In this episode, we talk about the science behind sleep and why you should get more than 8 hours of it. We also talk about how to get more sleep, and why it s so important that you get at least 7 hours of sleep a night, and how important it is to get a good night's rest. We also discuss the benefits of sleeping in a foreign environment, and whether or not you should try to get as much rest as you can in order to keep up with your day-to-day life. This episode is brought to you by Zapsplat, a sleep aid company that specialises in helping people get the most out of their sleep. To find a list of our sponsors and show-related promo codes, go to gimlet.fm/sponsorships and use promo code: CROWN10 at checkout to get 10% off your first purchase when you buy your first pack of CROWN 10 or more when you become a member! We're also looking for your feedback on this episode and we'll be looking to improve the quality of the next episode. Thank you so much to everyone who submitted questions and suggestions, we really appreciate the support we've received so far. We'll see you next week with a new episode next week! Thanks again for all the love and support, Caitie! Caitie - Caitie's Music: Sarah - Sarah's Song: The White Noise - The Good Life - The Bad Girl - Bad Girl: Bad Girl, Bad Boy - Good Morning - (feat. - Bad Girl (Music: The Good Morning, Bad Girl) - - Good Day - Bad Day - Good Life (featuring: ) Music: Bad Day, Good Morning (Bad Girl, Good Day, Bad Day (Bad Day, Bad Day) - Good Friday (Good Morning, Good Life, Good Day (Good Life, Good Night, ) - Good Night (Good Day, Great Day, and Good Life) - Thank You, God Bless You (Good Night, Good Rest, Good Place (Good Rest, Good Rest) , Good Day and Good Rest - Good Rest (Good Sleep, Good Nights, Good Week, Good Dreams, Good Sleep, Blessings, Good Loved You) (Good Place, Good Beginnings) - Sober October (Sober October, Sober Octobrown October)
00:00:15.000And we actually know the science that one half of your brain will actually not sleep as deeply than the other when you're sleeping in an unusual room, like a hotel room.
00:02:34.000And that really, for me, it fills in the blanks of why, even if I get seven, eight hours sleep on the road, I'm still kind of just out of it.
00:02:44.000Yeah, and that's in fact probably one of the, I think, the most impressive parts of new research on sleep.
00:02:50.000It's not just about quantity, it's also about quality.
00:02:54.000And quality can be as detrimental, if you don't get it, as a reduction in total quality.
00:02:59.000I mean, both are essential, but I think it speaks exactly to your point.
00:03:03.000You just don't feel like it's a refreshing sort of deep sleep.
00:03:09.000It just feels like, I guess I would say, it feels like half asleep.
00:03:13.000I mean, it's really kind of how it does feel.
00:03:16.000One of the things that I noticed, I did this thing with my friends called Sober October, where we didn't smoke any pot or do no drinking at all, nothing, for a month.
00:03:27.000And when I did it, one of the things I found was that after about...
00:03:32.000I don't know how many days, but it was noticeable that I would have these incredibly vivid dreams.
00:03:37.000And then I had read that marijuana does something to suppress heavy REM sleep.
00:03:47.000Yeah, so both of those chemicals, both of which are used as a sleep aid, alcohol and marijuana, are actually very good at blocking your dream sleep, your rapid eye movement sleep.
00:03:56.000And so what happens is that the brain is quite clever in this regard.
00:03:59.000It builds up a clock counter of how much dream sleep you should have had, but have not been getting.
00:04:11.000So that finally when the alcohol actually gets out of your system, sober October, love the name, that's all of a sudden where you get what's called a REM sleep rebound effect, where you not only get the normal amount of REM sleep that you would normally have, you get that plus the brain tries to get back some of that dream sleep that it's been losing over the past maybe 11 months.
00:04:54.000They say, I just had these crazy dreams.
00:04:56.000What happens there is a kind of an acute version where the alcohol is swilling around in your system.
00:05:02.000And after about six hours, your liver and your kidneys have finally excreted all of the alcohol and your brain has been deprived of dream sleep for that first six hours.
00:05:12.000So then it feasts in the last couple of hours and that's why you have these really bizarre dreams after you've been drinking a little bit too much.
00:06:13.000We think perhaps at the level of the brainstem, which is where these two types of sleep, non-REM and REM sleep, will actually get sort of worked out.
00:06:21.000That's where marijuana may actually impact dream sleep and shut it down and block it.
00:06:26.000Have there been any studies on chronic marijuana smokers, like those dawn-to-dust type characters that just are constantly high?
00:06:45.000So what happens is if you look at alcoholics...
00:06:47.000They will have something often when they come off alcohol, something called delirium trems, which is where sort of DT. There what happens is that the alcohol has been blocking dream sleep for so long, and the pressure for dream sleep is built up so powerfully in the brain,
00:07:06.000it actually just spills over into wakefulness.
00:07:09.000And so the brain just says, look, okay, if I'm not going to get this dream sleep whilst you're asleep, I'm just going to take it whilst you're awake.
00:07:17.000And so you start to essentially dream while you're awake.
00:07:20.000It's this sort of collision of two states of consciousness.
00:07:35.000So what is going on with them when this is happening?
00:07:39.000So if they are going through this delirium during the day while they're conscious, what's physiologically happening?
00:07:46.000So it's almost as though the veil of REM sleep gets pulled over the waking brain, as it were.
00:07:52.000So you have this mixed state of consciousness that you can pick up with brainwave recordings.
00:07:58.000And it just tells me, I mean, in some ways, how necessary sleep must be.
00:08:03.000If that's the lengths that the brain will go to to get that which it's been missing, it just shows you why, you know, it took Mother Nature 3.6 million years to put this thing called an eight-hour sleep necessity in place.
00:08:17.000And we've come along, and within the space of 100 years, we've lopped off almost 20% of that, if you look at the data.
00:08:41.000Well, I mean, you'd be glad to know that then, you know, men who sleep five to six hours a night will have a level of testosterone, which is that of someone 10 years their senior.
00:08:51.000So a lack of sleep will age you by a decade in terms of that critical aspect of wellness, virility, muscle strength, sexual performance.
00:10:14.000But she was saying that she hallucinates and that she starts seeing like rabbits are talking to her and she sees things that aren't there and like mystical beings and stuff.
00:10:24.000She said it's really freaky, but she knows that she's hallucinating because she's done this.
00:10:29.000She's done a bunch of ultra marathons.
00:10:48.000It's all about managing how little sleep that you get.
00:10:50.000And they will explain these wild hallucinogenic experiences on the bike.
00:10:55.000If you look at world records for people who have tried to sort of go without sleep, one of the most famous examples is a radio disc jockey called Peter Tripp back in the sort of 60s, 50s, 60s.
00:11:10.000And he tried to break the world record.
00:12:01.000But so we know that that same profile of just starting to become, you know, psychotic, which is essentially what happens naturally when you dream that you are, I mean, all of us here, you know, as long as we slept last night, became flagrantly psychotic when we went into dream sleep.
00:12:18.000Because you start to see things which are not there, so you hallucinate.
00:12:21.000You believe things that couldn't possibly be true, so you're delusional.
00:12:25.000You get confused about time, place and person, so you're suffering from disorientation.
00:12:30.000You have wildly fluctuating emotions, something that psychiatrists call being sort of affectively labile.
00:12:36.000And then how wonderful, we both woke up this morning and we forgot most if not all of that dream experience, so we're suffering from amnesia.
00:12:44.000What is happening when you're having these hallucinogenic experiences?
00:12:50.000Like, what are the chemicals that are causing it?
00:12:54.000So we've done some of these studies where we put people into brain scanners, we let them fall asleep, and then we see what happens within the brain, which parts of the brain are switching on, which parts of the brain are switching off.
00:13:05.000When you go into REM sleep, firstly, some parts of your brain become 30% more active than when you're awake.
00:13:13.000So, you know, we think of sleep as this sort of, you know, static passive state where everything just kind of drops down in terms of activity.
00:13:33.000Emotional centers and memory centers, they all increase.
00:13:36.000But the part of the brain that bucks the trend and goes in the opposite direction is the part of the brain that we call the prefrontal cortex, this sort of CEO of the brain that's very good at rational, logical thinking.
00:13:52.000So it's almost as though, you know, the prison guards are gone and everyone runs amok because there's no controller, you know, in place.
00:14:01.000And so we know sort of from the patterns of brain activity, why you become sort of so visual, you see things, why you have motor kinesthetic activity, why things feel so emotional, but also why things seem utterly illogical and irrational.
00:14:16.000Because your frontal brain, the thing that makes us most human, you can say goodbye to that for the rest of dream sleep.
00:14:36.000And I don't think I really remember them.
00:14:38.000I think what it is is very much like...
00:14:41.000You ever hear someone talk about a memory from a long time ago?
00:14:45.000I used to think that people actually remembered things from a long time ago, but now what I think is they remember remembering it.
00:14:53.000I think they remember talking about it, they remember how they described it, and then they sort of remember that and repeat it and in their mind convince themselves that that's what happened.
00:15:04.000Because I've heard people Tell stories about the past and they vary wildly from what is absolutely true.
00:15:13.000Like factual, you could check it, you could research it, you know what the facts are.
00:15:19.000But in their mind, it's very different.
00:15:21.000And I think that it's entirely possible that what people are doing is remembering the recollection of these memories and how they told them.
00:15:30.000And then also sort of people elaborate things and make themselves look better or make the situation look more dramatic.
00:15:36.000But with dreams, that doesn't make any sense.
00:15:40.000So I'm always trying to figure out, like, what is it about a dream where sometimes I can remember the dream.
00:15:46.000And sometimes it's so vivid when I wake up.
00:15:56.000So firstly, I mean, one theory of dreaming is that it's just simply a reconstruction when you wake up.
00:16:02.000So you have these fragments of activity and what your cortex does when it wakes up is what your cortex is designed to do when you're awake normally, which is try to package everything and make a good story, make logical fit out of the world.
00:16:23.000That doesn't necessarily mean I forget my dreams.
00:16:26.000And what I mean by that is accessibility versus availability.
00:16:31.000So if you ever had that experience where you've woken up, you thought, I was definitely dreaming, I can't quite grab it, you know, and it's gone.
00:16:39.000And then two days later, you're in the shower, you're sort of washing yourself, you see a bottle of shampoo, you see the label, and it just triggers the unlocking of that dream memory, and it sort of comes flooding back.
00:16:50.000Or someone says something to you, and you think, oh, that was the dream.
00:16:53.000What that tells me as a brain scientist is that the memory is there, it's preserved, it's available.
00:17:01.000But what happens most of the time when we wake up is that we lose the IP address to the memory.
00:17:06.000So it's present, but it's not consciously accessible.
00:18:30.000It's going to be ten minutes ago, and you wake up and, dude, it was King Kong, and he was swinging from my ceiling, and somehow or another he fit in the room, but the room got bigger, and you have these crazy dreams, and then 20 minutes later you forget all of it.
00:19:12.000Like, what if you fall off a building?
00:19:14.000Well, what's interesting is that that chemical is low whilst you're having that dream, but when you wake up from those, and some people often wake up, that's when you have the spike of noradhran, so it's still low when you're in dream sleep.
00:19:28.000But there's another chemical that goes in the opposite direction.
00:19:52.000When you take that, it's been clinically proven to enhance memory, especially verbal memory and recollection of words and things like that.
00:20:05.000But what may be happening, our current models, if you sort of build these neural models to sort of mimic dreaming, it may be that during dreaming, it's principally about the outflow of information to generate dreams.
00:20:17.000And in fact, the chemical profile is oppositional to input, which is about saving.
00:20:23.000So it's about sort of pumping out information rather than committing information.
00:20:28.000And so when you come out of a dream sleep, you still get this sort of lingering after sort of taste of chemistry as it were in the brain.
00:20:36.000That means that the dreaming brain is more programmed to be outputting a narrative and an experience rather than actually committing it to memory, which is the opposite direction if that makes sense.
00:21:22.000And then after you have it, within 10, 20 minutes, it is just like a dream that you can't remember.
00:21:29.000I remember like little flashes of experiences that I've had.
00:21:33.000And there's been a lot of speculation that that's one of the things that you're experiencing while you're in heavy REM sleep, and that could be responsible for the crazy visuals that you have that seem so vivid.
00:21:44.000I mean, there's been times where I've had dreams where I was 100% convinced that I was awake.
00:21:51.000And then something happened like I do this thing sometimes where I'll and if I do it consciously a lot I think I saw in one of those wacky movies like what the bleep do me know I think I saw it in that where you walk up to a door as you're walking through the door you knock on the side of the door and go am I awake?
00:22:31.000Like, what could possibly be causing me to construct this artificial reality in my mind that, at the moment at least, was indistinguishable from the reality that I experience right now?
00:22:43.000And I'm assuming because I just knocked on this table that I'm awake.
00:22:47.000Yeah, I really hope I'm not just a fictive character in your dreamscape.
00:22:59.000But I think, you know, what you're speaking about there really is almost why would Mother Nature create this thing called the dream experience?
00:23:09.000You know, what would be the function of Of essentially every night going into what sums up to be about two total hours of virtual reality experience and testing.
00:23:21.000One possibility which is deeply unsatisfying is that it's just a byproduct.
00:23:27.000That when your brain goes into this thing called REM sleep and all of the different patterns of brain activity that we described, an offshoot is this thing that we call dreaming.
00:23:38.000In the same way that a lightbulb, the reason that we construct the apparatus that's a lightbulb is to produce light, but when you produce light in that way, you also produce heat.
00:23:47.000It was never the function of the lightbulb, it's just what happens when you produce light in that way.
00:23:52.000Maybe dreaming is just sort of the heat of REM sleep, and REM sleep serves lots of other functions, but that doesn't feel to me right though.
00:24:21.000I read some article about the lack of REM sleep with marijuana users, and it was trying to say, and it made me super skeptical even as a pot smoker, that it was trying to say that it's not bad for you because what it's essentially doing is bypassing the REM sleep and going directly into the deep sleep,
00:24:41.000and that it's helping you in that regard.
00:24:47.000As a neuroscientist, he says nay, you fucking stoners.
00:24:50.000I'm so deeply unpopular, you know, I'm telling people, you know, don't smoke pot, stay away from alcohol, you know, apart from a general personality, which is dislikable, this doesn't help me.
00:25:01.000You're definitely not dislikable, but I don't think you're saying anything wrong.
00:25:05.000I think marijuana, like most things, is best used in moderation.
00:25:10.000And one thing that I got out of the Sober October thing wasn't just that it's fascinating to see the dreams just ramp up and get crazy, but also that when you take a few days off and then smoke a little pot, the pot actually has more of an impact.
00:25:27.000In fact, one of my favorite psychedelic authors and lecturers, the late, great Terence McKenna, his advice was to not do marijuana for long periods of time and then do as much as you could stand.
00:25:43.000And he was a real psychedelic adventurer.
00:25:46.000And his thought was to really get the benefit out of marijuana, it's not something that should be used daily and recreationally.
00:25:54.000It should be used as a psychedelic sacrament.
00:25:57.000Not should be, because he actually did smoke pot pretty regularly.
00:26:01.000But his thought was if you really want to get the full impact of it, you shouldn't be accustomed to it.
00:26:08.000And when you're accustomed to it, you build up a tolerance to it and it doesn't have the same impact.
00:26:13.000It's that thing, I don't know if you've ever been around pot smokers, but when someone doesn't smoke pot and then they get talked into smoking pot with some pot smokers, it's always a terrible idea.
00:26:23.000Because you've got a bunch of people with super high tolerances and some poor person that doesn't have any tolerance and they just get taken down a tornado rabbit hole journey into their childhood.
00:26:35.000It's like 0 to 60 in like 1.2 seconds.
00:26:37.000They're just so paranoid and thinking about everything and freaking out and all these sensations that they've just never experienced before.
00:26:43.000But the idea that you could bypass REM sleep and go straight into the deep sleep, that doesn't make any sense to you?
00:30:16.000I attribute it to the idea that it's so extreme, like, the activity of fighting is so extreme that my...
00:30:25.000Brain had kind of like hypercharged itself to compete at this very high level, you know, and that this was like so unusual that it was it was almost that red alert all the time and maybe even trying to work out patterns while I was sleeping.
00:30:43.000That's exactly the evidence that we have now.
00:30:45.000So for things like motor skills or even rats running around a maze where they will learn specific sort of navigational pathways and even skilled motor movements, what you can do is you can place these electrodes into centers of the brain.
00:31:02.000My sleep center works on humans, but other people have done these studies in rats.
00:31:07.000And you implant electrodes and you measure the brain cells firing as the rat is running around the maze.
00:31:12.000And let's say that you can sort of play little tones for each brain cell.
00:31:16.000So they're running around the maze and you can listen to the brain cells learning the signature of that maze.
00:31:24.000What was amazing is that when you let those rats sleep, but you keep listening to the brain, what you hear is as if the brain is actually, and in fact it is, it's replaying the exact same sequence,
00:31:40.000the memory sequence that it was learning whilst it was awake.
00:31:42.000It's replaying, but at a speed that is 20 times faster.
00:31:48.000So, you know, now we start to get into this Inception world, and I don't mean to because the scientific data, we're not sort of in that territory.
00:31:54.000But, you know, that notion of time compression and time dilation that Christopher Nolan played so well with in that movie, we can see that at the level of brain cell firing in rats as they're learning these mazes.
00:32:07.000And it comes back to what you're saying, which is that...
00:32:10.000The better that they rehearse those skilled memories, when you wake them up and test them the next day, that predicts how much better they are in terms of their performance.
00:32:21.000So it's not just that you learn, you go to sleep and you replay and you hit the save button on these new memories.
00:32:27.000You actually sculpt out those memories and you improve them.
00:32:31.000And we've done studies with motor skill learning, critical for athletic performance.
00:32:38.000Practice with a night of sleep is what makes perfect because you come back the next day and you're 20 to 30 percent better in terms of your skilled performance than where you were at the end of your practice session the day before.
00:33:06.000Skill learning, memory, and then also, you know, downstairs in the body, all of the recuperative benefits.
00:33:12.000And you can flip the coin, by the way.
00:33:14.000If you're getting six hours of sleep or less, your time to physical exhaustion drops by up to 30%.
00:33:22.000So you could spend all of your time training for a 10-round fight, perfect condition, but then I put you on six hours of sleep the night before, you're now going to be physically exhausted by round 7 rather than round 10. Wow.
00:33:34.000But, well, that's a really hard thing for fighters because they have a very difficult time sleeping the night before a big fight.
00:33:40.000It's very, very difficult because there's anxiety.
00:33:43.000And I would imagine it's got to be I mean, it's probably going to take a huge toll.
00:33:50.000I mean, it's probably a huge benefit if they can somehow or another bypass all that and just relax and learn how to relax and learn how to actually sleep.
00:33:59.000I mean, it's I think, you know, it's one of what constantly trying to hack the physiological system, especially in elite sports these days, because, you know, small fractions of a percent of gain can make a huge difference.
00:36:25.000You know, your peak muscle strength, your physical vertical jump height, and your peak running speed, all of those things correlate with sleep.
00:36:36.000The less that you have, the worse those outcomes are.
00:36:39.000Probably one of the most surprising factors there was injury risk when they've looked at athletes across a season and they've just plotted, you know, how frequently will they get injured?
00:36:48.000And then they surveyed them, you know, how much sleep were you getting?
00:36:51.000And they bucketed them into sort of people who are getting nine hours, seven hours, six, five, four.
00:36:55.000And it's a perfect linear relationship.
00:36:57.000The less sleep that you have, higher your injury risk.
00:37:01.000So people getting nine hours versus five hours, there was almost a 60% increase in probability of injury risk during a season.
00:37:10.000Do you attribute that to exhaustion or do you attribute that to a lack of recovery from the previous night's workout?
00:37:26.000I mean, even if you look at microbalance, if you look at sort of these stability muscles versus, you know, major muscles, those stability muscles also fail when you're not getting sufficient sleep.
00:37:36.000And I think we often underestimate how critical they are in sport performance, particularly in terms of combating and placating injury risk, too.
00:37:45.000So if you just get someone on a stability ball...
00:37:47.000You know, sort of just dose them down with sleep, eight hours, five hours, you know, three hours.
00:37:52.000And just notice how those stability muscles help you balance, just the basic act of balance.
00:38:02.000Now, as a neuroscientist, what do you attribute, when people talk about visualization, and visualization is a huge factor in improving technical skills, specifically martial arts,
00:38:21.000Martial arts, when you visualize, people who visualize, who sit down and go over their body, going through the motions and doing things, those people perform better.
00:39:46.000And he said, do you know how like when you were a little kid and you're trying to figure out how to tie your shoe, it's an extremely difficult thing to do.
00:41:21.000If you heard someone trying to sort of play piano to begin with, it doesn't sound very fluid.
00:41:27.000You know, as someone who is a maestro, it just flows out of them.
00:41:31.000So we looked at this with motor skill performance, again, sort of like keyboard playing musicianship.
00:41:37.000And you learn and you learn and you get better.
00:41:39.000And let's say that you type a sequence, let's say 4-1-3-2-4, and people learn it, but they have these problem points throughout the sequence.
00:41:46.000They go 4-1-3-2-4, 4-1-3-2-4, as if it's a sticking point.
00:41:52.000It's the same thing with any skilled performance in athletics.
00:41:57.000And it's the brain chunking things up.
00:41:59.000A very long motor sequence gets chunked up into small sort of digestible bites.
00:42:03.000It's a good way to begin learning, but it's not a way to create automaticity.
00:42:07.000At some point, what you have to do is stitch all of those things together, and it just flows.
00:42:34.000It goes in, finds that problem point, that friction point in your motor skill sort of deficit, and it smooths it out.
00:42:42.000So you come back the next day and now it's just 4-1-3-2-4, 4-1-3-2-4, 4-1-3.
00:42:46.000It's automaticity, and it's exactly what you're describing.
00:42:50.000You know, speak to musicians, they'll say, I was playing, I just couldn't get that piece the night before, and then I came back the next day and I sat down and I could just play.
00:43:25.000And there's lots of anecdotal evidence of sleep-inspired creativity.
00:43:30.000And now this shifts to one of the benefits of dreaming, in fact.
00:43:35.000It's during dream sleep when we take all of the information that we've previously learned and we start to collide it with all of the new information that we've learned.
00:43:44.000It's a little bit like group therapy for memories, you know.
00:43:48.000Everyone gets a name badge and you all get to speak to each other.
00:43:51.000And the brain starts to seek out and test novel connections and new associations.
00:43:58.000So it's almost like informational alchemy.
00:44:00.000And you wake up the next morning with a revised mind-wide web that is now capable of divining incredible solutions to previously impenetrable problems.
00:44:14.000And lots of anecdotes, you know, Dmitry Mendeleev came up with a periodic table of elements by way of dream-inspired insight.
00:44:21.000You know, talk about a Herculean task, take all of the elements in the known universe and figure out a structure as to how they all fit together.
00:44:43.000But even if he was, he was a habitual napper during the day.
00:44:47.000I've got some great pictures of him on his workbench.
00:44:51.000And he used sleep ruthlessly as a tool for creativity.
00:44:56.000And he would sit at his desk and he would have a sort of pad of paper and a pencil.
00:45:02.000And he had a chair with armrests and he would pick up two steel ball bearings and take a metal saucepan and turn it upside down, place it underneath the arm of the chair and put the two steel ball bearings in his hand then he would rest back and he would start to fall asleep.
00:45:20.000And so he didn't fall too far into sleep.
00:45:22.000What would happen is at some point, his muscle tone would relax, they would release the steel ball bearings, they would crash on the saucepan, wake him up, and then he would write down all of the creative ideas that he was having.
00:45:35.000No wonder you're never told to stay awake on a problem.
00:45:38.000And in every language that I've inquired about today, French, Swahili, that phrase, sleeping on a problem, seems to exist, which must mean that this benefit of dream sleep transcends cultural boundaries.
00:45:52.000I should note, I think it's important that the French, the French translation is much closer to you sleep with a problem.
00:45:59.000We, the British, you say you sleep on a problem.
00:46:01.000The French, you say you sleep with a problem.
00:46:03.000I think it says so much about the romantic difference between the British and the French, you know?
00:46:08.000Yeah, the French trying to fuck everything, trying to fuck their problems.
00:46:12.000I'll lose my British passport for saying that, but that's okay.
00:46:19.000That's fascinating that Einstein figured that out too, that he literally had like a whole routine and that he would drop this ball and hit it, bang, and wake up and start writing.
00:47:32.000It's a place I try to go to every year.
00:47:36.000Really stunning, because it's very high up.
00:47:39.000I think the observatory is somewhere more than 9,000 feet above sea level, and then I think you go even further, and then they have the telescopes.
00:47:49.000But you go to the visitor center, and you go to the visitor center, and they have some telescopes set up.
00:47:53.000But you actually drive through the clouds.
00:47:57.000So as you're driving up this mountain, we were bummed out.
00:48:38.000I think that perspective, that's a giant factor in the way human beings look at their relationship with the universe.
00:48:46.000But I think that also, just the light everywhere, constant light everywhere, that's got to be a big factor in why people sleep so little, right?
00:51:41.000Yeah, I mean, the evidence is pretty good that cooling the body actually works.
00:51:46.000In the book, I write about a series of studies where they had people in...
00:51:51.000It's almost like a wetsuit, but it has all of these veins running through it.
00:51:56.000And they could actually perfuse warm or cold water into any part of the body, hands, core of the body, feet...
00:52:04.000And so that you could exquisitely manipulate the temperature of any part of the body.
00:52:10.000And what they found is that they could effectively cool the body down and it instantaneously made people fall asleep faster and it gave them deeper, deep non-REM sleep, that sort of restorative sleep for the body.
00:52:24.000So, and you can even look at studies where people sleep semi-naked and And that also seems to improve their sleep and they get a little bit more deep sleep too.
00:52:37.000The paradox here though is that you need to warm your feet and your hands to kind of charm the blood away from your core out to the surface and radiate that heat.
00:52:54.000Evidence here too that I discuss where people say, you know, I get out of a hot bath, I feel nice and toasty, I'm relaxed and that's why I fall asleep.
00:53:31.000That sounds so counterintuitive, but it makes sense.
00:53:35.000And it makes sense because that's how we were designed.
00:53:38.000If you look at hunter-gatherer tribes whose way of life has not changed for thousands of years and you ask, how do they sleep?
00:53:44.000One of the things that seems to dictate their sleep is the rise and fall of temperature.
00:53:51.000Temperature is at its lowest in the nadir of the night, you know, three or four in the morning.
00:53:55.000And as that temperature, that climate temperature starts to drop, that's when they start to get drowsy.
00:54:01.000As if temperature is just sort of signaling to the brain, now it's time to sleep.
00:54:06.000So light as well as temperature are two key triggers to help you get better sleep.
00:54:12.000If you look at those tribes, by the way, and when they go to sleep and they wake up, You know, they go to sleep probably at two hours after dusk, sort of eight to nine in the evening, wake up about half an hour, even an hour before dawn.
00:54:25.000It's the rise in temperature rather than light that triggers their awakening.
00:54:30.000But there's a reason, you know, have you ever thought about what the term midnight actually means?
00:55:11.000Yeah, it's actually a little different than the idea of two sleeps.
00:55:14.000So there was a time in sort of the Dickensian era where people would sleep for the first half of the night, maybe sort of four hours or so.
00:55:22.000Then they would wake up, they would socialize, they would eat, they would make love, and then they would go back and have a second sleep.
00:55:30.000If you look at natural biological rhythms in the brain and the body, that doesn't really seem to be how we were designed.
00:55:36.000It certainly seems to be something that we did in society, but I think it's more of a societal trend than it was a biological edict.
00:55:46.000However, we do seem to have two sleep periods the way that we were designed.
00:55:51.000Those tribes will often sleep about six and a half hours, seven hours of sleep at night.
00:55:56.000And then especially in the summer, they'll have that siesta-like behavior in the afternoon.
00:57:35.000Well, they created a lot of art then, too, right?
00:57:37.000A lot of writing and a lot of fascinating stuff came out of that time.
00:57:40.000Now, when you're measuring people's health and when you're measuring people's health in regard to how much sleep they have, How do you do that?
00:57:55.000How do you get a detailed analysis of people's patterns?
00:58:00.000So you can do it at many different levels.
00:58:02.000I mean, we can start at the sort of gross high level, which is epidemiological studies across millions of people, where you do surveys, you ask them about their sleep, and then you look at health outcomes.
00:58:12.000The first thing from that data that's clear is an unfortunate truth.
00:58:17.000The shorter your sleep, the shorter your life.
00:59:10.000And it's sleep that offers a reparatory function.
00:59:12.000And I'll give you one example, which is your risk for Alzheimer's disease.
00:59:16.000Insufficient sleep across the lifespan now seems to be one of the most significant lifestyle factors determining whether or not you'll develop Alzheimer's.
00:59:24.000What studies, if any, have been done on people that work the third shift?
00:59:28.000So people have looked at shift work in general.
00:59:32.000They haven't necessarily split it down to that granular point.
00:59:35.000But what we see is that shift workers have higher rates of obesity, higher rates of diabetes, but perhaps most frighteningly cancer.
00:59:44.000And in fact, we now know the link between a lack of sleep and cancer is quite strong.
00:59:50.000Insufficient sleep is linked to cancer of the bowel, cancer of the prostate, cancer of the breast.
00:59:54.000And the association has become so powerful that recently the World Health Organization decided to classify any form of nighttime shift work as a probable carcinogen.
01:00:48.000It says you want to eat more, you're not satisfied with your food.
01:00:53.000If I take people, and these studies have been done, we've done some of these studies too, and you just put a group of healthy people on four or five hours of sleep for, let's say, one week.
01:01:03.000And you look at those two hormones, they go in unfortunately opposite directions.
01:01:08.000So leptin that says you're full, stop eating, that gets suppressed by a lack of sleep.
01:01:13.000Ghrelin, the hunger hormone, that gets ramped up.
01:01:16.000So firstly, people who are sleeping just five to six hours a night will on average eat somewhere between 200 to 300 extra calories each day because of their underslept state.
01:01:29.000Add that up, it's about 70,000 extra calories a year.
01:01:32.000It's about 10 to 15 pounds of obese mass each year, which for me is starting to sound familiar.
01:01:39.000But what we also know is that it's not just that when you're underslept, you eat more.
01:01:47.000And the great scientific work, if you give people this sort of finger buffet and they can eat whatever they want and it contains all of the different food groups, And you sleep deprive them or you give them a full eight hours of sleep.
01:02:00.000Yes, they start to overeat by somewhere around about 450 calories with total sleep deprivation.
01:02:06.000But what they go after is heavy hitting carbohydrates and simple sugars process food.
01:02:12.000And they stay away from the healthy sort of leafy greens, nuts, proteins, etc.
01:02:18.000So you're not just eating more, you're eating more of the wrong things.
01:02:21.000And that's why a lack of sleep has such a strong obesogenic profile to it.
01:02:27.000And you can take a step back, too, and you say, well, if you look at the rise of obesity over the past 70 years, just this upward exponential increase, and if you plot on the same graph the amount of sleep that society is getting, it goes in the opposite direction.
01:02:42.000As sleep time has declined, obesity rates have increased.
01:02:46.000I'm not going to sit here and tell you that the obesity epidemic is simply a sleep problem.
01:03:33.000So what you're talking about there is what we call prophylactic napping, which is sort of strategically trying to help combat your deficiency of sleep.
01:03:45.000We've done some of these studies where they improve, you know, your learning, your memory, your alertness, your concentration, especially your emotional regulation too.
01:03:52.000Sleep is critical for emotional first aid and mental health.
01:03:57.000However, you can't keep using naps to self-medicate sort of short sleep of, you know, four or five hours each night.
01:04:06.000We know that the system itself, your brain, has no capacity to regain all of the sleep that it's lost.
01:04:13.000It will try to sleep back some of that debt.
01:04:16.000But what we've discovered, let's say I take you tonight, I deprive you of sleep, eight hours lost.
01:04:21.000Then I give you all of the recovery sleep that you want on a second, third or fourth night.
01:04:25.000You will sleep longer, but you will only get back maybe just three or four hours of that lost total eight.
01:05:06.000Because there were times during our evolutionary past where we faced famine and we faced feast.
01:05:13.000And so the body learned to adapt to that and said, when you have feast, store it up as caloric energy in these things called adipose cells, fat cells.
01:05:21.000And then when you go into famine, you can spend that caloric credit.
01:06:42.000So fasting is when you're talking about multiple day fasting and not intermittent fasting?
01:06:48.000We don't know the evidence for intermittent fasting.
01:06:51.000So, you know, if you're some people are doing sort of 12 hours, 14 hours, 16 hours.
01:06:57.000That doesn't seem to be extreme enough to trigger a change in sleep.
01:07:01.000But if you fast for these long periods, you know, two days, three days, four days, you can really see some quite marked sleep fragmentation.
01:07:08.000You know, ask any of those people, they'll tell you.
01:07:11.000That's fascinating because people always cite the health benefits of multiple day fasts.
01:07:16.000Do you think that that's just like a placebo effect?
01:07:20.000I mean certainly we know that there are chemical pathways that when you go into fasting are activated that seem to be beneficial for health outcomes.
01:07:28.000There's a big literature on sort of fasting and aging with the mTOR pathway for example.
01:07:33.000But, you know, we also know that as a species, we were not designed to have such terrible fragmented sleep.
01:07:39.000And we spoke about how sleep regulates your appetite.
01:07:43.000If you're trying not to eat food and sort of control and manage your weight, the last thing that you probably want to do is be shortchanging yourself on sleep because it's only going to make you even more hungry and reach for sort of worse food.
01:07:57.000So I still think there's room for fasting in the equation, but I think those extreme fasts You know, and the havoc that it plays on sleep, it's still yet to be understood.
01:08:07.000You've got to be very careful with playing around with anything going beyond sensible, you know, behavior.
01:08:12.000So what does it, like what is, say if you're going to fast for two days, what switches on that forces your body into this haphazard sleep program?
01:08:22.000So that's where that hormone ghrelin just kicks into high gear.
01:08:26.000That hormone that is just saying, it's a starvation hormone at that point.
01:09:09.000We've never seen the body being able to sort of re-engage with, you know, cognitive function with a dose of sleep deprivation that keeps going.
01:09:19.000So if I, and these studies have been done, take people and give them two weeks of seven hours of sleep, five hours of sleep, three hours of sleep, or no sleep.
01:09:28.000You know, even by sort of seven days or even 14 days of six hours of sleep, your cognitive performance just nosedives like a dart into the ground.
01:09:38.000And it doesn't show any signs of leveling off as if there is no asymptote that it could keep going.
01:09:45.000And by the way, people should know that after 20 hours of being awake, you are as impaired cognitively as you would be if you were legally drunk.
01:09:56.000Yeah, in terms of your alertness and reaction time.
01:09:59.000But it's worse, and this is where, you know, drowsy driving comes in.
01:10:02.000For every 30 seconds that we've been speaking, there has been a car accident linked to sleeplessness.
01:10:09.000Drowsy driving, it seems, kills more people on the roads than either alcohol or drugs combined.
01:10:16.000Why are drowsy driving accidents so deathly?
01:10:20.000Now, I'm not endorsing those other things, of course not, but let's just think about why that's the case.
01:10:26.000When you're underslept, you start to have what are called microsleeps.
01:10:31.000Sometimes your eyelid does not close all the way, it just partially closes, but the brain essentially goes to sleep for just a very brief period of time.
01:10:40.000And you can even see individual brain cells, looks like they go to sleep during these microsleeps.
01:10:45.000At that moment, if you're traveling in a vehicle on the freeway, you've got a one-ton missile traveling at 65 miles an hour, and no one is in control.
01:13:21.000So I think if our goal as educators truly is to educate, and we've spoken about learning and memory, and not risk lives in the process, then we are failing our children in the most spectacular manner with this incessant model of early school start times.
01:14:48.000I don't mean to chastise school systems or the bus unions.
01:14:51.000It's an incredibly difficult logistics problem.
01:14:55.000But I have to think that, you know, what is our goal here?
01:14:58.000If our goal is to keep our kids safe and to get them well-educated and get information into the brain and nurture them and, you know, create them to be the next generation, early school start times, you know, are not the thing to do.
01:15:12.000There's a lot of lazy kids out there that are going, yes!
01:15:17.000I mean, the data, you know, they looked at these academic things, too.
01:15:20.000You know, one of these, another example comes from Adena in Minnesota, and they shifted school start times from, I think it was 7.25 to 8.30 in the morning, and they looked at SAT scores.
01:15:33.000And in the year before they made the time change, the top 10% performing students got an average SAT score of 1,288, which is a great score.
01:15:43.000The following year, when they were going to school now at 830 rather than 725, the average SAT score was 1,500.
01:15:52.000That's a 212-point increase, which is non-trivial.
01:15:59.000Yeah, I think it's the school time in correlation with the work time.
01:16:04.000It's very difficult to get people off of that.
01:16:06.000Yeah, and that's part of what modernity has done.
01:16:11.000We're working longer hours and also we're commuting for longer durations of time.
01:16:17.000So therefore people are having to wake up earlier, they come home later, and the one thing that gets squeezed, sort of like vice grips, is this thing called sleep.
01:16:27.000And the decimation of sleep throughout industrialized nations as a consequence is having a catastrophic impact on our health and our wellness and the safety and the education of our children.
01:16:41.000Now, other than making the room cold and warming up your hands and your feet and things along those lines, what about diet or even time that you eat?
01:16:53.000Is there a specific time before you go to bed that you should eat?
01:16:56.000How much time should you give yourself to digest your food?
01:16:59.000So the general advice right now is don't go to bed too full and don't go to bed too hungry.
01:17:05.000Again, if you're going to bed too hungry, you can get that sort of that signal of I'm starting to go into low level sort of starvation and that can keep people awake at night.
01:17:15.000The evidence in terms of diet composition and sleep is quite unclear.
01:17:19.000It's not a particularly well-researched area right now.
01:17:22.000What we do know is that diets that are high in sugar and sort of heavier stodgy carbohydrates and low in fiber, those diets tend not to be good for sleep.
01:17:35.000You tend to have less deep sleep and your sleep is also more fragmented throughout the night.
01:17:40.000So that's sort of right now the best advice.
01:17:43.000So you should eat several hours before you go to bed, but not five hours.
01:17:51.000And it's different for different people, and you will know it, you know, if you're sort of starting to wake up with really severe hunger pangs.
01:17:57.000What about supplements, like melatonin supplements or things along those lines?
01:18:06.000It's useful when you're traveling between time zones.
01:18:09.000So at that point, your body clock, your internal clock is out of sync with the actual real time in the new time zone.
01:18:16.000And let's say I fly from Los Angeles over to London back home.
01:18:21.000You know, my melatonin spike is going to be eight hours in the past, you know, sort of back in time.
01:18:28.000It's not going to arrive with me for eight hours.
01:18:30.000So I can take some melatonin and I can fool my brain into thinking, oh my goodness, it's actually dark.
01:18:36.000When despite in California it's still daylight once I've arrived at Heathrow Airport.
01:18:40.000So you can use melatonin strategically for jet lag.
01:18:43.000Once people however are stable in a new time zone, melatonin does not seem to be efficacious for helping sleep.
01:18:53.000That said, though, if people out there are taking melatonin and they think it helps, I would tell them to keep taking it because the placebo effect is the most reliable effect in all of pharmacology.
01:19:03.000So if it works for you, no harm, no foul.
01:19:07.000So the people that take melatonin nightly...
01:19:11.000Like, this is what gets me to go to bed.
01:19:13.000Really, they're just playing a trick on their mind.
01:19:14.000Yeah, unless you're an older individual where your sort of 24-hour rhythm, it's called your circadian rhythm, starts to get blunted and it's not as strong anymore, that's where nightly use of melatonin actually has been demonstrated to be efficacious.
01:19:29.000But if you're young, healthy, and you're taking melatonin, it's unlikely that it's actually helping your sleep.
01:20:10.000But what I read was that was bullshit.
01:20:12.000And what was really going on was that you just ate a gigantic meal and it's filled with stuffing and mashed potatoes and all those carbohydrates cause you to just crash.
01:20:21.000And it's usually, it's the time that everyone goes back through into sort of the living room.
01:21:24.000We have the number of people who can survive on six hours of sleep or less without showing any impairment rounded to a whole number and expressed as a percent of the population is zero.
01:22:38.000And that's completely counterintuitive based on the data.
01:22:41.000We know that people are more productive, you know, and we've seen some of these studies in the workplace where you look, firstly, underslept employees will take on fewer work challenges overall.
01:22:53.000They end up taking the simpler ones, like listening to voice messages, rather than actually digging into deep project work.
01:23:00.000They produce fewer creative solutions to challenges that you give them.
01:23:04.000They also slack off when they're working in groups.
01:23:08.000It's called social loafing, where they just ride the coattails of other people's hard work.
01:23:12.000The less sleep that you have, the more willing that you just sort of don't pull your weight.
01:23:17.000Furthermore, it goes all the way up to the top.
01:23:20.000So the more or less sleep that a business leader has had from one night to the next, the more or less charismatic their employees will rate that business leader, despite them knowing nothing about the sleep of that CEO. It's evident in their behavior.
01:23:34.000Well, because they're short with their temper.
01:23:38.000They're quicker to get upset about things.
01:23:40.000They're less charismatic and social with their conversations.
01:24:11.000That's what an underslept workforce will be for you.
01:24:14.000Now, what about the amount of time that people spend at work?
01:24:18.000I mean, I know this is not related to sleep, but I've always felt like people work too much.
01:24:24.000I feel like you probably could get more done with less time there.
01:24:29.000Yeah, so efficiency is what we're talking about, and that's another one of those things with sleep deprivation.
01:24:35.000I think many people, when they haven't had a good night of sleep, they're looking at this report and they realize, I've just read this paragraph a third time and I still can't quite get it.
01:24:59.000So you're kind of bleeding these people.
01:25:01.000You're getting blood out of a rock in the last couple hours.
01:25:05.000And it's, yeah, it's not, you know, either a creative way to work and creativity, you know, is supposed to be the engine of, you know, business and ingenuity.
01:25:13.000But why would you, you know, take twice the amount of time to boil, you know, a pot of water on half heat when you could do it in half the time if you just put it on high?
01:25:53.000And it's like they had used being silly and overtired as a strategy, almost like they were doing drugs, but they weren't doing any drugs.
01:26:02.000I mean, it comes back to, well, we don't know in that scenario, you know, it hasn't been studied, but what we have found, at least in our scientific studies, is that that prefrontal cortex region that we spoke about before, that sort of rational, logical part of the brain, that's one of the first things to go when you're sleep deprived.
01:26:19.000So that area of the brain just gets sort of switched off the more that you are sort of lacking in your sleep.
01:26:27.000And emotional, deep emotional centers of the brain, which are normally controlled and kept in check by that prefrontal cortex, they just erupt in terms of their activity.
01:26:37.000So you're all emotional gas pedal and too little regulatory control break, which for the most part, very bad.
01:26:44.000But, you know, one possibility is that if you want to try and get a little bit sort of, you know, Crazy, loosey-goosey.
01:26:51.000You know, maybe that's not bad for that type of sort of comedic writing that you, you know, you become a bit more childlike.
01:26:58.000And I say that affectionately because the last part of the brain to mature in development is the prefrontal cortex.
01:27:05.000So you revert back to almost a more childlike state.
01:27:08.000But I honestly would not condone that sort of, you know, undergoing sleep just based on the mortality and, you know, risk of Alzheimer's and cancer by itself.
01:27:19.000Even in short doses, like a couple days a week, if sleep is not a renewable resource, what is the effect of, say if you have three nights a week where you sleep eight hours, and then the next night, two hours?
01:27:44.000There was a study where they just took individuals and they just gave them four hours of sleep for one night.
01:27:49.000And what they saw was a 70% reduction in critical anti-canter-fighting immune cells called natural killer cells.
01:27:57.000These are wonderful immune assassins that target malignant cells.
01:28:03.000So today, both you and I have produced cancer cells in our body.
01:28:07.000What prevents those cancer cells from becoming the disease that we call cancer is in part these natural killer cells.
01:28:14.000And after one night of four hours of sleep, that is a remarkable state of immune deficiency, and that's one of the reasons why insufficient sleep predicts cancer.
01:28:24.000I could also speak about your cardiovascular system, though, and all it takes is one hour, because there is a global experiment that's performed on 1.6 billion people across 70 countries twice a year, and it's called Daylight Savings Time.
01:28:39.000Now, in the spring, when we lose an hour of sleep, we see a subsequent 24% increase in heart attacks.
01:29:33.000The first was that a sizable 711 genes were distorted in their activity caused by one week of six hours of sleep.
01:29:43.000Which is highly relevant, by the way, because we know that many people are trying to survive on six hours of sleep during the week.
01:29:52.000I was going to say the second sort of perhaps more interesting result was that about half of those genes were actually increased in their activity.
01:29:59.000The other half were actually suppressed.
01:30:02.000Those genes that were switched off by six hours of sleep for one week were genes related to your immune response, many of them.
01:30:12.000Those genes that were increased or what we call overexpressed were genes that were related to the promotion of tumors, genes that were related to long-term chronic inflammation within the body, and genes that were associated with stress and as a consequence cardiovascular disease.
01:30:30.000You know, it's really disturbing to me in my youth from age probably I guess I was price 18 when I started I delivered newspapers I used to drive around and throw newspapers out of my car and I did it for years and I would have to be up at five o'clock every morning and I never Never went to bed early.
01:31:19.000And the reason I ask, by the way, is because as you go through into those sort of later stages of adolescence and sort of early adulthood, your biological rhythm moves forward in time.
01:31:27.000So you want to go to bed later and wake up later.
01:31:29.000So even if you went to bed sort of conscientiously at that time, let's say like 10 o'clock or 9 o'clock, you wouldn't be able to sleep because it's biologically impossible.
01:31:39.000And then on Saturday, even worse, one day a week, Saturday night, I'd have to get up at 3 or 4 in the morning because I had to deliver Sunday papers.
01:32:00.000I'd start delivering somewhere around 4.35, depending on when the papers got in, and I was done by like 9, you know, 9.30, and then I'd try to crash, but I was a wreck.
01:32:11.000I mean, and it fucked me up for years.
01:32:15.000And I stop and think about that now, listening to you, listening to this conversation, like, what kind of fucking damage did I do to myself over those years?
01:32:23.000Yeah, I won't tell you about the stuff with Alzheimer's then and amyloid protein.
01:33:00.000There is a small fraction of 1% of the population that has a special gene that allows them to survive on about five hours of sleep.
01:33:11.000And most people, when I tell them this, they say, ah, I think I'm one of those people.
01:33:16.000The chances of you being, you know, you're much more likely, for example, to be struck by lightning in your lifetime, the odds of which are, I think, about 1 in 12,500, than you are to have this incredibly rare gene that means you can survive on something around five hours of sleep.
01:33:33.000Well, it's a gene that seems to promote, again, wakefulness chemistry within the brain that allows you to maintain wakefulness in a more sustained way.
01:33:46.000And so we're only trying to understand right now what the actual biochemical mechanisms are in terms of the consequence of that gene, that gene mutation.
01:33:56.000But certainly it seems to exist that there are some of those quote unquote short sleepers.
01:34:01.000By the way, you know, we hear of these business leaders and even actually heads of state, I'm not going to name any names, but I'll give you right now, but I'll give you two examples of the past.
01:34:11.000Margaret Thatcher and Ronald Reagan both were vociferous in their statement and their declaration of how little sleep that they would get.
01:34:19.000Both of them said four or five hours a night.
01:34:22.000And I think in part it was to paint this heroic ironclad status.
01:34:27.000And many people would say to me, you know, Margaret Thatcher, you know, it's your lifetime.
01:34:31.000Well, sadly and tragically, Thatcher and Reagan both ended up getting Alzheimer's disease, you know.
01:34:37.000And we now know because it's during deep sleep at night that there is a sewage system in the brain that kicks into high gear and it cleanses the brain of all of the metabolic toxins that have been built up throughout the day, this low-level brain damage.
01:34:51.000One of those toxic sticky proteins that builds up whilst we're awake is called beta amyloid.
01:34:57.000Beta amyloid is one of the leading causes of underlying the mechanism of Alzheimer's disease.
01:35:02.000So the less sleep that you're having across the lifespan, the more of that toxic amyloid is building up night after night, year after year.
01:35:12.000And I don't think it's coincidental that both of them ended up progressing tragically into a state of Alzheimer's disease.
01:35:19.000So it's good night sleep clean in that way in terms of deep sleep.
01:35:26.000Is there anything you can do in terms of how you eat or supplements you can take that could potentially at least somewhat mitigate the effects of having no sleep?
01:35:37.000We haven't found any good countermeasures.
01:36:10.000Yeah, so Modafinil is sort of the underlying chemical there.
01:36:14.000And it's debated who actually came up with it.
01:36:16.000It may have been the French military who actually ended up being the generators of that.
01:36:21.000That seems to work through a pathway, at least right now as we understand it, for a chemical called dopamine.
01:36:27.000And dopamine is principally known as a pleasure drug.
01:36:29.000It's the chemical that a lot of drugs of abuse will target to sort of ramp up.
01:36:34.000But it also is a basic alertness drug that when you get an increase in dopamine, you tend to actually get an increase in your alertness and your wakefulness.
01:36:42.000Don't you get an increase in happiness as well?
01:36:44.000You can too, although modafinil tends to come with the alertness component of that equation and less so with the euphoria.
01:36:51.000That's why it has a lower prevalence of sort of addiction and abuse.
01:37:16.000I've taken it when I have to drive like long periods of time like I'm driving from San Diego to California or to Los Angeles and maybe I have a gig.
01:37:25.000My gig's done at like 1130. I know I'm gonna be on the road late at night.
01:37:59.000And Adderall, you know, one of the interesting things is that if you look at the profile of what sleep deprivation is cognitively, you know, reduced alertness, impulsivity, lack of ability to concentrate, difficulties with learning and memory, difficulties with behavioral problems.
01:38:17.000If I were to describe those features to a pediatrician and say, what disorder is this?
01:38:25.000But what we now know is that there is some portion of children out there who are diagnosed with ADHD who either one are just underslept or two actually have sleep disordered breathing because of perhaps tonsil problems where they're not getting sufficient sleep.
01:38:39.000And when you treat the sleep disorder, when you do a sort of, you know, remove the tonsils, They start sleeping normally and the ADHD disappears.
01:38:49.000So there is an issue here, I think, within that sort of the explosion of ADHD. Not all people are, you know, sort of privy to this sort of sleep problem simply masquerading as ADHD. Some people are.
01:39:01.000One of the other problems, too, though, is that ADHD kids tend not to sleep very well.
01:39:07.000And what we end up giving them is a drug that is a stimulant which will combat sleep and fight back against sleep.
01:39:15.000So I think we need to have a bit more of a strategic approach as to when we think about at least the dose of that medication in terms of when sleep should be sort of expected during the day.
01:39:26.000Because, you know, taking it in the middle of the day, in the evening, if it's a stimulant, it's a weight-promoting drug.
01:39:33.000Well, that's terrifying because I don't know if the people that are prescribing these things have the sort of deep education in sleep and the necessity of it that you do.
01:40:40.000And I'm desperately appealing for this.
01:40:41.000You know, it's a third of their patient's life I think?
01:41:04.000If you have elective surgery, you should ask your surgeon how much sleep they've had in the past 24 hours.
01:41:09.000If they've had six hours of sleep or less, you have a 170% increased risk of a major surgical error, such as sort of organ damage or hemorrhaging relative to that same surgeon if they had been well rested.
01:41:26.000And then the irony here, by the way, is that when a resident finishes a 30-hour shift, gets back into their car to drive home, there is a 168% increased risk that they will get into a car accident because of their underslept state,
01:41:41.000ending up back in the same emergency room where they just came from but now as a patient from a car crash.
01:41:48.000You know, we need to radically rethink the importance of sleep in education, in business, in the workplace, and in medicine too.
01:42:37.000Early in his career, he was examining the anesthetic capacities of cocaine.
01:42:42.000So, you know, if well, I'm not going to say, you know, you may have heard from perhaps colleagues that when you snort cocaine, you get a numb face.
01:42:52.000The reason is because it blocks nerves.
01:42:54.000I like how you said it from colleagues.
01:43:10.000We talked about this yesterday, ironically, on the podcast and about doctors becoming drug addicts, the initial doctors that started doing lidocaine.
01:43:25.000And he structured a program where he expected his residents to match him, to go toe-to-toe with him for each hour that he would remain awake.
01:43:34.000Yeah, it sounds like what a coke head would do.
01:44:58.000You know, after 20 hours of being awake, you're as impaired as you would be if you were legally drunk.
01:45:04.000So unfortunately, we placed young residents in this position of, you know, acting and operating and decision-making under conditions of insufficient sleep.
01:45:13.000One in five medical residents will make a serious medical error due to insufficient sleep.
01:45:19.000One in 20 medical residents will kill a patient because of a fatigue-related error.
01:45:49.000You know, and the data now is so prolific.
01:45:52.000You know, I write all about that and try to build an evidence-based, you know, emotionless cold case for sleep in medicine, a sleep prescription for medicine, as it were.
01:46:03.000Well, most people don't realize the requirements that residents have.
01:46:08.000And they are literally, you know, beyond human capacity.
01:46:13.000Thinking that, you know, hubris and some degree of hours on the job is going to be able to allow you to sort of, you know, cut short what took three and a half million years to sort of, you know, get in place, which is an eight-hour night of sleep.
01:46:42.000I just don't understand how the very people that are working on the health of patients and fixing them and repairing injuries and taking care of diseases, those are the people that are ignoring one of the primary factors of disease and errors and cognitive function.
01:47:26.000I mean, how many warning bells do you need to tell you that you're in a deleterious state if you're falling asleep with your trousers around your ankles, with food all over your face, and yet you're in the deepest stages of non-REM sleep?
01:47:39.000And he's the guy who's working on people's eyes.
01:47:45.000And it's, you know, sleep is equally absent for the patient in the hospital, you know, setting.
01:47:50.000We know that somewhere between 50 to 70% of all ICU alarms are either unnecessary or ignorable.
01:48:01.000And the one place where you desperately need the Swiss Army knife of health that is a good night of sleep is the one place where you get at least, which is on a hospital ward.
01:48:10.000We could exit people out of hospital beds earlier.
01:48:13.000The data is already there for the neonatal intensive care unit.
01:48:16.000They used to leave bright lights on 24-7.
01:48:20.000And that would prevent sort of the signaling for sleep and wake and sleep and wake.
01:48:26.000If you regularize light in the neonatal intensive care unit, those infants ended up having higher levels of oxygen saturation because they were sleeping better.
01:48:38.000Their weight gain was dramatically increased and they ended up exiting the neonatal intensive care unit five weeks earlier.
01:49:52.000I mean, when the book came out, which was sort of the hardback came out back in October, and some people started to give pushbacks sort of in the medicine realm.
01:50:03.000You know, there was some concerns about continuity of care, that if you keep switching residents out every 16 hours, that you wouldn't have continuous patient care, and that was a problem.
01:50:13.000Well, there are other medical training systems, for example, France, Sweden, New Zealand.
01:51:31.000But I feel as though there is a mission that whose voice has not been actually gifted yet.
01:51:36.000And I wanted to try and help and be a sort of a sleep diplomat.
01:51:40.000I mean, that's why I chose the handle on social media, trying to be there as an ambassador for sleep.
01:51:44.000And now, once people start to understand the sciences we've spoken about for two hours, then people start to actually realize it's not the third pillar of good health alongside diet and exercise.
01:51:55.000It's the foundation on which those two other things sit.
01:51:59.000You know, for example, if you're dieting, but you're not getting sufficient sleep, 70% of all the weight that you lose will come from lean body mass, muscle, and not fat.
01:52:09.000Your body becomes stingy in giving up its fat when it's underslept.
01:52:14.000So once you get this information out there, things are starting to change.
01:52:18.000I've started to have some discussions with the World Health Organization.
01:52:22.000They seem to be very interested now in getting to grips with sleep.
01:52:26.000I'd love to speak to first world governments though.
01:52:29.000When was the last time you saw any first world nation have a government-supported public health campaign around sleep?
01:53:24.000What studies, if any, have been done on people who live in the Northern Hemisphere, where they experience these long days, like Alaska and Siberia, places like that?
01:53:34.000It's really tough for the regulation of the circadian rhythm.
01:53:38.000And a lot of people, they're not old, but a lot of people will suffer from what's called seasonal affective disorder, which is the winter blues.
01:53:46.000And it's an unfortunate acronym, you know, SAD. Your doctor comes along, you say, look, I'm not feeling good, it's the wintertime.
01:54:03.000And you end up having to use melatonin strategically to help you fall asleep to sort of signal darkness in the summertime when it's really light almost all day.
01:54:13.000And then in the wintertime, you reverse engineer the trick.
01:54:16.000And in the morning, you sit and you have your breakfast or you're working at your terminal, and you have one of these big light boxes that sits next to you, strong lux power light, to try and sort of fool your brain into thinking that you're getting a lot of daylight when it's, you know, it's not going to be light for the next four hours.