EP 201: Ed O'Malley, PhD | Making Quality Sleep Part of Your Self-Care

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Hi, welcome to the Radical Responsibility podcast. This is your host, Dr. Plitmal.

And I'm really happy to be here.

Today with Dr. Ed O' Malley of a renowned sleep medicine expert with over 25 years of clinical and research experience. So with Dr. Ed O', Malley, we're going to explore how to recognize our body's reliance on sleep to restore its biological and physiological systems to a healthy state so that we can really proactively take responsibility for getting the restorative sleep we need and how to do that. So we're going to talk about discovering the relationship between quality sleep and and quality memory recall. We're going to explore tips for creating an effective bedtime routine for winding down and promoting rest. Also, how our circadian rhythm plays a fascinating role in setting up a biological sleep cycle. And finally, we'll explore methods to implement when sleep is interrupted so you don't face a period of insomnia. So give this a listen. Dr. Ed O', Malley, a renowned sleep medicine expert.

And I'm really happy to be here with Dr. Ed O'. Malley. Welcome, Ed.

Hey, thank you, Fuj. Nice to meet you.

Well, it's really great to be here with you today and to explore a really important topic having to do with physical self care. This day one of the summit is about the physical dimension of self care and what's more important than sleep. Well, obviously a lot of things are important. Exercise, sleep, diet, all these things. But sleep, boy, we really know it when we don't get enough sleep. So I'm really looking forward to this conversation. So I want to share a little bit about your back background and then we'll jump right in.

Okay, Sounds good.

All right, so Ed O', Malley, PhD, FAASM, has practiced sleep medicine for over 25 years in academic, clinical and research environments. He completed a PhD in neurobiology from Cornell University Graduate School of Medical Sciences in 1992. Dr. O' Malley joined the faculty of New York University Medical Center Sleep Disorder center where he did postdoctoral research and EEG brain mapping during sleep and wake states. After completing a two year clinical fellowship in sleep disorders medicine, he received board certification in 1996 as a principal investigator in sleep medicine clinical trials. Dr. O' Malley has authored both basic and clinical research, as well as textbooks and sleep medicine. He's also considered A leading expert on teen sleep and school start times and has helped communities affect changes in high school start times to be more conducive to adolescent sleep and wellness. And.

Your website and where you offer your current work through is called your optimal nature. And we're really happy to have you with us today. And so welcome. Thank you for being generous with your time. And so today is.

Day one of the self care summit where we are focused on the physical dimension of self care. And clearly getting enough and getting quality sleep is. We all know common sense and intuitively we know it's important to our well being. But why is sleep so important? From a. What do we know scientifically about why sleep is so important for our physical, mental and emotional and spiritual health?

Well, you know, if you start with the only downtime we have during our active lives is the sleep period. That's when nature in her wisdom decided to do all of our repair work, all of our restoration. So all of the, you know, getting the muscles back in shape, taking care of all of the various biological systems in the body, the physiology of our body, all of that stuff is done during the sleep period. We regulate our hormones, we clear out the junk that's accumulated during the day. We allow some of our systems to rest, like cardiovascular system, it goes into a holding pattern so that it can do its work. When we don't sleep, a lot of these are negatively impacted for sure.

Is it true that in terms of our brain health and healthy brain function, which is so determinant in terms of various dimensional quality of life, that is it our lymphatic system that kind of carries off a lot of waste from the brain and kind of sloughs off built up. Yeah.

Again, you know, the, the brain, we have so much material crammed into a really small space in our skulls that we don't have the lymph system wide open like we do in our bodies, so we can't clear the toxins that build up during the day while we're active. And in fact some of the byproducts that build up from cognition. Just thinking, planning, doing the things we normally do during a day not only create some byproducts that leave us with sleepiness, but also some of the ones associated with Alzheimer's disease. We're finding out beta amyloid protein, tau protein, these accumulate during the day and, and they are only released during or metabolized away, cleared out during the physiologic state of sleep. Not rest, not quiet time, not meditation, only during sleep when we cut Our sleep short, these products build up, these toxins build up. A lot of studies are coming out in just the past five, seven years about the associations between reduced sleep and increased risk for Alzheimer's.

You know, it's really interesting, the parallels between the world of computers and the human brain. Obviously computers have been built to mimic our incredible brain capacities. But you know, the old days you had to periodically defragment your computer, right. And run it through these processes to clean it up. Now that all happens while you put it to sleep. You put your computer to sleep and over time or through the startups again, it's doing that, cleaning up net defragmentation. So it just seems about, you know, our brain is a bioelectrical chemical machine of sorts, and so it needs that maintenance. And you're saying that basically only happening when we're sleeping?

Yeah. Plus a lot of other functions of sleep are present as well. For instance, all of the material, all of the information we took in during the day, what becomes important is what we get laid down during sleep as memories. Right. Short term go into long term. We do our emotional processing during sleep, during REM sleep in particular.

All of that need that we have to function at our best really is determined by getting adequate and really good quality sleep.

Well, you mentioned the buildup of toxins possibly being a contributor to forms of dementia or Alzheimer's, but you just mentioned that.

Stabilizing or embedding of memory, short term memory into long term memory happens. More of that happens while we're sleeping. So there's a connection then, quality sleep and quality memory?

Absolutely. Studies have shown, in fact, even if you do a simple study where you teach someone some nonsensical words and you ask them to recall them a little later, if you give one group a nap and you keep the other group up, but not doing anything terribly difficult, then check the recall of those words. The people after the NAP recall 50, 75% more of the words. Simple memory tests like that term memory. This is why I got into the adolescent sleep issue. Because during adolescence that's when we're paring away all the stuff. As kids we take in all this stuff, we create all kinds of connections. Again, we're doing that during sleep, which is why children sleep for such longer periods, then that begins to decrease until we hit adolescence. From middle school to high school, the amount of sleep need does not change very much. But a couple of things do change. As we notice the hormones begin to to go a little wild in adolescence. But also the hormone that regulates sleep Melatonin, that whole rhythm shifts later. For the adolescent brain to get up in the morning, it's much more difficult. Difficult to fall asleep at night, difficult to arouse in the morning. And yet school start at 7, 7:30 or they got to be at the bus stop by 7 or 7. It's just crazy. It's like we're up, it's waking us up at 4 in the morning. That's the equivalent. We're cutting off both the amount of sleep and critically, the way sleep works is we get most of our dream sleep during the morning. That also handles emotional regulation. What are we trying to teach our adolescents? Impulse control. You can't just haul off and hit somebody when they take you off. You have to be able to manage these various hormones, various relationships developing. Growing up, we don't want to make it any more difficult, but we somehow have figured out a way to do that.

I thought that would just me that had trouble going to sleep at night and didn't want to get up in the morning. I thought that was just my own personality trait. It's good to know that that's actually what's going on with the teenage brain. You know, another thing that's happening in the adolescent years is the myelinization of, of neural networks which helps them be more efficient as well as the development of the executive function of neocortex. And that adolescent years is where, you know, we kind of have our, our hormones on, on, you know, steroid, you know, on steroids really going, but not a very well developed executive function which sets us up for risk taking and, you know, having struggles and so forth. And so again, what would be the relationship between getting enough. Because there's a lot of parents on this summit, I'm sure. So the relationship between getting enough sleep and that process of myelinization which makes the brain more efficient and the development of the executive function which gives us better judgment.

Yeah. Again, the basis for laying down memories is actually making new connections, creating more connection, more networks, networking, for example, during sleep. And that those networks can only stay functional if they get myelinated. That creates fast transition of material back and forth. And all that's happening during sleep and in particular REM sleep and REM sleep we get sleep is kind of, we have two major states of sleep. We have slow wave sleep, which is non dream sleep, non REM sleep and REM sleep. In the beginning part of the night we get a lot of that non dream sleep. And that's when our brains really are going. They're just Going into automatic pilot. We're clearing out the junk. We're fixing the muscles. We're doing all the repair work. It's where our bodies get really repaired. But then, as the night wears on, less of that. And then dream sleep begins to increase in cycles. And by the end of the night, if we're having at least eight hours, nine hours. For the adolescents, that last period of sleep is almost all REM sleep. And that's when all of this is happening. That's when all these connections are being made. All the stuff that doesn't belong gets cleared out. And what really allows for optimal learning and memory, insight, creativity, all of that happens when we get enough REM sleep by the end of night. That's the kind of sleep that allows your brain to feel clear. Oh, I've had a good night's sleep. That's what REM sleep does. The rest of your body thanks you for the other type of sleep, because you need that too. So we need both. Yeah.

Well, it's so helpful just to know all that in detail, I think. Really. I mean, you know, I'm sure, like a lot of people, I tend to think sleep's a waste of time, and I wish I could get away with less of it because I want to do more and all these things I want to accomplish. And, you know, sleep is just, you know. But listening to you talk, it's like I want to run upstairs and go to bed.

Obviously, it's really necessary. I need to do that. Right.

Yeah.

That's great.

Well, you know, look, the thing is, we need to recognize sleep is as important as nutrition and exercise for good health. Right. We just. We wouldn't chintz on that other stuff. Right. We wouldn't cut that short. And the problem is we have this culture that feels like if we're not doing something, we're not productive. But if you want to be more productive, get your sleep, and you will be much more productive the next day than if you stay up late. Cut your sleep short and try to keep getting the work done, because then your efficiency is beginning to drop. And if you just go to sleep, you will have double the efficiency and be able to do much more in that same amount of time if you do it in the morning rather than the night before.

Yeah. Fortunately, I've learned the hard way you can't cheat the clock. Sooner or later, it just catches up with you. And sometimes I forget that and I try again. And the older you get, the less you can get away with cheating the clock. Right.

So that Is true. That is true.

So what are some of the things that lead to poor sleep and sleep disturbances and insomnia and, you know, all the ways in which we're not able to get quality sleep? What are some of the maybe individual situations and some of the environmental factors that cause that?

Well, so let's start with the environmental first. Clearly, there's the big environment, right? There's society, there's what's going on in the world. And clearly today there is a lot of things going on that will stress us really seriously. We're just coming through a couple of years of the pandemic. People had a really hard time, and they're still having a hard time sleeping because of all the psycho emotional stress of losing some loved ones, not being able to see people. All of those social interactions that we absolutely need as human beings have created huge environmental stressors. The environment itself as a whole, climate change, eco grief we're dealing with. The world seems to be falling apart around us, both physically and mentally and socially and emotionally. We're having a lot more stress in this particular generation. And the kids who are growing up today, you know, they don't really know which way is up because they. They've only had this experience and they're like, I don't understand why we can't, you know, our parents and our authorities and our. The people we look up to aren't able to take care of the world. They're letting the world fall apart. Or they're, you know, they can't quite understand why. But that's what we see, and we see it in the news every day. So. So there's that. That we. That can make it difficult to fall asleep. Plus there are other immediate environmental issues like mold and dust. And we have lights on in our bedrooms. We have our devices up in our faces now with the blue light delaying our melatonin onset.

Plus, we're all working way too hard. 24 7. Society wants us working all the time.

Maybe there was a new almost disorder they called revenge sleep or revenge insomnia. Really, where we were so busy during the days that the only time we had to ourselves was by stealing it from sleep. So we would just stay up and I'm going to watch that next episode of Netflix. I'm going to binge a couple more to get some time for me. So it's part of. We have to factor this into our whole lifestyle. It's very important that we generate a lifestyle that supports sleep and as well as doing the other things that we need to have a well designed life, we need all of these things. So how do we do that? We need to work a little bit less. No one on their deathbed is saying, gee, I wish I worked a little harder. I wish I had done a couple. No, that's not what we want to do.

Well, I love what you just said about a well designed life because I do think we need to consciously sort of, we can't control life, but I think we do need to bring some intentionality to how we design our lives because otherwise life's going to design us and the world today is not going to design us for optimal health. I don't think so. And the idea that even if we were committed to getting somewhere between seven and eight hours sleep, that we're just going to go full throttle for 16 or 19 hours and then, okay, sleep time, it's probably not going to work that way, right?

No, no, it definitely doesn't. And that's. Those are part of the practices that we talk about, how to design a good night's sleep as well as a good life. And that is to, you know, those stressors that we experience all day long, they're still going to be there. We have to just find a way. We can't control them being out there, but we can control our response to them. And we want to learn how to respond and not just react. So get, you know, the worst thing beyond 10 o' clock news was the 11 o' clock news. Because we don't need to know the world's going to hell in the handbasket right before trying to go to sleep. Don't need that. We can get our news in the morning. Look where we're surrounded by it all day long. So you get it on your phone, you get it so you'll get the information, you'll know what's going on. We don't need to stay glued to our sets to find out or our tablets these days what's happening. So we spend time knowing what's going on in the world. We want to be good citizens. But then when we wind down our day, we need to let that go, take it off, hide the news. You don't need to know it right now that there's been another bombardment somewhere or something else. We need to let that go. We'll get plenty of it in the morning. So that's one thing. We need to offload the stress of the day. We need to find ways to manage our stress. And this is self care. Self care is not an option. It's A necessity.

If we want to.

Let's say we want to fall asleep at 10pm every night or 11, whatever it is. But let's say it's 10pm.

At what time do we need to begin kind.

Of.

Slowing down, ramping things down, you know, away from the devices, away from the bright lights, you know, stimulating activities. How long is that glide path into a good night's sleep?

Well, you know, a generic timeframe would say at least an hour before bed. You want to be winding down. And what I suggest to my patients, clients, to people who are asking these questions, is that, hey, let's put some of this technology to use. Grab your smartphone. They all have bedtime alarms now. They have a way. And of course, when I mentioned that, they say, I already have an alarm I hate in the morning. Why do I need another one at night?

It's more of a cue. You want to be reminded because again, when you sit down after a tough day, you just want to unwind. You're not even thinking anymore. You're just mindlessly watching something. But that thing going off about an hour before bedtime, remind you that, oh, yeah, I'm trying to prioritize my sleep a little bit here. I want to start winding down. That means it's time to dim the lights a little bit, pull out the blue lights, put on your blue block, or glasses if you need them, to really block that out and allow the brain to start doing what it's supposed to do and will do if we stay out of its way. Not bad. Not bad. You got yours handy there. I'm not in my office, so I'd have mine right here, too, but I have the orangey ones. The clear ones aren't very helpful. You really want those?

Mine are kind of yellow, and I was wearing them for a meeting the other day, and somebody said your eyes look yellow. Are you okay?

Well. And you have to watch, too. If you're doing Zoom after hours. You know, when you have your sunset stuff on, it'll start making the screen orangey and you'll look a little funny. But, you know, those are the exceptions. But in general, if you start winding down about an hour or so before bed, that will. That's a great place to start. You know, we could do an hour. Okay. Doesn't mean you have to turn the set off right then and there, but. Okay. I know this is the last episode I'm watching. I'm going to do my wind down and then get prepared for bed. Even after going out. Like, we're starting to Open up again. Maybe going out for dinner in the movie or something like we used to do. You can't watch the latest Marvel blockbuster and come home and jump into bed. The mind needs time to unwind and if you don't give it that time and you climb into bed, you're just going to be sort of running around in circles for a while anyway and just being frustrated that you're not falling asleep and wondering why when there's a very good reason you haven't given yourself that wind down time. So it's even better to stay up a little bit later to allow the wind down and make your sleep more efficient and then you'll make it up maybe the next day. Building a nap on the weekend or something like that.

What about.

What about, you know, you mentioned going out to dinner and so forth. What about food and alcohol intake and you know, related to the time when we want to be ready to go to sleep?

Yeah. So you know, there are foods, there are better foods and other foods for supporting sleep. Any foods that contain serotonin or support serotonin production are helpful, like a lot of dairy products and so forth. There are certain fruits and veggies that have more of like, like tart cherries. Have a load of melatonin. Excellent to have as a snack at night. You want some complex carbs before bed. There's a lot of intermittent fasting going on where people are eating at maybe 6, but they're not going to bed till 10 or 11 and that long block of no intake. So you want to have good protein and healthy fats with that dinner so that it's going to carry you through. But if you're not and you're eating early and needing to go to bed and again four or five hours later, have a snack of some complex carbs to carry you through the night. Otherwise your blood sugar begins to tank and then your body will wake you up saying, hey, where's my food? I don't have enough food on board to make it through the night.

And then you want to finish. You don't want to have the spicy heavy foods within an hour or two of bed. You want to give yourself three or four hours if it's a heavy meal.

Alcohol, we've learned the hard way, especially if we're in high school and college. Probably not in high school, but in college, that alcohol, it'll knock you right out. It'll relax you, you'll fall asleep and then it'll destroy sleep the rest of the night. It causes multiple arousals Rebound nightmares, REM and all kinds of disturbance. So alcohol, a glass of beer, wine with dinner, not an issue. If you have several hours, it's going to be metabolized out of your system by bedtime. But if you have that nightcap, not going to be good for sleep.

What about the other end of the day?

You know, the whole notion of light exposure, circadian rhythms and so forth. So when we start our day, in order to get our, our body, you know, in sync with and you know, we all kind of gotten away from the natural way of living. We used to kind of have to get up when it was light and we'd go to bed when it was dark. And you know, we were outdoors a lot. And now we've created these insulated environments where we can ignore nature and just, you know, have electric lights on whenever we want. And we've kind of gotten out of sync. So does it make a difference how we expose ourselves to light and when and when we get up and what we do and.

Absolutely. You know, you've done your homework. You know, this is really the crux. Like when people ask me what's the most important thing I can do for my sleep, the first thing I always say is get up same time every morning and get outside in natural daylight. Natural daylight has orders of magnitude more intensity. And we recognize that we have cells in our retina that recognize natural light. And that does two things. One is it tells us it's morning, which shuts off melatonin production. Very sharp signal. You know, if we get up, we lollygag, we hit the snooze a couple of times, we go in, the lights aren't that bright yet. The brain gets mixed signals as to when morning actually is. And why that's important is because when we shut off that melatonin rhythm, we're also setting a timer for it to come back on average 16 hours later in an 8 hour night sleep. 8 and 16 is 24 hours. So we set the melatonin clock by when we get exposed to light in the morning. And so if we get a strong outdoor light signal in the morning, like I have a slide in my presentations, you know, dog walkers rule because they're out, they have to. Fido's got to get out and do his business first thing in the morning. So if you're not the dog walker in your family, become the dog walker. You'll get better sleep. But for the rest of us, take that cup of tea or coffee, you know, outside on the back porch or just out for five or 10 minutes, you know, bundle up. If it's the wintertime, especially in the Northeast, we need a lot more vitamin D. Good. To get out there first thing in the morning. That's really the most important. And then, of course, melatonin will come on 16 hours later. If we don't have our devices and our blue light and all that. We need to prepare for that. But that's already set for both you and I. Whenever we got up this morning, it's already running. And so, you know, I tell people that's important because when you sleep in on the weekends, for example, and you get up later now, you're shifting, you're like the adolescents. You're shifting your clock later. Your whole rhythm is latent. So melatonin is going to come on by how much later you got up Saturday morning or Sunday morning. So a recommendation I make about that is to get up close to your same time. I know people. That's the best sleep I get all week. No, get up close to your regular time and then that time that you would have slipped in. Build in a nap in the afternoon during your circadian dip time. That's about eight hours after arising. We have this dip in energy where the circadian drive that keeps us alert and active all day backs off a little bit. It's a great time to take a nap. Go up into the bedroom, lock the door, put on the eye shades, pull the shades, put in the earbuds and take that nap. Make up that sleep that you needed to make up by sleeping in instead doing it it during that afternoon.

And that kicks in normally about eight hours after we've awakened. Especially if we get out and shut off the melatonin, we get the sun, natural light, about eight hours later, right?

Yep.

Yeah, that's really interesting. Tonight and often probably a lot of us experience that dip and we power through it with coffee or something, right?

Yeah, exactly. We all do that. And look, it's not a bad thing necessarily. It's sort of a drop in energy. If you're getting an adequate amount of sleep, you're meeting your sleep need on a regular basis. But most of us, you know, again, there's an average of eight hours for the entire human adult population. But it varies. And this is a good time to also point out all of the recommendations we make around sleep and what to do can vary by the individual. So you need to know what works for you. And if whatever you're doing is working fine right now, don't change it. Remember Ann Landers if it ain't broke, don't fix it. Whatever you're doing, if you get in your sleep and you're alert and pleasant and engaged all day, you're doing fine. But if you have that dip in the afternoon and it's like, I can't keep my eyes open, I got to go take a nap, I got to have my cup of coffee or my power drink right now, my Red Bull or whatever.

That'S telling you you're probably chronically sleep deprived and you need to build back in some sleep. Even if it's. Again, let's say you're a seven and a half hour need night person, but you're only getting seven every weeknight because you got to get up from work and do your whatever's in the morning. By the weekend, you owe the bank two and a half hours. And as you know, now we're learning, we have a sleep bank. It keeps track when we don't meet our need. It builds up so, you know, 15 minutes. Add 15 minutes and I go to bed 15 minutes earlier is what I would suggest. And just see if you can do that. If you can. Great. Now start doing next week a half an hour earlier and just notice how you feel. You'll stop having that crash mid afternoon. You'll have a dip, but you won't have a crash.

Yeah. I'm curious about one thing my mother told me when I was young. You can make up sleep if you didn't get enough sleep. You can sleep, you can make up to sleep and so forth, but you can't really pay it forward. You can't like add.

And I've kind of experientially found that maybe to be a little bit true, but I'm curious about whether scientifically that's true. I mean, could you sleep a bunch extra ahead of time to. For a period when you know you're not gonna, you know, get sleep?

Yeah. No.

Okay. My mother was right.

Your mother was right. You know, they usually were. You know, most of the time.

What happens is if, like most of us, we're not meeting our sleep need. Yeah, we can sleep in extra and then we can stay up longer. Right. You know, and also the biology is such that our circadian clocks are designed to move forward but not to move back. And the perfect example of that is jet lag. You know, you fly to California, you can stay up late. You fly from the east coast to the west coast, it's only three hours. We can find a way to push ourselves forward, stay up social Interaction, eating dinner with them later, the colleagues or the friends you're meeting. But then when you fly back, once you've been there for three days, four days or so, you begin getting light, adjusted to their light and their timing. And now you fly back and you can't fall asleep at your regular time because your clock is shifted forward. Now that's been built in because we have seasons and in fact Congress just noticed we have seasons and have tried to change the law. Right. Daylight savings time.

I hope there aren't going to be too many politicians on this self care. I mean they really need it, but they probably won't be listening to this. But if they do, they finally get around to making a change that we've been crying for, for years and they make it at the wrong end. They want to keep daylight savings time and really if you want to match the biology of the human being, you want to keep standard time because that's closer to how our clocks are set and that's just the way it goes. So the clocks, we can push off sleep, but we can't push off our clock. It's just the way it is.

Well, that'd be a tough sell with me. I love the longer daylight evenings with daylight savings time that we get yet. And you know when, when it comes fall and we make that shift back to standard time and suddenly it's getting dark at 4:30, I just.

Yeah, but that's really relative too. Yeah, yeah, yeah.

Yeah, yeah.

I'm wondering about, you know, a lot of people are into wearables and various devices these days and you have smart watches and Fitbits, things like that where you can track sleep. And I had one for a while, I was using it and I'm not sure how accurate they are, but I saw that I was getting a lot of REM sleep and I do dream a lot. I'm pretty aware of my dreams. But it measured like REM sleep, deep sleep and then light sleep. And I was getting a lot of rem, a lot of light and very little deep sleep. Now I don't know how accurate it was, but I'm wondering, you know, and yeah, you know, a lot of people are into tracking. The more data you get, you can adjust around that and improve your performance and so forth. So do you see a benefit in tracking your sleep performance? Are the devices accurate enough? And then what would that have meant if I wasn't getting enough deep sleep? Or how much deep sleep would we expect to get?

All right, so that's 15 questions. Let's see if we can get to a couple of them. Okay, so the first thing is let's just talk about what natural sleep is. And as we age, we do, unfortunately from those adolescent years onward, every decade we get a little bit less deep sleep. A little bit less. A little bit less. A little bit less. Okay. Does it mean, mean our need for sleep is changing. We still need sleep, we just have less of the deeper sleep, which means our sleep is more easily disturbed now. So noises that didn't used to disturb us, we may have more aches and pains. We have some medications we're on that disturb sleep. So it makes it a little more difficult. But generally each decade we have a little bit less deep sleep. So when we're 60s, 70s, 80s, we're not going to show a lot of deep sleep per se. But that's not to say we shouldn't be showing some. So that's one thing. How accurate are the devices, the trackers? Well, let's see, I've got one here, I've got the ring on here. I've got my.

I asked the right person, you know.

I get to say, I mean, I. My clinic is an insomnia clinic. I see a lot of people with insomnia and I see a lot of people come in saying, is this any good? And they bring in the data. You know, there's another sleep disorder we've come up with, you know, and it has to do with people coming in saying they're not getting enough deep sleep or enough whatever kind of sleep because their tracker is saying it and they're afraid they're going to get Alzheimer's or something.

The early versions were not very accurate at all. The ring was probably the most accurate. It was validated against sleep lab studies, clinical sleep studies done in the lab. I got that one right away because I believed that I measured the other ones against it. Now they've done a lot more in house studies on the other devices and they're getting better at what they record. But I have all three of these. I look in the morning and I can show you three different hypnograms of my sleep. Even though they're on the same body during that same night.

They'Re not entirely accurate. But what they are really good for is relative changes. You make a change, so you first should feel how you are in the morning. Was that a good night's sleep? Yeah, I felt pretty good. Okay, what does my data look like that reflects good sleep? That's all you need to know. And now when you're not feeling good. If you look at it again, whatever you see has changed. It's probably.

An accurate reflection of your sleep has now changed. Maybe there's more arousals, maybe there's less deep sleep, maybe there's more wake time. They have all their different algorithms.

So to use them in that way, you know, is something affecting my sleep, positive or negative, that's very helpful. But to say, is it exactly given. Oh, man, I'm only getting like 19% REM and I need 22. That's not really helpful.

It might be taken a little far. But I think with most data, I mean, you know, a lot of, you know, people are into working out and so forth, and runners and so forth are using devices to measure heart rate variability, things like that. So we got to get a baseline and. And then you're measuring differences. Right. And then you look at behavior. So it might be valuable if you were tracking your sleep with various wearables. And then you start, you know, getting out and getting that light exposure in the morning or taking that nap in the afternoon, or adjusting your diet or adjusting things and see, you know, are you getting improvements? Can you track? Are you getting improvements?

Yes, absolutely. Absolutely. So that's where it comes. Really becomes very handy. And also for the. For the guys who are working out and all the athletes. Yeah, that can be very helpful to know what you're doing. And your numbers there, they're much more accurate in daytime function than they are recording sleep.

And that's what happened. They started out as trackers, activity trackers, but then when they applied it to sleep, they did. The URA ring was the first one to apply heart rate variability and temperature. That made it more accurate because if you start putting together all these variables, you begin to differentiate the different states of sleep because they are. Are different physiologic states, but in terms of activity, they're much more accurate for the daytime, but helpful for sleep. Yeah.

It seems like another malady that's become endemic in our society is. What are they called? The CPAP machines. Is that it?

Cpap.

Cpap. I get it confused with that conservative political.

The CPAP machines. Right. And that seems to be almost endemic, that people having that. That issue. Snoring can be related, but it's also. I can't remember what it is you're getting.

So. Okay, so. So the thing about sleep apnea and snoring and all.

Sleep apnea, that's what I was. Yeah.

Sleep apnea. Yeah. What's happening is.

So snoring itself is A vibration of the tissues around the throat.

And as we put on weight, we put on more tissue, more fatty tissue around the throat. And the more fatty tissue we have, the more that's going to vibrate. So when we draw air through floppy tissue, it vibrates and makes the noise. But it's also a sign that not only is it making noise, but now your airway is getting narrower and narrower. And if your airway gets a certain amount of. To a certain threshold, it can begin collapsing. Okay. And collapsing is an apnea, which is. Apnea means no breath. Apnea, no breath. And so you stop breathing for roughly. We score them at three cycles, three breathing cycles, which is about 10 seconds. So you stop breathing for about 10 seconds before they even score. One apnea. How many times that's happening during the night is generally an indication of how severe the disorder is. And so one of the five per hour. Five times per hour. When we have those closing events or partial closings, because the sequelae are the same, what happens is when they start to close or completely close, you're not getting as much air, so your blood oxygen begins to drop because you're not breathing. Then at some point, the body finally goes, oh, wow, we're not breathing. And it wakes you up. The brain becomes awake. It moves into the wake state briefly. Not enough for people to be awake or know they're awake, but the brain moves from the sleep state to the wake state. That restores muscle tone to the body, which restores muscle tone to these floppy airway tissues. And they can open up. And that's the, you know, now you hear, that's the airway opening, and then you take a few breaths and then drift back into sleep. And when you drift back into sleep, the muscle tone goes away, the airway gets floppy and you begin vibrating. And then you can collapse again. Five times per hour is usually the diagnostic level. And that's mild apnea. When you hit 15, you're in moderate range. That's pretty significant. That's 15 times per hour of sleep. And when you hit 30, you are severe. People with 30 times per hour of sleep, I mean, think about it. It's. Every other minute throughout the entire night of sleep could be very dangerous. Your blood oxygen is now dropping, and sometimes it doesn't come all the way back because you have repetitive events.

The cardiovascular consequences, the cardiopulmonary consequences are pretty severe, and you need to take care of it. People with hypertension are more likely to have hypertension and more likely to have difficulty managing it. With medications, you're usually on 2, 3, 4, 5 medications and still having trouble keeping the blood pressure down. And that's because at night, remember I was talking about how important for all of our physiology sleep is? Well, one of the things that happens during sleep is your heart begins to beat less and there's a dipping in your heart rate, which, by the way, the trackers will show you too. If that's not happening, your heart, your cardiovascular system is working overtime. Instead of it getting to rest, it's beating harder and working hard. Plus, when you stop breathing and then aroused briefly, your heart rate goes down and comes up, goes down and comes up, your blood pressure down and up. So your system is not only working overtime, but it's being stressed during sleep as well as during wake. The CPAP device C Continuous Positive airway Pressure. CPAP blows air and it's continuous, so it pops open the airway. So even if you have floppy tissue, it props open the airway, it won't let it collapse. And we have to figure out what pressure will keep that airway open. And that's why that works. But there are also alternatives. Even now, for the severe people, there are appliances that help pulls the jaw forward a little bit, creates tension on the upper airway so it's less collapsible, and that can work in place of cpap. So for people who have really great difficulty with cpap, there are alternatives. Go back to your doc. Don't just stick it in the closet and give it up. Because, I mean, I understand it's a mask, it's blowing air, and it has all kinds of. But there are alternatives. So, yeah, it's important to take care of that.

Well, speaking of alternatives, there's been a huge surge in interest in recent years in various forms of breath work. Breath regulation coming from the Eastern traditions of yoga, pranayama, but also various Western researchers and practitioners and so forth. And almost everyone emphasizes the importance of nose breathing. Most of the time, we're designed to breathe through the nose, and especially at night to where actually, and I do this sometimes myself, people will tape the mouth shut a bit and so that you'll be sure to breathe through the nose at night. Because mouth breathing can contribute to some of these problems that you were just talking about, at least according to some of these breathwork practitioners. And I'm just curious about whether that can be another way of regulating ourselves during the day and being more in tune with circadian rhythms of having more breath awareness and so forth, as a way that we're Going to be more regulated when we go to sleep and be able to sleep better.

Yeah, yeah. In fact, you know, a lot of holistic people are looking for alternatives to the CPAP devices. And so they're trying to strengthen these upper airway muscles. And that's one way of doing it is making sure you're breathing through your nose. But also singing lessons and didgeridoo. You know the didgeridoo after you learn circular breathing, that helps strengthen, which is something you can do during the day. But of course we don't have apnea during the day. Right. Because here we are breathing just fine. Thank you very much. So it's to strengthen those muscles so they work better at night and. Yeah. And you know the whole taping the mouth thing. Yeah, that's an interesting. I've been hearing a lot about that. I don't know, I think the jury may still be out on how effective that makes your breathing because as long as you have good nasal breathing, that's probably okay. But if you have any compromise in your nasal passages, you have polyps, you have sinus issues.

That anywhere in the airway that there's constriction, it creates a greater pressure of the air going through that floppy airway during sleep and maybe increase the collapse. So yeah, we'll have to do some studies there and see what the latest data is there.

Well, I have a good friend who's both. A marathon. No, he's not a marathoner. It's what they call it triathlon. Started doing triathlons in his 60s and he's also a didgeridoo player. So I'm going to have to ask him how his sleep is doing. Is probably pretty good.

Yeah. And maybe for a few lessons, you know.

Yeah. How about, what about, you know, sort of holistic sleep aids. Now I, on the advice of my ayurvedic physician, I do micro dosing of melatonin. I can't remember, it's a very small dosage, but it's literally a dropper. It's three drops on the tongue at night. I do that regularly. He also feels it supports immune response as well as helping with sleep. And, and you know, sometimes I, I take things like valerian or ashwagandha or certain her things that are, you know, known to kind of relax a little bit. So obviously I don't think any of us want to get dependent on, on pharmaceutical sleep remedies. They may be a short time solution. I mean I went to a really tough loss, gosh, about.

14 years ago. Now and I couldn't sleep at all for months. And, and so some, you know, some pharmaceutical sleep remedy got me stabilized or I only was on it for about a month, but. So maybe they have a short term purpose, but we don't want to get dependent on those kinds of things. But I wonder about more herbal kind of supplementation and so forth.

Yeah, yeah. So you know, what you describe is having a major loss or having some reason for some significant insomnia. But that's what the pharmaceuticals are designed for and that's how they should be used. Short term use. Look, when your body gets stressed out beyond your ability to manage it.

Not getting sleep only makes that worse. Getting sleep any which way you can will be helpful. It may not be entirely all the sleep stages because it's a medicine, but it's still sleep and gives your body a chance to replenish itself and to bring you back sooner than if you hadn't done anything at all then on a regular basis. Again, because we live in such a stressful society, stressful world.

We'Re going to have good days and bad days, and on those bad days having some herbal support, Absolutely fine. I have no problem with that. And you start with the herbals, you know, ashwagandha, those are adaptogens. There are a number of different types and they can be very helpful for moderating how you're handling your stress during the day. So like the next most important thing I say to fix your sleep or to help your sleep or to gain sleep besides that morning light, is to find ways of offloading stress during the day. Manage your stress, take your breaks, okay? And so taking something like an adaptogen, that's probably around the clock, always a good medicine to have, it's sort of, it supports all of your systems, sort of keeps you in that even space throughout the day. So again, you become more responsive. Meditation, progressive muscle relaxation. Anything that elicits the relaxation response, which is essentially the opposite of the stress response, you want to move from sympathetic activation, the fight or flight into parasympathetic deep relaxation. Anything that supports that, if you can do that for 10, 15 minutes a couple of times a day, you're doing two things. One is whatever stress level has built up to that point, you are dropping it down. Now you're at a lower level than if you did nothing at all. Okay. If you do it a second time, you're dropping it even further. So now come bedtime, you're at a much lower level than if you hadn't done anything at all. But the second thing it's doing is it's allowing your.

Body to manage its day better so that you're not carrying. Carrying that stress to sleep. Okay, so not only are you not having a problem falling asleep, people tell me, oh no, I have no problem with my stress. I fall asleep just fine. But then again, I wake up in the middle of the night and I'm up for two hours. And that's because it's an interaction.

Everyone is individual. You may have a stronger sleep system that will get you to sleep and maybe a slightly weaker circadian system so you can override that sometimes times, or you have a stronger sleep system, you override the stressors. But then once you get a couple of cycles of deep sleep out of the way, then the stress of the day is allowed to break through. And that's why you're up and running things through your head for the next couple hours. So finding ways to mitigate stress during the day, whether it's through herbals, relaxations, finding ways to build practices in that whole holistic view, that's what we should take from the east, in addition to the ayurvedics, other substances, but a better way of holding life. And that's a way to design a good life.

How about, you know, despite our best efforts, we'll all find ourselves in situations. So there we are, we've turned off the lights, you know, we lay down to go to sleep, and it just won't come. And, you know, and then we start. And especially, you know, or maybe we sleep for an hour, we wake up, you know, and then said, but, you know, we got something to do the next day. And now we're starting to be anxious about the fact I'm not going to get to sleep. And, you know, and then this by. We use all the strategies. We count, you know, we count sheep, we do everything, you know, and sleep just won't come. What's, you know, you hear different things. You hear it's better to get up, get up, go read a book or something. When we're really in that spot where sleep just does not happen. What are some of the better strategies?

Well, I actually wrote up a paper called Strategies for Restful Nights. Okay. And you really do. The first thing you want to do is be prepared that we are all going to have that kind of night every so often, maybe two or three. We want to keep it from becoming weeks. We want to keep it from becoming every night. Okay? So if we have strategies and we're prepared for that may happen, particularly during big presentations and lots of things going on the next day, we want to be prepared. So be prepared for that potential is to have a bedside lamp that's low wattage, that's soft light. If it's LEDs, it's the softer colors. And I recommend people keep three levels of reading material right there on the nightstand. Right there. Three levels. So three levels. One is People magazine, Cosmo, something about us, you know, stories of the celebrities. Right. You know, like, we don't really need to know that, but it may be interesting enough to keep us from worrying about not sleeping because that just amplifies, right. And just escalates. And so if we can prevent that from escalating, we've solved half the battle because the sleepiness that we have is still there. You know, it's there. We're just in the way of it, so we have to get out of the way. So. So it can emerge. If that's not working and you're just turning pages and it's not really happening for you, then you want to pick level two. And that's like National Geographic, Nature magazine or something with something of real interest you might want to really follow up on. And although with climate change, maybe the nature magazines aren't so great to have, but something that you're going to get involved in a little bit more. And then if that's not working, you're just turning pages. Then you go to level three, which is. Is the page turner novel that you've enjoying reading because you're not sleeping anyway. You're not able to not worry about not sleeping. And so this will distract you even further. And what you'll notice is after you've read a chapter or two, you'll start to yawn and then you can go back to sleep. And if that's not working, that's when I say, get up, go somewhere else in the house, Go somewhere else in the room or somewhere else in the house and putz around, pare the socks.

You know, load the dishwasher, unload the dishwasher, do something mindless because you're not sleeping anyway. And you may as well at that point not continue to build up this association with the bed being frustrating and arousing and keeping you awake instead of allowing you to fall asleep.

That's great. I like that. Three levels of reading material there. I have a fourth level for you, by the way, something I've used this, like, really, really dense, philosophical, scientific, psychological stuff. Right. You know, in fact, there's books that I really want to Read and, you know, I keep them on bedstand like everybody else and sure enough, I plug it up, page and a half.

Yeah, I've had people fall asleep reading physics books. I've had people stay awake reading order by order geographies.

So, yeah, we have to find our own. Yeah. So again, I know you, you've addressed, you know, why sleep is important, but maybe we could go a little further with that because if we're chronically not sleeping well.

Whether if we had chronic insomnia or if we're just constantly trying to cheat the clock because of whatever we're hoping to achieve in life, what, what are some of the long term.

Possible.

Health effects of that? You know, what are some of the risks?

Yeah, yeah. Well.

If we had started at the beginning, I'd still be talking about them. There's so many. Because again, that first statement holds sleep is when we repair everything and people wonder why. Well, you know, this guy get that they got diabetes and this guy got obesity. And this guy, I got a heart attack. And that's because we're each individual and depending on what's the weak link in our physiology, that's what's going to suffer first.

If you're chronically sleep deprived.

It'S a laundry list. Increased mortality, increased heart attacks, increased cardiovascular disease, increased hypertension, increased.

Metabolic disorder, increased obesity, increased diabetes.

Increase in.

Stresses, increase in mood disorders, depression, anxiety, increase in GI disturbances. Shift workers are known for that. The body's not meant to really work through the night.

Even though there are morning people and night people sound like a night person. But there are, you know, there are limits. And so we get out of sync with our circadian rhythms and things begin to suffer. And in fact, I just read a paper today, just published, that was looking at the brain. Macrophages are part of the immune system that clear out the junk, right? Clear up the dead cells in the brain. They're called microglia. And what these researchers found that they were using mouse brain, but a lot of the immune system started, stuff carries over that the microglia have a circadian rhythm. And when you get out of your circadian rhythm, they get out of rhythm. And why that's important is because they clear the beta amyloid protein, the tau protein that creates Alzheimer's disease. And so if they're not working well and they work at night, if they're not working well, then, then you're going to have.

Higher risk for Alzheimer's. Every aspect of our being can potentially suffer if we don't get adequate sleep. The Final reason, the most probably important, that we just don't understand how we can't quite get it in our heads is that we can be driving a car at 60 miles an hour knowing full well about if we fall asleep, we die. And we can still fall asleep because that's how strong the drive sleep is, the need for sleep. Nature has built that in.

We can't avoid it, we can't. I mean we can push it off, we could strain it, we could take it to the limit. But ultimately even our survival is at stake when we don't sleep enough.

Well, this has been fascinating and you know, the body has tremendous capacities for self healing and for self regulation and so forth. But it's good to know. And what I'm really taking away is our healthcare system, right? Our healthcare providers, our internal, our whole internal healthcare system is mostly working at night. They're on the night shift, right?

Well, the overnighters are. And look, given who we are as a race, a human race, we need, we have 24, seven jobs, we have nuclear operators who need to be on with people, you know, cops and firemen. We need the first responders to be able to be on overnight shifts and you know, I, you know, more power to them for being there for us. So I'm.

Oh, I see. Well, yeah, actually what I meant was, and I do a lot of work with first responders and bless our hearts, we need to really support them because it's really challenging to be a ship worker and do the graveyard shift. But actually what I meant was what you're referencing kind of our internal healthcare system, the microglia, the macrophages, you know, all our internal systems, that's really our built in healthcare system, works at night for the most part, it's on the night shift. And so if we deprive it those hours, we're not getting the health care we need.

Yeah, absolutely. Sorry, yeah, I missed that. Yeah, absolutely. It's our internal healthcare system. Our internal self care system or.

The target of our self care system should be our night shift. Our internal healthcare.

That's great. That's great. Well, this has been really helpful. Anything else that you'd like to share with audience about any other kind of strategies to start to make that lifestyle shift to where we value sleep and start doing some of the things that are going to help us sleep better?

Yeah, Starting small, just starting with taking five minutes a day to take that few breaths, even do some deep breathing, kick back in your office chair, even find a way to interrupt your day for the purpose of Relaxation. And that helps you start to manage your stress. Do that twice a day. That's great. But if you start with just five minutes a day, even set your little timer somehow that every day, then it becomes a habit. And it takes more than a few weeks to do this, to really become a habit. But start somewhere. Maybe for you it's adding, not you personally, but for someone listening, it's 15 minutes. Going to bed 15 minutes earlier, setting their smartphone alarm to cue them in 15 minutes earlier. I'm going to bed tonight. The things that are simpler. You want to drink more water? Put a glass of water on the nightstand. So when you wake up in the morning, that's the first thing you do, is you drink your water. Water. Okay. So you want to build in something that's simple that you can do individually. What's going to work for you. You know you better than I do, so you tell me when I sit with my patients, you know, what I'm always asking is, what's going on in your life? How is your life? How are you managing your life? Okay, you know, what's the goal you have for all that you're doing? You know, is it to get the kids a better life? Is it to get more money and a vacation? What is it? You know, and let's weigh these and let's fig out what's really important versus what you think is important. Because society keeps telling you you got to have the new car, the new house, or the new bright red shoes.

Yeah. So start small, but make it regular. Whatever works for you, then that's the place to start.

That sounds like good advice. Well, thank you so much, Dr. Ed O'. Malley. Great way to kick off our self care summit. And, you know, great, great thing to prioritize right at the beginning here. And we're really encouraging everybody to kind of take this week of self care, not just a summit to attend and learn something, but actually really focus on self care this week. Take it as a self care challenge. So, you know, let's all focus on, on some strategies for sleeping better this week and try out some of this stuff. So thank you so much. This has been a great start.

Great. You're quite welcome. And great questions and always love to talk about sleep because it really is that important.

Great. Thank you so much.

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