170 countries that were surveyed by the World Health Organization in 2017 found that mental health expenditure accounted for less than 2% of government budgets. And I think one of the silver linings of the pandemic and its impact on mental health has been kind of getting the conversation started a little bit more. So I'm grateful, Emily, to have the opportunity to share that if someone is, first of all,

Starting point is 00:22:33 you're not alone if, you know, their mental health challenges for, for anyone. And then also seeking help is one of the strongest things that you can do. So we're going to post some links to some national and then global mental health resources with the podcast. And, yeah, really their mental health is health. There is this mental health pandemic kind of concurrently going on with, you know, this respiratory virus pandemic that we all think we're talking about. I think everybody thinks like, oh, we're vaccinated and everything's going to go back to normal now.

Starting point is 00:23:14 And, you know, this massive increase in mental health disorders, like aren't going to disappear with the vaccines. And so I think that one of the things that this is a lot of the things that this is a lot of this paper points to that's so important and why I feel like so lucky to have been a part of this research or honored to be a part of this research is that that's not going away. And I think that being able to draw attention to the fact that this thing, which really didn't get nearly as much attention as COVID itself, is very much real and something that, you know, we're not just going to pop back into quote unquote new normal.

Starting point is 00:23:49 Like we do need to address this. And now that the immediate threat of COVID itself is gone, I think we do need to shift our attention to this because, you know, it's really dangerous. People die from mental health causes all the time, you know, as Mark unfortunately was pointing out. And so, you know, I think it's really important that we're linking all these resources here. And, you know, as Mark so beautifully said, mental health is health. This is every bit as important and every bit as dangerous. And, you know, we'd be every bit as remiss to ignore this as, you know, we were. to ignore the early stages of the pandemic itself.

Starting point is 00:24:24 Mark, if people want to learn more about the COPE initiative and the mental health research during the pandemic that you've been working on beyond this one project with WOOP, where can we find that? We'll post the link, but it's www.thecoopinitiative.org. And we also have a Twitter at COPE initiative is the handle, and we regularly post updates about what's happening. in the world of the COVID initiatives.

Starting point is 00:24:53 Awesome. Well, thank you so much for joining us today on the pod and for all the incredible research that you've been doing. Thank you for having me and everyone for listening. And, yeah, really to the entire WOOP community for, you know, helping to make this COVID resilience project happen. Thank you to Emily and Mark and the whole COVID resilience project for this amazing research.

Starting point is 00:25:17 A reminder, you can use the code Will Ahmed to get 15% off a WOOP membership. Also, subscribe to the WOOP podcast, rate the WOOP podcast. We'd love to hear from you. You can follow us on social at Woop at Will Ahmed. Stay healthy, folks. Stay in the green.

WHOOP Podcast - How sleep affected mental health during the pandemic

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