Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / What's the deal with sleep?

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What's the deal with sleep? · Wellness, Actually with Emily Oster & Perry Wilson, MD

0:00
Speaker 1: Emily. Back when I was a resident in internal medicine
0:04
Speaker 1: at the Hospital University of Pennsylvania, we used to do
0:07
Speaker 1: these thirty hour call shifts. So you'd get there at
0:11
Speaker 1: like six in the morning and you'd stay, you know,
0:15
Speaker 1: all the way through the night, and then you'd leave
0:17
Speaker 1: at one pm the next day.
0:19
Speaker 2: It's no good, that's not good. That's not a good doctor.
0:22
Speaker 2: I do not want to see you at noon on
0:24
Speaker 2: that day, that's for sure.
0:25
Speaker 1: Well, that's this. This episode on Sleep had me reflecting
0:30
Speaker 1: back with mild PTSD on like the state I was
0:34
Speaker 1: in at one pm driving home. By the way, I
0:36
Speaker 1: had a very good friend in this situation who got
0:39
Speaker 1: in a car accident and lacerated her spleen and it
0:42
Speaker 1: had to be removed, and like, this is a this
0:44
Speaker 1: is a real problem. They limit the hours doctors can
0:47
Speaker 1: work to shorter than thirty now, thank goodness. But one
0:51
Speaker 1: of the experiences we all had after being awake for
0:54
Speaker 1: thirty hours and going home is something we labeled post
0:57
Speaker 1: call temperature dysregulation, which I have never seen officially studied,
1:02
Speaker 1: but it was this phenomenon where you would just be
1:05
Speaker 1: like shaking with cold, like you could no longer something
1:10
Speaker 1: was fun.
1:11
Speaker 2: It was like that was like we got to give
1:12
Speaker 2: up on temperature regulation.
1:14
Speaker 1: Yeah, it was just it was like something was fundamentally broken.
1:17
Speaker 1: And you know, I would drive home and I would stop,
1:20
Speaker 1: this is horrible. I would stop at this amazing little
1:23
Speaker 1: bodega and get like a chicken cheese steak because I
1:26
Speaker 1: was so hungry and cold and shaking, and I would
1:29
Speaker 1: sit on my couch and I would like eat the
1:32
Speaker 1: whole cheese steak, you know, still in my scrubs, and
1:35
Speaker 1: then I would like lie on the couch and fall
1:38
Speaker 1: fall into the like unhealthiest coma and then wake up,
1:42
Speaker 1: you know, at nine pm, and be up for a
1:43
Speaker 1: couple hours and then sleeping and then go in the
1:45
Speaker 1: next day. It was. It was crazy. And it's just
1:49
Speaker 1: one of many examples of how much we take sleep
1:53
Speaker 1: for granted, because when you don't get it, you are
1:57
Speaker 1: in trouble.
1:57
Speaker 2: And we're going to talk about that today and also
2:00
Speaker 2: why it makes you eat too much cheese steak and
2:05
Speaker 2: be really cold.
2:06
Speaker 3: So let's do it.
2:09
Speaker 2: I'm Emily ast I'm an economist and a data expert.
2:13
Speaker 1: And I'm Perry Wilson. I'm a medical doctor. It's Thursday,
2:16
Speaker 1: June eighteenth, twenty twenty six. And this is wellness actually,
2:20
Speaker 1: because you're getting a staggering amount of health and wellness
2:23
Speaker 1: information nowadays from every source imaginable, and some of it
2:27
Speaker 1: is awesome and some.
2:29
Speaker 2: Of it is well actually both Fortunately we are both
2:34
Speaker 2: people who know how to read studies, how to parse
2:36
Speaker 2: the data, and can tell you what's worth thinking about
2:39
Speaker 2: and what you can safely ignore.
2:41
Speaker 1: But before we dig in, a note that this podcast
2:44
Speaker 1: is for educational purposes and should not be construed as
2:46
Speaker 1: medical advice. We don't know your unique situation, so talk
2:49
Speaker 1: to your doctor for personal health decisions. This week we're
2:54
Speaker 1: asking what's the deal with sleep? Emily and I will
2:57
Speaker 1: give the official smash or pass, and then we'll get
3:00
Speaker 1: to your question of the week. But first let's do
3:03
Speaker 1: the health news roundup. After the break and we're back
3:18
Speaker 1: with the health news of the week. This is a
3:21
Speaker 1: special health news because my intrepid co host Emily is
3:25
Speaker 1: on vacation, so you get a solo Parry set of
3:29
Speaker 1: health news. But don't worry, Emily will be joining us
3:32
Speaker 1: when we ask what's the deal with sleep very shortly,
3:35
Speaker 1: so buckle in, folks, it's just me today. And we're
3:38
Speaker 1: going to start with screwworm. I've been getting a lot
3:42
Speaker 1: of questions about screw worm and the screw worm response lately,
3:45
Speaker 1: So what's going on with this invasive species. A couple
3:51
Speaker 1: of things that people need to know about screwworm. Number One,
3:54
Speaker 1: they're not worms. Screwworms are the larva of a species
3:57
Speaker 1: of blowfly, and unlike most fly larvae, they eat living
4:04
Speaker 1: flesh instead of dead or decaying tissue. That is fairly unique.
4:09
Speaker 1: And so these flies will come and lay hundreds of
4:13
Speaker 1: eggs near an open wound or another insect bite, or
4:18
Speaker 1: near a sensitive part typically of cattle, like around the
4:21
Speaker 1: eyes or nose, and when the magattatch, they start eating
4:26
Speaker 1: the living tissue, which can lead to secondary infection and
4:29
Speaker 1: death blow. The screwworm was eradicated in the US in
4:35
Speaker 1: nineteen eighty two, and over the following decade was pushed
4:38
Speaker 1: all the way south through Central America and past Panama,
4:43
Speaker 1: and that had been the state of play until twenty
4:47
Speaker 1: twenty four, when it re emerged in Mexico. June third,
4:53
Speaker 1: twenty twenty six, just a couple of weeks ago, there
4:56
Speaker 1: was the first case in the US, which was in tech.
5:00
Speaker 1: I think it's worth noting how we got rid of
5:02
Speaker 1: screwworm in the first place. We used something called the
5:05
Speaker 1: steril insect technique. So the screw worm flies, the women
5:11
Speaker 1: only mate once in their lifetime. The women, the females
5:15
Speaker 1: only mate once in their lifetime, and they store that
5:20
Speaker 1: sperm and lay multiple clutches of eggs over you over
5:26
Speaker 1: the next months and things like that. But they only
5:29
Speaker 1: mate that one time. And so what the USDA had
5:33
Speaker 1: been doing is breeding these sterile male flies and releasing
5:37
Speaker 1: them into the wild. They would mate with the female
5:39
Speaker 1: and then that's it. The female will never mate again.
5:42
Speaker 1: And that was a highly effective technique to push them
5:47
Speaker 1: back south. The problem is that there's only one steril
5:52
Speaker 1: fly manufacturing facility operating right now. It is in Panamon.
5:56
Speaker 1: It can produce about one hundred million flies per week.
5:59
Speaker 1: Estimate suggests we need about five hundred million flies per
6:02
Speaker 1: week to put down this spreading epidemic of blowfly. Texas
6:07
Speaker 1: broke round on a new blowfly screwworm sterile fly facility
6:13
Speaker 1: in April, but apparently it won't be ready till next year.
6:17
Speaker 1: The state of infections right now, or that there are
6:19
Speaker 1: twelve animals with documented infections, mostly cattle, but also a goat, sheep,
6:24
Speaker 1: and dog. The FDA has given an emergency authorization for
6:30
Speaker 1: a drug called ten per am, which is an over
6:32
Speaker 1: the counter drug for animals who are infected. But the
6:37
Speaker 1: experts that have been talking about this suspect that there's
6:39
Speaker 1: many more infections than have been currently diagnosed, and this
6:42
Speaker 1: can spread pretty quickly and threaten the cattle industry, so
6:47
Speaker 1: we're keeping a close eye on that. There is, of course,
6:50
Speaker 1: some politics here. It's worth noting that the USDA is
6:56
Speaker 1: the agency responsible for fighting this, and between January of
7:00
Speaker 1: twenty twenty five and January twenty twenty six, twenty thousand
7:04
Speaker 1: employees were lost from the USDA, both through layoffs and
7:08
Speaker 1: incentive retirement programs. The specific service responsible for screwworm response,
7:15
Speaker 1: the Animal Plant and Health Inspection Service, lost twenty five
7:18
Speaker 1: percent of its staff. The administration says those losses are
7:22
Speaker 1: not a problem, and they have the spread of screwworm
7:28
Speaker 1: well in hand. I hope that is the case. Moving on,
7:34
Speaker 1: let's talk about ozempic butt or ozempic face and a
7:38
Speaker 1: new drug that might prevent it. At least that's how
7:42
Speaker 1: the headlines are reporting this. Emily and I have talked
7:46
Speaker 1: before about this idea that the GLP one drugs lead
7:52
Speaker 1: to significant muscle loss in addition to total body weight loss,
7:56
Speaker 1: and how that can give an appearance of sort of
7:58
Speaker 1: a gaunt face, which has been labeled ozembic face. If
8:01
Speaker 1: you go back to our GLP one episode, you'll see
8:04
Speaker 1: that we point out that this muscle loss does happen,
8:07
Speaker 1: but happens in any situation where there is significant weight loss,
8:12
Speaker 1: including you know, gastric banding, gastric bypass. Anything that's going
8:16
Speaker 1: to get you to lose fifteen to twenty percent of
8:18
Speaker 1: your body weight in a year is going to result
8:21
Speaker 1: in some muscle loss because practically speaking, you're just not
8:25
Speaker 1: carrying as much weight around. You've got, you know, twenty
8:28
Speaker 1: thirty pounds that every time you take a step you're
8:30
Speaker 1: carrying around, and you'll lose muscle in your legs and
8:33
Speaker 1: your quadriceps in particular. So it's not unique to GLP ones,
8:37
Speaker 1: but it does happen. But we now have a new
8:40
Speaker 1: study appearing in Nature Medicine examining a drug called atpeitigra
8:45
Speaker 1: mab and Apatigra mab is an interesting. It's an antibody injection.
8:52
Speaker 1: It is an antibody to a protein called myostatin. The
8:57
Speaker 1: bodybuilders will know about myostatin. This is sort of in
9:00
Speaker 1: the wellness space. Muscles produce myostatin, and myostatin inhibits muscle growth,
9:06
Speaker 1: and so there is this sort of cycle where larger
9:11
Speaker 1: muscles produce more myostatin, which limits further muscle growth so
9:14
Speaker 1: that you don't become kind of too muscly. If you
9:17
Speaker 1: want to have some fun googling, you can look at
9:19
Speaker 1: some animals that are myostatin knockouts, including the Belgian blue cattle,
9:24
Speaker 1: which are like the most jacked cows you'll ever see
9:26
Speaker 1: in your life. I think there's also a whippet dog
9:29
Speaker 1: that is a myostatin knockout that is like super ripped,
9:35
Speaker 1: and so of course people are very interested in this
9:37
Speaker 1: kind of thing. For humans, aptagra mab was originally developed
9:41
Speaker 1: for people with some genetic muscle wasting conditions. But in
9:45
Speaker 1: this study they randomized one hundred people. Half of them
9:48
Speaker 1: got munjaro and aptagram mab and half just got munjaro
9:52
Speaker 1: for a twenty four week period. Both groups lost a
9:55
Speaker 1: significant amount of weight. As you might expect, twenty five
9:57
Speaker 1: pounds in the combo group twenty eight pounds, and the
10:00
Speaker 1: Manjaro alone group. Those weren't different statistically, but when they
10:04
Speaker 1: looked at lean body mass so muscle loss, the group
10:08
Speaker 1: that got the combo lost three point five pounds compared
10:12
Speaker 1: to seven point seven pounds in the group that only
10:15
Speaker 1: got Munjaro. So that was a finding that suggested that
10:20
Speaker 1: indeed this combination, when given with GLP one therapy, might
10:24
Speaker 1: reduce some of the muscle loss. We see. Bad news, folks.
10:28
Speaker 1: Not FDA approved for any indication. You cannot get your
10:31
Speaker 1: hands on it quite yet. And of course, because it
10:35
Speaker 1: is a myostatin inhibitor, it will be banned by all
10:39
Speaker 1: the anti doping agencies, which is, you know, as Emily
10:43
Speaker 1: likes to say, you know, it must work if it's
10:45
Speaker 1: going to be banned. I will say one other caveat though,
10:48
Speaker 1: these people had a bit more muscle functional metrics like
10:51
Speaker 1: grip strength and chair stands and things like that that
10:54
Speaker 1: test sort of how well your muscles work. Didn't show
10:56
Speaker 1: much difference, But you know, this might have been too
10:59
Speaker 1: small a study to look in detail at those things.
11:04
Speaker 1: Last one in our health News of the week is
11:07
Speaker 1: hard Seltzer causing a brand new kidney disorder. Hard Seltzer's,
11:13
Speaker 1: like Trullian high noons, are becoming incredibly popular. I will
11:20
Speaker 1: say that I may have one or more of these
11:22
Speaker 1: in my local drink fridge at home. And so I
11:25
Speaker 1: was a little concerned when I saw a headline about
11:29
Speaker 1: a new kidney syndrome called mehandru Vatchara Johnny syndrome. That's
11:35
Speaker 1: a tough one associated with these Seltzers. What this is
11:40
Speaker 1: is a series of cases of people who drank so
11:43
Speaker 1: much hard Seltzer that the sodium level in their blood
11:47
Speaker 1: got dangerously low, a condition we call hypononatremia the kidneys.
11:53
Speaker 1: This is an interesting The way this works. When you
11:56
Speaker 1: drink water, your kidneys sense that and they make you
11:59
Speaker 1: pee more water. So you know, if you drink some more,
12:03
Speaker 1: you piece some more, and the kidney's job is to
12:05
Speaker 1: keep you in balance. If they fail to excrete the
12:08
Speaker 1: water you drink, that dilutes the solutes in your blood
12:12
Speaker 1: like sodium and things like that, which are really important.
12:15
Speaker 1: And if your sodium gets too low, your brain stops
12:17
Speaker 1: functioning and you go into a coma and you die.
12:20
Speaker 1: And that's not great. What is going on with these
12:24
Speaker 1: hard seltzers, at least in the cases that they're reporting,
12:26
Speaker 1: are people who are drinking, you know, a dozen or
12:31
Speaker 1: more of these per day, and it sounds like to
12:33
Speaker 1: the exclusion of everything else. So, as a kidney doctor,
12:38
Speaker 1: one of the cool things or interesting things about the
12:40
Speaker 1: kidneys is that they can excrete a lot of water,
12:43
Speaker 1: about twenty liters of water per day. In someone who's
12:47
Speaker 1: kidneys work normally, that's you'd be drinking an awful lot
12:50
Speaker 1: four and a half gallons of water a day to
12:52
Speaker 1: outpace their ability to excrete it, although you'd be run
12:55
Speaker 1: into the bathroom a lot. But there is a caveat.
12:57
Speaker 1: They need either salt or urea, which is a protein
13:03
Speaker 1: byproduct to excrete that water. They don't need both, but
13:06
Speaker 1: they need one or the other otherwise they can't get
13:09
Speaker 1: the water out. That's just the way the physiology works.
13:12
Speaker 1: And so the problem with seltzers like these is that
13:16
Speaker 1: they don't have any protein and they don't have any salt.
13:19
Speaker 1: Right all they are basically are carbohydrates and water. If
13:23
Speaker 1: people are getting protein or salt from other sources, usually
13:26
Speaker 1: they won't run into these problems. Although obviously drinking twelve
13:29
Speaker 1: hard seltzers a day can cause multiple other problems, including
13:33
Speaker 1: with your liver. Doctors listening to this will recognize that
13:36
Speaker 1: this syndrome, despite getting a new name, is not really new.
13:39
Speaker 1: We've known about this for hundreds of years. Potentially this
13:44
Speaker 1: is beer potomania with a different, different name. Beer potomania
13:51
Speaker 1: was a syndrome where people drinking a ton of beer
13:54
Speaker 1: got this hyponatremia low sodium levels, and it's the same mechanism,
13:58
Speaker 1: you know, drinking a bunch of water, not taking in
14:01
Speaker 1: any protein, not taking in any salt. And if you
14:04
Speaker 1: want a sort of less of vice filled version, some
14:06
Speaker 1: little old ladies will get what's called tea and toast hypo,
14:09
Speaker 1: a trimia where if they're only surviving on tea and toast,
14:13
Speaker 1: they're not getting enough salt, they're not getting any protein
14:16
Speaker 1: because toast and jam and stuff is Jess carbohydrates. They
14:19
Speaker 1: can also get hyponatremia, so don't drink too much, but
14:23
Speaker 1: if you do, make sure you're getting some salt and
14:25
Speaker 1: protein in as well. That is it for the health
14:30
Speaker 1: news of the week. After the break, what's the deal
14:34
Speaker 1: with sleep? And we're back today. We're going to talk
14:42
Speaker 1: about what's the deal with sleep? And to get us started, Emily,
14:47
Speaker 1: I'm going to play quick clip for you from one
14:50
Speaker 1: of the greatest TV shows of all time.
14:52
Speaker 4: Truthfully, Shambo, I've been entirely preoccupied by the most frightening
14:58
Speaker 4: experience of my own. A couple of hours ago, I
15:03
Speaker 4: realized that my body was no longer functioning properly. I
15:06
Speaker 4: felt weak, I could no longer stand. The life was
15:10
Speaker 4: oozing out of me. I lost consciousness. You fell asleep?
15:16
Speaker 1: Oh, terrifying what you were hearing. There is the Great
15:19
Speaker 1: John Delancy as the omnipotent being who transcends time and
15:24
Speaker 1: space known as Q in Star Trek the Next Generation.
15:27
Speaker 1: He has temporarily been rendered fully human and has the
15:32
Speaker 1: experience for the first time in his immortal life of
15:36
Speaker 1: falling asleep. And you know of churs. Patrick Stewart as
15:39
Speaker 1: Jean Luke Picard is wonderfully dismissive of him. But as
15:45
Speaker 1: I was researching for this episode, this kept coming back
15:49
Speaker 1: to me, this scene because sleep is weird. It's maybe
15:55
Speaker 1: the weirdest thing that humans do.
15:59
Speaker 2: It's not just a weird thing that humans do, so
16:01
Speaker 2: basically every animal has sleep or a sleep like resting state.
16:07
Speaker 3: So like dolphins sleep half their.
16:10
Speaker 2: Brain at a time so they can like keep one
16:13
Speaker 2: side of their brain awake and like remember to breathe
16:15
Speaker 2: in the water and then they sleep the other the
16:17
Speaker 2: other side of the brain. And if you think about it,
16:20
Speaker 2: like it must be so important to sleep because it's
16:25
Speaker 2: so stupid, right, like think about the idea like early Evolutionarily,
16:30
Speaker 2: this is the dumbest idea, Like we're going to evolve
16:34
Speaker 2: to like lay around for eight hours in a row
16:39
Speaker 2: totally exposed to sabertoo tigers.
16:41
Speaker 3: They could eat us at any time.
16:42
Speaker 2: You would think you would select for the people who
16:45
Speaker 2: like didn't sleep, right, I mean that's how evolution works,
16:47
Speaker 2: natural selection eventually, so must be we're getting something out
16:50
Speaker 2: of sleep, and it must be all animals are. And
16:52
Speaker 2: yet this is actually, I think, still not super well understood.
16:56
Speaker 2: So we can't unlike with food, where you can be like,
16:58
Speaker 2: here's why you need food, It powers the cell if
17:00
Speaker 2: you don't have glucos, the sleep, we're just like, nah,
17:04
Speaker 2: it seems.
17:05
Speaker 1: Important, clearly, and you know the horrible experiments on animals
17:10
Speaker 1: where they keep them awake they die. We still aren't
17:14
Speaker 1: entirely sure why you pointed out dolphins sleep half their brain.
17:17
Speaker 1: I mean it's not just mammals. Jellyfish sleep like with
17:21
Speaker 1: a with a distributed nervous system. They go through these
17:24
Speaker 1: phases where they're like less responsive to stimuli and then
17:26
Speaker 1: and and it goes with the day night cycle. It's
17:29
Speaker 1: it is crazy. They're even single celled organisms that functionally sleep.
17:36
Speaker 1: I was trying to figure out, like what's the you know,
17:40
Speaker 1: how would this thing even get started? And you can
17:42
Speaker 1: go back when we talk about evolution, you can go
17:44
Speaker 1: back into our very very very distant evolutionary past, like
17:48
Speaker 1: before animals even existed. There's essentially sleep because plants will
17:56
Speaker 1: photosynthesize with oxygen but then also thi nitrogen, and those
18:02
Speaker 1: two things are incompatible. They can't happen in the same
18:04
Speaker 1: cell at the same time. Like those chemical reactions just
18:07
Speaker 1: like won't work if you're doing both at the same time.
18:09
Speaker 1: So from the very first plants, they had to evolve
18:12
Speaker 1: this ability to like turn on the oxygen like the
18:15
Speaker 1: photosynthesis thing, and then shut that down and then turn
18:18
Speaker 1: on the nitrogen fixation thing. And so it would do
18:20
Speaker 1: like photosynthesis during the day and nitrogen fixation at night.
18:23
Speaker 1: And it's everywhere.
18:26
Speaker 3: It's everywhere.
18:28
Speaker 2: We are sort of slowly, I think, understanding a bit better,
18:32
Speaker 2: Like what are we getting out of sleep?
18:34
Speaker 3: There's a sort of general idea.
18:37
Speaker 2: That people will say, which is like, well, the brain
18:39
Speaker 2: cleans itself out, like it's like your opportunity to clean
18:41
Speaker 2: things out of your brain.
18:43
Speaker 3: That's not very specific.
18:45
Speaker 2: There's actually some new evidence on mice from a couple
18:48
Speaker 2: of years ago where they looked at sort of the
18:51
Speaker 2: patterns of brain waves and basically found that like during
18:55
Speaker 2: the night, the brain waves lined up in a way
18:58
Speaker 2: that we're moving like.
19:00
Speaker 3: Debris effectively out of the brain.
19:02
Speaker 2: And so their idea was you needed this period of
19:05
Speaker 2: sleep where the brain waves lined up in this way
19:08
Speaker 2: to like flush the byproducts of being a functional thing
19:13
Speaker 2: out of your brain, and otherwise they just build up
19:15
Speaker 2: and build up and build up and then you die.
19:18
Speaker 1: Yeah, these are you can actually visualize. This is a
19:20
Speaker 1: very cool set of studies. Like the cerebrospinal fluid, like
19:25
Speaker 1: the fluid that the brain sits in, this you know,
19:28
Speaker 1: sort of salty clear fluid that protects it somewhat. Yeah,
19:31
Speaker 1: just kind of like washing over the brain at night. That's,
19:35
Speaker 1: of course not the only thing that's happening to your
19:38
Speaker 1: brain at night. Like, lots of stuff is going on.
19:40
Speaker 1: We'll need to get into some more detail as people
19:44
Speaker 1: start thinking about like what's happening during sleep. But you know,
19:47
Speaker 1: certainly for humans, it appears that memory consolidation between short
19:52
Speaker 1: term and long term memory is happening, probably primarily during sleep.
19:57
Speaker 3: I learned that from inside out. Did you see inside out? Oh?
20:00
Speaker 1: I have seen inside out, but I don't I don't remember.
20:02
Speaker 2: Yeah, they like remember like when she's the balls, they're
20:05
Speaker 2: like moving the balls from like the short term memory
20:08
Speaker 2: like to the memory storage area.
20:10
Speaker 3: That seems to happen at night.
20:12
Speaker 1: I learned that it's important to feel my feelings.
20:15
Speaker 2: Yeah, no, that's also true. I cried so much at
20:17
Speaker 2: that movie. Oh my gosh, that's a great that's really good.
20:19
Speaker 2: Should watch that really good?
20:20
Speaker 3: Okay, uh, back to sleep.
20:23
Speaker 2: Okay, So people sleep, big picture, everybody sleeps, including potentially
20:29
Speaker 2: plants and certainly all all you know living.
20:32
Speaker 3: All of the animal like and animal organisms.
20:36
Speaker 2: Probably it has something to do with cleaning something out,
20:38
Speaker 2: and your brain is doing something we don't completely understand it.
20:42
Speaker 3: People talk a lot about the idea of circadian uh
20:45
Speaker 3: biology here, So do you want to And I hesitate
20:50
Speaker 3: to ask this because of some earlier episodes where you
20:52
Speaker 3: got to involved, but do you want to do a
20:55
Speaker 3: little of the biology, Doctor Perry.
20:58
Speaker 1: I think that people want to hear about the biology.
21:01
Speaker 3: People do people do? Okay, do it briefly?
21:06
Speaker 4: No.
21:06
Speaker 1: Circadian biology is really cool, so circa around the end
21:10
Speaker 1: the day. So these this is the day night cycle,
21:12
Speaker 1: which everyone on the planet Earth has, I say, everyone,
21:17
Speaker 1: including the plants and everything like that. We live on
21:20
Speaker 1: a planet that has a daytime and a night time,
21:22
Speaker 1: and it's no wonder that biology has sort of adapted
21:24
Speaker 1: to these uh to the these different things. The way
21:27
Speaker 1: it works in humans is pretty cool. There's a specific
21:31
Speaker 1: part of your brain called the super chismatic nucleus which
21:34
Speaker 1: is the clock. Like to the point that if people
21:38
Speaker 1: have a stroke or a tumor and that part of
21:41
Speaker 1: the brain needs to get removed, they no longer follow
21:45
Speaker 1: day night cycles. They just like free run through their
21:49
Speaker 1: circadian rhythm. The super chismatic nucleus is the clock in
21:53
Speaker 1: your brain, and it doesn't only only tell you when
21:55
Speaker 1: you're tired and when to go to sleep, but all
21:58
Speaker 1: the other things that vary throughout the day, like your
22:00
Speaker 1: basal body temperature and your cortisol levels that spike in
22:04
Speaker 1: the morning, and all of those things are determined by
22:06
Speaker 1: the superch nucleus. That part of the brain has a
22:09
Speaker 1: direct neural pathway to your retinas and on planet Earth,
22:15
Speaker 1: if you're human, the way the super chismatic nucleus stays
22:19
Speaker 1: in sync with day and night is through light. It's
22:24
Speaker 1: very simple, and that's probably how you would design it anyway, right, Like,
22:28
Speaker 1: it turns out that if you put someone in an
22:31
Speaker 1: isolated room, right just like a no exposure to outside
22:35
Speaker 1: light whatsoever, you know, the lights on all the time
22:38
Speaker 1: or the lights off all the time, they have an
22:41
Speaker 1: inherent pace that their super chismatic nucleus will follow. Some
22:47
Speaker 1: people have a slightly longer day than twenty four hours,
22:50
Speaker 1: maybe twenty five, maybe even twenty six. And so if
22:52
Speaker 1: you just let them go and they've done these experiments
22:55
Speaker 1: where they keep these poor you know, graduate students in
22:58
Speaker 1: like a lab for weeks at a time while they
23:01
Speaker 1: you know, write their THESS or whatever they pay them,
23:03
Speaker 1: but you know, and they'll basically like go to sleep
23:05
Speaker 1: two hours later every night, and they'll just you know,
23:07
Speaker 1: buy seven days later there're all of a sudden twelve
23:10
Speaker 1: hours off. Some people have a shorter cycle twenty three
23:13
Speaker 1: twenty two hours, and the reverse happens. Right. They just
23:15
Speaker 1: kind of like every night they go to bed a
23:17
Speaker 1: little bit earlier than they would have the night before.
23:20
Speaker 1: So that's the biology. But we all fix that by
23:24
Speaker 1: seeing the day night cycle.
23:25
Speaker 2: Let me tell you that when I was in graduate school,
23:28
Speaker 2: one of my professors told me that when he was
23:30
Speaker 2: in graduate school, he actually tried to put himself on
23:33
Speaker 2: a twenty six hour cycle because he thought he could
23:35
Speaker 2: get more work done. And it turns out that putting
23:38
Speaker 2: yourself on a twenty six hour cycle does not work
23:41
Speaker 2: even if your natural cycle, say was twenty six hours,
23:43
Speaker 2: because the light exposure means that your body is like
23:48
Speaker 2: not is going to try to get back to the
23:50
Speaker 2: twenty four hour cycle.
23:51
Speaker 3: So he really messed He really messed things up.
23:53
Speaker 1: Yeah, it is. It is super powerful. You know that
23:56
Speaker 1: going outside seeing the sun really does in train the
23:59
Speaker 1: super kise matic nucleus just to close the loop on sleep.
24:03
Speaker 1: The super chismatic nucleus has a neural connection to the
24:06
Speaker 1: pineal gland, and the pineal gland releases the hormone melatonin,
24:10
Speaker 1: which is one of the important home hormones in making
24:15
Speaker 1: you sleep and is obviously also a supplement that many
24:17
Speaker 1: people use for sleep. So just a bit of biology em.
24:21
Speaker 3: Just that's only that was so good.
24:23
Speaker 2: So if we have people who are just like sort
24:26
Speaker 2: of not exposed, we can talk about artificial light. But
24:29
Speaker 2: if you're like living in the general world, most people
24:35
Speaker 2: will fall asleep a couple hours after sunset and wake
24:39
Speaker 2: up around sunrise or a little bit after sunrise because
24:43
Speaker 2: of the light.
24:45
Speaker 3: I'm curious given that if we.
24:47
Speaker 2: Sort of step outside the artificial light, like sort of
24:50
Speaker 2: go back into a time we didn't have a lot
24:51
Speaker 2: of artificial light.
24:52
Speaker 3: If people are living in places where.
24:53
Speaker 2: There's like sunlight all the time or darkness all the time,
24:57
Speaker 2: like the ends of the earth, do they sleep less
25:01
Speaker 2: in the summer and more in the winter. Is that
25:03
Speaker 2: a sort of standard adaptation?
25:05
Speaker 1: You know, I don't know, but let's google and find out,
25:09
Speaker 1: because it's a good question.
25:10
Speaker 3: It is a good question.
25:11
Speaker 1: Sleep times at extreme latitudes heavily disrupted by intense seasonal
25:17
Speaker 1: light variations, Shorter, fragmented sleep in summer, delayed often increased
25:19
Speaker 1: sleep durations during the dark winter. Yes, you know, humans
25:23
Speaker 1: evolved in sort of equatorial areas of Africa, so that's
25:27
Speaker 1: maybe our ideal environment in terms of how much we
25:30
Speaker 1: should be sleeping. But of course in the modern era,
25:33
Speaker 1: we're exposed to a lot of light sources that aren't
25:35
Speaker 1: the sun, which is one of the major problems people
25:38
Speaker 1: have in terms of, you know, staying on a good
25:40
Speaker 1: sleep schedule.
25:41
Speaker 3: At these high latitudes.
25:42
Speaker 2: Adapting your sleep in that way to the time of
25:45
Speaker 2: year is actually probably evolutionarily beneficial because in a summer
25:51
Speaker 2: you need more hours to work. In the winter, you
25:53
Speaker 2: need fewer hours to work because it's too cold.
25:57
Speaker 3: So anyway, all right, so in this modern world we
26:03
Speaker 3: are we need to sleep. We know why we sleep.
26:05
Speaker 3: Generally at night. People like to measure their sleep.
26:10
Speaker 2: Like getting back into the kind of like influencer wellness space,
26:13
Speaker 2: people are really really interested in measuring their sleep. It's
26:16
Speaker 2: one of the core things that all of these like
26:19
Speaker 2: trackers like to measure, and we tend to talk about.
26:23
Speaker 3: Three pieces of sleep.
26:25
Speaker 2: There is duration, which is how long we are sleeping.
26:31
Speaker 2: There is latency, which is how quickly we fall asleep.
26:36
Speaker 2: And there's efficiency, which is a metric of like how
26:39
Speaker 2: much of the time you are in bed, that you
26:42
Speaker 2: are actually asleep. Are there other measures that you feel
26:47
Speaker 2: like you care about? Those are the ones that my
26:49
Speaker 2: tracker likes to tell me about.
26:51
Speaker 1: I'm so curious how you do on your trackers because
26:54
Speaker 1: I have some theories, like I suspect as an endurance athlete,
27:00
Speaker 1: like I want you to have very good sleep parameters
27:05
Speaker 1: because I feel right, I appreciate it. I feel like
27:07
Speaker 1: that should be what you get for all the pain
27:10
Speaker 1: you're putting yourself through during the day is like a
27:12
Speaker 1: good night's sleep at the end of it. In terms
27:14
Speaker 1: of other sleep metrics, I mean I am interested in
27:17
Speaker 1: sleep stages, so we can talk in a minute after
27:21
Speaker 1: I hear your numbers about the different stages of sleep
27:23
Speaker 1: and what might be happening in them. And I think
27:25
Speaker 1: there's interesting actually pathology in each stage of sleep that
27:29
Speaker 1: is worth mentioning. But talk to me about like as
27:32
Speaker 1: a real athlete an endurance runner. I assume you're sleep
27:36
Speaker 1: latency is thirty seconds right head hits the pillow, you're out.
27:39
Speaker 1: You sleep as solid eight hours and you're good to go.
27:44
Speaker 2: So I don't sleep as many hours as I should,
27:47
Speaker 2: but my sleep efficiency is very good, so my sleep
27:50
Speaker 2: efficiency is like ninety five percent, which I think means basically,
27:53
Speaker 2: I'm asleep all the time that I'm in the bed.
27:56
Speaker 2: But my my tracker thinks of my duration sucks. It
27:59
Speaker 2: tells me every morning hours versus needed seventy three percent.
28:02
Speaker 3: That's like a stand it takes.
28:04
Speaker 2: I should be Yeah, okay, So to be fair, my whoop,
28:08
Speaker 2: I love whoop, I love you whoop. My whoop thinks
28:10
Speaker 2: that last night I should have been sleeping for nine
28:13
Speaker 2: hours and twenty eight minutes, but as a person with
28:15
Speaker 2: a job, I was unable to achieve nine hours and
28:19
Speaker 2: twenty eight minutes of sleep. I managed to get six
28:22
Speaker 2: hours and fifty two minutes of sleep, which I think
28:24
Speaker 2: was actually pretty good. That's not like, you know, that
28:26
Speaker 2: feels like a solid amount of time, but I uh,
28:31
Speaker 2: it's now. It tells me my sleep dead is one
28:34
Speaker 2: hour and eighteen minutes, and I feel like it's just
28:37
Speaker 2: gonna you know anyway.
28:38
Speaker 1: Yeah, that's how sleep debt works. It just adds up.
28:40
Speaker 1: It just adds until you're I think, whoop. Here is
28:46
Speaker 1: probably like looking at your activity during the day and
28:50
Speaker 1: extrapolating like how much sleep would be appropriate, and that
28:53
Speaker 1: probably isn't quite right. Full disclosure. We ran a study
28:56
Speaker 1: for Whoop back here several years ago, so I've received
28:59
Speaker 1: research funding from Whoop in the past.
29:02
Speaker 3: How many hours did you sleep last night? Perry?
29:04
Speaker 1: I slept seven hours, which is sort of the standard
29:09
Speaker 1: for me. I mean, my problem.
29:11
Speaker 2: It sounds like a number that somebody reports if they
29:14
Speaker 2: just estimate it and don't have a tracker or app
29:16
Speaker 2: on their phone.
29:17
Speaker 1: I mean, I can get if we could pause the
29:19
Speaker 1: podcast and I can get my app out because I
29:22
Speaker 1: am wearing a Galaxy Watch. I do sleep numbers, but
29:26
Speaker 1: I don't necessarily care that much. My problem with sleep
29:30
Speaker 1: is that I feel like I can't always sleep. You know,
29:33
Speaker 1: I have to wake up because kids need breakfast and
29:35
Speaker 1: all that kind of stuff, and high school starts way
29:37
Speaker 1: too early before the sun even comes up, which is
29:39
Speaker 1: clearly bad for your super chismatic nucleus. But then you know,
29:43
Speaker 1: there's some days on the weekend where I'm like, oh,
29:44
Speaker 1: I can sleep in, but then I don't, like, I
29:48
Speaker 1: want to sleep until eight or nine am, and I
29:50
Speaker 1: still wake up at six fifteen, and that bothers me.
29:55
Speaker 1: That's my sleep.
29:56
Speaker 3: Problem that I think a lot of people have a
29:57
Speaker 3: sleep problem.
29:58
Speaker 2: Okay, So it's not just how much time you're asleep,
30:01
Speaker 2: it is what you are doing when you are asleep.
30:03
Speaker 2: And there are different stages of sleep. There's deep sleep,
30:06
Speaker 2: there's REM sleep, there's light sleep. Should I care about
30:09
Speaker 2: which one I am in for how long?
30:12
Speaker 1: Yeah? I think so, I think so. So let's go
30:15
Speaker 1: through a couple of them. So REM sleep, which is
30:18
Speaker 1: rapid eye movement sleep, that is what's happening when you're dreaming.
30:22
Speaker 1: And the thinking from the neurologist is that this is
30:25
Speaker 1: where a lot of that memory consolidation is happening that
30:27
Speaker 1: we talked about from inside out. So converting short term
30:30
Speaker 1: to long term memories. REM sleep is a fascinating physiologic state.
30:34
Speaker 1: You may know that you're paralyzed from the neck down
30:38
Speaker 1: during REM sleep to prevent you from acting out your dreams.
30:43
Speaker 1: When this goes wrong, people do act out their dreams
30:46
Speaker 1: to kind of disastrous effect, as you might imagine. Check
30:51
Speaker 1: out comedian Mike Burbiglia's sleep Walk with Me, which is
30:55
Speaker 1: a hilarious retelling of him literally like jumping out a
31:00
Speaker 1: hotel window to escape from a missile that was like
31:03
Speaker 1: locked on him in a dream and waking up, you know,
31:06
Speaker 1: covered in glass in the hotel parking lot. This is
31:10
Speaker 1: very rare, fortunately, But what's not so rare a sleep paralysis,
31:15
Speaker 1: and so you can actually regain consciousness during REM sleep,
31:21
Speaker 1: so you're sort of like all of a sudden you're awake.
31:24
Speaker 1: REM is very close to being awake actually, like in
31:26
Speaker 1: terms of brain waves, and so you can open your
31:29
Speaker 1: eyes and still your brain has that paralysis function turned on.
31:33
Speaker 1: And the experience is you're lying in bed and you
31:36
Speaker 1: cannot move your body at all, and it's very frightening
31:40
Speaker 1: and a lot of people will talk about like alien
31:42
Speaker 1: experiences or feeling like you know, they're the like demons
31:47
Speaker 1: and things like that in the room that can be
31:48
Speaker 1: really disturbing. REM sleep is inhibited by alcohol and benzo diazepines,
31:54
Speaker 1: and so insofar as it's an important stage of sleep,
31:57
Speaker 1: that is something to be aware of if your drink
32:00
Speaker 1: at night. So that's REM and then deep sleep is
32:04
Speaker 1: also important, probably for that cleaning function that we talked about,
32:07
Speaker 1: the CSF, sort of washing over the brain and getting
32:10
Speaker 1: rid of all the junk. There's weird pathology that can
32:14
Speaker 1: happen in deep sleep too, So that's the place where
32:17
Speaker 1: night terrors happen. This is distinct from nightmares, which is
32:21
Speaker 1: a rem sleep phenomenon, just a bad dream. Night Terrors,
32:24
Speaker 1: if you've ever seen, are terrifying for people watching it
32:28
Speaker 1: is people will just scream bloody murder in the middle
32:32
Speaker 1: of the night.
32:32
Speaker 3: So it's like just to be there.
32:34
Speaker 2: This is like very common in kids, and it freaks
32:37
Speaker 2: out parents because there is sort of nothing you can do,
32:41
Speaker 2: Like your kid is sitting up in bed screaming, and
32:45
Speaker 2: unlike with a nightmare, where you know they are kind
32:48
Speaker 2: of a conscious and they'll be like, here's a bad dream.
32:50
Speaker 3: There was a monster chasing me.
32:51
Speaker 2: You can be like, Okay, they're just screaming and screaming
32:53
Speaker 2: and screaming, and there's nothing you can do because they're
32:56
Speaker 2: not really awake. They're just asleep and all you can
32:59
Speaker 2: do is kind of leave and then they just lay
33:01
Speaker 2: down and go back to sleep and they have no
33:02
Speaker 2: memory of it.
33:03
Speaker 1: But it's hot, yeah, really really bizarre. As we said,
33:06
Speaker 1: if there's a theme of this episode, sleep is very
33:09
Speaker 1: strange and weird. So weird again, clearly, you know a
33:14
Speaker 1: physiologic state that leads you every once in a while,
33:17
Speaker 1: especially when you're a young child to scream as loud
33:20
Speaker 1: as possible in the middle of the night is not
33:22
Speaker 1: good if you're trying to hide from sabertooth tigers. So
33:25
Speaker 1: the benefit is clearly, clearly extreme.
33:29
Speaker 3: Let's talk about that benefit a little bit.
33:31
Speaker 2: So you know, it's it's sleep is something where there
33:34
Speaker 2: is a fair amount of research on, you know, why
33:38
Speaker 2: it matters, and to some of it's in this very
33:39
Speaker 2: extreme like animal stuff. You know, if you keep the
33:41
Speaker 2: animal up for some amount of time, it just dies.
33:44
Speaker 2: But we can also sort of think about at smaller scales,
33:49
Speaker 2: what is the impact of sleep deprivation, either a single
33:54
Speaker 2: night of missleep or a long period of time of
33:56
Speaker 2: more limited sleep. The best studied parts of this, in
34:01
Speaker 2: my view, are cognitive. So not sleeping enough, either skipping
34:06
Speaker 2: an entire night of sleep or sleeping less than you
34:10
Speaker 2: should in a kind of consistent way, really impacts your
34:15
Speaker 2: ability to basically a people's executive function, short term memory,
34:19
Speaker 2: any kind of cognitive performance. It also impacts mental health,
34:23
Speaker 2: It impacts depression, impacts all kinds of stuff like that.
34:28
Speaker 1: Absolutely everything gets worse when everything's sleep, and a lot
34:32
Speaker 1: of these things can contribute to something of a vicious cycle.
34:35
Speaker 1: So you know, sleep deprivation can worsen depression symptoms. Depression
34:40
Speaker 1: can manifest as increased sleepiness, but also decrease sleepiness. It
34:45
Speaker 1: can go both ways. The same thing. You know, anxiety
34:47
Speaker 1: symptoms can worsen with lack of sleep, and then being
34:50
Speaker 1: more anxious can worsen your ability to fall asleep. So yeah,
34:54
Speaker 1: you can definitely get yourself into quite a bit of
34:57
Speaker 1: trouble here. The place that I worry about this a lot.
35:02
Speaker 1: I mean, I worry about adults, but having a teenager,
35:05
Speaker 1: actually having two teenagers in my home is are the kids? So, Emily,
35:11
Speaker 1: are you as concerned as I am about our kids
35:13
Speaker 1: not getting enough sleep?
35:15
Speaker 2: One of my major concerns as a person is the
35:17
Speaker 2: kids are not getting enough sleep. And let me say
35:21
Speaker 2: more about this because I care so much about it.
35:24
Speaker 2: So and I think this is adult's fault. So generally,
35:28
Speaker 2: kids who are you know, elementary school, middle school, high school.
35:32
Speaker 3: They need a lot of sleep.
35:33
Speaker 2: You know, high school kids need you know, nine to
35:36
Speaker 2: ten hours of sleep ideally, and they just they need
35:38
Speaker 2: a lot of sleep. And we are getting in the
35:41
Speaker 2: way of that in two ways. So one is with
35:44
Speaker 2: school start times. So high school tends to start early
35:48
Speaker 2: in the morning. It actually tends to start earlier than
35:51
Speaker 2: elementary school in many school districts.
35:53
Speaker 3: This is stupid because high school.
35:55
Speaker 2: Students are on a kind of delayed circadian rhythm relative
35:59
Speaker 2: to most people, so actually their ideal is to go
36:02
Speaker 2: to sleep later and wake up later.
36:04
Speaker 3: And we have seen.
36:06
Speaker 2: When school districts move back the school start time so
36:09
Speaker 2: kids can sleep more, we see that kids do better
36:12
Speaker 2: in school, and we see like things like less car
36:14
Speaker 2: accidents because they're just like a bunch of less tired
36:16
Speaker 2: teenagers driving around. So we're having a problem with school
36:21
Speaker 2: and the school start times.
36:22
Speaker 1: Yeah, why is this? Like I've got an elementary school
36:25
Speaker 1: kid and a middle school kid and a high school
36:26
Speaker 1: kid and they wake up in the opposite order, like
36:30
Speaker 1: my elementary school kids up first. Yeah, so like what
36:33
Speaker 1: is it not to.
36:35
Speaker 3: Be like I think it is?
36:37
Speaker 2: So I've I've talked to many school distress about this,
36:40
Speaker 2: and the answer I often get is something about bus schedules,
36:43
Speaker 2: but it's hard for them to be specific about exactly
36:46
Speaker 2: what that what that means. I think is also an
36:48
Speaker 2: issue with high school sports. At the end of the day,
36:50
Speaker 2: kids need to go to a game, and so if
36:51
Speaker 2: school starts later and ends later, you're a less time
36:53
Speaker 2: for sports. This relates to my second feeling about how
36:56
Speaker 2: adults are getting in the way of our children's sleep,
36:58
Speaker 2: which is putting them into many activities. And actually I
37:02
Speaker 2: think that hits even as.
37:04
Speaker 3: Early as middle school.
37:05
Speaker 2: People are like, Okay, my kid's got to go to
37:07
Speaker 2: like six hockey practices and you know, Russian math school,
37:10
Speaker 2: and so then they're not going to get home till
37:11
Speaker 2: nine o'clock at night, and then they still have to
37:13
Speaker 2: do their homework. Like no, no, we need to actually
37:17
Speaker 2: treat sleep as a priority for our children and understand
37:21
Speaker 2: that means they may not be able to do some
37:23
Speaker 2: of those other things. And that's okay, because sleep is
37:26
Speaker 2: important not just like a nice to have, it's a
37:29
Speaker 2: nice to have, it's like a need to have otherwise
37:31
Speaker 2: you die.
37:31
Speaker 1: Oh my gosh. I want there needs to be like
37:33
Speaker 1: a stop over subscribing your kid's movement because there's so
37:38
Speaker 1: much social pressure here, like all the other parents sign
37:42
Speaker 1: their kids up for thirty things, and like, if I
37:45
Speaker 1: don't sign my kid up for thirty things, then I
37:47
Speaker 1: clearly am not. You know, they like how will they
37:50
Speaker 1: learn Mandarin?
37:52
Speaker 2: But I think We also have an opportunity with our
37:54
Speaker 2: older kids to enroll them a bit in the sort
37:56
Speaker 2: of need for sleep and in actually thinking this is
37:59
Speaker 2: important and helping understand, like helping them prioritize this too,
38:04
Speaker 2: because of course, some of the things to get in
38:05
Speaker 2: the way of sleep are like I'm texting my friends.
38:08
Speaker 1: Sleep's clearly important. Let's get to brass tax here, like
38:12
Speaker 1: how much am I supposed to be sleeping? Is the
38:14
Speaker 1: best thing for me to do? To strap something on
38:16
Speaker 1: my wrist and trust what it tells me? Can I
38:18
Speaker 1: like it? Should? I base this on how I feel?
38:21
Speaker 1: Is it just eight hours? Full stop? Like what you're thinking?
38:25
Speaker 1: In terms of just the amount.
38:28
Speaker 2: Generally my senses that adults need about seven hours of
38:32
Speaker 2: sleep at night. If you are doing a high level
38:36
Speaker 2: of activity, you probably need more. There's a small share
38:40
Speaker 2: of the popularization that need less, but most people need
38:44
Speaker 2: about seven hours at night. There of course, there is
38:47
Speaker 2: variation in this, and I think the sort of standard
38:50
Speaker 2: diagnostic actually not so different from a diagnostic with kids
38:54
Speaker 2: is if you are sufficiently rested, you should not weekend
38:58
Speaker 2: over sleep, so you shouldn't be tire during the during
39:01
Speaker 2: the day. But then also if given an opportunity, you
39:04
Speaker 2: should basically get up at about the same time, like
39:06
Speaker 2: not exactly. You know, if you generally get up at six,
39:09
Speaker 2: like you if you generally get up at six and
39:12
Speaker 2: like you know, then on the weekend you get up
39:13
Speaker 2: at six thirty, like that's fine. But if like you're
39:15
Speaker 2: generally getting up at six and then you give yourself
39:17
Speaker 2: an opportunities and you sleep until noon, like you are
39:20
Speaker 2: not sufficiently rested. And I think that that can also
39:23
Speaker 2: work with kids, Like if you sort of see, you know,
39:25
Speaker 2: my kids sleeping till three o'clock in the afternoon, that
39:28
Speaker 2: does suggest that they are not getting enough sleep in general.
39:31
Speaker 2: So looking for that kind of signal for people can
39:35
Speaker 2: help ty trade a little bit, like do I does?
39:38
Speaker 2: It kind of seem like I'm hitting about the right amount, fair.
39:41
Speaker 1: Enough plug for familial natural short sleep a rare genetic
39:46
Speaker 1: mutation which has people sleeping about five to six hours
39:49
Speaker 1: a night and being completely fine with it. You don't
39:52
Speaker 1: have this if you are listening to this podcast, that's
39:54
Speaker 1: just the chances are, but you might come across it
39:57
Speaker 1: because it's very cool. As we were doing the this episode,
40:00
Speaker 1: I even looked into it in a little more detail,
40:02
Speaker 1: and it is an evolutionary mystery. Like one of the
40:04
Speaker 1: things that we're talking about that the people who study this,
40:08
Speaker 1: you know, syndrome. It's not really a syndrome because it
40:10
Speaker 1: doesn't cause any problems, But one of the questions they
40:12
Speaker 1: continually ask is like, wait, why hasn't this spread through
40:15
Speaker 1: the population. It's so clearly evolutionarily advantageous. So it may
40:20
Speaker 1: be that we're still missing something, like we're not measuring
40:24
Speaker 1: something that is beneficial from sleep, that even these miracle
40:27
Speaker 1: people who apparently don't need sleep might actually not be
40:30
Speaker 1: getting and it's it's hurting their reproductive chances in some way.
40:34
Speaker 3: Hear me out. Hear me out.
40:36
Speaker 2: It may be that an evolutionary, from an evolutionary standpoint,
40:39
Speaker 2: being awake while it's dark is actually not that helpful
40:41
Speaker 2: because you can't really do that much there's like no light.
40:44
Speaker 2: It's not like you're getting stuff done, and so there's
40:46
Speaker 2: not that much advantage. And more time in bed is
40:49
Speaker 2: more time for sex, and so then you like maybe
40:53
Speaker 2: by like being in bed for less time, you have
40:55
Speaker 2: less sex. And okay, okay, I'm okay.
40:59
Speaker 1: So this is a thing where it's like when you're married,
41:03
Speaker 1: and one partner goes to bed earlier than the other
41:06
Speaker 1: and the others like no, no, no, I'm going to
41:08
Speaker 1: like stay downstairs and play this video game or finish
41:10
Speaker 1: watching this movie. Like that's not great for the old
41:14
Speaker 1: marital relations. Yeah, I'm sold. Sold.
41:17
Speaker 3: Okay, there you go. We solve that problem.
41:19
Speaker 1: Solve that controversy.
41:22
Speaker 2: Speaking of short sleep, I think it's worth talking a
41:25
Speaker 2: little bit. You know, if we sort of know how
41:27
Speaker 2: much sleep people should get, we know that one of
41:29
Speaker 2: the things get gets in the way of people's sleep
41:31
Speaker 2: is just I don't have time to sleep. And I
41:33
Speaker 2: often tell people like, like, but it is important, Like
41:36
Speaker 2: even for adults. I think we can we can treat
41:39
Speaker 2: sleep like it's a like a spa day or something,
41:41
Speaker 2: but it's actually a biological necessity. So like one of
41:45
Speaker 2: the you know, trying to figure out your life so
41:48
Speaker 2: you can get more sleep is good. But the thing
41:50
Speaker 2: that is really frustrating to people is when you try
41:53
Speaker 2: to go to sleep and you can't, or when there's
41:55
Speaker 2: some sort of biological things.
41:57
Speaker 3: The two big.
41:58
Speaker 2: Things here, so one of them is inside and the
42:00
Speaker 2: first one is sleep apnea. So there's a lot so
42:02
Speaker 2: sleep apnea gets in the way of sleep for a
42:05
Speaker 2: large number of people in ways that they may actually
42:09
Speaker 2: be unaware of. So this is when we think this
42:11
Speaker 2: is going to affect the quality of your sleep less
42:14
Speaker 2: so than the than the sort of duration.
42:16
Speaker 3: It's like the realized duration.
42:18
Speaker 1: Let me, I'm going to sidebar sleep apnea. So full
42:22
Speaker 1: disclosure sleep apnea sufferer here, Really I use a yeah
42:27
Speaker 1: I do. I use a CPAP machine at night, and
42:30
Speaker 1: so you know a couple of things so massively underdiagnosed
42:33
Speaker 1: like it is, it is a huge problem. Some symptoms
42:37
Speaker 1: of sleep apnea. What you'll see on the sleep apnea
42:39
Speaker 1: scoring scales is how tired you are during the day.
42:41
Speaker 1: Like the classic symptoms to sleep apne is like, oh,
42:43
Speaker 1: I'm falling asleep at my desk, I'm falling asleep at
42:45
Speaker 1: a traffic light, and you know that kind of severe
42:47
Speaker 1: daytime sleepiness. There's a lot of other more subtle things migraine,
42:51
Speaker 1: headaches or recurrent headaches. Hypertension can even be caused by
42:55
Speaker 1: sleep apne, and there's a host of downstream cardiovascular problems.
43:00
Speaker 1: I was diagnosed as many people were, initially by my
43:05
Speaker 1: wife who sleeps in bed with me and heard me
43:08
Speaker 1: snoring a lot and you know, occasionally sort of stopping
43:11
Speaker 1: to breathe. If you do sleep in a bed with
43:14
Speaker 1: someone else, ask them about this. I think it's important
43:18
Speaker 1: to realize, Like, you know, if you're just listening to
43:20
Speaker 1: this on the podcast, you can't see me. But there's
43:23
Speaker 1: a misapprehension. I think that sleep apnea is exclusively reserved
43:28
Speaker 1: for people who might be overweight or obese. That is
43:31
Speaker 1: not true. There is increased risk in those populations, but
43:35
Speaker 1: it also has a lot to do with like the
43:36
Speaker 1: structure of your soft palate and like the way your
43:40
Speaker 1: nose in your mouth and your jaw is put together.
43:43
Speaker 1: One of the first treatments I tried was actually this
43:46
Speaker 1: like mouth prosthesis that like juts your lower jaw forward,
43:50
Speaker 1: which actually works for my type of sleep apnea. But
43:55
Speaker 1: like I woke up an incredible jaw pain every morning,
43:57
Speaker 1: so that didn't seem good. And then I just like
44:00
Speaker 1: buckled in and got the little seapap machine. And it's
44:03
Speaker 1: just like it's a little thing that goes in it
44:05
Speaker 1: like goes in my nose, only it's not like a
44:07
Speaker 1: full mask, and it's super quiet, and I don't snore anymore.
44:10
Speaker 1: And my wife is happier. We were like talking about
44:14
Speaker 1: have you heard of sleep divorce?
44:15
Speaker 3: You were going to have a sleep divorce.
44:17
Speaker 1: Sleep divorce is when spouses who still love each other
44:22
Speaker 1: very much sleep in separate rooms because of like sleep issues,
44:26
Speaker 1: and oftentimes it's snoring. So all right, that's probably enough
44:30
Speaker 1: on sleep apnea, but like, do get yourself checked out
44:33
Speaker 1: if you think this could remotely be a possibility.
44:36
Speaker 2: The other thing is insomnia. So insomnia is pretty common.
44:41
Speaker 2: Of course, everyone experiences some kinds of insomnia, you know,
44:45
Speaker 2: like I had a stressful day, I can't turn my
44:47
Speaker 2: brain off. But kind of chronic insomnia, which typically means,
44:52
Speaker 2: you know, a consistent disruption of sleep, inability to get
44:56
Speaker 2: quality sleep over a period.
44:58
Speaker 3: Of at least three months, for at least three a week.
45:00
Speaker 2: That's about ten percent of the population, and insomnia could
45:04
Speaker 2: be really debilitating.
45:05
Speaker 4: You.
45:05
Speaker 3: People get very very tired. It's also very very frustrating.
45:09
Speaker 2: And often people will respond by trying to like go
45:12
Speaker 2: to bed earlier, but then you're like laying in bed
45:15
Speaker 2: for more hours and then you know, at the end
45:18
Speaker 2: of it, you're tired, which is affecting your mental health.
45:20
Speaker 2: Like this is really bad, Like all kinds of sleep problems.
45:23
Speaker 2: So there is one really really good treatment for insomnia,
45:27
Speaker 2: which is cognitive behavioral therapy for insomnia, which is like
45:30
Speaker 2: a standard package of interventions that you know, for a
45:37
Speaker 2: very large share of people who do them improve people's sleep.
45:41
Speaker 2: And it's kind of a set of things like don't
45:44
Speaker 2: actually lie in your bed when you are not able
45:47
Speaker 2: to fall asleep, so and you know, reframe some of
45:50
Speaker 2: your thoughts around not panicking. There's a bunch of pieces
45:54
Speaker 2: of this that are that are popular, but this is
45:56
Speaker 2: a very very effective technique that not as many people
46:01
Speaker 2: know about.
46:02
Speaker 1: Is should yeah totally and apologies as a doctor here
46:05
Speaker 1: who has given the wrong answer to this question, like
46:07
Speaker 1: more times than I can count, so we have when
46:11
Speaker 1: people ask us about sleep problems, docs will go straight
46:14
Speaker 1: to sleep hygiene and it's this it's like, oh, okay,
46:18
Speaker 1: no screens before bed, like don't you know, don't lie
46:21
Speaker 1: in your bed unless you're there to sleep or have sex,
46:23
Speaker 1: and like sleep in a dark, quiet room and keep
46:25
Speaker 1: the temperature cool cool. And it's like these parameters around
46:29
Speaker 1: sleep that are kind of easy to say and make
46:33
Speaker 1: sense and they might offer some benefit, but actually looking
46:35
Speaker 1: into it, the randomized trial data about sleep hygiene exclusively
46:41
Speaker 1: for insomnia is pretty poor. It doesn't really work. So
46:44
Speaker 1: it's like, oh, put that phone away, Like, actually it doesn't.
46:48
Speaker 2: It's not the something wrong with putting your phone away,
46:51
Speaker 2: but it's not really going to work.
46:52
Speaker 1: It doesn't really work. Whereas this cognitive behavioral therapy, and
46:55
Speaker 1: there's there's interesting elements of it, one of the ones
46:58
Speaker 1: that I hadn't thought of because somewhat counterintuitive, but seems
47:01
Speaker 1: to work quite well. And by the way, this is
47:03
Speaker 1: delivered as a package, So don't you look into this
47:06
Speaker 1: in a little bit more detail if you're suffering from insomnia.
47:08
Speaker 1: But one thing that came out was, you know, if
47:12
Speaker 1: you are normally falling asleep at midnight instead of as
47:16
Speaker 1: you say, like getting in bed at eight and lying
47:18
Speaker 1: there for four hours, not able to fall asleep, get
47:21
Speaker 1: in bed at midnight so that your body and your
47:24
Speaker 1: brain more importantly is like, oh, yeah, I get in
47:26
Speaker 1: bed and I fall asleep, and then you can kind
47:28
Speaker 1: of move that time back. So there are solutions, but
47:31
Speaker 1: we should talk probably about you said, not enough people
47:35
Speaker 1: get access to cognitive behavioral therapy, and there are plenty
47:38
Speaker 1: ways to access CBT. This is not just necessarily through
47:41
Speaker 1: a psychiatrist or a psychologist. There's even apps that provide
47:44
Speaker 1: some of this support and information, but most people who
47:49
Speaker 1: are suffering from insomnia are going to turn to other
47:53
Speaker 1: things like drugs, supplements, medications, et cetera. Emily, what's your
48:00
Speaker 1: thoughts on this area?
48:04
Speaker 2: So I think that there are there are two categories
48:07
Speaker 2: of you know, how we think about substances and sleep.
48:09
Speaker 2: So there's one set of substances that are sort of
48:13
Speaker 2: category of substances that interfere with people sleep, alcohol being
48:16
Speaker 2: probably the most commonly consumed and for most people, alcohol,
48:22
Speaker 2: particularly close to bedtime, interferes with sleep. This is also
48:26
Speaker 2: true of benzos. So there's a sort of that category
48:30
Speaker 2: of like, don't do that if you are struggling with
48:34
Speaker 2: with sleep, or at least recognize the impacts. And then
48:37
Speaker 2: there are these sort of sets of drugs that people
48:39
Speaker 2: take to improve their sleep, like melatonin or you know,
48:45
Speaker 2: ambient in more extreme cases, and those you know, those
48:49
Speaker 2: can be effective. Melatonin is very effective for jet lag
48:53
Speaker 2: and in particular, you know, for most people, I think
48:58
Speaker 2: that they would like to not be depending didn't on
49:01
Speaker 2: medications for sleep ideally, which is where I think you know,
49:04
Speaker 2: going into something that actually fixes some of the sleep
49:07
Speaker 2: architecture in the first place is a you know, a
49:10
Speaker 2: sort of first best option. Doesn't mean there's not a
49:13
Speaker 2: place for some of these other some of these other
49:15
Speaker 2: things in the short term.
49:17
Speaker 1: Yeah, I think the dependency issue is a real one.
49:21
Speaker 1: Almost all of these substances, potentially with the exception of melatonin,
49:26
Speaker 1: do have some physiologic dependency. So ambient and things like that,
49:29
Speaker 1: certainly benadrill, the benzodiazepines, even alcohol. You become habituated to it,
49:36
Speaker 1: and once you stop, it's just harder to fall asleep.
49:38
Speaker 1: If you've been taking ambient and you stop ambient, it's
49:41
Speaker 1: harder to fall asleep for a few days when you're
49:43
Speaker 1: off of ambient. It's not the end of the world.
49:45
Speaker 1: There's there's little with melatonin in the in the data.
49:49
Speaker 1: Although probably melatonin, at least an adult for sleeping is
49:53
Speaker 1: not as effective it is does seem to be effective
49:57
Speaker 1: for jet lag to kind of reset that circadian clock
49:59
Speaker 1: go back to the pineal gland. There maybe not so
50:03
Speaker 1: great in adults, and maybe that's why we don't see
50:05
Speaker 1: too much rebound when you're off melatonin. People will have
50:08
Speaker 1: heard of kind of an alarming study suggesting that the
50:12
Speaker 1: chronic use of melatonin and adults increases the risk of
50:15
Speaker 1: heart failure. I don't buy this one.
50:18
Speaker 3: No, this is still just this is ridiculous.
50:20
Speaker 2: It's ridiculous because it is reverse causality. Okay, so let
50:23
Speaker 2: me explain what is happening there. Like, people who have
50:26
Speaker 2: a lot of trouble sleeping are at risk for cardiovascular issues,
50:31
Speaker 2: you know, because there's other things that are driving that,
50:33
Speaker 2: because potentially the lack of sleep puts you at risk
50:36
Speaker 2: for some of these of these issues because sleep is
50:39
Speaker 2: so important. And so what's going on here is that
50:42
Speaker 2: people are having a lot of trouble sleeping. To address
50:44
Speaker 2: their sleep issues, they take melatonin, and then there are
50:49
Speaker 2: negative cardiovascular issues which have to do with the lack
50:51
Speaker 2: of sleep. So it's like the lack of sleep is
50:53
Speaker 2: causing you to take the melatonin and causing you to
50:55
Speaker 2: have heart issues.
50:56
Speaker 3: It is not that the melatonin is causing the heart issue.
50:59
Speaker 2: This is like a standard reverse causality, omitted variable bias,
51:05
Speaker 2: something else going on. It is not a causal relationship
51:09
Speaker 2: and should not be treated as such.
51:12
Speaker 1: Yeah, yeah, don't figure out but I actually no, I
51:16
Speaker 1: love it. And I agree. You know, bottom line, sleep
51:19
Speaker 1: is a thing that happens in the brain. To the
51:21
Speaker 1: extent that you can retrain your brain, that's probably the
51:23
Speaker 1: best way to get better sleep.
51:25
Speaker 3: Agreed.
51:27
Speaker 2: Last thing I want to say is do you think
51:28
Speaker 2: there's a space for these sleep trekkers. Do you think
51:32
Speaker 2: that they help people? I'm not sure we know, Like
51:34
Speaker 2: this is really just a generic question. I don't think
51:36
Speaker 2: we know much from the data. It's hard to study
51:39
Speaker 2: that it.
51:41
Speaker 1: Depends on the person. There's a condition called orthosomnia, I
51:46
Speaker 1: think is what they're calling it now, which are people
51:47
Speaker 1: who get anxious about their sleep score right, so like
51:52
Speaker 1: they actually paradoxically have worse sleep because they're like, oh,
51:56
Speaker 1: I've got to like have my sleep latency below like
51:58
Speaker 1: fall sleep, falseleep, fall asleep. If you are that type
52:01
Speaker 1: of person who's trying to optimize, don't do it. Take
52:05
Speaker 1: it off. For many people, though, who aren't quite that
52:09
Speaker 1: obsessed with what the final score is, I think they
52:11
Speaker 1: can be useful in particular because some of those metrics,
52:13
Speaker 1: if you pay attention, really will show you how much alcohol,
52:17
Speaker 1: in particular adversely effects sleep. I've had multiple patients who
52:21
Speaker 1: have used these things and It's like I wasn't putting
52:23
Speaker 1: it together until my watch pointed out that, like, my
52:29
Speaker 1: sleep score is ten points lower, and it's on nights
52:32
Speaker 1: that I drink it's ten points lower, and on nights
52:33
Speaker 1: that I don't drink, it's ten points higher. And something
52:35
Speaker 1: about that biofeedback can change the underlying behavior. So if
52:39
Speaker 1: you think that's for you, go ahead and do it.
52:41
Speaker 1: I wear mine at night, but I actually don't really
52:45
Speaker 1: know what I don't pay attention to it. Yeah.
52:47
Speaker 2: I think this is an example where I would always
52:48
Speaker 2: ask people, like, you know, what are you going to do?
52:50
Speaker 3: Like, what's the information that you want? What are you
52:52
Speaker 3: going to do with it?
52:53
Speaker 1: Right?
52:53
Speaker 2: So if you're gonna, like, if you're just gonna like
52:55
Speaker 2: look at your sleep score and feel good or bad
52:57
Speaker 2: or whatever, like, that's not really very very helpful.
53:00
Speaker 1: If I just want to cope with others, I want
53:01
Speaker 1: to if.
53:02
Speaker 3: You want to win.
53:04
Speaker 2: So I will tell you that my husband has an
53:05
Speaker 2: Ora ring and I have a whoop, And because he
53:08
Speaker 2: doesn't want to see his sleep score, I have the
53:11
Speaker 2: Aura app on my phone so every morning I can
53:13
Speaker 2: see both my score.
53:14
Speaker 3: And in his score. And that's marriage for you.
53:20
Speaker 2: But I think for some people this the kind of
53:22
Speaker 2: feedback of like a little bit of sort of data
53:25
Speaker 2: data collection, largely round alcohol. There's a few other things
53:28
Speaker 2: that are that are kind of common to two people.
53:30
Speaker 2: You can sort of see, Okay, this is this is
53:32
Speaker 2: kind of affecting me in a way that that you know,
53:35
Speaker 2: maybe it would cause.
53:35
Speaker 3: Me to want to change change my behavior. Sounds good, Perry.
53:40
Speaker 3: Let's do the smash your pass. Smash your pass on
53:43
Speaker 3: sleep sleep.
53:45
Speaker 1: I'm smashing it.
53:46
Speaker 2: I love it.
53:48
Speaker 1: Let's do more of it. Uh, sleep is good, Emily,
53:50
Speaker 1: smash your pass.
53:51
Speaker 2: I'm smashing it, and I'm gonna I'm gonna aim to
53:54
Speaker 2: get my whoop recommended nine hours and twenty eight minutes
53:56
Speaker 2: of sleep tonight, and we'll see.
53:57
Speaker 3: I'm going to be in such good shape tomorrow.
54:00
Speaker 1: I'll see if I can email one of them about
54:01
Speaker 1: that algorithm.
54:02
Speaker 2: Yeah, tell the telling the algorithm maybe a little little,
54:05
Speaker 2: a little aggressive. All right, when we come back, we'll
54:08
Speaker 2: do your question the week.
54:15
Speaker 5: Hi, Emily and Perry, this is Lucy from Virginia. I'm
54:19
Speaker 5: curious about any possible benefits of eating your placenta. Is
54:23
Speaker 5: this something we should all be doing or is it
54:26
Speaker 5: just kind of gross. Thank you.
54:29
Speaker 1: Okay, it's only a matter of time, Emily should for me.
54:34
Speaker 1: Should we eat our placentas?
54:36
Speaker 3: No, you should not.
54:38
Speaker 2: So Actually, some mammals do eat their placentas, and that's
54:43
Speaker 2: because there's not a lot of other food available. And
54:46
Speaker 2: if you have, you know, just say, given birth out
54:52
Speaker 2: in some area where it's hard to access food. And again,
54:55
Speaker 2: you're a not a person, you're a different kind of mammal,
54:59
Speaker 2: like this may be a good source of you know,
55:02
Speaker 2: some nutrients, but people unfortunately have access generally to other food.
55:10
Speaker 2: And you should not eat your placenta because it's a
55:13
Speaker 2: medical product. And there is no evidence that eating your
55:17
Speaker 2: placenta improves postpartum depression or does anything else positive for you.
55:23
Speaker 3: And again it's a medical product.
55:25
Speaker 2: You shouldn't eat it fresh, you shouldn't need it frozen,
55:27
Speaker 2: you shouldn't need it put in pills. There's just like
55:29
Speaker 2: no reason to do anything with your placenta except say
55:33
Speaker 2: thank you very much for being an incredibly cool, interesting
55:36
Speaker 2: organ that allowed me to create a person. And in
55:40
Speaker 2: the words of Marie Condo, you'll thank it for its
55:42
Speaker 2: service and just like let it go.
55:45
Speaker 1: I love that. What about burying it in your yard
55:50
Speaker 1: under a tree or something.
55:52
Speaker 2: Look, I mean I wouldn't I wouldn't do that personally,
55:57
Speaker 2: but I think if you want to do that, that's fine.
55:59
Speaker 3: It's not going to make the tree any nicer.
56:01
Speaker 2: But if you have a feeling like this is an
56:03
Speaker 2: important I have a sentimental attachment to this and I
56:06
Speaker 2: would like to remember it, and you want to bury
56:08
Speaker 2: it in your backyard, like yeah, sure, but I think
56:11
Speaker 2: you should be prepared, Like a coyote could dig that
56:13
Speaker 2: chap and like then they'll be like placenta all over,
56:15
Speaker 2: So you want to bury it pretty deep?
56:20
Speaker 1: Okay? With that image, we can we can end stick
56:28
Speaker 1: with us next week when we will ask what's the
56:32
Speaker 1: deal with full body scans?
56:36
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56:41
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56:45
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