The Exchanges

Q And then talk to me about the importance of sort of like routine and timing of sleep. Like how important is the two to three hours leading up to sleep? And then sort of like the consistency around times we go to bed and how that impacts us.

A There have been studies to show that the more volatile your sleep onset time The worse, the cognitive outcomes for older people. So it hasn't really been studied as much in younger people, but if you have a regular bedtime in older people, you're, uh, it's predictive of better cognitive outcomes. Two things control our sleep. Our homeostatic need, which is the longer you're awake, the more you need sleep. And the other is the circadian clock timing of it. So, um, one thing that helps you to have a good, solid, even circadian clock is in the morning when you wake up, expose yourself to bright light because bright light, um, especially in the blue frequency is the strongest resetter of our daily clock. And that starts the clock at the right time of day so that you're ready to go to sleep at night. The circadian clock is one of the things that its drive for wakefulness starts relaxing at night at the same time that the homeostatic need for sleep builds, and so that allows you to go to sleep at the right time. If you expose yourself to really bright light in the evening, for example, with the electronic device with lots of blue in the frequency of light, you are setting your clock to, to say, oh, it's time to wake up, and so then your homeostatic Need for sleep, and your circadian rhythm are fighting one another. Yeah, so there are lots of things that set your circadian clock besid…

AI assessment note: “the more volatile your sleep onset time The worse, the cognitive outcomes”

Q How would you define sleep? I want to go into sort of, uh, resolving our emotions and cleaning our brain, but before we do that, how would you define?

A Uh, so, uh, sleep is behaviorally defined as an inattentive state, uh, where we're less attentive to the world around us. It's reversible though, so we can definitely wake ourselves up unlike coma. And, um, we usually have a characteristic posture and, um, And it's homeostatically regulated. So if we don't get enough of it, our, our brains, our bodies will demand more of it to make up for the sleep that we've lost. We've recently discovered in the last five, six years that sleep isn't necessarily a whole brain at the same time phenomenon. That in fact, some of our brain can be asleep while other parts of our brain can be awake. And that's probably what sleepwalking is about. We are unconscious, but we are awake enough to be able to interact with the world around us.

AI assessment note: “sleep is behaviorally defined as an inattentive state, uh, where we're less attentive”

Q And we're sort of talking about this as if this is a constant process happening throughout the night, but are there different states of sleep or different things happen at different points of time in our sleep?

A Yeah, there are three kind of gross states of sleep, but, um, people have characterized as many seven sub states of sleep that, um, happen throughout the night. Uh, typically we have about a Where we go through all the stages of sleep and they start with first the drowsiness, which is kind of stage one where we're being less attentive to the world. And we start to have amnesia. If someone's talking to us while we're in this stage one of sleep, we might be able to hold a conversation, but we won't remember it. We could read a page for reading a book, but we won't remember what was, what was set on that page. Then we go into a deeper stage, which is stage two, and that is where we start to get sleep spindles, which are these 15, 10 to 15 hertz blips in our brains that, um, come and go at different parts of our brains at different times, and these things called K-complexes, which are big surges of activity in our brain. And that's when we are definitely fully unconscious, but if you wake up someone out of that state, or they spontaneously awake out of that state, they will say that they have had hallucinations, kind of like dreams, but not full dreams. They're like, they're called hypnagogic hallucinations, hypno being sleep. You know, that's where some of these hallucinations are quite, um, vivid and scary sometimes, so waking up after just falling asleep after about five minutes…

AI assessment note: “Yeah, there are three kind of gross states of sleep”

Q And how long should it take to fall asleep ideally?

A Someone who's getting enough sleep at night, you know, um, takes about, I think on average, 14, 15 minutes, something like that, to fall asleep. And again, that time shouldn't be stressful, like, oh my gosh, I should be getting sleep, oh my gosh, you know, I can't believe I'm still awake. But if it's taking you 45 minutes, that's too long. That means that you're not trying to fall asleep in the right window of time, that you are stressing about something, or maybe that's, it just means you've had too much caffeine during the day, too late in the day, and that's still working on your brain to keep you, prevent that signal, that homeostatic drive signal from hitting your brain. So that one of the, um, Most effective ways to help people with that kind of insomnia, that delayed sleep onset insomnia, is to do what we said earlier, get out of bed, do something that relaxes and makes you happy, and then when you're feeling sleepy, again, just, just hit bed, and don't worry about having lost that 45 minutes, because, in fact, you probably would have been awake, you know, twiddling your thumbs in bed at that period of time, worrying about it anyway, so get up, do something useful, and not too Um, exciting. And, um, that's called cognitive behavioral therapy for insomnia. That's one of the recommendations of it.

AI assessment note: “takes about, I think on average, 14, 15 minutes, something like that”

Q case? Like, I think it's normal for most people to wake up at least once during the night, whether they're even conscious of it or not, whether they go pee or sort of like some people often wake up at like two or three a.m. and can't go back to sleep for a little bit. What should people do when that happens? Not beat themselves up, I guess, but like

A Definitely don't beat yourself up or get anxious about it, because anxiety will inhibit your ability to go back to sleep. Trust your body, and if your body's saying, hey, I really need to get This one thing done before I go back to sleep. I'm not going to feel good unless I get this one thing done. Get up and do it. You know, just do it and then, uh, and then go back to sleep. You'll feel better. You'll feel better, less anxious, and that will help you go back to sleep. Um, if you're lying there worrying and there's nothing that can be done about it, you know, this, or at least not done at that time, if it actually requires you to go into the, into work to do this thing that you're worrying about or, um, Call someone, and it's the middle of the night, and you can't talk to them. Instead, try and, you know, write a list to help yourself feel more ready for the next, to accomplish that thing the next day. Or, you know, meditate, deep breathe, try and put yourself back into A place where you are happy and relaxed. And some people, you know, I mean, maybe it just requires distraction. Maybe playing a mindless, uh, video game, uh, on your phone with your blue light off. You need to turn down that blue light because that's a circadian clock resetting signal that you don't want. I, I play threes on my phone. I don't know if you've ever seen threes. It's just, You know, it's like you p…

AI assessment note: “Definitely don't beat yourself up or get anxious about it, because anxiety will inhibit”

Q So as a parent of two teenagers, what does this mean for me as a parent? Do I wake them up on the weekend? Do I let them sleep until two PM? How do I, what do I do here to encourage? My mom used to wake me up at like seven o'clock with a vacuum cleaner.

A I love that. Um, my husband is a, is a physician and people would come to him with that question. Um, and really it's not a problem with the teenager. The teenager can sleep fine and, and should sleep. Um, we need, they need that sleep for that brain development. Uh, it's a problem with parents that we don't like it when our teenagers sleep in so late. Um, it makes, and it's a problem with school schedules too. Um, schools are not set up to allow teenagers to both listen to their own biological rhythm, which tells them, um, via combination of signals, um, that it, Children have a very strong circadian clock, and it helps them wake up in the morning. It also helps them go to sleep nicely at night. Teenagers have a circadian clock, of course, and it's much better than the circadian clock of older people, but they have all many other things that their brain and bodies are attending to besides that clock, which tends to push their bedtimes to later. Yet they need just as much sleep as a 12 year old because of all the brain development that's still going on. So, so that combination of later bedtime and needing enough sleep and not having a circadian clock that's quite as strong as a child's allows them to sleep in and get the sleep that they need. They also need more REM sleep. There's a lot of emotional and processing, and that happens mostly during that REM sleep stage. So, um, te…

AI assessment note: “I say, if it were me, let them sleep.”

Q Totally. And what, what sort of things can we do to make our sleep more efficient and maybe encourage more REM sleep? Cause you, you seem to think that that was, uh, part of the most valuable parts of sleep.

A You know, actually one of the things that we don't know yet is whether quantity is, is equivalent to quality, right? Um, and so more is not necessarily better. In fact, there are some sleep disorders where people have hypersomnia, hypersomulence, or too much REM, or REM too early, uh, in the night. So it's also the timing relationship between the sleep states that seems to be important. Um, if you are learning something, um, or have a, an emotional day that you will get more REM sleep. It's homeostatic. It's automatic. You don't need to worry about it. Um, you'll get it. Your body will get it if it needs it. And, um, so if you're learning a lot and you need more REM sleep to consolidate that, it will get more REM sleep at the cost of other states of sleep. Uh, if you can just sleep longer than those other states of sleep, don't have to suffer in addition to it. In the first half of the night, you get more of that deep slow waves, you know, uh, cleaning sleep. And in the second half of the night, uh, toward the wee hours of the morning, you get more REM sleep. So I said on average, you go through all those states of sleep within 90 minutes. But in fact, in the first half of the night, more of that 90 minutes is spent in deep slow wave sleep and less in REM sleep. And in the second half of that night, more of that 90 minutes is spent in REM sleep. And less than deep slow wave sle…

AI assessment note: “It's homeostatic. It's automatic. You don't need to worry about it.”

Q Why do we sleep more when we're sick or tend to?

A Yeah, so there is, um, some good studies to show that the immune response actually signals our brain that we need more sleep, so, and I, and it's kind of unknown exactly what's going on and why your body needs more sleep, but if you deprive Someone of sleep at the time that they're fighting an infection, they will not get better nearly as quickly. So in fact, it's actually super problematic in a hospital when someone's there for a viral or bacterial illness, something the immune system would need to fight. And the hospital procedures, um, the beeping sounds, the checks on you, the blood pressure checks, et cetera, keep you awake or awake, awaken you many times and prevent you from getting that deep slow-wave sleep state. It seems to be slow-wave sleep that's especially important for the immune system. If a hospital environment disallows good quality sleep, they're actually hurting their patient's chance of getting better As quickly as they otherwise could.

AI assessment note: “immune response actually signals our brain that we need more sleep”

Q And speaking of doing its thing, one of the things that you mentioned was resolving emotions and cleaning out our brain. Can you dive into those a little bit?

A So both of those have been long suspected to be functions of sleep, but only recently have we evidence that this is the case. We all feel like our brain is full and gunked up when we're sleepy and we need to get to sleep, but it's only been in the past 10 years or so We realized that there are actual, the slow waves that we didn't know what their function was when we fall asleep. Are actually sweeping through and cleaning our brains from the debris that builds up across wakefulness. Proteins get misfolded as they get used, and we need to refold them. We also need to clear away the debris of metabolism. That happens through these slow waves, sweeping through, almost like a bilge pump. I think of it like a bilge pump pumping out the waste. Um, as far as emotional Um, learning. We all realize that if we don't get enough sleep, we get cranky, and it's even more true of children who are developing. If they don't get their nap or don't get enough sleep, they get really hard to manage, but it's only been recently in the past 10 years or so that we've been able to see how that happens, and Mechanistically, what is actually happening to our emotions? Uh, we still only have a lot of hypotheses and possible mechanisms that should work now. So we still, it's hard to study emotional system, especially in animals that can't talk to us. Um, we can see evidence of volatile emotions, but it's h…

AI assessment note: “slow waves... Are actually sweeping through and cleaning our brains from the debris”

Q What does before bedtime mean, though? Is that like the preceding 30 minutes, 90 minutes, two hours? Like, is there a time ascribed to that?

A I think that varies by individual. For example, I know some people who take a very cold bath, um, and then, then they take a hot shower just to warm up so they're not freezing anymore, and then they get into bed. And what that cold bath does is it actually Activate your sympathetic nervous system. You're very aroused. You're very alert and awake during that cold bath, but it almost works like a reset of your sympathetic system. It's like a big button push that allows a parasympathetic rebound when that stressor is over. So within 30 minutes, you know, once they've warmed up a little bit, they feel so much More able to get a good night's rest, and there's some evidence that the sleep that they get is really, you know, good sleep. For me, that doesn't work. It's so stressful to me that I just, you know, it, I, it takes me too long to relax after that, but a warm bath is perfect, you know, because that's helping the parasympathetic system do what it does, so.

AI assessment note: “I think that varies by individual. For example, I know some people”

Q Uh, is there, do we know of any link between nutrition and the quality of our sleep and what we eat? Cause it seems like the function for everything sort of like, uh, often comes down to what we eat and sleep. And I'm wondering if there's a connection between the two of those things.

A Yeah, I think, um, that is a brand new field that hasn't, we haven't done enough research on it. Um, It was really very recently that we realized that the enteric nervous system, the, you know, our whole gut nervous system, um, is as intelligent and, um, influential in terms of our health as our brain is. Um, so it's not a separate nervous system. They're connected, but they're disconnected enough such that our brain is not really consciously aware Of the same things our gut is aware of. So I think it's a really good question. We do know that our microbiome or biome, um, generates neurotransmitters that affect our brain. And some of those neurotransmitters are really important To either be present or absent during sleep. And so, um, that thing that we mentioned earlier, which is having a big meal just before you go to sleep, having our whole gut work where as normally it should be, um, resting, uh, might also be generating neurotransmitters that shouldn't be there when we're asleep and could make our sleep more less efficient. Well, okay. There's some, Conflicting evidence. Ok, one says having a big meal makes people have more nightmares, more disturbing dreams that they remember, and that probably is because they're awakening out of sleep more often, um, in order to have the consciousness of those disturbing dreams and nightmares. Um, but there have also been studies in babies…

AI assessment note: “We do know that our microbiome or biome, um, generates neurotransmitters that affect our brain.”

Q What would you say is the most important lesson you learned from her that you still think about all the time today?

A What my mother had best was common sense. And just a very rational, even-handed approach to the world. She was not a radical in any sense of the word. She, you know, went to bed at a regular time every night. She met challenges with, um, with equanimity and, um, reached out to others when we needed help. And she was a fighter, though. She's, she was strong. She never just sat down and let the world happen to her. She got out there, and especially for kids' sake, she fought for us and made sure that we got what we needed. So, you know, what she did best for me, I think, is just Love me and used, I mean, she wasn't perfect. She had challenges of her own and, uh, but she didn't let those challenges get in the way of raising her kids. Um, and that really taught me strength.

AI assessment note: “and that really taught me strength.”

Q science-based information you can use to improve your sleep tonight. It's time to listen and learn. Let's start by diving in and talking about sleep, which is sort of the focus of this episode. I guess I want to start with what is sleep, and what is it for? Which sounds like a very simple question, but I don't know if we're going to get a, if it's that simple.

A Yeah, it's, um, it's for a lot of things, and that's what's great about it. It's not a waste of time. Your brain is really active while you're asleep. And, uh, we know a lot about the functions of sleep right now, um, whereas even 30 years ago, we basically had very little idea, um, or actually rather lots of ideas, but very little hard evidence that it was for anything in particular. We know we can't do without it. That's the first thing, um, animals that don't get it. For example, there's a biological condition called fatal familial insomnia, and that's where people develop a An inability to fall asleep, and unfortunately, it's fatal after a few months. As you can imagine, they don't develop this. This is, it's a genetic problem, and people don't develop this until after childbearing years, and so, um, that's how it is the case that one family and a couple of families in particular have been able to pass this along, but that's helped us to realize that sleep is absolutely essential for life. And so what do people die of when they don't get enough sleep? Well, it's, um, unclear because it seems to affect multiple organ systems. It affects our brains, our metabolism, our skin, um, our immune system, just a lot of things, and so what people die of are various things depending on what it targets first in them or what it, uh, targets worst in them. But in terms of getting sleep, i…

AI assessment note: “it helps us to resolve emotions, to learn better, and to actually just clean”

Q how that develops over the next 10 or 15 years, you know, Where are we on the right track, and where are we totally wrong? And, and on that note, you know, you, you have a lot of up and down, uh, ideas, right? You, you have a hypothesis, you test it, you discover something completely different. I wonder if you can talk to me about some of that journey.

A Oh yeah, absolutely. That's really the fun of science. The science, neuroscience is like building a giant puzzle that's, um, really difficult, but really rewarding. So every paper that we publish is just one piece of that puzzle. And we don't always know when we come up with the piece where it fits in the bigger picture. And so we actually sometimes think that it fits with this other thing. And I don't know if you ever built a puzzle before, but sometimes you think, oh, this, these two go together and they don't quite fit, but you think, ah, you know, they've got to fit and you sort of mash it together. And it's not until you have more pieces of the puzzle that you realize, oh no, this other piece goes there. And that one actually still doesn't belong anywhere, but eventually we're going to find You know, the use for it. So it's not like anything that we come up with if we have rigorous, um, approaches to it is wrong. It's just, we don't always know where things fit. So sometimes papers get, get published. And not cited. And so they, you know, are considered low impact fake papers because for 20 years, no one knows what to do with that, with that knowledge. But the good thing about publications and the record is that they are sitting there and someday someone will say, well, what about that? And they'll find that paper and say, oh, that fits perfectly with this portion of the p…

AI assessment note: “the way I've come up with Some discoveries is because I had a hypothesis that was completely wrong.”