WHOOP Podcast - The 7 Day Sleep Remedy with Dr. Aric Prather

Episode Date: November 29, 2023

On this week’s episode, WHOOP VP of Performance Science, Principal Scientist, Kristen Holmes is joined by Dr. Aric Prather. Aric is a Professor of Psychiatry and Behavioral Sciences at the University of California, San Francisco. He co-directs the UCSF Aging, Metabolism, and Emotions Center, is the Interim Director for the UCSF Center for Health and Community, and serves as a clinician at the UCSF Insomnia Clinic. He is also the author of The Sleep Prescription, a book that offers a simple yet powerful plan to improve your sleep in seven days. Kristen and Aric will discuss the AME Research Center (2:39), sleep impacting immune function (5:37), the connection between sleep and metabolic health (13:13), restrictive eating windows and sleep (19:51), The Sleep Prescription (25:25), labeling the worry (37:38), debunking sleep myths (42:11).Resources:Dr. Prather's Website The AME Research Center Support the showFollow WHOOP: www.whoop.com Trial WHOOP for Free Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

What's up, folks? Welcome back to the WOOP podcast. At Woop, we're on a mission to unlock human performance. I'm your host, Will Ahmed, the founder and CEO of Woop. I hope everyone is having phenomenal holidays. Our last podcast was the holiday hacks. And this one is WOOP VP of Performance Science, principal scientist, Kristen Holmes, being joined by Dr. Eric Prather.

Eric is a professor of psychiatry and behavioral sciences at the University of California, San Francisco. He co-directs the UCSF aging metabolism and emotion center, is the interim director for the UCSF Center for Health and Community, and serves as a clinician at the UCSF Insomnia Clinic. He is also the author of The Sleep Prescription, a book that offers a simple yet powerful plan to improve your sleep in just seven days. How about that? Eric's research is regularly featured in the New York Times, the Wall Street Journal, The Tays Show, and NPR. Kristen and Eric discuss Eric's research at the AME Center, how sleep is working with immune systems and vaccines, sleep impacting your metabolic health, sleep can actually be a big help when it comes to losing weight, the link between time-restricted eating and sleep. Eric's book, The Sleep Prescription, he touches on the small behavioral changes that can impact your sleep, mental health, and energy levels, and myths around sleep and stress.

This is a timely podcast. If you have a question, you want us to see answered on the podcast. Email us podcast at whoop.com. Call us 508-443-4952. Without further ado, here are Kristen Holmes and Dr. Eric Prather. Dr. Eric Prather is a professor of psychiatry and behavioral sciences at the University of California, San Francisco. Eric's research program focuses on the causes and consequences of insufficient sleep with particular interest on how poor sleep. impairs mental and physical health, including immunity and her health. His research has been

supported continuously by the National Institute of Health and spans large-scale analysis of populations down to laboratory-based experiments and everything in between. You will learn more about his research throughout our conversation today, but you can also pick up his amazing book, The Sleep Prescription, and learn how to improve your sleep in just seven days. Eric, I think a great place to start would be to understand a little bit more about your research and what you've discovered over the years and how that's informed your clinical practice. Yeah, absolutely. And thank you for kind of let me have this conversation with you. I'm really excited about it. So the AME Center, so that's the aging metabolism and emotion center here at

UCSF. And so I co-directed with Dr. Alyssa Epple. And we've been kind of, you know, close colleagues and friends for, you know, gosh, before I even went to graduate school, she was, she had just finish your post-doctoral fellowship at UCSF. And so it's been so wonderful to come back here. I mean, I've come back here. I've been here for over a decade now. And, you know, the work that we do together really focuses on kind of this interplay between kind of stress and emotion.

And I really dig deep on the sleep piece that makes up kind of our lives, right? And we know that these things interact with one another and have. kind of deep and profound impacts on our biology. And so we're always trying to unpack that, whether it's metabolism or aging biomarkers or mental health outcomes. I've really focused in on the sleep piece because of kind of all that we know about how it really, I think of it as kind of the glue that holds our life together, right? And we know that intuitively. But But it also seems to have such an important regulatory role on various biological processes, right? So my training is in graduate school and going forward has been in psycho-neuroimmunology.

So really focusing in on how these behavioral or psychological or social factors drive variation in immune outcomes. And it turns out that sleep just plays such a fundamental role in that. And so we've, you know, had, you know, I've had really great collaborations and opportunities to be able to really dig into what are those clinical outcomes, whether it be vaccination or susceptibility to kind of the common cold, if people are exposed, all of those are clearly linked to the sleep that we get. And I think the important thing about that, like, one, it's important on its own, like to really to verify this in the research. but, you know, we know how to intervene on sleep, right? It's such a, it's one of those things that we have a really great toolbox to get people sleeping better. And now we have shown that it makes a big impact on their health. And for me, that's really a passion. I love it. Yeah, I mean, it's, there's no question. Sleep is just absolutely foundational. As you,

as you point out, just impacts every, every aspect of our lives. And, you know, when you talk about from an immune standpoint. Can you, you know, what if you, what have you really found in your research in terms of how sleep impacts immune function and just our ability to be resilient to various diseases, how we accept vaccine, for example, I think it's another area that you've looked into. So, you know, I mean, like this, this work has, you know, really developed in kind of the animal research and then had been kind of carried forward in experimental studies in humans. And we see that, you know, both sleep and circadian factors contribute independently to kind of the number and the function of various immune kind of cells and subtypes that have relevance to how

we protect ourselves against viruses and, you know, have been linked to things like, you know, chronic disease conditions like cardiovascular disease, type two diabetes, those sorts of things. And that's really kind of the role of inflammation. And we've done a lot of work on that. You know, in general, what we and others have found is, you know, on the inflammation side and this chronic disease condition side is that, you know, when people get insufficient amounts of sleep, so that can be kind of typically less than seven hours on average for an adult, that puts people at risk for elevation in kind of inflammatory biomarkers like, you know, pro-inflammatory markers

like interleukin 6 and C-reactive protein, which are, you know, on the pathway to a variety of, you know, age-related conditions. And then where we probably, you know, really dug deep in our group has been in the context of infectious illness. So we've done this in two primary ways. So in collaboration with Sheldon Cohen at the Carnegie Mellon University, who's kind of world famous for doing these cold exposure studies. We were able to, you know, bring in a group of people around 160 of them. They were all healthy. We measured their sleep kind of objectively using wrist actigraphy. So kind of kind of like the, right? Just ones that we do use in the laboratory and, you know, measured it, got a good, stable average. And then everyone was brought in and

exposed to the same amount of live virus. In this case, it was the rhinovirus. And then they were quarantined to see who, in fact, got sick. And so, you know, what fascinating to me is that, you know, you give everybody rhinovirus or any virus and not everybody gets infected. You know, it's a, you know, a significant proportion, but not everybody. And then of those people, not everyone actually gets sick. And so we, you know, we had to, we didn't want to rely on people's self-report about their symptoms and things like that. We measured it objectively. And so we did that in two ways.

I mean, first, we ensured that they were infected. And so every single person. You know, we wash their nose every single day and then culture the cells to see if the virus was replicating and if it was that they were infected. And then for symptoms, we actually collected all the tissues that they used throughout the day, kind of got them in a baggie, weighed them and got an objective measure of mucus production. And then in a second step, had everybody every single day kind of put their head back and we squirted a dye into their nose and then timed how long it took to. to get to the back of their throat. And the longer it takes, the more congested they were. So it was kind of a, you know, a good measure of nasal congestion.

So the combination of being infected and then meeting some thresholds on mucus production or a nasal congestion, those people were deemed to have a cold, to have a biologically verified cold. So it became, you know, we do all of this work and then we just get this kind of yes, no outcome. Like, you got a cold or you didn't. And what we found and, you know, it has been really profound. And I think is kind of the strongest empirical evidence. that we have that sleep plays such an important role and susceptibility to infectious illness

is that, you know, people that were shorter on sleep, particularly people who were getting six or fewer hours per night on average based on this risk device, were about four times more likely to get a cold, you know, to meet this threshold than people who slept the recommended, right? So the seven hours or more group or the more than seven hours group. And so, you know, and again, everyone got exposed. You know, it was like that was controlled, but sleep played such an important role. And then we, you know, controlled for all of the important confounds that might also explain this. And it just was this independent effect that we've now kind of replicated with a larger set of data that just uses self-report sleep duration. And so we see that same thing. And we've seen it, you know,

time and time again in the population level epidemiology. And so this is some, some really clear evidence. Of course, we can't, can't do that type of study over and over again. And it's, you know, and so it may not be as health relevant in kind of a policy setting. And so we've kind of moved since then into vaccinations, right? And that has been really clear too, at least in the work that we've done that, you know, we've done it in the context of hepatitis B vaccination series. We've done it using the influenza vaccination series. And just most recent, recently, Alyssa Epple and I have just closed our study looking at the COVID-19 vaccine. And in all instances, we found some signal that suggests that when people have shorter amounts

of sleep or poorer sleep, they don't just, they just don't mount the same level of responses that we think are critical to protect us from a virus if, in fact, we were exposed to it. right so this has important you know policy implications right like as far as the messaging you know we've taken it a step further in the context of a study that we did in influenza where we wanted to know is there a particular day that matters when people get sleep right like if we were going to try to help people understand like obviously everyone should get as much sleep you know that they need all the time but like when we actually do vaccines and and people are going to get get that administration is that something that we want to include in the messaging. And so in this one small

study that certainly needs to be replicated when people got the influenza vaccine, we looked at kind of how they slept on each night, kind of leading up to the vaccine and the nights after it. And in this case, we found that when people got more sleep the night before the vaccine or the night before that, that seemed to be a strong predictor of how they responded in the future with respect to their antibodies. So, you know, if we're able to replicate that, maybe it is something that we can, you know, you know, consider in the messaging that like, hey, you're getting a vaccine, try to get a good night's sleep. You know, obviously the message shouldn't be, you know, if you don't get a good night sleep, you shouldn't get the vaccine. So we need to be careful

there. But certainly, you know, it's a good place to really raise the profile of the importance of sleep for something that, you know, since the pandemic, it's clear that this is going to be something that we face moving forward. And, you know, the more that we can amplify the protecting signals that our immune system creates, the better. You know, one other thing I wanted to talk about is you do, you're doing tons of work, the consortium for obesity assessment, study and treatment, also known as Coast. If you want to talk a little bit about that, because I think oftentimes folks don't associate the quality and sufficiency and consistency of their sleep with with metabolic outcomes, but there's obviously, you know, clear mechanistic connections there

and would love for you to just dig in a little bit into kind of what you found with that study and how sleep can help folks manage their metabolic health more effectively. Yeah, I mean, there's, there's, you know, so Coast and the other groups, you know, there's a nutrition center here at UCSF as well. And sleep is always been kind of a pillar for understanding those things. Because we know from kind of lots of experimental literature that, you know, when we deprive people of sleep, it not only impacts directly our metabolism and including things like insulin resistance and glucose regulation, but also kind of appetite hormones like ghrelin and leptin and shift us towards kind of a phenotype where, you know, You know, we may have, you know, increased hunger just because of – and I think what, you know, there's a really kind of elegant study that was done several years ago where they, you know, really controlled all aspects of the environment and people's kind of sleep and light exposure and found that – because there was always this concern that, well, you know, yeah, we know that when people don't sleep enough, like they eat more or they gain weight, is it really – I mean, your body's up longer. Like, is it just about kind of maintaining alertness and metabolic demand because of this prolonged weightfulness?

And it turns out that kind of when you control all of those things, that's not the case, that people will still eat more than their body requires. I think one of my most favorite studies is one done by Benedict and colleagues in Europe where they actually built a grocery store and they deprive people asleep. And so, you know, because it was more than like, oh, people have these preferences. do they really have these behaviors and they were given a set amount of money and they filled up their grocery cart and it was just like overflowing with like high caloric foods and it was like oh my gosh if given the chance you would do that and we all you know we all know that experience right like you know you have you've had a crummy day and you're like oh i'm going to have that salad for lunch you're like well but i i don't know i deserve the pizza today i mean it's been a tough day and and that's that's like

embedded in our biology and you see the same sort of thing with i mean and i don't know when when alissa was on, like, you know, is the same thing with stress, right? And so, you know, insufficient sleep and stress have kind of a lot of the same underlying biology. And so, you know, there's this kind of need to kind of, and it's possible that some of this is due to the stress response that you're really trying to dampen that down because of the insufficient sleep. And so, you know, we've kind of, you know, been looking at these sorts of things, both, you know, in different studies of like interventions, so like meditation trials and things like that and the role of sleep as like a moderator, does that impact how people kind of do, you know, improve in kind of weight outcomes

or metabolic outcomes. We did a really interesting study just using epidemiologic data, you know, tens of thousands of people and found that, you know, people that were short on sleep, we're much more likely to consume high amounts of sugar sweet beverages. And, you know, so you're trying to understand these links and what they might mean in the long term for people's health. But, you know, I mean, there's, there is just like a whole lot of work there. And we do know that, you know, when people go long periods without sleep, say chronic insufficient sleep, kind of they do put on the pounds. And it's not, it's not just a lack of willpower, right? There's like something happening below the surface that, you know, pushes you towards kind of this more

obisogenic status and, and again, underscores the importance of like why sleep should be a target because it can, it can have a, and I mean, the last thing I'll say, I mean, just around that is, you know, one of the other things in the sleep world that that really matters is obstructive sleep apnea, right? So this is a condition where, you know, that is, you know, very prominent and it increases with age, and it is kind of the tendency to kind of stop breathing to have, you know, occlusions in your, your respiration during the night, right? And that causes sleep fragmentation, that causes kind of sympathetic nervous system like surges and increases in cardiovascular, you know, outcomes like blood pressure and all these other things. And it,

it happens much more frequently with weight gain, right? So it's not just that sleep contributes to weight gain. Kind of the weight gain in turn can then lead to these sleep disorders that thankfully we do have some treatments for, but it becomes this cycle, right? And we know that when people have obstructive sleep apnea, probably because of the insufficient amounts of sleep that they're often getting, it's really hard to lose that weight, right? So then, you know, we really, you know, it's complex, but we do know that sleep in a lot of times is the lynch pen for some of these things.

So if we're just up for more hours in the day than what's typical, that is, you know, we're not getting seven to eight hours of sleep. So in theory, we're up longer. We're eating more calories. Have you found in your research or have you seen in any other research where folks end up biasing their calories toward closer to when they sleep? Just, we know, of course, glucose tolerance is higher earlier in the day than later in the day. So, you know, in my view or in what I've seen in our data, millions of sleeps, lots of logging food and the timing of food.

I'm very, very, of course, interested in the temporal aspect of things because I think that there is a knowing what we know about metabolism and when we're primed to kind of digest a metabolized food, we know that we're better at it earlier in the day. Like closer to when we wake up, we're going to be more, you know, able to. to deal with food and we've evolved to digest during the day, not during the night. So once the sun goes down, we're not as insulin, we're more insulin resistant. So I guess I'm wondering, you know, to what degree have you, do you know, I guess this concept of time restricted eating, we can talk about it through that lens, but, you know, is that an intervention that you deploy in your clinic to kind of help people, number one, sleep better, right? It's hard to digest and sleep at the same time, right? We know that. And just we know that glucose tolerance is is lower

later in the day. So given those two kind of profound things, like how much do you, you know, promote these kind of restricted eating windows that are, you know, yeah, get us away from. I mean, I, I mean, I love this question. I mean, it is absolutely, you know, I feel like every week there's a, you know, like a high impact study on this topic in a very variety of domains. And I, you know, I sit on, you know, grant review panels for the National Institute of Health. And I, I have been struck by how many groups are interested in this topic and the, and the level of evidence that is already accrued. So it, I mean, it does seem that, I mean, and it's usually been in the context of like time restricted eating. And it's like, and it's usually an eight hour window and it's usually like 11 to seven or 12 to 8 or, you know, 10 to 5 or 10 to 6 or it is striking how effective it seems to be for improving metabolism. And maybe as a consequence, sleep. You know, in our clinic. Our data is wild. I bet. I want to see it. I want to, I want to hear about it. Like it's, we're about to launch the largest time restricted dating study ever done. I that's amazing that's amazing uh yeah it's exciting uh congratulations um and and so you know I mean it it it's definitely you know I think this area of kind of like chrono medicine and you know

as a as a related thing time restricted eating I think is has has a lot of legs and I'm like really excited to see how how it goes with respect to sleep I mean and in our clinic and in our practice. I mean, we, you know, it's, it's primarily focused on insomnia. And so, you know, certainly, you know, trying to regulate people's eating times and keep them consistent and ideally not too close to the time that they want to go to bed is important. And, you know, if people are kind of have wildly shifting eating times, then we'll kind of use that in part because of the role that eating has in regulating your circadian rhythm. So kind of as a zeitgeiber or helping to entrain the rhythm. And, you know, so we do that. And then kind of the types of foods that

people eat. I mean, the general idea is that like, you know, obviously not something too heavy, too spicy. We don't want to kind of disrupt people's sleep in that way. But I mean, you raise kind of, I think there is a lot, like I have a colleague here who is in private practice that is a insomnia researcher, but also like really heavily involved in like kind of lifestyle medicine. And, and I've been really intrigued in kind of her recommendations. And, you know, some of it is we think it works, but we're not sure, but like, you know, it's probably not going to hurt, you know, those sorts of things. But I mean, I do think there's a place for for some of these things. And I, but I think we need more data to, you know, at least as like a provider to before I, you know, the level of

evidence before we start recommending. Yeah, yeah. But I mean, And, you know, it is interesting. And again, this idea of this interplay between sleep and circadian science is, you know, there are probably so many sorts of things that will enhance our overall health and well-being once we kind of marry those things more carefully and thoughtfully. So that's really exciting. I'm excited to hear how it goes. Yeah, yeah.

I'm excited to share. It'll be really cool to see the data. It's been kind of a long time coming. You know, we kind of, you know, obviously are sitting on loads and loads of data, and we have lots of journal data. So we kind of know when people are, they log when they're eating their meals. So just looking at their data, this isn't controlled, right? This is just kind of in the wild.

And this next study will be, is going to be controlled based on kind of those initial findings. But like a like a randomized study? Yeah. Oh, awesome. Yeah, yeah. Yeah. So it's a bit randomized controlled trial. But what's really interesting is.

and the data is, you know, we're able to, we see when folks log, report eating meals two hours prior to bed or within two hours of when they intend to sleep, we see drastic reductions in markers of sleep recovery on part of alcohol. So same sort of, you know, like alcohol is the big, you know, needle mover. You know, when folks report drinking alcohol, yeah, it's just massive. Every single time. Yeah, every single time. Like, there's no getting away from it. But food seems to have kind of a similar, similar impact. So, yeah, I think it's worthwhile to kind of dig into it further just to see exactly what's happening. And, you know, if certain windows are better than others and, et cetera. So I think to your point, there's a lot to, I think, still learn. Your book is so

beautiful, the sleep prescription. And, you know, it's a practical guide to getting, I love how, I forget who said this, and maybe it's just the way that the book is described, but getting out of your own way in changing your behaviors to set yourself up for a better night's sleep. So we talked about, you know, sleep in immunity, you know, sleep in metabolic health. Obviously, sleep impacts your cardiovascular health. Sleep is going to impact your, how you manage and think about stress during the day. Based on, you've just got all this clinical experience, all this research experience. Number one, what led you to write this book? If you can just kind of outline what this like optimal prescription is to help people get on on the right track to to getting the best night's

sleep. Yeah, absolutely. Yeah, I mean, it was, I was really fortunate to be able to do this. And, you know, I, I love talking about sleep. I love, I like, I like him like all in on this. And I wasn't always this way. I don't, I don't know. Just over time, I just became so convinced that it was such a, you know, I mean, you know, some of it's just like selfish. Like, I love how I feel when I help someone. And it just has so much. just has such a profound effect it's it really is like i you know some of licensed clinical psychologists and but i would you know i i've always done mostly research like almost a hundred percent research and i wasn't even sure i would ever get licensed and then when i was on clinical

internship which is what you have to do like before you finish graduate school i did it at duke university and i uh for this internship and i i got trained in cognitive behavioral therapy for insomnia by by kind of one of the leaders in the field jack edinger and i was like wow. I mean, if I ever get licensed, this is all I'm going to do because it's like, it's behavioral. It's like, it's time limited. And it's like so effective. And so, you know, in doing it over these number of years in our clinic, I was like, but, you know, our wait list is so long. It's like hundreds and hundreds and hundreds of people long. And it's, you know, they're on the wait list for like six months and there's just there's just no way we need to scale this and lots of people are talking

about how to scale this and there's lots of ways to do it and and and so then just by happenstance alissa epil had like signed on to do a book so this you know the sleep prescription is part of a series right so she wrote the stress prescription and then the john and julie gotman who are like you know world famous you know super famous uh relationship researchers wrote the love prescription. And so, you know, they were looking for someone to do the sleep one. And, like, my office is just down the row from, from Alyssa. And, you know, we're so close.

She's like, well, I know. So what I was like, oh, my gosh, like, this could be the, like, the way to try to reach more people, you know? And so, like, I was really fortunate. And the goal was to kind of just distill the principles of cognitive behavioral therapy for insomnia for kind of just for the general public, right? Because I think, though it is not a substitute for that, like, you know, that is a very clear, you know, empirically supported treatment, the principles that create that program are based in sleep science, right? And, and kind of psychotherapy and psychology.

And so, you know, it seemed like this was an opportunity to do that. And I also think, you know, the premise of this particular book is. is that, you know, we spend a lot of time. When people have trouble sleeping, they spend a lot of time worrying about their sleep. They spend a lot of time planning. You know, they spend a lot of time, like a lot of effort that goes into kind of the first, the hours just just leading up to sleep, right? But in fact, the best opportunity to improve your sleep like begins as soon as you wake up.

And so the idea is that, like, you know, you can do things, be intentional over time. like from the moment you wake up to put yourself in the best position. And then the other piece of it is like, you know, and this is true for, you know, cognitive behavioral therapy for insomnia or CBTI as well. It's like the real goal is to get people to like not worry about their sleep, right? Like you can never promise that tonight's going to be perfect, right? Like when you start going down that road, you've usually lost because, you know, that effort, that distress, that thinking, that worry about how to.

I make my night, like the best night I can have, gets in the way of our ability to sleep well. I say that, like, you know, most people never even wonder how sleep works until it stops working. And then when it stops working, they get like super focused on like, how do I make this happen? But sleep is not something that we make happen. Sleep is something that happens to us, right? It like kind of washes over us. But, you know, because it's adaptive to be able to kind of not sleep.

right like ask any parent ask anybody that's been in an you know any kind of emergency situation we can override those sleep signals with our worry with our anxiety with our distress with our behaviors and and so you know this book and cbTI is really about like how do we structure it structure your your sleep experience you know starting when you wake up to take the effort out of it take the thinking out of it like let it do what your body is like built to do which is to sleep, right? And so in doing so, you know, we start with kind of like, I mean, just like I do in clinic, like if we could change one thing, it's like start to stabilize your wake up time, right?

And that's based so clearly in what we know about sleep science. So, and circadian science. So it's like, you know, setting a stable wake up time kind of helps and train your circadian rhythm, right? ideally you get some sunlight exposure right as soon as you wake up and then then you can kind of shut down that melatonin system and it and it turns out that like our just our body works so much better when things are predictable would you say that it's more important so this is what I see in the data that it seems that that sleep wake time no question if that's

consistent it trumps duration we see so we see independent effects the more stable your sleep wake time, it almost, you need to spend the records of time in bed, but if you can stabilize sleep wait time, your markers of recovery and your psychological functioning, so we do lots of subjective measures kind of running alongside the physiological data that we're, and we see no question that workplace resilient, psychological functioning, you know, all these markers of resilience improve physiological and psychological when we have stable sleep wake times. So onset does matter, but I think to your point, offset really, really matters. So would you say if a person's prioritizing or trying to, you know,

figure out, okay, do I try to sleep in on Saturday morning or do I just, you know, wake up at my usual time? And you're saying that, hey, waking up at your usual time is actually going to be better than experience. Yeah. Well, so yeah. I mean, so yes, that I do make that case that, you know, waking up at the same time each day is kind of like the one. Also, it's like about control. Like, you can control that, right? We can't control when we fall asleep. I mean, the good news is that if you, you maintain a stable wake time because of the second thing that regular to sleep, which is like our homeostatic sleep drive, it, you know, our days aren't that different from one another, like the energy we expend, like it just isn't. And so you'll start to get

sleepy around the same time each day because like, you know, we're awake for a certain amount of time because we're humans, right? And that varies, right? Like, you know, there is, it is not one size fits all, though most people, it's like around seven, eight hours, seven, nine hours, but for the sleep need. So that is true. I guess around the sleeping in thing, I, you know, I try to take like a more gentle approach around that because these recommendations are for people that want to sleep better, right? Like I think it's a rule and the data is accruing that when people have this kind of social jet lag, this like waking up, you know, getting less sleep and then sleeping in on the weekend, that does seem to have independent metabolic and long-term health effects. Mental, huge mental health effects.

Yeah. And yeah, sure. And I mean, and, but, you know, it's, is it like, so the mental health effects are interesting. I like wonder what your thoughts are on this. I, I guess I, my first guess would be it's not about the shift. It's about because the reason they need to do the shift. Like, it's like. And so when I think about like, you know, people that have these big swings, sometimes it's like, okay, yeah, you're having to sleep in on the weekend. But like, isn't that maybe a symptom of, like, you know, people that have these big swings. Sometimes it's like, okay, yeah, you're having to sleep in on the weekend. But like, isn't that maybe a symptom of, like what's going on in the week? Like what is this that like you're not getting this? Like what else is going on in your life that's like structuring it in a way that you feel so compelled or your body feels so compelled to try to make up this amount? You know what I mean? Like I and so you know, I wonder if that is versus the actual like physiological outcome of shifting, right? And like maybe it's somewhere in between. Dependation for sure. Yeah, yeah. So the point I was I was trying to make was that like, you know, people, like, I never want to be say like, no, you can't sleep in on the weekend anymore. Sorry, I'm like the fun police. And it's like, you know, sorry, this is your

life now. It's like, you know, but if you're trying to improve your sleep, like if there's something that you perceive is wrong or you're not feeling good during the day, you don't feel like you're kind of optimized or what have you, like this is something you can do, right? Like, this is a very clear, concrete thing that you can control. And, and then it's like, up to you. Like, this is the information I'm giving you. Like, we know that this works. And, and where do, where do you, you know, where are you on kind of the behavior change journey to like take it up, right? And, and, and maybe there are things that like, maybe are, will be more or less motivating for you, but, you know, and then this is where we get into, like,

you know, what are the kind of motivators or, you know, reward systems that we can put in place to get people to do it more often, right? So, so we always like, I always talk about like tying kind of the awakening to something that you find pleasant. Right. So it's like, you know, whether it's like, you know, here in San Francisco, it's like, yeah, coffee, coffee or like, you know, like if you, you know, if you have a family, like that time alone by yourself like before everyone else is up. Like that's like a really special time for some people. I mean, certainly for me, I've gotten really into sunrises, you know, like it's like just. I can have that time. So, but, but, you know, I mean, and that and that is just it's, but it's, but it also has like such a clear kind of physiologic impact on like house. how your day and sleep is regulated. And so that's such a great place to start. Yeah, I love that. Yeah.

And then, you know, and then, you know, throughout the day, there are things we can do too. I mean, and a lot of it is like around like stress management and, you know, ensuring that, you know, you're kind to yourself, right? And like, because, you know, oftentimes the world is not, right? Like, there's a lot of demands. There's lots of pressures. And, you know, everyone I like the thing is like doing their best, you know, and like they're not trying to make people feel that pressure, like in their jobs and stuff like that.

But like, you know, everyone has their thing. And so just but being intentional about, say, taking breaks, doing meditation, ensuring, you know, scheduling out time for, for worrying, right? So that it doesn't seep into your night. So we always do like a worry time exercise where people kind of like break out and say for 20 minutes, like write down all the things that they're worried about or talk it out. or, I mean, one, it's like taking a break, but being active and intentional, but also, you know, in the middle of the night, we find that, like, you know, people can kind of have a shift in their thinking and say, like, no, I already worried about this today. And I have it scheduled for tomorrow. Like, I can do this when I'm more kind of feeling at my best. And just that practice helps people kind of shut it off, right? To like allow themselves to drift back to sleep. And so, you know, those are day things, but I'll stop there. No, it's amazing. So stabilizing kind of that wake-up time, being as consistent as possible, viewing

sunlight in the morning, and then love, you know, this concept of managing stress throughout the day. Because invariably, if we're not proactive and managing the stress, that's going to seep into our sleep onset latency. It's going to impact our sleep on set latency. It's going to impact our ability to stay, to fall asleep and stay asleep. So I love this idea of the worry time. Would you say, as a clinical psychologist, like, to what degree do we need to label that?

that worry? Like how beneficial is labeling the worry to kind of mitigate or manage stress? Yeah. Would you say? Yeah. I mean, I mean, so, you know, there's like a whole set of kind of interventions that are around affect labeling. And I think there is something about around language and defining things. I mean, oftentimes, you know, for many of us, like myself included at times, like I'm just not particularly insightful about how I'm feeling, right? Like, Like, I'm just like, I feel bad, you know, and, and, and, you know, that, that's, that's hard to be actionable, like, to be action oriented or to, you know, identify and let something go when you don't have a name for it. And so I do think there is something to, you know, putting in some of the work to, to kind of be like, what is it that's making me feel this way? Or like, what am I really worried about? Because in some cases, like, these worries, though, are real. Like, maybe they're big or they're amorphous and you just can't get a hold of it. But the feelings is still there and is still real.

So the more you can give it shape, the more you can name it, maybe there is a solution. Or maybe you take a step back and you're like, oh, well, like, now that I've like really broken it down, it's not something that I should be so worked up about. You know, I mean, I think there's lots of different outcomes that can come from. But I do think actually the naming can be really helpful. And this is why, you know, when I recommend this strategy, I do find that kind of writing it down so that you can visually see it and track it helps people kind of, you know, find the thread of logic or illogic in that, you know. And then, you know, you can also like come back to it and potentially come up with other

solutions or reflect on it. You know what I mean? So I think that is helpful. Yeah. I find that to be one of the most powerful interventions for helping my own sleep. And we developed a feature that is available to our members. It's called the stress monitor. And it basically just monitors your stress throughout the day.

And it maps it on a scale of zero to three. And our algorithm is basically looking at real-time heart rate variability and heart rate. And the algorithm, and it basically just kind of maps your whole entire like 24 hours. And you can kind of see your stress during sleep. You can see your stress during the day, and it doesn't account for, of course, your activity stress, although we do show you when you're engaging in a high cardiovascular activity, like running or whatever. But what's really interesting is when I notice I'm spending, you know, it has my baseline, so how I typically respond and react to stress throughout the day. And when I'm above my threshold, that is, I'm in kind of a high stress zone relative to my baseline, I know that even though I wasn't like consciously aware, that I was in this high stress zone, the monitor will alert me that I was in this high stress

zone for longer than I typically am. And that's when I sit down, I'm like, hey, like, you know, I reflect on my day and I write about it and I label those emotions. And invariably, like I know when I actually go through that and proactively, you know, reflect on my day and my stress and I journal a bit, there's no question my sleep is better for it. So I do think there's something about understanding our stress and not being afraid of our stress, but having tools and strategies to manage it proactively, I think it gives us such a high degree of agency. And I think it's the agency that impacts our sleep in a lot of ways, you know, just feeling like you have some sort of strategy, even though you're not resolving everything in that moment where you're

journaling, for example, but I think that agency does bleed into feeling, you know, a a higher degree of control, which I think invariably is going to help us fall asleep and have a better night's sleep. Yeah, no, that's really interesting. And that's, I mean, that sounds really promising. Yeah, it's definitely an area that, yeah, I'd love for us to dig into that stress monitor data together and see the relationships between kind of sleep, stress during the day and how that manifests in sleep.

And, yeah, and then, you know, there, you know, obviously we see, you know, alcohol, for example, you know, the stress monitoring sleep is just off the charts. So I'd love to just kind of shift a little bit and talk. I know we're only got a few minutes, but debunking some of the sleep mess and just pressing into some of the behaviors that we know really do impact sleep. All right. So people often think that insomnia and sleeping less is kind of the only issue, but actually sleeping longer can really impact folks.

So, you know, I think you'd probably say that there's some sort of sweet spot. But what do you know about really long sleep and how does that actually impact, you know, mentally, are mental and physical and emotional well-being? Yeah, long sleep has such an interesting history and it comes up all the time. We, you know, if you look in the epidemiologic literature, you know, you regularly see this you-shaped relationship between sleep and whatever outcome you're interested in that like short sleep, which we focus on a lot is related. But this long sleep, say like sleeping, you know, in some cases it's like sleeping more than

nine hours, sometimes it's sleeping more than 10 hours, depending on the study, is also associated with kind of increased risk for kind of a whole host of outcomes. I mean, I think the strongest is in kind of like physical health outcome type thing. But I mean, I'll talk about that in a second that we honestly don't have a great understanding of like why this is, like why there is this strong relationship. And so historically, the thought has been like, well, it could be one of two things that it's it's that people that are long sleepers are actually ill right that it's like they there is some underlying illness that is making them sleep longer right because as you know take anybody that's had a cold you know a bad cold or something like that like our sleep has changed in lots of ways

but oftentimes it's like you just don't want to you don't want to get up you like you know you might be in and out of sleep and it won't be the most restful or robust sleep but it's like you know your body is recovering. And so maybe that's why we see this relationship between long sleep and negative health outcomes because they were sick already. And we did it now. And that this is just going along with that. The other most common explanation is that it might be something about depression, right? That like, you know, there are subtypes of depression or kind of, you know, phenotype characteristics of people that are depressed that sometimes include hypersomnia or like, you know, sleeping excessively long. Or, you know, we also think that, you know, maybe people aren't

sleeping per se, but they're just in bed for a long time and can't discern like if they're sleeping or not. But like, and so it's and those that, that depression is kind of well known to be associated with like lots of negative health outcomes too, physical health outcomes. And so, you know, maybe that is helping to explain this long sleep duration. But I mean, you know, given to the to the mental health piece, right? Like, yes, like people that are depressed can spend a lot of time in bed. They may have less motivation. They may kind of, you know, catch sleep more throughout the day, throughout the night. It's probably more fragmented, right? We do know, I mean, this is how CBTI often works is that we kind of restrict people's time in bed and that creates a more robust and efficient sleep,

even though they might be getting less than they think they need. But just, the fact that people are getting kind of this like kind of big bolus of sleep, it makes people feel better. It can improve their mood, all of those sorts of things. And so those two potential explanations have not been, you know, necessarily proven, right? I mean, they're kind of like, you know, post hoc, like, why do we see this? But it is consistent, like that this long sleep duration can be associated with negative outcome. So, you know, I mean, I guess we can only make so much sleep, right? So that's the thing. Like, we can only make so much. And if you, you, And but you can, you can structure it in a way that it can take up a lot of time.

But ultimately, it will lead to, you know, when you give yourself like a huge window for sleep, it will create this experience of like little bouts of sleep, like in and out. And people's subjective experience is such that it just doesn't feel good. Like it doesn't feel restorative. One of the things I'm really interested in is, you know, is there a way to, by looking at sleep architecture, a way to predict depression, you know, so... Oh, my gosh. So interesting.

Yeah, I know. I shorten REM latency and increased REM density and increased total REM duration are, I think, regarded as biological markers of depression. And I feel like, you know, if we can get, if we can use, you know, a VOOP device, for example, and be able to kind of understand, you know, how quickly folks are dropping into REM. I feel like that would give us a really nice picture of someone's like overall like mental health resilience. And as a way, you know, if it's when it's become shorter and shorter, we would

imagine that, you know, people are, you know, struggling more, right? So you can almost get ahead of it before you get to a place a point where you're fully depressed, right? Like you can kind of like, hey, things are going a little south. Like let's intervene before it's, you know, you're in a clinical situation. Yeah. I mean, you know, like so I think that's one. of the areas that, you know, is ripe for kind of innovation in the sleep space and sleep and mental health space. I mean, I think there are challenges, obviously, that, like, you know, depression is a syndrome, right?

So it's not, it's not like one thing. And so that's, that makes it a little bit harder. And then sleep, you know, I think my experience has been that there is so much in those signals, like this, you know, that they're like signal processors and machine learning and all of these things that can be done to try to take advantage of the depth of information that you get, say in a home sleep study or in a in lab sleep study that maybe at some some day can be kind of harnessed by wearable devices like the whoop. I mean, that's such an exciting kind of avenue.

But I mean, even if we just, you know, if we start at like the gold standard of measurement, which is, you know, like polysymognography, EEG measurement, we've just like scratched the surface in like what is done with those signals. Like, I mean, you know, so I didn't train as like a sleep physiologist or anything like that. So like I pick it up as I go along and I was like shocked that the like the sleep scoring system currently like for REM or slow, you know, N3 or N1 or N2, you know, all these sleep stages is like if you. have 50% or more of one, you get labeled that. And I'm like, that's, that seems crazy. But like, from a clinical standpoint, like that, I get that probably is sufficient, but not from a discovery standpoint. Right. Like, this is where like spectral analysis is so much stronger and whatever comes after that. And I, you know, I'm excited to work with the like signal process people that like,

so we can begin to understand that. And, you know, the national, you know, the NIH has, you know, created a national sleep research database where people have to dump in all. of their sleep studies. And I think, like, wow, like maybe that is where we can begin to do that. And, you know, there are definitely groups that are doing it. So it's really exciting. Yeah. I love that you're thinking about it, too. It's really, it's amazing. Marijuana before bed. Gosh, one of the most common, common things that people ask about, you know, we don't have a good handle on, on, you know, it's efficacy. I think, you know, this is another area where, like, I probably in the next five years, this will become, you know, a little bit, particularly if, you know,

federally, it, it, it becomes available and legal because, you know, they're, the primary funding agency has for this type of work, uh, for sleep work has been kind of the National Institute of Health, but they, they don't regularly fund this kind of work because it's, you know, it's not federally legal. And so, you know, historically it's been, you know, companies that have a formulation that they want to test. But then, and there is some data out of Australia that shows that, you know, at least in their formulation of THC and CBD, that it did seem to improve insomnia symptoms compared to a placebo.

I mean, the placebo is hard to figure out, like, what would be a good placebo for this? But, you know, what happens is like, then you know this, but then you, you know, can people get that formulation? Like, now we have one empirically defined, you know, and so it's just not regulated in that way. But I, you know, there's, I guess my perspective is that, you know, marijuana is no different as a sleep aid as like taking a medication or taking Advil PM because what happens is like psychologically you become dependent upon it. And so my, you know, my perspective is that like for most people, maybe we can find a way to get people sleeping well without those types of AIDS, whether it be Advil PM or Benadryl or Ambien or marijuana, right? I mean, I think specifically, scientifically, there's lots of things that are interesting about trying to understand the endocannabinoid system in the brain and like how that plays a role in sleep regulation. Because, you know, enough people take it that, I mean, it probably does do something, but, you know, can we do it in a standardized way?

And, you know, it may ultimately be an avenue for helping people sleep better if, you know, other things fail like cognitive behavioral therapy for insomnia or what have you. But, you know, we just, we're kind of handcuffed currently on not having enough data or in kind of empirical evidence to make any kind of recommendation if it came to that point, right? And so, I mean, that is a challenge. Yeah, definitely. Yeah, it'll be interesting to kind of see where the research goes there. I know, I know Dr. Amen, I don't, Daniel Amen, I don't know if you follow him at all, but he's a brain scientist does all of these, like, you know, imaging of the brain and just kind

of looking at the brain on alcohol, brain on marijuana, and just kind of understanding what's actually happening in the brain when we're adjusting these different substances. And it's pretty compelling. It seems that marijuana probably not surprisingly seems to have a pretty negative impact on the brain because I think it cuts up blood flow and oxygen to the brain, different points. So it has this kind of a good effect. That's not that great.

But I think to your point, you know, it's, it's understanding the cost and opportunity, you know, if marijuana is helping us, you know, get to sleep and we're kind of recouping and recovering, but there's maybe some impact on the brain, you know, it's hard to know. I mean, you make the same, you can make the same case for like Ambien, right, or Zolpito, right? Like, I mean, it's the same. And like, I think about this all the time. I mean, now, you know, there's accruing evidence that suggests this association between like long term use of those types of substances and kind of, you know, brain health, right? And so then you're like, well, maybe it's not, you know, like you're getting sleep, but like it's a cost, right? And the cost might be really big. But then the question is like, well, what if they didn't take anything and they didn't sleep at all, all those years?

Like, would it be this? You know, and I think it's really, this is where I think these behavioral treatments that we know are effective are so important because they don't carry this risk, right? And that's what, why I, why I, like, it feels so adamant about it. But I get it, right? Like, it's like, people are just, they're trying to figure it out, you know, Often providers don't know any different or they don't have access. And it's like there's all these opportunities to improve the sleep health of populations at various levels,

whether it's like at medical education or, you know, in the primary care setting or research or, you know, policies that help protect people's sleep. All of these things can be done and we'll all be better off for it. Yeah. So much work to be done. Job security. Yes. what are you obsessing over right now? Oh, gosh.

You know, we, we, I am really obsessing over, I'm really interested in, you know, trying to understand biometric data that we collect and how that's related to, you know, daytime functioning. So, you know, sleep and stress like, like we talked about. But I'm also really focused on, we just put in a project to look at sleep in the context of lung transplant. So I'm like working with a lung transplant doc. And one of the things that's so interesting because like lung transplant, you know, people

that get these have to, you know, take, you know, things to protect the immune system from rejecting the organ. And, you know, at least in our preliminary data, we find this really strong relationship between people's sleep disturbances after they get a lung transplant and people that have more sleep disturbances are at significant increased risk of having this rejection. And so, you know, because I'm interested in sleep in the immune system, it's just, you know, one, we can probably improve on people's sleep and that will, you know, keep them alive longer. But, you know, trying to understand what's going on there is kind of compelling.

And so, you know, I mean, it's, you could look in lots of different conditions, but I just happen to have a friend who's a lung transplant surgeon. So we get to kind of do that work. So we just finish that. And then we have another project focused on insomnia and inflammation on the heart. So we know that there is, you know, this link between insomnia and cardiovascular disease, but trying to understand how that relationship happens is not clear. And so working with some kind of radiologists that do kind of simultaneous like pet and MRI imaging, we're able to look like recruit people that have insomnia and not they don't have cardiovascular disease but despite that they have this elevated level of like inflammation in the arterial walls in the cordial arteries

that we can see on the image is just kind of like striking right it's like and and it raises the question of like well what if you know how's that happening so we do a lot of mechanistic work to try to understand like we think it's the sympathetic nervous system that is driving changes in the bone marrow that like make things more inflammatory they get lodged in the in the heart but you know, what happens if we intervene on this? Like, can we reduce this early surrogate marker that will protect people in the long term? And so, you know, I think, you know, there's so much interesting, important, like experimental and interventional work that can be done in both healthy people, like in this case of this cardiovascular disease, and then in folks that are kind

of really, you know, trying to kind of survive a major surgery. I mean, it brings up other things about like sleep in the hospital and sleep in all these other things that I think or so. Yeah, where you just are not recovering at all. Yeah, we could have a whole other conversation about. But so I think those are probably the things that come to mind right now. But I think that's probably because that's like what I'm like deep in right now. I love it so much. It's all just such critical, just important work.

Yeah. Just the hospital, just thinking about chrono medicine too. Oh, yeah. Oh, gosh. Yeah. Yeah, as it relates to just waking folks up in the hospital and just understanding, like, when we're administering medication. Oh, yeah. I mean, that's like a whole, like, such an amazing area of study.

Yeah, but how it impacts sleep. And we notice in our data when folks are taking ns, so, you know, and just reporting that they're taking kind of ibuprofen, and we see a 15% decrease in sleep efficiency. Wow. Yeah. That's surprising, right? Yeah, I mean, I seem so benign, right? And N-Said. Well, I mean, you know, like, maybe it has something to do with, I mean, the immune system plays an important role in regulating sleep generally, right?

Like, not just when you're sick. And I mean, maybe it's something like if you have a large enough sample to be able to look at those things, like maybe you begin to notice these differences. And so I think that's what, you know, is so cool about, you know, the scale and the strength of the work that you guys are doing. to begin to uncover something that people are like, well, that's weird. Like, why would, you know, but you didn't think the, didn't have the capacity to look at it that way. Yeah. And I think it's something really, it's with athletes. So, you know, there's probably high degrees of, you know, they're working out a lot.

There's high degrees of inflammation. So they're trying to, like, reduce the inflammation. But I think it actually impacts sleep. So there's a second error effect that they're not actually recognizing. Yeah. Yeah. Yeah. Thank you so much for your time.

I know. Oh, my God. So awesome. I could just talk to you. I can do this all day. I know. Same. I, you're just, I wish there's so many questions I didn't get to and just, yeah.

Well, hopefully we can do this, do this again or do it offline and keep it going. I would love, love, love, love to do that. Thank you so much, Eric. Yeah, thank you. So, so great to chat. Big thank you to Dr. Eric Prather for sharing his vast knowledge of sleep, circadian rhythms, and stress. If you enjoyed this episode of the WooP podcast, please leave a rating or review. Please subscribe to the Wooop podcast.

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sign up for a 30-day free trial membership and take the first step to unlocking your own best performance today. New members can use the code W-I-L-L to get a $60 credit on W-W-A-Saccessaries. And that's a wrap. Thank you all for listening. We'll catch you next week on the World Podcast. As always, stay healthy and stay in the green.