252: Dr. Aric Prather, UCSF Sleep Psychologist & Author of The Sleep Prescription, Poor Sleep & Mental Health Are Linked

Welcome to the Sleep As a Skill podcast. My name is Mollie Eastman. I am the founder of Sleep as A Skill, a company that optimizes sleep through technology, accountability, and behavioral change. As an ex sleep sufferer turned sleep course creator, I am on a mission to transform the way the world. Thinks about sleep.

‍

Each week I'll be interviewing world-class experts, ranging from researchers, doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper. Ultimately, I believe that living a circadian aligned lifestyle is going to be one of the biggest trends in wellness, and I'm committed to keeping you up to date on all the things that you can do today to transform your circadian health, and by extension, allowing you to sleep and live better than ever before.

‍

Welcome to the Sleep and Skill Podcast. Today's conversation is one I've been wanting to have for a while because it sits right at the crossroads of insomnia, mental health and real life change. If you've ever had that moment where sleep used to feel effortless and then suddenly it doesn't, I know I have, and if you've ever wondered what is wrong with me.

‍

Or felt frustrated doing everything, quote unquote right, yet still having unpredictable nights. This episode is for you. You are not alone, and you are going to feel very seen here. So our guest today is Dr. Eric Prather, a professor at UCSF, director of Behavioral Sleep Medicine Research Program, and the Center for Health and Community.

‍

And a clinical psychologist who treats insomnia using CBTI through the UCSF Insomnia Clinic. His research shines a light on something we don't talk about nearly enough. How insufficient sleep impacts the immune system, including vaccination response and antibody production. He's also the author of the Sleep Prescription, seven Days to Unlocking Your Best Rest With Work featured in the New York Times, the Washington Post, and CNN.

‍

In our conversation, we explore why insomnia is often an early marker for anxiety and depression. How quote. Over efforting sleep can quietly keep people stuck. And why? Sleep isn't something you force, it's something that happens when the conditions set the tone for that result. We also unpack sleep debt, the stress sleep loop.

‍

And how CBTI is being scaled through digital therapeutics to improve access to evidence-based care. One of my favorite moments is when Dr. LERs reminds us, you can do all the right things and still have a rough night, and that doesn't mean you're broken. I mean, when I was in the throes of my insomnia, I needed that message.

‍

And I hope if any of you are dealing with something like that or just looking to uplevel your sleep, that this conversation can really help support you. So we're gonna get right into the episode. First, a few words from our sponsors. As we head into the fall and vacation season winds down IEA time when late nights irregular eating habits and indulgence tend to become the norm.

‍

It's time to get back on track with our health and of course our sleep. Just a quick, interesting fact about sleep to mention drinking more than two servings of alcohol per day for men and more than one serving per day for women can decrease sleep quality by. 39.2% a sleep Foundation survey reports, not even mentioning all the indulgent food and late night effects that often come along with it.

‍

And as we know, sleep is the key to your body's rejuvenation and repair process. It controls hunger and weight loss hormones, boost energy levels, and. Countless other functions. A good night's sleep will improve your wellbeing much more than just about anything else I can possibly think of on the planet.

‍

Uh, you know, I'm biased, but gotta say that. And sleep is your major to focus on as we head into the fall season and hopefully beyond. And that's why I recommend that if you're going to start taking some supplements on your sleep often, magnesium is a great place to begin. But not just any magnesium supplement.

‍

I do recommend getting the Magnesium Breakthrough by Bio Optimizers. Magnesium breakthrough contains all seven forms of magnesium designed to help you fall asleep, stay asleep, and wake up refreshed, which isn't that what we're all looking to do. The sleep benefits are really remarkable. I use it every night, and once your sleep is optimized, you'll find it much easier to tackle all the other major aspects of your health.

‍

And trust me, it is a game changer. To test it out, visit mag breakthrough.com/sleep. Isis. Skill, you can enter code. Sleep is a skill for 10% off for any order. This special offer is only available@magbreakthrough.com slash sleep is a 

‍

skill. I will also include this in the show notes as well. 

‍

Welcome to the Sleep is a Skill podcast.

‍

I know just about every episode I say I'm very excited for our guests, but I am very excited for our guests. Just some incredible research and things to share with our community around ways to manage a topic that I believe we need to do a lot more content around, and specifically insomnia, mental health, how they all coincide, and I'm sure many more topics.

‍

Given before we even hit record, we were going in so many different directions of different exciting things to discuss. So our challenge will be fitting this all into a short period of time. So thank you so much for taking the time to be here. 

‍

Oh my God, thank you for having me. Super excited. Yes, 

‍

yes. And already, I'm just so grateful for the work that you're doing.

‍

I shared with you that. For me, this all began of going through a period of insomnia for in my life that completely changed the course of my life. And so I absolutely feel for those going through a period of time like that, or chronically dealing with this. So excited to dive into that mental health, how it all coincides.

‍

But maybe starting at the beginning for you of how you found yourself as, uh, such an expert in this field. 

‍

So, I mean, I, I, so I'm a clinical psychologist and when I was in graduate school, I went to the University of Pittsburgh where there's a big sleep program there. My training was actually in stress and how stress impacts the immune system.

‍

Okay. 

‍

And so we were running all these laboratory studies, but there was a, an investigator who was involved in our study named, uh, Dr. Marika Hall, who always kept pushing sleep into all of the projects that she could get involved in. And. I, I started doing more research around and reading around sleep and its impact on the immune system and found that like a lot of the associations that we saw with stress, we also saw with sleep loss.

‍

And that made a lot of sense to me because, you know. Stress can absolutely impact sleep. And you know, if people don't get the sleep they need, they might be more sensitive to stress. And, and no one was really kind of looking at that in the context of kind of immune health. And so I was, I was kind of hooked on it.

‍

And so we were doing the work looking at, in this case, on sleep, in its impact on vaccinations Yes. And, and antibody production. And then like as through my training, I also had, I did one year at Duke University. Working with Jack Edinger who was like one of the kind of, kind of OGs with respect to the development of cognitive behavioral therapy for insomnia.

‍

And I was hooked. I wasn't sure I was ever gonna become clinically licensed. I was really like very much into the research, but I was like, if I ever am licensed, that's what I'm doing. And so now here I'm at UCSF in San Francisco, been here for 15 years, have like a big research program focused on sleep and health, but also help run an insomnia clinic where we do CBTI.

‍

You know, it really is kind of game changing for some people. And I mean, you know, like I, I like love helping people in this, in this capacity, but strangely, it's like also like super selfish. Like, I, like love, feel like I like have something I can do. It's like sleep is just, it's like, it's like such a powerful lever to, to push on, you know?

‍

I mean, yes. When you give people their sleep back. I mean, they're like better versions of themselves, you know, and, and, and that, that's really meaningful for me. And so, um, you know, to be able to have kind of non-pharmacologic tools to do that, that's reliable, um, is, is really special. And so, you know, my work is kind of gone, you know, still looking at kind of biomarkers of sleep, but also kind of trying to understand how we can improve these interventions.

‍

More recently working in kind of the digital space, um, to kind of deploy cognitive behavioral therapy for insomnia, kind of digitally, uh, just because there's just access issues, you know? So, um, yes. So yeah, and so I've kind of carried that on. For now. Well over a decade, which is shocking how time goes.

‍

Wow. Amazing. Well, so important, such important work and lots of different directions we can go in with all that 'cause it's so rich in different ways that that could help support people. I'm wondering maybe we could begin potentially with some of your work around sleep and mental health, sleep deprivation, depression, anxiety, how they kind of all play together.

‍

I mean, you know, like it's, it's no surprise that they're so tightly connected, you know, uh, you know, there's so much work showing that kind of insomnia symptoms, sleep disturbance, often kind of prodromal or kind of an early marker of kind of later psychiatric, uh, issues like depression, anxiety, kind of, you name it, really.

‍

Um, and, and there's been kind of been this interesting. Kind of focus in the field around insomnia and depression specifically, that like they're so tied to one another. Obviously insomnia symptoms are kind of part of the syndrome of depression. 

‍

Yeah. 

‍

Right. And so there's been this idea that like, oh, well you know what, if we have someone with depression and insomnia and we treat the insomnia, will the depression lift?

‍

Right? And so for like a decade, there were like clinical trials, one after the other to look at this. And you know, it's been sort of mixed and I guess that's not so surprising that for some people it's true. Like sleep is the thing. And we know that for some people, if you treat, if you improve someone's depression, but their sleep symptoms linger mm-hmm.

‍

They're much more likely to develop another episode of depression. Right. So it's like very key for some individuals. Um, but then there are people where, you know, it's. Sleep is disrupted, but, you know, depression has another, you know, part of, part of a monster to it that isn't always just about the sleep.

‍

And so, um, you know, it, we're trying to figure out kind of who are those people that might be uniquely benefited from say, a targeted sleep treatment that will have spillover effects for their depressive symptoms. Um, you know, I mean, we have done some work. I had a postdoc named Jennifer Felder, who's now associate professor here, who's done kind of really groundbreaking work in the context of pregnancy, where, you know, we're really concerned about postpartum depression and an insomnia is so common during kind of the, the pregnancy journey.

‍

And, you know, where we did find that if, if we intervened with kind of a digital CBTI in, in women that had, uh, who were pregnant and had insomnia symptoms, they were much less likely to develop postpartum depression. Their depressive system. So it was almost like it was a preventative strategy. And I think that's actually a really interesting place to kind of, kind of focus in on this because, you know, unlike many other behaviors that we do, like health behaviors, like whether it's nutrition or smoking or alcohol, um, physical activity, um, sleep is a, is an easy one to kind of get people to buy into, right?

‍

Like people don't really want to stop eating kind of really delicious fatty foods. Right. And not everyone like loves sweating and feel getting sore muscles, right? But sleep that, like, that richness, that nourishing aspect of it, which we know what it feels like to have a good night's sleep and what it feels like to not.

‍

And so you know that that is where there's like very clear buy-in and. Really trying to get, I, I think the, the biggest challenge that we come into, and maybe this is true for, from people, uh, listening to this, that like the biggest shift that I have to get kind of patients to make is that we can, you know, we can do all the right things and tonight can still be kind of crappy.

‍

Yeah. 

‍

Right. And it's really about kind of putting a program in place so that. On average, your sleep improves. Right. And being resilient to the bad nights and know that for every bad night the next night will probably be better. 

‍

Yes. So, so much of that framework approaching this from the long haul, and you know, it's so interesting what you said too about most of us can get behind the importance of sleep.

‍

We know the difference between bad night of sleep and a good night of sleep. And one of the things that you're so intimately connected with is this kind of. Juxtaposition of the group that maybe just hasn't been prioritizing sleep or they've, you know, just not thinking about it as much or they're over-indexed so they're not getting the quality whether or duration, et cetera.

‍

But then the insomniacs that then might be so fixated on their sleep and no, maybe too much about. And I was one of those people. And then the problems of over efforting. Yeah. And so, and I'm, I'm assuming then in your work, certainly that's where, uh, CBTI can shine, but any thoughts around that, the, the mental health issues of this hyper fixation on sleep, when and how that could backfire?

‍

Oh my gosh. I mean. I always say that like, you know, no one even wonders how sleep works until it stops. 

‍

Yeah, exactly. 

‍

It's like, oh my God. Like, it feels so unpredictable. It feels broken. It feels like something's kind of happening to you. 

‍

Yeah. 

‍

That like, you know, why, why is this happening to me? Like, why have I lost the, the ability to make this thing happen?

‍

And it, the truth is that, you know, we never made it happen. Sleep is something that happens to us. 

‍

Yes. 

‍

And it's kind of the absence of doing. That allows kind of your body to kind of transition for your parasympathetic nervous system to upregulate, for you to kind of turn down that hyper vigilance and, and, you know, that's, that's easier said than done, right.

‍

For a lot of people, right? Yeah. Like they want, everybody's doing their best. 

‍

Yes. 

‍

But the truth is that with people with insomnia, like all of the, a lot of the choices that we make. Makes so much sense in the moment. 

‍

Yeah. 

‍

You know? Right. Like you're just trying to solve the problem in front of you. 

‍

Yeah, 

‍

exactly.

‍

But 

‍

it's like it undermines the system, actually. Mm-hmm. Because it's like you're doing things that are focused on the moment and kind of actually are perpetuating the problem. So like the, you know, the most common is, you know, when sleep is unpredictable. People want to be in the right place at the right time if they fall asleep, right?

‍

Yes. Like they just don't know when's gonna happen. And so people will often get in bed earlier than they should otherwise, yes. And kind of wait because they're like, it's nighttime. I feel like garbage. Like I need to end this day and I need to get some sleep. And you know, I only get four hours of sleep.

‍

I need to get myself, you know, 10 hours because I don't know when that four hours is. And that makes a lot of sense. Right. Except it like. Disrupts the entire system. It kind of increases, kind of conditioned arousals that, you know, it cr it changes your relationship to the bed. It increases anxiety and distress.

‍

Um, gives you a lot of like me time to like let your mind kind of like, not of course, not focus on the best things of your life. Right, exactly. Exactly. It 

‍

like 

‍

only gloom and doom and all of those things in combination night after night, end up kind of creating a scenario where you're, you know. Changing your behaviors during, during the day to conserve energy.

‍

Maybe you're napping more. Maybe you're using substances to kind of like help you kind of be alert or to wind down and all of those right, have impacts on the brain and the body and kind of, you know, changes just, just the whole psychology around sleep and, and kind of, you know, erodes any sort of confidence that you might have.

‍

And so, you know, certainly kind of that angst is problematic. Um, you know, certainly there's, you know, some people are more predisposed to it than others. It runs in families. I mean, people, you know, it's also kind of complicated by, you know, some people having a different circadian preference, right? Being a night owl, but like living in a, like a, a morning lark world.

‍

And so being shorted on sleep and trying to go to bed, but their body won't let them. All of those things kind of coalesce to create, you know, problems for people. But the good news is that they're. CBTI, other types of behavioral approaches can really help disentangle those things, kind of like chip away at all of these, these problems and kind of, you know, increase the likelihood that you can get your sleep back on track.

‍

Yes. Okay. And I love kind of that transition to hope because sometimes, you know, for those that are showing up and actively right now, they might be in the midst of about, of struggles with their sleep. And sometimes it can feel, am I broken now? I could sleep and now I can't sleep. And all this kind of narratives that can start to take hold.

‍

So I'm wondering, one, given your knowledge around sleep deprivation. Any thought, maybe good news and bad news on our ability to make up for some of the kind of sleep loss that, that people might be experiencing or have experienced, and then maybe some additional words of hope and possibility for those dealing with insomnia.

‍

Yeah, I mean, and I, you know, I'd be very clear, like I'm very compassionate about this and I like, I have good nights and bad nights. Like that's same, you know, this isn't a whole me search situation, but you know, I was like, yeah. You know, like, it, it, it's, it can be a struggle and it changes over time. And, you know, I mean, like, I, so I have a 13-year-old and an 8-year-old, and I feel like I haven't slept as well in like 13 years.

‍

Right. I was like, you know, like this came, you know, just a different kind of experience now. 

‍

Yeah. 

‍

So, so sleep deprivation, um, I mean, you know, obviously we know that there are acute costs to sleep deprivation, right? Like with, with, with respect to reaction time, attention. All these other sorts of things like fall risks, you know, whatever, accidents, these kind of things.

‍

Um, but you know, we also, it's very adaptive to be able to stay awake under duress, right? Like we are kind of built for, uh, maintaining alertness despite, um, the need for sleep. Um, and, and there, you know, but we, but so, but there are some kind of hope with respect to when people have that happen. So. The good news is that you know, your body will take care of you.

‍

That, um, one sleep loss is not forever though. It feels like it is. Um, and you know, when we, when we take people into the laboratory and we, we deprive 'em of sleep and we have a sleep out here and we do this, um, you know, when we let them have their recovery sleep. They kind of are able to prioritize the type of sleep they need most, right?

‍

So one of the things that we, uh, think in the sleep field is that, you know, N three or slow wave sleep or deep sleep is so incredibly restorative, right? It's so important for repair. Uh, it, it's thought to potentially contribute to some of the refreshing experience and, uh, wellbeing aspects of sleep. Um, and when we deprive people of sleep, they drop almost immediately into deep sleep.

‍

That they, that your body kind of knows to try to make that up first. Yes. Um, now this question around sleep debt, and people have probably heard this, like, can you actually make up this debt? Um, you can make up some of it, but not a hundred percent. Yeah. And the good news is you can make some up. Like, you know, like not all things are lost.

‍

Yeah. And we don't have a really great idea of how to measure, kind of like incremental loss over time, right? Mm. My expectation and the way that I think about all of these things, whether it's stress, whether it's sleep, it's like chronic. Loss, right? Yeah. Like, like chronic short sleepers for decades and decades might likely put them at risk for, and all the data, you know, this is not my sure perspective, this is the data.

‍

Yeah. Yeah. Uh, does put people at risk for a variety of like negative health things. But one thing we don't really account for are like the positive health behaviors that might offset some of that, right? So, you know, what happens if you have short sleep, but also you have like really great nutrition, right?

‍

Like these are, these are, you know, we usually in science kind of think of a very specific exposure and we try to statistically account for other aspects. But I do believe that there are ways to try to offset some of these things. Like, you know, you're a short sleeper, but you have like, you meditate, you know, for an hour a day.

‍

Right? Like it's, it's, it's hard to know. Um, and so, you know, acute sleep loss, though it does have some acute. Concerns particularly, of course, cognitive ones. 

‍

Yeah. 

‍

Um, are unlikely to be, you know, a long-term problem for health outcomes. Right? Yeah. So, so some of that, like concerns that people have with insomnia where they have like a week of bad sleep or a month of bad sleep or like three nights over some period of time.

‍

Um, you know, it surely adds up in some way, but it probably still accounts for like a small percentage of. Health risk. Do you know? Like, like you would much, I mean, it's my, you know, I, I, I don't know, I'm sure there's analyses for this, but like, I would prefer that someone, you know, quits smoking and gets less sleep than, uh, than to smoke and get eight hours of sleep.

‍

Right, 

‍

right. Yes. So, you know, these are all like magnitude differences. Uh, and, and I say all that just to give people like a little bit of perspective. 'cause it's true, like when you are, when your sleep is disrupted, that is all of your effort, your mental effort is focused on that. Yeah. Like so often I see patients and they're like, they spend so much time during the day thinking about that night.

‍

Yes. 

‍

Right. And like as it gets closer to bedtime, right? Like the anxiety starts to rise. 'cause it's like, oh man, is tonight gonna be another night? Like that? Exactly. Exactly. And so, you know, it's really important to kind of, one, keep it in perspective and know that there are tools to try to kind of get that back in a, in a fashion that is more restorative, that is more predictable.

‍

Um, to, to, uh, get people the sleep they need. 

‍

Yeah, no, I appreciate that. 'cause it's this mix of the inspiration too, to take action. 'cause certainly we're trying to give hope and let people know not all is lost. But at the same time, if we've been hanging out in resignation and just, well, I guess this is my life now, now I'm an insomniac and my mom had it and my ex.

‍

Said it or whatever the heck people do. So instead, sometimes we do need to hear some of this reality so we're not trying to kind of put the wool over people's eyes or something because this can be so important. 'cause then they can get in touch with, you know, people like yourself and go into proper protocols that can really have such high effectiveness rates to get people to stave off some of those things that they might be doing.

‍

As you pointed to that are. Compensating and this kind of compensation is not, while in the short term, it feels like it might be helping in the long term. It's just not serving anyone. So having said that, if someone's listening and they're saying, oh geez, okay, I, I've gotta get myself involved in some sort of program.

‍

I know you mentioned that there's different possibilities around ways that we can provide more access and kind of democratize this information. What are the steps for people to get access? 

‍

Yeah. So, um, so again, what I'm talking about is cognitive behavioral therapy for insomnia, or CBTI, which is kind of well known as the kind of gold standard first line treatment for people with insomnia.

‍

Um, you know, in the, in a perfect world, this is something that people would, you know, embark on before they started taking sleep medications. Um, it's often not the case. Uh, I would say like 90% of the people that come to our clinic are on something. But the good news is that. Um, I mean, there's two things.

‍

One, they're in our clinic anyway, so clearly it's not as effective as it could be. Yeah. But also there's risks involved with taking chronic, uh, sleep medications. Yeah. Um, they weren't designed for that. Um, and so we often taper people off of that as we, as we do this, uh, protocol. It's short term. Um, it's incredibly effective and it's available in a variety of different formats.

‍

So, you know, research has shown that, you know, even. For some people maybe with, with, with modest symptoms, um, you know, books or kind of videos can be effective in helping people. But you know, it's also individual therapy, group therapy and now more recently, digital therapy. So, um, there was, there are now two FDA cleared.

‍

Digital therapeutics for, um, CBTI, one is called Sleepio rx, 

‍

and 

‍

then another one is, um, sorest is the other one, which I'm not sure is currently available, but, uh, in the US anyway. And so, um, you know, those are kind of protocol, protocol based, uh, treatments. Um, you know, we're trying to figure out different ways to kind of work with primary care physicians to get people all on the right track.

‍

For these things before they get on sleep medications. I mean, we do have a ways to go 'cause they're, you know, like all mental health resources, um, they're taxed. Um, meaning there's just like not a lot of availability, right? Like I think our clinic has many, many months of a wait list currently. Yes. Um, because there's just not enough people.

‍

But I, you know, I, I also don't think it's like rocket science to do this behavioral treatment. And so my hope is that there are opportunities to scale it in some way. Um, you know, there have been some other programs that have been developed, like, uh, Headspace just published a. A clinical trial using their Find My Sleep or Find Healthy Sleep program, that that was shown to be effective against the weightless control.

‍

And so there may, you know, there may be other options. Mindfulness based, uh, stress reduction therapies have been shown to be effective, um, in improving insomnia symptoms. So there are these behavioral strategies and I think it's just worth talking to someone's primary care physician, um, you know, making sure that it's not sleep apnea that is, is contributing to this.

‍

Oftentimes, yes, there's this co comorbidity with sleep apnea. So, yeah, very underdiagnosed. And, and the truth is, these behavioral strategies will not solve that problem. And so if that's a risk, then you certainly want to get that, uh, cleared up first and then, um, and then kind of seek out resources. I always point people towards, um, the Society for Behavioral Sleep Medicine that has a directory of clinicians around the country.

‍

Um, 'cause sometimes it's, you know, in certain places there may be just a couple. And so there are ways in which you can identify people that are, are doing this, um, for a job. 

‍

Oh, absolutely. Sleep and stress. So people are sleeping. Maybe they're not dealing with kind of chronic insomnia or acute situations, and yet they're just managing different levels of stress in their life.

‍

Curious your takes in so much of your work is also touching on this topic. Anything we missed? Yeah, 

‍

I mean, you know, so I think in one way it's not as appreciated, like the bi-directional nature of it. Like everyone, when people think of insomnia, like it's usually caused by some kind of stressor. Their life and, and the, and the sleep problems persist even though the stressor might kind of remitted.

‍

Right. Um, we did a, like a daily diary study where we kind of tracked people for three weeks and measured their sleep over time and then had them report on how stressed they were during the day and kind of what types of stressors that they experienced. And then we actually had kind of separate people code the stressors for like their severity because, you know, someone may report something very minor as very stressful to them and.

‍

What we found was that, you know, interestingly, the strongest relationship was on when people didn't got less sleep than they typically did. They reported more stressful experiences, but also they seem to be exposed to more stressful things that like when you don't get the sleep you need, you might select into situations.

‍

That are more severe and stressful, like you may be more likely to get into a conflict. Like there's these really fun, kind of, uh, studies with couples where they kind of deprive one of sleep and then they find that like, it doesn't matter which person it was, they're less likely to kind of find a resolution, um, from Yes, from this conflict.

‍

Right? Like it's, it's hard to, to be empathetic. With your partner when you're short on sleep, right? Like Totally. It makes people really focus in on 'em on themselves. 'cause it's kind of like a survival mechanism, right? 

‍

Yes. 

‍

And, and that makes it really hard to relate to the world. And so I think there's like a really a lot of interesting like emotion and psychology research that can be done in the context of sleep and sleep loss.

‍

To better understand how we interact with the, with the world. Right. I mean, we, before this call, we were talking about Wendy Troxel and her work Yes. Around kind of couples and has done really astounding, kind of, kind of groundbreaking work on kind of the concordance around couples and sleeping and what that means for their relationship satisfaction.

‍

Uh, and so I think there is a lot there with respect to, to stress and sleep. The, the thing that I'm hopeful about, the way that I, that, what I like about it, uh, in particular is because it's this circular pattern of like, you know, bad sleep, more stress, more stress, bad sleep is, it's actually too intervention opportunities, right?

‍

Mm-hmm. We know how to kind of help people deal with stress more effectively. There's a whole, you know, clinical psychology and kind of mindfulness based meditation. All of these types of tools to help people more effectively deal with stress, and that might have spillover effects on their sleep. In the same way we can address people's sleep and it should, you know, impart kind of more regulatory capacity for the stressors.

‍

Like we can't always control the stress that we experience, but the way in which we interact with it, the way in which we hold onto it, the way in which it kind of like trickles into our night. We can work on that, right? So, 

‍

yes, 

‍

I mean I, you know, these are both challenging things, but because they're tied together, we have lots of chances.

‍

To, to make impact, to improve wellbeing overall. 

‍

I love that. So well said. Yeah. I've often referred to sleep as a bit of a Trojan horse in that as you're addressing what you begin at what feels like the immediate problem of sleep. 'cause now as you pointed to that, becomes your core symptom. It's like everything stops.

‍

You gotta figure out the sleep problem. And yet in the process of alleviating or healing this. Situation, so many other areas of life you're often addressing. So whether it's stress management, nutrition, health and wellbeing, exercise, chrono pharmacology, or timing of whatever drugs or types of drugs, there's a thought management.

‍

There's so much that kind of goes into this and there could be this opportunity. I know sometimes when people are in the midst of full blown insomnia or severe insomnia. Try to say that there could be a gift of waiting there. It's like, thank 

‍

you, 

‍

thanks for nothing. But, but I do believe it can be true because nothing will get you motivated, like when you're not sleeping to try some new things.

‍

So 

‍

I just read this today, which, which made me kinda reflect on what you were saying was, yeah, there's lots of data that's tracked on wearable devices. 

‍

Yes. 

‍

Right. And you know, like. They're, they're really great for helping people kind of get a better sense of what's going on in their life. I mean, they, there's also kind of a dark side to them and people getting really anxious about their data, but 

‍

Yes.

‍

Yeah. 

‍

Um, I think on the whole, what, what people have found is when people begin. Kind of in investing in their wearable technology, a lot of aspects of their life start to improve from like a behavioral perspective. Because people are just like looking more, right? Yes. Like theyre thinking about it. It's like more front of mind and Absolutely.

‍

And, and it's not, you know, maybe you get an aura ring or whatever to start talking about sleep, but then you're like, oh, but look, now I need to track my exercise. And like, oh, now they have a way to kind of track nutrition. And you kind of. If you're kind of invested by, then you're like, okay, well I'm, this is me now.

‍

I'm gonna, I'm gonna work on my work on some, uh, Eric time and like, you know. Yeah. And, and it can have a lot of spillover effects and kind of synergistic improvements and that's, that's exciting. It's an exciting part of technology for sure. 

‍

Yeah. And you are at the forefront of it, so very exciting time.

‍

Well, every person that we do bring on the podcast, we ask four questions around how you're managing your own sleep. So excited to hear more. And you know, and I'm sure this is always evolving and shifting, but our first question is, what does your nightly sleep routine look like right now? 

‍

My nightly sleep routine, I'm definitely like an intermediate chronotype kind of person.

‍

Okay. And so like, I am not a night owl. Like I typically, uh, go to bed around like 10 30. Um, I think usually my wife and I, and now my 13-year-old son will like stay up and watch like some television. Yep. If we were, you know, watching some, whatever, Netflix, I think we're watching the residence, which is really good if you haven't seen 

‍

it.

‍

Oh, is it? I've heard good things. Okay. I'll have to, okay. 

‍

And then we'll go to bed and like, I have a Kindle, so I'll, I'll read on that. And. I mean, we'll just turn off the lights. Uh, we've tried different things. Like we, we, I was just at this, this sleep event and, and they reminded me about kind of red light therapy and I'm not sure that's that really effective, but like, they sent me one and so I've been trying it again.

‍

Okay. So we'll see. We'll see if it makes difference. I'm a pretty good sleeper generally. Yes. Um. But, uh, and so, and then I fall asleep. I do sleep with, um, like earbud things mm-hmm. For white noise. Kind of sensitive to sound. 

‍

Yes. 

‍

Um, and I live in the city and so, and then our room is. Cool. We actually have a sliding glass door and a deck in San Francisco, and so because of the fog, like we, I leave it open.

‍

Um 

‍

Oh, nice. 

‍

And so it kind of makes sure it cools down. We don't have air conditioning or anything like that. Yeah. Um, yeah. And, and so, you know, go to sleep, you know, and usually it's a good night. But I do, I also have an 8-year-old and he is just like not a good sleeper. And so, you know, sometimes, you know, maybe once a week, twice a week.

‍

He's like up in the middle of the night and like needs something or wants to kind of like join the group. And 

‍

yes, 

‍

he's very bony, so I'm like, I like, I like move to the couch, you know? I mean like these normal life things, right? Yeah. Like, it's like you just, you get through and you. You know that tonight is probably gonna be better even if I wake up and my like, aura ring score is less than I want, you know?

‍

Um, but that's, that's okay. 

‍

Yes. As you were kind of pointing to like building that resiliency and the knowledge that we will get through this before kind of throwing our hands up as there Oh insomnias here and having a, as an identity beautifully put. Okay. So our second question would be what might we see in your quote unquote morning sleep routine with the idea that how you start your day can impact your sleep?

‍

So I typically wake up around the same time each day, which I think is the probably, you know, like that's like my most important take home for anyone that I say if they wanna improve their sleep, yes, just like do that because it sets in line kind of your circadian rhythm, your homeostatic sleep drive.

‍

Can get some sunlight in the morning. I mean, it's nice now that we've kind of moved into the summer months in the, this part of the US and Yes. You know, in, in this part of the world. And so, uh, the light, you know, it's, it's light out and, um, yeah, I, I typically, I'm, I'm in charge of breakfast, so like I get up and I do the breakfast stuff and, and then I, I'm not one of those people that like, is like, oh, I won't drink coffee till I get to work.

‍

Like I drink coffee like immediately. Like I, yes. It's just part of my life and I love it. So Exactly. 

‍

Love that. 

‍

So, yeah. And so, but it is, it is very stable and, and I don't know if it's just age or what, but like. I wake up the same time on the weekend too. Like it's, it's just, you know, six 30 I wake up and I just like get up and if I can in the weekends I'll like exercise, but you know, probably not until, you know, my wife wakes up who's she is.

‍

We are not on the same sleep schedule. Okay. She needs more sleep. It seems like 

‍

she needs more. You. Yeah. She 

‍

like sleeps. Yeah. Like she's asleep all the time it seems like. 

‍

Yeah. I'm like you and my husband as like your wife. Then in that case, the, the like the different worlds that they need that extra sleep.

‍

Totally hear that. 

‍

Yeah. 

‍

So quick question because I love what you pointed to on the importance of that consistent wake time. So many people will say, okay, and what if I had a really rough night? Like, how much of a swing plus or minus. Do you have any thoughts or call outs there? 

‍

Yeah, so I mean. Like, I, I will say in clinic, like the seven days a week wake up time is like a hard sell, right?

‍

Like, it's like, you know, I know people like are like, you're insane. Like, get, you know, I'm not coming back here. But then I tell them like, okay, well, you know, it really, it really is relevant if you're trying to improve your sleep. Like mm-hmm. If, if you don't have sleep problems yeah. And you wanna sleep in and you can probably fine.

‍

Right. If you're trying to do something, this is one of the few things that we can control. 

‍

Yes. 

‍

That like, and it moves away. I mean, and I, I hear this and I, I understand where people are coming from, from others kind of sleep medicine folks where they're like, you know, you want to keep a consistent bedtime and a consistent wake time.

‍

I find that that can create some anxiety for people that have insomnia. 

‍

Completely agree. Yes. 

‍

Like, you know, like it's, you, you cannot, you know, you say to someone that they need to be asleep at 11. Like someone, the pressure, someone insomnia is like watching the clock. Yes. And like by 10 50 they've lost their mind.

‍

Yeah. Like, they're like, you know, and then, you know, then we're off off the rails. Yeah. So, uh, but we can control when we wake up, it can be hard. We're really just trying to push that sleepiness into the next night. Right. We're like in, we're like betting on ourselves for our body to kind of take care of us.

‍

Yeah. 

‍

You know? Can there be some wiggle room? Sure. Like, you know, this isn't an, it isn't an exact science and it's not so punitive because we can always make improvements starting tonight. 

‍

Yes. 

‍

Right. Like there's always a chance to improve. And so, you know, you, you are like, I can't do it. I can't do it. I need to fine.

‍

Okay. Sleep in. Okay. And then we will, then we'll start back out what we're doing, right? Yes. I mean it's, that is the beauty of this and also like, again, getting back to what I said before, we're all doing our best. Like, it's not like you want feel this way and so Exactly. This is just information to try to kind of slowly but surely using the science that we know about sleep.

‍

To get people to have more predictable and refreshing nighttime experiences. 

‍

Okay. And is there like a hard, and I hear you too, 'cause it, there might be sometimes of like, okay, we'll start it up another day. Like, you know, yeah. Do you make your choice powerfully, but do you find like a general rule of thumb?

‍

'cause often some of the people that we might be working with around sleep might be like plus or minus around 30 minutes, maybe max 

‍

like hour. Yeah. I, so I, I usually give, I usually give that as like a. It's usually Yeah. In that range. 

‍

In that range. Okay. And 

‍

then of course, not be on 30 minutes usually.

‍

Yeah. But like, but um, I, yeah, I don't know if there's like a bunch of empirical data to support that cutoff. 

‍

Yes. 

‍

But I think it's one that people are like, okay, 30 minutes I can, I can do that. You know, it's like, okay, we're exactly, you're gonna, it's really just like, what can I say? So that you'll do the thing that I know will work.

‍

Yeah. 

‍

And, and you, you know, you just be consistent about it. And then we just, you know, as you know, like. Then we track it. It's all about the tracking. Yes. And you know, everybody tells me how their sleep is, but it's always in this kind of like average or general, or like most proximal they're like, it's really bad.

‍

But that's because like last night was the worst night. You know? It's, and so the variability is really rich. Yes. And, um, you know, and, and so kind of this night to night tracking on a sleep diary. Um, can be golden in helping us kind of personalize 

‍

Yeah. 

‍

And, and create accountability. A lot of times I find people, like, even when we get their sleep, you know, better or you know, improved and they're ready to leave treatment, they're like, you know what, I'm gonna keep doing the sleep diary because they like gain a lot of insights.

‍

Yeah. 

‍

Yes. You know, and, and that's, I think that's really wonderful. 

‍

Absolutely. I know I've often pointed to sleep being this. Cool opportunity, especially if we are a group that is served in bringing in wearables, that it can be an opportunity for really amazing kind of personal development and introspection and seeing, like some of the people I've worked with over the years, they might have.

‍

Say eight years, a decade's worth of data now at this point. Right? And you'll see for instance, their HRV. And granted, is it infallible? No consumer grade. But from a, the volume of of data is interesting and you can very clearly see really different market things have happened in their lives. Like we'll see different things where people get divorced.

‍

Heart rate through the roof. HRV plummets a death in the family, they lose a job, whatever. And on the positive side of things, they start bringing in certain interventions and suddenly so much of their health markers are improved, their sleep durations improve. It's just really interesting and yet also helps support that management of their life.

‍

So yeah, really cool area. Okay, so then the third question would be, what might we visually see on your nightstand or in your sleep environment? 

‍

Oh, on my nightstand. So yeah, so on my nightstand, I love those. On my nightstand. I have a lamp. I have like, I feel like maybe like 11 books, like eight of them never opened.

‍

I get that. Yeah. 

‍

I'm like a chronic book buyer. 

‍

Yes. I have that problem too. 

‍

And I already said I use a Kindle, so I don't know why I have all these books, but I have so many, 

‍

they're like comforting for some reason. 

‍

I don't know, like I'm like pretty sure I'm gonna knock 'em over one day and I'm be like, okay, we gotta change this.

‍

Yes. 

‍

Uh, I have a water glass. 

‍

Okay. Yes. 

‍

With water in it. And I have. Um, like I have my cell phone and watch thing on like a stand there. Yes, 

‍

yes. 

‍

And then probably the earbud case thing. I use like that that has like the, that I wear at night. Yeah. 

‍

Because we'll have different experts in various arenas of sleep and some people will self admit, they'll, you know, that they might be still more actively struggling with some areas of their sleep or what have you, and maybe they've invented certain things to support these or whatever.

‍

And it has been interesting that. Feels like there's been just a anecdotal through line of the people that are pretty settled with their, like they're doing fine. Like of course, like anyone, they're gonna have rep nights or whatever, but for the most part, they're pretty good. There's a minimalist tendency of the things that are around them versus the group that's still struggling.

‍

It's like, well, I've got this. 12 step protocol to get me to sleep each night and 9 million supplements or whatever is going on. So I love that simplicity and it's clearly working so amazing. 

‍

I don't know. I mean, I guess it's working. I like it's, I I, it's funny. I wouldn't have thought my bedstand was minimalist, but, but I like to think that.

‍

I appreciate that. 

‍

You'd be surprised some of the things we hear that people are like, oh, I've got transcranial red light therapy, I've got, you know, these different trackers. I got all the things. Yeah, 

‍

exactly. I do. I, yeah, I, I do like, 'cause I do research, I do like si cycle through, like all these different things that come out.

‍

Yes. And so I guess right now I just, I, I wear an aura ring. That's it. Like I don't have. But I do have this sleep profiler, like single lead EEG that I've been testing. 'cause we're about to kind of deploy in a research study. We're, we're studying sleep in the context of uh, people who received a lung transplant.

‍

Wow, 

‍

okay. So because we had some kind of survey data that showed that like people that had kind of more severe sleep disturbances post their lung transplant just like didn't do as well. They were more likely to develop kind of like chronic. Rejection and actually not survive. Wow. And so we're trying to understand like it could be that like that's what was happening and their sleep got disturbed.

‍

We don't really know. So we're trying to kind of do some pilot work, but get more objective measures in the, in the hospital. And then when they go home to, to understand what it is about sleep. I mean, again, getting back to like my interest around sleep and the immune system or sleep in health. Like yes, 

‍

yes.

‍

There could be like really interesting kind of connections there. 

‍

Wow. Fascinating. Okay. I love that. Well, so the last question would be so far to date, and it's clear you're actively continuing to learn by the moment, but what would you say has made the biggest change to the management of your own sleep?

‍

Oh man. So, okay, so I'm in the process of it because, and, and we were, again, we were talking before we started, so last week. Or I went to New York City for this kind of global sleep symposium at the Equinox Hotel in New York. And it, I mean, it's by far like the nicest hotel I've ever stayed in. 

‍

Yeah.

‍

Because it's just like, it's like a luxury. Like I, I don't get to go to those places. Yeah. Let's just be aware. 

‍

Yeah. 

‍

So it was really awesome. But they're like, so sleep forward in the way in which they created these rooms. 'cause they're like. Super quiet. Like the, the blackout shades are like, you know, like you're in Las Vegas style.

‍

Yes. You know, and then, and then the temperature was so nice, but also just like the betting and you know, as I was telling you, like I came home and I was like, ah, like we need to up our game. 'cause I like didn't realize how nice. These things could be, and yeah. Um, you know, one of the things that they also do is, uh, they do, um, Scandinavian style like bedding.

‍

Right? 

‍

The duvets. 

‍

Yeah. And, and so I'm, yeah. So we're, there're separated and I was there by myself, but I'm like, you know, we need to work this into my life because I like having my own stuff. Totally. Um, but, but I mean, I, I think like, so as you said, like my sleep is, you know, is, is, is in a good place and I think my recommendations for people.

‍

Are often based on the idea that I don't want people to kind of become, uh, kind of put their sleep on a pedestal. 

‍

Yeah. Yeah. 

‍

Because that's for people with insomnia, that's a real slippery slope, right? Like it becomes this 12 step protocol. It becomes this, um, you know, I always talk about like how with people with insomnia.

‍

Many times they have like this one night where they like went to sleep. 

‍

Yes. 

‍

They like, you know, they had this perfect night. They woke up in the same position that they went to sleep in and they just felt amazing. 

‍

Yes. 

‍

And for the rest of their life, it's like they're chasing that moment. 

‍

Yeah. 

‍

Right.

‍

That's like, 

‍

like an addict 

‍

that is success. 

‍

Yes. 

‍

But, and so I, I have to talk to 'em about like, no, that's exceptional. 

‍

Mm. 

‍

Like that's something to be savored. 

‍

Yes. 

‍

And those are like few and far between for everyone. You know, and in the same way I like, you know, around people's sleep environment, there are like things we know that are, are necessary.

‍

I think, you know, darkness, quiet, cool, and then safe, which is one that I feel like people don't, don't talk enough about. Um, 

‍

very 

‍

important is, um. Is essential. But I also now from this experience appreciated like, you know, maybe my room isn't as dark as it could be, and like maybe my pillow could be soft and not like a rock that I sleep on.

‍

Like they're these things that I'm like, okay, so I'm like learning how to integrate these and, and part of it is just I didn't, I hadn't been exposed because I, I've definitely come from the framework of like, no, this is, we're built asleep. Like, it's so embedded in our biology. Um, but it could also be more comfortable.

‍

Sure. Like it could still be like more, you know, there are things that you could kind of z around to like, to make it maybe. Uh, just, you know, from like an A to an A plus or from a, you know, a minus to an A, you know? And so I think that that is, if there was an example that just comes to mind only 'cause it was so recent.

‍

That's, that's where I, where my head's at. And so I was telling you that I ordered the love it pillows from Equinox. Are so expensive for a pillow. I'm like, you know what? Like, like maybe like, maybe this will be the thing, like, I don't know, like, 

‍

oh, we don't dunno. 

‍

My guess is my wife will hate it and she'll be like, why did you buy these garbage pillows?

‍

And I'll be like, well, we're paying 'em off. So we're. 

‍

I wanna hear the results of this. What happens with the pillows and the upgrades and the blackout shades. 

‍

I know. My gosh. 

‍

Okay. 

‍

I have to do this again. I 

‍

too, I would love that. Okay. Amazing. Wow. Okay. Well, I'm sure for people listening, they're gonna wanna be a part of your world, follow your work, work with you, et cetera, et cetera.

‍

What are the best ways to do all those things? 

‍

I mean, honestly, email is the best way. 

‍

Okay. Yeah. 

‍

Sounds sure. Like I have like a pretty lame website, but, uh Okay. But you know, like it's just my first dot last name@ucsf.edu. Um, okay. Or I'm on social media, I'm on LinkedIn, I'm on Blue Sky. I might still be on X, I'm not a hundred percent 

‍

yes.

‍

But, uh, but all of it, uh, yeah, I would love to interact with people that are interested in sleep, um, interested in research, interested in kind of sleeping better. Um, I, I love talking to the public about kind of the benefits of sleep and so any way that I can be helpful to anybody listening, please let me know.

‍

Oh, well, amazing. And thank you so much for not only the work that you do, but for also taking the time and clearly your energy and passion around this topic is evidence. So, you know, keep up the important work. Just appreciate it. 

‍

Amazing. Thank you so much. 

‍

Awesome. Thank you. You've been listening to The Sleep Is a Skill podcast, the top podcast for people who wanna take their sleep skills to the next level.

‍

Every Monday I send out the Sleep Obsessions newsletter, which aims to be one of the most obsessive newsletters on the planet. Fun Facts. I've never missed a Monday for over. Five years in counting and it contains everything that you need to know in the fascinating world of sleep. Head on over to Sleep as a skill.com/newsletter to sign up.

‍