Sleeping six hours or less after age 45 makes a heart attack or stroke 200% more likely

How important is sleep? The shorter you sleep, the shorter you live. It's going to help every aspect of your life. There's not going to be an organ system or a brain process that it does not help. Not only does sleep deprivation make you more hungry, but it's actually been shown to make you eat more food. Alcohol is extremely detrimental to sleep. Dr. Paul Roddenberg has returned. He's deep in the science and a personal transformation of making sleep a non-negotiable in his life. We'll talk about what most people get wrong about sleep, why it's still not taught in medical school, and how to build habits that can change your body, your brain, and your life.

If you've ever said, I'll sleep when I'm dead, this episode might just change your mind. We don't just sleep. We really cycle through two different types of sleep. There's end-round sleep, and there's room sleep. Throughout the night, there's this continual, like, push-pull battle between end-rem and rem, trying to win dominance over the night. Short sleeping in men is also associated with smaller testicular size. We got less testosterone, less sperm, smaller balls. All parents realize that bad nights sleep equals a bad mood the next day, right? We understand it with our kids, but not ourselves.

What other tips do you have to concrete changes we can make to sleep better at night? The number one thing is, we got Paul Roadenburg in the house, everybody. Ah! Ah! All right, Paul. All right, brother. Oh, you know, for those people that don't know you, you are a licensed ER physician. You're really talented at taking your base of medical knowledge and then spending months or years diving into a new area of medicine, whether that's weight loss, weightlifting, nutrition. You got any other areas of specialty? I mean, we're gonna dive into sleep today, but yeah. Yes, and soon female health. All right, we gotta get you up on that microphone though.

Here, you wanna just pull it closer to you. The, you might need to change the arm there a little. Is that good? See, that's so much better. Yeah. But you can lean back. We just gotta move the arm, stretch the arm. No, this is good. Okay. I'll just sit forward. Okay, easier. There we go. Yeah. You sound so good. Okay, perfect. So good. This is like a new, this is a whole new level of sound. I know everybody's like, can you please get to the stuff about sleep? That's what you said you were gonna talk about. I'm ready. So yeah, I mean, I tend to dive into a lot of, sort of different things outside of emergency medicine.

I think some of it is sort of selfish for my own game to learn how to live longer and be stronger and be happier, sleep better. And then some of it's for my family and friends, you know? I mean, you know, like I'm after this, I'm gonna dive into women's health deeply because my wife's just struggling trying to find a provider that will help her with hormone replacement therapy. So that's next on the list. But right now we're dealing with sleep. Yeah, and I understand the hormone replacement therapy for women is really difficult to get the, there's just not an existing structure for people to step right into and get the help they need.

So I'm really excited to get to that topic someday. Yeah, I mean, I don't quite understand it. It's the science is there. It seems like the general practitioners just aren't diving deep enough into the knowledge, into the science to be able to help these women out. And so it's time to change things up a little bit. Yeah, all right. Well, we can look forward to that in a future episode. Let's see other housekeeping items. I'm really excited about these new arms for the microphone. It just takes the cord, you know, the cord runs right through the middle of it. It just cleans everything up in here.

It's just so nice. Got more space to move around in. So much more space. I don't feel like I'm trapped in. Yeah. I like it. Buckling you into a car seat before. I know I have a lot of room and it's cool. And the lighting's excellent. Yeah. Yeah, we're trying to just get it all dialed. I don't know. Great. It's like a whole new room. It is. It is. Yeah. Before when it gets to we come in and be like, let's make sure you use the bathroom before you sit down because once you're strapped in. Because you're not getting up. Okay. We got to move stuff to get you out of here again. Yeah. So it's a lot more breathing room now.

It's really nice. Okay. Let's talk about sleep. What is your journey with this? Right. Like when you were young and coming up through medical school, let's start there. What's your understanding of sleep at that point? I had a very poor understanding of sleep. I didn't understand what it was for, what it did, what it helped with. And I basically live by the mantra that you spoke about before, I'll sleep when I'm dead. I did that, gosh, probably until five or six years ago. And that's a pretty unfortunate mantra to live by. Because the shorter you sleep, the shorter you live. And yeah. So I've gone on this journey with sleep.

And I've gone from a time where I would sleep probably four to five hours a night to a time now where I make it mandatory that I give myself at least an eight hour sleep opportunity every night. And I've seen my mental and my physical health just improve exponentially. And so I think it's definitely a worthwhile endeavor. And I think it is unfortunate that, you know, like in medical school, my teaching or the my knowledge on sleep came from basically one lecture, right? You know, I mean, that's crazy. And I think it's been both a failure of science to really explain why sleep is important. And then also just a failure of our schooling to teach us about it.

And I think we just need to. I'm really excited that it seems like sleep awareness is on the rise. And a lot of that is due to Dr. Matthew Walker. I don't know if you've heard of him, but he wrote the book Why We Sleep. And I mean, he's just amazing. And I think he's really transformed this whole area, much props to him. But it gives me hope that at least the awareness is on the rise because it really does impact our health on so many levels. You know what I would just like to take a moment to say? I think it's fantastic that you actually give credit to other people when you study up on these other subjects and credit where it's due.

Because when I listen to podcasts and watch some of the big YouTubers now, like they go to great pains to not give credit to anybody else. Everybody needs to be the source of the information. So they'll say, well, I looked at the literature and I found blah, blah, blah. Even if 90% of what they found came from a single source, a single author. Well, yeah, I mean, most of science is not like my knowledge. Someone else thought of it, came up with it, experimented. And on this front, I mean, Dr. Walker is by far the guru and much props goes to him. But yeah. Well, I just want to give a shout out for that because there's great value in being able to communicate it.

I mean, you couldn't do all the experiments yourself, all the research yourself on all these different topics. But there is, you do need to have a basis of medical knowledge to be able to communicate, separate fact from fiction and then communicate it to other people. And I just appreciate the give credit where it's due as you go through that process. All right, let's keep rolling. So you didn't get any information on sleep in medical school. Why hasn't the medical establishment put a bigger priority on sleep? It's hard to say. I think some of it has to be the fact that a lot of this knowledge is actually probably relatively new.

Probably in the last 20 years or so, there's been an explosion in research in this area. But I think medicine just looks at sleep a little bit differently. Like with residency, it's frowned upon if you are sleeping a lot, if you're not in the hospital all the time, if you're not sleep deprived. Like it's just right of passage, right? But you're like, how can you practice medicine if you're sleep deprived? Like your concentration goes down, your memory goes down, you're emotionally liable, like labile. It's just a disaster, but it's this rite of passage and people just think that it's so important, but it's not.

Like sleep is way more important than that. Well, let's go a little deeper into that culture of medicine. What does a week in terms of sleep look like when you're in residency? So it's changed a little bit now. But when I was in residency, I would be on call every third night. So every third day, you'd basically be in the hospital for 24 hours. Yeah. But it usually would be a little bit longer, it'd be more like 30. And then the other days, you would probably be in there till about six or seven, getting in there, getting in the morning at five or six. So that'd be a typical day of the whole pregnancy.

So just to recap, you're doing six AM to six PM, like normally 12 hour shifts. And then every third day, you're in there for 24 to 30 hours. Yeah, that's not leaving a lot of time to sleep. And my impression of residency is that that's part of it is just can you get through this, survive this. It's almost like basic training for Navy seals, like they want to weed some people out in that process. And it's just part of the culture to make it as a doctor. And that might lead to just not looking as closely at some of the benefits of getting more sleep. Yeah, it's definitely a rite of passage. And it's interesting.

So I just just remember this. I think that residency first, at this rite of passage, first started back at John's Hopkins. And it was with this surgical, basically, professor. And he was known for just staying up all the time, operating all hours of the day, never sleeping. Right? And he really started this whole mantra and this whole movement of you don't sleep. Like, you've just got to be tough. We're just going to practice medicine. If you sleep, you're not learning all this stuff. But guess what they found out? Dude was a cocaine addict. Yeah. Yeah. So that helped him out a little bit. That will keep you up.

Yeah. I don't know why you guys are so tired. I feel great. Let's go. Let's talk a little. Yeah. And then I think he went to rehab and then he got hooked on morphine. Oh, geez. Yeah. He had a tough time. This was an interesting human. Yeah. This was a while ago. Okay. Okay. So in contrast to that, now knowing what you know, how important is sleep. Sleep is, I mean, so last time when we talked, we talked sort of about my hierarchies of importance for health and longevity. And this has become one of the main pillars in that. I mean, sleep helps regulate so many things. Right. So sleep can be broken down really.

Well, you know, and you know what, before we jump into that, let's go. What are you, what are those pillars of health? Let's name those again, just for anybody that hasn't seen the previous couple of episodes when you've come in. I think that would be a good basis to start from. Yeah. So the four pillars are first regarding nutrition or regarding food, avoid process food and avoid energy toxicity, trying to maintain energy balance. The second is going to be to work out hard and work out often. Next is going to be to avoid alcohol and to avoid smoking. Also, it's do something for your mental health every day, not just once in a while.

And the last is sleep. Gotcha. Well, let's dive into that last one. Let's talk about sleep. Yeah. So now I've lost my train of thought, what we were talking about. I know. I screwed you up. Sorry. The well, let's just get into why sleep so important. What are the benefits derived from regarding sleep? So we don't, we don't just sleep. We really cycle through two different types of sleep. There's N REM sleep. And there's REM sleep. Okay. So N REM can be dissected into four different stages, one through four with three and four being the deepest. Okay. And basically throughout the night, there's this continual like push pull battle between N REM and REM, trying to win dominance over the night.

These cycle through about every 90 minutes. Okay. And the first half of the night is one by N REM sleep. And the second half of the night is one by REM sleep. Okay. So this poses a big problem for people that only want to sleep six hours. Because people that only sleep six hours will think, well, it's not a big deal. I'm only missing 25% of my sleep. But because REM sleep occurs at the latter half of the night, you could be losing between 60 and 90% of your N REM sleep. Okay. So that can lead to emotional, you know, being emotionally labile and lots of other terrible things. But so N REM sleep is really characterized.

It's this highly coordinated state that's characterized by these large deep slow waves. Okay. And they start in the middle of the frontal lobe and they work their way back. And the whole reason for these deep slow waves is basically just to transmit information, to transmit memory. So the way that the memory works is that we basically store our memories in a short term repository for memory called the hippocampus. And then when we sleep, when we get into N REM sleep, that is then transferred to the cerebral cortex, which basically cements our memory into a long term storage site. Okay. So N REM sleep is important for memory.

And it's also important for multiple metabolic processes that aid in our health. Okay. So REM sleep is a little bit different. Now REM sleep, when we look at polysynography, this is basically when you put a bunch of electrodes on someone's head and measure their brain waves. When we look at REM sleep, it can actually look like people are awake. It's pretty wild. Like the activity is off the charts. And there's actually certain parts of the brain, four parts in particular, that have increased activity compared to when we are awake, increased activity, increased activity. So the visual visual part of the brain, the motor part of the brain, the amygdala, and the hippocampus.

Okay. So that means that when we're in our dream sleep, there's going to be highly visual, lots of motor going on, and it's going to be autobiographical and highly emotional. So those are the things that we dream about. Let me ask you a question about the memory part, because we kind of flew past that. But so when I'm going through my waking day, memories are sitting basically in temporary storage until I go to sleep, and then they are moved into permanent storage. That's exactly how it works. Yeah. So during REM sleep, when we learn something new, it goes into our short term knowledge storage reservoir, which is the hippocampus.

Okay. So it just sits there. It just sits there until we go to sleep. But there is a limited storage capacity there. So you can only gain so much new knowledge. And if you actually go over that, you can either not learn things, or you can sort of overwrite things that you've already learned. So when we go to sleep, then, that memory is then transferred. It's transferred to the cerebral cortex for long term memory. And that's an all or nothing event. So if you fail to sleep after coming up with these or learning these new memories, those memories are gone. It's not like the bank that you can't just, you know, assume a debt and hope to pay it off later.

It's all or nothing. So it's almost like this cup. For if you're listening, I'm holding a coffee cup in my hand and it will fill up to a certain amount. And once you try to keep pouring new memories into it or learning new things, it's just spilling over the sides. Exactly. And when you sleep, I'm taking this and pouring it into a much bigger container that can hold, it's like a reservoir that can hold this new knowledge, long term memories. And if I don't sleep, it's just not going to get transferred. I've missed that window, missed that opportunity. Those things are not going to be retained long term.

Yeah. So that whole situation is really sort of elegantly synergistic, right? So you take the memories from yesterday, you transform from the hippocampus to the cerebral cortex, you lock them in, you cement them in. But at the same time, you also refresh your ability to learn new things the next morning. So lack of sleep then, it hampers your ability to retain what you learned before. And is it also hampering your ability to learn new things the next day? Yeah. Wow. Yeah. Yeah. I mean, so the sleep to pry brain, I mean, basically, so if you're pulling an all-nighter or something, and if you're sleep deprived in the short term memory portion, you're going to be at a 40% deficit to being able to basically cram new memories into the brain.

Harmful in terms of your efforts to study if you're a student, if you are a adult trying to garner new skills, if you are a young child who's trying to learn all kinds of new things. I imagine even for an athlete learning new physical skills and techniques, you would struggle to encode that into your long-term memory if all through this one mechanism, if we short-circuit the sleep. Yeah. I mean, with athletes, it's the same exact thing, except it doesn't. So it goes, so when you're trying to learn new athletic skills, those short-term memories actually do go into the hippocampus, but they don't go to the cerebral cortex.

They go to a different area of the brain that lives below our level of consciousness. But yeah, when they are transferred, that's what equals a fine-tuned athletic performance. So coaches love to say practice makes perfect. It's really practice with sleep makes perfect. Well, and I think that can easily be overlooked for athletes. You were an athlete yourself, and again, there's a cultural aspect there of being able to overcome any hardship. So much of it is about your body. But we forget that learning new skills and techniques is actually happens upstairs in the brain. That it does. I mean, yeah, when I was an athlete, no one ever talked about sleep at all.

But it's crazy what sleep deprivation does to the body, right? So I mean, time to physical exertion decreases by like 10 to 30%. You have higher lactic acid buildup. You can't jump as high. You're not as strong. And worst of all, your risk of injury skyrockets. I mean, that's really the one thing that we have control over to help mitigate risk in our athletes is making sure they're getting enough sleep. Yeah, I'm thinking back to my college days. There was a group of guys on the soccer team, the Pomona Pitzer soccer team, they would stay out all hours of the night regularly throughout the week.

And they were in great shape. So they could get away with it for a certain amount of time. But there were a higher number of injuries within that subgroup than I would say, the people who were really prioritizing rest and recovery. I mean, it's college. So you, it's easy to get sucked into all of that. And you want to make time for a social life and get out there and meet girls and have fun and all that stuff. But yeah, that's just triggering a memory that like, Oh, yeah, that that tracks that. Oh, yeah. I mean, I got injured in college playing football. And I didn't sleep very much. I don't know if my injury wouldn't have been avoidable if I had gotten better sleep the night before.

But yeah, okay. Other benefits derived from getting more sleep or deficits incurred from not getting enough. Well, where do you want to go? I mean, we've talked a little bit about memory. We can talk a little bit about emotion, if you like. Oh, yeah. Yeah. This is one thing that I think has really taught me a lot about myself and has taught me really why I tended to act the way that I did when I worked overnight for so long. You know, it's just yeah. So, I mean, you know, all parents realize that a bad night sleep equals a bad mood the next day, right? Yeah. And that's why as parents, we sort of guard nap time with our lives.

We understand it with our kids, but not ourselves, but not ourselves. Yeah. Yeah. So with a good night's sleep, basically, there's a strong coupling. There's a strong coupling between our cerebral cortex, which basically handles rational thought and logical decision making. So there's a coupling between that and between the amygdala, which is basically where we create our emotions, such as anxiety or anger. Okay. So the coupling occurs by the prefrontal cortex, basically having inhibitory control over the amygdala. So it puts a little bit of a break on it. So when there's good coupling, when there's a good night's sleep, there's a good balance, there's a good balance there between our emotional gas pedal and our inhibitory regulatory break.

Okay. But when we don't get sleep, that coupling is completely lost. So we have too much of our emotional break, too much of our emotional gas pedal and not enough of our emotional of our inhibitory break. And by the inhibitory break, I mean, I have an immediate reaction to something you say that upsets me and I start to get angry and it just without a break, that reaction just comes pouring out of my mouth. Yeah. Whereas normally the prefrontal cortex would just slow that down a little bit. Yeah. Potentially allow you to have time to think to say, is this really what I want to be doing right now?

Or even not even so much that, it actually probably just calms that response. Right. So it's not so exaggerated. Right. So I mean, in the sleep deprived brain, the amygdala basically amplifies by 60%. Okay. Right. So that's, that's massive. Yeah. And that explains a lot about why I was, I think when I worked tonight's, when I was just hyper reactive, anxious, and more angry at times. Right. But what's interesting, too, is that what's also amplified during that time is a part of the brain called the striatum, which is basically bathed and dopamine as part of the basal ganglia. And this basically, that area is known for impulsivity and reward.

And so that can also lead to pleasure seeking when you are sleep deprived. So increasing impulsivity. Yeah. And so that's why there's a strong link as well between sleep deprivation and addiction. Yeah. Yeah. I think most people can imagine you're physically tired. You haven't had enough sleep. So you're extra worn out. And you just naturally go to, okay, what substance could easily make me feel better, whether that's booze or a cigarette or whatever your vice of choice might be. And if your impulsivity is increased, you're kind, it's kind of a double whammy in terms of giving in to your vices, which in moderation, sure, those things can be fine.

But I think all of us, whatever your thing is, might be watching too much TV or eating too many potato chips. I mean, whatever it might be, we all want to keep those things within a certain range. And what I'm hearing from you is if we don't get enough sleep because we're extra anxious and tired, and then we've got the increased impulsivity, we're going to overindulge in these things that we probably would rather not overindulge Oh, 100%. I don't have you ever felt that before? Oh, yeah. I mean, I just I I just feel that all the time when I am sleep deprived, like my desire to eat terrible foods, just absolutely skyrockets.

Yeah. And I can just eat and eat and eat and eat. It's just yeah, it's wild. Yeah, because it will temporarily make you feel good again, even if it long term makes you feel worse. Well, it feels good because of that, you know, because you're basically just eliciting that dopamine high. But yeah, yeah, you're just feeding into it. Yeah. I saw a thing on Netflix. On the scientists that manipulate foods for taste and mouth feel and all these all the tricks in their bag to make you eat more essentially. And I thought it was really fascinating. They're tasting these incredible oranges out in this orchard.

And he says, wow, that's a really good orange. Said I would never create a flavor like this. And I'm like tuned in like, why? That seems like that's the model you would be trying to replicate. And he says, because the taste lasts a really long time in your mouth. He's like, it's this this burst of flavor from this delicious orange. And then it just sits in your mouth. And he says, when we design foods, we want to hit you extra hard right at the beginning and then have that just disappear. And the only way you can get that flavor again is to have some more of it. And I thought, gosh, that's what happens to me with all these chips and processed foods, right?

Like in our home, the kids always joke like with the kettle potato chips, the salt and vinegar flavor, especially like you cannot eat just one, you can't it's impossible. And that really made sense to me why that is so and I know we're getting off track a little bit. But on the whoop, whoop, I might just fell down. Thank you for bearing with us through this technical difficulty. New equipment, you know, it comes with some growing pants goodness. Okay. Okay, slightly lost my train of thought there, but I believe I was heading towards we're all dealing with this industrial food complex in America that is trying to manipulate us to eat more of bad things.

And sleep could be a buffer against that, to have more self control and not be stuck in this pleasure seeking loop, where you're more susceptible to giving in to those manipulations. Oh, well, 100%. And I mean, it is well known now that I mean, if you want to lose weight, you should probably be getting a good night's sleep. Right. So if you basically, when you're sleep deprived, everything sort of goes out of whack and everything drives you to eat more and more and more. Okay. So if you don't get a good night's sleep, you're the hormones that control whether you're hungry or whether you're full, get completely out of whack.

So ghrelin, which basically stimulates hunger. You good? I finally got this thing. This is falling down. For those of you who are listening and can't actually see this on YouTube, this mic has fallen down like, I'm so excited, as I said, at the beginning of the episode about these new arms that fit onto the desk, but I have a little fit issue. And my mic has fallen down like five times. I think I've got it fixed now. Go ahead, Greg. Great. You look great. Yeah. So ghrelin, basically, the hormone that causes us to be hungry is significantly amplified with sleep deprivation. And leptin, which basically causes us to be full or the satiety-inducing hormone is actually decreased.

So again, you get a double jeopardy there. Yeah. So you get the, I'm full is gone and I'm hungry is amplified. Interesting. So not only does sleep deprivation make you more hungry, but it's actually been shown to make you eat more food. Because you won't feel satisfied. Yeah. So those that are sleep deprived, they eat about 300. So if you sleep six hours or less, it's been shown that you'll likely eat about 300 more calories that day. And so if you're going, if you're sleep deprived for a year, that equals about 10 to 15 pounds for that year. I mean, that's got to sound familiar to a lot of people.

Sure. Right. Okay. Let me ask you this question then. Is it stealing from Peter to pay Paul? If I get up at five AM to work out and getting up at five AM means I'm only going to sleep five or six hours in order to get this early workout in because I'm trying to get into shape. Like, right? Am I not that exercise is bad. But what I'm hearing is it would be much better to go to bed way earlier if you're going to get up super early to work out. Like you don't want to sacrifice the sleep for a workout, you need to figure out a way to get both. Yeah. So I mean, this is something that we sort of touched on last time.

So there's something called constrained energy theory. So basically what that means is that you're only going to burn so many calories each day. Right. So even if you spend four or five more hours awake, you're going to spend about the same amount of calories, you're going to burn about the same amount of calories. So that's not going to aid in more weight loss. It's just the way that the body works. Yeah. Yeah. So it would definitely be worthwhile to get the sleep instead of waking up for that workout. Yeah. So it's really a not an either or needs to be a yes and yes, that's my new framework and I'm going to be a good friend.

It's my new framework that I picked up for my friends, Scott Barry Kaufman. Yes and thinking. And something about social media has really trained us to be on yes or no. It's so binary. I'm going to hurt it or I'm not. I like it or I don't. I love it or I hate it. And that yes and which is an improv thing where somebody says something and you build on it. I mean, that's where it comes from. But it is use. I think it's a useful framework, a little shortcut to thinking in a new way. Yes. And it's not sleep versus exercise. It's yes, get the sleep and exercise. Yeah. That would really help with all the polarization today.

Huh? Yes, it would. And make the world a better place. So yeah, I mean additionally, so I mean, if you if you're sleep deprived and you're trying to lose weight, so you're calorically restricting as well, it's been shown that potentially 70% of the weight that you lose could be from lean muscle mass, which is absolutely terrible. Right. You want that number to be less than 20. You want to maintain your muscle mass at all costs. Well, speaking of retaining lean muscle mass, I think this is a really interesting new development. Eli Lilly is working really hard and thinks they've made a breakthrough in a drug to help people retain lean muscle mass as they grow older and they started working on it because they're so invested in the GOP ones.

And the one downside of the GOP ones is that as you are not eating nearly as much and shedding weight, people are losing muscle mass. And so a few of their researchers thought, man, if we could correct that, we'd really put down the naysayers and they believe they've made a big breakthrough in this. I'm really curious to see what happens next with these trials that they're working on, but it would basically be something you could take that would help you retain lean muscle mass. I haven't heard about that. That's wild. I don't quite understand how that would work as the decrease in muscle mass is all due to the fact that you're just taking in two little calories and then potentially you're not because you're having less calories or not as active.

So you're not working on those muscles enough. It would I'm just trying to think the mechanism that would work. Yeah, it's something that's like hormonal. I don't know because it's not my area of expertise. And I tried to look into it a little deeper, but I couldn't I one, I couldn't find much information on the actual trials they're running because they haven't publicized all the information. Yeah, this was basically on. I think it was the economist ran an article on it on what they're working on, but I couldn't find the like papers that this was based on. I was going to try to dig them up and text them to you to research this a little bit further, because I thought it would be right up your I like that a lot.

Yeah, that works. It's fantastic. But great to just be used for elderly people in general, regardless of whether they're on GLP ones or not, because I mean, all the morbidity and mortality from older people, most of it comes from falls and things. So if we could inhibit falls and habit fractures, goodness, that would be a be phenomenal. Yeah, as I learned last time retaining lean muscle mass throughout your the second half of your life is critical, not to your staying alive or not, but to having a solid health span, right? Am I using the right word? You are you're right on that. My gosh. I've learned so many medical works starts now.

Yeah, right? Yeah, because we're already starting to lose it in our 40s, right? God is start now to make sure that you don't lose it later. That's why I'm in the gym five days a week now, thanks to you, Dr. Paul, because you just want to be you want to be traveling through Europe on your 80 and you want to be carrying your wife's suitcase and you don't want to be in a wheelchair and in a home and just no fun. Well, never since that conversation. Now I when I see they're rare, but those older jacked men, I'm like, Oh, I love those guys. Yeah, and they it's not that they just that they're jacked.

It's that they have so much energy and vitality every single time. They're almost like a different species. Yeah, right? I mean, it's like night and day, those type of older gentlemen or older women versus versus the other. Yeah. Yeah. Okay, back to the back to sleep. So what? Oh, well, do you want to cover any other critical benefits or deficits incurred from not getting enough sleep? I mean, we can go through a ton of issues that that basically affect the body when we don't go through sleep. So, because I do want to get to ways to improve sleep. I mean, we'll get there next, but maybe let's let's continue down this path first on whether it harms your physical health or mental health.

I mean, yeah, perfect. So I mean, we'll go through a we can go through some of the physical health stuff now. So, lack of sleep definitely affects the cardiovascular system. So if you're 45 or older and you basically get six hours of sleep or less per night, you're 200% more likely to get a heart attack or a stroke during your life, which is massive. Yeah, right? And so the way that lack of sleep, basically, the mechanisms in which that affects the cardiovascular disease are numerous. But the most common cause is going to be it activates our sympathetic nervous system. So when we actually go into deep sleep, like I was talking about before, deep sleep can help us with multiple metabolic processes and other processes.

This is one of the things that it does. But actually emits like a calming signal onto our sympathetic nervous system, acting almost like an overnight blood pressure medication. Okay, and if we are sleep deprived, just one night is going to elevate our heart rate and our systolic blood pressure the next day. And to make this point sort of more more obvious is that every year we basically do this massive experiment in which 1.5 billion people lose an hour of sleep. And what happens the following day when I'm working in the ER? Well, and what is this experiment? Daylight savings. Yeah. And what happens the next day?

There is a massive increase in heart attacks. And why this is such an amazing experiment is because we can see what happens when when the opposite happens, right? Yeah, what happens in the fall when we gain an hour? Number of heart attacks significantly decrease. And the same is true for car accidents, right? I mean, sleep matters, right? I mean, we've talked about weight loss a little bit. Can I just say before we move on from that it is absolutely bonkers that as a country, we still have daylight savings, knowing what we know on the adverse effects from everyone changing their clocks and that Congress passed a bill to get rid of it.

And it still hasn't changed. Well, I think it's bonkers that we have daylight savings. And I think it's bonkers that high school starts so early. Yes. I mean, it is now proven fact that the circadian rhythm of our adolescents progressively move forward as they go through their teenage years. And we, as a society, and we as even as parents just fail to recognize and fail to understand that our adolescents, our teenagers need more sleep than we do. And they are just biologically wired to get that sleep at different times. Yep. Right. They're just biologically wired to go to sleep later and to wake up later.

And we need to allow them to do that unless we want to impose like, you know, brain abnormalities or increased risk of mental illness upon them. Like it's massive. So sleep during that, we can talk about that a little bit. So sleep during adolescence is super important. Let's just backtrack a little bit. So basically, when we are a fetus, when we are an infant, we have this first round of sort of brain maturation. And this happens actually during REM sleep, where there's this explosion where of basically new neurons being formed. REM sleep sort of acts like an electric fertilizer, if you will, causing the production of all these new neurons, of all these new synapses.

And it's actually called synaptogenesis. And during this time, it's like, it's it's overzealous, it's redundant. It's basically creating all these possible different configurations that could come out in the future. And basically, they're just it's just waiting for those things to be individualized later on. So it sort of creates like this generic type of brain structure that could go many different ways. But it's during adolescence and during REM sleep that we actually do that individualization. So that happens by something called pruning, where we now instead of sort of instead of, you know, trying to grow more neurons, we're actually trying to cut back so that the neurons can become more efficient and be more effective to specialize to basically specialize.

And that happens during end REM sleep. And that happens through our experiences in childhood and through adolescence. So not allowing our kids to get sleep during these times is just crazy. Yeah. So what do we do when high schools, generally moving in the opposite direction, trying to add more zero period classes so that school starts even earlier, rather than having it run longer, which would be in line with the circadian rhythms of that age group? Yeah, I mean, it seems like at least our high school seems to have pushed back a little bit. Yeah. And it seems like which I appreciate, Losel. It seems like they're trying.

There's late start Mondays. And so that's great. But it still should be later. They shouldn't probably start first period until nine o'clock. And I know that causes issues with parents that are working and then with sports after school. But I think we got to make it work. And yeah, I think Lauren's going to take a zero period next year, just because our schedule so jam packed and I hate it. But what else are you going to do? Well, right. And because we can't, it's very difficult for us as individuals to change that. You need the governing body to change that and say, what are we going to prioritize?

And it should be the health of our teenagers. Yeah, for all the talk in high schools across the country about wanting to prioritize mental health, this seems like an easy win on that front rather than creating safe spaces or trying to bring in a speaker which has a very which is great. I mean, I, I, that's fine to do those things. But you bring in that mental wellness speaker or a couple of them, you might think a little differently for a few weeks, but changing the start time of school is a long term solution, not just to make you feel better for a short period of time. Type of solution. Well, yeah, the whole point of school is to learn.

Yep. And the only way you're going to consolidate those memories is by getting a good night's sleep, which a lot of those kids aren't because of the early start times. And they're worried about all these kids being overly emotional and all these issues going on. Well, guess what? Maybe get a little bit more sleep and those issues then go away. Yeah, right. And you want our kids to be more creative and to be better at problem solving? Well, guess what? That comes back to sleep as well. I mean, there's something called a chronotype. Have you heard of a chronotype before? So that's basically, so there's evening types and morning types.

Right. So morning types tend to wake up earlier in the morning, go to sleep earlier in the evening. Evening types tend to go to sleep later and wake up later in the morning. And this is strongly determined by genetics. So that's your chronotype. Yes. Okay. I'm a deep evening chronotype. Yeah, I'm a morning one 100%. I mean, I do all my best work creatively between 7 p.m. and midnight. And I have all whatever sense hitting puberty, I've always wanted to stay up late and sleep in late not to stay up and play video games. It just felt natural and normal. And when I try to reverse that and push back against that for work commitments or whatever, I can do it.

I can muscle through it just like anybody can forego sleep if they decide to. But I am obviously weaker mentally in terms of creativity, in terms of my analytical thinking. I mean, any way I can examine it, I am worse off when I am forcing myself to wake up earlier. Yeah. So that's interesting because basically society is strongly biased against evening types. Everything that is set up, right? So I mean, you guys are, it's a multiple fronts are against you. You're deemed lazy because you like to sleep in. And, you know, society's work scheduling is totally biased towards early start times, which punishes evening types as well, causing you to burn the candle at both ends further detracting from sleep.

So I was going to make the, you know, sort of equate evening types to what our kids are going through because it's very similar, right? They have that pushed forward circadian rhythm. And I don't know if you know this or not, but evening types have much worse health outcomes overall. Interesting. Yeah, they have higher rates of blood pressure, higher rates of diabetes, higher rates of heart attack, higher rates of stroke, higher rates of anxiety, higher rates of depression. And that's all due to lack of sleep. Yeah, that makes sense. Because society has put them in a box and tried to force them to be morning types, but we need to realize that it's not evening types conscious fault, but it's their genetic fate.

And we've got to let these things play out, you know? Yeah, I think that was a big push for me to become an entrepreneur. I think that's interesting. I think I was wired towards that in many ways, but I can recall thinking actively about this. I have no problem working extremely hard for ridiculously long periods of time. But getting up and coming into work, being there, ready to go by 8 AM, it kills my output and the quality of my output. And I remember at the beginning of test prep gurus when we first started hiring more people, I said, yeah, we're going to have like a loose start time of hopefully everybody gets here at 9 AM.

But I just want people in the office by 10 AM. We're going to really be flexible on that. And if that means there's still work to be done, and we're going to stay later, then we're going to stay later and get it done. But I want to make sure when we when I first started hiring, I said, I want to make sure everybody's on board with this from the get go, or we can have these overlapping times. If you're somebody, I mean, I was just keyed into that because it's so extreme for me. I really fall apart when I don't get enough sleep and feel like I am at my absolute best when I get a lot of sleep. It's even more extreme for me because I often need nine hours of sleep instead of just eight.

And it was frustrating when I was younger because I was like, man, I'm missing out on parts of life because I'm sleeping so much. But once I came to terms with the quality of life is better when I get enough sleep. And if that means not every night, but oftentimes, at least once or twice a week, I'm getting nine hours of sleep at night. I want to go for quality, not quantity. Yeah, I mean, I think that's an interesting point because I was thinking about my wife, Jen. And she's definitely an evening type too. And she's an entrepreneur as well. And I was wondering if you looked at the proportion of entrepreneurs that were evening types, I bet they're probably a higher proportion.

Well, that's interesting because they don't want to be constrained by the early mornings. Yeah, I remember there was a older gentleman. I had tutored his daughter. This is in the early days of test prep gurus. I was just working maybe with two other teachers, but I had worked with this guy's daughter and she did really well on the exams. And so he wanted to just like sit down, have a chat, say thank you, he took me out to lunch. And started asking me these probing questions about where the business was going and what the strategies were to get there. And he was a super successful entrepreneur. So I was really dialed into this conversation and trying to learn from this guy.

And it ends up we end up developing a relationship where he was just a source of advice for many years. But I remember in that first conversation, he said, yeah, the beauty of being an entrepreneur is you're gonna work 60 plus hours a week for several years to get this thing going. But at least you get to choose when those 60 hours are. And that man that resonated so much with me because it was never an issue of the amount of work or how hard I had to work. But when I had to do it was of paramount importance to me. And I just remember getting so excited in that moment like, yeah, that sounds awesome.

Or as I have relayed this story to other people, and they'll go 60 70 hours, that sounds awful. I would much rather just know what I'm getting into show up at eight o'clock get to leave it four o'clock or five o'clock and just have a nice schedule and just know what I'm dealing with. And well, yeah, those people are probably true morning types. I mean, that's 40% of the population. You're 30% of the population. And then the other 30 sort of live in between. Okay. Okay. What's that called? What is chronotype chrono type? Okay, chrono for time. Okay. Strongly genetically determined. Yeah. It's not your conscious fault.

Yeah. All right. Why else is this sleep so critical? So I mean, we could talk about reproductive issues. So I mean, if you care about having kids or reproducing, you probably do well to have a good night's sleep. It's been shown that we can dive into men first. So men that sleep less than six hours a night have a significant decrease in their testosterone levels. It basically ages them by like 10 to 15 years. Whoa. On top of that, if they sleep six hours or less, they have 23% less sperm and significantly more deformities on top of that, which is pretty gnarly. And does that lead to issues with the babies?

In addition to having reproductive challenges, can that lead to I mean, if you have issues with your sperm, does that lead to issues with your children? Are you more likely to have kids with challenges? It can, but I think it's more directly related to the sperm's ability to be able to penetrate the egg and cause fertilization. Gotcha. Okay. And then additionally, you know, short sleeping in men is also associated with smaller testicular size. We got less testosterone, less sperm, smaller balls. So these young men, if you want to be virulent and be able to produce babies, get some sleep. Yeah. And men aren't the only ones that are affected.

Let's talk about the well. So I mean, women with erratic work schedules have been shown to be 80% more likely to have subfertility. So now you combine, you know, the sleep-deprived man and the sleep-deprived woman. And there's no wonder why we're having a problem with fertility right now. Right. Right. Which, and I'm not sure if everybody's aware of that, but massive increase in fertility issues. And not just in America, it's around the world, but it's really pronounced in America. I wish I had the figures on tap. I may, as you get into the next thing, I'll Google it real quick, because the increase is staggering in the number of people that have fertility issues now compared to 50 years ago.

Yeah. And like with all things that we're talking about, I mean, sleep is just a part of the issue with all of these things. It's not the magic bullet. It's not going to be the cure all, but it's definitely going to help. And it's just one of the, and it's just such an easily accessible thing to improve if you're trying to, you know, have better heart health or reproduce and get pregnant or lose weight. I mean, it's just very easily accessible and not that hard to do. Multi-variate, I believe. Multi-variate would be the right word. These issues are, yes. But sleep's a big factor within that is what I'm hearing from.

It is. Okay. We're going to pull this up. Global infertility rates have increased by about 25% from 1990 to 2017. That's from the World Health Organization. Where's America? Wow. Sperm counts have dropped by more than 50% since the 70s, according to a 2022 meta analysis in human reproduction update. Again, all those things are multifactorial. Right. So I mean, gaining weight, producing more estrogen, having lower testosterone, or the increase in estrogen, or drinking water, there's lots of things that are causing them. Absolutely. But sleep does play a big part, though. Yes. How about dementia?

Alzheimer's? Yeah. So that's a massive topic. So Alzheimer's dementia is basically one of the most fear diseases there is. My worst nightmare. And it's many people's worst nightmare. Having seen family members go through it, it is terrifying. It's terrible. I mean, my dad didn't have dementia, but he had brain cancer. And so he changed similarly to that. He just became someone completely different. He wasn't even the same person. And it's absolutely terrible. Yeah. Right. But so there's like 40 million people right now that have Alzheimer's disease. And this number is accelerating, not only as our lifespans are increasing, but also as we're sleeping less.

So now one in 10 people over the age of 65 have Alzheimer's. Say that again, one in 10 over the age of 65. Wow. Now have Alzheimer's. Yeah. So as we get older, we have basically a decrease ability to generate sleep. Okay. This just happens across the board. And that's been linked to a decrease in memory, right? Because we talked about how deep sleep consolidates memory. Yeah. Right. But with Alzheimer's, this is far more exaggerated. And actually, so the problems with sleep, actually, and Alzheimer's proceed that of the diagnosis of Alzheimer's by about two or three years. So you start having these problems with sleep, and then you'll be diagnosed.

So this suggests some sort of link, or maybe that it's predisposing it, or maybe it's some sort of contributing factor or a warning sign. And then once Alzheimer's actually is diagnosed, the symptoms associated with Alzheimer's and that with sleep sort of go on and unison together. Okay. Now Alzheimer's, basically recently, we found that the association between lack of sleep and Alzheimer's is much more than an association now. It's much more than association. So with Alzheimer's disease early on, what we get is we get a buildup of something called beta amyloid, basically in the middle part of the frontal lobes.

And that happens to be the same place where we develop deep sleep. And what we found is that the greater concentration of beta amyloid in our middle frontal lobes, the greater the loss of deep sleep, and therefore the greater the loss of memory. So beta amyloid is interesting as well, because it's actually cleared from the brain during deep sleep. So deep sleep basically can also cleanse the brain of all these metabolic byproducts and toxic chemicals that build up during the day. So these slow waves during N-REM sleep sort of push out all of these contaminants through the lymphatic system. But the problem is, is that when we have increased beta amyloid, that's going to decrease our deep sleep.

And if we have a decrease in deep sleep, we're then going to have an increase in beta amyloid. So this is actually this vicious positive feedback loop. And that's one of the ways in which sleep can affect Alzheimer's. Yeah. So is the thinking that getting enough sleep consistently earlier in life, making you less predisposed to dementia later in life? That's definitely the thought since beta amyloid is cleansed from the brain during deep sleep. The hope where one of the thoughts is that you get as much deep sleep as you can early in life, decreasing the amount of beta amyloid in those frontal lobes, which will then decrease your risk of getting Alzheimer's down the road.

All right. Any other critical areas that we're to understand the problem of not getting enough sleep regarding our bodies or regarding why we're not getting enough sleep? Mm. We could go either direction. Let's see. Other ways that sleep affects our body. We've talked about emotion. We've talked about memory, talked about cardiovascular. It also predisposes us to diabetes as well. It's shown that people that are sleep deprived actually absorb 40% less glucose than you do when you're well rested, which is wild. And this is actually another double whammy where the pancreas actually produces less insulin and the cells themselves become less insulin specific or sensitive.

It also affects the immune system. The immune system and sleep have a very strong interrelated relationship. When we sleep, we basically release a whole host of immune defenses. If we're sleep deprived, we have 30% increased chance of getting the common cold. If you happen to get an immunization the day that you're sleep deprived, you're going to have a 50% decrease reaction to that immunization. And there's a 70% reduction in your natural killer cells. And natural killer cells are important. And a lot of people don't know about those, but they actually, what natural killer cells do is they go around and look for cancer cells.

And so they find these free floating cancer cells in our body, which are pretty much always being produced, but our immune system can fight against them. And so these natural killer cells seek them out. They basically punch this whole in them, stick a protein in there and causes them to die. But when we're sleep deprived, those decrease by 70%. Well, and multiple studies, especially recently, have shown that overnight shift work leads to an increased risk of colon cancer, breast cancer, and prostate cancer. And now the WHO just came out saying that overnight shift work is a probable carcinogen, which is all related to lack of sleep, which was related to decrease in our immune function because of that lack of sleep.

Now, what does that mean that overnight shift work is a carcinogen? Because I think of a carcinogen as smoking a cigarette. And I know that that's bad for me, but I don't, if I was forced to be put on the spot and say, Nick, what is a carcinogen? I don't know that I could define it. And I am curious as to what carcinogen. It just means that it leads to the development of cancer. Right. Okay. So yeah, smoking can do it. Alcohol can do it. Not sleeping enough can do it. Yeah. Yeah. Because your natural killer cells just sit there dormant and not seeking out these malignant cells that are pretty much always being produced.

Yeah. Yeah, we always have free floating cancer cells in our body, but our immune system, when it's activated, can take care of them. And so as we get older, as, I mean, cancer increases as we get older, right? And there's lots of questions why that is, is it because our immune system isn't functioning as well? You know, it's a big question that's up for debate, but you've got to take that correlation between lack of sleep as we're getting older with decreased immune response, with our increased risk of cancer. Okay. So I'm properly scared now, increasing risk of cancer, risk of dementia, risk of stroke, risk of heart disease, poor emotional health, poor physical health.

Sounds like sleep is an incredible, I don't want to say cure all sleep is an incredible tool to help mitigate all of these risks. Let's turn to how do we get better sleep on the regular to not fall prey, at least as early to all of these bad outcomes? Yeah, so maybe we can talk about a few of the things that are basically hindering our sleep. And then we can talk to about some ways that, or just some staples for getting good sleep. So there's really four main factors that have led to us getting less sleep. So those are going to be basically constant, constant electrical light, regularized temperature, caffeine, and alcohol.

Caffeine, well, caffeine is something that I love dearly. You're talking, you're preaching the choir there. So with caffeine, we can start with that, let's just backtrack a little bit. So there's two main ways in which we basically determine if we want to sleep or we want to be awake. First is our sort of internal 24 hour clock. And the second is going to be adenosine, which basically creates this sleep pressure. Okay. Okay. So adenosine basically works as a chemical barometer. It's basically a medical, it's a metabolic byproduct that increases with every moment that we are awake, creating this sleep pressure.

So it works by like this clever dual action effect when the concentrations are high, it basically turns all on all the sleep promoting areas in the brain and turns down all the weight promoting areas in the brain. Okay. Now caffeine basically can mute adenosine. So caffeine and adenosine basically battle for the same receptor. When adenosine binds to the receptor in the brain, it stimulates sleepiness. When caffeine binds to it, it stimulates wakefulness. Okay. Okay. And now like we've said, caffeine's magical. I love it. It's amazing, but it has a downside. And the downside is that the half life is between five and seven hours.

That's a long time. And most people don't realize that it's that long, right? So they basically fail to equate that noon time or mid afternoon cup of coffee with their lack of being able to sleep at night. Right. So if I'm having a cup of coffee at 4 p.m. just to finish the day strong. Seven hours later, it's still having an effect on me. Seven hours later, half the caffeine is still there. Yeah. Right. Right. And that's going to inhibit you from giving when you have a stimulant in your system, it's going to make you sleep lighter, not being able to get into those deep stages of N-REM sleep, not allowing you to transfer those memories, not allowing you to go through all those metabolic issues that basically bolster your health and so on and so forth.

Yeah. Are there other stimulants that have a similar effect? Nicotine has a similar effect as well. Yeah. So nicotine is a stimulant. And it has a, it's half life isn't as long, but it basically causes the same thing. If you use nicotine too close to bedtime, it's going to basically cause you to sleep only very lightly and not get into the deeper stages of sleep. So you'll wake up not feeling as refreshed, even though you felt like you slept eight hours, you didn't get the quality that you needed. Gotcha. Okay. What about the light? Yeah. So I mean, constant electrical light is a massive issue.

So we're obviously visual creatures, right? I mean, I think a third of our cerebral cortex is made up of our visual cortex, which is wild. Now, so previously, the setting sun would basically take light away from our eyes, which would then signal to our internal 24 hour clocks that it was time to sleep. That would release melatonin and basically change our our core body temperature to allow us to sleep. But now, with, you know, since the discovery of fire and then candles and incandescent light bulbs and now LEDs are our night times are not always in darkness. Right. Right. I mean, just a hint of light can basically decrease our melatonin production.

If you use a tablet two hours before bed, it decreases your melatonin production by about 23%. A tablet like a phone. Yeah. Yeah. Yeah. Yeah. So get off your phone at least two hours before you're going to go to bed. At least. Yeah. Okay. Yeah. We get into the solutions, I think, after we get you now you're outlining the problem and then we'll get into like specific things to do. That's at the end. Yeah. I think that's a great. I think everybody's excited to get to the solution. Just so smart. We're just going to keep them on the hook a little bit longer. And then LED lights are something that I find fascinating because I'm super, I don't know.

The longer that I'm in medicine and study science, I'm just more and more intrigued by evolution. Yeah. Right. So do you understand why LED lights affect our affect our circadian rhythm so strongly? Not at all. Not at all. I'll probably be the only one that finds this interesting. Yeah. Yeah. Yeah. Yeah. So basically LED lights admit blue light. Okay. Exactly. Right. Which is a short wavelength light. And that's different than what incandescent bulbs do. Yeah. It's the full spectrum. Okay. And so basically it is thought that all terrestrial creatures, us being a terrestrial creature living on land, evolved from marine creatures.

Right. Okay. Now water acts as a filter when we're talking about light. Yeah. So water basically absorbs the short wavelength light, blue and purple, but reflects red and yellow. Okay. Okay. This is why when we look at a large body of water, it appears blue. Right. Or when we open our eyes underwater, it appears blue because basically it's absorbing the blue wavelength light. Right. Okay. So this is just thought to be a carryover because, you know, our marine ancestors basically grew up only with blue color, blue light that is just a carryover from from our marine ancestors. And so the LEDs emitting blue light, what does that do to us?

Oh, it basically turns back our circadian rhythm, making it much harder for us to go to sleep. Yeah. Interesting. That is really getting in the weeds. I love random stuff like that, though, that is, like you looked into that so deeply to get into the specific light bulbs and how they're affecting us. That stuff lights me up. When people go that that deep. Yeah, I just had to go deep what it has to do with evolution. I don't know. It just it just really gets me going just because I've been on this journey to understand myself a little bit better. So I feel like I can understand all of the things that came before me.

Maybe it'll give me better insight into myself. Okay. So LEDs, we got to make sure to turn them down. Turn them down. Some people even have alternative light bulbs in their rooms, like red color light bulbs. I've heard of this. Then will not stimulate or change your circadian rhythm and allowing you to go to sleep at a normal time. Okay. Where were the other ones? We had light caffeine. Alcohol. Oh, everyone's favorite topic. Yeah. Yeah. So alcohol is extremely detrimental to sleep, basically. So I'll call this quite more sure. I mean, you don't even have to tell me that. I just know. No, but this is something that is so misunderstood.

Right. Most people think that alcohol is a sleep aid. Right. They think it helps you sleep deeper and sleep longer. But all those things are false. You actually sleep much lighter because alcohol is basically part of a drug class called sedative hypnotics. And it basically just sedates you. And sedation is not the same as natural sleep. It's more akin to anesthesia than it is to sleep. Yeah. So you're going to sleep lighter. You're going to be more sedated. Alcohol also leads to fragmentation, meaning that you have a lot of awakenings at night that most people actually don't even know occur. Right.

And I first realized this when I was wearing the aura ring, you know, every night to sleep, I would notice, oh my gosh, after I drank, I'll just be waking up all the time. And I didn't recall it at all. Yeah. And then people because they don't realize that they're waking up so much, they fail to make that correlation between, you know, by being so fatigued the next day with that alcohol consumption the night before. And then lastly, alcohol is actually the strongest inhibitor of REM sleep that we know of. So it just doesn't let you get into that REM sleep. So it's going to inhibit your ability to calm those emotions.

And then REM sleep is also super important for creativity and problem solving. And so that goes out the window as well. So what happens with your REM sleep? Let's go with an extreme example. Let's say I'm a raging alcoholic. I drink every day for 25 years, never an exception. What happens to my sleep during that time? And what happens when I suddenly stop drinking? Well, it's interesting you asked that. So basically during that entire time you're drinking, you're not getting into the REM sleep you need, right? But your body desires it, your body wants it, your body knows you need it. So what often happens in alcoholics is that need for REM sleep actually explodes into consciousness and causes active hallucinations.

So it's almost like they are dreaming when they are awake because they're such a strong desire for that REM sleep. And like we talked about before, there's strong activation during dreams of that visual motor, emotional and autobiographical nature. And that just explodes into consciousness causing hallucinations. That's wild during your waking hours during your waking hours. Yeah, I mean, I see it all the time in the ER, these guys coming in hallucinating that are chronic alcoholics. Oh, wow. More common than I thought. I just tend to see a select subgroup of people. But yeah, right. Yeah, you have a unique window into humanity in the ER, into the greatest of all.

I think that's why people love that show the pit so much. I hear it's so funny because I did the same thing. Like as soon as I saw it, I was like, this show is awesome. And then I started asking every doctor, I know, especially our doctors like you, like, how have you seen it? And the response is pretty much the same across the board. And it's funny because a friend of mine who lives in a neighboring state said the same thing. Went through the same experience, asked several doctors about it. And I was like, yeah, none of them have watched it. And he's like, I know, I got the same thing. And then it was like, well, why would they want to go to work and then come home and watch a show about work?

But to those of us who don't have an experience in the ER, it's such a fascinating world. And what you're seeing day to day, it's such a different window into humanity. It definitely is. You're definitely not seeing people at their best. I'll tell you that. Yeah. Yeah. Great show for anybody looking for something to watch. On HBO season two, season two coming soon. Okay. What else was that? Was there one more? That was just three. Yeah. There was one more. What was the fourth? caffeine, light alcohol. This is something you should know. How would I know? Regularized temperature. Oh, I thought you were going to say being on a microphone too much.

Okay. Regularized temperature. Yeah. I am a. I love air conditioning. I love being cold because I run very hot. I'm a hot human being. Let's talk about temperature control. How does that matter? Yeah. Regularized temperature has, I think our thermal environments are really probably the most underappreciated mechanism for allowing us to fall asleep easily. Right. So when we go to sleep, our core body temperature actually needs to decrease by about two to three degrees Celsius for us to get into a good sleep. Okay. Now, this has become much more difficult with our indoor heating with our massive blankets and so on and so forth.

There's a couple of ways that our bodies try to decrease our core body temperature and it's with three main skin surfaces. It's going to be our palms, our soles and our foreheads. And these are interesting because they don't have any hair, right? Yeah. They don't have any capillaries, but they have something called arteriovenous anastomosis. And they basically just allow this radiation of heat from our body, allowing us to drop our core body temperature. This is why at night, at least I do, I sleep with my hands and feet outside of the outside of the covers because I just tend to run really warm.

Yeah, but that I didn't realize that it was just my mechanism of trying to cool down my body. Yeah, I have to get my feet out free in the air. Yeah, 100%. I try to sleep. Yeah, I cannot sleep warm. And that's, I mean, because we need to drop our temperature, it's why we always find it easier, at least I do, to fall asleep in rooms that are a little bit too cool and too warm, right? Yep. So they did this awesome study where they basically strap people in these thermal suits. It's sort of like a wetsuit, but it has these microtubules running through them with these that basically have water in them and they can control the temperature of the water.

And they basically measured people's sleep to see if they could, if they could decrease these people's core body temperature, if it would improve their sleep or not. Yeah. And it improves sleep across the board, whether you were young, whether you were old, or whether you were an insomniac. It basically allowed all of those people to fall asleep 20% faster. And more interesting is that before they used the thermal suits, there was a 58% chance that all these people would have nighttime awakening. So they would wake up in the middle of the night. Yeah. After using the suit, it dropped to 4%. That's wild.

Yeah. So because of that, and then because of basically the fact that I feel like I run warm at night, I bought a chili pad recently. Yeah. Right. So basically a chili pad is just like this mattress pad cover that circulates controlled water temperature. And for me, I turn it as low as possible down to 55 degrees. And it has helped my sleep tremendously. Right. I sleep longer. I sleep deeper. And I don't wake up at night and I feel significantly more refreshed. So I don't know. I think it's great for people that like myself that feel like they want run warm at night. I've also thought about it for potentially like perimenopausal women having hot flashes.

And then it also works well for me because my wife likes to sleep warm and I really like to sleep cool. So I think if you have couples that like, you know, differing temperatures, it's a great option as well. Yeah. And the chili pad, I contacted them prior to recording this episode because I was really curious when you first told me about it. And as anyone who listens to the show regularly will know, I am a big fan of the cold plunging and have found exposure to cold temperatures has a very positive net benefit to my life, whether it's waking me up in the morning, or I've also found when I would cold plunge, let's say an hour before I go to sleep, I would sleep so deeply, so incredibly deeply.

And so when you told me about the chili pad, I contacted the manufacturers and said, Hey, I'd like to test this product out because I'm going to be doing this episode with Dr. Paul. And I do not promise that I'm going to say anything good about your product whatsoever. But if you will, send me one, I would like to test it out and see if it works for me. And then we'll dissect it on the air. So full disclosure there, I did get one for free. It's a wonderful product. I am happy to report it. You can dial it in with your phone so that it turns on at a certain time to the temperature of your desire.

And I don't need to go as cold as you. I don't turn it down all the way. I may be putting it at, let's say 68, when it's already a cool night and then maybe 66 if it's a warm night. And it is crazy to me how I sit or lay down on that pad. And it's cold, but then there's a cover on top of me. So it's not like I'm sitting there shivering. No, it's like the perfect combo, you know, like a winter night when it's cold outside, but you're nestled up in the covers. I love that. And that's every night. Patrick Will, the biggest camper I know, he's so fond of when he's out in the wilderness and it's like going to be cold and he's like, Oh, this is this is good sleep weather.

And I know exactly what he means. Like when you're in a you have a sleeping bag that's going to keep you warm, but it's freezing cold outside, it's going to be the greatest sleep of your life. And I feel like the chili pad replicates that perfectly. I will say I turned it down all the way the first night because you told me you were doing that. I tend to be extreme. And I woke up in the middle of the night, like shivering and to turn the thing off. But once I got the temperature right, what's incredible to me is that it would it is a max of 10 minutes. And often I feel like it's maybe five, like whether I am tired or not, but I'm looking at the clock going like, okay, I need to get to sleep because I got to get up by X time.

I want to make sure I get enough hours of sleep tonight. I turn that chili pad on lay down on it, close my eyes, do a little meditation where I'm thinking about my breathing. I have never lasted more than 10 minutes. I mean, I don't even know it feels almost instantaneous. But as soon as what I am assuming happens, as soon as my core body temperature just drops a few degrees, I am just out. And I am like, I sleep so hard so well and wake up feeling so refreshed. And again, I would not say this unless it was the truth, but it really met my most optimistic expectations and it might even say exceeded them.

I actually totally agree. Like, I can't believe how quickly I fall asleep. I no longer lay in bed not being able to fall asleep. Like I am out. And that's funny because I actually meditate before I go to bed too. And that probably has something to do with it, calming our mind, allowing us to just prepare ourselves for sleep. But I agree that and just the fact that I feel like I just don't wake up in the middle of the night anymore to go the bathroom or whatever. I just sleep through and it's wonderful. I do wake up feeling cold in the morning though. When I wake up, I am cold. But whatever I just threw, I have a switcher right next to my bed that I throw on right when I get out of bed and then I'm good.

I would say the only downside I've found just to be completely honest is that when the mattress pad is on for a prolonged amount of time, say greater than eight or nine hours, I've found that sometimes water seeps through a little bit and will make my bedding somewhat damp. It's not overly wet, but it's noticeable. Interesting. But that's really the only thing I've noticed that isn't stellar. It makes a little bit of noise, but I actually like the noise. It's white noise for me. It's comforting. I don't think it would be too loud that it would actually bother anyone. It's really quiet. It's just this nice hum that I actually find pleasing.

I always turn a fan on at night because I do like white noise to sleep with. It's a big overhead ceiling fan. I don't even hear the chili pad. My variation on that is that my whole life, I think once I actually fall asleep, my body temperature goes way down and that might be why I have always been a hard sleeper to begin with. My wife has commented like a train could go through the bedroom and I wouldn't wake up. Where it really helps me is the falling asleep. I find I didn't need or I don't need to keep it on all night. I set it with the phone that somewhere around midnight or 1 a.m. it will just shut off because I'm already cold by that point and I still wake up cold as I always have.

But I think for me, that's the key to that deep sleep. When you wake up freezing, what is also cool about the chili pad and I did not know this was a feature until I had it is if you crank that thing to high, it also gets really warm. It goes to like 1.15. It gets hot and it's like having the sun shining on your back. It's like a heating pad. Oh yeah. A full body heating pad. It's awesome. If you wake up freezing cold, you turn that on and it takes just a couple of minutes to go from super cold to really hot and then you don't need that sweatshirt in the morning. I didn't know it went that hot.

But that's interesting. It made me think that people with back pain potentially like when you when you sleep, your back pain always gets worse. Right. People that get back pain, they always want to lie around and do nothing. But that actually just causes everything to get worse and worse. But if you slept on this pad and then you could heat it up right when you woke up and start warming up those muscles, that could potentially be really beneficial for back pain. Well, and I did messing around with the app, I just discovered this, you can program it to wake you up at a certain time by it warming.

So you could say, oh, I want to get up at 7 a.m. And according to them, if it suddenly goes from cold to warm, 100 percent, you're going to wake up. Yeah. I think that's much better than an alarm clock as a way to wake up. That would feel much nicer, much better. Yeah. I mean, alarm clocks have actually been shown to be not good for your health because of the sympathetic activation, like being scared all the time, being woken up, that's that show that's increasing your heart rate, increasing your blood pressure, increasing all those stress related hormones. Like it's not great for you. Yeah. And I had a long conversation the other day with a couple.

We were talking about alarm clocks and that they were trying to separate from their phones in the bedroom, but they use their phones as alarm clocks. And they didn't really want to buy an alarm clock. So you usually have really jolting noises like they liked their phones can wake you up with a soft noise that gently like grows louder. And it can be whatever peaceful sound you want. And that does seem like a better way to wake up. But does that work? I don't know if that worked for me. Oh, it did work for them. What they said the problem was though that right before the temptation is it right before you go to bed, you're on your phone and right when you wake up, it's right there.

And oh, let's see what's happening on the magic device. And they were trying to break that habit. But it was difficult because they have places to be and things to do and can't just wake up whenever. I'm going to tell them about this device, the chili pad, because that would be a much better way to wake up than the phones in the other room. And you know, for me, with any of this stuff, like trying to spend less time on social media or less time on your phone, trying to willpower it and white knuckle it is not the solution. You've got to put it in a different room and just not have the temptation altogether.

It's like being an addict of any kind, right? I mean, if you've got a problem with cocaine, you probably just shouldn't have cocaine in the house. That's the best solution not to just go, Oh, just look at it and be like, I'm going to choose not to every single day. You're going to have some weak moments. And the next thing you know, you're like that doctor, John Hopkins. Are you looking to get into shape or stay in shape? If so, you're going to want to add a low calorie high protein drink to your daily regimen. This episode is brought to you by Huel, makers of this delicious protein drink. I've also got energy drinks, protein bars, and my favorite, their daily greens mix, packed with 91 vitamins, minerals, and whole food source nutrients.

Let's go to receive a $15 off code, click the link to Huel in the show notes. Huel, it's fuel for humans. Huel. See what they did there. So I'll run this by the folks at Chili Pad. Maybe I can do a new commercial for them. Chili Pad sleep longer, deeper, harder. What do you think? Well, I love it because I keep up with it. During the break there, while we were fixing this mic, I did steel pulse joke. Okay. Now this mic is like in my grill. It's like, how are you going to sound even better? Is that any way? Is that possible? I don't know. You definitely can't look any better. It makes me so hyper aware of the register of my voice.

And I like it better when it's in a deeper tone. I don't know, people, I want to hear from you. If you like this better, hit those comments. It tickles the algorithm spreads this message far and wide. All right, back to sleep, Paul. What? I forgot what you were talking about. That's right. All right. It's okay. The vibes are good. The vibes are good. The show is good. Where do we go next? Well, we were just talking about temperature control. I guess one other thing we could touch on there is that taking a warm bath prior to going to bed also really helps. And so many people would actually think that taking a warm bath would increase your core body temperature, but it actually does the opposite.

It actually drops your core body temperature. So if you take a short, warm bath, what happens is that your blood vessels actually dilate, which invites the blood to the surface, which allows heat to then radiate. And then you actually drop your core body temperature. So even taking a warm bath has been shown to increase and REM sleep by like 10 or 15%. So it's another powerful way if you don't have a chili pan. Well, a shower worker does it need to be a bath? I'm sure a shower would work as well. Okay. Yeah, I don't think there's a discrepancy there. Jump in the hot tub. Any source of warm water will work.

Okay. Okay. Good to know. Now with the light, how dark should the bedroom be? I mean, I like to turn down all my lights before I go to bed. Like if I'm a couple hours before, I try to dim everything, especially stuff that's directly overhead that gets into your light that can directly gets directly into your eye that can sort of directly affect your super kismatic nucleus. You should dim this as much as possible. I mean, even just having a little bit of light in the room has been shown to decrease melatonin release. Something we should touch on really quickly is probably melatonin. I've said that a few times, a lot of people think that melatonin is a very powerful sleep aid.

Unfortunately, it is not, because people just don't understand how melatonin works. So melatonin is basically released from the pineal gland under the control of our 24 hour clock. So when melatonin is released, it basically regulates when we want to go to sleep, but does not generate sleep itself. So it's sort of like, like a starting official of a race. Got it. Sorry people. I'm interrupting Dr. Paul here because this might keep falling over. And if you're still watching on YouTube, you can see this structure I've constructed with books to mount the microphone. I will have this perfect score on the SAT.

Okay, back to melatonin. So where were we? So melatonin basically regulates when we want to go to sleep, but does not actually generate sleep itself. So like I was saying, it's like a starting official of a race. So it actually governs when the race begins, but does not actually participate in the race itself. Okay. So it helps your body prepare for sleep, but it does not actually help you sleep. If that makes sense. So there are certain circumstances where melatonin can be helpful. Like if you're jet lagged traveling to somewhere different, if you're trying to reset your circadian rhythm, melatonin can work.

Or potentially sometimes when people are getting older, they just release less melatonin. So it may help them get ready for bed. But it does not actually like generate deeper sleep. That's not what melatonin does. So it's overall not a very good sleep aid. And further, I mean, I don't know, the FDA does not regulate melatonin, even though it's something that our body produces, which is sort of crazy. But they've done studies to actually look to see what's actually in the bottle of these supplements that have melatonin. Yeah, you know, compare what they say, what's actually in the bottle compared to the label.

And there's usually between 40% less to more than 800% more. Like, I mean, that's wild. I hear that's a problem with a lot of supplements because they're completely unregulated. And if you actually look at how much melatonin you need, I mean, we're talking like less than one. And all of these sleep aids are five, 10, 20. And if you're four to 800% more, what are you taking in? I mean, that's crazy. It's just way more than you need. Yeah. Yeah. So what should we be taking instead? If any great question, I actually don't think currently there are no sleep aids on the market that actually induce natural sleep, not one.

Okay. Some of the older sleeping medications, such as like Ambien. Yeah. These are sedative hypnotics. So they sort of work like alcohol, they really just sedate you rather than get you into natural sleep. So you're going to be in lighter sleep. You're not going to get into very good sleep. And there's lots of side effects from these things. You wake up drowsy the next day, you wake up groggy, you're lightheaded. Your reaction time is decreased. And a lot of people do weird stuff when they're on it, like they forget things that they have done. It's like out of their consciousness and they'll text people and not realize it or make phone calls, like really bizarre things happen while they're supposedly asleep.

But turn on the stove, make some tacos. Yeah, it's bizarre. So yeah, I wouldn't recommend any sleep aids currently. They're working on some that potentially could induce real sleep, something called a rexin has been thrown out there. And if this actually starts working, then that'll be amazing because there'll actually be a sleep aid that actually works on the brain to induce natural sleep. But right now there doesn't seem to be anything. So the best guide or the best thing for people to do that are actually having insomnia or problem sleeping would probably be to investigate something called CBT or cognitive behavioral therapy, which works great.

It's been shown to, you know, help people get to sleep faster, sleep longer, sleep deeper, just like the chili pad. Yes. And it actually works long term, which is great, which is what sleeping pills don't do. When you come off of sleeping pills, you're going to have that rebound isomnia, which is absolutely terrible. Right. So if people are having problems sleeping, they should go to the National Sleep Foundation website and you can actually find practitioners and get some more information on it that can be extremely helpful. So right now, all of these sleep aids are really just band aids. They have side effects and they're not actually helping you get into real sleep.

And I think something that's just amazing is that no sleep medication has ever showed to improve longevity or mortality. Like there's no proven benefit. Long term benefit aside from potentially making you feel like you are going to sleep quicker, but you're actually not and you're not getting deeper sleep. Yeah, Seth Godin, I asked him about placebos and we discussed ambient placebos is an area of his deep interest. And he said, yeah, ambians are really interesting one because it is an amnesiaic in that you still wake up a lot in the middle of the night and don't get good sleep. You just don't remember any of that happening.

So you think you had a good night's sleep and you continue to take the pills because it feels like it's working and you think you're sleeping better. He said, but if he actually look at the studies on any of it, you're you're not sleeping. Oh my God. The mic is down again. Ladies and gentlemen, I cannot get this stand to function even. I told Nick we should switch spots. Seven books set up. I bumped the book though. Okay. Yeah, for seabos fascinating. I mean, I mean, they've even done they've done studies on people with sleep and they've looked at like people that you know, they go to sleep, wake up, and they give them a sleep score and they tell you you slept great last night, even though you slept terribly.

Yeah. All of a sudden you feel great that day. Right. And let's say you slept great that night, but they give you a terrible sleep score. And then you feel terrible the next day. No, it's just wild. Yeah. Yeah. It's powerful stuff. No, placebo affects our physiology. I mean, placebo is medicine 100%. Yeah, it's interesting that there's a little bit of a pushback like against placebo is a way to oh, that's just the placebo effect to debunk things and people sometimes come away with a feeling that they've been tricked. And yet with the history of placebos, it was an important, useful medical intervention for a long time for doctors to give a pill that they knew didn't do anything.

Might have been a sugar pill. I mean, it was basically what they use in a placebo study. Just it looks like any other pill and you could give it to the patient. But just by telling them that it would correct the small ailments, if they believed in it, it would have a positive effect on their health. It corrected a lot of problems. Sometimes believing creates the reality because your physiology will change as a result. It's how powerful your mind is. I mean, when you believe things will change. I mean, if you feel a certain way about something, like, I don't know, every time I practice and go into the ER, just simply putting my hand on someone's leg or giving them a reassurance, all of a sudden, they're a different person.

Everything's great because their mind has changed and they feel better about the situation. It's all interrelated. Yeah. So on the light thing when we're sleeping, what I meant is is it useful to have like blackout curtains. So even my lights are off. I'm going to sleep, but there's ambient light coming in from street lights or your lights outside because now with LEDs being so cheap. I mean, a lot of people have lights in their backyard or the front yard that are just on all the time. I have gone to using basically blackout curtains. So it's really dark. I find that helps me sleep better. Is there science to back that up?

Yes. And it's what I do too. I use blackout curtains and an eye mask. I used to only be a temporary or occasional eye mask user. And now I am permanent. Every night, every nap, every time I sleep, I put on an eye mask. It's almost become like the chili pad where I put that thing on. And it's just just tells my mind it's time for bed. Right. It just helps me fall asleep. But yeah. Well, I know what I wanted to ask you about on a possible drawback of the chili pad because we are doing an honest evaluation here. Is that something you could become dependent upon and then suddenly because it's not like you're going to take that thing with you when you travel.

Are you is it going to cause sleeping problems in the future if I get used to this device that drops my body temperature for me and then suddenly I'm going to go sleep. I'm going to go take a trip to Bali or wherever and there's no chili pad in sight. Is it going to cause problems? Well, I don't think that's known. But being a person that travels quite a bit, I've noticed no problem sleeping when I'm away. Got it. But again, it's I'm not sleeping in a non air conditioned room out in the middle of nowhere in Bali with mosquitoes. I probably wouldn't sleep that well if it was super warm. Independent of the chili pad.

Yeah. But I'm really fun. If I'm in a hotel room where it's temperature controlled, I'm sleeping fine. Yeah. You're going to jack that thermostat down. Set my wife likes it warm. So, you know, we have to figure that out. That's why they have extra blankets. That's what I tell her. But she says that's not the way it works. But I think that's the way it works. Yeah. But you know, how it goes. I'm never right. Yeah. Okay. What other tips do you have to concrete changes we can make to sleep better at night? Well, first I probably set a sleep schedule, right? I would go to sleep at the same time each night and wake up the same time each morning.

I think that's really helpful. It's just training your body. This is what we do. You get in a typical, you know, routine before you go to bed. You're going to sleep a lot better. You should avoid alcohol and caffeine before bed. Like we talked about before. I would avoid nicotine before bed as well. I would not eat large meals before bed or exercise before bed because both of those will basically increase your core body temperature. What's our timing on that on exercise and eating? I'd give yourself two hours. Okay. Sort of onto what we were talking about before. I think rooms need to be cold and they need to be dark and they need to be gadget free, right?

So set your air conditioning or ambient room temperature a few degrees colder than you typically do. Take a warm bath or use something like the chili pad. Use an eye mask or blackout curtains and keep the phones out. They're just a massive distraction and even shown to, you know, decrease all that melatonin production, which is going to decrease your ability to fall asleep. Is TV a problem before you go to bed? It's not as much. It's not as much. It doesn't seem to be as activating. Now the light that's emitted is similar, but the activate the way that the brain is activated by the screen, it just seems to the screens from our phones or from tablets just seem to be much more activating and hurt us from going to sleep.

Right. Well, they were designed by people from the gambling industry to mimic slot machines and TVs were not. I was just to keep on going back. Yeah. Additionally, I would make sure if you do nap, I wouldn't nap after three o'clock because that will decrease your sleep pressure, decrease that adenosine too much and you just won't be able to fall asleep. And last, if you're having a problem following a sleep, like don't just lay in bed awake. If you're if you can't fall asleep for 20 minutes or more, get up, do something relaxing, wait until you're tired again and then try again. There's no use in just laying there getting pissed off about not being able to sleep.

It's only going to make things worse. Yeah. It's funny. I'm reading so much less since I got that chili pad. Because you just fall asleep. Yeah, I used to read for 30, 40 minutes an hour before going to bed every night. And it's just changed. I'm getting a lot more sleep though. Yeah, it's funny. I usually if I do, I do most of my learning and reading in the morning, but I'll do some at night as well, but I'll do it at night. I do it at night. I'll do it then turn on the chili pad. Yeah. Then I meditate. Then I sleep. Because I know it'll just put me to sleep. Yeah, that's the change I'm going to have to make.

I really like reading right before I go to sleep because I find I really internalize the information. Like I wake up the next day thinking about what I read the night before like it's the first thing on my mind. What sleep does brother? Yeah, apparently it consolidates that memory that it makes it long term. Yeah, it's a great time to learn. Yeah. Yeah. And you've got a dream about it too. Yeah. That's what's wild. Sleeping isn't enough. You've got a dream too. They used to think the dreams were epiphenomenon. You know epiphenomenon are? I don't know any of these words, he said. Yes, you do. I'm just excited.

I know what senescence means now. Oh, SAT master. So epiphenomenon, it's like a byproduct. So when I think about epiphenomenon, we could think about a light bulb. So what's the purpose of light bulb is to create light. But light bulbs also create heat. So heat would be an epiphenomenon of a light bulb. It's just a byproduct. So they used to think that dreaming was just an epiphenomenon of REM sleep. But what they've come to realize is that REM sleep is definitely necessary, but it's not sufficient for all of the complex reasoning, logical thinking, and emotional and nursing that REM sleep does.

You actually have to dream and you have to dream about specific things for that to take place. So a lot of people think they don't dream. Like I don't dream, I don't remember my dreams very often. I actually remember a dream from last night, which is sort of rare. But everyone dreams, you just don't remember the dreams. Sure. Now what do you say? You said dream about specific things. Yeah, what do you have to relive that memory? Yeah, so that's the way that emotional resolution actually takes place. So it's actually interesting. So we can deep this is going to be a deeper dive into REM sleep. But so during REM sleep, there's actually this massive metabolic change in the brain where we basically the concentration of a stress inducing molecule, nor epinephrine is completely void from the brain.

It's the only time during the 24 hour period. So basically what that means, the REM sleep will allow us to remember the event, but it takes like the painful emotional sting out of it. It gives you emotional resolution regarding the event. And so that's why dreams will experiment with those scenarios and kind of wild different versions to take the emotional sting out of it. Well, the emotional sting out of it, basically, yes, that and the fact that the neuro epinephrine there, which stimulates anxiety and anger and hypersensitivity and all of these things. So the combination of the dreaming with the lack of that stress molecule seems to aid in that emotional resolution.

So people with PTSD, they actually have higher than normal, nor epinephrine levels in their brain, which does not allow them to get into REM sleep. So people with PTSD, they have like recurrent flashbacks. They have terrible nightmares, and they have disordered REM sleeping because of the higher than normal nor epinephrine levels, they're not able to get into the REM sleep. And if the brain cannot basically dissociate or dissolve the emotional memory from the memory itself, it tries over and over and over again, like a broken record to basically to divorce itself from it. So that's why they have the recurrent nightmares.

Yeah. Yeah, my grandfather, who was a US Marine and was captured by the Japanese forces during World War II, was fighting in the Pacific and his unit was captured. And he was imprisoned for two years and starved and tortured and all the worse stuff. I mean, it was something like 90% of the guys he initially went in with all died. But he did survive and he got out and had gnarly PTSD, even though no one knew to call it that for the rest of his life. But my grandmother told a story one time. They eventually, they slept in the same bedroom, but had two beds in there. And I was really confused by this as a little bit of an older kid at this point.

But I just one day I was like, why do you sleep in separate beds? That's weird. There's like two twin beds next to each other. But separate like there was space between them. They weren't pushed together. And she said, well, your grandfather has some really crazy dreams a lot of the time. And I kept asking and finally she explained it to me that one night, she woke up in the middle of the night, he was on top of her, choking her. And she could not wake him up. She couldn't get him to stop. And finally, I think she likes smack them across the face. I don't remember that particular detail. Somehow she got him to actually wake up.

And he was terrified that it happened because he had no recollection of what had happened. And she was obviously scared. And so that's when they had the two different beds. Yeah, PTSD is wild stuff. Yeah, I mean, they found a medication that helps it somewhat. There's a medicine called Prausicin, which is an alpha blocker, which they use for BPH benign prosthetic hypertrophy, which I feel like we talk about on every episode for some reason. Yeah. But basically it decreases the norepinephrine, the effect of norepinephrine in the brain and allows these people to get into REM sleep and helps them sort of dissolve their painful emotional attachment to those memories.

Now, what about people who they don't have PTSD, but they have just bad dreams, very anxiety-inducing dreams. They're waking up a lot in the middle. Let me mean that every night, but let's say often and then are rax with anxiety from the dream they had and then have difficulty going back to sleep. Were you able to help them? I'm not sure about that one. Yeah. Yeah. Well, it's okay to say that. We don't have to pretend we have all the answers. I don't. Okay. Dreams. That's a long time pet subject of mine that I've been really interested in. Really? I didn't know that. Oh, yeah. Since I was in high school, there was a book that a professor had written about the latest science of dreaming.

It might have been called the science of dreaming. I don't remember the title of it. I have tried to find this book again. It's something I need to figure out because I was trying to recommend it to somebody recently. But in any event, one of the things they recommended in there in order to take steps to understand your inner emotional landscape better was to keep track of your dreams. And then if you can't remember your dreams, there's no way to monitor any of this. And so they recommended keeping a dream journal, whereas if you wake up in the middle of the night or as soon as you wake up, you write down, even if it's just a one sentence that's a vague memory of what you might have dreamt about, you try to write that down.

And then you keep doing this for as long as it takes. But even just exerting that mental energy towards trying to remember your dreams, you will start to remember them. And I found it wild. I've always remembered a lot of the dreams that I have, but it was an exponential return once I started writing them all down. Suddenly, I could remember two, three, four separate dreams that had happened in the same night. And I never read the journal again. It was just going through the exercise of getting it all down. And it does provide some weird, I don't want to say weird, it's an alternative lens into what's going on internally.

And then you do start to see some patterns in reoccurring themes that are going on in your dreams. And just something to think about to understand yourself a little bit better. Yeah, I think dreams are very difficult to interpret. Oh, yeah. I mean, I think we've learned that from Freud that he thought he had it down. But it turns out that everything you thought was sort of bogus about dreams. It's not all about penises. It's not. I don't know. There's some great dream stories. You know, Keith Richards. I don't know the story. You don't? I know the satisfaction. Keith Richards says, you tell me song satisfaction now.

You don't know it? No. So, when every time Keith Richards goes to bed, he puts a guitar next to his bedside and he put, I guess a while ago, it was a tape recorder. Okay. Casey woke up in the middle of the night after a dream and had some amazing idea. Right? Yeah. And so one morning he woke up and the tape player had already played to the end. And he was like, that's weird. I must have just touched it in the middle of the night. Right? Yeah. So he rewinded it, pushed play. And he heard the entire verse of satisfaction. Followed by 40 minutes of snoring. Wow. Yeah. See that tracks me though. So one of the things that brought me back into the fascination of dreams was working for Chuck Sintmy High and looking at his book, Creativity, where he did these in-depth interviews on skills and habits and methods of all these hyper creative individuals.

And he defined creativity across industries and modes of work. So these might have been scientists that made massive scientific discoveries, not just creativity in terms of music and movies and the visual arts. But I mean, Linus Pauling was one of the people in the study. And so anybody that had made a huge innovative or creative contribution to their field. And I don't know what the percentage was, but there was a large number of them that reported it was really important to them to think about a problem that they were working on. So it might have been an author who was trying to resolve a plot twist or somebody trying to discover how DNA works.

But they would think about it as they were going to sleep and then write about it immediately when they woke up in the morning. Or think about how they had dreamt about it. And just like you said in the Keith Richards story, they all kept a notebook by the bed so they could write during the night or right when they woke up to get those thoughts down immediately. And I jumped on that one. I found it is a massive hack for problem solving, especially when you need to think outside the box. Yeah. So Thomas Edison called napping the genius gap. And so what he would do is he would work on problems, work on problems all morning and then take a nap.

Hopefully, hoping to figure it out while he was sleeping. And what he would do is he'd put these ball bearings in his right hand. And then he'd put this metal dish underneath his hand. So when he fell asleep, the ball bearings would fall out, hit the dish, wake him up. And then he'd write down everything that he was thinking about. Interesting. That's how he came up with a lot of his thoughts. Well, and there's something to I mean, that phrase, I'm going to sleep on it. We've all heard that, but we don't all put it into actual practice. Well, I mean, that's what REM sleep is all about, right? So, and REM sleep helps us remember sort of like facts, think single thoughts, like if you're studying for a test, right?

But REM sleep really creates more like wisdom, understanding how all of these things fit together, right? It's sort of takes all of these things and blends and uses them and makes us see things that aren't necessarily ordinary. It helps us see sort of novel and new things. That's what REM sleep's all about. Yeah. Okay, here's another wild idea on dreaming that tied into the that book that I read and on some of their therapies they recommended was to try to move into lucid dreaming where you realize you are dreaming and then can control the dream, which is really cool if you can get there. And once you have high recall of your dreams, you shift the focusing mental energy right before you fall asleep, right?

When you wake up from the remembering to trying to remind yourself that you're going to dream and be aware that you're dreaming when it happens. And so, it's almost like a little meditation as you fall asleep. You're just telling yourself that over and over again. And if you can maintain that for a few weeks, at least for me, I found it completely worked. And so, you can lose a dream? Oh, yeah, I was suddenly aware during my dream. I go, oh, oh, this is a dream. Now I found controlling them was different from being aware that you were dreaming. But even that is cool because it's a totally different framework for dreaming.

And I want to say this took like, I mean, I did, I went deep on this and I got super, I just nerded out on it was like into it every single night for a pretty long period of time. So then I wanted to start trying to control things. And I remember being in this dream and I was like, I'm going to fly. And I'm in this like huge, grassy field. And I realized I was like, all I got to do is run and fly. And I kept running and jumping and I could like jump high, but I couldn't ever fly. And it was just repeating again and again. But I did, I was fully aware I was dreaming about it. And it didn't work.

And this went on for like a couple times in a row where I would realize it and then try to fly and couldn't do it. And then I still remember this dream. It was so wild, this like angelic lady with this light colored hair. I'm in that same grassy field, but she comes along. And I don't, it's, I never could remember what it was. She said to me, but she just said something along the, she said, whatever I needed to hear. And then suddenly I could fly. And I remember this dream just flying. And it was like going all over the globe, like flying through the sky. And then now still to this day, like that is the coolest thing.

When I have a lucid dream, it's always like, oh, I want to fly. And it is, it's almost like going into VR, like where you just go, did that really just happen last night? It's an incredible experience. When you dream, do you have like a first person point of view? Is it like you flying or do you see yourself flying? It's first person. It's just like sitting here right now. And last night, my dream was like second person, like I saw myself. Oh, those are interesting too. Yeah, that was sort of weird. It's like an out-of-body experience. Yeah, I mean, they've been lucid dreaming is definitely the real deal.

So when you, when you go into REM sleep, you're paralyzed, right? Okay. But the only thing that isn't paralyzed are your involuntary muscles and also your your eye movements. That's why you have rapid eye movements. Right. And so they can actually communicate with people while they're lucid dreaming through their eyes. Wow. It's pretty wild. Yeah. So they can, you know, put these people on MRI machines and figure out what they're dreaming about, correlate the dreams to what they are, what they're thinking about by their blinking or their eye movements. So they understand what they're dreaming about.

And can dictate it. They can. They can. How do they, what are they doing to the eyes? They create some, I don't know, they have some sort of template for how to communicate with eye movements and then put them in an MRI, like a functional MRI scanner. Yeah. And then they can tell. I guess I got to update my dream knowledge here. Pretty wild. There's a lot of cool sleep interventions. So I think one that that's probably will explode in the next like two to five years is. So we've learned how to enhance Enrem sleep a little bit. So, you know, Enrem sleep helps with the consolidation of memories, right?

Yeah, we talked about. So good and bad. But what would be really interesting is if we could somehow erase memories, especially from people that have gone through trauma, yeah, or, you know, super emotional experiences. So we can enhance memories somewhat now by like auditory tones, different auditory tones by different electrical stimulation and even like rocking. Like the reason why we rock babies to sleep, it is actually gets them into deeper Enrem sleep. Oh, but we haven't quite figured out how to do the opposite and erase them. But I think that's just on the horizon. I mean, that's gonna, it's gonna open up a lot of ethical issues as well.

But it's gonna be for fantastic intervention. Right. You can see people using that for nefarious purposes. Oh, 100%. It could be terrible, but it could also be fantastic. Right. Yeah. It's like ketamine. Yeah. Yeah. It can have wonderful therapeutic effects. And some people would just make some of the most brilliant minds just go off the deep edge. Yeah. Yeah. There's one in particular I'm thinking of now, but no need to pick a fight with him. We don't need to mention him by name. Um, excuse you. Bless you. Bless you. Yeah. I didn't know we were going to get into dreaming today. That's what's so fun to talk to you, Dr.

Paul is we go into unexpected places. I thought we were just going to talk about sleep today. Well, this one was a little bit different. This is more like a typical conversation between you and I. Yeah. Like when we work out, this is what we talk about. Yeah. This is sort of just like a normal day with Paul and Nick that welcome to our lives. Is accurate. Yeah. Yeah. I was watching the Queen's Gambit. Do you remember that show on Netflix about the female chess player? Oh, I remember her and I like her very much. Awesome actress. Yeah. And that story is so well told and I hadn't watched it in a very long time.

And then my daughter had started it and was watching it and I caught some of it. I was like, oh man, I want to watch that again. And there was a moment last night. It's a little later in the series when she I hadn't noticed this the first time around, but how lonely she is amongst her peers because of the way she thinks. And she can't connect with most people because they're not so deeply invested in something like she is, especially in chess. And then even with other chess players, they don't think about it nearly to the same depth that she does. And she has her rival within the United States that beats her and then they play again and she wins the US championship against him.

And then in the aftermath of that, they become friends and he decides he's going to train her to go compete against the Russians and help her become better. And there's a moment where she says, do you ever when you're just sitting there by yourself, play out a game in your head? And he's like, what do you mean? Just like, I mean, the whole game, like just sitting on a park bench, every move and every possible variation on it from beginning to end. And you can just see all the pieces moving from both sides of the board beginning to end. And he looks at her and he says, doesn't everybody? And they just have this nice smile.

And then you just know, like, oh, there's a she connected with a human being in that way that's nearly impossible for her to do. And then it makes sense why he is like, we're going to work together to make you the best ever. And yeah, that's sometimes how I feel when we have conversations like this when we're working out. And it does goes the coast this deep. And it's like, man, we haven't done a set in like 30 minutes because we got lost in this conversation talking deeply about something. That makes me think. I wonder if our personalities are different based upon the type of sleeps we might bias, meaning I wonder if I I'm just much more logical than creative.

And I wonder if my sleep patterns dictate that personality. Like I just get much more and REM sleep than REM sleep. And because of that, I tend to be more logical. And people such as musicians or painters, maybe they're biased more towards REM sleep. It's something I don't know, but it's just some thought I've been throwing around in my head. That's interesting. That'd be cool. Very of study. I still look in to see if anybody's working on that. Probably. It's probably known. Maybe not. What's your boy, the producer? It's his name. Movie producer? No music. His books. Oh, Rick Rubin. Rick Rubin.

See, I bet he gets a lot of REM sleep. That tracks that tracks. Yeah. Yeah. I really want to have a conversation with him. Rick, if this can get to you somehow through the universe, man, I want to connect. I'd email you multiple times and never heard back in any way, shape or form. I know you're a big deal. But I think we would connect. I think you guys would have a great time. Yeah. I am fascinated by him as a human being. His experience is the way he looks and thinks about things. And usually when somebody's fascinated with somebody else, it makes for an interesting conversation. Yeah. Mine would be Sam Harris.

Oh, gosh. Get Sam on here. It would be so. I'll have to listen through the curtain. So exciting to talk to Sam. I mean, he does live in LA. Yeah. Sam is interesting to me because he's so well respected by all these people that I respect. Like you mentioned, he was on Scott Galloway show and that Galloway showed him a tremendous amount of respect. And I find all of these incredible minds, when they speak to Sam Harris, it's like they just show him the respect he deserves. Yeah. I mean, among podcasters, among authors, among anyone that has anything interesting to say, I think Sam Harris is it. I mean, he's not only intelligent, but he's ethical and he meditates.

He's just phenomenal. I don't know. I really enjoy him. Yeah. I reached out to his wife, Anika. Talk about a little consciousness. I am very interested in her project lights on about consciousness, especially because of Neil Seth and Donald Hoffman, we're both contributors to that to people I've had incredible conversations with in the past. And I thought, well, she not probably have a lot to talk about. And then she has a whole different perspective on that topic, which I think consciousness is a really interesting subject area to dive into. But we are entering into a whole new realm of what consciousness is in ways to think about it with the rise of AI and where this thing might go.

Because I would have said before, it was impossible for really smart machines to develop anything resembling consciousness. Or at least that was a question I asked of many of these people when I spoke to them. And that was about a year ago. And the consensus was Hoffman said it was impossible. I highly ask him. Let's see. I know I talked to a Neil Seth about it in depth. Because I just wonder. I don't know that that one came up with. He believes that consciousness is primary. I would think that he would believe that it could become well, I want to talk to Hoffman again to discuss this very topic with him.

So I do plan to reach out to him in the very near future. Dr. Hoffman. Fantastic human. What a wonderful guy and a wonderful mind. Yeah, but on a go to be fascinating to talk to consciousness. And I don't know, I really enjoyed the part of her audible book on on plants and consciousness. Yeah, which was very interesting about how plants could actually. Like mother trees could actually know where their offspring were. And actually, if they were hurting, they could actually send them nutrients through the soil that would actually get to their baby plants. Like that's wild that plants could do that.

Well, right. And that I think is an interesting lens for AI because you go, that's a type of consciousness that is different from our own. But there's no denying something is going on there. And defining it as consciousness, I don't think is incorrect at all. It's just a different kind than the one we experience, which also leaves the door open for well, maybe machines won't ever be conscious the way that we are, but they could have a consciousness that is completely different from our own. Yeah, I guess it all depends on how you define consciousness, which I think many people define it very differently.

True. I mean, Audica just defines it as, is there something that it's like to be that thing? Yes. And if there is, and that's consciousness. Yes. Which is she does it the very fundamental sort of basic lens. Yes. I think a Neil said those same words to me. Oh, really? Yeah. And I think there is something that it's like to be a tree that can do that, which is very different than what it is like to be next, Stanley or an octopus. And I now after reading the AI 2027, I'm very convinced that it is possible in the not too distant future for a mission for there to be something that it is like to be a neural network that's powered by microchips.

And like you said, if consciousness is fundamental, Donald Hoffman turns out to be correct about this. Man, we are way off the track of sleep. But if that turns out to be correct, you would say, well, then consciousness existed before humans existed, right? It just now has permeated through the process of evolution into the tree, the octopus and human beings. Why wouldn't it be possible for it to permeate into machines? Yeah. I mean, I don't know how you look at consciousness, but I see it as fundamental. And I see consciousness similar to sort of like light in a prism, where you know, it's basically just shines through the prism and you get this rainbow of colors and consciousness basically just sort of shines through us and makes us who we are sort of like the same thing.

Interesting. Paul, any closing thoughts on sleep? We've given everybody a lot to dream about right there. Think about consciousness. What does it mean to be you? These are good things to go deep into and then journal about in your dream journal when you wake up in the morning. Yeah, I mean, I just hope that people will make sleep a priority. It's just so important and so accessible. It's going to help every aspect of your life. There's not going to be an organ system or a brain process that it does not help. It's going to help your heart. It's going to help you reproduce, help you avoid diabetes, help your weight, it's going to help your memory.

It's going to help your emotional and mental health. It's going to help you be more creative. I mean, it's just there's nothing it doesn't touch and help. So please just make it a priority. Get your seven to nine hours. Try not to use sleeping pills. And that's what I got. Thank you so much, Dr. Paul. It is always a pleasure. I can't wait for the next one. All right, buddy. Have a good day. Okay, everybody. Until next time, ask questions. Don't accept the status quo and be curious.